Otology & Neurotology最新文献

Objective: To evaluate the efficacy and safety of transcutaneous electrical nerve stimulation (TENS) for the treatment of subjective tinnitus in adults.

Data sources: Cochrane Library, PubMed, EMBASE, Web of Science, VIP, WanFang, CNKI, SinoMed, and ClinicalTrials.gov.

Study selection: Randomized controlled trials (RCTs) comparing TENS with sham or active controls for subjective tinnitus were included.

Data extraction: Data were extracted and synthesized according to PRISMA guidelines. The primary outcomes evaluated were the change in Tinnitus Handicap Inventory (THI) and Visual Analog Scale (VAS) scores for loudness and annoyance.

Data synthesis: Seven RCTs (N=342 patients) were included in the random-effects meta-analysis. TENS produced a clinically meaningful reduction in THI scores compared with controls [Mean Difference (MD) =-8.60, 95% CI: -13.39 to -3.81], but with substantial heterogeneity ( I2 =62%). TENS did not significantly affect tinnitus loudness or annoyance. Sensitivity analysis identified a single active-control trial as the source of heterogeneity; after its removal, the effect of TENS versus sham control on THI was larger and more consistent (MD=-10.48, 95% CI: -13.42 to -7.54; I2 =11%). The certainty of evidence was rated "Very Low." No severe adverse events were reported.

Conclusions: Based on very low-certainty evidence, TENS safely provides a clinically meaningful reduction in THI but not in perceived loudness or annoyance. This effect is clearest against placebo controls. Further high-quality RCTs with larger sample sizes are necessary to substantiate these findings.

Objective: Update our expanded targeted screening program for congenital cytomegalovirus (cCMV) detection among newborns born in a health care system in Utah.

Study design: A retrospective cohort study was identified prospectively.

Setting: Intermountain Health care (IHC) system in Utah.

Patients: Infants from IHC facilities, born between March 1, 2021, and August 31, 2024, were tested for CMV within 6 months of birth.

Intervention: Expanded targeted screening program for cCMV.

Main outcome measures: Prevalence of cCMV; clinical characteristics of cCMV-positive infants; effectiveness of expanded targeted screening program.

Results: Between March 1, 2021, and August 31, 2024, a total of 8598 tests were ordered for cCMV screening among 93,529 live births (9%) across 27 facilities within Intermountain Health care. Over 3.5 years, the expanded targeted screening program detected 32 confirmed cCMV cases among 93,528 live births, yielding an estimated prevalence of cCMV disease of 34 cases per 100,000. Hearing loss was detected in 9 of 32 children (28%), with varying degrees of severity, including unilateral (n=4), bilateral asymmetric (n=1), and bilateral symmetric loss (n=4). Of these, 5 were fitted with hearing aids, and 3 underwent bilateral cochlear implantation at a median age of 11 months.

Conclusions: The expanded targeted early cCMV testing program has proven effective in enabling early intervention for children with cCMV. These results suggest feasibility and opportunities for improved early intervention and treatment.

Hypothesis: In our study, we investigated the ototoxic interaction of Janus kinase (JAK) inhibition in combination with aminoglycosides.

Background: The therapeutic landscape of JAK inhibitors has undergone a significant transformation since 2018, characterized by a rapid increase in FDA approvals for this class of drugs. Initially approved for conditions like myelofibrosis and polycythemia vera, the indications have expanded to include several inflammatory conditions, such as psoriatic arthritis, ulcerative colitis, and rheumatoid arthritis, leading to a substantial increase in patients exposed to these therapies. The potential interactions of this drug class with ototoxins are unknown.

Methods: C57Bl/6N mice corrected for Cadherin23 (Cdh23 tm2.1/kjn ) were treated with kanamycin (KM), (500 mg/kg, subcutaneously, twice daily for 14 d) either alone or with lipopolysaccharide (LPS) (1 mg/kg, intraperitoneally, 3 times during the treatment) to mimic inflammation from gram-negative infections. A separate group also received momelotinib (MMB), a dual JAK1/JAK2 inhibitor, at 50 mg/kg or 20 mg/kg by oral gavage twice daily for 14 days alongside KM and LPS. Hearing function was assessed through auditory brainstem response (ABR) and distortion product otoacoustic emissions (DPOAE), while cochlear damage and hair cell loss were evaluated using whole mount staining for phalloidin and myosin 7a.

