Asymmetric Sensorineural Hearing Loss Research Articles

Prospective study of location in patients with unilateral and asymmetric hearing treated with cochlear implant

Background and objectiveSound localization plays a crucial role in our daily lives, enabling us to recognize voices, respond to alarming situations, avoid dangers, and navigate towards specific signals. However, this ability is compromised in patients with Single-Sided Deafness (SSD) and Asymmetric Hearing Loss (AHL), negatively impacting their daily functioning. The main objective of the study was to quantify the degree of sound source localization in patients with single-sided deafness or asymmetric hearing loss using a Cochlear Implant (CI) and to compare between the two subgroups. Materials and methodsThis was a prospective, longitudinal, observational, single-center study involving adult patients diagnosed with profound unilateral or asymmetric sensorineural hearing loss who underwent cochlear implantation. Sound localization was assessed in a chamber equipped with seven speakers evenly distributed from -90º to 90º. Stimuli were presented at 1000 Hz and intensities of 65 dB, 70 dB, and 75 dB. Each stimulus was presented only once per speaker, totaling 21 presentations. The number of correct responses at different intensities was recorded, and angular error in degrees was calculated to determine the mean angular distance between the patient-indicated speaker and the speaker presenting the stimulus. Both assessments were conducted preoperatively without a cochlear implant and two years post-implantation. ResultsThe total sample comprised 20 patients, with 9 assigned to the SSD group and 11 to the AHL group. The Preoperative Pure Tone Average (PTA) in free field was 31.7 dB in the SSD group and 41.8 dB in the AHL group. There was a statistically significant improvement in sound localization ability and angular error with the use of the cochlear implant at all intensities in both SSD and AHL subgroups. ConclusionsCochlear implantation in patients with SSD and AHL enhances sound localization, reducing mean angular error and increasing the number of correct sound localization responses.

A mouse model of autoimmune inner ear disease without endolymphatic hydrops

Autoimmune inner ear disease (AIED) is an organ-specific disease characterized by irreversible, prolonged, and progressive hearing and equilibrium dysfunctions. The primary symptoms of AIED include asymmetric sensorineural hearing loss accompanied by vertigo, aural fullness, and tinnitus. AIED is divided into primary and secondary types. Research has been conducted using animal models of rheumatoid arthritis (RA), a cause of secondary AIED. However, current models are insufficient to accurately analyze vestibular function, and the mechanism underlying the onset of AIED has not yet been fully elucidated. Elucidation of the mechanism of AIED onset is urgently needed to develop effective treatments. In the present study, we analyzed the pathogenesis of vertigo in autoimmune diseases using a mouse model of type II collagen-induced RA. Auditory brain stem response analysis demonstrated that the RA mouse models exhibited hearing loss, which is the primary symptom of AIED. In addition, our vestibulo-oculomotor reflex analysis, which is an excellent vestibular function test, accurately captured vertigo symptoms in the RA mouse models. Moreover, our results revealed that the cause of hearing loss and vestibular dysfunction was not endolymphatic hydrops, but rather structural destruction of the organ of Corti and the lateral semicircular canal ampulla due to an autoimmune reaction against type II collagen. Overall, we were able to establish a mouse model of AIED without endolymphatic hydrops. Our findings will help elucidate the mechanisms of hearing loss and vertigo associated with AIED and facilitate the development of new therapeutic methods.

Nystagmus Based Screening System for Vestibular Schwannoma in Patients With Asymmetric Hearing Loss

Background and Objectives We conducted this study to propose a nystagmus based screening system (NBSS) for detecting vestibular schwannoma (VS) in patients with asymmetric sensorineural hearing loss (ASNHL).Subjects and Method Data of 90 patients diagnosed with VS were retrospectively analysed. For the 1:1 allocation, 90 ASNHL patients who were not diagnosed with VS were sequentially enrolled as the non-VS group and retrospectively analysed. Every participant received pure tone audiometry (PTA), a bedside vestibular function test, and magnetic resonance imaging. A total of 122 patients who passed the exclusion criteria were selected for the study.Results The sensitivity and specificity of the abnormal criteria of auditory brainstem response (ABR) for the detection of VS in patients (n=70) showing analyzable wave response were 80.0% and 52.0%, respectively. However, when we included all of the patients (n=122) who did not show analyzable wave response in ABR, the sensitivity and specificity of the abnormal criteria decreased to 34.8% and 68.4%, respectively. NBSS is composed of vertical spontaneous nystagmus, direction changing gaze evoked nystagmus, ipsilesional monophasic type head shaking nystagmus (HSN), and ipsilesional to contralesional biphasic type HSN. The sensitivity and specificity of the NBSS were 56.5% and 82.9%, respectively.Conclusion NBSS may be used as a supplementary test to ABR in detecting VS of ASNHL.

