Cochlear Implantation in Children with Meningitis: A Multicenter Study on Auditory Performance and Speech Production Outcomes

BACKGROUND

This study aims to evaluate speech production outcomes and auditory performance in children with post-meningitis deafness who were treated with cochlear implants. Additionally, the study assesses the impact of electrode insertion depth on surgical outcomes.".

METHODS

We conducted a study on 66 pediatric patients with bilateral postmeningitis hearing loss who were being prepared for cochlear implantation at four tertiary referral academic institutions. The speech intelligibility rating (SIR) and categories of auditory performance (CAP) were evaluated after the first and second years following implantation. The patients were divided into two groups based on electrode insertion depth: one group had full electrode insertion (more than two-thirds), while the other had partial electrode insertion (less than two-thirds). We compared the SIR and CAP scores between the two groups to assess the impact of electrode insertion depth on outcomes.

RESULTS

Before implantation, the median CAP score was one, but it improved significantly to six within two years after the procedure (P-value < 0.001). Similarly, the median SIR score before implantation was one, but it improved significantly to three within two years after surgery (P-value < 0.001). However, there was no significant difference between the partial and full electrode insertion groups in terms of CAP and SIR scores during the follow-up evaluations conducted after the first and second years.

CONCLUSION

The study found that cochlear implantation significantly improved speech production skills and auditory performance in children with postmeningitis deafness. Importantly, the amount of electrode insertion at the time of implantation did not have a significant impact on the outcomes.

Prognostic factors in pediatric cochlear implant: an outcome-based study

OBJECTIVE

To determine the prognostic factors in the pediatric cochlear implant (CI) outcome.

MATERIALS AND METHODS

This prospective cohort study was conducted on 289 pediatric cases with prelingual hearing loss who received cochlear implantation. Several possible salient factors have been recorded. Auditory and speech evaluations were performed before CI, as well as 6 and 12 months after surgery, using Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) tests.

RESULTS

According to univariate analysis, age at the time of surgery was a statistically significant factor. Neurological problems in the child, history of newborn infectious diseases, history of hearing aid use, proper parental cooperation, and round window approach were all significantly related to better auditory or speech outcomes. On the other hand, good parental cooperation and age (for CAP) and good parental cooperation, age, history of infectious disease, and hearing aids use (for SIR) are the significant factors in the multivariate setting.

CONCLUSION

As evidenced by the obtained results, age, background diseases, history of rehabilitation with hearing aids, and surgical details are essential factors to be taken into account in the case-selection process.

Evaluation of Sudden Sensory-Neural Hearing Loss Patients Treated with Systemic Steroids with Additional Intratympanic Dexamethasone Injection in Different Intervals; a Clinical Trial Study

Sudden Sensory-Neural Hearing Loss (SSNHL) is one of the most important otologic emergency. Although adding intratympanic (IT) steroids to systematic steroid may be beneficial, the exact timing of the IT injections to provide the best response needs further investigations. To compare different protocols in treting sudden sensorineural hearing loss. We performed a clinical trial study on 120 patients from October 2021 to February 2022. All patients were prescribed 1 mg/Kg daily oral prednisolone. After randomization to three groups, the control group received standard twice a week IT steroid injections in 12 days (four total injections) while intervention groups 1 and 2 received once and twice a day IT injections for ten days. Audiometric study repeated 10-14 days after the last injection and assessed based on the Siegel criteria. We used the Chi-Square, Analysis of Variance (ANOVA), Kruskal-Wallis's tests where appropriate. The most clinical improvement was found in the standard treatment group, and group-2 had the greatest number of patients with no improvement; however, no overall significant difference was observed among the three groups (p-value: 0.066; Pearson Chi-Square). Less frequent IT injections in patients already on systemic steroids provide similar results to more frequent injections.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-023-03641-4.

Hyperbilirobinemia and Its Effect on Auditory Perception and Speech Intelligibility in Cochlear Implanted Children (Cochlear Implantation Outcomes in Children Who Have Experienced Hyperbilirobinemia)