Results: Inhibition of JAK1 and JAK2 by MMB caused a substantial increase in the hearing loss and cochlear damage in animals exposed KM and LPS as measured by ABR, DPOAE, and outer hair cell (OHC) counts.

Conclusion: JAK1 and JAK2 inhibition worsens cochlear damage in mice exposed to aminoglycosides.

Objective: To examine the histopathologic features of inner ear malformations (IEMs) and their implications for cochlear implant (CI) surgery, focusing on neural tissue preservation and electrode selection.

Study design: Retrospective histopathologic case series analysis.

Setting: Tertiary academic center.

Patients: Twenty-three temporal bones (ears) with IEMs were identified, from which 7 representative cases (some bilateral, some unilateral), including 2 incomplete partition type I (IP-I), 1 IP-II, 1 IP-III, and 3 cochlear hypoplasia cases are described in detail.

Intervention: None.

Main outcome measures: Microscopic assessment of cochlear structures relevant to CI surgery, including modiolar development, neural tissue presence and location, spiral ganglion cell distribution, and interscalar septum integrity.

Results: Neural tissue was present in malformed cochleae despite the absence of bony structures in several cases. IP-I specimens demonstrated spiral ganglion cells predominantly in the internal auditory canal fundus. IP-II and IP-III cases showed unprotected neural tissue in the cochlear center. Cochlear hypoplasia cases exhibited variable neural development, ranging from well-developed to hypoplastic cochlear nerves and reduced spiral ganglion cells.

Conclusions: Histopathologic findings suggest that lateral wall electrodes may be preferable for many IEM cases to avoid damage to unprotected neural tissue. Electrode selection should be individualized based on the type of malformation, particularly considering compressed or shortened arrays in cases of cochlear hypoplasia. Neural tissue preservation despite bony malformation supports the potential for successful CI outcomes in IEM cases when appropriate surgical techniques and electrode choices are employed.

Hypothesis significant: Cochlear implant (CI) insertion trauma, as evidenced by fracture of the osseous spiral lamina (OSL), is associated with localized "dead zones" and focal spiral ganglion neuron (SGN) loss.

Background: Hearing and structure preservation approaches to CI insertion aim to minimize trauma and preserve residual SGNs. In cases of significant insertion trauma, peripheral axons running through the bony OSL inherently become damaged if the OSL is fractured. The current investigation sought to determine if the relative location of OSL fracture was associated with focal areas of SGN loss.

Methods: Five adult ears from the Mass Eye and Ear Otopathology Laboratory were identified with OSL fractures. When available, contralateral ears were also analyzed for comparison. Digitized e-Slides were used to create 3D cochlear reconstructions, and a coordinate system relative to the round window allowed for % distance along Rosenthal canal (RC) assignment of SGNs and OSL fracture locations. Abrupt changes in SGN density, defined as a drop >50% within a 5% segment along RC were used as criteria for a significant and focal SGN loss. Insertion trauma in the form of electrode translocation and spiral ligament (SL) perforation was also characterized.

Results: OSL fracture lengths ranged from approximately 72 to 109 degrees about the modiolus, with a median fracture length of 75 degrees. Total SGN counts ranged from 16,810 to 22,260. Abrupt and focal drops of >50% in SGN density occurred in all 5 temporal bones with OSL fracture. In 3 of the cases, there were areas of localized "dead zones" at or immediately adjacent to the OSL fracture site, whereas in the remaining 2 cases, drops were seen in various areas across the cochlea. The case with the longest fracture demonstrated nearly a complete loss of neurons apical to the deepest fracture location. Ears with OSL fractures demonstrate a higher number of "dead zones" than the contralateral ears used for comparison, with median values of 3 and 2, respectively. Cases with an OSL fracture, electrode translocation, and SL perforation demonstrated a notably higher number of "dead zones" (median = 3) as compared with ears with only 1 or 2 CI insertional trauma injuries (median = 2).

Conclusion: In temporal bones from CI patients, OSL fractures explain some-but not all-of the abrupt SGN loss observed following traumatic CI insertions. Distinct regions of SGN density observed across the length of these cochlea indicate multifactorial processes likely contribute to relative SGN "dead zones."

