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Results for “Speech Reception Threshold Test”

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PubMed2001

Intratympanic dexamethasone for sudden sensorineural hearing loss: clinical and laboratory evaluation.

OBJECTIVE: To discuss the value of intratympanic dexamethasone (IT-DEX) perfusion for sudden sensorineural hearing loss (SSNHL), clinically and in an animal model. STUDY DESIGN: Retrospective case review of 10 patients with SSNHL treated with IT-DEX. The findings are correlated with this institution's previous findings from a study of IT-DEX in guinea pigs. SETTING: Ambulatory tertiary otologic referral center. PATIENTS: Sequential patients with SSNHL who chose IT-DEX treatment. INTERVENTIONS: Dexamethasone 0.5 mg was injected transtympanically and bathed the round window for 20 minutes. Animal study: 79 ears were randomized into five groups: control, IT-DEX versus intravenous (IV)-DEX, IT-DEX with histamine, IT-DEX with hyaluronic acid, and IT-DEX with dimethylsulfoxide. MAIN OUTCOME MEASURES: Clinical study: postprocedure audiometry. Animal study: perilymph steroid concentration. RESULTS: IT-DEX results in significant hearing improvement and in significantly higher perilymph concentration of steroid than IV-DEX. CONCLUSIONS: IT-DEX is an appropriate treatment option for the treatment of SSNHL. Further study of dosages and frequency of administration is warranted.

Administration, Topical↗

PubMed2001

Multichannel cochlear implantation in visually impaired patients.

OBJECTIVE: To evaluate the outcome of cochlear implantation in patients with severe to profound hearing loss and visual impairment. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center with a large cochlear implant program. PATIENTS: Six adults and two children with severe or profound hearing loss and significant visual impairment underwent multichannel cochlear implantation. Follow-up period ranged from 6 months to 9 years. Case history, etiology of visual and hearing loss, and benefit from cochlear implant were evaluated. INTERVENTIONS: Cochlear implantation and subsequent rehabilitation. MAIN OUTCOME MEASURES: Speech perception measures were selected based on the patient age and cognitive abilities. Identical measures were used in each patient before and after implantation. RESULTS: As a group, patients did well after cochlear implantation. There was significant improvement in speech perception when compared with the score before implantation. CONCLUSIONS: Cochlear implants can play a significant rehabilitative role in patients with severe visual and auditory impairment. Additional skills are required by the implant team for rehabilitation of patients with multiple sensory deficits.

Adult↗

PubMed2001

Computer-aided virtual surgery for congenital aural atresia.

HYPOTHESIS: Computer-enhanced three-dimensional (3D) computed tomography (CT) provides accurate spatial representation of the complex surgical anatomy of congenitally atretic ears, and is superior to conventional CT for surgical planning. BACKGROUND: The surgical repair of congenital aural atresia is challenging. Conventional CT, routinely used for surgical planning, is limited in its ability to represent spatial relationships between important structures. Because of the lack of density differences between bony structures in the ear, 3D CT has thus far been useful for representing surface contour but not internal anatomy. METHODS: A two-level segmentation scheme was developed to distinguish structures in the temporal bone. 3D CT reconstructions of congenital ears were produced with a high-resolution helical scanner. An interactive tool was used to mark the ossicles and facial nerve. The segmentation scheme was used to color-enhance the ossicles and otic capsule, and render the surrounding bone translucent. "Virtual surgery" was then performed by subtracting a cylindrical volume of bone lateral to the atresia plate. The enhanced 3D CT reconstructions were correlated with intraoperative video recordings. RESULTS: In four congenital ears, computer-enhanced 3D CT was highly predictive of the actual anatomy. Surgery was avoided in two anatomically unfavorable cases. CONCLUSION: Computer-enhanced 3D CT is a major advance over conventional CT for demonstrating the complex spatial relationships in congenitally atretic ears.

Adolescent↗

PubMed2001

Tinnitus suppression in patients with cochlear implants.

