Surgical and Audiologic Comparison Between Sophono and Bone-Anchored Hearing Aids Implantation

OBJECTIVES: Bone-anchored hearing aids (BAHA) occasionally cause soft tissue problems due to abutment. Because Sophono does not have abutment penetrating skin, it is thought that Sophono has no soft tissue problem relating to abutment. On the other hand, transcutaneous device's output is reported to be 10 to 15 dB lower than percutaneous device. Therefore, in this study, Sophono and BAHA were compared to each other from surgical and audiological points of view. METHODS: We retrospectively reviewed the medical records of 9 Sophono patients and 10 BAHA patients. In BAHA cases, single vertical incision without skin thinning technique was done. We compared Sophono to BAHA by operation time, wound healing time, postoperative complications, postoperative hearing gain after switch on, and postoperative air-bone gap. RESULTS: The mean operation time was 60 minutes for Sophono and 25 minutes for BAHA. The wound healing time was 14 days for Sophono and 28 days for BAHA. No major intraoperative complication was observed. Skin problem was not observed in the 2 devices for the follow-up period. Postoperative hearing gain of bilateral aural atresia patients was 39.4 dB for BAHA (n=4) and 25.5 dB for Sophono (n=5). However, the difference was not statistically significant. In all patients included in this study, the difference of air-bone gap between two groups was 16.6 dB at 0.5 kHz and 18.2 dB at 4 kHz. BAHA was statistically significantly better than Sophono. CONCLUSION: Considering the audiologic outcome, BAHA users were thought to have more audiologic benefit than Sophono users. However, Sophono had advantages over BAHA with abutment in cosmetic outcome. Sophono needed no daily skin maintenance and soft tissue complication due to abutment would not happen in Sophono. Therefore, a full explanation about each device is necessary before deciding implantation.

Tinnitus Retraining Therapy / 한양의대학술지

According to the Jastreboff's neurophysiological model of tinnitus, if negative associations are attached to the tinnitus signal, tinnitus is perceived to be a threat or a danger and it activates the autonomic nervous and limbic systems. Consequently patient's awareness of tinnitus is heightened and so patient perceives it to be louder and more persistent. Jastreboff and Hazell started tinnitus retraining therapy (TRT) based on the neurophysiological model of tinnitus. The purpose of TRT is blocking tinnitus from activating the sympathetic nervous and limbic systems (habituation of reaction) and from reaching the cerebral cortex (habituation of perception). TRT is composed of two components directive counseling that tries to reclassify tinnitus into the meaningless stimuli and sound therapy that decreases the relative strength of the tinnitus signal. Physicians try to put patient's tinnitus into the territory of meaningless stimuli through retraining the brain (habituation of reaction). Because the brain habituates all unimportant stimuli, if habituation of reaction is fully achieved, habituation of perception will follow automatically. In most clinical results, clinical success rates of TRT approach or exceed 80% improvement. Early improvement can be achieved during the first few months, followed by additional progressive improvement. It should be recommended that the patient continue treatment at least 18 months.

Multicenter Study on the Clinician's Diagnostic and Therapeutic Approaches for Benign Paroxysmal Positional Vertigo in Korea / 대한평형의학회지

BACKGROUND AND OBJECTIVES: It is necessary to establish the most efficient diagnostic and therapeutic method for benign paroxysmal positional vertigo (BPPV), which is appropriate for Korean healthcare system. We aimed to evaluate current state of Korean clinician's diagnostic and therapeutic approaches for BPPV. MATERIALS AND METHODS: A 16-item survey was emailed to the members of dizziness department of Otology Research Interest Group in the Korean Otologic Society (n=68). 43 were returned and analyzed. RESULTS: All respondents (100%) used Dix-Hallpike test as a diagnostic tool for vertical canal-BPPV. Supine roll test was used for diagnosing lateral canal BPPV in nearly all the respondents (97.7%). Epley maneuver was chosen as otolith repositioning maneuver (ORM) for posterior canal BPPV in all respondents and barbecue rotation (BBQ) was used for treating lateral canal BPPV with geotropic nystagmus in 95.3% of respondents. Extreme variation was noted for therapeutic approach of lateral canal BPPV with ageotropic nystagmus BBQ, with 4 kinds of ORM and adjunctive measures to liberate otolith from cupula, while BBQ was again the most commonly used ORM (76.7%). CONCLUSION: The development of practical and efficient ORM for lateral canal BPPV with ageotropic nystagmus is necessary.

