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2.
Phys Med ; 61: 64-69, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31151581

RESUMO

PURPOSE: Head-and-neck (H&N) and cranial radiotherapy may cause hearing loss. Little has been published on the dose-response relationship and normal-tissue complication probability (NTCP) of the conductive subtype of hearing loss. The aims were to observe the incidence of hearing loss in patients undergoing non-intensity-modulated H&N or cranial radiotherapy, obtain the relationship between dose and conductive hearing loss (CHL) and test the current Lyman-Kutcher-Burman (LKB) NTCP model parameters. METHODS: The dose-response in the peripheral auditory system (PAS) of 35 patients (70 ears) was prospectively studied using mean dose and the current LKB model parameters. A wide dose range was obtained by conducting the study at a clinic without advanced treatment techniques. The patients underwent routine external-beam treatments following 3D treatment planning. Hearing status was evaluated by pure-tone audiometry one day before the start and one day and 30 days after the end of radiotherapy. RESULTS: Nineteen ears (27%) experienced hearing loss. Sixteen (23%) had CHL and three (4%) the sensorineural subtype. On average, mean doses of the PAS structures and V95%, V40Gy and V30Gy volumes of the middle-ear planning-organ-at-risk volume (PRV) were significantly greater in ears that suffered CHL. The modelled 50% NTCP of CHL occurred at approximately 30-40 Gy mean dose to middle ear planning organ-at-risk volume. CONCLUSIONS: Incidence of conductive hearing loss in non-intensity-modulated radiotherapy of H&N and brain can be significant. CHL exhibits a dose-effect. This suggests that the PAS should be considered in treatment plan optimization. The LKB NTCP model was reasonably accurate but modifications are indicated.


Assuntos
Orelha/efeitos da radiação , Cabeça , Perda Auditiva Condutiva/etiologia , Pescoço , Órgãos em Risco/efeitos da radiação , Lesões por Radiação/etiologia , Crânio , Adulto , Idoso , Idoso de 80 Anos ou mais , Relação Dose-Resposta à Radiação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Neoplasias/radioterapia , Probabilidade , Estudos Prospectivos , Adulto Jovem
3.
Ann Otol Rhinol Laryngol ; 128(11): 997-1005, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31161780

RESUMO

OBJECTIVES: To evaluate pure-tone audiometric results in otosclerosis patients undergoing revision stapes surgery following previous middle ear interventions. METHODS: A retrospective cohort study was performed in a tertiary referral center. Consecutive otosclerosis patients who underwent revision stapes surgeries, following previous middle ear interventions, for persistent conductive hearing loss, recurrent conductive hearing loss, or vertigo and had available postoperative pure-tone audiometry were included. Mean pre- and postoperative air conduction, bone conduction, and air-bone gap averaged over 0.5, 1, 2, and 3 kHz were obtained. Audiometric outcomes were obtained at 7 weeks postoperatively. RESULTS: In total, 63 consecutive otosclerosis patients who underwent 66 revision stapes surgeries were included. Air-bone gap improved significantly with a mean gain of 19 dB (95% CI, 15-22). Air conduction improved significantly with a mean gain of 18 dB (95% CI, 14-23). Bone conduction did not change significantly, with a mean deterioration of 0 dB (95% CI, -2 to 1). Air-bone gap closure to 10 dB or less was achieved in 38% of cases and to 20 dB or less in 80% of cases. Indication for surgery, previous type of procedure, primary cause of failure, and current surgical technique were not significantly associated with air-bone gap closure to 10 dB or less. Indication for surgery and primary cause of failure were associated with one another. CONCLUSIONS: Compared to the available literature, a slightly larger gain in air conduction and air-bone gap was achieved in our study. Air-bone gap closure to 10 dB or less was achieved less often in our study.


