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Sasaki A, Ikezono T, Matsuda H, Araki R, Matsumura T, Saitoh S, Wasano K, Matsubara A. Prevalence of perilymphatic fistula in patients with sudden-onset sensorineural hearing loss as diagnosed by Cochlin-tomoprotein (CTP) biomarker detection: its association with age, hearing severity, and treatment outcomes. Eur Arch Otorhinolaryngol 2024; 281:2373-2381. [PMID: 38123733 PMCID: PMC11024054 DOI: 10.1007/s00405-023-08368-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To determine the prevalence of perilymphatic fistula (PLF) in sudden-onset sensorineural hearing loss (SSNHL) patients by employing the Cochlin-tomoprotein (CTP) detection test, a specific diagnostic marker for perilymph. We also analyzed the clinical characteristics associated with hearing outcomes in this cohort. METHODS A total of 74 eligible patients were prospectively enrolled. Following myringotomy, middle ear lavage (MEL) samples underwent the CTP test to identify perilymph leakage. Intratympanic dexamethasone (IT-DEX) therapy was administered, and hearing outcomes were assessed. Control groups comprised patients with chronic otitis media (n = 40) and non-inflammatory middle ears (n = 51) with concurrent MEL sample collection. RESULTS CTP was positive in 16 (22%) patients. No control samples showed positive results. Multiple regression analysis indicated that age and pre-treatment hearing levels significantly contributed to the CTP value. We found a positive correlation between CTP values, age, and pre-treatment pure-tone averages. Notably, CTP values in SSNHL cases aged 60 and above were significantly higher than in those below 60 years. Patients with positive CTP had significantly worse recovery rates after IT-DEX treatment. CONCLUSION This study is the first prospective investigation demonstrating a positive relationship between CTP values, age, and hearing severity in SSNHL, indicating that PLF might be the essential cause of SSNHL, particularly in the elderly. Our findings suggest that IT-DEX may be less effective for PLF-associated SSNHL. Future research could reveal that PLF repair surgery is a viable treatment strategy for SSNHL. This study was registered under the UMIN Clinical Trials Registry (UMIN000010837) on 30/May/2013.
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Affiliation(s)
- Akira Sasaki
- Department of Otorhinolaryngology-Head and Neck Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tetsuo Ikezono
- Faculty of Medicine, Department of Otorhinolaryngology, Saitama Medical University, Saitama, Japan.
| | - Han Matsuda
- Faculty of Medicine, Department of Otorhinolaryngology, Saitama Medical University, Saitama, Japan
| | - Ryuichiro Araki
- Community Health Science Center, Saitama Medical University, Saitama, Japan
| | | | - Shiho Saitoh
- Faculty of Medicine, Department of Otorhinolaryngology, Saitama Medical University, Saitama, Japan
| | - Koichiro Wasano
- Department of Otolaryngology-Head and Neck Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Atsushi Matsubara
- Department of Otorhinolaryngology-Head and Neck Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Todt I, Ikezono T. Objective Assessment of Perilymphatic Fistula in Cases of Postoperative Vertigo after Cochlear Implantation by Cochlin Tomoprotein (CTP). Brain Sci 2023; 13:1525. [PMID: 38002485 PMCID: PMC10669772 DOI: 10.3390/brainsci13111525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVE Vertigo is a quite frequent complication after cochlear implantation. Perilymphatic fistula (PLF) is assumed to be one cause of this problem. Cochlin tomoprotein (CTP) is a newly introduced marker for PLF. The present aim was to evaluate the rate of positive CTP testing in cases of newly occurring vertigo after cochlear implantation. MATERIALS AND METHODS Twelve patients with vertigo after cochlear implantation and a revisional electrode-sealing procedure underwent intraoperative rinsing of their middle ear. The sample was evaluated for CTP with monoclonal antibody testing. Sixteen controls from six CI patients were taken. RESULTS 4 out of 12 (33%) cases showed positive CTP testing, indicating that a PLF could be evaluated. In all of the positive CTP cases, surgery decreased the vertigo symptoms. A relation between the subjective visual assessment of a fistula and a positive CTP value was not observed. Controls confirmed the value of the testing. DISCUSSION CTP detection objectively shows that PLF can occur in patients with vertigo after CI.