Single Vertical Incision Technique without Skin Thinning for the Bone Anchored Hearing Aid Surgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: After the bone anchored hearing aid (BAHA) surgery, soft tissue problems have frequently been reported. To solve this problem, a surgical procedure that routinely involves so-called skin thinning using BAHA dermatome has been utilized. But, this procedure includes many peri-implant complications and cosmetic trouble. Recently, a single vertical incision technique that does not involve skin thinning has been reported with favorable results. In this study, we evaluated the benefits of performing this procedure without skin thinning compared with the dermatome technique. SUBJECTS AND METHOD: We evaluated 10 patients who were operated on without skin thinning using longer (8.5 mm) abutments (the test group) and 5 patients with the routine skin thinning and 5.5-mm abutments (the control group). A mean follow-up time was 11.3 months, the mean age was 34.2 years in the test group, the mean follow-up time was 54.5 months and a mean age is 24.5 years in the control group. RESULTS: The mean time required for surgery was 25 minutes and 55 minutes for the test and control groups, respectively. The wound healing time was 28 days and 56 days for the test and control groups, respectively. Fixture extrusion, skin infection and skin overgrowth were not observed in the test group but fixture extrusion case, two skin infection cases and two skin overgrowth cases were observed in the control group. Two cases of abutment loosening were observed in the test group. CONCLUSION: The single vertical incision technique without skin thinning has many benefits when compared with the BAHA dermatome. With this technique, infection and skin overgrowth could be reduced, and a more rapid procedure and a more short healing time could also be possible. Moreover, the aesthetic outcome was far better when no skin thinning was involved.

Genetic Screening of GJB2 and SLC26A4 in Korean Cochlear Implantees: Experience of Soree Ear Clinic

OBJECTIVES: Genetic hearing loss is highly heterogeneous and more than 100 genes are predicted to cause this disorder in humans. In spite of this large genetic heterogeneity, mutations in SLC26A4 and GJB2 genes are primarily responsible for the major etiologies of genetic hearing loss among Koreans. The purpose of this study is to investigate the genetic cause of deafness in Korean cochlear implantees by performing a genetic screening of the SLC26A4 and GJB2 genes. METHODS: The study cohort included 421 unrelated Korean patients with sensorineural hearing loss (SNHL) and who had received cochlear implants (CI) at Soree Ear Clinic from July 2002 to December 2010. Among 421 CI patients, we studied 230 cases who had received the genetic screening for SLC26A4 or GJB2 genes. Written informed consent was obtained from all participants. All patients had severe to profound, bilateral hearing loss. For 56 patients who showed enlarged vestibular aqueduct on their computed tomography (CT) scan, we analyzed SLC26A4. For 174 CT negative patients, GJB2 gene was sequenced. RESULTS: For the 56 SLC26A4 patients, 32 (57.1%) had two pathogenic recessive mutations in SLC26A4. A single recessive SLC26A4 mutation was identified in 14 patients (25%). H723R and IVS7-2A>G were the most commonly found mutations, accounting for 60.3% (47/78) and 30.8% (24/78) of the mutated alleles, respectively. For the 174 GJB2 patients, 20 patients (11.5%) had two pathogenic recessive mutations in GJB2. 235delC was the most common mutation, accounting for 43.0% (31/72) of mutant alleles. CONCLUSION: The two major genes, SLC26A4 and GJB2, contribute major causes of deafness in CI patients. Continuous studies are needed to identify new genes that can cause hearing loss to Korean CI patients.

Fibrovascular Polyp of the Hypopharynx: A Case Report

We report here on a case of fibrovascular polyp arising in the hypopharynx of a 62-year-old man. Laryngomicroscopic surgery with laser ablation was performed to excise the mass. Histopathologically, the surface of the polyp was covered with mature squamous epithelium. The polyp showed a characteristic lobular proliferation of mature adipose tissue that was separated by myxoid or collagenous connective tissue. Some scattered skeletal muscle bundles were seen in the central portions of the polyp and these bundles were surrounded by a concentric proliferation of the spindle cells; this was reminiscent of Pacinian corpuscles. Regarding their location and the intermingled pattern of proliferating tissues, it is more plausible that the skeletal muscle is a hamartomatous component rather than entrapped, preexisting tissue.

