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Objective: The aim of the present study was to study patterns in the extended spectrum of the human hearing (0.125 to 20 kHz) in order to obtain reference thresholds. Then, we compare our values with existing results at extended high-frequencies (8 to 20 kHz) in an attempt to establish new standards for potential international adoption. Design: A prospective study in a group of otologically healthy subjects. Study sample: A total of 645 subjects aged between 5 and 90 years were recruited. Pure-tone thresholds were determined for conventional and extended high-frequencies. Results: There was an increase in the hearing thresholds as a function of frequency and age. For the 20 to 69 years old group, thresholds were lower in females than in males, especially at 12.5 and 16 kHz. Our threshold values are comparable to those presented in previous studies that used different instrumentation and populations. Conclusions: When comparing different studies the hearing thresholds were found to be similar. Therefore, it would be possible to establish international standard thresholds. [ABSTRACT FROM AUTHOR]

Objective:To evaluate patients with systemic lupus erythematosus and normal hearing over 10 years, compared with healthy controls.Methods:Thirty patients diagnosed with systemic lupus erythematosus were evaluated in a prospective, descriptive study. Eight patients fulfilled the inclusion criteria, i.e. normal otoscopy, normal hearing, normal imaging and disease duration of less than one year. Eleven healthy companions of ENT patients were recruited as controls.Results:At study commencement, the mean patient age was 32.75 years (range, 15–49 years) and there were no statistically significant audiometric differences between patients and controls. No statistically significant audiometric changes were found either within or between the patient and control groups at 10-year follow up.Conclusion:These results supply no evidence for progressive hearing loss in systemic lupus erythematosus patients with no hearing involvement at study commencement. Therefore, we recommend audiometric tests only for systemic lupus erythematosus patients complaining of hearing loss, or for other clinical purposes. It is conceivable that asymptomatic hearing loss could be observed over a more extended follow-up period (i.e. more than 10 years). [ABSTRACT FROM PUBLISHER]

In order to analyse the clinical presentation and laboratory tests used for the diagnosis of immune-mediated sensorineural hearing loss (IMSNHL) a prospective study was conducted involving 125 patients affected by diverse clinical forms of the disease. The following methods were used: analysis of clinical evolution, pure-tone audiometry, determination of the immunophenotype of peripheral blood lymphocytes, immunoglobulins, complement factors C3 and C4, erythrocyte sedimentation rate, antinuclear autoantibodies (ANA) and heat shock protein 70 and the response to therapy. Levels CD4 (p = 0.03) and CD4CD45RA (p = 0.002) T cells were significantly reduced in patients with sudden sensorineural hearing loss. ANA were found in 34.4% of patients and the incidence of antibodies to HSP-70 was similar in both patients and control subjects. Diagnosis of IMSNHL is still based on clinical impressions as laboratory testing is not sufficiently diagnostic. However, the long-term evolution of IMSNHL presented by the patients included in this study may explain the negative results obtained in the tests. The existence of a typical profile patient, including the clinical course, immunological changes (presence of ANA and detection of abnormalities in T-cell subpopulations) and the response to steroid therapy can facilitate diagnosis. Further investigation to help identify a specific marker characteristic of IMSNHL is required. [ABSTRACT FROM AUTHOR]

Objectives: To differentiate a novel type of benign circumscribed bone lesion of the external auditory canal from those described previously, such as exostoses and osteomas.Study Design: Information was obtained from computed tomography (CT) images, surgical findings, and pathologic study.Methods: Five patients (26 to 82 years old) who presented a hard, round, unilateral, skin-covered mass occluding the external auditory canal to varying degrees were studied. A CT study carried out before resection of the lesions by curettage disclosed the absence of a bony connection to the underlying structures. All the tissue specimens underwent pathologic study.Results: CT and surgical findings demonstrated the absence of a connective pedicle. The pathologic findings showed lesions consisting of an osteoma-like bone formation with sparse osteoblastic areas; mature lamellar bone was observed in three cases, bone marrow containing adipose tissue and hematopoietic remnants in two, and a dense, collagenous stroma in another. They all showed irregular trabeculae, bordered by osteoid osteoblasts. In no case was there evidence of a relationship to the cartilaginous tissue or to the bony structures of the external auditory canal.Conclusions: The data obtained from the clinical, CT, surgical, and pathologic findings suggest the existence of a lesion unlike those previously known, possibly related to ossifying reactions in other parts of the organism. [ABSTRACT FROM AUTHOR]

