Acute sialadenitis may be caused by viruses, including coronaviruses. Although there are anecdotal reports of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) salivary gland infections, ...there have been no well‐documented cases of sialadenitis in patients with COVID‐19 described in the literature. We report a case of parotitis and submandibular gland sialadenitis, as well as an isolated case of parotitis, in two patients with concurrent SARS‐CoV‐2 infections. Computed tomography imaging demonstrated parotid and submandibular gland enlargement with heterogenous enhancement and attenuation, consistent with sialadenitis. Medical management was sufficient for successful resolution of the acute sialadenitis. Laryngoscope, 130:2595–2597, 2020
Abstract
Age-related hearing loss (ARHL) has been connected to both cognitive decline and late-life depression. Several mechanisms have been offered to explain both individual links. Causal and ...common mechanisms have been theorized for the relationship between ARHL and impaired cognition, including dementia. The causal mechanisms include increased cognitive load, social isolation, and structural brain changes. Common mechanisms include neurovascular disease as well as other known or as-yet undiscovered neuropathologic processes. Behavioral mechanisms have been used to explain the potentially causal association of ARHL with depression. Behavioral mechanisms include social isolation, loneliness, as well as decreased mobility and impairments of activities of daily living, all of which can increase the risk of depression. The mechanisms underlying the associations between hearing loss and impaired cognition, as well as hearing loss and depression, are likely not mutually exclusive. ARHL may contribute to both impaired cognition and depression through overlapping mechanisms. Furthermore, ARHL may contribute to impaired cognition which may, in turn, contribute to depression. Because ARHL is highly prevalent and greatly undertreated, targeting this condition is an appealing and potentially influential strategy to reduce the risk of developing two potentially devastating diseases of later life. However, further studies are necessary to elucidate the mechanistic relationship between ARHL, depression, and impaired cognition.
To examine the longitudinal association between subclinical hearing loss (SCHL) and neurocognitive performance.
Longitudinal analyses were conducted among 2,110 subjects who underwent audiometric ...testing in a US multi-centered epidemiologic cohort study. The primary exposure was better ear hearing (pure tone average). SCHL was defined as hearing ≤ 25 dB. The primary outcome was neurocognitive performance, measured by Digit Symbol Substitution Test (DSST), Modified Mini Mental State Examination (3MS), and CLOX1. Linear mixed models were performed to assess the longitudinal association between hearing and cognitive performance, adjusting for covariates. Models were fit among all individuals and among individuals with SCHL only.
Among 2,110 participants, mean (SD) age was 73.5 (2.9) years; 52.3% were women. Mean (SD) better ear pure tone average was 30.0 (13.1) dB. Mean follow-up was 9.1 years (range 3-16). Among all participants, worse hearing was associated with significantly steeper cognitive decline measured by the DSST 0.054-point/year steeper decrease per 10 dB worse hearing, 95% confidence interval (CI): 0.026-0.082 and 3MS (0.044-point/year steeper decrease per 10 dB worse hearing, CI: 0.026-0.062), but not CLOX1. Among those with SCHL, worse hearing was associated with significantly steeper cognitive performance decline as measured by DSST (0.121-point/year steeper decrease per 10 dB worse hearing, CI: 0.013-0.228), but not CLOX1 or 3MS.
Among those with SCHL, worse hearing was associated with steeper cognitive performance declines over time as measured by DSST. The relationship between hearing loss and cognition may begin at earlier levels of hearing loss than previously recognized.
Objective Although speech recognition among cochlear implant (CI) users improved over the past few decades, many still report poor speech quality. Currently, there is no validated tool to measure ...speech quality. The objective was to examine whether a previously validated speech quality tool is applicable in the CI population using psychometric analysis. Design Cross-sectional psychometric analysis of the Columbia Speech Quality Instrument (CSQI; previously validated in normal-hearing individuals; consists of 2 original and 7 manipulated speech clips designed to accentuate selected speech characteristics) was performed in adult English-speaking CI recipients ( N = 36). Subjects rated each clip using a visual analog scale (VAS) on 14 characteristics: cartoonish/not-cartoonish, clear/unclear, like/dislike, breathy/not-breathy, smooth/rough, echo-y/not-echo-y, tinny/bassy, soothing/not-soothing, natural/unnatural, mechanical/not-mechanical, hoarse/smooth, pleasant/unpleasant, male/female, and speech-like/not-speech-like. Main outcome measures included validity, reliability, and factor structure. Results Content validity was previously confirmed during instrument design. Construct validity by item-item correlation analysis demonstrated correlation of 12/14 items with ≥1 other retained item ( r ≥ 0.35, Spearman). Reliability was confirmed by internal consistency; factor analysis using two subsets selected by Scree plot and factor loading ≥0.4 demonstrated Cronbach alpha coefficients of 0.89 and 0.74 for factors 1 and 2, respectively. Tinny/bassy and male/female were the only characteristics that did not pass construct validity or internal consistency. Conclusions The CSQI has strong psychometric properties in the CI population; however, our findings support removal of tinny/bass and male/female characteristics from the final instrument prior to implementation in the CI population. The CSQI can be utilized in cochlear implantees to investigate effects of changes in speech processing strategies and postoperative outcomes with different devices.
