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Purpose The purpose of this study is the evaluation of post-operative hearing threshold after revision surgery and obliteration of troublesome canal wall down mastoidectomy cavities (CWDMCs). The ability to use and tolerate conventional hearing aids (CHAs) was also evaluated. Methods A retrospective chart analysis of 249 patients with chronically draining CWDMCs who underwent revision surgery including obliteration of the mastoid cavity between 2007 and 2017 at the AMC location of the Amsterdam University Medical Centers (Amsterdam UMC) was performed. Patient characteristics, pre- and post-operative Merchant grade, surgical outcomes, pre- and post-operative hearing thresholds, and the ability/necessity to use a CHA or the ability/necessity to use a Bone Conduction Device (BCD) were recorded. Results Dry ears were found in 95% of the total cohort. Residual disease was detected in 1.6% during MRI follow-up with no residual cholesteatoma in the obliterated area. In 3.2% of the patients, recurrent disease was found. A significant improvement in mean air conduction level, mean bone conduction level, and mean air-bone gap (ABG) was found post-operatively (p p p Conclusion This study shows that revision surgery and obliteration of CWDMCs enable successful CHA rehabilitation post-operatively. Upon this type of surgery, hearing thresholds improve significantly, but the need for rehabilitation with a CHA remains necessary in most cases.

The objective of this work was to analyze the modulating effect of an auditory intervention (AI) on the threshold and symmetry of auditory perception in people with different emotional states. The effects of AI were compared 3 months after using threshold audiometry (air conduction). The studied groups were emotional well-being (EWB) (n = 50, 14 with AI, 36 without AI); anxiety (ANX) (n = 31, 10 with AI, 21 without AI); and mixed group (MIX) (n = 45, 19 with AI, 26 without AI). The EWB group with AI lost the advantage of the left ear due to the hearing gain of the right ear, whereas in EWB without AI, no changes were observed. The ANX group with AI showed a non-significant improvement in both ears, maintaining the left interaural advantage. Interestingly, in the group without AI, the interaural difference was lost. The MIX group did not show interaural differences either with or without AI. However, the AI group showed a lower left ear threshold than that of the right ear, in contrast to the non-AI group. In conclusion, the application of this AI manages to decrease the prioritization of high frequencies, in addition to balance hearing between ears, which could decrease activation in states of anxiety.

Speech perception is thought to rely on a cortical feedforward serial transformation of acoustic into linguistic representations. Using intracranial recordings across the entire human auditory cortex, electrocortical stimulation, and surgical ablation, we show that cortical processing across areas is not consistent with a serial hierarchical organization. Instead, response latency and receptive field analyses demonstrate parallel and distinct information processing in the primary and nonprimary auditory cortices. This functional dissociation was also observed where stimulation of the primary auditory cortex evokes auditory hallucination but does not distort or interfere with speech perception. Opposite effects were observed during stimulation of nonprimary cortex in superior temporal gyrus. Ablation of the primary auditory cortex does not affect speech perception. These results establish a distributed functional organization of parallel information processing throughout the human auditory cortex and demonstrate an essential independent role for nonprimary auditory cortex in speech processing.

Background Sensorineural hearing loss in beta-thalassemia is common and it is generally associated with iron chelation therapy. However, data are scarce, especially on adult populations, and a possible involvement of the central auditory areas has not been investigated yet. We performed a multicenter cross-sectional audiological and single-center 3Tesla brain perfusion MRI study enrolling 77 transfusion-dependent/non transfusion-dependent adult patients and 56 healthy controls. Pure tone audiometry, demographics, clinical/laboratory and cognitive functioning data were recorded. Results Half of patients (52%) presented with high-frequency hearing deficit, with overt hypoacusia (Pure Tone Average (PTA) > 25 dB) in 35%, irrespective of iron chelation or clinical phenotype. Bilateral voxel clusters of significant relative hypoperfusion were found in the auditory cortex of beta-thalassemia patients, regardless of clinical phenotype. In controls and transfusion-dependent (but not in non-transfusion-dependent) patients, the relative auditory cortex perfusion values increased linearly with age (p p = 0.01, left side p = 0.02) with its domain related to communication skills (right side p = 0.04, left side p = 0.07) in controls but not in beta-thalassemia patients. Audiometric test results did not correlate to cognitive test scores in any subgroup. Conclusions In conclusion, primary auditory cortex perfusion changes are a metabolic hallmark of adult beta-thalassemia, thus suggesting complex remodeling of the hearing function, that occurs regardless of chelation therapy and before clinically manifest hearing loss. The cognitive impact of perfusion changes is intriguing but requires further investigations.

Author(s): Goshtasbi, Khodayar; Chua, Janice T; Risbud, Adwight; Sarna, Brooke; Jamshidi, Shahrnaz; Abouzari, Mehdi; Djalilian, Hamid R | Abstract: ObjectivesTo describe a cohort of patients presenting with long-term sudden sensorineural hearing loss (SSNHL) treated with prophylactic migraine and intratympanic steroid therapy.MethodsPatients presenting to a neurotology clinic at least 6 weeks from SSNHL onset were included. All patients received migraine prophylactic medication (nortriptyline, topiramate, and/or verapamil) and lifestyle changes for at least 6 weeks, as well as intratympanic steroid injections, if appropriate.ResultsTwenty-one patients (43% female) with a mean age of 64 ± 11 years who presented 9 ± 8 months (median = 5) from symptom onset were included. Posttreatment hearing thresholds were significantly improved compared with pretreatment thresholds at 500 Hz (49 ± 19 dB versus 55 ± 20 dB, p = 0.01), 1000 Hz (52 ± 19 dB versus 57 ± 21 dB, p = 0.03), low-frequency pure-tone average (53 ± 15 dB versus 57 ± 17 dB, p = 0.01), and speech-frequency pure-tone average (57 ± 13 dB versus 60 ± 15 dB, p = 0.02). Posttreatment word-recognition-score (WRS) and speech-recognition-threshold (SRT) were also significantly improved (45 ± 28% versus 70 ± 28% and 57 ± 18 dB versus 50 ± 16 dB, respectively, both p l 0.01). Notably, ≥15% improvement in WRS and ≥10 dB improvement in SRT was observed in 13 (68%) and 8 (40%) patients, respectively. Of the 11 patients who presented with initial l 50% WRS, 8 (73%) had improved posttreatment g50% WRS with an average improvement of 39 ± 9%.ConclusionsMigraine medications in addition to intratympanic steroid injections significantly improved SRT and hearing frequencies in 40% and 29% of SSNHL patients, respectively, while significant WRS recovery was observed in most (68%) patients. This suggests SSNHL may be an otologic migraine phenomenon, which may be at least partially reversible even after the traditional 30-day postonset window.

