The latest medical research on Otology Neurotology
The research magnet gathers the latest research from around the web, based on your specialty area. Below you will find a sample of some of the most recent articles from reputable medical journals about otology neurotology gathered by our medical AI research bot.
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Bone Conduction Implants: Comparative of Audiometric Results and Quality of Life Bonebridge® vs Osia®.Audiology and Neuro-Otology
Bone conduction implants have been indicated for patients with conductive hearing loss, mixed hearing loss, and even profound unilateral sensorineural hearing loss. With the introduction of Bonebridge®, new transcutaneous implant options emerged. The latest is Osia®, a direct-drive variant or active systems where the implant directly generates and applies vibration to the bone.
Retrospective study of two cohorts of patients treated with active bone conduction implants at a single center, one with the Bonebridge® device and the other with Osia®.
Fourteen patients were included, seven in each group (n=14). The Bonebridge® group showed an average hearing gain in tonal intelligibility thresholds of 32.43±21.39 dB and a gain in the average intelligibility threshold (with 50% discrimination) of 26.29±19.10 dB. In the Osia® group, there was a gain in average tonal thresholds of 41.49±14.16 dB and 23.72±6.98 dB in average intelligibility thresholds. Both devices contributed to improvements in patients' quality of life, as assessed with APHAB in all the variables studied in the test. Both devices offer rehabilitation for hearing loss as an alternative to hearing aids. The Osia® system shows statistically significant(p<0.05) improvements in mid and high frequencies, but Bonebridge® slightly outperforms in speech understanding at 50%. Differences in average tonal thresholds and quality of life are not statistically significant.
While auditory improvement is observed post-implantation, other aspects, such as intelligibility thresholds and quality of life, lack statistical significance. Given the limited experience with Osia® and the small sample size, the choice of the device should be personalized. Although the literature is inconsistent due to small sample sizes and variable approaches, some studies suggest potential advantages of the Osia® system, especially in speech comprehension in different environments and greater hearing gain compared to Bonebridge®.
The Effect of Time-Restricted Feeding on Postural Balance: From Vestibular Perspective.Audiology and Neuro-Otology
The aims of the present study were to evaluate postural balance performance of the subjects on the time-restricted feeding (TRF) and reveal the effect of TRF on the vestibular system by comparing the results to those of traditional daily dietary (DD) condition.
Sixteen adults (3 males, 13 females; mean age 25.4 ± 4) who had experienced at least one month of TRF were included in the study. Sensory Organization Test (SOT) and Head-Shake Sensory Organization Test (HS-SOT) -which evaluate proprioceptive, visual and vestibular systems- were performed on TRF and DD conditions via the Computerized Dynamic Posturography System.
Significant differences were obtained between TRF and DD situations in SOT-5 (p=.008), SOT-6 (p=.01), and HS-SOT5 (p =.007) conditions in which the vestibular system dominated.
We revealed that time-restricted feeding has an effect on postural balance in the absence of proprioceptive and visual systems. This feeding model is a negative stressor that has a substantial effect on the vestibular system, but this impact is minimal once the proprioceptive and visual systems are intact. To best of our knowledge, it is the first study to evaluate postural balance utilizing vestibular parameters in time-restricted feeding.
Patient and device factors contributing to electrically-evoked stapedial reflex thresholds in cochlear implanted adults.Audiology and Neuro-Otology
Optimal cochlear implant (CI) outcomes are due to, at least in part, appropriate device programming. Objective measures, such as electrically-evoked stapedial reflex thresholds (ESRTs), can be used to more accurately set programming levels. However, underlying factors that contribute to ESRT levels are not well understood. The objective of the current study is to analyze how demographic variables of patient sex and age, along with cochlear implant electrode location, influence electrically-evoked stapedial reflex thresholds (ESRTs) in adult cochlear implant users.
