Audiological Patterns in Patients with Autoimmune Hearing Loss.

INTRODUCTION: The aim of this study was to illustrate clinical and audiological patterns of hearing impairment in patients with autoimmune hearing loss (AIHL). METHODS: Fifty-three patients with AIHL were retrospectively recruited, and a tapering schema of steroid treatment was administered in all these patients. The diagnosis of AIHL was essentially based on clinical symptoms, such as recurrent, sudden (sensorineural hearing loss [SSHL]), fluctuating, or quickly progressing (<12 months) SSHL (uni-/bilateral), in association with the coexistence of autoimmune diseases, high antinuclear antibodies (ANA) and the presence of human leukocyte antigen (HLA) B27, B35, B51, C04, and C07. Logistic regression analysis was applied to correlate the clinical data and laboratory features of AIHL with final outcomes. RESULTS: The onset of AIHL was mainly progressive (49%), followed by SSHL (39.6%) or fluctuating (11.3%). The pure-tone audiogram showed more commonly a downsloping pattern (42.6% of ears), but also an upsloping, flat, cookie-bite, or inverse cookie-bite shape. Bilateral progressive AIHL was more frequently simultaneous (23 patients) than heterochronous (4 patients). Nineteen patients (35.8%) showed a favorable response to steroid therapy. The presence of recurrent, bilateral SSHL versus recurrent, unilateral SSHL had statistically negative effect on hearing recovery (OR = 0.042, p < 0.05). The heterochronous bilateral SSHL may have better prognosis than simultaneous bilateral SSHL (OR = 10.000, p = 0.099). The gender, age, concomitant autoimmune disease, high ANA, HLA alleles, tinnitus, and vestibular symptoms had no statistical effect on a favorable outcome of AIHL. CONCLUSIONS: A bilateral, simultaneous, and progressive hearing loss combined with downsloping audiogram occurred more often in patients with AIHL. Bilateral simultaneous SSHL with recurrences represents the worse prognostic form of AIHL.

The effectiveness of hyperbaric oxygen therapy on the final outcome of patients with sudden sensorineural hearing loss.

PURPOSE: To evaluate the therapeutic effect of the combination of systemic steroids (SS) and hyperbaric oxygen therapy (HBOT) in patients with idiopathic sudden sensorineural hearing loss (SSNHL). MATERIALS AND METHODS: Fifty patients with idiopathic sudden sensorineural hearing loss were allocated into 2 groups: the control group received Dexamethasone IV (SS) and the therapy group received Dexamethasone IV combined with 15 sessions of hyperbaric oxygen therapy (SS + HBOT) as initial treatment. Hearing assessment was performed at the admission to hospital and 3 months after the onset of treatment. Siegel's criteria were used to evaluate the hearing outcomes. Prognostic factors were identified by linear regression analyses. RESULTS: Hearing improvement rate was 64 % in the therapy group and 56 % in the control group, difference which was not statistically significant (p = 0.369). Furthermore, when patients of each group were categorized into 5 subgroups by disease severity (mild, moderate, moderate to severe, severe, profound), differences in treatment outcome between the subgroups of the same severity were not significant. A descending type audiogram curve was proven an unfavorable prognostic factor in both groups, as it led to a significantly lower hearing gain (30 dB) compared to other curve shapes (b = -29.10, 95 % CI = -56.39, -1.82). CONCLUSIONS: The addition of hyperbaric oxygen therapy to systemic steroids caused no significant hearing improvement, despite a mild tendency toward a greater improvement rate within the combination group. More prospective randomized trials with larger series of patients could shed even more light on the effectiveness of combination therapy (SS + HBOT) in patients affected by SSNHL.

Facial nerve palsy in children: A retrospective study of 124 cases.

AIM: To report the causes and clinical evaluation of children with facial nerve palsy (FNP) admitted to an affiliated university hospital during a 5-year period (2011-2015). METHODS: A total of 124 children were retrospectively categorised into two groups: idiopathic Bell's palsy (109 patients) and the second group into other FNP aetiologies (15 patients). All children received a standardised work-up and follow-up. Therapy consisted of steroid administration associated with antiviral treatment when a viral infection was suspected. RESULTS: All children of the first group had a full recovery under oral steroids within 2 months of treatment. From the second group, seven children (46%) had a viral infection based on serological findings, two of them were positive for neurotropic herpes viruses, and one had Ramsay Hunt syndrome; six children with infectious FNP had recurrent FNP on the ipsilateral or contralateral side. Five patients had FNP as a complication of acute otitis media; three of them (60%) had partial or full recovery postoperatively. One child developed FNP following temporal bone trauma that had an uneventful recovery with conservative treatment. One child suffered from Melkersson-Rosenthal syndrome, and another child presented with FNP associated with unilateral hemiparesis following an ischaemic cerebral infarct. CONCLUSIONS: Facial palsy in children is a manifestation of a heterogeneous group of causes. The most common aetiology of FNP in children in our study was idiopathic (Bell's palsy), followed by infective causes, such as acute otitis media and neurotropic herpes viruses. Therefore, treatment should be adapted to each patient depending on the underlying disease and severity of FNP.

