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1.  Effects of the Simultaneous Application of Nonlinear Frequency Compression and Dichotic Hearing on the Speech Recognition of Severely Hearing-Impaired Subjects: Simulation Test 
Objectives
The clinical effects of the simultaneous application of nonlinear frequency compression and dichotic hearing on people with hearing impairments have not been evaluated previously. In this study, the clinical effects of the simultaneous application of these two techniques on the recognition of consonant-vowel-consonant (CVC) words with fricatives were evaluated using normal-hearing subjects and a hearing loss simulator operated in the severe hearing loss setting.
Methods
A total of 21 normal-hearing volunteers whose native language was English were recruited for this study, and two different hearing loss simulators, which were configured for severe hearing loss in the high-frequency range, were utilized. The subjects heard 82 English CVC words, and the word recognition score and response time were measured.
Results
The experimental results demonstrated that the simultaneous application of these two techniques showed almost even performance compared to the sole application of nonlinear frequency compression in a severe hearing loss setting.
Conclusion
Though it is generally accepted that dichotic hearing can decrease the spectral masking thresholds of an hearing-impaired person, simultaneous application of the nonlinear frequency compression and dichotic hearing techniques did not significantly improve the recognition of words with fricatives compared to the sole application of nonlinear frequency compression in a severe hearing loss setting.
doi:10.3342/ceo.2015.8.2.102
PMCID: PMC4451533  PMID: 26045907
Hearing Loss; Dichotic Listening Tests; Signal Processing, Computer-Assisted
2.  Degree of Sigmoid Sinus Compression and the Symptom Relief Using Magnetic Resonance Angiography in Venous Pulsating Tinnitus 
Objectives
To show that mechanical compression of sigmoid sinus is effective for treatment of pulsatile tinnitus caused by sigmoid sinus enlargement, and to evaluate the relationship between the compression degree of sigmoid sinus and the tinnitus symptom relief using magnetic resonance angiography.
Methods
Medical records of twenty-four patients who were diagnosed with venous tinnitus caused by sigmoid sinus enlargement and underwent mechanical compression of sigmoid sinus were reviewed between April 2009 and May 2013. All these patients received computed tomography and magnetic resonance venography study before undergoing surgery and were followed for at least 4 months.
Results
Twenty-three patients felt relief from tinnitus three months after the surgery, and the cross-sectional area of the sigmoid sinus on the tinnitus side was compressed approximately by half (46%-69%) after the surgery. There were 4 patients whose tinnitus suddenly disappeared while lying on the operating table before operation, which may be a result of the patient's emotional tension or postural changes from standing. One of the four patients felt no relief from tinnitus after the surgery, with the cross-sectional area of the sigmoid sinus only compressed by 30%. And two patients of them had a recurrence of tinnitus about 6 months after the surgery. Seven patients had sigmoid sinus diverticula, and tinnitus would not disappear merely by eliminating the diverticulum until by compressing the sigmoid sinus to certain degree. There were 3 minor complications, including aural fullness, head fullness and hyperacusis. The preoperative low frequency conductive and sensorineural hearing loss of 7 subjects subsided.
Conclusion
Mechanical compression of sigmoid sinus is an effective treatment for pulsatile tinnitus caused by sigmoid sinus enlargement, even if it might be accompanied by sigmoid sinus diverticulum. A compression degree of sigmoid sinus about 54% is adequate for the relief of tinnitus symptom. Cases in which patients' tinnitus suddenly disappeared before the surgery might be excluded to improve the efficacy of surgery.
doi:10.3342/ceo.2015.8.2.111
PMCID: PMC4451534  PMID: 26045908
Pulsatile Tinnitus; Angiography; Cranial Venous Sinuses
3.  Clinical Outcomes of Silk Patch in Acute Tympanic Membrane Perforation 
Objectives
The silk patch is a thin transparent patch that is produced from silk fibroin. In this study, we investigated the treatment effects of the silk patch in patients with traumatic tympanic membrane perforation (TTMP).
Methods
The closure rate, otorrhea rate, and closure time in all patients and the closure time in successful patients were compared between the paper patch and silk patch groups.
Results
Demographic data (gender, site, age, traumatic duration, preoperative air-bone gap, and perforation size and location) were not significantly different between the two groups. The closure rate and otorrhea rate were not significantly different between the two groups. However, the closure time was different between the two groups (closure time of all patients, P=0.031; closure time of successful patients, P=0.037).
