Benign paroxysmal positional vertigo (BPPV) is the most common cause of peripheral vertigo, which results from dislodged vestibular otoliths. Because the otoliths are mainly composed of calcium carbonate, it has been suggested that BPPV may be associated with osteoporosis. We aimed to assess the incidence and recurrence of BPPV in osteoporosis patients using a nationwide population-based cohort study with matched control. We used the database of the National Health Insurance Service of Korea, a universal system covering all 50 million Koreans. Osteoporosis was defined as patients who underwent bone mineral density tests and visited a clinic three or more times between Jan 2004 and Dec 2006. A control cohort consisted of non-osteoporotic subjects socio-demographically matched in a ratio of 1:1. The incidence and recurrence of BPPV between Jan 2007 and Dec 2016 were evaluated. A total of 177,797 osteoporosis patients and the same number of matched controls were identified. The incidence rates (IR) of BPPV in the osteoporosis patients and controls were 31.58 and 18.09 per 1000 persons, respectively (ratio of IR, IRR = 1.75, 95% CI 1.67–1.83). The IRs of recurrent BPPV were 187.3/1000 in the osteoporosis, 163.5/1000 in the controls (IRR = 1.15, 95% CI 1.02–1.28). In multivariate analysis, osteoporosis, female gender (adjusted HR = 1.76), age <65 (adjusted HR = 0.8), living in a metropolis, earning more than the lowest income and hypertension were significantly associated with increased risk of BPPV development. For recurrence, osteoporosis was the only meaningful risk factor (adjusted HR = 1.12). In conclusion, the risks of BPPV development and recurrence are higher in osteoporosis. Physicians might consider informing osteoporosis patients of the risk of developing BPPV and related falls.

Sudden sensorineural hearing loss (SSNHL) is a rapid decline in auditory function that needs urgent medical management. Although etiologic factors, including viral infections, autoimmune diseases, and vascular issues, contribute to the understanding of SSNHL, the condition remains unclear in most cases. Systemic steroids are often used as the first-line treatment because they reduce inner ear inflammation; however, there remains numerous discussions about the effectiveness of alternative treatments. To predict hearing recovery is crucial in patients’ counseling with factors, including delayed treatment, vertigo, and other health conditions, which indicate poor prognosis. Herein, we review contemporary research on the treatment approaches and outcome predictions of SSNHL to establish important guidelines for physicians in evaluating and treating patients with SSNHL.

To investigate the impact of olfactory dysfunction on quality of life (QOL) and psychological status in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). A retrospective observational study was conducted from January 2011 to May 2012 with 130 patients with septal deviation (SD) (n = 59) and CRSwNP (n = 71). All patients underwent computed tomography (CT), allergy tests, and sniffin’ stick olfactory test. Anosmia was defined by Threshold-Discrimination-Identification (TDI) scores less than 16. QOL and psychological symptoms were assessed with the Sinonasal Outcome Test-20 (SNOT-20) and Symptom Checklist-90-Revised (SCL-90-R). Odor discrimination and identification scores were significantly lower in CRSwNP than in SD (P = .008 and P = .005, respectively). In CRSwNP, identification score decreased with higher CT score (r = −0.29, P = .014). CRSwNP with anosmia showed a decreased QOL (P = .044), and SNOT-20 negatively correlated with TDI in severe CRSwNP (CT score ≥15, r = −0.714, P = .001). Anosmia patients had higher anxiety and phobia scores of SCL-90-R in both SD and CRSwNP. However, depression score increased only in CRSwNP with anosmia (P = .025). Olfactory dysfunction may have significant effects on QOL and psychological health. CRSwNP with anosmia is a distinct phenotype having mixed type of olfactory loss that might have a detrimental effect on depression.

Budesonide nasal irrigation was introduced recently for postoperative management of patients with chronic rhinosinusitis. The safety and therapeutic effectiveness of this procedure is becoming accepted by many physicians. The objective of this study was to evaluate the efficacy of postoperative steroid irrigation in patients with chronic rhinosinusitis and asthma. This prospective study involved 12 chronic rhinosinusitis patients with nasal polyps and asthma who received oral steroid treatment for recurring or worsening disease. The 22-item Sinonasal Outcomes Test (SNOT-22) and Lund-Kennedy endoscopy scores were checked before nasal budesonide irrigation, and 1, 2, 4, and 6 months after irrigation. We also calculated the total amount of oral steroids and inhaled steroids in the 6 months before irrigation and the 6 months after it. The mean SNOT-22 score improved from 30.8±14.4 before irrigation to 14.2±8.7 after 6 months of irrigation (P=0.030). The endoscopy score also improved from 7.4±4.7 before irrigation to 2.2±2.7 after 6 months (P<0.001). The total amount of oral steroid was decreased from 397.8±97.6 mg over the 6 months before irrigation to 72.7±99.7 mg over the 6 months after irrigation (P<0.001). Nasal irrigation with budesonide is an effective postoperative treatment for chronic rhinosinusitis with asthma, which recurs frequently, reducing the oral steroid intake.