Search Results (149)

Background/Objectives: Cochlear “injury” is thought to be a significant cause of tinnitus in patients with hearing loss. Interestingly, individuals with normal hearing may also experience tinnitus. This study evaluates otoacoustic distortion product emissions (DPOAEs) in individuals with normal hearing who experience tinnitus perception. Methods: In this prospective study, the tinnitus group (TG) consisted of 34 subjects with tinnitus (four unilaterally) and normal hearing (threshold ≤ 25 dBHL at 0.25–8 kHz). The control group (CG) comprised 10 healthy volunteers (20 ears) without tinnitus and normal hearing. Medical history was recorded, and all participants underwent a complete otolaryngological examination, pure tone audiometry, and DPOAE recording (DP-gram, L1 = 55 dB, L2 = 65 dB, for F2: 619–10,000 Hz). Moreover, participants in the TG completed a detailed tinnitus history (with self-rated loudness scoring) and the Tinnitus Handicap Inventory (Greek-version THI-G) and underwent tinnitus analysis. Results: The recorded mean DPOAE values during the DP-gram of the CG were significantly larger in amplitude at low (t-test, Bonferroni-corrected p < 0.09) and high frequencies (t-test, Bonferroni-corrected p < 0.02) compared with the TG. Tinnitus assessment showed tinnitus pitch matching at the frequency area in the DP-gram, where the acceptance recording criteria were not met. There were no statistically significant differences in tinnitus onset, self-rated loudness scores of >70, and severe disability (THI-G > 58) for TG subjects in whom DPOAEs were not recorded at frequencies of ≤1000 Hz. Participants with abnormal DPOAEs at around 4000 Hz had tinnitus of sudden onset and severe disability (THI-G > 58). Finally, those with pathological recordings of DPOAEs at ≥6000 Hz had gradual onset tinnitus (Pearson Chi-square test, p < 0.05). Conclusions: DPOAEs in normal hearing individuals with tinnitus show lower amplitudes in low and high frequencies compared with normal hearing individuals without tinnitus. The tinnitus matched-frequency coincided with the frequency area where DPOAEs were abnormal. Full article

Background: Sudden-onset bilateral mixed hearing loss in adults is an extremely rare condition but challenging to diagnose and treat. Conductive hearing loss is associated with otitis media, while the simultaneous presence of a sensorineural component requires supplementary investigation for possible shared pathophysiological mechanisms. Case Presentation: We report the case of a 41-year-old male who was admitted to our hospital with a 48 h history of bilateral, fast progressive hearing loss following a viral illness. The audiologic testing revealed bilateral severe mixed hearing loss. Tympanometry indicated the presence of middle-ear effusion, and myringotomy confirmed the existence of pressurized serous fluid. Treatment consisted of systemic and intratympanic corticosteroids, antibiotics, and supportive therapy. The patient had an unexpected full recovery of auditory function within one month. Discussion: Multiple hypotheses were considered. We hypothesized the coexistence of unrelated conductive and sensorineural hearing loss or a unifying pathological process. Theories discussed include a direct viral insult to the cochlear structures or even pressure-mediated damage to the basal cochlea due to the simultaneous inward displacement of the oval and round windows. The complete resolution of hearing loss is the indicator of a reversible etiology, possibly due to transient inner ear dysfunction secondary to middle-ear pathology or viral infection. Conclusions: This case illustrates the complexity of diagnosing acute mixed hearing loss. This report emphasizes a rare case of sudden-onset bilateral mixed hearing loss with a complete recovery, contributing valuable insight into under-reported and diagnostically complex presentations. Full article

