An-Suey Shiao

Ear Problems in Swimmers

&NA; Acute diffuse otitis externa (swimmers ear), otomycosis, exostoses, traumatic eardrum perforation, middle ear infection, and barotraumas of the inner ear are common problems in swimmers and people engaged in aqua activities. The most common ear problem in swimmers is acute diffuse otitis externa, with Pseudomonas aeruginosa being the most common pathogen. The symptoms are itching, otalgia, otorrhea, and conductive hearing loss. The treatment includes frequent cleansing of the ear canal, pain control, oral or topical medications, acidification of the ear canal, and control of predisposing factors. Swimming in polluted waters and ear‐canal cleaning with cotton‐tip applicators should be avoided. Exostoses are usually seen in people who swim in cold water and present with symptoms of accumulated debris, otorrhea and conductive hearing loss. The treatment for exostoses is transmeatal surgical removal of the tumors. Traumatic eardrum perforations may occur during water skiing or scuba diving and present with symptoms of hearing loss, otalgia, otorrhea, tinnitus and vertigo. Tympanoplasty might be needed if the perforations do not heal spontaneously. Patients with chronic otitis media with active drainage should avoid swimming, while patients who have undergone mastoidectomy and who have no cavity problems may swim. For children with ventilation tubes, surface swimming is safe in a clean, chlorinated swimming pool. Sudden sensorineural hearing loss and some degree of vertigo may occur after diving because of rupture of the round or oval window membrane.

Chronological changes of hearing in pediatric patients with large vestibular aqueduct syndrome

Objectives: To describe the chronologic changes of hearing in patients with large vestibular aqueduct syndrome (LVAS) and identify the prognostic factors.

Otitis media with effusion in children with cleft lip and palate: A narrative review

OBJECTIVE Repair surgery of cleft lip and palate (CLP) can produce satisfactory cosmetic results but the problem of recurrent otitis media with effusion (OME) secondary to CLP may persist. This can cause long-term hearing loss and affect linguistic, academic, and personal development. The aim of this review is to provide the most recent information regarding OME in children with CLP. METHODS All papers referring to children with CLP and OME were identified from searches in Medline, PubMed, Cochrane Library, and Web of Science. Abstracts were read and relevant papers were obtained. Additional studies were obtained from the references of the selected articles. RESULTS Both current and previous research on OME in children with CLP focused on the controversy over treatment strategies. Evidence on the optimal treatment for OME in CLP children was lacking. Ventilation tube surgery using the same anesthetic as lip or palate procedures was not well-supported. After summarizing the literature review, a flowchart of management guidance for such patients is also recommended. Updated reviews such as this will provide clinicians and patients/parents with a valuable reference. CONCLUSIONS The lack of evidence on the optimal treatment for OME in children with CLP should prompt a relatively conservative approach. However, only a consensus between patients/parents and surgeons regarding the most suitable treatment strategy for OME can ensure the greatest benefit to individual patients.

Migraine is a risk factor for sudden sensorineural hearing loss: A nationwide population-based study:

Background The pathophysiology of idiopathic sudden sensorineural hearing loss (SSNHL) is poorly understood. Few case reports have proposed a possible link between migraine and SSNHL. Objectives This study aimed to explore the risk of idiopathic SSNHL in patients with migraine in a nationwide, population-based cohort study. Methods We identified patients with migraine from the Taiwan National Health Insurance Research Database (NHIRD) between 2000 and 2009. Each migraine patient was matched with four randomly selected subjects without migraine for age, sex, and comorbidities. Both cohorts were followed up until the end of 2009. We compared the incidence rates of SSNHL in the two cohorts and identified the risk factors. Results A total of 10,280 migraine patients and 41,120 matched controls were enrolled with a median follow-up of five years. The migraine cohort had a greater risk of developing SSNHL than the matched cohort (81.6 vs. 45.7 per 100,000 person-years, incidence rate ratio (IRR) = 1.8; 95% confidence interval (CI) 1.22–2.61, p = 0.002). The Cox proportional hazards analysis revealed that among migraine subjects, comorbidity with hypertension was associated with a trend of developing SSNHL (hazard ratio (HR) = 1.92, 95% CI 0.97–3.79, p = 0.06). Conclusions This population-based study demonstrates that migraine is associated with an increased risk of idiopathic SSNHL, which, however, is a rare condition.

