Poor spellers with good phonetic skills are more often right-handed

from EurekAlert.org

Children who can read and have good phonetic skills – the ability to recognize the individual sounds within words – may still be poor spellers. In a paper published in the May 2008 issue of Cortex, Elizabeth Eglinton and Marian Annett, at the School of Psychology of Leicester, UK, show that this subgroup of poor spellers is more likely to be right-handed than other poor spellers.

Asymmetric Hearing Loss: Definition, Validation, and Prevalence

from Otology & Neurotology

Hypothesis: An algorithm for identifying asymmetric hearing loss (AHL) can be constructed that performs as well or better than expert judges.

Background: AMCLASS is a method for classifying audiograms based on configuration, severity, site of lesion, and interaural asymmetry. The development and clinician validation for all but asymmetry were reported separately. In this report, an algorithm for identifying AHL is described. Using the clinician-validated algorithm, the prevalence of AHL in a database from an academic health center audiology clinic was analyzed.

Methods: Five expert clinicians classified 199 audiograms as symmetric or asymmetric. Interjudge agreement was analyzed for each pair of judges and between each judge and the consensus of the panel. An algorithm was constructed based on the set of rules that maximized agreement between AMCLASS and judges. Using the clinician-validated algorithm, the prevalence of AHL was analyzed for groups based on quantity of bone conduction testing, hearing loss configuration, severity, and site of lesion.

Results: There was substantial disagreement among judges that was similar to interjudge comparisons for other medical tests. Average agreement between AMCLASS and the judges was higher than agreement between the best judge and the consensus of the judges. Approximately 50% of all patients and 55% of patients with sensorineural hearing loss were classified as AHL by the clinician-validated algorithm.

Conclusion: The algorithm met the goal of equaling or exceeding the performance of expert judges. The prevalence of AHL was higher than expected and suggests that the algorithm is not useful for screening for acoustic neuroma or other conditions. Perhaps, a criterion based on the magnitude of the asymmetry would better serve that purpose. The symmetry category provided by AMCLASS provides a determination of clinically significant AHL that agrees with the consensus of expert judges.

Cochlear Implantation in Atelectasis and Chronic Otitis Media: Long-Term Follow-Up

from Otology & Neurotology

Objective: To report the long-term results of cochlear implantation in cases with chronic otitis media or atelectasis using a single surgical technique performed in a single cochlear implant center.

Patients: Nine patients who were implanted using the blind-pit closure of the external ear canal technique (4 patients with adhesive otitis media and 5 with radical mastoid cavities). Follow-up ranged from 18 months to 12 years (mean, 7.05 yr).

Intervention: The surgical procedure was performed in 2 stages. The first stage included canal wall down or lowering any high facial ridge in previous mastoidectomies, removal of all skin, and blind-pit closure of the external ear canal without mastoid cavity obliteration or eustachian tube obliteration. Cochlear implantation was performed 6 months after the first surgical procedure.

Results: All operations were uneventful, and during cochlear implantation, as a second stage, no epithelia or other problems were encountered. No serious complications were encountered during the follow-up period. One case had a minor disruption of the external canal closure that was reclosed successfully under local anesthesia. All patients were using the device at the last follow-up interval with no device problems.

Conclusion: Blind-sac closure of the external ear canal without obliteration is a rather safe surgical procedure in cases with chronic otitis media or atelectasis. Meticulous surgical technique and proper patient selection are of paramount importance. However, a 2-stage procedure may not always be necessary andmight best be confined to those patients who have active inflammatory disease at the primary procedure.

Combination Therapy (Intratympanic Dexamethasone + High-Dose Prednisone Taper) for the Treatment of Idiopathic Sudden Sensorineural Hearing Loss

from Otology & Neurotology

Background: Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL), commonly defined as greater than 20 dB of unilateral hearing loss in at least 3 frequencies occurring within 3 days, has a reported incidence of 5 to 20 per 100,000 patients per year. Untreated, it has a recovery rate of 32 to 65%. Although accepted therapy is high-dose prednisone taper (HDPT), recent publications suggest that intratympanic dexamethasone (IT-Dex) therapy may improve hearing recovery.

