[Correlation of the vibration sensitivity thresholds and of thresholds of bone sound conduction in vibration disease].
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Adult↗
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[Dynamics of bone sound conduction in the process of stapedectomy].
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Adult↗
[The clinical investigation of labyrinthine fistula associated with chronic otitis media].
OBJECTIVE: To investigate CT, the clinical features and the management strategy of labyrinthine fistula (LF) caused by chronic otitis media (COM). METHOD: A retrospective review were investigated in 1068 patients with COM and 89 patients (8.33%) with LF. The positive fistula test was 22 (42.3%) in 52 patients. The clinical symptoms includes 34 patients (38.2%) with vertigo, 17 patients with headache, 7 patients with tinnitus or facial palsy and anacusis preoperatively. According to the extent of LF, the patients were classified into three groups. Group 1: intact labyrinth (blue line) 37 patients. Group 2: bony erosions (bony fistula) 48 patients. Group 3: complete erosions (perilymphatic fistula) 4 patients. With respect to surgical technique, the canal-wall-down procedure was performed in 86.5%, and the modified mastoidectomy performed in 13.5%. The site of LFs were 83 ears (93.3%) on lateral semicircle canal, 4 ears on superior semicircle cannal, 2 ears on posterior semicircle cannal, and 4 ears on cochlear respectively. RESULT: 90% patients underwent preoperative CT scans. The fistula was detected radiologically in 51 of 80 patients. Preoperative coronal computed tomography is sensitive for diagnosing LF. There were 65 patients underwent coronal CT and 48 patients (73.8%) detected with LF, and 15 patients underwent horizontal CT and 3 patients (20.0%) with LF. Hearing improved in 50 patients postoperatively. The air-bone gap was 20dB in 28 patients and 21-40 dB in 22 patients. There were 11 patients bone conduction improved and 8 patients bone conduction descend. There were 32 patients experienced hearing threshold deteriorate and 4 patients with anacusis postoperatively. Generally we attempted to completely remove the matrix with operative microscope, to graft the fistulous area with temporalis fascia and bone dust promptly, and to reconstruct the middle ear mechanism in single stage. Long-term follow up revealed the vertigo of all patients eliminated or alleviated. CONCLUSION: We must emphasis on the possibility of labyrinthine fistula in all COM patients. Even though the preoperative diagnosis is now more easily accessible with the HRCT, the surgeon should always remain aware that a fistula could be present in spite of a negative CT examination. The matrix on the fistula areas must be removed completely in the latest stage of operations. The coronal CT scan is a significant method in show of LSC fistula.
Adolescent↗
A reconsideration of the parameters for evaluating tympanic reconstruction.
Twenty years' experience with tympanoplasty operations incorporating ossicular reconstruction revealed some unexpected improvements in bone conduction thresholds postoperatively. Because there appeared to be a relationship between this occurrence and the degree of air-bone closure, the possibility that bone conduction thresholds were related to the efficiency of the middle ear sound transformer mechanism was investigated. It has been possible to demonstrate that such a relationship does exist. Its extent and the possible underlying mechanisms are discussed. It is concluded that the evaluation of ossiculoplasty results would be more realistic if they were based on a parameter that measures cochlear function with greater accuracy than do preoperative bone conduction thresholds.
Auditory Threshold↗
The occlusion effect created by custom canal hearing aids.
There has recently been a dramatic increase in the demand for custom canal hearing aids. One of the significant limitations sometimes created by these instruments is the increased sensitivity to bone-conducted stimuli known as the occlusion effect. A large occlusion effect is often cited as the reason for rejection of these devices. This investigation tested a method of measuring the occlusion effect through bone-conducted speech reception thresholds (SRTs). The results indicated that the bone conducted SRT procedure is sensitive enough to differentiate between the occlusion effect created by shell earmolds versus canal hearing aids.
Bone Conduction↗
[Assessment of mineral density of bone tissue in patients with rheumatoid arthritis using ultrasonic osteometry].
AIM: To examine bone mineral density in rheumatoid arthritis (RA) patients using echoosteometry (EOM), to analyze the speed of ultrasound bone conduction in patients with different variants of RA. MATERIAL AND METHODS: The study included 122 patients with verified RA diagnosis (ARA, 1987) who had not previously taken glucocorticosteroids, basic drugs or antiosteoporosis therapy. Group 1 consisted of 48 women of reproductive age, group 2--of 46 postmenopausal women and group 3 of 28 male patients. EOM measured the speed of ultrasonic conduction in collar-bones and radii (Echoosteometer EOM-02). RESULTS: The speed of ultrasound conduction in collar-bones and radii in RA patients is slower than control. This shows bone density loss. EOM demonstrated correlations between ultrasound bone conduction and RA patients age, RA duration and x-ray stage of the disease.
