Rapid Interpretation of Balance Function Tests. By Michael J. Ruckenstein and Sherrie Davis. 168 pp in one volume, illustrated. San Diego, CA: Plural Publishing, 2014. $89.95. ISBN 978-1-59756-443-4
Arriaga, Moises, 2015-08-01 08:00:00 AM
Tumor Biology of Vestibular Schwannoma: A Review of Experimental Data on the Determinants of Tumor Genesis and Growth Characteristics
de Vries, Maurits; van der Mey, Andel G. L.; Hogendoorn, Pancras C. W., 2015-08-01 08:00:00 AM
Objective: Provide an overview of the literature on vestibular schwannoma biology with special attention to tumor behavior and targeted therapy. Background: Vestibular schwannomas are benign tumors originating from the eighth cranial nerve and arise due to inactivation of the NF2 gene and its product merlin. Unraveling the biology of these tumors helps to clarify their growth pattern and is essential in identifying therapeutic targets. Methods: PubMed search for English-language articles on vestibular schwannoma biology from 1994 to 2014. Results: Activation of merlin and its role in cell signaling seem as key aspects of vestibular schwannoma biology. Merlin is regulated by proteins such as CD44, Rac, and myosin phosphatase-targeting subunit 1. The tumor-suppressive functions of merlin are related to receptor tyrosine kinases, such as the platelet-derived growth factor receptor and vascular endothelial growth factor receptor. Merlin mediates the Hippo pathway and acts within the nucleus by binding E3 ubiquiting ligase CRL4DCAF1. Angiogenesis is an important mechanism responsible for the progression of these tumors and is affected by processes such as hypoxia and inflammation. Inhibiting angiogenesis by targeting vascular endothelial growth factor receptor seems to be the most successful pharmacologic strategy, but additional therapeutic options are emerging. Conclusion: Over the years, the knowledge on vestibular schwannoma biology has significantly increased. Future research should focus on identifying new therapeutic targets by investigating vestibular schwannoma (epi)genetics, merlin function, and tumor behavior. Besides identifying novel targets, testing new combinations of existing treatment strategies can further improve vestibular schwannoma therapy.
A Retrospective Analysis of the Contribution of Reported Factors in Cochlear Implantation on Hearing Preservation Outcomes
Causon, Andrew; Verschuur, Carl; Newman, Tracey A., 2015-08-01 08:00:00 AM
Introduction: Preservation of residual hearing is essential to perceive acoustic stimulation from hybrid cochlear implants (CI). Preservation is a good marker of atraumatic surgery and residual hearing may be exploited further or enhanced in future therapies, making complete hearing preservation a desirable goal for all current CI surgeries. There is large variability in the amount of hearing preserved and the timeframe over which it is lost after CI. The increase in numbers of patients with high levels of residual hearing at implantation means that understanding the variables affecting its preservation is more important than ever. Data Sources: An English search term with generic and specific items concerning hearing preservation and cochlear implantation was searched on the Web of Science service. The search timeframe was limited to 2000 to 2014, with no language limitations on results. Study Selection: Hearing preservation, retrospective CI outcome studies which reported pre- and post-surgical pure-tone audiometry (PTA) were identified and selected. Data Extraction: PTA thresholds were extracted from audiograms or tables and converted into a low-frequency hearing preservation (LFHP) score. Data for 21 factors associated with hearing preservation were collected from studies. Data Synthesis: Factors were included in a hearing preservation model if they had both a significant bivariate correlation with LFHP and a significant Kruskal-Wallis H test result (for ordinal data) or a significant multiple regression analysis result (for scale data). Conclusions: Seven factors were found to have a significant effect on hearing preservation: insertion site, progressive versus stable hearing loss, insertion angle of electrode, use of intraoperative topical steroids, use of steroids (via any route/timing), hearing etiology, and electrode array type. The best hearing preservation options are given.
Magnetic Resonance Imaging Evaluation of Endolymphatic Hydrops in Cases With Otosclerosis
Mukaida, Tohru; Sone, Michihiko; Yoshida, Tadao; Kato, Ken; Teranishi, Masaaki; Naganawa, Shinji; Nakashima, Tsutomu, 2015-08-01 08:00:00 AM
Objective: Endolymphatic hydrops (EH) has been reported in cases with otosclerosis, and preoperative EH could be a risk factor for inner ear disturbances after stapes surgery. Visualization of EH has recently become possible using magnetic resonance imaging (MRI) with contrast agents. This study investigated the presence of EH on MRI in ears with clinical otosclerosis. Study design: Retrospective case series. Setting: University hospital. Patients: 27 ears of 15 cases diagnosed with otosclerosis. Intervention: Ears were evaluated by 3-T MRI performed 4 hours after intravenous injection of gadolinium. The degree of EH in the vestibule and cochlea was classified into three grades (none, mild, and significant). Imaging data were compared with clinical findings for all ears. Main Outcome Measures: Imaging and clinical findings. Results: Varying degrees of cochlear EH and vestibular EH were observed in 20 and 15 ears, respectively. Episodes of acute sensorineural hearing loss with rotatory vertigo occurred in four ears that showed severe EH in the cochleae and vestibules. Severe EH, however, was also observed in ears without such symptoms. Conclusions: The presence of EH in ears with otosclerosis was clearly visualized in the present patient series. Such MRI evaluation could provide useful information for managing symptoms related to EH.
