Search Results (148)

Background/Objectives: Obstructive Eustachian tube dysfunction (OETD) is common in adults and may lead to middle-ear conditions such as atelectasis and cholesteatoma. The ETDQ-7 questionnaire is used to assess symptom severity. Balloon dilation of the Eustachian tube (BDET) is a minimally invasive treatment with variable outcomes. This review evaluates the safety and effectiveness of BDET. Methods: A systematic review was conducted following PRISMA 2020 guidelines. Four databases (PubMed, Scopus, Cochrane, Web of Science) were searched using ETD- and BDET-related terms, with the last search on 11 April 2025. Randomized trials were selected based on predefined criteria, and data were extracted by two independent reviewers. Discrepancies were resolved by consensus. Results: This systematic review included 14 studies on BDET published between 2013 and 2025. BDET improved otoscopic findings, Valsalva maneuver (VM) performance, and tympanometry (TMM), particularly within the first 6 weeks. ETDQ-7 scores generally indicated symptom improvement, though pure tone audiometry (PTA) showed no significant changes. Most procedures were performed under general anesthesia, with some studies showing similar outcomes under local anesthesia. Combining BDET with other interventions produced mixed results. Reported complications were rare. Conclusions: BDET is a safe, low-risk procedure that effectively reduces tympanic membrane retraction and improves VM and TMM results. While it relieves ETD symptoms in many patients, evidence for long-term efficacy and impact on PTA is limited. Full article

Objective: To evaluate the outcomes of a modified infratemporal fossa approach (ITFA) that preserves the posterior external auditory canal (EAC) in patients with tumors in the infratemporal fossa and skull base, focusing on postoperative hearing and facial nerve function. Methods: This retrospective study included nine patients who underwent ITFA with posterior EAC preservation for tumor removal while minimizing facial nerve rerouting. All surgeries were performed by a single surgeon. Preoperative and postoperative hearing levels, facial nerve function, tumor characteristics, and surgical outcomes were analyzed. Air-bone gaps (ABG) were assessed using pure tone audiometry, and facial nerve function was assessed using the House–Brackmann grading system. Results: The cohort consisted of eight female patients and one male patient, with a mean tumor size of 3.0 cm. Surgical outcomes were promising, with no statistically significant increase in postoperative ABG and well-preserved facial nerve function. Only one patient developed postoperative grade II facial palsy. A residual tumor was identified in one case with extensive meningioma, which has remained stable, and no recurrence or regrowth was noted during the follow-up period (mean: 3.7 years). The modified approach minimized complications related to conductive hearing loss and facial nerve dysfunction. Conclusions: The modified ITFA with posterior EAC preservation provides a promising alternative to conventional ITFA for managing deep-seated tumors. It preserves both hearing and facial nerve function while ensuring adequate tumor resection. Full article

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

Objectives: Tinnitus, defined as the perception of sound without an external stimulus, is a complex condition with unclear etiology. Emerging evidence suggests a link between vascular dysfunction, particularly arterial stiffness, and tinnitus. This study aimed to evaluate vertebral artery stiffness in patients with idiopathic subjective tinnitus and assess the utility of Doppler ultrasonography as a non-invasive diagnostic tool. Materials and Methods: In this prospective study, 31 patients with idiopathic tinnitus (11 males, 20 females; mean age: 50.42 ± 9.64 years) and 24 healthy controls (12 males, 12 females; mean age: 39.67 ± 10.63 years) underwent comprehensive clinical evaluations, including pure tone audiometry, blood tests, and vertebrobasilar Doppler ultrasonography. Vertebral artery stiffness index (VAS), resistive index (RI), and pulsatility index (PI) were measured bilaterally. Results: A total of 31 patients with idiopathic subjective tinnitus and 24 healthy controls were evaluated. The mean age was significantly higher in the tinnitus group compared to controls (50.42 ± 9.64 vs. 39.67 ± 10.63 years, p < 0.001). Lipid profile analysis revealed significantly higher levels of total cholesterol (193.6 ± 47.28 vs. 167.5 ± 28.99 mg/dL, p = 0.021), LDL (149.4 ± 37.9 vs. 106.1 ± 10.7 mg/dL, p < 0.005), and triglycerides (202.2 ± 83.5 vs. 148.6 ± 26.4 mg/dL, p < 0.005) in tinnitus patients. Doppler ultrasonography demonstrated significantly higher vertebral artery stiffness values in the tinnitus group (left: 2.87 ± 0.72 vs. 2.12 ± 0.22; right: 2.99 ± 0.77 vs. 2.14 ± 0.5; both p < 0.005). Similarly, pulsatility index (PI) was significantly elevated in patients compared to controls (left: 2.45 ± 1.2 vs. 1.2 ± 0.43; right: 2.49 ± 1.02 vs. 1.19 ± 0.42; both p < 0.005). No significant differences were observed in resistive index (RI) or vertebral artery diameters between groups. Among tinnitus patients, PI and VAS were significantly higher on the side corresponding to reported tinnitus symptoms (p < 0.05), suggesting a lateralized vascular contribution. Conclusions: The findings suggested a potential relationship between idiopathic subjective tinnitus and vertebral artery stiffness. We demonstrated the utility of Doppler ultrasonography, a cost-effective and non-invasive imaging modality, for evaluating vascular parameters in tinnitus patients, paving the way for broader clinical applications. By uncovering a significant association between vertebral artery stiffness and tinnitus, our findings suggest that vascular health assessments could enhance diagnostic and therapeutic strategies for tinnitus management. Full article

