Yahav Oron

Cardiovascular Risk Factors as Causes for Hearing Impairment

The purpose of this paper is to provide a contemporary review of the correlation between cardiovascular risk factors (CVRFs) and hearing impairment (HI). We conducted a comprehensive review of the literature in order to assess the effects of the different CVRFs on HI. We focused on the pathological findings in the inner ear and their correlation with cochlear function in population-based studies. We found that CVRFs adversely affect hearing acuity. HI diagnosis should be accompanied by detecting and treating CVRFs, according to the presented outline, which may augment hearing rehabilitation and improve the general health and the well-being of the patient.

Impact of Pneumococcal Conjugate Vaccines on Selected Head and Neck Infections in Hospitalized Israeli Children.

Background: Streptococcus pneumoniae is a major pathogen of pediatric head and neck infections (HNIs), for example, acute otitis media (AOM), acute mastoiditis, acute bacterial sinusitis and meningitis. The aim of this study was to characterize the epidemiology of pneumococcal HNIs (pHNIs) before, during and after the introduction of pneumococcal conjugate vaccines (PCVs). Methods: Children 0–16 years of age, who were hospitalized with HNIs in the pediatrics department in a general hospital between January 1, 2007, and December 31, 2014, were retrospectively identified. Study years were categorized according to the PCV introduction timeline: 2007–2008: “pre-PCV years”; 2009–2011: “transition years” and 2012–2014: “post-PCV years.” pHNIs episodes were defined if pneumococcal culture or urine antigen was positive. Children who received ≥2 doses of PCV7/PCV13 were considered as immunized. All other children were considered as unimmunized. Results: HNIs accounted for 2.5%–4.7% of the total admissions; 3%–17% of them were pHNIs. Eighty-seven pHNI episodes were identified: AOM (n = 42), acute mastoiditis (n = 28) and meningitis (n = 17). There was a downward trend in the overall incidence of HNIs, and particularly of pHNIs, in the post-PCV years. The average age and hospitalization duration of children with HNIs/pHNIs remained stable during the study years. In 2009–2010, pHNIs incidence sharply decreased, from 7 to 1.74/1000 hospitalized children/year, due to ~55% reduction of pneumococcal AOM episodes. An additional decrease was observed in the post-PCV years (1.62/1000 hospitalized children/year). Immunized children were less likely to present with pHNIs (P = 0.001) but were more likely to undergo surgery (P = 0.042). Conclusion: We observed a reduction in pHNIs incidence after PCV program implementation.

Cardiovascular Risk Factors Among Patients With Vestibular Neuritis

Objective: To investigate the correlation between cardiovascular risk factors (CVRFs) and vestibular neuritis (VN) in hospitalized adult patients. Methods: A cross-sectional retrospective study was conducted in a tertiary hospital setting. The medical records of patients (aged over 18 years old) who were hospitalized between the years 2005 and 2014 with the diagnosis of VN were retrieved. Inclusion criteria were: (1) acute vertigo lasting for at least 24 hours, (2) absence of auditory complaints, (3) horizontal unidirectional nystagmus present during physical examination, and (4) absence of neurological symptoms or signs. The ratio of CVRFs among VN patients was compared to the ratio of those among the general Israeli population. Results: A significantly higher prevalence of CVRFs was found among VN hospitalized patients in comparison to the general population (P < .05). Furthermore, a significant correlation (P < .001) was found between the patients’ age and the number of CVRFs (r = .387). A positive correlation (r = .643) was found between the number of CVRFs and VN in each age group (P = .119). Conclusion: There may be a possible interrelation between CVRFs and VN. This correlation can be caused by occlusion of small blood vessels leading to labyrinthine ischemia and apparition of symptoms of VN.

Smelling Pseudomonas aeruginosa infections using a whole-cell biosensor – An alternative for the gold-standard culturing assay

Improved easy-to-use diagnostic tools for infections are in strong demand worldwide. Yet, despite dramatic advances in diagnostic technologies, the gold-standard remains culturing. Here we offer an alternative tool demonstrating that a bacterial biosensor can efficiently detect Pseudomonas aeruginosa infections in patients suffering from otitis externa. Detection was based on specific binding between the biosensor and 2-aminoacetophenone (2-AA), a volatile produced by P. aeruginosa in high amounts. We collected pus samples from ears of 26 subjects exhibiting symptoms of otitis externa. Detection of P. aeruginosa using the biosensor was compared to detection using gold-standard culturing assay and to gas-chromatograph-mass-spectrometry (GC-MS) analyses of 2-AA. The biosensor strain test matched the culture assay in 24 samples (92%) and the GC-MS analyses in 25 samples (96%). With this result in hand, we designed a device containing a whole-cell luminescent biosensor combined with a photo-multiplier tube. This device allowed detection of 2-AA at levels as low as 2 nmol, on par with detection level of GC-MS. The results of the described study demonstrate that the volatile 2-AA serves as an effective biomarker for P. aeruginosa in ear infections, and that activation of the biosensor strain by 2-AA provides a unique opportunity to design an easy-to-use device that can specifically detect P. aeruginosa infections.