OBJECTIVES:To characterize the progression of mid-frequency sensorineural hearing loss (MFSNHL) over time. METHODS:A retrospective chart review spanning 2012 to 2017 was performed at a tertiary care audiology and neurotology center. Our cohort included 37 patients met the criteria for MFSNHL also known as "cookie bite hearing loss." It was defined as having a 1, 2, and 4 kHz average pure tone audiometry greater than 10 dB in intensity compared with the average threshold at 500 Hz and 8 kHz. RESULTS:Average age at initial presentation was 11.8 years (range, 8 mo to 70 yr). Across all individuals, the average mid-frequency threshold was 47 dB, compared with 27 dB at 500 Hz and 8 kHz. Twenty-three patients (62%) had multiple audiograms with 4-year median follow up time. Average values across all frequencies (0.5, 1, 2, 4, 8 kHz) in the initial audiogram was 37 dB, compared with an average of 39 dB demonstrated on final audiogram. Of those with serial audiograms, only five patients demonstrated threshold changes of 10 dB or more. Of these five patients, only one was found to have clinical worsening of MFSNHL. CONCLUSIONS:MFSNHL is an uncommon audiometric finding with unspecified long-term outcomes. We demonstrated that most patients (96%) with MFSNHL do not experience clinical worsening of their hearing threshold over almost 4 years of follow up. Future prospective studies aimed at collecting longer-term data are warranted to further elucidate the long-term trajectory of MFSNHL patients.

Objective: Evaluation of a new active osseointegrated bone-conduction hearing implant in moderate to severe mixed-hearing loss. Study Design: Prospective observational study of a series of cases. Setting: Tertial referral center. Patients: Twenty patients with moderate mixed-hearing loss were evaluated (10 Cochlear Osia group and 10 Baha 5 Power Connect -control group). Intervention: Rehabilitative. Main Outcome Measures: Hearing performance in quiet and in noise and quality-of-life were evaluated. Results: Improvements in audibility, speech-understanding, speech-recognition, and quality-of-sound in noise and quiet were found for the Osia System compared with preoperative unaided hearing and performance was similar to that obtained with Baha 5 Power Connect. Conclusions: The new active transcutaneous bone conduction system provided a tonal improvement in free-field at middle and high frequencies. The performance in speech recognition in quiet and in noise was similar to control group outcomes.

Objective Malleus ankylosis is an uncommon finding during stapes surgery, which can result in functional failure if undetected during primary surgery. Its management can be difficult and different approaches and solutions have been described to date, most of which require interruption of the ossicular chain. We report the management of such condition through a transcanal endoscopic technique, with preservation of ossicular chain integrity. Patients The procedure was carried out in a patient affected by otosclerosis with persistent hearing loss after primary stapes surgery. Intervention Surgical treatment of malleus head fixation through a totally endoscopic transcanal approach during revision stapes surgery. Main outcome measure Pure tone audiometry, speech audiometry. Results The patient experienced a complete closure of the air-bone gap. No postoperative vertigo or sensorineural hearing loss were observed. Conclusions The present report describes the transcanal endoscopic management of malleus ankylosis during revision stapes surgery, which has not been previously reported in the literature. Pearls related to this approach and advantages in comparison to previously described approaches of the literature are discussed as well.

Background Cochlear implantation in patients with functional residual low-frequency hearing is performed according to an established hearing-preserving surgical technique in order to cause minimal trauma of inner ear structures. Due to the increasing number of cochlear implants in children, the preservation of residual hearing is becoming increasingly important in this patient collective. Objectives Short- and mid-term hearing preservation outcome in pediatric patients is investigated. Materials and methods A group of 9 children (12 ears) between 5 and 12 years of age were examined after hearing-assisted cochlear implantation with respect to the pure tone audiometric thresholds. Retrospectively, short-term hearing preservation (up to 3 months after surgery) was examined. In a subgroup of 5 children, mid-term hearing preservation (7.5 to 16 months after surgery) was also analyzed. The mean values of hearing preserved (HL%) and hearing loss (HL) due to electrode insertion were calculated as measured values. Results In the whole group, the mean values of the preoperative PTAlow were 29.8 dB and the short-term postoperative PTAlow 42.6 dB. The mean value of the HL% was 73.6%, corresponding to an HL of 9.4 dB. In the subgroup, the mean PTAlow postoperatively was 46.0 dB in the mid-term and the HL% at 80.7% with a HL of 6.6 dB. Conclusions The results in children are consistent with the results in adults. Electric-acoustic stimulation (EAS) should be used in the treatment of children with existing low-frequency residual hearing, as good residual hearing preservation can also be achieved in children after implantation.

