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PubMed1983

Otosclerosis and sensorineural hearing loss. A clinical study.

A causal relationship between otosclerosis and sensorineural hearing loss is thought to exist. Forty-nine patients with unilateral otosclerosis were studied by comparing the bone conduction threshold in the otosclerotic ear to the bone conduction threshold in the uninvolved ear. This difference was analyzed using the paired Student's t test, and significant differences were found at 1,000, 2,000, and 4,000 Hz but not at 500 Hz. This effect on the higher frequencies may be due to a change in the motion mechanics of the basilar membrane and is greatest at the basal end of the cochlea.

Audiometry↗
PubMedDate not supplied

Sensorineural hearing level in unilateral otosclerosis.

Preoperative bone conduction threshold measurements were made in the otosclerotic and opposite ears of 25 patients with unilateral otosclerosis to tabulate the sensorineural hearing impairment in this disease. Middle ear otosclerosis was confirmed at surgery in all cases. The bone conduction thresholds at all frequencies measured were similar in the otosclerotic and opposite ears. Adequate masking was applied to the nontest ear to measure an accurate bone conduction threshold in the test ear without producing overmasking.

Adult↗
PubMed1981

Osseointegrated titanium implants in the temporal bone. A clinical study on bone-anchored hearing aids.

The purpose of this study is to investigate the possibilities for attaching a new type of direct bone conduction hearing aid. Using a gentle surgical technique, titanium screws were inserted into the temporal bone of fourteen patients suffering from hearing impairment. The implants became integrated with the living bone tissue and have remained so for a follow-up period of, at present, two to four years. It is therefore concluded that titanium implants may be osseointegrated in the temporal bone in a similar manner to that previously described for long bones. The bone-anchored titanium screws were connected to a permanently skin-penetrating abutment, which in turn was used for attachment to a hearing aid. In this way a direct bone conduction without obstructing soft tissue layers is secured. The permanent skin penetration caused no adverse soft tissue effects. The new system has improved pure-tone hearing threshold by about 15 dB. Further research is aimed at the construction of a new hearing aid that is better adapted to the impedance situation existing in the directly bone-anchored cases.

Adolescent↗
PubMed2004

[Analysis of sensorineural hearing loss in chronic suppurative otitis media].

OBJECTIVE: To explore the association between chronic suppurative otitis media and sensorineural hearing loss. METHOD: The files of 147 patients with unilateral chronic suppurative media were reviewed in a retrospective study. Differences between diseased and control ear bone conduction thresholds were analysed by the paired student's t-test over the four frequencies (0.5 kHz, 1.0 kHz, 2.0 kHz, 4.0 kHz). The effect of the presence of cholesteatoma and ossicular erosion on sensorineural hearing loss over the speech frequencies (0.5 kHz, 1.0 kHz, 2.0 kHz) and 4.0 kHz were analysed by one-way ANOVA. Linear regression models were used to clarify the relationships between sensorineural hearing loss and chronic suppurative otitis media. RESULT: The differences in bone conduction threshold between diseased and control ear were statistically significant. Bone conduction threshold shift at speech frequency was associated with the ages. The presence of cholesteatoma and ossicular erosion was not associated with a significantly increased risk of sensorineural hearing loss. CONCLUSION: Chronic suppurative otitis media can result in sensorineural hearing loss. The higher frequencies are easier affected than the lower frequencies.

Adolescent↗
PubMed1980

The cancellation method for an accurate determination of an air-bone gap.

For a reliable detection of the bone conduction threshold blocking of the contralateral ear can be necessary but then the noise will affect the threshold in the test ear. To resolve this problem the cancellation method is used. The equalization of air and bone conduction sound level in the inner ear is very accurate, the relation between the intensities has been proved to be linear and independent of noise at the contralateral ear. An application for calibration of the bone conduction vibrator to the head phone is discussed. The benefit of the method for measuring an air-bone gap in an accurate way in patients suffering bilaterally from a severe conductive hearing loss is shown.

Auditory Threshold↗
PubMed1985

Speech discrimination in advanced otosclerosis following stapedectomy.

This paper studies the changes in speech discrimination following stapes surgery in patients with advanced otosclerosis. Two thirds of these patients showed a postoperative improvement in the discrimination score with obvious correlation with closure of bone-air gap. The results were slightly worse in comparison to those obtained on otosclerotic patients with good bone conduction. In advanced otosclerosis even a minimal impairment in bone conduction and/or an incomplete closure of the gap interfere with discrimination.

Bone Conduction↗
PubMed1991

[Cochlear damage caused by middle ear surgeries].