The goal of this study was to investigate the probable difference in auditory perception and speech intelligibility performance amongst cochlear implanted children who experienced hyperbilirubinemia or auditory neuropathy in comparison to the cochlear implanted children with unknown etiology for hearing loss. This case-control study was carried out on 106 cochlear implanted children with mean age of 32.36 ± 11.98 months who were purposively selected and allocated into four groups. Out of the total, 30 had no specific etiology for hearing loss, while the others had experienced auditory neuropathy or hyperbilirubinemia with/without blood exchange. The auditory perception and speech intelligibility performance of all the participants who had received auditory verbal therapy were assessed after 6 and 12 months of rehabilitation. Then, the data was analyzed, using the Statistical Package for Social Sciences-version 21(SPSS-21). Results indicated poor auditory perception and speech intelligibility performance of the cochlear implanted children with hyperbilirubinemia and blood exchange (P ≤ 0.05), while the participants in the control group with no specific etiology for hearing loss, the children with hyperbilirubinemia with no blood exchange, and those who suffered from auditory neuropathy performed better, respectively. Also, a significant correlation between auditory neuropathy and hyperbilirubinemia was observed. Despite lower improvement of auditory perception and speech intelligibility of the hearing impaired children who were experiencing moderate to severe degrees of hyperbilirubinemia or auditory neuropathy, cochlear implantation is highly recommended not only for children with unknown etiology for severe hearing loss but also for this group of hearing impaired children.

Comprehensive vestibular evaluation in patients with Otosclerosis: a case control study

Aim

Otosclerosis is one of the common otologic diseases. The mechanism and the probable site of vestibular involvement are not yet fully understood. The present study aimed to perform a comprehensive vestibular evaluation in patients with otosclerosis, compared to the cases without otosclerosis.

Materials and methods

patients underwent a comprehensive cochleovestibular evaluation, including audiometry, ocular and cervical vestibular evoked myogenic potential (o-VEMP and c-VEMP), video head impulse (vHIT) and caloric tests. The results were compared with those obtained from the non-otosclerosis control group.

Results

A total of 61 individuals were included in the study who were divided into two groups of the case (50.82%) and control (49.18%). The results showed that there was a significant difference in the mean vHIT gain between the case and control groups (P < 0.05). However, the mean gain was still within the normal range. Besides, the patients with otosclerosis had significant bilateral or unilateral weaknesses according to caloric test results. Moreover, their o-VEMP and c-VEMP results were significantly abnormal as well (P < 0.05).

Conclusion

Based on the results of the present study, the vestibular system even in asymptomatic cases, is affected by otosclerosis. Furthermore, it seems that the otolithic system has a higher chance of involvement, compared to the semicircular canals.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03147-5.

The Outcome of Cochlear Implantations in Deaf-Blind Patients: A Multicenter Observational Study

OBJECTIVE

This multicenter study aimed to evaluate the auditory and speech outcomes of cochlear implantation (CI) in deaf-blind patients compared with deaf-only patients.

STUDY DESIGN

Retrospective cohort study.

SETTING

Multiple cochlear implant centers.

PATIENTS

The current study was conducted on 17 prelingual deaf-blind children and 12 postlingual deaf-blind adults who underwent CI surgery. As a control group, 17 prelingual deaf children and 12 postlingual deaf adults were selected.

INTERVENTION

Cochlear implantation.

MAIN OUTCOME MEASURES

Auditory and linguistic performances in children were assessed using the categories of auditory performance (CAP) and Speech Intelligibility Rating (SIR) scales, respectively. The word recognition score (WRS) was also used to measure speech perception ability in adults. The mean CAP, SIR, and WRS cores were compared between the deaf-only and deaf-blind groups before CI surgery and at "12 months" and "24 months" after device activation. Cohen's d was used for effect size estimation.

RESULTS

We found no significant differences in the mean CAP and SIR scores between the deaf-blind and deaf-only children before the CI surgery. For both groups, SIR and CAP scores improved with increasing time after the device activation. The mean CAP scores in the deaf-only children were either equivalent or slightly higher than those of the deaf-blind children at "12 months post-CI" (3.94 ± 0.74 vs 3.24 ± 1.25; mean difference score, 0.706) and "24 months post-CI" (6.01 ± 0.79 vs 5.47 ± 1.06; mean difference score, 0.529) time intervals, but these differences were not statistically significant. The SIR scores in deaf-only implanted children were, on average, 0.870 scores greater than the deaf-blind children at "12 months post-CI" (2.94 ± 0.55 vs 2.07 ± 1.4; p = 0.01, d = 0.97) and, on average, 1.067 scores greater than deaf-blind children at "24 months post-CI" (4.35 ± 0.49 vs 3.29 ± 1.20; p = 0.002; d = 1.15) time intervals. We also found an improvement in WRS scores from the "preimplantation" to the "12-month post-CI" and "24-month post-CI" time intervals in both groups. Pairwise comparisons indicated that the mean WRS in the deaf-only adults was, on average, 10.61% better than deaf-blind implanted adults at "12 months post-CI" (62.33 ± 9.09% vs 51.71 ± 10.73%, p = 0.034, d = 1.06) and, on average, 15.81% better than deaf-blind adults at "24-months post-CI" (72.67 ± 8.66% vs 56.8 ± 9.78%, p = 0.002, d = 1.61) follow-ups.

