In Seok Moon

Intratympanic dexamethasone is an effective method as a salvage treatment in refractory sudden hearing loss.

Objectives This study aimed to investigate the therapeutic efficacy of intratympanic dexamethasone (ITD) as a salvage treatment in sudden hearing loss (SHL) patients who had no response to initial systemic combination steroid therapy. Patients and Methods From May 2007 to June 2010, 415 SHL patients visited 3 tertiary referral centers within 7 days of disease onset. They were all treated with an identical protocol, a 10-day scheduled hospitalization and oral steroid treatment. Of these, 151 patients were totally unresponsive 2 weeks after treatment initiation according to Siegel’s criteria. We divided these 151 refractory patients into 3 groups: those receiving no further treatment (control group, n = 59), those receiving one more 10-day cycle of oral steroids (systemic reapplication group, n = 26), and those receiving ITD therapy (ITD group, n = 66). Final assessment of hearing was conducted approximately 3 months after the onset of SHL. Hearing improvement was defined as demonstrating “any” improvement according to Siegel’s criteria. Results The initial average hearing thresholds of all groups were similar. Overall hearing improvement was observed in 10 of 59 patients in the control group, in 4 of 26 in the systemic reapplication group, and in 32 of 66 in the ITD group. No serious complications were observed. Analyzing by frequency, paradoxically, hearing of the low and mid frequencies was more significantly improved than high frequencies in the ITD group. Conclusion Intratympanic dexamethasone administration after failure of an initial treatment is effective, and this should be used as a salvage treatment in cases of refractory SHL.

The effect of surgical timing on functional outcomes of traumatic facial nerve paralysis.

BACKGROUND The optimal timing for surgical exploration of traumatic facial paralysis to best preserve facial function is currently controversial. This article reviews the final outcomes of facial function in patients with traumatic intratemporal facial nerve injury according to the timing of surgical exploration. METHODS We performed a retrospective review of 58 patients with complete facial nerve paralysis caused by temporal bone fractures as a result of head trauma between 1998 and 2007. Patients were divided into three groups according to the type of trauma. The only difference between patients in each group was the timing of the surgical exploration. Characteristics assessed in the study included type of trauma, location of facial nerve injury, timing of surgical intervention, audiometric findings, surgical approach, and long-term follow-up of recovery of facial nerve function, as assessed by two facial nerve grading systems. RESULTS The final functional gains in early-operated patients were 3.7 +/- 0.59 on the House-Brackmann (HB) scale and 75.6 +/- 10.88 on the Sunnybrook scale. The outcome in late-operated patients was 2.17 +/- 0.52 on the HB scale and 34.7 +/- 16.95 on the Sunnybrook scale, and that of nonoperated patients was 2.0 +/- 0.63 on the HB scale and 26.8 +/- 6.27 on the Sunnybrook scale. CONCLUSION This study demonstrated that some patients with traumatic facial nerve paralysis who had nerve conduction studies consistent with a poor prognosis regained considerable facial function after early surgical intervention. However, late exploration after facial nerve paralysis did not result in positive outcomes, regardless of the type of temporal bone fracture or the site of injury, and no difference was observed compared with conservative treatment.

Delayed Cochlear Implantation in Adults With Prelingual Severe-to-profound Hearing Loss

Objectives: To evaluate the results of late cochlear implantation in prelingually deaf patients with significant residual hearing loss and to evaluate patient factors relevant to postoperative auditory outcomes in this patient group. Study Design: Analysis of results of cochlear implantation using postoperative speech perception test scores per each condition. Setting: Tertiary referral center. Patients: Thirty-two subjects with severe to profound hearing loss that developed before the age of 4. Interventions: Subjects were implanted at a mean age of 24.8 years (range, 16-44) with Nucleus CI24 (n = 18, 56%), Clarion HiRes 90K (n = 11, 34%), and Medel PULSA (n = 3, 10%) device. Details of etiology, duration of deafness, hearing aid history, hearing thresholds before operation, communication mode, and educational environment were investigated. Speech perception tests were performed preoperatively and 12 months after the operation. Main Outcome Measures: Postoperative speech perception test scores between different options within patient group. Results: The results showed significant improvement in open set speech perception (sentence) scores after the implantation (mean scores from 7.0 to 46.7, p < 0.05). Preoperative hearing of better ear and preoperative speech perception scores correlated with postoperative performances (r = −0.70 and r = 0.46, respectively, p < 0.05). Education and communication mode were also closely related to postoperative performances. In the group with poorer performances, preoperative hearing thresholds were significantly worse than those with better performances, and a larger portion of those patients attended special schools and used sign language. Conclusion: We found that residual auditory capacity in the better ear is an important factor in predicting outcomes after cochlear implantation in patients with prelingual hearing loss.

Noise-induced hearing loss caused by gunshot in South Korean military service.