Typical Cogan's syndrome is a rare disease of young adults consisting of flares of interstitial keratitis and sudden onset of Ménière-like attacks (nausea, vomiting, tinnitus, vertigo and hearing loss). Life-threatening aortic insufficiency develops in 10% of reported cases. Atypical Cogan's syndrome (audiovestibular dysfunction with other types of inflammatory eye disease) is associated with vasculitis in 20% of cases and has a less favourable prognosis than typical Cogan's syndrome. [ABSTRACT FROM AUTHOR]

Introduction: To evaluate the utility of 18 F-FDG PET/TC as an imaging tool for the characterization of immune-mediated inner ear disease (IMIED), providing measurements of the inner ear region activity as well as detecting possible involvement of other organs., Material and Methods: The study included 28 patients with IMIED and 4 sex-matched and age-matched control subjects with no history of ear disease. Eighteen patients were considered to be suffering from primary IMIED and 10 patients from secondary. PET/CT scans with 18 F-FDG were performed to assess systemic involvement as well as inner ear region activity. Interpretation of PET/CT scans was performed independently by 2nuclear medicine physicians blinded to clinical history. In order to assess inter-rater agreement before performing the analysis of the inner ear, different Bland & Altman plots and the intraclass correlation coefficients were estimated., Results: Different metabolically active foci findings were reported in 13 patients. Four patients diagnosed as primary IMIED showed thyroid and aorta activity. Regarding the inner-ear semiquantitative analysis, the inter-rater agreement was not sufficiently high. Comparisons between groups, performed using Mann-Whitney test or Kruskal-Wallis tests, showed no differences., Conclusions: The study showed 18 F-FDG PET/TC could be an important tool in the evaluation of IMIED as it can support the characterization of this entity providing the diagnosis of unknown or underestimated secondary IMIED. Nevertheless, we consider PET is not an adequate tool to approach the inner ear because of the small size and volume of the cochlea which makes the assessment very difficult., (Copyright © 2018 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To detect and graduate endolymphatic hydrops or endolymphatic space dilations in patients with suspected Meniere's disease or immune-mediated inner ear disease by magnetic resonance imaging., Material and Methods: A prospective study was performed including all the patients with clinical suspicion of Meniere's disease or immune-mediated inner ear disease treated at the Otolaryngology department during a one year period. In all cases, magnetic resonance imaging (MRI) was performed in a 3T scanner. IR sequence was performed after 24 to 28h prior intratimpanic injection of gadolinium on both ears. Two neurorradiologist graduated endolymphatic space volume as agreed on normal, moderate and significant in the obtained images., Results: The presence of hydrops was documented by MRI in six patients with definite or probable Meniere's disease. In two of the four cases without vertigo hydrops was not demonstrated. In the other two cases with a high clinical suspicion of immune-mediated disease but with negative autoimmune tests hydrops was proved. There was only disagreement on cochlear hydrops presence on two patients., Conclusion: The detection of endolymphatic hydrops in patients with definite or probable Meniere's disease served to confirm the final diagnosis. Moreover, hydrops was detected in patients with suspected immune-mediated inner ear disease, which could have an impact on the diagnosis and treatment of these patients. Therefore, we suggest that this test could be included for the diagnosis of these inner ear diseases., (Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Cisplatin is a commonly prescribed drug that produces ototoxicity as a side effect. Lutein is a carotenoid with antioxidant and anti-inflammatory properties previously tested for eye, heart and skin diseases but not evaluated to date in ear diseases., Aim: To evaluate the protective effects of lutein on HEI-OC1 auditory cell line and in a Wistar rat model of cisplatin ototoxicity., Materials and Methods: In vitro study: Culture HEI-OC1 cells were exposed to lutein (2.5-100 μM) and to 25 μM cisplatin for 24h. In vivo study: Twenty eight female Wistar rats were randomized into three groups. Group A (n=8) received intratympanic lutein (0.03 mL) (1mg/mL) in the right ear and saline solution in the left one to determine the toxicity of lutein. Group B (n=8) received also intraperitoneal cisplatin (10mg/kg) to test the efficacy of lutein against cisplatin ototoxicity. Group C (n=12) received intratympanic lutein (0.03 mL) (1mg/mL) to quantify lutein in cochlear fluids (30 min, 1h and 5 days after treatment). Hearing function was evaluated by means of Auditory Steady-State Responses before the procedure and 5 days after (groups A and B). Morphological changes were studied by confocal laser scanning microscopy., Results: In vitro study: Lutein significantly reduced the cisplatin-induced cytotoxicity in the HEI-OC1 cells when they were pre-treated with lutein concentrations of 60 and 80 μM. In vivo study: Intratympanic lutein (1mg/mL) application showed no ototoxic effects. However it did not achieve protective effect against cisplatin-induced ototoxicity in Wistar rats., Conclusions: Although lutein has shown beneficial effects in other pathologies, the present study only obtained protection against cisplatin ototoxicity in culture cells, but not in the in vivo model. The large molecule size, the low dose administered, and restriction to diffusion in the inner ear could account for this negative result., (Copyright © 2016 Elsevier GmbH. All rights reserved.)

