A new active bone-conduction implant: surgical experiences and audiological outcomes in patients with bilateral congenital microtia

PURPOSE

First-generation bone bridges (BBs) have demonstrated favorable safety and audiological benefits in patients with conductive hearing loss. However, studies on the effects of second-generation BBs are limited, especially among children. In this study, we aimed to explore the surgical and audiological effects of second-generation BBs in patients with bilateral congenital microtia.

METHODS

This single-center prospective study included nine Mandarin-speaking patients with bilateral microtia. All the patients underwent BCI Generation 602 (BCI602; MED-EL, Innsbruck, Austria) implant surgery between September 2021 and June 2023. Audiological and sound localization tests were performed under unaided and BB-aided conditions.

RESULTS

The transmastoid and retrosigmoid sinus approaches were implemented in three and six patients, respectively. No patient underwent preoperative planning, lifts were unnecessary, and no sigmoid sinus or dural compression occurred. The mean function gain at 0.5-4.0 kHz was 28.06 ± 4.55-dB HL. The word recognition scores improved significantly in quiet under the BB aided condition. Signal-to-noise ratio reduction by 10.56 ± 2.30 dB improved the speech reception threshold in noise. Patients fitted with a unilateral BB demonstrated inferior sound source localization after the initial activation.

CONCLUSIONS

Second-generation BBs are safe and effective for patients with bilateral congenital microtia and may be suitable for children with mastoid hypoplasia without preoperative three-dimensional reconstruction.

Considerations on Ossicular Reconstruction Using Lenticular Prosthesis for the Necrosed Lenticular Process During Endoscopic Tympanoplasty in Chronic Otitis Media (Mucosal) Cases

Purpose: To evaluate hearing outcome and fate of LPIRP (lenticular process of incus replacement prosthesis) prosthesis in the reconstruction of erosion of long process of the incus. Methods: In this retrospective descriptive study 17 patients with erosion of long process of incus who were operated (reconstructed with LPIRP prosthesis) between January 2015 to December 2017 in a tertiary care center were included. The hearing outcome was evaluated by comparing mean PTA and mean ABG preoperatively and postoperatively at the end of 3 months and 18 months. The graft uptake rate, reperforation, and extrusion of the prosthesis were assessed using otoendoscopy. Results: Preoperative mean PTA was 53.8 dB while mean postoperative PTA was 36.6 dB and 33.4 dB at the end of 3 and 18 months respectively (p-value ˂ 0.05). The mean preoperative ABG was 30.2 dB while the postoperative mean was 13.4 dB and 11.2 dB at the end of 3 months and 18 months respectively (p < 0.05). Extrusion with re-perforation was seen only in one case 1/17 (5.8%). Conclusion: LPIRP has all the characteristics for an ideal middle ear implant which is a cost-effective alternative in the reconstruction of an eroded long process of the incus.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03317-5.

Frequency-specific prediction model of hearing outcomes in patients with idiopathic sudden sensorineural hearing loss

PURPOSE

The hearing outcome of idiopathic sudden sensorineural hearing loss (ISSNHL) is hard to predict. We herein constructed a multiple regression model for hearing outcomes in each frequency separately in an attempt to achieve practical prediction in ISSNHL.

METHODS

We enrolled 235 consecutive in-patients with ISSNHL who were treated in our department from 2015 to 2020 (average hearing level at 250-4000 Hz ≥ 40 dB; time from onset to treatment ≤ 14 days; 126 males/109 females; age range 17-87 years (average 61.0 years)). All patients received systemic prednisolone administration combined with intratympanic dexamethasone injection. The pure-tone hearing threshold of 125-8000 Hz was measured at every octave before (HL_pre) and after (HL_post) treatment. A multiple regression model was constructed for HL_post (dependent variable) using five explanatory variables (age, days from onset to treatment, presence of vertigo, HL_pre, and hearing level of the contralateral ear).

RESULTS

The multiple correlation coefficient increased as the frequency increased. Strong correlations were seen in high frequencies, with multiple correlation coefficients of 0.784/0.830 for 4000/8000 Hz. The width of the 70% prediction interval was narrower for 4000/8000 Hz (± 18.2/16.3 dB) than for low to mid-frequencies. Among the five explanatory variables, HL_pre showed the largest partial correlation coefficient for any frequency. The partial correlation coefficient for HL_pre increased as the frequency increased, which may partially explain the high multiple correlation coefficients for high frequencies.

