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The Tinnitus Functional Index (TFI) is considered the gold standard in measuring tinnitus severity. The aim of the study was to establish reference values to improve the interpretability of TFI scores.Results from 1114 patients with tinnitus were retrospectively analyzed. The participants were consecutive patients who attended our tertiary referral Ear, Nose, and Throat Center. The eligibility criteria were: at least 18 years old, persistent tinnitus, completed pure-tone audiometry, and answered all 25 items on the TFI. Hearing status (normal hearing vs. hearing impairment) was established according to the recommendation of the Bureau International d'Audiophonologie. Means (M) and SD on the TFI were the basis for grading tinnitus severity on four levels: low, lower moderate, upper moderate, and high. To gauge individual scores in clinical practice, percentiles are also proposed.All 1114 patients (586 women and 528 men) were Caucasian and aged from 19 to 87 years (M = 50.96; SD = 13.10 years). Tinnitus duration ranged from 0.5 to 50 years (M = 7.17; SD = 7.71 years). There were 258 patients with normal hearing and 856 patients with hearing loss. A score of above 65 points on TFI was established as the cutoff point for diagnosing high tinnitus severity. A regression model associating tinnitus severity with gender, age, tinnitus duration, and hearing loss was statistically significant: F(4,1109) = 8.99; p0.001, but the effect was very small (R2adj = 0.028) and only gender and age were associated with TFI global score, while tinnitus severity was not related to tinnitus duration or hearing loss.The reference values proposed here support those reported previously by Meikle et al. They are empirically based and can be used as benchmarks in clinical practice and scientific research. They make it possible to assess tinnitus severity, evaluate individual scores, and categorize individuals with tinnitus. This allows researchers to set inclusion or exclusion criteria when assigning patients to specific groups during clinical trials involving tinnitus intervention strategies.

Purpose To evaluate the safety and performance of three novel vibroplasty couplers that allow attachment of the floating mass transducer of a transcutaneous active middle ear implant (AMEI) to the round window (RW) membrane, the long process (LP), or the incus body and the short process (SP) of the incus. Methods Retrospective multicenter cohort study of 25 AMEI users with sensorineural or mixed hearing loss that were among the first implanted with an AMEI vibrating ossicular prosthesis in combination with the third generation of vibroplasty couplers between 2014 and 2016. Main Outcome Measures were bone-conduction pure-tone and vibroplasty thresholds, postoperative aided sound field thresholds and postoperative aided word recognition score (WRS). Results Bone conduction threshold changes of more than 10 dB in 4PTABC were observed in two subjects. A mean improvement of 57.8% in speech recognition was observed with a mean WRS at 65 dB SPL improving from 14.8% (SD 21.9%) preoperatively to a mean aided score of 72.6% (SD 18.6%). Sound field thresholds improved from an average 4PTASF of 64.1 dB HL (SD 9.8 dB HL) to 37.0 dB HL (SD 8.9 dB HL), resulting in a mean functional gain of 27.1 dB. There was no significant difference in WRS or functional gain between the coupler types. Conclusion Initial experience shows that all three third generation vibroplasty couplers represent safe and efficient attachment options for the FMT allowing the surgeon to choose the coupling type based on the present pathology.

During childhood, neuronal modifications occur so that typical childhood communicative development occurs. This work aims to contribute to the understanding of differences in the speech encoding of infants and school-age children by assessing the effects of child development, in different phases of early childhood, on the encoding of speech sounds. There were 98 subjects of both sexes, aged from 1 day to 8 years and 9 months who participated in the study. All subjects underwent a Frequency Following Response (FFR) assessment. A regression and linear correlation showed the effects of age in the FFR components, i.e., significant decrease in the latency and increased amplitude of all FFR waves with age. An increase in the slope measure was also observed. Younger infants require more time and show less robust responses when encoding speech than their older counterparts, which were shown to have more stable and well-organized FFR responses.

Objective: Tinnitus Handicap Inventory (THI) is one of the world’s most commonly used tools to assess tinnitus severity. The aim of the current study was to establish a revised THI grading system u...

Objective: To evaluate the impact of electrode length on hearing preservation (HP) in Partial Deafness Treatment–Electrical Complement (PDT-EC) subjects. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: Twenty-three PDT-EC patients (with preoperative air-conduction thresholds ≤30 dB up to 500 Hz) were divided into two groups: Flex20 electrode (Med-EL GmbH, Innsbruck, Austria) (12 patients) and Flex24 electrode (Med-EL GmbH, Innsbruck, Austria) (11 patients). Interventions: All participants were subjected to minimally invasive cochlear implantation using the round window approach. Main Outcome Measure(s): Pure tone audiometry (125–8000 Hz) was performed preoperatively and at 1, 6, 12, and 24 months postoperatively. HP was established using the HEARRING group formula. Speech understanding was assessed preoperatively and at 12 and 24 months postoperatively. Results: Analysis of HP for every individual indicates that more than half the patients with Flex20 and Flex24 had complete HP at 6 months follow-up. None of the patients from either group had complete loss of hearing. At activation, average air-conduction thresholds for low frequencies (125–500 Hz) were slightly better for the short electrode (M = 29.03) than for the long (M = 39.10) but the difference was not statistically significant (p = 0.067). The effect of electrode (Flex20 versus Flex24) was not significant in terms of pure tone audiometry and speech recognition at long-term follow-up. Conclusions: In the early postoperative period, complete HP was possible in a majority of patients from both groups, but slightly better HP outcomes were achieved by Flex20. In the long term, the length of the electrodes does not affect the degree of HP or speech understanding.

Objective To compare the audiological performance with the novel adhesive bone conduction hearing device (ADHEAR) to that with a passive bone conduction (BC) implant and to that with a bone conduction device (BCD) on a softband. Study design Prospective study in an acute setting, single-subject repeated measure in three situations: unaided, with conventional BCDs (passive implant or on softband), and with the ADHEAR. Setting Tertiary referral center. Patients Ten subjects with conductive hearing loss were evaluated with the ADHEAR. Five of these were users of a passive BC implant (Baha Attract with Baha4); five received a BCD (Baha4) on a softband for test purposes. Intervention Use of non-invasive adhesive bone conduction system for the treatment of conductive hearing loss. Main outcome measures Air and bone conduction thresholds, sound field thresholds, word recognition scores in quiet, and speech recognition thresholds in quiet and noise were assessed. Results Users of the passive BC implant received comparable hearing benefit with the ADHEAR. The mean aided thresholds in sound field measurements and speech understanding in quiet and noise were similar, when subjects were evaluated either with the ADHEAR or the passive BC implant. The audiological outcomes for the non-implanted group were also comparable between the ADHEAR and the BCD on softband. Conclusions Based on our initial data, the ADHEAR seems to be a suitable alternative for patients who need a hearing solution for conductive hearing loss but for medical reasons cannot or do not want to undergo surgery for a passive BC implant.

When identifying the auditory performance of children with phonological disorders, researchers assume that this population has normal peripheral hearing. However, responses at more central levels might be atypical.To investigate the effect of phonological disorders on Frequency-Following Responses (FFRs) in the time domain.Participants were 60 subjects, aged 5 to 8:11 years, divided into two groups: a control group, composed of 30 subjects with normal language skills; and a study group composed of 30 subjects diagnosed with Phonological Disorder (PD). All subjects were tested for Frequency-Following Responses.In the group of children with PD there was an increase in the latency of all FFR components, with a significant statistical difference for components V (p = 0.015); A (0.001); C (0.022); F (0.001); and O (0.001). There was also a reduction in the Slope measure in the group with PD (p = 0.004).The FFR responses are altered in children with PD. This suggests that children with PD present a disorganization in the neural coding of complex sounds. This could compromise specially the development of linguistic/phonological abilities, which can reflect in daily communication.

