Pure-tone Air Conduction Audiometry Research Articles

Cardiometabolic diseases according to the type and degree of hearing loss in noise-exposed workers.

This study aimed to determine the association between cardiometabolic diseases, including metabolic syndrome, hypertension, and diabetes, and the type and degree of hearing loss in noise-exposed workers. A total of 237,028 workers underwent air conduction pure tone audiometry in 2015 to assess their health and diagnose cardiometabolic diseases. The study defined metabolic syndrome, hypertension, and diabetes using blood pressure, fasting blood sugar, cholesterol, and triglyceride levels. Mid-frequency hearing loss was defined as ≥ 30 dB at 2,000 Hz, whereas high-frequency hearing loss was ≥ 40 dB at 4,000 Hz. The average air conduction hearing thresholds at these frequencies were used to determine hearing loss degrees. The odds ratio (OR) of combined exposure to noise and night-shift work in all cardiometabolic diseases was higher than that of noise exposure alone. The risk of cardiometabolic diseases was dose-response, with higher hearing loss causing higher ORs. The ORs of hypertension compared with the normal group were 1.147 (1.098-1.198), 1.196 (1.127-1.270), and 1.212 (1.124-1.306), and those of diabetes were 1.177 (1.119-1.239), 1.234 (1.154-1.319), and 1.346 (1.241-1.459) for mild, moderate, and moderate-severe hearing loss, respectively. Workers who are exposed to noise tend to demonstrate high risks of hearing loss and cardiometabolic diseases; thus, bio-monitoring of cardiometabolic diseases, as well as auditory observation, is necessary.

The Benefit of Air Conduction Pure-Tone Audiometry as a Screening Method for Hearing Loss over the VAS Score.

Hearing loss is commonly encountered by general practitioners. We aimed to evaluate the screening benefit of air conduction pure-tone audiometry over visual analogue scale (VAS) scores for hearing loss. Moreover, we intended to perform the first cross-sectional study in Greece to assess hearing loss with pure-tone audiometry in young adults of the general population. We evaluated Greeks between 15 and 40 years old in a high school in Karditsa, Greece, and a primary health care unit in a nearby community. Subjects filled out a VAS score sheet and underwent pure-tone audiometry in a room without sound isolation, with air conduction only. We named the latter procedure modified pure-tone audiometry (mPTA). Subjects with pathologic results were examined via otoscopy and standardized pure-tone audiometry (sPTA). Of the 286 subjects evaluated, the VAS score revealed 5 subjects (1.7%) with hearing loss. mPTA (100 s duration) doubled this percentage (in total 3.8%; Pearson Chi-Square test; p < 0.001). Based on sPTA, the sensitivity and positive predictive value of the VAS score were 40% and 13%, respectively. For mPTA, they were 100% and 37%, respectively. mPTA filtered out pathologic cases in a proper, rapid, cheap and simple way and may be considered a proper screening method for hearing loss in primary health care.

Hearing Loss in Older People With Schizophrenia: Audiologic Characteristics and Association With Psychosocial Functioning

The severity and impact of hearing deficits among adults with schizophrenia spectrum disorders may become increasingly relevant with advancing age. This study evaluated hearing ability and associated psychosocial functioning among older adults aged 50-70. Cross-sectional analysis. Four outpatient psychiatry clinics in New York City. Individuals aged 50-70 years with diagnoses of schizophrenia or schizoaffective disorder. Unaided pure tone air conduction audiometry conducted using a portable audiometry system determined the pure tone average (PTA) hearing threshold across four frequencies: 500, 1k, 2k, and 4k Hz. Better ear PTA defined the hearing threshold. Audiometry data retrieved from the U.S. National Health and Nutrition Examination Survey aided interpretation of sample hearing loss rates. Standard measures evaluated psychiatric symptoms, perceived impact of hearing impairment, loneliness, and quality of life. Among audiometry completers (N = 40), 35% (n = 14) demonstrated subclinical hearing loss (16-25 dB) and 35% (n = 14) had mild or worse hearing loss (≥26 dB). Rates were higher than expected based on age-based population data. Those who perceived hearing handicap rated it moderate (12.2%) or severe (7.3%); those who perceived tinnitus rated the impact as mild to moderate (12.2%) or catastrophic (2.4%). Neither psychiatric symptoms nor interviewer-rated quality of life was associated with hearing ability. Greater loneliness was significantly correlated with worse audiologic performance (r = 0.475, p <0.01) and greater perceived hearing handicap (r = 0.480, p <0.01). Identifying the need for hearing loss treatment among aging adults with schizophrenia spectrum disorders is important given the potential implications for social functioning, cognitive, and mental health.