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Affiliation(s)
- Ingo Todt
- Department of Otolaryngology, Head and Neck Surgery, Bielefeld University, Medical Faculty OWL, Campus Klinikum Bielefeld, Teutoburgerstr. 50, 33604 Bielefeld, Germany
| | - Tetsuo Ikezono
- Department of Otolaryngology, Head and Neck Surgery, Saitama University, Irumagun, Saitamaken 350-0495, Japan
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Kozarenko MA, Egorov VI, Sambulov VI, Kozarenko AV. [Improvement of cochleovestibular function in chronic non-inflammatory perilymphatic fistulas of the labyrinth windows: cases from practice]. Vestn Otorinolaringol 2022; 87:62-66. [PMID: 35605274 DOI: 10.17116/otorino20228702162] [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: 11/18/2022]
Abstract
After a brief discussion of the problem of idiopathic sensorineural hearing loss and perilymphatic fistulas of the labyrinth windows, audiometric tests are identified that are informative for the preoperative diagnosis of the latter. Taking into account the own results of surgical treatment, attention is drawn to the feasibility of a wider use of exploratory tympanotomy in cases of suspected occurrence of perilymphatic fistulas of the labyrinth windows.
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Affiliation(s)
- M A Kozarenko
- St. Petersburg Research Institute of Ear, Throat, Nose and Speech, St. Petersburg, Russia
| | - V I Egorov
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - V I Sambulov
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
| | - A V Kozarenko
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia
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Hofmann VM, Schoenfeld U, Jagielski M, Pudszuhn A. [Does sealing the oval window in addition to the round window bring an advantage in reserve therapy of acute idiopathic deafness?]. HNO 2021; 69:31-41. [PMID: 32728759 PMCID: PMC7806567 DOI: 10.1007/s00106-020-00903-3] [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] [Indexed: 11/30/2022]
Abstract
BACKGROUND Following sudden unilateral deafness or severe sensorineural hearing loss, patients with unsuccessful intravenous steroid therapy can be treated with explorative tympanotomy with sealing of the round (RW) and/or oval window (OW), due to suspected rupture of the RW with perilymph fistula (PLF) or a fissula ante fenestram (FAF). This study investigated whether additional sealing of the oval window (RW+OW) achieved an improved hearing benefit as compared to sealing of the round window only (RW) . METHODS This retrospective study investigated 54 patients with acute profound hearing loss who underwent tympanoscopy. Audiometric examinations were performed preoperatively and at two postoperative intervals (1 month and 3-6 months after surgery). In 28 patients, the OW was sealed in addition to the RW. RESULTS No intraoperatively visible PLF or FAF were reported. Hearing thresholds were significantly reduced in the early postoperative follow-up period and further improvement was observed 3-6 months later. No significant differences between the RW and RW+OW subgroups were seen at either follow-up timepoint. In 65% (Kanzaki criteria) and 74% (Siegel criteria) of patients, partial or complete postoperative hearing improvement was observed. Upon comparing the groups of patients with and without hearing improvement, no statistical significance was found in terms of gender, age, secondary diagnoses, or latency period between symptom onset and surgery. CONCLUSION Additional sealing of the OW did not lead to significantly better postoperative hearing thresholds. In general, postoperative hearing improvement corresponds to published spontaneous remission rates.
