Tinnitus reduction after active bone-conduction implantation in patients with single-sided deafness: a prospective multicenter study.

PURPOSE: Single-sided deafness (SSD) presents significant challenges for patients, including compromised sound localization, reduced speech recognition, and often, tinnitus. These issues are typically addressed using interventions such as cochlear implantation (CI) and bone conduction implant (BCI). However, evidence regarding the efficacy of BCI in reducing tinnitus in SSD patients remains limited. This study explored the ability of a novel active transcutaneous BCI (Bonebridge BCI602) to alleviate tinnitus in SSD patients. STUDY DESIGN: Prospective cohort multicenter study. SETTING: Tertiary referral hospitals. METHODS: A prospective multicenter study of 30 SSD patients was conducted. The patients were divided into two groups: those with (n = 19) and without (n = 11) tinnitus. Audiometric assessments, subjective questionnaires including the Abbreviated Profile of Hearing Aid Benefit (APHAB) and the Bern Benefit in Single-Sided Deafness (BBSS), and tinnitus evaluations with the Tinnitus Handicap Inventory (THI) and tinnitogram were conducted before and after BCI surgery. RESULTS: THI scores after surgery were significantly reduced in SSD patients with tinnitus. Subjective satisfaction improved in both the tinnitus and non-tinnitus groups; however, the former group exhibited a significantly greater improvement in the APHAB questionnaire score. According to tinnitograms, the loudness of tinnitus decreased, particularly in patients with ipsilateral tinnitus. Patients with residual hearing had greater reductions in their THI scores. However, three patients without residual hearing had a relative worsening of tinnitus after surgery. CONCLUSION: The Bonebridge BCI602 effectively reduced tinnitus in SSD patients, particularly in those with residual hearing. Subjective satisfaction improved in both the tinnitus and non-tinnitus groups. These findings demonstrate the therapeutic potential of BCI for managing SSD and associated tinnitus.

Interaction Between Allergy and Middle Ear Infection.

PURPOSE OF REVIEW: Recent studies have attempted to identify interactions among the causes of otitis media with effusion (OME). This review discusses the interaction between allergy and infection with regard to host and environmental factors in terms of the development of OME. RECENT FINDINGS: Protection of the upper airway against microbial invasion requires active interaction between the defense mechanisms of the respiratory epithelium, including innate and adaptive immunity, and mechanical factors. The impairment of these defenses due to allergy and/or increased bacterial resistance may lead to increased susceptibility to infectious organisms in the respiratory tract and middle ear mucosa. Recent genetic studies have provided valuable information about the association of Toll-like receptor signaling variations with clinical phenotypes and the risk of infection in the middle ear. Among the causal factors of OME, allergy not only induces an inflammatory reaction in the middle ear cavity but also facilitates the invasion of infectious pathogens. There is also evidence that allergy can affect the susceptibility of patients to infection of the upper respiratory tract, including the middle ear cavity.

Prevention of Recurrence in the Surgical Correction of Cryptotia Using Local Flaps With a Cartilage Wedge Graft.

Cryptotia attributable to deficient posterior skin coverage frequently recurs. Because local flaps cover only the posterior aspects of the defective upper auricular cartilage and lack functional support to resist collapse of the helix, especially if severe helical cartilage anomalies are present, additional support is required to prevent the postoperative recurrence of this anomaly. The authors present cases of cryptotia treated using local flaps including a Z-plasty or formation of a trefoil flap with an additional cartilage wedge graft on the cephaloauricular sulcus to enhance projection of the helix. The combination of a graft with a local flap using a large Z-plasty or trefoil flap efficiently corrects the cryptotia, and is associated with minimal visible scarring and few complications, including recurrence.

Reconstruction of the Auricular Defect After Excision of Verrucous Carcinoma.

Verrucous carcinoma is a highly differentiated variant of squamous cell carcinoma with a high local recurrence rate. Few studies of primary verrucous carcinoma of the auricle have reported on the surgical outcome. The authors present herein a case in which a verrucous carcinoma of the auricle was successfully removed and reconstructed using a retroauricular pull-through island flap, and the authors briefly review the relevant literature.

Correlation between the dizziness handicap inventory and balance performance during the acute phase of unilateral vestibulopathy.

