Novel Cellular Stress Models with Implications in Understanding and Treating ENT Pathologies

Interaction with the world around us requires extracting meaningful signals to guide behaviour. The mammalian senses of olfaction, vision, somatosensation, hearing, balance and taste facilitate extraction of sense-specific information. Most sensory organs in the vertebrate head originate from cranial placodes (CPs). CPs are formed embryonically through a series of differentiation steps arising at the boundary between neural and non-neural ectoderm, and they can be divided into anterior, posterior and intermediate groups depending on their place of origin in the developing embryonic head. Anterior CPs include adenohypophyseal, olfactory and lens placodes;intermediate CPs include the trigeminal placode, which gives rise to the sensory neurons of the ophthalmic and maxilla-mandibular divisions of the trigeminal ganglion;posterior CPs are comprised of the otic, lateral line placode and the epibranchial placodes that give rise to the inner ear, lateral line organs (in fish and amphibian) and sensory neurons of the geniculate, petrosal and nodose ganglia, respectively. The complexity of neural plate border specification in vitro poses a major limitation to gain deeper mechanistic insights into the developmental cues driving efficient placodal differentiation;hence generation and establishment of in vitro cellular models with improved cranial placode differentiation are challenging. Our group is interested in the establishment of cranial/sensory placodes in vitro using novel cellular stress stem cell reprogramming models with translational implications in sensorineural hearing loss regeneration and modelling COVID-19-associated anosmia. We are primarily interested in building the otic placodes that can form viable otic vesicles in vitro, which can be further directed to generate cochlear/vestibular systems of inner ear and the sensory neurons of its associated vestibulocochlear ganglion. Given the copious involvement of serine proteases in COVID-19 pathogenesis, we are also encouraged to leverage our proteolytic stress cellular models towards establishment and characterization of novel olfactory epithelial neurospheres housing supporting cells, progenitor cells and sensory neurons for investigating cellular and molecular targets of COVID-19-associated anosmia. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2022.

COVID as a potential risk factor for sensorineural hearing loss in newborns

Currently, numerous studies around the world are performed to investigate possible com-plications of COVID-19. Audiovestibular system damage can be a manifestation of a SARS-CoV-2 infection. Various viruses are known to cause congenital hearing impairment. Are neonates of SARS-CoV-2 positive mothers in a risk group of congenital hearing loss? Review of literature is not conclusive, but there is more evidence for COVID-19 not being a risk factor for congenital hearing loss. Limited cohort studies, using newborn hearing screening, were performed to compare the incidence of neonatal hearing loss with newborns with no potential risk factors. More studies are needed to support these results and regular checkups of newborns in a risk of hearing impairment due to maternal SARS-CoV-2 infection to inves-tigate possible complications.

Facial ageing . . . and other stories

When high quality photographs of the faces of 2700 middle aged and older participants in a longitudinal study were assessed by a panel without knowledge of their chronological age and medical history, people whose perceived age was lower than their chronological age were less likely to have osteoporosis, chronic obstructive pulmonary disease, hearing loss, or cataracts. Energy expenditure and incident type 2 diabetes Data from 90 000 participants in the UK Biobank study who wore an accelerometer for seven days reveal a linear relation between the amount of energy expended during physical activity and the subsequent incidence of type 2 diabetes—even after adjusting for body mass index. A study using data for 1.5 million prescriptions of PPIs in UK general practice found an increased risk of diagnosis of an inflammatory bowel disease in the first two years after treatment started.

Hearing handicaps, communication difficulties and depression in the older adults: a comparison of hearing aid users and non-users.

