The authors report a 64-year-old man who developed persistent direction fixed nystagmus after a canalith repositioning maneuver for horizontal canal benign paroxysmal positional vertigo (HC-BPPV). The patient was initially diagnosed with right HC-BPPV given that the Dix-Hallpike test showed geotropic horizontal nystagmus that was more pronounced on the right side, although the roll test did not show any positional nystagmus. The patient was treated with a canalith repositioning maneuver (Lempert maneuver). The next day, the patient experienced a different character of dizziness, and left-beating spontaneous nystagmus regardless of head position was observed. After a forced prolonged left decubitus and frequent head shaking, his symptoms and nystagmus resolved. This condition, referred to as canalith jam, can be a complication after the repositioning maneuver in patients with BPPV. Atypical positional tests suggest that abnormal canal anatomy could be the underlying cause of canalith jam.
Dizziness ; Head ; Humans ; Middle Aged ; Nystagmus, Pathologic ; Nystagmus, Physiologic ; Vertigo

Age-related hearing loss, or presbycusis, is the progressive hearing loss that occurs as people get older. With presbycusis, the hearing threshold is increased, especially at high frequencies and speech perception is decreased in noisy environments. In addition, presbycusis may have adverse effects on the cognitive, behavioral, and psychosocial functioning of the elderly. They may feel social isolation, depression, and loss of self-esteem. The pathophysiology of presbycusis is explained by age-related changes in the inner ear, the auditory system and the central nervous system. There is no single cause of presbycusis. It is a complex disease influenced by genetic, environmental, and psychosocial factors, as well as medical conditions. Hearing loss is one of the most common chronic conditions affecting the elderly. The population aged 65 years and older is now increasing at a rapid rate. Approximately 40% of people over 75 years of age are suffering from hearing loss. Because presbycusis is permanent and irreversible, there is no specific treatment to restore hearing loss. Because hearing loss in the elderly is closely related with quality of life, prevention and hearing rehabilitation programs using hearing aids are very important. In an aging society like Korea, an increase in social costs is inevitable for the welfare of the elderly. In particular, prevention and rehabilitation programs for hearing loss will play important roles in this perspective.
Aged ; Aging ; Central Nervous System ; Depression ; Ear, Inner ; Hearing ; Hearing Aids ; Hearing Loss ; Humans ; Korea ; Presbycusis ; Quality of Life ; Social Isolation ; Speech Perception ; Stress, Psychological

No abstract available.
Meniere Disease ; Vestibular Function Tests

OBJECTIVES: Our goal was to find the clinical value of cervical vestibular evoked myogenic potential (VEMP) in Meniere's disease (MD) and to evaluate whether the VEMP results can be useful in assessing the stage of MD. Furthermore, we tried to evaluate the clinical effectiveness of VEMP in predicting hearing outcomes. METHODS: The amplitude, peak latency and interaural amplitude difference (IAD) ratio were obtained using cervical VEMP. The VEMP results of MD were compared with those of normal subjects, and the MD stages were compared with the IAD ratio. Finally, the hearing changes were analyzed according to their VEMP results. RESULTS: In clinically definite unilateral MD (n=41), the prevalence of cervical VEMP abnormality in the IAD ratio was 34.1%. When compared with normal subjects (n=33), the VEMP profile of MD patients showed a low amplitude and a similar latency. The mean IAD ratio in MD was 23%, which was significantly different from that of normal subjects (P=0.01). As the stage increased, the IAD ratio significantly increased (P=0.09). After stratification by initial hearing level, stage I and II subjects (hearing threshold, 0-40 dB) with an abnormal IAD ratio showed a decrease in hearing over time compared to those with a normal IAD ratio (P=0.08). CONCLUSION: VEMP parameters have an important clinical role in MD. Especially, the IAD ratio can be used to assess the stage of MD. An abnormal IAD ratio may be used as a predictor of poor hearing outcomes in subjects with early stage MD.
Hearing ; Hearing Loss ; Humans ; Meniere Disease ; Prevalence ; Vertigo

