Byoung Soo Shim

Normative diameters and effects of aging on the cochlear and facial nerves in normal-hearing Korean ears using 3.0-tesla magnetic resonance imaging†

To assess the normative size of the cochlear nerve (CN) and facial nerve (FN) in normal‐hearing ears and to determine whether nerve size varies with age.

A Multicenter Randomized Double-Blind Study: Comparison of the Epley, Semont, and Sham Maneuvers for the Treatment of Posterior Canal Benign Paroxysmal Positional Vertigo

We evaluated the short-term efficacy of Epley, Semont, and sham maneuvers for resolving posterior canal benign paroxysmal positional vertigo (BPPV) in a prospective multicenter randomized double-blind controlled study. Subjects were randomly divided into three groups: Epley (36 patients), Semont (32 patients), and sham (Epley maneuver for the unaffected side, 31 patients). Out of 14 institutes which participated in this study, 5 institutes had previous experience of the Epley but not the Semont maneuver and the other 9 had previous experience of both maneuvers. Each maneuver was repeated twice if there was still positional vertigo or nystagmus on day 0, and the presence of nystagmus and vertigo on positional testing were evaluated immediately, 1 day, and 1 week after treatment. After the first maneuver, the Epley group showed a significantly higher resolution rate of positional nystagmus than the Semont or sham groups (63.9, 37.5, and 38.7%, respectively). After the second maneuver, the resolution rate (83.3%) of the Epley group was significantly higher than that (51.6%) of the sham group. At 1 day and 1 week after treatment, the resolution rate of the Epley group was significantly higher than those of the other groups. Similar results were seen for the resolution of positional vertigo. The Epley maneuver showed persistent resolution rates of positional vertigo and nystagmus without a fatigue phenomenon. The Epley maneuver was significantly more effective per maneuver than Semont or sham maneuvers for the short-term treatment of posterior canal BPPV. The Semont maneuver showed a higher success rate than the sham maneuver, but it was not significantly different.

Prevalence of radiologic superior canal dehiscence in normal ears and ears with chronic otitis media

Although labyrinth fistulae are caused mostly by cholesteatoma, they can occur in long‐standing chronic otitis media (COM) without cholesteatoma. We aimed to compare the prevalence of radiologic SCD on computed tomography (CT) between normal ears and contralateral COM ears in patients with unilateral COM and to assess the prevalence of superior canal dehiscence (SCD) according to the age.

Audiologic performance after cochlear implantation in children with X-linked deafness: comparison with deaf children with a normal inner ear structure.

Objective To compare audiologic performances of cochlear implantation (CI) in children with X-linked deafness with those of CI in age- and sex-matched children with normal cochleae. Patients We identified 4 patients with X-linked deafness and selected 10 age- and sex-matched deaf patients with normal cochleae between April 1999 and April 2012. Main Outcome Measures Auditory brainstem responses, Categories of Auditory Performance (CAP), and Meaningful Auditory Integration Scale (MAIS). Results The ages of patients with X-linked deafness at the time of implantation ranged between 1.3 and 13.6 years, with a mean age of 5.3 years. All patients were male subjects and showed severe-to-profound hearing loss. Patient 1 lacked ABR in both ears. Patients 2, 3, and 4 showed ABR in the contralateral ear, at 70, 70, and 90 dB nHL, respectively. All 4 patients had bilateral X-linked cochlear anomaly and experienced cerebrospinal fluid (CSF) gushers. Straight electrodes were used in Patients 1 and 3, with perimodiolar electrodes used in the others. Patients 2 and 3, who were about the same age, had CAP scores of 6 or more at 18 months after activation of the implant despite the use of different electrode arrays. There were no statistically significant differences in MAIS and CAP scores between each patient with X-linked deafness and the control group. Conclusion The audiologic performances of patient with X-linked deafness after CI are comparable to those of patients with normal inner ear structure after CI.

Interaural Differences of Distortion Product Otoacoustic Emission Amplitudes in Patients with Unilateral Tinnitus

Objective We aimed to determine whether abnormalities in outer hair cell (OHC) function were related to tinnitus through interaural comparison of distortion product otoacoustic emissions (DPOAEs). Study Design Cross-sectional study. Setting Tertiary care university teaching hospital. Participants Twenty-seven patients with unilateral tinnitus and pure-tone average of both ears ≤25 dB hearing loss (HL) at 500, 1000, 2000, and 4000 Hz were included. Subjects and Methods Pure-tone thresholds observed at 500 to 16,000 Hz and DPOAE amplitudes at f2 frequencies of 1001 to 6348 Hz were compared between the tinnitus ears and nontinnitus ears in patients with unilateral tinnitus. Results The pure-tone averages (13 ± 6 dB HL) in the nontinnitus ears were similar to those (15 ± 6 dB HL) in the tinnitus ears. There were no differences in pure-tone averages at all frequencies tested. While the DPOAE amplitudes measured at f2 frequencies of 1001 to 3174 Hz in tinnitus ears were not different from those in the nontinnitus ears, the tinnitus ears showed significantly reduced DPOAE amplitudes when compared with the nontinnitus ears at frequencies of 4004 to 6348 Hz. Conclusion OHC dysfunction was correlated with tinnitus at high frequencies, and DPOAE amplitudes can provide additional information about cochlear dysfunction, which is complementary to pure-tone audiometry.

