Audiology by Alexandros G. Sfakianakis: 08/16/16

Τρίτη 16 Αυγούστου 2016

The Relationship Between the Aerodynamic Parameters of Voice and Perceptual Evaluation in the Iranian Population With or Without Voice Disorders

Publication date: Available online 16 August 2016
Source:Journal of Voice
Author(s): Mahshid Aghajanzadeh, Akbar Darouie, Payman Dabirmoghaddam, Abolfazl Salehi, Mehdi Rahgozar
ObjectivesAerodynamic evaluations can provide useful information about the interaction between the respiratory and the phonation systems. The present study was conducted to investigate the relationship of maximum phonation time (MPT), vital capacity (VC), and phonation quotient (PQ) with perceptual evaluation in different types of dysphonia. The relationship between these parameters and the type of dysphonia was also examined.Materials and MethodsThe study participants consisted of 300 individuals with different types of dysphonia (104 women and 196 men) and 100 healthy samples (63 women and 37 men). A professional speech-language pathologist conducted the perceptual evaluation based on the G (grade) component of the GRBAS scale, which stands for grade, roughness, breathiness, asthenia, and strain. VC was measured using a spirometer and MPT using a stopwatch. PQ was calculated as the ratio of VC to MPT.ResultsThe difference between the mean ± standard deviation of PQ, VC, and MPT were found to be significant at all the four degrees of dysphonia severity (P < 0.001). There was a significant difference in mean MPT and VC between the genders (P < 0.001), but no significant gender differences were observed in terms of the mean PQ (P = 0.346). The study participants were classified into four groups, including the organic dysphonia group, neurologic dysphonia and functional dysphonia groups, and the normal group; the study variables measured were found to be significantly different between all the four groups (P < 0.001).ConclusionAs MPT and PQ were correlated with the perceptual G (grade) and differentiated dysphonic from healthy individuals, clinicians are recommended to take account of them in their instrumental evaluations.

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Lax Vox as a Voice Training Program for Teachers: A Pilot Study

Publication date: Available online 16 August 2016
Source:Journal of Voice
Author(s): Eva Mailänder, Lea Mühre, Ben Barsties
ObjectivesThe objective of this study was to explore the effectiveness of a 3-week training program with the voice therapy “Lax Vox” for teachers.MethodsFour healthy female teachers participated as volunteers for the study. Several voice measurements of perception, acoustics, aerodynamics, and self-evaluation were investigated. Furthermore, a survey to rate the applicability of Lax Vox was also part of the study. To assess the treatment effects of the Lax Vox training, an effect size analysis (dunb) was conducted.ResultsAfter 3 weeks of training, medium and large improvements were found in some parameters of perceptual and acoustic voice quality assessments (dunb >0.50 and dunb >0.80, respectively). Furthermore, medium improvements were revealed in some parameters of self-evaluation (ie, physical and total scale of the Voice Handicap Index) and aerodynamic (ie, maximum phonation time) assessments (all dunb >0.50). Additionally, acoustic measures of vocal function showed an expansion in the upper contour of voice range profiles after training. Particularly, the main improvements in the voice range profile was found in the modal and the beginning of the falsetto voice registers. There was an increase of the intensity levels of about 4.6 dB. No changes were revealed in some acoustic measures of the voice range profile, self-evaluation measurements, and the perception of breathy voice quality (all dunb <0.20). Finally, the applicability of Lax Vox perceptually showed clear support in training success, learning process, and transfer to the daily routine.ConclusionsLax Vox training for teachers appears to improve select measures of voice quality, maximum phonation time, vocal function, self-evaluation, and perceived applicability.

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Tinnitus Treatment

For those with moderate to severe tinnitus, the persistent ringing in your ears can degrade your quality of life. In some cases, it may be debilitating. Although there is no known cure, there are treatments that can help you manage the problem. The following are only five methods for tinnitus treatment.

A review of your diet and medications
A doctor can look at your diet to determine if there is anything that is contributing to the problem. For example, if you are a coffee drinker, this can lead to an increase in the symptoms associated with tinnitus. Likewise, certain medications can contribute to a worsening of your tinnitus. Often a patient is already taking certain drugs when a diagnosis has been made, so your doctor may need to adjust your medication.

Electronic devices
There are a variety of devices that can be used for tinnitus treatment. One example is a white noise generator. These devices produces a high frequency sound that can make the ringing in your ears diminish. They are especially useful for sleeping at night, when tinnitus can cause sleep deprivation. Those with a hearing loss have found relief by being fitted with a hearing aid. The ability to hear better has helped reduce tinnitus in many people.

Medications
Although there is no specific drug that can cure tinnitus, there are certain anti-depressants that have been effective for many patients. However, they can have side effects, so you should give serious consideration to using them, as well as making sure you are under the supervision of your doctor.

Vitamins and herbal supplements
There are certain vitamins and minerals that some sufferers of tinnitus have found relief by using. A B-complex supplement taken daily has helped many people as well as zinc. Among herbal supplements, it is ginkgo biloba that people have claimed to have provided relief. Always consult your primary care physician before taking any dietary supplement.

Alternative treatments
Two treatments you may want to consider are hypnosis and acupuncture. Although the medical field seems skeptical of both areas of treatment, they are also harmless. Because they may help and will do no harm, it may be worth a try, especially if you have a severe case of tinnitus.

Keep in mind that tinnitus treatment is still being researched, so there may be new treatments available in the near future. Keep experimenting and consulting with your doctor about various ways to relieve your discomfort. What works for one person may not work for another, but what works best may be a combination of treatments.

