The journal of international advanced otology最新文献

BACKGROUND: The aim of this study was to determine whether there are differences in the balance system between individuals with vision loss and a healthy control group using the video head impulse test (vHIT), cervical vestibular evoked myogenic potentials (cVEMP) and ocular vestibular evoked myogenic potentials (oVEMP) tests. METHODS: The study included 23 individuals diagnosed with bilateral low vision, 20 individuals diagnosed with bilateral blindness, and 50 healthy control subjects. vHIT, cVEMP, and oVEMP tests were applied to all participants to evaluate the vestibular system. In addition to the standard vHIT, 2-condition vHIT (in the dark and in daylight without a target) was performed on the control group to evaluate the effect of visual input. RESULTS: In vHIT responses, a significant difference in vestibulo-ocular reflex (VOR) gains was detected in the comparison between the bilateral low vision, bilateral blind, and control groups in all semicircular canals (SSC) (P < .001). When the vHIT responses in the 3 conditional groups of the control group (untargeted daylight, darkness, and standard) were examined, a significant difference in VOR gains was detected in the comparison of all 3 groups in the entire SSC (P < .001). CONCLUSION: The findings of statistically significantly low VOR gains obtained in individuals with low vision and the blind group showed the great effect of visual input on the vestibular system. This hypothesis was also supported by the results of vHIT, which was applied in 3 stages (dark, untargeted daylight, and standard) in healthy individuals.

BACKGROUND: Clinicians recommend that parents use noise-making toys for hearing conditioning, but these differ from formal testing stimuli, resulting in longer test times and more sessions to complete the hearing evaluation. The app-based (AB) conditioning method, having similar stimuli used in actual hearing evaluation with structured parental guidance, could reduce the clinician's task load and the number of sessions needed for pure tone audiometry (PTA) testing among children compared to the conventional conditioning method. METHODS: A comparative research design assessed the effectiveness of 2 conditioning methods for hearing in 30 participants aged 2 to 3.6 years, randomly assigned to conventional (n=15) or AB methods (n=15). The clinician was blinded to the method used. The clinician's workload during PTA testing was evaluated using the National Aeronautics and Space Administration (NASA) task load tool, and the number of sessions needed to complete PTA testing was recorded for each method. RESULTS: Children conditioned using the AB method required significantly less clinician task load and fewer PTA testing sessions than the conventional method (CM). Additionally, clinician task load decreased after conditioning, regardless of the method, with no correlation between task load before and after. CONCLUSION: App-based conditioning creates a strong stimulus-response link in children and reduces clinician task load compared to the CM.

BACKGROUND: Musical hallucinations have a great impact on a patient's life, but because of the rare frequency of occurrence and multiple causes, not enough research has been conducted on this topic yet, especially in Korea. Many patients with musical hallucinations have audiological and otologic problems. This study investigated the clinical manifestations of musical hallucinations in patients. METHODS: The authors retrospectively analyzed clinical data from patients with musical hallucinations who visited the outpatient clinic of the Department of Otorhinolaryngology at Severance Hospital, Seoul, Republic of Korea, for 7 years, from January 1, 2015, to December 31, 2021. RESULTS: Seven of 9 patients were female, the average age was 67.1 (52-89) years, and post-lingual hearing loss was diagnosed in all patients. They listened to songs 1-3 over and over again for 5.4 (±6.1) years. Four patients had chronic otitis media or underwent tympanomastoidectomy surgery because of chronic otitis media. Audiological rehabilitation was performed, including cochlear implantation surgery, in one patient. CONCLUSION: In most cases, patients with musical hallucinations had audiological and otologic symptoms. Therefore, when patients complaining of musical hallucinations visit the hospital, it is essential to perform an audiological and otologic evaluation, and treatment for their symptoms should be considered.

