| 1. |
- Fogels, Jonas, et al.
(författare)
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Single-Sided Deafness-Outcomes of Three Interventions for Profound Unilateral Sensorineural Hearing Loss: A Randomized Clinical Trial
- 2020
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Ingår i: Otology & Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 41:6, s. 736-744
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Tidskriftsartikel (refereegranskat)abstract
- Objective:A comparison of three interventions for profound unilateral sensorineural hearing loss.Study Design:Prospective, crossover randomized clinical trial.Participants:Fifteen participants with profound unilateral sensorineural hearing loss.Interventions:Three potential technical interventions were compared: Bone Conduction Device on softband, Contralateral Routing of Signal (CROS), and Remote Microphone . Each intervention was randomly trialed for a period of 3 weeks, separated by a 1 week washout period.Outcome Measures:Speech in noise recognition test performed under four conditions (lateral noise poorer ear, lateral noise better ear, speech poorer ear, speech better ear). Standardized questionnaires (Abbreviated Profile of Hearing Aid Benefit, Bern Benefit in Single Sided Deafness Questionnaire, and Speech, Spatial, and Other Qualities 12) were used to evaluate amplification benefit at baseline and following each intervention.Results:The use of remote microphone provided the best results in the speech recognition in noise test. A benefit in some signal-to-noise ratios was presented of the CROS over bone conduction device on softband in the Speech Poor Ear condition. On questionnaires of benefit, participants did not rate a particular intervention as significantly better than any other. Following the study, CROS was the intervention preferred by the 8 of 15 participants (53%). The majority of participants (80%) chose to continue with an intervention rather than no treatment.Conclusion:The use of all interventions resulted in increased performance in speech recognition in noise and rated higher on subjective benefits in comparison with baseline. People with SSD are a heterogeneous population when considering perceived difficulties. Future research should focus on segmenting the population of SSD depending on factors such as etiology, high frequency loss in the better ear, and age of acquired loss for the poorer ear. This stratification may possibly increase the benefit for the patient in terms of more individual-based clinical routines.
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| 2. |
- Gladine, Kilian, et al.
(författare)
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Evaluation of Artificial Fixation of the Incus and Malleus With Minimally Invasive Intraoperative Laser Vibrometry (MIVIB) in a Temporal Bone Model
- 2020
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Ingår i: Otology and Neurotology. - : LIPPINCOTT WILLIAMS & WILKINS. - 1531-7129 .- 1537-4505. ; 41:1, s. 45-51
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Tidskriftsartikel (refereegranskat)abstract
- Background: A significant number of adults suffer from conductive hearing loss due to chronic otitis media, otosclerosis, or other pathologies. An objective measurement of ossicular mobility is needed to avoid unnecessarily invasive middle ear surgery and to improve hearing outcomes.Methods: Minimally invasive intraoperative laser vibrometry provides a method that is compatible with middle ear surgery, where the tympanic membrane is elevated. The ossicles were driven by a floating mass transducer and their mobility was measured using a laser Doppler vibrometer. Utilising this method, we assessed both the absolute velocities of the umbo and incus long process as well as the incus-to-umbo velocity ratio during artificial fixation of the incus alone or incus and malleus together.Results: The reduction of absolute velocities was 8 dB greater at the umbo and 17 dB at the incus long process for incus-malleus fixations when compared with incus fixation alone. Incus fixation alone resulted in no change to the incus-to-umbo velocity ratio where incus-malleus fixations reduced this ratio (-11 dB). The change in incus velocity was shown to be the most suitable parameter to distinguish between incus fixation and incus-malleus fixation. When the whole frequency range was analyzed, one could also differentiate these two fixations from previously published stapes fixation, where the higher frequencies were less affected.Conclusion: Minimally invasive intraoperative laser vibrometry provides a promising objective analysis of ossicular mobility that would be useful intraoperatively.
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| 3. |
- Helpard, Luke, et al.