Methods: This multicenter, double-blinded, placebo-controlled, randomized study seeks to compare hearing results in ISSNHL patients who have received HDPT alone, IT-Dex alone, or IT-Dex and HDPT (combination therapy). Fifty-one patients with a less than 6-week history of ISSNHL were randomized to 1 of 3 arms and followed prospectively. Group A (17 patients) received IT-Dex therapy with placebo taper, whereas Group B (18 patients) were administered HDPT and placebo intratympanic injections. Patients in Group C (16 patients) were administered IT-Dex and HDPT, otherwise known as combination therapy. Injections (IT-Dex/placebo) and audiograms were performed weekly for 3 weeks, and a final audiogram was obtained 4 weeks after the final injection.

Results: Patients receiving combination therapy (IT-Dex + HDPT) in Group C had an average improvement in speech discrimination score of 44 percentage points and a 40-dB improvement in pure-tone average (PTA). Patients in Group C had statistically significant improvements in speech discrimination score compared with Group B patients (HDPT alone; p < 0.05). When defining a significant improvement in PTA as greater than 15 dB, there was a statistically significant difference between the groups in the proportion of patients achieving hearing improvement. Furthermore, the proportion of patients achieving a significant PTA improvement in Group C was statistically greater than patients in Group B (p < 0.02). Logistic regression analysis indicates that patients receiving combination therapy demonstrated better odds of hearing recovery than patients in both of the other groups (p < 0.05), when all 3 groups were adjusted for age, vertigo, initial hearing levels, and time delay between onset of hearing loss and treatment. Lastly, combination therapy patients recovered their hearing more quickly than patients in the other groups (p < 0.05).

Conclusion: The results of this study suggest that ISSNHL patients treated with IT-Dex + HDPT (combination therapy) have a higher likelihood of hearing recovery than those treated with HDPT alone.

Conductive Hearing Loss After Removal of Acoustic Neuroma

from Otology & Neurotology

Objective: To report 4 patients who have developed a conductive and/or mixed hearing loss due to dehiscence of the inner ear after retrosigmoid approach for removal of acoustic neuroma.

Patients: Four patients who presented with conductive and/or mixed hearing loss after retrosigmoid approach for removal of acoustic neuroma.

Main Outcome Measure: Evidence of inner ear dehiscence on postoperative computed tomographic scan of the temporal bones.

Conclusion: The occurrence of conductive hearing loss after the surgical removal of an acoustic neuroma has not previously been documented. Computed tomographic scan of the temporal bones showing inner ear dehiscence may explain this finding. Formal documentation of such cases may allow techniques to be developed to reduce its occurrence or reconstruction of the defect at the time of primary surgery.

High-Frequency Sensorineural Hearing Loss After Stapedectomy

from Otology & Neurotology

Objective: To describe the pattern and duration of high frequency sensorineural hearing loss after stapedectomy.

Study Design: Retrospective case series.

Setting: Tertiary referral center.

Patients: All patients who underwent stapedectomy by the senior author during the period between January 1, 1998, and October 1, 2005, with preoperative, 4- to 6-week postoperative, and at least 9-month postoperative audiograms were included. Fifty-three patients met the inclusion criteria, with surgeries performed on 61 ears.

Intervention(s): Stapedectomy was performed using a CO2 laser.

Main Outcome Measure(s): Mean preoperative and postoperative pure-tone bone thresholds, mean preoperative and postoperative pure-tone air thresholds, and hearing outcomes for 4,000 Hz bone conduction (BC) and 8,000 Hz air conduction (AC) based on the patient’s age and interval after the operative procedure.

Results: Mean BC thresholds at 4,000 Hz BC worsened by 6 dB at 4 to 6 weeks and improved by 3 dB by 9 months. There was an 8-dB average loss at 8,000 Hz AC at 4 to 6 weeks with a gain of 4 dB by 9 months. Patients older than 40 years were 4 times more likely to experience early loss at 4,000 Hz BC when preoperative thresholds were held constant. The late outcome for hearing loss was dependent more on the preoperative threshold than was the age of the patient. At 8,000 Hz AC, the preoperative hearing threshold was a predictor of early and late hearing loss at 8,000 Hz.

Conclusion: High-frequency sensorineural hearing loss is initially seen after stapes surgery, and improvement does occur over time. When preoperative hearing threshold is held constant, patients older than 40 years are more likely to experience short-term hearing loss at high frequencies than patients younger than 40 years. Age was not a predictor of postoperative high-frequency hearing loss in the long term.

Is There a Right Cochlear Implant Advantage?

from Otology & Neurotology

Objective: To compare behavioral speech perception performance of children with right versus left cochlear implants (CIs).

Study Design: A retrospective cohort study.

Setting: Academic university medical center.

Subjects: Seventy-one prelingually deafened children that obtained a CI device at 48 months or younger.

