Search Results (25)

Background: Hyperbaric oxygen therapy (HBOT) is the standard treatment for moderate to severe carbon monoxide (CO) poisoning, but middle ear barotrauma (MEB) remains a common complication. This study identified risk factors associated with MEB in patients undergoing monoplace HBOT. Methods: This retrospective cohort study included patients treated for CO poisoning with monoplace HBOT at a tertiary academic hospital between May 2021 and December 2023. MEB severity was assessed before and after treatment using video otoscopy and graded according to the modified O’Neill Grading System. Results: MEB occurred predominantly at lower severity grades according to the O’Neill scale. In univariate analysis, significant risk factors for MEB included altered mental status at presentation (OR: 3.16, 95% CI: 1.35–7.40, p = 0.008), serum albumin > 4.3 g/dL (OR: 0.22, 95% CI: 0.10–0.65, p = 0.004), and magnesium levels (OR: 0.21, 95% CI: 0.05–0.98, p = 0.046). Multivariate analysis confirmed altered mental status (OR: 3.16, 95% CI: 1.05–9.52, p = 0.041), albumin > 4.3 g/dL (OR: 0.26, 95% CI: 0.10–0.65, p = 0.004), and magnesium level (OR: 0.21, 95% CI: 0.05–0.88, p = 0.033) as independent predictors of MEB. Patients with higher albumin and magnesium levels showed lower risk. Conclusions: Altered mental status, lower albumin, and lower magnesium levels predicted middle ear barotrauma in patients undergoing monoplace HBOT for CO poisoning. These findings highlight the importance of careful pre-treatment evaluation and close monitoring during therapy to reduce the incidence of MEB. Full article

Background: Hearing-related disease is a significant cause of disability worldwide. In resource-limited settings, prevention and early detection are critical for preventing severe disease. Understanding what a population knows and believes with regards to hearing health can be critical in identifying knowledge gaps and developing targeted interventions. Objective: To assess community awareness of hearing health and otitis media (OM) treatment, both modern and traditional, to inform educational programs. Methods: A retrospective review of clinical records from 52 patients (aged 1–79 years) diagnosed with OM during a 3-day hearing health clinic in Kasungu district, Malawi was conducted. Patients diagnosed with OM during the clinic were invited to provide additional details about their hearing health. Surveys contained open-ended questions to assess knowledge and beliefs regarding the cause of their infection and therapies they had previously used for treatment, including home remedies and prescribed medications from allopathic providers or traditional healers. A WHO adapted survey on hearing knowledge was also administered. Results: Hearing loss was identified in 60% of participants. Otoscopy revealed either bilateral or unilateral drainage in 69% of participants and perforation in 73%. Confidence in understanding the causes and treatments of OM was voiced by 60% of participants and 54% had used home remedies as treatment. Of the 11 home remedies used, none aligned with modern medical practice, and only two were recommended by local herbalists. Conclusions: Hearing-related disease contributes significantly to global disability, particularly in resource-limited settings. Educational campaigns to improve hearing health knowledge offer low-cost yet impactful solutions and implementation via partnerships with community leaders and traditional healers can be critical to addressing hearing health challenges. The use of nonantibiotic antimicrobials should be explored further, as these are low-cost and readily available. However, therapeutic alliance between patients and healthcare providers remains crucial. Full article

Telemedicine brings several benefits to patients, healthcare providers, and the wider society, including reductions in the need for hospitalizations or readmissions, as well as in overall healthcare costs and the length of inpatient stay. In addition, these services may provide psychological benefits to patients, including excellent satisfaction and medication adherence. The present study aimed to investigate an in-house-developed otorhinolaryngologic remote diagnostic system (mobile app). The basis of the comparison was the incidence between the diagnoses and therapies made by remote diagnosticians and on-site specialists based on static images and videos captured by a smartphone otoscope device. In the study, 103 patients were involved. After registering demographic data, the telemedicine software was evaluated by comparing the matching of physically established diagnoses and/or therapies with remotely established diagnoses and/or therapies. The most remarkable result was in concordance with the diagnoses, with 79 matches identified of the 103 cases examined; the rate of the matching cases was 76.7% (95% CI: 68.5–84.9%). These results support that telemedicine-based otorhinolaryngological remote diagnostics could play a significant role in future healthcare. Full article