Occupational Lead Exposure Ototoxicity Evaluated With Distortion-Product Otoacoustic Emissions.

To evaluate the extent of hearing loss among pottery workers in Mexico exposed to lead. The authors conducted a cross-sectional study including 315 adult pottery workers. Auditory function was evaluated by air conduction pure-tone audiometry (pure-tone average) and distortion-product otoacoustic emission (DPOAE) levels (amplitude and signal-to-noise ratio). Lead exposure was assessed with a single blood sample test and classified as low, medium, and high according to blood lead tertiles. Logistic regression models were calculated for the association between blood lead levels, pure-tone average, and DPOAE records. Median (25th-75th) blood lead levels were 14 μg/dL (7.5-22.6 μg/dL). The audiometric pattern and DPOAE records were similar across blood lead levels groups in all frequencies, and no statistically significant differences were found. Adjusted logistic regression models showed no increase in the odds for hearing thresholds >25 dB (HL) and DPOAE absence associated with blood lead levels, and no dose-response pattern was observed ( p > 0.05). Given the results from this cross-sectional study, no association was found between blood lead levels and hearing loss assessed with DPOAE. Future longitudinal work should consider chronic lead exposure estimates among underrepresented populations, which can potentially inform safer work practices to minimize the risk of ototoxicity.

Hearing Aids Reduce Self-Perceived Difficulties in Noise for Listeners With Normal Audiograms.

This study assessed hearing aid benefits for people with a normal audiogram but hearing-in-noise problems in everyday listening situations. Exploratory double-blinded case-control study whereby participants completed retrospective questionnaires, ecological momentary assessments, speech-in-noise testing, and mental effort testing with and without hearing aids. Twenty-seven adults reporting speech-in-noise problems but normal air conduction pure-tone audiometry took part in the study. They were randomly separated into an experimental group that trialed mild-gain hearing aids with advanced directional processing and a control group fitted with hearing aids with no gain or directionality. Self-reports showed mild-gain hearing aids reduce hearing-in-noise difficulties and provide a better hearing experience (i.e., improved understanding, participation, and mood). Despite the self-reported benefits, the laboratory tests did not reveal a benefit from the mild-gain hearing aids, with no group differences on speech-in-noise tests or mental effort measures. Further, participants found the elevated cost of hearing aids to be a barrier for their adoption. Hearing aids benefit the listening experience in some listening situations for people with normal audiogram who report hearing difficulties in noise. Decreasing the price of hearing aids may lead to greater accessibility to those seeking remediation for their communication needs.

Associations Between Cardiovascular Risk Factors and Audiometric Hearing: Findings From the Canadian Longitudinal Study on Aging.

