OTOLOGY – NEUROTOLOGY

Background: The ability to hear significantly impacts a child’s learning experience. The prevalence of hearing loss among children in the U. S. has increased according to a recent analysis of NHANES data. Hearing is routinely screened in U.S. elementary schools and may be mandated by State law, as is the case in Illinois, but only at a limited range of pitches in many states. Despite the rise in prevalence of hearing loss in children, there is relatively little existing literature examining data collected by school-based hearing screening programs.

The Chicago Public Schools screen the hearing of all their general education students in Pre-Kindergarten, kindergarten, 1st and 3rd grades, students in special education, teacher referrals, and students new to CPS. Despite the screening initiative, on average less than 7% of students found to have a hearing problem are seen for follow-up care or received hearing intervention. The reasons for this are not well understood.

Objectives: The purpose of this study is to determine: 1) the reasons why students fail to pursue follow-up hearing care following a screening failure, 2) what type of hearing care they are receiving, if any, 3) which groups, based on ethnicity, socioeconomic status (zip codes), geographic locations, type and degree of hearing loss are more apt to avoid follow-up intervention, 4) what are the outcomes following treatment, 5) how has treatment, or the lack of treatment affected students’ academic and personal outcomes/performance

Background: Middle ear disease and otosclerosis (OS) are a common cause of progressive hearing loss. A positive family history and classic audiogram findings are normally used to diagnose otosclerosis (OS). The findings are later confirmed intraoperatively. Imaging with Computed Tomography (CT) is becoming more popular preoperatively in order to confirm a diagnosis and aid in preoperative planning. OS and ossicular abnormalities have been found difficult to diagnose on CTs, even with high resolution, thin cut protocols. Studies report a sensitivity ranging from 45-95% for diagnosing OS with CTs. One study reported a neuro-radiologist identifying 100% of patients with diagnosis of OS, while a general radiologist could only identify 30-40% of patients with OS, signifying that specialty training is highly beneficial.

In an effort to further investigate the true diagnostic accuracy of fine cut CT imaging to diagnose OS and ossicular abnormalities, this study is designed to have a single neuro-radiologist review head and neck CT imaging of subjects with either OS, ossicular abnormalities, or normal middle ears. The physician will describe how they came to the provided diagnosis, and how confident they are in their diagnosis.

Objectives: The purpose of this research is to determine the effectiveness of using thin cut, high resolutions CT scans for the diagnosis of middle ear status. The study will involve a single, blinded neuro-radiologist in diagnosing ossicular abnormalities and OS using preoperative fine-cut CT imaging. The study will in include both a control group and a test group in order to obtain more powerful data.

Background: Meniere’s disease is very well described disease of the inner ear. The experienced Otologist easily recognizes classic Meniere’s disease. Patients with Meniere's disease experience episodes of discomfort which last between one and twenty-four hours. The classic Meniere’s episode consists of unilateral ear pressure, tinnitus in the affected ear, and a spinning sensation. Usually the patient’s balance is disrupted to the point that they need to lie down, and often they are nauseated to the point of vomiting. Audiometric hearing testing shows that during a Meniere's episode, the ability to hear low-pitched noise is temporarily worsened.

Hearing after a Meniere's episode may or may not return to pre-episode hearing ability. This pattern repeats itself many times in a patient’s life. Variants of Meniere’s disease can involve the vestibular symptoms without tinnitus or tinnitus without vestibular symptoms, but these manifestations can be difficult to establish as true Meniere’s disease in an individual. While patients with Meniere's symptoms are easily diagnosed by Otologists, the overall effect of Meniere's disease on patient’s day to day life and self-image is poorly understood and has yet to be explored. This study is being conducted on three continents using an extensive questionnaire to capture the Meniere’s patient experience.

Objectives: The aims of the research are to: 1) learn directly from affected patients how Meniere's disease affects their life, 2) determine if patients from different cultures and different environmental/living conditions experience Meniere's disease differently, and 3) share the findings of this research to help health care professionals better understand and care for patients with Meniere's disease. We expect, that independent of a Meniere's patients’ environmental/living circumstances or culture, patients will describe similar life experiences and perceptions resulting from their disease.

Background: Eustachian tube (ET) dilation to improve middle ear ventilation has been practiced in Europe for several years. ET dilation is also now an approved medical procedure in the United States as well. To date, there have been no clinical complications reported in humans, and research involving cadaveric models have reported no issues of trauma or tissue damage to adjacent vital structures. Despite the reported safety in adults and children, otolaryngologists remain concerned about potential complications involved with the procedure, particularly any possible disruption of the adjacent carotid artery.

This retrospective study evaluates the anatomical orientation of the eustachian tube relative to the carotid artery in adult subjects. Three-dimentional remodeling of head and neck CT scans will be used for anatomical evaluation

Objectives: The objective of the study is to use 3-demensional CT scans to show that the eustachian tube and the carotid artery are not adjacent structures and that the two structures do not run in parallel to each other.

