In the early days of cochlear implantation (CI) surgery, when the types of electrodes were limited and the etiology of sensorineural hearing loss (SNHL) was not well understood, the one-size-fits-all approach to CI held true, as in all other fields. However, in the era of personalized medicine, there have been attempts to associate CI performance with the etiology of SNHL and to establish customized surgical techniques that can maximize performance according to individual cochlear dimensions. Personalized genomic-driven assessments of CI candidates and a better understanding of genotype-phenotype correlations could provide clinically applicable diagnostic and prognostic information about questions such as who, how, and when to implant. Rigorous and strategic imaging assessments also provide better insights into the anatomic etiology of SNHL and cochlear dimensions, leading to individualized surgical techniques to augment CI outcomes. Furthermore, the precision medicine approach to CI is not necessarily limited to preoperative planning, but can be extended to either intraoperative electrode positioning or even the timing of the initial switch-on. In this review, we discuss the implications of personalized diagnoses (both genetic and nongenetic) on the planning and performance of CI in patients with prelingual and postlingual SNHL.

Background and Objectives: Middle ear implants (MEI) have been reported to be an effective and safe alternative for the treatment of sensorineural hearing loss (SNHL) and conductive hearing loss (CHL). This study aimed to compare the functional outcomes between SNHL and CHL in terms of audiological gains.Subjects and Method The medical records of 14 consecutive SNHL and CHL patients who underwent MEI surgeries from 2015 to 2019 by a single surgeon were retrospectively reviewed. Audiological changes using hearing aids (HA) and MEI were compared. Results: In SNHL, the mean unaided air-conduction pure tone audiometry (PTA), (57.7 dB HL) decreased significantly using HA and MEI (44.7 and 41.4 dB HL), but with no significant difference from each other. Unaided word recognition score (WRS) at 65 dB HL (45.1%) was significantly improved using HA and MEI (72.6% and 76.6%), with no significant difference. In CHL, the mean unaided air-conduction and bone-conduction PTA were 77.1 (57.5-93.8) and 44.1 (26.3-57.5) dB HL. Three patients could not use conventional HAs due to otorrhea and deformity of the external auditory canal by previous surgeries and 4 patients had used conventional HAs before MEI. Though both HA and vibrant soundbridge (VSB) showed improvement of hearing thresholds (32.0 and 48.8 dB HL) and WRS (80.0% and 94.9%), it was significant only when using VSB. There was no significant difference between HA and VSB. Conclusion MEI can be an effective treatment option for both SNHL and CHL patients, especially for those who suffered from problems using conventional HA.

Background and Objectives: The relationship between hearing aid (HA) use and improvement in cognitive function is not fully known. This study aimed to determine whether HAs could recover temporal resolution or hearing in noise functions. Materials and Methods: We designed a prospective study with two groups: HA users and controls. Patients older than 45 years, with a pure tone average threshold of worse than 40 dB and a speech discrimination score better than 60% in both ears were eligible. Central auditory processing tests and hearing in noise tests (HINTs) were evaluated at the beginning of the study and 1, 3, 6, and 12 months after the use of a monaural HA in the HA group compared to the control group. The changes in the evaluation parameters were statistically analyzed using the linear mixed model. Results: A total of 26 participants (13 in the HA and 13 in the control group) were included in this study. The frequency (p<0.01) and duration test (p=0.02) scores showed significant improvements in the HA group after 1 year, while the HINT scores showed no significant change. Conclusions After using an HA for one year, patients performed better on temporal resolution tests. No improvement was documented with regard to hearing in noise.

