Childhood Ear Research Articles

Osseointegrated implants in the management of childhood ear abnormalities: with particular emphasis on complications.

Little has been published about the difficulties encountered during the insertion of osseointegrated implants for the attachment of bone anchored hearing aids (BAHA) and auricular prostheses in children. This study examines this issue in the first 51 children implanted at our centre. During surgery, the most common problem encountered was the presence of thin bone resulting in incomplete insertion of fixtures. Five fixtures had failed to integrate and six fixtures were lost in the long-term, however, only five children required revision surgery. The reason why few patients require revision was due to the judicious insertion of 'sleeper' fixtures. At follow-up, seven children required counselling for psychological problems. It is apparent from this study that osseointegrated implants in children are associated with difficulties, re-emphasizing that a paediatric osseointegration programme requires significant investment, and should only be undertaken by institutions that are committed to its success.

Hearing loss and use of personal stereos in young adults with antecedents of otitis media

In France, young men aged 18‐24 years undergo systematic medical assessments in the selection centres of the army. We did a cross-sectional study of risk factors for deafness in 1208 young men from two such selection centres in Vincennes (n=525) and Lyon (n=683). We assessed hearing status by tonal automated audiometry 1 at 0·5 kHz, 1·0 kHz, 2·0 kHz, 4·0 kHz, and 8·0 kHz. Hearing loss was expressed in dB relative to hearing level. The men were interviewed about hearing status and exposure to potential harmful sources of noise. Additionally, in Lyon, we recorded antecedents of childhood ear diseases, including history of repeated episodes of otitis media. We checked that the men were not exposed to noise before audiometry. Hearing thresholds in exposed and non-exposed groups were compared by ANOVA. Of the total population, in 449 (38%) of 1194, the hearing threshold at 1·0 kHz was slightly increased (p=0·04) in men who went to rock concerts and discos twice a month or more. Hearing thresholds at 2 kHz and 4 kHz were significantly increased in (p=0·02) 214 (18%) of 1208 men with noisy occupations (for 6 months or longer). The major factor influencing hearing was use of personal stereos. Hearing thresholds were increased at all frequencies (p=0·001) in 205 (17%) of 1208 men who used personal stereos for at least 1 h per day. The difference of mean hearing loss between personal stereo users and non-users was 3·5 dB relative to hearing level. However, further analysis of the data from the Lyon centre, showed that this harmful effect was strongly dependent on the presence of absence of repeated episodes of otitis media in infancy or childhood (figure). In this centre, the 114 (17%) of 683 men who had had repeated otitis media episodes were affected. Personal stereo use had no apparent effect on the hearing status of men without previous otitis media. Use of personal stereos was associated with a mean extra hearing loss of 11 (SE 2·99) dB relative hearing loss. This difference of susceptibility to personal stereo use was significant (p=0·001). We found also increases in risks of acute acoustic trauma and frequent tinnitus (odds ratio 3·32 [95% CI 1·47‐7·50 and 5·28 2·88‐9·65], respectively). Previous studies have shown harmful effects of personal stereo use on hearing performances in young adults. 2‐5 These effects were, however, apparently of limited clinical importance (mean differences of hearing loss about 3 dB). We show that personal stereo use has clinically important effects in men with antecedents of repeated episodes of otitis media in childhood. Our results show the importance of curing otitis in childhood and of a prevention policy. Young people with a history of repeated episodes of otitis media should be warned that personal stereo use is a risk factor for deafness. This study was supported by the French Government DSP/DGA “Committee on Noise Exposure”. We thank the selection centres’ staff for their participation, L Pellieux, IMASSA, W Durand, and P Castella for their crucial technical help in informatics and acoustics.

The Acoustic Reflex in Adults with Histories of Otitis Media in Childhood

To investigate the effects of a history of otitis media (OM) in childhood on the acoustic reflex threshold (ART) in young adults. Questionnaire responses on childhood ear and hearing problems were obtained from populations of university students. In Study 1, 31 students reporting histories of persistent childhood OM and 34 students with no known OM histories were identified. They received pure-tone audiometry, otomicroscopy, and measurement of ARTs for a 500 Hz pure tone. In Study 2, 20 students with OM histories and 20 students with no known OM histories received pure-tone audiometry, otomicroscopy, and measurement of ARTs for a broadband noise. Subjects with OM histories had higher ARTs than did subjects with no known OM histories. Multiple regression analyses showed that the main variables contributing to elevated reflex thresholds were raised hearing thresholds on the activator ear and tympanic membrane abnormalities on the probe ear. The elevated ARTs in adults with histories of childhood OM result from peripheral sequelae of OM. Further evidence is required to determine any functional significance of these raised reflex thresholds.

