An fMRI-study on single-sided deafness: Spectral-temporal properties and side of stimulation modulates hemispheric dominance.

OBJECTIVE: Our main aim was to investigate the blood oxygenation level dependent (BOLD) response to monaural and binaural speech- and non-speech stimuli as measured with fMRI in subjects with single-sided deafness and in normal hearing controls. We hypothesised that the response to monaural stimulation in both normal hearing subjects and persons with single-sided deafness would vary with the complexity and nature of the stimuli and the side of stimulation. DESIGN: Patients with left- and right single-sided deafness and controls with normal hearing receiving either binaural or monaural stimuli were tested using speech and non-speech auditory stimuli in an event-related fMRI experiment. STUDY SAMPLE: Twenty-two patients with single-sided deafness after treatment for vestibular schwannoma and 50 normal hearing controls. RESULTS: Normal hearing persons receiving right side monaural stimuli activate bilateral temporal regions. Activation following left side monaural stimulation is more right lateralized. Persons with single-sided deafness respond similarly to controls to monaural stimulation. Persons with right side single-sided deafness show activation of frontal cortical regions not seen in persons with left side single-sided deafness following speech stimuli. This is possibly related to increased effort and more frequently reported problems with communication. Right side single-sided deafness is related to increased activation of areas usually related to processing of degraded input, including the thalamus. CONCLUSION: Hemispheric dominance following monaural auditory stimulation is modulated by the spectral-temporal properties of the stimuli and by which ear is stimulated. Differences between patients with right- and left side deafness suggests that right side deafness is related to increased activation of areas involved in processing of degraded input.

Generic quality of life in persons with hearing loss: a systematic literature review.

BACKGROUND: To the best of our knowledge, no empirically based consensus has been reached as to if, and to what extent, persons with hearing loss (HL) have reduced generic Quality of life (QoL). There seems to be limited knowledge regarding to what extent a hearing aid (HA) would improve QoL. The main aim of the present study was to review studies about the relationship between HL and QoL. A supporting aim was to study the association between distress and HL. METHODS: Literature databases (Cinahl, Pub Med and Web of Science) were searched to identify relevant journal articles published in the period from January 2000 to March 17, 2016. We performed a primary search pertaining to the relationship between HL, HA and QoL (search number one) followed by a supporting search pertaining to the relationship between distress/mood/anxiety and HL (search number two). After checking for duplications and screening the titles of the papers, we read the abstracts of the remaining papers. The most relevant papers were read thoroughly, leaving us with the journal articles that met the inclusion criteria. RESULTS: Twenty journal articles were included in the present review: 13 were found in the primary search (HL and QoL), and seven in the supporting search (HL and distress). The literature yields equivocal findings regarding the association between generic QoL and HL. A strong association between distress and HL was shown, where distressed persons tend to have a lowered generic QoL. It is suggested that QoL is lowered among HL patients. Some studies suggest an increased generic QoL following the use of HA, especially during the first few months after initiation of treatment. Other studies suggest that HA use is one of several possible factors that contribute to improve generic QoL. CONCLUSIONS: The majority of the studies suggest that HL is associated with reduced generic QoL. Using hearing aids seem to improve general QoL at follow-up within the first year. HL is a risk factor for distress. Further research is needed to explore the relationship between HL and generic QoL, in addition to the importance of influencing variables on this relationship.

Clinical Application and Psychometric Properties of a Norwegian Questionnaire for the Self-Assessment of Communication in Quiet and Adverse Conditions Using Two Revised APHAB Subscales.

