Influence of stimulus presentation rate on intraoperative ECAP thresholds in cochlear implant users.

OBJECTIVE: The objective is to evaluate the influence of the presentation rate on intraoperative ECAP thresholds in cochlear implant users. DESIGN: The design was data on the ECAP thresholds (t-NRT) as well as the behavioural T- and C-levels have been collected in CI patients of a quaternary otologic referral centre. Measurements of the tNRT thresholds were performed intraoperatively for 250 Hz and 80 Hz presentation rates and correlated to the stabilised T- and C-levels measured at the 5th fitting session, 4-6 months after surgery. STUDY SAMPLE: There was a study sample of 35 consecutive CI patients. All patients were users of the Nucleus 24RECA (Freedom) or Nucleus CI512 cochlear implants with the Contour Advance-of-Stylet electrode. RESULTS: The result showed that the t-NRT thresholds were higher for the 250 Hz pulse rate typically used during the intraoperative stimulation under general anaesthesia than for the 80 Hz rate used typically during the postoperative fitting sessions. This difference was more pronounced for the basal electrodes where it exceeded 10 current levels (CL). Pearson's correlation coefficients between the t-NRT-measurements and the stabilised T- and C-levels r ranged between 0.34 and 0.47. CONCLUSION: In conclusion, the magnitude of the ECAP thresholds (t-NRT) recorded intraoperatively depends significantly on the stimulus presentation rate.

Hypertension and cochlear hearing loss.

This paper presents a review of experimental and clinical research on the contribution of hypertension to cochlear hearing loss. Hypertension is one of the crucial risk factors underlying pathophysiological processes taking place in the cochlea. Several mechanisms explaining these processes have been described, mainly in animal models, such as the disturbance of the inner ear potassium recycling process due to the detrimental action of natriuretic hormone, and the decrease in the cochlear oxygen partial pressure. Current evidence linking hypertension to sensorineural high-frequency cochlear hearing loss in humans may be confounded by other concomitant diseases or risk factors such as age, coronary artery disease, diabetes, obesity, hyperlipidemia, smoking and noise exposure. Therefore, further research in this field is clearly needed.

Auditory Spatial Deficits in the Early Stage of Ischemic Cerebral Stroke.

BACKGROUND: Clinical research, together with computed tomography/magnetic resonance imaging findings, proves that ischemic stroke (IS) that damages auditory pathways can cause hearing loss and impairment of higher auditory processes such as sound localization. The goal of the study was to find possible correlations between the IS risk factors, ischemic lesion volume and localization, neurologic status, and the sound localization capability in acute IS patients. METHODS: We consecutively enrolled 61 IS patients into the study. The control group consisted of 60 healthy volunteers. All neuro-otological evaluations were performed up to 30 days from the incidence of stroke. All the subjects underwent the horizontal minimum audible angle test (HMAAT) and standard tonal and speech audiometric assessments. RESULTS: HMMAT results were significantly worse in the IS patients and were present in 82.0% of the patients. There were more patients with unilateral disturbances than with bilateral ones (54.1% versus 27.9%). It was the characteristics of the ischemic lesions that correlated strongly with the sound localization deterioration, that is, their bilateral (the 90° azimuth, P = .018; the 180°, P = .002), multiple (the 45°, P = .020; the 180°, P = .007; the 225°, P = .047), and lacunar character (the 90°, P = .015; the 225°, P = .042). Differences in the types of HMAAT results were significant for lesions in the frontal and the temporal lobe (P = .018 and P = .040). In addition, worse sound localization ability was more common in patients with poor speech discrimination and the bilateral sensorineural hearing loss. We have not found statistically significant correlations for other analyzed factors such as the cortical/subcortical character of the lesions, the patients' neurologic status, and cerebrovascular risk factors. CONCLUSIONS: Sound localization impairment is common in IS patients and it is the multiple, bilateral, and lacunar character of the ischemic lesions that seems to be strongly positively correlated with the disturbance of the sound localization ability.

Auditory spatial deficits in brainstem disorders.

