The journal of international advanced otology最新文献

The inner ear is most susceptible to the aging effects. Distortion product otoacoustic emissions (DPOAEs) are a good indicator for interpreting the age effects but are usually recorded at up to 8000 Hz frequencies in routine audiologic testing. The present study was designed to assess and compare the DPOAEs at conventional frequencies and at extended high frequencies (EHFs) across different age groups. Extended high-frequency audiometry (9000-16000 Hz) and DPOAEs from 500-16000 Hz were recorded on 80 adult (160 ears) participants (15-55 years) with normal hearing sensitivity. The participants were categorized into 4 groups: group I (15-<25 years), group II (25-<35 years), group III (35-<45 years), and group IV (45-55 years). A statistically significant reduction in EHF thresholds was observed from group III onward. However, the thresholds were comparatively better for group III at frequencies 9000, 10000, and 11500Hz than group IV. No significant difference was observed for EHF DPOAEs in groups I and II (except at 16000 Hz) and III and IV. Distortion product otoacoustic emissions at conventional frequencies in group IV were significantly poorer than the other 3 groups. A weak negative correlation was observed between the DPOAE parameters and EHF thresholds. The effect of age was more pronounced on EHF DPOAEs than EHF thresholds for frequencies 9000, 10000, and 11500 Hz. Distortion product otoacoustic emissions at EHF started deteriorating below the age of 30 years and showed a rapid decline above 35 years. Extended high-frequency DPOAEs can be used as screening tools to assess the function of the basal part of the cochlea.

Ménière's Disease (MD) is a disease that may be difficult to diagnose and manage. Our UK survey showed variability in the practice of UK Otolaryngology consultants. We hence surveyed Otolaryngology consultants internationally, to assess their confidence levels in diagnosing MD, their use of the AAO-HNS guidelines and current diagnostic and treatment modalities. An online questionnaire was distributed internationally over four weeks. The questionnaire asked respondents to anonymously rank their confidence in diagnosing MD, identify the minimum investigations required to make a diagnosis, describe their use of the AAO-HNS criteria, share their preferred treatment modalities for acute attacks, and state their 1st and 2nd-line preventative treatment options. A total of 173 responses were collected with 77% of respondents reporting high levels of confidence in diagnosing MD. Most respondents stated the minimum tests required were "History, Otoscopy, Clinical Vestibular testing, and Pure Tone Audiometry" although some chose as few as 1 test. Regarding the use of the AAO-HNS criteria, responses ranged from "always" (20.2%) to "never" (22.5%). Cinnarizine was the first-line treatment for acute attacks followed by betahistine. Betahistine (30.1%) and dietary restrictions (28.3%) were recommended almost equally as first-line preventative measures. The most popular second-line measure was intratympanic steroids injection (30.1%). Our survey revealed disparities in the diagnosis of MD and its management, like the results of our previously conducted UK survey. This suggests the need for an international consensus regarding the diagnosis and subsequent management strategies for this disease.

Since its introduction by Wullstein, the binocular surgical microscope has remained the gold standard of visualization in the field of otology. However, in the last decade, new technology became available in the form of the three-dimensional (3D) exoscope. In this article, we describe our experience thus far in pediatric cochlear implantation with the 3D exoscope. This article is about prospective descriptive study of all exoscopic cochlear implant (CI) cases in a quaternary pediatric CI center performed with the Vitom® 3D system. All pediatric patients (age <18) were included without exclusion criteria, and our experience and conversion to microscope rates are reported. Since the introduction of the exoscope to our unit, we have successfully performed 68 cases, of which 53 were bilateral cochlear implantations. The age of the patient varied between 10 months and 209 months (average: 64 months; median 46.5 months). There were a total of 121 implantations (96 primary implantations, 24 revision implantations). There were 2 conversions to the traditional microscopic technique. The exoscope provides a 3D high-definition (4K) images in CI surgery. There is limited data regarding its use, and we identified a number of advantages including efficiency, occupational health, theater utilization, surgical training, and safety. Although there are areas still for improvement, such as loss of signal-to-noise ratio at higher magnification, manual focus, and lack of electromagnetic articulation in the holding arm, we have found it to be a useful addition to the surgical armamentarium within pediatric cochlear implantation.

