Tinnitus as a presenting symptom of neurosarcoidosis with ocular involvement

A 48-year-old woman with untreated hypothyroidism initially presented with tinnitus and hearing loss, followed by blurred vision and eye pain months later. Ophthalmic evaluation revealed no optic disc oedema. Visual field defects in both eyes suggested retrobulbar optic neuropathy. MRI of the brain and orbits demonstrated enhancement of both optic nerve sheaths and diffuse pachymeningeal enhancement. Audiologic evaluation revealed hearing loss in both ears, and frequent square wave jerks were seen on videonystagmography. Fine needle aspiration from one pulmonary lymph node showed non-necrotising granulomatous inflammation, confirming the diagnosis of neurosarcoidosis. The visual fields improved significantly on prednisone, and she is maintained on prednisone, infliximab and methotrexate. Though common, multiple cranial neuropathies in neurosarcoidosis are poorly represented in the literature. Clinicians should be aware of the symptoms that may herald a diagnosis of neurosarcoidosis, so that treatment may be implemented sooner, and further cranial neuropathies may be prevented.

Behavioral Audiology Procedures in Children With Down Syndrome

Purpose Normative data regarding behavioral audiologic testing procedures are based upon the general population and often do not apply to children with Down syndrome (DS). Testing children with DS can be challenging, and outcomes may be unreliable due to their different cognitive demands and delays. The aim of this study was to assess optimal audiologic testing procedures for specific age groups of children with DS. Method This study used a retrospective investigation of 273 children with DS (145 boys, 128 girls; average age at evaluation = 5.92 ± 4.74 years) who received an audiologic evaluation during 2013 as part of their medical care at a large pediatric hospital (satellite facilities included). Results Age ranges for the completion of audiometry procedures in children with DS are provided. Average age to reliably complete behavioral testing in children with DS was delayed by up to 30 months compared to typically developing children. The majority of children with DS achieved at least good-to-fair reliability for audiologic results starting at 16 months (85.7%) and two ear results at 6–10 years (76.1%). Though not statistically significant, the use of a two-tester assistant compared to a single tester appeared to be helpful in obtaining reliable results. Conclusion The results provide a guide to optimal audiologic test procedures for children with DS, as the standard audiologic guidelines for typically developing infants and children do not apply.

CARLOS POTENCIANO REYES, MD (1940 - 2020) Little-Known but Significant Pioneer

Consultants and more senior co-resident physicians at the Philippine General Hospital (PGH) would call him “Caloy.” Hardly would I hear anybody (including our ENT department secretary) address him as Dr. Reyes. This was not because he was not a respected faculty member. Rather, he was everybody’s friend and he probably preferred to be addressed by his nickname. Dr. Carlos P. Reyes was a tall, friendly guy, easily recognizable while walking through the short PGH corridor stretching from the old ENT Ward (Ward 3) to the old ENT operating room (OR) called Floor 15, later designated as the PGH Nursing Office. He would almost always be holding either an expensive photography camera, electronic gadget, ENT OR instrument, or car magazines – suggesting his varied interests aside from having good knowledge of Otolaryngology, particularly Otology. He would usually stop and chat with an acquaintance about his new medical or non-medical interests. I first met Dr. Caloy when I was the first year resident assigned to the Otology section. He would call me “Ging” while presenting the ear patients at the outpatient department (OPD) Ear Clinic, only to learn later that he would address all unfamiliar persons by that name. He was kind, helpful and very understanding. Equipped with ample information in Otology he gathered from postgraduate studies abroad, he would selflessly share these with the residents in order to sharpen our diagnostic acumen. He would instruct us to rely on concise yet complete clinical examination, involving audiologic evaluation tools and meager radiologic information in considering differential diagnoses. He was quite willing to assist us in our learning processes, particularly on how to distinguish middle ear from inner ear disorders, and cochlear versus retrocochlear diseases. Since we did not have any audiologist at that time, he admonished us to carry out the needed audiometric evaluations on our ear patients ourselves in order to learn both the techniques of the procedures and their limitations. Hence, after the OPD clinic we would not only perform routine pure tone and speech audiometric tests but also special examinations like the Bekesy test, short increment sensitivity index (SISI) test, alternate binaural loudness balance (ABLB) test and the test for tone decay. We would then discuss the test results during our next ear clinic and we would listen and be amazed at how Dr. Caloy would integrate the information and arrive at the complex diagnosis. Dr. Caloy was our mentor at the time when refinements in tympanoplasty and mastoidectomy aroused the excitement and imagination of budding otologists worldwide. Whereas canal down mastoidectomy was the usual norm to safely remove common mastoid pathology like cholesteatoma, Dr. Caloy introduced the concept of intact canal wall mastoidectomy that avoids or mitigates recurrent postoperative cleaning of the mastoid bone. The period was also the dawn of neuro-otology when Dr. William House popularized the transmastoid approach for acoustic neuroma and the endolymphatic mastoid shunt as treatment for Meniere’s disease. In order to teach us the anatomical and surgical principles of performing these procedures, Dr. Caloy set up the first temporal bone dissection laboratory in the country at the mezzanine above the ENT conference room. He would offer the course to all ENT residents-in-training and consultants nationwide. He practically revolutionized the method of otologic surgery by requiring ENT surgeons to practice doing ear surgery in the temporal bone dissection lab prior to performing ear surgeries in the operating room. In addition, he advocated the use of the operating microscope and dental drills in place of the old bone gouges, chisels and bone ronguers. His ideas were later adopted by other ENT training institutions as we see today. The requirement that every ENT resident must undergo temporal bone dissection in the course of his training obviously stemmed from the efforts of Dr. Caloy. Many senior ENT consultants who are still with us today were former students of Dr. Caloy in his temporal bone lab Unfortunately, before finishing my residency training, Dr Caloy expeditiously left the PGH ENT department for unknown reasons. He then set up his private clinic in Quezon City and later joined the ENT department of University of Santo Tomas. Reflecting on the significant yet probably unknown achievements of Dr. Caloy toward the advancement of otology and neuro-otology in our country, I realize how blessed I was to be one of his students during that brief period when he was still with us at UP-PGH. With our profound gratitude Sir, we will always remember you.

