Audiology and Neurotology 2021-04-08

One-Year Follow-Up in Children with Conductive Hearing Loss Using ADHEAR

Publication date 08-04-2021

Background: The ADHEAR™ system (MED-EL, Innsbruck, Austria) is a nonsurgical bone conduction device (BCD) to treat conductive hearing loss (CHL) and single-sided deafness. In contrast to the nonsurgical alternatives on headbands or spectacle frames, the audio processor of ADHEAR is placed retroauricularly on an adhesive adapter. The published evidence on the performance of this system is limited to studies with a trial period of 2–8 weeks.
Objective: This study assesses audiological and subjective outcomes over a period of 12 months, on patients with congenital aural atresia (CAA) using the ADHEAR hearing system.
Method: Fifteen children (mean age: 9.4 ± 4 years; range: 5–16 years) diagnosed with CAA (7 uni/8 bilateral) were included in this prospective, observational, repeated-measures study. Each subject used ADHEAR for 1 year, and the performance was evaluated after 1, 6, and 12 months. Free-field audiometry and speech discrimination tests were performed, and hearing-, general health- and device-specific questionnaires were used.
Results: The unaided sound field threshold improved from an average PTA4 of 63.6 ± 3.4 dB HL to an aided average PTA4 of 29.3 ± 3.0 dB HL after 1 month of device use. The word recognition score (WRS) improved from an average of 27.9 ± 15.9% unaided to an aided average WRS of 91.3 ± 4.4% (p = 0.0003) after 1 month, 92.0 ± 4.1% (p = 0.0002) after 6 months, and 92.7 ± 5.3% (p #x3c; 0.0001) after 12 months using the ADHEAR system compared to the unaided condition for all 3 time points. The improvements in the speech in noise at 1, 6, and 12 months were as well consistent over time. The average improvement at the signal to noise ratio (SNR) of +5 dB was 58% and 53% at the SNR of +0 dB. No complications were reported, and all patients continued to use the ADHEAR after the study end. The questionnaire results revealed high user satisfaction and an average wearing time of 12 h per day.
Conclusion: This 12-month trial of the nonsurgical adhesive BCD in CAA patients showed sufficient and reliable audiological and subjective outcomes, long wearing time, and high acceptance. The ADHEAR can be considered a suitable option to treat children with CAA for the given indication, without the drawbacks of nonsurgical devices that use pressure for retention of the audio processor or the costs and possible complications involved with a surgical alternative. Audiol Neurotol

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Risk Factors for Failure in First-Time Hearing Screening Tests among High-Risk Neonates in Neonatal Intensive Care Unit

Publication date 08-04-2021

Objective: The aim of the study was to investigate into the risk factors for failure in the first-time screening test among high-risk neonates in neonatal intensive care unit (NICU) in order to further clarify the etiology of neonatal hearing impairment, thus providing insights into early prevention and intervention.
Methods: We performed automated auditory brainstem response (AABR), distortion product otoacoustic emission (DPOAE), and acoustic immittance (AI) on 2,194 high-risk neonates admitted into the NICU of Shanghai Children’s Medical Center from January 2015 to December 2019, and the risk factors, including premature birth, hyperbilirubinemia, and infant respiratory distress syndrome, were analyzed retrospectively by the univariate χ2 test and multivariate stepwise logistic regression analysis.
Results: The pass rates of AABR, DPOAE, and AI were 70.21, 78.44, and 93.12%, respectively, in 2,194 cases of high-risk neonates screened, which are significantly lower than those of healthy controls. The most common diagnoses included artificial feeding, preterm birth, C-section, low birth weight (LBW), neonatal hyperbilirubinemia (NHB), neonatal respiratory distress syndrome (NRDS), congenital heart disease (CHD), gestational diabetes mellitus, pregnancy-induced hypertension syndrome, advanced maternal age (AMA), twins, and in vitro fertilization. Stepwise logistic regression analysis indicated that the AABR pass rate was negatively correlated with LBW (p = 0.002), NHB (p #x3c; 0.001), NRDS (p = 0.007), artificial or mixed feeding (p = 0.018), and CHD (p = 0.005). The pass rate of DPOAE was negatively correlated with artificial or mixed feeding (p = 0.041), NHB (p #x3c; 0.001), LBW (p = 0.007), very LBW (VLBW) (p = 0.008), and C-section (p #x3c; 0.001). The pass rate of AI was negatively correlated with revised AMA (≥40 year) (p #x3c; 0.001), NHB (p = 0.043), C-section (p = 0.005), and artificial/mixed feeding (p = 0.036).
Conclusion: The hearing screening pass rates of high-risk neonates in the NICU were lower than those of normal neonates, among which the rate of AABR was significantly lower than that of DPOAE. NRDS, NHB, LBW, revised AMA, CHD, C-section, and artificial feeding are potential risk factors of hearing impairment. The combination of different hearing screening tests is necessary for accurate diagnosis of congenital hearing disorders. Audiol Neurotol

