Predictors of computed tomography imaging in patients presenting with sudden hearing loss.

Objective: Sudden sensorineural hearing loss (SSNHL) is a rare presentation requiring timely diagnosis and treatment. Despite recommendations against obtaining computed tomography (CT) imaging of the head in clinical practice guidelines, this investigation is often completed in patients with sudden hearing loss. The aim of this study was to determine the proportion of patients undergoing CT imaging of the head for SSNHL at our center and identify predictive factors for the use of CT imaging. Methods: Retrospective chart review of adult patients referred for SSNHL to two academic otology/neurotology practices between January 2018 and May 2021. Patient demographics, comorbid medical conditions, associated symptoms, location of initial presentation, audiologic results, and completed imaging studies were collected. Statistical analysis was performed with SPSS software. Results: Ninety-eight patients with audiologically confirmed SSNHL were included. Twenty-two patients (22.4%) underwent CT imaging as an investigation for SSNHL. The presence of vertigo (odds ratio 6.90; 95% confidence interval 2.43, 19.56) and presentation to the emergency room (odds ratio 8.71; 95% confidence interval 3.02, 25.16) were significantly associated with undergoing CT imaging. These two variables were statistically significant independent predictors of CT imaging on multivariate regression analysis (p = .01, p = .001, respectively). Conclusion: A significant proportion of patients with SSNHL undergo low-yield CT imaging of the head, particularly patients presenting to the emergency room with vertigo. These results highlight an opportunity for focused education and quality improvement initiatives.Level of evidence: 4.

The Intelligibility of the Reversed-Stethoscope Technique in Age-Related Hearing Loss.

Background: This study evaluated the effectiveness of the reverse stethoscope technique in improving speech intelligibility. In this technique, a clinician places the earpieces of their stethoscope into the ears of a hearing-impaired patient and speaks into the chest piece. Methods: The International Speech Test Signal was presented to four Littman® stethoscope models and a Pocketalker® personal voice amplifier using an Audioscan® hearing instrument test box. The acoustic outputs of the stethoscopes and voice amplifier were measured across the frequency spectrum of speech. The Speech Intelligibility Index of the resulting speech was calculated for natural speech and for each device in relation to 10 standardized hearing losses representing the population of older adults. Results: For each of the 10 hearing losses, the speech signal emitted by the stethoscopes was quieter and yielded lower speech intelligibility scores than regular speech. In contrast, the voice amplifier provided mid- and high-frequency amplification and improved speech intelligibility scores for all but the mildest hearing losses. Conclusions: The reverse stethoscope technique worsens the clarity of speech and should not be used with older, hearing-impaired patients. Instead, clinicians should use regular speech or, preferably, personal voice amplifiers.

Effects of choral singing versus health education on cognitive decline and aging: a randomized controlled trial.

We conducted a randomized controlled trial to examine choral singing's effect on cognitive decline in aging. Older Singaporeans who were at high risk of future dementia were recruited: 47 were assigned to choral singing intervention (CSI) and 46 were assigned to health education program (HEP). Participants attended weekly one-hour choral singing or weekly one-hour health education for two years. Change in cognitive function was measured by a composite cognitive test score (CCTS) derived from raw scores of neuropsychological tests; biomarkers included brain magnetic resonance imaging, oxidative damage and immunosenescence. The average age of the participants were 70 years and 73/93 (78.5%) were female. The change of CCTS from baseline to 24 months was 0.05 among participants in the CSI group and -0.1 among participants in the HEP group. The between-group difference (0.15, p=0.042) became smaller (0.12, p=0.09) after adjusting for baseline CCTS. No between-group differences on biomarkers were observed. Our data support the role of choral singing in improving cognitive health in aging. The beneficial effect is at least comparable than that of health education in preventing cognitive decline in a community of elderly people. Biological mechanisms underlying the observed efficacy should be further studied.

Passive Transcutaneous Bone Conduction Hearing Implants: A Systematic Review.