(författare)
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Three-Dimensional Modeling and Measurement of the Human Cochlear Hook Region : Considerations for Tonotopic Mapping
- 2021
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Ingår i: Otology and Neurotology. - : Lippincott Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 42:6, s. E658-E665
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Tidskriftsartikel (refereegranskat)abstract
- Hypothesis: Measuring the length of the basilar membrane (BM) in the cochlear hook region will result in improved accuracy of cochlear duct length (CDL) measurements.Background: Cochlear implant pitch mapping is generally performed in a patient independent approach, which has been shown to result in place-pitch mismatches. In order to customize cochlear implant pitch maps, accurate CDL measurements must be obtained. CDL measurements generally begin at the center of the round window (RW) and ignore the basal-most portion of the BM in the hook region. Measuring the size and morphology of the BM in the hook region can improve CDL measurements and our understanding of cochlear tonotopy.Methods: Ten cadaveric human cochleae underwent synchrotron radiation phase-contrast imaging. The length of the BM through the hook region and CDL were measured. Two different CDL measurements were obtained for each sample, with starting points at the center of the RW (CDLRW) and the basal-most tip of the BM (CDLHR). Regression analysis was performed to relate CDLRW to CDLHR. A three-dimensional polynomial model was determined to describe the average BM hook region morphology.Results: The mean CDLRW value was 33.03 ± 1.62 mm, and the mean CDLHR value was 34.68 ± 1.72 mm. The following relationship was determined between CDLRW and CDLHR: CDLHR = 1.06(CDLRW)-0.26 (R2 = 0.99).Conclusion: The length and morphology of the hook region was determined. Current measurements underestimate CDL in the hook region and can be corrected using the results herein.
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| 4. |
- Koro, Eleonor, et al.
(författare)
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Long-term follow-up in active transcutaneous bone conduction implants
- 2023
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Ingår i: Otology and Neurotology. - : Wolters Kluwer. - 1531-7129 .- 1537-4505. ; 45:1, s. 58-64
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate long-term outcomes of active transcutaneous bone conduction implants (atBCIs) regarding safety, hearing, and quality of life.Study design: A clinical study with retrospective medical record analysis combined with prospective audiometry and quality of life questionnaires.Setting: Three secondary to tertiary care hospitals.Patients: All subjects operated with an atBCI in three regions in Sweden were asked for informed consent. Indications for atBCI were single-sided deafness (SSD) and conductive or mixed hearing loss (CMHL).Intervention: Evaluation of atBCI.Main Outcome Measures: Pure tone and speech audiometry and Glasgow Benefit Inventory (GBI).Result: Thirty-three subjects were included and 29 completed all parts. The total follow-up time was 124.1 subject-years. Nineteen subjects had CMHL and in this group, pure tone averages (PTA4) were 56.6 dB HL unaided and 29.6 dB HL aided, comparable with a functional gain of 26.0 dB. Effective gain (EG) was −12.7 dB. With bilateral hearing, Word Recognition Scores (WRS) in noise were 36.5% unaided and 59.1% aided. Fourteen subjects had SSD or asymmetric hearing loss (AHL) and in this group, PTA4 were >100 dB HL unaided and 32.1 dB HL aided with the contralateral ear blocked. EG was −9.1 dB. With bilateral hearing, WRSs were 53.2% unaided and 67.9% aided. The means of the total GBI scores were 31.7 for CMHL and 23.6 for SSD/AHL.Conclusion: Few complications occurred during the study. The atBCI is concluded to provide a safe and effective long-term hearing rehabilitation.
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| 5. |
- Li, Hao, 1984-, et al.
(författare)
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Aeration of the Human Prussak's Space : A 3D Synchrotron Imaging Study
- 2021
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Ingår i: Otology and Neurotology. - : Lippincott Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 42:7, s. E894-E904
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Prussak's space (PS) is an intricate middle ear region which may play an essential role in the development of middle ear disease. The three-dimensional (3D) anatomy of the human PS and its drainage routes remain relatively unknown. Earlier studies have histologically analyzed PS, by micro-dissection and endoscopy. Here, we used synchrotron-radiation phase-contrast imaging (SR-PCI), 3D reconstructions, and modeling to study the framework of the human PS, including aeration pathways. It may lead to increased understanding of development of middle ear pathology.Design: Nine human temporal bone specimens underwent in-line SR-PCI at the Canadian Light Source in Saskatoon, Saskatchewan, Canada. Data were processed with volume-rendering software to create 3D reconstructions using scalar opacity mapping and segmentations to visualize its walls in fixed, undecalcified human temporal bones.Results: The PS was found to be an irregular, variably shaped chamber with different aeration systems. Three different drainage pathways were found: 1) via the posterior malleolar pouch of von Troltsch in seven of nine ears; 2) directly posterior-inferior into the mesotympanum medial to the posterior malleolar pouch in one ear; and 3) anteriorly in another. The posterior-inferior communications depended on the anatomy of the posterior malleolar fold. In one bilateral case, the aeration differed between the ears. Earlier descriptions of upper ventilation routes between the PS and the epitympanic spaces could not be substantiated.Conclusions: The 3D anatomy of the membrane folds organizing the PS in humans was demonstrated for the first time using in-line SR-PCI. The PS was always aerated into the mesotympanum, suggesting its relative independence of attic ventilation. The impact of its various drainage routes on middle ear ventilation and disease were discussed.
