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Hearing Disorders: HELP
Articles by David E. Tunkel
Based on 7 articles published since 2009
(Why 7 articles?)
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Between 2009 and 2019, David Tunkel wrote the following 7 articles about Hearing Disorders.
 
+ Citations + Abstracts
1 Guideline Clinical practice guideline: tinnitus executive summary. 2014

Tunkel, David E / Bauer, Carol A / Sun, Gordon H / Rosenfeld, Richard M / Chandrasekhar, Sujana S / Cunningham, Eugene R / Archer, Sanford M / Blakley, Brian W / Carter, John M / Granieri, Evelyn C / Henry, James A / Hollingsworth, Deena / Khan, Fawad A / Mitchell, Scott / Monfared, Ashkan / Newman, Craig W / Omole, Folashade S / Phillips, C Douglas / Robinson, Shannon K / Taw, Malcolm B / Tyler, Richard S / Waguespack, Richard / Whamond, Elizabeth J. ·Otolaryngology-Head and Neck Surgery, Johns Hopkins Outpatient Center, Baltimore, Maryland, USA dtunkel@jhmi.edu. · Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA. · Partnership for Health Analytic Research, LLC, Los Angeles, California, USA. · Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York, USA. · New York Otology, New York, New York, USA. · Department of Research and Quality Improvement, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA. · Divisions of Rhinology & Sinus Surgery and Facial Plastic & Reconstructive Surgery, University of Kentucky, Lexington, Kentucky, USA. · Department of Otolaryngology, University of Manitoba, Winnipeg, MB, Canada. · Department of Otolaryngology, Tulane University, New Orleans, Louisiana, USA. · Division of Geriatric Medicine and Aging, Columbia University, New York, New York, USA. · National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, Oregon, USA. · ENT Specialists of Northern Virginia, Falls Church, Virginia, USA. · Ochsner Health System, Kenner, Louisiana, USA. · Mitchell & Cavallo, P.C., Houston, Texas, USA. · Department of Otology and Neurotology, The George Washington University, Washington, DC, USA. · Department of Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA. · Morehouse School of Medicine, East Point, Georgia, USA. · Department of Head and Neck Imaging, Weill Cornell Medical Center, NewYork-Presbyterian Hospital, New York, New York, USA. · Department of Psychiatry, University of California, San Diego, La Jolla, California, USA. · Department of Medicine, UCLA Center for East-West Medicine, Los Angeles, California, USA. · Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, Iowa, USA. · Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama, USA. · Consumers United for Evidence-based Healthcare, Fredericton, New Brunswick, Canada. ·Otolaryngol Head Neck Surg · Pubmed #25274374.

ABSTRACT: The American Academy of Otolaryngology--Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Tinnitus. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 13 recommendations developed address the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation and measurement of the impact of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers.

2 Guideline Clinical practice guideline: Tympanostomy tubes in children. 2013

Rosenfeld, Richard M / Schwartz, Seth R / Pynnonen, Melissa A / Tunkel, David E / Hussey, Heather M / Fichera, Jeffrey S / Grimes, Alison M / Hackell, Jesse M / Harrison, Melody F / Haskell, Helen / Haynes, David S / Kim, Tae W / Lafreniere, Denis C / LeBlanc, Katie / Mackey, Wendy L / Netterville, James L / Pipan, Mary E / Raol, Nikhila P / Schellhase, Kenneth G. ·Department of Otolaryngology, State University of New York Downstate Medical Center, Brooklyn, New York 11201, USA. richrosenfeld@msn.com ·Otolaryngol Head Neck Surg · Pubmed #23818543.