CONCLUSION

The present model would be of practical use for predicting hearing outcomes in high frequencies in patients with ISSNHL.

Prevalence of middle ear malformation and outcomes of tympanoplasty and/or canalplasty in patients with and without congenital external auditory canal stenosis

OBJECTIVE

To compare the prevalence of middle ear malformations between patients with and without congenital external auditory canal stenosis (CEACS) and to investigate the outcomes of tympanoplasty and/or canalplasty in terms of tympanic membrane (TM) size and external auditory canal (EAC) stenosis in patients with middle ear malformation.

METHODS

Twenty-five patients who underwent primary tympanoplasty and/or canalplasty for middle ear malformation at a tertiary academic medical center were retrospectively reviewed. CEACS was defined as an EAC diameter of 4 mm or less. Intraoperative findings, including irregularity of the ossicles, facial nerve, or chorda tympani; size of the TM and EAC on computed tomography; and pre- and postoperative hearing level, were collected.

RESULTS

We included 7 and 18 patients with and without CEACS, respectively. The malleus handle defect, anterior deviation of the chorda tympani, and small TM (≤7 mm) (p-values 0.015, <0.001, and 0.003, respectively; Fisher's exact test) had significantly higher prevalence in patients with CEACS than in those without. The mean postoperative air-bone gap (ABG) in patients with CEACS was not significantly different from that in patients with normal-sized EAC (20.6 dB and 19.5 dB, respectively; p-value, 0.121; Mann-Whitney U test). No difference was observed in mean postoperative ABG between patients with small TM and those with normal-sized TM (19.2 dB and 20.0 dB, respectively; p-value, 0.469; Mann-Whitney U test).

CONCLUSION

Patients with CEACS were more likely to have malleus handle defect, anterior deviation of the chorda tympani, and small TM than those without CEACS. Hearing outcome of patients with CEACS and a malformed malleus and/or incus might be equivalent to that of patients without CEACS following tympanoplasty and/or canalplasty, regardless of the EAC or TM size.

Comparison of Titanium versus Polycel as Partial Ossicular Replacement Prosthesis: A Randomized Clinical Trial

INTRODUCTION

Each type of prosthesis for ossiculoplasty has its advantages and disadvantages, and the choice of the best material has been a matter of various studies. The present study aimed to make a comparison between the hearing outcomes of partial ossicular replacement prosthesis (PORP) using titanium versus Polycel prosthesis.

MATERIAL AND METHODS

A total of 106 patients undergoing PORP as a second stage ossiculoplasty were analyzed in this study. Following that, they were randomly assigned to two groups of titanium (n=54) and Polycel (n=52) prosthesis. Subsequently, pre-and post-operative audiometric data were assessed based on the aim of the study.

RESULTS

In general, the post-operative air-bone gap within 20 dB was given to 63.5% and 55.6% of all ears in the Polycel and titanium groups, respectively, indicating a non-significant difference (P=0.407). Finally, no SNHL was observed in the groups.

CONCLUSION

Overall, the hearing outcomes and the success rate of PORP are comparable between titanium and Polycel prostheses. Therefore, the selection of these prostheses could be based on the surgeons' preferences, availability, and cost.

Clinical characteristics and correlation between hearing outcomes after different episodes of recurrent idiopathic sudden sensorineural hearing loss

OBJECTIVES

Recurrent idiopathic sudden sensorineural hearing loss (ISSNHL) is a rare disease. In this study, we evaluated the correlations between hearing recovery after the first and recurrent episodes of ISSNHL and characterized the clinical features of different episodes of ISSNHL.

METHODS

This retrospective study was conducted by reviewing medical records pertaining to the period 2008-2018. A total of 30 patients (16 male, 14 female) who had experienced at least two episodes of ISSNHL were included. All patients were had received steroid therapy (including systemic and IT) and/or hyperbaric oxygen therapy within 2 weeks after the onset of disease. The SDRG's criteria was used for the grading of hearing recovery.

