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Lauxmann M, Viehl F, Priwitzer B, Sackmann B. Preliminary results of classifying otosclerosis and disarticulation using a convolutional neural network trained with simulated wideband acoustic immittance data. Heliyon 2024; 10:e32733. [PMID: 38975150 PMCID: PMC11226844 DOI: 10.1016/j.heliyon.2024.e32733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/29/2024] [Accepted: 06/07/2024] [Indexed: 07/09/2024] Open
Abstract
Current noninvasive methods of clinical practice often do not identify the causes of conductive hearing loss due to pathologic changes in the middle ear with sufficient certainty. Wideband acoustic immittance (WAI) measurement is noninvasive, inexpensive and objective. It is very sensitive to pathologic changes in the middle ear and therefore promising for diagnosis. However, evaluation of the data is difficult because of large interindividual variations. Machine learning methods like Convolutional neural networks (CNN) which might be able to deal with this overlaying pattern require a large amount of labeled measurement data for training and validation. This is difficult to provide given the low prevalence of many middle-ear pathologies. Therefore, this study proposes an approach in which the WAI training data of the CNN are simulated with a finite-element ear model and the Monte-Carlo method. With this approach, virtual populations of normal, otosclerotic, and disarticulated ears were generated, consistent with the averaged data of measured populations and well representing the qualitative characteristics of individuals. The CNN trained with the virtual data achieved for otosclerosis an AUC of 91.1 %, a sensitivity of 85.7 %, and a specificity of 85.2 %. For disarticulation, an AUC of 99.5 %, sensitivity of 100 %, and specificity of 93.1 % was achieved. Furthermore, it was estimated that specificity could potentially be increased to about 99 % in both pathological cases if stapes reflex threshold measurements were used to confirm the diagnosis. Thus, the procedures' performance is comparable to classifiers from other studies trained with real measurement data, and therefore the procedure offers great potential for the diagnosis of rare pathologies or early-stages pathologies. The clinical potential of these preliminary results remains to be evaluated on more measurement data and additional pathologies.
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Affiliation(s)
- Michael Lauxmann
- Doctor of Engineering, Faculty of Engineering, Reutlingen University, Alteburgstr. 150, 72762, Reutlingen, Germany
| | - Felix Viehl
- Master of Science, Reutlingen Research Institute, Reutlingen University, Alteburgstr. 150, 72762, Reutlingen, Germany
| | - Barbara Priwitzer
- Doctor of Natural Sciences, Faculty of Engineering, Reutlingen University, Alteburgstr. 150, 72762, Reutlingen, Germany
| | - Benjamin Sackmann
- Master of Science, Reutlingen Research Institute, Reutlingen University, Alteburgstr. 150, 72762, Reutlingen, Germany
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2
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McManus B, Harbarger C, Grillis A, Prewitt MG, Baiduc R, Block D, Paul O, Spankovich C. Otoscopy and tympanometry outcomes from the National Health and Nutrition Examination Survey (NHANES). Am J Otolaryngol 2022; 43:103332. [PMID: 34953248 DOI: 10.1016/j.amjoto.2021.103332] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/12/2021] [Accepted: 12/09/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE The purpose of the study was to estimate the prevalence of conductive pathologies based on tympanometric and otoscopic findings in adults in the U.S. and examine relationships between abnormal findings and audiometrically defined or reported perceived hearing loss and tinnitus. MATERIALS AND METHODS Data from 3409 individuals aged 20-69 years from the 1999-2000 and 2000-2002 cycles of the National Health and Nutrition Examination Survey (NHANES) were analyzed. Outcomes included report of ear tubes, self-perceived hearing loss, and tinnitus (yes or no). Otoscopy involved screening for presence of cerumen (ear wax) and physical abnormality for each ear. Ear-specific tympanometry included measures of middle ear pressure, external ear volume, tympanometric width, and admittance/compliance for each ear. Mean and prevalence estimates are provided applying sample weights. A multivariate ordinal regression model adjusting for age, sex, race/ethnicity, and education was used to examine relationships between otoscopy or tympanometry measures with hearing loss and tinnitus. RESULTS Approximately 12% of the sample showed evidence of abnormal tympanometry and 12% showed evidence of abnormal otoscopy in at least one ear. Measured hearing loss was consistently related to tympanometry outcomes, in both univariate and adjusted models, but perceived hearing loss and tinnitus were not related to abnormal tympanometry or otoscopy. The most common reason for abnormal otoscopy was presence of excessive or impacted cerumen, representing an estimated 10% of the population. CONCLUSIONS With 1 out of 10 adults having excessive cerumen, adults considering over-the-counter (OTC) hearings aids may benefit from an ear examination prior to purchase.
