Three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) has recently been developed to detect high concentrations of protein or hemorrhage. Two-thirds of patients with sudden sensorineural hearing loss showed high-intensity signals in the affected inner ear on precontrast 3D-FLAIR at 3 Tesla. Postcontrast enhancement was recognized after intravenous gadolinium administration in a half of the inner ears showing precontrast high-intensity signals. Abnormal passage of the gadolinium reflects increased permeability of blood vessels or disruption of the blood-labyrinthine barrier in the inner ears. We hypothesized that glucocorticoids, which have anti-inflammatory actions and suppress the increased permeability of blood vessels, are effective in some cases showing postcontrast enhancement. Experimental and clinical reports on disrupted blood-labyrinthine barrier were reviewed.
In the present study, we monitored the implementation of self-checking of hearing by parents during health examination of children 3 years and one and a half years of age. Only 22% of the 289 children who were 3 years old and 15% of the 309 children who were one and a half years old could be properly examined. Then, a speech therapist conducted a screening test for hearing, and 15 children with abnormalities required further testing. An otolaryngologist diagnosed hearing loss or delay in language development in 9 children, 7 of whom had passed a self-checking of hearing by parents. This finding indicates that self-checking of hearing by parents of children is of limited accuracy, and that a screening test for hearing test by a speech therapist or otolaryngologist is needed during health examination of children.
We conducted an investigation of persons with unilateral hearing impairment, in order to clarify the factors surrounding self-disclosure and personal relationships, using Social Networking Services. A total of 135 people with unilateral hearing impairment were enrolled. In regard to self-disclosure, it is suggested that self-disclosure is difficult for persons with unilateral hearing impairment even though they understand its usefulness, because there may be negative feelings and a lack of understanding in people around. The results of the investigation revealed that in addition to the problems of hearing, these subjects also had psychological problems interfering with personal relationships. In addition, the usefulness of peer-counseling, in which persons with unilateral hearing impairment shared their worries and anxieties among themselves as part of a support system was suggested. The results of this investigation suggested that it is necessary to provide support to persons with unilateral hearing impairment with an understanding of the secondary problems associated with the hearing impairment in these subjects, especially of the psychological problems interfering with personal relationships.
A school-age subject with a cochlear implant showed difficulty in improvement of her listening skills. She had undergone the cochlear implant surgery at the age of 7 years 5 months. It was difficult to carry out regular auditory therapy after the implantation because of the treatment for atlanto-axial rotatory subluxation. Also, it was difficult to prepare an appropriate map due to facial stimulation, tongue numbness, and ear pain. Auditory therapy was carried out for 3 months about one year after switch-on. While a slight improvement in the listening skills was noted initially after the therapy, due to the difficulty of mapping, her listening skills again deteriorated gradually. Auditory therapy was restarted at the mother's request when the child was 11 years 5 months old. This time around, auditory checkups, including mapping, participation of the mother and discussions with the subject were included in the therapy. After 7 months of auditory therapy, the child's listening skills improved and satisfactory results of the cochlear implantation were obtained. This shows that a comprehensive approach, including auditory checkups, parental guidance and discussions with the subject himself/herself is necessary for auditory therapy of children undergoing cochlear implant surgery at school age.
We report the case of a patient with bilateral deafness in whom genetic testing was found to be very useful for making treatment decisions. Otologic testing clearly revealed that the patient suffered from severe bilateral sensorineural hearing loss. However, the past and family history of hearing loss were unclear, making it difficult to make appropriate treatment decisions. Genetic testing revealed a gene mutation in GJB2, suggesting hereditary hearing loss. This diagnosis finally convinced the patient to undergo cochlear implantation. After the cochlear implant surgery, the hearing ability of the patient recovered well and the patient was satisfied with its efficacy in improving daily life. Although there still remain methodological and ethical problems, genetic testing may prove to be one of the important methods for the differential diagnosis of hearing loss.
The hearing level in the high-frequency range, exceeding 8kHz (hereinafter, referred to as high frequency), and the tinnitus pitch were assessed in patients with tinnitus without hearing loss (TWOHL), and the association between these and the development of tinnitus was studied. The absence/presence of hearing abnormality was evaluated in 15 ears of 15 patients with unilateral TWOHL, based on the data obtained from 90 ears of 45 healthy individuals. Hearing abnormality was detected in 11 out of 15 ears, and of these, improvement of tinnitus and disappearance/reduction of the frequency range in which hearing abnormality was observed was noted in 3 ears. In the 7 ears for which the pitch could be identified, the tinnitus pitch was observed in a frequency range 2 or 4 kHz lower than the least frequency at which hearing abnormality was observed. Based on these findings, it seemed that some cases of TWOHL might show hearing abnormalities in the high-frequency range. In the 4 ears in which no hearing abnormalities were observed, the tinnitus might be attributable to the abnormality that appears at 18 or 20 kHz, which was not assessed in this study.