Superficial Temporal Fascia V-Y Advancement Flap for Delayed Complication in Cochlear Implantation.

Cochlear implantation (CI), a widely employed procedure for individuals with severe hearing loss, can encounter a serious complication in the form of implant exposure. In such instances, surgeons are tasked with deciding between salvage measures or opting for reimplantation with a healthy tissue covering. This case presented a challenge with delayed flap necrosis triggered by an increase in the magnetic force of the external device. Notably, this complication manifested 8 years after the initial operation. Following the removal of the device, it was reconstructed successfully using a superficial temporal fascia V-Y advancement flap.

Monthly Variation in Bell's Palsy Based on Population Data of Korea.

INTRODUCTION: Several studies have reported that the number of patients with Bell's palsy varied significantly by month and season. However, few studies have reported the monthly variation in Bell's palsy based on the whole population. We investigated the monthly variation in Bell's palsy in Korea during a long-term period based on whole population data. METHODS: This retrospective study used the data of the National Health Insurance Service of Korea, which included the entire Korean population from 2008 to 2020. The monthly incidence of Bell's palsy per 100,000 was evaluated in total and according to sex, age, and residence. RESULTS: The total average monthly incidence differed significantly by month, with the highest observed in January (9.1 per 100,000) and the lowest in June (7.7 per 100,000) (p < 0.001). The average monthly incidence according to sex, age, and residence also varied significantly by month, with most of the highest values noted in January and the lowest in June. CONCLUSION: There was significant monthly variation in the incidence of Bell's palsy, with the highest in January during the winter and the lowest in June during the summer, based on whole population data over a long-term period in Korea.

Analysis of Cochlear Morphology for Cochlear Implantation Using Three-Dimensional Reconstruction of Computed Tomography Images.

INTRODUCTION: Preoperative evaluation of cochlear morphology is important for successful cochlear implantation. This study analyzed the cochlear canal by three-dimensional reconstructions of temporal bones using computed tomography (CT). METHODS: Fifty temporal bones from 25 patients aged 42-74 years were evaluated. The inner spaces of the bony cochlea were reconstructed using a surface rendering technique on the CT images. Eight angular points (P0-P7) every 90° were selected from 0° to 630° from the center of the round window using the reconstructed cochlear canal images. The radius (R) and thickness (T) of the cochlear canal at each point were measured. The cochlear canal length (CoCL) was estimated using an equation based on the radius at each point. The cochlear width and height based on multiplanar CT images were also measured and compared with the length and volume of the cochlear canal. RESULTS: The mean CoCL from 0° to 630° was 31.5 mm, and the cochlear volume was 55.9 mm3. The CoCL to P7 was correlated with the cochlear volume (r = 0.77), coiling ratios (R4/R0, r = 0.47; R5/R1, r = 0.384), cochlear width (long) (r = 0.539), cochlear height (r = 0.385), and total thickness at each point (r = 0.475). The cochlear volume was correlated with CoCL (630°) (r = 0.77), coiling ratio (R4/R0, r = 0.367), cochlear width (long) (r = 0.616), cochlear height (r = 0.447), and total T (r = 0.566). CONCLUSION: Preoperative evaluation using three-dimensional reconstruction can elucidate the size and shape of the cochlear canal before cochlear implantation.

The clinical availability of facial nerve enhancement in temporal bone MRI for the patients of idiopathic acute peripheral facial palsy.

PURPOSE: This study is to evaluate the duration of facial nerve enhancement in gadolinium-enhanced temporal bone MRI after the onset of acute facial palsy. METHODS: Gd-enhanced MRI imagines were examined in 13 patients with idiopathic acute facial palsy within 14 days after the onset. The degree of facial nerve function was measured according to the House-Brackmann (H-B) grading system at their first visit at outpatient clinic. The follow-up MRI was taken about 16.5 months (7-24 months) after onset of disease. The degree of facial nerve enhancement was measured with signal intensity (SI) which was quantitatively analyzed using the region-of-interest (ROI) measurements for each segment of the facial nerve. SI was statistically analyzed by comparing SI values of contralateral site and ipsilateral site using the paired t test with SPSS program. RESULTS: The gadolinium enhancement was statistically increased at labyrinthine segment and geniculate ganglion area of facial nerve at initial temporal bone MRI. The gadolinium enhancement was statistically decreased at all the segments of facial nerve except tympanic segment (p < 0.05) at follow-up MRI. CONCLUSIONS: The facial nerve enhancement in Gd-enhanced MRI images prolonged more than 21 months of the onset. The newly developed pathologic lesions of acute facial palsy especially occur at the site of labyrinthine and geniculate ganglion.

