Objectives: . Endoscopic tympanoplasty (ET) provides minimally invasive transcanal access to the middle ear and improves middle ear visibility for the treatment of tympanic membrane (TM) perforations. However, the literature on surgical outcomes for large TM perforations is lacking and limited to small series. This study aimed to evaluate the clinical benefits of ET for large TM perforations. Methods: . This retrospective cohort study was conducted at nine tertiary referral hospitals in South Korea, where 252 patients who underwent ET as primary surgery from September 2019 to August 2021 were included. The outcome measures included the graft success rate and pre- and postoperative audiometric data. Results: . In 239 patients, the graft success rate of ET for large or subtotal perforations was 86.2% (206 patients), while the graft failure rate was 13.8% (33 patients). The graft failure rate was directly correlated with surgical techniques, including overlay and medial or lateral underlay tympanoplasty (P=0.027). Lateral underlay tympanoplasty showed the most favorable results. Sex, laterality, etiology, site and size of perforation, operation time, and graft materials did not vary significantly between the graft success and failure groups (P>0.05). The mean air-bone gap (ABG) improved significantly in both groups (graft success group: 10.0±0.6 dB and graft failure group: 7.7±0.3 dB; P<0.001). However, the ABG improvement did not significantly differ between the groups. Analysis of covariance revealed that the postoperative 500-Hz bone conduction threshold improved after successful ET (adjusted coefficient, –11.351; 95% confidence interval, –21.491 to –1.212; P=0.028). Conclusion . This study involved the largest population to date of large TM perforations treated by ET. The study findings suggest that ET is feasible and effective in treating large TM perforations.

Background and Objectives: To describe and evaluate modified circumferential subannular tympanoplasty (MCST) via endoscopic approach, we compared the results of MCST to those of the underlay technique and the results of previous studies.Subjects and Method A retrospective comparative study was conducted of 31 patients who underwent endoscopic transcanal tympanoplasty. Patients were classified into the MCST group (n=11) and the underlay group (n=20) according to the graft technique. Demographic data, size and location of the perforation, pre- and postoperative hearing, operating time, complication rate, and graft success rate were analyzed in each group. Results: No significant differences between the two groups were observed in the demographic data or the locations of the perforations. The sizes of the perforations were 31.4±14.3% and 25.0±18.1%, respectively. The average operating times were 68.6±16.5 min and 64.9±9.3 min, respectively, and canaloplasty was not required in any patient. The postoperative hearing improvement and air-bone gap were not significantly different. No postoperative complications were observed in either group. Conclusion MCST is a feasible and effective technique for endoscopic transcanal tympanoplasty. The postoperative results and operating times of MCST were comparable to those of other graft techniques. MCST showed more stable results in anterior perforation than in underlay graft.

Bilateral sudden sensorineural hearing loss (SSNHL) is rare and usually indicates a serious systemic pathology. We describe an unusual case of bilateral SSNHL caused by sepsis. A 28-year-old female complained of acute-onset bilateral hearing impairment; in addition to otological symptoms, she had a systemic condition that met the criteria for sepsis. We performed a physical examination and laboratory tests to diagnose sepsis. Pure tone audiogram and videonystagmography were performed to evaluate the otological symptoms. Intravenous antibiotics and high-dose methylprednisolone were prescribed for treatment, and audiogram was repeated during that period. The fever subsided and the vital signs were stabilized. The electrolyte imbalance and abnormal urine parameters became normal. Hearing gradually recovered to a normal level on day 7 of hospitalization. In conclusion, sepsis should be considered as a cause of SSNHL. When conducting a detailed examination of patients with bilateral SSNHL, the clinician should consider systemic disease.

