Kye Hoon Park

Intratympanic Steroids in Severe to Profound Sudden Sensorineural Hearing Loss as Salvage Treatment

OBJECTIVES Intratympanic steroids are being increasingly used in the treatment of sudden sensorineural hearing loss (SSNHL) after the failure of systemic therapy. This study evaluated the efficacy of administering intratympanic dexamethasone (ITD) as a salvage treatment for severe to profound SSNHL. METHODS We reviewed the medical records of patients who presented with severe to profound SSNHL between January 2007 and December 2009. ITD was given about 14 days after the initial systemic treatment. Successful recovery was defined as complete or partial recovery using Sigels criteria. We compared the results of treatment between the severe SSNHL (S-SSNHL) and profound SSNHL (P-SSNHL) groups. RESULTS All the patients in the S-SSNHL group showed significant improvement, as compared to the P-SSNHL group (P=0.017). The recovery rate after the initial systemic treatment was 36% (9/25) in the S-SSNHL group and 18.1% (4/22) in the P-SSNHL group (P=0.207). In comparison, the recovery rate of ITD as a salvage treatment was 37.5% (6/16) in the S-SSNHL group and 5.5% (1/18) in the P-SSNHL group (P=0.03). CONCLUSION Our comparative study dose not support the efficacy of ITD as salvage treatment for patients with P-SSNHL as compared with that for S-SSNHL. We recommend that patients with P-SSNHL be informed about the low efficacy of ITD as a salvage treatment.

Simultaneous versus Subsequent Intratympanic Dexamethasone for Idiopathic Sudden Sensorineural Hearing Loss

Objective. The authors compared the efficacy of simultaneous and subsequent intratympanic dexamethasone injections for the treatment of idiopathic sudden sensorineural hearing loss. Study Design. Prospective randomized controlled multicenter study. Setting. Three tertiary university hospitals. Subjects and Methods. In the simultaneous intratympanic dexamethasone group, intratympanic dexamethasone was given initially with systemic steroids. In the subsequent intratympanic dexamethasone group, intratympanic dexamethasone was given 7 days after systemic treatment. The authors compared hearing outcomes between the groups according to Siegel’s criteria and frequency (0.25, 0.5, 1, 2, 3, 4, 6, and 8 kHz). Results. A total of 88 patients were analyzed in this study. There was no difference between the groups in hearing recovery according to Siegel’s criteria or frequencies. Neither recovery time nor early recovery differed between the groups. In the subsequent intratympanic dexamethasone group, 15 patients showed hearing recovery within 7 days and did not need intratympanic dexamethasone treatment. After intratympanic dexamethasone treatment, >28% (25/88) of the patients complained of otalgia, transient dizziness, ear fullness, and headache. Five percent of the patients showed small, transient perforations and otorrhea during intratympanic dexamethasone treatment. Conclusions. Simultaneous intratympanic dexamethasone did not confer an additional hearing gain or earlier recovery rate compared with subsequent intratympanic dexamethasone. A considerable number of patients did not need intratympanic dexamethasone for idiopathic sudden sensorineural hearing loss, and some patients experienced unnecessary side effects due to intratympanic dexamethasone. Therefore, the use of intratympanic dexamethasone is recommended only for subsequent or salvage treatment of idiopathic sudden sensorineural hearing loss after systemic steroid treatment.

Combination therapy with systemic steroids, an antiviral agent, anticoagulants, and stellate ganglion block for treatment of sudden sensorineural hearing loss.

