Comparative study of surgical effects on patients with mixed deafness and otosclerosis with different air bone conduction differences / 中华耳鼻咽喉头颈外科杂志

Objective: To analyze the surgical efficacy of patients with mixed hearing loss and otosclerosis with different air bone gap (ABG) before surgery, and to provide reference for the prognosis evaluation of otosclerosis surgery. Methods: The clinical data of 108 cases(116 ears) of otosclerosis who had undergone stapes fenestration technique artificial stapes implantation in Xiangya Hospital of Central South University from November 2013 to May 2020 and had mixed hearing loss before surgery were collected, including 71 women(76 ears)and 37 men (40 ears), with an average age of 38.5 years. According to preoperative pure tone audiometry ABG, they were divided into three groups: group S, 15 dB≤ABG<31 dB, a total of 39 ears; group M, 31 dB≤ABG<46 dB, a total of 58 ears; and group L, ABG≥46 dB, 19 ears in total. The hearing outcomes of three groups of patients at 6-12 months after surgery were compared and analyzed using SPSS 24.0 statistical software. Results: A total of 3 patients (group S: 2 cases; group L: 1 case) experienced severe sensorineural hearing loss after surgery and were not included in the statistical analysis. After surgery, the pure tone hearing threshold of patients with otosclerosis in each group was significantly improved compared to before surgery, with an average air conduction threshold improvement of(21.6±13.4) dB. The difference between before and after surgery was statistically significant(t=17.13, P<0.01). The average bone conduction threshold improved by(3.7±7.6) dB, and the difference was statistically significant before and after surgery(t=5.20, P<0.01). The postoperative ABG was(18.3±9.3) dB, which was significantly reduced compared to preoperative(36.2±8.6)dB. Among the three groups of patients, the L group had the highest improvement in air conduction threshold[(29.9±10.8)dB], while the S group had the lowest improvement[(15.7±11.4)dB]. There was no statistically significant difference in post operative pure tone hearing thresholds between the three groups(P>0.05). The postoperative ABG in group S was the smallest[(16.5±9.0)dB], while in group L, the postoperative ABG was the largest[(20.5±10.0)dB]. Compared with group S, group M and group L still had a large residual ABG at 2 000 Hz after surgery. The bone conduction threshold of both S and M groups improved to some extent after surgery compared to before (P<0.01). Conclusions: Surgery can benefit patients with mixed hearing loss and otosclerosis with different preoperative ABG. Patients with small preoperative ABG have better surgical results and ideal ABG closure at all frequencies after surgery. Patients with large preoperative ABG can significantly increase the gas conduction threshold during surgery, but certain frequencies of ABG may still be left behind after surgery. The improvement effect of surgery on bone conduction threshold is not significant. Patients should be informed of treatment methods such as hearing aids based on their actual situation for selection.

Resultados audiológicos y de calidad de vida en pacientes con transición del sistema BAHA Connect® a BAHA Attract® / Audiological and quality of life outcomes in patients with transition from BAHA Connect® to BAHA Attract®

Introducción: los implantes auditivos de conducción ósea percutáneos han sido usados de forma exitosa; sin embargo, un número importante de pacientes reportan reacciones repetitivas en la piel. En esta medida, los implantes auditivos transcutáneos son una alternativa que puede solventar estas complicaciones. Con este estudio queremos describir los resultados audiológicos y de calidad de vida en los pacientes que requirieron una transición del sistema percutáneo al transcutáneo. Metodología: estudio observacional descriptivo de corte transversal, en el que se incluyeron pacientes con un implante auditivo percutáneo, quienes requirieron una transición al sistema transcutáneo. El desempeño auditivo se evaluó utilizando una prueba con fondo ruidoso, y se aplicó la escala de calidad de vida Glasgow Benefit Inventory (GBI). Resultados: se incluyeron 8 pacientes, 3 de ellos con cirugía bilateral, para 11 oídos. El implante percutáneo fue usado en promedio = 9,5 ± 5,0 años, y la razón de la transición fueron reacciones reiterativas en la piel. Los resultados auditivos muestran un buen desempeño, tanto en los umbrales en silencio = 37,1 ± 6,1 dB, como en el reconocimiento del habla en ambientes ruidosos = 71,2 % ± 19,8, medidas significativamente mejores que los resultados sin implante (p <0,05). La relación señal/ruido fue = -2,6 ± 2,7 dB. Los resultados de la escala GBI mostraron un cambio positivo tanto en el resultado global (mediana = +34,75) como en las tres subescalas (mediana; estado general = +35,4, relaciones sociales = +41,65, salud física = +33,3). Conclusión: la transición de un dispositivo de conducción ósea percutáneo a uno transcutáneo puede realizarse de forma segura y efectiva. Se encontró un desempeño auditivo satisfactorio con el uso del implante transcutáneo, así como un cambio positivo en la percepción de la calidad de vida.