PURPOSE: The dizziness handicap inventory (DHI) is widely used to evaluate self-perceived handicap due to dizziness, and is known to correlate with vestibular function tests in chronic dizziness. However, whether DHI reflects subjective symptoms during the acute phase has not been studied. This study aims to investigate the correlations of subjective and objective measurements to highlight parameters that reflect the severity of dizziness during the first week of acute unilateral vestibulopathy. MATERIALS AND METHODS: Thirty-seven patients with acute unilateral vestibulopathy were examined. Patients' subjective perceptions of dizziness were measured using the DHI, Vertigo Visual Analog Scale (VVAS), Disability Scale (DS), and Activity-Specific Balance Scale (ABC). Additionally, the oculomotor tests, Romberg and sharpened Romberg tests, functional reach test, and dynamic visual acuity tests were performed. The correlation between the DHI and other tests was evaluated. RESULTS: DHI-total scores exhibited a moderately positive correlation with VVAS and DS, and a moderately negative correlation with ABC. However, DHI-total score did not correlate with results of the Romberg, sharpened Romberg, or functional reach tests. When compared among four groups divided according to DHI scores, VVAS and DS scores exhibited statistically significant differences, but no significant differences were detected for other test results. CONCLUSION: Our findings revealed that the DHI correlated significantly with self-perceived symptoms measured by VVAS and DS, but not ABC. There was no significant correlation with other balance function tests during the first week of acute vestibulopathy. The results suggest that DHI, VVAS and DS may be more useful to measure the severity of acute dizziness symptoms.

Efficacy of the Bonebridge BCI602 for Adult Patients with Single-sided Deafness: A Prospective Multicenter Study.

OBJECTIVE: To investigate the safety and efficacy of a novel active transcutaneous bone conduction implant (BCI) device for patients with single-sided deafness (SSD). STUDY DESIGN: Prospective cohort study. SETTING: Tertiary referral hospitals. METHODS: This prospective multicenter study was conducted at 15 institutions nationwide. Thirty adult (aged ≥19 years) SSD patients were recruited. They underwent implantation of an active transcutaneous BCI device (Bonebridge BCI602). Objective outcomes included aided pure-tone thresholds, aided speech discrimination scores (SDSs), and the Hearing in Noise Test (HINT) and sound localization test results. The Bern Benefit in Single-Sided Deafness (BBSS) questionnaire, the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, and the Tinnitus Handicap Inventory (THI) were used to measure subjective benefits. RESULTS: The mean aided pure-tone threshold was 34.2 (11.3), mean (SD), dB HL at 500 to 4000 Hz. The mean total BBSS score was 27.5 (13.8). All APHAB questionnaire domain scores showed significant improvements: ease of communication, 33.6 (23.2) versus 22.6 (21.3), P = .025; reverberation, 44.8 (16.6) versus 32.8 (15.9), P = .002; background noise, 55.5 (23.6) versus 35.2 (18.1), P < .001; and aversiveness, 36.7 (22.8) versus 25.8 (21.4), P = .028. Moreover, the THI scores were significantly reduced [47.4 (30.1) versus 31.1 (27.0), P = .003]. Congenital SSD was a significant factor of subjective benefit (-11.643; 95% confidence interval: -21.946 to -1.340). CONCLUSION: The BCI602 active transcutaneous BCI device can provide functional hearing gain without any adverse effects and is a feasible option for acquired SSD patients with long-term deafness.

A case of necrotizing sialometaplasia involving bilateral parotid glands.

Necrotizing sialometaplasia of the parotid gland is infrequent and can be mistaken as a malignant disease. Its etiology is thought to be an insufficient blood supply. Bilateral involvement of this disease in parotid glands has been rarely reported in the English literature. We report a case of necrotizing sialometaplasia diagnosed after superficial parotidectomy due to bilateral parotid masses in a 69-year old heavy smoking female.

Interface-modified unipolar resistive random access memory (RRAM) structure for low-power application.

An interface-engineered resistive random access memory (RRAM) using bilayer transition metal oxide (TMO) is presented for improving unipolar resistive-switching characteristics. The experiment and simulation data show that better resistive switching characteristics and superb uniformity can be realized by inserting a thin AIOx insertion layer between the Ir/NiO interface. To elucidate the uniformity improvement of our bilayer structure, the conducting-defect effects in the resistive cell were also investigated using a random circuit breaker (RCB) simulation model. It has been verified that the forming and set characteristics are more effectively improved because the conducting-defect ratio in the insertion layer region is low, therefore making it more advantageous for a filament path controllability. Using the optimal oxygen contents in both the insertion layer and the resistive cell, it was confirmed that a significant reduction of up to 0.15 mA of the reset current (I(RESET)) is possible compared to the conventional cell. These results indicate that new AI insertion has a large contribution to the reset and forming processes.

Dimensional effect of non-polar resistive random access memory (RRAM) for low-power memory application.

