Triple semicircular canal occlusion with endolymphatic sac decompression for intractable Meniere's disease.

Background: Meniere's disease (MD) is characterized by idiopathic endolymphatic hydrops (ELH). Frequent vertigo attacks is the most disabling symptom of MD. Objective: This study evaluated the efficacy of triple semicircular canal occlusion combined with endolymphatic sac decompression in the treatment of frequent vertigo in patients with MD. Methods: Eleven patients with complete medical records were included in this study conducted from May 2021 to April 2022. All patients were enrolled to undergo triple semicircular canal occlusion (TSCO) with endolymphatic sac decompression (ESD). Various tests including pure tone audiometry (PTA), vestibular evoked myogenic potentials (VEMPs), the video head impulse test (v-HIT), caloric test data, the Dizziness Handicap Inventory (DHI), the Berg Balance Scale (BBS), and the Tinnitus Handicap Inventory (THI) were performed both before and after the surgery. Results: The successful control rate of vertigo was 100% (9/9) in the average 23-month postoperative follow-up period, with complete control rate of 88.89% (8/9) and substantial control rate of 11.11% (1/9). Conclusion: Triple semicircular canal occlusion combined with ESD may be an effective treatment option for managing frequent vertigo attacks in patients with MD. This combination therapy has the potential to become a significant addition to the treatment framework for MD.

The Impact of Sleep Quality on Cognitive Function in Patients with Chronic Subjective Tinnitus.

BACKGROUND: The aim of this study was to explore the impact of sleep quality on cognitive function in patients with chronic subjective tinnitus. METHODS: The Pittsburgh Sleep Quality Index (PSQI) and the Montreal Cognitive Assessment Scale (MoCA) were used to assess sleep quality and cognitive function in patients with chronic subjective tinnitus, sleep disorder patients (SD), and normal controls (NC). The tinnitus evaluation questionnaire (TEQ) and tinnitus loudness were used to assess the severity in patients with chronic subjective tinnitus. Tinnitus patients were divided into two groups based on PSQI results: "tinnitus with sleep disorder (TwSD)" and "tinnitus without sleep disorder (TnSD)." The MoCA scores in TwSD and TnSD groups were compared with those in SD and NC groups, and the correlation between PSQI, TEQ, tinnitus loudness, and MoCA scores in subjective tinnitus patients were analyzed. RESULTS: Whether TwSD group or TnSD group, the MoCA score was significantly lower than those in the NC group and SD group. Meanwhile, there was no significant difference between TwSD and TnSD groups in MoCA score, and PSQI, TEQ, and tinnitus loudness were not significantly correlated with MoCA. CONCLUSION: Subjective tinnitus may be an independent risk factor for cognitive impairment. The underlying neural mechanisms between subjective tinnitus, sleep disorders, and cognitive impairment need to be further explored and clarified.

Personality Traits and Tinnitus Distress: Results Based on Patients with Tinnitus in China.

Background: Due to the socio-cultural differences between China and other countries, which may affect the development of an individual's personality and behavior, it is necessary to explore the relationship between personality traits and tinnitus distress in the context of China's socio-cultural background. Methods: The Tinnitus Handicap Inventory and the Eysenck Personality Questionnaire Short Scale Chinese version were used to explore the influence of personality traits on tinnitus distress in Chinese patients with tinnitus. Results: The results were not entirely consistent with previous studies from other countries. First, extroversion was significantly higher in patients with bothersome tinnitus, both in acute and chronic conditions. Second, the personality traits that affected the patients with bothersome tinnitus were different in different conditions. Finally, the tridimensional personality structure, high psychoticism / normal extroversion / normal neuroticism, was significantly higher in people with bothersome tinnitus. Furthermore, the difference became more obvious with a prolonged disease course. Conclusions: This study suggested that the relationship between personality traits and tinnitus distress in Chinese patients with tinnitus was not the same as in other countries. "High psychoticism / normal extroversion / normal neuroticism" may be a risk factor for chronic bothersome tinnitus in China.

Analysis of the Efficacy and Safety of Intratymapanic Dexamethasone for Treating Meniere's Disease: A Randomized Controlled Trial.

