以突聋为首发症状的小脑扁桃体下疝畸形1例

1 临床资料 男,52岁,于2002年6月26日来诊。主诉:右耳突然听力下降伴阵发性耳鸣半个月。该患者半月前无明显诱因右耳听力突然下降伴耳鸣,耳鸣呈持续高音调,时有眩晕,无头痛,曾在当地医院静脉滴注能量合剂10天,疗效不显。检查:双耳鼓膜外观正常,标志清楚。自发性眼震(+),水平性,无明显快慢相。四肢肌力V级,生理反射存在,病理反射未引出。电测听示:右耳感音神经性聋曲线(平均听力58dB),左耳听力正常。入院诊断:①右耳突发性聋;②听神经瘤?脑CT示:脑积水(图1)。进一步明确引起脑积水形成的原因,检查MRI示:环枕发育畸     

颞骨巨细胞修复性肉芽肿一例

正1病例资料患者女,30岁,因右耳听力进行性下降,伴搏动性耳鸣3个月于2014年4月2日收入我院。患者3个月前无明显诱因出现右耳听力进行性下降,伴右侧头部钝痛,呈间歇性,右耳闷胀感,伴右耳搏动性耳鸣,呈持续性,与脉搏跳动一致,无溢液、溢脓、溢血,无发热、眩晕、恶心、呕吐,曾于外院行右侧外耳道肿物活检术,术后病理示:毛细胞瘤样增生伴出血,少量慢性炎细胞浸润及表皮坏死。入我院查体:     

手术刺激外耳道引起血压和心率骤降一例

患者男，８岁。双耳间断性流脓伴听力下降３年，要求手术。检查双耳鼓膜紧张部穿孔：左耳３ｍｍ×２ｍｍ，右耳３ｍｍ×３ｍｍ大小；电测听示：双耳均为中重度传导性耳聋，左耳骨气导差３５ｄＢ，右耳骨气导差４０ｄＢ。入院诊断为双耳慢性化脓性中耳炎，于１周后在气管插...     

搏动性耳鸣1例

1病例报道患者女,38岁,因右耳耳鸣3年于2012年4月1 6日入院。患者发病后听力下降、头痛、眩晕。无头部外伤或手术史。体查双耳鼓膜完整,标志清楚,光泽度佳。双耳纯音测听示听力正常,声导抗示鼓室A型曲线,镫骨肌反射引出。     

首发症状为听力明显下降的脑梗塞1例

听力突然下降可以是许多疾病的表现,笔者曾遇1例首发症状为听力突然下降的腔隙性脑梗塞患者,报告如下.患者,男,64岁.10年前始感双耳持续性耳鸣,伴听力下降,以右侧为著,并逐渐加重,平常只能用左耳进行语言交流,曾多次用药治疗,疗效不佳.4天前晨起时,左耳耳鸣加重,听力明显下降,至晚间大声喊才能听到,无头痛及眩晕.体检:一般情况好,心肺(一),双耳检查(一);纯音测听示右耳听力损失80dBHL,左耳75dBHL;声阻抗示:镫骨肌反射消失.入院后静滴能量合剂,静注大剂量烟酸并吸氧治     

以耳鸣耳聋为主要症状的自发性颈内动脉海绵窦瘘1例

病人，女，74岁，于2002年6月20日来诊。主诉：右耳听力下降伴搏动性耳鸣1个月，耳鸣呈低调，与心脏搏动一致。该病人1个月前无明显诱因出现右耳鸣，而后出现右耳听力下降，否认外伤史，未予任何治疗。检查：双耳鼓膜外观正常，标志清楚。双侧眼眶周围及面部听诊可闻及血管杂音；按压右侧颈总动脉，耳鸣消失，听诊双侧眼眶周围及面     

引起蓝鼓膜表现的特殊病例报告

病例1男,74岁。右耳进行性听力下降伴耳鸣2年,流脓血2月,于1998年3月3日入院。入院前2年,患者无明显诱因出现右耳堵,进行性听力下降伴博动性耳鸣。2个月前突发右耳剧痛,流出脓血性分泌物后疼痛缓解。以后右耳间断性流脓。无眩晕及其它颅神经受累的症状。入院前1个月就诊时检查发现,右耳鼓膜呈深蓝色,光泽度下降并向外膨隆,鼓膜前下方有一小裂隙,有少许脓血性分泌物。鼻及鼻咽部未见明显异常。纯音测听右耳为混合性聋,骨气导差距约40dB。X线检查示右侧乳突密度增高。CT扫描示右耳中、上鼓室及鼓窦处有软组织影,未见骨质破坏。…     

