Perceived disability from hearing and voice changes in the elderly

Aim: Dysphonia and hearing loss are underestimated conditions in the elderly, despite their significant prevalence (18% and 50%, respectively) and their sociopsychological implications. Previous studies have shown that the reason for this lack of consideration is related to the general misconception of a simple age-related issue, as well as to the reduced communication requirements of this population, which can result in infrequent requests/supply of care. The purpose of the present study was to evaluate, within an elderly population, the subjective perception of hearing and voice dysfunctions, the resulting changes in communication skills, and the perception of handicap and disability. Methods: Four anonymous questionnaires were administered to 400 participants (218 men, 182 women) aged older than 65 years, some of whom (276) were hospitalized and some of whom (124) were outpatients. The questionnaires consisted of questions regarding age-related changes in voice, multiple-choice questions on the qualitative characteristics of the voice, questions regarding verbo-acoustic communication (hearing), the Voice Handicap Index, and the Self Assessment of Communication regarding the perception of hearing loss-related handicap and disability. Statistical correlations were calculated for voice dysfunction between the perception of disability and the clinical assessment of voice quality obtained by the Grade, Roughness, Breathiness, Asthenia, Strain scale, and between the perception of disability and the demand for care. Results: More than half of the elderly patients reported not perceiving voice changes throughout their lives. Most of the participants were satisfied with their own voices, although 65% of them judged them to be qualitatively altered, and in 31.5% of the participants, pathology was found on phoniatric evaluation. Low scores for vocal handicap (Voice Handicap Index) were found, and the type of perceived disability was mainly physical, although the association between Voice Handicap Index scores and Grade, Roughness, Breathiness, Asthenia, Strain was statistically significant. A total of 62% of the patients perceived hearing changes over their lifetimes not related to previous ear infections, but significantly correlated with a family history of hearing problems and with the need for specialist consultations. However, the perception of hearing loss handicaps and disability showed lower mean values, showing that older patients recognized dysfunction, but did not consider it to be a disability. Conclusions: The present study showed that, despite the relevant incidence of hearing and voice disorders among the elderly population, the implications for communication abilities seems to be underestimated. Hence, it appears to be extremely important to undergo specialist screening consultations to detect eventual voice and hearing alterations, and to correct them with appropriate therapeutic strategies

Bone conductive implants in single sided deafness

Conclusion: The Bone Conductive Implants (BCI) showed to partly restore some of the functions lost when the binaural hearing is missing, such as in the single-sided deafness (SSD) subjects. The adoption of the single BCI needs to be advised by the clinician on the ground of a thorough counselling with the SSD subject. Objectives: To perform an overview of the present possibilities of BCI in SSD and to evaluate the reliability of the audiological evaluation for assessing the speech recognition in noise and the sound localization cues, as major problems related to the loss of binaural hearing. Method: Nine SSD subjects who underwent BCI implantation underwent a pre-operative audiological evaluation, consisting in the soundfield speech audiometry, as word recognition score (WRS) and sound localization, in quiet and in noise. Moreover, they were also tested for the accuracy of directional word recognition in noise and with the subjective evaluation with APHAB questionnaire. Results: The mean maximum percentage of word discrimination was 65.5% in the unaided condition and 78.9% in the BCI condition. The sound localization in noise with the BCI was better than the unaided condition, especially when stimulus and noise were on the same side of the implanted ear. The accuracy of directional word recognition showed to improve with BCI in respect to the unaided condition, in the BCI side, with either the stimulus on the implanted ear and the noise in the contralateral ear, or when both stimulus and noise were deliver to implanted ear

