摘要:

ObjectiveThe aim of this study was to determine the incidence and characteristics of tinnitus in otosclerosis and to evaluate the effects of stapes surgery on the course of this symptom.SettingHospital ear, nose, and throat department.Patients and DesignSixty-two patients (65 ears) scheduled to undergo stapes surgery were prospectively enrolled in the study. The incidence and characteristics of tinnitus were recorded using a specific questionnaire before surgery and 1 and 6 months after surgery. The frequency range of the tinnitus was noted during standard audiometric examination. Audiometric data were recorded following AAO-HNS guidelines.InterventionAll patients underwent stapes surgery (either stapedectomy or stapedotomy).ResultsTinnitus was present at the time of surgery in 74% of the patients. It was severely disabling for patients in 24.6% of the cases. In patients who were preoperatively free of tinnitus, no tinnitus was noted in the postoperative period (1 and 6 months). In patients with preoperative tinnitus, tinnitus ceased in 55.9%, decreased in 32.4%, remained the same in 8.8%, and increased in 2.9% 6 months after surgery. Statistical analysis did not reveal any significant prognostic factors regarding the course of tinnitus.ConclusionsIn otosclerotic patients who will undergo stapedectomy to improve hearing, stapes surgery may also improve tinnitus in most of them.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

HypothesisEtanercept will be able to reduce the inflammation and hearing loss associated with experimentally induced labyrinthitis.BackgroundInner ear immune responses cause hearing loss that may be reversible with pharmacologic treatment. Etanercept, tumor necrosis factor receptor blocker, was investigated in a guinea pig model of immune-mediated hearing loss. Sterile labyrinthitis was created by injection of keyhole limpet hemocyanin into the inner ear after systemic sensitization to keyhole limpet hemocyanin with adjuvant. Labyrinthitis involves infiltration of inflammatory cells and hearing loss detectable 3 to 5 days after challenge with keyhole limpet hemocyanin.MethodsEtanercept was administered either systemically (2.5 mg) 30 minutes before intracochlear challenge with keyhole limpet hemocyanin, with a second intraperitoneal dose (2.5 mg) 3 days later or locally by long-term infusion into the scala tympani with an osmotic pump (5.0 &mgr;g/h for 7 days). Auditory evoked brainstem response thresholds were measured before and after treatment to determine hearing loss. Cochleas were evaluated for the amount of inflammation.ResultsHearing loss in the untreated systemic group averaged 71 ± 21 dB versus 37 ± 32 dB in the etanercept-treated animals (ttest,P< 0.001). There was also less inflammation in the cochleas from etanercept-treated animals (ttest,P< 0.01). Hearing loss with local administration of etanercept was 59 ± 31 dB in the nontreated ears and 18 ± 8 dB in the treated ears (ttestP< 0.02). Inflammation was also less (ttest,P< 0.01). Etanercept was not ototoxic.ConclusionPrompt intervention with the anti-inflammatory drug etanercept significantly reduces inflammation sufficient for substantive hearing preservation.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo establish the audiometric profile and speech recognition characteristics in 36 Usher IIa patients, carrying one (A) or two (B) pathogenic mutations in theUSH2Agene.Study designFamily study.SettingTertiary referral center.PatientsThirty six Usher IIa patients from 21 Dutch families.MethodsOphthalmologic, vestibular, and audiometric examinations were performed on all patients. Cross-sectional analysis was performed on pure tone threshold data at 0.25 to 8 kHz and on speech phoneme recognition scores. Progression was evaluated using linear regression analysis on raw and presbyacusis corrected data.ResultsA downsloping audiogram was found, with a mean threshold slope of −9 dB per octave, that was mildly progressive, i.e., by approximately 0.5 dB per year. Individual monaural maximum phoneme recognition scores (% correct) were analyzed in 30 patients in relation to the patient's age and level of hearing impairment characterized by a pure tone average (PTA1–4kHz). The speech recognition score started to deteriorate from a score of 90% at 38 years at a rate of 0.4% per year. The 90% level was attained at 69 dB hearing level (PTA1–4kHz); at higher levels of impairment, the score deteriorated at a slope of 0.6% per dB hearing level. There was no significant difference between group A and B in pure tone threshold, with or without presbyacusis correction, or phoneme recognition score as related to age or PTA1–4kHz.ConclusionsPatients with various mutations inUSH2Ahave moderate to severe hearing impairment showing mild progression at approximately 0.5 dB hearing level per year.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

