Diagnosis and management of otosclerosis in a Filipino population: A case series

Objective@#This case series aims to describe the diagnosis and management of otosclerosis in a series of Filipino patients encountered in a private, subspecialty otologic clinical practice. In particular, it elucidates the demographics, clinical presentation, diagnostic exam findings, clinical intervention and hearing outcomes.@*Methods@#Study Design : Retrospective review of medical records of a case series. Setting : Subspecialty otologic / neurotologic clinical practice. Participants : Medical records of all patients diagnosed to have otosclerosis based on radiologic evidence of fenestral or retrofenestral otosclerosis and/or confirmed during surgical exploration of the middle ear, during the period 2004-2017. @*Results@#Nine patients with otosclerosis were identified. Most patients presented with bilateral, primarily conductive hearing loss in middle age. However, an adolescent patient was also identified. Most patients were from the component cities of the National Capital Region. However, patients from the Cordillera region and south-central Mindanao were also identified. Radiologic evidence of fenestral or retrofenestral otosclerosis was identified in the majority of patients. However, readings of normal temporal bone CT findings were also seen. Obliterative otosclerosis was identified in one patient. Both objective and subjective evidence of hearing improvement was documented after stapedectomy in patients undergoing surgery.@*Conclusions@#This study documents the presence of clinical otosclerosis in a Filipino population. As in other populations, it typically presents in middle age as a bilateral, primarily conductive hearing loss. However, a younger age does not preclude its diagnosis, as juvenile otosclerosis has been identified. The presence of patients in regions of the Philippines other than the National Capital Region implies that it has to be considered even in regional populations without a racial predilection for otosclerosis. The identification of radiologic evidence of fenestral and retrofenestral otosclerosis on CT imaging of the temporal bone makes this is an essential part of the work-up of Filipino patients with conductive hearing loss and normal otologic examinations. Surgical treatment via stapes surgery is an effective and viable option in the management of Filipino patients with otosclerosis. The identification of less common variants such as obliterative otosclerosis indicates the need for specialized surgical equipment and appropriate surgical training in order to successfully deal with these situations.

Efecto de la otitis media en el desarrollo de la cognición y lenguaje infantil: una revisión narrativa de la literatura / Effect of otitis media on the development of childhood cognition and language: a narrative review of the literature

Resumen La otitis media constituye una de las consultas médicas más comunes en la población infantil. Se caracteriza por la inflamación del oído medio en presencia de exudado en la cavidad timpánica, abarcando un amplio espectro de formas clínicas, dentro de las que destacan la otitis media aguda, con efusión y crónica. La hipoacusia de conducción es una de las complicaciones de la otitis media, por lo que es lógico pensar que algunas habilidades del lenguaje y cognición infantil podrían verse afectadas secundariamente. Sin embargo, la evidencia en torno al tema no es concluyente y se aprecian opiniones contrapuestas; asimismo, no existe actualmente una revisión de la literatura que agrupe las investigaciones existentes en torno al tema. Por ello, el presente estudio pretende identificar y analizar la evidencia científica disponible sobre el efecto de la otitis media en el desarrollo de la cognición y lenguaje infantil. Se realizó una revisión de la literatura guiada por protocolo PRISMA en bases de datos de acuerdo a términos claves. Fueron analizados 8 artículos que cumplieron con los criterios de inclusión. Los resultados recabados sugieren, por una parte, que la otitis media afecta el lenguaje en sus distintas dimensiones, el vocabulario comprensivo y la longitud media del enunciado; mientras que, por otra parte, no se encontró efecto directo de la otitis media o hipoacusia sobre la comprensión del lenguaje. Se concluye que las investigaciones analizadas presentan gran variabilidad de resultados y conclusiones. No existen reportes sobre su impacto en otros dominios de la cognición.