Introduction: the percutaneous bone-anchored hearing aid, has been successfully used. However, a significant number of patients report repetitive skin reactions. The transcutaneous bone-anchored hearing aid is an alternative that can solve these complications. With this study we aim to describe the audiological results and changes in the quality of life in patients who required transition from the percutaneous to the transcutaneous system. Methods: cross-sectional, descriptive observational study, patients with percutaneous hearing implants who required transition to the transcutaneous system were included. Hearing performance was assessed using a noisy background test and the quality of life scale Glasgow Benefit Inventory (GBI) was applied. Results: 8 patients were included, 3 of them with bilateral surgery, for 11 ears. The percutaneous implant was used on average = 9.5 ± 5.0 years, the reason for the transition was repetitive skin reactions. The auditory results show good performance, both in thresholds in silence = 37.1 ± 6.1 dB, and in speech recognition in noisy environment = 71.2% ± 19.8. These measures are significantly better than the results without implant, p <0.05. The signal/noise ratio was = -2.6 ± 2.7 dB. The results of the GBI scale showed a positive change, both in the overall result (median = +34.75), and in the three subscales (median; general state = +35.4, social relations = +41.65, physical health = +33.3). Conclusion: the transition from a percutaneous to a transcutaneous bone-anchored hearing aid can be performed safely and effectively. Satisfactory hearing performance was found with the use of the transcutaneous implant; as well as a positive change in the perception of quality of life.

Hearing Rehabilitation through Bone-Conducted Sound Stimulation: Preliminary Results

Abstract Introduction The bone-anchored hearing aid (BAHA) is a bone conduction system that transmits the sound directly to the inner ear by surpassing the skin impedance and the subcutaneous tissue. It is indicated for patients with mixed, conductive and unilateral sensorineural hearing loss who did not benefit from conventional hearing aids (HAs). Although the benefits from BAHA are well demonstrated internationally, this field still lacks studies in Brazil. Objective To assess the auditory rehabilitation process in BAHA users through audiological, speech perception and tinnitus aspects. Methods Individuals with hearing loss were assessed before and after the implantation. The participants were subjected to pure tone audiometry in free field, functional gain audiometry, speech perception tests, tinnitus handicap inventory (THI) in open format, and to the visual analog scale (VAS). Results It was found that the participants benefited from the use of BAHA. The difference in the performance of the participants before and after the BAHA surgery was significant in terms of hearing acuity. There was no statistically significant difference in the speech perception tests. The tinnitus assessment showed that 80% of the participants scored slight tinnitus severity in THI after using a BAHA. Eighty percent of the participants classified their tinnitus as absent tomild in the VAS after the surgery. Conclusion Based on the results of the current study, we can conclude that the participants improved both the auditory perception and the tinnitus handicap. (AU)

Safety and Effectiveness of Endoscopic Ear Surgery: Systematic Review / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aims to evaluate that usefulness of the endoscopic ear surgery (EES) through the systematic review. SUBJECTS AND METHOD: We searched literatures in literature databases (MEDLINE, EMBASE, Cochrane Library, etc.). Inclusion criteria is 1) studies of patients with chronic otitis media, otitis media with effusion, cholesteatoma, conductive hearing loss, mixed hearing loss etc. 2) studies in which a transcanal endoscopic surgery was performed; and 3) studies in which one or more of the appropriate medical outcomes have been reported. We excluded that 1) non-human studies and pre-clinical studies; 2) non-original articles, for example, non-systematic reviews; editorial, letter and opinion pieces; 3) research not published in Korean and English; and 4) grey literature. Finally, 65 articles were selected and those results were analyzed. RESULTS: The safety of the EES was reported in 61 articles. Some studies reported damaged facial nerve or perilymph gusher but these are the complications that can arise due to the characteristics of the disease and not due to the EES and other reported complications were of similar or lower level in the intervention group rather than the microscopy group. The effectiveness of the EES was reported in 23 articles. The EES tended to show improved effects in terms of graft uptake status, cholesteatoma removal, and hearing improvement although effective outcomes of most studies reported no significant difference between EES and microscopic ear surgery. CONCLUSION: EES is a safe and effective technique and as it is less invasive than the microscopic ear surgery.

