There is increasing evidence to suggest that the implementation offamily-centered care practices in clinical audiology yields positive patientoutcomes. Previous work showed that significant-other attendance at audiologyappointments, a recommended practice consistent with family-centered care, wasassociated with greater odds of hearing aid adoption and increased satisfactionwith hearing aids. The primary goal of this retrospective explorative study wasto investigate the unexplored question of whether an association exists betweenthe type of significant other (SO) in attendance at appointments and hearing aidadoption. The study sample consisted of adult patients from a chain of privateclinics in the United Kingdom who either attended their audiology appointmentwith a SO  or alone . Six SO types were identified andclassified: partner , parent (n = 76), child , sibling(n = 208), friend (n = 518), and carer (n = 28). In addition to replicatingprevious findings which showed that significant-other attendance at audiologyappointments was positively associated with hearing aid adoption, results fromthe current paper also revealed that the odds of hearing aid adoption weregreater if the SO was of a stronger relationship tie  and not a weaker relationship tie . These findings suggest that an extension of the non-audiological factorof significant-other attendance during the hearing rehabilitation process shouldbe considered: the relationship type patients have with their significantothers. Hearing loss is a significant global health issue that affects an estimated 1.5billion people to some degree , and theWhile a review of the barriers for, and predictors of, hearing aid adoption is beyondthe scope of the present paper, the focus here is on an emerging research theme witha family-centered care perspective that focuses on the influence of significantother (SO) attendance at audiological appointments. Evidence suggests that not onlyis hearing aid adoption significantly more likely for patients who attend theiraudiology appointment with a SO , but theThe involvement of family members in healthcare appointments is a well-knowncomponent of patient- and family-centered care . WithfaNot only are patients more likely to adopt hearing aids if they attendappointments with a SO , they alThe trans-theoretical model (TTM) of behavior change  hasbeenAs research on SO involvement at audiology appointments moves forward, importantinsights may be drawn by examining questions commonly asked by clinicians, suchas: 1) “who are the SOs that attend audiology appointments?”, 2) “does SO typematter for patient outcomes?”.The importance of such questions has recently been addressed in part byqualitative research examining the role of adult children during their parents’auditory rehabilitation process . It was In social network research, social relationships can be defined in terms of thestrength of a tie  which is a publicly funded healthcare system. Someindividuals opt to pursue hearing aid purchases via private clinics fordifferent reasons, including being able to select hearing aid models andstyles not available via the NHS, and faster accessibility to services. Themeasurement variables included information collected at each patients’first-time appointment at an audiology clinic. The data contained factorssuch as: demographics , clinical audiological profile, rehabilitation outcome decision , and otherfactors of interest to this paper, namely whether a patient attended theappointment alone, or with a SO. For those patients who attended with a SO,clinicians had the option to indicate using a free text data entry field,the type of relationship the SO reported with the patient . Free text data is often very messy to manage dueboth to typos and the numerous ways clinicians might decide to indicate theSO relationship type . For the current paper, clinician indications of SO relationshiptype were classified for each patient using custom code written in R R. Data prPrior to preparation, the data contained 192,523 patient records. Each time apatient attended an audiology clinic, a patient record was createdcontaining multiple measurement variables, described above. Data wereimported into R for processing R . A nine-The primary variable of interest for the classification procedure was a freetext column of a spreadsheet, where clinicians either identified whether apatient attended the appointment alone, or they identified the relationshipbetween the patient and the person(s) who accompanied the patient to theirappointment . The intent of theclassification was to classify the presence or absence of a SO at theappointment, as well as the relationship of the SO with the patient. Toperform this classification, nine relationship-type “tags” were identifiedas follows: “And”, “Carer”, “Child”, “Family”, “Friend”, “Parent”,“Partner”, “Semi-attend”, and “Sibling”. The purpose of conducting thisclassification was to create a final analytical dataset by excluding allparticipants in the dataset that did not meet a clear relationship-typeclassification.These relationship-type “tags” see  are selft tests revealed that patients in the SO condition weresignificantly older, more likely to be male (based on proportions), and morelikely to adopt hearing aids than those who attended audiology appointmentsalone  was entered into Block 1 of a hierarchical logistic regression analysisin SPSS, while sex  and SO relationship type  were entered into Block 2. The“alone” level operated as the reference level.The primary goal of the paper was to investigate whether an association existsbetween SO relationship type and hearing aid adoption. For model 1 the fullsample , discussed under “In order to replicate previous findings, two hierarchical binary logisticregression analyses were conducted by following the same protocol as performedin For each of the logistic regression models, variables were retained in the modelonly if they had a p value of < 0.05. All predictor variables had a varianceinflation factor of < 2.0, except for model 3, where the attendance of an SO(yes or no), and the interaction between the WE4PTA and the attendance of an SO,which were 17.59 and 17.90, respectively. By dropping the interaction term inmodel 3, it was possible to correct for multicollinearity, so this was done. Unfortunately, by dropping the interaction term here, it was no longerpossible to directly compare results to 2(df = 8) = 1217.09, Nagelkerke R2 = 0.036, p < 0.0001).Goodness-of-fit was deemed inappropriate according to the Hosmer-Lemeshowstatistic, which was significant (p < 0.0001). However, this is not of greatconcern, as it has been acknowledged by Hosmer and Lemeshow that for largesample sizes, this test may be significant even when the model fit is good = 823.70, p < 0.0001) and sex (x2 (df = 1) = 36.62,p < 0.0001) were both significant. Thus, the odds of adopting a hearing aidare significantly higher for participants who are older rather than younger, and they are significantly lower for patientswho are male rather than female . The Wald ratiofor the coefficient associated with the type of SO relationship was alsosignificant, x2 (df = 6) = 213.48, p < 0.0001. Compared toattending alone, the odds of hearing aid adoption were significantly higher if apatient attended with their child (x2 (df = 1) = 48.86,p < 0.0001; OR = 1.42; 95% CI ), parent (x2(df = 1) = 11.59, p = 0.001; OR = 2.44; 95% CI ), partner(x2 (df = 1) = 160.05, p < 0.0001; OR = 1.47; 95% CI ), or sibling (x2 (df = 1) = 4.65, p = 0.031; OR = 1.41; 95% CI). It was also observed that the odds of adopting a hearing aid werenot significantly different when attending with a carer (x2(df = 1) = 1.56, p = 0.21; OR = 0.61; 95% CI ) or a friend(x2 (df = 1) = 1.45, p = 0.23; OR = 1.13; 95% CI ),compared to attending alone.The Wald ratio for the coefficients associated with age (x2(df = 3) = 1201.91, Nagelkerke R2 = 0.035, p < 0.0001).Goodness-of-fit was deemed inappropriate according to the Hosmer-Lemeshowstatistic, which was significant (p < 0.0001). As reported above for model 1,for large sample sizes such as this, the Hosmer-Lemeshow statistic may besignificant even when the model fit is good  = 199.72,p < 0.0001. This means that the odds of hearing aid adoption for patients whoattended with a SO were significantly higher than for those who attended alone. The Wald ratios for age (x2(df = 1) = 829.01, p < 0.0001), and sex (x2 (df = 1) = 35.01,p < 0.0001) were also significant. Therefore, the odds of hearing aidadoption for older participants was significantly higher than for youngerparticipants , and contrary to The Wald ratio for the coefficient associated with SO attendance at audiologyappointments was statistically significant, xResults for model 3 are influenced by multicollinearity, which suggests weakenedstatistical power and questionable statistical significance of predictorvariables. However, results are reported here to compare against model 4,reported further below. Model 4 is the same as model 3, but without theinteraction term, and results for remaining variables remained interpretivelyidentical.2 (df = 4) = 170.29, Nagelkerke R2 = 0.096,p < 0.0001). Goodness-of-fit was deemed appropriate according to theHosmer-Lemeshow statistic, which was not significant, x2(df = 4) = 11.74, p = 0.16.Model 4 included the variables age, WE4PTA, sex, and SO attendance, aspredictors, and was statistically significant  = 8.59, p = 0.003), WE4PTA (x2 (df = 1) = 77.13,p < 0.0001), and SO attendance (x2 (df = 1) = 32.56,p < 0.0001), were all significant. Thus, the odds of hearing aid adoptionwere significantly higher for individuals who were older compared to younger, who had poorer compared to betteraudiometric hearing loss , and for those whoattended with a SO compared to those attended alone . The Wald ratio for the coefficient associated with sex (x2(df = 1) = 2.85, p = 0.092; OR = 0.85; 95% CI ) was notsignificant.The Wald ratio for the coefficients associated with age , but did nothave familial support at their hearing care appointment. Some patients may nothave familial connections, or may have relationships with SOs that are notsupportive. Clinicians should try to be aware about the general nature offamilial and non-familial relationship ties in their patients’ lives. Forexample, clinicians may need to implement more engaged follow-up discussionsafter a hearing aid recommendation, for those who have weaker, or onlynon-familial, relationship ties. Although more work needs to be done beforerecommendations can be made, who is in attendance at a patient's appointment canprovide a simple cue to inform clinicians about what level of support they mayneed to provide for adequate hearing care.The constraints associated with retrospective research designs are a notablelimitation to the current study. For example, it was not possible to controlwhich patients brought a SO to their appointment, as the data were analyzed wellafter collection. Hence, it is unclear whether SO attendance might influencehearing aid adoption for patients in a direct manner. Future work ought toimplement an experimental design with random assignment for patients to eitherattend with an SO or alone to better understand the nature of this association.Additionally, due to the nature of these data, there is no available informationregarding the perseverance of hearing aid adoption . This point could not bestated more strongly: future work about hearing aid adoption should consideroutcomes of hearing aid use after the decision to adopt hearing aids ismade.Another limitation was that clinicians did not follow the same approach whendocumenting the identities of the SOs in attendance because they were asked todo so using a free text description. Given the nature of free text data, it wasnecessary to develop a classification procedure that accounted for challengeslike typos or spelling errors, capitalizations, and compounded responses like“brother John” instead of simply “brother”. For this reason, data cleaning wastime consuming and resulted in data losses due to between-clinician differencesin data reporting. Although the classification of SO type presented challenges,it may also be viewed as a strength of the current study as well as an exampleof the usefulness of data-driven retrospective analyses in general. It waspossible to make use of available data to answer a relevant and novel researchquestion. That said, future data-base related work on this topic should employthe use of pre-defined SO type classifications that clinicians could select fromwhen defining the relationship of the SO to the patient during appointments.This would reduce ambiguity in response categories and increase dataretention.Clearly, the nature of SO relationships and their social support for patients isfar more complex than this retrospective study could describe. For example,significant others who are adult children may not be the primary conversationpartner of their parents who are patients. There are likely different dimensionsrelated to SO attendance  that are important tonote, but were not measured in the current study. This highlights the need forfuture studies to a) directly measure relationship strength, and b) includeother contextual factors that help to describe the relationship quality ofpatient-SO pair. A complementary variable of interest could be one that attemptsto measure the degree of conflict arising from communication challenges due to apatient's hearing loss. For example, if there is conflict surrounding hearingchallenges between a patient-SO pair, would the attendance of the SO help tounify the pair toward jointly addressing the communication issue by adoptionhearing aids, or would this further exacerbate conflict between the pair?Furthermore, it may be helpful to develop a metric for the quality of thetriadic patient-SO-clinician interaction to better understand and account fornot only the presence of an SO at an appointment, but also perspectives abouttheir presence from the triad  wasassociated with greater odds for patients to adopt hearing aids while the attendanceof non-familial SO relationship types  was not. Although morework needs to be done to better understand the nature of patient-SO relationships and their association withhearing aid adoption , the previousrecommendation from


