Otologic complications of temporomandibular joint arthrocentesis due to arteriovenous fistula

Arteriovenous fistula (AVF) is a rare sequela following arthrocentesis of the temporomandibular joint. This case report discusses a constellation of symptoms, findings, and appropriate management of a patient with a superficial temporal AVF. Several findings in this case, including vertigo, nystagmus, and hearing loss, have not been previously documented in the literature.     

Aborder la perte auditive

ObjectiveTo provide family physicians with a practical evidence-based approach to the management of patients with hearing loss.Sources of informationMEDLINE and PubMed databases were searched for English-language hearing loss research, review articles, and guidelines published between 1980 and 2020. Most of the retrieved articles provided level II or III evidence.Main messageHearing loss is one of the most common sensory impairments worldwide and causes great detriment to a patient’s overall well-being by affecting physical health, finances, social inclusion, and mental health. A robust clinical assessment of hearing loss includes a history and physical examination that effectively characterizes the deficit as conductive, sensorineural, or mixed. Patients presenting with red flags (such as sudden unilateral sensorineural hearing loss) must be urgently referred to otolaryngology–head and neck surgery or immediately assessed in the emergency department. Many nonurgent presentations of hearing loss will also require referral for further audiological assessment, diagnosis, and management.ConclusionAs primary care providers, family physicians are well equipped to manage the psychological concerns associated with hearing loss and to reinforce conservative treatment strategies. Frequently, referral or urgent workup, including imaging, is necessary to confirm a patient’s diagnosis and initiate management in order to prevent further complications.     

Hearing conservation: implementing and evaluating a program

1. More than eight million workers in the United States are affected by some noise-induced hearing loss. Noise pollution is a significant health hazard in the workplace today. 2. Occupational health nurses are in a key position to make tremendous contributions to the effectiveness of a hearing conservation program. 3. Cooperative efforts between management and labor are needed to prevent noise-induced hearing loss. 4. A hearing conservation program is an effective instrument for preventing noise-induced occupational hearing loss, complying with governmental regulation, and controlling a company's compensation cost.     

Help for the hearing-impaired. Early evaluation, advanced technology, improved management

Nearly one in ten Americans has some degree of hearing loss. The primary care physician generally is the first to evaluate patients who complain of hearing loss and thus has the first opportunity to determine the need for treatment or referral to an otolaryngologist or otologist. New technology provides better management of hearing loss than ever before. Virtually every case of hearing loss can now be corrected or improved.     

Hereditary sensorineural hearing loss: advances in molecular genetics and mutation analysis

Hearing loss has a genetic etiology in the majority of cases and is very common. The universal newborn hearing screening program, together with remarkable recent progress in the characterization of genes associated with the function of hearing, have resulted in increased demand and exciting possibilities of detecting the molecular basis of hereditary hearing loss through DNA testing. Future molecular diagnostic assays are expected to offer a greater variety of gene-specific tests, as well as combined mutation panels, which will aid in the management of the impressive genetic heterogeneity observed in hereditary hearing loss, especially in individuals with nonsyndromic forms. This review addresses the genetics of hearing loss, discusses the most commonly offered genetic assays for nonsyndromic hearing loss, with advantages and limitations, proposes a practical testing algorithm, and highlights current developments.     

Bilateral sensorineural hearing loss due to mumps

Viral infections implicated in acute hearing loss include rubella, measles, mumps, herpes zoster, cytomegalovirus and influenza. Mumps' deafness is the best documented disorder. We describe a case where bilateral sensorineural hearing loss, following a severe mumps infection at the age of two, remained unnoticed until the age of four when the patient presented with delayed speech and language. This report emphasises the risk of permanent hearing loss as a complication of mumps infection and discusses strategies for early diagnosis and prevention.     

Usher's syndrome with unusual otologic manifestations.

Usher's syndrome is characterized by a congenital hearing loss and retinitis pigmentosa. Ocular symptoms and signs are usually established at adolescence, and the hearing loss, the onset of which is at a young age, generally remains stable. The following case is of interest, therefore, because the hearing loss that had been present since birth progressed suddenly to total bilateral deafness in adulthood. There were no ocular symptoms at any time; the classic findings of retinitis pigmentosa were disclosed only on routine examination of the eyes.     

An audiological profile of elderly Australians reporting speech affecting stroke

This study examined the audiological profile and hearing rehabilitation of 73 people who reported having had speech-affecting strokes. Participants were drawn from the Blue Mountains Hearing Study (BMHS), a population survey of age-related hearing loss in 2956 members of a representative elderly Australian community. While speech-affecting stroke did not seem to cause greater levels of hearing impairment or handicap than for other participants matched for age and gender, this may be due to a low prevalence of participants with severe effects on speech or language as a result of their stroke. Although 52% of participants self-reported a hearing loss, fewer than 23% had ever worn a hearing aid with only 15% wearing hearing aids for more than 1 hour per day. Pure tone audiometry identified 64% of participants with thresholds considered appropriate for hearing aid fitting when previously established criteria were applied. Questions concerning use of hearing aid/s and self reported hearing loss were not reliable in determining which participants with a speech affecting stroke met these audiometric criteria. The risks of uncorrected hearing loss compromising speech and language assessment and rehabilitation following stroke are discussed.     