Surgical considerations during cochlear implantation: the utility of temporal bone computed tomography.

OBJECTIVE: This paper describes the construction of portals for electrode placement during cochlear implantation and emphasises the utility of pre-operative temporal bone three-dimensional computed tomography. METHODS: Temporal bone three-dimensional computed tomography was used to plan portal creation for electrode insertion. RESULTS: Pre-operative temporal bone three-dimensional computed tomography can be used to determine the orientation of temporal bone structures, which is important for mastoidectomy, posterior tympanotomy and cochleostomy, and when using the round window approach. CONCLUSION: It is essential to create appropriate portals (from the mastoid cortex to the cochlea) in a step-by-step manner, to ensure the safe insertion of electrodes into the scala tympani. Pre-operative three-dimensional temporal bone computed tomography is invaluable in this respect.

Predictive factors influencing facial nerve outcomes in surgery for small-sized vestibular schwannoma.

CONCLUSION: The most important predictive factor of facial nerve outcome in surgery for small-sized vestibular schwannoma (VS) is the adhesion between the tumor and the facial nerve. OBJECTIVES: To compare the facial nerve outcomes between middle cranial fossa (MCF) and translabyrinthine (TL) approaches, and to analyze the preoperative and intraoperative factors influencing facial nerve outcome after small VS surgery in our neurotologic department. METHODS: A total of 29 patients were retrospectively analyzed, with 16 in the MCF group and 13 in the TL group. Facial function was serially evaluated according to the House-Brackmann classification at 7 days, 1 month, 3 months, 6 months, and 1 year postoperatively. The effects of variables such as the surgical approach, tumor size, nerve origin, extrameatal extension, intraoperative tumor adhesion to the facial nerve, and facial nerve displacement were determined. RESULTS: Early and late facial nerve outcomes showed no significant correlation with surgical approach, tumor origin, tumor size, extrameatal extension, or facial nerve displacement pattern. However, a significant correlation was observed with tumor adhesion to the facial nerve and facial nerve outcomes.

Efficacy of intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss: comparison with systemic steroid therapy and combined therapy.

CONCLUSION: Intratympanic steroid therapy (IT-S) was as effective as systemic steroid therapy (SST) or combined therapy (CT) and could be considered a first-line therapeutic modality for idiopathic sudden sensorineural hearing loss (SSNHL). Due to its known safety and efficacy, IT-S will be particularly suitable for patients with SSNHL who have chronic diseases such as diabetes mellitus, hypertension, or chronic renal failure. OBJECTIVES: Systemic high dose steroid therapy is the main therapeutic modality for SSNHL. Comparable therapeutic efficacies for IT-S and CT with SST and IT-S for SSNHL have been reported recently. We compared the efficacy of IT-S, SST, and CT for treating SSNHL. METHODS: A retrospective, multicenter study investigating the therapeutic efficacy of SST, IT-S, and CT for SSNHL was designed and involved 735 patients with idiopathic SSNHL who were diagnosed and treated at seven tertiary referral medical centers of the Catholic University of Korea between 2007 and 2011. Patients were divided into three groups according to the treatment methods they received: IT-S group, SST group, and CT group (SS plus IT-S). Hearing was evaluated by pure tone audiogram performed before initial treatment and at 4 weeks following the final treatment. More than a 10 dB HL decrease in average air conduction threshold of hearing at 500, 1000, 2000, and 3000 Hz was defined as improved hearing. RESULTS: Among 735 patients with SSNHL, 94 were included in the IT-S group, 444 in the SST, and 197 in the CT group. Age, gender, interval from disease onset to start of treatment, and initial hearing level were not different among the three groups. Patients who had concomitant medical disorders such as diabetes mellitus, hypertension, or chronic renal failure were more frequently treated with IT-S. No difference in the level of hearing gain or ratio of hearing improvement was observed among the three groups (p = 0.147 and p = 0.067, respectively).

