Publications by authors named "Antti Aarnisalo"

66 Publications

MANF supports the inner hair cell synapse and the outer hair cell stereocilia bundle in the cochlea.

Life Sci Alliance 2022 Feb 23;5(2). Epub 2021 Nov 23.

Molecular and Integrative Biosciences Research Programme, University of Helsinki, Helsinki, Finland

Failure in the structural maintenance of the hair cell stereocilia bundle and ribbon synapse causes hearing loss. Here, we have studied how ER stress elicits hair cell pathology, using mouse models with inactivation of (mesencephalic astrocyte-derived neurotrophic factor), encoding an ER-homeostasis-promoting protein. From hearing onset, deficiency caused disarray of the outer hair cell stereocilia bundle and reduced cochlear sound amplification capability throughout the tonotopic axis. In high-frequency outer hair cells, the pathology ended in molecular changes in the stereocilia taper region and in strong stereocilia fusion. In high-frequency inner hair cells, deficiency degraded ribbon synapses. The altered phenotype strongly depended on the mouse genetic background. Altogether, the failure in the ER homeostasis maintenance induced early-onset stereociliopathy and synaptopathy and accelerated the effect of genetic causes driving age-related hearing loss. Correspondingly, mutation in a human patient induced severe sensorineural hearing loss from a young age onward. Thus, we present MANF as a novel protein and ER stress as a mechanism that regulate auditory hair cell maintenance in both mice and humans.
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http://dx.doi.org/10.26508/lsa.202101068DOI Listing
February 2022

Spoken Language Skills in Children With Bilateral Hearing Aids or Bilateral Cochlear Implants at the Age of Three Years.

Ear Hear 2021 Jul 13. Epub 2021 Jul 13.

Research Unit of Logopedics and Child Language Research Center, University of Oulu, Oulu, Finland University of Helsinki, Helsinki, Finland Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, Finland Department of Otorhinolaryngology-Head and Neck Surgery, Kuopio University Hospital, Kuopio, Finland Department of Otorhinolaryngology-Head and Neck Surgery, Oulu University Hospital, Oulu, Finland Department of Otorhinolaryngology-Head and Neck Surgery, Tampere University Hospital, Tampere, Finland Department of Otorhinolaryngology-Head and Neck Surgery, Turku University Hospital, Turku, Finland Department of Otorhinolaryngology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.

Objectives: Early hearing aid (HA) fitting and cochlear implants (CIs) aim to reduce the effects of hearing loss (HL) on spoken language development. The goals of this study were (1) to examine spoken language skills of children with bilateral HAs and children with bilateral CIs; (2) to compare their language skills to the age-norms of peers with normal hearing (NH); and (3) to investigate factors associated with spoken language outcomes.

Design: Spoken language results of 56 Finnish children with HL were obtained from a nationwide prospective multicenter study. Children with HL comprised two groups: children with mild-to-severe HL who used bilateral HAs (BiHA group, n = 28) and children with profound HL who used bilateral CIs (BiCI group, n = 28). Children's spoken language comprehension, expressive and receptive vocabulary, and phonological skills were compared with normative values of children with NH at the age of three years. Odds ratio (OR) was calculated to compare proportions of children below age-norms in BiHA and BiCI groups. Factors associated with spoken language outcomes were modeled with analysis of covariance.

Results: At the age of 3 years, 50%-96% of children with HL performed 1 SD or more below the mean of the normative sample of age-peers with NH in spoken language skills, depending on the language domain. Receptive vocabulary and phonological skills were the most vulnerable language domains. In receptive vocabulary, 82% of the children in the BiHA group and 50% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 4.4 times more likely to have poorer receptive vocabulary than the BiCI group. In phonological skills, 96% of children in the BiHA group and 60% of the children in the BiCI group scored 1 SD or more below the normative mean. The BiHA group was 18.0 times more likely to have poorer phonological skills than the BiCI group. The analysis of covariance models showed that unaided pure-tone average, PTA0.5-4 kHz, had a significant effect on spoken language comprehension in the BiHA group. For the BiCI group, age at HL diagnosis and age at CI activation had a significant effect on expressive vocabulary. High maternal level of education had a significant effect on language comprehension and expressive vocabulary and female gender on phonological skills.

Conclusions: At the age of 3 years, especially receptive vocabulary and phonological skills caused difficulties for children with HL showing also considerable individual variation. Children with bilateral HAs seemed to be more likely to have poorer receptive vocabulary and phonological skills than children with bilateral CIs. A variety of factors was associated with outcomes in both groups. Close monitoring of spoken language skills of children with HL is important for ensuring similar opportunities for all children with HL and timely intervention, when needed.
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http://dx.doi.org/10.1097/AUD.0000000000001092DOI Listing
July 2021

Development of otology specific outcome measure: Ear Outcome Survey-16 (EOS-16).

J Otol 2021 Jul 20;16(3):150-157. Epub 2021 Jan 20.

Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Purpose: An important outcome measure of patient care is the impact on the patient's health-related quality of life (HRQoL). Current ear-specific HRQoL instruments are designed for one diagnosis and emphasize different subdivisions such as symptoms, hearing problems, psychosocial impact, and the need for care. The optimal length of the recall period has not been studied. For these reasons, a new survey is needed that would cover most chronic ear diseases.

Methods: A preliminary 24-item survey (EOS-24) was created. Untreated adult patients (included n = 186) with one of seven different chronic otologic conditions from all university hospitals in Finland were recruited to respond to EOS-24 and the 15D general HRQoL instrument. The recruiting otologists evaluated the severity of the disease and the disability caused by it. A control group was recruited. Based on the patients' responses in different diagnosis groups, the items were reduced according to pre-defined criteria. The resulting survey was validated using a thorough statistical analysis.

Results: The relevance and necessity of the original 24 items were thoroughly investigated, leading to the exclusion of 8 items and the modification of 1. The remaining 16 items were well-balanced between subdivisions and were useful in all seven diagnosis groups, thus constituting the final instrument, EOS-16. The most suitable recall period was three months.

Conclusions: EOS-16 has been created according to the HRQoL survey guidelines with a versatile nationwide patient population. The survey has been validated and can be used for a wide range of chronic ear diseases as a HRQoL instrument.
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http://dx.doi.org/10.1016/j.joto.2021.01.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241709PMC
July 2021

Evaluation of pure-tone audiometric protocols in vestibular schwannoma screening.

