729. Lassa Fever Associated Hearing Loss

Background Hearing loss (HL) is the second leading cause of disability affecting approximately 19% of the world’s population. Despite well known social, economic, and neurologic consequences this condition receives little attention. Lassa Fever (LF) was noted to be associated with HL shortly after its discovery in the 1970’s. However, the true burden of this sequelae is likely underestimated due to a lack of standardized measurement and reporting. Methods We performed a cross-sectional study of LF survivors and household controls in Kenema, Sierra Leone. Upon recruitment, survivors and controls were screened for HL by determining Pure Tone Averages (PTA) of air conduction thresholds using an AMBCO audiometer, according to WHO standards. Individuals found to have elevated PTAs were referred to confirmatory testing measuring both air and bone thresholds using a SHOEBOX audiometer to differentiate sensorineural and conductive HL. All subjects completed symptom questionnaires and physical exams to understand the full spectrum of viral sequelae. Results 94 LF survivors and 281 controls were recruited. The average age of LF survivors was higher than controls (32.9 vs 28.7, p=0.008). Of these 94 LF survivors, 40 (43%) were found to have HL in comparison to 40 (14%) of controls (p< 0.001). Lassa fever survivors were also found to have significantly worse HL with 16 (40%) found to have profound HL compared to only 2 (5%) of controls (p< 0.001). Logistic regression of this cohort found that LF infection (OR = 1.30, p< 0.001), any inner or middle ear symptoms (OR = 1.20, p=0.041), or pharyngeal symptoms (OR = 1.23, p=0.012) were significant risk factors of developing HL (p< 0.001). Interestingly the development of any pulmonary symptoms was protective of HL (OR = 0.86, p=0.039). Animal model studies suggested that LF infection may result in the development of an ANCA vasculitis which may be causative of LF sequelae. A subset of LF survivors (n=80) and IgG negative controls (n=9) were tested for ANCA proteins, of these 20 (25%) survivors vs 5 (55%) tested positive with mean concentrations of 202.4 µg/ml and 135.7 µg/ml (p=0.449), respectively. Conclusion This data further characterizes the sequelae of LF and suggests mechanisms of pathogenesis of symptoms. Disclosures All Authors: No reported disclosures

Inner Ear Symptoms Are Prevalent in Patients with High Head Abbreviated Injury Scale Scores after Blunt Head Trauma

<b><i>Introduction:</i></b> The purpose of this article was to determine the prevalence of inner ear symptoms in patients with blunt head trauma and to explore whether the severity of head trauma was associated with the incidence of such symptoms. <b><i>Methods:</i></b> We performed a retrospective review of 56 patients admitted with blunt head trauma who underwent audiovestibular evaluation within 1 month after injury. Two scales were used to measure the severity of trauma; these were the Glasgow Coma Scale (GCS) and the Head Abbreviated Injury Scale (H-AIS). Patients with sensorineural-type hearing loss, or dizziness with nystagmus, were considered to have inner ear symptoms. <b><i>Results:</i></b> About half of all patients (45%) with blunt head trauma showed trauma-related inner ear symptoms. Patients with inner ear symptoms were significantly more likely to have H-AIS scores ≥4 than those without inner ear symptoms (<i>p</i> = 0.004), even without concomitant temporal bone fracture (<i>p</i> &#x3e; 0.05). Also, patients with inner ear symptoms required a statistically significantly longer time (measured from admission) before undergoing their ontological evaluations than did those without such symptoms (<i>p</i> = 0.002), possibly due to prolonged bed rest and use of sedatives. <b><i>Conclusion:</i></b> Thus, detailed history-taking and early evaluation using trauma scales are essential for all patients suffering from severe head trauma. It may be necessary to initiate early treatment of traumatic inner ear diseases.

Post-earthquake dizziness syndrome following the 2016 Kumamoto earthquakes, Japan

This study aimed to examine the types and causes of dizziness experienced by individuals after a major earthquake. This cross-sectional study enrolled healthy participants who experienced the 2016 Kumamoto earthquakes and their aftershocks. Participants completed a questionnaire survey on their symptoms and experiences after the earthquakes. The primary outcome was the occurrence of dizziness and the secondary outcome was the presence of autonomic dysfunction and anxiety. Among 4,231 eligible participants, 1,543 experienced post-earthquake dizziness. Multivariate logistic regression analysis revealed that age (≥21, P < .001), female sex (P < .001), floor on which the individual was at the time (≥3, P = .007), tinnitus/ear fullness (P < .001), anxiety (P < .001), symptoms related to autonomic dysfunction (P = .04), and prior history of motion sickness (P = .002) were significantly associated with the onset of post-earthquake dizziness. Thus suggesting that earthquake-related effects significantly affect inner ear symptoms, autonomic function, and psychological factors. Earthquake-induced disequilibrium may be further influenced by physical stressors, including sensory disruptions induced by earthquake vibrations, changes in living conditions, and autonomic stress. This study increases our understanding of human equilibrium in response to natural disasters.

