A multicenter randomized double-blind study: comparison of the Epley, Semont, and sham maneuvers for the treatment of posterior canal benign paroxysmal positional vertigo.

We evaluated the short-term efficacy of Epley, Semont, and sham maneuvers for resolving posterior canal benign paroxysmal positional vertigo (BPPV) in a prospective multicenter randomized double-blind controlled study. Subjects were randomly divided into three groups: Epley (36 patients), Semont (32 patients), and sham (Epley maneuver for the unaffected side, 31 patients). Out of 14 institutes which participated in this study, 5 institutes had previous experience of the Epley but not the Semont maneuver and the other 9 had previous experience of both maneuvers. Each maneuver was repeated twice if there was still positional vertigo or nystagmus on day 0, and the presence of nystagmus and vertigo on positional testing were evaluated immediately, 1 day, and 1 week after treatment. After the first maneuver, the Epley group showed a significantly higher resolution rate of positional nystagmus than the Semont or sham groups (63.9, 37.5, and 38.7%, respectively). After the second maneuver, the resolution rate (83.3%) of the Epley group was significantly higher than that (51.6%) of the sham group. At 1 day and 1 week after treatment, the resolution rate of the Epley group was significantly higher than those of the other groups. Similar results were seen for the resolution of positional vertigo. The Epley maneuver showed persistent resolution rates of positional vertigo and nystagmus without a fatigue phenomenon. The Epley maneuver was significantly more effective per maneuver than Semont or sham maneuvers for the short-term treatment of posterior canal BPPV. The Semont maneuver showed a higher success rate than the sham maneuver, but it was not significantly different.

Abnormal CT findings are risk factors for otitis media-related sensorineural hearing loss.

OBJECTIVES: Inflammatory processes in chronic otitis media (COM) can damage the inner ear, resulting in sensorineural hearing loss (SNHL). The purpose of this study was to evaluate risk factors by computed tomography (CT) findings for COM-related SNHL in patients with unilateral COM. DESIGN: Records from January 2009 to December 2012 of 231 patients with unilateral COM and a normal contralateral ear were retrospectively evaluated. Bone conduction thresholds were calculated for each ear at 0.5, 1, 2, and 4 kHz. If bone conduction threshold averaged across the four frequencies of the COM ear was 10 dB greater than that of the contralateral ear, the patient was classified under the SNHL group. Temporal bone CT images were analyzed to determine the presence or absence of soft tissue density in the attic (medial/lateral), antrum, oval window niche, and round window niche. Multivariate analysis of sex, age (< 50 years; ≥ 50 years), disease duration (< 20 years; ≥ 20 years), perforation size (small; moderate; large) and the presence of soft tissue density in the attic (medial/lateral), antrum, oval window niche, and round window niche was used to determine the factors related to COM-related SNHL. RESULTS: Of the 231 patients, there were 51 patients (22.1%) in the SNHL group and 180 patients (77.9%) in the non-SNHL group. Multivariate analyses showed that the presence of soft tissue density in the antrum (odds ratio [OR] 3.80; 95% confidence interval [CI] 1.74-8.32; p = 0.001), age ≥ 50 years and more (OR 3.32; 95% CI 1.62-6.81; p = 0.001), disease duration ≥ 20 years (OR 2.80; 95% CI 1.31-6.02; p = 0.008), and the presence of soft tissue density in the round window niche (OR 2.42; 95% CI 1.12-5.21; p = 0.024) were independently related to COM-related SNHL. CONCLUSIONS: COM-related SNHL was present in 22% of ears with COM. The presence of soft tissue density in the antrum, determined from temporal bone CT, increased the OR of SNHL to 3.8. Age, disease duration, and the presence of soft tissue density in the round window niche were also independent predicting factors for SNHL. These findings may be used as informative references for patients with COM.

Characteristics of central lesions in patients with dizziness determined by diffusion MRI in the emergency department.

