The Impact of the COVID-19 Pandemic on Bell's Palsy and Ramsay-Hunt Syndrome: A Multicenter Retrospective Study.

BACKGROUND: This article presents a comprehensive review of data on the impact of facial palsy during the coronavirus disease 2019 (COVID-19) pandemic. The possible causes and pathophysiological mechanisms of changes in the epidemiology of facial palsy during the COVID-19 pandemic are also discussed. METHODS: This multicenter retrospective cohort study included 943 patients diagnosed with Bell's palsy or Ramsay Hunt syndrome. This study compared patient demographics, comorbidities, symptoms, and treatments before the COVID-19 pandemic (from 2017 to 2019) and during the COVID-19 pandemic, from 2020 to 2022). RESULTS: Following the COVID-19 outbreak, there has been a significant increase in the number of cases of Bell's palsy, particularly among elderly individuals with diabetes. Bell's palsy increased after the COVID-19 outbreak, rising from 75.3% in the pre-COVID-19 era to 83.6% after the COVID-19 outbreak. The complete recovery rate decreased from 88.2% to 73.9%, and the rate of recurrence increased from 2.9% to 7.5% in patients with Bell's palsy. Ramsay Hunt syndrome showed fewer changes in clinical outcomes. CONCLUSION: This study highlights the impact of the COVID-19 pandemic on the presentation and management of facial palsy, and suggests potential associations with COVID-19. Notably, the observed increase in Bell's palsy cases among elderly individuals with diabetes emphasizes the impact of the pandemic. Identifying the epidemiological changes in facial palsy during the COVID-19 pandemic has important implications for assessing its etiology and pathological mechanisms of facial palsy disease.

Cortical reorganization following auditory deprivation predicts cochlear implant performance in postlingually deaf adults.

Long-term hearing loss in postlingually deaf (PD) adults may lead to brain structural changes that affect the outcomes of cochlear implantation. We studied 94 PD patients who underwent cochlear implantation and 37 patients who were MRI-scanned within 2 weeks after the onset of sudden hearing loss and expected with minimal brain structural changes in relation to deafness. Compared with those with sudden hearing loss, we found lower gray matter (GM) probabilities in bilateral thalami, superior, middle, inferior temporal cortices as well as the central cortical regions corresponding to the movement and sensation of the lips, tongue, and larynx in the PD group. Among these brain areas, the GM in the middle temporal cortex showed negative correlation with disease duration, whereas the other areas displayed positive correlations. Left superior, middle temporal cortical, and bilateral thalamic GMs were the most accurate predictors of post-cochlear implantation word recognition scores (mean absolute error [MAE] = 10.1, r = .82), which was superior to clinical variables used (MAE: 12.1, p < .05). Using the combined brain morphological and clinical features, we achieved the best prediction of the outcome (MAE: 8.51, r = .90). Our findings suggest that the cross-modal plasticity allowing the superior temporal cortex and thalamus to process other modal sensory inputs reverses the initially lower volume when deafness becomes persistent. The middle temporal cortex processing higher-level language comprehension shows persistent negative correlations with disease duration, suggesting this area's association with degraded speech comprehensions due to long-term deafness. Morphological features combined with clinical variables might play a key role in predicting outcomes of cochlear implantation.

A hidden pathophysiology of endolymphatic hydrops: case report of a patient with spontaneous intracranial hypotension presenting with sudden sensorineural hearing loss with vertigo.

Spontaneous intracranial hypotension (SIH) is characterized by decreased cerebrospinal fluid (CSF) volume due to leakage through the dural membrane. We present the case of a patient with SIH manifested by fluctuating low-frequency hearing loss, tinnitus, and vertigo. In this patient, endolymphatic hydrops in the cochlea and saccule were visualized by means of a special sequence of inner ear magnetic resonance imaging scans, with a gadolinium-based contrast agent administered intravenously. Endolymphatic hydrops is a potential underlying pathophysiology of SIH-associated hearing impairment. We hypothesize that SIH may be a rare cause of endolymphatic hydrops.