Conclusion
The silk patch which has transparent, elastic, adhesive, and hyper-keratinizing properties results in a more efficient closure time than the paper patch in the treatment of TTMP patients. We therefore believe that the silk patch should be recommended for the treatment of acute tympanic membrane perforation.
doi:10.3342/ceo.2015.8.2.117
PMCID: PMC4451535  PMID: 26045909
Ear, Middle; Tympanic Membrane Perforation; Silk; Fibroins
4.  Increase in the Level of Proinflammatory Cytokine HMGB1 in Nasal Fluids of Patients With Rhinitis and its Sequestration by Glycyrrhizin Induces Eosinophil Cell Death 
Objectives
The nuclear protein high mobility group protein box 1 (HMGB1) is a proinflammatory mediator that belongs to the alarmin family of proinflammatory mediators, and it has recently emerged as a key player in different acute and chronic immune disorders. Several lines of evidence demonstrate that HMGB1 is actively released extracellularly from immune cells or passively released from necrotic cells. Because of the ability of HMGB1 to sustain chronic inflammation, we investigated whether the protein is present in nasal fluids of patients with different forms of rhinitis.
Methods
HMGB1 levels were evaluated in nasal fluids of healthy subjects or rhinitis patients who were treated or not treated with different treatments.
Results
We report that the level of HMGB1 was significantly increased in nasal fluids of patients with allergic rhinitis, patients with NARES (nonallergic rhinitis with eosinophiliac syndrome), as well as patients with polyps. We also found that a formulation containing the HMGB1-binding compound glycyrrhizin (GLT) reduced the HMGB1 content in nasal fluids of rhinitis patients to an extent similar to that with nasal budesonide treatment. We also found that among the cultured human leukocyte populations, eosinophils released higher amounts of HMGB1. Based on the ability of HMGB1 to sustain eosinophil survival and the ability of GLT to inactivate HMGB1, we report that GLT selectively killed cultured eosinophils and had no effect on neutrophils, macrophages, and lymphocytes.
Conclusion
Collectively, these data underscore the role of HMGB1 in rhinitis pathogenesis and the therapeutic potential of GLT formulations in treatment of chronic inflammatory disorders of the nasal mucosa.
doi:10.3342/ceo.2015.8.2.123
PMCID: PMC4451536  PMID: 26045910
Rhinitis; Eosinophils; HMGB1 protein; Glycyrrhizin acid
5.  A Comparison of Cefditoren Pivoxil 8-12 mg/kg/day and Cefditoren Pivoxil 16-20 mg/kg/day in Treatment of Children With Acute Presumed Bacterial Rhinosinusitis: A Prospective, Randomized, Investigator-Blinded, Parallel-Group Study 
Objectives
Cefditoren pivoxil (CDT) has been used in the treatment of rhinosinusitis. However, little is known about the efficacy of this drug at low and high doses. This study was to compare the efficacy and safety of low dose (8-12 mg/kg/day) and high dose (16-20 mg/kg/day) CDT in the treatment of children with uncomplicated acute rhinosinusitis (ARS).
Methods
This investigation was a randomized, investigator-blinded, and parallel study, conducted in patients (aged 1-15 years) with a clinical diagnosis of uncomplicated ARS. Two groups of patients randomly received low dose or high dose CDT for 14 days. Patients' symptoms were assessed quantitatively using a quantitative symptom score (the S5 score). The changes in sinus symptoms and adverse events were provided by patients and their parents/caregivers. The response rate and adverse effects were evaluated at days 7 and 14. The relapse rate was recorded at days 21 and 28. The recurrences of sinus symptoms at day 60 were also assessed.
Results
One hundred forty patients were recruited and randomized; 72 received low dose CDT (group I) and 68 received high dose CDT (group II). There were no significant differences in demographic data including sex, age, presenting symptoms, medical history, and X-ray findings between two groups. The responses rate at day 14 in groups I and II were 95.5% and 95.4%, respectively (P>0.99). There were no significant differences between groups in relapse rate at day 28 and no recurrence at day 60 in either group. The most common treatment-related adverse events were diarrhea (4.2% in group I vs. 2.9% in group II) and vomiting (2.8% in group I vs. 10.3% in group II). There was no statistically significant difference in adverse events between groups.
Conclusion
Both low and high doses regimens of CDT appeared a similar clinical outcome for treatment in uncomplicated ARS in pediatric patients.
doi:10.3342/ceo.2015.8.2.129
PMCID: PMC4451537  PMID: 26045911
Cefditoren Pivoxil; Cephalosporins; Sinusitis; Child; Treatment Outcome
6.  A Prospective Study of the Surgical Outcome of Simple Uvulopalatopharyngoplasty (UPPP), UPPP Combined With Genioglossus Advancement or Tongue Base Advancement for Obstructive Sleep Apnea Hypopnea Syndrome Patients With Multilevel Obstruction 
Objectives
To investigate the surgical outcomes of different uvulopalatopharyngoplasty (UPPP).