Background/Objectives: Menière’s disease (MD) is a debilitating disorder with episodic and variable ear symptoms. Diagnosis can be challenging, and evidence for therapeutic approaches is low. Furthermore, patients show a unique and fluctuating configuration of audiovestibular impairment. As a psychometric instrument to assess hearing-specific disability is currently lacking, we evaluated a short form of the Speech, Spatial, and Qualities of Hearing Scale (SSQ) in a cohort of patients with MD. Methods: Data was collected in the context of a multicenter prospective patient registry intended for the long-term follow up of MD patients. Hearing was assessed by pure tone and speech audiometry. The SSQ was applied in the German language version with 17 items. Results: In total, 97 consecutive patients with unilateral MD with a mean age of 56.2 ± 5.0 years were included. A total of 55 individuals (57.3%) were female, and 72 (75.0%) were categorized as having definite MD. The average total score of the SSQ was 6.0 ± 2.1. Cronbach’s alpha for internal consistency was 0.960 for the total score. We did not observe undue floor or ceiling effects. SSQ values showed a statistically negative correlation with hearing thresholds and a statistically positive correlation with speech recognition scores of affected ears. Conclusions: The short form of the SSQ provides insight into hearing-specific disability in patients with MD. Therefore, it may be informative regarding disease stage and rehabilitation needs. Full article

Background/Objectives: Tonal thresholds, typically assessed through pure-tone audiometry (PTA), are central to the audiological evaluation of Ménière’s disease (MD). However, they fail to capture the complexity of real-life speech perception. This study aimed to characterize the relationship between PTA and speech recognition performance in unilateral MD and to determine whether a measurable dissociation exists between hearing sensitivity and verbal processing. We also evaluated frequency-specific audiometric patterns and potential threshold cut-off values associated with speech recognition decline. Methods: A total of 254 ears from 127 patients were included in the study across three groups: the Ménière group (affected and unaffected ears, n = 64 each) and the control group (n = 63). The pure-tone thresholds, speech recognition threshold (SRT), and the maximum word recognition scores (Rmax) were assessed in all participants. Results: Although the Ménière affected and control groups showed comparable pure-tone average (PTA) values (46.33 vs. 38.13 dB, p = 0.439), the affected group demonstrated significantly poorer speech performance (Rmax: 76.25% vs. 87.49%, p < 0.001; SRT: 50.64 vs. 38.45 dB, p = 0.009). The Ménière unaffected group exhibited near-ceiling performance (Rmax: 99.38%, SRT: 18.33 dB) and a mean PTA of 19.59 dB. A strong correlation between PTA and SRT was observed only in the Ménière affected group (r = 0.942, p < 0.001), whereas correlations were moderate in the unaffected (r = 0.671, p < 0.001) and control (r = 0.728, p < 0.001) groups. The ROC analysis revealed that PTA predicted impaired speech recognition with high accuracy in unaffected (AUC = 0.956, p < 0.001) and control (AUC = 0.829, p < 0.001) ears but far less so in affected ears (AUC = 0.784; all p < 0.001), confirming a functional tonal–verbal dissociation in MD. Conclusions: This study demonstrates a functional audiometric dissociation in unilateral Ménière’s disease. Affected ears show poorer speech recognition and require higher intensities despite similar PTA values. The predictive link between thresholds and verbal performance is disrupted. These findings support the need for combined tonal and speech-based assessment in clinical practice. Full article