Abstract Otitis media is one of the most common medical consultations in children. It is characterized by inflammation of the middle ear in the presence of exudate in the tympanic cavity, covering a wide spectrum of clinical forms, among which acute otitis media, otitis media with effusion and chronic otitis media are the most outstanding. Conductive hearing loss is one of the complications of otitis media, so it is logical to think that some language and cognitive skills in children could be affected. However, the evidence on this matter is not conclusive and there are conflicting opinions; likewise, there is currently no review of the literature that compile the existing research on this topic. Therefore, the present study aims to identify and analyze the available scientific evidence on the effect of otitis media on the development of children's cognition and language. A review of the literature, guided by PRISMA protocol, was conducted in databases according to key terms. Eight articles that met the inclusion criteria were analyzed. The results suggest, on the one hand, that otitis media affects language in its different dimensions, comprehensive vocabulary and average sentence length; while on the other hand, no direct effect of otitis media or hearing loss on language comprehension was found. In is concluded that the research that were analyzed present great variability of results and conclusions. There are no reports on its impact on other domains of cognition.

Salud auditiva en víctimas afrocolombianas del conflicto armado, sobrevivientes de artefacto explosivo improvisado / Hearing health in Afro-Colombian victims of the armed conflict, survivors of improvised explosive device

Introducción: En el año 2002 un artefacto explosivo improvisado estalló sobre la población civil afrocolombiana refugiada en una iglesia y generó una masacre. Los sobrevivientes presentaron importantes afectaciones en la salud, sin un estudio completo hasta la fecha. Objetivo: Establecer el perfil de salud auditiva en la comunidad de sobrevivientes a la masacre de Bojayá, Chocó. Métodos: A partir de evaluaciones clínicas audiológicas con anamnesis, otoscopia, audiometría, logoaudiometría e impedanciometría en 61 personas supervivientes, se efectuó un estudio descriptivo incluyendo variables sociodemográficas, factores de riesgo, signos y síntomas auditivos, y diagnósticos audiológicos. Resultados: Un 72,13 por ciento de los participantes fueron mujeres. Además de la exposición al estallido de artefacto explosivo improvisado, que les afectó tanto en recinto cerrado (78,69 %), como en exteriores adyacentes (3,28 por ciento) o ubicaciones más distantes; los principales factores de riesgo auditivo encontrados fueron la infección de oído previa (26,87 por ciento). Un 70,49 por ciento sufría de tinnitus y 14,75 por ciento de vértigo. El 81,97 por ciento de sobrevivientes (n = 50) presentaron alteraciones en su audición, sin estudio previo. Un 81 por ciento de quienes se encontraron con algún grado de hipoacusia, reportaban el antecedente de exposición al estallido dentro del espacio cerrado de la iglesia. Conclusiones: El perfil de salud auditiva de la comunidad de sobrevivientes a la masacre de Bojayá, Chocó, se caracterizó por la presencia de dificultades auditivas, tinnitus, otalgia, vértigo, antecedentes de trauma acústico y perforaciones timpánicas. El principal diagnóstico encontrado fue hipoacusia conductiva bilateral(AU)

Introduction: In 2002 an improvised explosive device exploded over a church with Afro-Colombian civilians sheltering there, generating a massacre. The survivors presented important health problems without a complete study to date. Objective: To establish the hearing health profile in the community of survivors of the Bojayá Massacre, Chocó. Methods: Based on clinical audiological evaluations with anamnesis, otoscopy, audiometry, speech audiometry and impedance in 61 survivors, a descriptive study was carried out including sociodemographic variables, risk factors, auditory signs and symptoms, and audiological diagnoses. Results: 72.13 percent of the participants were women. In addition to exposure to the explosion of an improvised explosive device, which affected indoors (78.69 percent), and in adjacent outdoors (3.28 percent) or more distant locations, the main auditory risk factors found were previous infection of ears (26.87 percent). 70.49 percent suffered from tinnitus and 14.75 percent from vertigo. 81.97 percent of survivors (n=50) presented alterations in their hearing, without previous study. 81 percent of those who encountered some degree of hearing loss reported a history of exposure to the blast within the closed space of the church. Conclusions: The hearing health profile of the community of survivors of the Bojayá massacre, Chocó, was characterized by the presence of hearing difficulties, tinnitus, earache, vertigo, a history of acoustic trauma, and tympanic perforations. The main diagnosis found was bilateral conductive hearing loss(AU)

Fenestral otosclerosis: A subtle lesion easily missed

@#A 29-year-old Filipina of Chinese descent presented with progressive bilateral conductive hearing loss of several years’ duration. While working overseas, she consulted with an otolaryngologist and underwent computerized tomographic (CT) imaging of the temporal bone as part of her evaluation. She was informed that no abnormalities were identified in the imaging exam, and she was offered exploratory middle ear surgery with possible stapes surgery. She then sought a second opinion, with the intention of obtaining a more definitive diagnosis prior to any invasive medical intervention. A review of the CT imaging study, with particular emphasis on looking for radiologic evidence of otosclerosis, revealed the presence of a focal region of bone demineralization in the region of the fissula ante fenestram. (Figure 1) This finding is consistent with a diagnosis of fenestral otosclerosis.