Purpose Although the cochlear implantation procedure does not interfere with vestibular structures directly, both the vestibulum and the cochlea share the same inner ear fluid space, and this fluid may be responsible for transferring possibly damaging forces from one to the other. The purpose of the study is to assess postoperative vestibular function after partial deafness treatment–electro-acoustic stimulation (PDT–EAS) cochlear implantation. Methods Fifty-five patients were included in the study (30 females, 25 males, age 11–80, mean 41.8 ± 19.35). cVEMP and oVEMP were performed preoperatively and 1–3 months after cochlear implantation. Caloric and vHIT tests were conducted preoperatively and 4–6 months after cochlear implantation. Results Our study shows that, based on a wide range of electrodes, use of PDT–EAS is protective in terms of preserving vestibular function. It gives a rate of saccular damage of 15.79%, utricular damage of 19.04%, and a horizontal semicircular canal response reduction of 15.79%. Conclusions PDT–EAS is protective in terms of preserving vestibular function. Nevertheless, it should be emphasized that the risk of vestibular damage cannot be totally eliminated even when hearing preservation techniques are adopted.

Purpose To assess the prevalence and severity of tinnitus among a group of Polish patients with otosclerosis who qualified for stapes surgery. A secondary objective was to gauge the relationship between tinnitus severity and hearing thresholds. Methods Based on the eligibility criteria, 460 adults with otosclerosis (236 women, 134 men) were included in the study. The Tinnitus Functional Index (TFI) was used to assess tinnitus severity. Hearing thresholds for air and bone conduction were established using clinical pure-tone audiometry in a soundproof cabin. Results Based on the medical interview, tinnitus was the first symptom of otosclerosis in 35% of the participants and 65% of all patients with otosclerosis experienced clinically significant, chronic tinnitus before stapes surgery. For 59% of patients, tinnitus was a significant or severe problem. The degree of hearing loss seemed to be marginally related to the severity of tinnitus reported by the patient. Conclusions Tinnitus is a common complaint among patients with otosclerosis, being a significant or severe problem for more than half of them. For this reason, it is worth considering in the future the implementation of standardized questionnaires for the assessment of tinnitus severity as a routine procedure in the diagnostic process of patients with otosclerosis, as well as in the postoperative period, which will be the next stage of our study.

Background: Due to the constant development of technology and medicine, the eligibility criteria for cochlear implantation (CI) are undergoing gradual expansion. Objectives: To provide long-term hearing preservation (HP) results for partial deafness treatment (PDT) of a group of adults using electro-natural stimulation (ENS). Methods: We examined a database of medical records of patients who underwent CI in a single ENT center. We identified 12 adults (3 men and 9 women) who fitted the PDT-ENS classification. To calculate HP, we used the ­HEARRING consensus and conducted statistical analyses using SPSS v24. Results: In the long-term follow-up, 7 of 12 patients had complete HP and the remaining 5 had partial HP. None of the patients experienced significant hearing impairment. A significant improvement in speech understanding in both quiet and noise conditions was also observed. Conclusions: The use of minimally invasive surgery leads to excellent HP results in PDT-ENS patients, enabling them to enjoy the benefits of good speech discrimination which they would be unable to get from traditional hearing aids. Our findings support extending the inclusion criteria for CI to include this new group of patients who would otherwise obtain only limited benefit from conventional hearing aids.

Background: Considering that hearing loss has a significant impact on social functioning, everyday activity and a person’s emotional state, one of the most important goals of hearing rehabilitation with bone conduction devices is improvement in a patient’s quality of life. Objectives: To measure self-assessed quality of life in patients implanted with the Bonebridge, a bone conduction device. Method: Prospective, observational, longitudinal study with one treatment group. Twenty-one patients with mixed or conductive hearing loss were included, and each individual served as its own control. The Abbreviated Profile of Hearing Aid Benefit (APHAB) was used to measure patient-reported quality of life before intervention and at 3 and 6 months after activation of the device. At the same time frames, pure-tone audiometry and speech understanding in quiet and in noise were tested. Results: Hearing-specific quality of life increased significantly after intervention and remained stable up to 6 months. Both word recognition in quiet and speech reception threshold in noise were significantly better after 6 months compared to before surgery. Outcomes of aided speech understanding were independent of initial bone conduction thresholds and equally high (word recognition score >75%) across the device’s indication range. Conclusions: The Bonebridge provides not only significant audiological benefit in both speech understanding in quiet and in noise, but also increases self-perceived quality of life in patients suffering from mixed and conductive hearing loss. Together with a very low rate and minor nature of adverse events, it is the state-of-the-art solution for hearing rehabilitation in patients with mixed or conductive hearing loss up to a bone conduction threshold of 45 dB HL.

Background: Stapes surgery is a common method of treatment of otosclerosis, and its effectiveness is reported based on audiometric hearing thresholds. Audiometric tests do not gauge the impact of tinnitus severity and auditory function on quality of life (QOL) after stapes surgery. Objective: To measure self-assessed QOL in otosclerosis patients after stapedotomy in terms of three major factors: change in audiometric hearing threshold, subjective hearing benefit, and tinnitus severity. Method: This prospective clinical study included 191 patients who underwent stapedotomy between April and October 2017 due to otosclerosis. All patients were tested by pure tone audiometry and filled in a questionnaire before surgery and 6 months afterwards. Subjective hearing was assessed with the Abbreviated Profile for Hearing Aid Benefit (APHAB); tinnitus severity was established using the Tinnitus Functional Index (TFI), and the QOL was measured by the Glasgow Benefit Inventory (GBI). Results: Statistical analysis showed that the average GBI total score (mean = 33.7; SD = 23.7) was statistically significantly higher than zero (t = 19.7; p < 0.001). Based on a regression model, all the three variables studied – audiometric hearing thresholds change, APHAB change, and TFI change – had a significant effect on QOL after stapedotomy. Interestingly, the highest beta value (b = 0.040; p < 0.001) was for TFI change, implying that TFI change had the greatest effect on QOL. Conclusion: Although the improvement of QOL after stapes surgery undoubtedly depended on improvement in both audiometric and self-reported hearing, the reduction of tinnitus severity had the greatest impact on increase in QOL.

Background Many tinnitus scales are available, but all of them have certain limitations. The aim of the current study was to present a psychometric data of a new brief and reliable questionnaire that could be conveniently used for evaluating tinnitus complaint in adults (either with normal or impaired hearing)—Skarzynski Tinnitus Scale (STS). Methods The study included 125 participants with at least 1 month of tinnitus duration. All participants were asked to complete the STS, Tinnitus and Hearing Survey (THS), Tinnitus Functional Index (TFI), Tinnitus Handicap Inventory (THI), and Beck Depression Inventory. Psychometric properties of the new tool were tested using exploratory factor analysis (EFA), Pearson bivariate correlation with other tinnitus questionnaires, Pearson bivariate correlation with pure-tone audiometry, Cronbach’s alpha coefficient, limits of agreement, smallest detectable change, and floor and ceiling effects. Norms for tinnitus severity as measured by the STS are proposed. Results As a whole, the STS has excellent reliability (ICC = 0.94) and good internal consistency (α = 0.91). The results of EFA and content analysis of wording of the items justified the three-factorial structure. The convergent validity was proven by a significant positive correlation with THI, TFI and THS Subscale A scores. Additionally, the authors proposed norms dividing the results into four tinnitus severity grades. Conclusions Statistical analysis shows that STS is a brief but robust tool well-suited to clinical practice. A feature of STS is that it takes into account the impact of tinnitus on the patient’s psychological (emotional, cognitive) and functional domains as well as their ability to cope with tinnitus-related distress. Electronic supplementary material The online version of this article (10.1186/s40001-018-0347-4) contains supplementary material, which is available to authorized users.

