Musical Hallucination Caused by Ceftazidime in a Woman with a Hearing Impairment

Musical hallucinations remain a poorly understood clinical phenomenon, possibly because these types of hallucination have multiple causes and are rarely the focus of published reports. Here, the case of a 51-year-old female patient with a hearing impairment who developed musical hallucinations during treatment with ceftazidime, a third-generation cephalosporin, is presented. She responded to the discontinuation of ceftazidime and the initiation of low-dose olanzapine treatment. Musical hallucinations associated with ceftazidime are very rare, and the mechanisms underlying its occurrence remain unknown. Further studies will be necessary to determine the pathophysiology of adverse psychiatric reactions associated with ceftazidime.ope

Postoperative results of ventilation tube insertion: a retrospective multicenter study for suggestion of grading system of otitis media with effusion

Background: In otitis media with effusion (OME), it is important to know when to surgically intervene and when careful monitoring is more appropriate. This study aimed to visualize and classify the clinical manifestations of OME and the correlation between the new grading system and postoperative results after ventilation tube insertion (VTI). Methods: We classified the collective 1,012 ears from 506 patients into six groups: grade 0 (no effusion), grade I (scant effusion, but abnormal), grade II (effusion less than half of the tympanic cavity), grade III (effusion over half of the tympanic cavity, with air bubbles), grade IV (complete effusion), and grade V (retracted tympanic membrane or hemotympanum without air bubbles). Results: The mean age at VTI was 5.2 (±2.9) years and mean duration between diagnosis and operation was 4.1 (±1.8) months. Between the grades, the nature of the middle ear effusion was also significantly different (p < 0.001). The duration of ventilation tube retention after VTI was significantly different when compared between two groups: grade I-IV and grade V (p = 0.019). Our results showed that the recurrence rate, as well as rate of revision VTI, increased as the grade increased (p < 0.001). Conclusions: The new grading system of OME using endoscopic otoscope evaluation had a significant correlation with the age at VTI, the nature of middle ear effusion, the recurrence rate of OME, and the rate of revision VTI.ope

Is Ossiculoplasty Necessary in Canal Wall Down Mastoidectomy? Comparison of Clinical Outcomes Between Type 0 Tympanoplasty and Ossiculoplasty

Background and objectives: To assess whether the audiological and clinical outcomes of type 0 tympanoplasty (T0) performed using cartilage were comparable with those of ossiculoplasty in patients who underwent canal wall down mastoidectomy (CWDM). Subjects and methods: This study included patients who had chronic otitis media with cholesteatoma and underwent CWDM with ossiculoplasty involving partial ossicular replacement prosthesis (PORP), total ossicular replacement prosthesis (TORP), or T0. Anatomical success rates and hearing outcomes were analyzed. Results: Seventy-two patients were included in this study; 29 of them underwent CWDM with T0, 27 underwent CWDM with PORP, while 16 underwent CWDM with TORP. The difference in mean improvement in the air-bone gap (ABG) between the groups was not significant. The differences in the rates of ABG closure to ≤10 dB HL (p=0.030) and ≤20 dB HL (p=0.029) were significant. There were significant differences in improvements in the ABG at 3 kHz among the PORP, TORP, and T0 groups. Conclusions: The audiological outcomes of CWDM with ossiculoplasty seemed to be better than those of CWDM with T0 with no significant difference in the incidence of complications following ossiculoplasty and T0.ope

삼출성 중이염으로 환기관삽입술을 받은 소아에서 중이삼출액 내의 면역세포 유형과 환기관 이루 발생의 관계

Background and ObjectivesZZTympanostomy tube insertion is one of the most common surgical procedures in children. Despite aseptic procedures with prophylactic antibiotic treatment, postoperative otorrhea may be encountered in some patients. The purpose of this study is to identify the relation between the types of immune cells in otitis media with effusion (OME) and tympanostomy tube otorrhea (TTO) in children. Subjects and MethodZZFifty-six patients underwent tympanostomy tube insertion with OME were analyzed retrospectively. Fluid from OME was harvested by suction via syringe connector after myringotomy. Light microscopic examination of middle ear effusion was performed by a pathologist after hematoxylin and eosin staining. We analyzed the relation between the types of immune cells from middle ear effusion and TTO. ResultsZZOf 56 children, 36 were male and 22 were female. The mean age for tympanostomy tube insertion was 3.56 (±2.63) years, with the average follow-up period of 12.56 (±9.96) months. Neutrophils were detected in 19, eosinophils in 14, lymphocytes in 22, mast cells in 2, plasma cells in 7, and histiocytes in 9. TTO occurred in 15 patients. In patients with early TTO, eosinophils were detected more frequently than in patients without TTO (p=0.006). Plasma cells were detected more frequently in patient with late TTO than without TTO (p=0.011). ConclusionZZAccording to the analysis of different types of immune cells, eosinophils in the middle ear effusion related with the occurrence of TTO.ope

Positional changes in the uvula tip after adenotonsillectomy in children: preliminary result