A prospective study was set up to study the reaction of the cochlea after the trauma of middle-ear surgery. For this purpose, the bone conduction of 50 patients was tested every day, beginning on the first post-operative day. To collect information on possible damaging mechanisms, three surgical techniques were studied: Stapes surgery with the opening of the inner ear; mastoidectomy with drill-generated noise; tympanoplasty with manipulations at the stapes. The comparison of the bone conduction thresholds with audiometry results after completed healing of the ear, disclosed that even under the ear-packing, bone conduction can give reliable information on cochlea function, if a 10-15 dB variance due to methodological causes is taken into account. Excessive drilling may result in a temporary threshold shift, which has already resolved at the time of unpacking the ear. No signs of hydraulic damage after manipulation at the stapes could be discovered.

Auditory Threshold↗
PubMed2000

[Inner ear depression after middle ear interventions].

BACKGROUND: Any type of otosurgical procedure involves the risk of inner ear damage. As middle ear surgery is also performed for functional reasons this risk should be taken into consideration. The aim of this study was to analyse the frequency and the nature of sensorineural hearing loss following chronic ear surgery. PATIENTS: A total of 3989 middle ear cases operated on between 1991 and February 1999 at the Department of Otorhinolaryngology, Head and Neck Surgery, University of Würzburg, Germany were studied retrospectively: 781 type I tympanoplasties, 2408 type III tympanoplasties and 800 cases of stapes surgery. The pre- and the postoperative audiograms in the frequency range between 500 and 8000 Hz were analysed and correlated to the different intraoperative findings. RESULTS: Sensorineural hearing loss occurred in a total of 1.3% of 2224 patients with normal preoperative bone conduction thresholds: 0.2% became deaf, 0.8% acquired a high tone loss at 4 kHz and in 0.3% patients also 2 kHz was affected. None of the documented intraoperative complications such as bleeding, unexpected opening of a semicircular canal, extensive manipulation at the ossicular chain or a gusher phenoma showed a relevant effect on postoperative bone conduction thresholds. The incidence of high tone loss was not increased in cases of extensive drilling of the temporal bone. An unexpected opening of the vestibulum led to a small, but statistically significant change in postoperative bone conduction thresholds. CONCLUSIONS: Our results demonstrated that the risk for sensorineural hearing loss caused by middle ear surgery is low. None of the analysed factors seems to be a relevant prognostic risk factor for postoperative inner ear depression.

Adolescent↗
PubMed1996

[Stapedotomy vs stapedectomy. Comparison of hearing results].

The Authors investigated 200 patients, selected at random from an operative case-report of 1857 subjects, in order to evaluate hearing results of stapes surgery and to compare the recovery obtained using both small (0.7 mm footplate hole) and large fenestra stapedectomy. More precisely, after 1 week and 6 months, they examined audiological findings (air, bone conduction and cochlear reserve) before performing the operation in order to evaluate the following problems: persisting conductive gap at low frequencies, sensorineural hearing loss at high frequencies, prognosis in advanced stages (compromised pre-operative bone conduction), preservation of hearing over time. Firstly, data from our research indicate extremely successful results in stapes surgery; in particular, hearing improvement seems to be more frequent for middle-low tones (in 98% of patients), due to the higher rate of sensorineural deficit at high frequencies, which are however characterized by a more complete closure of the conductive gap. However with stapedotomy better hearing recovery is obtained and in a greater number of patients with a lower evidence of bone conduction impairment. Such an advantage increases even further from the time of surgery (p significant after 6 months on every frequency) and particularly in cases where disease is advanced.

Adult↗
PubMed2004

Combined tuning fork tests in hearing loss: explorative clinical study of the patterns.

OBJECTIVE: To combine the tuning fork tests of Rinne, Weber, and absolute bone conduction, explore their clinical patterns, and study their combined specificity, sensitivity, and validity in assessing the hearing status of an individual. DESIGN: A cross-sectional study of the tests of Rinne, Weber, and absolute bone conduction was done on 317 adult patients from the otolaryngology outpatient clinic selected at random. All possible patterns in the combination of three tests were explored, and their interpretations worked out. The findings were compared with those of pure-tone audiometry to check their sensitivity, specificity, and validity. RESULTS AND OBSERVATIONS: Fifty-eight patterns were obtained, which were classified into 10 types (5 tables) according to the type of hearing loss. The type of hearing loss was determined in all cases, and the better ear was identified in many cases. The overall sensitivity was 76.86%, the specificity was 85.48%, and the validity was 78.54%. CONCLUSIONS: The tuning fork tests of Rinne, Weber, and absolute bone conduction, when combined and interpreted, can be reliable initial diagnostic tools. They can be used to decide whether referral to a specialist or further audiometric testing is required. The patterns presented here depict the vast number of logical possibilities wherein the authenticity of these tests can be checked and the source of errors identified.

Audiometry, Pure-Tone↗
PubMed1994

Audiologic results for the bone-anchored hearing aid HC220.

