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PubMed2001

Otologic injuries from airbag deployment.

Airbags became available as an optional passive restraint system in motor vehicles in 1973. The National Highway Traffic Safety Administration mandated placement of driver and right passenger airbags in all passenger vehicles and light trucks beginning in model year 1997. An estimated 2.1 million airbags have been deployed from the late 1980s until the present. There have been several case reports of hearing loss after exposure to airbag deployments in drivers and passengers since 1995. Members of the American Academy of Otolaryngology-Head and Neck Surgery submitted case reports on 71 patients with otologic symptoms after airbag deployment.

Adolescent↗
PubMed2002

The otologic consequences of the Omagh bomb disaster.

OBJECTIVES: The goal of the study was to compare the spontaneous healing rate for traumatic perforation of the tympanic membrane sustained in the Omagh bomb disaster with that of previous reports in the literature. DESIGN AND SETTING: A retrospective study was conducted at Tyrone County Hospital, Northern Ireland, 2 years after the incident. PARTICIPANTS: One hundred thirty-eight patients who sustained otologic injuries from the bomb blast were included in the study. RESULTS: Only 47 of the 124 perforations healed spontaneously. The previously reported spontaneous healing rate for traumatic perforations of the tympanic membrane is 80% to 90%; in our study, the healing rate was unexpectedly low at 38%. CONCLUSION: The massive explosion in a narrow street with hundreds of persons in close proximity to the bomb may account for the poor healing rate.

Adolescent↗
PubMed2004

Otologics Middle Ear Transducer Ossicular Stimulator: performance results with varying degrees of sensorineural hearing loss.

OBJECTIVES: This study was conducted to demonstrate the safety and efficacy of the Otologics Middle Ear Transducer (MET) Ossicular Stimulator and, in particular, to compare the audiologic benefits of this novel form of electromechanical stimulation with those of conventional acoustical amplification. MATERIAL AND METHODS: A total of 282 patients were implanted with the device in Europe and the USA. Pure-tone audiometry, speech recognition and subjective assessment of benefit were tested before the surgery and 2, 3, 6 and 12 months afterwards. The US patients were fitted with a digital hearing aid for a minimum of 4 weeks prior to surgery, and the same benefit measures were performed with the digital hearing aid and their "walk-in" hearing aid. RESULTS: Group mean postoperative bone and air conduction thresholds did not change significantly from preoperative levels. Postoperative air conduction thresholds decreased slightly in some individual patients, due to the mass loading effect exerted by the transducer on the ossicles. Sufficient gain was available to reach target prescription levels for moderate to severely impaired hearing individuals. Speech and subjective assessment of patient preference indicated that patients did as well or better with the MET Ossicular Stimulator than with their "walk-in" aid or the standardized digital aid. CONCLUSION: The capability of the MET Ossicular Stimulator to provide appropriate gain as a function of degree of hearing loss indicates that the device is a viable treatment for moderate to severe sensorineural hearing loss in adults.

Adult↗
PubMed2003

Evaluation of video-otoscopes suitable for tele-otology.

The objectives of this study were to assess the quality of digitized video-otoscopes as well as its ease of use and safety. Four video-otoscopes available in Australia were used to image 96 patients. At least 22 patients (age range 5-70 years) were imaged with each video-otoscope, and the images were stored in a JPEG format. Three experienced otolaryngologists assessed all images for quality, clarity, color accuracy, orientation of eardrum and therefore ability to make a definitive diagnosis. The grading was a five-level scale: poor, adequate, good, very good and excellent. Two telescope systems produced high quality images (>80% were adequate or better), essential for accurate diagnosis, but both were associated with increased risk for injury in unskilled hands. The MedRx video-otoscope produced high-quality images (87% were adequate or better), while the Welch Allyn Compact Video-otoscope produced poor image quality (only 40% were adequate or better). Both devices were seen to be safer to use than the telescope systems. The telescope systems and MedRx otoscope provided optimum quality images necessary for tele-otology. However, the telescope units were considered to be unsafe in unskilled hands. The MedRx can be recommended as a safe device producing high-quality images.