Patient-Reported Control of Asthma, Nasal Polyposis, and Middle-Ear Symptoms in NSAID-Exacerbated Respiratory Disease

Non-steroidal anti-inflammatory drug (NSAID)—exacerbated respiratory disease (NERD) is an adult-onset inflammatory condition of the upper and lower airways. It is characterized by the co-existence of asthma, nasal polyposis, and hypersensitivity to NSAIDs. Over one-fourth of patients also have symptoms of chronic middle-ear infection. The clinical course of NERD is often severe and generally requires multimodal treatment with recurrent surgical measures. Studies presenting the disease burden and subjective symptom control of NERD are limited. In this qualitative questionnaire study, we present the clinical characteristics of asthma, nasal polyposis, NSAID intolerance and possible recurrent or chronic middle-ear infection of 66 confirmed NERD patients treated at our tertiary referral center between January 2016 and May 2017. Additionally, we present the patient-reported disease control of asthma, nasal polyposis, and middle-ear symptoms on a four-category Likert scale. The proportion of NERD patients with recurrent or chronic middle-ear infection was 18%. The proportion of good or very good subjective disease control was 83% for asthma, 58% for nasal polyposis, and 33% for chronic middle-ear infection, if present. Chronic middle-ear infection is common among NERD patients and should more often be recognized as part of the entity. Together with nasal polyposis, chronic middle-ear infection seems to affect patients more than asthma. The patient's perspective of disease control should be considered when planning the interdisciplinary follow-up and treatment of NERD.

MRI With Gadolinium as a Measure of Blood-Labyrinth Barrier Integrity in Patients With Inner Ear Symptoms: A Scoping Review

Objective: Capillaries within the inner ear form a semi-permeable barrier called the blood-labyrinth barrier that is less permeable than capillary barriers elsewhere within the human body. Dysfunction of the blood-labyrinth barrier has been proposed as a mechanism for several audio-vestibular disorders. There has been interest in using magnetic resonance imaging (MRI) with intravenous gadolinium-based contrast agents (GBCA) as a marker for the integrity of the blood labyrinth barrier in research and clinical settings. This scoping review evaluates the evidence for using intravenous gadolinium-enhanced MRI to assess the permeability of the blood-labyrinth barrier in healthy and diseased ears.Methods: A systematic search was conducted of three databases: PubMed, EMBASE, CINAHL PLUS. Studies were included that used GBCA to study the inner ear and permeability of the blood-labyrinth barrier. Data was collected on MRI protocols used and inner ear enhancement patterns of healthy and diseased ears in both human and animal studies.Results: The search yielded 14 studies in animals and 53 studies in humans. In healthy animal and human inner ears, contrast-enhanced MRI demonstrated gradual increase in inner ear signal intensity over time that was limited to the perilymph. Signal intensity peaked at 100 min in rodents and 4 h in humans. Compared to controls, patients with idiopathic sudden sensorineural hearing loss and otosclerosis had increased signal intensity both before and shortly after GBCA injection. In patients with Ménière's disease and vestibular schwannoma, studies reported increased signal at 4 h, compared to controls. Quality assessment of included studies determined that all the studies lacked sample size justification and many lacked adequate control groups or blinded assessors of MRI.Conclusions: The included studies provided convincing evidence that gadolinium crosses the blood-labyrinth barrier in healthy ears and more rapidly in some diseased ears. The timing of increased signal differs by disease. There was a lack of evidence that these findings indicate general permeability of the blood-labyrinth barrier. Future studies with consistent and rigorous methods are needed to investigate the relationship between gadolinium uptake and assessments of inner ear function and to better determine whether signal enhancement indicates permeability for molecules other than gadolinium.

