Endoscopic ossiculoplasty in traumatic conductive hearing loss with intact tympanic membrane: a five-year experience

BACKGROUND

Exploratory tympanotomy in cases of traumatic ossicular disruption with intact tympanic membrane is crucial for both diagnostic and therapeutic purposes. Performing this procedure using the endoscope is gaining popularity. Hence, this study aimed to demonstrate varieties of ossicular pathology and their management in our institution.

METHODS

A retrospective evaluation was conducted of 136 ears in patients with traumatic ossicular disruption with an intact tympanic membrane, who underwent endoscopic exploratory tympanotomy. A proposed algorithm was followed, to incorporate different traumatic ossicular possibilities. Assessment of hearing outcomes and surgical complications was performed six months post-operatively.

RESULTS

Incudostapedial dislocation was the most commonly encountered type of traumatic ossicular disruption (35.3 per cent). Air conduction threshold improved significantly following endoscopic ossiculoplasty, from 50.9 ± 6.35 dB pre-operatively to 22.35 ± 3.27 dB post-operatively, with successful air-bone gap closure.

CONCLUSION

Endoscopic ear surgery is effective in the diagnosis and management of challenging cases of post-traumatic ossicular disruption with an intact tympanic membrane.

Evaluation of the Baha SoundArc in children

OBJECTIVE

The Baha SoundArc coupling system has been developed as a non-surgical coupling of a Baha sound processor to the skull allowing the transfer of vibrational energy to the cochlear partition via bone conduction pathways. Today, there are several alternatives to this non-surgical approach as the Baha headband/test band, or the Baha Softband, or adhesive patches. Each of these current options have benefits and liabilities. The aim of the study was to evaluate pediatric experience and performance when using two non-surgical options, the Baha SoundArc compared to the Baha Softband.

METHODS

Twenty-five children with unilateral mixed or conductive hearing loss aged 5-12 years of age evaluated the use of the Baha SoundArc compared to their existing Baha Softband in a one month take home trial. Participants had a minimum of 3 months experience using the control, Baha Softband. Participants were assessed at baseline and one month following fit of the Baha SoundArc. Measures included an experience and use patient reported outcome, speech perception testing in quiet using Phonetically Balanced Kindergarten (PBK) words, and sound field audiometry.

RESULTS

Mean aided soundfield thresholds across the frequency range were 27.6 dB HL for Softband and 26.0 dB HL for SoundArc, which were not significantly different (P = >.05). Mean word recognition score was 80.8% when aided with the Softband device and 85.1% with the SoundArc, which was also not significantly different (P = >.05). Most children favored the aesthetics and usability of the SoundArc over Softband, but comfort ratings were largely similar for both devices.

CONCLUSIONS

Bone conduction sound processors mounted on a SoundArc or a Softband resulted in comparable improvements in aided thresholds and speech understanding in children suffering from conductive or mixed hearing loss. Both wearing modalities can be considered equivalent in terms of audiological outcomes, although both patients and clinicians preferred the usability and aesthetics of the SoundArc. The SoundArc provides an alternative wearing option for patients that may otherwise be discouraged by the aesthetics and usability of the Softband device.

CLINICALTRIALS

GOV IDENTIFIER

NCT03333577.

Does the Location of a Small Tympanic Membrane Perforation Affect the Degree of Hearing Loss in Adult Patients with Inactive Mucosal Chronic Suppurative Otitis Media?

BACKGROUND

Tympanic membrane perforation due to inactive mucosal chronic suppurative otitis media is a common problem in otolaryngology, with consequent conductive hearing loss. Still, there is controversy about the relationship between the location of the tympanic membrane perforation and the degree of hearing impairment.

AIM OF THE STUDY

To assess the correlation between the location of a small tympanic membrane perforation and the degree of conductive hearing loss in adult patients with inactive mucosal chronic suppurative otitis media.

PATIENTS AND METHODS

A prospective cross-sectional study enrolled 74 adult patients with small tympanic membrane perforations (perforation involves less than one quadrant of the tympanic membrane) and conductive hearing loss (airbone gap ≥ 20 dB HL) due to inactive mucosal chronic suppurative otitis media for at least 3 months. The locations of the tympanic membrane perforations were classified as anterosuperior, anteroinferior, posterosuperior, and poster inferior perforations. Audiometric analysis and a CT scan of the temporal bone were done for all patients. The means of the air and bone conduction pure tone hearing threshold averages at frequencies 500, 1000, 2000, and 4000 Hz were calculated, and consequently, the air-bone gaps were calculated and presented as means. The ANOVA test was used to compare the means of the air-bone gaps, and the Scheffe test was used to determine if there were statistically significant differences regarding the degree of conductive hearing loss in relation to different locations of the tympanic membrane perforation.

RESULTS

The ages of the patients ranged from 20 to 43 years (mean = 31.9 ± 6.5 years), of whom 43 (58%) were females and 31 (42%) were males. The means of the air-bone gaps were 32.29 ± 5.41 dB HL, 31.34 ± 4.12 dB HL, 29.87 ± 3.48 dB HL, and 29.30 ± 4.60 dB HL in the posteroinferior, posterosuperior, anteroinferior, and anterosuperior perforations, respectively. Although the air-bone gap's mean was greater in the posteroinferior perforation, statistical analysis showed that it was insignificant (P-value=0.168).

CONCLUSION

In adult patients with inactive chronic suppurative otitis media, the anteroinferior quadrant is the most common location of the tympanic membrane perforation, and there was an insignificant correlation between the location of a small tympanic membrane perforation and the degree of conductive hearing loss.

Isolated Fracture of the Malleus: An Overlooked Cause of Conductive Hearing Loss?

OBJECTIVE

To report the largest case series of isolated malleus fractures with systematic review to characterize the disease's presentation and natural history, and provide suggestions for management.

DATA SOURCES

PubMed, Embase, Cochrane Library.

REVIEW METHODS

Retrospective cohort study was performed on 12 patients with isolated malleus fractures. History, physical exam, pre- and post-treatment audiograms, and imaging were obtained. Systematic review of the literature was performed.

RESULTS

Including the cases herein, 58 isolated malleus fractures were identified, the majority of which were published in the 21st century. Mean time to presentation after injury was 34.4 months. Most common etiology was external auditory canal (EAC) manipulation. Physical exam and imaging did not identify any abnormality at presentation in 16% and 21% of cases, respectively. The majority of fractures involved the manubrium. Air-bone gap (ABG) at initial presentation ranged from 16 to 26 dB, and was greater at higher frequencies. Thirty-six cases underwent surgery. ABG improvement was greater at all frequencies for those who underwent surgery. Final ABG was significantly less than initial ABG at nearly every frequency for those who underwent surgery (p < 0.05), while not at any frequency for those who were observed.

CONCLUSIONS

Isolated malleus fractures may occur more often than historical data suggests, and are perhaps underdiagnosed. Abrupt removal of a finger from the EAC with pain and hearing loss is nearly pathognomonic. Conductive hearing loss with ABG greater at higher frequencies is most often observed. Observation is unlikely to produce spontaneous improvements in hearing, while surgery demonstrates reliable decreases in ABG. Laryngoscope, 134:1032-1041, 2024.

Prediction of postoperative speech comprehension with the transcutaneous partially implantable bone conduction hearing system Osia®

BACKGROUND

The active transcutaneous, partially implantable osseointegrated bone conduction system Cochlear™ Osia® (Cochlear, Sydney, Australia) has been approved for use in German-speaking countries since April 2021. The Osia is indicated for patients either having conductive (CHL) or mixed hearing loss (MHL) with an average bone conduction (BC) hearing loss of 55 dB HL or less, or having single-sided deafness (SSD).

OBJECTIVES

The aim of this retrospective study was to investigate the prediction of postoperative speech recognition with Osia® and to evaluate the speech recognition of patients with MHL and in particular an aided dynamic range of less than 30 dB with Osia®.