Functional Results and Subjective Benefit of a Transcutaneous Bone Conduction Device in Patients With Single-Sided Deafness
Laske, Roman D.; Röösli, Christof; Pfiffner, Flurin; Veraguth, Dorothe; Huber, Alex M., 2015-08-01 08:00:00 AM
Objective: To analyze speech discrimination scores and subjective benefit of a transcutaneous bone conduction device (tBCD) in adults with single-sided deafness (SSD). Study Design: Prospective cohort study. Setting: Tertiary referral center. Patients: Nine adults with SSD for more than 1 year and normal hearing on the contralateral side (PTA <30 dB HL) were implanted with a tBCD. Interventions: Transmastoidal implantation of a Bonebridge (BB, MED-EL) tBCD. Main Outcome Measures: Aided and unaided speech discrimination scores in three different spatial settings were measured using the Oldenburg sentence test (OLSA). Quality of life was assessed by two questionnaires, the Bern Benefit in Single Sided Deafness Questionnaire (BBSS) and the Speech, Spatial and Qualities of Hearing scale for benefit questionnaire (SSQ-B). Results: Speech discrimination scores measured by OLSA showed a mean signal-to-noise ratio improvement of 1.7 dB SPL for the aided condition compared with the unaided condition in the setting where the sound signal is presented on the side of the implanted ear and the noise is coming from the front (p < 0.05). In the other two settings (signal and noise from front; signal from normal hearing ear and noise from front), the signal-to-noise ratio did not change significantly. This benefit became manifest after 6 months. Good satisfaction was indicated by positive results on the questionnaires. Conclusion: Speech discrimination in noise for patients implanted with the BB is comparable with patients with other bone conduction hearing aids. A learning curve is clearly detectable. The subjective benefit was rated positively by the patients. With the advantage of intact skin conditions after implantation, the BB is an adequate option for patients with SSD.
Changes in Gene Expression and Hearing Thresholds After Cochlear Implantation
Zhang, Hongzheng; Stark, Gemaine; Reiss, Lina, 2015-08-01 08:00:00 AM
Hypothesis: Gene expression changes occur in conjunction with hearing threshold changes after cochlear implantation. Background: Between 30 and 50% of individuals who receive electro-acoustic stimulation (EAS) cochlear implants lose residual hearing after cochlear implantation, reducing the benefits of EAS. The mechanism underlying this hearing loss is unknown; potential pathways include mechanical damage, inflammation, or tissue remodeling changes. Methods: Guinea pigs were implanted in one ear with cochlear implant electrode arrays, with non-implanted ears serving as controls, and allowed to recover for 1, 3, 7, or 14 days. Hearing threshold changes were measured over time. Cochlear ribonucleic acid was analyzed using real-time quantitative reverse transcription-polymerase chain reaction from the following gene families: cytokines, tight junction claudins, ion and water (aquaporin) transport channels, gap junction connexins, and tissue remodeling genes. Results: Significant increases in expression were observed for cochlear inflammatory genes (Cxcl1, IL-1β, TNF-α, and Tnfrsf1a/b) and ion homeostasis genes (Scnn1γ, Aqp3, and Gjb3). Upregulation of tissue remodeling genes (TGF-β, MMP2, MMP9) as well as a paracrine gene (CTGF) was also observed. Hearing loss occurred rapidly, peaking at 3 days with some recovery at 7 and 14 days after implantation. MM9 exhibited extreme upregulation of expression and was qualitatively associated with changes in hearing thresholds. Conclusion: Cochlear implantation induces similar changes as middle ear inflammation for genes involved in inflammation and ion and water transport function, whereas tissue remodeling changes differ markedly. The upregulation of MMP9 with hearing loss is consistent with previous findings linking stria vascularis vessel changes with cochlear implant-induced hearing loss.
Electrophysiological Detection of Intracochlear Scalar Changing Perimodiolar Cochlear Implant Electrodes: A Blinded Study
Mittmann, Philipp; Todt, Ingo; Wesarg, Thomas; Arndt, Susan; Ernst, Arneborg; Hassepass, Frederike, 2015-08-01 08:00:00 AM
Objective: To investigate whether a previous established neural response telemetry (NRT) ratio corresponds with the scalar position of the CI electrode. Study Design: Retrospective blinded controlled study. Setting: Tertiary referral center. Patients: The electrophysiological data sets of 85 patients with measured intraoperative NRTs were evaluated. All patients were implanted with the same CI system. Using a flat panel tomography system, the position of the electrode array was confirmed radiologically. Interventions: The radiological results were blindly compared with the intraoperatively obtained electrophysiological data (NRT ratio) and statistically evaluated. In a second step, irregularities between the NRT ratios and the radiologically confirmed electrode positions were determined and the entire study material was investigated deeper. Main Outcome Measures: Correlation of the NRT ratio with the intracochlear position of the CI electrode. Results: By electrophysiological evaluation only, 69 patients were detected without a scalar change at first. In 16 patients, a scalar change was probable. A significant correlation between the radiological results and the NRT ratios was found. Secondly, additional patient characteristics were identified which influences the electrode's position. Excluding those patients, the selectivity and specificity of the NRT ratio could be increased to a higher level. Conclusion: Evidenced by a blinded group of patients, we are able to show that the electrode array position within the cochlea could be predicted using the NRT ratio.
