Next-generation Sequencing of MicroRNA in Acquired Middle Ear Cholesteatoma.

OBJECTIVES/HYPOTHESIS: The pathophysiology of cholesteatoma is not precisely understood, and research on the associated microRNAs (miRNAs) is also deficient. We demonstrated the expression of miRNA in normal skin and middle ear cholesteatoma by next-generation sequencing (NGS) technology. The profiles of miRNA and relevant molecular interaction pathways were investigated. STUDY DESIGN: Case-control experimental study. METHODS: Middle ear cholesteatoma and post-auricular skin tissue specimens were collected from 13 adult patients. Total RNA was extracted, and miRNA expression profiles were analyzed by NGS technology. Functional gene classification to predict target genes and relevant biological pathways was performed using DIANA-microT-CDS and the Kyoto Encyclopedia Gene and Genome database (KEGG) pathways. RESULTS: The expression of 2588 miRNAs from middle ear cholesteatoma and skin tissue samples was analyzed. The expression of 76 upregulated and 128 downregulated miRNAs was identified in the cholesteatoma samples compared to normal skin (FC ≥2 and p < 0.05). Ninety-nine differentially expressed miRNAs (FC ≥4 and p < 0.05) were used to explore the biological pathways involved in the etiopathogenesis of cholesteatoma. The most predicted pathway in cholesteatoma in the upregulated miRNA group was the ErbB signaling pathway and it was extracellular matrix (ECM)-receptor interaction in the downregulated miRNA group. CONCLUSIONS: This was the first study investigating small miRNAs in human acquired cholesteatoma using NGS technique. We were able to identify new miRNAs and pathways related to cholesteatoma. The results of this study are expected to be helpful in revealing new pathophysiologies of cholesteatoma. LEVEL OF EVIDENCE: N/A Laryngoscope, 2024.

Microbiome of Unilateral Chronic Rhinosinusitis: A Controlled Paired Analysis.

The sinonasal microbiota in human upper airway may play an important role in chronic rhinosinusitis (CRS). Thus, this study aimed to investigate the human upper airway microbiome in patients with unilateral CRS, and compare the sinonasal microbiome of the unilateral diseased site with that of a contralateral healthy site. Thirty samples, 15 each from the diseased and healthy sites, were collected from the middle meatus and/or anterior ethmoid region of 15 patients with unilateral CRS during endoscopic sinus surgery. DNA extraction and bacterial microbiome analysis via 16S rRNA gene sequencing were then performed. Corynebacterium showed the highest relative abundance, followed by Staphylococcus in samples from both the diseased and healthy sites. Further, the relative abundances of Staphylococcus and Pseudomonas were significantly lower in samples from diseased sites than in those from healthy sites. Conversely, anaerobes, including Fusobacterium, Bacteroides, and Propionibacterium, were abundantly present in samples from both sites, more so in samples from diseased sites. However, the sites showed no significant difference with respect to richness or diversity (p > 0.05). Our results indicate that CRS might be a polymicrobial infection, and also suggest that Corynebacterium and Staphylococcus may exist as commensals on the sinus mucosal surface in the upper respiratory tract.

Feasibility of Powered Intracapsular Tonsillectomy in Pediatric Patients with Tonsil Problem, Including Recurrent Tonsillitis: A Single Surgeon's Experience.