RESULTS

The median age at the first and second episode of ISSNHL was 48 and 53.5 years, respectively; a total of 30% of patients presented with vertigo in the first episode and 40% presented with vertigo in the second episode. The hearing outcomes of both episodes showed significant improvement after treatment. The rate of complete recovery after the first and second episodes was 46.67% and 33.33%, respectively. A significant positive correlation was observed between the treatment outcomes of the first and second episodes (r = 0.721, p < 0.001).

CONCLUSION

In ISSNHL, hearing recovery after a recurrent episode is significantly correlated with the hearing outcome after the initial episode (p = 0.042). The treatment outcome of the first episode is a prognostic factor for the outcomes of recurrent episodes.

Otological outcome in cleft lip and palate children with middle ear effusion

OBJECTIVE

To evaluate the factors contributing to middle ear pathology, hearing and speech development among cleft palate children treated for middle ear effusion.

METHOD

A prospective cross-sectional otoscopic and audiological analysis was conducted on 102 cleft palate children (204 ears) aged 1-18 years old who were treated for middle ear effusion at our centre. Retrospective chart review was done to determine patient characteristics and prior patient management. The aim was to assess the effect of ventilation tube insertion (VTI) on hearing, speech and chronic otitis media; comparing the timing and number of ventilation tubes per ear and determining other factors affecting the short-term and long-term outcome.

RESULTS

68 children or 130 ears (63% of all cases) were selectively treated with ventilation tube insertion. Repeat procedures (more than 2) were performed in 41 ears. Among children with VTI performed, the incidence of chronic otitis media in children after the age of 4 was 17%. Overall, abnormal tympanic membrane findings and hearing loss were detected in nearly half the cases who were previously treated with VTI. Early ventilation tube insertion at less than 1 year of age, resulted in a better middle ear and hearing outcome in children less than 4 years old (p < 0.05), however there was no significant difference in children more than 4 years old. Early surgical repair of cleft palate prior to the age of one year resulted in favourable results in both age groups (p < 0.05). There was a higher prevalence of chronic otitis media with repeated grommet insertion (3 or more) (p < 0.05). Speech and language milestones were achieved in 94% of all children above the age of four.

CONCLUSION

Treatment with early ventilation tube insertion prior to the age of one year provides a hearing benefit in children less than 4 years of age, but no significant difference after 4 years of age. Factors significantly affecting the outcome after 4 years of age was the timing of palatal closure and total number of tube insertions. We recommend a conservative approach especially when considering repeated tube insertions. A long-term follow-up paired with interval hearing assessment is advocated until early adulthood.

Comparison of "Lenticular Process of Incus Replacement Prosthesis [LPIRP]" with "Conventional Autologous Tissue Ossiculoplasty Techniques" in Lenticular Process of Incus (LPI) Necrosis

To compare the outcome of ossiculoplasty using 'lenticular process of incus replacement prosthesis [LPIRP]' with that of 'conventional autologous tissue ossiculoplasty techniques' in patients with lenticular process of incus necrosis [LPI] in terms of: 1. Hearing results. 2. Graft take-up. 3. Complications like extrusion. Total 16 patients found intraoperatively to have LPI necrosis were allocated randomly using (simple random sampling technique) in two groups. Total 8 patients in group A underwent ossicular chain reconstruction using titanium prosthesis-LPIRP (manufactured by Decibel's gold prosthesis pvt. ltd.) and total 8 patients in group B underwent ossicular chain reconstruction using autologous cartilage/cortical bone. At the end of 4 weeks status of graft uptake was assessed and follow up pure tone audiogram [PTA] was performed at average 4th, 12th and 24th post-operative week. No significant difference in mean hearing gain (i.e. air-bone conduction gap closure) between two groups at 1 month, 3 months and 6 months post operatively [p > 0.05]. However postoperative 3 months and 6 months results have better air bone conduction gap closure in group A as compared to group B. Titanium LPIRP prosthesis can be a good alternative in patients undergoing ossiculoplasty where autografts are not available for ossicular reconstruction or there is inadequate surgical expertise for remodelling autologous bone/cartilage.