Surgical and radiologic anatomy of a cochleostomy produced via posterior tympanotomy for cochlear implantation based on three-dimensional reconstructed temporal bone CT images.

PURPOSE: In this study, we evaluated the surgical and radiologic anatomy of a cochleostomy produced via posterior tympanotomy for cochlear implantation (CI). MATERIALS AND METHODS: Twenty computed tomography (CT) images of the temporal bone from patients aged between 20 and 60 years were selected. The inclusion criterion was a radiologically normal temporal bone CT scan. Three-dimensional (3D) reconstructed images were obtained using high-resolution axial temporal bone CT scans. Eight points were used to evaluate the surgical anatomy of the posterior tympanotomy and cochleostomy. The length of lines between the points and the angles between the lines were measured. RESULTS: The mean length of line AB (superior-inferior length of the posterior tympanotomy for CI) was 6.48 ± 0.26 mm, while line AC (width of the chorda tympani and facial nerves) was 3.60 ± 0.2 mm. The mean angle of ABC (angle at which the chorda tympani nerve branched from the facial nerve) was 18.40° ± 1.05°. The mean length of line AD (distance from the facial ridge to the point of cochleostomy) was 9.58 ± 0.47 mm. CONCLUSIONS: 3D imaging of the facial recess and round window can be used to identify the facial recess before surgery. This may help to avoid injury to the chorda tympani nerve during posterior tympanotomy, and make it easier to insert the electrode array during CI by creating a large enough posterior tympanotomy to avoid injury to the facial nerve, which can cause immediate or delayed facial palsy.

Functional evaluation of paratubal muscles using electromyography in patients with chronic unilateral tubal dysfunction.

Eustachian tube dysfunction is closely related to the development of otitis media and result from several factors including inflammation within the nasal cavity and nasopharynx, adenoid hypertrophy, cleft palate and nasopharyngeal carcinoma. To some extent, eustachian tube dysfunction may be related to weakness of the paratubal muscles, such as the tensor veli palatini and levator veli palatini muscles. The aim of the study is to find out myogenic factors in eustachian tube dysfunction using electromyography (EMG), and to evaluate the clinical feasibility of EMG. Ten patients with unilateral eustachian tube dysfunction were included in this study. The healthy side of each patient was used as a control. EMG tests on paratubal muscles were conducted under the view of a 30° endoscope or fiberoptic laryngoscope. EMG on the tensor veli palatini showed decreased amplitudes on the affected side in one patient during phonation. EMG on the levator veli palatini showed decreased amplitudes on the affected side in two patients during both deglutition and phonation, one patient during phonation only, and two patients during deglutition only. The only patient who had decreased amplitude on EMG of the tensor veli palatini also had decreased amplitude on EMG of the levator veli palatini. In conclusion, although it is generally accepted that the tensor veli palatini plays a major role in opening the eustachian tube, reduced activity of the levator veli palatini may be related to eustachian tube dysfunction. When assessing eustachian tube function, EMG is useful for evaluating myogenic factors.

Tinnitus in patients with profound hearing loss and the effect of cochlear implantation.

