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PubMedDate not supplied

Otologic and audiologic evaluation of human immunodeficiency virus-infected patients.

PURPOSE: To quantify the incidence of ear disease in patients infected with human immunodeficiency virus (HIV). MATERIALS AND METHODS: This is a descriptive case series of HIV-positive patients, with data collected using an otologic questionnaire. otologic examination, audiologic evaluation, and chart review. The study was performed at an urban University Hospital's outpatient Infectious Disease and Otolaryngology clinics. A consecutive sample of 50 HIV-infected patients volunteered for this study. Ten subjects refused. Almost all patients received public assistance for medical care. Descriptive results were tabulated. Audiometric data were analyzed for ear, Centers for Disease Control (CDC) group, otologic complaint, and age effects. Data were compared with established norms. RESULTS: Twenty-three men and 27 women with a mean age of 40 years and mean duration of HIV disease of 3.5 years were studied. Eighteen percent of patients were in category CDC-A, 38% in CDC-B, and 44% in CDC-C. Otologic complaints were more prevalent than expected: 34% of patients reported aural fullness, 32% dizziness, 29% hearing loss, 26% tinnitus, 23% otalgia, and 5% otorrhea. Results of the neuro-otologic examination were abnormal in 33%. Tympanometric examination was abnormal in 21%. A significant degree of high-frequency sensorineural hearing loss was observed. CDC-B and CDC-C patients had worse hearing than CDC-A patients at 3 frequencies. Patients who complained of hearing loss had significantly worse otoacoustic emission results and hearing results than patients who did not, at all frequencies except 1,000 Hz. Patients in their 30s had better hearing in the speech frequencies than did all other patients. CONCLUSIONS: Ear disease affects up to 33% of HIV-infected patients. Otitis media is a frequent finding. Sensorineural hearing loss is more severe in patients with more severe HIV infection. Patients with ear complaints have demonstrable otopathology. Continuation of this preliminary descriptive work is necessary.

Adult↗
PubMed2003

Prevalence of otologic complaints in patients with temporomandibular disorder.

The prevalence and rank of order of 4 otologic complaints in 200 temporomandibular disorder (TMD) patients, as well as the relationship between the complaints and TMD subgroups, were investigated and compared with an asymptomatic control group. No subjective otologic complaints were reported by 45 (22.5%) TMD patients; the remaining 155 (77.5%) patients had at least 1 otologic complaint. Otalgia, tinnitus, vertigo, and hearing loss were reported by 63.6%, 59.1%, 50%, and 36.4%, respectively, of the subjects with myofascial pain and dysfunction; by 46.1%, 44.2%, 32.5%, and 22% of the patients with internal derangement; and by 62.5%, 45.8%, 41.6%, and 20.8% of the patients with both myofascial pain and dysfunction and internal derangement. However, the incidence of otalgia (8%), tinnitus (26%), vertigo (14%), and hearing loss (14%) was found to be lower for the control group. Statistically, the control group had fewer otologic complaints. Patients in the TMD groups had high incidences of otologic complaints compared with the control subjects without TMD signs or symptoms. Aural symptoms in patients with internal derangement or myofascial pain and dysfunction, or their combination, were nonspecific.

Acoustic Impedance Tests↗
PubMed2001

Otological manifestations of Churg-Strauss syndrome.

OBJECTIVES/HYPOTHESIS: To describe the clinical features, pathogenesis, and management of the otological complications in Churg-Strauss syndrome (CSS). STUDY DESIGN: Retrospective review of five patients with documented CSS who had otological manifestations in the later stages of CSS. METHODS: The history, treatment, and outcome were evaluated using office and hospital chart data in these five cases. RESULTS: In all cases, otological manifestations occurred during an advanced stage of CSS and was characterized by the presence of dense aural discharge, granulomatous eosinophilic infiltration into mastoid and middle ear, and subacute severe to profound hearing loss. In all cases, the recurrent aural discharge and granulomatous infiltrate was unresponsive to conventional treatment including repeated myringotomies and aggressive antibiotics. Systemic steroid administration resulted in a rapid, complete cessation of aural discharge and reversal or stabilization of hearing loss. Otological manifestations have been stable over a range of follow-up from 1 to 20 years on a maintenance regimen of steroids. CONCLUSIONS: Temporal bone involvement in CSS is rare. Surgical intervention of the temporal bone is relegated to complications that may include infectious mastoiditis and intracranial involvement. Recognition of the association between CSS and otological disease is important because it is highly responsive to systemic steroids, and early steroid treatment may prevent progression to irreversible hearing loss, infectious otomastoiditis, or intracranial complications.

