Clinical analysis of recurrent sudden sensorineural hearing loss.

OBJECTIVE: Although the literature includes many reports of the causes, pathogenesis, diagnostic criteria, treatment, and prognostic factors of sudden sensorineural hearing loss (SSNHL), few studies have examined recurrent SSNHL. This prompted us to investigate recurrent SSNHL. STUDY DESIGN: Retrospective study of the hearing results of patients with recurrent SSNHL. METHODOLOGY: We reviewed retrospectively the medical charts of 809 patients with SSNHL examined between January 2000 and June 2011 for information on their history, audiometric results, and magnetic resonance imaging findings. RESULTS: Eleven of the 809 patients had recurrent idiopathic SSNHL. In these 11 patients, the more than partial recovery of hearing after the second attack was poorer than after the first attack, and the second attack of SSNHL was ipsilateral in 10 of the 11 patients. CONCLUSION: The hearing outcome was poorer after a recurrent episode than after the first episode, and SSNHL almost always recurs in the same ear.

Analysis of psychological distress after management of dizziness in old patients: multicenter study.

Dizziness is a common problem in older people, with a reported prevalence of 13-38%. A large percentage of patients with dizziness develop secondary psychiatric disorders over the course of their disease. In particular, clinical depression and anxiety are significant health problems for older adults. We investigated the relationship between dizziness and psychological distress (depression and anxiety) in elderly patients with dizziness, and the relationship with psychological symptoms after managing the dizziness. This study enrolled 126 patients with dizziness, who were 65 years or older. Dizziness and the psychological symptoms of all patients were measured using the Korean Version of the Vestibular Disorders Activities of Daily Living Scale (K-VADL), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI) before and after management. We found a significant decrease in the BDI and STAI state scores after treatment with a reduction in the K-VADL score. For the STAI, the decrease in the score was relatively small after management. Nevertheless, there were significant correlations between the K-VADL score and both the BDI and STAI scores before and after management. Therefore, in the management of elderly patients with dizziness, a psychiatric approach should be considered and psychological support may be needed after managing the dizziness.

Ear, Nose, and Throat Foreign Bodies in Children: A Retrospective Study.

BACKGROUND: This study analyzed the presentation, characteristics, and management of foreign bodies in different age groups of pediatric patients with ear, nose, and throat foreign bodies. METHODS: A retrospective study was performed using data from October 2012 to September 2020. A total of 1285 patients with ear, nose, and throat foreign bodies who were less than 12 years of age and who presented to the emergency room were included in this study. Their biographical data, clinical presentations, foreign body types and locations, and management outcomes were obtained from medical records and analyzed as three age groups (infancy: <2 years old; early childhood: 2-5 years old; and late childhood: 6-12 years old). RESULTS: The early childhood group had the highest number of patients (n = 672; 52.2%). Throat was the most common location (59.2%), and bone was the most common type of foreign body. Among the children who visited our hospital, foreign bodies were actually found in only 657 patients (51.1%) and removed by an otolaryngologist in 625 (95.1%) cases. CONCLUSION: Our study could provide guidance for the diagnosis and management of pediatric patients who present to emergency departments with foreign bodies.

Strategy to Achieve Highly Porous/Biocompatible Macroscale Cell Blocks, Using a Collagen/Genipin-bioink and an Optimal 3D Printing Process.