Background/Objectives: The respiratory system is prone to infectious diseases, especially in children below five years of age. Upper respiratory tract infections in children are often associated with Eustachian tube dysfunction and complicated by otitis media with effusion (OME), an inflammatory process within the middle ear, which can lead to hearing loss. Treatment for these infections involves a combination of medication and symptom relief, depending on the severity and cause of the infection. In recent years, natural therapeutic drugs derived from herbal medicines have been gaining popularity in treating various pathologies. Bromelain, one of the most studied natural compounds, has been investigated extensively due to its numerous pharmacological properties, offering a potential new avenue for treatment. Based on these promising findings, our study was designed to examine the efficacy of supplementation with bromelain in countering symptoms associated with OME. Methods: This study was conducted on data acquired from medical records from the Section of Audiology of the University of Palermo, focusing on the period of January 2022 to June 2023 and selecting 224 children (age range 1–8 years), namely 174 males and 50 females, who were evaluated for presumed OME at the audiology pediatric ambulatory. All patients selected before initiating pharmacological treatment underwent thorough screening regarding the functionality of the tympanic cavities, otoacoustic emissions, the auditory threshold, and the ear canal’s integrity. Results: The preliminary findings of this study are significant, demonstrating that supplementation with bromelain led to notable improvements in the symptoms accompanying OME after 15 days and 60 days of therapy. Notably, patients who received the bromelain supplement reported reduced mucus secretions and improved auditory function. Conclusions: These results underscore the potential of naturally occurring compounds as adjuvants to standard therapeutic strategies in treating OME. Full article

The effects of music exposure on vocal performers remain relatively unknown. This study aimed to assess the immediate and long-term effects of music and singing practice on the peripheral auditory system of vocal performers using otoscopy, pure-tone audiometry, and noise dosimetry. The hearing status, sound pressure levels (SPLs), and sound doses of 12 vocal performers with normal hearing at the study’s onset were evaluated. Pre- and post-study questionnaires regarding the participants’ otologic health and music-making activities, as well as repeated hearing evaluations, were implemented. Additionally, noise dosimetry was conducted on each participant’s most vocally active day of the week. Audiometric assessments generally revealed normal hearing thresholds, with some exceptions. Half of the participants exhibited elevated low-frequency thresholds and over half of the participants displayed emerging audiometric “notches” at 6000 Hz. Noise dosimetry measurements indicated that most of the participants were consistently exposed to SPLs during music-making activities that exceeded recommended limits. Questionnaire responses highlighted that the participants often engaged in extra-curricular music-making activities, frequently with piano accompaniment, and with little to no use of hearing protection devices. A few of the participants reported histories of otologic issues and potential hearing problems. Full article

Background: Cochlear implant (CI) electrode insertion can change the mechanical state of the ear whereby wideband tympanometry absorbance (WBTA) may serve as a sensitive tool to monitor these mechanical changes of the peripheral auditory pathway after CI surgery. In WBTA, the amount of acoustic energy reflected by the tympanic membrane is assessed over a wide frequency range from 226 Hz to 8000 Hz. The objective of this study was to monitor changes in WBTA in CI recipients before and after surgery. Methods: Following otoscopy, WBTA measurements were conducted twice in both ears of 38 standard CI recipients before and in the range of 4 to 15 weeks after CI implantation. Changes from pre- to postoperative absorbance patterns were compared for the implanted as well as the contralateral control ear for six different frequencies (500 Hz, 750 Hz, 1000 Hz, 2000 Hz, 3000 Hz, 4000 Hz). Furthermore, the influence of the time point of the measurement, surgical access, electrode type, sex and side of the implantation were assessed for the implanted and the control ear in a linear mixed model. Results: A significant decrease in WBTA could be observed in the implanted ear when compared with the contralateral control ear for 750 Hz (p < 0.01) and 1000 Hz (p < 0.05). The typical two-peak pattern of WBTA measurements was seen in both ears preoperatively but changed to a one-peak pattern in the newly implanted ear. The linear mixed model showed that not only the cochlear implantation in general but also the insertion through the round window compared to the cochleostomy leads to a decreased absorbance at 750 and 1000 Hz. Conclusions: With WBTA, we were able to detect mechanical changes of the acoustical pathway after CI surgery. The implantation of a CI led to decreased absorbance in the lower frequencies and the two-peak pattern was shifted to a one-peak pattern. The result of the linear mixed model indicates that WBTA can detect mechanical changes due to cochlear implantation not only in the middle ear but also in the inner ear. Full article