In a complex auditory scene, signals of interest can be distinguished from masking sounds by differences in source location [spatial release from masking (SRM)] and by differences between masker-alone and masker-plus-signal envelopes. This study investigated interactions between those factors in release of masking of 700-Hz tones in an open sound field. Signal and masker sources were colocated in front of the listener, or the signal source was shifted 90° to the side. In Experiment 1, the masker contained a 25-Hz-wide on-signal band plus flanking bands having envelopes that were either mutually uncorrelated or were comodulated. Comodulation masking release (CMR) was largely independent of signal location at a higher masker sound level, but at a lower level CMR was reduced for the lateral signal location. In Experiment 2, a brief signal was positioned at the envelope maximum (peak) or minimum (dip) of a 50-Hz-wide on-signal masker. Masking was released in dip more than in peak conditions only for the 90° signal. Overall, open-field SRM was greater in magnitude than binaural masking release reported in comparable closed-field studies, and envelope-related release was somewhat weaker. Mutual enhancement of masking release by spatial and envelope-related effects tended to increase with increasing masker level.

To investigate the possibility of vestibular damage in a group of patients suffering from chronic inflammatory demyelinating polyneuropathy (CIDP) using a diagnostic protocol including the caloric test, C-VEMPs and O-VEMPs. Twenty patients suffering from CIDP (mean age 58.5 years, range 33–80 years; 4 women and 16 men) were investigated. To assess any eventual audio-vestibular involvement, all patients of the study underwent pure tone audiometry, Fitzgerald–Hallpike caloric vestibular test, C-VEMPs and O-VEMPs. In 11 patients with CIDP values of both O-VEMPs and C-VEMPs were either absent or abnormal. An absent trace at O-VEMPs testing occurred in 36% of these pathological patients, whereas an increase of n10 latency and amplitude was present in the other 64% . A specific diagnostic protocol including the caloric test, C-VEMPS, O-VEMPS, could be useful when employed for identifying vestibular damage in CIDP patients.

© 2015 Taylor & Francis Conclusion: This study described objective and subjective evaluations of the Nurotron® Venus™ Cochlear Implant System and indicated that this system produced a satisfactory performance. Objective: To observe the performance of the Nurotron® Venus™ cochlear implant (CI) system via electrophysiological and psychophysical evaluations. Methods: A 26-electrode CI system was specially designed. The performance of MRI in animal and cadaveric head experiments, EABR in cats experiment, the correlation between ESRT and C level, and psychophysics evaluations in clinical trials were observed. Results: In the animal and cadaveric head experiments, magnet dislocation could not be prevented in the 1.5 T MRI without removal of the internal magnet. The EABR was clearly elicited in cat experiment. In the clinical trial, the ESRT was strongly correlated with C level (p

OBJECTIVE The first aim was to determine the prevalence, kind, and functional effects on hearing of ossicular chain suffering (OCS) in chronic otitis without cholesteatoma (NCOM) and tympanic perforations (TP). The second aim was to correlate the findings with clinical parameters and hearing level. MATERIALS AND METHODS The study group comprised 250 consecutive patients affected by NCOM and who were subjected to tympanoplasty and never operated on before. Each patient underwent preoperative pure tone audiometry. Ossicles were evaluated during surgery. The incidence of OCS in NCOM was reported in 15-62% of the patients. RESULTS Ossicular chain suffering was found in 26 out of the 250 patients included in the overall sample (10%). It was found in 7% of the patients affected by TP without otorrhea and in 19% of the patients affected by chronic ear discharge with drum perforation. OCS was found most frequently in posterior eardrum perforations and in patients with bilateral disease. The incus was the ossicle most frequently interested by resorption (92% of the patients). The air conduction threshold and air bone gap were more impaired in NCOM than in TP. CONCLUSION Ossicular chain damages in patients with non-cholesteatomatous middle ear pathologies are not frequent and are present in no more than 10% of the patients, but lesions found were similar to those reported in patients with cholesteatoma. Otorrhea, posterior perforation, and bilateral disease can be considered as good predictors of OCS.

Objective: The purpose of this study was to evaluate the effect of tobacco use on the Eustachian tube and inner ear function. Study Design: Case-control study. Subjects and settings: Thirty-one nonsmoking volunteers and 34 smoking subjects recruited in an University Hospital, submitted to an audiological evaluation including pure tone audiometry, basal tympanogram, stapedial reflexes analysis, and nine-step eustachian tube (ET) function test. Results: Pure Tone Average (PTA) threshold at all frequencies tested was 12.5 dB in smokers and 3.7 in nonsmoking subjects. Nine smokers (27%) presented some degree of hearing loss versus none in the nonsmoker group. Linear regression analysis showed a higher degree of sensorineural hearing loss with age in smokers. Among the smokers, 20 subjects (59%) presented an impaired tubal function for the nine-step inflation/deflation tympanometric test, while only 6 (19%) subjects in the group of nonsmokers showed a tubal dysfunction. Conclusion: Tobacco use may reduce the ability to hear, mainly causing a sensorineural hearing loss for higher frequencies. We also found the presence of a high number of smokers suffering from tubal dysfunction. This has an important clinical relevance, not only because smoking increases the incidence of middle ear diseases, but also because tubal dysfunction may cause nonspecific symptoms characterised by ear fullness and difficulties in middle ear equalisation.