MATERIALS AND METHODS

Between 2017 and 2022, 29 adult patients were fitted with the Osia®, 10 patients (11 ears) with CHL and 19 patients (25 ears) with MHL. MHL was subdivided into two groups: MHL‑I with four-frequency pure-tone average in BC (BC-4PTA) ≥ 20 dB HL and < 40 dB HL (n = 15 patients; 20 ears) vs. MHL-II with BC-4PTA ≥ 40 dB HL (n = 4 patients; 5 ears). All patients tested a bone conduction hearing device on a softband preoperatively. Speech intelligibility in quiet was assessed preoperatively using the Freiburg monosyllabic test in unaided condition, with the trial BCHD preoperatively and with Osia® postoperatively with Osia®. The maximum word recognition score (mWRS) unaided and the word recognition score (WRS) with the test system at 65 dB SPL were correlated with the postoperative WRS with Osia® at 65 dB SPL.

RESULTS

Preoperative prediction of postoperative outcome with Osia® was better using the mWRS than by the WRS at 65 dB SPL with the test device on the softband. Postoperative WRS was most predictive for patients with CHL and less predictable for patients with mixed hearing loss with BC-4PTA ≥ 40 dB HL. For the test device on a softband, the achievable outcome tended to a minimum, with the mWRS tending to predict the realistically achievable outcome.

CONCLUSION

Osia® can be used for the treatment of CHL and MHL within the indication limits. The average preoperative bone conduction hearing threshold also provides an approximate estimate of the postoperative WRS with Osia®, for which the most accurate prediction is obtained using the preoperative mWRS. Prediction accuracy decreases from a BC-4PTA of ≥ 40 dB HL.

Comparison of ASSR and frequency specificity ABR induced by NB CE-Chirp for prediction of behavioral hearing thresholds in children with conductive hearing loss

BACKGROUND

Electrophysiological tests are often used to evaluate hearing loss in infants and young children with conductive hearing loss, no matter to quantify or characterize. However, there are advantages and disadvantages associated with the various electrophysiological tests that are currently available. Therefore, there is no gold standard test. This study aimed to compare the value of narrow-band (NB) CE-Chirp-induced auditory steady-state response (ASSR) and auditory brainstem response (ABR) for assessing hearing thresholds in children with conductive hearing loss. We hope to identify an effective electrophysiological testing method to evaluate conductive hearing loss and provide a reference for clinical hearing assessment of infants with conductive hearing loss.

SUBJECTS

and Methods: We selected 27 children (41 ears) aged 3-6 years with otitis media with effusion (OME). Within 1 day, they underwent behavioral audiometry and NB CE-Chirp-induced ASSR and ABR tests in sequence. Pearson's correlation analysis was performed to compare behavioral audiometry thresholds and ASSR and ABR response thresholds at 500, 1000, 2000, and 4000 Hz.

RESULTS

The behavioral audiometry thresholds of all children were strongly correlated with the response thresholds of the two electrophysiological tests, with correlation coefficients of 0.659, 0.605, 0.723, and 0.857 for ASSR, and 0.587, 0.684, 0.753, and 0.802 for ABR. The proportion of children with a difference of ≤10 dB between ASSR and behavioral audiometry thresholds or between ABR and behavioral audiometry thresholds was not high, especially in the low frequencies. ABR results were superior to ASSR results in terms of predicting actual hearing levels. At 0.5, 1, 2, and 4 kHz, the average differences between the behavioral hearing thresholds and ASSR thresholds in the 41 ears were 5.6, 5.7, 2, and 5.6 dB, respectively. The average differences between behavioral hearing thresholds and ABR thresholds was -5.6, -1.4, -6.8, and 3.2 dB, respectively. The hearing loss configuration of the ASSR exhibited a peaked pattern, similar to behavioral audiometry, whereas the ABR exhibited an ascending pattern. The time to perform the single-ear ASSR test was 5.9 min, whereas the ABR test took 17.0 min.

CONCLUSION

ASSR and ABR induced by the NB CE-Chirp correlated well with behavioral audiometry in children with conductive hearing loss. The NB CE-Chirp ASSR has advantages in terms of testing time and hearing configuration evaluation, whereas ABR has better reliability than ASSR. However, the stability of ASSR and ABR induced by the NB CE-Chirp is poor, and the thresholds obtained cannot replace behavioral audiometry in evaluating the true hearing of children with conductive hearing loss. However, ASSR and ABR can be used as auxiliary tests for cross-validation.

Prevalence of hearing loss and health vulnerability in children aged 25 to 36 months: an analysis of spatial distribution

PURPOSE

To analyze the association between hearing loss and health vulnerability in children aged 25 to 36 months.

METHODS

Analytical observational cross-sectional study conducted through child hearing screening in nine day-care centers. The screening consisted of anamnesis, otoscopy, tympanometry, transient otoacoustic emissions, and pure tone audiometry. For each exam performed, the 'pass' and 'fail' criteria were established. The children's residential addresses were georeferenced and a choropleth map of the spatial distribution was built, considering the Health Vulnerability Index (HVI). The analysis of the association between the HVI and the variables sex, auditory assessment, and region area of the household was performed using Pearson's Chi-square and Fisher's Exact tests.

RESULTS

Ninety-five children of both sexes were evaluated, of which 44.7% presented alterations in at least one of the exams performed, being referred for otorhinolaryngological evaluation and subsequent auditory assessment. Of the observed changes, 36.9% occurred in the tympanometry and 7.8% in the transient otoacoustic emissions. Among children referred for reassessment, 9.7% were diagnosed with conductive hearing loss, 13.6% results within normal limits and 21.4% did not attend for assessment. Of the children who presented the final diagnosis of conductive hearing loss (9.7%), 1.9% were classified as low-risk HVI and 6.8% as medium-risk HVI. There was statistical significance between HVI and the child's place of residence.

CONCLUSION

The association between hearing loss and HIV was not statistically significant; however, it was possible to observe that 77.7% of the children with hearing loss resided in sectors with medium- risk HIV.

Sensitivity of the antiphasic digits-in-noise test to simulated unilateral and bilateral conductive hearing loss

OBJECTIVES

The objective of this study is (1) to assess whether the presentation level of the antiphasic digits-in-noise (DIN) test affects the speech recognition threshold (SRT), (2) to evaluate how accurately simulated unilateral and bilateral conductive hearing loss is detected (CHL) and (3) to determine whether increasing the presentation level normalises the antiphasic DIN SRT.

DESIGN

Participants performed antiphasic and diotic DINs at different presentation levels with unilateral, bilateral or no earplugs.

STUDY SAMPLE

Twenty-four and twelve normal hearing adults.

RESULTS

Without earplugs, antiphasic DIN SRTs did not differ between 60 and 80 dB SPL. At 60 dB SPL, the antiphasic DIN correctly classified 92% of the unilateral earplug cases; the diotic DIN 25%. The binaural intelligibility level difference did not differ between the no-earplug condition and the condition with bilateral earplugs when the presentation was increased with the attenuation level.

CONCLUSIONS

In normal hearing participants, diotic and antiphasic DIN SRTs are independent of presentation level above a minimum level of 60 dB SPL. The antiphasic DIN is more sensitive than the diotic DIN for detecting unilateral CHL; not for bilateral CHL. The effect of CHL on DIN SRTs can be largely compensated by increasing the presentation level. Audibility plays an important role in the antiphasic and diotic DIN.

Incidental Finding of a Persistent Stapedial Artery in a Patient Presenting With Conductive Hearing Loss

A persistent stapedial artery is a congenital vascular malformation that can cause tinnitus and/or conductive hearing loss. Although rare, this case highlights the importance of recognizing aberrant anatomy as a potential cause of patients' symptoms. It also demonstrates how to recognize and treat patients with a symptomatic persistent stapedial artery.

