27th Politzer Meeting Poster Submissions - Basic Science

Abstract Title:  The Cochlea in Diabetes: An Animal Model
Main Organisation Work/Study Carried Out on Behalf of: Obafemi Awolowo University, Ile Ife Nigeria
Main Authors:

  • Olubunmi Akinpelu, Senior Lecturer/Consultant Otolaryngologist, Department of Surgery, Obafemi Awolowo University, Ile Ife, Nigeria

Additional Authors:

  • Stephen Adewole, Senior Lecturer, Anatomy Department Obafemi Awolowo University, Ile Ife, Nigeria
  • David Adeyemi, Lecturer, Anatomy Department, Obafemi Awolowo University, Ile Ife, Nigeria

Main Contact E-mail: olubunmilola@yahoo.co.uk
Abstract:
Objective: To describe the histological changes in the cochlea of alloxan diabetic rats.
Methods: 40 healthy adult wistar rats (rattus norvegicus) weighing between 150 and 280 grammes were used for this study. The rats were randomly divided into two groups: an experimental group and a control group. The experimental group received a single intraperitoneal dose of 100mg/kg of alloxan monohydrate, freshly dissolved in distilled water while the control group received an equal volume of distilled water. Diabetes was allowed to be established over a period of 24 hours. The serum glucose was assessed 24 hours after diabetes induction by the glucose-oxidase enzymatic method using Accu-Chec advantage (Germany). Experimental procedures complied with the guidelines for the use and care of laboratory animals. Animals in the experimental group, presenting with elevated serum glucose levels and which did not revert back to normoglycaemia were taken to be diabetic and were used for the study. Food and water were provided for all animals ad libitum. Daily weighing of the rats were done and the serum glucose was assessed weekly. After a period of four weeks, the animals in the 2 groups were sacrificed, the temporal bones of the animals were quickly removed and fixed in 10% frmal saline and subsequently decalcified in freshly prepared 10% EDTA solution for a period of 5 days, while changing the solution daily. The tissues were processed via paraffin wax embedding. Sections were cut using a rotary microtome 5 microns thick. The Hand E, PAS and masson trichrome were used to stain the sections. The histology of the tissue was studied under light microscopy.
Results: The cochlea of the diabetic rats were observed to have changes in the spiral ganglion, the stria vascularis and basement membrane compared to the control animals. There was no significant changes in the inner and outer hair cells of the experimental animals compared to the controls.
Conclusions and Discussion: Diabetes being a chronic disease tends to occur over a long time and is associated with microvascular changes which complicate the disease. The retina and the kidney have been extensively studied regarding these microvascular changes. The relationship between diabetes and hearing has also been a subject of research for a long time now. However, there are inconsistent and inconclusive reports on this relationship. The occurrence of histological changes in the stria vascularis, spiral gaglion and basement membrane may not be related to the hearing function. The relationship between the function and the various histogical stuctures within the cochlea is desirable.

 

Abstract Title: Effect of Manganese-Superoxide Dismutase Genetic Polymorphisms IVS3-23T/G on Noise Susceptibility in Taiwan
Main Organisation Work/Study Carried Out on Behalf of: Kaohsiung Medical University Hospital, Kaohsiung Medical University, Taiwan
Main Authors:

  • Ning-Chia Chang, Koahsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City, Taiwan
  • Kuen-Yao Ho, Associate Professor, Kaohsiung Medical University, Kaohsiung City, Taiwan

Additional Authors:

  • Chi-Kung Ho, Associate Professor, Kaohsiung Medical University, Kaohsiung City, Taiwan
  • Ming-Tsang Wu, Kaohsiung Medical University, Kaohsiung City, Taiwan
  • Ming-Lung Yu, Kaohsiung Medical Universit, Koahsiung City, Taiwan