Methods
All subjects underwent overnight polysomnography and were evaluated using the Epworth sleepiness scale (ESS), the Quebec sleep questionnaire and the snoring scale at the baseline and 3 and 12 months following operation. The primary endpoint was the overall effective rate representing the sum of the surgical success rate and effective rate.
Results
The overall effective rate at 12 months post surgery was 55.6% for simple UPPP, 95.8% for UPPP+GA, and 92.3% for UPPP+TBA. The surgical success rate at 3 and 12 months postoperation for UPPP+GA or UPPP+TBA was significantly higher than simple UPPP (P<0.05). Marked improvement was observed in all patients in the snoring scale score and the ESS score 3 and 12 months following surgery compared to the baseline (P<0.05 in all).
Conclusion
UPPP, UPPP+GA, and UPPP+TBA are all effective in improving the surgical outcome of obstructive sleep apnea hypopnea syndrome (OSAHS) patients with multilevel obstruction. UPPP+TBA appears to be the most effective in treating OSAHS patients.
doi:10.3342/ceo.2015.8.2.136
PMCID: PMC4451538  PMID: 26045912
Sleep Apnea Syndromes; Uvulopalatopharyngoplasty; Genioglossus Advancement; Tongue Base Advancement; Repose System; Epworth Sleepiness Scale
7.  Prognostic Value of Volume-Based Positron Emission Tomography/Computed Tomography in Patients With Nasopharyngeal Carcinoma Treated With Concurrent Chemoradiotherapy 
Objectives
The aim of this study was to evaluate the prognostic value of volume-based metabolic parameters measured by 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) in patients with nasopharyngeal carcinoma (NPC).
Methods
Forty-four NPC patients who underwent 18F-FDG PET/CT for initial staging work-up before concurrent chemoradiotherapy (CCRT) were retrospectively evaluated. Maximum standardized uptake value (SUV), mean SUV, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumors were measured. The prognostic significance and predictive performance of these parameters were assessed by Cox proportional hazards regression analysis and time-dependent receiver operating characteristics (ROC) curve analysis.
Results
Multivariate analysis showed that American Joint Committee on Cancer stage 7th edition (hazard ratio [HR], 1.525; 95% confidence interval [CI], 1.062 to 2.188; P=0.022), and TLG (HR, 7.799; 95% CI, 2.622 to 23.198; P≤0.001) were independent predictive factors associated with decreased disease-free survival (DFS). Time-dependent ROC curve analysis indicated that TLG was a better predictor of DFS than MTV (P=0.008).
Conclusion
The TLG of the primary tumor was a significant independent metabolic prognostic factor of DFS in patients with NPC treated with CCRT.
doi:10.3342/ceo.2015.8.2.142
PMCID: PMC4451539  PMID: 26045913
Fluorodeoxyglucose F18; Positron-Emission Tomography; Nasopharyngeal Carcinoma; Tumor Burden; Prognosis
8.  Nationwide Multicenter Survey for Current Status of Endoscopic Thyroidectomy in Korea 
Objectives
We evaluated the current status of endoscopic thyroidectomy procedures in Korea in terms of indications, contraindications, advantages, disadvantages, complications, and limitations of each approach.
Methods
An email survey, consisting of 15 questions, was sent to 29 experienced endoscopic thyroidectomy surgeons.
Results
The most commonly used approach was the gasless transaxillary approach (66.7%), followed by the bilateral axillo-breast approach with gas insufflation (23.8%). The most common indication was less than 1 cm, single papillary thyroid cancer. The role of endoscopic thyroidectomy is not still established; some consider it a novel procedure (34.8%), others a transition to robotic thyroidectomy (34.8%).
Conclusion
Our results shed light on the general consensus of opinions about endoscopic thyroidectomy, such as the advantages, disadvantages, complications, limitations, and even its future role.
doi:10.3342/ceo.2015.8.2.149
PMCID: PMC4451540  PMID: 26045914
Endoscopy; Data Collection; Thyroidectomy
9.  The Effect of Total Thyroidectomy on the Speech Production 
Objectives
Voice and speech alternations that can occur after total thyroidectomy are usually due to recurrent or superior laryngeal nerve injury. These alterations may also be associated with other extralaryngeal factors, such as neck muscle dysfunction and scar contracture of the neck. We performed a prospective acoustic analysis on speech changes after surgery, in the absence of laryngeal nerve injury.
Methods
Patients aged 19 to 58 years undergoing total thyroidectomy, in the absence of laryngeal/pulmonary disease, previous neck surgery, or other malignant diseases, were recruited prospectively. For the running speech analysis, the speaking fundamental frequencies (SFo), range of SFo and speaking intensity were evaluated before surgery, 7 days, and 1 and 3 months after surgery. For consonant analysis, the acoustic distinctions of stop consonant, the voice onset time (VOT), vowel duration and closure duration were evaluated at the same periods.