All patients underwent Bonebridge BCI 602 implant surgery. Before and after implantation, pure-tone audiometry, speech recognition tests (in quiet and noise), and free-field audiometry were performed. Word recognition scores were evaluated using the Polish Monosyllabic Word Test. Speech reception thresholds in noise were assessed using the Polish Sentence Matrix Test. Subjective assessment of benefits was done using the APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire.The APHAB questionnaire showed that difficulties in hearing decreased after BCI 602 implantation. Both word recognition in quiet and speech reception threshold in noise were significantly better after BCI 602 implantation and remained stable for at least 12 months. A significant advantage of the device is a reduced time for surgery while maintaining safety. In this study, the mean time for BCI 602 implantation was 28.3 min ± 9.4.The second-generation Bonebridge BCI 602 implant is an effective hearing rehabilitation device for patients with conductive or mixed hearing loss. Patient satisfaction and audiological results confirm its efficacy and safety. Its new shape and dimensions allow it to be used in patients previously excluded due to insufficient or difficult anatomical conditions. The new BCI 602 implant is as effective as its predecessor, the BCI 601. There are an increasing number of rehabilitation and treatment options for patients with conductive or mixed hearing loss, and professionals need to be able to inform their patients about their options based on actual experiences and results. Currently, the most common treatments for conductive and mixed hearing loss are drugs, middle ear surgery, hearing aids, bone-conduction hearing implants, or a combination of these , 2. The A large group of patients are patients with congenital anatomical defects of the outer and/or middle ear who cannot use the traditional methods of treatment and whose surgical procedures have not given satisfactory results. A possible way to improve their hearing is to use implantable or non-implantable bone-conduction devices , 4. For Before surgery, a patient must undergo a diagnostic process that qualifies them for the use of a specific device. This involves a consultation with an audiologist, hearing care professional, neurologist, psychologist, radiologist, and speech therapist , 6. BefoOften, the use of an implantable device is limited by insufficient or difficult anatomical conditions. Solutions using bone-conduction amplification are constantly improving, and this applies to both the external part  and the internal part, which vibrates the bone of the skull, thus transmitting sound directly to the inner ear. One solution for patients with conductive or mixed hearing loss is the Bonebridge (BB) bone-conduction implant .The Bonebridge was first implanted in 2011 as part of a clinical trial and was launched onto the EU market in September 2012 , 8. The There are many studies in the literature showing the effectiveness of the BCI 601 implant, and the device can provide improved hearing in both children and adults , 11–18. n = 14), chronic otitis media with cholesteatoma (n = 7), microtia and atresia (n = 13), atresia (n = 3), congenital defect of the middle ear (n = 2), congenital defect of the outer and middle ear (n = 1), middle ear tumor (n = 1), and tympanosclerosis (n = 1). The patients were selected according to the following criteria: patients had to be older than 18 years of age, ear reconstruction was completely finished, cooperative in audiological testing, and hearing thresholds had to accord with the manufacturer’s suggested criteria—conductive or mixed mild-to-moderate hearing loss; pure-tone average (PTA) BC threshold  ≤ 45 dB HL, BC thresholds over the last 12 months were stable, and appropriate anatomical conditions had been confirmed by computed tomography. In addition, patients were required to have realistic expectations of the benefits and know the limitations of the Bonebridge BCI 602.The study group consisted of 42 adult patients, 19–74 years old . There were 24 women and 19 men, and 23 patients had mixed and 19 had conductive hearing loss. In terms of ears, 23 were implanted on the right and 19 on the left. The causes of hearing loss were chronic otitis media  , 20.The study protocol was approved by the Institutional Review Board of the Institute of Physiology and Pathology of Hearing (IFPS:/KB/7/2020) and conformed with the Declaration of Helsinki. All patients signed an informed consent document prior to enrollment in the study.p level was set at less than 0.05. All statistical tests were performed using IBM SPSS Statistics 24.A Kolmogorov–Smirnov test was used to check whether the analyzed variables were normally distributed. A repeated-measures analysis of variance with Bonferroni adjustment for multiple comparisons was performed to test changes in mean scores over several time points. The 0N0) and the contralateral ear double-blocked with an earplug. The non-implanted ear was blocked but not masked, since masking would reduce the sensitivity of that ear to bone-conducted sound that is normally also heard from an implant on the other side of the skull. The Polish Sentence Matrix Test (PSMT) was used to measure intelligibility of speech presented against a background noise, and consists of five columns containing 10 names, 10 verbs, 10 numerals, 10 adjectives, and 10 nouns. For all patients, we simulated the result of a bone-conduction implant using a bone-conduction processor on a soft band (best-aided). Before surgery, we measured speech recognition (in quiet and noise) for the unaided and best-aided conditions, and made these same measurements after surgery using the recommended audio processor.All audiometric tests were performed before surgery as well as at activation and 6 and 12 months after surgery. Pure-tone thresholds were measured for air conduction (AC) and bone conduction (BC). Postoperatively, aided thresholds were measured using warble tones. Speech recognition in quiet was measured using the Demenko&Pruszewicz Polish Monosyllabic Word Test at 65 dB SPL presented via a loudspeaker. Speech reception thresholds in noise were assessed using the Polish Sentence Matrix Test . The 50%Patients’ satisfaction and quality of life were assessed before implantation and at 6 and 12 months post-operatively with the APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire for adults. This questionnaire measures subjective hearing impairment on four different subscales pertaining to different listening situations and gauges what benefit the patient experiences after implantation . Cox andAll implantations were carried out by two experienced surgeons as an in-patient procedure under general anesthesia. No complications occurred during surgery. To determine the optimal implant position, all patients underwent a CT scan of the temporal bone before the operation and a detailed assessment of anatomical conditions  , 24. TheFour weeks (± 1 week) after the operation, the device was activated and the settings adjusted according to the audiometric test results, vibrogram results, and the patient's subjective assessment and comfort. All patients were provided with Samba 1(Med-El) audio processors (the first version of Samba), and the Symfit 7.0 program was used for fitting. All fittings were performed by two experienced audiologists. The strength of the sound processor’s magnet was adjusted to allow a stable hold while avoiding skin compression; in 22 cases, magnet No. 4 was used and in 20 cases magnet No. 3.M = 61.8, SD = 12.2. PTA for bone conduction varied between 2.5 and 35 dB HL; M = 19.7, SD = 7.1. Details for all frequencies are shown in Fig. PTA (pure-tone average) for air conduction measured before implantation varied between 42.5 and 93.75 dB HL; SD = 10.7).The mean functional gain estimated in the simulation before implantation was 28.8 dB HL (SD = 9.3). The real mean functional gain obtained 12 months after implantation was 27.0 dB HL (SD = 10.6), and in the simulation, they were found to be 35.6 dB HL (SD = 7.4). Statistically significant improvements were observed after surgery . The mean hearing thresholds were 38.9 dB HL (SD = 7.6) at activation, 39.3 dB HL (SD = 7.1) after 6 months, and 37.4 dB HL (SD = 4.8) after 12 months . Before implantation, they were measured unaided as 15.7% (SD = 22.0) and aided (in the simulation) as 88.5% (SD = 9.8). Statistically significant improvement was observed after surgery . The mean WRS was 85.1% (SD = 11.8) at activation, 86.8% (SD = 11.0) after 6 months, and 87.6% (SD = 10.5) after 12 months  measured before implantation under headphones were 13.5%  and aided (in the simulation) − 1.72 dB SNR (SD = 6.51). Statistically significant improvement was observed after surgery . The mean SRT was − 2.01 dB SNR (SD = 5.83) at activation, − 0.35 dB SNR (SD = 4.99) after 6 months, and − 1.95 dB SNR (SD = 4.16) after 12 months  measured before implantation were unaided 4.36 dB SNR SD = .76 and aF = 54.73; p < 0.001; e2 = 0.57) and the pre-operative score  was significantly higher than both postoperative scores at 6 months  and at 12 months . Similarly, on the EC subscale , the BN subscale , and the RV subscale , a significant change was found between pre-operative score and both 6 month and 12 month follow-ups. On the AV subscale, no difference was found between the three measurements . The mean APHAB outcomes are shown in Fig. The APHAB questionnaire showed that difficulties in hearing decreased after BB implantation . There was a statistically significant improvement in the global score . Implantation of the first-generation BCI 601 implant took longer, with times ranging from 28 to 57 min (mean 35.6 ± 8.1) (n = 10).A significant advantage of the new implant is less time required for surgery. In this study, operation times for BCI 602 implantation ranged from 19 to 66 min (mean 28.3 min ± 9.4.) (Comparing the obtained results with results of other bone-conduction devices, the BCI 602 implant compares favorably , 38–40. The Bonebridge BCI 602 implant is an effective method of hearing rehabilitation in adult patients with conductive or mixed hearing loss. After 12 months, the BCI 602 provided significant improvements in objective and subjective auditory performance. The reduced thickness of the implant reduces surgical time and risk, especially in difficult anatomical conditions. The successful audiological results confirm the effectiveness of the implant, as do improvements in hearing and speech understanding and patient satisfaction. The hearing results after implantation of the BCI 602 were comparable to the published results of its predecessor, the BCI 601. Both the first- and second-generation implants confer significant benefits to the patient. Further observations of the results of patients with the new implant should be conducted to verify the stability of the results over several years and compare it with long-term follow-ups of the first-generation implant.