Comparison of short tone burst-evoked and click-evoked vestibular myogenic potentials in healthy individuals.

Background: Vestibular evoked myogenic potential (VEMP) is one of the clinical tools to evaluate vestibular function. The VEMP can be recorded from sternocleidomastoid muscle by auditory stimulation with various sound stimuli. The aim of this study was to compare the VEMP responses evoked by short tone burst (STB) with those evoked by click stimuli in healthy young individuals. Methods: Twenty‐two healthy volunteers (11 males, 11 females; 44 ears), with ages ranging from 17 to 30 years were enrolled in this study. Subjects were instructed to lie in supine position and elevate their heads unsupported. The VEMP was recorded using 500 Hz STB and then click sound stimuli to each ear. The latency p13, n23, peak‐to‐peak p13‐n23 amplitude and VEMP asymmetry ratio (VAR) were obtained for further analysis. Results: The VEMP responses were present in all subjects. The latencies p13 and n23 of STB‐VEMP were significantly longer, and the p13‐n23 amplitudes were significantly greater for STB‐VEMP (p < 0.05, paired t test), as well. The VAR, however, showed no significant difference between the 2 stimuli. The latency n23 of click VEMP in our study was significantly different from that of 1 of the other studies (p < 0.05). Conclusion: The VEMP responses were significantly different between the stimuli of STB and click, and the norms of different stimuli should be established for clinical interpretations. For clinical diagnosis using VEMP, we recommend STB stimuli because the latencies and amplitudes of click were significantly different among several labs, including ours.

How long is long enough to follow up children after cholesteatoma surgery? A 29-year study†

To identify an association between follow‐up period and cholesteatoma recidivism.

Healthy‐side dominance of middle‐ and long‐latency neuromagnetic fields in idiopathic sudden sensorineural hearing loss

Any lesion along the neural axis may induce a subsequent functional reorganization at the level above. The present study used magnetoencephalography to investigate auditory‐evoked magnetic fields [a component of the middle‐latency auditory evoked fields peaking at ~50 ms (P50m) and a component of the long‐latency auditory evoked fields peaking at ~100 ms (N100m)] on stimulation of both healthy and affected ears in patients with acute unilateral idiopathic sudden sensorineural hearing loss (ISSNHL) of moderate degree in order to elucidate the functional plasticity of the auditory system. Sixteen right‐handed, previously untreated adult patients with acute unilateral left (n = 8) or right (n = 8) ISSNHL of moderate degree were studied. Sixteen right‐handed healthy volunteers with normal hearing served as control. Auditory neuromagnetic responses, measured by a whole‐head 306‐channel neuromagnetometer, were detected by monaural tone stimulation applied to affected and healthy ears, respectively, in different sessions. Intragroup and intergroup interhemispheric differences of peak dipole strengths and latencies of P50m and N100m, respectively, to monaural tones were evaluated. Healthy‐side amplitude dominance of both P50m and N100m was found in ISSNHL, i.e. contralateral dominance was preserved on affected‐ear stimulation but ipsilateral dominance was seen on healthy‐ear stimulation. The phenomena could be attributed to the combined contralateral attenuation and ipsilateral enhancement of P50m and N100m activity in response to healthy‐ear stimulation. Our findings confirmed that functional modulation can occur within the first few tens of milliseconds of evoked response at the auditory cortex in ISSNHL. The mechanisms of healthy‐side dominance might be ascribed to a functional retune of auditory pathways, i.e. conjoined contralateral inhibition and ipsilateral excitation of the auditory pathway in response to healthy‐ear stimulation. The effect could be registered in cortical responses.

Healthy-side dominance of cortical neuromagnetic responses in sudden hearing loss.

