Gender Differences Affecting Psychiatric Distress and Tinnitus Severity

Objective

This study evaluated gender differences in the relationship between psychiatric distress and subjective tinnitus severity.

Methods

This cross-sectional study included 134 female and 114 male patients who visited the otology outpatient clinic at Seoul St. Mary's Hospital for tinnitus from February to July 2015. Patients completed a series of instruments, including the Tinnitus Handicap Inventory, Beck Depression Inventory, Korean version of Brief Encounter Psychosocial Instrument (BEPSI-K), and visual analogue scales assessing various tinnitus characteristics (loudness, awareness, annoyance, and effect on life).

Results

Tinnitus severity did not significantly differ between the gender groups (p=0.632), and it correlated significantly with tinnitus characteristics and psychiatric distress. Partial correlations between tinnitus severity and depressive symptoms were stronger in males (r=0.411, p＜0.01) than in females (r=0.304, p＜0.01) while controlling for duration of tinnitus and tinnitus characteristics. However, stress (BEPSI-K) was positively correlated with tinnitus severity in only males (r=0.463, p＜0.01). A multiple regression analysis revealed that effect of tinnitus on life, depressive symptoms, and stress were significantly associated with tinnitus severity in males, whereas only tinnitus annoyance and depressive symptoms were associated with tinnitus severity in females.

Conclusion

Tinnitus severity was significantly correlated with depressive symptoms and stress, and there were gender differences in the relationship between tinnitus severity and psychiatric components. It is necessary to be vigilant of psychiatric symptoms among patients with tinnitus who visit the otology outpatient clinic, especially for male patients.

Comparative study of new autologous material, bone-cartilage composite graft, for ossiculoplasty with Polycel® and Titanium

OBJECTIVE

Ossiculoplasty is a surgical procedure that recreates sound transmission of the middle ear in conductive hearing loss. Various materials have been used for ossicular reconstruction, but the most ideal material for ossiculoplasty remains controversial. The purpose of this study was to introduce a novel method of autologous ossiculoplasty, bone-cartilage composite graft (BCCG) and to compare its surgical results with different types of ossiculoplastic prostheses.

STUDY DESIGN

A retrospective study was performed in a tertiary referral centre.

METHODS

Data of 275 patients who received ossiculoplasty using the three different materials of BCCG, Polycel^® and titanium were analysed according to type of ossiculoplasty: partial or total ossicular replacement prosthesis (PORP or TORP). Hearing results, complication rates and clinical parameters including age, sex, past history, preoperative diagnosis and surgery type were compared among different groups.

RESULTS

Ossiculoplasty with BCCG showed satisfactory hearing outcomes and the lowest complication rate among the three different materials. In particular, its extrusion rate was 0%.

CONCLUSION

We propose that the BCCG technique is a useful alternative method for ossiculoplasty, with proper patient selection.

The effect of dexamethasone/cell-penetrating peptide nanoparticles on gene delivery for inner ear therapy

Dexamethasone (Dex)-loaded PHEA-g-C18-Arg8 (PCA) nanoparticles (PCA/Dex) were developed for the delivery of genes to determine the synergistic effect of Dex on gene expression. The cationic PCA nanoparticles were self-assembled to create cationic micelles containing an octadecylamine (C18) core with Dex and an arginine 8 (Arg8) peptide shell for electrostatic complexation with nucleic acids (connexin 26 [Cx26] siRNA, green fluorescent protein [GFP] DNA or brain-derived neurotrophic factor [BDNF] pDNA). The PCA/Dex nanoparticles conjugated with Arg8, a cell-penetrating peptide that enhances permeability through a round window membrane in the inner ear for gene delivery, exhibited high uptake efficiency in HEI-OC1 cells. This potential carrier co-delivering Dex and the gene into inner ear cells has a diameter of 120-140 nm and a zeta potential of 20-25 mV. Different types of genes were complexed with the Dex-loaded PCA nanoparticle (PCA/Dex/gene) for gene expression to induce additional anti-inflammatory effects. PCA/Dex showed mildly increased expression of GFP and lower mRNA expression of inflammatory cytokines (IL1b, IL12, and INFr) than did Dex-free PCA nanoparticles and Lipofectamine^® reagent in HEI-OC1 cells. In addition, after loading Cx26 siRNA onto the surface of PCA/Dex, Cx26 gene expression was downregulated according to real-time polymerase chain reaction for 24 h, compared with that using Lipofectamine reagent. After loading BDNF DNA into PCA/Dex, increased expression of BDNF was observed for 30 h, and its signaling pathway resulted in an increase in phosphorylation of Akt, observed by Western blotting. Thus, Dex within PCA/Dex/gene nanoparticles created an anti-inflammatory effect and enhanced gene expression.

Licoricidin, an isoflavonoid isolated from Glycyrrhiza uralensis Fisher, prevents UVA-induced photoaging of human dermal fibroblasts

OBJECTIVE

Licoricidin is an isoflavonoid isolated from Glycyrrhiza uralensis Fisher. In this study, we investigated the effects of licoricidin on photoaging of UVA-irradiated human dermal fibroblasts (HDFs).

METHODS

In vitro reactive oxygen species (ROS) scavenging activity, cellular protective effect and inhibition of elastase activity was determined by Fe³⁺ -EDTA/H₂ O₂ systems, photohaemolysis and elastase activity assay, respectively. Anti-oxidative capacity of the compound was evaluated by fluorescent ELISA and 2', 7'-dichlorofluorescin-diacetate (DCF-DA) assay. The expression of protein and phosphorylation was examined using Western blot.

RESULTS

The ROS scavenging activity (OSC₅₀ ) of licoricidin was 2.77 μM. It was 3.1-fold higher than that of L-ascorbic acid. Its protective effects were confirmed in a study of ¹ O₂ -induced cellular damage to human erythrocytes. The τ₅₀ value of 10 μM of licoricidin was 71.0 min; this was markedly higher than that obtained with α-tocopherol (37.0 min). The elastase inhibitory activity of licoricidin (IC₅₀ of 61.2 μM) was 2.1-fold more potent than that of oleanolic acid. Licoricidin markedly reduced the UVA-induced intracellular ROS in a concentration-dependent manner. Western blot revealed that licoricidin attenuated the UVA-dependent induction of MMP-1 protein. Mechanistically, this appeared to be due to licoricidin-dependent inhibition of mitogen-activated protein kinases (MAPK) phosphorylation, which resulted in decreased c-Jun activation and reduced c-Jun and c-Fos expression.

CONCLUSION

Licoricidin blocks UVA-induced photoaging via ROS scavenging. This activity converges to limit the activity of MMP-1. These data suggest that licoricidin may be considered as an active ingredient in new topically applied anti-ageing formulations.

