With an introduce of virtual reality (VR) technology, the issue of unpleasant side effect of VR immersion has been raised as “cybersickness.” Although exact mechanism of cybersickness is still elusive, sensory conflict theory has been generally accepted as in classic motion sickness. The absence of expected correlated vestibulo-proprioceptive sensory information during VR experience causes sensory conflict, which leads to dizziness, disorientation, nausea and fatigue. Herein, we review the recent literature to build the conceptual scheme for understanding cybersickness. From the brief description of motions sickness, assessment and management of cybersickness is also outlined.

With an introduce of virtual reality (VR) technology, the issue of unpleasant side effect of VR immersion has been raised as “cybersickness.” Although exact mechanism of cybersickness is still elusive, sensory conflict theory has been generally accepted as in classic motion sickness. The absence of expected correlated vestibulo-proprioceptive sensory information during VR experience causes sensory conflict, which leads to dizziness, disorientation, nausea and fatigue. Herein, we review the recent literature to build the conceptual scheme for understanding cybersickness. From the brief description of motions sickness, assessment and management of cybersickness is also outlined.
Dizziness ; Fatigue ; Immersion ; Motion Sickness ; Nausea

The Vibrant Soundbridge (VSB) middle ear implant is an alternative rehabilitation option for sensorineural, conductive, and mixed hearing loss. The mechanism of VSB implantation is direct-drive stimulation of the inner ear through a floating mass transducer placed on the ossicular chain. We report our experience of VSB incus vibroplasty, which were successfully performed in two cases without complications and resulted in good functional gain and improve-ment of speech discrimination.
Ear, Inner ; Ear, Middle ; Hearing Loss, Mixed Conductive-Sensorineural ; Incus ; Ossicular Prosthesis ; Speech Perception ; Transducers

Background and Objectives: Dizziness has diverse underlying causes, so the diagnosis is challenging especially in the emergency room. The aim of this study is to identify clinical characteristics of patients’ complaints of dizziness in the emergency room.Subjects and Method We retrospectively reviewed the medical records of 10367 patients who visited the emergency room with the chief complaint of dizziness from January 2016 to December 2020. Patients’ clinical information including age, sex, final diagnoses, consulting departments, treatment results and seasonal incidences were thoroughly assessed. Results: Of the total patients who visited the emergency room, 4.64% complained of dizziness. The mean age of patients was 57.6 years old. The most common age group was over 70’s (28.1%). There were 6322 (61.1%) female patients, while 4035 (38.9%) were male patients. Nearly half 4932 (47.6%) of the patients were managed by the emergency department, followed by 3204, who were managed by the department of otolaryngorhinology (30.9%), and 1166 (11.2%) managed by the neurology department. The dizziness was classified as peripheral vertigo (33.8%), nonspecific dizziness (27.4%), medical conditions (13.9%), central dizziness (11.0%), cardiac dizziness (6.2%), and other miscellaneous causes of trauma, neoplasm and psychogenic causes (7.7%). In peripheral vertigo, the incidence of BPPV, vestibular neuritis and Meniere’s disease were 23.5%, 8.8% and 0.6%, respectively. Conclusion Peripheral vertigo accounted for the majority for the patients with chief complaints of dizziness in the emergency room. As diverse medical conditions may cause dizziness, specialized departments have to be involved in the diagnostic process of dizziness.

Background and Objectives: Acute low tone sensorineural hearing loss (ALHL), an acuteonset hearing loss limited to low tone, was thought to be a subtype of sudden sensorineural hearing loss (SSNHL) but also considered as new disease entity because it shows quite different symptoms, progress, and prognosis. More recently, however, it is thought that SSNHL results from chronic inflammation and thrombosis. Some studies have reported that neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were high in SSNHL patients, and that they were significant as prognostic factors. The aim of this study was to evaluate the significance of NLR and PLR in ALHL.Subjects and Method From January 2009 to June 2019, we retrospectively studied 58 patients who were diagnosed with ALHL. Characteristics of patients such as sex, age, symptoms and signs, the results of serologic test and pure tone audiometry were evaluated for recovery and for recurrence. Also, we selected 58 people with the same age as control group. Results: A total of 167 patients were identified, of whom a half was diagnosed with ALHL and the other half with were the control group. Among the 58 patients, the mean age was 38.0±14.5 years old, and 10 (17.2%) patients were male and 48 (82.8%) patients were female. Among the patients, 35 (60.3%) were hospitalized and 23 (39.7%) were outpatients. For recovery, 38 (65.5%) patients fully recovered while 11 (19.0%) partially recovered, and 9 (15.5%) did not recover. Additionally, 16 (27.6%) patients recurred later with similar symptoms. Between the patient group and control group, there were significant differences in the total white blood cell count, neutrophil count, NLR and PLR (p=0.015, 0.001, 0.002, and 0.025), but there was no significant differences between the recovery group and non-recovery group in any laboratory findings. Also, NLR and PLR showed no significant differences between the recurred group and non-recurred group. Conclusion NLR and PLR in ALHL patients were relatively high compared to the control group, but there were no significant differences between the recovery group and non-recovery group. Furthermore, there was no correlation between NLR and PLR with recurrence. High NLR and PLR values in ALHL patients might reflect its inflammatory etiology, but there is lack evidence for them to serve as prognostic factors.

