Hearing Function Research Articles

Vestibular Schwannoma International Study of Active Surveillance Versus Stereotactic Radiosurgery: The VISAS Study

BackgroundThe present study assesses the safety and efficacy of stereotactic radiosurgery (SRS) versus observation for Koos grade I and II vestibular schwannoma (VS), benign tumors affecting hearing and neurological function. MethodsThis multicenter study analyzed data from Koos grade I and II VS patients managed with SRS (SRS group) or observation (observation group). Propensity score matching balanced patient demographics, tumor volume, and audiometry. Outcomes measured were tumor control, serviceable hearing preservation (SHP), and neurological outcomes. ResultsIn 125 matched patients in each group with a 36-month median follow-up (p=0.49), SRS yielded superior 5- and 10-year tumor control rates (99%, CI: 97.1%-100%, and 91.9%, CI: 79.4%-100%) vs. observation (45.8%, CI: 36.8%-57.2%, and 22%, CI: 13.2%-36.7%; p<0.001). SHP rates at 5 and 9 years were comparable (SRS 60.4%, CI: 49.9%-73%, vs. observation 51.4%, CI: 41.3%-63.9%, and SRS 27%, CI: 14.5%-50.5%, vs. observation 30%, CI: 17.2%-52.2%; p=0.53). SRS were associated with lower odds of tinnitus (OR=0.39, p=0.01), vestibular dysfunction (OR=0.11, p=0.004), and any cranial nerve palsy (OR=0.36, p=0.003), with no change in cranial nerves V or VII (p>0.05). Composite endpoints of tumor progression and/or any of the previous outcomes showed significant lower odds associated with SRS compared to observation alone (p < 0.001). ConclusionSRS management in matched cohorts of Koos grade I and II VS patients demonstrated superior tumor control, comparable hearing preservation rates, and significantly lower odds of experiencing neurological deficits. These findings delineate the safety and efficacy of SRS in in the management of this patient population.

Synaptic ribbon dynamics after noise exposure in the hearing cochlea

Moderate noise exposure induces cochlear synaptopathy, the loss of afferent ribbon synapses between cochlear hair cells and spiral ganglion neurons, which is associated with functional hearing decline. Prior studies have demonstrated noise-induced changes in the distribution and number of synaptic components, but the dynamic changes that occur after noise exposure have not been directly visualized. Here, we describe a live imaging model using RIBEYE-tagRFP to enable direct observation of pre-synaptic ribbons in mature hearing mouse cochleae after synaptopathic noise exposure. Ribbon number does not change, but noise induces an increase in ribbon volume as well as movement suggesting unanchoring from synaptic tethers. A subgroup of basal ribbons displays concerted motion towards the cochlear nucleus with subsequent migration back to the cell membrane after noise cessation. Understanding the immediate dynamics of synaptic damage after noise exposure may facilitate identification of specific target pathways to treat cochlear synaptopathy.

Predictive factors of tinnitus after vestibular schwannoma surgery: a case-control study

BackgroundTinnitus is very common in patients with vestibular schwannoma (VS). We analyzed the related factors of tinnitus after surgery.MethodsOne hundred seventy-three patients diagnosed with unilateral VS operated via the retrosigmoid approach were included in the study. All patients underwent relevant examinations and completed the THI scale before surgery and 6 months after surgery. The prognosis of tinnitus was evaluated according to the changes in THI.ResultsOf the 129 preoperative tinnitus patients, postoperative tinnitus resolved in 12.4%, improved in 29.5%, remained unchanged in 28.6%, and worsened in 29.5%. 18.2% of 44 patients without preoperative tinnitus appeared new-onset tinnitus postoperatively. Thirty-six patients never had tinnitus. Patients with smaller tumor sizes (≤ 3 cm) were more likely to experience preoperative tinnitus. Younger patients and those with serviceable hearing preoperatively were more likely to report their tinnitus unchanged or worsened. A new onset of postoperative tinnitus in the preoperative non-tinnitus group was found in better preoperative hearing function.ConclusionsIn this study, 70% of patients had persistent tinnitus after vestibular schwannoma resection. The prognosis of tinnitus was influenced by age and preoperative hearing function. Tinnitus is a bothersome symptom and is often underestimated by doctors. Assessment of tinnitus is mandatory during the management of vestibular schwannoma.