Adult↗
Tragal perichondrium and cartilage in reconstructive ear surgery.
Two hundred and fifty-five ear operations using tragal perichondrium and cartilage for reconstruction are presented. Of these, 108 were myringoplasties, 137 were tympanoplasties with ossicular reconstruction performed by nine different methods, and 10 were tympanoplasties with reconstruction of posterior canal wall defects left by radical mastoid surgery. The method presented in this study of using the tragal perichondrial graft is well suited for myringoplasty and can be used where the drum remnant is very small or the anulus is missing. The natural angle of the tragal perichondrium can take the place of the missing anulus anteriorly, inferiorly or posteriorly. Myringoplasty graft survival at one year follow-up was 92%, and 76% had hearing within 10 db of bone conduction. In tympanoplasty, the tragal perichondrium was used en bloc with its cartilage for reconstruction of the ossicular chain where suited. The malleus was used to reconstruct the ossicular chain in different variations. Other methods used are fully described. At one year follow-up the rate of grafting success for tympanoplasties was 91%, and 78% had hearing within 10 db of bone conduction. A method for reconstruction of the posterior canal wall and tympanoplasty after radical mastoidectomy is presented. It uses tragal cartilage and perichondrium en bloc. At one year follow-up, eight of ten cases operated on by this method had an intact drum and posterior canal wall, one had an intact drum but the posterior canal collapsed into the mastoid, and one had an intact canal wall but the eardrum re-perforated. Nine had postoperative hearing within 10 db of bone conduction. A randomly selected group of 100 tympanoplasties was examined for postoperative gain in hearing according to the speech reception threshold, a more practical criterion of surgical success than 10 db air-bone gap. Although the total number showing improvement was similar to the number gaining hearing within 10 db of pure tone bone conduction (76% vs. 78%), when changes of 5 db were discounted, only 56% were improved (and 33% had a significant gain in hearing).
Adult↗
Role of ossiculoplasty in canal wall down tympanoplasty for middle-ear cholesteatoma: hearing results.
The aim of this study was to evaluate the hearing results of ossiculoplasty in canal wall down tympanoplasty in one stage middle-ear cholesteatoma surgery. We carried out a retrospective review of a consecutive series of 142 cases which had undergone type two or three canal wall down tympanoplasty with ossicular reconstruction, between January 1995 and December 2002, due to chronic otitis media with cholesteatoma.Pre-operative audiometric testing revealed a mean air conduction pure tone average (PTA) of 50.97 dB and a mean bone conduction PTA of 22.14 dB. The mean post-operative result for air conduction PTA was 37.62 and for bone conduction PTA was 23.37 dB. The mean pre- and post-operative air-bone gaps (ABGs) were 28.83 and 13.94 dB, respectively, with a gain of 14.89 dB. Almost 62.67 per cent of patients closed their ABGs to within 20 dB. Our functional results are comparable with those of other authors. In the present study, we show that hearing improvement is possible following cholesteatoma surgery with canal wall down tympanoplasty and ossicular chain reconstruction.
Adult↗
Fitting range of the BAHA Cordelle.
The performance of the most powerful Bone-Anchored Hearing Aid (BAHA) currently available, the BAHA Cordelle, was evaluated in 25 patients with severe to profound mixed hearing loss. Patients showed bone conduction thresholds at 500, 1000 and 2000 Hz, ranged between 30 and 70 dB HL, and an additional air-bone gap of about at least 30 dB. With the BAHA Cordelle, free-field thresholds improve relative to bone-conduction thresholds with 1.5, 5.0, 17.8, and 4.3 dB at 500, 1000, 2000, and 4000 Hz, respectively, with substantial inter-individual variability. The differences in unaided air conduction thresholds and aided free-field thresholds amount to 45.3, 45.8, 47.5, and 43.5 dB at 500, 1000, 2000, and 4000 Hz, respectively. Speech perception, measured both with monosyllables of the consonant-vowel-consonant type and with bisyllables, showed highly similar results. The fitting range of a (linear) hearing aid is determined by its gain characteristics. Requiring aided speech reception thresholds at or better than 65 dB SPL results in an upper limit of the fitting range of the BAHA Cordelle for bone-conduction thresholds of 51, 56, 67, and 58 dB HL at 500, 1000, 2000, and 4000 Hz, respectively. The dynamic range provided by the BAHA Cordelle was estimated from loudness growth functions at 500, 1500, and 3000 Hz employing 7-point categorical scaling. On average, aided loudness growth functions exhibit normal slopes but they level off at input levels of about 80, 70, 65 dB SPL for 500, 1500, and 3000 Hz stimuli, respectively. Measurements with a skull simulator demonstrated that the levelling-off reflects saturation of the output of the Cordelle. The relatively low saturation levels of the device suggest that increasing maximum output levels may be a worthwhile consideration for candidates with more profound sensorineural loss.
