Audiology and Neuro-Otology最新文献

Introduction: We sought to evaluate the correlation between whole cochlear T2 signal changes obtained with a novel automated segmentation method and hearing levels, both at diagnosis and over time, in patients with observed vestibular schwannoma.

Methods: This retrospective correlation study within an academic medical center neurotology practice evaluated 127 patients with vestibular schwannoma observed over time, each with ≥2 MRI scans (367 total) and ≥2 audiograms (472 total). 86 patients had T2-weighted sequences with sufficient resolution for cochlear signal analysis, yielding 348 unique timepoint intervals. The main outcome measure was correlation of the ipsilateral-to-contralateral ratio of whole cochlear T2 signal with hearing outcomes as measured by pure tone average (PTA) and word recognition score (WRS).

Results: Whole cochlear T2 signal ratios did not show a correlation with hearing levels at diagnosis. Change in signal ratio over time showed weak correlation with changes in PTA, but not WRS, over time. Cochlear signal ratio did not precede changes in hearing but did follow changes in both PTA and WRS.

Conclusion: Whole cochlear T2 signal ratios were weakly correlated with changes in hearing in patients with observed vestibular schwannoma. The technology of automated segmentation and signal processing holds promise for future evaluation of clinical entities causing cochlear signal changes.

Introduction: The aim of this study was to better understand the onset time and factors associated with cochlear obliteration following translabyrinthine approach (TLA) surgery for large cerebellopontine angle tumors.

Methods: This retrospective cohort study included 117 patients with large cerebellopontine angle tumor (tumor diameter >2 cm) treated by TLA surgery from June 2011 to March 2019 in a single tertiary referral center. The Kaplan-Meier method with log-rank test was used to estimate cochlear patency survival and the association between survival and covariates, and the Cox proportional hazards regression analysis was used to identify possible factors associated with cochlear obliteration.

Results: Of the 117 patients included in our analysis, the median follow-up was 24.8 months. There were 30 (25.6%) patients in the cochlear obliteration group, and 87 (74.4%) in the patent cochlear group. Various degrees of cochlear obliteration was found in 25.6% patients in final MRI scan, comprised of 50% grade I, 30% grade II, and 20% grade III. Cochlear patency survival curves showed 94.0% at 3 months, 73.0% at 18 months, which plateaued after 20 months with a survival rate of 71.6%. In the multivariate Cox proportional hazards model, patients presented with postoperative hyperintense T1W cochlear signal had poorer cochlear patency survival compared to isointense T1W (HR = 4.15). Similarly, postoperative deteriorated facial function (HR = 4.52) and full IAC involvement of tumor (HR = 2.33) demonstrated a higher risks of cochlear obliteration after TLA surgery.

Conclusion: The 2-year estimated cochlear patency rate was 71.6% in patients that received TLA. Cochlear obliteration can develop as early as 3 months post-surgery, with no new obliteration 20 months after the surgery and half of these patients got severe obliteration. Three factors associated with cochlear obliteration were identified including full IAC involvement of tumor, postoperative facial function deterioration, and postoperative hyperintense T1W cochlear signal.

Introduction: Dizziness is a common complaint affecting up to 23% of the world population. Diagnosis is of utmost importance and routinely involves several tests to be performed in specialized centers. The advent of a new generation of technical devices would make envision their use for a valid objective vestibular assessment. Microsoft HoloLens 2 (HL2) mixed reality headset has the potential to be a valuable wearable technology that provides interactive digital stimuli and inertial measurement units (IMUs) to objectively quantify the movements of the user in response to various exercises. The aim of this study was to validate the integration of HoloLens with traditional methods used to analyze the vestibular function in order to obtain precise diagnostic values.

Methods: Twenty-six healthy adults completed the Dynamic Gait Index tests both with a traditional evaluation and while wearing HL2 headset, thus allowing to collect kinematic data of the patients' head and eyes. The subjects had to perform 8 different tasks, and the scores were independently assigned by two otolaryngology specialists.

Results: The maximum of the mean position of the walking axis of the subjects was found in the second task (-0.14 ± 0.23 m), while the maximum value of the standard deviation of the walking axis was found in the fifth task (-0.12 ± 0.27 m). Overall, positive results were obtained in regard to the validity of the HL2 use to analyze kinematic features.

Conclusion: The accurate quantification of gait, movement along the walking axis, and deviation from the normality using HL2 provide an initial evidence for its useful adoption as a valuable tool in gait and mobility assessment.

Introduction: A nonsurgical bone conduction hearing aid (BCHA) is a well-established treatment for children with congenital unilateral microtia and atresia (UMA). To date, limited studies have evaluated the audiological characteristics of the different wearing modes in the same nonsurgical BCHA.

