Otology & Neurotology最新文献

Introduction: Despite its importance for patient care, our understanding of postcochlear implant (CI) decisional regret (DR) and satisfaction is limited. Prior research indicates that 15%-42% of patients post-CI report DR. However, the cross-sectional design of these studies limits their ability to determine patient-specific factors that identify participants at risk for DR and low satisfaction. This study aims to build on this prior research by examining factors associated with post-CI DR and satisfaction using a longitudinal, prospective study design.

Methods: Longitudinal prospective study involving 15 adults with bilateral postlingual hearing loss meeting traditional CI indications. Outcome measures included: CIQOL-Expectation scores measured before CI evaluation (CIE), post-CIE, and day of surgery; CIQOL-35 Profile, CNC word scores, and AzBio sentence scores measured pre-CI and post-CI; and DR Scale and Satisfaction with Amplification in Daily Living (SADL) measured post-CI.

Results: Overall, participants demonstrated improvement in both speech recognition and CIQOL scores post-CI compared with their pre-CI abilities. On the basis of established cutoff scores, 40% of CI users had substantial (moderate or higher) DR (+DR) following cochlear implantation. Before their CIE, the +DR cohort had substantially higher CIQOL Communication expectations compared with the low DR (-DR) cohort (87.7±15.6 vs. 62.2±11.6, d =1.85). Expectations scores between the groups became more homogenous at post-CIE ( d =0.52) and trended toward similarity at the time of surgery ( d =0.26). Post-CI CIQOL-35 Communication scores for both +DR and -DR groups had no difference ( d =0.10). A similar trend of initial difference but convergence at the time of surgery were noted in multiple domains, including Emotional, Listening effort, and Global score. Although participants started with similar pre-CI CNC and AzBio scores ( d =0.11, d =0.14), the -DR group had slightly greater improvement in speech recognition scores, however, with substantial outcome variability ( d =0.63, d =0.74). There were no differences in age at implantation or duration of hearing loss between DR groups, but the -DR group had a higher percentage of females (78% vs. 33%) compared with +DR. Similar results were observed when using low versus high satisfaction (SADL) scores as an endpoint.

Conclusion: This pilot study suggests that expectation-outcome misalignment, particularly higher expectations before CIE, is a key driver of post-CI regret and dissatisfaction. Given prior research indicating that pre-CI expectations are modifiable, these findings, when confirmed in an expanded sample, may provide support for early interventions and counseling to set more realistic expectations for patients at high risk for DR and low satisfaction.

Level of evidence: Level II.

Objectives: To analyze the facial nerve outcomes after removing the infratemporal fossa approach type A (IFTA) with anterior rerouting for class C-D tympanojugular paragangliomas (TJPs).

Methods: We evaluated the medical records and follow-up visits of patients with class C-D TJPs treated with IFTA between 1989 and 2023 at 2 quaternary referral institutions.

Results: Of the 258 patients surgically treated for modified Fisch Class C-D TJPs, 154 cases were selected based on the selection criteria: 29 (18.8%) patients were classified as having a Class C1 TJP, while 86 (55.8%) had a Class C2 and 39 (25.3%) had a Class C3-4 TJP. Among the included subjects, 146/154 (94.81%) had normal-to-moderately impaired (grades I-II and III) facial nerve function at the last follow-up, including 27/29 (93.1%) patients with C1 TJPs, 81/86 (94.19%) patients with C2 TJPs, and 38/39 (97.44%) patients with C3-4 TJPs. Total tumor removal was achieved in 25 out of 29 (86.2%) patients with C1 TJPs, 67 out of 86 (77.9%) patients with C2 TJPs, and 31 out of 39 (79.5%) patients with C3-4 TJPs.

Conclusions: The main goal of TJP treatment is complete tumor removal, especially in young patients with a higher expected lifespan. IFTA is an appropriate approach for the resection of class C-D TJPs. With anterior rerouting of the facial nerve, adequate exposure to the jugular foramen, infralabyrinthine areas, and intratemporal internal carotid artery minimizes morbidity and avoids mortality. Postoperative facial asymmetry, mostly of recovery to grade I-II and III, is the price paid to achieve a higher total tumor resection rate and a lower rate of recurrence and complications.