BACKGROUND Nasal obstruction is the most common rhinologic complaint in ear, nose, and throat (ENT) clinical practice and septal deviation is the leading cause. The Nasal Obstruction Symptom Evaluation (NOSE) scale is a brief, self-administered questionnaire that has been widely used to assess symptoms and quality of life related to nasal obstruction, and is commonly used in clinical outcome studies. The aim of this study was to undertake a clinical evaluation of a Polish translation and cross-cultural modification of the NOSE scale for nasal obstruction. MATERIAL AND METHODS A controlled clinical validation study was conducted in a tertiary referral center. The Polish version of the NOSE scale was developed according to cross-cultural adaptation guidelines. The psychometric properties of the Polish version of the NOSE scale (internal consistency, reproducibility, validity, responsiveness, interpretability) were assessed in 51 patients with nasal obstruction and 51 controls matched according to gender and age. RESULTS Internal consistency of the Polish version of the NOSE scale was 0.80 as assessed by Cronbach's alpha, and an intraclass correlation of the reproducibility was 0.98. Construct inter-item and item-total correlations confirmed validity. Correlation confirmed appropriate criterion validity with a visual analog scale (VAS) and discriminant validity was confirmed between patients and controls. Responsiveness and interpretability were also confirmed. CONCLUSIONS The Polish version of the NOSE scale is a brief and reproducible clinical evaluation tool for use in clinical practice in Polish-speaking patients with nasal obstruction.

Objective The aim of the study was to develop a Markov model and apply it for the evaluation of three different treatment scenarios for adult patients with severe to profound bilateral sensorineural hearing loss. Study design Prospective Observational Study. Settings Hospital. Patients A clinical group of 22 adult patients (59.1% men, 40.9% women) aged from 59.13 ± 8.9 years were included in the study. The study comprised two arms: patients in group 1 received the second cochlear implant one to three months after the first implant; while patients in group 2 got the second cochlear implant approximately one year after the first implant. Main outcome measures All participants were first asked to complete an AQoL-8D questionnaire. For the cost-effectiveness analyses, a Markov model analyzed as microsimulation was developed to compare the different treatment options. Results The analyses show that bilateral cochlear implantation strategies are cost-effective compared to the 'no treatment' alternative when having a 10-year model time horizon. When all three model scenarios are compared, the bilateral simultaneous cochlear implantation strategy (Scenario 3) compared to the 'no treatment' option is even more cost-effective than the Scenarios 1 and 2, compared with the 'no treatment' alternative. Conclusions The model results summarize that bilateral (sequential and simultaneous) cochlear implantation that are represented in the model scenarios, are cost-effective strategies for Polish adult patients with bilateral severe to profound sensorineural hearing loss.

Introduction: Voice disorders in children especially in the school-age period comprise a major and challenging medical, social and educational issue. There is a lack of epidemiological data regarding children’s voice in Poland which limits the development of preventive and medical pediatric procedures in our country. Objective: The aim of study was to determine the prevalence of voice disorders in children starting school education in Mazovia. Material and method: The study was a retrospective analysis of survey data from parents of children attending the first grade of primary school. The survey consists of five questions describing the voice. A statistical analysis of 7891 questionnaires was carried out. Results: Analysis of the survey showed a prevalence of dysphonia in 12.8% children aged 7 starting primary school. In this study, voice disorders were observed more often in boys (14.6%) than girls (10.8%). The authors presented the correlation between voice disorders and the expression of emotions. Conclusions: Studies have shown that the percentage of children with voice disorders is significant in our country. The survey regarding voice in school children in Mazovia shows preliminary results of voice disorders in the pediatric population in Poland.

The aim of this article is to describe the audiological patterns of 71 adult patients presenting severe to profound sensorineural hearing loss, who were rehabilitated by cochlear implants (CIs) and hearing aids. This is a retrospective study in a university setting, where the clinical records of 71 adult patients were reviewed and processed. Speech intelligibility was evaluated at one aided ear (CI) or at both aided ears (double CI or a combination of CI and hearing aid [HA]). Patients with a bilateral CI or with a bimodal hearing setup (CI and HA) performed better than those with a single CI; data from the phonetic matrices test showed that there was a statistically significant difference among patients aided by a single CI versus binaural setup (double CI or CI + HA). In particular, patients aided by a bilateral CI, or by a CI and HA, showed an improvement in the functional results of the speech tests, compared to patients using a single CI. Binaural hearing (either with a bilateral CI or bimodal) allows an improvement in the functional results at the speech tests, compared to the use of a CI only.

Background Contralateral suppression of otoacoustic emissions (OAEs) may serve as an index of the medial olivocochlear (MOC) reflex. To date, this index has been studied in various populations but never in pre-school children. The purpose of this study was to fill this gap and describe how the MOC reflex affects the properties of transiently evoked OAEs (TEOAEs) in this age group. In addition, the influence of the presence of spontaneous OAEs (SOAEs) in the studied ear on the suppression of TEOAEs was also investigated. Methods TEOAEs with and without contralateral acoustic stimulation (CAS) by white noise were measured in 126 normally hearing pre-school children aged 3–6 years. The values of response levels, suppression by CAS, and signal-to-noise ratios (SNRs) of TEOAEs were investigated for the whole signal (global) and for half-octave frequency bands from 1 to 4 kHz. Only ears with SNR >6 dB were used in the analyses. SOAEs were acquired using the so-called synchronized SOAEs (SSOAEs) technique. Results Ears with SSOAEs had higher response levels and SNRs than ears without SSOAEs, and suppression was lower (0.58 dB compared to 0.85 dB). Only 22% of all studied ears had an SNR >20 dB, a level recommended in some studies for measuring suppression. There were no significant effects of age or gender on TEOAE suppression. Conclusions Suppression levels for pre-school children did not differ appreciably from those of adults measured under similar conditions in other studies. Taken together with no effect of age in the data studied here, it seems that there is no effect of age on TEOAE suppression. However, we did find that the presence of SSOAEs had an effect on TEOAE suppression, a finding which has not been reported in earlier studies on different populations. We suggest that the presence of SSOAEs might be a crucial factor related to MOC function.

Purpose Tinnitus described as individual perception of phantom sound constitutes a significant medical problem and has become an essential subject of many studies conducted worldwide. In the study, we aimed to examine the prevalence of tinnitus among Polish hearing loss (HL) patients with identified mitochondrial DNA (mtDNA) variants. Methods Among the selected group of unrelated HL patients with known mtDNA pathogenic variants, two questionnaires were conducted, i.e. Tinnitus Handicap Inventory translated into Polish (THI-POL) and Visual Analogue Scale (VAS) for measuring subjectively perceived tinnitus loudness, distress, annoyance and possibility of coping with this condition (VASs). Pathogenic mtDNA variants were detected with real-time PCR and sequencing of the whole mtDNA. Results This is the first extensive tinnitus characterization using THI-POL and VASs questionnaires in HL patients due to mtDNA variants. We have established the prevalence of tinnitus among the studied group at 23.5%. We found that there are no statistically significant differences in the prevalence of tinnitus and its characteristic features between HL patients with known HL mtDNA variants and the general Polish population. In Polish HL patients with tinnitus, m.7511T>C was significantly more frequent than in patients without tinnitus. We observed that the prevalence of tinnitus is lower in Polish patients with m.1555A>G as compared to other available data. Conclusions Our data suggest that the mtDNA variants causative of HL may affect tinnitus development but this effect seems to be ethnic-specific.