Objective: The aim of the present study was to provide thresholds data as a function of age for an otologically normal population in Spain, compared to the current ISO 7029 (2000) standard., Design: A prospective study in an otologically screened population., Study Sample: Data was collected from 1175 otologically-normal persons aged between 5 and 90 years. Inclusion criteria involved those listed in ISO 389-1 (1998) and the 8253-1 (2010). Suitability for inclusion was evaluated through interview, based on a questionnaire, and physical examination., Results: The hearing thresholds decreased slightly from 125 to 2000 Hz. From 2000 Hz onwards the thresholds increased; this increase being more pronounced with increasing frequency and age. No statistically significant sex differences were found. The hearing threshold levels in the present study were higher (poorer) than the ones provided by ISO 7029 (2000)., Conclusions: Results from this study suggest that the thresholds listed in ISO 7029 (2000) may be too restrictive, and could be useful in formulating the ISO 7029 update.

Objective: To determine common reference equivalent threshold sound pressure levels (RETSPL) for the earphones used in the extended high-frequency (EHF) range, as different earphones are commercially available, but there are not RETSPLs for each model., Design: Hearing threshold sound pressure levels were measured up to 20 kHz for the Sennheiser HDA 200 audiometric earphone, and were compared to the ISO 389-5 (2006) norm and other investigations using that earphone and different ones., Study Sample: A total of 223 otologically-normal subjects (aged 5-25 years old) participated in the hearing determination., Results: The results are in good agreement with previous studies of hearing thresholds using the same and other earphones., Conclusions: The results of the present investigation are relevant for the international standard for the calibration of audiometric equipment in the 8 to 16 kHz frequency range, ISO 389-5. The data may be used for a future update of the RETSPL for circumaural and insert audiometric earphones.

We report the case of an immunocompromised female patient with external otitis, who developed a picture of external otitis with poor response to conventional treatment and subsequent isolation of Pseudomona Aeruginosa in the ear secretion culture. The final diagnosis was malignant external otitis. Our objective is to describe the scintigraphic findings as well as to analyze their correlation with the clinical pattern and to evaluate the possible causes of the discordance found., (Copyright © 2011 Elsevier España, S.L. y SEMNIM. All rights reserved.)

