Hearing loss in Takayasu's arteritis

OBJECTIVES

Neurosensory hearing loss is well-documented in chronic autoimmune conditions such as systemic lupus erythematosus (SLE). However, the literature lacks data on the prevalence and characteristics of hearing impairment in Takayasu's arteritis (TAK). In this cross-sectional study, our principal objective was to systematically assess the auditory function of individuals diagnosed with TAK, against SLE patients and healthy controls (HC).

METHODS

Age and gender matched TAK and SLE patients followed up in a tertiary centre along with healthy controls were included in a two-phase study. In the first phase, a questionnaire on ENT symptoms was administered to the patient (TAK: n=104 and SLE: n= 151) and HC (n=174) groups. In the second phase, patients (TAK: n=53 and SLE: n=33) and HC (n=45) underwent audiometric tests.

RESULTS

The questionnaire survey revealed that both TAK and SLE patients reported hearing loss (27.9%, 25.8%, 7.4%, p<0.001), tinnitus (49%, 35.8%, 13.8%, p<0.001) and vertigo (46.2%, 33.8%, 16.7%, p<0.001) at significantly higher rates than HC. Audiometry results indicated that both TAK (30.2%) and SLE patients (18.2%) had increased hearing loss compared to HC (8.9%), however, only TAK patients were found to have significantly increased risk in age adjusted logistic regression analysis (OR= 3.915, 95%CI: 1.179-12.998, p=0.026). Hearing loss was mainly neurosensory in all groups. TAK patients were affected at both low (<6000 Hz) and high (>6000 Hz) frequencies, whereas SLE patients were affected only at high frequencies. Hearing loss was significantly associated only with older age. No association was observed with the anatomical location of vascular involvement or history of stroke.

CONCLUSIONS

Our study reveals an increased prevalence of hearing loss in TAK. Further research is crucial to uncover the underlying causes.

Facial and Auditory Recognition Abilities of Implanted Primary Schoolers

OBJECTIVE

Emotions are often conveyed via visual and together with the auditory mode in social interaction. We aimed to investigate the ability to recognize facial and/or auditory emotions in school-aged children with cochlear implantation and healthy controls.

METHODS

All participants were asked to respond to facial emotions of Ekman and Friesen's pictures, then auditory emotions, and last, they were asked to respond to video-based dynamic synchronous facial and auditory emotions.

RESULTS

The mean accuracy rates in recognizing anger (p = 0.025), surprise (p = 0.029), and neutral (p = 0.029) faces were significantly worse in children with cochlear implants (CIs) than in healthy controls. They were significantly worse than healthy controls in recognizing all auditory emotions except auditory emotion of fear (p = 0.067). The mean accuracy rates in recognizing video-based auditory/facial emotions of surprise (p = 0.031) and neutral (p = 0.029) emotions were significantly worse in children with CIs.

CONCLUSION

The children with hearing loss were poorer in recognizing surprise, anger, and neutral facial emotions than healthy children; they had similar performance in recognizing anger emotions when both stimuli were given synchronously which may have a positive effect on social behaviors. It seems beneficial that emotion recognition training should be included in rehabilitation programs.

A novel diagnostic method for myasthenia gravis

INTRODUCTION/AIMS

Videonystagmography (VNG) which directly records eye movements using infrared video goggles with mini-cameras, is used to measure nystagmus. Our aim is to explore whether VNG can be used to detect a decrement in the extraocular muscle (EOM) activity of patients with myasthenia gravis (MG).

METHODS

Thirty-four patients with MG, including 13 with ocular-predominant and 21 with generalized MG, and 23 healthy controls participated. Using VNG we recorded the velocity of the eye movements of the patients as they followed a moving target. We then calculated the gain by dividing the eye movement velocity (degrees/second) by the target velocity (degrees/second).

RESULTS

In MG subjects, the mean initial gain (maximum gain) was 1.23 ± 0.31 (range: 0.63-2.15) for the right eye and 1.22 ± 0.37 (range; 0.60-2.28) for the left eye. The mean minimum gain was 0.11 ± 0.12 (0.01-0.58) for the right and 0.14 ± 0.5 (0.02-0.55) for the left. Due to fatigue, the movement gain was reduced by 91.7% in the right eye and 88.2% in the left eye. After reaching minimum velocity, gain remained at a minimum for a mean of 1.08 ± 0.52 (0.3-2.4) s for the right and 1.49 ± 0.85 (0.4-3.6) s for the left, before the velocity increased again. There was no fatigue-induced decrement in healthy subjects.