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Cochlear Implant Outcomes in Patients with Neurosarcoidosis

D Ebode,F Cohen-Aubart,S Trunet,E Ferrary,G Lahlou,I Mosnier

Publication date 06-04-2021

Introduction: Audiovestibular symptoms are rare in sarcoidosis, but they may also be the first manifestation of the disease. Sudden or progressive bilateral hearing loss is usually associated with vestibular impairment. The mechanism of hearing loss remains unclear, but clinical presentation and magnetic resonance imaging suggest a retrocochlear site for the lesion in most patients. Several cases of hearing recovery after corticosteroid treatment have been reported. In patients with severe or profound hearing loss, the benefit of cochlear implantation is challenging to predict in the case of auditory neuropathy and is rarely described. We present a case series of cochlear implantation in patients with documented neurosarcoidosis.
Results: Seven cases of cochlear implantation in 4 patients with neurosarcoidosis are reported. All of the patients showed a great improvement very quickly in both quiet and noise. Speech performance remained stable over time with a follow-up ranging from 4 to 11 years, even in patients who had disease exacerbation.
Conclusion: Cochlear implantation is possible in deaf patients with neurosarcoidosis. The excellent benefit obtained in our patients suggests a particular type of neuropathy, but endocochlear involvement cannot be entirely ruled out. Audiol Neurotol

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Intratympanic Triamcinolone Acetonide as a Salvage Treatment for Idiopathic Sudden Sensorineural Hearing Loss

A Andrianakis,U Moser,A Wolf,P Kiss,C Holzmeister,PV Tomazic,M Graupp

Publication date 31-03-2021

Introduction: Intratympanic steroid (ITS) injections represent an increasingly used salvage treatment option for patients with idiopathic sudden sensorineural hearing loss ­(ISSHL) after systemic treatment. The most effective corticosteroid for this treatment modality still remains unclear. Triamcinolone acetonide has been used for ITS treatment in various clinical settings. However, there are limited clinical data of its usage in the therapeutic management of ISSHL. The aim of this study was to determine the efficacy of intratympanic triamcinolone acetonide injections as a salvage treatment for ISSHL.
Methods: We conducted a retrospective chart review on patients affected by ISSHL with insufficient hearing recovery after primary systemic corticosteroid therapy and who were treated with intratympanic triamcinolone acetonide as a salvage therapy between January 2014 and August 2019. The patients were divided into groups according to their degree of hearing recovery, and we evaluated potential predictors of hearing recovery. Audiometric results were then compared to historic studies using dexamethasone or methylprednisolone.
Results: One-hundred and fifty-two patients received up to 3 intratympanic injections with triamcinolone acetonide at 1-week intervals. The mean hearing improvement due to ITS salvage treatment was 15.9 ± 18.9 dB. Complete hearing recovery was noted in 15 patients (9.9%), while 73 patients (48%) obtained partial recovery, and 64 patients (42.1%) had no recovery. Primary systemic treatment delay, hearing improvement by primary systemic treatment, and severity of initial hearing loss were identified as significant predictors of hearing improvement. The first of the 3 injections resulted in the greatest hearing improvement.
Conclusion: The use of triamcinolone acetonide in ITS salvage treatment resulted in similar hearing improvements as the use of the commonly used corticosteroids, namely, dexamethasone and methylprednisolone. Longer treatment delays, lower hearing improvement by primary systemic treatment, and higher initial hearing loss are associated with poorer prognoses of hearing recovery. Audiol Neurotol

