Mohamed Ibrahim Shabana

Congenital aural atresia: Transmastoid approach; an old technique with good results

OBJECTIVE Congenital aural atresia prevents sound conduction to the inner ear, so the child may suffer learning problems. Transmastoid approach is a safe method to create functional pathway by which sound can reach the cochlear fluids but it leaves mastoid cavity which may be problematic. The purpose of this study is to assess the feasibility of improving hearing in those patients on the expense of mastoid cavity. METHODS Forty children with congenital aural atresia were included in this study. All had functioning cochlea on evoked response audiometry and normal cochlear morphology with pneumatized mastoid on CT scan. Transmastoid approach was used for reconstruction of the external auditory canal with covering of the newly created canal using split thickness skin graft. Reconstruction of the tympanic membrane was carried out by temporalis fascia graft. Follow-up of the patients for 3 years was carried out. RESULTS Surgical success is considered on restoration of hearing and maintenance of a patent, infection-free ear canal. This study showed a successful hearing result in 85% of patients at 3 months postoperatively, this result diminished to 65% after 3 years. The incidence of canal restenosis was 17.5%; the narrowing was in the outer cartilaginous part. No cases developed facial nerve paralysis or sensorineural hearing loss postoperatively. CONCLUSIONS Congenital aural atresia is one of the most difficult and challenging surgeries for the otologic surgeon. However, in the hands of experienced otologists, repair of this deformity can be performed safely and with predictable results using transmastoid approach.

Telemetry changes over time in cochlear implant patients

Abstract Objectives: This is a cross-sectional study conducted on cochlear implant recipients, to monitor changes in recorded impedance telemetry and evoked compound action potentials (ECAP) measured during surgery versus the same measures at post implant follow-up visits. An additional aim was to correlate the recorded ECAP measures with the patients post-operative performance and to evaluate the incidence of abnormal intra-operative cochlear implant telemetry measurements and their changes at device activation. Study design: The present study comprised 44 subjects – 12 adults and 32 children of both genders – implanted at the Cochlear Implant Unit, Cairo University. ECAP thresholds and electrode impedance measures were collected intra-operatively, at initial stimulation, and at 9–12 months post initial stimulation. Measurements were compared at the three intervals and ECAP measures were correlated to the patients post-operative performance in the form of aided sound field thresholds, speech detection and discrimination for adults and language assessment for children. Results: In the absence of electrical stimulation, there was an increase of impedance on all electrodes at the initial stimulation visit, which decreased at the 9–12 months follow-up. Open circuit findings were more prevalent than short circuits. Children had higher impedance values at post implant activation compared to adult patients. No correlation existed between ECAP thresholds and post-operative patient performance at the one-year evaluation. Conclusion: At the time of surgery, telemetry provides valuable information regarding the electrical output of the implant and the response of the auditory system to electrical stimulation; however, it is not a valuable predictor of post-operative performance.AbstractObjectives: This is a cross-sectional study conducted on cochlear implant recipients, to monitor changes in recorded impedance telemetry and evoked compound action potentials (ECAP) measured during surgery versus the same measures at post implant follow-up visits. An additional aim was to correlate the recorded ECAP measures with the patients post-operative performance and to evaluate the incidence of abnormal intra-operative cochlear implant telemetry measurements and their changes at device activation. Study design: The present study comprised 44 subjects – 12 adults and 32 children of both genders – implanted at the Cochlear Implant Unit, Cairo University. ECAP thresholds and electrode impedance measures were collected intra-operatively, at initial stimulation, and at 9–12 months post initial stimulation. Measurements were compared at the three intervals and ECAP measures were correlated to the patients post-operative performance in the form of aided sound field thresholds, speech detection a...