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Affiliation(s)
- V M Hofmann
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland.
| | - U Schoenfeld
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland
| | - M Jagielski
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland
| | - A Pudszuhn
- Klinik für Hals‑, Nasen- und Ohrenheilkunde, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland
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Harabuchi Y, Kishibe K, Tateyama K, Morita Y, Yoshida N, Okada M, Kunimoto Y, Watanabe T, Inagaki A, Yoshida T, Imaizumi M, Nakamura T, Matsunobu T, Kobayashi S, Iino Y, Murakami S, Takahashi H, Tono T. Clinical characteristics, the diagnostic criteria and management recommendation of otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) proposed by Japan Otological Society. Auris Nasus Larynx 2020; 48:2-14. [PMID: 32768313 DOI: 10.1016/j.anl.2020.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 07/09/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023]
Abstract
Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a form of necrotizing vasculitis with few or no immune deposits. It primarily affects small and medium blood vessels. AAV is classified into three categories, granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA) and eosinophilic granulomatosis with polyangitis (EGPA), and two major ANCAs, proteinase 3 (PR3)-ANCA or myeloperoxidase (MPO)-ANCA are involved in their pathogenesis. Intractable otitis media frequently occurs in patients with GPA, MPA or EGPA, although all patients show similar clinical features, regardless of the type of AAV. Furthermore, approximately 15% patients with otitis media caused by AAV do not show ANCA positivity, histopathological evidence, or any other AAV-related lesions at the initial visit; therefore, these patients do not fulfill the ordinary diagnostic criteria for systemic AAV. Thus, we first proposed that this condition could be categorized as "otitis media with AAV (OMAAV)". Subsequently, the Japanese Otological Society (JOS) conducted a nationwide survey between December 2013 and February 2014 and identified 297 patients with OMAAV. The survey revealed that OMAAV is a disease that initially occurs in the middle ear and subsequently spreads to other organs such as the lungs and kidneys, with eventual involvement of all body organs. Severe sequelae such as facial palsy, hypertrophic pachymeningitis, complete deafness, and subarachnoid hemorrhage resulting in death can also occur. In this review, we introduce the clinical features, diagnostic criteria, and treatment strategies recommended by JOS for early diagnosis and treatment of OMAAV.
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Affiliation(s)
- Yasuaki Harabuchi
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, , Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510 Hokkaido, Japan.
| | - Kan Kishibe
- Department of Otolaryngology-Head and Neck Surgery, Asahikawa Medical University, , Midorigaoka-Higashi 2-1-1-1, Asahikawa, 078-8510 Hokkaido, Japan
| | - Kaori Tateyama
- Department of Otolaryngology, Oita University Faculty of Medicine, Oita, Japan
| | - Yuka Morita
- Department of Otolaryngology, Niigata University Faculty of Medicine, Niigata, Japan
| | - Naohiro Yoshida
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Omiya, Japan
| | - Masahiro Okada
- Department of Otolaryngology, Ehime University Faculty of Medicine, Toon, Japan
| | - Yasuomi Kunimoto
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Tottori, Japan
| | - Takeshi Watanabe
- Department of Otolaryngology, Nagasaki University Faculty of Medicine, Nagasaki, Japan
| | - Akira Inagaki
- Department of Neuro-otolaryngology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tadao Yoshida
- Department of Otorhinolaryngology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuyoshi Imaizumi
- Department of Otolaryngology, Fukushima Medical University, Fukushima, Japan
| | - Takeshi Nakamura
- Department of Otolaryngology, Miyazaki University Faculty of Medicine, Miyazaki, Japan
| | | | - Shigeto Kobayashi
- Department of Internal Medicine, Juntendo University Koshigaya Hospital, Koshigaya, Japan
| | - Yukiko Iino
- Department of Otolaryngology, Jichi Medical University Saitama Medical Center, Omiya, Japan
| | - Shingo Murakami
- Department of Neuro-otolaryngology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Haruo Takahashi
- Department of Otolaryngology, Nagasaki University Faculty of Medicine, Nagasaki, Japan
| | - Tetsuya Tono
- Department of Otolaryngology, Miyazaki University Faculty of Medicine, Miyazaki, Japan
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Exploratory tympanotomy in sudden sensorineural hearing loss for the identification of a perilymphatic fistula - retrospective analysis and review of the literature. The Journal of Laryngology & Otology 2020; 134:501-508. [PMID: 32614760 DOI: 10.1017/s0022215120000948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The diagnostic value of exploratory tympanotomy in sudden sensorineural hearing loss remains controversial. This study and review were performed to identify the incidence of perilymphatic fistula in patients with sudden sensorineural hearing loss. The effectiveness of tympanotomy for sealing of the cochlear windows in cases with perilymphatic fistula was evaluated. METHODS A search in common databases was performed. Overall, 5034 studies were retrieved. Further, a retrospective analysis on 90 patients was performed. RESULTS Eight publications dealing with tympanotomy in patients with sudden sensorineural hearing loss were identified. In 90 patients diagnosed with sudden sensorineural hearing loss and undergoing exploratory tympanotomy, 10 patients (11 per cent) were identified with a perilymphatic fistula, and this corresponds to the results obtained from our review (13.6 per cent). CONCLUSION There was no significant improvement after exploratory tympanotomy and sealing of the membranes for patients with a definite perilymphatic fistula.
