Jin-Kook Lee

Rationale: Patulous Eustachian tube (PET) refers to condition where the Eustachian tube remains abnormally open or fails to close adequately, leading to autophony, aural fullness, breathing autophony, tinnitus, and hypernasality. This case study reports the acoustic characteristics of a PET patient with hypernasality evaluate the changes in symptoms before and after conservative therapy, and demonstrate the utility of objective assessment through speech evaluation in addition to subjective symptom assessment. Patient concerns: The 40-year-old female presented to the otolaryngology outpatient clinic with complaints of aural fullness and autophony, tinnitus, hypernasality. Otoscopic examination revealed bilateral adhesive tympanic membranes. Despite bilateral ventilation tube insertion performed to address the persistent aural fullness, the patient continued to experience the same symptoms postoperatively. Diagnoses and Interventions: The patient began evaluation and treatment including speech, physical, and drug therapy were performed, for hypernasality, dyspnea, and swallowing problem with the Department of Rehabilitation Medicine. We assessed nasalance, vocal quality, and questionnaire both before and after the treatment. The acoustic data related to PET and the questionnaire results were then obtained. Outcomes: Significant improvements were observed in nasalance and vocal quality, questionnaire. Nasalance and jitter, shimmer metrics, questionnaire results gradually decreased. Notably, jitter and shimmer, questionnaire score, which were outside the normal range in the pretreatment assessment, returned to within normal limits following the conservative treatment. Lessons: Studies focused on PET with hypernasality changes in acoustic data and questionnaire are extremely rare. This case is significant in that not only was PET with hypernasality improved after conservative therapy, but also changes in nasalance, voice quality, and questionnaire were observed.

This study classified the severity of aphasia through the Western Aphasia Battery and determined the optimal cut-off value for each Language-Related White Matter fiber and their combinations, we further examined the correlations between Language-Related White Matter and Western Aphasia Battery subscores. This retrospective study recruited 64 patients with aphasia. Mild/moderate and severe aphasia were classified according to cut-off Aphasia Quotient score of 51 points. Diffusion tensor imaging and fractional anisotropy reconstructed Language-Related White Matter in multiple fasciculi. We determined the area under the covariate-adjusted receiver operating characteristic curve to evaluate the accuracy of predicting aphasia severity. The optimal fractional-anisotropy cut-off values for the individual fibers of the Language-Related White Matter and their combinations were determined. Their correlations with Western Aphasia Battery subscores were analyzed. The arcuate and superior longitudinal fasciculi showed fair accuracy, the inferior frontal occipital fasciculus poor accuracy, and their combinations fair accuracy. Correlations between Language-Related White Matter parameters and Western Aphasia Battery subscores were found between the arcuate, superior longitudinal, and inferior frontal occipital fasciculi and spontaneous speech, auditory verbal comprehension, repetition, and naming. Diffusion-tensor-imaging-based language-Related White Matter analysis may help predict the severity of language impairment in patients with aphasia following stroke.