Cochlear Implantation in a Profoundly Deaf Patient Who also Suffers from Multiple Sclerosis — A Case Study

Outcomes of cochlear implantation in individuals with known central nervous system conditions are varied. Long-standing deafness is also thought to correlate negatively with auditory performance in post-linguistically deaf adult implant users.

We present a case study of cochlear implantation in a post-lingual adult having bilateral profound hearing loss for over 30 years in addition to multiple sclerosis unrelated to his deafness. Assessment of benefit in terms of speech-perception ability and quality of life reveal that long-term auditory deprivation and co-incidental multiple sclerosis are not a contraindication for cochlear implantation.     

Significance of Pseudo-Conductive Hearing Loss and Positional Nystagmus for Perilymphatic Fistula: Are They Related to Third-Window Effects?

ObjectivesPatients’ clinical presentation is critical for identifying suspected perilymphatic fistula (PLF). The involvement of third-window lesions in the pathomechanism of PLF has been hypothesized. This study investigated the clinical features of PLF and the relationship of the third-window effect with PLF. MethodsSixty patients underwent surgical exploration for suspected PLF and the oval and round windows were reinforced. Clinical features including demographics, pure-tone audiometry (PTA), and videonystagmography were evaluated preoperatively and 1 month postoperatively. Surgical outcomes were analyzed according to the improvement of hearing and vestibular symptoms and signs. The conductive components of PTA (air-bone gap [ABG]) were measured, and the relationship between ABG closure after surgery and hearing improvement was analyzed. In addition, postoperative subjective dizziness was assessed by clinical interviews. Changes in positional nystagmus were analyzed according to ABG closure and hearing improvement.ResultsABG at lower frequencies (LFABG; 250 Hz, 500 Hz, 1,000 Hz) was present in 27 patients (45%). Postoperatively, PTA significantly improved after surgical repair. Among the patients with preoperative LFABG (n=27), 15 (55.5%) showed postoperative ABG closure and significant improvement in PTA at all frequencies compared with the patients without ABG closure (P=0.012). Subjective dizziness improved in 57 patients (93.3%). Positional nystagmus was found in 45 of 49 patients. Multiple canal involvement was more common than single canal involvement (67% vs. 33%). The horizontal semicircular canal was most commonly involved, followed by the posterior and anterior canals. Postoperatively, positional nystagmus disappeared, or the number of involved canals decreased in 22 of 34 patients (64.7%). ConclusionPseudo-conductive hearing loss at lower frequencies and positional nystagmus originating from multiple semicircular canals were common findings in PLF. Surgical reinforcement of the oval and round windows improved the hearing threshold accompanied by closure of ABG. A third-window lesion might explain these clinical features of PLF.     

Survival in patients with submandibular gland carcinoma — Results of a multi-institutional retrospective study

Objective

Clinical studies demonstrating the prognostic factors in submandibular gland carcinoma are limited because the tumor is relatively rare. The aim of this study was to identify clinical outcomes and prognostic factors in submandibular gland carcinoma.

Can Long-Term Hearing Preservation be Expected in Children following Cholesteatoma Surgery? Results from a 14-Year-Long Study of Atticotomy-Limited Mastoidectomy with Cartilage Reconstruction

Objective: Following cholesteatoma surgery, effective long-term hearing preservation in children is difficult and is not typically expected. Hence, long-term data on hearing outcomes are lacking. The aim of this study was to analyze long-term hearing outcomes in children following cholesteatoma surgery. Methods: For this study, 49 ears in 47 children (≤16 years) with acquired cholesteatomas following atticotomy-limited mastoidectomy with cartilage reconstruction (inside-out approach) during 1986-2010 were included. Pre- and post-operative recidivism-free audiometric results were compared. Hearing success was defined as a post-operative air conduction (AC) threshold of ≤30 dB (serviceable hearing). Logistic regression analyses were used to evaluate potential prognostic factors that independently contributed to the prediction of hearing success. These factors included stapes condition, pre-operative AC threshold, ossicular chain integrity, disease severity, age, and gender. Results: The mean duration of follow-up was 14.2 years. The post-operative AC (33.55 ± 15.42 dB) and air-bone gap (17.88 ± 12.94 dB) were significantly improved compared with the pre-operative AC (42.90 ± 16.47 dB, p < 0.001) and air-bone gap (30.23 ± 13.68 dB, p < 0.001). The probability of hearing success following surgery (40.8%) was significantly higher than prior to surgery (24.5%, p = 0.008). Multivariate logistic regression analyses revealed a statistically significant correlation between hearing success and stapes integrity only (p = 0.005). Conclusions: This study provides important information on effective long-term hearing preservation over a mean follow-up of 14 years. In addition, stapes destruction is an independent negative prognostic determinant of achieving hearing success. The prediction model in this study provides otologists with useful pre-operative information to inform patients and parents on expected hearing outcomes and may be useful for post-operative observations.     

