Hesham Taha

Evaluation of Vestibular Function in Patients with Chronic Suppurative Otitis Media

Objective: The objective of this study was to assess vestibular functions in patients with chronic suppurative otitis media (CSOM) with and without sensorineural hearing loss. Study Design: This was a prospective case study performed at a tertiary referral university hospital. Sixty patients with CSOM were included, and patients with a history of head trauma, diabetes, hypertension, previous ear surgery, use of ototoxic drugs, neurological deficits and suspected fistulae were excluded. Patients and Methods: The patients underwent basic audiological evaluation, and clinical and instrumental vestibular evaluation. The incidence and extent of vestibular dysfunction in patients with CSOM were analyzed. Results: A total of 42 males and 16 females with a mean age of 29.5 years were included in this study. Forty ears had tubotympanic disease and 19 had cholesteatoma. There were 14 ears with sensorineural hearing loss. A positive history of vertigo was reported in 53.5% of the cases. Rotatory chair abnormalities were found in 70% of the cases, caloric hypofunction was found in 61.6%, and vestibular myogenic evoked potentials were abnormal in 25%. The only positive correlation with vestibular dysfunction was the duration of disease. Conclusions: The vestibular system is significantly affected in cases with CSOM. Both semicircular canals and the saccule are affected. All patients with long-standing CSOM should be evaluated for vestibular dysfunction irrespective of their hearing levels.

Next-generation sequencing reveals the mutational landscape of clinically diagnosed Usher syndrome: copy number variations, phenocopies, a predominant target for translational read-through, and PEX26 mutated in Heimler syndrome

Combined retinal degeneration and sensorineural hearing impairment is mostly due to autosomal recessive Usher syndrome (USH1: congenital deafness, early retinitis pigmentosa (RP); USH2: progressive hearing impairment, RP).

Visual vestibular mismatch: is it a vestibular disorder?

Background Visual vestibular mismatch (VVM) is a group of symptoms rather than a disease. All are exaggerated by introducing any visual conflict. For such reason, there is no adequate tools to investigate or to diagnose and limited research studies were done to explore such group of people. Aim To identify VVM disorder among dizzy patients and to study the vestibular function in them. Patients and methods This study was conducted on 30 patients suffering from VVM (out of 153 patients) who were selected by a questionnaire modified by the authors based on the original questionnaire. All patients were subjected to objective testing including: full neuro-otological history, office vestibular tests including dynamic visual test (DVA), modified clinical test of sensory integration of balance (MCTSIB), Fukuda stepping test, functional reach test, videonystagmography and vestibular evoked myogenic potentials (VEMPs). Results VVM symptomatology was found in 19 patients (subjectively by Mallison questionnaire) and reached 30 patients using a modified questionnaire. 23.33% patients had abnormal Fukuda test, 26.6% had abnormal functional reach test, while 97.6% of patients had abnormal MCTSIB test scores and 50% had abnormal DVA test scores. Abnormal cervical VEMP test results were present in 50% of cases, while only 10% suffered from videonystagmography abnormalities reflecting minor affection of semicircular canals as compared with the saccule. Conclusion This study showed that VVM is a fairly common complain among the dizzy population and it can be easily picked up using a simple questionnaire. Office tests as DVA and MCTSIB were highly sensitive tests for VVM patients but more research is needed to find the correlations between these tests and VVM. The study pointed out to the importance of cervical VEMP test to be routinely enrolled in testing of patients with suggestive symptoms of VVM. Further researches should be conducted for knowing the underlying cause and the exact role of saccule in VVM.