Intervention: Cochlear implantation with Cochlear, Advanced Bionics, and Med-El devices.

Main Outcome Measurements: Patients were divided into 2 groups according to ear of implant (right, n = 30; left, n = 41) and matched in age at implantation and preoperative audiologic results. Multivariate analysis of variance was used to evaluate the effects of 1) side of CI, 2) age at implantation, 3) time with CI (T1, 18-24 mo; T2, 36-42 mo), and 4) dominance (i.e., compatibility between CI side and handedness) on performance in a monosyllabic open-set test scored for words and phonemes.

Results: A small yet significant “right CI advantage” was evident throughout the study follow-up and was independent of age at implantation. The performance of children implanted at 24 months or younger was significantly higher than that of children implanted between 25 and 48 months. Regardless of CI side and age at implantation, all children exhibited improvement in speech perception with continuous use.

Conclusion: The present study provides first-time evidence for a right CI advantage for speech perception in prelingually deafened children that can be taken into account when selecting side of CI in candidates with similar residual hearing in both ears and no anatomic constraints. The present data lend further support to the notions that greater gains in speech perception are associated with earlier age at implantation and continuous use.

Otologics Fully Implantable Hearing System: Phase I Trial 1-Year Results

from Otology & Neurotology

Objective: To assess the safety of the Otologics fully implantable hearing system after 1 year of use in a Phase I clinical trial.

Study Design: Repeated-measures within-subjects design.

Setting: Procedures were performed in a variety of facilities, including a university, military, and private hospital’s ambulatory surgical center and outpatient clinical audiologic test facilities.

Patients: Adult patients with bilateral moderate to severe sensorineural hearing loss.

Intervention(s): Surgical insertion of this prosthesis included an atticotomy to expose the incus, securing the transducer to the mastoid bone, attaching the transducer tip to the incus via insertion into a laser-drilled hole, and postauricular implantation of the microphone/battery/electronics capsule.

Main Outcome Measure(s): Subjective patient benefit, aided sound field thresholds, and speech discrimination with the subject’s own, appropriately fit, walk-in hearing aid(s) and the prosthesis were assessed.

Results: There were no pre-post-implant differences noted for bone conduction: slight differences were noted in the pre-post-implant air conduction results (p < 0.05). These differences were attributed to the healing process and reversed to almost preimplant assessment levels by the third-month evaluation. Pure-tone averages and monaural word recognition scores were slightly better for the walk-in-aided condition (p < 0.05), whereas the patient benefit scales favored the postoperative implant-aided conditions.

Adverse effects of the implant were encountered on 14 occasions after the implantation of the 20 subjects. With the exception of partial device extrusions (that occurred later), all were rectified by the time of initial activation.

At the 12-month data collection point, problems that had been encountered by subjects included 1) partial device extrusion (3 subjects), necessitating explantation in 2; 2) loss of external communication (2 subjects), resulting in 1 explantation; and 3) increased charging times beyond 1.5 hours (7), resulting in 3 explantations and 2 patients not using their device while awaiting explantation.

Conclusion: Phase I trial results provide evidence that this fully implantable device can provide sound amplification to sensorineural hearing loss patients, with performance results similar to the patients’ walk-in hearing aids.

Performance Groups in Adult Cochlear Implant Users: Speech Perception Results From 1984 Until Today

from Otology & Neurotology

Introduction: More than 3,000 patients have received a cochlear implant in Hannover.

Methods: A group of 864 patients was selected from the main group for the analysis of speech perception development. Depending on the term of introduction of new implant technology, the viewed group was divided into 5 subgroups.

Results: The test battery during regular clinical checkups included speech perception tests. Those tests changed during 20 years; only speech tracking and monosyllable word test remained and were the bases for forming performance classes shown in this study. Three performance classes can be specified for all 5 subgroups by mean values and standard deviations.

Conclusion: In all subgroups, an improvement of speech perception can be observed over time. The current patient group showed significant better performing results than those of the first group.

Prognostic Model for Predicting Hearing Recovery in Idiopathic Sudden Sensorineural Hearing Loss

from Otology & Neurotology

Hypothesis: To aid in realistic counseling of patients at the time of their first visit concerning their chances for recovery, we created a simple prognostic model for predicting hearing recovery in idiopathic sudden sensorineural hearing loss (ISSHL).

Background: An important element of research on ISSHL is to identify prognostic factors for this disease. Many studies have described predictive indicators to identify patients with a good prognosis needing no or minimal treatment. Only a few of these studies have included a model for calculating the probability for patient recovery, which may be important for clinical work, but these prognostic tables have not achieved widespread use clinically.

