Treatment Protocol for Management of Bacterial and Fungal Malignant External Otitis

High rates of negative microbiologic test results highlight the potential role of empiric antimicrobial agents in management of malignant otitis externa (MOE) | Annals of Otology, Rhinology & Laryngology

Aims: This study investigates the clinical presentation, laboratory findings, and response to empiric treatment in a large group of patients admitted to a tertiary academic hospital in Tehran, Iran.

Methods and Materials: We recruited 224 patients diagnosed with MOE in a prospective observation from 2009 through 2015. All patients received a 2-agent antibacterial regimen at baseline (phase I). Patients with no improvement within 10 days and/or nonresponders to a second course of antibacterials were switched to antifungals (phase II). Response to treatment was observed and documented in both groups.

Results: All patients had physical symptoms for more than 12 weeks before admission. In total, 127 patients responded well to antibacterials. Eighty-seven out of 97 patients who were switched to antifungals had complete response to treatment; patients in the latter group had significantly higher A1C levels at baseline.

Conclusion: Our findings provide evidence to develop clinical guidelines that accelerate diagnosis and treatment of MOE to improve patient outcomes.

Full reference: Hasibi, M. et al. (2017) A Treatment Protocol for Management of Bacterial and Fungal Malignant External Otitis: A Large Cohort in Tehran, Iran. Annals of Otology, Rhinology & Laryngology. 126(7) pp. 561 – 567

Speech Intelligibility and Psychosocial Functioning in Deaf Children and Teens with Cochlear Implants

Deaf children with cochlear implants (CIs) are at risk for psychosocial adjustment problems, possibly due to delayed speech–language skills | The Journal of Deaf Studies and Deaf Education

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This study investigated associations between a core component of spoken-language ability—speech intelligibility—and the psychosocial development of prelingually deaf CI users. Audio-transcription measures of speech intelligibility and parent reports of psychosocial behaviors were obtained for two age groups (preschool, school-age/teen). CI users in both age groups scored more poorly than typically hearing peers on speech intelligibility and several psychosocial scales.

Among preschool CI users, five scales were correlated with speech intelligibility: functional communication, attention problems, atypicality, withdrawal, and adaptability. These scales and four additional scales were correlated with speech intelligibility among school-age/teen CI users: leadership, activities of daily living, anxiety, and depression.

Results suggest that speech intelligibility may be an important contributing factor underlying several domains of psychosocial functioning in children and teens with CIs, particularly involving socialization, communication, and emotional adjustment.

Full reference: Freeman, V. et al. (2017) Speech Intelligibility and Psychosocial Functioning in Deaf Children and Teens with Cochlear Implants. The Journal of Deaf Studies and Deaf Education. 22(3) pp.278-289.

Risk Factors Associated With Early Childhood Hearing Loss

In this study, we examined the association between risk factors for hearing loss and early childhood hearing status (normal hearing, congenital hearing loss, or delayed-onset hearing loss) | American Journal of Audiology

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Method: A retrospective data review was completed on 115,039 children born from 2010 to 2012. Data analyses included prevalence rates, odds ratios, and Fisher exact tests of statistical significance.

Results: Ninety percent of children were born with no risk factors for hearing loss; of those, 99.9% demonstrated normal hearing by 3 years of age. Of the 10% of children born with risk factors, 96.3% demonstrated normal hearing by age 3, 1.4% presented with congenital hearing loss, and 2.3% demonstrated permanent hearing loss by age 3. Factors that placed children at the highest risk of congenital hearing impairment were neurodegenerative disorders, syndromes, and congenital infections. Factors that placed children at the highest risk of developing permanent postnatal hearing loss were congenital cytomegalovirus, syndromes, and craniofacial anomalies.

Conclusions: Certain risk factors place a child at significantly greater risk of congenital hearing impairment or developing permanent hearing loss by age 3. Follow-up diagnostic testing should remain a priority for children with certain risk factors for hearing loss.

Full reference: Dumanch, K.A. et al. (2017) High Risk Factors Associated With Early Childhood Hearing Loss: A 3-Year Review. American Journal of Audiology, June 2017, Vol. 26, 129-142

Social Support and Coping on Quality of Life Among Elderly With Age-Related Hearing Loss

The consequences of hearing loss hinder the everyday life of older adults and are associated with reduced well-being | American Journal of Audiology

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Image source: Andrea Squatrito – Flickr // CC BY-NC-ND 2.0

Aim: The research aim was to explore the influence of hearing problems, various coping strategies, and perceived social support on quality of life.

