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Most traditional tympanoplasties require elevating the tympanic membrane (TM). These techniques are rather complicated and success rates are not perfect. Therefore, the authors developed a novel technique, transtympanic soft tissue (TST) tympanoplasty, which does not require raising eardrums, and evaluated its surgical efficiency compared to perichondrium underlay (PU) tympanoplasty.A retrospective study was conducted in a single center.152 cases who underwent TST tympanoplasty (n = 70) or PU tympanoplasty (n = 82) between 2011 and 2020 were included in the study. Perforation location, pure tone audiometry, complications, and closure rates were analyzed according to the size of the TM perforations: moderate perforation (25-40%, n = 100) and large perforation (≥ 40%, n = 52).For the moderate perforations, the closure rates of the TST (n = 45) and PU (n = 55) groups were 93.3% and 89.1%, respectively (p = 0.461), and even for the large perforations, the success rates were 88.0% in the TST group (n = 25) and 81.5% in the PU group (n = 27) (p = 0.515). The mean postoperative air-bone gap (ABG) values of the TST group for moderate and large perforations were 5.3 ± 5.8 dB and 6.6 ± 5.7 dB, respectively. There was no significant difference in postoperative ABG between the two surgical procedures (p 0.05). The total operation time for TST tympanoplasty was significantly shorter than that for PU tympanoplasty (p = 0.002).TST tympanoplasty is considered a novel, simple technique to replace traditional tympanoplasty techniques involving raising eardrums, even for large-sized perforations.

Objectives The education and school life of children who have undergone cochlear implantation (CI) is very important and should be monitored continuously. This study assessed auditory performance in children with cochlear implants over time, along with educational placement and peer relationship, and compared the results based on the age at CI and the presence of additional disabilities. Design In total, 77 children who had undergone CI at the Hearing Center in Ajou University Hospital at less than 10 years old and who were presently attending school or had already graduated from school within 3 years were enrolled in this study. All children had congenital bilateral severe or profound hearing loss at the diagnosis. They were classified based on the age at which they received CI: the "early-implanted group," younger than 3.5 years (n = 38), and the "late-implanted group," between 3.5 and 10 years old (n = 39). Results The early-implanted group had worse short-term auditory performance than the late group, but after 2 years of the implant use, auditory performance was similar in both groups. The early and late groups did not differ significantly in terms of the proportions of children who were enrolled in a regular school (94.7% and 89.7%, respectively). However, the early-implanted group had a larger proportion of children who were enrolled in a regular school without additional needs (73.0%), compared with the late group (48.6%) (p = .034). Children with multiple disabilities showed poorer performance (word score of 57.7% and sentence score of 44.7%) than children with hearing disability only (91.8% and 87.2%, respectively), which affected full-time enrollment in regular schools. With regard to peer relationships, 19.0% of children in the early-implanted group required close observation and assistance, and 9.5% even required help and counseling. Children who underwent early CI had a high tendency toward social restraint, apathy, and over-commitment. No correlations were observed between audiological factors and the aspects of peer relationships assessed in this study. Conclusions Early CI and the absence of other disabilities were the two main factors that increased the likelihood of full-time enrollment in mainstream classes at regular schools. Nevertheless, many children who underwent earlier CI still encountered difficulties in peer relationships.

We devised a surgical technique called 'atticosinuplasty' (AS) for the treatment of early-stage cholesteatoma.This study analyzed the adequacy and applicability of AS compared to canal wall-up mastoidectomy (CWU) in patients treated for early-stage cholesteatoma.A total of 187 patients with either AS (Hearing gain was significant in the AS group (AS is a surgical technique worth trying in patients with early stage of attic/sinus cholesteatoma in terms of the rate of recurrence and hearing improvement.

Objectives: This study was designed to evaluate the relationship between the degree of round window membrane (RWM) exposure and hearing outcome. Materials and methods: Forty-six ears with cochlear implantation (CI) were enrolled. The degree of RWM exposure was divided into Grade I ( 50%). The hearing outcomes were evaluated at 1.5 and 12 months postoperatively. Results: Twenty-seven ears were Grade I, 13 were Grade II, and 6 were Grade III. RW approach was used in all ears of Grades II and III and 20 ears of Grade I and cochleostomy was used in 7 ears of Grade I. The pattern of bony overhang was multidirectional in 41 ears. Threshold shift significantly decreased proportional to the increase of RWM exposure after CI. The mean RWM exposure was 32.1 ± 24.4% in ears with more than partial preservation (n = 17), and 13.3 ± 11.7% in the other ears (n = 6) at 12 months post-CI (p = .061). Age at CI differed significantly between ears that had more than partial preservation and the other ears at 1.5 months post-CI. Conclusions and significance: Degree of RWM exposure and age at CI might be factors predicting hearing outcome after CI using the RW approach.