DISCUSSION

Our study documents a decrement in EOM activity recorded by VNG in patients with MG which begins to improve within 1-2 s after reaching minimum velocity, analogous to traditional low-frequency repetitive nerve stimulation testing and its U-shaped pattern. Thus, VNG may be a promising diagnostic test for MG.

Ototoxicity associated with topical administration of diclofenac sodium as an otic drop: An experimental animal study

OBJECTIVES

The aim of the study is to evaluate the ototoxicity of topical diclofenac sodium in comparison to positive and negative controls prior to the investigation of analgesic and anti-inflammatory efficacy of the agent in otic administration.

METHODS

Twenty four ears of 12 guinea pigs were included in the study. Wide myringotomy was performed on all tympanic membranes under general anesthesia and auditory brainstem responses (ABR) were evaluated. The subjects were separated into four groups, two groups received diclofenac sodium at low and high doses, positive controls received gentamicin and negative controls received isotonic sodium chloride topically for 14 days and ABRs were reevaluated.

RESULTS

No significant difference were observed between the pre and post-treatment click response, 1 kHz and 8 kHz response threshold levels after isotonic sodium chloride administration. All threshold levels were elevated in the positive control group. In the low and high dose diclofenac sodium groups, click response, 1 kHz and 8 kHz response threshold levels were significantly higher compared to the baseline values. Pre and post-treatment mean threshold level changes were not significantly different between the low and high dose diclofenac sodium groups. Pre and post-treatment mean threshold level changes in the gentamicin group were not significantly different from low or high dose diclofenac sodium groups.

CONCLUSION

Diclofenac sodium, considered as an analgesic and anti-inflammatory otic preparation, is shown to be as ototoxic as gentamicin in chronic use which may lead to loss of hearing especially when used topically in chronic otitis cases with tympanic membrane damage.

Protective role of intratympanic nigella sativa oil against gentamicin induced hearing loss

OBJECTIVE

Aminoglycosides, used to combat with life-threatening infections, have a substantial risk of hearing loss. Nigella sativa is an annual herbaceous plant and used for treatment of many diseases for ages. We aimed to investigate the protective role of intratympanic nigella sativa oil against gentamicin induced hearing loss in an animal model.

METHODS AND MATERIALS

Twenty eight guinea pigs were randomly divided into four groups: i-control, ii- Intratympanic nigella sativa oil (IT-NSO), iii- Intraperitoneal gentamicin (IP-G) and iv- Intraperitoneal gentamicin and intratympanic nigella sativa oil (IP-G + IT-NSO). Preoperative and postoperative hearing thresholds were determined with auditory brainstem response with click and 8 kHz tone-burst stimuli. Histological analysis of the cochlea specimens were performed under light microscope. Semiquantitative grading of the histological findings was carried out and compared between the groups.

RESULTS

Highest posttreatment hearing thresholds were detected in IP-G group. Posttreatment mean hearing threshold of the IP-G group with click stimulus was significantly higher than the IP-G + IT-NSO group (p = 0.004). whereas the difference was not significant with 8 kHz tone-burst stimulus (p = 0.137). Both IP-G and IP-G + IT-NSO groups had significantly higher hearing thresholds compared to control and IT-NSO groups (p > 0.05). Histological examination of the control and IT-NSO groups demonstrated normal appearance of cochlear nerve, stria vascularis and organ of Corti. IP-G group showed the most severe histological alterations including hydropic and vacuolar degenerations, hair cell damage and deformation of the basilar mambrane. Histological evidence of damage was significantly reduced in IP-G + IT-NSO group compared to IP-G group.

CONCLUSION

Addition of intratympanic NSO to systemic gentamicin was demonstrated to have beneficial effects in hearing thresholds which was supported by histological findings.

Comparison of anesthetic agents on otoacoustic emissions in children: propofol vs ketamine

BACKGROUND

Otoacoustic emission (OAE) tests are important evaluation tools for diagnosis of peripheral auditory pathology. Sedation or general anesthesia may be required for the performance of the OAE tests. The aim of this retrospective study was to compare the effects of anesthetic agents, propofol and ketamine, on OAEs in children.

