Adriana L. Smit

Bio: Adriana L. Smit is an academic researcher from Utrecht University. The author has contributed to research in topics: Tinnitus & Cochlear implant. The author has an hindex of 14, co-authored 52 publications receiving 620 citations. Previous affiliations of Adriana L. Smit include Maastricht University & University Medical Center Utrecht.

Cochlear implantation for patients with single-sided deafness or asymmetrical hearing loss: a systematic review of the evidence.

Abstract: OBJECTIVE: A systematic review of the literature to evaluate the clinical outcome of cochlear implantation for patients with single-sided deafness (SSD) or asymmetrical hearing loss (AHL). DATA SOURCES: We searched the PubMed, Embase, Cochrane Library, and CINAHL databases from their inception up to December 10, 2013 for SSD or AHL and cochlear implantation or their synonyms. STUDY SELECTION: In total, 781 articles were retrieved, of which 15 satisfied the eligibility criteria. Our outcomes of interest were speech perception in noise, sound localization, quality of life (QoL), and tinnitus. DATA EXTRACTION: Critical appraisal showed that six studies reported on less than five patients or that they carried a low directness of evidence or a high risk of bias. Therefore, we extracted the data of nine studies (n = 112). Patient numbers, age, duration of deafness, classification of deafness, pure tone audiometry, follow-up duration, and outcome measurements were extracted from all nine articles. DATA SYNTHESIS: Because of large heterogeneity between studies, we were not able to pool data in a meta-analysis. We therefore summarized the results of the studies specified per outcome. CONCLUSION: There are no high-level-of-evidence studies concerning cochlear implantation in patients with SSD or AHL. Current literature suggests important benefits of cochlear implantation regarding sound localization, QoL, and tinnitus. Varying results were reported for speech perception in noise, possibly caused by the large clinical heterogeneity between studies. Larger and high-quality studies are certainly warranted.

The disease recurrence rate after the canal wall up or canal wall down technique in adults.

Abstract: OBJECTIVES/HYPOTHESIS: To review which type of cholesteatoma surgery, canal wall up (CWU) or canal wall down (CWD), provides the lowest risk for residual and/or recurrent disease in adults with primary acquired cholesteatoma. DATA SOURCES: PubMed, Embase, CINAHL, the Cochrane Library, Scopus and Web of Science. STUDY DESIGN: We selected articles comparing CWU with CWD, reporting on disease recidivism (combined residual and recurrent disease) or independent residual or disease recurrence rates. We included studies with a moderate to high relevance. RESULTS: Our search yielded 2,060 articles. We selected seven studies that carried a moderate risk of bias. Six studies described higher disease recidivism after the CWU procedure [16.7-61.0%] compared to the CWD technique [0-13.2%]. Four studies showed statistical significant difference (P < .05). One study showed opposite results: recidivism was found in 7.8% CWU and in 22.1% CWD cases (P < .001). Studies showed CWU recidivism more likely to be residual disease, whereas CWD recidivism tended to be recurrent disease. CONCLUSION: The majority of included studies showed CWU to result in more disease recidivism compared to the CWD technique in adult patients with a primary acquired cholesteatoma. If recidivism risk is the most important factor to consider a certain surgical technique, we recommend application of the CWD procedure. However, many additional factors in patient care will define the best treatment decision, such as residual hearing and access to health care. Our recommendations are based on Level II evidence, which underlines the need for future high-level evidence studies. Laryngoscope, 2015.

Review: Bone Conduction Devices and Contralateral Routing of Sound Systems in Single-Sided Deafness

Abstract: Objectives/Hypothesis Systematically review the literature on the clinical outcome of bone conduction devices (BCD) and contralateral routing of sound systems (CROSS) for patients with single-sided deafness (SSD). Data Sources PubMed, Embase, Cochrane Library, and CINAHL databases were searched up to April 7, 2014. Review Methods All studies investigating BCD and CROSS for patients with SSD on speech perception in noise, sound localization, or quality of life were selected and critically appraised. Results In total, 46 articles were retrieved, of which six satisfied the eligibility criteria. Critical appraisal showed that five studies (n = 91) carried a moderate to high directness of evidence and a low to moderate risk of bias. Subsequently, study characteristics and outcome measurements were extracted. Due to large heterogeneity between studies, pooling of data was not feasible. Studies did not show a clear advantage of BCD or CROSS on speech perception in noise. BCD and CROSS lead to the same sound localization ability as the unaided condition. Quality of life did not differ significantly between conditions; however, subjective speech communication did improve. Conclusion No high level of evidence studies compare BCD and CROSS in patients with SSD. Literature showed no beneficial effect of BCD or CROSS regarding speech perception in noise and sound localization. Subjective speech communication demonstrated a moderate improvement with BCD and CROSS. High evidence studies comparing all treatment options for single-sided deafness should be conducted. Laryngoscope, 125:218–226, 2015

