Otological Examination Research Articles

Audio-vestibular dysfunction in rheumatoid arthritis associated secondary Sjogren syndrome, and its correlation to serum level of anticardiolipin and muscarinic type 3 receptors antibodies: a cross-sectional observational study

BackgroundIn secondary Sjogren syndrome (sSS), the presence and extent of hearing and vestibular abnormalities are controversial. Hence, to ascertain if individuals with Rheumatoid arthritis (RA) associated secondary Sjogren syndrome (sSS) had subclinical audio-vestibular impairment as well as to investigate whether serum anticardiolipin and muscarinic receptors type 3 antibodies had a role in its pathogenesis, this cross-sectional study was conducted on 50 RA patients with secondary Sjogren syndrome manifestations and 50 RA patients without such manifestations were included, along with 50 apparently healthy volunteers who were aged, and sex-matched as controls. Full history taking, Otologic examination, Immunologic evaluation, and Audio-vestibular assessment were done for all subjects.ResultsTwenty-five percent of our patients experienced subjective audio-vestibular symptoms. In the audiogram, 30 (60%) of the 50 RA patients with sSS and 5 (10%) of RA patients without sSS had abnormal hearing loss compared to only 4 (8%) of the controls (p ≤ 0.001) with a predominance of high-frequency sensorineural hearing loss. Also, 20% of our patients experienced a higher frequency of head-shaking nystagmus than they did (p ≤ 0.001). 30% had a statistically significant increase in the frequency of abnormal caloric test results as compared to either controls (0%) or RA patients without sSS (0%); p ≤ 0.001 Finally, all audio-vestibular symptoms and tests exhibit a strong positive correlation with muscarinic receptors type 3 and anticardiolipin antibodies.ConclusionThe use of muscarinic receptors type 3 and anticardiolipin antibodies are beneficial for early diagnosis of audio-vestibular dysfunction in RA-associated secondary Sjogren syndrome patients. Therefore, this study is important since it justifies rheumatologists’ screening for inner ear damage in their RA patients especially if associated with secondary Sjogren.

Evaluation of auditory pathways and comorbid inner ear malformations in pediatric patients with Duane retraction syndrome.

This study aimed to investigate the presence, type, and severity of hearing losses in individuals with Duane Retraction Syndrome (DRS), and to ascertain if there are anomalies in the auditory pathways at the brainstem level in DRS, believed to arise from aberrant interaction between cranial nerves and brainstem nuclei. Cross-sectional observational study. Tertiary referral centre. The study group comprised 20 patients diagnosed with DRS, aged between 5 and 18 years, who underwent ophthalmological, otological and audiological follow-up at our clinic. The control group was established using data obtained from the previous work of Sanfins M.D., et al., 2022. Participants underwent tympanometry and pure tone audiometry after ophthalmological and otological examination. Patients with hearing loss underwent auditory brainstem response (ABR) testing, while patients with normal hearing underwent temporal CT and MRI to detect possible aetiology. Tympanograms, air and bone conduction pure tone averages, latencies of wave I, III and V and interwave latencies as well as radiological findings on CT and MRI were noted. Profound sensorineural hearing loss was detected in two of the 20 patients. One of the patients with hearing loss had left-sided exo-Duane, cochlear aplasia with dilated vestibule (CADV) anomaly in the right ear and profound sensorineural hearing loss in the right ear. The other patient had bilateral exo-Duane, incomplete partition type I (IP-I) malformation in the right ear and profound sensorineural hearing loss in the right ear. There was no significant difference observed in the ABR latencies of wave I, III, and V, as well as the inter-wave latencies, between the control group and the individuals diagnosed with DRS who had normal hearing. No statistically significant difference was found in auditory brainstem responses between the control group and patients with DRS without hearing loss. It can be speculated that Duane retraction syndrome and hearing loss do not share a common pathogenesis at the level of the brainstem. However, it should be noted that hearing loss may be associated with inner ear malformations in DRS patients.