J Otol 2021 Jul 31;16(3):138-143. Epub 2020 Dec 31.

Head and Neck Center, Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital, And University of Helsinki, Helsinki, Finland.

The objective was to evaluate the pure-tone audiogram-based screening protocols in VS diagnostics. We retrospectively analyzed presenting symptoms, pure tone audiometry and MRI finding from 246 VS patients and 442 controls were collected to test screening protocols (AAO-HNS, AMCLASS-A/B, Charing Cross, Cueva, DOH, Nashville, Oxford, Rule3000, Schlauch, Seattle, Sunderland) for sensitivity and specificity. Results were pooled with data from five other studies, and analysis of sensitivity, specificity and positive likelihood ratio (LR+) for each protocol was performed. Our results show that protocols with significantly higher sensitivity (AMCLASS-A/B, Nashville) show also significantly lowest specificity, and tend to have low association (positive likelihood ratio, LR+) to the VS. The highest LR+ was found for protocols AAO-HNS, Rule3000 and Seattle. In conclusions, knowing their properties, screening protocols are simple decision-making tools in VS diagnostic. To use the advantage of the highest sensitivity, protocols AMCLASS-A + B or Nashville can be of choice. For more reasonable approach, applying the protocols with high LR+ (AAO-HNS, Rule3000, Seattle) may reduce the overall number of MRI scans at expense of only few primarily undiagnosed VS.
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http://dx.doi.org/10.1016/j.joto.2020.12.004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8241708PMC
July 2021

Improvements in Hearing and in Quality of Life after Sequential Bilateral Cochlear Implantation in a Consecutive Sample of Adult Patients with Severe-to-Profound Hearing Loss.

J Clin Med 2021 May 28;10(11). Epub 2021 May 28.

Department of Otorhinolaryngology, Kuopio University Hospital, 70029 Kuopio, Finland.

Bilateral cochlear implantation is increasing worldwide. In adults, bilateral cochlear implants (BICI) are often performed sequentially with a time delay between the first (CI1) and the second (CI2) implant. The benefits of BICI have been reported for well over a decade. This study aimed at investigating these benefits for a consecutive sample of adult patients. Improvements in speech-in-noise recognition after CI2 were followed up longitudinally for 12 months with the internationally comparable Finnish matrix sentence test. The test scores were statistically significantly better for BICI than for either CI alone in all assessments during the 12-month period. At the end of the follow-up period, the bilateral benefit for co-located speech and noise was 1.4 dB over CI1 and 1.7 dB over CI2, and when the noise was moved from the front to 90 degrees on the side, spatial release from masking amounted to an improvement of 2.5 dB in signal-to-noise ratio. To assess subjective improvements in hearing and in quality of life, two questionnaires were used. Both questionnaires revealed statistically significant improvements due to CI2 and BICI. The association between speech recognition in noise and background factors (duration of hearing loss/deafness, time between implants) or subjective improvements was markedly smaller than what has been previously reported on sequential BICI in adults. Despite the relatively heterogeneous sample, BICI improved hearing and quality of life.
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http://dx.doi.org/10.3390/jcm10112394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8199295PMC
May 2021

Low inter-rater consistency in semantic profiles of tinnitus-like sounds rated by tinnitus patients.

Prog Brain Res 2021 13;262:93-113. Epub 2020 Aug 13.

Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Characterizations of the tinnitus sound percept are always based on a subjective description by the person affected. Since the experimenter cannot have access to the tinnitus percept, it is not possible to verify whether individuals use the adjectives describing the sound in the expected way, i.e., whether a label given to the tinnitus percept corresponds to the label that the experimenter or another individual would give to the same sound percept. However, if it is assumed that tinnitus patients can reliably describe their own tinnitus, then they should also be able to reliably describe tinnitus-like sounds, presented acoustically. In this study, 26 tinnitus patients used a tablet computer to rate 18 pre-defined adjectives on their level of descriptiveness for their own tinnitus percept as well as 17 tinnitus-like sounds presented via headphones. The main interest of the current study was to calculate intraclass correlation (ICC) and Krippendorff's alpha coefficients for the rating profiles of the acoustically-presented sounds, in order to quantify how well the individuals agreed on the ratings of known sounds, i.e., whether the adjectives would receive similar ratings from all participants for a specific tinnitus-like sound. The results show that the level of agreement was low for all adjectives and sounds, meaning that the different individuals did not use the adjectives in a consistent manner. The conclusion is that subjective tinnitus descriptions should be interpreted with great caution, and that the inherent variability involved in the characterization of sounds by naïve listeners can contribute to the observed heterogeneity in tinnitus symptoms and treatment outcomes.
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http://dx.doi.org/10.1016/bs.pbr.2020.06.021DOI Listing
November 2021

Intraoperative transimpedance and spread of excitation profile correlations with a lateral-wall cochlear implant electrode array.

Hear Res 2021 06 14;405:108235. Epub 2021 Apr 14.

Department of Otorhinolaryngology - Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, 00130 Helsinki, Finland.

A limiting factor of cochlear implant technology is the spread of electrode-generated intracochlear electrical field (EF) leading to spread of neural excitation (SOE). In this study, we investigated the relation of the spread of the intracochlear EF, assessed via transimpedance matrix (TIM), and SOE. A total of 43 consecutive patients (ages 0.7-82 years; 31.0 ± 25.7 years, mean ± SD) implanted with a Cochlear Nucleus CI522 or CI622 cochlear implant with Slim Straight electrode array (altogether 51 ears) were included in the study. Cochlear nerve was visualized for all patients in preoperative imaging and there were no cochlear anomalies in the study sample. The stimulated electrodes were in the basal, middle, and apical parts of the electrode array (electrode numbers 6, 11, and 19, respectively). The stimulation level was 210 CL on average for the TIM measurement and always 230 CL for the SOE measurement. Approximately 90% of the individual TIM and SOE profiles correlated with each other (p < .05; r = 0.61-0.99). Also, the widths of the TIM and SOE peaks, computed at 50% of the maximum height, exhibited a weak correlation (r = 0.39, p = .007). The 50% widths of TIM and SOE were the same only in the apical part of the electrode array; in the basal part SOE was wider than TIM, and in the middle part TIM was wider than SOE (p < .01 and p = .048, respectively). Within each measurement, TIM 50% widths were different between all three parts of the electrode array, while for SOE, only the basal electrode differed from the middle electrode. Finally, the size of the cochlea and the 50% widths of TIM and SOE had the strongest correlation in the middle part of the electrode array (r = -0.63, and -0.37, respectively). Our results suggest that there is a correlation between the spread of intracochlear EF and neural SOE at least in the apical part of the electrode array used in this study, and that larger cochleae are associated with more focused TIM and SOE.
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http://dx.doi.org/10.1016/j.heares.2021.108235DOI Listing
June 2021

Microbiome of the Healthy External Auditory Canal.