Amplification of the poorer ear by StereoBiCROS in case of asymmetric sensorineural hearing loss: effect on tinnitus.

Tinnitus is prevalent among patients suffering from Single-Sided Deafness (SSD) and Asymmetrical Hearing Loss (AHL). In addition to bothersome tinnitus in the poorer ear, these patients also report issues with understanding speech in noise and sound localization. The conventional treatment options offered to these patients to improve auditory abilities are cochlear implantation, bone conduction devices or Contralateral Routing Of Signal (CROS) hearing aids. It was recently found that the benefit of cochlear implantation for tinnitus associated with AHL/SSD was greater than the other two approaches. It is conceivable that the lack of stimulation provided to the poorer ear in these last approaches explains their modest impact on tinnitus perception. A new technology that combines the ability to reroute the sound from the poorer ear to the good ear (CROS system) while still stimulating the poorer ear with conventional sound amplification has recently been developed: the StereoBiCROS system. The aim of this study was to investigate the effects of this new device on tinnitus. Twelve AHL and two SSD patients aged 70.7 ± 7.9 years with tinnitus were fitted with bilateral hearing aids that included 3 programs: Stereophonic, BiCROS and StereoBiCROS (CROS + bilateral amplification). The short-and long-term effect of the approach on tinnitus was assessed using a tinnitus Loudness Visual Analog Scale (VAS) and the Tinnitus Handicap Inventory (THI), respectively. Both the VAS and the THI were used before and one month after the hearing aid fitting. Of the 14 patients who used their hearing aids daily (12.6 ± 1.6 h per day) the StereoBiCROS program was the most used program (81.8 ± 20.5% of the time). The average THI total score decreased from 47 (± 22) to 15 (± 16) (p = 0.002) and the VAS-Loudness score decreased from 7 (± 1) to 2 (± 2) (p < 0.001) after the one-month trial period. In conclusion, StereoBiCROS stimulation strategy seems to offer an effective alternative to reduce tinnitus handicap and loudness for patients with AHL/SSD and tinnitus. This effect may be driven by sound amplification of the poorer ear.

Cisplatin-associated ototoxicity amongst cervical cancer patients: A prospective cohort study in south Africa.

Concurrent chemoradiotherapy using weekly cisplatin remains standard of care for locally advanced cervical cancer in Sub-Saharan Africa. While cisplatin remains a popular cancer chemotherapeutic, it has an irreversible ototoxic effect on patients' auditory system. However, there is a paucity of epidemiological information on its extent and severity during cervical cancer treatment. In a region with a high burden of cervical cancer, this has serious consequences for aural intervention and rehabilitation. Using a prospective cohort study design, 82 patients with incident cervical cancer, receiving weekly cisplatin chemotherapy (50 mg/m2 body surface) at a tertiary level hospital in KwaZulu-Natal Province of South Africa, underwent audiological assessments at various intervals. We describe the temporal impact of cisplatin exposure on hearing loss, its combined effect with HIV-infection, and estimate ototoxicity incidence in this cohort. The median age was 52 years with Stages IIB (45%) and IIIB (35.4%) cancers being most common. Complaints of reduced hearing sensitivity increased significantly (p<0.0001). Bilateral, asymmetrical sensorineural hearing loss, with greater effect in the extended high-frequency range, was evident. Cisplatin dosage was significantly associated with ototoxicity severity at one- (p = 0.017), three- (p = 0.010), and six-month (p = 0.015) post-treatment follow-up. HIV-seropositivity (53.7%) was significantly associated with NCI-CTCAE Grading Scale at three- (p = 0.022) and six-months (p = 0.023) post-treatment. Multiple Tobit regression revealed a cumulative dose effect bilaterally, after adjustment for age and HIV status, evident from 9000Hz and above in the right ear, while a plateau effect was observed at 250mg/m2 in the left ear. The incidence was ototoxicity was 98% at a cumulative dose of 150mg/m2. The findings of this epidemiologic study highlight the temporal course and severity of ototoxicity experienced by cervical cancer patients treated with cisplatin, with greater impact in HIV-positive subgroup, thus underscores the need for audiological monitoring and timely interventions in this cohort.

