Active middle-ear implant fixation in an unusual place: clinical and audiological outcomes.

OBJECTIVE: The Vibrant Soundbridge is an active middle-ear implant for hearing rehabilitation that is usually placed in the long process of the incus or round window. This study reports on the unusual implant attachment to the short process of the incus in a patient with ear malformation, and describes their audiological and clinical outcomes. METHODS: Case report and literature review. RESULTS: Audiological evaluation with the Vibrant Soundbridge implant showed a pure tone average of 31 dB. The speech test, at 65 dB HL, revealed correct recognition of 92 per cent of disyllabic words. The Glasgow Hearing Aid Benefit Profile showed high levels of satisfaction, hearing aid use and benefit. CONCLUSION: Fixation of the Vibrant Soundbridge implant on the short process of the incus is a feasible option, with good clinical and audiological outcomes. Coupling the floating mass transducer to the short process of the incus is a good surgical option, especially when the long process and the oval or round window are inaccessible.

Reversible hearing loss from cerebellopontine angle tumors.

We report two patients who presented with a dramatic recovery from severe sensorineural hearing loss after total surgical removal of cerebellopontine angle tumors (meningioma and jugular foramen neurinoma). The factors that differentiate these "non-acoustic tumors" in relation to the prognosis for hearing are discussed. A surgical approach that maintains the labyrinthine structure and preserves the arachnoid membrane of the superior cerebellopontine angle cistern during tumor removal is stressed.

Results and prognostic factors in skull base surgery.

The charts of 81 patients who underwent skull base surgery between 1982 and 1993 were reviewed retrospectively. Data relative to demographic aspects, clinical stage, previous treatment, surgical approach, type of reconstruction, histology, extent of disease, complications, and follow-up were analyzed. The craniofacial approach for the anterior fossa was used in 53% of patients, the lateral skull base approach in 12%, and a combination of both in 17. Malignant tumors were diagnosed in 58 patients (72%), and histologically benign tumors in the remaining 23 (28%). Forty-one patients (51%) had skin cancer. There was dural invasion in 31 patients (38%), and 32 (40%) underwent microsurgical flap reconstruction. From the malignant group, 31 (53%) were alive with no evidence of disease (NED), and 6 (10%) were alive with disease. From the benign group, 19 (83%) were alive NED. The most common complications were cerebrospinal-fluid fistula (10%) and flap necrosis (9%). Statistical analyses of survival showed significantly different rates associated with histologic types (P = 0.0002), type of reconstruction (P = 0.0039), and previous treatment (P = 0.0018).

Clinical and surgical aspects of cholesteatomas in children.

A review of 101 charts of pediatric patients who underwent surgery for cholesteatoma in the Hospital das Clínicas, São Paulo, Brazil, showed that the peak incidence was in the 10- to 15-year-old age group (mean age, 10.7 years). A high incidence of complications (45.5%) and a significant functional impairment (air-bone gap greater than 40 dB in 49% of patients) were some of the particular features of our patients. Radical or modified radical mastoidectomies were performed in 75 cases (74.3% of cases). The open technique was chosen primarily to eradicate cholesteomatous disease, but the satisfactory functional results also achieved support our preference for this technique.

Morphological and functional study of the cochlea after administration of estrogen and progesterone in the guinea pig.

The aim of this study was to analyze the morphological cochlear changes and auditory function observed after the administration of estrogen or progesterone or both. Sixty-two guinea pigs were divided into four groups that received estrogen (group 1), progesterone (group 2), estrogen and progesterone (group 3), and saline solution (controls, group 4), respectively. The auditory evaluation consisted of brainstem evoked response audiometry, performed before and after drug administration. Structural analysis was based on histological hematoxylin and eosin staining preparations. Our results showed changes in latency and amplitude of waves in the study groups that received estrogen or progesterone. The main histological changes observed were inflammatory infiltrate and vacuolization of the stria vascularis. Our results suggest that both estrogen and progesterone lead to morphological and physiological lesions of the cochlea, the degree of the observed lesions depending not only on the presence of these hormones but also on the proportion between them.