Otomycosis: Epidemio-Clinical and Therapeutic Profile at the Fousseyni DAOU Hospital in Kayes, Mali

Introduction: Otomycosis is a relatively common pathology of the external ear canal, its prevalence is estimated to be 5 to 10% of all otitis externa [1,2, 3]. There are no data on otomycosis at the Kayes Hospital, hence the interest of this study. Methodology: This was a descriptive study with retrospective data collection that spanned the period from January 1, 2021 to December 31, 2023. All patients with clinically suspected otomycosis on otoscopy, otoendoscopy and/or confirmed on mycological examination and with usable medical records were included. Results: We recorded 1156 cases of otitis externa, including 384 cases of otomycosis, i.e. a frequency of 33.2%. Females were the most represented at 51.6% (n=198) with a sex ratio of 0.93. The mean age was 37 years with extremes of 7 and 77 years. The reasons for consultation were: otalgia 44.8% (n=172), pruritus 35.2% (n=135), otorrhea 20% (n=77). The main contributing factors were cleaning the ear with cotton swab, 57.8% (n=221), wearing a turban 26.3% (n=101), and using antibiotic and corticosteroid drops 9.6% (n=37). The otologic examination revealed whitish or blackish deposits, purulent otorrhea and inflammation of the external auditory canal. Mycological examination found yeasts 42.3% (n=122) and molds 57.2% (n=163). Treatment was based on topical antifungals and antibiotics in 69% (n=265) and the combination of antifungal and antihistamine in 31% (n=119). Conclusion: Otomycoses are benign, chronic infectious pathologies. Their occurrence is multifactorial. Cleaning with the cotton swab and wearing the turban were the main causes. Keywords: Otomycosis, Fousseyni DAOU Hospital in Kayes.

P1-N1-P2 Cortical Auditory Evoked Potentials in Chronic Unilateral Acquired Conductive Hearing Loss in Adults.

Chronic unilateral hearing loss causes imbalanced auditory input to the brain that triggers cortical reorganization. The effect of sensorineural hearing loss on the central auditory system (CAS) has been thoroughly studied, while there is a paucity of research on the effect of conductive hearing loss (CHL). The aim of this study was to assess the P1-N1-P2 cortical auditory evoked response potential (CAEP) in adult individuals with chronic acquired unilateral CHL. This study included 108 participants of both genders: 54 patients with unilateral chronic CHL who were compared to well-matched 54 controls. All were subjected to history-taking, otologic examination, basic audiological evaluation, and bone conduction N1-P2 CAEP. The affected ears of the cases showed highly statistically significant shorter CAEPs N1, P2, N1-P2 latencies but not P1, and showed highly statistically significant larger N1, P2, N1P2, amplitude than the control group. Latencies decreased and amplitudes increased as the degree of CHL increased, but were not affected by patients' age, side, or duration of the CHL. Cases with tinnitus had statistically significant and worse results than those without tinnitus. Unilateral chronic CHL might enhance neurocortical plasticity, with greater changes occurring at greater degrees of the CHL.

Novel GJB2 mutation c.188delT compound with c.235delC causing non-syndromic hearing loss in a Chinese family: A case report.

Congenital sensorineural hearing loss is a significant global health issue, primarily driven by genetic factors, such as mutations in the GJB2 gene. This report presents a Chinese girl with congenital deafness and a novel mutation of the GJB2 gene. A newborn Chinese girl exhibited signs of congenital deafness. Congenital deafness was confirmed through comprehensive newborn hearing screenings that included otologic, audiologic, and physical examinations. Genetic analysis revealed a compound heterozygous mutation involving c.188delT and c.235delC in the GJB2 gene, indicating a genetic basis for her hearing loss. The patient underwent cochlear implantation, which resulted in stable auditory outcomes. Despite follow-up difficulties, stable auditory outcomes were achieved post-cochlear implantation, highlighting the potential efficacy of this intervention in GJB2-related hearing loss. This case study enriches our understanding of GJB2 mutations and underscores the critical role of genetic testing in diagnosing congenital sensorineural hearing loss. It emphasizes the necessity for early intervention and sustained interdisciplinary care to enhance the quality of life for patients with genetic hearing impairment.

Noise Induced Hearing Loss among Industrial Workers in North India: A Tale of Various Influencing Factors.