Evaluation of adhesive bone conduction hearing aid in pediatric patients with unilateral congenital aural atresia / 中华耳鼻咽喉头颈外科杂志

Objective: To evaluate the auditory efficacy and subjective satisfaction of adhesive bone conduction hearing aid in children with unilateral congenital aural atresia (UCAA). Methods: Ten subjects (5 males and 5 females) diagnosed with UCAA with an average age of 8.3 years old (ranged from 5 to 15) were included in Beijing Tongren Hospital, Capital Medical University from January to August 2019. The free sound field hearing threshold, word recognition score in quiet, speech reception threshold in noise and sound localization ability (results were measured by RMS error) tests were performed in unaided and aided situation, respectively. Subjective satisfaction questionnaires were also distributed to subjects. Paired t test and Wilcoxon signed rank test were used as statistical analysis methods. Results: The average hearing threshold in aided condition was improved by (21.9±4.4) dB (t=15.8，P<0.05). Speech recognition abilities were generally improved both under quiet and noise (P<0.05);however, when the binaural summation, squelch and head shadow effects were analyzed respectively, the binaural squelch effect was not statistically improved (P>0.05), while the other effects were improved in aided condition (P<0.05). In sound localization test, there was no significant difference of the RMS error value between the unaided and aided situation (P>0.05). The subjects got high satisfaction rates in three subjective questionnaires. Conclusion: The adhesive bone conduction hearing aid can provide significant audiological benefit for children with UCAA as well as raising the quality of their life.

Effect of malleostapedotomy procedure on 17 cases of congenital middle ear malformation / 中华耳鼻咽喉头颈外科杂志

Objective: To conclude the clinical features and the postoperative efficacy of congenital middle ear malformation treated with Malleostapedotomy (MS), and to explore the security and effectiveness of MS surgery. Methods: The clinical data of 17 patients (18 ears) with congenital middle ear malformation undergoing MS procedure were analyzed. There were 10 males (11 ears) and 7 females (7 ears), aged from 7 to 48 years. The imaging examination, pure-tone audiometry, intraoperative findings and postoperative hearing improvement of these patients were analyzed and summarized, and software SPSS23.0 was used for statistical analysis. Rusults All the 17 patients (18 ears) presented with hearing loss since childhood on the affected sides. Preoperative high resolution CT (HRCT) of the temporal bone revealed definite malformations in 9 ears (6 ears with incus long process dysplasia and 3 ears with anterior and posterior crus dysplasia). Before surgery, the mean bone conductive hearing threshold at 500, 1 000, 2 000 and 4 000 Hz was (15.6±10.2) dB HL, the mean air conductive hearing threshold was (60.6±9.7) dB HL, and the mean air-bone gap was (45.0±8.9) dB. During the surgery, all 18 ears were found to be accompanied by absence or hypoplasia of incus long process. 12 ears had stapes fixation, 6 ears had oval window atresia. All patients were treated with MS procedure by using Piston. The patients were followed up for 3 months to 1 year. The mean bone conductive hearing threshold was (14.7±8.8) dB HL. The mean air conductive hearing threshold was (37.7±11.6) dB HL, and the mean air-bone gap was (23.0±8.0) dB. There were statistically significant differences in the mean air conductive hearing threshold and mean air-bone gap before and after surgery (P<0.05). While there were no statistically significant differences in the mean bone conductive hearing threshold before and after surgery (P=0.550). Conclusions: MS procedure is safe and reliable in patients with congenital middle ear malformation of incus long process dysplasia, stapes fixation or oval window atresia. HRCT is useful in evaluating the major deformity of ossicular chain and facial nerve deformity. However, it is not enough to evaluate the joint of incus-stapes and oval window atresia. MS surgery in middle ear malformation requires advanced surgical experience and skills. The hearing improvement can be significant, even though some air-bone gap after surgery exist.

