Acute acoustic trauma. An emergency condition

This paper reviews 16 selected patients reporting for acute acoustic trauma (AAT). All patients had a fairly recent pre-accident audiogram. Most of the patients were tested audiologically immediately after the acoustic accident. All patients were men, with ages varying between 16 and 50 years. Eight patients received pharmacological treatment with low-molecular-dextran intravenously, papaverin perorally and prednisolone perorally. The high-frequency pure-tone average (3-4-6 kHz) was more affected than the pure-tone average (0.5-1-2 kHz). In 2 patients, the converse was true. The most affected frequencies were 3, 4, and 6 kHz. The initial maximum hearing loss varied between 15 and 70 dB. In 6 patients, extra-high-frequency audiometry (8-20 kHz) was performed and in all patients an asymmetry was demonstrated. Younger patients had somewhat more hearing improvement after AAT than older patients. It also appears that patients reporting early had a somewhat better healing course than patients reporting later.     

Acute mastoiditis in children. A retrospective study and literature review

ObjectiveTo review our experience and results in the diagnosis and treatment of acute mastoiditis, a pathology with an increasing incidence in the recent years.MethodsThe study reviewed 49 pediatric patients diagnosed and treated of acute mastoiditis between 1994 and 2003 in our hospital. We summarize epidemiologic, laboratory and clinical features.ResultsThe mean age was 2.5 years. Seventy-five percent of cases were in autumn and winter months and nearly twenty-five percent had been diagnosed in the last year. S. pneumoniae was the most commonly isolated pathogen (28.6%), although a sterile result was the most frequent (38.1%). Twenty-four patients (48.9%) required surgical treatment. Only five patients (10.2%) developed complications.ConclusionsAcute mastoiditis is a pathology with an important incidence and is generally the consequence of an untreated otitis or an insufficient treatment. Due to the low number of complications, we can not estimate through statistical analysis valid markers like predictors for complication.     

镫骨肌反射阈存在的突聋患者预后及影响因素

目的 分析镫骨肌反射阈存在的突聋患者的预后情况,探讨其影响因素。方法 回顾性分析2018年1月至2021年12月收治的282例镫骨肌反射阈存在的突聋患者的临床资料,采用Excel进行数据整理,SPSS 26.0对收集的资料进行描述性分析及统计分析,对性别、年龄、就诊时间、是否伴有耳鸣、眩晕、基础疾病(糖尿病、高血压、冠心病)、听力曲线类型、听力损失程度、镫骨肌反射阈、镫骨肌反射阈与纯音听阈差值(A-T)等因素进行统计学分析。结果 282例镫骨肌反射阈存在的突发性聋患者中,治愈101例,显效8例,有效54例,无效119例,总有效率57.8%。耳聋侧别(P=0.907)、伴随症状(P_眩晕=0.686,P_耳鸣=0.534)、基础疾病(P_高血压=0.338,P_糖尿病=0.262,P_心脏病=0.780)、镫骨肌反射阈(P_{0.5 kHz}=0.152,P_{1.0 kHz}=0.701,P_{2.0 kHz}=0.810)、镫骨肌反射阈与...     

Prognosis of acute acoustic trauma: a retrospective study using multiple logistic regression analysis

OBJECTIVE: The prognosis for acute acoustic trauma (AAT) is difficult to predict. Multiple logistic regression analysis was used in this study to determine which factors were most strongly related to outcome for patients with AAT. METHODS: The study group was comprised of 52 patients (52 ears). Separate analyses were performed on the no change and partial recovery groups, and on the no change and full recovery groups. The following eight factors were examined as explanatory variables, age; number of days before the start of treatment; use of earplugs; drug therapy (adrenocortical hormones, low molecular weight dextrans, and vitamin B12), mean hearing levels at 0.5, 1, and 2 kHz (pure tone average, PTA), and mean hearing levels at 4 and 8 kHz (high tone average, HTA). RESULTS: Factors determined to be most strongly related to outcome were the number of days before the start of treatment, PTA, and HTA. No significant relation to outcome was determined for the five following factors, age; use of earplugs; and drug therapy (adrenocortical hormones, low molecular weight dextrans, and vitamin B12). CONCLUSION: Our results will increase the ability to prognosticate the outcome for AAT.     

