[Show abstract][Hide abstract] ABSTRACT: Objectives:
Aim of the present study was to define the relationship between petrous apex pneumatization and the nearby major anatomical landmarks using temporal bone computed tomography (CT) images.
This retrospective, Institutional Review Board-approved study analyzed CT images of 84 patients that showed normal findings bilaterally. Pneumatization of the petrous apex was classified using two methods. Eight parameters were as follows: angle between the posterior cranial fossa and internal auditory canal, Morimitsu classification of anterior epitympanic space, distance between the carotid canal and jugular bulb, distance between the cochlear modiolus and carotid canal, distance between the tympanic segment and jugular bulb, high jugular bulb, distance between the vertical segment and jugular bulb, and distance between the lateral semicircular canals and middle cranial fossa.
There was a significant difference in Morimitsu classification of the anterior epitympanic space between the two classification methods. Poorly pneumatic upper petrous apices were distributed uniformly in three types of Morimitsu classification, but more pneumatic upper petrous apices were found more often in anterior type. Lower petrous apex was well pneumatized regardless of the types of anterior epitympanic space, but the largest amount of pneumatization was found more frequently in the anterior type of anterior epitympanic space.
This study showed that there was no reliable anatomic marker to estimate petrous apex pneumatization and suggests that the pneumatization of the petrous apex may be an independent process from other part of the temporal bone, and may not be influenced by the nearby major anatomical structures in the temporal bone. In this study, the anterior type of anterior epitympanic space was found to be closely related to more well-pneumatized petrous apices, which implies that the anterior saccule of the saccus medius may be the main factor influencing pneumatization of the petrous apex.
Preview · Article · Dec 2015 · Clinical and Experimental Otorhinolaryngology
[Show abstract][Hide abstract] ABSTRACT: Purpose The dizziness handicap inventory (DHI) is widely used to evaluate self-perceived handicap due to dizziness, and is known to correlate with vestibular function tests in chronic dizziness. However, whether DHI reflects subjective symptoms during the acute phase has not been studied. This study aims to investigate the correlations of subjective and objective measurements to highlight parameters that reflect the severity of dizziness during the first week of acute unilateral vestibulopathy. Materials and methods Thirty-seven patients with acute unilateral vestibulopathy were examined. Patients' subjective perceptions of dizziness were measured using the DHI, Vertigo Visual Analog Scale (VVAS), Disability Scale (DS), and Activity-Specific Balance Scale (ABC). Additionally, the oculomotor tests, Romberg and sharpened Romberg tests, functional reach test, and dynamic visual acuity tests were performed. The correlation between the DHI and other tests was evaluated. Results DHI-total scores exhibited a moderately positive correlation with VVAS and DS, and a moderately negative correlation with ABC. However, DHI-total score did not correlate with results of the Romberg, sharpened Romberg, or functional reach tests. When compared among four groups divided according to DHI scores, VVAS and DS scores exhibited statistically significant differences, but no significant differences were detected for other test results. Conclusion Our findings revealed that the DHI correlated significantly with self-perceived symptoms measured by VVAS and DS, but not ABC. There was no significant correlation with other balance function tests during the first week of acute vestibulopathy. The results suggest that DHI, VVAS and DS may be more useful to measure the severity of acute dizziness symptoms.
[Show abstract][Hide abstract] ABSTRACT: Unlabelled:
Objective. To evaluate the usefulness of Dermabond® (octyl-2-cyanoacrylate) tissue adhesive, and to provide advice on its use for patients undergoing preauricular fistulectomy.
A retrospective, IRB-approved, case-control study.
This study reviewed the medical records of patients who underwent preauricular fistulectomy by one otologist at a single institution. Patient satisfaction was assessed by a questionnaire and the cosmetic result was assessed using the Hollander Wound Evaluation Scale (HWES).
There were 2 cases of wound dehiscence; a stitch abscess was noted in 2 patients. Aesthetically, scar appearance was considered very good. Among 33 patients who expressed an opinion postoperatively regarding the use of the tissue adhesive for skin closure, the degree of satisfaction was considerably high because patients were able to wash their face and bathe/shower (28 patients) soon after the procedure, followed by the lack of any dressing or wound care (21 patients), and the lack of skin sutures (19 patients).