Otol Neurotol 2021 06;42(5):e609-e614

Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital.

Objective: To investigate the microbiota of the healthy external auditory canal (EAC) culture-independently and to evaluate the usefulness of the swabbing method in collecting EAC microbiota samples.

Study Design: Cohort study.

Patients: Fifty healthy asymptomatic working-age volunteers.

Intervention: Samples were harvested with DNA-free swabs from the volunteers' EACs.

Main Outcome Measures: Amplicon sequencing of the 16S rRNA gene was used to characterize the microbial communities in the samples.

Results: The swabbing method is feasible for EAC microbiota sample collection. The analyzed 41 samples came from 27 female and 14 male subjects; 4 samples were excluded due to recent antimicrobial treatment and 5 because of low sequence count or suspected contaminant microbes. The four most frequent amplicon sequence variants in the microbiota data were Staphylococcus auricularis, Propionibacterium acnes, Alloiococcus otitis, and Turicella otitidis. Typically, the dominant amplicon sequence variant in a sample was one of the most frequent bacteria, but there were also subjects where the dominant species was not among the most frequent ones. The genus Alloiococcus was least common in females who reported cleaning their ears. Subjects with a high relative abundance of Alloiococcus typically had a low abundance of Staphylococcus, which may be a sign of the two being competing members of the microbial community.

Conclusions: The most common bacteria in the microbiome of the healthy EAC were Staphylococcus auricularis, Propionibacterium acnes, Alloiococcus otitis, and Turicella otitidis. The EAC microbiota seems more diverse and individualized than previously thought. Also, ear cleaning habits seem to alter the EAC microbiome.
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http://dx.doi.org/10.1097/MAO.0000000000003031DOI Listing
June 2021

An exploratory investigation of speech recognition thresholds in noise with auralisations of two reverberant rooms.

Int J Audiol 2021 03 23;60(3):210-219. Epub 2020 Sep 23.

Aalto Acoustics Lab, Department of Signal Processing and Acoustics, Aalto University, Espoo, Finland.

Objective: Speech-in-noise tests are widely used in hearing diagnostics but typically without reverberation, although reverberation is an inextricable part of everyday listening conditions. To support the development of more real-life-like test paradigms, the objective of this study was to explore how spatially reproduced reverberation affects speech recognition thresholds in normal-hearing and hearing-impaired listeners.

Design: Thresholds were measured with a Finnish speech-in-noise test without reverberation and with two test conditions with reverberation times of ∼0.9 and 1.8 s. Reverberant conditions were produced with a multichannel auralisation technique not used before in this context.

Study Sample: Thirty-four normal-hearing and 14 hearing-impaired listeners participated in this study. Five people were tested with and without hearing aids.

Results: No significant differences between test conditions were found for the normal-hearing listeners. Results for the hearing-impaired listeners indicated better performance for the 0.9 s reverberation time compared to the reference and the 1.8 s conditions. Benefit from hearing aid use varied between individuals; for one person, an advantage was observed only with reverberation.

Conclusions: Auralisations may offer information on speech recognition performance that is not obtained with a test without reverberation. However, more complex stimuli and/or higher signal-to-noise ratios should be used in the future.
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http://dx.doi.org/10.1080/14992027.2020.1817993DOI Listing
March 2021

The long-term learning effect related to the repeated use of the Finnish matrix sentence test and the Finnish digit triplet test.

Int J Audiol 2020 10 27;59(10):753-762. Epub 2020 Apr 27.

Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland.

To assess are there learning-related improvements in the speech reception thresholds (SRTs) for the Finnish matrix sentence test (FMST) and the Finnish digit triplet test (FDTT) in repeated use over 12 months. Test sessions were scheduled at 0, 1, 3, 6 and 12 months, and each session included five FMST measurements and four FDTT measurements. The within-session and inter-session improvements in SRTs were analysed with a linear mixed model. Fifteen young normal-hearing participants. Statistically significant mean improvements of 2.0 dB SNR and 1.2 dB SNR were detected for the FMST and the FDTT, respectively, over the 12-month follow-up period. For the FMST, majority of the improvement occurred during the first two test sessions. For the FDTT, statistically significant differences were detected only in comparison to the first test session and to the first test measurement of every session over the 12-month follow-up. Repeated use of the FMST led to significant learning-related improvements, but the improvements appeared to plateau by the third test session. For the FDTT, the overall improvements were smaller, but a significant within-session difference between the first and consecutive FDTT measurements persisted throughout the test sessions.
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http://dx.doi.org/10.1080/14992027.2020.1753893DOI Listing
October 2020

The Finnish simplified matrix sentence test for the assessment of speech intelligibility in the elderly.

Int J Audiol 2020 10 18;59(10):763-771. Epub 2020 Mar 18.

Department of Otorhinolaryngology, Kuopio University Hospital, Finland.