Silk fibroin-gelatin films crosslinked by genipin for regenerating tympanic membrane perforations

The tympanic membrane (TM) integrity is necessary for our normal hearing function. TM perforations pose significant morbidities such as middle ear infection, recurrent otorrhea, hearing loss, and acquired cholesteatoma. Myringoplasty is commonly performed to repair chronic perforations; although various grafts and materials have been utilized to promote TM regeneration, all have associated restrictions. This study aimed to prepare and evaluate the efficacy and feasibility of a tissue-engineered patch based on silk fibroin and gelatin (SF-GT) to improve regeneration. A casting technique was used to make the SF-GT films, using 0–30 v/v% GT, as it is shown that films are remarkably efficient for TM regeneration, easy to mass produce and cheap to make. The surface morphology (SEM), chemical structure (FTIR), crystallinity (XRD), mechanical strength (tensile test), water uptake and in vitro degradation, and cellular biocompatibility (MTT and scratch) were investigated for SF-GT films, and the optimal patch was chosen based on the results (SF-30GT). SF-30GT was used for in vivo studies in a rat model with TM perforations to induce TM regeneration. The morphology of the TM was assessed at days 0, 3, 5, 7, 9 and 11 post-implantation using otoscopy and functional outcomes by auditory brainstem responses (ABRs). This study indicates that compared with the control group (spontaneous healing), the SF-30GT scaffold was more effective in promoting early TM regeneration (complete healing at day 7) and normal hearing (back to 20 dB after healing), suggesting that this scaffold can be a potential substitute for clinical use.

Influence of Different Noise Types on Hearing Function in Patients Treated for Mild Otitis Media.

Otitis media (OM) refers to a common clinical ear disease. Noise seriously damages human hearing function. This study aimed to investigate the effects of various noise types on the hearing function of patients who have recovered from mild OM. A total of 160 patients with mild OM treated at our hospital from May 2020 to May 2023 were retrospectively selected for this study. Based on clinical data, the patients were divided into the non-noise group (n = 80) and the noise (n = 80) group. The hearing thresholds of the two groups were compared across various noise types at 500, 1000, and 2000 Hz. In addition, the hearing thresholds of the noise group were compared under the same conditions. The noise group exhibited significantly higher hearing thresholds at 500, 1000, and 2000 Hz than the non-noise group (P < 0.05). Under traffic, urban construction, and industrial noises, the auditory thresholds at 500, 1000, and 2000 Hz in the noise group were significantly higher than those observed under domestic and speech noises (P < 0.05). Noise shows a close relationship with the hearing function of patients with OM. Traffic, urban construction, and industrial noises greatly influence the hearing function of patients who have recovered from mild OM.

Midlife Speech Perception Deficits: Impact of Extended High-Frequency Hearing, Peripheral Neural Function, and Cognitive Abilities.

The objectives of the present study were to investigate the effects of age-related changes in extended high-frequency (EHF) hearing, peripheral neural function, working memory, and executive function on speech perception deficits in middle-aged individuals with clinically normal hearing. We administered a comprehensive assessment battery to 37 participants spanning the age range of 20 to 56 years. This battery encompassed various evaluations, including standard and EHF pure-tone audiometry, ranging from 0.25 to 16 kHz. In addition, we conducted auditory brainstem response assessments with varying stimulation rates and levels, a spatial release from masking (SRM) task, and cognitive evaluations that involved the Trail Making test (TMT) for assessing executive function and the Abbreviated Reading Span test (ARST) for measuring working memory. The results indicated a decline in hearing sensitivities at EHFs and an increase in completion times for the TMT with age. In addition, as age increased, there was a corresponding decrease in the amount of SRM. The declines in SRM were associated with age-related declines in hearing sensitivity at EHFs and TMT performance. While we observed an age-related decline in wave I responses, this decline was primarily driven by age-related reductions in EHF thresholds. In addition, the results obtained using the ARST did not show an age-related decline. Neither the auditory brainstem response results nor ARST scores were correlated with the amount of SRM. These findings suggest that speech perception deficits in middle age are primarily linked to declines in EHF hearing and executive function, rather than cochlear synaptopathy or working memory.