CONCLUSION

Cochlear implantation is a beneficial method for the rehabilitation of deaf-blind patients. Both deaf-blind and deaf-only implanted children revealed similar auditory performances. However, speech perception ability in deaf-blind patients was slightly lower than the deaf-only patients in both children and adults.

Identification of three novel homozygous variants in COL9A3 causing autosomal recessive Stickler syndrome

BACKGROUND

Stickler syndrome (STL) is a rare, clinically and molecularly heterogeneous connective tissue disorder. Pathogenic variants occurring in a variety of genes cause STL, mainly inherited in an autosomal dominant fashion. Autosomal recessive STL is ultra-rare with only four families with biallelic COL9A3 variants reported to date.

RESULTS

Here, we report three unrelated families clinically diagnosed with STL carrying different novel biallelic loss of function variants in COL9A3. Further, we have collected COL9A3 genotype-phenotype associations from the literature.

CONCLUSION

Our report substantially expands the molecular genetics and clinical basis of autosomal recessive STL and provides an overview about allelic COL9A3 disorders.

Intratympanic Steroid for the Management of Sudden Hearing Loss: Introduction of a Tapering Method

INTRODUCTION

Sudden sensorineural hearing loss (SSNHL) is a therapeutic challenge. There are several controversies regarding the management protocol of SSNHL. This study aimed to present the results of a novel treatment algorithm, which is a combination of systemic steroids and a tapering intratympanic (IT) dexamethasone regimen.

MATERIALS AND METHODS

The past 10 years' medical records of idiopathic SSNHL cases in Ghaem and Emamreza hospital, Mashhad University of Medical Sciences were evaluated. Patients were assessed using standardized methods for pure-tone threshold audiometry. The management method of SSNHL treatment included oral steroids combined with IT administration of dexamethasone once a day for 7 days and continuing it on an alternate day and then weekly basis. Patients' recovery was assessed using Siegel's criteria.

RESULTS

This study included a total of 248 cases of idiopathic sudden hearing loss, with a mean age of 40.63±16.19 years. In total, 105 (42.3%) and 143 (57.7%) patients were female and male, respectively. The most common associated symptoms included tinnitus (86.9%, n=205) followed by vertigo (52.1%, n=122). The final hearing outcome of patients showed that 39 (15.7%), 38(15.3%), 86 (34.7%), and 85 (34.3%) patients underwent a complete recovery, partial recovery, slight recovery, and no recovery, based on Siegel's criteria.

CONCLUSIONS

The dose, interval, and duration of IT steroid treatment were not universally approved. The treatment method designed based on a tapering of IT steroid injection in combination with already known systemic administration of steroids can be a treatment option in SSNHL patients.

Investigation of MYO15A and MYO7A Mutations in Iranian Patients with Nonsyndromic Hearing Loss

Hearing loss (HL) is the most common sensory disorder in humans, which affects individuals in both inherited and acquired forms. MYO15A and MYO7A gene mutations have a significant role in the development of deafness. In this study, we assessed the prevalence of MYO15A and MYO7A mutations in one hundred non-relative deaf Iranians. Materials and methods: The existence of MYO15A and MYO7A mutations were assessed using the tetra-primer ARMS-PCR method, High Resolution Melting (HRM) and sequencing method. Results: A heterozygote missense mutation, p.V2135L (c.6403G > T) in the MYO15A gene, was found in a patient using the sequencing method. Conclusion: These results explain the negligible prevalence of selected mutations among Iranian patients. Identifying common mutations in patients of an ethnic group can reduce the financial costs and time needed for identifying the causes of deafness.

Association Between Serum Vitamin D Level and Ménière's Disease

OBJECTIVES

Ménière's disease (MD) is a well-known inner ear disease; however, the etiopathogenesis is unknown. Several factors may be involved. Meanwhile, vitamin D is reported to have an important role in inner ear physiology. The aim of this study is to evaluate the relation between vitamin D deficiency and MD.

STUDY DESIGN

This matched case-control study compared serum vitamin D levels between patients with definite MD and those without it.

SETTING

The study was done between August 2018 and December 2019 at Ghaem University Hospital in Mashhad, Iran.

METHODS

Twenty-eight patients with definite MD were matched with a group of 84 healthy individuals, regarding age, sex, body mass index, and occupation (indoor vs outdoor). The serum level of vitamin D (25-hydroxyvitamin D3) was measured in both groups.