BACKGROUND AND AIM: Age-related hearing loss has potential effects on communication, cognitive, emotional, and social aspects of the older person's life. Evaluating the role of hearing aids in reducing these difficulties is important. This study aimed to evaluate communication difficulties, self-perceived handicaps, and depression in hearing-impaired older adults who are either hearing aid users or non-users. METHODS: A total of 114 older adults in the age range of 55-85 years with moderate to moderately severe hearing loss (two hearing-matched groups; hearing aid users: n = 57; hearing aid non-users: n = 57) took part in this study during the COVID-19 pandemic. Self-perceived hearing handicaps and communication were evaluated using the Hearing Handicap Inventory in the Elderly-Screening (HHIE-S) and Self-Assessment Communication (SAC) questionnaires. Depression was assessed using the geriatric depression scale (GDS). RESULTS: The average score of HHIE-S was significantly higher in the hearing aid users than the non-users (16.61 ± 10.39 vs. 12.49 ± 9.84; p = 0.01). Differences between groups were not significant for SAC or GDS scores (p ≥ 0.05). There were strong positive correlations between HHIE-S and SAC scores in both groups. Moderate correlations were found between SAC and GDS scores in the hearing aid users and between the duration of using hearing aid with SAC and HHIE-S scores. CONCLUSION: It seems that self-perceived handicaps, communication difficulties and depression are affected by many factors, and only receiving hearing aids without subsequent support such as auditory rehabilitation and programming services cannot bring the expected output. The effect of these factors was clearly observed due to reduced access to services in the COVID-19 era.

Four cases of audio-vestibular disorders related to immunisation with SARS-CoV-2 mRNA vaccines.

OBJECTIVE: To gain medical insight into the clinical course and safety of otolaryngologic disorders following immunisation with severe acute respiratory coronavirus (SARS-CoV-2) mRNA-based vaccines. DESIGN: Case description. STUDY SAMPLE: We report four cases of transient audio-vestibular symptoms, which occurred shortly after inoculation of two BNT162b2 (Pfizer-BioNTech®) and mRNA-1273 (Moderna®) vaccines. RESULTS: Hearing loss was unilateral in all cases and recovered at least partially: it was associated with persistent gait instability in two cases, after 1 and 7 months. Trigger mechanisms underpinning audio-vestibular impairment remain uncertain. Immune tolerance mechanisms with off-target innate activation of T-lymphocytes may be involved in vestibulocochlear nerve disorders, as for other cranial nerves involvement. CONCLUSIONS: The occurrence of audio-vestibular manifestations following mRNA-based vaccines needs ENT monitoring to support their causality in such rare vaccine-related adverse events. Audio-vestibular disorders appeared of transitory nature, including hearing loss, and should not deter further efforts in large-scale vaccination campaigns against SARS-CoV-2.

Corrigendum: COVID-19 and sudden sensorineural hearing loss: a systematic review.

[This corrects the article DOI: 10.3389/fneur.2022.883749.].

Sudden Sensorineural Hearing Loss Associated with Oral Consumption of Hand Sanitizer: A Case Report.

Introduction: Pediatric sudden sensorineural hearing loss (SSNHL) is a rare otological emergency. With the emergence of the Coronavirus 19 pandemic, alcohol-based hand sanitizers are among the essential household items. Many hand sanitizers are frequently coupled with scents that young children may find pleasant. Case Report: A 5-year-old girl presented to our clinic with hearing loss after the consumption of alcohol-based hand sanitizer. A pure tone audiogram showed bilateral SSNHL. The child was prescribed systemic corticosteroids resulted in a slight improvement in hearing thresholds. The child was followed up at 6 and 18 months showing no further improvement in hearing thresholds. Conclusion: Although various infective, vascular, and immune responses have been proposed, alcohol-based hand sanitizer consumption has not been reported to present with SSNHL to the best of our knowledge. In the current scenario of the Coronavirus pandemic, otorhinolaryngologists must keep in mind that SSNHL may occur as a result of hazardous alcohol-based hand disinfectant consumption.

Sudden Sensorineural Hearing Loss Following Immunization With BNT162b2 or mRNA-1273: A Danish Population-Based Cohort Study.