The geometry of photopolymerized topography influences neurite pathfinding by directing growth cone morphology and migration

Objective. Cochlear implants provide auditory perception to those with severe to profound sensorineural hearing loss: however, the quality of sound perceived by users does not approximate natural hearing. This limitation is due in part to the large physical gap between the stimulating electrodes and their target neurons. Therefore, directing the controlled outgrowth of processes from spiral ganglion neurons (SGNs) into close proximity to the electrode array could provide significantly increased hearing function. Approach. For this objective to be properly designed and implemented, the ability and limits of SGN neurites to be guided must first be determined. In this work, we engineer precise topographical microfeatures with angle turn challenges of various geometries to study SGN pathfinding and use live imaging to better understand how neurite growth is guided by these cues. Main Results. We find that the geometry of the angled microfeatures determines the ability of neurites to navigate the angled microfeature turns. SGN neurite pathfinding fidelity is increased by 20%–70% through minor increases in microfeature amplitude (depth) and by 25% if the angle of the patterned turn is made obtuse. Further, we see that dorsal root ganglion neuron growth cones change their morphology and migration to become more elongated within microfeatures. Our observations also indicate complexities in studying neurite turning. First, as the growth cone pathfinds in response to the various cues, the associated neurite often reorients across the angle topographical microfeatures. Additionally, neurite branching is observed in response to topographical guidance cues, most frequently when turning decisions are most uncertain. Significance. Overall, the multi-angle channel micropatterned substrate is a versatile and efficient system to assess neurite turning and pathfinding in response to topographical cues. These findings represent fundamental principles of neurite pathfinding that will be essential to consider for the design of 3D systems aiming to guide neurite growth in vivo.

Insufficient nutrient intake in individuals with disabling hearing loss and the restoration of nutritional sufficiency in hearing aid users

Hearing loss affects some nutrient intake. Disabling hearing loss may exacerbate these issues. We aimed to evaluate nutrient intake and assess deficiencies based on functional hearing status. The study included 6907 participants with information on demographic factors, nutrient intake, weight, height, disease status, and hearing level in the eighth Korea National Health and Nutrition Examination Survey, conducted from 2019 to 2021. We categorized the participants into 3 groups based on their functional hearing status: bilateral hearing, unilateral hearing, and disabling hearing loss. The disabling hearing loss group showed lower intake of most major nutrients (P < 0.05), dietary fiber (P < 0.001), and most minerals and vitamins (P < 0.05), with some insufficiencies. The unilateral hearing group showed lower intake only for potassium (P = 0.036) compared to the bilateral hearing group and significantly higher intake of hydration (P = 0.039), dietary fiber (P = 0.039), and calcium (P = 0.009) than the disabling hearing loss group. Nutrient insufficiency in the disabling hearing loss group was more prominent in women, and was partially resolved by using hearing aids. Clinicians and nutritionists should consider undernourishment in these patients, and appropriate interventions for nutrition and hearing aids should be recommended.

Osteopathic correction in complex rehabilitation of children who have undergone cochlear implantation