The objectives of the study were to determine, among a population-based sample of Canadian adults, if risk factors for cardiovascular disease (alone and in combination) were associated with hearing loss. Cross-sectional and longitudinal associations (the latter with about 3 years of follow-up) were examined. Risk factors considered included diabetes, dyslipidemia, hypertension, obesity, and smoking. We also aimed to determine if associations were modified by sex and age group (45 to 54, 55 to 64, 65 to 74, and 75 to 86 years old at baseline). A secondary analysis of data collected for the Canadian Longitudinal Study on Aging was performed. Data were collected in two waves, the first between 2012 and 2015, and the second between 2015 and 2018. Hearing was measured using screening air-conduction pure-tone audiometry. The outcome of interest was defined as the mid-frequency (1000, 2000, 3000, and 4000 Hz) pure-tone average for both ears. Diabetes was defined based on self-reported physician diagnosis, use of diabetes medications, or a hemoglobin A1c level ≥6.5%. Dyslipidemia was determined by blood lipid profile as defined using the Canadian guidelines for the diagnosis and treatment of dyslipidemia (low-density lipoprotein cholesterol ≥3.5 mmol/L or non-high-density lipoprotein cholesterol ≥4.3 mmol/L). Hypertension was determined by self-reported physician diagnosis or an average systolic blood pressure ≥140 mm Hg or an average diastolic blood pressure ≥90 mm Hg. Obesity was defined as a waist-to-height ratio ≥0.6. Smoking history was determined by self-report (current/former/never-smoker). Two composite measures of cardiovascular risk were also constructed: a count of the number of risk factors and a general cardiovascular risk profile (Framingham) score. Independent associations between risk factors for cardiovascular disease and hearing were determined using multivariable regression models. Survey weights were incorporated into the analyses. All results were disaggregated by sex. Effect modification according to age was determined using multiplicative interaction terms between the age group and each of the risk factor variables. A complete case (listwise deletion) approach was performed for the primary analysis. We then repeated the multivariable regression analyses using multiple imputation using chained equations to determine if the different approaches to dealing with missing data qualitatively changed the outcomes. In longitudinal analyses, hypertension and the general cardiovascular risk profile score were associated with greater loss of hearing over the 3-year follow-up period for both sexes. In addition, smoking in males and obesity in females were associated with faster rates of hearing decline. In cross-sectional analyses, smoking, obesity, diabetes, and composite measures were each independently associated with worse hearing for both sexes (although for females, obesity was only associated with hearing loss in the 55 to 64-year-old age group). The results were similar for the complete case and multiple imputation approaches, but more cross-sectional associations were observed using multiple imputation. Diabetes, obesity, hypertension, and smoking were associated with hearing loss. Higher combinations of risk factors increased the risk of hearing loss. Further studies are needed to confirm age and sex differences and whether interventions to address these risk factors could slow the progression of hearing loss in older adults.

Auditory Function in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol Up Young Adults: A Pilot Study.

To collect and compare selected hearing measures in a pilot study of young adults with perinatally acquired HIV (YAPHIV) and those with perinatal HIV exposure who are uninfected young adults with PHEU (YAPHEU). Cross-sectional hearing measures in YAPHIV and YAPHEU enrolled in the Pediatric HIV/AIDS Cohort Study Adolescent Master Protocol (AMP) for Participants 18 Years of Age and Older (AMP Up). Pure-tone air conduction audiometry and distortion product otoacoustic emission (DPOAE) data were collected in 1 visit. A low-frequency pure-tone average (PTA) (LFPTA, at 0.25, 0.5, 1, and 2 kHz), a speech-frequency PTA (SFPTA, at 0.5, 1, 2, and 4 kHz), and a high-frequency PTA (HFPTA, at 3, 4, 6, and 8 kHz) were calculated. Hearing loss was defined as worse ear SFPTA of ≥20 dB HL. Separate linear regression models were fit for worse ear LFPTA, SFPTA, and HFPTA to assess associations with PHIV status. DPOAE signal-to-noise ratios (SNRs) were obtained at 3 frequencies in each ear. Forty-seven YAPHIV and 9 YAPHEU completed hearing testing. All adjusted mean PTAs were similar between YAPHIV and YAPHEU. Hearing loss occurred more in YAPHIV (7/47, 15.2%; 95% CI: 6.3%-28.9%), compared with YAPHEU (0/9, 0%). No associations were detected between HIV disease severity measures and worse ear SFPTA. DPOAE SNRs were similar between YAPHIV and YAPHEU. In this pilot study, peripheral hearing (ie, PTAs) and cochlear function (ie, DPOAEs) were similar between YAPHIV and YAPHEU. A larger study is warranted to confirm these findings.