Background and Objectives Sudden sensorineural hearing loss (SSNHL) is commonly defined as a loss of at least 30 dB in three contiguous frequencies occurring within 3 days. Systemic steroid administration has become the most widely accepted treatment option for SSNHL. Since viral infection and vascular compromise are considered specific causes of SSNHL, antiviral agents, anticoagulants, and stellate ganglion block have been used for its treatment, although the evidence of their effectiveness is weak. The present study evaluated the hearing recovery rate in the combination therapy group (systemic steroids, antiviral agent, anticoagulants, and stellate ganglion block) in comparison with patients treated with systemic steroids alone. Subjects and Methods A total of 85 patients diagnosed with SSNHL were treated with combination therapy (group A, 46 patients) or systemic steroids only (group B, 39 patients). Hearing improvement was defined as a hearing gain of more than slight improvement using Siegels criteria. All patients were treated with a 10-day course of systemic steroids (10-mg dexamethasone for 5 days, followed by tapering for 5 days). Acyclovir, heparin, and stellate ganglion block were included in the group A treatment regimen. Results The overall rate of hearing improvement was 60.9% (28/46 patients) in group A, which was significantly higher than that (38.5%, 15/39 patients) in group B. The distribution of prognostic factors was not significantly different between the two groups with the exception of the degree of initial hearing loss, which was more severe in group A. Upon analysis according to prognostic factors, group A showed a better hearing improvement recovery rate than group B in patients with hearing loss >70 dB, age >41 years, dizziness, and early treatment (<1 week). Conclusions Thus SSNHL patients treated with combination therapy have a higher likelihood of hearing improvement than those treated with systemic steroids alone.

Spontaneous temporomandibular joint herniation.

An 84-year-old man presented with a history of left otalgia, hearing loss, and otorrhea. He had no history of ear surgery or trauma. The left external auditory canal (EAC) was blocked by a mass that was based anterosuperiorly, changing position with jaw movement. When the patient’s mouth was closed, the mass was visible (Figure 1), whereas it retracted from the EAC during mouth opening (view the video in the Supplemental Material section available online). The medial side of the mass was impacted with earwax. After the earwax was removed, the patient’s hearing improved. The tympanic membrane was intact. He had no more complaints of otalgia and otorrhea. High-resolution computed tomography revealed a 9-mm defect in the anterior EAC wall. Based on physical examination and an imaging study, his condition was diagnosed as spontaneous temporomandibular joint (TMJ) herniation.

Gastric carcinoma metastasis to the internal auditory canal.

A 41-year-old man underwent a radical total gastrectomy and postoperative chemotherapy for advanced gastric carcinoma (Borrmann Type IV, adenocarcinoma). Two years later, a bone scan and abdominal computed tomography were performed as part of the regular followup, and they showed multiple metastases to the bone and the liver. The patient refused further treatment. Three months later, he was referred to the Department of Otolaryngology for an evaluation of a sudden hearing loss and facial weakness on the left side, which had developed 2 days earlier. The physical examination revealed peripheral facial palsy of House-Brackmann grade IV on the left side with no spontaneous nystagmus; there was a normal external auditory canal and tympanic membrane. Pure tone audiometry demonstrated normal right-sided hearing, although there was severe sensorineural hearing loss on the left side with a pure tone average of 80 dB HL. The bone scan revealed multiple areas of uptake in the left temporal bone, 2 ribs, the spine, and the pelvic bones (Fig. 1). These clinical manifestations and the bone scan results suggested the possibility of metastasis to the internal auditory canal (IAC), so magnetic resonance imaging (MRI) of the temporal bone with a contrast study was performed. Fat-suppressed gadolinium-enhanced T1-weighted MRI showed a diffuse enhancing mass in the left petrous apex, clivus, and IAC, which was suggestive of extensive metastasis (Fig. 2, A and B). Direct invasion of the left IAC from the lesion in the petrous apex (Fig. 2C) and an enhancing lesion involving the left IAC and labyrinthine segment of the facial nerve (Fig. 2D) were noticed on the gadoliniumenhanced T1-weighted axial MRI, but there was no abnormal signal intensity or mass formation at the cerebellopontine angle. He was diagnosed with metastasis to the IAC, and he refused further evaluation and management. He is now being managed conservatively. His facial weakness and hearing loss have not improved.

