Multimodal imaging in conductive hearing loss: Optimising CT, MRI and CTA for accurate diagnosis and management.

Characterization of hearing loss in pediatric patients with osteogenesis imperfecta

Making Audiology Work During COVID-19 and Beyond

Three aspects of brainstem response audiometry were investigated in the present study. (1) The brainstem response threshold was compared with the pure-tone audiogram in 40 patients with conductive hearing loss. The brainstem response threshold has a one-to-one relationship with the mean of the pure-tone thresholds at 2 and 4 kHz. The correlation coefficient in this comparison is 0.84 and the standard error of the estimate is 8.3 dB. Taking into account corresponding results in cochlear hearing loss [Drift et al.: Audiology 26: 1-10, 1987] it is concluded that the brainstem response threshold provides a good estimate of the amount of peripheral hearing loss, independent of the type of hearing loss. (2) It was shown [Drift et al.: Audiology 27: 260-270, 1988] that different types of peripheral hearing loss can be distinguished reliably with brainstem response audiometry. Parameters relevant for this distinction were the horizontal shift of the latency-level curve (1(L) curve), that of its derivative and the response threshold. In the clinical situation measurement of the response threshold is not always possible due to restlessness of the patient. To simulate this situation we randomly truncated the lower parts of the 1(L) curves of quiet patients. The test group consisted of 22 adult normally hearing subjects, 79 patients with cochlear hearing loss, 40 with conductive hearing loss and 22 with mixed hearing loss. Linear discriminant analysis was applied to the horizontal shift of the 1(L) curve and of its derivative. The brainstem diagnosis 'normal hearing' correctly excludes a conductive hearing loss in 98% of the cases and the brainstem diagnosis 'cochlear hearing loss' does so in 79%. The brainstem diagnosis 'conductive hearing loss' correctly predicts a conductive component of hearing loss in 94% of the cases and the brainstem diagnosis 'mixed hearing loss' does so in 90%. The distinction between cochlear hearing loss and normal hearing is not reliable, neither is the distinction between conductive and mixed hearing loss. (3) The amount of the conductive component of hearing loss can be estimated by the horizontal shift of the 1(L) curve. Statistical comparison with the mean of the air-bone gaps at 2 and 4 kHz gave a correlation coefficient of 0.77, a standard error of the estimate of 9.7 dB, and a slope of the regression line of 0.93. An overestimation of about 7 dB has to be taken into account in case of mixed hearing loss.

The number of potential options for rehabilitation of patients with conductive or mixed hearing loss is continually expanding. To be able to inform patients and other stakeholders, there is a need to identify and develop patient-centred outcomes for treatment of hearing loss. To identify outcome measures in the physical core area used when reporting the outcome after treatment of conductive and mixed hearing loss in adult patients. Systematic review. Systematic review of the literature related to reported physical outcome measures after treatment of mixed or conductive hearing loss without restrictions regarding type of intervention, treatment or device. Any measure reporting the physical outcome after treatment or intervention of mixed or conductive hearing loss was sought and categorised. The physical outcome measures that had been extracted were then grouped into domains. The literature search resulted in the identification of 1434 studies, of which 153 were selected for inclusion in the review. The majority (57%) of papers reported results from middle ear surgery, with the remainder reporting results from either bone conduction hearing devices or middle ear implants. Outcomes related to complications were categorised into 17 domains, whereas outcomes related to treatment success was categorised into 22 domains. The importance of these domains to patients and other stakeholders needs to be further explored in order to establish which of these domains are most relevant to interventions for conductive or mixed hearing loss. This will allow us to then assess which outcome measures are most suitable for inclusion in the core set.