ABSTRACT: OBJECTIVE: Insertion of tympanostomy tubes is the most common ambulatory surgery performed on children in the United States. Tympanostomy tubes are most often inserted because of persistent middle ear fluid, frequent ear infections, or ear infections that persist after antibiotic therapy. Despite the frequency of tympanostomy tube insertion, there are currently no clinical practice guidelines in the United States that address specific indications for surgery. This guideline is intended for any clinician involved in managing children, aged 6 months to 12 years, with tympanostomy tubes or being considered for tympanostomy tubes in any care setting, as an intervention for otitis media of any type. PURPOSE: The primary purpose of this clinical practice guideline is to provide clinicians with evidence-based recommendations on patient selection and surgical indications for and management of tympanostomy tubes in children. The development group broadly discussed indications for tube placement, perioperative management, care of children with indwelling tubes, and outcomes of tympanostomy tube surgery. Given the lack of current published guidance on surgical indications, the group focused on situations in which tube insertion would be optional, recommended, or not recommended. Additional emphasis was placed on opportunities for quality improvement, particularly regarding shared decision making and care of children with existing tubes. ACTION STATEMENTS: The development group made a strong recommendation that clinicians should prescribe topical antibiotic eardrops only, without oral antibiotics, for children with uncomplicated acute tympanostomy tube otorrhea. The panel made recommendations that (1) clinicians should not perform tympanostomy tube insertion in children with a single episode of otitis media with effusion (OME) of less than 3 months' duration; (2) clinicians should obtain an age-appropriate hearing test if OME persists for 3 months or longer (chronic OME) or prior to surgery when a child becomes a candidate for tympanostomy tube insertion; (3) clinicians should offer bilateral tympanostomy tube insertion to children with bilateral OME for 3 months or longer (chronic OME) and documented hearing difficulties; (4) clinicians should reevaluate, at 3- to 6-month intervals, children with chronic OME who did not receive tympanostomy tubes until the effusion is no longer present, significant hearing loss is detected, or structural abnormalities of the tympanic membrane or middle ear are suspected; (5) clinicians should not perform tympanostomy tube insertion in children with recurrent acute otitis media (AOM) who do not have middle ear effusion in either ear at the time of assessment for tube candidacy; (6) clinicians should offer bilateral tympanostomy tube insertion to children with recurrent AOM who have unilateral or bilateral middle ear effusion at the time of assessment for tube candidacy; (7) clinicians should determine if a child with recurrent AOM or with OME of any duration is at increased risk for speech, language, or learning problems from otitis media because of baseline sensory, physical, cognitive, or behavioral factors; (8) in the perioperative period, clinicians should educate caregivers of children with tympanostomy tubes regarding the expected duration of tube function, recommended follow-up schedule, and detection of complications; (9) clinicians should not encourage routine, prophylactic water precautions (use of earplugs, headbands; avoidance of swimming or water sports) for children with tympanostomy tubes. The development group provided the following options: (1) clinicians may perform tympanostomy tube insertion in children with unilateral or bilateral OME for 3 months or longer (chronic OME) and symptoms that are likely attributable to OME including, but not limited to, vestibular problems, poor school performance, behavioral problems, ear discomfort, or reduced quality of life and (2) clinicians may perform tympanostomy tube insertion in at-risk children with unilateral or bilateral OME that is unlikely to resolve quickly as reflected by a type B (flat) tympanogram or persistence of effusion for 3 months or longer (chronic OME).

3 Article Clinical practice guideline: tinnitus. 2014

Tunkel, David E / Bauer, Carol A / Sun, Gordon H / Rosenfeld, Richard M / Chandrasekhar, Sujana S / Cunningham, Eugene R / Archer, Sanford M / Blakley, Brian W / Carter, John M / Granieri, Evelyn C / Henry, James A / Hollingsworth, Deena / Khan, Fawad A / Mitchell, Scott / Monfared, Ashkan / Newman, Craig W / Omole, Folashade S / Phillips, C Douglas / Robinson, Shannon K / Taw, Malcolm B / Tyler, Richard S / Waguespack, Richard / Whamond, Elizabeth J. ·Otolaryngology-Head and Neck Surgery, Johns Hopkins Outpatient Center, Baltimore, Maryland, USA dtunkel@jhmi.edu. · Division of Otolaryngology-Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA. · Partnership for Health Analytic Research, LLC, Los Angeles, California, USA. · Department of Otolaryngology, State University of New York at Downstate Medical Center, Brooklyn, New York, USA. · New York Otology, New York, New York, USA. · Department of Research and Quality Improvement, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA. · Divisions of Rhinology & Sinus Surgery and Facial Plastic & Reconstructive Surgery, University of Kentucky, Lexington, Kentucky, USA. · Department of Otolaryngology, University of Manitoba, Winnipeg, Manitoba, Canada. · Department of Otolaryngology, Tulane University, New Orleans, Louisiana, USA. · Division of Geriatric Medicine and Aging, Columbia University, New York, New York, USA. · National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, Oregon, USA. · ENT Specialists of Northern Virginia, Falls Church, Virginia, USA. · Ochsner Health System, Kenner, Louisiana, USA. · Mitchell & Cavallo, P.C., Houston, Texas, USA. · Department of Otology and Neurotology, The George Washington University, Washington, DC, USA. · Department of Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA. · Morehouse School of Medicine, East Point, Georgia, USA. · Department of Head and Neck Imaging, Weill Cornell Medical Center, New York-Presbyterian Hospital, New York, New York, USA. · Department of Psychiatry, University of California, San Diego, La Jolla, California, USA. · Department of Medicine, UCLA Center for East-West Medicine, Los Angeles, California, USA. · Department of Otolaryngology-Head and Neck Surgery, The University of Iowa, Iowa City, Iowa, USA. · Department of Surgery, University of Alabama School of Medicine, Birmingham, Alabama, USA. · Consumers United for Evidence-Based Healthcare, Fredericton, New Brunswick, Canada. ·Otolaryngol Head Neck Surg · Pubmed #25273878.

