Speech discrimination in the sensorineural hearing loss patient: how is it affected by background noise?

There are patients who have normal hearing below 3,000 Hz and normal speech discrimination who still complain of hearing difficulty, especially when background noise is present. The objective of this study is to document the fact that these individuals have a significant hearing impairment that is not detected with routine testing. We retrospectively reviewed 67 audiograms selected for 50-dB loss or greater at 3, 4, 6, and 8 kHz and speech discrimination scores better than 80%. Patients in this group had also previously undergone speech discrimination testing in the presence of 50-dB calibrated cafeteria noise at the time of the initial audiogram. Identical testing was carried out on 48 control subjects without hearing loss. The speech discrimination scores of the hearing-impaired group were lower than in the control group when tested in a quiet booth (88.2 and 98.2%, respectively). The significant finding was the change in the speech discrimination score when tested in noise. We found that the study group had a 33.1% loss in speech discrimination when tested in the presence of background noise. The control group had only a 5.2% loss in speech discrimination in the presence of the same noisy background; this was statistically different (p = 0.001). Our conclusion is that patients complaining of hearing loss who have normal low- to mid-frequency hearing and good speech discrimination should be tested in the presence of noise to adequately document their degree of impairment. Our findings also support the theories of signal attenuation and secondary auditory pathway distortions as causes of the loss of speech discrimination.

Metastatic hypernephroma to the larynx: an unusual presentation.

We report a renal cell carcinoma which presented as a metastasis to the larynx. The only preoperative clue to the diagnosis was its hypervascularity.

Adult supraglottitis due to herpes simplex virus.

Changes in the concepts regarding epiglottis have occurred over the last two decades. Supraglottis, once thought to occur exclusively in the pediatric population, is now recognized in adults. Supraglottis is a well-defined syndrome usually caused by a bacterial infection by Haemophilus influenzae type B. Recently, other organisms have been implicated as etiologic agents in cases of supraglottitis. Documented viral supraglottitis is very rare, and adult supraglottitis due to herpes simplex virus-I has not been reported to our knowledge.

The laryngeal mucocele. Imaging analysis of a rare lesion.

Four patients with laryngeal mucocele (fluid-filled laryngocele) are described. Two laryngeal mucoceles were external, lying outside the thyrohyoid membrane, and two were combined, lying both internal and external to the membrane. The combined laryngeal mucoceles presented with both neck mass and hoarseness. The external lesions and one combined lesion were diagnosed using computed tomography (CT) and ultrasound. Another combined lesion had the benefit of CT and magnetic resonance imaging (MRI) prior to exploration. All were homogeneously hypodense at CT with rim enhancement only in the case of the laryngopyocele. The mucocele evaluated with MRI had homogeneously long T1 and T2 relaxation times similar to cerebrospinal fluid.

Acquired disruptions of the incudostapedial articulation: diagnosis with CT.

To determine the best technique for diagnosing incudostapedial joint disruption with computed tomography (CT), the authors reviewed 15 surgically proved cases. In each case, the articulation was depicted on axial but not coronal images. Disruption was due to inflammation in ten cases and trauma in five. Axial high-resolution CT is valuable in the diagnosis of traumatic and inflammatory disruption of the incudostapedial joint.

Ossicular erosions in the dry ear: CT diagnosis.

Erosions of the ossicular chain that occurred as a complication of noncholesteatomatous chronic otitis media were studied with computed tomography (CT) in 55 patients. The incus (particularly the long and lenticular processes) was the ossicle most commonly involved (50 cases). Coronal and axial CT sections were complementary in the diagnosis of these erosions. Fibrous replacement of the incudostapedial articulation was diagnosed in four cases on axial CT scans when an unusually wide joint was present.

Synthetic ossicular replacements: normal and abnormal CT appearance.

Twenty-two patients with synthetic ossicular replacements were studied with computed tomography (CT). Twelve patients had total ossicular replacement prostheses (TORPs), and ten patients had partial ossicular replacement prostheses (PORPs). Good results were achieved in 12 patients (eight with TORPs and four with PORPs). Four of these prostheses were clearly visible on CT scans, six were discernible, and two were not identified. In the ten patients with unsatisfactory surgical results, CT was performed before surgical revision. It disclosed subluxation of the prosthesis in four patients and fibrous tissue fixation in four. In two patients the CT scan appeared normal; surgery disclosed lateralization of the graft with a nonfunctioning interface.

Blood transfusions in surgery of the larynx and neck.

Effective utilization of blood and blood products is an important consideration in elective surgical procedures. A cost-effective process will maintain availability to the general population while supplying reasonable surgical needs. Removing stored blood from the general pool strains these resources and drastically increases cost. To establish the first clinical model of study and to better predict blood requirements for elective surgery of the larynx and neck, medical records of 137 consecutive patients who underwent laryngeal surgery from January 1, 1981 to June 30, 1984 were reviewed. All patients had one or a combination of one of the following: radical neck dissection, total laryngectomy, hemilaryngectomy, and/or supra-glottic laryngectomy. Data analyzed included estimated allowable blood loss, estimated intraoperative blood loss, as well as preoperative and postoperative blood hemoglobin concentrations. Actual blood utilization was adjusted for individual patient need, and recommendations for appropriate blood screen and crossmatch were derived for each of the above surgical procedures. It was concluded that blood availability for the individual patient is best assessed by the surgeon.

A new autologous fibrinogen-based adhesive for otologic surgery.

Many middle ear reconstructive procedures would be facilitated by use of a relatively safe surgical adhesive. A fibrinogen-based adhesive (Tisseel) has been effective in otologic surgery in Europe, but because it is derived from pooled human blood, it carries a risk of transmitting hepatitis, acquired immune deficiency syndrome, and other illnesses. This report details a new procedure for creating an autologous fibrinogen-based adhesive, obviating these risks. The fibrinogen and factor XIII component of the adhesive was isolated by polyethylene glycol precipitation from human plasma within a few hours, and was used either immediately or frozen for use up to 3 weeks later. Fifteen chinchillas had either the single donor adhesive, the commercial European adhesive, or saline placed on the oval and round windows, and no evidence of cochlear, mucosal, or ossicular damage was seen by light microscopy 30 days later. Auditory brain stem response thresholds remained stable, except in three animals that developed otitis media. Based on this investigation, autologous fibrinogen-based adhesive appears promising as a relatively safe, biological bonding material for otologic surgery, and is worthy of further study.