Hearing Loss Symptoms Research Articles

Vestibular function in children with neurodevelopmental disorders: A neglected sense?

The study aimed to explore the vestibular function in children with neurodevelopmental disorders (NDDs). Twenty-eight participants with a NDD (6 girls, 22 boys; 6-13years; 9;3±2;4 years) were enrolled in this pilot study. Sixteen participants had a single NDD (Autism Spectrum Disorder: n=7, Developmental Coordination Disorder: n=3; Attention Deficit/Hyperactivity Disorder: n=6), the remaining 12 had comorbid NDDs. The integrity of the peripheral vestibular system was evaluated using ocular and cervical Vestibular Evoked Myogenic Potentials (o/cVEMP), and a video Head Impulse Test (vHIT); motor competence was assessed with the Movement Assessment Battery for Children, and the KörperkoordinationsTest für Kinder. Results were compared to an age and sex-matched control group (n=28; 9;7±1;9 years). The NDD group exhibited significantly higher interpeak amplitudes on both VEMP tests compared to the control group (p<0.001). No significant differences were found between the groups on vHIT measurements (p>0.05). Among the children with NDDs, 11 (39%) showed atypical vestibular responses, including one child with vHIT correction saccades and three children with reduced or absent otolith responses (n=3). Additionally, eight children showed abnormally elevated otolith amplitudes (cVEMP > 4.00µV; oVEMP > 55.00µV). Clinicians are encouraged to recognize the overlap and consider the possibility of vestibular alterations in individuals with NDD. Incorporating vestibular assessments into routine clinical evaluations, particularly in children with NDD who exhibit delayed motor development, balance issues, hearing loss, or vestibular-related symptoms, is strongly recommended.

Recovery Rates by Severity of Hearing Loss in Cases of Acute Low-Tone Sensorineural Hearing Loss

AbstractAcute low-tone sensorineural hearing loss (ALHL), first reported in 1982, is characterized by hearing loss (HL), tinnitus, and other auditory symptoms. It is a disease entity independent from sudden HL. Although the severity of HL was defined for the first time in 2015 by the Research Group on Intractable Hearing Impairment of the Ministry of Health, Labor and Welfare, only a few studies have examined the treatment outcomes by the severity of HL. In this study, we determined the overall cure rate (cure/all cases) in 336 ALHL cases treated over 11 years (2011–2021) and the cure rates by the severity of the HL and steroid use. The overall cure rate was 64.0%, with 75.0% in cases with grade 1 severity, 74.3% in grade 2, 57.4% in grade 3, and 34.7% in grade 4. The cure rate in grade ¾ cases was significantly lower than that in grade ½ cases. No significant difference was noted in the cure rate by steroid use. The cure rate of sudden HL is dependent on the hearing level at the initial diagnosis, and the cure rate of ALHL can be predicted by the sum of the hearing levels of the three lowest frequencies at the initial diagnosis. Although this study did not demonstrate the efficacy of steroid use, the study design biased the sample population. ALHL is associated with higher recurrence than sudden HL; however, steroids have various side effects. Therefore, the appropriateness of steroid use in the treatment of ALHL should be determined by a thorough assessment of comorbidities, patient age, and disease severity.

Investigating the Process of Autoimmune Inner Ear Disease: Unveiling the Intricacies of Pathogenesis and Therapeutic Strategies.

Autoimmune inner ear disease (AIED) is a rare condition characterized by immune-mediated damage to the inner ear, leading to progressive sensorineural hearing loss (SNHL) and vestibular symptoms such as vertigo and tinnitus. This study investigates the pathogenesis and therapeutic strategies for AIED through the analysis of three cases with different underlying autoimmune disorders: rheumatoid arthritis, relapsing polychondritis, and IgG4-related disease. The etiology of AIED involves complex immunopathological mechanisms, including molecular mimicry and the "bystander effect," with specific autoantibodies, such as those against heat shock protein 70 (HSP70), playing a potential role in cochlear damage. Diagnosis remains challenging due to nonspecific symptoms and the lack of distinct biomarkers, emphasizing the need for comprehensive clinical evaluation and exclusion of other hearing loss causes. Treatment primarily involves immunosuppressive therapies, with glucocorticoids as the first line, effective in 70% of cases. However, resistance or partial response necessitates the use of additional agents like methotrexate and biologics such as anti-TNF and IL-6 receptor antagonists. Early intervention is crucial for favorable outcomes, as demonstrated in the studied cases, where timely corticosteroid and immunosuppressive treatments led to significant hearing improvement. The study underscores the importance of personalized treatment strategies based on individual immunologic profiles and comorbidities. Our findings highlight the heterogeneity of AIED and the potential for biologic therapies in refractory cases.