Inner Ear Active Hearing Device in Non-Otosclerotic, Severe, Mixed Hearing Loss

OBJECTIVE: To verify the efficacy of a powerful active hearing device in a patient different from far-advanced otosclerosis, specifically when the stapes footplate is mobile. PATIENT: A patient with severe-to-profound mixed hearing loss, who was not benefiting from the use of a conventional hearing aid, was selected for an inner ear active implant. This was justified by a bone conductive threshold above 60 dB, which had discouraged any other rehabilitative solutions such as a bone conductive implant, or an active middle ear implant (AMEI). INTERVENTION: The hearing device was surgically applied using a combined transmastoid/transcanal approach. During surgery, a mobile stapes were found and was perforated for the insertion of a piston prosthesis, crimped on the new-incus of the device. MAIN OUTCOME MEASURE: The bone conduction threshold was assessed postoperatively to identify any possible surgery-related hearing deterioration. Pure tone audiometry was conducted in a sound field, and a speech reception threshold test was performed with the contralateral ear masked. The hearing outcome was assessed soon after the implant activation (6 weeks after surgery), and 6 months after surgery. RESULTS: Upon activation of the device, a PTA of 45 dB was obtained (at 0.5, 1, 2 and 4 kHz). At 6 months after surgery, the speech discrimination score reached 90% at 80 dB SPL. CONCLUSION: The application of the Codacs device has shown to be compatible with a mobile stapes footplate, as demonstrated in this report. The footplate perforation did not cause any further hearing deterioration, and has allowed to achieve a favorable auditory outcome

Patient satisfaction after auditory implant surgery. ten-year experience from a single implanting unit center

Conclusions: The satisfaction rate of the subjects with an auditory implant appears strictly related to the resulting auditory improvement, and the surgical variables would play a prevailing role in respect to the esthetic factors. Objectives: To assess the rate of satisfaction in subjects who underwent the surgical application of an auditory device at a single Implanting Center Unit. Method: A series of validated questionnaires has been administered to subjects who underwent the surgical application of different auditory devices. The Glasgow Benefit Inventory (GBI), the Visual Analog Scale (VAS), and the Abbreviated Profile of Hearing Aid Benefit (APHAB) have been used to compare the implanted situation with the hearing-aided one; a percutaneous bone conductive implant (pBCI) with an active middle ear implant (AMEI) on the round window in mixed hearing loss; and an invisible, fully-implantable device with a frankly and bulky semi-implantable device. Results: The mean GBI scores were higher in Vibrant Soundbridge (VSB)VR and BonebridgeVR subjects, without significant differences among the various devices. The mean VAS score increased for all the devices in comparison with the conventional hearing aid. The mean APHAB score was similarly better in the implanted condition as total and partial scores

Transitions in auditory rehabilitation with bone conductive implant (bci)

Background: The bone conductive implants (BCI) are nowadays a reliable alternative for rehabilitation of specific forms of hearing loss, i.e. conductive, mixed or single sided deafness (SSD). Aims/Objective: To analyse the various factors in play when considering an auditory rehabilitation with a bone-conductive device (BCI). Materials and Methods: The clinical charts of subjects who underwent BCI application at the same Implanting Center from 2005 to 2018 were retrieved analysing also the reason for eventual explantation and the alternative option (transition) for hearing rehabilitation. Results: Nine BAHA Compact, 4 BAHA Intenso, 21 BAHA Divino, 3 BAHA BP100, 4 Ponto, 2 Sophono, 5 Bonebridge, 5 BAHA5 Attract; 11 BAHA5 Connect were used in 12 unilateral COM; 16 bilateral COM; 3 unilateral cholesteatoma; 6 bilateral cholesteatoma; 2 unilateral otosclerosis; 5 bilateral otosclerosis; 9 congenital malformations; 6 major otoneurosurgical procedures; 5 sudden deafness. Explantation was necessary for five subjects. Conclusions: Middle ear pathology and sequels from surgery represent the most common reason for BCI implantation, both in unilateral and in bilateral cases. Transition from one implantable device to another one can be predictable, mostly when explantation is necessary. Significance: The role of BCI for rehabilitation in middle ear pathology may be extremely important

Cone beam computed tomography after round window vibroplasty. do the radiological findings match the auditory outcome?

Conclusion: The CBCT imaging technique has proved to be reliable for assessing the appropriate positioning of the FMT in the round window niche. However, when considering specific imaging parameters, such as lack of bony contacts and appropriate inferior support, they would not seem essential for achieving a satisfactory functional outcome. Objectives: To evaluate the value of some imaging parameters derived from a Cone Beam Computed Tomography of the temporal bone for predicting a good functional outcome after Round Window Vibroplasty (RW-VP). Method: A CBCT imaging has been carried out at certain time after RW-VP surgery in a homogenous group of patients who presented with a mixed-type hearing loss after open tympanoplasty for a cholesteatoma. Three arbitrary radiological parameters have been considered for the purpose: the FMT/RW membrane contact; eventual FMT bony contacts; appropriatmess of inferior FMT support. The audiological assessment has taken into consideration the PTA4 (500-4000 Hertz), the PTA2 (125.250 Hertz), the WRS in quiet and in noise (SNR=+10). A comparison between the unaided and the RW-VP aided condition has been performed

