242 research outputs found

    New frontiers in tinnitus, hearing loss and hyperacusis

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    Although considerable progresses have been made in the recent years, there are still wide-open pathways for research in tinnitus, hearing loss and hyperacusis. Among them, I’d like to put particular focus on basic and clinical research on the predisposing elements to ac- quired hearing loss to favour understanding in prevention and treatment, on the exploration of the pathophysiological basis of tinnitus necessary for future possible treatments, and on the correlation between tinnitus and hyperacusis, an interesting direction that could rise questions and give answers to identify target mechanisms able to help in therapeutic strategies

    Unilateral enlarged vestibular aqueduct syndrome and bilateral endolymphatic hydrops

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    Enlarged vestibular aqueduct (EVA) syndrome is a common congenital inner ear malformation characterized by a vestibular aqueduct with a diameter larger than 1.5 mm, mixed or sensorineural hearing loss that ranges from mild to profound, and vestibular disorders that may be present with a range from mild imbalance to episodic objective vertigo. In our study, we present the case of a patient with unilateral enlarged vestibular aqueduct and bilateral endolymphatic hydrops (EH). EH was confirmed through anamnestic history and audiological exams; EVA was diagnosed using high-resolution CT scans and MRI images. Therapy included intratympanic infusion of corticosteroids with a significant hearing improvement, more evident in the ear contralateral to EVA. Although most probably unrelated, EVA and EH may present with similar symptoms and therefore the diagnostic workup should always include the proper steps to perform a correct diagnosis. Association between progression of hearing loss and head trauma in patients with a diagnosis of EVA syndrome is still uncertain; however, these individuals should be advised to avoid activities that increase intracranial pressure to prevent further hearing deterioration. Intratympanic treatment with steroids is a safe and well-tolerated procedure that has demonstrated its efficacy in hearing, tinnitus, and vertigo control in EH

    Noise induced hearing loss: the role of oxidative stress

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    Introduction: Noise-induced hearing loss (NIHL) is a relevant source of hearing disability affecting the general population, and accounts for about 16% of all the reported cases of disabling hearing loss in the adult population worldwide. NIHL can follow workplace-related and recreational noise exposure, and can be influenced by individual factors such as age, sex, genetic predisposition and socio-economic factors. Objectives: The aim of this paper is to provide a quick overview of the principal ndings in noise induced hearing loss, focusing on the role of oxidative stress and antioxidant intervention. Review: Oxidative stress plays a central role in leading to a condition of NIHL. Reactive oxygen species (ROS) and reactive nitrogen species (RNS) largely participate in cellular mechanisms that underlie mainly the outer hair cell death after noise exposure and lead to sensorineural hearing loss. The beneficial effects of antioxidant supplementation have been demonstrated by several experimental studies in animals, while the observed results in humans are mixed. Conclusion: NIHL still represents a widespread condition among the general population; with a higher prevalence in developing countries among workers, and in developed countries among young adults exposed to leisure noise. Extensive literature confirms that increasing antioxidant levels in the organ of Corti may be an appropriate approach towards understanding NIHL in humans by increasing the endogenous antioxidant response or by administering antioxidant molecules systemically or locally

    Hearing loss in Takayasu's arteritis: a role for hyperbaric oxygen therapy?

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    In the scientific community, there is growing interest regarding associated symptoms in Takayasu’s arteritis (TA), an autoimmune condition that mainly affects the medium and large arteries. Hearing loss (HL) is a rare complication of TA that is often overlooked and has severe consequences on the quality of life. HL mainly presents as sudden sensorineural hearing loss (SSNHL) and responds to corticosteroid therapy. In the authors’ opinion, the reasons for misdiagnosing HL in patients with TA are lack of evidence re- garding this rare complication and because TA involves large caliber arteries, instead of small vessels that are typical of the inner ear. We recently used HBOT for a 36-year-old woman with TA, who had two SSNHL episodes in different ears in an 11-month period and observed a significant improvement in the patient's hearing. Although this was a single case finding and HBOT was administered together with steroid therapy, the significant recovery of HL in both ears following this therapeutic approach may be worth sharing with the scientific community. In conclusion, we recommend that awareness for inner ear involvement in TA should increase and that HL should be considered a possible complication of TA and should be treated with corticosteroid therapy and, after collecting further evidence, HBOT