Methods: Eighteen patients with UMA aged 5-24 years were included. Warble tones at frequencies of 0.5, 1, 2, and 4 kHz were presented to determine functional hearing gain (FHG) of hearing thresholds (in dB HL) in the sound field. The speech perception abilities were assessed by the speech discrimination score (SDS, in %) of monosyllables, disyllables, and sentences in quiet and noise using the Chinese Mandarin speech test materials. Hearing outcomes were evaluated with the ADHEAR™ worn on a softband and with an adhesive adapter. A correlational analysis was conducted to analyze the correlations between variables (e.g., age, height, weight, body mass index [BMI], bone conduction pure-tone threshold, and air conduction pure-tone threshold) and the differences in the two wearing modes.

Results: The mean FHG (standard deviation, SD) at 0.5-4 kHz was 20.63 (3.94) dB HL with the adhesive adapter and 26.39 (3.15) dB HL with the softband. When aided with the BCHA, significant improvements in SDS were revealed in all Mandarin speech test material lists either in quiet or noise for both wearing modes. Compared with the adapter mode, the softband provided higher aided SDS values. Correctional analyses revealed that higher BMI values were positively associated with larger delta outcomes between the two coupling methods of the softband and adhesive adapter in patients with UMA. Furthermore, a larger delta average FHG of 0.5-4 kHz was consistently associated with larger delta monosyllabic SDS in quiet, disyllabic SDS in quiet, and disyllabic SDS in noise.

Discussion: To the best of our knowledge, this is the first study to compare the hearing benefits of coupling methods using novel adhesive adapters and conventional softbands with the same audio processor (ADHEAR™). Under uniform internal settings, softband integration provided more hearing benefits than adhesive adapter integration, and the differences were more obvious in patients with higher BMI values. Besides, a brief measurement of FHG can be utilized to predict individualized speech perception levels.

Introduction: Sudden sensorineural hearing loss (SSNHL) is one of the most common acute symptoms in the otolaryngology department. Etiological diagnosis is the premise of effective treatment of SSNHL, and prognostic evaluation is the key. However, most of the patients are diagnosed as idiopathic due to a lack of overall assessment, while prognostic factors of SSNHL are numerous and controversial. Our purpose was to validate the potential value of a novel three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) MR protocol in SSNHL and to establish a clinical-image prognostic model for unilateral SSNHL.

Methods: This prospective study included consecutive patients from May 2019 to November 2021. Pathogenic diagnosis relied on expertise-based estimation and the associations of MR findings with clinical features of unilateral SSNHL were assessed. The prognostic evaluation of unilateral SSNHL was adopted for recovery and no recovery groups and complete and incomplete recovery groups. Significant clinical and MR features were compared and screened out by single-factor analyses. The primary clinical-image prognosis assessment model was built by multifactor logistic regression analyses.

Results: A total of 101 patients were enrolled in our study who acquired the correct etiological diagnosis based on the novel 3D-FLAIR MR combined with clinical examination. Among the 93 patients with unilateral SSNHL, 30.1% (28/93) showed labyrinthine abnormalities on 3D-FLAIR images. The severity of initial hearing loss in the MR+ group was worse than that in the MR- group (p < 0.05), and patients with positive MR findings tended to have poor recovery. An excellent prognostic model was built for hearing complete recovery and no recovery. The combination of three independent risk factors, including abnormal distortion products otoacoustic emission and transient evoked otoacoustic emission, the period from onset to treatment, and PTA at the onset, was adopted for hearing recovery/no recovery (accuracy = 90.2%, AUC = 0.820). Furthermore, adding the factor of positive MRI findings could improve the confidence for the judgment of hearing no recovery. The only independent risk factor, PTA at the onset, was adopted for complete/incomplete hearing recovery (accuracy = 86.1%, AUC = 0.874).

Conclusion: The novel MR protocol had a good advantage in pathogenic diagnosis. Labyrinthine MR 3D-FLAIR signal abnormalities were related to the severity of an initial hearing loss and had a greater tendency to be found in patients with no recovery. A prognostic model with two main steps of unilateral SSNHL, mainly for SSNHL with no recovery and complete recovery, was built successfully and needed further verification by larger series of patients.

Introduction: Noise can induce hearing loss and reduce speech understanding. The Acceptable Noise Level (ANL) test has been widely used in audiology. However, strategies used by listeners to determine ANLs are unclear. The current study evaluated the role of speech recognition in selecting ANL and how well ANL could predict speech understanding in a noisy situation.

Methods: Forty-five Mandarin speakers with normal hearing were tested in both ears. ANL is defined as Most Comfortable Level (MCL) minus Background Noise Level (BNL). To obtain ANL monaurally with an earphone, the study measured participants' MCL to hear a Mandarin story in quiet and the maximum BNL to tolerate while following the story. Then, based on the participant's ANL, speech recognition in noise was examined using a set of phonemic-balanced Mandarin words. The signal-to-noise ratio (SNR) was adjusted to ANL, ANL - 10 dB ("degraded noise condition"), and ANL + 10 dB ("improved noise condition").

Results: The mean ANLs were 2.4 dB and 2.6 dB for the left and right ears, respectively. The mean speech recognition with SNR adjusted to ANL was relatively high for both ears (81-83% correct). Even for those ear samples with very low ANL (<0 dB), speech performance obtained at SNR = ANL was still high. The mean speech recognition obtained at SNR = ANL was 5 percentage points lower than the mean speech recognition at the improved noise condition and 14 percentage points higher than the mean speech recognition at the degraded noise condition. Speech recognition obtained at SNR = ANL and ANL - 10 dB correlated significantly with ANL.