Acute mastoiditis in children: a retrospective study of 188 patients

Objective

The aim of this study is to define the clinical and bacteriological characteristics of acute mastoiditis (AM) in children in order to optimize diagnostic work-up and treatment.

Methods

In this retrospective study, 188 children between 3 months and 15 years of age (15 ± 24 months; median ± SD) were referred to our pediatric ENT emergency center for AM during a 7-year period (December 2001-January 2008).

Results

Fifty seven percent were male and 43% were female. Clinical follow-up duration was 3.9 ± 0.7 months (mean ± SEM). The incidence of AM remained stable during the whole study period. Microbiological samples (n = 236) were negative in 33% of cases. The most frequently isolated germs were Streptococcus pneumoniae (51%), Streptococcus pyogenes (11.5%), Anaerobes (6.5%), and coagulase-negative Staphylococcus (6.5%). Paracentesis, puncture of retro auricular abscess under local anesthesia, and peroperative samples all contributed to isolate the involved germ(s). All the patients were hospitalized and received intravenous antibiotics, and 36.2% (n = 68) underwent surgery. Several surgical procedures were necessary in 4 cases (2.1%). AM recurrences requiring a second hospitalization were observed in 8 patients (4.3%). The only observed complication was lateral sinus thrombosis (n = 6; 3.2%). Surgical failures, requiring more than one surgical procedure, were more frequent in case of: (i) presence of Anaerobes (p ≤ 0.001) or Gram-negative bacteria (p ≤ 0.05) in microbiological samples; (ii) surgical drainage without mastoidectomy (p ≤ 0.001). Recurrences were more frequent in AM due to Streptococcus pneumoniae.

Conclusions

Based on our findings and on literature data, a protocol was established in order to standardize the management of pediatric AM in our center. The mains points are: no systematic surgery; if surgery is indicated, it must encompass a mastoidectomy; broad-spectrum intravenous antibiotic treatment covering the most commonly involved germs (3rd generation cephalosporin) and secondarily adapted to the results of microbiological samples. If the infection is not controlled after 48 h of intravenous antibiotherapy, a mastoidectomy had to be performed.     

颅底骨坏死对鼻咽癌患者生存率的影响及干预策略研究

目的 探索发生放射性颅底骨坏死(sbORN)的鼻咽癌(NPC)患者的预后因素,分析可能影响患者生存率的原因。方法 回顾性队列研究2001年1月1日—2023年7月31日梅州市人民医院收治的发生sbORN的NPC患者临床数据,根据生存状态分为死亡组及存活组,使用t检验、Fisher’s精确检验比较两组之间差异;通过使用生存分析方法,Kaplan-Meier生存曲线和Cox比例风险模型,来评估不同预后因素对患者生存率的影响。结果 共纳入31例发生sbORN的NPC患者,男23例,女8例。16例死亡患者中大出血6例(37.5%)、脓毒血症7例(43.75%)、多器官衰竭2例(12.5%)、脑干脑梗1例(6.25%)。中位生存时间为23个月,1年生存率为70.96%(22/31),2年生存率为54.83%(17/31)。降钙素原水平在sbORN发生方面达到显著水平(χ²=4.229,P=0.040),降钙素原与sbORN的发生有关。在病变范围方面,病变涉及颅内的患者发生死亡的比例显著高于病变不涉及颅内的患者(χ²=7.515,P=0.006)。将患者...     

