Journal of Otology最新文献

The etiology and underlying mechanism of Meniere's disease (MD) development are still unknown, although inflammation and autoimmunity have been implicated as underlying mechanisms. The human endolymphatic sac (ES) has been reported to have innate and adaptive immune capacity in local immune reactions. In vivo demonstration of inflammation of the ES in patients with MD is missing in the literature. We report the case of a 47-year-old female patient diagnosed with unilateral MD with genetic variants and cytokine markers indicating inflammation and vascular congestion of the ES. Endolymphatic hydrops in the right cochlea (grade 2) and vestibulum (grade 3) were detected using MRI. She carried heterozygous variants in MEFV (c.442G > C), IRF8 (c.1157G > T), ADA (c.445C > T), PEPD (c.151G > A), NBAS (c.4049T > C), CSF2RB (c.2222C > T), HPS6 (c.277G > T), IL2RB (c.1109C > T), IL12RB1 (c.1384G > T), IL17RC (c.260_271del GCAAGAGC TGGG), LIG1 (c.746G > A), RAG1 (c.650C > A), and SLX4 (c.1258G > C, c.5072A > G). In the serum, the levels of granulocyte colony-stimulating factor (G-CSF), macrophage inflammatory protein 1α, and IL7 were significantly elevated, and the level of IL2Rα was reduced. Intratympanic administration of dexamethasone temporarily alleviated her hearing loss. Her vertigo was significantly relieved but remained slight after ES administration of corticosteroids.

The objective was to measure the effect of various face masks on speech recognition threshold and the word recognition score in the presence of varying background noise levels. 20 normal-hearing adult subjects (a total of 40 ears) participated. Pure tone audiometry followed by speech recognition threshold and word recognition score at the most comfortable level in varying signal-to-noise ratios (SNR0, SNR10, and SNR15) using surgical, pleated cloth, and N95 masks. Using surgical, cloth, and N95 masks, speech recognition thresholds increased by 1.8 dB, 4.4 dB, and 5.05 dB, respectively. Word recognition scores decreased by 32% without a mask, 43.7% in a surgical mask, 46.3% in a cloth mask, and 46.7% in N95 mask conditions, between SNR15 and SNR0. The speech recognition threshold was negatively affected with cloth and N95 masks. Surgical masks do not affect the word recognition scores at lower background noise levels. However, as the signal-to-noise ratio decreased, even the surgical, cloth, and N95 masks significantly impacted the word recognition score even in normal-hearing individuals.

Objective

The management of traumatic facial nerve paralysis (FNP) has remained a controversial issue with conflicting findings arguing between surgical decompression and conservative management. However, recent advances in endoscopic surgery may consolidate the management plan for this condition.

Methods

This prospective clinical study included patients with posttraumatic FNP at a tertiary referral center. Patients were categorized in two main groups: surgical and conservative. Indications for surgery included patients with immediate and complete FNP, no improvement in facial function on medical treatment, with electroneurography showing >90% degeneration or electromyography showing fibrillation potential. Patients who did not satisfy this criterion received the conservative approach. The transcanal endoscopic approach (TEA) or endoscopic assisted transmastoid approach was performed for facial nerve decompression in the surgical group.

Outcome

The main outcome was facial function improvement, assessed using the House Brackmann grading scale (HBGS) 6 months after surgery, and hearing state assessed using the air bone gap (ABG).

Results

The study included 38 patients, of whom 15 underwent had surgical decompression and 23 underwent conservative therapy. A significant improvement in facial nerve function from a mean of 4.66 ± 0.97 to 1.71 ± 0.69 (P = 0.001) and ABG from a median of 30 (10–40) to 20 (10–25) (P = 0.002) was observed.

Conclusion

Decision-making in cases of traumatic FNP is critical. The geniculate ganglion and tympanic segment were the most commonly affected areas in FNP cases. The TEA represents the most direct and least invasive approach for this area.

Background

Neuroplasticity is a phenomenon exhibited by our nervous system as an indicator of overall development and in response to training, injury/loss of particular function, treatment/drugs and as a result of stimulation from the surrounding environment.

