Effects of Vibrant Soundbridge on tinnitus accompanied by sensorineural hearing loss

OBJECTIVES: Tinnitus is a common symptom among patients with hearing loss, and many studies have reported successful tinnitus suppression with hearing devices. Active middle ear implantation of the Vibrant Soundbridge (VSB) is a good alternative to existing hearing devices. This study evaluated the effects of VSB implantation on tinnitus and sought to identify the main audiological factor that affects tinnitus suppression. METHODS: The study participants were 16 adults who had tinnitus with sensorineural hearing loss, and who underwent VSB implantations. Pure-tone audiometry; word recognition test; tinnitus handicap inventory (THI); and visual analog scale (VAS) assessment of loudness, awareness, and annoyance were performed before and 12 months after surgery. Changes in hearing threshold, word recognition scores (WRS), THI scores, and VAS scores were analyzed. RESULTS: VAS scores for loudness (mean difference: 1.9, 95% CI: 0.6, 3.1), awareness (mean difference: 1.6, 95% CI: 0.4, 2.8), and annoyance (mean difference: 1.7, 95% CI: 0.7, 2.8) showed significant improvements from baseline to 12 months after surgery. In addition, THI scores showed a significant decrease (mean difference: 13.8, 95% CI: 2.9, 24.9). The average hearing threshold level, WRS, and most comfortable level (MCL) also showed significant improvements at 12 months after surgery (mean difference: 17.3, 95% CI: 13.3, 21.3; mean difference: -7.6, 95% CI: -15.1, -0.1; mean difference: 26.3, 95% CI: 22.9, 29.6, respectively). Among the aforementioned factors, changes in MCL were best correlated with those in THI scores (mean difference: 2.55, 95% CI: 0.90, 4.21). CONCLUSION: A VSB implant is beneficial to subjects with tinnitus accompanied by sensorineural hearing loss. The changes in THI scores best correlated with those in MCL. This improvement may represent a masking effect that contributes to tinnitus suppression in patients with VSB implants.ope

Changes in Tinnitus After Middle Ear Implant Surgery: Comparisons With the Cochlear Implant

OBJECTIVES: Tinnitus is a very common symptom in patients with hearing loss. Several studies have confirmed that hearing restoration using hearing aids or cochlear implants (CIs) has a suppressive effect on tinnitus in users. The aim of this study was to analyze the effect of other hearing restoration devices, specifically the middle ear implant (MEI), on changes in tinnitus severity. DESIGN: From 2012 to October 2014, 11 adults with tinnitus and hearing loss underwent MEI surgery. Pure-tone audiometry, tinnitus handicap inventory (THI), and visual analog scale scores for loudness, awareness, and annoyance and psychosocial instruments were measured before, immediately after, and 6 months after surgery. Changes in hearing thresholds and THI scores were analyzed and compared with those of 16 CI recipients. RESULTS: In both MEI and CI groups, significant improvements in tinnitus were found after the surgery. The THI scores improved in 91% of patients in the MEI group and in 56% of those in the CI group. Visual analog scale scores and psychosocial scale scores also decreased after surgery, but there were no statistical differences between the groups. CONCLUSIONS: The results indicate that the MEI may be as beneficial as the CI in relieving tinnitus in subjects with unilateral tinnitus accompanying hearing loss. Furthermore, this improvement may manifest as hearing restoration or habituation rather than a direct electrical nerve stimulation, which was previously considered as the main mechanism underlying tinnitus suppression by auditory implants.ope

폐동맥 협착

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Myocardial Tissue Doppler Velocity in Child Growth