BACKGROUND: Difficulty in following and understanding conversation in different daily life situations is a common complaint among persons with hearing loss. To the best of our knowledge, there is currently no published validated Norwegian questionnaire available that allows for a self-assessment of unaided communication ability in a population with hearing loss. PURPOSE: The aims of the present study were to investigate a questionnaire for the self-assessment of communication ability, examine the psychometric properties of this questionnaire, and explore how demographic variables such as degree of hearing loss, age, and sex influence response patterns. RESEARCH DESIGN: A questionnaire based on the subscales of the Norwegian translation of the Abbreviated Profile of Hearing Aid Benefit was applied to a group of hearing aid users and normal-hearing controls. STUDY SAMPLE: A total of 108 patients with bilateral hearing loss, and 101 controls with self-reported normal hearing. DATA COLLECTION AND ANALYSIS: The psychometric properties were evaluated. Associations and differences between outcome scores and descriptive variables were examined. A regression analysis was performed to investigate whether descriptive variables could predict outcome. RESULTS: The measures of reliability suggest that the questionnaire has satisfactory psychometric properties, with the outcome of the questionnaire correlating to hearing loss severity, thus indicating that the concurrent validity of the questionnaire is good. CONCLUSIONS: The findings indicate that the proposed questionnaire is a valid measure of self-assessed communication ability in both quiet and adverse listening conditions in participants with and without hearing loss.

Cartilage island on stapes: autologous PORP in the hypoventilated middle ear.

The most common technique in sound restoration of the middle ear is prosthetic surgery. Hypoventilation of the middle ear may cause adhesive otitis or atelectasis resulting in a higher risk of prosthetic extrusion rate and recurrence of the underlying cholesteatoma. We report long-term results using an island of tragal cartilage as an autologous PORP in selected patients with poor middle ear ventilation. Retrospective chart reviews were performed for procedures involving 52 patients between year 2000 and 2009. All patients that underwent surgery using tragal cartilage interposed between the suprastructure of the stapes and the tympanic membrane were included in this study. Audiological parameters using four frequencies, 0.5, 1, 2 and 3 kHz, according to AAO-HNS guidelines, were assessed pre-and postoperatively. The hearing results on different PTA frequencies were also investigated. We report long-term follow-up of patients with hypoventilated middle ear with a success rate of 71% (ABG <20%). With regards to the ABG, the low frequency component (5 and 1 kHz) showed a significantly (p < 0.05) larger improvement of mean values after surgery as compared to the high-frequency component (2 and 3 kHz). Cartilage island PORP on stapes is a stable and efficient method for selected patients with chronic middle ear disease.

Functional-structural reorganisation of the neuronal network for auditory perception in subjects with unilateral hearing loss: Review of neuroimaging studies.

OBJECTIVE: This paper aims to provide a review of studies using neuroimaging to measure functional-structural reorganisation of the neuronal network for auditory perception after unilateral hearing loss. DESIGN: A literature search was performed in PubMed. Search criterions were peer reviewed original research papers in English completed by the 11th of March 2015. STUDY SAMPLE: Twelve studies were found to use neuroimaging in subjects with unilateral hearing loss. An additional five papers not identified by the literature search were provided by a reviewer. Thus, a total of 17 studies were included in the review. RESULTS: Four different neuroimaging methods were used in these studies: Functional magnetic resonance imaging (fMRI) (n = 11), diffusion tensor imaging (DTI) (n = 4), T1/T2 volumetric images (n = 2), magnetic resonance spectroscopy (MRS) (n = 1). One study utilized two imaging methods (fMRI and T1 volumetric images). CONCLUSION: Neuroimaging techniques could provide valuable information regarding the effects of unilateral hearing loss on both auditory and non-auditory performance. fMRI-studies showing a bilateral BOLD-response in patients with unilateral hearing loss have not yet been followed by DTI studies confirming their microstructural correlates. In addition, the review shows that an auditory modality-specific deficit could affect multi-modal brain regions and their connections.

Long-term Auditory Symptoms in Patients With Sporadic Vestibular Schwannoma: An International Cross-Sectional Study.