Palatine and pharyngeal tonsil hypertrophy may lead to dysfunction of the auditory tube due to a propensity for infection, potentially giving rise to otitis media. This is a quantitative and longitudinal study, developed from 2019 to 2021, at the State University of Campinas (UNICAMP). The studied sample comprised 15 participants aged 5 to 12 years (mean 7.9 years), 12 male and 3 female, arranged into two groups: children diagnosed with pharyngeal and/or palatine tonsil hypertrophy who were candidates for surgery (G1), and children who were later evaluated after surgery (G2). As part of the test, an otoscopy and measurements of logoaudiometry, pure-tone threshold audiometry, wideband tympanometry (ambient and peak pressure), and otoacoustic emissions (TEOAEs and DPOAEs, both at ambient and peak pressure) were all performed. There were statistically significant differences between phases in pure-tone audiometry, in terms of 226 Hz tympanometry, wideband tympanometry in peak pressure conditions, in the amplitude measurement TEOAEs in both pressure conditions, in DPOAEs in ambient pressure conditions, and in the signal/noise measurement in both pressures in DPOAEs. Overall, it was found that hearing tests were different for subjects with palatine and pharyngeal tonsil hypertrophy compared to the post-surgical group. Full article

Outer and middle ear pathologies are known to disproportionately affect low-income countries but data is limited. We aim to quantify the prevalence rate of patients presenting with middle/outer ear pathologies at ABC Hearing Clinic and Training Centre in Lilongwe, Malawi. Audiological consultations (adult and paediatric) from 2018–2020 were reviewed for outer and middle ear pathologies. Secondary outcomes included patient type (private vs. community) compared to otoscopy findings, tympanometry findings, need for follow up, and follow up compliance. Out of 1576 patients reviewed, the proportion of abnormal cases’ was 98.2%, with 41.4% being unilateral and 57.4% bilateral. Eighty-three percent presented with outer/middle ear pathologies. 68% of those presented with a pathology often associated with some degree of conductive hearing loss (occluding wax, perforation, discharge, Type B/Type C tympanogram). Average age was 29 + 0.527 years; 41.6% private and 58.2% community patients. Cerumen impaction was most common finding (51%). Higher rates of otoscopic abnormalities and type B tympanograms were noted in community vs. private patient (~40% vs. ~30%; ~70% vs. ~30%). Adherence to follow up was higher for community vs. private patients (29% vs. 17%); ~70% reported subjective improvement upon follow up. The majority required multiple interventions on follow up. Secondary follow up was recommended in 64.8%. A significant disease burden of outer and middle ear pathologies was identified. Further research is required to understand the disease burden and promote health policy. Full article

Background and Objectives: Granulomatosis with Polyangiitis (GPA) is a rare, autoimmune, multisystemic disease characterized by vasculitis and necrotizing granuloma that commonly affects the upper and lower respiratory tract and kidneys. Audiovestibular dysfunction in GPA diseases may have different clinical presentations. The aim of the present study was to evaluate hearing function in patients with GPA and to compare the results with a healthy control group. Materials and Methods: A total of 34 individuals participated in the study. The GPA group consisted of 14 participants, and the control group was composed of 20 healthy participants with no signs or symptoms of ear disease. The ages ranged from 18 to 65 years old, with a mean age of 43.8 years. The participants underwent a complete audiological evaluation using otoscopy, impedance audiometry, pure tone audiometry, speech audiometry—evaluation of speech thresholds, and speech recognition in quiet. Both ears were tested. All of the participants of the study were native Lithuanian speakers. Data were statistically analyzed using the Statistical Analysis System software SAS^® Studio 3.8. A p value < 0.05 was regarded as statistically significant. Results: 92.85% of patients from the GPA group reported hearing-related symptoms: hearing loss, tinnitus, and fullness in the ears. The arithmetic means of all hearing thresholds at frequencies from 125 Hz to 8000 Hz were significantly higher in the GPA group. The results revealed statistically significant differences between the two groups in the Speech Detection Threshold, Speech Recognition Threshold, Speech Discomfort level, and Word Recognition Scores. Conclusions: The frequency of hearing loss, the average hearing thresholds, and speech thresholds were higher in GPA patients than in healthy individuals. The most common type of hearing loss was sensorineural. Audiological assessments should be considered during the routine evaluation of patients with GPA disease to prevent hearing-related disabilities. Full article

