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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Using Clinical Audiologic Measures to Determine Cochlear Implant Candidacy.

Audiology and Neuro-Otology

Only a small percentage (6-10%) of patients who are candidates receive cochlear implants (CIs). One potential reason contributing to low usage rates may be confusion regarding which patients to refer for CI evaluation. The extent to which information provided by standard clinical audiologic assessments is sufficient for selecting appropriate CI evaluation referrals is uncertain. The objective of this study is to evaluate the capacity of standard clinical audiologic measures to differentiate CI candidates from noncandidates.

The study design is a retrospective review of a prospectively maintained CI database from a university-based tertiary medical center of 518 patients undergoing CI evaluations from 2012 to 2020. Each ear of each patient was treated as an independent value. Receiver operating characteristic (ROCs) curves were constructed using aided AzBio sentence recognition scores in quiet and aided AzBio +10 dB signal-to-noise ratio scores <60% as binary classifiers for CI candidacy. For each ROC, we examined the capacity of multiple pure-tone thresholds, pure-tone average (PTA), and CNC word recognition scores (WRSs) measured under earphones to determine CI candidacy. Area under the curve ROC (AUC-ROC) values were calculated to demonstrate the capacity of each model to differentiate CI candidates from noncandidates.

Variables with the greatest capacity to accurately differentiate CI candidates from noncandidates using aided AzBio in quiet scores were earphone CNC WRS, earphone pure-tone threshold at 1,000 Hz, and earphone PTA (AUC-ROC values = 0.86-0.88). Using aided AzBio +10 scores as the measure for candidacy, only CNC word recognition had a fair capacity to identify candidates (AUC-ROC value = 0.73). Based on the ROCs, a 1,000 Hz pure-tone threshold >50 dB HL, PTA >57 dB HL, and a monosyllabic WRS <60% can each serve as individual indicators for referral for CI evaluations.

The current study provides initial indicators for referral and a first step at developing evidence-based criteria for CI evaluation referral using standard audiologic assessments.

Fat-rich versus carbohydrate-rich nutrition in ALS: a randomised controlled study.

Neurology, Neurosurgery and Psychiatry

There is growing evidence that the course of amyotrophic lateral sclerosis (ALS) may be influenced beneficially by applying high-caloric food supplements (HCSs). However, it is unknown which composition of nutrients offers optimal tolerability and weight gain.

We conducted a randomised controlled study (Safety and Tolerability of Ultra-high-caloric Food Supplements in Amyotrophic Lateral Sclerosis (ALS); TOLCAL-ALS study) in 64 patients with possible, probable or definite ALS according to El Escorial criteria. Patients were randomised into four groups: a high-caloric fatty supplement (HCFS; 405 kcal/day, 100% fat), an ultra-high-caloric fatty supplement (UHCFS; 810 kcal/day, 100% fat), an ultra-high-caloric, carbohydrate-rich supplement (UHCCS; 900 kcal/day, 49% carbohydrates) and an open control (OC) group without any supplement. The primary endpoint was tolerability. Patients were followed up over 4 weeks.

Gastrointestinal side effects were most frequent in the UHCFS group (75.0%), while loss of appetite was most frequent in the UHCCS group (35.3%). During intervention, patients gained +0.9 kg/month of body weight (IQR -0.9 to 1.5; p=0.03) in the HCFS group and +0.9 kg/month (IQR -0.8 to 2.0; p=0.05) in the UHCFS group. A non-significant trend for weight gain (+0.6 kg/month (IQR -0.3 to 1.9; p=0.08)) was observed in the UHCCS group. Patients in OC group continued to lose body weight (-0.5 kg/month, IQR -1.4 to 1.3; p=0.42).

The findings suggest that HCSs frequently cause mild to moderate tolerability issues in patients with ALS, most notably gastrointestinal symptoms in high-fat supplements, and loss of appetite in high-carbohydrate supplements. All three HCSs tested are suited to increase body weight.

Development of novel clinical examination scales for the measurement of disease severity in Creutzfeldt-Jakob disease.