OBJECTIVES: Our objective was to study the efficacy and safety of intratymapanic dexamethasone (ITD) for treating in Méniere's disease in southern China. METHODS: A total of 124 patients with Méniere's disease were randomly divided into 2 groups: ITD group (n = 62) and intratympanic lidocaine (ITL) group (n = 62). The ITD group was further randomly divided into 2 groups based on dexamethasone dosage: ITD1 (2 mg/ml) (n = 31) and ITD2 (5 mg/ml) group (n = 31). Symptom alleviation and complications were recorded after every treatment. RESULTS: Vertigo was improved in 65% of patients who received ITD compared with 55% of patients who received ITL patients (P < .05). Three patients in the ITD2 group had from otomycosis, and 2 of these patients had a perforation; no tympanic membrane perforation was observed in the ITL and ITD1 group. CONCLUSIONS: Compared with lidocaine, dexamethasone is more effective in alleviating vertigo, and a lower concentration of dexamethasone can reduce the occurrence of complications.

[An analyzation on the characterization of frequency tuning of vestibular evoked myogenic potential in patients with unilateral vestibular hypofunction].

Objective: To explore the value of adding 1 kHz cervical vestibular evoked myogenic potential（cVEMP） and ocular vestibular evoked myogenic potential（oVEMP） in the auxiliary diagnosis of unilateral vestibular hypofunction. Methods:A retrospective analysis of 84 patients with unilateral vestibular hypofunction receiving two or more vestibular function tests was conducted,29 cases of unilateral Ménière's disease, 27 cases of benign paroxysmal positional vertigo （BPPV）, 8 cases of idiopathic sudden sensorineural hearing loss （ISSHL） with vertigo, and 20 cases of ISSHL without vertigo were included. SPSS 25.0 software was used for statistical analysis to observe the difference of frequency amplitude ratio （FAR） at 500 Hz/1 kHz of cVEMP and oVEMP between the experimental and control groups. Results:①The cVEMP elicitation rates were 95.24% （80/84） and 98.81% （83/84） for 500 Hz and 1 kHz, respectively; and the oVEMP elicitation rates were 78.57% （66/84） and 91.67% （77/84） for 500 Hz and 1 kHz, respectively. ②Except for the lateral difference of FAR in oVEMP of the posterior semicircular canal BPPV group and cVEMP of the horizontal semicircular canal BPPV group （P<0.05）, no significant lateral difference was observed in the other disease groups （P>0.05）. Conclusion:In patients with unilateral vestibular hypofunction, cVEMP and oVEMP showed different frequency tuning changes in different semicircular canal BPPV groups. Additionally, 1 kHz cVEMP and oVEMP as regular stimulation frequencies in clinical test, which has certain clinical reference significance for determining the diagnosis and prognosis of BPPV on the weak ear and in different semicircular canal involvement.

Correction of the Estimated Hearing Level of NB Chirp ABR in Normal Hearing Population.

INTRODUCTION: The narrowband chirp (NB Chirp), a frequency-specific sound stimulus signal obtained by limiting the frequency bandwidth based on chirp, is applied to the frequency specified auditory brainstem response (fsABR) increasingly. Although some studies demonstrated that NB Chirp-evoked auditory brainstem response (NB Chirp ABR) causes a better neural response than tone burst-evoked auditory brainstem response and is preferred for fsABR, there is little known about how to better estimate an individual's hearing level through the threshold of NB Chirp ABR. The present study intended to compare the accuracy and deviation of NB Chirp ABR corrected by different approaches in estimating the hearing level of people with normal hearing. METHODS: A total of 66 volunteers with normal hearing were randomly divided into a model group (n = 26), test group 1 (n = 20), and test group 2 (n = 20). The model group was used to calculate the threshold difference between NB Chirp ABR and pure-tone audiometry at 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz, as well as the regression equation, providing a reference for the correction of estimated hearing level of NB Chirp ABR. Test group 1 was used to observe the accuracy and deviation of the "noncorrection (N)," "threshold difference (A1)," and "regression equation (A2)" methods in correcting the estimated hearing level of NB Chirp ABR. Test group 2 was used to replicate the analysis of test group 1 to verify the repeatability of the experimental results. All data were analyzed using SPSS 24.0. RESULTS: Test group 1 and test group 2 had similar results. First, the accuracy of the estimated hearing level of N was significantly higher than that of A1 or A2. Second, compared with "0," the deviation of the estimated hearing level of N was bigger than that of A1 or A2 at 500 Hz and 1,000 Hz, while similar at 2,000 Hz and 4,000 Hz. Finally, there was no significant difference in the deviation of the estimated hearing level between A1 and A2 at 500 Hz and 1,000 Hz. CONCLUSION: Among people with normal hearing, it was necessary to correct NB Chirp ABR at 500 Hz and 1,000 Hz for lower deviation of the estimated hearing level. Both correction approaches based on threshold difference and regression equation can be used.

