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Recently surgical implantation of devices to stimulate the auditory nerve in man makes it apparent that sensory and neural pathologies of deafness need to be differentiated from each other. In this paper 10 exemplary cases are presented. In addition, an attempt is made to compile the information now available about sensory and neural pathologies in the various diseases that cause deafness. Superficially, it would appear that most such entities are sensory in nature and thus theoretically might be amenable to auditory nerve stimulation. However, loss of supporting cells seems to be associated with cochlear nerve fibre degeneration. Many individuals may, therefore, eventually develop combined pathology. The paucity of knowledge of pathology of the auditory pathways and their radiations in deaf persons is recognized as a limiting factor in attempts to predict which patients might benefit from auditory nerve stimulation. It is not within the scope of this paper to delineate the possible deleterious effects that cochlear implants might have on the auditory nerve.

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Objective: The aim of this study is to identify the otologic injuries due to handmade explosive-welded blast travma in the law enforcement officers during the combat operations in the curfew security region and to specify the disorders that Otolaryngology and Head Neck Surgery (OHNS) physicians can face during such operations. Methods: Medical records of patients in law enforcement who were initially treated by OHNS physicians of Silopi State Hospital during combat operations, between December 14, 2015 and January 15, 2016 were reviewed. Twenty-five patients with otologic injuries due to blast trauma were included in the study. Trauma characteristics, physical examination findings, and beginning treatments were identified. Results: Primary blast injury (PBI) was identified as the major disorder in all 24 cases. Tinnitus and hearing loss were the most frequent complaints. In physical examination, tympanic membrane perforations were found in four ears of three patients. Oral methylprednisolone in decreasing doses for 10 days was commenced as an initial treatment in patients with PBI. Secondary blast injury presented in the form of soft tissue damage in the auricular helix due to shrapnel pieces in one patient and a minor surgery was performed. Conclusion: Otologic injuries due to blast trauma may often develop during this type of combat operations. Otologic symptoms should be checked, otoscopic examination should be performed, and patients should consult OHNS physicians as soon as possible after trauma. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 35-year-old male patient that was diagnosed with cotton swab injury-related subacute deafness.

Objectives: The purpose of this study was to determine the various etiologies of traumatic tympanic membrane (TM) perforations; their clinical presentation, observation and establish masterly inactivity as the main modality of management. Materials and Methods: A prospective study was performed on 350 cases of traumatic TM perforation in the Department of ENT, SKIMS Medical College, Srinagar from January 2010 to December 2014. Results: A total of 350 patients with the traumatic TM. Perforation was enrolled for this study. The group consisted of 231 male and 119 female patients. It affects all age groups with the highest incidence among middle age group. The right ear was involved in 94 (26.85%) patients, the left ear in 249 (71.14%) patients and bilateral ear involvement was seen in 7 (2%) patients. The type of trauma included compression injury in 243 (64.42%) patients, instrumental injury in 88 (25.14%) patients, and blast injury in 19 (5.42%) patients. Tinnitus was the most common complaint, followed by aural fullness, impaired hearing, otalgia, bleeding from ear and vertigo. 217 (62%) patients presented with conductive hearing loss in the range of 20-35 dB, 77 (22%) patients with <20 dB, 28 (8%) patients presented with >35 dB hearing loss, and 28 (8%) patients presented with no air‑bone gap. Grade I perforation (<25% TM involvement) was seen in 91 (26%) patients, Grade II perforation (25-50% TM involvement) was seen in 221 (63.14%) patient, and Grade III perforation (>50% TM involvement) was present in 38 (10.90%) patients. Complete healing was observed within 2-6 weeks in 172 (49.10%) patients and within 7-9 weeks in 112 (32.20%) patients. 35 (10%) patients showed complete healing within 10-12 weeks. The minimum time taken to heal was 21 days and maximum time 72 days. Complete healing was observed in 319 (91.10%) patients. The intervention was only performed when spontaneous healing failed to occur after observing the patients for 1 week and included tympanoplasty in 8 (2.30%) patients, trichloroacetic acid cauterization in 14 (4%) patients. Residual perforation was observed in 9 (2.5%) patients. Conclusion: In our experience, traumatic TM perforation is still very common. Slap, instrumentation, road traffic accident, and blast injuries are common etiologies seen. It affects all age groups. Tinnitus and hearing loss are commonest symptoms. The masterly inactivity should be religiously followed and unnecessary surgical intervention should be discouraged. [ABSTRACT FROM AUTHOR]