The impact of middle ear aeration on surgical outcome after intact canal wall tympanoplasty for cholesteatoma

OBJECTIVE

The aeration status of the middle ear is presumed to be one of the factors affecting the outcome in acquired cholesteatoma. The present study investigated the impact of postoperative middle ear aeration on hearing and recurrence after intact canal wall tympanoplasty.

METHODS

We conducted a retrospective chart review of 127 pars flaccida cholesteatoma patients who underwent primary intact canal wall tympanoplasty at a tertiary academic medical center. We collected data on clinical characteristics, including extent of cholesteatoma, surgical procedure, pre- and postoperative middle ear aeration, hearing level, and recurrence. The aeration was measured before and at one year after operation on two axial computed tomography (CT) planes: at the lateral semicircular canal (mastoid cavity) and at the oval window (tympanic cavity). Based on the postoperative air-bone gap (ABG), patients were categorized into two groups: the successful hearing (ABG ≤15 dB) group and the unsuccessful hearing (ABG >15 dB) group. We used aeration ratio to assess the relationship between postoperative aeration improvement and hearing outcome or recurrence. Multivariate logistic regression analysis was used to identify the factors associated with hearing outcome.

RESULTS

At one year after operation, aeration ratio in both mastoid and tympanic cavities was significantly improved than the preoperative status (p < 0.001, p < 0.001, respectively, Wilcoxon signed-rank test). The positive correlation was found between postoperative aeration ratios of mastoid cavity and tympanic cavity (r = 0.348, p < 0.001, Spearman's rank-correlation coefficient). In mastoid and tympanic cavities, the postoperative aeration ratio in successful hearing group (n = 57) was significantly higher than that in the unsuccessful hearing group (n = 45) at one year after operation (p < 0.001, p = 0.028, respectively, Mann-Whitney U test). Multivariate logistic regression analysis demonstrated that postoperative aeration ratio in mastoid cavity and preoperative ABG were significant independent prognostic factors for successful hearing (odds ratio [95% confidence interval]: 2.630 [0.985 - 7.024], p = 0.045; 0.891[0.840 - 0.944], p < 0.001, respectively). However, postoperative aeration ratios did not significantly differ between with (n = 14) and without recurrence (n = 113) groups in both cavities.

CONCLUSION

Our results suggest that better postoperative aeration in mastoid cavity is independently associated with satisfactory hearing outcome after intact canal wall tympanoplasty in pars flaccida cholesteatoma. However, no significant differences were observed between middle ear aeration at one year after operation and recurrence.

Analysis of thyroid dysfunction in patients with sudden sensorineural hearing loss

Background

Sudden sensorineural hearing loss (SSHL) refers to the sudden occurrence of unexplained sensorineural hearing loss. The present study showed that different systemic diseases had different influence on the occurrence and hearing outcome of SSHL. Thyroid hormone is one of the important factors for the development of fetal ear and auditory function. However, the distribution of thyroid dysfunction in SSHL patients and the effect of thyroid dysfunction on the occurrence and hearing outcome of SSHL has not been studied.

Methods

In this study, a retrospective analysis had been done in 676 patients with SSHL. We had described the distribution of thyroid function in patients with SSHL in detail, and by the statistical method, analyzed the relationship between the hearing outcome and thyroid dysfunction, respectively.

Results

In all patients, 24.41% (165/676) had abnormal thyroid function testing results. The onset age of SSHL in FT3 abnormal group (including low and high group) was younger than that in normal FT3 group. Recovery group had more patients with lower-than-normal T3 level as compared to non-recovery patients. Significant associations between T3 levels and hearing outcome were observed in the subgroup with longer time elapse between symptom onset and treatment (≥14 d).

Conclusion

The incidence of thyroid dysfunction in SSHL is significantly higher than in the general population. There was obvious relationship between T3 and FT3 item of thyroid dysfunction and the onset time and hearing outcome of SSHL, which indicated that T3 or FT3 indicator may be one of the affecting factors for the SSHL. Early screening and diagnosis of thyroid dysfunction, especial T3 level, may help to evaluate the prognosis in SSHL patients.

