Hayoung Byun

Value of electroneurography as a prognostic indicator for recovery in acute severe inflammatory facial paralysis: a prospective study of Bell's palsy and Ramsay Hunt syndrome.

To evaluate the prognostic and predictive value of electroneuronography (ENoG) in acute severe inflammatory facial paralysis, including Bells palsy and Ramsay Hunt syndrome (RHS).

Treatment Outcomes and Quality of Life in Oropharyngeal Cancer after Surgery-based versus Radiation-based Treatment.

Objectives Advances in reconstruction and conservative surgery and the importance of quality of life (QOL) encouraged this reevaluation of surgery-based treatments for oropharyngeal cancer. We tried to compare treatment outcome and QOL after surgery-based versus radiation-based treatment in oropharyngeal cancer. Methods The 133 eligible patients were divided into surgery-based and radiotherapy (RT)-based treatment groups. Medical records were reviewed, and EORTC QLQ-C30 and HN65 questionnaires were completed for survivors. Three-year overall survivals, disease-free survivals, locoregional control rates, and QOL scores were compared between the two groups. Results Demographic data and overall stages were not significantly different between the two groups, and all survival rates were non-significantly different, either. The scores for most QOL items were equivalent, however, for a few items, scores were significantly better in surgery-based group. Conclusion The surgery-based group achieved equivalent treatment outcomes and slightly better QOL scores than the RT-based group. The results of this study suggest that surgery could still be considered as a first-line therapy for oropharyngeal cancer.

Expression of mitotic checkpoint proteins BUB1B and MAD2L1 in salivary duct carcinomas.

OBJECTIVE Defects in the mitotic checkpoint lead to aneuploidy and might facilitate tumorigenesis. However, the ploidy status in salivary duct carcinoma (SDC) has been reported to play limited role in prediction of prognosis. Thus, we need more reliable markers to reflect the rapid tumor progression in SDCs. We aimed here to investigate the expression of mitotic checkpoint proteins benzimidazole 1 homolog beta (BUB1B) and mitosis arrest-deficient 2 like 1 (MAD2L1) in SDCs and to determine their possible role as surrogate prognostic markers. METHODS We analyzed the clinical courses, pathologic findings and immunohistochemical profiles of mitotic checkpoint proteins (BUB1B and MAD2L1) in 27 pathologically confirmed SDCs. The expression status of BUB1B and MAD2L1 was compared with clinicopathologic factors and other molecular markers, such as TGF-beta, c-erb-B2, androgen receptor, vascular endothelial growth factor, and epidermal growth factor receptor, for prognostic significance. RESULTS High BUB1B expression was detected in 25.9% of subjects, and high MAD2L1 expression was in 55.6% of subjects. However, survival analysis revealed that mitotic checkpoint expression did not have prognostic significance in SDCs, nor did the other studied markers. Rather, the clinical variable of N classification at diagnosis (in N+ status, hazard ratio 5.19, 95% CI 1.26-21.32 for disease-free survival and hazard ratio 7.18, 95% CI 1.09-46.99 for overall survival) was strongly associated with survival and prognosis based on the Cox proportional hazard model. CONCLUSIONS Mitotic checkpoint proteins appeared to play a limited role in predicting prognosis in SDCs. Further study is required to elucidate the exact role of mitotic checkpoint proteins in SDCs.

Effects of Early Surgical Exploration in Suspected Barotraumatic Perilymph Fistulas

Objectives Treatment of traumatic perilymph fistula (PLF) remains controversial between surgical repair and conservative therapy. The aim of this study is to analyze the outcomes of early surgical exploration in suspected barotraumatic PLF. Methods Nine patients (10 cases) who developed sudden sensorineural hearing loss and dizziness following barotrauma and underwent surgical exploration with the clinical impression of PLF were enrolled. Types of antecedent trauma, operative findings, control of dizziness after surgery, postoperative hearing outcomes, and relations to the time interval between traumatic event and surgery were assessed retrospectively. Results All patients had sudden or progressive hearing loss and dizziness following trauma. Types of barotrauma were classified by the origin of the trauma: 4 external (car accident, slap injury) and 6 internal traumas (lifting, nasal blowing, straining). Surgical exploration was performed whenever PLF was suspected with the time interval of 2 to 47 days after the trauma. The possible evidence of PLF was found during surgery in 9 cases: a fibrous web around the oval window (n=3), fluid collection in the round window (RW; n=6) and bulging of the RW pseudomembrane (n=1). In every patient, vestibular symptoms disappeared immediately after surgery. The hearing was improved with a mean gain of 27.0±14.9 dB. When the surgical exploration was performed as early as less than 10 days after the trauma, serviceable hearing (≤40 dB) was obtained in 4 out of 7 cases (57.1%). Conclusion Sudden or progressive sensorineural hearing loss accompanied by dizziness following barotrauma should prompt consideration of PLF. Early surgical exploration is recommended to improve hearing and vestibular symptoms.