PREVALENCE OF INTRINSIC CAPACITY IMPAIRMENTS AMONG ELDERLY PEOPLE BASED ON THE ICOPE SCREENING RESULTS

Introduction. Improving the quality of medical and preventive care for elderly patients is an important and timely task. Ensuring access to quality medical care that takes into account the specific needs of older people was proclaimed in the Concept of 'Integrated Care for Older People' (ICOPE), developed in 2017. It is a key element of the 'Decade of Healthy Ageing'—the action plan of the World Health Organization (WHO) Global Strategy for 2020-2030. Aim. To study the prevalence of intrinsic capacity impairments among older age groups based on the results of ICOPE screening. Materials and methods. In 2023, a prospective study (selective, cross-sectional) was conducted at the State Institution of Science “Center of innovative healthcare technologies” State Administrative Department to assess functional impairments of intrinsic capacity among patients from older age groups using the adapted questionnaire (WHO ICOPE). The study involved 577 individuals over 60, including 238 men (41.2%) and 339 women (58.8%). Results and discussion. Among 318 individuals aged 60-74 years (127 men and 191 women), 97.2% (95% CI 94.7-98.5) had various impairments, with the most common being vision problems (95.9%; CI 93.1-97.6), followed by symptoms of depression (63.8%; CI 58.4-68.9), and hearing loss (34.6%; CI 29.6-40.0). Reduced motor activity and cognitive abilities were found in 15.4% (CI 11.9-19.8) and 9.1% (CI 6.4-12.8) of participants, respectively, while nutritional disorders were present in 8.8% (CI 6.2-12.4). In the group aged 75-89 years (250 individuals), all participants had impairments, with the most common being vision problems (98.4%; CI 96.0-99.4), followed by symptoms of depression (64.8%; CI 58.7-70.5) and hearing loss (44.0%; CI 38.0-50.2). In the 90+ age group (9 individuals), impairments were found in 100% (CI 70.1-100.0) of cases, with the highest frequency of vision problems and depression (100%). The frequency of cognitive impairments and reduced motor activity significantly increases with age (p&lt;0.001). Conclusions. Implementing screening tools is a priority in diagnosing intrinsic capacity impairments in older age groups. The WHO screening tool “Integrated Care for Older People” (ICOPE) enables the effective detection of key disorders associated with reduced intrinsic capacity, allowing for the assessment of their prevalence, planning further diagnosis, and organizing long-term home care based on the collaboration of medical and social services.

Changes in Plasma Levels of Prestin and Otolin-1 in Dental Students.

Dentists and dental professionals report a high prevalence of noise-induced hearing loss (NIHL) and related symptoms. Chronic exposure to high-frequency dental instrument sounds, which can damage the outer hair cells (OHCs) of the cochlea, is strongly linked to their NIHL. Similarly, dental students in teaching clinics often report symptoms associated with NIHL. In this study, we measured plasma levels of prestin and otolin-1, two biomarkers associated with inner ear health, in first-year (D1) and third-year (D3) dental students. D1 students were selected for their relatively short exposure to dental clinics, while D3 students represented a group with substantial cumulative exposure. First-year (M1) medical students, who have no exposure to dental instruments, served as the negative controls, while dental faculty, many of whom are diagnosed with NIHL or self-report hearing problems, served as the positive controls. Thirty-one students (D1=11, D3=8, M1=12) and 10 dental faculty volunteered for the study. Participating students completed an online survey about their hearing health, exposure to excessive sounds within and outside school, and use of hearing protection. Sound levels of medical Osteopathic Manipulative Medicine (OMM) and dental Simulation (SIM) labs while in session were recorded with a calibrated sound meter. Plasma levels of prestin and otolin-1 were quantitated using commercial ELISA kits. The sound level of in-session OMM lab was significantly higher (72.64 ± 1.69 dBA) than SIM lab (65.37 ± 3.97 dBA). Both medical and dental students experienced similar exposure to outside school noises; however, dental students had significantly longer exposure to high-frequency dental instrument sounds in the SIM lab (12.3 hours/week; 74.93-80.51 dBA). Plasma prestin levels were lowest in D3 students (559.88 ± 24.91 ng/ml), followed by D1 students (576.27 ± 71.44 ng/ml). Negative control M1 students had higher levels (675.73 ± 90.23 ng/ml), while the positive control dental faculty group exhibited the highest prestin levels (727.71 ± 128.65 ng/ml). Prestin levels in D3 students were significantly lower than those in M1 students, and the dental faculty group had significantly higher prestin levels than both D1 and D3 students. No differences in otolin-1 levels were observed among the groups. Our finding that D3 students, with greater experience using dental instruments in the SIM lab, exhibited the lowest plasma prestin levels may indicate a protective mechanism by the OHCs, downregulating its expression to reduce the risk of NIHL. This is in line with the findings in the dental faculty, who self-reported NIHL or hearing problems and exhibited the highest prestin levels. The lack of changes in plasma otolin-1 levels across groups, combined with students self-reporting excellent hearing health, may offer alternate view of subclinical inner ear damage among dental students. Future studies incorporating audiometry and otoacoustic emission tests along with the inner ear biomarkers may provide better understanding of NIHL in dental students.