HypothesisHistologic analysis of the hydropic and normal guinea pig cochleae was undertaken to assess a potential correlation between the magnitude of endolymphatic hydrops and hearing loss. It was hypothesized that a greater correlation than previously reported might be found by looking at long-standing endolymphatic hydrops and high-frequency range hearing.BackgroundSurgically induced endolymphatic hydrops in guinea pigs is the most widely used animal model for the study of human Ménière's Disease and recapitulates both endolymphatic hydrops and progressive sensorineural hearing loss. A strong correlation between the magnitude of hydrops and severity of hearing loss has been reported in the human condition, but not in the animal model.MethodsNine albino guinea pigs were each subjected to surgical obstruction of the endolymphatic sac and duct of the right ear. The left ears remained as internal histologic controls. Hearing was assessed from 2 kHz to 32 kHz by auditory brain stem response testing for 16 to 25 weeks after surgery. Histologic morphometry after the animals were killed was used to quantify both turn-specific and weighted overall hydrops. These measures were correlated with hearing loss in each animal at all tested frequencies.ResultsA statistically significant correlation between the magnitude of hydrops and the severity of hearing loss was observed for 2 kHz and 16 kHz. These frequencies correlated with both turn-specific hydrops and overall hydrops. However, turn-specific hydrops did not reliably correlate with the magnitude of hearing loss at anatomically appropriate frequency ranges. Where such a correlation did exist, it might well have been simply part of an expression of an overall correlation between hydrops and hearing loss.ConclusionsThere may be a greater correlation between hydrops and hearing loss in guinea pigs with long-standing surgically induced hydrops than has previously been reported in animals with less advanced disease. These findings help to validate continued use of the model for hearing loss related to Ménière's Disease, verify the rationale of treatment modalities aimed at reducing hydrops in the human condition, and may indicate that efforts at reducing hydrops in such patients has benefits toward long-term hearing preservation.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveMonaural hearing imposes constraints under many listening conditions. The authors compared the effects of a semi-implantable bone conductor, the Entific bone anchored hearing aid, with conventional contralateral routing of offside signal amplification to assess rehabilitative benefit in adults with unilateral deafness.DesignProspective trials of subjects with unilateral deafness using benefit surveys, source identification testing, and hearing in noise testing.SettingTertiary referral center, outpatient surgical and audiologic services.PatientsAdults with unilateral deafness (pure tone average >90 dB, SD <20%) after acoustic neuroma excision (n = 7), meningitis (n = 1), sudden sensorineural hearing loss (n = 1), and sudden sensorineural hearing loss with chronic suppurative otitis media (n = 1). Entry criteria included normal hearing in the contralateral ear (pure tone average <25 dB, SD >80%).InterventionSubjects were fitted with contralateral routing of offside signal amplification devices for 1 month and tested with contralateral routing of offside signal before mastoid implantation of the deaf ear, fitting, and testing for bone anchored hearing aid.Outcome measuresSubjects' assessment of experience with their devices and patterns of use, 2) source azimuth identification in noise test, and 3) speech discrimination in quiet and in noise under conditions of noise-front, noise-to-normal-ear, and noise-to-deaf-ear.ResultsThere was consistent satisfaction with bone anchored hearing aid implantation and amplification, and poor acceptance of contralateral routing of offside signal amplification. Sound localization was poor at baseline and with both bone anchored hearing aid and contralateral routing of offside signal. Relative to baseline, contralateral routing of offside signal and bone anchored hearing aid produced significantly better speech recognition in noise under most conditions. The bone anchored hearing aid enabled significantly better speech recognition than contralateral routing of offside signal in quiet and in a composite of noise conditions. The advantages may relate to averting the interference of speech signals delivered to the better ear, as occurs with conventional contralateral routing of offside signal amplification.ConclusionsPreliminary data in subjects with normal monaural hearing indicate that vibromechanical stimulation with the bone anchored hearing aid overcomes some of the negative head shadow effects in unilateral deafness. The bone anchored hearing aid system, when placed on the side of a deaf ear, yields greater benefit in subjects with normal monaural hearing than does contralateral routing of offside signal amplification. It seems that this rehabilitative approach can expand the sound field of monaural listeners in further enhancing speech understanding. Observations suggest that further understanding of bone conduction as implemented in transcranial stimulation will guide further options for patients with monaural hearing. Longer follow-up will help to determine whether communicative skill improvements with the bone anchored hearing aid outweigh the disadvantages of implantation surgery, costs, and device maintenance.