Objectives The purpose of this study was to identify the clinical features of posttraumatic benign paroxysmal positional vertigo (t-BPPV) in traumatically injured patients, investigating the effectiveness of the early diagnosis and management including canalith repositioning procedures (CRPs). Patients and methods The subjects of the present study were 74 patients who were hospitalized in the Trauma Center, Ajou University Hospital. We investigated the relationship between injury mechanisms and t-BPPV. Patients with t-BPPV were categorized into mild (typical BPPV) and severe (bilateral, recurrent, or persistent) types. Results Of the 74 patients, 41 were diagnosed with t-BPPV. Nineteen were mild and 22 were severe types. ‘A fall’ (36%) and ‘pedestrian car accident’ (32%) were common as the injury mechanisms provoking severe t-BPPV. In the severe t-BPPV group, they were hospitalized longer (as median value, 20 days in the severe group vs. 10 days in the mild group, P = 0.004), stayed longer in intensive care unit (3 days vs. 0 days, P = 0.016), and needed more days until the BPPV management (13.5 days vs. 6 days, P = 0.021). Major trauma (the Injury Severity Score >15) patients had a longer time to implementation of the first CRPs (10 days in major trauma and 3 days in minor trauma patients, P = 0.019). Conclusions Severity of trauma and longer duration of ICU treatment were factors delaying BPPV management. This delay could negatively affect the progress of t-BPPV. Diagnostic and therapeutic maneuvers including CRPs should be performed as early as possible, even in severely injured patients.

Objectives We suggest a simple measurement, called the "basal turn-facial ridge (BT-FR) angle," for determining the electrode insertion axis using preoperative temporal bone computed tomography (CT) to predict hearing preservation (HP) in cochlear implantation (CI). Study design Retrospective chart review. Setting Tertiary referral center. Patients Eighty-two ears that underwent CI between 2010 and 2018 were included. Ears with preoperative thresholds less than or equal to 80 dB HL at 125, 250, and 500 Hz were enrolled and grouped using the criteria of Skarzynski et al.: Group 1, complete or partial HP; Group 2, minimal HP or complete hearing loss. Intervention All subjects underwent CI with soft surgery techniques through the round window approach. Main outcome measures The BT-FR angle is the angle between the basal turn line (BT-line), which is a straight line passing through the center of the longitudinal axis of the BT, and the facial ridge line, which is a straight line running from the endpoint of the BT-line to a point just above the facial ridge. Results The BT-FR angle was 2.5 ± 2.9 degrees in Group 1 and -0.3 ± 2.7 degrees in Group 2 (p = 0.003). The angle and hearing loss showed a significant negative correlation (r = -0.401, p = 0.002). In multiple linear regression, "age at operation" (β coefficient 0.260; p = 0.001) and the "BT-FR angle" (-1.967; p = 0.001) were significant variables affecting the degree of residual hearing loss. Conclusions The BT-FR angle, which can be measured simply, may be useful to predict residual HP after CI.

Objectives: The objectives of this study were to measure the changes in hearing thresholds in the same individuals during a period of 10 years and suggest a clinical reference for the threshold changes by aging. Methods: In this retrospective cohort study, we used regular health checkup data including 2 pure tone audiometry results with a 10-year interval in the same individuals from 1288 subjects. The subjects’ data including demographics, smoking habits, and the diagnosis of chronic diseases were used. Results: Age, male gender, smoking, and osteoporosis were identified as factors affecting age-related hearing loss (ARHL). The sole effect of aging on ARHL for 10 years according to age groups and genders was as follows: a loss of 1.4 dB in 20s, 4.0 dB in 30s, 5.0 dB in 40s, 8.2 dB in 50s, and 11.2 dB in 60s of males compared to a loss of 2.3 dB in 20s, 2.9 dB in 30s, 5.1 dB in 40s, 6.5 dB in 50s, and 9.4 dB in 60s of females. Conclusions: We could demonstrate the actual effect of aging on ARHL, and it can be used as a clinical reference. Hearing ability decreases more in males than females but seems to decrease exponentially with age in both males and females.

