Eun Jin Son

Objective: This study compared the anatomical and functional outcomes of butterfly cartilage inlay tympanoplasty between small and medium‐to‐large tympanic membrane (TM) perforations. Methods: We retrospectively evaluated 50 patients (50 ears) who underwent butterfly cartilage inlay tympanoplasty between 2017 and 2023. Perforation sizes were quantitatively measured using ImageJ and categorized into small (< 20%, n = 28) and medium‐to‐large‐sized (≥ 20%, n = 22) groups. Graft success, operative time, complications, and preoperative and postoperative hearing thresholds were evaluated. Results: The graft success rate was high and comparable between the small and medium‐to‐large groups (92.9% vs. 86.4%; p = 0.643), as was the median operative time (32.0 vs. 30.5 min; p = 0.531). Both groups achieved significant postoperative reductions in the air‐bone gap (ABG) ( p < 0.001). The medium‐to‐large group demonstrated a significantly greater improvement in ABG (ΔABG) than the small group (−7.5 dB vs. 0 dB; p = 0.002). Perforation size was negatively correlated with ΔABG ( r = −0.403, p = 0.003) but not with operative time ( p = 0.31). Conclusion: The butterfly cartilage inlay technique achieved high graft success and favorable functional outcomes for both small and medium‐to‐large TM perforations. It remained surgically efficient and feasible under local anesthesia, regardless of perforation size. Level of Evidence: 3

Neuroendocrine tumors originating in the middle ear are rare, and presentation with facial paralysis is extremely uncommon. A 19-year-old woman with a history of transient facial paralysis presented with a right-sided middle ear mass. Surgical exploration of the tympanic cavity was performed using a transcanal endoscopic approach. Histopathologic examination confirmed the diagnosis of a middle ear neuroendocrine tumor. After surgical excision of the tumor, no recurrence or facial paralysis occurred. Herein, the authors present this rare case, along with a literature review.

Objectives: This study aims to evaluate the relationship between subjective dizziness disability, as assessed by the Dizziness Handicap Inventory (DHI), and objective vestibular function test (VFT) results in patients presenting with dizziness. Methods: We conducted a retrospective review of 177 patients who completed the DHI, vertigo visual analog scale, and disability scale at their initial visit. Objective VFTs included videonystagmography with caloric testing, cervical vestibular evoked myogenic potential (cVEMP), and the sensory organization test (SOT). Statistical analyses were conducted to assess correlations and differences in DHI scores based on VFT results and clinical characteristics.Results: The DHI scores indicated a higher perceived dizziness handicap among female patients compared to males (p=0.012). Chronic dizziness was associated with elevated DHI scores in specific items (DHI-2, DHI-12, and DHI-21; p<0.05). Patients with abnormal caloric responses exhibited higher scores in several DHI items and subscales (DHI-4, DHI-12, DHI-14, DHI-17, DHI-19, DHI-23, physical, emotional, and functional; p<0.05). No significant differences were found in cVEMP results. Only one SOT condition (equilibrium score 5) showed a statistically significant but weak association with DHI scores (r=–0.151, p=0.045).Conclusions: There were limited correlations between objective vestibular test outcomes and subjective dizziness disability. These findings underscore the multidimensional nature of dizziness and the importance of integrating subjective and objective measures for a comprehensive clinical assessment.

Traumatic neuroma is the reparative proliferation of axons and Schwann cells at the proximal end of a severed nerve following injury or surgery. Traumatic neuromas with or without clinical symptoms have rarely been reported in the external auditory canal. A 50-year-old woman with a history of trauma visited our otorhinolaryngology clinic with a 7 × 5-mm mass localized on the anterior wall of the external auditory canal. The mass was easily removed via surgical excision and was histopathologically diagnosed as a neuroma. No signs of recurrence were observed after excision. Herein, the authors present this case, along with a review of the literature.

