Left-sided Hearing Impairment Research Articles

ASYMMETRIES IN COGNITION AND MEASURES OF INTELLIGENCE IN CHILDREN WITH HEARING LOSSES IN RIGHT OR LEFT EARS

IntroductionHemispheric asymmetry of the central nervous system affects various features of the brain involved in cognitive ability. Functional asymmetry, such as different hearing ability in the left or right ear, will also affect cognitive processes.Material and methodsThe aim of this study was to assess how intelligence measures and cognitive abilities in children and adolescents might have been affected by hearing deficits in the left or right ear. The study involved 208 children, 126 who were in an experimental group and 82 in a control group. In the experimental group, there were 26 children who were diagnosed with right-sided hearing loss, 34 with leftsided hearing loss, and 66 with bilateral hearing loss; all children in this group had used hearing devices since diagnosis. We assessed hearing unilaterally and bilaterally and looked for asymmetries in terms of intelligence measures and visual and spatial functioning.ResultsChildren with bilateral hearing impairment had lower intelligence compared to those without impairment. Children with unilateral hearing impairment had similar intelligence level compared to well hearing children. Children with left-sided hearing impairment had higher intelligence compared to those with right-sided hearing impairment and lower nonverbal intelligence compared to well-hearing children. Children with right-sided hearing impairment had lower verbal intelligence.ConclusionsHearing impairment has an impact on various measures of intelligence, as well as on the organisation and performance of cognitive processes.

Low-frequency fluctuation amplitude changes in resting-state brain functional magnetic resonance imaging and its correlation with clinical hearing levels in patients with unilateral hearing impairment

Objective: To investigate low-frequency fluctuation amplitude changes in resting-state brain fMRI and its correlation with clinical hearing levels in patients with clinical hearing level in patients with unilateral hearing impairment. Methods: Forty-five patients with unilateral hearing impairment[12 males and 33 females, aged 36-67 (46.0±9.7) years], and 31 controls with normal hearing[9 males and 22 females, aged 36-67 (46.0±10.1) years], were retrospectively included. All subjects underwent blood oxygen level-dependent (BOLD) resting-state functional magnetic resonance imaging and high-resolution T1-weighted imaging. The patients were divided into the left-sided hearing impaired group(24 cases), and the right-sided hearing impaired group(21 cases). After data being preprocessed, differences in low frequency amplitude (ALFF) metrics between the evaluated patients and controls were calculated and analyzed, and the statistics were corrected for Gaussian random field (GFR). Results: Overall comparative analysis of patients with hearing impairment showed that one-way ANOVA among the three groups showed abnormal ALFF values only in the right anterior cuneiform lobe (GRF adjusted P=0.002). The ALFF value of the hearing impaired group was higher than that of the control group in one cluster (peak coordinates: X=9, Y=-72, Z=48, T=5.82), involving the left occipital gyrus, right anterior cuneiform lobe, left superior cuneiform lobe, left superior parietal gyrus, and left angular gyrus (GRF adjusted P=0.031). The ALFF value of the hearing impaired group was lower than that of the control group in three clusters (peak coordinates: X=57, Y=-48, Z=-24; T=-4.99; X=45, Y=-66, Z=0, T=-4.06; X=42, Y=-12, Z=36, T=-4.03), involving the right inferior temporal gyrus, the right middle temporal gyrus, and the right precentral gyrus (GRF adjusted P=0.009). Compared with the control group, the ALFF value of the left hearing impairment group was significantly higher than that of the control group in one cluster (peak coordinates: X=-12, Y=-75, Z=45, T=5.78), involving the left anterior cuneiform lobe, right anterior cuneiform lobe, left middle occipital gyrus, left superior parietal gyrus, left superior occipital gyrus, left cuneiform lobe, and right cuneiform lobe (P=0.023 after GRF correction). Compared with the control group, the right hearing impairment group had a significantly higher ALFF value in one cluster (peak coordinates: X=9, Y=-46, Z=22, T=6.06), involving the left middle occipital gyrus, right anterior cuneiform lobe, left cuneiform lobe, right cuneiform lobe, left superior occipital gyrus, and right superior occipital gyrus (GRF adjusted P=0.022); The brain area with reduced ALFF values is located in the right inferior temporal gyrus (GRF adjusted P=0.029). Spearman's two-tailed correlation analysis between ALFF values and pure tone average in the abnormal brain regions showed that ALFF values in the abnormal brain regions correlated to some extent with the pure tone average (PTA) only in the left-sided hearing impaired group(PTA=2 000 Hz, r=0.318,P=0.033;PTA=4 000 Hz,r=0.386,P=0.009). Conclusion: The abnormal neural activity within the brain are different in patients with left-sided and right-sided hearing impairment, and the severity of hearing impairment is related to the difference in functional integration of brain regions.