Objectives: This study evaluated the influence of the performance of the first cochlear implant (CI-1) on the second implant (CI-2) and the significance of inter-implant intervals in children with sequential cochlear implantation. Method: Thirty-four patients were included for speech perception outcome and 38 patients were included for subjective hearing satisfaction in daily life in this study. The patients were classified into 3 groups according to inter-implant interval: group I, 7 years. Open-set speech perception scores before and at 3, 6, 12, and 24 months after the second implantation was compared among the CI-1, CI-2, and bilateral CI conditions. Subjective hearing benefits in daily life were measured using a questionnaire of Speech, Spatial, and Qualities of Hearing Scale (SSQ) for parents of children with impaired hearing, and device use and preference were evaluated (by phone interview.) Results: The speech perception of children using the CI-2 only improved quickly within 3 months postoperatively and were similar to those using the CI-1 only. The results of monosyllabic and disyllabic word tests using CI-2 at 3 months after second implantation were not significantly different from those in patients using the CI-1 only. In the sentence test, the scores using the CI-2 only were not significantly different from those using the first implant only at 6 months after second implantation. SSQ scores were similar among groups and the worst score in each section was shown from the questions about performance under noisy conditions in each section. Device usage habits showed that 17 (44.7%) and 16 (42.1%) patients preferred bilateral and the CI-1, respectively. Only 5 (13.2%) patients wanted the CI-2 rather than the CI-1. While group I and II showed a prominent positive attitude to bilateral use, group III, for which the inter-implant interval was 7 years or more, showed a definite preference for the CI-1 (p < 0.01). Conclusions: Functional binaural benefits were achieved in patients who were good performers with the CI-1 after the second implantation irrespective of the inter-implant interval. Sequential CI should be strongly recommended for patients with unilateral CI showing a good performance.

A speech discrimination score (SDS) is a predictor for the successful use of hearing aids (HAs). This study is to evaluate the efficacy of HAs in patients with a low or poor SDS. We enrolled 186 ears using HAs, with an unaided SDS ≤ 64%. They were categorized into four groups by their unaided SDS: 0–16% for Group 1, 20–32% for Group 2, 36–48% for Group 3, and 52–64% for Group 4. Aided SDS was measured 1, 3, 6, and 12 months after the use. The Hearing In Noise Test (HINT), the Hearing Handicap Inventory for the Elderly (HHIE), and the International Outcome Inventory for Hearing Aids (IOI-HA) were assessed. The SDS increased by 27.4% (12.0 to 39.4%) in Group 1, 26.4% (26.9 to 53.3%) in Group 2, 24.6% (42.2 to 66.8%) in Group 3, and 10.5% (59.5% to 70.0%) in Group 4. HINT composite scores significantly decreased from 22.5 to 15.1 in Group 1, 9.4 to 7.0 in Group 2, and 4.4 to 2.4 in Group 4. Total HHIE score changed from 48.2 to 24.2 in Group 1, 64.0 to 32.8 in Group 2, 37.1 to 16.6 in Group 3, and 55.8 to 40.1 in Group 4 (P

Microbial infection is one of the most significant causes of ear diseases, but microbial profiles are very diverse according to the diseases and change over time. The purpose of the study was to clarify differences and chronological changes in causative pathogens among infectious ear diseases over the last 20 years, and to identify antibiotic resistance. In total, 1191 isolates were included from patients diagnosed with chronic otitis media without cholesteatoma (COM), cholesteatomatous otitis media (Chole), middle ear effusion (MEE), including acute otitis media and otitis media with effusion, and external otitis (EO). Data were collected periodically for the years 1995, 2000, 2004, 2009, and 2013. Culture results and antibiotic resistance were assessed. The most common microorganism identified was S. aureus. The microbial profiles differed significant among the COM, Chole, and MEE groups (p

The outcome of cochlear implantation (CI) is affected by various factors, including the manufacturer of the device. We validated the factors contributing to postoperative performance and evaluated the influence of different company devices on pure tone thresholds and postoperative performance.Our study included 56 postlingually deaf adults who underwent CI between June 2005 and March 2016. The ears were divided into groups according to the implant manufacturer: A (n=32 ears) and B (n=24 ears) groups. The prognostic factors for CI outcome were evaluated using speech perception at 3, 6 and 12 months postoperatively and compared across devices.The duration of hearing aid use, age at CI, and mean pure tone threshold with the implant were correlated with postoperative speech perception. The mean pure tone thresholds with the implant (averages of 0.25, 0.5, 1, 2, 4 and 6kHz) were 27.9±3.7dB HL in the group A and 33.5±5.6dB HL in the group B (P0.01). The open-set monosyllabic word, open-set disyllabic word and open-set sentence scores were not significantly different between the groups at 3, 6 and 12 months postoperatively.The mean pure tone threshold with implant differed between the devices; however, no device-related effect on postoperative performance was observed. Additional multifactorial analyses are needed to clarify the relationship between free-field pure tone threshold with implant and postoperative speech perception.