Systemic, intratympanic and combined administration of steroids for sudden hearing loss. A prospective randomized multicenter trial.

PURPOSE: The purpose of this prospective, randomized, multicenter clinical trial was to compare the therapeutic efficacy of systemic versus intratympanic versus combined administration of steroids in the treatment of idiopathic sudden sensorineural hearing loss. METHODS: 102 patients with an up to 14 days history of idiopathic sudden sensorineural hearing loss were randomized to 1 of 3 arms and followed prospectively. Group A (35 patients) received prednisolone intravenously followed by methylprednisolone orally, whereas Group B (34 patients) were administered intratympanic methylprednisolone. Patients in Group C (33 patients) were administered the combination of the above-mentioned treatment modalities. The patients were followed-up with pure tone audiograms on days 1 (initiation of treatment), 3, 5, 10, 30 and 90. RESULTS: The final mean hearing gain was 29.0 dB HL for Group A, 27.0 dB HL for Group B and 29.8 dB HL for Group C. The differences between the three groups were not statistically significant. When hearing improvement was assessed according to Siegel's criteria, no statistically significant difference was recorded either. Furthermore, patients younger than 60 years old achieved significantly better hearing outcomes. CONCLUSIONS: The results demonstrated that systemic, intratympanic and combined steroid administration have similar results in the primary treatment of idiopathic sudden hearing loss. Younger patients are more likely to achieve better hearing outcomes.

Utility of otoacoustic emissions and olivocochlear reflex in predicting vulnerability to noise-induced inner ear damage.

AIM: The aim of the present study was to explore the possible utility of otoacoustic emissions (OAEs) and efferent system strength to determine vulnerability to noise exposure in a clinical setting. MATERIALS AND METHODS: The study group comprised 344 volunteers who had just begun mandatory basic training as Hellenic Corps Officers Military Academy cadets. Pure-tone audiograms were obtained on both ears. Participants were also subjected to diagnostic transient-evoked otoacoustic emissions (TEOAEs). Finally, they were all tested for efferent function through the suppression of TEOAEs with contralateral noise. Following baseline evaluation, all cadets fired 10 rounds using a 7.62 mm Heckler & Koch G3A3 assault rifle while lying down in prone position. Immediately after exposure to gunfire noise and no later than 10 h, all participants completed an identical protocol for a second time, which was then repeated a third time, 30 days later. RESULTS: The data showed that after the firing drill, 280 participants suffered a temporary threshold shift (TTS) (468 ears), while in the third evaluation conducted 30 days after exposure, 142 of these ears still presented a threshold shift compared to the baseline evaluation [permanent threshold shift (PTS) ears]. A receiver operating characteristics curve analysis showed that OAEs amplitude is predictive of future TTS and PTS. The results were slightly different for the suppression of OAEs showing only a slight trend toward significance. The curves were used to determine cut points to evaluate the likelihood of TTS/PTS for OAEs amplitude in the baseline evaluation. Decision limits yielding 71.6% sensitivity were 12.45 dB SPL with 63.8% specificity for PTS, and 50% sensitivity were 12.35 dB SPL with 68.2% specificity for TTS. CONCLUSIONS: Interestingly, the above data yielded tentative evidence to suggest that OAEs amplitude is both sensitive and specific enough to efficiently identify participants who are particularly susceptible to hearing loss caused by impulse noise generated by firearms. Hearing conservation programs may therefore want to consider including such tests in their routine. As far as efferent strength is concerned, we feel that further research is due, before implementing the suppression of OAEs in hearing conservations programs in a similar manner.

Giant submandibular gland mucocele as a complication of previous sialolith removal.

Mucoceles are common lesions of minor salivary glands. Mucoceles of the major salivary glands including the submandibular gland are extremely rare, but should be considered in the differential diagnosis of submandibular space swellings. We present a rare case of a 25-year old man, who was diagnosed with a submandibular gland mucocele and had a history of sialolithiasis and intraductal sialolith excision, as well as numerous evacuating punctures and needle aspirations of the mass. The cyst was surgically excised and the specimen included the sublingual gland, in order to prevent recurrence. No postoperative complications were noted.