Background: Adenotonsillectomy has become the primary treatment for children with sleep-disordered breathing or obstructive sleep apnea. However, few studies have investigated positional changes in the soft palate or uvula after adenotonsillectomy in children. The present study aimed to evaluate positional changes in the uvula tip using cephalometric analyses after adenotonsillectomy in children. Methods: We analyzed 160 pediatric patients from December 2015 to July 2016, with 94 pediatric patients who underwent adenotonsillectomy as the experimental group and 66 children who were treated and followed up with frequent tonsillitis as the control group. Positional changes in the uvula tip after surgery in the adenotonsillectomy group were investigated using lateral cephalograms obtained within 1 month before surgery and 3-4 months after surgery. Two lateral cephalogram intervals for a few months in the control group who did not undergo adenotonsillectomy were analyzed. Results: The palatal length (23.92 ± 3.47 vs. 24.46 ± 3.26; p = 0.032), palatal angle (43.13 ± 7.76 vs. 46.12 ± 5.91; p < 0.001), and retrouvula length (15.60 ± 3.51 vs. 16.60 ± 2.97; p = 0.009) were significantly increased on postoperative images relative to those on preoperative images. In the control group, there was a significant change in the palatal angle (2.99 ± 5.85 vs. 0.27 ± 4.14; p < 0.001) and retrouvula length (0.99 ± 3.64 vs. 0.05 ± 1.44; p = 0.025), but not in the palatal length (0.58 ± 2.38 vs. 0.043 ± 1.26; p = 0.065). Conclusion: The findings of the present study suggest that the uvula tip is displaced in the anteroinferior direction 3 or 4 months after adenotonsillectomy in children. Thus, clinicians should be aware that the retropalatal space may expand after adenotonsillectomy in the pediatric population.ope

A therapeutic experience of diffuse cerebellopontine angle meningioma through combined translabyrinthine, infratemporal fossa, and suboccipital craniotomy approach

Meningioma is a slow growing tumor that mainly originates from the intracranial region, but rarely occurs at extracranial region. Once the extracranial meningioma shows diffuse and extensive involvement along the cranial nerves, surgical extirpation of the tumor becomes extremely difficult, and surgical morbidity often follows. We present a single case of en plaque meningioma extended to temporal area and parapharyngeal space, and reviewed the surgical technique for manipulation of facial nerve and postoperative cranial nerve palsy.ope

Results of Active Middle Ear Implantation in Patients With Mixed Hearing Loss After Middle Ear Surgery: A Prospective Multicenter Study (the ROMEO Study)

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.ope

Intratympanic steroid injection for sudden sensorineural hearing loss: Impact of injection interval on therapeutic efficacy

Objective: To compare the effect of injection time intervals of intratympanic (IT) dexamethasone (DEX) in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Methods: Seventy-five adults with ISSNHL were grouped into four groups according to the IT DEX interval. In addition to concurrent oral steroid medication for two weeks, patients received IT DEX injections every 1, 2, 3, and four days, respectively. (Group 1, Group 2, Group 3, and Group 4). We evaluated the treatment outcomes according to modified criteria from "Clinical Practice Guideline: Sudden Hearing Loss" of the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) to justify treatment success. Results: There were no significant differences in demographic and baseline audiometric data. The mean of pure tone audiometry (PTA) and speech discrimination score (SDSs) were significantly improved after oral steroid and IT DEX treatment in all four groups. Group 1 showed significantly higher improvement than Group 4 in PTA after treatment. There was a significantly higher complete recovery (CR) rate in Group 1 than Group 4. Conclusion: We found a statistically significant difference in the complete hearing recovery rate and audiometric results (PTA) between the group with a daily interval of injections and the group with a four-day time interval. Therefore, daily time intervals in intratympanic steroid injection may be considered as an option for better improvement of hearing in patients with ISSNHL.restrictio

A novel water occlusion test for disorders causing pulsatile tinnitus: Our experience in 32 patients

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Comparison of clinical outcomes between butterfly inlay cartilage tympanoplasty and conventional underlay cartilage tympanoplasty

OBJECTIVE: To assess the efficacy of butterfly inlay cartilage tympanoplasty and compare it with conventional underlay cartilage tympanoplasty in terms of success rate and hearing outcomes. MATERIALS AND METHODS: The study included 35 patients (36 ears) who underwent butterfly inlay cartilage tympanoplasty (inlay group, 23 ears of 22 patients) or conventional underlay cartilage tympanoplasty (underlay group, 13 ears). The anatomical success rate and hearing outcomes were analysed. RESULTS: Re-perforation occurred in 2 cases (8.7%) in the inlay group and 3 (23.1%) in the underlay group. One patient in the inlay group developed a serious infection, and one in the underlay group developed massive granulation of the tympanic membrane. In the inlay group, the air-bone gap (ABG) decreased from 19.9 (±12.6) dB HL preoperatively to 13.8 (±11.3) dB HL postoperatively (p=0.047), in the underlay group, it decreased from 23.5 (±15.8) dB HL to 18.3 (±20.6) dB HL. Regarding improvement in ABG, the difference between the group was not statistically significant (p=0.968). CONCLUSION: Butterfly inlay cartilage tympanoplasty is comparable with conventional underlay cartilage tympanoplasty in both anatomic and audiological success rates. Owing to its simplicity, shorter operation time, and rapid patient recovery, butterfly inlay cartilage tympanoplasty could be considered a favourable surgical option.restrictio