Glucocorticoids are considered the first-line therapy for sudden sensorineural hearing loss. But there is currently no consensus on administering them as a single dose versus multiple divided daily doses.We aim to evaluate the treatment outcome of sudden sensorineural hearing loss between a single-dose and multiple divided daily doses of steroid treatment.A total of 94 patients who were diagnosed and treated for sudden sensorineural hearing loss and followed up for more than three months were reviewed retrospectively. Patients were divided into single-dose and multiple divided-dose groups, based on their medication regimens. Hearing thresholds were repeatedly measured: on the initial visit and 1 week, 1 month, and 3 months after the initial treatment. Treatment outcomes were analyzed by comparing hearing recovery rates and post-treatment audiometric changes.The hearing threshold was significantly reduced at three months post-treatment in both groups. The hearing recovery rate of the single-dose group was significantly higher than that of the multiple divided-dose groups. Audiometric changes showed no statistical difference either in pure tone threshold or speech discrimination.When oral steroids are indicated for sudden sensorineural hearing loss, both a single dose and multiple divided doses can be effective for treatment and have comparable results. However, the single-dose regimen seems to be more efficacious than the divided-dose regimen. Glucocorticoids are considered a first-line therapy for sudden sensorineural hearing loss (SSNHL) and may be administered systemically . Although the mechanism of the steroid action in the inner ear remains unclear, high concentrations of steroids in the inner ear via high doses of oral steroids have shown an adequate therapeutic effect.The advantages of single-dose regimen are less suppression of hypothalamic–pituitary–adrenal functionIt is currently unclear as to which is more important—either peak or mean plasma concentration—regarding steroid treatment of SSNHL, and the efficacy of each regimen has not yet been compared.The AAO-HNS guidelines recommend the following single-dose regimen: prednisolone 1 mg/kg/day for 7–14 days, then taper medication over a similar period.One hundred twenty-nine SSNHL patients (age >18 years), who were treated with oral steroids and had more than 3 months’ follow-up duration between July 2013 and May 2016, were included in this study. SSNHL was diagnosed in patients who had experienced their first episode of sudden hearing impairment of more than 30 decibels (dB) across three contiguous frequencies. Patients who were treated with either a combined intratympanic steroid therapy or a different treatment regimen, patients with combined chronic otitis media, those who were finally diagnosed as having either Meniere's disease, acoustic neuroma, or Ramsay Hunt syndrome, and subjects who did not return for follow up, were excluded.The participants’ medical charts were retrospectively reviewed. Seventy (54%) of the patients were men and 59 (46%) were women. The mean age was 55.5 years (range: 18–79 years). The right ear was affected in 55 cases, the left ear in 68 cases, and both ears in 7 cases. Patients were divided into two groups based on steroid regimens:Single-dose group: prednisolone 1 mg/kg (or methylprednisolone 0.8 mg/kg) once a day for 5 days, and tapering doses .Multiple divided-dose group: the same dose in three equally divided doses, three times a day and tapering doses.Pure tone audiometry (PTA) and speech audiometry were performed at the initial visit and 1 week, 2 weeks, 1 month, 2 months, and 3 months after the initial treatment. The PTA threshold was calculated by the mean hearing threshold frequencies , 2000 (×2), 4000 Hz). The speech discrimination (SD) score was obtained by speech audiometry (0–100%). These values were recorded at each follow-up visit, and the results of the initial and the last follow-up were evaluated. Hearing improvement was evaluated according to Siegel's criteria of hearing recovery in sudden deafness .6 Complet-test. The Chi-square test was used to compare the hearing recovery rate between the two groups, and the Student t-test was used to evaluate the difference between the pre- and post-treatment PTA threshold and SD between the two groups Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) for Windows version 18.0. The criterion for statistical significance was set at p < 0.05.Comparisons between pre- and post-treatment PTA and SD in each group were performed using the paired This study was approved by the Institutional Review Board of Our Hospital (ID no. 2017-08-013).p = 0.997). The SD scores were also not different between the groups before treatment. There were no significant differences in age, sex, incidences of associated vertigo, hypertension and diabetes mellitus, and interval of onset of hearing loss and steroid treatment between the two groups .The hearing threshold and SD were significantly reduced at three months post-treatment in both groups . Howeverp = 0.003). When considering complete and partial recovery only, there was no significant difference in the hearing recovery rate between both groups  , and 56 out of 95 subjects  showed hearing improvement . The hea= 0.317) .Table 3Tp = 0.333 and 0.679, respectively). No severe side effect of the steroid was observed in any patient.Pre- and post-treatment changes of the PTA threshold and SD in each group were not different  in SSNHL patients with profound hearing loss.There is little data in the literature about the comparison of efficacy between different oral steroid dose regimens on SSNHL. We believe that this is the first description of the favorable efficacy of a single-dose regimen compared to a divided-dose regimen of steroid therapy. In our study, we divided patients into two groups according to steroid regimen (single dose versus multiple divided doses). The therapeutic effects of regimens on SSNHL were evaluated via both pre- and post-treatment pure tone threshold and speech discrimination scores, according to Siegel's criteria.The half-life of oral prednisolone was reported as 2.6–3.8 h, which varied by dose.Recently, the comparison of the efficacy of two and three divided steroid regimens in SSNHL patients was reported.n = 89, p = 0.003) and this result is consistent with previous studies.p = 0.216) in our study. When comparing the recovery rate between SSNHL patients with vertigo (n = 30) and without vertigo (n = 99), the recovery rate was not statistically different .Forty patients with diabetes mellitus showed poor prognosis compared to patients without diabetes (Our study has some limitations. First, several suspected risk factors for SSNHL were not available from the retrospective data, including personal histories of smoking, exposure to noise, and cardiovascular risk factors, such as body mass index, cholesterol level, and a family history of cardiovascular disease. The data also lacked information about the participants’ immune statuses, which might have caused some bias. However, we confirmed that major risk factors, including age, hearing threshold at initial presentation, interval of hearing loss and treatment, and incidences of associated vertigo, hypertension and diabetes, were not different between the two groups before steroid therapy. And the majority of the included patients in this study have a PTA range of moderate-to-severe hearing loss. Second, a relatively small sample of single-dose group participants were enrolled compared to the divided-dose group. Because we tried to include patients in the same treatment period, and a substantial portion of patients who were treated with a single morning dose of steroids had intratympanic steroid therapy simultaneously, they were excluded from analysis. Third, SSNHL patients who did not receive steroid treatment could not be included. There was no statistically significant difference between the values of post-treatment hearing threshold of the two groups; therefore, the result can be interpreted differently if other criteria of hearing recovery are used.The included patients had no serious side effect from the steroids; however, there were minor side effects, such as temporary elevation of blood pressure or blood sugar levels and gastrointestinal symptoms, in a few patients.This study suggests the advantage of a single-dose regimen compared to multiple divided doses in patients with SSNHL. It is meaningful in that few studies have researched this topic previously. Further studies are needed to evaluate whether either peak or mean concentration of a plasma steroid is effective for a better outcome of hearing in SSNHL, including the long-term side effects of steroids, when considering these limitationsWhen oral steroids are indicated for SSNHL, both a single dose and multiple divided doses can be effective and have comparable results. However, the single-dose regimen seems to be more efficacious than the divided-dose regimen in hearing recovery, even when considering the possibility of suppression of hypothalamic–pituitary–adrenal function.The authors declare no conflicts of interest.