Noise-induced hearing loss (NIHL) is a significant occupational health issue, characterized by permanent damage to the cochlea due to prolonged exposure to high-intensity noise. Circulating microRNAs (c-miRNAs) have emerged as promising non-invasive indicators of inner ear pathology and potential modulators of cellular stress responses. Nevertheless, their specific roles in NIHL remain inadequately characterized. This study evaluated miRNA expression in the peripheral blood of individuals with bilateral NIHL (n = 12) and matched healthy controls (n = 6) using GeneChip^® miRNA 4.0 arrays. The Transcriptome Analysis Console software was used for differential expression analysis, and bioinformatic predictions of gene targets and pathway enrichment were performed using TargetScan (version 8.0) and the Enrichr tool. Among the 72 differentially expressed miRNAs (FDR < 0.05), hsa-miR-486-2, hsa-miR-664b-3p, hsa-miR-4485, hsa-miR-501, and hsa-miR-663b were notably upregulated, while hsa-miR-6723, hsa-miR-194-2, hsa-miR-668-5p, hsa-miR-4722-3p, and hsa-miR-4716 showed significant downregulation. Enrichment analyses indicated involvement in apoptosis regulation, mitochondrial stability, and cell cycle control. Principal component analysis (PCA) and clustering methods revealed clear molecular distinctions between the patient and control groups. The observed alterations in c-miRNA profiles highlight their relevance to NIHL-related cellular stress and degeneration. These findings support their utility as candidate biomarkers for diagnosis and prognosis, warranting further validation in functional and longitudinal studies. Full article

Acute vertigo or dizziness that is accompanied by a sudden sensorineural hearing loss (SSNHL) often poses a diagnostic challenge. While a combined audiovestibular deficit makes an inner ear pathology most likely, this does not necessarily exclude a vascular pathology that may be a harbinger of future sinister events. This is especially true for strokes within the territory of the anterior inferior cerebellar artery (AICA), because the labyrinth receives its vascular supply most often by branches of the AICA. Thus, acute labyrinthine ischemia may present in combination with focal neurologic deficits, but also in isolation or as a warning sign before focal stroke signs arise. How can labyrinthine ischemia be differentiated from an idiopathic SSNHL? In this critical review, we discuss both the pathophysiology and the differential diagnosis of acute audiovestibular deficits. We will also address the value of state-of-the-art MR imaging in visualizing labyrinthine ischemia. Finally, we will discuss treatment options and review the prognosis of acute audiovestibular deficits. Full article

Background: Tele-practice, as an evidence-based practice, has gained momentum over the last two decades. However, routine clinical adoption is not spontaneous. Implementation science facilitates stakeholder engagement and the assessment of needs and plans. The study aims to assess the needs related to audiology and speech–language pathology services for children under six years of age and readiness for a tele-practice-based model of care for diagnostic and rehabilitation services among parents within the public sector in Tamil Nadu. Methods: A cross-sectional study design was used. The qualitative methods of focus group discussions and semi-structured interviews were conducted for parents of children with disabilities. A quantitative community survey was conducted on parents of children with no known disabilities. A deductive-inductive method of analysis was used. Results: Community survey responses were analyzed using percentage analysis. The results were classified based on the constructs of Bowen’s feasibility framework: demand/need for tele-practice, acceptability of tele-practice, and integration and practicality of tele-practice. Parents considered the existing services to be inadequate. Parents perceived tele-practice as beneficial, yet they felt a hybrid method would be more suitable, with sufficiently interspersed in-person visits. Parents believed that training and community awareness were necessary before implementing a technology-based model of services. Conclusions: The study’s findings guided the fine-tuning of the proposed comprehensive tele-practice model for hearing and speech–language services for children in this rural district. Full article

Sudden sensorineural hearing loss (SSHNL) is an abruptly appearing hearing loss. The etiology remains unclear, although vascular pathologies, viral infections, or autoimmune disease contribute to the understanding of this pathology. Systematic steroids are often used as the first-line treatment because of their anti-inflammatory effect. However, there remains controversy about the use of steroids and other alternative treatments, as hyperbaric oxygen therapy (HBOT), exploratory tympanotomy, prostaglandin, N-acetylcysteine, or defibrinogenation therapy. In this study, we aim to review the various treatment options currently available for sudden hearing loss, with the objective of advancing our understanding of this condition and clarifying information to guide future clinical practice guidelines. Full article

