Acta Oto-Laryngologica最新文献

Background: Conventional cochlear implant (CI) programming applies default frequency allocation without accounting for individual cochlear anatomy. Anatomy-based fitting (ABF) uses cochlear measurements to align frequency allocation with each recipient's tonotopic organization. Objectives: This study compared audiological and subjective outcomes between default fitting and ABF in adult CI users and evaluated the effect of ABF on frequency-to-place mismatch.

Methods: Twenty adult CI recipients underwent both default fitting and ABF. Outcomes included pure-tone audiometry, speech discrimination in quiet and noise, and the Abbreviated Profile of Hearing Aid Benefit (APHAB). Frequency-to-place mismatches were calculated for all electrode contacts, and outcomes were statistically compared across fitting strategies.

Results: ABF significantly reduced frequency-to-place mismatch (p < 0.001), with the greatest improvement in the mid-cochlear region. Speech discrimination scores were significantly higher with ABF in quiet and noise (p < 0.001). APHAB scores indicated significantly fewer self-reported hearing difficulties with ABF (p < 0.001). Pure-tone thresholds did not differ between the two fittings.

Conclusions: ABF improves speech perception and subjective hearing outcomes compared with default programming, supporting its clinical value for adults.

Significance: ABF offers a simple, software-based approach to improve speech perception and patient-reported outcomes in adult CI users without altering surgical technique.

Background: With the existing experimental techniques, it is unable to measure the overall structural vibration of the human ear, which is difficult to reflect the relationship between hearing and ear structures.

Aims/objectives: The overall biomechanical behaviour of the whole ear structure during sound perception is described.

Methods: Based on CT scanning data and knowledge of ear physiology, a 3D whole ear numerical model was developed that conforms to the actual physiological environment of the human body.

Results: The outer ear canal (EC) has an amplifying effect on sound conduction. The middle-lower part of tympanic membrane (TM) is susceptible to damage, which is mainly reflected in the high-tendency of clinically TM perforation phenomenon. Similarly, TM's damage or hypoplasia is also common. Peak amplitude occurs at the center of one-side of the oval window membrane (OWM) and the center of the round window membrane (RWM), respectively, and these areas are prone to disruption and more severely may evolve into perilymph fistulas. The BM's amplitude changes longitudinally along the cochlear helix as frequency increases.

Conclusions and significance: This model reflects the impact of localized structural damage on hearing under the coordinated working of the whole ear (outer, middle and inner ears).

Background: Deep neck abscess (DNA) is a otorhinolaryngological condition associated with morbidity, mortality, high treatment costs, and long-term wound care. Optimizing wound management is essential to improve outcomes and reduce healthcare burden. Honey is expected to be an effective treatment modality and may serve as an effective adjunctive therapy.

Objective: To compare the effectiveness of standard wound dressing combined with honey versus standard dressing in patients with DNA, based on wound size, Bates-Jensen Wound Assessment Tool (BWATs) scores, Visual Analog Scale (VAS), white blood cell (WBC) count, bacterial colony growth, and expression of interleukin-1 (IL-1), tumor necrosis factor-α (TNF-α), and vascular endothelial growth factor (VEGF).

Methods: A single-blind randomized controlled trial was conducted at Dr. Sardjito General Hospital between May 2024 and June 2025. Participants received either standard dressing or standard dressing supplemented with honey. Outcomes were analyzed using appropriate parametric and nonparametric statistical methods.

Results: Honey supplementation showed comparable clinical outcomes to standard dressings, demonstrated greater reductions in inflammatory markers (IL-1, TNF-α) and increased VEGF expression.

Conclusion: Honey as an adjunct to standard dressing may serve as an effective adjunct DNA wound healing by enhancing anti-inflammatory and proliferative responses.

Background: Branchio-oto-renal (BOR) syndrome is characterized by branchiogenic malformation, hearing loss, and renal anomalies, with EYA1, SIX1, and SIX5 known as the causative genes. As BOR syndrome presents with various clinical phenotypes, its characteristics and genotype-phenotype correlations remain unknown.

Aims/objectives: In this study, we aimed to clarify the detailed hearing loss phenotypes and genotype-phenotype correlations of BOR syndrome.

