Hyung Jong Kim

Analysis of Predisposing Factors for Hearing Loss in Adults.

We aimed to estimate the effects of various risk factors on hearing level in Korean adults, using data from the Korea National Health and Nutrition Examination Survey. We examined data from 13,369 participants collected between 2009 and 2011. Average hearing thresholds at low (0.5, 1, and 2 kHz) and high frequencies (3, 4, and 6 kHz), were investigated in accordance with various known risk factors via multiple regression analysis featuring complex sampling. We additionally evaluated data from 4,810 participants who completed a questionnaire concerned with different types of noise exposure. Low body mass index, absence of hyperlipidemia, history of diabetes mellitus, low incomes, low educational status, and smoking were associated with elevated low frequency hearing thresholds. In addition, male sex, low body mass index, absence of hyperlipidemia, low income, low educational status, smoking, and heavy alcohol consumption were associated with elevated high frequency hearing thresholds. Participants with a history of earphone use in noisy circumstances demonstrated hearing thresholds which were 1.024 dB (95% CI: 0.176 to 1.871; P = 0.018) higher, at low-frequencies, compared to participants without a history of earphone use. Our study suggests that low BMI, absence of hyperlipidemia, low household income, and low educational status are related with hearing loss in Korean adults. Male sex, smoking, and heavy alcohol use are related with high frequency hearing loss. A history of earphone use in noisy circumstances is also related with hearing loss. Graphical Abstract

Clinical observation on acute low-frequency hearing loss without vertigo: the role of cochlear hydrops analysis masking procedure as initial prognostic parameter.

Objectives: Even though it is currently not possible to prove a pathological diagnosis for inner ear disease, acute low-frequency hearing loss (ALFHL) without vertigo could be caused by inner ear hydrops because progression into the clinical spectrum of endolymphatic hydrops (EH) frequently occur among patients with the initial clinical presentation. Therefore, audiological measures representative of inner ear hydrops, such as the cochlear hydrops analysis masking procedure (CHAMP) test, may be used to predict the prognosis of ALFHL without vertigo. To test this hypothesis, we prospectively investigated patients with ALFHL unaccompanied by vertigo and examined whether the CHAMP test generated more useful information for prediction of progression into clinical spectrum of EH compared with other neurotologic parameters. Design: A prospective clinical study of 28 patients who initially presented with ALFHL without vertigo was conducted. Detailed neurotologic findings from pure-tone audiometry, electrocochleography, CHAMP, spontaneous nystagmus, head-shaking nystagmus, vibration-induced nystagmus, the bithermal caloric test, and the rotatory chair test were recorded at the time of initial presentation. A regular audiological and clinical examination was conducted until either the last follow-up at our clinic or on the day on which secondary audiovestibular symptoms occurred. The rates of progression to Ménière’s disease (MD) or clinical presentation compatible with isolated cochlear hydrops during the study period were calculated by the log-rank test and relative risk. A receiver operating characteristics curve was plotted to determine the prognostic value of CHAMP. Results: Of 28 patients, 15 (53%) showed improvement in hearing on pure-tone audiometry. Seven patients (25%) showed hearing fluctuation and nine (32%) developed a vertigo attack during the observation period. Of these, three patients experienced both vertigo and a hearing fluctuation. Abnormal results of electrocochleography and neurotologic tests reflecting vestibular ocular reflex on yaw plane were common at the time of diagnosis of ALFHL in many patients, but these parameters were not associated with an increased risk of progression of clinical spectrum of EH. In contrast, patients with an abnormal complex amplitude ratio (CAR) on CHAMP had a 2.6-fold increased risk of progression to a clinical spectrum of EH (either hearing fluctuation or MD). The hazard ratio of developing MD for patients with normal CAR as compared with those with an abnormal CAR was 0.137 (95% confidence interval 0.03–0.57; p < 0.001), which indicates an 84.3% reduced risk of developing MD in those with normal CAR. A CAR value of 0.975 or less indicated the possibility of developing either a hearing fluctuation or vertiginous episode with a sensitivity of 82% and a specificity of 73% by receiver operating characteristics curve analysis. Conclusions: The results of the study suggest that CHAMP measurement may be useful for determining the prognosis of patients with ALFHL without vertigo. A CAR value of 0.975 or less indicates the possibility of developing fluctuating hearing loss or vertigo in patients with ALFHL unaccompanied by vertigo.