Assuntos
Audiometria de Tons Puros/métodos , Limiar Auditivo/fisiologia , Condução Óssea/fisiologia , Perda Auditiva Condutiva/cirurgia , Otosclerose/cirurgia , Cirurgia do Estribo/métodos , Centros de Atenção Terciária/estatística & dados numéricos , Feminino , Seguimentos , Perda Auditiva Condutiva/etiologia , Perda Auditiva Condutiva/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Otosclerose/complicações , Otosclerose/fisiopatologia , Período Pós-Operatório , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
4.
J Laryngol Otol ; 133(6): 535-537, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31134874

RESUMO

OBJECTIVE: This study gives details of a rare case of petrous apicitis that presented as Gradenigo's syndrome and was managed surgically. METHOD: This study presents a case report and review of the literature. RESULTS: A four-year-old female was admitted for failure to thrive following recent sinusitis. Physical examination was positive for right sided facial pain, photophobia and right abducens nerve palsy. Subsequent magnetic resonance imaging revealed a 1.3 × 1.7 × 1.4 cm abscess encompassing the right Meckel's cave. A computed tomography scan showed petrous apicitis and otomastoiditis, confirming Gradenigo's syndrome. The patient was taken to the operating theatre for right intact canal wall mastoidectomy with myringotomy and tube placement. She was discharged on six weeks of ceftriaxone administered by a peripherally inserted central catheter line. At a two-week post-operative visit, she showed notable improvement in neuropathic symptoms. CONCLUSION: This study presents a rare case of petrous apicitis managed surgically without the need for a craniotomy or transcochlear procedure.


Assuntos
Imagem por Ressonância Magnética/métodos , Mastoidite/cirurgia , Petrosite/diagnóstico por imagem , Petrosite/terapia , Tomografia Computadorizada por Raios X/métodos , Antibacterianos/uso terapêutico , Pré-Escolar , Terapia Combinada , Feminino , Seguimentos , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/etiologia , Humanos , Infusões Intravenosas , Mastoidectomia/métodos , Mastoidite/diagnóstico por imagem , Mastoidite/patologia , Miringoplastia/métodos , Petrosite/complicações , Osso Petroso/diagnóstico por imagem , Osso Petroso/patologia , Osso Petroso/cirurgia , Doenças Raras , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
5.
Int J Pediatr Otorhinolaryngol ; 124: 1-5, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31136915

RESUMO

OBJECTIVES: The goal of this review was to review our series of isolated malleus fixation in pediatric patients, a rare entity causing conductive hearing loss. Malleolar fixation is poorly described in this patient population. METHODS: A retrospective review of pediatric tympanoplasties by the senior author over a four-year period was performed. Only cases with isolated fixation of the malleus were reviewed. Primary outcome of interest was post-operative hearing. Paired t-tests were used to calculate pre- and post-operative hearing outcomes. RESULTS: Five cases were analyzed. Mean age at time of surgery was 9.1 years (range 4.4-16.0 years). Average follow-up after surgery was 13.9 months (range 4.4-31.2 months). Patients were otherwise healthy and typically presented after a failed school hearing test despite previously good hearing. Three out of five cases showed radiographic evidence of bony fixation (60%) on computerized tomography (CT). Otoscopy was unremarkable in all cases. Average procedure time was 41.2 min and consisted of transcanal tympanoplasty with excision of fixed bony segment. A significant improvement in both pre- and post-operative air bone gaps was observed (p = 0.005)., with average ABG of 14.75 dB. CONCLUSIONS: Isolated pediatric malleolar fixation is an uncommon cause of pediatric conductive hearing loss. CT scan is useful for identifying this abnormality, and surgical correction results in improved post-operative hearing outcomes, potentially obviating the need for hearing amplification.


Assuntos
Perda Auditiva Condutiva/cirurgia , Martelo/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Audição , Perda Auditiva Condutiva/diagnóstico por imagem , Perda Auditiva Condutiva/etiologia , Testes Auditivos , Humanos , Masculino , Martelo/diagnóstico por imagem , Período Pós-Operatório , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Timpanoplastia/métodos
6.
Int J Pediatr Otorhinolaryngol ; 123: 51-56, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31071598

RESUMO

Posterior semicircular canal dehiscence is a rare condition and can cause a variety of symptoms. We report three cases of children between 5 and 12 years of age with a PSCD. They all presented with different complaints as follows: Tullio phenomenon in the first case, conductive hearing loss in the second and, conductive hearing loss and pulsatile tinnitus in the third. Imaging showed in all cases a PSCD on the right side, caused by a prominent jugular bulb (high riding bulb). We describe the clinical, audiometric and radiological findings, and discuss the management and therapy. A conservative "wait and see" approach is recommended, especially with children, because of the possible complications of surgery and the possibility that the symptoms will lessen with the skull base osseous maturation.