OBJECTIVE: To determine the degree of tinnitus suppression provided by currently available multichannel cochlear implants and to determine factors that can influence this process. STUDY DESIGN: Prospective cohort. SETTING: Tertiary-care referral center. PATIENTS: Thirty-eight adult patients (18 years of age or older) with severe-to-profound hearing loss and tinnitus who met criteria for cochlear implantation. INTERVENTION: Cochlear implantation with a multichannel cochlear implant device. MAIN OUTCOME MEASURES: Patients rated the intensity of their tinnitus using a semiquantitative scale before and after cochlear implantation. These data were analyzed to determine the significance of the reduction of tinnitus after implantation. Tinnitus levels after implantation were also analyzed to determine whether the level of speech recognition, patient gender, or the implant type influenced the degree of tinnitus reduction. RESULTS: Statistical analysis revealed a significant reduction in tinnitus intensity in patients using cochlear implants, with 35 of 38 patients (92%) experiencing a reduction in tinnitus intensity. All multichannel implants studied afforded similar degrees of tinnitus suppression. The degree of tinnitus reduction was not correlated with speech recognition, as measured by CID Everyday Sentence scores. Female patients had significantly greater degrees of tinnitus before implantation, but both male and female patients demonstrated similar levels of tinnitus after implantation. No patient experienced greater levels of tinnitus after implantation. CONCLUSION: All currently available multichannel cochlear implant devices provide effective and similar levels of tinnitus suppression when activated. Exacerbation of tinnitus as a result of cochlear implantation does not represent a significant risk. The mechanisms by which cochlear implants exert tinnitus suppression are, as yet, unclear.

Adult↗

PubMed2002

Use of homograft dehydrated temporal fascia in tympanoplasty.

OBJECTIVE: To investigate the results of myringoplasty operations using homograft dehydrated fascia temporalis (Tutoplast) and compare these with those performed with autograft fascia temporalis. STUDY DESIGN: Prospective cohort. SETTING: University hospital. PATIENTS: Forty-three adult patients (> or =18 years of age) with central, dry perforations of pars tensa with intact ossicular chains. INTERVENTION: Tympanoplasty with an endaural approach and underlay technique was performed. Homograft dehydrated temporal fascia was used in 22 patients, and autograft was used in the remaining 21 patients. MAIN OUTCOME MEASURES: Preoperative and postoperative air-bone gap and speech reception threshold levels and postoperative compliance values of the homograft and autograft groups were compared. RESULTS: Postoperative perforations were encountered in two patients (9.1%) from the homograft group and three patients (14.2%) from the allograft group. Significant postoperative improvements in air-bone gap and speech reception threshold values were detected for both groups (p < 0.05). Although the mean compliance of the tympanic membranes was significantly lower in the homograft group, no statistically significant difference was observed between groups when the postoperative air-bone gap and speech reception threshold values were compared. CONCLUSION: Homograft temporal fascia can be used in tympanoplasty with the same success rate of autograft temporal fascia without impeding hearing. Its main advantages are the reduction in the duration of surgery and the length of preauricular and postauricular incisions. However, the advantages of the dehydrated homograft temporal fascia should be weighed against its cost and risk of transmission of viral and prion-mediated diseases.

Adult↗

PubMed2002

Autosomal dominant low-frequency hearing impairment (DFNA6/14): a clinical and genetic family study.