Background: In adults, tissue Doppler imaging (TDI) is a recommended component of routine echocardiography. However, TDI velocities are less accepted in pediatrics, due to their strong variability and age dependence in children. This study examines the distribution of myocardial tissue Doppler velocities in healthy children to assess the effect of age with cardiac growth on the various echocardiographic measurements. Methods: Total 144 healthy children were enrolled in this study. They were recruited from the pediatric outpatient clinic for routine well-child visits. The statistical relationships between age and TDI values were analyzed. Also, the statistical relationships between body surface area (BSA) and TDI values, left ventricle end-diastolic dimension (LVEDD) and TDI values were analyzed. Also, we conducted multivariate analysis of cardiac growth parameters such as, age, BSA, LVEDD and TDI velocity data. Results: All of the age, BSA, and LVEDD had positive correlations with deceleration time (DT), pressure half-time (PHT), peak early diastolic myocardial velocity, peak systolic myocardial velocity, and had negative correlations with peak late diastolic velocity (A) and the ratio of trans-mitral inflow velocity to early diastolic velocity of mitral annulus (E/E'). In the multivariate analysis, all of the age, BSA, and LVEDD had positive correlations with DT, PHT, and negative correlations with A and E/E'. Conclusion: The cardiac growth parameters related alterations of E/E' may suggest that diastolic myocardial velocities are cardiac growth dependent, and diastolic function has positive correlation with cardiac growth in pediatric group. This cardiac growth related myocardial functional variation would be important for assessment of cardiac involvement either in healthy and sick child.ope

True island pectoralis major myocutaneous flap; its advantage

BACKGROUND AND OBJECTIVES: Pectoralis major myocutaneous flap(PMMCF) is a workhorse flap of head and neck reconstruction and it has four types depending on its nature of vascular pedicle. True island type PMMCF has many advantages over conventional muscular type, but reports on this type of flap and its advantages are lacking. Material and METHOD: Fifty two PMMCF(50 patients) used for head and neck reconstruction between 1992 and 1998 were reviewed retrospectively. There were 16 muscular type and 36 true island type PMMCF. We compared the incidence of complication between two groups. RESULT: Six marginal necrosis(less than 20%) and 1 major necrosis(more than 50%) developed in 16 muscular type PMMCF. However in 36 true island type PMMCF, 1 marginal necrosis and 2 major necrosis developed. CONCLUSION: True island type PMMCF has the following advantages over muscular type. 1. True island type has 3-4 cm gain in length. 2. Flap could be harvested at more cephalic portion of the chest. 3. Unwanted tension of the flap could be avoided. 4. Vascular pedicle is not compressed between skin and clavicle. 5. The rotation of vascular pedicle is natural without kinking. 6. Ugly bulge over clavicle is absent postoperatively. 7. This type could be used regardless of types of neck dissection.ope

Recent advances in transcatheter treatment of congenital heart disease

Over the last several decades there has been a remarkable change in the therapeutic strategy of congenital heart disease. Development of new tools and devices, accumulations of experience, technical refinement have positively affected the outcome of interventional treatment. Many procedures including atrial septostomy, balloon valvuloplasty, balloon dilation of stenotic vessel with or without stent implantation, transcatheter occlusion of abnormal vascular structure, transcatheter closure of patent arterial duct and atrial septal defect, are now performed as routine interventional procedures in many institutes. In diverse conditions, transcatheter techniques also provide complementary and additive role in combination with surgery. Intraoperative stent implantation on stenotic vessels, perventricular device insertion, and hybrid stage 1 palliative procedure for hypoplastic left heart syndrome have been employed in high risk patients for cardiac surgery with encouraging results. Transcatheter closure of ventricular septal defect has been performed safely showing comparable result with surgery. Investigational procedures such as percutaneous valve insertion and valve repair are expected to replace the role of surgery in certain group of patients in the near future. Continuous evolvement in this field will contribute to reduce the risk and suffering from congenital heart disease, while surgery will be still remained as a gold standard for significant portion of congenital heart disease.ope

Changes in the Pulmonary Circulation after Total Cavopulmonary Anastomosis Jae

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Changes in Strain Pattern and Exercise Capacity after Transcatheter Closure of Atrial Septal Defects