Problem/objective: Nasolacrimal duct obstruction is a common problem. A Song stent is a useful and simple treatment with low morbidity. However, the success rate is limited, especially in long-term follow-up. The aim of the present study is to determine the presence of biofilms in failing nasolacrimal stents., Methodology: Thirty-three polyurethane nasolacrimal stents were implanted between January 2006 and December 2007 using Song's technique. Patients were followed for a mean of 21.5 months (range 11-30 months). Removed nasolacrimal stents were preserved in saline and examined using environmental scanning electron microscopy (ESEM)., Results: Eighteen nasolacrimal stents were removed because of the failure of the device (follow-up range 11-30 months). Seven stents were recovered for this study. Biofilms were identified in all the specimens studied. Five prostheses showed occlusion caused by mucus or granulation tissue., Conclusions: Biofilm colonisation of nasolacrimal stents could play a major role in prosthetic failure leading to stent occlusion. Mucus, granulation tissue and irregularities of the biomaterial are factors that facilitate biofilm colonisation. Non-stick material for newly developed stents or drugs capable of destroying the polysaccharide matrix should be considered as future therapeutic options.

Objective: To quantitatively evaluate the diagnostic accuracy of diagnostic tests for immunomediated hearing loss., Data Sources: We searched Medline and the Cochrane Database of Systematic Reviews for potentially relevant studies., Study Selection: Twenty-five studies met the inclusion criteria of this systematic review. The diagnosis of immunomediated hearing loss was based on the clinical presentation and the response to corticosteroid administration., Data Extraction: The following data were extracted from the selected studies and entered into a standardised database: population demographics; exclusion and inclusion criteria; diagnostic tests; sensitivity; specificity; the number of true positive, true negative, false positive and false negative values; therapy used, including dose and duration; and delay between symptom onset and therapy commencement., Data Synthesis: This systematic review combined data from 679 patients with immunomediated hearing loss, reported by 22 research teams. Substantial heterogeneity was found among the included studies; for this reason, summary sensitivity and specificity values were not computed., Conclusions: The results of diagnostic tests for immunomediated hearing loss depend on many factors, and there is a risk of potential bias. This is the first time that such a systematic review has been presented; such a review is a more rigorous method of demonstrating the utility of the available diagnostic tests.

Conclusion: Inductively coupled plasma mass spectrometry (ICP-MS) can be applied to organic tissues obtained from experimental animals. Hearing loss does not correlate with the platinum (Pt) concentration found in the inner ear. Drug structure and affinity to inner ear proteins could explain ototoxicity caused by cisplatin., Objectives: To analyse Pt affinity for brain and ear tissues (of similar embryologic origin) in the Wistar rat and clearance gradient after a single dose, and to correlate these findings with hearing changes., Materials and Methods: Thirty-two Wistar rats were intraperitoneally injected with cisplatin at a dose of 5 mg/kg. Animals were sacrificed after obtaining auditory brain responses (ABRs) at 3, 7, 30 and 90 days (nine, seven, seven and nine animals, respectively). Brain and both temporal bones were extracted from each animal and analysed by ICP-MS to determine the absolute concentrations of the metal. Eight non-treated animals were employed as a control group., Results: The ABR thresholds were significantly elevated in animals from all groups after cisplatin treatment. A maximum accumulation of Pt for inner ear and brain was revealed around the first week: 3.175 (57%) and 0.342 (72%), respectively. Pt significantly accumulated in greater quantities in ear than in brain (p<0.01) and was cleared at a higher rate in brain than in ear (p<0.01) following cochlea/brain ratio analysis. No statistically significant correlation was found between amounts of Pt and hearing loss in the study animals.

Conclusion: The great variety of pathological entities related to the presence of circulating HSP-70 suggests a nonspecific cellular damage. As the present study shows, positive results decrease with respect to the time elapsed after the injection of the ototoxic agent. HSP-70 appears as an early and transient marker that could permit early detection of inner ear damage., Objectives: The aim of this study was to determine the presence of HSP-70 at different time points by means of Western blot immunoassay in the sera of rats treated with cisplatin., Materials and Methods: Thirty-six Wistar rats were intraperitoneally injected with cisplatin at a dose of 5 mg/kg and blood samples were collected at 7 and 90 days. Determination of HSP-70 was made by means of a modified Western blot immunoassay kit originally used for human HSP-70 antigen detection. A control group of 18 animals was used for comparison., Results: Western blot was positive in 77.8% of the animals in the 7 days group, decreasing to a 44.4% in the 90 days group. In the control group, Western blot was positive in 5.5%.