Background: Most previous studies are separate dosimetric analyses of conductive or sensorineural hearing loss, and they are not conducive to a comprehensive assessment of auditory radiation damage.Aims/objectives: Our study aimed to evaluate the long-term incidence of sensorineural hearing loss (SNHL) or conductive hearing loss (CHL) in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiation therapy (IMRT), and to investigate the relationship between SNHL or CHL and patient factors, treatment-related factors, and radiation dose parameters.Material and methods: Seventy patients (117 ears) with NPC, who were also treated with IMRT in our hospital from 2006 to 2014, were retrospectively analyzed. Radiation doses to the Eustachian tube (ET), middle ear (ME), cochlear (Co), and internal auditory canal (IAC) were assessed. Pure tone audiometry and impedance audiometry were performed before and during the follow-up period. The relationships between low-frequencies (0.5–2 kHz) or high-frequency (4 kHz) SNHL/CHL and radiotherapy dose parameters were analyzed.Results: Of the 117 ears studied, 7.69% had low-frequency SNHL, 35.9% had high-frequency SNHL, 23.93% had low-frequency CHL, and 18.80% had high-frequency CHL. The incidence of high-frequency CHL was higher in the T4 group than in the T (1–3) group (p < .05). When IAC Dmax > 42.13 Gy or IAC Dmean > 32.71 Gy, the risk of high-frequency SNHL increased in NPC patients. When ME Dmax > 44.27 Gy, ME Dmean > 29.28 Gy, or ET Dmax > 57.23 Gy, the risk of high-frequency CHL in NPC patients increased.Conclusions and significance: SNHL and CHL remain common ear complications after IMRT for NPC. IAC Dmax, IAC Dmean, ME Dmax, ME Dmean, and ET Dmax all need to be carefully considered during the IMRT treatment protocol.

Postoperative complications of myringotomy and tube placement often include otorrhea, tympanosclerosis, and tympanic membrane perforation. However, the incidence of sensorineural or conductive hearing loss has not been documented. Recent efforts to curb the use of preoperative audiometric testing requires documentation of this incidence. To define the incidence of conductive and sensorineural hearing loss associated with myringotomy and tube placement. A retrospective chart review of 550 patients undergoing myringotomy and tube placement was performed. A total of 520 patients undergoing 602 procedures (1204 ears), including myringotomy and tube placement, were assessed for preoperative and postoperative sensorineural and conductive hearing loss. No patient developed a postoperative sensorineural or conductive hearing loss. All patients resolved their conductive hearing loss after myringotomy and tube placement. There was a 1.3% incidence of preexisting sensorineural hearing loss. The incidence of sensorineural or conductive hearing loss after myringotomy and tube placement is negligible and the use of preoperative audiometric evaluation may be unnecessary in selected patients, but further studies need to be done to corroborate this small data set.

The aim of this study is to appreciate the incidence of patients with isolated conductive hearing loss with normal drum due to superior semicircular canal dehiscence (SCD). It is a prospective radiological study. Two hundred and seventy-two patients with a normal drum suffering from isolated unilateral or bilateral conductive or mixed hearing loss were included in a prospective radiological study. A high resolution computerized tomography (HRCT) was performed in all the patients. Those who were found to have a unilateral or bilateral SCD underwent further etiological, clinical, audiologic evaluation. Ten patients with conductive or mixed hearing loss were found to have a unilateral or bilateral SCD. The disease was bilateral in five cases, and most often associated with a dehiscence of the tegmen tympani on both sides, supporting the theory of the congenital nature of the disease. There was no clear correlation between symptoms and the size of the SCD. Because patients were not suffering from incapacitating vestibular symptoms, they were not operated for surgical occlusion of the SCD, and were referred to a hearing aid specialist to improve hearing. Conductive or mixed hearing loss due to SCD is relatively frequent, justifying in our opinion that a systematic HRCT be carried out before surgery of any patient with conductive hearing loss.

Background and ObjectivesConductive hearing loss is common among children and adults. This study aims at comparing the results of conductive hearing loss in summer and autumn.Subjects and MethodsPuretone audiometry and tympanometry tests were done for all patients who referred to the Iranian-based audiology center of Imam Khomeini Hospital in Ahvaz. Data on the patients with conductive or mixed hearing loss were analyzed. The impacts of season, age, and etiology of the disease were analyzed on the patients who visited the audiology clinic due to the conductive hearing loss in summer and autumn.ResultsOne hundred and fifty nine patients in summer and 123 patients in autumn had conductive or mixed hearing loss. Their age ranged from four to 82 years, with the average age of 35. The percentage of the patients, with acute otitis media and chronic otitis media (COM), who visited this clinic, was significantly higher than those with middle ear problems. COM and mastoid surgeries rate was higher in summer than autumn among adults.ConclusionsThere is no relationship between season and middle ear diseases between children and juveniles, but COM and mastoid problems are more common in summer among adults visiting this clinic. Most of the patients had mild conductive hearing loss and bilateral middle ear impairments.