Assessment of Hyperacusis in Egyptian patients: Evaluation of the Arabic version of the Khalfa questionnaire

Abstract Objectives: Hyperacusis appears to be a subjective phenomenon, which is not easily defined or quantified by objective measurements. The primary aim of this work was to evaluate the Arabic version of the Khalfa questionnaire for hyperacusis on a sample of normal hearing Egyptians complaining of hyperacusis. The secondary aim was to compare the audiological criteria of this group of hyperacusis patients (with or without tinnitus) with a control group of similar age and gender. Study design: The study group comprised 60 adult patients (age range 19–45 years) having normal hearing and complaining of hyperacusis with or without tinnitus. The control group comprised 20 normal hearing age and gender-matched individuals. All patients were subjected to full history-taking, otological examination, pure tone audiometry, immittance audiometry, uncomfortable loudness levels (ULLs) assessment, a transient evoked otoacoustic emissions (TEOAEs) test and, in addition, to the Arabic version of the Khalfa hyperacusis questionnaire. Results: The uncomfortable loudness levels indicated a markedly contracted dynamic range in the hyperacusis group, with the majority of individuals showing ULLs less than 90dB HL. Hyperacusis patients with tinnitus showed significantly lower TEOAEs amplitudes, with overall echo level and reproducibility percent lower than for hyperacusis patients without tinnitus or for the control group. Hyperacusis patients had higher means of total, attentional, social, and emotional scores on the Khalfa questionnaire compared to the control group. The emotional parameter of the questionnaire had the highest score for the hyperacusis patients. Both the emotional and attentional dimension scores were higher in females, while attentional scores were higher for males. The total and social dimensions were affected by age. Conclusions: The emotional impact of noise exposure was more severe than the attentional and social impact in hyperacusis patients. There was a gender difference evident in the results of the Khalfa questionnaire in hyperacusis patients. The Arabic version of the Khalfa hyperacusis questionnaire seems to be a fairly effective tool for the assessment of hyperacusis patients.

Counselling and amplification with and without fractal music (Zen tones) for management of patients suffering from hearing loss and tinnitus

Abstract Background: Counselling, stress reduction and sound stimulation have been effective in the management of tinnitus. Aim of the work: It was to investigate the effectiveness of counselling and amplification and sound stimulation (Zen tones of fractal music) technology for hearing impaired patients suffering from tinnitus. Methods: This study included 40 hearing impaired subjects with tinnitus, divided into two groups: Both received counselling for 2 months then amplification for 4 months. The study group had their hearing aids with Zen program activated. Results: Post-counselling, none of the cases or controls showed improvement >20 points in the total tinnitus handicap inventory (THI) score. Only 20% of the study group and 15% of the controls showed improved tinnitus severity. Only one of the study group showed improvement in the tinnitus functional index (TFI) > 13 points. After hearing aids, 80% of the study group showed improvement in the tinnitus severity degree compared to 60% of the controls. And 20% improved ≥20 points in the total THI score, compared to none of the controls. Half of the study group improved in the TFI >13 points, compared to only 10% of the controls, and this was statistically significant. After 6 months, both groups showed comparable improvement in THI tinnitus severity degree: But 60% of the study group and only 15% of the controls improved ≥20 points in total THI score and this difference was statistically significant. And (85%) of the study group improved >13 points in total TFI score following both counselling and hearing aid fitting, compared to 50% of the controls, and this was statistically significant. Conclusion: Counselling alone had no significant effect on tinnitus improvement in the hearing-impaired patients. The combined approach of counselling and amplification resulted in remarkable improvement. And added music resulted in greater improvements, but was more effective when the loudness of the perceived tinnitus was weaker.

Sound therapy for tinnitus patients

Sound therapy, or use of any sound for the purposes of tinnitus management, is widely accepted as a management tool for tinnitus. Sound therapy have varying goals. Reducing the attention drawn to tinnitus, reducing the loudness of tinnitus, substituting a less disruptive noise. Sound therapy can be achieved with many modalities: Environmental Enrichment, tinnitus maskers, hearing aids and combination instruments such as: Danalogic iFIT Tinnitus, ReSound Live TS, Oticon’s Tinnitus “SoundSupport”, Phonak’s Tinnitus Balance and Widex Zen Fractal Tones. There are other sound devices e.g.: Acoustic Co-ordinated Reset, Neuromodulation, Serenade, Neuromonics, Phase-Out, Phase-shift and tinnitus inhibitory pathway activation. The advantages of sound therapy are: being non-invasive, reduce patient frustration and anxiety, some patients experience residual inhibition and it can facilitate patient’s habituation to tinnitus.