    Somatic modulation of tinnitus: a review and some open questions

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    Tinnitus modulation by movements of the temporomandibular joint, head and neck musculoskeletal structures and the eye, can be found in one to two thirds of tinnitus sufferers; unfortunately this condition is often overlooked by otolaryngologists. Although somatic modulation has been initially hypothesized as a fundamental characteristic of tinnitus, there is increasing evidence of a tight connection with disorders of non-auditory regions. The structure that mostly modulates tinnitus is the temporomandibular joint, which mainly causes an increase in tinnitus loudness, followed by head and neck movements that may result in an increase or decrease of loudness and eye movements (gaze-evoked tinnitus). Besides loudness, somatic movements can also modulate tinnitus pitch and localization. Somatosensory tinnitus is a relatively new nding that leaves several open questions: are there individual predisposing factors to somatic modulation? How strong is the association between the capability to somatically modulate tinnitus and an underlying non-auditory disorder? Changes that occur after somatic maneuvers are only transitory? Why patients that have concomitant hyperacusis also have higher chances of tinnitus modulation? Further basic science and clinical research is required to address these and many other questions about somatosensory tinnitus

    Optimal management of Cogan’s syndrome: a multidisciplinary approach

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    Cogan's syndrome (CS) is a rare disorder characterized by nonsyphilitic interstitial keratitis (IK) and audio-vestibular symptoms. CS affects mainly young Caucasian adults, mostly during their first three decades of age, and may develop into typical and atypical variants. Typical CS manifests primarily with IK and hearing loss, whereas atypical CS usually presents with inflammatory ocular manifestations in association with audio-vestibular symptoms but mostly different Ménière-like symptoms and, more frequently, with systemic inflammation (70%), of which vasculitis is the pathogenic mechanism. CS is considered as an autoimmune- or immune-mediated disease supported mainly by the beneficial response to corticosteroids. Using well-developed assays, antibodies to inner ear antigens, anti-Hsp70, and antineutrophil cytoplasmic antibodies were found to be associated with CS. Corticosteroids represent the first line of treatment, and multiple immunosuppressive drugs have been tried with variable degrees of success. Tumor necrosis factor-alpha blockers and other biological agents are a recent novel therapeutic option in CS. Cochlear implantation is a valuable rescue surgical strategy in cases with severe sensorineural hearing loss unresponsive to intensive and/or innovative immunosuppressive regimens

    Somatosensory tinnitus: current evidence and future perspectives

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    In some individuals, tinnitus can be modulated by specific maneuvers of the temporomandibular joint, head and neck, eyes, and limbs. Neuroplasticity seems to play a central role in this capacity for modulation, suggesting that abnormal interactions between the sensory modalities, sensorimotor systems, and neurocognitive and neuroemotional networks may contribute to the development of somatosensory tinnitus. Current evidence supports a link between somatic disorders and higher modulation of tinnitus, especially in patients with a normal hearing threshold. Patients with tinnitus who have somatic disorders seems to have a higher chance of modulating their tinnitus with somatic maneuvers; consistent improvements in tinnitus symptoms have been observed in patients with temporomandibular joint disease following targeted therapy for temporomandibular disorders. Somatosensory tinnitus is often overlooked by otolaryngologists and not fully investigated during the diagnostic process. Somatic disorders, when identified and treated, can be a valid therapeutic target for tinnitus; however, somatic screening of subjects for somatosensory tinnitus is imperative for correct selection of patients who would benefit from a multidisciplinary somatic approach

    Relationship between hearing function and myasthenia gravis: a contemporary review

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    There is increasing evidence of a connection between hearing function and myasthenia gravis (MG). Studies of the pathophysiological basis of this relationship suggest that acetylcholine receptors (AChRs) on outer hair cells (OHCs) play a central role. In patients with MG, autoantibodies against AChRs induce a progressive loss of AChRs on OHCs, decreasing their electromotility. The stapedial reflex decay test can be altered in MG patients, and can be used as an additional tool for diagnosis and monitoring. Transient evoked and distortion product otoacoustic emissions are the main diagnostic tool for monitoring OHC functionality in MG patients, and can be used to record subclinical hearing alterations before the onset of clinically evident hearing loss. Understanding the association between MG and hearing dysfunction requires a multidisciplinary approach. Otolaryngologists should take this relationship into account when approaching patients with a diagnosis of myasthenia gravis and "in patients with MG" with ण128;\u9cin MG patients, and the progress of hearing alterations should always be monitored in patients with MG
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