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.

Total Bilirubin Is Associated with Small Intestinal Bacterial Overgrowth in Diarrhea Predominant Irritable Bowel Syndrome.

BACKGROUND: Small intestinal bacterial overgrowth (SIBO) associated with irritable bowel syndrome (IBS) can cause microscopic mucosal inflammation and oxidative damage. Bilirubin is a marker of oxidant stress that is responsible for anti-oxidative activities. The objective of this research was to determine whether or not total bilirubin is associated with SIBO according to IBS subtypes. MATERIALS AND METHODS: We retrospectively reviewed the charts of patients who showed IBS symptoms with documented results of lactulose breath test for SIBO. Multivariate models were used in order to assess the relationship of total bilirubin with SIBO according to IBS subtypes. In addition, we observed changes in total bilirubin when SIBO was treated with rifaximin in the relevant IBS subtype. RESULTS: The total bilirubin level of subjects with SIBO was significantly higher than it was in those without. An examination according to IBS subtype groups showed that total bilirubin was independently associated with SIBO only in the subjects with diarrhea-predominant IBS subtype (OR: 2.723, 95% CI: [1.303-5.692], p<0.001). Additionally, a decrease in total bilirubin level and overall improvement of abdominal symptoms were observed following rifaximin treatment. CONCLUSIONS: These findings suggest that total bilirubin levels may provide additional information regarding the presence of SIBO in diarrhea-predominant IBS patients.

Canal Wall-Down Mastoidectomy plus Meatoplasty for Extensive Verruca Vulgaris in the Ear Canal and Mastoid Bone.

Verruca vulgaris is commonly seen on the hands, feet, and face, but rarely in the external auditory canal. We report the case of a 57-year-old woman with a huge papillary mass filling the entire external auditory canal, with destruction of the posterior canal wall and excavation into the mastoid bone. We performed en bloc resection of the whole region affected by verruca vulgaris, including the external auditory canal, mastoid skin, and tympanic membrane using canal wall-down mastoidectomy plus meatoplasty. There was no evidence of recurrence 12 months postoperatively. Complete surgical removal by mastoidectomy is a promising option for wide-spread verruca vulgaris in the external auditory canal.

Comparison of Long-Term Outcome of Intratympanic Dexamethasone Therapy between Acute Noise-Induced Tinnitus and Acute Idiopathic Tinnitus.

OBJECTIVE: To compare the long-term outcomes of acute noise-induced tinnitus (ANT) and acute idiopathic tinnitus (AIT) to intratympanic dexamethasone (ITD) therapy. MATERIALS AND METHODS: Patients treated for tinnitus occurring immediately after noise exposure comprised the ANT group (n=20) and patients treated for idiopathic tinnitus comprised the AIT group (n=39). All patients were treated with ITD within 3 months of the onset of tinnitus. Quantitative assessment of the improvement in tinnitus using questionnaires and changes in hearing thresholds were compared between the two groups. RESULTS: Mean follow-up durations were 75.90±69.83 weeks in the ANT group and 93.41±101.43 weeks in the AIT group. Patients with ANT were younger in age than those with AIT (38.30±18.28 vs. 53.56±14.08, p=0.00) and were predominately male (Male: Female, M:F 13:7 vs. 13:26, p=0.02, respectively). The subjective tinnitus loudness, time of tinnitus awareness, and Tinnitus Handicap Inventory score improved in both groups, although the changes in these parameters were not significantly different between the groups. The cure and overall improvement rates of the ANT group were and 10.00% and 25.00%, respectively. The cure and overall improvement rates of the AIT groups were 25.64% and 35.90%, respectively and there were no significant differences between the two groups in terms of the cure and overall improvement rates (p=0.19 and 0.40, respectively). CONCLUSION: The long-term outcome in terms of control of tinnitus with ITD in the ANT group was similar to that in the AIT group. Thus, ITD injection may be a useful treatment option for acute tinnitus caused by noise trauma.