Adolescent↗
PubMed2002

Under-rated neuro-otological symptoms: Hoffman and Brookler 1978 revisited.

In 1978, Hoffman and Brookler published an article in The Laryngoscope to challenge prevailing views on the lack of diagnostic power of certain symptoms often reported by patients to neuro-otologists. Some of these 'under-rated neuro-otological symptoms' include complaints of non-rotational dizziness, blurred and double vision, and the development of visual motion hypersensitivity in patients with balance disorders. In this review, I revisit these visual symptoms in the light of new findings from our laboratory. Double vision due to skew eye deviation can indeed occur in peripheral vestibular disease when there is a large, acute peripheral imbalance of vestibular function. It is more frequent and severe in brain stem disease. In both cases, it is explained by disruption of the torsional vestibular ocular reflex. It is usually assumed that damage to the otolith underlies the emergence of skew diplopia, but recent evidence shows that the vertical canal system is likely to be partly responsible as well. The other 'under-rated symptom' revisited here is what patients describe as dizziness when watching moving objects or whilst walking in visually busy surroundings such as supermarkets. Recent work has shown that this 'visual vertigo' emerges in patients who, in addition to suffering from a vestibular disorder, have increased visual dependence. Visual dependence denotes subjects who preferentially use vision, as opposed to vestibular or proprioceptive input, for spatial orientation and postural control. We do not know as yet what makes some vestibular patients become extremely visually dependent. However, we have provided evidence for Hoffman and Brookler's impression that visually triggered complaints should not be summarily dismissed, as they often point to an underlying vestibular disorder.

Diplopia↗
PubMed1984

Neuro-otological manifestations of migraine.

Vestibulocochlear derangements have been studied in three groups of patients: 200 unselected patients with migraine (Series I), 80 migrainous patients referred because of their symptoms for full neuro-otological examination (Series II), and 116 patients with tension headache who served as controls (Series III). Significant differences were established between tension headache and migraine in respect of incidence and severity of symptoms and their time of onset in relation to the headache. In migraine, vestibulocochlear disturbances can occur as an aura, accompanying the headache or during headache-free periods, the highest incidence occurring during the headache. In Series I, 59 per cent reported vestibular and/or cochlear symptoms and these were of disabling severity in 5 per cent. Significantly, 50 per cent had a history of motion sickness and 81 per cent experienced phonophobia during the headache, the probable mechanism of which is discussed. Persisting vestibulocochlear derangements were found in 77.5 per cent of Series II, largely vestibular and of both central and peripheral origin. Involvement of the vertebrobasilar vascular system appears to be the most likely explanation. Possible links between Ménière's disease, benign paroxysmal vertigo and migraine are discussed.

Adolescent↗
PubMed1985

Neuro-otological abnormalities in xeroderma pigmentosum with particular reference to deafness.

The neuro-otological findings are described in 3 unrelated patients who had xeroderma pigmentosum. All had impaired hearing. Routine audiometric assessment suggested that the hearing loss was of cochlear origin; brainstem evoked potentials in 2 patients and electrocochleography in 1 support this conclusion. Two adult patients had a supranuclear ophthalmoplegia. Vestibular function was mildly deranged and visual suppression of the vestibulo-ocular reflex impaired.

Adult↗
PubMed1992

Torsional nystagmus. A neuro-otological and MRI study of thirty-five cases.