Evaluation of antioxidant treatment in presbyacusis: prospective, placebo-controlled, double-blind, randomised trial.

OBJECTIVE: There are many well-known aetiological mechanisms of presbyacusis, and free radicals have been shown to play an important role. This study aimed to evaluate the effect of antioxidant agents on the hearing threshold of patients with presbyacusis. METHODS: One hundred and twenty individuals were divided into four groups and received one of the following treatment schemes: ginkgo biloba dry extract, α-lipoic acid plus vitamin C, papaverine chlorhydrate plus vitamin E, or placebo. All participants were evaluated at recruitment and after six months, using pure tone audiometry (at isolated and average frequencies), speech recognition threshold and percentage index of speech recognition. RESULTS: The various treatments had no effect on any of the evaluated measures of hearing, either between groups or over time. CONCLUSION: There was no statistically significant change in the hearing threshold after treatment with any of the tested drugs, during the study period.

Classification and hearing evolution of patients with sudden sensorineural hearing loss.

The aim of this study was to analyze clinical aspects, hearing evolution and efficacy of clinical treatment of patients with sudden sensorineural hearing loss (SSNHL). This was a prospective clinical study of 136 consecutive patients with SSNHL divided into three groups after diagnostic evaluation: patients with defined etiology (DE, N = 13, 10%), concurrent diseases (CD, N = 63, 46.04%) and idiopathic sudden sensorineural hearing loss (ISSHL, N = 60, 43.9%). Initial treatment consisted of prednisone and pentoxifylline. Clinical aspects and hearing evolution for up to 6 months were evaluated. Group CD comprised 73% of patients with metabolic decompensation in the initial evaluation and was significantly older (53.80 years) than groups DE (41.93 years) and ISSHL (39.13 years). Comparison of the mean initial and final hearing loss of the three groups revealed a significant hearing improvement for group CD (P = 0.001) and group ISSHL (P = 0.001). Group DE did not present a significant difference in thresholds. The clinical classification for SSNHL allows the identification of significant differences regarding age, initial and final hearing impairment and likelihood of response to therapy. Elevated age and presence of coexisting disease were associated with a greater initial hearing impact and poorer hearing recovery after 6 months. Patients with defined etiology presented a much more limited response to therapy. The occurrence of decompensated metabolic and cardiovascular diseases and the possibility of first manifestation of auto-immune disease and cerebello-pontine angle tumors justify an adequate protocol for investigation of SSNHL.

Sensorineural hearing loss associated to gonadal dysgenesis in sisters: Perrault's syndrome.

Genetic alterations that involve the inner ear and other systems may present well-defined clinical differences. We present two oriental sisters, age 34 and 26 years, with a picture of primary amenorrhea and "infantile" uterus associated with progressive hearing loss begun in infancy in the older sister, and after 20 years of age in the younger sister. The gynecologic evaluation showed uterine hypoplasia and gonadal dysgenesis in both sisters. The audiologic study showed bilateral sensorineural hearing loss with a flat-type curve in both cases, with an average threshold of 500, 1000 and 2000 Hz (PTA) in 80 dB (older sister) and 60 dB (younger sister), with recruitment measured by stapedial reflex in the second case. Vocal discrimination was 30 percent and 80 percent, respectively. The clinical picture fits Perrault's syndrome: recessive autosomal genetic alteration, with XX gonadal dysgenesis and sensorineural hearing loss.

Autoimmune sensorineural hearing loss: a preliminary experimental study.

