Long-term results of atresiaplasty in patients with congenital aural atresia.

OBJECTIVES: To evaluate long-term benefits of atresiaplasty on hearing and the impact of surgery on quality of life (QoL) in congenital aural atresia (CAA) patients. METHODS: We evaluated the long-term hearing results, the impact of atresiaplasty on QoL, the meatal diameter of the operated ear canal, and the cumulative number of post-operative hospital visits in 14 CAA patients, on average, 12 years (range: 4-17 years) post-operatively. RESULTS: The mean preoperative pure tone average (PTA) was 61 dB HL. The postoperative short-term PTA was 36 dB HL and the long-term PTA was 51 dB HL. The mean total Glasgow Benefit Inventory (GBI) score was 16 (range: -11-39), showing the positive benefit of atresiaplasty on QoL. The mean postoperative diameter of the auditory meatus was 6 mm. The average number of hospital outpatient visits during the first postoperative year was 10. CONCLUSION: Surgery for CAA is a demanding operation with variable anatomical and hearing outcomes. Atresiaplasty operations should be centralized to hospitals with large numbers of such patients to ensure sufficient levels of surgical experience. Bone-anchored hearing devices or middle-ear implants should be considered as a first-line option because they offer good hearing predictability.

Hybrid cochlear implantation: quality of life, quality of hearing, and working performance compared to patients with conventional unilateral or bilateral cochlear implantation.

The objective of the present study is to evaluate the effect of hybrid cochlear implantation (hCI) on quality of life (QoL), quality of hearing (QoH), and working performance in adult patients, and to compare the long-term results of patients with hCI to those of patients with conventional unilateral cochlear implantation (CI), bilateral CI, and single-sided deafness (SSD) with CI. Sound localization accuracy and speech-in-noise test were also compared between these groups. Eight patients with high-frequency sensorineural hearing loss of unknown etiology were selected in the study. Patients with hCI had better long-term speech perception in noise than uni- or bilateral CI patients, but the difference was not statistically significant. The sound localization accuracy was equal in the hCI, bilateral CI, and SSD patients. QoH was statistically significantly better in bilateral CI patients than in the others. In hCI patients, residual hearing was preserved in all patients after the surgery. During the 3.6-year follow-up, the mean hearing threshold at 125-500 Hz decreased on average by 15 dB HL in the implanted ear. QoL and working performance improved significantly in all CI patients. Hearing outcomes with hCI are comparable to the results of bilateral CI or CI with SSD, but hearing in noise and sound localization are statistically significantly better than with unilateral CI. Interestingly, the impact of CI on QoL, QoH, and working performance was similar in all groups.

Quality of Life and Hearing Eight Years After Sudden Sensorineural Hearing Loss.

OBJECTIVES/HYPOTHESIS: To explore long-term hearing results, quality of life (QoL), quality of hearing (QoH), work-related stress, tinnitus, and balance problems after idiopathic sudden sensorineural hearing loss (ISSNHL). STUDY DESIGN: Cross-sectional study. METHODS: We reviewed the audiograms of 680 patients with unilateral ISSNHL on average 8 years after the hearing impairment, and then divided the patients into two study groups based on whether their ISSNHL had recovered to normal (pure tone average [PTA] ≤ 30 dB) or not (PTA > 30 dB). The inclusion criteria were a hearing threshold decrease of 30 dB or more in at least three contiguous frequencies occurring within 72 hours in the affected ear and normal hearing in the contralateral ear. Audiograms of 217 patients fulfilled the criteria. We reviewed their medical records; measured present QoL, QoH, and work-related stress with specific questionnaires; and updated the hearing status. RESULTS: Poor hearing outcome after ISSNHL was correlated with age, severity of hearing loss, and vertigo together with ISSNHL. Quality of life and QoH were statistically significantly better in patients with recovered hearing, and the patients had statistically significantly less tinnitus and balance problems. During the 8-year follow-up, the PTA of the affected ear deteriorated on average 7 dB, and healthy ear deteriorated 6 dB. CONCLUSION: Idiopathic sudden sensorineural hearing loss that failed to recover had a negative impact on long-term QoL and QoH. The hearing deteriorated as a function of age similarly both in the affected and the healthy ear, and there were no differences between the groups. The cumulative recurrence rate for ISSNHL was 3.5%. LEVEL OF EVIDENCE: 4 Laryngoscope, 127:927-931, 2017.

