Iatrogenic epidermoid cyst of the retroauricular area after ear surgery is extremely unusual. Epidermoid cyst is an intradermal or subcutaneous sac-like structure which is lined with well differentiated stratified squamous epithelium containing keratohyalin granules. These cysts are thought to arise as a result of implantation of epidermal cells into the deeper dermal elements by trauma or previous surgery. We report a 42-year-old female with retroauricular epidermoid cyst invading into the temporal bone who underwent tympanoplasty 15 years ago. The lesion was surgically excised, histopathologic examination revealed an epidermoid cyst. Therefore we report the case along with review of literature.
Adult ; Ear ; Epidermal Cyst ; Epithelium ; Female ; Humans ; Keratins ; Temporal Bone ; Tympanoplasty

Acute mastoiditis continues to be a potentially dangerous infection in the antibiotic era. Despite use of antibiotics to treat suppurative acute otitis media in children, the incidence of subsequent development of acute mastoiditis and its complications, including periauricular subperiosteal abscess, facial paralysis, meningitis, and brain abscess has not plunged down below a certain level. Mastoidectomy has been the routine procedure for treating acute mastoiditis with subperiosteal abscess but recently many authors suggest that subperiosteal abscess complicating acute coalescent mastoiditis can be successfully treated by broad-spectrum antibiotics, myringotomy, and minor surgical procedures such as incision and drainage, not necessarily requiring simple mastoidectomy. Contrary to the recent trend shift from a surgical disease to a medical disease, we report two consecutive acute mastoiditis cases definitely mandating simple mastoidectomy to emphasize the role of surgical intervention even in the recent trend shift from a surgical to a medical disease.
Abscess ; Anti-Bacterial Agents ; Brain Abscess ; Child ; Drainage ; Facial Paralysis ; Humans ; Incidence ; Mastoid ; Mastoiditis ; Meningitis ; Otitis Media ; Surgical Procedures, Minor

Semicircular canal dehiscence is a rare but well-described condition to be induced noise or straining. Patients with Superior semicircular canal dehiscence (SSCD) present with a wide variety of symptoms. Reported case is a 51-year-old woman who presented with intermittent vertigo and left-side aural fullness for one month after traffic accident. To establish the diagnosis, high resolution temporal bone CT scanning has been performed to demonstrate bone defect overlying superior semicircular canal, and vestibular auditory symptoms and signs are evaluated through vestibular function test and auditory examination. Cognitive behavior therapy, vestibular rehabilitation and vestibular suppressants are prescribed. Auditory symptoms and vertigo have been subsided. At the same time, Presented depression and anxiety have been improved after 3 month treatment and the quality of life of patient has been improved.
Accidents, Traffic ; Anxiety ; Cognitive Therapy ; Depression ; Female ; Humans ; Middle Aged ; Noise ; Quality of Life ; Semicircular Canals ; Sprains and Strains ; Temporal Bone ; Vertigo ; Vestibular Function Tests

Skull base osteomyelitis (SBO) is a rare disease and may develop as a complication of paranasal sinusitis or other regional infectious process. The characteristic symptom of SBO is headache and paralysis of cranial nerve. A potentially life-threatening disease, it requires aggressive antibiotic treatment. We present 2 cases of SBO. One case who were not immunocompromised or diabetics had paralysis of lower cranial nerves. The patient was effectively treated with complete mastoidectomy and antibiotics, so had a complete recovery. But, the other patient who were insulin-dependent diabetes mellitus was died due to meningitis and pons palsy.
Aged ; Anti-Bacterial Agents ; Cranial Nerve Diseases ; Cranial Nerves ; Diabetes Mellitus, Type 1 ; Headache ; Humans ; Meningitis ; Osteomyelitis ; Paralysis ; Pons ; Rare Diseases ; Sinusitis ; Skull ; Skull Base

