OtoRhinoLaryngology News: Φεβρουαρίου 2016

Δευτέρα 29 Φεβρουαρίου 2016

Negative prognostic factors for psychological conditions in patients with audiovestibular diseases.

Negative prognostic factors for psychological conditions in patients with audiovestibular diseases.

Auris Nasus Larynx. 2016 Feb 24;

Authors: Sakagami M, Kitahara T, Okayasu T, Yamashita A, Hasukawa A, Ota I, Yamanaka T

Abstract
OBJECTIVE: To examine the backgrounds of patients with audiovestibular disease regarding what influences their psychological state.
METHODS: During a 12-year period, 375 successive patients with audiovestibular diseases were enrolled in this study. Diseases included unilateral (n=174) and bilateral (n=51) Menière's disease, sudden deafness with vertigo (n=70), and vestibular neuritis (n=80). Diagnosis, sex, age, duration of disease, vertigo frequency, persistent nystagmus, and ipsilateral/contralateral hearing levels were recorded. Cornell Medical Index (domains III-IV=neurosis) and Self-Rating Depression Scale (score>40=depression) were applied during acute vertigo remissions in all patients.
RESULTS: Neurosis and depression, respectively, were diagnosed in 62.7% and 82.4% of bilateral Menière's, 32.7% and 48.9% of unilateral Menière's, 15.7% and 38.6% of sudden deafness/vertigo, and 12.7% and 31.3% of vestibular neuritis patients. Multivariable logistic regression analysis showed that Menière's disease with longer disease duration (Oz 1.212; P=0.021) and worse hearing in the secondary affected ear (Oz 1.131; P=0.042); sudden deafness/vertigo with persistent nystagmus (Oz 1.895; P=0.005); and vestibular neuritis with longer disease duration (Oz 1.422; P=0.019) and persistent nystagmus (Oz 1.950; P=0.0003) had mental illness significantly more often than those with shorter-duration disease, better hearing and no persistent nystagmus.
CONCLUSION: Mental disorder increased in accordance with solo vertigo, vertigo/hearing loss, repeated symptoms, and bilateral lesions. Treatment strategies should be carefully constructed for patients with persistent nystagmus, long disease duration, and hearing loss in the secondary affected ear to avoid psychological disorders.

PMID: 26922128 [PubMed - as supplied by publisher]

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Tinnitus prevalence in New Zealand.

Tinnitus prevalence in New Zealand.

N Z Med J. 2015;128(1424):24-34

Authors: Wu BP, Searchfield G, Exeter DJ, Lee A

Abstract
AIM: There is a lack of consensus in the international literature pertaining to the prevalence of tinnitus for the overall population, as well as sex and age sub-groups, suggesting the need for country-specific prevalence estimates. We aim to find prevalence estimates of tinnitus that are representative of the New Zealand population.
METHOD: We obtained data from random-digit dialled telephone surveys of households, conducted by Roy Morgan Research Limited between August, 2007, and July, 2013, for people aged ≥14 years in New Zealand (n=69,976). As part of the survey, participants were asked whether they have had tinnitus in the last 12 months. The response options were "yes" or "no". Estimates were standardised to the New Zealand population structure based on the 2013 national census. Sex, age and ethnic differences were explored.
RESULTS: The overall weighted prevalence for any tinnitus was 6.0% in the total New Zealand population age ≥14 years. Tinnitus was higher among males (6.5%) compared to females (5.5%). Males were 55% more likely to report tinnitus compared to females among young adults aged 14 to 24 years, while males were 32% more likely to report tinnitus compared to females among adults aged 50 to 64 years. Tinnitus prevalence increased with age, peaking at 13.5% for older adults aged ≥65 years. Adults aged ≥65 years are three times more likely to report tinnitus than people aged below 65 years. Tinnitus prevalence was highest among people identifying as European (7.05%) and lowest among people identifying as Asian (1.00%).
CONCLUSION: This is the first nationally representative study of tinnitus prevalence in New Zealand and largest study sample internationally for tinnitus prevalence to date. Tinnitus is a public health problem affecting approximately 207,000 people in the New Zealand population aged ≥14 years. This study has highlighted the importance of sex and age in defining a high-risk tinnitus population, but our knowledge falls short of profiling their ethnic and social-economic characteristics.

PMID: 26922445 [PubMed - as supplied by publisher]

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Investigation of the calcification at the petroclival region through Multi-slice Computed Tomography of the skull base.

Investigation of the calcification at the petroclival region through Multi-slice Computed Tomography of the skull base.

J Craniomaxillofac Surg. 2016 Feb 3;

Authors: Inal M, Muluk NB, Burulday V, Akgül MH, Ozveren MF, Çelebi UO, Şimşek G, Daphan BÜ

Abstract
OBJECTIVES: The aim of this paper was a retrospective investigation of calcification at the petroclival region using Multi-slice Computed Tomography (MSCT).
METHODS: One hundred thirty skull bases were reviewed. The images were acquired with a 64 slice CT (MSCT). At first images were taken at the axial plane; and then coronal and sagittal reconstructions of raw data were performed. Later investigations were carried out on these 3-dimensional images (3-D imaging). Petrosphenoidal ligament (PSL) (Gruber's ligament) and posterior petroclinoid ligament (PPCL) calcifications were evaluated as "none, partial or complete calcification" for the right and left sides.
RESULTS: In the right PSL, there were partial calcifications in 9.8% and complete calcifications in 2.3%. Calcification ratio was 9.8% partial and 2.9% complete in the left PSL. In the right side, there were 26.6% partial and 5.2% complete calcifications of PPCL. In the left side, there were 29.5% partial and 4.6% complete PPCL calcifications. PPCL calcification was detected more in males compared to females in the right and left sides. In older patients, left PSL; right and left PPCL calcification were detected more.
CONCLUSION: PPCL calcifications cannot be differentiated from PSL calcifications in MSCT slices. The distinction can be easily done in 3-D views. The presence of ossified ligaments may make surgeries in this region difficult, and special care has to be taken to avoid injuries to structures which pass under these ossified ligaments. Particularly in elderly patients, the appropriate surgical instrument for the PSL calcifications should be prepared preoperatively. If PSL is calcified, 6th cranial nerve palsy may not occur even though increased intracranial pressure syndrome is present. Whereas, in lateral trans-tentorial herniations, 3rd cranial nerve palsy occurs in earlier periods when PSL is calcified. Moreover, in subtemporal and transtentorial petrosal approaches, knowing the PSL calcification preoperatively is important to avoid damaging the 6th cranial nerve during surgery.

PMID: 26922483 [PubMed - as supplied by publisher]

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Acute toxicity in comprehensive head and neck radiation for nasopharynx and paranasal sinus cancers: cohort comparison of 3D conformal proton therapy and intensity modulated radiation therapy.

Acute toxicity in comprehensive head and neck radiation for nasopharynx and paranasal sinus cancers: cohort comparison of 3D conformal proton therapy and intensity modulated radiation therapy.

Radiat Oncol. 2016;11(1):32

Authors: McDonald MW, Liu Y, Moore MG, Johnstone PA

Abstract
BACKGROUND: To evaluate acute toxicity endpoints in a cohort of patients receiving head and neck radiation with proton therapy or intensity modulated radiation therapy (IMRT).
METHODS: Forty patients received comprehensive head and neck radiation including bilateral cervical nodal radiation, given with or without chemotherapy, for tumors of the nasopharynx, nasal cavity or paranasal sinuses, any T stage, N0-2. Fourteen received comprehensive treatment with proton therapy, and 26 were treated with IMRT, either comprehensively or matched to proton therapy delivered to the primary tumor site. Toxicity endpoints assessed included g-tube dependence at the completion of radiation and at 3 months after radiation, opioid pain medication requirement compared to pretreatment normalized as equivalent morphine dose (EMD) at completion of treatment, and at 1 and 3 months after radiation.
RESULTS: In a multivariable model including confounding variables of concurrent chemotherapy and involved nodal disease, comprehensive head and neck radiation therapy using proton therapy was associated with a lower opioid pain requirement at the completion of radiation and a lower rate of gastrostomy tube dependence by the completion of radiation therapy and at 3 months after radiation compared to IMRT. Proton therapy was associated with statistically significant lower mean doses to the oral cavity, esophagus, larynx, and parotid glands. In subgroup analysis of 32 patients receiving concurrent chemotherapy, there was a statistically significant correlation with a greater opioid pain medication requirement at the completion of radiation and both increasing mean dose to the oral cavity and to the esophagus.
CONCLUSIONS: Proton therapy was associated with significantly reduced radiation dose to assessed non-target normal tissues and a reduced rate of gastrostomy tube dependence and opioid pain medication requirements. This warrants further evaluation in larger studies, ideally with patient-reported toxicity outcomes and quality of life endpoints.

PMID: 26922239 [PubMed - as supplied by publisher]

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Negative prognostic factors for psychological conditions in patients with audiovestibular diseases.

Negative prognostic factors for psychological conditions in patients with audiovestibular diseases.

Auris Nasus Larynx. 2016 Feb 24;

Authors: Sakagami M, Kitahara T, Okayasu T, Yamashita A, Hasukawa A, Ota I, Yamanaka T

PMID: 26922128 [PubMed - as supplied by publisher]

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Pediatric central auditory processing disorder showing elevated threshold on pure tone audiogram.

Pediatric central auditory processing disorder showing elevated threshold on pure tone audiogram.

Auris Nasus Larynx. 2016 Feb 24;

Authors: Maeda Y, Nakagawa A, Nagayasu R, Sugaya A, Omichi R, Kariya S, Fukushima K, Nishizaki K

Abstract
Central auditory processing disorder (CAPD) is a condition in which dysfunction in the central auditory system causes difficulty in listening to conversations, particularly under noisy conditions, despite normal peripheral auditory function. Central auditory testing is generally performed in patients with normal hearing on the pure tone audiogram (PTA). This report shows that diagnosis of CAPD is possible even in the presence of an elevated threshold on the PTA, provided that the normal function of the peripheral auditory pathway was verified by distortion product otoacoustic emission (DPOAE), auditory brainstem response (ABR), and auditory steady state response (ASSR). Three pediatric cases (9- and 10-year-old girls and an 8-year-old boy) of CAPD with elevated thresholds on PTAs are presented. The chief complaint was difficulty in listening to conversations. PTA showed elevated thresholds, but the responses and thresholds for DPOAE, ABR, and ASSR were normal, showing that peripheral auditory function was normal. Significant findings of central auditory testing such as dichotic speech tests, time compression of speech signals, and binaural interaction tests confirmed the diagnosis of CAPD. These threshold shifts in PTA may provide a new concept of a clinical symptom due to central auditory dysfunction in CAPD.

