Journal of International Advanced Otology最新文献

Background: This study describes the efficacy of cochlear implantation under local anesthesia with conscious sedation with dexmedetomi- dine in adult patients and proposes a method to communicate with the conscious and cooperative patient intraoperatively. This less invasive anesthetic procedure is suitable for patients with comorbidities preventing general anesthesia.

Methods: Unilateral cochlear implantation with Oticon Medical systems was performed in 10 adult patients with comorbidities preventing general anesthesia. Classical cochlear implantation was performed under local anesthesia and conscious sedation with dexmedetomidine. Cue cards were used to support intraoperative dialogue. Outcome measures were intraoperative adverse events, patient perceptions, as well as post- operative completions measured with a questionnaire.

Results: The procedure was successful for all 10 patients. Dexmedetomidine lead to rapid and successful conscious sedation and no case of high blood pressure or aggravation of comorbidities was noted. Stapedial reflex measurements led to reliable thresholds. The usage of the cue cards was successful: patients were able to read the cue cards and thereby the medical team could inform the patients of surgical progress and ask the patients questions.

Conclusion: Cochlear implantation and intraoperative dialogue with the conscious and cooperative patient is possible. The main advantage of the anesthetic procedure is the reduction in intra- and postoperative complications. Further, expected benefits include a less invasive procedure, the conscious state of the patient which enables the recording of auditory perception, and the absence of nonauditory percepts such as facial nerve stimulation during implant stimulation, a shorter surgical duration, and lower-associated costs.

Background: Bone-anchored hearing aids represent a valid alternative for patients with conductive/mixed hearing loss who cannot use hear- ing aids. To date, these devices have given good audiological results, thanks to various fitting prescription programs (i.e., National Acoustic Laboratories and Desired Sensation Level). The aim of this study is to compare 2 types of fitting algorithms (National Acoustic Laboratories and Desired Sensation Level) implemented for bone-anchored hearing devices.

Methods: We retrospectively enrolled 10 patients followed at our operative unit, suffering from bilateral symmetrical mixed hearing loss and who underwent bone-anchored hearing aid implantation. All patients experienced each prescriptive procedure, National Acoustic Laboratories and Desired Sensation Level, for 7 months (on average), and they were subjected to audiological tests and questionnaires to evaluate the best program.

Results: National Acoustic Laboratories and Desired Sensation Level prescriptions yielded similar results. Desired Sensation Level allowed less amplification of the low frequencies than the National Acoustic Laboratories prescription, and these differences were the only statistically sig- nificant. Desired Sensation Level allowed better disyllabic word and sentence recognition scores only in quiet and not in noisy conditions. The subjective questionnaires showed similar results. At the end of the trial sessions, more patients (60%) definitively chose the Desired Sensation Level program for their device. These patients were those with a worse hearing threshold.

Conclusion: The 2 prescriptive programs allowed similar results although patients with a worse threshold seem to prefer the DSL program. This is the first evaluation of the 2 prescriptive programs, National Acoustic Laboratories versus Desired Sensation Level, for bone conduction devices available in the literature. Further studies are needed to confirm this initial finding.

Background: To investigate the relationship between residual hearing and early auditory speech performance in Mandarin-speaking children with cochlear implants.

Methods: Twenty-four prelingually deaf children implanted with a cochlear implants participated in the study. Auditory performance and speech intelligibility were longitudinally evaluated by categories of auditory performance, infant-toddler meaningful auditory integration scale/ meaningful auditory integration scale, speech intelligibility rating, and meaningful use of speech scale. According to the postoperative pure tone average threshold, children were grouped as "better" and "worse" residual hearing.

Results: Better hearing preservation was observed in 7 children (29.2%) and worse preservation in 17 children (70.8%). The scores of categories of auditory performance, infant-toddler meaningful auditory integration scale/meaningful auditory integration scale, speech intelligibility rating, and meaningful use of speech scalewere higher in children with better residual hearing. The residual hearing level was significantly associated with the performance of meaningful use of speech scale (P = .004), as well as the performance of speech intelligibility rating (P = .049).

Conclusion: The present study showed that children with better residual hearing exhibited advantages in the early auditory and speech out- comes. The study highlighted the effects of residual hearing on early auditory performance and speech intelligibility development in Mandarin- speaking children with cochlear implants.

Background: Both the Dix-Hallpike test and the supine head-roll test can provoke positional nystagmus in a group of benign paroxysmal positional vertigo patients, including but not limited to those with multiple canal involvement. This study aimed to determine the incidence and interpret the clinical significance of positional nystagmus provoked by both the Dix-Hallpike and the supine head-roll tests.

Methods: The results of video-nystagmography sessions recorded in the computer database that included both the Dix-Hallpike and the supine head-roll tests were examined.

Results: The records belonging to 2880 video-nystagmography sessions of 2387 patients were examined. Nystagmus was detected in both the Dix-Hallpike and the supine head-roll tests of 131 (5.5%) patients. The video images belonging to 142 session records of 122 patients were accessed and further analyzed. The diagnosis was posterior canal BPPV in 9.0%, and lateral canal BPPV in 62.3%. More than one canal was involved in 3.3%, one rehabilitation maneuver was performed in 75.0%, and recurrence was observed in 7.4% of those patients.

