Audiology and Neuro-Otology最新文献

Introduction: The ADHEAR is a non-surgical bone conduction device that makes use of an adhesive adapter. While clinical trials have demonstrated its efficacy with regard to audiological performance, safety, and compliance, data on real-world paediatric cohorts are scarce.

Methods: This retrospective cohort study analysed data from paediatric patients fitted with ADHEAR at a tertiary centre between January 2017 and September 2024. Baseline characteristics such as hearing loss aetiology were recorded. Long-term free-field aided and unaided warble-tone audiometry was performed within a subsample of 19 patients. Compliance and reasons for discontinuation were recorded over a follow-up period of up to 78 months and based on the last recorded status.

Results: A total of 111 children (mean age: 10.1 years) were included. Mean functional gain was 22.7 (95% CI: 18.3-27.1) decibels hearing loss (dB HL) and the mean effective gain was 20.3 dB HL (95% CI: 20.3 [16.4, 24.2]). Skin complications were low and reported in 16 children (14.4%), of whom 7 needed to temporarily refrain from device use. Long-term compliance was 40.9% (median follow-up: 24 months). Key reasons for discontinuation included lack of perceived benefit (23.5%), appearance or social stigmatization issues (20.6%), and practical issues with adhesives (16.2%).

Conclusion: For congenital malformation and chronic suppurative otitis media patients, the ADHEAR provides effective amplification, although air-bone gap closure is suboptimal. Complications associated with device use were relatively rare and mild in nature. Compliance rates were notably lower than observed in other studies. Appearance and social stigmatization issues should be addressed during consultation.

Introduction: Age-related hearing loss (ARHL) is a multifactorial disorder due to impairment in the peripheral or central auditory pathway (CAP). CAP impairment refers to difficulties in speech understanding, particularly in the presence of background noise, problems in discrimination, and integrating and separating binaural auditory information. Changes in CAP mechanisms, such as neurotransmitters or ion movement, may correlate with this impairment. The regulation of calcium (Ca2+) concentrations by Ca2+-binding proteins (CaBPs) is critical for synaptic function and plasticity, and changes are directly related to ARHL. Thus, changes in the neuronal expression of CaBPs in aging could be related to CAP disorders. Considering that supplementation with antioxidant and/or neuroprotective substances can delay neuronal loss in aging, antioxidant-based therapies can prevent and/or reduce the progression of ARHL in animal models and humans. The hormone melatonin has important antioxidant and neuroprotective actions, which can sometimes depend on melatonin receptors. This work aimed to investigate changes in the expression of CaBPs and melatonin receptors in the CAP stations and whether this expression could vary with aging.

Methods: Brain sections of Wistar rats young and elderly were processed using immunohistochemistry technique, and for analysis and quantification, the stereology and optical density technique were used.

Results: The analysis revealed a lower density of CaBP-immunoreactive cells in most CAP nuclei. In contrast, elderly rats showed increased expression of MT1 and MT2 in CAP stations.

Conclusion: These findings suggest that changes in neuronal number and transmission in these nuclei in aging are concomitant with increased melatonin's potential sites of action in the CAP.

Background: The aging process is accompanied by sensory, motor, and cognitive declines that increase the risk of balance disorders. Fatigue is a prevalent yet often overlooked symptom among older adults.

Objective: This study examines the relationship between fatigue and balance in individuals 60 years and older to provide evidence for preventive and rehabilitative strategies.

Methods: Fatigue was assessed using the Fatigue Assessment Scale (FAS) and the Fatigue Impact Scale (FIS), while balance was evaluated with the Timed Up and Go (TUG) test, the Tinetti Balance and Gait Test (TBT-TGT), and the Single-Leg Stance Test (SLST).

Results: While fatigue had a negative impact on both static and dynamic balance, no statistically significant differences were detected between the fatigued and severely fatigued groups. Analyses revealed weak to moderate negative correlations between fatigue scales and measures of both static and dynamic balance, with mental fatigue demonstrating a comparatively stronger relationship with static balance. In the regression analysis, the model including age and mental fatigue overall explained 27.9% of the variance in single-leg stance duration.

Conclusions: The results of our study indicate that fatigue markedly impairs both static and dynamic balance performance among older adults.

Introduction: Locally applied dexamethasone therapy of the inner ear is commonly used to treat disorders such as Meniere's disease and idiopathic sudden sensorineural hearing loss. Dexamethasone is also being used in conjunction with cochlear implantation to reduce electrode impedances and fibrous tissue formation around the implant. The variety of formulations currently in use makes it difficult to compare the dosing levels resulting from different therapies.

Methods: We have used the FluidSIM cochlear fluid simulation program to calculate perilymph and plasma dexamethasone levels achieved by a variety of dosing approaches used clinically in humans. Identical pharmacokinetic parameters for perilymph and plasma were used for each delivery condition.

Results: Each of the delivery protocols was calculated to generate therapeutic concentrations in perilymph, but the time course of influence differed markedly between them. Some protocols generate concentrations in the blood that are above therapeutic concentration, increasing the potential for systemic side effects.