INTRODUCTION: Powered intracapsular tonsillectomy (PIT) is a technique that protects the tonsillar capsule by using a microdebrider, resulting in faster wound-healing and reduced suffering. Many studies have found PIT to be effective, particularly in pediatric patients with obstructive sleep apnea (OSA). However, previous studies have not included patients with a history of recurrent tonsillitis. OBJECTIVE: The aim of this study was to determine the efficacy of PIT in pediatric patients even with a history of recurrent tonsillitis, and therefore, we want to expand the indication for PIT and reveal its safety. METHODS: A total of 886 pediatric patients underwent PIT between February 2013 and March 2016. All patients rated their postoperative pain using a visual analog scale (VAS) and completed the Korean obstructive sleep apnea (KOSA)-18 questionnaire for assessment of their quality of life (QOL). There were 539 males and 347 females. Their mean age was 6.2 years (range 2-14 years). The majority (77.7%) underwent the operation for OSA, and the rest (22.3%) had a history of recurrent tonsillitis. To compare the efficacy of PIT with traditional tonsillectomy, we selected 191 patients who underwent extracapsular tonsillectomy (ECT), a conventional technique, during the same time period. The median follow-up period was 16.7 months. During the follow-up period, instances of delayed bleeding and recurrent pharyngitis were monitored. RESULTS: In comparison to the patients who underwent ECT, the PIT group showed significantly fewer cases of postoperative bleeding (p = 0.027). Thirteen patients in the PIT group (1.5%) visited the hospital during the follow-up period for pharyngitis, while 8 in the ECT group (4.2%) visited for pharyngitis. The mean postoperative pain score, as assessed by a VAS, was 4.6 ± 3.2, and pain improved within an average of 2.9 days after surgery in the PIT group. The mean KOSA-18 score for the QOL of the patients was 65.9 preoperatively and 35.6 postoperatively in the PIT group. CONCLUSIONS: Pediatric tonsillectomy using PIT is valid for reducing postoperative pain and improving the QOL of OSA patients. PIT is also effective and safe for patients with a history of recurrent tonsillitis.

Biomimetic Gold Nanoshell-Loaded Macrophage for Photothermal Biomedicine.

The purpose of this study was to investigate the effect of photothermal treatment (PTT) with gold nanoshell (ANS) using a macrophage-mediated delivery system in a head and neck squamous cell carcinoma (HNSCC) cell line. To achieve this, ANS-loaded rat macrophages (ANS-MAs) were prepared via the coculture method with ANS. The human HNSCC (FaDu cell) and macrophage (rat macrophage; NR8383 cell) hybrid spheroid models were generated by the centrifugation method to determine the possibility of using ANS-MAs as a cancer therapy. These ANS-MAs were set into the tumor and macrophage hybrid spheroid model to measure PTT efficacy. Kinetic analysis of the spheroid growth pattern revealed that this PTT process caused a decreasing pattern in the volume of the hybrid model containing ANS-MAs (p < 0.001). Comparison with empty macrophages showed harmony between ANS and laser irradiation for the generation of PTT. An annexin V/dead cell marker assay indicated that the PTT-treated hybrid model induced increasing apoptosis and dead cells. Further studies on the toxicity of ANS-MAs are needed to reveal whether it can be considered biocompatible. In summary, the ANS was prepared with a macrophage as the delivery method and protective carrier. The ANS was successfully localized to the macrophages, and their photoabsorption property was stationary. This strategy showed significant growth inhibition of the tumor and macrophage spheroid model under NIR laser irradiation. In vivo toxicology results suggest that ANS-MA is a promising candidate for a biocompatible strategy to overcome the limitations of fabricated nanomaterials. This ANS-MA delivery and PTT strategy may potentially lead to improvements in the quality of life of patients with HNSCC by providing a biocompatible, minimally invasive modality for cancer treatment.

Analysis of the Microbiome in the Adenoids of Korean Children with Otitis Media with Effusion.