Evaluation of unilateral and bilateral bimodal bone conduction hearing intervention in patients with bilateral microtia-atresia / 中华耳鼻咽喉头颈外科杂志

Objectives: To evaluate the therapeutic effects of unilateral/bilateral bone conduction hearing rehabilitation in patients with bilateral microtia accompanied with severe conductive hearing loss following staged auricle reconstruction and bonebridge implantation. Methods: Thirty-two patients, including 20 males and 12 females, with an average age of 11.8, who received surgical treatment in Peking Union Medical College Hospital (PUMCH) from March, 2016 to January, 2020 with bilateral microtia-atresia were included. Hearing thresholds, speech perception and high-resolution CT of the temporal bone were evaluated prior to surgery and individualized surgery plans (staged auricle reconstruction and bonebridge implantation) were made. Hearing thresholds and speech perception in quiet and noise (SNR = 5 dB) using unilateral Bonebridge were tested two weeks after the implantation surgery when the Bonebridge was activated and at 3th, 6th, 12th month after activation. Hearing thresholds and speech perception were also tested at least three months after the activation of the Bonebridge under three conditions: unaided, unilateral Bonebridge, and bilateral bone conduction hearing devices (Bonebridge plus contralateral ADHEAR). The international hearing aid assessment questionnaire (IOI-HA) and Glasgow children's benefit questionnaire were used to evaluate the subjective benefits of the patients. SPSS 21.0 software was used for statistical analysis. Results: Among these 32 patients, nine were conducted Bonebridge implantation surgery before auricle reconstruction, six were simultaneously with auricle reconstruction and 17 were implanted after auricle reconstruction surgery. Compared with unaided, the mean hearing thresholds (0.5, 1, 2, and 4 kHz) and speech perception following unilateral BCHD and bilateral BCHD attachment were improved significantly (P<0.05 each). The speech perceptin in noise of bilateral BCHD was better than unilateral (P<0.05 each). The modified questionnaire revealed high levels of patient satisfaction following use of both unilateral and bilateral devices. Conclusions: Individulized surgical procedures involving auricle reconstruction and Bonebridge implantation are safe and effective for patients with bilateral microtia-atresia, solving both appearance and hearing problems. Speech perception in noise is better following bilateral BCHD than unilateral BCHD attachment.

Bonebridge implantation combined with simultaneous bilateral auricle reconstruction for bilateral congenital aural atresia / 中华耳鼻咽喉头颈外科杂志

Objective: To investigate the feasibility and safety of auricle reconstruction combined with Bonebridge implantation for bilateral aural atresia patients. Methods: A retrospective analysis was conducted for 36 cases(72 ears) who underwent Bonebridge implantation combined with bilateral auricle reconstruction from February 1, 2017 to January 15, 2020. All cases were bilateral congenital aural atresia and underwent Nagata auricle reconstruction for both sides simultaneously. Bonebridge implantations were performed during the second stage of auricle reconstruction. Results: All 36 patients healed well and had no surgical complications when discharged. The preoperative average bone conduction threshold of the patients was(8.5±5.8) dB HL and postoperative bone conduction threshold was (8.4±5.2) dB HL. There was no significant change after the implantation (P=0.724). The preoperative average air conduction threshold of was(64.9±7.4)dB HL and postoperative air conduction threshold was (24.0±5.3) dB HL, which had a significant change after the implantation (P<0.001). The hearing threshold with Bonebridge significantly decreased by 40.9 dB HL compared with the preoperative air conduction threshold(P<0.001). The speech recognition rate of monosyllable words, disyllabic words and short sentences in quiet environment increased by 62.5%, 63.5% and 72.2% respectively. The differences were statistically significant (P<0.001). The speech recognition rate of monosyllabic words, disyllabic words and short sentences in noise environment were significantly increased by 55.9%, 58.9% and 69.9% respectively (P<0.001). After a follow-up of 18.3 months in average, the hearing results were stable and the aesthetic outcomes were satisfied. One patient had implant rupture and healed after revision surgery. Conclusions: With an integrated surgical procedure, patients with bilateral congenital aural atresia can complete bilateral auricle reconstruction and hearing implantation within six months. This integrated surgical procedure is safe and efficient, with a stable hearing improvement and good appearance.

