Jeong Hwan Choi

Objectives: This study assessed the potential benefits of supplemental flunarizine administration in patients with sudden sensorineural hearing loss (SSNHL) experiencing incomplete recovery with conventional steroid treatment. Methods: Thirty-nine SSNHL patients, unresponsive to conventional steroid therapy, received either oral ginkgo biloba (control group, n = 24) or a combination of oral ginkgo biloba and flunarizine (treatment group, n = 15). Pure-tone average (PTA) evaluation at 0.5, 1, 2, and 4 kHz was conducted upon each patient’s visits. A change of ≥10 dB was considered ‘significant hearing gain’. Results: The treatment group showed a higher rate of hearing gain ≥10 dB (46.7%) compared to the control group (12.5%) (p = 0.03). Additional treatment with flunarizine was associated with greater improvement in hearing thresholds compared with ginkgo biloba alone (p = 0.004), suggesting a potential therapeutic benefit. Conclusion: This retrospective study suggests that flunarizine may provide additional benefit in patients with SSNHL experiencing incomplete recovery following conventional steroid treatment. These findings are preliminary and require validation in larger, controlled studies.

임상이비인후과(Journal of Clinical Otolaryngology Head and Neck Surgery)

External auditory canal exostosis (EACE) is prone to occur in patients frequently exposed to cold water, which causes earwax impaction, recurrent otitis externa, and conductive hearing loss. The main treatment for symptomatic EACE is surgical excision. External auditory canal cholesteatoma (EACC) is a bone-destructive cystic mass caused by accumulation of plugs of desquamated keratin debris in the external auditory canal (EAC), which is also mainly treated with surgical removal. The main difficulties in the surgical removal of obstructive EACEs or EACCs are related to the adjacency of EAC skin, tympanic membrane, temporomandibular joint, and the blockage of the medial EAC landmarks during the operation. The piezoelectric device (PZD), which has long been used to cut bony structures in dental surgery, has clinical advantages here with regards to accurate exclusive bone cutting ability and minimal heat production. We report a series of cases that managed EAC lesions using PZD.

Sebaceomas of the external auditory canal (EAC) are extremely rare. The recognition of sebaceoma is important as this benign tumor can be be part of the spectrum of the Muir-Torre syndrome (MTS), which is associated with visceral malignancy and multiple adenomatous polyps. Proper histological identification is thus important for further investigation. We describe a rare case of a sebaceoma that was confined to the EAC. Subsequent immunohistochemical (IHC) staining analysis of the mismatch repair genes (MLH1, MSH2, MSH6, and PMS2) was needed to investigate MTS. Even though the patient has had the history of colon cancer, the result was negative. Otorhinolaryngologists should be aware of rare sebaceoma and its potential association with the internal malignancy, besides the limitation of IHC screening test.

임상이비인후과(Journal of Clinical Otolaryngology Head and Neck Surgery)

Granular cell tumor (GCT) is a rare, benign neoplasm of Schwann cell origin. GCT is composed of cells with eosinophilic granular cytoplasm. GCT presents as a solitary painless nodule. Because of their subtle clinical presentation, GCTs are often misdiagnosed. This report of a 47-year-old woman with an auricular GCT serves to highlight that complete excision and histopathological evaluation should be attempted even in apparently benign cases, to ensure complete cure.

Trichofolliculoma (TF) is a follicular hamartoma in which hairs protruding out of single orifice. To the best of my knowledge, only two auricular TF has been reported in the English literature. Moreover, clinically TF have been described to mimic malignancy. I present a case of an adult female with mass at the intertragal notch of the left auricle for several years. The clinical diagnosis was thought to be epidermoid cyst, accessory tragus, and other benign skin adnexal tumor. To prevent recurrence, the wide local excision of the mass was performed. The final diagnosis of TF was made. No recurrence was noted during the follow-up of 1 year. It is important for otologists to be familiar with the clinical and pathologic characterization of TF, to make the correct diagnosis.

The auricle is a three-dimensional cartilaginous frame covered with thin overlying skin. Due to its complex features, reconstructing helical rim defects after the excision of an auricular mass is challenging. Shortage of subcutaneous tissue and the presence of a tightly bound epithelium further hamper the primary closure of lateral (anterior) auricular skin defects. We present herein a case in which we used a helical rim advancement flap along with an additional postauricular skin flap. We achieved a satisfactory esthetic result with minimal loss of helical diameter and a low risk of flap necrosis by preserving the vascular network of the flap. This technique is less traumatic and will facilitate faster healing as well as improved patient recovery.

Ototoxic side effects of cisplatin and aminoglycosides have been extensively studied, but no therapy is available to date. Sensory hair cells, upon exposure to cisplatin or aminoglycosides, undergo apoptotic and necrotic cell death. Blocking these cell death pathways has therapeutic potential in theory, but incomplete protection and lack of therapeutic targets in the case of necrosis, has hampered the development of clinically applicable drugs. Over the past decade, a novel form of necrosis, termed necroptosis, was established as an alternative cell death pathway. Necroptosis is distinguished from passive necrotic cell death, in that it follows a cellular program, involving the receptor-interacting protein kinase (RIPK) 1 and RIPK3. In this study, we used pharmacological and genetic interventions in the mouse to test the relative contributions of necroptosis and caspase-8-mediated apoptosis toward cisplatin and aminoglycoside ototoxicity. We find thatex vivo, only apoptosis contributes to cisplatin and aminoglycoside ototoxicity, whilein vivo, necroptosis as well as apoptosis are involved in both sexes. Inhibition of necroptosis and apoptosis using pharmacological compounds is thus a viable strategy to ameliorate aminoglycoside and cisplatin ototoxicity.SIGNIFICANCE STATEMENTThe clinical application of cisplatin and aminoglycosides is limited due to ototoxic side effects. Here, using pharmaceutical and genetic intervention, we present evidence that two types of programmed cell death, apoptosis and necroptosis, contribute to aminoglycoside and cisplatin ototoxicity. Key molecular factors mediating necroptosis are well characterized and druggable, presenting new avenues for pharmaceutical intervention.