Jong Woo Chung

Can Intratympanic Dexamethasone Added to Systemic Steroids Improve Hearing Outcome in Patients With Sudden Deafness

Objective: To evaluate the therapeutic efficacy of intratympanic dexamethasone (ITD) injections added to systemic steroids in patients with idiopathic sudden sensorineural hearing loss (HL).

Therapeutic effectiveness over time of intratympanic dexamethasone as salvage treatment of sudden deafness

Conclusion. Intratympanic dexamethasone (ITD) within 1 month after initial treatment failure should be utilized as salvage treatment for refractory sudden sensorineural hearing loss (SSNHL). Objective. To investigate the therapeutic efficacy over time of ITD as salvage treatment in SSNHL. Materials and methods. We retrospectively reviewed the medical records and audiograms of 99 SSNHL patients who were refractory to 2 weeks of oral steroid treatment, from August 2003 to October 2006. Patients were divided into those receiving no further treatment (control group) and those receiving ITD within 2 weeks (early-ITD), between 2 weeks and 1 month (mid-ITD), and between 1 and 2 months (late-ITD) after initial treatment failure. ITD was performed in the supine position on four separate occasions over the course of 2 weeks. Final assessment of hearing was carried out 3 months after outbreak of SSNHL. Hearing improvement was defined as a >15 dB decrease in four-tone average (FTA). Results. Overall hearing improvement was observed in 8 of 50 (16.0%) control patients, 7 of 16 (43.8%) early ITD patients, 6 of 20 (30.0%) mid ITD patients, and 2 of 13 (15.4%) late ITD patients.CONCLUSIONnIntratympanic dexamethasone (ITD) within 1 month after initial treatment failure should be utilized as salvage treatment for refractory sudden sensorineural hearing loss (SSNHL).nnnOBJECTIVEnTo investigate the therapeutic efficacy over time of ITD as salvage treatment in SSNHL.nnnMATERIALS AND METHODSnWe retrospectively reviewed the medical records and audiograms of 99 SSNHL patients who were refractory to 2 weeks of oral steroid treatment, from August 2003 to October 2006. Patients were divided into those receiving no further treatment (control group) and those receiving ITD within 2 weeks (early-ITD), between 2 weeks and 1 month (mid-ITD), and between 1 and 2 months (late-ITD) after initial treatment failure. ITD was performed in the supine position on four separate occasions over the course of 2 weeks. Final assessment of hearing was carried out 3 months after outbreak of SSNHL. Hearing improvement was defined as a > 15 dB decrease in four-tone average (FTA).nnnRESULTSnOverall hearing improvement was observed in 8 of 50 (16.0%) control patients, 7 of 16 (43.8%) early ITD patients, 6 of 20 (30.0%) mid ITD patients, and 2 of 13 (15.4%) late ITD patients.

Comparing pure-tone audiometry and auditory steady state response for the measurement of hearing loss

Objective To compare pure-tone audiometry and auditory steady state response (ASSR) to measure hearing loss based on the severity of hearing loss in frequencies. Study Design and Setting A total of 105 subjects (168 ears, 64 male and 41 female) were enrolled in this study. We determined hearing level by measurement of pure-tone audiometry and ASSR on the same day for each subject. Results Pure-tone audiometry and ASSR were highly correlated (r = 0.96). The relationship is described by the equation PTA = 1.05 × mean ASSR − 7.6. When analyzed according to the frequencies, the correlation coefficients were 0.94, 0.95, 0.94, and 0.92 for 0.5, 1, 2, and 4 kHz, respectively. Conclusion From this study, authors could conclude that pure-tone audiometry and ASSR showed very similar results and indicated that ASSR may be a good alternative method for the measurement of hearing level in infants and children, for whom pure-tone audiometry is not appropriate.