Anopheles gambiae, revealed that the heart-associated hemocytes, called periostial hemocytes, express transglutaminases more highly than hemocytes elsewhere in the body. Here, we further queried the expression of these transglutaminase genes and examined whether they play a role in heart-associated immune responses. We found that, in the whole body, injury upregulates the expression of TGase2, whereas infection upregulates TGase1, TGase2 and TGase3. RNAi-based knockdown of TGase1 and TGase2 did not alter periostial hemocyte aggregation, but knockdown of TGase3 increased the number of periostial hemocytes during the early stages of infection and the sequestration of melanin by periostial hemocytes during the later stages of infection. In uninfected mosquitoes, knockdown of TGase3 also slightly reduced the number of sessile hemocytes outside of the periostial regions. Taken altogether, these data show that TGase3 negatively regulates periostial hemocyte aggregation, and we hypothesize that this occurs by negatively regulating the immune deficiency pathway and by altering hemocyte adhesion. In conclusion, TGase3 is involved in the functional integration between the immune and circulatory systems of mosquitoes.The immune and circulatory systems of insects are functionally integrated. Following infection, immune cells called hemocytes aggregate around the ostia  of the heart. An earlier RNA sequencing project in the African malaria mosquito,  The dorsal vessel is the primary circulatory organ that maintains hemolymph currents, and it extends the entire length of the body and is subdivided into an aorta in the thorax and a heart in the abdomen3. Contraction of the heart aspirates hemolymph into the lumen of the dorsal vessel via six pairs of abdominal ostia  and one pair of thoraco-abdominal ostia. These contractions then propel the hemolymph to the anterior and posterior ends of the body6.Pathogens often invade the hemocoel of a mosquito, but they are immediately confronted by two forces: hemolymph currents and immune responses7. In mosquitoes, three quarters of hemocytes circulate with the hemolymph whereas one quarter attaches to tissues and is sessile8. The distribution of sessile hemocytes is not homogenous. Many hemocytes aggregate in the areas surrounding the heart’s ostia, where they are called periostial hemocytes9. During an infection, periostial hemocytes sequester and kill pathogens that are about to be swept into the heart by the flow of hemolymph10. As this is happening, additional hemocytes aggregate at the periostial regions, which amplifies the pathogen killing response11. As a result, the most intense immune responses and the highest concentration of hemocytes coincide with the regions of the body that receive the most hemolymph flow11. Therefore, periostial hemocyte aggregation highlights the functional integration between the immune and circulatory systems12.The primary drivers of immune responses in the hemocoel are the hemocytes13. Despite its significance in insect immunity, the genetic factors that govern heart-associated immune responses remain largely unknown. Genes belonging to the Nimrod gene family–Eater and Draper–and the Thioester-containing protein gene family–TEP1, TEP3 and TEP4—regulate periostial hemocyte aggregation in the mosquito, Anopheles gambiae15. Moreover, the IMD and JNK pathways—two of the major innate immune signaling pathways—also positively regulate periostial hemocyte aggregation16. The latter study also discovered that the mRNA abundance of two of the three transglutaminase genes in A. gambiae—TGase1 and TGase3—is enriched in the periostial hemocytes of infected mosquitoes relative to the circulating hemocytes or the rest of the body16. Based on these data, we hypothesized that transglutaminases are also involved in heart-associated immune responses.The periostial response to infection is not restricted to mosquitoes. Infection induces hemocyte aggregation on the heart of insects from all major branches of the class Insecta, which illustrates the evolutionary conservation of this immune process19. Transglutaminases in Drosophila melanogaster perform pleiotropic functions, including cuticular morphogenesis, hemolymph coagulation, pathogen entrapment, and peritrophic matrix formation21. Transglutaminases in other arthropods have similar functions, and of interest to the present study is that they coagulate wounds in horseshoe crabs23 and crayfish25, and are involved in immune defenses against viruses, bacteria and fungi in shrimps27, crabs28 and termites30.Transglutaminases catalyze the formation of isopeptide bonds between glutamine and lysine residues, and are encoded in the genomes of bacteria, plants and animalsA. gambiae genome encodes three transglutaminase genes: TGase1, TGase2 and TGase331. The function of TGase1 remains unknown. However, TGase2 functions in the wound-induced antimalarial response33, and TGase3 cross-links seminal secretions to form a gelatinous mating plug that is transferred to the female during mating and is essential for sperm storage in the spermatheca35. Here, we investigated whether transglutaminases are involved in heart-associated immune responses. We show that TGase3—but not TGase1 or TGase2—negatively regulates periostial hemocyte aggregation during the early stages of infection, indicating that it plays a role in the functional integration between the mosquito immune and circulatory systems.The 16. This 4 h timepoint was selected because the number of periostial hemocytes approximately doubles within the first hour of infection, and plateaus by 4 h after infection9. Mining that RNAseq data uncovered that an infection with GFP-E. coli or S. aureus more highly upregulates the expression of TGase1 and TGase3 in periostial hemocytes than in other tissues , TGase2 (AGAP009098) and TGase3 (AGAP009099)—in the whole body of female mosquitoes that were naïve, injured, or had been infected with tetracycline resistant, GFP-expressing Escherichia coli (GFP-E. coli) for 4 or 24 h  and evaluated the number of periostial hemocytes before infection and at 4 and 24 h after GFP-E. coli infection. The RNAi-based knockdown efficiency for TGase1, TGase2 and TGase3 was 57%, 79% and 41%, respectively, compared to the control dsbla(ApR)-injected mosquitoes -injected mosquitoes, infection for 4 h increased the number of periostial hemocytes 2.8-fold relative to their naïve counterparts, and this number remained elevated at 24 h after infection  mosquitoes, indicating that knocking down these two genes does not affect periostial hemocyte aggregation. However, the number of periostial hemocytes at 4 h post-infection in dsTGase3 mosquitoes was 27% higher than in dsbla(ApR) mosquitoes, although this effect disappeared by 24 h.In ds11. Overall, these data show that TGase3 negatively regulates infection-induced periostial hemocyte aggregation during the early stages of infection but does not alter the proportional distribution of hemocytes amongst the different periostial regions.When the spatial distribution of hemocytes along the six periostial regions was assayed, there was no interaction between the type of dsRNA treatment and the proportional distribution of periostial hemocytes along the length of the abdomen  injection, knockdown of TGase3 reduced the number of non-periostial sessile hemocytes by 26% (P = 0.07), whereas knockdown of TGase1 or TGase2 had a minimal effect on the number of non-periostial hemocytes -injected mosquitoes and the dsTGase1-, dsTGase2- and dsTGase3-injected mosquitoes at both 4 and 24 h post-infection -injected mosquitoes  pathway and altering hemocyte adhesion  TGase3 is a negative regulator of periostial hemocyte aggregation, (ii) the IMD pathway is a positive regulator of periostial hemocyte aggregation, and (iii) transglutaminase inhibits the transcription factor that positively regulates the IMD pathway, we hypothesize that mosquito TGase3 negatively regulates periostial hemocyte aggregation by inhibiting the IMD pathway.In TGase3 also slightly reduced the number of sessile hemocytes in uninfected mosquitoes. A plausible explanation is that silencing TGase3 causes sessile hemocytes to detach from the abdominal wall, trachea and other tissues, thus forcing them into circulation. This would increase the number of circulating hemocytes, thereby making more of these cells available to aggregate in the periostial regions of infected mosquitoes. Whether TGase3 regulates hemocyte attachment in mosquitoes is unknown, but two human transglutaminase homologs—Factor XIII and tissue transglutaminase 2 (hTGase2)—are involved in cell-substrate binding50. Moreover, in a freshwater crayfish, transglutaminase is expressed in hematopoietic cells and functions to maintain hemocytes within the hematopoietic organ51. In another crustacean, the white shrimp, reducing transglutaminase expression increases the circulating hemocyte population, possibly because of the detachment of sessile hemocytes27. Overall, this suggests that reduced levels of transglutaminase are associated with the release of sessile hemocytes into circulation. This may explain why mosquitoes with silenced TGase3 tended to have fewer non-periostial, sessile hemocytes than mosquitoes with a natural amount of TGase3.Silencing TGase1 and TGase2 are not involved in periostial hemocyte aggregation. This was expected for TGase2 because it is involved in wound-induced