Objective: We report a case of recurrent eosinophilic otitis media (EOM) successfully treated with the novel monoclonal IL-5 inhibitor benralizumab. We also review literature relevant to EOM diagnosis and potential for biologic treatment. Patient: A 24-year-old woman with bilateral otitis media with effusion unresponsive to standard treatment. Intervention(s): Multidisciplinary treatment using subcutaneous benralizumab after diagnosis of EOM. Main Outcome Measure(s): Behavioral audiometry, peripheral serology, otomicroscopy, and eosinophilic otitis media symptom severity. Results: Recalcitrant otitis media with effusion (OME) in the setting of nasal polyposis and asthma prompted clinical suspicion for EOM, which was confirmed by pathologic examination of middle ear effusion and soft tissue biopsy. Treatment with benralizumab was initiated by pulmonology and well-tolerated. Within 2 months of treatment onset there was a cessation of EOM symptoms, a reduction of peripheral eosinophil levels, and an improvement in conductive hearing loss. Conclusions: Monoclonal antibodies such as benralizumab may be an effective treatment option for EOM. A high level of clinical suspicion in patients with bronchial asthma, nasal polyposis, and recalcitrant OME may allow early diagnosis of EOM. Awareness of emerging biologic treatment options is important in the management of this challenging entity and may prevent long-term sequelae.
<b><i>Introduction:</i></b> Cochlear implantation (CI) is a reliable and safe means by which sensorineural hearing loss can be ameliorated in the elderly population. However, a high degree of variation exists in postimplantation hearing outcomes for which some modifiable factors of the daily natural auditory environment may be contributory. In this study, we analyze the relationship between cochlear implant patient age, natural auditory environment, and postimplantation speech perception among older adults. <b><i>Methods:</i></b> Data log from automatic environment classification enabled sound processors of postlingually deafened CI recipients ≥50 years old (<i>n</i> = 115) were obtained retrospectively and analyzed for time spent (hours per day) in listening environment and loudness (SPL dB). Speech perception testing was assessed in a subset of patients (<i>n</i> = 27) using open-set word recognition in quiet Consonant-Nucleus-Consonant in the short and intermediate postoperative period. <b><i>Results:</i></b> The mean subject age was 70 years (range, 53–99 years). Average daily implant use was 10.8 h and was not significantly correlated with age (<i>p</i> = 0.23, Spearman’s rho). Age was positively correlated with the percentage of hours spent at <40 and 40–50 dB and negatively correlated to proportional CI use at higher volume (60–70, 70–80, and >80 dB; <i>r</i><sub>s</sub> = 0.21, 0.20, −0.20, −0.35, −0.43; <i>p</i> = 0.021, 0.036, 0.033, <0.001, <0.001, respectively). Age was positively correlated with CI use in the quiet scene (<i>r</i><sub>s</sub> = 0.26, <i>p</i> = 0.006) and negatively correlated with scenes containing speech and noise (<i>r</i><sub>s</sub> = −0.19, −0.25; <i>p</i> = 0.046, 0.007). Total hours of device use and time spent at <40, 40–50 dB, and quiet environments were significantly correlated with improved CNC word scores (<i>r</i><sub>s</sub> = 0.48, 0.48, 0.51; <i>p</i> = 0.01, 0.01, <0.01, Spearman’s rho). While all speech (speech in noise + speech) was not significantly correlated to improvements in speech perception, a medium effect size was observed (<i>r</i><sub>s</sub> = 0.37, <i>p</i> = 0.057). <b><i>Discussion/Conclusion:</i></b> This study supports a relationship between auditory environment and age, with older CI recipients spending a greater proportion of time in quiet. Older CI users demonstrated greater improvements in speech perception with longer daily device use. Additional examination of the relationship between auditory environment and speech perception is necessary to conclusively guide future auditory rehabilitation efforts.
Objective This study aimed to evaluate the effectiveness of tai chi on balance in patients with improved but persistent dizziness and imbalance following completion of traditional vestibular rehabilitation therapy. Method Patients who completed vestibular rehabilitation therapy with persistent imbalance were prospectively enrolled in a tai chi programme comprising eight weekly classes. Balance was assessed before the first and after the eighth session using the Dynamic Gait Index, Activities-Specific Balance Confidence scale and Dizziness Handicap Inventory. Results A total of 37 participants (34 females, 3 males) completed the programme with balance testing. Mean age was 76.8 years (range, 56–91 years). Mean Dynamic Gait Index significantly increased after completion of tai chi (p < 0.00001). Mean Activities-Specific Balance Confidence scale score increased from 63.6 to 67.9 per cent (p = 0.046). A subset (n = 18) of patients completed a Dizziness Handicap Inventory without significant post-therapeutic change (p = 0.62). Most (36 of 37; 97.3 per cent) patients demonstrated post-therapy improvement on one or more assessments. Conclusion Tai chi is a viable adjunct to improve balance in patients who complete a vestibular rehabilitation therapy programme.
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