Alteração auditiva em osteogênese imperfeita: revisão sistemática de literatura / Auditory alteration in osteogenesis imperfecta: systematic literature review

RESUMO Objetivos Analisar as publicações científicas sobre audição em indivíduos com osteogênese imperfeita. Estratégias de pesquisa Trata-se de revisão sistemática de literatura. Foram selecionados os descritores Hearing OR Hearing Loss AND Osteogenesis Imperfecta. Duas revisoras consultaram as bases de dados Cochrane Library, PubMed, LILACS, Scopus e Embase. Critérios de seleção utilizaram-se os Descritores em Ciências da Saúde, não sendo delimitado período de publicação dos estudos. Foram critérios de inclusão estudos de coorte, seguimento, transversais, casos controle e em idioma inglês. Foram critérios de exclusão artigos editoriais, relatos/séries de casos, resumos de eventos e estudos conduzidos em animais. Os estudos selecionados foram analisados pela Iniciativa STROBE e pelo Sistema GRADE. Resultados Dos 652 estudos obtidos, foram selecionados 16. A perda auditiva do tipo condutiva foi o tipo mais comum na população com osteogênese imperfeita (OI) e seu início ocorre por volta da segunda década de vida. A definição e a classificação para aferição de perda auditiva, nas publicações com a população com osteogênese imperfeita, apresentaram discordância entre os estudos. Conclusão Esta revisão respondeu às perguntas a que se propôs, constatando que as alterações audiológicas encontradas em pacientes com OI são do tipo condutivo, neurossensorial e misto. Alterações condutivas são mais comuns em pacientes mais jovens e alterações neurossensoriais, em pacientes mais velhos. A Iniciativa STROBE apontou itens descritos de forma parcial e o Sistema GRADE concluiu que os estudos apresentaram alguma falha metodológica.

ABSTRACT Purpose To analyze scientific publications on the hearing issue of patients with osteogenesis imperfecta. Reserch strategy This study is a systematic literature review. The following descriptors were selected "Hearing" OR "Hearing Loss" AND "Osteogenesis Imperfecta". Two reviewers searched the Cochrane Library, Pubmed, Latin American and Caribbean Health Sciences Literature, Scopus and Embase databases. Selection criteria Descriptors in Health Sciences were used and the publication period of studies was not limited. Inclusion criteria were cohort, follow-up, cross-sectional, and control studies in English language. Exclusion criteria were editorial articles, case reports, case summaries, and animal studies. Selected studies were analyzed by the STROBE Initiative and the GRADE System. Results Of the 652 studies, 16 were selected. Conductive hearing loss is the most common type in the osteogenesis imperfecta (OI) population and its onset is around the second decade of life. Definition and classification for hearing loss measurement in publications with the osteogenesis imperfecta population present disparities among studies. Conclusion This review met the objectives proposed, concluding that audiological alterations found in OI patients are of conductive, sensorineural and mixed types; conductive alterations are more common in younger patients and sensorineural alterations in older ones. The STROBE initiative partially pointed out described items and the GRADE system concluded that studies present some methodological failure.

Achados audiológicos em pacientes portadores de disfunção temporomandibular / Audiological findings in patients with temporomandibular dysfunction

RESUMO Objetivo Analisar os achados audiológicos em indivíduos com desordem temporomadibular e comparar esses achados com indivíduos sem desordem temporomanbibular. Métodos A amostra foi composta por 39 participantes adultos, de ambos os gêneros, com diagnóstico prévio de desordem temporomandibular (grupo de estudo) e 39 participantes adultos, sem desordem temporomandibular (grupo controle). Todos os participantes foram submetidos à audiometria tonal limiar em altas frequências, imitanciometria e pesquisa das emissões otoacústicas evocadas por produto de distorção. Resultados Observou-se prevalência de desordem temporomandibular no gênero feminino e a média de idade ficou acima da quarta década de vida. Na audiometria tonal limiar, foi observada ocorrência de perda auditiva do tipo neurossensorial e condutiva, no grupo de estudo, além de piores limiares auditivos em altas frequências. Em ambos os grupos, houve maior ocorrência de curva timpanométrica do tipo A, bem como diferenças entre os grupos na pesquisa do reflexo acústico ipsilateral e contralateral e no registro das emissões otoacústicas evocadas por produto de distorção. Conclusão Indivíduos com desordem temporomandibular apresentam piores resultados nos limiares auditivos, na timpanometria, nos reflexos acústicos ipsilaterais e contralaterais e nas emissões otoacústicas evocadas, quando comparados com o grupo controle.

