Early Detection and Aggressive Management of Otologic Pathologies in Children with Down Syndrome

A 13-year-old boy with Down syndrome (DS) presents to the pediatric otolaryngologist after being lost to follow-up for several years. The child is accompanied by his stepmother, who has recently been granted full custody together with his father. The stepmother states that the child's mother was non-compliant with his medical care and now, as she describes it, they are "playing catch-up." According to his stepmother, he has a history of recurrent ear infections and had tympanostomy tubes inserted in the past (date(s) unknown). The child has several other co-morbidities including severe obstructive sleep apnea (OSA), premature ventricular beats and possible hypothyroidism. He receives services in school for his speech and language delays in addition to regular physical and occupational therapy. The child was referred by his pediatrician who initially sent him for an audiological evaluation after failing a hearing test in the office. The child's audiogram is consistent with bilateral, severe mixed sensorineural (SNHL) and conductive hearing loss (CHL) and reveals small canal volumes consistent with bilateral middle ear effusions (MEE). The physical exam also reveals bilateral MEE and possible cholesteatoma in the right ear, consistent with chronic otitis media. This case highlights the need for early education of families in the primary care setting when the diagnosis of DS is made, in order to ensure that the child receives adequate care to maximize developmental potential and quality of life.

Progressive Hearing Loss in Early Childhood

OBJECTIVES

Deterioration in hearing thresholds in children is of concern due to the effect on language development. Before universal newborn hearing screening (UNHS), accurate information on the progression of hearing loss was difficult to obtain due to limited information on hearing loss onset. The objective of this population-based study was to document the proportion of children who experienced progressive loss in a cohort followed through a UNHS program in one region of Canada. We explored risk factors for progression including risk indicators, audiologic, and clinical characteristics of children. We also investigated deterioration in hearing as a function of age. For this study, two working definitions of progressive hearing loss were adopted: (1) a change of ≥20 dB in the 3 frequencies (500, 1000, and 2000 Hz) pure-tone average, and (2) a decrease of ≥10 dB at two or more adjacent frequencies between 500 and 4000 Hz or a decrease in 15 dB at one octave frequency in the same frequency range.

DESIGN

Population-based data were collected prospectively on a cohort of children identified from 2003 to 2013 after the implementation of UNHS. Clinical characteristics including risk indicators (as per Joint Committee on Infant Hearing), age at diagnosis, type and severity of hearing loss, and initial audiologic information were recorded when children were first identified with hearing loss. Serial audiometric results were extracted from the medical charts for this study. Differences between children with progressive and stable hearing loss were explored using χ tests. Association between risk indicators and progressive hearing loss was assessed through logistic regression. The cumulative amount of deterioration in hearing from 1 to 4 years of age was also examined.

RESULTS

Our analysis of 330 children (251 exposed to screening) with detailed audiologic records showed that 158 (47.9%) children had some deterioration (at least ≥10 dB and) in hearing thresholds in at least one ear. The 158 children included 76 (48.1%) with ≥20 dB loss in pure-tone average in at least one ear and 82 (51.9%) with less deterioration in hearing levels (≥10 but <20 dB). In the children with progressive hearing loss, of 131 children initially diagnosed with bilateral loss, 75 (57.3%) experienced deterioration in 1 ear and 56 (112 ears; 42.7%) in both ears (total of 187 ears). Of 27 children with an initial diagnosis of unilateral loss, 25 experienced deterioration in the impaired ear and 5 in the normal-hearing ear, progressing to bilateral hearing loss. Within 4 years after diagnosis, the mean decrease in hearing for children with progressive loss was 25.9 dB (SD: 16.4) in the right ear and 28.3 dB (SD: 12.9) in the left ear. We explored the risk factors for hearing loss identified by Joint Committee on Infant Hearing where there were sufficient numbers in our sample. On multivariate analysis, there was no statistically significant relationship between most risk indicators examined (neonatal intensive care unit admission, family history, syndromes, and postnatal infections) and the likelihood of progressive loss. However, the presence of craniofacial anomalies was inversely associated with risk of progressive hearing loss (odds ratio = 0.27; 95% confidence interval: 0.10, 0.71; p = 0.01), that is, these children were more likely to have stable hearing.

