Journal of International Advanced Otology最新文献

Background: The suppression head impulse test is a new paradigm of the head impulse test, recently introduced for clinical use. The aim of this study was to assess the importance of the suppression head impulse paradigm in evaluating vestibular function.

Methods: This comparative study was conducted from June 2020 to June 2022. The ears of the participants were divided into 2 groups: (i) ears with vestibular weakness and (ii) healthy controls. All participants underwent video head impulse tests at the time of presentation with both conventional head impulse paradigm and suppression head impulse paradigm, performed by the same examiner. The results of the 2 tests were compared, and the correlation between the corresponding parameters obtained (vestibulo-ocular reflex gain and saccades) was examined.

Results: Ninety-five participants were included in the study (190 ears) with a mean age of 42.2 ± 12.6 years. Forty-six ears had vestibular weakness, and 144 were healthy controls. The suppression head impulse paradigm test showed a significantly lower vestibulo-ocular reflex gain than the head impulse paradigm in both groups. A positive correlation emerged between the vestibulo-ocular reflex gain measured with both paradigms. Regarding the saccades, a negative correlation was observed between the overt saccades latency and amplitude measured with both paradigms.

Conclusion: The new suppression head impulse paradigm complements the head impulse paradigm for a better evaluation of the vestibular function. The inconsistency of covert saccades in suppression head impulse paradigm makes it superior to head impulse paradigm in measuring vestibulo-ocular reflex gain, especially in patients with vestibular loss.

Background: Eustachian tube dysfunction affects from 1% to 5% of adults. This study evaluates the effectiveness of balloon dilation of eustachian tube for treating nonselected patients with eustachian tube dysfunction in a long term.

Methods: We evaluated all balloon dilation of eustachian tube operations at Turku University Hospital from 2013 to 2016. The data from 107 patients and 167 ears were collected retrospectively and a questionnaire was sent to these patients regarding their symptoms.

Results: An evident reduction of the symptoms was noticed. Aural fullness, otalgia, recurrent acute otitis media, or otitis media with effusion as well as symptoms from changes to ambient pressure and the ability to do the Valsalva maneuver were significantly improved. The mean followup time with the questionnaire was 33 months. Of patients, 80% (36/45) reported long-term reduction of symptoms.

Conclusions: In our study, balloon dilation of eustachian tube seems to have reduced symptoms of eustachian tube dysfunction and the results appear to be long lasting.

Background: Obstructive Eustachian tube dysfunction in adults is common. The purpose of this study was to examine whether balloon dilation of the Eustachian tube can improve ventilation of the middle ear among adult patients with mild chronic Eustachian tube dysfunction.

Methods: This study included patients aged ≥18 years with unilateral chronic Eustachian tube dysfunction confirmed with an abnormal tympanometry and a retracted tympanic membrane. Patients were treated daily with nasal steroid spray and Valsalva maneuver for 2 months. If Eustachian tube dysfunction persisted, they were enrolled in the study and randomized to balloon dilation of the Eustachian tube or control. All patients underwent otomicroscopy, tympanometry, pure-tone audiometry and the Eustachian Tube Dysfunction Questionnaire-7. Follow-up visits were completed at 3 weeks, 3 months, and 6 months.

Results: In total, 24 patients completed the study (13 balloon dilation of the Eustachian tube, 11 control). The balloon dilation of the Eustachian tube group showed normalization from retraction or serous otitis media in 9 out of 13 patients (P = .0006) compared to 0 out of 11 patients in the control group. In the balloon dilation of the Eustachian tube group, 9 out of 13 patients showed an improvement in tympanometry from B to C/A or from C to A (P = .04) compared to 3 out of 11 patients in the control group. The audiometric data showed no difference (P = .38). There was no significant difference in mean Eustachian Tube Dysfunction Questionnaire-7 score between the two groups (P = .35). In the balloon dilation of the Eustachian tube group, 69% answered that they had benefitted from the treatment.

Conclusion: The procedure is feasible and no complications were reported. The study indicates that balloon dilation of the Eustachian tube may be a beneficial treatment in a selected group of adult patients with mild chronic Eustachian tube dysfunction.

Background: Sudden sensorineural hearing loss is a common disease with several etiologic hypotheses, such as infection, vascular occlusion, inflammation, oxidative stress, etc. Studies have reported that the concentration of cell-free DNA in plasma will elevate in these situations. Former studies have reported that the whole-genome sequencing of cell-free DNA has high accuracy and sensitivity in inferring gene expressions. In this study, we plan to use the whole-genome sequencing of cell-free DNA to uncover novel prognostic factors of sudden sensorineural hearing loss and provide new insight into the clinical application of cell-free DNA.