A single institution retrospective review was performed. Electronic medical records, cochlear implant programming records, and clinic database of post-operative computerized tomography were reviewed to gather information regarding patient demographics, ESRTs, and electrode array metrics including medial-lateral distance and scalar location. Linear mixed models were constructed to determine how demographic variables and electrode position influence ESRTs recorded in 138 adult CI recipients.
ESRTs were significantly affected by recipient age, with older listeners demonstrating higher ESRT levels. On average, males had higher ESRT levels when compared to females. In a subset of the study sample, ESRT levels increased with increasing medial-lateral distance, however, there was not a statistically significant effect of electrode type (lateral/straight arrays compared to perimodiolar arrays). ESRTs were not affected by scalar location.
The results suggest that key demographic and electrode position characteristics influence the level of ESRTs in adult CI recipients. While ESRTs are widely used to assist with CI programming, underlying factors are not well understood. The significant factors of aging and sex could be due to middle ear mechanics or neural health differences, however further data are needed to better understand these associations.
Excellent response to anti-CD38 therapy with daratumumab in a patient with severe refractory CANOMAD.Neurology, Neurosurgery and Psychiatry
Intravenous immunoglobulin (IVIG) and rituximab are considered the first-line and second-line treatments for Chronic Ataxic Neuropathy and Ophthalmoplegia with IgM-paraprotein, cold Agglutinins, and anti-Disialosyl antibodies (CANOMAD), with an overall clinical response around 50%. New anti-CD38 daratumumab, targeting long-lived plasma cells, has been reported as a promising therapy for treatment-refractory antibody-mediated disorders. We report the first case of a severe refractory CANOMAD, successfully treated with daratumumab.
A patient in their 70s with severe relapsing CANOMAD, refractory to IVIG, steroids, rituximab and ibrutinib developed severe tetraparesis and respiratory failure. Plasma exchange (PE) improved motor and ventilatory function; however, after 6 weeks, patient remained PE dependent. Intravenous daratumumab was initiated at 16 mg/kg weekly for 3 weeks, every 2 weeks for the second and third month, and monthly afterwards.
After 3 weeks of starting daratumumab, PE was discontinued and, since then, the patient evolved to complete recovery. Antidisialosyl antibody titres decreased after PE and remained stable during daratumumab. Serum neurofilament light-chain levels were elevated in the exacerbation phase and normalised after daratumumab. The patient remains in clinical remission under monthly daratumumab, 12 months after initiation.
The first patient with aggressive treatment-refractory CANOMAD treated with daratumumab provides proof-of-principle evidence that daratumumab may be an effective treatment in IgM-related neuropathies.
Occlusion of the Lateral Semicircular Canal, Endolymphatic Sac Surgery, and Cochlear Implantation: A Low Destructive Treatment for Unilateral Ménière's Disease and Deafness.Audiology and Neuro-Otology
Surgical treatment of Ménière's disease (MD) and deafness aims to treat vertigo and hearing disabilities. Current treatment options like labyrinthectomy and cochlear implantation (CI) have shown acceptable results but are destructive. Less destructive procedures, like the occlusion of the lateral semicircular canal and endolymphatic sac surgery, have been shown to be successful in vertigo control. The combination of both procedures with CI has not been investigated; therefore the objective of this study was to investigate the outcome of this combination in patients with single-sided MD and moderately severe to complete sensorineural hearing loss.
In this retrospective study, 10 patients with single-sided MD and moderately severe to complete sensorineural hearing loss were included. In all of them, a single-staged surgery, which consisted of CI, endolymphatic sac surgery, and occlusion of the lateral semicircular canal, was performed. The surgery was performed after a failed conservative therapy trial. The clinical outcome was evaluated by the Dizziness Handicap Inventory (DHI) and audiological tests. These were assessed preoperatively, 3 and 6 months after surgery. An MRI with a hydrops sequence was performed to support the clinical diagnosis.
After the combined surgery, the mean DHI testing improved significantly from 71 to 30. Mean audiological monosyllabic speech testing outcome with the cochlea implant was 65% at 65 dB. The residual hearing of 2 patients could be preserved after the surgical procedure.