Background: Communication serves as a central component to patient safety and efficiency in the operating room. Sentinel event data from The Joint Commission in 2013 identified failures of communication during surgery as one of the leading root causes of error and poor patient outcomes. Recent research on hearing-critical jobs has advocated for functional hearing assessment procedures that take into account the specific noise environment of a job. This recommendation centers on the fact that speech recognition depends largely on the particular qualities of the background noise and is not accurately predicted by pure tone audiograms.

Given the evidence of potentially high noise levels in the operating room and the essential nature for effective communication in this setting, research is needed to investigate the perceptions of operating room personnel on their ability to communicate. This research could guide further investigation into auditory fitness for duty standards and evaluate whether noise reduction techniques should be employed in the operating room.

Objectives: The objectives of this study are to determine: 1) If operating room personnel perceive and/or realize that they are having difficulty hearing and communicating in the operating room due to occupational noise, 2) If the difficulty in communication is a hindrance and an issue of patient safety, and 3) What is the average noise exposure (dB and time exposed) for operating room personnel during various operating room cases

Background: Children born with severe to profound sensorineural hearing loss face challenges in a world built around spoken language communications. Hearing loss often has a significant impact on educational progress through the school age years, which later affect their ability for employment. These children and their families have two options: total communications with signing and speech therapy, or cochlear implantation, a surgical procedure where a device is implanted that raises the possibility of hearing restoration. In order for a cochlear implant patient to get the best result from the procedure, it is necessary for the recipient to have extensive testing before surgery, as well as consistent follow-up appointments with both an audiologist and a speech and language pathologist after surgery. Failure to comply with post-operative appointments and therapies can result in the patient eventually becoming a non-user of the implant.

Families coming from challenged social and economic backgrounds have difficulty with managing the appointments and therapies necessary for cochlear implant recipients. When a family fails to support their child in this effort clinicians are faced with a dilemma as to how best to help these families. One option available to medical professionals is to report the family to the Illinois Department of Children and Family services. Clinicians feel very conflicted about doing this for fear of alienating the family. Also, it is unclear if this action helps improve compliance with therapy and outcomes in cochlear implantation. The goal of our research is to review 3 cases where DCFS advocated on behalf of a minor with severe hearing loss

Objectives: The purpose of this study is to review 3 cases of pediatric cochlear implantation where the Illinois Department of Children and Family Services advocated on behalf of the child to determine 1) the effect of DCFS involvement on hearing outcomes, 2) adherence to appointments, and 3) compliance with therapy

Background: Ear infections can be caused by either bacteria or viruses and often involve fluid accumulation in the middle ear. Chronic ear infections can cause hearing loss and other serious complications if left untreated. Middle ear infections may resolve on their own without treatment, however, this is not always the case. Infections that do not resolve on their own are often treated with antibiotics, placement of tympanostomy tubes, and/or other methods in order to resolve the infection and inflammation in the ear and the surrounding tissues, including the eustachian tubes (ET).

During an illness, specifically an upper respiratory illness such as a cold or flu, the tissues lining the eustachian tube may swell impeding or blocking the drainage of serous fluid that settles in the middle ear. Over time the trapped fluid may result in a middle ear infection. Ear infections with effusion, if left untreated can lead to tympanic membrane perforation, advancing infection to surrounding tissues and bone, and damage to the ossicles of the middle ear resulting in various levels of hearing loss.

Objectives: The purpose of this research is to evaluate the effectiveness of cartilage-cuffed tympanostomy tubes when used for 1) the treatment of chronic middle ear disease in patients with a diagnosed eustachian tube dysfunction. It is generally accepted that T-tube placement is an affordable and easily reproducible surgical technique that offers significant benefit for a select group of patients

Background: Hearing loss is a significant health burden in the United States with approximately 15% of American adults (18 years old and greater) reporting at least some trouble hearing. Sensorineural hearing loss is also the third leading cause of disability worldwide. Cochlear implants are often the best treatment for this disability. Determining cochlear implant candidacy involves both audiogram testing and AzBio Sentence testing. Currently there are suggested guidelines for cochlear implant candidacy based on audiogram results, however, the medical literature does not contain any studies evaluating the relationship of audiogram results to AzBio Sentence scores.

Objectives: The aim of this study is to objectively determine the relationship between various audiogram parameters and AzBio Sentence scores in order to determine the best predictors for cochlear implant candidacy. Establishing a relationship between the two testing methods may 1) improve the cochlear candidacy referral process while 2) decreasing time and cost associated with testing poor candidates. The end result may aid in improving referrals of appropriate candidates for CI evaluation as well as cut down on time and cost of testing poor candidates.