Efficacy of the Head Rotation Test With Bowing for the Lateral Canal Benign Paroxysmal Positional vertigo.

OBJECTIVES: To evaluate the efficacy of the head rotation test with bowing (B-HRT) in the sitting position in diagnosing lateral semicircular canal benign paroxysmal positional vertigo (LSC-BPPV). METHODS: The efficacy outcomes of lateralization of 25 patients with LSC-BPPV were prospectively evaluated using B-HRT. Traditional head toration in the supine position (S-HRT) and the bow and lean test were also assessed for comparative effectiveness. RESULTS: Direction-changing nystagmus was detected in all patients with LSC-BPPV (100%) using B-HRT. The nystagmus direction (geotropic or apogeotropic) determined by B-HRT was consistent with that determined by S-HRT with a perfect level of agreement (Cohen κ = 1.0, p < 0.001**). In 76.0% of the cases, the determination of the affected ear was concordant between B-HRT and S-HRT (Cohen κ = 0.409, p = 0.037*). The concordance rate between B-HRT and bow and lean test showed a fair level of agreement (68.0%; Cohen κ = 0.286, p = 0.126) with no statistical significance. On comparing the peak slow-phase velocity (SPV), SPVs of positional nystagmus on the stronger side and weaker side did not differ statistically significantly between S-HRT and B-HRT. In 12 of the 25 cases, in which the peak SPV asymmetry was determined as less than 30% by S-HRT (average, 11.00 ± 6.87%), the asymmetry determined by B-HRT (average, 47.31 ± 34.78%) was significantly higher, facilitating lesion identification by performing B-HRT together ( p = 0.001*). CONCLUSION: B-HRT in the sitting position identified direction-changing nystagmus in LSC-BPPV. B-HRT is helpful in facilitating the diagnosis of LSC-BPPV in the sitting position and determination of the affected ears in cases with nonprominent differences in bilateral nystagmus intensity according to S-HRT.

Endoscopic surgery of a cavernous hemangioma in the external auditory canal.

Cavernous hemangioma of the external auditory canal (EAC) is a rare clinical finding. Endoscopic ear surgery has been successfully applied for various ear pathologies with a wider surgical sight, minimal canal cuts and precise manipulation of soft tissues. We report a case of a 60-year-old woman with hemangioma of EAC which increased in size without treatment for several years. She underwent excision of the hemangioma using transcanal endoscopic approach. The endoscopic transcanal approach allowed surgical resection of EAC cavernous hemangioma with wider views and minimally invasive techniques.

Endoscopic Ear Surgery for Congenital Cholesteatoma in Children.

BACKGROUND: Endoscopic ear surgery is a promising technique for removing congenital cholesteatoma in children. It can provide greater visual access to hidden areas of the middle ear and facilitate middle-ear manipulation. This study compares a single-center experience in manag- ing congenital cholesteatoma with an endoscopic approach with that in managing congenital cholesteatoma with a conventional microscopic approach. METHODS: Records of consecutive patients aged under 8 with congenital cholesteatoma confined to the middle ear at our tertiary referral hospital from January 2013 to December 2018 were retrospectively reviewed. Operation time, hospital stay, postoperative complications, and recurrence/residue of congenital cholesteatoma were compared between patients receiving microscopic versus endoscopic surgery. RESULTS: A total of 33 pediatric patients aged from 19 months to 7 years were enrolled; 12 children underwent microscopic surgery, and 21 received an endoscopic approach for removing congenital cholesteatoma. The mean operative time was 1.61 hours for the microscopic group and 1.49 hours for the endoscopic group without statistical difference. No postoperative sensorineural hearing loss and complications were reported. Four cases of recurrence/residue were observed on the follow-up endoscopic exam or computed tomography, and no differences were shown between the 2 groups. Of the total patients, 94.7% (n=11) in the microscopic group and 90.5% (n=19) in the endoscopic group demonstrated an intact tympanic membrane without perforation or retraction after surgery. No audiological differences were reported between the 2 groups. CONCLUSION: Endoscopic ear surgery can effectively and safely remove congenital cholesteatoma in children and is not inferior to conventional microscopic approaches.