Main Contact E-mail: aka@ms.kmuh.org.tw
Abstract:
Objectives: In the study presented by Fortunato et al, the authors reported genetic polymorphisms of paraoxonase and manganese-superoxide dismutase (SOD2) were associated with human noise susceptibility. However, the associations of SOD2 genetic polymorphisms with noise susceptibility were unknown for Asians. The purpose of this study was to investigate the distribution of SOD2 genetic polymorphisms IVS3-23T/G and their influence on noise susceptibility in Asians.
Materials and Methods: Questionnaires about noise-exposing history were administered to noise-exposed factory workers and audiometric data and blood specimens were obtained during their routine annual health examinations under informed consents. Participants with three-year-period hearing threshold shifts of 10 dB or above were considered noise susceptible. The SOD2 typing was extended with polymerase chain reaction and screened with single strand conformation polymorphism. The associations of genetic polymorphisms with noise induced hearing loss (NIHL) were analysed with logistic regressions.
Results: The allele frequencies of T and G in the population of this study were 0.868 and 0.132 respectively in Taiwanese. In 200 screened participants, it was found that individuals with T/G genotype were significantly more vulnerable to noise (adjust odds ratio=6.222; 95% confidence interval=1.498-25.855) than the wild type (i.e. T/T) by logistic regressions.
Conclusions: The distributions of SOD2 genetic polymorphisms for Asians are different from those reported on Europeans. Individuals with T/G genotype were more vulnerable to noise. This single nucleotide polymorphism is worthy of more studies for the application to NIHL monitoring.

 

Abstract Title: Rat Model For Chronic Tympanic Membrane Perforation And The Efficiency Of Chitosan Patch Scaffold For Treatment
Main Organisation Work/Study Carried Out on Behalf of: Ajou University School of Medicine, Suwon, Republic of Korea
Main Authors:

  • Yun-Hoon Choung, Professor, Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea

Additional Authors:

  • Seong Jun Choi Assistant Professor, Department of Otorhinolaryngology, College of Medical Science, Konyang University, Daejon, Republic of Korea
  • Jong Bin Lee, Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea
  • Jong Hoon Chung, Professor, Department of Biosystems & Biomaterials Science and Engineering, Seoul National University, Seoul, Republic of Korea
  • Keehyun Park, Department of Otolaryngology, Ajou University School of Medicine, Suwon, Republic of Korea

Main Contact E-mail: yhc@ajou.ac.kr
Abstract:
Objectives: Chronic tympanic membrane perforation (CTMP) is a representative otologic disease that requires surgical procedures. However, there have been no good alternative managements which can easily be applied at outpatient clinics and also no ideal animal models for the study of CTMP. Therefore, we devised rat models for CTMP and assessed the efficiency of chitosan patch scaffolds (CPS) which we had previously developed. Methods: We applied the following eight methods to 85 Spragu-Dawley rats to make CTMP which could remain for at least four weeks; I) simple perforation, II) mitomycin C (MC) for 10 min in the perforation areas, III) MC for 10 min and then saline gelfoam for 1 week, IV) MC for 10 min and dexamethasone gelfoam for 1 week, V) MC gelfoam for 1 week, VI) dexamethasone gelfoam for 1 week, VII) making perforation with a heated pick, and VIII) local application of dexamethasone gelfoam for 1 week after making perforations with heated micropicks.
Results: Among these methods, the method VIII showed 100% successes rate for maintenance of perforations over 4 weeks, followed by V (75%), IV (35.7%), and III (33.3%), whereas the methods I, II, VI, and VII showed 0%. Next, we assessed the healing efficiency of CPS using the CTMP models by comparing with paper patches and none management. In the method VIII models, there was no perforation healed with any patches during more than 9 weeks. In the animal models prepared with the method V, the CPS-applied rats showed 70% of healing rate which was better than 40% in rats with paper patches or none managements.
Conclusions: These results indicate that animal models with CTMP could be prepared with local application of MC for 1 week, and that CPS might be potentially an ideal material that could affordably be used in office-based settings for the regeneration of CTMP.

Abstract Title: Intracochlear Distribution of Intratympanic Quantum Dot-Dexamethasone Nanocomplex in Rats and Analysis of the Hearing Recovery According to the Frequency
Main Organisation Work/Study Carried Out on Behalf of: School of Medicine, Pusan National University, Busan, Korea
Main Authors:

  • Il-Woo Lee, Associate Professor, Pusan National University Yangsan Hospital, Busan, Korea

Additional Authors:

  • Eui-Kyung Goh, Professor, Pusan National University Hospital, Busan, Korea
  • Kyong-Myong Chon, Professor, Pusan National University Hospital, Busan, Korea
  • Jae-Beon Lee, Assistant Professor, Pusan National University Hospital, Busan, Korea
  • Sung-Hwan Park, Assistant Professor, Pusan National University Hospital, Busan, Korea
  • Soo-Keun Kong, Assistant Professor, Pusan National University Hospital, Busan, Korea