Factors associated with congenital cytomegalovirus infection detected by dried blood spot testing in children with hearing loss.

Congenital cytomegalovirus (cCMV) infection in infants leads to an increased risk of developing sensorineural hearing loss (SNHL), even if they are asymptomatic at birth. There are currently no national guidelines for universal screening for CMV, placing children with cCMV at a high risk for unidentified and untreated HL, which in turn places them at greater risk for lasting impacts on quality of life and cognitive and behavioral abilities. We sought to describe the sociodemographic and hearing loss characteristics of children with HL due to cCMV. We performed a retrospective cohort study of patients 0-18 years of age who completed CMV dried blood spot (DBS) testing in our HL clinic before April 1, 2022. Home ZIP codes were entered into the Healthy Places Index (HPI) database to quantify the health of the community in which the patient lived. Severity of HL was determined by pure tone averages (PTA) of hearing thresholds for frequencies of 500Hz, 1000Hz, 2000Hz, and 4000Hz. Progression was defined as those who referred on newborn hearing screen and then had a >15dB increase in PTA, and those who passed newborn hearing screen and were found to have HL later in life. Logistic regression was used to compare variables. Of 365 children who received a CMV DBS test, 15 (4%) had a positive test, indicating the presence of cCMV infection, and 350 (96%) had a negative test. 192 (53%) were male, 212 (58%) were URM, 202 (55%) had public insurance, the median number of ICD-10 codes was 2 (range 0-53), and the median HPI percentile score was 71.2 (range: 3.4-99.9). Although CMV DBS testing was ordered for those with suspicion of SNHL, ultimately diagnostic testing found 333 (91%) with SNHL, 4 (1%) with CHL, 13 (4%) with mixed HL, 9 (3%) with auditory neuropathy spectrum disorder, and 5 (4%) with unspecified HL, and 11 (3%) without HL. Of the 353 patients with HL, 126 (36%) had unilateral, 156 (44%) had symmetric bilateral, and 71 (20%) had asymmetric bilateral HL; 183 (52%) had progressive and 138 (39%) had stable HL. In children with SNHL (n=333), we tested the association of socio-demographic and audiologic factors with cCMV. Those with asymmetric bilateral SNHL (OR 5.19, 95% CI 1.81-14.90) or profound SNHL (>90dB) in either ear (OR 13.91, 95% CI 3.82-50.67) had higher odds of having cCMV. Those with symmetric bilateral SNHL had lower odds of a positive CMV DBS test result (OR 0.17, 95% CI 0.02-0.76). All sociodemographic variables, medical comorbidities, and other audiologic variables were not associated with CMV DBS test results. Congenital CMV infection is associated with asymmetric bilateral and profound SNHL. More research is warranted to determine best practices for universal screening for cCMV to identify these children.

154 ‘You’ve Lost Your Tuning Form’ – Don't Worry I Have the Solution…

Abstract Background Patients are frequently referred to ENT emergency services with sudden hearing loss. Differentiating sensorineural from conductive losses is paramount in establishing the urgency of review and when to commence urgent steroid therapy. Tuning fork tests are useful for this, but they are not always readily available in primary care or the emergency room. Aim To identify and evaluate an alternative method to Weber's test for differentiating conductive from sensorineural hearing loss. Method A pilot prospective diagnostic accuracy study was designed to include 10 individuals with unilateral conductive and 10 with asymmetrical sensorineural hearing loss. Each individual was subjected to a pure tone audiogram (PTA), Weber's test and the new index test. Results The new index test showed 100% correlation (r=1) with Weber's test and 90% sensitivity, specificity and overall accuracy when compared to Weber's test for diagnosing conductive and sensorineural hearing loss. Conclusion This new test may be used as an alternative to Weber's test when a tuning fork is not available. It might even replace the need for Weber's test when PTA testing is readily available. This test could be used to triage referrals and differentiate conductive from sensorineural hearing loss. Conflicts There are no conflicts to declare.