Methods: Evaluation of an electronic patient data base of 541 patients with ISSHL. The standard treatment was carbogen inhalation (95% O2 and 5% CO2 8 times per day in duration of 30 min) and prednisone orally (100 mg in 1 morning dose) for 7 days. Factors that were analyzed included the patient’s age, the interval between the onset of symptoms and beginning of treatment, the presence or absence of vertigo and tinnitus, audiometric patterns, the severity of hearing loss, and hearing in the opposite ear. Hearing gain was expressed either as absolute hearing gain or as relative hearing gain. Significant recovery of hearing was defined as the final pure-tone audiometry of 30 dB or less (or the same as the pure-tone audiometry of the opposite ear).

Results: The absolute hearing gain was 15.1 dB. The mean relative hearing gain was 47%. Three hundred one (57%) patients had significant recovery of hearing, and 228 (43%) did not have significant recovery of hearing. Using step-wise multiple linear regression analysis, the most important factors for prognosis included severity of hearing loss, presence of vertigo, time between onset and treatment, the hearing of the other ear, and the audiogram shape ([beta] coefficient was -0.216, -0.231, 0.211, 0.113, and -0.064, respectively; constant, 0.968). A recovery expectancy table was developed using the data from this study.

Conclusion: Based on a retrospective analysis, prognostic indicators for hearing recovery in ISSHL were found to be severity of hearing loss, presence of vertigo, time between onset and treatment, the hearing of the other ear, and the audiogram shape. We created a model for calculating the probability for hearing recovery based on the analysis of 529 patients with unilateral ISSHL.

Reliability of Vestibular Evoked Myogenic Potentials in Healthy Subjects

from Otology & Neurotology

Objective: To analyze test-retest reliability of vestibular evoked myogenic potential (VEMP) responses with and without the use of electromyography (EMG) monitoring in people with normal audiovestibular function.

Patients: Twenty adult volunteers with no history of ear disease, normal otoscopic examination, normal pure-tone audiometry thresholds, and normal tympanograms.

Interventions: Prospective evaluation of VEMP responses with and without the use of EMG monitoring in 2 separate sessions 1 to 4 weeks apart.

Main Outcome Measures: Threshold repeatability, p13 and n23 latency, p13-n23 interlatency, and interamplitude and interaural amplitude difference from the first and the second sessions were assessed via the intraclass correlation coefficient.

Results: Test-retest reliability of p13-n23 interamplitude was found to be excellent, and the reliability of threshold and latency was found to be fair to good (with the exception of poor reliability for p13 latency in the EMG monitoring condition).

Conclusion: Overall, VEMP response parameters were found to have fair to good test-retest reliability. The intraclass correlation coefficient value for amplitude was found to be more reliable than latency, with the latency of n23 more reliable than the latency of p13. Clinicians should consider these findings when interpreting VEMP responses. Maintenance of symmetric head rotation with and without EMG monitoring produced reliably reproducible results, the VEMP amplitude being the best criteria.

Remote Intraoperative Monitoring During Cochlear Implant Surgery Is Feasible and Efficient

from Otology & Neurotology

Objectives: Intraoperative testing of cochlear implant devices, establishment of electrical threshold for acoustic reflex, and recording neural responses to electrical stimulation have traditionally required the presence of a cochlear implant audiologist in the operating room. The goal of this study was to determine the feasibility of remote testing to improve time efficiency and reduce cost.

Study Design: Prospective.

Methods: A standard PC with Tridia VNC software and either Cochlear Corporation or Advanced Bionics Corporation mapping software was configured to perform remote testing. The time required to perform on-site or remote testing was measured.

Results: With the availability of the laptop and internet access, there were no geographic restrictions regarding the site of remote testing. Remote testing was time efficient, requiring 9 minutes of audiologist’s time compared with 93 minutes when the audiologist had to travel to the operating room.

Conclusion: Remote testing of the cochlear implant device and patient’s response to electrical stimulation is technically feasible. It is timesaving, practical, and cost efficient.

Sensorineural Hearing Loss After Radiotherapy for Head and Neck Tumors: A Prospective Study of the Effect of Radiation

from Otology & Neurotology

Introduction: In the treatment of head and neck cancers, the cochlea may be damaged if it is within the radiotherapy (RT) area; however, the severity and mechanism of such damage have yet to be clearly defined. The purpose of this study was to analyze the rates of early- and late-stage sensorineural hearing loss (SNHL) in patients receiving RT due to head and neck cancer and to investigate the reliability of distortion product otoacoustic emissions (DPOAEs) measurements and audiometric evaluation.

