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Congenital conductive hearing loss: Imaging and treatment
Otolaryngology– Head and Neck Surgery Volume 131 Number 2
8:08 AM Virtual Reality and Vestibular Rehabilitation: SevenYears Experience Enzo Mora (presenter); Francesco Mora, MD; Barbara Crippa; Renzo Mora; Marco Barbieri Genoa Italy; Genova Italy; Genoa Israel; Genoa Italy; Genoa Italy
Objectives: Antivertiginous drugs, antihistaminics or vasodilators, are known to give temporary relief but literature suggests the counterproductive effects of these drugs. Once the severe acute symptoms subside the antivertiginous drug therapy should be stopped and the patient should be considered for vestibular rehabilitation therapy. Current rehabilitation efforts are intended to drive the nervous system to adapt to the disordered vestibular input: physiopathological basics of vestibular rehabilitation are based on mechanisms of vestibular compensation: an appropriately designed virtual reality (VR) experience could greatly increase the rate of compensation in these patients. Methods: To test the application of VR on our patients we used a particular “helmet” connected to a personal computer. The rehabilitation training is divided in 2 phases: “passive” and “active.” Since 1997, 908 patients had been submitted to the vestibular rehabilitation with VR. The patients were affected with: paroxysmal positional vertigo, monolateral pe-
ripheral vestibular dysfunction, bilateral peripheral vestibular deficit, central nervous system lesions, psychogenic vertigo. Results: Seventy-five percent of patients showed an improvement demonstrated by stabilometric data while 92% of patients reported an improvement of their symptoms. Patients with peripheral vertigo showed an improvement both of symptoms and objective data while patients with central vertigo showed an improvement in objective data not always accompanied by a regression in subjective symptoms. Conclusions: Correct execution of the exercises permits a mobility of the neck that activates compensation mechanisms through somato-esthesic channels in cervical muscles. This method could also show success in pediatric patients where a playful approach to therapy could be used. 8:16 AM Congenital Conductive Hearing Loss: Imaging and Treatment Cecilia Vy Tran, MD (presenter); Jeffrey T Vrabec, Manolidis, MD; Newton J Coker, MD Houston TX; Houston TX; Houston TX; Houston TX
MD;
Spiros
Objectives: Conductive hearing loss in children is most often due to nonossicular problems, such as middle ear fluid or cholesteatoma. Hearing loss, however, can also be caused by congenital abnormalities of the conductive mechanism. This study evaluates the operative findings, results, and the role of imaging in children with congenital conductive hearing loss. Methods: A retrospective case review was performed at an academic medical center. Children with hearing loss due to trauma, chronic infections, or external auditory canal malformations were excluded. Twenty-five cases were included. Preoperative air and bone pure tone and speech thresholds were compared with 1-year postoperative hearing results. All preoperative computed tomography (CT) scans were reviewed, and the incidence of preoperative CT defined abnormalities was reported. Results: The most common causes of conductive hearing loss were malleus fixation (33%) and stapes fixation (33%). Fifty percent of abnormalities were identified on preoperative CT scan. Postoperative hearing results were mixed with only 30% of cases achieving a PTA of less than 30 dB. Fifty-five percent of cases had an improvement in postoperative air bone gap by 10 dB from preoperative levels. Cases of malleus fixation had better results overall, with 60% of these achieving a postoperative PTA of less than 30 dB and 60% improving by greater than 10 dB in postoperative air bone gap. Conclusions: CT scan is a useful diagnostic test in children with congenital conductive hearing loss. While surgical intervention overall has mixed results, isolated malleus fixation has the best prognosis for hearing improvement.
TUESDAY
has only been one previous comprehensive report on a cadre of patients with this entity. This study, prospectively evaluated patient with BiBPPV, with respect to demographics, management, and outcome. Methods: All patients identified and treated for BiBPPV in a previous 22-month period were included.They were followed up in a tertiary neurotology outpatient clinic. All patients were treated with Epley’s maneuver on the side that was more symptomatic at the time of initial presentation and had a greater velocity and amplitude of rotatory nystagmus. Patients were retreated according to symptoms and findings on follow-up visits. Results: During a period of 22 months, 145 patients were diagnosed with BPPV. Ten of the patients were identified with BiBPPV, with a minimal follow-up period of 6 months. Most patients complained of nonlocalized positional vertigo and unsteadiness. Four were males and 6 were females, and the mean age was 52.There was a positive history of recent head trauma in 5 of the patients. All patients were cured after performing a mean of 3 Epley’s maneuvers over a 3-month period. Conclusions: BiBPPV has typical charisteristics and can be managed sucsessfully with Epley’s maneuver performed on the more symtomatic side, followed by repeated treatments, as needed.