Main Contact E-mail: gohek@pusan.ac.kr
Abstract:
Objective and Background: Intratympanic dexamethasone (IT-DEX) injection for treatment of sudden idiopathic sensorineural hearing loss (SSNHL) is a remarkable treatment option for those who failed systemic steroid therapy. Intracochlear distribution of injected steroid varies according to the region of the cochlea, consequently high concentration in the basal turn and low concentration in apical turn is found. The clinical results of the SSNHL patient treated with IT-DEX is not like the above mentioned pattern, namely according to the apical-basal gradient. There is no tendency of hearing gain as high frequency (basal turn) is dominant. So we tried to see the distribution pattern of dexamethasone in the cochlea and analysed the results of IT-DEX treatment in patients with SSNHL according to the frequency. 
Materials and Methods: Quantum dot-dexamethasone bioconjugates (QD-DEX) were injected intratympanically into the bulla of Sprague -Dawley rats and the distribution of QD-DEX in the cochlea was analysed with fluorescent microscope. 137 patients with SSNHL were divided into 3 groups and treated with systemic steroid (N=60), systemic steroid + IT-DEX(QD-DEX) (N=60), and IT-DEX only(N=17).
Results: QD-DEX were distributed in the whole cochlea in 1 hour and remained through for 24 hours. QD-DEX with the highest concentration were seen in the spiral ganglion, spiral ligament, and organ of Corti especially in basa and middle turn of cochlea. Distribution of the QD-DEX paralleled locations of the glucocorticoid receptors. Though there was no statistical differences in hearing gain as a whole, the hearing gain in 8000Hz was higher in the systemic steroid + IT-DEX group than the systemic steroid only group.
Conclusions: Dexamethasone rapidly travels from the middle ear into the inner ear and QD-DEX seems to be good material for delivering steroid into the cochlea. IT-DEX injection effectively improves hearing in patients with SSNHL especially in 8000Hz(basal turn) and is appropriate for the distribution of the drugs in cochlea from middle ear through round window membrane.

Abstract Title: Inferior Space Of The Lateral Attic: Anatomy And Topography
Main Organisation Work/Study Carried Out on Behalf of: Department of Clinical and Topographical Anatomy, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
Main Authors:

  • Nicoleta Maru, ENT Specialist, Department of Clinical and Topographical Anatomy, Faculty of Dentistry, University of Medicine and, Bucharest, Romania
  • Adrian Cheita, ENT Specialist, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania

Main Contact E-mail: cheita_adrian@yahoo.com
Abstract:
Objectives: The inferior space of lateral attic is a passage between several distinctive spaces of the middle ear. Although bibliographic resources on this space name it subincudal space, this space belongs to the attic, not to mesotympanum, making it a difficult region to understand, of the middle ear. The inferior space of lateral attic is poorly described in the specific literature. This present study was performed to describe the anatomy and topography of the inferior space of lateral attic.
Methods: For this study we used 25 temporal bones, obtained in legal conditions at autopsies, from specimens without any known middle ear pathology. Combined, lateral, anterior and superior approaches were used for the anatomical microdissections of those specimens.
Results: The walls of the inferior space of the lateral attic resulted from our study, as it follows: the superior wall - the lateral incudomaleal fold that anteriorly has a variable length; the supero-internal wall - the body and short process of the incus; the antero-internal wall - the superior segment of the long process of incus and in front of it is the interossicular fold that we constantly found present in the interval between incus and chorda tympani but never inferior to the nerve; the external wall - attic wall; the inferior wall - the posterior extremity of the posterior malleal fold extended medially to choarda tympani; the anterior wall - has two parts, one internal, bony, represented by the neck of malleus and other external, fibrous, represented by pars ligamentosa of external malleal fold. The adjacent compartments of the inferior space of the lateral attic: anterior - the Prussak space; antero-superior - lateral malleal space; superior - superior lateral attic; inferior - mesotympanum; infero-medial - isthmus tympani posticus. Constantly, the inferior space of lateral attic widely opens posteriorly, and the inferior and internal ones through a limited orifice: a) infero-externally by the tympani chord; b) supero-internally: here is the body and the short process of the incus; c) anteriorly by the upper part of the long process of incus - this process is limited in its upper part by the orifice of the inferior space of the lateral attic and in its lower part it is limited by the isthmus tympani posticus. So, the two orifices comunicate with each other inferior to the incus.
Conclusion/Discussion: The inferior space of the lateral attic should be understood rather as a topographic passage similar to the tympani passage than an anatomical individual space. Thus, while the tympanic passage is internally placed by the incus, the inferior space of the lateral attic appears as a passage externally of this bone.

