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Objective: To investigate differences in the clinical features of bilateral Menière's disease (BMD) with early and late bilateral involvement., Study Design: A retrospective case-comparison study., Setting: Tertiary referral center., Patients: In total, 25 patients with definite BMD were enrolled. Patients with bilateral involvement with a transition interval shorter than 1 month were considered to have synchronous BMD, whereas the others had metachronous BMD., Interventions: We investigated differences in prognosis as defined by changes in the number of vertigo attacks after treatment, demographics, comorbidities, and inner ear function according to the transition interval from unilateral to bilateral involvement., Main Outcome Measure: We investigated other appropriate cut-off values in the interval from first- to second-ear involvement to predict poor prognosis., Results: Receiver operating characteristic curve analysis revealed that a cut-off value of < 18-month interval exhibited maximum sensitivity and specificity for predicting poor prognosis. According to this value, we categorized patients into the early bilateral involvement group (EBIG, < 18 months' interval) and the late bilateral involvement group (LBIG, ≥ 18 months' interval). Patients with synchronous BMD and patients in the EBIG group exhibited poorer prognosis compared with patients with metachronous BMD and those in LBIG (p = 0.011 and p ≤ 0.001). Demographics, hearing threshold, vestibular deficit, and comorbidities were not significantly different between the two groups (p > 0.05). None of the patients exhibited systemic autoimmune disease., Conclusion: BMD with early bilateral progression exhibited poorer prognosis compared with late bilateral progression.

Objective: Conventional hearing aids have some limitations in overcoming a large air-bone gap or in cases of severe high-frequency hearing loss. The authors aimed to evaluate the benefit of a new bimodal hearing configuration combining cochlear implantation (CI) and middle ear implant (MEI) in patients with severe mixed conductive and ski-slope hearing loss., Study Design: Retrospective case review., Setting: Tertiary referral center., Patients: Four patients with severe to profound hearing loss, who underwent CI in one ear and MEI in the other, were enrolled., Intervention: Audiological outcomes were assessed at least 6 months after the MEI/CI operation. Pure-tone audiometry (PTA) in unaided, CI-aided, and MEI-aided conditions were measured., Main Outcome Measures: Average threshold changes in bands of frequencies (<1 kHz, ≥1 kHz) were compared between MEI-aided and HA-aided conditions. The Korean version of the Hearing-in-Noise Test (K-HINT), and speech perception score in noisy and quiet conditions were evaluated in the bimodal configuration (i.e., MEI with CI)., Results: MEI-aided PTA was especially increased in high-frequency areas (≥1 kHz). Speech perception in noisy and quiet conditions demonstrated better scores in the bimodal configuration. K-HINT also demonstrated better scores in the bimodal configuration., Conclusions: There is an increasing number of patients with unilateral CI and residual hearing in the contralateral ear. The benefits of a new bimodal hearing configuration with CI and MEI were demonstrated in patients with severe high-frequency hearing loss or mixed conductive hearing loss in the contralateral ear.

Objective: The study investigated improvements in maximal speech intelligibility after Vibrant Soundbridge (VSB) implantation and analyzed the effect of the hearing loss pattern on maximal speech intelligibility represented by a phonetically balanced word score (PBmax). The effect of middle ear implants on PBmax has not been evaluated yet., Study Design: Study., Setting: Tertiary academic medical center., Patients/interventions: Sixty patients who underwent VSB from December 2011 to January 2016 were retrospectively reviewed. All the patients had hearing aids preoperatively., Main Outcome Measures: Pure-tone and speech audiometry were checked with and without hearing aids and then with the VSB. The patients were divided into two groups: flat and down-sloping type of hearing loss. PBmax score was evaluated at the most comfortable listening level before and after VSB implantation and compared with scores with/without HA., Results: PBmax for both conventional HA and VSB were significantly higher compared with the unaided condition. The improvement in speech recognition was significantly better using VSB than using HA (p = 0.003). However, there was no significant difference in the improvement provided by VSB and HA in patients with a flat hearing loss. Patients with a down-sloping audiogram showed significantly better improvement with VSB than with HA (p = 0.003). Moreover, patients with greater preoperative high-frequency hearing loss had greater improvement in PBmax after VSB implantation., Conclusion: Speech intelligibility can be significantly improved by VSB implantation, especially in patients with a down-sloping hearing loss. This finding can help select patients who will benefit most from VSB implantation.