A multicenter, randomized, active-controlled, clinical trial study to evaluate the efficacy and safety of navigation guided balloon Eustachian tuboplasty.

To assess the safety and efficacy of navigation-guided balloon Eustachian tuboplasty (BET) compared to medical management (MM) alone in patients with chronic Eustachian tube dilatory dysfunction (ETD). This is a prospective, multicenter, 1:1 parallel-group, randomized controlled trial (RCT). It aims to assess the efficacy of navigation-guided BET compared to MM alone in patients with chronic ETD. The primary outcome measure was an improvement in the Eustachian tube dysfunction questionnaire (ETDQ)-7 score at the 6-week follow-up compared with baseline. Secondary outcome measures included changes in the signs and symptoms during the follow-up, changes in the score for each subcategory of ETDQ-7, type of tympanometry, pure tone audiometry, and the availability of a positive modified Valsalva maneuver. Navigation-guided BET was safely performed in all patients. A total of 38 ears of 31 patients (19 ears of 16 patients in the BET group and 19 ears of 15 patients in the control group) completed the planned treatment and 6 weeks of follow-up. More patients in the BET group (1.99 ± 0.85) had less symptomatic dysfunction than in the control group (3.40 ± 1.29) at 6 weeks post-procedure (P = 0.001). More patients experienced tympanogram improvement in the BET group at 6 weeks compared to the control group (36.5% vs. 15.8%) with a positive modified Valsalva maneuver (36.6% vs. 15.8%, P = 0.014). Additionally, air-bone gap change was significantly decreased in the BET group compared to the control group at the 6-week follow-up visit (P = 0.037). This prospective, multicenter, RCT study suggests that navigation-guided BET is a safe and superior treatment option compared to MM alone in patients with chronic ETD.

Morphological Analysis of the Adult Eustachian Tube: A Fresh-Frozen Human Cadaver Study.

OBJECTIVES: To evaluate the dilated Eustachian tube (ET) anatomy configuration using fresh human cadavers. METHODS: Fourteen ears from human cadavers were used to identify the ET configuration. The cadaver head was cut in the sagittal plane parallel to the nasal septum, dividing it into right and left sides. Silicone was then inserted into the ET through the nasopharyngeal orifice (NO). The volume and length of the impression were measured using 3D computed tomography imaging. RESULTS: The ET lumen was found to narrow from the NO to the isthmus, and the ET surface was concave anteriorly and convex posteriorly. The lower portion of the ET lumen was the most dilated and displayed a narrow top. The average volume of the ET impression was 1.4 ±â€Š0.5 ml. The total length of the posterior side was 30.5 ±â€Š3.6 mm, and that of the anterior side was 26.3 ±â€Š3.4 mm. The widest ET area of the NO was 10.1 ±â€Š0.9 mm in height and 8.0 ±â€Š1.5 mm in width. The preisthmus was 2.4 ±â€Š0.4 mm in height and 1.3 ±â€Š0.5 mm in width. The height and width were 8.37 and 5.33 mm at the 5 mm point from the NO, and 5.51 and 1.94 mm at the 20 mm point from the NO, respectively. CONCLUSION: We evaluated the configuration of the cartilaginous ET lumen, which is the main target of balloon dilation, and our findings may give insights into this dilation process and assist with the further development of ET balloons and stents.

High-frequency Cochlear Nerve Deficit Region: Relationship With Deaf Duration and Cochlear Implantation Performance in Postlingual Deaf Adults.

