Audiology and Neuro-Otology最新文献

Introduction: Dichotic listening (DL) is a test where auditory stimuli are presented simultaneously to each ear. DL has clinical applications in assessing APD, schizophrenia, and brain injury. It is sensitive to hemisphere differences and has been used to study language lateralization. The study aimed to develop, validate, and establish norms for a Quadri condition Dichotic Double Word Test (free recall, forced right, forced left, and switch attention) in the Kannada language (DDWT-K).

Methods: This study was carried out in two phases. Phase 1 aimed to develop and validate the DDWT-K and phase 2 involved data collection. The developed novel dichotic test was administered on 100 normal-hearing adults in four conditions - free recall, forced right, forced left, and switch attention.

Results: The results showed significant ear differences in free recall condition indicating right ear advantage. The switch attention condition showed slightly poorer performance when compared to both the forced attention condition indicating greater task difficulty. The test-retest reliability was above 0.7 for all the conditions indicating good reliability.

Conclusions: The findings demonstrated the best preservation of the original dichotic effects and hence ready for clinical use.

Introduction: Jugulotympanic paraganglioma (JTP) refers to paraganglioma arising from jugular bulb, which can invade surrounding structures such as the bones, blood vessels, meninges, and cranial nerves. The authors conducted a study to find surgical indications to avoid a serious cranial nerve complications by analyzing the medical records of patients who underwent surgical management for JTP.

Methods: We performed a single-institution, retrospective review of patients who underwent resection of JTP from 2004 to 2022. Patients underwent either Fisch infratemporal fossa approach type A (ITFA-A) or modification of ITFA-A with partial rerouting of the facial nerve. Preoperative and postoperative lower cranial nerve (LCN) function and facial function using the House-Brackmann (H-B) grade were evaluated.

Results: The study included 19 patients with a mean age of 43.1 years (standard deviation [SD], 16.1 years). The average tumor size was 28.6 mm (SD 12.6 mm). In patients with Fisch classes C1 and C2 tumors, there were 3 and 11 patients, respectively. Gross total tumor removal (GTR) was performed in all patients with classes C1 and C2. GTR was achieved in 2 out of the 5 patients with class C3 tumor. Seventeen patients underwent ITFA-A and 2 patients underwent partial rerouting. Facial function before surgery was normal in all but 3 cases. Among 16 patients with preoperative normal facial function, 13 had H-B grade I to II and 3 had H-B grade III at 1 year after surgery. Total and partial rerouting did not significantly affect facial function immediately after surgery or at the postoperative 1-year evaluation (p = 1.00). Preoperative LCN function was normal in all patients. LCN palsy lasting more than 1 year occurred in 7 patients after surgery. Patients with Fisch class C1 tumor did not develop postoperative LCN palsy. Among the patients with class C2 tumor, none of 5 patients with medial invasion depth less than 9.5 mm developed LCN palsy, whereas 5 of 6 patients (83.3%) with invasion depth of 9.5 mm or greater developed LCN palsy (p = 0.02).

Conclusion: JTPs with deep medial invasion should be managed conservatively to prevent LCN palsy.

Objective: The aim of this study was to evaluate the utility of auditory steady-state responses (ASSRs) to narrow-band chirps (NB-chirps) for estimating hearing levels in children.

Design: Thresholds from the NB-chirp ASSR were evaluated in 30 sedated children with normal hearing or hearing loss. The correlation between the NB-chirp ASSR and pure-tone audiometry (PTA) thresholds was analyzed, and the difference score (DS) between these thresholds was calculated. Data from the NB-chirp ASSR were compared to retrospective data from conventional ASSR to exponentially amplitude-modulated tones in 25 sedated children.

