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The Laryngoscope Apr 2024This review aims to quantify the pooled functional gain (FG) in different types of hearing loss with the transcutaneous hearing device, Osia (Cochlear, Sydney,... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This review aims to quantify the pooled functional gain (FG) in different types of hearing loss with the transcutaneous hearing device, Osia (Cochlear, Sydney, Australia) in comparison with the unaided state. Secondary outcomes are patient-reported outcomes measures (PROMs) and complication rates.
DATA SOURCES
Medline, Embase, SCOPUS, Cochrane CENTRAL, PROSPERO and Cochrane Library.
REVIEW METHODS
Systematic review and meta-analysis of indexed search terms relating to "Osia," "Osseointegration," "Cochlear Implant," and "Bone-Anchored Prosthesis" was performed from database inception to September 20, 2022.
RESULTS
Of the 168 studies identified, 14 studies with 15 patient cohorts (n = 314) met inclusion criteria for meta-analysis. Pooled overall mean FG for all types of hearing loss was 35.0 dB sound pressure level (SPL) (95% confidence interval [CI] 29.12-40.97) compared against unaided hearing. Pooled FG for conductive/mixed hearing loss was 37.7 dB SPL (95% CI 26.1-49.3). Pooled single-sided deafness (SSD) FG could not be calculated due to the small patient cohort for whom SSD data was reported. There is a trend toward improvements in speech receptiveness threshold, signal to noise ratio, and some PROMs compared with baseline hearing. Early complication rates demonstrate risks similar to other transcutaneous implants, with a low predicted explantation (0.11%, 95% CI 0.00%-1.90%) and wound infection rate (1.92% [95% CI 0.00%-6.17%]). No articles directly comparing transcutaneous devices were identified.
CONCLUSION
The Osia devices demonstrate clear audiologic benefits and a good safety profile for the included patient population. Our study results indicate that frequency-specific gain, PROMs, and the audiological benefit in single-sided deafness may be areas for future prospective research. Laryngoscope, 134:1531-1539, 2024.
Topics: Humans; Bone Conduction; Hearing Aids; Cochlear Implants; Hearing Loss, Conductive; Hearing Loss; Deafness; Speech Perception; Treatment Outcome
PubMed: 37721219
DOI: 10.1002/lary.31053 -
The Laryngoscope Dec 2022Hearing loss is a clinical symptom, frequently mentioned in the context of mitochondrial disease. With no cure available for mitochondrial disease, supportive treatment... (Review)
Review
OBJECTIVES
Hearing loss is a clinical symptom, frequently mentioned in the context of mitochondrial disease. With no cure available for mitochondrial disease, supportive treatment of clinical symptoms like hearing loss is of the utmost importance. The aim of this study was to summarize current knowledge on hearing loss in genetically proven mitochondrial disease in children and deduce possible and necessary consequences in patient care.
METHODS
Systematic literature review, including Medline, Embase, and Cochrane library. Review protocol was established and registered prior to conduction (International prospective register of systematic reviews-PROSPERO: CRD42020165356). Conduction of this review was done in accordance with MOOSE criteria.
RESULTS
A total of 23 articles, meeting predefined criteria and providing sufficient information on 75 individuals with childhood onset hearing loss was included for analysis. Both cochlear and retro-cochlear origin of hearing loss can be identified among different types of mitochondrial disease. Analysis was hindered by inhomogeneous reporting and methodical limitations.
CONCLUSION
Overall, the findings do not allow for a general statement on hearing loss in children with mitochondrial disease. Retro-cochlear hearing loss seems to be found more often than expected. A common feature appears to be progression of hearing loss over time. However, hearing loss in these patients shows manifold characteristics. Therefore, awareness of mitochondrial disease as a possible causative background is important for otolaryngologists. Future attempts rely on standardized reporting and long-term follow-up.
LEVEL OF EVIDENCE
NA Laryngoscope, 132:2459-2472, 2022.
