Relationship between obesity and hearing loss

Conclusion: Underweight and severe obesity were associated with an increased prevalence of hearing loss in a Korean population.

Objective: The relationship between weight and hearing loss is unclear. This study, therefore, analyzed the relationship between hearing loss and body mass index (BMI) in a Korean population.

Methods: The prevalence and severity of hearing loss were assessed in 61 052 subjects who underwent health screening examinations, including hearing tests. Subjects were divided into five groups according to BMI (underweight, normal, overweight, obese, and severely obese). The relationships between the prevalence and severity of hearing loss and BMI were analyzed, after adjusting for the effects of age.

Results: The rates of mild or greater hearing loss in the underweight, normal, overweight, obese, and severely obese groups were 24.9%, 20.4%, 21.8%, 21.2%, and 24.1%, respectively. Mild severity of hearing loss was the most common in all five groups, followed by moderate, moderately severe, and severe hearing loss, in that order. Multivariate analysis, showed that the odds ratios of hearing loss in the severely obese, and underweight groups, compared with the normal group, were 1.312 and 1.282, respectively.     

Clinical analysis on surgical management of type III external auditory canal cholesteatoma: a report of 12 cases

Objective: To investigate surgical management of type III EACC with lesions involving the posterior external auditory canal and mastoid.

Methods: This retrospective case review was conducted in 12 patients with type III EACC who underwent intact canal wall mastoidectomy with tympanoplasty and canal wall reconstruction with autologous cortical bone.

Results: During the follow-up, all patients obtained successful results on external auditory canal structures and hearing improvement, except for one patient who needed a revision operation for the fistula between the reconstructed wall and the mastoid.

Conclusion: Intact canal wall mastoidectomy with tympanoplasty and canal wall reconstruction with autologous cortical bone was proved to be an effective and inexpensive choice for the patients with type III external auditory canal cholesteatoma (EACC) to achieve optimal outcomes.     

Comparison of electrode position between round window and cochleostomy inserting approaches among young children: a cone-beam computed tomography study

Background: As the two most commonly used approaches for cochlear implants (CIs), the round-window insertion (RWI) and cochleostomy are still controversial about which approach is optimal. The lack of visual observation methods makes it difficult to compare the electrode position between them.

Objectives: To evaluate and compare the electrode position between RWI and cochleostomy approaches for CI among young children.

Materials and methods: Twenty-four patients (16 male, 8 female) accepting CI and temporal cone-beam computed tomography (CBCT) scan post-operation in our hospital from January 2016 to July 2017 were analyzed retrospectively. Operative notes and images were used to identify the surgical technique. Mainly depending on the round-window exposure, 15 cochleae were performed with RWI and 11 performed with cochleostomy.

Results: Mean age, 2.4 (range 0.8–7) years. The CBCT images showed that all the electrode arrays were located in scala tympani. There were no significantly statistical differences in the distance between electrode contacts and modiolus (EMI), intracochlear insertion length and the angle of electrode arrays at the insertion site of the cochlea.

Conclusions and significance: Both approaches could insert electrodes into scala tympani satisfactorily. As electrodes and cochlear structures could be clearly visualized, CBCT can be applied to assess the electrode position reliably.     

Systematic review: Radiological and histological evidence of cochlear implant insertion trauma in adult patients

Introduction: Cochlear implantation (CI) has developed from its origins in the 1980s. Initially, CI was for profound bilateral hearing impairment. However, candidacy for CI have become more widespread in recent years with unilateral implantation and an emphasis on hearing preservation.

Evidence supports full electrode insertion in an atraumatic fashion into the scala tympani (ST) provides optimal hearing outcomes. The main aim of this systematic review was to elucidate the degree of trauma associated with CI insertion.

Methods: A systematic literature search was undertaken using PubMed Medline. A grading system described by Eshraghi was used to classify cochlear trauma. Both radiological and histological studies were included.

