Harmadikablak-szindróma – osztályozás, diagnózis, terápia

Összefoglaló. Halláspanasszal számos beteg fordul orvoshoz. A rutinszerűen elvégzett súgottbeszéd-, hangvilla- és tisztahangküszöb-audiometriai vizsgálat alapján vezetéses, sensorineuralis, illetve a kettő együttes fennállása esetén kevert típusú halláscsökkenést különböztetünk meg. Vezetéses halláscsökkenés létrejöhet mind a külső, mind a közép- vagy a belső fül veleszületett vagy szerzett rendellenességei esetén. Amennyiben a stapediusreflex kiváltható, ugyanakkor a betegnél nincs jelen a külső fület, valamint a középfület érintő kórfolyamat, felmerül a harmadikablak-szindróma lehetősége. A kórkép okaként egy, a belső fül csontos tokján „harmadik ablakként” funkcionáló laesio van jelen, amely az ovális ablakon keresztül beérkező hangenergia egy részét elvezeti, mielőtt az a kerek ablakon át kivezetődik a középfülbe. A diagnózis felállítása gyakran nehéz feladat elé állítja a klinikust, melyhez a megfelelő audiológiai, illetve képalkotó vizsgálatok elvégzése elengedhetetlen. Tekintettel arra, hogy a panaszok megszüntetésére számos műtéti módszer került leírásra, közleményünkben átfogó képet adunk a kórkép etiológiájáról, diagnosztikájáról, terápiájáról, valamint bemutatjuk saját kezdeti tapasztalatainkat is 2 eset prezentálásával. Orv Hetil. 2020; 161(46): 1944–1952. Summary. Patients frequently present to the physician with hearing loss. Routine hearing tests include speech field (whisper test), tuning forks and pure tone threshold audiometry, which can identify the presence of sensorineural hearing loss, conductive hearing loss or a combination of both (mixed type). Conductive hearing loss can be a symptom of many different conditions. These include congenital or acquired malformations of the outer, middle and inner ear. If a conductive hearing loss with intact stapedial reflexes are recorded and in the absence of outer or middle ear pathology, then the third window syndrome should be considered. The cause is a bony defect on the otic capsule that acts as a ’third window’, dissipating the incoming sound energy. Without the appropriate audiological and imaging tests, the diagnosis of the condition is challenging in clinical setting. Several surgical techniques have been described to treat the condition. The authors give a comprehensive review of the etiology, diagnosis and treatment of the disease presenting their initial experiences with 2 cases. Orv Hetil. 2020; 161(46): 1944–1952.

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Otologic Complications following Temporomandibular Joint Arthroscopy

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348948809700618 ◽

1988 ◽

Vol 97 (6) ◽

pp. 675-679 ◽

Cited By ~ 31

Author(s):

Edward L. Applebaum ◽

Arvind Kumar ◽

Lawrence F. Berg ◽

Mahmood F. Mafee

Keyword(s):

Hearing Loss ◽

Facial Nerve ◽

Temporomandibular Joint ◽

Facial Paralysis ◽

Conductive Hearing Loss ◽

Surgical Techniques ◽

Recent Application ◽

Main Trunk ◽

The Third ◽

Conductive Hearing

The recent application of arthroscopic surgical techniques to the temporomandibular joint (TMJ) has facilitated the diagnosis and treatment of TMJ disorders. However, as TMJ arthroscopy is performed more frequently, new complications are being recognized. We report three patients who developed severe otologic complications following TMJ arthroscopy. Two sustained complete or severe sensorineural hearing loss and severe vertigo from trauma to the ipsilateral ear. The third patient had complete facial paralysis from trauma to the facial nerve in the middle ear and a conductive hearing loss from incus dislocation. Complete hearing loss and facial paralysis from trauma to the main trunk of the facial nerve have not been reported previously as complications of TMJ arthroscopy.