Conclusion: Speech recognition in noise appears to play an important role for listeners with normal hearing in deciding their ANLs. Additionally, ANL can predict speech performance (r-squared = 53-61%) in the degraded noise condition.

Introduction: The aim of the study was to describe auditory and vestibular findings in Brazilian adults after COVID-19 in a municipality from the outskirts of the São Paulo state.

Methods: This was a transversal and exploratory study comprising sixteen participants infected by the SARS-CoV-2 virus, confirmed through RT-PCR detection, aged 20 to 55 years. Subjects underwent anamnesis, vestibular and auditory testing. Fisher's exact test was used to evaluate medication use, chemical and physical exposure, and occupational risk and McNemar test was used to compare auditory and vestibular symptoms pre- and post-COVID-19.

Results: Most patients were women (75%) and had been exposed to the virus over 90 days before testing (50%). 18.8% used hydroxychloroquine, 68.8% used ivermectin, and 87.5% used azithromycin to treat COVID-19. Auditory complaints were reported by 31.2% and vestibular by 18.7%. There was no statistical difference before and after the disease. Other reported symptomatology was hair loss, pain, fatigue, memory loss, difficulty to concentrate, and headache. Auditory findings were relevant in contralateral acoustic reflex, in the distortion-product otoacoustic emissions, and in the brainstem auditory evoked potential, characterizing a neurosensorial compromise. 43.74% of patients had altered vectonystagmography. When comparing both ears, no statistical relevance was found; however, when results were crossed with medication use and exposures, there was statistical relevance in the amplitude of the V wave for medications and absolute latency of the V wave to exposure to physical agents.

Discussion/conclusion: This study demonstrated auditory and vestibular findings of neurosensorial nature, considering hearing and of a peripheral vestibulopathy. As it is a study of transversal nature, it is not possible to extend results to general population; yet it may be a finding to future studies.

Introduction: Migraine is the third most common disease in the world with an estimated prevalence of 14.7%. The purpose of this study was to identify the characteristic changes in cervical and ocular vestibular evoked myogenic potential (VEMP) and analyse changes in symptoms and VEMP after flunarizine therapy in patients diagnosed with vestibular migraine (VM).

Methods: Prospective interventional study was conducted on 31 VM patients. Cervical VEMP (cVEMP) and ocular VEMP (oVEMP) were recorded. Flunarizine (10 mg) was given once daily for two consecutive months. Prophylactic therapy was monitored with a monthly follow-up assessment of their symptoms and VEMP was repeated after 2 months.

Results: Headache was the chief complaint (67.7%). Vertigo was spontaneous and mostly moderate in intensity (93%). cVEMP was absent in 1 patient and oVEMP was absent in 3 patients. Post prophylactic treatment with flunarizine, there was significant reduction in the frequency (p = 0.001) and duration (p = 0.001) of headache and frequency (p = 0.001), duration (p = 0.001), and intensity (p = 0.009) of vertigo. cVEMP and oVEMP showed no significant differences (p > 0.05) between pre- and post-treatment recordings.

Conclusion: Treatment with flunarizine helps in considerably reducing the episodes and duration of headache, as well as episodes, duration, and intensity of vertigo.

Introduction: Diagnosing Ménière's disease (MD) by its characteristics such as episodes of vertigo, fluctuating hearing loss, and tinnitus with aural fullness remains challenging. Available tests evaluating the presence of endolymphatic hydrops (EH) are often expensive or time assuming. An in-office quick and simple non-invasive diagnostic test is multifrequency tympanometry (MFT). It can measure conductance at 2 kHz probe tones, which was demonstrated to reflect variations in cochlear pressure. Previous studies investigating MFT as a diagnostic test for MD showed conflicting outcomes possibly biased by their retrospective design.

Methods: We prospectively collected MFT results (Y width) in patients with dizziness and compared MFT test results in affected (group 1) and unaffected (group 2) ears of 37 MD subjects and in control ears of 33 non-MD subjects (group 3).

Results: The mean value of the Y width in affected ears was 315.6 ± 70.2 daPa compared to 292.3 ± 98.6 daPa in unaffected ears in MD subjects and 259.4. ± 60.6 daPa in the non-MD group. A positive test result (i.e., a Y width of 235 daPa or more) was found in 35 ears in the MD group, 21 times involving the affected ear and 14 times involving the unaffected ear, compared to 16 in the non-MD group. No significant differences between the three groups could be demonstrated (p > 0.05). We found a sensitivity of 58.3% and specificity of 66.3% for detecting EH in an affected ear in MD subjects.

Conclusion: There is a trend towards increased conductance tympanometry in affected ears. However, we noticed a high false positive rate of MFT and do not support standardized use of MFT as an additional diagnostic tool for detecting EH in MD patients. A negative test result on the contrary is unlikely related to EH.