CONCLUSIONS

Given that almost half of the children in this cohort experienced deterioration in hearing, close postneonatal monitoring of hearing following early hearing loss identification is essential to ensure optimal amplification and therapy.

Large Jugular Bulb Diverticulum Invading the Internal Auditory Canal

Objectives:

We report, with neuro-otologic findings, a very rare case of a large jugular bulb diverticulum eroding the internal auditory canal (IAC).

Methods:

We present the imaging and functional studies of a 29-year-old woman in whom a large jugular bulb diverticulum on the left side was found incidentally.

Results:

Imaging studies revealed a normal external auditory canal, middle ear, and inner ear, but a large jugular bulb diverticulum extending superiorly on the left side had eroded the IAC from below and behind with destruction of the petrous bone. Caloric responses and facial movements were normal. Vestibular evoked myogenic potentials with bone conduction stimuli were absent on the left, indicating dysfunction of the left inferior vestibular system.

Conclusions:

This is the first report in the English-language literature of detailed imaging and functional findings in a very large diverticulum invading the IAC. Vestibular evoked myogenic potentials were useful in uncovering subclinical inferior vestibular system dysfunction in the jugular bulb diverticulum invading the IAC.

Diagnosis and management of hearing loss in elderly patients

BACKGROUND

Hearing loss is the most common sensory deficit in elderly patients, and is often under-recognised and poorly managed. It is essential for all clinicians to have awareness and knowledge in this field to enable the institution of early and appropriate care.

OBJECTIVE

The goal of this article is to review the causes, diagnosis and management of hearing loss as it applies to elderly patients. The review describes a useful approach that clinicians can apply to daily practice.

DISCUSSION

For elderly patients presenting with hearing loss, the basic assessment should include history, physical examination and pure tone audiometry. Management depends on the cause and type of hearing loss, and options include medical therapy, surgery and amplification. In the absence of a simple and correctable cause, consider referring patients to an otolaryngologist for further assessment.

Conventional Behind-the-Ear Hearing Aids after Subtotal Petrosectomy with Blind Sac Closure

OBJECTIVE: To overcome the limitations of monaural hearing resulting from a subtotal petrosectomy and blind sac closure by fitting of a behind-the-ear hearing aid.

STUDY DESIGN: Three patients were fitted with aids. Patient satisfaction and the decision to buy the aids were recorded.

RESULTS: Three patients reported good hearing result despite the absence of the middle ear structures.

CONCLUSION: For patients troubled by the limitations imposed on hearing with a unilateral conductive loss following a subtotal petrosectomy and blind sac closure, a behind-the-ear aid is a simple and easy option to try, if the residual canal allows fitting of the aid.

[The impact of implantable technologies on the quality of life in the patients with hearing loss]

The improvement of the effectiveness of the rehabilitation of the patients with hearing disorders is a priority task for an audiologist. One part of the present work was to assess satisfaction of the patients treated with the use of the hearing aids, drug therapy, and the surgical operations. The aim of the study was to evaluate the influence of the implantation of the Baha bone conduction system on the quality of life of the treated patients. The Russian-language versions of the Glasgow Benefit Inventory and Glasgow Children Benefit inventory questionnaires were used. The survey was conducted among the patients with bilateral moderate and moderate-to-severe conductive hearing loss due to congenital malformation of the external and middle ears or chronic suppurative otitis media followed by canal-down operation. A total of 47 patients took part in the present multicenter study. The results demonstrate the high effectiveness of rehabilitation with the use of the implantable bone conduction system. The beneficial effect of the treatment was especially well apparent in the children. The results are comparable with the data of the similarly designed investigations reported in the literature. Peculiarities of the data obtained in the present study and statistical characteristics made it possible to validate the Russian-language versions of the Glasgow Benefit Inventory and Glasgow Children Benefit inventory questionnaires.