Analysis of clinical characteristics of middle ear osteoma at different locations / 中华耳鼻咽喉头颈外科杂志

Objective: To explore the clinical characteristics, intervention and treatment of tympanic osteoma at different locations. Methods: The medical history, audiological and imaging examination, operation and follow-up results of two patients with tympanic osteoma at different sites were reviewed and summarized. Furthermore, the clinical characteristics and interventions of 36 patients reported in literatures with tympanic osteomas were also summarized and analyzed. Results: Osteoma of the two patients collected in this study located at promontory and incus respectively;both of them presented with intact tympanum and conductive deafness, without obvious etiology or predisposing factor. Both of them underwent surgeries and the hearing improved significantly. For patient one, the ossicular chain was intact and restored to activity after removed the osteoma. For patient two, an artificial ossicle was implanted after removed the osteoma and incus. In the 36 patients reported in literatures, the average age was 26.5 years, and 39.47% of them located at promontory; in addition, the main symptoms of them were progressive hearing loss, tinnitus and ear stuffy. Conclusions: Patients with tympanic osteoma are characterized by conduction deafness with intact tympanic membrane, and the most common lesion is promontory. Hearing can be restored by excision of the osteoma and maintenance or reconstruction of the ossicle chain.

Prótese auditiva ancorada ao osso percutânea: benefícios auditivos / Percutaneous bone ancored hearing aid: hearing benefits

RESUMO Objetivo Descrever os benefícios nos limiares auditivos e no desempenho de reconhecimento de sentenças no silêncio e no ruído em indivíduos com a adaptação unilateral do Sistema Ponto®. Métodos Estudo observacional, retrospectivo, de seguimento longitudinal. A casuística foi composta por fontes de dados secundários de dez indivíduos com perda auditiva condutiva ou mista, que foram submetidos à cirurgia com o Sistema Ponto®. Os resultados foram analisados nas seguintes condições: a) pré-cirúrgicas: sem AASI; com AASI por condução aérea ou óssea e com o processador Ponto Pro® acoplado a uma banda elástica; b) pós-cirúrgicas: na ativação e após seis meses de uso. Resultados Os limiares da audiometria tonal por conduções aérea e óssea mantiveram-se estáveis após a cirurgia, enquanto os limiares auditivos em campo livre e o reconhecimento de fala no silêncio e no ruído foram estatisticamente melhores na ativação e após seis meses de uso do Sistema Ponto®. Não houve diferença nos resultados com os indivíduos utilizando o Sistema Ponto® com a banda elástica e após a cirurgia. Conclusão O Sistema Ponto® propiciou benefício nas habilidades auditivas de detecção em todas as frequências testadas, assim como no reconhecimento de sentenças no silêncio e no ruído.

ABSTRACT Purpose To describe the benefits in hearing thresholds and sentence recognition performance in silence and noise, in users of the unilateral Ponto® system. Methods An observational, retrospective, longitudinal study. The sample consisted of secondary data sources from 10 individuals with conductive or mixed hearing loss who underwent surgery with the Ponto® System. The results were analyzed in the following pre-surgical conditions (without hearing aids; with hearing aids by air or bone conduction; with the Ponto Pro® processor with a soft band) and post-surgical (on activation and after six months of use). Results The thresholds of pure tone audiometry by air and bone conductions remained stable after surgery, while the auditory thresholds in free field and speech recognition in silence and in noise were statistically better when using the Ponto® system. There was no difference between the results obtained with the individuals using Ponto® with soft band and post-surgically. Conclusion The Ponto® system provided benefits in hearing detection skills in all tested frequencies, as well as, in recognition of the sentence in silence and noise.

Prevalencia de hipoacusia en una población escolar con síndrome de Down de Bogotá, Colombia / Prevalence of hearing loss in a population of schoolchildren with Down syndrome from Bogotá, Colombia