Assuntos
Doenças do Labirinto/diagnóstico , Doenças do Labirinto/terapia , Canais Semicirculares , Criança , Pré-Escolar , Feminino , Perda Auditiva Condutiva/etiologia , Testes Auditivos , Humanos , Doenças do Labirinto/complicações , Masculino , Nistagmo Patológico/etiologia , Zumbido/etiologia , Tomografia Computadorizada por Raios X , Vertigem/etiologia
7.
BMJ Case Rep ; 12(3)2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30898967

RESUMO

A 24-year-old man sustained significant injuries as a result of a motor bicycle accident. CT scans demonstrated multiple intracranial injuries including bilateral temporal bone fractures. On emergence from sedation, the patient reported right-sided hearing loss which was attributed to ossicular chain disruption after the incus was found to be in the external auditory canal. Unexpectedly, the initial conductive hearing loss resolved with conservative management and an ossicular chain reconstruction was not required. This is an unusual case of impressive long-term good hearing outcomes following complete dislocation of the incus and extrusion from the middle ear.


Assuntos
Perda Auditiva Condutiva/etiologia , Bigorna/lesões , Fratura da Base do Crânio/complicações , Osso Temporal/lesões , Acidentes de Trânsito , Humanos , Bigorna/cirurgia , Masculino , Motocicletas , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
8.
Eur Arch Otorhinolaryngol ; 276(5): 1335-1340, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30887165

RESUMO

PURPOSE: To clarify the anatomical distribution of otosclerotic loci in otosclerosis. METHODS: Ninety-five patients with surgically confirmed uni- or bilateral otosclerosis were enrolled into the study. Hypodense areas observed in the otic capsule by high-resolution computed tomography (HRCT) were defined as otosclerotic loci. The location and number of lesions were examined, and the probability of lesion overlap and correlation with age/hearing parameters (air and bone conduction threshold, air-bone gaps) were tested. RESULTS: Otosclerotic loci were confirmed by HRCT in 77 out of 115 operated ears. The three commonly affected sites were the anterior part of the oval window (ant-OW), anterior part of the internal auditory canal (ant-IAC), and pericochlear area (PCochA), with lesions detected in 96.1%, 46.8%, and 26.0% of ears, respectively. Only the ant-OW area was affected in 48.1% of the ears; the ant-IAC in 3.9%; and PCochA in none with significant differences (p < 0.01). The ant-OW lesions preferentially overlapped with ant-IAC (44.6%) than PCochA lesions (27.0%) (p < 0.05). Among double sites diseases, triple sites diseases occurred more commonly in the ant-OW + PCochA group (80%) than ant-OW + ant-IAC group (48.5%) (p < 0.05). There was no correlation between a number of lesions and age/hearing parameters. CONCLUSIONS: Based on the probability of lesion overlap, otosclerotic lesions may initiate at ant-OW followed by ant-IAC and later PCochA. Although the number of lesions showed no immediate correlation with hearing level or age, anatomical stage of the disease estimated by the location and the number of otosclerotic loci could be useful in predicting the future hearing status.


Assuntos
Orelha Interna , Orelha Média , Otosclerose , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Condução Óssea , Cóclea/diagnóstico por imagem , Cóclea/patologia , Correlação de Dados , Orelha Interna/diagnóstico por imagem , Orelha Interna/patologia , Orelha Média/diagnóstico por imagem , Orelha Média/patologia , Feminino , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Otosclerose/patologia , Otosclerose/fisiopatologia , Gravidade do Paciente
9.
Eur Arch Otorhinolaryngol ; 276(4): 1029-1034, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30725208