The aim of this study was to compare cochlear alterations produced by induction of anti-type II collagen antibodies with alterations produced by passive transfer of anticochlear antibodies. Guinea pigs (GP) were used. The anticochlear antibodies were obtained by injecting GP membranous cochlea plus Freund's adjuvant into rabbits. After partial purification of the immunoglobulins, the antibodies (20 mg) were injected intramuscularly into 10 normal GP. A second group of 10 normal GP received intramuscular injections of purified chicken type II collagen (1 mg) plus Freund's adjuvant. A control group of 10 normal GP was studied under the same conditions without any stimulus. The cochlea function was analysed with brainstem evoked audiometry (BERA). The structural study was carried out by immunofluorescent and hematoxylin preparations. The results showed structural alterations in both experimental groups (loss of nucleus in the spiral ganglion); however, significant changes in the BERA were not found. Only increase of the latency of wave I could be seen. These preliminary results support the hypothesis that antibodies to collagen type II may play an important role in human autoimmune sensorineural hearing loss, but the possible existence of other cochlear antigens is discussed.

Classification and hearing evolution of patients with sudden sensorineural hearing loss

The aim of this study was to analyze clinical aspects, hearing evolution and efficacy of clinical treatment of patients with sudden sensorineural hearing loss (SSNHL). This was a prospective clinical study of 136 consecutive patients with SSNHL divided into three groups after diagnostic evaluation: patients with defined etiology (DE, N = 13, 10%), concurrent diseases (CD, N = 63, 46.04%) and idiopathic sudden sensorineural hearing loss (ISSHL, N = 60, 43.9%). Initial treatment consisted of prednisone and pentoxifylline. Clinical aspects and hearing evolution for up to 6 months were evaluated. Group CD comprised 73% of patients with metabolic decompensation in the initial evaluation and was significantly older (53.80 years) than groups DE (41.93 years) and ISSHL (39.13 years). Comparison of the mean initial and final hearing loss of the three groups revealed a significant hearing improvement for group CD (P = 0.001) and group ISSHL (P = 0.001). Group DE did not present a significant difference inthresholds. The clinical classification for SSNHL allows the identification of significant differences regarding age, initial and final hearing impairment and likelihood of response to therapy. Elevated age and presence of coexisting disease were associated with a greater initial hearing impact and poorer hearing recovery after 6 months. Patients with defined etiology presented a much more limited response to therapy. The occurrence of decompensated metabolic and cardiovascular diseases and the possibility of first manifestation of auto-immune disease and cerebello-pontine angle tumors justify an adequate protocol for investigation of SSNHL.

Clinical and histopathological changes of the nasal mucosa induced by occupational exposure to sulphuric acid mists.

AIMS: To assess potential alterations of the nasal mucosa by clinical and histopathological evaluation of workers exposed to sulphuric acid mists at anodising plants, correlating the findings with duration of exposure and sulphuric acid concentrations in the air, and comparing them with a control group. METHODS: Fifty two workers from five plants underwent a clinical evaluation (standard questionnaire, clinical, and ear, nose, and throat examination including nasal endoscopy). For the histopathological study, 20 of the 52 subjects (study group) were randomly selected, as well as 11 unexposed subjects (control group), matched by sex, age, and smoking habits. Nasal biopsy specimens were obtained from the anterior septum mucosa and the anterior curvature of the middle turbinate in each individual. A total of 56 nasal mucosa specimens (37 in the study group and 19 in the control group) were evaluated with regard to normal respiratory epithelium or metaplastic epithelium, atypia or dysplasia, and alterations of the lamina propria. RESULTS: The histopathological study revealed squamous metaplasia in 29 (79%) and atypia in 13 (35%) of the 37 study group samples. No association was found between exposure duration and the clinical and histopathological variables, but a significant association was found between sulphuric acid concentrations higher than 200 micro g/m(3) and pale mucosal patches and ulcerations in the exposed subjects. Logistic regression analysis showed that the exposed subjects had a fivefold risk of developing atypia compared with the unexposed subjects. CONCLUSIONS: Workers exposed to sulphuric acid mists presented with a high incidence of nasal symptoms, and macroscopic and microscopic changes of the nasal mucosa, including squamous atypia and dysplasia. The risk for these histopthological lesions increased with higher sulphuric acid concentrations in the air, revealing an exposure-response relation.