Acute ultrastructural changes in acoustic trauma: serial-section reconstruction of stereocilia and cuticular plates

Single-unit recordings were made from populations of auditory-nerve fibers in 12 cats before and after acoustic overstimulation. Cats were killed 4 to 16 h after exposure, and the cochleas were analyzed at the light- and electron-microscopic levels. The exposures were designed to create 40 to 60 dB of acute threshold shift. Physiological changes were similar to those seen in cases of permanent threshold shift: tuning curves with elevation of 'tips' and 'tails' were associated with significant decreases in the mean spontaneous discharge rates; tuning curves with elevated tips but hypersensitive tails were associated with clear elevation of the mean spontaneous rates. At the light-microscopic level, none of the ears showed any significant stereociliary pathology. Some of the ears showed no light-microscopic pathology whatsoever, while others showed signs of swelling and vacuolization in both inner and outer hair cell areas in cochlear regions appropriate to the CF regions showing threshold shifts. The presence or absence of these light-microscopic changes was, to some extent, dependent on the nature of the exposure stimulus. At the electron-microscopic level, in addition to apparent swelling of radial afferent terminals, the inner hair cells themselves were swollen. In two cochlear regions (from two ears) which showed acute threshold shifts of 20 to 40 dB, but no light-microscopic changes, serial-section ultrastructural analysis of stereocilia and cuticular plates was performed. In contrast to the situation in ears with permanent threshold shifts [(1986) Hear Res. 26, 65-88], there was no pathology in the intracuticular portion of the stereocilia rootlets. There were, however, significant changes in the lengths of the supracuticular portion of the rootlets. It is suggested that this attenuation of the supracuticular rootlet could decrease the stiffness of the stereocilia tufts and thereby change the tuning properties and sensitivity of the cochlear partition.     

Cordless telephones and acoustic trauma: a case study

Cordless telephones have been reported to cause irreversible damage to the ear due to acoustic trauma. The present case study reports an unusual audiometric configuration associated with direct exposure to the ring from a cordless phone. Although pure-tone sensitivity was only moderately affected, speech understanding was severely compromised.     

Management of acoustic neuromas in the elderly: retrospective study

The wide availability of gadolinium-enhanced magnetic resonance imaging (MRI-Gd) has led to the discovery of an increasing number of small and less symptomatic acoustic neuromas in elderly patients. We conducted a retrospective study in order to obtain data on outcomes and complications associated with different management strategies that would be useful in establishing a management guideline. We identified 44 patients aged 65 to 77 years with acoustic neuromas who had been managed with either surgery or simple observation with MRI-Gd imaging. Of the entire group, 36 patients had tumors larger than 1 cm, and they underwent surgery (most via the translabyrinthine approach). Complete removal of the tumor was achieved in 34 of these patients (94.4%). At the 1-year follow-up, grade VI facial nerve paralysis was evident in only two of 35 evaluable patients (5.7%). Postsurgical complications occurred in five patients (13.9%), including one death. The remaining eight patients had tumors 1 cm or smaller, and they were managed with periodic MRI-Gd scanning. At the 5-year follow-up, no tumor growth was seen in six of these patients. The other two patients exhibited a tumor growth rate of less than 2 mm per year. No patient in the observation group required surgical intervention.     

A preliminary study of factors influencing perception of articulatory rate in Parkinson disease.

This investigation was a preliminary study of factors influencing perception of articulatory rate in idiopathic Parkinson disease (PD). Nine men with mild to moderate idiopathic PD and 9 healthy men of a similar age read the Farm Passage at habitual, fast, and slow reading rates. Spontaneous speech samples also were obtained. Speech severity for participants with PD was mild to moderate; prominent perceptual characteristics further suggested hypokinetic dysarthria. Nine listeners estimated the articulatory rate of speech runs (i.e., stretch of speech bounded by pauses) extracted from the reading and spontaneous speech samples. Regression analysis was used to explore the relationship between articulatory rate (i.e., syllables produced per second excluding pauses) and perceptual impressions of articulatory rate as well as the relationship between fundamental frequency (F0) range and perceptual estimates of articulatory rate. Regression functions predicting perceptual estimates of articulatory rate from F0 range were not significant for either speaker group. The regression analyses relating articulatory rate and perceptual estimates of articulatory rate, however, revealed a significant, positive relationship between the two measures for both speaker groups. There also was a nonsignificant trend for perception of articulatory rate to grow more rapidly for Parkinsonian speech samples. Although the current findings should be interpreted with caution until they have been validated by additional studies using much larger speaker populations and more extensive speech samples, the results hint at the possibility that perceptual impressions of articulatory rate in PD may overestimate the actual, physical rate. The results also highlight the importance of speech-language pathologists complimenting perceptual judgements of articulatory rate with physical measures.     

