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Kubota T, Ito T, Furukawa T, Matsui H, Goto T, Shinkawa C, Matsuda H, Ikezono T, Kakehata S. Clinical course of five patients definitively diagnosed with idiopathic perilymphatic fistula treated with transcanal endoscopic ear surgery. Front Neurol 2024; 15:1376949. [PMID: 38560729 PMCID: PMC10978713 DOI: 10.3389/fneur.2024.1376949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Objectives An idiopathic perilymphatic fistula (PLF) can be difficult to diagnose because patients present with sudden sensorineural hearing loss (SSHL) and/or vestibular symptoms without any preceding events. In such cases, we currently test for cochlin-tomoprotein (CTP) to confirm the diagnosis of idiopathic PLF because CTP is only detected in the perilymph. In this study, we report the clinical course of five patients definitively diagnosed with idiopathic PLF who underwent PLF repair surgery using transcanal endoscopic ear surgery (TEES). Patients and methods Five patients were initially treated with intratympanic dexamethasone for SSHL, at which time a CTP test was also performed (preoperative CTP test). Due to refractory hearing loss and/or fluctuating disequilibrium, PLF repair surgery using TEES was performed to seal the oval and round windows using connective tissue and fibrin glue. These patients were diagnosed with definite idiopathic PLF based on pre- or intra-operative CTP test results (negative, < 0.4 ng/mL; intermediate, 0.4-< 0.8 ng/mL; and positive, > 0.8 ng/mL). We evaluated pre- and intra-operative CTP values, intraoperative surgical findings via a magnified endoscopic view, and pre- and post-operative changes in averaged hearing level and vestibular symptoms. Results Pre- and intra-operative CTP values were positive and intermediate in three patients, positive and negative in one patient, and negative and positive in one patient. None of the patients had intraoperative findings consistent with a fistula between the inner and middle ears or leakage of perilymph. Only two patients showed a slight postoperative recovery in hearing. Four patients complained of disequilibrium preoperatively, of whom two had resolution of disequilibrium postoperatively. Conclusion A positive CTP test confirms PLF in patients without obvious intraoperative findings. The CTP test is considered more sensitive than endoscopic fistula confirmation. We consider that CTP test results are important indicators to decide the surgical indication for idiopathic PLF repair surgery. In our experience with the five cases, two of them showed improvements in both hearing and vestibular symptoms.
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Affiliation(s)
- Toshinori Kubota
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
- Department of Otolaryngology, Yonoezawa City Hospital, Yonezawa, Yamagata, Japan
| | - Tsukasa Ito
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Takatoshi Furukawa
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
- Department of Otolaryngology, Yamagata Prefectural Shinjyo Hospital, Shinjo, Yamagata, Japan
| | - Hirooki Matsui
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Takanari Goto
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Chikako Shinkawa
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
| | - Han Matsuda
- Department of Otolaryngology, Saitama Medical University, Iruma-gun, Saitama, Japan
| | - Tetsuo Ikezono
- Department of Otolaryngology, Saitama Medical University, Iruma-gun, Saitama, Japan
| | - Seiji Kakehata
- Department of Otolaryngology, Head and Neck Surgery, Yamagata University Faculty of Medicine, Yamagata, Yamagata, Japan
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Matsuda H, Hornibrook J, Ikezono T. Assessing the efficacy of perilymphatic fistula repair surgery in alleviating vestibular symptoms and associated auditory impairments. Front Neurol 2023; 14:1269298. [PMID: 37900598 PMCID: PMC10600483 DOI: 10.3389/fneur.2023.1269298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 09/19/2023] [Indexed: 10/31/2023] Open
Abstract
Perilymph Fistula (PLF), abnormal communication between the fluid-filled space of the inner ear and the air-filled space of the middle ear, is a significant cause of vestibular and auditory symptoms. This is a retrospective study of 22 cases treated with PLF repair surgery, selected based on our surgical indication. We analyzed the characteristics of these 22 cases and evaluated the efficacy of PLF repair surgery in treating vestibular and auditory symptoms. Cases with antecedent events had significantly shorter intervals before surgery. The postoperative recovery from vestibular symptoms following PLF repair surgery was strikingly rapid, with 82% of cases demonstrating marked improvement within a week, even in chronic cases. Despite the notable absence of a control group in the study, the marked improvements in vestibular symptoms and substantial reductions in Dizziness Handicap Inventory (DHI) scores suggest that the observed benefits are attributable to the surgical intervention. Further, timely surgery showed improvements in hearing, with some benefits also seen in late-stage surgeries. Using the perilymph-specific protein Cochlin-tomoprotein (CTP) as a diagnostic biomarker, we could prove that PLF could be responsible for disequilibrium and related auditory disturbances in these patients. A new hypothesis is proposed that the chronic disequilibrium experienced by many PLF patients is due to enhanced mobility of the utricle and not to endolymphatic hydrops. Further research is needed to fully elucidate PLF's symptoms and treatment efficacy using the surgical indication we developed.
