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Baha, single-sided deafness, and contralateral hearing loss
Program Oral Presentations
Baha, single-sided deafness, and contralateral hearing loss Mark J Van Ess, DO (presenter); Jack Wazen, MD OBJECTIVES: Understand the benefit, extent of utilization, and patient satisfaction of the Baha system in cases of SSD and mild to moderate hearing loss in the contralateral ear. METHODS: Study design: Prospective. Setting: Teritiary referral center. Patients: 20 patients with SSD and mild to moderate hearing loss in the contralateral ear implanted with the Baha system between June 2006 and March 2008. Intervention(s): Patient evaluation following Baha implantation and fitting with the Divino processor, and again following a fourweek trial with the Intenso processor. Outcome Measure(s): Pure-tone air/bone conduction thresholds, and soundfield testing of CNC words, NU-6 words, and HINT sentences with/ without the Baha Divino device compared to the same testing following a four-week trial with the Baha Intenso. Patient satisfaction questionnaires were administered pre-/post-intervention for either device. RESULTS: Patients having worse hearing in the better hearing ear tended to prefer the Intenso over the Divino device. A comparison of audiological and patient satisfaction scores is presented. CONCLUSIONS: The Baha system is effective in the rehabilitation of patients with single-sided deafness with mild to moderate hearing loss in the only hearing ear. The degree of improvement and patient satisfaction appear to depend upon the degree of hearing loss. Patients with mild contralateral hearing loss responded well to the Divino processor while those with more moderate hearing loss appear to prefer the Intenso processor. Bone conducted ocular VEMPS in superior vestibular neuritis Leonardo Manzari, MD (presenter); Ian Curthoys, PhD OBJECTIVES: Briefly review the published scientific basis for a fast, simple, new means of assessing unilateral otolith function. To show how the asymmetry ratio of the oVEMP indicates unilateral otolith loss. To show exactly how this test is carried out and how the results are interpreted.
METHODS: 65 patients (aged between 39 and 63 years, 34 female) were tested, and referred, between July 1 2008 and December 30 2008, to a tertiary otoneurological centre, with vestibular symptoms. All of them were identified as having superior vestibular neuritis. For recording oVEMPs the patient lay supine on a bed. During testing the subject looked up at a small fixation dot about 2 m from the eyes. Bone conducted vibration was delivered using a hand-held, Bruel and Kjaer, Mini-shaker 4810. Their results were combined with results from 51 healthy subjects. RESULTS: The early negative (excitatory) component (n10) is approximately equal in amplitude for both eyes in healthy subjects, but in patients with Superior Vestibular Neuritis, the n10 component is significantly asymmetrical under the 2 eyes. The n10 component is small or absent under the eye on the side contralateral to the prior unilateral vestibular nerve removal, but of normal amplitude under the eye on the side contralateral to the healthy ear. CONCLUSIONS: The n10 component of the oVEMP response to BCV at Fz stimuli reflects vestibular and mainly otolithic function via crossed otolithic-ocular pathways, and so n10 asymmetry is a new way of identifying the affected side in patients with superior vestibular neuritis. Can bupropion enhance TMS effects in tinnitus patients? Tobias Kleinjung, MD (presenter); Elmar Frank; Veronika Vielsmeier; Michael Landgrebe, MD; Thomas Steffens; Juergen Strutz, MD, PhD; Berthold Langguth, MD OBJECTIVES: Repetitive transcranial magnetic stimulation (rTMS) of the temporal cortex has shown positive effects in patients with chronic tinnitus. However, treatment effects were only moderate with high interindividual variability. Recent preclinical data in healthy controls suggested, that effects of low frequency rTMS can be improved by enhancing dopaminergic neurotransmission. The application of the dopamine agonist L-Dopa prior to rTMS treatment could not demonstrate additional beneficial effects in tinnitus patients. In this study we investigated, whether application of the dopamine reuptake inhibitor bupropion increases clinical effects of low frequency rTMS over the auditory cortex in tinnitus patients. METHODS: Twenty subjects with chronic tinnitus received 10 sessions of 1Hz rTMS (2000 pulses/d, 110% motor threshold) applied to the left temporal cortex. Additionally these subjects received one dosage of 150 mg bupropion (Wellbutrin XL/Elontril) four hours prior to each TMS session. Treatment outcome was assessed over a 3 months period with a tinnitus questionnaire (TQ). Treatment effects were compared to a control group matched for age, gender, tinnitus duration, and hearing loss, which received the same rTMS treatment without prior bupropion application.
ORALS
tumors, though these did not reach statistical significance. Real-time PCR did not show significant differential expression of microRNA-513. CONCLUSIONS: VS tumors express B7-H1, which has been associated with immune tolerance and adverse disease characteristics in several malignancies. Although clinical trends were seen, greater statistical power is required to evaluate whether B7H1 expression correlates with more aggressive tumor growth or recurrence. MicroRNA-513 does not regulate B7-H1 expression in VS tumors.