Introduction: Over-the-counter (OTC) hearing aids have become increasingly accessible, yet limited information exists regarding their online listings and marketing practices. This study evaluated cost, satisfaction ratings, review, volume, readability of product descriptions, and Food and Drug Administration (FDA) clearance status of OTC hearing aid listings on Amazon.com.

Materials and methods: This cross-sectional, descriptive study analyzed 138 Amazon OTC hearing aid listings. Listing characteristics were extracted, and FDA clearance or registration was verified. Analyses included descriptive data on listing characteristics and nonparametric analysis of key variables: price, FDA-clearance status, device type, and form factor. Readability indices were used to assess the accessibility of product descriptions.

Results: Of the 138 listings analyzed, 92 listings (66.7%) identified their product as "OTC hearing aids," while only 37 (26.8%) were verified as FDA-cleared or registered. FDA-cleared/registered devices cost significantly more than non-FDA-cleared devices. Behind-the-ear (BTE) devices had a significantly higher number of reviews compared with in-the-ear (ITE) devices. The readability of product descriptions was advanced, ranging from 11th-grade to college graduate levels. In addition, 52 listings (37.7%) lacked specific marketing for mild-to-moderate hearing loss, and 13 (9.4%) were marketed to those with hearing loss beyond mild-to-moderate.

Discussion: Amazon listings for OTC hearing aids reveal significant inconsistencies in marketing and labeling, including misleading FDA clearance claims and inadequate accessibility of product information. Advanced readability levels and marketing for hearing loss degrees beyond mild-to-moderate further impede consumers' ability to make informed purchasing decisions. These findings highlight the urgent need for stricter regulatory oversight and improved dissemination of accurate, accessible consumer information.

Objective: To investigate the association between tinnitus and hearing recovery prognosis in patients with sudden sensorineural hearing loss (SSHL).

Data sources: PubMed, Web of Science, and Embase.

Materials and methods: Eligible studies published between 1983 and 2025 were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS; scores ≥7 indicated high quality). Data were pooled using an inverse-variance random-effects model, with results presented through forest plots. Publication bias and sensitivity analyses were performed.

Results: Among 4782 patients from 10 studies, 3590 had SSHL with tinnitus, while 1192 had SSHL without tinnitus. All included studies had NOS scores ≥7. The hearing recovery rate was higher in the tinnitus group (57.44%) than in the non-tinnitus group (50.84%). Tinnitus was positively associated with better hearing recovery [odds ratio (OR) = 0.60; 95% CI, 0.42-0.85; I2 = 67.2%]. Subgroup analyses using Siegel criteria and systematic corticosteroid treatment yielded consistent results. However, no significant association was observed in the intratympanic corticosteroid subgroup (OR = 0.80; 95% CI, 0.45-1.44).

Conclusions: Tinnitus may serve as a favorable prognostic indicator for hearing recovery in SSHL, except in patients receiving intratympanic corticosteroids. Systemic corticosteroids might be more effective for SSHL patients with tinnitus. Future studies could explore personalized SSHL treatment strategies using tinnitus as a stratification criterion.

Objective: This study aims to compare the language and memory skills of cochlear implant (CI) users with and without auditory neuropathy spectrum disorder (ANSD).

Study design: Cross-sectional, comparative observational study.

Setting: Tertiary referral center.

Patients: Twenty-six children with CIs participated in the study. The study group consisted of 11 children diagnosed with ANSD, while the control group included 15 children without ANSD.

Intervention: Language skills were evaluated using the Test of Language Development-Primary: Fourth Edition (TOLD-P:4), and memory abilities were assessed using the Working Memory Scale (WMS).

Results: No statistically significant differences were found between the groups in listening [median (range): 64 (55 to 91) vs 76 (55 to 121), P = 0.27], organizing [58 (55 to 88) vs 73 (55 to 94), P = 0.68], speaking [58 (55 to -97) vs 79 (55 to 127), P = 0.16], grammar [65 (55 to 91) vs 82 (55 to 112), P = 0.12], semantics [61 (55 to 97) vs 80 (55 to 115), P = 0.15], and oral language [59 (55 to 88) vs 78 (55 to 115), P = 0.12] index scores. Similarly, verbal memory standard scores did not differ significantly between the groups [median (range): 332 (247 to 571) vs 417 (228 to 808), P = 0.10].