Correlation of Electrophysiological Properties and Hearing Preservation in Cochlear Implant Patients
Dalbert, Adrian; Sim, Jae Hoon; Gerig, Rahel; Pfiffner, Flurin; Roosli, Christof; Huber, Alexander, 2015-08-01 08:00:00 AM
Objective: To monitor changes in cochlear function during cochlear implantation using electrocochleography (ECoG) and to correlate changes to postoperative hearing preservation. Methods: ECoG responses to acoustic stimuli of 250, 500, and 1000 Hz were recorded during cochlear implantation. The recording electrode was placed on the promontory and stabilized to fix the position during cochlear implantation. Baseline recordings were obtained after completion of the posterior tympanotomy. Changes of the ongoing ECoG response at suprathreshold intensities were analyzed after full insertion of the cochlear implant electrode array. Audiometric tests were conducted before and 4 weeks after surgery and correlated with electrophysiological findings. Results: Ninety-five percent (18/19) of cochlear implant subjects had measurable ECoG responses. Under unchanged conditions, recordings showed a high repeatability without significant differences between 2 recordings (p ≤ 0.01). Ninety-four percent (17/18) of subjects showed no relevant changes in ECoG recordings after insertion of the cochlear implant electrode array. One subject showed decreases in responses at all frequencies indicative of cochlear trauma. This was associated with a complete hearing loss 4 weeks after surgery compared with mean presurgical low-frequency hearing of 78 dB HL. Conclusion: Extracochlear ECoG is a reliable tool to assess cochlear function during cochlear implantation. Moderate threshold shifts could be caused by postoperative mechanisms or minor cochlear trauma. Detectable changes in extracochlear ECoG recordings, indicating gross cochlear trauma, are probably predictive of complete loss of residual acoustic hearing.
Benefits of Adaptive Signal Processing in a Commercially Available Cochlear Implant Sound Processor
Wolfe, Jace; Neumann, Sara; Marsh, Megan; Schafer, Erin; Lianos, Leslie; Gilden, Jan; O'Neill, Lori; Arkis, Pete; Menapace, Christine; Nel, Esti; Jones, Marian, 2015-08-01 08:00:00 AM
Objective: Cochlear implant recipients often experience difficulty understanding speech in noise. The primary objective of this study was to evaluate the potential improvement in speech recognition in noise provided by an adaptive, commercially available sound processor that performs acoustic scene classification and automatically adjusts input signal processing to maximize performance in noise. Research Design: Within-subjects, repeated-measures design. Setting: This multicenter study was conducted across five sites in the U.S.A. and Australia. Patients: Ninety-three adults and children with Nucleus Freedom, CI422, and CI512 cochlear implants. Intervention: Subjects (previous users of the Nucleus 5 sound processor) were fitted with the Nucleus 6 sound processor. Performance was assessed while these subjects used each sound processor in the manufacturer's recommended default program (standard directionality, ASC + ADRO for the Nucleus 5 processor and ASC + ADRO and SNR-NR with SCAN for the Nucleus 6 sound processor). The subjects were also evaluated with the Nucleus 6 with standard directionality, ASC + ADRO and SNR-NR enabled but SCAN disabled. Main Outcome Measures: Speech recognition in noise was assessed with AzBio sentences. Results: Sentence recognition in noise was significantly better with the Nucleus 6 sound processor when used with the default input processing (ASC + ADRO, SNR-NR, and SCAN) compared to performance with the Nucleus 5 sound processor and default input processing (standard directionality, ASC + ADRO). Specifically, use of the Nucleus 6 at default settings resulted in a mean improvement in sentence recognition in noise of 27 percentage points relative to performance with the Nucleus 5 sound processor. Use of the Nucleus 6 sound processor using standard directionality, ASC + ADRO and SNR-NR (SCAN disabled) resulted in a mean improvement of 9 percentage points in sentence recognition in noise compared to performance with the Nucleus 5. Conclusion: The results of this study suggest that the Nucleus 6 sound processor with acoustic scene classification, automatic, adaptive directionality, and speech enhancement in noise processing provides significantly better speech recognition in noise when compared to performance with the Nucleus 5 processor.
Cochlear Implantation in Patients With Superficial Siderosis: Seven Cases and Systematic Review of the Literature
Modest, Mara C.; Carlson, Matthew L.; Wanna, George B.; Driscoll, Colin L., 2015-08-01 08:00:00 AM
Objective: To date, there have been less than 30 cases of cochlear implantation (CI) in patients with superficial siderosis (SS) reported in the literature. The primary objective of the current study is to evaluate CI outcomes in six additional patients (seven ears) with SS and sensorineural hearing loss (SNHL) and to perform a systematic review of the literature. Study Design: Case series and systematic review of the literature. Setting: Two tertiary academic CI centers. Patients: All patients with SS who underwent CI between 2007 and 2014. Intervention(s): Cochlear implantation. Main Outcome Measures: Pre- and post-implantation speech perception scores and durability of benefit. Results: A total of seven ears (four males; median age 52 yr) with SS and SNHL met inclusion criteria. All patients developed progressive bilateral SNHL that was no longer amenable to conventional hearing aids. Additional presenting symptoms included vestibulopathy (n = 4), cerebellar ataxia (n = 3), mild dementia (n = 1), and myelopathy (n = 1). All patients underwent uncomplicated CI, and intraoperative device telemetry revealed normal responses in all electrodes. The median postoperative auditory threshold average was 32.5 dB HL (range 16–36 dB) and the median postoperative CNC word score was 51% (range 46–64%). The median duration of follow-up was 15.5 months (range 3–64 mo). All patients demonstrated initial improvement in speech perception testing. Two patients had performance decline and worsening dementia resulting from progressive SS. Conclusion: Cochlear implantation is a viable strategy for auditory rehabilitation in patients with SS and associated SNHL. Most individuals enjoy benefit from CI; however, patients should be counseled regarding the risks of performance decline with progressive SS.