To study the prevalence and determinants of Noise Induced Hearing Loss (NIHL) among industrial workers. To access the benefit of Distortion Product Oto Acoustic Emissions (DPOAEs) in its early detection as compared to Pure Tone Audiometry (PTA). Detailed in-person questionnaires were filled followed by general and otological examination viz. local and otoscopic examination. NIHL was assessed by tuning fork test, PTA and DPOAEs. 360 participants aged 20-55 years from 6 industries 4 at noise level of 81-90 dBA and 2 at 91-100 dBA. Prevalence of NIHL at 81-90 dBA and 91-100 dBA was 48% and 59% on PTA. Overall Prevalence from 81 to 100 dBA was 49.45% on PTA and 67% on DPOAEs. NIHL was more prevalent at higher noise level, age group higher than 40 years, duration of service greater than 16 years of exposure and continuous noise type. Noise Induced Permanent Threshold Shift (NIPTS) was found to gradually increase at higher noise level and with increase in duration of service. Noise exposure monitoring at work place, engineering controls to reduce noise levels, provision of hearing protection devices, periodic audiometric evaluation of employees and employee's education regarding NIHL are some of the significant aspects to be considered to prevent NIHL.

Associations between tinnitus and body composition: a cross-sectional study

The relationship between tinnitus and body composition in specific regions has not been extensively investigated. This study aimed to identify associations between tinnitus and body composition. Individuals with data on physical and otological examination findings, and bioelectrical impedance analysis were included from the ninth Korea National Health and Nutritional Examination Survey. They were divided into a tinnitus group and a non-tinnitus group. Participants with tinnitus were further classified into acute or chronic tinnitus group. The tinnitus group showed significantly higher body fat percentages in each region (arms: P = 0.014; legs: P = 0.029; trunk: P = 0.008; whole body: P = 0.010) and waist circumference (P = 0.007) than the non-tinnitus group, and exhibited lower leg muscle percentage (P = 0.038), total body fluid percentage (P = 0.010), and intracellular fluid percentage (P = 0.009) than the non-tinnitus group in men. Furthermore, men with chronic tinnitus showed a significantly higher trunk fat percentage (P = 0.015) and waist circumference (P = 0.043), and lower intracellular fluid percentage (P = 0.042) than their counterparts without tinnitus. No significant differences in body composition were observed among the groups in the female population. In men, body composition may be associated with tinnitus.

Serum Vitamin-D and Benign Paroxysmal Positional Vertigo (BPPV)

Abstract Background Vitamin D deficiency can occur when usual intake is lower than recommended levels over time, exposure to sunlight is limited, the kidneys cannot convert 25(OH)D to its active form, or absorption of vitamin D from the digestive tract is inadequate. Decreases vitamin D levels show complex relationships with diseases, which can affect the inner ear. The aim of study: To examine the level of serum 25-OH vitamin D concentrations on patients diagnosed with BPPV. Patients and Methods This study included 60 subjects; 40 subjects with BPPV (study group) and 20 healthy persons (control group). Both groups underwent full history taking, vitamin D level assay, otological examination and audio-vestibular evaluation. Results Subjects with BPPV (study group) have lower vitamin D levels than norms (control group). The recurrence of BPPV occurs in subjects have lowest vitamin D levels. Vitamin D deficiency more in elderly & females. Hearing may be affected. Conclusion This study supports the relationship of lower vitamin D level with the occurrence of BPPV. Also, recurrent BPPV episodes are associated with a low level of vitamin D.

Preauricular sinus: A narrative review

ABSTRACT The preauricular sinus (PAS) is a common congenital malformation seen in the pediatric age. The PAS is often located at the anterior margin of the ascending limb of the helix. Most of the patients with PAS are asymptomatic. If the PAS is infected, the patient presents with painful swelling and foul odor discharge from the pit. A sinus pit near to anterior margin of the ascending limb of the helix is highly suggestive of the diagnosis. Proper history taking and head-and-neck examination are mandatory in all cases of PAS to rule out any association of anomalies. A thorough otologic examination is needed to differentiate PAS and preauricular cysts from first branchial cleft anomalies. No treatment is needed in case of isolated and asymptomatic PAS. Treatment of the infected PAS is usually challenging and often patients present with acute inflammation or abscess formation. When the surgery is indicated, complete excision is needed to prevent recurrence. Failure to remove the tract of PAS completely will lead to recurrence and require more difficult revision surgery. This review article aims to discuss the details of the epidemiology, etiopathology, variants, clinical characteristics, diagnosis, and current surgical treatment of the PAS.