METHODS

Fifty healthy children who underwent tonsillectomy and/or adenoidectomy under general anesthesia were included in this study. Three anesthesia induction protocols were defined for this study and the anesthesiologist applied his or her own choice. Transient evoked otoacoustic emissions (TEOAEs) and distortion-product otoacoustic emissions (DPOAEs) were automatically recorded in both ears of each patient prior to anesthetic (predrug) and following the loss of consciousness 5 min later (postdrug) by an audiologist blinded to the method of anesthesia. Acceptable TEOAEs were defined as signal noise ratio (S/N) of above 3 dB SPL (decibel sound pressure level) and DPOAEs of 6 dB SPL or above. Between-group and within-group comparisons and correlations were performed for statistical analysis.

RESULTS

Retrospective review of the anesthesia charts from 44 cases that completed the study showed that propofol, ketamine, and sevoflurane induction protocols were used in 21, 18, and 5 cases, respectively. Measurements of 36 ears in the propofol group and 34 ears in the ketamine group were included in the final analysis. Postdrug TEOAE and DPOAE amplitudes were significantly lower than predrug amplitudes except at 8 kHz in the ketamine group. There was no significant statistical difference in postdrug DPOAE measurements between propofol and ketamine groups but a significant difference was observed at 2 and 3 kHz of postdrug TEOAE measurements. TEOAE measurements were below 3 dB in 8 of 34 ears after ketamine and in 1 of 36 ears after propofol administration. There was a significant difference between the groups with respect to the incidence of successful measurements of TEOAEs. The DPOAE measurements were affected less by these drugs.

CONCLUSION

DPOAE measurements were reduced similarly by propofol and ketamine anesthesia. Lower false outcome ratio in TEOAE measurements made propofol a better option than ketamine.

Evaluation of balance in fallers and non-fallers elderly

Falls present a substantial health problem among the elderly population. Approximately one-third of community-dwelling people over 65 years of age will experience one or more each year.

Objective

The purpose of this study was to evaluate balance between fallers and non-fallers elderly. Study Design: Clinical study.

Methods

We studied 30 subjects older than 65 years of age. 15 subjects had a history of falls within a year (Group I) and 15 subjects had no history of falls (Group II). The scores of Computerized Dynamic Posturography (CDP); Sensory Organization Test (SOT), Limits of Stability (LOS), Rhytmic Weight Shift (RWS) and Berg Balance Scale (BBS) findings gathered from the individuals from Group I and Group II, were compared.

Results

The SOT 3, 6, composite, BBS scores and left-right on-axis velocity score of RWS test of the Group I were found to be significantly lower the Group II (p < 0.05). A positive correlation between the SOT 3, 5, composite and BBS scores of Group I and the SOT 4, 5, 6, composite and BBS scores of Group II is determined (p < 0.05).

Conclusion

The CDP and BBS scores in fallers were found to be significiantly lower as compared to the non-fallers elderly.

Functional outcomes of Vibrant Soundbridge applied on the middle ear windows in comparison with conventional hearing aids

CONCLUSION

Vibrant Soundbridge (VSB) application to the middle ear windows yields better functional outcomes than conventional hearing aids. However, speech discrimination scores obtained with VSB and conventional hearing aids are similar.

OBJECTIVE

To assess audiological outcomes of round and oval window applications of VSB in comparison with conventional hearing aids.

METHODS

Nineteen adult patients were included in the study. The patients had mild to moderate, moderate or moderate to profound conductive or mixed hearing loss. During surgery the floating mass transducer (FMT) was placed on the round (n = 14) or oval (n = 5) window. After the surgery, audiometric evaluation and free field audiometric evaluation of both ears was carried out.

RESULTS

The hearing thresholds in the low frequencies were not significantly different between the conventional hearing aids and VSB. The functional gains obtained with oval and round window approaches were similar except for 500 Hz. The hearing thresholds in the mid and high frequencies were significantly better with VSB than the conventional hearing aids. The functional gain in the low frequencies was not significantly different between VSB and conventional hearing aids. The functional gain in the other frequencies was significantly better with VSB than conventional hearing aids.