Results
SFo and range of SFo were specifically diminished after surgery, while speaking intensities were not changed significantly after surgery. The thyroidectomized speakers displayed systematically varied VOT for the consonant production, which was phonetically representative. However, VOT after surgery could be longer in the strong aspirated and glottalized stops, but not in the lax stop than before surgery. The vowel and closure durations were not affected before and after surgery.
Conclusion
Patients with thyroidectomy have some difficulty of pitch control and consonant articulation during speaking. VOT is also one of the meaningful acoustic parameters and provide a reference for comparing acoustic measures before and after thyroidectomy.
doi:10.3342/ceo.2015.8.2.155
PMCID: PMC4451541  PMID: 26045915
Thyroidectomy; Speech
10.  Changes in the Flow-Volume Curve According to the Degree of Stenosis in Patients With Unilateral Main Bronchial Stenosis 
Objectives
The shape of the flow-volume (F-V) curve is known to change to showing a prominent plateau as stenosis progresses in patients with tracheal stenosis. However, no study has evaluated changes in the F-V curve according to the degree of bronchial stenosis in patients with unilateral main bronchial stenosis.
Methods
We performed an analysis of F-V curves in 29 patients with unilateral bronchial stenosis with the aid of a graphic digitizer between January 2005 and December 2011.
Results
The primary diseases causing unilateral main bronchial stenosis were endobronchial tuberculosis (86%), followed by benign bronchial tumor (10%), and carcinoid (3%). All unilateral main bronchial stenoses were classified into one of five grades (I, ≤25%; II, 26%-50%; III, 51%-75%; IV, 76%-90%; V, >90% to near-complete obstruction without ipsilateral lung collapse). A monophasic F-V curve was observed in patients with grade I stenosis and biphasic curves were observed for grade II-IV stenosis. Both monophasic (81%) and biphasic shapes (18%) were observed in grade V stenosis. After standardization of the biphasic shape of the F-V curve, the breakpoints of the biphasic curve moved in the direction of high volume (x-axis) and low flow (y-axis) according to the progression of stenosis.
Conclusion
In unilateral bronchial stenosis, a biphasic F-V curve appeared when bronchial stenosis was >25% and disappeared when obstruction was near complete. In addition, the breakpoint moved in the direction of high volume and low flow with the progression of stenosis.
doi:10.3342/ceo.2015.8.2.161
PMCID: PMC4451542  PMID: 26045916
Maximal Expiratory Flow-Volume Curves; Spirometry; Bronchi
11.  Results of Free Flap Reconstruction After Ablative Surgery in the Head and Neck 
Objectives
Due to the complex anatomy and function of the head and neck region, the reconstruction of ablative defects in this area is challenging. In addition, an increasing interest in improving the quality of life of patients and achieving good functional results has highlighted the importance of free flaps. The aim of this study was to summarize the results of free flap reconstruction and salvage of free flaps in a single institute, and to analyze differences in the results by the flap donor site, recipient site, and learning curve.
Methods
The medical records of patients who underwent free flap reconstruction from 2004-2012 were reviewed retrospectively. One hundred and fifty free flaps were used in 134 patients, who had an average age of 57.7 years. The types of flaps applied, primary defect sites, success rates, results of salvage operations for compromised flap, and the learning curve were analyzed.
Results
The anterolateral thigh flap was preferred for the reconstruction of head and neck defects. The overall success rate was 90.7%, with 14 cases of failure. A total of 19 salvage operations (12.7%) for compromised flap were performed, and 12 flaps (63.2%) were salvaged successfully. Dependency on the facial vessels as recipient vessels was statistically different when oral and oropharyngeal defects were compared to hypopharyngeal and laryngeal defects. The learning curve for microvascular surgery showed decrease in the failure rate after 50 cases.
Conclusion
The free flap technique is safe but involves a significant learning period and requires careful postoperative monitoring of the patient. Early intervention is important for the salvage of free flaps and for lowering the failure rate.
doi:10.3342/ceo.2015.8.2.167
PMCID: PMC4451543  PMID: 26045917
Free Tissue Flaps; Head and Neck Neoplasms; Reoperation
12.  Multifocality and Bilaterality of Papillary Thyroid Microcarcinoma 
Objectives
Papillary thyroid carcinomas frequently occur as two or more separate foci within the thyroid gland (18%-87%). However, those multifocal tumors are easy to be undetected by preoperative radiologic evaluations, which lead to remnant disease after initial surgery. We aimed to study the incidence of multifocal papillary thyroid microcarcinomas (PTMCs), diagnostic accuracy of preoperative radiologic evaluation, predictive factors, and the chance of bilateral tumors.