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.

The aims of this study are to analyze the clinical characteristics of congenital middle ear cholesteatoma (CMC), to evaluate the treatment results according to the types of surgical approach, and to suggest the appropriate surgical treatment option in each stage.One hundred fifteen children (≤15 years old) with surgically confirmed CMC, who underwent surgery at a tertiary hospital during 1994-2012 and were followed up more than 2 years, were enrolled in this study. CMC was classified into four stages by the staging system proposed by Potsic. Clinical characteristics of CMC were analyzed and its association with the rate of residual disease was evaluated.Based on the location of the lesion, posterior-origin CMCs were detected significantly later (5.5 years old, P = 0.018) and more likely to be in the Stage 3 or 4 (P 0.001). Residual CMCs were observed in 10 out of 115 cases (8.7%) and were more frequent in the Stage 3 or 4 patients (P = 0.007). However, the rate of the residual disease was not statistically different between anterior- and posterior-origin CMCs (P = 0.101). All 58 cases of CMC in the Stage 1 or 2 were successfully removed by transcanal tympanoplasty with only one residual case (1.7%). In the Stage 3 cases, transcanal tympanoplasty was conducted in 24 out of 29 patients, and the residual disease rate was 12.5% (3 out of 24).The early stages of CMC were likely to be diagnosed at younger age, and the early diagnosis seemed to show better surgical outcomes with less invasive techniques. Transcanal tympanoplasty can be an effective surgical option for CMCs in the Stage 3.

Objectives Pediatric obstructive sleep apnea has a relatively high prevalence and has various negative health and behavioral consequences. Among the various complications of pediatric obstructive sleep apnea, growth disturbance is still controversial. Method 745 pediatric subjects with obstructive sleep apnea diagnosed by in-lab polysomnography were enrolled, after excluding ineligible subjects with abnormal growth related factors. Height, weight, and BMI of enrolled patients were measured and statistically converted to z-scores, and the converted data were analyzed statistically with the polysomnographic results. Multiple linear regression were used to analyze the relationships between age, gender, z-score for weight, polysomnography results, and z-score for height. Results Patients with higher respiratory related index or lower mean/lowest oxygen saturation of PSG showed smaller z-score for height. Mean apnea hypopnea index and standard deviation of enrolled patients was 7.46 ± 12.92, with moderate severity. And mean z-score for height and standard deviation was 0.21 ± 1.15. Apnea hypopnea index, respiratory disturbance index, obstructive apnea index, and hypopnea index, respiratory related results of polysomnography, were statistically negative correlated with a z-score for height. And mean oxygen saturation and lowest oxygen saturation, oxygen saturation results of polysomnography, were statistically positive correlated with a z-score for height. Conclusions Respiratory related results and oxygen saturation results of polysomnography show negative and positive correlation with z-score for height. Therefore, pediatric obstructive sleep apnea have a negative effect on longitudinal growth.

Background Tinnitus is a common condition and frequently can be annoying to affected individuals. We investigated the prevalence and associated factors for tinnitus in South Korea using the data from the Korea National Health and Nutrition Examination Surveys (KNHANES) during 2009–2011. Methods KNHANES is a cross-sectional survey of the civilian, non-institutionalized population of South Korea (n = 21 893). A field survey team that included an otolaryngologist moved with a mobile examination unit and performed interviews and physical examinations. Results Among the population over 12 years of age, the prevalence of any tinnitus was 19.7% (95% CI 18.8%–20.6%). Tinnitus was more prevalent in women, and the prevalence rate increased with age (P < 0.001). Among those with any tinnitus, 29.3% (95% CI 27.3%–31.3%) experienced annoying tinnitus that affected daily life. Annoying tinnitus also increased with age (P < 0.001), but no sex difference was demonstrated (P = 0.25). In participants aged 40 years or older, age, quality of life, depressive mood, hearing loss, feeling of dizziness, and rhinitis were associated with any tinnitus (P < 0.05). Age, hearing loss, history of cardiovascular disease, and stress were associated with annoying tinnitus (P < 0.05). Conclusions Tinnitus is a common condition, and a large population suffers from annoying tinnitus in South Korea. Public understanding of associated factors might contribute to better management of tinnitus.

