scholarly journals Ergebnisse der mit der Obliteration des runden/ovalen Fensters erreichten Behandlungserfolge bei der einseitigen, akut aufgetretenen, idiopathischen sensorineuralen Hörminderung 

2022 ◽  
pp. 49-68
Author(s):  
Thomas Eichhorn
Keyword(s):  
Hearing Loss ◽  
Operative Procedure ◽  
Study Groups ◽  
Oval Window ◽  
Sudden Deafness ◽  
Hearing Level ◽  
First Line ◽  
Hearing Gain ◽  
Time Of Admission

ZusammenfassungFormerly explorative tympanotomies including sealing of the round/oval window/s have only been used in treating perilymphatic fistulas. During the last years this operation especially in the middle European countries has also been performed more and more in patients suffering from an ISSNHL. In this chapter the effect of this operation including a simultaneous systematic steroid therapy on hearing levels has been collected from data presented in literature and the results will be presented by means of a systematic review. The survey also includes the results of this operative procedure in 41 patients who have been treated by us.Based on 19 publications dealing with the above mentioned topic only 6 studies (4 of them with information about the hearing loss at the time of admission at the hospital and additionally at a follow-up examination (n = 309)) could be integrated in this study and another 2 in which the hearing gains –regardless of the initial hearing loss- according to the modified „Kanzaki“-criteria (n = 288)) have been evaluated- could be used for estimating the therapeutic effects of tympanoscopy with sealing of the round/oval windosw/s in patients with sudden deafness.The follow-up examination had to exceed a 3 weeks interval up from the time of the operation. It is shown that several methods of evaluation the median hearing loss (PTA4 and PTA5) in pure tone audiograms are suitable to be accepted for the analysis of hearing losses in order to compare the results of the treatment.In each study-group collected from literature and two study-groups of our own patients the hearing loss before therapy was significantly higher than that which had been measured at the follow-up examination.Patients in which tympanoscopy was combined with a systematic application of steroids in a „first-line-mode“ (n = 79) had a hearing loss of 94,1 dB. Their hearing improved up to a hearing level of 70,7 dB at the follow-up examination (hearing gain: 23,4 dB; n = 79). Those who first had got systematic steroids followed by the tympanoscopy („second-line-mode“) had an intitial hearing loss of 105,1 dB and a hearing gain of 38,6 dB. So the final hearing level reached 66,5 dB (n = 197).Median hearing thresholds still rose after detamponation of the external ear canal which was usually done 10 days after the operation up to the follow-up examination.Based on the modified „Kanzaki“-criteria 58,7 % of the patients had a restoration in their hearing exceeding 30 dB. In 18,7 % of the cases the hearing improvement was between 10 and 30 dB. 23,1 % of the patients didn`t profit from tympanoscopy.Indications for deciding to perform an explorative tymapnosocopy which are mentioned in literature are collected and discussed.Explorative tympanotomy including sealing of the round/oval window/s seems to be a very valuable method in treating sudden deafness especially when the hearing loss was severe, profound or even when the patients were totally deaf and the therapeutic procedure had been done sequentially after having performed a systematic steroid application before operation. Further studies have to find out if tympanoscopy used in a „first-line-mode“ can also be a method in which the hearing gain is successful enough that this form of therapy can also be recommended.

Hearing Outcome of Stapes Surgery in NIENT, Bangladesh

2020 ◽  
Vol 26 (1) ◽  
pp. 31-36
Author(s):  
Md Zakaria Sarkar ◽  
AHM Ferdows Nur ◽  
Utpal Kumar Dutta ◽  
Muhammad Rafiqul Islam ◽  
Debabrota Roy ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Cross Sectional Study ◽  
Surgical Trauma ◽  
Group 14 ◽  
Progressive Hearing Loss ◽  
Cross Sectional ◽  
Hearing Gain ◽  
Hearing Outcome

