Analysis of Loudness Discomfort Level Tests in Tinnitus Patients

INTRODUCTION

We aimed to investigate the clinical significance of loudness discomfort level (LDL) test in tinnitus patients and its relationship with pure-tone audiometry, tinnitogram and questionnaires.

METHODS

We retrospectively reviewed the medical records of 320 tinnitus patients who visited a tertiary university hospital's tinnitus clinic and completed LDL tests between March 2020 and December 2022. Epidemiological data and psychoacoustic test results were collected.

RESULTS

LDL showed no significant differences between frequencies for both ears. Mean LDL did not correlate with mean pure-tone average or hearing thresholds at each frequency. The hearing loss group had higher LDL at 8 kHz compared to the normal hearing group (p<0.01). Objective sound intolerance was found in a quarter, correlating with subjective hyperacusis, anxiety, and depression. Weak negative correlations were found between most of questionnaire's scores and LDL on the left side. Tinnitus loudness weak negatively correlated with LDL at most frequencies, except 8 kHz.

DISCUSSION/CONCLUSION

Our findings suggest a notable association between LDL levels and emotional factors in tinnitus patients, rather than with auditory thresholds. While lateralized differences in LDL responses were observed, specifically on the left side, these preliminary results do not confirm a causal link and thus do not warrant changes to current clinical testing protocols without further research.

Initial Response to Combination Therapies for Tinnitus: Lessons Learned From a Retrospective Analysis

OBJECTIVE

To investigate the initial reduction of tinnitus effects by combining common therapies applicable in general otology clinics and establishing optimal treatment strategies.

STUDY DESIGN

Retrospective cohort study.

SETTING

A tertiary university hospital.

PATIENTS

Patients with nonpulsatile subjective tinnitus who visited the hospital between January and December 2022.

INTERVENTIONS

Combination therapies consisting of at least one of the directive counseling based on the neurophysiological model, hearing aids, medication, and/or neuromodulation were performed.

MAIN OUTCOME MEASURES

Tinnitus Handicap Inventory (THI) questionnaire at both their initial visit and 1-month follow-up.

RESULTS

A total of 151 patients were enrolled. THI improvement of 20 points or more was observed in 31.8% of participants. One-way analysis of variance revealed that counseling had a significant reduction in THI, whereas neuromodulation, medication, and hearing aids did not. THI improvement was significantly associated with received counseling, severity of initial THI, and mean loudness discomfort level. Hearing aids and neuromodulation were not significant prognostic factors for improvement.

CONCLUSION

Counseling alone is the best treatment for most patients with tinnitus. There will be other patients with tinnitus that, in addition to counseling, would benefit from hearing aids, medications, and/or certain forms of neuromodulation.

Exploring the origins of decreased sound tolerance in tinnitus patients

This study aimed to confirm the characteristics of auditory function alterations in tinnitus patients with concomitant decreased sound tolerance (ST) and provide insights for developing tailored therapeutic approaches. A retrospective analysis was conducted on patient records from a tertiary university hospital's tinnitus clinic between March 2020 and June 2023. Demographic attributes and audiological profiles were reviewed. Patients were categorized into Group 1 if loudness discomfort level test outcomes were 77 dB or below, measured using an average of frequencies from 250 Hz to 8 kHz. The remaining patients were allocated to Group 2. Among the 434 tinnitus patients, 115 (26.5%) demonstrated decreased ST and were classified as Group 1. This group exhibited higher DPOAE amplitudes (p < 0.001), shortened latency, and decreased threshold of ABR wave V bilaterally (p < 0.05). No significant disparities were observed in gender, age, tinnitus handicap inventory, visual analog scale, and pure-tone audiometry results except subjective hyperacusis. Binary logistic regression analysis utilizing the forward conditional method revealed that the difference between groups was independently linked to DPOAE response at 7,277 Hz on the left side [B = 0.093, p < 0.001, EXP(B) = 1.07, 95% CI = 1.044-1.153]. Increased DPOAE amplitude and shorter and decreased ABR wave V in tinnitus patients with decreased ST might suggest a possible association with lesions in or around the superior olivary complex or higher central auditory pathway, potentially linked to the inhibition of medial olivocochlear efferents.

