Journal of Otology最新文献

Gait speed is a valid measure of both physical function and vestibular health. Vestibular rehabilitation is useful to improve gait speed for patients with vestibular hypofunction, yet there is little data to indicate how changes in gait speed reflect changes in patient-reported health outcomes. We determined the minimal clinically important difference in the gait speed of patients with unilateral vestibular hypofunction, mostly due to deafferentation surgery, as anchored to the Dizziness Handicap Index and the Activities Balance Confidence scale, validated using regression analysis, change difference, receiver-operator characteristic curve, and average change methods. After six weeks of vestibular rehabilitation, a change in gait speed from 0.20 to 0.34 m/s with 95% confidence was required for the patients to perceive a significant reduction in perception of dizziness and improved balance confidence.

Objective

Multiple alternative approaches of cochlear implant surgery have been described, such as the suprameatal approach, transcanal approach, transmeatal approach and middle cranial fossa approach. Transmeatal (open trnascanal) approach has not been adapted since first described in the clinical field. we aimed to assess the long-term complications of the transmeatal approach in a series of 131 patients at our center between 2004 and 2008.

Methods

This study was a retrospective case series of all patients who underwent cochlear implants with the transmeatal (open transcanal) approach from May 2004 to December 2008 at King Faisal Specialist and Research Hospital (Riyadh, Saudi Arabia), which were conducted by the same surgeon.

Results

Complications were observed often with various combinations—recurrent otitis externa, posterior tympanic membrane perforation, electrode extrusion, cholesteatoma, and chronic mastoiditis. The overall long-term complication rate was 16% (21/131). The gap between the implantation and the diagnosis of a complication ranged from <1 year to 11 years. Major complications were as follows: cholesteatoma in 5 (3.8%) patients, extrusion of the electrode in 5 (3.8%) patients, and tympanic membrane perforation or deep retractions in 5 (3.8%) patients. Minor complications were as follows: recurrent mastoiditis with/without concomitant temporary facial nerve palsy in 4 (3%) patients, recurrent otitis externa infections in 7 (5%) patients, and weakness of the posterior canal wall in 1 patient.

Conclusion

The transmeatal approach posed an high rate of complications on long-term follow-up such as cholestetoma formation, extrusion of electrode or perielectrode reaction formation to tympanic membrane and external auditory canal

Objective

The purpose of this study was to evaluate the functional and patient-reported outcomes, and their correlation, after percutaneous bone-anchored hearing aid (BAHA) implantation.

Methods

A prospective study was conducted between January 2018 and December 2020 in a tertiary care center. All adult patients who were implanted with a percutaneous BAHA device during this evaluation period were included in the study. Complete auditory function and patients reported outcome measures (PROMs) were assessed in the preoperative period and 6 months after the implant activation. The PROMs included a generic form (Medical Outcome Study 36 Short Form Healthy Survey (MOS SF-36)), and three disease-specific forms (Hearing Handicap Inventory (HHI), Satisfaction with Amplification in Daily Life Scale (SADLS), and Tinnitus Handicap Inventory (THI)).

Results

Twenty-two patients with an average age of 53 years were included in the study. The overall functional gain with the BAHA in sound-field pure tone average (PTA) was 29 dB, with no statistically significant differences according to surgical indication (F(3,18) = 2.319, p = 0.110). The greater the preoperative air-bone gap, the greater the functional gain obtained (r = 0.505, p < 0.05). In the PROMs, we found a significant improvement in HHI scores (p < 0.005) and a significant increase in overall SADLS scores (p < 0.05) with the use of percutaneous BAHA devices. We did not verify any statistically significant correlation between functional and PROMs results.

Conclusions

The BAHA is a safe and effective alternative hearing rehabilitation option in selected patients. The PROMs results prove patient's overall satisfaction.

Background

Recent developments in virtual acoustic technology has levered promising applications in the field of auditory sciences, especially in spatial perception. While conventional auditory spatial assessment using loudspeakers, interaural differences and/or questionnaires are limited by the availability and cost of instruments, the use of virtual acoustic space identification (VASI) test has widespread applications in spatial test battery as it overcomes these constraints.

Purpose

The lack of test-retest reliability data of VASI test narrows its direct application in auditory spatial assessment, which is explored in the present study.