Septoplasty is a common surgical procedure used for correction of the nasal obstruction caused by a deviated septum. The aim of the study was to identify complications in septoplasty and analyze incidence depending on the surgical technique, based on the material from 2009 till 2017. The material consisted of 5639 medical records from patients aged 16–69, operated in the tertiary referral center. Patients were divided into two groups (2784 exclusively with septoplasty and 2855 with combined septoplasty and turbinoplasty). Z test for the equality of two proportions was made to investigate the assumption that the proportions from two populations are equal, based on two samples, one from each population. Complications were listed according to international standards. Among the whole study group, different types of complications were noted in 193 patients (3.42%). The most frequent complication was excessive bleeding. Significant differences were observed between the two investigated groups. In patients with combined septoplasty and turbinoplasty septal hematoma, hyposmia, prolonged healing due to infection, adhesions and temporary reduced visual acuity were significantly more often encountered. Meticulous attention to detail in identifying the appropriate anatomy and maintaining good visualization is the key to a safe and effective septoplasty, enabling for very low complication rate.

Hearing preservation surgery constitutes a considerable branch of cochlear implantation surgery and is being steadily developed and perfected. The aim of the study was to verify if insertion of a cochlear implant electrode according to individually calculated linear insertion depth improves hearing preservation. We evaluated the relations between the size of a cochlea, insertion depth angle, linear insertion depth and hearing preservation rate (HP) according to Hearing Preservation Classification in a retrospective case review of 54 patients implanted with a slim straight electrode Nucleus CI422 in 2008-2011. Group HP was 0.75 at activation, 0.67 at 12 months (for 53 patients) and 0.60 at 24 months. In 53 cases, the mean insertion depth angle was 375° (SD 17°); mean calculated cochlear duct length 35.87 mm (SD 1.95); mean calculated linear insertion depth 23.14 mm (SD 1.68). There was no significantly relevant relation between HP values and angular insertion depth or insertion depth. Preoperative measurements of cochlea and specific parameters such as linear insertion depth have no effect on hearing preservation. Poor hearing preservation in some deep insertion cases cannot be explained entirely by the electrode position.Misurazione radiologica della coclea e tasso di preservazione uditiva utilizzando elettrodo sottile a punta dritta (CI422) e approccio alla finestra rotonda.La chirurgia per la preservazione dell’udito costituisce oggi un’importante branca dell’implantologia cocleare e deve essere ancora sviluppata e perfezionata. L’obiettivo di questo studio è stato quello di verificare se l’inserimento dell’elettrodo dell’impianto cocleare, eseguito secondo l’angolo di inserimento calcolato individualmente, migliorasse la preservazione uditiva. In questo studio retrospettivo comprendente 54 pazienti impiantati con un elettrodo sottile a punta dritta Nucleus CI422 tra il 2008 e il 2011, abbiamo valutato la relazione tra la grandezza della coclea, l’angolo di inserimento e il tasso di preservazione uditiva (HP) in accordo con la Hearing Preservation Classification. Il tasso di preservazione uditiva è stato pari a 0,75 all’attivazione, 0,67 a 12 mesi (per 53 pazienti) e 0,60 a 24 mesi. Nei 53 pazienti l’angolo di inserimento medio è stato pari a 375° (SD 17°); la lunghezza media del condotto cocleare è risultata pari a 35,87 mm (SD 1,95); la profondità di inserimento pari a 23,14 mm (SD 1,68). Non è stata rilevata alcuna differenza statisticamente significativa tra i valori di HP e l’angolo di inserimento o la profondità di inserimento. La misura preoperatoria della coclea e di parametri specifici quale la profondità di inserimento non hanno effetto sulla preservazione uditiva. Bassi valori di preservazione uditiva in alcuni casi di inserimento profondo non possono essere spiegati solamente dalla posizione dell’elettrodo.

Alpha rhythm, described by Hans Berger, is mainly recorded from the occipital cortex (OCC) of relaxed subjects with their eyes closed.Early studies indicated the thalamo‑cortical circuit as the origin of alpha rhythm. Recent works suggest an additional relationship between alpha rhythm and the Default Mode Network (DMN). We simultaneously recorded electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) signals in 36 young males asked to alternately close and open their eyes in 30‑s blocks. Using an EEG source channel montage (the recorded signal was interpolated to designated source positions corresponding to certain brain regions) we found an alpha rhythm sub‑activity composed of its intrinsic events, called alpha bursting segments (ABS). More ABS were observed on source channels related to the DMN than those located over the OCC. Similarly, both the beamformer source analysis and fMRI indicated that the specific ABS activity detected on the posterior cingulate cortex/precuneus (PCC) source channel was less related to the OCC than to the DMN source channels. The fMRI analysis performed using the PCC‑ABS as a general linear model regressor indicated an increased blood oxygenation level‑dependent signal change in DMN nodes - precuneus and prefrontal cortex. These results confirm the OCC source of alpha activity a nd additional specific sources of ABS in the DMN.

The aim of this study was to evaluate the psychometric properties of patient-reported visual analogue scale (VAS) ratings. All of the participants (100 Polish-speaking adults) completed a Tinnitus Functional Index (TFI) once and a 4-component VAS twice over a period of 3 days. Spearman’s correlation coefficients between the VAS score and global TFI ranged from ρ = 0.52 for VAS-coping (VAS-C) to ρ = 0.81 for VAS-annoyance (VAS-A). Using the Bland-Altman method, the agreement ranged from 93% for VAS-A to 96% for VAS-distress (VAS-D). Interclass correlation coefficients ranged from 0.67 for VAS-C to 0.90 for VAS-A. The VAS cutoff points representing significant tinnitus severity ranged from 45 points for VAS-C to 66 points for VAS-D. VAS scales are a valid and reliable brief screening tool for obtaining quick information about tinnitus.

A number of electrophysiological tests have been proposed for the initial diagnostic assessment or for the follow-up phase of patients affected by Meniere disease. The most common are: (i) vestibular evoked myogenic potentials (VEMPs); (ii) electrocochleography (ECochG); and (iii) otoacoustic emissions (OAEs). This paper presents the latest clinical developments with these 3 testing modalities. The PubMed, Embase, and Cinahl databases were searched from 2006 to December 2016. Full-text articles were obtained in cases where the title, abstract, or key words suggested that the study may be eligible for this review. The medical subject heading (MeSH) terms included the following: Meniere, hearing threshold, vestibule, otoacoustic emissions, inner ear, ECochG, VEMPs. There were 368 identified papers, out of which 87 were eligible for inclusion. Overall the data in the literature are still limited and the recommended procedures have not reached an international consensus. From the available data, one can conclude that none of the electrophysiological tests could be considered as pathognomonic, for the diagnosis of Meniere disease: presently, the tests could be mostly used in a supportive role to the clinical diagnosis. Hopefully, in the future, improved technology in electrophysiological testing could contribute to the development of better strategies for the diagnosis of Meniere disease.

Interruptions in the activity of mitochondria induced by mutations in the mitochondrial genome (mtDNA) can be the source of numerous diseases including hearing loss (HL). One of the mitochondrial variants responsible for HL is the m.7511T>C mutation located in the mitochondrially encoded tRNA serine 1 (UCN) gene. Next‑generation sequencing was used to search for the HL mutations in the whole mtDNA of 2 patients with maternal inheritance and real time‑polymerase chain reaction was applied for population screening of the m.7511T>C mutation in a group of 1,644 patients with HL. Sequencing of the whole mtDNA in 2 probands revealed a homoplasmic m.7511T>C mutation. Inheritance of the m.7511T>C mutation has been confirmed in examined matrilineal relatives in both families. The mean age of HL onset was 14.1 years old with the mean degree of HL equaling 74.8 dB. A large‑scale search for the m.7511T>C mutation among the patients with HL established the frequency of the m.7511T>C mutation at 0.12% among Polish patients with HL. In conclusion, this first report on central European patients harboring the m.7511T>C mutation reveals that the m.7511T>C may be important when diagnosing patients with maternally inherited HL.