Methods: In this study, 84 sudden sensorineural hearing loss patients (47 in recovery group and 37 in no-recovery group) were enrolled. After whole-genome sequencing of the cell-free DNA, the protein-protein interaction network was constructed using the differentially expressed genes. Multinomial logistics regression analysis was used to analyze the prognostic factors of hearing improvement.

Results: In this study, we found distinct patterns of expressed and unexpressed genes in cell-free DNA sequence read depth coverage in sudden sensorineural hearing loss patients. The top centrality hub genes IGF1, NOTCH1, APOE, FAM3C, RPS6KB1, and RELB were identified from the protein-protein interaction network. Multinomial logistics regression analysis demonstrated that the coverage patterns of 3 key differentially expressed genes (NOTCH1, APOE, and RELB) are significantly different in sudden sensorineural hearing loss with and without hearing recovery.

Conclusion: The cell-free DNA could have more applications in diverse diseases, and the coverage patterns of 3 differentially expressed genes (NOTCH1, APOE, and RELB) are independent prognostic factors of sudden sensorineural hearing loss. Their expression levels may play a critical role in the hearing improvement of sudden sensorineural hearing loss patients.

Background: This study aimed to examine the plasticity of nerves indirectly by acoustic reflex after surgical repair of unilateral congenital aural atresia.

Methods: This study is a retrospective study including 80 patients who had undergone surgical repairs of congenital aural atresia before 18 years old and for whom acoustic reflex testing was performed postoperatively. Several variables correlated with acoustic reflex were analyzed to find factors affecting the presence of acoustic reflex.

Results: Among 80 patients, 44 were positive for acoustic reflex. As a result of multivariate analysis, good postoperative hearing (P = .017), younger age at surgery (P = .028), and the longer time interval between surgery and acoustic reflex test (P = .040) were revealed as factors affecting the acoustic reflex.

Conclusion: Acoustic reflex was present in 55% of surgically managed patients with congenital aural atresia. The results of this study imply that the reflex arc of acoustic reflex may be restored after proper surgical reconstruction and prolonged use of reconstructed ear in patients with unilateral congenital aural atresia.

Background: The aim of this study is to observe the application of the Chinese version of Tinnitus Handicap Inventory-China in Tinnitus patients and verify its reliability and validity.

Methods: About 1129 patients with tinnitus as the first complaint were selected as subjects. The patients were randomly divided into 2 groups: exploration group (n = 565), whose data were analyzed with reliability analysis method using Statistical Package for the Social Sciences software 19.0, validation group (n = 564), whose data were analyzed with validity analysis method using AMOS21.0.

Results: (1) Reliability test: The Cronbach's α coefficients of the Tinnitus Handicap Inventory-China scale in both groups were 0.94, among which, the Cronbach's α coefficients of functional factor (F), emotion factor (E), and catastrophic factor (C) in group E were 0.87, 0.90, and 0.78, respectively. The half-reliability of the 2 components is 0.87. The correlation coefficient between items and the scale in group E and group V is 0.36-0.78 and 0.33-0.77, respectively. (2) Content validity: The Kaiser-Meyer-Olkin value of group E is 0.96, a total of 4 common factors were extracted, and the cumulative interpretation rate is 57.844%. The number of factors with load less than 0.4 on the 4 common factors is only 1 (F24), suggesting that this factor had little significance; the number of factors with load more than 0.4 on the 2 common factors is 8 (F1, E6, F9, C11, F15, E21, E22, and C23), suggesting that patients had different understandings of these 8 questions. (3) Structural validity: The root mean square error of approximation value of the AMOS structural model in group V is 0.065, and the root mean square residual value is 0.114, indicating low fitness; the NC value is 3.353, indicating good fitness of the scale, but it still needed to be simplified.

Conclusion: The Chinese version of Tinnitus Handicap Inventory-China has a high reliability when applied in China, but the content validity and structure validity are not high, and the clinical practicability needs to be improved.

Background: It is aimed to investigate the incidence of cerebrospinal fluid gusher in cochlear implantation and the association between cerebrospinal fluid gusher and inner-ear malformations in adult and pediatric patients.

Methods: A retrospective case review of 1025 primary cochlear implantation procedures was performed. Patients with inner-ear malformation or cerebrospinal fluid gusher during primary cochlear implantation were included and divided into 2 groups according to age: pediatric and adult groups.

Results: The incidence of inner-ear malformation was 4.19% (17/405) and 7.6% (47/620) in the adult and pediatric groups, respectively. There was a significant difference in the incidence of inner-ear malformation in the pediatric group. The incidence of cerebrospinal fluid gusher was 0.9% (4/405) and 4.1% (26/620) in the adult and pediatric groups, respectively. There was a significant difference in the incidence of gusher between the adult and pediatric groups.

Conclusion: The incidence of a cerebrospinal fluid gusher is higher in the pediatric group, compared to adults due to a higher rate of inner-ear malformation. Inner-ear malformation poses a risk factor for cerebrospinal fluid gusher.

