Hearing Loss

Idiopathic bilateral auricular petrification

March 31, 2012     Karl J. Alsey, MbChB, MRCS, Simon R. Freeman, MBChB, FRCS, and Ajay Nigam, MBBS, FRCS
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Abstract

Auricular petrification is a rare diagnosis and presents an interesting therapeutic challenge. Fewer than 160 cases have been reported in the literature since the first description by Bochdalek in 1866. The most common etiology is ectopic calcification. It may also result from injurious processes including frostbite, physical trauma, inflammatory conditions, and various endocrinopathies. We report an incidental finding of idiopathic bilateral auricular petrification in a 40-year-old man presenting with idiopathic unilateral sensorineural deafness.

Is there a need for audiologic evaluation in patients with Behçet disease?

March 1, 2012     Saniye Cinar, MD, Fikret Cinar, MD, and Sibel Kiran, MD, PhD
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Abstract. Behçet disease is known to be a multisystem condition. We conducted a study to determine the prevalence of hearing loss in patients with Behçet disease and to identify any associations between audiologic findings and other clinical manifestations and treatment. Our study group was made up of 41 adults with Behçet disease and 41 healthy sex- and age-matched controls. All patients and controls underwent a complete clinical otolaryngologic examination, which included pure-tone audiometry, acoustic impedance testing, and otoacoustic emissions testing. Audiology revealed that the prevalence of sensorineural hearing loss (SNHL) was significantly higher in the Behçet patients than in the controls-68.3 vs. 22.0% (p < 0.002). The duration of Behçet disease had no significant impact on whether patients did or did not experience hearing loss. Hearing loss was the fourth most common clinical finding in the Behçet group, after oral ulcers, genital ulcers, and skin lesions. We conclude that SNHL is present in a significant number of Behçet patients, and we suggest the need for an adequate investigation of hearing in the routine follow-up of these patients.

Folliculosebaceous cystic hamartoma of the external auditory canal in an adult

February 18, 2012     Fabiana Pirani Carneiro, MD, Leonora Maciel de Souza Vianna, MD, Aline Marques dos Santos, MD, Igor Teixeira Raymundo, MD, and Ana Emília Borges de Azevedo, MD
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Abstract

Folliculosebaceous cystic hamartoma (FSCH) is a cutaneous hamartoma of pilosebaceous origin that usually occurs on the face. We present what we believe is only the second reported case of FSCH of the external auditory canal, and the first in an adult. The patient was a 59-year-old woman who presented with a 4-year history of a firm nodule on the left external auditory canal that had caused hearing loss, pruritus, and pain. The lesion was excised, and histopathologic examination identified infundibular cysts, hyperplasia of the sebaceous lobules, and a large amount of mucin, features that are consistent with FSCH. One year postoperatively, the patient was asymptomatic, and no evidence of recurrence was noted.

Ectodermal dysplasia: Otolaryngologic evaluation of 23 cases

February 18, 2012     Muzeyyen Yildirim, MD, Ediz Yorgancilar, MD, Ramazan Gun, MD, and Ismail Topcu, MD
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Abstract

The aim of this prospective study was to improve the quality of life of and reduce morbidity for patients with ectodermal dysplasia by assessing their actual and potential ENT pathologies, and offering methods of prevention and treatment. The study was conducted between 2006 and 2008 and included 23 patients diagnosed with ectodermal dysplasia. The major symptoms of ectodermal dysplasia were evaluated. Patient histories were obtained in all cases, and a complete head and neck examination was carried out. Of the 23 patients (11 males and 12 females, aged 5 to 45 years) diagnosed with ectodermal dysplasia, 22 had hypohidrotic ectodermal dysplasia and 1 had ectrodactyly-ectodermal dysplasia-clefting syndrome. In all patients diagnosed with hypohidrotic ectodermal dysplasia, the salivary glands were examined by ultrasonography and, when necessary, by scintigraphy. Hearing defects in patients with otologic problems were determined by audiometric examination: 39.1% of the patients had hearing loss, 43.5% had otitis media, and 39.1% had impacted cerumen. The most common rhinologic findings were saddle nose deformity in 56.5%, nasal obstruction and nasal dryness (52.2% each), and chronic rhinitis/rhinosinusitis (34.8%). The most common oral and oropharyngeal findings were difficulty chewing in 82.6% and dry mouth in 78.3%. All 23 patients had required dental work. Because this disorder affects several aspects of the body, its treatment requires a multidisciplinary approach, with the otolaryngologist being a vital part of the management team.

Hearing loss: Economic impact

January 25, 2012     Robert T. Sataloff, MD, DMA, FACS, Editor-in-Chief
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More and more of us are living long enough to experience hearing loss.

Was that my doctor?

December 15, 2011     Robert T. Sataloff, MD, DMA, FACS, Editor-in-Chief
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Confusion among patients about what kind of healthcare provider they have seen is pervasive. While reputable professionals in all disciplines are responsible about avoiding confusion and potential adverse health consequences, problems still exist.

Otomastoiditis with acute left facial nerve paralysis caused by Mycobacterium chelonae

December 15, 2011     Kang-Chao Wu, MD, Min-Tsan Shu, MD, and Bo-Nien Chen, MD
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Abstract

Mycobacterium chelonae usually causes soft-tissue and skin infection. It is a rare cause of otomastoiditis. The clinical presentation and operative findings are similar to those of other nontuberculous mycobacterial infections. We describe a case of left-sided otomastoiditis with acute facial nerve paralysis caused by this organism in a previously well middle-aged woman. Her facial palsy totally resolved after tympanomastoidectomy plus a 7-week regimen of clarithromycin and moxifloxacin. To our knowledge, a case of otomastoiditis with acute facial nerve paralysis caused by M chelonae has not been reported previously.