Two Cases of Sudden Hearing Loss With Vertigo as an Isolated Symptom of Anterior Inferior Cerebellar Artery Infarction

Isolated sudden hearing loss with vertigo is usually peripheral origin. We report two cases with anterior inferior cerebellar artery infarction (AICA) manifesting sudden hearing loss with vertigo as an isolated symptom. Patient 1 was a 64-year-old man presented with right sided sudden hearing loss and vertigo accompanying horizontal beating nystagmus to the left. He had no other neurologic symptoms. MRI showed right AICA infarction involving lateral pons and middle cerebellar peduncle. Patient 2 was a hypertensive 56-year-old man. Left sided sudden hearing loss with vertigo was as an initial manifestation. Two days later, left sided facial palsy developed and MRI showed acute infarction in left lateral pons, middle cerebellar peduncle, and cerebellum. AICA infarction can be presented the hearing loss and vertigo as an isolated symptom and mimic the syndrome of peripheral origin.

A Case Report of Brain Herniation into the Middle Ear Mimicking as Secondary Cholesteatoma Following Temporal Bone Fracture / 대한이비인후과학회지

Brain herniation into the middle ear cavity is a rare entity that occurs mostly as a complication of otologic surgery. Other causes include a congenital skull base defect, infection, trauma, neoplasm and irradiation. It gives rise to cerebrospinal fluid otorrhea, progressive hearing loss, tinnitus, meningitis and other neurologic symptoms. Such patients tend to be misdiagnosed as having chronic otitis media and are often treated for long periods with inadequate conservative therapy. We report a case of brain herniation into the middle ear following traumatic temporal bone fracture, which was treated surgically via a transmastoid approach.

Magnetic Resonance Imaging in Cochlear Implant Patient / 대한이비인후과학회지

Many cochlear implant recipients require magnetic resonance imaging (MRI). Cochlear implants (CI) have been contraindications to MRI, because of potential device displacement, generation of heat within the device and surrounding tissues and potential compromise of device integrity. The CI-MRI incompatibility has led to changes in the designing of CI. One approach has been to enable the magnet to be surgically removed before MRI. We report an experience of performing MRI on a cochlear implant recipient after magnet removal.

Effect of Caffeine on UTP-induced Ca2+ Mobilization and Mucin Secretion in Human Middle Ear Epithelial Cells / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Puringeric receptors and their agonists like uridine-5-triphosphate (UTP) and adenosine triphosphate (ATP), regulate mucin secretion in middle ear epithelial cells. In the present study, we examined the effects of purinergic agonists on Ca2+ influx ([Ca2+]i ) in normal human middle ear epithelial (NHMEE) cells. We also examined the effect of caffeine, an inositol 1, 4, 5-triphosphate (IP3) inhibitor, on UTP induced [Ca2+]i and mucin secretion in NHMEE cells. MATERIALS AND METHOD: NHMEE cells were stimulated with various purinergic agonists, such as UTP, and [Ca2+]i was measured using a miniature double perfusion chamber. UTP-induced mucin secretion was quantitated by immunoblotting assay. RESULTS: The determined order of purinergic agonist potency with respect to [Ca2+]i was ATP=UTP>2-MeSATP>ADP>> adenosine. UTP-induced mucin secretion was inhibited when the intracellular Ca2+ was removed with 2-bis (2-aminophenoxy)ethane-N, N, N', N'-tetraacetic acid-acetoxymethyl ester. Caffeine suppressed UTP-induced [Ca2+]i, and but inhibited UTPinduced and constitutional mucin secretion. CONCLUSION: Our results suggest that caffeine may have a therapeutic effect in mucoid otitis media by suppressing mucin secretion.

Decompression of Internal Auditory Canal via Middle Fossa Approach in Neurofibromatosis Type II with Only Hearing Ear / 대한이비인후과학회지

Neurofibromatosis type II (NF2) is a genetic disease and is transmitted as an autosomal dominant trait. NF2 is characterized by bilateral acoustic neuroma with multiple tumors of central nervous system. Progressive hearing loss is a significant problem in patients with NF2, and hearing preservation is an important factor for choice of treatment plan, especially in a NF2 patient with only one hearing ear. We report an experience of preservation of hearing in a NF2 patient with only one hearing ear through decompression of the internal auditory canal via middle cranial fossa approach.