OBJECTIVES: The aim of this study was to compare the hearing outcomes between canal wall up mastoidectmy (CWUM) and canal wall down mastoidectmy (CWDM). METHODS: One hundred seventy one chronic suppurative otitis media (CSOM) patients were enrolled in this retrospective study. The patients who underwent the second staged ossiculoplasty at least 6 months after mastoidectomy and who had an intact, well aerated tympanic cavity as well as intact mobile stapes at the time of operation were selected from the medical record. Based on the type of mastoid surgery, the patients were categorized into two groups: the CWUM (n=38) and CWDM groups (n=133). The hearing results of the CWUM and CWDM groups were compared using the pre- and post-operative air-bone gap (ABG) at 3 months after ossiculoplasty. RESULTS: The preoperative ABG in both groups (CWUM and CWDM) were 28.4+/-15.6 dB and 31.8+/-14.5 dB, respectively (P=0.18). Both groups didn't show any significant difference (10.9 dB vs. 13.5 dB, respectively) (P=0.21) for the postoperative ABG closure. The proportion of patients with an ABG less than 20 dB was 58.6% of the CWDM patients and 68.4% of the CWUM patients (P=0.25). CONCLUSION: The type of mastoid surgery (CWUM and CWDM) did not affect the hearing results of CSOM patients. When choosing the type of mastoidectomy procedure for CSOM surgery, the hearing outcomes are basically the same for both types of procedure.
Ear, Middle ; Hearing ; Humans ; Mastoid ; Medical Records ; Otitis Media ; Otitis Media, Suppurative ; Retrospective Studies ; Stapes

BACKGROUND AND OBJECTIVES: MarkeTrak survey is a subjective evaluation method for hearing aid users. This investigation evaluated the level of subjective satisfaction in hearing aid users by adopting the MarkeTrak survey method. SUBJECTS AND METHOD: Ninety-seven subjects participated in this study and replied to the Korean version of 8th MarkeTrak survey. The satisfaction score regarding hearing aids used a 7-point scale to analyze the patient-related as well as hearing aids-related factors. RESULTS: Overall satisfaction rate was 60.8%. Among the patient-related factors, women showed significantly higher satisfaction rate (p<0.05) than men but the level of education affected the satisfaction rate (p<0.05). Hearing aids users showed significantly higher satisfaction rate in small group communication than in other circumstances (p<0.05). The factors related to the hearing aids did not have significant influence on the satisfaction rating. CONCLUSION: MarkeTrak survey is a useful questionnaire for evaluating satisfaction about not only hearing factors but also sociodemographic factors and hearing-aids related factors.
Consumer Satisfaction ; Surveys and Questionnaires ; Education ; Female ; Hearing ; Hearing Aids* ; Humans ; Male ; Surveys and Questionnaires*

OBJECTIVE: The aim of this study was to assess the clinical role of 18F-FDG PET/CT for the evaluation of lymph node metastasis in periorbital malignancies, compared with CT alone. MATERIALS AND METHODS: We analyzed eighteen PET/CT and CT scans in 15 patients with biopsy-proven periorbital malignancies. We compared the diagnostic capabilities of PET/CT and CT with regard to nodal metastasis by level-by-level analysis and by N staging prediction. The reference standards were surgical pathology (n = 7) from dissected lymph node specimens and the results from radiological follow-up (n = 11, mean 20.5 months; range 10-52 months). Moreover, any changes in patient care as prompted by PET/CT were recorded and compared with treatment planning for CT alone. RESULTS: PET/CT had a sensitivity of 100%, while CT had a sensitivity of 57% (p = 0.03) for nodal metastasis by level-by-level analysis. PET/CT had a specificity of 97%, positive predictive value of 93%, negative predictive value of 100%, and diagnostic accuracy of 98%, while the CT values for these same parameters were 97%, 89%, 82%, and 84%, respectively. PET/CT correctly predicted N staging with an accuracy of 100%, while CT was only 83% accurate (p = 0.01). Regarding the impact on patient care, the extent of surgery for regional lymph nodes and the treatment decision were modified by PET/CT in 39% of patients. CONCLUSION: PET/CT could provide useful information in the management of regional lymph node metastases in patients with periorbital malignancies.
Adult ; Aged ; Contrast Media ; Eye Neoplasms/pathology/*secondary ; Eyelid Neoplasms/pathology/secondary ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Iohexol/analogs & derivatives/diagnostic use ; Lacrimal Apparatus Diseases/pathology ; Lymphatic Metastasis/diagnosis ; Male ; Middle Aged ; *Positron-Emission Tomography ; Radiopharmaceuticals/*diagnostic use ; Sensitivity and Specificity ; *Tomography, X-Ray Computed/methods