Comparison of two hearing aid fitting formulae in improving the patients’ satisfaction with amplification for experienced hearing aid users

Introduction The effectiveness of real word satisfaction is very important for optimal hearing aid (HA) fitting, which can be assessed using self-report questionnaires. The Client Oriented Scale of Improvement (COSI) and Abbreviated Profile of Hearing Aid Benefit (APHAB) are useful tools for assessing the effectiveness of HA in achieving patient satisfaction. Patients and methods This study included 20 hearing-impaired adults. Their hearing thresholds ranged from moderate to moderately severe sensorineural hearing loss and had previous experience with HAs. Their ages ranged from 18 to 60 years, and the mean duration of HA experience was 3.85±5.02 years. Participants were examined in three scheduled sessions: unaided, aided National Acoustics Laboratories-Nonlinear 2 (NAL-NL2), and aided desired sensation level (DSL) v5. Each session was scheduled 2 months after the previous session. Patient satisfaction was assessed using the COSI and APHAB questionnaires for each HA fitting formulae. Results Both formulae have improved patient’s five client needs of the COSI; however, NAL-NL2 had better final ability score compared with DSL v5. Using the APHAB questionnaire, both formulae have decreased the listening difficulty score significantly. Using APHAB questionnaire, NAL-NL2 showed significantly less listening difficulty compared with DSL v5 as regards difficulties in ease of communication, broadband noise, and reverberation. However, both formulae did not improve ‘aversiveness’ conditions. Conclusion Questionnaires are equally important to audiometric tests and should not be underestimated and hence should be relied upon it in HA-fitting verification.

Ocular motor tests in relapsing remitting multiple sclerosis

Background Multiple sclerosis (MS) is the quintessential neurologic disorder from which one can gain insights into the principles of afferent and efferent neuro-ophthalmology. The popularity of eye movements as an experimental tool can be partly attributed to the fact that they can be conveniently and accurately measured and analyzed, and also because much is known about their neural substrate. It is therefore no surprise that eye movements have been commonly applied to better understand the visual and motor disorders in patients with MS. Objectives The aim of this study was to demonstrate the vast ocular motor abnormalities that occur in this disease using videonystagmography as our tool of description and determine the relationship with Expanded Disability Status Scale (EDSS) and MRI findings. Materials and methods The current study included 76 patients who were divided into two groups. Group I comprised 54 patients with relapsing-remitting multiple sclerosis who fulfilled the Revised Mcdonald′s criteria for diagnosis of MS. The age of the patients in group I ranged from 20 to 68 years, with a mean of 35.13 ± 9.42 SD (23 men and 31 women). Group II comprised 22 healthy age-matched and sex-matched individuals who were recruited from the general population and were not relatives of the patients. Their ages ranged from 19 to 54 years, with a mean of 33.81 years ± 10.07 SD (11 men and 11 women). Video-nystagmography, saccadic tracking, random horizontal saccades, optokinetic tracking (at 20, 40, and 60΀/s), smooth pursuit (0.2, 0.3, 0.4, 0.5, 0.6, and 0.7 Hz), and gaze-evoked nystagmus were examined in both groups. Group I, in addition, was subjected to a thorough neurological history and neurological examination, EDSS assessment, ophthalmologic examination (visual acuity and ocular motility), and radiological assessment by MRI with and without contrast. Results The eye movement disorders most commonly noted are saccadic dysmetria, followed by gaze-evoked nystagmus and pendular nystagmus. They are caused by disease affecting the brain stem and cerebellar circuits. Reduced pursuit gain and saccadic pursuit were also noted. A strong correlation between brainstem and cerebellar MRI lesions and the affection of the ocular motor system was well noted. A high EDSS score was well correlated with abnormal ocular motor test findings. Conclusion Ocular motor system tests are more sensitive than conventional clinical examinations in identifying abnormalities in MS.

Assessing the applications of cortical auditory evoked potentials as a biomarker in children with hearing aids