Impact of an Endolymphatic Sac Tumor on Subjective and Objective Audiovestibular Function.

This study reports subjective and objective audiovestibular function in patients diagnosed with an endolymphatic sac tumor (ELST), to evaluate the clinical implication of vestibular testing in ELST patients. Retrospective cohort study. Tertiary referral center/university hospital. Five patients diagnosed with unilateral ELST. Subjective and objective audiovestibular tests; pure-tone average; speech discrimination score; the Video Head Impulse Test; the cervical vestibular evoked myogenic potential test; the caloric irrigation test; the Speech, Spatial and Qualities of Hearing Scale; the Tinnitus Handicap Inventory; and the Dizziness Handicap Inventory. Findings and characteristics of both subjective and objective audiovestibular functions. The mean pure-tone average and the mean speech discrimination score were 49 dB HL and 68% on the tumor ear and 13 dB HL and 99% contralaterally. The mean Speech, Spatial and Qualities of Hearing Scale score was 84, and the mean Tinnitus Handicap Inventory score was 64. Caloric testing showed a mean unilateral weakness of 80%. The Video Head Impulse Test of the lateral semicircular canal revealed refixation saccades on all tumor ears and an average gain value of 0.75 on the tumor ear versus 0.94 contralaterally. No cervical vestibular evoked myogenic potentials were elicited on the tumor side, whereas all but one was elicited contralaterally. The average Dizziness Handicap Inventory score was 47. A characteristic pattern of abnormal caloric findings, refixation saccades, and normal vestibulo-ocular reflex gain alongside sensorineural hearing loss on the tumor ear was identified. Asymmetric sensorineural hearing loss in any patient should lead to objective vestibular evaluation to strengthen not only a targeted tumor surveillance strategy and the indication for imaging, but also the design of vestibular rehabilitation. In addition, vestibular findings may guide the choice of surgical approach.

Hearing rehabilitation for unilateral deafness using a cochlear implant: the influence of the subjective duration of deafness on speech intelligibility

BackgroundFor patients with single sided deafness (SSD) or severe asymmetric sensorineural hearing loss (ASHL), cochlear implantation remains the only solution to restore bilateral hearing capacity. Prognostically, the duration of hearing loss in terms of audiological outcome is not yet clear. Therefore, the aim of this study was to retrospectively investigate the influence of subjective deafness duration on postoperative speech perception after cochlear implantation for SSD as well as its impact on quality of life.Materials and methodsThe present study included a total of 36 adults aged 50.2 ± 15.5 years who underwent CI for SSD/ASHL at our clinic between 2010 and 2015. Patients were audiometrically assessed at 3 and 12–36 months postoperatively. Test results were correlated with self-reported duration of deafness. Quality of life was assessed by questionnaire.ResultsMean duration of deafness was 193.9 ± 185.7 months. The side-separated hearing threshold showed an averaged target range between 30 and 40 dB HL. Freiburg monosyllable test increased from 0% pre-operatively to 20% after 3 months (p = 0.001) and to 50% after 12–36 months (p = 0.002). There was a significant correlation between audiometric outcome and subjective deafness duration at 12–36 months postoperatively (r = − 0.564; p = 0.02) with a cutoff for open-set monosyllable recognition at a duration of deafness of greater than 408 months. Quality of life was significantly improved by CI.ConclusionsCI implantation in unilaterally deafened patients provides objective and subjective benefits. Duration of deafness is unlikely to be an independent negative predictive factor and thus should not generally be considered as contraindication.

