Cochlear Implantation in a Patient with Granulomatosis with Polyangiitis.

BACKGROUND: Granulomatosis with polyangiitis (GPA) otologic manifestations include conductive and sensorineural hearing loss (HL). Vasculitis is assumed to be the primary cause of otologic manifestations. Deaf patients and patients with HL who do not benefit from hearing aids can benefit from cochlear implants (CI). There are currently no specific guidelines for treatment of patients with GPA suited for CI. OBJECTIVES: To assess whether patients who are deaf due to GPA are good candidates for CI and if prior surgical or medical treatment of the inflammation are needed. METHODS: A case report is presented. RESULTS: A 71-year-old female patient with GPA and bilateral profound HL underwent CI. Prior to CI, preparation consisted of audiological evaluations by an otolaryngologist and a rheumatologist, followed by a course of prednisone and methotrexate for middle ear and nasal inflammations. CI was performed with no complications. The speech reception threshold and the monosyllabic word discrimination score after surgery were 25 dBHL and 75%, respectively. CONCLUSIONS: Inflammation due to GPA can be controlled medically with immunosuppressive medications without subtotal petrosectomy, as in chronic suppurative otitis media. Satisfactory audiological results can be expected.

[IMPLANTATION OF A VIBRANT SOUNDBRIDGE IN A WOMAN WITH SENSORINEURAL HEARING LOSS AND RECURRENT OTITIS EXTERNA: A CASE STUDY].

INTRODUCTION: Rehabilitating hearing loss is highly important due to its positive impact on the ability to understand speech, and the related consequences on family, social and work communication abilities. Children with hearing loss have learning difficulties that adversely affect speech and language acquirement. Most patients with hearing loss can use conventional hearing aids that are partially or completely placed in the external ear canal. Middle ear implants are used when conventional hearing aids are not suitable due to medical reasons, mainly diseases of the external ear canal and the tympanic membrane. The external component of the middle ear implant digitally translates the acoustic information (sound waves) to the implanted part, where the digital information is back-translated to mechanical information (vibrations) which vibrates the ossicle to which it is attached. We present a patient who underwent a Vibrant Soundbridge implantation after unsuccessfully using hearing aids due to recurrent otitis externa. The patient's hearing improved significantly. We conclude that middle ear implants can be an effective treatment for patients who cannot use conventional hearing aids.

AzBio Sentence test in Hebrew (HeBio): development, preliminary validation, and the effect of noise.

The AzBio sentence test is widely used to assess speech perception pre- and post-cochlear implantation. This study created and validated a Hebrew version of AzBio (HeBio) and tested its intelligibility amidst background noise.In Experiment 1, 1,000 recorded Hebrew sentences were presented via five-channel vocoder to 10 normal hearing (NH) listeners for intelligibility testing. In Experiment 2, HeBio lists were presented to 25 post-lingual cochlear implant (CI) users amidst four-talker babble noise (4TBN) or in quiet, along with one-syllable word test. In Experiment 3, 20 NH listeners were presented with eight HeBio lists in two noise conditions [4TBN, speech shaped noise (SSN)] and four SNRs (+3, 0 dB, -3 dB, -6 dB).HeBio lists (33) produced 82% average understanding, no inter-list intelligibility differences among NH, and equal intelligibility for CI users. One-syllable words predicted 67% of the variance in HeBio among CI users. Higher intelligibility was found for SSN than for 4TBN, and the mean speech receptive threshold (SRT) was more negative for SSN than for 4TBN.HeBio results were similar to AzBio. Results obtained with two noise types were as expected. HeBio is recommended for evaluation of different populations in quiet and noise.

A Novel Device for the Evacuation of Cerumen.

OBJECTIVES: The aim of this study was to assess a new device designed to safely remove cerumen from the external auditory canal in an office setting with minimal training. METHODS: The research was conducted in the Department of Otolaryngology at Kaplan Medical Center in Israel. Patients with cerumen were treated with the device. Efficacy, safety, and pain were evaluated using scales developed for this experiment. The cerumen obstruction scale (0-5) was assessed before and after the procedure. Improvement by 2 or more grades was considered to indicate at successful procedure. RESULTS: Fifty-nine ears in 46 patients were treated. Seventeen patients (37%) had recurrent cerumen impaction, and 14 (30.4%) used cotton swabs frequently. Fifty-two ears (88%) had hard cerumen. The procedure was successful in 51 ears (86.4%). In 48 ears (81%) there was no pain or mild pain, and in 11 ears (19%), the patient reported the procedure to be uncomfortable. Seven patients (15.2%) asked to abort the procedure because of discomfort or pain. In 39 ears (66%), the cerumen was evacuated easily. Inspection after the procedure revealed no injury in 56 ears (95%). Three ears (5%) had mild irritation of the ear canal, and none had injury to the tympanic membrane. Median length of the procedure was 30 ± 42.1 seconds (range, 2-240 seconds). The median number of insertions of the device in 1 procedure was 2 (range 1-7; SD, 1.3). CONCLUSIONS: The tested device is an effective and safe device for the evacuation of cerumen. It can be used by general practitioners, pediatricians, and audiologists.