[Clinical application of retrosigmoid approach for BONEBRIDGE implantation after auricle reconstruction using expanded postauricular flap]

Objective: To explore the safety and reliability of retrosigmoid approach BONEBRIDGE implantation in patients with auricle reconstruction using skin expansion flap. Methods: A retrospective analysis was conducted on 43 congenital aural atresia cases (43 ears) who underwent BONEBRIDGE implantation from September 2019 to January 2023 in Beijing Tongren Hospital. 30 males and 13 females were included in this work. The implantation age was 9-36 years old (median age=10 y/o). All cases underwent auricle reconstruction surgery using the posterior ear flap expansion method, with 36 cases using the single expanded postauricular flap method and 7 cases using two-flap method. BONEBRIDGE implant surgery was performed during the third stage of auricle reconstruction or after all stages. The hearing improvements were evaluated by comparing the changes in pure tone hearing threshold and speech recognition rate of patients before and after BONEBRIDGE implantation. Routine follow-up was conducted to observe the hearing results and complications. SPSS 14.0 software was applied for data statistical analysis. Results: All 43 patients healed well and had no surgical complications when discharge. The average bone conduction hearing threshold after surgery was (8.2±6.6) dBHL, and there was no statistically significant difference compared to the preoperative [(8.1±5.7) dBHL] (P=0.95). After surgery, the threshold of hearing assistance with power on was significantly lower than that without hearing assistance [(32.8±4.6) dBHL vs (60.5±5.5) dBHL], and the difference was statistically significant (P<0.001). The speech recognition rate of monosyllable words, disyllabic words and short sentences in quiet environment increased to 72%, 84%, and 98% respectively. The differences were statistically significant (P<0.001). The speech recognition rate of monosyllabic words, disyllabic words, and short sentences in noise environment was significantly increased by 70%, 80%, and 92% respectively (P<0.001). After a follow-up of 4 to 47 months (median=24 months), the hearing results were stable and the aesthetic outcomes were satisfying. One patient had delayed hematoma around coil of the implant. After aspiration and compressed dressing for one week, hematoma was not recurrent. Conclusion: For patients after auricle reconstruction using expanded postauricular flap, the preference of retrosigmoid approach is a good choice in terms of safety and reliability of operation, as well as aesthetic appearance.

Acquired Stenosis of the External Ear Canal

Acquired stenosis of the external ear canal (ASEEC) is a relatively uncommon condition. Stenosis or narrowing of the external ear canal (EEC) occurs lateral to the tympanic membrane resulting in a skin lined blind canal. Recurrent otorrhea, and conductive hearing loss are typical clinical features. Although ASEEC can be due to different etiologies, a common pathogenesis, namely an inflammatory cascade, has been implicated. Clinical evaluation, audiogram, and Computed tomography (CT scan) form the mainstay of diagnosis. Surgery is the primary modality for treatment. Restenosis is the most common postsurgical complication.

Newborn Hearing Screening: Early Ear Examination Improves the Pass Rate

BACKGROUND

Temporary conductive hearing loss due to vernix accumulation in the external ear canal may lead to a false-positive result in newborn hearing screening tests. The aim of this study was to evaluate whether ear examination and intervention may reduce the false-positive rate prior to hospital discharge.

METHODS

A case series of 42 newborns who failed initial otoacoustic emissions screening were studied in our institution between May and December 2020.

RESULTS

During the study period, a total of 735 neonates (1470 ears) were screened by otoacoustic emissions in our hospital. Forty-two newborns who failed otoacoustic emissions were included in our study. They constituted 3.9% (n=58 ears) of the total number of ears screened. Forty-four ears (75.9%) passed and 14 ears (24.1%) failed otoacoustic emissions rescreening performed shortly following vernix cleaning. Twelve of the remaining 14 ears passed at 10-day rescreening. The remaining 2 ears presented true bilateral hearing loss. During the study period, the general false-positive rate decreased from 56/735 (7.61%) to 12/735(1.63%) (P < .00001).

CONCLUSION

Cleaning the vernix of infants who failed otoacoustic emissions prior to hospital discharge lowers the false-positive rate of universal neonatal hearing screening. We may assume that vernix cleaning will reduce significant healthcare workload, costs of unnecessary investigations, as well as parental anxiety.

Audiological assessment with Matrix sentence test of percutaneous vs transcutaneous bone-anchored hearing aids: a pilot study

PURPOSE

The study evaluated if there were differences between two types of bone-anchored hearing aids (BAHA), percutaneous vs transcutaneous implants in terms of audiological and psychosocial outcomes.

METHODS

Eleven patients were enrolled. Inclusion criteria were: patients with conductive or mixed hearing loss in the implanted ear with a bone conduction pure-tone average (BC PTA) of the hearing threshold at 500, 1000, 2000, and 3000 Hz ≤ 55 dB HL, aged > 5 years. Patients were assigned to two groups: percutaneous implant (BAHA Connect) and transcutaneous implant (BAHA Attract). Pure-tone audiometry, speech audiometry, free-field pure-tone and speech audiometry with the hearing aid, and Matrix sentence test were performed. The Satisfaction with Amplification in Daily Life (SADL) questionnaire, the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, and the Glasgow Benefit Inventory (GBI) were used to assess the psychosocial and audiological benefits provided by the implant, and the variation in the quality of life after the surgery.

RESULTS

No differences were found comparing the data of Matrix SRT. APHAB and GBI questionnaires did not show a statistically significant difference comparing each subscale and the global score. The comparison of scores obtained from the SADL questionnaire demonstrated a difference in the "Personal Image" subscale with a better score for the transcutaneous implant. Furthermore, the Global Score of the SADL questionnaire was statistically different between groups. Other subscales did not show any significant difference. A Spearman's ρ correlation test was used to evaluate if the age could influence the SRT results; no correlation was found between age and SRT. Furthermore, the same test was used to confirm a negative correlation between SRT and the global benefit of the APHAB questionnaire.

CONCLUSION

The current research confirms the absence of statistically significant differences comparing percutaneous and transcutaneous implants. The Matrix sentence test has shown the comparability of the two implants in the speech-in-noise intelligibility. Actually, the choice of the implant type can be done according to the patient's personal needs, the surgeon's experience, and the patient anatomy.

Conductive hearing loss in newborns: Hearing profile, risk factors, and occasions of service

OBJECTIVE

Infants diagnosed with a conductive hearing loss (CHL) are at increased risk of developmental delays. Using a sample of infants diagnosed with CHL through UNHS, this study aimed to investigate the relationship between specific demographic or clinical characteristics and 1) occasions of service to reach a hearing diagnosis and 2) the profile of CHL.

METHODS

Retrospective analysis was conducted for all infants with CHL born between 01/01/2007 and 31/12/2018 who had received UNHS. Chi squared analysis was conducted on data from 1208 records.

RESULTS

Infants with ≥1 risk factor for hearing loss were more likely to attend more than three occasions of service. Infants who were bilateral refer/medical exclusion, Torres Strait Islander, had ≥1 risk factors for hearing loss or were born pre-term had greater proportions of bilateral CHL than unilateral CHL. Mild to moderate was the most frequent degree of CHL, although a unilateral or bilateral CHL did not have an association with the severity of CHL. Compared to other risk factors, infants with a syndrome had greater proportions of bilateral than unilateral CHL. Risk factors of craniofacial abnormality, prolonged ventilation, or syndrome had greater proportions of mild to moderate CHL than moderate or greater. On average, infants were diagnosed with a CHL at 37.29 weeks of age.

CONCLUSION

These findings highlight the relationship between clinical/demographic characteristics and occasions of service to diagnose CHL in children, including the CHL profile. An understanding of this relationship may help clinicians to better plan, assess and manage infants diagnosed with a CHL through UNHS.

CHARACTERISTICS OF HEARING RECOVERY IN CHILDREN WITH CHRONIC OTITIS MEDIA WITH EFFUSION AFTER VENTILATION TUBE INSERTION

The objective was to determine the range of hearing improvement (in dB) post ventilation tube insertion in children with chronic otitis media with effusion (COME), and whether there was a difference in hearing improvement between age groups and genders. This study also investigated whether there was a difference in the mean hearing improvement between the left and right ear, how many months passed before recovery of eustachian tube function, and how long the aeration of the middle ear lasted. The children included in the study were between six and twelve years of age, diagnosed with COME by audiological processing (type B tympanometric recording and conductive hearing loss up to 40 dB on pure tone audiometry) and underwent surgical insertion of ventilation tubes in both ears. Patient data included preoperative tympanometric records, preoperative and postoperative tone audiometry findings, tubometry findings 6 and 10 months after insertion of ventilation tubes, age and gender data, and length of time during which the tubes were in place. The mean hearing improvement of the included patients was 24.2 dB on the right ear and 24.5 dB on the left ear. There was no statistically significant difference between the left and right ear or between the genders. Older age groups had a higher mean hearing improvement compared with the younger age group. Younger age groups had a longer expected period of eustachian tube function recovery, and were expected to have ventilation tubes inserted for a longer period of time. Treatment with ventilation tube insertion resulted in significant improvement in hearing in children where previous conservative therapy failed to recover eustachian tube function and improve hearing. Although children of older age groups had greater preoperative hearing impairment, the recovery of both eustachian tube function and hearing improvement was faster, and the mean length of time that the ventilation tubes had to be inserted was shorter.