Results: Twenty one papers were identified which were relevant to our search. In total, 653 implants were inserted and 115 (17.6%) showed evidence of trauma. The cochleas with trauma had basilar membrane elevation in 5.2%, ruptured in 5.2%, the electrode passed from the ST to the SV in 84.4% and there was grade 4 trauma in 5.2%. The studies used a variety of histological and radiological methods to assess for evidence of trauma in both cadaveric temporal bones and live recipients.

Conclusions: Minimizing cochlear trauma during implant insertion is important to preserve residual hearing and optimize audiological performance. An overall 17.6% trauma rate suggests that CI insertion could be improved with more accurate and consistent electrode insertion such as in the form of robotic guidance. The correlation of cochlea trauma with post-operative hearing has yet to be determined.     

Usefulness of radiological findings for predicting cochlear implantation outcomes in children with cochlear nerve deficiency: a pilot study

Conclusion: Children with CND received limited benefits from CIs and their results varied. The size of the vestibulocochlear nerve relative to the facial nerve could potentially be used as a predicator for CI outcomes in children with CND.

Objective: This study aimed to (1) retrospectively review the outcomes of cochlear implants (CIs) in children with cochlear nerve deficiency (CND) and (2) evaluate the clinical usefulness of radiological findings as predictors for post-implantation outcomes.

Methods: Study participants included 10 children with bilateral CND and profound sensorineural hearing loss. The preoperative magnetic resonance imaging and temporal bone computed tomography scans were evaluated. Auditory processing capability and speech perception performance were measured with Categories of Auditory Performance (CAP) and Speech Intelligibility Rating (SIR) scales. Aided hearing thresholds with CI were measured. The relationships between CI outcomes and the sizes of vestibulocochlear nerve and cochlear nerve canal (CNC) were analysed.

Results: Although post-operative CAP scores and hearing thresholds significantly improved in children with CND, their results were worse than those measured in implanted children with normal cochlear nerve. No significant correlation was found between the CI outcomes and the vestibulocochlear nerve diameters or the CNC diameters in children with CND. However, children with larger vestibulocochlear-nerve-to-facial-nerve-ratios got better results.     

Factors associated with self-reported outcome in adaptation of hearing aid

Objective: This investigation evaluated the associated factors with self-reported outcome in hearing aid users by adopting the Korean version of International Outcome Inventory for Hearing Aids (IOI-HA) and Hearing Handicap Inventory for the Elderly (HHIE).

Methods: Two hundred and eight participants were enrolled in this study. Participants completed the HHIE at pre-fitting, HHIE and the IOI-HA at 1 and 3 months after fitting. The outcomes of both questionnaires were analyzed with regard to the variable factors reported or expected to be associated with the outcome of hearing aid use.

Results: The hearing-related handicap evaluated by HHIE score at pre-fitting had significant associations with age and the severity of hearing impairment. The IOI-HA score with hearing aid use was significantly correlated with WRS and the severity of hearing impairment. The improvement of HHIE score showed a significant correlation with WRS.

Conclusion: Word recognition score (WRS) is the most significantly associated factor for outcome of hearing aid use. In addition, audiometric configuration, previous experience of hearing aid use, and initial hearing handicap should be considered as associated factors with hearing aid outcome.     

Speech recognition in bilaterally cochlear implanted adults in Tokyo,Japan

Introduction: The clinical effects of bilateral cochlear implantation (BCI) include binaural summation and better hearing under noise conditions. This study retrospectively examined the utility of BCI compared to unilateral cochlear implantation (CI) in adults.

Patients and methods: We investigated 34 adults who underwent BCI, comparing speech recognition between BCI and first CI under silent and noise conditions. We assessed correlations between speech recognition after first and second CIs, and between the interval from first to second CI surgery and speech recognition of second CI.

Results: Word recognition score (WRS) and sentence recognition score (SRS) were significantly better after BCI than after first CI under conditions of silence and noise. No significant correlation was found between speech recognition after first CI and that after second CI, or between inter-implant interval and speech recognition of second CI for either WRS or SRS.