Recently, a three-dimensional (3D) bioprinting process for obtaining a cell-laden structure has been widely applied because of its ability to fabricate biomimetic complex structures embedded with and without cells. To successfully obtain a cell-laden porous block, the cell-delivering vehicle, bioink, is one of the significant factors. Until now, various biocompatible hydrogels (synthetic and natural biopolymers) have been utilized in the cell-printing process, but a bioink satisfying both biocompatibility and print-ability requirements to achieve a porous structure with reasonable mechanical strength has not been issued. Here, we propose a printing strategy with optimal conditions including a safe cross-linking procedure for obtaining a 3D porous cell block composed of a biocompatible collagen-bioink and genipin, a cross-linking agent. To obtain the optimal processing conditions, we modified the 3D printing machine and selected an optimal cross-linking condition (∼1 mM and 1 h) of genipin solution. To show the feasibility of the process, 3D pore-interconnected cell-laden constructs were manufactured using osteoblast-like cells (MG63) and human adipose stem cells (hASCs). Under these processing conditions, a macroscale 3D collagen-based cell block of 21 × 21 × 12 mm3 and over 95% cell viability was obtained. In vitro biological testing of the cell-laden 3D porous structure showed that the embedded cells were sufficiently viable, and their proliferation was significantly higher; the cells also exhibited increased osteogenic activities compared to the conventional alginate-based bioink (control). The results indicated the fabrication process using the collagen-bioink would be an innovative platform to design highly biocompatible and mechanically stable cell blocks.

Clinical Analysis of Dizzy Patients with High Levels of Depression and Anxiety.

BACKGROUND AND OBJECTIVES: Some patients experiencing dizziness also report psychological distress. However, the association between vestibular deficits and psychological symptoms remains controversial. Thus, the aim of this paper is to report the proportion of patients who complained of dizziness who also had high depression and anxiety indices. Also we investigated the severity of their dizziness and the distribution of the diseases underlying this symptom. SUBJECTS AND METHODS: We assessed the dizziness and psychological distress of 544 patients experiencing dizziness using the Korean versions of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI). We also reviewed the audio-vestibular symtoms of patients with high levels of depression and anxiety. RESULTS: The incidences of high depression and anxiety scores were 11% (60/544) and 18% (98/544), respectively. Patients with vestibular migraine were most likely to have high depression and anxiety indices. Patients in the high-BDI or high-STAI groups (117/544) obtained significantly higher DHI scores than those in neither the high-BDI nor the high-STAI group (427/544). We noticed that about 20% of the patients experiencing dizziness had high levels of psychological distress in this study; this group also suffered from various vestibular diseases and more symptoms of dizziness. CONCLUSIONS: The results of the study suggest that psychological evaluation should be considered when assessing patients with vertigo.

Analysis of the Prevalence of and Factors Associated with Hearing Loss in Korean Adolescents.

BACKGROUND: Hearing loss can lead to a number of disabilities, subsequently reducing the quality of life. In general, hearing thresholds of adolescents are better than adults and the elderly. However, occasionally, adolescents acquire hearing loss for a number of reasons. In this study, our goal was to estimate the prevalence of hearing loss in the Korean population and to investigate the factors related to hearing thresholds in adolescents. METHODS: A cross-sectional study was conducted using data from the Korean National Health and Nutrition Examination Survey (KNHANES) between 2010 and 2012. We enrolled a total of 1,658 participants, ages 13 to 18 years. We investigated the prevalence of hearing loss and the factors associated with hearing thresholds at various frequencies (0.5, 1, 2, 3, 4, and 6 KHz). RESULTS: Weighted prevalence of unilateral and bilateral hearing loss in Korean adolescents was 2.2% and 0.4%, respectively. Weighted prevalence of hearing thresholds ≥ 20 dB at speech and high frequencies were 3.1% and 5.0%, respectively, for unilateral hearing loss and 0.7% and 1.9%, respectively, for bilateral. Age group, tympanometric data, and household income were significantly related to unilateral or bilateral hearing thresholds ≥ 20 dB at speech frequencies. Earphone use in noisy places was associated with bilateral hearing thresholds ≥ 20 dB at high frequencies. CONCLUSIONS: The prevalence of hearing loss in Korean adolescents was 2.6% using the general standard threshold associated with hearing loss. However, the prevalence of hearing thresholds ≥ 20 dB for speech and high frequencies was much higher. The results from this study provide an estimate of hearing loss in adolescents and suggest the need for early detection and hearing preservation programs among adolescents.

Mechanically reinforced cell-laden scaffolds formed using alginate-based bioink printed onto the surface of a PCL/alginate mesh structure for regeneration of hard tissue.

