Audiology and Neurotology 2021-09-06

Lateralized Readiness Potentials Recorded with Near-Threshold Auditory Stimuli in Subjects Simulating Hearing Loss

Publication date 06-09-2021

Introduction: Preparatory motor cortical responses like the lateralized readiness potential (LRP) may be useful in revealing persistent attempts to feign hearing loss. Previous studies suggest only a marginal effect of stimulus intensity on the amplitude of the LRP. However, this has not been investigated using low-intensity auditory stimuli to cue No Go trials. We address this in an experiment where subjects were instructed not to give a manual response to low-instensity stimuli, a situation that is akin to simulating hearing loss.
Methods: The LRP was recorded from normal hearing listeners (N = 10) with 500 and 4,000-Hz pure tones and trains of 4,000 Hz (2-1-2) tonebursts. Electrophysiologic data underwent processing to (i) analyze the effect of the stimulus type on the LRP, (ii) classify results according to manual response with both logistic regression and linear support vector machine (SVM) models, and (iii) derive auditory brainstem responses (ABRs) from the tonebursts.
Results: The amplitude of the LRP did not differ between the 3 stimuli used to elicit the response. Single-trial electrode data from Go and No Go trials were submitted to supervised binary classification, and the logistic regression model gave a mean accuracy of close to 0.7. The Jewett wave V latencies of the resultant ABRs from some subjects were found to increase between the high (Go) and low (No Go) intensity tonebursts.
Conclusion: This study shows that auditory stimulus type does not affect the amplitude of the LRP and that the response can be recorded with stimuli that are near the auditory threshold. It can also be recorded with transient stimuli, and this allows for the possibility of simultaneously recording other confirmatory measurements, like ABR. Audiol Neurotol

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Inner Ear Symptoms Are Prevalent in Patients with High Head Abbreviated Injury Scale Scores after Blunt Head Trauma

Publication date 26-08-2021

Introduction: The purpose of this article was to determine the prevalence of inner ear symptoms in patients with blunt head trauma and to explore whether the severity of head trauma was associated with the incidence of such symptoms.
Methods: We performed a retrospective review of 56 patients admitted with blunt head trauma who underwent audiovestibular evaluation within 1 month after injury. Two scales were used to measure the severity of trauma; these were the Glasgow Coma Scale (GCS) and the Head Abbreviated Injury Scale (H-AIS). Patients with sensorineural-type hearing loss, or dizziness with nystagmus, were considered to have inner ear symptoms.
Results: About half of all patients (45%) with blunt head trauma showed trauma-related inner ear symptoms. Patients with inner ear symptoms were significantly more likely to have H-AIS scores ≥4 than those without inner ear symptoms (p = 0.004), even without concomitant temporal bone fracture (p #x3e; 0.05). Also, patients with inner ear symptoms required a statistically significantly longer time (measured from admission) before undergoing their ontological evaluations than did those without such symptoms (p = 0.002), possibly due to prolonged bed rest and use of sedatives.
Conclusion: Thus, detailed history-taking and early evaluation using trauma scales are essential for all patients suffering from severe head trauma. It may be necessary to initiate early treatment of traumatic inner ear diseases. Audiol Neurotol

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Cochlear Implantation in Elderly Patients: Survival Duration, Hearing Outcomes, Complication Rates, and Cost Utility

A Hammond-Kenny,D Borsetto,JG Manjaly,T Panova,A Vijendren,M Bance,JR Tysome,PR Axon,NP Donnelly

Publication date 20-08-2021

Introduction: The prevalence of hearing loss and its consequences is increasing as the elderly population grows. As the guidelines for cochlear implantation (CI) expand, the number of elderly CI recipients is also increasing. We report complication rates, survival duration, and audiological outcomes for CI recipients aged 80 years and over and discuss the cost utility of CI in this age group.
Methods: A retrospective cohort study was undertaken of all CI recipients (126 cases), aged 80 years and over at the time of their surgery, implanted at our institution (Cambridge University Hospitals) during a period from January 1, 2001, to March 31, 2019. Data on survival at 1, 3, and 5 years post-implantation, post-operative complications and functional hearing outcomes including audiometric and speech discrimination outcomes (Bamford-Kowal-Bench sentence test) have been reported.
Results: The mean age at implantation was 84 years. The mean audiometric score improved from 108 dB HL to 28 dB HL post-implantation. The mean Bamford-Kowal-Bench score improved from 14% to 66% and 73% at 2 and 12 months post-implantation, respectively. The complication rate was 15.3%. The survival probability at 1 year post-implantation was 0.95 for females and 0.93 for males, at 3 years was 0.89 for females and 0.81 for males, and at 5 years was 0.74 for females and 0.54 for males.
Conclusion: CI is safe and well-tolerated in this age group and elderly patients gain similar audiometric and functional benefit as found for younger age groups. Audiol Neurotol

