Intratympanic injection in sudden sensorineural hearing loss

Purpose: the aim of this study was to evaluate intratympanic corticosteroid injection in cases with idiopathic sudden sensorineural hearing loss [SSNHL]

Material and Methods: seventy patients with sudden onset sensorineural hearing loss [SSNHL] were included in this study; 40 females and 30 males. Their age ranged from 14 to 67 years old. The hearing loss was graded into mild, moderate, severe and profound SNHL. The patients were classified into 3 groups according to the treatment modality; Group I did not receive corticosteroid therapy and included 10 patients, group II received systemic corticosteroid therapy and included 15 patients and group III received intratympanic corticosteroid therapy and included 45 patients

Results: in group I, 30% of patients showed improvement and in group 11, 40% of patients showed improvement and in group III, 82% showed improvement of hearing

Conclusion: intratympanic corticosteroid therapy for SSNHL has a better success rate than systemic corticosteroid therapy and control patients with no treatment. It has a low incidence of complications. Patients with mild and moderate hearing loss have a better prognosis than patients with severe and profound hearing loss

Probe microphone real ear insertion gain verification in children

The application of probe-microphone measurements to children is one of the most useful new developments in pediatric hearing aid selection. They offer a reliable method to verify hearing aid selection decisions. To assess the matching between real ear insertion gain [REIG] and prescribed target gain according to the desired sensation level [DSL] formula. This study included 40 ears of 30 children aged between 4 to 12 years with different degrees of hearing loss. They were fitted with linear hearing aids [10 binaural and 20 monaural]. Real ear unaided response [REUR], and real ear aided response [REAR] were measured. The real ear insertion gain was then calculated and compared to the prescribed target gain. There were 26 ears [of 19 children] failed to be within 10 dB of the DSL target gain at one or more frequencies from 500-3000Hz. Among these 26 ears who failed to achieve the DSL target gain, there were 16 ears [61.5%] found to have a flat audiogram and 13 ears [50%] had profound hearing loss. The difference in hearing threshold level was found to be of no clinical value in predicting the likelihood of failure. After appropriate modifications in hearing aid fitting, out of the 16 children [22 ears] who attended for hearing aid modifications, 18 ears [82 %] achieved a satisfactory gain within 10dB of the DSL target at all frequencies up to 3000Hz. No audiometric index was of clinical value in predicting those cases that required insertion gain measurements to ensure an adequate hearing aid prescription. The number of children who fail to achieve adequate gain with their initial hearing aid fitting is very high. These children have a wide range of degree and configuration of hearing loss. The routine measurement of real ear insertion gain in all first-time fittings would result in greatly improved amplification in many patients. More research in the field of pediatric hearing aid fitting is recommended to ensure delivery of adequate amplification to infants and young children

Speech and click evoked auditory brainstem response in delayed language children with normal pure tone audiogram

Children with normal auditory thresholds may still suffer from auditory processing disorders, resulting in poor speech understanding. Abnormal electrophysiological responses to speech syllables at the brainstem level have been associated with a wide spectrum of diagnosed learning problems. The aim of this study was to identify the pattern of speech evoked brainstem response in normal peripheral hearing children with delayed language development and to develop an objective method to test those children. The speech and click evoked ABR results of twenty children, their age ranging from 4-6 years [of both genders], complaining from delayed language development with normal pure tone audiogram and normal IQ results were compared to the results obtained from twenty normal children matching in age and gender. There was no significant difference in the wave V latency and amplitude values of click-evoked ABR in normal and delayed language subjects. However, a statistically significant difference between the wave V latency and amplitude values of the speech-evoked ABR in normal versus delayed language subjects was detected. There was also a highly significant difference in the duration and slope of the V-to-A transition between the two groups. Results obtained from this study suggest that speech evoked ABR may be a useful objective tool in the early diagnosis of children with delayed language development. More wide scale studies on speech evoked ABR must be conducted to obtain age related norms, and to assess other abnormalities such as learning disabilities

Rotary chair findings in patients with peripheral vestibular lesions

Imbalance and vertigo are among the most common symptoms causing patients to visit a physician. The rotational chair is one test modality used in the diagnosis of peripheral vestibular lesions through its ability to test higher, more physiologic frequencies and provides an adjunct to caloric and other ENG tests. The aim of this study was to assess the role of low frequency rotary chair testing in the evaluation and diagnosis of peripheral vestibular lesions. Forty subjects suffering from unilateral peripheral vestibular lesions, documented by the caloric test participated in this study. Twenty healthy adults served as control. They were subjected to: history taking, audiological evaluation, ENG and rotational chair testing in the form of Rotational Sinusoidal Harmonic Acceleration [SHA] test and Rotational Velocity Step Test [VST]. Results of the SHA test showed phase lead and reduced gain at low and mid frequencies [p<0.001] that improved at higher frequencies, together with reduced time constant [TC] in the velocity step test [p<0.001] between the study and control groups. TC was reduced in the study group in response to rotation towards the side of the lesion. Results of the VOR phase and gain between study groups according to different etiologies revealed that acoustic neuroma had the highest mean in the gain parameter [p<0.01]. In patients with unilateral peripheral vestibular lesions: gain reduction and phase lead are the main abnormalities seen with SHA test and are more pronounced at low frequencies of the test range. Rotational VST demonstrated response asymmetries in the form of reduced TC in response to rotation towards the side of the lesion. The onset and course of the peripheral vestibular lesion have an important effect on the degree of compensation mechanism