Clinical Features of Non-Lateralized Tinnitus

BACKGROUND

We aimed to analyze and confirm the clinical features of patients with non-lateralized tinnitus and to identify clues that can be used in their management.

METHODS

Data from 469 patients who visited a university hospital complaining of tinnitus between March 2020 and December 2021 were reviewed. The patients' medical histories, Tinnitus Handicap Inventory, Beck Depression Inventory, and numerical rating scale scores on tinnitus awareness, annoyance, loudness, and effect on life, audiological profiles, and quantitative electroencephalography findings were documented.

RESULTS

Forty-nine (10.4%) patients had non-lateralized tinnitus. They were older and had a shorter duration of symptoms (13.91 ± 34.16 months) than patients with bilateral tinnitus (duration: 39.15 ± 80.82 months) (P -lt; .05). The accompanying symptoms, Tinnitus Handicap Inventory scores, and numerical rating scale scores were not significantly different between the 2 groups (P -gt; .05). Patients with non-lateralized tinnitus had worse hearing at 12 kHz on the left side than those with unilateral tinnitus. Hearing asymmetry was least common in non-lateralized tinnitus (n=11/49, 10.4%), followed by bilateral tinnitus (n=54/198, 42.2%) and unilateral tinnitus (n=97/222, 47.3%) (P-lt; .001). Regarding quantitative electroencephalography, there were significant differences in the absolute power of the theta, alpha, beta, gamma, and total frequency bands based on tinnitus lateralization (P -lt; .001).

CONCLUSION

Non-lateralized tinnitus can be perceived in elderly patients with symmetric and extended high-frequency hearing loss before habituation is achieved at an early stage of tinnitus. However, there was no difference in the questionnaire scores and accompanying symptoms; therefore, it may not be worth managing non-lateralized tinnitus separately from tinnitus in the ear.

Short-Term Effect of Adjunctive Transcranial Random Noise Stimulation on Idiopathic Sudden Sensorineural Hearing Loss and Tinnitus: A Preliminary Study

BACKGROUND

Transcranial random noise stimulation has previously been used to manage tinnitus. This study assessed the feasibility of adjuvant transcranial random noise stimulation with conventional steroid treatment for idiopathic sudden sensorineural hearing loss with or without tinnitus.

METHODS

Prospective, randomized, single-blind study was conducted in Eulji University hospital. Twenty-four patients with idiopathic sudden sensorineural hearing loss were admitted for treatment between March 2019 and February 2020. The study group received 4 sessions of adjuvant transcranial random noise stimulation (frequency band: 0.1-100 Hz; target, T7/T8; duration: 20 minutes), while the control group received only conventional treatment. Hearing levels at admission, discharge day (day 7), and 4 weeks later and clinical characteristics were assessed. The primary outcome measure was hearing improvement at 4 weeks after neuromodulation. The secondary outcome measure was the presence of tinnitus at 4 weeks.

RESULTS

The mean hearing thresholds improved significantly over time (P < .05). Although initial hearing levels did not differ between the 2 groups, the study group had a significantly better hearing at 4 weeks after discharge (P > .05). A significant interaction was also observed between the mean hearing thresholds at various timepoints and transcranial random noise stimulation (P=.001). However, the persistence of tinnitus after treatment did not differ irrespective of the allocation groups.

CONCLUSION

Adjuvant transcranial random noise stimulation seems to be a potential treatment option for hearing restoration in patients with idiopathic sudden sensorineural hearing loss without serious complications. However, transcranial random noise stimulation does not seem to alleviate tinnitus.

The Tinnitus Handicap Inventory is a better indicator of the overall status of patients with tinnitus than the Numerical Rating Scale

OBJECTIVES

The Tinnitus Handicap Inventory (THI) and Numerical Rating Scale (NRS) for awareness, annoyance, loudness, and effect on life are two of the most commonly used questionnaires for patients with tinnitus. This study aimed to determine whether these two questionnaires can comprehensively evaluate the patient's condition and which questionnaire is better as a primary endpoint for tinnitus.