Cell-printing technology has provided a new paradigm for biofabrication, with potential to overcome several shortcomings of conventional scaffold-based tissue regeneration strategies via controlled delivery of various cell types in well-defined target regions. Here we describe a cell-printing method to obtain mechanically reinforced multi-layered cell-embedded scaffolds, formed of micron-scale poly(ε-caprolactone) (PCL)/alginate struts coated with alginate-based bioink. To compare the physical and cellular activities, we used a scaffold composed of pure alginate (without cells) coated PCL/alginate struts as a control. We systematically varied the ratio of alginate cross-linking agent, and determined the optimal cell-coating conditions to form the PCL/alginate struts. Following fabrication of the cell (MG63)-laden PCL/alginate scaffold, the bioactivity was evaluated in vitro. The laden cells exhibited a substantially more developed cytoskeleton compared with those on a control scaffold consisting of the same material composition. Based on these results, the printed cells exhibited a significantly more homogenous distribution within the scaffold compared with the control. Cell proliferation was determined via MTT assays at 1, 3, 7, and 14 days of culture, and the proliferation of the cell-printed scaffold was substantially in excess (∼2.4-fold) of that on the control. Furthermore, the osteogenic activity such as ALP was measured, and the cell-laden scaffold exhibited significantly greater activity (∼3.2-fold) compared with the control scaffold.

PCL/alginate composite scaffolds for hard tissue engineering: fabrication, characterization, and cellular activities.

Alginates have been used widely in biomedical applications because of good biocompatibility, low cost, and rapid gelation in the presence of calcium ions. However, poor mechanical properties and fabrication-ability for three-dimensional shapes have been obstacles in hard-tissue engineering applications. To overcome these shortcomings of alginates, we suggest a new composite system, consisting of a synthetic polymer, poly(ε-caprolactone), and various weight fractions (10-40 wt %) of alginate. The fabricated composite scaffolds displayed a multilayered 3D structure, consisting of microsized composite struts, and they provided a 100% offset for each layer. To show the feasibility of the scaffold for hard tissue regeneration, the composite scaffolds fabricated were assessed not only for physical properties, including surface roughness, tensile strength, and water absorption and wetting, but also in vitro osteoblastic cellular responses (cell-seeding efficiency, cell viability, fluorescence analyses, alkaline phosphatase (ALP) activity, and mineralization) by culturing with preosteoblasts (MC3T3-E1). Due to the alginate components in the composites, the scaffolds showed significantly enhanced wetting behavior, water-absorption (∼12-fold), and meaningful biological activities (∼2.1-fold for cell-seeding efficiency, ∼2.5-fold for cell-viability at 7 days, ∼3.4-fold for calcium deposition), compared with a pure PCL scaffold.

A New Approach for Fabricating Collagen/ECM-Based Bioinks Using Preosteoblasts and Human Adipose Stem Cells.

Cell-printing methods have been used widely in tissue regeneration because they enable fabricating biomimetic 3D structures laden with various cells. To achieve a cell-matrix block, various natural hydrogels that are nontoxic, biocompatible, and printable have been combined to obtain "bioinks." Unfortunately, most bioinks, including those with alginates, show low cell-activating properties. Here, a strategy for obtaining highly bioactive ink, which consisted of collagen/extracellular matrix (ECM) and alginate, for printing 3D porous cell blocks is developed. An in vitro assessment of the 3D porous structures laden with preosteoblasts and human adipose stem cells (hASCs) demonstrates that the cells in the bioinks are viable. Osteogenic activities with the designed bioinks show much higher levels than with the "conventional" alginate-based bioink. Furthermore, the hepatogenic differentiation ability of hASCs with the bioink is evaluated using the liver-specific genes, albumin, and TDO2, under hepatogenic differentiation conditions. The genes are activated within the 3D cell block fabricated using the new bioink. These results demonstrate that the 3D cell-laden structure fabricated using collagen/ECM-based bioinks can provide a novel platform for various tissue engineering applications.

Unilateral, multicentric Warthin's tumor mimicking a tumor metastatic to a lymph node. A case report.

