Hearing Loss

Distortion-product otoacoustic emissions testing in neonates treated with an aminoglycoside in a neonatal intensive care unit

April 27, 2015     Iosif Vital, MD; George Psillas, MD; Nikolaos Nikolaides, MD; George Kekes, MD; Stavros Hatzopoulos, MD; John Constantinidis, MD
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Abstract

We evaluated the ototoxic effect of aminoglycosides on the outer hair cells of newborns in a neonatal intensive care unit (NICU) by means of distortion-product otoacoustic emissions (DPOAE) testing. Our study population was made up of 164 newborns who were divided into three groups: group A consisted of 105 infants who were given aminoglycoside therapy (either gentamicin or amikacin, or a combination of the two) as treatment for suspected or proven bacterial infection and septic states; group B included 30 newborns who were not given an antibiotic or who were given an antibiotic other than an aminoglycoside; group C, a control group, was made up of 29 healthy neonates who were hospitalized in the well-baby nursery. All the neonates underwent DPOAE testing in both ears (the f2 primary tone was presented at 2.0, 2.5, 3.2, and 4.0 kHz). We found that 41 patients in group A (39.0%) and 13 in group B (43.3%) failed the DPOAE test in one or both ears; the difference between these two groups was not statistically significant (p = 0.673). In group C, the DPOAE fail rate was 13.8% (4 newborns). In group A, there was no statistically significant association between the pass/fail rate and the specific aminoglycoside that was administered, or in the duration of antibiotic treatment, the number of doses, and the size of the mean daily dose and the mean total dose. In clinical practice, DPOAE testing is a sensitive method of evaluating the integrity of the outer hair cells in the basal turn of the cochlea after exposure to ototoxic drugs such as aminoglycosides. However, our study did not demonstrate that the aminoglycosides had any ototoxic effect on the hearing of neonates in the NICU.

Cochlear implantation leading to successful stapedectomy in the contralateral only-hearing ear

March 2, 2015     Samantha J. Mikals, MD; Gerald I. Schuchman, PhD; Joshua G.W. Bernstein, PhD; Arnaldo L. Rivera, MD
article

Abstract

Cochlear implants have recently begun to be offered to patients with single-sided deafness (SSD). Implantation in these patients has led to good results in suppressing ipsilateral tinnitus and in providing audiologic benefits in terms of speech perception in noise and localization. One previously unreported benefit of cochlear implantation in patients with SSD is the restoration of functional hearing in the previously deaf ear, which may allow for surgical opportunities in the contralateral hearing ear. We report a case in which cochlear implantation in the deaf left ear of a 50-year-old man allowed for surgical intervention in the previously only-hearing right ear, which in turn led to the restoration of normal middle ear function. Further studies may be warranted to consider the surgical candidacy of the contralateral only-hearing ear as another potential indication for cochlear implantation in patients with SSD.

Progression of autoimmune inner ear disease to labyrinthitis ossificans: Clinical and radiologic correlation

March 2, 2015     Jenn Nee Khoo, FRCR; Tiong Yong Tan, FRCR
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Abstract

We report the case of a 42-year-old man who presented with fluctuating bilateral sensorineural hearing loss that subsequently progressed to a complete hearing loss, and we describe the correlation between the clinical and radiologic features of this case. To the best of our knowledge, this is the first report to demonstrate imaging evidence of progression from autoimmune inner ear disease to labyrinthitis ossificans. This is also the first reported case of a reversal of a loss of labyrinthine CISS (constructive interference in a steady state) signal, suggesting that T2-weighted hyposignal may be attributable to an alteration in labyrinthine fluid content and not to fibrosis only.