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Vestibular Function in Children with Type 1 Diabetes: Videonystagmography Testing

SA Hamed,AF ElHadad,AM Oseily

Publication date 18-08-2021

Background: Vestibular system is critical for maintaining balance and learning complex tasks. This study aimed to determine the frequencies, types, and predictors of vestibular dysfunctions (VDs) in children with type 1 diabetes (T1D) using videonystagmography (VNG).
Patients and Methods: This study included 65 patients (children with T1D = 40; controls = 25). The patients underwent VNG.
Results: Patients (boys = 15; girls = 25) had a mean age of 14.05 ± 1.82 years and duration of illness of 6.30 ± 2.84 years. The majority had frequent attacks of diabetic ketoacidosis (DKA) (65%) and hypoglycemia (40%). Dizziness was reported in 20%. VNG abnormalities were reported in 70% (n = 28), of them 71.43 and 28.57% had central and peripheral VDs, respectively. Dizziness was associated with peripheral VD. Compared to patients without VDs, those with VDs were older and had earlier age at onset and longer duration of diabetes (#x3e;5 years), higher levels of HbA1c (#x3e;7%), higher frequencies of DKA and hypoglycemic attacks, comorbid medical conditions, and diabetic complications. Multiple logistic regression analysis showed that presence of VNG abnormalities (VDs) was independently correlated with diabetes duration #x3e;5 years (odds ratio OR = 4.52 95% confidence interval CI = 3.55–7.04, p = 0.001), HbA1c% levels #x3e;7% (OR = 3.42 95% CI = 2.84–5.75, p = 0.001), and presence of hypoglycemic attacks (OR = 4.65 95% CI = 2.85–7.55).
Conclusions: -VDs are prevalent in children with T1D and correlated with the duration and severity of diabetes and the occurrence of hypoglycemic attacks. Therefore, optimizing glycemic control and prevention and treatment of diabetic complications and comorbidities are important. Multidisciplinary follow-ups are required for early detection and management of diabetic VDs. Audiol Neurotol

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Sympathetic Nervous System Regulation of Auditory Function

C Tian,D Zha

Publication date 18-08-2021

Background: The auditory system processes how we hear and understand sounds within the environment. It comprises both peripheral and central structures. Sympathetic nervous system projections are present throughout the auditory system. The function of sympathetic fibers in the cochlea has not been studied extensively due to the limited number of direct projections in the auditory system. Nevertheless, research on adrenergic and noradrenergic regulation of the cochlea and central auditory system is growing. With the rapid development of neuroscience, auditory central regulation is an extant topic of focus in research on hearing.
Summary: As such, understanding sympathetic nervous system regulation of auditory function is a growing topic of interest. Herein, we review the distribution and putative physiological and pathological roles of sympathetic nervous system projections in hearing.
Key Messages: In the peripheral auditory system, the sympathetic nervous system regulates cochlear blood flow, modulates cochlear efferent fibers, affects hair cells, and influences the habenula region. In central auditory pathways, norepinephrine is essential for plasticity in the auditory cortex and affects auditory cortex activity. In pathological states, the sympathetic nervous system is associated with many hearing disorders. The mechanisms and pathways of sympathetic nervous system modulation of auditory function is still valuable for us to research and discuss. Audiol Neurotol

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Facial and Auditory Recognition Abilities of Implanted Primary Schoolers

S Yilar,I Tasdemir,B Koska,E Belen,B Cetinkaya,I Baltaci,B Demirkundak,M Cinar,G Gultekin,A Atas,M Emul

