Positive and negative post stapedotomy effects on cervical VEMP recordings; a STROBE analysis.

AIMS: The primary goal of the present study was to compare the pre- and post-stapedotomy elicitation and waveform characteristics of both air- and bone-conduction (AC-, BC-) cervical vestibular evoked myogenic potentials (cVEMPs) through an individualized approach. A possible association between audiological characteristics, such as AC- and BC- pure tone audiometry thresholds and air-bone gap and the production of cVEMPs before and after stapedotomy was also investigated. MATERIAL AND METHODS: Twenty-five ears were subjected to full audiological evaluation as well as AC- and BC-cVEMPs pre- and post-stapedotomy. Four subgroups were studied; consistently present/absent, post-operatively disappeared and restored cVEMPs. RESULTS: Post-stapedotomy changes in cVEMP elicitability did not reach significance for either AC-cVEMP (OR=5.41, 95% CI 0.88-33.36, P=0.06) or BC-cVEMP (OR=2.40, 95% CI 0.42-13.60, P=0.3). Normal or abnormal AC-cVEMPs were equally subject to post-operative changes (OR=1.95, 95% CI 0.32-12.01, P=0.5), as were BC-cVEMPs (OR=3.75, 95% CI 0.66-21.25, P=0.1). Neither the audiological characteristics nor the surgical outcome, in terms of ABG results, were relevant to the presence or absence of AC- and BC-cVEMPs before or after stapedotomy. CONCLUSIONS: The presumed changes brought to the sacculus by stapedotomy are minor and beyond the diagnostic abilities of either AC-cVEMPs or BC-cVEMPs, both in terms of cVEMPs elicitability and waveform characteristics. In individual cases, however, which may deserve further investigation, cVEMPs may reappear or disappear after stapedotomy probably following minor changes toward a lower or higher vestibular system resistance for pressure and sound transmission.

Objective assessment of subjective tinnitus through contralateral suppression of otoacoustic emissions by white noise: effects of frequency, gender, tinnitus bilaterality and age.

SUMMARY: Accumulating evidence seems to support an association between tinnitus and medial olivocochlear bundle (MOCB) dysfunction. Most studies use patient/control comparisons to support this correlation. The aim of this study was to investigate the hypothesis in a substantially different way and evaluate the roles of gender, age, frequency and tinnitus bilaterality as possible confounding factors. The population consisted of 78 normal hearing patients with chronic tinnitus, 28 normal hearing controls, 19 presbycousic tinnitus patients and 13 presbycousic controls (n = 276 ears). Mean suppression amplitudes of transient evoked otoacoustic emissions (TEOAEs) and distortion product OAEs (DPOAEs) by contralateral white noise (50 dB SPL) were computed. Mean suppression values < 1 dB SPL or < 2 dB SPL were validated as positive test results. Overall suppression (OS) values < 1 dB SPL were qualified as a diagnostic test of moderate positive predictive value for both DPOAEs and TEOAEs, while OS values < 2 dB SPL were found to be of large negative predictive value for DPOAEs and moderate for TEOAEs. Mean suppression values (for all frequencies, OS) are of higher diagnostic value than suppression values corresponding to either lower (1-2 kHz) or higher frequencies (2.8-4 kHz for TEOAEs and 2.8-6 kHz for DPOAEs). After excluding patients with unilateral tinnitus from the analysis, correlations were found to be stronger. Useful correlations were also attributed for all age groups < 61 years. In females, OAE suppression seems to have a stronger positive predictive value, while in males it seems to have a stronger negative predictive value. OAE-based assays of MOCB function as an objective diagnostic tool for subjective tinnitus might deserve further investigation. Tinnitus uni- or bi-laterality is a confounding factor, which probably confirms the observation that defective function of the MOCB usually applies to the contralateral ear as well. Gender is an additional confounding factor, while correlations can be verified for all age groups < 61 years old.

Objective assessment of subjective tinnitus through contralateral suppression of otoacoustic emissions by white noise; suggested cut-off points.

OBJECTIVE: Normative otoacoustic emission (OAE) suppression values are currently lacking and the role of cochlear efferent innervation in tinnitus is controversial. The aim of this study was to investigate the association between tinnitus and medial olivocochlear bundle (MOCB) malfunction. Potential suppression amplitude cut-off criteria that could differentiate participants with tinnitus from those without were sought. DESIGN: Mean suppression amplitudes of transient evoked OAEs and distortion product OAEs by contralateral white noise (50 dBSL) were recorded. Six mean suppression amplitudes criteria were validated as possible cut-off points. STUDY SAMPLE: The population consisted of normal hearing (n = 78) or presbycusic adults (n = 19) with tinnitus or without (n = 28 and 13, respectively) chronic tinnitus (in total, n = 138 78 females/60males, aged 49 ± 14 years). RESULTS: Participants with mean suppression values lower than 0.5-1 dBSPL seem to present a high probability to report tinnitus (specificity 88-97%). On the other hand, participants with mean suppression values larger than 2-2.5dBSPL seem to present a high probability of the absence of tinnitus (sensitivity 87-99%). Correlations were stronger among participants with bilateral presence or absence of tinnitus. CONCLUSIONS: This study seem to confirm an association between tinnitus and low suppression amplitudes (<1 dBSPL), which might evolve into an objective examination tool, supplementary to conventional audiological testing.

Hearing evaluation in newborns with congenital aural malformation.