Adult↗
PubMedDate not supplied

Outcomes research in otology.

Among the otolaryngologic subspecialties, otology has historically been at the forefront of outcomes research in our specialty. Many traditional outcomes reporting tools have been consistently employed in the study of otologic disease and treatment outcomes including standardized reporting schemes for Meniere's disease and facial nerve dysfunction. However, recent interest has surfaced in disease-specific quality-of-life outcomes measures for many otologic diseases such as sensorineural hearing loss, conductive hearing loss and suppurative otitis media. Several reliable and validated outcomes tools are available for the assessment of the impact on quality of life and treatment outcomes for common otologic afflictions that carry with them significant quality-of-life burdens. Furthermore, similar outcomes tools have been developed that allow a scientific appraisal of disease status and quality of life for dizziness and tinnitus, which have been traditionally difficult to quantify. Increasing familiarity with these outcomes tools will allow investigators to accurately assess and compare treatments for these otologic diseases and justify treatment initiatives in the future.

Hearing Aids↗
PubMedDate not supplied

Otologic referral criteria.

Otologic referral is an important component of an industrial hearing conservation program. Recent federal regulations in this area are reviewed, and suggestions for implementation of otologic referral are made. Criteria for otologic referral must be distinguished from a definition of significant threshold shift for internal program action. Test-retest variability is higher in industrial than in clinical settings, and unduly stringent definitions of significant threshold shift will result in many spuriously identified cases. The American Council of Otolaryngology--Head and Neck Surgery has proposed criteria for otologic referral that are probably the best available guidelines. Referrals should be made on the basis of both baseline and periodic audiometry. Most workers referred for substantial audiometric abnormalities have otologic diagnoses other than noise-induced hearing loss, or require specific intervention, or both.

Auditory Threshold↗
PubMed1999

[Day surgery and otologic diseases].

The aim of the present work was to check the results obtained in a group of patients suffering from otological pathologies who had undergone day surgery. In addition, to determine the reliability and validity of this form of out-patient surgery in otology, complications were compared with a similar group of patients who had undergone surgery under normal hospital in-patient conditions. The study only viewed patients hospitalized for otological pathologies from January 1995 to April 1998. During this period of time 90 patients with varying degrees of otological pathologies underwent out-patient day surgery. This surgical activity was then compared to the same type of surgery performed under normal in-patient hospitalization. During the post-operative phase of day surgery, only 7 patients (7.7%) had to be fully hospitalized: 5 complaining of dizziness, the other 2 with fever that ruled out discharge in the evening. In all cases, after hospitalization for the night the patient could be safely discharged. In the normally hospitalized in-patients, complications arose in 14 cases (8.6%) with fever being the most common complication (8 patients). On the basis of the results, it appears that nearly all otological pathologies can be treated in day surgery. This solution limits complications and ensures good economic management; it results in savings and improved organization, reduces the waiting lists and rationalizes use of the operating rooms. Moreover, it must be pointed out that the program was highly appreciated by the patients who could better schedule their own activities, both work and social-family obligations. This aspect is quite important in view of a broader outlook on the economics of the national health system as it shows a savings, not only in the health costs, but also in the overall labor costs.

Adolescent↗
PubMedDate not supplied

Otologic manifestations of petrous carotid aneurysms.