The relationships between the resistive cell dimension and the related analytical parameters such as the forming voltage, set voltage, and reset current were investigated to implement high-density and low-power unipolar RRAM. It was shown that the formation process in unipolar switching is strongly related to the cell dimension in the sub-nm region, not only in terms of its vertical thickness but also of its horizontal length, using the numerical simulation method. With the optimal cell size having sufficient initial resistance and a low forming voltage, the achievement of the greatest feasibility of the high-density low-power RRAM will be further accelerated. A numerical simulation was performed using a random circuit breaker (RCB) simulation model to investigate the optimal resistive switching condition. The on/off resistance ratio increases as the cell area decreases at the sub-nm level, and these phenomena are explained in terms of the relatively large set resistance change in a very small area due to the conductive defect (CD) amount effect in the RCB network model.

Do prostate-specific antigen parameters have a similar role in predicting prostate cancer regardless of serum testosterone levels in men with gray-zone prostate-specific antigen levels?

Background: To evaluate whether various prostate-specific antigen (PSA) parameters have a similar diagnostic value in predicting prostate cancer (PCa) in men with gray-zone PSA levels (4.0-10.0 ng/mL) depending on different serum testosterone levels. Methods: We retrospectively reviewed the data of 635 men with gray-zone PSA levels who underwent prostate biopsy between January 2015 and December 2019. The study cohort was divided into two groups according to serum testosterone levels: normal (≥300 ng/dL) and low (<300 ng/dL) testosterone. Using the area under the receiver-operating characteristic curve (AUC), we analyzed the diagnostic accuracy of PSA parameters (total PSA, free PSA, free-to-total PSA ratio, testosterone-to-PSA ratio, and PSA density) in predicting PCa and compared the results between the two groups. Results: The median age was 68 (range, 40-88) years, and 76.1% (483 of 635) of the men had low testosterone levels. The PCa incidence was higher in the low testosterone group than in the normal testosterone group (45.5% vs. 35.5%, P=0.030). The AUC of free-to-total PSA ratio for predicting PCa showed no difference between the normal and low testosterone groups (AUC 0.616 vs. 0.684, P=0.257). Moreover, total PSA, testosterone-to-PSA ratio, and PSA density showed similar performance in predicting PCa between the two groups. Conclusions: The analyzed PSA parameters showed a similar diagnostic value in predicting PCa regardless of testosterone levels in men with gray-zone PSA levels.

Split-gate-structure 1T DRAM for retention characteristic improvement.

As the feature size of the conventional 1T-1C DRAM scales down, difficulties of the fabrication process are increasing and it is becoming harder to keep a constant capacitance value for data storage. Capacitor-less 1T DRAM is a promising candidate for the substitution of the conventional 1T-1C DRAM, but its poor retention time is one of the critical issues in its commercialization. In the selection of a bias condition for 1T DRAM, however, it is impossible to choose a gate bias condition that is suitable for both the "1" and "0" hold state data. In this paper, a split gate structure and hold bias scheme are proposed for the simultaneous improvement of the "1" and "0" data retention characteristics. It was confirmed through numerical simulation that this structure has a more than 3 sec retention time. A vertical gate-all-around split-gate structure and its fabrication method are also suggested to achieve high density, low cost, a higher sensing margin, and a longer retention time.

Current Treatments for Congenital Aural Atresia.

Congenital aural atresia is an ear malformation evident at birth, involving various degrees of failed external ear canal development. A true external ear canal is desirable, as devices that replace the canal are inconvenient and expensive. Therefore, an optimal surgical technique is required. Here, we review useful preoperative and operative techniques. Surgical correction is often not the preferred treatment; the hearing outcome is no better than the outcomes afforded by bone-conduction devices, and surgery may be associated with recurrence or complications such as meatal stenosis. Preoperative evaluation and appropriate management are important. Several means of preventing meatal stenosis are discussed in this review.

External Auditory Canal Reconstruction and Mastoid Obliteration Using Modified Palva Flap in Canal Wall Down Mastoidectomy With Tympanoplasty.

