Yong Bok Kim

Influence of Vestibular Disease on Psychological Distress A Multicenter Study

Objectives Some patients with dizziness show high comorbidity with psychiatric disorders. However, the association of vestibular deficit with psychological symptoms remains controversial. Thus, we investigated psychological distress (depression and anxiety) in patients with vestibular disease and examined factors modifying the development of psychological distress in these patients, including age, sex, severity of dizziness symptoms, and type of vestibular disease. Study Design Prospective study. Setting Tertiary referral center. Subjects and Methods This study enrolled 407 patients with dizziness. Dizziness and the psychological symptoms of all patients were measured using the Korean versions of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI). We evaluated the influence of vestibular disease type, DHI score, and other factors such as sex and age on the psychological scales (BDI, STAI) through multiple regression analysis. Results Only DHI score and vestibular neuritis were related significantly to BDI scores in patients with vestibular disease, and only DHI scores were associated with STAI scores. Conclusion Dizziness Handicap Inventory scores and psychological distress were closely associated. Psychological distress might be a consequence of high DHI score rather than of a specific type of vestibular disease, although depressive symptoms were related to vestibular neuritis.

Clinical Analysis of Recurrent Sudden Sensorineural Hearing Loss

Objective: Although the literature includes many reports of the causes, pathogenesis, diagnostic criteria, treatment, and prognostic factors of sudden sensorineural hearing loss (SSNHL), few studies have examined recurrent SSNHL. This prompted us to investigate recurrent SSNHL. Study Design: Retrospective study of the hearing results of patients with recurrent SSNHL. Methodology: We reviewed retrospectively the medical charts of 809 patients with SSNHL examined between January 2000 and June 2011 for information on their history, audiometric results, and magnetic resonance imaging findings. Results: Eleven of the 809 patients had recurrent idiopathic SSNHL. In these 11 patients, the more than partial recovery of hearing after the second attack was poorer than after the first attack, and the second attack of SSNHL was ipsilateral in 10 of the 11 patients. Conclusion: The hearing outcome was poorer after a recurrent episode than after the first episode, and SSNHL almost always recurs in the same ear.

Three cases of inner ear damage after electrical burns

Electrical injury is a significant cause of mortality and morbidity, accounting for 1000 deaths per year and a far greater number of injuries [1]. Electrical burns produce a spectrum of tissue injuries that range from obvious thermal destruction of tissue to the gradual onset of neurological defects even in the absence of apparent thermal injury. In spite of the ever increasing awareness and precautionary measures in both work and leisure environments, electrical injuries unfortunately are still happening. Until now, the exact pathophysiology of different types of burn along with electric trauma remains controversial due to different modalities depending on types and patterns of injuries [2]. Electrical injuries damage multiple organ systems, and there have been reports of neurologic and cardiovascular sequelae. However, there have been few reports about the relationship between electrical burn and otologic manifestation. If the ear or related structures are in the path of electrical current, they may be damaged. Hemorrhage can occur in the tympanic membrane, middle ear, cochlea, cochlear duct, and vestibular apparatuses. Damage to these structures may lead to a variety of infectious complications including mastoiditis, sinus thrombosis, meningitis, and brain abscess [3]. Hearing loss may come at the time of injury or later as a result of complications. Here we describe three patients with hearing disturbance, tinnitus, and dizziness after electrical burns.

Analysis of the Prevalence of and Factors Associated with Hearing Loss in Korean Adolescents

Background Hearing loss can lead to a number of disabilities, subsequently reducing the quality of life. In general, hearing thresholds of adolescents are better than adults and the elderly. However, occasionally, adolescents acquire hearing loss for a number of reasons. In this study, our goal was to estimate the prevalence of hearing loss in the Korean population and to investigate the factors related to hearing thresholds in adolescents. Methods A cross-sectional study was conducted using data from the Korean National Health and Nutrition Examination Survey (KNHANES) between 2010 and 2012. We enrolled a total of 1,658 participants, ages 13 to 18 years. We investigated the prevalence of hearing loss and the factors associated with hearing thresholds at various frequencies (0.5, 1, 2, 3, 4, and 6 KHz). Results Weighted prevalence of unilateral and bilateral hearing loss in Korean adolescents was 2.2% and 0.4%, respectively. Weighted prevalence of hearing thresholds ≥ 20 dB at speech and high frequencies were 3.1% and 5.0%, respectively, for unilateral hearing loss and 0.7% and 1.9%, respectively, for bilateral. Age group, tympanometric data, and household income were significantly related to unilateral or bilateral hearing thresholds ≥ 20 dB at speech frequencies. Earphone use in noisy places was associated with bilateral hearing thresholds ≥ 20 dB at high frequencies. Conclusions The prevalence of hearing loss in Korean adolescents was 2.6% using the general standard threshold associated with hearing loss. However, the prevalence of hearing thresholds ≥ 20 dB for speech and high frequencies was much higher. The results from this study provide an estimate of hearing loss in adolescents and suggest the need for early detection and hearing preservation programs among adolescents.