Hyperbaric Oxygen Therapy in the Treatment of Sudden Sensorineural Hearing Loss.

Sudden sensorineural hearing loss (SSHL) is a frustrating and frightening experience for a patient [...].

Facial Palsy Secondary to Cholesteatoma: A Case-Series of 14 Patients.

BACKGROUND: To evaluate patients with middle ear cholesteatoma presenting with facial palsy (FP). MATERIAL-METHODS: A total of 14 subjects (10 males and 4 females), with a mean age of 42.5 years, were included in our study. The majority of patients presented with incomplete FP (House-Brackmann HB II-IV, 11 cases) and the remaining 3 patients had complete facial paralysis (HB V-VI). A canal wall down mastoidectomy was performed in all the patients, followed by partial facial nerve decompression. RESULTS: At the one-year follow-up, eleven (78.5%) patients demonstrated satisfactory recovery to HB I-II. Facial function recovered to HB grade I-II in 9 (100%) patients who were surgically treated within one month, and in 2 (40%) patients who underwent surgery after one month. The tympanic segment of facial nerve was the most common site of involvement (8 patients). The multiple regression analysis showed that a higher preoperative HB grade combined with a gradual than sudden onset of FP more likely resulted in worse postoperative HB grade. CONCLUSION: Early surgical removal of cholesteatoma associated with FP is more likely to result in good facial nerve recovery (78.5% of cases), when it is performed within one month from the onset of FP. According to the literature, the tympanic segment of the facial nerve was more frequently damaged (77.7%), followed by the mastoid segment (22.9%), labyrinthine segment (11.1%), and geniculate ganglion (11.1%). Labyrinthine fistula, mainly of the lateral semicircular canal, can be expected in cases of facial nerve dehiscence. The canal wall down mastoidectomy combined with partial decompression surgery was the most preferred surgical treatment for the FP secondary to cholesteatoma.

The Effect of Anxiolytics on Tinnitus.

Tinnitus is a perceptual disorder in which sound is perceived by the patient in the absence of an external or internal acoustic stimulation [...].

Socio-Economic Status and Language Development in Hearing Loss: A Critical Appraisal.

The impact of language input on children's speech, language, and brain development was borne out of Hart and Risley's famous "30-million-word gap". A perspective bolstered by many studies in the last decade relates higher socio-economic status (SES) to better qualitative and quantitative differences in children's speech. The logic chains found in these studies suggest that literacy development depends on language and brain development. Thus, brain building develops based on environmental experience and language input depends on the brain's perception of the auditory information. This essay uses the latest published peer-reviewed research to outline the current landscape of the role of SES in the development of speech and language skills among children with hearing loss (HL) who are enrolled in auditory-driven habilitation programs. This essay argues that low SES families may provide sufficient input for their children. The outcome of auditory-driven programs implemented by speech-language pathologists (SLPs) seems to be detached from SES. The role of SES on this developmental trajectory remains unclear, and clinical practice may be related to other validated and robust parameters related to hearing loss.

Patient-Assessed Outcomes following Temporal Bone Fractures.

The long-term impact of neurotological symptoms after a temporal bone fracture (TBF), including facial nerve palsy (FP), hearing loss, tinnitus, and dizziness on the quality of life of patients is often underevaluated. Thus, we retrospectively assessed 30 patients with TBF (26 men and 4 women) in our university tertiary referral center. They participated from injury onset to the final follow-up, over an 18-month period. Quality of life was estimated using validated questionnaires, such as the Facial Disability Index (FDI: physical and social), Hearing Handicap Inventory (HHI), Tinnitus Handicap Inventory (THI), and Dizziness Handicap Inventory (DHI). The FDI score was significantly worse in patients with severe initial (for physical FDI) and final facial palsy (for both physical and social FDI), mainly with immediate onset. The HHI score was statistically worse in patients with mixed hearing loss compared to those with conductive or sensorineural hearing loss and in those with profound hearing loss vs. normal hearing. The mixed TBF and the severity of hearing loss (especially profound hearing loss) were correlated with HHI, THI and DHI score values. In the long-term period after a TBF, moderate or severe facial palsy, mainly with immediate onset, may cause psychological distress, more easily resulting in social disability than functional impairment. Mixed TBF and mixed or profound hearing loss may also negatively influence quality of life.