Scientific Session—Tuesday P91
8:08 AM Virtual Reality and Vestibular Rehabilitation: SevenYears Experience Enzo Mora (presenter); Francesco Mora, MD; Barbara Crippa; Renzo Mora; Marco Barbieri Genoa Italy; Genova Italy; Genoa Israel; Genoa Italy; Genoa Italy
Objectives: Antivertiginous drugs, antihistaminics or vasodilators, are known to give temporary relief but literature suggests the counterproductive effects of these drugs. Once the severe acute symptoms subside the antivertiginous drug therapy should be stopped and the patient should be considered for vestibular rehabilitation therapy. Current rehabilitation efforts are intended to drive the nervous system to adapt to the disordered vestibular input: physiopathological basics of vestibular rehabilitation are based on mechanisms of vestibular compensation: an appropriately designed virtual reality (VR) experience could greatly increase the rate of compensation in these patients. Methods: To test the application of VR on our patients we used a particular “helmet” connected to a personal computer. The rehabilitation training is divided in 2 phases: “passive” and “active.” Since 1997, 908 patients had been submitted to the vestibular rehabilitation with VR. The patients were affected with: paroxysmal positional vertigo, monolateral pe-
ripheral vestibular dysfunction, bilateral peripheral vestibular deficit, central nervous system lesions, psychogenic vertigo. Results: Seventy-five percent of patients showed an improvement demonstrated by stabilometric data while 92% of patients reported an improvement of their symptoms. Patients with peripheral vertigo showed an improvement both of symptoms and objective data while patients with central vertigo showed an improvement in objective data not always accompanied by a regression in subjective symptoms. Conclusions: Correct execution of the exercises permits a mobility of the neck that activates compensation mechanisms through somato-esthesic channels in cervical muscles. This method could also show success in pediatric patients where a playful approach to therapy could be used. 8:16 AM Congenital Conductive Hearing Loss: Imaging and Treatment Cecilia Vy Tran, MD (presenter); Jeffrey T Vrabec, Manolidis, MD; Newton J Coker, MD Houston TX; Houston TX; Houston TX; Houston TX
MD;
Spiros
Objectives: Conductive hearing loss in children is most often due to nonossicular problems, such as middle ear fluid or cholesteatoma. Hearing loss, however, can also be caused by congenital abnormalities of the conductive mechanism. This study evaluates the operative findings, results, and the role of imaging in children with congenital conductive hearing loss. Methods: A retrospective case review was performed at an academic medical center. Children with hearing loss due to trauma, chronic infections, or external auditory canal malformations were excluded. Twenty-five cases were included. Preoperative air and bone pure tone and speech thresholds were compared with 1-year postoperative hearing results. All preoperative computed tomography (CT) scans were reviewed, and the incidence of preoperative CT defined abnormalities was reported. Results: The most common causes of conductive hearing loss were malleus fixation (33%) and stapes fixation (33%). Fifty percent of abnormalities were identified on preoperative CT scan. Postoperative hearing results were mixed with only 30% of cases achieving a PTA of less than 30 dB. Fifty-five percent of cases had an improvement in postoperative air bone gap by 10 dB from preoperative levels. Cases of malleus fixation had better results overall, with 60% of these achieving a postoperative PTA of less than 30 dB and 60% improving by greater than 10 dB in postoperative air bone gap. Conclusions: CT scan is a useful diagnostic test in children with congenital conductive hearing loss. While surgical intervention overall has mixed results, isolated malleus fixation has the best prognosis for hearing improvement.
TUESDAY
has only been one previous comprehensive report on a cadre of patients with this entity. This study, prospectively evaluated patient with BiBPPV, with respect to demographics, management, and outcome. Methods: All patients identified and treated for BiBPPV in a previous 22-month period were included.They were followed up in a tertiary neurotology outpatient clinic. All patients were treated with Epley’s maneuver on the side that was more symptomatic at the time of initial presentation and had a greater velocity and amplitude of rotatory nystagmus. Patients were retreated according to symptoms and findings on follow-up visits. Results: During a period of 22 months, 145 patients were diagnosed with BPPV. Ten of the patients were identified with BiBPPV, with a minimal follow-up period of 6 months. Most patients complained of nonlocalized positional vertigo and unsteadiness. Four were males and 6 were females, and the mean age was 52.There was a positive history of recent head trauma in 5 of the patients. All patients were cured after performing a mean of 3 Epley’s maneuvers over a 3-month period. Conclusions: BiBPPV has typical charisteristics and can be managed sucsessfully with Epley’s maneuver performed on the more symtomatic side, followed by repeated treatments, as needed.
Scientific Session—Tuesday P91