Bomb blast injuries to the ear: the London Bridge incident series.

Twelve patients who were treated for ear injuries at Guy's Hospital following the London Bridge bomb blast in February 1992 were reviewed. Among three there were four perforated eardrums, two of which closed spontaneously (50%). All three patients had a persistent mixed hearing loss. The remaining nine patients had acute sensorineural hearing loss and/or tinnitus only. Four of these had resolved completely by 4h, another one by 48h, and two by 4 weeks. Two patients had a residual high frequency hearing loss. In total, five patients (42%) have a persistent hearing loss. None of the patients suffered from balance problems. In summary, the ear is very susceptible to bomb blast injury, but there is a high rate of spontaneous closure of perforations and improvement of sensorineural hearing loss and tinnitus.     

Screening for hearing loss in childhood: issues, evidence and current approaches in the UK

Until recently, screening for childhood hearing loss in the UK was based on two universal (i.e. whole population) screens: the infant distraction test screen at age eight months and the school entry hearing screen at age four to five years. Evidence reviewed in the 1990s indicated that the infant distraction test screen was seriously underperforming, but that (based on technology that had become available in the 1980s and 1990s) universal newborn hearing screening could be efficacious. At the same time, evidence was emerging on the importance and value of very early identification and intervention for permanent congenital childhood hearing loss. This led to the decision to implement a national newborn hearing screening programme (NHSP) in England and to phase out the distraction test at eight months. The initial implementation of the programme will be completed in 2005, and we summarize the evidence on the effectiveness of the first phase of the programme here. A number of important issues concerning childhood hearing loss and its management remain unresolved: the burden of late-onset and temporary childhood hearing losses, the most effective approaches to intervention and management, the case for screening for mild and/or unilateral hearing loss, and the role of the School entry screen. Some of the current research efforts to address these are outlined.     

Mefloquine and ototoxicity: a report of 3 cases

We report these cases of high-frequency sensorineural hearing loss and tinnitus, following malaria prophylaxis with mefloquine (Lariam). Only one patient had partial remission of hearing loss after suspension of the treatment. In the remaining two cases the symptomatology remained unchanged. None of the patients reported improvement of tinnitus. Our experience suggests that a routine audiologic evaluation, before and after prophylactic use of antimalarial drugs, is important to monitor potential hearing deficit.     

Differential diagnosis and treatment of hearing loss

Hearing loss is a common problem that can occur at any age and makes verbal communication difficult. The ear is divided anatomically into three sections (external, middle, and inner), and pathology contributing to hearing loss may strike one or more sections. Hearing loss can be categorized as conductive, sensorineural, or both. Leading causes of conductive hearing loss include cerumen impaction, otitis media, and otosclerosis. Leading causes of sensorineural hearing loss include inherited disorders, noise exposure, and presbycusis. An understanding of the indications for medical management, surgical treatment, and amplification can help the family physician provide more effective care for these patients.     

Hearing loss is often undiscovered, but screening is easy

Screening for hearing loss should be part of the routine physical examination, but it is often not done because of time constraints. We present a quick and easy office screening test that measures the functional impact of hearing loss. We also review the steps of audiologic management that follow referral by the primary care physician.     

Detection of mutations in genes associated with hearing loss using a microarray-based approach

Knowing the etiology of hearing loss in a person has implications for counseling and management of the condition. More than 50% of cases of early onset, nonsyndromic sensorineural hearing loss are attributable to genetic factors. However, deafness is a genetically heterogeneous condition and it is therefore currently not economically and practically feasible to screen for mutations in all known deafness genes. We have developed a microarray-based hybridization biochip assay for the detection of known mutations. The current version of the hearing loss biochip detects nine common mutations in the connexin 26 gene, four mutations in the pendrin gene, one mutation in the usherin gene, and one mutation in mitochondrial DNA. The biochip was validated using DNA from 250 people with apparent nonsyndromic, moderate to profound sensorineural hearing loss. The hearing loss biochip detected with 100% accuracy the mutations it was designed for. No false-positives or false-negative results were seen. The biochip can easily be expanded to test for additional mutations in genes associated with hearing impairment or other genetic conditions.     

Bone anchored hearing aids (B.A.H.A.)

