Archibald Hunter D, Ascha Mustafa, Gupta Amit, Megerian Cliff, Otteson Todd
Department of Otolaryngology, University Hospitals, Rainbow Babies and Children's Hospital and Case Western Reserve University, and Case Western Reserve University School of Medicine, USA.
Department of Otolaryngology, University Hospitals, Rainbow Babies and Children's Hospital and Case Western Reserve University, and Case Western Reserve University School of Medicine, USA.
Int J Pediatr Otorhinolaryngol. 2019 Mar;118:147-151. doi: 10.1016/j.ijporl.2018.12.023. Epub 2018 Dec 19.
To investigate any meaningful differences in hearing between patients with unilateral and bilateral enlarged vestibular aqueduct (EVA). EVA is a common radiological finding in children presenting with hearing loss. We hope to provide insight into the pathogenesis of EVA and provide further guidelines for unilateral EVA management. We hypothesized that hearing loss in unilateral EVA would be similar to that seen in bilateral EVA.
A longitudinal retrospective study design was used. Three measures of hearing, pure tone average (PTA) word recognition score (WRS) and speech awareness threshold (SAT) and radiologic morphologies were tested for difference across unilateral versus bilateral ear EVA status. Linear mixed effects models were used to identify differences while accounting for time and multiple measurements per ear.
Using Cincinnati criteria, 89 ears fit inclusion criteria, 75 of which were from patients with bilateral EVA compared to 14 ears from patients with unilateral EVA. No significant differences across bilateral status were observed in audiological measurements. Models showed that speech recognition threshold (SRT) (p = 0.925), word recognition score (WRS)(p = 0.521) and pure tone average (PTA) of air and bone conduction from 250 to 4000 Hz (p = 0.281-0.933) were not statistically different with respect to bilateral status. Wilcoxon rank-sum tests showed no statistical difference in vestibular aqueduct width or operculum size (VA)(p = 0.234, p = 0.623). Each year after the first audiogram was associated with significantly greater SRT (p = 0.003) decreased WRS (0.014) and increased PTA (0.003.). Greater midpoint width was associated with significantly lower SRT (p = 0.004) WRS (<0.001) and PTA (<0.001.) CONCLUSION: Our results indicate no statistically significant difference in hearing ability with respect to bilateral EVA status, suggesting that unilateral EVA patients require close follow-up. Our results also demonstrate the progressive nature of EVA and a relationship between VA midpoint width and hearing loss severity.
研究单侧和双侧大前庭导水管（EVA）患者在听力方面是否存在任何有意义的差异。EVA是听力损失儿童中常见的影像学表现。我们希望深入了解EVA的发病机制，并为单侧EVA的治疗提供进一步的指导方针。我们假设单侧EVA的听力损失与双侧EVA相似。
采用纵向回顾性研究设计。对听力的三项指标，即纯音平均听阈（PTA）、单词识别得分（WRS）和言语察觉阈（SAT）以及放射学形态进行检测，以比较单侧与双侧耳朵EVA状态的差异。使用线性混合效应模型来识别差异，同时考虑时间和每只耳朵的多次测量。
根据辛辛那提标准，89只耳朵符合纳入标准，其中75只来自双侧EVA患者，14只来自单侧EVA患者。在听力学测量中，未观察到双侧状态之间的显著差异。模型显示，言语识别阈（SRT）（p = 0.925）、单词识别得分（WRS）（p = 0.521）以及250至4000赫兹气导和骨导的纯音平均听阈（PTA）（p = 0.281 - 0.933）在双侧状态方面无统计学差异。Wilcoxon秩和检验显示前庭导水管宽度或骨盖大小（VA）无统计学差异（p = 0.234，p = 0.623）。首次听力图检查后的每一年，SRT显著升高（p = 0.003），WRS降低（0.014），PTA升高（0.003）。更大的中点宽度与显著更低的SRT（p = 0.004）、WRS（<0.001）和PTA（<0.001）相关。结论：我们的结果表明，双侧EVA状态在听力能力方面无统计学显著差异，这表明单侧EVA患者需要密切随访。我们的结果还证明了EVA的进展性以及VA中点宽度与听力损失严重程度之间的关系。