Asymmetric sensorineural hearing loss in children: progression and involvement of the contralateral ear

Background Sensorineural hearing loss in child has a profound impact on their neurodevelopment and on language acquisition. Thus, the diagnosis and early intervention are critical, namely in unilateral or bilateral asymmetric hearing losses, which are diagnosed later than symmetric bilateral hearing losses. Objectives This study aims to examine the progression of asymmetric SNHL in children, and the link between hearing thresholds and the technological level of the hearing aid fitted. Material and methods Eighteen children with asymmetric SNHL were submitted to a pure tone audiogram at the age of 5 years (T0) and reassessed at the age of 10 years (T1). Children were divided according to the technological level of the hearing aid fitted: basic, medium, and advanced. Results A positive correlation was established between the hearing thresholds at T0 and T1, revealing an accelerated progression of hearing thresholds in the better ear after a 5-year period. Conclusions Hearing thresholds in the worse ear influence the progression of the SNHL. Moreover, technologically advanced hearing aids led to a slower progression of the hearing thresholds over time.

Static posturographic balance in neurotologic patients may be associated with middle–high-frequency hearing levels during ageing process

Background Understanding how sensorineural hearing loss (SNHL) impacts postural balance in patients is important, as postural balance predicts the risk of falls. Aims/objectives We aimed to clarify the relationship between characteristics in the configuration of audiograms and static postural balance as measured by posturography. Materials and methods We evaluated 385 outpatients (mean [± standard deviation] age, 58.4 ± 18.4 years) with SNHL by audiometry and posturography. Data were analysed by multiple regression models with the outcome of postural sway area with eyes closed (PSA) and predictive variables of audiometric data, adjusted for sex, age and the presence of nystagmus. Results The increased hearing threshold in the better hearing ear was associated with poorer or higher PSA (beta coefficient [β] = 0.39, 95% confidence interval [CI] = 0.03–0.75, per 10-dB increment). No difference in PSA was detected between patients with asymmetric or symmetric SNHL. None of the frequent diagnoses (presbyacusis, Meniere’s disease, and idiopathic sudden SNHL) were associated with poorer PSA. Hearing thresholds at middle (β = 0.39, 95%CI = 0.10–0.67) and high frequencies (β = 0.31, 95%CI = 0.07–0.55) were associated with poorer PSA, whereas those at low frequencies was not. Conclusions and significance Postural balance in neurotologic patients may be associated with middle–high-frequency hearing levels during ageing.

The impact of cochlear implantation on speech and language outcomes in children with asymmetric sensorineural hearing loss

IntroductionCochlear implantation (CI) is considered in children with asymmetric sensorineural hearing loss (ASHL), or severe to profound sensorineural hearing loss in one ear, and better hearing contralaterally. The benefits of a CI in these children are not well established. This study investigated the impact of unilateral CI on speech and language outcomes in pediatric patients with ASHL. MethodsThe retrospective chart review identified pediatric patients who underwent cochlear implantation for ASHL at a tertiary single center institution between 2014 and 2017. Children who underwent cochlear implantation in the poorer ear and maintained a hearing aid in the better ear were included, while children with cognitive impairment or prior cochlear nerve deficiency and auditory neuropathy were excluded. Speech and language measures were evaluated prior to implantation and at regular six-month intervals postoperatively. Ear specific Audiometry was evaluated at every visit and varied developmentally appropriate speech recognition tasks, including questionnaires, closed-set, and open-set measures, accounted for advancing childhood milestones. Specific measures of speech articulation, expressive and receptive language, and vocabulary were assessed including: Goldman Fristoe Test of Articulation (GFTA-3), Clinical Evaluation of Language Fundamentals (CELF-P2 or CELF-5), Receptive One-Word Picture Vocabulary Test (ROWPVT) and Expressive One Word Picture Vocabulary Test (EOWPVT). The mean difference and standard deviation of speech and language outcomes at preoperative and postoperative evaluations were calculated. The change in outcomes were further assessed over each post-operative time point. ResultsTwenty-six children with asymmetric sensorineural hearing loss were included in the analysis, with 11 (42%) having bilateral enlarged vestibular aqueducts (EVA). At time of CI, unaided mean Pure Tone Average (PTA-4) for the better ear was 62Db HL, and worse ear was 92Db HL. There was an improvement in speech recognition in the implanted ear as expected. All preoperative speech and language evaluations were conducted within 7 months of cochlear implantation. Twenty-three patients had at least 1 postoperative re-evaluation. Fourteen children had preoperative and postoperative assessments with the same tool, with 13 patients (93%) showing improvement in at least 1 domain. For patients with repeated assessment within 12 months of surgery, we observed an average improvement in standard scores of: GFTA-3 (+11.2), CELF-P2 Core Language (+10.3), CELF-5 Core Language (+7.0), ROWPVT (+2.8) and EOWPVT (+4.5). Individual results are described. ConclusionImprovement in speech and language measures can be demonstrated in children undergoing unilateral cochlear implantation for asymmetric sensorineural hearing losses. These children, who are not typical CI candidates, can benefit from a CI in the poorer ear.