Adult ; Cartilage ; Female ; Humans ; Male ; Medical Records ; Nasal Bone ; Nose

BACKGROUND AND OBJECTIVES: We evaluated the correlation between video head impulse test (vHIT) and dizziness handicap inventory (DHI), which is commonly used to quantify severity of dizziness in vestibular neuritis (VN).SUBJECTS AND METHOD: Twenty VN patients undergoing vHIT either at the acute or follow-up stages of treatment were assessed by DHI questionnaire. Gain and gain asymmetry (GA) were correlated with DHI scores and abnormal vHIT rates were compared according to the severity of dizziness (mild ≤30; moderate-to-severe ≥32). RESULTS: vHIT gains significantly increased from the acute to follow-up stages (from 0.45±0.18 to 0.70±0.25), whereas GA and DHI scores decreased (GA, from 0.36±0.15 to 0.22±0.18; DHI scores, from 35±26 to 23±23). Although vHIT gains or GA showed no correlation with DHI scores at the acute stage, vHIT gains showed significant correlation with DHI scores at the follow-up (R-sq=0.32, p=0.01) stage. vHIT gains and GA did not differ according to the severity of dizziness during the acute stage; however, vHIT gains (0.78±0.25) of patients with mild dizziness were significantly higher than those (0.51±0.14) with moderate-to-severe dizziness at the follow-up stage. During the follow-up, all patients with moderate-to-severe dizziness showed abnormal vHIT gain, but 43% of patients with mild dizziness showed abnormal vHIT gain, showing a significant difference (p<0.05). CONCLUSION Reduced vHIT gain was significantly correlated with high degrees of dizziness at the follow-up, but not at the acute stage, suggesting that high-frequency canal dysfunction is contributed in part by the subjective dizziness at the follow-up. Our findings suggest that vHIT might give an indirect evidence for implementing vestibular rehabilitation for enhancing impaired vestibular function and relieving subjective dizziness.

BACKGROUND AND OBJECTIVES: We evaluated the correlation between video head impulse test (vHIT) and dizziness handicap inventory (DHI), which is commonly used to quantify severity of dizziness in vestibular neuritis (VN). SUBJECTS AND METHOD: Twenty VN patients undergoing vHIT either at the acute or follow-up stages of treatment were assessed by DHI questionnaire. Gain and gain asymmetry (GA) were correlated with DHI scores and abnormal vHIT rates were compared according to the severity of dizziness (mild ≤30; moderate-to-severe ≥32). RESULTS: vHIT gains significantly increased from the acute to follow-up stages (from 0.45±0.18 to 0.70±0.25), whereas GA and DHI scores decreased (GA, from 0.36±0.15 to 0.22±0.18; DHI scores, from 35±26 to 23±23). Although vHIT gains or GA showed no correlation with DHI scores at the acute stage, vHIT gains showed significant correlation with DHI scores at the follow-up (R-sq=0.32, p=0.01) stage. vHIT gains and GA did not differ according to the severity of dizziness during the acute stage; however, vHIT gains (0.78±0.25) of patients with mild dizziness were significantly higher than those (0.51±0.14) with moderate-to-severe dizziness at the follow-up stage. During the follow-up, all patients with moderate-to-severe dizziness showed abnormal vHIT gain, but 43% of patients with mild dizziness showed abnormal vHIT gain, showing a significant difference (p<0.05). CONCLUSION: Reduced vHIT gain was significantly correlated with high degrees of dizziness at the follow-up, but not at the acute stage, suggesting that high-frequency canal dysfunction is contributed in part by the subjective dizziness at the follow-up. Our findings suggest that vHIT might give an indirect evidence for implementing vestibular rehabilitation for enhancing impaired vestibular function and relieving subjective dizziness.
Dizziness ; Follow-Up Studies ; Head Impulse Test ; Head ; Humans ; Methods ; Rehabilitation ; Vestibular Neuronitis