Accuracy and precision of direct bone conduction measurements

OBJECTIVES

Variability in Baha® sound processor fittings arise from several sources including the nature of the implant-to-bone transmission and transcranial attenuation in patients with single-sided sensorineural deafness. One method of improving the predictability of Baha fittings is to measure the individual patient's actual bone conduction thresholds via the implant, thereby removing the influence of skin thickness and/or implant location site.

METHODOLOGY

One hundred thirty eight adult wearers of the Baha System participated in the study. Direct bone conduction thresholds were obtained through the BC Direct feature of the Cochlear™ Baha Fitting Software combined with the CochlearBaha BP100 sound processor. Test-retest reliability measurement was performed in 58 participants.

RESULTS

Improved transmission of sound through the implant rather than transcutaneously through the skin was confirmed. On average, the BC Direct thresholds were closer to the patient's unmasked thresholds than the masked values. In patients with single-sided sensorineural deafness, BC Direct results were elevated compared to the contralateral bone conduction thresholds due to transcranial attenuation. The test-retest reliability for the BC Direct measurements was within ±5 dB, which is in within the accepted variability for audiometric test measurements.

CONCLUSIONS

Direct bone conduction measurement provides a validated method of comparing the transcutaneous thresholds as measured through audiometry with the percutaneous responses from the Baha sound processor. The Baha fitting based on direct measurements of bone conduction may require less fine-tuning and provide a greater understanding of the variability of the bone conduction sound pathway.

A review of the diagnosis and management of sudden hearing loss in the military population

Sudden hearing loss can be both an immediately debilitating and long-term career-threatening condition within the military population. Careful assessment is key, particularly in an environment where heightened occupational risk factors may contribute to or confound diagnoses, and where access to basic investigation may be limited. This article looks at the patient with a new presentation of sudden hearing loss in a military setting and, by providing key features and a structured approach to examination and basic investigation, how to consider key diagnoses through clinical assessment alone. The acute management of sudden sensorineural hearing loss (SNHL) remains a difficult issue, particularly regarding the efficacy of treatment regimes to restore hearing. We have reviewed the evidence to help military medical personnel make well-informed decisions when treating and making occupational assessment of those they have diagnosed with sudden hearing loss.

Procedures for ambient-pressure and tympanometric tests of aural acoustic reflectance and admittance in human infants and adults

Procedures are described to measure acoustic reflectance and admittance in human adult and infant ears at frequencies from 0.2 to 8 kHz. Transfer functions were measured at ambient pressure in the ear canal, and as down- or up-swept tympanograms. Acoustically estimated ear-canal area was used to calculate ear reflectance, which was parameterized by absorbance and group delay over all frequencies (and pressures), with substantial data reduction for tympanograms. Admittance measured at the probe tip in adults was transformed into an equivalent admittance at the eardrum using a transmission-line model for an ear canal with specified area and ear-canal length. Ear-canal length was estimated from group delay around the frequency above 2 kHz of minimum absorbance. Illustrative measurements in ears with normal function are described for an adult, and two infants at 1 month of age with normal hearing and a conductive hearing loss. The sensitivity of this equivalent eardrum admittance was calculated for varying estimates of area and length. Infant-ear patterns of absorbance peaks aligned in frequency with dips in group delay were explained by a model of resonant canal-wall mobility. Procedures will be applied in a large study of wideband clinical diagnosis and monitoring of middle-ear and cochlear function.

Auditory-steady-state response reliability in the audiological diagnosis after neonatal hearing screening

INTRODUCTION AND OBJECTIVES

Conventional audiometry is the gold standard for quantifying and describing hearing loss. Alternative methods become necessary to assess subjects who are too young to respond reliably. Auditory evoked potentials constitute the most widely used method for determining hearing thresholds objectively; however, this stimulus is not frequency specific. The advent of the auditory steady-state response (ASSR) leads to more specific threshold determination. The current study describes and compares ASSR, auditory brainstem response (ABR) and conventional behavioural tone audiometry thresholds in a group of infants with various degrees of hearing loss.

METHODS

A comparison was made between ASSR, ABR and behavioural hearing thresholds in 35 infants detected in the neonatal hearing screening program.

