It's all about timing, early treatment with hyperbaric oxygen therapy and corticosteroids is essential in acute acoustic trauma

Background: Acute acoustic trauma (AAT) is an acute hearing impairment caused by intense noiseimpact. The current management strategy for AAT with substantial hearing loss in the Dutch militaryis the combination therapy with corticosteroids and hyperbaric oxygen therapy (HBOT). In a previousstudy, early initiation of the combination therapy was associated with better outcomes. Therefore, weperformed a new analysis to assess the difference in hearing outcome between patients in whomcombination therapy was started within two days, versus after more than two days.Methods: A retrospective analysis was performed on military patients diagnosed with AAT with substantial hearing loss who presented between February 2018 and March 2020. Absolute and relativehearing improvement between first and last audiograms were calculated for all affected frequencies(defined as loss of 20 dB on initial audiogram). We also determined the amount of patients whorecovered to the level of Dutch military requirement, and performed speech discrimination tests.Results: In this analysis, 30 male patients (49 ears) with AAT were included. The median age was 24.5years (IQR 23e29). The median time to initiation of therapy with corticosteroids and HBOT were one andtwo days, respectively. HBOT was started within two days in 31 ears, and after more than two days in 18ears. The mean absolute and relative hearing gains were 18.8 dB (SD 14.6) and 46.8% (SD 31.3) on allaffected frequencies. The 100% discrimination/speech perception level improved from 64.0 dB to 51.7 dB(gain 12.3 dB ± 14.1). There was significantly more improvement in absolute and relative hearingimprovement when HBOT was started in 2 days, compared to >2 days.Conclusion: Our analysis shows results in favor of early initiation ( 2 days) of the combination treatmentof HBOT and corticosteroids in patients with AAT.

Self-monitoring of the tympanic membrane:An opportunity for telemedicine during times of COVID-19 and beyond

The interest for telemedicine has increased since the COVID-19 pandemic because of the risk of infection.Recently,commercial companies started selling digital USB-otoscopes(DUO)that can be connected to a mobile phone.These DUOs are inexpensive(costing approximately$6e35 each)and make it possible to visualize the whole tympanic membrane.Here,we illustrate the case of a patient who had operative correction of a tympanic membrane retraction,and who self-monitored the tympanic membrane in the course of time.Additionally,we discuss the use of DUOs in otolaryngology telemedicine practice.The use of simple digital USB otoscopes provides a promising method to assess and monitor the tympanic membrane remotely.However,more research is needed to establish the role of DUOs in telemedicine.