OBJECTIVE: To analyze the changes of cochlear nerve diameter and the presence of a cochlear nerve deficit at a high-frequency region and investigate their effects on cochlear implant (CI) performance in postlingual deaf adults. STUDY DESIGN: Retrospective. SETTING: Tertiary care academic center. PATIENTS: Eighty-three postlingual deaf adults with no labyrinthine anomalies or cognitive deficits who received a CI with perimodiolar electrodes from a single manufacturer. MAIN OUTCOMES AND MEASURES: We evaluated the changes of cochlear nerve diameter and the presence of a "tail sign," defined as identifiable nerve fibers originating from the far basal turn of the cochlea, which represents the presence of cochlear nerve at a high-frequency region in magnetic resonance imaging, on monosyllabic word recognition scores. RESULTS: The cochlear nerve diameter showed a positive correlation with word recognition scores (maximum diameter, R2 = 0.26, p < 0.01; minimum diameter, R2 = 0.26, p < 0.01), but a negative correlation with deaf duration. Recipients with a positive tail sign performed better (73 ±â€Š19%) than those without (45 ±â€Š24%, p < 0.01). A positive tail sign was more commonly found in good performers (52 of 62, 84%) than in poor performers (5 of 21, 24%, p < 0.01). CONCLUSIONS: Favorable outcomes could be anticipated in postlingual deaf adults with a large cochlear nerve diameter and positive tail sign. A presence of cochlear nerve at a high-frequency region may be an imaging marker for predicting good CI performance.

Comparative nephrotoxicitiy induced by melamine, cyanuric acid, or a mixture of both chemicals in either Sprague-Dawley rats or renal cell lines.

Acute nephrotoxicities of melamine (MEL), cyanuric acid (CA), and a mixture of both melamine and cyanuric acid (MC) were comparatively investigated in male Sprague-Dawley rats at 5 doses each with 10-fold dose interval as follows: MEL at 0.0315, 0.315, 3.15, 31.5, and 315 mg/kg; CA at 0.025, 0.25, 2.5, 25, and 250 mg/kg, and MC: [1×: (0.0315 + 0.025), 10×: (0.315 + 0.25), 100×: (3.15 + 2.5), 1000×: (31.5 + 25), and (315 + 250) mg/kg]. No marked adverse effects in renal function were observed in animals treated with MEL alone or CA alone, but evidence related to nephrotoxicity was noted in rats administered MC. Renal calculi and increased kidney weights were found in rats 7 d after daily oral administration of MC. Blood urea nitrogen (BUN) and creatinine were significantly elevated in the high dose MC groups at 100× or 1000×. In addition, elevated numbers of white blood cells (WBC), neutrophils, and lymphocytes in vivo and increased levels of prostaglandin E(2) (PGE(2)) in vitro were found in the MC group. Based on these data, the NOAEL (no-observed-adverse-effect level) for nephrotoxicity for MC was estimated to be 3.15 mg/kg body weight (bw)/d (MEL) plus 2.5 mg/kg bw/d (CA). If a safety factor of 1000 or more were applied to NOAEL, tolerable daily intake (TDI) would be 0.00315 and 0.0025 mg/kg/d or less for MEL and CA, respectively, which is far below the TDI of 0.2 mg/kg/d set by World Health Organization (WHO). In addition, in vitro cytotoxicity assays showed that the ACHN human renal adenocarcinoma cell line was more sensitive to MEL, CA, and MC than the MDCK canine kidney epithelial cell line. The 24-h half maximal inhibitory concentration (IC(50)) values for MEL (4792, 2792 µg/ml) were less than those of CA (9890, 6725 µg/ml, respectively) in MDCK and ACHN cell lines, suggesting that MEL may be more cytotoxic than CA. Furthermore, the 24-h IC(50) value for MC was found to be 208 µg/ml in ACHN cells. Data suggest that NOAELs based upon acute nephrotoxic parameters for MC were low, which might require further reassessment of the current TDI.

Assessment of Objective Audiometry to Predict Subjective Satisfaction in Patients With Hearing Aids.

