Acute otitis media (AOM) is diagnosed in patients with acute onset of signs and symptoms of inflammation in the middle ear, accompanied by middle ear effusion. AOM is a common infectious disease in children, and its diagnosis and treatment can have significant impacts on the health of children.Current Concepts: The evidence-based clinical practice guidelines in Korea and other countries provide recommendations to primary care clinicians regarding the management of children with AOM. The treatment strategy for AOM depends on the patient’s age, severity of symptoms, the presence of otorrhea, and the laterality.Discussion and Conclusion: For children aged from 6-months to 2-years with unilateral non-severe AOM and children aged 2 years or older with unilateral or bilateral non-severe AOM, the published guidelines provide the option of observation rather than immediate treatment with antibiotics. High-dose amoxicillin (80 to 90 mg a day) is the firstline antibiotic for treating AOM in patients without penicillin allergies. Children in whom symptoms persist after 48 to 72 hours of antibiotic treatment should be re-examined and amoxicillin/clavulanate should be used as second-line antibiotics. Careful follow-up is required to identify the complications and sequelae of AOM, and to determine the optimum treatment.

Acute otitis media (AOM) is diagnosed in patients with acute onset of signs and symptoms of inflammation in the middle ear, accompanied by middle ear effusion. AOM is a common infectious disease in children, and its diagnosis and treatment can have significant impacts on the health of children.Current Concepts: The evidence-based clinical practice guidelines in Korea and other countries provide recommendations to primary care clinicians regarding the management of children with AOM. The treatment strategy for AOM depends on the patient’s age, severity of symptoms, the presence of otorrhea, and the laterality.Discussion and Conclusion: For children aged from 6-months to 2-years with unilateral non-severe AOM and children aged 2 years or older with unilateral or bilateral non-severe AOM, the published guidelines provide the option of observation rather than immediate treatment with antibiotics. High-dose amoxicillin (80 to 90 mg a day) is the firstline antibiotic for treating AOM in patients without penicillin allergies. Children in whom symptoms persist after 48 to 72 hours of antibiotic treatment should be re-examined and amoxicillin/clavulanate should be used as second-line antibiotics. Careful follow-up is required to identify the complications and sequelae of AOM, and to determine the optimum treatment.

A number of studies have demonstrated a significant association between age-related hearing loss (ARHL) and cognitive decline. However their relationship is not clear. In this review, we focused on the etiological mechanisms between ARHL and cognitive decline to explain the nature of this relationship: 1) causal mechanisms (e.g., cognitive load hypothesis, cascade hypothesis); 2) common cause mechanisms (e.g., microvascular disease); 3) overdiagnosis or harbinger hypothesis. We conclude that no single mechanism is sufficient and hearing and cognition related to each other in several different ways. In addition, we reviewed the effectiveness of hearing intervention (e.g., hearing aids and cochlear implants) on cognition function, and the role of hearing aid use and cochlear implant depends on the relevant mechanism.

Hearing loss is the third most common chronic health condition faced by older adults. Recently, a number of studies have demonstrated a significant association between hearing impairment and cognitive decline. However, the underlying explanatory mechanism of this relation has yet to be established. Given the relation between hearing loss and cognitive decline, researchers have been interested in the effect of restoring hearing ability on cognitive functions in older adults. One intervention option for management of the most severe to profound hearing loss in older adults is cochlear implantation (CI). We performed a review to assess the cur- rent status of the literature on the potential influence of CI on cognition in the older adults. Hearing rehabilitation through CI in elderly patients results in improvements in speech perception and cognitive function and lowers the progression to dementia. Further well-designed studies with long follow-up are needed to verify whether CI influences cognition in older adults.

Immunoglobulin G4 (IgG4)-related sclerosing disease (RSD) is a chronic inflammatory disorder characterized by elevated serum IgG4 levels as well as an abundant infiltration of IgG4-positive plasmacytes. Involvement of the paranasal sinus is very rare, so it is difficult to make an accurate diagnosis. Hence, various differential diagnoses, which typically include elevated serum IgG4 levels and the infiltration of IgG4-postive cells into tissues, need to be excluded, especially for malignant diseases and mimicking disorders. Systemic corticosteroids are generally effective at inducing IgG4-RSD remission. Recently, a 43-year-old woman presented with a mass originating from the ethmoid sinus, suggesting malignancy. The patient underwent biopsy of the lesion. The pathologic specimen revealed the magnitude of IgG4-positive plasma cell infiltration, which was consistent with IgG4-RSD. In addition, serum IgG4 levels were markedly increased. After glucocorticoid treatment, the serum IgG4 levels decreased and the symptoms improved. We present a rare case of IgG4-RSD with isolated involvement of the paranasal sinuses.
Adrenal Cortex Hormones ; Adult ; Biopsy ; Diagnosis ; Diagnosis, Differential ; Ethmoid Sinus ; Female ; Humans ; Immunoglobulin G ; Immunoglobulins* ; Paranasal Sinuses ; Plasma Cells