RESUMO

OBJECTIVES: Lateral semicircular canal (LSCC) malformations  are one of the most common inner ear malformations. The purpose of this study is to analyze the prevalence and type of hearing losses associated with LSCC malformations, compared to a control group. MATERIALS AND METHODS: We retrospectively included 109 patients (166 ears) presenting with a CT-confirmed LSCC malformation, compared to a control group (24 patients). The bony island surface and the width of the inner portion of the LSCC were measured to confirm the malformation. There results were correlated to audiogram data: sensorineural (SHNL), mixed (MHL) or conductive hearing loss (CHL) by an otologist. RESULTS: In the LSCC group, 60.9% of patients presented with an audiogram-confirmed hearing loss, especially SNHL (39.2%, n = 65) and MHL (12.7%, n = 21). Hearing was normal in 39.2% (n = 65) of the cases. Bilateral LSCC malformations (n = 57) were frequently associated with hearing loss (80.7%), SNHL in most of the cases (33.3%). Unilateral LSCC malformations were associated with hearing alterations (51.9%, n = 27), but we also observed a high rate (81%, n = 42) of contralateral abnormalities of the audiogram. CONCLUSION: LSCC malformations are commonly associated with hearing loss (61%), especially SHNL (39%). The high rate (81%) of contralateral hearing disturbances in unilateral LSCC malformations should be taken into account in the patient's daily life to avoid triggering or exacerbating any hearing loss. Otologists and radiologists must cooperate to ensure that all malformations are correctly described on CT, especially to improve the patient's education regarding hearing preservation.


Assuntos
Audiometria/métodos , Perda Auditiva Condutiva , Perda Auditiva Neurossensorial , Canais Semicirculares , Adulto , Anormalidades Congênitas/epidemiologia , Feminino , França/epidemiologia , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/epidemiologia , Perda Auditiva Condutiva/etiologia , Perda Auditiva Condutiva/prevenção & controle , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/epidemiologia , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Neurossensorial/prevenção & controle , Humanos , Masculino , Administração dos Cuidados ao Paciente/métodos , Prevalência , Estudos Retrospectivos , Canais Semicirculares/anormalidades , Canais Semicirculares/diagnóstico por imagem , Canais Semicirculares/fisiopatologia , Osso Temporal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos
10.
Ann Otol Rhinol Laryngol ; 128(6): 485-489, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30781969

RESUMO

OBJECTIVE: To identify and characterize hearing loss (HL) in children with septo-optic dysplasia (SOD). METHODS: Otologic and audiometric data for patients less than 18 years of age identified as having SOD who were seen in the Children's Healthcare of Atlanta-Scottish Rite Hospital clinic between 2013 and 2017 were collected and reviewed through a HIPAA-compliant medical record search. Relevant literature was also reviewed with the assistance of Medline. RESULTS: Sixty-four patients with SOD were identified, and 7 of those patients (10.9%) were diagnosed with hearing loss. Type of hearing loss was sensorineural (SNHL) in 5 patients (63%), mixed (MHL) in 1(14%), and conductive (CHL) in 1(14%). Bilateral loss presented in 60% (3/5) of SNHL patients, while the rest demonstrated unilateral loss. Unilateral findings included cochlear nerve deficiency (1) and atresia/microtia (1). Tympanostomy tubes were required in 57% (4/7) of SOD children with hearing loss. Amplification was successfully implemented in 86% (6/7). CONCLUSIONS: Hearing loss was found in nearly 11% of SOD children, and SNHL was identified as (63%) the predominant form of loss. To our knowledge, this is the first retrospective review of hearing loss in a pediatric SOD cohort and the first to report of cochlear nerve deficiency and atresia/microtia in this population. Based on these findings, early identification of hearing loss with imaging when appropriate and treatment of otitis in this population is recommended.