RESULTS

The mean ± SD vitamin D level was 18.9 ± 9.7 ng/mL in the case group and 25.2 ± 13.7 ng/mL in the control group (P = .027). There was a significant difference between the case and control groups according to the results of the conditional logistic regression model (P = .03; adjusted odds ratio, 0.96). In the MD group, 17 (60.7%) patients were vitamin D deficient, 6 (21.4%) insufficient, and only 5 (17.9%) sufficient.

CONCLUSIONS

The results of this study show that serum vitamin D level in MD is significantly lower than that of the control group. However, the role of vitamin D supplementation in the management of MD needs further study.

LEVEL OF EVIDENCE

4.

Predicting round window visibility by HRCT during cochlear implantation in children

Objective: The present study aimed to radiologically evaluate the visibility of round window during cochlear implantation by high-resolution computed tomography (HRCT) imaging of temporal bone. Study design: This was a cross-sectional descriptive analytic study. Methods: Two new radiologic measurements were evaluated on the presurgical HRCT of temporal bone, including (1) the angle between the line parallel to coronal axis that passes through the middle of the round window niche (RWN) and the line that connects the anterior portion of facial nerve (FN) to the middle of the RWN (RWN angle) and (2) the vertical distance between this coronal plane and the anterior portion of the FN, modified facial recess distance (MFRD). The measurements were then compared with the visibility of the round window (RW) during operation, as reported by the surgeon. Result: The present study compared the abovementioned CT scan findings of cochlear implanted children in visible (n = 21) and nearly invisible (n = 21) RW during surgery, as reported by the surgeon. The analysis revealed that both MFRD (P < 0.01) and RWN angle (P < 0.04) were significantly different between the two groups. Conclusion: the RWN angle and MFRD are fairly reliable predictors of round window visibility during cochlear implantation.

Cochlear implantation in children with inner ear malformation: A multicenter study on auditory performance and speech production outcomes

OBJECTIVES

This multicenter study evaluated the auditory performance and speech production outcomes of cochlear implantation in children with inner ear anomaly and compared the outcomes of patients with different kinds of malformation.

METHODS

Cochlear implantation was performed in 107 children with inner ear malformation at four tertiary academic centers. The categories of auditory performance (CAP) and speech intelligibility rating (SIR) scores were evaluated preoperatively and one year and two years postoperatively.

RESULTS

Types of inner ear malformation and their frequencies were: incomplete partition type-I, 19 (17.8%) patients; incomplete partition type-II, 31 (29%), common cavity, 17 (15.9%), cochlear hypoplasia, 17 (15.9%), and isolated enlarged vestibular aqueduct (isolated EVA), 23 (21.5%) patients. EVA was the coexisting anomaly in 27(25.2%) subjects. The median CAP and SIR scores improved significantly during the first two years after cochlear implantation in all groups (p-values <0.001 and < 0.001, respectively). No significant difference was seen in CAP and SIR scores of children with different inner ear malformations (p-value = 0.147 and 0.570, respectively) or in patients with isolated EVA compared to coexisting EVA (p-value = 0.538 and 0.075, respectively).

CONCLUSION

The median CAP and SIR scores two years after surgery were 5 (Understanding of common phrases without lip-reading) IQR: 4-6, and 3 (Connected speech is intelligible to a listener who concentrates and lip-reads within a known context) IQR: 3-4, respectively. Auditory performance and speech production were significantly improved in all inner ear malformation patient groups, and no significant difference was observed between the scores of patients with different types of anomaly.

Ramsay Hunt Syndrome Associated with True Vocal Cord Palsy- A Case Report

INTRODUCTION

Varicella-zoster virus may cause an infectious disease called Ramsay Hunt syndrome. The related symptoms include facial nerve palsy (FNP), otalgia, the vesicular eruptions of the auricle and external auditory canal, less common ocular movement disorder, facial hypoesthesia, myofascial pain, vestibular symptoms, hearing loss, dysphasia, vocal cord paralysis, as well as tongue paralysis due to cranial neuropathies.

CASE REPORT

Herein, we presented the case of a 55-year-old man with left peripheral facial nerve palsy, profound hearing loss, and true vocal cord paralysis. The FNP recovered after 2 weeks and synkinesis totally improved after 4 weeks.

CONCLUSION

Ramsay Hunt syndrome may present as cranial polyneuropathy; therefore, accurate history taking and physical examinations are necessary in this regard. The recovery rate of the vagus nerve is probably fair without polyneuropathy; however, it seems to be poor in cases suffering from polyneuropathy.

The conserved p.Arg108 residue in S1PR2 (DFNB68) is fundamental for proper hearing: evidence from a consanguineous Iranian family

BACKGROUND

Genetic heterogeneity and consanguineous marriages make recessive inherited hearing loss in Iran the second most common genetic disorder. Only two reported pathogenic variants (c.323G>C, p.Arg108Pro and c.419A>G, p.Tyr140Cys) in the S1PR2 gene have previously been linked to autosomal recessive hearing loss (DFNB68) in two Pakistani families. We describe a segregating novel homozygous c.323G>A, p.Arg108Gln pathogenic variant in S1PR2 that was identified in four affected individuals from a consanguineous five generation Iranian family.