Although newborn hearing screening programs have been introduced in most states in Australia, the prevalence of conductive hearing loss and middle ear pathology in the infants referred through these programs is not known. This study was designed to (1) evaluate the prevalence of conductive hearing loss and middle ear pathology in infants referred by a newborn hearing screening program in north Queensland, (2) compare prevalence rates of conductive hearing loss and middle ear pathology in indigenous and nonindigenous infants, and (3) review the outcomes of those infants diagnosed with conductive hearing loss and middle ear pathology. Retrospective chart review of infants referred to the Audiology Department of The Townsville Hospital was conducted. Chart review of 234 infants referred for one or both ears from a newborn hearing screening program in north Queensland was conducted. A total of 211 infants attended the diagnostic appointment. Review appointments to monitor hearing status were completed for 46 infants with middle ear pathology or conductive hearing loss. Diagnosis of hearing impairment was made using an age-appropriate battery of audiological tests. Results were analyzed for both initial and review appointments. Mean age at initial diagnostic assessment was 47.5 days (SD = 31.3). Of the 69 infants with middle ear pathology during initial diagnostic assessment, 18 had middle ear pathology with normal hearing, 47 had conductive hearing loss, and 4 had mixed hearing loss. Prevalence of conductive hearing loss in the newborns was 2.97 per 1,000 while prevalence of middle ear pathology (with or without conductive hearing loss) was 4.36 per 1,000. Indigenous Australians or Aboriginal and Torres Strait Islander (ATSI) infants had a significantly higher prevalence of conductive hearing loss and middle ear pathology than non-ATSI infants (35.19 and 44.45% vs 17.83 and 28.66%, respectively). ATSI infants also showed poor resolution of conductive hearing loss over time with 66.67% of ATSI infants reviewed showing persistent conductive hearing loss compared to 17.86% of non-ATSI infants. Medical management of 17 infants with persistent conductive hearing loss included monitoring, antibiotic treatment, examination under anesthesia, and grommet insertion. Conductive hearing loss was found to be a common diagnosis among infants referred through screening. ATSI infants had significantly higher rates of middle ear pathology and conductive hearing loss at birth and showed poor resolution of middle ear pathology over time compared to non-ATSI infants. Future research using a direct measure of middle ear function as an adjunct to the automated auditory brainstem response screening tool to distinguish conductive from sensorineural hearing loss may facilitate prioritization of infants for assessment, thus reducing parental anxiety and streamlining the management strategies for the respective types of hearing loss.

