Audiology Research最新文献

Background/Objectives: Tumors of the cerebellopontine angle (CPA) encompass a limited range of histologies, predominantly vestibular schwannomas (VSs), meningiomas, and paragangliomas (PGLs). Their growth region threatens the cranial nerves (V-XII), brainstem, and cerebellum, possibly causing functional deficits. This review aims to synthesize clinical features and multidisciplinary treatment strategies for CPA tumors with brainstem involvement, emphasizing functional preservation alongside tumor control. Methods: A systematic PubMed search identified studies on VSs, CPA meningiomas, and intradural PGLs. Eligibility criteria included studies reporting tumor management and cranial nerve outcomes. Data extraction focused on tumor size, neurological presentation, surgical approach, adjunctive therapies, and postoperative cranial nerve function. Multidisciplinary involvement and rehabilitation strategies were noted. Results: Twenty studies (3311 patients) analyzed large VSs, showing facial nerve dysfunction in 8-53%, trigeminal neuropathy in 20-77%, and cerebellar signs in up to 79%. Microsurgery (MS) achieved variable gross total resection, while stereotactic radiosurgery (SRS) preserved facial nerve function but carried trigeminal and hydrocephalus risks. CPA meningiomas demonstrated cranial nerve displacement patterns critical for surgical planning, with transient deficits common and recovery linked to baseline function. In 388 intradural PGL cases, staged surgery combined with preoperative embolization was standard; functional preservation of lower cranial nerves was often limited. Across all histologies, multidisciplinary management and targeted rehabilitation were essential. Conclusions: Optimal CPA tumor management balances tumor control with functional preservation. VSs benefit from individualized MS or SRS based on size and mass effect. Meningioma surgery prioritizes cranial nerve preservation over radical resection. Intradural PGLs require staged vascular-conscious approaches. Multidisciplinary care and structured rehabilitation are pivotal to improving outcomes and quality of life.

Background/Objectives: This study aims to evaluate the effectiveness of hearing aid amplification in reducing self-perceived tinnitus handicap in individuals with ski-slope hearing loss-a population seldom addressed in previous research. In addition, a correlation analysis was performed to examine the relationship between tinnitus duration, pitch, loudness, and THI scores. The results are then compared with those of patients with high-frequency gently sloping hearing loss. Methods: 38 patients with bilateral sensorineural hearing loss and chronic tonal tinnitus were retrospectively evaluated and divided into two equal groups: high-frequency gently sloping and ski-slope hearing loss (n = 19 each). Tinnitus pitch, loudness, and edge frequency were assessed. The Mann-Whitney test compared tinnitus characteristics between groups, while the Wilcoxon signed-rank test evaluated pre- and post-treatment THI scores. Spearman correlation was used to explore associations between tinnitus duration, intensity, pitch, and THI outcomes. Results: The Mann-Whitney test showed significant differences in tinnitus pitch, and edge frequency between both groups; no statistically significant differences were found for the tinnitus level. Tinnitus frequency was higher in the high-frequency gently sloping group. The Wilcoxon test confirmed significant improvements in THI scores post-treatment for both groups (p < 0.001). No significant correlations were found between tinnitus duration, level, pitch, and post-treatment THI scores. Conclusions: Hearing aids effectively reduce tinnitus severity in patients with ski-slope and gently sloping hearing loss, supporting their use as a therapeutic option. Larger, multicentric studies are recommended to validate these findings and explore specific auditory profiles and processing strategies.

Background: Cochlear implants (CIs) are a life-changing treatment for individuals with severe to profound hearing loss, yet adult CI uptake remains low despite high clinical and economic effectiveness. This study investigates adult patient experiences, adaptation, and barriers to CI access in Saudi Arabia.

Methods: A survey of 89 adult CI recipients was conducted across three major CI centers in Saudi Arabia. The electronic questionnaire explored pre- and post-implant experiences, including referral pathways, device choice, adaptation, and satisfaction. Descriptive statistics, ranked correlations, and inferential tests were used to analyze associations between demographic and clinical variables.

Results: The median time between hearing loss diagnosis and implantation was 17 years, with most patients using hearing aids beforehand. Healthcare professionals were the primary source of CI interest for 48% of respondents, though younger recipients were more often influenced by peers. Longer daily device use was linked to faster acclimatization (ρ = -0.26, p < 0.05); however, age, wait time, and initial attitude did not affect adaptation. Outcomes exceeded expectations for 54% of participants. Major barriers included lack of awareness (23%) and fear of surgery (18%). Only 4% learned about CI through social media. Advice for future candidates emphasized confidence and proactive action.

Conclusions: Despite expanded CI availability in Saudi Arabia, structural and societal barriers persist. Empowering healthcare professionals and utilizing social media for awareness may enhance adult CI uptake and improve hearing health outcomes.