Conclusions: The utility of BCI in Japanese patients was shown. Patients have no need to be pessimistic about hearing after the second implantation even if speech recognition after the first implantation is poor. A long interval from first CI does not necessarily contraindicate contralateral implantation in adults.     

Pilot study on the use of data mining to identify cochlear implant candidates

Objectives: The goal of this pilot study was to determine the clinical utility of data-mining software that screens for cochlear implant (CI) candidacy.

Methods: The Auditory Implant Initiative developed a software module that screens for CI candidates via integration with a software system (Noah 4) that serves as a depository for hearing test data. To identify candidates, patient audiograms from one practice were exported into the screening module. Candidates were tracked to determine if any eventually underwent implantation.

Results: After loading 4836 audiograms from the Noah 4 system, the screening module identified 558 potential CI candidates. After reviewing the data for the potential candidates, 117 were targeted and invited to an educational event. Following the event, a total of six candidates were evaluated, and two were implanted.

Discussion: This objective approach to identifying candidates has the potential to address the gross underutilization of CIs by removing any bias or lack of knowledge regarding the management of severe to profound sensorineural hearing loss with CIs.

Conclusion: The screening module was an effective tool for identifying potential CI candidates at one ENT practice. On a larger scale, the screening module has the potential to impact thousands of CI candidates worldwide.     

The impact of vestibular status prior to cochlear implantation on postural control: A multiple case study

Objective: The goal of the present study was to investigate the impact of unilateral cochlear implantation on postural control in relation to the vestibular status before CI surgery.

Methods: We recruited 17 participants (four CI candidates and 13 hearing controls) and performed complete vestibular evaluation (cVEMP, oVEMP, vHIT) and postural evaluation using a force platform, prior and following unilateral cochlear implant surgery.

Results: Our study suggests that an increase in postural sway following cochlear implant was present only for the participants that received the implant in the ear with the better vestibular function. cVEMP and oVEMP measures in the implanted ear prior to unilateral cochlear implantation may help to predict postural control performance following surgery.

Discussion: A thorough evaluation of the vestibular function, as described in the present study, could not only be helpful to make a more accurate prognosis of the risks of fall following cochlear implantation, but also to provide proper vestibular rehabilitation for at-risk patients.     

Cochlear implants in the management of hearing loss in Neurofibromatosis Type 2

Objective: Review of cochlear implant (CI) outcomes in patients with Neurofibromatosis Type 2 (NF2), implanted in the presence of an ipsilateral vestibular schwannoma (VS). Hearing restoration was combined in some cases with a Bevacizumab regime.

Method: Retrospective review of 12 patients, managed over the period 2009–2016, at a tertiary referral multidisciplinary NF2 clinic. The patients are grouped by hearing outcomes to explore likely protective factors, and to generate a proposed decision-making tool for the selection of either CI or Auditory Brainstem Implant (ABI).

Results: Four of the 12 patients achieved speech discrimination without lip-reading. In these individuals there is reason to think that the mechanism of their hearing loss was cochlear dysfunction. A further four patients received benefit to lip-reading and awareness of environmental sound. For such patients their hearing loss may have been due to both cochlear and neural dysfunction. Two patients gained access to environmental sound only from their CI. Two patients derived no benefit from their CIs, which were subsequently explanted. Both these latter patients had had prior ipsilateral tumour surgery, one just before the CI insertion.

Conclusion: Cochlear implantation can lead to open set speech discrimination in patients with NF2 in the presence of a stable VS. Use of promontory stimulation and intraoperative electrically evoked auditory brainstem response testing, along with case history, can inform the decision whether to implant an ABI or CI.     

Audiovestibular function in patients with juvenile idiopathic arthritis (JIA)

Conclusion: It was found that JIR children had potential sensory neural hearing loss and vestibular affection. Therefore, this study recommends: early complete audiologic evaluation of JIA child followed by regular follow-up, including TOAEs, extended high-frequency audiometry, and VNG. This follow-up is important for preliminary diagnosis and management in order to prevent the negative impact of hearing loss on a child’s life.