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Children with ANSD Fitted with Hearing Aids

Intervention for children with auditory neuropathy spectrum disorder (ANSD) represents a significant challenge in pediatric audiology. A critical tool for the fitting of amplification in young pediatric patients, the auditory brainstem response (ABR), is compromised in this population for estimation of behavioral thresholds. Despite compromised ABR responses, cortical auditory evoked potentials (CAEP) can often be recorded from ANSD patients, and there is emerging research in the application of CAEP for estimation of behavioral thresholds in this population (He et al. 2013).

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Transcranial Attenuation in Patients with Single-Sided Deafness

Transcranial attenuation (TA) of bone-conducted sound has a high degree of variability by frequency and subject, which may play a role in the objective benefit of individuals with single-sided deafness (SSD) treated with a bone-anchored implant (BAI). This study sought to determine whether TA is predictive of benefit in individuals with SSD who receive a BAI. Adult, English-speaking patients with unilateral profound sensorineural hearing loss who underwent a BAI evaluation were included for study. Absolute TA values were consistent with previously published reports. Regression analysis indicated no correlation between TA values and aided speech-in-noise performance for any combined or individual frequencies. Measures of TA do not provide predictive value in determining behavioral outcomes in the SSD population. Specifically, low TA does not suggest improved outcomes with a BAI.
Audiol Neurotol 2016;21:237-243

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Calcium Homeostasis During Attack and Remission in Patients With Idiopathic Benign Paroxysmal Positional Vertigo.

Calcium Homeostasis During Attack and Remission in Patients With Idiopathic Benign Paroxysmal Positional Vertigo.

Otol Neurotol. 2016 Aug 12;

Authors: Kahraman SS, Ozcan O, Arli C, Ustun I, Erduran R, Akoglu E, Gokce C

Abstract
OBJECTIVE: To evaluate changes in calcium metabolism in patients with idiopathic benign paroxysmal positional vertigo (BPPV) on initial presentation and at the follow-up visit.
SUBJECTS AND METHODS: The study comprised a total of 31 patients aged greater than 18 years who presented at the otorhinolaryngology outpatient clinic of our hospital, newly diagnosed as idiopathic BPPV based on the history compatible with BPPV and positive provocative maneuver (either Dix-Hallpike or Roll test). The first blood sample was obtained on the day of initial presentation when the patient was found to have active unilateral BPPV. After 6 months, a blood sample was again drawn in accordance with the procedure. Blood samples were analyzed for data on 25-hydroxyvitamin D (25(OH)-D), total calcium, parathormone and ionized calcium on initial presentation, and at the follow-up visit.
RESULTS: The patients comprised 20 (64.5%) women and 11 (35.5%) men with a mean age of 49.78 years (range, 23-75 years). During an attack a higher prevalence of decreased serum Vitamin D is less than 20 ng/ml, was determined (93.5% versus 38.7%). There were statistical differences between the Vitamin D values, parathormone, and corrected by pH ionized calcium in both periods (p < 0.05).
CONCLUSION: A statistically significant association was determined between Vitamin D and calcium metabolism in patients with idiopathic BPPV. It can be considered that Vitamin D deficiency and decreased ionized Ca level may be a risk for BPPV, not only in patients with osteoporosis but also in all patients. Very low levels of 25(OH)-D seem to be associated with recurrence of BPPV. The recurrences might possibly be prevented with supplementary Vitamin D especially in those with recurrent idiopathic BPPV but further studies would be necessary to determine this.

PMID: 27525708 [PubMed - as supplied by publisher]

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Oxidative Damage and Inflammation Biomarkers: Strategy in Hearing Disorders.

Oxidative Damage and Inflammation Biomarkers: Strategy in Hearing Disorders.

Otol Neurotol. 2016 Sep;37(8):e303-8

Authors: Haase GM, Prasad KN

Abstract
IMPORTANCE: Excess free radical-induced oxidative stress and inflammatory processes are increasingly recognized as causative factors in hearing and balance disorders. Antioxidant micronutrients neutralize free radicals and, at adequate doses, reduce inflammation and demonstrate benefits in animal models and human trials. Therefore, it is reasonable to expect that biomarkers of oxidative damage and inflammation are appropriate correlative biological outcome parameters in clinical hearing intervention studies.
OBJECTIVE: To provide the otology investigator a selected panel of biomarkers from the large universe of available tests that can be used as reasonable secondary endpoints in hearing and balance research.
BACKGROUND SETTING: The tenets of antioxidant science dictate that there are a great variety of free radicals and that they impact different cellular targets. They also demonstrate varying functions in different cellular environments. In addition, oxidative stress and inflammation may cause direct injury to tissues, cell membrane lipids, proteins and mitochondrial, and nuclear DNA. To accommodate these many pathways, the useful categories of potential biomarkers become extensive. The degree of injury is also reflected by separate markers of inflammation and measures of antioxidant levels. Therefore, to provide a reliable indication of oxidative damage, inflammation and antioxidant level, it is necessary to determine a broad spectrum of lipid peroxidation markers, adducts of DNA, oxidation levels of proteins and pro-inflammatory cytokines.
CONCLUSION: This report highlights some of the most clinically relevant and well-studied biomarkers in each category of tissue damage. It also includes those markers with which the authors have had direct positive clinical experience. The outcome from these studies is intended to provide a list of adjunctive measures that can be recommended as a relevant biomarker panel in hearing disorder clinical trials.

PMID: 27518139 [PubMed - in process]

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The gastric H,K-ATPase in stria vascularis contributes to pH regulation of cochlear endolymph but not to K secretion.

The gastric H,K-ATPase in stria vascularis contributes to pH regulation of cochlear endolymph but not to K secretion.