Efficacy and safety of acupuncture in the treatment of Meniere's disease: a systematic review and meta-analysis.

Meniere's disease (MD) is an idiopathic chronic inner ear disease that seriously impacts patients' physical and mental health. Medications may be effective for a proportion of patients, and additional effective treatments are still needed. This review aimed to evaluate the efficacy of acupuncture treatment for MD. Eight databases were systematically searched from their inception to June 1, 2024, to identify randomized clinical trials on acupuncture treatment for MD. The Cochrane Risk of Bias 2.0 tool was used to assess the risk of bias in included studies, and meta-analysis was conducted by RevMan 5.4 and Stata 16.0 software. Six studies were included in this review. The treatment group received acupuncture or acupuncture combined with Western medicine, while the control group was treated with Western medicine. The treatment group was superior to the control group in terms of efficacy rate (RR: 1.20; 95% CI: 1.11-1.29; p < 0.0001). The treatment group reduced dizziness handicap inventory (DHI) (MD: 6.94; 95% CI: 1.58-12.30; p = 0.01), tinnitus handicap inventory (THI) (MD: 6.52; 95% CI: 0.77-12.27; p = 0.03), stuffy ear visual analog scale (VAS) (MD: 0.87; 95% CI: 0.54-1.20; p < 0.0001) and pure tone audiometry score (MD: 6.57; 95% CI: 5.62-7.51; p < 0.0001) to a greater degree than those of the control group. There were some methodological shortcomings in the included studies, including failure to implement blinding, inappropriate outcome measures, and heterogeneity of clinical interventions, such as selected acupoints, acupuncture sessions, and therapist techniques. Acupuncture may improve the symptoms of vertigo, tinnitus, ear fullness and hearing loss in patients with MD. However, due to the lack of literature included in this study and methodological weaknesses like randomization, blinding, and clinical heterogeneity, more well-designed long-term follow-up RCTs are needed to evaluate the efficacy and safety of acupuncture. https://www.crd.york.ac.uk/PROSPERO/(CRD42024549261).

Evaluating the Auditory and Vestibular Functions of Patients with Multiple Sclerosis

Objective: Multiple sclerosis, a demyelinating disease of the central nervous system, is characterized by weakness of the arms and legs, sensory symptoms, ataxia, fatigue, diplopia, memory, concentration, attention disorder, and motor speech disorder. Common symptoms include epileptic seizures, cognitive impairment, hearing loss, and cortical symptoms. Materials and Methods: This study evaluated patients' mental functions with multiple sclerosis (MS) by considering their auditory and vestibular functions. A total of 30 patients, 15 healthy and 15 diseased, were recruited. In contrast, the experimental group consisted of individuals diagnosed with MS who had not had an attack for the last two months, over the age of 18, under the age of 60, and with similar characteristics in terms of gender. The audiological and vestibular tests on the experimental and patient groups were applied and the data obtained from these two groups were compared. Impedance audiometry test was performed on patients simultaneously. Result: The data obtained from our study, significant results were obtained for the right and left ears of MS patients to whom we applied the pure tone audiometry test. In the ABR test, unilateral hearing loss was observed in seven patients. In the VHIT test, while the VOR gains of 9 MS patients were outside the normal limits, the VOR gains of one patient in the left lateral canal were low. In the VEMP test, the wave latencies of 12 patients in the patient group were delayed, and the two patients' left-side P1 and N1 waveforms were not observed.