Objective: The aim of this study was to assess hearing in children with Juvenile idiopathic arthritis (JIA) and compare them with a healthy control group. In addition to conventional audiometry, extended high-frequency audiometry and Transient otoacoustic emission (TOAEs) were used. This study also tried to investigate the vestibular function in JIR children by videonystagmography (VNG).

Patients and methods: The study group comprised of 28 children with JIR and 28 healthy children. All subjects were examined audiologically using basic audiological evaluation, high-frequency audiometry, TOAEs, and VNG.

Results: Children with JIR had apparent normal peripheral hearing in conventional audiometry; sub-clinical sensory neural hearing loss was detected. This sub-clinical hearing loss appeared in statistically significant difference between them and normal in high-frequency audiometry and TOAEs. VNG test results showed affected tracking and second tests.     

Evaluation of a multi-channel algorithm for reducing transient sounds

Objective: The objective was to evaluate and select appropriate parameters for a multi-channel transient reduction (MCTR) algorithm for detecting and attenuating transient sounds in speech.

Design: In each trial, the same sentence was played twice. A transient sound was presented in both sentences, but its level varied across the two depending on whether or not it had been processed by the MCTR and on the “strength” of the processing. The participant indicated their preference for which one was better and by how much in terms of the balance between the annoyance produced by the transient and the audibility of the transient (they were told that the transient should still be audible).

Study sample: Twenty English-speaking participants were tested, 10 with normal hearing and 10 with mild-to-moderate hearing-impairment. Frequency-dependent linear amplification was provided for the latter.

Results: The results for both participant groups indicated that sounds processed using the MCTR were preferred over the unprocessed sounds. For the hearing-impaired participants, the medium and strong settings of the MCTR were preferred over the weak setting.

Conclusions: The medium and strong settings of the MCTR reduced the annoyance produced by the transients while maintaining their audibility.     

Cochlear volume as a predictive factor for residual-hearing preservation after conventional cochlear implantation

Objective: The preservation of residual hearing after conventional cochlear implantation (CI) is frequently observed when atraumatic soft surgery is adopted. The purpose of this study was to elucidate the predictive factors for residual hearing preservation after atraumatic CI.

Patients: This study included 46 patients who underwent CI based on an atraumatic technique using a standard-length flexible electrode implant through a round window approach.

Main outcome measure: Cochlear volume was measured using magnetic resonance imaging (MRI). Cochlear duct length (CDL) was taken as the length of the scala media measured using computed tomography (CT). The association between residual hearing preservation and cochlear volume/CDL was then examined.

Result: Cochlear volume and CDL were significantly larger in patients with complete hearing preservation than in those with hearing loss. Multivariate logistic regression analysis revealed that cochlear volume was a significant predictive factor for residual hearing preservation.

Conclusion: Residual hearing preservation after conventional CI was observed in patients with a larger cochlear volume and longer CDL. Cochlear volume could be a predictive factor for residual hearing preservation after conventional CI.     

Evaluation of pediatric cochlear implant care throughout Europe: Is European pediatric cochlear implant care performed according to guidelines?

Objectives: International guidelines indicate that children with profound hearing loss should receive a cochlear implant (CI) soon after diagnosis in order to optimize speech and language rehabilitation. Although prompt rehabilitation is encouraged by current guidelines, delays in cochlear implantation are still present. This study investigated whether European countries establish timely pediatric CI care based on epidemiological, commercial, and clinical data.

Methods: An estimation of the number of pediatric CI candidates in European countries was performed and compared to epidemiological (Euro-CIU), commercial (Cochlear^®), and clinical (institutional) age-at-implantation data. The ages at implantation of pediatric patients in eight countries (the Netherlands, Belgium, Germany, the United Kingdom, France, Turkey, Portugal, and Italy) between 2005 and 2015 were evaluated.

