Digits in noise testing in a multilingual sample of Asian adults.

OBJECTIVE: Appropriate speech-in noise assessment is challenging in multilingual populations. This study aimed to assess whether first preferred language affected performance on an English Digits-in-noise (DIN) test in the local Asian multilingual population, controlling for hearing threshold, age, sex, English fluency and educational status. A secondary aim was to determine the association between DIN test scores and hearing thresholds. DESIGN: English digit-triplets in noise testing and pure-tone audiometry were conducted. Multiple regression analysis was performed with DIN scores and hearing thresholds as dependent variables. Correlation analysis was performed between DIN-SRT and hearing thresholds. STUDY SAMPLE: 165 subjects from the Singapore Longitudinal Ageing Study, a population-based longitudinal study of community-dwellers over 55 years of age. RESULTS: Mean DIN speech reception threshold (DIN-SRT) was -5.7 dB SNR (SD 3.6; range 6.7 to -11.2). Better ear pure tone average and English fluency were significantly associated with DIN-SRT. CONCLUSIONS: DIN performance was independent of first preferred language in a multilingual ageing Singaporean population after adjusting for age, gender and education. Those with poorer English fluency had a significantly lower DIN-SRT score. The DIN test has the potential to provide a quick, uniform method of testing speech in noise in this multilingual population.

Peripheral Hearing Loss and Its Association with Cognition among Ethnic Chinese Older Adults.

INTRODUCTION: Many studies on hearing loss (HL) and cognition are limited by subjective hearing assessments and verbally administered cognition tests, the majority of the document findings in Western populations. This study aimed to assess the association of HL with cognitive impairment among ethnic Chinese Singaporean older adults using visually presented cognitive tests. METHODS: The hearing of community-dwelling older adults was assessed using pure tone audiometry. Cognitive function was assessed using the Computerized Cambridge Cognitive Test Battery (CANTAB). Multiple regression analyses examined the association between hearing and cognitive function, adjusted for age, education, and gender. RESULTS: HL (pure-tone average [PTA] of thresholds at 0.5, 1, 2, and 4 kHz in the better ear, BE4PTA) was associated with reduced performance in delayed matching and multitasking tasks (ß = -0.25, p = 0.019, and ß = 0.02, p = 0.023, respectively). Moderate to severe HL was associated with reduced performance in delayed matching and verbal recall memory tasks (ß = -10.6, p = 0.019, and ß = -0.28, p = 0.042). High-frequency HL was associated with reduced performance in the spatial working memory task (ß = 0.004, p = 0.022). All-frequency HL was associated with reduced performance in spatial working memory and multitasking (ß = 0.01, p = 0.040, and ß = 0.02, p = 0.048). CONCLUSION: Similar to Western populations, HL among tonal language-speaking ethnic Chinese was associated with worse performance in tasks requiring working memory and executive function.

Spontaneous Tegmen Tympani Dehiscence: Causes and Treatment of Conductive Hearing Loss.

OBJECTIVE: Conductive hearing loss (CHL) commonly arises in patients with spontaneous dehiscence of the tegmen of the temporal bone with meningoencephalocele (SME). The aim of this study was to further investigate 1) the potential mechanisms for CHL in this setting; 2) hearing outcomes following surgery to address SME, and 3) the possible causes of persistent CHL following surgery. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS AND INTERVENTION: Seven patients (six female; nine ears) who underwent middle cranial fossa repair of SME and were found to have a tegmen tympani dehiscence from October 2010 to September 2014 were included in the study. MAIN OUTCOME MEASURES: Pre- and postoperative pure-tone audiometry. RESULTS: Eight of nine ears (89%) had audiometric hearing loss at presentation. Seven ears (78%) had an air bone gap of ≥15 dB; all of these had an encephalocele traversing the tegmen tympani defect, four had a middle ear effusion, and three had a simultaneous superior semicircular canal dehiscence (SSCCD). The CHL resolved postoperatively in four of seven ears. Two of the three ears with persistent CHL had SSCCD. Attic ossicular fixation was identified in the other patient and the CHL resolved after ossiculoplasty. CONCLUSIONS: CHL associated with SME can be attributed preoperatively to ossicular chain fixation and synchronous SSCCD as well as the more commonly cited cerebrospinal fluid effusion and prolapse of meningoencephalocele onto the ossicular chain. Persistent postoperative CHL can also occur due to SSCCD and ossicular fixation by adhesions.

Long-Term Audiometric and Clinical Outcomes Following Stapedectomy With the Shape Memory Nitinol Stapes Prosthesis.