Objective: The aim of this study was to evaluate hearing outcome after stapedotomy in patients with Otosclerosis. Methods: This cross sectional study was carried out from July 2017 to January 2019 in National Institute of ENT, Unit V. About 22 patients with Otosclerosis were included in this study. Diagnosis of Otosclerosis was based on the history, medical status with Otoscopy, Tuning fork tests and Audiometric tests. We compiled data on the pre and post operative air-bone gap (ABG) at 0.5, 1, 2 KHZ. The ABG was Calculated using AC and BC thresholds on the same audiogram. Post operative hearing gain was then Calculated from the ABG before the operation minus the ABG of the last follow up examination Results: In this study most of the cases were age group 14-30 years (72.7%), female (54.5%). Most common symptoms was progressive hearing loss, tinnitus (77.8%).The average preoperative hearing loss in this study was (AC) was 48.31±7.68. The average post opt. hearing (AC) at follow up was 28.95±10.30 with an average hearing gain of 15.40±8.53 dB which was significant. The average pre-operative ABG was 28.99 dB ± 8.10. The average post opt. ABG was analyzed at 1 follow up showed ABG 13.18±8.09 dB which was found to be significant. Conclusion: Stapedotomy is an effective surgical procedure for the treatment of otosclerosis which leads to improvement in patient’s quality of life. A favorable hearing outcome can be obtained by the combination of experienced hands with minimal surgical trauma and appropriate surgical technique. Bangladesh J Otorhinolaryngol; April 2020; 26(1): 31-36

Sudden Deafness and Labyrinthine Window Ruptures

1973 ◽  
Vol 82 (1) ◽  
pp. 2-12 ◽  
Author(s):  
Victor Goodhill ◽  
Irwin Harris ◽  
Seymour J. Brockman ◽  
Oscar Hantz
Keyword(s):  
Hearing Loss ◽  
Surgical Intervention ◽  
Round Window ◽  
Vestibular Function ◽  
Sudden Hearing Loss ◽  
Oval Window ◽  
Sudden Deafness ◽  
Scala Tympani ◽  
Cochlear Aqueduct ◽  
History Of

In 1971, one of the authors reported sudden deafness associated with labyrinthine window membrane ruptures. Eighteen additional cases have been explored surgically since then. Data on 21 cases are presented. Sudden profound cochlear deafness has now been encountered in 21 cases which were surgically explored. In 15 instances, fistulae of round, oval, or both windows were encountered and repaired. In 10 of the 15, there was a definite history of sudden exertion or trauma prior to onset. The oval window alone was ruptured in nine patients, the round window alone in one, and both windows were ruptured in five patients. The oldest patient was 62 years and the youngest 11 years of age. Differential audiological studies showed profound losses in all cases. Almost every case was studied by pure tone AC-BC and speech audiometry, Békésy, and impedance tests. Whenever possible other audiologic tests, such as recruitment, tone decay, and SISI were performed. These findings are presented in detail. Vestibular function was studied by electronystagmography (ENG) in 15 of the 21 cases surgically explored. There was evidence of vestibular dysfunction in almost every case with sudden hearing loss. Significant ENG details are presented. Surgical repairs of ruptured window membranes were followed by improvements in some of the patients. Postoperative audiologic data are presented. The theoretical aspects include discussion of possible cerebrospinal fluid (CSF) perilymph pathways between cochlear aqueduct and scala tympani and between internal auditory meatus and scala vestibuli. It is concluded that spontaneous labyrinthine window ruptures must now be added to the etiologic factors in “sudden hearing loss.” It is premature to set down criteria for surgical intervention in such cases. Further careful studies are necessary.

Hearing Screening of High-Risk Newborns with Brainstem Auditory Evoked Potentials: A Follow-up Study

PEDIATRICS ◽  
1984 ◽  
Vol 73 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Dorothy A. Shannon ◽  
Jacob K. Felix ◽  
Allan Krumholz ◽  
Phillip J. Goldstein ◽  
Kenneth C. Harris
Keyword(s):  
Hearing Loss ◽  
High Risk ◽  
Predictive Value ◽  
Screening Test ◽  
Normal Hearing ◽  
Hearing Screening ◽  
Auditory Evoked Potential ◽  
Hearing Level ◽  
Lost To Follow Up