Background and Objectives: In this study, we introduce our method of hearing aid (HA) verification using real ear measurement (REM). We verified HAs that have gone through the fitting program using speech mapping REM; we then compared the outcome with word recognition scores (WRS) to evaluate functional gain. Subjects and Method Fifty-six patients of sensorineural hearing loss (81 ears) were enrolled in the study. In REM, if the gap between the target gain of HA and real ear aided response (REAR) was less than 10 dB SPL, fitting was considered successful. In speech audiometry, unaided maximum discrimination score (PB max), unaided WRS at 65 dB HL and aided WRS at 65 dB HL were measured. By comparing PB max and aided WRS at 65 dB HL, patients were sorted into best (n=15), good (n=57), and poorly (n=9) aided groups and analyzed for the successes of fitting. Fitting was deemed unsuccessful if REAR was ≥10 dB SPL lower than the target value of HA. Results: The mean aided WRS at 65 dB HL of best, good and poorly aided groups were 85.6%, 77.3%, and 54.2%, respectively. There were statistically significant differences between all groups (p=0.019, 0.001, 0.002). The success rates of HA fitting showed significant differences at 0.5, 0.75, 1, 4 kHz of 55 dB SPL (p=0.023, 0.005, 0.003, 0.014), and at 4 kHz of 65 and 75 dB SPL (p=0.004, 0.001). The high WRS group showed sufficient gain at many frequencies. Conclusion Well fitted HAs can provide sufficient increase in speech intelligibility. Using the speech mapping REM is a great method to verify fitting of HA.

Background and Objectives: There have been no reports in Korea regarding cochlear implant surgeries using Cochlear Nucleus Profile Slim Modiolar electrode [CI532 (Cochlear Ltd.)], as it has been recently released in Korea. We aimed to investigate the short-term results of CI532 and compare them with previous devices with perimodiolar or straight electrodes arrays from the same manufacturer.Subjects and Method From August 2018 to July 2019, 52 patients (26 adults; 26 children) who underwent cochlear implantation of CI532 were included. The intraoperative impedance and evoked compound action potential (ECAP) threshold in each electrode were analyzed and compared with the devices with a perimodiolar electrode array [Contour Advance® (Cochlear Ltd.)] and a lateral wall electrode array [CI422 and CI522 (Cochlear Ltd.)]. Postoperative changes of hearing thresholds at each frequency (250, 500, and 1000 Hz) and aided word recognition scores (WRS) were also compared. Results: CI532 showed significantly lower intraoperative impedance in the basal regions compared to the lateral wall electrode array. The ECAP thresholds of CI532 in the apical electrodes were significantly lower than that in the other two groups. After implantation, CI532 showed a significant preservation of hearing thresholds at most frequencies and showed significantly higher preservation rates than the other electrodes. However, there was no difference between the three groups regarding the postoperative short-term aided WRS. Conclusion CI532 showed lower intraoperative impedances and ECAP thresholds, and better short-term hearing preservation outcomes compared to the other electrodes, suggesting that CI532 electrode might be a better option with less traumatic insertion. However, there was no significant difference in the aided WRS, and further studies with a longer follow-up are necessary to examine the difference of audiologic outcomes.

Objectives: . This study was conducted to evaluate the user satisfaction, efficacy, and safety of round window (RW) vibroplasty using the Vibrant Soundbridge (VSB) in patients with persistent mixed hearing loss after mastoidectomy. Methods: . The study included 27 patients (mean age, 58.7 years; age range, 28–76 years; 11 men and 16 women) with mixed hearing loss after mastoidectomy from 15 tertiary referral centers in Korea. The VSB was implanted at the RW. The Korean translation of the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire and the Korean version of the International Outcome Inventory for Hearing Aids (K-IOI-HA) questionnaire were used to evaluate user satisfaction as the primary outcome. The secondary outcome measures were audiological test results and complication rates. Results: . The mean scores for ease of communication (61.3% to 29.7% to 30.2%), reverberation (62.1% to 43.1% to 37.4%), and background noise (63.3% to 37.7% to 34.3%) subscales of the APHAB questionnaire significantly decreased after VSB surgery. The mean K-IOI-HA scores at 3 and 6 months after surgery were significantly higher than the mean preoperative score (18.6 to 27.2 to 28.1). The postoperative VSB-aided thresholds were significantly lower than the preoperative unaided and hearing aid (HA)-aided thresholds. There was no significant difference between preoperative unaided, preoperative HA-aided, and postoperative VSB-aided maximum phonetically balanced word-recognition scores. None of the 27 patients experienced a change in postoperative bone conduction pure tone average. One patient developed temporary facial palsy and two developed surgical wound infections. Conclusion . RW vibroplasty resulted in improved satisfaction and audiological test results in patients with mixed hearing loss after mastoidectomy, and the complication rate was tolerable.