Sudden Sensorineural Hearing Loss in Patients Aged from 15 to 40 Years.

Objectives: The purpose of this study was to investigate the hearing characteristics and causes of sudden sensorineural hearing loss (SSNHL) in patients aged from 15 to 40 years, focusing on audiological outcomes one year after the diagnosis. Methods: The medical records of individuals with SSNHL who were referred to our tertiary-level audiologic center were reviewed. All patients had undergone comprehensive diagnostic evaluations, including high-resolution 3D-FLAIR delayed magnetic resonance imaging (MRI), cone beam computed tomography (CBCT), and screening for coagulation, infectious, and autoimmune diseases. Results: Overall, 56 patients (mean age 28.1 ± 7.6 years) were included in the study. The hearing threshold in the affected ear improved significantly from 56.0 ± 18.0 dB at the diagnosis to 46.9 ± 22.3 dB after one year (p = 0.02). The degree of hearing loss, audiometric configurations, hearing improvements, and adherence to hearing treatments showed considerable variability among patients. Aural fullness, tinnitus, and hyperacusis were the predominant symptoms associated with SSNHL, and their prevalence decreased significantly over time. The diagnostic protocol led to the identification of the specific cause of SSNHL in 75% (42/56) of patients. The known etiology was found to be otological (39.3%), infectious (21.4%), autoimmune (7.1%), vascular (5.4%), or neoplastic (1.8%). In particular, Menière's disease (n = 12), isolated cochlear endolymphatic hydrops (n = 6), HSV-1 (n = 5), and EBV (n = 4) infections were the most frequent causes of SSNHL. Conclusions: The identification of the specific etiology of SSNHL may facilitate a more personalized approach to management and treatment.

Differences between Pressurized and Non-Pressurized Transient-Evoked Otoacoustic Emissions in Neonatal Subjects.

INTRODUCTION: Recently, Interacoustics presented a new otoacoustic emission protocol where the probe pressurizes the ear cavity, thus eliminates the risk of non-assessment (REFER outcome) due to a negative middle ear pressure. This study evaluated the characteristics and the performance of this new protocol on a newborn well-baby population. METHODS: One hundred sixty-three newborns (age 2.7 ± 1.1 days) for a total of 294 ears were assessed randomly. Transiently evoked otoacoustic responses were acquired by the Titan device (Interacoustics), using the default and a pressurized TEOAE protocol. The data were analyzed in terms of signal to noise ratios (S/Ns) at 5 frequencies, namely, 0.87, 1.94, 2.96, 3.97, and 4.97 kHz. To assess any possible gestational age (GE) effects on the TEOAE variables, the responses were subdivided in 4 different age subgroups. RESULTS: There were no significant differences between the left and right ear TEOAE responses, for age (in days), GE (in weeks), weight (in grams), and S/N at all 5 frequencies. Considering the pooled 294 ears, paired t tests between the default and the pressurized TEOAE data showed significant differences across all 5 frequencies (p < 0.01). The pressurized protocol generated TEOAE responses presenting larger S/Ns, and a positive additive effect of approximately 2.31 dB was observed at all tested frequencies. There were no significant GE effects on the pressurized TEOAE responses. In terms of performance, both protocols performed equally (same number of PASSes). CONCLUSION: The pressurized TEOAE protocol generates responses with higher S/Ns which might be useful in borderline cases where the middle ear status might cause a REFER screening outcome.

Early Magnetic Resonance Imaging for Patients With Idiopathic Sudden Sensorineural Hearing Loss in an Emergency Setting.