Frequency and intensity discrimination in children with cochlear implants

BackgroundFrequency discrimination underlies more complicated auditory activities like speech comprehension and interpretation. However, intensity differences indicate how far apart noises are. This study aimed to evaluate and compare results of frequency modulation and difference limen for intensity in children with cochlear Implants (CI) as well as normal hearing children.ResultsThis case–control work was performed on 40 children, aged from 5–18 years, divided into two equal groups: a study group with unilateral CI and a control group with normal peripheral hearing. All patients were subjected to otological examination, audiological evaluation, frequency modulation difference limen (FMDL) and difference limen for intensity (DLI) tests. Patients with CI, as compared to normal hearing (NH) subjects, required significantly higher frequencies to discriminate FMDL and DLI respectively (P value = 0.001). At 2000 and 4000 Hz: FMDL had a significant diagnostic power for patients with CI (AUC = 0.980, 0.998 respectively, P < 0.001), at cut off 1.5, with 100% sensitivity and 100% specificity. While, at 4000 Hz: DLI had a significant diagnostic power for patients with CI (AUC = 0.999, P < 0.001), at cut off 1.5, with 100% sensitivity and 100% specificity.ConclusionA statistically substantial variation was observed among CI and NH children in FMDL and DLI at all frequencies tested. Patients with CI required significantly higher frequencies to discriminate as compared to NH subjects. Frequencies at 2000 Hz and 4000 Hz possess the best specificity and sensitivity of FMDL. While frequency 4000 Hz possess the best specificity and sensitivity of DLI.

Assessment of Hearing in Patients with Head Injury: A Prospective Study.

Hearing impairment is a well-known outcome of head trauma. The most prevalent site of injury is the peripheral structures. Hearing loss dissipates in most cases but can continue in some cases and may improve in some. To evaluate the incidence of hearing loss and ascertain its type and degree in patients with head injury. To estimate the progression or regression of hearing loss in head injury patients during follow-up. 60 patients with head injuries with any ear symptoms were included in the study. The severity of head injury is graded according to the Glasgow Coma Scale (GCS). Patients were subjected to High Resolution Computed Tomogram (HRCT) temporal bone, and Pure Tone Audiometry (PTA) was performed within 24h of presenting. PTA repeated after 3months. The degree of hearing loss and its progression or regression were assessed. Of the 60 patients, 56 (93.3%) had hearing loss on PTA. 50 Cases (83.3%) showed conductive hearing loss (CHL). 6 (10%) had mixed hearing loss (MHL). 4 cases with MHL had a transverse temporal bone fracture on radiological evaluation. 41 (68.3%) had mild CHL, 4 (6.7%) had moderate MHL, and 2 (3.3%) had moderately severe MHL. PTA values reduced significantly from 1st to 2nd visit in both ears. In our study, there was significant improvement in hearing during follow-up, after 3months of head injury indicating improvement in hearing. The improvement in hearing was noticed in all cases except for one case with transverse temporal bone fracture and moderately severe hearing loss. Routine otological examination should be considered in all patients with head injuries. Meticulous and timely management of these cases can significantly reduce morbidity in the patient.

Pathogenic Potential of Turicella otitidis and Staphylococcus auricularis: A Case Report.

Objective: Turicella otitidis and Staphylococcus auricularis have been considered normal aural flora. Their significance in active infection is controversial. We examined a series of patients presenting with acute and chronic otitis media whose ear canal culture isolated T. otitidis and S. auricularis and explored possible pathogenicity, associated factors, and outcomes. Methods: This is a retrospective chart review of patients who presented to a tertiary center outpatient clinic between 2017 and 2022 with otologic microscopic examination of active infection and ear canal culture isolating T. otitidis or S. auricularis only. Clinical course was collected including history, microscopic otoscopy findings, interventions given, outcomes, and sensitivity results. Results: A total of 13 patients (10 with T. otitidis and 3 with S. auricularis) were included. Majority of the patients had a history of otologic surgery (92%) and tympanic membrane perforation (62%). All were treated with combinations of antibiotic otic drops (ie, fluoroquinolone, sulfa, or aminoglycoside based) ± oral antibiotics (ie, penicillin or trimethoprim/sulfamethoxazole). Otorrhea resolved among majority of patients. Otorrhea and mucosalization returned or continued among 4 patients. Sensitivity results demonstrated that 2 of 3 strains of T. otitidis were resistant to clindamycin. There was no resistance against S. auricularis for tested antibiotics. Conclusions: Our findings suggest the potential pathogenicity of T. otitidis and S. auricularis, especially among patients with prior ear surgery and tympanic membrane perforation. Violation of the epithelial barrier from surgery or trauma may contribute to their pathogenicity. Future study is warranted to elucidate pathogenicity of normal aural flora and its mechanisms.