OBJECTIVES: The adenoid pad, which is located between the orifice of the Eustachian tube (ET) and posterior nasal cavity, can affect the development of otitis media with effusion (OME) because of its anatomical location. The aim of the present study was to evaluate adenoid microbial colonization through 16S ribosomal RNA (rRNA) pyrosequencing, an advanced molecular technique, and to document the relationship with OME. MATERIALS AND METHODS: Adenoid samples were collected using sterile cotton from 32 children during ventilation tube insertion. Sixteen children with OME who underwent tonsillectomy and adenoidectomy due to obstructive symptoms were assigned to the OME group and sixteen children without OME were assigned to the control group. We performed a 16S rRNA-based culture-independent survey of bacterial communities using the MiSeq platform. RESULTS: The diversity index, mean operational taxonomic units, and Shannon index were lower in the OME group than those in the control group. A taxonomic analysis showed differences in microbiota distribution between the OME and control groups at the phylum, genus, and species levels. The analysis, which was based on weighted UniFrac distances, revealed differences in microbial composition between the two groups. CONCLUSION: Bacterial community analysis using 16S rRNA pyrosequencing allows us to understand the relationship between the microbial communities of adenoids and the development of OME better.

Association Between Migraine and Benign Paroxysmal Positional Vertigo Among Adults in South Korea.

Importance: Patients with migraine often experience various types of vertigo, and several studies have suggested an epidemiologic and physiologic association of migraine and vertigo with vestibule. However, few researchers have investigated the association between migraine and benign paroxysmal positional vertigo (BPPV). Objective: To determine the incidence of BPPV in individuals with migraine in a large national population-based sample. Design, Setting, and Participants: This cohort study obtained data from the Korean Health Insurance Review and Assessment Service covering the period January 1, 2002, through December 31, 2013. These data included personal information, health insurance claim codes, diagnostic codes, death records, socioeconomic data, and medical examination data for each individual in the database. A 1:4 matching method was used to select individuals for the migraine group (n = 40 682) and the control group (n = 162 728). Individuals who had a history of BPPV before the index date, for whom a match could not be identified, and who received a migraine diagnosis before age 20 years were excluded from the analysis. Data analysis was conducted from September 1, 2015, to December 31, 2017. Main Outcomes and Measures: The crude and adjusted (by age, sex, income, region of residence, and medical history [hypertension, diabetes, or dyslipidemia]) hazard ratios for migraine and BPPV were analyzed using the Cox proportional hazards regression model. Results: Of the 40 682 individuals in the migraine group, 10 381 (25.5%) were male and 30 301 (74.5%) were female. Of the 162 728 controls, 41 524 (25.5%) were male and 121 204 (74.5%) were female. The incidence of BPPV was statistically significantly higher in the migraine group than in the control group (2431 [6.0%] vs 3677 [2.3%]). Migraine increased the risk of BPPV (adjusted hazard ratio, 2.54; 95% CI, 2.41-2.68). In a subgroup analysis, the incidence of BPPV in all age groups and in both men and women was statistically significantly higher in the migraine group than in the control group. The incidence of BPPV was the highest in men younger than 40 years (adjusted hazard ratio, 4.49; 95% CI, 3.05-6.62), and the HR decreased in both men and women as age increased. Conclusions and Relevance: Migraine appeared to be statistically significantly associated with higher incidence of BPPV; future studies are needed to determine the association between BPPV and specific factors related to migraine.

Differences in Antibiotic Resistance of MRSA Infections in Patients with Various Types of Otitis Media.

OBJECTIVES: We investigated the epidemiological and antibiotic resistance differences in methicillin-resistant Staphylococcus aureus (MRSA) infections in patients with otitis media with effusion (OME), acute otitis media (AOM), chronic suppurative otitis media (CSOM), and chronic cholesteatomatous otitis media (CCOM). MATERIALS AND METHODS: We conducted a retrospective study of patients with newly identified MRSA infections from January 2009 through January 2017. Overall, 3,522 patients from 10 tertiary referral hospitals were included in the study. An antibiotic sensitivity test was performed for each isolate. RESULTS: MRSA infections in patients with CSOM and CCOM were more resistant to ciprofloxacin, clindamycin, erythromycin, gentamicin, levofloxacin, and tetracycline. Patients showed good susceptibility to rifampicin, trimethoprim/sulfamethoxazole (TMP/SMX), and vancomycin. CONCLUSION: MRSA infections in various otitis media cases showed different resistance patterns. MRSA infections in patients with COM and CCOM were more resistant to antibiotics than those in patients with OME and AOM.

