Herpes zoster oticus is caused by herpetic viruses including varicella zoster and most commonly affects cranial nerves (CN) VII and VIII. With a review of literature, we report a case of herpes zoster oticus with selective involvement of CN VIII, IX and X. Interestingly, the motor fibers of CN VII were spared while ipsilateral recurrent laryngeal nerve involvement was evident. The patient was treated with antiviral medication and systemic steroids and symptoms were improved.
Chickenpox ; Cranial Nerves ; Facial Nerve ; Herpes Zoster ; Herpes Zoster Oticus ; Humans ; Polyneuropathies ; Recurrent Laryngeal Nerve ; Steroids ; Vocal Cord Paralysis

Tophus due to gout is most commonly found in the toes and ankles, but can also be found in the auricle. Although small nodules on the helix are sometimes found in gout patients, a large mass lesion on the back side of the auricle is rare. We report a patient who visited the otology clinic due to an auricular mass lesion, which was diagnosed as a large auricular tophus. A 17-year-old male patient who suffered from gout complained of a right side auricular mass. A 3 cm sized solid mass lesion was detected on the back side of the right canvum conchal cartilage. The mass was soft, non-tender, and well-circumscribed. The lesion was first found 1-2 years earlier. The size of the lesion had been slowly increasing, but had recently stopped growing. The mass was surgically removed for pathologic confirmation and cosmetic reasons. Specimens were composed of 2 irregularly shaped pieces of soft-gray tan and yellowish tissue. The upper larger tophus was attached to the cartilage and the lower smaller tophus was embedded inside the auricular cartilage. Pathologic findings suggested tophus with amorphous deposits and subepithelial tissue.
Adolescent ; Animals ; Ankle ; Cartilage ; Cosmetics ; Ear Cartilage ; Gout ; Humans ; Male ; Otolaryngology ; Toes ; Triacetoneamine-N-Oxyl

Facial nerve schwannoma is a rare benign tumor that arises from the Schwann cell sheath of facial nerve. Although the tumor can occur anywhere along the course of the peripheral nerve, it is frequently present as an internal auditory canal mass in the head and neck region. We experienced a rare case of facial nerve schwannoma on the mastoid segment, which was presented as an external auditory canal mass in a 24-years-old man. The lesion was removed via the transmastoid approach and the facial nerve was grafted using the greater auricular nerve. The patient's facial nerve function was preserved postoperatively as House-Brackmann grade III.
Ear Canal ; Facial Nerve ; Head ; Mastoid ; Neck ; Nerve Sheath Neoplasms ; Neurilemmoma ; Peripheral Nerves ; Transplants

BACKGROUND AND OBJECTIVES: Absence of incus is one of the most common ossicular anomalies and also frequently found in chronic otitis media or chornic otitis media with cholesteatoma. Ossiculoplasty with malleus footplate assembly (MFA) can be an excellent option in the above situations. We reviewed our procedures and evaluated the hearing results of ossiculoplasty using the MFA. SUBJECTS AND METHODS: This study retrospectively reviews a series of 32 patients who underwent MFA ossiculoplasty between September 2001 and March 2010 in an academic tertiary referral center. The autologous incus or hydroxyapatite (HA) was used as materials for reconstruction. RESULTS: Thirteen of 32 patients (40.6%) had ossicular chain anomaly, 9 patients (28.1%) had congenital cholesteatoma and 8 patients (25.0%) had chronic otitis media with cholesteatoma and 2 patients (6.3%) had chronic otitis media. The patients with ossicular chain ano-maly showed the greatest air-bone gap (ABG) closure. Overall, postoperative ABG was 17.7+/-11.7 dB at postoperative 6 months and 19.7+/-14.3 dB at postoperative 1 year, compared with preoperative ABG of 37.9+/-9.3 dB. There was no statistical difference of ABG at postoperative 12 months, 24 months between MFA using incus (n=17) and HA (n=15)(p=0.300, and p=0.563). There was no meaningful difference of postoperative ABG between the patients with combined mastoidectomy (n=10) and those without mastoidecmoy (n=22)(p=0.555). No extrusions occurred. CONCLUSIONS: MFA can be an effective option in the case of absent incus expecting good postoperative hearing results.
Cholesteatoma ; Durapatite ; Hearing ; Humans ; Incus ; Malleus ; Ossicular Prosthesis ; Otitis Media ; Retrospective Studies ; Tertiary Care Centers

