Objective:
To evaluate the treatment outcomes of nimodipine and steroid combination therapy for idiopathic sudden sensorineural hearing loss (ISSNHL).
Study Design:
Retrospective case review.
Setting:
Tertiary referral center.
Patients:
Seventy-eight patients who were diagnosed with ISSNHL were divided into two group based on the treatment strategies used: steroid+nimodipine (SN, n = 36) and steroid only (SO, n = 42) groups. Based on the level of hearing loss before treatment, subgroup analysis (<90 dB HL, SN-S versus SO-S groups; ≥90 dB HL, SN-P versus SO-P groups) was performed.
Interventions:
Nimodipine+dexamethasone versus dexamethasone alone.
Main Outcome Measures:
Hearing thresholds and complete/partial recovery rate after treatment.
Results:
Hearing thresholds after treatment were not significantly different between the SN and SO groups (46.8 ± 29.4 versus 54.8 ± 27.6 dB HL, p = 0.218). However, the complete recovery rate was significantly higher in the SN group than in the SO group (41.7% versus 16.8%, p = 0.014). In subgroup analysis, the complete recovery rate was significantly higher in the SN-S group than in the SO-S group (60.9% versus 19.2%, p = 0.003), whereas the difference between the SN-P and SO-P groups was not significant (7.7% versus 12.5%, p = 0.672). The cumulative incidence of complete recovery was significantly higher in SN-S group than in the SO-S group (p = 0.005); the mean recovery time was 4.4 weeks (95% confidence interval [CI], 2.8–6.1) in the SN-S group and 8.8 weeks (95% CI, 7.0–10.5) in the SO-S group.
Conclusions:
The results of this study suggest that nimodipine and steroid combination therapy for ISSNHL results in a higher complete recovery rate than steroid alone in patients with moderate to severe hearing loss.
Objectives: Respiratory mechanics instability (RMI) based on paradoxical movement is correlated with respiratory disturbance such as apnea-hypopnea index (AHI) and reflects the severity of obstructive sleep apnea (OSA). The purpose of this study was to identify RMI as a method for assessing the effectiveness of continuous positive airway pressure (CPAP) in the management for OSA. Methods: A total of 71 consecutive OSA patients with CPAP titration were included in this study. We compared sleep (sleep efficiency, arousal index, and sleep stages), respiratory (AHI, oxygen desaturation index ≥3% [ODI3], and lowest oxygen saturation), and RMI parameters (events, index, duration, and % of stage duration) between diagnostic polysomnography and CPAP titration data. Results: All RMI parameters (events [157.5 ± 80.9 vs 80.0 ± 47.1; P < .001], index [25.3 ± 12.4 vs 12.7 ± 7.0; P < .001], duration [182.6 ± 96.2 vs 79.8 ± 88.9; P < .001], and % of stage duration [49.0 ± 24.4 vs 20.5 ± 21.3; P < .001]) were significantly improved by the alleviation of obstructive respiratory disturbance parameters (AHI [45.1 ± 23.0 vs 4.2 ± 4.3; P < .001], ODI3 [44.9 ± 22.6 vs 4.8 ± 4.6; P < .001], and lowest oxygen saturation [77.7 ± 7.3 vs 89.3 ± 3.8; P < .001]) compared to diagnostic polysomnography and CPAP titration data. Conclusion: RMI may be a useful method for evaluating the effect of CPAP in OSA patients.
Glomus jugulare is slow growing, highly vascularized, histologically benign tumor. The authors report the case of huge glomus jugulare tumor treated by skull base surgical resection via posterolateral approach with preoperative embolization of ascending pharyngeal artery. A 59-year old female patient presented with symptoms of right side pulsatile tinnitus, hearing loss and hoarseness. Magnetic resonance imaging demonstrated an approximately 5.7 cm mass along the right jugular foramen, extension to right cerebellopontine angle. Prior to surgical excision of tumor, the patient proceeded embolization in ascending pharyngeal artery. Next day, the patient proceeded a posterolateral approach to remove the skull base tumor. The purpose of this case report is to debate the effectiveness of preoperative embolization and posterolateral approach for the glomus jugulare tumor and its pathological result.
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