Introducción: Los niños con síndrome de Down presentan mayor prevalencia de alteraciones de la capacidad auditiva, secundaria a variaciones anatómicas y fisiológicas. En Colombia, no se realiza tamizaje auditivo universal, y no hay datos sobre la prevalencia de hipoacusia en esta población. El propósito de este estudio fue determinar la frecuencia y tipo de estas alteraciones en nuestra población por medio de evaluación audiológica.Pacientes y métodos: Se realizó un estudio de corte trasversal en dos instituciones especializadas en el acompañamiento y terapia de familias de niños con síndrome de Down en Bogotá D. C., Colombia. Entre octubre de 2017 y septiembre de 2018, se realizó audiometría comportamental y/o tonal e impedanciometría en 40 y en 37 niños respectivamente. Los sujetos asistían a las instituciones dos veces por semana y estaban integrados en diferentes grados escolares hasta quinto de primaria. Se estimó la prevalencia y se describieron las características, antecedentes clínicos e hitos del desarrollo del lenguaje. Resultados: Se obtuvo una muestra de 40 niños (22 mujeres) con edades entre 6 y 18 años (media: 11,23). Se encontró antecedente de otitis en 19 sujetos e hipoacusia de leve a moderada en 17 niños, predominantemente, conductiva. Hubo retraso en hitos del desarrollo del lenguaje, en apariencia, no asociado a hipoacusia.Conclusiones: En una muestra de niños con síndrome de Down en Bogotá, se encontró una alta prevalencia de hipoacusia, consistente con resultados de estudios previos. Estos datos resaltan la necesidad de un control estricto de la capacidad auditiva basado en parámetros y guías estandarizadas.

Introduction: Children with Down syndrome have a higher prevalence of hearing disorders, secondary to anatomical and physiological variations. No universal hearing screening is implemented in Colombia, so there are no data available on the prevalence of hearing loss in this population. The objective of this study was to determine the frequency and type of such disorders in this population based on hearing tests.Patients and methods: This was a cross-sectional study conducted at two institutions specialized in accompanying and supporting the families of children with Down syndrome in Bogotá, D.C., Colombia. Between October 2017 and September 2018, a behavioral and/or pure-tone audiometry and an impedance audiometry were done in 40 and 37 children respectively. Subjects attended the institutions twice a week and were integrated at school, up to fifth grade. Prevalence was estimated and characteristics, clinical history, and language developmental milestones were described.Results: The sample was made up of 40 children (22 girls) aged 6-18 years (mean: 11.23). A history of otitis was found in 19 children and of mild to moderate hearing loss, in 17, predominately conductive. A delay in language developmental milestones was observed, apparently not associated with hearing loss. Conclusions: A sample of children with Down syndrome from Bogotá showed a high prevalence of hearing loss, consistent with the results of previous studies. These data stress the need for a strict control of hearing status based on standardized parameters and guidelines.

Análise da percepção da fala com uso de dispositivos de amplificação em indivíduos com malformação de orelha e perda auditiva unilateral / Analysis of speech perception with amplification devices in subjects with ear malformation and unilateral hearing loss

RESUMO Objetivo: Verificar a percepção da fala de indivíduos com malformação de orelha e perda auditiva unilateral utilizando dois tipos de amplificação: amplificação sonora individual (AASI) convencional e softband (faixa com vibrador ósseo). Método: Foram selecionados 15 indivíduos, de ambos os sexos, com malformação congênita de orelha externa e/ou orelha média, diagnóstico de perda auditiva unilateral do tipo condutiva ou mista de grau moderado a severo, idade entre 15 e 25 anos, e encaminhamento para amplificação realizado pelo médico otorrinolaringologista. Após a adaptação com AASI e softband, foi realizada avaliação da percepção da fala sem uso da amplificação, com AASI acoplado ao arco e vibrador ósseo (convencional) e com uso do softband (faixa com vibrador). Os indivíduos foram avaliados por meio do Hearing in Noise Test (HINT) nas condições de silêncio e de ruído. Resultados: Foram avaliados sete indivíduos com malformação de orelha unilateral, sendo 57,1% na orelha direita e 42,9% na orelha esquerda. Quanto ao tipo e grau da perda, 71, 4% da amostra possuía perda auditiva condutiva moderada. No teste de percepção de fala na condição de silêncio, ruído frontal e ruído lateral, em três situações: sem amplificação, com o uso do AASI convencional e com o uso do softband, os resultados com uso de dispositivos de amplificação apresentaram-se melhores em todas as condições. Conclusão: Os indivíduos apresentaram melhora sutil, porém não significativa, na percepção de fala tanto em situações de silêncio, ruído frontal e lateral independentemente do tipo de amplificação.