BACKGROUND The aim of this study was to assess the effectiveness of bone conduction hearing aids in children under 2 years old who have congenital microtia and atresia. MATERIAL AND METHODS This prospective study involved 42 children under 2 years old with congenital microtia and atresia who were divided into 2 groups: 21 with unilateral defect and 21 with bilateral defect. All children were provided with bone conduction hearing aids on a softband. Air and bone auditory thresholds were assessed by auditory brainstem responses (ABRs). The LittlEARS questionnaire was used to evaluate auditory development at baseline and after 6 months of hearing aids use. Behavioral observation audiometry (BOA) was used to assess auditory thresholds and compare aided and unaided hearing. RESULTS After 6 months of hearing aid use, the total score of the LittlEARS questionnaire in children with unilateral defect was 24±5.60, while children with bilateral defect achieved a result of 26.29±6.17. Hearing thresholds in both groups with bone conduction hearing aids improved significantly and approached the normal level. CONCLUSIONS Our results confirm that bone conduction hearing aids provide an effective method of auditory rehabilitation for children with conductive and mixed hearing loss caused by microtia and atresia. Using bone conduction hearing aids in such children is crucial for proper hearing, speech, and language development.

This study investigates the psychometric properties of the Polish version of the Tinnitus and Hearing Survey (THS-POL), which is a tool for evaluating what proportion of patients' tinnitus is due to hearing problems and what proportion is specifically due to the tinnitus. The THS-POL was created using the translation-backtranslation method. Study participants completed the THS-POL twice over a period of 3 days. The test-retest analysis shows excellent strength of correlations (THS-POL subscale A r = 0.89, subscale B r = 0.9). For subscales A and B, reliability measured using Cronbach's alpha was α = 0.86 and 0.95, respectively, in the first administration and α = 0.91 and 0.94 in the second administration. Confirmatory factor analysis confirmed a good 2-factor structure of the THS. Convergent validity evaluated using the Pearson product-moment correlation between subscale A (tinnitus) and the Tinnitus Handicap Inventory shows good correlations. In conclusion, the THS-POL is a valid and reliable screening tool to assist in deciding about the optimal management approach.

PurposeChildren with (central) auditory processing disorder [(C)APD] exhibit many cognitive difficulties and receive negative psychosocial consequences from their disorder. Diagnosis of (C)APD relies on multidisciplinary assessment, including psychological testing. There is a strong need for valid and reliable questionnaires to identify children who are at risk of (C)APD. This work aims to establish the psychometric properties of the Polish version of the Scale of Auditory Behaviors (SAB;Domitz & Schow, 2000;Krzeszewska & Kurkowski, 2015;Miranda, Bruera, & Serra 2016;Musiek & Chermak, 2007;Nunes et al., 2013) as a screening tool in children.MethodThe SAB was administered to parents of 326 children (152 girls and 174 boys) aged from 6 to 12 years (M= 8.24,SD= 1.56). The questionnaire consists of 12 items related to various symptoms of (C)APD and allows the frequency of particular behaviors to be assessed. In addition, the questionnaire Children's Home Inventory for Listening Difficulties was administered to parents, and 3 other psychoacoustic behavioral tests (Frequency Pattern Test, Duration Pattern Test, Dichotic Digit Test;Czajka et al., 2012) were conducted on the children to evaluate their auditory abilities.ResultsThe Polish version of SAB demonstrated high internal consistency (Cronbach's α = .93), confirmed by interitem correlations. Intraclass correlation, which was used to determine reproducibility, was .95. There were also significant and positive relationships, ranging fromr= .17 to .68, between the SAB score and scores of other measures, indicating convergent validity of the tool. Girls demonstrated higher SAB scores than boys (p< .05); however, age was not statistically significant. A ceiling effect was detected, but no floor effect.ConclusionsResults of psychometric and statistical analyses suggest the Polish version of SAB appears to be a valid and reliable questionnaire to evaluate symptoms of (C)APD in children, especially as a screening tool.

Objectives In addition to progressive hearing loss, subjective tinnitus is one of the primary symptoms of the otosclerosis development. The aim of this study was to evaluate the prevalence and severity of preoperative tinnitus among a group of consecutive adult patients with otosclerosis, using standardized research tools. Materials and methods The study included 157 cases of clinical otosclerosis (106 women, 51 men). All patients were tested using pure-tone audiometry. The preoperative prevalence and severity of tinnitus were tested using three validated questionnaires: The Tinnitus and Hearing Survey (THS-POL), Tinnitus Handicap Inventory (THI-POL), and Tinnitus Functional Index (TFI-Pl). Results Preliminary results showed that 107 of 157 patients with otosclerosis (68.2%) had preoperative tinnitus. Of them, 51 (47.7%) had unilateral tinnitus (in the ear that qualified for stapes surgery), and 56 (52.3%) had bilateral tinnitus. The THS results showed that for 23.4% patients, tinnitus was a problem equal to or greater than hearing loss. The average result of the TFI-Pl questionnaire was 31.6 points, and for THI-POL, it was 38.6 points, indicating that preoperative tinnitus was moderately severe. The statistical analysis did not reveal a correlation between the tinnitus severity and audiometric results (p>0.05). The severity of tinnitus did not differ significantly between men and women (p>0.05), although the TFI-Pl and THI-POL questionnaires indicated that the tinnitus severity generally increased with age in women, while it decreased in men. Conclusion This is a scientific study conducted to evaluate the prevalence and severity of preoperative tinnitus in Polish patients with otosclerosis, using three validated questionnaires.

To determine whether stapedotomy was effective in reducing tinnitus severity. In addition, the relationship between reduction in tinnitus and improvement in hearing after stapedotomy was analyzed.Prospective clinical study.Tertiary referral center.A group of 168 otosclerosis patients diagnosed with chronic tinnitus.Stapedotomy.The Tinnitus Functional Index questionnaire (TFI) was used to assess tinnitus severity before surgery, and at 3 and 6 months postoperatively. Pure-tone audiometry was conducted before surgery and 6 months postoperatively.The TFI Total score before the operation was M = 34.5 (standard deviation [SD] = 1.6) points, and decreased 3 months after stapedotomy to M = 17.5 (SD = 1.7), a statistically significant change (T = -8.200; p 0.001). A weak correlation was found between the pre- and postoperative difference of TFI Total score and air-conduction thresholds (r = 0.21; p = 0.013) as well as between the TFI Total score and the size of the air-bone gap (r = 0.21; p = 0.013). Preoperatively, 86 patients tinnitus was a not or small problem, and for 82 it was moderate to very big. After stapedotomy, 93 (55%) of patients experienced a significant reduction in tinnitus severity. Of the whole group, 62 patients (37%) reported complete disappearance of their tinnitus. No change in tinnitus severity was reported by 63 patients (38%), and an increase was observed by 12 patients (7%).Stapedotomy not only improves hearing but also reduces tinnitus severity. The current results extend knowledge of postoperative results in terms of tinnitus severity, and might benefit patients undergoing tinnitus counseling. It might also be useful to otolaryngologists when making decisions regarding qualification criteria.

RSI and RFS questionnaires are a basic and common method used for initial diagnosis of laryngopharyngeal reflux (LPR). However, they only measure symptoms which may or may not be concurrent with LPR. The severity of these symptoms is assessed either by the patients themselves (with the use of the Reflux Symptoms Index -RSI) or by the doctor specialising in the field (with the use of the Reflux Finding Score - RFS). Therefore, the findings of the questionnaire may to a large extent depend on the study population - its demographic and cultural characteristics; the extent to which the medical terms used in the questionnaires are understood; and on the linguistic aspects and translation choices. As for the Polish language versions of these questionnaires, there is no reliable analysis of their consistency and if they reach the assumed goal. The studies we have conducted on a group of 84 patients show that we encounter at least one of the above-mentioned problems. Therefore, to make the questionnaires reliable and useful for diagnosis, it is necessary to conduct a formal validation of their translation and to conduct studies on reference groups.