BACKGROUND: There are limited data on the long-term auditory symptoms in patients with sporadic small- and medium-sized vestibular schwannoma (VS). The initial treatment strategy for VS is controversial. OBJECTIVE: To characterize auditory symptoms in a large cohort of patients with VS. METHODS: Patients with ≤3 cm VS who underwent primary microsurgery, gamma knife surgery, or observation between 1998 and 2008 at 2 independent hospitals were identified. Clinical data were extracted from existing VS databases. At a mean time of 7.7 years after initial treatment, patients were surveyed via mail with the use of the Hearing Handicap Inventory for Adults (HHIA) and the Tinnitus Handicap Inventory. RESULTS: The response rate was 79%; a total of 539 respondents were analyzed. Overall, the hearing prognosis was poor, because more than 75% of all patients had nonserviceable hearing at the last clinical follow-up. Good baseline hearing proved to be a strong predictor for maintained serviceable hearing. Treatment modality was independently associated with both audiometric outcome and HHIA results. Active treatment with microsurgery or gamma knife surgery did not appear to be protective, because patients who were observed had the greatest probability of durable hearing. Patients in the surgical series had the greatest hearing loss. Tinnitus Handicap Inventory results were less predictable. The only predictors of tinnitus handicap were age and HHIA score. CONCLUSION: The overall prognosis for hearing in sporadic VS is poor regardless of treatment strategy. Treatment modality was an independent predictor of hearing status; observation was associated with the highest rate of hearing preservation. .

Predictors of vertigo in patients with untreated vestibular schwannoma.

OBJECTIVES: Previous studies have shown that vertigo is the most powerful negative predictor of quality of life in patients with vestibular schwannomas, but the variability in vertigo symptom severity is still poorly understood. We wanted to find out whether vertigo could be related to objective parameters such as tumor size, location, vestibular nerve function, hearing, and postural stability in patients with untreated vestibular schwannomas. STUDY DESIGN: Baseline data from prospective cohort study. SETTING: Tertiary referral center. PATIENTS: Four hundred thirty-four consecutive patients with unilateral VS diagnosed on MRI. Mean age 56 years (range 16-84 yr). Fifty-three percent women. INTERVENTION: Diagnostic, with a medical history, otolaryngological examination, pure-tone and speech audiometry, MRI, posturography, and videonystagmography with bithermal caloric tests. MAIN OUTCOME MEASURE: Dizziness measured on a 100-mm visual analog scale (VAS). Secondary outcome measures were canal paresis and postural imbalance (static and dynamic posturography). RESULTS: Three hundred three patients (70%) completed the VAS. Severe dizziness, defined as VAS 75 or greater, was reported by 9% of the patients. Larger tumors were associated with higher risk of postural instability and canal paresis. Moderate to severe dizziness was associated with postural imbalance and canal paresis, and possibly with small to medium-sized tumors. Postural instability was related to tumor size and canal paresis when measured by dynamic, but not with static, posturography. CONCLUSION: A minority of VS patients experience severe vestibular symptoms related to canal paresis and postural instability. A curvilinear relationship is hypothesized between tumor size and dizziness.

Long-term hearing result using Kurz titanium ossicular implants.

Titanium implants in middle ear surgery were introduced in the late 90s and are now frequently used in middle ear surgery. However, long-term studies of patient outcome are few and have only been published in subgroups of patients. We report the long-term effect of titanium middle ear implants for ossicular reconstruction in chronic ear disease investigated in a Norwegian tertiary otological referral centre. Retrospective chart reviews were performed for procedures involving 76 titanium implants between 2000 and 2007. All patients who underwent surgery using the Kurz Vario titanium implant were included in the study. Audiological parameters using four frequencies, 0.5, 1, 2, and 3 kHz, according to AAO-HNS guidelines, was assessed pre and postoperatively. Otosurgical procedures, complications, revisions, and extrusion rates were analyzed. The study had no dropouts. The partial ossicular replacement prosthesis (PORP) was used in 44 procedures and the total ossicular replacement prosthesis (TORP) in 32 procedures, respectively. Mean follow-up was 5.2 years (62 months). The ossiculoplasties were performed as staging procedures or in combination with other chronic ear surgery. The same surgeon performed all the procedures. A postoperative air-bone gap of ≤ 20 dB was obtained in 74 % of the patients, 82 % for the Bell (PORP) prosthesis, and 63 % for the Arial (TORP) prosthesis. The extrusion rate was 5 %. We conclude that titanium ossicular implants give stable and excellent long-term hearing results.