Prospective, Multicenter Study on Tinnitus Changes after Cochlear Implantation

Objective: To investigate the time course of tinnitus changes in patients receiving cochlear implantation (CI) in a prospective, multicenter setting and to determine related factors. Materials and Methods: A total of 79 adult patients who underwent CI were included in this study. We used the same questionnaires sequentially 5 times. The questionnaires included the Visual Analog Scale (VAS) for tinnitus severity, the Tinnitus Handicap Inventory (THI), Beck's Depression Index (BDI), and the Brief Encounter Psychosocial Instrument (BEPSI) for stress assessment. Results: Tinnitus was present in 59 (74.7%) of the 79 study subjects. After CI, tinnitus was eliminated in 10 patients (25%) and improved in 16 patients (40%) of the 40 patients who completed the final questionnaires, and most of the tinnitus reduction occurred in the early period of CI use. In an analysis of psychological functioning with CI, BDI was reduced significantly after CI. Multiple linear regression analysis revealed that preoperative auditory steady-state response (ASSR), THI, and final BDI score were significantly associated with the changes in tinnitus after CI. Conclusions: Most of the tinnitus reduction occurred within 1 month after CI use, and the changes were significantly associated with THI, ASSR, and BDI scores 6 months after CI. CI is a valuable therapeutic modality in tinnitus of a deafened ear.

Blue Emitters Based on Aryl End-Capped Pyrene Groups for OLEDs

We have synthesized four pyrene-derived blue emitting materials using Suzuki cross coupling reactions. All OLED devices using these materials as emitting materials showed efficient blue electroluminescence (EL). Particularly, a device using 1,1'-(9,9-dimethyl-9H-fluorene-2,7-diyl)bis-pyrene (1) showed best EL properties with the luminous efficiency of 4.32 cd/A, the power efficiency of 3.98 lm/W and the external quantum efficiency of 2.48% at 500 cd/m2.

Physical characterization and in vitro skin permeation of solid lipid nanoparticles for transdermal delivery of quercetin

OBJECTIVE

Quercetin, a phenolic compound isolated from plants, can act as an antioxidant to protect the skin from oxidative stress induced by ultraviolet rays. The aims of this work were (i) to compare the physical characterization of quercetin-loaded solid lipid nanoparticles (QSLNs) and (ii) to investigate the enhanced skin permeation of quercetin using QSLNs.

METHODS

QSLNs were prepared with a certain amount lipid (palmitic acid) and the different ratio of surfactant (Tween(®) 80) by homogenization and ultrasonification method.

RESULTS

QSLNs showed mono-dispersed particle size distribution in the ranges of 274.0-986.6 nm and zeta potential from -50.4 to -29.4 mV. Entrapment efficiency of QSLN was 15.2-46.2%, and their crystallinity index was low (0-18.2%). In vitro occlusion test showed QSLN-2 has the highest occlusive effect due to its smallest particle size (274.0 nm), and through these result, QSLN-2 was selected as the optimum formulation. Transmission electron microscopy (TEM) analysis further confirmed the uniform spherical shape of QSLN-2 particles. Field emission-scanning electron microscope (FE-SEM) analysis and histological observation of hairless rat skin showed that the lipid particles of QSLN-2 formed a fused lipid film and, subsequently, it hydrated the surface of the rat skin. Franz diffusion cell was used to measure in vitro skin permeation of quercetin dissolved in propylene glycol (QPG), QSLN-2 and QSLN-3. The results showed that QSLN-2 (33.5 μg cm(-2) , 21.9%) exhibited higher skin permeability than QPG (6.6 μg cm(-2) , 4.2%) and QSLN-3 (14.2 μg cm(-2) , 9.1%), which was visually confirmed by confocal laser scanning microscope (CLSM) image analysis as well.

CONCLUSION

The results suggest that QSLN-2, prepared with a surfactant content of 2%, could be used as useful skin delivery system for transdermal delivery of hydrophobic antioxidants such as quercetin.

Therapeutic Effect of Middle Ear Tendon Resection on Middle Ear Myoclonic Tinnitus

Objectives:

Tinnitus secondary to middle ear myoclonus (MEM) is very rare but troublesome symptom. Recently, we published a paper about the clinical characteristics and the general therapeutic effects of this rare type of tinnitus in a large case series. Here in this study, we evaluated the therapeutic effects of middle ear tendon resection surgery on intractable tinnitus caused by MEM.

Methods:

This study included 20 patients with intractable tinnitus diagnosed with MEM and treated eventually with surgical resection of middle ear tendons through January 2007 to December 2013. Clinical characteristics and therapeutic response to surgical therapy were thoroughly evaluated.

Results:

Patients had a mean age of 32.3 years (range, 16-60 years) and the male to female ratio was 10 to 10.The most frequent nature of their tinnitus was crackling sound. Impedance audiogram and otoendoscopic examination of the tympanic membrane were helpful in diagnosing MEM. Postoperatively, tinnitus decreased or even immediately disappeared in all cases of the study. Scores of tinnitus visual analog scale (VAS) and Tinnitus Handicap Inventory were significantly decreased. One of the patients showed delayed facial nerve palsy with complete recovery in 2 weeks. One patient showed the recurrence of symptom of MEM tinnitus within 1 year and was completely recovered by re-operation.

Conclusions:

Sectioning of the middle ear tendons for middle ear myoclonic tinnitus seems to be safe and effective which can be considered as a promising treatment modality for intractable MEM tinnitus.

Protective effect of unilateral and bilateral ear plugs on noise-induced hearing loss: functional and morphological evaluation in animal model

The aim of the following study is to evaluate immediate protective effect of ear plug from noise morphologically and functionally. An 1-month aged 29 male C57BL/6 mice. Subjects were divided into four groups as normal control(G1), bilaterally plugged group (G2), unilaterally plugged group (G3) and noise control group (G4) and later 3 groups were exposed to 110 sound pressure level white noise for 60 min. Immediately after noise exposure, audiologic tests were performed and cochlear morphology and expression levels of a-synuclein in the cochlea were investigated. There were no functional changes in G2 and plugged ears of G3 after noise exposure, whereas unplugged ears of G3 and G4 showed significant hearing loss. In morphological study, there were a significant degeneration of the organ of Corti and mean number and diameter of efferent buttons, in unplugged ears of G3 and G4. Plugged ears of G3 also showed mild changes in morphological study. Reduction of a-synuclein was observed at the efferent terminals or cochlear extracts after noise exposure. The protective effect of ear plug on noise exposure was proven morphologically and functionally in the animal model of noise-induced hearing loss. Further study on cellular or ultrastructural level with ear plug will be needed to reveal more precise mechanism.

Childhood tinnitus: clinical characteristics and treatment

PURPOSE

Troublesome tinnitus in children can have an impact on their lives leading to behavioral or psychological problems. The present study was designed to identify the clinical features of childhood tinnitus, to establish the treatment strategy for each tinnitus category and severity, and to assess the treatment outcomes.