RESULTS

Mean difference scores (±SD) between ABR and high frequency ABR thresholds were 11.2 dB (±13) and 10.2 dB (±11). Pearson correlations between the ASSR and audiometry thresholds were 0.80 and 0.91 (500Hz); 0.84 and 0.82 (1000Hz); 0.85 and 0.84 (2000Hz); and 0.83 and 0.82 (4000Hz).

CONCLUSION

The ASSR technique is a valuable extension of the clinical test battery for hearing-impaired children.

Otolaryngologic manifestations of Noonan syndrome

Noonan syndrome is an autosomal dominant disorder with associated anomalies that include short stature, congenital heart defects, developmental delay, and characteristic facial features among other abnormalities. Articulation deficiency and language delay are often present and require speech therapy. Otitis media and hearing loss have been reported to be common in these patients. We performed a retrospective chart review of pediatric patients who were diagnosed with Noonan syndrome at our tertiary care center from January 1979 through December 2009. We found 19 such patients. Of these, 8 had received single-specialty care at our hospital; it is not known if they had received otolaryngologic care from an outside provider. These 8 patients were not included in our study. The remaining 11 patients-6 boys and 5 girls, aged 1 to 19 years (mean: 9.2)-had all received multidisciplinary care at our institution; 9 of them had received care from an otolaryngologist at our center. Of this group, 7 had history of feeding difficulty, 6 had experienced speech delay that required speech therapy, 6 had undergone placement of a pressure equalization tube, 4 had undergone adenoidectomy with or without tonsillectomy, and 1 had been treated with endoscopic sinus surgery. Although this study is limited by our small number of patients, our results suggest that early otolaryngologist involvement must be considered in the care of children with Noonan syndrome because many have evidence of eustachian tube dysfunction, hearing loss, and speech delay.

The occurrence of auditory dysfunction in children with TB receiving ototoxic medication at a TB hospital in South Africa

OBJECTIVES

to describe the auditory dysfunction of children with tuberculosis receiving ototoxic medication at a residential TB hospital in the Cape Town metropolitan area.

METHODS

A descriptive survey research design was adopted. The auditory status of participants was evaluated by otoscopy, immittance, audiometry or OAE and AABR (depending on the age).

STUDY SAMPLE

29 in-patients (7 months to 16.6 years).

RESULTS

Fifty five percent of participants presented with middle ear abnormalities (n=16) and 48% (n=12) had sensorineural or mixed hearing loss. The degree of hearing loss ranged from mild to profound in 16% of the ears. The conventional pure-tone average of .5, 1, & 2 kHz did not allow for the determination of the degree of hearing loss in the remaining 18% which had high frequency hearing loss.

CONCLUSIONS

The high occurrence of hearing loss necessitates the implementation of monitoring program for children receiving ototoxic medication. Consideration should be given to using the average of hearing thresholds at 4, 6 and 8 kHz to determine the classification of degree of hearing loss in cases of ototoxicity.

Quantification of hearing loss in patients with posterior semicircular canal dehiscence

CONCLUSION

Patients with posterior semicircular canal dehiscence (PSCD) have low frequency conductive hearing loss similar to patients with superior semicircular canal dehiscence (SSCD) secondary to a pathologic third window.

OBJECTIVES

PSCD can result in conductive hearing loss, but the magnitude of this hearing loss remains to be quantified. Patients with SSCD have been shown to have low frequency conductive hearing loss. The underlying pathophysiology of hearing loss from PSCD and SSCD is similar and related to a pathologic third window.

METHOD

A PubMed search was completed for a meta-analysis of patients with PSCD. Articles with quality audiograms were obtained. Air conduction thresholds for ears with posterior semicircular canal dehiscence were compared to the opposite ear as well as normal control data.

RESULTS

Eight articles with 21 patients with PSCD and quality audiograms were included. Two patients had bilateral PSCD and one of those was excluded because hearing thresholds were at the limit of the audiometer. Patients with posterior semicircular canal dehiscence have statistically significant lower air conduction thresholds in frequencies at and below 2000 Hz.

Is complex signal processing for bone conduction hearing aids useful?

OBJECTIVES

To establish whether complex signal processing is beneficial for users of bone anchored hearing aids.