Sound localization performance improves after canaloplasty in unilateral congenital aural atresia patients.

Objective To investigate the changes in sound localization ability in the horizontal plane after canaloplasty in unilateral congenital aural atresia (CAA) patients. Study Design Prospective interventional study. Setting Tertiary referral center. Patients Twenty-eight patients with unilateral CAA were enrolled. All patients had unilateral conductive hearing loss. Interventions Canaloplasty. Main Outcome Measures Pure tone audiometry, sound localization test, and the Speech, Spatial, and Quality questionnaire (SSQ) were administered preoperatively, 6 and 12 months postoperatively. For the sound localization test, 8 loudspeakers were positioned in a circle at 45-degree intervals, and patients were instructed to identify the speaker from which sound was coming. Mean correct response rate and mean error degree were calculated for each patient. The correct lateralization rate to the ipsilesional/contralesional stimuli was also calculated. Results Mean hearing threshold decreased from preoperatively 63.8 to 39.4 dB 12 months after canaloplasty. Mean correct response rate and error degree at preoperative evaluation were 26.0% and 60.7 degrees, respectively, and these were respectively improved to 58.5% and 27.8 degrees postoperatively. Respective mean correct lateralization rate to ipsilesional stimuli after canaloplasty improved from 20.6% to 84.0%, and that to contralesional stimuli slightly improved from 93.8% to 98.8%. Patients with good postoperative hearing (<40 dBHL) showed better sound localization results. In addition, self-assessment scores of spatial domain in the SSQ questionnaire were significantly improved after the operation. Conclusion Sound localization performance improved significantly after canaloplasty. Canaloplasty could provide better localization benefit and subjective improvement in spatial sensation to unilateral CAA patients.

Performance after timely cochlear implantation in prelingually deaf children with cerebral palsy

OBJECTIVES To investigate auditory perception, speech production, and language ability of prelingually deaf toddlers with cerebral palsy (CP) who were implanted within a sensitive period and who received proper speech therapy. Comparison of their outcomes with age- and sex-matched CI recipients without additional disabilities was also performed. METHODS We retrospectively reviewed a cohort of pediatric CI in Samsung Medical Center. Eight CP subjects who received CI before 3 years of age and age-sex matched control recipients who had no additional disabilities except idiopathic sensorineural hearing loss (SNHL) were included for the analysis. Preoperative evaluation included the Categories of Auditory Performance (CAP) score, Korean Version of the Lings Stage (K-Ling), Sequenced Language Scale for Infants (SELSI), Bailey Scales of Infant Development II assessment, Social Maturity Scale test, and grading of CP severity using severity level and Gross Motor Function Classification System for CP (GMFCS). To measure the outcome, the CAP scores, K-Ling, and SELSI were performed at 3, 6, 12, and 24 months after implantation. RESULTS Four CP children with outstanding performances showed comparable achievement with matched control recipients. These patients had less severe motor disabilities (mild-moderate severity, GMFCS level 1-3), better social quotient, and better cognitive abilities. Although the others showed poor language abilities and hardly produced meaningful speech, their CAP scores reached 1 or 2 in 24 months after implantation. CONCLUSIONS Deaf children with CP could have various ranges of benefits up to the levels of normal peers whose only disability was hearing loss, when CI was performed within a critical period. Especially, children with mild or moderate CP had a favorable outcome after CI, equivalent to that of normal peers.

Objective and Subjective Improvement of Hearing in Noise After Surgical Correction of Unilateral Congenital Aural Atresia in Pediatric Patients: A Prospective Study Using the Hearing in Noise Test, the Sound-Spatial-Quality Questionnaire, and the Glasgow Benefit Inventory.