Theoretical and Experimental Investigations into a Crawling Robot Propelled by Piezoelectric Material.

Conventional motors with complicated electromagnetic structures are difficult to miniaturise for millimetre- and centimetre-sized robots. Instead, small-scale robots are actuated using a variety of functional materials. We proposed a novel robot propelled by a piezoelectric ceramic in this work. The robot advances due to the asymmetric friction created by the spikes on the surface. The structural modelling was completed, static and dynamic models were established to predict the moving characteristics, the prototype was built using three dimensional (3D) printing technology, and the models were evaluated via experiments. Compared with conventional inchworm-type robots, the proposed robot is superior in simple structure because the clamping components are replaced by spikes with asymmetric friction. Compared with SMA (shape memory alloy) actuating inchworm-type robots, it has a faster velocity with higher resolution. Meanwhile, the components are printed through an additive manufacturing process that is convenient and avoids assembly errors. This design could make contributions to many areas, such as pipe inspection, earthquake rescue, and medicine delivery.

Social Support and Tinnitus Distress: The Importance of Developing Positive Psychological Qualities in Patients with Chronic Tinnitus.

INTRODUCTION: The role of social support in the relief of tinnitus distress and related mechanisms remains unclear. This study aimed to confirm a hypothesis that the influence of social support on tinnitus distress is mediated by resilience and self-esteem. METHODS: The Social Support Rating Scale, Connor-Davidson Resilience Scale, Positive Version of Rosenberg Self-Esteem Scale, and Tinnitus Handicap Inventory were used to assess 296 patients who experience chronic subjective tinnitus. The collected data were subjected to correlational analysis, mediating effect testing, and structural equation model analysis using R 3.3.1 with the mediate and lavaan packages. RESULTS: The result showed that social support had significant positive correlations with resilience and self-esteem, while resilience and self-esteem had significant negative correlations with tinnitus distress. Furthermore, social support indirectly affected tinnitus distress through the full mediating effects of resilience and self-esteem and could indirectly affect resilience through the partial mediating effects of self-esteem. CONCLUSION: These results suggested that the key to social support for alleviating tinnitus distress lies in the development of patients' resilience and self-esteem. Promoting the development of positive psychological quality of tinnitus patients and improving their perception of social support may become the new approaches of clinical management of tinnitus.

[Efficacy of percutaneous vagal stimulation in the treatment of chronic tinnitus].

Objective:The aim of this study is to investigate the efficacy of transcutaneous vagus nerve stimulation（taVNS） in the treatment of chronic tinnitus. Methods:taVNS was used to treat chronic decompensated tinnitus, 10 days as a course of treatment. Record and analyze the improvement of the patient's subjective symptoms during treatment. The THI, PSQI and DASS-21 scores were performed at 10 days, 3 months and 6 months after treatment. The improvement of tinnitus in taVNS group and control group at the above recorded time points was compared, and the THI score of taVNS group was compared before and after treatment. Results:① During the taVNS treatment, 93.65% of the patients achieved improvement in subjective symptoms, and 28.6% of the patients voluntarily accepted the second course of taVNS treatment; ② The sleep improvement was optimal when the treatment was 10 days, and some patients had poor sleep status after 3 or 6 months; ③ The anxiety of taVNS group was improved during and after treatment, and the best effect time was 3 months and 6 months after treatment; ④ There was no significant difference in THI score between the two groups, but there was significant improvement in taVNS group at 3 months and 6 months after treatment. Conclusion:taVNS treatment can significantly improve the sleep disorder, anxiety disorder and tinnitus disturbance of tinnitus patients, and the curative effect is good after 3 months and 6 months of prevention.