Introduction. Currently, the only way to rehabilitate patients with deafness is cochlear implantation (CI). CI includes not only surgery, but also rehabilitation carried out by a whole group of specialists. This is a multi- stage, labor-intensive, complex, long-term process of developing and maintaining speech function, so there is a constant search for new approaches and methods that could increase the effectiveness of ongoing rehabilitation measures. Previous studies have demonstrated that osteopathic correction in preschool children reduces the severity of speech disorders, contributes to the regression of speech therapy disorders, and helps in the correction of certain forms of dysarthria. Of particular interest is the work in which the authors demonstrated the existence of relationships between certain somatic disfunctions and the presence of disturbances in peripheral sound conduction and/or central sound conduction in children with sensorineural hearing loss. The question of the possibility of using osteopathic correction in the rehabilitation of children with pathologies of hearing and speech function (since, in addition to the consequences of highly invasive surgical intervention, children who have undergone CI, as a rule, have delayed speech development), seems promising for study.The aim was to study the results of the use of osteopathic correction in the rehabilitation of children who have undergone CI.Materials and methods. A randomized controlled prospective study was conducted from March 2022 to December 2022 on the basis of the Federal State Budgetary Institution RNTSCAiS FMBA of Russia, FSBI NMCIO FMBA of Russia. 36 children aged from 17 to 37 months were under observation. Depending on the treatment used, all observed patients were divided into 2 groups using a simple randomization method: main (20 people) and control (16 people). Patients in both the main and control groups received standard rehabilitation treatment. Each patient of the main group additionally underwent a single session of osteopathic correction lasting from 45 to 60 minutes. All patients were assessed for osteopathic status, time of connection and adjustment of the cochlear implant, and quality of life.Results. In children after CI, global neurodynamic disorders and regional biomechanical disorders in the regions of the head, neck, and dura mater were most often detected. After treatment, only patients in the main group showed a statistically significant (p&lt;0,05) decrease in the frequency of detection of both global neurodynamic and the above-mentioned regional biomechanical disorders. A single session of osteopathic correction contributes to a significant reduction in the time of connection and adjustment of the cochlear implant, which can be considered as a favorable factor for subsequent rehabilitation measures. Against the background of the ongoing rehabilitation, a statistically significant increase in the level of quality of life was obtained in both groups, however, in the main group this indicator was statistically significantly higher.Conclusion. For children who underwent CI, the most characteristic was the presence of a global neurodynamic disorder, as well as regional biomechanical disorders at the level of the head, neck and dura mater. A single session of osteopathic correction can significantly reduce the time of initial connection and adjustment of a cochlear implant, as well as improve the quality of life of this category of patients. This allows us to recommend the inclusion of osteopathic correction in comprehensive rehabilitation programs for children who have undergone cochlear implantation.

Pathophysiology of Postoperative Hearing Disorders after Vestibular Schwannoma Resection: Insights from Auditory Brainstem Response and Otoacoustic Emissions.

Background: In order to better understand the pathophysiology of surgically induced hearing loss after vestibular schwannoma (VS) surgery, we postoperatively analyzed the hearing status in a series of patients where hearing was at least partially preserved. Methods: Hearing was assessed through tonal audiometry, speech discrimination score, maximum word recognition score (dissyllabic word lists-MaxIS), otoacoustic emissions (OAEs), and auditory brainstem response (ABR). The magnetic resonance imaging (MRI) tumor characterization was also noted. Results: In a series of 24 patients operated on for VS over 5 years, depending on the results of this triple hearing exploration, we could identify, after surgery, patients with either a myelin alteration or partial damage to the acoustic fibers, others with a likely partial cochlear ischemia, and some with partial cochlear nerve ischemia. One case with persisting OAEs and no preoperative ABR recovered hearing and ABR after surgery. Long follow-up (73 ± 57 months) revealed a mean hearing loss of 30 ± 20 dB with a drastic drop of MaxIS. MRI revealed only 25% of fundus invasion. Conclusion: a precise analysis of hearing function, not only with classic audiometry but also with ABR and OEAs, allows for a better understanding of hearing damage in VS surgery.

Functional outcomes and caloric response changes after endolymphatic sac decompression

ObjectiveTo evaluate caloric response changes after endolymphatic sac decompression (ESD), together with hearing outcomes and the functional benefit of the operation. MethodsA retrospective chart review of subjects who underwent endolymphatic sac decompression at a tertiary referral centre was performed. Data on audiological results, caloric testing, and functional level scale of the patients were analysed. ResultsTwenty-eight patients who met our criteria were eligible for enrolment in the study. The average follow-up after surgery was 25 months (range, 13–41). Postoperative pure-tone threshold averages and reduced vestibular response values (RVR) were not significantly altered by ESD; whereas, functional level scores improved significantly. ConclusionEndolymphatic sac decompression is a surgical procedure that preserves hearing and vestibular function, and improves the daily functional level of patients with Ménière's disease. ESD can be preferred both in bilateral and unilateral disease because it does not alter vestibular function and preserves hearing.

The transcription factor Pou4f3 is essential for the survival of postnatal and adult mouse cochlear hair cells and normal hearing.