Single-Sided Deafness: The Effect of Cochlear Implantation on Quality of Life, Quality of Hearing, and Working Performance.

AIMS: To evaluate the effect of a cochlear implant (CI) on quality of life (QoL), quality of hearing (QoH), and working performance in patients with single-sided deafness (SSD). METHODS: Using specific questionnaires, we measured QoL, QoH, and working performance in 7 SSD patients scheduled for CI surgery of the affected ear. Sound localization and speech perception in noise were also assessed. All questionnaires and tests were performed before the CI surgery and at 6 and 12 months after CI activation. RESULTS: The QoL, QoH, sound localization, and speech perception in noise had improved statistically significantly after CI surgery. Communication with co-workers became easier, and the patients were less fatigued after the working day. CONCLUSIONS: CI clearly improves QoL, QoH, and working performance in patients with SSD.

Unilateral common cavity deformity: Recurrent meningitis due to insufficient newborn hearing screening.

Insufficient newborn hearing screening may leave the other ear with undetected hearing loss. Subsequently, the missed pathology behind the impairment may have potential risk for severe infections. We describe a case of recurrent Streptococcus pneumoniae meningitis in an infant with unilateral common cavity deformity. The diagnosis of the deaf left ear was delayed due to insufficient newborn hearing screening and not until the second meningitis the pathology behind the deafness was confirmed. Subtotal petrosectomy was performed unsuccessfully and resulted in another meningitis. We highlight the importance of proper newborn hearing screening and surgical technique to treat cochlear malformations.

Sequential bilateral cochlear implantation improves working performance, quality of life, and quality of hearing.

CONCLUSIONS: This prospective study shows that working performance, quality of life (QoL), and quality of hearing (QoH) are better with two compared with a single cochlear implant (CI). The impact of the second CI on the patient's QoL is as significant as the impact of the first CI. OBJECTIVES: To evaluate the benefits of sequential bilateral cochlear implantation in working, QoL, and QoH. METHODS: We studied working performance, work-related stress, QoL, and QoH with specific questionnaires in 15 patients with unilateral CI scheduled for sequential CI of another ear. Sound localization performance and speech perception in noise were measured with specific tests. All questionnaires and tests were performed before the second CI surgery and 6 and 12 months after its activation. RESULTS: Bilateral CIs increased patients' working performance and their work-related stress and fatigue decreased. Communication with co-workers was easier and patients were more active in their working environment. Sequential bilateral cochlear implantation improved QoL, QoH, sound localization, and speech perception in noise statistically significantly.

[Pott's puffy tumor--a rare complication of frontal sinusitis]. / "Pott's puffy"-tuumori--otsaontelotulehduksen harvinainen komplikaatio.

Pott's puffy tumor is an extremely rare complication of frontal sinusitis. It is most typically found in young men. Streptococci, staphylococci or anaerobic bacteria are usually the causative agents. In our patients the inflammation was caused by Streptococcus milleri and Streptococcus pneumoniae. The treatment should be started with broad-spectrum antibiotics. The antibiotics are administered intravenously for 1 to 2 weeks and thereafter orally for at least four weeks. Paranasal sinuses must be operated, and if necessary, intracranial abscesses are treated neurosurgically.

Speech recognition and communication outcomes with cochlear implantation in Usher syndrome type 3.

BACKGROUND: Usher syndrome Type 3 (USH3) is an autosomal recessive disorder characterized by variable type and degree of progressive sensorineural hearing loss and retinitis pigmentosa. Cochlear implants are widely used among these patients. OBJECTIVES: To evaluate the results and benefits of cochlear implantation in patients with USH3. STUDY DESIGN: A nationwide multicenter retrospective review. MATERIALS AND METHODS: During the years 1995-2005, in 5 Finnish university hospitals, 19 patients with USH3 received a cochlear implant. Saliva samples were collected to verify the USH3 genotype. Patients answered to 3 questionnaires: Glasgow Benefit Inventory, Glasgow Health Status Inventory, and a self-made questionnaire. Audiological data were collected from patient records. RESULTS: All the patients with USH3 in the study were homozygous for the Finnish major mutation (p.Y176X). Either they had severe sensorineural hearing loss or they were profoundly deaf. The mean preoperative hearing level (pure-tone average, 0.5-4 kHz) was 110 ± 8 dB hearing loss (HL) and the mean aided hearing level was 58 ± 11 dB HL. The postoperative hearing level (34 ± 9 dB HL) and word recognition scores were significantly better than before surgery. According to the Glasgow Benefit Inventory scores and Glasgow Health Status Inventory data related to hearing, the cochlear implantation was beneficial to patients with USH3. CONCLUSION: Cochlear implantation is beneficial to patients with USH3, and patients learn to use the implant without assistance.