ABSTRACT Purpose To analyze the audiological findings in individuals with temporomandibular disorder and compare these findings with individuals without temporomandibular disorder. Methods The sample was composed by 39 adult participants, both genders, with previous diagnosis of temporomandibular disorder (study group) and 39 adult participants, without temporomandibular disorder (control group). All the participants were submitted to audiometry including high frequencies, Immittance acoustic (Tympanometry and contralateral acoustic reflexes) and distortion product evoked otoacoustic emissions. Results The prevalence of temporomandibular disorder on female gender was observed, average age was over forty years old. In the audiometry, it was observed the incidence of hearing loss of a sensorineural and conductive type in the Study Group, besides worst hearing thresholds in high frequencies. In both groups, there was a bigger incidence of a type A tympanometric curve, as well as there were differences between the groups in the research of the ipsilateral and contralateral acoustic reflex and in the recording of distortion product evoked otoacoustic emissions. Conclusion It's possible to conclude that individuals with temporomandibular disorder show worst results in the hearing thresholds, in the tympanometry, in the ipsilateral and contralateral acoustic reflexes, in the evoked otoacoustic emissions, when compared to the control group.

Características clínico-epidemiológicas de pacientes ancianos con Hipoacusia atendidos en el Hospital Calixto García / Clinical and epidemiological characteristics of elderly patients with hearing loss treated in Calixto García University Hospital

Introducción: El envejecimiento en Cuba constituye el principal problema demográfico y la Hipoacusia es una de las condiciones crónicas más frecuentes en los adultos mayores. Objetivo: Describir las características clínico-epidemiológicas de los pacientes de la tercera edad con Hipoacusia atendidos en el Hospital Universitario General Calixto García en el período de septiembre de 2015 hasta septiembre de 2016. Material y Método: Se realizó un estudio descriptivo, transversal en el Hospital Universitario General Calixto García durante el período de septiembre de 2015 hasta septiembre de 2016. La población (N) estuvo constituida por 387 pacientes de la tercera edad, quienes asistieron a consulta en el período estudiado. Resultados: Predominó la Hipoacusia en los pacientes con edades entre 65 y 79 años (67,2 por ciento) y el sexo masculino fue el más afectado con esta discapacidad (69,5 por ciento). La Hipoacusia en el anciano se asoció con frecuencia a otras afecciones crónicas como las enfermedades cardiovasculares. La Presbiacusia o Hipoacusia asociada a la edad fue la causa más frecuente de sordera. Conclusiones: La Hipoacusia resultó ser una discapacidad frecuente en los pacientes masculinos de la tercera edad. La misma estuvo asociada a enfermedades crónicas no trasmisibles. Las perdidas auditivas neurosensoriales y mixtas, de moderada y severa intensidad, fueron las más frecuentemente encontradas en la audiometría tonal(AU)

Introduction: Aging constitutes the main demographic problem in Cuba, and hearing loss is one of the most frequent chronic conditions in older adults. Objective: To describe the clinical and epidemiological characteristics of elderly patients with hearing loss, treated in Calixto Gracía University Hospital during the period from September 2015 to September 2016. Material and Method: A descriptive cross-sectional study was conducted in Calixto Garcia University Hospital during the period from September 2015 to September 2016. The population (N) was composed of 387 elderly patients, who went to the doctor´s office during the period under study. Results: Hearing loss predominated in patients aged from 65 to 79 years (67,2 percent), and the male sex was the most affected by this disability (69,5 percent). Hearing loss in the elderly was frequently associated with other chronic conditions such as cardiovascular diseases. Age-related hearing loss (Presbycusis) or hearing loss associated with age was the most frequent cause of deafness. Conclusions: Hearing loss was a frequent disability in male elderly patients. It was associated with non-communicable chronic diseases. Sensorineural and mixed hearing losses of moderate and severe intensity were the most frequent ones found in the tonal audiometry(AU)

A Case of Middle Ear Implantation Using the Vibrant Soundbridge in a Patient with Bilateral Mixed Hearing Loss / 대한이비인후과학회지

It is challenging to achieve sufficient hearing gain in patients with mixed hearing loss. In chronic middle ear diseases, conventional passive reconstructive surgeries often result in suboptimal hearing gain and additional hearing aids may have limitations due to insufficient sound amplification, occlusion effect, acoustic feedback, and skin irritation. Middle ear implantation (MEI) using Vibrant Soundbridge (VSB) is another option for auditory rehabilitation in mixed hearing loss as well as sensorineural hearing loss. The floating mass transducer of VSB can be placed on various middle ear structures either directly or using different types of couplers in order to deliver vibratory mechanical energy to the cochlea. We report a patient who presented with bilateral mixed hearing loss due to chronic otitis media and had limitations using conventional hearing aids in the worse hearing ear. The patient was successfully treated with MEI using the Bell coupler together with middle ear surgery in a single step.