OBJECTIVE: To systematically review the literature on currently available passive transcutaneous bone conduction hearing implants (pTCBI) with regard to complications, audiological outcomes, and quality-of-life scores. DATA SOURCES: MEDLINE, EMBASE, Scopus, and Cochrane Library. STUDY SELECTION: All identified English-language articles reporting on the implantation of currently available pTCBI's and their complications. Both pediatric and adult patients were included. No limitation was placed on study design or level of evidence. DATA EXTRACTION: Complications, audiological outcomes including mean pure-tone average gain and mean speech reception threshold gain, and quality-of-life outcomes. DATA SYNTHESIS: Twenty-six articles were included in the review. Four hundred eighty-two pTCBIs have been reported in the literature. Major complications including skin breakdown, wound dehiscence, hematoma, seroma, and inability to use the device occurred in 5.2% of patients. Minor complications including pain and self-resolving erythema at the implant site occurred in 13.1% of the patients. The weighted mean pure-tone average gain of the two included devices was 28.4 ±â€Š2.1 dB and the mean speech reception threshold gain was 32.9 ±â€Š3.9 dB. Favorable quality-of-life scores have been demonstrated with pTCBIs. CONCLUSION: pTCBIs are a viable alternative to percutaneous devices in a carefully selected group of patients. These devices have demonstrated good audiological outcomes, low morbidity, and high patient satisfaction.

The palisade cartilage tympanoplasty technique: a systematic review and meta-analysis.

BACKGROUND: Tympanoplasty is a common procedure performed by Otolaryngologists. Many types of autologous grafts have been used with variations of techniques with varying results. This is the first systematic review of the literature and meta-analysis with the aim to evaluate the effectiveness of one of the techniques which is gaining popularity, the palisade cartilage tympanoplasty. PubMed, EMBASE, and Cochrane databases were searched for "palisade", "cartilage", "tympanoplasty", "perforation" and their synonyms. In total, 199 articles reporting results of palisade cartilage tympanoplasty were identified. Five articles satisfied the following inclusion criteria: adult patients, minimum 6 months follow-up, hearing and surgical outcomes reported. Studies with patients undergoing combined mastoidectomy, ossicular chain reconstruction, and/or other middle ear surgery were excluded. Perforation closure, rate of complications, and post-operative pure-tone average change were extracted for pooled analysis. Study failure and complication proportions that were used to generate odds ratios were pooled. Fixed effects and random effects weightings were generated. The resulting pooled odds ratios are reported. Palisade cartilage tympanoplasty has an overall take rate of 96% at beyond 6 months and has similar odds of complications compared to temporalis fascia (OR 0.89, 95% CI 0.62, 1.30). The air-bone gap closure is statistically similar to reported results from temporalis fascia tympanoplasty. CONCLUSIONS: Cartilage palisade tympanoplasty offers excellent graft take rates and good postoperative hearing outcomes for perforations of various sizes and for both primary and revision cases. This technique has predictable, long-term results with low complication rates, similar to temporalis fascia tympanoplasty.

Mastoidectomy and mastoid obliteration with autologous bone graft: a quality of life study.

BACKGROUND: A mastoid cavity resulting from a canal wall down mastoidectomy can result in major morbidity for patients due to chronic otorrhea and infection, difficulty with hearing aids and vertigo with temperature changes. Mastoid obliteration with reconstruction of the bony external ear canal recreates the normal anatomy to avoid such morbidity. Few have the studied the quality of life benefit that this procedure confers. METHODS: This retrospective observational study was conducted to determine if mastoid obliteration with autologous cranial bone graft following mastoidectomy improves quality of life (QOL). Patients with cholesteatoma who had mastoidectomy with primary or secondary mastoid obliteration by a tertiary otologist were surveyed using the validated Glasgow Benefit Inventory (GBI), our primary outcome measure. RESULTS: Fifty-eight patients were interviewed. Forty-six were primary obliteration after canal wall down mastoidectomy of a primary cholesteatoma. Twelve were secondary obliteration of an existing canal wall down mastoid cavity. Overall GBI scores were improved, with average scores of 22. Average general subscale scores were 23, physical health scores were 25, and social health scores were 22. The primary obliteration group had average scores of 19, general subscale scores of 20, physical health scores of 21, and social health scores of 22. Those with secondary obliteration scored higher, with average scores of 31, general subscale scores of 34, physical health scores of 39, and social health scores of 25. CONCLUSION: This study shows that mastoidectomy with obliteration using autologous cranial bone graft offers a significant QOL benefit. The GBI scores compare favourably with other otorhinolaryngology procedures. Secondary obliterations after revision mastoidectomy scored much higher than primary obliterations. This is currently the only QOL study comparing these two patient groups.

