The Crista Fenestra and Its Impact on the Surgical Approach to the Scala Tympani during Cochlear Implantation.

OBJECTIVE: The aim of this work was to describe the dimensions of the crista fenestra and determine its presence by means of high-resolution computed tomography (CT) for the purpose of cochlear implantation via the round window approach. METHODS: A series of 10 adult human temporal bones underwent high-resolution CT scanning and were further dissected for microscopic study of the round window niche. RESULTS: In all of the specimens, the round window membrane was fully visualized after the complete removal of bony overhangs. The crista fenestra was identified as a sharp bony crest located in the anterior and inferior borders of the niche; its area ranged from 0.28 to 0.80 mm2 (mean 0.51 ± 0.18). The proportion of the area occupied by the crista fenestra in the whole circumference of the round window ranged from 23 to 50% (mean 36%). We found a moderate positive correlation between the area of the niche and the dimensions of the crista fenestra (Spearman rho: 0.491). In every case, high-resolution CT scanning was unable to determine the presence of the crista fenestra. CONCLUSION: The crista fenestra occupies a variable but expressive area within the bony round window niche. Narrower round window niches tended to house smaller crests. The presence of the crista fenestra is an important obstacle to adequate access to the scala tympani. Nevertheless, a high-resolution CT scan provides no additional preoperative information with regard to its presence for the purpose of surgical access to the scala tympani via the round window niche.

Controlled study of the frequency of anti-HSP 70 with the ELISA and the Western Blot methods in patients with Ménière Disease.

OBJECTIVES: To establish the frequency of auto-antibodies anti-HSP 70 using ELISA and Western Blot (WB) methods and to compare the results of each method among patients with the Ménière's Disease (MD) and internal ear diseases (IED) who do not fulfill criteria for MD. Sensibility, specificity and predictive values of anti-HSP70 test in diagnosis of MD were calculated. STUDY: Prospective, case-control. METHODS: Blood samples were collected from 31 patients with MD and 78 patients with non Ménière IED. Data regarding cochlear and vestibular symptoms were obtained and blood sample was tested. RESULTS: ELISA tests results were positive in 4(13%) patients and results of WB were positive in 8(26%) patients. Among patients with positive ELISA results, 1 patient presented active disease and in the remaining 3 patients the disease was inactive. Among the 8 WB positive patients, only 2 patients presented active disease. Statistical analyses did not establish any association between serologic findings and clinical factors of MD. CONCLUSION: The presence of anti-HSP70 using the ELISA and the WB methods did not demonstrate clinical value for the diagnosis of MD. We did not find association between idiopathic MD nor unspecific etiology MD and the presence of anti-HSP70 auto-antibodies.

Tympanic Membrane Retractions in patients with Williams Syndrome: A Controlled Study.

Introduction The role of elastin in tympanic retractions and chronic otitis media is not well established. Williams Syndrome (WS), a pathology related to a mutation in the elastin gene, could generate tympanic retractions. Objective To compare the prevalence of tympanic retractions among patients with WS and controls. Methods WS patients ( n = 43 ears) and controls ( n = 130 ears) were evaluated by digital otoscopic examination and the degree of tympanic membrane retraction was classified by 2 blinded experienced otolaryngologists. Results The agreement rate between the evaluators was 71.1% for pars tensa and 65% for pars flaccida retraction ( p < 0.001). The pars tensa and pars flaccida retractions are present in patients with WS after an adjusted residue of respectively - 2.8 and - 2.6 ( p = 0.011 and p = 0.022) compared with controls. Conclusions Tympanic membrane retractions are not more common in the WS group when compared with controls.

The Role of Magnetic Resonance Imaging of the Temporomandibular Joint to Investigate Tinnitus in Adults with Temporomandibular Joint Disorder: A Comparative Study.