Topics: Humans; Hearing Loss; Deafness; Hearing Loss, Sensorineural; Mitochondrial Diseases
PubMed: 35188226
DOI: 10.1002/lary.30067 -
The Cochrane Database of Systematic... Jan 2020Chronic suppurative otitis media (CSOM), sometimes referred to as chronic otitis media (COM), is a chronic inflammation and often polymicrobial infection (involving more... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Chronic suppurative otitis media (CSOM), sometimes referred to as chronic otitis media (COM), is a chronic inflammation and often polymicrobial infection (involving more than one micro-organism) of the middle ear and mastoid cavity, characterised by ear discharge (otorrhoea) through a perforated tympanic membrane. The predominant symptoms of CSOM are ear discharge and hearing loss. Topical antibiotics, the most common treatment for CSOM, act to kill or inhibit the growth of micro-organisms that may be responsible for the infection. Antibiotics can be used alone or in addition to other treatments for CSOM, such as antiseptics or ear cleaning (aural toileting).
OBJECTIVES
To assess the effects of topical antibiotics (without steroids) for people with CSOM.
SEARCH METHODS
The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL via the Cochrane Register of Studies); Ovid MEDLINE; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 1 April 2019.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) with at least a one-week follow-up involving participants (adults and children) who had chronic ear discharge of unknown cause or CSOM, where the ear discharge had continued for more than two weeks. The interventions were any single, or combination of, topical antibiotic agent(s) of any class, applied directly into the ear canal as ear drops, powders or irrigations, or as part of an aural toileting procedure. The two main comparisons were topical antibiotic compared to a) placebo or no intervention and b) another topical antibiotic (e.g. topical antibiotic A versus topical antibiotic B). Within each comparison we separated studies where both groups of participants had received topical antibiotic a) alone or with aural toileting and b) on top of background treatment (such as systemic antibiotics).
DATA COLLECTION AND ANALYSIS
We used the standard Cochrane methodological procedures. We used GRADE to assess the certainty of the evidence for each outcome. Our primary outcomes were: resolution of ear discharge or 'dry ear' (whether otoscopically confirmed or not), measured at between one week and up to two weeks, two weeks to up to four weeks and after four weeks; health-related quality of life using a validated instrument; ear pain (otalgia) or discomfort or local irritation. Secondary outcomes included hearing, serious complications and ototoxicity measured in several ways.
MAIN RESULTS
We included 17 studies with a total of 2198 participants. Twelve studies reported the sample size in terms of participants (not ears); these had a total of 1797 participants. The remaining five studies reported both the number of participants and ears, representing 401 participants, or 510 ears. A: Topical antibiotics versus placebo or no treatment (with aural toilet in both arms and no other background treatment) One small study compared a topical antibiotic (ciprofloxacin) with placebo (saline). All participants received aural toilet. Although ciprofloxacin was better than saline in terms of resolution of discharge at one to two weeks: 84% versus 12% (risk ratio (RR) 6.74, 95% confidence interval (CI) 1.82 to 24.99; 35 participants, very low-certainty evidence), the very low certainty of the evidence means that it is very uncertain whether or not one intervention is better or worse than the other. The study authors reported that "no medical side-effects and worsening of audiological measurements related to this topical medication were detected" (very low-certainty evidence). B: Topical antibiotics versus placebo or no treatment (with use of oral antibiotics in both arms) Four studies compared topical ciprofloxacin to no treatment (three studies; 190 participants) or topical ceftizoxime to no treatment (one study; 248 participants). In each study all participants received the same antibiotic systemically (oral ciprofloxacin, injected ceftizoxime). In at least one study all participants received aural toilet. Useable data were only available