The objectives of this study were to characterize the features of tinnitus in patients with profound sensorineural hearing loss and to evaluate the effect of cochlear implantation (CI) on their tinnitus. Medical records were reviewed for 35 patients who underwent CI, and completed tinnitus questionnaire between March 2003 and August 2011. Of them, 22 had tinnitus prior to CI (62.9 %) and the tinnitus group was older than the non-tinnitus group (47.5 ± 15.1 vs. 28.9 ± 15.2). The mean tinnitus handicap inventory (THI) score of the tinnitus group was 50.5 ± 28.7 before surgery, and the mean THI score and visual analogue scale (VAS) scores for loudness, annoyance, effect on life, and awareness decreased significantly after CI, with a mean follow-up period of 10.7 months. Tinnitus was completely eliminated in ten patients (45.5 %) and THI scores decreased in all patients. In a correlation analysis of the decrease in THI scores, preoperative VAS scores for loudness, awareness, effect on life, and annoyance, as well as preoperative THI scores, were highly correlated with the degree of decrease in THI scores postoperatively. The auditory performance of patients older than 40 years did not differ from that of younger patients, but their tinnitus was more improved after CI. In conclusion, tinnitus is a common complaint in patients with cochlear implants, and is more prevalent in elderly implantees. In the present study, CI improved tinnitus in all patients, although the most severe cases had the greatest benefit.

Risk factors for decreased distance between internal carotid artery and pharyngeal wall.

OBJECTIVES: The risk of disastrous bleeding during pharyngeal surgery is increased in cases of an internal carotid artery (ICA) that is medially displaced due to its anomalous course. We attempted to assess the distance between the ICA and the pharyngeal wall (DIP) and to evaluate the predisposing factors associated with ICA variation. METHODS: The course of ICA was studied in 509 CT scans, and a retrospective chart review was performed. The course of ICA and DIP were evaluated at each level of the pharynx: nasopharynx (NP), oropharynx (OP), and hypopharynx (HP). RESULTS: The mean DIP value was greatest (15.8±4.6mm) at NP, decreased at OP (15.8±4.6mm), and was shortest at HP (13.5±6.0mm). DIP was significantly shorter in females compared with males at all three pharyngeal levels. Age was inversely correlated with DIP at NP and OP. Tortuous ICA was most common (51.4%), followed by straight (41.2%), kinking (6.9%), and coiling (0.5%) types. DIP was longest in the straight type and decreased as the curvature of ICA increased. The most common ICA type differed between younger (<60 years; 56.2% having the straight type) and older groups (≥60 years; 66.2% having the tortuous type). Females older than 60 years displayed a higher incidence of kinking ICA compared with males. CONCLUSIONS: Hypopharynx, old age, female gender, and tortuous or kinking ICA types were risk factors for a decreased distance between the ICA and the pharyngeal wall. Meticulous examination of the pharyngeal wall should therefore be performed prior to pharyngeal surgery in patients with these associated risk factors.

Temporal bone myeloid sarcoma.

Myeloid sarcoma is a rare condition that's caused by the aggregation of immature myeloid cells in leukemic patients. Myeloid sarcoma occurring in the temporal bone more frequently involves the mastoid bone than is the case for metastatic lesions arising from non-systemic malignancies. The disease is difficult to diagnose when it presents with symptoms that mimic otomastoiditis. However, an early diagnosis is important in order to achieve complete remission of the disease. Magnetic resonance imaging of the temporal bone is useful for making the diagnosis of myeloid sarcoma, and especially to evaluate the extent of disease. High-dose radio- or chemotherapies are the first-line approaches and possibly the only approaches to achieve complete remission and to cure the disease. With the aim of improving our understanding of myeloid sarcoma in the temporal bone, the present report describes our experience with 5 such cases and we compare the clinical features of these 5 patients with those clinical features of patients who have metastatic lesions.

Hearing outcome of sudden sensorineural hearing loss: long-term follow-up.

OBJECTIVE: To evaluate the time-dependent progress and delayed improvement in patients who were treated with combination therapy including oral corticosteroid for idiopathic sudden sensorineural hearing loss. STUDY DESIGN AND SETTING: This retrospective study at a secondary referral and university-based center included 156 patients who were treated by 10-day course of admission therapy and followed for at least three months. RESULTS: Of 121 patients who recovered over three months of follow-up, 45.5% showed a delayed recovery after the end of 10-day course of therapy. Of these 55 patients, 78.2% recovered within one month, 5.5% recovered within one to two months, 12.7% recovered in two to three months, and 3.6% recovered later than three months after discharge. CONCLUSIONS: This study describes the long-term results for a three-month retrospective series of 156 patients diagnosed with idiopathic sudden sensorineural hearing loss, although this result should be further studied by additional research.