Results: Positive correlations between the NB-chirp ASSR and PTA thresholds were found at 500, 1,000, 2,000, and 4,000 Hz. Multiple comparisons of the DSs for the NB-chirp ASSR and PTA revealed significant differences at 500-2,000 Hz and 4,000 Hz, as well as 1,000-2,000 Hz, and 4,000 Hz. Comparisons of the DSs demonstrated that the DS of the NB-chirp ASSR was significantly smaller than that of the conventional ASSR at 2,000 Hz. Furthermore, the testing times for the NB-chirp ASSR were significantly shorter than those for the conventional ASSR.

Conclusion: The NB-chirp ASSR closely reflected the PTA thresholds, and the testing time was shorter than that of the conventional ASSR. Thus, this study demonstrated that the NB-chirp ASSR is useful for hearing threshold estimation in children.

Introduction: Preservation of residual hearing, mainly the low frequencies, is the current main objective of cochlear implantation. New electrode arrays and the development of minimally invasive surgery have allowed electroacoustic stimulation. Over the past several years, robotic-assisted cochlear implant surgery aimed to improve the insertion process while respecting inner ear structures. However, the introduction of a foreign body inside the cochlea can lead to the development of fibrous tissue around the electrode array, or even induce osteogenesis. These histological changes disrupt the parameters of the cochlear implant, resulting in elevated impedance. In addition, long-term auditory performance can be affected, with a deterioration in word comprehension. We evaluated the potential impact of RobOtol® on impedance changes over time, leading to potentially positive functional outcomes.

Methods: Cochlear implant surgery with a round window approach was performed under general anesthesia. Fifteen Med-El Flex24 electrode arrays were inserted manually and 24 using RobOtol®. All subjects underwent pure-tone audiometry tests before the surgery and at regular intervals up to 1 year after the surgery. Based on the pure-tone average at the low frequencies from 250 to 1,000 Hz, we divided the patients according to the degree of auditory preservation (full preservation ≤15 dB, partial preservation 15 dB-30 dB, significant loss >30 dB). These different groups were compared in terms of impedance changes and auditory performance, specifically word recognition score.

Results: We found proportionally fewer patients who experienced significant low-frequency hearing loss after robotic insertion (53.33% in the manual group compared to 41.67% in the robot-assisted insertion group). Impedance changes at the apex of the electrode array, especially at the first electrode (p = 0.04), after robotic surgery, with less overall variability, a continuous decreasing trend without secondary elevation, and lower values in cases of complete residual hearing preservation (for the three first electrodes: p = 0.017, p = 0.04, p = 0.045). The speech intelligibility amelioration over time showed favorable evolution in patients with complete residual hearing preservation regardless of the insertion method. However, in the absence of auditory preservation, the positive evolution continued more than 6 months after robotic surgery but stagnated after manual insertion (difference at 1 year, p = 0.038; median auditory capacity index 83% vs. 57%).

Conclusion: Atraumatic electrode array insertion with consistent, slow speed and the assistance of RobOtol® minimizes disturbances in the delicate neurosensory structures of the inner ear and leads to better auditory performance.

Introduction: Hearing loss is a common sensory disorder that impacts patients across the lifespan. Many genetic variants have been identified that contribute to non-syndromic hearing loss. Yet, genetic testing is not routinely administered when hearing loss is diagnosed, particularly in adults. In this study, genetic testing was completed in patients with known hearing loss.

Methods: A total of 104 patients who were evaluated for hearing loss were enrolled and received genetic testing.

Results: Of those 104 patients, 39 had available genetic testing, 20 had one missing allele, and 45 yielded no genetic diagnosis. Of the 39 cases with genetic testing data, 24 were simplex cases, and 15 were multiplex cases. A majority of patients presented with an autosomal recessive inheritance pattern (n = 32), 26 of whom presented with congenital hearing loss. 38% of cases were positive for GJB2 mutation with c.35delG being the most common pathogenic variant. These findings are consistent with previous literature suggesting GJB2 mutations are the most common causes of non-syndromic hearing loss.

Conclusion: Given the frequency of genetic variants in patients with hearing loss, genetic testing should be considered a routine part of the hearing loss work-up, particularly as gene therapies are studied and become more widely available.