P75
Baha, single-sided deafness, and contralateral hearing loss Mark J Van Ess, DO (presenter); Jack Wazen, MD OBJECTIVES: Understand the benefit, extent of utilization, and patient satisfaction of the Baha system in cases of SSD and mild to moderate hearing loss in the contralateral ear. METHODS: Study design: Prospective. Setting: Teritiary referral center. Patients: 20 patients with SSD and mild to moderate hearing loss in the contralateral ear implanted with the Baha system between June 2006 and March 2008. Intervention(s): Patient evaluation following Baha implantation and fitting with the Divino processor, and again following a fourweek trial with the Intenso processor. Outcome Measure(s): Pure-tone air/bone conduction thresholds, and soundfield testing of CNC words, NU-6 words, and HINT sentences with/ without the Baha Divino device compared to the same testing following a four-week trial with the Baha Intenso. Patient satisfaction questionnaires were administered pre-/post-intervention for either device. RESULTS: Patients having worse hearing in the better hearing ear tended to prefer the Intenso over the Divino device. A comparison of audiological and patient satisfaction scores is presented. CONCLUSIONS: The Baha system is effective in the rehabilitation of patients with single-sided deafness with mild to moderate hearing loss in the only hearing ear. The degree of improvement and patient satisfaction appear to depend upon the degree of hearing loss. Patients with mild contralateral hearing loss responded well to the Divino processor while those with more moderate hearing loss appear to prefer the Intenso processor. Bone conducted ocular VEMPS in superior vestibular neuritis Leonardo Manzari, MD (presenter); Ian Curthoys, PhD OBJECTIVES: Briefly review the published scientific basis for a fast, simple, new means of assessing unilateral otolith function. To show how the asymmetry ratio of the oVEMP indicates unilateral otolith loss. To show exactly how this test is carried out and how the results are interpreted.
METHODS: 65 patients (aged between 39 and 63 years, 34 female) were tested, and referred, between July 1 2008 and December 30 2008, to a tertiary otoneurological centre, with vestibular symptoms. All of them were identified as having superior vestibular neuritis. For recording oVEMPs the patient lay supine on a bed. During testing the subject looked up at a small fixation dot about 2 m from the eyes. Bone conducted vibration was delivered using a hand-held, Bruel and Kjaer, Mini-shaker 4810. Their results were combined with results from 51 healthy subjects. RESULTS: The early negative (excitatory) component (n10) is approximately equal in amplitude for both eyes in healthy subjects, but in patients with Superior Vestibular Neuritis, the n10 component is significantly asymmetrical under the 2 eyes. The n10 component is small or absent under the eye on the side contralateral to the prior unilateral vestibular nerve removal, but of normal amplitude under the eye on the side contralateral to the healthy ear. CONCLUSIONS: The n10 component of the oVEMP response to BCV at Fz stimuli reflects vestibular and mainly otolithic function via crossed otolithic-ocular pathways, and so n10 asymmetry is a new way of identifying the affected side in patients with superior vestibular neuritis. Can bupropion enhance TMS effects in tinnitus patients? Tobias Kleinjung, MD (presenter); Elmar Frank; Veronika Vielsmeier; Michael Landgrebe, MD; Thomas Steffens; Juergen Strutz, MD, PhD; Berthold Langguth, MD OBJECTIVES: Repetitive transcranial magnetic stimulation (rTMS) of the temporal cortex has shown positive effects in patients with chronic tinnitus. However, treatment effects were only moderate with high interindividual variability. Recent preclinical data in healthy controls suggested, that effects of low frequency rTMS can be improved by enhancing dopaminergic neurotransmission. The application of the dopamine agonist L-Dopa prior to rTMS treatment could not demonstrate additional beneficial effects in tinnitus patients. In this study we investigated, whether application of the dopamine reuptake inhibitor bupropion increases clinical effects of low frequency rTMS over the auditory cortex in tinnitus patients. METHODS: Twenty subjects with chronic tinnitus received 10 sessions of 1Hz rTMS (2000 pulses/d, 110% motor threshold) applied to the left temporal cortex. Additionally these subjects received one dosage of 150 mg bupropion (Wellbutrin XL/Elontril) four hours prior to each TMS session. Treatment outcome was assessed over a 3 months period with a tinnitus questionnaire (TQ). Treatment effects were compared to a control group matched for age, gender, tinnitus duration, and hearing loss, which received the same rTMS treatment without prior bupropion application.
ORALS
tumors, though these did not reach statistical significance. Real-time PCR did not show significant differential expression of microRNA-513. CONCLUSIONS: VS tumors express B7-H1, which has been associated with immune tolerance and adverse disease characteristics in several malignancies. Although clinical trends were seen, greater statistical power is required to evaluate whether B7H1 expression correlates with more aggressive tumor growth or recurrence. MicroRNA-513 does not regulate B7-H1 expression in VS tumors.
P75