Abstract Title: Abnormal White Matter Integrity in Prelignuial and Postlingual Deaf
Main Authors:

  • Seung Ha Oh, Professor, Department of Otolaryngology, Seoul National University College of Medicine, Seoul, Korea
  • Dong Soo Lee, Professor, Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea

Additional Authors:

  • Hyejin Kang, Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
  • Eunkyung Kim, Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
  • Min Woo Park, Resident, Department of Otolaryngology, Seoul National University College of Medicine, Seoul, Korea
  • Jeong Hun Jang, Clinical and Research Fellow, Department of Otolaryngology, Seoul National University College of Medicine, Seoul, Korea
  • Jae-Jin Song, Clinical and Research Fellow, Department of Otolaryngology, Seoul National University College of Medicine, Seoul, Korea
  • Hyo-Jeong Lee, Professor, Department of Otolaryngology, Seoul National University College of Medicine, Seoul, Korea
  • Myung-Whan Suh, Professor, Department of Otolaryngology, Seoul National University College of Medicine, Seoul, Korea
  • Jae Sung Lee, Professor, Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea

Main Contact E-mail: shaoh@snu.ac.kr
Abstract:
Objectives: The functional difference of the neural network depending on the period of auditory deprivation has been proposed in deafness. In our previous study, the different form of speech reading network has been elucidated in the prelingual deaf group using the analysis of equivalent current dipoles. In this study, structural differences between prelingual and postlingual deaf were investigated using diffusion tensor imaging (DTI). DTI, a magnetic resonance imaging (MRI) technique used to examine water diffusion in different tissue, reflects microstructural features and the organizing patterns of the white matter. The degree of anisotropic diffusion, the fractional anisotropy (FA) value, reflects the degree of fiber organization and integrity. 
Methods: 10 normal controls (median age 48 ± 7.7 years), 7 prelingual deaf subjects (median age 50.7 ± 6.5 years), and 13 postlingiual deaf subjects (median age 51.9 ± 11.7 years) participated in this study. MRIs were conducted at 3Tesla and the DTI data was obtained using a double spin echo planar imaging sequence. The diffusion tensor sequence used in this study had a total of 25 diffusion gradient directions for acquisition of 38 slices through the whole brain and T2 images without diffusion gradient (B0 images) were acquired. An FA map was computed from the 26 DTI volumes for each subject after derivation of the eigenvalues of the diffusion tensor matrix for each voxel. The voxel-wise analysis of the FA map was performed using Statistical Parametric Mapping (SPM5). Group differences between the normal control group and the prelingual or postlingual deaf groups were examined using an independent samples t-test.
Results: The distribution of age and Korean version Central Institute for the Deaf (K-CID) scores (word and phoneme) did not differ significantly between the 2 deaf groups. The prelingiual deaf group revealed a significant decrease in the mean FA in the inferior longitudinal fasciculus adjacent to the right auditory cortex, right inferior frontooccipital fasciculus, right arcuate fasciculus, and right inferior frontal region compared with the normal control group. In contrast, the postlingual deaf group showed a lower mean FA value in the inferior longitudinal fasciculus adjacent to bilateral auditory cortex, superior thalamic radiation, bilateral frontooccipital fasciculus, and right superior longitudinal fasciculus compared with the normal control group. 
Conclusions: Although no differences of auditory speech perception were found between the 2 groups, hemispheric differences in the white matter integrity were elucidated. In the prelingual deaf group, the white matter disruptions were observed only in the right hemisphere, while bilateral disruptions of the white matter were observed in the postlingual deaf group. This information of the whiter matter integrity may be useful for understanding not only the functional and anatomical connectivity but also the brain plasticity in deaf patients. 
Acknowledgments: This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry of Health, Welfare and Family Affairs, Republic of Korea. (A080588). This work was supported by the Korea Science and Engineering Foundation (KOSEF) grant funded by the Korea government. (MOST) (No. 2006-05090).