PMID: 26922127 [PubMed - as supplied by publisher]

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Response.

Response.

Auris Nasus Larynx. 2016 Feb 24;

Authors: Kim CW

PMID: 26922126 [PubMed - as supplied by publisher]

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Ultrasonography of the Tympanic Bullae and Larynx in Cattle.

Ultrasonography of the Tympanic Bullae and Larynx in Cattle.

Vet Clin North Am Food Anim Pract. 2016 Mar;32(1):119-131

Authors: Gosselin VB, Babkine M, Francoz D

Abstract
Diseases of the middle ear or the larynx are not numerous in cattle but their diagnosis can be challenging for veterinary practitioners in the field. This article presents the ultrasonography of these 2 anatomic structures in order to provide new diagnostic tools to veterinary practitioners in the field. Brief anatomic reminders are first reported. The scanning techniques and normal images are then described. Finally, abnormal images of specific conditions are presented.

PMID: 26922115 [PubMed - as supplied by publisher]

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Episodic Laryngeal Breathing Disorders: Literature Review and Proposal of Preliminary Theoretical Framework.

Episodic Laryngeal Breathing Disorders: Literature Review and Proposal of Preliminary Theoretical Framework.

J Voice. 2016 Feb 24;

Authors: Shembel AC, Sandage MJ, Verdolini Abbott K

Abstract
OBJECTIVE: The purposes of this literature review were (1) to identify and assess frameworks for clinical characterization of episodic laryngeal breathing disorders (ELBD) and their subtypes, (2) to integrate concepts from these frameworks into a novel theoretical paradigm, and (3) to provide a preliminary algorithm to classify clinical features of ELBD for future study of its clinical manifestations and underlying pathophysiological mechanisms.
STUDY DESIGN: This is a literature review.
METHODS: Peer-reviewed literature from 1983 to 2015 pertaining to models for ELBD was searched using Pubmed, Ovid, Proquest, Cochrane Database of Systematic Reviews, and Google Scholar. Theoretical models for ELBD were identified, evaluated, and integrated into a novel comprehensive framework. Consensus across three salient models provided a working definition and inclusionary criteria for ELBD within the new framework. Inconsistencies and discrepancies within the models provided an analytic platform for future research.
RESULTS: Comparison among three conceptual models-(1) Irritable larynx syndrome, (2) Dichotomous triggers, and (3) Periodic occurrence of laryngeal obstruction-showed that the models uniformly consider ELBD to involve episodic laryngeal obstruction causing dyspnea. The models differed in their description of source of dyspnea, in their inclusion of corollary behaviors, in their inclusion of other laryngeal-based behaviors (eg, cough), and types of triggers.
CONCLUSION: The proposed integrated theoretical framework for ELBD provides a preliminary systematic platform for the identification of key clinical feature patterns indicative of ELBD and associated clinical subgroups. This algorithmic paradigm should evolve with better understanding of this spectrum of disorders and its underlying pathophysiological mechanisms.

PMID: 26922093 [PubMed - as supplied by publisher]

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Κυριακή 28 Φεβρουαρίου 2016

The effects of a canalplasty and a canal wall reconstruction on perceived sound quality: preliminary results.

The effects of a canalplasty and a canal wall reconstruction on perceived sound quality: preliminary results.

Eur Arch Otorhinolaryngol. 2016 Feb 26;

Authors: van Spronsen E, Brienesse P, Ebbens FA, Dreschler WA

Abstract
Objective of this work was to evaluate the perceptual effect of the acoustic properties before and after canalplasty and a reconstruction of the posterior canal wall in revision modified radical cavity surgery. This is a prospective study. Twenty normal hearing subjects were presented six simulated sound conditions representing the acoustic properties of six different ear canals (two normal ears, and two pre- and postoperative conditions). The six different real ear unaided responses of these ear canals were used to filter Dutch sentences, resulting in six simulated sound conditions. A seventh unfiltered 'reference' condition was used for comparison. Sound quality was evaluated using a seven-point paired comparison rating and a visual analogue scale (VAS). Significant differences in sound quality were found between all conditions and the pre-operative cavity condition (all p < 0.001) using both the paired comparison rating and VAS. No significant differences in VAS were found comparing the other conditions with each other. But when using the paired comparison rating, the post-operative canalplasty condition and both the pre and post-operative cavity conditions differed significantly from the other conditions. This explorative study shows that altering the acoustics of the OEAC after a canalplasty and a reconstruction of the ear canal in revision modified radical cavity surgery results in perceivable changes in sound quality. It is likely that these changes are primarily due to volume changes. To which extent these changes are of clinical importance remains to be determined.

PMID: 26920704 [PubMed - as supplied by publisher]

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The strategy for management of tympanic membrane retractions.

The strategy for management of tympanic membrane retractions.

Auris Nasus Larynx. 2016 Feb 23;

Authors: Kuo CL

PMID: 26920071 [PubMed - as supplied by publisher]

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Lignocaine topicalization of the pediatric airway.

Lignocaine topicalization of the pediatric airway.

Paediatr Anaesth. 2016 Feb 26;

Authors: Roberts MH, Gildersleve CD

Abstract
The application of topical laryngeal lignocaine is a technique used frequently in pediatric anesthesia. It is often used to facilitate open airway procedures, tracheal intubation, or to reduce the incidence of perioperative adverse respiratory events such as coughing and laryngospasm. A number of studies have shown that applying topical lignocaine to the larynx reduces perioperative respiratory adverse events, while others have shown an increased incidence of respiratory complications with lignocaine administration. There is a lack of evidence on the effect of topical lignocaine on the sensitivity of upper airway reflexes and swallowing, the duration of time that airway reflexes are obtunded, and the optimum and safe maximum dose of lignocaine when used by this route. We review the current literature relating to the use of lignocaine to topicalize the pediatric airway. This review concentrates on the indications for use, the maximum safe dose, the effect on swallowing, and risk of aspiration and the complications of the technique.

PMID: 26919822 [PubMed - as supplied by publisher]

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Comparative Effectiveness of the Different Treatment Modalities for Snoring.

Comparative Effectiveness of the Different Treatment Modalities for Snoring.

Otolaryngol Head Neck Surg. 2016 Mar;154(3):577-8

Authors: Delsupehe K, Terryn S, Bouckaert B

PMID: 26921405 [PubMed - in process]

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Letter to the Editor on "Comparative Effectiveness of the Different Treatment Modalities for Snoring".

Letter to the Editor on "Comparative Effectiveness of the Different Treatment Modalities for Snoring".

Otolaryngol Head Neck Surg. 2016 Mar;154(3):577

Authors: Ugur KS, Dağlı E, Ark N, Kurtaran H

PMID: 26921404 [PubMed - in process]

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Response to Comment on "Olfactory Function Assessment of Blind Subjects Using the Sniffin' Sticks Test".

Response to Comment on "Olfactory Function Assessment of Blind Subjects Using the Sniffin' Sticks Test".

Otolaryngol Head Neck Surg. 2016 Mar;154(3):576-7

Authors: Çomoğlu Ş

PMID: 26921403 [PubMed - in process]

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Comment on "Olfactory Function Assessment of Blind Subjects Using the Sniffin' Sticks Test".

Comment on "Olfactory Function Assessment of Blind Subjects Using the Sniffin' Sticks Test".

Otolaryngol Head Neck Surg. 2016 Mar;154(3):576

Authors: Kaya A, Binar M

PMID: 26921402 [PubMed - in process]

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Regarding "Does Nasal Surgery Improve OSA in Patients with Nasal Obstruction and OSA? A Meta-analysis" by Ishii et al, 2015.

Regarding "Does Nasal Surgery Improve OSA in Patients with Nasal Obstruction and OSA? A Meta-analysis" by Ishii et al, 2015.

Otolaryngol Head Neck Surg. 2016 Mar;154(3):575

Authors: Stupak HD

PMID: 26921401 [PubMed - in process]

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Highlights from the Current Issue: March 2016.

Highlights from the Current Issue: March 2016.

Otolaryngol Head Neck Surg. 2016 Mar;154(3):401-2

Authors: Krouse JH

PMID: 26921400 [PubMed - in process]

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Σάββατο 27 Φεβρουαρίου 2016

Targeting irradiation-induced mitogen-activated protein kinase activation in vitro and in an ex vivo model for human head and neck cancer.

Targeting irradiation-induced mitogen-activated protein kinase activation in vitro and in an ex vivo model for human head and neck cancer.

Head Neck. 2016 Feb 26;

Authors: Affolter A, Muller MF, Sommer K, Stenzinger A, Zaoui K, Lorenz K, Wolf T, Sharma S, Wolf J, Perner S, Weber KJ, Freier K, Plinkert PK, Hess J, Weichert W

Abstract
BACKGROUND: Despite new radiotherapeutic strategies, radioresistance in head and neck squamous cell carcinoma (HNSCC) remains a major problem. Preclinical model systems are needed to identify resistance mechanisms in this heterogeneous entity.
METHODS: We elucidated the interplay among mitogen-activated protein kinase (MAPK)-inhibition, radiation, and p53 mutations in vitro and in a novel ex vivo model derived from vital human HNSCC samples. HNSCC cell lines (p53WT/mut) were treated with the mitogen-activated protein kinase (MEK)-inhibitor PD-0325901 and subsequently irradiated. Radiosensitization was functionally assessed and evaluated in the ex vivo model.
RESULTS: We observed a pronounced irradiation-induced extracellular signal-regulated kinase (ERK) phosphorylation in 2 cell lines, which was independent of their p53 mutation status and associated with PD-0325901-related radiosensitization in a clonogenic assay. Heterogeneity in irradiation-induced ERK phosphorylation and in radiosensitization after MEK-inhibition was also reflected in the ex vivo model.
CONCLUSION: We provide experimental evidence for radiosensitizing effects of PD-0325901 in HNSCC. The ex vivo culture technology might offer a promising tool for individualized drug efficacy testing. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26918677 [PubMed - as supplied by publisher]

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Phase II study of erlotinib and docetaxel with concurrent intensity-modulated radiotherapy in locally advanced head and neck squamous cell carcinoma.

