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PubMed1995

The use of addition reaction silicone materials in the fabrication of ear plugs.

Ear plugs are currently recommended for patients with tympanostomy tubes or for those requiring noise attenuation. Most techniques used today require a two-step process involving an impression of the ear followed by laboratory fabrication from a cast. This paper presents an alternative technique which is accomplished in one appointment and eliminates the laboratory phase by using addition reaction silicones. The indications for ear plugs and clinical results achieved with this new technique were also reviewed.

Dentistry↗
PubMed1996

Large vestibular aqueduct syndrome: a tutorial and three case studies.

The large vestibular aqueduct (LVA) syndrome is a congenital malformation that predisposes the patient ultimately to a loss of hearing and possible continuing vestibular disorder. If the LVA patient is diagnosed, it typically is not until later life, when he/she exhibits profound sensorineural hearing loss. To better understand this disorder and to bring it to the attention of audiologists, we provide a brief tutorial of LVA and present three case studies that illustrate the syndrome.

Adolescent↗
PubMed1996

Outcome of residual cholesteatoma and hearing in mastoid surgery.

OBJECTIVE: To review 12 years of the senior author's experience with mastoid surgery for cholesteatoma. DESIGN: Retrospective review. SETTING: Northwestern University Medical School. METHODS: Available records included 97 mastoid procedures for cholesteatoma: 54 with intact canal-wall and 43 canal-wall-down. MAIN OUTCOME MEASURES: Residual cholesteatoma, pure-tone audiometry, and speech audiometry were compared for both groups. RESULTS: Residual disease rate was 11 of 54 (20%) for intact canal-wall procedures and 2 of 43 (5%) for canal-wall-down procedures. Average follow-up was 2 years. Hearing was preserved postoperatively, and neither procedure demonstrated clear superiority in this regard. CONCLUSION: While canal-wall-down mastoidectomy provides a lower residual disease rate with equal hearing outcome, the role of intact wall mastoidectomy remains a viable choice in certain clinical situations.

Adult↗
PubMed1996

Stapedectomy in the elderly.

Clinical records were reviewed to examine the effectiveness of stapedectomy in patients 70 years and older. A total of 154 patients was studied, including 11 with profound hearing loss with long-standing otosclerosis. Ages at the time of surgery ranged from 70 to 92 years (mean, 76.3 years). The mean pure-tone average (500, 1,000, 2,000, and 4,000 Hz) improved 30.6 dB after surgery for the 143 patients in the main otosclerotic group and 26.8 dB for the patients in the profound-hearing-loss group. The rate of successful stapedectomies for the 70(+)-year-old patients (90.9%) and the younger comparison group (90.0%) were similar. These findings extend the documented range of stapedectomy as a safe and effective procedure through the eighth decade of life.

Aged↗
PubMed1997

Predictive value of intraoperative brainstem auditory evoked responses in surgery for conductive hearing losses.

OBJECTIVE: To assess the efficacy of intraoperative brainstem auditory evoked responses (BAER) in predicting postoperative hearing improvement in surgery for conductive hearing loss. STUDY DESIGN: A prospective study of consecutive patients undergoing surgery for conductive hearing loss under general anesthesia by a single surgeon. SETTING: A tertiary care university affiliated medical center. PATIENTS: All patients undergoing surgery for conductive hearing loss by the senior author between June 25, 1993 and March 20, 1995. INTERVENTIONS: Pre- and postreconstruction intraoperative BAERs; pre- and postoperative pure tone and speech audiometry. MAIN OUTCOME MEASURES: Changes in audiometric pure tone air-conduction thresholds, bone-air gaps (BAG), and speech reception thresholds (SRT), compared with changes in BAER wave five (V) latencies. RESULTS: A decrease in the wave V latency on the intraoperative BAER correlates significantly with improvement in postoperative pure-tone air-conduction, BAG, and SRT using chi 2 and linear regression analyses. CONCLUSIONS: Improvement in intraoperative BAER correlates with postoperative hearing improvement in surgery for conductive hearing loss done under general anesthesia in our population.

Adolescent↗
PubMed1997

Cochlear microphonics in Ménière's disease.