Clinical Evaluation of Transcranial Attenuation in Bone Conduction Audiometry

Purpose: It is commonly known that there is no significant transcranial attenuation across the cranium through bone conduction. The aim of this study was to evaluate transcranial attenuation for bone conduction as a function of each frequency by hearing loss types on subjects of unilateral hearing loss or unilateral with bilateral hearing loss. Methods: A total of 82 subjects with sensorineural (40 ears), conductive (20 ears) and mixed hearing loss (22 ears), were enrolled and then were analyzed prospectively. The transcranial attenuation was analyzed for 82 ears with the differences over 10 dB HL in all frequencies (0.25-4 kHz) by air conduction audiometry. The transcranial attenuation at each frequency was obtained by bone conduction threshold without masking. Results: We observed a significant in the mean of transcranial attenuation for bone conduction of the overall subjects. It was closed to 0-9 dB HL at 0.25 kHz to 2 kHz and 13 dB HL at 3 to 4 kHz. There are more difference in principal the transcranial attenuation for bone conduction in high frequency than a low frequency. Conclusion: Therefore, the conductive and mixed hearing loss always need to consider about the masking by crosshearing. The cross-hearing, however, needs to consider by type of hearing loss because the transcranial attenuation of bone conduction as a function of each frequency depends on hearing loss types. Further research should work for the transcranial attenuation of bone conduction by degrees of hearing loss.

Analysis of Dizzy Patients with High Depression and Anxiety Index

Objectives: Some patients with dizziness often show psychological distress. However, the association of vestibular deficit with psychological symptoms remains controversial. Thus, we investigated the incidence of high depression and anxiety index in patients who complained of dizziness, their dizziness severity, and the distribution of disease to induce dizziness. Methods: In 562 patients with dizziness, dizziness and the psychological distress of all patients were measured using the Korean versions of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI). We examined the incidence of patients having high depression and anxiety using a cutoff value (BDI ≥21, STAI ≥57). We divided patients into a high psychological distress index group and a moderate to low index group on the basis of cut-off value and compared the type of disease and DHI score between the 2 groups. Results: The incidence of high BDI and STAI scores were 11% and 13.5%, respectively. The high BDI and STAI group showed the higher DHI scores, including functional, emotional and physical subscales, and the higher STAI and BDI scores, respectively. The mean age, sex and the distribution of the type of disease between high psychological distress index group and moderate to low index group showed no difference. Conclusions: Of patients with dizziness, about one-tenth have serious psychological distress, various vestibular diseases, and more dizzy symptoms. Thus, we should keep in mind the psychological factor in dizzy patients and the necessity of psychological support in the patients.

Comparison of Distortion Product Otoacoustic Emissions(DPOAEs) following Stimulus Intensity of AuditoryBrainstem Response (ABR) Test

The purpose of this study is to examine whether the auditory function of patients are subtlely influenced by loud sound used in auditory brain stem response (ABR) test using a distortion product otoacoustic emissions (DPOAEs). A total of 33 subjects who visited the ENT clinic with sudden idiopathic hearing loss disease or a suspected other peripheral vertigo disease (9 males and 24 females) were enrolled in this study. Fifty-seven ears with hearing threshold levels less than 15 dB HL were selected (0.25 ~ 8 kHz). The DPOAEs test was performed before and immediately after ABR test. We found no statistically significant changes in DPOAEs parameters before and immediately after ABR test. And also, DPOAEs implemented before and immediately after ABR test showed a higher correlation at all frequencies. This study showed that the intensity of sound stimulus of ABR test do not affect the subtle changes in auditory function. it is suggested that the exposure duration and intensity of the sound stimulus applied to ABR test of this study is insufficient to achieve a statistically significant result. Therefore, further study will be needed about other auditory evoked potential test, which use the continuous stimulus intensity of 90 dB nHL for identification of effect on auditory function.