Phase II study of erlotinib and docetaxel with concurrent intensity-modulated radiotherapy in locally advanced head and neck squamous cell carcinoma.

Head Neck. 2016 Feb 26;

Authors: Yao M, Woods C, Lavertu P, Fu P, Gibson M, Rezaee R, Zender C, Wasman J, Sharma N, Machtay M, Savvides P

Abstract
BACKGROUND: The purpose of this study was to establish the efficacy and toxicities of concurrent erlotinib and docetaxel with intensity-modulated radiotherapy (IMRT) for locally advanced head and neck squamous cell carcinoma (HNSCC).
METHODS: Patients received daily erlotinib for 2 weeks, followed by daily IMRT with concurrent weekly docetaxel and daily erlotinib, followed by daily erlotinib for up to 2 years. The primary objective was disease-free survival (DFS). Secondary objectives included overall survival (OS), patterns of failure, and toxicities. Forty-three patients were recruited for this study.
RESULTS: With a median follow-up of 48.7 months, the 3-year DFS, OS, locoregional failure-free survival, and distant metastasis-free survival was 69.5%, 81%, 82.4%, and 83.7%, respectively. The most common grade III/IV local toxicities were dysphagia, dermatitis, and mucositis. Patients with p16-positive tumors had significantly better outcomes.
CONCLUSION: The regimen is tolerable and effective. It is worthy of further investigation in selected patients and may be useful in patients who cannot tolerate cisplatin. © 2016 Wiley Periodicals, Inc. Head Neck, 2016.

PMID: 26918562 [PubMed - as supplied by publisher]

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Cerebral Processing of Emotionally Loaded Acoustic Signals by Tinnitus Patients.

Cerebral Processing of Emotionally Loaded Acoustic Signals by Tinnitus Patients.

Audiol Neurootol. 2016 Feb 27;21(2):80-87

Authors: Georgiewa P, Szczepek AJ, Rose M, Klapp BF, Mazurek B

Abstract
This exploratory study determined the activation pattern in nonauditory brain areas in response to acoustic, emotionally positive, negative or neutral stimuli presented to tinnitus patients and control subjects. Ten patients with chronic tinnitus and without measurable hearing loss and 13 matched control subjects were included in the study and subjected to fMRI with a 1.5-tesla scanner. During the scanning procedure, acoustic stimuli of different emotional value were presented to the subjects. Statistical analyses were performed using statistical parametric mapping (SPM 99). The activation pattern induced by emotionally loaded acoustic stimuli differed significantly within and between both groups tested, depending on the kind of stimuli used. Within-group differences included the limbic system, prefrontal regions, temporal association cortices and striatal regions. Tinnitus patients had a pronounced involvement of limbic regions involved in the processing of chimes (positive stimulus) and neutral words (neutral stimulus), strongly suggesting improperly functioning inhibitory mechanisms that were functioning well in the control subjects. This study supports the hypothesis about the existence of a tinnitus-specific brain network. Such a network could respond to any acoustic stimuli by activating limbic areas involved in stress reactivity and emotional processing and by reducing activation of areas responsible for attention and acoustic filtering (thalamus, frontal regions), possibly reinforcing negative effects of tinnitus.

PMID: 26918795 [PubMed - as supplied by publisher]

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Progression of unilateral moyamoya disease resulted in spontaneous occlusion of ipsilateral cavernous dural arteriovenous fistula: Case report.

Progression of unilateral moyamoya disease resulted in spontaneous occlusion of ipsilateral cavernous dural arteriovenous fistula: Case report.

Interv Neuroradiol. 2016 Feb 24;

Authors: Liu P, Xu Y, Lv X, Ge H, Lv M, Li Y

Abstract
The pathogenic association between cavernous dural arteriovenous fistula (CDAVF) and moyamoya disease remains unclear. This unusual case is the first report of a progression of unilateral moyamoya disease resulting in the spontaneous occlusion of ipsilateral CDAVF. A 52-year-old woman presented with two-week spontaneous exophthalmos, chemosis and tinnitus, and cerebral angiography showed a right CDAVF coexisting with ipsilateral moyamoya disease. Transvenous approaches through the inferior petrosal sinus and facial vein were attempted but failed. However, a progression of the moyamoya disease and disappearance of the CDAVF were observed on one month follow-up angiogram in accordance with the resolution of clinical symptoms. This extremely rare coincidental presentation may have deeper pathogenic implications. This case report may give a clue to the underlying mechanism of the progression of moyamoya disease and occlusion of the CDAVF.

PMID: 26916656 [PubMed - as supplied by publisher]

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Racial differences in vestibular schwannoma.

Racial differences in vestibular schwannoma.

Laryngoscope. 2016 Feb 24;

Authors: Carlson ML, Marston AP, Glasgow AE, Habermann EB, Sweeney AD, Link MJ, Wanna GB

Abstract
OBJECTIVES/HYPOTHESIS: To estimate the impact of race on disease presentation and treatment of vestibular schwannoma (VS) in the United States.
STUDY DESIGN: Analysis of a national population-based tumor registry.
METHODS: Analysis of the Surveillance, Epidemiology, and End Results database was performed, including all patients identified with a diagnosis of VS. Associations between race, disease presentation, treatment strategy, and overall survival were analyzed in a univariate and multivariable model.
RESULTS: A total of 9,782 patients with VS were identified among 822 million person-years. Of these, 7,400 (75.6%) claimed white, 807 (8.2%) Hispanic, 755 (7.7%) Asian, 397 (4.1%) black, and 423 (4.3%) patients reported other race. The median annual incidence of disease was lowest among black (0.43 per 100,000 persons) and Hispanic populations (0.45 per 100,000 persons) and highest among white (1.61 per 100,000 persons) populations (P < 0.001). Overall, Hispanic patients were diagnosed at the youngest age, and white patients were diagnosed at the oldest age (mean of 50.0 vs. 56.0 years, respectively; P < 0.001). Compared to white populations, black, Hispanic, and Asian populations were more likely to present with larger tumors (P < 0.001). After controlling for tumor size, age, and treatment center in a multivariable model, Hispanic patients were more likely than white patients to undergo surgery (P = 0.010); however, there were no differences between white, black, and Asian populations with regard to treatment modality. Hispanic and black patients had the poorest overall survival following surgery compared to other groups.
CONCLUSION: Racial differences among patients with VS exist within the United States. Further studies are required to determine which factors drive differences in tumor size, age, annual disease incidence, and overall survival between races.
LEVEL OF EVIDENCE: 3. Laryngoscope, 2015.

PMID: 26917495 [PubMed - as supplied by publisher]

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Risk of post-operative pneumocephalus in patients with obstructive sleep apnea undergoing transsphenoidal surgery.

Risk of post-operative pneumocephalus in patients with obstructive sleep apnea undergoing transsphenoidal surgery.

J Clin Neurosci. 2016 Feb 22;

Authors: White-Dzuro GA, Maynard K, Zuckerman SL, Weaver KD, Russell PT, Clavenna MJ, Chambless LB

Abstract
Patients undergoing transsphenoidal surgery (TSS) have an anterior skull base defect that limits the use of positive pressure ventilation post-operatively. Obstructive sleep apnea (OSA) can be seen in these patients and is treated with continuous positive airway pressure (CPAP). In our study we documented the incidence of pre-existing OSA and reported the incidence of diagnosed pneumocephalus and its relationship to OSA. A retrospective review was conducted from a surgical outcomes database. Electronic medical records were reviewed, with an emphasis on diagnosis of OSA and documented symptomatic pneumocephalus. A total of 324 patients underwent 349 TSS for sellar mass resection. The average body mass index of the study cohort was 32.5kg/m(2). Sixty-nine patients (21%) had documented OSA. Only 25 out of 69 (36%) had a documented post-operative CPAP plan. Out of all 349 procedures, there were two incidents of pneumocephalus diagnosed. Neither of the patients had pre-existing OSA. One in five patients in our study had pre-existing OSA. Most patients returned to CPAP use within several weeks of TSS for resection of a sellar mass. Neither of the patients with pneumocephalus had pre-existing OSA and none of the patients with early re-initiation of CPAP developed this complication. This study provides preliminary evidence that resuming CPAP early in the post-operative period might be less dangerous than previously assumed.

PMID: 26916903 [PubMed - as supplied by publisher]

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Functions of the inner ear in psoriatic arthritis.

Functions of the inner ear in psoriatic arthritis.

Auris Nasus Larynx. 2016 Feb 22;

Authors: Gunes A, Gundogdu I, Mutlu M, Ozturk EA, Cakci A, Akin I

Abstract
OBJECTIVE: This study aimed to investigate whether there is a negative impact as a result of psoriatic arthritis disease of the inner ear function.
METHODS: Twenty-four successive patients and 38 healthy volunteers, younger than 60 years of age, who were followed up for at least for one year in the outpatient clinics of physical therapy and rehabilitation with the diagnosis of PsA according to CASPAR criteria (17) and who did not complain of any hearing impairment were included in the study. Distortion-product otoacoustic emission (DPOAE) values between 1kHz and 4kHz, tympanometric examination results, stapes reflex values, speech reception threshold (SRT) and speech discrimination (SD) values, pure-tone values between 250 and 8000Hz and high-frequency values between 10,000, 12,500 and 16,000Hz were analyzed. Statistical comparisons between both groups were performed using chi-square test and Mann-Whitney U test. p<0.05 was accepted as the level of statistical significance.
RESULTS: Our study population consisted of 24 [9 male (37.5%) and 15 female (62.5%)] patients with a mean age of 47.21±11.28 (range, 28-59) years and 38 [16 male (42.1%) and 22 female (57.9%)] healthy volunteers with a mean age of 44.39±8.12 (range, 29-59) years as the control group. Mean duration of arthritis was 7.62±4.88 years. In the evaluation of hearing frequencies of the patients between 4000 and 6000Hz, a statistically significant difference was found relative to the control group (p<005). DPOAE values of the patients were analyzed within the 1000-4000Hz interval. When compared with the control group, a statistically significant difference was found at 3000 and 4000Hz (p<005).
CONCLUSION: Our study provides strong evidence suggesting the necessity of monitorization of these patients regarding sensorineural hearing loss so as to take measures against the development of hearing loss during early stage, which may be another disability in patients with PsA, which is itself a potential cause of severe disability.