Articulation skills in Turkish speaking children with cochlear implant

OBJECTIVE

The benefits of using cochlear implant (CI) on speech perception and production have been documented. The aim of this study is to investigate the effect of age of cochlear implantation performed and length of auditory experience with CI on the development of articulation skills in prelingual children with CI.

METHODS

For this purpose, 14 children with CI were administered through the standardized articulation test named AAT (Ankara Articulation Test). In order to evaluate the development of articulation skills, AAT was applied to each child with CI at the first and the fourth years of CI. The test group was selected among those congenitally hearing impaired children who had used hearing aids bilaterally before the age of one and a half, and received intervention after fitting hearing aids. The test group was divided into two subgroups: Group 1 consisted of the children implanted at and below the age of 3 and Group 2 consisted of the children implanted after the age of 3. Evaluations of articulation skills between groups and within groups were performed in the first and fourth years of implantation. In the study, nonparametric statistics have been used to compare the test scores. Mann-Whitney U-test and Wilcoxon test have been used in the comparisons made between groups and within groups, respectively.

RESULTS

While there has not been observed any statistically significant difference between the first year articulation skills of children with CI at and below the age of three and children with CI above the age of 3, for the fourth year this difference has been found to be statistically significant.

CONCLUSIONS

The results demonstrate the importance of the early application of CI and length of auditory experience with CI in the development of articulation skills.

Complete labyrinthine aplasia: clinical and radiologic findings with review of the literature

BACKGROUND AND PURPOSE

Complete labyrinthine aplasia (CLA), also referred to as Michel aplasia, is a severe congenital anomaly of the inner ear, defined by the complete absence of inner ear structures. The purpose of this study was to document the imaging findings in a series of patients with CLA, with review of the literature, to better understand this anomaly.

MATERIALS AND METHODS

The CT and MR imaging findings of 9 patients (14 ears with CLA) were retrospectively evaluated. The audiologic tests and patient charts were also retrospectively reviewed.

RESULTS

CLA was bilateral in 5 and unilateral in 4 patients. The petrous bone was hypoplastic in all 14 ears, but the otic capsule was aplastic in only 5. The middle ear and mastoid volumes were decreased in most of the ears. The stapes was aplastic in 1 ear and was dysplastic in 5 ears. The internal acoustic canal was aplastic in 4 ears and markedly narrowed in 10 ears. The facial nerve canal showed a variety of anomalies and aberrant courses in 11/14 ears. The bony covering of the jugular bulb was defective in 9 ears. Tegmen tympani defects were seen in 3 patients, and there were several accompanying skull base and posterior fossa anomalies.

CONCLUSIONS

Although CLA is a rare developmental anomaly, its accurate diagnosis and its differential diagnosis from labyrinthine ossificans is crucial. Proper guidance of these patients for brain stem implantation in the critical period of brain development depends on the recognition of the characteristic imaging findings of CLA.

Evaluation of the effect of dexamethasone in experimentally induced endolymphatic hydrops in guinea pigs

PURPOSE

The aim of this study was to investigate the audiological and histopathologic effects of dexamethasone in the treatment of experimentally induced endolymphatic hydrops.

MATERIALS AND METHODS

Thirty mature, male guinea pigs weighing 400 +/- 50 g were operated on to induce experimental endolymphatic hydrops in their right ear. Left ear served as control. Subjects were separated into control and dexamethasone groups, with the latter receiving dexamethasone 5 mg/(kg d) intraperitoneally for 10 days. Electrocochleography and auditory brainstem response were applied to all subjects at preoperation, on the second postoperative day and also on the 15th postoperative day in animals that lived for a long time. The histopathologic examination of the inner ear in all animals was done at the end of the study.

RESULTS

The summating potential and the ratio of the summating potential to the action potential measured on the second postoperative day were found to be increased in both groups, but more significantly in the control one. When the left and right ears were compared, significant difference was found in the control group; however, no significant difference was found between the ears in the dexamethasone group. Histopathologic examination revealed varying degrees of hydrops in the control group, but showed only normal findings or minor changes in the dexamethasone group.

CONCLUSIONS

Dexamethasone can prevent the audiological and histopathologic findings of experimentally induced endolymphatic hydrops. However, these results must be supported by clinical and experimental studies designed with a large number of subjects.

Effects of various densities of middle ear fluids on acoustic immittance: experimental study

OBJECTIVE

To study the effects of various densities of middle ear fluids on acoustic immittance and elucidate the characteristics of this study that might be beneficial for clinical use in otitis media with effusion.