BACKGROUND AND PURPOSE: The petrous and cavernous segments of the extradural internal carotid artery take a complex course through the skull base before entering the subarachnoid space distal to the cavernous sinus. Despite the protection from trauma afforded by the anatomy, the petrous and carotid internal carotid artery (ICA) segments of the vessel remains subject to disease, the most important of which are aneurysms. Aneurysms affecting the petrous portion of the vessel are extremely uncommon, and presentation with otologic symptoms is unusual. These symptoms include hearing loss, tinnitus, and life threatening hemorrhage. This article emphasizes the need for a high level of suspicion for aneurysm as a potential cause for otologic symptoms. We report and discuss three cases of petrous carotid aneurysms with otologic manifestations to increase the awareness and aid in the diagnosis and treatment of this uncommon disorder. METHODS: The medical records and imaging studies of three patients presenting to our institution with aneurysms involving the petrous internal carotid artery were reviewed. One presented with progressive bilateral sensorineural hearing loss. The next patient presented with pulsatile tinnitus. The last patient presented to the emergency room unresponsive with severe epistaxis. RESULTS: All three patients had imaging studies revealing petrous carotid aneurysms. Each patient had symptoms related to the aneurysms ranging from hearing loss, tinnitus, and life-threatening hemorrhage. CONCLUSION: Petrous carotid aneurysms are rare, and presentation with otologic symptoms is unusual. Awareness of these lesions as a cause of otologic symptoms, however, is highly important. These cases also illustrate the usefulness of endovascular treatments for aneurysms of the petrous portion of the internal carotid artery, which are extremely difficult to treat by using an open surgical approach.

Aged↗
PubMed1984

[Combined computer-assisted neuro-otologic diagnosis of inner ear function in children].

Among 10 284 data files of neuro-otological patients of our neuro-otological data bank NODEC III, 8,6% pertain to children between 0 and 15 years of age. 350 (3,5%) of these are in the age group of 0-5 years, 261 (2,5%) in the group of 6-10 years and 267 (2,6%) in the group of 11-15 years. Modern inner ear functional diagnostic methods combine computerised neuro-otological audiometric as well as equilibriometric tests. Ranking of diagnostic applicability and efficiency comprises the following 6 steps of neuro-otological equilibriometric and audiometric tests: Child-adapted psychophysical hearing tests, Perrotatory nystagmus tests via electronystagmography, Postrotatory nystagmus tests via electronystagmography, Acoustic brain-stem evoked potentials ( ABEP ) with 2-channel averager, Caloric vestibular test via electronystagmography, Optokinetic nystagmus test via electronystagmography. It has been proved both clinically and statistically that the perrotatory as well as the postrotatory nystagmus recordings are accepted much better by the preschool children than the caloric test. The latter, however, provides us with superior topodiagnostic information. Acoustically evoked potentials usually require to be performed under sedation in preschool children. Automatic nystagmus evaluation via the computer system NYDIAC immediately yields all the important monocular nystagmus parameters and synoptical test charts, i.e. the butterfly calorigram . The computerbased neuro-otological equilibriometric as well as audiometric investigations should be performed by an experienced and specifically trained otolaryngologist. This diagnostic method promotes intense co-operation with colleagues in paediatrics, ophthalmology, neurology and traumatology.

Adolescent↗
PubMed1999

Use of the laryngeal mask airway in otologic surgery.

OBJECTIVE/HYPOTHESIS: The combination of intravenous sedation and local infiltration anesthesia is routinely utilized in otologic surgery. Advantages over general anesthesia with endotracheal intubation include ease and speed of induction and emergence, safety, and decreased postoperative discomfort. Anatomic and physiological patient constraints may preclude the use of intravenous sedation and anesthetists inexperienced in this technique may find it difficult to achieve a consistent level of anesthesia appropriate for major otologic surgery. Administration of anesthesia using the laryngeal mask airway (LMA) has been proposed to offer many of the advantages of intravenous sedation with less risk of oversedation and obstructive apnea. STUDY DESIGN: A retrospective chart review. METHODS: A review of 100 consecutive adult and pediatric patients undergoing major otologic procedures in which the LMA was utilized. RESULTS: All laryngeal masks were introduced without a laryngoscope and successful placement was accomplished on the first attempt in 98%. Procedures were performed under spontaneous ventilation and in only one instance was surgery temporarily interrupted because of patient movement. No major complications occurred and no patients required endotracheal intubation. Only three patients complained of mild throat discomfort in the immediate postoperative period. CONCLUSIONS: The laryngeal mask airway is a safe and effective means of providing anesthesia during major otologic surgery.

