Otosclerosis and vestibular dysfunction

Vestibular dysfunction associated with otosclerosis has been observed for many years. In a recent clinical study of patients exhibiting progressive sensorineural hearing loss of unknown origin, it was demonstrated that approximately 50% of the cases had cochlear otosclerosis/otospongiosis as the most probable cause for the hypacusis. Of these, approximatley 55% had vestibular symptoms. In the present study, the effect of sodium fluoride therapy in this group of patients is analyzed. It will be demonstrated that such therapy is beneficial not only in controlling the progressive sensorineural hearing loss but also the symptoms of vestibular dysfunction in patients with cochlear otosclerosis (otospongiosis).

Bacterial meningitis and sensorineural hearing loss: a prospective investigation

The objectives of the present investigation are as follows: to prospectively assess the incidence of sensorineural hearing loss (SHL) associated with bacterial meningitis; to evaluate the onset and degree of SHL; and to describe the audiometric pattern. Forty-seven patients were studied otologically and audiologically. The incidence of SHL was 11%. Late onset of SHL was not observed, however, one patient demonstrated a probable progressive hearing loss. Both bilateral and unilateral hearing loss were noted. The degree of hearing loss varied from mild to profound, with no consistent audiometric pattern. Intensive follow-up on one hearing-impaired patient included temporal bone polytomograms. Obliterative labyrinthitis is detailed. Antibiotic treatment and laboratory data are evaluated. Suggestions are provided for the post-meningitic course.

Congenital hearing loss and rubella infection

In an examination of Danish children aged 0 to 4 years, with congenital sensorineural hearing loss, 60% (39/65) had rubella antibody, compared with only 23% (17/72) in an age-matched control group. Based upon these results and similar investigations reported in the literature, it is concluded that serological testing for rubella antibody has proved to be of major importance in the evaluation of etiological factors of congenital hearing loss. Although diagnostic conclusions cannot be drawn on the basis of serological testing per se in the individual child, it is important to estimate the incidence of fetal rubella infection as the cause of congenital hearing loss, since this type of hearing loss may be prevented by active immunization.

A sensorineural component in chronic otitis media

Traditionally, it has been accepted that conductive deafness involves a breakdown in the mechanical conduction of sound, whilst the cochlea remains unaffected. Over a ten year period, it was noticed that a number of patients, mainly children, displayed a mild, high-tone sensorineural component to their conductive loss, whereas others tested under identical conditions with parallel etiologies did not. A sample of 80 children with chronic otitis media and sensorineural involvement was selected from Prince Henry's Hospital and Alfred Hospital, Melbourne, and was compared with 80 children with the same histories, but whose audiograms did not display any sensorineural involvement. The results of this study indicate a need for further research into: 1. The establishment of an internationally acceptable terminology. 2. Early detection of chronic otitis media. 3. Medical/surgical management. 4. The effects on hearing, caused by fluctuating nature of chronic otitis media. 5. Educational and social management.

Silent otitis media

There is a traditional view that chronic otitis media and chronic mastoiditis must exist in the presence of a tympanic membrane perforation. Based on a human histopathological study of 123 temporal bones with chronic otitis media out of 333 temporal bones with all forms of otitis media pathology, only 24 patients (36 ears) had symptoms of otological disease recorded on their charts and only 19.5% of these had an associated tympanic membrane perforation. Unsuspected findings of chronic otitis media (active or inactive) are occasionally confirmed at exploratory tympanotomy. Such quiet chronic pathological findings in the middle ear have occurred in association with endolymphatic hydrops and cochlear end organ lesions suggesting the possibility that silent chronic otitis media may help explain sensorineural hearing loss, vertigo, and tinnitus for certain patients. We put forth the hypothesis that clinically undetectable silent otitis media in neonates and infants might help explain why certain children are otitis media prone. Our otopathology laboratory includes 111 ears harvested from neonates and infants (average age 8 months). Histological analysis revealed normal findings in some, whereas significant numbers of others show all forms of otitis media, including purulent otitis media, chronic otitis media, serous otitis media, and mucoid otitis media, with occasional overlap of types. Clinical implications will be discussed with emphasis on silent otitis media and its relationship to the pathogenesis of otitis media and silent chronic otitis media and its possible role in causing insidious labyrinthine changes. A significant outcome of this study was the marked degree of unresolved mesenchyme in the clinically manifest otitis media group or silent otitis media group as compared to a control group. This association and role of mesenchyme is discussed relative to the pathogenesis of infantile otitis media.