Assuntos
Perda Auditiva/diagnóstico , Perda Auditiva/etiologia , Displasia Septo-Óptica/complicações , Testes de Impedância Acústica , Criança , Pré-Escolar , Doença Crônica , Feminino , Perda Auditiva Bilateral/diagnóstico , Perda Auditiva Bilateral/etiologia , Perda Auditiva Condutiva/diagnóstico , Perda Auditiva Condutiva/etiologia , Perda Auditiva Condutiva-Neurossensorial Mista/diagnóstico , Perda Auditiva Condutiva-Neurossensorial Mista/etiologia , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Perda Auditiva Unilateral/diagnóstico , Perda Auditiva Unilateral/etiologia , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Ventilação da Orelha Média , Otite Média/etiologia , Otite Média/terapia , Estudos Retrospectivos , Displasia Septo-Óptica/diagnóstico por imagem
11.
Eur Ann Otorhinolaryngol Head Neck Dis ; 136(2): 123-126, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30606652

RESUMO

INTRODUCTION: We report a case of unilateral progressive primary hypertrophic lichen planus of the external auditory canal requiring several surgical interventions to deal with constant pruritus, otorrhoea, stenosis and conductive hearing loss. CASE SUMMARY: A 58-year-old woman was initially treated with meatoplasty for suspected chronic obliterating otitis externa. She remained symptom-free for 5 years, before the disease recurred, affecting other body surfaces as well. Otorrhoea, conductive hearing loss and pruritus worsened, and a canal wall down tympanomastoidectomy was performed, removing the skin of the external auditory canal and the tympanic membrane completely. Lichen planus was confirmed histopathologically. DISCUSSION: Very few surgical results have been published on stenosis of the external auditory canal caused by lichen planus. Complete medial external auditory canal skin elevation and removal with postoperative split-skin grafting is advised for initial treatment. We discuss treatment options and surgical outcome after initial surgical failure.


Assuntos
Meato Acústico Externo/cirurgia , Otopatias/cirurgia , Líquen Plano/cirurgia , Progressão da Doença , Meato Acústico Externo/patologia , Otopatias/complicações , Otopatias/patologia , Feminino , Perda Auditiva Condutiva/etiologia , Humanos , Hipertrofia , Líquen Plano/complicações , Líquen Plano/patologia , Processo Mastoide/cirurgia , Pessoa de Meia-Idade , Otite Externa/cirurgia , Prurido/etiologia , Recidiva , Reoperação , Membrana Timpânica/cirurgia
12.
J Clin Neurosci ; 62: 242-243, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30611628

RESUMO

Traumatic head injuries can be associated with ossicular chain disruption. Especially in the setting of temporal bone fractures, proper alignment of the ossicular chain has to be insured. Loss of normal ossicular alignment is associated with conductive hearing loss. Treatment of ossicular chain disruption, so called ossiculoplasty, aims to restore proper anatomic alignment of the ossicles with osseous or cartilaginous autograft and/or prosthetic devices.


Assuntos
Traumatismos Craniocerebrais/complicações , Ossículos da Orelha/lesões , Perda Auditiva Condutiva/etiologia , Humanos , Masculino , Pessoa de Meia-Idade
13.
Eur J Radiol ; 110: 74-80, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30599877

RESUMO

Conductive hearing loss (CHL) commonly results from middle ear fluid and inflammation (otitis media). Less commonly in patients with CHL, the middle ear cleft is well aerated or 'dry' with absence of soft tissue or fluid clinically and on imaging. There are numerous causes for this but they can be clinically challenging to diagnose. This pictorial review aims to illustrate and discuss the CT features of both common and less common causes of CHL in patients with a "dry middle ear cavity".


Assuntos
Orelha Média/diagnóstico por imagem , Perda Auditiva Condutiva/etiologia , Adolescente , Adulto , Idoso , Ossículos da Orelha/anormalidades , Ossículos da Orelha/diagnóstico por imagem , Ossículos da Orelha/lesões , Feminino , Perda Auditiva Condutiva/diagnóstico por imagem , Humanos , Bigorna/anormalidades , Bigorna/diagnóstico por imagem , Labirintite/complicações , Labirintite/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Miringoesclerose/complicações , Miringoesclerose/diagnóstico por imagem , Otosclerose/complicações , Otosclerose/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Cirurgia do Estribo/efeitos adversos , Tomografia Computadorizada por Raios X , Membrana Timpânica/anormalidades
14.
Eur Ann Otorhinolaryngol Head Neck Dis ; 136(2): 93-97, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30639598