Objective Benign paroxysmal positional vertigo of horizontal semicircular canal (HSC-BPPV) is characterized by either geotropic or apogeotropic nystagmus induced by head roll test. Some patients also present with spontaneous nystagmus. The aim of this study is to examine the clinical manifestation of spontaneous nystagmus in HSC-BPPV and evaluate the effect on the treatment outcome. Patients and methods Electronystagmography and video eye movement recordings of 125 patients diagnosed as HSC-BPPV were reviewed retrospectively. Presence of spontaneous nystagmus was analyzed and treatment outcome after repositioning therapy was compared. Results Overall, spontaneous nystagmus was observed in 19 patients (15.2%) with HSC-BPPV at initial presentation. In canalolithiasis group (n = 64), the treatment outcome did not differ between patients with or without spontaneous nystagmus. However, in cupulolithiasis group (n = 61), patients presenting with spontaneous nystagmus (n = 10) required more repositioning therapy sessions. Conclusion The presence of spontaneous nystagmus at initial presentation may implicate poorer treatment outcome in cupulolithiasis HSC-BPPV patients.

Objective The relatively low success rate of the treatment maneuver for horizontal semicircular canal (HSC) benign paroxysmal positional vertigo (BPPV) may be caused by the difficulty determining the affected side. We developed a 180-degree supine roll test (SRT) by modifying the 90-degree SRT to increase diagnostic accuracy and evaluated its significance. Study design A prospective study. Setting Tertiary referral center. Patients A total of 122 patients with HSC-BPPV performed both the 90- and 180-degree SRTs. Interventions The affected side was determined by the 90- and 180-degree SRTs. The bow and lean (BL) test was also performed in cases with ambiguous or opposite results on both SRTs. Main outcome measure A comparison of the difference in slow phase velocity (SPV) of nystagmus among the 90- and 180-degree SRTs and BL test. Results The maximum SPV of nystagmus during the 180-degree SRT was significantly greater than that during the 90-degree SRT. The SPV difference was less in the 180-degree SRT than that in the 90-degree SRT. Although the 180-degree SRT showed fewer meaningful results (n = 65) than the 90-degree SRT (n = 71), the affected side was determined by the 180-degree SRT in 15 cases with ambiguous results on the 90-degree SRT. Among 10 cases showing opposite results, 7 were identified by the BL test. Five (71.4%) of 7 cases had consistent affected sides with the 180-degree SRT. Conclusion The 180-degree SRT can be an additional method when it is difficult to determine the affected side from the 90-degree SRT.

Nevi, which consist of nevus cells arising from external auditory canals (EACs) and auricles, are rare and their characteristics are not thoroughly understood. The purpose of this study was to analyze the clinicopathological characteristics of melanocytic nevus (MN) in EACs and auricles. Medical records were reviewed in 35 cases with junctional, compound and intradermal nevi treated in Ajou University Hospital, Korea between 2001 and 2011. Patient demographic, location, shape, and diameter of nevi, and pathologic results were analyzed according to the location, EACs (23 cases) and auricles (12 cases). Female predominance was noted in both EAC (60.9 %, 14 cases) and auricular (75 %, 9 cases) nevi. The mean age of EAC nevi (37.1 years) was younger than that of auricular nevi (42.2 years). The chief complaint was a symptomless mass in both groups, mostly in dome-like gross appearances. The mean diameter of EAC and auricular nevi was 9.6 (3-16) mm and 12.2 (3-25) mm, respectively. Histological findings chiefly presented intradermal nevi in EACs (78.3 %) and auricles (83.3 %) which showed preference to older patients, in contrast to the compound type. All nevi including five cases with skin grafts were completely excised without any recurrence within the follow-up period (average 5.3 months). A possible dysplastic nevus was detected in only one case. All MNs in EACs or auricles reveal similar characteristics. Early and complete excision is recommended to avoid skin graft, functional problems, and the risk of malignant melanoma.

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.

