Serum antidiuretic hormone (ADH) levels were measured in patients with acute low tone hearing loss (ALHL) and Meniere's disease. The serum ADH level was significantly elevated in not only Meniere's disease patients but also ALHL patients. Correlations were investigated between plasma level of ADH and recurrence rate of hearing loss in patients with ALHL. Those with high plasma ADH levels tended to have frequent episodes of hearing loss. These findings suggested that disorders of ADH-control in the inner ear are part of the mechanism underlying hearing loss episodes in ALHL patients.
We reviewed 182 patients with sudden hearing loss at our hospital to investigate the effect of oxygenation at high pressure (OHP). 116 patients received a course of intravenous administration of steroids, ATP with OHP, and 69 patients received a course of intravenous administration of steroids, ATP without OHP (non-OHP group). The improvement rate was compared between OHP group and non-OHP group according to some prognostic factors: initial averaged five frequency hearing level, age, vertigo, number of days between onset and beginning of the treatment. The improvement rate was 63.79% in OHP group and 52. 17% in non-OHP group, and in OHP group the improvement rate was significantly high. In patients with initial hearing levels up to 60 dB, high age, vertigo, the improvement rate was significantly high at OHP group. But in patients received the treatment over 14 days after onsets, there was no difference between OHP group and non-OHP group. We conclude that the addition of OHP is effective for primary sudden hearing loss.
We investigated the efficacy of ear lavage with 3% hydrogen peroxide solution (oxydol) for refractory aural discharge related to acute otitis media after tympanotomy or insertion of a ventilation tube. The subjects were 30 patients (55 ears) in whom aural discharge persisted for 10 days or more despite therapy with antimicrobial agents. Ear lavage with 3% hydrogen peroxide solution (oxydol) was initiated, and antimicrobial agents was discontinued. Ear lavage was continued every day until aural discharge disappeared. In all patients, the disappearance of aural discharge was achieved within 14 days (mean: 6.9 days). In particular, the interval until its disappearance was 12 to 14 days (mean: 13.0 days) in patients with acute MRSA-related otitis media, but 7 days or less (mean: 6.0 days) in those in whom other types of bacteria were detected. Thus, ear lavage with 3% hydrogen peroxide solution (oxydol) was effective for refractory aural discharge related to acute otitis media after tympanotomy or insertion of a ventilation tube for the following reasons: 1) 3% hydrogen peroxide solution (oxydol) destroyed the lipid membrane, DNA, and cellular contents of bacteria by generating hydroxy radicals. 2) Oxygenation of the middle ear cavity via decomposition of 3% hydrogen peroxide solution (oxydol) normalized middle ear mucosa. 3) Oxygenation of the middle ear cavity influenced the morphology of the pneumococcal membrane; it changed from the strongly pathogenic opaque type to the less pathogenic transparent type.
Most cases of tympanosclerotic stapes fixation are accompanied by fixation or erosion of the malleus and/or incus. This status of the ossicular chain is one of the reasons that ossiculoplasty for tympanosclerotic sates fixation is more difficlt than that for otosclerosis. We reported postoperative hearing resuts of 13 ears in which stapedectomy or stapedotomy was performed for tympanosclerotic stapes fixation. We divided them into two groups, 6 in the malleus-connection group (interposing homograft or a wire Teflon piston between the malleus and the oval window) and 7 in TORP (total ossicular replacement prosthesis) group (interposing TORP between the tympanic membrane and the oval window), and then compared the postoperative hearing results. According to the criteria of Otology Japan (2000), successful postoperative hearing improvement was archieved in 66.7% of the malleus-connection group, and 100% of the TORP group. At lower frequencies than 500Hz, the average hearing gain was less than 10 dB in the malleus-connection group, and more than 20dB in the TORP group. Obvious cochlear damage was not observed in all but one of the malleus-connection group. This report demonstrates that ossiculoplasty with TORP is safe and more difficult than that connected to the malleus, in the tympanosclerotic stapes fixation.