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3
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Ukaegbe OC, Tucker DA. The Role of Eye Color in the Emergence of Tinnitus in Silence. Int Arch Otorhinolaryngol 2021; 26:e407-e413. [PMID: 35846819 PMCID: PMC9282950 DOI: 10.1055/s-0041-1726039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 11/24/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction
Previous research suggests that African Americans are less likely than Caucasians to perceive tinnitus in sustained silence.
Objective
To evaluate the association between non-cutaneous melanin as indicated by eye color and the emergence of temporary tinnitus during a brief period of silence.
Methods
A cross-section of adults grouped according to their eye color were exposed to silence. A total of 62 adults, aged 18 to 35 years (10 males, 52 females) were required to sit in silence for 10 minutes, after which they filled out a questionnaire to report their eye color and any perception of sounds in the ears or head.
Results
In total, 63% of the participants perceived tinnitus while sitting in silence, and, of these 95% perceived the tinnitus sounds within 5 minutes of sitting in silence. Though African Americans were less likely to perceive tinnitus in silence, this difference was not significant (
p
= 0.6). After a period of silence, 69% of the subjects with light-colored eyes and 58% of the dark-eyed subjects perceived tinnitus. This difference was not statistically significant (χ
2
(1) = 0.77;
p
= 0.38).
Conclusion
When exposed to reduced auditory stimulation, 3 out of 5 normal-hearing people are likely to experience tinnitus. However, there was no relationship between eye color and the perception of tinnitus in silence. Although melanin has been shown to play a role in the protection of the ear against noise trauma and the effects of age-related hearing loss, its role in the emergence of tinnitus needs further investigation.
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Affiliation(s)
- Onyinyechi C. Ukaegbe
- Communication Sciences and Disorders Department, School of Health and Human Sciences, University of North Carolina, Greensboro
- Otorhinolaryngology Department, Faculty of Medical Sciences, University of Nigeria, Enugu
| | - Denise A. Tucker
- Communication Sciences and Disorders Department, School of Health and Human Sciences, University of North Carolina, Greensboro
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4
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Lohi V, Ohtonen P, Sorri M, Mäki-Torkko E, Hannula S. The impact of cardiovascular diseases on hearing deterioration: a 13-year follow-up study. Int J Audiol 2021; 61:826-831. [PMID: 34751079 DOI: 10.1080/14992027.2021.1998838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To study the impact of cardiovascular diseases (CVDs) on hearing deterioration among ageing adults in a longitudinal setting. Furthermore, to describe the pure tone threshold changes at the 0.125-8 kHz frequency range over 13 years. DESIGN A population-based follow-up study. STUDY SAMPLE A random sample of 850 adults, of whom 559 participated in the follow-up study. Otological examination, a structured interview, and pure tone audiometry were conducted. Multivariate regression models were used to estimate the effect of CVD (participants had at least one cardiovascular condition) on hearing deterioration of the better ear hearing level (BEHL), defined as a change in the pure-tone average (PTA) of the frequencies 0.5, 1, 2, and 4 kHz and separately at the lower (0.125, 0.25, and 0.5 kHz) and higher (4, 6, and 8 kHz) frequencies. RESULTS In the multivariable-adjusted analysis, the BEHL change at 13 years was 0.7 dB greater among participants with CVD (p = 0.3). The mean BEHL change during the 13-year follow-up was 12.0 dB (95% CI 11.4-12.6) among all participants. CONCLUSIONS No significant association between CVD and hearing threshold changes was found.