Son EJ, et al. Yonsei Med J. 2022 Jan;63(1):82-87. https://doi.org/10.3349/ymj.2022.63.1.82

Nam GS, et al. Yonsei Med J. 2021 Jul;62(7):615-621. https://doi.org/10.3349/ymj.2021.62.7.615

Kim JH, et al. J Korean Med Sci. 2020 Jun;35(30):e244. https://doi.org/10.3346/jkms.2020.35.e244

Objectives: The head impulse test paradigm (HIMP) assesses semicircular canal function by measuring compensatory saccades during head movements as an indication of an impaired vestibulo-ocular reflex (VOR). The recently introduced suppression head impulse test paradigm (SHIMP) examines anticompensatory saccades after head movements as a measure of intact VOR. Thus, HIMP measures a decrease in vestibular function, whereas SHIMP measures residual function. We evaluated the effectiveness of SHIMP, compared HIMP and SHIMP results in the same subjects, and examined the relationship between the 2 tests. Methods: HIMP and SHIMP protocols were performed in 73 patients. The patients were instructed to maintain their gaze on a fixed target for the HIMP, or a moving target for the SHIMP during head impulses. The VOR gain and saccade parameters were compared. Results: HIMP and SHIMP data were obtained for all ears except in 3 patients. The VOR gain with SHIMP was smaller than for HIMP, but showed significant correlation (r=0.8356, p＜0.001) and substantial agreement (k=0.79). However, neither the percentage of saccades (appearance of HIMP compensatory saccades and reduction of SHIMP anticompensatory saccades) nor their amplitudes were correlated between the 2 tests. Conclusions: The HIMP and SHIMP protocols are valuable tools to evaluate VOR during high-velocity head movements. Our results confirm their agreement as measures of VOR gain during head impulses, but also show that the relationship between compensatory and anticompensatory saccades is not straightforward. Thus, care should be taken during clinical interpretation of either protocol.

Carcinomas of the external auditory canal (EAC) are rare, and management remains challenging. Previous studies seeking prognostic factors for EAC cancers included cancers other than carcinomas. In this study, we analyzed the treatment outcomes of, prognostic factors for, and survival rates associated with specifically squamous cell carcinoma (SCC) of the EAC. A retrospective review of 26 consecutive patients diagnosed with SCCs of the EAC in a 10-year period was performed in terms of clinical presentation, stage, choice of surgical procedure, and adjunct therapy. Overall survival (OS) and recurrence-free survival (RFS) were calculated and univariate analysis of prognostic factors was performed. The median age of the 26 patients with SCCs of the EAC was 63 years (range, 40 to 72 years), and 16 males and 10 females were included. According to the modified University of Pittsburgh staging system, the T stages were T1 in 11, T2 in six, T3 in four, and T4 in five cases. The surgical procedures employed were wide excision in three cases, lateral temporal bone resection (LTBR) in 17, and extended LTBR in four, and subtotal temporal bone resection in two. Two patients underwent neoadjuvant chemotherapy, and two underwent adjuvant chemotherapy. One patient received preoperative radiation therapy, and eleven received postoperative radiation therapy. Of the possibly prognostic factors examined, advanced preoperative T stage and advanced overall stage were significant predictors of RFS, but not of OS. The advanced T stage and overall stage were associated with decreased survival after surgical treatment in patients with SCC of the EAC, highlighting the importance of clinical vigilance and early detection.

Growth of vestibular schwannomas (VS) causes progressive vestibular symptoms and postural instability. Since the tumor grows slowly, compensation of decaying vestibular input may decrease subjective symptoms of dizziness. This study aims to estimate the relationship of subjective vestibular symptoms and objective postural instability in patients with VS. A retrospective review of 18 patients newly diagnosed with VS and with subjective vertigo symptoms was performed. The results of vestibular function tests including the sensory organization test (SOT) using computerized dynamic posturography, caloric test, and self-report measures of subjective dizziness handicap (Dizziness Handicap Inventory) and visual analogue scale were compared according to the onset of vertigo symptoms. In VS patients, SOT showed decreased equilibrium score for all vestibular function related conditions, condition (C) 5 and 6, and composite (COMP) score. COMP scores were not correlated with visual analogue scale or Dizziness Handicap Inventory scores. Acute onset group included six patients and insidious onset group, 12 patients. Equilibrium scores for C5 and C6, and COMP scores were lower for insidious onset group, but the difference was not statistically significant. Our findings confirmed postural instability is prevalent in VS patients. SOT parameters did not differ significantly between acute onset and insidious onset groups, but increased tumor size and canal weakness were noted in the insidious onset group. Clinicians should consider that postural instability is likely present even in patients who do not complain of acute vertigo, and appropriate counseling should be discussed with the patients.