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Affiliation(s)
- Han Matsuda
- Department of Otorhinolaryngology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Jeremy Hornibrook
- Department of Otolaryngology-Head and Neck Surgery and Audiology, Christchurch Hospital, Christchurch, New Zealand
| | - Tetsuo Ikezono
- Department of Otorhinolaryngology, Faculty of Medicine, Saitama Medical University, Saitama, Japan
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Egorov VI, Ryazantsev SV, Kozarenko AV, Lilenko SV, Kozarenko MA, Pol'schikova AY. [Peculiarities of differential diagnostics of perilymphatic fistulas of the labyrinth windows of non-inflammatory genesis]. Vestn Otorinolaringol 2021; 86:17-22. [PMID: 34499442 DOI: 10.17116/otorino20218604117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
THE PURPOSE OF THE STUDY To determine the value of the results of various audiological and vestibulometric studies for the differential diagnosis of non-inflammatory perilymphatic fistulas of the labyrinth windows (PFOLW). MATERIAL AND METHODS The retrospective and prospective analysis of the informative value of the results of audiological and vestibulometric studies was carried out in 124 people with different combinations of cochleovestibular complaints, who had different pathology of the inner and middle ear, with different terms of the disease - from several days to 30 years. To assess the informativeness of the applied testing, the following operational characteristics were determined: general sensitivity (Se), specificity (Sp) and the prognostic value of a positive result (PPV=positive predictive value). A pair-by-pair comparison of the prognostic value of a positive result of vestibulometric and audiometric tests was performed using the Pearson criterion χ2 and the exact Fisher criterion. RESULTS It is shown that none of the tests used has 100% reliability, but the consistent application of some of them can successfully improve the diagnosis of idiopathic PFOL. When comparing the results of a number of tests, such as the Fukuda walking test and / or the Babinsky-Weil walking test, audiometric tests with head clone and hyperventilation, the test of fluid injection into the external auditory canal and the test of J. Frasser & L. Flood, it was found that the average prognostic value of a positive result was 87.3%, which is statistically significantly higher than the average result (47.9%) for other samples. CONCLUSIONS Correlations of the results of simple vestibulometric and audiometric tests allow us to recommend them to improve the diagnosis of idiopathic perilymphatic fistulas of the labyrinth windows. The possibilities of modern electrophysiological audiological research methods are subject to further study.