Methods

Data from 75 normal-hearing young adults (mean age: 25.11 y ± 4.65 SD) was collected in three sessions: baseline, within 15 min of baseline (intra-session), and one week after baseline session (inter-session). Test-retest reliability was assessed using the intra-class correlation coefficient (ICC), coefficient of variation (CV), and cluster plots.

Results

The results showed excellent reliability for both accuracy and reaction time measures of VASI, with ICC values of 0.93 and 0.87, respectively. The CV values for overall VASI accuracy and reaction time 9.66% and 11.88%, respectively. This was also complemented by the cluster plot analyses, which showed 93.33% and 96.00% of temporal stability in the accuracy and reaction time measures, indicative of high test-retest reliability of VASI test in auditory spatial assessment.

Conclusions

The high temporal stability (test-retest reliability) of VASI test validates its application in spatial hearing test battery.

Objective

Tinnitus—a common clinical symptom—can be categorized into pulsatile tinnitus (PT) and non-PT. Among these, PT is usually associated with sigmoid sinus symptoms, such as sigmoid sinus wall defect or diverticulum, for which various surgical treatments are available. We have discussed the clinical efficacy of surgery for sigmoid sinus-associated PT via the transmastoid approach in this study.

Methods

We conducted a retrospective review of 4 patients who underwent surgery for sigmoid sinus-associated PT via the transmastoid approach at Nanjing Drum Tower Hospital from January to December 2020. Of these, 2 patients had sigmoid sinus wall defect and 2 had sigmoid sinus diverticulum. Post-operative tinnitus grading and surgical efficacy were determined.

Results

After surgery, PT dissolved in 3 patients, while tinnitus significantly decreased in 1 patient. During the follow-up period of 12–18 months, none of the 4 patients showed complications related to increased intracranial pressure or venous sinus thrombosis, and tinnitus symptoms disappeared in 3 patients without recurrence, although 1 patient occasionally developed tinnitus. Postoperative thin-slice CTA of the temporal bone indicated that the sigmoid sinus bone wall defect or diverticulum was completely repaired with a thick soft tissue coverage.

Conclusion

Surgical repair of sigmoid sinus-associated PT via the transmastoid approach deserves clinical promotion as it exhibited better efficiency while being relatively less invasive.

Objectives

The study aimed to determine the most appropriate hearing screening test to identify disabling hearing loss for adults aged 65 years or older.

Methods

This study included 577 older adults. Four hearing screening tests were considered in the study, including the Hearing Handicap Inventory for Elderly Screening (HHIE-s), three single question tests, the whisper test, and the finger rub test. The sensitivity and specificity of these tests referenced to the hearing threshold of disabling hearing loss were estimated.

Results

Among all tests, only the single self-perception question (0.7064 for sensitivity; 0.7225 for specificity) and whisper test (0.7833 for sensitivity; 0.7708 for specificity) could obtain both sensitivity and specificity higher than 70% for adults aged ≥65 years.

Conclusion

Overall, we suggest using the whisper test to identify disabling hearing loss (>40 dB HL at the better ear) for adults aged 65 years or older. However, if the conditions do not permit, the single self-perception question is also acceptable. Moreover, HHIE-s might not be a good test to detect disabling hearing loss for adults aged 80 years or older.

Blast injuries are common among the military service members and veterans. One of the devastating effects of blast wave induced TBI is either temporary or permanent hearing loss. Treating hearing loss using minocycline is restricted by optimal drug concentration, route of administration, and its half-life. Therefore, therapeutic approach using novel therapeutic delivery method is in great need. Among the different delivery methods, nanotechnology-based drug delivery is desirable, which can achieve longer systemic circulation, pass through some biological barriers and specifically targets desired sites. The current study aimed to examine therapeutic effect of minocycline and its nanoparticle formulation in moderate blast induced hearing loss rat model through central auditory system. The I.v. administered nanoparticle at reduced dose and frequency than regularly administered toxic dose. After moderate blast exposure, rats had hearing impairment as determined by ABR at 7- and 30-days post exposure. In chronic condition, free minocycline also showed the significant reduction in ABR threshold. In central auditory system, it is found in this study that minocycline nanoparticles ameliorate excitation in inferior colliculus; and astrocytes and microglia activation after the blast exposure is reduced by minocycline nanoparticles administration. The study demonstrated that in moderate blast induced hearing loss, minocycline and its nanoparticle formulation exhibited the optimal therapeutic effect on the recovery of the ABR impairment and a protective effect through central auditory system. In conclusion, targeted and non-targeted nanoparticle formulation have therapeutic effect on blast induced hearing loss.