Background: CSOM is the leading cause of hearing loss. It has usually a higher mortality rate than other forms of ear infections. Objective: The aim of this study was to find out the frequency of Sensorineural hearing loss and its severity in patients suffering from longstanding aural suppuration. Material and method: This prospective study was conducted at the Department of ENT, Bolan Medical College / Complex Hospital, Quetta from May 2023 to October 2023 after taking approval from the research committee of the institute. A total of 154 individuals of both sexes and different age groups (12-40 years) presented with chronic CSOM were enrolled in this study. A thorough ENT examination was conducted. The pure tone thresholds for both air and bone conduction were measured across the frequency range of 250 Hz, 500 Hz, 1000 Hz, 2000 Hz, and 4000 Hz. The two types of hearing impairment were Sensorineural Hearing Loss (SNHL) and Conductive Hearing Loss (CHL). A proforma was used to record the data, and descriptive statistics were used to calculate the frequencies of several variables, including age, gender, the type of hearing loss, and the severity of SNHL. The age groups and length of CSOM were taken into consideration while calculating the severity of SNHL. For the analysis, SPSS 15.0 was used. Results: A total of 154 individuals were examined in this study out of which male were 87 (56.4%) and female were 67 67(43.5%). Conductive hearing loss was diagnosed in 97(63%) individuals and Sensorineural hearing loss in 57(37%) individuals. When patients with persistent otorrhea presented, 37% of them had sensorineural hearing loss and 63% had conductive hearing loss. Moderate hearing loss was the most common among individuals with sensorineural hearing loss (18.8%).The detected cases of conductive hearing loss are not included in the severity analysis. The age group most frequently associated, including 40.2% of the individuals with SNHL, was 12–20 years old. According to tests of significance, a substantial proportion of CSOM patients had sensorineural hearing loss (p-value &lt;0.05). The duration of chronic suppurative otitis media did not positively correlate with the degree of sensorineural hearing loss (p value &gt;.05) Conclusion: The current study concluded that both conductive and sensorineural hearing loss is brought on by chronic suppurative otitis media. Until SNHL complicates it, which is usually permanent, CSOM is a curable cause of acquired deafness. Keywords: Sensorineural; Hearing loss; Severity; Longstanding aural suppuration

Keratitis-ichthyosis-deafness (KID) syndrome most commonly results from a mutation in the gap-junctional protein connexin 26 (Cx26) gene, GJB2. Most cases are sporadic and are associated with sensorineural hearing loss. We encountered a mother and daughter with KID syndrome, and pursued genetic analysis and an extensive hearing loss evaluation. The analysis of genomic DNA of both affected patients revealed the mutation 148G --> A in GJB2 (D50N). No mutation was found in an unaffected son. Auditory phenotype analysis showed a combined conductive and sensorineural hearing loss in both affected patients. This is the second vertical transmission of the D50N mutation. These are the first two cases with combined sensorineural and conductive hearing loss without any significant history of middle ear disease. This points to the possibility that the Cx26 D50N mutation can cause conductive hearing loss.

Natural myringostapediopexy is an infrequent abnormality, and studies about resulting hearing loss are scarce. In several cases, natural myringostapediopexy may function as a Type III tympanoplasty. This study evaluated conductive hearing loss in myringostapediopexy. This cross-sectional comparative study included a historical and current sample of 46 patients, one with bilateral myringostapediopexy, at a total of 47 ears. All underwent pure tone and speech audiometry and were divided according to age into a pediatric (younger than 18 yr) and an adult group. The Statistical Package for Social Science (SPSS) 10.0 was used for statistical analysis, and the level of significance was set at p lower than 0.05. Patient distribution according to sex was similar (53.2% male), and 57.4% were adults. Mean conductive hearing loss in ears with myringostapediopexy ranged from 14.13 to 21.28 dB according to the frequency assessed. Pure tone average was 18.46 dB. A conductive hearing loss equal to or lower than 25 dB at all frequencies was found in 53% of the patients. The 2,000 and 3,000 Hz frequencies had the greatest prevalence of clinically nonsignificant conductive hearing loss (87% and 91%). Sensorineural hearing loss was found in 14 patients (30%), all adults, and 43% of the cases were mild. The comparison according to age did not reveal any significant differences in conductive hearing loss at any of the frequencies. Most patients with natural myringostapediopexy included in the study had clinically irrelevant conductive hearing loss. There were no differences in conduction loss between children and adults. The reconstruction of the ossicular chain and tympanoplasty, for purely functional reasons, are not justified in these cases, particularly not for patients with mixed hearing loss.