Clinical comparison of two automated audiometry procedures.

ObjectiveAutomated pure-tone audiometry has been shown to provide similar hearing threshold estimates to conventional audiometry, but lower correlations were reported at high and low frequencies in audiometric tests than those of manual tests, while the correlations were better in the middle frequencies. In this paper, we used the same equipment and different test procedures for automated testing, and compared the results with manual test results.DesignOne hundred subjects aged 18–36 years were randomly divided into two groups to perform air-conduction pure-tone audiometry (0.25, 0.5, 1, 2, 4, 8 kHz) using the ascending and shortened ascending protocols built-in to the automated audiometer, respectively. Recorded testing time, the total number of responses and the subject’s preference tests were compared with those of manual tests.ResultsSignificant difference was found at 250 Hz regarding the distribution of the absolute difference between the two automated and the manual thresholds. The testing time spend in the ascending method (9.8 ± 1.4 min, mean ± SD) was significantly longer than in the shorted ascending method (5.8 ± 0.9 min). The total numbers of responses of the ascending method (90.5 ± 10.8 times) and shorted ascending method (62.0 ± 11.4 times) were significantly different. Finally, no significant difference was found in preferences between automated and manual procedures.ConclusionThe shorted ascending method can save lots of testing time. The difference between the two automated thresholds at 250 Hz is caused by the different test procedures, and the difference at 8,000 Hz between the automated test and the manual test can be due to the transducer types and allowable differences in calibration.

User-operated audiometry – an evaluation of expert vs. non-expert headphone placement

Objective User-operated audiometry faces multiple barriers. One of these is the concern of audiologists that patients (non-experts) placing headphones by themselves results in invalid hearing thresholds due to greater placement variability. Design Comparative study. Participants took the AMTAS pure-tone air-conduction audiometry under two different conditions, expert and non-expert circumaural headphone placement for five frequencies within the range 250–8000 Hz. Questionnaires were also used to gain insight into the usability of the user-operated audiometry system – as well as the participants’ perceived handling of the audiometry headphones. Study sample Thirty participants (mean age 67.5 years). Results No statistically significant mean differences in hearing thresholds between the expert and non-expert conditions were found. The mean system usability scale score was 84.5. Handling the headphones was also rated as being easy (30%) or very easy (60%) by most non-experts. Conclusion The conclusion of the study is that non-experts can be trusted to properly equip a pair of circumaural audiometry headphones for the correct conduction of pure-tone audiometry with only a few digital instructions.

Outcomes of Anterior Scutum-Anchoring Tympanoplasty for Reconstruction of Tympanic Membrane Perforation Extending to Anterosuperior Quadrant

Background and Objectives It can be troublesome to repair tympanic membrane (TM) perforation extending to anterosuperior quadrant (ASQ). Underlay technique may cause re-perforation at ASQ, whereas overlay technique may result in anterior blunting or lateral healing of TM, causing conductive hearing loss. Anterior scutum-anchoring tympanoplasty (ASAT) can be a good alternative to repair TM perforation involving ASQ. ASAT is a variant of classic underlay tympanoplasty during which a graft is overlayed only at anterosuperior aspect by way of inserting a graft between the bony and fibrous annulus and anchoring the anterosuperior end of graft on the anterior scutum. This study was performed to assess the outcome of ASAT.Subjects and Method The medical records of patients with chronic otitis media who received type 1 tympanoplasty between April 2014 and August 2019 were reviewed. Depending on the size of the TM perforation, patients were classified into four groups. The tympanic graft success rate, complication rate, and hearing improvement were evaluated by group.Results The 82 ears of 78 patients were included for the study. At the most recent examination after 6 months of surgery, the graft success rate was 100% in all four groups. There were no postoperative complications. The mean hearing threshold was improved at 17.2 dB HL in air-conduction pure tone audiometry after surgery.Conclusion ASAT is a reliable and easily performable technique to repair TM perforation extending to ASQ with a high graft success rate and good postoperative hearing.