Adolescent↗
PubMed2005

Width of the extended facial recess: a numerical study of ultrahigh-resolution computed tomography and its implications in minimally invasive otologic surgery.

BACKGROUND: Methods of minimally invasive computer-assisted otologic surgery lag behind other fields. The reason seems to be the extremely small dimensions of the corridors between important structures in the temporal bone and the fact that these structures are encased in bony frameworks, are obscured before drilling, and are not movable. The extended facial recess is a surgical pass to the tympanic cavity. It is bounded medially by the facial nerve and laterally by the tympanic annulus, and varies among individuals. For computer-assisted, minimally invasive temporal bone surgery, high-resolution definition is critically important. AIMS: To determine the width of the extended facial recess and evaluate the computerized findings as a pre- and intraoperative aid to otologic surgery planning. METHODS: Bilateral temporal bone high-resolution computed tomographic images of 100 male and 100 female patients were measured twice at five levels (caudal to cephalic), first using a window-independent algorithm (extended facial recess, full-width at half-maximum), implemented in a computed tomographic image-processing workstation, and then manually with calipers on the same axial computed tomographic images. RESULTS: As expected, the extended facial recess, full-width at half-maximum method yielded the widest values superiorly (4.15 +/- 0.41 mm in the female patients and 4.32 +/- 0.54 mm in the male patients). From this level down, the extended facial recess, full-width at half-maximum method yielded values that tapered gradually to 2.50 +/- 0.56 mm in the female patients and 2.42 +/- 0.46 mm in the male patients at the most interior level. The manual method (extended facial recess, computed tomographic images) yielded a significantly higher value than that obtained with the objective, window-independent method at all levels, and at some levels was higher by as much as one-third. At Level 2, which corresponded roughly to the round window, the extended facial recess was 4.00 +/- 0.65 in the female study group and 4.11 +/- 0.67 mm in the male study group. CONCLUSION: Image processing methods such as extended facial recess, full-width at half-maximum method might lead to fine tuning and thus improvement of computer-assisted otologic surgery. Before clinical application and complete dependence on these automated methods during otologic surgery, their reliability should be further validated.

Adolescent↗
PubMed2006

[Delayed facial nerve palsy after otologic surgery].

Delayed facial nerve palsy (DFP) is rarely experienced after otologic surgeries that do not directly touch the facial nerves, such as tympano-mastoidectomy, cochlear implants, and stapes surgery, and is troublesome to both surgeons and patients if it happens. Here, we report 7 cases of DFP, including one case that developed DFP after endolymphatic sac surgery. The ratios of occurrence were as follows: 0.7% (2/305) for tympano-mastoidectomy, 0.8% (3/354) for cochlear implant, 0.4% (1/260) for stapes surgery and 1.0% (1/98) for endolymphatic sac surgery. All otologic surgeries, except for endolymphatic sac surgery, exposed the chorda tympani, and all surgeries, except for stapes surgery, underwent drilling for a mastoidectomy. Furthermore, DFP was always observed ipsilaterally to the operated ear after otologic surgeries and was never seen after benign parotid tumor surgery or total laryngectomy. Therefore, there may be a strong relationship between DFP and the procedures, used during otologic surgeries.

Adult↗
PubMed1999

Image-guided surgical navigation in otology and neurotology.

OBJECTIVE: To review the impetus for the development of image-guided surgical navigation, its technologies, and the few prior outcome studies, and to make recommendations for its role in otologic and neurotologic surgery. DATA SOURCES: A literature search of English language publications by Medline from 1966 to 1998, using the key words: stereotactic, stereotaxy, navigation, intraoperative, and surgery. DATA EXTRACTION: Attempted review of the literature on image-guided surgical navigation in otology and neurotology revealed little relevant data. CONCLUSION: There are many possible applications for image-guided surgical navigation in otology and neurotology, but technologic limitations preclude its extensive application. There are no data available that assesses whether image-guided surgical navigation can reduce operative time, hospital stay, or cost. Clinical outcomes have not been studied in patients with otologic and neurotologic disease. In this scenario, image-guided surgical navigation is an adjuvant tool that aids in navigation of the skull base but is not a substitute for sound surgical principles and knowledge of microsurgical anatomy.