Diotic and Antiphasic Digits-in-noise Testing as a Hearing Screening and Triage Tool to Classify Type of Hearing Loss.

The digits-in-noise test (DIN) is a popular self-test measure that has traditionally been used to screen for hearing loss by providing either a pass or refer result. Standard approaches either tested each ear monaurally or used a binaural diotic version where identical digits and noise were presented simultaneously to both ears. Recently, a dichotic, antiphasic version was developed, increasing sensitivity of the DIN to unilateral or asymmetric sensorineural hearing loss (SNHL) and conductive hearing loss (CHL). The purpose of this study was to determine predictors and normative ranges of the antiphasic and diotic DIN and to determine if a combination of diotic and antiphasic DIN could accurately categorize hearing into (1) normal, (2) bilateral SNHL, or (3) unilateral SNHL or CHL. The analytical sample consisted of 489 participants between the ages of 18 and 92 years with varying types, symmetry, and degrees of hearing loss. Degree and type of hearing loss were determined based on standard clinical four-frequency (0.5-4 kHz) pure-tone air and bone conduction threshold averages. The sample consisted of bilateral normal hearing (n = 293), bilateral SNHL (n = 172), unilateral SNHL (n = 42), and CHL (n = 32). All participants (n = 489) first completed an antiphasic DIN (digit stimuli 180° out-of-phase between ears), while 393 of the sample also completed a diotic DIN. Two procedures were assessed for their ability to categorize hearing into one of the three hearing groups. The first used a fixed antiphasic cutoff combined with a cutoff formed by a linear combination of antiphasic and diotic speech recognition threshold (SRT) or binaural intelligibility-level difference. Poorer ear pure-tone average was the strongest predictor of antiphasic DIN score, whereas better ear pure-tone average explained more of the variance in diotic SRT. The antiphasic DIN sensitivity and specificity was 90% and 84%, respectively, for detecting hearing loss, with outstanding area under the receiver operating characteristics values exceeding 0.93 to identify hearing loss in the poorer ear. The first fixed SRT cutoff procedure could categorize 75% of all participants correctly, while the second procedure increased correct categorization to 79%. False negative rates for both procedures were below 10%. A sequential antiphasic and diotic DIN could categorize hearing to a reasonable degree into three groups of (1) normal hearing; (2) bilateral SNHL; and (3) unilateral asymmetric SNHL or CHL. This type of approach could optimize care pathways using remote and contactless testing, by identifying unilateral SNHL and CHL as cases requiring medical referral. In contrast, bilateral SNHL cases could be referred directly to an audiologist, or nontraditional models like OTC hearing aids.

A High Risk of Missing Congenital Cytomegalovirus-Associated Hearing Loss through Newborn Hearing Screening in Japan.

It remains unclear to what extent newborn hearing screening (NHS) detects congenital cytomegalovirus (cCMV)-associated sensorineural hearing loss (SNHL) in Japan. This study aimed to clarify the NHS results and audiological characteristics of patients with cCMV-associated SNHL. A total of 541 individuals with unilateral or bilateral hearing loss of unknown etiology were examined for cCMV infection. cCMV infection was defined by the presence of CMV DNA in the dried umbilical cord detected using real-time quantitative PCR. NHS results and audiological data were retrospectively obtained from medical records. Forty-four cases (8.1%) were positive for cCMV infection. Of them, 33 cases underwent NHS and 13 cases (39.4%) passed NHS bilaterally. The pure-tone audiograms of 21 patients were obtained. There were seven cases of unilateral SNHL, five cases of asymmetric bilateral SNHL, and nine cases of symmetric bilateral SNHL. cCMV-related hearing loss is highly heterogeneous, and there is a high risk of missing this condition through NHS.