Analysis of Studies in Tinnitus-Related Gene Research.

OBJECTIVE: Summarize and analyze the current research results of tinnitus-related genes, explore the potential links between the results of each study, and provide reference for subsequent studies. METHODS: Collect and sort out the research literature related to tinnitus genes included in PubMed, Web of Science, China National Knowledge Infrastructure, and Wanfang Data Knowledge Service Platform before December 31, 2019. Then the relevant contents of the literature were sorted out and summarized. RESULTS: Fifty-one articles were finally selected for analysis: 31 articles (60.8%) were classified as researches on animal models of tinnitus, and 20 (39.2%) as researches on tinnitus patients. Existing studies have shown that genes related to oxidative stress, inflammatory response, nerve excitation/inhibition, and nerve growth are differentially expressed in tinnitus patients or animal models, and have presented the potential links between genes or proteins in the occurrence and development of tinnitus. CONCLUSION: The research on tinnitus-related genes is still in the exploratory stage, and further high-quality research evidence is needed.

Impacts of different methylprednisolone administration routes in patients with sudden hearing loss or Meniere's disease.

BACKGROUND: Evidence suggests that glucocorticoids are important in the treatment of sudden hearing loss (SHL) and Meniere's disease (MD). However, different glucocorticoid administration methods may have a significant impact on treatment outcomes. OBJECTIVE: This study aimed to investigate effects of different glucocorticoid administration methods on sudden hearing loss and Meniere's disease. METHODS: In this study, glucocorticoids were administered orally in 18 patients, by retroauricular injection in 15 patients and by intratympanic injection in 15 patients. White blood cell (WBC) count, serum K+, fasting plasma glucose (FPG), body temperature, heart rate and blood pressure were used to evaluate effects of glucocorticoids on patients with hearing loss. Visual analog scale (VAS) of pain and sleep disorders were also surveyed, and pure tone audiometry (PTA) results were compared among groups to evaluate efficacy of different glucocorticoids administration methods. RESULT: WBC count, heart rate and blood pressure were higher in patients taking oral glucocorticoids, while body temperature, serum K+ and FPG levels did not change in all three groups. However, patients who received intratympanic injection of glucocorticoids experienced more pain, while those taking oral glucocorticoids reported more sleep impairment. Treatment efficacy on hearing loss was not significantly different among the three groups. CONCLUSION: These findings suggest that systemic glucocorticoid administration can result in greater whole body responses than local administration, but with similar hearing treatment efficacy.

Analysis of Click and Swept-Tone Auditory Brainstem Response Results for Moderate and Severe Sensorineural Hearing Loss.

INTRODUCTION: Auditory brainstem response (ABR) is one of the commonly used methods in clinical settings to evaluate the hearing sensitivity and auditory function. The current ABR measurement usually adopts click sound as the stimuli. However, there may be partial ABR amplitude attenuation due to the delay characteristics of the cochlear traveling wave along the basilar membrane. To solve that problem, a swept-tone method was proposed, in which the show-up time of different frequency components was adjusted to compensate the delay characteristics of the cochlear basilar membrane; therefore, different ABR subcomponents of different frequencies were synchronized. METHODS: The normal hearing group, moderate sensorineural hearing loss group, and severe sensorineural hearing loss group underwent click ABR and swept-tone ABR with different stimulus intensities. The latencies and amplitudes of waves I, III, and V in 2 detections were recorded. RESULTS: It was found that the latency of each of the recorded I, III, and V waves detected by swept-tone ABR was shorter than that by click ABR in both the control group and experimental groups. In addition, the amplitude of each of the recorded I, III, and V waves, except V waves under 60 dB nHL in the moderate sensorineural hearing loss group, detected by swept-tone ABR was larger than that by click ABR. The results also showed that the swept-tone ABR could measure the visible V waves at lower stimulus levels in the severe sensorineural hearing loss group. CONCLUSION: Swept-tone improves the ABR waveforms and helps to obtain more accurate threshold to some extent. Therefore, the proposed swept-tone ABR may provide a new solution for better morphology of ABR waveform, which can help to make more accurate diagnosis about the hearing functionality in the clinic.