PURPOSE: Brainstem disorders seem to negatively influence the central auditory system, causing spatial hearing deficits. MATERIAL AND METHODS: We tested 11 patients with brainstem lesions due to ischemic stroke (IS), multiple sclerosis (MS), or cerebellopontine angle tumor (CPAT) together with 50 age- and sex-matched healthy volunteers. We used pure tone audiometry (PTAud), brainstem auditory evoked potentials (BAEPs) and the horizontal minimum audible angle test (HMAAT) for 8 azimuths with binaural stimulation. RESULTS: The chosen patients and the controls had normal or near normal hearing in PTAud. BAEPs interaural wave I-V latency difference was over 7 times longer in the patients group compared to the controls. Additionally, 9 of the 11 patients (81.1%) had abnormal HMAAT results. The biggest quantitative disturbances in HMAAT were present in the CPAT and the MS patients. The sound localization ability in HMAAT was significantly worse in the patients in 0° azimuth in comparison with the controls, and in 45° and 90° azimuth in patients with auditory pathway involvement compared with the ones without the involvement. CONCLUSIONS: Our study confirms the strong relationship between various brainstem pathologies and sound localization disability and sheds some light on the complexity of the relationship.

Automated hearing loss type classification based on pure tone audiometry data.

Hearing problems are commonly diagnosed with the use of tonal audiometry, which measures a patient's hearing threshold in both air and bone conduction at various frequencies. Results of audiometry tests, usually represented graphically in the form of an audiogram, need to be interpreted by a professional audiologist in order to determine the exact type of hearing loss and administer proper treatment. However, the small number of professionals in the field can severely delay proper diagnosis. The presented work proposes a neural network solution for classification of tonal audiometry data. The solution, based on the Bidirectional Long Short-Term Memory architecture, has been devised and evaluated for classifying audiometry results into four classes, representing normal hearing, conductive hearing loss, mixed hearing loss, and sensorineural hearing loss. The network was trained using 15,046 test results analysed and categorised by professional audiologists. The proposed model achieves 99.33% classification accuracy on datasets outside of training. In clinical application, the model allows general practitioners to independently classify tonal audiometry results for patient referral. In addition, the proposed solution provides audiologists and otolaryngologists with access to an AI decision support system that has the potential to reduce their burden, improve diagnostic accuracy, and minimise human error.

Numerical analysis of the ostiomeatal complex aeration using the CFD method.

We aimed to analyse ostiomeatal complex (OMC) aeration using the computational fluid dynamics (CFD) method of simulation based on human craniofacial computed tomography (CT) scans. The analysis was based on CT images of 2 patients: one with normal nose anatomy and one with nasal septal deviation (NSD). The Reynolds-Average Simulation approach and turbulence model based on linear eddy viscosity supplemented with the two-equation k-[Formula: see text] SST model were used for the CFD simulation. As a result, we found differences in airflow velocity through the ostiomeatal complex in patients with a normal nose and those with NSD. In a patient with NSD, the flow is turbulent in contrast to the normal nose (laminar flow). A faster (more intensive) airflow through the OMC was observed in the wider nasal cavity of the patient with NSD than on the narrower side. In addition, we want to emphasise the higher speed of airflow through the apex uncinate process area towards the ostiomeatal complex during exhalation, which, in the presence of secretions in the nose, predisposes to its easier penetration into the sinuses of the anterior group.

Efficacy and Safety of Intranasal Betahistine in the Treatment of Surgery-Induced Acute Vestibular Syndrome: A Double-Blind, Randomized, Placebo-Controlled Phase 2 Study.

OBJECTIVE: To evaluate the safety and efficacy of AM-125 nasal spray (intranasal betahistine) in the treatment of surgery-induced acute vestibular syndrome (AVS). STUDY DESIGN: Prospective, double-blind, randomized, placebo-controlled exploratory phase 2 study with dose escalation (part A) followed by parallel dose testing (part B); open-label oral treatment for reference. SETTING: Twelve European study sites (tertiary referral centers). PATIENTS: One hundred and twenty-four patients 18 to 70 years old undergoing surgery for vestibular schwannoma resection, labyrinthectomy or vestibular neurectomy with confirmed bilateral vestibular function presurgery and acute peripheral vertigo postsurgery. INTERVENTIONS: AM-125 (1, 10, or 20 mg) or placebo or betahistine 16 mg p.o. t.i.d. for 4 weeks, starting 3 days postsurgery; standardized vestibular rehabilitation. MAIN OUTCOME MEASURES: Tandem Romberg test (TRT) for primary efficacy, standing on foam, tandem gait, subjective visual vertical and spontaneous nystagmus for secondary efficacy, Vestibular Rehabilitation Benefit Questionnaire (VRBQ) for exploratory efficacy; nasal symptoms and adverse events for safety. RESULTS: At treatment period end, mean TRT improvement was 10.9 seconds for the 20-mg group versus 7.4 seconds for the placebo group (mixed model repeated measures, 90% confidence interval = 0.2 to 6.7 s; p = 0.08). This was corroborated by nominally higher frequency of complete spontaneous nystagmus resolution (34.5% vs. 20.0% of patients) and improvement in the VRBQ; the other secondary endpoints showed no treatment effect. The study drug was well tolerated and safe. CONCLUSIONS: Intranasal betahistine may help accelerate vestibular compensation and alleviate signs and symptoms of vestibular dysfunction in surgery-induced AVS. Further evaluation in a confirmatory manner appears warranted.