Conclusion: Children with ANSD who use CIs demonstrate language and memory abilities comparable to those of CI users without ANSD. These findings suggest that despite the auditory processing challenges associated with ANSD, cochlear implantation effectively supports the development of language and memory skills.

Objective: To assess the long-term impact of cochlear implantation (CI) on cognitive outcomes in older adults 5 years post-implantation.

Study design: Prospective, interventional study.

Setting: Tertiary care center.

Patients: Cochlear implant recipients aged 65 or older.

Interventions: Subjects underwent preoperative cognitive testing with a novel battery of validated neuropsychological tests including those assessing global cognition (Mini-Mental Status Exam), verbally based cognition (Digit span, Stroop, Hopkins Verbal Learning Test-Revised, Hayling Sentence Completion) and comparable visually-based cognition [Spatial span, d2 Test of Attention, Brief Visuospatial Memory Test-Revised (BVMT-R), Trail Making Test Part B]. Testing was repeated 5 years postoperatively.

Main outcome measures: Cognitive outcomes assessed with cognitive testing battery.

Results: After 5.71±1.14 years after CI, 16 subjects (mean age 83±7.22 y, 93.75% male, 87.5% with normal preoperative cognitive status) repeated the cognitive battery. In comparison to preoperative testing, subjects showed stable performance on 4 of 11 cognitive test scores, including those assessing global cognition, auditory attention, verbal learning and memory, and auditory-based executive functioning. Conversely, there was a significant decrease on a verbal test of executive functioning (Stroop Color-Word: Z=-2.557, P =0.011) and all visually based tests of attention (d2 total correct scores Z=-2.667, P =0.008; spatial span total score: Z=-2.388, P =0.017, BVMT-R: total raw score Z=-2.615, P =0.009, BVMT-R delayed raw score Z=-2.829, P =0.005; trails B seconds: Z=-2.158, P =0.031).

Conclusions: In a 5-year follow-up of CI, participants demonstrated stability on a global scale in addition to 3 other verbally based cognitive measures. When contrasted with declines on all visually based analog cognitive tests, these preliminary findings in a small and select sample, suggest a beneficial role of CI in enhancing cognition in older recipients.

Professional practice gap and educational need: The long-term effect of CI on cognitive status of older adults who are at risk of dementia associated with hearing loss.

Learning objective: Learners will better understand the long-term impact of CI on cognition in older adults.

Desired result: To demonstrate that CI in older adults can improve cognition in certain domains, whereas other domains are unaffected or continue to decline with age.

Level of evidence: Level III.

Indicate irb or iacuc: IRB 00083983, The University of Utah.

Objective: To describe and investigate the diagnostic value of a spectrotemporal assessment of sound recorded from the outer ear canal in patients with pulsatile tinnitus.

Study design: A small microphone was placed in the outer ear to record sound. Meanwhile, a pulsoximeter recorded heartbeats. Both signals were visually assessed for pulse-synchronicity.

Setting: Tertiary referral center.

Patients: One hundred fifteen patients presenting with pulsatile tinnitus (PT) who had a normally aerated middle ear and in whom a radiologic explanation was identified or excluded with CT-angiography (CTA) and/or neuroangiography (NA).

Intervention: Diagnostic.

Main outcome measure: The diagnostic value of our method, including sensitivity and specificity.

Results: Sixty-nine (60%) of all patients had an extra pulse-synchronous sound in the spectrogram at one or both ears that was clearly visible in 60 and somewhat more difficult to recognize in 9 patients. In 86 (75%) of all patients, we found a vascular cause of PT. Two patients with a pulse-synchronous sound at one or both ears had no vascular explanation on both CTA and NA (false-positive). In 19 patients, we did not see a pulse-synchronous spectrogram in either ear, although radiologic workup showed a vascular cause (false-negative). Five of them had an arterial cause of PT, in 14, a venous cause was found.

Conclusions: Transcanal sound recording in patients presenting with PT provides diagnostic information on the likelihood of a vascular origin, although sensitivity is limited. This noninvasive method can help the clinician to decide on the appropriate diagnostic workup, avoiding unnecessary burden, risk, and costs of diagnostic imaging, including NA.

Objectives: This study explored genetic and drug-induced hearing loss by focusing on the m.827A>G variation of the MT-RNR1 gene. In particular, we investigated the variant's frequency, its association with hearing loss, and its potential interaction with gentamicin-induced damage within the Taiwanese adult population.