Thirty-five patients with torsional nystagmus (TN) underwent vestibular and ocular motor assessment and magnetic resonance image (MRI) scanning of the head. Patients were divided into two groups according to whether TN was predominant and present in primary gaze (Group I, 23 patients) or elicited by head positioning or gaze deviation and less prominent than other concurrent nystagmus (Group II, 12 patients). The main aetiologies in both groups were demyelination, vascular disease and posterior fossa tumours. In Group I, a frequent pattern of findings, occurring in 30-50% of cases, was a caloric canal paresis contralateral to the direction of the fast phases ('beat') of the TN, whereas the duration of horizontal caloric/rotational nystagmus and the slow-phase eye velocity of pursuit and of optokinetic nystagmus were all reduced in the direction of beating. The TN was more frequently and consistently modulated by vertical canal stimuli (head oscillation in roll) than by otolith stimuli (static tilt). Statistical analysis of the MRI showed significant overlap of abnormal MRI signals in the area of the vestibular nuclei, on the side opposite to the beat direction of TN. These results suggest that TN originates in a central imbalance of vertical semicircular canal function, resulting from lesions involving the vestibular nuclei on the opposite side of the TN. Group II was heterogeneous with no consistent pattern of neuro-otological findings, although lesions ipsilateral to the TN were frequent occurrence; in these cases cerebellar system lesions may have produced ipsilateral vestibular nuclei disinhibition.

Adolescent↗
PubMed1999

Illness and otological changes during upper respiratory virus infection.

OBJECTIVES: Upper respiratory virus infection is associated with the expression of symptoms and signs of illness, and with the development of complications in anatomically contiguous structures. In most epidemiological studies, the frequency of the various complications is expressed as a fraction of the total population judged to be ill by report, signs, or symptoms. Because not all infected subjects become ill and because infected non-ill subjects may develop complications, such risk estimates could be inaccurate. The objective of this study was to estimate the magnitude of the presentation bias during controlled, experimental infections. STUDY DESIGN: This was a prospective, experimental study of the relationship between illness and otological complications during experimental upper respiratory virus infection in 316 adult volunteers. METHODS: The data for illness and for abnormal middle ear underpressure in adult (18-54 y) volunteers experimentally infected with one of three viruses (rhinovirus type 39, rhinovirus strain hanks, influenza A virus) were analyzed and expressed as the relative frequencies of infected subjects reporting illness, developing abnormal middle ear pressure, and developing abnormal middle ear pressure in the absence of illness. RESULTS: For all three viruses, illness was documented in approximately 50% of the infected subjects. While the frequency of persons developing abnormal middle ear underpressure was greater in the infected-ill subjects, approximately one third of all infected subjects developing that complication did not report illness. CONCLUSIONS: These results support a large presentation bias in epidemiological surveys of viral upper respiratory infections, and infer that those surveys underestimate the true frequency of complications resulting from such infections.

Adolescent↗
PubMed1976

Polytomography in an otologic practice.

The polytome should be used as an adjunct to conventional roentgenograms of the temporal bone and not as a substitute. The purpose of this paper is to demonstrate how the polytome has been used to great advantage in a private otologic practice.

Ear Deformities, Acquired↗
PubMed1988

Cooperative neuro-otologic management of acoustic neuromas and other cerebellopontine angle tumors.

Over a recent 16-month period, 35 cerebellopontine angle tumors were removed at our institution by a surgical team consisting of one neurosurgeon and one otologist. Nineteen tumors were less than 2 cm in diameter and six were greater than 4 cm. There were 26 acoustic neuromas, six meningiomas, two epidermoid tumors, and a glossopharyngeal schwannoma. A suboccipital transmeatal approach was used in the majority of patients. There were no deaths. Thirty-two patients had an excellent outcome. Twenty-four patients had complete tumor removal (92% of the acoustic neuromas). The facial nerve was preserved anatomically in all but one patient, who had nerve grafting intraoperatively and has partial recovery of function. Thirteen of the 24 patients who had auditory function retained some of it postoperatively. With current diagnostic techniques, combined with the neurosurgical and otologic team approach, the majority of patients with acoustic tumors of all sizes may expect a complete resection of the tumor with a good outcome. Certainly, early diagnosis and resection of smaller tumors will increase the likelihood that hearing will be preserved, thus providing impetus for aggressive diagnostic and surgical treatment of patients with these lesions.