Publication date 11-08-2021

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. Audiol Neurotol

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The Difficulties Encountered by Pediatric Cochlear Implant Patients and Their Parents during the COVID-19 Pandemic

Publication date 05-08-2021

Introduction: The daily escalation in incidence and mortality caused by Coronavirus disease (COVID-19) has mandated forced curfew in our country (same as many other countries) to limit the spread of infection. This is predicted to have a more negative impact on cochlear implant (CI) patients since this group of patients needs a unique type of psychological, medical, and technical care in addition to a daily rehabilitation program.
Methods: A cross-sectional study based on Arabic questionnaire that looked into the collateral consequences of COVID-19 on the pediatric CI patients. The questionnaire was designed to highlight different problems such as exposure to head trauma or ear infection, difficulties in device maintenance and getting spare parts, impacts of the delay of programing or switch on appointments, and the impacts of missing rehabilitation sessions. Different ways of management of these problems are presented and discussed.
Results: A total of 174 parents responded to the questionnaire. The main problem met by the patients was missing their device programing and rehabilitation sessions. Many children had device maintenance and spare parts problems. Virtual clinics were helpful in solving different problems. Additionally, children who needed device programing were scheduled for remote programing sessions.
Conclusion: Although the inevitable consequences of the COVID-19 pandemic are catastrophic, they are forcing the medical field to explore new opportunities by sitting up an infrastructure for future usage of telemedicine. Telemedicine is cost-effective and more convenient and enables health-care providers to be immune to future circumstances. Audiol Neurotol

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Objective and Subjective Outcomes in Patients with Hearing Aids: A Cross-Sectional, Comparative, Associational Study

X Wang,Y Zheng,G Li,J Lu,Y Yin

Publication date 28-07-2021

Introduction: Outcome assessment for hearing aids (HAs) is an essential part of HA fitting and validation. There is no consensus about the best or standard approach for evaluating HA outcomes. And, the relationship between objective and subjective measures is ambiguous. This study aimed to determine the outcomes after HA fitting, explore correlations between subjective benefit and acoustic gain improvement as well as objective audiologic tests, and investigate several variables that may improve patients’ perceived benefits.
Methods: Eighty adults with bilateral symmetrical hearing loss using HAs for at least 1 month were included in this study. All subjects completed the pure tone average (PTA) threshold and word recognition score (WRS) tests in unaided and aided conditions. We also administered the Chinese version of International Outcome Inventory for Hearing Aids (IOI-HA), to measure participants’ subjective benefits. Objective HA benefit (acoustic gain improvement) was defined as the difference in thresholds or scores between aided and unaided conditions indicated with ΔPTA and ΔWRS. Thus, patients’ baseline hearing levels were taken into account. Correlations were assessed among objective audiologic tests (PTA and WRS), acoustic gain improvement (ΔPTA and ΔWRS), multiple potential factors, and IOI-HA overall scores.
Results: PTA decreased significantly, but WRS did not increase when aided listening was compared to unaided listening. Negative correlations between PTAs and IOI-HA scores were significant but weak (r = −0.370 and r = −0.393, all p #x3c; 0.05). Significant weak positive correlations were found between WRSs and IOI-HA (r = 0.386 and r = 0.309, all p #x3c; 0.05). However, there was no correlation among ΔPTA, ΔWRS, and IOI-HA (r = 0.056 and r = −0.086, all p #x3e; 0.05). Moreover, 2 nonaudiological factors (age and daily use time) were significantly correlated with IOI-HA (r = −0.269 and r = 0.242, all p #x3c; 0.05).
Conclusions: Correlations among objective audiologic tests, acoustic gain, and subjective patient-reported outcomes were weak or absent. Subjective questionnaires and objective tests do not reflect the same hearing capability. Therefore, it is advisable to evaluate both objective and subjective outcomes when analyzing HA benefits on a regular basis and pay equal attention to nonaudiological and audiological factors. Audiol Neurotol

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Atraumatic Insertion of a Cochlear Implant Pre-Curved Electrode Array by a Robot-Automated Alignment with the Coiling Direction of the Scala Tympani