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Affiliation(s)
- V I Egorov
- Moscow Regional Scientific Research Clinical Institute MF Vladimirsky, Moscow, Russia
| | - S V Ryazantsev
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, Saint-Petersburg, Russia
| | - A V Kozarenko
- Moscow Regional Scientific Research Clinical Institute MF Vladimirsky, Moscow, Russia
| | - S V Lilenko
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, Saint-Petersburg, Russia
| | - M A Kozarenko
- Saint-Petersburg Research Institute of Ear, Throat, Nose and Speech, Saint-Petersburg, Russia
| | - A Yu Pol'schikova
- Moscow Regional Scientific Research Clinical Institute MF Vladimirsky, Moscow, Russia
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Rupp R, Hornung J, Balk M, Sievert M, Müller S, Hoppe U, Iro H, Gostian AO. Cochlear Implantation Following Explorative Tympanotomy in Patients With Sudden Sensorineural Hearing Loss: Surgical Features and Audiological Outcomes. EAR, NOSE & THROAT JOURNAL 2021; 102:NP277-NP283. [PMID: 33848205 DOI: 10.1177/01455613211009141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the anatomical status of the round window niche and hearing outcome of cochlear implantation (CI) after explorative tympanotomy (ExT) with sealing of the round window membrane in patients with sudden sensorineural hearing loss at a tertiary referral medical center. METHODS Between January 1, 2007, and July 30, 2020, 1602 patients underwent CI at our department. Out of these, all patients previously treated by ExT with sealing of the round window membrane because of unilateral sudden hearing loss were included in the study. A retrospective chart review was conducted concerning method of round window membrane sealing, intraoperative findings during CI, postoperative imaging, and hearing results. RESULTS Twenty one patients (9 females; 8 right ears; 54.3 years [± 12.9 years]) underwent ExT with sealing of the round window membrane with subsequent CI after 26.6 months (± 32.9 mo) on average. During CI, in 76% of cases (n = 16), the round window niche was blocked by connective tissue due to the previous intervention but could be removed completely in all cases. The connective tissue itself and its removal had no detrimental effects on the round window membrane. Postoperative computed tomography scan showed no electrode dislocation. Mean postoperative word recognition score after 3 months was 57.4% (± 17.2%) and improved significantly to 73.1% (± 16.4%, P = .005) after 2 years. CONCLUSION Performing CI after preceding ExT, connective tissue has to be expected blocking the round window niche. Remaining tissue can be removed safely and does not alter the round window membrane allowing for a proper electrode insertion. Short- and long-term hearing results are satisfactory. Consequently, ExT with sealing of the round window membrane in patients with sudden sensorineural hearing loss does not impede subsequent CI that can still be performed safely.
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Affiliation(s)
- Robin Rupp
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Joachim Hornung
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matthias Balk
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Matti Sievert
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Sarina Müller
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ulrich Hoppe
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Antoniu-Oreste Gostian
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, 9171Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Hofmann VM, Schoenfeld U, Jagielski M, Pudszuhn A. [Does sealing the oval window in addition to the round window bring an advantage in reserve therapy of acute idiopathic deafness?]. HNO 2021; 69:31-41. [PMID: 32728759 PMCID: PMC7806567 DOI: 10.1007/s00106-020-00903-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Following sudden unilateral deafness or severe sensorineural hearing loss, patients with unsuccessful intravenous steroid therapy can be treated with explorative tympanotomy with sealing of the round (RW) and/or oval window (OW), due to suspected rupture of the RW with perilymph fistula (PLF) or a fissula ante fenestram (FAF). This study investigated whether additional sealing of the oval window (RW+OW) achieved an improved hearing benefit as compared to sealing of the round window only (RW) . METHODS This retrospective study investigated 54 patients with acute profound hearing loss who underwent tympanoscopy. Audiometric examinations were performed preoperatively and at two postoperative intervals (1 month and 3-6 months after surgery). In 28 patients, the OW was sealed in addition to the RW. RESULTS No intraoperatively visible PLF or FAF were reported. Hearing thresholds were significantly reduced in the early postoperative follow-up period and further improvement was observed 3-6 months later. No significant differences between the RW and RW+OW subgroups were seen at either follow-up timepoint. In 65% (Kanzaki criteria) and 74% (Siegel criteria) of patients, partial or complete postoperative hearing improvement was observed. Upon comparing the groups of patients with and without hearing improvement, no statistical significance was found in terms of gender, age, secondary diagnoses, or latency period between symptom onset and surgery. CONCLUSION Additional sealing of the OW did not lead to significantly better postoperative hearing thresholds. In general, postoperative hearing improvement corresponds to published spontaneous remission rates.