BMC Physiol. 2016;17(1):1

Authors: Miyazaki H, Wangemann P, Marcus DC

Abstract
BACKGROUND: Disturbance of acid-base balance in the inner ear is known to be associated with hearing loss in a number of conditions including genetic mutations and pharmacologic interventions. Several previous physiologic and immunohistochemical observations lead to proposals of the involvement of acid-base transporters in stria vascularis.
RESULTS: We directly measured acid flux in vitro from the apical side of isolated stria vascularis from adult C57Bl/6 mice with a novel constant-perfusion pH-selective self-referencing probe. Acid efflux that depended on metabolism and ion transport was observed from the apical side of stria vascularis. The acid flux was decreased to about 40 % of control by removal of the metabolic substrate (glucose-free) and by inhibition of the sodium pump (ouabain). The flux was also decreased a) by inhibition of Na,H-exchangers by amiloride, dimethylamiloride (DMA), S3226 and Hoe694, b) by inhibition of Na,2Cl,K-cotransporter (NKCC1) by bumetanide, and c) by the likely inhibition of HCO3/anion exchange by DIDS. By contrast, the acid flux was increased by inhibition of gastric H,K-ATPase (SCH28080) but was not affected by an inhibitor of vH-ATPase (bafilomycin). K flux from stria vascularis was reduced less than 5 % by SCH28080.
CONCLUSIONS: These observations suggest that stria vascularis may be an important site of control of cochlear acid-base balance and demonstrate a functional role of several acid-base transporters in stria vascularis, including basolateral H,K-ATPase and apical Na,H-exchange. Previous suggestions that H secretion is mediated by an apical vH-ATPase and that basolateral H,K-ATPase contributes importantly to K secretion in stria vascularis are not supported. These results advance our understanding of inner ear acid-base balance and provide a stronger basis to interpret the etiology of genetic and pharmacologic cochlear dysfunctions that are influenced by endolymphatic pH.

PMID: 27515813 [PubMed - in process]

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Micro CT visualization of silver nanoparticles in the middle and inner ear of rat and transportation pathway after transtympanic injection.

Micro CT visualization of silver nanoparticles in the middle and inner ear of rat and transportation pathway after transtympanic injection.

J Nanobiotechnology. 2015;13:5

Authors: Zou J, Hannula M, Misra S, Feng H, Labrador RH, Aula AS, Hyttinen J, Pyykkö I

Abstract
BACKGROUND: Silver nanoparticles (Ag NPs) displayed strong activities in anti-bacterial, anti-viral, and anti-fungal studies and were reportedly efficient in treating otitis media. Information on distribution of AgNPs in different compartments of the ear is lacking.
OBJECTIVE: To detect distribution of Ag NPs in the middle and inner ear and transportation pathways after transtympanic injection.
METHODS: Contrast effect of Ag NPs in the micro CT imaging was assessed in a phantom. AgNPs at various concentrations (1.85 mM, 37.1 mM, and 370.7 mM) were administered to rat middle ear using transtympanic injection and cadaver heads were imaged using micro CT at several time points.
RESULTS: The lowest concentration of Ag NPs that could be visualized using micro CT was 37.1 mM. No difference was observed between the solvents, deionized H2O and saline. Ag NPs at 37.1 mM were visible in the middle ear on 7 d post-administration. Ag NPs at 370.7 mM generated signals in the middle ear, ossicular chain, round window membrane, oval window, scala tympani, and Eustachian tube for both 4 h and 24 h time points. A gradient distribution of Ag NPs from the middle ear to the inner ear was detected. The pathways for Ag NPs to be transported from the middle ear into the inner ear are round and oval windows.
CONCLUSION: This study provided the imaging evidence that Ag NPs are able to access the inner ear in a dose-dependent manner after intratympanic administration, which is relevant to design the delivery concentration in the future clinic application in order to avoid adverse inner ear effect.

PMID: 25622551 [PubMed - indexed for MEDLINE]

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Tumor progression driven by pathways activating matrix metalloproteinases and their inhibitors.

http:--media.wiley.com-assets-7315-19-Wi

Tumor progression driven by pathways activating matrix metalloproteinases and their inhibitors.

J Oral Pathol Med. 2015 Jul;44(6):437-43

Authors: Bodnar M, Szylberg Ł, Kazmierczak W, Marszalek A

Abstract
BACKGROUND: Laryngeal squamous cell carcinoma (LSCC) is still a problem worldwide. In some publications interactions between the expression of matrix metalloproteinases (MMPs), particularly MMP-2 and MMP-9, and their tissue inhibitors (TIMPs) implicated during cancer progression were suggested.
METHODS: The immunohistochemical staining using primary antibody against MMP-2, MMP-9, TIMP-1, TIMP-2, and TIMP-3 were performed. The research group consists of primary N(0) LSCC (20 cases), primary N(+) LSCC (17 cases), and 18 cases of normal mucosa.
RESULTS: Studied MMPs and TIMPs were localized in tumor cells and tumor stroma compartment. MMP-2 expression was higher in stroma compared to tumor cells. MMP-9, TIMP-1, TIMP-2, and TIMP-3 expression was higher in tumor cells than in tumor stroma (P < 0.05). In tumor stroma MMP-2, MMP-9, TIMP-1, and TIMP-3 expression, in LSCC N(0) vs. LSCC N(+) was significantly higher (P < 0.05). The ratios between MMP-2 and TIMP-3 expression were statistically significant (N(0) vs. N(+); P = 0.012). The analyses using classification trees predicted the probability of metastases according to TIMP-3/MMP-14/MMP-2 and MMP-9/TIMP-1 expression levels.
CONCLUSIONS: The presence of MMP-2, MMP-9, TIMP-1, TIMP-2, TIMP-3 expression in tumor cells and in tumor stroma, and additionally different expression according to lymph node involvement suggested of their impact during cancer progression. The significant correlation between TIMP-3 expression and the presence of lymph node metastases and MMP-2 expression might suggest the importance of TIMP-3 as a prognostic factor during tumor progression. The evaluation of molecular markers which participate in MMP-2 activation pathway have a major impact during metastasis.