MATERIALS AND METHODS

Data from 90 patients who visited a university hospital with subjective, non-pulsatile tinnitus and without a history of any psychiatric disorders were reviewed between March 2020 and May 2022. The patients' medical histories, audiological profiles, questionnaires including the THI and NRS, Beck Depression Inventory (BDI), Beck Anxiety Depression (BAI), Hospital Anxiety-Depression Scale (HAD), and the Brief Encounter Psychosocial Instrument (BEPSI) were analyzed.

RESULTS

The THI had a moderately positive correlation with the NRS for effect on life, annoyance, and loudness. It also had a low positive correlation with the BDI, HAD-A, BEPSI, and BAI. Considering annoyance and loudness, the NRS did not correlate with the other questionnaires, except for the THI (p > 0.05). The NRS for tinnitus awareness correlated with most audiological profiles. The ROC curve analysis revealed that the THI significantly predicted depression, anxiety, and stress. Conversely, none of the four NRS items significantly predicted these psychiatric problems (p > 0.05).

CONCLUSIONS

Using the THI as a primary endpoint after interventions rather than the NRS is more reasonable because the THI covers the emotional, functional, and catastrophic aspects of tinnitus, although not the audiological status. To compensate for this, the auxiliary use of NRS for awareness should also be considered.

Audiological and psychological assessment of tinnitus patients with normal hearing

Introduction

This study was performed to assess identifiable abnormalities in tinnitus patients with normal hearing.

Methods

The medical records of subjective non-pulsatile tinnitus patients with normal hearing confirmed by conventional pure-tone audiometry who visited our tinnitus clinic between March 2020 and May 2022 were reviewed. The loudness discomfort level (LDL), extended high-frequency hearing loss (EHFHL), summating potential (SP)/action potential (AP) ratio, distortion product otoacoustic emission (DPOAE), thresholds of auditory brainstem response (ABR) wave V, somatic modulation, and psychiatric symptoms, such as anxiety, depression, and stress were evaluated by questionnaires.

Results

Decreased LDL (n = 48, 59.8%) was the most frequent finding, followed by EHFHL (n = 29, 35.4%), increased SP/AP ratio (n = 27, 32.9%), psychiatric symptoms (n = 24, 29.3%), decreased DPOAE (n = 17, 20.7%), somatic modulation (n = 8, 9.8%), and increased ABR threshold (n = 3, 3.7%); 75.6% of patients had one or more of these findings. The presence of psychiatric symptoms was independently associated with the Tinnitus Handicap Inventory (THI) score.

Conclusion

Tinnitus in patients with normal hearing may be accompanied by a combination of various subclinical abnormal audiological findings. However, the presence of psychiatric symptoms alone was independently associated with tinnitus distress.

Clinical Findings That Differentiate Co-Occurrence of Hyperacusis and Tinnitus from Tinnitus Alone

PURPOSE

We aimed to assess the characteristics of patients with concurrent tinnitus and hyperacusis, determine the best audiological criteria for predicting hyperacusis, and confirm whether objective evidence of changes in the brain exists.

MATERIALS AND METHODS

The medical records of patients with tinnitus who visited the hospital between March 2020 and December 2021 were reviewed. Data on accompanying hyperacusis, audiological profiles, and questionnaires including the Tinnitus Handicap Inventory (THI), Beck Depression Inventory, and numerical rating scale were analyzed. Resting-state quantitative electroencephalography (qEEG) using power spectral density (PSD) and event-related spectral perturbation (ERSP) were performed to objectively quantify changes in the brain.

RESULTS

A total of 194 patients were analyzed. Among them, 51 (26.3%) reported combined subjective hyperacusis with tinnitus. However, the proportions widely varied from 7.4% to 68.4% based on three audiological criteria for assessment. A higher score on the THI questionnaire was independently associated with the co-occurrence of tinnitus and hyperacusis. Fair agreement was observed between subjective hyperacusis and the audiological criterion based on a loudness discomfort level (LDL) of ≤90 dB at two or more frequencies for the diagnosis of hyperacusis. An increased beta-PSD and decreased levels of gamma-PSD, all-ERSP, and delta-ERSP were observed in patients with hyperacusis (p<0.05).