Is the modified cupulolith repositioning maneuver effective for treatment of persistent geotropic direction-changing positional nystagmus?

OBJECTIVE: Clinicians sometimes see patients with relatively persistent geotropic direction-changing positional nystagmus (DCPN) as a variant of lateral semicircular canal-benign paroxysmal positional vertigo (LSCC-BPPV). Recently, the concept of a "light cupula" in the lateral semicircular canal, exhibiting persistent geotropic DCPN, has been introduced. However, the underlying pathogenesis of light cupula is not known. We investigated the efficacy of a modified cupulopathy repositioning maneuver (mCuRM), designed to reduce light debris attached to the cupula in patients with persistent geotropic DCPN. STUDY DESIGN: Retrospective cohort study. METHODS: Participants included 65 patients with a persistent geotropic DCPN: 35 underwent treatment (mCuRM group), and 30 were followed-up but received no treatment (No CuRM group). We compared the therapeutic and survival rate of persistent geotropic DCPN between two groups. RESULTS: On Day 1, the persistent geotropic DCPN did not resolve in either group. On the first and second follow-up days, persistent geotropic DCPN was observed in 28 (80%) and 21 (60%) of patients, respectively, in the mCuRM group, and in 28 (93.3%) and 24 (80%) patients, respectively, in the no mCuRM group. The differences between groups were not statistically significant. Furthermore, no between-group differences were found in the time from diagnosis to resolution of nystagmus, or the time from symptom onset to resolution of nystagmus. Kaplan-Meier analysis of the time course of persistent geotropic DCPN resolution from the day of diagnosis and day of symptom onset revealed no significant differences between the groups. CONCLUSION: Our findings indicate that mCuRM had no therapeutic benefit for a persistent geotropic DCPN and suggest that the pathophysiology of persistent geotropic DCPN is less likely to be a light debris attached to the cupula.

Attic cholesteatoma with tiny retraction of pars flaccida.

OBJECTIVE: This clinical study was performed to analyze the characteristics of attic cholesteatoma occurring behind a tiny retraction of the pars flaccida, which was classified as Tos type I or II and had an intact pars tensa of the tympanic membrane. METHODS: The clinical records of patients who underwent tympanomastoidectomy for attic cholesteatoma at a tertiary care referral center (Kangdong Sacred Heart Hospital of Seoul, Korea) between March 2004 and December 2012 were retrospectively reviewed. Eleven patients (five men and six women) who underwent tympanomastoidectomy between March 2004 and December 2012 for attic cholesteatoma occurring behind a tiny attic retraction were included. The mean age of patients was 41.1 years (range 20-58 years) and the mean duration of follow-up was 29.5 months (range 13-52 months). RESULTS: Every patient had a unilateral cholesteatoma, and the opposite side was normal except in one patient. Hearing loss was the most common symptom, followed by earfullness and otalgia. Five patients had type I attic retraction, and six patients had type II attic retraction. No patient had definite scutum erosion. Interestingly, during regular postoperative checkup, one patient was found incidentally for the opposite ear. Six patients had a cholesteatoma sac that was separated from the pars flaccida, whereas in five patients it was in contact with the pars flaccida but was easily separated. Six patients had a limited cholesteatoma within the epitympanum, and five patients had extension beyond the epitympanum. The average air-bone gap was 24.3±10.1dB before the operation and 14.2±6.6dB after the operation. Every patient had an intact tympanic membrane without retraction pocket postoperatively. There was no recurrence of cholesteatoma during follow-up. CONCLUSION: The rate of attic cholesteatomas occurring behind a tiny retraction of the pars flaccida was 7.7% (11 of 142 patients with attic cholesteatoma). Attic retractions must be followed closely using endoscopy, microscopy, and temporal bone Computed tomography, even though the patient has a tiny retraction of the pars flaccida or a normal hearing level.

