Cochlear Implantation in the Elderly: Speech Performance, Associated Factor, Complication, and Surgical Safety

Background and Objectives@#The guidelines for cochlear implantation (CIs) are expanding, and the number of CI procedures performed on the elderly is increasing. The purpose of this study was to analyze the results and safety of cochlear implantation in the elderly, as well as to evaluate the predictive factors on CI outcomes. @*Subjects and Methods@#The study included 56 patients aged ≥40 years, who received CIs between 2009 and 2020. They were divided into two groups: 27 younger adults (40-64 years) and 29 elderly (>64 years). The study compared their pre- and postoperative speech perception and category of auditory performance (CAP) scores, surgical complications, and hospitalization periods. It also evaluated associated factors in the elderly group by examining categorical and continuous variables and postoperative CAP score. @*Results@#There was a significant improvement in speech recognition tests (both word and sentence) and CAP scores in both groups compared to the pre-implantation scores (p<0.001). Postoperative results were slightly lower in the elderly group than in younger adults for sentence recognition and CAP scores, except for word recognition. No significant associated factors were found on postoperative CAP scores, except for etiology. Postoperative CAP significantly improved in the sudden hearing loss group compared to the groups with other etiologies (p=0.045). The elderly group had more comorbidities than that in the younger adult group (p=0.026), but there were no significant differences in postoperative complications and hospitalization periods. @*Conclusions@#While speech recognition and CAP scores were relatively lower in the elderly group compared to the younger adults, the elderly group showed significant improvements in audiological results after CI. Moreover, CI was safe and well tolerated in elderly patients.

Treatment Efficacy of Various Maneuvers for Lateral Canal Benign Paroxysmal Positional Vertigo With Apogeotropic Nystagmus: A Randomized Controlled Trial

Objectives@#The aim of this study was to determine the most effective treatment approach by comparing the impacts of various otolith reduction techniques in patients with apogeotropic lateral semicircular canal benign paroxysmal positional vertigo (LC-BPPV). @*Methods@#We performed a multicenter randomized prospective study from January to December 2015, involving 72 consecutive patients with apogeotropic LC-BPPV. The patients were divided into three treatment groups: therapeutic head-shaking (group A), the Gufoni-Appiani maneuver (group B), and the cupulolith repositioning maneuver (CuRM; group C). Each group underwent evaluation and treatment up to the fourth week. Treatment success was defined as the disappearance of positional vertigo and nystagmus. @*Results@#This study included 72 patients (49 male and 23 female), with a mean (±standard deviation) age of 55.4±13.5 years. The mean duration of vertigo experienced prior to treatment was 3.9±4.4 days. The mean latency and duration of nystagmus were 2.7±3.0 seconds and 47.9±15.8 seconds, respectively. The overall treatment frequency was 2.0±0.9. The number of treatments differed significantly among the three groups (P0.05). However, CuRM was the only method with a 100% treatment success rate. @*Conclusion@#While no clear difference was observed among the three treatments for LC-BPPV, CuRM was found to be superior to the other approaches in the long term.

Hearing Rehabilitation of Single-Sided Deafness: Benefit and Selection Criteria of Bone Anchored Hearing Aid and Contralateral Routing of Signal Hearing Aid / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: There are two ways to route sound from a deaf hemifield to a functional ear: the bone anchored hearing aid (BAHA) and the contralateral routing of signal hearing aid (CROS HA). BAHA uses transcranial bone conduction; on the other hand, CROS HA uses air conduction. The objectives of this study were to evaluate the benefit of these auditory rehabilitation devices objectively and subjectively, and to analyze factors that affect daily using time. SUBJECTS AND METHOD: We retrospectively reviewed the medical records of 19 patients who selected BAHA and 9 patients who selected CROS HA to undergo rehabilitation of unilateral hearing loss. Preoperative pure tone air and bone conduction thresholds, BAHA-aided thresholds and CROS HA-aided thresholds were measured. Hearing in noise test (HINT) was measured with unaided and aided in signal to noise ratio 10 (signal 75 dB HL, noise 65 dBA). Bern Benefit in Single-Sided Deafness Questionnaire (BBSS) was evaluated for all patients to assess subjective satisfaction and also, daily device using time was investigated. RESULTS: The aided pure tone audiometry was 44.58 dB HL, 42.71 dB HL for in BAHA and CROS HA, respectively, whereas the unaided PTA was 111.29, 103.28 dB HL for BAHA and CROS HA, respectively. The aided HINT was 63.03 and 64.06%, whereas the unaided HINT was 22.13% and 37.44% for BAHA and CROS, respectively. BBSS showed more satisfactory results with BAHA and CROS HA when compared unaided in all items. Daily using time did not correlate with the degree of satisfaction, better ear hearing levels or etiology. CONCLUSION: It was found that not only the preoperative BAHA rod test and HA trials but also the customized and detail counseling were needed for single sided deaf patients to use auditory rehabilitation devices frequently.