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Affiliation(s)
- V M Hofmann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland.
| | - U Schoenfeld
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland
| | - M Jagielski
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland
| | - A Pudszuhn
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland
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Bader W, Gottfried T, Degenhart G, Johnson Chacko L, Sieber D, Riechelmann H, Fischer N, Hoermann R, Glueckert R, Schrott-Fischer A, Schmutzhard J. Measurement of the Intracochlear Hypothermia Distribution Utilizing Tympanic Cavity Hypothermic Rinsing Technique in a Cochlea Hypothermia Model. Front Neurol 2021; 11:620691. [PMID: 33505351 PMCID: PMC7830138 DOI: 10.3389/fneur.2020.620691] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/07/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Cochlea implants can cause severe trauma leading to intracochlear apoptosis, fibrosis, and eventually to loss of residual hearing. Mild hypothermia has been shown to reduce toxic or mechanical noxious effects, which can result in inflammation and subsequent hearing loss. This paper evaluates the usability of standard surgical otologic rinsing as cooling medium during cochlea implantation as a potential hearing preservation technique. Material and Methods: Three human temporal bones were prepared following standard mastoidectomy and posterior tympanotomy. Applying a retrocochlear approach leaving the mastoidectomy side intact, temperature probes were placed into the basal turn (n = 4), the middle turn (n = 2), the helicotrema, and the modiolus. Temperature probe positions were visualized by microcomputed tomography (μCT) imaging and manually segmented using Amira® 7.6. Through the posterior tympanotomy, the tympanic cavity was rinsed at 37°C in the control group, at room temperature (in the range between 22 and 24°C), and at iced water conditions. Temperature changes were measured in the preheated temporal bone. In each temperature model, rinsing was done for 20 min at the pre-specified temperatures measured in 0.5-s intervals. At least five repetitions were performed. Data were statistically analyzed using pairwise t-tests with Bonferroni correction. Results: Steady-state conditions achieved in all three different temperature ranges were compared in periods between 150 and 300 s. Temperature in the inner ear started dropping within the initial 150 s. Temperature probes placed at basal turn, the helicotrema, and middle turn detected statistically significant fall in temperature levels following body temperature rinses. Irrigation at iced conditions lead to the most significant temperature drops. The curves during all measurements remained stable with 37°C rinses. Conclusion: Therapeutic hypothermia is achieved with standard surgical irrigation fluid, and temperature gradients are seen along the cochlea. Rinsing of 120 s duration results in a therapeutic local hypothermia throughout the cochlea. This otoprotective procedure can be easily realized in clinical practice.
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Affiliation(s)
- Werner Bader
- Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria
| | - Timo Gottfried
- Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria
| | - Gerald Degenhart
- Department of Radiology, University Clinics Innsbruck, Innsbruck, Austria
| | - Lejo Johnson Chacko
- Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria
| | - Daniel Sieber
- MED-EL Medical Electronics GesmbH, Research and Development, Innsbruck, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria
| | - Natalie Fischer
- Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria
| | - Romed Hoermann
- Department of Anatomy, Histology, and Embryology, Medical University Innsbruck, Innsbruck, Austria
| | - Rudolf Glueckert
- Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria
| | | | - Joachim Schmutzhard
- Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria
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Li C, Zhou H, Feng Y, Zhao Y, Wang J, Chen Z, Yin S. Coagulation States in Patients With Sudden Sensorineural Hearing Loss Evaluated by Thromboelastography. Otolaryngol Head Neck Surg 2020; 164:1280-1286. [PMID: 33138704 DOI: 10.1177/0194599820965240] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The state of coagulation is controversial in patients with sudden sensorineural hearing loss (SSNHL). We used thromboelastography (TEG) to explore the relationships between blood coagulation parameters and SSNHL pathogenesis and recovery. STUDY DESIGN Prospective study. SETTING Affiliated Sixth People's Hospital, Shanghai Jiao Tong University. METHODS A total of 104 newly diagnosed patients with SSNHL and 29 matched healthy controls were recruited. Hearing assessments, TEG, and conventional coagulation tests (CCTs) were performed, followed by standard treatments and follow-up. RESULTS The TEG parameters of patients with SSNHL were in the normal range, but the group exhibited a significantly prolonged kinetic time (K; P = .004) and a smaller angle (P = .003) as compared with the controls. After grouping the patients with SSNHL according to audiograms and comparing them in pairs, we found that the differences were significant only when controls were compared with patients with low-frequency SSNHL (K, P = .023; angle, P = .04) and flat-type SSNHL (K, P = .017; angle, P = .014). Logistic regression analysis showed that neither TEG nor CCT parameters significantly affected hearing improvement after SSNHL treatment. CONCLUSIONS Although the K value and angle were significantly increased and significantly reduced, respectively, in the test group as compared with the control group, the state of coagulation in patients with SSNHL was still within the normal range. No CCT or TEG coagulation parameters (except the angle) differed significantly among patients in each group according to hearing recovery status, which suggested that the coagulation status does not determine the prognosis of patients with SSNHL.