Significant association between osteoporosis and hearing loss: a systematic review and meta-analysis / Associação significativa entre osteoporose e perda auditiva: uma revisão sistemática e metanálise

Abstract Introduction: There is inconclusive evidence whether osteoporosis increases risk of hearing loss in current literature. Objective: We conducted this meta-analysis to determine whether there is an association between hearing loss and osteoporosis. Methods: This systematic review and meta-analysis was conducted from studies of MEDLINE, EMBASE, and LILACS. Osteoporosis was defined as having a bone mineral density with a T-score of less than −2.5 standard deviation. The outcome was hearing loss as assessed by audiometry or self-reported assessment. Random-effects model and pooled hazard ratio, risk ratio, or odds ratio of hearing loss with 95% confidence intervals were compared between normal bone mineral density and low bone mineral density or osteoporosis. Results: A total of 16 articles underwent full-length review. Overall, there was a statistically significant increased odds of hearing loss in the low bone mineral density or osteoporosis group with odds ratio of 1.20 (95% confidence intervals 1.01-1.42, p = 0.04, I 2 = 82%, Pheterogeneity = 0.01). However, the study from Helzner et al. reported significantly increase odds of hearing loss in the low bone mineral density in particular area and population included femoral neck of black men 1.37 (95% confidence intervals 1.07-1.76, p = 0.01) and total hip of black men 1.36 (95% confidence intervals 1.05-1.76, p = 0.02). Conclusion: Our study proposed the first meta-analysis that demonstrated a probable association between hearing loss and bone mineral density. Osteoporosis could be a risk factor in hearing loss and might play an important role in age-related hearing loss.

Abstract Introduction: There is inconclusive evidence whether osteoporosis increases risk of hearing loss in current literature. Objective: We conducted this meta-analysis to determine whether there is an association between hearing loss and osteoporosis. Methods: This systematic review and meta-analysis was conducted from studies of MEDLINE, EMBASE, and LILACS. Osteoporosis was defined as having a bone mineral density with a T-score of less than −2.5 standard deviation. The outcome was hearing loss as assessed by audiometry or self-reported assessment. Random-effects model and pooled hazard ratio, risk ratio, or odds ratio of hearing loss with 95% confidence intervals were compared between normal bone mineral density and low bone mineral density or osteoporosis. Results: A total of 16 articles underwent full-length review. Overall, there was a statistically significant increased odds of hearing loss in the low bone mineral density or osteoporosis group with odds ratio of 1.20 (95% confidence intervals 1.01-1.42, p = 0.04, I 2 = 82%, Pheterogeneity = 0.01). However, the study from Helzner et al. reported significantly increase odds of hearing loss in the low bone mineral density in particular area and population included femoral neck of black men 1.37 (95% confidence intervals 1.07-1.76, p = 0.01) and total hip of black men 1.36 (95% confidence intervals 1.05-1.76, p = 0.02). Conclusion: Our study proposed the first meta-analysis that demonstrated a probable association between hearing loss and bone mineral density. Osteoporosis could be a risk factor in hearing loss and might play an important role in age-related hearing loss.

Minimally Invasive Transcanal Removal of Attic Cholesteatoma / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: In treating attic cholesteatoma, traditional microscopic approach provides limited exposure to the attic space. Recently, the use of endoscope has emerged as a new treatment option for attic cholesteatoma. The aim of this study is to report the preliminary results of transcanal endoscopic removal of attic cholesteatoma and to evaluate the feasibility of endoscopic approach to attic cholesteatoma. SUBJECTS AND METHOD: Six patients with attic cholesteatoma were enrolled in this study from Sep 2014 to Oct 2015. Cholesteatoma was removed via transcanal endoscopic approach. We analyzed the clinical characteristics, surgical management and treatment outcomes. RESULTS: All patients had attic cholesteatoma in the epitympanic space with scutum erosion. However, the disease was restricted to the epitympanic space in three patients, whereas a limited extension of cholesteatoma to the aditus ad antrum was observed in two patients, and mesotympanum was involved in the remaining one patient. All of the patients suffered from conductive or mixed hearing loss with mean air-bone gap of 17.4 dB, and underwent endoscopic transcanal removal of cholesteatoma and scutoplasty. In three patients, the incus and malleus head were removed due to ossicular erosion, and a second-stage ossicular reconstruction was planned. No residual or recurrent diseases were noted during the follow-up period (mean: 13 months). No surgical complications were observed postoperatively, and favorable hearing outcome was obtained in all patients. CONCLUSION: Transcanal endoscopic approach was successfully performed in patients with limited attic cholesteatoma. Further studies involving a large number of patients with long-term follow-ups are necessary to prove the clinical efficacy of transcanal endoscopic approach in managing limited attic cholesteatoma.