1262 Audit of MRI IAM (Internal Auditory Meatus) Requests at Darlington Memorial Hospital and Review of The Literature

Abstract Aim To assess if the MRI IAM scans are being requested as suggested in NICE guidelines Draft 2017 for consultations. Educate and implement any changes if needed to minimise unnecessary investigations. Method Retrospective data collection of 1000 data. Variables included hearing loss (HL), tinnitus (T), dizziness (D) and other lateralized symptoms. Audiograms assessed for asymmetrical HL at decibel level ≥20 Db at a frequency of 0.5 kHz, 1.0 kHz, 2.0 kHz. MRI of IAM assessed if a cerebellar pontine angle (CPA) lesion was presented. Results 853 (85.3%) met criteria. 16/1000 (1.6%) MRI showed CPA lesion. All 16 cases had unilateral sensorineural hearing loss (SNHL) and met NICE guidelines criteria. Discussion Limited value in the scanning of asymptomatic patients, those who do not fit audiometric guidelines, those bilateral symptoms or those with unilateral tinnitus without audiometric asymmetry. Very few studies were found in the literature in relation to symptoms associated with positive findings of CPA lesion. Our results indicate unilateral SNHL were linked with positive findings of MRI and it is similar findings in the literature. We recommend that patients who present with asymmetrical SNHL with this audiometric asymmetrical characteristic of 20Db or more will need an urgent MRI IAM as part of their diagnostic workup.

Hear me out: rethinking internal auditory meatus magnetic resonance imaging in primary care. A cohort evaluation.

Imaging detects acoustic neuroma, a rare pathology associated with asymmetric sensorineural hearing loss and tinnitus, that is mostly managed conservatively. Scanning indication is debatable, without evaluation in primary care, despite the high burden of audiovestibular symptoms and commissioning of general practitioner imaging. Cohort evaluation of two years' internal auditory meatus magnetic resonance imaging in primary care. Of 200 scans requested by 77 general practitioners, only 33 per cent conformed to guideline indications. Most were referred to specialists, regardless of result. Only 10.5 per cent were appropriately imaged to rule out neuroma without specialist referral. One neuroma was detected (diagnostic yield 0.5 per cent) in a patient already referred. Incidental findings were shown in 44.5 per cent, triggering low-value cascades in 18 per cent. Whilst fewer than 1 in a 1000 imaged patients may improve through surgery, 1 in 5 can suffer negative imaging cascades. Considering the bi-directional relationship between distress and audio-vestibular symptoms, anxiety-provoking imaging overuse should be minimised. In low-prevalence primary care, retrocochlear imaging could be limited to those with asymmetric sensorineural hearing loss. Alternatively, assessment and imaging could be shifted to audiologist-led settings, with a wider therapeutic offer, likely more beneficial and cost-effective than conventional surgical pathways.

Vestibular and acoustic dysfunction in patients with early stages of vestibular schwannoma

Introduction: Vestibular schwannoma (VS) is known to be a benign tumor. It develops from the Schwann cells in the vestibular portion of the VIII nerve. The causes of tumor development are not fully defined. VS is diagnosed more often in people of active age (30-60 years), mostly in women. Aim: The aim is to study the state of vestibular and acoustic dysfunctions in patients with VS at an early stage. Materials and Methods: A total of 71 patients with MRI-verified VS at an early stage were analyzed. The 1st group consisted of 34 patients with intracanal VS, and the 2nd group included 37 patients with stage one VS. Vestibular dysfunction, including the registration of three pathological vestibular reactions vestibulo-somatic, vestibulo-sensory and vestibulo-vegetative, was studied. Acoustic dysfunction was studied using tonal, speech and suprathreshold speech audiometry, and auditory brainstem responses (ABR). Results: Unilateral or asymmetric bilateral vestibular dysfunctions have been established in all patients at the early stages of VS, which forms phantom phenomena of sensory and motor memory in the cortical structures of the brain in the form of pathological vestibulo-somatic, vestibulo-sensory and vestibulo-vegetative reactions, which are to be considered during rehabilitation. Acoustic dysfunction of different manifestations—from normal symmetrical hearing to socially adequate unilateral or asymmetric sensorineural hearing loss of degree I-II, and significant socially inadequate sensorineural hearing loss of degree III-IV, deafness, and also mixed hearing loss, was determined in these patients. ABR registration indicated unilateral or asymmetric delays of sound signals transferring in the brainstem structures at the early stages of VS with both normal hearing and socially adequately impaired hearing. Conclusion: Various manifestations of vestibular and acoustic dysfunctions with development of excitatory and inhibitory processes in the peripheral, brainstem, and cortical structures of the vestibular and acoustic systems were defined in all patients at the early stages of VS.