Bilateral spontaneous hemotympanum secondary to chemotherapy-induced thrombocytopenia.

OBJECTIVE: To present a case of spontaneous, bilateral hemotympanum secondary to chemotherapy-induced thrombocytopenia. METHODS: Case report and review of the literature. RESULTS: Bilateral spontaneous hemotympanum is an exceedingly rare event. We present the first case of nontraumatic bilateral hemotympanum secondary to chemotherapy-induced thrombocytopenia in a patient with acute myelogenous leukemia. The patient presented with a 7-day history of progressive bilateral hearing loss and a platelet count of 10 × 10(9)/L after receiving his first dose of induction chemotherapy. A small, left-sided subdural hematoma was present in this patient though no extra-aural sources of bleeding to explain the bilateral hemotympanum were identified. CONCLUSION: Full resolution of symptoms was achieved with conservative management.

Can Uhear me now? Validation of an iPod-based hearing loss screening test.

OBJECTIVE: To evaluate the uHear iPod-based application as a test for hearing loss. METHODS: We recruited 100 adult participants through a single otology practice. Patients with otorrhea and cognitive impairment were excluded. All patients completed the uHear test in the clinic and in the sound booth and underwent a standard audiogram by the same audiologist. We compared the results of the uHear test to the standard audiogram. RESULTS: The uHear was able to correctly diagnose the presence of hearing loss (pure-tone average [PTA] > 40 dB) with a sensitivity of 98% (95% CI = 89-100), a specificity of 82% (95% CI = 75-88), and a positive likelihood ratio of 9 (95% CI = 6.0-16). Compared to the audiogram, the uHear overestimated the PTA among all ears by 14 dB in the clinic and by 8 dB in the sound booth (p < .0001). Compared to the audiogram, the uHear overestimated the PTA among ears with hearing loss by 6 dB in the clinic and by 4 dB in the sound booth. CONCLUSIONS: The uHear application is a reasonable screening test to rule out moderate hearing loss (PTA > 40 dB) and and is valid at quantifying the degree of hearing loss in patients known to have abnormal hearing.

Automated hearing tests: applying the otogram to patients who are difficult to test.

OBJECTIVE: The Otogram is an automated audiometer capable of determining air and bone conduction thresholds with masking when appropriate. The manufacturer claims that testing can be done in a quiet physician's consultation room without a sound-treated booth. We aimed to test the validity of the Otogram on "difficult-to-test" patients, all of whom require masking. METHODS: Twenty-eight difficult-to-test patients underwent three audiograms: two by an audiologist and one by the Otogram. First, audiograms performed by the audiologists were compared, establishing test-retest reliability. Second, audiograms performed by the Otogram were compared to those of the audiologists. We calculated the percentage of pure-tone thresholds that were in agreement by 10 dB. Weighted kappa statistical analyses demonstrated levels of agreement. RESULTS: Comparisons between audiologists demonstrated a very high degree of agreement. More than 90% of air and bone conduction thresholds fell within 10 dB of each other. Comparisons between audiologists and the Otogram also demonstrated a high degree of agreement. CONCLUSIONS: The Otogram has the capability to accurately ascertain air and bone conduction thresholds. It appropriately used masking when indicated. The Otogram has great potential as a diagnostic tool to improve access to health care, especially where hearing test facilities are limited or unavailable.

Analysis of Vibrant Soundbridge placement against the round window membrane in a human cadaveric temporal bone model.

OBJECTIVE: To evaluate optimal placement of the Floating Mass Transducer of the Vibrant Soundbridge (Med-El, Innsbruck, Austria) against the round window membrane, particularly the impact of interposed coupling fascia and of covering materials. METHOD: : Six fresh human cadaveric temporal bones were used. After mastoidectomy, posterior tympanotomy and removal of the round window niche, the Floating Mass Transducer (FMT) of the Vibrant Soundbridge (VSB) was placed against the round window membrane (RWM) in the following ways: in direct contact, or with interposed fascia. Both conditions were combined with a second parameter: no cover over the FMT or covered with fascia, fat or cartilage. The inner ear was stimulated through the VSB with a frequency sweep from 0.1 to 8 kHz at 1 V RMS. Stapedial footplate vibrations were recorded with a PSV-400 Scanning Laser Doppler Vibrometer (Polytec, Waldbronn, Germany). RESULTS: A learning curve exists for optimal placement of the VSB. Sufficient removal of bone around the round window is essential. Without covering materials, there is increased transmission of vibrations if fascia is interposed between the RWM and the FMT. If there is no interposed fascia, vibration transmission is increased with a fascia or fat (but not cartilage) cover. There is no added advantage of cover and interposed fascia, either is as good as the other. CONCLUSION: Optimal placement of the VSB against the round window relies heavily on surgical precision in placement. There is improved transmission of vibrations with either interposed fascia, or with a covering material.