Introduction The prevalence of tinnitus is higher in individuals with temporomandibular joint disorder (TMD) than in the general population. Magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) is the method of choice for investigation, and it has been hypothesized that specific MRI findings might be observed in TMD with comorbid tinnitus. Objective To comparatively describe MRI findings in patients with TMD with and without tinnitus, identifying the most common TMJ alterations and determining whether a correlation exists between severity of TMD and tinnitus. Methods A cross-sectional study of 53 adult patients with bilateral or unilateral TMD (30 with and 23 without tinnitus). The association between tinnitus and morphological aspects of TMD (changes in condylar morphology, articular eminence morphology, and disc morphology), disc displacement (with/without reduction), condylar translation, and intra-articular effusion was analyzed on MRI images. Results The mean patient age was 46.12 ± 16.1 years. Disc displacement was the most common finding in both groups (24 patients with tinnitus versus 15 without; p = 0.043). Only the frequency of disc displacement with reduction was significantly different between groups. Conclusion Additional imaging techniques should be explored to detect specific aspects of the relationship between tinnitus and TMD.

Neurotology: definitions and evidence-based therapies - Results of the I Brazilian Forum of Neurotology.

INTRODUCTION: Neurotology is a rapidly expanding field of knowledge. The study of the vestibular system has advanced so much that even basic definitions, such as the meaning of vestibular symptoms, have only recently been standardized. OBJECTIVE: To present a review of the main subjects of neurotology, including concepts, diagnosis and treatment of Neurotology, defining current scientific evidence to facilitate decision-making and to point out the most evidence-lacking areas to stimulate further new research. METHODS: This text is the result of the I Brazilian Forum of Neurotology, which brought together the foremost Brazilian researchers in this area for a literature review. In all, there will be three review papers to be published. This first review will address definitions and therapies, the second one will address diagnostic tools, and the third will define the main diseases diagnoses. Each author performed a bibliographic search in the LILACS, SciELO, PubMed and MEDLINE databases on a given subject. The text was then submitted to the other Forum participants for a period of 30 days for analysis. A special chapter, on the definition of vestibular symptoms, was translated by an official translation service, and equally submitted to the other stages of the process. There was then a in-person meeting in which all the texts were orally presented, and there was a discussion among the participants to define a consensual text for each chapter. The consensual texts were then submitted to a final review by four professors of neurotology disciplines from three Brazilian universities and finally concluded. Based on the full text, available on the website of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, this summary version was written as a review article. RESULT: The text presents the official translation into Portuguese of the definition of vestibular symptoms proposed by the Bárány Society and brings together the main scientific evidence for each of the main existing therapies for neurotological diseases. CONCLUSION: This text rationally grouped the main topics of knowledge regarding the definitions and therapies of Neurotology, allowing the reader a broad view of the approach of neurotological patients based on scientific evidence and national experience, which should assist them in clinical decision-making, and show the most evidence-lacking topics to stimulate further study.

Distortion product otoacoustic emissions in sheep before and after hyperinsulinemia induction.

UNLABELLED: Transient evoked otoacoustic emissions and distortion product otoacoustic emissions have gained significant importance in the identification of cochlear alterations. AIM: To record distortion product thresholds through the monitoring of otoacoustic emissions in normal conditions and in the presence of electrophysiologic changes in cochlear outer hair cells in sheep after hyperinsulinemia induction. MATERIAL AND METHODS: Experimental study, with seven sheep in the control group and seven in the study group. Insulin and glucose concentrations were measured simultaneously for the recording of distortion product otoacoustic emission every 10 minutes, all the way to 90 minutes. The control group received saline solution, and the study group received a bolus injection of 0.1 U/kg of regular human insulin. RESULTS: There was a significant reduction in distortion product thresholds in the study group when compared to the control group at frequencies greater than 1,500 Hz and after 60 minutes (P < 0.001). CONCLUSION: This study established distortion product otoacoustic emission thresholds in sheep with constant reproducibility, demonstrating that the method is adequate for use in audiology and otology investigations. Results also fully confirm that acute hyperinsulinemia may cause important changes in these thresholds.

Postural adaptation in elderly patients with instability and risk of falling after balance training using a virtual-reality system.