Whole-genome sequencing to identify rare variants in East Asian patients with dementia with Lewy bodies

Dementia with Lewy bodies (DLB) is the second most common form of age-related dementia, following Alzheimer’s disease (AD). DLB is associated with a worse prognosis than AD and is characterized by a more rapid progression of cognitive impairment and a poorer quality of life. In addition, the pathogenesis of DLB is less understood than that of AD, and only three genes—SNCA (α‐synuclein), APOE (apolipoprotein E), and GBA1 (glucosylceramidase beta 1)—have been convincingly demonstrated to be associated with DLB. In this study, we utilized whole-genome sequencing data from 1744 Japanese individuals, comprising 45 DLB patients and 1699 cognitively normal older adults, aiming to identify new genes associated with DLB. Our genome-wide association studies of genes with potentially deleterious mutations identified the CDH23 gene as being associated with DLB, reaching a Bonferroni-corrected significance (P = 7.43 × 10−4). The gene contained three ethnicity-specific heterozygous missense variants (rs181275139, rs563688802, and rs137937502). CDH23 has been linked to deafness syndromes, and DLB patients carrying these mutations displayed symptoms of subjective hearing loss, suggesting a potential association between DLB onset and auditory impairment. Additionally, we explored human leukocyte antigen (HLA) genotypes associated with DLB but found no significant associations. This result suggests that the pathology of DLB differs from that of Parkinson’s disease, which has been reported to have an association with HLA. Although a limitation of this study is the lack of replication of our findings, which require further validation in independent cohorts, our study enhances the understanding of the etiology of DLB in the Japanese population and provides new insights into the underlying mechanisms of its pathogenesis.

Audiovestibular symptoms in systemic sclerosis: a systematic review and meta-analysis.

Answer the following PICO question: Are patients diagnosed with systemic sclerosis (SSc) (Population) who are evaluated clinically and audiometrically (Intervention), have a higher prevalence of audiovestibular pathology when compared with non-SSc patients (Comparison), and how do they present symptomatically and on testing audiovestibular symptomatology and testing modalities (Outcome)? A systematic review and meta-analysis was performed. PubMed, Scopus, CINAHL, and Cochrane Library databases were searched from inception to November 27, 2023. Studies of patients diagnosed with SSc and audiologic and vestibular symptoms were selected for review. Studies of non-SSc pathologies, studies without audiovestibular outcomes, and case reports (fewer than four patients) were excluded. A meta-analysis of proportions and comparison of weighted proportions was performed in MedCalc 20.217. Thirteen studies with 414 SSc patients and 390 control patients were included. The mean ± SD symptom duration was 108.5 ± 71.8 (range: 6-600) months for SSc patients. Comparison of proportions showed patients with SSc were significantly more burdened with symptoms of tinnitus (Δ34.1% [95% CI, 27.6-40.5]; p < 0.0001), vertigo (Δ32.4% [95% CI, 24.8-40.3]; p < 0.0001), and subjective hearing loss (Δ26.0% [95% CI, 20.8-31.3]; p < 0.0001) compared to control patients. Findings regarding vestibular testing were not meta-analyzable because of incomplete data and lack of standard reporting. SSc patients showed statistically significant, yet not clinically significant, worse hearing than controls. These differences, along with increased reports of subjective audiological and vestibular symptoms in patients with SSc, emphasize interdisciplinary collaboration and assessment of SSc for audiovestibular pathologies in the appropriate clinical context.

The role of socioeconomic factors in sex differences in intrinsic capacity among older adults: A cross-sectional study in Taiwan

ObjectivesThe World Health Organization’s Integrated Care for Older People (ICOPE) framework launched in 2019 is used to assess the intrinsic capacity of older individuals. Older women may face greater socioeconomic disadvantages, which can impact their physical and mental well-being. Therefore, we examined sex differences in intrinsic capacity and the influence of socioeconomic status. MethodsWe conducted a cross-sectional study in Tainan, Taiwan, recruiting 1,268 adults aged 60 or older in 2022. The ICOPE screening assessed cognitive decline, limited mobility, malnutrition, visual impairment, hearing loss, and depressive symptoms. Intrinsic capacity scores ranged from 0 to 6 and were categorized as impairment (1 or higher) or no impairment (0). Binary logistic regression models were used to analyze sex differences in intrinsic capacity, adjusting sequentially for demographics, lifestyle, and socioeconomic factors. ResultsThe prevalence of intrinsic capacity impairment was 34 %. Women had significantly higher odds of intrinsic capacity impairment (women vs. men, odds ratio [OR] = 1.39, 95 % CI = 1.10–1.75). After sequentially adjusting for demographic characteristics, lifestyle, and socioeconomic factors, the ORs were 1.46 (95 % CI = 1.12–1.90), 1.69 (95 % CI = 1.23–2.31), and 1.24 (95 % CI = 0.88–1.73), respectively. Stratified analyses showed that higher odds of impairment in women than in men was evident only in the financially dependent group (P for interaction = 0.059). ConclusionsOlder women in Taiwan have poorer intrinsic capacity than men, a disparity largely attributable to women’s lower socioeconomic status. Strategies to promote healthy aging among women from disadvantaged socioeconomic backgrounds may help mitigate this sex difference in intrinsic capacity.