Adolescent↗
PubMed1993

Neuro-otology.

New techniques for the assessment of vestibulospinal, neck-afferent, and viscerograviceptive function may show future clinical applications for a broader assessment of balance function in neuro-otological patients. Magnetic resonance imaging studies revealed that many intralabyrinthine disorders (labyrinthitis, hemorrhage, schwannomas) can be adequately visualized. Perceptual and oculomotor clinical studies improved our understanding of vestibular disordered function in the roll (coronal) plane. Therapeutic studies highlight the importance of a team approach, with individually tailored programs for the rehabilitation of patients with vestibular disorders. Reasonable agreement on the criteria for attempting hearing preservation during acoustic neuroma surgery seems to have been reached.

Brain Stem↗
PubMed1989

Perilymph fistulas in children: experience of the Otologic Medical Group.

We reviewed records of 86 consecutive fistula explorations over 12 years. Four cases were children under age 18. There were 35 fistulas, all in adults. Since this series, we have identified five more children with fistula explorations for a total of nine patients. Two had bilateral explorations. Presenting symptoms were hearing loss and dizziness. None of the children had a definite fistula. Of the nine patients, one patient had a significant improvement in hearing postoperatively, five had no change, and two had worse hearing. There was no follow-up in two patients or in the second ear of a bilateral case. We feel that a fistula should be considered in any case of progressive or fluctuating sensorineural hearing loss, especially in cases with a congenital inner ear deformity. In such cases, an exploration may be reasonable to rule out a fistula. Otherwise, we are hesitant to explore patients for fistulas regardless of whether they are children or adults. Sudden, progressive, and fluctuating sensorineural hearing loss, dizziness, and meningitis have been attributed to perilymph fistulas in both adults and children. The literature reports fistulas in all types of conditions. The incidence and degree of success of treatment have varied widely. When Goodhill first reported round window rupture as a cause of sudden sensorineural hearing loss (SNHL), the Otologic Medical Group (OMG) began routine exploration of all cases of sudden SNHL for the presence of fistulas. After 50 consecutive cases were explored and no fistulas were found, we became selective in our exploration candidates.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2005

Neuro-otologic findings in unilateral isolated narrow internal auditory meatus.

OBJECTIVE: To report neuro-otologic findings concerning the four nerves in the internal auditory meatus (IAM) in patients with isolated congenitally narrow IAM and explore the implications regarding ontogeny of the nerves in the IAM. DESIGN: Retrospective case series study. SETTING: University hospital. SUBJECTS: Five consecutive patients between 1997 and 2002 with unilateral isolated narrow IAM demonstrated by high-resolution computed tomography whose chief complaint was hearing loss (1 male and 4 females, 4 right sides and 1 left; age range 5-37 years, mean 20 years; IAM diameter at the porus: 26-33% of that on the normal side). MAIN OUTCOME MEASURES: Functional studies concerning the VIIth cranial nerve and the three branches of the VIIIth cranial nerve. RESULTS: In all ears, auditory brain stem responses were absent, the speech discrimination score was 0%, and otoacoustic emissions were absent or markedly reduced compared with those on the normal side. Caloric responses were absent in two ears, reduced in two ears, and normal in one ear. Galvanic body sway tests showed no responses in the two ears in which caloric responses were absent. Inferior vestibular nerve function was estimated as normal in all ears on the basis of vestibular evoked myogenic potential recordings. Facial nerve functions were normal in all patients. CONCLUSIONS: In isolated congenital stenosis of IAM, dysfunction of each nerve in the IAM can occur independently. In the ontogeny of the VIIIth cranial nerve, the cochlear and superior vestibular nerves tended to be involved together, whereas the cochlear and inferior vestibular nerves appeared independent of each other.

Adolescent↗
PubMed2005

Idiopathic sudden sensorineural hearing loss is not an otologic emergency.