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo report and evaluate the results of auditory brainstem implantation in a case of postmeningitis hearing loss with totally ossified cochleae on both sides.Study DesignCase report.SettingTertiary referral center.PatientA 49-year-old man was referred to the authors' department for bilateral total hearing loss subsequent to bacterial meningitis 2 years earlier. Pure tone audiometry, auditory brainstem response tests, and promontory tests did not reveal any cochlear activity. Computed tomography showed bilateral and totally ossified cochleae. Magnetic resonance imaging confirmed the diagnosis by showing no cochlear signal on T2-weighed images and ruled out brainstem and cerebellopontine angle abnormalities.InterventionA left auditory brainstem implantation was performed through a translabyrinthine route, using a Nucleus 22-channel device.Main Outcome MeasuresWord and sentence recognition tests in sound-only and sound plus vision modes.ResultsNo postoperative complication was observed. Twelve electrodes could be activated, and their tonotopy was defined. Nine other electrodes were inactivated because of an absence of auditory response (4 electrodes) or paresthesia (5 electrodes). At the last follow-up visit, 26 months after the implantation, 50% of disyllabic word scores and 60% of sentence scores were achieved using auditory brainstem implant sound only. These scores reached 80% and 93%, respectively, with lip-reading.ConclusionAuditory brainstem implantation is an efficient means of auditory rehabilitation in cases of bilateral total hearing loss with totally ossified cochleae. It should be considered in cases of predictable failure in cochlear implantation.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo describe two different types of device extrusion occurring in the same patient 1 and 6 years after cochlear implantation and to discuss the relation between the two extrusions and problems of cochlear implantation in patients with chronic suppurative otitis media.Study DesignRetrospective case review.SettingTertiary referral center.Patient and InterventionsThe patient was a 52-year-old man with profound hearing loss in the right ear caused by chronic otitis media and deafness in the left ear caused by removal of an acoustic neuroma. Surgery for cleaning the tympanic cavity and reconstruction of the bony canal after previous radical mastoidectomy was performed in the right ear first. One year later, cochlear implantation was performed in this ear.ResultsOne year after implantation, the anterior edge of the internal device of cochlear implant was exposed along the skin incision. This site was stable after corrective surgery. Five years after this operation, however, the posterior edge of the internal device extruded, accompanied by infection around the device.ConclusionThe two extrusions occurred with a long interval in between and at two different sites. The first extrusion occurred along the skin incision, and the second extrusion occurred away from the skin incision with infection around the device. The authors assumed that the first and the second extrusion occurred independently; the first extrusion was caused by insufficient blood supply resulting from scar formation from repeated mastoid operations and by pressure on the skin from the internal and external devices, and the second extrusion was caused by proliferated tissue pushing the device upward and against the skin as a result of chronic middle ear infection. The clinical course indicates that sufficiently long follow-up periods are needed to determine the usefulness of the prevention techniques for cochlear implantation in patients with chronic suppurative otitis media.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveThis study was designed to investigate the role of zinc administration in treatment of tinnitus.Study DesignRandomized, prospective, placebo-controlled study.SettingPatients with tinnitus were admitted to the ear, nose, and throat clinic of the authors' hospital.PatientsPatients with tinnitus with no know pathologic conditions of the ear, nose, and throat; the mean age of 28 patients receiving zinc was 51.2 years, and that of 13 patients given placebo was 55 years.InterventionBlood zinc levels were measured. Frequency was detected by audiometry, and loudness of tinnitus was screened by tinnitus match test. A questionnaire that scored tinnitus subjectively between 0 and 7 was given to patients before zinc treatment. After 2 months of treatment (zinc 50 mg daily to zinc group, placebo pill containing starch to placebo group), all of the tests were performed again. There was no difference in age, sex, duration of tinnitus, and affected ears between the patients treated with zinc and those treated with placebo. Blood zinc levels were lower than normal in 31% of patients before treatment.Main Outcome MeasuresA decrease in tinnitus loudness by at least 10 dB was accepted as clinically favorable progress. A decrease of more than 1 point in subjective tinnitus scoring was accepted as valid.ResultsClinically favorable progress was detected in 46.4% of patients given zinc. Although this decrease was not statistically significant, the severity of subjective tinnitus decreased in 82% of the patients receiving zinc. The mean of subjective tinnitus decreased from 5.25 ± 1.08 to 2.82 ± 1.81 (P< 0.001). However, the decrease in severity of the tinnitus was not significant in patients receiving placebo.ConclusionIt can be concluded that patients with tinnitus may have low blood zinc levels (31%) and clinical and subjective improvement can be achieved by oral zinc medication. However, it remains to be seen whether the longer duration of treatment has more significant results.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo study the otolaryngologic disorders in patients with superficial siderosis of the meninges.BackgroundSuperficial siderosis of the central nervous system is a rare disorder characterized by progressive bilateral hearing loss and ataxia caused by recurrent bleeding into the subarachnoid space. The cerebellum, eighth cranial nerve, and olfactory nerve are particularly susceptible to the deposition of hemosiderin, which is responsible for the symptoms. The diagnosis is confirmed by magnetic resonance imaging.MethodsThe clinical notes of five patients with superficial siderosis of the meninges were reviewed with the intent of reporting the otolaryngologic symptoms and signs, the clinical investigations, and treatments.ResultsFour of the five patients had sensorineural deafness, two had smell disturbances, and three had gait abnormalities. Magnetic resonance imaging was the most important investigation used to identify the condition.ConclusionsSuperficial siderosis of the meninges is an important differential diagnosis in patients with progressive sensorineural deafness.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