Mupirocin Ointment Prevents Early Post-Tympanostomy Tube Otorrhea: A Preliminary Study

Background and Objectives The most common complication of tympanostomy tube (T-tube) insertion is the development of postoperative otorrhea. Post-tympanostomy tube otorrhea (PTTO) is defined as active drainage through an existing T-tube. Many surgeons routinely use topical antibiotics as prophylaxis against early PTTO. Mupirocin calcium ointment is a topical antimicrobial agent with broad-spectrum antimicrobial activity against many Gram-positive organisms. This study evaluated the clinical effectiveness of topical mupirocin ointment in reducing early PTTO. Subjects and Methods The study included 98 ears (67 patients, mean age 32.9 years) that had a T-tube inserted because of chronic middle ear effusion or atelectatic otitis media. A Paparella type-I polyethylene-tube coated with mupirocin was inserted through the tympanostomy. Patients were instructed not to use otic drops or any other medications. All patients were seen by day 14 postoperatively. Results Early PTTO occurred in one case (1.5%). No early PTTO was seen with a middle ear effusion. Nineteen children were treated under general anesthesia; none developed early PTTO. Conclusions Insertion of a T-tube coated with mupirocin ointment could be effective at preventing early PTTO.

Evaluation of Cerebral White Matter in Prelingually Deaf Children Using Diffusion Tensor Imaging

This study compared white matter development in prelingually deaf and normal-hearing children using a tract-based spatial statistics (TBSS) method. Diffusion tensor imaging (DTI) was performed in 21 prelingually deaf (DEAF group) and 20 normal-hearing (HEAR group) subjects aged from 1.7 to 7.7 years. Using TBSS, we evaluated the regions of significant difference in fractional anisotropy (FA) between the groups. Correlations between FA values and age in each group were also analyzed using voxel-wise correlation analyses on the TBSS skeleton. Lower FA values of the white matter tract of Heschls gyrus, the inferior frontooccipital fasciculus, the uncinate fasciculus, the superior longitudinal fasciculus, and the forceps major were evident in the DEAF group compared with those in the HEAR group below 4 years of age, while the difference was not significant in older subjects. We also found that age-related development of the white matter tracts may continue until 8 years of age in deaf children. These results imply that development of the cerebral white matter tracts is delayed in prelingually deaf children.

Volumetric Changes in the Bony External Auditory Canal in Unilateral Chronic Otitis Media

Background and Objectives Pneumatization of air cells in the mastoid bone is decreased in chronic otitis media (COM). A decrease in the size of the external auditory canal (EAC) is also found frequently in patients with COM, but this has been little studied. We compared the size of affected bony EACs and the contralateral side in patients with single-side COM using high-resolution computed tomography. Subjects and Methods In total, 99 patients with single-side COM were included. Four indicators related to the size of the bony EAC and IAC were measured using high-resolution computed tomography: the axial and coronal lengths of the tympanic membrane, the length of the isthmus, and the area of the bony ear canal. We also compared both internal auditory canals as negative controls. These assessments were made by radiologists who were blinded to the objective of this study. Results In patients with single-side COM, the axial length of the tympanic membrane was significantly shorter than normal, and the volume of the EAC was also significantly smaller. The length of the isthmus of the EAC was shorter on the affected side, but the difference was not significant. The IAC volume showed no difference between the two sides. Conclusions COM affects general temporal bony development, including the bony EAC and mastoid bone. Therefore, whether to correct this should be considered when preparing for COM surgery.

Compound Nevus Occurring Near External Auditory Canal: Successful Treatment by CO2 Laser Abrasion

Melanocytic nevus is common pigmented skin tumor, but it has rare occurrence near the external auditory canal. A skin graft is required if a wide surgical excision is performed for the nevi occurring near the external auditory canal. A CO2 laser was considered to be a good alternative for the removal of melanocytic nevus in this area. We herein report a case of compound nevus occurring near the external auditory canal that was successfully treated by CO2 laser abrasion.