BACKGROUND AND OBJECTIVES: The study was designed to measure the change of serum aldosterone concentration after noise exposure in BALB/c mice. MATERIALS AND METHODS: BALB/c hybrid mice with < or =25 dB nHL in auditory brainstem responses (ABR) were used. Six mice were exposed to 120 dB SPL broad white band noise for 3 hours per day for 3 consecutive days. ABRs in all mice were examined after noise exposure. Serum aldosterone concentration was checked by radioimmunoassay in three mice without noise exposure, in three mice immediately after noise exposure (0 day after noise group), and in three mice 3 days after noise exposure (3 days after noise group). RESULTS: Permanent noise exposure-related threshold shift was induced in mice of 0 day after noise group and 3 days after noise group (83.3+/-2.9 and 88.3+/-2.9 dB nHL, respectively). The serum aldosterone concentration of the mice after noise exposure was significantly lower than control mice (p=0.046). The changes of aldosterone concentration were 879+/-137.5 pg/mL without noise exposure, 623+/-75.9 pg/mL immediately after noise exposure, and 683+/-49.2 pg/mL 3 days after noise exposure. CONCLUSIONS: In BALB/c mice, serum aldosterone concentration is decreased significantly after noise exposure.
Aldosterone ; Animals ; Chimera ; European Continental Ancestry Group ; Evoked Potentials, Auditory, Brain Stem ; Hearing Loss ; Humans ; Mice ; Noise ; Radioimmunoassay

BACKGROUND AND OBJECTIVES: Corticosteroids have been used for therapeutic management of sudden sensorineural hearing loss (SSNHL). Because of the complications associated with systemic steroid therapy and low levels of steroid in the inner ear after systemic administration, intratympanic steroid injection (ITSI) is currently used. The purpose of this study was to compare the efficacy of systemic steroid therapy with systemic combined high frequency ITSI therapy. SUBJECTS AND METHODS: Forty-six SSNHL patients were divided into the only systemic dexamethasone therapy group (systemic steroid IV group, 27 patients) and the systemic with frequent intratympanic dexamethasone injection group (combined ITSI group, 19 patients). In the systemic steroid IV group, dexamethasone was administered intravenously for 5 days followed by oral tapered doses for 10 days. In the combined ITSI group, intratympanic dexamethasone was administered 5 times per day for 5 consecutive days in addition to intravenous administration of dexamethasone. Hearing was assessed both before therapy and at 15 days, 4 weeks, and 8 weeks after the initiation of therapy. RESULTS: The recovery rate and hearing gain were 74% (20 out of 27 patients) and 33 dB mean improvement in the systemic steroid IV group and 73.6% (14 out of 19 patients) and 41.5 dB mean improvement in the combined ITSI group. There was no statistically significant difference in hearing gain and the recovery rate between the two groups. CONCLUSIONS: The therapeutic effect of a combination of highly frequently administered intratympanic dexamethasone and systemic steroid therapy was not superior to only systemic steroid injection therapy.
Administration, Intravenous ; Adrenal Cortex Hormones ; Dexamethasone ; Ear, Inner ; Hearing ; Hearing Loss, Sensorineural ; Humans

BACKGROUND AND OBJECTIVES: Facial nerve dysfunction in Bell's palsy is evaluated using various parameters including physical examination and electrophysiological studies. Associated symptoms of facial numbness or paresthesia are reported by some patients with Bell's palsy. The aim of this study was to investigate trigeminal nerve involvement in Bell's palsy using blink reflex test. SUBJECTS AND METHODS: Facial nerve and trigeminal nerve functions were assessed using House-Brackmann (HB) grading system, electroneuronography (ENoG) and blink reflex tests in 28 patients diagnosed as Bell's palsy. RESULTS: HB grades correlated with degeneration ratio from ENoG (p=0.002, chi-square test). The ipsilateral R1 reponse of the blink reflex was absent or abnormal in 27/28 patients (96.4%), and ipsilateral R2 response was absent or abnormal in 26/28 patients (92.8%). Contralateral R2 was abnormal in 5/28 patients (17.8%), suggesting involvement of trigeminal nerve in a portion of patients. The results of blink reflex test showed no significant correlation to the outcome of facial nerve function (HB grade) in Bell's palsy patients. CONCLUSIONS: Blink reflex test provides information about trigeminal and facial nerve functions in addition to ENoG results. Our study suggests that subclinical involvement of trigeminal nerve may accompany facial nerve dysfunction in Bell's palsy.
Bell Palsy ; Blinking ; Facial Nerve ; Humans ; Hypesthesia ; Paresthesia ; Physical Examination ; Trigeminal Nerve