Numerous techniques have been used in attempts to find a reliable and efficient screening method for determining auditory function in the newborn. The brainstem auditory evoked potential (BAEP) is the latest method advocated for that purpose. The BAEP was evaluated as a hearing screening test in 168 high-risk newborns between 35 and 45 weeks of conceptual age. Follow-up data were obtained after 1 year (mean 17.3 months) on 134 of the infants (80%). Normal hearing was defined as a reproducible response in both ears to a 25 dB normal hearing level (nHL) click stimulus; 21 infants (12.5%) failed the initial screening test. Follow-up on 19/21 infants revealed 18 infants with normal hearing and one infant with an 80 dB nHL bilateral hearing loss substantiated. One infant with an abnormal screening test died before retesting, and the other infant was lost to follow-up but had only a unilaterally abnormal BAEP. None of the infants with a normal BAEP screening study had evidence of hearing loss on retesting. Sensitivity of the BAEP was 100%, specificity was 86%, predictive value of a positive test was 5.26%, and the predictive value of a negative test was 100%. The incidence of significant hearing loss in our population was between 0.75% (1/134 infants) confirmed, and 2.24% (3/134 infants) including infants who failed screening but were lost to follow-up. The BAEP is a sensitive procedure for the early identification of hearing-impaired newborns. However, the yield of significant hearing abnormalities was less than predicted in other studies using BAEP for newborn hearing screening.

Stapedectomy — A Long-Term Report

1982 ◽  
Vol 91 (5) ◽  
pp. 516-520 ◽  
Author(s):  
John J. Shea
Keyword(s):  
Vein Graft ◽  
Oval Window ◽  
Great Change ◽  
Autoimmune Response ◽  
Long Term Results ◽  
Hearing Gain ◽  
Teflon Piston

The long-term results with large fenestra stapedectomy with vein graft and Teflon piston are compared with results with the small fenestra stapedectomy with Teflon piston directly into the vestibule. There were 1,943 operations in the former group and 2,155 in the latter when compared in 1970. One hundred consecutive patients from the beginning of each group with follow-up to present were compared. Results were generally the same with no great change in 15 and 20 years as compared to those at 5 years. The complication of perilymph fistula was caused by creating an opening in the footplate much larger than the prosthesis and was eliminated by interposing a living oval window seal if the opening was much larger than the prosthesis and a flap of lining membrane from the promontory when it was not. Other factors that influence a good result are discussed, including the type and the diameter of the piston used, the type of living oval window seal and the method of attachment to the incus. The small fenestra operation was found to be superior to the large, not only for the hearing gain achieved, but the ease of performance and the freedom from complications due to migration of the prosthesis and/or the oval window seal. At present we have done about all that can be done for the conductive components. What remains is the sensorineural component which our studies indicate may be due to an autoimmune response.

Internal Auditory Canal Decompression for Hearing Maintenance in Neurofibromatosis Type 2 Patients

Neurosurgery ◽  
2015 ◽  
Vol 79 (3) ◽  
pp. 370-377 ◽  
Author(s):  
Daniele Bernardeschi ◽  
Matthieu Peyre ◽  
Michael Collin ◽  
Mustapha Smail ◽  
Olivier Sterkers ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Internal Auditory Canal ◽  
Neurofibromatosis Type ◽  
Early Postoperative Period ◽  
Neurofibromatosis Type 2 ◽  
Hearing Level ◽  
Speech Discrimination ◽  
Unilateral Deafness

Abstract BACKGROUND: In neurofibromatosis type 2 (NF2), multiple therapeutic options are available to prevent bilateral hearing loss that significantly affects the quality of life of patients. OBJECTIVE: To evaluate the morbidity and functional results of internal auditory canal (IAC) decompression in NF2 patients with an only hearing ear. METHODS: Twenty-one NF2 patients operated on for IAC decompression in a 3-year period with a minimum follow-up of 1 year were included in this retrospective study. They presented unilateral deafness due to previous contralateral vestibular schwannoma removal in 16 patients or contralateral hearing loss due to the tumor in 5 patients. Hearing level was of class A (American Academy of Otolaryngology-Head and Neck Surgery classification) in 7 patients, B in 8 patients, C in 1 patient, and D in 5 patients. Pure-tone average and speech discrimination score evaluations were performed at 6 days, 1 year, and during the follow-up. Eight patients had postoperative chemotherapy. RESULTS: No case of facial nerve palsy was observed. In the early postoperative period; all patients maintained the hearing class of the preoperative period. At 1-year follow-up, all but 3 patients maintained their hearing scores; at last follow-up (mean follow-up, 23 + 8 months; range, 12-44 months), hearing classes remained stable with only 1 patient worsening from class B to C and 1 patient improving from class D to B. CONCLUSION: Decompression of IAC seems to be a useful procedure for hearing maintenance in NF2 patients, with very low morbidity. Ideal timing and association with chemotherapy should be evaluated in the future.