Neurology, Neurosurgery and Psychiatry

To use a robust statistical methodology to develop and validate clinical rating scales quantifying longitudinal motor and cognitive dysfunction in sporadic Creutzfeldt-Jakob disease (sCJD) at the bedside.

Rasch analysis was used to iteratively construct interval scales measuring composite cognitive and motor dysfunction from pooled bedside neurocognitive examinations collected as part of the prospective National Prion Monitoring Cohort study, October 2008-December 2016.A longitudinal clinical examination dataset constructed from 528 patients with sCJD, comprising 1030 Motor Scale and 757 Cognitive Scale scores over 130 patient-years of study, was used to demonstrate scale utility.

The Rasch-derived Motor Scale consists of 8 items, including assessments reliant on pyramidal, extrapyramidal and cerebellar systems. The Cognitive Scale comprises 6 items, and includes measures of executive function, language, visual perception and memory. Both scales are unidimensional, perform independently of age or gender and have excellent inter-rater reliability. They can be completed in minutes at the bedside, as part of a normal neurocognitive examination. A composite Examination Scale can be derived by averaging both scores. Several scale uses, in measuring longitudinal change, prognosis and phenotypic heterogeneity are illustrated.

These two novel sCJD Motor and Cognitive Scales and the composite Examination Scale should prove useful to objectively measure phenotypic and clinical change in future clinical trials and for patient stratification. This statistical approach can help to overcome obstacles to assessing clinical change in rapidly progressive, multisystem conditions with limited longitudinal follow-up.

Three-Dimensional High-Resolution Temporal Bone Histopathology Identifies Areas of Vascular Vulnerability in the Inner Ear.

Audiology and Neuro-Otology

Hypothesized causes of vestibular neuritis/labyrinthitis include neuroinflammatory or vascular disorders, yet vascular disorders of the inner ear are poorly understood. Guided by known microvascular diseases of the retina, we developed 2 hypotheses: (1) there exist vascular vulnerabilities of artery channels in cases of hypothetical nerve swelling for the superior, inferior, and vestibulocochlear artery and (2) there are arteriovenous crossings that could compromise vascular flow in disease states.

Two fully mounted and stained temporal bones were used to render three-dimensional reconstructions of the labyrinth blood supply. Using these maps, areas of potential vascular compression were quantified in 50 human temporal bones.

Although inner ear arteries and veins mostly travel within their own bony channels, they may be exposed (1) at the entrance into the otic capsule, and (2) where the superior vestibular vein crosses the inferior vestibular artery. At the entry into the otic capsule, the ratio of the soft tissue to total space for the superior vestibular artery was significantly greater than the inferior vestibular artery/cochleovestibular artery (median 44, interquartile range 34-55 vs. 14 [9-17], p < 0.0001).

Three-dimensional reconstruction of human temporal bone histopathology can guide vascular studies of the human inner ear. Studies of retinal microvascular disease helped identify areas of vascular vulnerability in cases of hypothetical nerve swelling at the entrance into the otic capsule and at an arteriovenous crossing near the saccular macula. These data may help explain patterns of clinical findings in peripheral vestibular lesions.

Speech-in-Noise Audiometry in Adults: A Review of the Available Tests for French Speakers.

Audiology and Neuro-Otology

Difficulty understanding speech in background noise is the reason of consultation for most people who seek help for their hearing. With the increased use of speech-in-noise (SpIN) testing, audiologists and otologists are expected to evidence disabilities in a greater number of patients with sensorineural hearing loss. The purpose of this study is to list validated available SpIN tests for the French-speaking population.

A review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and Scopus databases were searched. Search strategies used a combination of 4 keywords: speech, audiometry, noise, and French. There were 10 validated SpIN tests dedicated to the Francophone adult population at the time of the review. Some tests use digits triplets as speech stimuli and were originally designed for hearing screening. The others were given a broader range of indications covering diagnostic or research purposes, determination of functional capacities and fitness for duty, as well as assessment of hearing amplification benefit. Key Messages: As there is a SpIN test for almost any type of clinical or rehabilitation needs, both the accuracy and duration should be considered for choosing one or the other. In an effort to meet the needs of a rapidly aging population, fast adaptive procedures can be favored to screen large groups in order to limit the risk of ignoring the early signs of forthcoming presbycusis and to provide appropriate audiological counseling.