Correlation of Endolysmphatic Duct Signal Intensity With Clinical Features in Otological Diseases.

Bilateral high signal intensity (SI) in the endolymphatic duct (ED) on magnetic resonance imaging (MRI) has been reported as a common characteristic in ears with large vestibular aqueduct syndrome (LVAS). However, the significance of bilateral high SI in the ED remains unknown. The present study aimed to compare the correlation between SI in the ED and the clinical manifestations in various otological disorders and consider the significance of the MRI findings. Retrospective study. University hospital. The study included 2,450 ears from 1,225 patients with various otological disorders. All ears underwent 3T enhanced MRI and were evaluated for the degree of endolymphatic hydrops (EH) and the SI ratios (SIRs; i.e., the calculation between SIs in the ED and those in the cerebellum). The imaging findings were compared with their clinical symptoms. Ears with bilateral high SIRs in the ED tended to have considerably less occurrence of EH in both the cochlea and vestibule than those with bilateral low SIRs. Ears with SIR ≥8 showed significantly elevated hearing thresholds at lower frequencies on pure-tone audiometry, although they exhibited a markedly lower incidence of cochlear EH than those with SIR <8. Moreover, ears with vertigo exhibited notably higher SIRs than those without vertigo. Bilateral high SI in the ED on MRI may reflect pathophysiology underlying sensorineural hearing loss and vestibular symptoms, which are not associated with EH formation.

Trigeminal cervical complex: A neural network affecting the head and neck

ObjectivesTo introduce the trigeminal cervical complex (TCC) as a comprehensive framework for understanding the anatomical and functional scope of the afferences and efferences of the trigeminal nerve and explaining common otolaryngologic symptoms, including head and neck myofascial pain syndrome. Additionally, it explores how the bidirectional transmission of neurotransmitters contributes to the sensitization of the TCC and motor nuclei. MethodsThe study was conducted as a narrative review. The authors performed a comprehensive search of multiple databases, including Medline/OVID, Embase, Scopus, and PubMed, covering publications from inception until August 2023. Both keywords and medical subject headings related to the TCC were utilized in the search. Information from 66 studies was extracted based on predetermined inclusion and exclusion criteria. ResultsThis review discusses the multiple afferent connections from cranial nerves, specifically VII, IX, X, and XI, to the TCC, and their respective efferent pathways. These connections may explain various clinical manifestations in the head and neck that cannot be attributed to other medical conditions. Additionally, the review highlights the dual sensory and motor nature of cranial nerves, emphasizing the bidirectional transmission of neurotransmitters in head and neck areas, which leads to the sensitization of both the TCC and motor nuclei innervating the cervicofacial muscles. ConclusionThe authors hypothesize that the central and peripheral sensitization and the intricate connections of the TCC can elucidate the pathophysiology of conditions such as otalgia, tinnitus, hearing loss, vertigo, headache, cervicogenic dizziness, bruxism, and other symptoms affecting the head and neck.

Vestibular schwannoma-related increased labyrinthine post-gadolinium 3D-FLAIR signal intensity and association with hearing impairment.

