Sensorineural hearing loss in chronic otitis media

Although many studies have demonstrated an association between chronic otitis media (COM) and sensorineural hearing loss (SNHL), there still remains disagreement about the relationship. A retrospective study was conducted to examine the relationship between sensorineural hearing loss and chronic otitis media. Forty-one patients met the following criteria: unilateral COM and no history of head injury, meningitis or previous otological surgery. The differences in preoperative bone conduction threshold between diseased and control (contralateral normal) ear were statistically significant (P < 0.01) and varied from 5.24 to 9.02 dB across the frequency range. The effect of duration of disease on the degree of SNHL was also analysed but no correlation was found. The presence of cholesteatoma and/or ossicular erosion was not associated with a significantly increased risk of sensorineural hearing loss.     

Prevalence of middle ear pathologies in children with bilateral sensorineural hearing loss

OBJECTIVES: In poor countries, hearing aids are too expensive for sensorineural hearing loss (SNHL) children's parents to offer for their children. These children may have middle ear problem, this will aggravate the level of hearing loss which may lead to delay in their ability to speak. This study is to highlight the prevalence of middle ear pathology in SNHL children. METHODS: Two hundred children with bilateral sensorineural hearing loss (SNHL) were selected in our study from the outpatient clinic of ENT department of Sohag University Hospital, Egypt. Children were classified into three categories according to their middle ear status. They were normal middle ear, middle ear with unhealthy tympanic membrane or otitis media with intact drum and chronic suppurative otitis media with perforation. RESULTS: Seventy percent of cases were normal, 25% had middle ear problem with intact tympanic membrane and 5% had chronic suppurative otitis media with perforation. CONCLUSION: Thirty percent of SNHL children have middle ear pathology which aggravate the degree of hearing loss. Regular evaluation of SNHL children to treat those having middle ear pathology medically and/or surgically and this may help those having no ability to have hearing aids to learn language early.     

慢性化脓性中耳炎与感音神经性聋

目的：观察慢性化脓性中耳炎（CSOM）对感音神经性聋（SNHL）的影响。方法：测量135例（168耳）CSOM患者的骨导听阈,并以66例单侧患者的健耳为对照,比较不同类型、不同病程的CSOM的骨导听阈。结果：CSOM各组骨导听阈均值明显高于对照组,且与中耳炎的类型和病程相关。结论：CSOM可引起SNHL,且中耳病变越重,病程越长,听力下降越明显     

Sensorineural hearing loss in experimental purulent otitis media due to Streptococcus pneumoniae

Sensorineural hearing loss (SNHL) has been described clinically following chronic otitis media with effusion, but to the best of our knowledge, no studies have demonstrated SNHL in an animal model of otitis media. Using the chinchilla model of pneumococcal otitis media, significant SNHL was demonstrated after purulent otitis media, especially at higher frequencies. Animals with otitis media received penicillin G procaine treatment for five days after otitis media with effusion (OME) was first documented; resolution of middle ear infection was confirmed by middle ear effusion culture in all animals. Both the inoculated and uninoculated ears were examined by tone burst-elicited compound action potential at threshold. The inoculated ear showed a marked hearing loss of 13 to 36 dB three to four days after OME was first documented; a hearing loss up to 24 dB persisted two to five weeks after inoculation. The change in the compound action potential was highly significant at all frequencies studied. Conductive losses were largely ruled out because there was no middle ear effusion at death and the tympanogram was normal. Purulent labyrinthitis was ruled out by histopathological study. These results indicate that purulent pneumococcal otitis media in the chinchilla model causes significant SNHL and suggest that the pathogenesis of SNHL associated with chronic OME in humans may be studied in this model.     

Sensorineural hearing loss associated with otitis media with effusion in children

Sensorineural hearing loss (SNHL) is known to occur in various types of otitis media. Although the mechanism by which SNHL develops in association with otitis media with effusion (OME) is unknown, several hypotheses have been advocated up to now. We reviewed the clinical records of children with otitis media with effusion (OME) to reveal the association with sensorineural hearing loss. The material consisted of 71 children (119 ears) who were diagnosed as having OME and gave reliable audiograms in our clinic during an 11 month period from February 1997 through January 1998. From these cases those which showed bone conduction loss of 25 dB or higher at any one of the frequencies of 250 through 4 kHz were selected and considered to be cases of SNHL. Eight cases (9%) which had temporary threshold shift (TTS) or permanent threshold shift (PTS) were considered to be etiologically related to OME. The clinical course in each of these cases with SNHL was reviewed and evaluated in detail. We noted that all children with TTS improved completely. The result of this study indicates that we have to be aware of a possible development of SNHL during the course of OME.     