OBJECTIVE: To compare the occurrence of sudden sensorineural hearing loss following immunization with BNT162b2 (Comirnaty®; Pfizer BioNTech) or mRNA-1273 (Spikevax®; Moderna) to the occurrence among unvaccinated individuals. STUDY DESIGN: Cohort study. SETTING: Nationwide Danish health care registers comprised all Danish residents living in Denmark on October 1, 2020, who were 18 years or older or turned 18 in 2021. METHODS: We compared the occurrence of sudden sensorineural hearing loss following immunization with BNT162b2 (Comirnaty®; Pfizer BioNTech) or mRNA-1273 (Spikevax®; Moderna) (first, second, or third dose) against unvaccinated person time. Secondary outcomes were a first-ever hospital diagnosis of vestibular neuritis and a hearing examination, by an ear-nose-throat (ENT) specialist, followed by a prescription of moderate to high-dose prednisolone. RESULTS: BNT162b2 or mRNA-1273 vaccine was not associated with an increased risk of receiving a discharge diagnosis of sudden sensorineural hearing loss (adjusted hazard ratio [HR]: 0.99, confidence interval [CI]: 0.59-1.64) or vestibular neuritis (adjusted HR: 0.94, CI: 0.69-1.24). We found a slightly increased risk (adjusted HR: 1.40, CI, 1.08-1.81) of initiating moderate to high-dose oral prednisolone following a visit to an ENT specialist within 21 days from receiving a messenger RNA (mRNA)-based Covid-19 vaccine. CONCLUSION: Our findings do not suggest an increased risk of sudden sensorineural hearing loss or vestibular neuritis following mRNA-based COVID-19 vaccination. mRNA-Covid-19 vaccination may be associated with a small excess risk of a visit to an ENT specialist visit followed by a prescription of moderate to high doses of prednisolone.

Insights into perceived listening difficulties post COVID-19 infection: no measurable hearing difficulty on clinical tests despite increased self-reported listening effort.

Objective: The aim was to use a battery of clinic-based auditory assessment procedures to compare participants with and without self-reported hearing difficulties following a confirmed COVID-19 infection. A further aim was to compare the groups on self-reported measures of listening effort and fatigue. Methods: There were 25 participants in each group (age range 20-59 years, 80% females). Participants were recruited after a minimum of 4 weeks of testing positive. Hearing assessment involved tympanometry, acoustic reflex thresholds, pure-tone audiometry (PTA; 0.25-14 kHz), and distortion product otoacoustic emissions (DPOAEs; 0.5-10 kHz). Listening effort was assessed using the Arabic version of the Effort Assessment Scale (EAS-A) and fatigue was assessed using the Arabic version of the Fatigue Assessment Scale (FAS-A). Results: There was no difference between groups on any measure except for greater self-reported listening effort in the perceived hearing difficulty group (p = 0.01). Conclusion: The only difference between groups was self-reported listening effort. This could be due to a subclinical auditory deficit following COVID-19, increased listening effort due to the impact of COVID-19 on cognitive processes, or a psychosomatic response/health anxiety.

Auditory Screening in Newborns after Maternal SARS-CoV-2 Infection: An Overview.

BACKGROUND AND AIM: Several viruses have previously been reported to be responsible for congenital hearing loss; therefore, since the beginning of the SARS-CoV-2 infection pandemic, various reports have investigated a possible link. The aim of this review is to assess the possible link between maternal COVID-19 infection and congenital hearing loss. METHODS: This systematic review was performed using PRISMA criteria, searching Medline and Embase databases from March 2020 to February 2023. A total of 924 candidate papers were identified; however, considering the specific selection criteria, only nine were selected for additional analysis. RESULTS: The overall number of children born from mothers infected with COVID-19 during pregnancy identified through this review was 1687. The confirmed cases of hearing loss were 0.7% (12/1688); a description of its nature (sensorineural vs. conductive) is missing in the selected studies, and the follow-up period is variable across the analyzed papers. Surprisingly, a large proportion of false positives were recorded at the first stage of screening, which resulted normal at the re-test. CONCLUSIONS: Currently, a correlation between congenital hearing loss and SARS-CoV-2 infection cannot be definitively established. Further studies are desirable to provide additional evidence on this topic.