Vestibular schwannomas (VSs) are benign neurogenic tumors commonly associated with progressive unilateral hearing loss, tinnitus, and vestibular symptoms. Growing evidence links signal changes in the VS-adjacent labyrinth with sensorineural hearing loss. This study seeks to quantify the association of labyrinthine signal on post-gadolinium 3D-FLAIR imaging correlates with hearing loss and to evaluate potential longitudinal changes over time. Selected patients were identified from a prospectively maintained VS registry. Mean signal intensity ratios of the bilateral labyrinth and pons were measured on 3D-FLAIR post-gadolinium MRI. Correlations with paired audiometric data including pure tone average (PTA), word recognition score (WRS), and AAO-HNS hearing class within one year were evaluated. 125 studies obtained from 2015 to 2022 among 66 patients undergoing observational management for sporadic VS were analyzed. Increased signal intensity was noted of the VS-affected labyrinth/contralateral labyrinth (mean ratio 1.56, SD 0.58). Increased signal intensity was associated with increased PTA on both labyrinthine (correlation coefficient [CC] 0.20, p=0.03) and pontine comparisons (CC 0.24, p=0.006), and with decreased WRS on pontine comparisons (CC -0.18, p=0.04). Increased signal intensity was significantly associated with non-serviceable AAO-HNS C/D hearing when intensities were compared to the pons (p=0.01) but not the contralateral labyrinth (p=0.1). Among 44 patients with available follow-up, no statistically significant associations were identified between audiometric data and signal changes over the same interval. Increased 3D-FLAIR post-gadolinium labyrinthine signal is associated with sensorineural hearing loss; however, its relationship with hearing trajectory remains unclear. Overall findings suggest that while post-gadolinium 3D-FLAIR techniques are sensitive to inner ear involvement associated with VS, the driving mechanism and their temporal relationships with labyrinthine signal intensity and hearing impairment remain unknown. AAO-HNS =American Academy of Otolaryngology -Head and Neck Surgery. BLB =blood-labyrinth barrier. CPA = cerebellopontine angle. IAC = internal auditory canal. PTA = pure tone average; SIR = signal intensity ratio. VS = vestibular schwannoma. WRS = word recognition score.

Stakeholder-informed positivity thresholds for disease markers and risk scores: a methodological framework and an application in obstructive lung disease

ObjectivesA positivity threshold is often applied to markers or predicted risks to guide disease management. These thresholds are often decided exclusively by clinical experts despite being sensitive to the preferences of patients and general public as ultimate stakeholders. Study Design and SettingWe propose an analytical framework for quantifying the net benefit (NB) of an evidence-based positivity threshold based on combining preference-sensitive (eg, how individuals weight benefits and harms of treatment) and preference-agnostic (eg, the magnitude of benefit and the risk of harm) parameters. We propose parsimonious choice experiments to elicit preference-sensitive parameters from stakeholders, and targeted evidence synthesis to quantify the value of preference-agnostic parameters. We apply this framework to maintenance of azithromycin therapy for chronic obstructive pulmonary disease using a discrete choice experiment to estimate preference weights for attribute level associated with treatment. We identify the positivity threshold on 12-month moderate or severe exacerbation risk that would maximize the NB of treatment in terms of severe exacerbations avoided. ResultsIn the case study, the prevention of moderate and severe exacerbations (benefits) and the risk of hearing loss and gastrointestinal symptoms (harms) emerged as important attributes. Four hundred seventy seven respondents completed the discrete choice experiment survey. Relative to each percent risk of severe exacerbation, preference weights for each percent risk of moderate exacerbation, hearing loss, and gastrointestinal symptoms were 0.395 (95% confidence interval [CI] 0.338–0.456), 1.180 (95% CI 1.071–1.201), and 0.253 (95% CI 0.207–0.299), respectively. The optimal threshold that maximized NB was to treat patients with a 12-month risk of moderate or severe exacerbations ≥12%. ConclusionThe proposed methodology can be applied to many contexts where the objective is to devise positivity thresholds that need to incorporate stakeholder preferences. Applying this framework to chronic obstructive pulmonary disease pharmacotherapy resulted in a stakeholder-informed treatment threshold that was substantially lower than the implicit thresholds in contemporary guidelines.

Hearing Loss and Depressive Symptoms Among Community-Dwelling Older Adults - Liaoning, Henan, and Guangdong Provinces, China, 2019-2020.

More than half of Chinese older adults over 60 are suffering from hearing loss (HL), which might increase the risk of depressive symptoms. The results indicated a significant association between severe or profound HL and depressive symptoms, characterized by notable age and gender disparities, particularly among women aged 60-74 years old. Timely intervention and treatment for elderly individuals with HL, particularly younger female elders suffering from severe or profound HL, are pivotal in reducing depressive symptom rates and are key policy considerations.