Objective: Aural fullness in Ménière's disease and the predisposing and consequential factors were investigated and possible consequences of aural fullness on participation activity were explored. Methods: 726 subjects of the Finnish Ménière Association replied to a questionnaire focusing on symptoms of Ménière's disease, sense of coherence, attitude, participation restriction, and general health-related quality of life (EQ-5D). In the analysis, the severity of the disease was controlled. Results: 68% of the subjects had aural fullness and in 37% it was moderate or strong. Aural fullness was rated as the worst problem by 4.4% of the subjects. Females reported more aural fullness than males. Tinnitus, hyperacusis and balance problems were significant predictors of aural fullness. Aural fullness was associated with reduced quality of life and complaints such as vertigo attacks, balance problems and hearing loss. Analysis based on participation restriction indicated that severe aural fullness leads to social isolation. Conclusions: Largely, psychological factors and personal traits modify problems experienced by aural fullness. Relaxation was the only statistically significant method that alleviated aural fullness. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Direct ear trauma through external auditory canal causing an avulsion injury of malleoincudal complex is a grievous injury that can happen during ear cleaning with indigenous ear hook. One such case of avulsion injury is presented here with its symptomatology, investigation, and management with the review of available literature because of its rarity. Various locally designed indigenous ear hooks are available in street side markets and even online for purchase and used by many without knowing its ill effects on health. Injury caused by these types of hooks may lead to a severe hearing disability, if not properly treated. This presentation is to highlight the fact that indigenous ear hooks; rampantly available online for purchase can cause a potentially major injury leading to hearing disability and thereafter poor quality of life. Reporting and highlighting of such incidents among the ENT community can help increase the public awareness; thereby, eliminating such disastrous consequences. Wikipedia, PubMed, and Google search engine has been used for our data collection and analysis. [ABSTRACT FROM AUTHOR]

A hearing aid using cartilage conduction (CC) has been proposed as an alternative to bone conduction (BC) hearing aids. The transducer developed for this application is lightweight, requires a much smaller fixation force than a BC hearing aid, and is more convenient to use. CC can be of great benefit to patients with fibrotic aural atresia. Fibrotic tissue connected to the ossicles provides an additional pathway (termed fibrotic tissue pathway) for sound to reach the cochlea by means of CC. To address the function of fibrotic tissue pathway, BC and CC thresholds were measured in six ears with fibrotic aural atresia. The relationship between the CC thresholds and the results of computed tomography was investigated. In the ears with the presence of a fibrotic tissue pathway, the CC thresholds were lower than the BC thresholds at 0.5 and 1.0 kHz. At 2.0 kHz, no significant difference was observed between the BC and CC thresholds. The current findings suggest that sound in the low to middle frequency range is transmitted more efficiently by CC via a fibrotic tissue pathway than BC. The development of hearing devices using CC can contribute to rehabilitation, particularly in patients with fibrotic aural atresia. [ABSTRACT FROM AUTHOR]

