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1.
Ear Hear ; 37(2): 206-15, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26510125

RESUMO

OBJECTIVES: Ossicular discontinuity may be complete, with no contact between the disconnected ends, or partial, where normal contact at an ossicular joint or along a continuous bony segment of an ossicle is replaced by soft tissue or simply by contact of opposing bones. Complete ossicular discontinuity typically results in an audiometric pattern of a large, flat conductive hearing loss. In contrast, in cases where otomicroscopy reveals a normal external ear canal and tympanic membrane, high-frequency conductive hearing loss has been proposed as an indicator of partial ossicular discontinuity. Nevertheless, the diagnostic utility of high-frequency conductive hearing loss has been limited due to gaps in previous research on the subject, and clinicians often assume that an audiogram showing high-frequency conductive hearing loss is flawed. This study aims to improve the diagnostic utility of high-frequency conductive hearing loss in cases of partial ossicular discontinuity by (1) making use of a control population against which to compare the audiometry of partial ossicular discontinuity patients and (2) examining the correlation between high-frequency conductive hearing loss and partial ossicular discontinuity under controlled experimental conditions on fresh cadaveric temporal bones. Furthermore, ear-canal measurements of umbo velocity and wideband acoustic immittance measurements were investigated to determine the usefulness regarding diagnosis of ossicular discontinuity. DESIGN: The authors analyzed audiograms from 66 patients with either form of surgically confirmed ossicular discontinuity and no confounding pathologies. The authors also analyzed umbo velocity (n = 29) and power reflectance (n = 12) measurements from a subset of these patients. Finally, the authors performed experiments on six fresh temporal bone specimens to study the differing mechanical effects of complete and partial discontinuity. The mechanical effects of these lesions were assessed via laser Doppler measurements of stapes velocity. In a subset of the specimen (n = 4), wideband acoustic immittance measurements were also collected. RESULTS: (1) Calculations comparing the air-bone gap (ABG) at high and low frequencies show that when high-frequency ABGs are larger than low-frequency ABGs, the surgeon usually reported soft-tissue bands at the point of discontinuity. However, in cases with larger low-frequency ABGs and flat ABGs across frequencies, some partial discontinuities as well as complete discontinuities were reported. (2) Analysis of umbo velocity and power reflectance (calculated from wideband acoustic immittance) in patients reveal no significant difference across frequencies between the two types of ossicular discontinuities. (3) Temporal bone experiments reveal that partial discontinuity results in a greater loss in stapes velocity at high frequencies when compared with low frequencies, whereas with complete discontinuity, large losses in stapes velocity occur at all frequencies. CONCLUSION: The clinical and experimental findings suggest that when encountering larger ABGs at high frequencies when compared with low frequencies, partial ossicular discontinuity should be considered in the differential diagnosis.


Assuntos
Ossículos da Orelha/fisiopatologia , Perda Auditiva Condutiva/fisiopatologia , Perda Auditiva de Alta Frequência/fisiopatologia , Doenças do Labirinto/fisiopatologia , Adolescente , Adulto , Idoso , Audiometria , Cadáver , Ossículos da Orelha/cirurgia , Orelha Interna , Orelha Média , Feminino , Perda Auditiva Condutiva/cirurgia , Perda Auditiva de Alta Frequência/cirurgia , Humanos , Doenças do Labirinto/cirurgia , Masculino , Pessoa de Meia-Idade , Prótese Ossicular , Substituição Ossicular , Adulto Jovem
2.
Otol Neurotol ; 36(1): 126-32, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25122596

RESUMO

OBJECTIVE: Studies have reported high early success rates in rectifying dizziness and autophony after primary repair of superior canal dehiscence (SCD). We sought to identify the prevalence of dizziness and autophony at later time points in patients who had undergone SCD repair. We also assessed any problems with hearing in this population, along with prevalence of headaches and decreases in overall quality of life. STUDY QUALITY DESIGN: Identification of patients via retrospective chart review, followed by administration of multiple validated surveys. SETTING: Tertiary, hospital-based neurotology practice. PATIENTS: All 62 patients who had undergone primary SCD repair at Massachusetts Eye and Ear Infirmary with follow-up time of at least 3 months were contacted, with 38 responses from 22 women and 16 men. The average follow-up was 34 months (range, 3-155 mo). INTERVENTIONS: Patient surveys. MAIN OUTCOME MEASURES: Dizziness Handicap Inventory and Autophony Index. SECONDARY OUTCOME MEASURES: Hearing Handicap Survey, MIDAS headache survey, and Short Form-36 Quality of Life Survey. RESULTS: Twenty patients reported low DHI scores, whereas 18 patients reported elevated DHI scores corresponding to moderate-to-severe dizziness. Autophony was less prevalent, as 3 patients experienced autophony in the operated ear, whereas 3 patients experienced "unmasking" of autophony in the contralateral ear. HHI scores were not significantly different between the low DHI and high DHI group. There were significantly more female subjects in the high DHI group, which was also characterized by significantly more severe MIDAS grades and significantly worse SF-36 scores. CONCLUSION: Dizziness is more prevalent than autophony among patients who have undergone SCD repair, although the majority of these patients are satisfied with their decision to undergo surgery. Female sex and migraine headaches are associated with dizziness in this patient population. Further work is necessary to determine causal relationships among these associations.


Assuntos
Tontura/epidemiologia , Transtornos da Audição/epidemiologia , Doenças do Labirinto/cirurgia , Procedimentos Cirúrgicos Otológicos/efeitos adversos , Canais Semicirculares/cirurgia , Adulto , Idoso , Tontura/etiologia , Feminino , Transtornos da Audição/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida , Estudos Retrospectivos , Canais Semicirculares/patologia
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