以耳聋为首发症状的脑梗塞一例

患者，女，60岁，5年前感双耳持续性耳鸣，如蝉鸣音，伴听力下降，以右耳为重，呈渐进性加重趋势，并有语言交流障碍，曾用中西药物治疗无效。近10天突感左耳耳鸣加重，仍为蝉鸣样，听力下降无明显加重，无头痛、眩晕、呕吐。心电图示心肌受累，肺、腹部正常。专科检查：鼻、咽、喉正常。纯音听阈测试：双耳感音神经性聋，言语频率平均气导听阈右耳85dBHL，左耳70dBHL，     

易误、漏诊的罕见颅内感染死亡1例报告

1临床资料患者,女,66岁、因双耳听力下降2月余,于1998年4月24日以“神经性耳聋”收入院。患者自述2月前出现双耳流水,在外院诊为“中耳炎”,经用抗生素治疗双耳流水止,之后出现右耳听力下降,继之友耳亦听力下降,伴低调耳鸣,听力｝降逐渐加重,在山东医科大学附属医院查电测听示“神经性聋（双）”,脑CT检查示正常。给予能量合剂、维生素类及金钠多等治疗,病情无好转,近半个月近全聋,遂来我院住院综合治疗。入院时见双耳近全聋,靠书写交流,伴低调耳鸣,偶有头晕,走路自觉高低不平,伴周身乏力、无发热、无头痛。检查：双耳…     

外耳道Merkel细胞癌一例

患者男,54岁,因右耳听力下降1年于2010年7月30日入院.患者1年前无明显诱因出现右耳听力下降伴耳堵塞感,l0d前出现右耳疼痛伴右半侧舌感觉异常,无耳漏、眩晕及面肌无力等症状,门诊检查发现右外耳道内有一肿物,以"外耳道肿物"收住院.人院查体:一般状态良好,全身浅表淋巴结未触及肿大.专科检查:右外耳道后上壁可见一暗红色表面光滑的新生物,质地软,基底广,鼓膜未窥及,乳突皮肤无红肿及压痛.颞骨CT检查示右外耳道狭窄,其内可见软组织影,鼓膜显示不清,外耳道底皮肤软组织影增厚;听小骨部分吸收并被软组织包绕,面神经管各段未见异常;耳蜗、前庭及半规管未见异常;鼓室盾板存在.     

Rehabilitation of the hearing impaired adult in Denmark

An outline is given of the rehabilitation of the hearing impaired adult in Denmark. Emphasis is put on the comprehensiveness and the professionalism of the services provided.     

Results of the bone-anchored hearing aid in unilateral hearing loss

OBJECTIVES: The advantages of binaural hearing are well established and universally accepted. However, a tendency remains to withhold the benefits of binaural hearing to adults and children with one normal ear. The purpose of this study is to demonstrate the benefit of the bone-anchored hearing aid (BAHA) in a group of patients with unilateral conductive or mixed hearing loss. STUDY DESIGN: This is a prospective study of nine patients (five males and four female patients) with conductive or mixed hearing loss who met the criteria for BAHA except for having normal hearing in the other ear. They had congenital aural atresia or mastoidectomies secondary to chronic ear infections with or without cholesteatoma or had a temporal bone tumor excised METHODS: Patients had evaluations before and after implantation, including audiological testing and responses to a standardized hearing handicap questionnaire. Statistical analyses of the data were made using the Wilcoxon signed rank test and the paired Student t test for repeated measures. RESULTS: All patients had tonal and spondee threshold improvement with BAHA when compared with thresholds before treatment. Speech recognition performance in BAHA-aided conditions was comparable to the patient's best score in unaided condition. Patients reported a significant improvement in their hearing handicap scores with the BAHA. CONCLUSIONS: The use of BAHA has significantly improved the hearing handicap scores in patients with unilateral conductive or mixed hearing loss. The proven safety and efficacy of the device promote its use in unilateral cases that traditionally had been left unaided.     

