Audiology and Neuro-Otology最新文献

Introduction: The reason why chronic tympanic membrane (TM) perforations fail to heal is an enigma. A better insight into the premises and cellular events in this process is fundamental. Previous large studies on human TMs are lacking. The main objective of the present study was to map potential stem cells in the human TM and to address the regenerative capacity in the TM keratinocytes. Further, the study aimed to assess the regenerative premises for three regions of the TM: the malleus, the annulus, and the unattached portion of the pars tensa (UPT), including different anatomical levels (inferior, intermediate, and superior) within each region.

Methods: Ten healthy human TMs were harvested during lateral skull base surgery. Using immunohistochemistry, the TMs were stained for α6 and β1 integrin, CK19, p63, and Ki-67. Semi-quantification was made with two single-blinded observers scoring the staining of the slides. Inter-rater reliability was evaluated with weighted Cohen's kappa, and group differences between the mean grading were further calculated.

Results: Antibodies for α6 and β1 integrin, CK19, p63, and Ki-67 could be detected along the malleus, annulus, and UPT of human TMs displaying diversity in the regenerative capacity of the human TM. The staining of Ki-67 and p63 was more prevalent in the annulus and malleus compared to in the UPT. α6 staining was more prevalent in the annulus, while CK19 staining was more prevalent in the malleus. Finally, several antibodies displayed a higher staining intensity in the inferior anatomical levels of the TM.

Conclusion: The present study shows the presence of putative stem cells in all regions of the human TM, with a stronger regenerative capacity close to the annulus and malleus compared to the UPT. These findings may set a baseline for the localization and diversity of putative stem cells in the human TM.

Introduction: Tinnitus and smell dysfunction have been reported to be associated. The long-term course of tinnitus and sensory dysfunctions, including olfactory and gustatory dysfunctions, following COVID-19 infection requires further study.

Materials and methods: A cohort study of tinnitus and sensory dysfunctions before and during the COVID-19 pandemic was conducted through health checkups in a rural area in Japan. Five hundred ten participants attended health checkups in August 2019, 434 in 2023, and 437 in 2024. Two hundred twenty-five participants attended the 2019 and 2023 health checkups, and one hundred seventy-one participants attended all three. The subjects included people 40 years of age or older. The questionnaire included information on tinnitus, hearing, vertigo, headache, smell, taste, and lifestyle habits. In 2023, the questionnaire included questions about COVID-19.

Results: Tinnitus, hearing impairment, and smell dysfunction were associated. Fear and anxiety about COVID-19 infection were significantly associated with tinnitus after adjusting for age and sex. Irregular sleep time and fewer sports and exercise habits were significantly associated with tinnitus, not smell or taste dysfunction. In an investigation of identical persons, deterioration of tinnitus was conspicuous in 2023 compared to 2019 in persons with strong fear and anxiety about COVID-19.

Conclusions: Tinnitus is related to lifestyle habits compared to other sensory disorders. Fear and anxiety about COVID-19, rather than COVID-19 infection itself, significantly influenced tinnitus during the COVID-19 pandemic in rural areas.

Aim: There are a range of approaches to intraoperative electrocochleography (ECochG) monitoring across different implant systems, and these show inconsistent results. Here, we synthesize by meta-analysis the evidence for real-time intracochlear ECochG recorded during cochlear implantation predicting residual hearing.

Methods: Inclusion criteria included original studies in which real-time ECochG was undertaken on a commercial cochlear implant (CI) and residual hearing outcomes at least 4 weeks after implantation were reported. Thirteen studies comprising 313 individual patient data sets met inclusion criteria. Full data sets were sought from the authors. Studies were rated for quality and bias. Details about study design (observational or interventional) and electrode characteristics (lateral wall or perimodiolar) were extracted. Relative hearing loss across the low frequencies (250-1,000 Hz) was the main outcome, with decibel loss and functional hearing as secondary outcomes. Effects were explored by forest plot, and then linear mixed modelling on the full data sets. Sensitivity analyses included recalculation of hearing preservation using thresholds across different frequencies.