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Affiliation(s)
- Chunyan Li
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Xuhui District, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Huiqun Zhou
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Xuhui District, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yanmei Feng
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Xuhui District, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Yan Zhao
- Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China.,Shanghai Jinshan District Central Hospital, Shanghai, China.,Shanghai Jinshan Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Jingjing Wang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Xuhui District, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Zhengnong Chen
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Xuhui District, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
| | - Shankai Yin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Xuhui District, Shanghai, China.,Otolaryngology Institute of Shanghai Jiao Tong University, Shanghai, China.,Shanghai Key Laboratory of Sleep Disordered Breathing, Shanghai, China
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Exploratory tympanotomy in sudden sensorineural hearing loss for the identification of a perilymphatic fistula - retrospective analysis and review of the literature. The Journal of Laryngology & Otology 2020; 134:501-508. [PMID: 32614760 DOI: 10.1017/s0022215120000948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The diagnostic value of exploratory tympanotomy in sudden sensorineural hearing loss remains controversial. This study and review were performed to identify the incidence of perilymphatic fistula in patients with sudden sensorineural hearing loss. The effectiveness of tympanotomy for sealing of the cochlear windows in cases with perilymphatic fistula was evaluated. METHODS A search in common databases was performed. Overall, 5034 studies were retrieved. Further, a retrospective analysis on 90 patients was performed. RESULTS Eight publications dealing with tympanotomy in patients with sudden sensorineural hearing loss were identified. In 90 patients diagnosed with sudden sensorineural hearing loss and undergoing exploratory tympanotomy, 10 patients (11 per cent) were identified with a perilymphatic fistula, and this corresponds to the results obtained from our review (13.6 per cent). CONCLUSION There was no significant improvement after exploratory tympanotomy and sealing of the membranes for patients with a definite perilymphatic fistula.
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Carol Liu YC, Ibekwe T, Kelso JM, Klein NP, Shehu N, Steuerwald W, Aneja S, Dudley MZ, Garry R, Munoz FM. Sensorineural hearing loss (SNHL) as an adverse event following immunization (AEFI): Case definition & guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2020; 38:4717-4731. [PMID: 32418788 DOI: 10.1016/j.vaccine.2020.05.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 01/22/2023]
Abstract
This is a Brighton Collaboration case definition of the term "Sensorineural Hearing Loss" to be utilized in the evaluation of adverse events following immunization. The case definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of vaccines for Lassa Fever and other emerging pathogens. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and define levels of diagnostic certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network.
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Affiliation(s)
- Yi-Chun Carol Liu
- Department of Otorhinolaryngology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Titus Ibekwe
- Department of Otorhinolaryngology, University of Abuja, Nigeria
| | - John M Kelso
- Division of Allergy, Asthma and Immunology, Scripps Clinic, San Diego, CA, USA
| | - Nicola P Klein
- Kaiser Permanente Vaccine Study Center, Oakland, CA, USA
| | - Nathan Shehu
- Department of Pediatric Infectious Diseases, Jos University, Nigeria
| | - Wendy Steuerwald
- Department of Audiology, Phoenix Children's Hospital, Phoenix, AZ, USA
| | - Satinder Aneja
- Department of Pediatrics, School of Medical Sciences and Research, Sharda University, Gr Noida, India
| | - Matthew Z Dudley
- Department of International Health, and Institute for Vaccine Safety, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Flor M Munoz
- Department of Pediatrics, Section of Infectious Diseases, and Department of Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA.
