Vascular involvement in the pathophysiology of idiopathic sudden sensorineural hearing loss (iSSNHL) has been previously proposed. The objective of this study was to perform a systematic review of... Show moreVascular involvement in the pathophysiology of idiopathic sudden sensorineural hearing loss (iSSNHL) has been previously proposed. The objective of this study was to perform a systematic review of the current literature and conduct meta-analyses to evaluate associations between cardiovascular risk factors, cerebral small vessel disease, and subsequent stroke after presentation with iSSNHL. Three systematic literature reviews and meta-analyses were conducted using PubMed, Embase, and CINAHL. All studies investigating associations between iSSNHL and the cardiovascular risk factors: body mass index (BMI), diabetes mellitus, hyperlipidemia, hypertension, medical history of myocardial infarction (MI), smoking, the degree of white matter hyperintensities, and incidence of stroke were included. Adhering to the PRISMA guidelines, two independent reviewers reviewed the articles and assessed risk of bias. The cardiovascular risk factors of abnormal BMI, diabetes, hypertension, total cholesterol, low-density lipoprotein cholesterol, and a medical history of MI were significantly associated with iSSNHL. The adjusted hazard ratio of a higher degree of white matter hyperintensities was 0.70 (95% CI 0.44, 1.12). Patients with iSSNHL showed a higher risk of stroke compared to controls, with hazard ratios ranging from 1.22 up to 4.08. Several cardiovascular risk factors are more frequently present in patients with iSSNHL than in the general population. The degree of white matter hyperintensities does not appear to be increased in patients with iSSNHL, while the risk of stroke following ISSNHL is increased. Prospective studies with larger study populations are needed to confirm the associations between generalized cardiovascular disease and iSSNHL and to assess whether these patients benefit from cardiovascular risk management to prevent future cardiovascular and cerebrovascular disease. Show less
Introduction: Contralateral routing of signals (CROS) overcomes the head shadow effect by redirecting speech signals from the contralateral ear to the better-hearing cochlear implant (CI) ear. Here... Show moreIntroduction: Contralateral routing of signals (CROS) overcomes the head shadow effect by redirecting speech signals from the contralateral ear to the better-hearing cochlear implant (CI) ear. Here we tested the performance of an adaptive monaural beamformer (MB) and a fixed binaural beamformer (BB) using the CROS system of Advanced Bionics. Methods: In a group of 17 unilateral CI users, we evaluated the benefits of MB and BB for speech recognition by measuring speech reception threshold (SRT) with and without beamforming. MB and BB were additionally evaluated with signal-to-noise ratio (SNR) measurements using a KEMAR manikin. We also assessed the effect of residual hearing in the CROS ear on the benefits of MB and BB. Speech was delivered in front of the listener in a background of homogeneous 8-talker babble noise. Results: With CI-CROS in omnidirectional settings with the T-mic active on the CI as a reference, BB significantly improved SRT by 1.4 dB, whereas MB yielded no significant improvements. The difference in effects on SRT between the two beamformers was, however, not significant. SNR effects were substantially larger, at 2.1 dB for MB and 5.8 dB for BB. CI-CROS with default omnidirectional settings also improved SRT and SNR by 1 dB over CI alone. Residual hearing did not significantly affect beamformer performance. Discussion: We recommend the use of BB over MB for CI-CROS users. Residual hearing in the CROS ear is not a limiting factor for fitting a CROS device, although a bimodal option should be considered. (c) 2023 The Author(s). Published by S. Karger AG, Basel Show less
Jong, M.A. de; Esch, B.F. van; Benthem, P.P.G. van; Zaag-loonen, H.J. van der; Bruintjes, T.D.; Thomeer, H.G.X.M. 2023
Introduction: Diagnosing Meniere's disease (MD) by its characteristics such as episodes of vertigo, fluctuating hearing loss, and tinnitus with aural fullness remains challenging. Available tests... Show moreIntroduction: Diagnosing Meniere's disease (MD) by its characteristics such as episodes of vertigo, fluctuating hearing loss, and tinnitus with aural fullness remains challenging. Available tests evaluating the presence of endolymphatic hydrops (EH) are often expensive or time assuming. An in-office quick and simple non-invasive diagnostic test is multifrequency tympanometry (MFT). It can measure conductance at 2 kHz probe tones, which was demonstrated to reflect variations in cochlear pressure. Previous studies investigating MFT as a diagnostic test for MD showed conflicting outcomes possibly biased by their retrospective design. Methods: We prospectively collected MFT results (Y width) in patients with dizziness and compared MFT test results in affected (group 1) and unaffected (group 2) ears of 37 MD subjects and in control ears of 33 non-MD subjects (group 3). Results: The mean value of the Y width in affected ears was 315.6 +/- 70.2 daPa compared to 292.3 +/- 98.6 daPa in unaffected ears in MD subjects and 259.4. +/- 60.6 daPa in the non-MD group. A positive test result (i.e., a Y width of 235 daPa or more) was found in 35 ears in the MD group, 21 times involving the affected ear and 14 times involving the unaffected ear, compared to 16 in the non-MD group. No significant differences between the three groups could be demonstrated (p > 0.05). We found a sensitivity of 58.3% and specificity of 66.3% for detecting EH in an affected ear in MD subjects. Conclusion: There is a trend towards increased conductance tympanometry in affected ears. However, we noticed a high false positive rate of MFT and do not support standardized use of MFT as an additional diagnostic tool for detecting EH in MD patients. A negative test result on the contrary is unlikely related to EH. Show less