STUDY DESIGN

Experimental, in vivo model.

MATERIALS AND METHODS

The study was performed on 12 ears of six white Vienna rabbits. Rabbits were placed in six positions: normal resting position (group 1); after drilling a hole into the tympanic bulla (group 2); filling the bulla with distilled water (group 3; density = 1000 g/cm(3)); filling the bulla with 8.4% bicarbonate solution (group 4; density = 1005 g/cm(3)); filling the bulla with Tonimer gel (group 5; density = 1035 g/cm(3)); and filling the bulla with glycerine (group 6; density > 1050 g/cm(3)). Acoustic immittance measurements were then made in vivo. During each measurement, volume, compliance, pressure, and gradient values were recorded. Analysis of variance, Student t-test, and Pearson correlation coefficient and multiple regression analyses were used for statistical evaluations of the data.

RESULTS

Volume, compliance, and pressure values were obtained in all of the six measurements. A significant difference in volume was found between groups 1 and 2 (p < .001) and between the other four groups in this study (p < .001). With regard to compliance, group 2 was significantly different from groups 3, 4, 5, and 6 (p < .001). With regard to pressure, there was no intergroup (1 and 2) difference (p = .639); however, a significant difference (p < .001) was found between groups 1 and 2 and the other four groups. A significant difference was found between groups 3 and 6 (p = .006). A gradient value was obtained in all of the six measurements only for groups 1 and 2. In group 2, a significant rise in gradient was observed (p = .001).

CONCLUSION

Generally, volume, compliance, and pressure values declined significantly in rabbits in which the bulla had been filled with fluid when compared with rabbits with empty bullae. Drilling a hole into the bulla increased volumetric values under normal conditions but had no effect on compliance and pressure values. The significant difference between groups 3 and 6 regarding pressure demonstrates that the density of fluid in the middle ear plays a role in pressure values when measured with tympanometry. We conclude that the correlation between density and pressure values of middle ear fluids may be useful in the clinical decision-making process when treating disorders such as otitis media.

Reversed ipsilateral acoustic reflex pattern

OBJECTIVE

To determine the characteristics and possible origin of reversed ipsilateral acoustic reflex.

STUDY DESIGN

Retrospective.

SETTING

University hospital.

PATIENTS

Sixty-three ears in 52 patients (mean age 37.6 years) with unilateral or bilateral sensorineural hearing loss and 45 age- and sex-matched persons as controls.

METHODS

Audiometry and impedance audiometry examinations were studied retrospectively. Hearing test records were investigated, and patients with unilateral or bilateral sensorineural hearing loss were included. Forty-five age- and sex-matched persons served as controls. The ipsilateral and contralateral acoustic reflex patterns of these patients were investigated. Reflex-forming acoustic thresholds and latencies of ipsilateral reversed (positive) reflexes were compared with ipsilateral negative (upward) reflexes.

RESULTS

The ipsilateral acoustic reflexes of 18 of 63 ears with sensorineural hearing loss were absent, and the remaining 45 were reversed (positive). A significant difference was found between ipsilateral reversed and ipsilateral negative acoustic reflex thresholds (p < .001) and latencies (p < .001). No statistically significant differences were found between ipsilateral and contralateral negative reflex latencies.

CONCLUSIONS

The reversed acoustic reflex pattern is not an artifact but a physiologic event. This reflex does not appear to be related to stapedius or tensor tympani muscle contraction. We believe that the etiology of the reversed reflex is related to the system that contains the tympanic membrane, malleus, and incus and their ligaments but not the middle ear muscles.

Case report of two siblings with familial ovarian dysgenesis

Two sisters were admitted separately at different times (ages 15 and 12 years, respectively) to our unit because of amenorrhea, lack of secondary sex characteristics, and short stature. No evidence of other congenital anomalies was found. Laboratory studies indicated hypergonadotropic hypogonadism. Peripheral blood samples revealed normal 46,XX karyotype for both patients. No gonads were visualized by ultrasonography. The two cases underline the need to take familial ovarian dysgenesis into consideration in female patients with short stature, lack of secondary sex characteristics, normal karyotypes, and similar sibling histories.

Investigation of ototoxic effects of Taxol on a mice model

OBJECTIVE

To investigate the effects of taxol on the inner ear in a mice model.