METHODS

Whole exome sequencing and bioinformatics analysis of 116 hearing loss-associated genes was performed in an affected individual from a five generation Iranian family. Segregation analysis and 3D protein modeling of the p.Arg108 exchange was performed.

RESULTS

The two Pakistani families previously identified with S1PR2 pathogenic variants presented profound hearing loss that is also observed in the affected Iranian individuals described in the current study. Interestingly, we confirmed mixed hearing loss in one affected individual. 3D protein modeling suggests that the p.Arg108 position plays a key role in ligand receptor interaction, which is disturbed by the p.Arg108Gln change.

CONCLUSION

In summary, we report the third overall mutation in S1PR2 and the first report outside the Pakistani population. Furthermore, we describe a novel variant that causes an amino acid exchange (p.Arg108Gln) in the same amino acid residue as one of the previously reported Pakistani families (p.Arg108Pro). This finding emphasizes the importance of the p.Arg108 amino acid in normal hearing and confirms and consolidates the role of S1PR2 in autosomal recessive hearing loss.

Cochlear implantation in children with auditory neuropathy spectrum disorder: A multicenter study on auditory performance and speech production outcomes

OBJECTIVES

To evaluate the auditory performance and speech production outcome in children with auditory neuropathy spectrum disorder (ANSD). The effect of age on the outcomes of the surgery at the time of implantation was also evaluated.

METHODS

Cochlear implantation was performed in 136 children with bilateral severe-to- profound hearing loss due to ANSD, at four tertiary academic centers. The patients were divided into two groups based on the age at the time of implantation; Group I: Children ≤24 months, and Group II: subjects >24 months. The categories of auditory performance (CAP) and speech intelligibility rating (SIR) scores were evaluated after the first and second years of implantation. The differences between the CAP and SIR scores in the two groups were assessed.

RESULTS

The median CAP scores improved significantly after the cochlear implantation in all the patients (p value < 0.001). The improvement in the CAP scores during the first year in Group II was greater than Group I (p value: 0.007), but the improvement in CAP scores tended to be significantly higher in patients who were implanted at ≤24 months (p value < 0.001). There was no significant difference between two groups in SIR scores at first-year and second-year follow-ups. The evaluation of the SIR improvement revealed significantly higher values for Group I during the second-year follow-up (p value: 0.003).

CONCLUSION

The auditory performance and speech production skills of the children with ANSD improved significantly after cochlear implantation, and this improvement was affected by age at the time of implantation.

Is Sudden Hearing Loss Associated with Atherosclerosis?

INTRODUCTION

Sudden sensorineural hearing-loss (SSNHL) patients constitute approximately 2-3% of referrals to ear, nose and throat (ENT) clinics. Several predisposing factors have been proposed for this condition; one of which is vascular disorders and perfusion compromise. In this research the atherosclerotic changes and their known risk factors are studied in SSNHL patients.

MATERIALS AND METHODS

Thirty SSNHL patients and 30 controls were evaluated with regard to cardiovascular risks including history, heart examination, blood pressure, body mass index, waist circumference, electrocardiogram, blood sugar, triglycerides, cholesterol, high-sensitivity C-reactive protein (HSCRP); also, carotid artery color Doppler study was undertaken to measure intima media thickness(IMT).

RESULTS

IMT and HSCRP showed an increased risk in the case group compared with the controls (P= 0.005 & P=0.001). However, waist circumference, history of smoking, fasting blood sugar, lipid profile, and electrocardiogram revealed no significant difference between the two groups. Interestingly, blood pressure and body mass index were higher in the controls in this study.

CONCLUSION

Sudden sensorineural hearing loss may be associated with subclinical atherosclerosis.

Temporal Bone Measurements; A Comparison Between Rendered Spiral CT and Surgery

Background:

Accurate radiological assessment of the anatomical features of the temporal bone is crucial to prevent damage to vital elements in this area during surgery. Knowing the approximate location of specific temporal bone related landmarks in advance is very important for planning surgery.

Objectives:

This study compared findings from computed tomography images with those observed directly during ear surgery.

Patients and Methods:

Patients with various pathologies of the ear who needed surgery were referred to an imaging center for a spiral CT scan of the temporal bone. The following parameters were measured by a radiologist and also later recorded by the surgeon during surgery: 1) The distance between the postero-superior border of the outer ear canal and the sigmoid sinus; 2) The distance between the dome of the lateral semicircular canal and the mastoid cortex; and 3) The distance between the external surface of the incus and the mastoid cortex.