Resection of the Lateral Ear Canal in a Sheep with Zepp Technique

Background: Otitis in farm animals’ compromises health and well-being, leading to economic losses, risk of herd infection and poor performance. In sheep, otitis is usually of bacterial or parasitic origin. Surgical treatment is routinely used in small animal practice, and it is also reported in the horses. Nevertheless, corrective surgery is considered an adjuvant to conservative therapy. Herein, we report the successful outcome in a case of otitis in sheep treated surgically by the technique of resection of the lateral auditory canal (Zepp procedure). Case: A 4-year-old crossbred ewe weighing 43 kg was referred for hospital care. Anamnesis revealed the history of placing an identification earring approximately 90 days before in the affected ear, which was removed due to infection in the region. Physical evaluation was performed, revealing edema, fetid odor, purulent discharge, aural hematoma and pain when handling the right pinna. Neurological examination revealed moderate rotation of the head to the right side, but without signs of involvement of the vestibular system. Otological examination of the vertical auditory canal showed inflammation, wall fibrosis, complete obstruction and a purulent fistula in the inner part of the external ear, making it impossible to perform an otoscopic evaluation of the auditory canal. Conservative treatment by needle puncture was successful resolving the aural hematoma. Although otitis was refractory to 5-days of medical treatment (systemic antibiotics and topical wound cleaning). After this period, there was still otologic secretion and correct cleaning of the auditory canal was unfeasible due to the severe auditory canal narrowing. Therefore, surgical treatment by resection the lateral wall of the external auditory canal (Zepp technique) was performed. Both surgery and post-operatory period were uneventful, and there was complete healing with good aesthetic results. Hospital discharge occurred on the 18th day after surgery. The ewe was followed-up during 23-months after regress to the flock, and there was no otitis recurrence. Discussion: Probably, in the present case, the presence of contamination with inappropriate placement of the identification earring, promoted aural hematoma, infection and pruritus, favoring the stenosis of the external auditory canal and the chronicity of the otitis. Identification of sheep by earrings must comply with a series of recommendations, from the choice of the adequate earring to the follow-up after its placement. Clinical signs of external otitis in sheep may include head shaking, ear itching with attempts to scratch with the limbs, pain during ear handling, and excessive cerumen at the base of the ear canal, as observed on the sheep herein. Treatment of external otitis in sheep should start with a conservative approach through daily cleaning that may be combined with antibiotics and anti-inflammatory therapies. Surgical procedure is indicated in cases refractory to medical treatment, allowing adequate drainage and ventilation of the auditory canal. In the sheep herein, final outcome was considered good, considering the absence of surgical site infection, dehiscence and recurrence. Thus, we concluded that the technique of resection of the lateral auditory canal (Zepp procedure) was effective in the sheep of this report, and may be a good alternative for the treatment of chronic otitis in sheep. Keywords: ear disorders, otitis, small ruminant, stenosis. Título: Ressecção do canal auditivo lateral em um ovino com a técnica de Zepp Descritores: afecções das orelhas, estenose, otite, pequenos ruminantes.

Study on the role of otological endoscopic technique in otology teaching.