Acoustic Stimulation↗
The effect of ultraviolet radiation on the electrical conductivity of human bone.
The electrical conductivity of intact bone, collagen and apatite mineral was determined in the region of moderately high fields. After exposure to ultraviolet (UV) radiation the conductivity of the specimens was redetermined. Following exposure marked decreases in electrical conductivity occurred in all specimens. The possible modes of interaction of UV radiation with bone are discussed. It is suggested that protonic conduction may be an important mode of charge transport in bone.
Apatites↗
Erbium: yttrium-aluminum-garnet laser application in stapedotomy.
OBJECTIVE: To assess clinical safety and efficacy of the erbium: yttrium-aluminum-garnet (Er:YAG) laser in the stapes surgery; to define and optimize parameters that render the procedure safe for the inner ear. STUDY DESIGN: Retrospective study. MATERIAL AND METHODS: A microscope-integrated Er:YAG laser stapedotomy was performed on 29 patients and a conventional stapedotomy on 41 patients. An early (within 1 to 3 days after stapes surgery) and late (at least 6 weeks) pure-tone bone-conduction threshold audiogram was obtained. RESULTS: No statistically significant differences were found by Student's t test over all measured frequencies between pre- and postoperative bone-conduction thresholds in each group. There was no statistically significant difference for all frequencies between early (3 days) and late postoperative mean bone-conduction thresholds. CONCLUSIONS: The results of our preliminary clinical study showed that erbium laser poses no risk to inner ear function. However, the lack of standardization obliges further investigation to establish safe clinical parameters of the Er:YAG laser.
Adult↗
Hearing and hearing loss in 5-year-old children. Pure-tone thresholds and the effect of acute otitis media.
Air and bone conduction pure-tone thresholds of 420 unselected urban children were measured with standard clinical audiometry. The mean of air conduction pure-tone averages (average threshold at 0.5, 1 and 2 kHz) was 8.6 dB HL in girls and 8.3 dB HL in boys. In only 5 ears (0.6%), was this average greater than or equal to 35 dB HL. The threshold greater than or equal to 35 dB HL at 4 kHz was found in 1.4% of the ears and at 8 kHz in 4.1%. The bone conduction threshold greater than 20 dB HL at any of the frequencies from 0.5 to 4 kHz was very rare, and only once, at 4 kHz, was it greater than 35 dB HL. Earlier attacks of acute otitis media seemed to have only a marginal long-term effect on air conduction hearing, and an almost negligible effect on bone conduction hearing.
Acute Disease↗
Effect of temporal area bone vibrator placement on auditory brain stem response in newborn infants.
The effect of bone conduction vibratory placement on the temporal area, revealed by the auditory brain stem response (ABR), in newborn infants, was investigated. Twenty-five full term neonates were tested at 48 to 72 hours postparturition. ABR wave V latencies were obtained from three different temporal area postauricular vibrator placements at 15 and 30 dB nHL stimulus intensity levels. Results showed that significant ABR wave V latency shifts were observed with changes in the three vibrator placements (p less than 0.05). It is suggested that, with ABR testing in newborn infants using bone conducted stimuli, bone vibrator placement on the temporal area remain consistent.
Audiometry, Evoked Response↗
The problem of the sensorineural component in otosclerotic hearing loss: a comparison between operated and non-operated ears.
The behaviour of bone conduction audiograms in the operated and non-operated ears of 200 otosclerotic patients was analysed. The majority (84%) of both operated and unoperated ears showed virtually unchanged bone conduction thresholds throughout the follow-up period (mean follow-up period = 13.4 +/- 5.3 years). Slight but statistically significant bone conduction deterioration was observed in the remaining 16% of cases, most frequently in the non-operated ears. However, this deterioration was generally within the usually accepted limits of the Carhart effect, and does not demonstrate the presence of any causative factor other than evolution of the ostosclerotic disease. Our findings do not support the hypothesis that total stapedectomy per se may be responsible for sensorineural deterioration.
Adult↗
Early post-laser stapedotomy hearing thresholds.