R Torres,B Hochet,H Daoudi,F Carré,I Mosnier,O Sterkers,E Ferrary,Y Nguyen

Publication date 20-07-2021

Introduction: Electrode array translocation is an unpredictable event with all types of arrays, even using a teleoperated robot in a clinical scenario. We aimed to compare the intracochlear trauma produced by the Hi Focus™ Mid-Scala (MS) electrode array (Advanced Bionics, Valencia, CA, USA) using a teleoperated robot, with an automated robot connected to a navigation system to align the pre-curved tip of the electrode array with the coiling direction of the scala tympani (ST).
Methods: Fifteen freshly frozen temporal bones were implanted with the MS array using the Rob Otol® (Collin, Bagneux, France). In the first group (n = 10), the robot was teleoperated to insert the electrode array into the basal turn of the ST under stereomicroscopic vision, and then the array was driven by a slow-speed hydraulic insertion technique with an estimated placement of the pre-curved electrode tip. In the second group (n = 5), 3 points were obtained from the preoperative cone-beam computed tomography: the 2 first defining the ST insertion axis of the basal turn and a third one at the center of the ST at 270°. They provided the information to the automated system (Rob Otol® connected with a navigation system) to automatically align the electrode array with the ST insertion axis and to aim the pre-curved tip toward the subsequent coiling of the ST. After this, the electrode array was manually advanced. Finally, the cochleae were obtained and fixed in a crystal resin, and the position of each electrode was determined by a micro-grinding technique.
Results: In all cases, the electrode array was fully inserted into the cochlea and the depth of insertion was similar using both techniques. With the teleoperated robotic technique, translocations of the array were observed in 7/10 insertions (70%), but neither trauma nor array translocation occurred with automated robotic insertion.
Conclusion: We have successfully tested an automated insertion system (robot + navigation) that could accurately align a pre-curved electrode array to the axis of the basal turn of the ST and its subsequent coiling, which reduced intracochlear insertion trauma and translocation. Audiol Neurotol

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Noise Exposure and Distortion Product Otoacoustic Emission Suprathreshold Amplitudes: A Genome-Wide Association Study

J Lavinsky,G Kasperbauer,RF Bento,A Mendonça,J Wang,AL Crow,H Allayee,RA Friedman

Publication date 19-07-2021

Background: Although several candidate-gene association studies have been conducted to investigate noise-induced hearing loss (NIHL) in humans, most are underpowered, unreplicated, and account for only a fraction of the genetic risk. Mouse genome-wide association studies (GWASs) have revolutionized the field of genetics and have led to the discovery of hundreds of genes involved in complex traits. The hybrid mouse diversity panel (HMDP) is a collection of classic inbred and recombinant inbred strains whose genomes have been either genotyped at high resolution or sequenced. To further investigate the genetics of NIHL, we report the first GWAS based on distortion product otoacoustic emission (DPOAE) measurements and the HMDP.
Methods: A total of 102 strains (n = 635) from the HMDP were evaluated based on DPOAE suprathreshold amplitudes before and after noise exposure. DPOAE amplitude variation was set at 60 and 70 dB SPL of the primary tones for each frequency separately (8, 11.3, 16, 22.6, and 32 k Hz). These values provided an indirect assessment of outer hair cell integrity. Six-week-old mice were exposed for 2 h to 10 k Hz octave-band noise at 108 dB SPL. To perform local expression quantitative trait locus (eQTL) analysis, gene expression microarray profiles were generated using cochlear RNA from 64 hybrid mouse strains (n = 3 arrays per strain).
Results: Several new loci were identified and positional candidate-genes associated with NIHL were prioritized, especially after noise exposure (1 locus at baseline and 5 loci after exposure). A total of 35 candidate genes in these 6 loci were identified with at least 1 probe whose expression was regulated by a significant cis-eQTL in the cochlea. After careful analysis of the candidate genes based on cochlear gene expression, 2 candidate genes were prioritized: Eya1 (baseline) and Efr3a (post-exposure).
Discussion and Conclusion: For the first time, an association analysis with correction for population structure was used to map several loci for hearing traits in inbred strains of mice based on DPOAE suprathreshold amplitudes before and after noise exposure. Our results identified a number of novel loci and candidate genes for susceptibility to NIHL, especially the Eya1 and Efr3a genes. Our findings validate the power of the HMDP for detecting NIHL susceptibility genes. Audiol Neurotol

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