Results: From 2010 onwards, over 30% of the pediatric CI candidates were implanted before 24 months of age. Northern European institutions implanted children on average around 12 months of age, whereas southern European institutions implanted children after 18 months of age. The Netherlands and Germany implanted earliest (between 6 and 11 months).

Discussion: Implemented newborn hearing screening programs and reimbursement rates of CIs vary greatly within Europe due to local, social, financial, and political differences. However, internationally accepted recommendations are applicable to this heterogeneous European CI practice. Although consensus on early pediatric cochlear implantation exists, this study identified marked delays in European care.

Conclusion: Regardless of the great heterogeneity in European practice, reasons for latency should be identified on a national level and possibilities to prevent avoidable future implantation delays should be explored to provide national recommendations.     

Subjective hearing-related quality-of-life is a major factor in the decision to continue using hearing aids among older persons

Conclusion: Audiological parameters alone do not determine the choice to use hearing aids (HA). Subjective hearing-related QoL is a major factor that determines whether or not an older person will continue to wear HA.

Objective: This study aimed to identify which audiological parameters and quality-of-life (QoL) measures determine whether or not older persons will continue wearing HA.

Methods: Charts of 157 patients aged ≥65 years who attended the HA service unit at the Otolaryngology Department were retrospectively reviewed. After HA fitting and a trial, the patients were divided into groups, depending upon whether or not they wanted to continue wearing the HA (users, 58.2%; non-users, 41.8%) and then audiological parameters were compared between them. At least 4 months after the HA fitting, the self-reported QoL questionnaire, Hearing Handicap Inventory for the Elderly (HHIE), was mailed to all 157 patients and HHIE scores were compared between HA users and non-users.

Result: Speech discrimination score and dynamic range did not significantly differ between HA users and non-users. A difference in the average hearing threshold was marginally significant. The response rate to the HHIE was 65.2%. Total HHIE and emotional scores were higher (more impaired) among HA users than non-users.     

Plunging ranula – patient characteristics,treatment, and comparison between different populations

Objectives: To review our clinical experience and characteristics of Finnish patients with plunging ranula and compare our results with reports from other populations.

Design: A retrospective study from the electronic hospital records between 2005 and 2016.

Setting: The Department of Otorhinolaryngology and Head and Neck Surgery of Helsinki University Hospital, Finland.

Results: We describe the characteristics and treatment of 41 patients with MRI-confirmed plunging ranula. Most of our patients were young adults and 88% of them were male. Surgery and sclerotherapy were used for treatment.

Conclusions: The vast majority of Finnish plunging ranula patients in our cohort were male, suggesting significant population-related differences in plunging ranula gender distribution. Transoral surgery seemed to result in lowest recurrence rate and was the most common treatment in our clinic.     

Development of a multimedia educational programme for first-time hearing aid users: a participatory design

Objective: To develop content for a series of interactive video tutorials (or reusable learning objects, RLOs) for first-time adult hearing aid users, to enhance knowledge of hearing aids and communication.

Design: RLO content was based on an electronically-delivered Delphi review, workshops, and iterative peer-review and feedback using a mixed-methods participatory approach.

Study sample: An expert panel of 33 hearing healthcare professionals, and workshops involving 32 hearing aid users and 11 audiologists. This ensured that social, emotional and practical experiences of the end-user alongside clinical validity were captured.

Results: Content for evidence-based, self-contained RLOs based on pedagogical principles was developed for delivery via DVD for television, PC or internet. Content was developed based on Delphi review statements about essential information that reached consensus (≥90%), visual representations of relevant concepts relating to hearing aids and communication, and iterative peer-review and feedback of content.

Conclusions: This participatory approach recognises and involves key stakeholders in the design process to create content for a user-friendly multimedia educational intervention, to supplement the clinical management of first-time hearing aid users. We propose participatory methodologies are used in the development of content for e-learning interventions in hearing-related research and clinical practice.     