BACKGROUND: To describe the rate and risk factors of central lesions among patients with dizziness in the emergency department based on diffusion-weighted MRI, which otologists consulted for evaluation of patients with dizziness need to know. METHODS: 902 Consecutive patients who presented with dizziness symptoms as a chief complaint in the emergency department (ED) of our tertiary referral centre between January 2011 and June 2011 were studied. Central lesions were confirmed by diffusion-weighted MRI. Univariate and multivariate analyses were used for factors predictive of central lesions. RESULTS: Of 645 patients who underwent MRI, 23 (3.6%) had acute central lesions (22 infarcts/1 haemorrhage). Univariate analyses revealed that older age, hypertension, atrial fibrillation, non-whirling type of dizziness symptoms and combined neurological symptoms were significantly associated with the development of central lesions (p<0.05). The incidence of central lesions in patients aged in their 40s, 50s, 60s, 70s and ≥80s was 0, 3.9%, 3.4%, 7.4% and 16.7%. Multivariate analyses showed that hypertension (p=0.01, OR=3.42), symptoms of non-whirling type (p=0.03, OR=3.12) and combined neurological symptoms (p<0.01, OR=16.72) were independent predictors of central lesions. CONCLUSIONS: Although dizziness in the ED is generally benign, the prevalence of acute central lesions was 3.6% among 645 patients with dizziness who underwent MRI. Old age (>50 years), hypertension, non-whirling type of dizziness symptoms and associated neurological symptoms were significant risk factors for central lesions.

Hearing gain with a BAHA test-band in patients with single-sided deafness.

PURPOSE: It is assumed that preoperative use of a bone-anchored hearing aid (BAHA) test-band will give a patient lower gain compared to real post-operative gain because of the reduction of energy through the scalp when using a test-band. Hearing gains using a BAHA test-band were analyzed in patients with unilateral hearing loss. MATERIALS AND METHODS: Nineteen patients with unilateral sensorineural hearing loss were enrolled. A test-band, which was connected to BAHA Intenso with full-on gain, was put on the mastoid. Conventional air-conduction (AC) pure-tone averages (PTAs) and sound-field PTAs and speech reception thresholds (SRTs) were obtained in conditions A (the better ear naked), B (the better ear plugged), and C (the better ear plugged with a test-band on the poorer mastoid). RESULTS: Air-conduction PTAs of the poorer and better ears were 91 ± 19 and 18 ± 8 dB HL. Sound-field PTAs in condition B were higher than those in condition A (54 vs. 26 dB HL), which means that earplugs can block the sound grossly up to 54 dB HL through the better ears. The aided PTAs (24 ± 6 dB HL) in condition C were similar to those of the better ears in condition A (26±9 dB HL), though condition C showed higher thresholds at 500 Hz and lower thresholds at 1 and 2kHz when compared to condition A. The hearing thresholds using a test-band were similar to the published results of BAHA users with the volume to most comfortable level (MCL). CONCLUSION: Our findings showed that a BAHA test-band on the poorer ear could transmit sound to the cochlea as much as the better ears can hear. The increased functional gain at 1 and 2kHz reflects the technical characteristics of BAHA processor. The reduction of energy through the scalp when using a test-band seems to be offset by the difference of output by setting the volume to full-on gain and using a high-powered speech processor. Preoperative hearing gains using a test-band with full-on gain seems to be similar to the post-operative gains of BAHA users with the volume to MCL.

Hearing loss following ventriculoperitoneal shunt in communicating hydrocephalus patients: a pilot study.

OBJECTIVES/HYPOTHESIS: Hearing loss can be associated with a decrease in cerebrospinal fluid (CSF) pressure because changes in CSF pressure induce changes in perilymph pressure. Hearing loss after neurosurgical procedures have been reported, but clinical information on hearing loss after the placement of ventriculoperitoneal (VP) shunts, the most commonly used CSF shunt for hydrocephalus patients, is limited. This study is aimed to show the relationship between VP shunt and hearing loss. STUDY DESIGN: Prospective study. METHODS: Pure tone threshold and electrocochleography were preoperatively performed in nine patients (18 ears) undergoing elective VP shunt placement. Five-day and 1-month post-shunt placement hearing thresholds were compared with baseline data. A correlation analysis was conducted between the threshold and summating potential/action potential (SP/AP) ratio changes at 5 days and 1 month after shunt placement. Cochlear aqueduct dimensions measured by high-resolution CT were compared between ears with and without hearing loss. RESULTS: About 40% of subject ears showed hearing loss with a threshold elevation of at least 15 dB in one or more frequencies. After VP shunt placement, the mean threshold of all ears showed a significant increase in most frequencies and the pure tone average. The change in the SP/AP ratios was significantly correlated with the change in the pure tone average at both 5 days and 1 month after shunt placement. Cochlear aqueduct dimensions were not correlated with hearing loss occurrence. CONCLUSIONS: Hearing thresholds may increase following VP shunt placement, possibly due to secondary endolymphatic hydrops.

Results of caloric and sensory organization testing of dynamic posturography in migrainous vertigo: comparison with Meniere's disease and vestibular neuritis.