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Cochlear Implantation and Other Treatments in Single-Sided Deafness and Asymmetric Hearing Loss: Results of a National Multicenter Study Including a Randomized Controlled Trial

M Marx,I Mosnier,F Venail,M Mondain,A Uziel,D Bakhos,E Lescanne,Y N'Guyen,D Bernardeschi,O Sterkers,O Deguine,B Lepage,B Godey,S Schmerber,NX Bonne,C Vincent,B Fraysse

Publication date 31-03-2021

Introduction: Cochlear implantation is a recent approach proposed to treat single-sided deafness (SSD) and asymmetric hearing loss (AHL). Several cohort studies showed its effectiveness on tinnitus and variable results on binaural hearing. The main objective of this study is to assess the outcomes of cochlear implantation and other treatment options in SSD/AHL on quality of life.
Methods: This prospective multicenter study was conducted in 7 tertiary university hospitals and included an observational cohort study of SSD/AHL adult patients treated using contralateral routing of the signal (CROS) hearing aids or bone-anchored hearing systems (BAHSs) or who declined all treatments, and a randomized controlled trial in subjects treated by cochlear implantation, after failure of CROS and BAHS trials. In total, 155 subjects with SSD or AHL, with or without associated tinnitus, were enrolled. After 2 consecutive trials with CROS hearing aids and BAHSs on headband, all subjects chose any of the 4 treatment options (abstention, CROS, BAHS, or cochlear implant CI). The subjects who opted for a CI were randomized between 2 arms (CI vs. initial observation). Six months after the treatment choice, quality of life was assessed using both generic (Euro QoL-5D, EQ-5D) and auditory-specific quality-of-life indices (Nijmegen Cochlear implant Questionnaire NCIQ and Visual Analogue Scale VAS for tinnitus severity). Performances for speech-in-noise recognition and localization were measured as secondary outcomes.
Results: CROS was chosen by 75 subjects, while 51 opted for cochlear implantation, 18 for BAHSs, and 11 for abstention. Six months after treatment, both EQ-5D VAS and auditory-specific quality-of-life indices were significantly better in the “CI” arm versus “observation” arm. The mean effect of the CI was particularly significant in subjects with associated severe tinnitus (mean improvement of 20.7 points ± 19.7 on EQ-5D VAS, 20.4 ± 12.4 on NCIQ, and 51.4 ± 35.4 on tinnitus). No significant effect of the CI was found on binaural hearing results. Before/after comparisons showed that the CROS and BAHS also improved significantly NCIQ scores (for CROS: +7.7, 95% confidence interval 95% CI = 4.5; 10.8; for the BAHS: +14.3, 95% CI = 7.9; 20.7).
Conclusion: Cochlear implantation leads to significant improvements in quality of life in SSD and AHL patients, particularly in subjects with associated severe tinnitus, who are thereby the best candidates to an extension of CI indications. Audiol Neurotol

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High Blood Glucose Levels Affect Auditory Brainstem Responses after Acoustic Overexposure in Rats