Hearing Loss in Turner Syndrome

A retrospective study was undertaken to answer the following questions: Is the sensorineural hearing loss (SNHL) in Turner syndrome progressive? Can the occurrence of hearing loss be explained by the parental origin of the intact X chromosome? Twenty-four individuals recruited through the Turner Syndrome Society completed a questionnaire and submitted sufficient medical records to determine their otologic status. The majority (21/24) have had problematic otitis media (OM), and two thirds (16/24) have SNHL. In seven of the Turner subjects (age range: 12 to 51 years), gradual progressive SNHL began in late childhood or early adulthood. Molecular techniques showed no correlation between parental origin of the retained X chromosome and hearing status in 17 Turner subjects and at least one of their parents. SNHL and frequent OM appear to be independent variables that are both present in Turner syndrome. It is postulated that the presence of unpaired genes on the X chromosome may account for hearing loss and other phenotypic abnormalities seen in this syndrome.     

Cochlear implantation in the chronically diseased ear

PURPOSE OF REVIEW: The presence of chronic ear disease in patients with profound SNHL presents a challenge to the otologic surgeon and was considered, in the past, a contraindication to cochlear implantation. This review discusses options for cochlear implantation in patients with chronically diseased ears. RECENT FINDINGS: Several management options are available for cochlear implantation in patients with chronic suppurative otitis media (CSOM) and severe to profound sensorineural hearing loss (SNHL). CONCLUSION: Cochlear implantation can be safely achieved in patients with CSOM. The approach chosen should be individualized based on clinical findings.     

Clinicostatical study on the sensorineural hearing loss accompanying otitis media with effusion

It is pointed out that sensorineural hearing loss sometimes accompanies otitis media with effusion. In order to clarify the incidence and clinical features of sensorineural hearing loss associated with otitis media with effusion, the cases over the past ten years were reviewed. During the period from January 1979 through December 1988, 1338 patients were diagnosed to have otitis media with effusion and showed reliable audiograms in our clinic. Among these patients, 237 patients (17.7%) showed sensorineural hearing loss, defined as a bone conduction loss of 25 dB or more at any one of the frequencies of 500 through 4 kHz. The incidence of sensorineural hearing loss increased as the age of the patients increased. By analyzing their clinical course, these 237 patients were classified into 3 groups according to the etiological relationship of sensorineural hearing loss and otitis media with effusion. In Group A which comprises 14 patients (1.0%), a strong causal relationship was suspected. This group was further divided into 2 subgroups. In one subgroup of 4 patients, sensorineural hearing loss developed rather rapidly during the course of otitis media with effusion and recovered gradually. In the other subgroup of 10 patients, sensorineural hearing loss progressed and did not recover. The clinical features of these 2 subgroups were quite different. In Group B which comprises 50 patients (3.7%), causal relationship was suspected but was not confirmed. Many of the patients in this group showed unilateral otitis media with effusion and the sensorineural hearing loss in the same ear, which was characteristically demonstrated as bone conduction loss at 2 and 4 kHz.(ABSTRACT TRUNCATED AT 250 WORDS)     

慢性化脓性中耳炎与感音神经性聋的相关性分析

目的：探讨慢性化脓性中耳炎与感音神经性聋之间的相关性。方法：回顾分析174例单侧慢性化脓性中耳炎患者的骨导阈值改变。采用配对t检验分析0．5kHz，1．0kHz，2．0kHz，4．0kHz患耳与健耳骨导阈值的差异，单因素方差分析法分析胆脂瘤存在及听骨链破坏对语频(0．5kHz，1．0kHz，2．0kHz)和4．0kHz骨导阈值的影响，直线回归法讨论了语频和4．0kHz骨导阈值改变与年龄和病程之间的相关性。结果：患耳与健耳各频率骨导阈值之间差异有统计学意义。语频骨导听力损失程度随着患者年龄的增加而逐渐加重。胆脂瘤的存在以及听骨链破坏亦未增加感音神经性聋的发生概率。结论：慢性化脓性中耳炎可引起感音神经性聋。高频骨导听阈较低频更易受到影响。     