Objective: Hair cell death caused by acute acoustic trauma (AAT) reaches a secondary maximum at 7-10 days after noise exposure due to a second oxidative stress. Therefore, this study tested the effects of a combination of hydroxylated alpha-phenyl-tert-butylnitrone (4-OHPBN), N-acetyl-L-cysteine (NAC) and acetyl-L-carnitine (ALCAR) on AAT when the duration of treatment was extended over the period of 7-10 days after noise exposure as well as when the initial treatment was delayed 24 to 48 h after noise exposure. Methods: Thirty chinchilla were exposed to a 105 dB octave-band noise centred at 4 kHz for 6 h and received the following treatments: (1) noise ++ saline (2-5) 4-OHPBN (20 mg/kg) ++ NAC (50 mg/kg) ++ ALCAR (20 mg/kg) intraperitoneally injected beginning 24 or 48 h after noise exposure twice daily for the next 2, 8 or 9 days. Auditory brainstem response (ABR) threshold shifts, outer hair cell (OHC) counts and organ of Corti immunohistochemistry were analyzed. Results: The combination administration decreased ABR threshold shifts, inhibited OHC loss and reduced 4-hydroxynonenal (4-HNE) immunostaining. Significant decreases in the threshold shifts and reduction in OHC loss were observed with a shorter delay before starting treatment (24 h) and longer duration (9 days) treatment. Conclusions: These results demonstrate that the administration of antioxidant drugs extended up to 10 days after noise exposure can effectively treat AAT in a chinchilla model. This may provide significant and potentially clinically important information about the effective therapeutic window for AAT treatment. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to review our experience with cochlear implants in profound hearing loss following bilateral inner ear fractures. Methods: A retrospective study of patients treated at King Abdulaziz University Hospital was conducted. Results: Six ears in five patients with profound hearing loss following bilateral temporal bone fractures who underwent cochlear implantation were reviewed. All patients had an uneventful recovery, and none of them experienced facial nerve stimulation. All patients became regular users of their implants, although one of them underwent bilateral implantation to maximize benefit. Conclusions: Cochlear implants should be considered for patients with profound hearing loss following bilateral inner ear fracture. We recommend bilateral cochlear implants for patients with bilateral inner ear fractures to maximize their benefit from cochlear implantation. [ABSTRACT FROM AUTHOR]

Hearing loss from acoustic trauma is a risk factor for tinnitus. Animal models using acoustic trauma have demonstrated hyperactivity in central auditory pathways, which has been suggested as a substrate for tinnitus. We used a guinea-pig model of unilateral acoustic trauma. Within the same animals, measurements of peripheral hearing loss, spontaneous activity of single neurons in the inferior colliculus and gene expression in cochlear nucleus and inferior colliculus were combined, acutely and after recovery from acoustic trauma. Genes investigated related to inhibitory (GABA-A receptor subunit alpha 1; glycine receptor subunit alpha 1) and excitatory neurotransmission (glutamate decarboxylase 1; glutamate receptor AMPA subunit alpha 2; glutamate receptor NMDA subunit 1), regulation of transmitter release (member of RAB family of small GTPase; RAB3 GTPase activating protein subunit 1) and neuronal excitability (potassium channel subfamily K member 15). Acoustic trauma resulted in unilateral hearing loss and hyperactivity bilaterally in inferior colliculus. Changes in expression of different mRNAs were observed in ipsilateral cochlear nucleus and in ipsi- and contralateral inferior colliculus, immediately after acoustic trauma, and after 2 and 4 weeks’ recovery. Gene expression was generally reduced immediately after trauma, followed by a return to near normal levels or over-expression as recovery time increased. Different mechanisms appear to underlie the spontaneous hyperactivity observed. There is evidence of down-regulation of genes associated with neuronal inhibition in the contralateral inferior colliculus, whereas in ipsilateral cochlear nucleus, competing actions of inhibitory and excitatory systems seem to play a major role in determining overall excitability. [ABSTRACT FROM AUTHOR]

Abstract: Thresholds of auditory brainstem responses (ABRs) are widely used to estimate the level of noise-induced hearing loss or the level of acquired resistance to acoustic trauma after repeated exposures, i.e., the “toughening” effect. Less is known about ABR latencies and their relation to threshold changes. Guinea pigs were exposed to a traumatic pure tone at 5 kHz, 120 dB SPL, as either single (2 h, 4 h) or repeated (1 h every 48 h, four times) sessions. Thresholds and latencies of ABRs were monitored up to 45 days following the acoustic trauma. We show that latencies are prolonged in the case of large temporary threshold shifts observed in the days following trauma. The latency shift decreases after several repeated exposures, then stabilizes, similar to thresholds, suggesting that the “toughening” effect also applies to latencies. Permanent latency shift is usually very small compared to the permanent threshold shift. This effect could produce a recovery in the ability to process auditory information through the precise timing of neuronal events. Our study indicates that when estimated at suprathreshold stimulation level (70 dB SPL), latency provides complementary information to the sole threshold. [Copyright &y& Elsevier]