PMID: 26915283 [PubMed - as supplied by publisher]

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Motivational engagement in first-time hearing aid users: A feasibility study.

Motivational engagement in first-time hearing aid users: A feasibility study.

Int J Audiol. 2016 Feb 26;:1-11

Authors: Ferguson M, Maidment D, Russell N, Gregory M, Nicholson R

Abstract
OBJECTIVE: To assess (1) the feasibility of incorporating the Ida Institute's Motivation Tools into a UK audiology service, (2) the potential benefits of motivational engagement in first-time hearing aid users, and (3) predictors of hearing aid and general health outcome measures.
DESIGN: A feasibility study using a single-centre, prospective, quasi-randomized controlled design with two arms. The Ida Institute's Motivation Tools formed the basis for motivational engagement.
STUDY SAMPLE: First-time hearing aid users were recruited at the initial hearing assessment appointment. The intervention arm underwent motivational engagement (M+, n = 32), and a control arm (M-, n = 36) received standard care only.
RESULTS: The M+ group showed greater self-efficacy, reduced anxiety, and greater engagement with the audiologist at assessment and fitting appointments. However, there were no significant between-group differences 10-weeks post-fitting. Hearing-related communication scores predicted anxiety, and social isolation scores predicted depression for the M+ group. Readiness to address hearing difficulties predicted hearing aid outcomes for the M- group. Hearing sensitivity was not a predictor of outcomes.
CONCLUSIONS: There were some positive results from motivational engagement early in the patient journey. Future research should consider using qualitative methods to explore whether there are longer-term benefits of motivational engagement in hearing aid users.

PMID: 26919044 [PubMed - as supplied by publisher]

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The case for earlier cochlear implantation in postlingually deaf adults.

The case for earlier cochlear implantation in postlingually deaf adults.

Int J Audiol. 2016 Feb 26;:1-6

Authors: Dowell RC

Abstract
OBJECTIVE: This paper aimed to estimate the difference in speech perception outcomes that may occur due to timing of cochlear implantation in relation to the progression of hearing loss.
DESIGN: Data from a large population-based sample of adults with acquired hearing loss using cochlear implants (CIs) was used to estimate the effects of duration of hearing loss, age, and pre-implant auditory skills on outcomes for a hypothetical standard patient.
STUDY SAMPLE: A total of 310 adults with acquired severe/profound bilateral hearing loss who received a CI in Melbourne, Australia between 1994 and 2006 provided the speech perception data and demographic information to derive regression equations for estimating CI outcomes.
RESULTS: For a hypothetical CI candidate with progressive sensorineural hearing loss, the estimates of speech perception scores following cochlear implantation are significantly better if implantation occurs relatively soon after onset of severe hearing loss and before the loss of all functional auditory skills.
CONCLUSIONS: Improved CI outcomes and quality of life benefit may be achieved for adults with progressive severe hearing loss if they are implanted earlier in the progression of the pathology.

PMID: 26918896 [PubMed - as supplied by publisher]

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Exploration of a physiologically-inspired hearing-aid algorithm using a computer model mimicking impaired hearing.

Exploration of a physiologically-inspired hearing-aid algorithm using a computer model mimicking impaired hearing.

Int J Audiol. 2016 Feb 26;:1-12

Authors: Jürgens T, Clark NR, Lecluyse W, Meddis R

Abstract
OBJECTIVE: To use a computer model of impaired hearing to explore the effects of a physiologically-inspired hearing-aid algorithm on a range of psychoacoustic measures.
DESIGN: A computer model of a hypothetical impaired listener's hearing was constructed by adjusting parameters of a computer model of normal hearing. Absolute thresholds, estimates of compression, and frequency selectivity (summarized to a hearing profile) were assessed using this model with and without pre-processing the stimuli by a hearing-aid algorithm. The influence of different settings of the algorithm on the impaired profile was investigated. To validate the model predictions, the effect of the algorithm on hearing profiles of human impaired listeners was measured.
STUDY SAMPLE: A computer model simulating impaired hearing (total absence of basilar membrane compression) was used, and three hearing-impaired listeners participated.
RESULTS: The hearing profiles of the model and the listeners showed substantial changes when the test stimuli were pre-processed by the hearing-aid algorithm. These changes consisted of lower absolute thresholds, steeper temporal masking curves, and sharper psychophysical tuning curves.
CONCLUSION: The hearing-aid algorithm affected the impaired hearing profile of the model to approximate a normal hearing profile. Qualitatively similar results were found with the impaired listeners' hearing profiles.

PMID: 26918797 [PubMed - as supplied by publisher]

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Safety of epidural triamcinolone acetonide use during lumbar decompression surgery in pediatric patients: an association with delayed pseudomeningocele formation.

Safety of epidural triamcinolone acetonide use during lumbar decompression surgery in pediatric patients: an association with delayed pseudomeningocele formation.

J Neurosurg Pediatr. 2016 Feb 26;:1-5

Authors: Sellin JN, Vedantam A, Luerssen TG, Jea A

Abstract
OBJECTIVE The complication profile of epidural triamcinolone acetonide use during lumbar decompression surgery is not known. However, isolated reports of increased risk of delayed CSF leakage with the use of triamcinolone acetonide in adult spinal surgery patients have been published. The purpose of this study was to determine the safety of epidural triamcinolone acetonide use in conjunction with lumbar decompression surgery in pediatric patients. METHODS The medical records of all patients who underwent lumbar decompression surgery with or without discectomy between July 1, 2007, and July 31, 2015, were retrospectively reviewed. RESULTS During the study period, 58 patients underwent 59 spine procedures at Texas Children's Hospital. There were 33 female and 25 male patients. The mean age at surgery was 16.5 years (range 12-24 years). Patients were followed for an average of 38.2 months (range 4-97 months). Triamcinolone acetonide was used in 28 (of 35 total) cases of discectomy; there were no cases of delayed symptomatic CSF leaks (0%) in the minimally invasive and open discectomies. On the other hand, triamcinolone acetonide was used in 14 (of 24 total) cases of multilevel laminectomy, among which there were 10 delayed CSF leaks (71.4%) requiring treatment. The use of triamcinolone acetonide in patients who underwent multilevel laminectomy was significantly associated with an increased risk of delayed CSF leaks or pseudomeningoceles (Fisher's exact test, p < 0.001). CONCLUSIONS There was an unacceptable incidence of delayed postoperative CSF leaks when epidural triamcinolone acetonide was used in patients who underwent multilevel laminectomy.

PMID: 26919317 [PubMed - as supplied by publisher]

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Παρασκευή 26 Φεβρουαρίου 2016

Association between Lateral Skull Base Thickness and Surgical Outcomes in Spontaneous CSF Otorrhea.

Association between Lateral Skull Base Thickness and Surgical Outcomes in Spontaneous CSF Otorrhea.

Otolaryngol Head Neck Surg. 2016 Feb 23;

Authors: Stevens SM, Rizk HG, McIlwain WR, Lambert PR, Meyer TA

Abstract
OBJECTIVES: (1) Correlate skull base thickness with perioperative outcomes for spontaneous cerebrospinal fluid (CSF) otorrhea. (2) Augment perioperative counseling of patients with abnormally thin skull bases.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary center. Patients with spontaneous CSF otorrhea have thin skull bases. This is associated with obesity and/or idiopathic intracranial hypertension. The influence of skull base thinning on perioperative outcomes is unknown.
SUBJECTS AND METHODS: A retrospective review was conducted from 2004 to 2014. Forty-eight cases of spontaneous CSF otorrhea met the inclusion criteria of primary surgery by the senior authors: preoperative dedicated temporal bone computed tomography, absence of other leak etiologies, and follow-up >6 months. Patients were stratified into thin (<0.9 mm) and thick (>0.9 mm) groups based on computed tomography measures of their tegmen. Primary outcomes measures were as follows: postoperative meningitis, recurrent leak, second site leak (contralateral ear/anterior fossa), and permanent shunt placement. Hearing outcomes were not assessed in this study.
RESULTS: Thirty and 15 patients composed the thin and thick groups, respectively. Both the incidence (P < .0001) and the rate (P = .005) of adverse outcomes were significantly higher in the thin group. Only 2 patients in the thick group experienced an adverse outcome. Eleven patients underwent multiple procedures for spontaneous leaks. The recurrence rate was 14.5%. All but 1 recurrence occurred in the thin group.
CONCLUSIONS: An abnormally thin tegmen was significantly associated with adverse perioperative outcomes in cases of spontaneous CSF otorrhea. A thick skull base and the presence of an encephalocele may be protective against recurrence. The effect of untreated intracranial hypertension on the results is unknown.

PMID: 26908549 [PubMed - as supplied by publisher]

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Prospective Evaluation of CT Esophagram Findings after Peroral Endoscopic Myotomy.

Prospective Evaluation of CT Esophagram Findings after Peroral Endoscopic Myotomy.

