Patient-Provider Communication in the Context of Hearing Loss.

Hearing is the primary mechanism through which most of us receive ideas from other people. When that ability is altered, it affects how we interpret and react to information. In a physician's office, the transfer of thought is critical to ensuring that patients understand their healthcare information and are compliant with things like medication. In this article, we discuss ways to enhance that communication.

Cochlear Implantation in Ménière's Disease.

IMPORTANCE: Though the effects of cochlear implantation (CI) on patients with hearing loss has been well described, its effect on the auditory and vestibular symptoms in patients with Ménière's disease (MD) has not been firmly established. OBJECTIVES: To determine whether CI in patients with MD improves hearing performance as measured by standard post-CI audiometric testing and to describe the impact of CI on subjective auditory and vestibular quality-of-life measures. DESIGN, SETTING, AND PARTICIPANTS: Retrospective review of all patients with MD 18 years or older who met diagnostic criteria for definite MD and underwent CI at Wake Forest University Baptist Medical Center, a tertiary care academic medical center, from 2000 through 2012. INTERVENTIONS: Patients were invited to answer questions regarding their current hearing ability, subjective perception of symptoms, and functional status related to their MD before and after CI. Patient records were reviewed for pertinent information. Results were then analyzed for statistical significance. MAIN OUTCOMES AND MEASURES: Pre-CI and post-CI sentence testing scores, frequency and severity of MD vestibular and auditory symptoms via the MD Functional Level Scale (FLS), and hearing quality of life via the Hearing Handicap Index were reviewed. RESULTS: Eleven CIs were performed in 10 patients. Mean long-term follow-up was 41 months. The mean age at first implantation was 64 years. The mean sentence testing scores in quiet improved from 22.8% before CI to 77.0% after CI (P < .001) at the most recent follow-up. Mean (SD) pre-CI and post-CI MD-FLS vestibular scores were similar: 3.9 (1.9) and 3.4 (1.9) (P = .52). CONCLUSIONS AND RELEVANCE: Patients with MD who undergo CI are capable of achieving substantial receptive communication improvement comparable to the gains experienced by patients without MD. Implantation seems to neither adversely alter the natural history of vestibular function nor notable exacerbate auditory symptoms.

Computed tomography demonstrates abnormalities of contralateral ear in subjects with unilateral sensorineural hearing loss.

PURPOSE: Prior studies have associated gross inner ear abnormalities with pediatric sensorineural hearing loss (SNHL) using computed tomography (CT). No studies to date have specifically investigated morphologic inner ear abnormalities involving the contralateral unaffected ear in patients with unilateral SNHL. The purpose of this study is to evaluate contralateral inner ear structures of subjects with unilateral SNHL but no grossly abnormal findings on CT. MATERIALS AND METHODS: IRB-approved retrospective analysis of pediatric temporal bone CT scans. 97 temporal bone CT scans, previously interpreted as "normal" based upon previously accepted guidelines by board certified neuroradiologists, were assessed using 12 measurements of the semicircular canals, cochlea and vestibule. The control-group consisted of 72 "normal" temporal bone CTs with underlying SNHL in the subject excluded. The study-group consisted of 25 normal-hearing contralateral temporal bones in subjects with unilateral SNHL. Multivariate analysis of covariance (MANCOVA) was then conducted to evaluate for differences between the study and control group. RESULTS: Cochlea basal turn lumen width was significantly greater in magnitude and central lucency of the lateral semicircular canal bony island was significantly lower in density for audiometrically normal ears of subjects with unilateral SNHL compared to controls. CONCLUSION: Abnormalities of the inner ear were present in the contralateral audiometrically normal ears of subjects with unilateral SNHL. These data suggest that patients with unilateral SNHL may have a more pervasive disease process that results in abnormalities of both ears. The findings of a cochlea basal turn lumen width disparity >5% from "normal" and/or a lateral semicircular canal bony island central lucency disparity of >5% from "normal" may indicate inherent risk to the contralateral unaffected ear in pediatric patients with unilateral sensorineural hearing loss.

Computed tomography supports histopathologic evidence of vestibulocochlear sexual dimorphism.