Comparative Study of Hearing Improvement of Type 1 Tympanoplasty Using Temporalis Fascia and Conchal Cartilage as Graft Material

Tympanic Membrane perforation is a common cause of hearing loss. Various surgical techniques with different types of graft materials have been described for the treatment of perforations. The conchal cartilage and temporalis fascia graft are most widely used. We conducted a prospective Randomized control trial at Sri Guru Ram Das Institute of Medical Sciences and Research to compare the post operative hearing outcomes between the patients of safe CSOM (n = 40) using temporalis fascia (n = 20) and conchal cartilage (n = 20). It was found that the AB gap closure at 2 months post-operatively was 11.55 ± 8.173 for conchal perichondrium group as compared to 10.49 ± 9.069 for temporalis fascia group. At 6 months the AB gap closure was 14.98 ± 9.915 for conchal cartilage group as compared 11.41 ± 8.288 db for temporalis fascia group. Thus hearing improvement was better for conchal cartilage group both at 2 and 6 months but the comparison of the AC gain at the end of 6 months and subjective improvement in hearing between the two techniques was not statistically significant owing to the small sample size of the study. Both Temporalis fascia and conchal cartilage with perichondrium were acceptable graft material for successful closure of tympanic membrane perforation, hearing improvement was better with conchal cartilage group.

Titanium ossicular chain reconstruction in single stage canal wall down tympanoplasty for chronic otitis media with mucosa defect

PURPOSE

To evaluate surgical outcomes for chronic otitis media with mucosa defect underwent titanium ossicular chain reconstruction (OCR) in single stage canal wall down tympanoplasty (CWD).

METHODS

A clinical retrospective study was performed on 83 cases of the chronic otitis media with mucosa defect and 123 ears with mucosa integrity according to intraoperative findings that underwent synchronous titanium OCR in single stage CWD form January 2012 to January 2018. Pre- and postoperative air conduction threshold (AC), air-bone gap (ABG) and ABG closure at 0.5, 1, 2, and 4 kHz were investigated.

RESULTS

The overall mean AC threshold of 53.4 ± 16.5 dB was lowered to 41.2 ± 15.9 dB postoperatively (p < 0.01). The mean pre- and postoperative ABG of all patients were 27.9 ± 9.9 dB and 17.2 ± 9.3 dB (p < 0.01), respectively, with a mean ABG closure of 10.7 ± 8.4 dB. The total rate of success, postoperative ABG ≤ 20 dB was achieved in 71.4%. In the mucosa defect group underwent TORP, the mean pre- and postoperative ABG were 28.1 ± 9.8 dB and 20.1 ± 9.0 dB (p < 0.01), respectively, with the ABG closure was 8.0 ± 7.9 dB. In the mucosa defect group underwent PORP, the mean pre- and postoperative ABG were 27.9 ± 10.1 dB and 16.5 ± 9.1 dB (p < 0.01), respectively, with the ABG closure was 11.4 ± 8.6 dB. Furthermore, in the mucosa defect group, there was significant difference in success rate of achieved postoperative ABG ≤ 20 dB between the TORP (48.9%) and PORP (77.5%) (p < 0.05).

CONCLUSION

It is revealed PORP in single stage CWD tympanoplasty for the patients suffered from chronic otitis media with mucosa defect is favored.

Minimal Reporting Standards for Active Middle Ear Hearing Implants

There is currently no standardized method for reporting audiological, surgical and subjective outcome measures in clinical trials with active middle ear implants (AMEIs). It is often difficult to compare studies due to data incompatibility and to perform meta-analyses across different centres is almost impossible. A committee of ENT and audiological experts from Germany, Austria and Switzerland decided to address this issue by developing new minimal standards for reporting the outcomes of AMEI clinical trials. The consensus presented here aims to provide a recommendation to enable better inter-study comparability.