Background: Surgical treatment of lesions involving the temporal bone, petrous apex, or internal auditory canal is usually performed using the classical microscopic approach that necessitates wide external incisions and soft tissue dissection. At present, the main application of endoscopic surgery is in the surgical treatment of middle ear cholesteatoma, but with the natural evolution of the technique, there will be an increasing number of applications in lateral skull base surgery. Objective: This study aimed to describe the pilot clinical experiences of our institution with combined microscopic/endoscopic-assisted approaches to the lateral skull base. Methods: A retrospective chart review was performed on patients undergoing an operation between July 2005 and September 2011 for lateral skull base pathology using the endoscope-assisted technique. Results: Nine patients (7 female, 2 male; mean age = 57.4 years) were reviewed and included in the present study. In all cases, the petrous apex lesion of each patient was unilateral: 6 cases had cholesteatoma of the petrous bone; 2 cases had cholesterinic granuloma of the petrous apex; and 1 case had a low-grade chondrosarcoma of the petrous apex. Overall, after a mean follow-up of 30.7 months, no residual disease has been found in our series up to the present time in the cholesteatoma group. In the cholesterinic granuloma group, only a partial success was obtained in the patient who underwent the infracochlear approach, since the most medial part of the pathology was not accessed and still persisted at neuroradiologic examinations made postoperatively. Conclusion: In our case series, lateral combined microscopic/endoscopic procedures have proved to be effective in the treatment of petrous apex lesions, allowing less destructive approaches compared to exclusive microscopic procedures.

Background The aim of this prospective clinical study was to evaluate the clinical importance of Vestibular-Evoked Myogenic Potentials (VEMPs) in the assessment and differential diagnosis of otosclerosis and otologic diseases characterized by “pseudo-conductive” components. We also investigated the clinical appearance of balance disorders in patients with otosclerosis by correlating VEMP results with the findings of caloric testing and pure tone audiometry(PTA). Material/Methods Air-conducted(AC) 4-PTA, bone-conducted(BC) 4-PTA, air-bone Gap(ABG), AC, BC tone burst evoked VEMP, and calorics were measured preoperatively in 126 otosclerotic ears. Results The response rate of the AC-VEMPs and BC-VEMPs was 29.36% and 44.03%, respectively. Statistical differences were found between the means of ABG, AC 4-PTA, and BC 4-PTA in the otosclerotic ears in relation to AC-VEMP elicitability. About one-third of patients presented with disequilibrium. A statistically significant interaction was found between calorics and dizziness in relation to PTA thresholds. No relationship was found between calorics and dizziness with VEMPs responses. Conclusions AC and BC VEMPs can be elicited in ears with otosclerosis. AC-VEMP is more vulnerable to conductive hearing loss. Evaluation of AC-VEMP thresholds can be added in the diagnostic work-up of otosclerosis in case of doubt, enhancing differential diagnosis in patients with air-bone gaps. Otosclerosis is not a cause of canal paresis or vertigo.

Sensorineural hearing loss has been reported as an extraintestinal manifestation of inflammatory bowel disease, especially in adult patients with ulcerative colitis. However, to date only a few series have been reported in the literature, and none from Italy. The aim of the present investigation was to assess the prevalence of symptomatic sensorineural hearing loss in Italian patients with ulcerative colitis.We retrospectively assessed the charts of all patients with ulcerative colitis who underwent otolaryngologic investigation in a 10-year period.Complete charts of 57 patients were available for the observation period. Reasons for head and neck investigation were transient, mild hearing loss and sporadic vertigo. Clinical and instrumental head and neck examination was unremarkable in all but one woman who complained of mild hearing loss without vertigo or tinnitus, in whom sensorineural hearing loss was diagnosed.In our series, sensorineural hearing loss was found in less than 2 % of adult patients with ulcerative colitis evaluated in a department of otolaryngology. Systematic evaluation for this extraintestinal manifestation should not be carried out unless hearing loss is present.

A Bayesian adaptive procedure for estimating the auditory-filter shape was proposed and evaluated using young, normal-hearing listeners at moderate stimulus levels. The resulting quick-auditory-filter (qAF) procedure assumed the power spectrum model of masking with the auditory-filter shape being modeled using a spectrally symmetric, two-parameter rounded-exponential (roex) function. During data collection using the qAF procedure, listeners detected the presence of a pure-tone signal presented in the spectral notch of a noise masker. Dependent on the listener's response on each trial, the posterior probability distributions of the model parameters were updated, and the resulting parameter estimates were then used to optimize the choice of stimulus parameters for the subsequent trials. Results showed that the qAF procedure gave similar parameter estimates to the traditional threshold-based procedure in many cases and was able to reasonably predict the masked signal thresholds. Additional measurements suggested that occasional failures of the qAF procedure to reliably converge could be a consequence of incorrect responses early in a qAF track. The addition of a parameter describing lapses of attention reduced the likelihood of such failures.

ObjectiveTo record envelope following responses (EFRs) to monaural amplitude-modulated broadband noise carriers in which amplitude modulation (AM) depth was slowly changed over time and to compare these objective electrophysiological measures to subjective behavioral thresholds in young normal hearing and older subjects.DesignParticipantsthree groups of subjects included a young normal-hearing group (YNH 18 to 28 years; pure-tone average = 5 dB HL), a first older group ("O1"; 41 to 62 years; pure-tone average = 19 dB HL), and a second older group ("O2"; 67 to 82 years; pure-tone average = 35 dB HL). Electrophysiology: In condition 1, the AM depth (41 Hz) of a white noise carrier, was continuously varied from 2% to 100% (5%/s). EFRs were analyzed as a function of the AM depth. In condition 2, auditory steady-state responses were recorded to fixed AM depths (100%, 75%, 50%, and 25%) at a rate of 41 Hz. Psychophysics: A 3 AFC (alternative forced choice) procedure was used to track the AM depth needed to detect AM at 41 Hz (AM detection). The minimum AM depth capable of eliciting a statistically detectable EFR was defined as the physiological AM detection threshold.ResultsAcross all ages, the fixed AM depth auditory steady-state response and swept AM EFR yielded similar response amplitudes. Statistically significant correlations (r = 0.48) were observed between behavioral and physiological AM detection thresholds. Older subjects had slightly higher (not significant) behavioral AM detection thresholds than younger subjects. AM detection thresholds did not correlate with age. All groups showed a sigmoidal EFR amplitude versus AM depth function but the shape of the function differed across groups. The O2 group reached EFR amplitude plateau levels at lower modulation depths than the normal-hearing group and had a narrower neural dynamic range. In the young normal-hearing group, the EFR phase did not differ with AM depth, whereas in the older group, EFR phase showed a consistent decrease with increasing AM depth. The degree of phase change (or phase slope) was significantly correlated to the pure-tone threshold at 4 kHz.ConclusionsEFRs can be recorded using either the swept modulation depth or the discrete AM depth techniques. Sweep recordings may provide additional valuable information at suprathreshold intensities including the plateau level, slope, and dynamic range. Older subjects had a reduced neural dynamic range compared with younger subjects suggesting that aging affects the ability of the auditory system to encode subtle differences in the depth of AM. The phase-slope differences are likely related to differences in low and high-frequency contributions to EFR. The behavioral-physiological AM depth threshold relationship was significant but likely too weak to be clinically useful in the present individual subjects who did not suffer from apparent temporal processing deficits.