Objective To determine whether cochlear hydrops analysis masking procedure (CHAMP) has diagnostic value in patients with definite Meniere’s disease (MD) comparing the diagnostic validity index of CHAMP with those of electrocochleography (ECoG). Study Design A prospective study. Setting Tertiary referral center. Patients One hundred eight patients were classified into 3 groups: the “definite MD” group (MD group, n = 47); the “non-MD” group (n = 41) of other vestibular diseases including vestibular neuritis, and benign paroxysmal positional vertigo; and the control group (n = 20), which included patients without dizziness. Interventions CHAMP and extratympanic ECoG were performed in all patients. Main Outcome Measure Sensitivity, specificity, and definitions of abnormal values were less than 0.3 ms in latency delay (0.5 kHz high pass noise [HPN]–click alone) and less than 0.95 in compound amplitude ratio (click alone–0.5 kHz HPN/click alone) in CHAMP and 0.4 for the summating potential/action potential ratio in ECoG. Results The mean latency delay and amplitude ratio of CHAMP in the MD group significantly differed from these values for other groups, whereas the mean summating potential/action potential ratio of ECoG did not. In ECoG, sensitivity was as low as 21%, specificity was 97%, and diagnostic accuracy was 62%. Sensitivity, specificity, and diagnostic accuracy of CHAMP were 64%, 98%, and 80%, respectively, in latency delay and 91%, 83%, and 88%, respectively, in amplitude ratio. The sensitivity and diagnostic accuracy of CHAMP were significantly higher than the corresponding values for ECoG. Conclusion CHAMP is more valuable in detection of definite MD than extratympanic ECoG.

Cochlear implantation is a widely accepted, safe procedure for patients with severe to profound sensorineuronal hearing loss. While complications are rare, revision surgeries are required for complications like device failure, misplaced electrode, flap necrosis, and wound infection. Foreign body reaction is a rare complication following cochlear implantation. We experienced a case of foreign body reaction after cochlear implantation treated by device removal. Foreign body reaction has to be considered as one of several causes in cochlear implantation cases that show symptoms mimicking recurrent wound infection or delayed extrusion. We report a case of foreign body reaction with a literature review.

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

Hypothesis Epithelial sodium channels are expressed in cultured human endolymphatic sac (ES) epithelial (HESE) cells and epithelial sodium channel (ENaC) expression is suppressed by interleukin 1beta. Background The ES is part of the membranous labyrinth in the inner ear that plays an important role in maintaining homeostasis of the endolymphatic fluid system. However, the exact mechanism of fluid volume regulation is not yet known. Methods The ES specimens were harvested during acoustic neuroma surgery (n = 13) using the translabyrinthine approach and were subcultured with high-epidermal growth factor (25 ng/mL) media. Results The serially passaged HESE cells differentiated into a monolayer of confluent cells and some of the cultured cells had features of mitochondria-rich cells. Reverse transcription-polymerase chain reaction revealed that ENaC subunits are expressed in the cultured HESE cells. We also confirmed the presence of an ENaC-dependent short-circuit current in the cultured HESE cells. Interestingly, ENaC mRNA expression and ENaC-dependent current decreased after treatment with interleukin 1beta (10 nmol/L for 24 h). Conclusion These findings suggest that ENaC plays an important role in fluid absorption in the human ES and that its function may be altered during inflammatory conditions.

Hepatocyte growth factor (HGF) has recently attracted a considerable amount of attention as a stromal-derived mediator in tumor-stromal interactions, particularly because of its close involvement in cancer invasion and metastasis, and (-)-epigallocatechin-3-gallate (EGCG) can modulate the cell signaling associated with angiogenesis, metastasis, and migration of cancer cells. In the present study, we have investigated the effects of HGF on invasion and metastasis of hypopharyngeal carcinoma cells and the effect of EGCG on blocking HGF-induced invasion and metastasis in these cells. We found that HGF promoted the autophosphorylation of c-Met, HGF receptor, and that HGF-induced proliferation, colony dispersion, migration and invasion of tumors. We also observed that HGF enhanced the activity of matrix metalloproteinase (MMP)-9 and urokinase-type plasminogen activator (uPA) in hypopharyngeal carcinoma cells. In addition, HGF-induced the activation of Akt and Erk pathway as a downstreaming pathway of invasion. On the other hand, EGCG at physiologically relevant concentration (1 microM) suppressed HGF-induced tumor motility and MMP-9 and uPA activities, and the suppression of Akt and Erk pathway by EGCG was one of the downstream mechanisms to facilitate EGCG-induced anti-invasion effects. These results suggest that EGCG may serve as a therapeutic agent to inhibit HGF-induced invasion in hypopharyngeal carcinoma patients.