Results: Quality of life was predicted by perceived social support and the number of comorbid diseases (i.e., the physical, psychological, environmental, and social quality of life was better the greater the extent of perceived social support and poorer the more diseases from which the participants suffered).

Conclusions: Perceived social support may be a relevant factor to focus on in auditory rehabilitation programs, in particular, for participants who communicate little support in hearing-related situations and are, hence, at a relative disadvantage. The involvement of significant others in counseling could facilitate the everyday life for older adults with age-related hearing loss and their significant others

Full reference: Moser, S. et al. (2017) The Influence of Social Support and Coping on Quality of Life Among Elderly With Age-Related Hearing Loss. American Journal of Audiology. Vol. 26(6) pp. 170-179. 

Effectiveness of Tympanostomy Tubes for Otitis Media

Tympanostomy tube placement is the most common ambulatory surgery performed on children in the United States| Pediatrics

Objectives: The goal of this study was to synthesize evidence for the effectiveness of tympanostomy tubes in children with chronic otitis media with effusion and recurrent acute otitis media.

Results: Children with chronic otitis media with effusion treated with tympanostomy tubes compared with watchful waiting had a net decrease in mean hearing threshold of 9.1 dB (95% credible interval: −14.0 to −3.4) at 1 to 3 months and 0.0 (95% credible interval: −4.0 to 3.4) by 12 to 24 months. Children with recurrent acute otitis media may have fewer episodes after placement of tympanostomy tubes. Associated adverse events are poorly defined and reported.

Conclusions: Tympanostomy tubes improve hearing at 1 to 3 months compared with watchful waiting, with no evidence of benefit by 12 to 24 months. Children with recurrent acute otitis media may have fewer episodes after tympanostomy tube placement, but the evidence base is severely limited. The benefits of tympanostomy tubes must be weighed against a variety of associated adverse events.

Full reference: Steele, D.W. (2017) Effectiveness of Tympanostomy Tubes for Otitis Media: A Meta-analysis. Pediatrics. 139 (6) e20170125

Music Rehabilitation for Adult Cochlear Implant Users

A music-related quality of life (MuRQoL) questionnaire was developed for the evaluation of music rehabilitation for adult cochlear implant (CI) users. The present studies were aimed at refinement and validation | American Journal of Audiology

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Method: Twenty-four experts reviewed the MuRQoL items for face validity. A refined version was completed by 147 adult CI users, and psychometric techniques were used for item selection, assessment of reliability, and definition of the factor structure. The same participants completed the Short Form Health Survey for construct validation. MuRQoL responses from 68 CI users were compared with those of a matched group of adults with normal hearing.

Results: Eighteen items measuring music perception and engagement and 18 items measuring their importance were selected; they grouped together into 2 domains. The final questionnaire has high internal consistency and repeatability. Significant differences between CI users and adults with normal hearing and a correlation between music engagement and quality of life support construct validity. Scores of music perception and engagement and importance for the 18 items can be combined to assess the impact of music on the quality of life.

Conclusion: The MuRQoL questionnaire is a reliable and valid measure of self-reported music perception, engagement, and their importance for adult CI users with potential to guide music aural rehabilitation.

Full reference: Dritsakis, G. et al. (2017) A Music-Related Quality of Life Measure to Guide Music Rehabilitation for Adult Cochlear Implant Users. American Journal of Audiology. Published online: 15 June 2017

MRI for residual and recurrent cholesteatoma

Diagnosis and management of recurrent or residual cholesteatoma can be problematic. Diffusion-weighted imaging magnetic resonance imaging (MRI) sequences have been used for follow-up of such lesions

Objective of review: Evaluate whether diffusion-weighted magnetic resonance imaging is useful in the diagnosis of recurrent or residual cholesteatoma.

 

Results: A total of 575 studies were identified of which 27 met the inclusion criteria. These covered 727 patient episodes. For EPI studies: sensitivity (sd) 71.82 (24.5), specificity (sd) 89.36 (13.4), PPV (sd) 93.36 (8.1) and NPV (sd) 73.36 (15.8). For non-EPI studies: sensitivity 89.79 (12.1), specificity (sd) 94.57 (5.8), PPV (sd) 96.50 (4.2) and NPV 80.46 (20.2). Improved sensitivity of non-EPI sequences reached significance (P = 0.02).

Conclusions: Diffusion-weighted MRI is both sensitive and specific for the detection of recurrent or residual cholesteatoma following ear surgery. Non-EPI techniques are superior to EPI techniques.

Full reference: Muzaffar, J. et al. (2017) Diffusion-weighted magnetic resonance imaging for residual and recurrent cholesteatoma: a systematic review and meta-analysis. Clinical Otolaryngology. 42(3) pp. 536–543