The pathophysiology of hearing deterioration in Ménière's disease (MD) is unclear. Hair cell loss has been proposed to be the cause of severe hearing loss in Ménière's disease. The cochlear microphonic (CM) is known to be the receptor potential of the outer hair cells in the cochlea. This study measured the CM in Ménière's disease and investigated its relationship with the degree of hearing impairment and endolymphatic hydrops. Transtympanic electrocochleography (ECoG) using rarefaction (RAR) and condensation (CON) tonebursts at 1 kHz was performed on 130 ears of 119 patients. Ninety six ears were diagnosed to have MD and 34 were diagnosed non-Ménière's disease (NMD). The mean amplitude of the CM was 33.10 +/- 46.04 microV in the MD group and 13.15 +/- 12.77 microV in the NMD group (p < 0.001). Enlarged negative summating potential and action potential ratios (SP:AP > 40%) were found in 81.3% of the MD group and 17.6% of the NMD group. In the MD group, the CM in the group with an enlarged negative SP was 36.98 +/- 49.78 microV, and 16.31 +/- 15.88 microV in the group without (p < 0.01). The CM was 34.33 +/- 49.28 microV in the pure-tone average (PTA) < or = 25 dB group, 46.97 +/- 58.31 microV in the 26-40 dB group, 29.12 +/- 42.62 microV in the 41-70 dB group, and 26.20 +/- 22.41 microV in the > 70 dB group (p > 0.05). The CMs in 11 pairs of MD ears and sensorineural hearing loss (SNHL) ears with matching hearing (MD 44 dB, SNHL 45 dB) were measured. They were 71.42 +/- 75.94 microV and 7.90 +/- 5.89 microV, respectively (p < 0.01). Our study shows that the CM is higher in ears with endolymphatic hydrops, evidenced by an enlarged SP:AP ratio, than ears without and the CM shows no statistical difference in groups with different levels of hearing loss. These findings suggest that hearing loss with a large CM in Ménière's disease patients may be the result of an alteration of cochlear mechanics and only severe hearing loss with a small CM is caused by hair cell loss. The CM measurement, to evaluate the hair cell status, may be helpful in identifying patients whose hearing may be recoverable if the underlying hydrops can be corrected. Our data do not permit the conclusion that an enlarged CM can be used in the diagnosis of MD.

Adult↗
PubMed1997

Lack of association between hearing loss and glaucoma.

Some studies have suggested a relationship between glaucoma and sensorineural hearing loss. Others have found no evidence for an association. We performed a study to determine whether there is a significant difference in hearing between patients with glaucoma and a matched control population. Patients presenting themselves to a glaucoma clinic were grouped by type of glaucoma: uveitis, primary open-angle, pigmentary, pigmentary dispersion, congenital, or ocular hypertension. Patients older than 60 were excluded from the study, as were those who met certain carefully chosen exclusion criteria. Subjects included 40 men and 27 women, ranging in age from 15 to 60 years. Glaucoma was bilateral in all cases. Auditory thresholds at 0.5, 1.0, 2.0, and 3.0 kHz were measured bilaterally and statistically compared with American National Standards Institute (ANSI) normative values. Speech reception threshold and intelligibility were also assessed. When compared with speech ANSI values, there were no significant differences in mean thresholds at any frequency for any of the glaucoma types. Mean speech reception thresholds and intelligibility scores were all within normal limits and no subjects showed evidence of sensorineural hearing loss greater than expected for age. There were no differences between glaucoma groups, and we found no evidence of an association between glaucoma and hearing loss. There is disagreement about whether or not an association exists between glaucoma and hearing loss. Among those who do feel there is a relation, there is wide disagreement about what proportion of glaucomatous patients have a hearing loss. Rampoldi (1) first described an association between glaucoma and inner ear disease in 1889. Since that time, a number of reports have suggested such an association (2-4; 6-12). However, many of these studies are methodologically flawed. A few studies found no evidence of a relationship between glaucoma and sensorineural hearing loss (14, 15). There have been few reports since the 1970s, and the question remains unresolved. If there is, in fact, a relationship between glaucoma and inner ear disease, potentially much could be learned about certain forms of hearing loss from the study of glaucoma. In particular, surgical specimens (trabecular meshwork) could be obtained in those patients who undergo operations for their glaucoma. This tissue could be examined using current histopathological techniques. On the basis of the results, hypotheses might be made, by inference about which pathological processes are manifested in the inner ear. Therefore, we performed a study to evaluate whether there is a significant difference in hearing between patients with glaucoma and a matched control population.

Adolescent↗
PubMed1997

Plasmapheresis in autoimmune inner ear disease: long-term follow-up.