Results: Thirteen studies, including 313 full patient data sets, were included, and meta-analysis was performed on lateral wall electrodes. A drop of ECochG amplitude of >30%, even if transient, predicted residual hearing across all metrics (decibel, relative, and functional), and data-synthesis methods (forest plots and linear modelling) for all systems where real-time measurements were available. A drop of amplitude of at least 60% across insertion predicted relative but not decibel hearing loss in linear mixed modelling. The "pattern" of ECochG drop, as described by Harris in 2017, did not predict residual hearing by any method.

Discussion: The only truly "real-time" measurement that predicted residual hearing was an instantaneous drop in ECochG amplitude, with or without recovery. Large drops over the insertion did too, but these can only be calculated after insertion, and after the cochlear trauma has been done. All CI systems now offer real-time monitoring - these results provide guidance on how best to use it to optimize clinical outcomes.

Introduction: Tinnitus is the perception of sound when no sound is present. Due to its heterogenous nature, tinnitus can impact people differently. Tinnitus disorder occurs when the perception of tinnitus affects quality of life. Personalized digital mHealth therapy approaches to tinnitus treatment have been proposed to address the heterogeneity of tinnitus. To build self-efficacy in tinnitus management, there should be alignment between therapeutic objectives and the needs of end users. This survey was undertaken to learn the desirable features a digital therapy should have from the perspective of people with tinnitus.

Methods: A cross-sectional online survey of 986 people on a tinnitus research list was undertaken asking questions about their experience of tinnitus and desirable features in a digital tinnitus therapy.

Results: The highest rated problems with tinnitus were "loss of peace and quiet" and "sound intrusiveness" (median [Mdn] 4/5). The most common problems that participants wanted help with were learning about treatments and management, hearing, tinnitus elimination, sleep, and reduction in tinnitus. Participants rated sound-based brain-training games (training to focus away from tinnitus) as the top feature they wanted in digital therapy (Mdn 5/5, extremely important). Mann-Whitney U tests identified differences in problems and solutions when variables were grouped according to gender (female/male), self-reported hearing loss (yes/no), country of residence (New Zealand [NZ], non-NZ), and app use (yes/no). Females and males rated tinnitus problems differently, and females tended to rate solutions as more valuable than males.

Conclusions: A survey of many people with tinnitus identified common problems and preferred solutions. Although a high percentage of responders wanted tinnitus eliminated, a large number recognized the desirability of management through sound-based and psychological approaches. This information can assist clinicians and researchers developing therapies.

Introduction: This study aimed to investigate differences between two precurved cochlear implant electrode arrays - Contour Advance (CA) and Slim Modiolar Electrode (SME) - in adult users, with a focus on electrically evoked compound action potential (ECAP) thresholds, 1-year postoperative C-levels, and battery consumption.

Methods: Data from 70 adult cochlear implant recipients (35 CA, 35 SME) were analyzed. Intra- and postoperative ECAP thresholds were obtained using Cochlear Custom Sound software. One-year C-levels were measured through psychophysical loudness scaling. Estimated battery runtimes were examined in relation to median C-levels. A linear mixed-effects model was used to assess differences across electrode positions and between arrays. Model validation was performed through examination of standardized residuals versus fitted values, QQ-plots analysis, and comparison of observed versus expected serial correlations.

Results: The CA array showed a more linear and more directly proportional relationship between ECAPs and C-levels. The SME array demonstrated significantly higher ECAPs and C-levels for the basal electrodes, larger pre- to postoperative changes in thresholds, and larger differences between ECAPs and C-levels, compared to the CA array. Battery runtime was significantly correlated with C-levels in the CA group, whereas impedance appeared more closely related to battery consumption in the SME group.

Conclusion: Electrode array design affects electrophysiological and behavioral responses as well as battery consumption. We found significant differences between two precurved electrode arrays from the same manufacturer. These findings highlight the importance of array-specific programming strategies and suggest that electrode characteristics should be considered in clinical decision-making and device optimization.

Introduction: Cochlear implantation (CI) is the standard treatment for severe-to-profound sensorineural hearing loss, but CI users often struggle with speech understanding in noisy environments. The Dutch/Flemish Matrix test is frequently used to evaluate speech-in-noise performance due to its assumed immunity to learning effects. However, studies challenge this assumption, revealing significant learning effects that can confound research outcomes. In this study, we modeled the learning curves of the Dutch/Flemish Matrix test to assess the influence of both between-session and between-test effects. We hypothesized that a exponential model would describe the learning effects more accurately than a linear model.