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Affiliation(s)
- Venla Lohi
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu, Finland
| | - Pasi Ohtonen
- Division of Operative Care and Oulu University Hospital and Research Unit of Surgery, Anesthesia and Intensive care, University of Oulu, Oulu, Finland
| | - Martti Sorri
- PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu, Finland
| | - Elina Mäki-Torkko
- PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu, Finland.,Audiological Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Samuli Hannula
- Department of Otorhinolaryngology and Head and Neck Surgery, Oulu University Hospital, Oulu, Finland.,PEDEGO Research Unit, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu, Finland
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5
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Gafford J, Freeman M, Fichera L, Noble J, Labadie R, Webster RJ. Eyes in Ears: A Miniature Steerable Digital Endoscope for Trans-Nasal Diagnosis of Middle Ear Disease. Ann Biomed Eng 2021; 49:219-232. [PMID: 32458223 PMCID: PMC7688494 DOI: 10.1007/s10439-020-02518-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 04/24/2020] [Indexed: 01/17/2023]
Abstract
The aim of this work is to design, fabricate and experimentally validate a miniature steerable digital endoscope that can provide comprehensive, high-resolution imaging of the middle ear using a trans-nasal approach. The motivation for this work comes from the high incidence of middle ear diseases, and the current reliance on invasive surgery to diagnose and survey these diseases which typically consists of the eardrum being lifted surgically to directly visualize the middle ear using a trans-canal approach. To enable less-invasive diagnosis and surveillance of middle ear disease, we propose an endoscope that is small enough to pass into the middle ear through the Eustachian tube, with a steerable tip that carries a 1 Megapixel image sensor and fiber-optic illumination to provide high-resolution visualization of critical middle ear structures. The proposed endoscope would enable physicians to diagnose middle ear disease using a non-surgical trans-nasal approach instead, enabling such procedures to be performed in an office setting and greatly reducing invasiveness for the patient. In this work, the computational design of the steerable tip based on computed tomography models of real human middle ear anatomy is presented, and these results informed the fabrication of a clinical-scale steerable endoscope prototype. The prototype was used in a pilot study in three cadaveric temporal bone specimens, where high-quality middle ear visualization was achieved as determined by an unbiased cohort of otolaryngologists. This is the first paper to demonstrate cadaveric validation of a digital, steerable, clinical-scale endoscope for middle ear disease diagnosis, and the experimental results illustrate that the endoscope enables the visualization of critical middle ear structures (such as the epitympanum or sinus tympani) that were seldom or never visualized in prior published trans-Eustachian tube endoscopy feasibility studies.
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Affiliation(s)
- Joshua Gafford
- Vanderbilt University Engineering Department, Nashville, TN, USA.
| | | | | | - Jack Noble
- Vanderbilt University Engineering Department, Nashville, TN, USA
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA
| | - Robert Labadie
- Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA
| | - Robert J Webster
- Vanderbilt University Engineering Department, Nashville, TN, USA
- Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Institute for Surgery and Engineering (VISE), Nashville, TN, USA
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6
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Lisan Q, van Sloten TT, Lemogne C, Offredo L, Climie RE, Boutouyrie P, Guibout C, Thomas F, Danchin N, Jouven X, Empana JP. Association of Hearing Impairment with Incident Depressive Symptoms: A Community-Based Prospective Study. Am J Med 2019; 132:1441-1449.e4. [PMID: 31247178 DOI: 10.1016/j.amjmed.2019.05.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/14/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim was to investigate the potential association between hearing impairment and incident depressive symptoms. METHODS Using a prospective community-based cohort study in France (the Paris Prospective Study III), participants aged 50-75 years were recruited between 2008 and 2012 and thereafter followed up every 2 years up to 2018. Hearing impairment, measured at study recruitment by audiometry testing, was defined as a pure tone average >25 decibels in the better ear. Incident depressive symptoms, measured using the validated 13-item Questionnaire of Depression 2nd version, was assessed during follow-up. Multivariate generalized estimating equations were used to compute odds ratio (OR) and 95% confidence intervals (CI). RESULTS Among 7591 participants free of depressive symptoms at baseline (mean age 59.8 years, 63% of men), 14.3% had hearing impairment. Over 6 years of follow-up, 479 subjects (6.3%) had incident depressive symptoms. The OR for incident depressive symptoms was 1.36 for subjects with baseline hearing impairment (95% CI, 1.06-1.73). A pooled analysis of 4 published prospective studies yielded a multivariable relative risk of baseline hearing impairment for incident depressive symptoms of 1.29 (95% CI, 1.09-1.53). CONCLUSIONS In this community-based prospective cohort study of participants aged 50 to 75 years, baseline hearing impairment was associated with a 36% increased odds of incident depressive symptoms.