Bias↗
PubMed1988

Can acquired immunodeficiency syndrome and Creutzfeldt-Jakob disease be transmitted via otologic homografts?

Materials commonly employed in the preparation of otologic homografts such as ethanol and formaldehyde are effective in vitro in inactivating human immunodeficiency virus (HIV). However, to our knowledge, the complete permeation of homograft materials with preservative has not been demonstrated. Ethanol and formaldehyde have not been shown to be effective in inactivating the Creutzfeldt-Jakob agent. The literature on sterilization procedures for these agents is reviewed. Standard procedures for preparation of otologic homografts are examined. It is recommended that donor HIV serologic status be determined when otologic homografts must be used. Further research is required to determine the efficacy of otologic homograft sterilization techniques against HIV and Creutzfeldt-Jakob disease.

Acquired Immunodeficiency Syndrome↗
PubMed1982

Sudden sensorineural hearing loss: operative complication in non-otologic surgery.

Sudden sensorineural hearing loss is a well recognized phenomenon in otologic practice with both viral and vascular etiologies being supported. However, sudden hearing loss as a complication of non-otologic surgical procedure is a seldom reported and rare phenomenon. Five cases of unilateral sudden sensorineural hearing loss which are time related and probably causally related to non-otologic surgery are presented. Two cases underwent open heart surgery and support previous reports of hearing loss secondary to cardiopulmonary bypass procedures. Three noncardiac cases are also reviewed. None of these patients had prior otologic disease which would predispose to a sudden hearing loss, and no intraoperative or postoperative complication was specifically noted as a cause of the hearing loss. The literature is reviewed and attention is drawn to the problem. We wish to encourage further reports and to recommend early identification and treatment in those cases related to cardiopulmonary bypass.

Adult↗
PubMedDate not supplied

Otologic pathophysiology in patients with human immunodeficiency virus.

During the initial phase of clinical diagnosis and treatment of the manifestations of acquired immunodeficiency syndrome, involvement of the ear appeared minor. In the past several years, however, otologic disorders increasingly have been reported in individuals with human immunodeficiency virus (HIV), as well as in retrospective studies of such patients. The otologic data appear quite variable. Functionally, conductive hearing loss, unilateral and bilateral sudden or progressive sensorineural hearing losses, vertigo, and tinnitus have been reported. In addition, tissue responses in each division of the ear have been observed. Based on collective serologic and immunologic diagnostic assays, clinical histories, and temporal bone histopathology, otologic symptoms may not be the direct effect of HIV alone, but rather a combination of the effects of HIV infection coupled with that of opportunistic microorganisms and/or possible ototoxic effects of certain therapeutic agents. It is within this context that otologic findings in this population of subjects will be discussed.

Acquired Immunodeficiency Syndrome↗
PubMed2006

Otologic manifestations of relapsing polychondritis. Review of literature and report of nine cases.

OBJECTIVE: Relapsing polychondritis (RP) is an episodic disease most likely of autoimmune etiology, characterized by recurrent inflammation of cartilaginous structures. METHODS: Retrospective case study at two tertiary referral centers with presentation of nine patients with otologic involvement of RP, review of the spectrum of otologic disorders seen, and treatment. RESULTS: The clinical course of otologic manifestations of RP was highly variable and ranged from mild to moderate. In 6/9 patients there was an association with other autoimmune disorders. In addition to recurrent auricular chondritis, which was present in 8/9 patients, our patients had otitis externa, chronic myringitis, Eustachian tube dysfunction, conductive hearing loss, sensorineural hearing loss, and tinnitus. All patients had their diagnosis of RP made on the basis of their otologic involvement and the response to systemic corticosteroids. CONCLUSION: The diagnosis of RP is primarily clinical, but laboratory studies and biopsy may contribute as well. Once the diagnosis is suspected, the otolaryngologist should consider consultation with a rheumatologist to assist in the management of additional systemic manifestations.