Canceling Crosstalk Sound in Bone Conduction Hearing: An Accelerometer-Based Approach

Bone conduction hearing aids offer a unique solution for people with conductive hearing loss, providing a direct transmission of sound to the cochlea. However, a common issue called "crosstalk" can occur, where sound intended for one ear is received by the opposite ear via bone conduction, affecting the ability to localize sound sources and understand speech in noise. To address this issue, we investigated whether canceling "crosstalk" at an accelerometer located on the mastoid would create a "quiet zone" that reaches the cochlea in the inner ear. Our evaluation with individuals having normal hearing abilities showed that their hearing thresholds were improved with crosstalk cancellation than without. These results indicate that although designed to cancel "crosstalk" at the mastoid, the cancellation still reached the cochlea, making it perceptible and potentially beneficial for those with conductive hearing loss.

Otosclerosis under the magnifying glass

Otosclerosis is a bone condition affecting the stapes bone within the otic capsule, and its exact cause is still unknown. It is characterized by a lack of proper remodeling of newly formed vascular and woven bone, leading to the development of abnormal osteons and the formation of sclerotic bone. Bilateral otosclerosis is seen in 80% of patients and 60% of otosclerosis patients have a family history of the condition. The etiology of this disease is still unknown, there are lots of theories to explain it. The histopathological (HP) studies of otosclerosis showed that osteoblasts, osteoclasts, vascular proliferation, fibroblasts, and histiocytes were observed in the stapes footplate. The onset of the symptoms occurs by the early third decade of life, usually it doesn't start later. In otosclerosis, the energy exerted by sound at the level of the tympanic membrane is reduced in the inner ear due to the fixation and rigidity of the ossicular chain, leading to hearing loss, especially for low frequencies. The primary clinical symptom of otosclerosis is conductive hearing loss but it is important to note that sensorineural hearing loss and mixed hearing loss can also occur as secondary symptoms of the condition. Another symptom present in patients with otosclerosis is tinnitus. The paper carried out a retrospective study of 70 patients diagnosed with otosclerosis in the Department of Otorhinolaryngology of Emergency City Hospital, Timişoara, Romania, between January 2021 to December 2022. Tissue fragments were processed at Service of Pathology by standard Hematoxylin-Eosin staining. The HP diagnosis was completed using Masson's trichrome staining, Giemsa histochemical staining, and immunohistochemical (IHC) reactions with anti-cluster of differentiation (CD)20, anti-CD3, anti-CD4, anti-CD8, anti-CD34, and anti-CD31 antibodies. The microscopic examination showed a chronic diffuse inflammatory infiltrate that consisted predominantly of mature T-lymphocytes, immunohistochemically positive for CD3, CD4 and CD8. There were also present rare CD20-positive B-lymphocytes. Among the lymphocytes, relatively numerous mast cells were identified, highlighted histochemically by the Giemsa staining. They had numerous purple-violet intracytoplasmic granules. In the connective tissue support, a relatively rich vascular network was identified, consisting of hyperemic capillaries, highlighted immunohistochemically with anti-CD31 and anti-CD34 antibodies. Bone tissues trabeculae showed extensive areas of fibrosis. The collagen fibers were highlighted by Masson's trichrome staining, being stained in green, blue, or bluish green.

[Analysis of audiological features in infants with unilateral hearing loss]

Objective:To investigate the audiological characteristics and possible causes of unilateral hearing loss in infants and young children. Methods:105 infants from Beijing Maternal and Child Health Care Institution who failed the newborn hearing screening and were referred to the Children's Hearing Diagnosis Center of PLA General Hospital for hearing diagnosis. They were diagnosed with unilateral hearing loss and underwent clinical data collection. A full set of audiological examinations included ABR, 40 Hz auditory event related potential, ASSR, DPOAE, tympanometry. Results:①In initial diagnosis, 45 cases（42.86%） had mild hearing loss, 19 cases（18.10%） had moderate hearing loss, 14 cases（13.33%） had severe hearing loss, and 27 cases（25.71%） had severe hearing loss; Among them, 65 cases（61.90%） were conductive hearing loss or mixed hearing loss, and 40 cases（38.10%） were sensorineural hearing loss. ②83 of 105 cases had follow-up visits: 24 cases were normal, 15 cases with mild hearing loss, 4 cases with moderate hearing loss, 12 cases with severe hearing loss, and 26 cases with extremely severe hearing loss, 2 cases of hearing loss in both ears. ③From the initial diagnosis to the follow-up diagnosis, the change of mild hearing loss was the largest, followed by moderate hearing loss, severe and extremely severe hearing loss basically did not change; the number of mild and severe conductive hearing loss which recovered to normal hearing was most, the number of sensorineural hearing loss changed little. Conclusion:The infants who failed the newborn hearing screening and were diagnosed with unilateral hearing loss were mainly mild to moderate conductive hearing loss and severe to extremely severe sensorineural hearing loss. The hearing of children with hearing loss gradually improved, and severe and extremely severe sensorineural hearing loss remained unchanged.

[Etiology analysis and diagnosis of noninflammatory conductive hearing loss in children]

Objective:To investigate the etiology, diagnosis and treatment of noninflammatory conductive hearing loss in children. Methods:The clinical data of children patients admitted to the Eye & ENT Hospital of Fudan University from January 2019 to November 2022 were retrospectively analyzed. Results:A total of 179 cases（189 ears） were analyzed. The main symptoms from high to low were: ear tightness, hearing loss, earache, and facial paralysis. The degree of hearing loss was mild in 34 ears（19.5%）, moderate in 70 ears（40.2%）, moderate-severe in 52 ears（29.9%）, severe in 18 ears（10.3%）. The mean hearing threshold of otosclerosis was the highest（63.5±7.8） dB HL, and the mean air-bone gap of ossicular chain malformation was the largest（35.4±9.8） dB HL. The mean hearing threshold of the affected ear was（50.4±14.5） dB HL, and the mean air bone gap was（30.3±10.4） dB HL. After operation, the results were（36.1± 14.5） dB HL and（20.0±8.6） dB HL, respectively. Distribution of surgical methods for ossicular chain reconstruction: 88 ears（46.6%） of TORP, 49 ears（25.9%） of PORP, 8（4.2%） ears of Piston, 9 ears（4.8%） of autogenous ossicular reconstruction, and 35 ears（18.5%） of ossicular chain relaxation. CT diagnostic rate showed more sensitivity to malleus and incus abnormalities, the diagnosis rate of congenital middle ear cholesteatoma was the highest. The mean duration time of diagnosis was（2.2±2.9） years, while the diagnosis of ossicular chain malformation（[5.2±4.2]years）, otosclerosis（[4.4±4.1]years）, tympanosclerosis（[5.4±0.9]years） took longer. Conclusion:In the diagnosis and treatment of noninflammatory conductive hearing loss in children, the combination of detailed medical history, specialized examination and imaging examination can maximize the accuracy of diagnosis and achieve the purpose of personalized comprehensive treatment. Surgical intervention with appropriate timing is important to remove lesions and improve hearing.