METHODS

This study was performed on 112 ears of 56 albino Swiss mice. All animals underwent baseline auditory brainstem response (ABR) testing bilaterally and baseline Peak Equivalent Sound Pressure Levels (PESPLs) were obtained. The mice were randomly assigned to seven groups consisting of one control and six study groups. The control group received no medications while the mice in groups 1-6 received 1 x 60, 1 x 20, 2 x 20, 3 x 20, 4 x 20 and 5 x 20 mg/kg taxol intraperitoneally. Control ABR assessments were performed 3 weeks after the last dose. The animals were then sacrificed while still anaesthetised and the bullae (cochleae included) were dissected from their temporal bones. Haematoxylin-eosin and Masson's trichrome stains were used to demonstrate connective tissue, and periodic acid Schiff (PAS) stain was used to highlight epithelial elements.

RESULTS

Significant decreases in the hearing levels were observed in all the groups which received taxol. No correlation was observed between the dose given and the degree of hearing loss. The sections from the control group showed no histopathologic abnormalities while the sections from the study groups demonstrated vacuolisation in the epithelial cells of the spiral limbus, and the stria vascularis, vacuolisation of the fibroblasts and decreasing the number of the fibroblasts in the spiral limbus.

CONCLUSION

Taxol causes mild to moderate sensorineural hearing loss in mice. Histopathologically, there were degenerative changes in the cochlea resembling the ones that take place in salisylate and interferon alpha 2a ototoxicity which are thought to be reversible. There was no sensory cell loss. The hearing loss begins with doses less than or equal to 20mg/kg and is not dose dependent after this dose. Hearing monitorisation with audiologic evaluation is strongly recommended before and during the use of the drug in human subjects.

Sensorineural hearing loss as an extra-intestinal manifestation of ulcerative colitis in an adolescent girl with pyoderma gangrenosum

Inflammatory bowel disease is becoming increasingly frequent in children of all ages. In addition to the usual gastrointestinal stigmata of weight loss, anaemia, and rectal bleeding, children may exhibit prominent extra-intestinal manifestations such as joint symptoms, skin signs and some other auto-immune manifestations. Here we present a 15-year-old girl with ulcerative colitis in whom pyoderma gangrenosum and acute sensorineural hearing loss developed.

CONCLUSION

Although pyoderma gangrenosum is well described with inflammatory bowel disease, sensorineural hearing loss a is very unusual finding, possibly of auto-immune aetiology. We recommend steroid or immunosuppressive therapy in such a patient.

Bernard-Soulier Syndrome Like Platelet Defect in a Patient with Noonan Syndrome; A Case Report

Noonan's Syndrome (NS) is characterized by dismorphic facial features, short stature, short or webbed neck, congenital heart defects and testicular abnormalities. Various bleeding disorders in Noonan Syndrome have been reported. Bernard-Soulier Syndrome (BSS) is a rare congenital bleeding disorder characterized by thrombocytopenia and giant platelets. There is not any reported case of Noonan syndrome associated with BSS in literature. We report here a four-year-old male patient with Noonan Syndrome and BSS like platelet defect.

Altered anti-oxidant status and increased lipid peroxidation in marasmic children

BACKGROUND

Protein energy malnutrition (PEM) is a common pediatric health problem in developing countries. Although the clinical features of PEM are well known, its pathophysiology is still unclear. Free radicals have been implicated in pathogenesis of PEM. In the present study, oxidant/anti-oxidant status in marasmus was investigated.

METHODS

Red cell glutathione, glutathione peroxidase and superoxide dismutase and their related cofactors, serum selenium and copper, were studied in marasmic and control children. Serum lipid peroxidation was also evaluated to assess oxidative stress.

RESULTS

The red cell glutathione levels and glutathione peroxidase activities were found to be significantly lower in the marasmic children than in the controls. Red cell superoxide dismutase (SOD) activity was not different between two groups. Serum selenium and copper concentrations were significantly lower in the marasmic children than in the control subjects. The malondialdehyde concentration, which is an index of lipid peroxidation, was significantly higher in the marasmic group compared with the controls.

CONCLUSION

The anti-oxidant defense system was affected in marasmic children. Reduced anti-oxidant status and increased oxidative stress occurs in marasmic children.