CONCLUSION: Our findings suggest that migrainous vertigo (MV) has a substantial vestibulo-spinal abnormality that can be uncovered by posturography. Patients with MV also showed a difficulty in using multisystem information, especially somatosensory information. Caloric and sensory organization tests (SOTs) have complementary roles in assessing vestibulo-ocular and vestibulo-spinal function, particularly for Meniere's disease (MD) and MV. OBJECTIVES: To compare vestibular dysfunction through caloric testing and posturography in patients with MV, MD, and acute vestibular neuritis (VN). METHODS: Caloric tests and SOTs were performed in 31 patients with MV, 23 with MD, and 37 with VN. The abnormal results in caloric test, SOT conditions, and somatosensory, visual, and vestibular ratios were analyzed. RESULTS: Abnormal canal paresis was found in 7 patients with MV (23%), 11 with MD (48%), and 37 with VN (100%). An abnormal vestibular ratio in SOT was found in 14 patients with MV (45%), 6 with MD (26%), and 23 with VN (62%). In MV, an abnormal vestibular ratio was more common than canal paresis and an abnormal vestibular ratio was more common than in MD. An abnormal somatosensory ratio (19%) in MV was significantly more common than in VN and MD (3% and 0%). For condition 2, MV showed a significantly higher abnormal rate than VN. An abnormal visual ratio in MV was more common than in VN and MD but this was not significant.

Audiologic performance after cochlear implantation in children with X-linked deafness: comparison with deaf children with a normal inner ear structure.

OBJECTIVE: To compare audiologic performances of cochlear implantation (CI) in children with X-linked deafness with those of CI in age- and sex-matched children with normal cochleae. PATIENTS: We identified 4 patients with X-linked deafness and selected 10 age- and sex-matched deaf patients with normal cochleae between April 1999 and April 2012. MAIN OUTCOME MEASURES: Auditory brainstem responses, Categories of Auditory Performance (CAP), and Meaningful Auditory Integration Scale (MAIS). RESULTS: The ages of patients with X-linked deafness at the time of implantation ranged between 1.3 and 13.6 years, with a mean age of 5.3 years. All patients were male subjects and showed severe-to-profound hearing loss. Patient 1 lacked ABR in both ears. Patients 2, 3, and 4 showed ABR in the contralateral ear, at 70, 70, and 90 dB nHL, respectively. All 4 patients had bilateral X-linked cochlear anomaly and experienced cerebrospinal fluid (CSF) gushers. Straight electrodes were used in Patients 1 and 3, with perimodiolar electrodes used in the others. Patients 2 and 3, who were about the same age, had CAP scores of 6 or more at 18 months after activation of the implant despite the use of different electrode arrays. There were no statistically significant differences in MAIS and CAP scores between each patient with X-linked deafness and the control group. CONCLUSION: The audiologic performances of patient with X-linked deafness after CI are comparable to those of patients with normal inner ear structure after CI.

Interaural differences of distortion product otoacoustic emission amplitudes in patients with unilateral tinnitus.

OBJECTIVE: We aimed to determine whether abnormalities in outer hair cell (OHC) function were related to tinnitus through interaural comparison of distortion product otoacoustic emissions (DPOAEs). STUDY DESIGN: Cross-sectional study. SETTING: Tertiary care university teaching hospital. PARTICIPANTS: Twenty-seven patients with unilateral tinnitus and pure-tone average of both ears ≤ 25 dB hearing loss (HL) at 500, 1000, 2000, and 4000 Hz were included. SUBJECTS AND METHODS: Pure-tone thresholds observed at 500 to 16,000 Hz and DPOAE amplitudes at f2 frequencies of 1001 to 6348 Hz were compared between the tinnitus ears and nontinnitus ears in patients with unilateral tinnitus. RESULTS: The pure-tone averages (13 ± 6 dB HL) in the nontinnitus ears were similar to those (15 ± 6 dB HL) in the tinnitus ears. There were no differences in pure-tone averages at all frequencies tested. While the DPOAE amplitudes measured at f2 frequencies of 1001 to 3174 Hz in tinnitus ears were not different from those in the nontinnitus ears, the tinnitus ears showed significantly reduced DPOAE amplitudes when compared with the nontinnitus ears at frequencies of 4004 to 6348 Hz. CONCLUSION: OHC dysfunction was correlated with tinnitus at high frequencies, and DPOAE amplitudes can provide additional information about cochlear dysfunction, which is complementary to pure-tone audiometry.

The effect of gingko biloba on hearing in mice with noise-induced temporary threshold shift.