Superior Canal Dehiscence Patients Have Smaller Mastoid Volume than Age- and Sex-Matched Otosclerosis and Temporal Bone Fracture Patients

Background and Objectives The purpose of the study was to compare the mastoid air-cell volume of the patients with superior semicircular canal dehiscence syndrome (SCDS) and that of the control patients with otosclerosis and temporal bone (TB) fracture. Subjects and Methods Ten patients with SCDS were enrolled and 10 patients with bilateral otosclerosis and TB fracture were selected as control groups by age and sex matching. To measure the mastoid air-cell volume, 3D reconstruction software was used. Results In 10 patients with SCDS, the mean age was 44.5 years, ranging from 16 to 79 years (M : F=4 : 6). Mean mastoid air-cell volume in the SCDS side was 3319.9 mm3, whereas 4177.2 mm3 in the normal side (p=0.022). Mean mastoid air-cell volume in the right side of otosclerosis patients was 6594.3 mm3 and it was not different from 6380.5 mm3 in the left side (p=0.445). Mean mastoid air-cell volume in normal side of TB fracture was 6477.2 mm3. The mastoid air-cell volume in the SCDS side was significantly smaller than that of otosclerosis and TB fracture patients (p=0.009, p=0.002, respectively). The mastoid air-cell volume in the normal side of SCDS was significantly smaller than that of TB fracture (p=0.019), but not significant with that of otosclerosis (p=0.063). Conclusions Our findings revealed that the mastoid air-cell volume in the SCDS side was significantly smaller than control group, which suggest that the decreased mastoid pneumatization is closely related to the generation of SCDS.

Hearing loss following ventriculoperitoneal shunt in communicating hydrocephalus patients: A pilot study

Hearing loss can be associated with a decrease in cerebrospinal fluid (CSF) pressure because changes in CSF pressure induce changes in perilymph pressure. Hearing loss after neurosurgical procedures have been reported, but clinical information on hearing loss after the placement of ventriculoperitoneal (VP) shunts, the most commonly used CSF shunt for hydrocephalus patients, is limited. This study is aimed to show the relationship between VP shunt and hearing loss.

The Effect of Gingko Biloba on Hearing in Mice with Noise-Induced Temporary Threshold Shift

Background and Objectives Gingko biloba extract is known for enhancing blood circulation, scavenging free radicals, and antagonizing against platelet-activating factor. This study evaluated the effect of Gingko biloba on the noise-induced temporary threshold shift of hearing. Materials and Methods Temporary threshold shift was induced by exposing mice to 110 dB SPL sound for 1 hour. The experimental group consisted of mice fed Gingko biloba [3 mg/kg, 6 mg/kg, and 12 mg/kg in 0.5% carboxymethyl cellulose (CMC)] for 7 days before noise exposure. CMC solution without Gingko biloba was fed to control mice. Hearing threshold was measured by auditory brainstem response (ABR) and distortion product otoacoustic emission (DPOAE). Results The hearing threshold increased after noise exposure and recovered to normal within 5 days in all groups. Compared to control mice (fed CMC solution only), mice fed Gingko biloba showed more rapid recovery of ABR threshold at 16 kHz in all three experimental groups. At the other frequencies, there was no significant change in hearing recovery in the Gingko biloba groups. There was no difference in DPOAE between groups. Conclusions Temporary threshold shift of hearing after noise exposure was partly affected by oral Gingko biloba.

Spontaneous Cervical Emphysema With Nasopharyngeal Fistula

Cervical subcutaneous emphysema is typically caused by air in the upper aerodigestivetractexpandingintotheretropharyngealspaceandthemediastinum.Amongsuch cases, spontaneous subcutaneous emphysema is a rare disease that can occur without clear external injuries and often does not require medical or surgical intervention. Predisposing factors include repeated coughing and vomiting. The condition is presumed to be caused by an increase in intrathoracic and pulmonary alveolar pressure. 1 However, we report herein the first case, to our knowledge, of cervical subcutaneous emphysema in the context of an anatomic deficit in the nasopharynx diagnosed by nasal endoscopy and a review of the literature.

Pediatric Cholesteatoma: Congenital versus Acquired

Objective: 1) To compare the characteristics of congenital and acquired pediatric cholesteatoma. 2) To investigate the risk factors influencing recidivism after initial surgery to propose a guided therapeutic approach. Method: Retrospective analysis was made on pediatric cholesteatoma cases under the age of 18 years. A total of 163 patients (92 of congenital and 71 of acquired cholesteatoma) were operated by the same surgeon from 1993 to 2011. We analyzed the symptoms, physical findings, computed tomography, operative findings, hearing, and recurrence. Results: The ages at diagnosis and operation in congenital cholesteatoma were significantly younger than acquired. The chief complaint of congenital was mainly the incidental mass (74%), whereas the otorrhea (66%) in acquired. Mass shadow behind the intact tympanic membrane was observed in 95% of congenital cholesteatoma. The main tympanic membrane abnormalities of acquired cholesteatoma were attic retraction and pars tensa perforation (56% and 56%). Invasion of epitympanum and ossicular erosion were more frequently found in the acquired cholesteatoma (P < .05). There was no difference in recurrence rate between congenital and acquired cholesteatoma. Statistically significant factors at high risk of recurrence were pars tensa perforation, diploic pneumatization, incus erosion. On the other hand, lowering risk factors were sclerotic mastoid on CT and no mastoidectomy. Conclusion: The congenital and acquired cholesteatoma showed very different clinical features. Careful eradication and continued follow-up is recommended in the children with high risk of recurrence.