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OBJECTIVES To investigate the change of hearing threshold over time and analyze factors that could affect hearing, this longitudinal study of pure-tone threshold changes in the same subjects at a 9-year interval was performed. STUDY DESIGN Retrospective longitudinal study in a single center (n = 1,978). METHODS A total of 1,978 subjects were included; they received pure-tone audiometry at a 9-year interval. The degree of the threshold changes was examined and compared between age groups. The subjects' data, such as the level of cholesterol, were analyzed to find risk factors on hearing. RESULTS The average of the threshold changes was 3.35 dB in the 20s to 30s; 4.38 dB in the 30s to 40s; 5.75 dB in the 40s to 50s; 7.21 dB in the 50s to 60s; and 10.00 dB in the 60s to 70s (all P

Objectives/Hypothesis We compared the clinical characteristics between acute low- and high-frequency hearing loss (LF and HF, respectively) patients, and the efficacy of three different treatment protocols (systemic steroids, intratympanic steroid injection, and combination therapy). Study Design Prospective, randomized controlled study. Methods A total of 111 patients diagnosed with LF or HF were treated on an outpatient basis. Each group was randomly divided into three equal subgroups based on therapy: oral steroid, intratympanic dexamethasone injection (IT), and combination therapy. Hearing gain was estimated by comparing pre- and post-treatment pure-tone averages. Recovery rate was assessed by Clinical Practice Guideline: Sudden Hearing Loss from the American Academy of Otolaryngology–Head and Neck Surgery. Results In comparison of chief complaints, ear fullness and hearing loss were more common in the LF and HF group, respectively (P = .033 and P = .001, respectively). Hearing recovery rates were significantly different between the two groups (i.e., 74.1% [40/54] in the LF group and 45.6% [26/57] in the HF group; P

To investigate the change of hearing threshold over time and analyze factors that could affect hearing, this longitudinal study of pure-tone threshold changes in the same subjects at a 9-year interval was performed.Retrospective longitudinal study in a single center (n = 1,978).A total of 1,978 subjects were included; they received pure-tone audiometry at a 9-year interval. The degree of the threshold changes was examined and compared between age groups. The subjects' data, such as the level of cholesterol, were analyzed to find risk factors on hearing.The average of the threshold changes was 3.35 dB in the 20s to 30s; 4.38 dB in the 30s to 40s; 5.75 dB in the 40s to 50s; 7.21 dB in the 50s to 60s; and 10.00 dB in the 60s to 70s (all P 0.05). If the low-density lipoprotein cholesterol (LDL-C) was maintained below 100 mg/dl, the difference in the weighted four-frequency average was 5.45 dB, whereas it was 6.15 dB in the subjects whose LDL-C was over 100 mg/dl (P = 0.032, age-adjusted). In current smokers, the thresholds increased more than in never- or ex-smokers (P = 0.026 in the weighted four-frequency average and P = 0.011 at 8,000 Hz, age-adjusted).The degree of the threshold changes exhibited an exponential increase with age. Cessation of smoking is advisable to prevent increased aggravation of hearing. Strict management of the low-density lipoprotein cholesterol may have a positive effect on hearing.3 Laryngoscope, 129:470-476, 2019.

Intralabyrinthine schwannomas (ILSs) are rare benign tumors arising from the distal part of the cochleovestibular nerve confined within the labyrinth. Patients with ILSs complain of hearing loss, vertigo, tinnitus, and ear fullness. Surgical treatment of ILS is performed in special cases such as in cases of patients with nonserviceable hearing, progressive hearing loss, intractable vertigo, or tumor extension. We present an unusual case of a patient with intralabyrinthine schwannoma who underwent surgery to treat progressive hearing loss and recovered his hearing after surgery.

We compared the clinical characteristics between acute low- and high-frequency hearing loss (LF and HF, respectively) patients, and the efficacy of three different treatment protocols (systemic steroids, intratympanic steroid injection, and combination therapy).Prospective, randomized controlled study.A total of 111 patients diagnosed with LF or HF were treated on an outpatient basis. Each group was randomly divided into three equal subgroups based on therapy: oral steroid, intratympanic dexamethasone injection (IT), and combination therapy. Hearing gain was estimated by comparing pre- and post-treatment pure-tone averages. Recovery rate was assessed by Clinical Practice Guideline: Sudden Hearing Loss from the American Academy of Otolaryngology-Head and Neck Surgery.In comparison of chief complaints, ear fullness and hearing loss were more common in the LF and HF group, respectively (P = .033 and P = .001, respectively). Hearing recovery rates were significantly different between the two groups (i.e., 74.1% [40/54] in the LF group and 45.6% [26/57] in the HF group; P .001). Oral steroid therapy was most effective in the LF group (P = .017). In the HF group, all three modalities showed similar results, although IT tended to be the most effective (P = .390).There were differences in chief complaints and treatment responses between LF and HF patients. Although they showed similar partial damage in the cochlea, the pathophysiology of LF and HF may be quite different.1b. Laryngoscope, 127:1878-1884, 2017.