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Herrera M, Berrocal JRG, Arumí AG, Lavilla MJ, Plaza G. Update on consensus on diagnosis and treatment of idiopathic sudden sensorineural hearing loss. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2018.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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11
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Ji S, Chen X, Shi H, Zhang B, Yao S, Deng S, Tian C, Jiang J, Chen F, Wang X. Relationship between platelet parameters and sudden sensorineural hearing loss: a systematic review and meta-analysis. Biosci Rep 2018; 38:BSR20181183. [PMID: 30232233 PMCID: PMC6239278 DOI: 10.1042/bsr20181183] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/05/2018] [Accepted: 09/11/2018] [Indexed: 11/17/2022] Open
Abstract
Recent years, the discussion about whether platelets participant in the development of sudden sensorineural hearing loss (SSHL) continues and many studies on the relationship between them have come to our attention. Some studies believe that platelet parameters have significantly changed in patients with SSHL, while some not, controversially. Therefore, to investigate the association between platelet parameters, including mean platelet volume (MPV), platelet distribution width (PDW) and platelet count (PLT), and SSHL, expecting to resolve controversy and provide clinical evidence for diagnosis and monitoring of SSHL. Basic methods: Literature was retrieved searching electronic databases (PubMed, Embase, Cochrane, and Scopus) and searching references of related articles by hand. A total of 18 case-control studies involving 1837/1734 subjects (SSHL/control) were included. Meta-analysis showed there was no difference between the patients who suffered SSHL and healthy controls in MPV level [standard mean difference (SMD) (95% confidence interval (CI)) = 0.16 (-0.07, 0.40), I2 = 80%, P<0.00001] and PLT [SMD (95% CI) = -0.03(-0.18, 0.12), I2 = 73%, P<0.00001]. While PDW exhibited significant difference [SMD (95% CI) = 0.85 (0.20, 1.49), I2 = 93%, P<0.00001]. Subgroup analysis about geographical area suggested PLT have obvious evidence for SSHL in Eastern country [SMD (95% CI) = 0.23 (0.14, 0.33), I2 = 0%, P=0.81]. Our study did not support a correlation between MPV and SSHL, while PLT may have clinical significance for SSHL in Eastern country. With insufficient data to explore the resource of heterogeneity for PDW, there is no decisive conclusion reached.
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Affiliation(s)
- Shuaifei Ji
- School of Basic Medicine, Air Force Medical University, Xi'an, 710032, China
| | - Xuemin Chen
- Center of Clinical Aerospace Medicine, School of Aerospace Medicine, Key Laboratory of Aerospace Medicine of Ministry of Education, Air Force Medical University, Xi'an, 710032,China
| | - Heng Shi
- School of Basic Medicine, Air Force Medical University, Xi'an, 710032, China
| | - Babo Zhang
- School of Basic Medicine, Air Force Medical University, Xi'an, 710032, China
| | - Shun Yao
- School of Basic Medicine, Air Force Medical University, Xi'an, 710032, China
| | - Senlin Deng
- School of Basic Medicine, Air Force Medical University, Xi'an, 710032, China
| | - Chunlong Tian
- Department of ENT, Tianshui 407 Hospital, Tianshui, 741000, China
| | - Jun Jiang
- Department of ENT, Tianshui 407 Hospital, Tianshui, 741000, China
| | - Fei Chen
- People's Liberation Army Troop 94587, Lianyungang, 222300, China
| | - Xiaocheng Wang
- Center of Clinical Aerospace Medicine, School of Aerospace Medicine, Key Laboratory of Aerospace Medicine of Ministry of Education, Air Force Medical University, Xi'an, 710032,China
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Herrera M, García Berrocal JR, García Arumí A, Lavilla MJ, Plaza G. Update on consensus on diagnosis and treatment of idiopathic sudden sensorineural hearing loss. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 70:290-300. [PMID: 30093087 DOI: 10.1016/j.otorri.2018.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Idiopathic sudden sensorineural hearing loss (ISSNHL) is a sudden, unexplained unilateral hearing loss. OBJECTIVES To update the Spanish Consensus on the diagnosis, treatment and follow-up of ISSNHL. MATERIAL AND METHODS After a systematic review of the literature from 1966 to March 2018, on MESH terms «(acute or sudden) hearing loss or deafness», a third update was performed, including 1508 relevant papers. RESULTS Regarding diagnosis, 11ISSNHL is clinically suspected, the following diagnostic tests are mandatory: otoscopy, acumetry, tonal audiometry, speech audiometry, and tympanometry, to discount conductive causes. After clinical diagnosis has been established, and before treatment is started, a full analysis should be performed. An MRI should then be requested, ideally performed during the first 15 days after diagnosis, to discount specific causes and to help to understand the physiopathological mechanisms in each case. Although treatment is very controversial, due to its effect on quality of life after ISSNHL and the few rare adverse effects associated with short-term steroid treatment, this consensus recommends that all patients should be treated with steroids, orally and/or intratympanically, depending on each patient. In the event of failure of systemic steroids, intratympanic rescue is also recommended. Follow-up should be at day 7, and after 12 months. CONCLUSION By consensus, results after treatment should be reported as absolute decibels recovered in pure tonal audiometry and as improvement in speech audiometry.