ABSTRACT Purpose: To verify the speech perception in subjects with ear malformation and unilateral hearing loss, fitted with two types of amplification as follows: conventional hearing aids and softband (band with vibrator bone). Method: The study included fifteen subjects of both sexes who presented congenital malformation of the middle or outer ear, diagnosed with unilateral conductive or mixed hearing loss, moderate to severe hearing loss, age range between 15 to 25 years and, prescription from a specialist doctor for hearing device fitting. We performed the speech perception assessment without amplification after the hearing aid and softband fitting, with the hearing aid linked to the bone vibrator (conventional) and the softband (band with the bone vibrator). The subjects were evaluated using the Hearing in Noise Test (HINT), in silence and in noise. Results: Seven subjects with unilateral ear malformation were evaluated, 57.1 % had impairment in the right ear and 42.9 % in the left ear. Regarding the type and the level of hearing loss, 71 % of all subjects included in the sample presented moderate conductive hearing loss. The assessment of speech perception was performed during silence, frontal noise, lateral noise and, during three specifics situations: no amplification, with conventional hearing aid and with the softband. The results with the amplification devices were positive in all evaluated conditions. Conclusion: Evaluated subjects presented improvement in speech perception, in silence, frontal noise and lateral noise situations, regardless of the type of amplification; however, the difference was not statistically significant.

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 loss in the pediatric age group

Background: Hearing loss is one of the preventable diseases listed by the WHO, even though the prevalence is decreasing in the developed countries. The pediatric age is very important in terms of hearing and therefore speech development. The prevalence and pattern of hearing loss in this age group in this environment is not known. Objective: The aim of the study was to determine the etiology and pattern of hearing loss in the pediatric age group in Port Harcourt. Materials and Methods: The study involved the pediatric age group (0-18 years) presenting with hearing loss, seen in the ENT Surgery Department of UPTH from January 2010 to December 2016. The clinic registers and patients' folders were the sources from which the biodata, clinical presentations, audiological assessments, possible etiologies, and treatment were extracted. These were analyzed using IBM SPSS Statistics, version 20.0. Results: A total of 752 patients with hearing impairment were seen: males ­ 502 and females ­ 250 with a ratio of 2.01:1. Patients with the age group of 0­3 years (28.6%) were more affected, whereas 16­18 years (11.2%) were the least affected. Sensorineural hearing loss (SNHL) was 37.6%; among this, birth asphyxia made up 38.5%, syndromic 6.0%, postmeningitis (2.7%, and neonatal jaundice 21.9%. However, conductive hearing loss (62.4%); was made up of cerumen auris (31.8%), otomycosis (19.4%), chronic suppurative otitis media (13.6%), Otitis media with effusion (11.7%). Most children with SNHL had severe­to­profound degree. The most common clinical presentation was hearing impairment and speech impairment followed by discharging ears. Conclusion: Hearing loss secondary to preventable causes such as birth asphyxia and neonatal infections still ranks high among the pediatric age group in this environment

Avaliação de Crianças com Indicadores de Risco para Deficiência Auditiva Atendidas em um Serviço de Referência em Triagem Auditiva Neonatal / Evaluation of Children with Risk Indicators for Hearing Loss in a Newborn Hearing Screening Reference Service / Evaluación de Niños con Indicadores de Riesgo para Deficiencia auditiva Atendidas en un Servicio de Referencia en Triagem Auditiva Neonatal

Objetivo: Avaliar a audição de crianças com indicadores de risco para deficiência auditiva que realizaram triagem auditiva neonatal e retornaram para o acompanhamento após seis meses. Métodos: Estudo longitudinal realizado no Serviço de Referência em Triagem Auditiva Neonatal de um hospital universitário com crianças com indicadores de risco para deficiência auditiva. O estudo foi realizado em duas etapas: teste e reteste (quando necessário) e acompanhamento (aos seis meses de idade corrigida). Resultado: Na triagem foram avaliadas 179 crianças. Nesta etapa houve associação entre resultado "falha" em ambas as orelhas e suspeita de síndrome e resultado "falha" e citomegalovirose. Em todas as etapas 12 crianças apresentaram alterações condutivas confirmadas pela imitanciometria, e nenhuma apresentou alteração neurossensorial. Conclusão: A alteração auditiva condutiva foi a mais presente nesta população. Não foram detectadas alterações auditivas neurossensoriais em nenhuma criança avaliada no período do estudo, portanto o monitoramento auditivo dessas crianças deve ser realizado até idades mais avançadas para se detectar eventuais perdas auditivas progressivas ou de origem tardia.