Factors Affecting the Outcome of Stapes Surgery

To study the outcome of stapes surgery based on the Clinical, Audiometry, and Surgical pre- and postoperative factors. This study is a prospective study of factors affecting the outcome of stapes surgery in otosclerosis patients. From February 2010 to June 2011, 57 patients of confirmed clinical otosclerosis were analysed. Out of them, 31 patients were included in our study as were available for follow-up. Clinical, audiometry and surgery-related parameters were included to assess the surgery outcome. Results were reported as suggested by AAO-HNS (American Association of Otolaryngology and Head and Neck Surgery) guidelines for stapes surgery, 1995. The paired t-test and analysis of variables test (ANOVA) were used to evaluate the results. A p value of <0.05 was considered significant. There was statistically significant improvement in ABG (air bone gap) closure at 3 months of surgery (p value <0.001). Among all cases, PTA BC (pure tone average bone conduction) at 3 months of surgery was found in the range of 7.5 dB to 43.75 dB. ABG closure was achieved in the range of 0 dB to 27.5 dB among all cases. Variables like gender, degree of hearing loss, type of footplate, sealing material, and piston diameter were definitely predicting the outcome of stapes surgery. Pure tone audiometry plays an important role to diagnose the otosclerosis, to evaluate degree and type of hearing loss and to assess hearing outcome after surgery. Our results may improve knowledge of predictive factors, providing the surgeon with useful information to plan surgery with a better case selection as well as to counsel the patient on the likelihood of success of the procedure.

Efficacy of systemic and intratympanic corticosteroid combination therapy versus intratympanic or systemic therapy in patients with idiopathic sudden sensorineural hearing loss: a randomized controlled trial

OBJECTIVE

The present study was conducted to compare the rates of recovery from idiopathic sudden deafness after the treatment with oral and intratympanic corticosteroids in both mono and combination therapies.

STUDY DESIGN

Triple-blind randomized clinical trial.

SETTINGS

Tertiary referral hospital.

SUBJECTS AND METHODS

A total of 112 patients who were admitted to the ENT emergency department randomly divided into three groups: an oral corticosteroid plus intratympanic placebo (systemic corticosteroid monotherapy group); an intratympanic corticosteroid plus oral placebo group (IT monotherapy group); and a combination therapy group (IT plus systemic combination group). All patients were treated additionally with antiviral and proton pomp inhibitor. An audiometry was performed once before beginning the therapies and again at the end of the therapy.

RESULTS

Of the total of 112 patients, 32 received intratympanic (IT) corticosteroids, 45 were receiving systemic corticosteroids, and 35 were receiving a combination of the two. A total of 74 patients (66.1%) responded positively [response to treatment was calculated as gain of at least 10 dB in 10 dB in average threshold or with the minimum improvement of 15% in speech discrimination scores (SDS)] to corticosteroid therapy. No significant differences were observed between the three groups (IT, systemic group, and combination therapy group) in their overall response to treatment (p = 0.5). Patients who suffered from concomitant tinnitus and dizziness responded less positively to the treatment (p < 0.002). Positive family history of SSNHL seems to be negative prognostic factors in the response to treatment (p < 0.001). The response to treatment was not related to the pattern (p = 0.04) and initial severity of hearing loss (p = 0.9).

CONCLUSION

This study did not find any difference in the rate of hearing improvement between systemic, intratympanic, and combined corticosteroid therapy for sudden hearing loss.

LEVEL OF EVIDENCE

1b.

Hearing outcome does not depend on the interval of intratympanic steroid administration in idiopathic sudden sensorineural hearing loss

We studied the effect of intratympanic steroid administration with different intervals on hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). The subjects were 197 consecutive patients (197 ears) with ISSNHL (hearing level ≥40 dB, interval between onset and treatment ≤30 days). They received systemic administration of prednisolone (100 mg followed by tapered doses) combined with intratympanic injection of dexamethasone (4 mg/ml). Intratympanic injection was performed once a week for 4 weeks in 105 patients (long-interval group), or 4 times in 1 week in 92 patients (short-interval group). The hearing outcomes were evaluated at two points of time: 1 week from the start of treatment, and 1-2 months after the completion of treatment when the hearing level reached a plateau. There was no significant difference in the cure rate, marked-recovery rate, recovery rate, hearing gain, hearing level, or percent hearing improvement between the long- and short-interval groups at either point of time. Multiple regression analysis also showed that the final hearing level did not depend on the interval of intratympanic steroid injection. These results indicate that the hearing outcome of ISSNHL does not improve even if the interval of intratympanic injection is shortened. This implies that a lower total number of intratympanic steroid injections may be as effective as the present protocol.

