Clinical Characteristics and Treatment Outcomes of Congenital Cholesteatoma.

OBJECTIVES: Since its introduction in 2002, the staging system for congenital cholesteatoma, as defined by Potsic, has been used widely owing to its simplicity and predictability. The aim of the present study was to analyze the clinical characteristics and surgical treatment outcomes of congenital cholesteatoma and to correlate them with postoperative recurrence. MATERIALS AND METHODS: A retrospective chart review was performed for 38 patients who were diagnosed with congenital cholesteatoma and who underwent surgical resection between August 2007 and November 2014 at the Department of Otorhinolaryngology of our hospital. RESULTS: The mean age of the patients was 7.9±8.2 years, and the number of males and females was 20 and 18, respectively. The mean follow-up period was 30±26 months. Of the 38 patients, 9 (24%) had residual or recurrent cholesteatoma during follow-up examination after primary surgery. The results showed that the size (≥4 mm) of the lesion was significantly correlated with residual or recurrent disease (p=0.026). The disease extent (single vs. multiple quadrant involvement), type (closed vs. open type), and stage; applied surgical method (with mastoidectomy vs. without mastoidectomy); and preoperative hearing level (normal vs. abnormal) were not significantly correlated with residual or recurrent disease. CONCLUSION: The disease extent, type, and stage; applied surgical methods; and preoperative hearing level were not significantly correlated with residual or recurrent disease. The size (≥4 mm) of congenital cholesteatoma was significantly correlated with residual or recurrent disease.

One-Stage Complete Resection of Cholesteatoma With Labyrinthine Fistula: Hearing Changes and Clinical Outcomes.

OBJECTIVES: To evaluate long-term hearing changes and surgical outcomes for middle ear cholesteatoma with labyrinthine fistula following complete surgical removal of the cholesteatoma matrix. METHODS: Consecutive samples of 43 patients who underwent 1-stage complete resection of the cholesteatoma matrix overlying a labyrinthine fistula were obtained. Immediate and long-term hearing changes were analyzed in association with fistula size. Accuracy of various diagnostic examinations was assessed. RESULTS: Immediately postsurgery, the average bone conduction threshold (43.34 dB) did not differ significantly from the preoperative value (36.66 dB, P = .083). There were also minimal changes thereafter (45.63 dB) without recurrent case over an average follow-up time of 38.3 months (range, 17-69 months). More than 10 dB hearing loss was found in 7 patients with a case of intraoperative perilymph leakage (2.3%), although 5 of them had had preoperative air conduction threshold above 90 dB. Their fistulas were significantly larger than those of patients without hearing loss ( P = .027). CONCLUSION: Although caution is required for total removal of a large fistula, owing to increased risk of postoperative hearing deterioration, 1-stage complete resection of cholesteatoma matrix on labyrinthine fistula could be effective in disease control and long-term hearing preservation.

Analysis of Eustachian Tube Dysfunction by Dynamic Slow Motion Video Endoscopy and Eustachian Tube Dysfunction Questionnaire in Chronic Otitis Media.

OBJECTIVES: Eustachian tube dysfunction has been associated with most cases of middle-ear disease. We aimed to assess the effectiveness of dynamic slow motion video endoscopy (DSVE) as a test of eustachian tube dysfunction. Furthermore, we assessed the correlation of the test with the Valsalva maneuver, the seven-item Eustachian Tube Dysfunction Questionnaire (ETDQ-7), and intraoperative findings of the eustachian tube. METHODS: We retrospectively reviewed medical records from April to September 2014 to identify patients who were diagnosed with chronic otitis media (COM) at Korea University Ansan Hospital. They all underwent surgery because of COM without cholesteatoma and were assessed via the DSVE and ETDQ-7 to determine eustachian tube function. RESULTS: We reviewed 46 COM patients and examined 46 ears with COM and 46 ears on the contralateral side to COM that were thought to be normal. The mean DSVE grade in COM ears was 1.57±0.96, while the mean DSVE grade in contralateral ears was 1.15±0.94. The difference in DSVE between COM ears and normal ears was statistically significant (P=0.006). In the ETDQ-7, a higher score was related to intraoperative obstruction of the eustachian tube (P=0.012). CONCLUSION: DSVE and ETDQ-7 can provide information regarding preoperative status of eustachian tube dysfunction by measuring dynamic structural changes of the eustachian tube in combination with other diagnostic tests.

Clinical Correlation between Perverted Nystagmus and Brain MRI Abnormal Findings.