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Affiliation(s)
- Mayte Herrera
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España.
| | - José Ramón García Berrocal
- Servicio de Otorrinolaringología, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma, Madrid, España
| | - Ana García Arumí
- Servicio de Otorrinolaringología, Hospital Vall d'Hebron, Universidad Autónoma, Barcelona, España
| | - María José Lavilla
- Servicio de Otorrinolaringología, Hospital Clínico, Universidad de Zaragoza, España
| | - Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
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Thomas JP, Drewermann S, Voelter C, Dazert S. Prognostic factors regarding the hearing outcome in severe to profound sudden sensorineural hearing loss treated by tympanotomy and sealing of labyrinthine windows after ineffective systemic corticosteroid application. Eur Arch Otorhinolaryngol 2018; 275:1749-1758. [PMID: 29855690 DOI: 10.1007/s00405-018-5023-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/26/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Tympanotomy and sealing of labyrinthine membranes has become in some centers used to treat severe to profound sudden sensorineural hearing loss refractory to conservative treatment. The aim of this retrospective study was to determine which preoperative factors influence the likelihood of postoperative recovery according to different audiological assessment criteria. METHODS The mean final hearing threshold, the hearing improvement, the probability of a complete recovery according to two different classifications, and probability of a significant recovery of 136 adult subjects were studied by univariate and multivariate analyses. RESULTS The subject's mean postoperative 4-pure-tone-average was 63.9 ± 35.9 dB, the mean improvement was 42.8 ± 32.6 dB. Depending on the classification system used, 18.4-28.0% of subjects experienced a complete recovery. 77.2% of subjects had a significant hearing improvement. History of a pressure change (odds ratio (OR):4.6) was the only positive prognostic factor for hearing improvement. It also enhanced probability of experiencing a complete hearing recovery (OR: 2.8-6.3). Preoperative total deafness (OR: 1.5-1.9) and vertigo (OR: 3.3-4.6) were negative prognostic factors for the mean final hearing threshold and the probability of a complete hearing recovery. Patients with a preceding pressure change event achieved a complete recovery in 45.5-50.0%, those without such an event recovered completely only in 13.2-23.7%. CONCLUSION Evaluating prognostic factors and the rate of complete hearing recovery are influenced by the underlying assessment parameters. In addition to the mean postoperative hearing threshold and hearing gain, the probability of regaining a serviceable hearing is clinically important for the individual and should be added to the assessment criteria in future studies.
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Affiliation(s)
- Jan Peter Thomas
- Department of Otolaryngology, Head and Neck Surgery, St. Elisabeth-Hospital, Ruhr University Bochum, Bleichstr. 15, 44787, Bochum, Germany.
| | - Silke Drewermann
- Department of Otolaryngology, Head and Neck Surgery, St. Elisabeth-Hospital, Ruhr University Bochum, Bleichstr. 15, 44787, Bochum, Germany
- Medical Supply Centre of the Federal Armed Forces, Bremerhavener Heerstr. 10, 27711, Osterholz-Scharmbeck, Germany
| | - Christiane Voelter
- Department of Otolaryngology, Head and Neck Surgery, St. Elisabeth-Hospital, Ruhr University Bochum, Bleichstr. 15, 44787, Bochum, Germany
| | - Stefan Dazert
- Department of Otolaryngology, Head and Neck Surgery, St. Elisabeth-Hospital, Ruhr University Bochum, Bleichstr. 15, 44787, Bochum, Germany
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