József Pytel

Hyponatremia and Sensorineural Hearing Loss in Preterm Infants

In a case-control study the role of hyponatremia in the hearing loss of preterm infants was investigated. One hundred and sixty-four premature infants treated at the neonatal intensive care unit were screened with transient evoked otoacoustic emission (TEAOE). In 32 infants TEAOE results indicated the need for further investigations. Auditory brainstem response was performed and 22 of 32 cases had bilateral hearing impairment (HI). The birth weight and gestational age in the HI group were 1,425 ± 528 g and 30.4 ± 3.7 weeks. The matched control group consisted of 25 infants with a mean birth weight and gestational age of 1,410 ± 280 g and 31.1 ± 2.1 weeks. Significant differences were found between the HI and control groups: Apgar score (p < 0.05), pH value (p < 0.01) and pO2 level (p < 0.05) were lower; the total dose of aminoglycosides (p < 0.01), furosemide usage (p < 0.01), the maximum pCO2 level (p < 0.01), incubator stay (p < 0.05) and hyponatremia (p < 0.01) were higher, and the duration of hyponatremia (p < 0.05) was longer in the HI group. Multivariate logistic regression revealed that aminoglycoside treatment and hyponatremia were the two most significant factors in the development of hearing impairment. These results suggest that hyponatraemia is an additional risk factor for hearing loss in preterm infants.

Detection of Osteoprotegerin and TNF‐alpha mRNA in Ankylotic Stapes Footplates in Connection With Measles Virus Positivity

Hypothesis: Otosclerosis is a bone remodeling disorder of the otic capsule causing conductive and sensorineural hearing loss. Persistent measles virus infection of the temporal bone with increased tumor necrosis factor (TNF)‐alpha and decreased osteoprotegerin mRNA expression is supposed to be the main etiologic factor in otosclerosis.

Codetection of Measles Virus and Tumor Necrosis Factor-Alpha mRNA in Otosclerotic Stapes Footplates†

Hypothesis: Otosclerosis is a disease of unknown etiology causing conductive or sensorineural hearing loss. Persistent measles virus infection of the otic capsule is considered to be one of the etiologic factors in otosclerosis.

Transitory evoked otoacoustic emission (TEOAE) in a child with profound hearing loss

The case of a 3-month-old, prematurely born boy with auditory brainstem response (ABR), verified profound hearing loss and normal transitory evoked otoacoustic emission is presented. Isolated retrocochlear deafness which did not influence TEOAE is hypothesised as a possible cause. The critical evaluation of results when using TEOAE as a screening method is suggested.

Antimeasles immunoglobulin g for serologic diagnosis of otosclerotic hearing loss.

Hypothesis: Persistent measles virus infection of the otic capsule is suggested to be an etiologic factor in otosclerosis. Otosclerosis is a disease of complex unknown etiology causing progressive conductive and/or sensorineural hearing loss (HL).

Prospective effectiveness of stapes surgery for otosclerosis in a multicenter audit setting: feasibility of the Common Otology Database as a benchmark database.

Introduction: The Common Otology Database (COD) is a joint effort by an international group of otologists to organize audit with a standardized reporting method in middle ear surgery. The first results on hearing outcome of the COD are presented in this article. Objective: The primary objective was to confirm the validity of the benchmark group by comparing hearing outcome results with previously reported results. The secondary objective was to describe the population, technical aspects, and hearing outcomes of stapes surgery. Study Design: Nonrandomized prospective multicenter audit. Setting: Twenty tertiary-referral otologic centers. Patients and Intervention: Primary and revision stapes operations in patients with otosclerosis. Main Outcome Measures: Air-bone gap (ABG), bone-conduction (BC) thresholds, and air-conduction (AC) thresholds were evaluated at 3 and 12 months according to the guidelines of the Committee on Hearing and Equilibrium for the evaluation of conductive hearing loss. Raw data were displayed in an Amsterdam Hearing Evaluation Plot. Results: In primary stapes surgeries, the postoperative ABG was closed to 10 dB or less in 63.6% and to 20 dB or less in 92.6% (median, 8.75 dB). In revision stapes surgeries, the postoperative ABG was closed to 10 dB in 41.2% and to 20 dB in 76.5% of cases (median, 11.25 dB). The overall mean postoperative ABG at 12 months was 10.38 dB compared with 28.75 dB preoperatively. Using laser to perform the fenestration results in a less pronounced BC improvement when compared with procedures without laser assistance. No statistically significant difference in ABG pure-tone average at 3 months could be demonstrated between the different prosthesis types. Conclusion: Results of hearing outcome are similar to previous, primarily retrospective, single-center studies. Our data confirm the effectiveness of stapes surgery in patients with otosclerosis.

