Audiology and Neuro-Otology最新文献

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.

Introduction: During postoperative implant control, we observed extraordinary peaks in transimpedance measurements. While searching for a possible reason, it appeared that they might correlate with scalar dislocations.

Methods: In this retrospective case series, six adult CI patients who underwent transimpedance measurements and postoperative imaging were analyzed. Intra- and postoperative transimpedance measurements were visual inspected. The intracochlear position of electrodes was radiologically identified.

Results: From 6 patients with transimpedance matrices showing an extraordinary peak in the off-diagonal area, five electrode arrays showed no correct scalar localization in the scala tympani, and one had a correct scalar localization in the scala tympani.

Conclusions: A peaking transimpedance might be a marker for scalar dislocation in CIs.

Introduction: Balance disorders are a major challenge today as they greatly affect people's quality of life. Although medical treatment and vestibular rehabilitation are insufficient in many cases, significant improvements in the treatment of vestibular pathologies have been achieved in recent decades. New trends toward minimally invasive procedures have led to the study of direct treatment at the vestibular level, such as the use of vestibular implants. Great efforts have been made to acquire a thorough knowledge of these organs. However, the surgical anatomy and exact spatial orientation of the vestibular end organs remain partially unknown. The aim of this study was to evaluate in three-dimensional (3D) reconstructions the feasibility of new minimally traumatic surgical approaches to the vestibule.

Methods: In order to plan and explore new surgical approaches to the vestibular end organs, a methodology based on 3D models of the inner ear has been developed. This methodology is tested on human temporal bones treated with vestibular implants to analyze possible new minimally traumatic approaches to the vestibular system. Pre- and post-implantation cone-beam computed tomography (CBCT) images were acquired. Image segmentation of the vestibular end organs was performed on the pre-implantation CBCT scan. An already validated, freely and openly available anatomical atlas of the inner ear, IE-Map, was used as a reference template for the anatomy. Alignment of the IE-Map with the CBCT images was achieved using the MATLAB image processing toolbox. Interactive 3D models were visualized with the non-commercial version of Dragonfly 2021.1 software.

Results: Image segmentation of the vestibular end organs and their 3D reconstructions were successfully performed in all cases. The 3D images showed reasonably realistic estimation of the location of the electrode within the vestibule and their relationships with respect to the different ampullary and otolithic receptors.

Conclusion: 3D reconstruction by segmentation of the inner ear with superposition of CT images and an anatomical model is feasible and offers valuable morphological insight into the complex anatomy of the inner ear. This technique is particularly useful for exploring potential new surgical approaches to access the vestibule and shows promising results in the context of future local drug delivery and/or direct electrical stimulation at the vestibular level. Three such approaches were proposed and preliminarily assessed.

Introduction: The floating mass transducer (FMT) of the Vibrant Soundbridge (VSB) is successfully used for reverse stimulation of the round window membrane (RWM) since 2005, enabling the treatment of conductive and mixed hearing loss. The FMT can be placed directly to the RWM or indirectly by using an interposed material such as fascia and Tutopatch, or a coupler, e.g., the round window coupler (RWC), the round window soft (RWS) coupler, or the custom-made Hannover coupler version 2 (HCV2). The aim of the study was to retrospectively evaluate the long-term outcome of the most common VSB round window (RW) coupling modalities in our clinic with regard to (1) safety and preservation of residual hearing, (2) coupling efficiency (C_eff), and (3) speech outcome.

Methods: A total of 111 RW vibroplasties, a surgical procedure including the implantation of the VSB, in 102 ears (95 patients) performed at the Hannover Medical School between 2006 and 2021 were analyzed. Seventy-nine RW vibroplasties in ears with available preoperative bone conduction pure tone average (BC PTA₄) were included in the safety analysis, focusing on adverse events (AEs). Furthermore, the audiological outcomes were evaluated in 56 ears (52 patients, 4 bilateral implanted) preoperatively, at initial activation (6-8 weeks), 2 years, and 5 years, including BC PTA₄ (at 0.5, 1, 2, 4 kHz), C_eff (in situ measurement - BC PTA₄), effective gain (BC PTA₄ - sound field threshold), and monosyllable word recognition score (WRS; Freiburg monosyllable test at 65 dB SPL).

Results: The safety analysis showed a total mean AE rate of 29.1%. A statistically significant decline over time in BC PTA₄ was found in groups RWS and HCV2 by 7.6 dB and 8.8 dB (paired t test, p = 0.022 and p ≤ 0.001, respectively), at 2 years. The WRS improved over time in all groups, resulting in an overall mean score of 81.1% in the range 70.0% to 90.8% at 2 years, with a statistically significant improvement between IA and 2 years and the best mean WRS of 90.8% at 2 years in group HCV2 (paired t test, p ≤ 0.001). While the C_eff was stable and below 25 dB at all time points in most groups, it improved statistically significantly in group RWC by a total of 9.9 dB between IA and 5 years to 16.8 dB (paired t test, p ≤ 0.001).