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| 6. |
- Lindell, Ellen, 1979, et al.
(författare)
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Dizziness Symptoms, Balance Confidence, and Vestibular Function in Older Women Reporting Dizziness and Unsteadiness
- 2022
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Ingår i: Otology & Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 43:4, s. E482-E488
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of this article is to evaluate older women who report dizziness on a daily or weekly basis, but not seeking medical care for their problems, for levels of patient-reported outcome measures related to dizziness, balance confidence, vestibular impairment, benign paroxysmal positional vertigo walking speed, Timed Up and Go (TUG), balance confidence, depression, and anxiety. Study Design: Cross-sectional survey. Setting: Secondary referral center. Patients: Patients coming for bone density measurements answered questions regarding occurrence of dizziness. Women reporting dizziness on a daily or weekly basis were considered eligible and invited for investigation at the Ear, Nose, and Throat clinic at Sodra alvsborg Hospital, Sweden. Main Outcome Measure: Patients completed the Dizziness Handicap Inventory (DHI), Activities-specific Balance Confidence Scale, and Hospital Anxiety and Depression Scale and were investigated with the video Head Impulse Test, for benign paroxysmal positional vertigo, walking speed, and TUG test. Results: Fifty-two female patients were enrolled. Associations were found between high levels of DHI and high distress due to dizziness, and low levels of balance confidence and reduced walking speed and TUG test time. Participants with higher DHI levels reported higher levels of both depression and anxiety. No associations were found between levels of DHI and results on vestibular tests. Conclusion: Women reporting higher levels of distress due to dizziness had reduced walking speed and reported less balance confidence and higher levels of anxiety and depression. The findings support the theory that DHI captures aspects of overall self-rated wellbeing and function rather than structural vestibular deficits.
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| 7. |
- Maier, Hannes, et al.
(författare)
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Consensus Statement on Bone Conduction Devices and Active Middle Ear Implants in Conductive and Mixed Hearing Loss
- 2022
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Ingår i: Otology and Neurotology. - : Lippincott, Williams & Wilkins. - 1531-7129 .- 1537-4505. ; 43:5, s. 513-529
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Tidskriftsartikel (refereegranskat)abstract
- Nowadays, several options are available to treat patients with conductive or mixed hearing loss. Whenever surgical intervention is not possible or contra-indicated, and amplification by a conventional hearing device (e.g., behind-the-ear device) is not feasible, then implantable hearing devices are an indispensable next option. Implantable bone-conduction devices and middle-ear implants have advantages but also limitations concerning complexity/invasiveness of the surgery, medical complications, and effectiveness. To counsel the patient, the clinician should have a good overview of the options with regard to safety and reliability as well as unequivocal technical performance data. The present consensus document is the outcome of an extensive iterative process including ENT specialists, audiologists, health-policy scientists, and representatives/technicians of the main companies in this field. This document should provide a first framework for procedures and technical characterization to enhance effective communication between these stakeholders, improving health care.
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| 8. |
- Osborne, M. S., et al.
(författare)
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Clinical Evaluation of a Novel Laser-Ablated Titanium Implant System for Bone Anchored Hearing Systems in a Pediatric Population and the Relationship of Resonance Frequency Analysis With Implant Survival
- 2022
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Ingår i: Otology & Neurotology. - : Ovid Technologies (Wolters Kluwer Health). - 1531-7129 .- 1537-4505. ; 43:2, s. 219-226
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the clinical outcomes of pediatric patients implanted a novel 4.5 mm wide laser ablated titanium bone anchored implant system and to evaluate the implant stability over the first 12-month period. Study Design: A prospective, single-subject, repeated measure, cohort study. Participants served as their own controls. Setting: Community and tertiary referral hospital pediatric assessment center. Patients: A total of 115 consecutive pediatric patients aged 4 to 15 years were implanted with 176 laser ablated titanium bone anchored implants from January 2016 to January 2019. Main Outcome Measure: Clinical outcomes, implant failure rates, and post implantation implant stability quotient (ISQ) scores were studied over the first 12-month period. Data were analyzed for statistical significance through mixed effect modeling, with the significance level p = 0.01. Results: A median 12-month survival of 96.6% was observed. Six implants (3.5%) were lost in total, one of these (0.6%) was lost due to trauma. Adverse skin reactions (Holgers grade 2-4) were observed in 4.4% of all postoperative visits, occurring in 22 individuals (19.1%). Neither the ISQ high (ISQH) nor ISQ low (ISQL) values increased significantly between the stage 1 and 2 surgeries. In contrast, the ISQ results, irrespective of abutment size, demonstrated an increasing trend from 49.1 to 57 over the 12 months review period. A statistically significant change was only demonstrated from the 3 months follow up onwards. Conclusion: The use of 4.5 mm wide laser-ablated titanium bone anchored hearing implants resulted in superior survival rates and excellent clinical outcomes compared with previous implant systems.