MATERIALS AND METHODS

Clinical data were retrospectively collected on 108 tinnitus patients in childhood and adolescence. The authors have classified tinnitus according to the acoustic source: otic (idiopathic subjective), myoclonic, and vascular tinnitus based on the tinnitus quality and appropriate diagnostic approaches. Treatment selection depended on the tinnitus category and severity. Treatment modalities included counseling, a simplified tinnitus retraining therapy, counseling with medications, and surgery.

RESULTS

Of all 108 subjects, otic tinnitus was the most common form of childhood tinnitus (n=80) followed by myoclonic (n=21) and vascular tinnitus (n=6). The prevalence of otic tinnitus increased with age. The mean age of myoclonic tinnitus patients was younger than that of the others. The majority of otic tinnitus showed normal hearing. The origin of 81% of myoclonic tinnitus was middle ear muscles. Of all subjects, 67.6% had mild tinnitus responsive to counseling alone. Distressing tinnitus was most common in myoclonic tinnitus. Almost all patients (97%) who were followed up at 3 months (64%) showed improvements.

CONCLUSIONS

We suggest that understanding the clinical characteristics of childhood tinnitus, establishing a diagnosis based on the acoustic source, and implementing appropriate therapy customized to the individual tinnitus category and severity would help clinicians to relieve tinnitus children of their troublesome tinnitus effectively.

A case of direct intracranial extension of tuberculous otitis media

We describe a very rare case of tuberculous otitis media (TOM) with direct intracranial extension. The patient was a 55-year-old man who presented to our ENT clinic for evaluation of severe headaches and right-sided otorrhea. A biopsy of granulation tissue obtained from the right external auditory canal demonstrated chronic inflammation that was suggestive of mycobacterial infection. Magnetic resonance imaging of the brain indicated intracranial extension of TOM through a destroyed tegmen mastoideum. After 2 months of antituberculous medication, the headaches and otorrhea were controlled, and the swelling in the external ear canal subsided greatly. Rarely does TOM spread intracranially. In most such cases, intracranial extension of tuberculosis occurs as the result of hematogenous or lymphogenous spread. In rare cases, direct spread through destroyed bone can occur, as it did in our patient.

Development of a drug delivery system for the inner ear using poly(amino acid)-based nanoparticles

CONTEXT

Local delivery systems for treatment of intractable inner ear disorders have been attempted by many investigators.

OBJECTIVE

To evaluate the permeability and safety of a drug delivery system for the inner ear using a poly(2-hydroxyethyl aspartamide) (PHEA) polymersome.

MATERIALS AND METHODS

One-month-old male C57/BL6 mice were used. We administered the same amount of the fluorescent dye, Nile red, into the middle ear in two forms: loaded in PHEA polymersomes (NP group) or diluted in ethanol (NR group). At 1 day after administration, we harvested the cochlea and counted visible red particles in the tissues of cochlea under confocal microscopy and compared the groups. In a safety evaluation, 1 week after the same surgery, we conducted hearing tests and histological evaluations of the bulla and cochlea, and compared the results with those of the sham operation and negative control groups.

RESULTS

In terms of permeability, the number of red particles in the organ of Corti was increased significantly in the NP group, and three subjects in the NP group showed uptake of red particles in inner hair cells. However, there was no statistically significant difference in the observations in the lateral wall or modiolus. In safety tests, the NP and sham-operation groups showed decreased DPOAE responses and mildly swollen middle ear mucosa, compared with the negative control group, which was thought to be the result of postoperative changes.

CONCLUSIONS

PHEA nanoparticles may have utility as a drug carrier into the inner ear in terms of both permeability and safety.

Clinical significance of orthostatic dizziness in the diagnosis of benign paroxysmal positional vertigo and orthostatic intolerance

PURPOSE

Orthostatic dizziness (OD) and positional dizziness (PD) are considerably common conditions in dizziness clinic, whereas those two conditions are not clearly separated. We aimed to evaluate the clinical significance of simple OD and OD combined with PD for the diagnosis of benign paroxysmal positional vertigo (BPPV) and orthostatic intolerance (OI).

PATIENTS AND METHODS

Patients presenting with OD (n=102) were divided into two groups according to their symptoms: group PO, presenting with PD as well as OD; group O, presenting with OD. A thorough medical history, physical examination, and vestibular function tests were performed to identify the etiology of the dizziness. Orthostatic vital sign measurement (OVSM) was used to diagnose OI.

RESULTS

The majority of patients were in group PO (87.3%). BPPV was the most common cause of OD for entire patients (36.3%) and group PO (37.1%), while OI was most common etiology for group O (38.5%). Total of 17 (16.7%) OI patients were identified by OVSM test. Orthostatic hypotension (n=10) was most frequently found, followed by orthostatic hypertension (n=5), and orthostatic tachycardia (n=2). Group O showed significantly higher percentage (38.5%) of OI than group PO (13.5%) (P=0.039).

CONCLUSION

It is suggested that orthostatic testing such as OVSM or head-up tilt table test should be performed as an initial work up for the patients with simple OD. Positional tests for BPPV should be considered as an essential diagnostic test for patients with OD, even though their dizziness is not associated with PD.

Efficacy of Intratympanic Steroid Therapy as a Salvage Treatment for Idiopathic Sudden Sensorineural Hearing Loss

Objectives:

Recently, comparable therapeutic efficacy of intratympanic steroid injection (IT-S) as a salvage treatment for sudden sensorineural hearing loss (SSNHL) has been reported. We aimed to compare the efficacy of intratympanic steroid injection as salvage treatment, systemic steroid, and intratympanic steroid injection alone.

Methods:

A retrospective, multicenter study investigating therapeutic efficacies of systemic steroid, intratympanic steroid, and combined therapy as a salvage treatment for SSNHL was designed in 660 patients with idiopathic SSNHL. Patients were divided into three groups according to the therapy they received: Intratympanic steroid injection group (IT-S group), systemic steroid therapy group (SST group) and salvage therapy group (systemic steroid failure + intratympanic steroid, ST group). Hearing was evaluated and more than a 10dBHL decrease was defined as hearing improvement in our study.

Results:

Among a total number of 660 patients with SSNHL, 94 patients were included in IT-S group, while 444 patients and 122 patients were included in SS and ST group, respectively. Age, gender, time interval from onset to treatment, and initial hearing level of each group were not statistically different. Patients who had concomitant medical disorders such as diabetes mellitus, hypertension and chronic renal failure were more frequently treated with IT-S. There was no significant difference in hearing gain or the ratio of improvement in hearing among three different therapeutic groups of our study. ( P = 0.140, P = 0.450).

Conclusions:

IT-S as a salvage treatment seemed to be as effective as SS or IT-S alone. We can conclude that IT-S as a salvage therapy is not superior to other monotherapy.

