Audiol. Res., Volume 7, Issue 1 (February 2017) – 6 articles

The benign paroxysmal positional vertigo (BPPV) is a vestibular disorder cause of vertigo. The BPPV may be corrected mechanically by repositioning maneuvers but even after successful maneuvers, some patients report residual dizziness for a certain period afterward. Early recognition and treatment might decrease the incidence of residual dizziness in patients with BPPV, especially in those patients with psychiatric comorbidities and in the elderly, lowering the risk of falling. Many pathogenetic hypotheses for residual dizziness are under debate. The purpose of this review was to identify, evaluate and review recent researches about possible causal factors involved in residual dizziness and the implications on clinical practice. A literature search was performed using different databases such as Pubmed and Scopus. The following search terms were used: residual dizziness, otolithic membrane and BPPV. The search found a total of 1192 titles, which were reduced to 963 after a procedure of de-duplication of the found titles. The research was then restricted to an interval of time comprised between 2000 and 2016 for a total of 800 titles. Among these titles, only those including the terms benign paroxysmal positional vertigo were considered eligible for this review. Only publications in English language were taken into consideration and we excluded those with not available abstract. Finally, 90 abstracts were obtained and critically evaluated by two different Authors, and additional studies were identified by hand searching from the references of artiche of interest. Only 53 were included in this work. Full article

The autoimmune inner ear disease is a clinical syndrome with uncertain pathogenesis that is often associated to rapidly progressive hearing loss that, especially at the early stages of disease, may be at monoaural localization, although more often it is at binaural localization. It usually occurs as a sudden deafness, or a rapidly progressive sensorineural hearing loss. In this study a particular form of autoimmune inner ear disease is described, Cogan’s syndrome. Cogan’s syndrome is a chronic inflammatory disorder that most commonly affects young adults. Clinical hallmarks are interstitial keratitis, vestibular and auditory dysfunction. Associations between Cogan’s syndrome and systemic vasculitis, as well as aortitis, also exist. We report a case of a young woman who presented audiological and systemic characteristics attributable to Cogan’s syndrome. In the description of the case we illustrate how the appearance and evolution of the disease presented. Full article

The purpose of this study was to consider the possible role of autoimmune diseases and paraneoplastic syndrome in the genesis of tinnitus. The incidence of autoimmune inner ear disease (AIED) is rare, accounting for <1% of all cases of hearing impairment and dizziness. In presence of auditory and vestibular deficit in oncological patients, a paraneoplastic syndrome with cochleovestibulopathy should be considered. We described a 50-year-old Caucasian woman came to our attention with complaints of severe disabling bilateral tinnitus (Tinnitus Handicap Inventory, THI: 96), ear fullness and headache. The onset of tinnitus was associated to the last breast implant and prolonged antibiotic therapy. Serological autoimmunity tests were positive and a diagnosis of mixed connective tissue disease with notes of fibromyalgia was made. Pure tone audiometry testing revealed bilateral fluctuating mild hearing loss on high frequencies. The tinnitus was successfully treated with bilateral wideband sound generators (listening 8-9 hours for day) regulated at the mixing point. At 12 months follow up THI has shrunk considerably (THI: 4) and the patient has continued treatment only with the sound pillow. In conclusion significant progress is needed to better understand the role of autoantibodies in the pathogenesis and diagnosis of paraneoplastic cochleovestibulopathy. To our knowledge, our study is the first in which hearing loss and tinnitus is considered as a manifestation of a paraneoplastic syndrome. Full article

This study aimed to investigate differences between ears in performance on a monaural word recognition in noise test among individuals across a broad range of ages assessed for (C)APD. Word recognition scores in quiet and in speech noise were collected retrospectively from the medical files of 107 individuals between the ages of 7 and 30 years who were diagnosed with (C)APD. No ear advantage was found on the word recognition in noise task in groups less than ten years. Performance in both ears was equally poor. Right ear performance improved across age groups, with scores of individuals above age 10 years falling within the normal range. In contrast, left ear performance remained essentially stable and in the impaired range across all age groups. Findings indicate poor left hemispheric dominance for speech perception in noise in children below the age of 10 years with (C)APD. However, a right ear advantage on this monaural speech in noise task was observed for individuals 10 years and older. Full article

The purpose of this retrospective study was to analyze the clinical characteristics and document hearing recovery in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). 122 patients diagnosed with unilateral ISSNHL, from March 2009 to December 2014, were treated with oral steroids and pentoxifylline. Hearing change was evaluated by comparing pre-treatment and post-treatment pure-tone average (PTA) (500, 1K, and 2K Hz), and categorized into complete, partial, and no recovery of hearing. T-test, Wilcoxon Signed Rank test and Regression analysis were employed to analyze the statistical significance. Of the 122 patients, seventy-one (58%) had complete recovery and 34 (28%) had partial recovery. The average pre-treatment PTA was 78.3 ± 16.9 dB whereas post-treatment average was 47.0 ± 20.8 dB, showing statistically significant improvement (t=24.89, P≤0.001). The factors such as presence of tinnitus (P=0.005) and initial milder hearing loss (P=0.005) were found to be significant predictors for hearing recovery. Conventional steroid regimes produced a recovery rate in ISSNHL, which exceeds the spontaneous recovery rate. The current study results highlight the importance of medical treatment in the management of ISSNHL. Full article

iChirp-evoked auditory brainstem responses (ABRs) yield a larger wave V amplitude at low intensity levels than traditional broadband click stimuli, providing a reliable estimation of hearing sensitivity. However, advantages of iChirp stimulation at high intensity levels are unknown. We tested to see if high-intensity (i.e., 85 dBnHL) iChirp stimulation results in larger and more reliable ABR waveforms than click. Using the commercially available Intelligent Hearing System SmartEP platform, we recorded ABRs from 43 normal hearing young adults. We report that absolute peak latencies were more variable for iChirp and were ~3 ms longer: the latter of which is simply due to the temporal duration of the signal. Interpeak latencies were slightly shorter for iChirp and were most evident between waves I-V. Interestingly, click responses were easier to identify and peak-to-trough amplitudes for waves I, III and V were significantly larger than iChirp. These differences were not due to residual noise levels. We speculate that high intensity iChirp stimulation reduces neural synchrony and conclude that for retrocochlear evaluations, click stimuli should be used as the standard for ABR neurodiagnostic testing. Full article