Background Cortical auditory evoked potentials (CAEPs) are noninvasive measures used to quantify central auditory system function in humans. More specifically, the P1-N1-P2 CAEP has a unique role in identifying a central auditory system that has benefited from amplification or implantation. P1 reflects the maturation of the auditory system in general as it has developed over time. Objective The objective of this study was to assess the CAEP in children with hearing aids versus age-matched controls, and to compare the pattern of P1 CAEP in patients with hearing aids versus those with cochlear implants. Materials and methods Twenty hearing-impaired children (using their own binaural digital hearing aids) were compared with 20 age-matched and sex-matched children with normal hearing. In both groups, P1 CAEP latency and waveform morphology were recorded by free-field auditory stimulation using tone bursts at 500 and 2000 Hz at 100 dB sound pressure level. Finally, P1 CAEP was compared between patients using hearing aids and 20 children with cochlear implants. Results We have assessed the use of P1 latency and CAEP waveform morphology in a total of 20 children with hearing aids as a biomarker for the development of the central auditory pathway in patients with hearing loss. Children using hearing aids exhibited an exponential decay in P1 latencies, indicating an overall delay in maturation when compared with that in children with normal hearing. There was no statistically significant difference as regards P1 latencies and amplitudes between cochlear implant and hearing aid users, who showed statistically significantly higher mean values compared with the normal group. Conclusion Childrens auditory systems develop comparatively as long as they are receiving appropriate amplification, whether this is through a cochlear implant or through the use of hearing aids. The P1 CAEP test can be applied as a tool in the diagnosis of central processing disorders in children with hearing impairments fitted with cochlear implants or hearing aids. This information will be useful when monitoring a childs progress with his hearing device and in auditory training.

Fast psychophysical tuning curves of the cochlea in normal hearing individuals

Introduction Fast psychophysical tuning curve (fPTC) test is a fast computer-based method that aims to assess the frequency selectivity of the cochlea and to detect the dead regions. It can quickly identify tip frequency and Q10 of psychophysical tuning curves (PTCs) derived by using a band of noise that changes in center frequency and a Bιkιsy method to adjust the masker level required for threshold of the noise. We applied this method in normal hearing individuals in the presence of threshold equalizing noises at three signal levels. The sharpness of the PTCs (Q10) and the typical shift of tips of the PTCs for 16 normal hearing individuals, when the tip frequency is estimated for the average of a forward and reverse sweep, were obtained. The results were used to determine the mean, SD, and 95% confidence interval of the shifts in normal hearing individuals. Objective The purpose of this experiment was to estimate the typical shift of tips of the PTCs for normal hearing individuals. The results were used to determine the mean, SD, and 95% confidence interval of the shifts. The sharpness of the PTCs change with signal level under conditions where off-frequency listening is restricted, using a background noise, was also assessed. This was performed to allow a comparison with the results of hearing-impaired patients tested at the same level (but without background noise). Study design Sixteen adults of both sexes (eight male individuals and eight female individuals) were randomly selected to establish normative data for the fPTC test. They were selected with age ranging from 18 to 45 years. All individuals had normal middle ear function as indicated by tympanometry and acoustic reflex measurement and by hearing threshold equal to or better than 20 dB at octave frequencies in the frequency range (250-8000 Hz) (as defined by ANSI S3.6-2004).

Comparison of three fitting rationales in adults in an artificial intelligence parallel processing hearing aid

Introduction Hearing rehabilitation using nonlinear hearing aid (HA) fitting formulae provides hearing-impaired individuals with the audibility, comfort, and speech intelligibility for a better life. Objective To compare three nonlinear HA fitting formulae in adults in a Channel Free artificial intelligence parallel processing HA. Materials and methods The study included 19 adults with bilateral moderate to severe sensorineural hearing loss, monaurally fitted with nonlinear HA. Comparisons were made on the basis of aided speech intelligibility in quiet and in noise, aided sound field thresholds, and functional performance in real life using APHAB, COSI, and GHABP questionnaires. Results The three formulae have significantly improved speech discrimination in adults, with no significant difference among the formulae for speech intelligibility in quiet or in noise, with no sex or HA experience differences. The three formulae have significantly improved functional performance in real-life speech communication, with the NAL-NL1-based formula showing the greatest degree of benefit and improvement in listening needs, followed by NAL-NL1 and then DSL [I/O]. However, amplification with the three formulae increased aversiveness to environmental sounds. Participants reported significant benefits using NAL and NAL-NL1-based formulae. Experienced HA users, using the NAL-NL1-based formula, showed significantly less difficulty in listening quality in large spaces and greater capacity to recognize speech within competitive noise and better tolerance to environmental sounds than nonexperienced users. The SPIN test correlated well with real-life speech communication. Conclusion The three fitting rationales have equally improved intelligibility, with variable degrees of improvement in real-life speech communication with preferences for NAL-NL1 and the manufacture-specific NAL-NL1-based formula.