A simplified version of the Finnish matrix sentence test (FMST) was developed to improve the reliability of hearing diagnostic for children and for patients with limited working memory capacity and/or vocabulary. Study 1 evaluated the word matrix of the Finnish simplified matrix sentence test (FINSIMAT) to rule out systematic differences between the new FINSIMAT test lists, and to provide reference values for normal-hearing (NH) young adults (YA). In Study 2, the FINSIMAT and the FMST were evaluated in elderly listeners with mild-to-moderate hearing impairment (HI). Twenty NH YAs participated in Study 1, and 16 elderly HI adults participated in Study 2. For NH YAs, the reference speech reception threshold (SRT) estimate and the slope for the FINSIMAT were -11.2 ± 1.0 dB signal-to-noise ratio (SNR) and 19.4 ± 1.9%/dB SNR. For the elderly HI listeners, the mean SRT estimates for the FINSIMAT and FMST were -4.1 and -3.6 dB SNR, respectively. The correlation between the FMST and FINSIMAT results was strong (r = 0.78,  < 0.001). The FINSIMAT showed comparable characteristics to the FMST and proved feasible for measurements in elderly HI listeners.
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http://dx.doi.org/10.1080/14992027.2020.1741704DOI Listing
October 2020

The efficacy of microphone directionality in improving speech recognition in noise for three commercial cochlear-implant systems.

Cochlear Implants Int 2020 05 11;21(3):153-159. Epub 2020 Mar 11.

Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland.

To investigate the effect of fixed and adaptive microphone directionality on speech reception threshold (SRT) in noise when compared to omnidirectional mode in unilateral cochlear-implant (CI) use for three different CI systems. Twenty-four CI recipients with bilateral severe-to-profound hearing loss participated in the study. Eight recipients of each CI system were enrolled, and their SRT in noise was measured when the speech and noise signals were co-located in the front to serve as a baseline. The acute effect of different microphone directionalities on SRT in noise was measured with the noise emanating at 90° in the horizontal plane from the side of the CI sound processor (S0NCI). When compared to the baseline condition, the individual data revealed fairly similar patterns within each CI system. In the S0NCI condition, the average improvement in SRT in noise for fixed and adaptive directionalities over the omnidirectional mode was statistically significant and ranged from 1.2 to 6.0 dB SNR and from 3.7 to 12.7 dB SNR depending on the CI system, respectively. Directional microphones significantly improve SRT in noise for all three CI systems. However, relatively large differences were observed in the directional microphone efficacy between CI systems.
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http://dx.doi.org/10.1080/14670100.2019.1701236DOI Listing
May 2020

The efficacy of microphone directionality in improving speech recognition in noise for three commercial cochlear-implant systems.

Cochlear Implants Int 2020 05 11;21(3):153-159. Epub 2020 Mar 11.

Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland.

To investigate the effect of fixed and adaptive microphone directionality on speech reception threshold (SRT) in noise when compared to omnidirectional mode in unilateral cochlear-implant (CI) use for three different CI systems. Twenty-four CI recipients with bilateral severe-to-profound hearing loss participated in the study. Eight recipients of each CI system were enrolled, and their SRT in noise was measured when the speech and noise signals were co-located in the front to serve as a baseline. The acute effect of different microphone directionalities on SRT in noise was measured with the noise emanating at 90° in the horizontal plane from the side of the CI sound processor (S0NCI). When compared to the baseline condition, the individual data revealed fairly similar patterns within each CI system. In the S0NCI condition, the average improvement in SRT in noise for fixed and adaptive directionalities over the omnidirectional mode was statistically significant and ranged from 1.2 to 6.0 dB SNR and from 3.7 to 12.7 dB SNR depending on the CI system, respectively. Directional microphones significantly improve SRT in noise for all three CI systems. However, relatively large differences were observed in the directional microphone efficacy between CI systems.
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http://dx.doi.org/10.1080/14670100.2019.1701236DOI Listing
May 2020

Otitis Media-associated Bacterial Meningitis in Children in a Low-income Country.

Pediatr Infect Dis J 2019 08;38(8):791-797

Department of Otorhinolaryngology and Head and Neck Surgery, University of Turku, Turku, Finland.

Background: Otitis media (OM) is a common childhood infection that may result in bacterial meningitis (BM). However, OM-associated BM remains poorly characterized. We aimed to study the occurrence, clinical presentation and outcome of this type of childhood BM in Luanda, Angola.

Methods: Five hundred twelve children from our previous clinical BM trial, with the ear meticulously examined, were analyzed whether they had or not OM, and according to their age, ≤12 month old and >12 month old. Prospectively collected clinical data, laboratory test results and outcome for these groups were assessed.

Results: Sixty-two children (12%) had OM-associated BM, of whom 39 had otorrhea. Ear discharge was more common in older children (median age 45 months old vs. 12 months old; P < 0.001). Children with OM often showed an additional infectious focus (n = 20, 32% vs. n = 82, 18%; P = 0.016), were dehydrated (n = 16, 26% vs. n = 66, 15%; P = 0.04), and showed higher odds of complicated clinical course or death (odds ratios 2.27, 95% CI: 1.004-5.15, P = 0.049) compared with children without OM. The >12-month-old children with OM often arrived in poor clinical condition with coma and/or ptosis. Otorrhea was associated with HIV positivity. Infants with otorrhea frequently lived under poor socioeconomic conditions.

Conclusions: Children with OM-associated BM were prone to many problems, such as being especially ill at presentation, undergoing a difficult clinical course and showing a higher risk of complicated or fatal outcome. HIV infection and malnutrition were common in children with otorrhea, which was also associated with low socioeconomic status.
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http://dx.doi.org/10.1097/INF.0000000000002335DOI Listing
August 2019

Bacterial biofilm in salivary stones.

Eur Arch Otorhinolaryngol 2019 Jun 26;276(6):1815-1822. Epub 2019 Apr 26.

Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Haartmaninkatu 4 E, 00029 HUS, Helsinki, Finland.

Purpose: To assess the susceptibility of salivary stones to bacterial biofilm formation, which may be involved in the development of salivary gland infection, and to investigate a relation between microbiological aspects and patient characteristics.

Methods: This prospective study comprises of 54 patients with sialolithiasis attended in Helsinki University Hospital during 2014-2016. A total of 55 salivary stones were removed, and studied for biofilm formation using fluorescence microscopy and sonication. The isolated organisms were quantified and identified using matrix-assisted laser desorption ionization time-of-flight mass spectrometry.