Assessment of the American Medical Association guide to the evaluation of binaural hearing impairment

Abstract

Objective: To assess the American Medical Association (AMA) guide to the evaluation of binaural hearing impairment (BHI) as a procedure for estimating severity of hearing loss from audiograms. Design: The BHIs of Australian war veterans were calculated from their hearing threshold levels (HTLs) and compared with their scores on a hearing questionnaire, the hearing measurement scale (HMS). Study sample: The HTLs of 282 Australian war veterans were measured at frequencies from 0.25 to 8 kHz and scores on the HMS were obtained from 154 of those veterans. Results: No grounds could be found for altering the frequencies included in the average HTL or the high fence of 92 dB HL used in calculating the monaural hearing impairments (MHIs) of the veterans, and no grounds could be found for altering the ratio of 5:1 used in determining the BHI from the MHIs of the better and worse ears. However, agreement between HMS score and BHI was improved by reducing the low fence used in calculating MHI from 25 to 15 dB HL. Conclusion: A modified version of BHI provided an improved procedure for estimating severity of hearing loss from audiograms but would not be suitable for compensation purposes.     

Plasticity of the auditory system: theoretical considerations

Auditory plasticity refers to the possibility of anatomical and/or functional changes in the system where transmission of auditory information takes place. The auditory system is often required in communication; it is important to learn how the auditory system reacts to stimuli in order to improve performance in individual communication of subjects with impaired hearing.AimTo review the literature on auditory plasticity and the possibility and ability of plastic responses in the auditory system; also to review the evidence of auditory plasticity.MethodologyA review of the Brazilian and international literature (journals, books, and graduate studies) was carried out. The MEDLINE, SCIELO, BIREME, PUBMED, and LILACS data bases were consulted, as well as 24 papers from the 1990s to the present date; each paper was assessed for relevance to the topic.ConclusionThe findings showed that the auditory system is able to reorganize itself if there is variation, whether by by reducing, increasing, or conditioning of sound stimuli. This is evidence of plasticity in the auditory system.     

Audiological and genetics studies in high-risk infants

Hearing is one of the main ways with which one person can contact the external world; it plays a key role in their integration with society.AimThe objective of this study was to analyze the results of the hearing, medical and genetic evaluation of high-risk infants who failed the newborn hearing screening.Materials and MethodsClinical and experimental study. We assessed thirty-eight neonates, with ages between one and six months. The infants underwent the following procedures: medical interview; immittance testing; Brainstem Auditory Evoked Potential; Transient Evoked Otoacoustic Emission and otorhinolaryngological evaluation. DNA extraction from the oral mucosa was performed for genetic studies using the protocol method adapted from the Human Genetics Lab of the CBMEG/UNICAMP.ResultsRegarding gender and presence of risk factors, significant statistically differences were not found in normal hearing infants and in those with hearing loss. Concerning gestational age, term infants were more affected by hearing loss. Hearing loss was identified in 58% of the sample, conduction hearing loss represented 31.5% (12/38) and neurossensory 28.9% of cases. There were none of the genetic mutations most commonly seen in cases with a genetic etiology.ConclusionHearing loss was identified in the majority of High-risk infants.     

Early discovery of hearing impairment: A Critical evaluation of the BOEL test

The BOEL test was originally devised for the early discovery of communication disorders in infants. The sound stimuli employed for hearing testing have been calibrated and standardized and any deviation from normal hearing responses to these stimuli indicate a hearing impairment.

Since 1971 the BOEL screening program has been applied experimentally in a number of child health centers in Stockholm. Up to 1975, more than 30 000 infants have been examined and approximately 5% have not responded fully regarding visual or tactile attention, auditory, motor or mental functions or social contact. The results of the audiological follow-up are reported.

Application of the BOEL hearing subtest proved very effective. It is pointed out that the BOEL test covers not only hearing defects but also other communication malfunctions and as such it is a more useful technique than simple hearing screening methods.     

