A Case of Acute Vestibular Neuritis with Periodic Alternating Nystagmus / 대한이비인후과학회지

Detection of nystagmus is an important diagnostic clue in patients with acute vertigo. Patients with peripheral disorders exhibit nystagmus with a constant direction whereas those with central disorders exhibit nystagmus with changes in direction with or without gaze fixation. Periodic alternating nystagmus (PAN) is a horizontal or horizontal-rotary jerk-type nystagmus that reverses its direction with time. PAN is typically observed in patients with central disorders, such as cerebellar or pontomedullary lesions, but it is also observed in patients with peripheral disorders, albeit rarely. Here we report a rare case of a 58-year-old patient with vertigo with PAN, which was initially suspected as a central disorder, but eventually diagnosed as a peripheral vestibular disorder. We investigated the characteristics and mechanisms of peripheral PAN in this case. The absence of central disorder symptoms, visual suppression of PAN, normal oculomotor findings, and transient persistence are important diagnostic clues for differentiating peripheral from central PAN.

Idiopathic Sudden Sensorineural Hearing Loss Is Correlated with an Increased Risk of Stroke: An 11-Year Nationwide Population-Based Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sudden sensorineural hearing loss (S-SNHL) occurs abruptly, developing rapidly within 3 days. The criteria for the diagnosis of S-SNHL are idiopathic hearing loss of at least 30 dB over at least three serial test frequencies. This study estimated whether S-SNHL increases the risk of stroke using Korean National Health Insurance Service National Sample Cohort (NHIS-NSC 2002-2013) data. SUBJECTS AND METHOD: Among NHIS-NSC 2002-2013, we excluded the patients diagnosed as S-SNHL or stroke in 2002. The patients who were diagnosed and treated as S-SNHL (n=2510) and the comparison group (n=12550) extracted using propensity score matching were enrolled. During an 11-year follow-up period until December 2013, the incidence of stroke among two groups was analyzed and the result was adjusted for the impact of comorbidities such as hypertension, diabetes, and chronic kidney disease with Cox proportional hazard regression. RESULTS: According to our data, 10.8% of S-SNHL patients (among 2510) and 7.8% of the comparison group (among 12550) had strokes. Stroke incidence was reported higher in patients with history of S-SNHL compared to the comparison group [hazard (HR), 1.15; 95% confidence interval (CI), 1.01-1.32] followed by patients with hypertension (HR, 2.51; 95% CI, 2.22-2.84), diabetes mellitus (HR, 1.62; 95% CI, 1.43-1.85). In terms of the type of strokes, S-SNHL increased the risk of ischemic stroke (HR, 1.18; 95% CI, 1.02-1.37). CONCLUSION: S-SNHL appeared to be associated with an increased risk of developing stroke after adjusting for other risk factors.

The Prevalence and Risk Factors of Tinnitus in Korean Adolescents / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Tinnitus is the perception of sound in the absence of any outside acoustic stimulus with high prevalence. Multiple risk factors for tinnitus have been identified. So far, most of studies have concentrated on prevalence and associated chronic disease of tinnitus in adults. In the present study, we focused on tinnitus in adolescents which has not been adequately evaluated. The main goal of this study was to assess the prevalence and associated risk factors of tinnitus in adolescents. SUBJECTS AND METHOD: This study was a retrospectively designed analysis of data from the 5th Korea National Health and Nutrition Examination Survey conducted in 2011-2012. We used tinnitus related interview data, the results of physical and audiological evaluation by ENT specialists, the results of daily intake of vitamin using a 24-hour dietary recall method, and blood samples in 1370 subjects. RESULTS: The prevalence of tinnitus was 22.2% in the age range of 12 and 19 years old. Logistic regression is a statistical method used to assess the association between tinnitus and independent variables. The following factors were independently and positively associated with tinnitus; sex (adjusted OR=1.531, CI=1.097-2.137), excessive earphone use (adjusted OR=1.422, CI=1.026-1.970), Non-occupational noise (adjusted OR=4.096, CI=1.702-9.859), explosive noise (adjusted OR=4.100, CI=1.703-9.872), niacin intake (adjusted OR=0.966, CI=0.940-0.993), vitamin (vit.). D serum concentration (adjusted OR=0.959, CI=0.925-0.994). CONCLUSION: This study showed an association between tinnitus prevalence in adolescents and gender, noise exposure, and vit. D supplement. Tinnitic patients are recommended to reduce excessive noise and use hearing protection devices such as earplugs or earmuffs; they are also recommended to obtain a supply vit. D from adequate sun exposure and outside activities.