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Hearing Status after Stapedotomy in Otosclerotic Patients

Bangladesh Journal of Otorhinolaryngology ◽

10.3329/bjo.v25i2.45205 ◽

2020 ◽

Vol 25 (2) ◽

pp. 85-93

Author(s):

Ahmed Tariq ◽

Mostafizur Rahman ◽

Delwar Hossain ◽

Sheikh Hasanur Rahman

Keyword(s):

Hearing Loss ◽

Conductive Hearing Loss ◽

Bone Conduction ◽

Surgical Techniques ◽

Neck Surgery ◽

Speech Discrimination ◽

College Hospital ◽

Medical College ◽

Medical University ◽

Conductive Hearing

Otosclerosis is the most frequent cause of conductive hearing loss in patients with intact tympanic membrane. It can be treated by surgery with various techniques. Because of limited manipulation and comparably similar results, stapedotomy at present is preferred over other surgical techniques by most surgeons. Here we present the operative results of 35 otosclerotic patients who underwent stapedotomy between January 2009 - October 2010 in the department of Otolaryngology- Head & Neck Surgery of Bangabandhu Sheikh Mujib Medical University, Dhaka Medical College Hospital and Shahid Suhrawardhy medical college & hospital, Dhaka. The aim of this study was to evaluate the hearing results following stapedotomy in otosclerosis surgery. The average air-bone gap of patients improved significantly to 21.74 dB after operation. Other hearing parameters of patients (including air conduction, bone conduction, speech discrimination score, and tinnitus) also improved. No patient experienced persistent vertigo after the operation and pre operative tinnitus resolved in 12 out of 22 patients. Stapedotomy is a safe and effective modality for improving conductive hearing loss in otosclerotic patients. Bangladesh J Otorhinolaryngol; October 2019; 25(2): 85-93

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Conductive hearing loss: investigation of possible inner ear origin in three cases studies

The Journal of Laryngology & Otology ◽

10.1258/00222150260369507 ◽

2002 ◽

Vol 116 (11) ◽

pp. 942-945 ◽

Cited By ~ 5

Author(s):

Hamad Al Muhaimeed ◽

Yousry El Sayed ◽

Abdulrahman Rabah ◽

Abdulrahman Al-Essa

Keyword(s):

Hearing Loss ◽

Inner Ear ◽

Conductive Hearing Loss ◽

Round Window ◽

The Third ◽

Conductive Deafness ◽

Mixed Hearing Loss ◽

Stapedial Reflex ◽

Conductive Hearing ◽

Inner Ear Disorders

This is a report of three cases of mixed hearing loss that resulted from inner ear disorders. Two cases were unilateral and the third was bilateral. The diagnosis was based on the findings of normal middle and external ears in association with the absence of round window reflexes. The contralateral stapedial reflex was present in the two unilateral cases. This is the first documentation of conductive deafness due to inner ear abnormality. This diagnosis should be considered in cases of conductive hearing loss if the middle and external ears are normal. More studies are needed to establish the pathophysiology of this entity.

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Congenital Conductive Hearing Loss in Apert Syndrome

Otolaryngology ◽

10.1177/019459988609500402 ◽

1986 ◽

Vol 95 (4) ◽

pp. 429-433 ◽

Cited By ~ 16

Author(s):

Susan G. Phillips ◽

Richard T. Miyamoto

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Conductive Hearing Loss ◽

Otitis Media With Effusion ◽

Apert Syndrome ◽

Review Of The Literature ◽

Stapes Fixation ◽

The Third ◽

Hands And Feet ◽

Conductive Hearing

Acrocephalosyndactyly (Apert syndrome) is a rare cranlosynostotic syndrome characterized by acrocephaly, syndactyly of the hands and feet, and—occasionally—-conductive hearing loss. We report three cases of conductive hearing loss in Apert syndrome. One patient was found to have bilateral stapes fixation. His daughter (the second case) had chronic bilateral otitis media with effusion. The third case involved a fixed Incus and hypomobile stapes. The management of these patients and a review of the literature are presented.

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Identification of Hearing Loss in Children and Young Adults Using Measures of Transient Otoacoustic Emission Reproducibility

American Journal of Audiology ◽

10.1044/1059-0889.0403.71 ◽

1995 ◽

Vol 4 (3) ◽

pp. 71-86 ◽

Cited By ~ 29

Author(s):

Theodore J. Glattke ◽

Irene A. Pafitis ◽

Cynthia Cummiskey ◽

Gilbert R. Herer

Keyword(s):