Background and Objectives: Assessment of left ventricle (LV) function by using strain and strain rate is popular in the clinical setting. However, the use of these echocardiographic tools in assessing right ventricle (RV) failure, and the manner in which they both reflect the functional capacity of the patient, remains poorly understood. This study aimed to investigate the change in exercise capacity and strain between before and (1 month) after the transcatheter closure of atrial septal defects (ASDs). Subjects and Methods: Thirty patients who underwent transcatheter closure of ASD between May 2014 and June 2015 at the Division of Pediatric Cardiology, Severance Cardiovascular Hospital, were enrolled. We compared and analyzed the results of the following examinations, before and (1 month) after the procedure: echocardiography, cardiopulmonary exercise test (CPET), and N-terminal probrain natriuretic peptide level. Results: There were no mortalities, and the male-to-female ratio was 1:2. The mean defect size was 22.3±4.9 mm; the mean ratio of pulmonary to systemic flow, 2.1±0.5; and the mean device size, 22.3±4.9 mm. Changes in global RV longitudinal (GRVL) strain and LV torsion were measured echocardiographically. Exercise capacity improved from 7.7±1.2 to 8.7±1.8 metabolic equivalents (p=0.001). These findings correlated to the change in GRVL strain (p=0.03). Conclusion: The average exercise capacity increased after device closure of ASD. The change in strain was evident on echocardiography, especially for GRVL strain and LV torsion. Further studies comparing CPET and strain in various patients may show increased exercise capacity in patients with improved RV function.ope

The role of salvage surgery in the treatment of irradiation-failed nasopharyngeal carcinoma

Background and Objectives: When nasopharyngeal carcinomas recur after radiotherapy, it becomes difficult to select further treatment modality. We reviewed surgical results of irradiation-failed nasopharyngeal carcinoma patients and investigated the role of salvage surgery. Materials and Methods: Surgical results of 10 cases of nasopharyngeal carcinoma were investigated. All of them had a recurrent or residual nasopharyngeal carcinoma after radiation therapy. The medical records of these patients were reviewed retrospectively and the mean survival time was calculated by Kaplan-Meier method. Results: The mean survival time of the irradiation-failed nasopharyngeal carcinoma patients was 21.8 months. The survival times of early staged irradiation-failed tumor were longer than that of the tumor in the advance stage. Among 3 patients whose recurrent tumor stages were T1, two patients had the negative resection margin and they lived without the disease. However, none of the patients whose recurrent tumor stages were beyond T2(n=7) had the negative resection margin and lived without the disease. Conclusion: Surgical treatment was an useful treatment modality for improving the survival time of early staged irradiation-failed nasopharyngeal carcinomas.ope

Mastoid Obliteration with bone paste and fat

Background and Objectives : Mastoidectomy with canal wall-up technique provides more healthy skin lining conditions of the external ear canal than mastoidectomy with canal wall-down techniques which have several disadvantages. However, in patients who have erosive scutum or posterior wall defects, the canal-wall down procedure is selected for preventing retraction pocket and recurrence of cholesteatoma. We have attempted a new surgical procedure to avoid disadvantages of the canal wall-down procedure in patients with scutum or posterior wall defects. Materials and Methods : In 84 patients with chronic otitis media whose scutum or posterior walls have defects, we advocated a new surgical procedure. The posterior wall kept up, the defected scutum and/or posterior wall was reconstructed with cortical bone paste, and the mastoid cavity was obliterated with abdominal fat. Staged ossiculoplasty was performed for 11 patients. Results : Removal of the bone paste was necessary for only one patient due to infection, but none of the patents had absorption of reconstructed posterior canal wall. In most patients, the wound completely healed within 3 weeks. The mean hearing gain was 21 dB after the staged ossiculoplasty. Conclusion : With this procedure, we could avoid disadvantages of the canal wall-down procedure. And in staged ossiculoplasty we found enough middle ear space for ossicle reconstruction.ope