PMID: 25244188 [PubMed - indexed for MEDLINE]

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Oxidative Damage and Inflammation Biomarkers: Strategy in Hearing Disorders.

Oxidative Damage and Inflammation Biomarkers: Strategy in Hearing Disorders.

Otol Neurotol. 2016 Sep;37(8):e303-8

Authors: Haase GM, Prasad KN

PMID: 27518139 [PubMed - in process]

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The gastric H,K-ATPase in stria vascularis contributes to pH regulation of cochlear endolymph but not to K secretion.

The gastric H,K-ATPase in stria vascularis contributes to pH regulation of cochlear endolymph but not to K secretion.

BMC Physiol. 2016;17(1):1

Authors: Miyazaki H, Wangemann P, Marcus DC

PMID: 27515813 [PubMed - in process]

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Micro CT visualization of silver nanoparticles in the middle and inner ear of rat and transportation pathway after transtympanic injection.

Micro CT visualization of silver nanoparticles in the middle and inner ear of rat and transportation pathway after transtympanic injection.

J Nanobiotechnology. 2015;13:5

Authors: Zou J, Hannula M, Misra S, Feng H, Labrador RH, Aula AS, Hyttinen J, Pyykkö I

PMID: 25622551 [PubMed - indexed for MEDLINE]

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Tumor progression driven by pathways activating matrix metalloproteinases and their inhibitors.

Tumor progression driven by pathways activating matrix metalloproteinases and their inhibitors.

J Oral Pathol Med. 2015 Jul;44(6):437-43

Authors: Bodnar M, Szylberg Ł, Kazmierczak W, Marszalek A

PMID: 25244188 [PubMed - indexed for MEDLINE]

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Signal type and signal-to-noise ratio interact to affect cortical auditory evoked potentials

Use of speech signals and background noise is emerging in cortical auditory evoked potential (CAEP) studies; however, the interaction between signal type and noise level remains unclear. Two experiments determined the interaction between signal type and signal-to-noise ratio (SNR) on CAEPs. Three signals (syllable /ba/, 1000-Hz tone, and the /ba/ envelope with 1000-Hz fine structure) with varying SNRs were used in two experiments, demonstrating signal-by-SNR interactions due to both envelope and spectral characteristics. When using real-world stimuli such as speech to evoke CAEPs, temporal and spectral complexity leads to differences with traditional tonal stimuli, especially when presented in background noise.

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Stapedectomy in Teunissen-Cremers Syndrome: Intraoperative Findings and Hearing Outcomes.

Stapedectomy in Teunissen-Cremers Syndrome: Intraoperative Findings and Hearing Outcomes.

Otol Neurotol. 2016 Aug 12;

Authors: Coombs AC, Bird PA

Abstract
OBJECTIVE: To describe the intraoperative findings and outcomes of stapedectomy surgery in Teunissen-Cremers syndrome.
PATIENTS: A family of three patients with bilateral conductive hearing loss because of Teunissen-Cremers syndrome.
INTERVENTION: Six exploratory tympanotomies and stapedectomies, including one revision operation.
MAIN OUTCOME MEASURES: Intraoperative findings and postoperative hearing results.
RESULTS: There was an increased distance between the incus and the vestibule, a thicker long process of the incus, and slight variation in the relative position of the ossicles in all patients. Surgery resulted in closure of the air-bone gap to less than 10 dB in all five operated ears.
CONCLUSION: We describe anatomic abnormalities of the ossicular chain in Teunissen-Cremers syndrome. Prosthesis availability should include prostheses that can adapt to these potential anatomic abnormalities. Stapedectomy resulted in good long-term hearing outcomes in this series.

PMID: 27525709 [PubMed - as supplied by publisher]

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Long-term clinical follow-up and molecular testing for diagnosis of the first Tunisian family with Alström syndrome.

Long-term clinical follow-up and molecular testing for diagnosis of the first Tunisian family with Alström syndrome.

Eur J Med Genet. 2016 Aug 11;

Authors: Chakroun A, Ben Said M, Ennouri A, Achour I, Mnif M, Abid M, Ghorbel A, Marshall JD, Naggert JK, Masmoudi S

Abstract
Alström syndrome is a clinically complex disorder characterized by progressive degeneration of sensory functions, resulting in visual and audiological impairment as well as metabolic disturbances. It is caused by recessively inherited mutations in the ALMS1 gene, which codes for a centrosomal/basal body protein. The purpose of this study was to investigate the genetic and clinical features of two Tunisian affected siblings with Alström syndrome. Detailed clinical examinations were performed including complete ophthalmic examination, serial audiograms and several biochemical and hormonal blood tests. For the molecular study, first genomic DNA was isolated using a standard protocol. Then, linkage analysis with microsatellite markers was performed and DNA array was used to detect known mutations. Subsequently, all ALMS1 exons were simultaneously sequenced for one affected patient with the TaGSCAN targeted sequencing panel. Finally, segregation of the causal variant was performed by Sanger sequencing. Both affected siblings had cone rod dystrophy with impaired visual acuity, sensorineural hearing loss and truncal obesity. One affected individual showed insulin resistance without diabetes mellitus. Other clinical features including cardiac and pulmonary dysfunction, hypothyroidism, hyperlipidemia, acanthosis nigricans, renal and hepatic dysfunction were absent. Genetic analysis showed the presence of a homozygous splice site mutation (c.10388-2A > G) in both affected siblings. Although Alström syndrome is relatively well characterized disease, this syndrome is probably misdiagnosed in Tunisia. Here, we describe the first report of Tunisian patients affected by this syndrome and carrying a homozygous ALMS1 mutation. The diagnosis was suspected after long-term clinical follow-up and confirmed by genetic testing.