Speech Intelligibility in Noise With a Single-Unit Cochlear Implant Audio Processor
Wimmer, Wilhelm; Caversaccio, Marco; Kompis, Martin, 2015-08-01 08:00:00 AM
Introduction: The Rondo is a single-unit cochlear implant (CI) audio processor comprising the identical components as its behind-the-ear predecessor, the Opus 2. An interchange of the Opus 2 with the Rondo leads to a shift of the microphone position toward the back of the head. This study aimed to investigate the influence of the Rondo wearing position on speech intelligibility in noise. Methods: Speech intelligibility in noise was measured in 4 spatial configurations with 12 experienced CI users using the German adaptive Oldenburg sentence test. A physical model and a numerical model were used to enable a comparison of the observations. Results: No statistically significant differences of the speech intelligibility were found in the situations in which the signal came from the front and the noise came from the frontal, ipsilateral, or contralateral side. The signal-to-noise ratio (SNR) was significantly better with the Opus 2 in the case with the noise presented from the back (4.4 dB, p < 0.001). The differences in the SNR were significantly worse with the Rondo processors placed further behind the ear than closer to the ear. Conclusion: The study indicates that CI users with the receiver/stimulator implanted in positions further behind the ear are expected to have higher difficulties in noisy situations when wearing the single-unit audio processor.
Predicting Microsurgical Aptitude
Osborn, Heather A.; Kuthubutheen, Jafri; Yao, Christopher; Chen, Joseph M.; Lin, Vincent Y., 2015-08-01 08:00:00 AM
Objective: Microscopic techniques are an essential part of otolaryngologic practice. These procedures demand advanced psychomotor and visuospatial skills, and trainees possess these abilities to varying degrees. No method currently exists to predict who will possess an aptitude for microscopic surgery. Our goal was to determine whether performance can be predicted by background experiences or skills. Study Design: Retrospective cohort study. Setting: Tertiary academic hospital. Subjects: Students with no previous surgical experience. Interventions: Subjects were surveyed on a wide range characteristics thought to affect surgical aptitude, with a primary focus on video gaming and musical training. Main Outcome Measure: Subjects performed a microsurgical task using a novel simulator and their performance was assessed by blinded investigators. Results: Forty-six students were assessed. There was no correlation between video gaming and improved microsurgical performance. Rather, video gamers obtained worse scores, although this difference did not reach significance. The majority of students played a musical instrument. Within this group, musicians who began playing at younger ages obtained higher scores, with the highest scores obtained by musicians who began playing before age 6. However, musicians did not obtain higher scores than non-musicians, regardless of their age of initiation. Conclusions: No improvement in microsurgical aptitude was seen in subjects who had a history of video gaming or musical instrument playing.
Evaluation of Bone Conduction Implant Stability and Soft Tissue Status in Children in Relation to Age, Bone Thickness, and Sound Processor Loading Time
Mierzwinski, Józef; Konopka, Wieslaw; Drela, Maria; Laz, Piotr; Smiechura, Malgorzata; Struzycka, Malgorzata; Kusmierczyk, Joanna, 2015-08-01 08:00:00 AM
Objective: To measure the stability, as determined by implant stability quotient (ISQ) values, of bone conduction implants placed using FAST (one-stage) surgery in children to look for the differences between various ages and indications. To monitor the status of the peri-implant soft tissue using the classification proposed by Holgers et al. Study Design: It was a prospective, open, multicenter study performed in two investigation centers. Patients: Twenty-two subjects under 18 years of age implanted with the Cochlear BIA300 and BIA400 types of devices at the ENT Departments of Children's Hospitals in Bydgoszcz and Lodz in Poland. Intervention(s): Implantation and use of the bone conduction implant system. The implants were placed unilaterally or bilaterally according to a one-stage surgical procedure as per normal practice at the hospitals. Loading time was adjusted to individual patient, and it was based on the assessment of implant stability and status of the soft tissue. Main Outcome Measure(s): The attention was given to the differences in the ISQ values obtained during the subsequent visits in the various age and indication groups. Resonance frequency analysis was performed as per the routine follow-up schedule at the hospital. Results: Age at the time of implantation on average was 9.8 years (min. 5.2 yr; max. 16 yr). On average, ISQ value on each of the study observations in this group equaled to 59.17 (median, 58.79). Seventh to tenth day post-surgery seemed to be a sensitive period as the lowest ISQ values (on average: 56.38 ISQ) were recorded for these dates. On average, implant was loaded 7.5 weeks after surgery in the study group (min. 2 wk, max. 14 wk). In none of the subjects the significant decrease of the implant stability values after sound processor loading was observed. Statistically significant correlation rate (p < 0.05) showed that the thicker the bone the higher the obtained ISQ value on each of the visits. It was also confirmed that the younger the implanted child, the higher the skin reactions grade at the 2 to 4 weeks post-sound processor fitting. There was no correlation observed between the time of the sound processor fitting and the skin reactions status.