OBJECTIVE: To delineate the phenotype and genotype of an autosomal dominant low-frequency sensorineural nonsyndromic hearing impairment trait in relation to similar traits. STUDY DESIGN: Family study, including retrospective case reviews. SETTING: Tertiary referral center. PATIENTS: Hearing impairment was documented in 11 family members in five generations, 8 of whom were alive and participated in this study. INTERVENTION: Diagnostic. MAIN OUTCOME MEASURES: Clinical study: medical and otologic history and examination, retrieval of previous audiograms, pure-tone audiometry, and statistical analysis of audiometric data. Genetic study: linkage analysis of blood samples in 18 clinically affected and nonaffected family members. RESULTS: Hearing impairment had been present since early childhood, mainly affecting the low frequencies (mean threshold 45 dB HL at 0.25-1 kHz); speech recognition was hardly affected during the first three decades of life. Higher frequencies became involved with increasing age, thus causing a flat-type audiogram at middle age and down-sloping audiograms after age 60 years. Progression was mild but significant at all frequencies (0.5 dB/year at 0.25 kHz to 1.3 dB/year at 8 kHz) and persisted after correction was applied for normal presbyacusis. The trait was linked to chromosome 4p16.3, in a region comprising both the previously located, closely adjacent DFNA6 and the DFNA14 loci for low-frequency hearing impairment. CONCLUSION: A third family (designated Dutch II) was identified with a low-frequency hearing impairment trait showing linkage to chromosome 4p16.3 (DFNA6/14). The progression of hearing impairment beyond presbyacusis in the current study is unprecedented for DFNA6/14 traits.

Adolescent↗

PubMed2002

Unexpected complication of posterior canal occlusion surgery for benign paroxysmal positional vertigo.

OBJECTIVE: The purpose of this report was to illustrate how an unusual complication of posterior canal occlusion surgery for benign paroxysmal positional vertigo (BPPV) may be recognized and prevented. Recurrence of BPPV after occlusion surgery of the posterior semicircular canal has not previously been reported in the literature, to the authors' knowledge. Failure of occlusion not only permits the continued symptoms of BPPV but also burdens the patient with the additional morbidity of a fistula of the PSCC. The authors describe the successful treatment of a patient with recurrent and incapacitating BPPV after the failure of occlusion surgery of the posterior semicircular canal, when the patient was simultaneously crippled by the distressing morbidity of an iatrogenic fistula. DESIGN: Case report. SETTING: Tertiary care referral center. INTERVENTION: Surgical excision of the fistulous segment of the membranous posterior semicircular canal. OUTCOME MEASURES: The BPPV was resolved. The distressing symptom of a fistula was eliminated. Hearing was preserved. CONCLUSION: Failure to completely occlude the posterior semicircular canal during posterior canal occlusion surgery results in recurrence of BPPV and an iatrogenic fistula, both of which are preventable. The occurrence of such an event is described, its management is outlined, and some thoughts are offered about its prevention.

Electronystagmography↗

PubMed2003

Vestibular dysfunction after cochlear implantation.

OBJECTIVE: To determine the prevalence, symptom characteristics, and potential risk factors for vestibular symptoms after cochlear implantation. STUDY DESIGN: Case-control study design embedded within an ongoing cohort of patients undergoing implantation. SETTING: Academic medical center cochlear implant research program funded by the National Institutes of Health. PATIENTS: Seventy five eligible consecutive patients undergoing cochlear implantation. INTERVENTION: Medical record review. MAIN OUTCOME MEASURE: Recorded symptoms of vestibular symptoms after cochlear implantation. Subjects with vestibular symptoms were considered case subjects; those without vestibular symptoms were considered control subjects. RESULTS: Twenty-nine of 75 (39%) patients experienced dizziness postoperatively. Four patients experienced a single, transient acute vertigo attack occurring less than 24 hours after surgery. The majority, 25 patients, experienced delayed, episodic onset of vertigo. The median (interquartile range) time of delayed onset was 74 (26-377) days after implantation. Delayed dizziness manifested as spontaneous episodic or positional vertigo. Preoperative dizziness, age at implantation, and age at onset of hearing loss were significantly greater in the dizzy group. Preoperative electronystagmography did not differentiate between groups. CONCLUSIONS: Thirty-nine percent (29/75) of subjects with implants were dizzy after implantation. The majority of subjects experienced dizziness in a delayed episodic fashion. Dizziness was not related to implant activation. It seemed that delayed dizziness was not related to immediate surgical intervention but could result from chronic changes occurring in the inner ear; there was some suggestion this could take the form of endolymphatic hydrops.