Diagnostic Criteria for Somatosensory Tinnitus: A Delphi Process and Face-to-Face Meeting to Establish Consensus

Since somatic or somatosensory tinnitus (ST) was first described as a subtype of subjective tinnitus, where altered somatosensory afference from the cervical spine or temporomandibular area causes or changes a patient’s tinnitus perception, several studies in humans and animals have provided a neurophysiological explanation for this type of tinnitus. Due to a lack of unambiguous clinical tests, many authors and clinicians use their own criteria for diagnosing ST. This resulted in large differences in prevalence figures in different studies and limits the comparison of clinical trials on ST treatment. This study aimed to reach an international consensus on diagnostic criteria for ST among experts, scientists and clinicians using a Delphi survey and face-to-face consensus meeting strategy. Following recommended procedures to gain expert consensus, a two-round Delphi survey was delivered online, followed by an in-person consensus meeting. Experts agreed upon a set of criteria that strongly suggest ST. These criteria comprise items on somatosensory modulation, specific tinnitus characteristics, and symptoms that can accompany the tinnitus. None of these criteria have to be present in every single patient with ST, but in case they are present, they strongly suggest the presence of ST. Because of the international nature of the survey, we expect these criteria to gain wide acceptance in the research field and to serve as a guideline for clinicians across all disciplines. Criteria developed in this consensus paper should now allow further investigation of the extent of somatosensory influence in individual tinnitus patients and tinnitus populations.

The association between auditory nerve neurovascular conflict and sudden unilateral sensorineural hearing loss: Auditory nerve neurovascular conflict and SSNHL

There may be an association between a neurovascular conflict (NVC) of the auditory nerve and unilateral sudden sensorineural hearing loss (SSNHL).

The Hebrew version of the Eustachian tube dysfunction questionnaire-7

Abstract Background: Eustachian tube (ET) dysfunction is a common condition that can lead to significant morbidity, yet few reliable instruments are available to measure ET function. History, physical examination and tympanometry are the mainstay tools, with video endoscopy, manometry and sonotubometry used less frequently. Even when combined together, these may be unable to accurately estimate ET function. Questionnaires for assessing pain, organ function and quality of life are considered useful measurements, and they are used routinely in a variety of medical fields, including otolaryngology. The English-language Eustachian Tube Dysfunction Questionnaire, ETDQ-7, was developed in 2012 and was subsequently included in the assessment of ET function. Objective: To validate a Hebrew version of the ETDQ-7 questionnaire. Methods: The ETDQ-7 questionnaire was translated into Hebrew by a validated method. Native Hebrew speakers with and without ETD were asked to fill in the Hebrew version on 3 separate occasions, and the results were analysed and interpreted. Results: A total of 115 patients filled in the questionnaires. Internal consistency (alpha Cronbachs coefficient) of the first, second and third questionnaires was 0.918, 0.922 and 0.890, respectively. The Interclass Correlation Coefficient for consistency between the first and second questionnaires was 0.930. The area under the ROC curve for the first and second questionnaires was 0.956, representing an excellent discrimination capability. Conclusion: The Hebrew version of the ETDQ-7 showed significant consistency and clinical relevance. It was validated and can now be helpful in the assessment of ET function and the effects of ET manipulations.

A Hebrew Adaptation of the Tinnitus Functional Index

Tinnitus is the perception of sounds, when no external stimuli exists. Its prevalence has been estimated to be between 8% and 30% in the general population (1). Some patients describe intrusive tinnitus which affects many aspects of their lives, while others describe an insignificant disturbance caused by the tinnitus (2). Since tinnitus is a subjective symptom in most cases, defining its effect on patients’ lives can be challenging. Several questionnaires have been developed in order to characterize the effects of tinnitus on patients’ lives. n nThis article is protected by copyright. All rights reserved.

Superior semicircular canal dehiscence with concomitant otosclerosis-A literature review and case discussion

Computed tomography scan should be performed as a routine before every stapes surgery, in order to exclude concomitant superior semicircular canal dehiscence, since no other clinical, audiological, or electro‐physiological criteria are available to exclude concomitant superior semicircular canal dehiscence in the otosclerotic temporal bone.

The Middle Ear Cleft Status in a “Natural” Cohort With Eustachian Tube Dysfunction

BACKGROUNDnThe Eustachian tube (ET) has a major role in the middle ear (ME) pressure homeostasis. ET dysfunction is the accepted paradigm for pressure-related ME disorders. We studied the ME status in patients with severely diminished ET opening abilities, and anticipated to find ME disorders in most of them.nnnPATIENTS AND METHODSnME status was evaluated in unconscious adults, who were hospitalized in a rehabilitation center with severe brain damage, requiring tracheotomy and gastrostomy. These patients were unable to swallow, produce valsalva, yawn, and needed oral suctioning. Examination included fiberoptic nasopharyngoscopy, gag reflex and soft palate assessments, otoscopy, and tympanometry.nnnRESULTSnNineteen patients (38 ears) were evaluated: 14 men and 5 women, aged 18 to 93 years (average 59). Duration of gastrostomy and tracheotomy were between 3 months and 18 years. All the patients lacked gag reflex, palatal movements, or supraglottic sensation. Eighteen ears (47%) had otitis media with effusion (OME) (versus ∼3% in the general population, pu200a=u200a0.00001), none had significant tympanic membrane atelectasis, but 20 (53%) ears were normal. Twenty-two ears (59%) had tympanometry types B/C and 16 (41%) had type A. Cerumen impaction incidence (26 ears, 68%) was significantly higher than in normal adults (10%), mentally retarded (36%), and nursing homes residents (57%).nnnCONCLUSIONSnA dysfunctional ET predisposed ME disorders. Yet, ∼50% of the ears were normal, in contrast to the current paradigm. This implies that ME pressure homeostasis is maintained by factors that can compensate for ET dysfunction. Treating cerumen impaction and OME may be beneficial for rehabilitation.