CONCLUSION

Patients with co-occurring tinnitus and hyperacusis had more severe tinnitus distress. An LDL of ≤90 dB at two or more frequencies may be applicable to predict accompanying hyperacusis in subjects with tinnitus, and qEEG also provides more objective information.

Clinical Significance of White Matter Lesions in Idiopathic Sudden Sensorineural Hearing Loss

Background: We aimed to analyze the patient characteristics in accordance with white matter lesions and confirm whether white matter lesions affect final treatment outcomes in idiopathic sudden sensorineural hearing loss.

Methods: Medical records of 126 patients treated for unilateral idiopathic sudden sensorineural hearing loss and who underwent magnetic resonance imaging of the brain at an otology clinic in a university hospital from 2013 to June 2019 were reviewed. The Fazekas scale was used to evaluate the severity of white matter lesions. Complete recovery was defined if final hearing at 3 months did not exceed 25 dB.

Results: Overall, 107 patients were enrolled in this study. A score of 0 on the Fazekas scale was most frequent (n = 78, 72.9%), followed by 1 (n = 17, 15.9%), and 2 (n = 12, 11.2%). Prevalence of diabetes (P = .032) and/or hypertension (P = .006) and distribution of age (P < .001) were different according to Fazekas scale scores. Hearing level in the affected side was significantly different between those with scores of 1 and 2 (P = .009). Contralateral hearing thresholds were not different according to Fazekas scale scores, but hearing on the contralateral side was significantly poorer in patients with hypertension than those without hypertension (P < .001). Regression analysis revealed that Fazekas scale score and initial hearing thresholds of the affected side were significant prognostic factors for complete recovery.

Conclusion: Although the prevalence of white matter lesions in idiopathic sudden sensorineural hearing loss was not high, severe white matter lesions and accompanying cardiovascular risk factors may increase the possibility of initially worse hearing and decrease response to treatment in idiopathic sudden sensorineural hearing loss. Therefore, it might be important to control cardiovascular abnormalities in idiopathic sudden sensorineural hearing loss to achieve a better prognosis.

Measures of Subjective Tinnitus: What Does Visual Analog Scale Stand for?

BACKGROUND

Patients with tinnitus may have different severity levels of tinnitus distress. Visual analog scale (VAS) is a simple method to measure the extent of subjective distress caused by tinnitus. It includes ratings of tinnitus loudness, awareness, annoyance, and impact of tinnitus on life.

PURPOSE

The purpose of this study was to evaluate what led to different distress levels in patients with bilateral tinnitus by analyzing the relationships among all subscales of VAS scores for tinnitus distress and the documented variables.

RESEARCH DESIGN

This study was a retrospective cohort study.

STUDY SAMPLE

The medical records of 268 patients who visited a tinnitus clinic between March and December 2020 were reviewed.

DATA COLLECTION AND ANALYSIS

Epidemiologic characteristics, subjective tinnitus distress factors including tinnitus loudness, awareness, annoyance, and impact of tinnitus on life, questionnaire results including those from the Tinnitus Handicap Inventory (THI) and Beck Depression Inventory (BDI), and audiometric profiles were documented. Based on a bivariate analysis between variables and subtypes of subjective tinnitus distress, stepwise logistic regression was performed to identify potential influencing factors for aggravating each subtype.

RESULTS

Data from a total of 122 patients with bilateral tinnitus were collected. The cohort included 77 males and 45 females with a mean age of 51.16 ± 13.50 years. Tinnitus loudness was associated with an accompanying headache (p < 0.001), the BDI score (p = 0.001), and the duration of tinnitus (p = 0.006). A high THI (p < 0.001) and an accompanying headache (p = 0.016) were both associated with tinnitus annoyance. Hearing thresholds at 250 Hz (p = 0.011) and 500 Hz (p = 0.002) on the left side were associated with an impact of tinnitus on life. The hearing threshold at 4 kHz on the left side alone was associated with tinnitus awareness (p = 0.013).