Current indications for the treatment with cochlear and brainstem implants in children. New directions and possibilities.

The publication presents the latest trends in indications for cochlear implantation in children. The principles of early detection of hearing loss in children as well as the detailed methodology and tools for diagnosis of a child before cochlear implant were discussed. Based on a review of publications from recent years, reference was made to the latest trends in implantation, taking into account: electroacoustic stimulation, electronatural stimulation, unilateral deafness, asymmetric sensorineural hearing loss, early implantation in children under 12 months of age and indications for brainstem implants in children with inner ear malformations . The significance of residual hearing in patients with cochlear implants as well as the use of appropriate electrodes for a specific clinical situation were also discussed. These factors may influence future development of speech and hearing.

Vibration-induced nystagmus and head impulse test screening for vestibular schwannoma

Level of evidence II-2 Background Vestibular schwannomas are benign tumors of the eight cranial nerve that may cause asymmetric sensorineural hearing loss (ASHL) and vestibular dysfunction. Objective The aim of this study was to assess the role of the video head impulse test (vHIT) and vibration-induced nystagmus (VIN) test in diagnosing vestibular schwannoma in a population of patients with Asymmetric sensorineural hearing loss. Material and methods For this prospective case-control study, 23 consecutive patients with ASHL and normal magnetic resonance were enrolled in the control group, and 33 consecutive patients with ASHL and vestibular schwannoma were enrolled in the case group. Gold standard was magnetic resonance imaging. Audiometry, vHIT, and VIN tests were performed for each patient. Significance of VIN and vHIT testing was determined by evaluation of their sensitivity, specificity, and correlation with vestibular function tests. Results Regarding the vHIT, sensitivity and specificity were 45.5% and 82.6%, respectively, for horizontal canal gain, 60.6% and 87.6%, respectively, for posterior canal gain, and 45.5% and 78.3%, respectively, when analyzing superior canal gains. Regarding the VIN test, the sensitivity and specificity were 81.8% and 73.9%, respectively, when based on the presence of a VIN with any mastoid stimulation. Conclusions Our results suggest that using the VIN test may be an efficient approach to screen for vestibular schwannoma in patients with asymmetric sensorineural hearing loss. Significance Our results suggest that using the VIN test may be an efficient approach to screen for vestibular schwannoma in patients with ASHL.

Распространенность и классификация асимметричных форм сенсоневральной тугоухости в старшей возрастной группе

The significance of asymmetric sensorineural hearing loss (ASNHL) is due to a special approach to diagnosis, followed by the process of hearing aids and auditory rehabilitation. Currently, there is no standard audiometric criterion for determining the forms of asymmetry, which significantly affects the assessment of the prevalence of ASNHL. The study aimed to assess the prevalence and classification of ASNHL forms in the older age group using two methods of calculation: 1) the difference in the average hearing threshold at speech frequencies (in the range of 0,5–4 kHz) ≥15 dB was detected in 14,14% of cases; 2) the different degree of hearing loss, according to the International classification, in the right and left ear was 35,98%. In most cases, asymmetry was manifested by bilateral sensorineural hearing loss of varying severity, prevailing in the group of long-livers – 82,6%. Given the potentially high prevalence of asymmetry depending on the audiological criterion, the results of the work are a reason for further research in the development of a unified method for verifying a clinically significant form of ASNHL.