BACKGROUND: Electrocochleography (EcochG) is a valuable method for determining frequency-specific objective hearing thresholds. While pure tone audiometry (PTA) is the gold standard, it can be inconclusive in certain populations, such as infants and non-responders. Auditory brainstem response is the primary electrophysiological test for threshold estimation in these groups. However, EcochG offers the advantage of closer field measurements, making it a promising alternative. This study compares PTA-based subjective thresholds with EcochG-derived objective thresholds in patients with varying degrees of hearing loss. METHODS: Participants consisted of individuals with both normal hearing and varying degrees of hearing loss. 0.5, 1, 2, and 4 kHz tone-burst stimuli and click stimuli were used to measure the latency and amplitude of action potentials (APs) using extra-tympanic electrodes. The AP component of the EcochG response was used as the primary measure for estimating hearing thresholds and was compared with PTA data. RESULTS: There is a strong correlation between 0.5, 1, 2, and 4 kHz pure tone thresholds (PTTs) and EcochG thresholds of the same frequencies (P < .001). Also, there is a strong correlation between click stimulus and the 4-frequency pure tone average (P < .001). The results of the linear regression analysis showed that the 0.5, 1, 2, and 4 kHz PTTs can be predicted using EcochG. Electrocochleography with click stimuli can also predict PTA of 4 frequencies. CONCLUSION: Using the EcochG test, hearing thresholds can be estimated without the need for a correction factor according to our results.

BACKGROUND: Tinnitus is a common symptom in patients with vestibular schwannoma (VS). The impact of Gamma Knife radiosurgery (GKRS) on tinnitus and the health-related quality of life (HRQoL) of patients with VS remains unclear. This study evaluated the effect of GKRS on HRQoL affected by tinnitus. METHODS: From December 2020 to April 2022, spontaneous VS patients who had no prior history of treatment and underwent their first GKRS in this period were analyzed. Subjective distress from tinnitus was measured by the Tinnitus Handicap Inventory (THI) and their HRQoL by 36-Item Short Form Survey Version 2 (SF-36v2). Pre-GKRS THI and SF-36v2 were obtained, and after GKRS, consecutive THI and SF-36v2 were obtained during the follow-up period. Bowker's test, paired Student's t-test, and Spearman's correlation were used to analyze the changes in THI grade, SF-36v2 score, and the correlation between THI grade and SF-36v2 score. Factors affecting the THI grade change and SF-36v2 score were evaluated through univariate and multivariate models. RESULTS: Twenty of 34 patients showed serviceable hearing before GKRS. The median radiation dose of GKRS was 12.75 Gy (range, 12-21 Gy). Twenty-two of 33 patients demonstrated no change or worse THI grade after GKRS, but the change was not statistically significant (P =.34). However, with age, the odds ratio of THI improvement is 0.905 (95% CI 0.83-0.98, P=.02). Patients with serviceable hearing before GKRS displayed THI grade improvement (OR = 6.721; P = .03). Compared to those with pre-GKRS THI grade 1, grades 3 and 4 exhibited lower odds of THI improvement (OR =0.095; P=.0449). No significant change was noted in SF-36v2 scores after GKRS. A high THI grade was correlated with a low physical component score (P =.03) and mental component score (P=.0002) of SF-36v2. CONCLUSION: Although THI grade and SF-36v2 change before and after GKRS did not show statistical significance, several factors affected THI grade change. Moreover, the THI grade and SF-36v2 score had a significant negative correlation. Factors that may aggravate tinnitus and further impact HRQoL of VS patients should be taken into account when planning treatment and providing counseling to VS patients.

BACKGROUND: To compare the quality of life scores of children with monoaural cochlear implants (CIs) aged 4-16 with those of normally hearing (NH) children and parents' reports. METHODS: The KINDL-R questionnaire that measures health-related quality of life (HRQoL) was delivered to 72 children aged 4-16 years and their parents. The children were divided into 3 subgroups of 4-7, 8-11, and 12-16 years and asked to report their quality of life from their own perspectives. The parents were divided into 2 subgroups for 4-7 aged and 8-16 aged children and were asked to report their child's quality of life status from their perspectives. The QoL scores of children with CI in the 3 subgroups were compared with the scores of their parents and NH peers. RESULTS: The total scores of children with CIs in all subgroups were significantly worse than NH peers. The total scores of parents and children with CIs in all subgroups revealed no statistically significant differences. In the correlation analysis, the age of implantation was negatively correlated with the total score both in 8-11 (ρ: -0.777) and 12-16 year subgroups (ρ: -0.591). Similarly, the implant usage duration was positively correlated with the total score in all age groups. CONCLUSION: Children with CI experience worse QoL status than their NH peers. The possible causes of the lower QoL scores following cochlear implantation must be investigated. Reports from parents on their children's QoL status are reliable.

