Otology & Neurotology - Papers Presented at the Annual Meeting of the German Audiology and Neurotology Group 2016 (ADANO) in Berlin

Special Issue of Audiology and Neurotology: Annual Autumn Meeting of the German Audiology & Neurotology Group (ADANO), Berlin October 19th to 20th, 2016 No abstract available

Superior Canal Dehiscence Syndrome: Relating Clinical Findings With Vestibular Neural Responses From a Guinea Pig Model Hypothesis: In superior canal dehiscence (SCD), fluid displacement of the endolymph activates type I vestibular hair cells in the crista of the affected canal and thus irregular superior canal (SC) neurons in Scarpa's ganglion, which provides the neurophysiological basis for the clinical presentation of SCD. Background: Patients with SCD display sound- and vibration-induced vertigo/nystagmus and increased amplitudes of vestibular evoked myogenic potentials. Methods: Extracellular recordings from n = 25 primary vestibular neurons of 16 female guinea pigs were analyzed. We recorded from the same vestibular neuron before, during and after creating the dehiscence and after closing the dehiscence. Neurobiotin labeling was employed in n = 11 neurons. Results: After SCD, previously unresponsive irregular SC neurons displayed a stimulus-locked increase in discharge during application of air-conducted sound (ACS) or bone-conducted vibration (BCV) for a broad range of frequencies (ACS: 200–4000 Hz; BCV: 500–1500 Hz). This typical response was only observed for irregular SC neurons (n = 19), but not regular SC neurons, or irregular/regular horizontal canal neurons (n = 2 each), and was abolished after closing the dehiscence. Eleven irregular SC neurons responsive to ACS and/or BCV were traced back to calyx synapses in the central crista of the affected superior canal by neurobiotin labeling. Conclusions: Stimulus-locked activation of irregular SC neurons by ACS and BCV is the neurophysiological basis for sound- and vibration-induced vertigo/nystagmus and increased VEMP amplitudes in SCD. The results of the present study help to improve vestibular diagnostics in patients with suspected SCD.

The Obliteration of Noncritical Size Bone Defects With Bone Dust or Bone Replacement Material (Bioactive Glass S53P4) Hypothesis: Bone dust (BD) harvested during operation may be suitable as an autologous obliteration material for noncritical size defects. Bioactive glass (BA) can be an alternative. Background: To treat noncritical size defects, BD and BA are commonly used for obliteration techniques. However, the optimal harvesting method and parameters for BD have not been examined. In this study, we analyzed the osseoregenerative potential of both materials. Methods: Thirteen female merino sheep (7-yr old) underwent surgery on the frontal calvaria. Three defects were inserted. The first defect was considered a reference and remained unfilled, the second defect was filled with BD from the calvaria bone, and the third defect was filled with BA S53P4. The animals were sacrificed after 3 weeks. To evaluate bone regeneration, we used digital volume tomography, bone density measurement, fluorochrome sequence labeling, and histological analysis. Results: All analyses showed quantitative and qualitative bone regeneration 3 weeks after operation. The control blank defect showed significantly less new bone growth than the BD-filled defect. Moreover, bone regeneration occurred from the surrounding bone and showed only a defect bridge in the BD-filled defect. The BA completely filled the defect and had the highest density although the same amount of new mineralized bone generated as in the reference. Conclusion: BD and BA seemed to be suitable bone replacement materials for obliteration techniques because they completely filled the defects. Thus, BD harvested under standardized conditions provided a higher level of osteoreparation potential for the generation of woven bone and establishment of defect bridges.