The Vibrant Soundbridge in Children and Adolescents: Preliminary European Multicenter Results
Frenzel, Henning; Sprinzl, Georg; Streitberger, Christian; Stark, Thomas; Wollenberg, Barbara; Wolf-Magele, Astrid; Giarbini, Nadia; Strenger, Tobias; Müller, Joachim; Hempel, John-Martin, 2015-08-01 08:00:00 AM
Objective: Evaluation of safety and efficacy of the Vibrant Soundbridge in the treatment of hearing loss in children and adolescents with primary focus on improvement in speech discrimination. Study Design: Prospective, single-subject repeated-measures design in which each subject serves as his/her own control. Setting: Tertiary referral center. Patients: Nineteen patients aged 5 to 17 years. Intervention: Implantation of an active middle ear implant. Main Outcome Measure: Improvement in word recognition scores, speech reception thresholds, and signal-to-noise ratios (SNRs) were evaluated, in addition to air and bone conduction. Oldenburger Kids Satztest/Oldenburger Satztest sentences and Göttinger/Freiburger monosyllables at 65-dB hearing level were tested in two age groups. Results: Significant speech discrimination improvement was seen in all patients after 6 months. In children 5 to 9 years old, mean monosyllable recognition improved from 28.9% (unaided) to 95.5% (Soundbridge-aided). Aided 50% sentence discrimination at 44.1 dB and SNR of −4.9 dB were measured. In patients 10 to 17 years old, mean word recognition improved from 18.5% to 89.0%, sentence reception threshold improved to 40.2 dB, and SNR to −3.6 dB. Comparison between age groups indicated a slight trend toward quicker adaptation by older subjects. However, after initial adjustment, a higher level of overall benefit was seen at 6 months in younger children. Conclusions: Currently, the only middle ear implant approved for pediatric patients, the Vibrant Soundbridge, provides an option in cases of congenital aural atresia or disease-induced defects, when surgical intervention and reconstruction is indicated. The 6-month results in this comparatively large study population validated conclusions found in previous trials.
Does Coupling and Positioning in Vibroplasty Matter? A Prospective Cohort Study
Marino, Roberta; Lampacher, Peter; Dittrich, Gregor; Tavora-Vieira, Dayse; Kuthubutheen, Jafri; Rajan, Gunesh P., 2015-08-01 08:00:00 AM
Objective: Vibroplasty has offered a new modality of hearing rehabilitation in patients with mixed, conductive, and sensorineural hearing loss who cannot wear hearing aids. Potentially, the positioning of the floating mass transducer (FMT) in vibroplasty surgery has a critical effect on hearing outputs. In this study, the impact on hearing outputs and coupling efficiency are evaluated by comparing various vibroplasty applications in the middle ear. No other study to date has examined the coupling efficiency of round window (RW) versus an ossicular vibroplasty application. Study Design: Prospective cohort study of patients with underlying ear pathologies who were not able to wear hearing aids. Methods: This is an ongoing prospective study of 16 patients. All patients had a standard audiological test battery. Direct drive transfer function analysis results were correlated with bone conduction thresholds to assess the efficiency of the FMT coupling. Speech perception in quiet and quality of life measure questionnaires were used to assess outcomes. Nine patients had round window vibroplasty, six patients had stapes vibroplasty, and one patient had traditional incus vibroplasty. Results: Patients with a soft tissue coupler between the FMT and the RW had significantly reduced coupling efficiency. Patients who had direct RW contact had significantly improved coupling efficiency. Patients who underwent stapes or incus vibroplasty had the greatest coupling efficiency. Conclusion: This study demonstrates that attachment to the stapes or incus provides the best coupling when compared to round window vibroplasty. When applicable, stapes or incus coupling should be the first choice when implementing vibroplasty.
Diagnostic Role of Head-Bending and Lying-Down Tests in Lateral Canal Benign Paroxysmal Positional Vertigo
Yetiser, Sertac; Ince, Dilay, 2015-08-01 08:00:00 AM
Objectives: To compare the diagnostic value of the head-bending test (HBT), lying-down positioning test (LDPT) and patient's report to identify the affected canal in video-nystagmographically (VNG) confirmed patients with lateral canal benign paroxysmal positional vertigo (LC-BPPV). Study Design: Case series with chart review. Setting: Head-bending, lying-down positioning and the head-roll maneuver (HRM) under VNG guidance. The data were collected in a referral community hospital. Patients: Seventy-eight patients (32 apogeotropic and 46 geotropic nystagmus) with LC-BPPV who had been recruited between 2009 and 2013 were enrolled in the study. Main Outcome Measures: Patients were tested with the HRM and then were asked about subjectively worse side. Later, they were subjected to HBT when sitting and the LDPT. The results were compared and studied with the 1-way ANOVA and chi-square tests. Statistical significance was set at p < 0.05. Results: Affected side was identified by HRM in 75% of patients with apogeotropic nystagmus and 95.6% of patients with geotropic nystagmus. Approximately 65.6% of patients with apogeotropic and 52% of patients with geotropic nystagmus had nystagmus during LDPT. However, its comparability with HRM was low. However, treatment plan based on LDPT results alone provided relief of symptoms in additional 12.5% of patients with apogeotropic and in 2.2% of patients with geotropic nystagmus. Approximately 63% of patients with apogeotropic and 56% of patients with geotropic nystagmus were able to tell the worse side. Nystagmus comparable with HRM during HBT was low and not diagnostic. Conclusion: HRM has the greatest diagnostic value of positioning tests in LC-BPPV in this study. LDPT provides some contribution in the diagnosis of LC-BPPV but much less than HRM. Patients' subjective feeling of vertigo was also a useful test. However, HBT was not as sensitive as other measures in uncertain cases.