The combination of occlusion of the lateral semicircular canal, endolymphatic sac surgery, and CI is an efficient low traumatic treatment for patients with a single-sided MD and moderately severe to complete sensorineural hearing loss.
ON/OFF non-motor evaluation: a new way to evaluate non-motor fluctuations in Parkinson's disease.Neurology, Neurosurgery and Psychiatry
NMF are currently poorly evaluated in therapeutic decisions. A quantification of their severity would facilitate their integration. The objective of this study was to validate an autoquestionnaire evaluating the severity of non-motor fluctuations (NMF) in Parkinson's disease (PD).
Patients with PD were included in presurgical situation for deep brain stimulation of subthalamic nuclei. They participated in the PREDISTIM cohort (a study evaluating the predictive factors for therapeutic response of subthalamic stimulation in PD) in 17 centres in France. Our questionnaire, resulting from previous phases of development, included 11 non-motor symptoms (NMS). Their severity ranged from 0 to 10 and was assessed in OFF and then ON-Dopa to study their fluctuations.
310 patients were included, of whom 98.8% had NMS and 98.0% had NMF. Each NMS was significantly improved by L-Dopa (decrease in severity score ranging from 43.1% to 69.9%). Fatigue was the most frequent and most severe NMS. NMS were considered more bothersome than motor symptoms by 37.5% of patients in OFF-Dopa and 34.9% in ON-Dopa.
This is the first questionnaire allowing a real-time quantification of the severity of NMS and their fluctuation with levodopa. It was able to confirm and measure the effect of L-dopa and show differences according to the patients and the NMS. It differs from other questionnaires by its measurement at a precise moment of the severity of the NMS, allowing its use during pretherapeutic assessments.Our questionnaire has been validated to measure the severity of NMF. It will be able to quantify the non-motor effect of anti-parkinsonian treatments and could facilitate the integration of NMF in therapeutic decisions.
Unraveling the Diversity of GJB2 Mutations in Nonsyndromic Hearing Loss: A Comprehensive Study in the Moroccan Population.Audiology and Neuro-Otology
Despite the high genetic heterogeneity of hearing loss, mutations in the GJB2 gene are a major cause of autosomal recessive nonsyndromic hearing loss (NSHL) worldwide. However, the mutation profile of GJB2 in NSHL is under-investigated in Morocco, especially among simplex cases. This study aimed to identify the spectrum and frequency of GJB2 mutations in the Moroccan population among simplex and multiplex families with NSHL.
Moroccan families with NSHL were selected according to well-defined criteria. Selected families were screened for GJB2 gene variants using direct sequencing of the entire coding region of GJB2.
A total of 145 affected individuals from 115 families with NSHL were included in this study (49 simplex, 66 multiplex). Mutations in the GJB2 gene were noted in 28.69% of the families (33/115), of which 75.75% were multiplex families and 24.24% were simplex. In total, seven different mutations were detected: c.35delG(p.G12fs), c.551G>A(p.R184Q), c.139G>T(p.E47X), c.109G>A(p.V37I), c.167delT(p.L56fs), c.617A>G(p.N206S), c.94C>T(p.R32C). The last three mutations have not previously been reported in Morocco. The most common GJB2 mutation was c.35delG (21.73%), followed by p.V37I (2.60%) and p.E47X (1.73%).
Our study confirms a high prevalence of GJB2 variants in the Moroccan population, particularly the c.35delG mutation. Additionally, we have identified previously unreported or rarely reported mutations, revealing a greater diversity of GJB2 mutations. These findings emphasize the importance of comprehensive screening beyond the 35delG mutation for patients with NSHL, regardless of their family history. Integrating this approach into clinical care will enhance diagnosis and management of hearing loss in the Moroccan population.