Lipid profiles and obesity as potential risk factors of sudden sensorineural hearing loss.

Objectives The objective of our study was to establish whether increased lipid profiles and obesity affect the prevalence and prognosis of sudden sensorineural hearing loss (SSNHL). Methods This was a case-controlled study with a longitudinal design. According to our criteria, 324 patients with SSNHL were included in this study. To manage potential covariates, 972 subjects with normal hearing from the Korean National Health and Nutrition Examination Survey were matched as control group according to their propensity scores. Age, level of total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and body mass index (BMI) were obtained from the clinical data. Multivariate logistic regression analysis was used to investigate the association between SSNHL and lipid profiles or obesity in the 1296 subjects. Multivariate Cox regression analysis was used to determine whether lipid profiles and obesity are prognostic factors in patients with SSNHL. Results Mean body weight, BMI, TC, and TG were significantly higher in patients with SSNHL compared with control subjects (p<0.05). However, LDL-C values did not differ significantly between the two groups. Subjects with elevated TC and TG levels had a 2.20- (95% CI 1.50–3.24) and 1.50-fold (95% CI 1.08–2.08) increased odds, respectively, of SSNHL compared with subjects with normal TC and TG levels. Subjects with grade III BMI had a 1.59-fold (95% CI 1.17–2.16) increased odds of SSNHL. Multivariate Cox regression analyses revealed that BMI was an independent risk factor of treatment outcome, as patients with BMI ≥27.5 were less likely to achieve complete recovery than those with BMI <27.5 (p<0.05). Conclusions The results of this study revealed that elevated TC and TG levels and increased BMI are significantly associated with the prevalence of SSNHL and its prognosis, indicating that vascular compromise may play an important role in the pathogenesis of SSNHL.

Pseudo-Spontaneous Nystagmus in Lateral Semicircular Canal Benign Paroxysmal Positional Vertigo

Objectives Spontaneous nystagmus, which has been considered a typical sign of acute vestibulopathy, has recently been reported in benign paroxysmal positional vertigo involving the lateral semicircular canals (LC-BPPV) without unilateral vestibulopathy (pseudo-spontaneous nystagmus, PSN), but research about its clinical application is still limited. Here we investigate the frequency and characteristics of PSN in LC-BPPV patients, and estimate its prognostic value. Methods For 95 patients with LC-BPPV, we examined nystagmus in the sitting position in the clinic with video goggles. Patients were categorized as PSN or non-PSN, according to presence of horizontal nystagmus in the sitting position at diagnosis. The duration of vertiginous symptoms before diagnosis and the duration of treatment were compared between the two groups. The results of video-nystagmography test were reviewed when available. Results PSN was examined in 16 (16.8%) patients, all of whose symptoms disappeared immediately after successful repositioning therapy. While the duration of symptoms did not differ statistically between groups (P=0.481), the duration of treatment in the PSN group was significantly longer than in the non-PSN group (P<0.001). Conclusion We conclude that the presence of spontaneous nystagmus in the sitting position does not preclude a diagnosis of LC-BPPV without unilateral vestibulopathy. PSN was related to a poor outcome of LC-BPPV in this study.

Music Perception Ability of Korean Adult Cochlear Implant Listeners

Objectives Although the cochlear implant (CI) is successful for understanding speech in patients with severe to profound hearing loss, listening to music is a challenging task to most CI listeners. The purpose of this study was to assess music perception ability and to provide clinically useful information regarding CI rehabilitation. Methods Ten normal hearing and ten CI listeners with implant experience, ranging 2 to 6 years, participated in the subtests of pitch, rhythm, melody, and instrument. A synthesized piano tone was used as musical stimuli. Participants were asked to discriminate two different tones during the pitch subtest. The rhythm subtest was constructed with sets of five, six, and seven intervals. The melody & instrument subtests assessed recognition of eight familiar melodies and five musical instruments from a closed set, respectively. Results CI listeners performed significantly poorer than normal hearing listeners in pitch, melody, and instrument identification tasks. No significant differences were observed in rhythm recognition between groups. Correlations were not found between music perception ability and word recognition scores. Conclusion The results are consistent with previous studies that have shown that pitch, melody, and instrument identifications are difficult to identify for CI users. Our results can provide fundamental information concerning the development of CI rehabilitation tools.