[Major salivary gland disorders in children and adolescents]. / Choroby duzych gruczolów slinowych u dzieci i mlodziezy.

The aim of this study was a review of 67 children treated for salivary gland tumors in the ENT Department Medical University of Gdansk since 1974 to 2008. In that group we observed 52 children with tumor of the parotid gland, 13 with tumor of submandibular gland and 2 with subligual gland tumors. Tumor-like lesions were stated the largest group of tumors and were observed in 33 (49%) of children, mainly of chronic sialadenitis (17 cases). Predominant number of tumors was observed in scholarship children. The most common symptoms were slow enlargement of tumor and swelling of the salivary gland. In the group of benign tumors most common was pleomorphic adenoma (19 cases) and in the group of malignant tumors most common was clear cell carcinoma (2 cases) and rhabdomyosarcoma (2 cases). In this report the authors describe basic epidemiological and clinical data (age, sex, duration of symptoms, histological structure of tumor, diagnostic methods, methods and results of treatment) and observations connected with differences of salivary gland tumors in that group of patients.

[Nonchromaffin paragangliomas (chemodectoma) of the middle ear in the material of the ENT Department Medical University of Gdansk]. / Przyzwojaki niechromochlonne (chemodectoma) ucha srodkowego w materiale Kliniki Gdanskiej.

INTRODUCTION: Nonchromaffin paraganglioma (chemodectoma) is the most common neoplasm of the middle ear. The diagnosis and treatment is one of the most challenging in otolaryngology. THE AIM OF THE STUDY: was clinical and epidemiological analysis of patients with nonchromaffin paraganglioma of the middle ear. MATERIAL AND METHODS: The material consisted of 13 patients (10 females, 3 males), age 19-62 years, treated for paraganglioma of the middle ear in the ENT Department Medical University of Gdansk between 1968 and 2009. We analyzed the symptoms and results of additional diagnostic tests necessary to establish the diagnosis. RESULTS: We have diagnosed 12 cases of benign chemodectoma (92.3%) and 1 case of chemodectoma malignum (7.7%). The surgical treatment was applied in 6 patients (46.1%), 4 patients (30.8%) received complementary radiotherapy and 3 patients (23.1%) were treated only with radiotherapy. CONCLUSIONS: The diagnosis of paragangliomas of the ear is difficult and should be based on clinical data, audiometric tests, CT, MRI and histological examination. Surgical treatment of paragangliomas is limited to early stages of the disease. The results of the research show that the best therapeutic method in advanced cases is surgical treatment with complementary radiotherapy.

[Osteomas and exostoses of external auditory canal in material of Otolaryngology Department Medical University of Gdansk]. / Kostniaki i wyrosla kostne przewodu sluchowego zewnetrznego w materiale Kliniki Otolaryngologii Gdanskiego Uniwersytetu Medycznego.

INTRODUCTION: Osteomas and exostoses of the external auditory canal are benign tumours arising in bones, leading to its obstruction and causing hearing loss. The treatment of these entities may present a therapeutic dilemma. AIM OF THE STUDY: To assess epidemiological and clinical data and surgical treatment effectiveness. SUBJECTS AND METHODS: The study group consisted of 21 patients (14 men and 7 women) between 18 to 63 years of age, treated in the Otorhinolaryngology Department of Medical University of Gdansk from 1995 to 2009. The results of audiometric, radiological and histopathological examination were taken into consideration. RESULTS: Unilateral osteomas developing in tympanosquamous suture in 5 patients, in tympanomastoid suture in 4. Bilateral exostoses occured in 12 patients in anterior, posterior and inferior wall of the external auditory canal. In all patients: conductive hearing loss ranged from 15 to 30 dB (average 29.9 dB), in 6 patients with concomitant sensorineural component. Osteomas were removed via intrauricular approach according to Mawson-Goodhill's method. Exostoses were removed via intrauricular, intracanal or postauricular approach. Histological examination confirmed benign overgrowth of compact and trabecular bone. The auditory canal was successfully reamed, the hearing improved in all patients. CONCLUSIONS: Osteomas are benign tumours leading to obstruction of the external auditory canal. Exostosis is the overgrowth of the external auditory canal's compact bone in adults. Osteomas and exostoses may lead to hearing loss. Indications to surgical treatment are ear pain, progressive hearing loss and recurrent otitis external.