Acute Disease↗

PubMed2003

Oral steroid treatment of sudden sensorineural hearing loss: a ten year retrospective analysis.

OBJECTIVE: To describe ten years of experience with Sudden Sensorineural Hearing Loss and compare the outcomes with and without treatment with oral corticosteroids. STUDY DESIGN: Retrospective review of medical records. SETTING: Large specialty hospital, Department of Otolaryngology. PATIENTS: Patients presenting with sudden onset (72 hours) unilateral sensorineural hearing loss, with no evidence of Ménière's Disease, acoustic injury, retrocochlear disease, and other specifiable disorders. INTERVENTIONS: The majority of patients received a standard course of oral corticosteroids (Prednisone 60 mg and taper). A smaller group declined treatment. MAIN OUTCOME MEASURES: Recovery of hearing sensitivity was measured using standard audiometry and reported as change in Pure Tone Average. Word recognition scores were also analyzed. RESULTS: When severe-to-profound cases are analyzed, a significant improvement (p <.01) in Pure Tone Average is seen in cases treated with steroids versus those untreated. When milder cases are included, a statistical floor effect prevents differentiation of these groups. Word recognition scores were significantly improved (p <.05) in the treated group. CONCLUSIONS: Application of steroid medication significantly improves the recovery outcomes in cases of Severe Sudden Sensorineural Hearing Loss.

Administration, Oral↗

PubMed2003

Progressive late-onset sensorineural hearing loss and vestibular impairment with vertigo (DFNA9/COCH): longitudinal analyses in a belgian family.

OBJECTIVE: To evaluate audiometric and vestibular signs and symptoms in a new DFNA9 family. SETTING: Tertiary referral centers. METHODS: A multigeneration Belgian family with late-onset progressive sensorineural hearing loss and concomitant ves-tibular impairment with an autosomal dominant pattern of inheritance underwent clinical and genetic evaluation. Medical history was recorded. Blood samples were taken for genetic linkage and mutation analyses. Pure-tone audiometry, speech audiometry and vestibular examinations were performed. Onset and progression in hearing impairment were evaluated with linear regression analysis of longitudinal threshold-on-age data. RESULTS: Linkage to DFNA9 was confirmed and mutation analysis revealed a P51S mutation in the COCH gene. Several patients had a Ménière's-like presentation. All patients developed late-onset progressive sensorineural hearing loss eventually leading to severe deafness and vestibular failure.

Adult↗

PubMed2003

Cochlear implantation in human immunodeficiency virus-infected patients.

OBJECTIVE: To evaluate the efficacy of cochlear implants in human immunodeficiency virus-infected individuals and correlate these results with a proposed pathophysiological mechanism of human immunodeficiency virus-associated hearing loss. STUDY DESIGN: Retrospective case series and temporal bone analysis of deceased human immunodeficiency virus-positive patients. SETTING: Tertiary care hospital. PATIENTS: Seven human immunodeficiency virus-positive individuals with profound sensorineural hearing loss. INTERVENTION: Cochlear implantation at New York University Medical Center. METHODS: The surgical outcomes and complications were analyzed. Additionally, electron microscopic and immunohistochemical findings of cadaver temporal bone specimens of other known human immunodeficiency virus-positive individuals were reviewed. The performance results of the human immunodeficiency virus-positive cochlear implant patients were then correlated with the previously hypothesized pathophysiological mechanism of human immunodeficiency virus-associated hearing loss. RESULTS: The patients had a varied performance with cochlear implantation, and as a group performance was good. There were no surgical complications or postoperative complications. The good performance of these patients supports the hypothesis that the mechanism of human immunodeficiency virus-associated deafness involves infiltration, malfunction, and premature degeneration of the hair cells and supportive cells of the cochlea. CONCLUSIONS: Human immunodeficiency virus-positive individuals benefit from cochlear implantation without increased surgical risk.

