Differentiating Acute Otitis Media and Acute Mastoiditis in Hospitalized Children

Acute otitis media is a common infection in children. Most acute otitis media episodes can be treated at an outpatient setting with antimicrobials, or only expectant observation. Hospital treatment with parenteral medication, and myringotomy or tympanostomy, may be needed to treat those with severe, prolonged symptoms, or with complications. The most common intratemporal complication of acute otitis media is acute mastoiditis. If a child with acute mastoiditis does not respond to this treatment, or if complications develop, further examinations and other surgical procedures, including mastoidectomy, are considered. Since the treatment of complicated acute otitis media and complicated acute mastoiditis differs, it is important to differentiate these two conditions. This article focuses on the differential diagnostics of acute otitis media and acute mastoiditis in children.Peer reviewe

Plasticity of histamine H3 receptor expression and binding in the vestibular nuclei after labyrinthectomy in rat

Background: In rat, deafferentation of one labyrinth (unilateral labyrinthectomy) results in a characteristic syndrome of ocular and motor postural disorders (e.g., barrel rotation, circling behavior, and spontaneous nystagmus). Behavioral recovery (e.g., diminished symptoms), encompassing 1 week after unilateral labyrinthectomy, has been termed vestibular compensation. Evidence suggesting that the histamine H3 receptor plays a key role in vestibular compensation comes from studies indicating that betahistine, a histamine-like drug that acts as both a partial histamine H1 receptor agonist and an H3 receptor antagonist, can accelerate the process of vestibular compensation. Results: Expression levels for histamine H3 receptor (total) as well as three isoforms which display variable lengths of the third intracellular loop of the receptor were analyzed using in situ hybridization on brain sections containing the rat medial vestibular nucleus after unilateral labyrinthectomy. We compared these expression levels to H3 receptor binding densities. Total H3 receptor mRNA levels (detected by oligo probe H3X) as well as mRNA levels of the three receptor isoforms studied (detected by oligo probes H3A, H3B, and H3C) showed a pattern of increase, which was bilaterally significant at 24 h post-lesion for both H3X and H3C, followed by significant bilateral decreases in medial vestibular nuclei occurring 48 h (H3X and H3B) and 1 week post-lesion (H3A, H3B, and H3C). Expression levels of H3B was an exception to the forementioned pattern with significant decreases already detected at 24 h post-lesion. Coinciding with the decreasing trends in H3 receptor mRNA levels was an observed increase in H3 receptor binding densities occurring in the ipsilateral medial vestibular nuclei 48 h post-lesion. Conclusion: Progressive recovery of the resting discharge of the deafferentated medial vestibular nuclei neurons results in functional restoration of the static postural and occulomotor deficits, usually occurring within a time frame of 48 hours in rats. Our data suggests that the H3 receptor may be an essential part of pre-synaptic mechanisms required for reestablishing resting activities 48 h after unilateral labyrinthectomy

Acute Acoustic Trauma after Exposure to Assault Rifle Noise among Conscripts in the Finnish Defence Forces—A Population-Based Survey

Conscripts are exposed to various sources of impulse noise despite hearing protection recommendations. The aim of this study was to investigate the frequency of acute acoustic trauma (AAT) among conscripts after exposure to assault rifle noise in the Finnish Defence Forces (FDF). This nationwide population-based cohort comprised all conscripts (>220,000) in the FDF during the years 1997–2003 and 2008–2010. We included those who claimed to have AAT symptoms from assault rifle noise during the study periods. During the investigated 10 years, 1617 conscripts (annual variation, 75–276) experienced a new hearing loss due to AAT. Altogether, 1456 (90%) of all AAT-induced hearing losses were caused by rifle-caliber weapons and 1304 (90%) of them when firing a blank cartridge. There was no clear diminishing trend in the annual numbers of AATs. In 1277 (88%) incidents, no hearing protector was used. Tinnitus was the most prominent symptom. Hearing losses after AAT were typically mild, but serious deficits also occurred. In conclusion, we found that 0.7–1.5% of the conscripts experienced an AAT during their service in the FDF. Most incidents occurred when firing a blank cartridge with a rifle-caliber weapon and with no hearing protector in use

Hearing and tinnitus in head and neck cancer patients after chemoradiotherapy

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Tinnitus and suicide : An unresolved relation

Tinnitus is an auditory phantom sensation which can be a devastating condition for the affected person causing annoyance and discomfort. It may be associated with psychiatric conditions. Patients with highly annoying tinnitus and different comorbidities may have a higher risk of expressing suicidal behaviour and ideation. We aimed to review available reports on the prevalence of suicide and suicidal behaviour with tinnitus patients in order to collate current concepts and to identify possible alarming signs and risk factors. A comprehensive search for appropriate studies listed in PubMed, Ovid and Cochrane databases was conducted using appropriate keyword combinations. We identified 22 publications including original articles, case reports and reviews of which 10 fit our stringent search criteria. Most importantly, from the present studies it appears not feasible to univocally conclude on the co-incidence of tinnitus and suicide. This is due to methodological differences in these approaches, complex interrelations between tinnitus and other psychiatric comorbidities and confounding factors such as the inclusion of patients suffering from post-traumatic stress disorder. More concerted actions involving different medical disciplines are needed to reflect the ethiological heterogeneity of tinnitus and suicide or suicidal behaviour to test for a relationship.Peer reviewe