from the first three studies; ciprofloxacin was better than no treatment, resolution of discharge occurring in 88.2% versus 60% at one to two weeks (RR 1.47, 95% CI 1.20 to 1.80; 2 studies, 150 participants; low-certainty evidence). None of the studies reported ear pain or discomfort/local irritation. C: Comparisons of different topical antibiotics The certainty of evidence for all outcomes in these comparisons is very low. Quinolones versus aminoglycosides Seven studies compared an aminoglycoside (gentamicin, neomycin or tobramycin) with ciprofloxacin (734 participants) or ofloxacin (214 participants). Whilst resolution of discharge at one to two weeks was higher in the quinolones group the very low certainty of the evidence means that it is very uncertain whether or not one intervention is better or worse than the other (RR 1.95, 95% CI 0.88 to 4.29; 6 studies, 694 participants). One study measured ear pain and reported no difference between the groups. Quinolones versus aminoglycosides/polymyxin B combination ±gramicidin We identified three studies but data on our primary outcome were only available in one study. Comparing ciprofloxacin to a neomycin/polymyxin B/gramicidin combination, for an unknown treatment duration (likely four weeks), ciprofloxacin was better (RR 1.12, 95% CI 1.03 to 1.22, 186 participants). A "few" patients experienced local irritation upon the first instillation of topical treatment (numbers/groups not stated). Others Other studies examined topical gentamicin versus a trimethoprim/sulphacetamide/polymixin B combination (91 participants) and rifampicin versus chloramphenicol (160 participants). Limited data were available and the findings were very uncertain.
AUTHORS' CONCLUSIONS
We are uncertain about the effectiveness of topical antibiotics in improving resolution of ear discharge in patients with CSOM because of the limited amount of low-quality evidence available. However, amongst this uncertainty there is some evidence to suggest that the use of topical antibiotics may be effective when compared to placebo, or when used in addition to a systemic antibiotic. There is also uncertainty about the relative effectiveness of different types of antibiotics; it is not possible to determine with any certainty whether or not quinolones are better or worse than aminoglycosides. These two groups of compounds have different adverse effect profiles, but there is insufficient evidence from the included studies to make any comment about these. In general, adverse effects were poorly reported.
Topics: Administration, Topical; Anti-Bacterial Agents; Chronic Disease; Humans; Otitis Media, Suppurative; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 31896168
DOI: 10.1002/14651858.CD013051.pub2 -
The Laryngoscope May 2023To determine if exfoliation syndrome (XFS) is associated with hearing loss (HL) or vestibular dysfunction. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine if exfoliation syndrome (XFS) is associated with hearing loss (HL) or vestibular dysfunction.
DATA SOURCES
PubMed, Scopus, CINAHL, and Cochrane Library through April 1, 2022.
REVIEW METHODS
Two reviewers independently screened abstracts, selected articles for inclusion, and extracted data. Studies included for qualitative analysis conducted audiometric, tympanometric, or vestibular evaluations on all subjects.
RESULTS
Twenty-one publications (1148 patients with XFS and 1212 controls) were included in the systematic review, and 16 publications (968 patients with XFS and 1147 controls) in the meta-analysis. Greater severity of HL was seen for patients with XFS compared to controls across all frequencies (odds ratio [OR] 8.8 [7.3-10.2]). Patients with XFS were more likely to have moderate to profound sensorineural HL (OR 1.8 [1.3-2.5]), and less likely to have none to mild HL (OR 0.34 [0.17-0.67]) or no HL (OR 0.37 [0.28-0.50]). Three studies found patients with XFS had lower tympanometric peaks. Two studies found that abnormal vestibular testing results could be more common for patients with XFS.
CONCLUSIONS
HL is associated with XFS. A sensorineural component to HL is confirmed, and mixed HL is possible. Given the high prevalence and infrequent diagnosis of XFS, the authors hypothesize that the current understandings of presbycusis might be improved by further investigation in XFS. Laryngoscope, 133:1025-1035, 2023.