ABSTRACT Background: Noise-induced hearing loss is a preventive disease and yet the effective treatment modality has not been established. Acute acoustic traumas caused by an exposure to gunshot noise are common in young South Korean males in military service. Considering the significant lack of awareness on this serious issue as well as the absence of proper protective gear, an in-depth analysis is desperately needed. Method: All 3,650 soldiers performed regular periodic gunfire exercise without any hearing protective measures. Seven patients with hearing impairment after periodic gunfire visited the aeromedical squadron; all were right-handed males. Six were tested with the K-2 rifle and one was tested with a K-5 revolver. History taking, physical examination, pure-tone audiometry, and impedance audiometry were conducted. In the next periodic gunfire exercise, all 3,650 soldiers performed gunfire with unilateral hearing protection. Results: The average outcome of postexposure air conduction thresholds w...BACKGROUND Noise-induced hearing loss is a preventive disease and yet the effective treatment modality has not been established. Acute acoustic traumas caused by an exposure to gunshot noise are common in young South Korean males in military service. Considering the significant lack of awareness on this serious issue as well as the absence of proper protective gear, an in-depth analysis is desperately needed. METHOD All 3650 soldiers performed regular periodic gunfire exercise without any hearing protective measures. Seven patients with hearing impairment after periodic gunfire visited the aeromedical squadron; all were right-handed males. Six were tested with the K-2 rifle and one was tested with a K-5 revolver. History taking, physical examination, pure-tone audiometry, and impedance audiometry were conducted. In the next periodic gunfire exercise, all 3650 soldiers performed gunfire with unilateral hearing protection. RESULTS The average outcome of postexposure air conduction thresholds was 6.5 dB in the right ear and 33.1 dB in the left ear. After medical treatment, hearing impairment was much improved; however, tinnitus was not diminished. In the next periodic gunfire exercise, the result of a supplement of unilateral earplug protection proved its effectiveness on acoustic trauma caused by gunfire noise. CONCLUSION Asymmetry in hearing loss is related to the position of the head during gunfire. A unilateral hearing protection device was enough to protect hearing from gunfire noise. At the same time, it can effectively prevent a potential firearm accident that can be caused by trainees mishearing the instruction of a firearm instructor if both earplugs are worn. Thus, providing a unilateral earplug for protection against acoustic trauma must be taken into serious consideration.

Interferon‐γ suppresses Na+–H+ exchanger in cultured human endolymphatic sac epithelial cells

Adequate regulation of endolymphatic pH is essential for maintaining inner ear function. The Na+–H+ exchanger (NHE) is a major determinant of intracellular pH (pHi), and facilitates Na+ and fluid absorption in various epithelia. We determined the functional and molecular expression of NHEs in cultured human endolymphatic sac (ES) epithelial cells and examined the effect of IFN‐γ on NHE function. Serial cultures of human ES epithelial cells were generated from tissue samples. The molecular expression of NHE1, ‐2, and ‐3 isoforms was determined by real‐time RT‐PCR. The functional activity of NHE isoforms was measured microfluorometrically using a pH‐sensitive fluorescent dye, 2′,7′‐bis(carbonylethyl)‐5(6)‐carboxyfluorescein (BCECF), and a NHE‐inhibitor, 3‐methylsulfonyl‐4‐piperidinobenzoyl guanidine methanesulfonate (HOE694). NHE1, ‐2, and ‐3 mRNAs were expressed in human ES epithelial cells. Functional activity of NHE1 and ‐2 was confirmed in the luminal membrane of ES epithelial cells by sequentially suppressing Na+‐dependent pHi recovery from intracellular acidification using different concentrations of HOE694. Treatment with IFN‐γ (50 nM for 24 h) suppressed mRNA expression of NHE1 and ‐2. IFN‐γ also suppressed functional activity of both NHE1 and ‐2 in the luminal membrane of ES epithelial cells. This study shows that NHEs are expressed in cultured human ES epithelial cells and that treatment with IFN‐γ suppresses the expression and functional activity of NHE1 and ‐2. J. Cell. Biochem. 107: 965–972, 2009.

Canal wall reconstruction and mastoid obliteration in canal wall down tympanomastoidectomized patients

Conclusion: Posterior canal reconstruction using autogenous bone pate and mastoid obliteration with allogenous cancellous bone chips (ACBCs) is a useful method to eliminate cavity problems after canal wall down tympanomastoidectomy (CWDT). It is also an appropriate method to obtain adequate middle ear space for hearing gain and to apply hearing aids for patients with poor eustachian tube function after surgery. Objective: This study was performed to suggest a new technique for posterior canal reconstruction and mastoid obliteration and to evaluate the outcome of the surgery. Patients and methods: The entire posterior canal was reconstructed with autogenous bone pate, and the new isolated mastoid cavity was obliterated with ACBCs in patients who had undergone CWDT and suffered from cavity problems. Outcomes were measured by external auditory canal shape, condition of the neotympanum, hearing outcome, improvement of cavity problems, and surgical complications. Results: In 90.9%, the reconstructed canal wall maintained a cylindrical shape. The drum healed without perforation/retraction in 90.9%. The average air–bone gap value was 34.5 dB hearing level (HL) before the staged operation and 17.8 dB HL after the staged operation; 95.5% had no more cavity problems. Minor postauricular wound infection was the most common complication (13.6%).