immunity32, and injury does not induce periostial hemocyte aggregation11. However, we had hypothesized that TGase1 would be involved in periostial hemocyte aggregation. This was because infection upregulates the expression of both TGase1 and TGase3 more highly in the heart with periostial hemocytes than in other tissues16, but perhaps the lack of involvement of TGase1 in heart-associated immune responses is congruent with a previous study that found that TGase1 does not participate in the immune response against malaria parasites, at least in the gut32. However, it remains possible that TGase1 has an alternate function in periostial hemocytes or that TGase1 is involved in heart physiology; Drosophila transglutaminase is highly expressed in the ostia of the embryo and adults53.In this study, we found that TGase3 is a negative regulator of periostial hemocyte aggregation. Prior to this study, TGase3 was only known to be essential for the formation of the anopheline-specific mating plug31. A previous study suggested that TGase3 is expressed in the male accessory glands of A. gambiae, but that it is not expressed in female mosquitoes31. However, we previously detected TGase3 expression in the heart, periostial hemocytes and whole body of female mosquitoes by RNAseq16, and did so again here by quantitative RT-PCR and conventional RT-PCR. Because TGase3 is involved in periostial hemocyte aggregation it is possible that it may be involved in the immune response against malaria sporozoites. Sporozoites inside midgut oocysts are released into the hemocoel and passively migrate with the flow of hemolymph until they reach and invade the salivary glands54. Some of these sporozoites are captured and destroyed by periostial hemocytes10, and therefore, the role that TGase3 plays against the sporogonic stages of Plasmodium parasites should be investigated. Altogether, this suggests that the three transglutaminases in A. gambiae have different functions. Based on our limited knowledge of TGase1-3, we conclude that (i) TGase1 plays a lesser role or no role in immunity, (ii) TGase2 is involved in wound-related immunity, and (iii) TGase3 is involved in both mating biology and periostial hemocyte aggregation. Alternatively, a possible explanation for the lack of a phenotype in TGase1 or TGase2 RNAi mosquitoes is that the residual amount of protein that remained after partial RNAi-based silencing prevented us from observing a phenotype shift, or that there is a redundant mechanism involving TGase3. This would not be entirely surprising because our treatments were conducted four days after the onset of RNAi, and Drosophila transglutaminase can still be detected 12 days after the initiation of RNAi43.Here we show that TGase3 is involved in heart-associated immune responses. Based on what is already known about arthropod transglutaminases, we hypothesize that this occurs via two complementary mechanisms: (i) modification of the infection-induced activation of the IMD pathway and (ii) modulation of hemocyte adhesion. In conclusion, this study shows that a factor that is not classically associated with immunity or circulatory physiology is involved in the functional integration of the immune and circulatory systems of mosquitoes.Transglutaminases participate in many physiological processes. Here we show that Anopheles gambiae, Giles sensu stricto , were reared and maintained in an environmental chamber at 27 °C and 75% relative humidity, with a 12 h:12 h light:dark photoperiod4. Adults were fed 10% sucrose ad libitum, and only females were used for experimentation. GFP-E. coli (modified DH5α) were grown overnight in Luria–Bertani’s (LB) rich nutrient medium in a 37 °C shaking incubator . On average, 17,388 GFP-E. coli were injected into the thoracic anepisternal cleft using a Nanoject III Programmable Nanoliter Injector .E. coli. RNA was extracted and isolated from a pool of 10 whole-body mosquitoes at 4 and 24 h after treatment using TRIzol Reagent , and purified using the RNeasy Mini Kit . The concentration of RNA was quantified using a BioPhotometer Plus spectrophotometer , and up to 5 μg of RNA was treated with RQ1 RNase-free DNase . The extracted RNA was then used for cDNA synthesis using Oligo(dT)20 primers and the SuperScript III First-Strand Synthesis System for RT-PCR (Invitrogen).Six-day-old mosquitoes were cold-anesthetized and separated into three groups: (1) naïve (unmanipulated), (2) injured by injecting 69 nL of sterile LB medium, and (3) infected by injecting 69 nL of GFP--ΔΔCT method, with the housekeeping gene RpS7 as the reference gene and RpS17 as a control56. The mRNA fold change was relative to naïve mosquitoes at 4 h. Three independent trials were conducted, each with 2–3 technical replicates. The absence of genomic DNA in the cDNA preparations was confirmed by (i) conducting a melting curve analysis at the end of each qPCR run to show that there is only one peak, and (ii) testing each cDNA with primers that span an intron to show that only one amplicon that is of the predicted mRNA size amplified. Gene expression analyses for this study and for another recent study were conducted concurrently and using the same cDNAs, and hence, the RpS17 data are the same for both studies16.qPCR was conducted using cDNA as template, gene-specific primers  (beta-lactamase)—except that the template was DNA extracted from E. coli BL21(DE3) containing the pET-46 plasmid .Double-stranded RNA was synthesized for three mosquito genes—E. coli. An injury group  was not assayed because injury does not induce periostial hemocyte aggregation11. To assess RNAi efficiency, RNA was purified from whole bodies at 4 days after dsRNA injection, cDNA was synthesized, and qPCR was conducted with gene-specific primers (Supplementary Table bla(ApR) mosquitoes. For qPCR, three to four independent trials were conducted with two technical replicates each.Two-day-old female mosquitoes were injected with 300 ng of dsRNA. Four days later, mosquitoes were divided into two groups: (1) uninfected and (2) infected with GFP-9. Briefly, live mosquitoes were injected with ~ 0.4 μL of a solution consisting of 67 μM CM-DiI and 1.08 mM Hoechst 33342  in PBS. Mosquitoes were incubated in the environmental chamber for 20 min, and then fixed by injecting 16% paraformaldehyde into the hemocoel. Ten minutes later, a razor blade was used to separate the abdomen from the head and thorax, and to bisect the abdomen along a coronal plane such that the dorsal and ventral sides were separated. The dorsal abdomens were then immersed in PBS containing 0.1% Triton X-100 and the internal organs were removed. The dorsal abdomens—containing the heart, periostial hemocytes and pericardial cells—were rinsed briefly in PBS and mounted between a glass slide and a coverslip using Aqua-Poly/Mount .Hemocytes were stained in vivo using Vybrant CM-DiI Cell-Labeling Solution (Invitrogen) as we have previously describedE. coli) and blue fluorescence (nuclei) channels were acquired using a linear encoded Z-motor. For image presentation and pixel measurements, a specific channel (or channels) was (were) selected and all images within a stack were combined into a two-dimensional, focused image using the Extended Depth of Focus (EDF) function in NIS Elements.Each dorsal abdomen was imaged using a Nikon Eclipse Ni-E compound microscope connected to a Nikon Digital Sight DS-Qi1 monochrome digital camera and Nikon’s Advanced Research NIS Elements software . Z-stacks of bright-field, red fluorescence (hemocytes), green fluorescence  from background fluorescence intensity (pixel intensities below the threshold). Then, each of the periostial regions was delineated using the region of interest (ROI) tool in NIS Elements, and the sum binary area of pixels above the threshold was measured for each periostial region ROI. Each treatment group contained between 22 and 38 mosquitoes, which were assayed across 3–4 independent trials.GFP-11. Images were first examined to determine a threshold of pixel intensity that distinguished melanized areas (pixel intensities below the threshold) from non-melanized areas (pixel intensities above the threshold). Then, each periostial region was delineated using the ROI tool, and the sum binary area of pixels below the threshold was measured for each periostial region ROI. Each treatment group contained between 22 and 38 mosquitoes, which were assayed across 3–4 independent trials. Phagocytosis (GFP-E. coli) and melanization were quantified in the same mosquitoes (and ROIs).Dark melanin deposits in the periostial regions were quantified by measuring the area of pixels with intensities below a thresholdbla(ApR)-injected mosquitoes were used as the reference group. A two-way ANOVA yields three distinct P-values, which in the aggregation experiments examine: (1) whether dsRNA treatment affects the outcome, regardless of infection status; (2) whether infection status affects the outcome, regardless of dsRNA treatment; (3) whether the infection status has effects that depend on the dsRNA treatment, and vice versa. All data analysis was done in GraphPad Prism version 8.4.3, and differences were deemed significant at P < 0.05.Data on gene expression or the aggregation of hemocytes, pathogens or melanin were analyzed by two-way ANOVA, followed by Tukey’s or Dunn’s multiple comparison test. For aggregation, the dsSupplementary Information 1.Supplementary Information 2.


Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of dizziness; it constitutes the most common vestibular disorder in the elderly with vertigo. Its characteristic clinical aspect is dizziness at head movement, with not hearing alteration.This paper aims at studying the audiologic characteristics of elderly with BPPV of the posterior semicircular canal.We carried out a retrospective analysis of threshold tonal audiometry exams of 37 senior citizens with posterior semicircular canal BPPV and also of 37 elderly without complaints of dizziness and/or vertigo, and we studied the audiologic characteristics of the two groups.Both groups had high rates of hearing loss, especially the descending curve sensorineural type, and there was no statistically significant difference between the groups.Having such data, we can conclude that posterior semicircular canal BPPV has no impact on the hearing loss features of senior citizens; nonetheless, because of the spontaneous degeneration of the vestibulocochlear system, such population has a prevalence of hearing loss. Brazil is ceasing to be a country of young people. According to the Instituto Brasileiro de Geografia e Estatística ,Auditory and vestibular vulnerability increases with age, as function deteriorates in these systems.5Patients describe deafness as a decreased ability to hear, including difficulty to understand speech, intolerance to sound, pressure in the ear, distorted sound sensations, and attention deficit. Hearing loss may be conductive, sensorineural or both, ranging from mild to profound. It is common for elderly patients to become deaf due to inner ear or cochlear nerve injury, which characterizes sensorineural hearing loss.Sensorineural hypoacusis due to aging is named presbyacusis; it may be caused by noise exposure and senility. In some cases, presbyacusis may be associated with presbyvertigo, which consists of vertigo or dizziness with no apparent cause.Bodily balance results from stable acceleration between an individual and the surrounding environment, notwithstanding the various accelerations and velocities to which that individual is subjected. Various organs regulate bodily balance , interacting under cerebellar control.There is a close anatomical relation between auditory sensory organs and bodily balance in the labyrinth. The saccule (part of the vestibular system) is connected to the cochlear duct (part of the auditory system) by the ductus reuniensThe right and left vestibular systems send information about movement and position of the head to the central nervous system, which is then processed to adjust the body to a new situation. Information provided to the central nervous system needs to be harmonious and precise; any change in such information may alter the status of bodily balance, which might result, for instance in dizziness.Dizziness may be rotatory (vertigo) or non-rotatory . Vertigo is the most common form of dizziness;––Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common forms of dizziness.The typical presentation is dizziness or vertigo upon head movements. This clinical picture is usually the result of bending down, looking up, lying down or getting up from bed, and rolling on the bed.8Schuknecht in 1969 described the pathophysiology of cupulolithiasis. This theory states that otoliths become detached from the matrix of the utricle and adhere to the cupula of a semicircular canal, which then stops working as a liner acceleration transducer.This mechanical disease of the peripheral vestibular system affects mainly the posterior semicircular canal, although it may involve other canals simultaneously.Investigation of positional nystagmus aims to define the side and the canal that is involved; it also makes it possible to differentiate canaliculolithiasis from cupulolithiasis. This is important to define which rehabilitation exercises - an essential part of therapy - are appropriate for each case. Vestibular rehabilitation exercises and maneuvers in BPPV are specific for treating each canal.The purpose of this paper was to verify the audiological features of subjects aged 60 years or more with posterior canal BPPV, since aging may cause degeneration of auditory and vestibular sensory organs.The Research Ethics Committee of the institution approved this study (number 15037/2005).An analysis was made of 74 medical files of male and female patients aged 60 years or over. The files were provided by the Medical Archival System and separated into groups A and B:Group A: 37 files of patients with a medical otorhinolaryngological diagnosis of posterior canal BPPV.Group B: 37 files of patients with no dizziness and/or vertigo.Inclusion criteria:Age 60 years or above;Having undertaken pure tone audiometry;Intact tympanic membranes.Exclusion criteria:Age below 60 years;No pure tone audiometry;Presence of tympanic perforation.All data were analyzed and presented on tables. The SAS 9.0 software was used for the statistical analysis.Fisher's exact test was applied to analyze any correlation between the presence and absence of hearing loss in both groups and its features (type and configuration of hearing loss).The significance level as p < 0.05.There were 74 files in total, of which 37 files belonged to group A and 37 files to group B.The mean age of group A patients was 73.3 years, ranging from 62 to 87 years. The mean age of group B patients was 71.7 years, ranging from 60 to 91 years.Each ear was analyzed individually, given the type and configuration of hearing loss. In group A, we found that there was hearing loss in 70 ears (94.6%); there were 4 normal hearing ears in this group (5.4%). In group B, we found that there was hearing loss in 72 ears (97.3%); there were 2 normal hearing ears in this group (2.7%) .Table 1FThe audiometric tests for assessing hearing loss revealed that in group A, 54 ears (76.15%) had sensorineural hearing loss, 5 ears (7.14%) had conductive hearing loss, and 11 ears (15.71%) had mixed hearing loss. In group B, there were 64 ears (88.89%) with sensorineural hearing loss, 1 ear (1.39%) with conductive hearing loss, and 7 ears (9.72%)with mixed hearing loss .Table 2FThe configuration of hearing loss in group A patients was described as follows: there were 40 ears (57.14%) with a descending configuration, 10 ears (14.29%) with U-shaped hearing loss, 5 ears (7.14%) com a flat configuration, and 15 ears (21.43%) with other configurations. In group B, we found 47 ears (65.28%) with a descending configuration, 6 ears (8.33%) with a U-shaped hearing loss, 10 ears (13.89%) with a flat configuration, and 9 ears (12.50%) with other configurations .Table 3FOur aim was to analyze the audiological features of elderly patients with posterior canal BPPV, and to compare them with those of elderly patients with no complaints of dizziness and/or vertigo.We chose to classify hearing loss according to the configuration,Aging may cause vertigo and/or dizziness.Aging not only affects the vestibular system, but also causes changes in the auditory system; this may lead to sensorineural hypoacusis or presbyacusis.According to Ganança et al.,Sensorineural descending hearing loss is prevalent in elderly individuals; the threshold is decreased as age progresses.In Another study, 97.1% of a sample of elderly individuals with complaints of dizziness had sensorineural hearing loss, and 81.8% of this sample had descending hearing loss. This study also showed that the prevailing vestibular complaint was postural vertigo , which was encountered in 61.8% of the sample.Inherent degenerative processes may explain this type of hearing loss and the prevalence of BPPV in elderly individuals.We concluded in this study that we may not state with certainty that elderly individuals with a diagnosis of posterior canal BPPV have no auditory alterations, since the study sample was a geriatric population, in which degenerative processes that may alter the auditory and/or vestibular system - such as hearing loss and posterior canal BPPV - may occur.We concluded in this study that posterior canal BPPV does not affect the features of hearing loss in elderly subjects. We were unable to state, however, that elderly individuals with posterior canal BPPV have no hearing loss, since spontaneous degeneration of the vestibulocochlear system is inherent to all individuals aged 60 years or above.


There is inconclusive evidence whether osteoporosis increases risk of hearing loss in current literature.We conducted this meta-analysis to determine whether there is an association between hearing loss and osteoporosis.T-score of less than −2.5 standard deviation. The outcome was hearing loss as assessed by audiometry or self-reported assessment. Random-effects model and pooled hazard ratio, risk ratio, or odds ratio of hearing loss with 95% confidence intervals were compared between normal bone mineral density and low bone mineral density or osteoporosis.This systematic review and meta-analysis was conducted from studies of MEDLINE, EMBASE, and LILACS. Osteoporosis was defined as having a bone mineral density with a p = 0.04, I2 = 82%, Pheterogeneity = 0.01). However, the study from Helzner et al. reported significantly increase odds of hearing loss in the low bone mineral density in particular area and population included femoral neck of black men 1.37  and total hip of black men 1.36 .A total of 16 articles underwent full-length review. Overall, there was a statistically significant increased odds of hearing loss in the low bone mineral density or osteoporosis group with odds ratio of 1.20 (95% confidence intervals 1.01–1.42, Our study proposed the first meta-analysis that demonstrated a probable association between hearing loss and bone mineral density. Osteoporosis could be a risk factor in hearing loss and might play an important role in age-related hearing loss. Hearing loss is a common chronic condition of a disability estimated at 24.9 million people worldwide. It was reported by The World Health Organization as one of the leading causes of years lived with disability.10Osteoporosis has also been identified in some studies as a risk factor of hearing loss. The underlying mechanism of hearing loss in osteoporosis is complex and undetermined. Some studies purposed that a possible underlying mechanism is systemic demineralization of the skeletal system in osteoporosis includes temporal bone, which contains the cochlea capsule and the conductive system.This systematic review and meta-analysis was conducted and reported according to the Meta-analysis Of Observational Studies in Epidemiology statementTwo authors  independently searched published studies indexed in the MEDLINE, EMBASE, and LILACS (Literatura Latino Americana em Ciências da Saúde) from their date of inception to November 2015. References of all selected studies were also examined. The following main search terms were used: osteoporosis, osteopenia, bone density, bone mass, bone loss, hearing loss, audiometry, otoacoustic. The full search strategy was detailed in Articles were considered eligible for inclusion if the following criteria were met: (1) published observational studies including cross-sectional, cohort, and case–control studies; (2) study in adults age 18 years or older; (3) clear methods of assessment of bone mineral density and hearing status were described; (4) clear diagnostic criteria for osteoporosis and hearing loss were reported; and (5) association of low BMD or osteoporosis and hearing loss was reported as either adjusted or unadjusted hazard ratios (HRs), relative risks (RRs), or odds ratios (ORs) with associated 95% confidence intervals (CIs), or hearing sensitivity in decibels. Exclusion criteria were (1) reviews, case reports, abstracts, and unpublished studies, (2) studies without specific sample origins, (3) data in the study was not presented clearly enough, and (4) participants with known otosclerosis.T-score of less than −2.5 SD as measured by dual-energy X-ray absorptiometry or other standard