Topics: Humans; Exfoliation Syndrome; Hearing Loss, Sensorineural; Deafness; Acoustic Impedance Tests; Presbycusis
PubMed: 36087028
DOI: 10.1002/lary.30384 -
Sensors (Basel, Switzerland) Jul 2023Children and adolescents with sensorineural hearing loss (SNHL) often experience motor skill disturbances, particularly in balance and gait, due to potential vestibular... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Children and adolescents with sensorineural hearing loss (SNHL) often experience motor skill disturbances, particularly in balance and gait, due to potential vestibular dysfunctions resulting from inner ear damage. Consequently, several studies have proposed the use of virtual reality-based games as a technological resource for therapeutic purposes, aiming to improve the balance and gait of this population.
OBJECTIVE
The objective of this systematic review is to evaluate the quality of evidence derived from randomized or quasi-randomized controlled trials that employed virtual reality-based games to enhance the balance and/or gait of children and adolescents with SNHL.
METHODS
A comprehensive search was conducted across nine databases, encompassing articles published in any language until 1 July 2023. The following inclusion criteria were applied: randomized or quasi-randomized controlled trials involving volunteers from both groups with a clinical diagnosis of bilateral SNHL, aged 6-19 years, devoid of physical, cognitive, or neurological deficits other than vestibular dysfunction, and utilizing virtual reality-based games as an intervention to improve balance and/or gait outcomes.
RESULTS
Initially, a total of 5984 articles were identified through the searches. Following the removal of duplicates and screening of titles and abstracts, eight studies remained for full reading, out of which three trials met the eligibility criteria for this systematic review. The included trials exhibited a very low quality of evidence concerning the balance outcome, and none of the trials evaluated gait. The meta-analysis did not reveal significant differences in balance improvement between the use of traditional balance exercises and virtual reality-based games for adolescents with SNHL (effect size: -0.48; [CI: -1.54 to 0.57]; = 0.37; I = 0%).
CONCLUSION
Virtual reality-based games show promise as a potential technology to be included among the therapeutic options for rehabilitating the balance of children and adolescents with SNHL. However, given the methodological limitations of the trials and the overall low quality of evidence currently available on this topic, caution should be exercised when interpreting the results of the trials analyzed in this systematic review.
Topics: Humans; Child; Adolescent; Postural Balance; Exercise Therapy; Hearing Loss, Sensorineural; Gait; Virtual Reality
PubMed: 37514897
DOI: 10.3390/s23146601 -
Laryngoscope Investigative... Apr 2022Establish anatomical considerations, audiological outcomes, and optimal management in patients with branchiootic/branchiootorenal syndrome (BO/BOR). (Review)
Review
OBJECTIVE
Establish anatomical considerations, audiological outcomes, and optimal management in patients with branchiootic/branchiootorenal syndrome (BO/BOR).
METHODS
Databases reviewed: Medline, Pubmed, Embase, Web of Science, Cochrane Collection, and ClinicalTrials.gov. Clinical or radiological studies of patients with BOR syndrome describing either the audiological profile or anatomical changes were included. Articles in which BOR syndrome was associated with other syndromes, and those that were focused only on general and genetic aspects of BOR syndrome were excluded. Articles were assessed using Oxford Centre for Evidence-Based Medicine (OCEBM) grading system and the Brazzelli risk of bias tool for nonrandomized studies.
RESULTS
Searches identified 379 articles. Of these, 64 studies met the inclusion criteria, reporting outcomes in 482 patients from at least 95 families. In 308 patients, hearing loss was categorized as sensorineural (29%), conductive (20%), and mixed (51%). Hearing outcomes were variable in terms of onset, pattern, and severity; ranging from mild to profound deafness. One hundred sixty-nine patients presented with inner ear anomalies, 145 had middle, and 151 had external ear abnormalities. In 44 studies, 58 ear operations were described. Mixed outcomes were reported in patients managed with hearing aids or middle ear surgery; however, successful cochlear implantation was described in all five cases.