Background and Objectives: We aimed to compare the treatment outcomes of primary intratympanic steroid (ITS) and the salvage ITS protocol.Subjects and Method We assessed 440 patients with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) from January 2016 to December 2019. Of the 440 patients, 37 patients received ITS only as a primary treatment while other patients received systemic steroid; of those remaining patients, 276 received systemic steroid as well as ITS as a salvage treatment. We performed a 1:2 propensity score matching analysis for both groups using parameters such as the initial hearing level, presence of vertigo, onset of treatment, age, sex, hypertension and diabetes. The rate of hearing recovery was determinied by comparing the matching propensity score between the primary ITS and the control group according to the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guideline and Siegel’s criteria. Results: Of the 440 ISSNHL patients, 28.9% received systemic steroid only and 62.6% of patients were managed with systemic steroid plus salvage ITS. Thirty-seven patients (8.4%) were managed with ITS only. While 36.8% of patients completely recovered, 35.0% did not recover their hearing according to AAO-HNS guideline. The propensity score matching showed that the initial hearing level, age and onset of treatment were not significantly different between the primary ITS and control group. Regarding the treatment outcome, complete recovery rate for the primary ITS group and control group were 29.7% and 33.8%, respectively. Although the recovery rate of the salvage ITS protocol group was higher than that of the primary ITS group, statistical significance was not identified. Conclusion Treatment strategies of primary ITS and salvage ITS protocol did not significantly affect the clinical outcomes of ISSNHL differently.

Pharyngeal dysphagia can be caused by structural abnormalities or neurological disorders such as stroke, meningitis, and other conditions. Herpes zoster (HZ), caused by the varicella-zoster virus (VZV), is a rare cause of pharyngeal dysphagia. The symptoms of HZ usually involve a painful rash with vesicles along the dermatome area, but it can also affect the cranial nerves (CN), such as CN VII (Ramsay-Hunt syndrome), and less commonly, other CN. A 69-year-old man presented with a sore throat and dysphagia symptoms. A laryngoscopy revealed multiple ulcerative mucosal lesions on the right soft palate and lateral pharynx. The patient was treated with oral valacyclovir, and although the lesions disappeared, the dysphagia symptoms remained. While dysphagia associated with a VZV infection is rare, it can occur with the additional symptoms of vocal cord paralysis. This paper reports a rare case of pharyngeal dysphagia caused by a VZV infection, and the patient presented only with the initial symptoms of sore throat and dysphagia without skin lesions or signs of vocal cord paralysis.

Objective: To investigate long-term changes in femoral anteversion angle (FAA) in children with intoeing gait and to identify factors that affect FAA changes. Methods: We retrospectively analyzed three-dimensional computed tomography data from 2006 to 2022 of children with intoeing gait with ≥3 years of follow-up without active treatment. The study examined the mean changes in FAA, the effects of sex, age, and initial FAA on FAA change, and mean FAAs by age. Changes in FAA severity up to eight years of age were also observed and analyzed by sex. Results: A total of 126 lower limbs of 63 children (30 males, 33 females) with intoeing gait were included, with a mean age of 5.11±1.05 years and a mean follow-up period of 43.59±7.74 months. The initial FAA was 41.42°±8.29° and the follow-up FAA was 33.25°±9.19°, indicating a significant decrease (p<0.001). Significant correlations were observed between age and changes in FAA, as well as between initial FAA and changes in FAA (r=0.248, p=0.005; r=-0.333, p<0.001). At age 8 years, only 22 limbs were classified as having mild FAA severity. Conclusion During the follow-up period, children with intoeing gait had a significant decreased in FAA. No significant difference in FAA change was found between sex, but younger children and those with greater initial FAA were more likely to have decreased FAA. However, most children retained moderate to severe severity of increased FAA. Further studies are required to validate these findings.

Most cases of sudden sensorineural hearing loss (SSNHL) occur without a specific identifiable cause, although vascular factors may serve as potential etiological contributors. Silent infarction refers to ischemic changes observed on imaging studies without accompanying clinical symptoms; however, this condition is clinically significant owing to the increased risk of future stroke. We report a case of left-sided SSNHL accompanied by dizziness in a 62-year-old male patient who was diagnosed with left pontine infarction without any other neurological symptoms. The cochlea and pons receive blood supply from the anterior inferior cerebellar artery; the cochlea lacks collateral vessels and is therefore susceptible to fluctuations in blood flow. This case report provides evidence to support the vascular hypothesis as the etiology underlying SSNHL

Background: To compare the muscle strength of patients with a hip fracture according to the presence of sarcopenia after surgery and the correlation of measured values between a Biodex and surface electromyography (sEMG) in postoperative measurement of muscle strength. Methods: Seventy-one patients who underwent hip fracture surgery were included in this study. Muscle mass was measured using dual energy X-ray absorptiometry and the grip strength was evaluated using a dynamometer. The diagnosis of sarcopenia followed the Asian Working Group for Sarcopenia criteria. We evaluated the Biodex to assess muscle strength according to the presence of sarcopenia and at the same time measured the sEMG to evaluate the correlation of muscle strength between Biodex and sEMG. Results: We assigned 34 patients with sarcopenia and 37 without sarcopenia to 2 groups. In the comparison of muscle strength using Biodex and sEMG between the 2 groups, it was confirmed that muscle strength of sarcopenia group was decreased compared with that of the non-sarcopenia group, although there was no statistical significance between the groups. However, Biodex and sEMG showed very close correlation with muscle strength in all variables. Conclusions We suggest that using sEMG for the evaluation of muscle strength after hip fracture surgery may be an excellent tool alternative to isokinetic testing machines such as the Biodex.