Methods
Two hundred and seventy-seven patients with PTMC were included in this study. All patients underwent total thyroidectomy as an initial treatment. Medical records, pathologic reports, and radiological reports were reviewed for analysis.
Results
Multifocal PTMCs were detected in 100 of 277 patients (36.1%). The mean number of tumors in each patient was 1.6±1.1, ranging from 1 to 10. The additional tumor foci were significantly smaller (0.32±0.18 cm) than the primary tumors (0.63±0.22 cm) (P<0.001). There was no significant relationship between primary tumor size and the presence of contralateral tumors. With more tumors detected in one lobe, there was greater chance of contralateral tumors; 18.8% with single tumor focus, 30.2% with 2 tumor foci, and 46.2% with 3 or more tumor foci in one lobe. Sensitivity of preoperative sonography was 42.7% for multifocal tumors and 49.0% for bilateral tumors. With multivariate analysis, nodular hyperplasia was the only significant factor for multifocal tumors.
Conclusion
In cases of PTMCs, the incidence of multifocal tumors is high. However, additional tumor foci are too small to be diagnosed preoperatively, especially under the recent guidelines on radiologic screening tests for papillary thyroid carcinoma. Multifocal PTMCs have high risk of bilateral tumors, necessitating more extensive surgery or more thorough follow-up.
doi:10.3342/ceo.2015.8.2.174
PMCID: PMC4451544  PMID: 26045918
Thyroid Nodule; Papillary Thyroid Microcarcinoma; Neoplasms, Multiple Primary; Ultrasonography; Preoperative Procedures
15.  Neural-Induced Human Mesenchymal Stem Cells Promote Cochlear Cell Regeneration in Deaf Guinea Pigs 
Objectives
In mammals, cochlear hair cell loss is irreversible and may result in a permanent sensorineural hearing loss. Secondary to this hair cell loss, a progressive loss of spiral ganglion neurons (SGNs) is presented. In this study, we have investigated the effects of neural-induced human mesenchymal stem cells (NI-hMSCs) from human bone marrow on sensory neuronal regeneration from neomycin treated deafened guinea pig cochleae.
Methods
HMSCs were isolated from the bone marrow which was obtained from the mastoid process during mastoidectomy for ear surgery. Following neural induction with basic fibroblast growth factor and forskolin, we studied the several neural marker and performed electrophysiological analysis. NI-hMSCs were transplanted into the neomycin treated deafened guinea pig cochlea. Engraftment of NI-hMSCs was evaluated immunohistologically at 8 weeks after transplantation.
Results
Following neural differentiation, hMSCs expressed high levels of neural markers, ionic channel markers, which are important in neural function, and tetrodotoxin-sensitive voltage-dependent sodium currents. After transplantation into the scala tympani of damaged cochlea, NI-hMSCs-injected animals exhibited a significant increase in the number of SGNs compared to Hanks balanced salt solution-injected animals. Transplanted NI-hMSCs were found within the perilymphatic space, the organ of Corti, along the cochlear nerve fibers, and in the spiral ganglion. Furthermore, the grafted NI-hMSCs migrated into the spiral ganglion where they expressed the neuron-specific marker, NeuN.
Conclusion
The results show the potential of NI-hMSCs to give rise to replace the lost cochlear cells in hearing loss mammals.
doi:10.3342/ceo.2015.8.2.83
PMCID: PMC4451547  PMID: 26045904
Hair Cells, Auditory; Mesenchymal Stem Cells; Hearing Loss; Cell Differentiation; Transplantation
16.  Determinants of Conductive Hearing Loss in Tympanic Membrane Perforation 
Objectives
Tympanic membrane perforations are common, but there have been few studies of the factors determining the extent of the resulting conductive hearing loss. The aims of this study were to determine whether the size of tympanic membrane perforation, pneumatization of middle ear & mastoid cavity, and location of perforation were correlated with air-bone gap (ABG) of patients.
Methods
Forty-two patients who underwent tympanoplasty type I or myringoplasty were included and preoperative audiometry were analyzed. Digital image processing was applied in computed tomography for the estimation of middle ear & mastoid pneumatization volume and tympanic membrane photograph for the evaluation of perforation size and location.
Results
Preoperative mean ABG increased with perforation size (P=0.018), and correlated inversely with the middle ear & mastoid volume (P=0.005). However, perforations in anterior versus posterior locations showed no significant differences in mean ABG (P=0.924).
Conclusion
The degree of conductive hearing loss resulting from a tympanic membrane perforation would be expected with the size of perforation and pneumatization of middle ear and mastoid.
doi:10.3342/ceo.2015.8.2.92
PMCID: PMC4451548  PMID: 26045905
Tympanic Membrane Perforation; Tympanoplasty
17.  The Evaluation of Oxidative Stress in the Serum and Tissue Specimens of Patients With Chronic Otitis Media 
Objectives
To underline the effect of oxidative stress in chronic otitis media with and without cholesteatoma and to compare the oxidative stress values in the serum and tissue specimens in these two forms.