Achieving Cochlear Therapeutic Hypothermia through Irrigation of the Mastoid and Tympanic Cavities.Audiology and Neuro-Otology
Mild therapeutic hypothermia (MTH) is an exciting nonpharmaceutical otoprotection strategy. In this study, we applied simple irrigation of the tympanic and mastoid cavities to understand the timing of both achieving MTH and recovery back to euthermic temperatures for application in the clinical setting.
Three human temporal bones were used in this study in the temporal bone laboratory. A standard mastoidectomy was performed on each followed by the insertion of temperature probes into the basal turn of the cochlea via a middle cranial fossa approach. The temporal bones were warmed in heated bead baths to 37°C. The tympanic and mastoid cavities were then irrigated with room temperature water, and intracochlear temperature readings were recorded every minute. After 15 min, irrigation was stopped, and temperature readings were collected until temporal bones returned to euthermic levels.
Intracochlear MTH was achieved within the first minute of irrigating the tympanic and mastoid cavities. Intracochlear temperatures plateaued after 5 min around 30°C. Discontinuation of irrigation resulted in the temperature rising logarithmically above the MTH levels after 9-10 min.
Intracochlear MTH can be achieved via irrigation of the tympanic and mastoid cavities with room temperature irrigation within 60 s. After irrigation for 5 min, hypothermic temperatures will remain therapeutic for 10 min following cessation of irrigation.
Analysis of Cochlear Morphology for Cochlear Implantation Using Three-Dimensional Reconstruction of Computed Tomography Images.Audiology and Neuro-Otology
Preoperative evaluation of cochlear morphology is important for successful cochlear implantation. This study analyzed the cochlear canal by three-dimensional reconstructions of temporal bones using computed tomography (CT).
Fifty temporal bones from 25 patients aged 42-74 years were evaluated. The inner spaces of the bony cochlea were reconstructed using a surface rendering technique on the CT images. Eight angular points (P0-P7) every 90° were selected from 0° to 630° from the center of the round window using the reconstructed cochlear canal images. The radius (R) and thickness (T) of the cochlear canal at each point were measured. The cochlear canal length (CoCL) was estimated using an equation based on the radius at each point. The cochlear width and height based on multiplanar CT images were also measured and compared with the length and volume of the cochlear canal.
The mean CoCL from 0° to 630° was 31.5 mm, and the cochlear volume was 55.9 mm3. The CoCL to P7 was correlated with the cochlear volume (r = 0.77), coiling ratios (R4/R0, r = 0.47; R5/R1, r = 0.384), cochlear width (long) (r = 0.539), cochlear height (r = 0.385), and total thickness at each point (r = 0.475). The cochlear volume was correlated with CoCL (630°) (r = 0.77), coiling ratio (R4/R0, r = 0.367), cochlear width (long) (r = 0.616), cochlear height (r = 0.447), and total T (r = 0.566).
Preoperative evaluation using three-dimensional reconstruction can elucidate the size and shape of the cochlear canal before cochlear implantation.
Factors Predictive of Binaural Hearing Restoration by Cochlear Implant in Single-Sided Deafness.Audiology and Neuro-Otology
Cochlear implants (CIs) can restore binaural hearing in cases of single-sided deafness (SSD). However, studies with a high level of evidence in support of this phenomenon are lacking. The aim of this study is to analyze the effectiveness of CIs using several spatialized speech-in-noise tests and to identify potential predictors of successful surgery.
Ten cases underwent standard CI surgery (MEDEL-Flex24). The speech-in-noise test was used in three different spatial configurations. The noise was presented from the front (N0), toward the CI (NCI), and toward the ear (Near), while the speech was always from the front (S0). For each test, the speech-to-noise ratio at 50% intelligibility (SNR50) was evaluated. Seven different effects were assessed (summation, head shadow [HS], speech released of masking [SRM], and squelch for the CI and for the ear).
A significant summation effect of 1.5 dB was observed. Contralateral PTA was positively correlated with S0N0-B and S0NCI-B (CIon and unplugged ear). S0N0-B results were positively correlated with S0N0-CIoff (p < 0.0001) and with S0Near-CIoff results (p = 0.004). A significant positive correlation was found between delay post-activation and HS gain for the CI (p = 0.005). Finally, the HS was negatively correlated with the squelch effect for the ear.