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Affiliation(s)
- Quentin Lisan
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France; Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Head and Neck Surgery, Georges Pompidou European Hospital, Paris, France.
| | - Thomas T van Sloten
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France; Cardiovascular Research Institute Maastricht and Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Cédric Lemogne
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; AP-HP, Department of Psychiatry, Georges Pompidou European Hospital, Paris, France; INSERM, U894, Centre Psychiatrie et Neurosciences, Paris, France
| | - Lucille Offredo
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
| | - Rachel E Climie
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France; Baker Heart and Diabetes Institute, Melbourne, Australia; Menzies Institute for Medical Research, University of Tasmanian, Hobart, Australia
| | - Pierre Boutouyrie
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France; AP-HP, Department of Pharmacology, Georges Pompidou European Hospital, Paris, France
| | - Catherine Guibout
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
| | | | - Nicolas Danchin
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Preventive and Clinical Investigation Center, Paris, France; AP-HP, Department of Cardiology, Georges Pompidou European Hospital, Paris, France
| | - Xavier Jouven
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France; AP-HP, Department of Cardiology, Georges Pompidou European Hospital, Paris, France
| | - Jen-Philippe Empana
- Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Paris, France; Institut National de la Santé et de la Recherche Médicale (INSERM), UMR-S970, Paris Cardiovascular Research Center, Integrative Epidemiology of Cardiovascular Disease Team, Paris, France
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7
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Abstract
Purpose
The purpose of this paper is to illuminate strengths and limitations in quality improvement work, when involving patients.
Design/methodology/approach
The experience-based co-design (EBCD) method was used when improving care for patients undergoing otosclerosis surgery. Individual interviews and focus groups were interpreted using qualitative content analysis.
Findings
Strengths mentioned by patients were that their participation made a difference. The first steps were found effective in giving an in-depth view of patients’ experiences and the staff got an increased understanding about specific patient needs. However, weaknesses were found in the latter phases, those of improving and follow-up, health care staff had difficulties to keep their focus on patients’ experiences and invite patients to be involved. Patients’ participation decreased, and there was a lack of tools to support the process.
Research limitations/implications
The content in this paper is mainly based on one case. However, the findings are in congruence with earlier research and add further knowledge to the research area.
Practical implications
The findings can be used in healthcare when involving patients in improvement work.
Originality/value
There is no earlier study which involves patients with otosclerosis when using EBCD. Furthermore, this paper illuminates that there is a need to increase collaboration with patients. The latter phases often seem to be handled by health care professionals without involving patients; this paper suggest a development using dedicated quality tools.
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8
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Klopper M, Biagio–de Jager L, Vinck B. The correlation between hair and eye colour and contralateral suppression of otoacoustic emissions. Noise Health 2019; 21:155-163. [PMID: 32719302 PMCID: PMC7650858 DOI: 10.4103/nah.nah_36_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 12/11/2019] [Accepted: 01/23/2020] [Indexed: 11/08/2022] Open
Abstract
Genetics and environmental factors frequently influence individual's susceptibility to hearing loss. It is postulated that melanin in the inner ear is related to individual's susceptibility to noise induced hearing loss (NIHL). General pigmentation in turn, suspected to be related to the amount of pigmentation in the inner ear. The amount of melanin in the inner ear is said to modulate the endocochlear potential and provide an otoprotective effect. AIM The study aimed to determine the relationship between the contralateral suppression of otoacoustic emissions (CSOAE) in individuals with brown eyes and hair, and blue eyes and blond hair, and temporary emission shift (TES) after short-term noise exposure. SETTING AND DESIGN The research was conducted using a quantitative research design with a quasi-experimental repeated within the subject design to compare the CSOAE in subjects with different hair and eyes colour with TES after short-term noise exposure. Quantitative research was used to determine the relationship between the measurable variables to predict occurrence. MATERIAL AND METHOD The hearing sensitivity of young adults was determined by using pure tone audiometry followed by CSOAE's and distortion product otoacoustic emissions (DPOAE) before listening to music for one hour individually. Pure tone audiometry and DPOAE's were repeated after music exposure to determine the amount of TES and temporary threshold shift (TTS). STATISTICAL ANALYSIS USED One-way ANOVA was used during the analysis of the data obtained during this research study, in addition to, two-tailed Wilcoxon Sign Rank test and Friedman's test. In all analyses, a 95% level of significance (P<0.05) was used. RESULTS No statistically significant difference between efferent suppression was measured by CSOAE's between the participant groups. A larger TTS at 4000 Hz and TES at 2000 Hz was evident in the blue eyes and blond hair group after short-term music exposure. Conclusion: CSOAE's were unable to predict which group of individuals were more susceptible to NIHL after short-term noise exposure.