Self-Administered Domiciliary tDCS Treatment for Tinnitus : A Double-Blind Sham-Controlled Study

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An exploratory investigation of speech recognition thresholds in noise with auralisations of two reverberant rooms

Objective Speech-in-noise tests are widely used in hearing diagnostics but typically without reverberation, although reverberation is an inextricable part of everyday listening conditions. To support the development of more real-life-like test paradigms, the objective of this study was to explore how spatially reproduced reverberation affects speech recognition thresholds in normal-hearing and hearing-impaired listeners. Design Thresholds were measured with a Finnish speech-in-noise test without reverberation and with two test conditions with reverberation times of similar to 0.9 and 1.8 s. Reverberant conditions were produced with a multichannel auralisation technique not used before in this context. Study sample Thirty-four normal-hearing and 14 hearing-impaired listeners participated in this study. Five people were tested with and without hearing aids. Results No significant differences between test conditions were found for the normal-hearing listeners. Results for the hearing-impaired listeners indicated better performance for the 0.9 s reverberation time compared to the reference and the 1.8 s conditions. Benefit from hearing aid use varied between individuals; for one person, an advantage was observed only with reverberation. Conclusions Auralisations may offer information on speech recognition performance that is not obtained with a test without reverberation. However, more complex stimuli and/or higher signal-to-noise ratios should be used in the future.Peer reviewe

tACS-mediated modulation of the auditory steady-state response as seen with MEG

Background: Previous studies have shown that transcranial electrical stimulation can be successfully applied during simultaneous MEG measurements. In particular, using beamforming they have established that changes of stimulus induced as well as evoked activity can be inspected during transcranial alternating current stimulation (tACS). Objective/Hypothesis: We studied tACS-mediated changes of the auditory steady-state response (ASSR), hypothesizing that-due to the putatively inhibitory role of alpha oscillations-these evoked responses would be diminished. Methods: We compared ASSRs in conditions with and without 12-Hz and 6.5-Hz sinusoidal 1.5 mA tACS, applied bilaterally over temporal areas. Source-level activity was estimated using a linearly constrained minimum variance beamformer and compared across tACS conditions using paired t-tests following a condition-internal normalization procedure. Conclusions: By separating the electrical and auditory stimulation to non-overlapping parts of the frequency spectrum, we were able to compare auditory-evoked steady-state activity across tACS conditions. We observed a significant decrease in normalized ASSR power in the 12-Hz tACS condition, illustrating that tACS could induce immediate changes in auditory evoked activity. This study sets a methodology to further interrogate the causal roles of oscillatory dynamics in auditory cortices, as well as suggests perspectives for employing tACS in clinical contexts. (C) 2018 Published by Elsevier B.V.Peer reviewe

Patient satisfaction in the long-term effects of Eustachian tube balloon dilation is encouraging

Object: To investigate the long-term effects of balloon Eustachian tuboplasty (BET) from patient's perspective and to discover which symptoms of Eustachian tube dysfunction (ETD) benefit the most from BET. Method: We designed a retrospective postal questionnaire based on the seven-item ETD questionnaire (ETDQ-7). Our questionnaire covered the severity of present ETD symptoms in comparison with the preoperative situation, the severity of current overall ear symptoms, and possible surgical interventions after BET. Forty-six patients treated in our institution between 2011 and 2013 fulfilled the inclusion criteria and 74% (34 patients; total 52 ears treated with BET) returned the questionnaire with a mean follow-up time of 3.1 years (range 1.8-4.6 years). Results: Pain in the ears, feeling of pressure in the ears, and feeling that ears are clogged had reduced in 75% of the ears that suffered from these symptoms preoperatively. Seventy-seven percent of all the responders felt that their overall ear symptoms were reduced. Altogether, 82% of all the patients stated that they would undergo BET again if their ear symptoms returned to the preoperative level. Conclusion: Patient satisfaction in the long-term effects of BET is encouraging. These results may help clinicians in preoperative patient selection and counselling.Peer reviewe

Sisäkorvaistute - kokeellisesta hoidosta arkipäivän kuntoutukseksi

Sisäkorvaistutehoito sopii sekä synnynnäisen vaikea-asteisen kuulovian että etenevän kuulovian hoidoksi. Istutteella voidaan saavuttaa hyvä puheentunnistuskyky vaikea-asteisessa kuulonalenemassa. Hoito on osoitettu kustannusvaikuttavaksi kaikissa ikäryhmissä. Nuorimmat potilaat ovat olleet 8–10 kuukauden ja vanhimmat yli 80 vuoden ikäisiä. Vanhusväestössä on paljon vaikea-asteisesta kuuloviasta kärsiviä potilaita, jotka hyötyisivät istutehoidosta. Heitä tulisi ohjata nykyistä aktiivisemmin leikkausarvioon.Peer reviewe