Twenty-six patients with severe mixed hearing loss (PTA range 57 to 108 dB HL) were fitted with the "super-bass" bone-anchored hearing aid (BAHA) HC220 and divided into two groups. Group I contained 19 patients who previously used a conventional bone conduction hearing aid that had resulted in serious complaints. Group II contained 7 patients who had previously used an air conduction hearing aid that could no longer be used because of recurrent otorrhoea. Sound field speech audiometry for the patients in Group I revealed that for 7 patients the maximum phoneme score did not change, but that it improved for 12 patients with the HC220, compared with their conventional bone conduction hearing aid. In Group II, the maximum phoneme score improved for 3 patients, worsened for 3 patients and did not change for 1 patient with the HC220, compared with their air conduction hearing aid. Speech recognition in noise was difficult for most of the patients regardless of group. However, results were obtained from 10 patients, and 7 improved significantly with the HC220 compared with their previous aid. Overall, speech recognition with the HC220 was comparable with or better than a conventional bone conduction hearing aid; however, compared with an air conduction hearing aid the results were ambiguous.

Adult↗
PubMed1989

Sensorineural loss in chronic otitis media. Is it clinically significant?

Charts of 161 patients with unilateral chronic otitis media were reviewed for evidence of sensorineural hearing loss, defined as the difference in preoperative bone conduction thresholds between diseased and normal contralateral ears. Mean bone conduction differences were small but statistically significant, ranging from 5.6 to 12.8 dB across the frequencies. Approximately 45% of the subjects had differences greater than 10 dB for high frequencies, but less than 12% had a difference greater than 20 dB for the pure-tone average. Significant relationships were found between sensorineural hearing loss and the presence of acquired cholesteatoma in the middle ear, diseased mucosa of the promontory and hypotympanum, and diseased ossicles. These findings suggest that more severe middle ear disease may result in sensorineural hearing loss. However, for the majority of subjects, the amount of sensorineural hearing loss was judged not to be clinically significant.

Adult↗
PubMed1998

[The sensorineural component of hearing loss associated with cholesteatoma].

Patients with cholesteatoma often suffer neurosensorial hearing loss with variable bone conduction thresholds. Its origin is debated and has been attributed to the ototoxicity of topical drugs, immune reactions, effects of ototoxic antibiotics applied to the ear, etc. A selected series of 50 patients who underwent surgery for chronic ear disease due to cholesteatoma in our ENT department were studied to evaluate the possible origin of the bone conduction component of hearing loss. Different clinical, audiological, and surgical aspects were analyzed, including cholesteatoma site and extension, age, sex, evolution of the symptoms, pure tone audiometry data, middle ear involvement, the operation performed, and the occurrence of complications. Bone conduction thresholds were reported as pure tone differential thresholds (affected vs non-affected ear). A specific cholesteatoma-related neurosensorial hearing loss was observed that might lead to irreversible hearing loss. Neurosensorial involvement seems to be related mainly to the duration of symptoms, type of surgery, certain specific clinical aspects, and complications.

Adolescent↗
PubMed1994

Mechanism of hearing disturbance due to alteration in atmospheric pressure.

We used a soundproof pressure chamber to examine how the changes in atmospheric pressure as experienced in daily life reduces bone conduction in a total of 48 normal adults. The subjects were given special ear plugs that connected external auditory canal to the pressure gauge and a small pump located outside the chamber, and were instructed not to swallow, to avoid active opening of the Eustachian tube. The chamber pressure was increased (or decreased) to +/- 500 mmH2O at a rate of 33 mmH2O/s. Then pressure in the external auditory canal was increased (or decreased) gradually after the chamber pressure had reached +/- 500 mmH2O, to equilibrate the pressure across the ear drum. Bone conduction did not recover the level before increase (or decrease) in the chamber pressure. We conclude that at least a minor part of the deterioration in bone conduction after changes in the chamber pressure was caused by displacement of the round window membrane.

Adult↗
PubMed2004

A potential link between oral status and hearing impairment: preliminary observations.

Some previous studies suggest an association between tooth loss and hearing loss. The aim of this study is to assess the relation between oral status and hearing acuity. Forty-eight patients (mean age: 64.7 years) were allocated to four groups: one was wearing complete dentures in both jaws, another had shortened dental arches, a third had full dental arches in both jaws and the last lacked any occlusal stops (i.e. no occlusal vertical dimension, because of the absence of teeth or occlusal pairs). Audiological testing was performed in a noise-free chamber. Air and bone conduction were checked at different frequencies and the air-bone gap was determined. After correction for age and gender, a difference in air and bone conduction because of the oral status was found for low and for high frequencies while no significant differences were (P < 0.05) found for the air-bone gap. The number of teeth, number of occluding tooth pairs and presence or lack of occlusal vertical dimension, was significantly related to the gradient of hearing loss (P < 0.05). The discrepancy in hearing loss between complete denture wearers and patients without any occlusal vertical dimension, strengthens the hypothesis that it is the lack of the latter that is associated with hearing loss. At what level hearing loss occurs, needs further investigation.

Aged↗