Conclusions. The present findings show that magnesium administration can significantly reduce threshold shift 7 days after gunshot noise exposure. However, this improvement seems to be temporary, suggesting a probable advantage in prolonging the treatment. Objective. To evaluate the therapeutic efficacy of magnesium administration after hearing loss induced by gunshot noise. Material and methods. Forty-eight guinea pigs were exposed to an impulse noise (blank shot from a rifle; 170 or 176 dB SPL peak). The therapeutic efficacy of magnesium was evaluated by administering either the treatment or a placebo to the traumatized animals for 7 days, beginning 1 h after the trauma. Auditory function was explored for up to 14 days of recovery by recording the compound action potential in the round window. The functional study of hearing was supplemented by histological analysis. Results. The threshold shifts of the 170-dB SPL group that received magnesium were significantly lower than those of controls after 2 and 7 days of recovery, but no significant difference was evidenced at 14 days in this group, nor at any time in the 176-dB SPL group. Animals treated with magnesium after the 176-dB SPL exposure had a significant reduction in hair cell loss in the basal region. [ABSTRACT FROM AUTHOR]

Electrically evoked otoacoustic emissions (EEOAEs) are sounds measured in the ear canal when alternating current (AC) stimulation is passed into the cochlea. These sounds are attributed to the motile responses of outer hair cells (OHCs). The EEOAE has characteristic amplitude, phase, and fine structure. Multicomponent analysis of the EEOAE shows short (SDC) and long delay components (LDC) that are thought to originate from OHCs near the AC stimulating site and from OHCs at more remote locations, respectively. We measured the effects of various loud noise exposures on the EEOAE and the cochlear whole-nerve action potential (CAP) in animals chronically implanted with a scala tympani electrode. Noise exposures that produced permanent (PTS) or temporary threshold shifts (TTS) were associated with frequency-specific changes in CAP thresholds, EEOAE fine structure, and reductions in the amplitude of the LDC. A frequent observation in this study was an increase in the overall EEOAE amplitude after the noise exposure. The increase was correlated with increased SDC amplitude. The SDC was present in animals chemically treated with ototoxic drugs and mechanical damage to the cochlea. The SDC was eliminated after disarticulation of the ossicular chain. The presence of EEOAE fine structure in the postexposure response is an indicator of TTS in advance of CAP recovery. The results suggest that the EEOAE might be used to differentiate the mechanisms associated with TTS and PTS. [ABSTRACT FROM AUTHOR]

Objective Although the mutation in the Gap Junction Beta 2-encoding gap junction protein connexin 26 (Cx26) has been related to hereditary non-syndromic deafness and maturation of cochlear development, the physiological role of Cx26 in the cochlear lateral wall remains unclear. It has been suggested to be responsible for the recycling of K + in the endolymph and for maintenance of the endocochlear potential (EP). In noise-induced hearing loss, alterations in the EP and the K + concentration in endolymph have been observed. Thus Cx26, which is widely expressed in the cochlear lateral wall, may play a role in the mechanism of acoustic trauma. Material and Methods We used a rat model of noise-induced hearing impairment to detect changes in Cx26 expression in the cochlear lateral wall. By means of immunofluorescent staining and Western blotting, we investigated whether Cx26 was involved in the pathophysiological mechanism of acoustic trauma. Results The results indicated that abundant Cx26 protein was found on fibrocytes of the spiral ligament in the cochlear lateral wall. Protein extract of cochlear lateral wall expressed Cx26 with a molecular weight of ≈21 kDa. After noise exposure, with an increasing threshold of the auditory brainstem response (ABR) of ≈54.2±21.8 dB SPL, the expression of Cx26 protein increased significantly ( p <0.05) as revealed by semi-quantitative analysis from Western blotting. Conclusion Cx26 protein was present in the cochlear lateral wall of rats and was upregulated when the ABR threshold shifted after intense noise exposure. Cx26 protein was involved in the pathogenesis of acoustic trauma. [ABSTRACT FROM AUTHOR]