External auditory canal cholesteatomas are a rare disease. Their usual clinical appearance is a mass eroding the bony external auditory canal, normally in the inferior or anterior parts, with an intact tympanic membrane and a normal middle ear. A case of this uncommon disease with a review of the scientific literature is presented. Guidelines for the prevention, diagnosis and management are examined.

Hypothesis: Supporting cells have a crucial role in degenerative and regenerative events of primary sensorial hair cells of the organ of Corti. This new role should determine future studies about pathophysiology of hearing loss and its regenerative treatment., Supporting Evidence: Recent findings suggest an active role of supporting cells in the maintenance of hair cell function and structure. Evidences of high energy consumption and close proximity to auditory nervous fibers suggesting K+ active exchange, preferential expression of specific proteins and antigens, presence of glucocorticoids receptors, affinity for cisplatin and regenerative potential give the supporting cells an important role in homeostasis of the organ of Corti and in some specific diseases affecting this structure., Conclusion: As well as glial cells provide protection and regeneration to neural tissues, supporting cells may provide the necessary metabolic and electrolitic conditions for hair cells mechanical and bioelectrical function. This opens new possibilities for the treatment of apparently "irreversible" destruction of the inner ear.

Nasopharyngeal carcinoma is frequently diagnosed in advanced stages due to the anatomic characteristics of its site of origin and of the inspecificity of many of its clinical manifestations. However, cure rates are directly related with the early diagnosis. In this study of 200 patients affected by this tumor we analyse the different clinical manifestations, their chronology and their value as early indicators of nasopharyngeal tumour.

Cisplatin is an antitumoral agent commonly used in the treatment of different solid tumors. Its use induces adverse effects like oto- and nephrotoxicity due to acute renal failure. This makes it a suitable drug when creating an experimental model of ototoxicity. Our aim is to study the cellular lesions induced in the cochlea of the rat and the guinea pig by variable doses of cisplatin injected intraperitoneally, after short, middle, and long term survival, by means of scanning electronic microscopy. Results show the global effect of the cells of the organ of Corti with a more intense initial damage of the supporting cells, continuing with the late effect of the sensorial cells.

The implantation of ossicular replacement prothesis made of dense hydroxyapatite (HA) appears to be a wider method of reconstruction of ossicular chain damaged by suppurative processes or surgery. A review of 19 patients who underwent implantation of HA prosthesis disclosed 4 cases of extrusion and 3 cases of atrophy. When X-ray diffraction analysis of explanted commercially available prosthesis made of dense HA was compared with the results with porous implants and with HS powder employed in the manufacture of both, is suggested that tympanic membrane atrophy could be caused by mechanical and/or chemical factors.

Labyrinthitis ossificans is a recently recognized entity with the extending cochlear implant surgery. Up to date there are not so many studies of the cellular response leading the organization of the inflammatory reaction within the cochlea. Immunemediated labyrinthitis is a valid experimental model that allow the knowledge of the cellular infiltration mechanisms within the cochlea. The inner ear communicates with systemic immunity via the circulation by the passage of cells through the spiral modiolar vein (SMV) and its collecting venules in the scala tympani. Inflammatory reaction within the cochlea lead to the formation of fibrotic tissue and bone (osteoneogenesis) inside it and injuring the neurosensory organs of hearing and balance. To test which cells are proliferating early in an inflammatory response, an animal model of Keyhole limpet haemocyanin (KLH) induced labyrinthitis was utilized, showing a granulomatous lesions not previously reported in this experimental model.

Objective: To study a family with inner ear malformations and sensorineural hearing loss., Design: Clinical, radiological, and genetic study of the members of a family with different degrees of sensorineural hearing loss., Results: The males in the family manifested profound congenital hearing loss with severe inner ear malformations, while the only affected female had progressive hearing loss that had begun during puberty. Computed tomography showed inner ear malformations in both males, with enlarged internal auditory meatus and Mondini dysplasia. Genetic analysis disclosed a microdeletion at the locus DFN3 on chromosome X., Conclusion: A familial Mondini dysplasia is associated to a microdeletion at the deafness locus DFN3.