The intricate anatomy, narrow confines of each otolaryngological organ, and complex structures that are often concealed make it challenging to comprehend the fundamental theoretical knowledge required for early clinical practice teaching. Despite an increase in literature research on otological endoscopic surgery both domestically and internationally, there is a lack of reports regarding its application value, advantages, and disadvantages from a pedagogical perspective. This study aimed to investigate the impact of incorporating otological endoscopic into otoscopy clinical practice teaching. In July 2020, 10 doctors of standardized training for residents who were rotated in the department of Otorhinolaryngology-Head and Neck Surgery (OHNS) of the First Affiliated Hospital of Anhui Medical University in 2019 were selected as the research objects. A randomized controlled trial (RCT) was used randomly divided into control (n=5) and experimental (n=5) groups by drawing lots. The control group received traditional teaching methods through video instruction, while the experimental group received traditional teaching combined with otological endoscopic examination, operation, and instruction. After completing both theoretical exams and skill operation assessments, a questionnaire survey was conducted to evaluate the effectiveness of each method. No significant differences existed between groups in age, gender composition, or test scores before teaching. However, after completion of the course material, students in the experimental group scored significantly higher on both theoretical tests (42.90) and operational tests (49.60) compared to those in the control group (28.1, 32.70), respectively; this difference was statistically significant (P=0.001). Additionally, feedback from questionnaire surveys indicated that students who participated in otological endoscopic-based learning reported greater confidence in consolidating clinical practice ability as well as applying relevant knowledge under different scenarios than those who did not receive such instruction; these differences were also statistically significant (P=0.04, P=0.02, P=0.01). Incorporating otological endoscopic technology into otolaryngology education can enhance student engagement levels while improving overall learning efficiency by establishing standardized educational practices for future medical professionals.

A Rare Complication of Chronic Otitis Media: Septic Thrombosis of the Transverse Sinus and Meningoencephalitis due to a Parameningeal Infection. A Case Report

BACKGROUND: Septic cerebral venous sinus thrombosis or septic cavernous thrombosis is an extremely rare disorder, with 2 to 13 cases per million per year, following the introduction of antibiotics and advances in diagnostic imaging. It is a complex pathology, difficult to diagnose and life threatening. It has a high risk of otoneurologic sequelae, and it requires follow-up by various specialties, as treatment is medical and surgical, including neurology, internal medicine, intensive care, otorhinolaryngology, and infectiology, among others. Due to the low occurrence of septic cavernous thrombosis, the diagnosis may be erroneous or delayed, increasing complications and mortality. It is essential to perform a complete physical examination with emphasis on the ophthalmological, otological, rhinosinusal and neurological examinations, which is why this case is described. THE CASE: We describe a 77-year-old male patient, with history of high blood pressure, nasopharyngeal carcinoma in remission, bilateral hearing loss, prostatic hyperplasia, otitis media, and chronic mastoiditis. He was admitted due sudden onset of difficulty standing, gait instability, mutism, unquantified fever spikes, headache, and vertigo. The initial laboratory tests only revealed a complete blood count with leukocytosis. A simple brain computed tomography (CT) scan did not show relevant findings; therefore, a lumbar puncture (LP) was carried out due to suspicion of bacterial meningoencephalitis. Analysis of cerebrospinal fluid (CSF) showed pleocytosis with a predominance of polymorphonuclear cells, hypoglycorrhachia and hyperproteinorrachia. Empirical antibiotic therapy was started with Vancomycin and Cefepime. At day five since onset of symptoms, he did not have improvements of his symptoms, so a new LP was carried out and antibiotic therapy was escalated. In the CSF it was found an increased cellularity with greater hypoglycorrhachia, persistent hyperproteinorrachia, and cellular shift to lymphocyte predominance. A contrast-enhanced magnetic resonance imaging (MRI) of the brain was requested, showing pyogenic ventriculitis and decreased flow at the left transverse sinus, suggesting possible thrombosis, which was later confirmed with a contrast-enhanced brain angio-MRI. Furthermore, due to the otological involvement, a CT scan of the ears was performed, which showed severe bilateral otomastoiditis with bilateral mastoid cholesteatomas, bilateral otitis externa, and osteomyelitis of the left petrous apex. A diagnosis of a septic thrombosis of the left transverse sinus, in the context of meningoencephalitis secondary to a parameningeal focus, was made. Treatment with Meropenem 1 gr intravenously every 8 hours and Vancomycin 1 gr every 8 hours was continued up to 28 days. During the hospitalization, otorhinolaryngology did a mastoidectomy and continued outpatient antibiotic management with Ciprofloxacin for seven more days. The patient did not require anticoagulation, and at follow-up he was notably recovered, and in control studies the recanalization of the thrombosis was confirmed. CONCLUSION: Septic cerebral venous sinus thrombosis is a rare pathology, but with a high associated morbidity and mortality, which requires multidisciplinary management. It is vital to know its pathophysiology and predisposing factors to include it in differential diagnoses when managing a patient with meningeal symptoms.