BACKGROUND AND OBJECTIVES: The masking should be used in pure tone audiometry when the difference between the air-conduction threshold of the tested ear and the bone-conduction threshold of the non-tested ear is more than interaural attenuation (IA). But the standardized average value of IA in Korean has not been evaluated until now. The purpose of this study is to evaluate the interaural attenuation in Korean population. SUBJECTS AND METHODS: Of the patients who visited our department from March, 2007 to August, 2009, 44 patients were selected who had unilateral severe sensorineural hearing loss or deafness and contralateral normal hearing. When the difference between air-conduction threshold with and without masking was more than 10 dB, the interaural attenuation at each frequency was obtained by subtracting the contralateral bone conduction from the air-conduction threshold without masking. RESULTS: The interaural attenuations at each frequency were 45-75 dB (250 Hz), 50-75 dB (500 Hz), 40-75 dB (1 kHz), 45-85 dB (2 kHz), 50-90 dB (4 kHz). 77.2% of the subjects showed interaural attenuation of 55-65 dB at 250 Hz, and 80.9% in 50-60 dB at 500 Hz, 79.5% in 55-65 dB at 1 kHz, 83.4% in 45-60 dB at 2 kHz, and 76.4% in 50-65 dB at 4 kHz. Most of the patients were distributed 15-25 dB higher than the minimal interaural attenuation at 1 kHz. At 2 kHz and 4 kHz, most of the patients were distributed around 15 dB of the minimal interaural attenuation. CONCLUSIONS: These results can be used as reference values for masking of pure tone audiometry. But, further studies with large population should be done to get more precise results and contributing factors to IA values.
Audiometry ; Bone Conduction ; Deafness ; Ear ; Hearing ; Hearing Loss, Sensorineural ; Humans ; Masks ; Reference Values

BACKGROUND AND OBJECTIVES: Chronic otitis media (COM) is strongly related to the degree of aeration of the middle ear and mastoid. The developmental pattern of these air cell systems can affect those of COM, especially cholesteatoma, or vice versa. We investigated several anatomical indexes representing the middle ear and mastoid air cell system to research their relationship with different types of COM. SUBJECTS AND METHODS: Temporal bone computed tomography were performed on 51 patients with cholesteatoma, 50 with COM, and 50 normal subjects. Height of epitympanum, degree of mastoid pneumatization and anterior epitympanic space (AES) development were measured. AES development was classified into three categories: undeveloped, single cell and multiple cells. Anatomical index measurements were compared according to the types of COM. RESULTS: The mean height of epitympanum was 5.12mm in cholesteatoma, 6.04 mm in COM, and 7.40 mm in normal group (p<0.05). The degree of pneumatization was 20.9%, 17.2%, and 42.2% respectively. AES was undeveloped in 65%, single cell in 33%, and multiple cells in only 2% of cholesteatoma patients. In COM and normal groups, the proportions of AES were 60%, 30%, 10% and 7%, 48%, 45% respectively (p<0.05). Comparing between attic and pars tensa types of cholesteatoma, all indexes failed to show any difference. However, there was a significant difference in height of epitympanum between affected ear (5.12 mm) and contralateral ear (5.62 mm) in cholesteatoma group. CONCLUSIONS: In patients with COM, the degree of development of epitympanum and AES are significantly lower than control group. We believe epitympanic underdevelopment may be related to the pathogenesis of COM, especially with cholesteatoma.
Cholesteatoma ; Ear ; Ear, Middle ; Humans ; Mastoid ; Otitis ; Otitis Media ; Temporal Bone

BACKGROUND AND OBJECTIVES: Tympanosclerosis is a nonspecific and irreversible result of chronic inflammation or infection of the middle ear. However, there remains disagreement about how best to surgically treat tympanosclerotic ossicular fixation, with the controversy over its management when stapes is involved. The aim of this study was to evaluate operative findings and hearing results of tympanosclerosis involving the ossicular chain, which in turn would establish better surgical treatment of tympanosclerotic ossicular fixation. SUBJECTS AND METHODS: In this prospective study conducted from Mar 2000 to Dec 2007, 38 patients with tympanosclerosis who had undergone surgical treatment were evaluated. The clinical and operational records and pre- and postoperative pure tone audiograms were reviewed. RESULTS: Operative findings showed stapes fixation is the most common. In 8 patients (21.1%), stapes was mobile, while, in the remaining 30 patients (78.9%), stapes fixation was found. In all cases with stapes fixation, stapes mobilization was possible. Following hearing result reporting guideline by the Korean Otological Society, the success rate of middle ear surgery was 68.4% (26 of 38 patients). In cases with stapes fixation, the success rate was 66.6% (20 of 30 patients), while, in cases with no stapes fixation, the success rate was 75.0% (6 of 8 patients). However, there was no statistical significance between the two groups. CONCLUSION: Stapes fixation was found in 78.9% of tympanosclerotic ossicular fixation. In management of tympanosclerotic stapes fixation, meticulous excision of tympanosclerotic plaques and removal of new bone formation around stapes footplate after adequate exposure could achieve a relatively good hearing result without stapes surgery.
Ear, Middle ; Hearing ; Humans ; Inflammation ; Myringosclerosis ; Ossicular Replacement ; Osteogenesis ; Prospective Studies ; Stapes ; Stapes Mobilization ; Stapes Surgery