Results:

Twenty cases were included. In the three measurements performed in this study, only the first parameter (distance between the canal and the sigmoid sinus) was significantly different between the direct measurement made during surgery and that obtained from CT scans. There was no significant difference in the measurements of the distance between the dome of the lateral semicircular canal and the bone cortex, and the distance between the external surface of the incus and the surface of the bone cortex.

Conclusions:

Our study shows in terms of figures that measurements of features of the temporal bone made from spiral CT scan images and those directly obtained during surgery are similar to an adequate extent.

Hearing disorders in Turner's syndrome: a survey from Iran

Turner syndrome (TS) is one of the most frequently encountered sex-linked chromosomal abnormalities, occurring in one per 2,000 female births. These patients present with short stature and failure to begin puberty. In this syndrome, there are multiple organ abnormalities, including auditory disorders. TS patients were referred to the ENT clinic by a pediatric endocrinologist. A questionnaire was filled out and the patients went through a complete otologic examination. They were then referred to the audiology clinic to undergo audiologic test battery plus high-frequency pure tone audiometry. From a total of 48 ears examined, 11 (22.9 %) had a normal audiometry. Mid-frequency sensorineural hearing loss (SNHL), high-frequency SNHL, combined and mixed hearing loss were diagnosed in 6 (12/5 %), 20 (41/7 %), 6 (12/5 %) and 1 (2/1 %) ear, respectively. Tympanogram results showed normal compliance (A, As, Ad) in the majority of cases. B and C patterns were found in a few cases. Speech discrimination score was normal in all patients whereas speech reception threshold was normal in 92 % of the ears. Audiometry abnormality especially SNHL is common in TS patients, with the high-frequency pattern being the most frequent.

Middle Ear Function in Sinonasal Polyposis: A Case-Control Study

Objectives:

Determine the effect of sinonasal polyposis on middle ear (ME) and Eustachian tube (ET) function.

Methods:

In a case-control survey, 90 cases in 3 groups including 42 advanced stage sinonasal polyposis patients, 24 patients with chief complaint of nasal obstruction in the absence of polyposis, and 24 healthy cases (not suffering from nasal obstruction or allergic rhinitis) were studied. Subjective ear- and nose-related complaints, tympanic membrane condition and movement during the Valsalva and Toynbee maneuvers, type of nasal secretions, polyposis staging both clinically (Lund Kennedy) and by imaging (Lund McKay), audiometric evaluation, and ET function tests were recorded.

Results:

Subjective hearing loss ( P = .017), impaired TM movement during Toynbee maneuver ( P = .027), Type B tympanogram ( P = 0.025) showed significant difference in the polyposis group in comparison with the other 2. Furthermore, allergic rhinitis and nasal mucopurulent secretion were seen significantly more commonly among polyposis patients compared with other groups ( P = .026, P = .000, respectively). TM movement during Toynbee maneuver ( P = .004), type B tympanogram ( P = .030), and Toynbee test ( P = .004) showed a significant difference between patients who had purulent secretion compared with those without.

Conclusions:

It seems that sinonasal polyposis may change middle ear function to some extent, but the changes are related to the inflammation (allergic or infectious) associated with polyposis, rather than the nasal airway obstruction per se.

An unusual cause of dysphonia with hemoptysis: a laryngeal live leech

INTRODUCTION

Foreign bodies in the upper airway are one of the most challenging otolaryngology emergencies and have various presentations depending on their physical properties and location. Leeches are blood-sucking hermaphroditic worms that vary in color, length, and shape. They usually reside in fresh-water streams and lakes. When rural untreated water is drunk, leeches may localize in the nose, pharynx, and esophagus, or rarely in the larynx.

CASE REPORT

This case is a man who was referred to our otolaryngology clinic with a complaint of hemoptysis and mild respiratory distress. The patient's symptoms were all relieved post operatively and he was discharged on the second day following the procedure.

CONCLUSION

Leeches should be suspected as an airway foreign body in patients with a recent history of drinking stream water.

Differentiation between CSF Otorrhea and Rhinorrhea in an Obscure Case of Recurrent Meningitis

INTRODUCTION

Leakage of cerebrospinal fluid in the skull base may be accompanied with recurrent meningitis. The site of leakage may either be anterior (in the nose and paranasal sinuses) or posterior (in the temporal bone). Various imaging techniques can be used to precisely locate the point of leakage but despite all the advances in imaging techniques there are still some rare cases in which the surgeon can't be sure on the management approach before the beginning of surgery.