Design: The study included 59,091 participants from the Taiwan Precision Medicine Initiative dataset. We examined the relationship between m.827A>G variant carriers, age, gentamicin exposure, and sensorineural hearing loss. Pure-tone audiometry assessed hearing thresholds and severity, while genetic analysis determined the mutation frequency. Phenome-wide association studies established connections between the variant and clinical diagnoses.

Results: Genotyped from 58,091 Taiwanese adults, the m.827A>G variant minor allele frequency was 4.49%. Analyzing data from 186 carriers included age, sex, and audiograms. The carriers of m.827A>G variant who had been exposed to gentamicin did not display significant hearing level distinction. PheWAS analysis was conducted and confirmed a significant association between the variant and hearing loss.

Conclusions: This study confirms the association between the m.827A>G variant and hearing loss, while suggesting that its role in gentamicin-induced ototoxicity may be limited.

Objective: To analyze radiographic characteristics that predict adequate internal auditory canal (IAC) access through retrolabyrinthine corridor for potential removal of vestibular schwannoma (VS).

Study design: Retrospective imaging analysis of the retrolabyrinthine corridor (RLC) and fundal fluid cap (FC) were measured and multiple linear regression models were used to examine the relationship between RLC width and FC and their impact on extent of IAC access as well as logistic regressions to analyze the likelihood of tumor exposure achievable with both 0 and 30-degree endoscopic views.

Setting: Single-institution radiology analysis of patients undergoing MRI IAC with diagnosis of VS (ICD-10 D33.3).

Results: The predicted IAC exposure was 68.6% and 42.2% with 30 and 0-degree views, respectively ( P <0.05, CI: 17.1%-35.6%). For every 1 mm increase in RLC width, the 30-degree IAC access increases by ∼1.54 mm ( P <0.001) and the 0-degree IAC access increases by 1.45 mm ( P <0.001), while FC did not significantly impact IAC access. When predicting the impact on tumor exposure with a 0-degree view, each 1 mm increase in RLC width increases the odds of complete exposure by 153% (OR=2.53, P =0.043), while each 1 mm increase in FC corresponds to 109% higher odds (OR=2.09, P =0.012). With a 30-degree view, each 1 mm increase in RLC increases the odds of complete exposure by nearly 300% (OR=3.99, P <0.001). FC has less impact on tumor exposure when utilizing a 30-degree view compared with a 0-degree view with each 1 mm increase in FC increasing odds of complete exposure by 56% (OR=1.56, P =0.011). In addition, the use of a 30-degree endoscope over a 0-degree endoscope is associated with 4,336% higher odds of achieving complete tumor exposure (OR=44.35, 95% CI: 8.46-232.52, P <0.001), highlighting the importance of angled visualization and exposure in skull base surgery.

Conclusion: Greater retrolabyrinthine corridor and fundal cap measurements are correlated with improved IAC access and VS exposure. These radiographic characteristics may be used as tools to predict candidacy for a retrolabyrinthine approach to VS.

Objective: Vestibular schwannomas (VSs) treated with stereotactic radiosurgery (SRS) often show transient loss of central tumor enhancement. We hypothesized that this loss of enhancement may correlate with better tumor control on follow-up imaging.

Methods: We evaluated 198 consecutive patients from a single center who met eligibility criteria. Tumor volumes on the pre-SRS and post-SRS scans were quantified along with regions of loss of enhancement on the first post-SRS study. The latter was correlated with tumor volumes at follow-up, radiation isocenter density, and loss of serviceable hearing.

Results: For the entire cohort, the median loss of enhancement on the first post-SRS scan was 14% (IQR: 6 to 25) and median rate of change in tumor volume was -4.5% per year (IQR: -10.5 to 1.5). Percent loss of central enhancement showed significant negative correlation with tumor growth not only for the entire cohort (correlation coefficient: -0.18, P =0.01), but also for the subset of patients who had available imaging until at least 2 years (n=185) and 4 years (n=179) post-SRS. Loss of enhancement also strongly correlated positively with tumor volumes and number of radiation isocenters and negatively with isocenter density. Finally, patients with greater percent loss of enhancement had an increased likelihood of progression to non-serviceable hearing, although this association was not statistically significant.

Conclusions: These findings suggest that loss of central tumor enhancement in VSs post-SRS may be associated with improved tumor control.