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Affiliation(s)
- Marike Klopper
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Leigh Biagio–de Jager
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Bart Vinck
- Department of Speech-Language Pathology and Audiology, Ghent University, Ghent, Belgium
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9
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Keefe DH, Archer KL, Schmid KK, Fitzpatrick DF, Feeney MP, Hunter LL. Identifying Otosclerosis with Aural Acoustical Tests of Absorbance, Group Delay, Acoustic Reflex Threshold, and Otoacoustic Emissions. J Am Acad Audiol 2018; 28:838-860. [PMID: 28972472 DOI: 10.3766/jaaa.16172] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Otosclerosis is a progressive middle-ear disease that affects conductive transmission through the middle ear. Ear-canal acoustic tests may be useful in the diagnosis of conductive disorders. This study addressed the degree to which results from a battery of ear-canal tests, which include wideband reflectance, acoustic stapedius muscle reflex threshold (ASRT), and transient evoked otoacoustic emissions (TEOAEs), were effective in quantifying a risk of otosclerosis and in evaluating middle-ear function in ears after surgical intervention for otosclerosis. PURPOSE To evaluate the ability of the test battery to classify ears as normal or otosclerotic, measure the accuracy of reflectance in classifying ears as normal or otosclerotic, and evaluate the similarity of responses in normal ears compared with ears after surgical intervention for otosclerosis. RESEARCH DESIGN A quasi-experimental cross-sectional study incorporating case control was used. Three groups were studied: one diagnosed with otosclerosis before corrective surgery, a group that received corrective surgery for otosclerosis, and a control group. STUDY SAMPLE The test groups included 23 ears (13 right and 10 left) with normal hearing from 16 participants (4 male and 12 female), 12 ears (7 right and 5 left) diagnosed with otosclerosis from 9 participants (3 male and 6 female), and 13 ears (4 right and 9 left) after surgical intervention from 10 participants (2 male and 8 female). DATA COLLECTION AND ANALYSIS Participants received audiometric evaluations and clinical immittance testing. Experimental tests performed included ASRT tests with wideband reference signal (0.25-8 kHz), reflectance tests (0.25-8 kHz), which were parameterized by absorbance and group delay at ambient pressure and at swept tympanometric pressures, and TEOAE tests using chirp stimuli (1-8 kHz). ASRTs were measured in ipsilateral and contralateral conditions using tonal and broadband noise activators. Experimental ASRT tests were based on the difference in wideband-absorbed sound power before and after presenting the activator. Diagnostic accuracy to classify ears as otosclerotic or normal was quantified by the area under the receiver operating characteristic curve (AUC) for univariate and multivariate reflectance tests. The multivariate predictor used a small number of input reflectance variables, each having a large AUC, in a principal components analysis to create independent variables and followed by a logistic regression procedure to classify the test ears. RESULTS Relative to the results in normal ears, diagnosed otosclerosis ears more frequently showed absent TEOAEs and ASRTs, reduced ambient absorbance at 4 kHz, and a different pattern of tympanometric absorbance and group delay (absorbance increased at 2.8 kHz at the positive-pressure tail and decreased at 0.7-1 kHz at the peak pressure, whereas group delay decreased at positive and negative-pressure tails from 0.35-0.7 kHz, and at 2.8-4 kHz at positive-pressure tail). Using a multivariate predictor with three reflectance variables, tympanometric reflectance (AUC = 0.95) was more accurate than ambient reflectance (AUC = 0.88) in classifying ears as normal or otosclerotic. CONCLUSIONS Reflectance provides a middle-ear test that is sensitive to classifying ears as otosclerotic or normal, which may be useful in clinical applications.