CASE REPORT

In this article we present one of these cases; we used intrathecal fluorescein to locate the source of the leak and made the final decision on the operating table.

CONCLUSION

Intrathecal fluorescein is helpful in locating the leakage in the ear or the nose in ambiguous cases.

Use of a sternocleidomastoid myocutaneous flap based on the sternocleidomastoid branch of the superior thyroid artery to reconstruct extensive cheek defects

INTRODUCTION

Reconstruction of head and neck defects has always been challenging due to functional and cosmetic concerns. Although sternocleidomastoid (SCM) flaps have been used for many head and neck defects, use of an SCM flap to reconstruct a cheek defect based only on the superior thyroid artery has not been reported previously.

CASE REPORT

The case of a 40-year-old farmer with a large full-thickness cheek squamous cell carcinoma is reported. An SCM myocutaneous flap based on the SCM branch of the superior thyroid artery was used.

CONCLUSION

An SCM myocutaneous flap is a valuable option for head and neck reconstructions with reasonable aesthetic results. For properly selected cases, this flap obviates the need to use the pectoralis major or other more distant flaps.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Mandibular metastasis from follicular thyroid carcinoma: a rare case after twelve years

Metastatic tumor of the mandible is a rare lesion and differentiated carcinomas of the thyroid as the primary site of origin are even more uncommon. A case of late metastasis of follicular thyroid carcinoma (FTC) to the mandible is presented here. The metastasis arose 12 years after thyroidectomy. Although relatively rare, thyroid tumors metastasis to the mandible should be born in mind, as in rare cases this metastasis may be the only presentation of the original malignancy.

Music training program: a method based on language development and principles of neuroscience to optimize speech and language skills in hearing-impaired children

INTRODUCTION

In recent years, music has been employed in many intervention and rehabilitation program to enhance cognitive abilities in patients. Numerous researches show that music therapy can help improving language skills in patients including hearing impaired. In this study, a new method of music training is introduced based on principles of neuroscience and capabilities of Persian language to optimize language development in deaf children after implantation.

MATERIALS AND METHODS

The candidate children are classified in three groups according to their hearing age and language development. The music training program is established and centered on four principles, as follows: hearing and listening to music (with special attention to boost hearing), singing, rhythmic movements with music and playing musical instruments.

RESULTS

Recently much research has demonstrated that even after cochlear implant operation, a child cannot acquire language to the same level of detail as a normal child. As a result of this study music could compensate this developmental delay .It is known that the greater the area of the brain that is activated, the more synaptic learning and plasticity changes occur in that specific area. According to the principles of neural plasticity, music could improve language skills by activating the same areas for language processing in the brain.

CONCLUSION

In conclusion, the effects of music on the human brain seem to be very promising and therapeutic in various types of disorders and conditions, including cochlear implantation.

Prediction of Stapes Footplate Thickness Based on the Level of Hearing Loss in Otosclerosis

During surgical treatment of a patient with otosclerosis, the probability of success depends in large part on the extent of the surgeon's experience. Therefore, predicting the preoperative severity of disease may help determine the choice of surgeon based on how experienced the surgeon should be. We conducted a study to evaluate the relationship between hearing thresholds and footplate thickness in otosclerosis patients who underwent stapes surgery. We used a qualitative method for measuring footplate thickness that was based on the simplicity or difficulty of opening the footplate. Our study population was divided into two groups; group 1 was made up of 66 patients whose footplates were easily opened with low pressure or with repeated motions by hand, and group 2 was made up of 14 patients whose footplate was either opened by drilling or not opened because it had been obliterated. We found that the patients in group 2, who had more severe disease, had significantly higher air-and bone-conduction thresholds than did the patients in group 1. According to our findings, otosclerotic patients with high air- and bone-conduction thresholds generally have more severe disease and thus require a more experienced surgeon.

Prediction of stapes footplate thickness based on the level of hearing loss in otosclerosis

During surgical treatment of a patient with otosclerosis, the probability of success depends in large part on the extent of the surgeon's experience. Therefore, predicting the preoperative severity of disease may help determine the choice of surgeon based on how experienced the surgeon should be. We conducted a study to evaluate the relationship between hearing thresholds and footplate thickness in otosclerosis patients who underwent stapes surgery. We used a qualitative method for measuring footplate thickness that was based on the simplicity or difficulty of opening the footplate. Our study population was divided into two groups; group 1 was made up of 66 patients whose footplates were easily opened with low pressure or with repeated motions by hand, and group 2 was made up of 14 patients whose footplate was either opened by drilling or not opened because it had been obliterated. We found that the patients in group 2, who had more severe disease, had significantly higher air- and bone-conduction thresholds than did the patients in group 1. According to our findings, otosclerotic patients with high air- and bone-conduction thresholds generally have more severe disease and thus require a more experienced surgeon.