Awake craniotomy for assisting placement of auditory brainstem implant in NF2 patients

Objectives: Auditory brainstem implants (ABIs) may be the only opportunity for patients with NF2 to regain some sense of hearing sensation. However, only a very small number of individuals achieved open-set speech understanding and high sentence scores. Suboptimal placement of the ABI electrode array over the cochlear nucleus may be one of main factors for poor auditory performance. In the current study, we present a method of awake craniotomy to assist with ABI placement.

Methods: Awake surgery and hearing test via the retrosigmoid approach were performed for vestibular schwannoma resections and auditory brainstem implantations in four patients with NF2. Auditory outcomes and complications were assessed postoperatively.

Results: Three of 4 patients who underwent awake craniotomy during ABI surgery received reproducible auditory sensations intraoperatively. Satisfactory numbers of effective electrodes, threshold levels and distinct pitches were achieved in the wake-up hearing test. In addition, relatively few electrodes produced non-auditory percepts. There was no serious complication attributable to the ABI or awake craniotomy.

Conclusions: It is safe and well tolerated for neurofibromatosis type 2 (NF2) patients using awake craniotomy during auditory brainstem implantation. This method can potentially improve the localization accuracy of the cochlear nucleus during surgery.     

Occurrence of major complications after cochlear implant surgery in Ireland

Objectives: Cochlear implantation (CI) is considered an effective and relatively safe procedure for patients with severe-profound hearing loss. However, severe complications are reported in several studies. The purpose of this study was to report the frequency and management of major complications following CI surgery at the National CI Programme (NCIP) in Ireland.

Methods: Major complications were defined according to the classification of Hansen et al. 2010. The medical records of 1017 patients undergoing CI between 1995 and 2016 were analyzed retrospectively for major complications. In addition, radiological and intraoperative findings as well as therapeutic management of all patients with a major complication were reviewed.

Results: Altogether, 1017 patients underwent 1266 CI surgeries. The median follow-up of all CI surgeries was 44 months. The total number of major complications identified was 21 which corresponds to an overall rate of 1.7%. The majority of major complication (71%) occurred at least one week after surgery. The most common major complications were internal receiver/stimulator protrusion and migration (6/21), followed by migration of the electrode array (4/21) and recurrent otitis media requiring re-implantation (4/21). All patients with major complications required additional surgery, with reimplantation necessary in 19 patients (90%).

Discussion: CI surgery is a safe surgical procedure for hearing rehabilitation associated with a low rate of severe complications. However, major complications can occur many years after surgery, making revision surgery necessary.

Conclusion: Long-term follow-up is necessary for the early identification of complications to facilitate appropriate care.     

Comparison of the effects of four different cochlear implant electrodes on intra-cochlear pressure in a model

Conclusion: Based on this model experiment, a small tip and low volume electrode show lowest intra-cochlear pressure values. Insertional support by a tool minimizes fast pressure changes. Higher electrodes volumes affect slow and fast pressure changes as well.

Objective: Insertion causing low intra-cochlear pressure is assumed to be important for atraumatic cochlear implant surgery to preserve residual hearing. Cochlear implant electrodes differ in terms of parameters like tip size, length, volume, and technique of insertion. The aim of this study was to observe the effect of different cochlear implant electrodes on insertional intra-cochlear pressure in a cochlear model.

Materials and methods: Cochlear implant electrode insertions were performed in an artificial cochlear model and intra-cochlear pressure changes were recorded in parallel with a micro-pressure sensor positioned in the apical region of the cochlear model to follow the maximum values, temporal changes, maximum amplitude, and frequency of changes in intra-cochlear pressure. Insertions were performed with four different electrodes (Advanced Bionics 1j, Helix, HFMS, and LW23).

Results: This study found statistically significant differences in the occurrence of initial maximum pressure values correlating with the electrode tip size. The different electrodes and the technique of insertion significantly affected the occurrence of maximum value, amplitude, and frequency of intra-cochlear pressure occurrence.