OBJECTIVE: This study aimed to evaluate the outcome of long-term hearing benefits of plasmapheresis (PMP) in presumed autoimmune inner ear disease (AIED). STUDY DESIGN: The study was a case series, with retrospective chart review, written questionnaire, telephone interview, and follow-up examination. SETTING: It was performed in a private practice otology and neurotology referral center. PATIENTS: Sixteen patients (5 males, 11 females) whose symptoms were compatible with the diagnosis of AIED, who underwent PMP, and who had 2-year or later objective follow-up. Age ranged from 8-62 years, with a mean of 40.9 years. Follow-up ranged from 2-12 years, with a mean of 6.7 years. INTERVENTION: Plasmapheresis at one or more times during the active phase of disease. MAIN OUTCOME MEASURE: Stability of hearing, defined according to the American Academy of Otolaryngology-Head and Neck Surgery recommended criteria for reporting hearing results in Meniere's disease, was used as the main outcome measure. RESULTS: Eight (50%) of 16 patients had improved or stable hearing in 1 or both ears. Eleven (39.3%) of 28 ears with measurable hearing pre-PMP were improved or stable. Only 25% of patients required continued use of immunosuppressive drugs. CONCLUSION: Plasmapheresis may be beneficial as an adjunctive therapy for maintaining hearing in some patients with AIED. Cost and reimbursement factors are major obstacles in the use of this therapy. The overall success rate and individual patient results warrant further study of PMP in the treatment of AIED.

Adolescent↗
PubMed1997

[Implantable bone conduction hearing aids].

Conventional extern bone conduction hearing aids often cause retroauricular pain by compression of the skin, distortion is enhanced by the vibrational pattern and feedback can be a problem and, last but not least, do not fit into cosmetic schemes. We report about experiences with 2 different systems of partly implantable bone conduction hearing aids which were designed to overcome the technical, audiological and cosmetical problems of conventional bone conduction hearing aids. There is a transcutaneous and a percutaneous system discussed. Clinical experiences demonstrate that the percutaneous system is superior in both objective hearing gain and patient acceptance.

Bone Conduction↗
PubMed1997

[Patients with trauma-induced deafness--rehabilitation using a cochlear implant].

Deafness due to bilateral temporal bone fractures is a dramatic consequence for the injured patients. Out of more than 1000 patients in Hannover which received a cochlear implant we analyzed the medical history of 44 patients (36 male, 8 female, average age of adults: 41 years) which were implanted after posttraumatic deafness (Nucleus device n = 33, Clarion device n = 11). Postoperatively the patients underwent an auditory rehabilitation program. Most of them (84%) reached open set speech understanding. Results are different caused by additional damage of auditory nerve fibers and posttraumatic central lesions. Due to the risk of posttraumatic fibrosis of the cochlea, implantation should be performed early and can be recommended to the patient if bilateral deafness is diagnosed. In the case of auditory nerve damage brain stem implants offer new possibilities.

Adolescent↗
PubMed1997

Speech perception performance of congenitally deaf patients with a cochlear implant: the effect of age at implantation.

The relation between age at cochlear implantation and long-term open-set speech recognition was studied in a group of nine congenitally deaf children. The age at cochlear implant surgery ranged from 4 to 13 years. The results showed that there was a tendency toward poorer results in the children implanted at a relatively older age. However, the results also indicated that an upper limit for age at implantation cannot yet be defined in these children.

Adolescent↗
PubMed1997

Nonsurgical factors predictive of postoperative hearing for patients with vestibular schwannoma.

OBJECTIVE: The purposes of the study were to determine whether preoperative cochlear reserve as measured by evoked otoacoustic emissions (EOAE) as well as other hearing variables often associated with hearing preservation are correlated with hearing preservation after tumor removal and to determine whether any hearing variables are independent of tumor size as a predictor of hearing preservation. STUDY DESIGN: Preoperative audiologic data for 104 patients having vestibular nerve schwannomas removed via a retrosigmoid surgical approach were reviewed and subjected to factor analysis. SETTING: All patients were seen at the Mayo Clinic, Rochester, Minnesota. PATIENTS: The patient sample was divided into two groups based on hearing thresholds after surgery. Group I consisted of 73 ears without hearing preservation. The remaining 31 ears, group II, had preserved hearing (defined as average postoperative pure-tone thresholds < or = 85-dB HL for 0.5, 1, 2, and 3 kHz). MAIN OUTCOME MEASURES: Variables not predictive of hearing preservation were age, gender, tumor laterality, and cochlear reserve (EOAE). Variables predictive of hearing preservation were small tumor size, pure-tone hearing sensitivity, speech reception thresholds, word recognition scores, integrity of cochlear nerve (acoustic reflex thresholds, and auditory brain stem response [ABR] waveforms). RESULTS: A multivariate logistic regression analysis showed that only word recognition scores at 40-dB sensation level were independent of tumor size as a predictor of hearing preservation.

