Useful hearing preservation is improved in vestibular schwannoma patients who undergo stereotactic radiosurgery before further hearing deterioration ensues

INTRODUCTION

The present study evaluates whether hearing deterioration during observation reduces serviceable hearing preservation rates after stereotactic radiosurgery (SRS) in vestibular schwannoma (VS) patients with useful hearing.

METHODS

We retrospectively analyzed 1447 VS patients who underwent SRS between 1992 and 2017. We identified 100 VS patients who had Grade I Gardner- Robertson (GR) hearing at initial diagnosis but were observed without surgery or SRS. We compared hearing after SRS in 67 patients who retained GR Grade I hearing from initial diagnosis to SRS (the hearing maintenance or HM group) to 33 patients whose hearing worsened from GR grade I to grade II (the hearing deterioration or HD group). We also investigated whether a decline in pure tone average (PTA) or speech discrimination score (SDS) before SRS affected hearing preservation after SRS.

RESULTS

The serviceable hearing (GR I and II) preservation in HM patients was 80%s, 63%, and 51% at 3, 5, and 10 years, respectively. The serviceable hearing preservation in HD patients was 40%, 33%, and 20% at 3, 5, and 10 years, respectively. In multivariate analysis, younger age (< 55 years, p = 0.045) and HM during observation (p = 0.001) improved serviceable hearing preservation rates. Patients whose PTA increased ≥ 15 dB (p = 0.024) or whose SDS declined ≥ 10% (p = 0.019) had reduced serviceable hearing preservation rates.

CONCLUSIONS

Hearing deterioration during observation before SRS reduced long term hearing preservation rate in VS patients with GR grade I hearing at initial diagnosis. SRS before hearing deterioration was recommended for hearing preservation.

Glucocorticoid and Breviscapine Combination Therapy Versus Glucocorticoid Alone on Sudden Sensorineural Hearing Loss in Patients with Different Audiometric Curves

INTRODUCTION

We aimed to retrospectively analyze the therapeutic outcomes of using glucocorticoid combined with a vasodilator, breviscapine, versus glucocorticoid alone in patients with sudden sensorineural hearing loss (SSNHL) and to explore the impact on different audiometric curves.

METHODS

Data from 154 patients were collected between January 2017 and December 2018. Patients received treatments of either glucocorticoid combined with breviscapine (GC + Bre) or glucocorticoid alone (GC). These two groups were stratified into low frequencies SSNHL (LF-SSNHL), high frequencies SSNHL (HF-SSNHL), all frequencies SSNHL (AF-SSNHL), and total deafness SSNHL (TD-SSNHL) subgroups according to their corresponding audiograms. The hearing level was evaluated by pure tone audiometry, and hearing recovery was calculated by comparing the pure tone average (PTA) at pretreatment and 4 weeks after therapy.

RESULTS

Hearing recovery was significantly greater for GC + Bre than GC-only treatment in the AF-SSNHL and TD-SSNHL subgroups (P < 0.05) and to a lesser extent in the LF-SSNHL and HF-SSNHL subgroups (P > 0.05). Logistic regression analysis also showed a favorable outcome for SSNHL in the GC + Bre group (odds ratio 2.848, P < 0.05).

CONCLUSION

Treating SSNHL using glucocorticoid combined with breviscapine could be more beneficial than using glucocorticoid alone, especially for patients with AF-SSNHL and TD-SSNHL.

TRIAL REGISTRATION NUMBER

ChiCTR18000170072.

Outcomes of audiometric testing in children with auditory neuropathy spectrum disorder

INTRODUCTION

Auditory Neuropathy Spectrum Disorder (ANSD) is characterized by hearing loss ranging from normal to profound. Additionally, results are confounded by commonly fluctuating hearing thresholds in ANSD. As such, we sought to evaluate results of audiometric testing on children with ANSD and the impact of age and time on testing results.

METHODS

Retrospective chart review on children <18 years of age diagnosed with ANSD at two tertiary care academic institutions. Data analyzed included initial audiogram with speech detection thresholds (SDT) and pure tone averages (PTA) as well as most recent unaided audiogram SDT and PTA.