Etiology of newborn hearing impairment in Guangdong province: 10-year experience with screening, diagnosis, and follow-up.

BACKGROUND: Hearing impairment is one of the most common birth defects in children. Universal newborn hearing screenings have been performed for 19 years in Guangdong province, China. A screening/diagnosis/intervention system has gradually been put in place. Over the past 10 years, a relatively complete data management system had been established. In the present study, an etiological analysis of newborn cases that failed the initial and follow-up screenings was performed. METHODS: The nature and degree of hearing impairment in newborns were confirmed by a set of procedures performed at the time of initial hearing screening, rescreening and final hearing diagnosis. Then, multiple examinations were performed to explore the associated etiology. RESULTS: Over a period of 10 years, 720 children were diagnosed with newborn hearing loss. Among these children, 445 (61.81%) children had a clearly identified cause, which included genetic factor(s) (30.56%), secretory otitis media (13.30%), maternal rubella virus infection during pregnancy (5.83%), inner ear malformations (4.86%), maternal human cytomegalovirus infection during pregnancy (2.92%), malformation of the middle ear ossicular chain (2.50%) and auditory neuropathy (1.81%). In addition, 275 cases of sensorineural hearing loss of unknown etiology accounted for 38.19% of the children surveyed. CONCLUSIONS: Long-term follow-up is needed to detect delayed hearing impairment and auditory development in children. The need for long-term follow-up should be taken into account when designing an intervention strategy. Furthermore, the use of the deafness gene chip should further elucidate the etiology of neonatal hearing impairment.

Research on high-frequency small-load fatigue testing device driven by piezoelectric actuator.

A novel small-load fatigue testing device whose actuation resource is the piezoelectric material is proposed. The procedure of energy conversion and motion transfer is analyzed in detail. In the experiment by which the characteristic of the fatigue testing device is tested, the testing device works at resonance and the amplitude of the output could be up to 6.3 mm and output force is in the range of 0.6-2.5 N when the actuation frequency is higher than 100 Hz. The article presents the details of a piezoelectric device that is superior not only in smaller output force and higher testing frequency but also in high resolution, quick response, small scale, no noise, and anti-electromagnetic interference. The research about this kind of testing device benefits increasing the testing efficiency and development of a new material.

Effect of balloon dilation eustachian tuboplasty combined with tympanic tube insertion in the treatment of chronic recurrent secretory otitis media.

PURPOSE: To investigate the long-term clinical effect of balloon dilation eustachian tuboplasty (BET) combined with tympanic tube insertion (TTI) in the treatment of chronic recurrent secretory otitis media (CRSOM). MATERIALS AND METHODS: A retrospective study of 30 cases of CRSOM treated with BET combined with TTI under general anesthesia between August 2014 and September 2016. Thirty cases of CRSOM treated with TTI in the same period were taken as the control group. All cases were followed over 24 months. The scores of eustachian tube (ET) function preoperation, 1 month, 6 months, 12 months, and 24 months postoperation were collected and analyzed, respectively. A satisfaction questionnaire was used to evaluate the therapy at 24-months postoperation. RESULTS: The symptoms were significantly improved and the ET score was obviously increased postsurgery in most cases treated with BET plus TTI compared with those treated with TTI alone. The highest ET score was obtained at 6 months post BET. Five (14%) cases (6 ears) of CRSOM recurred. The 24-month postoperation follow-up questionnaire showed that 84.6% of the patients were satisfied with the treatment, while ten cases (25%) in the TTI group recurred. CONCLUSION: BET combined with TTI surgery is an effective therapy for patients with CRSOM.

Loss of Vision Dominance at the Preresponse Level in Tinnitus Patients: Preliminary Behavioral Evidence.