Is Intratympanic Dexamathasone Injection Effective for the Treatment of Idiopathic Sudden Sensorineural Hearing Loss?

BACKGROUND AND OBJECTIVES

The purpose of this study is to identify the effectiveness of intratympanic (IT) steroids when used as an initial therapy in sudden sensorineural hearing loss (SSNHL), and when it is used as a salvage therapy in a refractory SSNHL.

SUBJECTS AND METHODS

This retrospective study included 122 patients with SSNHL. First, patients were divided into three groups according to the initial treatment; IT steroid, systemic steroid and combined (systemic and IT steroid) groups. Second, patients were divided into two groups according to the salvage treatment in a refractory SSNHL; IT steroid and the control (non IT group). Fifty eight patients who did not respond to initial therapy were included in the second analysis. Hearing was assessed immediately before the treatment and 2 weeks, 4 weeks and 3 months after the treatments. Hearing recovery was defined as an improvement of >15 dB and the final hearing of 25-45 dB in the audiogram.

RESULTS

When we analyzed the hearing recovery in initial treatment, the comparison of audiogram among three groups did not result in significantly different outcomes. There were no differences in the recovery rate in 2 and 4 weeks throughout all the frequencies. Also, the analysis of the salvage treatment demonstrated that neither IT steroid group nor control group was significantly effective in treating the refractory SSNHL.

CONCLUSIONS

The results suggest that initial treatment of SSNHL with IT steroid alone is as effective as systemic steroid alone or a combination therapy. Also, salvage IT steroids for refractory SSNHL did not have any additional beneficial effects.

Ipsilateral cochlear implantation in patients with sporadic vestibular schwannoma in the only or best hearing ear and in patients with NF2

The aim of this study was to evaluate the cochlear implant (CI) performances in neurofibromatosis type 2 (NF2) patients with bilateral vestibular schwannoma (VS) and in patients with sporadic VS in the only or better hearing ear. All patients with bilateral VS or sporadic VS in the only or better hearing ear who underwent cochlear implantation, either simultaneous to VS surgery or staged after treatment for VS, in the tumor side were chosen for the study. Postimplantation audiometric scores (sound detection, closed-set and open-set discrimination scores) and device use patterns were the main outcome measures. 15 patients were implanted. Eight patients (53 %) were NF2 and seven patients had VS in the only or better hearing ear. One patient was explanted for cerebrospinal fluid leak. In the CI-only condition, the other 14 patients obtained sound detection, 64 % of them achieving open-set discrimination (mean 70 ± 38 %) and 85 % achieving closed-set discrimination (mean 41 ± 33 %). At the last follow-up 10 patients (67 %) were using the CI. Cochlear implantation provides hearing in particular cases of patients with bilateral VS or VS in the only or better hearing ear. As long as anatomic preservation of the cochlear nerve is achieved, cochlear implantation may offer improvement in communication skills for most patients.

Association between Vestibular Function and Hearing Outcome in Idiopathic Sudden Sensorineural Hearing Loss

BACKGROUND AND OBJECTIVES

To investigate whether different vestibular function tests such as cervical vestibular evoked myogenic potential (cVEMP) and caloric test were correlated with severity, pattern and prognosis in idiopathic sudden sensorineural hearing loss (ISSNHL).

SUBJECTS AND METHODS

Ninety-two patients with unilateral ISSNHL were subjected to complete audiovestibular evaluation. cVEMP and caloric test results were compared with patients' initial and final audiogram. We classified patients in 4 groups as cochlear nerve (C) type, cochlear and superior vestibular nerve (C+S) type, cochlear and inferior vestibular nerve (C+I) type and cochlear, superior vestibular nerve, inferior vestibular nerve (C+S+I) type, for evaluation of the results. cVEMP and caloric tests were compared among the groups.

RESULTS

Abnormal caloric test results and abnormal cVEMP results were found in 50% and 31.6% patients, respectively. Multivariate analysis showed that abnormal caloric result (canal paresis) is a significant negative prognostic factor.

CONCLUSIONS

Initial vestibular function test can be valuable in predicting the final outcome in patients with ISSNHL.