Stapes Bar-Normal Stapedial Superstructure with a Mobile Footplate Fixed to the Promontory.

This report describes a case of stapedial superstructure fixation with a mobile footplate, which is a rare occurrence among the ossicular malformations that cause conductive hearing impairment. A 44-year-old man with symptoms of left-sided hearing impairment since childhood presented to our department. The eardrum was normal, and pure tone audiometry showed conductive hearing impairment with a three-frequency (500, 1000, and 2000 Hz) mean of 53.3 dB and a normal tympanogram result. An abnormal shadow was observed on the internal side of the left stapes during the three-dimensional reconstruction of computed tomography. We suspected a stapes malformation and performed an exploratory tympanotomy with transcanal endoscopic ear surgery. We found a bony bar between the superstructure of the stapes and the promontory. The mobility of the stapes was significantly improved by removing the bony bar. Findings of postoperative audiometry were normal after surgery. The treatment of such cases of stapedial fixation is simple, and the prognosis of hearing gain after surgery is quite good. Thus, regarding the treatment of patients with conductive hearing impairment, clinicians and surgeons should be aware of the possibility of single stapedial superstructure fixation.

Compensation capacities of brain in unilateral and bilateral auditory system damage in children

Neuroplasticity is a basic feature of neuronal system which provides function rebuilt or developmental dysfunction repair. Hearing impairment can have an impact on intelligence levels, organization and structure of cognitive processes. Cognitive capacities profiles of deaf people present neuropsychological results of functional reorganization of brain. 208 children were accepted for this study. Experimental group consisted of 126 children suffering from sensorineural hearing insufficiency. 26 children were diagnosed with right-sided hearing loss, 34 children were diagnosed with left-sided hearing loss and 66 children were diagnosed with bilateral hearing loss. Control group consisted of 82 normally hearing children, confirmed in audiometric assessment. In order to establish levels of cognitive abilities and intelligence in patients enrolled for the study polish adaptation of Wechsler Intelligence Scale for Children (WISC-R) was administered. Children with bilateral hearing loss obtained worse results in verbal scale compared to well hearing controls. Verbal intelligence in control group was statistically higher than in right-sided auditory dysfunction group. Control group average result in nonverbal scale was statistically significantly higher compared to left-sided hearing loss patients. Children with right-sided auditory dysfunction obtained higher results in nonverbal scale compared to children with left-sided auditory dysfunction. Left-sided hearing impairment group had higher scores in almost all subtests of verbal scale than right-sided hearing impairment group. Left-sided auditory disability enhances linguistic capacity, which indicates compensation abilities of left hemisphere responsible for verbal processes. Right-sided auditory disability enhances analytic processes, visual synthesis and image reasoning, which indicates compensation abilities of right hemisphere responsible for nonverbal processes.

Intracranial giant cell tumour\u2014a case report

BackgroundGiant cell tumours (GCT) are rare benign bone tumours that typically occur in the appendicular skeleton. In typical locations, these tumours are relatively simple to diagnose by radiography. However, at atypical locations, these tumours can be confused with other disease pathologies. Here, we describe a patient with an intracranial GCT that was initially thought to be a cystic teratoma.Case presentationA 49-year-old man with no previous medical illness was investigated for left-sided hearing impairment and tinnitus associated with a left-sided headache of 2 years’ duration. He did not complain of fever, vertigo, nasal or constitutional symptoms. Examination confirmed a sensory neural hearing loss with no other neurological deficit. Imaging by CT and subsequent MRI revealed an extra axial, multiloculated, and septated mass at the left temporal area with a significant mass effect. A provisional diagnosis of cystic teratoma was made. However, histopathological examination of the resected mass indicated that the lesion was a GCT. The patient required a second excision of the tumour, which he refused. His latest follow-up MRI showed no further progression of the residual tumour. His headaches have resolved and there was no progression of other symptoms.ConclusionThis case highlights that GCTs can occur at sites outside the appendicular skeleton and that these tumours may be confused with other diseases that have a similar appearance on imaging.