Gastrointest Endosc. 2016 Feb 20;

Authors: Pannu D, Yang D, Abbitt PL, Draganov PV

Abstract
BACKGROUND AND AIMS: Peroral endoscopic myotomy (POEM) is a procedure with potential for serious adverse events. Postprocedure imaging is routinely done yet there is no consensus on the optimal imaging protocol. We describe a novel and simple CT esophagram protocol for post-POEM evaluation and report the full spectrum of radiographic findings and subsequent interventions.
METHODS: Single-center prospective study of consecutive patients treated with POEM evaluated with CT esophagram.
RESULTS: Eighty-four consecutive post-POEM patients underwent CT esophagram. Most common findings were pneumomediastinum (85.7%), pneumoperitoneum (66.7%), subcutaneous emphysema (52.4%) and pleural effusion (46.4 %). Other findings included retroperitoneal air (38.1%), pneumothorax (19%), atelectasis (14.3%), intramural air in the esophagus/stomach (13.1%), pericardial effusion (2.4%), and pneumopericardium (2.4%). Five patients required intervention based on CT findings. In one patient, a leak was detected on CT esophagram before any clinical manifestation; facilitating prompt intervention and avoiding potential serious outcome. Four patients were diagnosed with pneumonia and treated with antibiotics. There was frequent postprocedural atelectasis, which prompted the introduction of routine incentive spirometry in all post-POEM cases.
CONCLUSION: CT esophagram is a simple and accessible imaging test for routine post-POEM evaluation. Numerous and dramatic postprocedure radiographic findings may be expected and demonstrated with this imaging modality. Although most of these findings may not require intervention, some are of potential significance, and early identification may help modify post-procedure management.

PMID: 26907745 [PubMed - as supplied by publisher]

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An appraisal of current dysphagia diagnosis and treatment strategies.

An appraisal of current dysphagia diagnosis and treatment strategies.

Expert Rev Gastroenterol Hepatol. 2016 Feb 24;

Authors: Kaindlstorfer A, Pointner R

Abstract
Dysphagia is a common, serious health problem with a wide variety of etiologies and manifestations. This review gives a general overview of diagnostic and therapeutic options for oropharyngeal as well as esophageal swallowing disorders respecting the considerable progress made over recent years. Diagnosis can be challenging and requires expertise in interpretation of symptoms and patient history. Endoscopy, barium radiography and manometry are still the diagnostic mainstays. Classification of esophageal motor-disorders has been revolutionized with the introduction of high-resolution esophageal pressure topography and a new standardized classification algorithm. Automated integrated impedance manometry is a promising upcoming tool for objective evaluation of oropharyngeal dysphagia, in non-obstructive esophageal dysphagia and prediction of post fundoplication dysphagia risk. Impedance planimetry provides new diagnostic information on esophageal and LES-distensibility and allows controlled therapeutic dilatation without the need for radiation. Peroral endoscopic myotomy is a promising therapeutic approach for achalasia and spastic motility disorders.

PMID: 26906944 [PubMed - as supplied by publisher]

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Preoperative steroids for hearing preservation cochlear implantation: A review.

Preoperative steroids for hearing preservation cochlear implantation: A review.

Cochlear Implants Int. 2016 Feb 25;

Authors: Kuthubutheen J, Smith L, Hwang E, Lin V

Abstract
Preoperative steroids have been shown to be beneficial in reducing the hearing loss associated with cochlear implantation. This review article discusses the mechanism of action, effects of differing routes of administration, and side effects of steroids administered to the inner ear. Studies on the role of preoperative steroids in animal and human studies are also examined and future directions for research in this area are discussed.

PMID: 26913646 [PubMed - as supplied by publisher]

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Cochlear implant assessment and candidacy for children with partial hearing.

Cochlear implant assessment and candidacy for children with partial hearing.

Cochlear Implants Int. 2016 Feb 25;

Authors: Wilson K, Ambler M, Hanvey K, Jenkins M, Jiang D, Maggs J, Tzifa K

Abstract
Children who have partial hearing (PH) in the low frequencies and profound sensorineural hearing loss in the high frequencies can present a challenge to cochlear implant (CI) teams in terms of referral, assessment, and candidacy. Neither clinical criteria nor optimal timing for implantation has been explored in the literature. Data from both the Hearing Implant Centres of Birmingham Children's Hospital and St Thomas' Hospital indicate that it is clinically appropriate to implant children with PH; they perform better with CIs than with hearing aids, even if their hearing is not fully preserved. We have also found that children need early access to high frequency sound in order to reach their full potential.

PMID: 26913562 [PubMed - as supplied by publisher]

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JAAA CEU Program.

JAAA CEU Program.

J Am Acad Audiol. 2016 Feb;27(2):159-60

Authors:

PMID: 26905535 [PubMed - in process]

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Erratum.

Erratum.

J Am Acad Audiol. 2016 Feb;27(2):157

Authors:

Abstract
[This corrects the article DOI: 10.3766/jaaa.14102.].

PMID: 26905534 [PubMed - as supplied by publisher]

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On Diagnostic Accuracy in Audiology: Central Site of Lesion and Central Auditory Processing Disorder Studies.

On Diagnostic Accuracy in Audiology: Central Site of Lesion and Central Auditory Processing Disorder Studies.

J Am Acad Audiol. 2016 Feb;27(2):141-56

Authors: Vermiglio AJ

Abstract
BACKGROUND: In the field of audiology a test protocol (index test) is used to determine the presence or absence of a target condition. The value of an index test rests in its diagnostic accuracy. Results from an index test must be verified through the use of a reference standard. The clinician and researcher should determine the quality and applicability of diagnostic accuracy studies. The Standards for Reporting of Diagnostic Accuracy (STARD) statement was published in response to the low quality of research conducted across many fields of study. It provides guidelines for the development and interpretation of diagnostic accuracy studies.
PURPOSE: The primary purpose of this article is to assess the degree to which the main principles of diagnostic accuracy studies are used for the detection of central auditory nervous system lesions and a central auditory processing disorder (CAPD). The secondary purpose is to compare the design of these studies to select key guidelines from the STARD statement. The third purpose of this article is to present an argument against the reassignment of diagnostic accuracy values of a particular index test for one target condition (e.g., a central site of lesion) to a different target condition (e.g., a CAPD).
RESULTS: A review of diagnostic accuracy literature on the detection of a central site of lesion reveals the use of a reference standard for the independent verification of the index test results. However, diagnostic accuracy studies involving index tests for the detection of a CAPD show that independent verification of index test results is nonexistent or at best questionable.
CONCLUSION: For a particular index test, while the diagnostic accuracy for detection of a central site of lesion may have been determined appropriately, it is inappropriate to reassign these diagnostic accuracy values to a different diagnostic target such as a CAPD.

PMID: 26905533 [PubMed - in process]

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Vestibular Assessment and Rehabilitation: Ten-Year Survey Trends of Audiologists' Opinions and Practice.

Vestibular Assessment and Rehabilitation: Ten-Year Survey Trends of Audiologists' Opinions and Practice.

J Am Acad Audiol. 2016 Feb;27(2):126-40

Authors: Nelson MD, Akin FW, Riska KM, Andresen K, Mondelli SS

Abstract
BACKGROUND: The past decade has yielded changes in the education and training of audiologists and technological advancements that have become widely available for clinical balance function testing. It is unclear if recent advancements in vestibular instrumentation or the transition to an AuD degree have affected audiologists' vestibular clinical practice or opinions.
PURPOSE: The purpose of this study was to examine predominant opinions and practices for vestibular assessment (VA) and vestibular rehabilitation (VR) over the past decade and between master's- and AuD-level audiologists.
METHOD: A 31-question survey was administered to audiologists via U.S. mail in 2003 (N = 7,500) and electronically in 2014 (N = 9,984) with a response rate of 12% and 10%, respectively.
RESULTS: There was an increase in the number of audiologists providing vestibular services in the past decade. Most respondents agreed that audiologists were the most qualified professionals to conduct VA. Less than half of the surveyed audiologists felt that graduate training was adequate for VA. AuD-level audiologists were more satisfied with graduate training and felt more comfortable performing VA compared to master's-level audiologists. Few respondents agreed that audiologists were the most qualified professionals to conduct VR or that graduate training prepared them to conduct VR. The basic vestibular test battery was unchanged across surveys and included: calorics, smooth pursuit, saccades, search for spontaneous, positional, gaze and optokinetic nystagmus, Dix-Hallpike, case history, and hearing evaluation. There was a trend toward greater use of air (versus water) calorics, videonystagmography (versus electronystagmography), and additional tests of vestibular and balance function.
CONCLUSIONS: VA is a growing specialty area in the field of audiology. Better training opportunities are needed to increase audiologists' knowledge and skills for providing vestibular services. The basic tests performed during VA have remained relatively unchanged over the past 10 yr.

PMID: 26905532 [PubMed - in process]

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The Effects of FM and Hearing Aid Microphone Settings, FM Gain, and Ambient Noise Levels on SNR at the Tympanic Membrane.

The Effects of FM and Hearing Aid Microphone Settings, FM Gain, and Ambient Noise Levels on SNR at the Tympanic Membrane.

J Am Acad Audiol. 2016 Feb;27(2):117-25

Authors: Norrix LW, Camarota K, Harris FP, Dean J

Abstract
BACKGROUND: Speech understanding in noise is challenging for individuals with hearing loss. Hearing aids (HAs) alone are typically unable to resolve these listening difficulties. Frequency modulation (FM) systems or other remote microphone accessories, coupled to HA, are intended to provide listeners with a good signal-to-noise ratio (SNR), thus improving signal audibility and speech understanding.
PURPOSE: The goal of this study was to assess variables that influence SNR at the tympanic membrane (TM) when using a remote microphone/HA combination. We examined microphone setting, transmission system gain, and background noise levels using (1) mathematical computations to manipulate variables and observe the outcomes and (2) behavioral testing.
RESEARCH DESIGN: This study used mathematical computations to estimate SNR at the TM and a mixed-model experimental design to confirm a subset of the calculations.
STUDY SAMPLE: Ten children with normal hearing (mean age, 13.7 yr) and ten adults with high-frequency sensorineural hearing loss (mean age, 49.6 yr) participated.
DATA COLLECTION AND ANALYSIS: Speech recognition thresholds were obtained using Bamford-Kowal-Bench sentences in the presence of noise. Participants used an FM system coupled to an HA in an FM-only and an FM + HA microphone condition.
RESULTS: Better performance was observed in the FM-only compared to FM + HA condition with the overall amount of the FM-only advantage slightly larger than the mathematical calculations predicted. Further calculations demonstrated that (1) when using an FM-only microphone setting, the SNR at the TM is determined primarily by the SNR at the FM microphone; (2) when both HA and FM microphones are active, the SNR is determined by the highest level of the speech, which is typically at the FM microphone, and the highest level of noise at either the FM or HA microphone; (3) increasing FM gain has no impact on SNR in an FM-only condition; and (4) in an FM + HA condition, increasing FM gain improves SNR. The amount of improvement depends on noise levels at the FM and HA microphones. When the noise levels are similar at the two microphones, an improvement in SNR of ∼2 dB is expected. Greater improvement is expected when the level of the noise at the FM microphone can be reduced relative to the level at the HA microphone.
CONCLUSIONS: When using a remote microphone system coupled with a listener's HA, several variables influence SNR at the TM. Two variables that can be manipulated by programming of either or both devices are the microphone setting and gain setting. Mathematical calculations were used to determine the specific influence of and interactions between these variables and showed the importance of (1) managing noise levels to optimize SNR; and (2) counseling clients regarding optimal use of and realistic expectations from their system. This information is useful in the clinical management of persons with hearing loss, especially with the advent and affordability of wireless microphone accessories to assist listeners in background noise.