Our aim in this study was to assess postural control adaptation quantitatively in unsteady elderly patients at risk of falls in open spaces and given balance training with a virtual-reality system reproducing environmental stimulation. Using a balance rehabilitation unit based on a virtual-reality system that changes sensory information (visual, vestibular, and somatosensory), we treated 26 elderly, unsteady patients who were prone to falling (age range, 73-82 years) and who were enrolled in a customized vestibular rehabilitation program. We assessed postural responses by posturography before and after 6 weeks in the vestibular rehabilitation program under two conditions: (1) standing, eyes open, static visual field, and (2) standing, eyes open, dynamic visual field through virtual-reality goggles, generating horizontal optokinetic stimulation (70 degrees per second angular velocity). We recorded postural responses with a platform measuring the confidential ellipse of the center-of-pressure distribution area and sway velocity with a scalogram analyzing postural behavior by wavelets. After 6 weeks of treatment, postural response confidential ellipse and sway velocity values were lower, evincing decreased amplitudes and sway frequency contents in the scalogram by wavelet under both stimulation paradigm conditions. These findings suggest postural adaptation under the two perceptual conditions when patients had static and dynamic visual fields. The possibility of treating elderly fallers with balance disorders using a virtual-reality environmental stimulation reproduction system is discussed.

Distortion product otoacoustic emissions in an animal model of induced hyperinsulinemia.

The existence of a relationship between abnormal insulin levels and the occurrence of labyrinth disorders has been demonstrated in several works. Among many metabolic alterations, such studies indicate that hyperinsulinemia is one of the most frequent causes of cochlear and vestibular syndromes. In this study, we monitored distortion product evoked otoacoustic emission thresholds during induced acute hyperinsulinemia in sheep so as to identify the occurrence of electrophysiological changes in cochlear outer hair cells. In the study group, seven sheep received a bolus of 0.1 U/kg of regular human insulin. In the control group, seven sheep received saline solution. We measured insulin and glucose levels simultaneously with the recording of distortion product otoacoustic emissions at 10-minute intervals over 90 minutes. We successfully induced hypoglycemia and hyperinsulinemia. We detected no changes in distortion product thresholds in the control group during the 90 minutes of the experiment. In the study group, we recorded a reduction in distortion product thresholds in relation to the control group at frequencies above 1,500 Hz and after 60 minutes (p < .001). We observed significant electrophysiological changes in cochlear outer hair cells reflected in the variation of distortion product thresholds at high frequencies after 60 minutes.

CT-Scan sheep and human inner ear morphometric comparison.

INTRODUCTION: Studies about the use of sheep in surgical training and experimental otologic surgery are rare. This study intends to contribute to the knowledge on this field. AIM: To study sheep inner ear structures using computerized tomography and serial cross-sections to collect more accurate morphometric data to compare sheep and human ears. MATERIAL AND METHODS: This descriptive study compared the inner structures of sheep and human ears. Measurements were made using computerized tomography, and they were stored in a DICOM compact disc for later analysis and manipulation, with a program used for medical image analysis (Osíris 4.16). RESULTS: Mean measures for sheep and human ears were found to be similar in this morphological study. Most structures (10 out of 15) maintained the 2/3 ratio of sheep to human ear. CONCLUSION: The results of this morphometric study of sheep ear are an important contribution to the development of an animal model to be used for surgical training and experimental otologic surgeries.

Tympanic Membrane Retractions in patients with Williams Syndrome: A Controlled Study

Abstract Introduction The role of elastin in tympanic retractions and chronic otitis media is not well established. Williams Syndrome (WS), a pathology related to a mutation in the elastin gene, could generate tympanic retractions. Objective To compare the prevalence of tympanic retractions among patients with WS and controls. Methods WS patients (n= 43 ears) and controls (n= 130 ears) were evaluated by digital otoscopic examination and the degree of tympanic membrane retraction was classified by 2 blinded experienced otolaryngologists. Results The agreement rate between the evaluators was 71.1% for pars tensa and 65% for pars flaccida retraction (p< 0.001). The pars tensa and pars flaccida retractions are present in patients with WS after an adjusted residue of respectively - 2.8 and - 2.6 (p= 0.011 and p= 0.022) compared with controls. Conclusions Tympanic membrane retractions are not more common in the WS group when compared with controls.

Glucose and insulin profiles and their correlations in Ménière's disease.