Conclusion: In both geotropic and apogeotropic variants of lateral canal BPPV, nystagmus can be observed during the Dix-Hallpike test in addition to the supine head-roll test. In patients with posterior canal benign paroxysmal positional vertigo, nystagmus can also be observed in the head-roll test. To reach a correct and comprehensive diagnosis and apply appropriate treatment in benign paroxysmal positional vertigo, the Dix-Hallpike test and the head-roll test should be completely performed on both sides, and the results of those tests must be interpreted concomitantly.

It was the aim of this study to report a rare case of electrode positioner extrusion in cochlear-implanted patients as a late complication and introduce safe management. A retrospective case report in a tertiary referral center. Extrusion of Silastic electrode positioner through tympanic membrane occurred 17 years after cochlear implantation surgery. Although electrode positioner cochlear implants are not being used anymore, otologists and surgeons should be aware of their possible related complications and provide a proper management.

Background: To explore potential causes leading to the failure of the surgical reconstruction of sigmoid sinus wall in patients with pulsatile tinnitus.

Methods: This study retrospectively analyzed pulsatile tinnitus patients with sigmoid sinus wall dehiscence and/or sigmoid sinus diverticulum, who underwent revision surgeries following the surgical reconstruction of the sigmoid sinus wall.

Results: A total of 7 pulsatile tinnitus patients were included. After the first surgery, 5 of 7 patients showed varying degrees of remission in pulsatile tinnitus, but pulsatile tinnitus gradually recurred. The other 2 patients experienced no change in pulsatile tinnitus. Images after the first surgeries revealed that the surgical failure of Patients 1-5 was caused by incompleted elimination of sigmoid sinus wall dehiscence and sigmoid sinus diverticulum. Following revision surgeries, they all acquired great or complete resolution of pulsatile tinnitus. In Patient 6, an abnormal diploic vein entering the sigmoid sinus was overlooked during the first surgery for repairing sigmoid sinus wall dehiscence. As soon as the diploic vein was blocked during the revision surgery, the patient's pulsatile tinnitus was alleviated significantly. Patient 7 had a recurrence of pulsatile tinnitus after transient improvement following the first surgery, and still experienced no change in pulsatile tinnitus after the revision surgery. However, after venous sinus stenting in the stenosis of transverse-sigmoid sinus junction, she got complete resolution of pulsatile tinnitus. It sug- gested that the unresolved stenosis of the venous sinus was the cause of the surgical failure.

Conclusions: Both sigmoid sinus diverticulum and sigmoid sinus wall dehiscence are recommended to be resolved during surgery. Abnormal diploic veins and venous sinus stenosis are potential causes of pulsatile tinnitus.

Background: Congenital cholesteatomas account for just up to 5% of all cholesteatomas and most commonly arise in the petrous apex and middle ear. Congenital cholesteatomas arising in the mastoid are rare and typically present late.

Methods: In this study, we report a case series of 3 cases managed in our department between 2006 and 2021 and present a summary of the current literature.

Results: Congenital cholesteatomas arising in the mastoid is a rare finding and even among reported cases, not all are clearly mastoid in origin. Their location allows for considerable growth before symptoms develop. Pain and localized swelling in the temporal area are the most common presenting symptoms which can lead to diagnostic challenges. Our cases show that although surgery is often appropriate, conservative manage- ment may be suitable in certain situations.

Conclusion: Congenital cholesteatoma of mastoid origin is rare and can present a diagnostic challenge. Greater awareness is important to facilitate early detection. A high index of suspicion is needed in those presenting with retro-auricular pain and swelling in the context of a normal ontological examination.

Background: The primary goal of this study was to determine the occurrence of bilateral vestibular hypofunction in a specialized dizziness clinic and to assess the etiology in patients diagnosed with bilateral vestibular hypofunction. Secondary goal was to find out if the diagnosis was already made before the patient was seen at our clinic.

Methods: A retrospective cohort study, including patients who visited our specialized dizziness center between January 1, 2008, and December 31, 2018, fulfilling the criteria for bilateral vestibular hypofunction according to the Classification Committee of the Bárány Society (2017). Data were collected regarding symptoms, causes, and vestibular function.

Results: In total, 126 patients met our initial inclusion criteria, of which 103 patients met the Classification Committee of the Bárány Society criteria for bilateral vestibular hypofunction, so patients with bilateral vestibular hypofunction comprised 0.9% of the total population seen at our clinic. Mean age was 65.2 years and 49.5% were female. In only 29.1% of patients, the diagnosis was already made elsewhere. A definite cause was identified in 39.8%, the most common cause being ototoxicity.

Conclusion: About 1% of the patients visiting our dizziness clinic has bilateral vestibular hypofunction. In our patient population, ototoxicity was the most common cause of bilateral vestibular hypofunction, and in more than 40%, the cause remains unknown. In the majority of the cases, the diagnosis of bilateral vestibular hypofunction was first made at our clinic and not by the referring general practitioner or specialist. When using the Classification Committee of the Bárány Society criteria for bilateral vestibular hypofunction and presbyvestibulopathy, some patients with bilateral vestibular weakness and complaints cannot be categorized in either group.

Ototoxic side effects such as sensorineural hearing loss and tinnitus can be caused by acute salicylate intoxication. Bilateral symmetric sensori- neural hearing loss involving all tested frequencies is a typical pattern of hearing loss in acute salicylate intoxication, which usually resolves within 2 or 3 days without any specific treatment for ototoxicity. Herein, we report a case of suicidal aspirin intoxication resulting in sudden bilateral hearing loss and vertigo. The patient exhibited spontaneous downbeat nystagmus, and the mechanism underlying this characteristic nystagmus is discussed.