Introduction: This study aimed to compare different scoring methods, such as phoneme, syllable, and word-based scoring, during word recognition in noise testing and their interaction with hearing loss severity. These scoring methods provided a structured framework for refining clinical audiological diagnosis by revealing underlying auditory processing at multiple linguistic levels. We highlight how scoring differences inform differential diagnosis and guide targeted audiological interventions. Methods: Pure tone audiometry and word-in-noise testing were conducted on 100 subjects with a wide range of hearing loss severity. Speech recognition was scored using phoneme, syllable, and word-based methods. All procedures were designed to reflect standard diagnostic protocols in clinical audiology. Discriminant function analysis examined how these scoring methods differentiate the degree of hearing loss. Results: Results showed that each method provides unique information about auditory processing. Phoneme-based scoring has pointed out basic auditory discrimination; syllable-based scoring can capture temporal and phonological processing, while word-based scoring reflects real-world listening conditions by incorporating contextual knowledge. These findings emphasize the diagnostic value of each scoring approach in clinical settings, aiding differential diagnosis and treatment planning. Conclusions: This study showed the effect of different scoring methods on hearing loss differentiation concerning severity. We recommend the integration of phoneme-based scoring into standard diagnostic batteries to enhance early detection and personalize rehabilitation strategies. Future research must involve studies about integration with other speech perception tests and applicability across different clinical settings. Full article

Background and Objectives: Systemic small-vessel vasculitis (SV) represents a group of rare autoimmune disorders with varied etiologies and clinical manifestations. Audiovestibular involvement in SV may present with a broad spectrum of symptoms, often complicating diagnosis and management. This study aimed to evaluate auditory function and speech perception in individuals diagnosed with SV and to investigate associations with disease-specific clinical parameters. Materials and Methods: A total of 40 patients diagnosed with SV (mean age: 48.9 years; range: 28–65 years) were recruited for comprehensive audiological assessment. The evaluation protocol included otoscopic examination, tympanometry, pure-tone audiometry, and speech audiometry. Statistical analysis was conducted using R software (version 4.3.1), and significance was set at p < 0.05. Results: Diagnoses included granulomatosis with polyangiitis (52.5%), eosinophilic granulomatosis with polyangiitis (27.5%), necrotizing vasculopathy (12.5%), and microscopic polyangiitis (7.5%). Mean disease duration was 4.14 years. Hearing complaints were reported by 77.5%; in 20%, they were the initial symptoms. Audiometry identified hearing loss in 50% of patients—predominantly sensorineural (33.8%), followed by mixed (13.7%) and conductive (2.5%) types. Hearing loss was most frequent in necrotizing vasculopathy (60%) and among ANCA-positive individuals (53.7%). Conclusions: Sensorineural hearing loss is common in SV, particularly in ANCA-positive patients, highlighting the need for routine hearing assessment in SV management. Full article

Objectives: This systematic review aimed to evaluate the diagnostic accuracy of self-administered web- and app-based tools for audiometric testing compared to pure-tone audiometry (PTA), the clinical gold standard. Methods: Studies were eligible if they involved human participants, evaluated self-administered digital tools for audiometric testing, reported diagnostic accuracy metrics (e.g., sensitivity, specificity, and accuracy), were published between 2014 and 2024, and were written in English. Studies were excluded if they did not compare to PTA, were reviews, or did not assess self-administered tools. MEDLINE, Web of Science, Scopus, and EMBASE were systematically searched throughout November 2024. Study quality was assessed using the QUADAS-2 tool, evaluating four domains: patient selection, index test, reference standard, and flow and timing. Most studies showed some concern for a risk of bias. Results: Twelve studies, including a total of 2453 participants and evaluating 15 applications, met the inclusion criteria. The studies reported wide variability in diagnostic accuracy. Sensitivity ranged from 18% to 100%, specificity from 35.5% to 99.1%, and accuracy from 14% to 97.4%. SHOEBOX and Screenout demonstrated high diagnostic accuracy, while other apps showed inconsistent results across studies and settings. Heterogeneity in definitions of hearing loss, test environments, device and headphone types and a lack of standardized reporting limited comparability. Most studies were conducted in non-soundproof environments, and some had unclear or a high risk of bias. Conclusions: Self-administered audiometric apps and web tools show promise for remote hearing screening but require further validation and methodological standardization. Clinicians should interpret the results cautiously given the current variability in performance. Full article