When the spatial location or identity of a sound is held constant, it is not masked as effectively by competing sounds. This suggests that experience with a particular voice over time might facilitate perceptual organization in multitalker environments. The current study examines whether listeners benefit from experience with a voice only when it is the target, or also when it is a masker, using diotic presentation and a closed-set task (coordinate response measure). A reliable interaction was observed such that, in two-talker mixtures, consistency of masker or target voice over 3–7 trials significantly benefited target recognition performance, whereas in three-talker mixtures, target, but not masker, consistency was beneficial. Overall, this work suggests that voice consistency improves intelligibility, although somewhat differently when two talkers, compared to three talkers, are present, suggesting that consistent-voice information facilitates intelligibility in at least two different ways. Listeners can use a template-matching strategy to extract a known voice from a mixture when it is the target. However, consistent-voice information facilitates segregation only when two, but not three, talkers are present.

ObjectiveTo compare outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL) treated with intratympanic (IT) dexamethasone (DEX) at either 10 mg/mL or 24 mg/mL.Study designRetrospective case series.SettingTertiary referral center.PatientsThirty-seven adults with ISSNHL.InterventionsIn addition to concurrent prednisone taper, patients received a series of IT DEX injections for 2 weeks with either 10 mg/mL or 24 mg/mL.Main outcome measureGreater than 30-dB improvement in pure-tone average (PTA).ResultsBaseline characteristics were similar between groups. Mean follow-up was 10 weeks. Ten (53%) of 19 patients treated with 24 mg/mL had greater than 30-dB improvement in PTA compared with 3 (17%) of 18 treated with 10 mg/mL (p = 0.0382, Fisher's exact test). There was a trend toward improved word recognition score outcome with 24 mg/mL. The interval between onset and initiation of IT DEX significantly affected outcome, with earlier treatment resulting in greater improvement in PTA and word recognition score. Multivariate logistic regression confirmed that IT DEX dose and interval to starting treatment were both independent predictors of PTA outcome. Change in PTA was not significantly affected by age, sex, pretreatment hearing levels, or concurrent treatment with hyperbaric oxygen.ConclusionTo our knowledge, this is the first demonstration of superiority of IT DEX at 24 mg/mL for the treatment of ISSNHL, with significantly better recovery of PTA. Our data suggest that treatment should be initiated as soon as possible. A prospective randomized trial to confirm the optimal dose is warranted.

Background: External auditory canal exostoses are benign, bony overgrowths that arise in patients who experience chronic cold water exposure. While considerable advancement has been made in canalplasty techniques in recent decades, many patients continue to experience prolonged healing periods and recurrent stenosis following surgery. Objective: To perform a retrospective outcomes analysis of our experience with a skin-preserving canalplasty technique with temporoparietal fascia grafting and use of bone wax for skin flap protection. Study Design: Retrospective review. Subjects and Methods: Thirty-four patients (41 ears) underwent canalplasty from 2008 to 2014 at a tertiary referral center. Primary outcome measures included rates of prolonged healing and restenosis, need for revision surgery, and audiometric results. Rates of intraoperative and postoperative complications were also tabulated. Results: No patient experienced recurrent stenosis or required a revision surgery within the follow-up period. All but one patient (97%) achieved complete healing within 8 weeks. Minimal intraoperative complications were found. Statistically significant improvements in air pure tone averages and air-bone gaps were achieved. Conclusion: The proposed technique is a safe and effective method of canalplasty for exostoses that imparts accelerated wound healing and minimizes the rate of recurrent stenosis.