Acoustic Stimulation↗
PubMed1998

Is the unaided ear effect independent of auditory aging?

As a group, adults with bilateral symmetric sensorineural hearing loss (SNHL) who receive a monaural hearing aid fitting experience a progressive decline in their word recognition score (WRS) for monosyllabic word materials in the unaided ear but not in the aided ear. However, adults with binaural fittings do not demonstrate a similar deterioration in their WRS. In an effort to determine the role of senescent auditory changes on the unaided ear effect, a retrospective investigation was carried out on a group of hearing aid wearers. Using NU-6 to assess the WRS, this investigation attempted to answer the following question: is the unaided ear effect related to asymmetric senescent auditory changes? The present results indicate that the unaided ear effect is not related to such an asymmetric effect since it is shown to occur in adults with SNHL whether in the fourth or seventh decade of life.

Adult↗
PubMed1998

Irradiated rib cartilage graft for reconstruction of the tympanic membrane: preliminary results.

OBJECTIVE: To evaluate the advantages, disadvantages, safety, and results in reconstruction of the tympanic membrane using irradiated rib cartilage. STUDY DESIGN: Retrospective chart review. SETTING: A tertiary referral center. PATIENTS: All patients who had > or =6 months follow-up who underwent tympanoplasty or tympanomastoidectomy using irradiated rib cartilage graft at our institution from January 1, 1993 to December 31, 1996. INTERVENTION: Tympanoplasty or tympanomastoidectomy using homologous irradiated rib cartilage as graft material. MAIN OUTCOME MEASURES: Postoperative speech reception thresholds, speech discrimination scores, and air-bone gap were compared with preoperative levels. Complications directly related to irradiated rib cartilage tympanoplasty were sought. RESULTS: Speech reception threshold did not significantly change. Speech discrimination scores were stable or improved in all patients. Postoperative air-bone gap was < or =10 dB in 43.2% of patients and < or =20 dB in 70.3% of patients. There was a 16% complication rate regarding tympanoplasty in general. No complications unique to irradiated rib cartilage occurred. CONCLUSION: Irradiated rib cartilage is an alternative tympanoplasty material that may save operating time, spares patients an added incision, provides results similar to other grafting material, and is safe.

Adolescent↗
PubMed1998

Acoustic neuromas presenting with normal or symmetrical hearing: factors associated with diagnosis and outcome.

OBJECTIVE: To evaluate the clinical features leading to diagnosis in patients with acoustic neuroma (AN) who present with normal or symmetrical hearing. Underlying tumor characteristics are also studied to identify a possible explanation for this unique presentation in the AN population. STUDY DESIGN: Retrospective case review comprising patients who were identified as having AN that presented with normal audiometry. SETTING: A tertiary referral center. PATIENTS: Patients with AN who met the criteria for normal were included in the report. For this study, abnormal audiometry is defined as an interaural difference of > or =15 dB at a single frequency or > or =10 dB at two or more frequencies, and an interaural speech reception threshold difference of > or =20 dB, or a speech discrimination score of > or =20%. MAIN OUTCOME MEASURES: Presenting symptoms and signs, clinical features that led to the diagnosis of AN, auditory brain stem response results, tumor location, size and relationship to temporal bone landmarks, surgical intervention, surgical outcome, and results of hearing preservation attempts were tabulated for each patient. RESULTS: A total of 29 patients (5%) were identified who had normal or symmetrical pure-tone audiograms between 500 and 4,000 Hz. The average difference in speech reception threshold between tumor and nontumor ear was 3.2 dB, and the average difference in speech detection score was 2.6%. The most common presenting symptoms that led to the diagnosis of the AN were dysequilibrium/vertigo (12 cases), cranial nerve V and VII abnormalities (11 cases), routine screening for families with neurofibromatosis type 2 (5 cases), asymmetrical tinnitus (4 cases), headaches (4 cases), unilateral subjective hearing difficulty (4 cases), and incidental finding during evaluation for another problem (4 cases). The average tumor size was 19 mm, with five cases presenting with tumors of size > or =30 mm. Nineteen patients underwent a hearing preservation procedure (middle fossa or retrosigmoid), 11 of whom had useful hearing postoperatively. CONCLUSIONS: Despite normal audiometry, patients presenting with imbalance or vertigo, Vth or VIIth cranial nerve deficits, or unilateral hearing complaints may warrant further evaluation to rule out the possibility of AN or other retrocochlear lesion. To seek an explanation for this phenomenon, the incidence of various tumor characteristics (e.g., depth of penetration into the internal auditory canal and degree of porous erosion) is discussed and compared with the entire AN population.

Adult↗