Objective: To determine the in vivo radiological prevalence of the round window niche veil (RWNV) using the ultra-high-resolution (UHR) mode of photon-counting detector computed tomography (PCD-CT) and to assess variations in its prevalence across different age groups in a Japanese cohort.

Patients: This retrospective study analyzed temporal bone PCD-CT scans from 191 consecutive patients (382 temporal bones), aged 0 to 79 years. After excluding temporal bones with middle ear opacification or prior surgery, 261 temporal bones were included in the final analysis.

Intervention: All imaging was performed on a clinical dual-source PCD-CT scanner using a standardized, noncontrast UHR protocol.

Main outcome measures: The presence of an RWNV was evaluated based on established radiologic criteria, requiring visualization of the characteristic soft-tissue shadow on both axial and coronal reformatted images. The primary outcome was the radiologic prevalence of the RWNV, calculated for the entire cohort and stratified by decadal age groups.

Results: An RWNV was identified in 66 of 261 temporal bones, yielding an overall prevalence of 25.3% (95% CI: 20.4%-30.9%). Prevalence varied across age groups, ranging from 5.3% (30-39 y) to 33.3% (40-49 y), but no consistent monotonic trend was observed with advancing age.

Conclusions: This study provides the first large-scale, in vivo quantification of RWNV radiologic prevalence using UHR PCD-CT. The findings establish this advanced imaging modality as a valuable tool for noninvasively identifying this anatomic barrier, which has significant implications for predicting and potentially improving the efficacy of intratympanic drug delivery for inner ear disorders.

Objective: To compare hearing preservation (HP) outcomes between ears for adult sequential bilateral cochlear implant (CI) recipients.

Study design: Within-subject, retrospective cohort.

Setting: Tertiary referral CI center.

Patients: Sixty adults with preoperative functional acoustic hearing [low-frequency pure-tone average (LFPTA; 125, 250, and 500 Hz) ≤80 dB HL] were implanted with the same electrode array in both ears.

Interventions: Sequential bilateral cochlear implantation from 2012 to 2022.

Main outcome measures: Initial (1 mo) and long-term (12 mo) HP outcomes between ears were assessed by comparing the LFPTA shift in the first and second implanted ear.

Results: Correlations between LFPTA shift in the first and second implanted ear at 1 month ( rs = 0.221, P = 0.090) and 12 months ( rs = 0.234, P = 0.123) were weak and nonsignificant. However, a multilevel linear mixed-effects model demonstrated greater LFPTA shifts in the second implanted ear when compared with the first, with a mean difference of 6.3 dB HL (95% CI: 0.2-12.4, P = 0.048). In addition, the model showed that HP declined during the first 12 months following implantation, and younger patients had greater LFPTA shifts over time ( p interaction = 0.012). There were no significant associations between LFPTA shift and preoperative LFPTA, biological sex, electrode array design, or postoperative steroid use.

Conclusions: In the present sample, HP in the first implanted ear was poorly predictive of the outcome in the second ear. Substantial variability in outcomes between ears could indicate that subtle differences in surgical technique and insertion dynamics have a relatively larger impact on HP than patient-specific factors.

Objective: To describe a novel method for identifying cochlear implant (CI) electrode intrascalar location and electrode orientation using in-vivo high-definition flat-panel computed tomographic imaging (FPCT).

Study design: Retrospective, observational study.

Setting: Tertiary referral center.

Patients: Adult patients following cochlear implantation with a flexible, lateral wall electrode.

Interventions: Postoperative flat-panel CT scans were analyzed using reformatted mid-modiolar image slices, with landmarks of the lateral wall, scala tympani modiolar wall, and electrode array centers. Electrode contact orientation was determined visually using mid-modiolar image slices and 3D volume renderings.

Main outcome measures: Insertion angle, intrascalar location, electrode contact orientation.

Results: Average angular insertion depth of the most apical contact was 494° (range: 444 to 559 degrees). The average lateral wall to electrode radial distance was 0.69 mm at 90-degree angular depth, decreasing in an expected manner to 0.34 mm at 360 degrees. Vectors perpendicular to electrode contact faces in the mid-modiolar slices, where modiolus-facing contacts have an orientation of 0 degrees, and cochlear partition-facing have an orientation of 90, were measured. Basal contacts were oriented towards the cochlear partition, on average 59 degrees (SD: 18 degrees), while the apical electrodes were oriented towards the modiolus, on average 28 degrees (SD: 11 degrees).