Book Review: Glue Ear in Childhood. A Prospective Study of Otitis Media with Effusion

Book Review: Glue Ear in Childhood. A Prospective Study of Otitis Media with Effusion

Book Reviews

Book reviewed in this article:Children at Risk? Safety as a Social Value. By H. Roberts, S.J. Smith and C. Bryce.Glue Ear in Childhood. By A.R. Maw.GIS for Health and the Environment: Proceedings of an International Workshop held in Colombo, Sri Lanka 5–10 September 1994. Edited by D. de Savigny and P. Wijeyaratne.Individual Differences in Language Development. By Cecilia M. Shore

Book Review: Glue Ear in Childhood

Book Review: Glue Ear in Childhood

Growth Potential of Autogenous Cartilage Grafts in Expanded Skin: An Experimental Study in Rabbits

The effect of tissue expansion on the growth potential of autogenous cartilage grafts was studied in 10-day-old New Zealand white rabbits. The rabbits were divided into two groups: In Group 1 (n = 12) after 2 weeks of tissue expansion by using a 10-ml tissue expander, a cranially based 4 x 4-cm dorsal skin flap was raised and a 1 x 1-cm autogenous cartilage graft from the midportion of the left ear was transplanted beneath the flap in each rabbit. In Group 2 (n = 12) elevation of dorsal skin flaps and transplantation of the grafts were performed in the same way but without a previous tissue expansion. The grafts were removed at 30 and 60 days after transplantation in both groups, for histological examination and measurement of the dimensional changes to determine the growth rate. In both groups, histological examination revealed characteristic findings for cartilage growth, however, Group 1 (expansion) demonstrated a statistically significant increase in the growth of cartilage grafts when compared with Group 2 (control) (p = 0.0001). The results of this study indicate, from the standpoint of acceptance and growth potential of autogenous cartilage framework, that there is no drawback to using this tissue expansion technique for reconstruction of the ear in childhood.

聴神経鞘腫と顔面神経鞘腫の合併例

A 52-year-old female had lost hearing in her right ear in childhood due to middle ear infection. She had sudden left hearing loss in 1980. Idiopathic sudden deafness was diagnosed at that time. Hearing was partially restored but then became gradually worse. In 1983 bilateral total deafness was noted. She visited our clinic to receive a cochlear implant. She had no facial palsy, no cafe-au-lait spots and no family history of neurofibromatosis. CT and MRI showed a tumor in the C-P angle and at the base of middle cranial fossa. Total removal was accomplished through a translabyrinth approach and middle and posterior craniotomy. Two different tumors were found, one of the acoustic nerve and one of the facial nerve. The acoustic neurinoma extended from the internal auditory canal to the CPA, and the facial nerve neurinoma from the geniculate portion to the middle ear, the base of the middle cranial fossa and the CPA. The sural nerve was used as a facial nerve graft.This is a rare instance of facial and acoustic nerve neurinoma in a patient without neurofibromatosis. Our investigations have turned up only two reports of such cases in the literature.

Osseointegrated implants in the management of childhood ear abnormalities: the initial Birmingham experience

Over a four-year period 72 children with ear abnormalities have been referred for assessment by the extraoral osseointegrated implant team at The Queen Elizabeth Hospital, Birmingham. Thirty-two children have been judged suitable for rehabilitation. Twelve children have completed rehabilitation using bone-anchored hearing aids and/or auricular prostheses. Two fixtures (seven per cent of those loaded) have dislodged and required replacement. Audiological assessment of the bone-anchored hearing aid users shows only small improvements in their aided thresholds, compared to thresholds obtained with their previous aid. However all now have thresholds of 30 dB(A) or better and report a marked improvement in sound quality. When surveyed, hearing aid and prosthesis users report high levels of satisfaction with this form of rehabilitation. The technique adds a new dimension to the management of children with aural anomalies. The approach and results of a multidisciplinary programme are reported.

Abnormalities of the neonatal ear: otoscopic observations, histologic observations, and a model for contamination of the middle ear by cellular contents of amniotic fluid.

It is unknown whether childhood ear disease could be present long before symptoms provoke an initial otoscopic examination. A newborn middle ear might or might not start in a pristine, privileged state. The clinician evaluating later infant and childhood ear disease is often unaware of the status of a patient's ear from the neonatal period, the earliest time at which the tympanic membrane can be evaluated. Adding to the physician's handicap, normative otoscopic and histologic data on the neonatal ear are incomplete. In order to test the hypothesis that disease in the neonatal middle ear may be more common than is generally appreciated, the population of critically ill neonates was selected for study since this group can provide both clinical as well as histologic data. This manuscript is divided into three parts. Clinically, otoscopic observations were analyzed on infants in an intensive care unit. Histologically, neonatal temporal bones were studied for normal anatomy and pathology of the middle ear and antrum. Experimentally, an animal study was performed to evaluate the potential effect of amniotic fluid cellular contents aspirated into the middle ear. I. Clinical Otoscopic Observations. Daily otoscopic examination was conducted on 44 neonates in an intensive care unit. Specific parameters of the otoscopic examination were evaluated to compare with the normal, translucent tympanic membrane of the older child. The otoscopic appearance was found to be abnormal in 97.7% of neonatal ears. Of the otoscopic parameters evaluated, right ears averaged 2.6 abnormalities and left ears averaged 2.5 otoscopic abnormalities. The otoscopic appearance of the neonate in the neonatal intensive care unit is nearly universally abnormal. II. Temporal Bone Histologic Observations. One hundred eleven temporal bones from 56 neonates were collected for histologic study by light microscopy. Mesenchyme filling more than 60% of the middle ear space was found in 13 bones. Amniotic fluid cellular content was detected in 90 bones. Purulent otitis media was detected in 24 bones. Varying amounts of blood were found in the middle ear space of 34 bones. Only 7 of the bones had no significant middle ear abnormality. It is concluded that in the critically ill neonate, the middle ear and antrum usually contain cellular or fluid material, often in significant volume, that would not be considered normal in the older patient. III. An Animal Model Simulating Contamination of the Middle Ear by Cellular Contents of Amniotic Fluid.(ABSTRACT TRUNCATED AT 400 WORDS)

Auditory brainstem evoked response in at risk children.