Methods: The perceptual learning effects associated with the Dutch/Flemish Matrix test were assessed in 17 bimodal CI users. All participants performed the Matrix speech-in-noise tests across four sessions, with 13 randomized tests per session. The tests were conducted in a soundproof booth with an eight-speaker babble noise. The outcome parameter was the speech recognition threshold and was analyzed with a linear mixed model to account for confounders.

Results: The results showed a statistically significant learning effect between sessions that added up to a speech intelligibility increase of 1.3 dB signal-to-noise ratio (SNR) (equivalent to ∼10% word score) between the first and second sessions, 0.86 dB SNR (∼7%) between the second and third sessions and 0.67 dB SNR (∼5%) between the third and fourth sessions. In addition, a statistically significant within-session learning effect (i.e., between tests) was observed with a linear slope of -0.11 dB SNR/test (∼0.9% word score/test), which accumulates to a total of 1.7 dB SNR (13%) between session start and end. The between-session learning curve was described more accurately with an exponential fit than with a linear fit. The between-test learning curve can be described equally well with a linear and an exponential fit.

Conclusion: A robust between-test learning effect was observed, which could be accurately modeled using either a linear or exponential learning curve. Additionally, a between-session learning effect was evident and was best described by an exponential learning curve. This study provides an important handle for correcting these learning effects in future studies.

Introduction: Early pediatric conductive hearing loss intervention is crucial for ensuring optimal development outcomes. This study evaluated the impact of early access to bone conduction devices (BCDs) on children's quality of life (QoL) and academic performance, comparing results between those who received BCDs and those who did not.

Methods: We conducted a prospective cohort study involving children aged <12 years with congenital conductive hearing loss caused by external auditory canal atresia. The participants were categorized into three groups: those without BCDs, those using nonsurgical BCDs, and those implanted with active transcutaneous BCDs. QoL was assessed using the Arabic version of the Hearing Environments and Reflection on Quality of Life Measurement for Children Survey (HEAR-QL-AR) questionnaire at enrollment and during the last month of the study. School performance was evaluated based on annual academic results, grade repetition rates, and involvement in extracurricular activities. For children who were implanted with a piezoelectrive active transcutaneous bone conduction implant (OSI), data collection included age of implantation, duration of surgery, perioperative and long-term complications, and duration of device use.

Results: A total of 57 children participated in the study and were categorized into three groups: 14 in the non-BCDs group, 17 in the nonsurgical BCDs group, and 27 in the active transcutaneous BCDs group. At enrollment, the median HEAR-QL-AR scores were significantly higher in both BCD groups (80 and 81 in the nonsurgical and implanted groups, respectively) than in the non-BCD group (66, p = 0.013). After 6 months, the implanted group achieved the highest median HEAR-QL-AR score (90, IQR = 8), followed by the nonsurgical group (76, IQR = 14) and the non-BCD group (64, IQR = 16; p < 0.001). Academic performance was better in the BCD groups, with a median grade of "A" compared to "B" in the non-BCD group (p = 0.004). Participation in extracurricular activities was also higher in the implant group (median = 1.5) than in the nonsurgical (median = 1) and non-BCD groups (median = 0; p < 0.001). No surgical complications occurred, and the median surgical duration was 38 min (IQR = 7.5).

Conclusion: Early access to BCDs significantly improves QoL, academic performance, and social participation in children with conductive hearing loss. The implantation of active transcutaneous BCDs has been demonstrated to be both safe and effective, delivering superior auditory and developmental outcomes. These findings underscore the importance of advocating for timely intervention and expanding access to active transcutaneous BCDs for young children.

Introduction: This study aimed to evaluate long-term auditory outcomes in patients with inner ear malformations (IEMs) treated with cochlear or auditory brainstem implants (CI/ABI) and assess the influence of anatomical subtype, electrode design, insertion depth, and genetic/syndromic background on hearing performance over a 10-year follow-up.

Methods: We conducted a prospective cohort study including patients with radiologically confirmed IEMs and bilateral severe-to-profound hearing loss, all of whom underwent implantation and completed at least 10 years of follow-up. Outcomes were assessed using pure-tone average (PTA) and speech recognition scores (SRSs) at defined intervals. Additional analyses explored the influence of electrode array design, insertion depth, genetic and syndromic diagnosis, and intraoperative complications.