There has been no clear evidence to discriminate the nature of hearing impairment of idiopathic sudden deafness from acute hearing loss in patients with dialysis for renal failure, and treatment has never been established. In this report, five cases of hearing loss in the patients with dialysis for renal failure are presented. The patients had various renal diseases and receiving dialysis ranged from six months to eight years. Their hearing loss developed acutely and severity was from moderate to high. Two cases had vertigo. Steroids and vasodilators were used in four cases, but no severe complications were seen in their renal function. In three cases without vertigo hearing improvement was satisfactory but two cases with vertigo resulted in poor recovery. Therefore, vertigo might be a risk factor in hearing recovery as similar as in idiopathic sudden deafness. One case had no steroids treatment due to renal function and old age. She, however, showed good hearing recovery. Steroids might be not definitively necessary in the treatment of sensorineural hearing loss. If deafness is severe and recovery is delayed, steroids might be used safely with support of nephrologists.
Four patients (2 children and 2 adults) with the Nucleus 24 cochlear implant showed no electrically evoked compound action potential (EAP) in intra-operative neural response telemetry (NRT) measurements. The causes of hearing impairment were congenital sensorineural hearing loss, inner ear anomaly, ossified cochlear due to sepsis and progressive sensorineural hearing loss. Three cases with no EAP in the intraand post-operative NRT measurements revealed poor post-operative speech cognition despite having measurable behavioral T and/or C levels. Consistent poor intra- and post-operative NRT response may predict poor post-operative speech cognition. On the other hand, one case with good speech cognition immediately after operation presented apparent EAPs 4 months after operation. Some cases with discrepancy between intra-operative NRT results and post-operative auditory outcome may demonstrate significant EAPs within several months after operation.
Cochlear implantation has been established as safe and effective surgery for bilateral severe sensorineural hearing loss. In Japan, one of the major criteria for cochlear implantation in adults is bilateral pure tone threshold average more than 90dB HL. Recently, from a standpoint of quality of hearing (QOH), expansion of the criteria has been made. We performed cochlear implantation in 5 patients with residual hearing who received little or no benefit from hearing aids. Also we performed hearing ability examination, discrimination score examination, visual analogue scale (VAS), and the patient's questionnaire was sent to 3 cases that used a hearing aid together, and therapeutic effect, patient satisfaction, binaural hearing effect were reviewed. There was a difference of degree in each case. but satisfaction by concomitant use of a cochlear implant and a hearing aid was high in all cases.
Secondary cholesteatoma, an acquired open-typed cholesteatoma, is considered to be formed by disorderly migration of epidermis. The epidermis, which is activated by chronic inflammation, becomes to extend from the manubrium of the malleus at the center of a perforation of the tympanic membrane. The epidermis then passes along the inner surface of the tympanic membrane through the edge of perforation of an opentyped cholesteatoma. We reported 3 cases of secondary cholesteatoma. Patients 1 and 2 showed common characteristics of secondary cholesteatoma that have been reported: a large perforation of the tympanic membrane, long-term inflammation of the middle ear and an open-typed cholesteatoma extended from the manubrium of the malleus to the inner surface of the tympanic membrane. However, in patients 3 with a traumatic small perforation of the tympanic membrane, his secondary cholesteatoma seemed to be formed under a specific condition of severe persistent inflammation due to MRSA. After tympanoplasty, it is suggested that the epidermis folded on the inner surface of the tympanic membrane at the edged of the perforation was activated by MRSA inflammation and extended to form an open-typed cholesteatoma.
We present a case of malignant external otitis (MEO) in a diabetic patient. He had received three operations for debridement, but the lesion could not be eradicated because of extensive infection of the temporal bone, and the adjacent areas such as the left parotid gland and external surface of the skull base. He also received a long-term administration of antibiotics, but he died of sepsis 13 months after the onset. Recently, treatment outcome of MEO has been improved. In the literature, surgical excision of the lesion and a long-term treatment of antibiotics are standard treatment of MEO. We thought that insufficient surgical debridement due to the involvement of inaccessible region was the major cause of incurability of his illness.
The aim of study was to evaluate the safety of edaravone applied into the inner ear of the guinea pig, as assessed physiologically and morphologically. Edaravone (6mg/ml)-soaked Gelform pieces were put on the round window membrane of guinea pigs in the right ear. Before and 7 days after treatment, each animal was studied auditory brainstem response (ABR) and caloric test. After physiological examination, ampulla of the lateral semicircular canal, utricle and cochlea were investigated morphologically. No significant ABR threshold shift was observed in the animals between before and 7 days after treatment. No significant difference was found in the caloric response time between the right and left side 7 days after treatment. Seven days after treatment, no obvious morphological change in the vestibular and cochlear endorgans was observed in all animals. These results suggested that the topical application of edaravone to the inner ear induces no obvious tissue damage physiologically and morphologically.