Assessment of the Clinical Utility of Cervical and Ocular Vestibular Evoked Myogenic Potential Testing in Elderly Patients
Piker, Erin G.; Baloh, Robert W.; Witsell, David L.; Garrison, Doug B.; Lee, Walter T., 2015-08-01 08:00:00 AM
Objectives: To assess whether patient age or sex was predictive of a bilaterally absent cervical or ocular vestibular evoked myogenic potential (cVEMP or oVEMP). Study Design: Retrospective case review. Setting: Tertiary center. Patients: Patients presenting with normal vestibular tests (i.e. normal caloric and rotational chair) who underwent cVEMP and/or oVEMP testing. Patients with conductive hearing loss were excluded as were those with unilaterally abnormal VEMP results because they presented with evidence of a possible unilateral vestibular impairment. A total of 895 patients met criteria for cVEMPs and 297 for oVEMPs. Main Outcome Measures: The presence or absence of cVEMP and oVEMP responses elicited with a 500-Hz 125-dB pSPL air conduction stimulus. Results: A logistic regression was performed including odd ratios and confidence intervals. Compared with adults in their 20s, the odds of bilaterally absent cVEMP responses are 6 times greater for patients in their 50s and 60s and over 22 times greater for patients in their 70s and 80s. A bilaterally absent oVEMP response is 6 times more likely for patients in their 40s, 50s, and 60 and 13 times greater for patients in their 70s. Conclusions: VEMPs in response to air conduction stimuli are bilaterally absent in a large percentage of older patients complaining of dizziness who otherwise have normal vestibular and auditory testing for their age. In combination with other abnormal vestibular findings, an absence of VEMP responses may be of value. However, the functional consequence of an isolated bilaterally absent VEMP is not known and may provide minimal information to an older patient's diagnostic picture. In cases where the response is bilaterally absent, a more intense AC stimulus should be used or bone conducted vibration should be considered.
Quality of Life in Vestibular Schwannoma Patients Managed by Surgical or Conservative Approaches
Jufas, Nicholas; Flanagan, Sean; Biggs, Nigel; Chang, Phillip; Fagan, Paul, 2015-08-01 08:00:00 AM
Objective: The aim of our study was to assess quality of life (QOL) among patients who underwent microsurgical excision of vestibular schwannoma (VS) compared with those managed conservatively. Study Design: Retrospective study. Setting: Tertiary care center. Patients: There was a total sample population of 376 patients diagnosed with a unilateral VS. Intervention: A total of 223 patients with unilateral VS returned the mailed questionnaires. These were then divided into two groups—78 that had undergone microsurgical excision and 145 that were managed conservatively. Subgroups within these primary groups were created for analysis. Main Outcome Measure: The primary outcome measure was the Medical Outcomes Study 36 Items Short Form (SF-36). The Dizziness Handicap Inventory test, Hearing Handicap Inventory test, and Tinnitus Handicap Inventory were also used. Results: The surgically managed group had a worse QOL when compared with the conservatively managed group using SF-36, significantly so in the domains of physical role limitation and social functioning. Trends were seen toward a better QOL in some domains in the subgroups of male patients and patients younger than 65 years. Worse QOL scores in the Tinnitus Handicap Inventory were seen in the subgroups with larger tumor size. Finally, on correlation analysis between all handicap inventories and SF-36, handicap due to disequilibrium had the strongest correlation with worsening of QOL. In SF-36, the vitality domain showed the greatest correlation with otologic handicap overall, whereas the role emotional domain showed the least. Conclusion: This study found that worse QOL scores for surgically managed versus conservatively managed VS patients are most significant in the areas of physical role limitation and social functioning. In some areas, patients who are male and younger report better QOL. Handicap due to disequilibrium seems to have the greatest negative impact on QOL. These factors should be considered when counseling patients regarding approach to VS, in the context of an experienced management program.
Dexamethasone Regulates Cochlear Expression of Deafness-associated Proteins Myelin Protein Zero and Heat Shock Protein 70, as Revealed by iTRAQ Proteomics
Maeda, Yukihide; Fukushima, Kunihiro; Kariya, Shin; Orita, Yorihisa; Nishizaki, Kazunori, 2015-08-01 08:00:00 AM
Aim: Using proteomics, we aimed to identify the proteins differentially regulated by dexamethasone in the mouse cochlea based on mass-spectrometry data. Background: Glucocorticoid therapy is widely used for many forms of sensorineural hearing loss; however, the molecular mechanism of its action in the cochlea remains poorly understood. Methods: Dexamethasone or control saline was intratympanically applied to the cochleae of mice. Twelve hours after application, proteins differentially regulated by dexamethasone in the cochlea were analyzed by isobaric Tag for Relative and Absolute Quantitation (iTRAQ)–mass spectrometry. Next, dexamethasone-dependent regulation of these proteins was verified in the cochleae of mice with noise-induced hearing loss (NIHL) and systemic administration of dexamethasone by western blotting. Immunolocalizations of these proteins were examined in cochleae with NIHL. Results: A total of 247 proteins with a greater than 95% confidence interval of protein identification were found, and 11 differentially expressed proteins by dexamethasone were identified by the iTRAQ–mass spectrometry. One protein, myelin protein zero (Mpz), was upregulated (1.870 ± 0.201-fold change, p < 0.01) at 6 hours post-systemic dexamethasone and noise exposure in a mouse model of NIHL. Heat shock protein 70 (Hsp70) was downregulated (0.511 ± 0.274-fold change, p < 0.05) at 12 hours post-systemic dexamethasone. Immunohistochemistry confirmed Mpz localization to the efferent and afferent processes of the spiral neurons, whereas Hsp70 showed a more ubiquitous expression pattern in the cochlea. Conclusion: Both Mpz and Hsp70 have been reported to be closely associated with sensorineural hearing loss in humans. Dexamethasone significantly modulated the expression levels of these proteins in the cochleae of mice.