Adult↗

PubMed2004

The RetroX auditory implant for high-frequency hearing loss.

OBJECTIVE: The objective of this study was to analyze the subjective satisfaction and measure the hearing gain provided by the RetroX (Auric GmbH, Rheine, Germany), an auditory implant of the external ear. STUDY DESIGN: We conducted a retrospective case review. SETTING: We conducted this study at a tertiary referral center at a university hospital. SUBJECTS: We studied 10 adults with high-frequency sensori-neural hearing loss (ski-slope audiogram). INTERVENTION: The RetroX consists of an electronic unit sited in the postaural sulcus connected to a titanium tube implanted under the auricle between the sulcus and the entrance of the external auditory canal. Implanting requires only minor surgery under local anesthesia. MAIN OUTCOME MEASURES: Main outcome measures were a satisfaction questionnaire, pure-tone audiometry in quiet, speech audiometry in quiet, speech audiometry in noise, and azimuth audiometry (hearing threshold in function of sound source location within the horizontal plane at ear level). RESULTS: : Subjectively, all 10 patients are satisfied or even extremely satisfied with the hearing improvement provided by the RetroX. They wear the implant daily, from morning to evening. We observe a statistically significant improvement of pure-tone thresholds at 1, 2, and 4 kHz. In quiet, the speech reception threshold improves by 9 dB. Speech audiometry in noise shows that intelligibility improves by 26% for a signal-to-noise ratio of -5 dB, by 18% for a signal-to-noise ratio of 0 dB, and by 13% for a signal-to-noise ratio of +5 dB. Localization audiometry indicates that the skull masks sound contralateral to the implanted ear. Of the 10 patients, one had acoustic feedback and one presented with a granulomatous reaction to the foreign body that necessitated removing the implant. CONCLUSION: The RetroX auditory implant is a semi-implantable hearing aid without occlusion of the external auditory canal. It provides a new therapeutic alternative for managing high-frequency hearing loss.

Adult↗

PubMed2004

A comparison of cartilage palisades and fascia in tympanoplasty after surgery for sinus or tensa retraction cholesteatoma in children.

OBJECTIVE: To compare cartilage palisades with fascia grafting in reconstruction of the eardrum after surgery for sinus or tensa retraction cholesteatoma in children, with respect to postoperative drum retraction and perforation, cholesteatoma recurrence, and hearing. MATERIAL: From March 1995 to October 2000, a total of 64 children, aged 5 to 15 years, underwent surgery for either sinus or tensa retraction cholesteatoma. The eardrum was reconstructed using cartilage palisades in 32 children and fascia or perichondrium in 32 children. Postoperatively, the patients were seen as out-patients and were recently reevaluated by otomicroscopy and audiometry. MAIN OUTCOME MEASURES: Postoperative drum retraction and perforation, cholesteatoma recurrence, and hearing (pure tone average, speech reception threshold, and air-bone gap). RESULTS: All patients in the palisade group and all but one patient in the fascia group attended the follow-up examination. In the palisade group, the mean follow-up period was 37 months (range, 3-65 mo) and in the fascia group 52 months (range, 17-75 mo). Two (6%) retractions and no perforations were found in the palisade group, versus 12 (36%) retractions and 4 perforations (12%) in the fascia group at follow-up (both significant differences). No cholesteatoma recurrence occurred. Late hearing results in sinus cholesteatomas were significantly better in the palisade group. CONCLUSIONS: The comparison of fascia and cartilage palisade grafting for drum reconstruction after tensa cholesteatoma surgery in children indicates that the palisade technique may be superior in respect to prevention of drum retraction and perforation. Further, in sinus cholesteatoma surgery, the long-term hearing results are better when grafting cartilage palisades.

Adolescent↗

PubMed2005

Estimating noise-induced permanent threshold shift from audiometric shape: the ISO-1999 model.