PMID: 26905531 [PubMed - in process]

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The Effect of Contralateral Pure Tones on the Compound Action Potential in Humans: Efferent Tuning Curves.

The Effect of Contralateral Pure Tones on the Compound Action Potential in Humans: Efferent Tuning Curves.

J Am Acad Audiol. 2016 Feb;27(2):103-16

Authors: Najem F, Ferraro J, Chertoff M

Abstract
BACKGROUND: The compound action potential (CAP) has been suggested in the literature as an alternative to otoacoustic emissions for evaluating the efferent auditory system. However, very few studies have examined efferent influence on auditory nerve potentials in humans.
PURPOSE: This study examines the effects of presenting contralateral pure tones on the ipsilateral CAP onset and offset amplitudes as a potential clinical tool for the assessment of efferent auditory function.
RESEARCH DESIGN: CAPs for 1- and 4-kHz tone pips (TPs) and clicks were recorded from 9, 9, and 8 participants, respectively. Contralateral tones were presented at levels ranging from 20 to 70 dB HL in 10-dB steps. The frequencies of the contralateral tones were 0.5, 1, 2 kHz for the 1-kHz TP CAP; 2, 4, 8 kHz for the 4-kHz TP CAP; and 0.5, 1, 2, 4, 8 kHz for the click CAP.
DATA ANALYSIS: The CAP onset and offset amplitudes in all experimental conditions were analyzed and compared to the CAP amplitude without contralateral stimulation (i.e., baseline).
RESULTS: Maximum suppression of 1-kHz TP CAP onset amplitude was obtained in seven out of nine participants by the 1-kHz contralateral pure tone at 40 dB HL. The 4-kHz TP CAP onset amplitude was maximally suppressed in eight out of nine participants by the 8-kHz contralateral pure tone at 30 dB HL. The click CAP offset amplitude was maximally suppressed in four out of eight participants by the 8-kHz contralateral tone presented at 40 dB HL. The 1- and 4-kHz TP CAP offset and click CAP onset amplitudes were not affected by contralateral stimulation.
CONCLUSIONS: These results along with the previous studies may suggest that the efferent system is maximally stimulated by moderate signal-level tones (i.e., 30-40 dB HL), and that efferent activity is dependent on frequency cues of both the stimulus and suppressor tones. Other factors that might be affecting efferent influence on the CAP in humans such as sound duration, phase, bandwidth, and periodicity need to be further investigated.

PMID: 26905530 [PubMed - in process]

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The Effects of Preprocessing Strategies for Pediatric Cochlear Implant Recipients.

The Effects of Preprocessing Strategies for Pediatric Cochlear Implant Recipients.

J Am Acad Audiol. 2016 Feb;27(2):85-102

Authors: Rakszawski B, Wright R, Cadieux JH, Davidson LS, Brenner C

Abstract
BACKGROUND: Cochlear implants (CIs) have been shown to improve children's speech recognition over traditional amplification when severe-to-profound sensorineural hearing loss is present. Despite improvements, understanding speech at low-level intensities or in the presence of background noise remains difficult. In an effort to improve speech understanding in challenging environments, Cochlear Ltd. offers preprocessing strategies that apply various algorithms before mapping the signal to the internal array. Two of these strategies include Autosensitivity Control™ (ASC) and Adaptive Dynamic Range Optimization (ADRO(®)). Based on the previous research, the manufacturer's default preprocessing strategy for pediatrics' everyday programs combines ASC + ADRO(®).
PURPOSE: The purpose of this study is to compare pediatric speech perception performance across various preprocessing strategies while applying a specific programming protocol using increased threshold levels to ensure access to very low-level sounds.
RESEARCH DESIGN: This was a prospective, cross-sectional, observational study. Participants completed speech perception tasks in four preprocessing conditions: no preprocessing, ADRO(®), ASC, and ASC + ADRO(®).
STUDY SAMPLE: Eleven pediatric Cochlear Ltd. CI users were recruited: six bilateral, one unilateral, and four bimodal.
INTERVENTION: Four programs, with the participants' everyday map, were loaded into the processor with different preprocessing strategies applied in each of the four programs: no preprocessing, ADRO(®), ASC, and ASC + ADRO(®).
DATA COLLECTION AND ANALYSIS: Participants repeated consonant-nucleus-consonant (CNC) words presented at 50 and 70 dB SPL in quiet and Hearing in Noise Test (HINT) sentences presented adaptively with competing R-Space(TM) noise at 60 and 70 dB SPL. Each measure was completed as participants listened with each of the four preprocessing strategies listed above. Test order and conditions were randomized. A repeated-measures analysis of was used to compare each preprocessing strategy for the group. Critical differences were used to determine significant score differences between each preprocessing strategy for individual participants.
RESULTS: For CNC words presented at 50 dB SPL, the group data revealed significantly better scores using ASC + ADRO(®) compared to all other preprocessing conditions while ASC resulted in poorer scores compared to ADRO(®) and ASC + ADRO(®). Group data for HINT sentences presented in 70 dB SPL of R-Space(TM) noise revealed significantly improved scores using ASC and ASC + ADRO(®) compared to no preprocessing, with ASC + ADRO(®) scores being better than ADRO(®) alone scores. Group data for CNC words presented at 70 dB SPL and adaptive HINT sentences presented in 60 dB SPL of R-Space(TM) noise showed no significant difference among conditions. Individual data showed that the preprocessing strategy yielding the best scores varied across measures and participants.
CONCLUSIONS: Group data reveal an advantage with ASC + ADRO(®) for speech perception presented at lower levels and in higher levels of background noise. Individual data revealed that the optimal preprocessing strategy varied among participants, indicating that a variety of preprocessing strategies should be explored for each CI user considering his or her performance in challenging listening environments.

PMID: 26905529 [PubMed - in process]

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Assessing Auditory Processing Abilities in Typically Developing School-Aged Children.

Assessing Auditory Processing Abilities in Typically Developing School-Aged Children.

J Am Acad Audiol. 2016 Feb;27(2):72-84

Authors: McDermott EE, Smart JL, Boiano JA, Bragg LE, Colon TN, Hanson EM, Emanuel DC, Kelly AS

Abstract
BACKGROUND: Large discrepancies exist in the literature regarding definition, diagnostic criteria, and appropriate assessment for auditory processing disorder (APD). Therefore, a battery of tests with normative data is needed.
PURPOSE: The purpose of this study is to collect normative data on a variety of tests for APD on children aged 7-12 yr, and to examine effects of outside factors on test performance.
RESEARCH DESIGN: Children aged 7-12 yr with normal hearing, speech and language abilities, cognition, and attention were recruited for participation in this normative data collection.
STUDY SAMPLE: One hundred and forty-seven children were recruited using flyers and word of mouth. Of the participants recruited, 137 children qualified for the study. Participants attended schools located in areas that varied in terms of socioeconomic status, and resided in six different states.
DATA COLLECTION AND ANALYSIS: Audiological testing included a hearing screening (15 dB HL from 250 to 8000 Hz), word recognition testing, tympanometry, ipsilateral and contralateral reflexes, and transient-evoked otoacoustic emissions. The language, nonverbal IQ, phonological processing, and attention skills of each participant were screened using the Clinical Evaluation of Language Fundamentals-4 Screener, Test of Nonverbal Intelligence, Comprehensive Test of Phonological Processing, and Integrated Visual and Auditory-Continuous Performance Test, respectively. The behavioral APD battery included the following tests: Dichotic Digits Test, Frequency Pattern Test, Duration Pattern Test, Random Gap Detection Test, Compressed and Reverberated Words Test, Auditory Figure Ground (signal-to-noise ratio of +8 and +0), and Listening in Spatialized Noise-Sentences Test. Mean scores and standard deviations of each test were calculated, and analysis of variance tests were used to determine effects of factors such as gender, handedness, and birth history on each test.
RESULTS: Normative data tables for the test battery were created for the following age groups: 7- and 8-yr-olds (n = 49), 9- and 10-yr-olds (n = 40), and 11- and 12-yr-olds (n = 48). No significant effects were seen for gender or handedness on any of the measures.
CONCLUSIONS: The data collected in this study are appropriate for use in clinical diagnosis of APD. Use of a low-linguistically loaded core battery with the addition of more language-based tests, when language abilities are known, can provide a well-rounded picture of a child's auditory processing abilities. Screening for language, phonological processing, attention, and cognitive level can provide more information regarding a diagnosis of APD, determine appropriateness of the test battery for the individual child, and may assist with making recommendations or referrals. It is important to use a multidisciplinary approach in the diagnosis and treatment of APD due to the high likelihood of comorbidity with other language, learning, or attention deficits. Although children with other diagnoses may be tested for APD, it is important to establish previously made diagnoses before testing to aid in appropriate test selection and recommendations.

PMID: 26905528 [PubMed - in process]

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Celebrating the Accomplishments of Those Special Individuals Who Have Contributed Significantly to Our Profession: The Academy Honors.

Celebrating the Accomplishments of Those Special Individuals Who Have Contributed Significantly to Our Profession: The Academy Honors.