Exploring the influence of culture on hearing help-seeking and hearing-aid uptake

Objective: The purpose of this paper was to highlight the importance of cultural influence in understanding hearing-help seeking and hearing-aid uptake. Design: Information on audiological services in different countries and ‘theories related to cross-culture’ is presented, followed by a general discussion. Study sample: Twenty-seven relevant literature reviews on hearing impairment, cross-cultural studies, and the health psychology model and others as secondary resources. Results: Despite the adverse consequences of hearing impairment and the significant potential benefits of audiological rehabilitation, only a small number of those with hearing impairment seek professional help and take up appropriate rehabilitation. Therefore, hearing help-seeking and hearing-aid uptake has recently become the hot topic for clinicians and researchers. Previous research has identified many contributing factors for hearing help-seeking with self-reported hearing disability being one of the main factors. Although significant differences in help-seeking and hearing-aid adoption rates have been reported across countries in population studies, limited literature on the influence of cross-cultural factors in this area calls for an immediate need for research. Conclusions: This paper highlights the importance of psychological models and cross-cultural research in the area of hearing help-seeking and hearing-aid uptake, and consequently some directions for future research are proposed.     

The development of audiological services in the Cardiff area

An account of the development of audiological services in the Cardiff area is presented so that otolaryngologists may be encouraged to extend and improve the facilities present in their locality.     

Patient selection for incus body coupling of a totally implantable middle ear implant

Objective—To evaluate audiologic selection criteria for incus body coupling (IBC) of a totally implantable middle ear implant (TI-MEI) for the treatment of sensorineural hearing loss (SNHL). Material and Methods—The protocol is specified in the Investigational Device Exemption of a Food and Drug Administration-approved multicenter clinical trial. The prospective study compared pre- and postoperative hearing levels using each patient as their own control. In addition, an implant on/off comparison was made. All patients had a follow-up interval of at least 6 months. Audiologic assessment tests included speech discrimination in quiet as the primary efficacy variable and pure-tone audiometry (aided thresholds), gain, speech recognition in noise and subject satisfaction using standardized questionnaires and visual analog scales (VASs) as secondary efficacy variables. The study group of patients (n = 13) was divided into 3 subgroups based on their pure-tone and speech discrimination scores: Group A consisted of 6 patients, Group B 9 patients and Group C of all 13 patients. All patients suffered from long-standing bilateral moderate to severe SNHL. Five patients were dissatisfied hearing aid (HA) users and eight subjects could not wear HAs. All patients were implanted with a TI-MEI which was coupled to the incus body. The amplification level of the device was set postoperatively using inductive digital fitting based on "most comfortable loudness" specifications. Results—The implant produced median improvements from 30% (optimally fit bilateral HAs; n = 5) and 50% (HA non-users; n = 8) to 70% word recognition at 60 dB SPL. Average word recognition scores at 60, 80 and 90 dB SPL in Groups A and B showed increases from 42% (interquartile range +27%, -12%) to 93.5% (+3%, -5%) and 92.5% (+3%, -7%), respectively. In the presence of background noise, the sentence recognition threshold ranged from -2 to 1 dB signal-to-noise ratio. Maximum amplification was 50 dB at 3 kHz and 55 dB at 4 kHz. In Groups A and B, VASs revealed improvements in both natural sound impression and clarity from 62-70% of a natural sound impression to maximum scores of 100%. Using the standardized Gothenburg profile, subjective evaluations of hearing, orientation, social behavior and self-confidence reached 96-98%, 92-96% and 84-92% of the maximum score for Groups A-C, respectively. Conclusions—In selected cases, IBC of the TI-MEI investigated herein may be indicated for the treatment of SNHL, provided the following four conditions are met. First, the patient does not derive sufficient benefit from conventional HAs. Second, the specific indication for IBC is restricted to situations that do not allow the coupling of the MEI to the long incus process (e.g. due to an anatomical variation of facial nerve location). Third, IBC is restricted to patients with a steeply sloped moderate to severe high frequency SNHL, amounting to 90 dB HL from 3 to 8 kHz. Patients with low frequency SNHL should not be operated on with the IBC technique, as maximum low frequency hearing loss at 0.5 kHz must not exceed 30 dB. Fourth, Schueller's X-ray should reveal normal mastoid pneumatization. Being restricted to a 6-month follow-up period, this paper provides early clinical results and no clinical evidence of long-term efficiency of the implant.