Congenital cholesteatoma localized to the tip of the mastoid bone: a case report and possible etiology.

Congenital cholesteatomas of mastoid origin are extremely rare. We reported one in 2007 and experienced an additional case. A male presented with a 5-month history of right-sided ear discharge. Computed tomography of the temporal bone showed a soft tissue density occupying the mastoid tip. At surgery, the cholesteatoma sac was completely isolated from the mastoid antrum and lateral air cell in the mastoid tip area. We now doubt the rarity of this entity. With a brief literature review, we consider how the cholesteatoma localizes to the tip of the mastoid bone.

Changing patterns of bacterial strains in adults and children with otitis media in korean tertiary care centers.

OBJECTIVES: Otitis media (OM) is an infectious disease that affects all age brackets. Aural discharge is a typical symptom, occurring in all subtypes of OM. We have compared the identity and antibiotic sensitivity of bacteria isolated from aural discharges of adults and children with various types of OM, including acute OM (AOM), OM with effusion (OME), chronic OM (COM), and cholesteatomatous OM (CSOM). METHODS: The study involved 2,833 patients who visited five tertiary hospitals between January 2001 and December 2010 and were diagnosed with AOM, OME, COM, or CSOM. The patients were divided into a pediatric group and an adult group, and the distribution of cultured bacteria and their antibiotic sensitivity were compared in the two groups. RESULTS: Bacterial detection rates were higher in adults than in children with OME and COM (P=0.000 each). The majority of the bacteria cultured from patients with AOM and OME bacteria were methicillin-susceptible Staphylococcus aureus (MSSA) and Streptococcus pneumoniae. Bacteria cultured from children were more susceptible to antibiotics (P=0.002) and had higher antibiotic sensitivity (P=0.001) than were bacteria cultured from adults. The majority of bacteria culture from patients with COM and CSOM were MSSA and pathogenic Pseudomonas aeruginosa. The frequency of methicillin-resistant Staphylococcus aureus was significantly higher in adults than in children, and more strains of bacteria isolated from adults were sensitive to the antibiotics septrin, vancomycin, and teicoplanin. CONCLUSION: Bacteria cultured from children were more susceptible to antibiotics and had higher antibiotic sensitivity than did bacteria cultured from adults.

Unusual presentation of a metastatic tumor to the temporal bone: severe otalgia and facial paralysis.

Metastatic temporal bone tumors are rare diseases and they are usually clinically asymptomatic, so it is difficult to diagnose them. Breasts are the most common sites of temporal bone metastasis. Tumors of lung, kidney, gastrointestinal tract, prostate gland, larynx and thyroid gland are the other sites. The pathogenesis of the temporal bone is most commonly related to the hematogenous route. We present the case of a 78-year-old man with facial paralysis combined with severe otalgia. This patient was initially diagnosed with Bell's palsy. However, based on the radiologic findings, the patient was diagnosed with lung cancer with temporal bone metastasis.

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.

Open reduction of nasal bone fractures through an intercartilaginous incision.

CONCLUSION: Open reduction through an intercartilaginous incision was useful for treating delayed-diagnosed nasal bone fractures because it resulted in a successful outcome with minimal complications. OBJECTIVES: Nasal bone fractures are generally managed with closed reduction, which is usually inadequate and results in airway obstruction with a delayed diagnosis of nasal bone fracture when bone healing and fibrotic adhesions around the bone fragment have progressed. This study investigated the surgical outcome of open reduction through an intercartilaginous incision for delayed-diagnosis nasal bone fractures. METHODS: The study enrolled 18 patients who underwent open reduction through an intercartilaginous incision to correct delayed-diagnosis nasal bone fractures. Three independent otorhinolaryngologists evaluated the outcomes 4-35 months (average 12.7 months) postoperatively as excellent, fair or poor. RESULTS: The time from injury to surgery was 11-39 days (20-39 days in adults and 11-30 days in children). The 18 cases included 16 primary repairs and two revisions. A Kirschner wire was inserted in six (33.3%) patients who had unstable reduced nasal bones. Postoperatively, l5 (83%) patients had excellent results, two (11%) had fair, and one (6%) had a poor outcome. No patient experienced any complication.