Background/Objectives: Congenital rubella syndrome (CRS) is an infection caused by rubella virus transmitted to the fetus during pregnancy, which can cause congenital hearing loss. Cochlear implant can be an effective therapy in patients with severe to profound bilateral hearing loss. The aim of this study was to evaluate the benefits of cochlear implantation in patients with profound hearing loss caused by congenital rubella syndrome. Methods: In total, 38 patients with profound hearing loss caused by intrauterine rubella virus infection were considered for cochlear implantation. Patients ranged in age from 8 to 72 years on the day of surgery, with a mean age of 27 years and median of 25 years (SD = 13.2). Preoperatively, all patients underwent pure-tone audiometry, and free-field speech audiometry was conducted in a quiet environment with the patient wearing a fitted hearing aid. Postoperatively, patients underwent pure-tone audiometry to assess residual hearing, and free-field speech audiometry was conducted when the patients had an active implant. Results: The average preoperative hearing threshold (averaged across the seven frequencies from 0.125 to 8 kHz) was 99.2 dB HL (SD = 6.79), while the average postoperative hearing threshold was 103.4 dB HL (SD = 5.74). Twelve months after the operation, patients achieved a WRS in quiet scores ranging from 10% to 90%, with an average of 59.1% and median of 70% (SD = 25.8). Conclusions: Rubella during pregnancy can lead to severe congenital defects, with sensorineural hearing loss being the most common. Cochlear implants appear to be an effective treatment for profound hearing loss caused by congenital rubella syndrome. Full article

Hearing loss (HL) is a major global health concern, with drug-induced ototoxicity contributing significantly, particularly in patients undergoing treatment for drug-resistant tuberculosis (DR-TB). In South Africa, where both TB and HIV are prevalent, the risk of treatment-related auditory damage is especially high. This study aimed to assess the prevalence and predictors of hearing impairment among DR-TB patients in rural Eastern Cape, South Africa. A retrospective analysis was conducted on 438 DR-TB patients treated between 2018 and 2020, using pure tone audiometry (PTA) to assess hearing status post-treatment. Demographic, clinical, and lifestyle data were extracted from patient records and analyzed using logistic regression. The overall prevalence of hearing loss was 37.2%. Risk was significantly associated with an older age, a male gender, DR-TB classification (MDR, pre-XDR, and XDR), unsuccessful treatment outcomes, and substance use. Prevalence of HL increased notably in patients aged 70 and older. Lifestyle factors, particularly combined use of tobacco, alcohol, and drugs, were linked to higher odds of HL. These findings underscore the need for routine audiometric screening and personalized treatment monitoring in DR-TB care, especially for high-risk populations. Early identification of ototoxicity risk factors can inform safer treatment regimens and improve patient outcomes in resource-limited settings. Full article

Background/Objectives: Cochlear implantation is a crucial intervention for individuals with severe hearing loss, aiming to restore auditory function and improve quality of life. The decision to recommend cochlear implantation critically depends on accurate audiological evaluations. However, challenges arise when subjective assessments of hearing loss do not align with objective audiological measurements, leading to potential misdiagnoses. Comparisons are to be made between subjective and objective results, with an investigation into the characteristics, warning signs, and risk factors of functional hearing loss (FHL). Methods: A retrospective study of hearing loss presentations at an otorhinolaryngological university clinic between 2020 and 2024 was performed, whereby we collected FHL cases. The evaluation process included measurements of subjectively perceived hearing loss through pure-tone audiometry, speech understanding, and communication testing. The objective assessments comprised impedance measurement, otoacoustic emission measurement, auditory brainstem responses, auditory steady-state responses, and medical imaging. Results: During the studied period, 11 patients, with an average age of 35.2 years (13 to 64 years), who were originally referred for cochlear implantation evaluation and subsequently diagnosed with FHL, were identified. The majority (10 patients) were female. No organic cause was identified in four cases, while seven cases exhibited some organic ear abnormalities insufficient to justify the reported hearing loss. The degree of FHL ranged from 30 dB to 90 dB, with an average of 60 dB. Conclusions: Diagnosing FHL is challenging and requires comprehensive assessment and interdisciplinary collaboration. Failure to recognize it may lead to inappropriate treatment, including unnecessary cochlear implantation. This study advocates for the mandatory integration of ABR and ASSR in the clinical evaluation of all cochlear implant candidates to ensure accurate diagnosis and optimal treatment. Full article