Variables affecting speech intelligibility in prelingual Arabic speaking cochlear-implanted children

Background Speech intelligibility (SI) is usually expressed as the degree to which a speaker′s intended message can be recovered by other listeners. It is determined by many factors that may be affected by the degree of hearing loss. The use of cochlear implants (CIs) can facilitate the development of speech and language skills of prelingually deaf children. Thus, improvements in SI after CI fitting can provide indirect evidence of sensory aid benefits. Aim This cross-sectional study aimed to explore the different variables that affect SI in prelingual CI children in order to achieve the maximum benefit for improving SI in such candidates. Participants and methods This study included 30 prelingually hearing-impaired participants, with ages ranging from 6 to 10 years. They used bilateral hearing aids for a duration of 2.6 ΁ 1.7 years before undergoing CI, which was performed at ages ranging from 4 to 9 years. They were enrolled in specific language intervention programs after implantation for a duration ranging from 1 to 3.8 years. Then, the Arabic Speech Intelligibility test was used to assess their SI. The effect of different variables on their SI was assessed through both comparative and correlative analysis. Results SI scores showed highly significant differences in patients at younger age at implantation (aged ≤5years) and in those who had received language therapy for more than 2 years after implantation. Meanwhile, preimplantation therapy for more than 1 year and usage of hearing aids for more than 1 year before CI had significant effects on the SI scores. SI was highly significantly negatively correlated with age at CI and highly significantly positively correlated with the duration of postimplantation therapy. The SI scores were also affected by the three groups of the SI test. The front consonants had higher significant scores compared with both back consonants and sentences, and back consonants had significantly higher scores compared with sentences. Conclusion The SI of prelingual cochlear-implanted children was affected by all of the studied variants. However, for best SI, age at implantation and postimplantation therapy duration should be considered to enable better SI in these children.

Folic acid and vitamin-B 12 in idiopathic sensorineural hearing loss in children

Aim The aim of the study was to evaluate the role of vitamin-B 12 and folate blood concentrations in children suffering from moderate, severe, and severe-to-profound sensorineural hearing loss (SNHL). Materials and methods This study was conducted on 95 children: 30 children with severe-to-profound SNHL who were scheduled for cochlear implantation, 25 children who are hearing aid users for moderate and severe SNHL, and another 40 healthy volunteers considered as the control group. Full audiological examination was performed to all children, as well as computed tomographic scan and MRI to temporal bone were performed for the SNHL groups. Results Median vitamin-B 12 and folic acid levels were significantly higher in the control group 3 than in the SNHL groups 1 and 2 patients (P Conclusion Study demonstrated that the serum levels of folate and vitamin-B 12 are decreased in patients with SNHL. Measurement of folic acid and vitamin-B 12 in patients suffering SNHL might be useful. These data may give us some clues about how hearing loss is developed in these patients.

Office vestibular tests: A battery approach to guide the diagnosis of dizzy patients

Abstract Background: Laboratory vestibular tests are relatively expensive and may be not available in every clinic. On the other hand, office vestibular tests can be easily performed and are low-cost. Objectives: To measure the sensitivity of a proposed battery approach to be conducted as an office procedure to diagnose side and site of vestibular lesions. Methods: This study was conducted on 36 patients suffering from vertigo with a confirmed diagnosis of vestibular disorder by laboratory vestibular tests. These included a standard video nystagmography (VNG) test that entails recording of eye examination including gaze testing, saccadic eye movements and smooth pursuit together with positional and positioning examinations as well as bithermal calorics and Vestibular Evoked Myogenic Potential (VEMP) tests. Patients were evaluated independently by history, examination of eye movements and a battery of office vestibular tests that included the Head Shake nystagmus Test (HST), Head Thrust Test (HTT) and Fukuda Stepping Test as well as the Dix-Hallpike test. Audiological, radiological and laboratory tests were applied to establish aetiological diagnosis whenever indicated. Results and conclusions: One patient showed abnormal eye movements that were confirmed by full diagnostic work-up for vestibular disorders in keeping with a diagnosis of multiple sclerosis, and was excluded from forthcoming analysis. Sensitivity of the HST test with respect to results of the laboratory vestibular tests (VNG and VEMP) was 51.5% while that of HTT was 43%. Moreover, the Fukuda Stepping Test showed a sensitivity of 48.5% with non-significant correlation to the side of caloric weakness and a significant correlation to the side of abnormal VEMP response. The proposed battery of office vestibular tests proved to be a quick screening approach that was successful in helping to identify site and side of peripheral vestibular lesions in 77% of patients. On the other hand, normal office vestibular tests were obtained in patients with laboratory findings showing mild caloric weakness or with only an abnormal VEMP.