We report the results of neuropsychological tests and 6 years' auditory training of a deaf child (N. K., female) who received a cochlea implant. She was a multiple handicapped (deafness, a slight developmental retardation, orthopedical impairment) by embryonal cytomegalovirus infection. We trained her speech with a hearing aid from age 4 years 5 months to 6 years 2 months. After entering a school for hardness of hearing class, she showed notable learning disability and attention deficit with hyperactivity disorder. She weared cochlea implant to the left ear at the age of 7 years 7 months at Okayama University We trained her up to the age of 10 years 5 months by auditory method. 1) Cochlea implantation contributed greatly the development of her hearing, daily conversation, and a stable relationship between mother and child. 2) Disability for acquisition of articulation, vocabulary, intelligence and reading remained, suggesting the importance of speech training till the age of six years old. 3) The effectiveness of cochlear implantation in a multiple handicapped deaf child was suggested.
Clinical findings of 47 ears of 43 patients (24 females and 19 males) with inner ear damage due to acute otitis media were studied. The ages of the patients ranged from 16 to 78 years old (average 49 years old). Patients complained of hearing loss, otalgia, tinnitus, otorrhea and vertigo at the time of their first visit. They were treated by systemic administration of antibiotics, steroids, and vitamins. All of the inpatients showed remarkable recovery of hearing, but 8 cases of the outpatients showed no change. In this disease, we recommend that the patients should keep rest and be treated for inflammation immediately.
The present status and the future of the clinical application of auditory evoked potentials were discussed mainly concerning auditory brainstem response (ABR). The clinical applications of ABR are divided into 2 groups: neurological diagnosis and objective audiometry. ABR is an important examination in the diagnosis of brainstem and acoustic nerve lesions, such as acoustic neurinoma, auditory neuropathy, brainstem infarction etc. However, nermal ABR finding became to be found in about 15% of acoustic neurinoma patients after the introduction of MRI in the diagnosis of acoustic neurinoma. In the diagnosis of brain death, diagnostic significance of ABR is limited due to the presence of hearing impairment. ABR is a bit time consuming as a device for intra-operative monitoring. ABR is now most widely used as an objective audiometry for young children. Recently, automated ABR was successfully introduced in the infant hearing screening. Amplitude-modulation following response (AMFR), a kind of auditory steady-state response, detected by phase spectral analysis using fast Fourier transform appears to be accurate in hearing assessment and to have a good frequency specificity, and it became possible to generate an audiogram in a frequency-specific manner only by the thresholds of AMFR.
To investigate the situation of FM systems used at elementary and junior high schools, I analyzed answers to questionnaires from the boards of education of administration units in Osaka Prefecture. One board of education did not grasp even the number of students with difficulty in hearing However, others were eagerly engaged in education for them. In 33 of 43 cities, 147 students are going to non-hearing-impaired elementary and 45 to junior high schools. In 16 cities, teachers use FM systems for all of these students. Totally, 61% and 44% of these students receive benefit from FM system at their classroom in the elementary and the junior high schools, respectively. In some instances, there are scarcely otolaryngologists' contributions. Otolaryngologists should educate teachers more intensively.
A new simple method to detect functional hearing loss cases from other organic hearing loss cases using an air conduction pure-tone audiometer was presented. One hundred twelve cases of functional hearing loss underwent pure-tone audiometry test. Pure-tone audiometry test was performed firstly using 7 pulse pure-tones at 125Hz, 250Hz, 500Hz, 1000Hz, 2000Hz, 4000Hz, and 8000Hz and then, using 7 continuous pure-tones. Thresholds of pulse and continuous tone were compared at each frequency, and the numbers of frequencies with 10dB or more threshold difference were counted. The number was scored as positive when the threshold measured with continuous pure-tone was better than those measured with pulse pure-tone. On the contrary, the number was scored as negative when the pulse pure-tone threshold was better than that of continuous pure-tone. Finally, each ear was classified from 7 to -7, and the score, which is larger in the absolute number, was represented as case score. The average case score of functional hearing loss (3 plus minus 3, average plus minus SD) was significantly larger than the case score of control (-0.3 plus minus 0.9) (p<0.001; Mann-Whitney test). Functional hearing loss is highly suspected, when the case score shows larger than 2.
Acute Low-tone Sensorineural Hearing Loss (ALSH) is a disease characterized by repetition or recurrence and shift to Meniere's disease. Grasping these characteristics is important in determining the duration of medication and follow-up period. History taking of the patients with this disease at their first medical examination reveals some cases of spontaneous cure, in which the patient, though without the history of medical examination, was aware of tinnitus or feeling of ear fullness for a fixed period of time without any cause. In short, there is a possibility that not a few patients presented with this disease as repetition or recurrence at their first medical examination. Setting an eye on this point, we studied whether the difference between the cases suspected of recurrence on history taking and the cases considered as the first occurrence is reflected in the audiograms and subjective symptoms. As a result, the hearing level at 1kHz was significantly low in the audiograms at the first medical examination and prognosis was also poor in the group of patients suspected of recurrence. This is a result not contradictory with the judgement that the disease had developed previously. For the patients with this disease at their first medical examination, therefore, it seems necessary to suspect and confirm previous occurrence by history taking even when the patient has no history of treatment.
Isosorbide (Isobide®, 70w/v% solution of isosorbide, Nikken Chemicals Co. Inc., Tokyo, Japan), an osmotic diuretic, was effective in 54 of 112 cases with acute sensorineural hearing loss in whom the effect of steroid therapy, was limited. We analyzed the 54 cases including 45 female and 9 male patients. The audiogram showed acute low-frequency sensorineural hearing loss (group: ALHL, n=26) or high-frequency hearing losses with ALHL (group: Others, n=28). The mean age of the patients was 47.7 years (ALHL: 39.4 years, Others: 55.5 years). Their effectiveness was mostly obtained in 1 day and mean was 3 days. Though isosorbide was reduced gradually, 22 cases showed fluctuation of hearing, 12 cases (ALHL: 6 cases, Others: 6 cases) improved after increasing to the first dosage (90-120ml/day), except one ease who introduced to another hospital the other 9 cases (ALHL: 2 cases, Others: 7 cases) needed the combination therapy of steroid with isosorbide. The average therapeutic course of stable cases was 8.2 weeks (ALHL: 8.5w, Others: 7.8w), whereas that of fluctuating cases was 31 weeks (ALHL: 24.3w, Others: 34.9w) with more slowly reduction of isosorbide.