Methods
The study included a total of 75 individuals, 35 cases with chronic otitis media (COM; 16 females and 19 males) and a healthy control group of 40 cases (20 females and 20 males). The COM patient group was comprised of 18 patients with cholesteatoma and 17 patients without cholesteatoma. All patients underwent mastoidectomy. Serum specimens were taken prior to surgery and diseased tissue specimens from the ear were obtained during surgery from all patients. Only serum specimens were taken from the healthy control cases. The malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GHPx) were measured in the serum and tissue samples of the patient group and in the serum specimens of the control group.
Results
The age ranged from 14 to 48 years in the patient group (mean age, 20.4±12.2 years) and from 19 to 40 years in the control group (mean age, 26.4±4.64 years). When the serum values of all COM patients were compared with those of the control group, in the patient group MDA, which reflects lipid peroxidation, was found to be significantly higher (P<0.01) whereas the antioxidant enzymes SOD, CAT, and GHPx were found to be significantly lower (P<0.01). When the serum and tissue MDA, SOD, CAT, and GHPx values in patients with and without cholesteatoma were compared, no significant difference was found these parameters (P>0.01).
Conclusion
Although oxidative stress plays a role in the pathogenesis of COM with or without cholesteatoma, it may not reflect the severity of the disease. In patients with COM, the evaluation of only serum oxidative stress values without tissue evaluation may be sufficient for assessing oxidative stress.
doi:10.3342/ceo.2015.8.2.97
PMCID: PMC4451549  PMID: 26045906
Otitis Media; Cholesteatoma; Oxidative Stress; Lipid Peroxidation
18.  Do All Antioxidant Supplements Have the Same Potential Effect on Preventing Myringosclerosis? 
Objectives
Myringosclerosis is an irreversible pathological healing mechanism of the tympanic membrane which can result in the formation of sclerotic plaques. Antioxidant treatment is a recognised prevention therapy and coenzyme Q10 (CoQ10), lycopene, and grape seed extract (GSE), were used in this manner.
Methods
Forty-four Wistar rats were used in this experiment, and, following myringotomies, the animals were randomly divided into four groups. CoQ10, lycopene or GSE was administered orally to the respective groups, starting from the day of surgery. Otomicroscopy examination was performed on the 14th day. All tympanic membrane lesions were evaluated and compared otomicroscopically and histopathologically.
Results
The otomicroscopy and histopathological findings, compared against a control (saline) group, showed the CoQ10, lycopene, and GSE groups had statistically significant differences of degree of sclerosis (P<0.001).
Conclusion
CoQ10, lycopene, and GSE were compared against a saline group and their antioxidative and anti-inflammatory effects were similar. The formation of myringosclerotic plagues after experimental myringotomy in rats significantly decreased and diminished after systemic administration of the three different antioxidant supplements.
doi:10.3342/ceo.2015.8.1.1
PMCID: PMC4338085  PMID: 25729488
Myringosclerosis; Grape Seed Extract; Lycopene; Coenzyme Q10; Antioxidant
19.  Donor-Site Morbidity Following Minimally Invasive Costal Cartilage Harvest Technique 
Objectives
Autologous costal cartilage is a promising alternative for mastoid obliteration. However, donor-site morbidities of the chest wall limit the use of this graft. To address this issue, we have developed a minimally-invasive technique of harvesting costal cartilage and report donor site morbidity associated with the procedure.
Methods
Donor site morbidities were evaluated for 151 patients who underwent costal cartilage harvest, canal wall down mastoidectomy, and mastoid obliteration. Pain and cosmetic concern were evaluated via visual analogue scale (VAS). Scars were evaluated via the modified Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Postoperative complications were assessed during the follow-up period.
Results
The mean duration of noticeable pain was 5.3 days post operation. The mean VAS score for pain was 3.0 of 10 on the first day after the operation and gradually declined. At the 6 months post operation, the mean VAS cosmetic score at the costal cartilage harvest site was 0.6 of 10. The mean VSS score was 9.5 out of 10 total, and the mean POSAS score was 23.27 out of 110 total.