Lay summary: Many genetic variants have been identified that contribute to non-syndromic hearing loss. Given the frequency of genetic variants in patients with hearing loss, genetic testing should be considered a routine part of the hearing loss work-up.

Introduction: The international outcome inventory for hearing aids (IOI-HA) is a questionnaire widely used to assess the subjective benefits of hearing aids. This study aimed to evaluate the relationship between IOI-HA outcomes and target mismatch in real-ear measurement (REM).

Methods: Thirty-four ears of 25 patients who had worn hearing aids were evaluated using the Korean version of the IOI-HA and REM after fitting for 2 months. Real-ear insertion gain (REIG) was measured at three different levels of input intensity - 50, 65, and 80 dB sound pressure level (SPL) - and a frequency range of 0.25-6 kHz. Factors 1 and 2 and total IOI-HA scores were compared with the mismatches of REIGs and target gains of REM.

Results: Factor 1, factor 2, and total IOI-HA scores were 14.6 ± 3.5, 11.4 ± 2.2, and 25.9 ± 5.1, respectively. The averages of the difference of REIGs and target gains in REM at 50, 65, and 80 dB SPL input levels were -3.1 ± 6.7, -2.3 ± 7.2, and -3.0 ± 8.2, respectively. Factors 1 and 2 scores of the IOI-HA showed significant correlations with target mismatch in REM at 1 kHz and 0.75 kHz frequencies, respectively. Total IOI-HA scores had significant correlations with target mismatches in REM at 0.75 and 1 kHz frequencies.

Conclusion: IOI-HA scores correlated with target mismatch in REM at mid frequencies. The IOI-HA can be a useful screening measure for evaluating the necessity of further adjustments in hearing aids through REM at mid frequencies.

Introduction: Electrically evoked cortical auditory evoked potentials (ECAEPs) are central brain responses to auditory stimuli that correlate with postoperative cochlear implant (CI) hearing outcomes. They differ from electrically evoked compound action potentials (ECAPs) which are peripheral responses that can be elicited intraoperatively and may also predict CI hearing outcomes. It is not known to what degree ECAP and ECAEP responses are associated with each other. Such a correlation, if present, may allow for an earlier and more accurate prediction of postoperative hearing outcomes.

Methods: This retrospective study involved 42 adult CI users. Threshold levels and amplitude growth function slopes of intraoperative ECAPs were compared to the latencies and peak-to-peak amplitudes of postoperative ECAEP responses at three different cochlear electrode array sites (apical, medial, and basal).

Results: A weak positive relationship was found between intraoperative ECAP thresholds and ECAEP N1-P2 peak-to-peak amplitude (r = 0.301, p = 0.005). Time between ECAP and ECAEP measurements was weakly correlated with P1-N1 peak-to-peak amplitude (r = 0.321, p = 0.002) and ECAEP N1-P2 peak-to-peak amplitude (r = 0.340, p = 0.001). ECAP amplitude growth function slopes varied by electrode location (χ2 = 26.701, df = 2, p = 0. 000002).

Conclusion: These results suggest that intraoperative ECAP responses do not robustly predict postoperative ECAEP responses, providing caution against the use of ECAPs as a predictive tool for CI hearing outcomes.

Introduction: ISSNHL, a common clinical condition, can be accompanied by vertigo. Initially, research on sudden deafness primarily focused on the hearing loss itself, with less emphasis on episodic vertigo. However, as vertigo research has advanced, it has been recognized that BPPV is a frequent accompaniment to ISSNHL-associated vertigo. Even after treatment, some patients may experience residual dizziness. This study investigates the characteristics of patients with ISSNHL accompanied by BPPV and the impact of residual dizziness on their lives.