Acute acoustic trauma: dynamics of hearing loss following cessation of exposure

The natural history of individuals with acute acoustic trauma who ceased to be exposed to impact noise was examined. Retrospective follow-up was carried out for 4 years on patients who were qualified as disabled following acoustic trauma with permanent threshold shift. Eight hundred forty-one individuals (1682 ears) were examined, of which 1514 ears with acoustic trauma were included in the study group; 150 individuals (300 ears) who continued to be exposed to impact noise even after discovery of acoustic trauma comprised the control group. In the latter, as long as exposure to gunfire continued, the severity of acoustic trauma increased. In the study group, during the first year after injury, changes were observed in hearing, whether improvement or deterioration; after this period, hearing loss appeared to be final. We suggest that, after 1 year following acute acoustic trauma, the associated hearing loss be considered as final, provided there is no further exposure to noise. This finding holds great importance from the medicolegal standpoint, an aspect that is unclear in the literature. It clarifies that beyond the period of 1 year after initial exposure, the pathologic process ceases (as long as there is no additional exposure to noise or gunfire). Further hearing deterioration beyond this period is not related to the initial acoustic trauma but rather to other factors.     

A study of factors influencing intensity and annoyance in vertigo or dizziness

For 74 men and 123 women averaging 52.5 years of age with vertigo and dizziness, we recorded the age, gender, vertigo type, duration of illness, concomitant symptoms, and vestibular and psychological test results and used a 100 mm horizontal visual analog scale (VAS) to quantitatively assess sensation intensity and annoyance in vertigo or dizziness. Factors influencing these 2 quantitative assessment parameters were analyzed by stepwise multiple regression analysis. Factors influencing sensation intensity were nausea or vomiting as a concomitant symptom, duration of vertigo or dizziness (within a day), and first episode onset. Intensity of sensation to vertigo or dizziness, self-rating depression score (SDS), and gender (female) were selected as significantly influencing annoyance. These results suggest that rational care of significant factors that involve the intensity and annoyance in vertigo is essential to treating patients with vertigo or dizziness.     

A clinical study of Bell's palsy and factors influencing its prognosis

We encountered 185 patients with Bell's palsy at our hospital between January 2003 and December 2005. Of these patients, 60% visited our department within 3 days of the onset, and 90% within 7 days of the onset; the interval from onset to hospital visit showed no relation with the severity of the paralysis. Complete recovery was obtained in 85.0% of the patients with steroid or steroid + antiviral treatment. Preservation of the stapedius reflex was a statistically significant predictor of good prognosis, with a high positive predictive value (95.5%). Several factors influencing the prognosis were examined with a Cox's proportional hazards model. The factors considered were the sex of the patients, left / right localization, age, postauricular pain, eye symptoms, taste disorder, underlying diabetes, the Yanagihara facial grading system score, and use of antiviral drugs. The analysis revealed only the Yanagihara score and antiviral drug use as statistically important, with hazard ratios of 1.101 and 1.586, respectively. Although this study had several limitations, steroid + antiviral treatment could yield a better prognosis as compared to steroid treatment alone.     

Acute acoustic trauma. The therapeutic effect of bencyclan in a controlled clinical trial (author's transl)]

In a retrospective study 103 patients with acute acoustic trauma (AAT) were investigated. The control group (53 patients) was treated with Dextran 40 (10% solution), neurotrop vitamins and Betahistin. Bencyclan was administered additionally in the test group (50 patients). Statistical analysis of the audiometric data showed the following results: 1. Mean hearing levels of the test group showed better improvement of threshold shifts, if the therapy started within 2 days or after more than 10 days after the AAT. 2. Regression-and correlation coefficients, however, in a regression analysis of absolute hearing gains and hearing losses before therapy, did not indicate a substantial effect of Bencyclan. 3. Neither did statistical tests with relative hearing gains show any significant differences between test-and control groups. Consequently Bencyclan is not likely to have a positive effect in AAT, if it is administered in the above mentioned way.