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Oral Presentations Provide Otology, Neurotology Updates

Guidelines and standard practices need occasional reality checks. That is the ultimate lesson from “Scientific Oral Presentations: Otology/Neurotology” on Tuesday morning. New evidence suggests that the 2003 AAO-HNSF guidelines recommending against the use of polymyxin B, neomycin, and hydrocortisone suspension (PNH) should be revisited.

“To our knowledge, this is the first study of PNH in tympanoplasty,” said James R. House III, MD, University of Mississippi School of Medicine. “The 2003 consensus statement was based on grade C evidence at best. We have grade B findings that show no evidence of cochlear ototoxicity when used in tympanoplasty.”

Dr. House described the findings of “Ototoxicity of Polymyxin B, Neomycin, and Hydrocortisone Suspension (PNH) in Tympanoplasty.” Researchers reviewed patient charts for Type I Tympanoplasty during 10 years in a private practice. They identified 277 ears operated on by a single surgeon who used PNH saturated Gelfoam, had pre- and post-operative bone audiometry and did not use an overlay technique.

The average hearing difference pre- and post-op was just -0.54r dB.

“We pride ourselves on practicing evidence-based medicine,” Dr. House said, “but it is clear that the 2003 consensus panel did not base their recommendation on strong clinical evidence. In tympanoplasty, we have grade B evidence that points to a different conclusion.”

 

Counseling Can Improve Hearing Aid Use

Hearing loss is a significant problem in older adults, affecting about 77 percent of individuals 65 and older. Hearing aids can dramatically improve hearing, but adherence is generally poor. In Chile, where a government health program provides hearing aids to older adults with documented hearing loss, adherence is estimated at 53 percent.

“We wanted to see if active communication education (ACE), a semistructured counseling program for people with hearing loss, might improve adherence,” said Felipe Cardemil, MD, Barros Luco Trudeau Hospital, Santiago, Chile.

Dr. Cardemil is the lead author on “Clinical trial to assess the ‘Active Communication Education (ACE)’ program for rehabilitation in patients with hearing loss users of hearing aids.” Researchers randomized 180 patients to ACE and usual care, which is no support after the aids are dispensed.

Overall adherence was 78 percent, he reported. But the ACE group reported 80 percent regular use compared to just 8.9 percent regular use in the control group (o<0.001).

“You can get a direct improvement in the quality of life by improving adherence and you get a much more cost-effective use of healthcare resources,” Dr. Cardemil said. “It would be very useful to include an active counseling program in Chile’s hearing aid program.”

 

High-Frequency Audiometry Helpful in Tinnitus

Tinnitus patients typically show a high frequency hearing loss on a conventional audiogram. But a significant proportion of tinnitus patients show normal thresholds on a convention audiogram.

“We wondered if high-frequency audiometry, 10 to 15 kHz, might provide more information,” said Tobias Kleinjung, MD, Interdisciplinary Tinnitus Clinic, University of Regensburg, Germany. He is lead author on “How much additional information is provided by high-frequency-audiometry in tinnitus patients with normal standard audiogram?” And the answer is “a lot.”

Researchers combed the Tinnitus Center database to find patients with chronic tinnitus and normal thresholds by standard audiometry and existing high-frequency audiometry results. They compared those with normal high frequency thresholds (15 dB or less hearing loss) and those with pathologic high frequency audiometry (greater than 15 dB hearing loss).

They found that high frequency audiometry correlates better with tinnitus than standard audiometry. Pathologic high frequency correlates with higher scores in tinnitus questionnaires and there is a positive relationship between tinnitus laterality and hearing loss laterality.

“High frequency audiometry is more sensitive to hearing damage compared to standard audiometry,” Dr. Kleinjung said. “High frequency audiometry should be used for all tinnitus patients, even children. It helps you explain tinnitus to patients and helps them understand the damage that is causing it.”