Postoperative Assessment of Speech and Swallowing Functions in Oral Tongue Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sometimes the oral cavity functions such as swallowing and articulation may be seriously disabled after surgery despite excellent reconstruction. So, the preservation of the functions and oncologic resection of cancer in the treatment of oral tongue cancer are challenging problems for head and neck surgeon. We evaluated speech and swallowing functions in postoperative stage in the patients with oral tongue cancer to help predict the postoperative status of speech and swallowing according to the size of defect and the reconstruction methods. SUBJECTS AND METHOD: In 10 oral tongue cancer patients who had been treated by surgery as initial management, we performed speech function tests (speech intelligibility score, articulation score, predominant class of errors, diadochokinetic test, and tongue mobility test) and swallowing function tests (modified barium swallow (MBS) test, deglutition test, and swallowing ability score) and reviewed operation findings. RESULTS: In the primary repair group, the speech and swallowing function test was nearly normal, except mild mis-articulation of the lingua alveolars. In the free flap group, the speech function was intelligible despite impaired tongue mobility and mis-articulation of the lingua alveolars, the lingua palatals and the lingua velars. Impaired lateral tongue movement, marked stasis in oral cavity, delayed swallowing reflex on the MBS test resulted in decreased pharyngeal peristalsis, stasis in vallecula, incomplete laryngeal closure and elevation and aspiration. Swallowing ability was also impaired. In less over-reconstructed group (less than 200%) according to tongue defect and reconstruction volume ratio, much earlier oral diet start, seal-up and more excellent speech and swallowing function were observed because adynamic portion was relatively small. We observed that the postoperative speech and swallowing functions were not affected in the group with less than 3 cm of the tongue defect and the reconstruction with primary closure. The lingua alveolars were mainly affected on postoperative speech evaluation in primary closure and free flap group irrespective of defect volume. Speech and swallowing functions in less over-reconstructed group were superior to those in over-reconstructed group. CONCLUSION: We suggest that the results of this study can aid in counseling patients and predicting the postoperative status of speech and swallowing function according to the size of primary defect and the reconstruction methods. To better predict the postoperative functional status, we need to carry out functional evaluations and comparative assessment of the preoperative and postoperative status.

Treatment Outcomes and Pattern of Failure in the Surgically Treated Squamous Cell Carcinoma of Floor of the Mouth / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Squamous cell carcinoma involving the floor of the mouth remains one of the most aggressive neoplasms of the head and neck. Its propensity to invade the mandible and to involve the lymphatic beds of both necks often makes local and regional control exceedingly difficult. This study reports the oncologic results of the surgically treated squamous cell carcinoma of the floor of mouth. SUBJECTS AND METHOD: From July 1992 to September 2001, 27 previously untreated floor of the mouth squamous cell carcinoma patients were treated with surgery with or without postoperative radiotherapy at Severance Hospital. Survival rates and factors affecting survival were studied using standard statistical analysis to determine statistical significance. RESULTS: The 2 year and 3 year disease-specific free survival rate in early staged carcinomas (stage I and II) were 85% and 77%, respectively, and in advanced staged carcinomas, 75% and 60%, respectively. Significantly decreased survival was seen in the patients with positive pathologic lymph nodes (p=0.001). However, there was no statistical significance for the effects of cT stage (p=0.56), performance of mandibular resection (p=0.755), mandibular invasion (p=0.688), and positive margins (p=0.98) on survival. Thirty-three percent of patients had recurrence. Recurrence was highest at the primary site, followed by the neck, and these were the most common sites of treatment failure. Two cases (67%) of nodal recurrence occurred in the anterior lymphatic chain (level VI). Distant metastasis was noted in 7.4% of the patients. CONCLUSION: Treatment with radical surgery of primary lesions and elective neck dissection including the anterior neck lymphatic chains may improve survival of patients with squamous cell carcinoma of the floor of mouth.

Voice Analysis after the Vertical Partial Laryngectomy / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: It is generally believed that reconstruction of the glottic region after vertical partial laryngectomy (VPL) can improve glottic and supraglottic function. But reports on secondary healing without glottic reconstruction after VPL are lacking. This study attempts to obtain an objective phonatory data after VPL without glottic reconstruction. MATERIALS AND METHODS: From 1993 to 2001, 13 patients, who had been treated with VPL without glottic reconstruction, and 44 patients who underwent VPL were included in this study. Patients who had been followed up postoperatively less than 12 months were excluded from this study. Seven lesions were classified as T1 glottic cancer and six as T2 glottic cancer ; classic VPL (11 cases) and frontolateral VPL (2 cases). For the evaluation of voice, acoustic (fundamental frequency (Fo), jitter, shimmer, noise to harmonic ratio (NHR)), aerodynamic (maximal phonation time (MPT), mean flow rate (MFR)) analysis and videostroboscopy were done. RESULTS: There were significant differences in Fo, jitter, shimmer, NHR, MPT and MFR between VPL group and the normal control group. In videostroboscopy, the following tendencies were observed in many cases: incopmplete glottic closure, decreased and irregular mucosal wave and amplitude, supraglottic voicing, abnormal arytenoid movement and anterior commissure blunting. CONCLUSION: We had objective phonatory data after VPL without glottic reconstruction, which showed that voice quality after VPL without glottic reconstruction were somewhat unsatisfactory. Further studies on other surgical techniques of VPL would help to elucidate better ways of improving voice quality in these patients.