OBJECTIVE: To evaluate the effectiveness of a modified Palva flap used for external auditory canal reconstruction and mastoid obliteration in canal wall down mastoidectomy. METHODS: We retrospectively analyzed patients who underwent canal wall down mastoidectomy with tympanoplasty using modified Palva flap. All patients underwent pure tone audiometry and temporal bone computed tomography (CT) before surgery, and the same tests were performed in the first year after surgery. The external auditory canal volumes were calculated by summing the areas of each section selected in temporal bone CT. For each patient, the ratio of external auditory canal volume was calculated from CT taken before and after surgery. RESULTS: The mean of external auditory canal volume after canal wall down with a modified Palva flap was about 1.4 times larger than before surgery. The modified Palva flap is effective for the reconstruction of the external auditory canal. Both pure tone audiometry level and air-bone gap showed statistically significant improvement after surgery ( Ps = .001 and .002, respectively). CONCLUSIONS: The external auditory canal volume slightly increased, but the status of mastoid obliteration was well maintained 1 year after surgery. The modified Palva flap used in this study is an easy and effective method in external auditory canal reconstruction and mastoid obliteration.

The efficacy of a modified Dix-Hallpike test with a pillow under shoulders.

BACKGROUND: Dix-Hallpike (DH) test is sometimes done in a modified or reduced manner in a clinical setting. However, there has been no study that evaluated the reliability of this modified test. OBJECTIVES: The purposes of this study were to determine whether the efficacy of a modified DH test, named the 'pillow under shoulders' test, was equivalent to the standard DH test and to assess the difference in patient discomfort between the two methods. METHODS: Randomized controlled study at three academic referral hospitals, conducted in compliance with the CONSORT statement. Patients suspected for BPPV based on symptoms were randomly assigned to Group A or Group B. Patients in Group A received a standard DH test initially, followed by a modified DH test with a pillow under shoulders. Patients in Group B also received the two tests, but in the reverse order. The diagnostic results of both tests and patients' subjective scoring for uneasiness (discomfort, pain, anxiety) were statistically analyzed. RESULTS: McNemar's test and Kappa statistics showed a statistically equivalent diagnostic value between standard and modified DH tests (Cohen's kappa = 0.823 and McNemar P = 0.18). The modified DH test had high sensitivity (95.5%) and fairly good specificity (87.9%). There was no statistical significance in the patients' subjective scoring for uneasiness between the two methods, although most patients reported less inconvenience after the modified DH test compared to the standard DH test. CONCLUSIONS: The modified version of the standard DH test, the 'pillow under shoulders' method, may be a reliable, comfortable option to diagnose vertical canal BPPV. We suggest that this method can be used when head hanging is not feasible or sufficient for the standard DH test.

Effect of infliximab on experimentally induced otitis media in rats.

OBJECTIVES: We performed a prospective randomized and controlled animal study to investigate the effects of infliximab on experimental otitis media in rats. METHODS: Seventy-two Sprague-Dawley rats were randomly allocated to 3 study groups and 1 control group. Infliximab was injected intravenously. Histopathologic changes were determined by hematoxylin-eosin staining. Fluorescence microscopy was performed to examine the leakage of the exudates. Vascular permeability was measured by the Evans blue dye technique. RESULTS: In comparison with the control group, we found significant differences in the extent of middle ear mucosa without active inflammation and the presence of reparable lesions in all study groups treated with infliximab. A significant reduction of extravasated Evans blue dye in all study group animals was found as compared with the control group animals. CONCLUSIONS: This study suggests that the monoclonal tumor necrosis factor alpha antibody, infliximab, can reduce inflammatory activity in experimental otitis media in rats.

Hydrocelectomy via scrotal incision is a valuable alternative to the traditional inguinal approach for hydrocele treatment in boys.

Purpose: Few studies have explored the treatment of isolated communicating hydroceles via scrotal incision. We prospectively evaluated the surgical outcomes of such treatment in boys with hydroceles compared with that using traditional, inguinal incision hydrocelectomy. Materials and Methods: Of 347 boys aged 0-12 years who were diagnosed as hydrocele on ultrasonography, 173 boys were assigned to the scrotal incision hydrocelectomy group (group I, n=173) and 172 boys were assigned to the traditional inguinal incision hydrocelectomy group (group II, n=172), and finally 156 boys in group I and 156 boys in group II were included in this study. Surgical outcomes, including postoperative complications and hydrocele relapse rates, were compared between groups. Results: The overall success rates were similar in both groups (group I, 96.8%; group II, 89.1%; p=0.740). The operation time and hospital stay were significantly shorter in group I (30.94±3.95 minutes and 3.94±0.30 days) than in group II (38.02±7.12 minutes and 4.24±0.99 days; p<0.001 and p=0.009, respectively). The postoperative complication rate was lower in group I than in group II (3.2% vs. 10.9%, p=0.740). Conclusions: Scrotal incision hydrocelectomy in boys was associated with shorter operative time and hospital stay, and a lower postoperative complication rate, than was the inguinal incision approach. The scrotal incision technique might be an easy and effective alternative treatment when used to treat hydroceles in boys as well as inguinal incision approach.