Adult↗
PubMed1998

Otologic management in children with the CHARGE association.

OBJECTIVES: To characterize otologic management of two patient groups, those with the CHARGE association and those not strictly labeled as CHARGE but with several features of the disorder (CHARGE-like), in order to determine: (1) the clinical validity and utility of managing CHARGE-like children in a similar manner to patients with the strictly defined CHARGE association, (2) the progression and prognosis of hearing loss and (3) the identification of factors that may predict the degree of hearing loss. DESIGN: Case series. SETTING: Tertiary care urban children's hospital. PATIENTS: 37 children, 22 in the CHARGE group and 15 in the CHARGE-like group. INTERVENTIONS: Otorhinolaryngologic and audiologic management. MAIN OUTCOME MEASURES: Otorhinolaryngologic and audiologic evaluation. RESULTS: All patients required otologic and/or audiologic care. Bilateral hearing loss was found in 32 patients (86%) and unilateral hearing loss in five patients (14%) when hearing was assessed in the absence of otitis media. Among the 32 patients with bilateral hearing loss, 31 (97%) were able to be fit with useful hearing aids. External ear anomalies were present in 25/37 (68%) patients, and middle ear and ossicular anomalies were identified in four cases (4/37, 11%), 36/37 (97%) patients required surgical management of otitis media. Three patients (3/37, 8%) exhibited radiographic evidence of inner ear deformity. Facial nerve dysfunction was noted in the records of 14/37 (38%) patients. No statistically significant difference was found when CHARGE and CHARGE-like patients were compared for degree of hearing loss (P = 0.5964), type of hearing loss (P = 0.2657), worsening of hearing level (P = 0.7908), or anomalies of the external ear (P = 0.6921), ossicles (P = 0.7908), inner ear (P = 0.7908) or facial nerve (P = 0.6409). Patients with external ear anomalies did not exhibit statistically different degrees (P = 0.3125) or types (P = 0.1515) of hearing loss from patients without auricular anomalies. The presence of facial nerve anomaly correlated significantly (P = 0.0021) with profound hearing loss. CONCLUSIONS: Children who are CHARGE-like may be may be considered equivalent in terms of otologic and audiologic management to children strictly defined as CHARGE patients. These children all require otologic care due to the high prevalence of middle ear disease and the underlying permanent hearing loss that is both stable and aidable. The degree of hearing loss cannot be predicted by external ear morphology, but may be predicted by facial nerve palsy.

Abnormalities, Multiple↗
PubMed1999

Otologic surgery in patients with HIV-1 and AIDS.

Otologic disease in patients infected with HIV occurs frequently and usually represents rhinologic disease and associated eustachian tube dysfunction rather than manifestations of HIV infection. As in all patients, the decision to operate on an HIV-infected individual who would benefit from major otologic surgery is a balance between the risks of the procedure and the possible benefits to the patient. Many concerns regarding wound infection and healing have been raised. The objective of this study is to evaluate the outcome of otologic procedures in this population. The charts of 9 men and 4 women were reviewed. Seven patients (54%) met the Centers for Disease Control and Prevention criteria for AIDS. Patients with chronic otitis media (46%) underwent tympanomastoidectomies, and the cases of acute mastoiditis (31%) were managed with simple mastoidectomies. Other procedures included repair of cerebrospinal fluid leak (15%) and stapedectomy (8%). Two patients had early complications and died during their hospitalizations. Three patients had prolonged hospital courses requiring long-term antibiotics. These 5 patients underwent urgent procedures and were severely immunocompromised. Of the remaining 8 patients only 2 had AIDS, and all had an uncomplicated postoperative course. Six of these patients were followed up for more than 1 year, and only 2 developed subsequent otologic disease.

AIDS-Related Opportunistic Infections↗