Clinical characteristics of persistent postural-perceptual dizziness and its visual subtype in Korean patients: A multicenter cross-sectional study.

OBJECTIVES: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder for which the Bárány Society has established diagnostic criteria. This nationwide multicenter study aims to investigate the clinical features of individuals with definite PPPD and clinical variant PPPD who do not fully meet the diagnostic criteria, with a particular focus on visual exaggeration. METHODS: Between September 2020 and September 2021, a total of 76 individuals with definite PPPD and 109 individuals with clinical variant PPPD who did not meet all three exacerbating factors outlined in Criterion B were recruited from 18 medical centers in South Korea. The study gathered information on demographic factors, clinical manifestations, balance scales, and personality assessments. RESULTS: Comparative analysis between groups with definite PPPD and clinical variant with visual exacerbation revealed no significant differences in sociodemographic characteristics, clinical course, dizziness impact, and specific precipitants. Only disease duration was significantly longer in definite PPPD compared with variant with visual exacerbation. However, the variant without visual exacerbation displayed significantly reduced rates of panic disorder, diminished space-motion discomfort, lesser impact of dizziness, and decreased prevalence of depression when compared with the definitive PPPD. CONCLUSION: This is the first comprehensive nationwide study examining clinical features of both definite PPPD patients and its clinical variants, considering visual exacerbating factors. Differences in dizziness and personality traits emerged between definite PPPD and its potential variant without visual issues. Our results highlight the possibility of a distinct clinical variant of PPPD influenced by visual dependency.

Personalized Neuromodulation: A Novel Strategy for Improving Tinnitus Treatment.

This study evaluated the efficacy of personalized neuromodulation, where treatment modalities are chosen based on the patient's responses in a pilot trial. A total of 71 patients with tinnitus were divided into two groups: a personalized group and a randomized neuromodulation group. In the personalized group (n = 35), repetitive transcranial magnetic stimulation (rTMS) and transcranial direct-current stimulation (tDCS) were assessed in a pilot trial, and responsive modalities were administered to 16 patients, while the non-responders (n = 19) were randomly assigned to rTMS, tDCS, or combined modalities. Patients in the randomized group (n = 36) were randomly allocated to rTMS, tDCS, or combined modalities. The Tinnitus Handicap Inventory (THI) score improvement after 10 sessions of each neuromodulation was significantly greater in the personalized group than in the randomized group (p = 0.043), with no significant differences in tinnitus loudness, distress, or awareness. The treatment success rate was highest in the personalized responder subgroup (92.3%), and significantly greater than that in the non-responder subgroup (53.0%; p = 0.042) and the randomized group (56.7%; p = 0.033). Personalized neuromodulation, where the treatment modality is chosen based on the patient's responses in a pilot trial, is an advantageous strategy for treating tinnitus.

Effect of face masks on speech perception in noise of individuals with hearing aids.

Although several previous studies have confirmed that listeners find it difficult to perceive the speech of face-mask-wearing speakers, there has been little research into how masks affect hearing-impaired individuals using hearing aids. Therefore, the aim of this study was to compare the effects of masks on the speech perception in noise of hearing-impaired individuals and normal-hearing individuals. We also investigated the effect of masks on the gain conferred by hearing aids. The hearing-impaired group included 24 listeners (age: M = 69.5, SD = 8.6; M:F = 13:11) who had used hearing aids in everyday life for >1 month (M = 20.7, SD = 24.0) and the normal-hearing group included 26 listeners (age: M = 57.9, SD = 11.1; M:F = 13:13). Speech perception in noise was measured under no mask-auditory-only (no-mask-AO), no mask-auditory-visual (no-mask-AV), and mask-AV conditions at five signal-to-noise ratios (SNRs; -16, -12, -8, -4, 0 dB) using five lists of 25 monosyllabic Korean words. Video clips that included a female speaker's face and sound or the sound only were presented through a monitor and a loudspeaker located 1 m in front of the listener in a sound-attenuating booth. The degree of deterioration in speech perception caused by the mask (no-mask-AV minus mask-AV) was significantly greater for hearing-impaired vs. normal-hearing participants only at 0 dB SNR (Bonferroni's corrected p < 0.01). When the effects of a mask on speech perception, with and without hearing aids, were compared in the hearing-impaired group, the degree of deterioration in speech perception caused by the mask was significantly reduced by the hearing aids compared with that without hearing aids at 0 and -4 dB SNR (Bonferroni's corrected p < 0.01). The improvement conferred by hearing aids (unaided speech perception score minus aided speech perception score) was significantly greater at 0 and -4 dB SNR than at -16 dB SNR in the mask-AV group (Bonferroni's corrected p < 0.01). These results demonstrate that hearing aids still improve speech perception when the speaker is masked, and that hearing aids partly offset the effect of a mask at relatively low noise levels.