Hair cells (HCs) of the cochlea are responsible for sound transduction and hearing perception in mammals. Genetic mutations in the transcription factor Pou4f3 cause non-syndromic autosomal dominant hearing loss in humans (DFNA15) which varies in the age of onset depending on the individual mutation. Mouse models with germline deletion or mutations in Pou4f3 have previously demonstrated its critical role in the maturation and survival of cochlear HCs during embryonic development. However, the role of Pou4f3 in auditory function and in the survival or maintenance of cochlear HCs after birth and during adulthood has not been studied. Therefore, using the inducible CreER-loxP system, we deleted Pou4f3 from mouse cochlear HCs at different postnatal ages, relevant to specific stages of HC maturation and hearing function. Elevated auditory brainstem response thresholds and significant HC loss were detected in mice with Pou4f3 deletion compared to their control littermates, regardless of the age when Pou4f3 was deleted. However, HC loss occurred more rapidly when Pou4f3 was deleted from immature HCs. Additionally, HC loss caused by Pou4f3 deletion did not affect the number of cochlear supporting cells, but caused a delayed loss of spiral ganglion neurons at 4 months after the deletion. In conclusion, Pou4f3 is necessary for the survival of cochlear HCs and normal hearing at all postnatal ages regardless of their maturation state. Our data also suggest that Pou4f3 indirectly regulates the survival of spiral ganglion neurons.

Awareness of Health Professionals about Candidacy of Cochlear Implant

Background: Cochlear implants serve as a transformative solution for individuals with sensorineural hearing loss, particularly benefiting children aged 12-24 months with bilateral profound deafness who find little to no benefit from traditional hearing aids. This advanced auditory technology converts acoustic signals into electrical stimuli, directly stimulating the auditory nerve and thereby providing an essential hearing function. The determination of candidacy for cochlear implants is a collaborative process involving ENT specialists, audiologists, and speech and language pathologists. These devices significantly impact the lives of profoundly deaf individuals by offering a means to access sound and develop communication skills, crucial for their integration into a hearing world.&#x0D; Objective: To assess the awareness of health professionals about candidacy of cochlear implant.&#x0D; Methods: This cross-sectional study was meticulously designed, adhering to standardized protocols for data collection and analysis to enhance the reliability and validity of findings. The research unfolded in various government and private hospitals across Lahore, focusing on a specific cohort of health professionals—ENT specialists and speech and language pathologists. A total of 55 participants, both male and female, aged between 29 to 52 years, were systematically selected through non-probability convenience sampling. The assessment of awareness among these professionals regarding the candidacy for cochlear implants was conducted using a carefully structured pediatric checklist. This tool encompassed multiple items directly relating to the core candidacy criteria, ensuring a comprehensive evaluation of professional knowledge and awareness. The analysis was performed using statistical methods appropriate for cross-sectional data, aiming to draw meaningful insights from the responses collected.&#x0D; Results: The study's participant pool consisted of 24 ENT specialists (43.6%) and 31 speech and language pathologists (56.4%), highlighting a diverse representation of the field. Among these professionals, a significant discrepancy in awareness was observed. Those who had practical experience working in cochlear implant centers demonstrated a higher level of awareness, with nuanced understanding of both audiometric and speech-based candidacy criteria. Conversely, participants lacking this practical exposure showed considerable gaps in their knowledge, particularly in applying these criteria to pediatric cases. The numerical data revealed that only a fraction of the respondents could accurately identify all key candidacy indicators, underscoring the need for targeted educational interventions.&#x0D; Conclusion: The findings of this study underline a palpable deficiency in the awareness and understanding of cochlear implant candidacy criteria among ENT specialists and speech and language pathologists. Despite the critical role these professionals play in the identification and management of potential implant candidates, a notable portion exhibited limited knowledge, especially in aspects beyond their immediate field of expertise. This gap was more pronounced among those without direct experience in cochlear implant centers, suggesting that hands-on involvement significantly contributes to a deeper comprehension of candidacy nuances. Therefore, there is an urgent need for comprehensive training programs and continued professional development opportunities to bridge these knowledge gaps, ensuring that all children who could benefit from cochlear implants are accurately identified and referred.

Superparamagnetic iron oxide nanoparticle regulates microbiota-gut-inner ear axis for hearing protection.

Noise-induced hearing loss (NIHL) is a highly prevalent form of sensorineural hearing damage that has significant negative effects on individuals of all ages and there are no effective drugs approved by the US Food and Drug Administration. In this study, we unveil the potential of superparamagnetic iron oxide nanoparticle assembly (SPIOCA) to reshape the dysbiosis of gut microbiota for treating NIHL. This modulation inhibits intestinal inflammation and oxidative stress responses, protecting the integrity of the intestinal barrier. Consequently, it reduces the transportation of pathogens and inflammatory factors from the bloodstream to the cochlea. Additionally, gut microbiota-modulated SPIOCA-induced metabolic reprogramming in the gut-inner ear axis mainly depends on the regulation of the sphingolipid metabolic pathway, which further contributes to the restoration of hearing function. Our study confirms the role of the microbiota-gut-inner ear axis in NIHL and provides a novel alternative for the treatment of NIHL and other microbiota dysbiosis-related diseases.