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Affiliation(s)
| | - Kelly L Archer
- Boys Town National Research Hospital, Omaha, NE.,University of Nebraska Lincoln, Lincoln, NE
| | - Kendra K Schmid
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE
| | | | - M Patrick Feeney
- National Center for Rehabilitative Auditory Research, Veterans Administration and Oregon Health & Science University, Portland, OR
| | - Lisa L Hunter
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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10
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Wales J, Gladiné K, Van de Heyning P, Topsakal V, von Unge M, Dirckx J. Minimally invasive laser vibrometry (MIVIB) with a floating mass transducer – A new method for objective evaluation of the middle ear demonstrated on stapes fixation. Hear Res 2018; 357:46-53. [DOI: 10.1016/j.heares.2017.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/08/2017] [Accepted: 11/15/2017] [Indexed: 12/30/2022]
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11
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Fichera L, Dillon NP, Zhang D, Godage IS, Siebold MA, Hartley BI, Noble JH, Russell PT, Labadie RF, Webster RJ. Through the Eustachian Tube and Beyond: A New Miniature Robotic Endoscope to See Into The Middle Ear. IEEE Robot Autom Lett 2017; 2:1488-1494. [PMID: 29202035 DOI: 10.1109/lra.2017.2668468] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This paper presents a novel miniature robotic endoscope that is small enough to pass through the Eustachian tube and provide visualization of the middle ear (ME). The device features a miniature bending tip previously conceived of as a small-scale robotic wrist that has been adapted to carry and aim a small chip-tip camera and fiber optic light sources. The motivation for trans-Eustachian tube ME inspection is to provide a natural-orifice-based route to the ME that does not require cutting or lifting the eardrum, as is currently required. In this paper, we first perform an analysis of the ME anatomy and use a computational design optimization platform to derive the kinematic requirements for endoscopic inspection of the ME through the Eustachian tube. Based on these requirements, we fabricate the proposed device and use it to demonstrate the feasibility of ME inspection in an anthropomorphic model, i.e. a 3D-printed ME phantom generated from patient image data. We show that our prototype provides > 74% visibility coverage of the sinus tympani, a region of the ME crucial for diagnosis, compared to an average of only 6.9% using a straight, non-articulated endoscope through the Eustachian Tube.
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Affiliation(s)
- Loris Fichera
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235 USA
| | - Neal P Dillon
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235 USA
| | - Dongqing Zhang
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235 USA
| | - Isuru S Godage
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235 USA
| | - Michael A Siebold
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235 USA
| | - Bryan I Hartley
- Department of Radiology, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Jack H Noble
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN 37235 USA
| | - Paul T Russell
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Robert F Labadie
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37232 USA
| | - Robert J Webster
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235 USA
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12
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13
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High-frequency hearing, tinnitus, and patient satisfaction with stapedotomy: A randomized prospective study. Sci Rep 2015; 5:13341. [PMID: 26293121 PMCID: PMC4544016 DOI: 10.1038/srep13341] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/21/2015] [Indexed: 11/23/2022] Open
Abstract
Otosclerosis is a common disorder that leads to conductive hearing loss. Most patients with otosclerosis also have tinnitus, and surgical treatment is known to improve hearing as well as tinnitus. Some patients however experience worsening of tinnitus after the operation, but there are no known factors that allow surgeons to predict who will be at risk. In this prospective observational study on 133 patients undergoing stapedotomy, we show that postoperative air conduction thresholds at very high stimulus frequencies predict improvement of tinnitus, as assessed with proportional odds logistic regression models. Young patients were significantly more likely to experience reduction of tinnitus and patients whose tinnitus became better were also more satisfied with the outcome of the operation. These findings have practical importance for patients and their surgeons. Young patients can be advised that surgery is likely to be beneficial for their tinnitus, but a less positive message should be conveyed to older patients.
