Interaction of tinnitus suppression and hearing ability after cochlear implantation

To study the postoperative impact of cochlear implants (CIs) on tinnitus, as well as the impact of tinnitus on speech recognition with CI switched on | Acta Oto-Laryngologica 

Methods: Fifty-two postlingual deafened CI recipients (21 males and 31 females) were assessed using an established Tinnitus Characteristics Questionnaire and Tinnitus Handicap Inventory (THI) before and after cochlear implantation. The tinnitus loudness was investigated when CI was switched on and off in CI recipients with persistent tinnitus. The relation between tinnitus loudness and recipients’ satisfaction of cochlear implantation was analyzed by the visual analogue scale (VAS) score.

Results: With CI ‘OFF’, 42 CI recipients experienced tinnitus postimplant ipsilaterally and 44 contralaterally. Tinnitus was totally suppressed ipsilateral to the CI with CI ‘ON’ in 42.9%, partially suppressed in 42.9%, unchanged in 11.9% and aggravated in 2.4%. Tinnitus was totally suppressed contralaterally with CI ‘ON’ in 31.8% of CI recipients, partially suppressed in 47.7%, unchanged in 20.5%. Pearson correlation analysis showed that tinnitus loudness and the results of cochlear implant patients satisfaction was negatively correlated (r = .674, p < .001).

Conclusion: The study suggests six-month CI activation can be effective for suppressing tinnitus. The tinnitus loudness may affect patients’ satisfaction with the use of CI.

Full reference: Wang, Q. Interaction of tinnitus suppression and hearing ability after cochlear implantation. Acta Oto-Laryngologica Vol. 137 (Issue 10) pp. 1077-1082

Early Hearing Detection and Vocabulary of Children With Hearing Loss.

The primary purpose of the current study was to examine the impact of the current EHDI 1-3-6 policy on vocabulary outcomes across a wide geographic area | Pediatrics

Background: To date, no studies have examined vocabulary outcomes of children meeting all 3 components of the Early Hearing Detection and Intervention (EHDI) guidelines (hearing screening by 1 month, diagnosis of hearing loss by 3 months, and intervention by 6 months of age). A secondary goal was to confirm the impact of other demographic variables previously reported to be related to language outcomes.

Results: The combination of 6 factors in a regression analysis accounted for 41% of the variance in vocabulary outcomes. Vocabulary quotients were significantly higher for children who met the EHDI guidelines, were younger, had no additional disabilities, had mild to moderate hearing loss, had parents who were deaf or hard of hearing, and had mothers with higher levels of education.

Conclusions: Vocabulary learning may be enhanced with system improvements that increase the number of children meeting the current early identification and intervention guidelines. In addition, intervention efforts need to focus on preventing widening delays with chronological age, assisting mothers with lower levels of education, and incorporating adults who are deaf/hard-of-hearing in the intervention process.

Yoshinaga-Itano, C. et al. (2017) Early Hearing Detection and Vocabulary of Children With Hearing Loss. Pediatrics. Vol. 140 (no. 2) e20162964

Increased risk of cholesteatoma among patients with allergic rhinitis

This study used a nationwide population-based claims database to investigate the hypothesis that AR may increase the risk of cholesteatoma | The Laryngoscope

Data from Taiwan’s Longitudinal Health Insurance Database were analyzed to compile the following: 1) 15,953 patients newly diagnosed with AR between 1997 and 2000, and 2) a comparison cohort of 63,812 matched non-AR enrollees (with a ratio of 1 to 4). Each patient was followed for 10 years to identify cases in which cholesteatoma subsequently developed. The Kaplan-Meier method was used to determine the cholesteatoma-free survival rate, and the log-rank test was used to compare survival curves. Cox proportional hazard regressions were performed to compute adjusted hazard ratios (HRs).

Among the 79,765 patients enrolled in this study, 45 (159,364 person-years) from the AR cohort and 88 (638,130 person-years) from the comparison cohort were diagnosed with cholesteatoma during the follow-up period (incidence rates 0.28 and 0.14 of 1,000 person-years, respectively). Patients with AR were more likely to develop cholesteatoma compared to those without AR. Patients with AR presented a significantly lower 10-year cholesteatoma-free survival rate than did those in the comparison group .

This is the first study to demonstrate a link between AR and the development of cholesteatoma. We suggest that clinicians keep this association in mind and carefully investigate the possibility of development of cholesteatoma among patients with AR.

Full reference: Kuo, C-L. et al. (2017) Increased risk of cholesteatoma among patients with allergic rhinitis: A nationwide investigation. The Laryngoscope. Published online: 3 August 2017

Hearing aids for otitis media with effusion: Do children use them?

This study investigated what proportion of children referred for hearing aids actually receive them, and whether children use them | International Journal of Pediatric Otorhinolaryngology

https://www.flickr.com/photos/kristof_home/3630576026/

Image source: Kristof Borkowski – Flickr // CC BY-NC 2.0

ENT surgeons may refer children with otitis media with effusion (OME) to audiology for consideration of hearing aids. They are an option for the treatment of OME, but are only effective if the child actually wears them.

During the study period, there were 202 referrals of children to audiology, of which 70 (34.7%) were for consideration of hearing aids for OME. Of these 70 referred children, 37 (52.9%) were not fitted with hearing aids due to normal audiometry (23), asymptomatic mild hearing loss (7), nonattendance (3), clinical decision to just monitor hearing (1), parental decline (2), and unrecorded reason (1). A total of 38 children (including direct access patients) were fitted with hearing aids for OME. Majority (36/38) of children issued aids used them, 16 all day, 7 only at school, 1 only at home, 3 only when needed, and 9 used them for an unspecified duration; 1 child’s use of hearing aids was unrecorded, and 1 child refused to use it. 21 were fitted bilaterally and 17 unilaterally. 37 were behind the ear aids and 1 a BAHA softband.