Conclusion: The RW vibroplasty is a safe surgery, though complex and challenging. All investigated coupling modalities provided effective treatment for conductive and mixed hearing loss. Patients in group RWC and HCV2 tended to perform noticeably better in terms of aided speech understanding and C_eff than those in the other groups.

Introduction: Emotional response to music, though a central facet of music listening, remains poorly understood. In this study, we investigate the emotional responses to music among bilateral cochlear implantees.

Methods: Bilateral CI users and normal-hearing (NH) controls were recruited from a tertiary academic center and community hearing loss groups. Participants listened (via an online survey) to ten previously validated 15-s musical clips representing multiple genres and wide range of valence (happiness vs. sadness) and arousal (excitement vs. calm) and rated the musical clips on validated nine-point visual analog scales of valence and arousal.

Results: In total, 25 bilateral CI users and 18 NH controls completed the study. Compared to NH controls, CI users demonstrated significantly increased error in valence identification (mean [SD] 1.75 [0.61] vs. 1.16 [0.29], p < 0.001) but equivalent arousal error. There were significant differences for 8 of 20 total ratings between NH and CI groups. Additionally, CI users demonstrated a significantly constricted range of arousal (4.69 [1.39] vs. 6.04 [1.33], p = 0.0025) but a preserved range of valence (4.99 [1.57] vs. 5.62 [1.13], p = 0.13). Implantees reported significantly lower music enjoyment (5.78 [3.57] vs. 8.57 [1.17], p = 0.0016) than NH controls, and enjoyment was significantly associated with both valence and arousal range.

Conclusions: Bilateral CI users' emotional response to music is significantly constricted compared to NH controls. Blunted appreciation of emotional content likely contributes to reduced music enjoyment among cochlear implantees and is a critical target for improvement.

Introduction: For a comprehensive approach in children with hearing loss (HL), some cognitive and language skills should also be considered, along with auditory skills. The main aim of this study was to evaluate the working memory and language skills in children with mild to moderate HL.

Methods: Forty children with mild to moderate HL between the ages of 4 and 9 years were included in this study. The children with mild and moderate HL were evaluated in two groups. The Meaningless Word Repetition test, Test of Language Development-Primary test, and Meaningful Auditory Integration Scale were administered to assess working memory, language skills, and auditory perception, respectively. Also, the relationship between language and memory skills was evaluated.

Results: The study found statistically significant correlations between language skills and working memory test scores. Additionally, statistically significant differences were found between children with mild and moderate HL in terms of language and memory skills (p < 0.001).

Conclusion: The children with moderate HL demonstrated poorer performance compared to those with mild HL. Even if it is mild, the degree of HL affects children's language and memory skills. It is emphasized that the relationship between language and working memory should be taken into consideration in auditory rehabilitation programs for these children.

Introduction: Tinnitus, the perception of sound without an external auditory stimulus, affects approximately 10-15% of the population and is often associated with significant comorbidities such as headaches. These conditions can severely impact the quality of life. The aim of this study was to evaluate the efficacy of a food supplement in reducing the symptoms of both tinnitus and headache in patients experiencing these conditions concurrently.

Methods: This prospective study included 32 patients (21 males and 11 females) aged between 23 and 68 years (mean age 49.38 years) who were experiencing both tinnitus and headache. The study assessed the impact of a food supplement on tinnitus and headache over a 90-day treatment period using three main instruments: the Tinnitus Handicap Inventory (THI), the Headache Impact Test (HIT-6), and a Visual Analog Scale (VAS) for discomfort. Statistical analyses, including paired t tests, were conducted to compare pre- and posttreatment scores. In the same dataset, Ridge Regression, a linear regression model with L2 regularization, was used to predict posttreatment scores (THI90, HIT90, VAS90).

Results: The results indicated a statistically significant reduction in all three measures after 90 days of treatment. The mean THI score decreased from 29.81 to 27.06 (p = 0.011), the mean HIT-6 score decreased from 50.41 to 48.75 (p = 0.019), and the mean VAS score for discomfort decreased from 7.63 to 7.13 (p = 0.033). The optimal Ridge Regression model was found with an "alpha" value of approximately 3.73. The performance metrics on the test set were as follows: Mean Squared Error (MSE) of 13.91 and an R-squared score of 0.61, indicating that the model explains approximately 61% of the variance in the posttreatment scores. These results indicate that pretreatment scores are significant predictors of posttreatment outcomes, and gender plays a notable role in predicting HIT and VAS scores posttreatment.

Conclusion: This study demonstrates that a food supplement is effective in reducing the symptoms of tinnitus and headache in patients suffering from both conditions. The significant improvements in THI, HIT-6, and VAS scores indicate a positive impact on patient quality of life. Further research with larger sample sizes and more detailed subgroup analyses is recommended to fully understand the differential impacts of treatment across various demographics.

Background: Temporal bone meningoencephalocele (TB-MEC) diagnosed with or following cholesteatoma is a rare yet complex neurotological scenario. This study aimed to characterize the clinical features and treatment strategies to facilitate clinicians' decision-making and patients' counseling.