ObjectiveTo propose a new hypothesis that attempts to explain the pathogenesis of petrous apex cholesterol granuloma (PA CG).Classic Obstruction-Vacuum HypothesisPA CGs form when mucosal swelling blocks the circuitous pneumatic pathways to the apical air cells. Trapped gas resorption results in a vacuum that triggers bleeding, and CG forms through anaerobic breakdown of blood products.Problems with the Classic (Obstruction-Vacuum) HypothesisImpaired ventilation of mucosa-lined pneumatic tracts in the middle ear, mastoid, paranasal sinuses, and lung are very common, but CG is rare. The extraordinary levels of temporal bone pneumatization typically observed in PA CG cases is indicative of excellent ventilation and freedom from inflammatory mucosal disease. Were underpressure due to gas absorption alone sufficient to trigger hemorrhage, CG ought to be frequent in otitis media with effusion.PatientsThe opposite PA of 13 patients with PA CG compared with 31 highly pneumatic PAs in patients undergoing imagery for nonotologic reasons.Main Outcome MeasureThe nature of the bony partition, as seen on computed tomography, between the PA air cell system and the adjacent marrow compartment.Results4 of 13 PAs with CGs on the opposite side showed deficient septation between air cells and marrow, whereas this was not observed in any of the 31 extensively pneumatized normal ears.New Hypothesis (Exposed Marrow)As cellular tracts penetrate the apex during young adulthood, budding mucosa invades and replaces hematopoietic marrow. The bony interface becomes deficient, with coaptation of richly vascular marrow and the mucosal air cell lining. Hemorrhage from the exposed marrow coagulates within the mucosal cells and occludes outflow pathways. Sustained hemorrhage from exposed marrow elements provides the engine responsible for the progressive cyst expansion. As the cyst expands, bone erosion increases the surface area of exposed marrow along the cyst wall. This exposed marrow theory explains the unique proclivity of the healthy and well-pneumatized PA to form a CG.

ISSN:1531-7129    

出版商:OVID    

年代:2003

数据来源: OVID