CONCLUSION

Psychologic complaints are mainly associated with tinnitus loudness and annoyance. On the other hand, hearing loss is linked with tinnitus awareness and its impact on life. Thus, an individualized, sequential approach that considers different subtypes of tinnitus severity to assess subjective tinnitus distress is needed.

Optimal First-Line Therapy for Acute Low-Tone Sensorineural Hearing loss

Background and Objectives

We aimed to analyze treatment outcomes following different initial management approaches and confirm treatment regimens for acute low-tone sensorineural hearing loss (ALHL) that would yield the best results.

Subjects and Methods

We retrospectively analyzed the medical records of 106 patients with ALHL who visited a university hospital’s otology clinic from March 2013 to June 2019. Pure-tone averages at the initial visit and at 2 and 4 weeks after the initial visit were evaluated.

Results

Forty-nine patients were enrolled in this study; of them, 41 (83.7%) exhibited complete recovery (CR) at 2 weeks and 43 (87.8%) exhibited CR at 1 month after the initial visit. Regression analysis revealed that CR at 2 weeks after the initial visit was associated with diuretic use [Exp(B): 10.309, 95% confidence interval (CI): 1.007-100]. An initial daily low-dose steroid use was marginally significant [Exp(B): 1.042, 95% CI: 0.997-1.092; p=0.066]. Isolated diuretic use [Exp(B): 25.641, 95% CI: 1.121-90.909; p=0.039] was an independent, good prognostic factor at 1 month after the initial visit. However, other treatment regimens did not affect the final results.

Conclusions

A combination of initial daily administration of ≤30 mg prednisolone plus diuretics was sufficient as the first-line treatment for ALHL. High-dose steroids and salvage intratympanic steroid injections can be applied as a second choice; however, the predicted outcome would not be good in that case.

Can an average of thresholds at 2 kHz and 4 kHz substitute for the threshold at 3 kHz in pure tone audiometry? A study based on the Korean National Health and Nutrition Examination Survey 2010-2012

Background

When evaluating hearing disability in medicolegal cases, an average of thresholds at several frequencies is calculated using pure tone audiometry. Occasionally, there are instances in which thresholds at certain frequencies are omitted. One typical example is the threshold at 3 kHz (H3k). The American Academy of Otolaryngology–Head and Neck Surgery Committee on Hearing and Equilibrium (1995) suggested that the average of thresholds at 2 kHz and 4 kHz (H24k) could replace H3k for a comparison of results between studies. However, to the best of our knowledge, there is no report in the literature that compares H3k and H24k.

Objective

This study aimed to investigate the agreement between H3k and H24k.

Methods

This study is based on the Korea National Health and Nutrition Examination Survey (KNHANES) 2010–2012, which was conducted by the Korean government. A total of 18,472 participants (unweighted) who represented 39,357,497 Koreans (weighted) were included. To verify the agreement of H3k and H24k, a paired t-test, Cohen’s d, Pearson’s correlation, Cronbach’s coefficient, intraclass correlation coefficient (ICC), a Bland–Altman plot, and linear regression analysis were used.

Results

The means of H3k and H24k were 16.2 dBHL and 16.6 dBHL, respectively. They were significantly different in a paired t-test (p<0.0001), which resulted from the large sample size. In contrast, the effect size (Cohen’s d) was 0.02, which meant that the two groups nearly overlapped. The means showed strong correlation: Pearson’s correlation coefficient = 0.92, Cronbach’s alpha = 0.96, and ICC = 0.92. A strong linear predictive relationship between H3k and H24k was found: y = –0.6821 + 1.0186x, where x = H24k, y = H3k, and p<0.0001. However, the Bland–Altman plot showed large upper and lower limits of agreement (LOA) of 15.0 dBHL and –15.8 dBHL, respectively. Irrespective of age and degree of the four-tone average (0.5, 1, 2, and 3 kHz) hearing loss or thresholds at 2 kHz, 3 kHz, and 4 kHz, the absolute LOAs were greater than 10 dBHL.