Analysis of prognostic factors in Bell's palsy and Ramsay Hunt syndrome.

OBJECTIVE: This study evaluated the prognostic factors in Bell's palsy and Ramsay Hunt syndrome (HZO). METHODS: A retrospective, institutional review board-approved study at a university-based hospital. A total of 81 patients consisting of 55 Bell's palsy patients and 26 HZO patients were enrolled in this study. The treatment consisted uniformly in all cases, and acyclovir was administered in the case of Ramsay Hunt syndrome. All patients were followed up until they recovered or for least up 6 months. RESULTS: The recovery rates to House-Brackmann grade II or better were 96.3% in those with Bell's palsy and 84.6% in those with HZO. In the HZO cases, older patients had a poorer initial and final status, and less chance of making a complete recovery than the younger patients. The HZO patients without diabetes mellitus had a higher chance of recovery, a higher chance of complete recovery, and a better final status. In addition, HZO patients without essential hypertension had a higher degree of recovery. HZO patients not suffering from vertigo had a higher chance of recovery. CONCLUSION: There was no prognostic factor found in the Bell's palsy patients in this study. The prognostic factors of HZO were age, diabetus mellitus, essential hypertension and vertigo.

Deep temporal fascial-periosteal flap for canal wall down mastoidectomy.

It is very important to make a safe, dry, trouble-free ear for the canal wall down mastoidectomy. Although fascia graft is the most common material used for the repair of the perforated tympanic membrane, it is usually too small to cover the whole mastoid cavity in canal wall down mastoidectomy. The presence of exposed bone delays the epithelialization and results in prolonged otorrhea. We present a new simple technique that uses a postauricular, inferiorly based pedicled flap. Although our deep temporalis fascial-periosteal flap is not bulky, it is large enough to obliterate a sclerotic mastoid cavity without the need for additional flaps. It shrinks much less than a muscular flap during the healing period. In addition to reducing the cavity volume, this flap promotes the epithelialization over the bone and the shortening of the healing time. Although only a small number of patients were included in this study, coverage of a canal wall down mastoid cavity by a deep temporalis fascial-periosteal flap is expected to be a reliable and effective technique that results in a dry, trouble-free mastoid cavity.

The preauricular sinus: factors contributing to recurrence after surgery.

PURPOSE: The objective of this study was to summarize clinical presentation, treatment, and recurrence of preauricular sinuses. MATERIALS AND METHODS: This retrospective, institutional review board-approved study reviewed the medical records of patients who underwent preauricular fistulectomy between January 1995 and June 2005 at university-based hospitals in South Korea. Only patients who underwent classic preauricular fistulectomy (not incision and drainage) and could be followed up for at least 3 months were included in the study. RESULTS: A total of 191 patients (206 ears) were enrolled. The right and left ears were involved in 79 and 97 patients, respectively. The most common location of the preauricular pit was the anterior margin of the ascending limb of the helix (93.2%). The most common indication for surgery was the recurrent exacerbation of acute infection (58.3%). The recurrence rate after surgery was 4.9%. Surgery under local anesthesia contributed to recurrence after the procedure (P = .009) and the cases that featured local infiltrative anesthesia had a higher rate of recurrence than the cases that had general anesthesia with an odds ratio of 6.875. CONCLUSIONS: Although this study showed that surgery under local anesthesia contributed to recurrence, it did not mean that it was only the anesthesia technique that influenced the recurrence. Surgeons should bear in mind that complete removal of the epithelial lining provides a lower recurrence rate, especially under local anesthesia. The main limitation of this study was that recurrent cases were too few to allow a statistical analysis.

Magnetic resonance imaging of the mastoid cavity and middle ear: prevalence and clinical significance of incidental abnormal findings in a nonotolaryngologic adult and pediatric population.