Increased Monocyte Chemotactic Protein-1 Accompanying Pro-Inflammatory Processes are Associated with Progressive Hearing Impairment and Bilateral Disability of Meniere's Disease.

Audiology and Neuro-Otology

The progression of hearing impairment and the bilateral involvement of Meniere's disease (MD) may depend on the disease duration and aging. Recent studies reported that MD might involve dysfunction of the microvascular circulation damaged due to inflammatory changes.

The aim of this study was to determine that the progress of the MD's hearing impairment and bilateral disability may be associated with the pathogenesis of several pro-inflammatory processes.

We recruited 30 unilateral MD patients (56.8 ± 14.7 years old), 7 bilateral MD patients (65.3 ± 13.9 years old), and 17 age-matched control subjects (53.5 ± 14.4 years old, p > 0.05). We measured the plasma vascular endothelial growth factor (VEGF), plasma interleukin-6 (IL-6), plasma tumor-necrosis factor α (TNFα), and plasma monocyte chemotactic protein-1 (MCP-1).

The bilateral MD group and the unilateral MD group had higher plasma MCP-1 (204.7 ± 41.0 pg/mL and 169.5 ± 32.0 pg/mL) than the control group (149.2 ± 30.7 pg/mL) (p < 0.05). There was no significant difference in plasma TNFα, IL-6, and VEGF among 3 groups (p > 0.05). There was a strong correlation between the plasma MCP-1 and age in MD patients (r = 0.58, p < 0.01); however, no significant correlation between the plasma MCP-1 and age was found in control subjects (p > 0.05). The plasma MCP-1 significantly correlated with the average hearing level of 500, 1,000, 2,000, and 4,000 Hz, and the maximum slow phase eye velocity in caloric test in the better side (p < 0.05). Also, the plasma MCP-1 showed significant positive correlations with the plasma IL-6 (r = 0.49, p < 0.01) and plasma TNFα (r = 0.32, p < 0.05) in MD group.

Our results suggest that the increased plasma MCP-1 accompanying pro-inflammatory processes are associated with the progression of the hearing impairment and the bilateral disability of MD.

Efficacy of Hyperbaric Oxygen on Idiopathic Sudden Sensorineural Hearing Loss and Its Correlation with Treatment Course: Prospective Clinical Research.

Audiology and Neuro-Otology

This study was conducted to explore the effectiveness of hyperbaric oxygen (HBO) in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL) and recommend the appropriate course of treatment.

102 patients (105 diseased ears) with ISSNHL were recruited from the Department of Neurology and Otorhinolaryngology, West China Fourth Hospital, Sichuan University, between January 2018 and September 2020. Of them, 45 patients (group A) received intravenous steroid (IVS), and the remaining patients (group B) received IVS and HBO therapy (HBOT). Pure-tone audiometry (PTA) was performed twice at baseline and 10 days after treatment. Patients in group B were subdivided into group 1 (≤10 sessions) and group 2 (>11 sessions) to verify the correlation between the efficacy and course of HBOT, at the follow-up endpoint, the PTA was performed again. The multivariate logistical regression model was used to analyze the related factors of prognosis.

Compared with the control group, significantly larger hearing gains and better hearing recovery rate were observed in the IVS + HBOT group (p < 0.05). The time of treatment and course of HBOT were significantly correlated with the hearing threshold after treatment (p < 0.05) and had no significant relationship with tinnitus and age (p > 0.05).

HBOT + IVS is an effective method for ISSNHL, especially for the recovery of low-frequency hearing and initial hearing levels of severe and profound. Tinnitus is the most common concomitant symptom of ISSNHL, and prolonging the course of HBOT did not significantly improve it. Initiating HBOT within 7 days for 10-25 sessions of treatment was more beneficial.

Prevalence and correlates of REM sleep behaviour disorder in patients with major depressive disorder: a two-phase study.