OBJECTIVE: To investigate whether delay in treatment has any influence on the audiometric outcome at Day 30 in idiopathic sudden sensorineural hearing loss. STUDY DESIGN: Prospective study. SETTING: Otorhinolaryngologic emergency center in Paris, France. PATIENTS: Three hundred forty-seven consecutive cases of sudden sensorineural hearing loss were examined. A neurologic or retrocochlear cause was revealed in 17 cases. Four additional cases were lost for follow-up. Three hundred twenty-six cases of "idiopathic" sensorineural hearing loss seen within 7 days of onset were enrolled and classified by type according to five audiogram shapes: low tone (Type A), flat (Type B), high tone (Type C), cup-shaped (Type D) or total or subtotal (Type E). Because of loss for follow-up, the hearing outcome at 1 month could be evaluated in only 249 cases. INTERVENTION: All 326 patients were given 1 mg/kg per day corticosteroids intravenously for 6 days and 500 ml mannitol 10% in the subgroup presenting ascending audiometric shape. MAIN OUTCOME MEASURES: The following parameters were used. The first parameter was hearing recovery (initial PTA-PTA at Day 6 or Day 30). It was considered as complete if final PTA was below 25 dB. The second parameter was incidence of hearing recovery based on the following formula: (initial PTA-PTA on a given test day)/(initial PTA) x 100%. Using regression analysis and ANOVA, the audiometric outcome was analyzed at Day 6 and Day 30 as a function of the day of onset of treatment and of the audiometric type. RESULTS: Whatever the audiometric type, there was no significant difference in final outcome whether the treatment was started within the first 24 hours or within the first week. CONCLUSIONS: Delay in initiating treatment does not appear to influence the final degree of hearing loss. Idiopathic sudden sensorineural hearing loss cannot be considered as an otologic emergency.

Analysis of Variance↗
PubMed1988

Experience with a new topical anaesthetic in otology.

Producing good local anaesthesia of the external auditory meatus and tympanic membrane has always been a difficult problem facing otologists. Previously used methods are mentioned and the use of a new eutectic mixture of local anaesthetics (EMLA) for electrocochleography, myringotomy and grommet insertion in adults and older children is described. A double-blind controlled trial involving 15 patients (30 ears) undergoing electrocochleography showed EMLA to be a very effective, safe and convenient preparation for outpatient otological use.

Adolescent↗
PubMed1993

The otological profile of a cohort of Dutch 7.5-8-year-olds.

The otological characteristics of a birth cohort of 7.5-8-year-old Dutch children are reported. Questionnaire information was available for 1004 children, while otomicroscopic, tympanometric and pure-tone audiometric data were available for 946 children. Twenty-nine per cent of the children had been treated surgically for various ENT diseases. Fifty-five per cent of the children had normal tympanic membranes, 19% mild abnormalities, and 26% moderate to severe abnormalities. At this age the prevalence of bilateral otitis media with effusion (OME), as shown by a type B tympanogram was 2.5%, while that of unilateral OME was 7%. A pure-tone average hearing level of > or = 15 dB in the better-hearing ear was found in 4% of the children. The presence of OME was associated with a mean hearing loss of 20 dB. This study shows that structural and functional middle-ear abnormalities are highly prevalent in Dutch school children.

Acoustic Impedance Tests↗
PubMed1980

Otological manifestations in temporomandibular joint dysfunction.

Forty-seven patients with temporomandibular joint dysfunction were studied. A total of 100 subjective symptoms localized in the ear were encountered in thirty-nine patients. The treatment of dysfunction eradicated or reduced 56% of these symptoms. A hearing defect was established audiometrically in eight cases and the probable cause was outside the masticatory apparatus in seven cases. There was conceviably a causal relationship in one case between the patient's cochlear hearing defect and temporomandibular joint dysfunction. The neuro-otological finding was pathological in nine cases, in three of which the causative agent was independent of the masticatory apparatus. The vestibular disturbance diagnosed in six cases may have originated from temporomandibular joint dysfunction, but this could not be confirmed.

Adolescent↗