Psychiatric Disorders in Tinnitus Patients without Severe Hearing Impairment: 24 Month Follow-up of Patients at an Audiological Clinic: Alteraciones psiquiátricas en pacientes con tinnitus sin hipoacusia severa: Seguimiento durante 24 meses en una clínica audiólogica

The relationship between tinnitus and psychiatric disorders has long been recognised. We have addressed this question by investigating the prevalence of psychiatric diagnosis in a consecutive series of tinnitus patients (n = 82) without severe socially disabling hearing loss referred to an audiological clinic. The psychiatric evaluation was based on a standardised diagnostic interview (SCID-P) in accordance with the Diagnostic and Statistical Manual of mental disorders (DSM-III-R) and on the Hospital Anxiety and Depression Scale (HAD Scale). An experienced psychiatrist performed the interview 24 months after the patient's first visit to the clinic. Lifetime depressive and anxiety disorders were recorded in 62 per cent and 45 per cent of the cases respectively, but only 34 per cent had had contact with any healthcare institution for emotional disturbances. Only 7 per cent reported that they had tinnitus prior to their depressive and/or anxiety disorders. We conclude that it is of great importance to identify these emotional disturbances in patients suffering from tinnitus.

La relación entre tinnitus y las alteraciones psiquiátricas ha sido ampliamente reconocida. Nos hemos acercado a este tema investigando la prevalencia de diagnóstico psiquiátrico en una serie consecutiva de pacientes sin hipoacusia severa (n=582) referidos a una clinica audiológica. La evaluateón psiquiátrica se basó en una entrevista diagnóstica estandarizada (SCID-P) de acuerdo con el Manual Diagnóstico y Estadístico de Desórdenes Mentales (DSM-IIIR) y con la Escala de Ansiedad y Depresión Hospitalaria (HAD scale). Un psiquiatra experimentado condujo la entrevista 24 meses después de la primera visita de cada paciente a la clínica. 62% de los pacientes presentaban alteraciones depresivas y 42%, ansiedad de larga evolutión, pero sólo el 34% había tenido contacto con alguna instituteón de salud especializada. Sólo un 7% reportaron que tenían el tinnitus antes de inicíar con los problemas de ansiedad o depresion. Concluimos que es sumamente importante identificar estas alteraciones emocionales en los pacientes con tinnitus.     

Preliminary results of a new delivery system for gentamicin to the inner ear in patients with Meniere’s disease

Intratympanic gentamicin therapy has gained some clinical popularity in the treatment of vertigo associated with Meniere’s disease. This therapeutic modality offers some advantages over traditional surgical treatment. The vestibulotoxic effect of gentamicin is well documented, but there is no general agreement about the dose needed to control vertigo attacks without affecting hearing. In the current preliminary study 27 patients with Meniere’s disease refractory to medical management were treated by small doses of gentamicin delivered via microcatheter in the round window niche and administered by an electronic micropump. The patients received a total dose of 0.24–90 mg. The effect on vestibular symptoms resulted in the cessation of vertigo in the 22 patients, control of drop attacks in 4 of 6, and release of aural pressure and fullness in 2 of 4. Significant hearing loss (anacusis) occurred in six patients, slightly related to the flow rate in the pump setting. Different explanations for the loss of hearing are presented. The new delivery system for gentamicin appears to be effective in controlling vertigo, but with an unacceptable negative effect on hearing. The effectiveness and the safety of this new delivery system must be investigated further in controlled studies. However, it opens up the possibility of future novel ways of treating inner ear diseases, such as sudden deafness and tinnitus, as well as for the protection, repair, and regeneration of inner ear sensory cell function in damage due to aging, noise, toxic substances, immune reactions, etc. Received: 8 September 1999 / Accepted in revised form: 29 May 2000