RESUMO

OBJECTIVES: To analyze the etiologies, auditory consequences, diagnostic tools and therapeutic results of three often confused pathologies: acquired fibrous stenosis of the medial part of the external auditory canal (EAC), fibrous anterior tympanomeatal angle blunting, and lateralized tympanic membrane. MATERIAL AND METHODS: Retrospective study of 18 cases operated on over a 16-year period (14 patients: 7 female, 7 male; aged 11-64 years): 8 cases of medial EAC stenosis, 3 of blunting, and 7 of tympanic membrane lateralization. RESULTS: In all 3 pathologies, otoscopic and radiologic diagnosis was easily established, so that they could not be confused. All 3 induced>33dB conductive hearing loss. Medial EAC stenosis was secondary to chronic inflammation of the EAC, aggravated by surgery in 5 cases. Blunting was secondary to surgery altering the anterior tympanic annulus. Tympanic membrane lateralization was secondary to prior surgery without inflammatory process. Underlying EAC cholesteatoma was found in 3 cases of medial stenosis and in 1 case of blunting. Surgical results were disappointing in medial stenosis, with 62.5% recurrence and mean functional gain of 9dB, and in blunting, with 66.7% recurrence and mean functional gain of 6dB; auditory results were, however, good in these 2 pathologies when there was no recurrence of fibrosis. Results were significantly better in lateralized tympanic membrane, with 28.6% recurrence and mean functional gain of 16dB. CONCLUSION: The good results obtained in tympanic membrane lateralization seem to justify surgery in patients bothered by their hearing loss. The indication is more questionable in cases of medial fibrous stenosis and blunting, although significant auditory improvement is achieved in case of surgical success.


Assuntos
Meato Acústico Externo/patologia , Membrana Timpânica/patologia , Adolescente , Adulto , Criança , Colesteatoma da Orelha Média/diagnóstico , Constrição Patológica/diagnóstico , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Feminino , Fibrose , Perda Auditiva Condutiva/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Otite/complicações , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Recidiva , Resultado do Tratamento , Membrana Timpânica/cirurgia , Perfuração da Membrana Timpânica/cirurgia , Timpanoplastia/efeitos adversos , Adulto Jovem
15.
Int J Pediatr Otorhinolaryngol ; 119: 54-58, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30665177

RESUMO

OBJECTIVES: The objective of this study is to evaluate the safety and efficacy of the transcutaneous Bone Conduction Implant, the Bonebridge, in patients with congenital aural atresia. METHODS: Audiometry, speech recognition test and free field audiometry were performed. Word recognition scores and speech perception was evaluated using Spanish phonetically-balanced disyllables word list. RESULTS: Fourteen subjects were implanted with the Bonebridge (seven bilateral placements). The study cohort comprised seven males and seven females aged from 3 to 17 years (mean age 9.76yrs). All patients accepted and benefited from the implanted Bonebridge system. The pre-operative PTA4 was 66.4 dB (64.2-68.6, 95-%CI) and improved after activation to 19.2 dB (16.9-21.5, 95%CI), resulting in a mean functional gain of 47,2 dB. Regarding speech discrimination, the pre-operative outcomes of the disyllabic measurements were 34.3% and for monosyllables 27.4%. Following activation the speech discrimination improved to 98.6% and 97.9%, respectively. No infections or adverse device related effects occurred in patient group. CONCLUSION: We have concluded that the Bonebridge implant is an innovative solution for patients with conductive or mixed hearing loss and unilateral loss suffering from congenital atresia. Different surgical techniques may be used for implant placement, based on the patient's anatomy. Studies show improved functional gain, better speech perception, and lower rates of percutaneous complications associated with this implant.


Assuntos
Condução Óssea , Anormalidades Congênitas/fisiopatologia , Anormalidades Congênitas/cirurgia , Orelha/anormalidades , Perda Auditiva Condutiva/cirurgia , Próteses e Implantes , Adolescente , Audiometria , Criança , Pré-Escolar , Orelha/fisiopatologia , Orelha/cirurgia , Feminino , Perda Auditiva Condutiva/etiologia , Humanos , Masculino , Percepção da Fala , Resultado do Tratamento
16.
Auris Nasus Larynx ; 46(1): 43-49, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29885747