A Case of the Vibrant Soundbridge Implantation to Unilateral Congenital Aural Atresia / 대한이비인후과학회지

Middle ear implantation is indicted for patients who have sensorineural, conductive or mixed hearing loss when conventional surgery or hearing aids do not producde sufficient improvement. This study reports the long-term results of an active middle ear implant, the Vibrant Soundbridge® (VSB) implantation, in a patient with unilateral congenital aural atresia (CAA). VSB was implanted for hearing rehabilitation after failed canaloplasty in a 15-year-old girl. After exposure of deformed ossicle, the floating mass tranceducer was coupled to the stapes head and subsequent subtotal petrosectomy was completed. Preoperative pure-tone air conduction threshold was 68.8 dB, which improved to 15 dB at one year of surgery. The mean aided free field speech discrimination in quiet was 98%. The speech understanding in noise evaluated by the composite score of Hearing-In-Noise test improved from SNR −2.5 dB to −5.2 dB. We present a first report of VSB implantation in a patient with unilateral CAA in Korea. The patient showed a significant hearing gain after the implantation of VSB; moreover, her hearing in noisy environment also showed improvement.

Unilateral horizontal semicircular canal malformation causing recurrent vertigo

@#A 62-year-old man consulted for recurrent episodes of vertigo lasting from seconds to several minutes. The vertigo was variably described as spinning, lateral swaying, and a feeling of being “unsure of his position in space.” These episodes were noted to have begun when the patient was still in his 20’s. Standard pure tone audiometry revealed a mild-to-moderate downsloping mixed hearing loss in the left ear. Bithermal caloric testing indicated the presence of a significant left-sided peripheral vestibular loss. Due to the fact that the vertigo episodes presented relatively early in life, the possibility of a congenital inner ear malformation was considered as a cause for his symptoms. Computerized tomographic (CT) imaging of the temporal bone was performed. This clearly showed the left horizontal semicircular canal lacking a central bony island. (Figure 1 and 2) The cochlea, superior and posterior semicircular canals, vestibular and cochlear aqueducts, and ossicular chain were grossly normal. A malformation of the horizontal or lateral semicircular canal is one of the most common inner ear malformations, as it is the last vestibular structure to be formed during inner ear embryogenesis. As such, it may occur in isolation or may be associated with other vestibular, cochlear, or middle ear malformations.1,2 Although vertigo and dizziness are symptoms to be expected in such a condition, existing data indicates that it may be totally asymptomatic, or it may also present as a sensorineural, conductive, or mixed type of hearing loss.1,3 Radiologic imaging is of prime importance in diagnosing such conditions, especially when auditory and/or vestibular symptoms manifest early in life. This case perfectly illustrates the need for such studies, as the patient went undiagnosed for more than forty years! No definitive statements can be gleaned from existing medical literature with respect to treatment. However, in patients with debilitating vestibular symptoms, management with modalities that selectively target the vestibular system, but spare the auditory system, such as vestibular neurectomy and trans-tympanic aminoglycoside therapy appear to be reasonable options.

Listas de monossílabos para teste logoaudiométrico: validação de construto / Lists of monosyllables for speech audiometry testing: construct validity