A case of von Hippel-Lindau disease with multi-organ involvement: a rare case report

Von Hippel-Lindau (VHL) disease is a rare autosomal dominant syndrome manifested by a spectrum of tumours in the central nervous system (CNS) and other visceral organs. We herein report a case of 35 years aged newly diagnosed diabetic female patient presented with headache, gait instability, loss of vision in both eyes, left sided hearing impairment and subsequently diagnosed to have VHL disease. The pathophysiology involves the inactivation of the VHL tumour suppressor gene. Early recognition and treatment remains the mainstay of management. Even many years after the complete tumour excision, newer neoplasms may develop. Increasing knowledge about the molecular enabled us to investigate the role of anti-angiogenic drugs. Continuous surveillance at regular interval must be conducted in patients with VHL disease.

Differences in Intrinsic Brain Abnormalities Between Patients With Left- and Right-Sided Long-Term Hearing Impairment.

Unilateral hearing impairment is characterized by asymmetric hearing input, which causes bilateral unbalanced auditory afferents and tinnitus of varying degrees. Long-term hearing imbalance can cause functional reorganization in the brain. However, differences between intrinsic functional changes in the brains of patients with left- and those with right-sided long-term hearing impairments are incompletely understood. This study included 67 patients with unilateral hearing impairments (left-sided, 33 patients; right-sided, 34 patients) and 32 healthy controls. All study participants underwent blood oxygenation level dependent resting-state functional magnetic resonance imaging and T1-weighted imaging with three-dimensional fast spoiled gradient-echo sequences. After data preprocessing, fractional amplitude of low frequency (fALFF) and functional connectivity (FC) analyses were used to evaluate differences between patients and healthy controls. When compared with the right-sided hearing impairment group, the left-sided hearing impairment group showed significantly higher fALFF values in the left superior parietal gyrus, right inferior parietal lobule, and right superior frontal gyrus, whereas it showed significantly lower fALFF values in the left Heschl’s gyrus, right supramarginal gyrus, and left superior frontal gyrus. In the left-sided hearing impairment group, paired brain regions with enhanced FC were the left Heschl’s gyrus and right supramarginal gyrus, left Heschl’s gyrus and left superior parietal gyrus, left superior parietal gyrus and right inferior parietal lobule, right inferior parietal lobule and right superior frontal gyrus, and left and right superior frontal gyri. In the left-sided hearing impairment group, the FC of the paired brain regions correlated negatively with the duration and pure tone audiometry were in the left Heschl’s gyrus and right supramarginal gyrus. In the right-sided hearing impairment group, the FC of the paired brain regions correlated negatively with the duration was in the left Heschl’s gyrus and superior parietal gyrus, and with pure tone audiometry was right inferior parietal lobule and superior frontal gyrus. The intrinsic reintegration mechanisms of the brain appeared to differ between patients with left-sided hearing impairment and those with right-sided hearing impairment, and the severity of hearing impairment was associated with differences in functional integration in certain brain regions.

Monaural-driven Functional Changes within and Beyond the Auditory Cortical Network: Evidence from Long-term Unilateral Hearing Impairment

Long-term unilateral hearing impairment (UHI) results in changes in hearing and psychoacoustic performance that are likely related to cortical reorganization. However, the underlying functional changes in the brain are not yet fully understood. Here, we studied alterations in inter- and intra-hemispheric resting-state functional connectivity (RSFC) in 38 patients with long-term UHI caused by acoustic neuroma. Resting-state fMRI data from 17 patients with left-sided hearing impairment (LHI), 21 patients with right-sided hearing impairment (RHI) and 21 healthy controls (HCs) were collected. We applied voxel-mirrored homotopic connectivity analysis to investigate the interhemispheric interactions. To study alterations in between-network interactions, we used four cytoarchitectonically identified subregions in the auditory cortex as “seeds” for whole-brain RSFC analysis. We found that long-term imbalanced auditory input to the brain resulted in (1) enhanced interhemispheric RSFC between the contralateral and ipsilateral auditory networks and (2) differential patterns of altered RSFCs with other sensory (visual and somatomotor) and higher-order (default mode and ventral attention) networks among the four auditory cortical subregions. These altered RSFCs within and beyond the auditory network were dependent on the side of hearing impairment. The results were reproducible when the analysis was restricted to patients with severe-to-profound UHI and patients with hearing-impairment durations greater than 24 months. Together, we demonstrated that long-term UHI drove cortical functional changes within and beyond the auditory network, providing empirical evidence for the association between brain changes and hearing disorders.