RESUMO

OBJECTIVE: This study was aimed to investigate whether wideband tympanometry (WBT) can distinguish among various kinds of conductive hearing loss and provide additional information. METHODS: We recruited normal subjects and patients with conductive hearing loss due to the following reasons: tympanic membrane perforation only, ossicular chain problem only, and one or other of those conditions combined with mastoid problems. Wideband absorbance at ambient pressure, peak pressure, resonance frequency, and averaged tympanogram data were measured by WBT and compared between the normal, tympanic membrane perforation only, ossicular chain problem only, and combined with mastoid problems groups. RESULTS: The normal subjects showed an average peak pressure of -19.51daPa and an average resonance frequency of 965.94Hz. Tympanic membrane perforation only patients showed a very low peak pressure (-124.93daPa) and resonance frequency (73.12Hz). When patients have ossicular chain problems, they showed slightly low peak pressures (43.08daPa) without changes in the resonance frequency (1024.8Hz). Mastoid problem subjects showed slightly decreased resonance frequencies (787.71Hz). Tympanic membrane perforation subjects showed decreased absorbance at low frequencies and ossicular chain problem subjects showed decreases at high frequencies. When comparing the perforation only and ossicular chain subjects by absorbance at 707Hz, the area under the ROC curve was 0.719 (P<0.022). Mastoid problems subjects showed decreased absorbance at all frequencies. CONCLUSION: WBT can help to distinguish tympanic membrane perforation only and ossicular chain problem patients. WBT may provide additional information on "combined with mastoid problems" patients.


Assuntos
Testes de Impedância Acústica/métodos , Ossículos da Orelha/fisiopatologia , Perda Auditiva Condutiva/diagnóstico , Processo Mastoide/fisiopatologia , Perfuração da Membrana Timpânica/diagnóstico , Adulto , Idoso , Audiometria de Tons Puros , Audiometria da Fala , Feminino , Perda Auditiva Condutiva/etiologia , Perda Auditiva Condutiva/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Perfuração da Membrana Timpânica/complicações , Perfuração da Membrana Timpânica/fisiopatologia
17.
Acta Otorrinolaringol Esp ; 70(2): 89-96, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-29880223

RESUMO

INTRODUCTION AND OBJECTIVES: Paget's disease of bone (PDB) may lead to hearing loss. The present study was conducted with the aim of measuring, characterizing and determining the risk factors for hearing loss in a group of subjects with PDB. METHODS: An observational, transversal, case-control study was conducted, a cohort of 76 subjects diagnosed with PDB in the case group and a control group of 134 subjects were included. Clinical, demographic and audiometric data were analysed. RESULTS: The comparative analysis between the subjects in the PDB group and the control group found that the case group showed higher hearing thresholds (39,51dB) compared with the control group (37.28dB) (P=.069) and presented a greater rate of conductive hearing loss (22.76%) than the control group (12.05%) (P=.0062). The study of risk factors for hearing loss found that skull involvement in bone scintigraphy, age and high blood pressure were risk factors for higher impairment in PDB. CONCLUSIONS: The subjects with PDB showed more profound and a higher proportion of conductive hearing loss than the control group. The patients with PDB and skull involvement presented a more severe hearing loss compared with the subjects without skull involvement. Skull involvement and age were found to be risk factors for hearing loss.


Assuntos
Perda Auditiva Condutiva/etiologia , Osteíte Deformante/complicações , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Audiometria de Tons Puros , Limiar Auditivo , Estudos de Casos e Controles , Estudos Transversais , Saúde da Família , Feminino , Audição , Perda Auditiva Condutiva/diagnóstico , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Crânio/diagnóstico por imagem
18.
J Zhejiang Univ Sci B ; 20(2): 111-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-29770646

RESUMO

The incidence of blast injury has increased recently. As the ear is the organ most sensitive to blast overpressure, the most frequent injuries seen after blast exposure are those affecting the ear. Blast overpressure affecting the ear results in sensorineural hearing loss, which is untreatable and often associated with a decline in the quality of life. Here, we review recent cases of blast-induced hearing dysfunction. The tympanic membrane is particularly sensitive to blast pressure waves, since such waves exert forces mainly at air-tissue interfaces within the body. However, treatment of tympanic membrane perforation caused by blast exposure is more difficult than that caused by other etiologies. Sensorineural hearing dysfunction after blast exposure is caused mainly by stereociliary bundle disruption on the outer hair cells. Also, a reduction in the numbers of synaptic ribbons in the inner hair cells and spiral ganglion cells is associated with hidden hearing loss, which is strongly associated with tinnitus or hyperacusis.