At present, the mechanisms underlying changes in visual processing in individuals with tinnitus remain unclear. Therefore, we investigated whether the vision dominance of individuals with tinnitus disappears at the preresponse level through behavioral study. A total of 38 individuals with tinnitus and 31 healthy controls completed a task in which they were asked to attend to either visual or auditory stimuli while ignoring simultaneous stimulus inputs from the other modality. We manipulated three levels of congruency between the simultaneous visual and auditory inputs: congruent (C), incongruent at the preresponse level (PRIC), and incongruent at the response level (RIC). Thus, we differentiated the cross-modal conflict explicitly into the preresponse (PRIC > C) and response (RIC > PRIC) levels. The results revealed no significant difference in the size of the preresponse level conflict between the auditory attention and visual attention conditions in tinnitus group. In brief, the preresponse level of individuals with tinnitus showed a loss in vision dominance. This may be due to the reduced interference of visual information in auditory processing.

NLRC5: potential novel non-invasive biomarker for predicting and reflecting the progression of IgA nephritis.

BACKGROUND: The nucleotide oligomerization domain-like receptor subfamily C5 (NLRC5) is primarily expressed in the adaptive and innate immune systems. NLRC5 was recently discovered to regulate immunity and inflammatory responses. Abnormal immune and inflammatory responses are considered critical pathogenesis in IgA nephritis (IgAN). However, the role of NLRC5 in IgAN is unknown. We previously showed that NLRC5 can be detected in patients with IgAN; herein, we further examined the pathophysiological significance of NLRC5 in the serum and renal deposits of patients with IgAN. This study is the first to find that NLRC5 is closely correlated with IgAN. METHODS: IgAN patients (n = 50) who were diagnosed by renal biopsy provided blood and renal biopsy tissue, and age-matched healthy control subjects (blood donators n = 22; tissue donators n = 5) were included. Renal biopsies were diagnosed, and blood biochemical parameters were tested. Serum creatinine, urea, proteinuria, haematuria, albumin, and immunoglobulin A levels were recorded. Serum NLRC5 concentrations were detected by enzyme-linked immunosorbent assay, and tissue NLRC5 expression in kidney tissue was detected by immunohistochemical analysis. ROC curve analysis was used to evaluate the diagnostic value of the serum NLRC5 concentration in IgAN. RESULTS: Serum NLRC5 concentration was significantly decreased in the IgAN group compared to that in the healthy control group (P < 0.0001), especially in S1 (Oxford classification) patients (P < 0.0001). Furthermore, serum NLRC5 concentration had a negative correlation with Lee's grade (r = 0.3526, P = 0.0060) and proteinuria levels (r = 0.4571, P = 0.0004). Tissue NLRC5 expression was significantly increased in the IgAN group compared to that in the healthy control group (P < 0.0001); a more significant increase was identified in the S1 group (P < 0.05) and had a positive correlation with Lee's grade (r = 0.497, P < 0.0001). We proposed a cut-off value of 1415 pg/ml for serum NLRC5 concentration, which was able to predict IgAN with 77.27% sensitivity and 87.5% specificity. CONCLUSIONS: Serum NLRC5 concentrations in IgAN are significantly decreased, and tissue NLRC5 expression is significantly increased in IgAN renal tissue, which is consistent with pathological severity. This finding suggests that NLRC5 could potentially be a diagnostic index and represents a prognostic factor in IgAN patients.

Experimental Research on Fluid Coupling Flexible Actuator.

In the field of micromechanics, piezoelectric actuator has attracted great attention for its high-frequency response, high displacement resolution, and high output force. However, its prospect of practical application has been largely limited by the displacement of micrometer. A fluid coupling flexible actuator was proposed, which utilizes resonance to enlarge the output displacement. The actuator uses a piezoelectric oscillator as an excitation source, fluid as the transmission medium and a flexible diaphragm for the displacement output. On the condition that the fluid is inviscid and incompressible, mathematical formulation of the membrane vibration theory has been analyzed. Then, the prototype is made. The displacement is amplified 21 times to 1.106 mm when driving frequency is 127 Hz. The flexible diaphragm appears the largest displacement output when driving frequency is close to one of the system's natural frequency. Then, the points with zero amplitude form a circle on the surface of flexible diaphragm and the movement direction of the flexible diaphragm is opposite on different sides of the circle. In fact, rather than vibrates at the first resonance frequency, the membrane in the essay is vibrating at a certain higher-order resonance frequency. The experimental results are mainly consistent with the theoretical analysis.