J Am Acad Audiol. 2016 Feb;27(2):70-1

Authors: McCaslin DL, Saunders G

PMID: 26905527 [PubMed - in process]

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Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German stroke society.

Flexible endoscopic evaluation of swallowing (FEES) for neurogenic dysphagia: training curriculum of the German Society of Neurology and the German stroke society.

BMC Med Educ. 2016;16(1):70

Authors: Dziewas R, Glahn J, Helfer C, Ickenstein G, Keller J, Ledl C, Lindner-Pfleghar B, G Nabavi D, Prosiegel M, Riecker A, Lapa S, Stanschus S, Warnecke T, Busse O

Abstract
BACKGROUND: Neurogenic dysphagia is one of the most frequent and prognostically relevant neurological deficits in a variety of disorders, such as stroke, parkinsonism and advanced neuromuscular diseases. Flexible endoscopic evaluation of swallowing (FEES) is now probably the most frequently used tool for objective dysphagia assessment in Germany. It allows evaluation of the efficacy and safety of swallowing, determination of appropriate feeding strategies and assessment of the efficacy of different swallowing manoeuvres. The literature furthermore indicates that FEES is a safe and well-tolerated procedure. In spite of the huge demand for qualified dysphagia diagnostics in neurology, a systematic FEES education has not yet been established.
RESULTS: The structured training curriculum presented in this article aims to close this gap and intends to enforce a robust and qualified FEES service. As management of neurogenic dysphagia is not confined to neurologists, this educational programme is applicable to other clinicians and speech-language therapists with expertise in dysphagia as well.
CONCLUSION: The systematic education in carrying out FEES across a variety of different professions proposed by this curriculum will help to spread this instrumental approach and to improve dysphagia management.

PMID: 26911194 [PubMed - in process]

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A Case of Discontinued Proximal Limb of a Ventriculoperitoneal Shunt With Patent Fibrous Tract.

A Case of Discontinued Proximal Limb of a Ventriculoperitoneal Shunt With Patent Fibrous Tract.

Clin Nucl Med. 2016 Feb 24;

Authors: Bermo M, Leung AS, Matesan M

Abstract
Radionuclide shuntogram is important in the evaluation of cerebrospinal fluid (CSF) shunts complications such as mechanical failure, malpositioning, pseudocyst, or overdrainage. We present here a case of congenital hydrocephalus and posterior fossa cyst with multiple shunt procedures and revisions with breakage of the proximal tube of the ventriculoperitoneal shunt but preserved CSF drainage through the patent fibrous tract. Careful correlation with SPECT/CT images helped confirm the breakage and exclude CSF leak outside of the tract, which was suspected on planar images.

PMID: 26914568 [PubMed - as supplied by publisher]

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Intracranial hypotension secondary to spinal pathology: Diagnosis and treatment.

Intracranial hypotension secondary to spinal pathology: Diagnosis and treatment.

Clin Neurol Neurosurg. 2016 Feb 16;143:95-98

Authors: Sartip K, McKenna G, Spina M, Grahovac S

Abstract
Spinal pathology resulting in cerebrospinal fluid (CSF) leak and intracranial hypotension is an infrequently reported and a potentially severe cause of headaches. We present a case of cerebrospinal fluid (CSF) leak caused by a thoracic disk herniation successfully treated with two targeted epidural blood patches. Although patients typically present with orthostatic headaches, the imaging findings of intracranial hypotension should prompt investigation of the spine for site and cause of the CSF leakage. Treatment includes autologous blood patch and surgery in refractory cases.

PMID: 26914140 [PubMed - as supplied by publisher]

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Association between Lateral Skull Base Thickness and Surgical Outcomes in Spontaneous CSF Otorrhea.

Association between Lateral Skull Base Thickness and Surgical Outcomes in Spontaneous CSF Otorrhea.

Otolaryngol Head Neck Surg. 2016 Feb 23;

Authors: Stevens SM, Rizk HG, McIlwain WR, Lambert PR, Meyer TA

PMID: 26908549 [PubMed - as supplied by publisher]

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Construction and in vitro testing of a cellulose dura mater graft.

Construction and in vitro testing of a cellulose dura mater graft.

Neurol Res. 2016 Feb 23;:1-7

Authors: Goldschmidt E, Cacicedo M, Kornfeld S, Valinoti M, Ielpi M, Ajler PM, Yampolsky C, Rasmussen J, Castro GR, Argibay P

Abstract
INTRODUCTION: Cerebrospinal fluid (CSF) leaks are a common complication after cranial and spinal surgery and are associated with increased morbidity. Despite continuous research in this field, this problem is far from solved. In this paper, we describe the construction and testing of a bacterial cellulose (BC) membrane as a new dural patch.
MATERIALS AND METHODS: The synthesis of BC was performed using Gluconacetobacter hansenii (ATCC 23769) and films were sterilized by autoclaving. The membranes were seeded with human dural fibroblasts. Growth, shape, and cell viability were assessed after 4 weeks.
RESULTS: Normally shaped fibroblasts were seen on the BC grafts; confocal microscopy showed cells inside the structure of the mesh. Both viable and nonviable cells were present. Cellular attachment and viability were confirmed by replating of the membranes.
DISCUSSION: BC membranes are used in clinical practice to improve skin healing. In the presence of water, they form an elastic, nontoxic, and resistant biogel that can accommodate collagen and growth factors within their structure, thus BC is a good candidate for dural graft construction.

PMID: 26905484 [PubMed - as supplied by publisher]

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Aberrant cerebellar development in mice lacking dual oxidase maturation factors.

Aberrant cerebellar development in mice lacking dual oxidase maturation factors.

Thyroid. 2016 Feb 25;

Authors: Amano I, Takatsuru Y, Toya S, Haijima A, Iwasaki T, Grasberger H, Refetoff S, Koibuchi N

Abstract
BACKGROUND: Thyroid hormone (TH) plays a key role in the developing brain including the cerebellum. TH deficiency induces organizational changes of the cerebellum, causing cerebellar ataxia. However, the mechanisms causing these abnormalities are poorly understood. Various animal models have been used to study the mechanism. Lacking dual oxidase (DUOX) and its maturation factor (DUOXA) are major inducers of congenital hypothyroidism. Thus, we examined the organizational changes of the cerebellum using knockout mice of Duoxa gene (Duoxa-/-).
METHODS: We analyzed the morphological, behavioral, and electrophysiological changes in wild-type (Wt) and Duoxa deficient (Duoxa-/-) mice from postnatal day (P) 10 to P30. To detect the changes in the expression levels of presynaptic proteins, Western blot analysis was performed.
RESULTS: The proliferation and migration of granule cells was delayed after P15 in Duoxa-/- mice. However, these changes disappeared by P25. Although the cerebellar structure of Duoxa-/- mice was not significantly different from that of Wt mice at P25, motor coordination was impaired. We also found that the amplitude of paired-pulse facilitation at parallel fiber-Purkinje cell synapses decreased in Duoxa-/- mice, particularly at P15. There were no differences among expression levels of presynaptic proteins regulating neurotransmitter release at P25.
CONCLUSIONS: Our results indicate that the anatomical catch-up growth of the cerebellum did not normalize its function because of the disturbance of neuronal circuits by the combined effect of hypothyroidism and functional disruption of Duox/Duoxa complex.

PMID: 26914863 [PubMed - as supplied by publisher]

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Clinical Manifestations and Gene Expression in Patients with Conventional Papillary Thyroid Carcinoma Carrying the BRAFV600E Mutation and BRAF Pseudogene.

Clinical Manifestations and Gene Expression in Patients with Conventional Papillary Thyroid Carcinoma Carrying the BRAFV600E Mutation and BRAF Pseudogene.

Thyroid. 2016 Feb 25;

Authors: Lin JD, Fu SS, Chen JY, Lee CH, Chau WK, Cheng CW, Wang YH, Lin YF, Fang WF, Tang KT

Abstract
BACKGROUND: The association of BRAFV600E with the clinical manifestations of papillary thyroid carcinoma (PTC) remains controversial. Recent studies have shown that the BRAF pseudogene can activate the MAPK pathway and induce tumorigenesis. In this study, we investigated the association of BRAFV600E, the BRAF pseudogene, and their mRNA levels with clinical features and thyroid-specific gene expression in conventional PTCs.
MATERIALS AND METHODS: A total of 78 specimens were collected from patients with conventional PTCs. RNA was isolated, and quantitative polymerase chain reaction (PCR) was performed to measure the mRNA levels of BRAF, the BRAF pseudogene, and thyroid-specific and tumor-related genes. Immunohistochemical (IHC) staining of BRAF, ERK, sodium-iodide symporter (NIS), thyroid-stimulating hormone receptor (TSHR), glucose transporter 1 (GLUT1), and Ki67 was also performed.
RESULTS: BRAFV600E and the BRAF pseudogene were detected in 73.0% (57/78) and 91.7% (44/48), respectively, of the conventional PTCs. The presence of BRAFV600E was not associated with the multiple clinical features assessed or the recurrence rate during 76.9  47.2 months of follow-up. Neither was it associated with IHC staining or tumor-related/thyroid-specific gene expression, except for decreased NIS gene expression. The BRAF pseudogene was not associated with clinical characteristics or thyroid-specific gene expression, except for decreased decoy receptor 3 (DCR3) expression. High BRAF mRNA levels were associated with bilateral and multifocal lesions, and BRAF-pseudogene mRNA levels were positively correlated with BRAF mRNA levels (r = 0.415, p = 0.009).
CONCLUSION: Our results do not support the use of the BRAFV600E mutation as a prognostic marker of conventional PTC. However, the association of high BRAF mRNA levels with more advanced clinical features suggests that BRAF mRNA levels might be a more useful clinical marker of PTCs, independent of the BRAFV600E mutation status. The correlation between BRAF-pseudogene mRNA levels and BRAF mRNA levels in PTCs is in agreement with the hypothesis that the BRAF pseudogene regulates BRAF expression during tumorigenesis by acting as competitive noncoding RNA. However, additional studies with larger sample sizes are required to confirm these findings.