Intralabyrinthine Vestibular Schwannoma Responsive to Intratympanic Gentamicin Treatment

Intralabyrinthine schwannoma (ILS) is a rare benign tumor that affects the ends of cochlear and vestibular nerves. In a majority of the cases, it occurs with unilateral progressive sensorineural hearing loss. Less frequent symptoms include tinnitus, imbalance, vertigo, or fullness. The advent of magnetic resonance imaging allows early diagnosis and enables an appropriate therapeutic protocol. This report describes a case of intravestibular schwannoma, with fluctuating hearing loss and intractable vertigo, treated with intratympanic gentamicin. The patient was a 28-year-old woman with intractable vertigo and fluctuating left-side hearing loss caused by left intravestibular schwannoma. Because surgery was temporarily rejected by the patient, a single dose of intratympanic gentamicin was administered. Following this, the patient showed a significant improvement in the symptoms. However, moderate to flat sensorineural hearing loss was also observed. Intratympanic gentamicin infiltration is a valid therapeutic option for patients with ILS, affected by intractable vertigo, when the patient refuses surgery

The role of cochlear implantation in alleviating Tumarkin drop attacks of Meniere's disease; a case report

Ménière's disease (MD) patients may suffer episodes of sudden falls, named Tumarkin drop attacks (DAs). This fall occurs abruptly and without warning or loss of consciousness. DAs usually aggravate the clinical picture of MD and are challenging to manage. The present report describes a case treated by cochlear implantation (CI) due to concomitant deafness and offers some clinical considerations for this condition. A male patient aged 48 years with a 10-year history of definite bilateral MD had profound SNHL on the right and severe SNHL on the left side. He suffered from intermittent attacks of vertigo, ear fullness, and tinnitus and, in the last year, had developed DAs and experienced 14 episodes in the previous six months. The preoperative category of acoustic performance was 3. The Dizziness Handicap Inventory (DHI) questionnaire showed a total score of 46, which indicated a moderate degree of disability. A CI was planned for the right side. The patient did not report any further DAs episode for two years since then. The postoperative category of acoustic performance became 11, and the postoperative DHI questionnaire showed a decrease in the total score (from 46 to 19), which indicated a mild disability. Unilateral CI effectively alleviated the DAs associated with bilateral MD. Our report proposes a new modality for managing vertiginous symptoms in cases of MD with hearing loss without the need for more aggressive surgical interventions with the need for clinical trials to confirm our results

Delayed Effect of Active Pressure Treatment on Endolymphatic Hydrops

OBJECTIVE: To identify eventual correlations between the effect of low-pressure treatment and endolymphatic hydrops in Ménière patients. MATERIAL AND METHODS: The study group consisted of subjects affected by definite Ménière disease (2015) and a severe degree of disability, who received a ventilation tube with or without a low-pressure treatment before undergoing a surgical procedure (vestibular neurectomy). After the placement of the ventilation tube, the subjects were either left alone with the tube or received 1 month of self-administered low-pressure therapy with a portable device. In all subjects, an electrocochleography (ECochG) was performed and specific questionnaires - Dizziness Handicap Inventory (DHI) and Functional Scale Level (FSL) - were completed before starting either arm of treatment, at the end of treatment, and then 3 and 6 months later. RESULTS: All selected subjects presented with an ECochG pattern that was indicative of endolymphatic hydrops before starting either treatment. At the end of pressure treatment, 80% showed symptomatic improvement while maintaining the hydropic ECochG pattern. At the 3-month control stage, the hydropic pattern resulted normalized (<0.5) in all the improved subjects. CONCLUSIONS: Although 1 month of low-pressure treatment provided a positive symptomatological outcome, normalization of the hydropic ECochG parameters occurred only at a later time. Therefore, it is possible to assume that endolymphatic hydrops could be concurrent with a non-symptomatic stage of Ménière disease, and that the anti-hydropic effect of the low-pressure treatment, if any, would present with a certain delay after its completion