Current Trends in the Treatment of Subjective Tinnitus at University Hospitals in Korea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The effective management of subjective tinnitus should start with an accurate diagnosis based on an appropriate classification. Since there is no gold standard for managing subjective tinnitus, clinicians can select from various treatment options after considering the multifactorial etiology of tinnitus. This study surveyed otologists at university hospitals in Korea to identify the treatments used for subjective tinnitus and to obtain basic information on evidence-based medicine for treating tinnitus. SUBJECTS AND METHOD: A five-major-item questionnaire on current tinnitus treatments was sent by email to otologists at 37 university hospitals in Korea; 30 (81.1%) replied. RESULTS: The mean incidence of tinnitus in otology outpatient clinics was 22.7% (range 10-40%). Common treatments were oral pharmacological therapy, regular counseling with tinnitus retraining or cognitive behavioral therapy and hearing aids. Tinnitus retraining therapy and hearing aids were considered the most effective when the visual analog scale scores were 7.0 and 6.6, respectively, and considered safe when the scores were 9.9 and 9.3. Ginkgo biloba and benzodiazepines were the most frequently prescribed drugs, although their reported effectiveness was questionable. Intra-tympanic steroid injection was not considered effective (3.8) or safe (6.3). Somatosensory-based treatments such as treating neck muscle or temporomandibular joint disorders were also used to relieve a subgroup of somatic tinnitus. CONCLUSION: Our results showed trends similar to those in other countries, yet we have not reached the level of evidence-based clinical practice due to the lack of reliable and effective treatment options. Further research on tinnitus-treatments is needed, particularly about randomized controlled studies with blinding.

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.

Treatment Strategy for Sudden Sensorineural Hearing Loss / 대한이비인후과학회지

Sudden sensorineural hearing loss is an emergent disease in otologic field. Because the etiology and pathological mechanism were not proven yet, treatment protocol was not established. Therefore, medications, duration, and dosage were different from each institute. In this review, authors collected and analyzed articles on sudden sensorineural hearing loss published during recent 11 years. From those, we described the recommendations on the criteria and method of diagnosis, tools for treatment and their results, and guideline for reporting results and follow up.

The Feasibility of Using Automated Distortion Product Otoacoustic Emission (DPOAE) as a Screening Auditory Function Test of Workers in a Noisy Environment / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Automated DPOAE (Distortion product otoacoustic emission) was tested on workers exposed to a noisy environmnent to determine its feasibility as a screening test for noise-induced hearing loss. SUBJECTS AND METHOD: Sensitivity and specificity were analyzed for in both automated DPOAE and Pure tone audiometry conducted on 300 subjects working in a noisy environment. Of these subjects, a subgroup of 40 workers who were available for a follow-up study underwent the same experiment again a year later, and the results were compared with the first one. RESULTS: In terms of the frequency of automated DPOAE, it was noted that it showed 91% sensitivity with a 9% false negative rate. The pass rate according to the period of service indicated statistical significance, although the results of a 1 year follow-up experiment did not indicate statistical significance. CONCLUSION: The automated DPOAE seems feasible to use as a screening test when frequency and adjusted reference criteria are considered.

A Case of Collagen Graft for Patulous Eustachian Tube / 대한이비인후과학회지

The patulous eustachian tube is not a common otorhinolaryngological disease, for which a standard therapy is not established yet. It is considered benign, but symptoms affecting the patient should not be overlooked or ignored. Using an acellular dermal graft (Collagen), we gained positive results in treating a patient, and thus report this case with a review of the literature.

A Case of Hereditary Hemorrhagic Telangiectasia: Surgical Treatment with Modified Septodermoplasty / 대한이비인후과학회지

Hereditary hemorrhagic telangiectasia (HTT) or Rendu-Osler-Weber disease, identified nearly a century ago, is a familiar syndrome inherited by an autosomal dominant mode. It is characterized by recurrent epistaxis with multiple telangiectatic lesions on the mucosa and skin, basically capable of involving blood vessels in any part of the body. HTT is an important disease for otolaryngologists to familiarize with, because 90 percent of patients who experience epistaxis are referred to the department of otorhinolaryngology for its evaluation and treatment. Its occurence is not unusual in the western countries, but relatively rare in many Asian countries. We report a recent case of a 64-year-old male patient who had been suffering from GI bleeding, and experiencing recurrent epistaxsis for more than 30 years. His epistaxis was successfully treated with modified septodermoplasty.

Morphologic Changes in Cultured Normal Human Nasal Epithelial Cells Following Treatment with Histamine

The aims of this study are to observe morphologic changes in normal human nasal epithelial (NHNE) cells caused by varying concentrations of histamine, to evaluate the changes in relation to the degree of epithelial differentiation, and to examine whether these changes are caused by the proper action of histamine or are general inflammatory processes represented by lipopolysaccharide (LPS). Cultured NHNE cells were treated with histamine diphosphate and LPS 0111 : B4 at different concentrations : 20 ng/ml, 200 ng/ml, 2 microgram/ml and 20 microgram/ml. The timing of the treatment was conducted in one of two ways : a duration of 48 hours on floating day 12 or a duration of seven days on floating day seven. On floating day 14, all specimens were collected, and hematoxylin & eosin staining and scanning electron microscopy (SEM) were conducted. The areas of ciliated and secretory cell were calculated with the Optimas program. In SEM of specimens that were given 48-hour treatments of histamine and LPS at 20 microgram/ml dosages, coverage by secretory cells had increased and damaged cilia were noted. In SEM of specimens given the seven-day treatment, enlargement of the secretory cell area and damaged cilia were observed after a treatment of 20 microgram/ml LPS, but in specimens treated with histamine, findings were normal. Morphologic changes caused by histamine treatment may be a nonspecific finding observed in inflammation, and the changes can vary according to the differentiation of the epithelium.