Methods: We conducted a retrospective case series with a systematic literature review of the past 3 decades. For the literature review, PRISMA guidelines were followed, with articles sourced from PubMed and EMBASE. The study examined demographics, clinical aspects, imaging findings, surgical approaches, and postoperative outcomes.

Results: We identified 75 cases (n = 72 from the literature and n = 3 original). The majority of the patients with TB-MEC had prior cholesteatoma surgeries (79%), mostly canal wall down (CWD) mastoidectomy, with a relatively high complication rate (15%) at presentation. TB-MECs were incidentally discovered intraoperatively in 39.5% of the cases. Most (65%) of the preoperatively diagnosed had major defects (>1 cm). Tegmen mastoideum was involved in 68%. Surgical treatment employed a trans-mastoid approach in 72%, including minor and major defects, whereas middle fossa or combined approaches were reserved for major defects only. Autologous grafts, mainly temporalis fascia, were the primary choice for reconstruction (98%), regardless of defect sizes or surgical approach. Single surgery was mostly sufficient, irrespective of defect size (100% and 93% for minor and major defects), and complications were minimal.

Conclusions: Despite advancements in imaging, TB-MED is still discovered intraoperatively at a substantial rate. High-risk cases are patients with prior complications and multiple past surgeries, mainly CWD. Although previously described complications were ominous, today, a single-stage procedure yields positive outcomes.

Introduction: This study investigates whether high levels of headphone music listening in young adults contribute to hidden hearing loss (HHL) and whether listening effort (LE) and cognitive skills differ based on headphone exposure.

Methods: Fifty participants (18-30 years) with normal hearing were divided into high-risk (HR) and low-risk (LR) groups based on annual headphone exposure levels recorded via smartphone applications. Participants underwent high-frequency audiometry, auditory brainstem response (ABR), matrix sentence test, behavioral LE measurement, and P300 testing. The measurement of LE and P300 was conducted at varying signal-to-noise ratio (SNR). Working memory was assessed using the reading span test, while attention abilities were evaluated with the Stroop test. Finally, short-term memory was assessed through the visual auditory number sequences test.

Results: The findings from the ABR and matrix sentence tests indicated signs of noise-induced cochlear synaptopathy in the HR group. In this group, an increase in LE was observed as SNR decreased, which was statistically significant. Furthermore, a significant decrease in P300 amplitude was found in response to SNR changes in the HR group; however, no significant difference was observed in the LR group. Statistical analysis revealed no significant differences between the two groups in the cognitive tests administered.

Conclusions: The present study lends support to the hypothesis that the habitual listening of music at high volumes through headphones has the potential to result in HHL; however, further longitudinal studies are required to assess the impact of this condition on cognitive skills.

Objectives: The primary goal was to investigate the suitability of CHAPS for assessing cognitive abilities and auditory processing in people with hearing loss (HL), specifically in the domains of auditory processing, verbal working memory, and auditory attention.

Method: The study comprised 44 individuals between the ages of seven and 14, 22 with HL (N = 11 males) and 22 with normal hearing (N = 10 males). Individuals' auditory attention, working memory, and auditory processing skills were assessed in the study, and self-report questionnaires were used. The evaluation utilized the Sustained Auditory Attention Capacity Test (SAACT), Working Memory Scale (WMS), Filtered Words Test, Auditory Figured Ground Test (AFGT), and the Children's Auditory Performance Scale (CHAPS). Analyses were conducted, including group comparisons, correlation examinations, and receiver operating characteristic evaluations.

Results: There were significant differences in CHAPS total, attention, noise, quiet, and multiple inputs between groups. No significant differences were seen in CHAPS_ideal and CHAPS_auditory memory across groups. The study of SAACT and its subscores, WMS and its subscores, FWT, and AFGT revealed a significant difference between groups, caused by the poor performance of persons in the HL group compared to those in the NH group. The SAACT and its subscores correlated significantly with CHAPS_attention. The AUC calculation showed that The SAACT and CHAPS_attention distinguished persons with or without HL (p < 0.05). WMS_STM and WMS_total correlated with CHAPS auditory memory subscale; however, WMS_VWM did not. AUC values for WMS and its subscores showed significant discrimination in identifying children with or without HL (p < 0.05), whereas CHAPS_auditory memory did not (AUC = 0.665; p = 0.060). FWT and AFGT had a significant relationship with CHAPS_noise and CHAPS_multiple inputs subscales. The CHAPS_quiet and CHAPS_ideal subtests only correlated with AFGT. CHAPS_quite and CHAPS_ideal did not exhibit significant discriminative values (p < 0.05) for identifying children with or without HL, while CHAPS_noise, CHAPS_multiple inputs, FWT, and AFGT did.

Conclusion: The CHAPS_attention subscale could be a trustworthy instrument for assessing auditory attention in children with HL. However, the CHAPS_auditory memory subscale may not be suitable for testing working memory. While performance-based auditory processing tests showed improved discrimination, the CHAPS_noise and CHAPS_multiple inputs subtests can still assess hearing-impaired auditory processing. The CHAPS_quiet and CHAPS_ideal subtests may not evaluate auditory processing.