Changes of Electrocochleographic Responses During Cochlear Implantation Presented at the Annual Meeting of ADANO 2016 in Berlin Objective: To assess by electrocochleography (ECoG) at which times during cochlear implantation changes of cochlear function occur. Methods: Tone bursts with a frequency of 500 or 750 Hz were used as acoustic stimuli. The recording electrode was placed on the promontory and left in an unchanged position for all ECoG recordings. Results: Eight subjects were included. After opening the cochlea, an increase of the amplitude of the ECoG signal was detectable in four subjects (mean change 3.9 dB, range from 0.2 to 10.8 dB). No decreases were detectable after opening the cochlea or during the first half of the insertion of the CI electrode array (mean change 0.5 dB, range from −2.2 to 1.6 dB). During the second half of the insertion, the amplitude of the ECoG signal decreased in four subjects (mean change −2.5 dB, range from −0.04 to −4.8 dB). If a decrease occurred during the second half of the insertion, then the decrease continued in the earliest phase after insertion of the CI electrode array (mean change −2.1 dB, range from −0.5 to −5.8 dB). Conclusion: Pressure changes inside the cochlea can lead to an increase of ECoG signals after opening the cochlea. If detectable, then a decrease of ECoG signals occurs during the second half of the insertion of the CI electrode array and continues in the earliest phase after completed insertion. These findings suggest that cochlear trauma occurs toward the end of the insertion and that trauma-dependent postoperative mechanisms contribute to postoperative hearing loss.

Long-term Benefit of Unilateral Cochlear Implantation on Quality of Life and Speech Perception in Bilaterally Deafened Patients Objective: Cochlear implantation (CI) is a common treatment modality for unilaterally and bilaterally deafened patients as well as patients with severe to profound hearing loss. The aim of our study is the complex evaluation of the improvement and influence of health related quality of life (HRQoL) and auditory performance in cochlear implant patients during a long-term follow-up. Methods: Sixty-one bilaterally, postlingually deafened patients with unilateral CI were included in this prospective study. Assessment tools for auditory performance and HRQoL included the Freiburg Monosyllabic Speech test, Oldenburg Inventory (OI) questionnaire, Nijmegen Cochlear Implant Questionnaire (NCIQ) and 36-item Short Form Survey (SF-36). Data were collected before CI, at 6, 12, and 24 months postoperatively. Results: The assessment tools for speech perception yielded a statistically significant improvement in the Freiburg Monosyllabic Speech test scores and of all subdomain scores of the OI during the 6-month follow-up period. The subdomain scores of the NCIQ and the psychological score of the SF-36 also improved significantly during this follow-up period. All results remained stable thereafter during the 12- and 24-month follow-up. There was a statistically significant correlation between subjective speech perception and HRQoL after CI. Conclusion: This is the first prospective study to show results in regard to speech perception and HRQoL and their correlation during a 2-year follow-up after unilateral CI in bilaterally deafened patients. Our results for speech perception and HRQoL showed a significant improvement during the 6-month follow-up that remained stable thereafter during a 24-month follow-up, even after finishing the hearing rehabilitation program.

Age-Dependent Psychological Factors Influencing the Outcome of Cochlear Implantation in Elderly Patients Introduction: Increasing number of older adults undergo cochlear implantation (CI). Accumulating evidence implicates that the outcome of implantation may not only depend on physical and psychological health status of patients but also on their age. In the present work, we analyzed the elderly (70–80) and very old (80+) patients who underwent CI regarding their hearing abilities, health-related quality of life (HRQoL), and psychological comorbidities. Patients and Methods: Eighty-six patients were included in this prospective study. The patients were split into two groups: 70–80 years-old (n = 62) and ≥ 80 years-old (n = 24). Hearing performance was assessed with Freiburg monosyllabic test and Oldenburg inventory (OI); the health-related quality of life was measured with Nijmegen Cochlear Implantation Questionnaire (NCIQ); depressive symptoms with General Depression Scale (ADS-L); stress with Perceived Stress Questionnaire (PSQ) and anxiety with General Anxiety Disorder-7 (GAD-7). Results: Prior to CI, the hearing performance (Ol) impacted positively the HRQoL of both groups whereas the perceived stress (PSQ) had a negative impact. Six months after implantation, the HRQoL of 70–80 group was still positively influenced by the hearing performance (Ol) whereas HRQoL of 80+ group was influenced by stress perception (negative impact) and anxiety (positive impact). Twelve months later, anxiety and depressive symptoms correlated negatively with HRQoL of both age groups. Hearing performance had the positive and anxiety the negative impact on HRQoL in both groups but in addition, the 80+ group seemed to benefit from an increased level of anxious symptoms. Conclusion: In elderly patients, the outcome of CI depends on their psychological status. Differences found between the age groups imply a need for an age-group targeted psychological counselling, which might further improve outcome of CI.