Material and methods: In this study, we performed an etiological analysis of 169 BOR syndrome patients from 129 families. We also performed genetic testing for 78 probands.

Results: In all, 66.7% of BOR patients carried EYA1 variants, whereas 17.9% carried SIX1 variants. We also clarified the detailed clinical features including the prevalence of major and minor symptoms, asymmetrical hearing loss, type of hearing loss, severity of hearing loss and detailed clinical characteristics of auricular, external ear, and middle ear and inner ear anomalies. In terms of genotype-phenotype correlations, patients with SIX1 variants had no kidney anomalies and fewer middle ear anomalies.

Conclusions and significance: We clarified the detailed hearing loss phenotypes of BOR syndrome patients. Our study results will contribute to a better understanding and clinical management of BOR syndrome patients.

Background: Although the cervical vestibular-evoked myogenic potential (cVEMP) frequency response has diagnostic value in Ménière's disease (MD), a method that accounts for age-related changes is needed.

Aims/objective: To develop an age-independent diagnostic approach for MD using cVEMP.

Subjects and methods: cVEMP frequency responses were recorded at six stimulus frequencies (250-2000 Hz) in 35 definite unilateral MD ears and 55 control ears. The discrete peak frequencies were converted into a continuous variable by spline approximation. This spline peak was normalized age-adjusted Z (AAZ) scores which were from a linear regression model using data for controls.

Results: The spline peak frequency was significantly higher in MD ears (1171 ± 395 Hz) than in controls (707 ± 270 Hz). A receiver operating characteristic analysis identified a cutoff value of 0.866 for AAZ score, yielding a sensitivity of 0.771, specificity of 0.825, and area under the curve of 0.858 for distinguishing MD from controls. The AAZ score achieved stable diagnostic performance across age groups.

Conclusions and significance: Spline approximation enables the physiologically meaningful estimation of cVEMP peaks, and AAZ scoring eliminates age-related effects. This novel approach may serve as a practical diagnostic tool for MD in aging populations.

Background: Stimulation of the utricle has been hypothesized to elicit nystagmus. However, the observation that nystagmus rarely occurs immediately following the Epley maneuver for posterior semicircular canal benign paroxysmal positional vertigo has raised questions about the existence of a robust otolith-ocular reflex.

Objective: To determine whether nystagmus can be elicited from the utricle by applying linear acceleration.

Materials and methods: The subjects were 10 healthy individuals. Each subject was seated in a wheelchair, rotated their upper body 90° to the right, and moved side to side. The amplitude was approximately 0.2 m, with a frequency of 0.33 Hz.

Results: In all subjects, no eye drift was observed in response to body movement.

Conclusions and significance: Low-frequency stimulation of the utricle does not always produce nystagmus. Therefore, we need to reconsider the function of the utricle.

Background: Tinnitus is a common symptom in otolaryngology with a complex and multifactorial etiology. Ginkgo biloba extract (EGB 761) is widely used in clinical practice, but the reported results vary across studies, partly due to differences in dosage and outcome assessment.

Objective: To compare tinnitus outcomes between two commonly used EGB 761 dosages (120 mg/day vs. 240 mg/day) in patients with SSNHL-associated newly onset tinnitus, and to identify clinical factors associated with tinnitus prognosis.

Methods: Participants from mainland China were randomly assigned (1:1) to receive either 120 mg/day or 240 mg/day of EGB 761 tablets for one month. Follow-up assessments were conducted at 1, 2, 3, 4, 6, 9, 12, and 18 months after treatment initiation.

Results: A total of 195 valid data sets were analyzed. The mean baseline Tinnitus Handicap Inventory (THI) score of 48.99 significantly decreased to 28.33 at 1 month, 16.97 at 6 months, and 10.54 at 18 months. A slightly higher proportion of patients met the improvement criterion in the high-dose group (95.9%) than in the low-dose group (91.9%), but the between-group differences were not statistically significant for THI reduction or other outcomes. In multivariable analyses, higher anxiety (GAD-7 ≥ 10), higher reflux symptom burden (RSI ≥13), and a history of vestibular disorders were associated with less favorable tinnitus outcomes at follow-up.