OBJECTIVE: To describe the relation between audiometric shape and noise-induced permanent threshold shift averaged across the speech frequencies (N5123). DESIGN: Using an international standard (ISO-1999), 270 audiograms were created, representing both sexes and a variety of ages, exposure levels, and percentiles. Bulge depth (BD) was defined as the difference between pure-tone average for 2, 3, and 4 kHz and PTA for 1 and 6 kHz. RESULTS: N5123 was well-predicted by quadratic functions of BD, which accounted for 72 to 95% of the variance in N5123. CONCLUSIONS: Estimates of N5123, based on BD, can be helpful in medical-legal diagnosis and allocation of hearing loss.

Adult↗

PubMed2006

Effect of training on word-recognition performance in noise for young normal-hearing and older hearing-impaired listeners.

OBJECTIVE: The objective of this study was to evaluate the effectiveness of a training program for hearing-impaired listeners to improve their speech-recognition performance within a background noise when listening to amplified speech. Both noise-masked young normal-hearing listeners, used to model the performance of elderly hearing-impaired listeners, and a group of elderly hearing-impaired listeners participated in the study. Of particular interest was whether training on an isolated word list presented by a standardized talker can generalize to everyday speech communication across novel talkers. DESIGN: Word-recognition performance was measured for both young normal-hearing (n = 16) and older hearing-impaired (n = 7) adults. Listeners were trained on a set of 75 monosyllabic words spoken by a single female talker over a 9- to 14-day period. Performance for the familiar (trained) talker was measured before and after training in both open-set and closed-set response conditions. Performance on the trained words of the familiar talker were then compared with those same words spoken by three novel talkers and to performance on a second set of untrained words presented by both the familiar and unfamiliar talkers. The hearing-impaired listeners returned 6 mo after their initial training to examine retention of the trained words as well as their ability to transfer any knowledge gained from word training to sentences containing both trained and untrained words. RESULTS: Both young normal-hearing and older hearing-impaired listeners performed significantly better on the word list in which they were trained versus a second untrained list presented by the same talker. Improvements on the untrained words were small but significant, indicating some generalization to novel words. The large increase in performance on the trained words, however, was maintained across novel talkers, pointing to the listener's greater focus on lexical memorization of the words rather than a focus on talker-specific acoustic characteristics. On return in 6 mo, listeners performed significantly better on the trained words relative to their initial baseline performance. Although the listeners performed significantly better on trained versus untrained words in isolation, once the trained words were embedded in sentences, no improvement in recognition over untrained words within the same sentences was shown. CONCLUSIONS: Older hearing-impaired listeners were able to significantly improve their word-recognition abilities through training with one talker and to the same degree as young normal-hearing listeners. The improved performance was maintained across talkers and across time. This might imply that training a listener using a standardized list and talker may still provide benefit when these same words are presented by novel talkers outside the clinic. However, training on isolated words was not sufficient to transfer to fluent speech for the specific sentence materials used within this study. Further investigation is needed regarding approaches to improve a hearing aid user's speech understanding in everyday communication situations.

Adult↗

PubMed2006

Speech recognition for unilateral and bilateral cochlear implant modes in the presence of uncorrelated noise sources.