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Herrera M, Berrocal JRG, Arumí AG, Lavilla MJ, Plaza G. Update on consensus on diagnosis and treatment of idiopathic sudden sensorineural hearing loss. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019. [DOI: 10.1016/j.otoeng.2018.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Herrera M, García Berrocal JR, García Arumí A, Lavilla MJ, Plaza G. Update on consensus on diagnosis and treatment of idiopathic sudden sensorineural hearing loss. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2018; 70:290-300. [PMID: 30093087 DOI: 10.1016/j.otorri.2018.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 04/18/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Idiopathic sudden sensorineural hearing loss (ISSNHL) is a sudden, unexplained unilateral hearing loss. OBJECTIVES To update the Spanish Consensus on the diagnosis, treatment and follow-up of ISSNHL. MATERIAL AND METHODS After a systematic review of the literature from 1966 to March 2018, on MESH terms «(acute or sudden) hearing loss or deafness», a third update was performed, including 1508 relevant papers. RESULTS Regarding diagnosis, 11ISSNHL is clinically suspected, the following diagnostic tests are mandatory: otoscopy, acumetry, tonal audiometry, speech audiometry, and tympanometry, to discount conductive causes. After clinical diagnosis has been established, and before treatment is started, a full analysis should be performed. An MRI should then be requested, ideally performed during the first 15 days after diagnosis, to discount specific causes and to help to understand the physiopathological mechanisms in each case. Although treatment is very controversial, due to its effect on quality of life after ISSNHL and the few rare adverse effects associated with short-term steroid treatment, this consensus recommends that all patients should be treated with steroids, orally and/or intratympanically, depending on each patient. In the event of failure of systemic steroids, intratympanic rescue is also recommended. Follow-up should be at day 7, and after 12 months. CONCLUSION By consensus, results after treatment should be reported as absolute decibels recovered in pure tonal audiometry and as improvement in speech audiometry.
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Affiliation(s)
- Mayte Herrera
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España.
| | - José Ramón García Berrocal
- Servicio de Otorrinolaringología, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma, Madrid, España
| | - Ana García Arumí
- Servicio de Otorrinolaringología, Hospital Vall d'Hebron, Universidad Autónoma, Barcelona, España
| | - María José Lavilla
- Servicio de Otorrinolaringología, Hospital Clínico, Universidad de Zaragoza, España
| | - Guillermo Plaza
- Servicio de Otorrinolaringología, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, Madrid, España
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Thomas JP, Drewermann S, Voelter C, Dazert S. Prognostic factors regarding the hearing outcome in severe to profound sudden sensorineural hearing loss treated by tympanotomy and sealing of labyrinthine windows after ineffective systemic corticosteroid application. Eur Arch Otorhinolaryngol 2018; 275:1749-1758. [PMID: 29855690 DOI: 10.1007/s00405-018-5023-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/26/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Tympanotomy and sealing of labyrinthine membranes has become in some centers used to treat severe to profound sudden sensorineural hearing loss refractory to conservative treatment. The aim of this retrospective study was to determine which preoperative factors influence the likelihood of postoperative recovery according to different audiological assessment criteria. METHODS The mean final hearing threshold, the hearing improvement, the probability of a complete recovery according to two different classifications, and probability of a significant recovery of 136 adult subjects were studied by univariate and multivariate analyses. RESULTS The subject's mean postoperative 4-pure-tone-average was 63.9 ± 35.9 dB, the mean improvement was 42.8 ± 32.6 dB. Depending on the classification system used, 18.4-28.0% of subjects experienced a complete recovery. 