METHODS

Review and analysis of two studies from our own group, each comparing a speech processor with basic digital signal processing (either Baha Divino or Baha Intenso) and a processor with complex digital signal processing (either Baha BP100 or Baha BP110 power). The main differences between basic and complex signal processing are the number of audiologist accessible frequency channels and the availability and complexity of the directional multi-microphone noise reduction and loudness compression systems.

RESULTS

Both studies show a small, statistically non-significant improvement of speech understanding in quiet with the complex digital signal processing. The average improvement for speech in noise is +0.9 dB, if speech and noise are emitted both from the front of the listener. If noise is emitted from the rear and speech from the front of the listener, the advantage of the devices with complex digital signal processing as opposed to those with basic signal processing increases, on average, to +3.2 dB (range +2.3 … +5.1 dB, p ≤ 0.0032).

DISCUSSION

Complex digital signal processing does indeed improve speech understanding, especially in noise coming from the rear. This finding has been supported by another study, which has been published recently by a different research group.

CONCLUSIONS

When compared to basic digital signal processing, complex digital signal processing can increase speech understanding of users of bone anchored hearing aids. The benefit is most significant for speech understanding in noise.

Slight conductive hearing loss in children with narrowed maxilla and deep palatal vault

PROBLEM/OBJECTIVES: Maxillary constriction and high palatal arch are associated with increased risk of chronic eustachian tube dysfunction and conductive hearing loss (CHL) due to chronic effusion. However, this relationship has not been clearly demonstrated. This study assessed CHL in school children with a narrowed maxilla and deep palatal vault.

METHODOLOGY

Thirty-two children with maxillary constriction were randomly selected for the study group and 28 children with normal transverse maxillary development were selected for the control group. Pure-tone audiograms were obtained for all children, and hearing levels and air-bone gaps were measured.

RESULTS

Air-bone gap measurements in the control group ranged from 5.50 to 14.50 decibels (dB), and in the study group they were between 5.00 and 24.00 dB. In the study group, 14 (43.8%) children had slight CHL, and the remaining 18 (56.2%) children had normal hearing levels. In the control group, all of the children had normal hearing levels. Hearing levels and air-bone gaps were greater in the study group than the control group.

CONCLUSION

This study showed that children with a narrowed maxilla and deep palatal vault may have slight CHL. Therefore, the onset of CHL should be followed with hearing screening programs.

Traumatic ossicular disruption with isolated fracture of the stapes suprastructure: comparison with incudostapedial joint dislocation

CONCLUSION

More severe high frequency hearing loss, especially at 8 kHz, occurs with fracture of the stapes suprastructure (SSF) compared with isolated incudostapedial joint dislocation (ISD). Successful hearing gain can be achieved in the speech range with appropriate ossicular reconstruction.

OBJECTIVES

Traumatic SSF is a rare consequence of head trauma. This study aimed to demonstrate the characteristic features of SSF compared with traumatic ISD.

METHODS

Eighteen patients who suffered from conductive hearing loss after head trauma and were operated from 2000 to 2012 were enrolled. Eight and 10 patients were confirmed to have a traumatic SSF (SSF group) and ISD (ISD group), respectively. The etiology of ossicular disruption, preoperative CT scan of the temporal bone, and intraoperative findings were retrospectively reviewed. Pre- and postoperative hearing was analyzed by both pure tone averages and thresholds at each frequency (0.5-8 kHz).

RESULTS

The most common etiologies in the SSF group were fall (n = 3) and direct ear trauma (n = 3), and for those in the ISD group, the most common etiology was traffic accident (n = 6). CT scan showed no evidence of fracture in the SSF group, whereas findings of ossicular dislocation were found in 70% of patients in the ISD group. Hearing outcomes according to the frequencies demonstrated that pre- and postoperative hearing loss at 8 kHz was more severe in the SSF group than in the ISD group. In a comparison of hearing outcomes at each frequency, the postoperative hearing threshold at 8 kHz was higher than for other frequencies. Postoperatively, 63% of the SSF group and 70% of the ISD group obtained an air-bone gap of within 15 dB.