Neurology, Neurosurgery and Psychiatry

To investigate the prevalence and clinical correlates of video polysomnography (vPSG)-confirmed rapid eye movement sleep behaviour disorder (RBD) in patients with major depressive disorder (MDD).

This is a clinic-based two-phase epidemiological study. In phase 1, patients with MDD were screened by a validated questionnaire, RBD Questionnaire-Hong Kong (RBDQ-HK). In phase 2, a subsample of both the screen-positive (RBDQ-HK >20) and screen-negative patients with MDD underwent further clinical and sleep assessment (vPSG) to confirm the diagnosis of RBD (MDD+RBD). Poststratification weighting method was used to estimate the prevalence of MDD+RBD. The total likelihood ratio and the probability of prodromal Parkinson's disease (PD) were calculated from prodromal markers and risk factors, as per the Movement Disorder Society research criteria.

A total of 455 patients with MDD were screened (median age (IQR)=52.66 (15.35) years, 77.58% woman, 43.74% positive). Eighty-one patients underwent vPSG and 12 of them were confirmed MDD+RBD. The prevalence of MDD+RBD was estimated to be 8.77% (95% CI: 4.33% to 16.93%), with possibly male predominance. MDD+RBD were associated with colour vision and olfaction deficit and a higher probability for prodromal PD.

Almost 9% of patients with MDD in the psychiatric outpatient clinic has vPSG-confirmed RBD. Comorbid MDD+RBD may represent a subtype of MDD with underlying α-synucleinopathy neurodegeneration. Systematic screening of RBD symptoms and necessity of vPSG confirmation should be highlighted for capturing this MDD subtype with a view to enhance personalised treatment and future neuroprotection to prevent neurodegeneration.

Retinal inter-eye difference and atrophy progression in multiple sclerosis diagnostics.

Neurology, Neurosurgery and Psychiatry

The visual system could be included in the diagnostic criteria for multiple sclerosis (MS) to demonstrate dissemination in space (DIS) and dissemination in time (DIT).

To investigate the diagnostic value of retinal asymmetry in MS.

A prospective, longitudinal study in individuals with MS (n=151) and healthy controls (n=27). Optical coherence tomography (OCT) was performed at 0, 2 and 4 years. Macular ganglion cell and inner plexiform layer (mGCIPL) thickness was determined as well as measures for retinal asymmetry: the inter-eye percentage difference (IEPD) and inter-eye absolute difference (IEAD). Receiver operator characteristics curves were plotted and the area under the curve (AUC) was calculated for group comparisons of the mGCIPL, IEPD, IEAD and atrophy rates.

The diagnostic accuracy of both the IEPD and IEAD for differentiating bilateral and unilateral MS optic neuritis was high and stable over time (AUCs 0.88-0.93). The IEPD slightly outperformed the IEAD. Atrophy rates showed low discriminatory abilities for differentiating MS from controls (AUC 0.49-0.58).

The inter-eye differences of the mGCIPL have value for demonstration of DIS but in individuals with longstanding MS not for DIT. This may be considered as a test to detect DIS in future diagnostic criteria. Validation in a large prospective study in people presenting with symptoms suggestive of MS is required.

Identifying Subclinical Hearing Loss: Extended Audiometry and Word Recognition in Noise.

Audiology and Neuro-Otology

Normal-hearing people often have complaints about the ability to recognize speech in noise. Such disabilities are not typically assessed with conventional audiometry. Suprathreshold temporal deficits might contribute to reduced word recognition in noise as well as reduced temporally based binaural release of masking for speech. Extended high-frequency audibility (>8 kHz) has also been shown to contribute to speech perception in noise. The primary aim of this study was to compare conventional audiometric measures with measures that could reveal subclinical deficits.

Conventional and extended high-frequency audiometry was done with 119 normal-hearing people ranging in age from 18 to 72. The ability to recognize words in noise was evaluated with and without differences in temporally based spatial cues. A low-uncertainty, closed-set word recognition task was used to limit cognitive influences.