Conclusions

Despite a very strong correlation between the two thresholds, H3k and H24k showed clinically large LOAs. Therefore, it would be improper to substitute H24k for H3k in an individual requesting a hearing disability rating. However, since the overall means of the H3k and H24k samples were nearly equal, H24k can replace H3k for a mean comparison of results between studies. This result supports the 1995 Committee on Hearing and Equilibrium guideline.

Normal Mastoid Air Cell System Geometry: Has Surface Area Been Overestimated?

OBJECTIVES

The aim of this study was to emphasize the necessity of a standard in segmentation threshold and algorithm for measuring volume and surface area of mastoid air cell system (MACS).

METHODS

First, we obtained axial computed tomography scans of 54 normal temporal bones from 27 subjects. Then, we manipulated Hounsfield units (HU) image data in DICOM (digital imaging and communications in medicine) files directly using our program. The volume and surface area of MACS were computed and compared at segmentation thresholds (HU) from -700 to 0 at intervals of 50 using 2 algorithms; square pixel based (SP) algorithm and marching square (MS) algorithm.

RESULTS

No significant difference was found between the volumes computed by SP and MS algorithms at each segmentation threshold. The surface area computed by SP algorithm, however, was significantly larger than that by MS algorithm. We could minimize this significant difference through a modification of the SP algorithm. As the lower HU threshold value was set, the smaller volume was measured. The surface area showed a plateau at a threshold of approximately -200 HU. The segmentation threshold had greater influence on the measured volume of MACS than the algorithm did.

CONCLUSION

A standard method for measuring volume and surface area of MACS is thought to be necessary. We suggest that the MS algorithm and -200 HU of the threshold could be a standard in the measurement of volume and surface area of MACS.

Age- and Gender-Related Mean Hearing Threshold in a Highly-Screened Population: The Korean National Health and Nutrition Examination Survey 2010-2012

Background

In evaluating hearing disability in medicolegal work, the apportionment of age- and gender-related sensorineural hearing loss should be considered as a prior factor, especially for the elderly. However, in the literature written in the English language no studies have reported on the age- and gender-related mean hearing threshold for the South Korean population.

Objective

This study aimed to identify the mean hearing thresholds in the South Korean population to establish reference data and to identify the age- and gender-related characteristics.

Methods

This study is based on the Korea National Health and Nutrition Examination Survey (KNHANES) 2010–2012, which was conducted by the Korean government, the data of which was disclosed to the public. A total of 15,606 participants (unweighted) representing 33,011,778 Koreans (weighted) with normal tympanic membrane and no history of regular or occupational noise exposure were selected and analyzed in this study. The relationship between the hearing threshold level and frequency, age, and gender was investigated and analyzed in a highly-screened population by considering the sample weights of a complex survey design.

Results

A gender ratio difference was found between the unweighted and the weighted designs: male:female, 41.0%: 59.0% (unweighted, participants) vs. 47.2%:52.8% (weighted, representing population). As age increased, the hearing threshold increased for all frequencies. Hearing thresholds of 3 kHz, 4 kHz, and 6 kHz showed a statistical difference between both genders for people older than 30, with the 4 kHz frequency showing the largest difference. This paper presents details about the mean hearing threshold based on age and gender.

Conclusions

The data from KNHANES 2010–2012 showed gender differences at hearing thresholds of 3 kHz, 4 kHz, and 6 kHz in a highly-screened population. The most significant gender difference in relation to hearing threshold was observed at 4 kHz. The hearing thresholds at all of the tested frequencies worsened with increasing age. The mean hearing thresholds suggested in this study will be useful for the formulation of healthcare-related hearing policies and used as reference data for disability ratings for hearing loss due to various causes.

Analysis of Age-Related Changes in Asian Facial Skeletons Using 3D Vector Mathematics on Picture Archiving and Communication System Computed Tomography

PURPOSE

There are marked differences in facial skeletal characteristics between Asian and Caucasian. However, ethnic differences in age-related facial skeletal changes have not yet been fully established. The aims of this study were to evaluate age-related changes in Asian midfacial skeletons and to explore ethnic differences in facial skeletal structures with aging between Caucasian and Asian.