Arnold-Chiari malformation type 1 is a congenital disease characterized by herniation of the cerebellar tonsils through the foramen magnum. Most common clinical symptom is pain, including occipital headache and neck pain, upper limb pain exacerbated by physical activity or valsalva maneuvers. Various otoneurological manifestations also occur in patients with the disease, which has usually associated with dizziness, vomiting, dysphagia, poor hand coordination, unsteady gait, numbness. Patients with Arnold-Chiari malformation may develop vertigo after spending some time with their head inclined on their trunk. Positional and down-beating nystagmus are common forms of nystagmus in them. We experienced a 12-year-old female who presented complaining of vertigo related to changes in head position which was initially misdiagnosed as a benign paroxysmal positional vertigo.
Arnold-Chiari Malformation ; Benign Paroxysmal Positional Vertigo ; Child ; Deglutition Disorders ; Dizziness ; Female ; Foramen Magnum ; Gait Disorders, Neurologic ; Hand ; Head ; Headache ; Humans ; Hypesthesia ; Motor Activity ; Neck Pain ; Palatine Tonsil ; Upper Extremity ; Valsalva Maneuver ; Vertigo ; Vomiting

OBJECTIVES: Ménière disease is a clinical syndrome characterized by the four major symptoms of episodic vertigo, sensorineural hearing loss, tinnitus, and aural fullness. Sensorineural hearing loss, especially low frequency, is the characteristic type of audiogram in Ménière's disease. However, it is difficult to distinguish idiopathic sudden sensorineural hearing loss (ISSNHL) with vertigo from the first attack of Ménière disease. The purpose of this study was to investigate the incidence of progression into Ménière Disease from low frequency ISSNHL. METHODS: Two hundred eighty-three patients were included in this study. We classified the patients with ISSNHL according to the hearing loss in audiogram and analyzed how many of them actually progressed to Ménière disease based on diagnosis criteria. RESULTS: Among the 240 patients, 37.1% (89 patients) were confirmed low frequency ISSNHL and 14.6% (13 patients) of them were diagnosed with Meniere disease. CONCLUSIONS: This study showed that the progression from low frequency ISSNHL to Ménière disease was higher than other frequency ISSNHL, as in other studies.
Diagnosis ; Follow-Up Studies ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Humans ; Incidence ; Meniere Disease ; Tinnitus ; Vertigo

With focused ultrasound (FUS) and microbubbles, BBB can be transiently disrupted with a localized and non-invasive approach. BBB disruption induced by FUS has made progressions to move forward on delivery of therapeutic agents into a brain in a specific area of brain for better treatment of neurological diseases. In addition to be used as an improvement of drug delivery, BBB disruption has been found to induce biological effects such as a clearance of protein aggregation which cause Alzheimer's disease, regulation of proteins which facilitate drug uptake, and modulation of neuronal function and neurogenesis. In this review, we discuss overview about the principles of BBB opening with FUS and milestones in these biological effects of FUS-induced BBB disruption.
Alzheimer Disease ; Brain ; Microbubbles ; Neurogenesis ; Neurons ; Ultrasonography*

BACKGROUND AND OBJECTIVES: Many patients experience middle ear surgery via retroauricular approach. While not a main interest of the surgery, the change of the auricular shape after surgery has been a subject of complaint by some patients. In this study, we wanted to determine if a change in the auricular shape occurs after middle ear surgery and evaluate the possibility of using reconstruction of posterior auricular muscle as a treatment option for this kind of change. SUBJECTS AND METHOD: Forth patients who received middle ear surgery were enrolled in this study. Retroauricular incision and canal up mastoidectomy were carried out to all patients. The patients were separated into two groups randomly before surgery: one group that had the reconstruction of posterior auricular muscle during surgery, and the other that did not. The average of heights of the helix was compared. Also, patients were asked to fill out a questionnaire about auricular shape before and after surgery. RESULTS: The heights of helix increased about 1.6 mm after surgery; however, the difference of increment as a result of reconstruction of posterior auricular muscle was not statistically significant. Questionnaire about the change of auricular shape after surgery showed that only 8% patients had noticed about the change of auricular shape after surgery. CONCLUSION: Most patients have no complaint about auricular shape after middle ear surgery via retroauricular approach. The average of heights of the helix increases after middle ear surgery. However, the reconstruction of the posterior auricular muscle is not effective for reducing the observed increment of heights of the helix following middle ear surgery via retroauricular approach.
Ear Auricle ; Ear, Middle* ; Humans ; Methods