Bilateral muscular tinnitus due to myoclonus of extrinsic auricular muscles

The muscular tinnitus due to an extrinsic auricular myoclonus is an extremely rare disorder which demonstrates a semirhythmic involuntary movement of the ear. We report a 33-year-old man with clicking tinnitus caused by focal myoclonic jerks of bilateral posterior auricularis muscle and bilateral temporalis muscle. This muscular tinnitus persisted except for when he was sleeping or breath holding. His symptom responded poorly to medical therapy but was controlled by botulinum toxin type A injection under electromyography monitoring with favorable outcome. Previous reports of this condition and possible therapeutic approaches are discussed.

Protective role of edaravone against cisplatin-induced ototoxicity in an auditory cell line

Edaravone is a neuroprotective agent with a potent free radical scavenging and antioxidant actions. In the present study we investigated the influence of edaravone on cisplatin ototoxicity in auditory cells. Cell viability was determined using a 3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromide cell proliferation assay. Oxidative stress and apoptosis were assessed by reactive oxygen species (ROS) measurement, Hoechst 33258 staining, caspase-3 activity assay, and immunoblotting of PARP. Pretreatment with 100 μM of edaravone prior to application of 15 μM of cisplatin increased cell viability after 48 h of incubation in HEI-OC1 cells (from 51.9% to 64. 6% viability) and also, attenuated the cisplatin-induced increase in reactive oxygen species (ROS) (from 2.3 fold to 1.9 fold). Edaravone also decreased the activation of caspase-3 and reduced levels of cleaved poly-ADP-ribose polymerase (PARP). We propose that edaravone protects against cisplatin-induced ototoxicity by preventing apoptosis, and limiting ROS production in HEI-OC1 cells.

Congenital cholesteatoma localized to the tip of the mastoid bone: a case report and possible etiology.

Congenital cholesteatomas of mastoid origin are extremely rare. We reported one in 2007 and experienced an additional case. A male presented with a 5-month history of right-sided ear discharge. Computed tomography of the temporal bone showed a soft tissue density occupying the mastoid tip. At surgery, the cholesteatoma sac was completely isolated from the mastoid antrum and lateral air cell in the mastoid tip area. We now doubt the rarity of this entity. With a brief literature review, we consider how the cholesteatoma localizes to the tip of the mastoid bone.

Is Intratympanic Dexamathasone Injection Effective for the Treatment of Idiopathic Sudden Sensorineural Hearing Loss

Background and Objectives The purpose of this study is to identify the effectiveness of intratympanic (IT) steroids when used as an initial therapy in sudden sensorineural hearing loss (SSNHL), and when it is used as a salvage therapy in a refractory SSNHL. Subjects and Methods This retrospective study included 122 patients with SSNHL. First, patients were divided into three groups according to the initial treatment; IT steroid, systemic steroid and combined (systemic and IT steroid) groups. Second, patients were divided into two groups according to the salvage treatment in a refractory SSNHL; IT steroid and the control (non IT group). Fifty eight patients who did not respond to initial therapy were included in the second analysis. Hearing was assessed immediately before the treatment and 2 weeks, 4 weeks and 3 months after the treatments. Hearing recovery was defined as an improvement of >15 dB and the final hearing of 25-45 dB in the audiogram. Results When we analyzed the hearing recovery in initial treatment, the comparison of audiogram among three groups did not result in significantly different outcomes. There were no differences in the recovery rate in 2 and 4 weeks throughout all the frequencies. Also, the analysis of the salvage treatment demonstrated that neither IT steroid group nor control group was significantly effective in treating the refractory SSNHL. Conclusions The results suggest that initial treatment of SSNHL with IT steroid alone is as effective as systemic steroid alone or a combination therapy. Also, salvage IT steroids for refractory SSNHL did not have any additional beneficial effects.