Katarzyna Pierchała

Second stage of Universal Neonatal Hearing Screening – A way for diagnosis and beginning of proper treatment for infants with hearing loss

PURPOSE To analyze retrospectively the results of hearing testing in infants at the second stage of the Polish Universal Neonatal Hearing Screening Program carried out in the Department of Otolaryngology at the Medical University of Warsaw. MATERIAL/METHODS A total of 351 infants referred to our Department for the second stage of UNHS were included in the study. There were 39.60% infants referred due to positive result of hearing screening at the first stage of the Program performed in neonatal units, 55.27% with negative screening but risk factors present, and 5.13% without any tests due to equipment failure in the maternity unit. RESULTS Risk factors were identified in 86.61% of the infants. The most frequent ones were hyperbilirubinemia (71.51%), premature birth (63.25%), and ototoxic medication (62.11%). Otoacoustic emission test showed fail results in 17.66% of the infants, and auditory brainstem responses confirmed hearing loss in 16.81%. Correlation between risk factors and confirmed hearing loss was found for hyperbilirubinemia, low birth weight, intensive therapy for at least 7 days, low Apgar scores, and craniofacial abnormalities. CONCLUSIONS The early identification of infants with hearing loss is essential for early intervention. Not only infants who fail the initial screening but also the ones with risk factors of hearing impairment should be referred to the centers that are capable of providing the necessary diagnostic services required for the second stage of the UNHSP. Those two steps are needed to both minimize the risk of overlooking a child with hearing loss and properly diagnose hearing impairment.

Does effect of rehabilitation based on sensory conflicts in patients with vestibular deficits exceed learning effect

OBJECTIVE The purpose was to assess learning and rehabilitation effect and their influence on Sensory Organization Test results in young and elderly patients with peripheral, central and mixed vestibular pathology. MATERIAL AND METHODS 26 patients with different vestibular system deficits participated in this study. Rehabilitation was held five days a week, for two weeks. To assess learning effect, SOT was administered to each patient twice and compared: 1) on the day preceding the beginning of rehabilitation (SOT1), and 2) on the first day of rehabilitation (SOT2). To evaluate rehabilitation effect, results of SOT2 were compared to SOT3 (administered on the last day of rehabilitation). RESULTS Learning effect showed similar improvement in CS in all groups but young. Rehabilitation caused further improvement in CS in all groups but central pathology. This improvement was similar between those groups. There was no significant difference found between learning and rehabilitation effect in CS. CONCLUSIONS The results of our study indicate that none of the groups achieved significant benefit from rehabilitation based on sensory conflicts that would overcome the learning effect. However, the lack of significant advantage of rehabilitation over learning does not mean that it does not exist.

Evaluation of the Sensory Organization Testto differentiate non-fallers from single- and multi-fallers

BACKGROUND Among the elderly, instability leading to falls (and consequences of them) is one of the most important problems. The etiology of falls is usually complex, but balance, posture and gait problems are considered to be the most important risk factors. OBJECTIVES The objective of this study was to assess the usefulness of the Sensory Organization Test (SOT) in differentiating multi-fallers from single-fallers. MATERIAL AND METHODS The studied group included 92 patients aged >60 years with balance disorders and falls in their history. The patients were divided into 2 groups: multi-fallers and single-fallers. The control group (non-fallers) included 21 individuals. The SOT was performed on the 1st day (SOT1) and on the last day (SOT2) of rehabilitation. Mean equilibrium score (ES) of 1-3 and 4-6 sensory conditions and composite score (CS) of the SOT1 and SOT2 were analyzed. The falls were analyzed as a total number of falls while performing SOT and a number of falls in all 3 repetitions of both conditions 5 and 6 separately. In SOT conditions 1-4 there were no falls observed. RESULTS The importance of SOT to differentiate fallers from non-fallers and single-fallers from multi-fallers is ambiguous. CONCLUSIONS The SOT may or may not indicate the differences between the groups - it does not fully explain those differences. It shows only postural dysfunction without indicating any localization in particular part of vestibular organ. The basic diagnostic evaluation in the elderly with a proneness to falls should include clinical examination and the Dix-Hallpike maneuver, supplemented with a videonystagmography (VNG), which would assess the structure of damage in vestibular organ. Posturography is of less validity in the differentiation of fallers from non-fallers.

Evoked Auditory Potentials Recorded at Fast Stimulation Rates

A precise diagnostics of hearing damages is still a challenge, especially because of limitations of present audiological methods. In this paper, the authors presented the main assumptions of the new method to record auditory responses evoked by high rate of acoustic stimulation. Continuous Loop Averaging Deconvolution (CLAD) is a technique for reading the overlapping recorded responses using the mathematical model of deconvolution developed by Delgado and Ozdamar (2004) and improved by Bohorquez and Ozdamar (2006). Such an option of acoustic stimulation and auditory evoked potential acquisition is getting a new tool for evaluation of the adaptation processes in the hearing organ.