Simple mass loading of the tympanic membrane to alleviate symptoms of patulous eustachian tube.

BACKGROUND: Patulous eustachian tube (PET) has a major impact on a patient's quality of life. The purpose of this study was to understand mechanisms behind the symptoms, develop treatments based on these, and develop and use a questionnaire to measure changes in PET symptoms with a novel intervention. Our hypothesis is that PET symptoms can be addressed at the level of the eardrum more easily than at the level of the eustachian tube. METHODS: In a population of 14 PET subjects and 6 fresh temporal bones, several investigations were performed. Nasal audiometry was used to measure frequencies preferentially transmitted to the ear in PET subjects. An intervention consisting of mass loading of the eardrum was devised in the temporal bones to damp these frequencies. This was then applied to subjects with PET. A questionnaire was developed and administered to measure the response to this intervention. This questionnaire included the more common symptoms associated with PET, such as echoing sounds, increased environmental sounds, and a plugging sensation in the ear. Mass loading of the eardrum was performed with Blu Tack, a clay-like, nontoxic substance. RESULTS/CONCLUSION: Low frequencies are preferentially transmitted in PET, and eardrum vibrations to these can be mitigated with mass loading. Mass loading in human subjects significantly reduced major symptoms of PET, although temporarily.

Computer-assisted audiometry versus manual audiometry.

OBJECTIVE: The Otogram is an automated computer-assisted audiometer that allows patients to self-administer audiometry for their pure-tone audiogram. There has been no research published in a peer-reviewed journal, validating its use in an otology outpatient clinic. We therefore proposed to investigate and compare the inter-rater and intrarater accuracy and reliability of audiologists and of the Otogram in an English-speaking British population. DESIGN: Prospective nonrandomized validation study. SETTING: Secondary otolaryngology center and otology outpatient clinic. PARTICIPANTS: Forty-eight NHS patients referred to an otology outpatient clinic. MAIN OUTCOME MEASURES: Each patient had 2 pure-tone audiograms. Hearing thresholds in decibels hearing level were ascertained by fully trained British audiologists and by the Otogram. RESULTS: Using the weighted kappa statistic, the level of agreement in air-conduction (kappa = 0.965) and bone-conduction (kappa = 0.927) thresholds between the audiologist and the Otogram on the same patient was equivalent to the inter-rater level of agreement between pairs of audiologists. Approximately 94% of air-conduction thresholds and 91% of bone-conduction thresholds measured by the Otogram fell within 10 dB of thresholds measured by an audiologist. Intrarater comparisons between audiologists were very good for air-conduction (kappa = 0.978) and bone-conduction (kappa = 0.964). The intrarater level of agreement between repeated Otogram thresholds was just as good for air-conduction (kappa = 0.974) and bone-conduction (kappa = 0.945) thresholds. CONCLUSION: The Otogram is just as reliable as audiologists at determining hearing thresholds. We recommend that the Otogram can be safely used in a controlled clinical setting supervised by audiologists.

Altering first impressions after facial plastic surgery.

BACKGROUND: First impressions are greatly influenced by facial appearance. Clinical data from psychiatric medicine overwhelming indicate that attractive individuals receive better judgment, treatment and behavior [1,2,10]. This study aimed to determine whether cosmetic alteration of facial features projects a better first impression. METHODS: Random reviewers were asked independently to grade standardized preoperative and postoperative photographs of patients who underwent facial plastic surgery. The reviewers were blinded to the pre- or postoperative status of the photograph. The questions posed to the reviewers were based on first-impression studies used in the past. RESULTS: The findings indicate that postoperative cosmetic surgery patients were graded as 31% more attractive, 27% better in social skills, 22% more successful in dating, 19% better in athletic skills, 15% better in relationship skills, and 13% more financially successful. CONCLUSION: Facial cosmetic surgery can improve the first impression an individual creates.