OBJECTIVE: Since the 2000s, CyberKnife radiosurgery (CKRS) is either a primary or an adjunct management approach used to treat patients with vestibular schwannoma (VS). The goals of CKRS are prevention of tumor growth, preservation of cranial nerve function and prevention of new neurologic deficiencies. The aim of this study was to assess the efficacy and safety of CKRS, in terms of tumor control, hearing preservation, and complications. METHODS: Forty patients with VS underwent CKRS as a treatment modality for from January 2010 to February 2016. The long term results of 32 patients were evaluated who received CKRS as primary treatment. 8 patients presented with previously performed surgical resection. Information related to clinical history, Brain MRI and outcomes of patients with VS collected retrospectively by reviewing patient's chart and telephone survey. RESULTS: The mean tumor volume was 3.3 cm³ and the mean follow-up was 41 months. The most recent follow-up showed that tumor size decreased in 17 patients (42.5%), displayed no change in 19 patients (47.5%), and increased in 4 patients (10%). Progression-free survival rates after CKRS at 1, 3, and 5 years were 95%, 90%, and 90%. After CKRS, 13 patients experienced hearing degradation. The overall rate of preservation of serviceable hearing at the long-term follow-up was 60%. Vertigo, ataxia, and headache were improved after CKRS compared with pretreated status. But, facial weakness, trigeminal nerve neuropathy, and tinnitus were worsen. CONCLUSION: CKRS provide an excellent tumor control rate and a comparable hearing preservation rate in VS patients. Also CKRS is associated with low rate of cranial neuropathy, other complications.
Ataxia ; Brain ; Cranial Nerve Diseases ; Cranial Nerves ; Disease-Free Survival ; Follow-Up Studies ; Headache ; Hearing ; Humans ; Magnetic Resonance Imaging ; Neuroma, Acoustic ; Radiosurgery ; Retrospective Studies ; Telephone ; Tinnitus ; Trigeminal Nerve ; Tumor Burden ; Vertigo

BACKGROUND AND OBJECTIVES: Orthostatic dizziness (OD) is defined as dizziness provoked by standing up from a supine or sitting position. It can be caused by the abnormality of autonomic nerve function system as well as vestibular system. We studied the autonomic nerve function in patients with OD. SUBJECTS AND METHOD: The authors reviewed the medical records of 50 OD patients who showed normal findings of vestibular function test and brain magnetic resonance imaging. Of the 50 patients, 34 patients were enrolled in this study. We performed a standardized autonomic function test to 34 OD patients. RESULTS: The result of autonomic nerve function test revealed abnormal findings in 26 (76%) of the 34 patients. Tests performed were for the following: sympathetic failure, including abnormal decrease in blood pressure during tilt table test, Valsalva maneuver, sympathetic skin response and heart rate response to deep breathing. CONCLUSION: Autonomic dysfunction is frequently found in patients with OD after excluding other causes with extensive investigations. Sympathetic failure or hyperactivity may be postulated as one of the possible causes of OD. Autonomic function test could be useful in understanding the mechanism of OD and treatment of OD in patients.
Autonomic Pathways ; Blood Pressure ; Brain ; Dizziness* ; Heart Rate ; Humans ; Magnetic Resonance Imaging ; Medical Records ; Methods ; Orthostatic Intolerance ; Respiration ; Skin ; Tilt-Table Test ; Valsalva Maneuver ; Vestibular Function Tests

OBJECTIVE: Vestibular neuritis (VN) is one of the most common causes of acute spontaneous vertigo. However, such dizziness symptoms in patients with VN vary among patients, and various methods are used to evaluate subjective vestibular symptoms following attack of VN. Studies on correlation between subjective vestibular symptom changes and result of rotation chair test after vestibular rehabilitation therapy (VRT) have not been reported. Therefore, we compared change of dizziness handicap inventory (DHI) and results of rotation chair test in patients with VN between attack and 3 month later following VRT. METHODS: Forty-seven patients were included in this study. In patients with VN, DHI and rotation chair test were performed at the time of VN attack and recovery time of 3 months after VN attack. RESULTS: In general, the DHI score and the percentage of directional preponderance (DP) in a rotation chair test performed on patients with VN have all decreased. However, the changes in these results were not statistically significant. DP% difference and DHI score were compared to each other among patients with VN and showed no relational significance to each other (r=0.326). CONCLUSION: The degree of improvement in a rotation chair test done on patients with VN did not reflect the severity of improvement for symptom like dizziness.
Dizziness ; Humans ; Rehabilitation ; Vertigo ; Vestibular Neuronitis