Objectives: The aim of this study was to assess the objective and subjective long-term binaural benefits of surgical correction in children with unilateral congenital aural atresia, using an open-set sentence test in noise and subjective questionnaires. Design: A prospective study was performed between August 2010 and February 2013. This study included pediatric patients who had unilateral conductive hearing loss (normal bone conduction hearing) on the atretic side but normal air conduction hearing on the normal side and were scheduled to undergo a primary canaloplasty. Pure-tone audiometry, the hearing in noise test (HINT), and questionnaires (Sound-Spatial-Qualities of Hearing Scale; Glasgow Benefit Inventory [GBI]) were administered preoperatively and at 6 and 12 months postoperatively. Results: Among 34 consecutive patients who initially met enrollment criteria, 26 subjects (23 boys and 3 girls) aged 10 to 16 years (mean 12.3 years) completed this study. Canaloplasty and hearing restoration procedures were performed uneventfully in all patients. The mean air conduction thresholds were significantly improved from 63.9 to 35.0 dB (6 months) and 39.4 dB (12 months) after surgery (p < 0.001). In HINT, speech understanding in noise that was presented toward the newly opened atretic ear significantly improved at 1 year postoperatively (p = 0.014). In noise toward the normal ear, speech understanding significantly improved after surgery, from −0.1 dB preoperatively to −2.0 dB at 6 months (p = 0.002) and −1.8 dB at 12 months (p = 0.005) (p for quadratic trend = 0.036). The composite score improved from −2.6 dB preoperatively to −3.4 dB at 6 months and −3.6 dB at 12 months (p = 0.045; p for linear trend = 0.005). The Sound-Spatial-Qualities of Hearing Scale scores in all domains significantly improved 1 year after surgery (p < 0.034). The mean GBI scores in each domain ranged from 14.2 to 49.4. Total GBI score was correlated with better signal to noise ratio in noise toward the atretic ear as measured by HINT at postoperative 1 year (Spearman &rgr; = 0.482, p = 0.013). Conclusions: Teenaged patients with unilateral congenital aural atresia showed satisfactory hearing improvement after canaloplasty with hearing restoration surgery. In a serial long-term follow-up, speech understanding in noise measured by HINT improved over time. One year after surgery, teenaged children acquired binaural hearing (binaural squelch), as measured by the HINT with noise presented to the newly opened atretic ear. Subjective questionnaires also showed improvements in binaural hearing function and quality of life.

Factors Associated With Age-related Hearing Impairment: A Retrospective Cohort Study.

AbstractAge-related hearing impairment (ARHI) is a complex degenerative disease in the elderly. As multiple factors interact during the development of ARHI, it is important to elucidate the major influencing factors to understand and prevent ARHI. We aimed to identify risk factors associated with the development of ARHI with a retrospective cohort from 2001 to 2010. The records of the adult subjects over 40 years of age who consecutively underwent a comprehensive health checkup including pure-tone audiometry at the Health Promotion Center were reviewed. During this period, 1560 subjects who underwent pure-tone audiometry more than twice, had no other otologic diseases, and were followed-up more than 2 years were included. A pure-tone average (PTA: 0.5, 1, 2, 4 kHz) was calculated. Development of ARHI was defined as a PTA at follow-up more than 10 dB greater than the baseline PTA. Times to the first development of ARHI were investigated. Overall, 12.7% of subjects developed ARHI within the first 4 years. High blood ionized calcium (hazard ratio [HR] 0.084), albumin (HR 0.239), systolic blood pressure (HR 0.577), thyroid hormone (T3) (HR 0.593), and alpha fetoprotein levels (HR 0.883) were associated with decreased hazard for the development of ARHI. In contrast, high blood high-density lipoprotein (HR 2.105), uric acid (HR 1.684), total protein (HR 1.423), and total bilirubin levels (HR 1.220) were potential risk factors for the development of ARHI. Development of ARHI is common among the aged population, and a variety of factors may interact during this process. The results of this study can be used for counseling of adults at high-risk of developing ARHI with regard to regular audiological check-up.

Labeling of cervical lymph node levels during neck dissection: from ex vivo to in situ mapping.

To analyze the error rate of ex vivo mapping and to evaluate in situ mapping of lymph node (LN) levels during neck dissection (ND)

Clinical value of 4-hour delayed gadolinium-Enhanced 3D FLAIR MR Images in Acute Vestibular Neuritis: Delayed-Enhanced MRI in Vestibular Neuritis

To investigate the clinical significance of 4‐hour delayed‐enhanced 3.0 Tesla three‐dimensional (3D) fluid‐attenuated inversion recovery (FLAIR) magnetic resonance (MR) imaging in acute vestibular neuritis.