Conclusion
The minimally-invasive chopped costal cartilage harvest technique resulted in acceptable pain, cosmetic concern, and postoperative complications for most patients. There were no major postoperative complications. Costal cartilage is an acceptable donor for mastoid obliteration in canal wall down mastoidectomy, especially in the context of the extremely low donor site morbidity of the minimally-invasive technique presented in the study.
doi:10.3342/ceo.2015.8.1.13
PMCID: PMC4338086  PMID: 25729490
Pain, Postoperative; Pain Measurement; Otologic Surgical Procedures; Cartilage; Tissue and Organ Procurement
20.  Critical Evaluation of Round Window Membrane Sealing in the Treatment of Idiopathic Sudden Unilateral Hearing Loss 
Objectives
Rupture of the round window membrane with consecutive development of a perilymphatic fistula (PLF) is still a matter of controversial debate in the pathogenesis of idiopathic sudden sensorineural hearing loss (SSHL). Until now no consensus exists about whether these patients benefit from performing an exploratory tympanotomy with sealing of the round window. The aim of the present study was to analyze critically the effectiveness of sealing the round window membrane in patients with SSHL.
Methods
The clinical data of 51 patients with SSHL and a mean hearing decline of at least 60 dB over 5 frequencies who were treated with tympanotomy and sealing of the round window membrane were retrospectively analyzed. The results have been compared to the current state of the literature.
Results
Intraoperatively a round window membrane rupture or fluid leak was observed in none of the patients. After performing tympanotomy the mean improvement of hearing level was 32.7 dB. Twenty of 51 examined patients (39.2%) showed a mean improvement of the hearing level of more than 30 dB and a complete remission could be detected in 12 patients (23.5%). Reviewing the literature revealed no standard guidelines for definition or treatment of SSHL as well as for evaluation of hearing loss and its recovery.
Conclusion
The results of the present study and the literature should be discussed critically. It is unclear whether tympanotomy and sealing of the round window membrane may be a meaningful treatment for SSHL. Therefore this procedure should be discussed as a therapeutic option only in selected patients with sudden deafness or profound hearing loss in which PLF is strongly suspicious or conservative treatment failed.
doi:10.3342/ceo.2015.8.1.20
PMCID: PMC4338087  PMID: 25729491
Hearing Loss; Sudden; Round Window; Ear; Perilymph
21.  Vowel Perception in Listeners With Normal Hearing and in Listeners With Hearing Loss: A Preliminary Study 
Objectives
To determine the influence of hearing loss on perception of vowel slices.
Methods
Fourteen listeners aged 20-27 participated; ten (6 males) had hearing within normal limits and four (3 males) had moderate-severe sensorineural hearing loss (SNHL). Stimuli were six naturally-produced words consisting of the vowels /i a u æ ɛ ʌ/ in a /b V b/ context. Each word was presented as a whole and in eight slices: the initial transition, one half and one fourth of initial transition, full central vowel, one-half central vowel, ending transition, one half and one fourth of ending transition. Each of the 54 stimuli was presented 10 times at 70 dB SPL (sound press level); listeners were asked to identify the word. Stimuli were shaped using signal processing software for the listeners with SNHL to mimic gain provided by an appropriately-fitting hearing aid.
Results
Listeners with SNHL had a steeper rate of decreasing vowel identification with decreasing slice duration as compared to listeners with normal hearing, and the listeners with SNHL showed different patterns of vowel identification across vowels when compared to listeners with normal hearing.
Conclusion
Abnormal temporal integration is likely affecting vowel identification for listeners with SNHL, which in turn affects vowel internal representation at different levels of the auditory system.
doi:10.3342/ceo.2015.8.1.26
PMCID: PMC4338088  PMID: 25729492
Hearing Loss; Sensorineura; Speech Perception; Phonetics
22.  Extended Draf IIb Procedures in the Treatment of Frontal Sinus Pathology 
Objectives
Draf IIb approach provides wide, unilateral access to the frontal sinus. This approach can be extended without destruction of the contralateral frontal sinus drainage pathway, performed during Draf III (modified Lothrop) procedure. There is limited data in the literature regarding the use of modified Draf IIb procedures.
Methods
Patients treated with extended Draf IIb procedures in a single center were retrospectively assessed.
Results
Ten patients were identified, including 2 cases of osteoma, 1 inverted papilloma, 1 carcinoma, 5 mucoceles, and 1 chronic rhinosinusitis patient. Six patients had undergone prior surgery, including external procedures in 3 cases. Modifications of Draf IIb were classified as the following: removal of the anterosuperior nasal septum adjacent to the nasal beak, removal of the intersinus septum, and a combination of the above-mentioned methods (upper nasal septum and intersinus septum removal). There were 3 patients operated on with type 1 modification, one patient with type 2 modification, and 6 patients with type 3 modification. There were no perioperative complications.
Conclusion
In selected cases, extended Draf IIb procedures are safe and effective in the treatment of frontal sinus disease.
doi:10.3342/ceo.2015.8.1.34
PMCID: PMC4338089  PMID: 25729493
Endoscopy; Frontal Sinus; Surgery
23.  Categorization and Clinicopathological Features of Chronic Rhinosinusitis With Eosinophilic Mucin in a Korean Population 
Objectives
Chronic rhinosinusitis (CRS) with eosinophilic mucin is relatively rare in Korea. We categorized CRS patients with characteristic eosinophilic mucin into several groups and compared the groups based on their clinicopathological features.