Results: Biofilm formation was confirmed on the surface of 39 (70.9%) stones. A total of 96 microorganisms were isolated from 45 salivary stones (81.8%). Two or more organisms were isolated in 33 (73.3%) cases. The main isolates were Streptococcus mitis/oralis (n = 27; 28.1%), followed by Streptococcus anginosus (n = 10; 9.6%), Rothia spp. (n = 8; 8.3%), Streptococcus constellatus (n = 7; 7.3%), and Streptococcus gordonii (n = 6; 6.2%). In all patients showing pre-operative (12 cases) or peri-operative (three cases) drainage of pus, the presence of biofilm was detected in microscopy (p = 0.004). Four patients showed post-operative infection, and in three of them (75.0%), the presence of biofilm was detected. Increased number of pus drainage was found among patients with reflux symptoms or use of proton-pump inhibitors.

Conclusions: Salivary stones are susceptible to bacterial biofilm formation, which could be related with the development and severity of the inflammation and the refractory nature of the disease. Sonication of salivary gland stones could be a useful method for finding the etiology of the chronic infection.
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http://dx.doi.org/10.1007/s00405-019-05445-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6529597PMC
June 2019

Cochlear Implantation With a Novel Long Straight Electrode: the Insertion Results Evaluated by Imaging and Histology in Human Temporal Bones.

Otol Neurotol 2018 10;39(9):e784-e793

Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio.

Hypothesis: To evaluate the insertion results of a novel straight array (EVO) by detailed imaging and subsequent histology in human temporal bones (TB).

Background: The main focuses of modern cochlear implant surgery are to prevent damage to the intracochlear structures and to preserve residual hearing. This is often achievable with new atraumatic electrode arrays in combination with meticulous surgical techniques.

Methods: Twenty fresh-frozen TBs were implanted with the EVO. Pre- and postoperative cone beam computed tomography scans were reconstructed and fused for an artifact-free representation of the electrode. The array's vertical position was quantified in relation to the basilar membrane on basis of which trauma was classified (Grades 0-4). The basilar membrane location was modeled from previous histologic data. The TBs underwent subsequent histologic examination.

Results: The EVOs were successfully inserted in all TBs. Atraumatic insertion (Grades 0-1) were accomplished in 14 of 20 TBs (70%). There were three apical translocations, and two basal translocations due to electrode bulging. One TB had multiple translocations. The sensitivity and specificity of imaging for detecting insertion trauma (Grades 2-4) was 87.5% and 97.3.0%, respectively.

Conclusion: Comparable insertion results as reported for other arrays were also found for the EVO. Insertion trauma can be mostly avoided with meticulous insertion techniques to prevent bulging and by limiting the insertion depth angle to 360 degrees. The image fusion technique is a reliable tool for evaluating electrode placement and is feasible for trauma grading.
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http://dx.doi.org/10.1097/MAO.0000000000001953DOI Listing
October 2018

tACS-mediated modulation of the auditory steady-state response as seen with MEG.

Hear Res 2018 07 28;364:90-95. Epub 2018 Mar 28.

Center for Mind/Brain Sciences, University of Trento, Italy; Centre for Cognitive Neuroscience, University of Salzburg, Austria.

Background: Previous studies have shown that transcranial electrical stimulation can be successfully applied during simultaneous MEG measurements. In particular, using beamforming they have established that changes of stimulus induced as well as evoked activity can be inspected during transcranial alternating current stimulation (tACS).

Objective/hypothesis: We studied tACS-mediated changes of the auditory steady-state response (ASSR), hypothesizing that-due to the putatively inhibitory role of alpha oscillations-these evoked responses would be diminished.

Methods: We compared ASSRs in conditions with and without 12-Hz and 6.5-Hz sinusoidal 1.5 mA tACS, applied bilaterally over temporal areas. Source-level activity was estimated using a linearly constrained minimum variance beamformer and compared across tACS conditions using paired t-tests following a condition-internal normalization procedure.

Conclusions: By separating the electrical and auditory stimulation to non-overlapping parts of the frequency spectrum, we were able to compare auditory-evoked steady-state activity across tACS conditions. We observed a significant decrease in normalized ASSR power in the 12-Hz tACS condition, illustrating that tACS could induce immediate changes in auditory evoked activity. This study sets a methodology to further interrogate the causal roles of oscillatory dynamics in auditory cortices, as well as suggests perspectives for employing tACS in clinical contexts.
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http://dx.doi.org/10.1016/j.heares.2018.03.023DOI Listing
July 2018

Prognostic Value and Changes of Auditory Brain Stem Response in Children With Bacterial Meningitis in Luanda, Angola.

Clin Med Insights Ear Nose Throat 2018 28;11:1179550618758648. Epub 2018 Feb 28.

Children's Hospital, Helsinki University Hospital, Helsinki, Finland.

Objective: To assess the role of single and repeated auditory brain stem response (ABR) in predicting mortality and severe neurological injury among children having bacterial meningitis (BM) in Luanda, Angola.

Methods: The morphology of ABR traces of 221 children (aged 2 months to 12 years) from admission day was analyzed and compared with age-matched normative data. Absence and delay of traces were compared with mortality and mortality or severe neurological injury in subgroup analyses. Outcome was also evaluated with repeated ABR of 166 children based on presence or absence of responses at 80 dB nHL (normal hearing level) stimulation level.

Results: Individually, the absence of typical ABR waveform did not signify poor outcome. At the group level, latencies and interpeak latencies (IPLs) were significantly prolonged among patients with BM in comparison with controls, and the prolongation correlated with higher mortality or severe neurological sequelae.

Conclusions: We confirmed the effect of BM on neural conduction time in auditory pathway. However, ABR in similar settings seems not useful for individual prognostication, although at the group level, delayed latencies, IPLs, or both associated with poorer outcome.
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http://dx.doi.org/10.1177/1179550618758648DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5843090PMC
February 2018

Attenuation of Positive Valence in Ratings of Affective Sounds by Tinnitus Patients.

Trends Hear 2018 Jan-Dec;22:2331216518816215

1 Department of Otorhinolaryngology-Head and Neck Surgery, Helsinki University Hospital, University of Helsinki, Finland.

