Chan Joo Yang

Quantitative analysis of gains and catch-up saccades of video-head-impulse testing by age in normal subjects.

To evaluate video‐head‐impulse test (vHIT) results in normal subjects, to determine the normative values of vHIT for the vestibulo‐ocular reflex (VOR) and to characterise the catch‐up saccades (CSs).

Results of video head impulse and caloric tests in 36 patients with vestibular migraine and 23 patients with vestibular neuritis: a preliminary report.

Abstract Caloric test has been used to probe the low-frequency range of lateral canal function and video head impulse test (vHIT) provides an objective measurement of the high-frequency range of canal function in vestibular disorders. Abnormal lateral canal function for high-frequency stimuli tested by vHIT was rare (8%) in vestibular migraine (VM), suggesting that there is a substantial remaining high-frequency canal function in VM. In vestibular neuritis (VN), caloric and vHIT responses are more frequently affected than VM, with a significant positive correlation between both tests. Caloric and vHIT probe different frequencies of head movement and provide complementary information regarding the lateral canal function. This article is protected by copyright. All rights reserved.

Vestibular Function Tests for Vestibular Migraine: Clinical Implication of Video Head Impulse and Caloric Tests

Vestibular migraine (VM) is one of the most common causes of episodic vertigo. We reviewed the results of multiple vestibular function tests in a cohort of VM patients who were diagnosed with VM according to the diagnostic criteria of the Barany Society and the International Headache Society and assessed the efficacy of each for predicting the prognosis in VM patients. A retrospective chart analysis was performed on 81 VM patients at a tertiary care center from June 2014 to July 2015. Patients were assessed by the video head impulse test (vHIT), caloric test, vestibular-evoked myogenic potentials (VEMPs), and sensory organization test (SOT) at the initial visit and then evaluated for symptomatic improvement after 6 months. Complete response (CR) was defined as no need for continued medication, partial response (PR) as improved symptoms but need for continued medication, and no response (NR) as no symptomatic improvement and requiring increased dosage or change in medications. At the initial evaluation, 9 of 81 patients (11%) exhibited abnormal vHIT results, 14 of 73 (19%) exhibited abnormal caloric test results, 25 of 65 (38%) exhibited abnormal SOT results, 8 of 75 (11%) exhibited abnormal cervical VEMP results, and 20 of 75 (27%) exhibited abnormal ocular VEMP results. Six months later, 63 of 81 patients (78%) no longer required medication (CR), while 18 (22%) still required medication, including 7 PR and 11 NR patients. Abnormal vHIT gain and abnormal caloric results were significantly related to the necessity for continued medication at 6-month follow-up (OR = 5.67 and 4.36, respectively). Abnormal vHIT and caloric test results revealed semicircular canal dysfunction in VM patients and predicted prolonged preventive medication requirement. These results suggest that peripheral vestibular abnormalities are closely related to the development of vertigo in VM patients.

Short-term changes in tinnitus pitch related to audiometric shape in sudden sensorineural hearing loss

OBJECTIVE Sudden sensorineural hearing loss (SSNHL) is frequently accompanied by tinnitus. This study investigated the relationships between new-onset tinnitus and audiometric parameters in SSNHL patients. METHODS Sixty-one patients with SSNHL with new-onset tinnitus were enrolled. Changes of tinnitus pitch, and their correlations with the maximum hearing loss frequency (Fmax) and the edge frequency (Fedge) at initial and 1-month follow-up (FU) were analyzed. RESULTS At 1-month FU, tinnitus disappeared in 16 (26%) patients and they also showed hearing normalization. In 36 patients who still showed tonal tinnitus, the mean tinnitus pitch (2.9 kHz) at initial examination, which was close to Fedge (2.7 kHz), increased to a significantly higher frequency (4.6 kHz) at 1-month examination, which was close to Fmax (5.6 kHz). The tinnitus pitch had a more significant correlation with Fedge (r=0.46) than with Fmax (r=0.33) at initial examination and the tinnitus pitch showed a significant correlation only with Fmax (r=0.52) at 1-month examination. CONCLUSIONS Hearing normalization was crucial for the disappearance of tinnitus at 1-month FU. Patients who still had tonal tinnitus at 1-month FU showed the tinnitus pitch closer to the edge frequency (Fedge) at initial examination, and this tinnitus pitch increased to the maximum hearing loss frequency (Fmax) at 1-month FU. This change in tinnitus pitch may give insight about tinnitus generation.

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.

Abnormal CT findings are risk factors for otitis media-related sensorineural hearing loss.

Objectives: Inflammatory processes in chronic otitis media (COM) can damage the inner ear, resulting in sensorineural hearing loss (SNHL). The purpose of this study was to evaluate risk factors by computed tomography (CT) findings for COM-related SNHL in patients with unilateral COM. Design: Records from January 2009 to December 2012 of 231 patients with unilateral COM and a normal contralateral ear were retrospectively evaluated. Bone conduction thresholds were calculated for each ear at 0.5, 1, 2, and 4 kHz. If bone conduction threshold averaged across the four frequencies of the COM ear was 10 dB greater than that of the contralateral ear, the patient was classified under the SNHL group. Temporal bone CT images were analyzed to determine the presence or absence of soft tissue density in the attic (medial/lateral), antrum, oval window niche, and round window niche. Multivariate analysis of sex, age (< 50 years; ≥ 50 years), disease duration (< 20 years; ≥ 20 years), perforation size (small; moderate; large) and the presence of soft tissue density in the attic (medial/lateral), antrum, oval window niche, and round window niche was used to determine the factors related to COM-related SNHL. Results: Of the 231 patients, there were 51 patients (22.1%) in the SNHL group and 180 patients (77.9%) in the non-SNHL group. Multivariate analyses showed that the presence of soft tissue density in the antrum (odds ratio [OR] 3.80; 95% confidence interval [CI] 1.74–8.32; p = 0.001), age ≥ 50 years and more (OR 3.32; 95% CI 1.62–6.81; p = 0.001), disease duration ≥ 20 years (OR 2.80; 95% CI 1.31–6.02; p = 0.008), and the presence of soft tissue density in the round window niche (OR 2.42; 95% CI 1.12–5.21; p = 0.024) were independently related to COM-related SNHL. Conclusions: COM-related SNHL was present in 22% of ears with COM. The presence of soft tissue density in the antrum, determined from temporal bone CT, increased the OR of SNHL to 3.8. Age, disease duration, and the presence of soft tissue density in the round window niche were also independent predicting factors for SNHL. These findings may be used as informative references for patients with COM.