Results: Eighty-two patients were included in the study, of whom 71 (86.58%) received a CI, while the remaining 11 patients (13.41%) were treated with an ABI. After a 10-year follow-up, the mean PTA gain with CI was 64.56 ± 14.52 dB, and mean SRS improved by 56.88 ± 25.32%. On the other hand, patients treated with ABI presented a gain of 45.00 ± 18.22 and 32.62 ± 10.67% dB, respectively. Enlarged vestibular aqueduct had the highest 10-year SRS (80.04%), whereas cochlear nerve agenesis, Michel deformity, and cochlear hypoplasia type I had the lowest (23.72%, 24.00%, and 26.50%, respectively). The mean insertion depth was 19.66 ± 3.74 mm and showed a non-significant correlation with final SRS (r = 0.243, p = 0.084). The presence of residual auditory brainstem responses was significantly associated with better pre-implant PTA (p = 0.041) and higher SRS at 10 years (p = 0.034). Finally, having a syndromic condition was not significantly associated with the risk of a worse SRS at 10 years post-implantation (p = 0.091), nor with poorer auditory outcomes measured in PTA prior to surgery (p = 0.315).

Conclusion: Auditory outcomes in IEMs are modulated by malformation subtype, neural status, and electrode design. A stratified, anatomy-guided approach is essential, especially when considering perimodiolar arrays. Delayed gains in some subtypes underscore the value of long-term follow-up, and integrating imaging and genetic data may enhance personalized implant strategies.

Introduction: Slim perimodiolar electrodes (PSEs) are designed for close modiolar proximity, but deviations from ideal placement may affect speech perception. This study investigates the prevalence, radiologic characteristics, and audiologic outcomes of abnormally positioned PSE arrays and proposes intraoperative management strategies.

Methods: We retrospectively reviewed 239 adults implanted with Cochlear® PSE arrays (2015-2023). Postoperative CT scan identified arrays positioned laterally to mid-scala without tip fold-over. Objective metrics such as angular insertion depth (AID), intracochlear position index (ICPI), wrapping factor (WF), and maximum insertion angle were compared to a control group with normal positioning (n = 52). Speech perception outcomes at 3 and 12 months were assessed using monosyllabic word tests and compared to a reference cohort (n = 1,414).

Results: Abnormal positioning occurred in 3% (n = 7). All arrays remained within scala tympani but had shallower insertions (AID 296° vs. 392°), greater lateralization (ICPI 0.52 vs. 0.33), and higher WF (0.62 vs. 0.36). Compared to controls, speech scores were lower at 3 months (33% vs. 65%) and 12 months (45% vs. 74%). Intraoperative X-rays did not detect these deviations.

Conclusion: Abnormal PSE placement is uncommon but associated with poorer speech outcomes. Surgeons should assess electrode shape intraoperatively and consider reinsertion if the classic curl is absent. Postoperative CT remains critical for quality assurance. Tailored intraoperative strategies are needed to prevent lateralization and optimize outcomes.

Introduction: The speech reception threshold (SRT) test is a fundamental component of audiological assessment. It helps in assessment of speech recognition, fitting of hearing aids and cochlear implant. This test facility is not available for Urdu speakers. Thus, the objective of the study is to digitally record and psychometrically evaluate Urdu spondee word list for SRT testing.

Methods: A total of n = 107 spondee words were selected from a prior study. These words were recorded digitally by a native female Urdu speaker in a studio. The words were presented to normal hearing Urdu speakers between -10 and 20 decibels of hearing levels (dB HL). The performance intensity of these words was assessed psychometrically as intercept, slope, threshold, slope at 50%, slope between 20 and 80%. The minor intensity adjustment of each word was made equivalent to threshold. The words with slope steeper than ≥7%/dB were included in the final list.

Results: A list of 46 Urdu spondee words was finalized. The average psychometric slope of these final words between 20% and 80% was 7.06-10.70%/dB ± 0.83. The slope at 50% ranged from 8.33%/dB HL to 13.33%/dB HL ± 1.56 dB. The threshold for the 46 spondee words varied from 7.43 dB to 10.80 dB HL ± 0.77 dB.

Conclusion: Digitally recorded Urdu spondee word list is valid for assessment of SRT testing in Urdu speakers.