OBJECTIVE: To assess long-term hearing outcomes following stapedectomy using a self-crimping shape memory nitinol prosthesis. The results were compared with those of a group of patients who received a conventional prosthesis. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: All patients who underwent stapedectomy for otosclerosis between July 2001 and November 2008 with a minimum dataset of preoperative, early postoperative (≤2 yr), and late postoperative (≥6 yr) audiometry were included. Fifty-six patients with a nitinol prosthesis and 27 patients with a titanium prosthesis met the inclusion criteria. INTERVENTION: Stapedectomy using a nitinol or conventional prosthesis. MAIN OUTCOME MEASURE(S): Hearing outcomes by audiological assessment. RESULTS: Mean duration of follow up was 9.5 (standard deviation [SD] 1.4) years in the nitinol group and 12.6 (SD 2.1) years in the titanium group. The early and late mean postoperative air-bone gaps (ABGs) were 9.7 and 9.8 dB in the nitinol group and 11.0 and 12.6 dB in the titanium group, respectively. The proportion of patients achieving an ABG less than or equal to 20 dB at early and late follow up was 96% and 96% in the nitinol group and 92% and 86% in the titanium group respectively. CONCLUSIONS: The excellent closure of the ABG achieved at early follow up remains remarkably stable up to 12 years using a self-crimping shape memory nitinol prosthesis. There is no evidence that firm fixation of the hook around the long process of incus has a detrimental effect in the long-term.

Assessment and Outcome in Non-Traditional Cochlear Implant Candidates.

The objectives of this study were to assess: (i) patient expectations met as a measure of outcome in early-deafened, late-implanted (non-traditional) cochlear implant recipients and (ii) pre-implantation predictive factors for postoperative speech perception. The notes of 13 recipients were retrospectively reviewed. The mean age at onset of profound deafness was 1.5 years (range 0-6). The mean age at implantation was 37 years (range 22-51 years). Patient expectations were assessed pre-operatively and 1 year after implantation. They were met or exceeded in 129/140 (92%) domains overall. A higher Speech Intelligibility Rating and audiovisual City University of New York sentence score before implantation were found to be positive predictive factors for improved speech discrimination after cochlear implantation.

Comparison of hearing thresholds obtained with Baha preoperative assessment tools and those obtained with the osseointegrated implant.

We conducted a study of the Baha bone-anchored hearing aid system to quantify the difference between (1) hearing thresholds obtained through preoperative testing methods with the Baha sound processor attached to three different bone-conduction testing devices and (2) thresholds obtained postoperatively with the sound processor attached to a surgically placed osseointegrated titanium implant. Twenty-three patients underwent free-field testing in four situations: with the Baha sound processor attached to (1) the Baha Testband (transcutaneous transmission), (2) the Baha Softband (transcutaneous transmission), (3) a test rod (bone conduction via the teeth), and (4) the osseointegrated implant (percutaneous transmission). The main outcome measure was the result of a comparison of the thresholds obtained with the three preoperative test methods and those obtained with the osseointegrated implant. We found that aided thresholds obtained with the osseointegrated implant were significantly better (p < 0.05) than those obtained with the three preoperative test methods. The degree of superiority increased with higher frequencies. We conclude that thresholds of 1 to 18 dB better than those obtained by preoperative test methods can be expected postoperatively with the osseointegrated implant. The damping effect of sound transmission via the teeth or transcutaneously must be accounted for in making predictions of postoperative outcome.

The role of the nasopharyngeal airway for obstructive sleep apnea in syndromic craniosynostosis.

Syndromic craniosynostosis is known to be associated with obstructive sleep apnea (OSA), which can often present in infancy. Although multifactorial, a predominant contributing factor is midface hypoplasia. Nasal continuous positive airway pressure has proven to be an effective treatment modality but may be poorly tolerated in certain cases. This study looks at the effectiveness of bypassing midface obstruction with a nasopharyngeal airway (NPA). Twenty-seven children with syndromic craniosynostosis with confirmed moderate to severe OSA were initially treated with an NPA. The mean age of NPA insertion was 12.3 months (range, 0.5-48 mo). Seventeen had severe OSA, and 10 had moderate OSA preinsertion. Post-NPA insertion, 26 of 27 children (96%) demonstrated an improvement in sleep severity scores, resulting in 3 with moderate OSA and 24 with mild OSA. There was a significant improvement in mean oxygen saturation, mean number of saturation dips greater than 4% per hour, percentage time spent less than 90% SpO2, and number of pulse rate rises per hour. There were no significant differences in mean pulse rate. The NPA was well tolerated by this patient group, with 24 of 26 children retaining it for at least 6 weeks. We believe that an NPA is therefore an effective first-line treatment modality in the management of OSA in children with syndromic craniosynostosis. It is well tolerated by the patient and may obviate the need for continuous positive airway pressure or tracheostomy.

Excision of nasal dermoids with intracranial extension - anterior small window craniotomy approach.

OBJECTIVE: Dermoid cysts are the most common midline congenital nasal masses and may extend intracranially. They commonly become infected, may distort nasal growth, and are cosmetically unacceptable. The treatment of nasal dermoids is complete surgical excision. Removal of any intracranial extension traditionally required a bicoronal incision and frontal craniotomy, with significant associated morbidity. This retrospective study describes a new minimally invasive approach for excision of the intracranial component of the dermoid. METHODS: We present three cases where a brow incision was used. The intracranial part was removed by cutting a small window in the frontal bone directly over the dermoid, minimizing complications of formal craniotomy. RESULTS: Good access allowing complete excision of the dermoid and very low morbidity was achieved in all patients. The dura was breached in one patient at operation but this was easily repaired with a periosteal patch. All patients recovered quickly and hospital stay was short. The resultant scar was cosmetically acceptable. CONCLUSION: The use of a brow incision and small window craniotomy is a successful low morbidity technique for excision of nasal dermoids with intracranial extension.