Superior Versus Inferior Vestibular Neuritis: Are There Intrinsic Differences in Infection, Reactivation, or Production of Infectious Particles Between the Vestibular Ganglia?
Nayak, Shruti; He, Lifan; Roehm, Pamela Carol, 2015-08-01 08:00:00 AM
Hypothesis: Intrinsic differences in neurons of the vestibular ganglia result in the increased likelihood of superior vestibular ganglion involvement in vestibular neuritis. Background: Vestibular neuritis is hypothesized to result from herpes simplex type I (HSV1) infection or reactivation in vestibular ganglia. Involvement of the inferior vestibular ganglion is extremely rare in patients with vestibular neuritis. Methods: Primary cultures of rat superior and inferior vestibular ganglion neurons (VGNs) were cultivated separately. Neurons were lytically and latently infected with HSV1 with a US11-green fluorescent protein (GFP) chimera. Percentage lytic infection and baseline reactivation was assessed by microscopy for GFP fluorescence. Trichostatin-A (TSA) was used to stimulate HSV1 reactivation. Virion production was assessed by viral titers. Relative numbers of latency-associated (LAT) transcripts were determined by real-time reverse-transcription polymerase chain reaction (real-time RT-PCR). Results: Lytic infection rates were equivalent between the two ganglia (p > 0.05). Lytic infections yielded similar amounts of plaque-forming units (p > 0.05). Relative amounts of LAT transcripts did not differ between latently infected superior and inferior VGNs. Latently infected cultures showed no differences in rates of baseline and TSA-induced HSV1 reactivation (p > 0.05). Production of virions was not significantly different between reactivated, latently infected superior versus inferior VGNs (p = 0.45). Conclusion: Differences in prevalence of superior and inferior vestibular neuritis do not result from intrinsic differences in HSV1 infection or virion production of these neurons. Other factors, such as the length and width of the bony canal containing the ganglia and nerves, account for the greater involvement of the superior vestibular ganglion in vestibular neuritis.
Carotid Artery Compression Caused by the Cochlea
Giese, Dina; Rask-Andersen, Helge, 2015-08-01 08:00:00 AM
Hypothesis: We investigated the possible interference between the human internal carotid artery and the cochlea. Background: The cochlea and the internal carotid artery (ICA) are anatomically closely related in the human temporal bone. The intimacy may even result in functional interferences. Methods: Here, we analyzed 324 human plastic inner ear corrosion casts including the ICA canal and jugular bulb. Results: Results showed that in 23% (14 cases), the cochlea caused physical impression in the carotid canal (CA) with luminal restriction. In one case, there was no separation between the CC and the basal turn of the cochlea. The distance between the CC and the cochlea varied between 0 and 1 mm among these 14 specimens. The lumen restriction of the CC in the pyramid-axial projection varied between 39% and 79%. Conclusion: We speculate that the reduction in ICA canal lumen size caused by the cochlea may form a predilection site for intratemporal ICA plaque formation and therefore be clinically relevant.
Heparin Binding Epidermal Growth Factor-Like Growth Factor Heals Chronic Tympanic Membrane Perforations With Advantage Over Fibroblast Growth Factor 2 and Epidermal Growth Factor in an Animal Model
Santa Maria, Peter Luke; Weierich, Kendall; Kim, Sungwoo; Yang, Yunzhi Peter, 2015-08-01 08:00:00 AM
Hypothesis: That heparin binding epidermal growth factor-like growth factor (HB-EGF) heals chronic tympanic membrane (TM) perforations at higher rates than fibroblast growth factor 2 (FGF2) and epidermal growth factor (EGF) in an animal model. Background: A nonsurgical treatment for chronic TM perforation would benefit those unable to access surgery or those unable to have surgery, as well as reducing the cost of tympanoplasty. Growth factor (GF) treatments have been reported in the literature with variable success with the lack of a suitable animal providing a major obstacle. Methods: The GFs were tested in a validated mouse model of chronic TM perforation. A bioabsorbable hydrogel polymer was used to deliver the GF at a steady concentration as it dissolved over 4 weeks. A control (polymer only, n = 18) was compared to polymer loaded with HB-EGF (5 μg/ml, n = 18), FGF2 (100 μg/ml, n = 19), and EGF (250 μg/ml, n = 19). Perforations were inspected at 4 weeks. Results: The healing rates, as defined as 100% perforation closure, were control (5/18, 27.8%), HB-EGF (15/18, 83.3%), FGF2 (6/19, 31.6%), and EGF (3/19, 15.8%). There were no differences between FGF2 (p = 0.80) and EGF (p = 0.31) with control healing rates. HB-EGF (p = 0.000001) showed a significant difference for healing. The HB-EGF healed TMs showed layers similar to a normal TM, whereas the other groups showed a lack of epithelial migration. Conclusion: This study confirms the advantage of HB-EGF over two other commonly used growth factors and is a promising nonsurgical treatment of chronic TM perforations.