Affective processing appears to be altered in tinnitus, and the condition is to a large extent characterized by the emotional reaction to the phantom sound. Psychophysiological models of tinnitus and supporting brain imaging studies have suggested a role for the limbic system in the emergence and maintenance of tinnitus. It is not clear whether the tinnitus-related changes in these systems are specific for tinnitus only, or whether they affect emotional processing more generally. In this study, we aimed to quantify possible deviations in affective processing in tinnitus patients by behavioral and physiological measures. Tinnitus patients rated the valence and arousal of sounds from the database. Sounds were chosen based on the normative valence ratings, that is, negative, neutral, or positive. The individual autonomic response was measured simultaneously with pupillometry. We found that the subjective ratings of the sounds by tinnitus patients differed significantly from the normative ratings. The difference was most pronounced for positive sounds, where sounds were rated lower on both valence and arousal scales. Negative and neutral sounds were rated differently only for arousal. Pupil measurements paralleled the behavioral results, showing a dampened response to positive sounds. Taken together, our findings suggest that affective processing is altered in tinnitus patients. The results are in line with earlier studies in depressed patients, which have provided evidence in favor of the so-called positive attenuation hypothesis of depression. Thus, the current results highlight the close link between tinnitus and depression.
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http://dx.doi.org/10.1177/2331216518816215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291869PMC
August 2019

Clinical Characteristics of Troublesome Pediatric Tinnitus.

Clin Med Insights Ear Nose Throat 2017 23;10:1179550617736521. Epub 2017 Oct 23.

Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Objectives: The frequency of tinnitus in children and adults is practically the same. However, although adults reveal their symptoms and seek for medical aid, the suffering often remains unrecognized in the young. This is due to both the inability of children to properly describe their symptoms and the lack of recognition.

Materials And Methods: Among 5768 patients entering our department with complaints of tinnitus between 2010 and 2015, there were only 112 children. A full clinical history and medical status had been determined at the time of presentation and were analyzed retrospectively.

Results: The average duration from first complain to clinical presentation was approximately 12 months. A normal hearing capability of less than 25 dB was measured in 80% of the cases. Only 23 patients presented with a hearing impairment. The causes ranged from hearing loss, previous orthodontic treatment, noise trauma, middle ear aeration, muscular neck tension, and skull base fracture. Typical co-morbidities such as sleeping disorders, concentration disorders, and hyperacusis were observed.

Conclusions: This retrospective study shows that recognition of tinnitus in the childhood is generally delayed. A better characterization of complaints and triggers, however, is a prerequisite to sensitize medical personnel and caretakers for the suffering and to avoid developmental impairments.
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http://dx.doi.org/10.1177/1179550617736521DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5656107PMC
October 2017

Patient satisfaction in the long-term effects of Eustachian tube balloon dilation is encouraging.

Acta Otolaryngol 2018 Feb 10;138(2):122-127. Epub 2017 Oct 10.

a Department of Otorhinolaryngology, Head and Neck Center , Helsinki University Hospital, University of Helsinki , Helsinki , Finland.

Object: To investigate the long-term effects of balloon Eustachian tuboplasty (BET) from patient's perspective and to discover which symptoms of Eustachian tube dysfunction (ETD) benefit the most from BET.

Method: We designed a retrospective postal questionnaire based on the seven-item ETD questionnaire (ETDQ-7). Our questionnaire covered the severity of present ETD symptoms in comparison with the preoperative situation, the severity of current overall ear symptoms, and possible surgical interventions after BET. Forty-six patients treated in our institution between 2011 and 2013 fulfilled the inclusion criteria and 74% (34 patients; total 52 ears treated with BET) returned the questionnaire with a mean follow-up time of 3.1 years (range 1.8-4.6 years).

Results: Pain in the ears, feeling of pressure in the ears, and feeling that ears are clogged had reduced in 75% of the ears that suffered from these symptoms preoperatively. Seventy-seven percent of all the responders felt that their overall ear symptoms were reduced. Altogether, 82% of all the patients stated that they would undergo BET again if their ear symptoms returned to the preoperative level.

Conclusion: Patient satisfaction in the long-term effects of BET is encouraging. These results may help clinicians in preoperative patient selection and counselling.
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http://dx.doi.org/10.1080/00016489.2017.1384568DOI Listing
February 2018

Hearing disorder from music; a neglected dysfunction.

Acta Otolaryngol 2018 Jan 31;138(1):21-24. Epub 2017 Aug 31.

b Helsinki Ear Institute , Helsinki , Finland.

Conclusion: Music-induced acute acoustic trauma is not inevitably linked to hearing dysfunction as validated by conventional pure tone audiometry. Tinnitus is often in combination with hyperacusis. Our results point at 'silent hearing loss' as the underlying pathology, having afferent nerve terminal damage rather than hair cell loss as the structural correlate.

Objectives: Exposure to loud music is one of the most common causes of acute acoustic trauma, which adolescents and teenagers experience by voluntary exposure to loud music of sound levels up to 110 dB(A).

Methods: The clinical and psychophysical data of 104 consecutive patients with music-induced hearing disorder (MIHD) were analyzed to construct individual hearing and tinnitus profiles. In all cases, tinnitus was the presenting symptom.

Results: Hearing abilities were normal in about two-thirds of the tinnitus patients. Tinnitus was experienced most often as a high-frequency tone (83%). The Tinnitus Handicap Inventory (THI) scores ranged from 0 to 94 with an average score of 43.1. Visual analog scales (VAS) were used to assess tinnitus loudness (average 42.4) and annoyance (average 54.2), and tinnitus awareness was estimated (average 60.3). All VAS values correlated strongly with the THI. Hyperacusis was present in 65% and 71% of the patients reported sleeping disorders.
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http://dx.doi.org/10.1080/00016489.2017.1367100DOI Listing
January 2018

Balloon Eustachian tuboplasty under local anesthesia: Is it feasible?

Laryngoscope 2017 May 3;127(5):1021-1025. Epub 2017 Feb 3.

Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Objective: To study whether balloon Eustachian tuboplasty (BET) is a feasible and safe procedure under local anesthesia.

Study Design: Prospective multicenter case-control study.

Methods: Patients undergoing either BET (n = 13) or endoscopic sinus surgery (ESS) (n = 12) under local anesthesia, with the possibility of sedation and analgesia, were monitored during the procedure and recovery period for possible adverse effects. After the procedure, the patients responded to a questionnaire assessing their experience.