Audiovestibular and vaccination complications of COVID-19

Objectives: Since its first appearance in Wuhan December 2019, SARS-CoV2 virus received great attention due to its severe symptoms and high spread causing COVID-19 disease which spread all over the world like a pandemic. The causative virus is capable of human-to-human transmission via droplet and direct contact suggesting that upper respiratory tract is the main site to virus manifestations. There is a great diversity in its clinical picture, although the severe respiratory and neurological symptoms are commonly present;however, other symptoms are present. Although otological manifestations are reported in many COVID-19 patients even in asymptomatic cases, they did not receive much attention compared with other critical manifestations. In this article, we paid our attention specifically to the otological manifestations of COVID-19 and their relevance either to the virus infection, treatment, or vaccination through literature review. Conclusion(s): COVID-19 disease has a deleterious effect on the inner ear. This effect is not only due to SARS-Cov-2 infection, but it could be also due to the ototoxic drugs used for treatment. The COVID-19 vaccinations are found to be implicated in the otological symptoms in some cases.Copyright © 2022, The Author(s).

Sudden Sensorineural Hearing Loss in a Patient with COVID-19: A Case Report

Background: Several viral infections may lead to hearing loss. It>s still unknown whether COVID-19 has effects on the auditory system or not. In this regard, to evaluate the possibility of sudden sensorineural hearing loss due to COVID-19, this study aimed to report sudden sensorineural hearing loss (SSNHL) in patients with COVID-19 in Iran. Case Report: The patient was a 7-year-old girl diagnosed with COVID-19 and sensorineural hearing loss. An audiogram revealed normal hearing in the right ear and severe sensorineural hearing loss in the left ear. The tympanometry test result was bilateral type A. The treatment started with prednisolone (1 mg/kg/d). The audiogram of follow-up pure-tone audiometry did not reveal any improvement. Conclusion(s): SSNHL appears to be a possible complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. COVID-19 infection could have deleterious effects on cochlear hair cells and eight nerve functions. Therefore, audiological monitoring should be initiated in patients presenting with COVID-19.Copyright © 2023 The Author(s);Published by Kerman University of Medical Sciences.

Impact of COVID-19 Pandemic on Older Adults Using Hearing aid/s: Indian Scenario.

The present study explored the impact of COVID-19 on hearing health and problems faced by older adults using hearing aid/s. Fifty older adults in the age range of 55-95 years were selected for the study based on the inclusion and exclusion criteria. Therefore, the developed questionnaire was administered to them. Statistical analysis was performed for all the responses achieved. Closure of hearing aid companies and audiological centers was found to have a negative impact on availing audiological services. Likewise, a huge hike in the price of these services made it impossible for people to afford them. Despite the availability of tele-audiology, older adults were not able to make the best use of it due to numerous reasons. We sought to explore patients' perceptions to break down these barriers by enhancing the quality of tele-audiology, home visits, and remote services. Therefore, the present report may facilitate in planning and implementation of policies related to audiological services, especially during times of crisis, which may help strengthen our hearing health care system. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03209-8.

Auditory function in symptomatic patients recovered from SARS-CoV-2 and unexposed patients: An analytical cross-sectional study.

Objective: To describe audiological symptoms, audiometric profile, and distortion product otoacoustic emission in symptomatic patients recovering from SARS-CoV-2 infection (positive RT-PCR test) and asymptomatic patients (negative RT-PCR test). Methods: An analytical cross-sectional study was conducted using data obtained from clinical charts, physical examination, audiometry, and distortion product otoacoustic emission on 40 patients [case patients (CP)] recovering from SARS-CoV-2 infection diagnosed by a positive RT-PCR test and 22 asymptomatic participants with a negative RT-PCR test [non-case (NC)]. Results: Sixty-two patients (mean age: 31.1 and 28.2 years in the CP and NC groups, respectively) were included. All participants were young without significant comorbidities, risk factors for hearing loss or otological history. Vertigo (5%), tinnitus (17.5%) and aural fullness/hearing loss (35%) were found in the CP group. A statistically significant difference was found in specific frequencies (1000, 4000, and 8000 Hz) and pure tone average (low and high conversational frequencies with increased threshold in the PC group compared with the NC group), which was not found in distortion product otoacoustic emission. Conclusion: Audiovestibular symptoms are frequent in symptomatic patients recovering from SARS-CoV-2 infection. SARS-CoV-2 infection was consistently associated with an increased audiometric hearing threshold at specific frequencies and low tone average.