Background/Objectives: Idiopathic immune-mediated uveitis (IIMU) is an intraocular inflammatory condition affecting the uveal tract and adjacent ocular structures, potentially leading to systemic involvement. Audiovestibular symptoms, such as sensorineural hearing loss (SNHL) and balance disturbances, are often underdiagnosed in these patients. The potential correlation between IIMU and audiovestibular dysfunction remains insufficiently studied. This study aimed to estimate the prevalence and describe the clinical characteristics of audiovestibular manifestations in patients with IIMU. Methods: We conducted a cross-sectional observational study of 34 patients with a confirmed diagnosis of IIMU at a tertiary academic center. All participants underwent a standardized neurootological assessment, including pure-tone audiometry, video head impulse testing (vHIT), and cervical vestibular-evoked myogenic potentials (cVEMP). Demographic and clinical data were also collected. Results: Audiovestibular dysfunction was identified in 41.18% of patients, with bilateral SNHL (B-SNHL) being the most common finding. Patients with B-SNHL had a significantly later age of uveitis onset (52.3 ± 14.4 vs. 35.9 ± 13.9 years, p = 0.003) and a higher incidence of ocular complications (83.3% vs. 59.1%, p = 0.252). Furthermore, worsening ophthalmologic activity was observed in 25% of patients with B-SNHL, compared to 0% in those without B-SNHL (p = 0.037). Vestibular dysfunction was also associated with delayed onset of uveitis (51.0 ± 17.4 vs. 36.0 ± 12.2 years, p = 0.006) and a non-significantly higher complication rate (76.9% vs. 61.9%, p = 0.465). Conclusions: Audiovestibular dysfunction is a frequent finding in patients with IIMU and is associated with delayed uveitis onset and greater ocular morbidity. These results support the inclusion of systematic audiovestibular screening in clinical evaluations of IIMU patients and suggest that earlier detection may inform prognosis and guide multidisciplinary management strategies. 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

Objectives: This study aimed to analyse the potential influence of abnormalities detected through carotid–vertebral ultrasonography and brain MRI on pure-tone averages (PTAs) and the frequency and intensity of tinnitus. Methods: 423 participants with subjective tinnitus were enrolled in this investigation. All patients underwent carotid– vertebral ultrasonography, brain MRI, and pure-tone audiometry, including tinnitus matching. Results: The median values for tinnitus onset indicated chronic tinnitus in most cases. Regarding tinnitus location, left-sided symptoms (32%) and bilateral symptoms (44%) were the most prevalent. In analysing the effects of abnormalities detected by carotid–vertebral ultrasonography on PTAs, a statistically significant difference was found between the groups (p = 0.0037). Specifically, individuals with intimal hyperplasia had significantly higher PTAs (p = 0.02), as did those with carotid artery plaques (p = 0.005). However, no significant differences in PTAs were noted in relation to carotid artery stenosis (p = 0.07). Similar trends emerged regarding tinnitus intensity (p = 0.013), with significantly higher values observed in the presence of any carotid–vertebral ultrasonography abnormalities. In contrast, tinnitus frequencies were not significantly affected (p = 0.401). Regarding brain MRI findings, Fazekas scores of 2 (p = 0.02) and 3 (p = 0.0052) significantly influenced PTAs. For tinnitus intensity, Fazekas scores of 2 (p = 0.0027) and 3 (p = 0.0005), and the presence of acoustic neuromas (p = 0.019), significantly impacted the intensity values. However, tinnitus frequencies were not significantly (p = 0.36) influenced by brain MRI abnormalities. Conclusions: The findings of this study show that carotid–vertebral ultrasonography and brain MRI abnormalities significantly influence PTAs and tinnitus intensities. Full article