Previous brain imaging and mapping studies have reported findings indicating functional reorganization in the central auditory pathways of patients with profound unilateral hearing loss. This study reports for the first time to our knowledge, using a whole‐head neuromagnetometer with monaural stimulation of both intact and affected ears, a pattern of healthy‐side dominance for cortical neuromagnetic responses in adult patients in the early stage of idiopathic sudden sensorineural hearing loss, and a pattern of contralateral dominance is verified in controls. Ann Neurol 2003;53:810–815

Mastoid Obliteration for Pediatric Suppurative Cholesteatoma: Long-Term Safety and Sustained Effectiveness after 30 Years' Experience with Cartilage Obliteration

Objective: To analyze the long-term safety of mastoid obliteration with cartilage in children with suppurative cholesteatomatous ears. Methods: The medical records of children (≤18 years) with cholesteatomas after primary tympanomastoidectomies were performed with cartilage obliteration over a 30-year period (1982-2012) were analyzed. The recidivism rate was calculated using the Kaplan-Meier survival analysis. Potentially confounding factors of recidivism were entered into a Cox regression model as covariates for multivariate analysis. Results: Of the 150 cholesteatomatous ears in 146 children, there were 95 discharging ears (63%) in 94 children. Among the 95 discharging ears, tympanomastoidectomy was performed with cartilage obliteration (CO group) in 77 ears (81%) and without cartilage obliteration (WO group) in 18 ears (19%). The mean follow-up period was 12 years. Recidivism was observed in 16 ears in the CO group and 4 ears in the WO group. The 10-year cumulative recidivism rates were comparable between the CO and WO groups (19 vs. 25%, p = 0.762). Multivariate analysis confirmed that mastoid obliteration was not a negative predictor of recidivism (p = 0.760). Recidivism of cholesteatoma was detected within 6.5 years after surgery in the WO group and was found as late as 16.1 years after surgery in the CO group. Cartilage could be maintained in the cavity with limited resorption, preventing reretraction pockets and subsequent recidivism. Conclusion: This study provides evidence supporting the long-term safety, feasibility and effectiveness of mastoid cartilage obliteration for children with suppurative cholesteatomatous ears. Despite comparable recidivism rates between the groups, the potential for the delayed detection of recidivism with cavity obliteration may warrant long-term follow-up, with careful attention paid to the potential for recidivism during postoperative care in children. i 2014 S. Karger AG, Basel

New therapeutic strategy for treating otitis media with effusion in postirradiated nasopharyngeal carcinoma patients

Background: Postirradiation otitis media with effusion (OME) is the most common radiotherapy‐associated otologic complication associated with nasopharyngeal carcinoma (NPC). This studys aim was to evaluate the efficacy of laser myringotomy followed by intratympanic steroid injection (LMIS) for treating OME in postirradiated NPC patients. Methods: From August 2002 to January 2006, 27 newly diagnosed NPC patients who developed OME after a full course of radiotherapy were enrolled. Laser myringotomy was performed followed by once‐weekly administration of steroids (0.5 mL dexamethasone at a concentration of 5.0 mg/mL) into the middle ear for 3 consecutive weeks. The success rate of dry eardrum perforation and the prognostic factors associated with OME resolution were analyzed. Results: The procedure was performed on 44 ears of 27 patients. The mean follow‐up period was 37 weeks. Of the 44 ears, 23 (52.3%) developed persistent eardrum perforation, 18 (40.9%) developed recurrent OME, and three (6.8%) were disease‐free on follow‐up. Of the 23 ears with persistent eardrum perforation, 18 (78.3%) were diagnosed as dry perforation. The absence of pretreatment mastoiditis was an independent factor associated with OME resolution (p < 0.001). Conclusion: LMIS is a quick, minimally invasive, office‐based technique that can be repeatedly performed to treat highly recurrent postirradiation OME, and it results in relatively slight pain to NPC patients. Long‐lasting dry eardrum perforation allows for adequate middle ear ventilation and drainage and guarantees sustained relief from symptoms. The absence of preoperative mastoiditis is a favorable prognostic factor associated with OME resolution.