Abstract Title: Effect of Neurotrophic Factors on Hearing Restoration and Spiral Ganglion Regeneration in Deafened Animal Model
Main Organisation Work/Study Carried Out on Behalf of: Department of Otolaryngology -HNS, College of Medicine, The Catholic University of Korea, Seoul, Korea
Main Authors:

  • Kyoung Ho Park, Associate Professor, Department of Otolaryngology -HNS, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • Jae Hyun Seo, Assistant Professor, Department of Otolaryngology -HNS, College of Medicine, The Catholic University of Korea, Seoul, Korea

Additional Authors:

  • Hyeog-gy Choi, Clinical Fellow, Department of Otolaryngology -HNS, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • Shi-nae Park, Associate Professor, Department of Otolaryngology -HNS, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • Sang W. Yeo, Professor, Department of Otolaryngology -HNS, College of Medicine, The Catholic University of Korea, Seoul, Korea

Main Contact E-mail: khpent@catholic.ac.kr
Abstract:
Objectives: Multiple neurotrophic factors have been shown to have important roles in the survival of auditory neurons and protecting spiral ganglion cells. This study evaluated the efficacy of brain-derived neurotrophic factor (BDNF) combined with glial-cell derived neurotrophic factor (GDNF) and neurotrophin-3(NT-3),  insulin growth factor(IGF),  and epidermal growth factor(EGF) with fibroblast growth factor(FGF) application in 2 weeks post-deafening guinea pigs.
Method: 30 healthy guinea pigs were deafened by infusion of kanamycin and ethacrynic acid. Myringotomy was done in both ears, gelfoams immersed with neurotrophic factors were placed on the round window membrane while gelfoams immersed with saline were applied to control ear. 1 week after drug application, a hearing test was done and the cochleae were collected in every 2 weeks. The number of spiral ganglion cells was quantitatively analysed.
Results: Significant hearing restoration was observed in group 1 (BDNF, GDNF, NT-3 treated group) & group 2 (IGF treated group). The number of spiral ganglion cells of group 1 on 5 week after the treatment, and group 3 (EGF, FGF treated group) on 3 week after the treatment were significantly increased compared with control group.  However, no statistically significant regeneration was observed in group 2.
Conclusion: These findings demonstrate that BDNF+GDNF+NT-3 and EGF+FGF neurotrophic factors application through round window membrane have the potential for regeneration of spiral ganglion cells.

Abstract Title: Ear Disorders in Goldenhar Syndrome
Main Organisation Work/Study Carried Out on Behalf of: Virgen de la Arrixaca University Hospital, Murcia, Spain
Main Authors:

  • Beatriz Rodriguez, Virgen de la Arrixaca University Hospital, Murcia, Spain

Additional Authors:

  • Pablo Melgarejo, Montserrat Hospital, Lleida, Spain
  • Diego Hellin, Virgen de la Arrixaca University Hospital, Murcia, Spain
  • Rafael Perez, Virgen de la Arrixaca University Hospital, Murcia, Spain
  • Luis M. Amorós, Virgen de la Arrixaca University Hospital, Murcia, Spain

Main Contact E-mail: pablomelgarejo@wanadoo.es
Abstract:
Objectives: Goldenhar syndrome is a disorder where the patient's facial features are incompletely developed on one side, resulting in eye, ear, and jaw abnormalities. Goldenhar syndrome is sometimes called oculoauriculovertebral displaysia, or OAV dysplaysia. The syndrome was first described in 1952 by the French ophthalmologist Maurice Goldenhar. Severe cases of Goldenhar syndrome can affect many aspects of the patient's life and sometimes requires immediate intervention from birth. Without hearing assistance or surgical reconstruction, individuals with full bilateral microtia and atresia will not able to acquire normal spoken language.
Methods: Three cases of Goldenhar syndrome are presented. The age of the children was 4 months, 6 months and 5 year-old. Audiology studies were performed with BAER tests and acoustic otoemission. Also radiological findings are show as computed tomography and magnetic resonance imaging.
Results: Treatment of Goldenhar syndrome and Hemifacial microsomia is complex, since there are many aspects of the syndrome to manage. In addition to surgeries associated with restoring hearing, patients with Goldenhar syndrome often require reconstructive surgery of the jaw and skull, specialized orthodontic treatment, and repair of cleft palates and notched eyelids Microtia can be corrected with reconstructive surgery. Microtia repair surgery is often done when the patient is between 3 and 6 years of age, although it can be done at any later time. Congenital aural atresia or canal stenosis can be surgically reconstructed once the skull has reached a sufficiently large size, generally between ages 3 and 8. Since the inner ear is rarely affected by Goldenhar syndrome, hearing aids can be effective in giving the patient access to sound. Another kind of hearing aid that is commonly used is a bone-conduction hearing aid, which bypasses the ear canal by vibrating against the skull behind the ear.
Discussion: The rate of occurrence of Goldenhar syndrome ranges from 1 in 3,500 to 1 in every 5,600 births. It is believed to be caused primarily by sporadic genetic mutations rather than inherited ones. Goldenhar syndrome is usually diagnosed based on the patient's appearance, skeletal malformations, and hearing deficits. There is no single lab test that confirms the disorder. A large team of professionals is necessary to treat all of the issues associated with Goldenhar syndrome. Expert audiological treatment and ear surgery are almost always required. In case of bilateral severe to profound hearing loss, a cochlear implant may be used.