We induced acoustic trauma by applying click stimuli of 130 dB (SPL) for 30 min to one ear of adult rats. This treatment resulted in an instant and permanent threshold shift of 96 dB in the affected ear. A massive reduction of cochlear nerve fibers in the ventral cochlear nucleus (VCN) was demonstrated by tracing them from the cochlea of rats that survived acoustic overstimulation for 1 year or longer. In the auditory brainstem, we observed a deprivation-dependent appearance of fibers positive for tyrosine receptor kinase B in the ipsilateral VCN between day 3 and day 21 after trauma and an increase in phosphoserine immunostaining in the neuropil of the ipsilateral VCN and in neurons of the contralateral lateral superior olive during the first 30 days after trauma. Immunoreactivity for the cAMP response element binding protein in its phosphorylated form was transiently depressed in the ipsilateral inferior colliculus immediately after trauma and was elevated as late as 7 months after trauma in the ipsilateral VCN. Apparently, a unilateral acoustic overstimulation entails specific regulations of the activity of plasticity-associated molecules through phosphorylation and includes changes to neurotrophin signaling between neurons of the auditory brainstem.Copyright © 2003 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

While occupational noise is tightly regulated by various noise protection programs, some kinds of leisure noise have been poorly addressed. The aim of this study was to estimate prospectively the incidence of blast and explosion trauma due to the use of New Year's firecrackers in a western industrialized society. The results are based on 562 centers in Germany, including the otorhinolaryngology departments of 31 university hospitals and of 87 city hospitals as well as a random sample of specialized otorhinolaryngology private practices (n=444). After extrapolation of the number of reported cases to the number of hospitals and practices on duty, a total of 8,160 cases (95% confidence interval 7,515–8,805) was estimated giving an incidence of 9.9 per 100,000 inhabitants. There were three times as many men affected as woman. The incidence for the age group of 6 to 25 years was much higher: 28 per 100,000 with a maximum of 107 per 100,000 for 19-year-old men. These incidences suggest that firecrackers may pose a momentous public health risk. Because of the medical and economic importance of incurable sensorineural hearing loss, it is the task of public health services to promote the effective prevention of irreversible damage to the hearing organ. [ABSTRACT FROM AUTHOR]

Abstract: Background: Many ENT injuries are not recognized easily, but they have the potential of increasing the morbidity. Methods: ENT injuries managed in two tertiary care Level-IV hospitals between 2006 and 2007 were studied with a view to formulate strategy in efficient management of these cases. Result: Emergency bags did not carry readymade packs to control nasal bleeds. Routinely screening of ears in all blast injury cases in the ‘Blast Injury Program’ helped in early identification of hearing loss. Lack of sufficient stenting of nasal cavities resulted in severe nasal stenosis which was difficult to repair. Splinters lodged in pharyngeal wall escaped detection, resulting in concealed haemorrhage and shock. Conclusion: Nasal packs and epistaxis catheters must be included in emergency bags to minimize blood loss at first contact. Screening for ear trauma in all blast injuries increases detection rate and is beneficial to the soldier. Stenting of injured nasal cavities and early transfer to a tertiary care hospital could reduce morbidity. Plain radiography of head and neck areas could help detect splinters in vital areas and guide management. [Copyright &y& Elsevier]

Three uncommon cases of ear trauma caused by a yucca plant leaf spine are presented. One patient presented with tympanic perforation and the second with mixed hearing loss after spontaneous closure. The third patient probably had a perilymphatic fistula with subsequent labyrinthitis and hearing loss. Although the yucca is a ubiquitous plant, to the best of our knowledge, such incidents have not been previously reported. [ABSTRACT FROM AUTHOR]

This section presents a reprint of the article "Harmful Noise," by J. J. A. Blakely, which appeared in a 1956 issue of the journal "Occupational Medicine." The article highlights the claims for loss of hearing due to acoustic trauma in the U.S. It reminds that very loud noise can cause permanent ear damage such as deafness. It also notes the duty of industrial medical officers in addressing the impact of industrial noise.