Two Subgroups of Stapes Fixation: Otosclerosis and Pseudo-Otosclerosis†

Hypothesis: Stapes ankylosis is a disease with variable histopathology and can be caused by otosclerosis or pseudo‐otosclerosis. Viral pathogenesis of otosclerosis could be established only by correlative analysis: histologic examination of the stapes footplate and reverse‐transcriptase polymerase chain reaction (RT‐PCR) amplification of the viral RNA.

KTP-laser stapedotomy with a self-crimping, thermal shape memory Nitinol SMart piston: 1 year follow-up results: how we do it.

• We evaluate the long-term speech perception results in 12 children with bilateral large vestibular aqueduct syndrome, who received cochlear implantation as the treatment. The mean duration of implant usage was 4.8 years. The performance of cochlear implantation in the originally poorer hearing ear is compared to that of the contralateral better hearing ear using a hearing aid after at least 3 years of follow-up. • Speech perception measures included a Mandarin closed-set consonant discrimination test, a closed-set tone identification test, two open-set sentence recognition tests and an open-set word identification test. These tests were carried out with live voice in a sound-proofed room. • The median scores of the five speech perception tests were 80%, 75%, 97%, 91.5% and 86% respectively for the implanted ears. For the opposite ear with hearing aids, the median scores were 35%, 40%, 11%, 8% and 10% respectively. In all five tests, the results were statistically significantly higher in the implanted ear. • Our results confirmed that cochlear implantation is an effective treatment for subjects with large vestibular aqueduct syndrome once their hearing deteriorated to the profound level. Moreover, we have shown that the long-term speech perception results are significantly better in ears with cochlear implantation than the contralateral ear using hearing aids. Conflict of interest

Histopathology of nonotosclerotic stapes fixations

Hypothesis: Different diseases without exact histopathologic classification can cause stapes ankylosis. Background: Otosclerosis is a complex bone remodeling disorder of the otic capsule due to persisting measles virus infection and consecutive inflammatory reaction. In fact, clinical and demographic features of otosclerosis have reference to stapes ankylosis. In the clinical practice, otosclerosis and stapes ankylosis are incorrect synonyms. Methods: Nonotosclerotic stapes footplates (n = 284) removed during stapedectomy were analyzed histologically. Otosclerosis was excluded during the histologic preselection (n = 437). Total RNA was extracted, and measles virus-specific reverse-transcriptase-polymerase chain reaction was performed. Results: Nonotosclerotic stapes ankylosis was associated with total absence of measles virus RNA. Six main types of nonotosclerotic stapes fixations could be distinguished histologically: annular calcification (n = 152; 53.5%), globular fibrosis (n = 49; 17.25%), lymphocytic infiltration (n = 31; 10.9%), hemosiderosis (n = 22; 7.75%), granulomas (n = 17; 6%) and amyloidosis (n = 13; 4.6%). Fragmentation of nonotosclerotic stapes footplates was infrequent (7%) during stapes surgery. Only 1 floating footplate (0.35%) was reported. Conclusion: Two thirds of nonotosclerotic stapes footplates represented complete pathologic bone remodeling. Unlike otosclerosis, nonotosclerotic stapes fixations were characterized by basic histopathologic findings without organ specificity that can also be identified in case of different diseases. Prevalence of nonotosclerotic stapes ankylosis is approximately 30 to 40% among stapes fixation cases. The long-term prognosis and surgical considerations theoretically differ from those of otosclerosis.

Ionomer cement for reconstruction of the long process of the incus: the Pécs experience

•  Experience gained with the repair of the defects of the long process of the incus with ionomer cement in 35 patients is reported. •  The integrity of the reconstructed tympanic membrane and the four‐frequency average of the air‐bone gaps of the postoperative audiograms (best, most recent and at around 1 year) were evaluated. •  This ‘physiological’ reconstruction of the ossicular chain fulfilled our expectations in 40% of the patients (air‐bone gap ≤ 10 dB). •  The background of the unsuccessful cases was investigated.