Diagnostic Value of Gains and Corrective Saccades in Video Head Impulse Test in Vestibular Neuritis

Objectives We investigated changes in video head impulse test (vHIT) gains and corrective saccades (CSs) at the acute and follow-up stages of vestibular neuritis to assess the diagnostic value of vHIT. Study Design Case series with chart review. Setting Tertiary medical center. Subjects and Methods Sixty-three patients with vestibular neuritis who underwent vHIT at an initial presentation and an approximately 1-month follow-up were included. vHIT gains, gain asymmetry (GA), peak velocities of CS, and interaural difference of CS (CSD) were analyzed. Results Mean vHIT gains increased significantly from the acute stage to the follow-up exam. The mean GA, peak velocities of CS, and CSD had decreased significantly at the follow-up. The incidence of CSs was also significantly decreased at the follow-up. The abnormal rate (87%) considering both gain and CS value was significantly higher than that (62%) considering vHIT gain only at the follow-up, although the abnormal rates did not differ at the acute stage (97% vs 87%). Conclusion The abnormal rates based on both vHIT gains and CS measurements are similar at the acute stage of VN but are considerably higher at the follow-up stage compared with the abnormal rates based on vHIT gains alone. It is thus advisable to check both CS and vHIT gain while performing vHIT to detect vestibular hypofunction.

Repair of the foramen of Huschke using an extended endaural approach

INTRODUCTION The foramen of Huschke develops due to an ossification defect of the anteroinferior part of the temporal bone in the first 5 years of life and is an anatomic variation of the tympanic portion of the temporal bone. A small-sized (mean 2.7 mm in length and 2.0 mm in width) persistent foramen is commonly observed in 9% to 27% of adult temporal bone and varies with age and sex. However, spontaneous temporomandibular joint (TMJ) herniation that requires surgical intervention is rare. A persistent foramen of Huschke may result in complications, such as TMJ herniation and salivary fistula formation, and facilitate ear injury during TMJ arthroscopy. Previous studies have reported successful preauricular approaches to surgery in these cases. We herewith report two cases with a patent foramen of Huschke that presented with TMJ herniation and otalgia. We repaired this defect using an extended endaural method and we herewith discuss the advantages of our approach.

A Case of Squamous Cell Carcinoma in the External Auditory Canal Previously Treated for Verrucous Carcinoma

Carcinoma in the external auditory canal (EAC) is a rare malignancy with an annual incidence of one per one million people, accounting for less than 0.2% of all head and neck cancers. The most common histopathological type of EAC cancer is squamous cell carcinoma. Verrucous carcinoma is a well-differentiated, low-grade variant of squamous cell carcinoma. It is a locally destructive, invasive, and slow growing tumor that rarely metastasizes. Verrucous carcinoma occurs predominantly in the oral cavity and larynx, and its occurrence in the EAC is extremely rare. In this report, we present a histologically confirmed case of verrucous carcinoma in the EAC and temporal bone, which for several years had been classified as epithelial hyperplasia. Two-and-a-half years after diagnosis of verrucous carcinoma, a recurrent mass was found and the lesion was then confirmed to be squamous cell carcinoma.

Amplification of transcutaneous and percutaneous bone-conduction devices with a test-band in an induced model of conductive hearing loss

Abstract Objective: Transcutaneous devices have a disadvantage, the dampening effect by soft tissue between the bone and devices. We investigated hearing outcomes with percutaneous and transcutaneous devices using test-bands in an induced unilateral conductive hearing loss. Design: Comparison of hearing outcomes of two devices in the same individuals. Study sample: The right ear was plugged in 30 subjects and a test-band with devices (Cochlear™ Baha® BP110 Power and Sophono® Alpha-2 MPO™) was applied on the right mastoid tip with the left ear masked. Sound-field thresholds, speech recognition thresholds (SRTs), and word recognition scores (WRSs) were compared. Results: Aided thresholds of Sophono were significantly better than those of Baha at most frequencies. Sophono WRSs (86 ± 12%) at 40 dB SPL and SRTs (14 ± 5 dB HL) were significantly better than those (73 ± 24% and 23 ± 8 dB HL) of Baha. However, Sophono WRSs (98 ± 3%) at 60 dB SPL did not differ from Baha WRSs (95 ± 12%). Conclusion: Amplifications of the current transcutaneous device were not inferior to those of percutaneous devices with a test-band in subjects with normal bone-conduction thresholds. Since the percutaneous devices can increase the gain when fixed to the skull by eliminating the dampening effect, both devices are expected to provide sufficient hearing amplification.