Otalgia consists of primary otalgia associated with disorders of the ear itself and referred otalgia due to disorders of organs that share the same innervation with the ear. Disorders of the oral cavity and laryngopharynx served by the glossopharyngeal and vagus nerves are common causes of referred otalgia. Chest pain from myocardial infarction spreads through the afferent pain pathway, especially through the sympathetic nerves in the cardiac plexus and the phrenic nerve, resulting in a typical chest pain or referred pain in the left upper extremity. However, pain spreading through the vagus nerve can theoretically cause referred otalgia. This association between the heart and ear has not been widely acknowledged, even though a referred otalgia can occasionally be the only symptom of the tragic disease, myocardial infarction, and should be taken seriously. We report a patient who complained of left otalgia as the only symptom of myocardial infarction.
Cardiomyopathies ; Chest Pain ; Ear ; Earache* ; Heart ; Humans ; Hypopharynx ; Infarction ; Mouth ; Myocardial Infarction* ; Pain, Referred ; Phrenic Nerve ; Upper Extremity ; Vagus Nerve

Ceruminous glands are specialized apocrine glands located in the external auditory canal (EAC). Pleomorphic adenoma (PA) of the EAC is derived from these ceruminous glands. Tumors arising from these ceruminous glands are rare. Furthermore, ceruminous PA of the EAC is extremely rare. About 35 cases have been reported to date in the English literature, and only 4 cases have been reported in Korea. There are several controversial issues about these rare tumors such as nomenclature, histogenesis and classification. We report here on two cases of ceruminous PA and review the cases in the Korean literature.
Adenoma ; Adenoma, Pleomorphic* ; Apocrine Glands ; Classification ; Ear Canal* ; Korea

Objectives: . Intratympanic dexamethasone injection (ITDI) has been introduced as a treatment option for subjective tinnitus. However, the effects of ITDI on patients with tinnitus remain unclear. In the present systematic review and metaanalysis, we evaluated the effectiveness of ITDI for tinnitus treatment. Methods: . We searched Medline, the Cochrane Central Register of Controlled Trials, and Embase. Four double-blind randomized controlled trials that tested the efficacy of ITDI compared with a placebo were deemed eligible for a quantitative meta-analysis, while four prospective studies and seven retrospective studies reporting the effectiveness of ITDI on tinnitus treatment were included in a qualitative synthesis. Results: . In the four studies included in the quantitative meta-analysis, ITDI did not show evidence of tinnitus improvement compared with placebo (odds ratio [OR], 1.38; 95% confidence interval, 0.53–3.61). In the 11 studies included in the qualitative synthesis, seven retrospective studies without controls reported rates of tinnitus improvement after ITDI ranging from 35.9% to 91.3%. In the four prospective studies with controls, ITDI seemed to be effective when combined with other drugs for tinnitus treatment. Conclusion . ITDI alone did not show a significant effect for treating tinnitus compared with placebo. However, the potential of combination treatment of ITDI with other drugs for tinnitus therapy should be further studied in more systematic research.

Background and Objectives: Sudden sensorineural hearing loss (SSNHL) is characterized by sudden onset of impaired hearing, and systemic steroid is the most widely accepted treatment option for it. The aim of this study is to evaluate the effectiveness of stellate ganglion block (SGB) as a treatment option for SSNHL.Subjects and Method A total of 318 patients diagnosed with SSNHL were treated with systemic steroid and SGB (SGB group, 127 patients) or systemic steroid only (non-SGB group, 191 patients). Hearing improvement was defined as a hearing gain of more than slight improvement using Siegel’s criteria. Results: The SGB group did not show any significant effects on hearing improvement compared with the non-SGB group (60% vs. 65%). However, some patients with profound hearing loss of more than 90 dB have recovered above average after the SGB treatment. Also, we used multiple regression analysis to ascertain which factors influenced hearing recovery, and found that the initial pure-tone audiometry thresholds at 2000 Hz and 4000 Hz were statistically associated with hearing recovery. Conclusion In conclusion, SGB did not show a clear therapeutic effect, but suggested the possibility of treatment for improving the inner ear circulation of patients with profound hearing loss.

Angioleiomyoma is an uncommon benign tumor composed of smooth muscle cells and vascular endotheliums. It is common in the uterus and the gastrointestinal tract but rare in the head and neck. This neoplasm is extremely rare in the nasal cavity, accounting for less than 1% of all vascular leiomyomas. The tumor has a benign nature and the recurrence of tumor is rare and complete removal is the treatment of choice. We present a case of angioleiomyoma which involves the nasal vestibule and was excised by a sublabial approach.
Accounting ; Angiomyoma ; Endothelium, Vascular ; Gastrointestinal Tract ; Head ; Myocytes, Smooth Muscle ; Nasal Cavity ; Neck ; Recurrence ; Uterus