In vivo optical mapping of the tympanic membrane impulse response

The wide frequency range of the human hearing could be narrowed by various pathologies in the middle ear and in the tympanic membrane that lead to conductive hearing loss. Diagnosing such hearing problems is challenging, however, often relying on subjective hearing tests supported by functional tympanometry. Here we present a method for in vivo 2D mapping of the impulse response of the tympanic membrane, and demonstrate its potential on a healthy human volunteer. The imaging technique is based on interferometric spectrally encoded endoscopy, with a handheld probe designed to scan the human tympanic membrane within less than a second. The system obtains high-resolution 2D maps of key functional parameters including peak response, rise and decay times, oscillation bandwidth and resonance frequency. We also show that the system can identify abnormal regions in the membrane by detecting differences in the local mechanical parameters of the tissue. We believe that by offering a full 2D mapping of broad-bandwidth dynamics of the tympanic membrane, the presented imaging modality would be useful for effective diagnosis of conductive hearing loss in patients.

Prevalence of hearing loss in patients with Sjögren syndrome: a systematic review and meta-analysis

Sjögren syndrome (SS) is a multisystem autoimmune disease, primarily targeting salivary and lacrimal glands; skin, nasal and vaginal dryness, along with musculoskeletal pain and fatigue are the most commonly reported symptoms. Hearing loss is hypothesized to be frequent as well. The purpose of this systematic review was to estimate the prevalence of Hearing loss and its different subtypes in patients with Sjögren syndrome. PRISMA guidelines were followed to ensure highest quality for our systematic review. A random effects model meta-analysis and meta-regression was conducted using I² as heterogeneity indicator. Eleven observational studies were included in this systematic review. Ten of them were cross-sectional, while one study was case-control. Studies were assessed for risk of bias: all were rated to a moderate level, except for two rated to a low level. Pooled prevalence of any type of hearing loss was 52.2%. After excluding studies rated to moderate bias, the pooled prevalence of hearing loss was 36.7%. We also conducted a subgroup analysis depending on type of hearing loss. Pooled prevalence of sensorineural hearing loss was 42.6%., while pooled prevalence of conductive hearing loss and mixed hearing loss were 5% and 2.3%, respectively. Meta-regression was conducted in an effort to identify possible variables capable to explain high heterogeneity between studies. Sample size and year of study were separately found to account for a portion of heterogeneity between studies of sensorineural hearing loss. Year of study was also found to account for a portion of heterogeneity between studies of conductive hearing loss. In conclusion, sensorineural hearing loss, is highly prevalent in patients with Sjögren syndrome. On this basis, early screening and follow-up of patients with Sjögren syndrome by pure tone audiometry is important.

Ten years' experience with bone conduction hearing aids in the Western Cape, South Africa

Untreated conductive and mixed hearing losses as a result of middle ear pathology or congenital ear malformations can lead to poor speech, language and academic outcomes in children. Lack of access to centralised hearing healthcare in resource-constrained environments limits opportunities for children with hearing loss. Red Cross War Memorial Children's Hospital (RCWMCH) is one of only two dedicated paediatric hospitals in sub-Saharan Africa. Between 2016 and 2021, 29 children received implanted bone conduction hearing devices, and 104 children were fitted with bone conduction devices on softbands. The authors' experience at RCWMCH suggests that bone-anchored hearing devices, either fitted on softbands or on implanted abutments, can provide solutions in settings where patients have limited access to hearing healthcare and optimal classroom environments. Hearing healthcare should be accessible and delivered at the appropriate level of care to mitigate the adverse effects of hearing loss in children.Contribution: This article describes strategies employed at RCWMCH such as fitting bone conduction hearing devices on a softband immediately after hearing loss diagnosis and conducting follow-up via remote technology to make hearing healthcare more accessible to vulnerable populations.

[Choristoma of the middle ear]

Choristoma is one of the varieties of congenital developmental anomalies, where one or another normal tissue of the body is located in an atypical place for itself. The short literary review of choristoma of middle ear is presented in article. A rare clinical cases of salivary gland choristoma of the middle ear (5-year-old girl with left-sided conductive hearing loss of III degree) and glial choristoma of the mastoid (19-year-old man with signs of chronic suppurative otitis media of the right ear) are described.

[Role of computed tomography in the preoperative diagnosis of otosclerosis]

BACKGROUND

Otosclerosis is an osteodystrophy of the otic capsule and presents with progressive conductive hearing loss. Imaging studies, especially computed tomography (CT) and cone-beam CT, have gained increased relevance in the diagnosis of otosclerosis.

OBJECTIVE

This study investigated whether there is a correlation between the extent of otosclerosis in high-resolution or cone-beam CT and hearing loss in pure-tone audiometry.

MATERIALS AND METHODS

Based on an existing classification of otosclerotic foci, a classification was established. Preoperative CT scans of patients undergoing stapedotomy between 2015 and 2019 were evaluated and classified by two independent otorhinolaryngologists. The preoperative pure-tone audiograms were analysed and compared to the results of CT.

RESULTS

A total of 168 CT studies (i.e., 168 ears) in 156 patients with intraoperatively confirmed otosclerosis were included in our study. A correlation between the extent of the otosclerotic focus or the calculated scores and hearing loss in pure-tone audiometry (air conduction, bone conduction and air-bone-gap) could not be proven.

CONCLUSION

Preoperative CT is not obligatory. However, preoperative imaging using CT or cone-beam CT can be helpful to confirm the diagnosis and exclude other middle or inner ear pathologies as well as in planning of the surgical procedure in the overall context of otoscopy and audiometry. A correlation with the degree of hearing impairment could not be demonstrated and remains unclear.

Tone in Noise Detection in Children with a History of Temporary Conductive Hearing Loss

Children with a history of temporary conductive hearing loss (CHL) during early development may show long-term impairments in auditory processes that persist after restoration of normal audiometric hearing thresholds. Tones in noise provide a simplified paradigm for studying hearing in noise. Prior research has shown that adults with sensorineural hearing loss may alter their listening strategy to use single-channel energy cues for tone-in-noise (TIN) detection rather than rove-resistant envelope or spectral profile cues. Our objective was to determine the effect of early CHL on TIN detection in healthy children compared to controls. Children ages 4-7 years, with and without a history of CHL due to otitis media with effusion (OME) before age 3 years, participated in a two-alternative forced choice TIN detection task. Audiometric thresholds were normal at the time of testing. Thresholds for detection of a 1000 Hz tone were measured in fixed-level noise and in roving-level noise that made single-channel energy cues unreliable. Participants included 23 controls and 23 with a history of OME-related CHL. TIN thresholds decreased with increasing age across participants. Children in both groups showed similar TIN sensitivity and little or no threshold elevation in the roving-level condition compared to fixed-level tracks, consistent with use of rove-resistant cues. In contrast to older listeners with sensorineural hearing loss, there was no detectable change in TIN sensitivity with roving level for children with a history of OME-related CHL.

Tympanic membrane perforations: the importance of etiology, size and location

PURPOSE

The ability to predict the degree of a conductive hearing loss caused by a tympanic membrane perforation is important for every otologist, as it may require additional diagnostic tests and prevent unexpected intraoperative findings. The aim of this study was to correlate the various characteristics of a perforation (etiology, size, location, involvement of the manubrium or umbo) with the degree and frequency predominance of the consequent hearing loss.

METHODS

A transversal study in a tertiary hospital center was conducted between July 2019 and December 2020. Fifty-eight patients with 65 tympanic perforations underwent a comprehensive medical and audiological evaluation, which included an otoendoscopy. An image processing software (ImageJ®) was used to measure the perforated area. The qualitative variables were etiology, affected quadrants, presence of myringosclerosis and involvement of umbo or manubrium of the malleus. The air-bone gap was measured at 250, 500, 1000, 2000 and 4000 Hz. Primary outcomes (mean air-bone gap and pure-tone average) were evaluated to find clinical factors associated with worse hearing.

RESULTS

Data collected from 50 ears was included. Perforation size showed a positive statistically significant correlation with the air-bone gap (r = .508; p < .001) and pure-tone average (r = .375; p < .001). Higher air-bone gaps were found in perforations involving the posterior quadrants and the manubrium (p < .001 and p = .031, respectively). Inflammatory causes showed higher bone and air conduction pure-tone averages (p = .031 and p = .084, respectively) compared to traumatic or iatrogenic. An "inverted V" pattern of the air-bone gap, with the 2 kHz frequency being the least affected, was a consistent finding. However, it was not due to the Carhart's notch in bone conduction.