Conductive Hearing Loss as the Initial Manifestation of Spontaneous Herniation of Epitympanic Meningocele

Although the incidence of tegmen tympani dehiscence is relatively high, diagnosis can be difficult if there are no clinical clues or a high degree of suspicion. We describe the case of a 79-year-old male patient with progressive left-sided hearing impairment and ear ringing for 1 year who was eventually diagnosed with middle ear meningocele. Audiometry showed conductive hearing loss with an air-bone gap of 20 dB. This was caused by impaired mobility of the ossicular chain due to meningocele herniation from the dehiscence of the tegmen tympani. In the absence of typical symptoms, such as cerebrospinal fluid middle ear effusion and otorrhoea, diagnosis of tegmen tympani dehiscence may be challenging. Consequently, tegmen tympani dehiscence should be included in the differential diagnosis of conductive hearing loss, which may be the only or early clinical manifestation of tegmen tympani dehiscence. High clinical suspicion and fully assessment are necessary to prevent misdiagnosis and further serious complications.

Prevalence of Musical Hallucinations in Patients Referred for Audiometric Testing

To assess the prevalence of musical hallucinations in patients referred for audiometric testing and to analyze associations with age, sex, degree of hearing loss, asymmetrical hearing loss, and tinnitus. Patients referred for audiometric testing underwent a semi-structured interview on tinnitus and musical hallucinations. Out of 194 patients, most of whom had mild to moderate hearing loss, seven (3.6%) had musical hallucinations. Significant associations were found with female sex and predominant left-sided hearing impairment, but not with age, severity of hearing loss, or tinnitus. This study offers no evidence that age is a risk factor. Musical hallucinations seem to be prevalent in women with predominant left-sided hearing impairment.

A case of middle-ear cavernous lymphangioma with facial palsy

Only a few benign tumours of the middle ear have been reported to lead to the development of facial palsy. Here, we describe a patient with middle-ear cavernous lymphangioma and facial palsy. Single case study. A 61-year-old man presented with left-sided hearing impairment and incomplete left facial palsy. A tumour was confirmed to be occupying the epi- to mesotympanum and to be joined to the facial nerve. The tumour was removed along with facial nerve tissue, which was resected at its horizontal portion, and the remaining facial nerve was fixed by end-to-end anastomosis. Complete facial paralysis occurred after the operation, but the patient's House-Brackmann grade gradually improved to grade III. Post-operative histopathological examination revealed infiltration of the lymphangioma into the facial nerve tissue, together with mild neural atrophy of the facial nerve. These findings suggested that tumour invasion was the cause of facial palsy in this patient.

外リンパ瘻罹患後遅発性に発症した良性発作性頭位眩暈症の一例

A 12-year-old male experienced left-sided hearing impairment, tinnitus, and vertigo after being hit by a volleyball. Pure tone audiometry showed severe, mixed left hearing loss and nystagmus to the right side. We diagnosed perilymphatic fistula and treated it conservatively. After ten days, his vertigo had disappeared and hearing on his left side showed improvement except at 2,000 and 8,000 Hz. However, he experienced slight dizziness after discharge from our hospital. About eleven months later, because of severe vertigo, he again came to our hospital. We diagnosed benign paroxysmal positional vertigo (BPPV) based on his symptoms and the characteristic nystagmus. We performed the Epley maneuver, and his vertigo and nystagmus disappeared the next day. Exploratory tympanotomy was carried out, but no sign of a perilymphatic fistula was detected. He experienced BPPV again, and so we tried the Epley and Lempert maneuver. We believed his prolonged dizziness was due to a partial collapse of the utricular wall, a condition called floating labyrinth. This phenomenon may occur with migration of otoliths from the utricle, leading to BPPV.

Temporal bone chondroblastoma: A review

The objective of this paper was to review temporal bone chondroblastomas in regard to their presentation, radiographic findings, histopathology, and treatment. A case report of a 38-year-old man who presented with the left-sided hearing impairment and temporal swelling was reviewed. A CT scan revealed an osteolytic lobulated expansile mass. MRI depicted two cystic components with fluid-fluid level and enhanced solid mass. Immunohistochemical study of S-100 was performed using avidinbiotin-complex method. The tumor was totally removed, with eroded squamous bone and temporal muscle, via the left zygomatic-extended middle fossa approach. The pathology of the tumor showed that the tumor cell was spindle-shaped, along with multinucleated giant cells. These cells had oval to polygonal nuclei; some cells showed grooved nuclei. Intercelluar calcification and hemorrhagic components were also observed in the tumor. Tumor cells were strongly positive for S-100 protein. Temporal bone chondroblastomas are extremely rare osseous tumors with only 45 cases previously reported in the published literature. They may be confused with more common lesions seen in the temporal bone. Diagnostic radiology, including CT and/or MRI, as well as immunohistochemical staining with S-100 protein, may assist in making the diagnosis. Treatment is complete surgical excision with preservation of vital neurovascular structures.

