To Örebro University

Background and Aim: It is estimated that 10–15% of the general population suffers from tinnitus, including 60% of all otologic patients. Quality of life is reportedly affected in approximately 0.5% of tinnitus patients. The aim of this study is to investigate the role of low-laser therapy in alleviating the symptoms of tinnitus.

Material and Methods: Seventeen tinnitus patients (8 men, 9 women) were included in the study. Tinnitus was identified by the patients either as their sole complaint, or as symptom within the context of other otologic diseases. A 0–5 Visual Analogue Scale (VAS) was used to personally quantify the severity of patients' symptoms. Treatment included the use of an external laser beam in the periauricular area and the external auditory canal, which was produced either by a GaAlAs (808 nm, 450 mW), or by a GaAs (904 nm, 240 mW) laser, for 4 and 2 minutes, respectively. The mean number of sessions for each patient was 17, and the mean duration of therapy was 4 weeks.

Results: With regard to the severity of symptoms, the pretreatment mean score was 4.3, and the respected number after the intervention was 3.2. There was a consistent trend toward symptom improvement; however, the results were not statistically significant due to the small sample size. No side effects or deterioration of symptoms was reported.

Conclusion: Low-laser therapy does seem to have some effect in alleviating tinnitus. However, additional studies are necessary to prove the actual efficacy of this treatment mode and to establish superior outcomes compared with placebo.

Aim: To explore in a prospective study the evidence of certain viral and toxoplasmosis infections in sudden sensorineural hearing loss (SSHL).

Methods: 84 consecutive patients with SSHL meeting certain criteria. All patients were assessed for specific IgM antibodies against cytomegalovirus, herpes simplex virus, toxoplasma and Epstein-Barr virus. All were treated with intravenous steroids and assigned to two groups: 76 IgM negative (NV group) and 8 IgM positive (no history of acute infection - V group).

Results: The mean hearing level at presentation was 86.5 dB HL (median, 100) in the V group and 60.7 dB HL (median, 61) in the NV group. The difference was statistically significant (p = 0.003). The mean hearing level following treatment was 81.8 dB HL (median, 88) in the V group and 48.7 dB HL (median, 39) in the NV group. The difference was statistically significant (p = 0.004). There was a considerable improvement in hearing after treatment only in the NV group (p < 0.000001).

Conclusions: Recent subclinical viral or toxoplasmosis infections may be involved in the pathogenesis of SSHL (in approx. 10% of cases), suggesting that SSHL is not a single disease. When certain viruses or toxoplasmoses are involved, the hearing is much worse in comparison to patients with no such indication of infection. An alteration in treatment dosage or method of steroid administration may be needed in such cases.

Background and Aim: The medial olivocochlear (MOC) system contributes to better sound perception and distinction in noisy environments by causing an inhibitory effect on the cochlear hair cell system. The aim of this study is to search for possible involvement of olivocochlear dysfunction in the generation of tinnitus. The function of the MOC system was evaluated by contralateral suppression (CS) of the TEOAEs and DPOAEs.

Material and Methods: Seventeen patients with bilateral tinnitus (6 men, 11 women; mean age, 46.8 years), 16 patients with left unilateral tinnitus (7 men, 9 women; mean age, 51.1 years), and a control group (CG) of 15 people (7 men, 8 women; mean age, 40.5 years) without tinnitus were included in this study. All the subjects were right-handed with normal pure tone audiogram and without any other underlying pathology. The subjects were evaluated with TEOAEs and DPOAEs without and with the presence of contralateral white noise of 50 dB. The frequencies measured were 1–4 kHz for the TEOAEs and 1–6 kHz for the DPOAEs.

Results: Bilateral tinnitus individuals tended to present less suppression than the CG subjects (presence of suppression 32.3–60%, depending on the frequency, for the tinnitus group vs. 66.6–90% for the CG), and lower volume of suppression than the CG subjects (1.3–2.22 dB vs. 2.47–4.66 dB, depending on the frequency). Similar results were observed in patients with left unilateral tinnitus—presence of suppression in their left ears from 31.2–75% and mean value of suppression 0.62–3.38 dB, whereas 73.3–100% of the left ears of the CG presented suppression with mean value of 2.85–5.38 dB. The differences regarding the right ear were less marked.