Clinical use of skull tap vestibular evoked myogenic potentials for the diagnoses of the cerebellopontine angle tumor patients.

Objective. To document our experiences using a new skull tapping induced Vestibular Evoked Myogenic Potentials (tap VEMPs) technique combined with standard Auditory Vestibular Evoked Myogenic Potentials (AC VEMPs) for advanced clinical assessment of cerebellopontine angle tumor (CPAT) patients. Design and Study Sample. Three patients were selected in order to highlight observations shown in a larger patient population and to show the variability of the findings. Both tap VEMPs and AC VEMPs were acquired from the sternocleidomastoid muscle (SCM) with EMG-based biofeedback and monitoring. Results. The usefulness of VEMPs was demonstrated, indicating the presence of a tumor and contributing additional information as to the involved nerve bundles in two out of the three cases. Conclusion. Due to the sensory organ dependency and related innervations differences, acquiring both AC VEMPs and tap VEMPs is likely to increase the probability of diagnosing CPATs and provide more information on the involved vestibular nerve bundles. This study demonstrates the feasibility of the possible expansion and combination of tap VEMPs and AC VEMPs techniques into a clinical diagnostic battery for advanced assessment of CPAT patients and its contribution as a guideline for the use of tap VEMPs in general.

Zalecenia postępowania diagnostyczno-terapeutycznego w chorobie Ménière’a

Summary Authors presented review of diagnostic methods and recommended therapeutic rules in Meniere disease. Diagnostic and therapeutic process was presented in a scheme allowing use in a clinical practice. This scheme was the result of analysis of previous experience of authors, data from polish and foreign ENT literature. It is a continuation of recommendations developed in 2008 by the Board of Polish Society of Otorhinolaryngologists, Head and Neck Surgeons

Możliwości zachowania słuchu u pacjenta z neurofibromatozą typu 2 – opis przypadku

The main tumor of cerebellopontine angle are vestibular schwannoma (80-90%). Most of them are unilateral lesion but 5% of them are bilateral pathological mass. There are genetic disease like neurofibromatosis type 1 and 2. According to National Institute of Heath Consensus Development Conference the best treatment method is microsurgery. The possibility of hearing preservation surgery give middle fossa approach and suboccipital approach, radiotherapy or auditory brainstem implants and cochlear implants. The aim of the study is case report of the patient suffered from bilateral vestibular schwannoma. Early diagnosis and therapy enable hearing preservation and good facial nerve function.Summary The main tumor of cerebellopontine angle are vestibular schwannoma (80–90%). Most of them are unilateral lesion but 5% of them are bilateral pathological mass. There are genetic disease like neurofibromatosis type 1 and 2. According to National Institute of Heath Consensus Development Conference the best treatment method is microsurgery. The possibility of hearing preservation surgery give middle fossa approach and suboccipital approach, radiotherapy or auditory brainstem implants and cochlear implants. The aim of the study is case report of the patient suffered from bilateral vestibular schwannoma. Early diagnosis and therapy enable hearing preservation and good facial nerve function.

Narząd równowagi – ocena uszkodzenia w procesie diagnostycznym do operacji wszczepu ślimakowego

Summary Introduction the main problem of a deaf patient is per se communication process. Some of the patients, who are candidates to cochlear implantation report vertigo or imbalance in some everyday situations. The relation of patients’ complaints to vestibular loss was evaluated. The authors used electronystagmography which was realized in diagnostic process to cochlear implantation. The results come from the patients diagnosed in our department in 2006–2007. In accordance to the literature, the true vertigo, was rather rare. Material and methods medical history, caloric tests as electronystagmography results were evaluated retrospectively in 47 patients qualified for cochlear implantation in 2006–2007. Results in the study group, 25 patients did not complain of vertigo; with symmetrical calorics in 10 subjects (40%). The true vertigo reported 6 subjects; 8 subjects had imbalance and unsteadiness on walking. In the group of 47 subjects 8 of them complainted the both- vertigo and imbalance. In the ENG of this group the results of symmetrical responses were evaluated in 57% cases and vestibular hypofunction in 43% subjects. In the group with vertigo (6), 4 subjects (66%) had diagnosed unilateral hypofunction, 1 (17%) bilateral areflexion, 1 subject (17%) had symmetrical responses. Conclusions the necessity of the confrontation ENG results to additional examination in audiological part of diagnostic process to cochlear implantation is underlined.