Cardiovascular testing of seasickness in healthy volunteers on life rafts.

OBJECTIVES: The role of the cardiovascular system in the development of seasickness remains uncertain. MATERIAL AND METHODS: Overall, 18 healthy students (10 males and 8 females) aged 18-24 years volunteered in the project, spending 2-7 h on life rafts. The cardiovascular system was examined with impedance cardiography. Susceptibility and symptoms of seasickness were evaluated by the Motion Sickness Susceptibility Questionnaire Shortform (MSSQ-Short) and the Motion Sickness Assessment Questionnaire (MSAQ). The Visual Analogue Scale (VAS), ranging 0-10, was used to assess nausea, dizziness and mood. The parameters were assessed at 2 time points. RESULTS: Differences in the heart rate (HR), the thoracic fluid content index (TFCI), the stroke index (SI) and the Heather index (HI) before launching the life rafts and after leaving them were observed (78.6, 20.8, 55.6 and 15.9 vs. 70.1, 19.7, 60.5 and 17.9, with p-values of 0.002, <0.001, 0.003 and 0.004, respectively). Females reacted with changes in SI and HR more vividly, whereas males regulated more HI and TFCI. In addition, HR correlated significantly with the central and peripheral symptoms in MSAQ, stroke volume (SV) with peripheral and sopite-related ones, SI with overall ones, and pulse pressure with overall, gastrointestinal and central ones (Spearman's rank correlation coefficient [ρ] was -0.478, -0.711, 0.476, 0.472, 0.525, -0.476, -0.579 and -0.584, respectively). As regards MSSQ-Short, it correlated negatively with sopite-related symptoms in MSAQ (ρ= -0.486). Mood in VAS correlated significantly with gastrointestinal symptoms, SI and the cardiac index (CI) (ρ = -0.752, -0.492 and -0.489, respectively). CONCLUSIONS: It was found that HR correlated negatively, and SV/SI correlated positively, with the severity of seasickness symptoms measured with MSAQ. Gender is probably an independent factor influencing reactions to motion. Women react with SI increase whereas men react with increased heart contractility (HI rise). Negative mood in seasickness evaluated with VAS seems to be mostly determined by gastrointestinal symptoms assessed with MSAQ and diminished cardiovascular indices (both CI and SI). Int J Occup Med Environ Health. 2020;33(4):467-77.

Hearing loss in patients with extracranial complications of chronic otitis media.

OBJECTIVE: A pure tone audiomety analysis of patients with extracranial complications of chronic suppurative otitis media (ECCSOM). MATERIAL AND METHODS: We retrospectively analyzed audiometric data performed before treatment from 63 patients with ECCSOM (56 single, 7 multiple complications) including groups of frequencies. RESULTS: The greatest levels of hearing loss were noted for 6 and 8 kHz (79.0 and 75.7 dBHL) and for the frequency groups high tone average (76.1 dBHL). As regards the severity of hearing impairment in pure tone average the prevalence of complications was as follows: labyrinthitis (77.8±33.6 dBHL), facial palsy (57.1±14.3 dBHL), perilymphatic fistula (53.9±19.9 dBHL) and mastoiditis (42.2±9.5 dBHL) (p=0.023). CONCLUSIONS: Hearing loss in ECCSOM is dominated by mixed, high-tone, moderate type of hearing loss, most profound in labyrinthitis. In 11% of patients the complication causes total deafness.

Is the Keros classification alone enough to identify patients with the 'dangerous ethmoid'? An anatomical study.

CONCLUSION: By means of three-dimensional display of the critical measurements, the authors suggest a novel definition of 'dangerous ethmoid'. Parallel to Keros type III, the proposed determining factors include: olfactory fossa width >6 mm, its distance to the medial nasal concha (turbinate) <20 mm and to the orbit interval of <10 mm. Clinical evaluation of these preliminary criteria based only on radiological data is required and underway. OBJECTIVES: Detailed pre-operative assessment of sinus computer tomography (CT) scans reduces the frequency of severe complications in patients undergoing endoscopic sinus surgery (ESS). The authors aimed to identify a sub-set of anatomical features pre-disposing to major post-operative complications. METHOD: Sinus computer tomography (CT) scans of patients of a single institution qualified for ESS were examined. Besides the Keros classification, authors focused on the anatomic measurements as follows: the olfactory fossa depth, width, and its distance from the medial nasal concha and the medial wall of the orbit (referred to as 'critical measurements'). The sample comprised 120 consecutive CT exams, without clinical validation. RESULTS: Keros type I, II, and III was noted in 9.2%, 75.8%, and 15.0% of cases, respectively. Despite some statistically significant correlations, it was not possible to identify the patient age, sex, and side of body clearly correlating with the critical measurements.