OBJECTIVE: The purpose of the current investigation was to compare speech recognition in noise for bilateral and unilateral modes within postlingually deafened, adult bilateral cochlear implant recipients. In addition, it was of interest to evaluate the time course of the bilateral speech-recognition advantage and the effect of changing signal-to-noise ratio (SNR) on the magnitude of the bilateral advantage. DESIGN: In the first experiment, 16 postlingually deafened adults who were bilaterally implanted with the MED-EL C40+ cochlear device were evaluated in unilateral left, unilateral right, and bilateral conditions 4 to 7 mo after activation. Speech recognition in the presence of five spatially separated, uncorrelated noise sources was evaluated using both a single fixed SNR of +10 dB and an adaptive-SNR method. In a follow-up study, a subset of 10 participants was re-evaluated using an identical fixed-SNR method 12 to 17 mo after activation to examine the time course of speech-recognition performance in both unilateral and bilateral modes at a single SNR. A third study was performed with a subset of six participants to examine performance over a range of SNRs. In this study, speech recognition was measured 12 to 17 mo after activation in quiet and at +5, +10, +15, and +20 dB SNRs using the same five uncorrelated noise sources. RESULTS: The speech-recognition data revealed a significant bilateral advantage of 3.3 dB using the adaptive-SNR method. A significant bilateral advantage of 9% was also measured using a fixed +10 dB SNR. Results from the second study revealed that experience resulted in a significant (11 to 20%) increase in speech-recognition-in-noise performance for both unilateral and bilateral modes; however, the magnitude of the bilateral advantage was not affected by experience. Results from the third study revealed the largest bilateral advantage at the poorest SNR evaluated. In addition, performance in quiet was significantly better than that measured in the presence of noise, even at the +20 dB SNR. CONCLUSIONS: The results of these experiments support a small but significant bilateral speech-recognition-in-noise advantage for cochlear implant recipients in an environment with multiple noise sources. This advantage is presumed to be attributable to the combined effects of binaural squelch and diotic summation. Although experience generally improved speech-recognition-in-noise performance in both unilateral and bilateral modes, a consistent bilateral advantage (approximately 10%) was measured at 4 to 7 mo and at 12 to 17 mo postactivation.

Acoustic Stimulation↗

PubMed2005

Long-term outcome of atticotomy for cholesteatoma in children.

OBJECTIVE: To evaluate the long-term outcome of atticotomy (AT) surgery for cholesteatoma in children. STUDY DESIGN: Case series, retrospective chart review. SETTING: General otology practice in a teaching hospital. PATIENTS: Fifty-three children aged 5 to 16 years old with cholesteatoma limited to the attic and middle ear who underwent AT between the years 1979 to 1994. INTERVENTIONS: AT consisting of removal of cholesteatoma confined mainly to the attic. The procedure consists of removal of the lateral attic wall (scutum) and involved ossicles with excision of the cholesteatoma and tympanic membrane grafting with temporalis fascia, leaving a small attical cavity. The mastoid antrum was left intact. MAIN OUTCOME MEASURES: Disease recurrence, middle ear status, hearing results, and the need for further surgery. RESULTS: Mean follow up was 5.1 (+/-3.6) years. Eleven (21%) children required completion canal wall down tympanomastoidectomy because of residual disease or recurrence. The mean preoperative speech recognition threshold was 39.4 +/- 13.4 dB. The mean postoperative speech recognition threshold was 34.5 +/- 15.4, an improvement of 6.1 dB compared with the preoperative level. Last follow-up examination revealed a dry ear in all cases but one. CONCLUSIONS: In selected cases, AT can be a less invasive option in children with cholesteatoma limited to the attic and middle ear.

Adolescent↗

PubMed2005

Intratympanic corticosteroids for sudden idiopathic sensorineural hearing loss.

OBJECTIVE: To determine whether instillation of intratympanic steroids is effective in the treatment of sudden idiopathic sensorineural hearing loss. METHODS: A retrospective chart review of all patients who underwent intratympanic steroid treatment (methylprednisolone and/or dexamethasone) between 1996 and 2002 at a tertiary care university otology clinic. Thirty-three patients were identified, of which 26 met inclusion criteria for having an idiopathic hearing loss. Pretreatment and posttreatment pure-tone audiograms and speech discrimination scores were compared. RESULTS: Overall, there was a 27.2 +/- 5.7 dB improvement in the pure-tone thresholds and a 25.4 +/- 6.2% improvement in speech discrimination scores. Those treated within 10 days of onset had a statistically significant better outcome than those treated after 10 days. No adverse reactions or complications were reported. CONCLUSION: Instillation of intratympanic steroids represents a safe and potentially effective treatment of sudden idiopathic sensorineural hearing loss.

Administration, Topical↗