scholarly journals Congenital Oval Window Aplasia: An Unusual Cause of Conductive Hearing Loss in an Adult

2016 ◽  
Vol 31 (1) ◽  
pp. 39-44
Author(s):  
Charlotte M. Chiong ◽  
Rachel T. Mercado-Evasco ◽  
Alessandra E. Chiong ◽  
Mary Ellen C. Perez ◽  
Franco Louie L. Abes ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Facial Nerve ◽  
Recent Literature ◽  
Conductive Hearing Loss ◽  
Oval Window ◽  
Surgical Approaches ◽  
Hearing Gain ◽  
Temporal Bone Ct ◽  
Conductive Hearing

Objective: To report a case of congenital oval window aplasia (COWA) in a Filipino adult presenting with  unilateral maximal conductive hearing loss and discuss the diagnostic considerations, pathophysiology and management. Methods:             Study Design:  Case report             Subjects: One (1)             Setting:  Tertiary Public Referral Center Results: Audiometric evaluation showed a maximal unilateral left conductive hearing loss. High resolution temporal bone CT showed absence of the oval window on the left along with facial and stapes abnormalities.  Exploratory tympanotomy showed an aberrant facial nerve, monopodal and abnormally located stapes and absent oval window.  Postoperative hearing gain achieved after a neo-oval window and Schuknecht piston wire prosthesis remained stable over two years. Conclusion: A congenital minor ear anomaly classified as Cremers Class 4a in which a congenital oval window aplasia was associated with an aberrant facial nerve anomaly and a monopodal stapes is reported. Recent literature supported the view that congenital oval window aplasia can in selected cases be amenable to various surgical approaches and a stable postoperative hearing gain is achievable in the long term. Keywords: oval window absence,  Cremers classification, congenital middle ear

scholarly journals Does acute sensorineural deafness befall to urgent conditions?

2009 ◽  
Vol 66 (1) ◽  
pp. 35-38
Author(s):  
Ljiljana Cvorovic ◽  
Dragoslava Djeric ◽  
Ljubomir Pavicevic ◽  
Rudolf Probst ◽  
Stefan Hegemann
Keyword(s):  
Hearing Loss ◽  
Sensorineural Deafness ◽  
Sudden Hearing Loss ◽  
University Hospital ◽  
Hearing Level ◽  
Controversial Issues ◽  
Significant Recovery ◽  
Hearing Gain ◽  
Significant Difference ◽  
The University

Background/Aim. Idiopathic sudden sensorineural hearing loss (ISSHL) is one of the most controversial issues in otology. The aim of this study was to determine whether a delay in treatment has any influence on hearing recovery in ISSHL. Method. This study was designed as a retrospective evaluation of an electronic patient data base of the University Hospital Z?rich from January 1995 to August 2006. Five hundred and forty one patients with a sudden hearing loss were identified. The standard treatment was carbogen inhalation (95% O2 and 5% CO2 eight times per day in the duration of 30 minutes) and prednisone orally (100 mg in one morning dose) for 7 days. Factor that was analyzed included the interval between the onset of symptoms and the beginning of the treatment. The initial hearing loss was described using the pure tone average (PTA in dB) hearing level at 4 frequencies (0.5, 1, 2 and 4 kHz). Hearing gain was expressed either as absolute hearing gain (dB values from initial PTA minus dB values from final PTA) or as relative hearing gain (absolute hearing gain divided by initial PTA minus baseline PTA) ? 100. Significant recovery of hearing was defined as the final PTA ? 30 dB (or same as PTA of the opposite ear). Results. An absolute hearing gain between the initial audiogram and the final audiogram was 15.1 dB. The mean relative hearing gain was 47%. Three hundred one (57%) patients had a significant recovery of hearing, and 228 (43%) had not. If the patients received treatment in the first 24 hours after onset of symptoms, then the rate of significant recovery was 56%, and no significant difference existed between this group and the patients who received the therapy after 24 hours, but within seven days (?2 = 0.007, DF = 1, p > 0.01). Conclusion. These results suggest that it is not critical to begin the treatment of ISSHL immediately as an emergency, but within seven days.