Objectives/Hypothesis: Horizontal semicircular canal (HSC) benign paroxysmal positional vertigo (BPPV) has been reported to have a poorer prognosis than posterior semicircular canal BPPV. Incorrect determination of the affected ear appears to be one of the causes of poorer outcome. The aim of this study was to assess the efficacy of the “bow and lean test” (BLT) for proper determination of the affected ear followed by preferable treatment outcomes of HSC-BPPV. Study Design: A prospective study. Methods: The 211 patients (225 cases) with HSC-BPPV were sequentially classified into two groups by hospital visiting time and diagnostic methods. The head roll test (HRT) group (61 cases) was treated with canalith repositioning procedure (CRP) on the basis of the results of HRT alone between 2001 and 2004. The BLT group (164 cases) was treated based on the results of both BLT and HRT from 2005 to 2008. Results: The remission rates after two sessions of CRPs in the BLT group and the HRT group were 83.1% and 67.4% (P = .041), respectively, for the canalolithiasis type and 74.7% and 61.1% (P = .250), respectively, for the cupulolithiasis type. In the BLT group, 76.8% had bowing and/or leaning nystagmus; 35.7% of them (45 of 126 cases) benefited from BLT with regard to determining the affected ears because HRT was unable to provide the definitive affected ears (17 cases) or showed different localization between two methods (28 cases). Conclusions: BLT is a useful method to improve the remission rates of HSC-BPPV, giving more corrective information regarding affected ears than the HRT alone. Laryngoscope, 2010

Objective: Preauricular sinuses (PAS) are common congenital malformations that usually occur at the anterior margin of the ascending limb of the helix, but the positions of PAS and directions on the fistular tracts are rarely posterior to the external auditory canal (EAC), which presents as a postauricular swelling. We named these cases as the variant type of PAS (‘postauricular sinuses’), and compared their clinical manifestations with those of the classical type. Study Design: A retrospective study. Methods: We retrospectively reviewed the charts of patients who had undergone preauricular fistulectomy from 2002 to 2006. These patients were then categorized into two groups according to the position of the preauricular sinus sac. The classical group was defined as the group of patients with sacs located on the (superior) anterior to the EAC, and the variant group as those whose sacs are located on the posterior site of the EAC. We analyzed the incidence, previous histories, clinical manifestations, recurrence rates, and surgical techniques of the variant type of preauricular sinuses and compared them with those of the classical type. Results: Eleven (10.9%) of 101 patients were diagnosed with preauricular sinuses of the variant type. The male to female ratios of the classical and the variant groups were 44:46 and 7:4, respectively. The average age of the patients was approximately 11 to 13 years in both groups. All variant types of preauricular sinuses showed preauricular pits located posterior to the imaginary line that connects the tragus with the posterior margin of the ascending limb of the helix, unlike the classical type. Most (72.8%) of the fistular tracts of the variant type were directed in the posterior-middle direction from the pits. The variant types were operated with a dual approach using preauricular and retroauricular incisions, unlike the classical type, and the recurrence rate was 0% (compared with 2.2% in the classical type). Conclusion: Frequent postauricular infected swellings may indicate the presence of the variant type of preauricular sinuses. The variant type of preauricular sinuses presenting in the postauricular area were found to have an unusual location of the fistula pit that was positioned posterior to the imaginary tragal extended line. A comprehensive physical examination of the preauricular pits should be performed to avoid incomplete excision of the variant types.

Intralabyrinthine schwannomas (ILSs) are rare benign tumors arising from the distal part of the cochleovestibular nerve confined within the labyrinth. Patients with ILSs complain of hearing loss, vertigo, tinnitus, and ear fullness. Surgical treatment of ILS is performed in special cases such as in cases of patients with nonserviceable hearing, progressive hearing loss, intractable vertigo, or tumor extension. We present an unusual case of a patient with intralabyrinthine schwannoma who underwent surgery to treat progressive hearing loss and recovered his hearing after surgery.

Objectives/Hypothesis: Tumor necrosis factor-alpha (TNF-α) is released in a variety of pathological states in the inner ear. Inducible nitric oxide synthase (iNOS) can be induced by cytokines and other inflammatory factors, and is generally thought to be associated with inflammation and other pathological processes in the cochlea. The purpose of the present study was to reveal that TNF-α could induce apoptosis in the auditory cell line and to investigate the role of nitric oxide (NO) in TNF-α–induced auditory cell death. Study Design: Experimental study. Methods: UB-OC1 cells and zebrafish were exposed to TNF-α. Flow cytometry, terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick end labeling (TUNEL) assay, assay of mitochondrial membrane potential (MMP), and electron microscopy were used to show that TNF-α could induce apoptosis. Western blot was used to measure iNOS expression and mitogen-activated protein kinase pathway. Results: Flow cytometric analysis, TUNEL assay, MMP, and electron microscopy all demonstrated that TNF-α could induce apoptosis in UB-OC1 cells. TNF-α significantly increased NO generation and iNOS expression. Pretreatment with iNOS blocker NG-methyl-L-arginine (NMA) attenuated TNF-α–induced cell death and caspase-3 activation. Also, TNF-α treatment increased p-p38 and p-ERK, and pretreatment of NMA reduced this increased expression of p-p38 and p-ERK. Conclusions: TNF-α can induce apoptosis in the auditory cell line, and NO production in response to TNF-α is essential for apoptosis. Laryngoscope, 2012