Changes in carbohydrate metabolism, admittedly one of the most prevalent etiologies of Méière's syndrome, can be diagnosed early by 5-hour glucose and insulin curves with a 100-g glucose load, a test more sensitive than those traditionally used in investigating impaired glucose tolerance or diabetes mellitus. This study investigated carbohydrate metabolism characteristics in 64 patients with typical Ménière's disease. We demonstrated that 72% of them had some variable degree of hyperinsulinemia as shown by their plasma insulin curves, whereas alterations on the glucose curve (reactive hypoglycemia or hyperglycemia) were found for only 21%. More advanced hyperinsulinemic conditions (i.e., glucose intolerance or diabetes mellitus) were usually associated with changes in lipid profiles and with a central pattern of fat distribution and systemic hypertension. We found a very strong correlation between insulin concentrations measured by chemoluminescence and by radioimmunoassay; the latter, however, showed values 1.3 times higher than those measured by chemoluminescence. These findings confirm the need to include 5-hour glucose and insulin curves in the diagnostic routine when investigating Ménière's disease. In that way, an early diagnosis of hyperinsulinemia, the metabolic change most often involved in the pathogenesis of cochleovestibular disorders, can be made.

The Role of Magnetic Resonance Imaging of the Temporomandibular Joint to Investigate Tinnitus in Adults with Temporomandibular Joint Disorder: A Comparative Study

Abstract Introduction The prevalence of tinnitus is higher in individuals with temporoman- dibular joint disorder (TMD) than in the general population. Magnetic resonance imaging (MRI) of the temporomandibular joint (TMJ) is the method of choice for investigation, and it has been hypothesized that specific MRI findings might be observed in TMD with comorbid tinnitus. Objective To comparatively describe MRI findings in patients with TMD with and without tinnitus, identifying the most common TMJ alterations and determining whether a correlation exists between severity of TMD and tinnitus. Methods A cross-sectional study of 53 adult patients with bilateral or unilateral TMD (30 with and 23 without tinnitus). The association between tinnitus and morphological aspects of TMD (changes in condylar morphology, articular eminence morphology, and disc morphology), disc displacement (with/without reduction), condylar translation, and intra-articular effusion was analyzed on MRI images. Results The mean patient age was 46.12 ± 16.1 years. Disc displacement was the most common finding in both groups (24 patients with tinnitus versus 15 without; p = 0.043). Only the frequency of disc displacement with reduction was significantly different between groups. Conclusion Additional imaging techniques should be explored to detect specific aspects of the relationship between tinnitus and TMD.

Neurotology: definitions and evidence-based therapies - Results of the I Brazilian Forum of Neurotology / Otoneurologia: definições e terapias baseadas em evidências - Resultados do I Fórum Brasileiro de Otoneurologia

Abstract Introduction: Neurotology is a rapidly expanding field of knowledge. The study of the vestibular system has advanced so much that even basic definitions, such as the meaning of vestibular symptoms, have only recently been standardized. Objective: To present a review of the main subjects of neurotology, including concepts, diagnosis and treatment of Neurotology, defining current scientific evidence to facilitate decision-making and to point out the most evidence-lacking areas to stimulate further new research. Methods: This text is the result of the I Brazilian Forum of Neurotology, which brought together the foremost Brazilian researchers in this area for a literature review. In all, there will be three review papers to be published. This first review will address definitions and therapies, the second one will address diagnostic tools, and the third will define the main diseases diagnoses. Each author performed a bibliographic search in the LILACS, SciELO, PubMed and MEDLINE databases on a given subject. The text was then submitted to the other Forum participants for a period of 30 days for analysis. A special chapter, on the definition of vestibular symptoms, was translated by an official translation service, and equally submitted to the other stages of the process. There was then a in-person meeting in which all the texts were orally presented, and there was a discussion among the participants to define a consensual text for each chapter. The consensual texts were then submitted to a final review by four professors of neurotology disciplines from three Brazilian universities and finally concluded. Based on the full text, available on the website of the Brazilian Association of Otorhinolaryngology and Cervical-Facial Surgery, this summary version was written as a review article. Result: The text presents the official translation into Portuguese of the definition of vestibular symptoms proposed by the Bárány Society and brings together the main scientific evidence for each of the main existing therapies for neurotological diseases. Conclusion: This text rationally grouped the main topics of knowledge regarding the definitions and therapies of Neurotology, allowing the reader a broad view of the approach of neurotological patients based on scientific evidence and national experience, which should assist them in clinical decision-making, and show the most evidence-lacking topics to stimulate further study.

