Feasibility of Personal Sound Amplification Products in Patients With Moderate Hearing Loss: A Pilot Study

Objectives@#. This study was conducted to investigate the electroacoustic characteristics of personal sound amplification products (PSAPs), to identify whether PSAPs provide adequate gain and output for three common hearing loss (HL) configurations, and to compare the benefits of a representative PSAP (RPSAP) and a conventional hearing aid (HA) for clinical hearing outcomes as a pilot study. @*Methods@#. The study comprised three phases: electroacoustic analysis, simulated real-ear measurements (REMs), and clinical hearing experiments. Electroacoustic analysis and simulated REMs were performed for three basic PSAPs (BeethoSOL, EarJJang, and Geniesori2) and three high-end PSAPs (Hearing Able, Olive Smart Ear, and SoriIn) using the Aurical Hearing Instrument Test box with a 2-mL coupler. Four electroacoustic characteristics (maximum output sound pressure level at 90 dB SPL, frequency range, equivalent input noise, and total harmonic distortion) were investigated. By simulated REMs, appropriate levels of the six PSAPs for three common HL configurations (mild-to-moderate high-frequency HL, moderate to moderately severe sloping HL, and moderate flat HL) were determined. Clinical experiments compared the performance of RPSAP to HA, both of which were fitted by audiologists using REMs. Clinical experiments were administered using functional gain, a word recognition test, and the Korean version of the Hearing in Noise Test in six participants with bilateral moderate sensorineural HL. @*Results@#. The two high-end devices met all tolerances. One basic and two high-end PSAPs showed appropriate levels for three common HL configurations. In the clinical experiments, the RPSAP showed better performance than unaided, but slightly worse than HA under all test conditions. @*Conclusion@#. Certain PSAPs met all specified tolerances for electroacoustic analysis and approximated prescriptive targets in well-controlled laboratory conditions. The pilot clinical experiments explored the possibility that the RPSAP could serve as a hearing assistive device for patients with moderate HL.

Significance of Pseudo-Conductive Hearing Loss and Positional Nystagmus for Perilymphatic Fistula: Are They Related to Third-Window Effects?

Objectives@#. Patients’ clinical presentation is critical for identifying suspected perilymphatic fistula (PLF). The involvement of third-window lesions in the pathomechanism of PLF has been hypothesized. This study investigated the clinical features of PLF and the relationship of the third-window effect with PLF. @*Methods@#. Sixty patients underwent surgical exploration for suspected PLF and the oval and round windows were reinforced. Clinical features including demographics, pure-tone audiometry (PTA), and videonystagmography were evaluated preoperatively and 1 month postoperatively. Surgical outcomes were analyzed according to the improvement of hearing and vestibular symptoms and signs. The conductive components of PTA (air-bone gap [ABG]) were measured, and the relationship between ABG closure after surgery and hearing improvement was analyzed. In addition, postoperative subjective dizziness was assessed by clinical interviews. Changes in positional nystagmus were analyzed according to ABG closure and hearing improvement. @*Results@#. ABG at lower frequencies (LFABG; 250 Hz, 500 Hz, 1,000 Hz) was present in 27 patients (45%). Postoperatively, PTA significantly improved after surgical repair. Among the patients with preoperative LFABG (n=27), 15 (55.5%) showed postoperative ABG closure and significant improvement in PTA at all frequencies compared with the patients without ABG closure (P=0.012). Subjective dizziness improved in 57 patients (93.3%). Positional nystagmus was found in 45 of 49 patients. Multiple canal involvement was more common than single canal involvement (67% vs. 33%). The horizontal semicircular canal was most commonly involved, followed by the posterior and anterior canals. Postoperatively, positional nystagmus disappeared, or the number of involved canals decreased in 22 of 34 patients (64.7%). @*Conclusion@#. Pseudo-conductive hearing loss at lower frequencies and positional nystagmus originating from multiple semicircular canals were common findings in PLF. Surgical reinforcement of the oval and round windows improved the hearing threshold accompanied by closure of ABG. A third-window lesion might explain these clinical features of PLF.

Significance of Pseudo-Conductive Hearing Loss and Positional Nystagmus for Perilymphatic Fistula: Are They Related to Third-Window Effects?