Results: No adverse effects were detected in the BET group. Patients in the BET group reported similar Visual Analog Scale scores for pain during the operation as the ESS group (5.0 ± 0.7 vs. 3.2 ± 0.7, mean ± standard error of the mean). However, patients in the BET group experienced more discomfort (4.2 ± 0.6 vs. 2.5 ± 0.3, respectively, P = 0.049). Seventy-seven and 92% of the patients in the BET and ESS groups, respectively, considered the anesthesia and pain relief to be sufficient. Patients from both the BET and ESS groups were almost devoid of pain 1 to 2 hours postoperatively (0.8 ± 0.2 and 1.4 ± 0.3, respectively). In total, 12 of 13 patients in the BET group, and all 12 patients in the ESS group, would choose local anesthesia with sedation and analgesia if they needed to undergo the same procedure again.

Conclusion: BET is a safe and feasible procedure under monitored anesthesia care, including local anesthesia along with sedation and analgesia. There is need for further methodological improvement to reduce pain and discomfort during the operation.

Level Of Evidence: 4. Laryngoscope, 127:1021-1025, 2017.
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http://dx.doi.org/10.1002/lary.26488DOI Listing
May 2017

Prevention of Biomaterial Infection by Pre-Operative Incubation with Human Cells.

Surg Infect (Larchmt) 2017 Apr 7;18(3):336-344. Epub 2017 Mar 7.

1 Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki , Helsinki, Finland .

Background: Cells of tissues and biofilm forming bacteria compete for the living space on the surface of an implant. We hypothesized the incubation of the implant (titanium, polydimethylsiloxane, and polystyrene surface) with human cells before implantation as a strategy to prevent bacterial adhesion and biofilm formation.

Methods: After 24 hours of incubation with human osteogenic sarcoma SaOS-2 cells (1 × 10 cells/mL), the materials were incubated for 4.5 hours or two days with Staphylococcus aureus in serial 1:10 dilutions of 10 colony-forming units/mL. The bacterial adherence and biofilm biomass on materials pre-incubated with SaOS-2 cells were compared with our previous results on materials incubated only with bacteria or in simultaneous co-culture of SaOS-2 cells and S. aureus. Fluorescent microscopy and crystal violet stain were used. The number of viable SaOS-2 and bacterial cells present was tested using colorimetric methods (MTT, LDH) and drop plate method, respectively.

Results: The pre-treatment with human cells was associated with a reduction of bacterial colonization of the biomaterial at 4.5 hours and 48 hours compared with the non-pre-treated materials. The presence of bacteria decreased the number of viable human cells on all materials. ( Supplementary Fig. 1 ; see online supplementary materials at www.liebertpub.com/sur ).

Conclusions: These results suggest that the pre-operative incubation of prostheses with host cells could prevent infection of biomaterials.
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http://dx.doi.org/10.1089/sur.2016.263DOI Listing
April 2017

Otogenic Intracranial Abscesses, Our Experience Over the Last Four Decades.

J Int Adv Otol 2017 Apr 13;13(1):40-46. Epub 2017 Jan 13.

Department of Allergy, University of Helsinki and Helsinki University Hospital, Finland.

Objective: To evaluate the predisposing factors for otogenic intracranial abscesses, assess their changes over time, and analyze how they differ from those due to other causes.

Materials And Methods: The medical records of all patients treated for otogenic intracranial abscesses, between 1970 and 2012 at a tertiary referral center, were retrospectively analyzed. The analysis included patient demographics, clinical characteristics, causative pathogens, treatments, outcomes, and comparisons of otogenic and non-otogenic intracranial abscesses.

Results: Of all intracranial abscesses, 11% (n=18) were otogenic. In the 1970s, otogenic infections were a common predisposing factor for intracranial abscess; but within our study period, the incidence of otogenic intracranial abscesses decreased. Most (94%) otogenic cases were due to chronic suppurative otitis media and 78% were associated with cholesteatoma. Most patients (94%) had ear symptoms. The most common presenting symptoms were discharge from the infected ear (50%), headache (39%), neurological symptoms (28%), and fever (17%). The most common pathogens belonged to Streptococcus spp. (33%), Gram-negative enteric bacteria (22%), and Bacteroides spp. (11%). Neurosurgery was performed on all patients, 69% of which were prior to a later ear surgery. Surgery of the affected ear was performed on 14 patients (78%). A favorable recovery was typical (78%); however, one patient died.

Conclusion: Otogenic intracranial abscesses were most commonly due to a chronic ear infection with cholesteatoma. Ear symptoms and Gram-negative enteric bacteria were more common among patients with otogenic than non-otogenic intracranial abscesses.
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http://dx.doi.org/10.5152/iao.2016.2758DOI Listing
April 2017

Non-invasive vagus nerve stimulation reduces sympathetic preponderance in patients with tinnitus.

Acta Otolaryngol 2017 Apr 13;137(4):426-431. Epub 2017 Jan 13.

a Helsinki Ear Institute , Helsinki , Finland.

Conclusion: Transcutaneous vagal nerve stimulation (tVNS) might offer a targeted, patient-friendly, and low-cost therapeutic tool for tinnitus patients with sympathovagal imbalance.

Objectives: Conventionally, VNS has been performed to treat severe epilepsy and depression with an electrode implanted to the cervical trunk of vagus nerve. This study investigated the acute effects of tVNS on autonomic nervous system (ANS) imbalance, which often occurs in patients with tinnitus-triggered stress.

Methods: This study retrospectively analysed records of 97 patients who had undergone ANS function testing by heart rate variability (HRV) measurement immediately before and after a 15-60 min tVNS stimulation.

Results: The pre-treatment HRV recording showed sympathetic preponderance/reduced parasympathetic activity in about three quarters (73%) of patients. Active tVNS significantly increased variability of R-R intervals in 75% of patients and HRV age was decreased in 70% of patients. Either the variability of R-R intervals was increased or the HRV age decreased in 90% of the patients. These results indicate that tVNS can induce a shift in ANS function from sympathetic preponderance towards parasympathetic predominance. tVNS caused no major morbidity, and heart rate monitoring during the tVNS treatment showed no cardiac or circulatory effects (e.g. bradycardia) in any of the patients.
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http://dx.doi.org/10.1080/00016489.2016.1269197DOI Listing
April 2017

Severe Acute Otitis Media and Acute Mastoiditis in Adults.

J Int Adv Otol 2016 Dec 28;12(3):224-230. Epub 2016 Nov 28.

