Clinical findings and bone conduction thresholds were studied in 28 patients, including 20 (22 ears) with acute otitis media (AOM) and 8 (8 ears) with otitis media with effusion (OME). The results were as follows: 1) Upper respiratory infection or common cold like symptoms were noted in 75% of the cases. 2) Blisters, subepithelial bleeding or erosion of the tympanic membrane and/or the external ear canal were found in 23.3%, and remarkable bulging of the tympanic membrane in 26.7% of the cases. 3) 17.9% of the cases complained of vertigo. 4) There were no significant differences among five frequencies (0.25, 0.5, 1, 2, 4kHz) in mean value of bone conduction thresholds at the first visit, in that of air-bone gap and in that of the degrees of improvement of bone conduction thresholds after treatment. 5) After treatment, 73.9% showed complete recovery of bone conduction hearing loss. 6) The raised bone conduction thresholds may not be due to inner ear damage in cases showing remarkable improvement of bone conduction thresholds immediately after removal of effusion by myringotomy. This phenomenon may be due to effect of middle ear effusion on round window and/or ossicles.
Clinical findings in 36 cases (39 ears) of acute otitis media accompanied by inner ear damage were studied. The age of the patients ranged between 4 and 80 years old (average 44.3±15.8). Twenty-seven patients complained of otalgia, and most patients were fouund to have high-tone sensorineural hearing loss. Complete recovery of hearing (recovery of air conduction within 20 dB or to the level within 15 dB of normal side) was obtained in 25 ears and remarkable recovery (recovery of bone conduction 15 dB or greater at least in one frequency) in the remaining 14 ears. Bacterial examination was done in all cases, and 16 isolates of Streptococcus pneumoniae, 3 of Group A streptococci, and 3 of Haemophilus influenzae were recovered. Of the 16 strains of S. pneumoniae, 6 were mucoid type S. pneumoniae. These are invasive and virulent strains, which caused severe otalgia and sensorineural hearing loss of patients. These strains are resistant to cephems but susceptible to penicillins. So when cephems were selected as a first choice, healing of the otitis media tend to be delayed. We should have bacterial examination to select adequate antibiotics.
Bone conduction thresholds were measured in 48 patients with unilateral chronic otitis media to examine the relationship between chronic otitis media and sensorineural hearing loss (SNHL). They consisted of 23 ears with chronic otitis media, 23 ears with cholesteatoma without labyrinthine fistula and 2 ears with cholesteatoma with labyrinthine fistula. Audiograms were analyzed for evidence of SNHL, defined as the difference in preoperative bone conduction thresholds between the diseased and control (normal contralateral) ears. There were significant differences between the diseased and control ears in both diseases across the frequency range and they varied from 3.7dB to 9.8dB. Bone conduction differences at 2000Hz were significantly worse in the ears with ossicular disruption while they were not significant in those without ossicular disruption, suggesting the influence of Carhart effect on this frequency. Two ears with labyrinthine fistula showed larger bone conduction differences than those without labyrinthine fistula. These results indicate that chronic otitis media is associated with SNHL, but the degree of SNHL is small in the majority of patients.
So-called eosinophilic otitis media is an intractable otitis media characterized by bilateral, consistent viscous middle ear effusion, and severe granulation in the middle ear. Patients with this otitis media also have mature onset bronchial asthma. The pure-tone audiometry of these patients reveal various types, and some of them show severe and progressive sensorineural hearing loss. We reported a case with cochlear implant in a 59-year-old man with ‘eosinophilic otitis media’ who received treatment for bronchial asthma for seven years. He visited our department complaining of consistent otorrhea and progressive bilateral hearing impairment. The pure tone audiogram showed bilateral profound sensorineural hearing loss. With the bronchial asthma and otorrhea, under control, we performed cochlear implantation in his right ear. He was able to distinguish his family's voice immediately after the first fitting. We speculated that this inner ear dysfunction was associated with ischaemic changes caused by secreting inflammatory cytokines in addition to adhesion molecules.