This is a retrospective study of hearing results and characteristics of osteogenesis imperfecta (OI) patients treated for hearing loss by stapedotomy at tertiary reference center.This study enrolled 20 patients with a clinical diagnosis of OI- (11M:9F). 18 patients (90%) underwent surgery due to hearing loss in the period 2003-16. The audiometric analysis provides the pure tone audiometry results of stapedotomy in adult patients in 2 periods (≤12 months and12 months). Air-bone gap (ABG), hearing gain (HG), and changes in air and bone conduction thresholds after surgical treatment were analyzed.In short-time follow-up we noted statistically significant improvement in mean AC thresholds and ABG (p 0.001 for both), change in mean BC thresholds was statistically negligible. Comparing the observation periods short-term and long-term, it was found that AC thresholds, ABG, HG, ABG closure did not significantly change, although BC thresholds and BC closure deteriorated significantly (p 0.05).Stapes surgery for OI can be considered as a method of treating the conductive and/or mixed hearing loss suffered by these patients; however, the surgery is more difficult than that for otosclerosis because OI cases often have extremely difficult anatomical conditions. The hearing results of OI stapes surgery differ from typical otosclerosis cases, with the ABG closure not being as good. In addition, sensorineural hearing loss inevitably progresses.

Objectives Osteogenesis imperfecta (OI) is a systemic connective tissue disease that affects many systems and organs. Features of the disease are bone deformities, blue sclerae, and changes in the teeth, all of which may be accompanied by hearing loss. Bone fragility also affects structures of the ear, with half the patients developing changes in the auditory ossicles, which manifest as hearing loss. The most typical malformation affects the stapes, although the site of malformation within the middle ear varies. This study aims to characterize patients with OI who underwent surgery due to hearing loss and to find factors that affect the hearing results. Materials and methods This study presents an analysis of phenotypic and intraoperative changes among 20 patients with OI, treated surgically for hearing loss. Results Hearing loss typically affects type I patients with OI. The most common changes concern stapes footplate, arms, and tympanic cavity lining. During reoperations, osseous regrowth was typically detected. Conclusion The greater the changes induced systemically by OI, the greater the risk of significant malformations in the middle ear. Patients with OI are at an increased risk of needing revision surgery and of suffering intraoperative complications such as bleeding, which hinders safe completion of the procedure.

Objectives The aim of this study was to assess the usefulness of 24-h pharyngeal pH monitoring in the diagnosis of laryngopharyngeal reflux (LPR) in children with voice disorders. Methods The study was conducted on 68 children aged 3–18 years old. In all cases, pH monitoring was successful; no child removed the probe from the nasal cavity or reported discomfort or other complaints. The following definitions were adopted: LPR in the upright position if Ryan Score upright >9.41; LPR in the supine position if there was at least one supine episode below pH 5.0 (equal to a Ryan Score supine >2.91). Results In 43 children (63%), vocal fold edema was strongly related to recorded reflux episodes, especially in the upright position. In 18 children (26%), vocal nodules were observed, but their occurrence did not significantly affect the Ryan Score, either upright or supine. The selected potential LPR markers were significantly correlated to all the pH monitoring variables and individual elements on the Reflux Symptoms Index and the Reflux Finding Score questionnaire. Conclusion Our findings indicate that, together with vocal fold edema, laryngeal edema and posterior commissure mucosal hypertrophy are important determinants of paediatric LPR. In fact, if LPR is suspected in a child, 24-h pharyngeal pH monitoring appears to be a valuable and welltolerated diagnostic tool. Vocal fold edema observed in laryngeal endoscopy can be considered a probable sign of LPR. The Reflux Finding Score appears to be helpful in diagnosing LPR in children, especially if a cut-off value of 4/5 is adopted.

OBJECTIVE To report the improvement in hearing preservation and speech understanding of five pediatric patients who received cochlear implantation via Electro-natural Stimulation Partial Deafness Treatment, the largest group so far treated. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS A series of five children aged 9 to 16 years old with bilateral normal hearing at 125 to 1500 Hz and severe-to-profound hearing loss above 1500 Hz, who were subjected to unilateral cochlear implantation. INTERVENTION All the patients underwent unilateral cochlear implantation by the same senior otosurgeon. Surgery involved six principal steps using an approach to scala tympani through the round window and use of an extremely delicate electrode with active length of up to 21 mm. MAIN OUTCOME MEASURES Pre- and postoperative hearing for air- and bone-conduction was assessed using pure-tone audiometry. Speech understanding was evaluated with the Pruszewicz monosyllabic word test in free field. Hearing preservation was assessed using the Hearing Preservation Calculator developed by the HEARRING group. RESULTS Over the 3-year observation period, preoperative hearing thresholds were completely preserved in three children (60%) and partially in the remaining two (40%). A useful improvement in speech understanding of about 30% (compared with the best fitted hearing aids in the preoperative period) was observed in both quiet and noise. CONCLUSIONS Cochlear implantation seems to be a successful way of restoring hearing ability in ENS-Partial Deafness Treatment patients who are beyond the scope of effective rehabilitation with hearing aids. Excellent results of hearing preservation in ENS patients encourage discussion on extending the inclusion criteria for cochlear implantation.

The aim of the study was to assess the relationship between psychoacoustic matches of tinnitus loudness and tinnitus loudness measured with a visual analogue scale (VAS) in patients with normal hearing and patients with hearing loss.Cross-sectional study.A clinical group of 140 adult patients (46.4% women, 53.6% men) aged from 19 to 81 years old who had had tinnitus for at least 6 months were included in the study. The most frequent reported localization of their tinnitus sensation was bilateral (48.6%); 40% experienced unilateral tinnitus; and 11.4% heard tinnitus in the head.All participants were first asked to complete a VAS to indicate their tinnitus loudness. Hearing thresholds were then determined for each patient at frequencies from 0.125 to 8 kHz; loudness and frequency of the tinnitus were also matched psychoacoustically.Tinnitus loudness measured in dB SL was significantly lower in patients with bilateral hearing loss than in patients with unilateral hearing loss or in patients with normal hearing. Tinnitus loudness measured with VAS was significantly higher in patients with bilateral hearing loss than in patients with normal hearing. In patients with normal hearing there was a relationship between psychoacoustic matches of tinnitus loudness and tinnitus loudness measured with VAS, but this relationship did not hold for the hearing loss patients.The VAS scale for tinnitus loudness does not generally correspond to psychoacoustic measures of tinnitus loudness. It is only indicative for tinnitus patients who have normal hearing.

The study addressed the efficacy of 12 weeks of yoga training in treating 25 patients with chronic tinnitus. Ten of the patients underwent magnetic resonance imaging (MRI) before and after training. A control group comprised 13 people reporting chronic tinnitus. All participants were assessed with the Tinnitus Functional Index. After the 12-week yoga course, the areas considered to have benefited most were the sense of control of tinnitus, sleep, quality of life, and intrusiveness. The MRI studies indicated that connections in the white matter of the motor cortex appeared to be stronger as a result of training. Yoga training has good potential to improve the daily functioning of patients with chronic tinnitus and can be considered a promising supporting method for tinnitus treatment.