Esch, B. van; Zaag-loonen, H. van der; Bruintjes, T.; Benthem, P.P. van 2021
Background: Meniere's disease is characterized by recurrent episodes of vertigo, hearing loss, and tinnitus, often with a feeling of fullness in the ear. Although betahistine is thought to be... Show moreBackground: Meniere's disease is characterized by recurrent episodes of vertigo, hearing loss, and tinnitus, often with a feeling of fullness in the ear. Although betahistine is thought to be specifically effective for Meniere's disease, no evidence for a benefit from the use of betahistine exists, despite its widespread use. Reassessment of the effect of betahistine for Meniere's disease is now warranted. Search Methods: We searched for randomized controlled trials (RCTs) in the Central Register of Controlled Trials (CENTRAL), Ovid Medline, Ovid Embase, CINAHL, Web of Science, Clinicaltrials.gov, ICTRP, and additional sources for published and unpublished trials, in which betahistine was compared to placebo. Data Collection and Analysis: Our outcomes involved vertigo, significant adverse effect (upper gastrointestinal discomfort), hearing loss, tinnitus, aural fullness, other adverse effects, and disease-specific health-related quality of life. We used GRADE to assess the quality of the evidence. Main Results: We included 10 studies: 5 studies used a crossover design and the remaining 5 were parallel-group RCTs. One study with a low risk of bias found no significant difference between the betahistine groups and placebo with respect to vertigo after a long-term follow-up period. No significant difference in the incidence of upper gastrointestinal discomfort was found in 2 studies (low-certainty evidence). No differences in hearing loss, tinnitus, or well-being and disease-specific health-related quality of life were found (low- to very low-certainty of evidence). Data on aural fullness could not be extracted. No significant difference between the betahistine and the placebo groups (low-certainty evidence) could be demonstrated in the other adverse effect outcome with respect to dull headache. The pooled risk ratio for other adverse effect in the long term demonstrated a lower risk in favor of placebo over betahistine. Conclusions: High-quality studies evaluating the effect of betahistine on patients with Meniere's disease are lacking. However, one study with low risk of bias found no evidence of a difference in the effect of betahistine on the primary outcome, vertigo, in patients with Meniere's disease when compared to placebo. The main focus of future research should be on the use of comparable outcome measures by means of patient-reported outcome measures. Show less
Introduction: Contralateral routing of signals (CROS) can be used to eliminate the head shadow effect. In unilateral cochlear implant (CI) users, CROS can be achieved with placement of a microphone... Show moreIntroduction: Contralateral routing of signals (CROS) can be used to eliminate the head shadow effect. In unilateral cochlear implant (CI) users, CROS can be achieved with placement of a microphone on the contralateral ear, with the signal streamed to the CI ear. CROS was originally developed for unilateral CI users without any residual hearing in the nonimplanted ear. However, the criteria for implantation are becoming progressively looser, and the nonimplanted ear can have substantial residual hearing. In this study, we assessed how residual hearing in the contralateral ear influences CROS effectiveness in unilateral CI users. Methods: In a group of unilateral CI users (N = 17) with varying amounts of residual hearing, we deployed free-field speech tests to determine the effects of CROS on the speech reception threshold (SRT) in amplitude-modulated noise. We compared 2 spatial configurations: (1) speech presented to the CROS ear and noise to the CI ear (SCROSNCI) and (2) the reverse (SCINCROS). Results: Compared with the use of CI only, CROS improved the SRT by 6.4 dB on average in the SCROSNCI configuration. In the SCINCROS configuration, however, CROS deteriorated the SRT by 8.4 dB. The benefit and disadvantage of CROS both decreased significantly with the amount of residual hearing. Conclusion: CROS users need careful instructions about the potential disadvantage when listening in conditions where the CROS ear mainly receives noise, especially if they have residual hearing in the contralateral ear. The CROS device should be turned off when it is on the noise side (SCINCROS). CI users with residual hearing in the CROS ear also should understand that contralateral amplification (i.e., a bimodal hearing solution) will yield better results than a CROS device. Unilateral CI users with no functional contralateral hearing should be considered the primary target population for a CROS device. Show less
Beek, F.B. van der; Briaire, J.J.; Marel, K.S. van der; Verbist, B.M.; Frijns, J.H.M. 2016