OBJECTIVE: The role of magnetic resonance (MR) imaging in idiopathic sudden sensorineural hearing loss (ISSHL) is controversial due to the inhomogeneity of clinical and MR protocols. The aim of this work is to relate early MR findings obtained immediately after the admission, with the clinical presentation, the audiological findings, and the outcomes of treatment. STUDY DESIGN: Prospective observational study. SETTING: Tertiary referral university center. PATIENTS: Forty-seven patients (22 M, 25 F; age: 54.4 ±â€Š17.5 yr) consecutively referred to the Department of Emergency for ISSHL. INTERVENTIONS: All patients underwent the diagnostic and therapeutic work-up for ISSHL, and MR imaging within 72 hours from the admission, independently of the symptoms onset. All patients received the same treatment (systemic steroid therapy, intratympanic steroid injection, and hyperbaric oxygen therapy). MAIN OUTCOME MEASURE(S): MR patterns, clinical, and laboratory findings. RESULTS: MR imaging was positive in 25 of 47 cases (53%), with a perfect agreement between clinical and MR examinations (Cohen K = 1) upon the affected ear. Three different radiological patterns were observed: labyrinthine haemorrhage (n = 5), acute inflammatory process (n = 14), isolated blood-labyrinth barrier breakdown (n = 6). By binary logistic regression, only vertigo was associated with a positive MR imaging [B = 2.8; p = 0.011; OR = 9.5 (95% CI: 2.2-40.8)] and the latter was the only variable associated with an unfavorable outcome [(B = 2.8; p = 0.02 OR = 12.8 (95% CI: 2.9-56.7)]. CONCLUSION: Patients affected by ISSHL with associated vertigo show a higher likelihood of having a positive MR imaging, which, in turn, seems to predict an unfavorable outcome.

The occlusal imaging and analysis system by T-scan III in tinnitus patients.

BACKGROUND: Several studies have demonstrated that the prevalence of temporomandibular disorders (TMDs) in tinnitus patients ranges from 7% to 95%, and it is reported in literature that idiopathic tinnitus patients should be referred to a dentist to define whether or not the tinnitus is associated with TMD. However, the possible pathophysiological relation between TMDs and tinnitus is not generally investigated in clinical practice. METHODS: The patterns and forces of occlusal contacts have been studied by means of T-scan III in 47 tinnitus patients (23 suffering from idiopathic tinnitus and 24 affected by Ménière disease [MD]) and 13 healthy subjects. RESULTS: The center of force target was offset in the opposite direction in 15/23 idiopathic tinnitus and in 7/24 MD patients (p = 0.026). No significant variation was found in the occlusal force. CONCLUSIONS: Our data suggest that a diagnostic screening method for occlusal stability in the intercuspidal position might be clinically useful in idiopathic tinnitus patients.

Ménière disease and gluten sensitivity: recovery after a gluten-free diet.

We report the case of a 63-year-old female with definite unilateral Ménière disease, osteoarthritis of the distal finger joints with mucous cysts and Heberden's nodes, and constipation with recurrent abdominal pain whose symptoms remitted after 6months of a restrictive gluten-free diet.

Benign paroxysmal positional vertigo and tinnitus.

INTRODUCTION: In our clinical experience, some of the patients affected by benign paroxysmal positional vertigo (BPPV) reported the onset of tinnitus shortly before or in association with the positional vertigo. OBJECTIVES: The aim of this study was to describe the prevalence and the clinical patterns of tinnitus episodes which occurred in association with BPPV and to suggest possible interpretative hypotheses. METHODS: 171 normal hearing patients affected by BPPV (50 males and 122 females; age range: 25-77 years; mean age 60.3 years ± 14.9) underwent pure tone audiometry, immittance test and a clinical vestibular evaluation before and after repositioning manoeuvers. Those suffering from tinnitus were also assessed using visual analogue scales and tinnitus handicap inventory. RESULTS: 19.3% of the patients reported the appearance of tinnitus concurrently with the onset of the positional vertigo. It was mostly unilateral, localized on the same ear as the BPPV, slight in intensity and intermittent. Tinnitus disappeared or decreased in all patients except two, either spontaneously, before performing the therapeutic manoeuvers, or shortly after. CONCLUSIONS: A possible vestibular origin of tinnitus determined by the detachment of macular debris into the ductus reuniens and cochlear duct is discussed.

Auditory late potentials in normal-hearing adult subjects with Down's syndrome.