Background When measuring the treatment effect in tinnitus with multi-item outcome instruments, it is crucial for both clinical and research purposes to take into consideration clinical importance of the outcome scores. The aim of the present study is to determine minimal important change (MIC) in tinnitus which is clinically meaningful to patients with otosclerosis. Methods The study population was 95 patients with otosclerosis, suffering from tinnitus. They completed the Tinnitus Functional Index before stapedotomy and 3 months after the surgery. The minimal important change was estimated with the Clinical Global Impression Scale as the external criterion (anchor). The mean change method and the receiver operating characteristic (ROC) method were used to determine minimal important change in tinnitus sensation. Results The improvement in tinnitus after stapedotomy was reported by 69.4% of the patients with otosclerosis. Minimal important change in tinnitus was estimated as reduction of 8.8 points in the Tinnitus Functional Index. Conclusions The anchor-based approach using an external criterion (anchor) allows to determine change in tinnitus sensation which is meaningful to patients after stapedotomy. The value of 8.8 points in Tinnitus Functional Index could be used as benchmark of stapedotomy effectiveness in otosclerosis patients suffering from tinnitus. Hearing difficulties comorbid with tinnitus could affect the perception of tinnitus change.

Background Bioactive glass (S53P4), abbreviated BG, currently seems to be the best material for reconstructing the posterior wall of the auditory canal and obliterating the postoperative cavity. Purpose The aim of the study was to report preliminary results of otosurgery involving obliteration of the mastoid cavity after canal wall down mastoidectomy. Methods 11 adult patients who had had a history of chronic otitis media with cholesteatoma in one or both ears and previous canal wall down mastoidectomy. The duration of the follow-up was 6 months, with routine visits after 7 days, then 1, 3, and 6 months after surgery. The patient's medical history, noting other diseases potentially affecting the healing process, was analyzed. Healing, audiometric results, reduction of the volume of the cavity after surgery, and reduction of bacterial flora growth were assessed. Results There was not worsening in the audiological evaluation. Healing period was uneventful. There was a reduction in volume of the postoperative cavity, no development of pathological flora, and no recurrence of cholesteatoma. Conclusion Obliteration of the mastoid process with S53P4 bioactive glass is a safe and effective method of treatment. Such a procedure should be considered as a treatment for patients after canal wall down surgery (CWD).

Patient: Male, 41-year-old Final Diagnosis: Bilateral otitis media with cholesteatoma Symptoms: Hearing loss Medication: — Clinical Procedure: — Specialty: Otolaryngology Objective: Unusual or unexpected effect of treatment Background: Obliteration of the mastoid cavity with S53P4 bioactive glass is becoming a popular method of treatment, allowing most of the problems with the postoperative cavity to be eliminated. In the case of a hearing aid, reconstruction of the posterior wall of the auditory canal is an extremely beneficial procedure and, in the case of the Bonebridge implant, is necessary. After reconstruction, the FMT transducer is covered by bone and bioactive glass and has no contact with the postoperative cavity. The aim of this article is to present a case report. Case Report: A 41-year-old male patient with a history of bilateral otitis media with cholesteatoma since childhood had undergone many ear operations since 2001, including radical modified operations and postoperative revisions. There had been ossiculoplasty using own materials and a Kurz TORP prosthesis which gave a short-term hearing improvement for 3 months. The patient underwent tests for implantable devices, which showed a potential significant improvement in hearing and understanding speech. The patient met the audiological criteria qualifying him for the use of an implantable bone conduction device. However, a CT scan of the temporal bone showed that the Bonebridge implant could not be implanted due to insufficient mastoid volume. In order to safely implant the Bonebridge device, it was necessary to first rebuild the posterior wall of the left ear canal. The absolute condition was no inflammation of the ear or leaks for several months. Conclusions: The two-stage surgical procedure as described in this case report can allow the Bonebridge implant to be used in a wider group of patients with previous anatomical limitations.

BACKGROUND Cochlear implants (CIs) have been recognized as a safe and effective means for profound hearing loss rehabilitation in children and adults and recently their use has been extended to subjects over 65 years of age. The aim of this paper was to assess indices related to changes in the quality of life (QoL) in elderly CI recipients. MATERIAL AND METHODS A case-control paradigm was used to assess the effects of CIs on the QoL. Forty-two subjects were assigned to the Case group and 15 subjects to the Control group. All 57 subjects were affected by profound hearing loss and had received a CI. Audiological data were collected from both groups at: (i) 1 month pre-implantation [T1]; (ii) 1 day pre- implantation [T2]; (iii) 30 days post-implantation, with CI used in free field [T3]; and (iv) 12 months post-implantation, with CI used in a free field [T4]. The QoL was assessed via a Glasgow Benefit Inventory (GBI) questionnaire, adapted to otolaryngology. To compare subjects across different ages with varying degrees of speech development, a perception parameter was used from the Speech Perception Categories test developed by Geers and Moog. RESULTS Hearing performance was considerably improved after CI. In relation to the hearing performance at time T1, statistically significant threshold gains were observed in both groups in the T3 and T4 observation windows. At time T4, a threshold gain of 70 dB HL in the Case group and a gain of 84 dB HL in the Control group were observed. With speech therapy rehabilitation, a perception level of 6 was reached by 80.0% of patients in the Case group and by 100% of patients in the Control group. In terms of QoL, both groups showed improved post-CI scores. Statistical differences were observed between the 2 groups, with the Control group outperforming the Case group in all but the social section. CONCLUSIONS Despite age-related changes in auditory system and prolonged hearing deprivation, CIs offer audiological and QoL benefits in the elderly.

BACKGROUND According to the guidelines of the European Scientific Consensus on Hearing (European Federation of Audiology Societies 'EFAS' Congress, June 2011, Warsaw, Poland), the detection and treatment of communication disorders in early school-age children is of the highest importance. This objective was adopted by the Polish president of the EFAS Council from the second half of 2011; as a result, pilot programs on children's hearing screening were initiated in various European countries. This paper reports data from a pilot program in Dushanbe, Tajikistan. MATERIAL AND METHODS We randomly selected 143 children from 2 primary schools. Each child was assessed by pure tone audiometry and 2 questionnaires (dedicated to parents and children). The study allowed the validation of: (i) hearing screening procedures in young children, and (ii) data collection via a telemedicine model. RESULTS Hearing impairments were identified in 34 cases (23.7%) with a 50% ratio between unilateral and bilateral losses. We found a higher incidence of hearing impairment in children than that reported in previous Polish studies. CONCLUSIONS The data from the present study suggest that it is possible to use a telemedicine model to assess the hearing status of children and to provide a long-distance expert assistance. The latter is very important for rural areas without specialized medical services.

BACKGROUND Pathologies that alter the impedance of the middle ear may consequently modify the DPOAE amplitude. The aim of this study was to correlate information from 2 different clinical procedures assessing middle ear status. Data from DPOAE responses (both DP-Gram and DP I/O functions) were correlated with data from multi-component tympanometry at 1000 Hz. MATERIAL AND METHODS The subjects were divided into a double-peak group (DPG) and a single-peak group (SPG) depending on 1000 Hz tympanogram pattern. Exclusion criteria (described in the Methods section) were applied to both groups and finally only 31 ears were assigned to each group. The subjects were also assessed with traditional tympanometry and behavioral audiometry. RESULTS Compared to the single-peak group, in terms of the 226 Hz tympanometry data, subjects in the DPG group presented: (i) higher values of ear canal volume; (ii) higher peak pressure, and (iii) significantly higher values of acoustic admittance. DPOAE amplitudes were lower in the DPG group only at 6006 Hz, but the difference in amplitude between the DPG and SPG groups decreased as the frequency increased. Statistical differences were observed only at 1001 Hz and a borderline difference at 1501 Hz. In terms of DPOAE I/O functions, significant differences were observed only in 4 of the 50 tested points. CONCLUSIONS The 1000-Hz tympanometric pattern significantly affects the structure of DPOAE responses only at 1001 Hz. In this context, changes in the properties of the middle ear (as detected by the 1000 Hz tympanometry) can be considered as prime candidates for the observed variability in the DP-grams and the DP I/O functions.