CONCLUSION

The conductive hearing loss resulting from a tympanic membrane perforation is etiology, size and location-dependent, with higher losses occurring for inflammatory backgrounds, large perforations and when the posterior quadrants or the manubrium are involved. If the "inverted V" is absent, additional middle ear pathology should be investigated.

Percutaneous Bone-Anchored Hearing Implant: Is It Clinically Useful in Korean?

BACKGROUND

The aim of this study is to investigate the clinical effectiveness of Ponto in Korea, a recently released percutaneous bone-anchored hearing implant.

METHODS

16 patients with single-sided deafness (SSD) and mixed or conductive hearing loss who underwent Ponto implantation from December 2018 to September 2020 were enrolled in the study. Puretone audiometry, the Korean version of the Hearing in Noise Test (K-HINT), sound localization test (SLT), and Pupillometry were performed pre- and three months post-operation. Standardized questionnaires, the Hearing Handicap Inventory for the Elderly (HHIE) and Speech, Spatial and Qualities of Hearing Scale (SSQ), were administered.

RESULTS

The mean age of subjects was 55.5 (range, 48-67) years. Four males and 12 females participated in the study. The mean puretone average was 73.17 dB hearing level (HL) before surgery and significantly improved to 36.72 dB HL three months after surgery. The mean word recognition score improved from 26.0% to 90.75% after implantation. In the case of K-HINT, there was a significant difference in summation (Z = -2.250, P = 0.024) and head shadow effects (Z = -3.103, P = 0.002). There was no significant difference in root mean square error degree (RMSE) and hemifield identification scores for SLT testing. Pupillometry was performed to measure listening effort and the results revealed that the degree of pupillary dilatation decreased under the condition of quiet, 0 dB signal to noise ratio (SNR) and 3 dB SNR. The total score for HHIE decreased significantly (Z = -3.130, P = 0.002) while the SSQ score increased significantly (Z = -2.216, P = 0.027).

CONCLUSIONS

The Ponto bone-anchored hearing system showed significant clinical benefit in Korean patients with conductive and mixed hearing loss and SSD.

Endoscopic Transcanal and Transmastoid Laser-Assisted Resection of Middle Ear Capillary Hemangioma

OBJECTIVE

To present a rare case of a middle ear capillary hemangioma in an adult.

PATIENT

A 31-year-old woman with a 6-month history of left ear fullness, pressure, tinnitus, and progressive hearing loss.

INTERVENTION

Endoscopic laser-assisted resection.

MAIN OUTCOME MEASURES

Clinical, radiographic, and histopathological findings of a capillary hemangioma.

RESULTS

Otoscopy revealed an erythematous and slightly pulsating multilobulated middle ear retrotympanic mass. Her audiogram demonstrated a left-sided mixed hearing loss with air-conduction thresholds in the severe-to-profound range. Computed tomography (CT) imaging was significant for total opacification of the left middle ear and mastoid air cells. She underwent a combined endoscopic transcanal and transmastoid excision of the mass with ossicular chain reconstruction. A KTP laser was used to ablate and shrink down the periphery of the lesion. Pathology of the specimen was consistent with a capillary hemangioma. The patient's pulsatile tinnitus and spontaneous vertigo resolved postoperatively.

CONCLUSIONS

Capillary hemangiomas are an uncommon cause of vascular middle ear lesions in adults and typically present with symptoms of aural fullness, pulsatile tinnitus, conductive hearing loss, otalgia, and vertigo. Surgery resection provides definitive treatment and the use of laser ablation techniques can allow for hemostasis and excellent visualization.

Hearing Loss and Tinnitus

A focused history, otoscopic and tuning fork examination and formal hearing testing are the diagnostic pillars for the workup of hearing loss and tinnitus. The causes of hearing loss and tinnitus are varied and range from relatively common age-related hearing loss to rare tumors of the brain and skull base. In this chapter, the authors explain the diagnostic workup of hearing loss and tinnitus, review the pathophysiology of the most common causes, and describe the treatments available.

Effects of tympanic membrane perforation, middle ear cavity volume, and mastoid aeration on hearing impairment

AIMS

To investigate the effects of the location and size of tympanic membrane (TM) perforation and middle ear cavity volume on conductive hearing loss in patients with TM perforation.

METHODS

Data were collected via a retrospective medical chart review.

RESULTS

We enrolled 128 patients with a mean age of 45.6 ± 10.1 years. The mean perforation size was 21.2 ± 8.6% of the TM area, and the mean air-bone gap (ABG) was 20.2 ± 8.6 dB HL on pure tone audiometry. Patients were divided into two groups based on mean ABG. Patients with a large ABG had a significantly larger TM perforation area and smaller mastoid volume. The TM perforation was most commonly located in the central section. However, regression analyses showed that the proportion of the perforated TM area was the only independent predictor of a large ABG (odds ratio, 1.053; 95% confidence interval, 1.022-1.085; p = 0.001). When we analyzed the frequencies in which hearing loss occurred due to TM perforation, we confirmed that hearing loss occurred mainly in the low-frequency range.

CONCLUSION

In patients with TM perforation, conductive hearing loss occurs mainly at low frequencies and in proportion to the size of the TM perforation.

[Clinical application of transcanal endoscopic ear surgery in the diagnosis and treatment of conductive hearing loss with intact tympanic membrane]

Objective:To explore the clinical efficacy of transcanal endoscopic ear surgery in the diagnosis and treatment of conductive hearing loss with intact tympanic membrane. Method:The clinical data of 16 patients with conductive hearing loss with intact tympanic membrane were retrospectively analyzed. They were diagnosed and treated by transcanal endoscopic ear surgery. Result:All patients were diagnosed by exploratory tympanotomy, including 6 cases of congenital middle ear anomalies, 5 cases of congenital cholesteatoma, 2 cases of congenital middle ear anomalies with congenital cholesteatoma, 2 cases of otosclerosis, and 1 case of traumatic ossicular chain disruption. During the tympanic exploration by transcanal endoscopic ear surgery, different methods of hearing reconstruction were applied according to the intraoperative lesions. Among 14 cases（14 ears）, 7 patients underwent reconstruction with partial ossicular replacement prosthesis （PORP）, 5 patients had total ossicular replacement prosthesis （TORP）, and 2 patients had piston. The remaining 2 patients did not undergot ossicular reconstruction. After the operation, the mean air-conductive threshold of 14 patients decreased from （61.7±6.5） dB HL to （29.8±10.7） dB HL （P<0.01） and the mean ABG decreased from（36.8±3.2） dB HL to （10.7±6.9） dB HL （P<0.01）. 1 case of congenital middle ear anomalies with congenital cholesteatoma underwent the lesion resection without ossicular reconstruction. Due to lack of suitable Piston, 1 case of congenital middle ear anomalies with fixed stapes did not perform hearing reconstruction. No serious complications occured after operations. Conclusion:Transcanal endoscopic ear surgery was suitable for the diagnosis and treatment of conductive hearing loss with intact tympanic membrane. It was minimally invasive with low complications, and the patients had a good hearing recovery after ossicular reconstruction.

Renal Syndromic Hearing Loss Is Common in Childhood-onset Chronic Kidney Disease

BACKGROUND

Hearing loss (HL) in children may adversely affect their development. HL is more prevalent in patients with chronic kidney disease (CKD) than in the general population. This study evaluated the prevalence of HL and its underlying diseases in patients with childhood-onset in CKD.

METHODS

In this retrospective study of a tertiary referral center, childhood-onset CKD patients (stage 2-5, age at onset of renal symptom < 18 years) were recruited. We referred to the "renal" syndromic HL as cases with genetic or syndromic diseases, or extra-renal anomalies in addition to HL and CKD.