BACKGROUND: Warthin's tumor may be associated with false positive diagnoses of malignancy on fine needle aspiration. The most common cause of error is markedly atypical squamous metaplasia mimicking metastatic cystic squamous carcinoma. The common location of Warthin's tumors within periparotid nodes may add to the clinical suspicion of metastasis. We report a case of unilateral, multicentric Warthin's tumor arising in periparotid and intraparotid glands, leading to a strong clinical and cytologic suspicion of malignancy. CASE: A 60-year-old female presented with a 3-month history of several enlarged lymph nodes in the right side of the neck. Fine needle aspiration, performed at the right upper neck lymph node, suggested the possibility of metastatic tumor. On computed tomography and ultrasonography there were 4 nodular lesions in the right retromandibular area and lateral aspect of the neck, 1-1.5 cm in diameter. A thyroid scan revealed diffuse enlargement of the thyroid gland and a nodular lesion in the right lobe. Right thyroid lobectomy and modified radical neck dissection, including right superficial parotidectomy, were performed for evaluation of occult malignancy. Histologically we confirmed that the tumor was a synchronous, multicentric Warthin's tumor arising in the parotid gland and intraparotid and paraparotid lymph nodes. CONCLUSION: Clinicians and pathologists should consider an extraparotid Warthin's tumor in the differential diagnosis of multiple cervical masses.

Influence of vestibular disease on psychological distress: a multicenter study.

OBJECTIVES: Some patients with dizziness show high comorbidity with psychiatric disorders. However, the association of vestibular deficit with psychological symptoms remains controversial. Thus, we investigated psychological distress (depression and anxiety) in patients with vestibular disease and examined factors modifying the development of psychological distress in these patients, including age, sex, severity of dizziness symptoms, and type of vestibular disease. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. SUBJECTS AND METHODS: This study enrolled 407 patients with dizziness. Dizziness and the psychological symptoms of all patients were measured using the Korean versions of the Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), and the Spielberger State-Trait Anxiety Inventory (STAI). We evaluated the influence of vestibular disease type, DHI score, and other factors such as sex and age on the psychological scales (BDI, STAI) through multiple regression analysis. RESULTS: Only DHI score and vestibular neuritis were related significantly to BDI scores in patients with vestibular disease, and only DHI scores were associated with STAI scores. CONCLUSION: Dizziness Handicap Inventory scores and psychological distress were closely associated. Psychological distress might be a consequence of high DHI score rather than of a specific type of vestibular disease, although depressive symptoms were related to vestibular neuritis.

"Angiographic late catch-up" phenomenon after sirolimus-eluting stent implantation.

BACKGROUND: Although several randomized trials have shown that sirolimus-eluting stent (SES) substantially reduces in-stent restenosis, recent studies have suggested the possibility of late catch-up after SES implantation. We investigated long-term angiographic outcomes after SES implantation in real-world practice. METHODS: This study was conducted on 195 patients with 253 lesions who underwent the first and long-term angiographic follow-up after SES implantation. First follow-up was done at near 6 months after SES implantation. Long-term angiographic follow-up was defined as that performed at least 36 months after index procedure. Angiographies in patients who experienced target lesion revascularization at the time of the first angiographic follow-up were excluded from the current analysis. RESULTS: Minimal luminal diameter at long-term angiographic follow-up was significantly smaller compared with that at the first follow-up (2.21 ± 0.65 vs. 2.40 ± 0.55, p<0.001). In-stent late lumen loss between the first and long-term follow-up tended to be larger compared with that between SES implantation and the first follow-up (0.19 ± 0.47 vs. 0.15 ± 0.39, p=0.298). There was a trend for increased incidence of coronary artery aneurysm (1.6% and 7.5% at the first and long-term follow-up) and stent fracture (4.3% and 10.3%). Two stent aneurysms and one stent fracture were related with definite very late stent thrombosis. CONCLUSION: An "angiographic late catch-up" phenomenon and a trend toward increased incidence of coronary artery aneurysm and stent fracture were found at a median 46.5-month angiographic follow-up compared with a median 6-month follow-up.