ABSTRACT: OBJECTIVE: Tinnitus is the perception of sound without an external source. More than 50 million people in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. Despite the high prevalence of tinnitus and its potential significant effect on quality of life, there are no evidence-based, multidisciplinary clinical practice guidelines to assist clinicians with management. The focus of this guideline is on tinnitus that is both bothersome and persistent (lasting 6 months or longer), which often negatively affects the patient's quality of life. The target audience for the guideline is any clinician, including nonphysicians, involved in managing patients with tinnitus. The target patient population is limited to adults (18 years and older) with primary tinnitus that is persistent and bothersome. PURPOSE: The purpose of this guideline is to provide evidence-based recommendations for clinicians managing patients with tinnitus. This guideline provides clinicians with a logical framework to improve patient care and mitigate the personal and social effects of persistent, bothersome tinnitus. It will discuss the evaluation of patients with tinnitus, including selection and timing of diagnostic testing and specialty referral to identify potential underlying treatable pathology. It will then focus on the evaluation and treatment of patients with persistent primary tinnitus, with recommendations to guide the evaluation and measurement of the effect of tinnitus and to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers. ACTION STATEMENTS: The development group made a strong recommendation that clinicians distinguish patients with bothersome tinnitus from patients with nonbothersome tinnitus. The development group made a strong recommendation against obtaining imaging studies of the head and neck in patients with tinnitus, specifically to evaluate tinnitus that does not localize to 1 ear, is nonpulsatile, and is not associated with focal neurologic abnormalities or an asymmetric hearing loss. The panel made the following recommendations: Clinicians should (a) perform a targeted history and physical examination at the initial evaluation of a patient with presumed primary tinnitus to identify conditions that if promptly identified and managed may relieve tinnitus; (b) obtain a prompt, comprehensive audiologic examination in patients with tinnitus that is unilateral, persistent (≥ 6 months), or associated with hearing difficulties; (c) distinguish patients with bothersome tinnitus of recent onset from those with persistent symptoms (≥ 6 months) to prioritize intervention and facilitate discussions about natural history and follow-up care; (d) educate patients with persistent, bothersome tinnitus about management strategies; (e) recommend a hearing aid evaluation for patients who have persistent, bothersome tinnitus associated with documented hearing loss; and (f) recommend cognitive behavioral therapy to patients with persistent, bothersome tinnitus. The panel recommended against (a) antidepressants, anticonvulsants, anxiolytics, or intratympanic medications for the routine treatment of patients with persistent, bothersome tinnitus; (b) Ginkgo biloba, melatonin, zinc, or other dietary supplements for treating patients with persistent, bothersome tinnitus; and (c) transcranial magnetic stimulation for the routine treatment of patients with persistent, bothersome tinnitus. The development group provided the following options: Clinicians may (a) obtain an initial comprehensive audiologic examination in patients who present with tinnitus (regardless of laterality, duration, or perceived hearing status); and (b) recommend sound therapy to patients with persistent, bothersome tinnitus. The development group provided no recommendation regarding the effect of acupuncture in patients with persistent, bothersome tinnitus.