Category: Vestibular Disorders

Abstract Title: Relationship Between Clinical Features and Vestibular Function by Caloric Testing and Vestibular Evoked Myogenic Potentials in Patients With Idiopathic Unilateral Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo
Main Organisation Work/Study Carried Out on Behalf of: 1. Department of Otolaryngology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Taiwan. 2. Department of Otolaryngology, Kaohsiung Medical University Hospital, Taiwan
Main Authors:

  • Kuen-Yao Ho, Associate Professor, Department of Otolaryngology, Kaohsiung Medical University Hospital, Taiwan, Kaohsiung City, Taiwan

Additional Authors:

  • Chen-Yu Chien, Medical Doctor, Department of Otolaryngology, Kaohsiung Medical University Hospital, Taiwan, Kaohsiung City, Taiwan
  • Shih-Meng Tsai, Assistant Professor, Department of Pubic Health, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
  • Ling-Feng Wang, Assistant Professor, Department of Otolaryngology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
  • Chih-Feng Tai, Lecturer, Department of Otolaryngology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
  • Ning-Chia Chang, Visiting Staff, Department of Preventive Medicine, Kaohsiung Medical University Hospital, Taiwan, Kaohsiung City, Taiwan
  • Wang Hsun-Mo, Medical Doctor, Department of Otolaryngology, Kaohsiung Medical University Hospital, Taiwan, Kaohsiung City, Taiwan
  • Lee Ming-Fang, Audiological Technologist, Department of Otolaryngology, Kaohsiung Medical University Hospital, Taiwan, Kaohsiung City, Taiwan

Main Contact E-mail: kuyaho@kmu.edu.tw
Abstract:
Objectives: To evaluate the relationship between clinical features and vestibular function in patients with idiopathic unilateral posterior semicircular canal benign paroxysmal positional vertigo (BPPV-PC). We compared the treatment outcome of patients with idiopathic BPPV-PC unassociated with additional objective evidence of vestibular dysfunction with that in patients who did demonstrate additional vestibular dysfunction on caloric testing and vestibular evoked myogenic potentials (VEMP).
Methods: Between July 2007 and January 2009, a study was conducted on 82 patients with a final diagnosis of idiopathic unilateral posterior semicircular canal benign paroxysmal positional vertigo (BPPV-PC). The patients were subjected to both bithermal air caloric testing and VEMP testing after diagnosis of BPPV-PC with a Dix-Hallpike test demonstrating positioning nystagmus characteristic. If both caloric test and VEMP results were normal, the vestibular function was considered as "normal" (Group I); either abnormal caloric test or abnormal VEMP appeared, the vestibular function was considered as "abnormal" (Group II). The patients were treated with canalith repositioning procedure (CRP) and the CRPs were repeated each visit until treatment success was achieved. The treatment outcome was assessed with regard to vestibular function, the number of CRPs, and the presence of recurrence.
Results: A total of 82 patients were reviewed, twenty-six were male, and 56 were female. Their ages varied from 22 to 83 years, with mean age of 53.9 years. All patients had unilateral BPPV-PC. The right side was affected in 49 ears, and the left side in 33. Mean follow-up was 8.1 months (range 1- 19 months). Caloric testing results were abnormal in 49 (59.8%) patients with demonstrating unilateral weakness. VEMP results were abnormal in 26 (31.7%) patients. Group I was 28 patients. Group II was 54 patients. All patients required an average of 1.24 CRPs for treatment success (range 1-3 CRPs). Group I patients required an average of 1.28 CRPs, and Group II required 1.22 CRPs. Vestibular dysfunction had no impact on the number of CRPs (p= 0.59). About 78.6% of Group I patients no longer demonstrated characteristic positioning nystagmus after 1 CRP compared with 79.6% of Group II patients (p=0.91), where 21.4% of Group I patients and 20.4% of Group II patients required two of more CRPs to achieve treatment success.
There was a treatment success after 1 CPR in 65 (79.3%) of all 82 patients. Recurrence developed in 2 (7.1%) of Group I patients, and in 3 (5.6%) of Group II patients, no significance was noted in the recurrence rate (p>0.05).
There was a recurrence in 5 (6%) of all 82 patients.
Conclusions: Our study demonstrates that patients with vestibular dysfunction do not have a worse prognosis with respect to resolution of BPPV-PC, on performing the canalith repositioning procedure, compared with patients with normal vestibular function, no significant difference was found in the number of CRPs and recurrence rate respectively.