Medical applications of optical technology have increased tremendously in recent decades. Label-free techniques have the unique advantage of investigating biological samples in vivo without introducing exogenous agents. This is especially beneficial for a rapid clinical translation as it reduces the need for toxicity studies and regulatory approval for exogenous labels. Emerging applications have utilized label-free optical technology for screening, diagnosis, and surgical guidance. Advancements in detection technology and rapid improvements in artificial intelligence have expedited the clinical implementation of some optical technologies. Among numerous biomedical application areas, middle-ear disease is a unique space where label-free technology has great potential. The middle ear has a unique anatomical location that can be accessed through a dark channel, the external auditory canal; it can be sampled through a tympanic membrane of approximately 100 microns in thickness. The tympanic membrane is the only membrane in the body that is surrounded by air on both sides, under normal conditions. Despite these favorable characteristics, current examination modalities for middle-ear space utilize century-old technology such as white-light otoscopy. This paper reviews existing label-free imaging technologies and their current progress in visualizing middle-ear diseases. We discuss potential opportunities, barriers, and practical considerations when transitioning label-free technology to clinical applications. Full article

Hearing loss is commonly encountered by general practitioners. We aimed to evaluate the screening benefit of air conduction pure-tone audiometry over visual analogue scale (VAS) scores for hearing loss. Moreover, we intended to perform the first cross-sectional study in Greece to assess hearing loss with pure-tone audiometry in young adults of the general population. We evaluated Greeks between 15 and 40 years old in a high school in Karditsa, Greece, and a primary health care unit in a nearby community. Subjects filled out a VAS score sheet and underwent pure-tone audiometry in a room without sound isolation, with air conduction only. We named the latter procedure modified pure-tone audiometry (mPTA). Subjects with pathologic results were examined via otoscopy and standardized pure-tone audiometry (sPTA). Of the 286 subjects evaluated, the VAS score revealed 5 subjects (1.7%) with hearing loss. mPTA (100 s duration) doubled this percentage (in total 3.8%; Pearson Chi-Square test; p < 0.001). Based on sPTA, the sensitivity and positive predictive value of the VAS score were 40% and 13%, respectively. For mPTA, they were 100% and 37%, respectively. mPTA filtered out pathologic cases in a proper, rapid, cheap and simple way and may be considered a proper screening method for hearing loss in primary health care. Full article

Low-frequency air–bone gap (ABG) associated with pulsatile tinnitus (PT) and normal impedance audiometry represents a common finding in patients with third window syndromes. Other inner disorders, including Meniere’s disease (MD), perilymphatic fistula and intralabyrinthine schwannoma, might sometimes result in a similar scenario. On the other hand, PT is frequently associated with dural arteriovenous fistula (DAVF), while conductive hearing loss (CHL) is extremely rare in this clinical setting. A 47-year-old patient was referred to our center with progressive left-sided PT alongside ipsilateral fullness and hearing loss. She also experienced headache and dizziness. Otoscopy and video-oculographic examination were unremarkable. Conversely, a detailed instrumental audio-vestibular assessment revealed low-frequency CHL with normal impedance audiometry, slight left-sided caloric weakness, slightly impaired vestibular-evoked myogenic potentials on the left and normal results on the video-head impulse test, consistent with an MD-like instrumental profile. Gadolinium-enhanced brain MRI revealed an early enhancement of the left transverse sinus, consistent with a left DAVF between the left occipital artery and the transverse sinus, which was then confirmed by angiography. A trans-arterial embolization with Onyx glue was performed, resulting in a complete recession of the symptoms. Post-operatively, the low-frequency ABG disappeared, supporting the possible role of venous intracranial hypertension and abnormal pressure of inner ear fluids in the onset of symptoms and offering new insights into the pathomechanism of inner ear CHL. Full article