The tissue adhesive offered equivalent wound closure as traditional suture for preauricular fistulectomy. Tissue adhesive is a safe method for closing wounds in preauricular fistulectomy and has many advantages, especially in young children and young women.
No preview · Article · May 2015 · Wounds: a compendium of clinical research and practice
[Show abstract][Hide abstract] ABSTRACT: To evaluate the relationship between age and anesthesia method used for tympanostomy tube insertion (TTI) and to provide evidence to guide the selection of an appropriate anesthesia method in children.
We performed a retrospective review of children under 15 years of age who underwent tympanostomy tube insertion (n=159) or myringotomy alone (n=175) under local or general anesthesia by a single surgeon at a university-based, secondary care referral hospital. Epidermiologic data between local and general anesthesia groups as well as between TTI and myringotomy were analyzed. Medical costs were compared between local and general anesthesia groups.
Children who received local anesthesia were significantly older than those who received general anesthesia. Unilateral tympanostomy tube insertion was performed more frequently under local anesthesia than bilateral. Logistic regression modeling showed that local anesthesia was more frequently applied in older children (odds ratio=1.041) and for unilateral tympanostomy tube insertion (odds ratio=8.990). The cut-off value of age for local anesthesia was roughly 5 years.
In a pediatric population at a single medical center, age and whether unilateral or bilateral procedures were required were important factors in selecting an anesthesia method for tympanostomy tube insertion. Our findings suggest that local anesthesia can be preferentially considered for children 5 years of age or older, especially in those with unilateral otitis media with effusion.
[Show abstract][Hide abstract] ABSTRACT: To determine the use of a hearing aid at six months post-fitting and to evaluate the predictors of its ongoing use in Korean adults with unilateral hearing impairment (HI).
Retrospective study at a secondary referral hospital over a 15-year period.
This study analysed 119 adults with unilateral HI who had been recommended for hearing amplification (55 men and 64 women, mean age, 58.0 ± 11.7 years). Six months after the fitting, all of the participants were surveyed regarding subsequent decisions and actions about obtaining hearing aids.
General uptake rate for a hearing aid was 68.1% (58.0% of participants surveyed were successful users, and 10.1% were intermittent users). The most significant parameter associated with hearing-aid use was social and/or work activities (R(2) = 0.457), and the significant predictors for successful hearing-aid use were social and/or work activities and method of signal processing (discriminatory power = 56.3%).
Six months post-fitting, 68.1% of Korean adults with unilateral HI who had agreed to try a hearing aid continued to use it regularly. The predictors for hearing-aid use six months post-fitting included social and/or work activities and digital signal processing.
No preview · Article · Mar 2015 · International journal of audiology
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE: To evaluate the association between nasal septal deviation (NSD) and the volume of mastoid air cell pneumatization and compare it with the volume of maxillary sinus in a pediatric population. MATERIALS and METHODS: This retrospective cross-sectional study was conducted at a university-based, secondary referral hospital. Paranasal sinus CT imaging data of 59 children were reconstructed to the 3-dimensional model, and subsequently, we measured the volume of the maxillary sinus and mastoid air cell. On coronal images, nasal septal angle (NSA) and NSD/NC (nasal septal deviation/nasal cavity) ratio were measured. RESULTS: Mastoid air cell volume, as well as maxillary sinus volume, of the deviated side was smaller than that of the contralateral side, but these were not statistically significant. There was no correlation between NSA and volumes of mastoid air cell and the maxillary sinus. There also was no correlation between NSD/NC ratio and mastoid air cell and maxillary sinus volumes. Significant linear and growth regression was found between age and volume of the mastoid air cell and maxillary sinus but not between age and NSA and NSD/NC ratio. CONCLUSION: Mastoid air cell volume and maxillary sinus volume of the deviated side tended to be smaller than those of the contralateral side, which suggests that NSD can influence both aerations. However, because the degree of NSD did not correlate with the volumes of the mastoid air cell and maxillary sinus in this study, we should consider that further possible factors may be involved in both aerations.