Background/Objectives: In the early stage of presbycusis, patients experience reduced speech perception in noisy environments despite normal audiometry, normally known as hidden hearing loss. Diagnostic indicators like the reduced amplitude of ABR wave I, elevated extended high-frequency threshold (EHT), and decreased middle ear muscle reflex (MEMR) amplitude aim to identify biomarkers of peripheral auditory pathology but remain inconsistent. Mismatch negativity (MMN) is a cortical auditory evoked potential generated when the brain detects sound changes. This study aimed to assess MMN as a diagnostic tool for hidden hearing loss in adults. Methods: Seventy-three subjects with normal hearing underwent an extended pure-tone audiogram examination ranging from 0.125 to 16 kHz and a subsequent MMN assessment with two different paradigms: a speech (ba/da) and a tone (1/2 kHz) paradigm. The MMN’s amplitude and latency were measured and analyzed. Results: The outcome shows a significant age-related effect on MMN amplitude in the speech condition (χ² = 13.0, p = 0.002). Specifically, the MMN amplitude in the 25–30-year-old group was significantly smaller than in the 20–25-year-old group (p = 0.0015, Cohen’s d = 0.63). Additionally, no further effects of age were observed on the cortical potentials examined. Also, neither tone nor speech paradigms showed a significant influence of EHT on the amplitude or latency of either MMN or P300. Conclusions: The application of MMN as an electrophysiological tool to diagnose hidden hearing loss in normal hearing adults has limitations. However, in contrast to MMN responses to tonal stimuli, the present study reveals that MMN amplitude obtained with speech stimuli may indicate early signs of central auditory deficits. Full article

Background: Vestibular function implements head position regulation and body spatial navigation. It matures during childhood and adolescence and integrates with the completion of an individual’s motor development. Nevertheless, vestibular impairment is associated with profound paediatric hearing loss and has a negative impact on the child’s motor proficiency. Cochlear implantation (CI) is the treatment of choice for severe hearing loss, where conservative treatment plans are not appropriate or fail. The Teenager and Young Adults Cochlear Implant (TAYACI) study investigates the long-term outcomes of early implantation with respect to the hearing, speech, psychological, and balance development among CI users. Methods: This study focuses on the vestibular function and the appropriate methods for vestibular assessment. The results of two established vestibular test methods are explored: the video head impulse test (vHIT) and cervical/ocular vestibular-evoked myogenic potentials (cVEMP, oVEMP) with air and bone conduction vibration stimulation. The results of vHIT, cVEMP, and oVEMP, per implanted ear and the relation to the aetiology of hearing loss are reported. An additional dynamic visual acuity (DVA) test was included to assess clinical oscillopsia. Results: Overall abnormal lateral canal testing was detected in 35/76 (46.1%) of the implanted ears. Bone-conducted cVEMP (BC cVEMP) was pathological in 33/76 (43.3%) and BC oVEMP in 42/76 (55.3%). Lateral canal impairment was associated with the background diagnosis of the hearing loss. Oscillopsia was related to bilateral canal impairment (sensitivity 73% specificity 100%). Conclusions: Lateral canal testing together with BC VEMPs were the most reproducible modules for vestibular testing The above tests were related to each other and complemented the overall vestibular assessment. DVA is a helpful tool to screen dynamic oscillopsia in patients with bilateral vestibular impairment. Full article

The inner ear is a relatively isolated organ, protected by the blood-labyrinth barrier (BLB). This barrier creates a unique lymphatic fluid environment within the inner ear, maintaining a stable physiological state essential for the mechano-electrical transduction process in the inner ear hair cells while simultaneously restricting most drugs from entering the lymphatic fluid. Under pathological conditions, dysfunction of the stria vascularis and disruption in barrier structure can lead to temporary or permanent hearing impairment. This review describes the structure and function of the BLB, along with recent advancements in modeling and protective studies related to the BLB. The review emphasizes some newly developed non-invasive inner ear drug delivery strategies, including ultrasound therapy assisted by microbubbles, inner ear-targeting peptides, sound therapy, and the route of administration of the cerebrospinal fluid conduit. We argue that some intrinsic properties of the BLB can be strategically utilized for effective inner ear drug delivery. Full article