Does Superior Semicircular Canal Dehiscence Surgery Resolve or Exacerbate BPPV? Background/Objectives: BPPV is commonly found to be associated with other inner ear disorders. It has been found to occur with Superior Semicircular Canal Dehiscence (SSCD) as well as postoperatively following SSCD surgical repair. This paper will analyze the preoperative and postoperative incidence of positional vertigo in patients undergoing SSCD surgery. Methods: This is a retrospective chart review of 50 consecutive patients with SSCD undergoing surgical repair. They were evaluated preoperatively, at 1 week postoperative, at 6 weeks postoperative, and at 12 weeks postoperative for evidence of BPPV. Information collected included demographics, the semicircular canal involved, type of BPPV, and whether the patient required canalith repositioning. Results: Preoperatively, 33 (66%) patients reported symptoms of positionally induced vertigo with confirmation during VNG testing. No patient was treated for BPPV prior to surgery. At one week postoperative, 17 (35%) patients continued to have symptoms of positionally induced vertigo; at 6 weeks postoperative, 9 (18%), and at 12 weeks postoperative, 5 (10%) patients had positional vertigo requiring canalith repositioning (p < 0.05). Three patients (6%) had no evidence of BPPV preoperatively but had positional vertigo at the one-week postoperative evaluation. At the 6-week post-op visit, only one of the patients had new-onset postoperative positional vertigo. At the 3-month visit, no patient had new-onset postoperative positional vertigo. Conclusions: BPPV and positional vertigo symptoms were found commonly prior to SSCD surgery and in the week after SSCD surgery. However, BPPV resolved by 6 weeks after SSCD surgery without additional intervention for most of these patients, while the others underwent canalith repositioning. A small percentage developed BPPV after surgery who had none preoperatively and in the contralateral ear.

Background: Tinnitus has been increasingly reported during the COVID-19 pandemic, following both infection and vaccination. While these reports suggest that pandemic-related factors may influence the onset or worsening of tinnitus, the perceptual characteristics and functional consequences of such cases remain poorly understood. This study examined the nature, severity, and communication-related impact of self-reported tinnitus following COVID-19 vaccination. Methods: A total of 770 adults who self-reported new or worsened tinnitus after vaccination completed a structured online survey between August 2021 and May 2023. Standardized instruments included the Tinnitus Functional Index (TFI), the Speech, Spatial and Qualities of Hearing Scale (SSQ), and visual analog scales assessing loudness discomfort and hyperacusis-related symptoms. Analyses included descriptive statistics, chi-square tests, t-tests, and correlation matrices. Results: Respondents reported moderate to severe tinnitus-related distress, with the greatest impacts on emotional control, sleep, and relaxation. Many described communication difficulties in noisy or multi-talker environments, despite relatively preserved spatial hearing and sound quality. A substantial subset endorsed hyperacusis symptoms, including sound-induced annoyance, fear, and intolerance. Correlation analyses revealed strong associations between emotional, cognitive, and auditory domains, underscoring the multidimensional burden of tinnitus in this population. Conclusions: Self-reported tinnitus after COVID-19 vaccination was associated with distress, sleep disruption, and communication difficulties, mirroring patterns commonly observed in tinnitus more broadly. Although causality cannot be determined, these findings highlight the importance of comprehensive audiological and psychological assessment for individuals reporting auditory complaints after vaccination and support the inclusion of functional hearing outcomes in tinnitus evaluation protocols.

Background: Binaural hearing is crucial for spatial auditory perception, including sound localization. Cochlear implants (CIs) are commonly used in children with congenital deafness to support binaural auditory development, but the extent to which they facilitate effective localization remains unclear.

Objective: This study evaluates the impact of CIs on binaural functional auditory development and sound localization in children with congenital deafness, considering factors such as age at implantation, hearing experience, and CI laterality.

Methods: Thirty-eight CI-assisted children (aged 4-9 years) underwent directional hearing assessments using the "Erfassung des Richtungshörens bei Kindern (ERKI)" device. Localization accuracy was analyzed across various noise stimuli, and correlations with audiometric parameters and CI history were examined.

Results: Localization accuracy improved with age and CI experience. Bilateral CI users outperformed unilateral users, particularly with pulse pink noise stimuli. The use of SmartSound iQ with SCAN technology enhanced localization, especially in younger children.

Conclusion: CIs support binaural functional auditory development in children with congenital deafness, with localization skills improving over time. Bilateral implantation and early intervention may further enhance outcomes, warranting continued research.