The Hearing Function and Ambulatory Blood Pressure in Older Adults.

To examine the association between hearing function, assessed with pure-tone average (PTA) of air conduction thresholds, and 24-hour ambulatory blood pressure (BP) in older adults. Cross-sectional study. A total of 1404 community-dwelling individuals aged ≥65 years from the Seniors-ENRICA cohort were examined. Hearing loss was defined as PTA > 40-AudCal hearing loss decibels (dB-aHL) in the better ear for standard frequency (0.5, 1, and 2 kHz), speech frequency (0.5, 1, 2, and 4 kHz), and high frequency (3, 4, and 8 kHz). Circadian BP patterns were calculated as the percentage decline in systolic BP during the night, and participants were classified as dipper, nondipper, and riser. Ambulatory hypertension was defined as BP ≥ 130/80 mm Hg (24 hour), ≥135/85 (daytime), and ≥120/70 (nighttime) or on antihypertensive treatment. Analyses were performed with linear- and logistic-regression models adjusted for the main confounders. In multivariable analyses, the PTA was associated with higher nighttime systolic BP [β coefficient per 20 dB-aHL increment standard frequency (95% confidence interval, CI): 2.41 mm Hg (0.87, 3.95); β (95% CI) per 20 dB-aHL increment speech frequency 2.17 mm Hg (0.70, 3.64)]. Among hypertensive patients, hearing loss at standard and high-frequency PTA was associated with the riser BP pattern [odds ratio: 2.01 (95% CI, 1.03-3.93) and 1.45 (1.00-2.09), respectively]; also, hearing loss at standard PTA was linked to uncontrolled nighttime BP [1.81 (1.01-3.24)]. PTA was associated with higher nighttime BP, and hearing loss with a riser BP pattern and uncontrolled BP in older hypertensives.

Association between sarcopenia and hearing impairment in middle-aged and elderly people in China: a prospective cohort study

This study used longitudinal data from CHARLS 2011–2018 for cross-sectional and longitudinal analyses to investigate the relationship between sarcopenia and hearing impairment in middle-aged and elderly adults in China. The study selected 9723 participants aged 45 years and older from CHARLS 2011 and followed up in 2015 and 2018. Binary logistic regression and cox proportional risk regression models were used for testing. The results of the study showed that in the cross-sectional analysis, probable sarcopenia was significantly associated with hearing impairment compared with the group without sarcopenia [OR (95% CI) 0.342 (1.187, 1.669), p < 0.001], but sarcopenia was not significantly associated with hearing impairment. In the longitudinal analysis, middle-aged and elderly adults with sarcopenia [HR (95% CI) 0.354 (1.043, 1.945), p < 0.01] were more likely to have hearing impairment than those with probable sarcopenia and without sarcopenia. Probable sarcopenia was strongly associated with hearing impairment in middle-aged and elderly adults, whereas sarcopenia was a strong predictor of hearing impairment over the next 7 years. The results of this study emphasize the urgent need for measures to address sarcopenia in order to prevent and delay the decline in hearing function.

Changes in hearing function and intracochlear morphology after electrode array insertion in minipigs

Background In temporal bone specimens from long-term cochlear implant users, foreign body response within the cochlea has been demonstrated. However, how hearing changes after implantation and fibrosis progresses within the cochlea is unknown. Objectives To investigate the short-term dynamic changes in hearing and cochlear histopathology in minipigs after electrode array insertion. Material and Methods Twelve minipigs were selected for electrode array insertion (EAI) and the Control. Hearing tests were performed preoperatively and on 0, 7, 14, and 28 day(s) postoperatively, and cochlear histopathology was performed after the hearing tests on 7, 14, and 28 days after surgery. Results Electrode array insertion had a significant effect for the frequency range tested (1 kHz–20kHz). Exudation was evident one week after electrode array insertion; at four weeks postoperatively, a fibrous sheath formed around the electrode. At each time point, the endolymphatic hydrops was found; no significant changes in the morphology and packing density of the spiral ganglion neurons were observed. Conclusions and Significance The effect of electrode array insertion on hearing and intracochlear fibrosis was significant. The process of fibrosis and endolymphatic hydrops seemed to not correlate with the degree of hearing loss, nor did it affect spiral ganglion neuron integrity in the 4-week postoperative period.