Methods: This study is being conducted on patients with ISSNHL accompanied by BPPV, analyzing the characteristics of such patients and the impact of residual dizziness on their lives. Overall, 54 adult inpatients with ISSNHL and BPPV were included in this study. All patients received 50 mg of intravenous prednisolone for 5 consecutive days and hemodilution agents for 10 days. At the same time, BPPV was treated with repositioning by the same therapist using the SRM-IV vertigo diagnostic and treatment system, and different repositioning methods were used for different types of otolithiasis. Patients were grouped according to the absence of residual dizziness when the nystagmus disappeared at the time of discharge.

Results: There were 24 cases in the group with residual symptoms, including 10 males and 14 females. The proportion of females was 58.33%, with an average age of 46.75 ± 13.80. The group without residual symptoms consisted of 30 cases, including 13 males and 17 females. The female proportion was 56.67%, with an average age of 45.77 ± 11.86. There is no statistical significance between the two groups in the pre-treatment hearing status and DHI scores. The HAMA (Hamilton Anxiety Rating Scale) scores before treatment were compared, revealing a significant statistical difference.

Conclusion: ISSNHL-associated BPPV may be caused by vascular embolism or thrombosis in the cochlear or spiral modiolar artery. This disrupts blood flow, leading to ischemia in the otolithic membrane and subsequent detachment of otoconia. Because this detachment often occurs within 24 h of the initial event, patients experience positional vertigo early in the course of the disease.

Introduction: Preservation of residual hearing after cochlear implantation remains challenging. There are several approaches to preserve residual hearing, but the configuration of the implant electrode array seems to play a major role. Lateral wall electrode arrays are seemingly more favorable in this context. To date, there are no experimental data available which correlate the spatial electrode position in the scala tympani with the extent of hearing preservation.

Methods: Based on micro-computed tomography (µCT) imaging data, this study analyses the exact position of a pure silicone electrode array inserted into the cochlea of four guinea pigs. Array position data were correlated with the extent of hearing loss after implantation, measured using auditory brainstem measurements in the frequency range of the area occupied by the electrode array area as well as apical to the array.

Results: The use of pure silicone arrays without electrodes resulted in artifact-free, high-resolution µCT images that allowed precise determination of the arrays' positions within the scala tympani. The electrode arrays' locations ranged from peri-modiolar to an anti-modiolar. These revealed a correlation of a lower postoperative hearing loss with a higher spatial proximity to the lateral wall. This correlation was found in the low-frequency range only. A significant correlation between the inter-individual differences in the diameter of the scala tympani and the postoperative hearing loss could not be observed.

Conclusion: This study demonstrates the importance of the intra-cochlear electrode array's position for the preservation of residual hearing. The advantage of such an electrode array's position approximated to the lateral wall suggests, at least for this type of electrode array applied in the guinea pig, it would be advantageous in the preservation of residual hearing for the apical part of the cochlea, beyond the area occupied by the electrode array.

Introduction: Accumulating reports suggest an increase in sudden sensorineural hearing loss during the COVID-19 pandemic and vaccination periods. However, clear evidence is lacking. The goal of this study was to determine if sudden sensorineural hearing loss is associated with COVID-19 illness or its vaccine.

Methods: Retrospective chart review of 50 randomly selected patients from three, 6-month time periods: "pre-pandemic," "early pandemic," and "late pandemic." Group comparisons were performed for demographics, comorbid conditions, audiologic history, audiometric data, speech reception thresholds, and word recognition.

Results: One hundred 50 patients were included in this study. A mean difference was observed in that the relative percentage of sensorineural hearing loss (SNHL) cases increased over time, corresponding to a relative decrease in conductive hearing loss cases. However, this change was not explained by proportional changes in sudden SNHL. Patients in the early pandemic time period were more likely to report tinnitus. Otherwise, the patient groups did not differ on demographic variables, hearing health history, hearing loss presentation, pure tone averages, speech reception thresholds, or word recognition performance.

Conclusions: Proportion of patients with sudden sensorineural hearing loss did not change over time from the pre-pandemic period to the early or late pandemic phases. Despite a randomized sample, these findings do not support the hypothesis that COVID-19 illness or vaccine is associated with sudden sensorineural hearing loss.