Patient-Centered Neurosurgery: Improved Outcomes after Subtotal Surgical Resection and Nonframe-Based Fractionated Stereotactic Radiotherapy for Large Cerebellopontine Angle Vestibular Schwannoma

Abstract Background The novel paradigm in neurosurgery for large vestibular schwannomas (VSs) involves a combination of planned subtotal resection (STR) and scheduled postoperative fractionated stereotactic radiotherapy (FSRT). Methods This retrospective observational study aimed to evaluate and compare the outcomes of patients who underwent either near-total resection (NTR) or were treated with STR and scheduled FSRT over 6 years. We systematically coded and analyzed the data to obtain comprehensive insights into the results. Results Our study included 65 patients diagnosed with large VS, who underwent retrosigmoid craniotomy and NTR or STR for tumor removal. The mean age of the cohort was 42.6 (standard deviation: 16.2) years, with 40 (61.5%) female patients. All patients presented with asymmetrical sensory neural hearing loss and other prevalent symptoms such as headache (58) and tinnitus (58). Cerebellar signs, speech abnormalities, and pyramidal signs were also observed. Ten patients underwent NTR, and 55 underwent STR followed by an FSRT at 3 months or later based on the physical and radiological findings. Facial nerve palsy was noted in all cases of those who underwent NTR, while no instances of facial nerve palsy, lower cranial nerve palsy, posterior fossa, or brain stem injury were noted in the STR group. One patient undergoing STR experienced meningitis and died despite best possible medical management. The majority of patients showed symptom improvement, and none of the patients reported recurrence at 3-year follow-up. Conclusion The combined approach of STR and FSRT ensures safety, high tumor control rates, and favorable outcomes. It provides a sensible alternative to NTR for managing large tumors, emphasizing tumor debulking while preserving neurological function for overall benefit.

Association of intrinsic capacity and medication non-adherence among older adults with non-communicable diseases in Taiwan

ObjectivesMedication non-adherence among older adults with non-communicable diseases (NCDs) remains prevalent worldwide, which causes hospitalization and mortality. Our study aimed to examine the association of medication non-adherence with level of overall intrinsic capacity (IC), pattern of IC, and specific IC component among older adults with NCDs. MethodsA cross-sectional questionnaire-based survey of 1268 older adults aged 60 years and above was conducted in 2022 in southern Taiwan. Among them, 894 suffered from 1 more NCD were included in this study. The Integrated Care for Older People Screening Tool for Taiwanese and the Adherence to Refills and Medication Scale were used to assess IC and medication non-adherence, respectively. Latent class analysis (LCA) was used to identify patterns of IC impairment, and binary logistic regression was used to assess the association between medication non-adherence and IC. ResultsOlder adults in the moderate (score: 1–2) or low (score≧3) overall IC groups were more likely to experience medication non-adherence (moderate: adjusted odds ratio (aOR) 1.57 [95% CI: 1.05–2.36]; low: 2.26 [1.40–3.67]). The “physical and nutritional impairments accompanied by depressive symptoms” group was associated with statistically higher odds of medication non-adherence (aOR 1.66 [1.01–2.73]). Older adults with cognitive impairment, hearing loss, or depressive symptoms showed greater likelihood of medication non-adherence (cognitive impairment: aOR 1.53 [1.03–2.27]; hearing loss: aOR 1.57 [1.03–2.37]; depressive symptoms: aOR 1.81 [1.17–2.80]). ConclusionsIntervention for improving medication non-adherence among older adults with NCDs should consider IC.

Pharmacological Interventions for Menière's Disease: A Systematic Review and Network Meta-Analysis.

Objective: Evaluation of the effectiveness and posttreatment effects of intratympanic gentamicin and corticosteroids in treating patients with Ménière's disease (MD). Methods: Based on PubMed and Embase databases, randomized controlled trials using intratympanic injections of 4 drugs (gentamicin, methylprednisolone, dexamethasone, and placebo) for the treatment of MD were searched from 1995 to October 2023, and the literature was screened according to inclusion and exclusion criteria, and data were netted for meta-analysis using Stata 17. Results: A total of 13 studies were selected, involving 559 participants, with follow-up time ranging from 3 to 28 months. Meta-analysis showed that there was no statistically significant difference in pure-tone average between gentamicin and dexamethasone [standardized mean difference (SMD) = 0.09, 95% confidence interval (CI) (-0.42, 0.24), P < .05]. Compared to placebo, intratympanic injection of gentamicin [risk ratio (RR) = 1.18, 95% CI (0.43, 1.93)], methylprednisolone [RR = 0.88, 95% CI (0.07, 1.70)], and dexamethasone [RR = 0.70, 95% CI (-0.01, 1.41)] all showed better efficacy in treating vertigo. For the treatment of tinnitus, the SUCRA ranking results showed that dexamethasone was the most effective, followed by methylprednisolone and gentamicin. Conclusion: Pharmacological intervention is more effective than placebo in treating MD. Although gentamicin treatment shows significant effects in treating vertigo, corticosteroid combination therapy is markedly superior to gentamicin in controlling hearing loss and vertigo symptoms.