Diagnosis and Management of Otosclerosis in a Filipino Population

OBJECTIVE :&#x0D; This case series aims to describe the diagnosis and management of otosclerosis in a series of Filipino patients encountered in a private, subspecialty otologic clinical practice. In particular, it elucidates the demographics, clinical presentation, diagnostic exam findings, clinical intervention and hearing outcomes. &#x0D; METHODS :&#x0D; Study Design : Retrospective review of medical records of a case series&#x0D; Setting : Subspecialty otologic / neurotologic clinical practice&#x0D; Participants : Medical records of all patients diagnosed to have otosclerosis based on radiologic evidence of fenestral or retrofenestral otosclerosis and/or confirmed during surgical exploration of the middle ear, during the period 2004-2017.&#x0D; RESULTS :&#x0D; Nine patients with otosclerosis were identified. Most patients presented with bilateral, primarily conductive hearing loss in middle age. However, an adolescent patient was also identified. Most patients were from the component cities of the National Capital Region. However, patients from the Cordillera region and south-central Mindanao were also identified. Radiologic evidence of fenestral or retrofenestral otosclerosis was identified in the majority of patients. However, readings of normal temporal bone CT findings were also seen. Obliterative otosclerosis was identified in one patient. Both objective and subjective evidence of hearing improvement was documented after stapedectomy in patients undergoing surgery.&#x0D; CONCLUSIONS :&#x0D; This study documents the presence of clinical otosclerosis in a Filipino population. As in other populations, it typically presents in middle age as a bilateral, primarily conductive hearing loss. However, a younger age does not preclude its diagnosis, as juvenile otosclerosis has been identified. The presence of patients in regions of the Philippines other than the National Capital Region implies that it has to be considered even in regional populations without a racial predilection for otosclerosis. The identification of radiologic evidence of fenestral and retrofenestral otosclerosis on CT imaging of the temporal bone makes this is an essential part of the work-up of Filipino patients with conductive hearing loss and normal otologic examinations. Surgical treatment via stapes surgery is an effective and viable option in the management of Filipino patients with otosclerosis. The identification of less common variants such as obliterative otosclerosis indicates the need for specialized surgical equipment and appropriate surgical training in order to successfully deal with these situations.

Augmented otorhinologic evaluation in telemedical visits

PurposeTo determine if an endoscopic otologic and rhinologic examination performed by a patient and interpreted remotely by an otolaryngologist is non-inferior to in-person examination, and to assess the feasibility of this system for telemedical visits. Materials and methodsTwenty healthy subjects performed a self-examination of their ears and nose using a commercially available endoscope under remote guidance by an otolaryngology provider over Zoom. This same provider and another otolaryngologist also performed separate, in-person examinations of each subject and rated their findings. Finally, both providers blindly reviewed a video recording of each virtual exam four weeks later and rated their findings. Subjects were surveyed about their experience. Interrater reliability was calculated using Cohen's kappa coefficients and the ability to detect different anatomic structures and features by in-person vs. virtual examination was compared using Wilcoxon tests and Chi-squared proportion tests. ResultsThe subjects' average age was 30 (SD 11.5) years. Interrater reliability was excellent; kappa coefficients were 0.72 and 0.81 (p < 0.001) for virtual and in-person exams, respectively. Of the 3 anatomic structures within the ear exam, none showed a difference in detectability between virtual and in-person exams. Of the 12 structures in the nasal exam, 3 were better visualized in-person and 9 showed no difference. Subject satisfaction was excellent; the average likelihood of recommending this virtual technology to peers (1–10) was 8.65 (SD 1.4). ConclusionsPatient self-examination of the ears and nose using a portable endoscope may be an effective strategy for obtaining valuable data during telemedical otolaryngology visits.