Retinoic acid applied after noise exposure can recover the noise-induced hearing loss in mice

Conclusion. The early post-exposure treatment with All-trans retinoic acid (ATRA) can reduce hair cell loss and hearing deterioration in mice in which permanent threshold shift has been induced. Objective: One of the mechanism by which intense noise induces apoptosis of cochlea hair cells is the C-Jun NH2-terminal kinase (JNK) pathway. ATRA is a potent inhibitor of activator protein 1, a transcription factor of the JNK pathway. In this study we evaluated that the effect of post-exposure treatment of ATRA on noise-induced hearing loss and aimed to determine a time window for effective post-exposure treatment of ATRA. Methods. All mice were exposed to white noise for 3 h per day for three consecutive days and induced permanent threshold shift. The treatment groups fed with ATRA from 1 h, one day, two days, and three days after noise exposure for five days were compared with mice fed with same dosage of sesame oil. We measured the threshold shifts of hearing and survival rates of hair cells on the cytocochleogram. Results. Mice fed with ATRA beginning within two days after noise had less threshold shifts and more hair cell survivals than mice fed with sesame oil.

Lipoic acid rescues DBA mice from early-onset age-related hearing impairment.

We fed DBA mice with &agr;-lipoic acid (100u2009mg/kg body weight/day), beginning 2, 4, or 8 weeks after birth. Hearing thresholds were measured weekly. At 12 weeks after birth, control mice not fed with &agr;-lipoic acid showed significant hearing decreases at all frequencies. In contrast, mice fed with &agr;-lipoic acid beginning at 2 weeks after birth showed significantly better hearing at all frequencies. Mice fed with &agr;-lipoic acid beginning at 4 and 8 weeks after birth also showed significantly better hearing than control mice after they were fed with &agr;-lipoic acid. The stria vascularis of mice fed with &agr;-lipoic acid showed reduced 8-oxoguanine residues in DNA and cytoplasm compared with that of control mice. Western blotting showed that the level of hypoxia-inducible factor-1&agr; was lower in mice fed with &agr;-lipoic acid than in control mice. From these results, we suggest that &agr;-lipoic acid prevented early-onset hearing impairment in DBA mice.

Pre-operative Evaluation of Eustachian Tube Function Using a Modified Pressure Equilibration Test is Predictive of Good Postoperative Hearing and Middle Ear Aeration in Type 1 Tympanoplasty Patients

Objectives The Eustachian tube (ET) plays an important role in maintaining a normally aerated middle ear. Inflammation in middle ear disease is related to ET dysfunction, and postoperative restoration of middle ear integrity and hearing are closely related to ET function in chronic ear disease patients. After successful tympanoplasty, restoration of a well-aerated middle ear with good ET function can permit better compliance of the tympanic membrane. In this study, we evaluated the predictive validity of preoperative ET function measurements. Methods We reviewed 137 patients who underwent type 1 tympanoplasty. All patients had non-cholesteatomatous chronic otitis media and received canal wall-up-type tympanomastoidectomies. Patients were categorized into four groups according to preoperative ET function measurements using a modified pressure inflation-deflation equilibration test. Group I patients had residual pressures less than 10 daPa, and Group IV patients showed no pressure change (poor results). Groups II and III were intermediate. Hearing levels were determined using pure tone averages at four frequencies. Postoperative tympanography was performed to determine middle ear aeration. Results The preoperative air bone (AB) gap was 29.6±7.0 dB, and the postoperative gap was 16.5±5.7 dB; thus, there was significant overall improvement. In all groups, hearing was significantly better after surgery, but the worst postoperative hearing level was seen in Group IV patients. Type B tympanograms were more frequently recorded in Group IV patients than they were in Group I or II patients. Postoperative AB gaps were 9.2±3.8 dB in patients with type A tympanograms, 13.4±2.1 dB in those with type As, 24.1±2.5 dB in those with type C, and 18.5±2.8 dB in those with type B. Conclusion ET function measured with a modified pressure equilibration test using an inflation-deflation manometric method is a good indicator of an aerated middle ear and is predictive of improved postoperative hearing.

Inner ear anomalies in cochlear implantees: importance of radiologic measurements in the classification.