Vestibular dehiscence syndrome caused by a labyrinthine congenital cholesteatoma

February 2, 2015     Francesco Fiorino, MD; Francesca B. Pizzini, MD, PhD; Barbara Mattellini, MD; Franco Barbieri, MD
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Abstract

A 40-year-old man presented with conductive hearing loss and pressure- and sound-related vestibular symptoms. Computed tomography and diffusion-weighted magnetic resonance imaging revealed the presence of a cholesteatoma involving the vestibular labyrinth. The patient underwent a canal-wall-up tympanoplasty, which revealed evidence of a disruption of the vestibular labyrinth and a wide dehiscence of the vestibule, which was immediately resurfaced. At the 2-month follow-up, the patient's pressure- and sound-related vestibular symptoms had disappeared. Pure-tone audiometry showed a reduction in the air-bone gap with a slight deterioration of bone conduction and an improvement in the air-conduction threshold. Fistulization of the otic capsule produces a “third window,” which can lead to a dehiscence syndrome. One possible cause is a cholesteatoma of the middle ear or petrous bone. When the vestibule is invaded by a cholesteatoma, hearing is almost invariably lost, either pre- or postoperatively. However, in our case, wide opening of the vestibule resulted in hearing preservation.

Osteoradionecrosis of the temporal bone

January 19, 2015     Edmund W. Lee, BA; Robert W. Jyung, MD
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The pathogenesis of osteoradionecrosis is not completely understood, but it has been thought that radiation causes tissues to become hypoxic, hypovascular, and hypocellular, leading to tissue breakdown and a nonhealing wound.

Giant-cell tumor of the tendon sheath in the external auditory canal

October 17, 2014     Margherita Trani, MD; Massimo Zanni, MD; Paolo Gambelli, MD
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Abstract

Giant-cell tumor of the tendon sheath (GCTTS) and pigmented villonodular synovitis belong to the same type of benign proliferative lesions originating in the synovia that usually affect the joints, bursae, and tendon sheaths. They frequently involve the hands, knees, ankles, and feet. We report a case of GCTTS in the external auditory canal in a 53-year-old woman who presented with hearing loss, fullness, and a sessile lesion protruding from the anterior wall of her external ear canal. The 1.5-cm diameter mass was spherical, well encapsulated, firm, and covered with normal skin. The lesion was completely excised, and the patient's symptoms resolved. No recurrence was detected at 2 years of follow-up.

Laterality of sudden sensorineural hearing loss

August 27, 2014     Michael Reiss, MD; Gilfe Reiss, MD
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Abstract

It is known that sudden sensorineural hearing loss and other otoneurologic diseases, such as tinnitus or Ménière disease, occur more frequently in the left ear than in the right. We studied lateralization of sudden deafness in 489 patients treated at Radebeul Hospital from January 2004 to December 2009. The male-to-female ratio was 1:1.24; we found a predominance of the left side only in female patients. The cause for this predominance is unclear. The slight asymmetry might indicate a greater vulnerability of the left inner ear in women, suggesting hormonal factors in the genesis of sudden deafness.

Tympanic membrane perforation with squamous epithelial ingrowth

August 27, 2014     Danielle M. Blake, BA; Alejandro Vazquez, MD; Senja Tomovic, MD; Robert W. Jyung, MD
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The squamous epithelium of the tympanic membrane and external auditory canal exhibits an inherent migration pattern to facilitate the exfoliation of keratinizing squamous cells as part of a natural cleansing mechanism.

Pediatric sensorineural hearing loss

June 8, 2014     Dennis J. Kitsko, DO, FACS, FAOCO
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Children with hearing loss should avoid noise exposure, and families should be counseled to protect their child's hearing environment and to educate their children about the long-term need to avoid excessive noise exposure.

Evaluating occupational hearing loss: The value of the AMA's Guides to the Evaluation of Permanent Impairment

May 7, 2014     Robert T. Sataloff, MD, DMA, FACS, Editor-in-Chief
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As scientific knowledge and methodology expand and our knowledge base grows, it is essential for physicians and scientists to incorporate new knowledge and allow our practices to evolve.

Tympanic paraganglioma

May 7, 2014     Danielle M. Blake, BA; Senja Tomovic, MD; Robert W. Jyung, MD
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Patients classically present with pulsatile tinnitus and a red mass medial to the tympanic membrane. Some patients may have findings of a red mass that blanches with pneumatic otoscopy, called Brown's sign.

Implants in otology

March 18, 2014     Barry E. Hirsch, MD
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Progress in technology facilitates progress in patient care.

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