MATERIALS AND METHODS

The study included 108 men (aged 20-79 years) and 115 women (aged 20-81 years). Axial CT images with a gantry tilt angle of 0 were analyzed. We measured three-dimensional (3D) coordinates at each point with a pixel lens cursor in a picture archiving and communication system (PACS), and angles and widths between the points were calculated using 3D vector mathematics. We analyzed angular changes in 4 bony regions, including the glabellar, orbital, maxillary, and pyriform aperture regions, and changes in the orbital aperture width (distance from the posterior lacrimal crest to the frontozygomatic suture) and the pyriform width (between both upper margins of the pyriform aperture).

RESULTS

All 4 midfacial angles in females and glabellar and maxillary angles in males showed statistically significant decreases with aging. On the other hand, the orbital and pyriform widths did not show statistically significant changes with aging.

CONCLUSION

The results of this study suggest that Asian midfacial skeletons may change continuously throughout life, and that there may be significant differences in the midfacial skeleton between both sexes and between ethnic groups.

Various tumors in the nasal vestibule

Various types of diseases can involve the nasal vestibule. Diagnosis and treatment of a nasal vestibular mass is often challenging due to the anatomical features of the nasal vestibule. Here, we present four cases with nasal vestibular masses. Two cases were diagnosed as squamous papillomas. The others were a trichofolliculoma and pseudoepitheliomatous hyperplasia with hyperkeratosis. Our aim was to discuss the characteristics of each disease and the considerations thought to be necessary for diagnosis and treatment of nasal vestibular tumors from these cases and the related literature.

A schwannoma in the nasal septum

Schwannomas of the sinonasal tract are very rare neoplasms. We present the case of a schwannoma developing in the nasal septum. The patient was a 51-year-old woman with the complaint of unilateral nasal obstruction. We completely removed this tumor by an endoscopic approach. We discuss the clinical presentation, differential diagnosis, and treatment of this rarely encountered neoplasm.

Endoscopic removal of the antral portion of antrochoanal polyp by powered instrumentation

OBJECTIVES

To introduce a new surgical technique for endoscopic removal of the antral portion of antrochoanal polyp (ACP) by powered instrumentation and to determine its efficacy by measures of relevant patient outcome.

STUDY DESIGN

Prospective study in 28 patients undergoing endoscopic sinus surgery for ACP by our surgical technique.

METHODS

Improvements of clinical symptoms and endoscopic and computed tomographic findings were evaluated postoperatively with a follow-up period ranging from 12 to 52 months. All symptom scores on a 100-mm visual analogue scale before operation were compared with those at the last visit after operation. Postoperative endoscopic and computed tomographic findings were graded using a three-point scale ranging from 0 to 2. In surgical technique, the antral portion of ACP was identified through the enlarged ostium under intranasal endoscopy and removed by a blade of powered instrumentation that was inserted through the canine fossa.

RESULTS

Symptom scores were all significantly reduced postoperatively. All but one patient showed improvement in clinical symptoms and endoscopic and computed tomographic findings during the follow-up period. There were no major complications specific to this technique.

CONCLUSION

Our technique provides an attractive alternative to other methods for removing the antral portion of an ACP and is associated with excellent outcomes and minimal morbidities.

Idiopathic orbital pseudotumours in adults

We treated 24 cases of orbital pseudotumour from January 1981 through January 1993. The clinical characteristics and treatment outcomes were analyzed retrospectively by reviewing the medical records, radiological studies, and histological examination. All patients presented with symptoms related to the eye (proptosis, lid swelling, limited ocular motion and/or pain, chemosis, and visual disturbance), while only five patients had symptoms pertaining to the ear, nose, and throat besides the ophthalmological symptoms. Plain X-ray findings were not contributory to the diagnosis. Computed tomograms (CT) showed non-specific findings such as hypertrophy of the extra-ocular muscles and well-defined or poorly defined mass. Pathological findings were non-specific, only to reveal benign lymphoid hyperplasia and inflammatory cell infiltration with necrotizing vasculitis. Twenty-four patients were treated with high-dose steroid therapy which resulted in a significant improvement in 10 patients (42%).