Changes in the Mean and Variance of the Numbers of Medical Visits for Allergic Diseases before and during the COVID-19 Pandemic in Korea.

The implementation of precautionary measures, such as wearing a mask and social distancing, may have affected allergic diseases during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to compare the numbers of medical visits for allergic diseases before and during the COVID-19 pandemic. Data were obtained from the Korean National Health Insurance claims database. Monthly numbers of patients for four allergic diseases, i.e., allergic rhinitis (AR), asthma, atopic dermatitis (AD), and allergic conjunctivitis (AC), were evaluated using ICD-10 codes and compared between the 'before COVID-19' period from January 2018 to February 2020, and the 'during COVID-19' period from March 2020 to June 2021, since the first COVID-19 patient was detected on 20 January 2020, in Korea. Subgroup analyses were performed according to age and sex. The mean numbers of medical visits for AR and asthma were significantly greater before COVID-19 than those during COVID-19 (both p < 0.001). The variance in the number of medical visits for asthma decreased during the COVID-19 pandemic. However, the mean number of medical visits for AD increased slightly during COVID-19 and that for AC did not change before and during the COVID-19 pandemic. In subgroup analyses, the results showed a similar pattern to that of the total number of participants, regardless of age and sex. In conclusion, medical visits for AR and asthma significantly decreased during the COVID-19 pandemic, regardless of age and sex.

The Relation of Sound Level Tolerance to Tinnitus Ears in Human.

BACKGROUND: The aim of this study was to evaluate the relationship between sound level tolerance and tinnitus in humans. METHODS: We compared the loudness discomfort levels at 500 and 3000 Hz pure tones in 33 subjects with bilateral tinnitus and 33 subjects with unilateral tinnitus with normal and symmetric hearing thresholds and those of age- and sex-matched control subjects. RESULTS: Both the tinnitus ears (108.18 ± 10.22 dB HL and 103.03 ± 11.04 dB HL) and non-tinnitus ears (108.94 ± 12.61 dB HL and 104.24 ± 11.60 dB HL) in the unilateral tinnitus subjects showed significantly lower loudness discomfort levels at 500 and 3000 Hz than the control ears (115.91 ± 6.78 dB HL and 111.52 ± 8.88 dB HL, P < .008; α=0.05/6=0.008), whereas there was no difference in the loudness discomfort levels of the tinnitus ears of the bilateral tinnitus subjects (111.52 ± 10.42 dB HL or 106.36 ± 11.34 dB HL) and the control ears. CONCLUSION: These results support the hypothesis that the reduced loudness discomfort levels in tinnitus subjects with normal and symmetric hearing thresholds are associated with a hidden injury to the cochlea that induces the development of tinnitus, especially on one side. Whether tinnitus is perceived unilaterally or bilaterally depends on the status of the auditory system, which may be reflected in the sound level tolerance and loudness discomfort levels.

Long-Term Effects of Hearing Aid Use on Auditory Spectral Discrimination and Temporal Envelope Sensitivity and Speech Perception in Noise.