Conservative management of vestibular schwannoma--a prospective cohort study: treatment, symptoms, and quality of life.

BACKGROUND: One hundred ninety-three patients with sporadic unilateral vestibular schwannoma given conservative management were enrolled in a prospective study. OBJECTIVE: To evaluate the efficacy of conservative management and to determine the effect of an initial conservative management on the quality of life (QOL) and severity of audio vestibular symptoms. METHODS: The patients underwent magnetic resonance imaging scans, clinical examination, and QOL assessment by 2 validated questionnaires, the Short Form-36 (SF-36) and Glasgow Benefit Inventory (GBI). Using regression analysis of clustered data, we analyzed possible associations between tumor growth and symptoms and tested whether our earlier finding that vertigo is associated with reduced QOL could be verified. RESULTS: The median follow-up time was 43 months (range, 9-115 months; SD, 21.48 months). Results are based on 703 clinical controls and 642 (SF-36) and 638 (GBI) questionnaires. Seven patients were lost to follow-up. Approximately 40% of patients were in need of treatment during follow-up. We found a statistically significant association between tinnitus and vertigo and tumor growth. Vertigo was found to significantly reduce QOL. There was a significant drop in the Social Function subscales of both SF-36 and GBI, possibly attributable to progressive hearing loss. Otherwise, there was no overall trend toward any change in QOL during the observation period. In addition, QOL seemed to be little affected by treatment. CONCLUSION: There was a small but statistically significant improvement in vestibular complaints and no change in the occurrence of tinnitus. Except for hearing loss caused by surgery, treatment did not affect symptoms or QOL significantly. Growth was associated with the occurrence of tinnitus and balance problems.

In vitro cholesteatoma growth and secretion of cytokines.

CONCLUSION: Our results show a significant difference between skin and cholesteatoma biology in vitro. OBJECTIVES: Cholesteatoma disease is a process of destruction characterized by uncontrolled growth of squamous epithelial cells in the middle ear or temporal bone. The pathophysiology behind the cholesteatoma development is controversial, and the mechanisms driving the cholesteatoma growth, migration and destructive properties is still unclear. We aimed to provide a method to study the effect of various compounds on cholesteatoma and skin tissue growth, as well as to further investigate the biological differences between normal skin and cholesteatoma tissue. METHODS: We have established a method to study cholesteatoma biopsy tissue in vitro. Cholesteatoma tissues from patients undergoing surgery for chronic otitis were grown in culture medium and compared to growth patterns and behaviour of normal retroauricular skin. Conditioned medium was analysed for various secreted cytokines. RESULTS: We found a radial outgrowth of keratinocyte epithelium from the circular biopsies. After 5 days of culture we found a significant growth of both cholesteatoma and skin-derived cells. Cholesteatoma samples showed higher growth rate as compared with skin control cultures from the same patient. Moreover, the cholesteatoma cells showed higher production of monocyte chemoattractant protein-1 (MCP-1) and interleukin (IL)-6 as compared with normal skin.

Short-term results using Kurz titanium ossicular implants.