CONCLUSION
The anatomical and audiological profiles of patients with BO/BOR are variable. A range of surgical procedures were described, however lacked objective outcome measures. Given the range of anatomical variants, management decisions should be made on an individual basis including full audiological and radiological assessment.
LEVEL OF EVIDENCE
NA.
PubMed: 35434312
DOI: 10.1002/lio2.749 -
Vaccines Dec 2023(1) Background: Vaccine safety is an important topic with public health implications on a global scale. The purpose of this study was to systematically review available... (Review)
Review
(1) Background: Vaccine safety is an important topic with public health implications on a global scale. The purpose of this study was to systematically review available literature assessing sensorineural hearing loss (SNHL) incidence and severity following both coronavirus disease 2019 (COVID-19) and non-COVID-19 vaccinations, as well as prognosis and outcomes. (2) Methods: This systematic review was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Relevant publications evaluating post-vaccination SNHL were selected from PubMed and Embase, searching from inception to July 2023. (3) Results: From 11 observational studies, the incidence of post-vaccination SNHL was low for both COVID-19 and non-COVID-19 vaccines, ranging from 0.6 to 60.77 per 100,000 person-years, comparable to all-cause SNHL. (4) Conclusions: The incidence rates of SNHL following COVID-19 and non-COVID-19 vaccinations remained reassuringly low. Most patients experienced improved hearing function in the weeks to months following vaccination. This study underscores the importance and safety of vaccinations and encourages ongoing surveillance and detailed reporting of hearing loss cases post-vaccination.
PubMed: 38140238
DOI: 10.3390/vaccines11121834 -
Journal of Neurodevelopmental Disorders Aug 2022CHARGE syndrome (OMIM #214800) is a phenotypically complex genetic condition characterised by multi-system, multi-sensory impairments. Behavioural, psychological,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
CHARGE syndrome (OMIM #214800) is a phenotypically complex genetic condition characterised by multi-system, multi-sensory impairments. Behavioural, psychological, cognitive and sleep difficulties are not well delineated and are likely associated with biopsychosocial factors.
METHODS
This meta-analysis investigated the prevalence of clinical features, physical characteristics and conditions, behavioural, psychological, cognitive and sleep characteristics in CHARGE syndrome, and statistically evaluated directional associations between these characteristics. Pooled prevalence estimates were calculated using reliable, prespecified quality weighting criteria, and meta-regression was conducted to identify associations between characteristics.
RESULTS
Of the 42 eligible studies, data could be extracted for 1675 participants. Prevalence estimates were highest for developmental delay (84%), intellectual disability (64%), aggressive behaviour (48%), self-injurious behaviour (44%) and sleep difficulties (45%). Meta-regression indicated significant associations between intellectual disability and choanal atresia, intellectual disability and inner ear anomalies, sleep difficulties and growth deficiency, and sleep difficulties and gross motor difficulties.
CONCLUSIONS
Our comprehensive review of clinical features, behavioural, psychological, cognitive and physical characteristics, conditions and comorbidities in CHARGE syndrome provides an empirically based foundation to further research and practice.
Topics: Aggression; CHARGE Syndrome; Humans; Intellectual Disability; Self-Injurious Behavior; Sleep Wake Disorders
PubMed: 36045324
DOI: 10.1186/s11689-022-09459-5 -
Journal of Speech, Language, and... Aug 2023The development of vocabulary size in deaf/hard of hearing (DHH) children and adolescents can be delayed compared to their peers due to lack of access to early language... (Meta-Analysis)
Meta-Analysis
PURPOSE
The development of vocabulary size in deaf/hard of hearing (DHH) children and adolescents can be delayed compared to their peers due to lack of access to early language input. Complementary vocabulary interventions are reported in the literature. Our aim is to evaluate the effectiveness of intervention methods for their vocabulary improvement.