OBJECTIVE: The purposes of this study were to determine the prevalence of abnormalities in the mastoid cavity and middle ear in a nonotolaryngologic population and to correlate the results with clinical data. DESIGN: Prospective, cross-sectional study. SETTING: An academic tertiary care centre. METHODS: We evaluated 100 adults and 30 children from May to July 2003. Patients who had a history of mastoid or middle ear surgery or were presently suffering from otitis media were excluded. Magnetic resonance imaging (MRI) was conducted for the suspected intracranial pathology. MAIN OUTCOME MEASURES: The T2-weighted image was reviewed. The abnormality detected by MRI was divided into (1) mastoid cavity abnormality and (2) middle ear abnormality. All patients were asked to complete a questionnaire pertaining to the symptoms of the mastoid or middle ear pathology and the history of the otitis media. Also, their ears were examined carefully by an otoscope or otomicroscope. RESULTS: In both groups, most of the abnormalities were found in the mastoid cavity. Analysis of the clinical data revealed that abnormal MRI findings of the mastoid cavity were significantly correlated to clinically significant mastoid or middle ear disease in adults. CONCLUSIONS: Incidental MRI abnormalities in the mastoid cavity and middle ear detected in a nonotolaryngologic population were relatively uncommon compared with incidental paranasal sinus abnormalities. However, clinicians should remember the possibility of the pathologies that demand active treatment among these abnormalities, especially when a high signal abnormality is found in the mastoid cavity of an adult.

Three-dimensional reconstruction based on images from spiral high-resolution computed tomography of the temporal bone: anatomy and clinical application.

The aim of this study was to investigate the usefulness of a three-dimensional (3D) reconstruction of computed tomography (CT) images in determining the anatomy and topographic relationship between various important structures. Using 40 ears from 20 patients with various otological diseases, a 3D reconstruction based on the image data from spiral high-resolution CT was performed by segmentation, volume-rendering and surface-rendering algorithms on a personal computer. The 3D display of the middle and inner ear structures was demonstrated in detail. Computer-assisted measurements, many of which could not be easily measured in vivo, of the reconstructed structures provided accurate anatomic details that improved the surgeon's understanding of spatial relationships. A 3D reconstruction of temporal bone CT might be useful for education and increasing understanding of the anatomical structures of the temporal bone. However, it will be necessary to confirm the correlation between the 3D reconstructed images and histological sections through a validation study.

Clinical feasibility of the new technique of functional 3D laryngeal CT.

CONCLUSIONS: Functional 3D laryngeal CT (F3DLxCT) is an informative tool for visualizing the active changes in length, tension and mass of the vocal folds for pitch control. Furthermore, volume defects and level differences of paralyzed vocal folds are easily detectable with this new technique. OBJECTIVE: To evaluate the clinical feasibility of F3DLxCT images, which can provide clear coronal images of the vocal fold in each anteroposterior direction during phonation and in the resting state. MATERIAL AND METHODS: FLxCT images were reconstructed to three dimensions to visualize laryngeal motion. FLxCT was performed in four normal controls and in four patients with unilateral vocal fold paralysis in the resting state and during phonation with three vowel sounds of different pitch. 3D images were reconstructed with segmentation and a surface-rendering algorithm on a PC, using the DICOM file of axial images. RESULTS: The dynamic vocal fold 3D image during phonation could visualize that the thickness and volume were decreased in relatively to the pitch increase. Typical subglottic shoulder-like image formation and ventricular widening were noted with the high-pitch tone.

A case of osteoma with cholesteatoma in the external auditory canal.

Osteoma in the external auditory canal (EAC) is an uncommon benign lesion, which presents as a solitary, unilateral, and slow-growing pedunculated mass in the outer half of the bony canal. It is usually asymptomatic; but symptoms can arise if a canal obstruction occurs. External canal cholesteatoma is also a rare lesion of the external auditory canal. Cholesteatoma of the external auditory canal may arise via several mechanisms. However, an occlusion or narrowing of the external auditory canal is the basic pathogenesis. The association of an osteoma with a cholesteatoma is extremely rare, and there have been very few reports published. We encountered a rare case of a 49-year-old man with an osteoid osteoma that was complicated by a cholesteatoma in the external auditory canal. The canal wall down mastoidectomy and tympanoplasty successfully removed the osteoma and the cholesteatoma, and no recurrence or complications had occurred in the first 6 months postoperatively.