BACKGROUND AND OBJECTIVES: Bone defect of the attic wall is a critical cause of the postoperative retraction pocket after canal wall up mastoidectomy. So, proper treatment of the attic defect is important and attic reconstruction is an acceptable procedure but it is controversial when the attic is reconstructed or not. The aim of this study is to analyze the usefulness of the attic reconstruction using tragal cartilage and perichondrium for prevention of retraction pocket and propose the indication to perform the attic reconstruction. SUBJECTS AND METHODS: We retrospectively reviewed the medical records of 46 consecutive patients who underwent tympanomastoidectomy and attic reconstruction using tragal cartilage between January 2005 and January 2009. The follow-up period varied from 12 to 65 months, with the average period of 34 months. We analyzed postoperative status of the scutum and the tympanic membrane, and development of the residual or recurrent cholesteatomas and evaluate development of the retraction pocket according to the preoperative size of the bony defect of the scutum and status of the ossicular chain. RESULTS: Retraction pocket was developed in the 13% of the operations and most of the cases had large attic destruction more than 3 mm and destructed ossicular chain. CONCLUSIONS: Attic reconstruction using tragal cartilage is a simple method to repair the bony defect of the external ear canal and effective in preventing postoperative retraction pocket if the size of destructed scutum is less than 3 mm.
Cartilage ; Cholesteatoma ; Ear Canal ; Follow-Up Studies ; Humans ; Medical Records ; Reconstructive Surgical Procedures ; Retrospective Studies ; Tympanic Membrane

BACKGROUND AND OBJECTIVES: The evaluation of tinnitus is becoming increasingly important in assessing the degree of disability. However, until now, there are no tools to verify the presence of tinnitus. The aim of this study was to identify the possibilities in discriminating the presence of tinnitus through tinnitus test, pitch match test and loudness balance test. MATERIALS AND METHODS: Typically, 50 patients who have suffered from continuous tinnitus and 20 subjects with normal hearing ability who did not suffer from tinnitus were selected for the present investigation. All the patients underwent the tests for pitch match and loudness balance, which were replicated thrice with 1-minute intervals with a TDH 49 headphone and an oribiter model 922, GN otometrics in a soundproof room. Non-tinnitus group that didn't have tinnitus chose virtual tinnitus based on their own discretion. RESULTS: The most similar sounds mimicking tinnitus were of pure tone in both the groups. However, subjects of the tinnitus group were exposed to a greater variety of sounds than those of the non-tinnitus group. Moreover, the most common frequency of tinnitus was 4 and 8 kHz in the tinnitus group, but 1 kHz in the non-tinnitus group. The mean loudness of tinnitus was 7.28 dBSL in the tinnitus group and 13.6 dBSL in the non-tinnitus group. The loudness of tinnitus in the tinnitus group was less than that in the non-tinnitus group in a statistically significant manner (p<0.05). Loudness in each repeated tinnitus tests was identical in tinnitus group, but significantly different in non-tinnitus group (p<0.05). CONCLUSIONS: We concluded that repeated tinnitus tests for loudness matching were helpful in identifying the presence of tinnitus.
Hearing ; Humans ; Tinnitus

One of surgical complications in cochlear implantation is the necrosis of the skin flap above the receiver-stimulator coil. We present a case of 55-year-old woman who underwent cochlear implantation and developed a bluish skin necrosis due to bone marking. The planned position for the receiver-stimulator was marked using methylene blue through skin to bone. She did not undergo skin flap thinning and underwent successful implantation with complete electrode insertion. Few weeks postoperatively, the patient developed bluish discoloration with progressive thick, blue eschar formation and skin flap necrosis. She subsequently underwent wound debridement and skin flap closure. Cochlear explantation was not necessary. Timely diagnosis and management about this complication is necessary to prevent further skin breakdown and subsequent device extrusion. This report identifies the marking using methylene blue as another possible source of skin flap necrosis in cochlear implantation, and surgeons should be aware of this potential complication.
Cochlear Implantation* ; Cochlear Implants* ; Debridement ; Diagnosis ; Electrodes ; Female ; Humans ; Methylene Blue* ; Middle Aged ; Necrosis* ; Postoperative Complications ; Skin* ; Wounds and Injuries