Immune-mediated inner-ear disease includes clinical conditions associated with unilateral or bilateral rapidly progressive forms of sensorineural hearing loss. A systemic autoimmune disorder can be present in less than one-third of cases. Because of the lack of well defined detection methods to identify immune-mediated processes within the inner ear, and the fact that the human inner ear is not amenable to diagnostic biopsy, there has been great interest in developing animal models. Experimental models of sterile and virus-induced labyrinthitis support the participation of the immune system in the aetiopathogenesis of inner-ear disorders: interleukin-2 emanates from the endolymphatic sac and assists in changing the spiral modiolar vein, as in the expression of intercellular adhesion molecule 1, which allows the egrees of immune cells from the circulation. The formation of a fibro-osseous matrix ultimately results in degeneration of the inner ear. These investigations have allowed us to alter the immune response for the purpose of regulating its intensity and the subsequent damage to patients.

Pleomorphic adenoma is a benign growth frequently encountered in major salivary glands, although minor salivary glands sometimes can be affected. In the latter non-specific clinical signs allows only the postoperative diagnosis. Nevertheless the existence of lesser salivary glands outside the oral cavity, and therefore pleomorphic adenomas, justify the specialist's need of its knowledge because of the difficulties arising in differential diagnosis. The AA. present a review of 22 cases in various sites treated in their Department in a 9 year-term.

DNA ploidy and cell-cycle distribution were determined by flow cytometry in fresh tumor tissue of 27 epithelial head and neck carcinomas. Epithelial cells were labeled with a fluorescein-isothiocyanate-conjugated cytokeratin antibody to study the possible influence of contaminating stromal and inflammatory cells on the results of cell-cycle analysis of tumor cells. The patient sample included 26 men and 1 women with a mean age of 60 years. Without cytokeratin gating, 11/27 tumors (40.74%) were aneuploid. After selecting the cytokeratin population, 10 more aneuploid tumors were found that had not been detected when considering the total population. Therefore, aneuploid tumors increased from 40.74% to 77.74%. The remaining 6/27 (22.26%) tumors were diploid. In the tumors that were either aneuploid without cytokeratin gating or diploid, the S-phase and G2M phase were significantly higher after cytokeratin staining, specially in diploid tumors (24.2% versus 10% and 6.8% versus 3.2%, respectively, p < 0.01). Therefore, in head and neck tumors cytokeratin staining optimizes both the determination of DNA ploidy and cell-cycle analysis, which is advantageous for tumor staging and prognosis assessment in these patients.

Sarcoidosis is a multisystem granulomatous disease of unknown cause with frequent pulmonary, ocular, and lymphatic system manifestations. Central nervous system involvement, although rare (1 to 5%), most commonly affects the cranial nerves. Cranial nerve VIII abnormalities occur in 20% of these patients and are associated with other neuropathies and organ or system involvement. We report a case of neurosarcoidosis that presented as isolated sudden sensorineural hearing loss and uveitis.

Destruction of the membranous labyrinth can lead to sensorineural hearing loss. This is especially frequent in surgery for active otorrhea. However, destruction of the posterior labyrinth sometimes can be solved without loss of cochlear function. We report three cases of partial labyrinthectomy for intralabyrinthine cholesteatoma without functional loss. Current theories regarding the conservation of hearing are discussed.

There are two types of rapidly progressive sensorineural hearing loss: sudden hearing loss, which is generally unilateral and develops in less than 72 hours, and rapidly progressive sensorineural hearing loss, which develops over days or months. The origin of sudden deafness is difficult to establish. Several etiopathogenic factors have been postulated, such as viral infection, autoimmune origin, vascular and metabolic disease, rupture of the labyrinthine membrane, and, recently, immune-mediated inner ear disease. We made a retrospective study of 40 patients seen in our department. Patients were given a combined treatment with steroids, nimodipine, heparin, and oxygen. Patients were divided into two groups by intravenous or oral treatment.

Many clinical and experimental studies have obtained evidence of immune-mediated inner ear disease. Discrepancies between theories of the mechanisms of injury to the inner ear and the laboratory tests that identify it mean that the diagnosis is based on clinical symptoms and a positive response to treatment. We report four cases of immune-mediated inner ear disease characterized by endolymphatic hydrops, fluctuating hearing loss, sudden deafness (first symptom of primary Sjögren's syndrome), and rapidly progressive sensorineural hearing loss.