BACKGROUND AND OBJECTIVES: Adhesion of middle ear and mastoid cavity after mastoidectomy represents a potential source of surgical failure. GUARDIX-SL(R), absorbable anti-adhesive material, which is composed of sodium hyaluronate and sodium carboxymethyl cellulose, is an effective agent that widely used as a surgical adjuvant to decrease adhesion in the surgery. Therefore, we evaluated the clinical efficacy of the GUARDIX-SL(R) for the prevention of adhesion after mastoidectomy. SUBJECTS AND METHODS: This study was randomized and double-blinded. Conventional intact canal wall mastoidectomy was conducted in both control (n=14) and study group (n=10). To avoid bias because of different surgeons, we only included patients who were operated on by one surgeon. In the study group, 1.5 g GUARDIX-SL(R) was applied in the mastoid cavity at the end of mastoidectomy. To evaluate anti-adhesive effect of GUARDIX-SL(R), the volume of aerated area in the mastoid cavity was calculated and compared with temporal bone computed tomography performed at preoperatively and postoperatively. Besides, to assess the success of operation, pure tone audiometry was also performed at preoperatively and postoperatively. RESULTS: The volume of aerated area of mastoid cavity after mastoidectomy was more increased in GUARDIX-SL(R) group, but was not statistically significant in the GUARDIX-SL(R) group than the control. And all results of pure tone audiometry satisfied the criteria of successful operation which has been suggested by Otological Society of Korea. CONCLUSION: The results suggest that GUARDIX-SL(R) may be an efficacious and safe material in decreasing the incidence of adhesion after mastoidectomy.
Audiometry ; Bias (Epidemiology) ; Carboxymethylcellulose Sodium ; Ear, Middle ; Humans ; Hyaluronic Acid ; Incidence ; Mastoid ; Sodium ; Temporal Bone ; Tissue Adhesions ; Tympanoplasty

OBJECTIVES: This study was designed to observe the clinical and audiologic characteristics of patients diagnosed as low tone hearing loss (LHL) and to evaluate the treatment response and prognosis. SUBJECTS AND METHODS: A retrospective chart review of 61 patients who were diagnosed with LHL was performed. Result of various audiologic studies and therapeutic responses of medication have been evaluated. Data were statistically analyzed with variables such as age, sex, interval between onset and treatment, initial hearing levels, findings of electrocochleargraphy, and initial concomitant symptoms according to their treatment response. RESULTS: Frequent chief complaints of LHL were tinnitus and earfullness. Tinnitus was usually matched at lower frequencies. Treatment with low-dose steroids, diuretics, and betahistine produced a high response rate of 79.4%. Complete response occurred in 49 of the 68 ears (72.1%) and partial response occurred in five of the 68 ears (7.4%). Fourteen of the 68 ears (20.6%) were in the non-responder group. Patients treated within 7 days after the onset of symptoms all showed complete response. Statistically significant prognostic factors affecting treatment response were age and intervals between onset and treatment (p<0.05). CONCLUSION: Patients with acutely onset tinnitus or ear fullness should be carefully evaluated and promptly treated under the diagnosis of LHL.
Betahistine ; Diuretics ; Ear ; Hearing ; Hearing Loss ; Humans ; Prognosis ; Retrospective Studies ; Steroids ; Tinnitus

Sudden sensorineural hearing loss (SSNHL) is characterized by abrupt unilateral loss of hearing, sometimes accompanied by tinnitus or vertigo. From the majority of patients with SSNHL, no specific cause can be identified, but numerous conditions including viral infection, vascular compromise and intracochlear membrane break are considered as possible causes of disease. According to these etiologic hypotheses, a combination therapy has been frequently used combining several options among steroids, antiviral agents, vasodilators, volume expanders, stellate ganglion block and carbogen or hyperbaric oxygen. The contents of the combination could vary according to the experience of each clinic, but steroids have been accepted as the mainstay of the treatment for SSNHL since Wilson's landmark study although two recent meta-analysis of steroid treatment suggested there was no benefit. The amount and the length of oral steroid therapy have not been well established. Commonly used regimen of oral steroid therapy is prednisone. A reported success rate with systemic steroid therapy is between 49% and 89%, whereas only 30% to 65% of patients without treatment achieved hearing improvement. Recently there is an obvious trend for an increasing number of positive results of intratympanic steroids injection. It is difficult to evaluate the efficacy of a certain drug or regimen prescribed for SSNHL because of various drugs used as combination therapy, many prognostic factors and different inclusion criteria.
Antiviral Agents ; Carbon Dioxide ; Hearing ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Humans ; Membranes ; Oxygen ; Prednisone ; Stellate Ganglion ; Steroids ; Tinnitus ; Vasodilator Agents ; Vertigo