Hearing Loss

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.

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.

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.

Vibrant Soundbridge System: Round window stimulation with the vibroplasty technique

March 31, 2011     Willis S.S. Tsang, MD, Terence K.C. Wong, MSc, and Michael C.F. Tong, MD
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Treatment-refractory autoimmune sensorineural hearing loss: Response to infliximab

January 1, 2011     Yi-Chun Liu, MD, Rene Rubin, MD, and Robert T. Sataloff, MD, DMA, FACS
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Abstract

We conducted a retrospective study to assess the effects of infliximab, a chimeric monoclonal antibody, on hearing in patients with autoimmune sensorineural hearing loss who had previously not responded to steroid therapy and/or treatment with other immunosuppressive drugs such as methotrexate and cyclophosphamide. We reviewed the rec-ords of 8 such patients. Our objective measures of outcome were pure-tone averages at 500, 1,000, 2,000, and 3,000 Hz and speech discrimination scores. At the completion of treatment, no patient exhibited a positive response to infliximab therapy by objective measurements, and only 1 patient (12.5%) reported subjective improvement.

Glomus jugulare

January 1, 2011     Jeffrey D. Suh, MD, Ashley E. Balaker, MD, Brian D. Suh, MD, and Keith E. Blackwell, MD
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Malleus head fixation

December 17, 2010     Julia Vent, MD, PhD and Dirk Beutner, MD
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The effects of glutathione enhancement on sensorineural hearing loss

August 31, 2010     Robert T. Sataloff, MD, DMA, FACS, Therese Bittermann, MD, Linda Marks, RN, Deborah Lurie, PhD, and Mary Hawkshaw, BSN, RN, CORLN
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Abstract

Previous research has demonstrated the benefits of anti-oxidant treatment in the prevention of hearing loss in animals. Our study tested the effects of an undenatured whey protein supplement rich in glutathione on human patients with hearing loss. Over an average of 36 months, 30 patients with hearing loss and who had data sufficient for analysis were treated with a glutathione supplement and were compared with 30 retrospective controls selected from the same otologic patient population. Patients were followed using regular hearing tests. Linear regression analysis was used to determine whether study group, baseline audiometric score, time followed, and autoimmune etiology modified the rate of hearing loss. Treatment with the glutathione supplement failed to modify significantly the progression of hearing loss in the treated population. The baseline audiometric score was most predictive of the final audiometric score (p < 0.0005). Although glutathione supplementation was not shown to be helpful in slowing hearing loss in the patients studied, our research model proved valid as it demonstrated an overall decline in hearing in both the treated and control groups over time of sufficient magnitude to permit detection of a treatment effect if a substantial effect had occurred. We suggest that this model be applied to future studies investigating the effects of antioxidants on hearing loss.

Vibrant Soundbridge implantable hearing device: Critical review and single-surgeon short- and long-term results

August 31, 2010     Charles M. Luetje, MD, FACS, Sandra A. Brown, MA, CCC-A, and Robert D. Cullen, MD
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Abstract

We conducted a retrospective descriptive study of a series of 31 consecutively presenting patients who had been implanted with the Vibrant Soundbridge middle ear hearing device. All implantations had been performed by the senior author. Three of these patients had undergone bilateral implantation, and 4 others had undergone subsequent explantation and reimplantation in response to known or suspected device failure, giving us a total of 34 ears and 38 implants. Our goal was to ascertain short- and long-term outcomes as measured by conventional audiometry (pure-tone average at 1 to 6 kHz) and long-term benefit as defined by the use or nonuse of the device. We found that at the initial activation session 2 months postoperatively, the average hearing thresholds were within 3 dB of the preoperative thresholds in all 34 ears and all 38 implants. The mean short-term gain at activation in the 38 implants was 28.1 dB. Nineteen patients (20 ears) were available for long-term evaluation, with the length of follow-up ranging from less than 1 year to 11 years (mean: 7.3). Of these 20 ears, 9 demonstrated further gain (mean: 10.8 dB) despite any natural hearing deterioration; of the remaining 11 ears, gain was unchanged in 2, diminished in 7 (mean: -3.6 dB), and gain data were unavailable in 2. In the final analysis, there were 20 user ears and 10 nonuser ears; 4 ears were lost to all follow-up. We conclude that direct-drive hearing with the Vibrant Soundbridge middle ear hearing device is beneficial and provides sustained audiometric gain. Factors that have a significant impact on patient use or nonuse include difficulty in obtaining audiologic support and the direct and indirect costs of the device. Without audiologic or financial support, some patients may choose to become nonusers and to either switch to conventional hearing aid amplification or become apathetic about hearing improvement.