PMID: 27523285 [PubMed - as supplied by publisher]

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A deafness and diabetes associated tRNA mutation caused the deficient pseudouridinylation at position 55 in tRNAGlu and mitochondrial dysfunction .

A deafness and diabetes associated tRNA mutation caused the deficient pseudouridinylation at position 55 in tRNAGlu and mitochondrial dysfunction .

J Biol Chem. 2016 Aug 12;

Authors: Wang M, Liu H, Zheng J, Chen B, Zhou M, Fan W, Wang H, Liang X, Zhou X, Eriani G, Jiang P, Guan MX

Abstract
Several mitochondrial tRNA mutations have been associated with maternally inherited diabetes and deafness (MIDD). However, the pathophysiology of these tRNA mutations remains poorly understood. In this report, we identified the novel homoplasmic 14692A>G mutation in the mitochondrial tRNAGlu gene among three Han Chinese families with maternally inherited diabetes and deafness. The m.14692A>G mutation affected a highly conserved uridine at position 55 of TΨC loop of tRNAGlu. The uridine is modified to pseudouridine (Ψ55), which plays an important role in the structure and function of this tRNA. Using lymphoblastoid cell lines derived from a Chinese family, we demonstrated that the m.14692A>G mutation caused the loss of Ψ55 modification and increased the angiogenin-mediated endonucleolytic cleavage in mutant tRNAGlu. The destabilization of base-pairing (18A-Ψ55) caused by the m.14692A>G mutation perturbed the conformation and stability of tRNAGlu. Approximately 65% decrease in the steady-state level of tRNAGlu was observed in mutant cells, compared to control cells. A failure in tRNAGlu metabolism impaired mitochondrial translation, especially for polypeptides with high proportion of glutamic acid codons such as MT-ND1, MT-ND6 and MT-CO2 in mutant cells. An impairment of mitochondrial translation caused the defective respiratory capacity, especially reducing activities of complexes I and IV. Furthermore, marked decreases in the levels of mitochondrial ATP and membrane potential were observed in mutant cells. These mitochondrial dysfunctions caused an increasing production of reactive oxygen species in the mutant cells. Our findings may provide new insights into pathophysiology of MIDD, which was primarily manifested by the deficient nucleotide modification of mitochondrial tRNAGlu.

PMID: 27519417 [PubMed - as supplied by publisher]

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[Influencing factors for the use of earplugs in workers exposed to noise in a city].

[Influencing factors for the use of earplugs in workers exposed to noise in a city].

Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi. 2016 Apr 20;34(4):271-4

Authors: Zhu QR, Shao YX, Cao CJ, Wu X, Xie WQ, Xu M, Yang L, Xu LW

Abstract
OBJECTIVE: To investigate the current status of hearing loss and the use of earplugs in workers exposed to noise who have been provided earplugs in a city, as well as major influencing factors for the use of earplugs.
METHODS: Cluster random sampling was used to conduct a questionnaire survey in workers exposed to noise who had been provided earplugs in 15 enterprises with noise exposure in a city from June to December, 2014.
RESULTS: In the workers exposed to noise who had been provided earplugs, the rate of high-frequency anomaly in both ears was 57.8%, and the workers who kept wearing earplugs only accounted for 55.4%. The results of binary logistic regression analysis showed that the protective factors for the use of earplugs included workers' own feeling of hearing condition (OR=1.704), comfort of earplugs (OR= 1.892), enterprise's inspection of the use of earplugs (OR=1.461), workers' knowledge of the function and usage of earplugs (OR=1.581), workers' understanding of the necessity of earplugs (OR=4.482), workers' initiative to search for related data (OR=4.029), the use of earplugs by colleagues (OR=5.071), and reminders from family members or friends (OR=2.678) (all P<0.05).
CONCLUSION: The workers exposed to noise in this city have a high rate of abnormal hearing, and only half of the workers keep wearing earplugs during work. The use of earplugs is related to the factors including workers' own feeling of hearing condition, comfort of earplugs, workers' knowledge of protection, the enterprise' s management of hearing protection, and environmental support.

PMID: 27514260 [PubMed - in process]

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[Conductive hearing loss caused by ear canal stenosis].

[Conductive hearing loss caused by ear canal stenosis].

Laryngorhinootologie. 2015 Sep;94(9):609-10

Authors: Franzen AM, Ihbe J, Lieder A

PMID: 26212509 [PubMed - indexed for MEDLINE]

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Audiologic, cVEMP, and Radiologic Progression in Superior Canal Dehiscence Syndrome.