Objective

The aim of the current study was to assess the auditory working memory capacities in Bharatanatyam dancers.

Method

The participants comprised fifty-four females with normal hearing sensitivity who belonged to two groups. Group-I consisted of 27 individuals who underwent formal training in Bharatanatyam for a minimum period of three years. Group-II consisted of the age-matched control group, consisting of 27 individuals who were non-dancers. The auditory working memory tasks included arranging the English digits presented binaurally in forward, backward, ascending, and descending spans. The maximum values (for the length of sequence arranged), midpoint values (average score), and response time for each task were noted down and compared among groups.

Results

The scores were compared using the Mann-Whitney U test, which revealed enhanced working memory exhibited by dancers for maximum values and midpoint scores for all three tasks except ascending span. It was also noted that the dancers exhibited a shorter response time compared to non-dancers for all the tasks except ascending span.

Conclusion

The current study highlights an enhanced auditory working memory capacity in Bharatanatyam dancers, which could be perceived as evidence of neuroplastic changes induced in the auditory and motor cortex as a consequence of extensive stimulation for auditory processing abilities and motor planning resulting from long-term dance training and regular practice.

Background

The activation of the medial olivocochlear reflex reduces the cochlear gain, which is manifested perceptually as decreased auditory sensitivity. However, it has remained unclear whether the extent of this suppression varies according to the cochlear region involved. Here we aims to assess the magnitude of contralateral efferent suppression across human cochlea, at low levels, and its impact on hearing sensitivity.

Methods

Assuming that acoustic stimulation activates the contralateral medial olivocochlear reflex, we evaluated the magnitude of the suppressive effect as a function of frequency in 17 subjects with normal hearing. Absolute thresholds were measured for bursts tones of various durations (10, 100, and 500 ms) and frequencies (250, 500, 1000, 4000, and 8000 Hz) in the presence or absence of contralateral white noise at 60 dB SPL.

Results

We found that contralateral noise raised the absolute threshold for the burst tones evaluated. The effect was greater at lower than higher frequencies (3.85 dB at 250 Hz vs. 2.22 dB at 8000 Hz).

Conclusions

Our findings suggest that in humans, the magnitude of this suppression varies according to the cochlear region stimulated, with a greater effect towards the apex (lower frequencies) than the base (higher frequencies) of the cochlea.

Permanent damage to hair cells (HCs) is the leading cause of sensory deafness. Supporting cells (SCs) are essential in the restoration of hearing in mammals because they can proliferate and differentiate to HCs. MDS1 and EVI1 complex locus (MECOM) is vital in early development and cell differentiation and regulates the TGF-β signaling pathway to adapt to pathophysiological events, such as hematopoietic proliferation, differentiation and cells death. In addition, MECOM plays an essential role in neurogenesis and craniofacial development. However, the role of MECOM in the development of cochlea and its way to regulate related signaling are not fully understood. To address this problem, this study examined the expression of MECOM during the development of cochlea and observed a significant increase of MECOM at the key point of auditory epithelial morphogenesis, indicating that MECOM may have a vital function in the formation of cochlea and regeneration of HCs. Meanwhile, we tried to explore the possible effect and potential mechanism of MECOM in SC proliferation and HC regeneration. Findings from this study indicate that overexpression of MECOM markedly increases the proliferation of SCs in the inner ear, and the expression of Smad3 and Cdkn2b related to TGF signaling is significantly down-regulated, corresponding to the overexpression of MECOM. Collectively, these data may provide an explanation of the vital function of MECOM in SC proliferation and trans-differentiation into HCs, as well as its regulation. The interaction between MECOM, Wnt, Notch and the TGF-β signaling may provide a feasible approach to induce the regeneration of HCs.

Objective tinnitus is defined as a type of tinnitus perceived by both the patient and external observer. This paper presents two cases of objective tinnitus related to palatal tremor, along with a literature review. Palatal tremor is a condition characterized by soft palate involuntary contractions. Two types of palatal tremor have been described: symptomatic palatal tremor and essential palatal tremor, with different clinical manifestations. Diagnostic workup is based on medical history and physical examination, including direct oropharynx exploration and cavum visualization through nasopharyngoscopy. Brain MRI is mandatory in all cases. If a secondary origin is suspected, additional lab tests should be performed based on clinical suspicion. First-line treatment is botulinum toxin injection into the levator veli palatini and tensor veli palatini muscles, with velopharyngeal insufficiency being its main adverse effect. Other medications have not been shown to be effective.