Young Adults ◽

Hearing Loss ◽

Conductive Hearing Loss ◽

Otoacoustic Emission ◽

Frequency Region ◽

Routine Clinical Practice ◽

Transient Evoked Otoacoustic Emission ◽

Children And Young Adults ◽

Conductive Hearing ◽

Pure Tone Threshold

Measures of transient evoked otoacoustic emission (TEOAE) reproducibility were obtained for 506 ears of 260 children and young adults. Frequency-specific and whole reproducibility (WR) data were obtained using ILO88 hardware and software and were analyzed with respect to pure-tone threshold and immittance data for the same ears. Reproducibility scores were most robust in the frequency region of 2,000 Hz. In addition, the 2,000-Hz reproducibility score was the most efficient of all measurements (0.85 to 0.91) in separating normal and hearing-impaired ears, regardless of the frequency or frequencies at which the hearing loss occurred. Conductive hearing loss precluded detection of emissions. The present findings suggest that TEOAEs provide useful information in routine clinical practice and that they may be employed to screen for the presence of hearing loss in children and young adults.

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Can smartphone vibration provide a valid alternative to tuning forks for use on the ENT ward round?

The Journal of Laryngology & Otology ◽

10.1017/s0022215119000525 ◽

2019 ◽

Vol 133 (03) ◽

pp. 245-247 ◽

Cited By ~ 1

Author(s):

M E Hopkins ◽

D Owens

Keyword(s):

Hearing Loss ◽

Tuning Fork ◽

Conductive Hearing Loss ◽

Ward Round ◽

Chi Square ◽

Tuning Forks ◽

Chi Square Test ◽

The Right ◽

Conductive Hearing

AbstractBackgroundAll patients undergoing tympanomastoid surgery should be assessed post-operatively for a ‘dead ear’; however, tuning forks are frequently inaccessible.ObjectiveTo demonstrate that smartphone-based vibration applications provide equivalent accuracy to tuning forks when performing Weber's test.MethodsData were collected on lay participants with no underlying hearing loss. Earplugs were used to simulate conductive hearing loss. Both the right and left ears were tested with the iBrateMe vibration application on an iPhone and using a 512 Hz tuning fork.ResultsOccluding the left ear, the tuning fork lateralised to the left in 18 out of 20 cases. In 20 out of 20 cases, sound lateralised to the left with the iPhone (chi-square test, p = 0.147). Occluding the right ear, the tuning fork lateralised to the right in 19 out of 20 cases. In 19 out of 20 cases, sound lateralised to the right with the iPhone (chi-square test, p > 0.999).ConclusionSmartphone-based vibration applications represent a viable, more accessible alternative to tuning forks when assessing for conductive hearing loss. They can therefore be utilised on the ward round, in patients following tympanomastoid surgery, for example.

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Utility of Rinne’s tuning fork test for quantitative assessment of conductive hearing loss

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20203988 ◽

2020 ◽

Vol 6 (10) ◽

pp. 1878

Author(s):

Shivakumar Senniappan ◽

Rohith Chendigi

Keyword(s):

Hearing Loss ◽

Retrospective Study ◽

Sample Size ◽

Quantitative Assessment ◽

Tuning Fork ◽

Conductive Hearing Loss ◽

Medical College ◽

Hearing Acuity ◽

Tuning Forks ◽

Conductive Hearing

Background: The Rinne tuning fork test is used routinely in clinical ENT examination. It is used to assess the person’s hearing acuity. Ideally, 3 tuning forks are used 256, 512 and 1024 Hz. Rinne tuning fork tests can be used to diagnose conductive hearing loss. Aim of our study an attempt is made to find the utility of three different tuning forks (256,512,1024 Hz) for quantification of conductive hearing loss and their accuracy.Methods: A retrospective study with a sample size of 300 was undertaken over 12 months from April 2018 to March 2019 at the out-patient department of ENT of VMKV medical college and hospital, Salem. Patients of both sexes and aged above 10 yrs presenting with conductive hearing loss due to varied etiology were subjected to complete ENT examination including Rinne test with three different tuning forks (256, 512, 1024 Hz).Results: The results of all the tuning forks (256, 512, 1024 Hz) shows that 29 patients were Rinne’s positive to all tuning forks had the air-bone gap range of 15 dB to 19 dB with a mean air-bone gap of 17.63 dB. 83 patients were negative to 256 Hz tuning fork but positive to 512 and 1024 Hz tuning forks had the air-bone gap range of 20 to 29 dB with a mean air-bone gap of 25.46 dB.Conclusions: We conclude that Rinne’s tuning fork test can be used to quantify the degree of conductive hearing loss into mild (20-30 dB), moderate (30-45 dB), and severe (45-60 dB).

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