Objective: To assess the change in hearing, vestibular function, and size of superior canal dehiscence (SCD) in patients with SCD syndrome over time. Patients: Adult patients with SCD in one or both ears with documented sign and symptom progression, as shown by the medical record, audiometry, cervical vestibular-evoked myogenic potentials (cVEMP), and computed tomography (CT). Intervention: Audiometry, cVEMPs, and temporal bone CT were performed on patients with high clinical suspicion of disease progression. Main Outcome Measure: Audiometry (magnitude of the air-bone gap [ABG]), cVEMP (magnitude of the thresholds), and CT scans (size of the superior canal dehiscence) were analyzed. Symptoms were assessed at each clinical visit and before repeat testing. Results: Retrospective review of 250 patients with SCDS showed three patients with disease progression over time with follow-up testing as outlined above. All patients presented initially with mild symptoms, ABGs, low cVEMP thresholds, and small bony defects of the arcuate eminence. Four, 6, and 8 years later, progression of SCD signs and symptoms was observed in these three patients, respectively. Audiometry showed larger ABGs and lower cVEMP thresholds compared with previous testing. CT showed an increase in bony defect size. Conclusion: Progression of SCD symptoms can be associated with a wider air-bone gap, lower cVEMP thresholds, and a larger bony defect. Prospective studies using validated measures of hearing loss and dizziness in patients who have not yet undergone surgery for SCD will determine the association between specific symptoms and objective test outcomes and how these change over time. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Auditory Brainstem Implantation in Neurofibromatosis Type 2: Experience From the Manchester Programme.

Objective: To describe the experience of auditory brainstem implantation (ABI) in patients with Neurofibromatosis type 2 (NF2). Study Design: Retrospective case review. Setting: Tertiary referral centre. Patients: Implanted with a Cochlear ABI22 or ABI24M between 1994 and 2009 because of NF2 disease. Intervention(s): Rehabilitative. Main Outcome Measure(s): Surgical complication rate; audiological outcomes. Results: There were 50 primary ABI insertions in 49 patients, including 16 inserted at the time of first side tumor removal as a sleeper, and two revision repositionings which failed to improve outcome. Postoperatively three patients had cerebrospinal fluid leaks which did not require reoperation, one patient had meningitis, and eleven patients suffered either temporary or permanent lower cranial nerve dysfunction. Twenty-nine patients became full time users; a further 12 patients became non-users. Three patients died while their device was inactive. Five patients retain serviceable contralateral hearing. Audiological open set testing of users showed means of: environmental sounds discrimination 51%; phoneme discrimination: with ABI alone 22%/lip reading (LR) 45%/ABI with LR 65%; sentence testing: with ABI alone 13%/LR 19%/ABI with LR 54%. Conclusions: The majority of patients with NF2 implanted with an ABI find the device a useful aid to communication in conjunction with LR and in recognizing common environmental sounds. A small proportion gain open set discrimination. Almost a third of patients may end up as non-users. There is probably an increased risk of postoperative lower cranial nerve dysfunction so careful preoperative assessment is advised. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Parsonage-Turner Syndrome: A Case of Idiopathic Upper Extremity Paresis Following Middle Cranial Fossa Resection of a Vestibular Schwannoma.

Objective: In this patient report, Parsonage-Turner syndrome (acute brachial neuropathy) developed in our patient 1 day after resection of a vestibular schwannoma by a middle cranial fossa approach. Aiming to increase awareness of this rare disorder among neurotologists, we describe differential diagnoses, work-up, and management strategies. Patient: A 67-year-old man treated for vestibular schwannoma at a single tertiary referral center. Intervention: Surgery for vestibular schwannoma, electromyography for confirmation of diagnosis, and physical therapy. Main Outcome and Results: After ruling out postoperative complications by intracranial imaging and physical examination, electromyography was confirmatory of the suspected diagnosis, Parsonage-Turner syndrome; steroids were not indicated. With physical therapy as treatment, our patient is experiencing gradual recovery of all neurologic deficits, including gross motor function. Conclusion: As a rare condition reported only sporadically in the orthopedic and neurology literature, our patient with Parsonage-Turner syndrome represents (to our knowledge) the first within neurotology literature. This rare, idiopathic disease process is usually self-limiting, and may mimic cerebral-vascular accident or injury from surgical positioning. Its presentation is one of limited motor and sensory neuropathies of the brachial plexus distribution. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Calcium Homeostasis During Attack and Remission in Patients With Idiopathic Benign Paroxysmal Positional Vertigo.

Objective: To evaluate changes in calcium metabolism in patients with idiopathic benign paroxysmal positional vertigo (BPPV) on initial presentation and at the follow-up visit. Subjects and Methods: The study comprised a total of 31 patients aged greater than 18 years who presented at the otorhinolaryngology outpatient clinic of our hospital, newly diagnosed as idiopathic BPPV based on the history compatible with BPPV and positive provocative maneuver (either Dix-Hallpike or Roll test). The first blood sample was obtained on the day of initial presentation when the patient was found to have active unilateral BPPV. After 6 months, a blood sample was again drawn in accordance with the procedure. Blood samples were analyzed for data on 25-hydroxyvitamin D (25(OH)-D), total calcium, parathormone and ionized calcium on initial presentation, and at the follow-up visit. Results: The patients comprised 20 (64.5%) women and 11 (35.5%) men with a mean age of 49.78 years (range, 23-75 years). During an attack a higher prevalence of decreased serum Vitamin D is less than 20 ng/ml, was determined (93.5% versus 38.7%). There were statistical differences between the Vitamin D values, parathormone, and corrected by pH ionized calcium in both periods (p

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Stapedectomy in Teunissen-Cremers Syndrome: Intraoperative Findings and Hearing Outcomes.