Cochlear implantation in chronic otitis media

Patients with chronic otitis media (COM) may have profound sensorineural hearing loss either due to the disease process or secondary to a surgical procedure. Some patients who are candidates for cochlear implantation may have COM coincidentally. The patients in this group need special attention when cochlear implantation is applied. The aim of this study is to evaluate the potential risks and complications in patients with COM. Cochlear implantation was performed in six patients with COM or an infected radical cavity and profound hearing loss. Five of them underwent a two-stage operation, and one had a single-stage operation. Cochlear implantation was performed in all patients without complications. The follow-up period was uneventful. Although such patients have some potential risks, when certain surgical rules are followed very strictly cochlear implantation can be successfully performed in patients with COM.     

Ototoxicity of ear drops in patients suffering from chronic otitis media

The sensorineural hearing loss in 150 patients with chronic otitis media who were treated in the Haifa Medical Center (Rothschild) during a ten year period was studied. There were 124 patients treated with a mixture containing neomycin, polymyxin B and dexamethasone and a control group of 26 patients with dexamethasone only. All patients were followed up for a period of 1-2 years. Patients with hearing loss due to factors such as previous ear surgery, family history, exposure to noise etc., have been excluded. The conclusions reached were that there is a relationship between the period of disease and the sensorineural hearing loss and that the local treatment with a mixture containing neomycin + polymyxin B appears to contribute to the worsening of the sensorineural hearing loss in patients with chronic otitis media. Our numbers are small and further studies must be done, but the fact that currently used ear drops may produce a sensorineural hearing loss should not be ignored.     

Incidence of long-term ipsilateral and contralateral ototoxicity following radiotherapy for nasopharyngeal carcinoma

Objective

To characterize the long-term adverse effects of radiotherapy on the ears in patients with nasopharyngeal carcinoma (NPC), we investigated ipsilateral and contralateral ototoxicities in the external, middle, and inner ear.

Methods

The records of 48 ears in 24 radiotherapy-treated NPC patients were retrospectively analyzed. Radiotherapy doses varied between 60 and 70 Gy in 2-Gy fractions at 5 fractions/week. Ototoxicities were identified by otoscope and pure-tone audiograms conducted at 2-3 month intervals for ≥12 months. The relationship between radiation dosage and sensorineural threshold deterioration was statistically compared using the Mann-Whitney U-test.

Results

Post-radiotherapy, 50% of all ears (3 of 6) that developed severe otitis externa were on the contralateral side. There was a post-radiotherapy increase in contralateral otitis media with effusion (OME) (1-7 ears), but a decrease in ipsilateral cases (16-12 ears), with 2 ears on either side subsequently developing chronic otitis media (COM). All ears that showed sensorineural hearing loss (SNHL) before radiotherapy exhibited a further threshold deterioration of more than 15 dB. No statistically significant difference (p = 0.086) in average radiation dose was seen between ears with sensorineural threshold deterioration (50.0 Gy) and those without (48.2 Gy).

Conclusion

Long-term ototoxicity following radiotherapy for NPC can occur in either the ipsilateral or contralateral ears. Pathophysiology varies between and within each side. The post-therapy increase in OME on the contralateral side was thought to be due to radiotherapy-induced Eustachian tube damage, and the sensorineural threshold deterioration in at least 4 ears was thought to be due to chronic cochlea damage secondary to COM.     