JH Lee,SH Ji,JY Jung,MY Lee,CK Lee

Publication date 18-03-2021

Introduction: Diabetes mellitus (DM) is a systemic disease characterized by hyperglycemia and several pathological changes. DM-related hearing dysfunctions are associated with histological changes. Here, we explore hearing function and synaptic changes in the inner hair cells (IHCs) of rats with streptozotocin (STZ)-induced diabetes.
Methods: STZ was injected to trigger diabetes. Rats with DM were exposed to narrow-band noise (105 dB SPL) for 2 h, and hearing function was analyzed 1, 3, 7, and 14 days later. Both the hearing threshold and the peak 1 amplitude of the tone auditory brainstem response were assessed. After the last functional test, animals were sacrificed for histological evaluation.
Results: We found no changes in the baseline hearing threshold; however, the peak 1 amplitude at the low frequency (4 k Hz) was significantly higher in both DM groups than in the control groups. The hearing threshold had not fully recovered at 14 days after diabetic rats were exposed to noise. The peak 1 amplitude at the higher frequencies (16 and 32 k Hz) was significantly larger in both DM groups than in the control groups. The histological analysis revealed that the long-term DM group had significantly more synapses in the 16 k Hz region than the other groups.
Conclusions: We found that high blood glucose levels increased peak 1 amplitudes without changing the hearing threshold. Diabetic rats were less resilient in threshold changes and were less vulnerable to peak 1 amplitude and synaptic damage than control animals. Audiol Neurotol

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Differences between Pressurized and Non-Pressurized Transient-Evoked Otoacoustic Emissions in Neonatal Subjects

G Zimatore,PH Skarzynski,F Di Berardino,E Filipponi,S Hatzopoulos

Publication date 10-03-2021

Introduction: Recently, Interacoustics presented a new otoacoustic emission protocol where the probe pressurizes the ear cavity, thus eliminates the risk of non-assessment (REFER outcome) due to a negative middle ear pressure. This study evaluated the characteristics and the performance of this new protocol on a newborn well-baby population.
Methods: One hundred sixty-three newborns (age 2.7 ± 1.1 days) for a total of 294 ears were assessed randomly. Transiently evoked otoacoustic responses were acquired by the Titan device (Interacoustics), using the default and a pressurized TEOAE protocol. The data were analyzed in terms of signal to noise ratios (S/Ns) at 5 frequencies, namely, 0.87, 1.94, 2.96, 3.97, and 4.97 k Hz. To assess any possible gestational age (GE) effects on the TEOAE variables, the responses were subdivided in 4 different age subgroups.
Results: There were no significant differences between the left and right ear TEOAE responses, for age (in days), GE (in weeks), weight (in grams), and S/N at all 5 frequencies. Considering the pooled 294 ears, paired t tests between the default and the pressurized TEOAE data showed significant differences across all 5 frequencies (p #x3c; 0.01). The pressurized protocol generated TEOAE responses presenting larger S/Ns, and a positive additive effect of approximately 2.31 dB was observed at all tested frequencies. There were no significant GE effects on the pressurized TEOAE responses. In terms of performance, both protocols performed equally (same number of PASSes).
Conclusion: The pressurized TEOAE protocol generates responses with higher S/Ns which might be useful in borderline cases where the middle ear status might cause a REFER screening outcome. Audiol Neurotol

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Is Decorin a Promising New Agent for Facial Nerve Regeneration? An Experimental Study

Z Çınar,U Emre,M Gül,Ö Yiğit,E Mammadov,E Yiğit,S Gül,HR Cırık

Publication date 05-03-2021

Objective: The aim of this study was to investigate the effects of systemic administration of decorin (DC) on facial nerve (FN) regeneration.
Methods: A total of 32 female albino Wistar rats were divided into 4 groups: control (C) group: no bilateral FN neurorrhaphy (B-FNN), no DC application, sham-operated group: B-FNN without DC application, DC group: DC application without B-FNN, and B-FNN + DC group: B-FNN and DC application. Nerve conduction studies were performed before and after skin incisions at 1st, 3rd, 5th, and 7th weeks in all groups. The amplitude and latency of compound muscle action potentials were recorded. FN samples were obtained and were investigated under light microscopy and immunohistochemical staining. The nerve and axon diameter, number of axons, H score, Schwann cell proliferation, and myelin and axonal degeneration were recorded quantitatively.
Results: In the sham group, the 3rd and 5th postoperative week, amplitude values were significantly lower than those of the B-FNN + DC group (p #x3c; 0.05). Nerve diameters were found to be significantly larger in the sham, DC, and B-FNN + DC groups than in the C group (p #x3c; 0.05). The number of axons, the axon diameter, and the H scores were found to be significantly higher in the B-FNN + DC group than in the sham group (p #x3c; 0.05). The Schwann cell proliferation, myelin degeneration, and axonal degeneration scores were significantly lower in the B-FNN + DC group than in the sham group (p #x3c; 0.05).
Conclusion: Electrophysiological and histopathological evaluation revealed the potential benefits provided by DC. This agent may increase FN regeneration. Audiol Neurotol