Objective: To describe the intraoperative findings and outcomes of stapedectomy surgery in Teunissen-Cremers syndrome. Patients: A family of three patients with bilateral conductive hearing loss because of Teunissen-Cremers syndrome. Intervention: Six exploratory tympanotomies and stapedectomies, including one revision operation. Main Outcome Measures: Intraoperative findings and postoperative hearing results. Results: There was an increased distance between the incus and the vestibule, a thicker long process of the incus, and slight variation in the relative position of the ossicles in all patients. Surgery resulted in closure of the air-bone gap to less than 10 dB in all five operated ears. Conclusion: We describe anatomic abnormalities of the ossicular chain in Teunissen-Cremers syndrome. Prosthesis availability should include prostheses that can adapt to these potential anatomic abnormalities. Stapedectomy resulted in good long-term hearing outcomes in this series. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Postoperative Complications and Readmission Rates Following Surgery for Cerebellopontine Angle Schwannomas.

Objective: To investigate the 30-day postoperative complication, readmission, and reoperation rates following surgery for cerebellopontine angle (CPA) schwannomas. Study Design: Cross-sectional analysis. Setting: National surgical quality improvement program dataset (NSQIP) 2009 through 2013. Patients: All surgical cases with an International Classification of Diseases, 9th edition, Clinical Modification (ICD-9-CM) diagnosis code of 225.1, benign neoplasms of cranial nerves, and one of the following current procedural terminology (CPT) codes, were included: 61616, 61526, 61530, and 61520. Intervention(s): Surgical resection as indicated by the CPT codes above. Main Outcome Measure(s): Demographics, comorbidities, 30-day postoperative complications, readmission rate, and reoperation rate. Results: Overall, 404 cases were identified, of which 42.6% were men. The average age was 51 years. Comorbidities were present in 45.3%. NSQIP-tracked complications occurred in 9.7% of patients. Most common complications were wound infections including surgical-site infection and wound dehiscence (11 patients, 2.7%), sepsis (10 patients, 2.5%), blood loss (nine patients, 2.2%), and deep vein thrombosis (DVT; seven patients, 1.7%). Mortality occurred in four patients (1.0%). The complication rate was statistically higher in patients with comorbidities versus those without (10.2% versus 4.1%, p = 0.04). Patients with complications were more likely to undergo reoperation (2.5% with versus 4.1% without, p = 0.001). Unplanned readmissions occurred in 41 cases (10.1%) and reoperations occurred in 23 patients (5.7%). Conclusions: Most common NSQIP-tracked complications in excision of CPA neoplasms are infections, sepsis, blood loss, and deep vein thrombosis (DVT). Further, investigation of patients with unplanned readmission and reoperation are warranted. Neurotologists need to take an active role in the data to be gathered in the NSQIP database as it relates to vestibular schwannomas. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Magnetic Resonance Imaging at 1.5 Tesla With a Cochlear Implant Magnet in Place: Image Quality and Usability.

Objective: To study the quality and usability of magnetic resonance imaging (MRI) obtained with a cochlear implant magnet in situ. Study Design: Retrospective chart review. Setting: Tertiary care center. Patients: All patients who underwent brain MRI with a cochlear implant magnet in situ from 2007 to 2016. Intervention(s): None. Main Outcome Measure(s): Grade of view of the ipsilateral internal auditory canal (IAC) and cerebellopontine angle (CPA). Results: Inclusion criteria were met by 765 image sequences in 57 MRI brain scans. For the ipsilateral IAC, significant predictors of a grade 1 (normal) view included: absence of fat saturation algorithm (p = 0.001), nonaxial plane of imaging (p = 0.01), and contrast administration (p = 0.001). For the ipsilateral CPA, significant predictors of a grade 1 view included: absence of fat saturation algorithm (p = 0.001), high-resolution images (p = 0.001), and nonaxial plane of imaging (p = 0.001). Overall, coronal T1 high-resolution images produced the highest percentage of grade 1 views (89%). Fat saturation also caused a secondary ring-shaped distortion artifact, which impaired the view of the contralateral CPA 52.7% of the time, and the contralateral IAC 42.8% of the time. MRI scans without any usable (grade 1) sequences had fewer overall sequences (N = 4.3) than scans with at least one usable sequence (N = 7.1, p = 0.001). Conclusion: MRI image quality with a cochlear implant magnet in situ depends on several factors, which can be modified to maximize image quality in this unique patient population. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Massive Tension Pneumocephalus Following Cochlear Implant Surgery.

Objective: To report clinical presentation, management and outcomes of a rare complication of cochlear implant surgery. Patient: A 68-year-old man, affected by profound bilateral deafness because of superficial cerebral hemosiderosis, presented to Authors' Department 8 days after cochlear implant surgery with vomiting, fever, and mental confusion. Brain computed tomographic (CT) scan showed a massive collection of intracranial air from an osteodural defect in the right tegmen mastoideum because of repeated nose blowing in the postoperative period. Intervention: A multilayer reconstruction of the tegmen with obliteration of the mastoid cavity using abdominal subcutaneous adipose tissue was performed, preserving the cochlear implant in place. Main Outcome and Results: Following surgery the patient showed rapid neurological improvement and CT scan performed 2 days later showed complete resolution of the intracranial air collection. He is currently using the cochlear implant with open set performances. Conclusion: Pneumocephalus is a rare complication of cochlear implant surgery. In patients with severe neurological signs following cochlear implantation (CI), pneumocephalus should be suspected. Drilling of mastoid air cells may expose dura mater and positive high pressure events may break meningeal layers and force air into the cranial cavity. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Real Incidence of Vestibular Schwannoma? Estimations From a National Registry.