The Effect of Early Canalith Repositioning on Benign Paroxysmal Positional Vertigo on Recurrence

Objectives Benign paroxysmal positional vertigo (BPPV) can be treated using a simple repositioning maneuver. This study demonstrates the effects of early repositioning therapy in patients with BPPV, especially with regard to recurrence. Methods We enrolled 138 consecutive patients who had been diagnosed with BPPV in the emergency rooms and ENT out-patient clinics of Chung-Ang University Hospital and Samyook Medical Center from January to June 2009. All patients immediately underwent appropriate canalith repositioning procedures (CRPs) depending on canalith type and location. The CRPs were performed daily until the patients symptoms were resolved. The patients were classified into two groups according to the duration between symptom onset and initial treatment: less than 24 hours (early repositioning group, n=66) and greater 24 hours (delayed repositioning group, n=72). We prospectively compared the numbers of treatments received and the recurrence rates between the two groups. Results Follow-up periods ranged from 8 to 14 months, 77 cases involved posterior canal BPPV, 48 cases were lateral canal BPPV (of which 20 cases were cupulolithiasis), and 13 cases were multiple canal BPPV. BPPV recurrence was found in a total of 46 patients (33.3%). The necessary numbers of CRPs were 2.3 for the early repositioning group and 2.5 for the late repositioning group, a difference that was not statistically significant (P=0.582). The early repositioning group showed a recurrence rate of 19.7%, and the delayed repositioning group showed a recurrence rate of 45.8% (P=0.002). Conclusion Performing repositioning treatments as soon as possible after symptom onset may be an important factor in the prevention of BPVV recurrence.

Association between vestibular schwannomas and mobile phone use

Vestibular schwannomas (VSs) grow in the region where the energy from mobile phone use is absorbed. We examined the associations of VSs with mobile phone use. This study included 119 patients who had undergone surgical tumor removal. We used two approaches in this investigation. First, a case–control study for the association of mobile phone use and incidence of VSs was conducted. Both cases and controls were investigated with questions based on INTERPHONE guidelines. Amount of mobile phone use according to duration, daily amount, and cumulative hours were compared between two groups. We also conducted a case–case study. The location and volume of the tumors were investigated by MRI. Associations between the estimated amount of mobile phone use and tumor volume and between the laterality of phone use and tumor location were analyzed. In a case–control study, the odds ratio (OR) of tumor incidence according to mobile phone use was 0.956. In the case–case study, tumor volume and estimated cumulative hours showed a strong correlation (r2 = 0.144, p = 0.002), and regular mobile phone users showed tumors of a markedly larger volume than those of non-regular users (p < 0.001). When the analysis was limited to regular users who had serviceable hearing, laterality showed a strong correlation with tumor side (OR = 4.5). We found that tumors may coincide with the more frequently used ear of mobile phones and tumor volume that showed strong correlation with amount of mobile phone use, thus there is a possibility that mobile phone use may affect tumor growth.

Long-term effects of repetitive transcranial magnetic stimulation in unilateral tinnitus.

We investigated the long‐term effects of repetitive transcranial magnetic stimulation (rTMS) delivered to the temporoparietal junction and compared contralateral and ipsilateral application in patients with unilateral tinnitus.

Is there a deafness duration limit for cochlear implants in post-lingual deaf adults?

Abstract Conclusion: Patients with post-lingual deafness should not be excluded from cochlear implantation (CI) on the basis of duration of deafness. We found that the prognosis was favorable in patients who developed deafness after adolescence, even in those with extremely long-term deafness. Objectives: CI is an effective treatment for post-lingual deafness. However, it remains unclear whether CI would benefit patients with extremely long-term deafness. We evaluated the auditory performance after CI of patients who had been deaf for more than 30 years. Methods: The study enrolled 81 adults with post-lingual deafness. Speech perception tests were performed preoperatively and 12 months postoperatively, and factors affecting the postoperative auditory performance were investigated. The subjects were divided into groups according to the duration of deafness and the postoperative speech perception scores were compared. Results: A marked improvement in the open-set speech perception scores (mono/disyllabic words and sentences) after implantation was seen in all groups, and no significant difference in the improvement in speech perception scores was observed among the groups. Age at onset of deafness was closely related to the postoperative performance, and patients who had lost their hearing before adolescence performed poorly.