METHOD
Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched five databases for peer-reviewed journal articles in English, published between 2000 and 2022 (inclusive), reporting vocabulary interventions for 2- to 18-year-old DHH children and adolescents without comorbidities. We conducted separate meta-analyses using a random-effects model on receptive oral vocabulary, expressive oral vocabulary, and signed vocabulary. We assessed the methodological quality of each paper. This review is preregistered in PROSPERO (International Prospective Register of Systematic Reviews) with ID CRD42021243479.
RESULTS
We included 25 group studies in this review out of 1,724 identified records. The quality assessment of the studies revealed risk of bias ranging from some concerns to high risk. Experimental vocabulary instruction produced improvement in receptive oral vocabulary (Hedges's = 1.08, 95% CI [0.25, 1.90], = 93.46, = .01), expressive oral vocabulary (Hedges's = 1.00, 95% CI [0.18, 1.83], = 96.37, = .02), and signed vocabulary (Hedges's = 1.88, 95% CI [1.09, 2.66], = 96.01, < .001) in the experimental groups. Written vocabulary and general vocabulary skills are also reported as a synthesis of results.
CONCLUSIONS
Multisensory and multimodal explicit vocabulary instruction for DHH children and adolescents is helpful in improving vocabulary acquisition with respect to baseline levels. However, its effectiveness must be carefully interpreted due to the lack of proper control groups and details on reported in the studies.
SUPPLEMENTAL MATERIAL
https://doi.org/10.23641/asha.23646357.
Topics: Child; Humans; Adolescent; Child, Preschool; Vocabulary; Writing; Peer Group; Hearing; Deafness
PubMed: 37437529
DOI: 10.1044/2023_JSLHR-22-00570 -
Otology & Neurotology : Official... Sep 2014In recent years, otologists have begun to place cochlear implants into nonfunctioning ears after sudden unilateral hearing loss. Patients in these trials demonstrate... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
In recent years, otologists have begun to place cochlear implants into nonfunctioning ears after sudden unilateral hearing loss. Patients in these trials demonstrate differing degrees of hearing loss in the unimplanted ear. Few studies have examined the role of implantation in patients with normal hearing in the unimplanted ear. To understand if this practice benefits these patients in terms of tinnitus, sound localization, and speech understanding, the available world literature is reviewed.
DATA SOURCES
MEDLINE, Embase, and Cochrane databases were searched for publications from database inception to June 1, 2013, without restriction of language.
STUDY SELECTION
A search of multiple medical databases was performed to identify articles reporting cases series of cochlear implantation for unilateral hearing loss. Subjects were included for analysis only if the course of hearing loss was acute and rapidly progressive, if the loss was severe to profound, and if the contralateral ear had normal hearing.
DATA EXTRACTION AND SYNTHESIS
Nine appropriate articles were identified, in which 36 patients met our inclusion criteria. Three meta-analyses were performed: of tinnitus (22 patients); of the lowest signal-to-noise ratio, which still allowed 50% sentence understanding (16 patients); and of sentence understanding at a fixed signal-to-noise ratio (12 patients). These found that measures of tinnitus reduction and decreased signal-to-noise ratios to still allow 50% speech discrimination were statistically significantly reduced. Systematic review of subjective changes of tinnitus in 27 patients, speech understanding in 16 patients, and sound localization in 16 patients found 96%, 100%, and 87% were improved, respectively.
CONCLUSION
Cochlear implantation in unilateral sudden hearing loss with a normal functioning contralateral ear might prove to be an effective therapy. Tinnitus is reduced as is the signal-to-noise ratio, which still allows 50% speech discrimination. All patients felt that they localized sound better, and most felt that they understood speech better. Further studies should be conducted to compare the success of hearing rehabilitation of cochlear rehabilitation and traditional modalities such as contralateral routing of signal and bone-anchored hearing aids.
Topics: Cochlear Implantation; Cochlear Implants; Hearing Loss, Sudden; Hearing Loss, Unilateral; Humans; Speech Perception; Tinnitus; Treatment Outcome
PubMed: 24786540
DOI: 10.1097/MAO.0000000000000431