OBJECTIVES: To investigate the correlation of objective audiometry with user satisfaction as measured with the questionnaire scores. METHODS: Twenty patients with hearing loss, who agreed to wear a hearing aid and were referred for hearing aid fitting, were included in this prospective clinical study. All patients used the in-the-canal type of Wide7 hearing aid provided by BSL Co., Ltd. We performed the Korean version of the Hearing Handicap Inventory for the Elderly (K-HHIE) and the International Outcome Inventory for Hearing Aids (K-IOI-HA) before and 1, 3, and 6 months after wearing the hearing aid. We also performed pure tone audiometry (PTA), speech audiometry (SA), functional gain (FG), hearing in noise test (HINT), and central auditory processing disorder tests, such as frequency pattern test (CA-f), duration pattern test (CA-d), and dichotic test (CA-Di). Patients were divided into two groups (group A-HHIE, improved; group B-HHIE, same or worse) by comparing the score of K-HHIE before and 6 months after wearing the hearing aid. In the 6-month K-IOI-HA questionnaire, 21 points were considered as the average score. Based on this, we further divided patients into two groups (group A-IOI, >21 points; group B-IOI, ≤21 points). RESULTS: Group A-HHIE included six patients and group B-HHIE included 14 patients. In PTA, SA, HINT, CA-d, and CA-Di, group A-HHIE showed higher improvements than group B-HHIE, which were not statistically significant. Group A-IOI included 12 patients and group B-IOI included eight patients. No statistically significant difference was noted in the improvement of audiometric results over a period of 6 months after wearing the hearing aid between groups A-IOI and B-IOI. CONCLUSION: There were no significant and consistent audiometric results to reflect patient's satisfaction with the hearing aid. Therefore, when analyzing the hearing aid-fitting outcome, both the objective audiometric tests and subjective questionnaire should be performed together for validating hearing aid performance.

Long-term Change in the Speech Perception Ability in Pediatric Cochlear Implants and the Effect of the Age at Implantation.

OBJECTIVE: We analyzed the long-term changes in speech perception ability of pediatric cochlear implants (CIs) to evaluate the effect of the age at the time of surgery. STUDY DESIGN: Retrospective. SETTING: Tertiary care academic center. PATIENTS: One hundred fourteen prelingually deaf children with CI use duration >10 years. MAIN OUTCOME MEASURES: Categories of auditory performance (CAP) scores and monosyllabic word recognition scores using the Asan-Samsung Korean word list (ASK-WRS) and a conventional word list (KS-WRS) were the main outcomes. Outcomes were compared according to the age at surgery (group I, 1-2 yr; II, 2.1-3 yr; III, 3.1-7 yr; IV, 7.1-13 yr). RESULTS: CAP scores reached plateaus at 2.6 to 3.3 years post-CI; groups I to III showed better scores than group IV. The maximum CAP score was obtained in all children of groups I to III and in 65% of group IV. ASK-WRSs reached plateaus at 3.2 to 4.8 years post-CI. Younger patients at CI operation showed better ASK-WRSs (97, 93, 90, and 54% in groups I-IV, respectively), but the differences were not significant (I versus II and II versus III). Ceiling effect (perfect score) was observed in early groups (67, 44, 30, and 0% in groups I-IV). KS-WRSs, which is a challenging test, reached plateaus at 7.2 to 8.4 years postsurgery with no ceiling effect. Early implantees showed significantly better scores (88, 82, 73, and 46% in groups I-IV). CONCLUSIONS: Speech perception ability after CI showed audiological age-specific improvement evaluated by various test methods. The most challenging test demonstrated long-term performance differences by the age at CI operation.

Intratympanic steroid injection for sudden sensorineural hearing loss: Impact of injection interval on therapeutic efficacy.