Background: Although there are a number of reports concerned with the role of immunity in the sudden onset of progressive sensorineural hearing loss, there are few references dealing with the involvement of immune-mediated mechanisms in sudden deafness., Objectives: To study the phenotype of peripheral blood lymphocytes in a group of patients with sudden deafness by use of 3-color flow cytometry., Design: The study was carried out prior to the start of steroid therapy. Fourteen patients underwent a follow-up study once steroid therapy had been completed. Prospective analysis, case-control., Setting: Tertiary case referral center, ambulatory and hospitalized care., Patients: Twenty-two patients (13 men and 9 women; mean age, 45.3 years) were compared with 14 healthy control subjects (9 men and 5 women; mean age, 36 years). Patients were divided in 2 groups according to their response to steroid therapy., Results: Decreased numbers of both CD4+ helper cells (38.4% vs 45.5%; P = .04) and CD8+ cytotoxic cells (17.5% vs 22.3%; P = .02) were observed in patients and compared with those in the control subjects, as well as reduced numbers of CD4+CD45RA+ cells (14.4% vs 29.3%; P = .01) and CD8+CD45RA+ naive cells (18.2% vs 25.4%; P = .04). In the group of patients with a good response to steroid therapy (group 1), a tendency toward normalization of the CD4+ (pretreatment, 38.6%; posttreatment, 44.6%), CD4+CD45RA+ (pretreatment, 15.2%; posttreatment, 21.7%), and CD4+CD45RO+ (pretreatment, 21.1%; posttreatment, 18.2%) cell counts was observed, with a slight decrease in the CD8+ population (pretreatment, 18%; posttreatment, 15.7%). However, in patients with a poorer response (group 2), while there were increases in the CD4+ (pretreatment, 38%, posttreatment, 50%) and CD4+CD45RA+ (pretreatment, 12.8%; posttreatment, 16.7%) cell counts after steroid therapy, there was a significant increment in the CD4+CD45RO+ memory cell count (pretreatment, 14.1%; posttreatment, 28.5%) and low CD8+CD45RA+ counts (pretreatment, 14.6%; posttreatment, 15.5%). No differences were observed in the numbers of B or natural killer cells or in the presence of activation antigens CD25 and HLA-DR when pretreatment and posttreatment levels were compared., Conclusion: These results demonstrate significant abnormalities in the subpopulations of lymphocytes in patients with sudden hearing loss, suggesting the existence of immune-mediated responses in the inner ear as possible etiopathogenic factors in this entity.

A preliminary analysis was published in 1993 of 100 cases of endoscopic sinus surgery (ESS) carried out in our service following a protocol that included sinusitis, nasal polyps, and other endoscopic nasal procedures. Another 100 cases of ESS were analyzed for the present study and compared with the 1993 group. Comparative analysis showed improved results in the second series, with fewer minor complications and no major complications. These findings confirm the general opinion that endoscopic sinus surgery requires an adequate training period before optimal results are obtained.

Evidence of hearing loss in humans with systemic autoimmune disease has suggested the possibility of isolated forms of deafness originated by a autoimmune mechanism. Several authors reject McCabe's (1) proposed clinical description based mainly on response to treatment and have attempted to develop an animal model of autoimmune deafness. A comparative analysis was made of several experimental models of sensorineural hearing loss in guinea pigs developed in our laboratory for the study of this problem.

A case of tympanic glomic tumor associated with vascular malformation of the perifacial plexus is reported. The case and its possible relation with persistent stapedial artery are discussed. The embryological development of the middle-ear vessels and blood supply to glomic tumors were reviewed.

Experience has revealed a higher rate of functional failure of biocompatible prostheses used in the surgical reconstruction of the middle ear than was reported initially. The cause of these failures was analyzed in a retrospective study of 135 patients who underwent middle ear reconstructive procedures: 47 of them involved implantation of plastic prostheses. Proplast or Plastipore, and had a sufficient follow-up. We evaluated the prosthetic material and middle-ear conditions for which they were implanted.