Conclusions: Contralateral suppression is lower and less frequent in ears with tinnitus compared with normal ears. This may reflect a disfunction of MOC in patients with tinnitus. Both TEOAEs and DPOAEs seem to be sensitive methods to confirm this relation.

Objectives: Vestibular Evoked Myogenic Potentials (VEMPs) are electric potentials, used as a parameter for the assessment of the otolith function. They can be recorded after sound stimulation with surface electrodes over each sternocleidomastoid muscle. The purpose of the study is to investigate VEMPs and correlate them with the electronystagmic findings in cases of Sudden HearingLoss (SHL).

Methods: Pure tone audiometry, acoustic immittance testing, caloric testing, Auditory Brainstem Responses and VEMP testing was performed on 34 patients with unilateral idiopathic SHL. Same testing was performed on a control group of healthy volunteers. VEMP responses were measured and compared to caloric responses.

Results: VEMPs were present in all normal subjects of the control group and ipsilaterally normal on the unaffected side in all patients with SHL. Twenty five out of 34 patients (73,53%) showed normal VEMP responses. In 13 patients both electronystagmographic findings and VEMPs were normal, but in 12 patients VEMPs were normal but there were abnormal caloric responses (canal paresis in 7 patients, spontaneous nystagmus in 5 patients). Nine patients displayed abnormal VEMPs (26,47%) on the affected side (in eight cases absent, in one case delayed) and eight of them demonstrated decreased caloric responses, while one patient had normal caloric responses.

Conclusions: In a considerable number of cases VEMPs were abnormal. However, most of the patients displayed normal VEMPs. Also, in the majority of patients, VEMPs correlated to the caloric responses, although in a certain number of cases either the superior or the inferior vestibular nerve was involved.

Aims: Vestibular evoked myogenic potentials (VEMPs) are short-latency electromyograms recorded from the ipsilateral tonically contracting sternocleidomastoid muscle in response to loud clicks or tone-bursts. It is reported that this reflex is generated via a disynaptic pathway, beginning in the saccule. The purpose of the study is to investigate the VEMPs in cases of sudden hearing loss.

Materials and Methods: Twelve patients with unilateral idiopathic sudden hearing loss were subjected to pure tone audiometry, acoustic immittance testing, caloric testing, auditory brainstem responses, and VEMP testing. A group of healthy volunteers was also enrolled. VEMP responses were measured and compared to caloric responses.

Results: VEMPs were present in all normal subjects and ipsilaterally normal on the unaffected side in all patients with sudden hearing loss. Five out of 12 patients displayed abnormal VEMPs (41.6%) on the affected side (in 4 cases were absent, in 1 case delayed) and 4 of them demonstrated decreased canal paresis, while the fifth had normal caloric responses. In 5 patients both electronystagmographic findings and VEMPs were normal, while the remaining 2 patients showed normal VEMP test results but abnormal caloric responses.

Conclusion: Most of the patients displayed normal VEMPs. However, in a considerable number of cases they were abnormal. Also, in the majority of patients, VEMPs correlated to the caloric responses, although in 3 patients either the superior or the inferior vestibular nerve was involved.

Objective: To evaluate the correlation between caloric and vestibular evoked myogenic potential test results, initial audiogram data, and early hearing recovery, in patients with idiopathic sudden hearing loss.

Materials and methods: One hundred and four patients with unilateral idiopathic sudden hearing loss underwent complete neurotological evaluation. Results for vestibular evoked myogenic potential and caloric testing were compared with patients' initial and final audiograms.

Results: Overall, abnormal vestibular evoked myogenic potential responses occurred in 28.8 per cent of patients, whereas abnormal caloric test results occurred in 50 per cent. A statistically significant relationship was found between the type of inner ear lesion and the incidence of profound hearing loss. Moreover, a negative correlation was found between the extent of the inner ear lesion and the likelihood of early recovery.

Conclusion: In patients with idiopathic sudden hearing loss, the extent of the inner ear lesion tends to correlate with the severity of cochlear damage. Vestibular assessment may be valuable in predicting the final outcome.