Objectives—Cochlear implantation has been suggested to be associated with an air-bone gap, possibly secondary to increased middle- and inner-ear stiffness. To explore the effect of possible changes in mechanics due to cochlear implantation, we measured wideband tympanometry (WBT) in individuals with normal hearing and individuals with severe to profound sensorineural hearing loss who underwent unilateral or bilateral cochlear implantation. Our goal was to characterize differences in WBT patterns associated with severe to profound sensorineural hearing loss and with cochlear implantation. Design—The study participants were 24 individuals with normal hearing (48 ears) and 17 with cochlear implants, of which 15 were unilaterally implanted and two were implanted bilaterally. All the participants had normal otoscopy. In the implanted group, inner-ear anatomy was normal according to preoperative imaging. All participants underwent pure-tone audiometric assessment, standard tympanometry (226 Hz probe tone), and WBT to a click stimulus (analyzed from 226 to 8000 Hz). WBT was recorded at ambient and peak pressures. To elucidate the effect of sensorineural hearing loss on WBT, we compared normal-hearing ears with impaired non-implanted ears. The impact of cochlear implantation was assessed by comparing the WBT of the implanted and non-implanted ears of the same participants. Moreover, the effect of the ear (right vs. left) and test–retest reproducibility were evaluated. Results—WBT results for right and left ears showed no statistically significant differences in the normal hearing participants. There were no statistical differences shown between repeated measurements of WBT with removal and re-insertion of the probe in any of the groups—the normal ears, the implanted ears, and the non-implanted ears with hearing impairment. Peak compensated admittance (Ytm) in standard tympanometry was normal in 32 out of 34 (94%) ears with sensorineural hearing loss, with one CI user having bilateral negative middle-ear pressure. Compared to normal-hearing ears, ears with severe to profound SNHL, with or without cochlear implantation, showed a significant decrease in absorbance at high frequencies (4000–5000 Hz). Implanted ears, compared both to normal-hearing and contralateral-non-implanted ears, showed a significant decrease in absorbance at low frequencies (400–800 Hz) and an increase in absorbance around 1600 Hz. Conclusions—WBT analysis revealed that the implanted ears showed a significant decrease in absorbance at low frequencies (400–800 Hz) and an increase at 1600 Hz. This finding is likely a result of an increased stiffness due to the implantation surgery and the presence of the implant in the inner ear. In contrast, the specific decrease in absorbance around 4000–5000 Hz in the implanted and non-implanted ears compared to the normal ears is likely either due to aging or the impact of the severe-to-profound SNHL on the input impedance of the cochlea. The structural and functional changes of both the conductive system and the cochlea associated with aging and SNHL may change the wideband acoustic immittance of the ear and these alterations might be correlated with the hearing loss severity. Additional research is needed to determine how much hearing loss and age influence wideband acoustic immittance of the ear. Full article

Some nutraceuticals have been studied as supportive treatment for fighting upper respiratory tract infection and middle ear disease. Our study aims at evaluating the effect of a specific oral supplementation in the treatment of pediatric otits media. The subjects were randomly assigned by the physician (single-blinded study) to one of three groups: Control Group (CG), Treatment Group 1 (TG1), or Treatment Group 2 (TG2). Both TG were treated with Flogostop Duo (for 20 days—TG1 or 30 days—TG2) in combination with the standard treatment, while CG underwent standard treatment only. The standard treatment was nasal aerosol with Fluticasone and Mucolytic, and nasal washing with hypertonic solution. All patients were analyzed by otoscopy, impedance, fibroscopy, and pure auditory test at the baseline (T0), after 20 days (T1) and 35 days (T2). 120 children were included in the study, 40 in the CG, 40 in the TG1, and 40 in the TG2. Both TG1 and TG2 presented statistically significant differences with respect to controls in otoscopy, impedance, fibroscopy, and PTA at T2. The otoscopy improved at T2 with statistically significant value only in TG2. The impedance and fibroscopy improved at T1 both in TG1 and TG2 compared to CG. A statistically significant improvement was observed in TG2 at T2 in comparison to both CG and TG1. Statistically significant differences were observed in PTA at T2 only compared with controls. This study confirmed the efficacy of nutraceutical as supporting therapy in the upper respiratory tract infection in children. In particular, the supplement containing Boswellia serrata and Bromelain, which are molecules with strong anti-inflammatory and pain-control capacities, could add the benefit without the adverse effects which are related to NSAID use. Full article

Understanding the risk of infection by routine medical examination is important for the protection of the medical personnel. In this study we investigated respiratory particles emitted by patients during routine otolaryngologic procedures and assessed the risks for the performing physician. We developed two experimental setups to measure aerosol and droplet emission during rigid/flexible laryngoscopy, rhinoscopy, pharyngoscopy, otoscopy, sonography and patient interview for subjects with and without masks. A high-speed-camera setup was used to detect ballistic droplets (approx. > 100 µm) and an aerosol-particle-sizer was used to detect aerosol particles in the range of 0.3 µm to 10 µm. Aerosol particle counts were highly increased for coughing and slightly increased for heavy breathing in subjects without masks. The highest aerosol particle counts occurred during rigid laryngoscopy. During laryngoscopy and rhinoscopy, the examiner was exposed to increased particle emission due to close proximity to the patient’s face and provoked events such as coughing. However, even during sonography or otoscopy without a mask, aerosol particles were expelled close to the examiner. The physician’s exposure to respiratory particles can be reduced by deliberate choice of examination technique depending on medical indication and the use of appropriate equipment for the examiners and the patients (e.g., FFP2 masks for both). Full article