4 Article Does microtia predict severity of temporal bone CT abnormalities in children with persistent conductive hearing loss? 2013

Tekes, Aylin / Ishman, Stacey L / Baugher, Katherine M / Brown, David J / Lin, Sandra Y / Tunkel, David E / Unalp-Arida, Aynur / Huisman, Thierry A G M. ·Division of Pediatric Radiology, Department of Radiology and Radiological Science, Johns Hopkins Hospital, Baltimore, MD 21287-0842, USA. atekes1@jhmi.edu ·J Neuroradiol · Pubmed #23428239.

ABSTRACT: PURPOSE: This study aimed to determine the spectrum of temporal bone computed tomography (CT) abnormalities in children with conductive hearing loss (CHL) with and without microtia. PATIENTS AND METHODS: From 1993 to 2008, a total of 3396 pediatric records including CHL were reviewed at our institution and revealed 180 cases of persistent CHL, 46 of whom had diagnostic temporal bone CT examinations. All of these examinations were systematically reviewed by two pediatric neuroradiologists, working in consensus, who had 5 and 18 years, respectively, of dedicated pediatric neuroradiology experience. RESULTS: Of the 46 children, 16 were boys and 30 were girls (age: 0.2-16 years; mean: 5 years). Also, 21 (46%) children had microtia and 25 (54%) children did not, as determined by clinical evaluation. External auditory canal atresia/stenosis (EAC-A/S) was the most common anomaly in both microtia and non-microtia groups. Two or more anomalies were observed in 18/21 children with microtia. The frequency of EAC-A/S was greater in children with microtia versus those without it (86% versus 32%, respectively; P = 0.0003). Syndromic diagnoses were also significantly more frequently made in children with microtia versus those without microtia (76% versus 20%, respectively; P = 0.0001). Temporal bone CT scans were normal in 10 children (22%) with persistent CHL. CONCLUSION: Microtia is an important finding in children with CHL. EAC and middle ear/ossicle anomalies were significantly more frequently seen in children with microtia, and multiple anomalies and bilateral microtia were more common in children with syndromic associations. These findings highlight the importance of understanding the embryological development of the temporal bone. The presence of one anomaly should raise suspicion of the possibility of other anomalies, especially in the setting of microtia. Bilateral microtia and multiple anomalies should also raise suspicion of genetic syndromes.

5 Article Inner ear anomalies seen on CT images in people with Down syndrome. 2012

Intrapiromkul, Jarunee / Aygun, Nafi / Tunkel, David E / Carone, Marco / Yousem, David M. ·The Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins Medical Institutions, 600 N. Wolfe St., Phipps B100F, Baltimore, MD 21287, USA. ·Pediatr Radiol · Pubmed #22936282.

ABSTRACT: BACKGROUND: Although dysplasia of inner ear structures in Down syndrome has been reported in several histopathological studies, the imaging findings have not been widely studied. OBJECTIVE: To evaluate the prevalence and clinical significance of inner ear anomalies detected on CT images in patients with Down syndrome. MATERIALS AND METHODS: The temporal bone CT images of patients with Down syndrome were assessed for inner ear anomalies; clinical notes and audiograms were reviewed for hearing loss. Logistic regression models were employed to identify which CT findings were associated with sensorineural hearing loss (SNHL). RESULTS: Inner ear anomalies were observed in 74.5% (38/51) of patients. Malformed bone islands of lateral semicircular canal (LSCC), narrow internal auditory canals (IACs), cochlear nerve canal stenoses, semicircular canal dehiscence (SCCD), and enlarged vestibular aqueducts were detected in 52.5% (53/101), 24.5% (25/102), 21.4% (21/98), 8.8% (9/102) and 2% (2/101) of patients' ears, respectively. IAC stenosis had the highest odds ratio (OR = 5.37, 95% CI: 1.0-28.9, P = 0.05) for SNHL. CONCLUSION: Inner ear anomalies occurred in 74.5% of our population, with malformed (<3 mm) bone island of LSCC being the most common (52.5%) anomaly. Narrow IAC was seen in 24.5% of patients with Down syndrome and in 57.1% of ears with SNHL. High-resolution CT is a valuable for assessing the cause of hearing loss in people with Down syndrome.