The effectiveness of 1-point fixation for zygomaticomaxillary complex fractures.

OBJECTIVES: To introduce the surgical technique of 1-point fixation at the zygomaticomaxillary buttress (ZMB) and to verify its effectiveness using 3-dimensional computed tomography (3D CT). DESIGN: Case series with chart review. SETTING: Academic tertiary care medical center. PATIENTS AND METHODS: The study included 29 patients who underwent 1-point fixation at the ZMB for zygomaticomaxillary complex fractures without comminution of lateral orbital rim fractures. Preoperative and postoperative 3D CT scans were obtained to evaluate vertical and horizontal changes of the zygoma, which were were analyzed according to preoperative 3D CT findings. RESULTS: The ZMB area was fixed with a resorbable system in 26 patients and with a metal system in 3 patients. After surgery, the mean vertical change improved from 1.28° to 0.58° (P < .001), and the mean horizontal change improved from 1.71° to 0.92° (P < .001). Postoperative vertical movement of the zygoma was not significantly affected by comminution of the inferior orbital wall, zygomaticofrontal process displacement, or comminution of the ZMB area and zygomatic arch (P > .05 for each). However, comminution of the ZMB area had an adverse effect on horizontal movement of the zygoma (P = .03). Complications after surgery included facial cellulitis associated with acute sinusitis in 1 patient, who was treated successfully. No patient required revision reduction because of facial deformity. CONCLUSION: Our findings suggest that 1-point fixation at the ZMB provides sufficient stability of the zygomaticomaxillary complex without comminuted fractures of the lateral orbital rim.

Analysis of psychological distress after management of dizziness in old patients: multicenter study.

Dizziness is a common problem in older people, with a reported prevalence of 13-38%. A large percentage of patients with dizziness develop secondary psychiatric disorders over the course of their disease. In particular, clinical depression and anxiety are significant health problems for older adults. We investigated the relationship between dizziness and psychological distress (depression and anxiety) in elderly patients with dizziness, and the relationship with psychological symptoms after managing the dizziness. This study enrolled 126 patients with dizziness, who were 65 years or older. Dizziness and the psychological symptoms of all patients were measured using the Korean Version of the Vestibular Disorders Activities of Daily Living Scale (K-VADL), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI) before and after management. We found a significant decrease in the BDI and STAI state scores after treatment with a reduction in the K-VADL score. For the STAI, the decrease in the score was relatively small after management. Nevertheless, there were significant correlations between the K-VADL score and both the BDI and STAI scores before and after management. Therefore, in the management of elderly patients with dizziness, a psychiatric approach should be considered and psychological support may be needed after managing the dizziness.

Histologic changes in transplanted expanded polytetrafluoroethylene in an animal model.

OBJECTIVES/HYPOTHESIS: Several materials have been used for nasal augmentation surgery. Expanded polytetrafluoroethylene (e-PTFE) (Gore-Tex; W. L. Gore & Associates, Flagstaff, AZ) has proven to be an ideal synthetic material for nasal augmentation. Gore-Tex contains numerous pores that stabilize an implant, but this advantage has been tempered by unpredictable outcomes. The purpose of this study was to evaluate morphologic and histologic changes in nonreinforced Gore-Tex in a rabbit model. STUDY DESIGN: In vivo study using a rabbit model. METHODS: To analyze histologic changes, we used 20 New Zealand white rabbits. Gore-Tex was implanted into the nasal dorsum of the rabbits. Then, en bloc specimens containing the implant and surrounding soft tissues were sampled 1, 3, 6, and 12 months after implantation. We evaluated the three-dimensional size of the implants over time using light and electron microscopy to investigate histologic and morphologic changes. RESULTS: Following gross analysis, none of the implants were lost or extruded, and there was no evidence of wound infection. Diminution rates of thickness, width, and height in the implants were 22%, 2%, and 5%, respectively. Histologically, connective tissue growth was observed in all specimens, and the internodal space decreased owing to connective tissue ingrowth over time. Neovascularization was observed 3 months after implantation, and degenerative changes were also observed after 6 months. CONCLUSIONS: Gore-Tex should be carefully trimmed for use in augmentation because of its potential to decrease in size over time. Additional studies are necessary before these results can be applied in clinical practice.