Chronic inflammation has been proposed as a contributing factor in the pathogenesis of sudden sensorineural hearing loss (SSNHL). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) are well-established indices of inflammation, but their roles in SSNHL pathogenesis and prognosis remain controversial. This meta-analysis aimed to explore these associations. A systematic review was performed by 2 independent investigators across PubMed, Web of Science, Cochrane Library, and Embase databases. The quality of included studies was assessed using the Newcastle-Ottawa Scale. Twenty-six studies including 2392 SSNHL patients and 1865 controls were included. Recovery data were available for 1343 patients, of whom 785 recovered and 558 did not. Meta-analysis revealed that both NLR (standardized mean difference [SMD]=1.082, 95% CI=0.949, 1.216, P < .001) and PLR (SMD=0.516, 95% CI=0.333, 0.700, P < .001) were significantly elevated in SSNHL patients compared to controls. MPV (SMD=1.103, 95% CI=0.820, 1.483, P=.516) showed no significant difference. Additionally, higher NLR (SMD=-0.472, 95% CI=-0.784, -0.160, P=.003) and PLR (SMD=-0.327, 95% CI=-0.630, -0.023, P=.035) were associated with non-recovery in SSNHL, whereas differences in MPV (SMD=-0.352, 95% CI=-0.881, 0.177, P=.192) were not statistically significant. NLR and PLR may be involved in the pathogenesis of SSNHL and may serve as cost-effective and accessible prognostic markers.

BACKGROUND: Successful cochlear implantation depends on many factors, one of which is the electrode type. The aim of this study was to evaluate it in terms of the preservation of residual hearing, as well as to investigate the effects of patient age and preoperative low-frequency hearing loss. METHODS: Twenty-three patients were implanted unilaterally with the HiFocus™ SlimJ electrode array. Pure tone audiometry (0.125-8 kHz) was performed preoperatively and at 1, 3, and 6 months postoperatively. Hearing preservation was established using the HEARRING group formula. RESULTS: Residual hearing was preserved in all patients. For hearing to be preserved, it was found that preoperative low-frequency hearing levels were more important than age. CONCLUSION: Residual hearing was preserved in all the patients who received the HiFocus™ SlimJ electrode array. Hearing preservation depended more on a patient's preoperative low-frequency hearing threshold than their age.

The internal auditory canal (IAC) connects the inner ear to the posterior cranial fossa. In this case report, the authors presented an 8-month-old patient with an IAC anomaly and bilateral deafness. The patient has hypotonia and epilepsy, and there is multifocal epileptiform activity on Electroencephalography (EEG). Severe (total) sensorineural hearing loss was detected bilaterally. Temporal bone computed tomography showed that the internal acoustic canal is localized as a single entity at the midline and bifurcates into right and left branches approximately ~4 mm beyond. Following branching, the diameter of each IAC measures approximately ~2 mm. On both sides, inner ear structures are located more medially than normal, positioned close to the midline and each other. Both cochleae undergo approximately 1.5 turns, classified as cochlear hypoplasia type III according to Sennaroğlu and Bajin's classification. Magnetic resonance imaging showed that in the anterior aspect of the pons, extending from the midline to the internal acoustic canal, a paired appearance, resembling a couple, of the VIII cranial nerve is observed in close proximity to each other. The pair of the VIII nerve seems to diverge at the entrance of the internal acoustic canal, and immediately thereafter, they bifurcate into branches believed to belong to the superior and inferior vestibular nerves on both sides, but the cochlear nerve cannot be discerned. To the best of current knowledge, this is the first case in the literature as fused IAC.

Congenital cholesteatomas are defined as a collection of epithelium in the absence of prior surgery or pathologic retraction. They are most commonly found in the middle ear and are thought to arise from a residual epithelial rest present since birth; however, a small number of cases present with disease isolated to the mastoid bone. One such case and a review of prior reports are presented. A 29-year-old male with a 2-year history of headaches and no otologic surgery was found to have a destructive mass centered in the right mastoid bone, invading the jugular foramen and posterior fossa without middle ear disease. He underwent a mastoidectomy with complete resection of the cholesteatoma. A literature review identified 21 prior cases of isolated mastoid congenital cholesteatoma. Congenital cholesteatoma should be considered in the differential diagnosis when patients present with postauricular pain or headaches. Mastoidectomy is considered the treatment of choice.