Autoimmune Hearing Loss: A Diagnostic Challenge.

Autoimmune hearing loss (AIHL) is a clinical disease and may involve the deposition of immune complexes in the labyrinth vessels, the activation of the complement system, the functional alteration in T-cell subpopulations, or an inflammation process in the inner ear [...].

Epistaxis in dental and maxillofacial practice: a comprehensive review.

The lifetime incidence of epistaxis in dental and maxillofacial practice has been reported to be as high as 60% and can be caused by dental implant placement, Le Fort I osteotomy, intranasal supernumerary tooth, odontogenic tumors, blood disorders and maxillofacial trauma. Most epistaxis cases are minor and easily managed with direct compression on the nares for 10 minutes. For more significant or recurrent epistaxis, other techniques might include electrocautery, anterior or posterior nasal packing, or Foley catheter balloon. For patients with refractory epistaxis, cauterization of the sphenopalatine artery under endonasal endoscopy or embolization of the internal maxillary artery should be performed. Epistaxis control is required in patients diagnosed with inherited or acquired bleeding disorders or with drug-induced coagulopathies during dental procedures. In these cases, hemostatic system adjustment and hemostasis achieved by local and adjunctive methods are required. Dentists and maxillofacial surgeons must be aware that the nasal cavity is a potential source of perioperative hemorrhage. Depending on the invasiveness of the dental intervention, preoperative involvement of the hematologist and cardiologist is usually necessary to reverse anticoagulation or to cease anticoagulant therapy.

Video Head Impulse Test (vHIT): Value of Gain and Refixation Saccades in Unilateral Vestibular Neuritis.

The aim of this study was to evaluate gain and refixation saccades (covert and overt) using a video head impulse test (vHIT) in the horizontal and vertical planes in patients after the onset of unilateral acute vestibular neuritis (AVN). Thirty-five patients were examined in the acute stage of AVN and at follow-up (range, 6-30 months); a control group of 32 healthy subjects also participated. At onset, the mean gain was significantly lower on the affected side in all of the semi-circular canal planes, mainly in the horizontal canal plane, and saccades (covert and overt) were more prevalent in the horizontal compared to the vertical canal planes. Multi-canal affection occurred more frequently (80% for gain, 71% for saccades) than isolated canal affection. At follow-up, which ranged from 6 to 30 months, the gain was recovered in all of the canals (anterior in 50%, horizontal in 42.8%, and posterior canal in 41.1% of cases), while covert and overt saccades were reduced in the horizontal and vertical planes. However, covert saccades were still recorded in a greater proportion (69%) than overt saccades (57%) in the horizontal plane and at a lower rate in the vertical planes. The compensatory mechanisms after AVN mainly involve the horizontal canal, as the refixation saccades-especially covert ones-were more frequently recorded in the horizontal than vertical canals.

Conversion of canalolithiasis to cupulolithiasis in the course of a horizontal benign paroxysmal positional vertigo case.

The benign paroxysmal positional vertigo of the horizontal semicircular canal is manifested with either geotropic or apogeotropic horizontal nystagmus. A 61-year-old male patient who experienced repeated episodes of positional vertigo is presented in this study. The vertigo was reported to be more severe while rotating his head to the left and then to the right. The initial examination revealed a geotropic purely horizontal nystagmus at the lateral positions of the head compatible with canalolithiasis of the left horizontal semicircular canal. In this case, the otoconia debris migrates from the vestibule into the horizontal semicircular canal through its nonampullary end, where they float freely (canalolithiasis). Five days later, the geotropic nystagmus transformed to apogeotropic. Thus, it may be assumed that the otoconia debris adhered to the cupula and converted the canalolithiasis to cupulolithiasis of the horizontal semicircular canal on the same side. With rotation of the head to the left while the patient was in the supine position, gravity causes the weighted cupula to deflect ampullofugally, resulting in apogeotropic nystagmus; the opposite was noticed when the head was rotated to the right. The so-called barbecue maneuver was initially effective curing the geotropic form of the condition and consequently the modified Semont maneuver for the apogeotropic form.

How Effective Is Auditory-Verbal Therapy (AVT) for Building Language Development of Children with Cochlear Implants? A Systematic Review.