The efficiency of titanium middle ear prosthesis for ossicular reconstruction in chronic ear disease is investigated in a Scandinavian two-center retrospective study from a Norwegian tertiary otology referral center and a Finnish otology referral center. Retrospective chart reviews were performed for procedures involving 73 titanium prostheses between 1999 and 2004. All patients that underwent surgery including the Kurz Vario titanium prosthesis were included in the study, 38 procedures including the partial ossicular replacement prosthesis (PORP) and 35 procedures including the total ossicular replacement prosthesis (TORP). Mean follow-up was 14 months. The ossiculoplasty was performed alone (29 patients) or in combination with other chronic ear surgery procedures (34 patients). Comparisons of preoperative and postoperative pure tone averages (0.5, 1, 2, and 3 kHz) according to AAO-HNS guidelines are presented, as well as data for different PTA definitions. Otosurgery procedures, complications, revisions, and extrusion rates are reported. A postoperative air-bone gap (ABG) of

Vestibular schwannomas: clinical results and quality of life after microsurgery or gamma knife radiosurgery.

OBJECTIVE: The aim of the present study was to evaluate the overall treatment efficacy (tumor control, facial nerve function, complications) and quality of life for patients treated primarily for unilateral vestibular schwannomas of 30 mm or less, either by microsurgery or by gamma knife (GK) radiosurgery. The results for the two treatment groups are compared with each other, with main emphasis on the long-term quality of life. METHODS: This is a retrospective study of 189 consecutive patients, 86 treated by microsurgery and 103 by gamma knife. The mean observation time was 5.9 years. All patients had a magnetic resonance imaging scan and clinical evaluation performed toward the end of the study. To evaluate the quality of life, we used two standardized questionnaires, the Glasgow Benefit Inventory and Short-Form 36. The questionnaires were sent to the 168 living patients. The reply rate was 83.3%. RESULTS: A total of 79.8% of the patients in the microsurgery group and 94.8% of the GK patients had a good facial nerve function (House-Brackmann Grade 1-2). Hearing was usually lost after microsurgery, whereas the GK patients had preserved hearing, which often became reduced over the years after the treatment. The treatment efficacy, defined as no need for additional treatment, was similar for the two treatment modalities. Quality of life was reduced compared with normative data, being most reduced in the microsurgery group. Some of the quality of life questions showed an association with facial nerve function and sex. CONCLUSION: Posttreatment facial nerve function, hearing, complication rates, and quality of life were all significantly in favor of GK radiosurgery.

Identification of functional VEGF receptors on human platelets.

Platelets secrete platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF) upon stimulation. We have demonstrated that platelets have functionally active PDGF alpha-receptors, a transmembrane tyrosine kinase involved in negative feedback regulation. Here we demonstrate the presence of the related VEGF receptors fms-like tyrosine kinase-1 and kinase-insert domain region on human platelets. VEGF itself did not cause platelet aggregation. However, addition of exogenous VEGF to SFRLLN or thrombin-stimulated platelets potentiated platelet aggregation. Moreover, thrombin-induced phosphoinositide 3-kinase and mitogen-activated protein kinase activity were enhanced in the presence of VEGF.

Acute mastoiditis in a Norwegian population: a 20 year retrospective study.

We have retrospectively examined the nature of acute mastioditis (in western Norway) during a 20 year period (1980-2000). Sixty-one cases of AM were identified in 57 patients with a mean age of 3.6 years. We found no significant change in the incidence of AM during the last 20 years. Seven patients were treated solely with intravenous antibiotics and myringotomies. Fifty patients also underwent cortical mastoidectomy, four cases with bilateral surgery. Antibiotic treatment was given to 31 of the patients before admission to hospital and this group had a significant longer duration of symptoms (12.4 days) compared to untreated patients (7.3 days). Streptococcus pneumoniae was the most common organism recovered from patient cultures. Surgery was found to correlate to patients with retroauricular fluctuation or to children with at least two of the three clinical signs: protrusion of the ear, retroauricular oedema and swelling of the ear canal. Our data show that clinical examination only reveal 50% of the cases with surgically proven retroauricular subperiostal abscess. We therefore recommend a CT scan of patients treated conservatively.