Sensorineural hearing loss in patients with chronic otitis media

Chronic otitis media is generally associated with some degree of hearing loss, which is often the patient’s chief complaint. This hearing loss is usually conductive, resulting from tympanic membrane rupture and/or changes in the ossicular chain due to fixation or erosion caused by the chronic inflammatory process. When cholesteatoma or granulation tissue is present in the middle ear cleft, the degree of ossicular destruction is even greater. An issue that has recently gained attention is additional sensorineural hearing loss due to chronic otitis media. While the conductive loss can be minimized through surgery, sensorineural hearing loss constitutes a permanent after effect, attenuated only through the use of a hearing aid. However, a few groups have reported a decrease in sensorineural function in these patients as well. This survey study performed at a referral center evaluates the occurrence of sensorineural hearing loss in ambulatory patients with this disease. We reviewed the files of patients with unilateral chronic otitis media. One hundred and fifty patients met the inclusion criteria: normal otoscopy and normal hearing in the contralateral ear. Main outcome measure: bone-conduction threshold averages were calculated for frequencies of 500, 1,000, 2,000, 3,000 and 4,000 Hz, with comparison between the normal ear and the ear with chronic otitis media. Thresholds were examined separately for each frequency. The bone-conduction threshold averages for the normal side were lower than those for the ear with chronic otitis media. The threshold shift was statistically significant for each frequency (P < 0.0001, Student’s t test). There were differences between the groups when analyzed for age (500 and 1,000 Hz) or the presence of cholesteatoma (1,000 Hz). This study shows that chronic otitis media is associated with a decrease in cochlear function.     

Perilymphatic fistulas in children: rationale for therapy

We report 26 consecutive patients (32 ears) who were identified in a 2 year period (July 1, 1985-June 30, 1987) with unexplained sudden, fluctuating, or progressive sensorineural hearing loss (SNHL). All patients underwent an exploratory tympanotomy and a perilymphatic fistula was identified in 13 patients (14 ears). The mean change of 14 +/- 27 dB in speech reception threshold before and after surgery was significant at p = 0.08 among children with fistula and ranged from -30 to 80 dB. In children with sudden, progressive or fluctuating SNHL and multiple sensory deficits, including blindness or contralateral SNHL, or prior head trauma, prompt surgical exploration is mandatory. Additionally, the aggressive management of otitis media with effusion is essential in such patients to minimize fluctuations in hearing caused by superimposed conductive hearing loss. Caution must be exercised to separate fluctuating hearing loss from fluctuations in audiologic testing.     

Sensorineural hearing loss associated with otitis media with effusion.

The clinical records of 1,372 cases of otitis media with effusion (OME) treated during the past 10 years were reviewed in search of associations with sensorineural hearing loss (SNHL). In 14 cases (1.0%), the development of SNHL was considered to be etiologically related to OME. These 14 cases were classified into two groups. In group A, which consisted of 5 cases, the clinical feature was acute onset of SNHL and gradual improvement. In group B of 9 cases, SNHL progressed gradually or insidiously and did not improve. Different pathophysiology may be assumed to underlie these two groups. The results of this study demonstrate that we have to pay attention to a possible development of SNHL during the course of OME.     

Prevalence of otitis media,hearing impairment and cerumen impaction among school children in rural and urban Dar es Salaam,Tanzania

Eight hundred and two (802) primary school children in rural and urban Dar es Salaam, Tanzania, were examined to determine the prevalence of otitis media, hearing impairment and cerumen impaction by otoscopy and pure tone audiometry. Ear disease was found in 222 (27.7%) of the children. One hundred and twenty six (15.7%) had cerumen impaction, 70 (8.7%) had sensorineural hearing loss and 21 (2.6%) had chronic suppurative otitis media. Cerumen impaction was found in 20.45% of the rural school children and in 14.8% of the urban school children. This difference in prevalence between the two groups was not statistically significant. The prevalence of chronic suppurative otitis media (COM) was 9.44% among the rural school children and 1.3% among the urban school children, the difference being statistically significant (P < 0.001). Sensorineural hearing impairment was found in 14.1% of the rural school children and in 7.7% of the urban children, this also being statistically significant (P < 0.05). The low prevalence of chronic suppurative otitis media among the urban school children is ascribed to better medical services which facilitate early diagnosis and treatment of acute otitis media. This emphasizes the need to improve the health services in the rural areas so that acute otitis media is diagnosed and treated at the primary level of health care. This will in turn prevent hearing impairment due to chronic suppurative otitis media.     

Chronic suppurative otitis media and sensorineural hearing loss: Is there a correlation?