Associations of Symptomatic- and Anatomical-Based Severity of Chronic Rhinosinusitis With Patients' Anxiety and Depression

Background Patients with chronic rhinosinusitis (CRS) have a high incidence rate of anxiety and depression. However, changes in anxiety and depression with different severities of CRS,and the effects of symptoms and anatomical factors on the anxiety and depression of CRS patients remain unclear.Methods A total of 112 patients were enrolled in the study. The Sino-Nasal Outcome Test-20 (SNOT-22) score, Lund-Mackay scale and Lund-Kennedy scale were used to assess the severity of CRS, and the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9) were used to evaluate anxiety and depression in patients. Results In the univariate analysis, SNOT-20 scores, nasal symptom scores, facial/ear symptom scores and sleep scores are significantly positively correlated with patients’ GAD-7 scores (all P<0.05); the patients’ SNOT-20 scores, nasal symptom scores, facial/ear symptom scores, sleep scores, and the higher side of the anterior ethmoid sinus and frontal sinus Lund-Mackay scores were significantly positively correlated with the patients’ PHQ-9 scores (all P<0.05). In a multivariate linear regression model, however, none of the covariates were found to be statistically associated with GAD-7. Another multivariate model indicated associations among the SNOT-20 sleep domain scores, the higher side of frontal sinus Lund- Mackay scores and PHQ-9 scores (both P < 0.01). Conclusions Exacerbated nasal and facial/ear symptoms, sleep dysfunction increase patients’ depression and anxiety. Lesions of the frontal sinus and anterior ethmoid sinus may be related to patients' depression. Treatment should be tailored to patients with these symptoms.

Efficacy of Three Dimensional Fast Imaging Employing Steady State Acquisition Combined with Conventional MRI in Evaluation of Patients with Cerebellopontine Angle Lesions

Introduction: The Three Dimensional Fast Imaging Employing Steady state Acquisition (3D FIESTA) has higher spatial resolution between the Cerebrospinal Fluid (CSF) and cranial nerves with accurate identification of Cerebellopontine Angle (CPA) and internal auditory canal tumours and takes shorter acquisition imaging time than conventional Magnetic Resonance Imaging (MRI) scan. Aim: To evaluate the efficacy of 3D FIESTA imaging as a screening tool for CPA lesions, hence to depict the fine anatomy of the cisternal and canalicular segments of the facial nerve and vestibulocochlear nerves in order to elucidate the aetiopathogenesis of unexplained inner ear symptoms. Materials and Methods: The present study was a hospital based cross-sectional study which was done in Department of Radiodiagnosis, Chettinad Hospital and Research Institute, Chennai, Tamil Nadu, India. The study was conducted on 30 patients, who were referred for MRI Brain to the department and diagnosed with cerebellopontine angle lesion from August 2018 to October 2019. A 1.5 Tesla, MRI scanner was used to scan all patients with a 8 channel Neurovascular (NV) radiofrequency coil. Along with routine conventional MRI sequences, 3D FIESTA sequence was also performed. All the data was collected and analysed by Statistical Package for Social Sciences (SPSS) software version 23.0. Data for descriptive statistics i.e. frequency and percentage analysis, mean±Standard Deviation (SD), sensitivity, specificity, Positive Predictive Value (PPV) and Negative Predictive Value (NPV) were calculated. Results: On Histopathological Examination (HPE), 63.3% were schwannoma, 16.7% meningioma, 10% epidermoid cyst and 3.3% intracanalicular lipoma. In 6.7% of patients, imaging features were in favour of CPA arachnoid cyst. The size of the intracanalicular part of tumour was underestimated in T2 weighted images (T2WI). 3D FIESTA gave a better estimated tumour area, even though slightly less but almost equivalent to that in post-contrast imaging. In this study, post-contrast imaging was considered as the gold standard. It was proven that conventional sequences like T2WI showed a sensitivity of 85.71% and specificity of 100% whereas 3D FIESTA sequence showed 100% sensitivity and specificity in assessing the CPA tumour extent and cranial nerve involvement. Conclusion: 3D FIESTA imaging is a sensitive technique for the diagnosis of retrocochlear and CPA lesions without contrast administration. 3D FIESTA imaging can be considered as a useful screening tool for patients presenting with inner ear symptoms.

PREVALENCE OF OTOLARYNGOLOGICAL SYMPTOMS IN PATIENTS WITH TEMPOROMANDIBULAR DISORDERS- A CROSS-SECTIONAL STUDY

Aim:To investigate the prevalence of otolaryngological symptoms with Temporomandibular Disorders (TMD) in TMD patients. Materials and Methods: In this cross sectional study, the sample consisted of 172 TMD patients, both males and females of 18-59 years. Diagnosis of TMD was based on Research Diagnostic Criteria for TMD (RDC-TMD) Axis 1. The prevalence of otolaryngological symptoms was determined using questionnaire. Results: Of the 172 TMD patients evaluated, 81 patients were having Muscular disorder alone or combined with Intracapsular disorder. Out of the 81 patients having muscular disorder, 74 had ear symptoms (91.4%). Conclusion: A high prevalence (91.4%) of Otolaryngological symptoms with TMD was found in the present study. Ruling out causes of ear symptoms other than TMD by an ENT specialist is essential before proceeding with the treatment of these category of patients for a better prognosis.