Acute cochlear disorders: the combination of hearing loss, recruitment, poor speech discrimination, and tinnitus

The combination of hearing loss, recruitment, poor speech discrimination and tinnitus, which is characteristic of acute cochlear disorders, can be accounted for on the basis of a decoupling of hair cells from their drive system, the tectorial membrane. Decoupling may either be caused by a temporary reduction of ciliary stiffness (shown to occur during periods of noise-induced temporary threshold shifts) or by temporary and/or chronic ciliary pathology (demonstrated to exist in cases of antibiotic ototoxicity and in endolymphatic hydrops). Since ciliary coupling is elastic in nature, the decoupling is only partial. The hearing loss and the tinnitus are manifestations of the reduced coupling per se, the magnitude of the loss depending on the degree of decoupling and the number of hair cells involved. Recruitment and poor speech discrimination result from center-clipping of the signal waveform applied to an involved hair cell, the direct corollary of partial, ciliary decoupling.

Sickle cell anemia and hearing

The present investigation examined the effects of sickle cell anemia on threshold hearing. The study included 43 homozygous sickle cell anemia patients, ages 7-18 years, and 23 age-matched controls with documented normal hemoglobin. Both the study and control groups received otologic and audiologic examinations. Bilaterally normal hearing was found in 88% of the sickle cell subjects. Unilateral or bilateral mild high frequency sensorineural hearing loss was demonstrated in 12% (5 of 43). The control subjects revealed no hearing loss. The sickle cell group, therefore, exhibited a higher than usual incidence of hearing loss. Further, three of the five subjects with hearing loss evidenced central nervous system involvement, resulting in a probability of < 0.025 that this relation might occur by chance. Periodic hearing evaluations of children with sickle cell anemia should be performed to identify those with auditory complications and those who possibly may have CNS involvement.

Unilateral sudden loss of hearing: an unusual complication of cardiac operation

Between 1969 and 1978 7,000 patients underwent cardiopulmonary bypass at Bellevue and University Hospitals. In seven of these patients, sudden loss of hearing in one ear developed immediately after the operation. Four of the seven patients showed improvement in hearing after the initial loss, although in no case did the hearing return completely to normal. None of the patients had vertigo but two were listless postoperatively. Two of the operations were for congenital heart disease; the remainder were coronary artery bypass procedures. All of the affected patients were male. There was no predilection as to which ear was affected. The most likely cause is particulate emboli generated by cardiopulmonary bypass. Other possible sources of emboli include air, antifoam, fat, and particulate matter from calcified valves and the aorta. Improvement in the kind of pump and the addition of various filters in the period between 1969 and 1978 did not eliminate unilateral hearing loss. The relationship between cerebral emboli and decreased consciousness after operations is also discussed.

Bullous myringitis: its relation to sensorineural hearing loss

Bullous myringitis is considered to be a self-limiting disease without complications. Clinical evidence has shown it to be frequently accompanied by sensorineural hearing loss, more often than it was thought to be. The case of a 20-year-old girl is presented in whom bullous myringitis was accompanied by transient sensorineural hearing loss. The site of the lesion was determined to be in the cochlea. We determined, with a high degree of certainty, that the causative agent was mycoplasma.

Reversible neuroaudiologic findings in a case of right frontal lobe abscess with recovery

A patient with a large right frontal lobe abscess was administered a battery of audiologic and neuroaudiologic tests. Results indicated a definite central auditory processing deficit with essentially normal peripheral hearing. The same test battery was given three months later, after the abscess had completely resolved. The neuroaudiological results on retest were essentially normal for the entire test battery. The specific central auditory processing deficit noted in this case is discussed, along with details of the neuroaudiologic assessment.

Jugular bulb diverticula in medial petrous bone

Upward extension or diverticulum of the jugular bulb is rare. Most often, it protrudes into the middle ear. Three patients are reported in whom direct superior extension from the medial portion of the jugular bulb resulted in a defect in the medial part of the petrous bone. In this position, a jugular bulb diverticulum relates directly to the posterior wall of the internal auditory canal. The distinctive radiographic characteristics of this entity obviate unnecessary investigation and surgery. Encroachment on the internal auditory canal may possibly contribute to neurosensory hearing deficit.

Audiologic management of head and neck carcinoma patients

Hearing impairment occasionally accompanies head and neck carcinoma. This report reviews the underlying causes of the hearing loss and the specific communication needs of such patients. In addition, audiologic case management is discussed with reference to audiologic assessment, counseling, and use of amplification.