Bilateral versus unilateral sudden sensorineural hearing loss.

OBJECTIVES: To analyze the clinical characteristics and treatment results between bilateral (bi-) and unilateral (uni-) sudden sensorineural hearing loss (SSNHL). STUDY DESIGN AND SETTING: A retrospective study. METHODS: Three hundred twenty-four patients with SSNHL were classified into two groups; simultaneous bi-SSNHL (n = 16) and uni-SSNHL (n = 308). We compared clinical characteristics, medical history, hearing level, and treatment results between the 2 groups. RESULTS: The incidence of bi-SSNHL was 4.9 percent of overall patients with SSNHL. Bi-SSNHL occurs more commonly in patients of older age, with preexisting diabetes mellitus, and lipid panel abnormalities compared with uni-SSNHL. Ten patients (62.5%) in the bi-SSNHL group showed hearing recovery in 1 or both ears compared with 56.5 percent of patients with uni-SSNHL. Only 12 (37.5%) of all 32 ears recovered in bi-SSNHL, which was significantly lower than in uni-SSNHL. CONCLUSION: Bi-SSNHL has a very low incidence and lower recovery rate than uni-SSNHL. Recognition of similarities and differences between bilateral and unilateral SSNHL can help in counseling and managing the patients.

Two Cases of Angioleiomyoma of the Auricle.

Angioleiomyoma is a benign tumor originating from the muscularis layer of blood vessel walls. It usually occurs in extremities, and the auricle is not a frequent site for the development of this tumor. We present two cases of auricular angioleiomyoma diagnosed after pathological examination along with a review of literature.

Clinical characteristics of keratosis obturans and external auditory canal cholesteatoma.

OBJECTIVE: Keratosis obturans (KO) and external auditory canal cholesteatoma (EACC) have been considered separate entities. While the disorders are distinct, they share many overlapping characteristics, making a correct diagnosis difficult. In the present study, we compared their clinical characteristics and radiological features to clarify the diagnostic criteria. STUDY DESIGN: Retrospective case series. SETTING: Academic medical center. SUBJECTS AND METHODS: The clinical data of 23 cases of EACC and KO were retrospectively reviewed. The following clinical characteristics were compared between the 2 groups: sex, age, onset of symptoms, follow-up period, audiometric results, and imaging findings on temporal bone computed tomography including bilaterality, location, and the presence of extension to adjacent tissue. RESULTS: The mean age of the EACC group was significantly older than that of the KO group. All of the cases of EACC occurred unilaterally, and bilateral occurrences of KO were observed in 4 of 9 cases. All of the lesions in the KO group were circumferential, and no lesion in the EACC group invaded the superior canal wall. No significant differences in symptoms, such as acute otalgia, otorrhea, and hearing loss, were noted between the 2 groups. The incidence of conductive hearing impairment more than 10 dB was higher in the KO group than in the EACC group. CONCLUSION: Thus, KO and EACC are 2 distinct disease entities that share common features in clinical characteristics except for predominant age and bilaterality. Conservative treatment with meticulous cleaning of the lesion was successful in most cases with a long-term follow-up.

Simple assessment of olfaction in patients with chronic rhinosinusitis.

CONCLUSION: The brief-smell identification test (B-SIT) can substitute for the butanol threshold test (BTT) in screening of anosmia and postoperative assessment of olfactory outcomes in patients with chronic rhinosinusitis (CRS). A time-effective test battery composed of B-SIT and the visual analog scale (VAS) can be implemented for simple olfactory assessment in any otolaryngology clinic. OBJECTIVES: Anosmia is a distinct clinical entity requiring special attention. Unpredictable olfactory outcomes after surgery make preoperative assessment more important. We compared the results of the BTT, B-SIT, and VAS to investigate whether B-SIT or VAS can substitute for BTT in screening of anosmia and postoperative follow-up. METHODS: We collected data on 68 CRS patients who had bilateral CRS and underwent endoscopic sinus surgery. Olfactory performance was graded using the BTT: normosmia, hyposmia, or anosmia. VAS and B-SIT were also performed. All tests were repeated 6 months after surgery. Postoperative improvement was defined by an increase of the BTT score ≥ 2. RESULTS: The B-SIT and VAS scores of the anomics were significantly lower than those of the normosmics. B-SIT discriminated anosmia with high specificity. Within the improvement group, postoperative increase of B-SIT/VAS score showed significance. However, neither the B-SIT nor the VAS differentiated between no change and deterioration of olfaction.