Resumo Introdução: A otoneurologia é uma área de conhecimento que tem se expandido muito rapidamente. O estudo do sistema vestibular tem avançado tanto que mesmo definições básicas, como o significado dos sintomas vestibulares, foram apenas recentemente padronizadas. Objetivo: Apresentar uma revisão dos principais assuntos da otoneurologia, inclusive conceitos, diagnóstico e tratamento da otoneurologia, definir a evidência científica atual para facilitar a tomada de decisões e demonstrar as áreas mais carentes de evidência para estimular novas pesquisas. Método: Este texto é fruto do I Fórum Brasileiro de Otoneurologia, que reuniu os principais pesquisadores brasileiros dessa área para uma revisão da literatura. Serão feitos três trabalhos de revisão a serem publicados. Este primeiro abordou as definições e as terapias, o segundo abordará as ferramentas diagnósticas e o terceiro definirá os principais diagnósticos. Cada autor fez um levantamento bibliográfico na base de dados da Lilacs, SciELO, Pubmed e Medline de um determinado assunto. O seu texto foi então submetido aos demais participantes do Fórum por 30 dias para análise. Um capítulo especial, da definição dos sintomas vestibulares, foi traduzido por serviço de tradução oficial e igualmente submetido às demais etapas do processo. Houve então uma reunião presencial em que todos os textos foram apresentados oralmente e houve uma discussão entre os participantes para a definição de um texto consensual para cada capítulo. Os textos consensuais foram então submetidos a uma revisão final por quatro professores de otoneurologia de três universidades brasileiras e, por fim, finalizado. A partir do texto completo, publicado no site da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, foi escrita esta versão-resumo como artigo de revisão. Resultado: O texto apresenta a tradução oficial para o português da definição dos sintomas vestibulares propostos pela Barany Society e agrupa as principais evidências científicas para cada um das principais terapias existentes para as doenças otoneurológicas. Conclusão: Este texto agrupou de forma racional os principais tópicos de conhecimento a respeito das definições e terapias da otoneurologia, permite ao leitor uma visão ampla da abordagem dos pacientes otoneurológicos baseada em evidências científicas e experiência nacional, que deverá auxiliá-lo na tomada de decisões clínicas, e mostra os assuntos mais carentes de evidência para estimular novos estudos.

An ELISA serum assay for autoantibodies to HSP70 in immune-mediated hearing loss.

A Western blot to detect anti-HSP70 autoantibodies has been reported to be of diagnostic value for immune-mediated hearing loss patients. While setting up this Western blot in our lab, we detected two main problems. First, some patients were positive for antibodies to a 70-kDa protein when tested against a whole cell lysate, but negative if the antigen used was purified HSP70. Second, if high amounts of purified HSP70 were loaded on the gel, both patients and healthy controls were positive. We have developed and optimized an ELISA as an alternative to the Western blot. This assay is more appropriate to identify positive and negative individuals because it is semi-quantitative. The ELISA is also more sensitive, requiring very low concentrations of the antigen and thus minimizing false positives. Finally, we demonstrated that immune-mediated hearing loss patients recognize mainly the native form of HSP70, a fact that potentially leads to false negatives when a denaturing Western blot assay is used for diagnosis. To test the diagnostic value of the ELISA, we performed a blind test with 70 hearing loss patients, as well as 30 healthy controls. A sensitivity of 84% and a specificity of 93% were obtained, superior to what has been reported so far for the Western blot.

Otitis media in children: seasonal changes and socioeconomic level.