RESULTS

A total of 421 patients (male:female = 279:142) were reviewed according to the causes of CKD: congenital anomalies of the kidney and urinary tract (CAKUT; n = 184, 43.7%), glomerulopathies (GP; n = 105, 24.9%), cystic kidney diseases (CYST; n = 39, 9.3%), perinatal problems (PP; n = 29, 6.9%), and others (n = 64, 15.2%). HL was detected in 82 (19.5%) patients, including 51 (12.1%) patients with sensorineural hearing loss (SNHL), 30 (7.1%) with conductive hearing loss (CHL), and 1 patient with mixed HL. The prevalence of HL in each group was as follows: 16.8% in the CAKUT group, 28.6% in the GP group, 12.8% in the CYST group, 24.1% in the PP group, and 14.1% in the others group. HL was more common in higher CKD stages, especially CHL in end-stage renal disease. SNHL was more prevalent in CKD from GP. Of the 82 patients with HL, 50% had renal syndromic HL: 58.8% of SNHL and one-third of CHL were renal syndromic HL.

CONCLUSION

One-fifth of the childhood-onset CKD had HL. Collectively, renal syndromic HL comprised half of the HL in this study. To improve the quality of life in patients with childhood-onset CKD, we suggest that HL should be considered, requiring surveillance, and if necessary, early intervention.

Are long-term auditory results following ossiculoplasty with bone cement as successful as early-middle period results?

PURPOSE

Bone-cement (BC) ossiculoplasty is one of the options to solve ossicular chain problems. Many authors reported successful results in the early or mid-follow-up period; however, there is no long-term result in the literature. We aim to evaluate long term results of BC ossiculoplasty.

MATERIALS AND METHODS

Forty-eight patients who underwent BC ossiculoplasty as incudostapedial re-bridging by the same surgeon were invited to evaluation. Postoperative otomicroscopic examination was performed. Pre-operative and post-operative audiological results after longer follow up and graft success rate were noted.

RESULTS

Fourteen patients came for control examination. The follow-up period was between 87 and 135 months (mean 102 months). None of the patients had graft failure. Ten patients had early postoperative follow-up results (between 10 and 52; mean 24 months). In the comparison of preoperative and early postoperative air-bone gap, there were significant differences in all frequencies while the comparison of preoperative and long-term postoperative results showed a significant difference only in 250 and 500 Hz. Early postoperative results were better than late with significant difference only in the 2000 and 4000 Hz.

CONCLUSIONS

As reported by many studies, bone cement application provides a significant auditory improvement in the early postoperative period. The results of the present study showed that this early auditory success may decrease over time with a long-term follow-up. Further studies should be conducted with larger patient groups to clarify the long-term benefits of this treatment and possible causes for its deterioration.

An atypical stapedial artery

The persistence of the stapedial artery is a rare vascular anomaly. It is mostly asymptomatic but sometimes cause conductive hearing loss, pulsatile tinnitus, or vertigo. The estimated prevalence of this rare postembryonic persistence ranged from 0.02% to 0.48%. Four different anatomical forms have been identified, and their preoperative diagnostic is essential. We report the case of an incidental discovery of pharyngo-hyo-stapedial artery, the most uncommon form of persistent stapedial artery. Its per-operative finding has become rare because tomodensitometry is performed in case of conductive hearing loss. The continuous improvement of imagery resolution will probably help to revise the incidence of this malformation.

[Conductive hearing loss with a normal eardrum]

Conductive hearing loss with a normal eardrum. Conductive hearing loss with a normal eardrum is defined by a hearing loss in in relation to a disturbance in the transmission of sound waves from a normal eardrum to an intact cochlear nerve. The interest in diagnosing these kinds of hearing loss is due on the one hand to their high frequency, on the other hand to the socio-professional repercussions that they can induce and finally to the fact that a large part of them are accessible to surgical treatment or, hearing aid. The CT-scan contributes to the diagnostic orientation and the preoperative assessment. If the pathologies of the middle ear dominate in frequency the possible causes of conductive hearing loss with a normal eardrum, especially otosclerosis, abnormalities of the inner ear, which can be responsible for conductive or mixed hearing loss, have recently listed thanks to advances in modern digital imaging. After a brief anatomical reminder of the tympano-ossicular system, we will deal with their positive, differential and etiological diagnosis.

Bilateral superior semicircular canal dehiscence: bilateral conductive hearing loss with subtle vestibular symptoms

Superior semicircular canal dehiscence is caused by a bone defect on the roof of the superior semicircular canal. The estimated prevalence when unilateral varies between 0.4% and 0.7% and is still unknown when bilateral. Patients may present with audiologic and vestibular symptoms that may vary from asymptomatic to disabling. We report a case of a 72-year-old Caucasian woman presented to otolaryngology department reporting imbalance, bilateral pulsatile tinnitus, hypoacusis while being very sensitive to certain sounds. Physical examination was unremarkable, except for the Rinne test that was negative in both sides. The patient underwent an audiometry revealing a mild bilateral conductive hearing loss. A temporal bone CT scan was performed which evidenced bilateral superior semicircular canal dehiscence. Cervical vestibular evoked myogenic potentials and electrocochleography confirmed diagnosis. Although rare, superior semicircular canal dehiscence shall be considered in conductive hearing loss with vestibular symptoms.

Contralateral occlusion test: The effect of external ear canal occlusion on predicting conductive hearing loss

INTRODUCTION AND OBJECTIVES

The contralateral occlusion test (COT) has the potential to allow the quantitative evaluation of unilateral conductive hearing loss. The purpose of this study was to determine the accuracy of the test in predicting the degree of hearing loss.

MATERIALS AND METHODS

Fifty-three subjects with unilateral conductive hearing loss were recruited from an otolaryngology department of a tertiary hospital. The COT was performed using 128, 256, 512, 1024 and 2048Hz tuning forks with the non-affected ear canal totally occluded to determine lateralization. Pure-tone audiometry was performed to establish the presence and degree of the air-bone gap (ABG) and the pure-tone average (PTA). The tuning fork responses were correlated with the ABG and the PTA to determine their accuracy.

RESULTS

The COT showed a better association between hearing loss and the lateralization response using the 512Hz tuning fork (p=0.001). The sensitivity of the 512Hz fork in detecting a PTA of at least 35.6dB was 94.6% and the specificity was 75.0% for a positive predictive value of 89.7% and a negative predictive value of 85.7%, assuming a pretest prevalence of 69.8%.

CONCLUSIONS

The overall accuracy of the COT in predicting the degree of unilateral conductive hearing loss was significant. The COT had significant power in one direction: if lateralization to the affected ear occurred, it was almost certain evidence of a moderate or severe conductive hearing loss.

Diagnosing Conductive Dysfunction in Infants Using Wideband Acoustic Immittance: Validation and Development of Predictive Models

Purpose The aims of this study were (a) to validate the wideband acoustic immittance (WAI) model developed by Myers et al. (2018a) in a new sample of neonates and (b) to develop a prediction model for diagnosing middle ear dysfunction in infants aged 6-18 months using wideband absorbance, controlling for the effect of age. Method Tympanometry, distortion product otoacoustic emissions, and WAI were measured in 124 neonates and longitudinally in 357 infants at 6, 12, and 18 months of age. Results of tympanometry and distortion product otoacoustic emissions were used to assess middle ear function of each infant. For the first study, results from the neonates were applied to the diagnostic WAI model developed by Myers et al. (2018a). For the second study, a prediction model was developed using results from the 6- to 18-month-old infants. Results from 1 ear of infants in each age group (6, 12, and 18 months) were used to develop the model. The amount of bias (overfitting) was estimated with bootstrap resampling and by applying the model to the opposite ears (the test sample). Performance was assessed using measures of discrimination (c-index) and calibration (calibration curves). Results For the validation study, the Myers et al. (2018a) model was well calibrated and had a c-index of 0.837 when applied to a new sample of neonates. Although this was lower than the apparent performance c-index of 0.876 reported by Myers et al., it was close to the bias-corrected estimate of 0.845. The model developed for 6- to 18-month-old infants had satisfactory calibration and apparent, bias-corrected, and test sample c-index of 0.884, 0.867, and 0.887, respectively. Conclusions The validated and developed models may be clinically useful, and further research validating, updating, and assessing the clinical impact of the models is warranted.