RESUMO Introdução Estímulos de fala são usados como parte da avaliação audiológica básica, para análise do reconhecimento de fala, e materiais validados são necessários para este fim. Objetivo Realizar validação de construto de novas listas de monossílabos, para uso na avaliação logoaudiométrica. Métodos Pesquisou-se o Índice Percentual de Reconhecimento de Fala, com dois materiais: duas novas listas de monossílabos, validadas quanto ao conteúdo e consideradas equivalentes e a lista de Pen e Mangabeira-Albernaz (1973), considerada padrão-ouro na rotina clínica da avaliação logoaudiométrica, no Brasil. As novas listas foram apresentadas na forma gravada e a segunda, à viva voz, pelo mesmo locutor. Foram selecionados, por meio de um banco de dados, indivíduos residentes no município onde a pesquisa foi realizada e que possuíam perda auditiva de grau moderado a moderadamente severo em, pelo menos, uma das orelhas. Participaram 20 sujeitos destros, com idades entre 18 e 44 anos, com perda auditiva do tipo neurossensorial, mista ou condutiva. Foram correlacionados os escores obtidos, resultantes da aplicação das listas. Os dados foram analisados por orelha, sendo então, 18 orelhas direitas e 18 orelhas esquerdas. Resultados Não houve diferença significativa entre as orelhas direita e esquerda. Observou-se forte correlação entre as novas listas previamente desenvolvidas para esta pesquisa e a lista de Pen e Mangabeira-Albernaz, nos diferentes grupos de perda auditiva. Ao comparar os pares de escores obtidos, também houve forte correlação linear entre as novas listas e a lista de Pen e Mangabeira-Albernaz. Conclusão As novas listas de monossílabos foram validadas, em relação ao construto.

ABSTRACT Introduction Speech stimuli are used as part of basic audiological assessment for speech recognition analysis, and validated materials are required for this purpose. Purpose To perform construct validation of new lists of monosyllables for speech audiometry assessment. Methods The speech recognition percentage index was determined with two materials: two new lists of monosyllables, which were validated for content and considered to be equivalent, and the list of Pen and Mangabeira-Albernaz (1973), considered as the gold standard in the clinical routine of speech audiometry assessment in Brazil. The former were presented as recorded material and the latter, via monitored live voice, by the same speaker. Individuals living in the same city where the research was conducted and who had moderate to moderately severe hearing loss in at least one ear were selected from a database. Twenty right-handed subjects - aged between 18 and 44, with mixed or conductive and sensorineural hearing loss - participated in this research. The scores resulting from the application of these lists were correlated. Data were analyzed by ear; there was a total of 18 right ears and 18 left ears. Results There was no statistically significant difference between the right and left ears. There was a strong correlation between the new lists previously developed for this research and the list of Pen and Mangabeira-Albernaz in different hearing loss groups. When comparing the pairs of resulting scores, there was also a strong linear correlation between the new lists and the list of Pen and Mangabeira-Albernaz. Conclusion The new monosyllable lists were validated for the construct.

Middle Ear Implant / 한양의대학술지

Patients with hearing loss have been increasing according to the extension of lifespan. Recently, new technology which solves the limitation of conventional hearing aids has been developed. For example, the active middle ear implantation which can directly transfer the vibration energy to the ossicles and inner ear fluid can avoid the feedback and occlusion effect, because this device uses the electromagnetic transducer, not a microphone. Active middle ear implants give more clear sounds and more gain in high frequency area. This device can apply to the patients with ski-sloping hearing loss and severe mixed hearing loss. In the paper, we reviewed the benefits and ideal candidates of the middle ear implant.

Hearing Rehabilitation with Sophono(R) in Patients with Unilateral Hearing Loss after Meningioma Removal / 대한이비인후과학회지

Various bone conduction hearing aids have been widely used to improve hearing fuction for the last 30 years. Sophono(R), a newly introduced device without percutaneous abutment, improved disadvantages of previously used bone conduction hearing aids. Recently, we experienced a case of Sophono(R) implantation in a patient presenting with mixed hearing loss followed by tumor surgery. The patient gained air conduction threshold of 60 dB HL compared to preoperative pure tone audiogram and a speech discrimination test in noisy environment showed improved results. Furthermore, the patient has had no cutaneous complications since implantation. The results of this case demonstrate the feasibility of implanting Sophono(R) in patients similar to this case. Considering its advantages of MRI compatibility and non-invasive surgery, as well as esthetical benefit, Sophono(R) implantation could be a preferable option for hearing rehabilitation.

A Case of Middle Ear Implantation with Vibroplasty Coupler at the Stapes / 대한이비인후과학회지

Middle ear implantation is an effective treatment for sensorineural, conductive and mixed hearing loss. The active middle ear implant's floating mass transducer (FMT) is placed on the middle ear structure or coupled to the inner ear fluid. Since the device is not directly placed on the external auditory canal, patients are free from feedback phenomenon and occlusion effect resulting from hearing aids. A 66-year-old patient suffered from bilateral hearing loss. The patient had difficulties in adapting to a conventional hearing aid because of feedback phenomenon in the right ear. The patient underwent a middle ear implantation using a CliP-Coupler to connect stapes head and FMT in the left ear. To our knowledge, this is the first case reported in Korea on middle ear implantation with CliP-Coupler at the stapes, for which hearing results were successful at postoperative 7 months.