Objective: To identify incidence of vestibular schwannoma (VS) in the Netherlands. Determining incidence of VS poses considerable challenges given the lack of complete epidemiologic data. Study Design: Retrospective patient review. Setting: Tertiary referral center. Patients: Patients with VS in the Netherlands. Data on patients with VS during 2001 to 2012 were obtained from the Netherlands Cancer Registry (NCR). Notification to the NCR is primarily pathology-based, but additional sources are used, including databases from hospital registrations and radiology departments. In addition, VS incidence estimations for the Leiden region were made; since these data are considered most complete, it was anticipated that estimates calculated from this region approximated the true incidence of VS in the Netherlands. Intervention(s): Magnetic resonance imaging (MRI). Main Outcome Measure(s): Incidence of VS. Results: From 2001 to 2012, a total of 3,663 patients of VS were registered. One thousand forty patients (28.4%) were pathologically confirmed, the majority only had a clinical diagnosis (n = 2623, 71.6%). Incidence increased from 10.3 per one million inhabitants (European Standardized Rate, ESR) to 15.5. Considerable variation in incidence rates was observed across regions, ranging from 12.0 to 24.9 per million over the total period. In the Leiden region, incidence was estimated at 25.5 per million during 2005 to 2007, and 33.2 per million during 2009 to 2012. In this region, the ratio of clinical versus histopathological diagnoses rose from 1.4 to 6.7. Conclusions: Completeness of the registration of VS varies across regions in the Netherlands. Incidence estimates obtained from regions with the highest rates are higher than those reported by previous studies. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Pseudo-low Frequency Hearing Loss and Its Improvement After Treatment May Be Objective Signs of Significant Vascular Pathology in Patients With Pulsatile Tinnitus.

Objective: In patients with pulsatile tinnitus (PT), physical examination such as auscultation with head position change or digital compression over the ipsilateral jugular vein provides physicians with important information. However, objective diagnosis of PT is sometimes limited because 1) audible bruit is absent on auscultation in some patients, 2) abnormal vascular structures found in radiologic evaluation is not always pathognomonic because they can be found in asymptomatic subjects as well, and 3) although an objective diagnostic tool using transcanal sound recording has recently been introduced, special equipment is needed. In this regard, recent studies that have reported ipsilateral low-frequency hearing loss (LFHL) on pure-tone audiometry (PTA) in some patients with PT, and its recovery after successful management, prompted us to conduct a retrospective observational study on the characteristics of the audiometric profile, the association between the audiometric profile and radiologic findings, and pre- and posttreatment changes in low-frequency hearing thresholds in PT patients. We tested two hypotheses: PT patients with marked vascular pathologies located close to the cochlea may show ipsilateral pseudo-LFHL (PLFHL) because of the masking effects of the PT itself, and their PLFHL may disappear if their vascular pathology is successfully managed by surgical or endovascular intervention. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: A total of 85 PT subjects who underwent both audiologic and radiologic examinations. Main Outcome Measure: All patients' pre- and posttreatment PTA thresholds and radiologic findings were analyzed. By comparing the LFHL (an ipsilateral hearing threshold greater than 10 dB HL at both 250 and 500 Hz or greater than 20 dB HL at either 250 or 500 Hz compared with the contralateral side) group and a non-LFHL group with regard to the incidence of vascular structural abnormalities, we evaluated the incidence of abnormal vascular structures in the head and neck between the LFHL and non-LFHL groups. In addition, by comparing pre- and posttreatment PTA thresholds of seven PT patients with ipsilateral LFHL, we further evaluated the changes in low-frequency hearing thresholds and their role as an objective sign for diagnosis and outcome evaluation. Results: Of 85 patients, 22 (25.9%) presented with ipsilateral LFHL. Compared with patients without this condition, patients with ipsilateral LFHL showed a significantly higher rate of abnormal vascular structure. In addition, most of the radiologic abnormalities found in the LFHL group were highly suspicious causative lesions that are responsible for the perception of PT according to the previous literature. In eight PT patients with ipsilateral LFHL who underwent both pre- and posttreatment audiograms, the average posttreatment pure-tone threshold at 250 Hz showed significant improvement compared with the pretreatment threshold. Conclusion: PT patients presenting with ipsilateral LFHL have higher possibility of having a discrete vascular pathology near the cochlea on radiologic evaluation. As ipsilateral LFHL improves in most patients after treatment, LFHL in patients with PT may be PLFHL because of the masking effects of the pulsatile sound, and the changes in the low-frequency thresholds may be applicable for objective diagnosis and evaluation of the effects of the treatment. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Hearing Results After Tympanoplasty Are Stable Short-term: A Prospective Database Study.

Objective: To evaluate the short-term stability of postoperative hearing results after tympanoplasty. Study Design: Prospective database study. Setting: Tertiary referral center. Patients: 1,367 cases of tympanoplasty I-IV were registered in the OTOKIR database between February 2004 and November 2013. Intervention: The authors included the 553 cases attending postoperative follow-ups at both 3 and 12 months. Main Outcome Measure: Analysis of the changes in pure-tone average of air conduction (AC), air-bone gap, and speech reception threshold and Word Recognition Score between follow-ups were performed. Results: The overall mean change between follow-ups was 0.7, 0.5, and 0.3 dB for the AC, air-bone gap, and speech reception threshold, respectively. A majority of cases (87.7%) had a change in AC of 10 dB or less, and only 7.6% of the tympanoplasty type I cases had a decrease in AC of more than 10 dB. Of the 1,367 cases registered, 47.5% of cases were lost to follow-up at 12 months. Conclusion: The changes in hearing results after tympanoplasty are minimal during 3 to 12 months after surgery. This suggests that 3-month results are as valid for reporting as 12-month results. In addition, a possible bias that compromises the validity of reported results is introduced at 12 months because half of the cases are lost to follow-up. Including results from 3-month postoperative follow-up when reporting on tympanoplasty could reduce bias in reporting and enable more centers to contribute valid results. Copyright (C) 2016 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Πληροφορίες

Τρίτη 16 Αυγούστου 2016