Sudden sensorineural hearing loss in children and adolescents: Clinical characteristics and age-related prognosis.

OBJECTIVE: Although many studies have investigated sudden sensorineural hearing loss (SSNHL) in adults, there were few studies on SSNHL in the pediatric population; especially research on treatment and prognosis of pediatric SSNHL was limited. The aim of this study was to evaluate clinical characteristics, treatment outcomes and prognostic factors in children and adolescents with SSNHL. METHODS: A retrospective review of medical records of 67 pediatric patients (67 ears) who had diagnosed with SSNHL at our hospitals was performed to analyze patients' clinical manifestations and audiograms. All patients were treated with high-dose systemic prednisolone (1mg/kg), and 17 of them underwent intratympanic steroid injection therapy. Audiological evaluation was carried out before and after treatment, and hearing recovery was defined as complete recovery and partial recovery according to Siegel's criteria. Patients were divided into two groups: childhood group (ages between 4 and 12 years old) and adolescence group (age>12years), and clinical characteristics and treatment outcomes were investigated. In addition, patients were divided into two groups according to degree of hearing recovery, and evaluation was made regarding possible prognostic factors. RESULTS: The recovery rate in total 67 patients was 55.2%. The recovery rate of the childhood group was significantly lower than that of the adolescence group (p=0.038). While the presence of vertigo did not significantly correlate with prognosis (p=0.219), the presence of tinnitus was significantly associated with hearing recovery (p=0.005). Audiological assessment revealed that a low initial hearing threshold, high speech discrimination score, and descending type of audiogram were positively associated with hearing recovery (p=0.002, p=0.003, and p=0.029, respectively). CONCLUSION: The childhood group had worse treatment outcomes than the adolescence group. High initial hearing threshold and absence of tinnitus were poor prognostic factors of hearing recovery. Active treatment is required for patients with these poor prognostic factors and childhood patients with SSNHL.

Characteristics of rib cartilage calcification in Asian patients.

IMPORTANCE Rib cartilage from the sixth, seventh, and eighth ribs offers a long cartilaginous curvature, making the material reliable for grafting. Calcification of cartilage causes unexpected absorption, difficult manipulation, and donor site morbidity. Most studies of calcification were performed in Western countries. OBJECTIVE To investigate the incidence, degree, and pattern of rib cartilage calcification in Asian patients. DESIGN, SETTING, AND PARTICIPANTS Retrospective study of computed tomographic scans of the chest in 120 patients (60 male and 60 female). The incidence, degree, and pattern of cartilage calcification of the sixth through eighth ribs were noted. The patients were stratified into 6 age groups, and 20 patients (10 male and 10 female) were selected for each group. The degree of calcification was assessed as 0%, 1% to 25%, 26% to 50%, 51% to 75%, and 76% to 100%. Meaningful calcification was defined as 26% or greater. The pattern of calcification was classified as marginal, granular, and central. EXPOSURE Computed tomographic scans of the chest. MAIN OUTCOMES AND MEASURES Degree of calcification, presence of meaningful calcification, and calcification pattern. RESULTS Overall, 50.8% of cartilage was calcified, and female patients showed more frequent calcification than male patients (59.4% vs 42.2% [P < .001]). Calcification rates of the sixth and seventh rib cartilage were higher than those of the eighth rib cartilage in all age groups except teenagers, who had a similar rate for all 3 ribs. Calcification of the sixth and seventh rib cartilage significantly increased with age. A meaningful calcification rate was very low in males younger than 60 years, whereas the rate was relatively higher in females than males for all age groups. Males predominantly had the marginal type of calcification, whereas females predominantly had a granular type. The rate and pattern of calcification had no relationship to age. CONCLUSIONS AND RELEVANCE In Asian patients, males younger than 60 years show a very low incidence of calcification, whereas females 30 years or older show a relatively high incidence of meaningful calcification. Asian females also show a predominantly granular or central pattern of calcification that may hinder proper harvest and incision of the rib cartilage. These differences in the incidence and pattern of rib cartilage calcification need appropriate preoperative attention.

Association between Positional Dependency and Obstruction Site in Obstructive Sleep Apnea Syndrome.

OBJECTIVES: The purpose of this study is to find out associations between positional dependency and obstructive levels based on sleep videofluoroscopy (SVF) in patients with obstructive sleep apnea syndrome (OSAS). METHODS: Retrospective review was made of 91 OSAS patients who underwent polysomnography and SVF from August 2009 through June 2010. Polysomnography variables including apnea-hypopnea index (AHI), supine AHI, non-supine AHI, time spent in supine sleep position of the total sleep time and positional dependency (PD) were analyzed. Obstruction sites were evaluated as SVF variables. RESULTS: Of 91 patients, 65 (71.4%) were positional patients (PP) and 26 (28.6%) were non-positional patients (NPP). An analysis of polysomnography variables according to PD revealed that overall AHI, non-supine AHI and supine AHI in PP was significantly lower than that in NPP. The patients with soft palate obstruction (SP type) were more likely to have PD than the patients with tongue base obstruction (TB type; P=0.046). PD was inversely related to OSAS severity significantly (P=0.001). CONCLUSION: These results provide evidence that positional dependent patients may have higher success rate of soft palate OSA surgery alone than non-positional dependent patients. Although PD may be associated with obstruction site, PD only itself may not be useful in planning surgical treatment for OSAS.

Tracheal growth after airway stenosis surgery: serial radiographic comparative study.

CONCLUSION: The proportion of stenotic area over normal tracheal lumen does not decrease over time after airway stenosis surgery regardless of endoscopic or open surgery, which suggests that the operated laryngotracheal complex may grow and develop similarly to the normal surrounding tissue. OBJECTIVES: To evaluate the effect of pediatric airway stenosis surgery on the growth of the laryngotracheal complex and to compare the differences between endoscopic and open surgery. METHODS: Forty-five successful stoma closures after pediatric airway stenosis surgery were performed between 2001 and 2007. Thirty patients had a minimal postoperative follow-up time of 3 years and were included in this study. Evaluation was based on a retrospective review of the patients' images and data. The parameters analyzed were: diameter of tracheal stenosis, diameter of normal trachea, and the ratio of stenotic area to normal tracheal lumen. RESULTS: In all, 24 patients were treated with the endoscopic technique. Among the six open laryngotracheal reconstructions, cricoid splitting and rib cartilage graft were performed in four patients and laryngotracheal resection and end-to-end anastomosis were performed in two patients. Stenosis to normal ratio tended to increase after endoscopic intervention, but it did not show statistical significance (p = 0.082). Open surgery did not cause significant narrowing (p = 0.443).

A huge chondromyxoid fibroma of the nasal cavity in a newborn baby.

Chondromyxoid fibroma is a rare benign tumor that usually occurs in the long bones. A 2-month newborn presented with huge masses in the both nasal cavities, which turned out to be chondromyxoid fibroma. The masses originated from both inferior turbinates. Total turbinectomy on the left side and submucosal mass excision on the right side were performed. No recurrence or new lesion was observed during the 2 years of follow up. We report here on a rare case of nasal cavity chondromyxoid fibroma in a neonate and we review the relevant literature.