Discussion: Detailed simulations of delivery procedures allow different approaches to be compared quantitatively, giving a measure of dosing efficiency and allowing the merits of each protocol to be compared. Cochlear implants provide the most efficient dosing, generating therapeutic concentrations in the cochlea with minimal systemic influence. For intratympanic delivery, Spiral Therapeutics SPT-2101 provides therapeutic concentrations in perilymph with minimal systemic dosing. Conventional IT therapy with dexamethasone phosphate provides brief therapeutic concentrations in perilymph but substantial systemic exposure, with plasma concentration calculated to exceed therapeutic levels.

Objective: This study aims to assess the effectiveness of the ForwardFocus (FF) feature in cochlear implant (CI) users by evaluating its impact on speech comprehension in noisy environments, potentially improving communication outcomes for individuals with hearing loss.

Methods: A prospective study was conducted on 48 CI users from an audiology clinic over a 7-month period, between July 2023 and February 2024. Native Arabic speakers, using either N7 or Kanso2 external processors with the FF feature, were recruited. The study measured aided audiometry, word recognition score, and speech comprehension in noise using the Arabic Matrix Test with and without the FF feature, along with a survey assessing ease of use and satisfaction among other factors.

Results: The impact of FF on speech perception and user experience in CI users were evaluated. FF significantly improved speech perception in noise (p < 0.001), with users reporting high satisfaction (54.3% very satisfied, 26.1% satisfied) and intention to continue using FF (97.8%). Most participants used FF 1-2 times a week (56.5%), with 17% using it daily. Most found its noise reduction to be adequate (82.6%).

Conclusion: FF effectively enhanced speech understanding, with users expressing high satisfaction and intention to continue using the feature. This suggests FF's ability to improve communication and quality of life for CI users.

Introduction: Optimizing inner ear access is necessary for the genetic and regenerative treatment of sensorineural hearing loss. This is a descriptive histological study, with three-dimensional modeling of the microanatomy of minimally invasive transcanal access routes to the scala tympani through the round window, and suggested form and dimensions of injection needles for inner ear drug delivery.

Methods: Three-dimensional models of eight human temporal bone histological sections were created to measure key anatomical relationships and optimal needle trajectories.

Results: To spare the inner ear structures and reach the greatest depth in the scala tympani, the optimal trajectory via the round window is achieved with a needle leaned on and bent at the superiormost point of the round window niche operculum. The length of the needle's medial part is between 1.375 mm (1.2-1.6 mm) and 3.49 mm (2.8-4.3 mm), with a bend angle of 147° (123-167°). The penetration point of the round window membrane is its vertical axis center, reducing the risk of damage to the inner ear structure and avoiding the crista fenestra. The crista may shift the penetration point inferiorly when visible and not found behind the round window membrane. In all eight temporal bones, the crista never reached the center of the round window membrane, with the horizontal distance between the crista edge and the center being 0.55 mm (0.4-0.75 mm).

Conclusion: The data reveal the form and size factors for optimal transcanal access to the inner ear for structure- and function-preserving drug delivery.

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: Anatomy-based fitting (ABF), a relatively new technique for cochlear implant (CI) programming, attempts to lessen the impact of the electrode insertion location-related frequency-to-place mismatch (FPM). This study aimed to compare vowels and consonant perception in quiet and in noise among experienced adult CI users using the ABF and the regular, conventional-based fitting (CBF) map (pre-ABF) over 6 months.

Methods: Nine ears from eight experienced adult CI users were included in the experimental and longitudinal research. Using surgical planning software called Otoplan, postoperative computed computed tomography scans were used to determine the locations of intracochlear electrodes and their angle of insertion. The anatomy-based frequency bands were produced by Maestro 9.0 CI fitting software using the Otoplan data. Nonsense syllables with consonant-vowel-consonant (CVC) recognition scores in quiet and noise (+5 dB SNR) were compared at baseline, 3, and 6 months after ABF. The vowels involved were /a, i, u/, while the consonants were voiced /b, d, g/ and voiceless /p, t, k/ plosives. Speech pieces were presented at 30 dB SL in a sound-treated room through a loudspeaker positioned at 0° azimuth.

Results: On average, the ABF maps shifted center frequency ranging from 0.46 semitones (0.04 octave) at (E12) to 23.94 semitones (1.99 octave) at (E1) as compared to the CBF maps. The mean vowel and consonant identification scores in quiet and in noise were significantly higher in ABF than in CBF (p < 0.05) with a large effect size and the trend of improvement was seen with time. Voiced consonants had better scores than the voiceless consonants.

Conclusion: The results demonstrated improved perception of vowels and consonants, particularly for sounds containing voicing cues after using the ABF maps. The results also suggested that ABF could be more effective for voice detection in noise. Overall, the findings indicate that correcting place mismatch with an ABF map may improve speech perception, at least among experienced adult CI users.