Methods
In total, 52 CRS patients with eosinophilic mucin were enrolled. Based on the presence or absence of an allergy (A) to a fungus or fungal element (F) in the mucin, the patients were divided into four groups: allergic fungal rhinosinusitis (AFRS, A+F+), AFRS-like sinusitis (A+F-), eosinophilic fungal rhinosinusitis (EFRS, A-F+), and eosinophilic mucin rhinosinusitis (EMRS, A-F-). Clinical and immunological variables were compared between the groups.
Results
There were 13 patients in the AFRS group, 13 in the EFRS group, and 26 in the EMRS group. No patient was assigned to the AFRS-like sinusitis group. The AFRS group showed a significantly higher association with allergic rhinitis than did the EFRS and EMRS groups. The mean total serum IgE level in the AFRS patients was significantly higher than in the EFRS and EMRS patients. While 7.7% of the patients with AFRS and EFRS were asthmatic, 65.4% of the patients with EMRS had bronchial asthma. In the AFRS and EFRS groups, 31% had bilateral disease, in contrast to 100% of EMRS patients with bilateral disease. The prevalence of high attenuation areas by computed tomography was significantly higher in the AFRS group than in the EMRS group, and the mean Hounsfield unit values of the areas of high attenuation in the AFRS patients were significantly greater than those in the EMRS patients.
Conclusion
AFRS is believed to be an allergic response to colonizing fungi in atopic individuals. In EFRS, local allergies to fungi may play a role in the pathogenesis of the disease. EMRS is thought to be unconnected with fungal allergies.
doi:10.3342/ceo.2015.8.1.39
PMCID: PMC4338090  PMID: 25729494
Sinusitis; Mucins; Fungi; Eosinophils
24.  Risk Factors of Emergence Agitation in Adults Undergoing General Anesthesia for Nasal Surgery 
Objectives
To identify the incidence and the risk factors of emergence agitation in adults undergoing general anesthesia for nasal surgery.
Methods
We retrospectively examined 792 patients aged ≥18 years who underwent general anesthesia for elective nasal surgery between July 2012 and August 2013. Patients in the postanesthesia care unit with a Richmond Agitation Sedation Scale≥+1 at any time were considered to have emergence agitation.
Results
The overall incidence of emergence agitation is 22.2%. From multivariate regression analysis, the following six variables were found to be significantly associated with emergence agitation (P<0.05): younger age, recent smoking, sevoflurane anesthesia, postoperative pain on the numerical rating scale (NRS)≥5, presence of a tracheal tube, and presence of a urinary catheter. Presence of a tracheal tube was the greatest risk factor, increasing the risk of developing emergence agitation by approximately fivefold (odds ratio, 5.448; 95% confidence interval, 2.973 to 9.982). Younger age was also a strong risk factor (odds ratio, 0.975 for each 1-year increase; 95% confidence interval, 0.964 to 0.987). Current smoking, sevoflurane anesthesia, postoperative pain of NRS≥5, and the presence of a urinary catheter nearly doubled the risk of emergence agitation.
Conclusion
Emergence agitation following general anesthesia is a common complication in adult nasal surgery patients. To reduce the occurrence and consequences of agitation episodes, elimination of the associated risk factors is necessary, especially in at-risk patients.
doi:10.3342/ceo.2015.8.1.46
PMCID: PMC4338091  PMID: 25729495
Anesthesia Recovery Period; Nasal Surgical Procedures; Psychomotor Agitation
25.  Reconstruction of the Orbit With a Temporalis Muscle Flap After Orbital Exenteration 
Objectives
This study presents the role of the temporalis muscle flap in primary reconstruction after orbital exenteration.
Methods
A retrospective nonrandomized study of orbital exenterations performed between 1990 and 2010 for malignant tumors of the skin, paranasal sinus, and nasal cavity is presented.
Results
The study included 13 patients (nine men, four women; age range, 30-82 years) with paranasal sinus, nasal cavity, or skin carcinomas. Primary reconstruction of the cavity was performed in all patients after orbital exenteration. No visible defects in the muscle flap donor site were present. Local recurrences were readily followed up with nasal endoscopy, whereas radiology helped to diagnose intracranial involvement in three patients. Two patients died of systemic metastases and five died for other reasons
Conclusion
The temporalis muscle flap is readily used to close the defect after orbital exenteration, and does not prevent the detection of recurrence.
doi:10.3342/ceo.2015.8.1.52
PMCID: PMC4338092  PMID: 25729496
Orbit Evisceration; Surgical Flaps; Neoplasms

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