BACKGROUND: The aims of this study were to evaluate the long-term effects of hearing-aid use on auditory spectral discrimination, temporal envelope sensitivity, and speech perception ability and to determine whether hearing performance changes with the duration of hearing-aid use. METHODS: The study included 13 elderly participants (64.15 ± 9.87 years) who had used hearing-aids for 12 months in everyday life. We compared the auditory performance without hearing-aids at the time of pre-fitting with the auditory performance with hearing-aids at 1 month and 12 months after fitting. Three different psychoacoustic measurements were made at their most comfortable levels to exclude the effect of amplification: (1) spectral-ripple discrimination, (2) temporal modulation detection, and (3) speech recognition in white noise. RESULTS: Repeated-measures analysis of variance demonstrated that the duration of hearing-aid use significantly affected spectral-ripple discrimination thresholds and 100 Hz temporal modulation detection threshold (P < .05). Post hoc tests revealed that the improvements in spectral discrimination in the early post-fitting stage (1 month) did not seem to increase over the period of hearing-aid use, whereas the temporal envelope sensitivity improved continuously over time (up to 12 months). CONCLUSION: These results imply that hearing-aid users adapt to hearing-aid processing for spectral discrimination immediately, whereas they need time to adapt to hearing-aid processing for temporal envelope sensitivity. Alternatively, long-term hearing-aid use could induce positive plastic changes exclusively in terms of temporal envelope sensitivity.

Coprevalence of Presbycusis and Its Effect on Outcome of Voice Therapy in Patients With Presbyphonia.

OBJECTIVE: To identify the coprevalence of presbycusis and presbycusis and analyze the effect of presbycusis on compliance and result of voice therapy in presbycusis patients. METHODS: This cross-sectional, prospective cohort study initially screened patients aged ≥65 years who visited our hospital from February 2019 to January 2020. Unaided pure tone audiometry was performed in these subjects to determine the presence of presbycusis. Perceptual voice assessment by an examiner was conducted for screening of presbycusis, and its diagnosis was confirmed through the voice handicap index-10 (VHI-10) questionnaire and a laryngoscopic exam. Patients with presbycusis underwent voice therapy and were assessed for their compliance and outcomes of the treatment according to the coexistence of presbycusis. RESULTS: Among the 221 patients, presbycusis and presbycusis were diagnosed in 125 (56.6%) and 110 (49.8%) patients, respectively. The copresence of these two disorders were identified in 87 (39.4%) patients, and there was a significant correlation between presbycusis and presbycusis. The effects of voice therapy were examined in the consecutive 40 patients who were diagnosed with presbycusis. There were 21 patients without presbycusis and 19 patients with presbycusis. The average pretreatment voice handicap index-10 score was significantly higher in presbycusis patients; there was no significant difference in the incidence of dropout from voice therapy between the groups. The patients without presbycusis showed a significant improvement in the functional communication measurement (FCM) level and maximum phonation time (MPT) compared with those of patients with presbycusis after voice therapy. CONCLUSIONS: Presbyphonia and presbycusis coexisted in many elderly people. The improvement in the FCM level and MPT after voice therapy was relatively low if patients with presbycusis accompanied by presbycusis. The copresence of presbycusis did not significantly affect compliance with voice therapy in the patients.

Within-Subject Comparisons of the Auditory Brainstem Response and Uncomfortable Loudness Levels in Ears With and Without Tinnitus in Unilateral Tinnitus Subjects With Normal Audiograms.