Background: The role of imaging in cholesteatoma continues to evolve with excellent bony details provided by high-resolution computed tomography and high soft tissue identification for cholesteatoma by diffusion-weighted magnetic resonance imaging. The fusion of highresolution computed tomography and diffusion-weighted magnetic resonance imaging combines the advantages of both imaging techniques.

Methods: A random sample of 40 consecutive patients with chronic suppurative otitis media with cholesteatoma was included in this study. Both high-resolution computed tomography of the petrous bone and non-echoplanar diffusion-weighted magnetic resonance imaging were performed. This was followed by their fusion. Patients were classified according to The European Academy of Otology and Neurotology, in cooperation with the Japanese Otological Society Joint Consensus Statement on the Definitions, Classification, and Staging of Middle Ear Cholesteatoma. All patients were operated, and the technique was tailored according to the data obtained from the preoperative fusion of computed tomography and diffusion-weighted magnetic resonance imaging and the intraoperative findings.

Results: Patients were equally divided between males and females with a mean age of 26.8 years of which 52.5% were left-sided ears. The fusion of high-resolution computed tomography and diffusion-weighted magnetic resonance imaging had a 100% sensitivity and 88.9% specificity regarding The European Academy of Otology and Neurotology, in cooperation with the Japanese Otological Society classification. On the other hand, it showed 100% specificity and 100% sensitivity for all middle ear subsites except sinus tympani which obtained 55.56% sensitivity and 100% specificity. In all patients with preoperative fusion showing cholesteatoma not reaching the mastoid antrum (30%), exclusive endoscopic approach was employed, and no postauricular incision was needed.

Conclusion: The fusion of high-resolution computed tomography and diffusion-weighted magnetic resonance imaging images is an accurate tool for localizing cholesteatoma in various middle ear cleft subsites. This makes it a valuable tool for cholesteatoma classification and staging and surgical planning preoperatively.

Background: This study aimed to identify the incidence of benign paroxysmal positional vertigo following head trauma.

Methods: This study is a prospective cross-sectional study. Initially, a targeted search for the identification of patients with the international classification of diseases (ICD-10) diagnosis of cerebral commotio at relevant emergency units in the Northern Region of Denmark was done. This was followed by a clinical examination to determine the incidence of benign paroxysmal positional vertigo (BPPV) within this population. Of the 295 patients diagnosed with commotio cerebri during a 4-and-a-half month period, 85 patients were included. All patients underwent clinical examination in a mechanical repositional chair wearing Video Frenzel Goggles. Additional examinations included a complete video head impulse test.

Results: A total of six patients were identified with benign paroxysmal positional vertigo (BPPV) following minor head trauma. Bilateral BPPV, multicanal BPPV, and BPPV of a single semicircular canal were identified. All patients experienced relief of benign paroxysmal positional vertigorelated symptoms within 3 treatment sessions. Five patients were identified with a pathological video head impulse test, 54 with an inconclusive examination, and 15 with a normal video head impulse test.

Conclusion: The incidence of benign paroxysmal positional vertigo following minor head trauma was 7%. A relatively high number of atypical subtypes of benign paroxysmal positional vertigo was found. When applying strict criteria for the interpretation of video head impulse test examination, the number of patients with inconclusive video head impulse test examination was higher than expected and 6.7% of patients had a pathological video head impulse test examination. No relationship between benign paroxysmal positional vertigo and pathological video head impulse test was observed.

Background: The effect of chronic noise on the middle ear is not fully known. This study aimed to evaluate the middle ear functions of metal workers exposed to chronic noise using wideband tympanometry.

Methods: In this study, 62 male workers exposed to chronic noise and 30 healthy men were included. Workers exposed to chronic noise were divided into 2 groups according to their pure tone averages. Totally 30 workers (60 ears) with pure tone average less than 20 dB were included in group I, and 32 workers (64 ears) with pure tone average more than 20 dB were included in group II. All individuals were subjected to wideband tympanometry. Tympanometric peak pressure, equivalent ear canal volume, static acoustic admittance, resonance frequency, and absorbance ratios at peak pressure and ambient pressure values were analyzed.

Results: There was no difference between the groups in terms of traditional tympanometric parameters such as tympanometric peak pressure, equivalent ear canal volume, and static acoustic admittance (P >.05). Resonance frequency of workers exposed to chronic noise (group I and group II) was lower than the control group (P <.05). The absorbance ratios of workers exposed to chronic noise at approximately 4 kHz were lower in both peak pressures and ambient pressures (P <.05).

Conclusion: Chronic noise does not only damage the inner ear but also causes changes in the middle ear structures. Wideband tympanometry can be used to detect minor auditory damage due to noise that cannot be detected by audiogram early. In this way, necessary measures can be taken in the early period before noise-induced hearing loss occurs.