Efficacy of intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss: comparison with systemic steroid therapy and combined therapy

CONCLUSION

Intratympanic steroid therapy (IT-S) was as effective as systemic steroid therapy (SST) or combined therapy (CT) and could be considered a first-line therapeutic modality for idiopathic sudden sensorineural hearing loss (SSNHL). Due to its known safety and efficacy, IT-S will be particularly suitable for patients with SSNHL who have chronic diseases such as diabetes mellitus, hypertension, or chronic renal failure.

OBJECTIVES

Systemic high dose steroid therapy is the main therapeutic modality for SSNHL. Comparable therapeutic efficacies for IT-S and CT with SST and IT-S for SSNHL have been reported recently. We compared the efficacy of IT-S, SST, and CT for treating SSNHL.

METHODS

A retrospective, multicenter study investigating the therapeutic efficacy of SST, IT-S, and CT for SSNHL was designed and involved 735 patients with idiopathic SSNHL who were diagnosed and treated at seven tertiary referral medical centers of the Catholic University of Korea between 2007 and 2011. Patients were divided into three groups according to the treatment methods they received: IT-S group, SST group, and CT group (SS plus IT-S). Hearing was evaluated by pure tone audiogram performed before initial treatment and at 4 weeks following the final treatment. More than a 10 dB HL decrease in average air conduction threshold of hearing at 500, 1000, 2000, and 3000 Hz was defined as improved hearing.

RESULTS

Among 735 patients with SSNHL, 94 were included in the IT-S group, 444 in the SST, and 197 in the CT group. Age, gender, interval from disease onset to start of treatment, and initial hearing level were not different among the three groups. Patients who had concomitant medical disorders such as diabetes mellitus, hypertension, or chronic renal failure were more frequently treated with IT-S. No difference in the level of hearing gain or ratio of hearing improvement was observed among the three groups (p = 0.147 and p = 0.067, respectively).

Differentiation into Hair Cells from AM-Derived Stem Cells

Objective: Placenta, umbilical cord, and blood are alternative sources of stem cells. We designed an experiment to isolate and culture stem cells from human amniotic membrane. And we made a plan to induce auditory hair cells and neurons from the stem cells of amniotic membrane.

Method: Human amniotic membrane was obtained.) We dissociated amniotic membrane with trypsin and transferred it to culture medium which contained 10ï¼… fetal bovine serum and 1ï¼… penicillin-streptomycin. We sub cultured it until the third generation was used for further experimental procedures. For differentiation into neural progenitor cells, we cultured amniotic membrane stem cells in EGF (epidermal growth factor) and β-FGF (fibrous growth factor) and for differentiation into hair cells and neurons, we cultured in neurobasal medium.

Results: We can isolate and culture stem cells from human amniotic membrane. By flow cytometric analysis of stem cells from human amniotic membrane, they showed positive responses at mesenchymal stem cell marker (CD 73, CD90, CD105) and negative responses at hematopoietic stem cell marker (CD34, CD14, CD19, HLA). The results of culture at different culture medium showed a differentiation to neural progenitor cells, hair cells, and neuron, and we confirmed by immunofluorescence staining and RT-PCR.

Conclusion: We demonstrated that amniotic membrane–derived stem cells could be differentiated into neuronal progenitor cells, and this could lead to the differentiation into hair cells and neurons.

Korean clinical practice guidelines: otitis media in children

Acute otitis media (AOM) and otitis media with effusion (OME) are common infections in children, and their diagnosis and treatment have significant impacts on the health of children and the costs of providing national medical care. In 2009, the Korean Otologic Society organized a committee composed of experts in the field of otolaryngology, pediatrics, and family medicine to develop Korean clinical practice guidelines (CPG) for otitis media in children with the goal of meeting regional medical and social needs in Korea. For this purpose, the committee adapted existing guidelines. A comprehensive literature review was carried out primarily from 2004 to 2009 using medical search engines including data from Korea. A draft was written after a national questionnaire survey and several public audits, and it was editorially supervised by senior advisors before publication of the final report. These evidence-based guidelines for the management of otitis media in children provide recommendations to primary practitioners for the diagnosis and treatment of children younger than 15 yr old with uncomplicated AOM and OME. The guidelines include recommendations regarding diagnosis, treatment options, prevention and parent education, medical records, referral, and complementary/alternative medicine for treating pediatric otitis media.

New Route for Stem Cell Transplantation into the Cochlea

Objective: Cell transplantation provides a potential method to replace the irreversible loss of auditory hair cells and neurons. In this study, we will prove the intravenous route of stem cell transplantation to the inner ear and the efficacy of the umbilical cord blood-derived mesenchymal stem cell transplantation in hearing restoration of deaf animal model.

Method: About 100,000 umbilical cord blood-derived mesenchymal stem cells which were tagged as PKH26 were infused to deaf guinea pigs intravenously. After 1 week and 3 weeks, auditory brainstem response test was checked and we obtained a guinea pig cochlea. A cryosection of each cochlea every 120 μm was obtained and we calculated stem cells for 3 sections of each animal.

Results: No hearing gain was shown after stem cell transplantation, but PKH26 tagging mesenchymal stem cell was found in Modiolus, Rosenthal’s canals and organ of Corti. Cells were not found in scala tympani, scala media, and scala vestibuli. Average number of cells in the inner ear was about 88 cells (59-123 cells/section). Most cells were found in spiral ganglion and migrated into the organ of Corti.

Conclusion: In this study, we demonstrated that cord blood-derived mesenchymal stem cells could be delivered into the inner ear with intravenous infusion. Based on these results, intravenous injection of stem cells may be used in the treatment of sensorineural hearing loss, regeneration of the auditory hair cells, and neurons.

Middle ear myoclonus associated with forced eyelid closure in children: diagnosis and treatment outcome

OBJECTIVES/HYPOTHESIS

Forceful eyelid closure syndrome (FECS) was first reported at the Proceedings of the Second International Tinnitus Seminar in 1983. The main symptom of this syndrome is a spontaneous muscular tinnitus related only to forced eye closure, specifically the voluntary contraction of the periorbital muscles. Although investigation of the syndrome was initiated >100 years ago, only four cases have been published in the past 20 years. We report six cases of middle ear myoclonus tinnitus diagnosed as FECS in children and discuss issues surrounding the diagnosis and treatment of this syndrome.

STUDY DESIGN

Retrospective case series.

METHODS

From 2009 to 2011, six children complaining of clicking or crackling sounds in their ears presented at Seoul St. Mary's Hospital. Endoscopic examination and recording of the tympanic membrane were performed while the patients were asked to close their eyes forcefully. Audiologic studies including acoustic reflex decay and static compliance were performed for documentation of the movement of the tympanic membrane. Triggering factors of FECS in the children were carefully evaluated.