6 Article Hearing loss in skeletal dysplasia patients. 2012

Tunkel, David / Alade, Yewande / Kerbavaz, Richard / Smith, Beth / Rose-Hardison, Danielle / Hoover-Fong, Julie. ·Department of Otolaryngology-Head and Neck Surgery, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland 21287-0910, USA. dtunkel@jhmi.edu ·Am J Med Genet A · Pubmed #22628261.

ABSTRACT: A hearing screening program was performed to determine the prevalence of hearing loss and abnormal tympanometry in individuals with short-stature skeletal dysplasias attending a national meeting. Behavioral audiometry, otoacoustic emission testing, and tympanometry were used to assess hearing. Failed hearing screen was defined as hearing ≥ 35 dB at one or more frequencies or by "fail" on otoacoustic emissions. One hundred ten of 112 subjects completed the screening. 58 (51.8%) were children. Seventy-three (65.2%) had achondroplasia, 34 (30.4%) had one of 11 other diagnoses, and 5(4.4%) were undiagnosed. 25.8% of children failed hearing screening in one or both ears, while 46.3% of adults failed in one or both ears. 55.1% of adults and 25.0% of children with achondroplasia failed screening. Abnormal hearing was also found in the some patients with spondyloepiphyseal dysplasia congenital (SEDC; 75%), diastrophic dysplasia (66%), and Morquio (66%). Hearing was normal in those with hypochondroplasia, pseudoachondroplasia, and microcephalic osteodysplastic primordial dwarfism. Tympanometry was abnormal in at least one ear in 53.3% of children and 38.5% of adults. Abnormal tympanometry in the absence of functioning tympanostomy tubes was associated with 9.5 greater odds of hearing loss in children and 2.8 greater odds of hearing loss in the total cohort. Only 3 (2.7%) respondents reported the use of hearing aids. Hearing loss and middle ear disease are common in both children and adults with skeletal dysplasia. Adults were more likely to fail hearing screening than children. Abnormal tympanometry is associated with hearing loss. Hearing screening with appropriate intervention is recommended for these patients.

7 Article Hearing screening in children with skeletal dysplasia. 2011

Tunkel, David E / Kerbavaz, Richard / Smith, Beth / Rose-Hardison, Danielle / Alade, Yewande / Hoover-Fong, Julie. ·Johns Hopkins Outpatient Center, 601 N Caroline St, Baltimore, MD 21287-0910, USA. dtunkel@jhmi.edu ·Arch Otolaryngol Head Neck Surg · Pubmed #22183904.

ABSTRACT: OBJECTIVE: To determine the prevalence of hearing loss and abnormal tympanometry in children with skeletal dysplasia. DESIGN: Clinical screening program. SETTING: National convention of the Little People of America. PATIENTS: Convenience sample of volunteers aged 18 years or younger with skeletal dysplasias. INTERVENTIONS: Hearing screening with behavioral testing and/or otoacoustic emissions, otoscopy, and tympanometry. MAIN OUTCOME MEASURES: A failed hearing screen was defined as hearing 35 dB HL (hearing level) or greater at 1 or more tested frequencies or by a "fail" otoacoustic emissions response. Types B and C tympanograms were considered abnormal. RESULTS: A total of 58 children (aged ≤18 years) with skeletal dysplasia enrolled, and 56 completed hearing screening. Forty-one children had normal hearing (71%); 9 failed in 1 ear (16%); and 6 failed in both ears (10%). Forty-four children had achondroplasia, and 31 had normal hearing in both ears (71%); 8 failed hearing screening in 1 ear (18%), and 3 in both ears (7%). Tympanometry was performed in 45 children, with normal tympanograms found in 21 (47%), bilateral abnormal tympanograms in 15 (33%), and unilateral abnormal tympanograms in 9 (20%). Fourteen children with achondroplasia had normal tympanograms (42%); 11 had bilateral abnormal tympanograms (33%); and 8 had unilateral abnormal tympanograms (24%). For those children without functioning tympanostomy tubes, there was a 9.5 times greater odds of hearing loss if there was abnormal tympanometry (P = .03). CONCLUSIONS: Hearing loss and middle-ear disease are both highly prevalent in children with skeletal dysplasias. Abnormal tympanometry is highly associated with the presence of hearing loss, as expected in children with eustachian tube dysfunction. Hearing screening with medical intervention is recommended for these children.