Background/Objectives: Cochlear implantation is the most widely used treatment option for patients with severe to profound hearing loss. Despite being a relatively standardized surgical procedure, cochlear implant (CI) outcomes vary considerably among patients. Several studies have attempted to develop predictive models for CI outcomes but achieving accurate and generalizable predictions remains challenging. The present study aimed to evaluate whether simple and complex statistical and machine learning models could outperform the Null model based on various pre-CI implantation variables. Methods: We conducted a retrospective analysis of 236 ears with postlingual profound sensorineural hearing loss (SNHL) and measurable residual hearing (WRS_max > 0%) at the time of implantation. The median postoperative word recognition score with CI (WRS₆₅(CI)) was 75% [Q1: 55%, Q3: 80%]. The dataset was divided using a 70:15:15 split into training (n = 165), validation (n = 35) and test (n = 36) cohorts. We evaluated multiple modeling approaches: different Generalized Linear Model (GLM) approaches, Elastic Net, XGBoost, Random Forest, ensemble methods, and a Null model baseline. Results: All models demonstrated similar predictive performance, with root mean squared errors ranging from 26.28 percentage points (pp) to 30.74 and mean absolute errors ranging from 20.62 pp to 23.75 pp. Coefficients of determination (R²) ranged from -0.468 to -0.073. Bland-Altman analyses revealed wide limits of agreement and consistent negative bias, while Passing-Bablok regression indicated calibration errors. Nonetheless, all models incorporating predictors significantly outperformed the Null model. Conclusions: Increasing model complexity yielded only marginal improvements in predictive accuracy compared with simpler statistical models. Pre-implantation clinical variables showed limited evidence of predictive validity for CI outcomes, although further research is needed.

Introduction: Cochlear implantation is the treatment of choice for severe hearing loss and deafness. Cholesteatomas can cause this deafness. A frequently used procedure in the course of surgical rehabilitation is a subtotal petrosectomy combined with a cochlear implant. The clinical follow-up of residual cholesteatomas is related to the blind sac closure difficult. Cholesteatoma MRI sequence-related CI magnet artefacts make follow-up challenging. Recent developments in combining cochlear implants and necessary MRI examinations enable the assessment of the internal auditory canal and cochlea. The study aimed to develop a procedure for detecting cholesteatomas in patients with cochlear implants using magnetic resonance imaging (MRI).

Methods: Ex vivo MRI examinations were performed on five volunteers with fixed cochlear implants (Medel Synchrony) and swim caps. MRI examinations were performed at 1.5 T and 3 T using EPI, HASTE, and RESOLVE sequences (Siemens). The position of the implant was 12 cm distal to the external auditory canal, with anteversional head position of the volunteers in the MRI.

Results: Due to artefact effects, assessment of the ipsilateral and contralateral mastoid is not possible with EPI sequences and a cochlear implant. The combination of cholesteatoma-detecting MARS sequences (HASTE, RESOLVE), a distal implant position, and a specific head position allows the assessment of the ipsilateral mastoid.

Conclusions: Postoperative cholesteatoma assessment after CI implantation and subtotal petrosectomy appears to be possible under 1.5 T and 3 T, considering the MRI sequence, implant position, and head position.

Background: The inner ear hosts several macrophage populations. Endolymphatic sac macrophages can phagocytose otoconia, and spiral limbus macrophages express genes for fluid shear stress sensing and bone remodeling. Obstruction of endolymph flow by saccular otoconia could be linked to endolymphatic hydrops. Since macrophages are strongly affected by inflammatory status, a role for them in otolith removal could provide a link between inflammation and hydrops. However, the distribution of macrophages around the reuniting duct (RD) and endolymphatic duct (ED), which are narrow structures likely prone to blockage, remains unexplored. Methods: We performed tissue clearing and light-sheet imaging on rat temporal bones. Autofluorescence and immunolabeling for collagen IV, smooth muscle actin, and Iba1 were used to visualize inner ear structures, blood vessels, and macrophages. Results: The connective tissue layer underlying the RD extended from the cochlear spiral limbus. The RD and spiral limbus hosted a continuous microvascular network and macrophage population, comprising both ameboid and ramified cells; macrophages also surrounded the underlying vestibulocochlear artery (VCA). A separate macrophage population, continuous with that of the saccular connective tissue, was found around the endolymphatic sinus and utriculo-endolymphatic (Bast's) valve; macrophage patterns changed in the vestibular aqueduct and endolymphatic sac. Conclusions: Macrophages are observed in positions consistent with potential roles in sensing luminal changes and in the clearance of obstructive material from the RD and ED; functional confirmation will require targeted experiments.

The points of contact between the vestibular system and the trigeminal nerve remain an active area of research. Anatomically, several connections have been clearly identified, and these may play a role in the development of various disorders. Understanding these connections also proves to be extremely valuable from a clinical perspective. It is increasingly evident that the etiopathogenesis of various vestibular disorders is multifactorial. Therefore, knowledge of the points of interaction between the two systems can assist clinicians in patient assessment and, most importantly, in selecting the most appropriate therapeutic approach. This study is presented as a narrative review. A literature search was conducted to identify studies investigating the correlation between the trigeminal system and the vestibular system, as well as their respective characteristics, to provide a comprehensive overview. Since this is a narrative rather than a systematic review, no specific inclusion or exclusion criteria were applied. So, the aim of this study is to analyze these connections through a comprehensive review of the literature, trying to present a multidisciplinary approach to the topic, one that can involve both the neurologist and the otologist, in order to achieve a more refined management of clinical cases. To better understand their anatomical relationships, we begin by examining the embryological development of both the vestibular system and the trigeminal nerve. Finally, we present current knowledge on the trigeminal influence in certain vestibular disorders-particularly vestibular migraine-and, conversely, the vestibular system's potential impact on trigeminal-related conditions.