Conclusion: Both 120 mg/day and 240 mg/day dosages of EGB 761 demonstrated similar tinnitus outcomes over follow-up. Anxiety, LPR, and a history of vestibular disorders may be prognostic factors for tinnitus.

Background: Visible tympanic membrane (TM) pulsation is an uncommon otoendoscopic finding that may reflect middle ear or intracranial pathology.

Objective: To characterize clinical features and etiologies of TM pulsation in an outpatient otology setting.

Methods: We retrospectively reviewed 34 consecutive adults (mean age 56 ± 13 years) with TM pulsation identified on routine otoendoscopy (January 2022-September 2024). All patients underwent audiologic testing and temporal bone computed tomography; internal auditory canal magnetic resonance imaging was performed when indicated. Patients with neurological symptoms or suspected intracranial hypertension were excluded.

Results: Middle ear effusion was the most common cause (61.8%), frequently associated with pulsatile tinnitus. Healed TM perforation accounted for 26.5% of cases. Less common etiologies included jugular diverticulum, arachnoid granulation with tegmen dehiscence, temporal encephalocele, and postoperative TM graft pulsation. Imaging findings supported correlations between TM movement and underlying middle ear or adjacent structural abnormalities.

Conclusion: In outpatient populations, visible TM pulsation predominantly reflects middle ear cavity conditions rather than intracranial pressure changes. Awareness of this sign may facilitate early detection of clinically relevant lesions, including encephalocele and vascular anomalies, and guide timely imaging and management.

Background: Vestibular involvement in CDH23-related nonsyndromic hearing loss remains incompletely understood, particularly prior to cochlear implantation.

Aims/objectives: To evaluate vestibular function prior to cochlear implantation in patients with severe to profound non-syndromic hearing loss caused by CDH23 mutations.

Material and methods: We retrospectively evaluated vestibular function in seven patients with severe to profound non-syndromic hearing loss caused by CDH23 mutations who were scheduled for cochlear implantation. Vestibular assessment included caloric testing, ACS-cVEMP, BCV-oVEMP, and damped rotation testing, depending on age.

Results: Six patients had homozygous missense mutations, and one had compound heterozygous mutations in CDH23. Caloric testing revealed unilateral reduced responses in two patients (28.6%). Damped rotation testing, performed in four pediatric patients, showed a unilateral reduced response in one patient (25%). ACS-cVEMP demonstrated a unilateral reduced response in one patient (14.3%) and an absent response in another (14.3%). BCV-oVEMP, conducted in three patients, revealed a unilateral absent response in one patient (33.3%). Overall, unilateral vestibular dysfunction was identified in four of seven patients (57.1%).

Conclusions and significance: More than half of patients with CDH23-related non-syndromic deafness exhibited unilateral vestibular dysfunction prior to cochlear implantation, suggesting that preoperative vestibular assessment may be clinically relevant in this population.

Background: Hearing-aid (HA) satisfaction influences sustained use in older adults, and performance on auditory-processing tests may be associated with HA satisfaction.

Aims/objectives: To determine whether audiometric and auditory-processing measures are associated with HA satisfaction in individuals with presbycusis and preserved cognition.

Materials and methods: Retrospective review at a tertiary centre. Twenty-two adults (63-88 years) underwent pure-tone audiometry, monosyllabic word recognition, fast-rate speech test (FST) and rapidly alternating speech perception test (RASPT), presented 40 dB SL at a comfortable hearing level. Self-reported questionnaires evaluated HA satisfaction (0-100%), hearing-related distress (100-mm visual analogue scale) and self-perceived hearing handicap (0-50 points). Groups: thresholds ≤55 vs. >55 dB HL; word recognition ≥80% vs. <80%; FST/RASPT ≤5% vs. ≥10%.

Results: Outcomes did not differ by average thresholds. Compared with ≥80% recognition, <80% yielded lower satisfaction and higher distress and handicap (p ≤ 0.01). FST ≤5% vs. ≥10% predicted lower satisfaction and greater handicap (p < 0.05). RASPT ≤5% vs. ≥10% predicted lower satisfaction and higher distress and handicap (p ≤ 0.01-0.001).

Conclusions and significance: In older adults, satisfaction aligns more with word- and sentence-level processing than with pure-tone thresholds. Auditory processing tests alongside word recognition may refine counselling and support sustained HA use.