Semi-implantable bone conduction hearing aids of the type Bone Anchored Hearing Aids (B.A.H.A.) consist of an external vibrator hearing aid that is attached to a titanium screw implanted in the mastoideal bone behind the ear by means of a transcutaneous connector. In this way sound waves are transmitted directly to the bones of the skull, from where they are conducted to the cochlea. The primary indication for a semi-implantable bone conduction hearing aid is hearing loss due to conduction failure that is not surgically correctable. This may be caused, e.g. by ear canal atresia and other malformations of the external auditory meatus and of the middle ear, by chronic ear infections or by persistent high grade conduction hearing impairment after radical mastoidectomy. Today B.A.H.A.'s largely replace the less convenient conventional bone conducting hearing aids as hearing glasses or hearing bands, in which a vibrator is pressed against the skull. In conduction hearing impairment on both ears B.A.H.A.'s can be implanted bilaterally and thus binaural hearing with sound source localisation are made possible. A novel application is in cases of unilateral deafness, where the device is implanted on the side of the deaf ear and the amplified sounds are transmitted through the skull to the side of the hearing ear. Here it serves as a substitute for a CROS hearing aid. In adults the implantation is performed under local anesthesia as an out-patient procedure. Implantation may be undertaken under general anesthesia on children after two years of age. In Berne, B.A.H.A. bone conduction hearing aids have been implanted in 112 patients (ages 2-82 years) in the past 13 years. The operations have proved simple and without intra-operative complications. The long-term post-operative incidence of complications was low. The transcutaneous screw caused only isolated cases of transient skin reactions or local infections. In 7% of cases, rejection of the implant or a traumatic loosening of the screw required a reimplantation procedure. Over 90% of patients reported themselves satisfied with their partially-implantable B.A.H.A. hearing aids.     

Age-related hearing loss: a case for nursing intervention

This review paper selectively examines the problem of age-related hearing loss. Drawing on specialist audiological research, nursing research and patient anecdotes to make a case for nursing intervention. The limitations of national prevalence estimates are highlighted with regard to dependent elderly people, and are challenged as political underestimations of need. Despite the evidence of an exceptionally high level of potential demand only a minority of elderly people who might benefit from amplification possess a hearing aid. Factors to explain the low levels of hearing aid ownership and use are discussed. Through considerable reference to the author's own research the potential for nurses to lead practice developments and initiate service reform in the management of age-related hearing loss is debated.     

Caring for older adults with hearing loss

This article discusses hearing impairment and the frequency with which it occurs in older adults. Anatomy and physiology of the ear are examined. Categories of hearing loss, causes, assessment and management are explored, including hearing aids, auditory implants and approaches to communication with hearing-impaired patients.     

Congenital Cytomegalovirus Infection

Congenital cytomegalovirus (CMV) infection is the most common intrauterine infection and is the leading nongenetic cause of sensorineural hearing loss and neurodevelopmental delays in the pediatric population. Despite its high prevalence and significant sequelae, congenital CMV in the pregnant woman and neonate often goes undiagnosed. We present the case of a 23-month-old child presenting with developmental delays and bilateral sensorineural hearing loss as a result of CMV and describe with this case report the clinical features, diagnosis, testing, management, and prognosis of congenital CMV.     

Unusual presentation of glomus tympanicum tumour: New bone formation in the middle ear

The objective of this study is to increase awareness of the rare presentation, diagnostic difficulties and management of glomus tympanicum of the middle ear. A 49 years old male, with a background of hypertension and epilepsy, presented with a two month history of left sided conductive hearing loss, pulsatile tinnitus and headache. Clinically and radiologically a diagnosis of glomus tympanicum was made. Intraoperatively, extensive osteogenesis of the middle ear resulting in ossicular fixation and erosion was found. This patient required a two stage operation for full clearance of disease. A stapedectomy drill was used to drill off the bony overgrowth surrounding the ossicles resulting in improved hearing thresholds and full clearance of the disease at two year follow up. Glomus tympanicum can result in new bone formation in the middle ear with resultant ossicular fixation and conductive hearing loss. This can be effectively treated surgically with restoration of hearing.     

Cell-gene delivery of brain-derived neurotrophic factor to the mouse inner ear.

Sensorineural hearing loss is a common disability, but treatment options are currently limited to cochlear implants and hearing aids. Studies are therefore being conducted to provide alternative means of biological therapy, including gene therapy. Safe and effective methods of gene delivery to the cochlea need to be developed to facilitate the clinical application of these therapeutic treatments for hearing loss. In this study, we examined the potential of cell-gene therapy with nonviral vectors for delivery of therapeutic molecules into the cochlea. NIH3T3 cells were transfected with the brain-derived neurotrophic factor (Bdnf) gene using lipofection and then transplanted into the mouse inner ear. Immunohistochemistry and Western blotting demonstrated the survival of grafted cells in the cochlea for up to 4 weeks after transplantation. No significant hearing loss was induced by the transplantation procedure. A Bdnf-specific enzyme-linked immunosorbent assay revealed a significant increase in Bdnf production in the inner ear following transplantation of engineered cells. These findings indicate that cell-gene delivery with nonviral vectors may be applicable for the local, sustained delivery of therapeutic molecules into the cochlea.