Background/Objectives: A crucial factor for a successful cochlear implant (CI) outcome is an intact auditory nerve (AN). The integrity of the AN can be tested during implantation by measuring electrical auditory brainstem responses (eABR) via the CI. A method that does not require a CI is the use of the auditory nerve test stimulator (ANTS) from MED-EL (Innsbruck, Austria). The aim of the current study was to investigate the cases tested with the ANTS at our clinic and to describe the hearing results following CI for the cases who were implanted with a CI. Methods: All patients underwent preoperative magnetic resonance imaging (MRI) and high-resolution computed tomography (HRCT) to rule out cochlear malformation or retrocochlear pathology. In this study, we described all cases from when we began using the ANTS in 2011. Results: Five patients were tested intraoperatively: three adults with long-term deafness prior to CI and two children with no detectable AN. Three of the five patients were implanted with a CI. All implanted patients in this study could hear with their CIs, even though the speech perception results were limited. Conclusions: The ANTS can be used as a method to assess cochlear nerve function during implantation. The eABR results from the ANTS and the implanted CI were comparable for all cases in our study. Minor changes in waveform latencies were found between ANTS and CI stimulation and may be explained by the insertion depth of the electrode used for stimulation. Full article

Objectives: Evaluating middle ear function is essential for interpreting screening results and prioritizing diagnostic referrals for infants with hearing impairments. Wideband Acoustic Immittance (WAI) technology offers a comprehensive approach by utilizing sound stimuli across various frequencies, providing a deeper understanding of ear physiology. However, current clinical practices often restrict WAI data analysis to peak information at specific frequencies, limiting its comprehensiveness. Design: In this study, we developed five machine learning models—feedforward neural network, convolutional neural network, kernel density estimation, random forest, and support vector machine—to extract features from wideband acoustic immittance data collected from newborns aged 2–6 months. These models were trained to predict and assess the normalcy of middle ear function in the samples. Results: The integrated machine learning models achieved an average accuracy exceeding 90% in the test set, with various classification performance metrics (accuracy, precision, recall, F1 score, MCC) surpassing 0.8. Furthermore, we developed a program based on ML models with an interactive GUI interface. The software is available for free download. Conclusions: This study showcases the capability to automatically diagnose middle ear function in infants based on WAI data. While not intended for diagnosing specific pathologies, the approach provides valuable insights to guide follow-up testing and clinical decision-making, supporting the early identification and management of auditory conditions in newborns. Full article

Diabetes mellitus (DM) is a common chronic health condition, affecting millions of people worldwide, and its incidence is projected to increase by almost 50% in the next two decades. The effects of DM on the auditory system have been reported. However, there is limited evidence on the association between DM and middle ear pathologies. This scoping review aimed to map the available evidence and identify research gaps regarding DM and middle ear pathologies in the adult population. Five electronic databases, namely Scopus, CINAHL, MEDLINE, PubMed, and Web of Science, were searched using a combination of specific key terms. This review followed the guidelines stipulated by the Joanna Briggs Institute (JBI) methodology for scoping reviews and reporting using PRISMA Extension for Scoping Reviews (PRISMA-ScR): checklist and explanation. A thematic narrative analysis was used to synthesize key findings. Of the 1809 articles, only 2 articles met the inclusion criteria. Neither of these studies focused exclusively on middle ear pathologies in DM, but they did report incidental findings related to middle ear function. Available evidence suggests that middle ear pathologies may occur in individuals with DM, with a reported prevalence ranging from 3.1% to 19.6%. Otitis media with effusion and conductive hearing loss were common middle ear pathologies identified. Additionally, recent studies have provided new evidence suggesting ossicular joint changes in individuals with DM and a causal link between DM and acute suppurative otitis media. However, age-related hearing loss (presbycusis) and sensorineural hearing loss (SNHL) were more commonly associated with DM, with studies reporting a high prevalence of SNHL in younger to middle-aged adults with diabetes. This review highlights a significant research gap in the literature, as no studies directly investigated the relationship between DM and middle ear function as a primary focus. Further research is required to investigate this potential association using methodologies explicitly designed for middle ear assessment. While some evidence suggests a possible association, the lack of age-stratified analyses, imaging data, and comprehensive diagnostic testing limits the ability to draw strong conclusions. Further research incorporating age-based analyses, radiological assessments, and microbiome studies is needed to fully understand the potential impact of DM on middle ear health. Full article