OBJECTIVE: Our objective was to determine the frequency of otitis media (OM) in relation to socioeconomic and seasonal factors in a city in southern Brazil. METHODS: A prospective, longitudinal study was carried out with a 3-4-year-old cohort of children randomly selected in schools serving populations of higher socioeconomic status (AB; monthly family income >10 minimum wages, US$ 1000) or lower socioeconomic status (CD; monthly family income < or = 3 minimum wages, US$ 300). The children were assessed in the fall, winter, and spring of 1997 using otoscopy and tympanometry. RESULTS: Among 156 children who finished the study, 53.8% belonged to socioeconomic group CD. Otoscopy suggested chronic suppurative otitis media (OM) (tympanic membrane perforation or otorrhea) in <6% of children in the CD group, with no seasonal variation. Alterations suggesting secretory otitis media (SOM) were significantly more frequent in the CD group (P< or = 0.001), with a peak in the winter. The prevalence of SOM on otoscopy was: fall (20.9% AB; 38.1% CD); winter (28.6% AB; 81% CD), and spring (23% AB; 49.3% CD). The incidence of SOM in the winter according to tympanometry was 18.4% (group AB) and 72.9% (group CD). Among children with a normal tympanogram in the fall, 44.7% presented a type B tympanogram (presence of middle ear effusion) in the winter. Only 17.6% still presented a type B tympanogram in the spring. From the ears with type B tympanogram in the fall, 80% had the same result in the winter, and 60.9%, in the spring. A sharp seasonal SOM peak was observed in the CD group in the winter. CONCLUSION: Children in the lower socioeconomic group have a peak incidence of serous otitis media (OM) in the winter. Presence of type B tympanogram in the fall and belonging to socioeconomic group CD are indicators of poor prognosis in terms of the spontaneous resolution of SOM.

[Prevalence of hearing loss in very low birth weight neonates]. / Prevalência de perda auditiva em recém-nascidos de muito baixo peso.

OBJECTIVE: To evaluate the prevalence of hearing alterations in very low birth weight patients in the Neonatal Intensive Care Unit of the Hospital de Clínicas de Porto Alegre and to study the variables that can be related to alterations of the hearing acuity. METHODS: A transversal study was carried out. The study included all very low birth weight neonates admitted to the Neonatal Intensive Care Unit of the Hospital de Clínicas de Porto Alegre from September 1, 2000 to January 31, 2002. All patients were submitted to distortion product otoacoustic emission tests at hospital discharge. When the test showed alterations, it was repeated 30 days later. However, when the same patient presented otoacoustic emission alterations in both tests, he/she was submitted to the auditory brain response testing. The result of this test was considered abnormal from 35 dB NA. RESULTS: We studied 96 neonates. Six children presented alteration in the distortion product otoacoustic emission test as well as in the auditory brain response test. Children's mean age was 31.5 +/- 2.6 weeks, their birthweight was between 640 g and 1,500 g, and 57.3% of the patients were female. The gestational age and the Apgar score of 5 minutes were inferior in the group presenting abnormal results of otoacoustic emission and auditory brain response tests compared to the other groups, reaching bordering significance. All the remaining aspects investigated did not present any statistically significant difference. CONCLUSIONS: The prevalence of hearing loss in the very low birth weight neonates cared for at the Neonatal Intensive Care Unit of the HCPA was 6.3%, and bordering significance associations related to gestational age and 5 minutes Apgar score were observed.

Hyperinsulinemia and tinnitus: a historical cohort.

Tinnitus affects millions of people worldwide, and it signals the presence of several underlying diseases, including hyperinsulinemia. The aim of this study was to evaluate the response to dietary treatment in 80 patients with associated tinnitus and hyperinsulinemia. On the basis of data obtained by a questionnaire, two groups were established: One included patients who followed the prescribed diet; the other group included patients who did not comply with the treatment. The likelihood of improving tinnitus symptoms was fivefold higher in hyperinsulinemic patients who followed the diet than in those who did not (relative risk [RR], 5.34; 95% confidence interval [CI], 1.85-15.37; p < .05). In addition, resolution of tinnitus was reported by 15% of the patients who followed the diet as compared to 0% of those who did not. These findings underscore the importance of including hyperinsulinemia in the routine diagnostic investigation of patients with tinnitus regardless of whether associated with neurosensory dysacusis or vertigo (or both).