Conclusion. Peroxiredoxin (Prx) III plays a protective role in cisplatin- and gentamicin-induced apoptosis via a mitochondria-dependent pathway in cochlear hair cells. Objectives. The aim of the present study was to investigate the effects of the depletion of endogenous Prx III on oxidative damage to mitochondrial components and on apoptotic events with the use of RNA interference. Materials and methods. Depletion of Prx III was done by RNA interference in cochlear hair cells (UB/OC-1), and cells were exposed to ototoxic drugs (cisplatin or gentamicin). We then compared the apoptotic signaling between Prx III-depleted and control cells. Results. The depletion of Prx III resulted in increased intracellular ROS levels accompanied by enhanced apoptosis by ototoxic drugs. The Prx III-depleted cells showed mitochondrial membrane potential collapse, cytochrome c release, and caspase activation.

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.

Objective To investigate the capability of preoperative evaluations in predicting the precise anatomic origin of intracanalicular tumors. Study design We conducted a retrospective case review. Setting Tertiary referral center. Patients A total of 11 patients (8 men and 3 women, 26-70 years old) with intracanalicular tumors who were treated surgically were included. Interventions Pure-tone average, auditory brainstem response, caloric test, and temporal magnetic resonance imaging were done in all 11 patients. Electroneuronography has only been performed since 2003, and only 3 patients were evaluated. Main outcome measure Preoperative symptoms, pure-tone average, auditory brainstem response, caloric test, electroneuronography, and magnetic resonance imaging were compared between patients with facial nerve schwannomas and patients with vestibular schwannomas. Results Postoperatively, facial nerve schwannomas were diagnosed pathologically in 2 (18%) of 11 patients. There were not any clues suggesting facial nerve schwannoma in preoperative evaluations. Conclusion A facial nerve schwannoma may be misdiagnosed as a vestibular schwannoma, especially when the tumor is confined to the internal auditory canal. There are no useful preoperative evaluation tools in predicting the precise nerve origin of intracanalicular tumors. These emphasize the need to fully inform the patient preoperatively.

Ion channels, such as the epithelial sodium channel (ENaC), are essential for maintaining a fluid-free middle ear cavity by controlling periciliary fluid. Deviations from the normal volume or compositions of periciliary fluid are probably responsible for otitis media with effusion. To elucidate the physiologic roles of the ENaC and cystic fibrosis transmembrane conductance regulator (CFTR) in the middle ear mucosa, we compared the electrophysiological activity and protein expressions of ENaC and CFTR in normal human middle ear epithelial (NHMEE) cells with those in normal human nasal epithelial (NHNE) cells. We also evaluated the role of ENaC and CFTR in fluid transport by NHMEE cells. Short-circuit current (Isc) was measured in cell monolayers by modified Ussing chambers. Immunoblotting was performed for ENaC and CFTR. In addition, transepithelial fluid transport was measured after loading 100 microl of fluid onto the luminal cell surface. The amiloride-sensitive Isc in NHMEE cells was much larger than in NHNE cells, whereas the forskolin-induced Isc, presumably mediated by CFTR, was significantly smaller in NHMEE cells. ENaC subunits alpha, beta, and gamma were all detected in NHMEE cells, and their expressions were stronger than those in NHNE cells. In comparison, CFTR was also detected in the middle ear mucosa, but at a lower expression level than in NHNE cells. NHMEE cells showed more amiloride-sensitive fluid absorption than NHNE cells. In contrast, fluid absorption was less sensitive to forskolin/IBMX in NHMEE cells than in NHNE cells. The ATP induced Cl- efflux and the amplitude of ATP-induced current in NHMEE cells was much larger than in NHNE cells. In the present study, we have demonstrated an enhanced amiloride-sensitive Isc and fluid absorption in NHMEE cells, where the role of CFTR is limited. Our data also suggest that the ATP-induced Cl- channel could be an alternative Cl- channel to CFTR in NHMEE cells.