Sudden Sensorineural Hearing Loss after Rapid Reduction of Blood Pressure in Malignant Hypertension

Although circulatory impairment of the cochlea would be intuitively a possible cause of sudden sensorineural hearing loss (SSHL), definite proof is lacking. A 46-year-old man developed bilateral SSHL immediately after rapid reduction of the blood pressure in malignant hypertension. Vertigo and left-sided hearing impairment and tinnitus resolved spontaneously a few hours after onset. The right-sided hearing loss and tinnitus persisted, and the hearing loss improved only 17 dB after 3 months of treatment. This case may provide an in vivo human model of SSHL caused by ischemia. Bilateral involvement is possible in SSHL if the circulatory disturbance is systemic. In addition, a poorer prognosis is anticipated on the side with the more severe initial attack.

外傷性アブミ骨転位例

We report a case of traumatic dislocation of the stapes without disruption of the ossicular chain.An 8-year-old boy visited our clinic because of left-sided hearing impairment. Pure tone audiography showed average conductive hearing loss of 50dB. Stapedial dislocation was suspected by temporal bone CT. Exploratory tympanotomy revealed that the stapes was dislocated inf eriorly with its footplate fused with the bony promontory wall. Both malleo-incudal and incudo-Stapedial joints were intact. The oval window was closed with thin scar tissue being covered by intact mucosa. When the superstructure of the stapes was removed and the overlying tissue of the oval window was incised, outflow of perilymph was observed. With the placement of a 4.5mm-long teflon wire piston, his hearing improved to 13dB on average, without particular complications. Although the history of head trauma he experienced was not severe enough to explain the dislocation of the stapes, a mechanical cause was more likely in this case than a congenital anomaly because there were no anomalies in his middle ear or any other parts of his body.

Tinnitus--incidence and handicap.

A questionnaire investigation, comprising 1091 patients, was conducted at a hearing centre. A majority of patients, 59%, claimed that they were troubled by tinnitus. A strong correlation was found between the laterality of tinnitus and that of subjective hearing loss. Neither a greater degree of hearing loss nor a longer duration of tinnitus was shown to be associated with more severe tinnitus. Among patients with both subjective hearing loss and tinnitus, 23% stated that tinnitus was the greater problem and 38% that their tinnitus and hearing loss were equally troublesome. The corresponding figures for patients with hearing impairment of such a degree that a hearing aid had been fitted were 9% and 41% respectively. Stress symptoms such as headache, tension of facial muscles and sleep disturbances were correlated to tinnitus. Psychosomatic complaints should therefore be taken into account in the treatment of tinnitus. Of patients with tinnitus, 83% were interested in obtaining treatment for their tinnitus. It is postulated that the previously reported predominance of left-sided tinnitus is due to a higher frequency of left-sided hearing impairment. A majority of patients with tinnitus and hearing impairment regarded their tinnitus as the major problem. Efforts towards investigation and treatment of tinnitus might therefore considerably improve the prospects for hearing rehabilitation.

Two cases of osteoma of the external auditory canal

The tumors of the external auditory canal are relatively rare. Among these tumors an osteoma is not common.Two cases of osteoma of the external auditory canal were reported.The patient, 26-year-old female, had a history of left-sided hearing impairment and w hard mass protruding from the posterior part of the left external canal.A stony hard mass almost completely occlu ded the left external canal. The sessile tumor covered with normal skin, which was found to be attached to the posterior wall, was removed by means of retroauricular partial mastoidectomy.The histologic examination revealed a solitary osteocartilaginous tumor.The other patient, 17-year-old female, suffered from tinnitus and earache of the right ear.A bony tumor, covered with gray-whitish skin, completely occluded the right external auditory canal. It was removed by means of retroauri-cular incision.The histopathologic examination revealed osteoma.The histopathologic examination revealed osteoma.The two lesions, osteoma and exostosis, have been defined and reviewed the literatures. Osteoma of the external auditory canal is a solitary unilateral pedunculated lesion, attached to the tympanosquamous suture or to the tympanomastoid suture. By contrast, exostosis of the external canal is broad-based elevation of bone, usually multiple and bilaterally symmetrical, located deeply to the isthmus, at the upper edges of the tympanic bone.