77.2% of subjects had a significant hearing improvement. History of a pressure change (odds ratio (OR):4.6) was the only positive prognostic factor for hearing improvement. It also enhanced probability of experiencing a complete hearing recovery (OR: 2.8-6.3). Preoperative total deafness (OR: 1.5-1.9) and vertigo (OR: 3.3-4.6) were negative prognostic factors for the mean final hearing threshold and the probability of a complete hearing recovery. Patients with a preceding pressure change event achieved a complete recovery in 45.5-50.0%, those without such an event recovered completely only in 13.2-23.7%. CONCLUSION Evaluating prognostic factors and the rate of complete hearing recovery are influenced by the underlying assessment parameters. In addition to the mean postoperative hearing threshold and hearing gain, the probability of regaining a serviceable hearing is clinically important for the individual and should be added to the assessment criteria in future studies.
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Affiliation(s)
- Jan Peter Thomas
- Department of Otolaryngology, Head and Neck Surgery, St. Elisabeth-Hospital, Ruhr University Bochum, Bleichstr. 15, 44787, Bochum, Germany.
| | - Silke Drewermann
- Department of Otolaryngology, Head and Neck Surgery, St. Elisabeth-Hospital, Ruhr University Bochum, Bleichstr. 15, 44787, Bochum, Germany
- Medical Supply Centre of the Federal Armed Forces, Bremerhavener Heerstr. 10, 27711, Osterholz-Scharmbeck, Germany
| | - Christiane Voelter
- Department of Otolaryngology, Head and Neck Surgery, St. Elisabeth-Hospital, Ruhr University Bochum, Bleichstr. 15, 44787, Bochum, Germany
| | - Stefan Dazert
- Department of Otolaryngology, Head and Neck Surgery, St. Elisabeth-Hospital, Ruhr University Bochum, Bleichstr. 15, 44787, Bochum, Germany
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Comacchio F, Mion M. Sneezing and Perilymphatic Fistula of the Round Window: Case Report and Systematic Review of the Literature. J Int Adv Otol 2018; 14:106-111. [PMID: 29764784 DOI: 10.5152/iao.2018.4336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The goal of the present study was to describe a case of perilymphatic fistula (PLF) of the round window (RW) that occurred after sneezing, along with a review of the literature. We report a case of PLF of RW, which was provoked by sneezing, and its consequent medical and surgical treatments. With respect to the review of the literature, articles were initially selected based on their titles or abstracts, followed by methodological evaluation. The patient underwent an explorative tympanotomy (ET) with packaging of RW with the pericondrium, following which the patient's complaints regarding vertigo and imbalance disappeared, but the severe sensorineural hearing loss persisted. For the literature review, five references were selected. These studies showed a great variety in the clinical presentation and healing of symptoms. Sneezing represents a rare but well-recognized cause of PLF, as reported in our case. The correct selection of patients who should undergo ET and an early surgical repair of PLF are mandatory for better outcomes, especially in case of hearing.