Traditionally, it has been accepted that chronic suppurative Otitis media is associated with a breakdown in meekanical conduction of sound leading to conductive hearing loss, On;the contrary, there are two schools of thought when it come, to the issue of cpchlear involvement leading to sensorineural hearing loss (SNIIL) in chronic suppura the Otitis media. The present study was undertaken to find out whether a sensorineural component exists in hearing loss associated with chronic suppurative otitis media, A sample of 100 patients of unilateral chronic suppurative otitis media was selected for the Study and their bone conduction thresholds Mere analyzed in relation to the duration of disease using audiometric data. A 24 per cent incidence of sensoineural hearing loss was found in this series, garticularly involving the higher frequencies. Moreover, the incidence of sensorineural hearing loss progressively increased with the increase in duration of chonic suppurative Ouns meadia     

分泌性中耳炎骨导听阈改变的临床观察

目的证实分泌性中耳炎可导致感音神经性聋,为临床干预分泌性中耳炎,尤其是顽固的分泌性中耳炎提供依据.方法115例(164耳)分泌性中耳炎患者治愈后或未愈患者病程中复查的纯音测听检查结果,记录0.5、1、2、4kHz频率骨导听阈,计算骨导听力损失dB数.分为单侧组66例,双侧组49例,将66例单耳患者的健耳作为对照组.结果在164耳中,出现骨导听阈提高的共94耳(57.3%).双侧组与单侧组骨导听力损失程度差异均无显著性(P>0.05);单侧组和双侧组患耳在同一频率的骨导听力损失程度相似,且平均的骨导听力损失程度也相似;不同频率之间的骨导听力损失不同,4kHz的骨导听力损失为最大.结论半数以上分泌性中耳炎可以导致感音神经性聋.在不同频率间的骨导听力损失不同,以高频损失为主,并有向语言频率区过渡的趋势.     

Expression of C-type lectin receptor mRNA in otitis media with effusion and chronic otitis media with and without cholesteatoma

Background & objectivesC-type lectin receptors (CLRs) are a family of pattern recognition receptors (PRPs). The expression of CLRs has been analyzed in other diseases but has not yet been compared in patients with otitis media with effusion (OME), chronic otitis media (COM) and COM with cholesteatoma (Chole OM). This study therefore evaluated the levels of expression of mRNAs encoding Dectin-1, MR1, MR2, DC-SIGN, Syk, Card-9, Bcl-10, Malt-1, Src, DEC-205, Tim-3, Trem-1, and DAP-12 in patients with OME, COM, and Chole OM.MethodsCLR mRNA levels in patients with OME, COM, and Chole OM were assessed by real-time polymerase chain reaction. The level of expression of each mRNA was compared in patients with and without bacteria, and in patients with conductive hearing loss (CHL) and sensorineural hearing loss (SNHL).ResultsThe patterns of expression of CLRs differed in patients with OME, COM, and Chole OM. Galectin-1 mRNA level was significantly higher in the COM than in the Chole OM group (p < 0.05), and MR1 and Galectin-1 mRNA levels among patients with CHL were significantly higher in those with COM than with Chole OM (p < 0.05). Galectin-1 mRNA level among patients with SNHL was also significantly higher in the COM than in the Chole OM group (p < 0.05).ConclusionsThe levels of expression of mRNAs encoding the CLRs Dectin-1, MR1, MR2, DC-SIGN, Syk, Card-9, Bcl-10, Malt-1, Src, DEC-205, Tim-3, Trem-1 and DAP-12 differ among patients with OME, COM, and Chole OM.     

Incidence of coexisting sensorineural hearing loss and secretory otitis media

There are currently no standard guidelines for assessing hearing in children who are evaluated for tympanostomy tubes. We describe the results of audiologic testing on 587 children, age 2 months to 17 years admitted to Pediatric Otolaryngology Department Bia?ystok for treatment of secretory otitis media. Ten children (1.7%) were found to have previously unrecognized sensorineural hearing loss. In four cases total unilateral deafness, in six others moderate to severe sensorineural bilateral hearing loss was diagnosed. Three other children referred to our clinic as sensorineural hearing loss were found to have secretory otitis media as the only or coexisting cause of deafness. Results of our study show the importance of age--appropriate hearing assessment as part of diagnostic procedure for secretory otitis media.