Analysis of hearing improvement in patients with severe to profound sudden sensorineural hearing loss according to the level of pure tone hearing threshold.

Patients with profound sudden sensorineural hearing loss (SSNHL) have a poor prognosis regardless of the type of treatment they receive. However, there is evidence that a proportion of patients with profound hearing loss may exhibit variable degrees of recovery, and this has yet to be specifically investigated. Here, we report a comparison of levels of hearing improvement in patients stratified according to their level of hearing threshold before treatment. We divided patients with severe to profound SSNHL into three groups: patients with an initial hearing threshold of 80-89 dB (n = 18), 90-99 dB (n = 16), and ≥100 dB (n = 34). We compared improvements in hearing threshold at different frequencies and recovery rates between the three groups. No significant differences were observed in hearing threshold improvements at different frequencies in the three groups after treatment. However, in the group with an initial hearing threshold of ≥100 dB, significantly less complete and partial recoveries occurred compared to those in the 80-89 or 90-99 dB groups. Our results suggest that initial hearing threshold in excess of 100 dB alters the likelihood of satisfactory recovery in patients with severe to profound SSNHL.

Reduction of inferior orbital wall fractures using a Foley catheter and an Endoloop.

BACKGROUND: Various surgical approaches have been used to treat orbital blowout fractures. Among them, the transnasal endoscopic approach avoids external scars and allows clear observation of the fracture site. We conducted a retrospective study of blowout fractures reduced using a Foley catheter and an Endoloop. METHODS: Patients (n=24) who underwent endoscopic reduction of inferior orbital wall fractures were analyzed. They were diagnosed using 3-mm facial computed tomography, and the surgical treatment consisted of fracture reduction using Foley catheter and Endoloop. Postoperatively, they were followed up for at least 3 months. RESULTS: There was no significant intraoperative or postoperative complication. The symptoms in all but two patients resolved completely after surgery. CONCLUSION: The technique using Foley catheter and Endoloop to reduce inferior orbital wall fractures endoscopically is safe and efficacious.

Vestibular-evoked myogenic potentials in migrainous vertigo.

OBJECTIVE: Patients with migraine headaches have a high prevalence of episodic vertigo, and several studies support the clinical association of migraine and vertigo. Various tests have been conducted in patients with migrainous vertigo; however, only a few studies have been reported on otolith function. The aim of the present study was to increase the understanding of migrainous vertigo pathophysiology by assessing the sacculocollic pathway in patients with migrainous vertigo using vestibular-evoked myogenic potentials testing (VEMPs). STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. SUBJECTS AND METHODS: VEMP testing was performed in 30 patients with migrainous vertigo and 31 healthy volunteers using 90- and 100-dB tone-pip stimuli. We compared hearing, p13 and n23 latency, VEMP asymmetry, and VEMP formation rate between the patient and control groups. RESULTS: No between-group difference was observed in p13 and n23 latency or VEMP asymmetry. The rate of normal VEMP wave formation in both ears was significantly lower in the patient group compared with that of the control group in response to the 90-dB stimulus. Furthermore, VEMP wave formation was absent in both ears at 100 dB in significantly more patients than in control subjects. CONCLUSION: The results indicate that patients with migrainous vertigo show abnormal VEMP findings, suggesting that migrainous vertigo might have a lesion at the sacculocollic pathway.