Development of speech and language skills in children depends greatly on the effective hearing function. Early detection of any auditory deficit and institution of rehabilitation measures are the key to success in the total management of such hearing handicaps. Twenty at risk children were studied and their hearing function evaluated employing auditory brainstem evoked response technique (ABER). Auditory deficit was detected with the help of this technique as early as at 1 month of age. The risk factors in this study chiefly included hydrocephalus, neonatal jaundice requiring, exchanged blood transfusion, head injury during childhood and congenital ear deformity. Auditory evoked response technique provides the most reliable objective information about the hearing threshold of a child normal or handicapped. It can assess hearing function even at birth and thus it greatly helps in the management of hearing handicapped children at an early date.

The aetiology of glue ear--a case-control study.

A case-control study was carried out to investigate many of the proposed causes of glue ear in childhood. One hundred and fifty cases with two matched controls were found to be remarkably similar in nearly all medical and social aspects of their past and present lives, thus providing no support for many of the currently held views on the aetiology of glue ear. Of the 5 factors which were found to increase the risk of a child undergoing surgery for glue ear, only one of these is thought to be related to the development of the condition, rather than to the chances of its detection. This factor was parental smoking (RR 1.64). The 4 other risk factors appear to influence the chance of glue ear being detected, diagnosed and referred for surgical treatment - the child's mother being employed outside the home, but only if the father is employed in non-manual work (RR 3.0); attending pre-school day-care (RR 2.00); having an older sibling who had been diagnosed as suffering from glue ear (RR 1.84); and having been born locally (in Oxfordshire) (RR 1.89). Possible explanations for these social and behavioural factors are discussed.

CURRENT MANAGEMENT OF HEARING LOSS IN CHILDREN.

Introduction The purpose of this paper is to familiarize physicians with the problem of hearing impairment in children. The incidence of impaired hearing in our population is not accurately known. Various surveys, however, indicate that 5% to 10% of the population is affected. 1 The incidence of hearing loss is higher in adults than in children. It is estimated that 50% of all adult hearing problems had their origin in childhood and most middle ear problems could have been avoided if adequate treatment had been provided at the onset of the pathological change in the middle ear. This paper will describe the types of hearing loss encountered in children together with their etiology, diagnosis, medical and surgical treatment, and rehabilitation. Types of Hearing Loss A child with a hearing impairment has either a conductive, a sensorineural, or a mixed conductive-sensorineural type of hearing loss. A conductive or middle ear hearing

RELATION OF THE EUSTACHIAN TUBE TO CHRONIC PROGRESSIVE DEAFNESS

It is an established fact that blockage of the eustachian tube plays an important role in the development of chronic progressive deafness. Coates¹stated that most of the chronic progressive deafness which becomes evident in adult life has an origin in a neglected eustachian tube or inflammation of the middle ear in childhood. Crowe and Baylor²stated that a long-continued partial obstruction of the eustachian tube in children causes retraction of the tympanic membrane, impaired hearing for high tones, with relatively good hearing for low tones, and sometimes total loss of hearing by bone conduction. The eustachian tube was treated for this type of deafness as far back as 1654 by Tulpus, who first described blockage of the eustachian tube in relation to certain types of deafness. Valsalva in 1707 described self inflation of the eustachian tube to act as a means of clearing mucus from the ear

Pediatrics.

The appearance of the eighth volume and the index of the Abt Pediatrics concludes the publication of a monumental contribution to this field. The volume under consideration is devoted largely to special topics. The section on diseases of the skin is edited by Dr. O. S. Ormsby, in association with other western dermatologists. This section comprises 267 pages, and constitutes a textbook in itself. It is furthermore fully illustrated, and should be of great value to pediatricians who are constantly consulted concerning eruptions of the skin of infants. Dr. George E. Shambaugh contributes the section on diseases of the ear in childhood, placing the most emphasis, naturally, on otitis media and mastoiditis. Every well informed pediatrician now realizes that many fevers, convulsions or other disorders of infancy are the result of middle ear infections. Dr. Casey A. Wood, now retired from practice and investigating the eyes of birds in Tibet,

Diseases of the Ear, Nose, and Throat in Childhood. By Guthrie Douglas, M.D., F.R.C.S.E. (A. & C. Black, Ltd., 1921.)

Diseases of the Ear, Nose, and Throat in Childhood. By Guthrie Douglas, M.D., F.R.C.S.E. (A. & C. Black, Ltd., 1921.)