OBJECTIVE: To compare the effect of injection time intervals of intratympanic (IT) dexamethasone (DEX) in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: Seventy-five adults with ISSNHL were grouped into four groups according to the IT DEX interval. In addition to concurrent oral steroid medication for two weeks, patients received IT DEX injections every 1, 2, 3, and four days, respectively. (Group 1, Group 2, Group 3, and Group 4). We evaluated the treatment outcomes according to modified criteria from "Clinical Practice Guideline: Sudden Hearing Loss" of the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) to justify treatment success. RESULTS: There were no significant differences in demographic and baseline audiometric data. The mean of pure tone audiometry (PTA) and speech discrimination score (SDSs) were significantly improved after oral steroid and IT DEX treatment in all four groups. Group 1 showed significantly higher improvement than Group 4 in PTA after treatment. There was a significantly higher complete recovery (CR) rate in Group 1 than Group 4. CONCLUSION: We found a statistically significant difference in the complete hearing recovery rate and audiometric results (PTA) between the group with a daily interval of injections and the group with a four-day time interval. Therefore, daily time intervals in intratympanic steroid injection may be considered as an option for better improvement of hearing in patients with ISSNHL.

Speech Perception Growth Patterns in Prelingual Deaf Children With Bilateral Sequential Cochlear Implantation.

OBJECTIVE: To evaluate speech perception following the first (CI-1) and second (CI-2) cochlear implantation (CI) in children with sequential bilateral CI. STUDY DESIGN: Retrospective. PATIENTS: Seventy children with follow-up for 60 months post CI-1 and 36 months post CI-2. MAIN OUTCOME MEASURES: Word recognition score (WRS) was the main outcome. WRSs were compared by age at CI operation (group A ≤ 3.5 yr, B 3.6-8.6, for CI-1; group I ≤ 3.5 yr, II 3.6-7.0, III 7.1-13, IV > 13, for CI-2). RESULTS: For CI-1, the WRS of group A exceeded 80% at 24 months post procedure, earlier than group B (54 mo). Group A also had a shorter period of CI-1 use up to the WRS plateau than group B. CI-2 showed an initial burst of WRS growth much earlier than CI-1. This initial burst was most robust within 3 months in group II, but modest in group IV. The periods of CI-2 use (11-17 mo) up to the WRS plateau were much shorter than CI-1 (40-64 mo). Group I did not show the best WRS at 1 month post CI but later exceeded the other groups. CONCLUSION: Children received an immediate benefit by a burst of WRS growth from CI-2 earlier than CI-1, even within 3 months, suggesting that CI-1 gets the auditory cortex ready to foster speech processing from CI-2. The CI-2 performance depends on age at CI-2 implantation and on CI-1 performance. Our current findings will be relevant for clinicians who are counselling parents on CI-2 surgery.

Further Beneficial Effect of Hearing Aids on Speech Recognition Performance Besides Amplification: Importance of the Restoration of Symmetric Hearing.

OBJECTIVE: To identify the improvement in auditory spectral resolution, temporal resolution, and speech recognition conferred with various hearing-aid (HA) technologies when the amplification effect of the HA is excluded, and to compare the beneficial effects depending on the restoration of symmetric hearing with different amplification settings in various hearing impairment conditions. STUDY DESIGN: Prospective study. SETTING: Tertiary referral center. SUBJECTS: Sixty-two subjects who had used HAs for more than 3 months were divided into four groups: group 1, bilateral HAs (n = 28); group 2, unilateral HA in the better ear (n = 12); group 3, unilateral HA in the worse ear (n = 12); group 4, unilateral HA with symmetric hearing thresholds (n = 10). METHODS: Aided performance and unaided performance were compared in each group. Four different psychoacoustic measurements were made: 1) spectral ripple discrimination; 2) temporal modulation detection; 3) speech recognition threshold in white noise; and 4) speech discrimination score (SDS) under quiet conditions. All test signals were presented by a loudspeaker located 1 m in front of the subject in a sound-attenuating booth, at their most comfortable levels, with or without HAs. RESULTS: In group 1, the use of HAs significantly improved both SDS under quiet conditions and speech recognition in noise compared with the unaided condition. Group 2 showed better SDS under quiet conditions with HAs, and group 3 showed improved speech recognition in noise with HAs. In contrast, in group 4, no measurements differed with or without HAs. CONCLUSIONS: These results demonstrate the benefits of HAs on speech perception in noise, in addition to their amplification effect, but only when HA restores symmetric hearing.