Comparison of speech recognition performance with and without a face mask between a basic and a premium hearing aid in hearing-impaired listeners.

BACKGROUND: The mask mandate during the COVID-19 pandemic leads to communication challenges as sound energy gets reduced and the visual cues are lost due to the face mask. This study examines the impact of a face mask on sound energy and compares speech recognition performance between a basic and a premium hearing aid. METHODS: Participants watched four video clips (a female and a male speaker with and without a face mask) and repeated the target sentences in various test conditions. Real-ear measurement was performed to investigate the changes in sound energy in no mask, surgical, and N95 mask conditions. RESULTS: With the face mask on, sound energy significantly decreased for all types of masks. For speech recognition, the premium hearing aid showed significant improvement in the mask condition. CONCLUSION: The findings emphasize and encourage health care professionals to actively use communication strategies, such as speaking slowly and reducing background noise, when interacting with individuals with hearing loss.

Common and uncommon audio-vestibular findings in COVID-19 patients

Background: COVID-19 is the new version of the old coronavirus known since 1960, which caused the Middle East respiratory syndrome (MERS-CoV) in 2012 and the severe acute respiratory syndrome (SARS) in 2003. Symptoms included fever and cough, diarrhea and vomiting, and neurological symptoms like anosmia. Method(s): One hundred twenty-eight patients diagnosed as COVID-19 with audio-vestibular complaints were subjected to audio-vestibular assessment and were included in the study. Result(s): In our study on COVID-19 patients who reported audio-vestibular complaints, hearing loss was found in 43.8% of patients in comparison to vertigo that represented 40.6% of cases. The most common type was sensorineural hearing loss representing 29.7% of patients and which was unilateral and sudden in 35.7% of them. Less commonly conductive hearing loss (CHL) was found in 14.1% of cases the most common form was bilateral mild to moderate CHL (83.3%) due to bilateral middle ear effusion. Among cases with vertigo, the most common etiology was benign paroxysmal positional vertigo (BPPV) (42.5%) then uncompensated vestibular neuritis (VN) (31.5%), and lastly, combined BPPV with VN (25%) of cases. Less frequently we found tinnitus in (13.3%) which was bilateral in (64.7%), labyrinthitis (5.5%), and acute VN 5.5%). The significant increase in the number of audiovestibular complaining cases that were observed in the course of the recurrent waves' peaks pushed us to study the relationship between the pandemic and the audiovestibular system. The effect of COVID on AV systems is well noticed and management would be mandatory.Copyright © 2022, The Author(s).

Hearing Happiness: Deafness Cures in History by Jaipreet Virdi (review)

The book begins with bacterial meningitis, an infection the author contracted in early childhood that left her with "profound-to-severe" hearing loss (Virdi, 7). Not only do we see her as a scholar in the archive, requesting permission to try a Victorian ear trumpet, we also see her as a child with her d/Deaf classmates, being fitted for hearing aids "as we squirmed and giggled when the wet silicone mold was injected into our ears," and as an adult, experiencing difficulty switching from analog to digital hearing aids (258). When Virdi's first pair of behindthe-ear hearing aids make her six-year-old ears stick out, and her hair "tied in a long braid as per the Sikh tradition, did little to disguise them," it is the hearing aids, not the braid, that provoke "snickers, puzzled glances, and finger-pointing from younger children" (18).

Impact of COVID-19 on diagnosis and management of newborn hearing loss.