Preview · Article · Feb 2015 · Journal of International Advanced Otology
[Show abstract][Hide abstract] ABSTRACT: Conclusion:
Intratympanic steroid therapy (IT-S) was as effective as systemic steroid therapy (SST) or combined therapy (CT) and could be considered a first-line therapeutic modality for idiopathic sudden sensorineural hearing loss (SSNHL). Due to its known safety and efficacy, IT-S will be particularly suitable for patients with SSNHL who have chronic diseases such as diabetes mellitus, hypertension, or chronic renal failure.
Systemic high dose steroid therapy is the main therapeutic modality for SSNHL. Comparable therapeutic efficacies for IT-S and CT with SST and IT-S for SSNHL have been reported recently. We compared the efficacy of IT-S, SST, and CT for treating SSNHL.
A retrospective, multicenter study investigating the therapeutic efficacy of SST, IT-S, and CT for SSNHL was designed and involved 735 patients with idiopathic SSNHL who were diagnosed and treated at seven tertiary referral medical centers of the Catholic University of Korea between 2007 and 2011. Patients were divided into three groups according to the treatment methods they received: IT-S group, SST group, and CT group (SS plus IT-S). Hearing was evaluated by pure tone audiogram performed before initial treatment and at 4 weeks following the final treatment. More than a 10 dB HL decrease in average air conduction threshold of hearing at 500, 1000, 2000, and 3000 Hz was defined as improved hearing.
Among 735 patients with SSNHL, 94 were included in the IT-S group, 444 in the SST, and 197 in the CT group. Age, gender, interval from disease onset to start of treatment, and initial hearing level were not different among the three groups. Patients who had concomitant medical disorders such as diabetes mellitus, hypertension, or chronic renal failure were more frequently treated with IT-S. No difference in the level of hearing gain or ratio of hearing improvement was observed among the three groups (p = 0.147 and p = 0.067, respectively).
No preview · Article · Jan 2013 · Acta oto-laryngologica
[Show abstract][Hide abstract] ABSTRACT: We undertook to verify the usefulness of computed tomography Hounsfield units (HU) in differentiating cholesteatoma from inflammatory tissue.
In 91 enrolled cases, the lesions were classified according to the gross pathology, and the specific locations of each lesion were documented by 1 surgeon within 1 day after the operation. The densities in HU of cholesteatoma and non-cholesteatoma lesions were retrospectively measured 3 times by the same examiner, and the difference between the two groups was analyzed. The interobserver reliability among the 3 examiners was assessed to verify the confidence level of the HU measurements in preoperative detection of cholesteatoma.
The mean HU values of cholesteatoma were 35.7 to 66.6 HU, and those of non-cholesteatoma lesions were 32.9 to 51.3 HU. A general linear model-repeated-measures analysis of variance did not show any significant difference between the cholesteatoma and non-cholesteatoma lesions (p = 0.305). The general linear model-repeated-measures analysis of variance showed a significant difference of the measured HU levels among the 3 examiners (p = 0.021).
This study showed that the HU values on preoperative computed tomography did not suffice for the detection of cholesteatoma lesions. A clinician's physical examination together with an interpretation of computed tomography is still the "gold standard" method.
No preview · Article · Dec 2012 · The Annals of otology, rhinology, and laryngology
[Show abstract][Hide abstract] ABSTRACT: The objectives of this study were to characterize the features of tinnitus in patients with profound sensorineural hearing loss and to evaluate the effect of cochlear implantation (CI) on their tinnitus. Medical records were reviewed for 35 patients who underwent CI, and completed tinnitus questionnaire between March 2003 and August 2011. Of them, 22 had tinnitus prior to CI (62.9 %) and the tinnitus group was older than the non-tinnitus group (47.5 ± 15.1 vs. 28.9 ± 15.2). The mean tinnitus handicap inventory (THI) score of the tinnitus group was 50.5 ± 28.7 before surgery, and the mean THI score and visual analogue scale (VAS) scores for loudness, annoyance, effect on life, and awareness decreased significantly after CI, with a mean follow-up period of 10.7 months. Tinnitus was completely eliminated in ten patients (45.5 %) and THI scores decreased in all patients. In a correlation analysis of the decrease in THI scores, preoperative VAS scores for loudness, awareness, effect on life, and annoyance, as well as preoperative THI scores, were highly correlated with the degree of decrease in THI scores postoperatively. The auditory performance of patients older than 40 years did not differ from that of younger patients, but their tinnitus was more improved after CI. In conclusion, tinnitus is a common complaint in patients with cochlear implants, and is more prevalent in elderly implantees. In the present study, CI improved tinnitus in all patients, although the most severe cases had the greatest benefit.