Granular myringitis is a chronic inflammatory condition of the tympanic membrane that does not involve the middle ear. Various treatment modalities have been proposed for the treatment of granular myringitis, but there is no standard treatment regime. A 60-year-old woman had left persistent ear discharge for 4 months. Examination revealed diffuse granulation tissue, forming a pseudomembrane at the medial aspect of the ear canal and obstructing the tympanic membrane. An audiogram revealed mild-to-moderate left-sided conductive hearing loss. She was treated with multiple courses of ear drop antibiotics but had no improvement. The decision for surgical intervention was driven by the presence of a grade IV medial meatal stenosis, the potential risks associated with prolonged medical management, the distressing impact on the patient's life, and a shared decision-making process. A combined transcanal and postauricular endoscopic approach whereby excision of the granulation tissue, canalplasty, and myringoplasty were performed. She exhibited complete symptom resolution and reported an improved quality of life. This approach yielded successful symptom resolution, highlighting its potential in managing refractory chronic granular myringitis. We aimed to carefully weigh the risks of surgery against its potential benefits in a refractory chronic case, acknowledging the inherent risks and disadvantages of surgical interventions. Further studies are warranted to evaluate the long-term outcomes and benefits of this approach.

Patients with sudden sensorineural hearing loss (SSNHL) may lose their hearing. The relationship between SSNHL and total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels is still unclear. The association of TC, TG, HDL-C, and LDL-C levels with the risk and prognosis of SSNHL was explored in this study. After searching for literature in different databases, 13 researches were used to summarize the risk and prognosis of SSNHL associations with TC, TG, HDL-C, and LDL-C using meta-analysis. Total cholesterol had a significant association with the risk of SSNHL (95% CI, 1.34-2.91). Adjustment for confounding factors and grouping criteria of TG were all significant sources of heterogeneity. One of the significant sources of heterogeneity in the LDL-C subgroup analyses was an adjustment for confounders. Sensitivity analysis revealed a robust association between TC and the risk of SSNHL. There was a significant publication bias in the association between TC and SSNHL prognosis High TC level is a risk factor for SSNHL.

The study aimed to determine whether there was a difference or an association between auditory memory and visual memory in typically developing children. Eighteen children, aged 8 to 12 years, with normal hearing and visual acuity, were evaluated using the Children's Memory Scale (CMS) to determine their auditory and visual memory performance. Using the core subtest battery of the CMS, auditory/verbal (immediate and delayed), visual/nonverbal (immediate and delayed), and general memory index scores were assessed. No significant difference was found between auditory/verbal memory and visual/nonverbal memory scores for both immediate and delayed recall. Likewise, no correlation between auditory/verbal memory and visual/nonverbal memory scores was found. However, there was a significant correlation between immediate and delayed recall scores within each modality. The non-significant difference between the two modalities for both immediate and delayed recall gives the impression that memory is modality independent. However, the lack of any correlation between the two suggests there was no association between them. The absence of a significant difference between modalities can be attributed to the auditory and visual test material used in CMS not being analogous. It can thus be inferred that the auditory and visual modalities are independent. While the visual material evaluates simultaneous/concurrent perception, the auditory material assesses sequential perception.

The objective of this research was to test whether efficient tinnitus suppression could be achieved by electrical stimulation of the single most basal electrode contact of a cochlear implant. This approach simulates the effects of electrical stimulation using a round-window electrode. The study was performed in 10 adult cochlear implant patients showing complete or almost complete tinnitus suppression during electrical stimulation with their standard fitting-MAP. In all patients, tinnitus appeared again when the implant was switched off. Five Nucleus implant (1 CI532, 4 CI24RE CA) users and 5 Mi12xx series with FLEX28 electrodes with at least 6 months of CI experience were included. Two types of stimulation were presented at the most basal CI contact: a constant pulse train and a modulated pulse train. The variation in pulse rates was low rate (100-300 pps) and high (≥900 pps), and the current level ranged from the C-level to less than the T-level for both stimulation types. The effect of acute electrical stimulation at the most basal electrode contact was compared to the effect obtained with multichannel stimulation with the patient's current fitting MAP. Electrical stimulation was paused between tests with different stimulation types until tinnitus returned to baseline intensity. Patients reported Visual Analog Scale (VAS) scores for tinnitus loudness and intrusiveness during normal CI use and for each single contact stimulation type. Eight participants perceived complete suppression with one or more stimulation patterns. In 2 patients, suppression was less efficient than full-band CI stimulation. Louder stimuli are generally perceived as annoying and less effective in reducing tinnitus. In FLEX28 patients, it was also possible to obtain full tinnitus suppression with current amplitudes under the thresholds for auditory perception (this was not tested in patients with the Nucleus device). In 8 of the 10 included patients, we were able to obtain complete or almost complete tinnitus suppression with electrical stimulation at only 1 most basal electrode contact. Therefore, round-window stimulation with a single electrode may be a potential treatment for tinnitus in patients with significant residual hearing. The long-term effects of this therapy should be confirmed in future studies.