Pesquisas apontam que a audiometria tonal de altas freqüências é um instrumento de diagnóstico precoce de alterações auditivas provenientes de agentes etiológicos. OBJETIVO: Verificar possíveis diferenças na avaliação audiométrica de altas freqüências de indivíduos com audição normal em função da pessoa que posiciona o fone de ouvido. CASUÍSTICA E MÉTODO: Estudo clínico e experimental na qual participaram 55 graduandos de uma Universidade do interior paulista, com audição normal. Para cada participante, foram realizadas duas testagens: na primeira o avaliador posicionou o fone no participante e na segunda, o próprio participante o fez. Utilizou-se um audiômetro AC40 calibrado para emitir tom puro nas freqüências de 10, 12.5 e 16 khz. RESULTADOS: A análise estatística por meio do coeficiente kappa (k) verificou a concordância entre as duas formas de posicionamento do fone, tendo como critério o valor de kappa>"0,70. Os resultados obtidos para ambas as orelhas ficaram abaixo desse valor, com média de k=0,50. DISCUSSÃO: Os resultados indicaram existência de risco de comprometimento da fidedignidade da avaliação em função da pessoa que ajusta o fone ao ouvido do examinado. CONCLUSÃO: Ao realizar audiometria deve-se levar em consideração a interferência dessa variável, para obtenção de resultados fidedignos. Research considers high frequency tonal audiometry as a tool for the early diagnosis of auditory alterations derived from etiological agents. AIM: to investigate possible differences in high frequency audiometry of individuals with normal hearing, based on the person who places the earphone. PATIENTS AND METHOD: clinical and experimental study with 55 undergraduate students from a country side branch of the São Paulo State University, with normal hearing, underwent two tests each; for the first, the evaluator positioned the earphone on the participant; for the second one, the participant did it by him/herself. An AC40 audiometer calibrated to emit pure tone was used in the frequencies of 10, 12.5, and 16 kHz. RESULTS: The kappa(k) coefficient statistical analysis was used to verify the agreement between the two ways of earphone positioning of earphone, bearing a ≥0.70 kappa value as a criterion. Results attained for both ears were below this criterion, with k average of 0.50. DISCUSSION: results indicate a risk of compromising the exam reliability when the patient him/herself adjusts phone to his/her own ear. CONCLUSION: when performing audiometric assessment, this variable must be considered in order to attain reliable results.

Summary Research considers high frequency tonal audiometry as a tool for the early diagnosis of auditory alterations derived from etiological agents. Aim to investigate possible differences in high frequency audiometry of individuals with normal hearing, based on the person who places the earphone. Patients and method clinical and experimental study with 55 undergraduate students from a country side branch of the Sao Paulo State University, with normal hearing, underwent two tests each; for the first, the evaluator positioned the earphone on the participant; for the second one, the participant did it by him/herself. An AC40 audiometer calibrated to emit pure tone was used in the frequencies of 10, 12.5, and 16 kHz. Results The kappa(k) coefficient statistical analysis was used to verify the agreement between the two ways of earphone positioning of earphone, bearing a ≥0.70 kappa value as a criterion. Results attained for both ears were below this criterion, with k average of 0.50. Discussion results indicate a risk of compromising the exam reliability when the patient him/herself adjusts phone to his/her own ear. Conclusion when performing audiometric assessment, this variable must be considered in order to attain reliable results.

OBJECTIVE: To assess, in otosclerosis surgery, whether the vein or the tragal perichondrium in stapedotomy with interposition yields the better long-term hearing outcome. STUDY DESIGN: A retrospective chart review of prospectively collected audiometric data of 452 ears. SETTING: Academic tertiary otology-neurotology referral center. PATIENTS: Four hundred fifty-two stapedotomies with interposition were performed in 412 patients (bilateral in 40 patients) by the senior author (R.C.) between 1987 and 1998. A tragal perichondrium graft was used in 314 cases and a vein graft was used in 138 cases as sealing material of the oval window. MAIN OUTCOME MEASURES: Audiometric data were recorded at 4 months, at 1 year, and at 3 years after surgery after American Academy of Otolaryngology-Head and Neck Surgery guidelines, except for thresholds at 3 kHz, which were not available and which were replaced with those at 4 kHz. RESULTS: There were no significant intergroup differences in initial or late postoperative hearing outcome with regard to change in the pure-tone average bone conduction and air-bone gaps, or sensorineural hearing loss. Ears treated with a vein graft showed statistically better postoperative 2-kHz air-bone gap closure (p =0.0157), but the pure-tone average air-bone gap difference was not significant. Postoperative air-bone gap closure to within 10 dB was achieved in 91% of cases in the vein group and in 76% of cases in the perichondrium group. Specific study of the bone conduction level at 4 kHz showed a sensorineural hearing loss greater than 10 dB in 8% of cases in the vein group and in 11% of cases in the perichondrium group. One case of complete sensorineural hearing loss was observed with a tragal perichondrium graft (0.22%). CONCLUSION: These results suggest that the vein should be preferred to the tragal perichondrium in stapedotomy with interposition.

Bush-crickets (Orthoptera: Tettigoniidae) generate sound using tegminal stridulation. Signalling effectiveness is affected by the widely varying acoustic parameters of temporal pattern, frequency and spectral purity (tonality). During stridulation, frequency multiplication occurs as a scraper on one wing scrapes across a file of sclerotized teeth on the other. The frequency with which these tooth–scraper interactions occur, along with radiating wing cell resonant properties, dictates both frequency and tonality in the call. Bush-cricket species produce calls ranging from resonant, tonal calls through to non-resonant, broadband signals. The differences are believed to result from differences in file tooth arrangement and wing radiators, but a systematic test of the structural causes of broadband or tonal calls is lacking. Using phylogenetically controlled structural equation models, we show that parameters of file tooth density and file length are the best-fitting predictors of tonality across 40 bush-cricket species. Features of file morphology constrain the production of spectrally pure signals, but systematic distribution of teeth alone does not explain pure-tone sound production in this family.