The Na-K-2Cl cotransporter-1 (NKCCl) may be essential for the maintenance and functioning of the vestibular morphology in mice and it is strongly expressed in human vestibular end organs.NKCCl is a member of the cation-coupled chloride transporter which participates in salt transport and cell volume regulation in diverse tissues. NKCCl-deficient mice exhibit deafness, and show structural alterations in the cochlea. In addition to hearing loss, NKCCl-deficient mice show a shaker-waltzer behavior, which suggests a vestibular system defect. In this study we investigated the morphology of the vestibular system of NKCCl-deficient mice and also evaluated whether NKCCl mRNA and its protein are expressed in human vestibular end organs.NKCCl-deficient and wild-type mice aged 4-5 weeks were sacrificed. Their heads were cut in the midsagittal plane, fixed and decalcified. For light microscopy, 5-microm sections were cut and stained with hematoxylin-eosin. Human vestibular end organs were harvested during acoustic tumor surgery via a translabyrinthine approach. Some of these end organs were used for total mRNA extraction and the remainder for immunostaining. Reverse transcriptase polymerase chain reaction and immunostaining were performed for NKCCl.The scala media of the cochleae of the NKCCl-deficient mice had collapsed but the bony labyrinth appeared unaffected. However, the semicircular canals (SCCs) were much smaller than those in the wild-type mice. Furthermore, the SCCs were completely missing in some NKCCl-deficient mice. NKCCl mRNA was expressed in both the human macula and crista ampullaris, and its protein was expressed mainly in the transitional and dark cell areas of the human crista ampullaris.

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.

Objective Change in matrix metalloproteinases (MMPs) and regulation of their tissue inhibitors of metalloproteinases (TIMPs) could play certain role in the pathogenesis of otitis media. This study was designed to evaluate the modulation of MMPs and TIMPs in middle ear epithelium by lipoteichoic acid (LTA) isolated from Staphylococcus aureus. Methods Human middle ear epithelial (HMEE) cells were treated with LTA. MMP activities were examined by PCR, ELISA and zymography, and levels of TIMPs were measured by PCR and ELISA. Results LTA isolated from S. aureus increased MMP-9 mRNA expression and secretion in HMEE cells, whereas no effect on the expressions of MMP-1, -2, -3, -7 and TIMP-1, -2 was observed. Conclusions LTA increased the activity of MMP-9, not TIMPs in middle ear epithelia, suggesting that disturbed balance between MMP-9 and TIMPs could play an active role in LTA-induced otitis media.

The effect of intratympanic steroid injection is controversial as salvage or initial treatment option for sudden sensorineural hearing loss (SSNHL) and almost unknown if it is consecutively to use after initial systemic steroids. This study aimed to analyze the efficiency of intratympanic dexamethasone injection (ITDI) as a sequential treatment in the patients who failed initial systemic steroid treatments for SSNHL. Forty-six patients with SSNHL who did not respond to initial systemic steroids were prospectively included in the study. The patients were randomly classified into two groups; the ITDI group (21 patients) did not take four sequential ITDI within 2 weeks after systemic steroids, and the control group (25 patients) took any more medications. Hearing improvement was defined as a 10 dB or more decrease in the pure tone average (PTA) of the four-frequencies (0.5, 1, 2, and 3 kHz). Hearing improvement was observed in 10 (47.6%) of 21 ITDI patients and in 4 (16.0%) of 25 control patients (P = 0.027). An improvement of the mean PTA was 11.4 dB in the ITDI group and 1.7 dB in the control group (P = 0.004). The ITDI group showed significant hearing improvement at low frequency (500 Hz) than the control group. The patients with 70 or more dB in PTA before ITDI showed significant hearing improvement than the other patients with better PTAs (P = 0.038). The sequential ITDI, which is performed immediately after initial systemic steroid therapy, may be a simple, effective second-line treatment of choice for the patients who show poor response to initial treatments for SSNHL.

Objective To measure the effect of septoplasty on the volume of inferior turbinate in patients with a deviated nasal septum. Design In this retrospective analysis, patients who underwent septoplasty without turbinate surgery from May 1, 2003, through April 30, 2006, were studied. The thicknesses and cross-sectional areas of mucosa and conchal bones were measured with computed tomography before the operations and at least 1 year after the operations. Setting University hospital. Patients A total of 20 patients who presented with a chief concern of nasal obstruction. Main Outcome Measures The thicknesses of the medial mucosa, bone, and lateral mucosa and the cross-sectional area of turbinate before and after septoplasty were compared using the Wilcoxon signed rank test. P Results The medial mucosa and cross-sectional area of the inferior turbinate on the concave side of the septum were significantly decreased by septoplasty (both, P = .01), and the medial mucosa and cross-sectional area of the inferior turbinate on the convex side of the septum were significantly increased by septoplasty ( P = .01). The thicknesses and cross-sectional areas of the conchal bone on the concave and convex sides of the septum were not affected by septoplasty. Conclusion After septoplasty, inferior turbinate hypertrophy, especially in the medial mucosa, may reverse.