Effect of hyperinsulinism on sensorineural hearing impairment in Ménière's disease: a cohort study.

OBJECTIVE: To compare the degree of sensorineural hearing loss in patients with Ménière's disease (MD) with and without hyperinsulinism by different methods of assessment. STUDY DESIGN: Historical cohort study. SETTING: Ménière's Disease Care and Research Clinics of Hospital de Clinicas de Porto Alegre, a tertiary care university hospital in Southern Brazil. PATIENTS: Patients with a definite diagnosis of MD based on the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines. INTERVENTION: Patients were assessed by glucose overload tests (5-h glucose and insulin curves) and under baseline physiological conditions (Homeostasis Model Assessment/Insulin Resistance [HOMA-IR], Quantitative Insulin Sensitivity Check Index [QUICKI], and glucose/insulin ratio). These patients underwent annual pure-tone audiometry and were analyzed using 4-tone average (FTA), that is, arithmetic mean of 500, 1,000, 2,000, and 3,000 Hz, during the third, fourth, and fifth years of disease progression. MAIN OUTCOME MEASURE: Hearing loss assessed by FTA and classified in Stages I to IV (AAO-HNS). RESULTS: Forty-nine (76.6%) patients were defined as hyperinsulinemic and 15 (23.4%) as normoinsulinemic. Impairment on FTA was higher in the hyperinsulinemic group (52.04 ± 17.5 versus 39.75 ± 9.20, p = 0.027) when assessed by the 5-hour insulin curve. Hyperinsulinemic subjects were 3.5 times more likely to develop hearing damage greater than 40 dB (i.e., Stages III and IV) than normoinsulinemic subjects (OR = 3.52; 95% CI, 1.05-11.76). A moderate correlation between the insulin curve and the HOMA-IR was found (r = 0.524, p = 0.001). CONCLUSION: Hyperinsulinism in MD is associated with greater clinical hearing damage.

Rehabilitation with cochlear implant in patient with harboyan syndrome.

Background Harboyan syndrome, defined as congenital corneal dystrophy associated with progressive sensorineural hearing loss, was first described by Harboyan in 1971. It is a hereditary disease manifested by eye lesions consistent with corneal endothelial dystrophy and progressive sensorineural hearing loss. There is bilateral symmetric progressive hearing loss, which may be either dominant or recessive. Objective To report a case of a patient with a diagnosis of Harboyan syndrome. Case Report A 25-year-old woman with profound bilateral sensorineural hearing loss, showing poor hearing performance while using a personal sound amplification device, underwent hearing rehabilitation with a cochlear implant. Conclusion Rehabilitation was imperative in this case. The cochlear implant has proven to be the best therapeutic option, providing the patient with a better quality of life.

Assessing cochlear evoked potentials after electrocautery-induced trauma to the utricle.

UNLABELLED: Utriculostomy is a new surgical alternative for Ménière's disease. The basis of this procedure is that the outcome of an electrocautery-induced utricular trauma does not affect cochlear function. However, a demonstration of the hypothesis that this approach to the utricle would preserve hearing is still pending. OBJECTIVE: To determine whether any changes would occur in the electrical potentials evoked in the cochlea and auditory nerve before, during, and 1 month after a surgical procedure in the utricule in an animal model. MATERIALS AND METHODS: An experimental study. Eight sheep underwent electrocautery-induced utricular trauma, and their cochlear function was assessed by electrocochleography--recording of electrical evoked potentials, in the preoperative, immediate postoperative and medium-term postoperative periods. The results were analyzed statistically. RESULTS: There were no statistically significant variations in amplitude (p = 0.099) and latency (p = 0.591) before and 1 month after the surgical procedure. There was a statistically significant change in the summation of the potential/action potential area ratio (p = 0.0122), a calculated loss of 11.8 dB. CONCLUSION: The intervention performed in this study enabled us to conclude that, taking into account the impaired electrophysiological responses observed during and 1 month after the surgical procedure, hearing was preserved in the operated sheep.