Objective: To classify the inner ear anomalies of cochlear implantees with profound sensorineural hearing loss. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: For the normative data of the inner ear structures, the temporal bone computed tomography of 60 patients (120 ears) with normal bone-conduction threshold (<15 dB) were used, and the data were applied to 570 ears of 285 cochlear implantees. Interventions: Predesignated inner ear structures were measured in temporal bone computed tomography images from the normal and cochlear implantation groups using a computer-based caliper that formed part of a picture archiving and communication system. Main Outcome Measures: The inner ear anomalies were defined when the structures presented visually obvious malformations or the measurements deviated 2 standard deviations from the means in the normative data. Results: The application of normative data to 570 profound SNHL ears resulted in the identification of 293 individual anomalies in 127 anomalous ears. An enlarged vestibular aqueduct was the most common individual anomaly (49 cases), followed by vestibular enlargement (38 cases) and other semicircular canal dysplasia (37 cases). When the individual anomalies were reaccounted according to the more prominent anomaly where multiple anomalies were present in each ear, incomplete partition type II was the most common (34 ears), followed by cochlear hypoplasia (22 ears) and incomplete partition type I (20 ears). Conclusion: We suggested a measurement technique for the inner ear structures using computed tomography and derived normative measurements helpful for diagnosing inner ear anomalies. Using these normative data, we classified the inner ear anomalies of profound SNHL ears in cochlear implantees.

Audiological Follow-up Results after Newborn Hearing Screening Program

Objectives To investigate the validity of newborn hearing screening protocol using automated auditory brainstem response (AABR) with a confirmation method using click auditory brainstem response (ABR) and to evaluate changes in hearing status of infants with confirmed congenital hearing loss. Methods Neonates in the well-baby nursery were screened by staged AABR. Subjects whose final AABR result was refer were tested by diagnostic click ABR and 226 Hz tympanometry within 3 months of age. Changes in hearing status of subjects with confirmed hearing loss were analyzed by follow-up ABR at 3-6 month intervals. Results Of the 12,193 healthy babies born during this period, 10,879 (89.22%) were screened by AABR. Of 10,879 neonates screened by AABR, 148 (1.36%) were referred; of these, 45 subjects showed ABR thresholds over 30 dB nHL in at least one ear. Thirty-four subjects underwent serial follow-up ABR tests, with 11 (32.4%) found to have normal ABR thresholds. Most subjects with mild to moderate hearing loss were found to be normal before 1 year of age, whereas all infants with severe or profound hearing loss were identified as having congenital hearing loss. Conclusion The referral rate and the positive predictive value of our protocol were acceptable. We have also found here that substantial temporary hearing loss can be included in the first confirmative diagnosis. Temporary hearing loss of our study on follow-up give emphasis to need of further differentiation using the testing for bone conduction and middle ear status.

Visceral adipose tissue is significantly associated with hearing thresholds in adult women

Metabolic syndrome is a risk factor for age‐related hearing impairment (ARHI). There are metabolic differences between abdominal adipose tissue present in subcutaneous and visceral areas. In this study, we investigated the association between abdominal fat composition, measured by computerized tomography (CT), and hearing thresholds.

Complications following cochlear implantation in patients with anomalous inner ears: experiences in Asan Medical Center

Conclusion. Although the rate of postoperative complications was higher in patients with anomalous inner ears than in patients with normal inner ears, most were minor and could be managed conservatively. These findings suggest that cochlear implantation (CI) is safe even for patients with anomalous inner ears in experienced hospitals. Objective. To report complications encountered in patients with various types of anomalous inner ears undergoing CI in Asan Medical Center. Patients and methods. We retrospectively analyzed 388 patients who underwent CI between April 1999 and July 2006; of these, 80 patients had various inner ear anomalies. Immediate complications were defined as those occurring within 1 week of implantation and delayed complications as those occurring after 1 week. Minor and major complications were defined by severity requiring further management. Results. Of the 80 patients with anomalous inner ears, 20 cases (25.0%) had postoperative complications, including 5 (6.3%) with major complications: facial nerve palsy, recurrent meningitis, device failure, and cerebrospinal fluid (CSF) leakage. Re-implantations were performed in three patients (3.8%).