Objective:In cochlear implantation, there are two crucial factors promoting hearing preservation: an atraumatic surgical approach and selection of an electrode that does not damage cochlear structures. This study aimed to evaluate hearing preservation in children implanted with the Nucleus Slim Straight (CI422) electrode.Methods:Nineteen children aged 6–18 years, with partial deafness, were implanted using the 6-step Skarzynski procedure. Electrode insertion depth was 20–25 mm. Hearing status was assessed with pure tone audiometry before surgery, and at 1, 5, 9, 12 and 24 months after surgery. Electrode placement was confirmed with computed tomography.Results:Mean hearing preservation in the study group at activation of the cochlear implant was 73 per cent (standard deviation = 37 per cent). After 24 months, it was 67 per cent (standard deviation = 45 per cent). On a categorical scale, hearing preservation was possible in 100 per cent of cases.Conclusion:Hearing preservation in children implanted with the Nucleus CI422 slim, straight electrode is possible even with 25 mm insertion depth, although the recommended insertion depth is 20 mm. A round window approach using a soft, straight electrode is most conducive to hearing preservation.

Background Some adolescents have hearing impairments characterized by normal or slightly elevated thresholds in the low and mid-frequency bands (below 1500 Hz) and nearly total deafness in the high frequency range. These patients often remain beyond the scope of effective hearing aid treatment. Case report This study presents the case of a 16-year-old adolescent with good hearing in the range 125–1500 Hz and deafness at other frequencies. An implant was used to restore hearing at high frequencies, while preserving low and mid frequency acoustic hearing in the implanted ear. This is described as electro-natural stimulation (ENS) of the inner ear. Conclusions The results demonstrate that low and mid frequency hearing (up to 1500 Hz) can be preserved using the round window surgical technique. A substantial improvement in speech discrimination was also observed when electrical stimulation on one side was combined with acoustic stimulation on both sides. There is scope to extend qualifying criteria for cochlear implantation to include adolescents who are suited to ENS.

Objective To investigate the effect of congenital toxoplasmosis (CTP) on the Frequency-Following Response (FFR) in infants. Study design 11 infants diagnosed with CTP and 12 healthy infants with no risk indicators for hearing impairment, aged 29–90 days old. All infants underwent an FFR neurophysiological assessment. The test stimulus was the syllable [da], 40 ms in duration, which was monaurally presented to the right ear at an intensity of 80 dBnHL. Absolute latencies and amplitudes of the V, A, C, D, E, F, and O waves, the slope (μV/ms) and measure between onset (A) and offset (O), were compared between the two groups. Results Infants with CTP had increased latency of FFR waves V, A, E, F, and O, and decreased amplitude for waves A and F. They also showed a reduction in A–O slope and a higher latency difference between onset (A) and offset (O). Conclusion The neurophysiological responses of Frequency-Following Response can be influenced by congenital toxoplasmosis. Since, the CTP showed prolongation of the V, A, E, F and O waves and decrease of the amplitude for waves A and F.

Background Hearing loss in children is a relevant health issue, both for its prevalence and for its physical, emotional and social consequences. Our aim was to estimate the national prevalence of hearing loss in school-age children from rural areas in Poland. Methods The study was conducted in the general, pediatric, nonclinical population of school-age children from rural areas in Poland. It was a population-based, epidemiological study. The participants were 67416 children (32630 girls and 34786 boys) aged from 6 to 13 years old (M = 8.65; SD = 2.54). Pure-tone air-conduction hearing threshold were obtained at 0.5–8 kHz. Hearing loss was defined as a pure-tone average higher than 20 dB in one or both ears in at least one of the following pure-tone average: four-frequency pure-tone average (FFPTA), high-frequency pure-tone average (HFPTA) and low-frequency pure-tone average (LFPTA). Results The rate of positive results of hearing screening was 16.4% and it was significantly higher in younger children than in older children. Mild hearing loss was more frequently than moderate or worse hearing loss. The children more often experienced unilateral than bilateral hearing loss. Conclusions This study reveals that hearing problems are common in this population, especially among younger children. It shows a strong need for systematic monitoring of hearing status among children and increasing awareness of parents and educators of the significance of hearing loss, including unilateral and mild hearing loss. Further studies conducted among children in urban areas are needed to compare the prevalence of hearing loss in children from various environments.

In the last years, the attention to the role of gender in physiopathology and pharmacology of diseases in several medical disciplines is rising; however, the data on the relationship between gender and audio-vestibular disorders are still inconclusive and sometimes confusing. With this letter to the editor, we would like to review the role of gender in audio-vestibular disorders. Literature data show that anatomic variances of the inner ear do exist in men and women and that the different physiology and/or hormonal influence between genders could produce different clinical outcome of routine audiological and vestibular tests. Beyond the epidemiological gender-related differences, the clinical data suggest that the gender has a potential role as an etiopathogenetic factor in audio-vestibular disorders and it is probably responsible for the different clinical features observed between male and female subjects.

Introduction For children with conductive or mixed hearing loss, in whom use of conventional hearing aids is impossible or limited, use of bone conduction devices is recommended. The choice between the available types of devices depends mostly on the degree of hearing loss, age, and anatomical conditions. One device application in children older than 5 years is the Bonebridge implant. The aim of this study is to assess the benefits and safety of this device in children. Methods The material was a group of 11 older children and adolescents aged 10–17 years (mean = 14.7, SD = 2.45) with single-sided or bilateral conductive or mixed hearing loss, implanted unilaterally with the Bonebridge system at the World Hearing Center in Kajetany near Warsaw between 2014 and 2016. Benefits of the Bonebridge were assessed with warble tone audiometry and word audiometry in free field, as well as an APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire before and after implantation. Results Hearing tests showed a statistically significant improvement in hearing sensitivity and speech discrimination. Results of the questionnaire confirm the benefits of Bonebridge implantation to the older children in terms of their auditory performance under various acoustic conditions. Conclusions At a one-year follow up the Bonebridge system was found to be a safe, efficient, and effective tool for compensating for conductive or mixed hearing loss in older children and adolescents. For good anatomical conditions the Bonebridge implant provides a safe alternative to other popular bone conduction systems.

BACKGROUND A prospective clinical study was conducted to assess different regimens of steroid therapy and preservation of hearing following cochlear implantation. MATERIAL AND METHODS Study participants were ≥18 years-of-age, with a cochlear duct length ≥27.1 mm measured by computed tomography (CT), with hearing sound levels in the range of 10-120 decibels (dB) and sound frequencies of 125-250 hertz (Hz); sound levels of 35-120 dB and frequencies of 500-1,000 Hz; sound levels of 75-120 dB and frequencies of 2,000-8,000 Hz. Study exclusion criteria included diseases with contraindications for steroid therapy or medications that increased the effects of steroids. Patients had cochlear implantation and were divided into three treatment groups: intravenous (IV) steroid therapy (standard steroid therapy): combined oral and IV steroid therapy (prolonged steroid therapy); and a control group (cochlear implantation without steroid therapy). Hearing preservation was established by pure tone audiometry based on the pre-operative and postoperative average hearing thresholds according to the formula developed by the HEARRING Network. RESULTS There were 36 patients included in the study. In all cases, the cochlear implant electrode was inserted via the round window approach with a straight electrode length of 28 mm. Patients with combined oral and IV steroid therapy (prolonged steroid therapy) had better results when compared with patients with intravenous (IV) steroid therapy (standard steroid therapy) and the control group. CONCLUSIONS Prolonged steroid therapy using combined oral and IV steroids stabilized hearing thresholds and preserved hearing in adult patients following cochlear implantation.