BACKGROUND AND OBJECTIVES: Gingko biloba extract is known for enhancing blood circulation, scavenging free radicals, and antagonizing against platelet-activating factor. This study evaluated the effect of Gingko biloba on the noise-induced temporary threshold shift of hearing. MATERIALS AND METHODS: Temporary threshold shift was induced by exposing mice to 110 dB SPL sound for 1 hour. The experimental group consisted of mice fed Gingko biloba [3 mg/kg, 6 mg/kg, and 12 mg/kg in 0.5% carboxymethyl cellulose (CMC)] for 7 days before noise exposure. CMC solution without Gingko biloba was fed to control mice. Hearing threshold was measured by auditory brainstem response (ABR) and distortion product otoacoustic emission (DPOAE). RESULTS: The hearing threshold increased after noise exposure and recovered to normal within 5 days in all groups. Compared to control mice (fed CMC solution only), mice fed Gingko biloba showed more rapid recovery of ABR threshold at 16 kHz in all three experimental groups. At the other frequencies, there was no significant change in hearing recovery in the Gingko biloba groups. There was no difference in DPOAE between groups. CONCLUSIONS: Temporary threshold shift of hearing after noise exposure was partly affected by oral Gingko biloba.

Normative diameters and effects of aging on the cochlear and facial nerves in normal-hearing Korean ears using 3.0-tesla magnetic resonance imaging.

OBJECTIVES/HYPOTHESIS: To assess the normative size of the cochlear nerve (CN) and facial nerve (FN) in normal-hearing ears and to determine whether nerve size varies with age. STUDY DESIGN: Cross-sectional. METHODS: We included 169 ears with normal hearing between 2005 and 2010. The height, width, and cross-sectional area (CSA) of the CN and FN in the middle of the internal auditory canal were measured on oblique sagittal images of 3.0-T magnetic resonance imaging. Results were compared by age. Young subjects were divided into three age groups, 0-5, 6-10, and 11-15 years. Subjects over age 40 years were divided into groups at 10-year intervals. RESULTS: Mean age was 32.6 years (range, 0.75-79 years). We found that the CN had significantly greater vertical (1.10 ± 0.21 mm vs. 0.95 ± 0.21 mm) and horizontal (1.11 ± 0.20 mm vs. 1.03 ± 0.22 mm) diameters than the FN. The CSA of the CN was larger than that of the FN (0.98 ± 0.33 mm(2) vs. 0.79 ± 0.31 mm(2) ). Except for the CN vertical diameter, there were no significant differences between right and left ears. Sex did not affect the nerve size. Although the CN was not affected by age, the FN vertical diameter and CSA of children <5 years were significantly smaller than those of children aged >5 years. The size of the two nerves did not differ among groups over age 40 years. CONCLUSIONS: The CN is not affected by age in normal-hearing ears. The FN vertical diameter and CSA of children <5 years are smaller than those of older children.

Superior canal dehiscence patients have smaller mastoid volume than age- and sex-matched otosclerosis and temporal bone fracture patients.

BACKGROUND AND OBJECTIVES: The purpose of the study was to compare the mastoid air-cell volume of the patients with superior semicircular canal dehiscence syndrome (SCDS) and that of the control patients with otosclerosis and temporal bone (TB) fracture. SUBJECTS AND METHODS: Ten patients with SCDS were enrolled and 10 patients with bilateral otosclerosis and TB fracture were selected as control groups by age and sex matching. To measure the mastoid air-cell volume, 3D reconstruction software was used. RESULTS: In 10 patients with SCDS, the mean age was 44.5 years, ranging from 16 to 79 years (M : F=4 : 6). Mean mastoid air-cell volume in the SCDS side was 3319.9 mm(3), whereas 4177.2 mm(3) in the normal side (p=0.022). Mean mastoid air-cell volume in the right side of otosclerosis patients was 6594.3 mm(3) and it was not different from 6380.5 mm(3) in the left side (p=0.445). Mean mastoid air-cell volume in normal side of TB fracture was 6477.2 mm(3). The mastoid air-cell volume in the SCDS side was significantly smaller than that of otosclerosis and TB fracture patients (p=0.009, p=0.002, respectively). The mastoid air-cell volume in the normal side of SCDS was significantly smaller than that of TB fracture (p=0.019), but not significant with that of otosclerosis (p=0.063). CONCLUSIONS: Our findings revealed that the mastoid air-cell volume in the SCDS side was significantly smaller than control group, which suggest that the decreased mastoid pneumatization is closely related to the generation of SCDS.