RESULTS

Synchronous movement of the tympanic membrane in response to forced eye closure on endoscopic examination was the most reliable finding to diagnose FECS. Acoustic reflex decay and other impedance audiogram findings showed irregular perturbations during forced eye closure, which led to diagnosis of the tinnitus as middle ear myoclonus. Most of the patients had triggering factors for FECS. Reassurance and removal of the triggering or causal factors with or without medication improved clicking sounds coming from middle ear myoclonus.

CONCLUSIONS

FECS is a rare clinical entity and can be easily missed in routine clinical examination. We suggest that patients, especially children, with clicking or crackling tinnitus should be evaluated for FECS using proper diagnostic tools. A possible mechanism of FECS in children postulated from our case review is suggested.

Comparison of functional and morphologic characteristics of mice models of noise-induced hearing loss

OBJECTIVES

This study was conducted to compare morphologic and audiologic changes after noise exposure in two different strains of mice (CBA and C57) and to create morphologically proven models of noise-induced hearing loss.

METHODS

Mice were exposed to white noise at 110-dB sound-pressure level for 60 minutes at the age of 1 month. Hearing thresholds and outer hair cell functions were evaluated by auditory brainstem response recordings and distortion product otoacoustic emission immediately and 22 days after noise exposure. Cochlear pathology was observed and compared by light and electron microscopic studies.

RESULTS

Both mice strains showed hearing threshold shifts with decreased outer hair cell function immediately and 22 days after noise exposure. More severe auditory brainstem response threshold shifts were observed in C57 mice compared with CBA mice at click, 8-, 16-, and 32-kHz tone-burst stimuli. A cochlear morphologic study demonstrated predominant outer hair cell degeneration at all turns of the cochlea; degeneration was most severe at the basal turn in both mice strains. A scanning electron microscopic study revealed more severe ultrastructural damage of outer hair cells at each turn of the cochlea in C57 mice. The lateral wall of the cochlea was more severely degenerated in CBA mice.

CONCLUSION

Both mice strains showed consistent, permanent noise-induced hearing loss with different susceptibilities and site vulnerabilities. Further studies to investigate the mechanism of the different degree and cochlear site vulnerability to noise exposure between two mice strains are necessary.

Prevalence and significance of high-frequency hearing loss in subjectively normal-hearing patients with tinnitus

OBJECTIVES

We investigated the incidences of high-frequency hearing loss (HFHL; above 2 kHz) and extended high-frequency hearing loss (EHFHL; above 8 kHz) in patients with tinnitus and subjectively normal hearing, and evaluated their effects on the clinical and audiological features of the patients.

METHODS

The sample included 85 patients with sensorineural tinnitus who had normal hearing sensitivity in the frequencies from 250 Hz to 2 kHz, and who had undergone extended high-frequency audiometry between July 2009 and February 2010. We investigated the incidences of HFHL and EHFHL in these patients and analyzed the significance of the hearing losses.

RESULTS

The incidence of HFHL or EHFHL was 88%. The proportion of patients with EHFHL, among the patients who had normal hearing sensitivity up to 8 kHz, was about 74%. The patients with normal hearing sensitivity at all test frequencies were significantly younger, had larger otoacoustic emissions, and had tinnitus that was less loud as measured by tinnitus matching than did the subjects with HFHL and/or EHFHL. However, other comparisons of clinical factors in the three groups did not show any differences.

CONCLUSIONS

Even if patients with tinnitus do not have any subjective hearing impairment, most of them have HFHL and/or EHFHL. The effects on the clinical features of the patients are still vague.

High and Ultra High Hearing Loss in Tinnitus Patients

Objective: Investigate the incidence of high- (>2 kHz; HFHL) and ultra-high-frequency (>8 kHz; UHFHL) hearing loss in tinnitus patients with subjectively normal hearing, and to evaluate their effects on the clinical and audiological features of the patients.

Method: The sample included 85 patients with sensorineural tinnitus who had normal hearing sensitivity in frequencies from 250 Hz to2 kHz, and who had received extended high-frequency audiometry between July 2009 and February 2010. We investigated the incidence of HFHL and UHFHL in the subjects and analyzed their significance.

Results: The incidence of HFHL and UHFHL in the subjects was 88%. The proportion of patients with UHFHL, in the subjects who had normal hearing sensitivity up to 8 kHz, was about 74%. The patients with normal hearing sensitivity at all test frequencies were significantly younger and had greater otoacoustic emission responses, and mean loudness of tinnitus as measured by tinnitus matching was significantly lower than the patients with HFHL and UHFHL. However, other analysis about clinical aspects of HFHL and UHFHL did not show any significance.

Conclusion: Even if the patients with tinnitus do not feel any hearing impairment subjectively, most of them have high- and ultra-high-frequency hearing loss. But their effects on the clinical features of the patients are vague.

Korean red ginseng prevents gentamicin-induced hearing loss in rats

OBJECTIVES

To evaluate the preventive effects of Korean red ginseng (KRG) on gentamicin (GM)-induced ototoxicity and to identify the effective components of KRG.

STUDY DESIGN

In vivo and in vitro studies.

METHODS

Thirty-five Sprague-Dawley rats were divided into four groups. The GM group (n = 15) received intraperitoneal injections (IPI) of GM (160 mg/kg) for 5 days. The KRG + GM group (n = 12) was treated with intragastric feeding of KRG (500 mg/kg) for 12 days with 5 days of IPIs of GM. KRG (n = 4) and control (n = 4) groups were treated with KRG and saline, respectively. Auditory brainstem response (16 or 32 kHz) and Rotarod treadmill tests were done before and after treatments. Cochleas were evaluated by a scanning electron microscope (SEM) and phalloidin staining. Ginsenosides Rb1, Rb2, Rg1, and Re were evaluated as the water-soluble terazolium salt assay, annexin V/propidium iodide assay, and Western blots in HEI-OC1 cells.

RESULTS

Posttreatment hearing thresholds in GM, KRG + GM, KRG, and control groups were: 27.7 ± 7.2 dB, 23.1 ± 4.1 dB, 16.9 ± 2.6 dB, and 21.3 ± 3.5 dB, respectively, for 16 kHz, 30.5 ± 6.6 dB, 25.2 ± 4.3 dB, 22.5 ± 2.7 dB, and 22.5 ± 3.8 dB, respectively for 32 kHz. The KRG + GM group had significantly better hearing than the GM group (P < .05). On SEM and phalloidin staining, the GM group showed severe loss of stereocilia in the basal outer hair cells and a few losses in the middle turns, whereas the KRG + GM group showed relatively intact hair cells. Balance impairment in treadmill tests was not definite in any group. Rb1 and Rb2 showed more effective protection than other components.

CONCLUSIONS

KRG protects against GM-induced hearing loss and hair cell death in rats. Laryngoscope, 2011.