A rare cause of malignant otitis externa and skull base osteomyelitis.

An elderly male with type 2 diabetes presented with a 2-month history of otalgia and severe headaches. He was diagnosed with malignant otitis externa (MOE) and was commenced on empirical treatment with oral ciprofloxacin. Pseudomonas is the most common cause of MOE. A baseline CT scan was undertaken that demonstrated skull base osteomyelitis (SBO) due to findings of bone erosion at the mastoid tip and an infiltrating soft tissue mass eroding the clivus. Eight weeks later, he returned with worsening and bilateral symptoms of otitis externa, hearing loss, temporomandibular pain and dysfunction. Worsening and now bilateral malignant otitis externa were confirmed with an MRI scan that also demonstrated a small fluid collection in his left temporal region. The collection was aspirated and grew scedosporium apiospermum. He was diagnosed with fungal SBO and was commenced on treatment with the antifungal voriconazole, with significant improvement in symptoms and radiological findings. Fungal osteomyelitis is more likely in immunosuppressed patients, particularly those with type 2 diabetes. Fungal aetiology should be suspected in patients with progressive symptoms, despite treatment. A microbiology diagnosis of fungal SBO or MOE can be challenging to obtain and can lead to diagnostic delay. A sampling of the external auditory canal can aid in diagnosing MOE; however, scedosporium may also be isolated as a commensal organism. Aspirations from accessible fluid collections, infratemporal fossa needle sample and bone biopsy can provide material for diagnosis. Scedosporium is a rare cause of disease in humans, however, fungal infections are increasing in humans, due to an increase in susceptible populations. Scedosporium apiospermum is a rare cause of SBO and should be considered in patients not responding to standard treatment.

The NM_033380.2 transcript of the COL4A5 gene contains a variable splice site c.4822-10T>C, which has been identified as a causative factor for Alport syndrome.

Alport Syndrome (AS) is a genetic kidney disorder characterized by progressive hearing loss and atypical eye symptoms, resulting in a poor prognosis and lack of effective targeted therapy. The primary mode of inheritance is X-linked dominant (XLAS) due to variants in the COL4A5 gene. This study revealed a previously unidentified alternative form of the COL4A5 gene, namely, the c.4822-10T>C variant, which was confirmed through in vitro experiments. To investigate the impact of a splicing variant on COL4A5 mRNA production, an in vitro minigene splicing assay was utilized. Additionally, molecular dynamics was employed to predict the ability of α5(IV) to form a triple helix. Results from the experiment revealed that the wild-type (WT) plasmid produced two distinct mRNA products simultaneously. Sequence analysis using the BLAST database revealed a 173-bp deletion in the mRNA sequence of the first product, indicating a potential similarity to the XM_016942897.2 transcript of Pan troglodytes. The second mRNA product of the WT plasmid contained the full sequence of exons 51, 52, and 53, as anticipated. Conversely, the mutant (MT) plasmid generated a single mRNA product with a 173-bp deletion in exon 52, leading to the identification of the mature mRNA expression as NM_033380.2: COL4A5: c.4822_4994del. In the context of nonsense-mediated mRNA decay (NMD), the deletion c.4822_4994 results in the production of a truncated protein, p.His1608*, that terminates prematurely. This truncated protein may disrupt the secondary structure of α5(IV) and potentially cause an abnormal conformation of α345(IV). This study examines the relationship between the variable splicing pattern in the NM_033380.2 transcript of the COL4A5 gene in XLAS patients and the presence of the COL4A5 gene splice variant c.4822-10T>C. Our findings indicate that the c.4822-10T>C splice variant leads to activation of nonsense-mediated mRNA degradation (NMD) and reduced COL4A5 mRNA expression, resulting in inadequate synthesis of the corresponding proteins. This aligns with the patient's immunofluorescence results showing negative α5(IV) chain presence at the glomerular basement membrane, bursa, and tubular basement membrane, confirming the pathogenic nature of c.4822-10T>C.