Hearing loss in syndromic craniosynostoses: otologic manifestations and clinical findings

OBJECTIVE

This review addresses hearing loss as it occurs and has been reported in Muenke syndrome as well as six additional FGFR related craniosynostosis syndromes (Apert syndrome, Pfeiffer syndrome, Crouzon syndrome, Beare-Stevenson syndrome, Crouzon syndrome with acanthosis nigricans, and Jackson-Weiss syndrome.

DATA SOURCES

Pub-Med, Medline, Cochrane Database, Science Direct, NLM Catalog.

REVIEW METHODS

A Medline search was conducted to find all reported cases of the 7 FGFR related syndromic craniosynostosis. Special attention was paid to literature that reported hearing findings and the audiology literature.

RESULTS

Hearing loss occurs in variable percentage as a component part of all FGFR related craniosynostosis syndromes. Our literature review revealed the following incidences of hearing loss in FGFR craniosynostoses: 61% in Muenke syndrome, 80% in Apert Syndrome, 92% in Pfeiffer syndrome, 74% in Crouzon syndrome, 68% in Jackson Weiss syndrome, 4% in Beare Stevenson syndrome and 14% in Crouzon syndrome with Acanthosis Nigricans. The majority of the hearing loss is a conductive hearing loss, with the exception of Muenke syndrome where the majority of patients have a sensorineural hearing loss and Crouzon syndrome where almost half of patients have a pure or component of sensorineural hearing loss.

CONCLUSION

This manuscript presents a diagnostic and management algorithm for patients with syndromic craniosynostosis. It will aid clinicians in treating these patients and further, the recognition of a possible syndrome in patients with hearing loss who also have syndromic features.

[Early diagnosis and intervention in 0-9 months old infants with hearing loss]

OBJECTIVE

To investigate the current situation of early diagnosis and intervention in 0-9 months old infants with hearing loss and analysis factors that will affect early diagnosis and intervention.

METHOD

One hundred and eighty-six infants referred to the West China hospital from February 2014 to September 2014 were included. All 186 children were referred due to the fact that either they failed infant hearing screening or outer ear malformation. Early diagnosis and/or intervention were performed on those 186 children and their records of early diagnosis and intervention were analyzed.

RESULT

Among the 186 infants, 167 (89.8%) were diagnosed with an average age at (4.0 ± 1.4) months. Among the 167 infants with final diagnosis, there were 31 (18.6%) infants diagnosed as conductive hearing loss (CHL), and 99 cases (59.3%) diagnosed as sensorineural hearing loss (SNHL), among whom, there were 75 (44.9%) bilateral SNHL and 24 (14.4%) unilateral SNHL. There were 2 cases (1.20%) with SNHL on one side and atresia on the other side. 5 (2.99%) of all conductive hearing loss cases with unilateral atresia and 2 cases with auditory neuropathy (AN) were found. 33 infants (19.8%) were found to have normal hearing. 30.7% (23/75) infants diagnosed as bilateral SNHL and 8.3% (2/24) infants diagnosed as unilateral SNHL were fitted with hearing aids. The fitting rate in infants with bilateral SNHL with mild, moderate, severe to profound degrees were 0 (0/23), 24.0% (6/25), 66.7% (6/9), 61.1% (11/18) respectively. The average intervention age was (5.0 ± 2.1) months.

CONCLUSION

Although the early diagnosis and intervention situation in this study are very close to international standard, there are still infants without final diagnosis and infants with hearing loss without hearing aid fitting. Further studies and efforts to promote early diagnosis and intervention in infants with hearing loss are needed.

Skull vibration-induced nystagmus test in unilateral superior canal dehiscence and otosclerosis: a vestibular Weber test

CONCLUSIONS

The skull vibration-induced nystagmus test (SVINT) acts as a vestibular Weber test and reveals a vibration-induced nystagmus (VIN), elicited mainly on the vertex location, with a horizontal or torsional component beating more often toward the side of the lesion in superior canal dehiscence (SCD) than in otosclerosis (OS). In SCD, the VIN vertical component is most often up-beating. These results suggest more a global vestibular contribution than the sole stimulation of the superior semicircular canal.