OBJECTIVE: Several studies have demonstrated that adult subjects with Down's syndrome (DS) and hearing impairments show significantly delayed latencies in auditory late potentials (ALPs). The aim of this study was to investigate whether the differences were still present in ALPs in an adult DS population with normal hearing, taking into consideration sex, handedness, and head size. STUDY DESIGN: Prospective study. SETTING: Audiology unit of the hospital Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. PATIENTS: Sixteen normal-hearing adult DS subjects referred to the health monitoring program for DS patients of Vivi Down Onlus Association in Milan, Italy (7 male subjects with a mean age of 26 ± 7.74 yr and 9 female subjects with a mean age of 28 ± 8.63 yr) and 16 controls (7 male subjects with a mean age of 26 ± 7.74 yr and 9 female subjects with a mean age of 28 ± 8.86 yr) matched for sex, age, and handedness. MAIN OUTCOME MEASURE: The 2 negative peaks, N1 and N2, and the 2 positive peaks, P1 and P2, of ALP. RESULTS: ALP N1 and P2 components were well defined in all subjects. The P1 and N2 components were less evident than the others. There were significant delayed latencies in the DS group with respect to the control subjects for P1, N1, P2, and N2 components. CONCLUSION: Our study demonstrated that ALP longer latencies are present in adult DS participants even when they have a normal hearing threshold, regardless of handedness and head size.

The influence of music on static posturography.

It is well known that high intensity sounds modify balance by activating the saccule, which is sensitive to both vestibular and acoustic stimuli. Few studies have examined the effects of music on the postural responses in healthy subjects. The aim of this study was to evaluate the influence of different types of music (Mozart, Köhler, Köhler with a carrier of 12 KHz and subjects' favourite music) on twelve healthy subjects standing on a stabilometric platform. With each type of music, all subjects underwent static posturography with eyes opened and eyes closed, and with and without foam pads. We evaluated the length and the surface of body sway and the correlation between them, and we analyzed the visual, vestibular and somatosensory sub-components. Listening to different types of music did not significantly change the stabilometric variables, with the exception of listening to Mozart's Jupiter, which caused a significant reduction in the visual component with a consequent increase in both the vestibular and somatosensory inputs. Further studies are needed to determine the effect of Mozart's music in modifying the sensory strategy in the rehabilitation of patients with vestibular impairments.

The use of rubber foam pads and "sensory ratios" to reduce variability in static posturography assessment.

UNLABELLED: Despite the numerous works published, static posturography has still a limited clinical use due to its intrinsic inter-individual high variability. For this reason, foam pads have been introduced but their use is still not standardized. Aim of the study was to define the variability of static posturography parameters in standard and foam standing. METHODS: 50 healthy subjects were studied with static posturography in four standing conditions: eyes open (EO) and eyes closed (EC), with and without foam pads. Unstable tests have been performed with two different types of rubber foam pads placed on the force platform. "Sensory ratios" have been calculated by the ratio of sway length among the four different conditions, adapted from dynamic posturography, in order to measure the relative contributions of vestibular, visual and somatosensory inputs. RESULTS: Static posturography in standard conditions showed unacceptable coefficients of variation (>than 15%) for all the parameters. The use of foam pads reduced the high intrinsic variability, in particular for LFS (12.6-15.4%). The use of "sensory ratios" led to decrease the inter-subject coefficient of variation of this measurement to about 9.47-14.42% using the bilayer foam pads. CONCLUSIONS: Further studies are needed to confirm these data by applying the ratio formulas in clinical practice.

Auditory brainstem responses (ABR) in normal hearing adult subjects with Down's syndrome.

BACKGROUND: Auditory brainstem responses (ABRs) have been previously investigated in subjects with Down's syndrome (DS), but the published data are generally from children with hearing loss. The aim of this study was to evaluate the hearing pathway in normal hearing adult DS patients. METHODS: We used ABRs to analyze absolute and interpeak latencies in 19 adult DS patients aged 18-45 years whose pure tone audiometry (PTA) test results indicated thresholds within normal limits, and 19 normal controls. RESULTS: The DS sample showed statistically significant gender-related differences in interpeak interval III-V (p = 0.015). The latencies of waves III and V, and interpeak intervals III-V and I-V, were significantly shortened in the DS patients than in the controls. CONCLUSIONS: Our findings may be due to the smaller brain sizes and simpler afferent auditory pathways of DS subjects.