Objective

This study aims to analyze the clinical characteristics of persistent geotropic and apogeotropic positional nystagmus of LC-BPPV in view of light and heavy cupula discussion.

Material and method

The study group includes 184 patients with LC BPPV (98 apogeotropic, 86 geotropic type) who have been examined between 2009 and 2020. Ninety-nine females and 85 males, aged between 16 and 92 years were included (Ageotropic 49.32 ± 14.12, geotropic 44.49 ± 13.90 years). Average slow phase velocity (SPV) of positional nystagmus was documented and those with persistent direction-changing positional nystagmus lasting more than a minute were grouped separately. Age, gender difference, side of involvement, and recurrence pattern were particularly reviewed. Chi-square and One way ANOVA tests were used to compare the difference between groups. Statistical significance was set at P < 0.05.

Results

Thirty-seven patients with apogeotropic nystagmus (30.7%; 37/98) and 18 patients with geotropic nystagmus (20.9%; 18/86) had persistent nystagmus (p ˂0.05). Comparison of slow phase velocity (SPV) of persistent and non-persistent geotropic and apogeotropic positional nystagmus of the affected side was significant (p ˂0.05). Comparison of average age, male to female ratio, side of involvement, and the recurrence rate in patients with persistent and non-persistent geotropic and apogeotropic type positional nystagmus groups were not significant (p = 0.177, p = 0.521, p = 0.891, p = 0.702).

Conclusion

Persistent geotropic and apogeotropic positional nystagmus is mostly correlated with the size, amount, and position of otoconial debris. It is difficult to justify the light cupula as a new geotropic variant of cupular pathology. Patients with persistent positional nystagmus present similar therapeutic outcomes and recurrence rates.

Objective

To evaluate the audiologists’ attitudes and practice towards teleaudiology, as well as to assess the audiological services provided in Egypt and Saudi Arabia during the COVID-19 pandemic.

Methods

A cross sectional study was conducted among 112 audiologists who were recruited through convenience sampling . Multinomial logistic regression was used to test the association between practice of tele audiology as a dependent variable and some independent variables.

Results

25.4% of the studied sample were practicing tele audiology. Participants’ age and attitude toward telemedicine were the independent predictors of tele audiology practice at p value ≤ 0.05.

Conclusion

The tele audiology practice is essential. Therefore, raising the knowledge of audiologist about the great value of practicing tele audiology is very important, infrastructure, equipment, and technology especially telecommunication should be improved and facilitated for both audiologist and patients.

Objective

This study was conducted to determine whether there is a reliable method for measuring the thickness of the retroauricular skin before, during, and after cochlear implantation, which allows the assessment of the optimal force of the external magnet of the cochlear implant (CI).

Methods

The retroauricular skin thickness of 83 patients who received a CI was measured using three different methods. The thickness was measured on pre- and postoperative CT images, as well as intraoperatively. The magnet category chosen by the surgeon was recorded when the implant was switched on and during the first follow-up visit. Correlation analyses were performed on the different skin thickness measurements and between the skin thickness and magnet strength categories.

Results

Only six patients required an exchange of the magnet until the follow-up. Although the median absolute thickness differed significantly between the three measures (p < 0.0001), their thickness values showed highly significant correlations (Pearson's r = 0.457–0.585; p < 0.01). In addition, magnet strength, was significantly correlated with the flap thickness determined pre-, post-, and during surgery. The lowest correlation with magnet strength was found in the intraoperative needle method.

Conclusion

All three measurements methods provided a suitable base for determining the ideal magnetic force. However, of particular interest were the pre- and postoperative CT measurements. The first enabled the early assessment of the required magnetic strength and thus a timely postoperative supply, whereas the latter helped to estimate the need for magnetic strength reduction during follow-up care and the feasibility of an early swith-on.