OBJECTIVES

This study aimed to evaluate the possible occurrence of nystagmus during SVINT in unilateral conductive hearing loss related to SCD or OS.

METHODS

The slow-phase velocities (SPVs) of the VIN horizontal, torsional, and vertical components were recorded in patients with a unilateral otologic lesion (17 SCD, 38 OS) and 12 control subjects. Vibratory stimulations (60 Hz, 100 Hz) were applied on the vertex and on each mastoid.

RESULTS

In SCD, VIN was observed in 82% of patients with a primarily torsional, horizontal, and vertical (up-beating) component in 40%, 30%, and 30%, respectively. Horizontal and torsional components beat toward the side of the lesion more often than in OS. Higher SPVs were observed after vertex stimulation. In OS, VIN was sparse with low amplitude and was not systematically lateralized to a specific side.

Congenital defects of the middle ear - uncommon cause of pediatric hearing loss1,2

Introduction

In children, hypoacusis, or conductive hearing loss, is usually acquired; otitis media with effusion is the most common etiology. However, in some cases this condition is congenital, ranging from deformities of the external and middle ear to isolated ossicular chain malformations. The non-ossicular anomalies of the middle ear, for instance, persistent stapedial artery and anomaly of the facial nerve, are uncommon but may accompany the ossicular defects.

Objective

This study aimed to describe the clinical presentation, diagnostic tests, and therapeutic options of congenital malformations of the middle ear.

Methods

This was a retrospective study of cases followed in otolaryngologic consultations since 2007 with the diagnosis of congenital malformation of the middle ear according to the Teunissen and Cremers classification. A review of the literature regarding the congenital malformation of the middle ear and its treatment is presented.

Conclusion

Middle ear malformations are rarely responsible for conductive hearing loss in children. As a result, there is often a late diagnosis and treatment of these anomalies, which can lead to delays in the development of language and learning.

Hearing screening using auditory steady state responses obtained by simultaneous air- and bone-conduction stimuli

INTRODUCTION AND OBJECTIVES

Minimising false positives rates is an important goal of universal newborn hearing screening programmes. An adequate way for reaching that goal could be differentiating between transient conductive hearing losses (false positives) and permanent sensorineural hearing impairments (true positives) by means of a methodology that studies electrophysiological responses obtained using both air- and bone-conduction stimuli. Our objective was to evaluate the efficiency of an automated hearing screening test based on auditory steady state responses obtained using simultaneous air- and bone-conduction stimuli.

METHODS

A sample of 80 high risk babies lees than 2 months of born were screened using the automatic screening test. A confirmatory clinical and electrophysiological evaluation was used as the gold standard.

RESULTS

The estimated diagnostic efficiency of this screening test was equivalent (100% sensitivity and 97.7% specificity) to the efficiency reported for otoacoustic emissions and automated auditory brainstem responses. The introduction of bone conduction in the screening reduced the false positive rate from 13.3% to 2.2%. The test duration was 5.3 (± 1.9)min. In 34% of babies only one repetition of the test was needed to raising the result.

CONCLUSIONS

The screening test performed quite well in this initial clinical trial, differentiating transient conductive hearing losses from permanent neurosensory impairments and improving the diagnostic efficiency of auditory steady state responses.

Magnetically driven middle ear ossicles with laser vibrometry as a new diagnostic tool to quantify ossicular fixation

CONCLUSION

Information on the degree of incus fixation can be gathered by measuring the ratio of incus to umbo long process velocity through the ear canal.

OBJECTIVES

To test a new method of quantifying partial ossicular fixation in an ear with an elevated tympanic membrane.

METHODS

Measurements were made on four fresh-frozen human temporal bones. After elevating the tympanic membrane a small magnet was attached to the manubrium and an electromagnetic excitation coil was used to vibrate the ossicles. The vibration response of the tip of the incus long process and the umbo were measured before and after artificially fixating the incus to the lateral attic wall.

RESULTS

Partial incus fixation resulted in a decrease in both the incus and umbo velocities, with the incus velocity being more severely reduced. The decreased ratio of their vibrations is a clear indicator of the degree of incus fixation.