A purely intracanalicular cochlear schwannoma presenting with progressive hearing loss

October 26, 2011     Hüseyin I&scedil;&inodot;ldak, MD, Metin Ibrahimov, MD, Mehmet Yilmaz, MD, Ozgun Enver, MD, and Sait Albayram, MD
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Abstract

Schwannomas arising from the cochlear nerve and confined to the internal auditory canal are rare. Clinically, a cochlear schwannoma can cause a progressive hearing loss. We report the case of a 56-year-old woman with a cochlear schwannoma that manifested as a slowly progressive hearing loss. The lesion was diagnosed by gadolinium-enhanced 3-Tesla magnetic resonance imaging.

Meningioma mimicking vestibular schwannoma

July 13, 2011     Sung Won Chae, MD and Moo Kyun Park, MD
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Is virtual endoscopy of the middle ear useful?

June 13, 2011     Ambrose Chung-Wai Ho, FRCSEd, Raymond Lee, FRCR, Michael Tiong-Hong Co, MRCSEd, Chun-Kuen Chow, FRCSEd, and Kai-Ming Au Yeung, FRCR
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Abstract

Virtual endoscopy is a relatively new imaging technology in otology, and therefore data on its efficacy in clinical situations are limited. We conducted a prospective study to evaluate the clinical relevance of radiologic diagnoses based on virtual endoscopy of the middle ear. Our patient population was made up of 30 adults who were scheduled to undergo surgery to correct conductive hearing loss of unknown etiology. Virtual endoscopy was performed on three-dimensional images that were constructed from images obtained with conventional two-dimensional computed tomography (CT). Findings on virtual endoscopy were then compared with the subsequent surgical findings. Virtual endoscopy suggested a middle ear pathology in 19 patients and a normal middle ear in 11 patients. Postoperatively, we found that the virtual diagnoses correlated moderately well with the surgical findings in the group of patients with predicted pathology; 13 of these 19 patients were found to have middle ear problems such as ossicular chain anomalies, otosclerosis, and cholesteatoma (positive predictive value: 68%). However, among the 11 patients whose middle ear structures were radiologically predicted to be normal, only 2 had negative middle ear findings on surgical exploration; of the remaining 9 patients, 8 had otosclerosis and 1 had malleus fixation (negative predictive value: 18%). Thus, the sensitivity and specificity of virtual endoscopy were 59 and 25%, respectively. Virtual endoscopy provides images from a surgeon's perspective, and so it has the potential to be useful in the preoperative evaluation of the middle ear cavity. With ongoing advancements in computer systems and imaging techniques, the cost, reliability, and efficacy of virtual endoscopy may improve. However, further clinical validation and cost-benefit analysis are required before we can determine if it has any additional advantages over conventional two-dimensional CT.

Comparison of hearing thresholds obtained with Baha preoperative assessment tools and those obtained with the osseointegrated implant

April 30, 2011     Rebecca L. Heywood, MRCS, Parag M. Patel, FRCS(ORL), and David A. Jonathan, FRCS
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Abstract

We conducted a study of the Baha bone-anchored hearing aid system to quantify the difference between (1) hearing thresholds obtained through preoperative testing methods with the Baha sound processor attached to three different bone-conduction testing devices and (2) thresholds obtained postoperatively with the sound processor attached to a surgically placed osseointegrated titanium implant. Twenty-three patients underwent free-field testing in four situations: with the Baha sound processor attached to (1) the Baha Testband (transcutaneous transmission), (2) the Baha Softband (transcutaneous transmission), (3) a test rod (bone conduction via the teeth), and (4) the osseointegrated implant (percutaneous transmission). The main outcome measure was the result of a comparison of the thresholds obtained with the three preoperative test methods and those obtained with the osseointegrated implant. We found that aided thresholds obtained with the osseointegrated implant were significantly better (p < 0.05) than those obtained with the three preoperative test methods. The degree of superiority increased with higher frequencies. We conclude that thresholds of 1 to 18 dB better than those obtained by preoperative test methods can be expected postoperatively with the osseointegrated implant. The damping effect of sound transmission via the teeth or transcutaneously must be accounted for in making predictions of postoperative outcome.

The role of ultrahigh-frequency audiometry in the early detection of systemic drug-induced hearing loss

April 30, 2011     Rajeev Singh Chauhan, MS, Ravinder Kumar Saxena, MS, and Saurabh Varshey, MS
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Abstract

In monitoring patients for drug-induced hearing loss, most audiometric evaluations are limited to the range of frequencies from 0.25 to 8 kHz. However, such testing would fail to detect ototoxicity in patients who have already experienced hearing loss in the ultrahigh frequencies from 10 to 20 kHz. Awareness of ultrahigh-frequency ototoxicity could lead to changes in a drug regimen to prevent further damage. We conducted a prospective study of 105 patients who were receiving a potentially ototoxic drug-either gentamicin, amikacin, or cisplatin-to assess the value of ultrahigh-frequency audiometry in detecting systemic drug-induced hearing loss. We found that expanding audiometry into the ultrahigh-frequency range led to the detection of a substantial number of cases of hearing loss that would have otherwise been missed.

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