Surgery for external auditory canal exostoses: a report of 182 operations.

The pre-operative findings and operative outcome were evaluated from patient records in 136 patients (182 ears) who had surgery for external auditory canal (EAC) exostoses. Furthermore, 114 patients (84%) replied to a questionnaire inquiring about the symptoms and the operation's impact on their quality of life. The main symptoms prior to the surgery were recurrent external otitis, hearing loss and wax retention. Interestingly, 23 patients (21%) were operated without any symptoms. After the operation, 75 patients (66%) had relief of their symptoms. In 33 patients (29%) the symptoms remained the same, and in 5 patients (4%) they became worse. The quality of life improved in 77 patients (68%); 19 patients (14%) had a complication due to the surgery, and 8 patients (6%) needed a re-operation. The surgery for EAC exostoses should be reserved only for symptomatic cases and only for experienced specialists in order to minimize complications and unnecessary operations.

Differential ear effects of profound unilateral deafness on the adult human central auditory system.

This study investigates the effects of profound acquired unilateral deafness on the adult human central auditory system by analyzing long-latency auditory evoked potentials (AEPs) with dipole source modeling methods. AEPs, elicited by clicks presented to the intact ear in 19 adult subjects with profound unilateral deafness and monaurally to each ear in eight adult normal-hearing controls, were recorded with a 31-channel system. The responses in the 70-210 ms time window, encompassing the N1b/P2 and Ta/Tb components of the AEPs, were modeled by a vertically and a laterally oriented dipole source in each hemisphere. Peak latencies and amplitudes of the major components of the dipole waveforms were measured in the hemispheres ipsilateral and contralateral to the stimulated ear. The normal-hearing subjects showed significant ipsilateral-contralateral latency and amplitude differences, with contralateral source activities that were typically larger and peaked earlier than the ipsilateral activities. In addition, the ipsilateral-contralateral amplitude differences from monaural presentation were similar for left and for right ear stimulation. For unilaterally deaf subjects, the previously reported reduction in ipsilateral-contralateral amplitude differences based on scalp waveforms was also observed in the dipole source waveforms. However, analysis of the source dipole activity demonstrated that the reduced inter-hemispheric amplitude differences were ear dependent. Specifically, these changes were found only in those subjects affected by profound left ear unilateral deafness.

Long-term hearing results after stapes surgery: a 20-year follow-up.

OBJECTIVE: The aim of this study was to evaluate the results of stapes surgery after 20 years of follow-up and to compare the results between large fenestra versus small fenestra stapedotomy. STUDY DESIGN: Retrospective clinical study. SETTING: Tertiary referral center (university hospital). PATIENTS: One hundred forty-two patients with otosclerosis treated by surgery. INTERVENTION: Eighty patients had a total stapedectomy with House-wire prosthesis and 62 patients a stapedotomy with Teflon-piston prosthesis. MAIN OUTCOME MEASURES: Preoperative, postoperative, and long-term hearing thresholds were compared. Patients filled in a questionnaire about the impact of surgery on the quality of life and postoperative symptoms. RESULTS: The long-term pure tone average improvement did not differ significantly between the techniques compared with the preoperative values. The air-bone gap tended to enlarge as a function of time. The change in the pure tone average was 0.9 dB per year for both techniques. In the questionnaire, some patients reported vertigo, tinnitus, loud noise intolerance, and taste disturbances. Loud noise intolerance seemed to persist in the long term. Surgery had no effect on preoperative tinnitus. CONCLUSIONS: There were no statistically significant differences between the techniques regarding hearing results. Over the long term, both techniques are safe and effective in restoring hearing and improving quality of life.