The aim of this study was to report our experience with cartilage tympanoplasty (CT) in smokers and compare it with that of non-smokers using a retrospective chart review at a tertiary referral center. Between September 2008 and September 2010, cartilage tympanoplasty was performed in 52 patients. Among them, 27 were active smokers and 25 former or non-smokers. The entire tympanic membrane was replaced with conchal cartilage, shaped either as a shield for cases with intact canal wall mastoidectomies, or crashed for cases with canal wall down procedures. The mean post-operative follow-up was 12 months (range 6-18 months). A complete pre- and post-operative audiologic evaluation was obtained in all patients. Graft take was successful in all patients. The overall average pre-operative and post-operative pure tone average air-bone gaps (PTA-ABG) was 52.2 dB +/- A 17.7 dB and 35.4 dB +/- A 17.9 dB, respectively, with an overall improvement of 16.8 dB (p < 0.001). A post-operative PTA-ABG of 25 dB or less was achieved in 39 (75 %) patients (p < 0.001). In smokers, the hearing improvement was 17.6 dB (p < 0.001) with a PTA-ABG of 25 dB or less in 19 (70 %). In non-smokers, the average hearing improvement was 16.8 dB (p < 0.0005) with a post-operative PTA-ABG of 25 dB or less in 19 (76 %), (p < 0.001). The results showed that the CT technique is a very effective procedure for smokers. Excellent graft take and satisfactory hearing results can be accomplished regardless of smoking habits.

Background and Aim: Stapes surgery, the first-choice treatment for otosclerosis, restores the ossicular chain mobility. Otoacoustic emissions, particularly transient-evoked (TEOAEs) and distortion product (DPOAEs), are capable of noninvasively recording both conductive hearing and cochlear function.

Aim: The aim of this study was to process the effects of otosclerosis pre- and postoperatively, using otoacoustic emissions as an objective method of hearing evaluation.

Material and Methods: Thirty patients (23 women and 7 men) who were candidates for surgery were included in the study. The same patients were asked to be evaluated 2 and 5 months after surgery. All of the patients were evaluated with the use of pure tone audiometry, stapedial reflexes, tympanometry, TEOAE, and DPOAE recordings.

Results: Preoperatively, tympanometry showed type A or As tympanogram, and no stapedial reflexes were detected. Pure tone audiometry showed conductive hearing loss and mean air-bone gaps for frequencies 500 Hz to 4000 Hz between 15.167 dB and 33.167 dB. In 10% of the patients, TEOAEs were measured, whereas DPOAEs were detected in no cases (0%) before surgery. Two months after surgery, only 21 out of 30 patients were re-examined. Air-bone gaps were decreased for speech frequencies (500–4000 Hz), ranging from 8.1dB to 14.05 dB. In 52.4% of the patients who took the reappraisal, TEOAEs were measured, whereas DPOAEs were detected in 28 (57%) of them. Five months after surgery, air-bone gaps decreased even more, ranging between 4.32 dB and 13.4 dB. The presence of both TEOAEs and DPOAEs was increased in the 21 patients who underwent this re-examination, with TEOAEs detected in 54.55% and DPAOEs in 50% of them.

Conclusions: Despite hearing improvement and sufficient air-bone gap closing, OAEs are not always detected postoperatively. It seems that OAEs can be—in addition to an objective tool for testing ossicular chain's restoration—an approach to cochlear function after surgery.

Objective: To evaluate Vestibular Evoked Myogenic Potentials (VEMP) testing results in patients with unilateral Idiopathic Sudden Hearing Loss (ISHL) and to correlate them with the findings of caloric testing, the clinical appearance of vertigo, the influence of age, the grade and type of initial hearing loss and finally, the early recovery of subjects.Materials and

Methods: One hundred and four (104) patients with unilateral ISHL and 35 healthy controls were subjected to a standard protocol of neurotological evaluation. VEMP responses were measured and compared to caloric responses, to epidemiological and clinical parameters and to the initial and final audiograms of each subject. Results: Overall, abnormal VEMP responses were observed on the affected side in 28.8% of patients whereas abnormal Caloric findings occurred in 50% of the subjects studied. A significant relationship was found between the results of the two tests, meaning that the highest probability is either of the lesion to spare both otoliths and semicircular canals or, to involve both labyrinthic structures at the same time. A significant relationship was found between the type of vestibular lesion and subjective vertigo. Advancing age correlated statistically with more extended labyrinthic lesion, mostly including both semicircular canals and otolithic organs. Moreover, a statistically significant relationship was found between the type of inner ear lesion and the incidence of profound hearing loss. The type of vestibular lesion did not correlate with the occurrence of high frequency hearing loss, and the audiogram type had no significant effect on the likelihood of hearing recovery. Finally, a negative correlation was found between the extent of inner ear lesion and the likelihood of early recovery.