Cochlear Implantation in Postlingually Deaf Adults is Time-sensitive Towards Positive Outcome: Prediction using Advanced Machine Learning Techniques.

Given our aging society and the prevalence of age-related hearing loss that often develops during adulthood, hearing loss is a common public health issue affecting almost all older adults. Moderate-to-moderately severe hearing loss can usually be corrected with hearing aids; however, severe-to-profound hearing loss often requires a cochlear implant (CI). However, post-operative CI results vary, and the performance of the previous prediction models is limited, indicating that a new approach is needed. For postlingually deaf adults (n de120) who received CI with full insertion, we predicted CI outcomes using a Random-Forest Regression (RFR) model and investigated the effect of preoperative factors on CI outcomes. Postoperative word recognition scores (WRS) served as the dependent variable to predict. Predictors included duration of deafness (DoD), age at CI operation (ageCI), duration of hearing-aid use (DoHA), preoperative hearing threshold and sentence recognition score. Prediction accuracy was evaluated using mean absolute error (MAE) and Pearson's correlation coefficient r between the true WRS and predicted WRS. The fitting using a linear model resulted in prediction of WRS with r = 0.7 and MAE = 15.6 ± 9. RFR outperformed the linear model (r = 0.96, MAE = 6.1 ± 4.7, p < 0.00001). Cross-hospital data validation showed reliable performance using RFR (r = 0.91, MAE = 9.6 ± 5.2). The contribution of DoD to prediction was the highest (MAE increase when omitted: 14.8), followed by ageCI (8.9) and DoHA (7.5). After CI, patients with DoD < 10 years presented better WRSs and smaller variations (p < 0.01) than those with longer DoD. Better WRS was also explained by younger age at CI and longer-term DoHA. Machine learning demonstrated a robust prediction performance for CI outcomes in postlingually deaf adults across different institutes, providing a reference value for counseling patients considering CI. Health care providers should be aware that the patients with severe-to-profound hearing loss who cannot have benefit from hearing aids need to proceed with CI as soon as possible and should continue using hearing aids until after CI operation.

Feasibility and Safety of Transcutaneous Vagus Nerve Stimulation Paired with Notched Music Therapy for the Treatment of Chronic Tinnitus.

BACKGROUND AND OBJECTIVES: A recent study demonstrated that tinnitus could be eliminated by vagus nerve stimulation (VNS) paired with notched sounds in a rat tinnitus model. The aims of this clinical study were to investigate the effects and safety of transcutaneous VNS (tVNS) by patch-type electrode paired with notched music for treating chronic tinnitus. SUBJECTS AND METHODS: Thirty patients with refractory chronic tinnitus for >12 months were included in this study. A patch-type electrode was attached to the auricular concha of the patient's left ear and tVNS was performed for 30 min (pulse rate 25 Hz, pulse width 200 µs, and amplitude 1-10 mA) using a transcutaneous electric nerve stimulation eco2. During tVNS, the patients listened to notched music cleared of the frequency spectrum corresponding to the tinnitus with a 0.5 octave notch width. RESULTS: After 10 treatment sessions, 15/30 patients (50%) reported symptom relief in terms of a global improvement questionnaire. The mean tinnitus loudness (10-point scale) and the mean tinnitus awareness score (%) improved significantly from 6.32±2.06 to 5.16±1.52 and from 82.40±24.37% to 65.60±28.15%, respectively (both p<0.05). None of the patients had any specific side effects, such as changes in heart rate or blood pressure. CONCLUSIONS: This study has demonstrated the feasibility and safety of tVNS paired with notched music therapy in patients with chronic tinnitus, with the use of a pad-type electrode attached to the auricular concha.