Objective: To evaluate the hearing of children with risk indicators for hearing loss who underwent newborn hearing screening and returned to follow up after six months. Methods: Longitudinal study conducted at the Newborn Hearing Screening Service of a university hospital with children with risk indicators for hearing loss. The study was performed in two stages: test and retest (when necessary) and follow-up (at six months). Results: 179 children were evaluated in the screening. In this stage there was an association between "failed" result in both ears and suspected syndrome and "failed" result and cytomegalovirus. In all the stages, 12 children presented conductive alterations confirmed by the immittanciometry and none presented sensorineural alteration. Conclusion: Conductive hearing loss was more present in this population. No sensorineural hearing loss was detected in any child evaluated during the study period; therefore the auditory monitoring of these children should be performed until later ages to detect any progressive or late-onset hearing loss.

Objetivo:Evaluar la audición de niños con indicadores de riesgo para la deficiencia auditiva que realizaron la tamizaje auditivo neonatal y regresaron para el seguimiento después de seis meses. Métodos:Estudio longitudinal realizado en el Servicio de Referencia enTriage Auditiva Neonatal de un hospital universitario con niños con indicadores de riesgo para la deficiencia auditiva. El estudio fue realizado en dos etapas: prueba y reprueba (cuandonecesario) y seguimiento (a los seis meses de edad corregida). Resultado:En la selección se evaluaron 179 niños. En esta etapa hubo asociación entre resultado "falla" en ambas orejas y sospechosa de síndrome y resultado "falla" y citomegalovirosa. En todas las etapas, 12 niños presentaron alteraciones conductivas confirmadas por la imitanciometría y ninguna presentó alteración neurosensorial. Conclusión: La alteración auditiva conductiva fuela más presente en esta población. No se detectaron alteraciones auditivas neurosensorial en ningún niño evaluado en el período del estudio, por lo que el monitoreo auditivo de estos niños debe ser realizado hasta edades más avanzadas para detectar eventuales pérdidas auditivas progresivas o de origentardío.

Speech Perception and Gap Detection Performance of Single-Sided Deafness under Noisy Conditions

BACKGROUND AND OBJECTIVES: Many studies have reported no benefit of sound localization, but improved speech understanding in noise after treating patients with single-sided deafness (SSD). Furthermore, their performances provided a large individual difference. The present study aimed to measure the ability of speech perception and gap detection in noise for the SSD patients to better understand their hearing nature.

Clinical Features of Fracture versus Concussion of the Temporal Bone after Head Trauma

BACKGROUND AND OBJECTIVES: Temporal bone fracture (TBF) is a common occurrence in cases of head trauma. Although the incidence of temporal bone concussion (TBC) has increased in cases of head trauma, it has not been extensively studied. We assessed the characteristics of TBF and TBC in patients with head trauma. SUBJECTS AND METHODS: We conducted a retrospective review of 432 patients with head injury who visited our hospital between January 2011 and April 2016. Of these patients, 211 who met the inclusion criteria were included in the study. Their clinical characteristics, causes of injury, and hearing function were analyzed. RESULTS: Among the 211 patients, 157 had TBFs and 54 had TBCs. Ear symptoms were more common among patients with TBF than among those with TBC. Car accidents were the most common cause of both TBF and TBC, but assault and sports injuries were more common among patients with TBC than among those with TBF. The occurrence of facial palsy in both cases of TBF and TBC. Hearing loss was observed among 35 patients with TBF and 11 patients with TBC. However, patients with TBF showed conductive hearing loss with an air-bone gap. Hearing function of these patients with TBF recovered with a reduced air-bone gap, but the patients with TBC showed little recovery. CONCLUSIONS: Emergency physicians should focus more on temporal bone injury in patients with head trauma. Therefore, an early complete diagnostic battery, which includes high-resolution computed tomography, audiometric tests, neurologic examination, and vestibular tests, be performed in patients with head trauma.

Auditory Localization Performances in Subjects with Simulated Unilateral Conductive Hearing Loss

No abstract available.

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.