OBJECTIVE: Auditory testing is not routinely performed within 4-6 weeks after stapedotomy, because hearing acuity is thought to be transiently depressed. In rare circumstances, postsurgical auditory and vestibular complaints may lead one to test hearing soon after stapedotomy. The early postoperative effects of carbon dioxide (CO2) and potassium titanyl phosphate (KTP) lasers, which now are routinely used to perform stapedotomies, have not been reported. The purpose of this report is to present normative data for auditory thresholds measured within 2 weeks of laser stapedotomy. STUDY DESIGN: The study design was a prospective, unblinded study. SETTING: The study was conducted at three academic medical centers. PATIENTS: Thirty-six subjects undergoing 38 stapedotomies for otosclerosis by 5 surgeons participated. MAIN OUTCOME MEASURES: Behavioral audiometry was performed using standard techniques beginning before surgery and continuing through > 1 year after surgery. RESULTS: The CO2 laser was used in 26 stapedotomies and the KTP laser was used in 12. Nine cases were revision procedures. Bone conduction pure-tone averages and speech discrimination scores did not worsen during the early postoperative period. Bone conduction at 250 and 4,000 Hz dropped slightly within the first 2 weeks (-4.3 and -6.7 dB) but recovered thereafter. Bone conduction at 1,000 Hz actually improved within the first week after surgery (+6.2 dB, p = 0.021). Significant improvements in air conduction thresholds (and air-bone gap) were seen at the second week and late audiometry. The results for CO2 and KTP laser-treated groups were not significantly different. CONCLUSIONS: Cochlear function is not significantly depressed in the early postoperative period after laser (CO2 or KTP) stapedotomy.
Audiometry, Pure-Tone↗
Cochlear pathology in chronic suppurative otitis media.
Chronic suppurative otitis media (COM) is reported to cause elevation of bone-conduction thresholds either by damage to cochlear sensorineural structures or by alteration in the mechanics of sound transmission in the ear. A retrospective study was made of the medical records of 87 patients with unilateral uncomplicated COM to document that abnormality in bone conduction does exist. In a separate study the cochlear pathology in 12 pairs of temporal bones with unilateral COM was studied by light microscopy. Infected ears showed higher than normal mean bone-conduction thresholds by amounts ranging from 1 dB at 500 Hz to 9.5 dB at 4,000 Hz. The temporal bones showed no greater loss of specialized sensorineural structures in infected ears than in normal control ears. Because there is no evidence that COM caused destruction of hair cells or cochlear neurons, alteration in the mechanics of sound transmission becomes a more plausible explanation for the hearing losses.
Adolescent↗
Vestibular evoked potentials (VsEPs) in patients with severe to profound bilateral hearing loss.
OBJECTIVE: To confirm the exclusive vestibular dependence of the evoked potentials (P10 and N15) recorded in normal subjects, by recording the potentials evoked in response to bone-conducted sound stimulation in patients with bilateral hearing loss. METHODS: Fourteen patients with severe to profound bilateral hearing loss were stimulated via a B71 bone-vibrator above the mastoid with bone-conducted tone bursts (500 Hz, 6 ms) at fixed levels above their individual vestibular evoked myogenic potential (VEMP) thresholds. Surface potentials were recorded from scalp electrodes at F7, F3, Fpz, F4, F8, T3, Cz, and T4 and referred to linked earlobes. RESULTS: Seven of 14 patients had suitable VEMPs to the maximal stimulus. P10 and N15 potentials were present in each of these 7 patients, but were absent in patients with absent VEMP responses. The potentials were only detected above VEMP threshold, and were similar in size, shape and latency to those recorded in normal controls at a matched intensity above VEMP threshold. CONCLUSIONS: Normal P10 and N15 potentials can be recorded from patients with profound bilateral hearing loss using bone-conducted acoustic stimulation of the vestibular apparatus. SIGNIFICANCE: The P10 and N15 appear to be dependent purely upon vestibular activation.
Acoustic Stimulation↗
Predisposing factors for inner ear hearing loss association with chronic otitis media.
The aim of the present study was to investigate the consequences of chronic otitis media on inner ear function. Retrospective analysis of conventional pure-tone audiometry tests was carried out on 344 patients who were scheduled for surgical treatment of unilateral chronic otitis media without other risk factors for sensorineural hearing loss. Bone conduction thresholds of diseased ears were compared with those of contralateral, non-diseased ears. Selected clinical features were assessed among diseased ears to examine possible influences on inner ear function. Mean bone conduction threshold differences varied from 0.6 dB at 0.5 kHz to 3.7 dB at 4 kHz. These differences augmented with increasing duration of middle ear disease. Impaired hearing by bone conduction thresholds of diseased ears correlated with increased age at every frequency and with an interruption of the ossicular chain only at higher frequencies. The severity of sensorineural hearing loss correlated with longer duration of middle ear disease. Thus, surgical treatment of dry and apparently stable tympanic membrane perforation is warranted.
Adult↗