A Case of the Vibrant Soundbridge Stapes Coupler in Patients with Mixed Hearing Loss

The Vibrant Soundbridge (VSB) with stapes clip coupler placement at the stapes head has been used successfully to treat mixed hearing loss. Coupling between the floating mass transducer of the VSB and the stapes head is technically less demanding than incus vibroplasty and is more likely to generate a positive outcome without significantly changing residual hearing or resulting in medical or surgical complications. A 65-year-old man with bilateral mixed hearing loss and chronic otitis media underwent vibroplasty with a stapes clip coupler. Speech discrimination scores in both quiet and noise environments showed better functional gain with the VSB than with the use of a conventional hearing aid. The results of the present case show the feasibility of implanting a VSB with a stapes coupler in patients with mixed hearing loss due to chronic otitis media.

Conductive and Mixed Hearing Losses: A Comparison between Summer and Autumn

BACKGROUND AND OBJECTIVES: Conductive hearing loss is common among children and adults. This study aims at comparing the results of conductive hearing loss in summer and autumn. SUBJECTS AND METHODS: Puretone audiometry and tympanometry tests were done for all patients who referred to the Iranian-based audiology center of Imam Khomeini Hospital in Ahvaz. Data on the patients with conductive or mixed hearing loss were analyzed. The impacts of season, age, and etiology of the disease were analyzed on the patients who visited the audiology clinic due to the conductive hearing loss in summer and autumn. RESULTS: One hundred and fifty nine patients in summer and 123 patients in autumn had conductive or mixed hearing loss. Their age ranged from four to 82 years, with the average age of 35. The percentage of the patients, with acute otitis media and chronic otitis media (COM), who visited this clinic, was significantly higher than those with middle ear problems. COM and mastoid surgeries rate was higher in summer than autumn among adults. CONCLUSIONS: There is no relationship between season and middle ear diseases between children and juveniles, but COM and mastoid problems are more common in summer among adults visiting this clinic. Most of the patients had mild conductive hearing loss and bilateral middle ear impairments.

Subjective and Audiologic Results of Bone Anchored Hearing Aids (BAHA) / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: This study aims to evaluate audiologic results and subjective satisfaction of bone anchored hearing aids (BAHA) patients. SUBJECTS AND METHOD: Preoperative air-conduction and bone-conduction thresholds, postoperative aided thresholds were measured for 14 patients. To evaluate patient satisfaction, two questionnaires derived from single sided deafness (SSD) questionnaire and Bern Benefit in SSD questionnaire were used. RESULTS: The mean age of patients, consisting of 8 males and 6 females, was 40.0+/-5.9 year. Ten patients (71%) received implantations for conductive or mixed hearing loss and 4 (29%) for SSD. The mean follow-up period was 27.8+/-5.6 months. The mean preoperative bone-conduction threshold of conductive or mixed hearing loss group was 21.4 dB and the mean air-conduction threshold was 65.4 dB. The mean bone-conduction threshold of SSD group was 60.0 dB and the mean air-conduction threshold was 105.9 dB. The postoperative aided threshold was significantly improved in conductive or mixed hearing loss group (p=0.005). The patients in the conductive or mixed hearing loss group showed more satisfaction with BAHA than those in the SSD group did, but the degree of satisfaction was not statistically significant (p=0.08 for questionnaire 1, p=0.12 for questionnaire 2). Patients with better preoperative bone-conduction threshold and patients with better preoperative speech discrimination score showed more satisfaction with BAHA in the questionnaire 1 (p=0.045, p=0.036). CONCLUSION: BAHA can be considered effective and beneficial for patients with conductive or mixed hearing loss and SSD. Further studies will be needed to choose the appropriate indications for BAHA, especially in SSD group in Korea.

Two Cases of Middle Ear Implantation: Incus Vibroplasty / 대한이비인후과학회지

The Vibrant Soundbridge (VSB) middle ear implant is an alternative rehabilitation option for sensorineural, conductive, and mixed hearing loss. The mechanism of VSB implantation is direct-drive stimulation of the inner ear through a floating mass transducer placed on the ossicular chain. We report our experience of VSB incus vibroplasty, which were successfully performed in two cases without complications and resulted in good functional gain and improve-ment of speech discrimination.