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Bone-Anchored and Closed Skin Bonebridge Implant in Adults: Hearing Performances and Quality of Life

M Garcier,A Lavedrine,C Gagneux,T Eluecque,A Bozorg Grayeli

Publication date 04-03-2021

Introduction: Bonebridge® is a novel active bone-anchored hearing implant. The purpose of this study was to evaluate the ease of implantation, the hearing performances, and the patient-reported benefit.
Materials and Methods: This is a prospective cross-sectional study of 24 consecutive adult patients implanted for a mixed hearing loss (13 chronic otitis media (COM) and 11 other aetiologies). Twenty-one implants were placed in the retrosigmoid position and 3 in the mastoid. Audiometry, Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire, as well as 5 implant-specific questions (analogue visual scale AVS 0–10 score), was administered.
Results: Surgery lasted 73 ± 29.7 min on average. No major complication occurred. All patients were users at the last follow-up visit (median: 9-month range: 3–25). The average prosthetic gain was similar in COM and other aetiologies (43 ± 4.8 dB and 50 ± 7.2, respectively, not significant, Wilcoxon test). Bone-conduction thresholds were not deteriorated by surgery (Kruskal-Wallis test, not significant). APHAB scores improved in all categories except aversiveness (global score 45 ± 7.0% in COM and 32 ± 10.2% in others, not significant, and Wilcoxon test). Local pain (AVS: 3.23 ± 3.2, n = 16) and manipulation difficulties (3.1 ± 3.69) were low. The device was considered aesthetic (8.3 ± 2.49). Perfectible autonomy (5.0 ± 2.8) and difficulties wearing the implant during sport or at work (5.1 ± 3.47) were the weakest points.
Conclusions: Bone Bridge® implant provides reproducible results for the rehabilitation of mixed hearing losses and unilateral hearing loss. Audiol Neurotol

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Long-Term Follow-Up of Early Cochlear Implant Device Activation

S Bruschke,U Baumann,T Stöver

Publication date 03-03-2021

Background: The cochlear implant (CI) is a standard procedure for the treatment of patients with severe to profound hearing loss. In the past, a standard healing period of 3–6 weeks occurred after CI surgery before the sound processor was initially activated. Advancements of surgical techniques and instruments allow an earlier initial activation of the processor within 14 days after surgery.
Objective: Evaluation of the early CI device activation after CI surgery within 14 days, comparison to the first activation after 4–6 weeks, and assessment of the feasibility and safety of the early fitting over a 12 month observation period were the objectives of this study.
Method: In a prospective study, 127 patients scheduled for CI surgery were divided into early fitting group (EF, n = 67) and control group (CG, n = 60). Individual questionnaires were used to evaluate medical and technical outcomes of the EF. Medical side effects, speech recognition, and follow-up effort were compared with the CG within the first year after CI surgery.
Results: The early fitting was feasible in 97% of the EF patients. In the EF, the processor was activated 25 days earlier than in the CG. No major complications were observed in either group. At the follow-up appointments, side effects such as pain and balance problems occurred with comparable frequency in both groups. At initial fitting, the EF showed a significantly higher incidence of medical minor complications (p #x3c; 0.05). When developing speech recognition within the first year of CI use, no difference was observed. Furthermore, the follow-up effort within the first year after CI surgery was comparable in both groups.
Conclusions: Early fitting of the sound processor is a feasible and safe procedure with comparable follow-up effort. Although more early minor complications were observed in the EF, there were no long-term wound healing problems caused by the early fitting. Regular inspection of the magnet strength is recommended as part of the CI follow-up since postoperative wound swelling must be expected. The early fitting procedure enabled a clear reduction in the waiting time between CI surgery and initial sound processor activation. Audiol Neurotol

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