A Case of Recurrent Multiple Myoepithelioma in Cheek / 대한이비인후과학회지

Myoepithelioma, adenomas consisting only of myoepithelial cells, are very rare tumors that comprise 1% or less of salivary neoplasms. Myoepithelioma resembles pleomorphic adenomas in its appearance and growth pattern but is more aggressive than pleomorphic adenoma. Myoepithelioma rarely transforms into malignant myoepithelioma like pleomorphic adenoma. We report a case of myoepithelioma with low malignant potential of the minor salivary gland in cheek and accessory parotid gland on its third recurrency, progressing from benign myoepithelioma. The third recurrency showed more aggressive clinical features and more frequent mitotic features than the first and second recurrent tumor.

Effect of Cervical Lymph Node Metastasis on Prognosis and it's Risk Factors in Parotid Carcinomas / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Management of the clinically negative neck remains a controvertial issue in patients with carcinoma of the parotid gland. In order to assist in selecting appropriate patients of elective neck dissection, we sought to determine how regional nodal metastasis affects survival in patients with parotid carcinomas and to identify clinical predictors for nodal disease. MATERIALS AND METHOD: We retrospectively evaluated 124 patients with parotid carcinoma who received their definitive treatment at the Severance hospital between 1988 and 2003. A total of 84 neck dissections (ND) were performed. 24 of 84 patients who underwent neck dissection had pN(+)-staged stage. Seventy patients had an elective ND (subdigastric ND in 50 and supraomohyoid ND in 20), usually because of ominous histology or high T stage. Kaplan-Meier survival analysis was conducted to compare patients with and without histopathologic evidence of nodal disease. Univariate and multivariate analyses were carried out using logistic regression evaluating the significance of demographic, clinical, and pathological data. RESULTS: Patients with no evidence of nodal disease had significantly improved survival over patients with pathologically positive nodes (p<0.00001). The following variables were significantly associated to the risk of lymph node metastasis by univariate analysis: sex (p=0.0093), facial palsy (p=0.0001), T stage (p=0.0003), tumor location (p=0.01) and histologic type (p=0.0009). By multivariate analysis, only facial palsy had the highest correlation with lymph node metastasis. CONCLUSION: Nodal disease significantly decrease survival in patients with parotid carcinoma. Tumor histopathologic type and facial nerve involvement are the most important predictors of nodal disease. Therefore, even in cN0, we should consider elective neck dissection in parotid carcinomas in case of high-grade malignancy and/or facial nerve paralysis.

Results of Otolith Reposition Therapy in Various Types of BPPV / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Benign paroxysmal positional vertigo (BPPV) has been well controlled with otolith reposition maneuver. The purpose of this study was to investigate the incidence of various forms of BPPVs such as type change during the reposition maneuver, combined type and recurred cases, to study the therapeutic result of physical therapy in various forms of BPPVs, and to figure out the therapeutic strategy. MATERIALS AND METHOD: One hundred and twenty-seven patients who were diagnosed with BPPV were included in this study. Reposition maneuver was performed once a day until nystagmus disappeared. In the case of posterior canal BPPV, Epley maneuver was performed. In the case of lateral canal BPPV, barbecue rotation maneuver was performed in canalolithiasis type, and cupulolith reposition maneuver in cupulolithiasis type. In each type of BPPV, we analyzed the number of treatment, recurrence, changing type, and the relationship between recurrence and age or sex of patients. RESULTS: Posterior canal origin was more common than lateral canal origin. All cases except 2 were recovered by reposition maneuver. In 8 cases, the type of disease was changed, and the treatment of these cases were changed according to new type and origin. Overall recurrence rate was 14%, and they were completely treated with reposition maneuver. There was no correlation between recurrence and origin, type, age or sex of patients. CONCLUSION: Patients showed various origin, type and recurrence. Type of the disease was possibly changeable. Almost all the cases were cured with suitable reposition maneuver. Recurrence rate was relatively high, and the close follow up is required.