In normal-hearing listeners, word recognition in noise ability decreases significantly with increasing pure-tone average (PTA). On average, signal-to-noise ratios worsened by 5.7 and 6.0 dB over the normal range, for the diotic and dichotic conditions, respectively. When controlling for age, a significant relationship remained in the diotic condition. Measurement error was estimated at 1.4 and 1.6 dB for the diotic and dichotic conditions, respectively. Controlling for both PTA and age, EHF-PTAs showed significant partial correlations with SNR50 in both conditions (ρ = 0.30 and 0.23). Temporally based binaural release of masking worsened with age by 1.94 dB from 18 to 72 years old but showed no significant relationship with either PTA.

All three assessments in this study demonstrated hearing problems independently of those observed in conventional audiometry. Considerable degradations in word recognition in noise abilities were observed as PTAs increased within the normal range. The use of an efficient words-in-noise measure might help identify functional hearing problems for individuals that are traditionally normal hearing. Extended audiometry provided additional predictive power for word recognition in noise independent of both the PTA and age. Temporally based binaural release of masking for word recognition decreased with age independent of PTAs within the normal range, indicating multiple mechanisms of age-related decline with potential clinical impact.

Multiple-region grey matter atrophy as a predictor for the development of dementia in a community: the Hisayama Study.

Neurology, Neurosurgery and Psychiatry

To assess the association of regional grey matter atrophy with dementia risk in a general older Japanese population.

We followed 1158 dementia-free Japanese residents aged ≥65 years for 5.0 years. Regional grey matter volume (GMV) at baseline was estimated by applying voxel-based morphometry methods. The GMV-to-total brain volume ratio (GMV/TBV) was calculated, and its association with dementia risk was estimated using Cox proportional hazard models. We assessed whether the predictive ability of a model based on known dementia risk factors could be improved by adding the total number of regions with grey matter atrophy among dementia-related brain regions, where the cut-off value for grey matter atrophy in each region was determined by receiver operating characteristic curves.

During the follow-up, 113 participants developed all-cause dementia, including 83 with Alzheimer's disease (AD). Lower GMV/TBV of the medial temporal lobe, insula, hippocampus and amygdala were significantly/marginally associated with higher risk of all-cause dementia and AD (all p for trend ≤0.08). The risks of all-cause dementia and AD increased significantly with increasing total number of brain regions exhibiting grey matter atrophy (both p for trend <0.01). Adding the total number of regions with grey matter atrophy into a model consisting of known risk factors significantly improved the predictive ability for AD (Harrell's c-statistics: 0.765-0.802; p=0.02).

Our findings suggest that the total number of regions with grey matter atrophy among the medial temporal lobe, insula, hippocampus and amygdala is a significant predictor for developing dementia, especially AD, in the general older population.

Humoral immunity to SARS-CoV-2 mRNA vaccination in multiple sclerosis: the relevance of time since last rituximab infusion and first experience from sporadic revaccinations.

Neurology, Neurosurgery and Psychiatry

The effect of disease-modifying therapies (DMT) on vaccine responses is largely unknown. Understanding the development of protective immunity is of paramount importance to fight the COVID-19 pandemic.

To characterise humoral immunity after mRNA-COVID-19 vaccination of people with multiple sclerosis (pwMS).

All pwMS in Norway fully vaccinated against SARS-CoV-2 were invited to a national screening study. Humoral immunity was assessed by measuring anti-SARS-CoV-2 SPIKE RBD IgG response 3-12 weeks after full vaccination, and compared with healthy subjects.

528 pwMS and 627 healthy subjects were included. Reduced humoral immunity (anti-SARS-CoV-2 IgG <70 arbitrary units) was present in 82% and 80% of all pwMS treated with fingolimod and rituximab, respectively, while patients treated with other DMT showed similar rates as healthy subjects and untreated pwMS. We found a significant correlation between time since the last rituximab dose and the development of humoral immunity. Revaccination in two seronegative patients induced a weak antibody response.

Patients treated with fingolimod or rituximab should be informed about the risk of reduced humoral immunity and vaccinations should be timed carefully in rituximab patients. Our results identify the need for studies regarding the durability of vaccine responses, the role of cellular immunity and revaccinations.