Association of age-related hearing loss, tinnitus, and chronic low back pain in middle-aged and older Korean adults.

This was a cross-sectional study conducted to evaluate the association between hearing impairment and low back pain (LBP) using data from the Korean National Health and Nutrition Examination Survey. A total of 5,504 middle-aged and older Korean adults (aged ≥50 years old) who underwent plain radiography of the lumbar spine and pure tone audiometry were included. The presence of LBP was evaluated using a questionnaire, which included a question on whether the patient had experienced LBP that lasted for more than 30 days during the past three months. Patients with age-related hearing loss (ARHL) were defined as those with bilateral hearing impairment who met the following criteria: 1) normal otologic examination results, 2) average pure-tone hearing thresholds of ≤15 dB in both ears, and 3) no occupational noise exposure. Multivariable logistic regression analysis showed that ARHL was not associated with LBP (odds ratio, 1.33; 95% CI, 0.94-1.89) after adjusting for potential confounders in the final model. However, when participants without both ARHL and tinnitus were defined as the reference group, the results showed that the participants with both ARHL and tinnitus were more likely to have LBP (OR, 1.86; 95% CI, 1.11-3.11). These results indicate that ARHL with tinnitus is significantly associated with LBP. We recommend that elderly patients with ARHL and tinnitus increase their daily physical activities and engage in more muscle-strengthening exercises to prevent LBP.

Proposal for a screening protocol for falls among old subjects attending the audio-vestibular clinic

BackgroundOlder adults suffer from falls. 30% of the elderly fall annually in United States of America (Otorhinolaryngol Head Neck Surg. 5:1-4 2020). Falls have also cost society and people heavily. The aim of this study is to identify fall risk factors in elderly visiting the audio-vestibular clinic and propose a screening strategy.MethodsThe study included 500 elderly participants over 60 years old who visited the audio-vestibular clinic for hearing and/or vestibular evaluations. All participants in this study underwent a full audiological and neuro-otological history, general examination, otological examination, audiological evaluation, and office vestibular testing.ResultsOne hundred fifty-nine out of 500 (32%) of the study group had a history of vertigo, and 153 out of 500 (31%) had fallen at least once in the past two years. Dizziness and age were significantly associated. Dizziness was more common in people over 70 years old. Similar results were found for the fall history and age. Falls were more common in elderly participants with dizziness. 25% of participants with a history of falls had dizziness, compared to 14.5 percent of those without. Systemic diseases and falls were significantly associated. Falls and abnormal office vestibular test results were statistically significant. Multiple regression analysis showed that Diabetes Mellitus, hypertension, orthostatic hypotension, positional and positioning nystagmus, Romberg and Fukuda tests, and falls were all associated. Multiple risk factors cause older adult to fall. Dizziness increases the risk of falling, especially in the elderly. In our study, hypertension and diabetes were the two greatest independent fall risk factors. Office vestibular tests can detect elderly fallers.

Acute hearing and visual loss caused by thiamine deficiency

BackgroundWernicke encephalopathy (WE) is a devastating acute or subacute neurological disorder caused by thiamine deficiency. Wernicke encephalopathy is characterized by the triad of ocular signs, cerebellar dysfunction, and confusion. Visual loss and hearing loss are less common findings in WE. Here, we report a case of Wernicke encephalopathy in a nonalcoholic liver cirrhosis patient who presented with acute bilateral deafness and bilateral blindness.Case presentationA 60-year-old Chinese man presented with a history of bilateral blindness and bilateral hypoacousia for 3 days. He had a history of liver cirrhosis and chronic hepatitis C virus infection and did not have a habit of alcohol consumption. Ophthalmologic and otologic examinations showed no obvious abnormalities. MRI findings revealed symmetric fluid-attenuated inversion recovery (FLAIR) hyperintensities in the bilateral medial dorsal thalamus, periventricular region around the third ventricle and tectum, and dorsal medulla oblongata. One day after hospitalization, the patient developed a mild coma. Based on the laboratory and neuroimaging findings, we diagnosed the patient with Wernicke encephalopathy. He soon regained consciousness after administration of thiamine. Both his visual acuity and his hearing function improved gradually.ConclusionsWe suggest that Wernicke encephalopathy can present with bilateral blindness and bilateral deafness.