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Bagger-Sjöbäck D, Strömbäck K, Hakizimana P, Plue J, Larsson C, Hultcrantz M, Papatziamos G, Smeds H, Danckwardt-Lillieström N, Hellström S, Johansson A, Tideholm B, Fridberger A. A randomised, double blind trial of N-Acetylcysteine for hearing protection during stapes surgery. PLoS One 2015; 10:e0115657. [PMID: 25763866 PMCID: PMC4357436 DOI: 10.1371/journal.pone.0115657] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 09/24/2014] [Indexed: 12/01/2022] Open
Abstract
Background Otosclerosis is a disorder that impairs middle ear function, leading to conductive hearing loss. Surgical treatment results in large improvement of hearing at low sound frequencies, but high-frequency hearing often suffers. A likely reason for this is that inner ear sensory cells are damaged by surgical trauma and loud sounds generated during the operation. Animal studies have shown that antioxidants such as N-Acetylcysteine can protect the inner ear from noise, surgical trauma, and some ototoxic substances, but it is not known if this works in humans. This trial was performed to determine whether antioxidants improve surgical results at high frequencies. Methods We performed a randomized, double-blind and placebo-controlled parallel group clinical trial at three Swedish university clinics. Using block-stratified randomization, 156 adult patients undergoing stapedotomy were assigned to intravenous N-Acetylcysteine (150 mg/kg body weight) or matching placebo (1:1 ratio), starting one hour before surgery. The primary outcome was the hearing threshold at 6 and 8 kHz; secondary outcomes included the severity of tinnitus and vertigo. Findings One year after surgery, high-frequency hearing had improved 2.7 ± 3.8 dB in the placebo group (67 patients analysed) and 2.4 ± 3.7 dB in the treated group (72 patients; means ± 95% confidence interval, p = 0.54; linear mixed model). Surgery improved tinnitus, but there was no significant intergroup difference. Post-operative balance disturbance was common but improved during the first year, without significant difference between groups. Four patients receiving N-Acetylcysteine experienced mild side effects such as nausea and vomiting. Conclusions N-Acetylcysteine has no effect on hearing thresholds, tinnitus, or balance disturbance after stapedotomy. Trial Registration ClinicalTrials.gov NCT00525551
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Affiliation(s)
- Dan Bagger-Sjöbäck
- Center for Hearing and Communication Research, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Otolaryngology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Karin Strömbäck
- Department of Otolaryngology, Academic Hospital, SE-751 85 Uppsala, Sweden
| | - Pierre Hakizimana
- Center for Hearing and Communication Research, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, SE-581 85 Linköping, Sweden
| | - Jan Plue
- Department of Physical Geography and Quaternary Geology, Stockholm University, SE-106 91 Stockholm, Sweden
| | - Christina Larsson
- Department of Otolaryngology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Malou Hultcrantz
- Center for Hearing and Communication Research, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Otolaryngology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Georgios Papatziamos
- Department of Otolaryngology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Henrik Smeds
- Center for Hearing and Communication Research, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Otolaryngology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | | | - Sten Hellström
- Center for Hearing and Communication Research, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Audiology and Neurotology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Ann Johansson
- Department of Audiology and Neurotology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Bo Tideholm
- Department of Otolaryngology, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Anders Fridberger
- Center for Hearing and Communication Research, Department of Clinical Science, Intervention, and Technology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Department of Clinical and Experimental Medicine, Linköping University, SE-581 85 Linköping, Sweden
- * E-mail:
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Mujica-Mota MA, Schermbrucker J, Daniel SJ. Eye color as a risk factor for acquired sensorineural hearing loss: A review. Hear Res 2015; 320:1-10. [DOI: 10.1016/j.heares.2014.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 12/01/2014] [Accepted: 12/08/2014] [Indexed: 12/20/2022]
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Lohi V, Hannula S, Ohtonen P, Sorri M, Mäki-Torkko E. Hearing impairment among adults: The impact of cardiovascular diseases and cardiovascular risk factors. Int J Audiol 2014; 54:265-73. [DOI: 10.3109/14992027.2014.974112] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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17
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In search of correlation between hand preference and laterality of hearing impairment in patients with otosclerosis. Eur Arch Otorhinolaryngol 2014; 271:2835-7. [DOI: 10.1007/s00405-014-3173-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Accepted: 06/19/2014] [Indexed: 11/30/2022]
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