Expression and Localization of Aquaporin Water Channels in Human Middle Ear Epithelium
Seo, Young Joon; Choi, Jae Young, 2015-08-01 08:00:00 AM
Background: Although aquaporins (AQPs) are known to play critical roles as the basis for water and solute transport in water homeostasis, AQPs in normal human middle ear epithelium (NHMEE) has not previously been investigated. Objectives/Hypothesis: To investigate the expressions of AQP water channels in NHMEE in situ, in proliferating epithelial cell cultures in vitro. Methods: AQP 0–12 expressions by cultured NHMEE cells in situ were assessed by reverse transcriptase–polymerase chain reaction. Normal middle ear epithelial tissue was harvested and investigated for expressions of AQPs (1, 3, 4, and 5) by immunohistochemistry. Expression screening was also carried out on the differentiated NHMEE cells. Results: Transcripts for AQP 1, 2, 3, 4, 5, 6, 8, 10, and 11 were expressed consistently in cultured NHMEE cells; however, AQP 0, 7, 9, and 12 subtypes were not expressed. Immunochemistry confirmed the expressions of AQP 1, 3, and 5 at the protein level. AQP 1 was localized at capillary endothelial cells and fibroblasts in lamina propria mucosae; AQP 3 was present solely at the basolateral membrane of ciliated cells, whereas AQP 5 was on the apical surface of ciliated cells. AQP 3 and 5 were intensely expressed in both cultured NHMEE cells in situ and NHMEE tissue in vitro. Conclusion: This is the first study to demonstrate that AQPs are expressed by human middle ear epithelium in situ and in vitro, suggesting a potential role in otitis media with effusion. Our study suggests that the presence of AQP 1, 3, and 5 in the middle ear cavity may be to have an important role for water transportation.
Was Cheselden's One-Century-Long Otological Writings Concordant With His Time?
Corrales, C. Eduardo; Mudry, Albert, 2015-08-01 08:00:00 AM
Abstract: William Cheselden's famous anatomical treatise spanned the entire 18th century period with its 15 editions. The aim of this study is to analyze the otological knowledge described in all these editions, to identify key 18th century otological advancements, and to study their concordance. In the first edition (1713), Cheselden notably mentioned four middle ear ossicles: malleus, incus, fourth ossicle, and stapes; four auditory muscles: "external tympani," "external oblique," tensor tympani, and stapedial; and a small opening in the tympanic membrane. In subsequent editions, minimal changes appeared, except for nomenclature changes and the proposal of an artificial opening of the tympanic membrane. Virtually no changes were performed up to the last edition (1806). All Cheselden's Editions confirm the uncertain presence of a fourth ossicle, the disputable presence of a tympanic membrane opening and the "usual" accepted presence of three muscles to the malleus. Key otologic advancements, not found in any of Cheselden's writings, were catherization of the Eustachian tube, presence of fluid in the inner ear, and the surgical opening of the mastoid. This study demonstrates that Cheselden, and his subsequent editors, were unaware of some important otologic developments that revolutionized the field of otology. Description of key advancements lacking in his treatise includes catherization of the Eustachian tube, the presence of fluid in the inner ear, and the surgical opening of the mastoid. Nevertheless, Cheselden is first in proposing to artificially open the tympanic membrane in humans.
Comment on "Longitudinal Results of Intratympanic Injection of Budesonide for Otitis Media with Effusion in Children Over 12 Years and Adults"
Lee, Dong-Hee, 2015-08-01 08:00:00 AM
Reply to Dong-Hee Lee's Letter to the Editor RE: Yang F, Zhao Y, An P, et al. Longitudinal Results of Intratympanic Injection of Budesonide for Otitis Media With Effusion in Children Over 12 Years and Adults. Otol Neurotol 2014;35:629–34
An, Ping; Zhao, Yu; Yang, Fengling, 2015-08-01 08:00:00 AM
Giant Cell Reparative Granuloma of the Temporal Bone Treated With Calcitonin—10 Years on
Bird, Philip; Souter, Melanie, 2015-08-01 08:00:00 AM
Pulsatile Tinnitus Secondary to a Dural Arteriovenous Fistula
Fitzgerald, Ryan T.; Pollitzer, Rachel; Samant, Rohan S.; Kumar, Manoj; Ramakrishnaiah, Raghu H.; Amole, Adewumi; Akdol, Mehmet S.; Angtuaco, Edgardo J., 2015-08-01 08:00:00 AM
No abstract available
Otogenic Brain Abscess Mimicking as Stroke
Braun, Eva Maria; Nemetz, Ulrike; Bachna-Rotter, Sophie; Walch, Christian, 2015-08-01 08:00:00 AM
No abstract available
Desmoplastic Fibroma of the Temporal Bone
Majumder, Ananya; Gupta, Sachin; Friedman, Paul; Isaacson, Brandon, 2015-08-01 08:00:00 AM
No abstract available
Παρασκευή 14 Αυγούστου 2015
Otology & Neurotology - Current Issue
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