technique at anatomical bone sites including lumbar spine, femoral neck, and total hip. The main outcome of this study was hearing loss as assessed by audiometry or self-reported assessment. We used the definition of hearing loss  as described by each study.Osteoporosis was defined as having a bone mineral density (BMD) with a Two authors (AS and SU) independently reviewed titles and abstracts of all citations that were identified. After all abstracts were reviewed, data comparisons between the two investigators were conducted to ensure completeness and reliability. The inclusion criteria were independently applied to all identified studies. Differing decisions were resolved by consensus.Full-text versions of potentially relevant papers identified in the initial screening were retrieved. If multiple articles from the same study were found, only the article with the most complete data was included. Data concerning study design, participant characteristics, source of data, comorbidities, methods of assessing BMD and hearing impairment, outcome assessment, and factors adjusted in multivariable analysis were independently extracted.A subjective assessment of methodological quality for observational studies was evaluated by two authors (AS and SU) using the Newcastle–Ottawa Scale (NOS). The NOS is a quality assessment tool for non-randomized studies. The NOS includes eight items, categorized into three dimensions of selection, comparability, and outcome. For each dimension, a list of response options is provided. Scoring is based on a semi-quantitative assessment of study quality. The highest quality studies are scored a maximum of one point for each item. However, there is an exception of the item related to comparability that allows the assignment of two points. The range of NOS is between zero up to nine points.I2 > 50%) and fixed-effects model if there was low heterogeneity (I2 < 50%). We calculated pooled HR, RR, or OR of hearing loss with 95% confidence intervals (CI) comparing between participants with normal BMD and with low BMD or osteoporosis at each anatomical site and with any anatomical sites. We also calculated pooled mean difference (MD) with 95% CI of hearing sensitivity in each frequency comparing between the normal BMD group and the low BMD group. We excluded studies from meta-analysis and only presented the result with narrative description when there were not sufficient comparable data available for outcome of interest. The heterogeneity of effect size estimates across these studies was quantified using the Q statistic, its p-value, and I2 (p < 0.10 was considered significant). Subgroup analysis by site of BMD was performed to find the source of heterogeneity. Publication bias was assessed using funnel plot and Egger's regression test.We performed meta-analysis of the included studies using Comprehensive Meta-Analysis 3.3 software from Biostat, Inc. We used a random-effects model if there was high heterogeneity . Sites of BMD measurement were femur, lumbar spine, head, and methods of assessing hearing status included audiometry, otoscopic examination, and self-reported. The characteristics of the eight extracted studies included in this review are outlined in The quality of nine cross-sectional, three cohort and, two case–control studies were evaluated by NOS . Total sp = 0.04, I2 = 82%, Pheterogeneity = 0.01) (p < 0.01), 4.50 , 2.08 , and 1.76 , respectively. However, the study from Helzner et al. reported significantly increased odds of hearing loss in the low BMD group, in particular the area and population included the femoral neck of black men 1.37  and total hip of black men 1.36 .Five studies  were included in the meta-analysis of hearing loss. There was a statistically significant increased odds of hearing loss in the low BMD or osteoporosis group with OR of 1.20  . The stuTo assess the stability of the results of the meta-analysis, we conducted a sensitivity analysis by excluding one study at a time. None of the results was significantly altered, indicating that our results were robust.p = 0.36). Using the trim and fill methods in the random-effects model, there was no difference of the imputed OR (1.38) and its 95% CI (1.08–1.7).To investigate potential publication bias, we examined the contour-enhanced funnel plot of the included studies in assessing change in log OR of hearing loss . The verSince the association between bone mass and hearing loss from previous studies are inconsistent, we conducted the first meta-analysis of the association between bone mineral density and hearing loss. According to our meta-analysis of 5 studies from different countries, age groups, genders and races, we found that a decrease in BMD or osteoporosis was significantly associated with hearing loss.Age related hearing loss or “presbycusis” is caused by multifactorial etiologies. A recent study purposed that demineralized petrous temporal bone in addition to age-related bone mass loss could be the cause of developing presbycusis.The etiology of Paget disease of the bone and otosclerosis share similar pathogenesis in the lateral wall of the cochlea, where the abnormal bone remodeling manipulates the change in ion and fluid hemostasis in perilymphatic space of the cochlea.Therefore, imbalance in bone formation and bone resorption from osteoporosis may play an important role in dysfunctional ionic metabolism leading to sensory neural hearing loss.Normally, BMDs at peripheral sites has a strong correlation with measurements at hip and spine. The correlation coefficients between peripheral sites and central sites is between 0.6 and 0.70 (25). However, some populations whose peripheral measurements are normal could have osteoporotic hip or spine; for example, the postmenopausal woman with significant osteoporotic risk factors.The limitations of our study include different hearing loss outcomes and different sites of BMD measurement from different studies. Hearing loss outcomes were determined in different aspects of measurement including audiometry and patient self-evaluation. Variation in the outcome of hearing loss could potentially alter the results and conclusion. Since different sites of BMD measurement may not be accurate as total BMD, the interpretation of our study may be limited.In conclusion, our study proposed the first meta-analysis that demonstrated a probable association between hearing loss and BMD. Osteoporosis could be a risk factor in hearing loss and might play an important role in age-related hearing loss.This article does not contain any studies with human participants or animals performed by any of the authors.The authors declare no conflicts of interest.


Listeners with normalhearing rated sounds without hearing devices. Hearing aid candidates ratedsounds while using one or two hearing aids. Bimodal cochlear-implant listenersrated sounds while using a hearing aid alone, a cochlear implant alone, or thehearing aid and cochlear implant simultaneously. Analysis revealed significantdifferences between groups in ratings of pleasant and unpleasant stimuli;ratings from hearing aid candidates and bimodal cochlear-implant listeners wereless extreme (less pleasant and less unpleasant) than were ratings fromlisteners with normal hearing. Hearing aid candidates’ ratings were similar withone and two hearing aids. Bimodal cochlear-implant listeners’ ratings of valencewere higher (more pleasant) in the configuration without a hearing aid (implantonly) than in the two configurations with a hearing aid . These data support the need for further investigation into hearingdevice optimization to improve emotional responses to non-speech sounds foradults with hearing loss.The purpose of this project was to evaluate differences between groups and deviceconfigurations for emotional responses to non-speech sounds. Three groups ofadults participated: 1) listeners with normal hearing with no history of deviceuse, 2) hearing aid candidates with or without hearing aid experience, and 3)bimodal cochlear-implant listeners with at least 6 months of implant use.Participants ( Permanent, bilateral hearing loss is associated with psychosocial consequences, suchas reduced quality of life , increasAdults who have hearing loss demonstrate deficits on emotion recognition tasks. Forexample, adults who have bilateral, mild to moderately-severe sensorineural hearingloss, traditionally considered hearing aid (HA) candidates, demonstrate poorerperformance on tasks of vocal emotion recognition compared to their peers withbetter hearing . These dRecognition of emotion in speech and music is not the only way emotion perceptionis important for typical functioning. An individual's responses to potentiallyemotional events  have pervasive impacts thatcan be measured in a variety of domains, but the effects are asymmetric.Aversive or unpleasant stimuli prepare a body to respond to negative events,facilitThe dimensional view of emotion provides a convenient framework for measuring theextent to which an individual is affected by stimuli by having them rate theirresponse to the stimulus along a combination of two or more dimensions e.g.,. Among tUsing ratings of valence and arousal , evidence suggests CI users demonstrate reduced ratings of arousalcompared to their peers with normal hearing . AlthougCompared to music and speech, relatively less is known about the effects ofhearing loss on emotional responses to non-speech sounds, especially sounds thatare commonly encountered . For non-speechsounds, level is also a robust cue for arousal ,althougAs with speech and music, emerging work suggests people with hearing lossdemonstrate different emotional responses to non-speech sounds than their peerswith normal hearing . For exaTo our knowledge, ratings of valence and arousal in response to non-speech soundsfor bimodal CI listeners have not been reported, nor have direct comparisonsbetween adults with normal hearing, adults who are HA candidates, and adults whoare CI users. Given the work in other areas of emotion perception, is expectedthat the effects of hearing loss on emotional responses to these everydaynon-speech sounds will be quite different for adults who are HA candidates  than foradults who use a HA in conjunction with a cochlear implant (CI) in the oppositeear . Moreover, given the potential for level andspectral cues to influence ratings of arousal and valence, it is also likelyassistive hearing device configuration might affect emotion perception forlisteners with hearing loss.It is not clear how to optimize assistive hearing device configurations foremotion perception. For hearing aid candidates, HAs can improve audibility andconsequently speech recognition . HoweverClinically, bilateral hearing aids are generally recommended for people withsymmetrical hearing loss  to evaluate the between-groupdifferences in emotional responses to non-speech sounds between listeners withnormal hearing, hearing aid candidates, and bimodal CI listeners and 2) toevaluate the effects of device configuration on emotional responses tonon-speech sounds. To evaluate the effects of group membership, three groups oflisteners were tested with a standard-of-care intervention . It was expected that, relative to their peerswith NH, both groups would demonstrate ratings of valence that were less extreme(less pleasant and less unpleasant), even while using assistive hearing devicetechnology, due to the continued difficulties with emotion perception adultsexhibit with hearing aids e.g.,  and cochThe second purpose was to evaluate the effect of device configuration. For HAcandidates, the configuration options were unilateral or bilateral HA fitting.Ideally, the range of emotional responses would be broadest under bilateral HAconditions, given the current clinical recommendations for bilateral fittings inmost cases e.g., . For bimParticipants were recruited through review of clinic records in the Department ofAudiology at Vanderbilt University Medical Center and through mass