Objectives@#. Patients’ clinical presentation is critical for identifying suspected perilymphatic fistula (PLF). The involvement of third-window lesions in the pathomechanism of PLF has been hypothesized. This study investigated the clinical features of PLF and the relationship of the third-window effect with PLF. @*Methods@#. Sixty patients underwent surgical exploration for suspected PLF and the oval and round windows were reinforced. Clinical features including demographics, pure-tone audiometry (PTA), and videonystagmography were evaluated preoperatively and 1 month postoperatively. Surgical outcomes were analyzed according to the improvement of hearing and vestibular symptoms and signs. The conductive components of PTA (air-bone gap [ABG]) were measured, and the relationship between ABG closure after surgery and hearing improvement was analyzed. In addition, postoperative subjective dizziness was assessed by clinical interviews. Changes in positional nystagmus were analyzed according to ABG closure and hearing improvement. @*Results@#. ABG at lower frequencies (LFABG; 250 Hz, 500 Hz, 1,000 Hz) was present in 27 patients (45%). Postoperatively, PTA significantly improved after surgical repair. Among the patients with preoperative LFABG (n=27), 15 (55.5%) showed postoperative ABG closure and significant improvement in PTA at all frequencies compared with the patients without ABG closure (P=0.012). Subjective dizziness improved in 57 patients (93.3%). Positional nystagmus was found in 45 of 49 patients. Multiple canal involvement was more common than single canal involvement (67% vs. 33%). The horizontal semicircular canal was most commonly involved, followed by the posterior and anterior canals. Postoperatively, positional nystagmus disappeared, or the number of involved canals decreased in 22 of 34 patients (64.7%). @*Conclusion@#. Pseudo-conductive hearing loss at lower frequencies and positional nystagmus originating from multiple semicircular canals were common findings in PLF. Surgical reinforcement of the oval and round windows improved the hearing threshold accompanied by closure of ABG. A third-window lesion might explain these clinical features of PLF.

Clinical Characteristics of Sphenoid Sinus Fungal Ball Patients With Visual Disturbance

OBJECTIVES: A sphenoid sinus fungal ball is a rare disease that can cause visual disturbances. Most afflicted patients remain in an indolent state. However, once the visual disturbance has occurred, the recovery rate is very low. The purpose of this study was to overview the clinical characteristics of patients with a sphenoid sinus fungal ball and ascertain factors possibly related to the occurrence of a visual disturbance. METHODS: We retrospectively reviewed the medical records of all patients who underwent endoscopic sinus surgery for a sphenoid sinus fungal ball at our hospital. We enrolled 47 patients in this study. RESULTS: Old age and a female predominance were noted. Nasal symptoms were the most common symptom. Eight patients showed visual disturbances. We also compared the clinical characteristics between patients with and without visual disturbances in univariate analysis. Old age, underlying diabetes mellitus, and a sphenoid sinus wall defect visible by computed tomography were factors significantly related to the occurrence of visual disturbances. But only sphenoid sinus wall defect showed significance in multivariate analysis. CONCLUSION: It is important to prevent complications, such as visual disturbance, in patients with a sphenoid sinus fungal ball. This study describes an early surgical treatment that may be required for patients with a sphenoid sinus fungal ball and particularly patients with a sphenoid sinus wall defect.

A Case of Aspergillus Clival Abscess Treated by Endoscopic Removal / 대한이비인후과학회지

Aspergillus clival abscess, especially without a sphenoid sinus lesion, is a very rare infection of central nervous system. In this report, we describe the successful treatment of a patient with aspergillus clival abscess. A 63-year-old man was referred to our hospital with the diagnosis of sphenoid mass lesion in magnetic resonance image accompanied by headache and diplopia. The computed tomography scan revealed a clival cystic lesion without connection with the sphenoid sinus. The patient underwent the endoscopic endonasal clival approach and histopathological examination revealed aspergillosis. Postoperatively, the patient was given IV amphotericin-B for 2 weeks and oral voriconazole for 3 months. After surgery, patient's headache and diplopia disappeared. Aspergillus abscess originating from the skull base is rare but has a high mortality rate. Histopathological confirmation via endonasal approach and intensive antifungal therapy should be started for a successful treatment.

Spontaneous Recovery of Vestibulo-Ocular Reflex Gain after Bilateral Complete Vestibular Loss Following Head Injury / 대한평형의학회지

Dizziness is a frequent complication of head injury and objective evidence of vestibular dysfunction in the dizzy patient following head injury has been reported in literatures. However, there is no report about bilateral spontaneous recovery of caloric response after complete loss of bilateral vestibular function following head injury. A 27-year-old male patient who presented with continuous dizziness and disequilibrium following head injury was diagnosed as diffuse axonal injury after brain magnetic resonance image and bilateral complete loss of vestibular function after caloric and rotary chair test. He showed gradual improvement of dizziness, vestibulo-ocular reflex gain and left caloric response at 2 months after vestibular exercise. After another 4 months, his caloric function was fully recovered, and dizziness disappeared at 16 months after the onset of dizziness. We present this case with reviews of previous literatures about dizziness following head injury and diffuse axonal injury.