Hearing impairment in persons with the hemoglobin SC genotype

June 30, 2010     Paul A. Onakoya, FWACS, Onyekwere G.B. Nwaorgu, FWACS, and Wuraola A. Shokunbi, FWACP
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Abstract

The hemoglobin (Hb) SC genotype is seen in persons who have inherited the gene for hemoglobin S from one parent and the gene for hemoglobin C from the other. Some people with this genotype develop Hb SC disease, a variant of sickle cell disease. Hb SC disease, a compound heterozygous condition, is the most common of the hemoglobinopathies and the least severe, although it is still serious. One of the documented complications of the presence of the Hb SC genotype is sensorineural hearing loss (SNHL). We conducted a prospective case-control study of 43 subjects, aged 15 to 65 years, who had the Hb SC genotype to determine the incidence of SNHL and to determine if the hearing loss in these subjects was correlated with sex or age. Our control group was made up of 100 generally healthy, sex- and age-matched subjects with the normal Hb AA genotype. SNHL was defined as a loss of more than 25 dB HL at two or more frequencies in the same ear or at one or more frequencies in both ears. We found that SNHL was present in 12 of the 43 subjects (27.9%) in the Hb SC group (17 of 86 ears [19.8%]) and in 17 of the 100 subjects (17.0%) in the Hb AA group (21 of 200 ears [10.5%]; the difference between the two groups was not statistically significant (χ2 = 1.589; p = 0.105). We found that in the Hb SC group, SNHL was more common among females than males (38.5 vs. 11.8%), although the difference was not quite significant statistically (χ2 = 2.435; p = 0.056); in the Hb AA group, the incidence was fairly equal-15.4 and 18.8%, respectively (χ2 = 0.033; p = 0.427). Therefore, we conclude that the hearing loss in the subjects of this study was not correlated with the presence of the Hb SC genotype in either sex. In terms of age, SNHL was significantly more common in subjects aged 41 to 65 years than in those aged 15 to 40 years in both genotype groups. In the Hb SC group, SNHL was present in 4 of the 33 younger subjects (12.1%) and in 8 of the 10 older subjects (80.0%) (χ2 = 14.354; p < 0.001). In the Hb AA group, the corresponding figures were 7 of 85 (8.2%) and 10 of 15 (66.7%) (χ2 = 26.840; p < 0.001). Therefore, we conclude that the hearing loss in the subjects of this study was a function of age and was not associated with the presence of the Hb SC genotype.

Acute ototoxicity from a single infusion of oxaliplatin

May 31, 2010     Narinder K. Malhotra, MD, Rizwan Aslam, DO, Sydney P. Lipman, MD, and Vicki J. Bilski, MS, CCC-A
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Abstract

Ototoxicity secondary to the administration of the chemotherapeutic agent oxaliplatin is uncommon. We report a case of unilateral hearing loss that occurred immediately after the infusion of a single dose of oxaliplatin in a 70-year-old woman who was undergoing postoperative chemotherapy for rectal adenocarcinoma. To the best of our knowledge, no such case has been previously reported in the literature. The hearing loss in our patient was severe enough to limit her daily activities, and she experienced only minimal improvement during the next 2 years of follow-up.

Dissection of the incus long process by the chorda tympani nerve

March 31, 2010     Julia Vent, MD, PhD and Dirk Beutner, MD
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