Background: Transcanal endoscopic ear surgery (TEES) avoids a postauricular incision, which has been shown to minimize pain and numbness. Our objective is to assess how much patients value minimizing ...pain and numbness relative to other postoperative otologic outcomes. Methods: Cross-sectional anonymous surveys were distributed to otolaryngology clinic patients in a tertiary care center. Patients were instructed to rate how much they value various outcomes when undergoing hypothetical ear surgery on a scale of 0 (not important) to 10 (very important). Results: 102 patients responded. Ten percent of survey respondents were Spanish-speaking. Outcomes of the highest importance included hearing (mean 9.3; SD 1.9), staff friendliness (8.9; 1.8), numbness (8.3; 2.4), and pain (8.1; 2.5). Outcomes of moderate importance included time spent under anesthesia (7.0; 3.2), scar visibility (6.3; 3.5), incision size (5.5; 3.4), incision hidden in the ear canal (5.4, 3.9), and surgery cost to the hospital (5.1; 3.9). In linear regression analysis, increasing age was associated with decreased value placed on incision size (p < 0.001) and scar visibility (p < 0.001). Conclusion: Patients placed a high value on minimizing pain and numbness after ear surgery, nearly as much as a good hearing outcome. These patient-centric outcomes are important in justifying the minimally invasive approach of TEES.
Age-related Hearing Loss and Dementia Chern, Alexander; Golub, Justin S
Alzheimer disease and associated disorders,
2019-July–September, Volume:
33, Issue:
3
Journal Article
Open access
Dementia is a devastating disease and global health challenge that is highly prevalent worldwide. A growing body of research has shown an independent association between age-related hearing loss ...(ARHL) and dementia, identifying ARHL as a compelling potential target in preventive strategies for dementia. However, a causal linkage between ARHL and dementia needs to be investigated before making definitive clinical guidelines and treatment recommendations regarding ARHL as a modifiable risk factor. In this review, we discuss the association between ARHL and dementia, the importance of addressing this finding, as well as common mechanisms (eg, microvascular disease) and causal mechanisms (eg, depletion of cognitive reserve and social isolation) that may explain the nature of this relationship. Future directions for research are also highlighted, including randomized controlled trials, developing high-resolution microvascular imaging, and further refining audiometric testing.
Abstract In an era of concern over the rising cost of health care, cost-effectiveness of auxiliary services merits careful evaluation. We compared costs and benefits of Helicopter Emergency Medical ...Service (HEMS) with Ground Emergency Medical Service (GEMS) in patients with an isolated ankle fracture. A medical record review was conducted for patients with an isolated ankle fracture who had been transported to a level 1 trauma center by either HEMS or GEMS from January 1, 2000 to December 31, 2010. We abstracted demographic data, fracture grade, complications, and transportation mode. Transportation costs were obtained by examining medical center financial records. A total of 303 patients was included in the analysis. Of 87 (28.71%) HEMS patients, 53 (60.92%) had sustained closed injuries and 34 (39.08%) had open injuries. Of the 216 (71.29%) GEMS patients, 156 (72.22%) had closed injuries and 60 (27.78%) had open injuries. No significant difference was seen between the groups regarding the percentage of patients with open fractures or the grade of the open fracture ( p = .07). No significant difference in the rate of complications was found between the 2 groups ( p = 18). The mean baseline cost to transport a patient via HEMS was $10,220 + a $108/mile surcharge, whereas the mean transport cost using GEMS was $976 per patient + $16/mile. Because the HEMS mode of emergency transport did not significantly improve patient outcomes, health systems should reconsider the use of HEMS for patients with isolated ankle fractures.
To describe a case of bilateral sudden sensorineural hearing loss (SSNHL) and intralabyrinthine hemorrhage in a patient with COVID-19.
Clinical capsule report.
Tertiary academic referral center.
An ...adult woman with bilateral SSNHL, aural fullness, and vertigo with documented SARS-CoV-2 infection (IgG serology testing).
High-dose oral prednisone with taper, intratympanic dexamethasone.
Audiometric testing, MRI of the internal auditory canal with and without contrast.
A patient presented with bilateral SSNHL, bilateral aural fullness, and vertigo. Serology testing performed several weeks after onset of symptoms was positive for IgG COVID-19 antibodies. MRI showed bilateral intralabyrinthine hemorrhage (left worse than right) and no tumor. The patient was treated with two courses of high-dose oral prednisone with taper and a left intratympanic dexamethasone injection, resulting in near-resolution of vestibular symptoms, a fluctuating sensorineural hearing loss in the right ear, and a severe to profound mixed hearing loss in the left ear.
COVID-19 may have otologic manifestations including sudden SSNHL, aural fullness, vertigo, and intralabyrinthine hemorrhage.
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