Clinical efficacy of fat-graft myringoplasty for perforations of different sizes and locations

CONCLUSION

Fat-graft myringoplasty (FGM) has a reliable tympanic closure rate for small to large perforations, but yields poor hearing improvement in the latter case. A topographic evaluation of FGM showed that the procedure resulted in a reliable perforation closure rate and audiologic outcome, regardless of perforation location.

OBJECTIVES

This study assessed the utility of FGM in treating perforations of different sizes and locations.

METHODS

This retrospective study involved 45 patients (46 ears) who underwent FGM at St Mary's Hospital (Seoul, Korea) between August 2007 and February 2010.

RESULTS

The total perforation closure rate after FGM was 87% (40 cases), with no statistical difference among perforation size groups, even though the mean closure rates of the 10-20% and >30% perforation groups were lower than other groups. The difference in the closure rates of patients with anteriorly located perforations and those with perforations in other sites was not significant. The mean postoperative air-bone gap (ABG) was 14.3 (±7.5) dB. Mean postoperative ABG improved significantly after FGM; however, on a per-group basis, the >30% perforation group had the poorest results and the difference was statistically significant. The difference in mean postoperative ABGs of the two groups depending on the location of the perforation (anterior and other) was not significant.

Efficient molecular genetic diagnosis of enlarged vestibular aqueducts in East Asians

CONTEXT

Enlargement of the vestibular aqueduct (EVA) is a commonly detected inner ear anomaly related to hearing loss and often associated with mutations of SLC26A4 encoding pendrin, a transmembrane exchanger of Cl(-), I(-), and HCO(3)(-). Here we describe the phenotypes of 27 Korean EVA subjects and their SLC26A4 genotypes determined by bidirectional nucleotide sequencing.

RESULTS

The detected variants include two novel missense substitutions (p.V138L and p.P542R). We characterized the ability of p.V138L and p.P542R pendrin products to traffic to the plasma membrane in COS-7 cells and to transport Cl(-), I(-), and HCO(3)(-) in Xenopus oocytes. The results indicate that p.P542R is a benign polymorphic variant, whereas p.V138L is a pathogenic mutation. Since this and other studies of East Asian EVA cohorts show that the majority of SLC26A4 mutations affect either or both of two amplicons (exons 7-8 and 19), we developed a hierarchical protocol that integrates direct sequencing with denaturing high-performance liquid chromatography analyses for detection of SLC26A4 mutations in these populations. We validated the cost efficiency of the integrated protocol by a simulated screen of published East Asian EVA cohorts with known SLC26A4 genotypes.

CONCLUSIONS

Our study further defines the spectrum of SLC26A4 mutations among East Asians and demonstrates a rapid and efficient protocol for their detection.

Congenital middle ear cholesteatoma in children; retrospective review of 35 cases

Congenital middle ear cholesteatoma (CMEC) is a rare disease entity in otolaryngology. However, we try to assess the characteristic features and recurrences of CMEC in pediatric patients according to stages, and to determine the value of preoperative computed tomography (CT) scan. Retrospective review of 35 cases of CMEC under the age of 15 yr that had been treated at the tertiary referral center from 1995 through 2006. The main outcome measures were CT findings, surgical findings, recurrence rate and hearing assessment. Preoperative CT scan accurately predicted the extent of the cholesteatoma seen during surgery in 30/35 (85.7%). The recurrence rate of CMEC was 5.7% (2/35) and all of recurred cases were stage IV. In recurred cases, cholesteatomas were extended to sinus tympani and facial recess at revisional operation as well as initial operation. So we concluded that preoperative CT scan is essential in defining the extent of existing pathology. The intraoperative CMEC extension and location influence the outcome of surgery. In the higher stages, careful eradication of disease, particularly in the region of sinus tympani and facial recess is recommended.

The determination of sensation-dependent bladder emptying time in patients with complete spinal cord injury above T11

STUDY DESIGN

Retrospective investigation using urodynamic studies and medical records.

OBJECTIVE

To evaluate the safety of sensation-dependent bladder emptying in complete spinal cord injury (SCI) patients, based on the preservation of the desire to void.

SETTING

Spinal Cord Injury Unit, Yonsei Rehabilitation Hospital, Seoul, Korea.

METHODS

This study was performed retrospectively on 79 complete SCI patients with lesions above T11, who had preserved the desire to void during conventional urodynamic studies. Patients were classified according to detrusor compliance and maximal bladder capacity. The clinical and urodynamic characteristics of each group were analyzed.

RESULTS

Forty-five (57.0%) patients were classified as group A and 34 (43.0%) patients were classified as group B. There were no significant differences in clinical features, such as voiding methods and the presence of autonomic dysreflexia between the two groups. Compared with group B, there were significantly more areflexic neurogenic bladder cases in group A (P<0.05). There were significantly higher maximal detrusor pressures in group B (P<0.05). There were significantly more cases with the preservation of the strong desire to void in group B (P<0.05).

CONCLUSION

Not all patients with discomplete SCIs accepted the use of sensation-dependent bladder emptying. The safe use of sensation-dependent bladder emptying will be determined based on the results of urodynamic studies.

Protective effect of oxidative stress in HaCaT keratinocytes expressing E7 oncogene

In a previous study, we established a stable cell line which constitutively expresses E7 in HaCaT human keratinocyte cell line and identified various relevant factors including oxygen modulators affected by the E7 oncogene. E7-expressing HaCaT cells (HaCaT/E7) appeared to be more resistant to H2O2-induced cell death. Here, we demonstrate how E7 oncogene would modulate oxidative stress-induced cell death. In addition, we verified the increased expression of catalase in the HaCaT/E7 by Western blot analysis. The results suggest that the E7 oncogene would induce higher resistance to ROS-induced cell injury in the E7-infected cells via the upregulation of catalase. To investigate these paradoxical effects of high concentrations of H2O2 (500 microM-1 mM), we examined their effects on receptor mediated apoptosis, cell death via the mitochondrial pathway and modulation of apoptosis related factors. Our results revealed that HaCaT keratinocytes infected with HPV 16 E7 oncogene modulated expressions of catalase, Bcl-xL, IL-18, Fas, Bad, and cytochrome c as well as NF-kappaB, resulting in the resistance to oxidative stress-induced cell death.

Clinical and biochemical factors that affect DPOAE expressions in children with middle ear effusion

OBJECTIVES

To evaluate the clinical and biochemical characteristics of middle ear effusion (MEE) that affect distortion product otoacoustic emissions (DPOAE) responsiveness and to investigate the possible role of DPOAE as a tool to know the characteristics of MEE preoperatively.

STUDY DESIGN AND SETTING

Prospective analysis of children with MEE effusion in a tertiary referral center. DPOAE results were compared with other audiologic tests, the character, amount of MEE, the amount of total protein, and TNF-alpha in the effusion.