Counseling Adolescents With Hearing Loss Using a Narrative Therapy Approach

2009 ◽  
Vol 19 (2) ◽  
pp. 72-78
Author(s):  
Rebecca L. Nelson Crowell ◽  
Julie Hanenburg ◽  
Amy Gilbertson
Keyword(s):  
Hearing Loss ◽  
Process Evaluation ◽  
Narrative Therapy ◽  
Daily Life ◽  
Hearing Aid ◽  
Self Esteem ◽  
Therapy Approach ◽  
Self Worth ◽  
Counseling Adolescents

Abstract Audiologists have a responsibility to counsel patients with auditory concerns on methods to manage the inherent challenges associated with hearing loss at every point in the process: evaluation, hearing aid fitting, and follow-up visits. Adolescents with hearing loss struggle with the typical developmental challenges along with communicative challenges that can erode one's self-esteem and self-worth. The feeling of “not being connected” to peers can result in feelings of isolation and depression. This article advocates the use of a Narrative Therapy approach to counseling adolescents with hearing loss. Adolescents with hearing loss often have problem-saturated narratives regarding various components of their daily life, friendships, amplification, academics, etc. Audiologists can work with adolescents with hearing loss to deconstruct the problem-saturated narratives and rebuild the narratives into a more empowering message. As the adolescent retells their positive narrative, they are likely to experience increased self-esteem and self-worth.

The Significance of Renal Function in Response to Cardiac Resynchronisation Therapy – The Piece of a Much Larger Puzzle

2020 ◽  
Vol 18 ◽  
Author(s):  
Agnieszka Dębska-Kozłowska ◽  
Izabela Warchoł ◽  
Marcin Książczyk ◽  
Andrzej Lubiński
Keyword(s):  
Renal Function ◽  
Nyha Class ◽  
Heart Association ◽  
Cardiac Resynchronisation Therapy ◽  
Study Groups ◽  
Creatinine Concentration ◽  
Significant Difference ◽  
Cardiac Resynchronisation ◽  
Resynchronisation Therapy

Background: Although cardiac resynchronisation therapy (CRT) is an important player in the treatment of heart failure (HF) patients, the proportion of CRT patients with no improvement in either echocardiographic or clinical parameters remains consistently high and accounts for about 30% despite meeting CRT implantation criteria. Furthermore, in patients suffering from HF, renal dysfunction accounts for as many as 30-60%. Accordingly, CRT may improve renal function inducing a systemic haemodynamic benefit leading to increased renal blood flow. Objectives: The aim of the present study was to evaluate the importance of renal function in response to resynchronisation therapy during a 12-month follow-up period. Materials and methods: The study consisted of 46 HF patients qualified for implantation of cardiac resynchronisation therapy defibrillator (CRT-D). A CRT responder is defined as a person without chronic HF exacerbations during observation whose physical efficiency has improved owing to New York Heart Association (NYHA) class improvement ≥1. Results: A statistically significant difference was noted between responders and non-responders regarding creatinine level at the 3rd month (p=0.04) and, particularly, at the 12th month (p=0.02) of follow-up (100±23 vs 139±78 μmol/l). Moreover, there was a remarkable difference between both study groups with regard to GFR CKD-EPI (glomerular filtration rate (GFR) assessed using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula) at the 6th (p=0.03) and 12th month (p=0.01) of follow-up. The reference values for initial creatinine concentrations (101 μmol/l) as well as GFR CKD-EPI (63 ml/min/1.73m2 ) were empirically evaluated to predict favourable therapeutic CRT response. Conclusions: Predictive value of GFR CKD-EPI and creatinine concentration for a positive response to CRT were found relevant.

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