CI benefits patients with SSD in noise and can improve the threshold for detecting low-level noise. Contralateral PTA could predict good postoperative results. Simple tests performed preoperatively can predict the likelihood of surgical success in reversing SSD.
Cochlear Implant: Analysis of the Frequency-to-Place Mismatch with the Table-Based Software OTOPLAN® and Its Influence on Hearing Performance.Audiology and Neuro-Otology
The purpose of this study was to compare the originally applied frequency allocation of cochlear implant electrodes assigned by default at the time of activation with a more recent frequency allocation that is anatomy-based by a software called OTOPLAN®. Based on a computed tomography scan of the temporal bone, this software calculates the position of each electrode in the cochlea and its corresponding tonotopic frequency. We also evaluated whether patients with a significant mismatch between these two allocations present poorer speech intelligibility.
Patients who underwent cochlear implantation from 2016 to 2021 at the University Hospital of Liege were included in this retrospective study. We used OTOPLAN® to calculate the tonotopic frequency allocation of each electrode according to its exact position in the cochlear duct. This anatomical frequency mapping was compared with the default frequency mapping at the time of cochlear implant activation. Finally, we compared the mismatch with the patients' auditory performance, represented by the Auditory Capacity Index (ACI).
Thirteen patients were included in the study. All patients had a mismatch between the two frequency maps, to a variable extent (200 Hz-1,100 Hz). Frequency shift was significantly inversely correlated with ACI and with the time needed to improve speech intelligibility.
Our primary results show that patients with a larger mismatch between default frequency mapping and anatomically assigned frequency mapping experience poorer hearing performance and slower adaptation to a cochlear implant.
Histological Reaction in the Round Window Membrane after Cochlear Implant Insertion in Nonhuman Primates.Audiology and Neuro-Otology
The primary objective of this article was to determine if any histological alterations occur in the round window (RW) and adjacent anatomical structures of an animal model with normal hearing when a cochlear implant (CI) electrode array is inserted. Furthermore, this article aims to relate these histological alterations to the auditory changes generated.
Cochlear implantation was performed, following the principles of minimally traumatic surgery (MTS), in 15 ears of nonhuman primates (Macaca fascicularis) (Mf) with normal hearing. Auditory brainstem-evoked potentials (ABR) using clicks and tones were used prior to surgery and during a 6-month follow-up period. Histological evaluation was carried out, analyzing the position of the electrode array with respect to the round window membrane (RWM), its percentage of occupation and integrity, the presence of intracochlear damage, and the tissue reaction provoked, the latter of which was quantified in the temporal bones.
Surgery was performed on all 15 ears without relevant incidences. Regarding histology, the electrode array in the RW of all ears presented a lateral position with respect to the modiolus. No lesions affecting the integrity of the RW were observed. The mean value of the array's occupation in the RW was 25%. Tissue reaction, in the form of fibrosis, was observed in all ears and more intensely in the trans-RWM and post-RWM areas. In all ears, the electrodes remained on the scala tympani. No profound hearing impairment was recorded in any ear, being the mean loss of 25.4 dB when comparing presurgical thresholds with those collected 6 months after implantation in ABR click and 24.4 dB in ABR tone burst.
The animal model and Hybrid L-14 (HL14) electrode array were optimal for implementing a surgical technique similar to that routinely performed on humans. Mild histological alterations were observed in the round window membrane and adjacent anatomical structures from the insertion of a cochlear implant electrode array. Following the minimally invasive technique, levels of hearing preservation were satisfactory, reaching a pre-post difference of 25.4 dB in the ABR click and 24.4 dB for a high-frequency tone burst. Complete hearing impairment was not observed in either ear. Correlation between the severity of histological alterations and hearing changes recorded in the ABR studies was observed.