Abstract Title: Subjective Visual Vertical During Eccentric Rotation in Patients With Vestibular Neuritis
Main Authors:

  • Seok Min Hong, Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, College of, Chuncheon, South Korea

Additional Authors:

  • Chang Il Cha, Department of Otorhinolaryngology and Head & Neck Surgery, College of Medicine, Kyung Hee University, Seoul, South Korea

Main Contact E-mail: thecell@medimail.co.kr
Abstract:
Objective: The subjective visual vertical (SVV) is a useful tool to evaluate clinical manifestations of vestibular loss, but there have been normal variations of the SVV within 1 to 3 degrees, and over time, the absolute deviated degrees of SVV tilts decreases. We investigated SVV values in patients with vestibular neuritis (VN) during eccentric rotation, the method used to assess utricular function during stimulation of one labyrinth.
Methods: SVV values were measured in 17 patients with VN and 20 normal subjects in the resting state and during eccentric rotation to the lesion side and the healthy side. We compared the SVV values before and during eccentric rotation in both with the VN and control group.
Results: No difference in the resting state SVV values were observed between the VN patients and the control group, but there were significant differences in SVV values between these two groups during eccentric rotation.
Conclusion: SVV during eccentric rotation allowed us to obtain information about unilateral vestibular loss that could not be found by conventional SVV in patients with VN. Thus, SVV during eccentric rotation might be a good tool to diagnose unilateral vestibular loss.

Abstract Title: Ménière's Disease in Noise-Induced Hearing Loss Claimants
Main Organisation Work/Study Carried Out on Behalf of: Christchurch Hospital and University of Canterbury, Christchurch, New Zealand
Main Authors:

  • Jeremy Hornibrook, Otolaryngologist-Head and Neck Surgeon, Christchurch Hospital and University of Canterbury, Christchurch, New Zealand

Additional Authors:

  • John Gourley, Audiologist, Christchurch Hospital, Chrischurch, New Zealand

Main Contact E-mail: jhornibrook@paradise.net.nz
Abstract:
Objectives: Over an eight year period the presenting author examined 1008 noise-induced hearing loss (NIHL) claimants. In 12 with a significant hearing
assymetry 2 had an acoustic neuroma. In the 10 with normal MRI of 8th nerves the objective was to verify the cause. Six volunteered a vertigo history, and 4 denied ever having vertigo. Electrochleography (EcochG) with tone-burst stimuli now has high sensitivity for implying the presence of endolymphatic hydrops and Ménière'sdisease without all the symptoms present at one time.
Methods: Transtympanic EcochG with 90dB clicks and 100dB
0.5,1,2,4kHz tone bursts were performed on both ears. The SP/AP ratio and tone burst SP (microvolts) were measured and graded according to Gibson "normals" as an indicator of the presence or absence of hydrops. The audiograms and EcochG data for the 10 claimants are shown.
Results: In 7 subjects the EcochG was "normal" in the better hearing ear. In all 10 the test diagnosed hydrops (Ménière's disease) in the ear with the
greatest loss. One claimant was seen with a vertigo attack and admitted having many more, and enquiries revealed 2 others had had attacks
and withheld the information.
Conclusions: EcochG confirmed the diagnosis of Ménière's disease in the worst hearing ear in 10 NIHL claimants, giving a more precise diagnosis of
both disorders. In occupational hearing loss some claimants may conceal a history of vertigo. The high prevalence of Ménière's disease (992/100,000) in this series probably reflects the underestimate of Ménière's prevalence based
on symptoms alone. The EcochG can detect hydrops and confirm Ménière's disease long after the vertigo attacks have ceased.
Reference: Arenberg IK, Gibson WP, Hoehmann D. International standards for transtympanic electrocochleography. In: Hoehmann D ed. Proceedings of First International Conference on EcochG, OAE and Intraoperative Monitoring. Amsterdam; The Netherlands: Kugler Press, 1993: 115-8.