Department of Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Objective: To evaluate and compare clinical and microbiological findings in adults hospitalized for acute otitis media (AOM) or mastoid infections (acute or latent).

Materials And Methods: We retrospectively reviewed the medical records of all adults (≥17 years old) hospitalized (between 2003 and 2012) at a tertiary referral center for acute mastoid infections or AOM not responding to outpatient medical treatment.

Results: Of the 160 patients in the study sample, 19% had an infection caused by S. pyogenes, 14% by S. pneumoniae, and 11% by P. aeruginosa. AOM was the most common infection (38%), whereas 33% had acute mastoiditis (AM), 18% had latent mastoiditis (LM), and 13% AM of a chronically infected ear (AMc). In contrast to the other infections, P. aeruginosa (30%) and S. aureus (25%) were most common in AMc. Otorrhea (83%), tympanic membrane perforation (57%), and hearing problems (83%) were common in S. pyogenes infections. Patients with S. pneumoniae had longer lengths of hospitalization than those with other bacterial infections (7 vs. 4 days). Otorrhea (94%) and retroauricular symptoms were more common in P. aeruginosa infections. Hearing symptoms were common (67%) but fever (32%) and retroauricular symptoms were uncommon in AOM. Fever (44%) and mastoid tenderness (65%) were common in AM. Patients with LM underwent the most mastoidectomies (54%). Prior medical conditions, retroauricular symptoms, otorrhea (90%), and post-infection problems were common in AMc.

Conclusion: The bacteriological etiology of hospitalized AOM more closely resembled those of LM and AM than that of AMc. Adults hospitalized for AOM or AM required fewer mastoidectomies than those hospitalized for LM or AMc.
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http://dx.doi.org/10.5152/iao.2016.2620DOI Listing
December 2016

Differentiating Acute Otitis Media and Acute Mastoiditis in Hospitalized Children.

Curr Allergy Asthma Rep 2016 10;16(10):72

Department of Otorhinolaryngology, University of Helsinki and Helsinki University Hospital, Kasarmikatu 11-13, P.O. Box 263, Fin-00029 HUH, Helsinki, Finland.

Acute otitis media is a common infection in children. Most acute otitis media episodes can be treated at an outpatient setting with antimicrobials, or only expectant observation. Hospital treatment with parenteral medication, and myringotomy or tympanostomy, may be needed to treat those with severe, prolonged symptoms, or with complications. The most common intratemporal complication of acute otitis media is acute mastoiditis. If a child with acute mastoiditis does not respond to this treatment, or if complications develop, further examinations and other surgical procedures, including mastoidectomy, are considered. Since the treatment of complicated acute otitis media and complicated acute mastoiditis differs, it is important to differentiate these two conditions. This article focuses on the differential diagnostics of acute otitis media and acute mastoiditis in children.
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http://dx.doi.org/10.1007/s11882-016-0654-1DOI Listing
October 2016

Label-free visualization of cholesteatoma in the mastoid and tympanic membrane using CARS microscopy.

J Otol 2016 Sep 10;11(3):127-133. Epub 2016 Sep 10.

Hearing and Balance Research Unit, Field of Oto-laryngology, School of Medicine, University of Tampere, Tampere, Finland.

Objective: The present study aimed to evaluate the possibility of using coherent anti-Stokes Raman spectroscopy (CARS) microscopy to determine the specific molecular morphology of cholesteatoma by detecting the natural vibrational contrast of the chemical bonds without any staining.

Materials And Methods: Specimens from the mastoid and tympanic membrane with and without cholesteatoma were analyzed using CARS microscopy, two-photon excited fluorescence (TPEF) microscopy, and the second harmonic generation (SHG) microscopy.

Results: In cholesteatoma tissues from the mastoid, a strong resonant signal at 2845 cm was observed by CARS, which indicated the detection of the CH hydro-carbon lipid bonds that do not generate visible signals at 2940 cm suggestive of CH bonds in amino acids. A strong resonant signal at 2940 cm appeared in an area of the same specimen, which also generated abundant signals by TPEF and SHG microscopy at 817 nm, which was suggestive of collagen. In the tympanic membrane specimen with cholesteatoma, a strong resonant signal with corrugated morphology was detected, which indicated the presence of lipids. A strong signal was detected in the tympanic membrane with chronic otitis media using TPEF/SHG at 817 nm, which indicated collagen enrichment. The CARS and TPEF/SHG images were in accordance with the histology results.

Conclusion: These results suggest the need to develop a novel CARS microendoscope that can be used in combination with TPEF/SHG to distinguish cholesteatoma from inflammatory tissues.
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http://dx.doi.org/10.1016/j.joto.2016.09.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002602PMC
September 2016

Competitive colonization of prosthetic surfaces by staphylococcus aureus and human cells.

J Biomed Mater Res A 2017 01 27;105(1):62-72. Epub 2016 Aug 27.

Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Implantation of a biomaterial provides an adhesion substratum both to host cell integration and to contaminating bacteria. We studied simultaneous competitive adhesion of Staphylococcus aureus in serial 1:10 dilutions of 10 colony forming units (CFU)/mL and human osteogenic sarcoma (SaOS-2) or primary osteoblast (hOB) cells, both 1x10 cells/mL, to the surfaces of titanium, polydimethylsiloxane and polystyrene. The bacterial adherence and human cell proliferation, cytotoxicity and production of reactive oxygen species (ROS) were studied using fluorometric (fluorescent microscopy and flow cytometry) and colorimetric methods (MTT, LDH and crystal violet). The bacterial cell viability was also evaluated using the drop plate method. The presence of bacteria resulted in reduced adherence of human cells to the surface of the biomaterials, increased production of ROS, and into increased apoptosis. On the other hand, the presence of either type of human cells was associated with a reduction of bacterial colonization of the biomaterial with Staphylococcus aureus. These results suggest that increasing colonization of the biomaterial surface in vitro by one negatively affects colonization by the other. Host cell integration to an implant surface reduces bacterial contamination, which opens novel opportunities for the design of infection-resistant biomaterials in current implantology and future regenerative medicine. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 62-72, 2017.
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http://dx.doi.org/10.1002/jbm.a.35863DOI Listing
January 2017
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