No preview · Article · Sep 2012 · Archives of Oto-Rhino-Laryngology
[Show abstract][Hide abstract] ABSTRACT: Clin. Otolaryngol. 2012, 37, 355–361
Objectives: To evaluate the vascularisation process of the grafted fascia or perichondrium in active and inactive chronic mucosal otitis media.
Design: Prospective study.
Setting: University-based, secondary referral hospital.
Participants: Two hundred thirty-two patients who underwent type 1 tympanoplasty or myringoplasty by one experienced surgeon.
Main outcome measures: After postoperative days 5–7, the graft was inspected using a binocular operating microscope at least twice weekly until vascularisation was confirmed to have commenced. This point was defined as the time of vascularisation. An intact graft at 3 months postoperatively was considered a closure success.
Results: The mean time of vascularisation of 232 grafts was 14.2 ± 3.6 days (range 8–25). The vascularisation time differed according to the perforation size. The perforations involving 50% and less of the pars tensa were revascularised earlier than those involving 75% and more. There was no relationship between vascularisation time and closure success or failure. Age itself did not influence the vascularisation time or the risk of closure failure. Postoperative otorrhea was higher in patients with a preoperative wet middle ear mucosa than among those with a dry one.
Conclusion: The vascularisation time was shorter in perforations of 50% and less than those of 75% and more but the rate of closure success was not different between two. The graft failure was not attributed to the failure of vascularisation. Age itself seemed not to be a contraindication for myringo-/tympanoplasty in otherwise healthy elderly patients.
No preview · Article · Sep 2012 · Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery
[Show abstract][Hide abstract] ABSTRACT: To investigate the electric-acoustic interactions within the inferior colliculus of guinea pigs and to observe how central masking appears in invasive neural recordings of the inferior colliculus (IC).
A platinum-iridium wire was inserted to scala tympani through cochleostomy with a depth no greater than 1 mm for intracochlear stimulation of electric pulse train. A 5 mm 100 µm, single-shank, thin-film, penetrating recording probe was inserted perpendicularly to the surface of the IC in the coronal plane at an angle of 30-40° off the parasagittal plane with a depth of 2.0-2.5 mm. The peripheral and central masking effects were compared using electric pulse trains to the left ear and acoustic noise to the left ear (ipsilateral) and to the right ear (contralateral). Binaural acoustic stimuli were presented with different time delays and compared with combined electric and acoustic stimuli. The averaged evoked potentials and total spike numbers were measured using thin-film electrodes inserted into the central nucleus of the IC.
Ipsilateral noise had more obvious effects on the electric response than did contralateral noise. Contralateral noise decreased slightly the response amplitude to the electric pulse train stimuli. Immediately after the onset of acoustic noise, the response pattern changed transiently with shorter response intervals. The effects of contralateral noise were evident at the beginning of the continuous noise. The total spike number decreased when the binaural stimuli reached the IC most simultaneously.
These results suggest that central masking is quite different from peripheral masking and occurs within the binaural auditory system, and this study showed that the effect of masking could be observed in the IC recording. These effects are more evident and consistent with the psychophysical data from spike number analyses than with the previously reported gross potential data.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the volumetric relationship between the mastoid air cell (MAC) and paranasal sinus (PNS) in the pediatric population using three-dimensional reconstruction and the analysis technique of CT.
Retrospective cross-sectional study was conducted at a university-based, secondary referral hospital.