Prognostic factors for the outcomes of intratympanic dexamethasone in the treatment of acute subjective tinnitus.

OBJECTIVE: To determine the prognostic factors for the outcomes of treating acute subjective tinnitus with intratympanic dexamethasone (ITD). STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: We enrolled 139 subjects who were treated with ITD for acute subjective tinnitus with symptoms lasting for 3 months or less. Overall, 114 of 139 subjects completed questionnaires 3 months after treatment or fully recovered within 3 months. Audiograms were performed 3 months after treatment in 43 patients. INTERVENTION: ITD for acute subjective tinnitus. MAIN OUTCOME MEASURE: Quantitative assessment of the severity of tinnitus by questionnaires and changes in hearing thresholds at all frequencies by pure-tone audiometry. RESULTS: Tinnitus was cured in 43 of 114 patients (37.7%) within 3 months. The mean tinnitus loudness score, the mean tinnitus awareness score, and the mean tinnitus handicap inventory score were significantly reduced at 3 months after ITD. Audiometric responses were detected in 12 of 43 patients (27.9%) who underwent follow-up audiograms. The cure rate was significantly greater in patients with symptoms lasting for 2 weeks or less than in patients with symptoms lasting for more than 1 month (64.7% vs. 15.7%; p < 0.05). The mean global improvement index for tinnitus was significantly greater in patients with unilateral tinnitus than in patients with bilateral tinnitus (6.2 ± 1.9 vs. 5.0 ± 2.0; p < 0.05). Among patients with unilateral tinnitus, the audiometric response rate was significantly greater in patients with asymmetric hearing threshold than in patients with symmetric hearing threshold (48.8% vs. 4.8%; p < 0.01). The cure rate was significantly associated with the duration of symptoms. Unilateral tinnitus and audiologic asymmetry were positively associated with the audiometric response rate. CONCLUSIONS: The duration of symptoms affected the cure rate of ITD for acute subjective tinnitus. Unilateral tinnitus was associated with better improvements in symptoms than bilateral tinnitus. Furthermore, unilateral tinnitus and audiologic asymmetry were positively associated with the audiometric response.

Comparison of the effectiveness of monitoring Cisplatin-induced ototoxicity with extended high-frequency pure-tone audiometry or distortion-product otoacoustic emission.

BACKGROUND AND OBJECTIVES: To compare the effectiveness of monitoring cisplatin-induced ototoxicity in adult patients using extended high-frequency pure-tone audiometry (EHF-PTA) or distortion-product otoacoustic emission (DP-OAE) and to evaluate the concurrence of ototoxicity and nephrotoxicity in cisplatin-treated patients. SUBJECTS AND METHODS: EHF-PTA was measured at frequencies of 0.25, 0.5, 1, 2, 3, 4, 6, 8, 9, 11.2, 12.5, 14, 16, 18, and 20 kHz and DP-OAE at frequencies of 0.5, 0.75, 1, 1.5, 2, 3, 4, 6, and 8 kHz in cisplatin-treated patients (n=10). Baseline evaluations were made immediately before chemotherapy and additional tests were performed before each of six cycles of cisplatin treatment. Laboratory tests to monitor nephrotoxicity were included before every cycle of chemotherapy. RESULTS: Four of 10 patients showed threshold changes on EHF-PTA. Five of 10 patients showed reductions in DP-OAE, but one was a false-positive result. The results of EHF-PTA and DP-OAE were consistent in two patients. Only one patient displayed nephrotoxicity on laboratory tests after the third cycle. CONCLUSIONS: In our study, the incidence rate of cisplatin-induced ototoxicity was 40% with EHF-PTA or DP-OAE. Although both EHF-PTA and DP-OAE showed the same sensitivity in detecting ototoxicity, they did not produce the same results in all patients. These two hearing tests could be used to complement one another. Clinicians should use both tests simultaneously in every cycle of chemotherapy to ensure the detection of ototoxicity.