Hearing function in patients with nasopharyngeal carcinoma after three-dimensional conformal radiotherapy or intensity modulated radiotherapy: a prospective cohort study

Hearing function in patients with nasopharyngeal carcinoma after three-dimensional conformal radiotherapy or intensity modulated radiotherapy: a prospective cohort study

Summary of the clinical characteristics of tuberculous otitis media

Objective:The purpose of this study was to analyze and summarize the clinical characteristics and diagnostic methods of tuberculous otitis media（TOM）, to enrich clinical experience in diagnosis and treatment of tuberculous otitis media, so as to reduce missed diagnosis and misdiagnosis, and facilitate timely and effective therapy for better prognosis. Methods:This study retrospectively analyzed the clinical data of patients with tuberculous otitis media who were hospitalized in the Ear ward of our hospital and received surgical treatment from 2008 to 2022. The data of patients' clinical characteristics, radiological examination, intraoperative findings and therapeutic strategies were recorded and summarized. Results:A total of 23 cases （26 ears） of tuberculous otitis media were included in this retrospective study. The most common clinical symptoms were otorrhea（thin odorless fluid）（100%） and conductive hearing loss（100%）, with a high incidence of facial paralysis（23.1%）. It was not sensitive to traditional antibiotic treatment, eg. Levofloxacin （50% effective rate only）, and relapsed soon after drug withdrawal. It was revealed that all the surgical views had gray and white tough granulation tissue hyperplasia（100%）, and 23.1% with caseous necrosis. The purpose of surgery was to clear the lesion, reduce the recurrence rate of suppurative infection, and repair the function （hearing reconstruction or facial nerve decompression） as appropriate. The paraffin pathology of granulation tissue were reported as typical granulomatous inflammation and caseous necrosis with positive acid-fast staining, which was consistent with tuberculosis. Conclusion:It was easily confused by the clinical manifestations of tuberculous otitis media and common chronic suppurative otitis media. When met with the following conditions, we should pay highly attention to suspect tuberculous otitis media: The severity of local manifestations did not match with the length of the disease; with poor tympanic membrane at the early stage with no obvious cholesteatomas, with facial paralysis or hearing loss early onset; insensitive to traditional antibiotic treatment; with extensive granulation appeared in the tympanum and or mastoid cavity, with or without caseous necrosis or dead bone in the early days. The diagnosis should be confirmed based on the acid-fast staining of the histopathological section to detect positive acid-fast bacilli. Meanwhile, multiple laboratory examination methods（such as T-spot and PCR） should be integrated synchronously to help support the diagnosis.

Perceptual consequences of reverberant environments on spatial unmasking

Spatial hearing provides access to auditory spatial cues that promote speech perception in noisy listening situations. However, reverberation degrades auditory spatial cues and limits listeners’ ability to utilize these cues for segregating target speech from competing babble. Hence, spatial unmasking—an intelligibility benefit from a spatial separation between a target and masker—is reduced in reverberant environments as compared to free field. To understand the perceptual consequences of poorer spatial unmasking in reverberation, we assessed three aspects of functional spatial hearing in virtual reverberant environments: perceived auditory source width, auditory spatial acuity, and spatial unmasking. Three auditory environments were simulated and auralized using ODEON to vary interaural coherence (IC): (1) a control anechoic environment, (2) a classroom designed to meet classroom acoustics standards (IC = 0.58), and (3) a classroom of the same size with more severe reverberation (IC = 0.37). Individually measured head-related transfer functions were used to binaurally reproduce the auralized signals over headphones. We hypothesize that interaural decorrelation, the result of increasing reverberation, will broaden the perceived auditory source width with a cascading effect of reduced auditory spatial acuity and subsequently poorer spatial unmasking. Preliminary data from normal-hearing adults will be presented. [Work supported by NIH R21DC020532.]