Background/Objectives: A sizeable population of patients with normal pure-tone audiograms endorse a consistent difficulty of following conversations in noisy environments. Termed hidden hearing loss (HHL), this condition evades traditional diagnostic methods for hearing loss and thus is significantly under-diagnosed and untreated. This review sought to identify emerging methods of diagnosing HHL via measurement of its histopathologic correlate: cochlear synaptopathy, the loss of synapses in the auditory nerve pathway. Methods: A thorough literature search of multiple databases was conducted to identify studies with objective, electrophysiological measures of synaptopathy. The PRISMA protocol was employed to establish criteria for the selection of relevant literature. Results: A total of 21 studies were selected with diagnostic methods, including the auditory brainstem response (ABR), electrocochleography (EcochG), middle ear muscle reflex (MEMR), and frequency-following response (FFR). Measures that may indicate the presence of synaptopathy include a reduced wave I amplitude of ABR, reduced SP amplitude of EcochG, and abnormal MEMR, among other measurements. Behavioral measures were often performed alongside electrophysiological measures, the most common of which was the speech-in-noise assessment. Conclusions: ABR was the most common diagnostic method for assessing HHL. Though ABR, EcochG, and MEMR may be sensitive to measuring synaptopathy, more literature comparing these methods is necessary. A two-pronged approach combining behavioral and electrophysiological measures may prove useful as a criterion for diagnosing and estimating the extent of pathology in affected patients. Full article

In the current landscape of hearing rehabilitation, ear mold manufacturing typically involves the injection of silicone into the external ear canal (EEC) of each patient. This invasive procedure poses several risks, including the potential for silicone residue retention and tympanic membrane perforation, which may necessitate surgical intervention. To mitigate these risks, we present the design of a video otoscope that integrates a scanner capable of capturing high-precision, real-time images of the EEC’s geometry. The developed device allows (i) the generation of a 3D CAD model leading to the direct, quick, and low-cost production of customized hearing aids using 3D printing and (ii) the establishment of medical protocols for carrying out diagnoses and monitoring of hearing pathology evolution using methodologies based on Artificial Intelligence. Furthermore, the use of customized hearing aids that allow the application of Rhythmic Auditory Stimulation (RAS) and music therapy enhances audiology as an alternative and innovative way to treat cognitive and degenerative diseases, as well as pathological disorders. Full article

Background/Objectives: Since we started endoscopic stapes surgery, we have frequently noticed a white spot (WS) with a clear boundary on the bone surface around the fissula ante fenestrum (FAF) in otosclerosis cases. We investigated the significance of this surgical finding. Methods: We enrolled 27 cases of otosclerosis and 28 control cases of conductive hearing loss due to pathologies other than otosclerosis, both operated on endoscopically at the University of Tokyo Hospital. We retrospectively reviewed surgical videos to determine whether WS was present or absent. We examined the incidence of WS in otosclerosis cases and the controls and also in cases of otosclerosis, the presence or absence of WS was compared with the preoperative hearing level, preoperative air–bone gap, vasodilatation on the promontory, and a low-density area on high-resolution computed tomography (HRCT). Results: WS was present in 11 (41%) of 27 cases of otosclerosis but none in 28 control cases. There were no significant differences in patients’ age and gender, the incidence of vasodilatation on the promontory, preoperative hearing level, or preoperative air–bone gap between otosclerosis cases with and without WS. Although a hypodense focus anterior to the oval window was more frequently present on HRCT in otosclerosis cases with WS (82%) than those without WS (56%), the difference in the incidence failed to reach significance (p = 0.10). Conclusions: We observed WS around the FAF only in cases of otosclerosis, indicating that WS is unique in otosclerosis. WS did not correlate with vasodilatation on the promontory, preoperative hearing level, or air–bone gap. A hypodense focus anterior to the oval window on HRCT tends to be more common in otosclerosis cases with WS. Full article