Study Design: Prospective.

Method: The study included 38 ears of 19 patients scheduled for RT due to head and neck cancer diagnoses. The patients received RT at a fractioned dose of 200 cGy (5 d/wk) and were evaluated pretreatment and posttreatment (1st and 12th mo), both audiometrically and with DPOAE measurement. Any decrease greater than 10 dB was considered SNHL. The amplitudes of DPOAE measurements were statistically compared.

Results: The audiometric evaluation performed in the 1st posttreatment month showed no SNHL in any of the patients, whereas in the 12th month, 47% of the ears had SNHL. In all the patients that developed SNHL, the amplitudes obtained in DPOAE measurements in the first posttreatment month were statistically significantly lower.

Conclusion: The results of the present study show that DPOAE measurement is a reliable method for determining which patients are at risk of developing SNHL in the early post-RT period.

Soluble Intercellular Adhesion Molecule 1 and Soluble Vascular Cell Adhesion Molecule 1 in Sudden Hearing Loss

from Otology & Neurotology

Hypothesis: The aim of the present study was to evaluate the concentration of soluble intercellular adhesion molecule 1 and soluble vascular cell adhesion molecule 1 in patients affected by sudden sensorineural hearing loss (SSHL).

Study Design: Prospective study.

Setting: Tertiary referral center.

Patients: Patients affected by SSHL were evaluated. Inclusion criteria for this study were hearing loss of more than 30 dB hearing level affecting at least 3 contiguous frequencies, normal hearing on the contralateral ear, negative history of hearing loss or ear surgery in the affected ear, and magnetic resonance with gadolinium negative for VIII cranial nerve pathologic findings.

Intervention: Circulating levels of soluble intercellular adhesion molecule 1 and soluble vascular cell adhesion molecule (VCAM) 1 were evaluated by means of enzyme-linked immunosorbent assay.

Main Outcome Measures: The levels of adhesion molecules in SSHL patients were compared with those of a control group.

Results: Intercellular adhesion molecule 1 and VCAM-1 levels in sera of patients with SSHL were significantly higher than those of the matched control subjects (p < 0.001). Statistical analysis did not show significant differences between the 2 groups in terms of the known vascular risk factors such as total and fractionated cholesterol, triglycerides, fibrinogen, erythrocyte sedimentation rate smoking, and diabetes.

Conclusion: The results of this study show that in SSHL patients, there is an increased expression of circulating adhesion molecules confirming the existence of an endothelial dysfunction and supporting the vascular involvement in the pathogenesis of the disease. The identification of high levels of adhesion molecules and of the endothelial dysfunction open the way to selective pharmacologic treatments able to correct the activation of endothelial cells.

Surgical Factors in Pediatric Cochlear Implantation and Their Early Effects on Electrode Activation and Functional Outcomes

from Otology & Neurotology

Objective: To assess the impact of surgical factors on electrode status and early communication outcomes in young children in the first 2 years of cochlear implantation.

Study Design: Prospective multicenter cohort study.

Setting: Six tertiary referral centers.

Patients: Children 5 years or younger before implantation with normal nonverbal intelligence.

Intervention: Cochlear implant operations in 209 ears of 188 children.

Main Outcome Measures: Percent active channels, auditory behavior as measured by the Infant Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale and Reynell receptive language scores.

Results: Stable insertion of the full electrode array was accomplished in 96.2% of ears. At least 75% of electrode channels were active in 88% of ears. Electrode deactivation had a significant negative effect on Infant Toddler Meaningful Auditory Integration Scale/Meaningful Auditory Integration Scale scores at 24 months but no effect on receptive language scores. Significantly fewer active electrodes were associated with a history of meningitis. Surgical complications requiring additional hospitalization and/or revision surgery occurred in 6.7% of patients but had no measurable effect on the development of auditory behavior within the first 2 years. Negative, although insignificant, associations were observed between the need for perioperative revision of the device and 1) the percent of active electrodes and 2) the receptive language level at 2-year follow-up.

Conclusion: Activation of the entire electrode array is associated with better early auditory outcomes. Decrements in the number of active electrodes and lower gains of receptive language after manipulation of the newly implanted device were not statistically significant but may be clinically relevant, underscoring the importance of surgical technique and the effective placement of the electrode array.