Conclusions: The combination of VEMP and ENG testing has proven vestibular involvement in many ISHL patients. Both tests are necessary in order to obtain a more thorough and deep knowledge of the pathophysiology of ISHL. The extent of inner-ear lesion tends to correlate with the severity of cochlear damage in ISHL. Vestibular assessment can be extremely valuable in prediction of the final outcome.

Objective: To evaluate the results of vestibular evoked myogenic potential testing in patients with idiopathic sudden hearing loss, and to correlate these results with the findings of caloric testing, the clinical appearance of vertigo and the influence of age.

Materials and methods: Eighty-six patients with unilateral idiopathic sudden hearing loss and 35 healthy controls underwent a standard protocol of neurotological evaluation. Vestibular evoked myogenic potential responses were measured and compared with caloric responses.

Results: On the affected side, 30.2 per cent of patients showed abnormal vestibular evoked myogenic potential responses., while 52.3 per cent had abnormal caloric responses. A statistically significant relationship was found between the results of these two tests. A statistically significant relationship was also found between the type of vestibular lesion and the occurrence of vertigo. Advancing age correlated statistically with more extensive labyrinthic lesions.

Conclusions: A combination of vestibular evoked myogenic potential and electronystagmography testing indicated the existence of vestibular involvement in many patients with idiopathic sudden hearing loss. Both tests are necessary in order to obtain a more thorough and in-depth knowledge of the pathophysiology of idiopathic sudden hearing loss.

Background and Aim: Vestibular involvement in cases of idiopathic sudden hearing loss (ISHL) is common and is reported to be an important prognostic factor. The aim of this study was to evaluate the extent of inner ear lesion in ISHL and to correlate it with the severity of hearing loss and the degree of short-term recovery.

Material and Methods: Ninety-six patients with unilateral ISHL were subjected to a standard protocol of neurotological evaluation. All subjects were hospitalized and treated similarly. A group of 35 healthy volunteers was also enrolled in the study. The results of the VEMP test and the caloric test were measured and compared with the initial and final audiograms of each patient. Each inner ear lesion was ranked into one of three groups according to the results of vestibular tests: complete (group A), partial (group B), and cochlear lesion only (group C). A statistical analysis was done to correlate severity of inner ear damage with severity of hearing loss and early recovery rate.

Results: In total, 22 patients were ranked in group A, 35 in group B, and 39 in group C. Profound hearing loss appeared in 54%, 23%, and 23% of cases in each group, respectively. However, early recovery was shown in 74% of patients of group C, 54% of cases of group B, and in only 5% of subjects included in group A.

Conclusions: Our study results revealed a significant positive correlation between the extent of inner ear lesion and severity of hearing loss and a significant negative correlation between the extent of inner ear lesion and the grade of early recovery. This means that, in ISHL cases, the more the inner ear is affected the less chance there is for recovery.

Objectives: We describe our experience of intraoperative and postoperative complications of cochlear implantation in an adult population.

Methods: Between April 1986 and June 2010, the senior author (A.S.) performed 449 cochlear implantations in two different institutions. Of these, 212 implantations were in adults. The operative techniques were similar in all cases.

Results: Complications were observed in 12 of the 212 adult cases (5.7%), of which 10 were major (4.7%) and 2 minor (1%). In 7 cases, reimplantation was necessitated by device failure (6 cases; 2.8%) or device extrusion (I case; 0.5%). In 2 elderly patients (1%), a minor dural injury with a cerebrospinal fluid leak was controlled during the operation with temporalis fascia grafting. In 1 patient (0.5%), a subdural hematoma was observed after bipolar cauterization of a prominent diploic vein. In 2 subjects (1%), a wound infection was noted soon after implantation and was treated successfully on an outpatient basis.

Conclusions: Cochlear implantation is generally a safe procedure. The most common complication was device failure. Although complications in this adult population were rather uncommon, some of them were serious, and an immediate intervention was necessary for a successful outcome.

Hypothesis: Deafrress genes are intercoonected through common molecular pathways.