Introduction

The masseter vestibular evoked myogenic potential (mVEMP) is a bilaterally generated, electromyographically (EMG)-mediated response innervated by the trigeminal nerve. The purpose of the present investigation was to 1) determine whether subjects could accurately achieve and maintain a range of EMG target levels, 2) to examine the effects of varied EMG levels on the latencies and amplitudes of the mVEMP, and 3) to investigate the degree of side-to-side asymmetry and any effects of EMG activation.

Methods

Subjects were nine neurologically and otologically normal young adults. A high-intensity tone burst was presented monaurally while subjects were seated upright and asked to match a range of EMG target levels by clenching their teeth. Recordings were made from the ipsilateral and contralateral masseter muscles referenced to the ear being monaurally stimulated.

Results

We found that the tonic EMG target had no effect on mVEMP latency. Additionally, although mVEMP amplitudes “scaled” to the EMG target, there was a tendency for the subjects’ EMG level to “undershoot” the EMG target levels greater than 50 μV. While some individuals did generate differences in EMG activation between sides, there were no significant differences on average EMG activation between sides. Further, while average corrected amplitude asymmetry was similar across EMG targets, some individuals demonstrated large, corrected amplitude asymmetry ratios.

Conclusions

The results of this investigation suggest that, as with cVEMP recordings, the underlying EMG activation may vary between subjects and could impact mVEMP amplitudes, yet could be mitigated by amplitude correction techniques. Further it is important to be aware that even young normal subjects have difficulty maintaining large, tonic EMG activity during the mVEMP recording.

Objective

Saccades accompanied by normal gain in video head impulse tests (vHIT) are often observed in patients with vestibular migraine (VM). However, they are not considered as an independent indicator, reducing their utility in diagnosing VM. To better understand clinical features of VM, it is necessary to understand raw saccades data.

Methods

Fourteen patients with confirmed VM, 45 patients with probable VM (p-VM) and 14 age-matched healthy volunteers were included in this study. Clinical findings related to spontaneous nystagmus (SN), positional nystagmus (PN), head-shaking nystagmus (HSN), caloric test and vHIT were recorded. Raw saccades data were exported and numbered by their sequences, and their features analyzed.

Results

VM patients showed no SN, PN or HSN, and less than half of them showed unilateral weakness (UW) on caloric test. The first saccades from lateral semicircular canal stimulation were the most predominant for both left and right sides. Neither velocity nor time parameters were significantly different when compared between the two sides. Most VM patients (86%) exhibited small saccades, around 35% of the head peak velocity, with a latency of 200–400 ms. Characteristics of saccades were similar in patients with p-VM. Only four normal subjects showed saccades, all unilateral and seemingly random.

Conclusions

Small saccades involving bilateral semicircular canals with a scattered distribution pattern are common in patients with VM and p-VM.

Objectives

This study aimed to determine the prognostic value of otoacoustic emissions (OAEs) in idiopathic sudden sensorineural hearing loss patients.

Methods

The study included 30 subjects with unilateral idiopathic sudden sensorineural hearing loss (ISSNHL). Each patient was evaluated four times: at baseline and after one week, one month, and three months of treatment. During each visit, each patient was subjected to full audiological history, otoscopic examination, basic audiological evaluations, and transiently evoked and distortion product otoacoustic emission (TEOAEs & DEOAEs).

Results

The hearing thresholds (frequency range 250–8000 Hz) and word recognition scores of patients with detectable TEOAEs and DPOAEs improved significantly, whereas no significant improvements were observed in those with no response.

Conclusion

Hearing improvement is better in patients with detectable TEOAEs and DPOAEs. As a result, TEOAEs and DPOAEs are recommended as routine tests in all SSNHL patients to predict outcomes and monitor treatment as TEOAEs and DPOAEs reflect the cochlear OHCs activity.