BACKGROUND AND OBJECTIVES: To analyze the clinical correlation between perverted nystagmus and brain magnetic resonance imaging (MRI) abnormal findings and to evaluate whether perverted nystagmus is clinically significant results of brain abnormal lesions or not. SUBJECTS AND METHODS: We performed medical charts review from January 2008 to July 2014, retrospectively. Patients who were suspected central originated vertigo at Frenzel goggles test were included among patients who visited our hospital. To investigate the correlation with nystagmus suspected central originated vertigo and brain MRI abnormal findings, we confirmed whether performing brain MRI or not. Then we exclude that patients not performed brain MRI. RESULTS: The number of patients with perverted nystagmus was 15, upbeating was 1 and down-beating was 14. Among these patients, 5 patients have brain MRI abnormal findings. However, 2 patients with MRI abnormal findings were not associated correctly with perverted nystagmus and only 3 patients with perverted nystagmus were considered central originated vertigo and further evaluation and treatment was performed by the department of neurology. CONCLUSIONS: Perverted nystagmus was considered to the abnormalities at brain lesions, especially cerebellum, but neurologic symptoms and further evaluation were needed for exact diagnosis of central originated vertigo.

Comparison of transaxillary approach, retroauricular approach, and conventional open hemithyroidectomy: A prospective study at single institution.

BACKGROUND: The aims of this study were to evaluate and compare the operative outcomes and postoperative subjective functional parameters of transaxillary (TA) and retroauricular (RA) approach thyroidectomy, with those of conventional hemithyroidectomy. METHODS: From May 2011 through December 2013, 153 patients who underwent hemithyroidectomy were categorized prospectively into 3 groups according to the surgical approach used (TA, RA, and conventional hemithyroidectomy groups). All patients underwent prospective acoustic and functional evaluation, using a comprehensive battery of functional assessments, preoperatively and postoperatively at 1 week, 1 month, 3 months, 6 months, and 12 months. RESULTS: Age at diagnosis was significantly lower in the TA (n = 50) and RA groups (n = 42) than in the conventional group (n = 61; P < .001). The frequency of occurrence of vocal cord paralysis, inadvertently excised parathyroid, and hematoma did not differ among the groups (P = .447, .519, and .069, respectively). Three months postoperatively, maximal vocal pitch was significantly higher in the RA group than in the conventional and TA groups (P = .021). Although the overall pain score was not different, the Dysphagia Handicap Index of the RA group at 1 month postoperatively was significantly higher (P < .001) than in the other groups. Chest paresthesia was significantly more severe in the TA group, especially at 3 months postoperative (P = .035). The cosmetic satisfaction score was significantly higher in the RA and TA groups than in the conventional group (P = .001 and 0.035, respectively) at 3 and 6 months postoperatively. CONCLUSION: Both TA and RA hemithyroidectomy were followed by excellent surgical outcomes, especially with regard to cosmesis. However, delayed recovery of swallowing in RA and chest paresthesia in TA may be mitigating factors.

Protective effects of caffeic acid phenethyl ester (CAPE) against neomycin-induced hair cell damage in zebrafish.

OBJECTIVE: Caffeic acid phenethyl ester (CAPE) is known to reduce the generation of oxygen-derived free radicals, which is a major mechanism of aminoglycoside-induced ototoxicity. The objective of the present study was to evaluate the effects of CAPE on neomycin-induced ototoxicity in zebrafish (Brn3c: EGFP). METHODS: Five-day post-fertilization zebrafish larvae (n=10) were exposed to 125 µM neomycin and one of the following CAPE concentrations for 1h: 50, 100, 250, 500, or 1000 µM. Ultrastructural changes were evaluated using scanning electron microscopy (SEM). The terminal deoxynucleotidyl transferase (TdT)-mediated dUTP-biotin nick-end labeling (TUNEL) assay and 2-[4-(dimethylamino)styryl]-N-ethylpyridiniumiodide (DASPEI) assay were performed for evaluation of apoptosis and mitochondrial damage. RESULTS: CAPE decreased neomycin-induced hair cell loss in the neuromasts (500 µM CAPE: 12.7 ± 1.1 cells, 125 µM neomycin only: 6.3 ± 1.1 cells; n = 10, P < 0.05). In the ultrastructural analysis, structures of mitochondria and hair cells were preserved when exposed to 125 µM neomycin and 500 µM CAPE. CAPE decreased apoptosis and mitochondrial damage. CONCLUSION: In the present study, CAPE attenuated neomycin-induced hair cell damage in zebrafish. The results of the current study suggest that neomycin induces apoptosis, and the apoptotic cell death can be prevented by treatment with CAPE in zebrafish.

A new patch material for tympanic membrane perforation by trauma: the membrane of a hen egg shell.

CONCLUSION: The egg shell membrane (ESM) patch may promote tympanic membrane (TM) healing in acute traumatic TM perforation. OBJECTIVE: To evaluate the use of ESM for treating acute traumatic TM perforation. METHODS: We reviewed charts of patients with traumatic TM injury from 2008 to 2011. Treatments were an ESM patch or a perforation edge approximation. We divided patients into two groups according to the treatment used. Each patient was matched by treatment onset and perforation size. We compared healing ratio, healing time, and frequency of otorrhea between the perforation edge approximation group and the ESM patch group. Matched t tests were used for analysis. RESULTS: The healing ratio of the TM showed no significant difference between the two groups, but the time to heal was significantly shorter in the ESM patch group than in the perforation edge approximation group.