A study on risk factors of deafness in neonates: a descriptive study

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Identification of newborn hearing loss is addressed in the healthy people 2010 goals, stated as “increasing the proportions of newborn who are screened for hearing loss by age one month, have audiologic evaluation by age 3 months and are enrolled in appropriate intervention services by age 6 months. </span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The study was conducted between October 2008 to October 2009 at Manipal Hospital, Bangalore. The study group constituted of 200 ears of 100 neonates (0-28 days) that were randomly selected. The neonates were taken from immunization clinic, newborn nursery, neonatal ward and intensive care unit of our hospital and also those referred from other hospitals. </span></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Out of 100 the neonates aged between 1-4 days were 67, 5-9 days were 24 and between 10-28 days were 9. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">There were no neonates with low Apgar score, no family history of hearing loss, no exposure to ototoxic drugs and no neonate on mechanical ventilator.</span></p>

Pathophysiology of Tinnitus and Evidence-Based Options for Tinnitus Management

Tinnitus is the perception of sound that has no source outside of the head – it is a “phantom” sound. A great many people experience chronic tinnitus, which can be problematic to different degrees. To date, no cure for tinnitus has been discovered in spite of worldwide efforts from researchers studying the pathophysiological mechanisms of tinnitus. Until a cure is discovered, individuals whose tinnitus is bothersome have evidence-based options available. Tinnitus management is provided mainly by audiologists, otolaryngologists, and mental health (MH) providers. The starting point for most patients is to receive an audiologic evaluation. Audiologists can provide tinnitus counseling and fit hearing aids, both of which can be beneficial for tinnitus management. Patients with symptoms of secondary tinnitus (somatosounds) should be referred to an otolaryngologist for a medical examination. If further tinnitus-specific services are needed for primary (idiopathic) tinnitus, then MH providers can offer cognitive-behavioral therapy and audiologists can facilitate different approaches to sound therapy. It is essential for all providers to follow evidence-based guidelines when offering tinnitus management services.

The Impact of Subjective and Objective Hearing Loss on Cognition and Memory in Older Adults

For this exploratory cross-disciplinary study, a speech-language pathologist and an audiologist collaborated to investigate the effects of objective and subjective hearing loss on cognition and memory in 11 older adults without hearing loss (OAs), 6 older adults with unaided hearing loss (HLOAs), and 16 young adults (YAs). All participants received cognitive testing and a complete audiologic evaluation including a subjective questionnaire about perceived hearing difficulty. Memory testing involved listening to or reading aloud a text passage then verbally recalling the information. Key findings revealed that objective hearing loss and subjective hearing loss were correlated and both were associated with a cognitive screening test. Potential clinical implications are discussed and include a need for more cross-professional collaboration in assessing older adults with hearing loss.