OBJECTIVES: Over 5 years, 68,472 newborns were screened through a newly implemented universal newborn hearing screening program. In 15 cases, atresia of the external ear canal was found. The aim of this study was to estimate the hearing status of these newborns using transiently evoked otoacoustic emissions (TEOAEs) and auditory brainstem responses (ABRs). METHODS: TEOAEs were performed during the first days after birth in the normal ears of all newborns. Diagnostic ABR audiometry was performed in 10 newborns. RESULTS: Unilateral involvement occurred in all newborns studied. TEOAEs were present in all the contralateral ears. Normal ABRs were recorded from the healthy ear, whereas a conductive hearing loss, of approximately 50-60 dB, was found in the involved ear. In long-term follow-up, a satisfactory level of hearing, language, and speech development was found in 9 of the newborns; it was too early to come to definite conclusions in 4 newborns and 2 newborns were lost in follow-up. CONCLUSIONS: In this study, all newborns with aural atresia had normal function in the contralateral ear. Yet, a comprehensive assessment of hearing is essential as early intervention is necessary in the rare case of bilateral hearing impairment.

Relative diagnostic importance of electronystagmography and magnetic resonance imaging in vestibular disorders.

OBJECTIVE: The aim of this study was to investigate the contribution of electronystagmography and magnetic resonance imaging to the aetiological diagnosis of vertigo and unsteadiness, in a population in which the history and clinical examination provide no conclusive diagnosis of the origin of the dysfunction (i.e. peripheral or central). PATIENTS AND METHODS: This retrospective study included 102 patients, who underwent full ENT clinical evaluation, history and neurotological assessment (including pure tone audiography, auditory brainstem response testing, electronystagmography and magnetic resonance imaging). RESULTS: Electronystagmography contributed to establishment of a diagnosis in 53/102 patients (52 per cent), whereas magnetic resonance imaging did the same in four of 102 patients (3.9 per cent). CONCLUSION: Electronystagmography remains the most useful examination for aetiological diagnosis of patients with vertigo and unsteadiness, since the actual number of patients with vertigo and unsteadiness of central origin is small (3.9 per cent), even in a population in which history and clinical examination may indicate an increased probability of central nervous system dysfunction.

Comparison of clinical and histopathological evaluation of tonsils in pediatric and adult patients.

The aim of this study was to determine clinical features that could predict the presence of tonsillar malignancy in children and adults. A retrospective review of the histopathologic reports of the children, who underwent tonsillectomy (753 cases) during the past 16 years (January 1991-December 2006) in a busy district general hospital, was undertaken. We compared the results to the pre-operative data of the patients, for risk factors of malignancy. Such proposed risk factors were tonsillar asymmetry, palpable firmness, visible lesions, neck adenopathy, history of malignancy, and systemic symptoms. The same data (history, risk factors and histopathologic results) were reviewed for an adult group (>16 years old, 1,027 cases) who underwent tonsillectomy during that period, and the results of the two groups were compared. In the pediatric group only one case was diagnosed as lymphoma (0.13%) and the rest as chronic inflammation (47%), reactive tonsil tissue (26%), lymphoid hyperplasia (19%) and actinomycosis (8%). In the lymphoma case, the diagnosis was suspected preoperatively by history and clinical manifestations. In the adult group, there were 21 cases of malignancy out of 1,027 cases (2.04%), again with one or more positive risk factors in the pre-surgery history. Based on our review, it is concluded that histopathology of tonsillectomy is not necessary in children unless there is clinical suspicion based on preoperative findings. A protocol based on proposed risk factors which may be predictive of possible malignancy can be used as a guide to intraoperative histology.

Extended high-frequency audiometry in subjects exposed to occupational noise.

OBJECTIVES: The aim of this study was to evaluate hearing in a population of industrial workers exposed to occupational noise by using both conventional and extended high-frequency (EHF) audiometry, and to compare our results with the findings from a control group. METHODS: A total of 139 industry workers exposed to noise were examined over a period of two years and 32 healthy subjects were used as controls. Conventional audiometry in the frequency range 0.25-8 kHz and EHF audiometry in the frequency range 9-20 kHz were performed. RESULTS: Thresholds in the noise-exposed group were higher than in the control group for both standard and extended high frequencies, but variability was greater in EHF. Larger differences were found in the 4,000-18,000 Hz frequency region, and especially in the 12,500-18,000 frequency zone. A statistically significant correlation between the elevation of puretone thresholds and time of exposure was found across all frequencies (from 250 to 20,000 Hz), with the exception of 10,000 Hz. CONCLUSIONS: EHF audiometry is a useful adjunct to conventional audiometry in the audiological assessment of subjects exposed to occupational noise. This test performs well in the frequency range 12,500-18,000 Hz, but there is greater variability in the results compared with conventional audiometry.

The effect of very low birth weight on otoacoustic emissions.

UNLABELLED: The effect of very low birth weight on otoacoustic emissions. OBJECTIVES: The aim of this study was to examine the effect of very low birth weight (VLBW) on the measurement of transiently evoked otoacoustic emissions (TEOAEs) in newborns. METHODS: TEOAEs were recorded in all VLBW newborns (birth weight < 1500 g) who were admitted in the Neonatal Intensive Care Unit of the Iaso Maternity Hospital, during a period of 1 year. Twenty-four VLBW newborns were included in the study. Their mean birth weight was 1283 g and they had mean gestational age 31.3 weeks. Forty full-term newborns with absence of any risk factor for hearing impairment were used as controls. RESULTS: TEOAEs were present in 97.5% of controls, but only in 79.2% of the VLBW group. Statistically significant differences were found between VLBW newborns and controls in most TEOAE measures. CONCLUSIONS: Increased rate of initial 'fail' in hearing screening, in conjunction with statistically confirmed lower TEOAE measures in VLBW newborns, justifies special care and long term follow-up for this group of newborns.