Otitic hydrocephalus associated with lateral sinus thrombosis and acute mastoiditis in children.

The incidence of intracranial complications of acute otitis media (AOM) has decreased and the need for operative and medical treatment is declined during the antibiotic era. To describe pathognomonic signs, evaluation management, operative findings, clinical course and outcome of otitic hydrocephalus and lateral sinus thrombosis as complications of AOM and mastoiditis in pediatric patients. Two children, 9 and 13 years old, with the diagnosis of OH and TK and MRI findings are presented. Intracranial complications in children resulted from unsuccessful treatment of AOM, which led to acute mastoiditis and lateral sinus thrombosis. Both of the presented children had thrombus in their sigmoid sinus preoperatively, demonstrated by MRI, causing decreased blood flow. Both patients underwent a mastoidectomy and delamination of sigmoid sinus with puncture of sinuses. After medical and surgical treatment, blood flow through the sinus increased significantly. In both cases signs of increased intracranial pressure ceased. The clinical presentation of otogenic lateral sinus thrombosis (LST) as a complication of acute otitis media (AOM) can be masked by antibiotic treatment. The episodes of vomiting, headache, visual impairment and a history of AOM seem to be indicative for otitic hydrocephalus. MRI scans of patients with similar symptoms should be carefully studied to facilitate the early diagnosis of dural sinus thrombosis with increased intracranial pressure. Contrast-enhanced computed tomography scan and magnetic resonance imaging play a major role in determining diagnosis and treatment plans in this intracranial complications. Management included systemic antibiotics, short-term heparin anticoagulation and surgical decompression. In our patients intensive i.v. antibiotic treatment, steroids, anticoagulants and surgery led to a significant improvement in the clinical condition.

[Sigmoid sinus thrombosis in 5-year old child with acute otitis media and acquired CMV infection]. / Zakrzepowe zapalenie zatoki esowatej u 5-letniego dziecka z ostrym zapaleniem ucha srodkowego i zakazeniem nabytym cytomegalia.

Cytomegalovirus (CMV) belongs to Herpesvirida family and it occurs quite frequently in the human environment. It is a very important pathogen in persons with suppressed or lowered resistance. Having special kindship with epithelium, it may cause primary infection or reveal secondary influence in the latent form. Congenital CMV infection is a major cause of sensorineural hearing loss and neurological impairment in children. Otogenic complications may develop in patients with viral infection immunodeficiency. Aim of the paper was assessment of lateral sinus thrombosis (LST) in children with acute otitis media (AOM) and CMV infection. Authors present a case of LST in 5-year old child with AOM with mastoiditis and acquired CMV infection. In the first phase a disease appeared as mononucleosis-like infection with developing neurological signs resulting from meningitis. In the second phase the signs of acute otitis media, mastoiditis and lateral sinus thrombosis increased. Despite broad spectrum antibiotics therapy the intracranial complication developed which was surgically treated with good outcome. All the symptoms resulting from mastoiditis, LST and meningitis ceased. Clinical symptoms of the secondary CMV infection are rare in children. Complications may develop despite proper treatment of the ear and throat infections, and may result from immunodeficiency after CMV infection.

Possibilities of spatial hearing testing in occupational medicine.

Dysfunctions of the organ of hearing are a significant limitation in the performance of occupations that require its full efficiency (vehicle driving, army, police, fire brigades, mining). Hearing impairment is associated with poorer understanding of speech and disturbed sound localization that directly affects the worker's orientation in space and his/her assessment of distance and location of other workers or, even most importantly, of dangerous machines. Testing sound location abilities is not a standard procedure, even in highly specialized audiological examining rooms. It should be pointed out that the ability to localize sounds which are particularly loud, is not directly associated with the condition of the hearing organ, but is rather considered an auditory function of a higher level. Disturbances in sound localization are mainly associated with structural and functional disturbances of the central nervous system and occur also in patients with normal hearing when tested with standard methods. The article presents different theories explaining the phenomenon of sound localization, such as interaural differences in time, interaural differences in sound intensity, monaural spectrum shape and the anatomical and physiological basis of these processes. It also describes methods of measurement of disturbances in sound localization which are used in Poland and around the world, also by the author of this work. The author analyzed accessible reports on sound localization testing in occupational medicine and the possibilities of using such tests in various occupations requiring full fitness of the organ of hearing.