Background: Some experimental and human data suggest that exposure to polychlorinated biphenyls (PCBs) may induce ototoxicity, though results of previous epidemiologic studies are mixed and generally focus on either prenatal or postnatal PCB concentrations exclusively. Objectives: Our aim was to evaluate the association between pre- and postnatal PCB concentrations in relation to cochlear status, assessed by distortion product otoacoustic emissions (DPOAEs), and to further clarify the critical periods in development where cochlear status may be most susceptible to PCBs. Methods: A total of 351 children from a birth cohort in eastern Slovakia underwent otoacoustic testing at 45 months of age. Maternal pregnancy, cord, and child 6-, 16-, and 45-month blood samples were collected and analyzed for PCB concentrations. At 45 months of age, DPOAEs were assessed at 11 frequencies in both ears. Multivariate, generalized linear models were used to estimate the associations between PCB concentrations at different ages and DPOAEs, adjusting for potential confounders. Results: Maternal and cord PCB-153 concentrations were not associated with DPOAEs at 45 months. Higher postnatal PCB concentrations at 6-, 16-, and 45-months of age were associated with lower (poorer) DPOAE amplitudes. When all postnatal PCB exposures were considered as an area-under-the-curve metric, an increase in PCB-153 concentration from the 25th to the 75th percentile was associated with a 1.6-dB SPL (sound pressure level) decrease in DPOAE amplitude (95% CI: –2.6, –0.5; p = 0.003). Conclusions: In this study, postnatal rather than maternal or cord PCB concentrations were associated with poorer performance on otoacoustic tests at age 45 months. Citation: Jusko TA, Sisto R, Iosif AM, Moleti A, Wimmerová S, Lancz K, Tihányi J, Šovčíková E, Drobná B, Palkovičová L, Jurečková D, Thevenet-Morrison K, Verner MA, Sonneborn D, Hertz-Picciotto I, Trnovec T. 2014. Prenatal and postnatal serum PCB concentrations and cochlear function in children at 45 months of age. Environ Health Perspect 122:1246–1252; http://dx.doi.org/10.1289/ehp.1307473

Cochlear Implant (CI) users typically perform poorly on musical tasks, especially those based on pitch ranking and melody recognition. It was hypothesized that CI users would demonstrate deterioration in performance for a pitch ranking and a melody recognition task presented with iterated rippled noise (IRN) in comparison to pure tones (PT). In Addition, it was hypothesized that normal hearing (NH) listeners would show fewer differences in performance between IRN and PT for these two tasks. In this study, the ability of CI users and NH subjects to rank pitches and to identify melodies created with IRN and PT was assessed in free field in a sound-isolated room. CI subjects scored significantly above chance level with PT stimuli in both tasks. With IRN stimuli their performance was around chance level. NH subjects scored significantly above chance level in both tasks and with all stimuli. NH subjects performed significantly better than CI subjects in both tasks. These results illustrate the difficulties of CI subjects to rank pitches and to identify melodies.

Objective: To determine postoperative hearing outcomes after surgical plugging via middle cranial fossa approach for superior semicircular canal dehiscence syndrome (SCDS). Study Design: Clinical review. Setting: Tertiary care medical center. Patients: Forty-three cases of SCDS based on history, physical examination, vestibular function testing, and computed tomography imaging confirming the presence of a dehiscence. All patients underwent surgical plugging of the superior semicircular canal via middle cranial fossa approach. Intervention: Pure tone audiometry was performed preoperatively and at 7 days and at least 1 month postoperatively. Main Outcome Measures: Change in air-bone gap (ABG) and pure tone average (PTA). Results: Preoperative average ABG across 0.25, 0.5, 1, and 2 kHz was 16.0 dB (standard deviation [SD], 7.5 dB). At 7 days postoperatively, average ABG was 16.5 dB (SD, 11.1; p = 0.42), and at greater than 1 month was 8.1 dB (SD, 8.4; p G 0.001). 53% (95% confidence interval, 33Y69) of affected ears had greater than 10 dB increase in their 4-frequency (0.5, 1, 2, and 4 kHz) PTA measured by bone-conduction (BC) threshold 7 days postoperatively and 25% (95% confidence interval, 8Y39) at greater than 1 month postoperatively. Mean BC PTA of affected ears was 8.4 dB hearing loss (HL) (SD, 10.4) preoperatively. Compared with baseline, this declined to 19.2 dB HL (SD, 12.6; p G 0.001) at 7 days postoperatively and 16.4 dB HL (SD, 18.8; p = 0.01) at greater than 1 month. No significant differences in speech discrimination score were noted (F = 0.17). Conclusion: Low-frequency air-bone gap decreases after surgical plugging and seems to be due to both increased BC thresholds and decreased AC thresholds. Surgical plugging via a middle cranial fossa approach in SCDS is associated with mild high-frequency sensorineural hearing loss that persists in 25% but no change in speech discrimination. Key Words: Hearing outcomesVMiddle cranial fossaVSuperior semicircular canal dehiscence. Otol Neurotol 33:1386Y1391, 2012.

The excellent tolerability of intratympanic (IT) steroid offers the possibility to use a high dose, which would appear to be more effective than intravenous (IV) steroid treatment, when both are associated with hyperbaric oxygen (HBO) therapy.The purpose of the study was to assess for the first time the efficacy of the association of IT steroid and HBO therapy in patients presenting idiopathic sudden sensorineural hearing loss (ISSNHL), comparing this protocol with another consisting of IV steroid administration and HBO therapy.A total of 48 patients presenting ISSNHL were recruited. Patients were divided into two categories: the severe ISSNHL group with a pure-tone average (PTA) between 70 and 90 dB, and the profound ISSNHL group with a PTA90 dB. The first protocol consisted of 10 days of HBO therapy together with IV methylprednisolone 1 mg/kg body weight for 7 days; the second protocol consisted of HBO therapy for 10 days, associated with an IT injection of prednisolone at a dose of 62.5 mg/ml, once a day for 3 consecutive days, performed 2 h before the HBO therapy.The overall success rate was superior in the group submitted to IT steroid and HBO therapy. Nevertheless, these clinical results were not statistically significant.