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Affiliation(s)
- Francesco Comacchio
- Department of Neurosciences, Institute of Otolaryngology, Padova University School of Medicine, Padova, Italy
| | - Marta Mion
- Department of Neurosciences, Institute of Otolaryngology, Padova University School of Medicine, Padova, Italy
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Surgical indications or inclusion/exclusion criteria of explorative tympanotomy on sudden sensorineural hearing. Am J Otolaryngol 2018; 39:365-366. [PMID: 29402523 DOI: 10.1016/j.amjoto.2018.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/28/2018] [Indexed: 11/20/2022]
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Plontke SK. Diagnostics and therapy of sudden hearing loss. GMS CURRENT TOPICS IN OTORHINOLARYNGOLOGY, HEAD AND NECK SURGERY 2018; 16:Doc05. [PMID: 29503670 PMCID: PMC5818684 DOI: 10.3205/cto000144] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article reviews recent aspects of diagnostics, differential diagnostics, and evidence in systemic and local therapy of idiopathic sudden sensorineural hearing loss (ISSHL). Since a number of disorders can be accompanied by sudden hearing loss, a meaningful and targeted diagnostic strategy is of utmost importance. An important differential diagnosis of sudden hearing loss are intralabyrinthine schwannomas (ILS). The incidence of ILS is probably significantly underestimated. This may be due to the lack of awareness or lack of explicit search for an intralabyrinthine tumor on MRI or an inappropriate MRI technique for the evaluation of sudden hearing loss ("head MRI" instead of "temporal bone MRI" with too high slice thicknesses). Therefore, the request to the radiologist should specifically include the question for (or exclusion of) an ILS. With special MRI techniques, it is possibly today to visualize an endolymphatic hydrops. The evidence in the therapy of ISSHL is - with respect to the quality and not quantity of studies - unsatisfying. The value of systemically (low dose) or intratympanically applied corticosteroids in the primary treatment of ISSHL is still unclear. In order to investigate the efficacy and safety of high dose corticosteroids as primary therapy for ISSHL, a national, multicenter, three-armed, randomized, triple-blind controlled clinical trial is currently performed in Germany (http://hodokort-studie.hno.org/). After insufficient recovery of the threshold with systemic therapy of ISSHL, intratympanic corticosteroid therapy appears to be associated with a significantly higher chance of an improved hearing threshold than no therapy or placebo. Both, hearing gain and final hearing threshold, however, appear to be independent from the onset of secondary therapy. Based on currently available data from clinical studies, no recommendation can be made with respect to the type of corticosteroid and specifics of the intratympanic application protocol.
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Affiliation(s)
- Stefan K. Plontke
- Department of Otorhinolaryngology, Head & Neck Surgery, University Medicine Halle, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Heuschkel A, Geißler K, Boeger D, Buentzel J, Esser D, Hoffmann K, Jecker P, Mueller A, Radtke G, Guntinas-Lichius O. Inpatient treatment of patients with idiopathic sudden sensorineural hearing loss: a population-based healthcare research study. Eur Arch Otorhinolaryngol 2018; 275:699-707. [PMID: 29330597 DOI: 10.1007/s00405-018-4870-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/06/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE The aim was to determine inpatient treatment rates of idiopathic sudden sensorineural hearing loss (ISSNHL) with focus on diagnostics, treatment, and outcome. METHODS A retrospective population-based study in the federal state Thuringia in 2011 and 2012 was performed on all 490 inpatients (51% females, median age: 60 years) treated for ISSNHL (Median duration: 7 days). The association between analyzed parameters and the probability of recovery was tested using univariable and multivariable statistics. RESULTS The inpatient treatment rate for ISSNHL was 11.23 per 100,000. 172 patients (35%) had an outpatient treatment prior to inpatient treatment. For pure-tone audiometry of the three most affected frequencies (3PTAmax), the initial median hearing loss was 66.67 dB, the median absolute hearing gain ΔPTAabs was 10.0 dB, and the median relative hearing gain in relation with the contralateral side ΔPTArel contral was 30.86%. 51% of the patients reached a ΔPTAabs of ≥ 10 dB. About 2 of 5 patients recovered to a ΔPTArel contral ≥ 50% or reached ≤ 10 dB of contralateral ear. The multivariate analysis revealed that an ISSNHL on the left side [Hazard ratio (HR) = 1.6.88; confidence interval (CI) = 1.161-2.454], no down-sloping audiogram type (HR = 2.016; CI = 1.391-2.921), and no prior outpatient prednisolone treatment (HR = 2.374; CI = 1.505-3.745) were independent factors associated with better recovery (ΔPTAabs ≥ 10 dB). CONCLUSION Inpatient treatment of ISSNHL is variable in daily practice. The population-based recovery rate was worse than reported in clinical trials. More standardization and clearer criteria for outpatient, inpatient, and salvage therapy are needed.