Otological findings in cervico-oculo-auditory dysplasia

A case of congenital ear dysplasia, combined with cleft palate and anomalies of the cervical spine and eyes, is described. The case belongs to the group of cervico-ocular-auditory dysplasias (Klippel-Feil syndrome). A strange feature in our case was the co-existence of conductive hypakousia in the right ear, due to congenital fixation of the stapes footplate, with perceptive deafness in the left ear, due to dysplasia of the cochlea and internal auditory meatus. The conductive hypakousia in the right ear was successfully treated by stapedectomy. A review of the literature on the Klippel-Feil syndrome has shown that, in some of them the conductive deafness was unexplained, while in others the deafness was due to dysplasia of the ossicular chain or to a combination of dysplasias of the labyrinth and middle ear in the same ear. The co-existence of middle ear dysplasia in one ear with contralateral dysplasia of the inner ear and internal auditory meatus is rare.

Round window membrane rupture and acquired sensorineural hearing loss in children

The aetiology of acquired sensorineural hearing loss includes many conditions. The disparity between the number of children affected by the conditions which are supposed to cause hearing loss and the number of children who are actually deaf, has never been satisfactorily explained. Clinical features observed in children with surgically proven round window membrane rupture have been noted in all conventional aetiological groups. These features include otitis media, doubt about the hearing status in early life, disturbance of balance and other occasional neurological phenomena. Wide variation in the appearance of round window niche has been observed in children with secretory otitis and similar appearances have been observed in children with proven round window membrane rupture. The appearances may represent a reaction to perilymph. Round window membrane rupture is probably common and may prove to be a unifying factor for many cases of acquired sensorineural hearing loss. Occasional neurological phenomena may be related to it.

Perimacular changes in Alport's syndrome

From 1962 to 1977, 79 patients with Alport's syndrome underwent serial fundoscopic examination. In 29 patients (24 males, 5 females), symmetric bilateral perimacular changes were found, consisting of bright, whitish or yellowish dense granulations, surrounding the foveal area. Fluorescein angiography was normal in 8/8 studied cases. All 29 patients had bilateral lenticonus and neural hearing loss; ultrastructural lesion of glomerular basement membrane was present in 11/11 studied patients. Chronic renal failure developed in 26 patients, with 20 treated by maintenance hemodialysis. In contrast, perimacular lesions were absent in the other 50 patients (27 males, 23 females). Anterior lenticonus was detected in none; perceptive deafness was demonstrated in only 20; kidney ultrastructural lesions in 16 of 30 studied cases. Patients with perimacular changes had significantly earlier renal failure (P less than 0.001) than patients without. In conclusion, perimacular changes appear as a simple and reliable indicator of Alport's syndrome, often associated with early renal failure.

Effects of cranial radiation on hearing in children with acute lymphocytic leukemia

We serially assessed the hearing sensitivity of 61 children with acute lymphocytic leukemia who were admitted to our Total Therapy IX study between December, 1975, and July, 1977. Their treatment included combined chemotherapy, 2,400 rads of cranial radiation, and intrathecal methotrexate. Subjects initially received an otologic examination and middle ear function testing. Audiometric testing was not done until ears were free of outer or middle ear pathology. If the child had no outer or middle ear disease, audiometric thresholds were obtained for the test frequencies: 500, 1,000, 2,000, 4,000, 6,000, and 8,000 Hz. Pure-tone thresholds were obtained before irradiation (61 patients) and at 6, 12, and 36 months thereafter (49, 46, and 22 patients, respectively). The median age at time of baseline testing was 10 years, 2 months. A paired sample test based on group data was used to test whether there were any significant changes from the threshold values at 6, 12, and 36 months after irradiation. Thresholds were not significantly affected for any test frequency at any test time. Assessments of individual audiograms indicated that none of the children had any significant reductions in hearing levels at the end of the third year after cranial irradiation.

An evaluation of revision stapes surgery

The expected success rate in primary stapedectomy is well documented in recent literature, but few reports have commented on the difficulties or the expected results in revision stapes surgery. Reports have dealt with different techniques, but the surgeon and the patients should be aware of the problems and risks involved in revision stapedectomy. The records of 35 patients who had undergone revision stapedectomy were analyzed to determine the following: 1. cause of failure, 2. how to avoid these difficulties, 3. hearing results, and 4. possible identifying factors which might pinpoint those patients with a high risk for sensorineural hearing loss. A review of these cases demonstrates that the results of revision stapedectomy are different than those for primary stapedectomy.

The cochlear component in operated otosclerosis after a mean period of 16 years. A follow-up study

107 patients operated on for otosclerosis were studied after an average of 16 years after the operation. The mean age-corrected bone thresholds measured after the postoperative stabilization period and at the follow-up examination did not differ significantly. Our results support the opinion that, in cases of operated otosclerosis, the sensorineural component follows the clinical course of presbyacusis.