PNS CT imaging data of 62 children (40 boys and 22 girls; mean age=13.4±4.0 years) was reconstructed to the three-dimensional model with the surface-rendering algorithm (lower threshold of -1024HU and upper threshold of -318HU), and subsequently measuring the volume of the three PNSs (frontal, maxillary and sphenoid) and MAC. Hierarchical linear regression analysis was used to control the effect of age.
Controlling the effect of age, no significant linear regression relationship was found between the volume of MAC and PNSs. It was observed that PNSs and MAC showed a significant linear relationship with age. The regression slopes of PNSs were larger than that of MAC, especially the growth of maxillary and sphenoid sinuses was faster and larger than that of the frontal sinus and MAC. As the coefficient of determination was extremely small, the aging process itself could not effectively explain the volume variation of PNSs and MAC.
No interaction was observed in the pneumatization of the three PNSs (frontal, maxillary, and sphenoid) and MAC. It was found that the growths of PNSs and MAC are influenced by age. Further, maxillary and sphenoid sinuses tend to grow faster and become larger than the frontal sinus and mastoid air cell system. Thus, it is verified that environmental factors could be involved in the postnatal pneumatization process of the PNSs and MAC, which might influence MAC to a greater extent than the PNSs.
No preview · Article · Aug 2012 · International journal of pediatric otorhinolaryngology
[Show abstract][Hide abstract] ABSTRACT: To investigate acoustic differences between conversational and clear speech of Korean and to evaluate the influence of the gender on the speech clarity using the long-term average speech spectrum (LTASS).
Each subject's voice was recorded using a sound level meter connected to GoldWave program. Average long-term root mean square (RMS) of one-third octave bands speech spectrum was calculated from 100 to 10,000 Hz after normalizing to 70 dB overall level using the MATLAB program. Twenty ordinary Korean were compared with 20 Korean announcers with equal numbers of men and women in each group.
Compared with the LTASS of ordinary men, that of ordinary women was lower at low frequencies, but higher at 630, 800, 1,600, 5,000, and 10,000 Hz. Compared with the LTASS of male announcers, that of female announcers was lower at low frequencies. Compared with the LTASS of ordinary men, that of male announcers was significantly lower at 100, 125, 200, and 250 Hz. Compared with the LTASS of ordinary women, that of female announcers was lower at 100, 125, 160, 200, 250, 500, and 10,000 Hz. The LTASS of announcer showed lower levels at 100, 200 Hz and higher at 500, 630, 800, and 1,000 Hz that that of ordinary Koreans.
This study showed that the drop-off of the LTASS in the low frequency region might make the ratings of women and announcers more clearly than those of men and ordinary persons respectively. This drop-off in the low frequency might result in less upward spread of masking and clearer speech. This study reduced an error resulting from a wide variability of clear speech strategies and intelligibility gains, because this study recruited professional speakers. We hope that our results demonstrate the difference in acoustic characteristics of the speech of ordinary Korean persons.
Preview · Article · Jun 2012 · Clinical and Experimental Otorhinolaryngology
[Show abstract][Hide abstract] ABSTRACT: To radiologically evaluate the anatomic factors that may determine the view field or the accessibility of the posterior tympanotomy into the posterior mesotympanum, a cohort of 30 patients with pneumatic mastoids and 30 patients with unilateral sclerotic mastoids were included. Anatomic relationships were evaluated according to 5 parameters. The reference parameter of the view field through posterior tympanotomy was the maximum view to the stapes area through posterior tympanotomy. Direct distance between the chorda tympani nerve and the facial nerve (FN) and angle between the cortex of the external auditory canal and the FN showed significant positive correlations in pneumatic and sclerotic mastoids. However, the location of the FN was negatively correlated with the maximum view to the stapes area through posterior tympanotomy only in pneumatic mastoids. In particular, the angle between the cortex of the external auditory canal and the FN showed the best correlation with the maximum view to the stapes area through posterior tympanotomy. The angle between the cortex of the external auditory canal and the FN was the most important anatomic determinant for visibility through posterior tympanotomy. This study suggests that pneumatic mastoids, but not sclerotic mastoids, may have a more complex relationship including more factors than those considered in this study. Although this study was performed radiologically, this study can present the insight to surgeons or radiologists.
No preview · Article · May 2012 · The Journal of craniofacial surgery