RESULTS

The negative DPOAE with MEE group had much more thick mucous fluid in their middle ears than that of positive DPOAE with MEE group. The levels of total protein and TNF-alpha in MEE were significantly higher in the negative DPOAE group than those of the positive DPOAE group (P < 0.01).

CONCLUSIONS AND SIGNIFICANCE

The measurement of DPOAE in the children with MEE may predict the amount and the characteristics of MEE, which may help to decide the treatment methods.

Serum heat shock protein 70 and its correlation with clinical characteristics in patients with sudden sensorineural hearing loss

OBJECTIVES

Previous studies have reported that in cochlear cells, heat shock protein (HSP)70 is expressed after ototoxic stimuli. We performed this study to investigate the possibility of HSP70 being found in circulation and to observe its possible clinical role in patients with sudden sensorineural hearing loss (SSNHL).

METHODS

A total of 67 patients with SSNHL and age-sex matched normal controls were included in this study. Their serum HSP70 levels were measured with highly sensitive enzyme-linked immunoadsorbent assay (ELISA) test and confirmed with Western blot immunoassay. Clinical variables including initial and final audiometric findings and accompanying symptoms were analyzed to find the possible clinical value of serum HSP70 level in the patients with SSNHL.

RESULTS

Serum HSP70 levels were significantly higher in the patients with SSNHL than those of normal controls by ELISA test (P < .01), and their presence were confirmed as strong bands in the Western blot assay. There was significant correlation between serum HSP70 levels and the recovery of HL in the patients with SSNHL (P < .01).

CONCLUSION

This is the first report showing elevated serum HSP70 levels in the patients with SSNHL compared with normal controls. We suggest that serum HSP70 levels might have a clinical role for predicting prognosis of HL in the patients with SSNHL.

Superoxide dismutase in pediatric palatine tonsils and adenoids and its related clinical parameters

PURPOSE

The objective of this study was to investigate a protective system of pediatric palatine tonsils and adenoids against superoxide radicals (O(2)(-)) and to evaluate the clinical factors including otitis media with effusion that are related to both the expression and activities of copper zinc superoxide dismutases (CuZnSODs).

DESIGN

CuZnSODs in the palatine tonsils and adenoids were studied using immunohistochemistry and reverse-transcription polymerase chain reaction.

RESULTS

Immunohistochemistry showed that CuZnSODs distribute in the crypt epithelium, mucous membrane, mantle zone, and extrafollicular area of the pediatric adenoids as well as in the palatine tonsils. Otitis media with effusion and paranasal sinusitis were related to CuZnSODs expression in the pediatric adenoids. In addition, the frequency of tonsillitis and presence of recent tonsillitis were significantly related to CuZnSODs expression in the pediatric tonsils (P <.05).

CONCLUSIONS

In both the pediatric palatine tonsils and adenoids, the mechanism of tissue protection against infection and frequent inflammatory reactions may be closely related to CuZnSODs expression. There may be close relationship between the increased level of O(2)(-) that leads to an increase in CuZnSODs in the pediatric adenoid tissue and the development of otitis media.

Effects of testosterone in the treatment of immune-mediated sensorineural hearing loss

Testosterones have beneficial effects not only on the modulation of expression of autoimmunity of B/W mice, but on other unrelated models such as autoimmune thyroiditis as well. This study was performed to evaluate the effect of testosterone in the treatment of immune-mediated sensorineural hearing loss (IMSNHL). To induce IMSNHL, 29 female Wistar rats were sensitized with bovine inner ear antigen three times weekly. Fourteen of 29 rats were injected subcutaneously three times a week with 250 microg of testosterone propionate from 1 week prior to the first sensitization to 1 week following the second booster sensitization. An auditory brain-stem response (ABR) test was performed prior to each antigen challenge and at 1, 2, 3, 4, 6 and 8 weeks following sensitization. On ABR testing, the testosterone-treated animals showed better results than the control animals with IMSNHL in the degree of hearing loss (10 to 20 dB vs. 10 to 40 dB) and incidence of hearing loss over 20 dB (25.0% vs. 53.3%). None of testosterone-treated animals showed a hearing loss over 20 dB, whereas 40% of the control animals with IMSNHL revealed hearing loss over 20 dB. These results suggest that testosterone propionate may be effective in the prevention of and early recovery from IMSNHL and may be used in the future as a one treatment modality for IMSNHL.

Prognostic value of otoacoustic emissions in children with middle ear effusion

The amplitude and frequency spectra of otoacoustic emissions are influenced by the condition of the middle ear. These are noninvasive measurements of cochlear function that are accurate, rapid, and simple to perform. In this study, prognostic value of otoacoustic emissions in children with middle ear effusion (MEE) was investigated. A total of 49 children aged 3.5 to 11.2 years with MEE were included. Spontaneous otoacoustic emission, transient evoked otoacoustic emission (TEOAE), and distortion product (DP) otoacoustic emission measurements were performed on each ear before medical treatment and were compared according to the responsiveness of medical treatment (medicine responder vs medicine nonresponder groups). Responses of spontaneous otoacoustic emissions and DP audiogram showed no significant difference between the 2 groups but TEOAE response was significantly decreased in medicine nonresponders ( P > 0.05). Positive responses of the DP Input-Output function curve in geometric mean frequencies at 5 and 6 kHz using a primary tone of 55 dB SPL were significantly detected in medicine responders ( P > 0.01). The sensitivity, specificity, and predictive values of TEOAE and the DP I-O function curve in geometric mean frequency at 6 kHz using a primary tone of 55 dB SPL showed the high prognostic value of these tests in terms of predicting response to medical treatment in the patients with MEE. This suggests that otologists may have to be more aggressive in their treatment of children with MEE who showed no response.

Influence of human leukocyte antigen in the pathogenesis of Ménière's disease in the South Korean population

In order to study the associations of Ménière's disease (MD) with human leukocyte antigen (HLA) alleles in the South Korean population, we examined the distribution of HLA class I and II alleles in 39 MD patients and 199 healthy controls. The frequencies of HLA-Cw*0303 (relative risk (RR) = 2.5; p < 0.02) and -Cw*0602 (RR = 3.7; p < 0.03) were significantly increased in patients with MD compared to controls. However, HLA-B44 (RR = 0.2, p < 0.004) and -Cw*0102 (RR = 0.3; p < 0.03) were significantly decreased in patients compared to controls. When the association between hearing level and the presence of HLA alleles was evaluated, the frequencies of HLA-B13 (RR = 7.4; p < 0.004), -B39 (RR = 45.7; p < 0.003), -Cw*0303 (RR = 4.5; p < 0.02) and -Cw*0602 (RR = 6.5; p < 0.02) were significantly increased and those of -B44 (RR = 0.1; p < 0.02) and -Cw*0102 (RR = 0.1; p < 0.03) were significantly decreased in MD patients with hearing losses (stages II-IV) compared to controls. The frequency of HLA-B13 was significantly higher in MD patients with hearing loss (stages II-IV) than in those with normal hearing (stage I). In terms of HLA-DRB1, -DQA1 and -DQB1 allele frequencies, a significantly higher frequency of DRB1*15 was seen in the patients (RR = 2.4; p < 0.03). These results suggest that some HLA alleles may be a useful genetic marker for predicting prognosis in South Korean patients with MD.