OBJECTIVE: To investigate whether the effects of sex (male/female) that have been demonstrated in the pathology literature using 0.1 mm histopathologic slices are measurable and statistically significant using high-resolution (0.625 mm slice) computed tomography (CT). METHODS: IRB-approved retrospective analysis of high-resolution "normal" CT temporal bone images in pediatric subjects (0-18 years) using comparative anatomic measurements between males and females obtained from the semicircular canals, cochlea and vestibule as follows: (1) lateral semicircular canal (LSCC) bony island width, (2) superior semicircular canal (SSCC) bony island width, (3) central lucency of the LSCC bony island, (4) coronal cochlear height, (5) axial cochlear height, (6) cochlear length, (7) cochlea basal turn lumen width, (8) cochlear aperture width, (9) cochlear aperture height, (10) vestibular length, (11) vestibular width, and (12) coronal vestibule oblique diameter. RESULTS: Eighteen females (36 ears) and twenty males (36 ears) were included in the study. Independent-samples t-tests revealed statistically significant differences in measurements for females and males as follows (differences reported as a percentage and as an absolute difference (AD) in mm): (1) vestibular width was 4.2% (0.13 mm AD) smaller in females (mean ± SD; 3.0 ± 0.27) compared to males (mean ± SD; 3.2 ± 0.25) [t(70) = 2.083, p = 0.041]; (2) cochlear length was 3.9% (.23 mm AD) smaller in females (mean ± SD; 5.8 ± 0.32) compared to males (mean ± SD; 6.0 ± 0.40) [t(70)=2.660, p = 0.010]; (3) cochlear aperture height was 11.6% (0.13 mm AD) smaller in females (mean ± SD; 1.0 ± 0.18) compared to males (mean ± SD; 1.2 ± 0.22) [t(70)=2.549, p = 0.013]; and (4) coronal cochlear height was 11.4% (0.55 mm AD) smaller in females (mean ± SD; 4.8 ± 0.58) compared to males (mean ± SD; 5.4 ± 0.48) [t(68) = 4.270, p < 0.005]. CONCLUSION: Sexual dimorphism of inner ear structures may contribute to variability in reported normative and pathologic measurements of inner ear structures. This variability must be taken into consideration when designing future research studies to investigate inner ear structures and for drawing accurate conclusions about possible inner ear morphologic abnormalities associated with SNHL compared to controls.

A review of unilateral hearing loss and academic performance: is it time to reassess traditional dogmata?

OBJECTIVE: The aim of this paper was to review traditional approaches to habilitation of unilateral hearing losses as well as new research concerning management of unilateral hearing loss. DATA SOURCES: Literature review/systematic review. REVIEW METHODS: A PubMed search was performed for articles pertaining to unilateral hearing loss and academic loss and academic performance. Articles ranged in date from 1986 to 2012. Five resources were reviewed for content to determine the pertinence of the materials to the understanding of the history of diagnosis of unilateral hearing loss, the traditional treatment methods and their advantages and disadvantages, and more recent publications concerning academic outcomes for patients with unilateral hearing loss with and without treatment. RESULTS: Unilateral hearing loss scan be detrimental to the academic success of children. Effects encompass not only auditory effects such as difficulty hearing in noise, but also self esteem and exhaustion. Although assistive devices were traditionally not offered as options, more recent literature suggests that devices such as BAHA, hearing aids, or FM systems may provide aids in the classroom and that early intervention may provide more favorable outcomes. CONCLUSION: Since the 1980s, the approach to management of unilateral hearing losses has evolved. In order to maximize academic potential, treatment options should be discussed and implemented.

A comparison of tympanometry with 226 Hz and 1000 Hz probe tones in children with Down syndrome.

BACKGROUND: For children with Down syndrome, the incidence of hearing loss may be as high as 78% [1], therefore the American Academy of Pediatrics recommends regular screening for the presence of hearing abnormalities. Tympanometry is used as an indication of middle ear pathology. In our experience, Down's patients' tympanograms do not always correlate with otoscopic findings. Down's patients have joint laxity, small ear canals, anterior tympanic membrane orientation and softer tissue composition, all factors thought to affect tympanogram results in infants. Because the use of the 1000 Hz tympanometry is widely recognized as standard procedure in the evaluation of infants aged 0-6 months, we propose it may have greater reliability in testing patients with Down syndrome. OBJECTIVE: Compare the results of visual inspection of the tympanic membrane by a Pediatric Otolaryngologist to the results of tympanometry at traditional probe tone (226 Hz) and at the infant probe tone (1000 Hz). METHODS: Institutional Review Board - approved prospective study of 26 subject-ears in patients with Down syndrome aged 6 months-18 years but recent stable middle ear/Eustachian tube function using physical examination and tympanometric probe tones at 226 Hz and 1000 Hz. Subject-ears were examined with record of "clear of effusion," showed the presence of "fluid," or were to be "excluded." Blinded to ear exam results, tympanometry was then completed with record of which Jerger classification tympanogram was found at each frequency. RESULTS: Although the sensitivity of each test was 1, the specificity of the 1000 Hz tympanometry (100%) in this study was markedly improved compared to the specificity of the 226 Hz tympanometry (71%) (p=0.016). CONCLUSIONS: This pilot study demonstrated evidence that tympanometry in children with Down syndrome may be more reliable at 1000 Hz than at 226 Hz in detecting the presence of middle ear effusion beyond infancy. Use of the 1000 Hz probe tone yielded fewer false positives for disease (type B tympanograms in the setting of absent middle ear disease). Further studies of a larger patient population are needed to corroborate these results.