Clinical findings in 21 ears of 21 patients (3 males and 18 females) with sensorineural hearing loss due to acute otitis media were studied. Total number of patients (above 10 years old) who were suffering from acute otitis media and treated in same period were 801 cases. The patients were 14 to 66 years old and complained of otalgia, hearing loss and tinnitus. They were treated with antibiotics combined with steroids, adenosine triphosphate and vitamins. Following results were obtained; complete recovery of hearing loss in 10 cases, moderate recovery in 5 cases and no recovery in a case but in 5 cases final audiological result was not obtained. We recomended earmy auditory examinations for patients who had complaint about signs of sensorineural hearing loss and/or tinnitus.
Based on the results of questionnaire given to the cochlear implant (CI) users, current CI usage status, potential problems, factors that influence their satisfaction were discussed. Questionnaires were sent by mail to 80 CI users who have been implanted for more than five years at the Tokyo Medical University Hospital since 1985, when CI was first introduced to Japan. It was shown that CI is practically used in their daily life and more CI users expect further improvement in speech discrimination in noise, music perception, telephone usage and hard ware. Technological development, such as waterproof CI and total implantable CI was also desired. Despite the fact that they obtained hearing ability and were well encouraged, the degree of CI usefulness tended to decrease as compared with the results of the survey we made in 2000. Judging from their comments, they seemed to expect more from CI as they get accustomed to using CI.
Many patients with cochlear implantation can use the devices very stably and comfortably after several months of rehabilitation for auditory communication. Some patients, however, may have clinical problems even more than one year after operation. They may suffer from otitis media in operated ears, electrode disorder, or extrusion of the implanted devices out of skin. In three cases we have experienced such problems, treatment needed for disorder was not similar; topical cleaning of the implanted ear was effective in one case and operation were performed in two cases. The effect of trouble on their hearing also varied in each case, and mapping of the electrodes needed to be readjusted in all three cases. Their clinical course and our procedure are reported in this article.
Lingual development and behavioral changes after cochlear implantation were studied in 6 children. Caselis a male with congenital deafness and implanted at 2 years and 5 months old. Case 2 is a female with congenital rubella syndrome and implanted at 3 years and 7 months old. Case 3 is a male with congenital deafness syndrome and implanted at 7 years and 9 months old. Case 4 is a female with congenital cochlear malformation (common-cavity type) and implanted at 4 years and 8 months old. Case 5 is a female with progressive deafness and implanted at 6 years and 2 months old. Case 6 is a female with congenital deafness and implanted at 1 year and 11 months old. Their pre-post changes of the lingual development and the developmental index were studied with lingual-social area of a shin-pan K shiki developmental examination, and their behavioral changes were also examined. Every child demonstrated well lingual development. But their developmental indexes did not reached at normal level. Behavioral changes showed that every child but one became able to hear environmental sounds after 3 months, and speech sounds after 6 months. We concluded that cochlear implantation is useful for all, but they have been in development, so we have to follow them up more long-term.
Eight patients with cisplatin-induced hearing loss were evaluated. All 8 patients had sensory neural hearing loss at 4kHz and 8kHz or at 8kHz after cisplatin administration. Their hearing thresholds at 8kHz were remarkably worse than at 4kHz. Hearing loss in 6 patients progressively worsened after successive administration of the drug. However, 5 patients recovered from their cisplatin-induced hearing loss. The average hearing threshold after recovery was 12dB at 4kHz and 33dB at 8kHz. Hearing thresholds at 4kHz showed a tendency to be better than at 8kHz after recovery. Unfortunately, the hearing in 4 out of 5 patients deteriorated again after cisplatin re-administration. In DPOAE testing, recovery of DP level paralleled the hearing threshold finding strongly suggested that damage to outer hair cell function was reversible.