Outcome of stapes surgery for tinnitus recovery in otosclerosis

INTRODUCTION

Stapes surgery is mainly used to improve hearing in otosclerosis; however, many patients report alleviation of tinnitus after surgery.

OBJECTIVE

to evaluate the effectiveness of stapes surgery for improving tinnitus symptoms.

MATERIALS AND METHODS

This prospective study included 29 patients with surgically proven otosclerosis, who had undergone stapedectomy or stapedotomy. We compared symptomatic (tinnitus, hearing loss, and vertigo) and audiological findings obtained before and after surgery. Using Newman's method the level of discomfort caused by tinnitus was scored from grade I to V pre- and postoperatively.

RESULTS

The mean preoperative tinnitus discomfort grade was 2.72, at day 1 after surgery it was 1.29, and after 1 month it had decreased to 0.96, indicating a significant improvement in the level of tinnitus discomfort (p < 0.0001). One month after surgery 82.8% of patients had a complete or partial absence of tinnitus.

CONCLUSION

We conclude that stapes surgery is quite effective for treatment of tinnitus as well as improvement of hearing. When deciding upon management in patients with otosclerosis the presence of tinnitus should be considered as well as hearing level.

Effect of silymarin in the treatment of allergic rhinitis

OBJECTIVE

Although the role of oxidative stresses has been confirmed in the pathophysiology of allergic rhinitis and the protective effect of silymarin against oxidative stresses has been proven in different organs, no study has yet been conducted on the impact of silymarin on allergic rhinitis treatment.

STUDY DESIGN

A randomized clinical trial study.

SETTING

Two tertiary referral centers with otorhinolaryngology-head and neck surgery and allergy and immunology departments.

PATIENTS AND METHODS

In a randomized clinical trial, 94 patients with the signs and symptoms of allergic rhinitis and a positive skin prick test were selected and randomly divided into 2 groups. Their signs and symptoms, eosinophil percentage on nasal smear, serum IgE, and interleukin (IL-4, IL-5, interferon-γ) levels were recorded. The study group was treated with silymarin, whereas the control group received placebo, both for 1 month, along with routine antihistamine treatment. At the end of the treatment course, clinical and laboratory findings were statistically analyzed.

RESULTS

Sixty patients completed the trial. Based on the Sino-Nasal Outcome Test 20 (SNOT-20), a significant improvement in clinical symptom severity was observed in both groups (9.23 ± 5.14 vs 2.20 ± 2.69; P < .001), which was statistically significantly higher in the study group (P < .001). Posttreatment percentage of nasal eosinophils and cytokine levels showed no significant difference (P > .05). Rise in serum IgE level was seen after treatment with silymarin (P = .003).

CONCLUSION

Considering the statistically effective role of silymarin in alleviating the severity of allergic rhinitis symptoms, applying this herbal antioxidant along with other medications may result in better management.

Classification of voice disorder in children with cochlear implantation and hearing aid using multiple classifier fusion

Background

Speech production and speech phonetic features gradually improve in children by obtaining audio feedback after cochlear implantation or using hearing aids. The aim of this study was to develop and evaluate automated classification of voice disorder in children with cochlear implantation and hearing aids.

Methods

We considered 4 disorder categories in children's voice using the following definitions:

Level_1: Children who produce spontaneous phonation and use words spontaneously and imitatively.

Level_2: Children, who produce spontaneous phonation, use words spontaneously and make short sentences imitatively.

Level_3: Children, who produce spontaneous phonations, use words and arbitrary sentences spontaneously.

Level_4: Normal children without any hearing loss background. Thirty Persian children participated in the study, including six children in each level from one to three and 12 children in level four. Voice samples of five isolated Persian words "mashin", "mar", "moosh", "gav" and "mouz" were analyzed. Four levels of the voice quality were considered, the higher the level the less significant the speech disorder. "Frame-based" and "word-based" features were extracted from voice signals. The frame-based features include intensity, fundamental frequency, formants, nasality and approximate entropy and word-based features include phase space features and wavelet coefficients. For frame-based features, hidden Markov models were used as classifiers and for word-based features, neural network was used.

Results

After Classifiers fusion with three methods: Majority Voting Rule, Linear Combination and Stacked fusion, the best classification rates were obtained using frame-based and word-based features with MVR rule (level 1:100%, level 2: 93.75%, level 3: 100%, level 4: 94%).

Conclusions

Result of this study may help speech pathologists follow up voice disorder recovery in children with cochlear implantation or hearing aid who are in the same age range.