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Affiliation(s)
- Anne Heuschkel
- Department of Otorhinolaryngology, HELIOS-Klinikum, Erfurt, Germany
| | - Katharina Geißler
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Daniel Boeger
- Department of Otorhinolaryngology, Zentralklinikum, Suhl, Germany
| | - Jens Buentzel
- Department of Otorhinolaryngology, Südharz-Krankenhaus gGmbH, Nordhausen, Germany
| | - Dirk Esser
- Department of Otorhinolaryngology, HELIOS-Klinikum, Erfurt, Germany
| | - Kerstin Hoffmann
- Department of Otorhinolaryngology, Sophien/Hufeland-Klinikum, Weimar, Germany
| | - Peter Jecker
- Department of Otorhinolaryngology, Klinikum Bad Salzungen, Bad Salzungen, Germany
| | - Andreas Mueller
- Department of Otorhinolaryngology, SRH Wald-Klinikum, Gera, Germany
| | - Gerald Radtke
- Department of Otorhinolaryngology, Ilm-Kreis-Kliniken, Arnstadt, Germany
| | - Orlando Guntinas-Lichius
- Department of Otorhinolaryngology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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Garov EV, Zelenkova VN, Fedorova OV, Meparishvili AS. [The fistula of the round window of the cochlea]. Vestn Otorinolaringol 2017; 82:69-71. [PMID: 28980602 DOI: 10.17116/otorino201782469-71] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article presents the data on the frequency, diagnostics, and variants of the surgical treatment of the fistula of the round window of the cochlea. A case of this pathology is reported with the special emphasis placed on the approaches to the diagnostics and surgical management of this condition.
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Affiliation(s)
- E V Garov
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - V N Zelenkova
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - O V Fedorova
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
| | - A S Meparishvili
- L.I. Sverzhevskiy Research Institute of Clinical Otorhinolaryngology, Moscow Health Department, Moscow, Russia, 117152
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Karimi D, Mittmann P, Ernst A, Todt I. Surgical treatment of vertigo in cochlear implantees by electrode resealing. Acta Otolaryngol 2017; 137:1031-1034. [PMID: 28541825 DOI: 10.1080/00016489.2017.1331045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONCLUSION Our present findings demonstrate that resealing to cover the electrode is an effective method to treat vertigo after CI. An insufficient cochleostomy sealing can be regarded as a cause of postoperatively newly occuring vertigo after CI. A transtympanic revision is a promising treatment option in cases of post-operative dizziness. Intoduction: A well-known and frequently reported complication after cochlear implantation is the appearance of postoperative vertigo symptoms. The aim of the present study was to observe if the postoperatively new occurrence of vertigo can be treated by resealing of the round window patch after cochlear implantation. MATERIAL AND METHODS A retrospective analysis revealed that 10 patients underwent revision surgery transtympanally. Vertigo was assessed preoperatively and directly postoperatively and after 6 month after revision surgery by using the Dizziness Handycap Inventory (DHI). RESULTS The most common symptom was rotating vertigo. A spontanous nystagmus was seen in four cases. No nystagmus was found after the revision surgery. In three cases, the onset of dizziness was associated with an event (sneezing, otitis media, climbing a mountain). A preoperative CT showed insuspectible results in seven patients but revealed pathologies two patients. Vertigo was improved significantly in six patients, and three of them were symptom-free.
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Affiliation(s)
- Dania Karimi
- Department of Otolaryngology at Unfallkrankenhaus Berlin, Berlin, Germany
| | - Philipp Mittmann
- Department of Otolaryngology at Unfallkrankenhaus Berlin, Berlin, Germany
| | - Arneborg Ernst
- Department of Otolaryngology at Unfallkrankenhaus Berlin, Berlin, Germany
| | - Ingo Todt
- Department of Otolaryngology at Unfallkrankenhaus Berlin, Berlin, Germany
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