Pediatric Bilateral Cochlear Implantation: Simultaneous Versus Sequential Surgery Objective: To compare outcomes of bilateral cochlear implantation between simultaneous and sequential surgeries. Study Design: Retrospective study of surgical outcome for 54 children who received bilateral cochlear implants (CIs) over a five-year period. Setting: Tertiary health care Patients: We analyze surgical outcomes for 54 children who received two CIs over a five-year period. Thirty-two of these children received these implants simultaneously and 22 of these children received their implants sequentially (76 CI operations and 108 CI). Intervention: One hundred and eight CIs; Group A—bilateral simultaneous CI; Group B— bilateral sequential CI. Main Outcome Measures: Measurement of body temperature; recording drug administration measurement of the total length of hospital stay, surgery time, and total operating room utilization; recording complications. Results: Simultaneous bilateral CI-implantation is associated with a significantly reduced cumulative surgical time and cumulative operating room time. It shortens the total in-patient stay for children in comparison to sequential implantations. There were no clinically significant, adverse consequences of simultaneous implant surgery. Further information include medical history including cochlear malformations as well as complications after the surgery, use of analgesic and antiemetic medication and length of hospital stay. Conclusions: Simultaneous bilateral surgery is a safe option of pediatric cochlear implantation.

Cochlear Implantation in Patients With Single-sided Deafness After the Translabyrinthine Resection of the Vestibular Schwannoma—Presented at the Annual Meeting of ADANO 2016 in Berlin Objective: To evaluate effectiveness of the cochlear implant (CI) to facilitate single-sided deafness (SSD) rehabilitation following translabyrinthine resection of the vestibular schwannoma. Study Design: Retrospective patient review. Setting: Single center, University hospital. Patients: Patients with SSD who underwent translabyrinthine resection of a vestibular schwannoma with anatomical preservation of the cochlear nerve and subsequent CI on the same ear. Interventions: CI at post-translabyrinthine resection of the acoustic neuroma to treat SSD, and evaluation by retrospective individual case review in a period from 2009 to 2016. Main Outcome Measures: Individual patients' clinical outcome and speech understanding. Results: Thirteen patients were provided CI. In all cases, complete removal of the tumor was achieved and the cochlear nerve was preserved; in one case, the CI was implanted simultaneously. In most cases, the follow-up interval was 2 years. In 9 of 13 cases, the implanted ear achieved capability to understand and discriminate monosyllabic words at 65 dB. Level of speech understanding of over 50% at 65 dB was possible in 7 patients at 12 months after the first fitting of CI. Conclusions: Under certain conditions, CI was an effective solution to restore hearing in patients with SSD following translabyrinthine access to the skull base. Study with prospective design is required to provide more significant results.

Association Between Stress and Tinnitus—New Aspects This contribution focuses on the relationship between stress and tinnitus. While the causal and directional pathways between these constructs continue to remain unclear, this paper uses an allostasis-based framework to discuss associations between physiological stress responses, individuals' idiosyncratic experiences of the tinnitus percept, and psychological treatment approaches.

How Do We Know That Our Patients Have Benefitted From Our ENT/Audiological Interventions? Presented at the Annual Meeting of ADANO 2016 in Berlin This short review article gives an introduction to some of the fundamental concepts and challenges facing measurement in hearing healthcare practice and research. The impact of hearing loss almost always extends beyond the sensory impairment itself, even when the measured degree of audiometric loss is mild. Yet, going beyond audibility, into the realm of measuring impact, takes us into a much more complex and less well-defined space. How does one therefore best measure the therapeutic benefit for evaluating efficacy or for clinical practice audit? Three case studies illustrate approaches to overcome such challenges. Each example highlights the importance of thinking critically about what it is one is seeking trying to measure, rather than selecting a questionnaire instrument based simply on its popularity or accessibility. We conclude by highlighting the important role that clinicians can play in collecting clinical data about their preferred instruments so that we have some evidence to inform decisions about good practice (content validity etc.). We would also strongly support open data sharing as we think that this is one of the best ways to make the most rapid progress the field.

Alexandros Sfakianakis
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alsfakia@gmail.com