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| 9. |
- Pierre, Pernilla Videhult, et al.
(författare)
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High-Dose Furosemide Enhances the Magnetic Resonance Signal of Systemic Gadolinium in the Mammalian Cochlea
- 2020
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Ingår i: Otology and Neurotology. - : LIPPINCOTT WILLIAMS & WILKINS. - 1531-7129 .- 1537-4505. ; 41:4, s. 545-553
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Tidskriftsartikel (refereegranskat)abstract
- Hypothesis:Furosemide alters the permeability of the intrastrial fluid-blood barrier.Background:The cochlear sensory cells are protected by the blood-perilymph and intrastrial fluid-blood barriers, which hinder substances, including gadolinium-based contrast agents (GdCAs), to enter the endolymphatic space. High-dose furosemide causes transient shift of hearing thresholds and morphological changes in stria vascularis. Furosemide is also known to enhance drug-induced ototoxicity.Methods:Furosemide (400mg/kg b.w.) was injected i.v. in Balb/C mice (n=20). Twenty minutes later, the GdCA gadobutrol, gadopentetic acid, or gadoteric acid was injected i.v. The distribution of GdCA to the perilymphatic and endolymphatic spaces was studied with MRI (9.4T) for 250minutes.Results:The perilymphatic and endolymphatic spaces were signal-enhanced in all animals. Gadopentetic acid and gadoteric acid yielded similar signal enhancement in all three scalae, while gadobutrol yielded significantly higher enhancement in scala tympani than scala media (p=0.043) and scala vestibuli (p=0.043). The signal enhancement reached a plateau but did not decrease during the time of observation.Conclusion:Treatment with a high dose of furosemide before injection of a GdCA resulted in enhancement of the MRI signal in the endolymphatic space as well as the perilymphatic space, which supports our hypothesis that furosemide alters the permeability of the intrastrial fluid-blood barrier.
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| 10. |
- Prodanovic, Srdan, et al.
(författare)
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Consequences of Mastoidectomy on Bone Conducted Sound Based on Simulations in a Whole Human Head
- 2020
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Ingår i: Otology and Neurotology. - : LIPPINCOTT WILLIAMS & WILKINS. - 1531-7129 .- 1537-4505. ; 41:9, s. E1158-E1166
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Tidskriftsartikel (refereegranskat)abstract
- Hypothesis: The aim of this study is to investigate how a mastoidectomy surgery affects bone conduction (BC) sound transmission using a whole head finite element model. Background: Air conduction (AC) and BC hearing thresholds are normally used to evaluate the effect of an ear surgery. It is then assumed that the BC hearing thresholds are unaffected by the surgery. Moreover, BC hearing aids are used in cases of unilateral or conductive hearing loss in heads that have undergone a mastoidectomy surgery. Given the invasiveness of the surgery, the BC hearing sensitivity may be altered by the surgery itself. Methods: Two types of mastoid surgery, canal wall up and canal wall down, with and without obliteration, were simulated in a whole head finite element model for BC stimulation, the LiUHead. The evaluations were conducted for two different methods of applying the BC sound, at the skin surface (B71 transducer) and directly at the bone (BC hearing aid). Results: The results showed that a mastoidectomy surgery increased the cochlear vibration responses with BC stimulation. The increase was less than 5 dB, except for a canal wall down surgery which gave an increase of up to 8 dB at frequencies close to 10 kHz. The increase was greater at the ipsilateral cochlea compared with the contralateral cochlea. Conclusion: A mastoidectomy surgery increases the vibration at both cochleae for BC stimulation and the increase generally improved with frequency. Obliteration of the surgical cavity does not influence BC sound transmission.
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