PMID: 26914762 [PubMed - as supplied by publisher]

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Development of a Statistical Model for the Prediction of Common Vestibular Diagnoses.

Development of a Statistical Model for the Prediction of Common Vestibular Diagnoses.

JAMA Otolaryngol Head Neck Surg. 2016 Feb 25;

Authors: Friedland DR, Tarima S, Erbe C, Miles A

Abstract
Importance: Treatment of patients with vestibular disorders can be complex, requires lengthy clinic visit time, and uses greater clinical resources for diagnosis. A pre-encounter intake questionnaire may predict the most common disorders, allowing for more efficient allocation of resources and use of clinicians.
Objective: To develop a statistical model for predicting vestibular diagnoses, prior to clinical evaluation, from an intake questionnaire.
Design, Setting, and Participants: Retrospective review of 414 consecutive new vestibular patient intake questionnaires (September 2012 through January 2014) and associated medical records with performance of logistic regression analyses and development of predictive models (July 2013 through May 2015).
Interventions: Use of a vestibular intake questionnaire for triaging of new patients with complaints of dizziness.
Main Outcomes and Measures: Predictors for the diagnosis of benign paroxysmal positional vertigo (BPPV), Ménière's disease, and vestibular migraine.
Results: Of the 414 questionnaires analyzed, 381 (92%) had clinician information necessary to define a final diagnosis. Patients were 34% male and had a mean (range) age of 57 (19-91) years. Of the diagnoses, 183 (48%) were ear related (including 103 BPPV and 49 Meniere's disease), 141 (37%) neurological (including 109 vestibular migraine), 36 (9%) medical, 8 (2%) of psychological origin, 46 (12%) of unknown etiology, and 33 (9%) other causes. The diagnosis of BPPV could be predicted from 4 variables with a sensitivity of 79% and specificity of 65%. The diagnosis of Ménière's disease could be predicted from 5 variables with a sensitivity of 81% and specificity of 85%. The diagnosis of vestibular migraine could be predicted from 4 variables with a sensitivity of 76% and specificity of 59%.
Conclusions and Relevance: A pre-encounter history questionnaire can provide useful diagnostic information for common vestibular disorders. This can help direct appointment scheduling to improve clinical efficiency, time to intervention, and use of resources. Further refinement may enable the use of shorter questionnaires or screening algorithms.

PMID: 26913615 [PubMed - as supplied by publisher]

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Rhabdomyolysis after lamotrigine overdose: a case report and review of the literature.

Rhabdomyolysis after lamotrigine overdose: a case report and review of the literature.

Ann Gen Psychiatry. 2016;15:6

Authors: Karaoulanis SE, Syngelakis M, Fokas K

Abstract
BACKGROUND: Lamotrigine is an effective anticonvulsant drug that has also been demonstrated to be effective in the treatment of bipolar disorder. We report a case of rhabdomyolysis after intentional overdose in a woman aged 48.
CASE PRESENTATION: A 48-year-old female presented to the emergency department after an acute ingestion of 6 g of lamotrigine. The patient suffered from bipolar disorder, and she was taking lamotrigine and olanzapine. At that point, she had a major depressive episode, and she wanted to commit suicide. Activated charcoal was administered in the emergency department. Her vital signs were still normal, and she entered the Medical clinic, where she had been there for 2 days in a good condition. The hematological and biochemical results were normal. On the fourth day, the levels of creatine phosphokinase (CPK) showed remarkable increase (2500 IU/ml). Fluid and bicarbonate intravenous administration was performed, and CPK levels returned to normal after 3 days.
CONCLUSION: The majority of patients exposed to lamotrigine in overdose experienced no toxic clinical effects. The most common clinical effects are drowsiness and lethargy, vomiting, nausea, ataxia, dizziness/vertigo, and tachycardia. In this case report, the patient was alert and did not have any serious complications, except for mild rhabdomyolysis, which was the main consequence of lamotrigine overdose.

PMID: 26913053 [PubMed]

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[Intratympanic versus systemic steroid initial treatment for idiopathic sudden hearing loss: a Meta-analysis].

[Intratympanic versus systemic steroid initial treatment for idiopathic sudden hearing loss: a Meta-analysis].

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Nov;29(22):1970-7

Authors: Chen P, Wang S, Zhang Y, Huang H, Zhang C, Xiao Z

Abstract
OBJECTIVE: To assess the efficacy and safety of glucocorticoid in initial treatment of sudden hearing loss with intratympanic (IT) and systemic ways.
METHOD: We searched the database of PubMed, Cochrane, Embase,CBM, CNKI, VIP, Wanfang systematically. Literatures were screened according to the preestablished inclusion and exclusion standards,and all the RCT literatures associated with intratympanic and systemic glucocorticoid in the initial treatment of sudden hearing loss before may 2015 were collected. All the data, which meet the inclusion standards, were analyzed by using Meta-analysis software.
RESULT: Among all the qualified literatures, 11 randomized controlled trials were included. A total of 1298 cases were involved, including 521 cases with intratympanic administration, 410 with IV-therapy, and 201 with oral therapy. Meta analysis results showed that there was significant difference of the total effective rate and improvement rate between the intratympanic and systemic administration. Intratympanic injection (P > 0.05) was more effective than systemic administration. There was no significant difference between intratympanic group and oral group (RR = 1.15, 95% CI: 0.92-1.42, P > 0.05). A significant difference of the effective rate occurred between intratympanic group and IV therapy group (RR = 1.17, 95% CI: 1.02-1.34, P < 0.05). The major complications of intratympanic were pain, dizziness/vertigo, which occurred more frequently than systemic therapy group; The major complications of systemic therapy group were hyperglycaemia, loss of appetite and insomnia.
CONCLUSION: This study shows that the intratympanic (IT) glucocorticoid for sudden deafness is more effective than the systemic administration. But it was not the first choice in clinical treatment. Further studies are warranted.

PMID: 26911061 [PubMed - in process]

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[Clinical analysis of idiopathic sudden sensorineural hearing loss with vertigo].

[Clinical analysis of idiopathic sudden sensorineural hearing loss with vertigo].

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Nov;29(22):1963-5, 1969

Authors: Gong N, Zhang X, Ge L, Xu D

Abstract
OBJECTIVE: To explore the clinical characteristics and prognosis of patients with idiopathic sudden sensorineural hearing loss (ISSHL) with vertigo.
METHOD: By analyzing the clinical data of 271 ISSHL patients, they were divided into without vertigo group (n = 169) and vertigo group (n = 102). In vertigo group, 34 cases were patients with benign paroxysmal positional vertigo (BPPV) secondary to the ISSHL. All patients received conventional treatment. According to the types of BPPV, patients with secondary BPPV received Epley maneuver or Barbecue roll maneuver. By analyzing the results of the pure tone audiometry test and treatment outcomes of the patients, we summarized the clinical characteristics of ISSHL patients with vertigo.
RESULT: The audiometric curves of ISSHL with vertigo group were mainly at high frequency. The degrees of hearing loss of these patients were severe and profound. After treatment, the improvement of hearing threshold for ISSHL with vertigo group was lower than that for ISSHL without vertigo group. What's more, the rate of recovery, success and total effective of audition for ISSHL with vertigo group was also obviously lower than that for ISSHL without vertigo group. Of all the patients with BPPV, 27 cases of posterior semicircular canal and 7 cases of lateral semicircular canal were identified. All patients with BPPV were diagnosed as the same ears as the ISSHL.
CONCLUSION: ISSHL with vertigo group lost hearing more severely than ISSHL without vertigo group. Also, the improvement of hearing and the effective after treatment were really poor. The symptoms of ISSHL with BPPV group improved and eased significantly than that of ISSHL without BPPV group. The major of BPPV secondary to the ISSHL occurs in the posterior semicircular canal. The canalith repositioning is an effective therapy to the secondary BPPV.

PMID: 26911059 [PubMed - in process]

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[Prognostic factors of sudden sensorineural hearing loss in children].

[Prognostic factors of sudden sensorineural hearing loss in children].

Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2015 Nov;29(22):1931-5

Authors: Li F, Xue X, Wang L, Yang F, Wang H, Guan J, Du W, Xiong W, Wu K, Wu M, Yin Z, Lan L, Wang D, Wang Q

Abstract
OBJECTIVE: The aim of this retrospective study was to analyze the recovery rate of sudden sensorineural hearing loss in children, and explore the prognostic factors in order to guide the clinical diagnosis and treatment.
METHOD: A retrospective review was conducted for the prognosis of children with sudden sensorineural hearing loss during the past 5 years (from November 2010 to May 2015) in Chinese PLA General Hospital. This paper have a complete clinical data of 101 patients (113 ears)with sudden hearing loss, ranging from 0 to 18 years old Patients were divided into four groups according to hearing recovery and eight putative prognostic factors were analyzed.
RESULT: Among 101 patients (113 ears), the ratio of male and female was 60:53. Treatment was initiated from 1 to 183 days after disease onset, with an average of (18.5 ± 22.1) d. Bilateral and unilateral hearing loss were 24 ears and 89 ears, respectively. The proportion of mild hearing loss, moderate hearing loss, severe hearing loss and profound hearing loss were 7.1%, 6.2%, 23.9% and 62.8%, respectively. Vertigo and tinnitus occurred in 54.9% and 77.9% of the patients, respectively. After the treatment, the complete recovery rate was 9.7% and the overall recovery rate was 36.3%. The degree of hearing loss, earlier treatment onset, sex and bilateral involvement were significantly associated with hearing recovery (P < 0.05).
CONCLUSION: Sudden sensorineural hearing loss in children was generally identified as severe and profound hearing loss, but after positive and timely treatment, it can be improved or even cured. The mild hearing loss, earlier treatment onset, unilateral hearing loss and female were positive prognostic factors. The concurrence of tinnitus or vertigo, the results of ABR and DPOAE had no significant influence on prognosis.

PMID: 26911052 [PubMed - in process]

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Αρχειοθήκη ιστολογίου

Δευτέρα 29 Φεβρουαρίου 2016

Κυριακή 28 Φεβρουαρίου 2016

Σάββατο 27 Φεβρουαρίου 2016

Παρασκευή 26 Φεβρουαρίου 2016