e-mailsolicitation to the Vanderbilt University Medical Center community. Three groupsof 18 adults participated: 1) listeners with NH, 2) HA candidates, and 3)bimodal CI listeners. TM), which resulted in occludingfittings for most participants. The HAs were programed for each participantaccording to prescriptive targets from the National Acoustic Laboratories –Nonlinear v 2 . The HAs were coupled using foam,non-custom eartips . The HA, fitted to thenon-implanted ear, was coupled with a custom, fully-occluding earmold madefor the purpose of this study, or with the participant's own,fully-occluding earmold if they used a custom mold regularly. Consistentwith the HA group, the advanced features on the HAs used for the bimodalgroup were deactivated, with the exception of feedback reduction. As withthe HA group, the microphone was set to be mildly directional. HA gain wasprogrammed and verified to match NAL-NL2 targets. Match to target was within10 dB 250–4000 Hz for 10 participants. For 8 participants, adequate gaincould not be achieved for 4000 Hz and real ear aided responses were morethan 10 dB below NAL-NL2 targets.n = 9) or a Cochlear (n = 9)implant. In all cases, their ‘Every day’ program was used during testing.Prior to testing, CI-aided thresholds were completed in the sound field towarbled pure tones. Thresholds were in the range of 20–30 dB HL from250–6000 Hz for most qualifying participants. Three participantsdemonstrated thresholds up to 40 dB HL.The bimodal CI listeners also used a CI. The CI map was not adjusted for thisstudy; their existing maps were used. Participants either used an AdvancedBionics  at the position of the participant's ear, without aparticipant in the room, was used to verify the level. Following informedconsent, participants completed the Hospital Anxiety and Depression Scale andthen underwent hearing evaluation  and HAfitting in a quiet, clinic-like environment. Then, they rated valence andarousal in a sound-attenuating audiometric test booth. Testing was blocked; theyrated valence and arousal in response to all 75 sounds in one condition beforeswitching conditions or taking a break. Within the condition, sounds in allthree categories were randomly presented. Participants with NH rated sounds inonly one condition (unaided). Participants who were HA users rated sounds in twoconditions . Participants who were bimodal CIlisteners rated sounds in three conditions . Forparticipants who completed more than one condition, their condition order wascounterbalanced. Breaks were provided as needed during testing.The participant was seated in the center of the audiometric booth(4.0 × 4.3 × 2.7 m) with a loudspeaker (Tannoy Series 600) placed 1.25 m infront of the participant. A computer monitor (21.5-in Dell S2240T) was placeddirectly below the loudspeaker and in front of the participant. During testing,the monitor displayed a small, black fixation cross on a white screen duringsound presentation. Immediately after the sound finished, the SAM stimuli forrating valence were displayed . Aparticipant then selected their rating of valence using a keypad .Then the SAM stimuli for rating arousal were displayed  and participants provided a rating of arousal. When theywere ready to advance, they would press ‘Enter’ and the next sound waspresented. The experimental timing and data collection were controlled usingPresentation  on an experimental computer (Dell)outside the test booth. The computer monitor inside the test booth displayed acloned image of the experimental computer monitor. From the experimentalcomputer, which stored the stimuli for testing, the sounds were routed to anaudiometer for level control (Madsen Orbiter 922 v.2), to an amplifier(Russound), and then to the loudspeaker.Prior to analysis, five participants were excluded. A computer error prohibitedresponses from one participant with NH  from being recorded.In the group of HA users, two participants  provided only one rating  in all conditions ratherthan two ratings . Also in the HA candidate group, oneparticipant provided a single rating in one condition . All three participants had no HA experience. In addition, oneparticipant in the bimodal listener group did not have data recorded due toexperimenter error in the “HA only” condition. Therefore, these participantswere excluded from further analysis.Scores for individual participants were calculated by taking the average ratingof valence or arousal in each stimulus category for each condition. Separatelinear effects models were constructed to address each of the research questionsregarding 1) hearing loss and 2) device configuration. To examine the effect ofthe hearing loss on emotion, the models of valence and arousal included a singlebetween-group factor  and onewithin-participant variable .Prior to analysis, the ratings of valence and arousal were z-score transformedfor each participant in the “maximum” device configuration  for the bimodal CI listeners). To examine the effect ofdevice configuration on emotional responses, the models of valence and arousalincluded two within-participant factors, stimulus category and deviceconfiguration. Separate linear mixed effects models were constructed for the HAcandidates  and bimodal CI listeners , each with participant as a random factor. Analysis of variance(ANOVA) was conducted on each linear model; significant main effects andinteractions were explored using pairwise comparisons of the estimated marginalmeans using Satterthwaite degrees of freedom and false discovery rate correction.lme4 package and a significant Group × Category interaction . The effect of Group alone wasnot significant . As a result of the significant Group × Categoryinteraction, the estimated marginal means were calculated on the full model toevaluate the effect of group membership for each category separately. Theresults, displayed in Transformed ratings of valence and arousal for the listeners with NH, HAcandidates, and bimodal CI listeners are displayed in F  = 4.02, p < 0.05) and asignificant Group × Category interaction . The effect of Group alone was not significant.Differences between groups were small and variable .The effect of Configuration  and the Configuration × Category interaction werenot significant. As expected, ratings in response to pleasant stimuli werehigher than in response to neutral stimuli  or unpleasantstimuli . In addition, ratings were lower in responseto unpleasant sounds than neutral ones . However, these resultsdemonstrate that ratings were similar with unilateral and bilateral HAs.Normalized, z-scored ratings of valence and arousal for the group of HAcandidates are displayed in F  = 16.68,p < 0.001) and non-significant effects of Condition andCategory × Condition . Pairwise comparison testing revealedratings of arousal were higher in response to the unpleasant stimuli than inresponse to the neutral stimuli  or the pleasant stimuli,whereas ratings were not different in response to neutral and pleasantstimuli .Ratings of arousal were similar with unilateral and bilateral HA fittings.Analysis of ratings of arousal also revealed only a significant main effectof Category  and Category,but no significant Configuration × Category interaction . Follow-up pairwise comparisontesting revealed that all categories were significantly different from eachother (p < 0.001). In addition, as displayed in Normalized, z-scored ratings of valence and arousal for the group of bimodalCI listeners are displayed in F  = 9.717,p < 0.001) and Category , but no significantConfiguration × Category interaction . Follow-up pairwise comparison testingrevealed that ratings of arousal were higher in response to pleasant stimulithan with neutral  or unpleasant  stimuli. Ratings of arousalwere not different in response to neutral or unpleasant stimuli. Inaddition, as displayed in Analysis of ratings of arousal revealed significant main effects ofConfiguration (p < 0.01)and positive correlations between degree of hearing loss and ratings of valencein response to unpleasant sounds (p < 0.01). Importantly,the pattern of results was the same for both device configurations. These data indicate that, regardless of device configuration,listeners with more hearing loss were more likely to rate valenced sounds asless extreme (less pleasant or less unpleasant) than listeners with betteracoustic hearing thresholds.To explore the relationship between degree of hearing loss on ratings of valence,exploratory correlation analyses were conducted between a participant's betterear, acoustic, pure-tone average  and ratings ofvalence, either with a minimal intervention  or witha maximum intervention . Mean scores in eachcondition/category combination were examined to preserve the data in theoriginal scale. Data from listeners with NH was always unaided. The results,displayed in The purpose of this project was two-fold: 1) to evaluate the between-groupdifferences in emotional responses to non-speech sounds between listeners withnormal hearing, hearing aid candidates, and bimodal cochlear-implant listeners and2) to evaluate the effects of device configuration on emotional responses tonon-speech sounds. Consistent with previous work , ratingsThe results of this study replicate those by ,demonstConsistent with existing literature with HA users , thesefNote that the relationships A secondary purpose of this study was to evaluate the potential for changingthe device configuration to affect emotional responses. The findings suggestthat, for HA candidates, using unilateral or bilateral HAs did not affectemotional responses. The results demonstrate that the second HA did notcontribute to ratings of valence or arousal for HA candidates. These datademonstrate that the clinical recommendation of fitting bilateral hearingaids for people with bilateral hearing loss is not contraindicated by theeffect of the number of devices on emotional responses. That is, the numberof hearing aids is irrelevant to the ratings of valence recorded in responseto non-speech sounds. In a recent study by To our knowledge, our data provide the first examination of bimodal CIlisteners’ emotional responses to emotional stimuli. Our data suggest thatbimodal stimulation interacts with emotional stimuli to affect the emotionalresponse in a manner that differs from emotion in response to music. In thecurrent study, ratings of valence were higher in configurations without aHA. That is, adding a HA to the contralateral ear of the CI participants didnot improve ratings of valence; instead, adding a HA to the non-implantedear had a negative effect on ratings of valence. These data were surprisingas they are inconsistent with the large body of evidence demonstratingbimodal benefit shown for speech recognition e.g., , perceptReasons for this discrepancy are unclear and could be related to how the twomodalities, acoustic and electric, might interfere with emotion. Some havesuggested that integration of acoustic-electric hearing may be better whencombined in the same ear as opposed to across ears for vowel recognition. Other sdecrease of important high-frequency information (viathe CI). Such a perceptual decrease of high-frequency information could beat least partly responsible for the reduced emotional responses in theCI + HA condition as demonstrated here, which would be consistent with thedocumented negative effects on emotional responses of increasing overallstimulus presentation level , adults with hearing lossdemonstrate a reduced range of valence ratings in response to non-speech sounds, asevidenced by less extreme ratings (less pleasant and less unpleasant) than theirsimilarly aged peers with normal hearing. Those with more significant acoustichearing loss were more likely to exhibit less extreme ratings of valence than werethose with better unaided acoustic thresholds. This finding has importantimplications for the psychosocial well-being of adults with hearing loss, whereemotional responses to sounds have been linked to isolation and loneliness ,stress