Active middle ear implants, such as the Vibrant Soundbridge, are used as an important part in the rehabilitation of sensorineural, conductive hearing, or mixed hearing loss. The attachment of the Vibrant Soundbridge at the round window and the usage of the Vibroplasty couplers strongly expanded the application of the Vibrant Soundbridge.The Vibrant Soundbridge is developed for patients who have an intolerance to hearing aids and a moderate to profound sensorineural hearing loss. The VSB also provides an optimal solution for patients with failed middle ear reconstructions or patients with atresia. To capture the improvement with the VSB Implant with different hearing losses a literature analysis was conducted. The functional gain was analyzed for 107 patients with conductive hearing loss and for 214 patients with sensorineural hearing loss out of 14 studies.Patients with conductive and mixed hearing loss resulted in a functional gain from 30 to 58 dB with the VSB. Patients with a pure sensorineural hearing loss showed a functional gain of 23-30 dB. The VSB bone conduction threshold shift was analyzed for all studies conducted in the years between 2000 and 2009. In 11 of the 16 studies there was no significant (p=0.05) change found. In 5 studies, the pre- to post-surgical bone conduction threshold shift was less than 10 dB. None of these studies measured a threshold shift of more than 10 dB.The flexible attachment at either the long process of the incus with sensorineural hearing loss, with an conductive hearing loss at the round window or the use of Vibroplasty couplers at the oval window, head of the stapes or round window makes the VSB an extremely versatile instrument. If patients can't wear conventional hearing aids, had failed middle ear reconstructions or atresia the VSB presents, due to the significant hearing improvement in any type of hearing loss, an ideal solution.

Background Vestibular evoked myogenic potential (VEMP) test is an electrophysiological testing that can assess dysfunction of otolithic organs and the integrity of their pathways precisely. Aim Compare amplitude and latency of ocular and cervical vestibular evoked myogenic potentials evoked by air- and bone-conducted stimuli in three different groups. Materials and methods The control group (group 1) included ten healthy volunteers adults (20 ears) with normal hearing thresholds. Group 2 consisted of ten patients (20 ears) with conductive hearing loss (CHL) and group 3 comprised 10 patients (20 ears) with sensorineural hearing loss (SNHL). All participants underwent pure tone audiometry, immittancemetry ocular vestibular evoked myogenic potential (oVEMPs) and cervical vestibular evoked myogenic potential (cVEMPs) by air and bone conduction stimuli. Results The response rate of cVEMPs and oVEMPs elicited by both types of stimuli was 100% in control group and SNHL group. In the group of conductive hearing loss, air conduction(AC) (c VEMPs and o VEMPs) response rate was 60%. There was a statistically significant positive correlation between latencies of oVEMPs and cVEMPs evoked by AC and BC methods and degrees of hearing loss in SNHL group. Conclusion Ocular and cervical VEMPs elicited by bone conduction (BC) stimuli aren’t vulnerable to conductive hearing loss. Bc VEMPs provides assessment of vestibular system in patients with conductive hearing loss. Significant correlation was found between cVEMPs and oVEMPs abnormalities and severity of sensorineural hearing loss.

ntroduction: Bone conduction implants are currently used for rehabilitation of conductive and mixed hearing loss as well as for single sided deafness. A growing number of these implants available on the market increases requirements on detailed knowledge on their technical properties, and on their advantages and disadvantages in clinical practice. Sophono is one of the recent members in this implant group. The aim of the study is to summarize our first experiences with Sophono at our implantation center in Bratislava. Patients and methods: We present data of the first two adult patients who underwent Sophono implantation. Both suffered from bilateral conductive hearing loss of different etiology. We focused on their audiological functional outcomes, basic surgical aspects and subjective assessment by the patients. Results: In free field tone audiometry with the implant, both patients achieved improvement of hearing thresholds by 21.25 dB and 31.25 dB, respectively. In speech tests with and without noise, we also demonstrated a clear benefit of the implant, which was in a narrow relationship with the degrees of their hearing loss: speech discrimination scores in noise were 30% and 60% in patients 1 and 2, respectively. The surgical procedure in Sophono implantation is relatively simple and does not include any work on middle ear structures. Patient satisfaction with the implant does not always correspond to the measured functional outcomes. Conclusion: The Sophono implant represents a suitable option for rehabilitation of conductive and mixed hearing loss as well as single sided deafness in selected patients. The candidate selection is always based on comprehensive assessment in which the audiological results are an elementary criterion, but definitely not a single one. Keywords: Sophono – implantation – conductive hearing loss