A relationship exists between autoimmune thyroid disorders and vestibular dysfunction. This study aimed to analyze cervicalevoked myogenic potentials (cVEMP) and video head impulse test (vHIT) results between children with Hashimoto thyroiditis (HT) and healthy controls to determine vestibular end-organ problems. Thirty-six children with HT and 30 healthy subjects were recruited. The main inclusion criteria for the healthy group were the presence of normal thyroid function and no clinical history of vestibular problems. Each participant (both HT and healthy groups) was assessed using audiovestibular tests, cVEMP, and vHIT. There was no significant difference between the groups in terms of cVEMP (p1 and n1) latencies for both ears. There was no significant difference in cVEMP amplitudes (p1-n1 peak-to-peak) between the groups. There were statistically significant differences in the VOR gain of the right and left ears between the groups (P < .001, P < .001). When we considered lower cutoff value as 0.80 for VOR gain, 29 of 36 patients with HT (80.6%) had lower VOR gain scores. Only 1 of 30 healthy participants (3.3%) had a lower VOR gain score. This difference was statistically significant (P < .001). Subclinical vestibulopathy may occur in children with HT. The vHIT seems to be a valuable tool for identifying and screening preclinical vestibular pathologies in this patient group.

Pain associated with subjective tinnitus is known to be alleviated by treatments using a repetitive transcranial magnetic stimulation (rTMS). However, the mechanisms underneath are still on debate. We investigated the mechanism of tinnitus alleviation using time-frequency analyses. Twenty-four patients were randomly assigned to the dual-site stimulation group (temporal and frontal stimulation, TF), singlesite stimulation group (temporal stimulation, T), or sham stimulation group. An age-matched control group was also included (n = 12). Electroencephalography (EEG) was recorded and patient data were analyzed before and after treatment. A frontal increase in EEG power was observed in the alpha (8-12 Hz) frequency band domain after treatment; this increase was most pronounced in the TF group, followed by the T group. The TF and T groups showed increased alpha power in the fronto-central channels only in the silent period between paired-pulse tones. The TF and T groups showed decreases in alpha power in the temporal region, particularly in the neural response to the first of the paired-pulse tones. The difference in tinnitus handicap index between pre- and post-treatment was positively correlated with the alpha power of the silent period in the frontal and fronto-central channels. Dual-site stimulation showed the greatest alleviation of tinnitus-related discomfort, followed by single-site stimulation. Additionally, the modulation of alpha power was prominent in the active stimulation groups. Low frequency rTMS can alleviate tinnitus by increasing alpha band power and reducing hyperactivity.

The aim was to explore and characterize dizziness and vertigo (constant vs episodic) and associated problems in patients with Ménière's disease (MD) to allow characterization of the impact of the disease. The study used a retrospective survey design. A total of 539 people with MD participated in this study. The online questionnaire included 36 items which had mixture of structured and open-ended questions that were focusing on MD symptoms, impact of their symptoms, vestibular rehabilitation, as well as health-related quality of life (HRQoL). Forty-six percent of the patients had episodic vertigo, 6% had constant dizziness, 15% had both episodic vertigo and constant dizziness, and 31% did not have vertigo or dizziness within the last 2 years. Patients with MD without any vertigo rated their HRQoL as 73.9%, those with episodic vertigo as 71.1%, those with constant dizziness as 56.9%, and those with constant dizziness and episodic vertigo as 57.9% indicating significant reduction in HRQoL in constant dizziness patients. Constant dizziness was associated with cognitive visual problems, fatigue, balance problems, vestibular drop attacks and syncope. The impact of balance problem was more severe among those with constant dizziness. The most common balance problem was tripping-off (34%), followed by swaying (25%) or rocking (8%) sensations. In the self-administered rehabilitative training, there were no differences between any of the vertigo or dizziness groups although disease profile of MD differed significantly. We emphasize that constant dizziness in MD constitutes a long-term maladaptation to a vestibular and visual cognitive function causing cognitive dissonance. Different types of vertigo and their associated complaints require different treatment strategies to the manage balance problems and to cope with the disease, but best practices is still under research.