INTRODUCTION: The COVID-19 pandemic has caused unexpected disruptions in patient care, including adherence to the Early Hearing Detection and Intervention (EHDI) 1-3-6 guidelines. These guidelines mandate newborn hearing screening (NHS) by 1 month of age, diagnosis of hearing loss (HL) by 3 months, and referral to Early Intervention by 6 months. The objective of this study was to investigate the impact of COVID-19 on EHDI benchmarks in a major US city to help clinicians address current needs and prepare for future disruptive events. METHODS: Retrospective review was performed for all patients who did not pass NHS at two tertiary care centers between March 2018 and March 2022. Patients were divided into three cohorts based on the periods of time before, during, and after the COVID-19 Massachusetts State of Emergency (SOE). Demographics, medical history, NHS results, Auditory Brainstem Response results, and hearing aid (HA) intervention data were collected. Two-sampled independent t-tests and analysis of variance were used to compute rate and time outcomes. RESULTS: 30,773 newborns underwent NHS and 678 failed NHS. There was no difference in 1-month benchmark NHS rates, increased 3-month benchmark HL diagnosis rate post-SOE COVID (91.7%; p = 0.002), and increased 6-month benchmark HA intervention rate post-SOE COVID compared to pre-COVID (88.9% vs. 44.4%; p = 0.027). Mean time to NHS was lower during SOE COVID compared to pre-COVID (1.9 days vs. 2.0 days; p = 0.038) and mean time to HL diagnosis was higher during SOE COVID (47.5 days; p < 0.001). Lost to follow-up (LTF) rate at HL diagnosis decreased post-SOE (4.8%; p = 0.008). CONCLUSION: No differences in EHDI 1-3-6 benchmark rates between pre-COVID and SOE COVID patients were observed. However, increased 3-month benchmark HL diagnosis and 6-month benchmark HA intervention rates and a decreased LTF rate at 3-month benchmark HL diagnosis were observed post-SOE COVID.

Prevalence of hearing loss in COVID-19 patients: a systematic review and meta-analysis.

BACKGROUND AND OBJECTIVE: 'Hearing loss' has been reported as a clinical atypical symptom in some COVID-19 patients. We searched and collated the existing literature for a systematic review and meta-analysis to assess the prevalence of hearing loss during the COVID-19 epidemic. METHODS: An exhaustive search of the PubMed, Embase, Web of Science, China National Knowledge Infrastructure and other sources from the inception of the database until 31st December 2022. The Search terms were set to: 'COVID-19', 'SARS-CoV-2', '2019-nCoV', 'hearing impairment', 'hearing loss', 'auditory dysfunction'. The literature data meeting the inclusion criteria were extracted and analyzed. Prevalence was pooled from individual studies using a randomized effects meta-analysis. RESULTS: A total of 22 studies were included in the final analysis, involving 14281 patients with COVID-19 infection, of which 482 patients had varying degrees of hearing loss. Our final meta-analysis demonstrated that the prevalence of hearing loss in COVID-19-positive patients was 8.2% (95%CI 5.0-12.1). Subgroup analysis of age showed that the prevalence of middle-aged and older patients aged 50-60 and over 60 years was 20.6% and 14.8%, respectively, which was significantly higher than that of patients aged 30-40 (4.9%) and 40-50 years (6.0%). CONCLUSION: Hearing loss is one of the clinical symptoms of COVID-19 infection, compared with other diseases, it is less likely to attract the attention of clinical experts or researchers. Raising awareness of this disease can not only enable early diagnosis and treatment of hearing loss, and improve the quality of life of patients, but also enhance our vigilance against virus transmission, which has important clinical and practical significance.

Rhino-Cerebral Mucormycosis with Otologic Involvement.

Mucormycosis is an opportunistic invasive fungal infection, recently been detected in Covid-19 due to several underlying conditions. Otologic involvement in such patients though exceptional, should not be simply ignored even when presented without any clinical signs or symptoms. This report manifests the need of evaluating otologic involvement in post-covid mucormycosis.