Evaluation of ocular and cervical vestibular evoked myogenic potentials in a conductive hearing loss model

Objective:To investigate the effects of conductive hearing loss (CHL) on vestibular evoked myogenic potentials (VEMPs) using a simulated CHL model, and to provide the basis for future studies. Methods:Twenty-one healthy subjects were recruited in this study. We measured ocular VEMPs (oVEMPs) and cervical VEMPs (cVEMPs) in these subjects by air-conduction sound (ACS) stimulation. CHL was simulated later by blocking the right external auditory canal with a soundproof earplug to evaluate its impacts on VEMPs. Subjects' responses before simulated CHL served as the control, and were compared to their responses following simulated CHL. Results: oVEMPs following simulated CHL showed decreased response rate, elevated thresholds, attenuated amplitudes and prolonged N1 latencies compared with those before simulated CHL, and the differences were statistically significant. Similarly, cVEMPs following simulated CHL also showed decreased response rate, elevated thresholds and attenuated amplitudes, with prolonged P1 latencies compared with those before simulated CHL, although only differences in response rate, threshold and amplitude were significant. Conclusions:Conductive hearing loss affects the response rate and other response parameters in oVEMPs and cVEMPs.

Hearing Assessment among Sudanese Rheumatoid Arthritis Patients versus Non-Rheumatoid Arthritis Individuals

Background: Rheumatoid arthritis (RA) disease is one of the most common chronic autoimmune diseases that affect many body systems including the auditory system. Objectives: To assess hearing thresholds and to ascertain types of hearing loss among Sudanese rheumatoid arthritis patients attending rheumatology clinic in Omdurman military hospital and matching them with non-rheumatoid arthritis subjects. Methodology: This descriptive and analytic (comparative) hospital based cross sectional study conducted from October 2020 to April 2021 which include 66 RA patients with age range (21 - 60 years) matched with 41 non-rheumatoid arthritis group sharing same characteristics (nation, gender and age). Pure tone audiometry, tympanometry and acoustic reflexes were done for all RA patients and matched groups. Statistical analysis of the data was carried out using the association and correlation tests for associations and t-test for independent samples. Results: Thirty-six (54.5%) of RA patients had hearing impairment versus 9 (22%) non-RA in PTA test. Twenty-four RA cases (36.3%) showed asymmetrical hearing threshold and graph in PTA between right and left ears. Thirty-four (51.5%) right and 36 (54.5%) left ears were normal degree followed by 23 (34.8%) in the right and 24 (36.4%) in the left ears were mild degree hearing loss. Among hearing impaired RA patients;20 right ears (62.5%) and 19 left ears (65.5%) had sensorineural hearing loss (SNHL), conductive hearing loss 11 (34.4%) right ears and 9 (31%) left ears. Mixed HL was in 1 right ear (3.1%) and 1 left ear (3.5%). The most common degree of SNHL type was mild in (75%) and (78.9%) in right and left ears respectively, moderate and moderate severe were (20%) in the right and (15.7%) in the left ears. Fifty-eight right ears (87.9%) and 56 left ears (84.8%) had type A tympanogram while 7 (10.6%) right ears and 9 left ears (13.6%) were type As tympanogram, one right and one left ears had type Ad tympanogram. Acoustic reflex was impaired in 17 right ears and 17 left ears (25.8% for both). There were significant statistical differences in most of the specific frequency means between the study group and non-rheumatoid group in the right and left ears p-value 0.05). Also there was no significant statistical association between anti-rheumatic drugs used and hearing threshold of RA patients (p-value > 0.05). Conclusion: Hearing impairment especially sensorineural type is common in Sudanese rheumatoid arthritis patients. Conductive hearing loss is less common and most likely due to ossicles diarthrodial joint stiffness. No influence of the disease activity or used anti-rheumatic drugs on hearing threshold of the RA patients was detected in this study.

Bilateral Middle Fossa Floor Meningiomas Invading the Middle Ear

This case is a 49-year-old female patient who presented with suspected eustachian tube dysfunction symptoms that were refractory to medical treatment. She presented with conductive hearing loss and aural fullness on the left. A physical exam revealed an epitympanic fleshy mass in the middle ear with effusion. Imaging with MRI and CT showed opacification of the epitympanum with surrounding bony demineralization bilaterally left greater than right and significant thinning versus dehiscence of the tegmen mastoideum and tympani on the left with only thinning of the tegmen on the right. An MR temporal bone with and without contrast, demonstrated enhancement of the left middle ear extending to the tegmen and corresponding enhancement of the dura along the floor of the left middle cranial fossa as well as extending along foramen ovale into the infratemporal fossa. There was to a lesser degree similar appearance on the right. A biopsy of the middle ear mass on the left revealed meningioma. This case highlights the need to widen your differential with common symptoms when they are refractory to treatment.

Malleostapedotomy for otosclerosis,our experience of nitinol piston on twelve patients

Objective:Malleostapedotomy allows to completely by-pass the incus in otosclerosis surgery.Recently its use has been rivaled by hydroxyapatite cement for cases of mild and moderate necrosis of the incus.However,it remains gold standard for cases of extensive necrosis,incus dislocation,or epitympanic fixation.Modern heat-crimping pistons make surgery easier and safer.This study focuses on our experience with this technique.Methods:Retrospective analysis of patient’s files and pre-and post-operative audiograms,for cases of surgically treated otosclerosis with malleostapedotomy.Results:Twelve patients underwent malleostapedotomy for otosclerosis between 2011 and 2019.Amongst them there were 10 revision surgeries and 2 primary cases.75%had incus long-process necrosis,17%had epitympanic fixation and one had a history of incus transposition.Nine patients(75%)had closure of air-bone gap(ABG)of<10 dB(p<0.001)and 11(92%)had a threshold of 20 dB(p<0.001).Mean pre-operative ABG was 31 dB(15 dBe55 dB),and mean post-operative ABG was 7 dB(0 dBe21 dB;p<0.001).There was no sensorineural hearing loss nor any other post-operative complication.Conclusions:Malleostapedotomy is a safe and reliable technique,allowing an ABG closure comparable to conventional incus to vestibule prosthesis.It remains the preferred technique whenever the incus cannot be used.

Middle ear osteoma causing Eustachian tube obstruction:A case report and literature review

Middle ear osteoma is an extremely rare benign tumor of the middle ear.Due to its very slow growth rate and benign nature,osteoma of the middle ear can be found incidentally without causing any symptoms.The most common clinical signs are conductive hearing loss,the sense of fullness in the ear,tinnitus,and otorrhea.Small-sized osteomas can be misdiagnosed as otosclerosis without showing any signs other than conductive hearing loss.When the mass becomes very large,and symptoms caused by the tumor increase,treatment also becomes difficult.In this paper,we report a case of middle ear osteoma causing conductive hearing loss and effusion due to the effect of pressure on the middle ear ossicles and the Eustachian tube.We also present a review of the pertinent literature.