Hearing Rehabilitation with Sophono(R) in Patients with Unilateral Hearing Loss after Meningioma Removal / 대한이비인후과학회지

Various bone conduction hearing aids have been widely used to improve hearing fuction for the last 30 years. Sophono(R), a newly introduced device without percutaneous abutment, improved disadvantages of previously used bone conduction hearing aids. Recently, we experienced a case of Sophono(R) implantation in a patient presenting with mixed hearing loss followed by tumor surgery. The patient gained air conduction threshold of 60 dB HL compared to preoperative pure tone audiogram and a speech discrimination test in noisy environment showed improved results. Furthermore, the patient has had no cutaneous complications since implantation. The results of this case demonstrate the feasibility of implanting Sophono(R) in patients similar to this case. Considering its advantages of MRI compatibility and non-invasive surgery, as well as esthetical benefit, Sophono(R) implantation could be a preferable option for hearing rehabilitation.

Study about Economic Adequacy of Tonsillectomy and Adenoidectomy Based on Medical Prime Costs / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The Korean National Health Insurance is based on 'fee for service' system, but recently 7 groups of diseases were forcibly applied to diagnosis related groups (DRG) system. In these 7 group of diseases, tonsillectomy and adenoidectomy were included in the otorhinolaryngology field. The objective of this research is to estimate the invested medical costs, profit and loss, and improvement points for the disease groups according to DRG and 'fee for service' system. SUBJECTS AND METHOD: We investigated 1,377 subjects who underwent tonsillectomy and adenoidectomy based on DRG between January 2011 to December 2013 at our hospital. The profit and loss of medical costs were calculated according to medical record data, medical service fee, and activity based costing (ABC). RESULTS: The total of 1,377 subject comprised of 905 patients younger than 17 years-old and 472 patients older than 18 years-old. A main moderate complication that was not one of the DRG diseases, postoperative bleeding, was only found in 19 patients (1.38%). Profit related to tonsillectomy and adenoidectomy studied for a 3 year-period was higher in the DRG system than in the 'fee for service' system; however, profit was reported as 62.9-67.5% of the actual prime costs. CONCLUSION: DRG system for tonsillectomy and adenoidectomy seems to have higher compensation rate than the 'fee for service' system does. However, the system is still insufficient to compare profit with the input medical cost. Furthermore, the present system of disease grouping needs to be improved to reflect actual medical prime costs.

A Case of Sudden Deafness with Intralabyrinthine Hemorrhage Intralabyrinthine Hemorrhage and Sudden Deafness

Sudden hearing deterioration may occur in our population, but it is difficult to explain the exact pathophysiology and the cause. Magnetic resonance imaging (MRI) in sudden sensorineural hearing loss (SSNHL) is usually useful to evaluate neural lesions such as acoustic schwannoma and hemorrhage in labyrinth. Recently some cases of SSNHL caused by intralabyrintine hemorrhage were reported by the advance of MRI. In the case of intralabyrintine hemorrhage, MRI showed a hyperintense signal in the labyrinth on the pre-contrast and contrast enhanced T1-weighted image and relatively weak intensity on T2-weighted image. The prognosis SSNHL by intralabyrintine hemorrhage is generally known to be poor. We report a case of sudden deafness with intralabyrintine hemorrhage who has a history of anticoagulant administration, with a review of literature.

A Case of Herpes Zoster Oticus Involving Multiple Cranial Nerves without Facial Palsy / 대한이비인후과학회지

Varicella zoster virus (VZV) infection of the head and neck region may present with various symptoms. We present a case of VZV infection of the external ear (cranial nerve V), pharynx and larynx with neuropathy of three ipsilateral lower cranial nerves (IX, X, XII). The patient's paresthesia was reduced after antiviral therapy and oral steroids. By the end of one month follow-up, the patient showed normal movement of vocal cord, soft palate and tongue.

Change of Voice Quality before and after Treatment of Short-Term Therapy with Proton Pump Inhibitor in Laryngopharyngeal Reflux / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The aim of this study was to verify that voice analysis could be an alternate tool for the evaluation of proton pump inhibitor treatment of laryngopharyngeal reflux (LPR). SUBJECTS AND METHOD: Twenty-two patients with LPR symptoms underwent laryngoscopy, stroboscopy and their reflux finding index (RFI) were evaluated. Subjective reflux symptom scores (RSS) and voice handicap index (VHI) were completed at the baseline. All patients underwent voice analysis. Thereafter, patients had short-term proton pump inhibitor therapy for 6 weeks. The RFI, RSS, VHI and voice analysis were repeated during the last week of the treatment. RESULTS: RFI was improved and both RSS and VHI were improved after the treatment. RSS and VHI were significantly correlated. In voice analysis, shimmer significantly improved and harmony to noise ratio (HNR) also improved. CONCLUSION: Voice analysis can be indicators of treatment results of laryngopharyngeal reflux disease.