Abstract Title: HSP-70 Antibodies in Clinically Certain Ménière's Disease
Main Organisation Work/Study Carried Out on Behalf of: Christchurch Hospital, Christchurch, New Zealand
Main Authors:

  • Jeremy Hornibrook, Otolaryngologist, Christchurch Hospital, Christchurch, New Zealand

Additional Authors:

  • Peter George, Chemical Pathologist, Christchurch Hospital, Christchurch, New Zealand
  • Myfanwy Spellerberg, Scientist, Christchuch Hospital, Christchurch, New Zealand
  • John Gourley, Audiologist, Christchurch Hospital, Christchurch, New Zealand

 Main Contact E-mail: jhornibrook@paradise.net.nz
Abstract:
Objectives: To test the claim that a significant proportion of Ménière’s disease patients have autoantibodies to HSP-70 antigen.
In Ménière’s disease the fundamental histological feature is endolymphatic hydrops. Excess endolymph is usually cleared by the endolymphstic sac.
Defective sac function is the most likely cause of Ménière’s disease. One postulated mechanism is that sac function is damaged by an autoimmune mechanism, which the presence of HSP-70 autoantibodies may reflect.
Methods: Ethical approval was obtained. Serum samples
were taken from 80 subjects with a CERTAIN diagnosis of Ménière’s disease (American Academy criteria PLUS electrococleographic proof of hydrops with tone-burst stimuli) and tested for HSP-70 autoantibodies with the "OTOblot" Anti-68kD (hsp70) Western Blot assay. The response was recorded as negative, equivocal or positive.
Results: In 80 Ménière’s disease patients 14 were positive or equivocal; in 86 controls 10 were positive or equivocal. There was no significant
difference (p= 0.8229).
Conclusion: Patients with an unequivocal diagnosis of Ménière’s disease do not have a significantly raised incidence of HSP-70 autoantibodies.
Abstract Title: Subjective Visual Vertical in Patients With Ear Surgery
Main Organisation Work/Study Carried Out on Behalf of: Tokyo Medical University, Tokyo, Japan
Main Authors:

  • Yasuo Ogawa, Medical Doctor, Tokyo Medical University, Tokyo, Japan

Additional Authors:

  • Mami Hayashi, Tokyo Medical University, Tokyo, Japan
  • Koji Otsuka, Tokyo Medical University, Tokyo, Japan
  • Shigetaka Shimizu, Tokyo Medical University, Tokyo, Japan
  • Taro Inagaki, Tokyo Medical University, Tokyo, Japan
  • Akira Hagiwara, Tokyo Medical University, Tokyo, Japan
  • Tetsuya Yamada, Tokyo Medical University, Tokyo, Japan
  • Mamoru Suzuki, M.D., PhD, Tokyo Medical University, Tokyo, Japan

Main Contact E-mail: y-ogawa8@tokyo-med.ac.jp
Abstract:
Objective: To investigate the influences of various types of ear surgery to the otolithic function.
Methods: Subjective visual vertical (SVV) was tested for 72 patients that underwent ear surgeries.  We investigated the directional changes of SVV tilting before and after the surgery.  The surgeries were tympanoplasty in 48 patients, cochlear implants in 11, stapes surgery in 3, exploratory tympanoplasty in 3, vestibular neurectomy in 2, canal plugging in 1, partial removal of temporal bone in 1 and removal of external ear osteoma in 1.
Results: The postoperative SVV of the patients underwent vestibular neurectomy shifted toward the operated side.  Thirty-two (79.2%) of the 48 patients with tympanoplasty, 8 (72.7%) patients with cochlear implants, 3 (100%) patients with stapes surgery, 3 (75.0%) patients with exploratory tympanoplasty showed SVV tilting toward the healthy side.     
Conclusion/Discussion:  Postoperative SVV tilting of patients underwent vestibular neurectomy shifted toward the operated side, but the SVV of other ear surgery tended to shift toward the healthy side.  These results indicate that surgical procedure might increase the resting activity of the utricular afferent.  Dysequilibrium is one of the most important side effects of ear surgery.  The subjective visual vertical can be used as a good indicator for the evaluation of otolithic function in patients with ear surgeries.