CONCLUSION: Our results indicate that repeated treatment courses with tobramycin 10 mg/kg (twice daily for 3 weeks) may be safely applied in cystic fibrosis (CF) patients with respect to ototoxicity. The risk of hearing loss in this patient group is less than expected, which could be explained by either unfavourable baseline audiometry or the use of unidentified protective medication, or both. However, due to large inter-individual variations, audiometry screening remains important with respect to the detection of individual outliers.OBJECTIVES: Tobramycin is frequently prescribed for CF patients. In this study, hearing loss due to cumulative tobramycin exposure in adult CF patients was investigated.PATIENTS AND METHODS: We retrospectively investigated 19 patients with both baseline and follow-up audiometry before and after repeated courses of intravenous tobramycin (10 mg/kg/day in twice daily administrations for 3 weeks). Pure tone audiometry was performed at 0.250-16 kHz.RESULTS: After repeated courses of tobramycin (median 3, range 1-8), the mean increase per frequency was 2.1 dB (median 0.5 dB, SD 12.6) with large (inter-individual) variations (range -23.5 to 34.5 dB). The pure tone averages (PTA) at 1-2-4 kHz and 8-10-12 kHz increased 1.4 dBHL and 2.3 dBHL, respectively, but were neither statistically significant, nor correlated with the cumulative tobramycin exposure.

Objectives To compare tinnitus patients who have normal hearing between 250 Hz and 8 kHz with normal controls with regard to the ability of each group to hear extended high-frequency pure tone thresholds. Methods We enrolled 18 tinnitus patients, each of whom had a threshold of HL

Auditory deficiencies have profound implications for the development of communication abilities, social exchange, and cognitive skills. Although advances in technological instrumentation have decreased the age at which it is possible to detect auditory deficits, an absence of electrophysiological or behavioral reaction to sound does not always reflect hypoacusis. The objective of this study was to evaluate the evolution of audition in a group of children referred for therapy to the CINDA Foundation (Center for Research and Information in Auditory Deficiencies) in Bogota, Colombia, with an initial diagnosis of severe to profound sensorineural hearing loss. We evaluated 25 patients younger than 2.5 years of age with a protocol which included auditory evoked potentials, behavioral responses (tonal audiometry-responses to voice and startle) and language observation. After evaluation, the children began a program of auditory stimulation with audiological follow-up for a period of 6 months to 1 year. The audiological follow-up of the children after auditory stimulation showed significant improvements in both electrophysiological and behavioral indices of their hearing levels (p less than .001, one-tailed Wilcoxon exact test). We found a high percentage of children in early stages of auditory maturation with a false diagnosis of hypoacusis (32%). The absence of response may result from compromised auditory reception or processing. Thus, delayed maturation of the auditory pathway should be considered in the differential diagnosis of young children with sensorineural hearing loss. © 2007 Elsevier Ireland Ltd. All rights reserved.

Theoretical considerations and experimental evidence suggest that otoacoustic emission parameters may be used to reveal early cochlear damage, even before it can be diagnosed by standard audiometric techniques. In this work, the statistical distributions of a set of otoacoustic emission parameters chosen as candidates for the early detection of cochlear damage (global and band reproducibility, response level, signal-to-noise ratio, spectral latency, and long-lasting otoacoustic emission presence) were analyzed in a population of 138 ears. These ears have been divided, according to a standard audiometric test, in three classes: (1) ears of nonexposed bilaterally normal subjects, (2) normal ears of subjects with unilateral noise-induced high-frequency hearing loss, and (3) their hearing impaired ears. For all analyzed parameters, a statistically significant difference was found between classes 1 and 2. This difference largely exceeds the difference observed between classes 2 and 3. This fact suggests that the noise exposure, which was responsible for the unilateral hearing loss, also caused subclinical damage in the contralateral, audiometrically normal, ear. This is a clear indication that otoacoustic emission techniques may be able to early detect subclinical damages.

Meniere's disease is a clinical disorder, characterized by fluctuating hearing loss, recurrent spontaneous episodic vertigo, tinnitus and aural fullness, which may be defined as the idiopathic syndrome of endolymphatic hydrops. The most important test for diagnosis of Meniere's disease is the glycerol test. This is a simple and rapid method and several authors have confirmed its efficiency for identifying endolymphatic hydrops. This test provides information on the cochlear response to the osmotic changes produced by glycerol in the inner ear, whereas modifications in the vestibular labyrinth are usually not evaluated. The aim of this study was to evaluate the effects of glycerol on postural control during attacks of Meniere's disease, and to correlate this data with data on cochlear function. After the glycerol test, an improvement in postural control was recorded in 70% of patients, with all patients reporting a recovery of vertigo. The impairment of postural control during endolymphatic hydrops could be related to a pressure increase in the labyrinth, which interferes with the normal dynamics of the endolymph, and a rapid functional recovery could occur during an osmotic depletion. Dynamic posturography improves the sensitivity of the glycerol test and may therefore be useful in the diagnosis and staging of Meniere's disease.

Aim: Sudden sensorineural hearing loss is a condition of emergency in Otolaryngology. Although there is no universally accepted treatment protocol, corticosteroids, intravenous and oral, are the most common treatment The purpose of this study is to evaluate the efficacy of intratympanic administration of dexamethasone as first line therapy, or as a rescue therapy after treatment with systemic steroids in patients not responders. Methods: The population, consisting of 85 patients referred to our unit from January 2010 to December 2013, was divided into two groups according to the treatment protocol performed. We also analyzed possible variables that may affect the response to treatment such as age, smoking, and therapeutic delay. Results: Age and smoking did not exert any kind of influence on the response to treatment, unlike the therapeutic delay. In fact, patients treated within one week after the onset of the deafness, achieved an improvement of threshold for all frequencies tested. The group of patients treated with intratympanic injection as single therapy shows an improvement of the auditory threshold for all frequencies tested, but, in any event, is not statistically significant Conclusion: The exclusive use of desametasone by intratympanic has demonstrated effective. In addition, its use after the systemic steroid therapy changes the prognosis of patients improving their hearing threshold. Therefore, the infiltration of intratympanic corticosteroids is effective both as a first-line treatment and as salvage.