Assuntos
Traumatismos por Explosões/complicações , Perda Auditiva Condutiva/etiologia , Perda Auditiva Neurossensorial/etiologia , Orelha/lesões , Humanos , Perfuração da Membrana Timpânica/complicações
19.
Einstein (Sao Paulo) ; 16(4): eRC4509, 2018 Nov 29.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30517366

RESUMO

Facial nerve hemangioma is a rare and benign vascular tumor, and accounts for 0.7% of intratemporal tumors. We report the second case described in the literature of a facial nerve hemangioma in its tympanic segment. A 14-year-old male patient presented with a history of progressive right ear hearing loss with preserved facial mimicry. Pure tone audiometry showed a right ear moderate conductive hearing loss. Magnetic resonance imaging demonstrated an expansive lesion involving the tympanic segment of the right facial nerve, suggestive of hemangioma. Watchful waiting was chosen as management. In the first case of middle ear facial hemangioma described in the literature, facial palsy was the symptom that led the patient to seek medical care. In the present case, it can be inferred that the first symptom was conductive hearing loss ipsilateral to the lesion. Facial palsy may not be present and the clinical presentation may resemble otosclerosis, ossicular chain disruption, and third window abnormalities, among other differential diagnoses of conductive hearing loss. The second case of tympanic portion facial nerve hemangioma is reported, describing the specificity of conductive hearing loss as its only clinical manifestation.


Assuntos
Orelha Média/diagnóstico por imagem , Doenças do Nervo Facial/diagnóstico por imagem , Hemangioma/diagnóstico por imagem , Adolescente , Diagnóstico Diferencial , Nervo Facial/diagnóstico por imagem , Doenças do Nervo Facial/complicações , Perda Auditiva Condutiva/etiologia , Hemangioma/complicações , Humanos , Imagem por Ressonância Magnética , Masculino , Tomografia Computadorizada por Raios X , Conduta Expectante
20.
J Laryngol Otol ; 132(10): 885-890, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30387409

RESUMO

OBJECTIVE: To evaluate the therapeutic effect that the titanium partial ossicular reconstruction prosthesis and autologous ossicles have on hearing loss after reconstruction of a damaged ossicular chain. METHODS: Forty-two medical records of treatments carried out from 2013 to 2015 for ossicular chain damage with facial nerve paralysis due to temporal bone fractures were reviewed. The study assessed: causes of damage, pre-operative pure tone audiometry findings, types of intra-operative ossicular chain damage, intra-operative ossicular chain repair methods (titanium partial ossicular reconstruction prosthesis or autologous ossicles) and post-operative pure tone audiometry results. RESULTS: The titanium partial ossicular reconstruction prosthesis was used in 26 cases; the average air-bone gap was 32.3 ± 5.3 dB pre-operatively and 12.8 ± 5.3 dB post-operatively. Autologous ossicles were used in 16 cases; the average air-bone gap was 33.4 ± 4.5 dB pre-operatively and 17.8 ± 7.8 dB post-operatively. CONCLUSION: Ossicular chain reconstruction is an effective way of improving hearing in patients with ossicular chain damage. The results suggest that repair with either the titanium partial ossicular reconstruction prosthesis or autologous ossicles can improve hearing following ossicular chain injury with facial nerve paralysis caused by a temporal bone fracture.


Assuntos
Ossículos da Orelha/cirurgia , Perda Auditiva Condutiva/etiologia , Perda Auditiva Condutiva/reabilitação , Prótese Ossicular , Substituição Ossicular , Adulto , Audiometria de Tons Puros , Orelha Média/cirurgia , Traumatismos do Nervo Facial/etiologia , Feminino , Fraturas Ósseas/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Substituição Ossicular/métodos , Estudos Retrospectivos , Osso Temporal/lesões , Titânio/uso terapêutico , Resultado do Tratamento
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