Conclusions: In vivo mapping of intrascalar electrode positioning is possible using FPCT. Transformation onto a standard cochlear system produces anatomically relevant measurements within expected ranges. Moreover, we have measured electrode contact orientation based on imaging characteristics and introduced a model for describing directionality of electrode contacts. In future studies, we will focus on correlating these rotational measurements to electrophysiologic and psychophysical parameters, including electrode current spread, activation settings, and hearing performance.

Objective: To analyze the efficacy of tympanoplasty for severe tympanosclerosis under the continuous irrigation mode.

Study design: Retrospective.

Setting: First Affiliated Hospital of Wenzhou Medical University.

Patients: Patients with severe tympanosclerosis involving critical anatomic structures (eg, stapes footplate, facial nerve canal, vestibular window niche).

Interventions: Tympanoplasty with continuous irrigation mode. Saline irrigation to reduce bleeding, improve surgical continuity, and shorten operative time. Removal of calcified lesions and ossicular chain reconstruction.

Main outcome measures: Surgical efficacy (assessed by completeness of lesion removal and hearing improvement), operative time, frequency of endoscope withdrawal for cleaning, complication rates (including facial paralysis, vertigo, sensorineural hearing loss, and taste disturbances), tympanic membrane healing status, chorda tympani preservation rate, and feasibility in overcoming traditional limitations (eg, single-handed operation, bone drilling difficulties).

Results: Reduced intraoperative bleeding. Improved procedural continuity. Shortened operative time. Enhanced feasibility for complex lesions (eg, near facial nerve). Postoperative outcomes improved with reduced complication rates.

Conclusions: The continuous irrigation mode represents a safer and more effective advancement in tympanosclerosis surgery, addressing limitations of conventional endoscopy by improving efficiency and reducing complications. Further clinical validation is needed.

Objective: Cochlear implantation (CI) under local anesthesia facilitates intraoperative behavioral patient feedback to potentially improve acoustic hearing preservation and limit intracochlear trauma. Patient feedback during electrode insertion is potentially confounded by loudness adaptation, a perception of tone decrease despite stable presentation, or insufficient intensity discrimination, a failure to detect a change in hearing despite one actually occurring. Both loudness adaptation and intensity discrimination are critical factors for awake CI and have not been systematically studied in the CI candidate population.

Patients: Adult candidates for CI.

Interventions: Under routine audiometric testing conditions in a soundproof booth, a standard behavioral audiogram, audiogram obtained in recorded ambient operating room (OR) noise, loudness adaptation to sustained suprathreshold (+10 and +20 dB) pure tones at 500, 1000, 2000, and 4000 Hz in both quiet and in ambient OR noise, and intensity discrimination to sustained suprathreshold (+10 and +20 dB) pure tones at 500, 1000, 2000, and 4000 Hz were performed.

Main outcome measures: Pure tone average (PTA) in quiet and in ambient OR noise, proportion of patients reporting loudness adaptation at different suprathreshold levels and frequencies, and reliability of intensity discrimination.

Results: In total, 20 ears were included for study. The median PTA was similar between testing in quiet (68 dB, IQR: 63 to 73) and in ambient OR noise (68 dB, IQR: 62 to 73). Most participants (n = 11, 55%) reported loudness adaptation when testing at +10 dB suprathreshold intensity, with a decreased proportion (n = 8, 40%) demonstrating adaptation at the higher tone intensity (+20 dB suprathreshold). Loudness adaptation varied among frequencies, with a trend toward increasing adaptation at higher frequencies at both testing intensities. Participants demonstrated excellent intensity discrimination, detecting a 5 dB difference when testing at +10 dB both in quiet and with background OR noise in 82 of the 85 (96%) tests performed across the frequency range, although with lower intensity discrimination at +20 dB, particularly in background OR noise.

Conclusions: For CI candidates, pure tone audiometric performance did not significantly differ in background OR noise, confirming the reliability of intraoperative audiometric testing. For optimal tone presentation, there is decreasing loudness adaptation with increased tone presentation (+20 dB suprathreshold) and in lower frequencies of tone presentation. Intensity discrimination was reliable at a 5 dB increment across a range of testing parameters.