Objective: To compare the audiological and non-audiological benefits of incus short process (SP) vibroplasty with those of conventional incus long process (LP) vibroplasty., Study Design: Retrospective analysis., Setting: Tertiary referral center., Patients: Thirty-six patients with sensorineural hearing loss were treated with the semi-implantable middle ear hearing device. Of these, 22 were treated with conventional LP vibroplasty, and 14 were treated with SP vibroplasty using SP couplers., Interventions: Implantation with the semi-implantable middle ear hearing device by different methods., Main Outcome Measures: Pre- and postoperative hearing level, word recognition score, operation time, and duration of hospital stay were compared. We also surveyed a questionnaire to assess postoperative complications., Results: The improvement in hearing gain was comparable between SP vibroplasty and conventional LP vibroplasty, except at 8 kHz, at which LP vibroplasty showed better hearing gain (p < 0.05). Patients undergoing SP vibroplasty had shorter operation time (p < 0.01) and duration of hospital stay (p < 0.01). While four patients who underwent incus LP vibroplasty experienced taste changes, none who underwent incus SP vibroplasty experienced any complications., Conclusions: SP vibroplasty with the newly invented SP coupler could be a good alternative to conventional LP vibroplasty for treating patients with sensorineural hearing loss. Although both SP vibroplasty and LP vibroplasty produce good results, the former is associated with a shorter operation time and duration of hospital stay as well as fewer complications.

Objective: We attempted to investigate whether the integrity of saccular function influences the severity of subjective dizziness after vestibular rehabilitation in vestibular neuritis., Study Design: Retrospective analysis., Setting: Tertiary referral center., Patients: Forty-six patients with acute unilateral vestibular neuritis were included., Interventions: Diagnostic, therapeutic, and rehabilitative., Main Outcome Measures: All the patients completed vestibular rehabilitation therapy until their computerized dynamic posturography and rotary chair test results were significantly improved. The rehabilitation patients were classified into the normal to mild subjective dizziness and moderate to severe subjective dizziness groups according to the dizziness handicap inventory score (cutoff of 40). Differences between the two groups were analyzed., Results: After rehabilitation, 32.6% of the patients still complained of moderate to severe dizziness. Age, sex distribution, the presence of comorbidities, caloric weakness, pre- and postrehabilitation gain values in rotary chair test, postrehabilitation composite scores in posturography, and the duration of rehabilitation were not significantly different between the two groups. However, initial dizziness handicap inventory (DHI) score and composite score in dynamic posturography were worse and the proportion of patients with absent cervical vestibular-evoked myogenic potential in the moderate to severe group was much higher (93.3% vs. 35.5%, p < 0.001). After multiple regression analysis of those factors, initial DHI score and absent cervical vestibular-evoked myogenic potential response were identified as being associated with higher postrehabilitation DHI score., Conclusion: Saccular dysfunction in acute vestibular neuritis can contribute to persistent subjective dizziness, even after the objective parameters of vestibular function tests have been improved by vestibular rehabilitation.

Objectives: Quality of life (QOL) and satisfaction level of patients with Ménière's disease who underwent intratympanic streptomycin injection were evaluated across physical, psychological, and social domains of function., Study Design: Preoperative and postoperative QOL of patients were evaluated based on the chart records of patients and questionnaire surveys. From January 2000 to August 2005, 81 patients underwent intratympanic streptomycin injection at Yonsei University Severance Hospital, and their medical records were retrospectively reviewed. In addition, a mailed questionnaire survey was conducted. Ménière's Disease Outcome Questionnaire-Retrospective Version, proposed by Kato et al., was used as the QOL measure and was completed by 51 patients., Results: The average QOL score was 35.6 +/- 9.6 before surgery and 52.8 +/- 10.3 after surgery, indicating improvement of QOL by 17.2 after surgery. The improvement of QOL score did not correlate to age and sex of patients; nonetheless, higher improvement of score was found in patients with professional career (p < 0.001). The improvement of QOL in the preoperative Stage 3 and 4 patient groups was greater than that in the preoperative Stage 1 and 2 patient groups (p = 0.032). The mean change in hearing of the patients after surgery was 1.5 + 7.2 dB hearing loss based on a 4-frequency pure-tone average (500, 1,000, 2,000, 3,000 Hz). Furthermore, 4 (7.8%) of 51 patients demonstrated greater than 10-dB change in 4-frequency pure-tone average. The status of hearing loss after surgery did not influence the QOL score (p = 0.530). As the frequency of vertigo decreased, the improvement of QOL score increased (p = 0.042)., Conclusion: The level of satisfaction with intratympanic streptomycin injection was strongly correlated to the QOL score in Ménière's Disease Outcome Questionnaire-Retrospective Version. As for the factors that improved the QOL after surgery, the status of hearing was not closely associated; however, the frequency of vertiginous symptom was the most important factor.