RESULTS

75 ANSD patients were analyzed, of which 32 (42.7%) were female. Bilateral and unilateral ANSD was seen in 55 (73.3%) and 20 (26.7%), respectively. A total of 130 ears with ANSD were assessed with 80 (61.5%) meeting inclusion criteria. Of these patients, the median age in years at first audiogram and most recent audiogram were 1.94 (0.45-13.68) and 4.22 (0.97-14.61), respectively. The median ages at which an SDT and PTA could first be acquired on the audiogram in ANSD patients were 1.94 (0.50-13.68) and 2.86 (0.45-13.68), respectively. The average SDT/PTA at the initial and most recent audiogram were 47.5/45.7 and 49.4/53.0 dB, respectively. SDT to PTA within the same audiogram exhibited strong correlation (r = 0.82, p < 0.001). Similarly, comparison of initial SDT to SDT at a later time interval showed strong correlation (r = 0.73, p < 0.001). SDT and PTA at initial audiogram and PTA at later time demonstrated lower correlation but was still statistically significant (r = 0.49, p < 0.009 and r = 0.51, p < 0.044, respectively). Individual PTA was associated with age (r = -0.56, p < 0.001).

CONCLUSIONS

SDT and PTA within the same audiogram and initial SDT to SDT acquired at a later time correlate strongly in audiometric testing in children with ANSD. Although not as strong, initial SDT and PTA still correlate with PTA at a later time interval. These findings suggest that audiometric results yielding a reliable SDT and frequency specific information necessary to calculate the PTA is not typically obtained until 2-3 years old. However, once this information is obtained, the child's hearing is fairly stable but may fluctuate over time.

Improvement in word recognition following treatment failure for sudden sensorineural hearing loss

Objectives

Patients with sudden sensorineural hearing loss (SSNHL) may have word recognition scores (WRS) that correlate with pure tone average (PTA). We hypothesize that there is a subset of patients with SSNHL who have improved WRS despite stable PTA.

Methods

Retrospective case review at a tertiary otolaryngology practice.

Results

We identified 13 of 113 patients with SSNHL whose WRS increased despite overall stable pure tone averages. There was an observed average improvement in WRS by 23.8 points in this patient cohort at follow-up, with mean initial PTA in the affected ear at 48.7 dB.

Conclusions

We identify a novel cohort of SSNHL patients that have failed treatment as measured by PTA, but who have increased WRS over time. These data have implications for patient counseling and lend insight into the pathophysiology of SSNHL.

Software intelligent system for effective solutions for hearing impaired subjects

PURPOSE

The anatomy and physiology of the ear is complex in nature, which makes it a challenge for audiologists to prescribe solutions for varied hearing-impaired subjects. There is a need to increase the satisfaction level of hearing-aid users by adopting better strategies that involve modern technological advancements.

AIM

To design and develop a decision support Software Intelligent System (SIS) that performs audiological investigations to assess the degree of hearing loss and to suggest appropriate hearing-aid gain values.

METHODS

SIS is developed based on the study conducted in the Government General Hospital, Chennai, India, between 2013 and 2015. In the study period, audiological investigations were performed on 368 subjects, using the clinical audiometer (Inventis-Piano, Italy) and the SIS. Gain suggestions were recommended for hearing-aid users (Siemens Intuis life & Intuis-SP) using standard prescriptive procedures, alterations made by the audiologists, and by the SIS. It was developed with artificial neural network-based gain predictions.

RESULTS

Of the tested subjects, 256 were identified as hearing-impaired. The calculated sensitivity, specificity and accuracy of the computerised audiometer incorporated in the SIS are 93%, 85% and 90% respectively. Furthermore, 86% of the hearing-impaired subjects were satisfied during their first hearing-aid trial with the gain recommendations from SIS.

CONCLUSION

The findings suggest that the proposed SIS could be used to perform audiological screening tests and to recommend appropriate hearing-aid gain values to the hearing-impaired subjects. This could eventually be helpful for audiologists in the areas where routine mass audiological screening and fast hearing-aid solution is required.