Comparison of Bilateral and Unilateral Cochlear Implantation in Adults: A Randomized Clinical Trial

Abstract: Importance The cost of bilateral cochlear implantation (BCI) is usually not reimbursed by insurance companies because of a lack of well-designed studies reporting the benefits of a second cochlear implant. Objective To determine the benefits of simultaneous BCI compared with unilateral cochlear implantation (UCI) in adults with postlingual deafness. Design, Setting, and Participants A multicenter randomized clinical trial was performed. The study took place in 5 Dutch tertiary referral centers: the University Medical Centers of Utrecht, Maastricht, Groningen, Leiden, and Nijmegen. Forty patients eligible for cochlear implantation met the study criteria and were included from January 12, 2010, through November 2, 2012. The main inclusion criteria were postlingual onset of hearing loss, age of 18 to 70 years, duration of hearing loss of less than 20 years, and a marginal hearing aid benefit. Two participants withdrew from the study before implantation. Nineteen participants were randomized to undergo UCI and 19 to undergo BCI. Interventions The BCI group received 2 cochlear implants during 1 surgery. The UCI group received 1 cochlear implant. Main Outcomes and Measures The primary outcome was the Utrecht Sentence Test with Adaptive Randomized Roving levels (speech in noise, both presented from straight ahead). Secondary outcomes were consonant-vowel-consonant words in silence, speech-intelligibility test with spatially separated sources (speech in noise from different directions), sound localization, and quality of hearing questionnaires. Before any data were collected, the hypothesis was that the BCI group would perform better on the objective and subjective tests that concerned speech intelligibility in noise and spatial hearing. Results Thirty-eight patients were included in the study. Fifteen patients in the BCI group used hearing aids before implantation compared with 19 in the UCI group. Otherwise, there were no significant differences between the groups’ baseline characteristics. At 1-year follow-up, there were no significant differences between groups on the Utrecht Sentence Test with Adaptive Randomized Roving levels (9.1 dB, UCI group; 8.2 dB, BCI group; P = .39) or the consonant-vowel-consonant test (median percentage correct score 85.0% in the UCI group and 86.8% in the BCI group; P = .21). The BCI group performed significantly better than the UCI group when noise came from different directions (median speech reception threshold in noise, 14.4 dB, BCI group; 5.6 dB, BCI group; P P Conclusions and Relevance This randomized clinical trial demonstrates a significant benefit of simultaneous BCI above UCI in daily listening situations for adults with postlingual deafness. Trial Registration trialregister.nl Identifier:NTR1722

Towards a Unified Testing Framework for Single-Sided Deafness Studies: A Consensus Paper

Abstract: Background: While hearing aids for a contralateral routing of signals (CROS-HA) and bone conduction devices have been the traditional treatment for single-sided d

The nuclear transcription factor FoxG1 affects the sensitivity of mimetic aging hair cells to inflammation by regulating autophagy pathways.

Abstract: Inflammation is a self-defense response to protect individuals from infection and tissue damage, but excessive or persistent inflammation can have adverse effects on cell survival. Many individuals become especially susceptible to chronic-inflammation-induced sensorineural hearing loss as they age, but the intrinsic molecular mechanism behind aging individuals' increased risk of hearing loss remains unclear. FoxG1 (forkhead box transcription factor G1) is a key transcription factor that plays important roles in hair cell survival through the regulation of mitochondrial function, but how the function of FoxG1 changes during aging and under inflammatory conditions is unknown. In this study, we first found that FoxG1 expression and autophagy both increased gradually in the low concentration lipopolysaccharide (LPS)-induced inflammation model, while after high concentration of LPS treatment both FoxG1 expression and autophagy levels decreased as the concentration of LPS increased. We then used siRNA to downregulate Foxg1 expression in hair cell-like OC-1 cells and found that cell death and apoptosis were significantly increased after LPS injury. Furthermore, we used d -galactose (D-gal) to create an aging model with hair cell-like OC-1 cells and cochlear explant cultures in vitro and found that the expression of Foxg1 and the level of autophagy were both decreased after D-gal and LPS co-treatment. Lastly, we knocked down the expression of Foxg1 under aged inflammation conditions and found increased numbers of dead and apoptotic cells. Together these results suggest that FoxG1 affects the sensitivity of mimetic aging hair cells to inflammation by regulating autophagy pathways.