Changes in middle ear transmission characteristics secondary to altered bone remodelling

Alteration in the process of bone remodelling results in conditions like osteopenia and osteoporosis in which the bones become susceptible to fracture. The functioning of middle ear bones in such individuals were assessed in this study and it was found that the middle ear bones are equally susceptible to micro-fractures and can cause reduction in the transmission of sound energy.

INTRODUCTION

Alteration in the process of bone remodelling or increase in the number of osteoclasts cells as it occurs in osteoporosis and osteopenia are likely to affect the middle ear bones in the same way it affects the skeletal bones. Whether these micro-structural changes occurring at the level of the middle ear secondary to altered bone remodelling cause any significant impairment in its functioning is not explored. Thus, the present study aimed at assessing the different aspects of middle ear functioning in individuals with reduced BMD.

METHODS

The study included 25 normal, 39 osteopenic and 40 osteoporotic participants. The participants underwent pure-tone audiometry, otoscopic examination, conventional immittance evaluation using a 226 Hz probe tone, multi-component and multi-frequency tympanometry and acoustic reflex threshold testing. None of the participants had any current or previous history of middle ear effusion.

RESULTS

A significantly higher proportion of participants in the clinical group had hearing loss compared to the normal group. The clinical group participants also had reduced middle ear resonance frequency, elevated static compliance values and elevated or absent acoustic reflexes compared to the normal participants. There was no difference among the three groups for the proportion of participants having conductive hearing loss.

CONCLUSIONS

There is a detrimental impact of reduction in bone mineral density on middle ear transmission characteristics which may go unnoticed initially. Treatment of osteoporosis may potentially mitigate hearing loss from middle ear fractures due to reduced bone mineral density. Absence of significant air-bone gap with the presence of reduced middle ear resonance frequency may be early signs of reduced BMD.

Auditory System Involvement in Psoriasis

Psoriasis is a systemic inflammatory disorder associated with many other chronic and progressive diseases. There are few studies on the association of psoriasis with alterations in auditory function. A clinical and instrumental pilot study of auditory function was performed with 77 psoriatic patients and 77 age- and sex-matched healthy controls. The main results were: (i) hearing loss, mostly of sensorineural type, was significantly more frequent in patients than in controls; (ii) conductive and mixed hearing loss were more frequent in arthropathic than in non-arthropathic psoriatic patients; (iii) duration of psoriasis > 10 years or smoking were associated with higher frequency of hearing loss; (iv) psoriasis was more severe in patients with hearing loss than in those without hearing loss. Tympanogram abnormalities were found in patients more often than in controls. These data expand the list of extracutaneous conditions associated with psoriasis, and support the need for further basic and clinical research in this field.

Differentiating among conductive hearing loss conditions with wideband tympanometry

OBJECTIVE

This study was aimed to investigate whether wideband tympanometry (WBT) can distinguish among various kinds of conductive hearing loss and provide additional information.

METHODS

We recruited normal subjects and patients with conductive hearing loss due to the following reasons: tympanic membrane perforation only, ossicular chain problem only, and one or other of those conditions combined with mastoid problems. Wideband absorbance at ambient pressure, peak pressure, resonance frequency, and averaged tympanogram data were measured by WBT and compared between the normal, tympanic membrane perforation only, ossicular chain problem only, and combined with mastoid problems groups.

RESULTS

The normal subjects showed an average peak pressure of -19.51daPa and an average resonance frequency of 965.94Hz. Tympanic membrane perforation only patients showed a very low peak pressure (-124.93daPa) and resonance frequency (73.12Hz). When patients have ossicular chain problems, they showed slightly low peak pressures (43.08daPa) without changes in the resonance frequency (1024.8Hz). Mastoid problem subjects showed slightly decreased resonance frequencies (787.71Hz). Tympanic membrane perforation subjects showed decreased absorbance at low frequencies and ossicular chain problem subjects showed decreases at high frequencies. When comparing the perforation only and ossicular chain subjects by absorbance at 707Hz, the area under the ROC curve was 0.719 (P<0.022). Mastoid problems subjects showed decreased absorbance at all frequencies.

CONCLUSION

WBT can help to distinguish tympanic membrane perforation only and ossicular chain problem patients. WBT may provide additional information on "combined with mastoid problems" patients.

Dehiscent high-riding jugular bulb presenting as conductive hearing loss: A case report

RATIONALE

Jugular bulb anomalies are asymptomatic lesions commonly seen in routine practice. However, some patients with jugular bulb anomalies may present with symptoms such as tinnitus or conductive hearing loss (CHL).

PATIENT CONCERNS

A 9 year old boy complained right sided hearing disturbance without any vestibular symptoms. Pure tone audiometry (PTA) revealed a mild right sided conductive hearing loss. Otoscopy showed a red-purplish mass like lesion in his right middle ear cavity, which was regarded as hypervascular tumor.

DIAGNOSIS

Based on otoscopic findings, preliminary differential diagnoses included jugular bulb anomaly, hemotympanum, cholesterol granuloma and paraganglioma.

INTERVENTIONS

We performed contrast enhanced computed tomography of the temporal bone (TBCT).

OUTCOMES

CT scan showed and enhancing lesion which was bulging from his right jugular foramen to the middle ear with dehiscent jugular bulb. The lesion showed the same degree of contrast enhancement with the venous vasculature. This lesion contacted with the tympanic membrane, incudostapedial joint and round window, which might be attributable to interruption of sound transmission mechanics. Otherwise there was no evidence of mass or trauma related lesions in the temporal bone.

LESSONS

Although most of jugular bulb anomalies are asymptomatic, patients may present with conductive hearing loss due to the interference of sound transmission mechanics.

[Stapedo-Vestibular Ankylosis: Retrospective Study of Five Cases in São Tomé e Príncipe]

INTRODUCTION

Otosclerosis is a common form of conductive hearing loss characterized by abnormal bone remodeling exclusively in the otic capsule. The prevalence of otosclerosis varies in racial populations and is described as being rare in black African populations. In this paper we aim to report five cases of clinical, and surgically confirmed, otosclerosis in black individuals, in São Tomé and Príncipe.

MATERIAL AND METHODS

Since February 2011, Ear, Nose and Throat consultations and surgeries specialty have been carried out at Dr. Ayres de Menezes Hospital in cooperation with the project 'Health for all'. A retrospective analysis was undertaken of the records of all patients subjected either to stapedectomy or partial stapedectomy until February 2014. Information regarding clinical presentation, audiometric data and surgery reports was recorded.

RESULTS

Five adult patients underwent stapedectomy or partial stapedectomy. All of them presented with normal otoscopy, conductive or mixed hearing loss on audiogram and normal tympanometry with absent stapedial reflexes. None of the patients had signs of infection or history of head trauma. Three cases showed improvement in the air-bone gap after surgery. The other two were lost to follow-up.

DISCUSSION

We documented and surgically confirmed five cases of clinical otosclerosis in this population. A thematic review was carried out and concluded that, despite being described as a rare event in this race, available literature on this topic is not enough to state that there is lower prevalence of otosclerosis amongst the African population.

CONCLUSION

Even if not common, otosclerosis cannot be disregarded as a possible cause for conductive hearing loss among the population of São Tomé and Principe.

Tympanometry and isolated fracture of the stapes

INTRODUCTION

Temporal bone fractures are frequently associated with ossicular dislocations or fractures, most commonly involving the incus. To our knowledge, isolated fracture of the posterior crus of the stapes has not been previously reported.

CASE REPORT

A 20-year-old man consulted for persistent left hypoacusis several months after a head injury. Initial computed tomography of the temporal bone showed a simple temporal bone fracture with no other associated abnormalities. The diagnosis of stapes fracture was suggested by increased compliance on tympanometry, leading to a second thin-section temporal bone computed tomography, which suggested a fracture of the posterior crus of the stapes. Endaural surgical exploration confirmed the diagnosis and allowed placement of ionomer cement in the posterior crus.

DISCUSSION

The possibility of ossicular dislocation or fracture must be considered in patients with persistent conductive hearing loss associated with increased compliance on tympanometry, even when computed tomography of the temporal bone does not show dislocation of the ossicular chain or ossicular fracture. Hearing rehabilitation can be performed by hearing aid or surgical reconstruction of the ossicles.

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.