A third of referrals to paediatric audiology by ENT are for consideration of hearing aids for OME. Only about half of children referred to audiology for hearing aids for OME actually receive them, as by the time they see audiology the hearing loss has frequently resolved or is asymptomatic so that aiding is unwarranted. Once fitted, they appear to be well accepted. Hearing aids have fair utilization in children fitted with them for OME.

Full reference: Gan, R.W.C. et al. (2017) Hearing aids for otitis media with effusion: Do children use them? International Journal of Pediatric Otorhinolaryngology. Vol. 99 (August) pp. 117–119.

Clinical Practice Guideline (Update): Earwax (Cerumen Impaction) Executive Summary

The American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue of Otolaryngology–Head and Neck  Surgery featuring the updated Clinical Practice Guideline: Earwax (Cerumen Impaction). | Otolaryngology– Head and Neck Surgery

This clinical practice guideline is as an update, and replacement, for an earlier guideline published in 2008 by the American Academy of Otolaryngology—Head and Neck Surgery Foundation (AAO-HNSF).1 An update was planned for 5 years after the initial publication date and was further necessitated by new primary studies and systematic reviews that might suggest a need for modifying clinically important recommendations. Changes in
content and methodology from the prior guideline include the following:

  • addition of a consumer advocate to the guideline update group (GUG)
  • 3 guidelines, 5 systematic reviews, and 6 randomized controlled trials (RCTs)
  • emphasis on patient education and counseling with new explanatory tables
  • expanded action statement profiles to explicitly state quality improvement opportunities, confidence in the evidence, intentional vagueness, and differences
    of opinion
  • enhanced external review process to include public comment and journal peer review
  • new algorithm to clarify decision making and action statement relationships
  • 3 new key action statements on managing cerumen impaction that focus on primary prevention, contraindicated intervention, and referral and coordination
    of care.

Full reference: Schwartz, S.R. et al. (2017) Clinical Practice Guideline Update): Earwax (Cerumen Impaction) Executive Summary. Otolaryngology– Head and Neck Surgery. Vol. 156 (no. 01) pp. 14–29

Bilateral congenital cholesteatoma: Surgical treatment and considerations.

A multicenter study regarding surgical management of bilateral congenital cholesteatoma (BCC) and underline the importance of endoscopes in the management of this condition | International Journal of Pediatric Otorhinolaryngology

In BCC, hearing preservation is more crucial than in unilateral cases. The endoscopic approach allows complete removal of cholesteatoma via a minimally invasive technique offering low residual disease rates while preserving the normal physiology of the middle ear and possibly the ossicular chain.

From 2002 to November 2016, six patients were identified with bilateral congenital cholesteatoma and included in this study. Pre-operative assessments, surgical treatments and outcomes were collected and described.

The median age at presentation was 4 years (range 2-7 years). A microscopic post auricular tympanoplasty was performed in two ears, four underwent a canal wall up mastoidectomy procedure and in the other six a transcanal endoscopic approach (TEA) was used. No intra- or post-operative complications were observed in any patients. The mean follow up period was 54.5 months.

When both ears are involved with congenital cholesteatoma, it is particularly important to use a minimally invasive technique that preserves normal ossicular and mastoid structure and function whenever possible. In many cases this can be achieved with TEA, even in young children. In addition the endoscope allows good surgical control of cholesteatoma removal from hidden recesses.

Full reference: Marchioni, D. et al. (2017) Bilateral congenital cholesteatoma: Surgical treatment and considerations. International Journal of Pediatric Otorhinolaryngology. Vol. 99. (no. 08) pp. 146–151

Ear Care for the Most Vulnerable Infants

Each year, approximately 6,000 newborns-of the nearly 4 million births in the U.S.-are diagnosed with permanent hearing loss, and premature infants are 50 percent more likely than full-term infants to develop hearing loss | ASHA Leader

Infants’ experiences in the neonatal intensive care unit (NICU) are highly variable, depending on the complexity of their cases and degree of prematurity. Those with more severe or chronic medical and neurodevelopmental conditions present particular challenges to the audiology team.

Complications of their conditions can delay hearing screening, and the medical equipment helping to support them may interfere with the screening itself. The NICU environment can also be noisy for this vulnerable population. Yet another challenge is the emotional fragility of these infants’ parents.

Although audiology isn’t part of the primary NICU care team, every infant receives a hearing screen, and any infant with a failed screen receives diagnostic audiological testing. This means the hearing-screening staff and audiology team play an important role, particularly after a baby does not pass the hearing screening. Audiologists can also play a key role in the development, implementation and oversight of the newborn hearing program (see more on newborn hearing screening on the ASHA Practice Portal: on.asha. org/newborn-screening). In these cases, the audiologist serves as the primary source of hearing-related information for the parents and the medical team.

To address the particular challenges of the NICU population, audiologists need to communicate and work closely with the NICU staff as soon as it’s appropriate, consider the effects of medical equipment, communicate with parents with a great deal of sensitivity, and work at coordinating discharge planning and follow-up care with the infant’s parents and other providers.

Full reference: McGrath, A. P., & Vohr, B. R. (2017). Ear care for the most vulnerable infants. ASHA Leader, 22(8), 20-22.