Effect of middle-ear effusion on otoacoustic emissions

Because otoacoustic emissions (OAEs) are transmitted from the cochlea to the ear canal via the middle ear, the transmission properties of the middle ear directly influence OAEs' characteristics. In general, middle-ear effusion (MEE) reduces measured emission amplitudes and sometimes eliminates the response entirely. The purpose of this study was to establish the relationship between the conduction of the middle ear and OAEs' properties and to elucidate the effect of middle-ear effusion on detecting OAEs. Spontaneous otoacoustic emissions (SOAEs), transiently evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) were recorded from 44 normal ears and 32 ears with middle-ear effusion. DPOAEs were collected in two basic forms consisting of distortion product audiograms (DP grams) and input-output (I-O) functions, elicited by two primary tones F1 and F2 and varying geometric mean frequencies between 1-6 kHz. The results of air and bone conduction hearing levels in pure tone audiogram were also analysed. In 21 ears out of 32 otitis media with effusion (OME) ears, SOAEs were absent. In the 28 ears with middle-ear effusion, the response and wave reproducibility were diminished, and in the 17 ears with middle-ear effusion, the DP gram was diminished or eliminated. In particular, I-O function curves at 3 kH and 4 kHz were diminished by the primary tones of 45 and 55 dB under the condition of MEE. The SOAEs, TEOAEs and DPOAEs (DP gram and I-O function curve) are highly reliable and useful tests for monitoring changes in middle-ear condition in children with OME and in predicting the course of OME.

Effects of antibiotics and steroid on middle ear mucosa in rats with experimental acute otitis media

The prevention of mucosal changes induced by experimental pneumococcal otitis media by means of antibiotics has been demonstrated previously. However, the effect of combined antibiotic and steroid therapy on the middle ear mucosa in acute otitis media (AOM) has not been determined. The right middle ears of 27 rats were inoculated with a log-phase type 3 Streptococcus pneumoniae, with the left ears serving as controls. Penicillin G was administered to nine rats and penicillin G and dexamethasone in combination were administered to nine rats after bacterial challenge; the remaining nine rats were not treated. Three animals from each group were sacrificed on Days 4, 7 and 14 after challenge. Tympanic membranes and middle ear mucosa were examined using otomicroscopy and light microscopy. Structural changes were diminished in both the antibiotic-treated and antibiotic + steroid-treated groups, compared with those in the untreated infected controls. The antibiotic + steroid-treated group showed the most marked decrease in structural change, especially in the mucosal metaplasia to the secretory epithelium. The results suggest that combination therapy with antibiotics and steroid in AOM is the most effective at reducing the treatment period and preventing persistent mucosal changes, which may decrease the risk of development of secretory otitis media as a sequela of AOM.

Different distribution of HLA class II alleles according to response to corticosteroid therapy in sudden sensorineural hearing loss

OBJECTIVE

To investigate the association of HLA class II alleles with the susceptibility to sudden sensorineural hearing loss and with the results of corticosteroid treatment in the Korean population.

DESIGN

HLA-DRB1, -DQA1, -DQB1, and -DPB1 genotyping by the sequence-specific oligonucleotide probes method in 41 patients with sudden sensorineural hearing loss and in 206 healthy control subjects. Initial hearing levels at the onset of hearing loss and final hearing levels after treatment were evaluated for the association with HLA class II alleles.

SETTING

Tertiary care referral center, ambulatory and hospitalized care.

SUBJECTS

Forty-one patients (24 men and 17 women; mean age, 49.2 years) were compared with 206 controls. Patients were divided into 2 groups according to their response to corticosteroid therapy (good response vs nonresponse).

RESULTS

The frequencies of HLA-DRB1, -DQA1, -DQB1, and -DPB1 alleles were not significantly different between patients and controls (P>.05). When an association between the results of corticosteroid treatment and the frequency of HLA alleles was evaluated, the frequencies of HLA-DRB1*14 (relative risk [RR] = 3.5, P<.02), -DQA1*03 (RR = 4.2, P<.02), and -DQA1*05 (RR = 3.1, P<.03) were significantly increased, but HLA-DQA1*01 (RR = 0.2, P<.004) and -DQB1*06 (RR = 0.2, P<.009) were decreased in the group nonresponsive to corticosteroid therapy, compared with the controls. The distribution of HLA-DQA1*01 (P<.04), -DQB1*06 (P<.02), and -DQA1*03 (P<.003) was significantly different between the responsive and the nonresponsive groups. HLA-DQA1 allelic combination analysis showed that the frequencies of DQA1*03 and *05 had a high RR value in patients with sudden sensorineural hearing loss (RR = 4.1, P<.003) and in patients in the nonresponsive group (RR = 8.9, P<.001), compared with the controls.

CONCLUSION

The presence of HLA class II alleles may be a useful genetic marker in forecasting a prognosis in Korean patients with sudden sensorineural hearing loss.

Down modulation of IL-18 expression by human papillomavirus type 16 E6 oncogene via binding to IL-18

To understand modulation of a novel immune-related cytokine, interleukin-18, by human papillomavirus type (HPV) 16 oncogenes, HaCaT, normal keratinocyte cell line, and C-33A, HPV-negative cervical cancer cell line, were prepared to establish stable cell lines expressing E6, E6 mutant (E6m), E6E7, or E7 constitutively. Expressions of various HPV oncogene transcripts were identified by RT-PCR. Expression of HPV oncogene E6 was reversely correlated to the expression of interleukin-18, a novel pro-inflammatory cytokine. The expression of E6 in C-33A, independent of E6 splicing, resulted in decreased IL-18 expression and that of IL-18 was also significantly reduced in HaCaT cells expressing E6. The level of p53 was reduced in C-33A cells expressing E6 whereas not altered in HaCaT cells expressing E6, suggesting that E6 downregulated IL-18 expression via an independent pathway of p53 degradation in HaCaT cells which have a mutated p53 form. However, E7 did not affect IL-18 expression significantly in both C-33A and HaCaT cells. Cotransfection experiments showed that E6 oncogene did not inhibit the activities of IL-18 promoter P1 and P2, suggesting that E6 oncogene indirectly inhibited IL-18 expression. Taken together, E6, E6m and E6/E7 inhibited IL-18 expression with some variation, assuming that cells expressing E6 oncogene can evade immune surveillance by downregulating the expression of immune stimulating cytokine gene, IL-18, and inhibiting the cascade of downstream effects that follow activation of the IL-18 receptor.