This systematic review sheds light on the effectiveness of auditory-verbal therapy (AVT) outcomes in children with cochlear implants (CIs). The presented outcome is based on research findings from the last 10 years. The systematic review was designed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Critical Appraisal of Treatment Evidence (CATE) checklist. Specific keywords were chosen based on the research question and searched on the PubMed database. All searched papers were analysed based on specific exclusion criteria and classified into four evidence levels. The results revealed that children who participated in AV therapy can achieve linguistic skills at the same level as their hearing peers. Voice quality seemed positively affected, placing young children with CIs in the normal range for receptive vocabulary development. In contrast, reading skills seemed less benefited. AV therapy seems to contribute to integration into mainstream society. Despite the recorded speech and language improvements of young children with CIs, the aim of AV therapy is still not fulfilled. AV therapy can be seen as the best clinical practice for young children with CIs till now, but the lack of well-controlled studies is undermining.

Human Leukocyte Antigen (HLA) Influence on Prognosis of Autoimmune Hearing Loss.

BACKGROUND: To evaluate the effect of human leukocyte antigen (HLA) on hearing outcome in patients suffering from autoimmune hearing loss (AIHL). MATERIALS AND METHODS: The diagnosis of AIHL was essentially based on clinical symptoms, such as recurrent, sudden, fluctuating, or quickly progressing (<12 months) sensorineural hearing loss (uni-/bilateral). The molecular typing of HLA alleles was achieved by using polymerase chain reaction procedures. Patients underwent a tapering schema of steroid treatment and audiometric features were recorded. A logistic regression model was used to identify which HLA typing alleles were statistically significant in patients' response to treatment. RESULTS: Forty patients with AIHL were found to be carriers of HLA B27, B35, B51, C4, C7, and DRB1*04 alleles. No statistically significant influence of HLA B27, B35, B51, C4, C7, DRB1*04 HLA alleles typing was detected for the prognosis of AIHL. In these patients, the onset of AIHL was mainly progressive (53.8%), 29.2% of them had moderate hearing loss, and most of the cases had both bilateral hearing loss (62.5%) and downsloping audiogram (40%). CONCLUSION: The presence of HLA B27, B35, B51, C4, C7, and DRB1*04 alleles had no significant effect on a favorable outcome of AIHL. However, larger samples of patients are necessary in order to improve the knowledge about the HLA influence on the clinical course of AIHL.

Odontogenic maxillary sinusitis: A comprehensive review.

Odontogenic maxillary sinusitis (OMS) is a well-recognized condition in both the dental and otolaryngology communities. Close to 30% of cases of unilateral maxillary sinusitis may have an underlying dental pathology. Failure to identify a dental cause usually lead to cases recalcitrant sinusitis often associated with serious complications. The aim of this study is to describe the literature findings on odontogenic maxillary sinusitis that discuss anatomy, epidemiology, etiology, bacteriology, diagnosis and treatment. The present review is based on a current search using bibliographic database and academic search engine. All the articles on odontogenic maxillary sinusitis published after 2000 were included. This study seeks to provide clinicians with evidence that motivates a comprehensive approach to the evaluation and management of OMS. Controversies on diagnosis and management have been addressed and data from different treatment plans were collected by exploring relevant publications. The surgical treatment of OMS is based essentially on the dental surgery, combined with endoscopic sinus surgery, in order to completely remove the infection, restore the physiological drainage of the sinus and prevent recurrences of sinusitis. A multidisciplinary otolaryngology and dental team is mandatory to successfully manage the dental pathology and the complications resulting from the dental treatments.

Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review.

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere's disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.

An acoustic and auditory analysis of vocants in infants with cochlear implants.

INTRODUCTION: The duration of the nuclei is a crucial factor for the shift of prelexical to mature speech, since control of duration is closely related with improved speech intelligibility. OBJECTIVES: This work records the suprasegmental feature of duration in infants with normal hearing (NH) compared to those with cochlear implants (CI) based on vocant productions (quasivowels and full vowels). MATERINALS AND METHODS: In this longitudinal study, 102 vocant productions were analyzed from cases of congenitally hearing-impaired infants (implantation ages 1:4 and 1:11 years; post-implant ages 0:6 months and 1:3 years) who were matched with three NH infants of similar hearing experience (ages 0:8-0:11 months). Current methodology analyzes vocants using a combination of acoustical and auditory analyses. Vegetative data or reflexive sounds were excluded. Participants had had unknown deafness etiology and no other disabilities. Duration was measured using wideband spectrographic analysis, from voice onset to the loss of audible signal and the decrease of higher formant's energy. RESULTS: The results showed that the mean vocant duration of young CI users was longer, compared to hearing matched peers during the first six months after cochlear implantation. CONCLUSIONS: This recorded weakness for CI users' speech production is a challenge for future work in speech processing strategies. This is the first study measuring production of vocants during the pre-linguistic stage in CI recipients.