OBJECTIVE: To evaluate whether cochlear synaptopathy is a common pathophysiologic cause of tinnitus in individuals with normal audiograms. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. METHODS: We enrolled 27 subjects with unilateral tinnitus and normal symmetric hearing thresholds, and 27 age- and sex-matched control subjects with normal symmetric hearing thresholds. We measured 1) the amplitudes of waves I and V with 90 dB nHL click stimuli in quiet conditions; 2) the latency shift of wave V with 80 dB nHL click stimuli in background noise, varying from 40 dB HL to 70 dB HL; and 3) uncomfortable loudness levels (UCLs) at 500 Hz and 3000 Hz pure tones. RESULTS: There were no significant differences in the wave V/I amplitude ratio or the latency shift in wave V with increasing noise levels among the tinnitus ears (TEs), nontinnitus ears (NTEs), and control ears. There were no significant differences in UCLs at 500 Hz or 3000 Hz between TEs and NTEs, but the UCLs were lower in TEs (mean 111.3 dB or 104.1 dB) and NTEs (mean 109.4 dB or 100.6 dB) than in control ears (mean 117.9 dB or 114.1 dB, p < 0.017). No subject met our criteria for cochlear synaptopathy or increased central gain in terms of all three parameters. CONCLUSION: Based on these results for UCL, increased central gain is a major mechanism of tinnitus in humans with normal audiograms. However, this compensatory mechanism for reduced auditory input may originate from other pathophysiologic factors rather than from cochlear synaptopathy.

Predictive Factors for the Success of Intratympanic Dexamethasone Treatment of Acute Subjective Tinnitus.

OBJECTIVES: The purpose of this study was to determine the factors predicting the success or failure of intratympanic dexamethasone (ITD) injection in the treatment of acute subjective tinnitus (AST). MATERIALS AND METHODS: We enrolled patients who were treated with ITD within 3 months of the onset of tinnitus, between 2013 and 2017. We compared the clinical characteristics and audiological data of the patients in the cured group (n=38, 45.6±13.3 years old) and the nonresponder group (n=40, 48.9±18.6 years old). RESULTS: The cured group was predominantly female (p=0.002). The mean duration of tinnitus before ITD was shorter in the cured group than the nonresponder group (p=0.002). The pure-tone averages in both sides were lower in the cured group than in the nonresponder group (p=0.018). The time of tinnitus awareness was shorter in the cured group than in the nonresponder group (p=0.014). Multivariable analysis showed that the duration of tinnitus (odds ratio [OR]=1.045), a history of exposure to noise just before tinnitus development (OR=7.766), and distortion product otoacoustic emissions results (OR=4.580) predicted the outcome of ITD treatment in AST. CONCLUSION: A short duration of tinnitus, no history of immediate noise exposure, and normal distortion product otoacoustic emissions could be favorable prognostic factors for AST treated with ITD injection.

Influence of Cochlear Dead Regions on Hearing Outcome in Sudden Sensorineural Hearing Loss.

OBJECTIVE: The aims of this multicenter study were to prospectively evaluate the prevalence of dead regions (DRs) in sudden sensorineural hearing loss (SSNHL) and compare the clinical characteristics and hearing outcomes of SSNHL according to the presence of DRs. STUDY DESIGN: Prospective study. SETTING: Multicenter study. PATIENTS AND METHODS: The threshold-equalizing noise (TEN) test was prospectively performed on a total of 130 patients diagnosed with SSNHL. All patients received systemic steroid therapy and/or intratympanic steroid injection within 1 month after onset. Pure-tone audiograms and the TEN test were conducted before and after steroid treatment. Age, sex, side of affected ear, recurrence, onset of symptoms, presence of dizziness, and comorbid diseases were also collected. The prevalence of DRs in SSNHL and clinical factors related to the DRs were assessed. Hearing outcomes for SSNHL according to DRs were evaluated in 68 patients who followed a pure-tone audiogram. RESULTS: The overall prevalence of one or more DRs in SSNHL evaluated using the TEN test was 20.8% (27/130 subjects) and the overall frequency-specific prevalence of DR was 6.7% (61/910 DRs). Although the DRs (+)and DR (-) groups had similar initial pure-tone thresholds, the DRs (+) group had significantly worse initial WRS compared to the DRs (-) group (p = 0.015). The presence of DRs was not associated with hearing recovery in a multivariate logistic regression model, but it was significantly associated with the degree of hearing gain in a multivariate linear regression model (p = 0.018). CONCLUSIONS: The presence of DRs can be considered one of the poor prognostic factors for SSNHL and the TEN test may contribute to assess the prognosis of SSNHL in clinical settings.