Background: There are many genes implicated in genetic hearing loss, and many more to be identified. This daunting complexity can be simplified by analyzing molecular pathways that these genes belong to.

Methods: Genes relevant for hearing and deaftress were identified through PubMed literature searches, and assembled into 3 groups: (1) 74 genes that cause non-syndromic deafress, (2) 125 genes that cause non-syndromic and syndromic deafress, and (3) 122 getes associated with otic capsule development and malformations. Each group was analyzed using lngenuity Pathway Analysis to discover the most interconnected ,i.e. 'nodal' molecules, within the most statistically sipificant networks (p<10-45).

Results: The number of networks that met our criterion for significance was I (group l) or 2 (groups 2 and 3). Nodal molecules of these networks were: Transforming Growth Factor Betal (TGFBI) for group 1, p42/p44 MAP Kinase (ERK l/2) and the G Protein Coupled Receptors (GPCR) for group 2, and TGFBI and Hepatocyte Nuclear Factor 4 alpha (HNF4a) for group 3. The nodal molecules included not only those known to be associated with deaftress (GPCR), or with predisposition to otosclerosis (TGFB I ), but also novel genes that have not been described in the cochlea (HNF4a), and signaling kinases (ERK l/2).

Conclusions: A number of molecules that are likely to be key mediators of genetic hearing loss were identified through three different molecular pathway analyses. The molecules included new candidate genes for deafress. Therapies targeting these molecules may be useful to treat deahess.

Objective: To perform comprehensive network and pathway analyses of the genes known to cause genetic hearing loss.

Study Design: In silico analysis of deafness genes using ingenuity pathway analysis (IPA).

Methods: Genes relevant for hearing and deafness were identified through PubMed literature searches and the Hereditary Hearing Loss Homepage. The genes were assembled into 3 groups: 63 genes that cause nonsyndromic deafness, 107 genes that cause nonsyndromic or syndromic sensorineural deafness, and 112 genes associated with otic capsule development and malformations. Each group of genes was analyzed using IPA to discover the most interconnected, that is, "nodal" molecules, within the most statistically significant networks (p < 10(-45)).

Results: The number of networks that met our criterion for significance was 1 for Group 1 and 2 for Groups 2 and 3. Nodal molecules of these networks were as follows: transforming growth factor beta1 (TGFB1) for Group 1, MAPK3/MAPK1 MAP kinase (ERK 1/2) and the G protein coupled receptors (GPCR) for Group 2, and TGFB1 and hepatocyte nuclear factor 4 alpha (HNF4A) for Group 3. The nodal molecules included not only those known to be associated with deafness (GPCR), or with predisposition to otosclerosis (TGFB1), but also novel genes that have not been described in the cochlea (HNF4A) and signaling kinases (ERK 1/2).

Conclusion: A number of molecules that are likely to be key mediators of genetic hearing loss were identified through three different network and pathway analyses. The molecules included new candidate genes for deafness. Therapies targeting these molecules may be useful to treat deafness.

Background: Depression represents one of the most common disorders in diabetic patients and frequently complicates the health care of this population. Poor self-efficacy has been associated with increased depressive symptoms as well as poor glycemic control.

Objective: To assess depression and self-efficacy in adults with type 2 diabetes in Northern Greece and to explore the factors which may affect them in this group of population.

Method: A descriptive study was conducted in a tertiary hospital in the largest city of Northern Greece. The study group included a convenience sample of 170 adults with type 2 diabetes mellitus who completed the General Health Questionnaire-28 (GHQ-28) and the Diabetes Empowerment Scale- short form (DES) questionnaire.

Results: The overall rate of diabetic patients showing psychological distress in the present study was 50.6%. Adults with low and moderate income experienced higher levels of depression and anxiety, compared to those with high economical status (p<0,001). Also, adults who graduated elementary education experienced higher levels of depressive and anxiety symptoms than those with a higher educational level (p =0,038). There was a statistically significant difference between age (p<0.001), type of residence (p=0.019), family status (p=0,002), financial status (p<0.001) and self-efficacy. Also, there was a negative correlation between BMI and self-efficacy (r=-0.206, p<0.001) and a negative correlation between depression and self-efficacy scale (r=-0.439, p<0.001)

Conclusion: The results of the present study highlight the importance of well-planned interventions in order to reduce depression and increase self-efficacy in diabetic adults and to help them further improve their quality of life.