The Associations of Hearing Sensitivity and Different Cognitive Functions with Perception of Speech-in-Noise.

Impaired speech-in-noise perception affects individuals' daily lives and is a frequent symptom of age-related hearing loss, which is a common disabling condition and a health concern in aging populations. The relative impact of hearing sensitivity loss and different cognitive functions on speech-in-noise perception is not well understood. We aimed to assess to what extent hearing sensitivity and different cognitive functions were associated with sentence-in-noise performance across the adult lifespan. This study is based on data of 2585 participants of the Rhineland Study, which is a German community-based cohort study of persons of age 30 years and older. We assessed speech-in-noise with a sentence-in-noise test (Göttinger Satztest), hearing sensitivity thresholds (air conduction pure-tone audiometry [PTA] average of 0.5, 1, 2, and 4 kHz), and the following cognitive domains: crystallized intelligence (German Mehrfachwahl-Wortschatz-Intelligenztest, MWT-B), executive functioning (Trail Making Test B, TMT), working memory (Digit Span forward, DS), and long-term memory (Verbal Learning and Memory Test delayed recall; VLMT). We examined the association between hearing sensitivity and cognitive functions with sentence-in-noise perception using a multivariable linear regression model adjusted for age, sex, and multiple potential confounders. Better hearing sensitivity was associated with better speech-in-noise perception (0.25 signal noise ratio [SNR] dB HL decrease per 5 dB HL decrease in PTA; 95% confidence interval [CI]: 0.20 to 0.25; p < 0.001). Better cognitive performance was also associated with better speech-in-noise perception, but to a lesser extent. Crystallized intelligence (MWT-B) showed an effect size of -0.10 SNR dB HL decrease per SD (95% CI: -0.14 to -0.06; p < 0.001), executive functioning (TMT) of -0.08 SNR dB HL decrease per SD (95% CI: -0.13 to -0.03; p = 0.002), working memory (DS) of -0.04 SNR dB HL decrease per SD (95% CI: -0.08 to -0.003; p = 0.03), and long-term memory (VLMT) of -0.03 SNR dB HL decrease per SD (95% CI: -0.07 to 0.01; p = 0.12). The standardized effect of hearing sensitivity (ß = 0.34) on speech-in-noise perception was four to five times larger than the effects of crystallized intelligence (ß = -0.08) and executive functioning (ß = -0.06). Hearing sensitivity was the strongest determinant of sentence-in-noise perception in adults above the age of 30. We determined the relative effect of different cognitive functions on sentence-in-noise perception. Crystallized intelligence and executive functions showed stronger associations while working and long-term memory functions had much smaller independent effects. Our results contribute to the understanding of determinants of speech-in-noise perception in aging adults.

Validation of a Personalized Hearing Screening Mobile Health Application for Persons with Moderate Hearing Impairment.

Hearing impairment is a frequent human sensory impairment. It was estimated that over 50% of those aged >75 years experience hearing impairment in the United States. Several hearing impairment–related factors are detectable through screening; thus, further deterioration can be avoided. Early identification of hearing impairment is the key to effective management. However, hearing screening resources are scarce or inaccessible, underlining the importance of developing user-friendly mobile health care systems for universal hearing screening. Mobile health (mHealth) applications (apps) act as platforms for personalized hearing screening to evaluate an individual’s risk of developing hearing impairment. We aimed to evaluate and compare the accuracy of smartphone-based air conduction and bone conduction audiometry self-tests with that of standard air conduction and bone conduction pure-tone audiometry tests. Moreover, we evaluated the use of smartphone-based air conduction and bone conduction audiometry self-tests in conductive hearing loss diagnosis. We recruited 103 patients (206 ears) from an otology clinic. All patients were aged ≥20 years. Patients who were diagnosed with active otorrhea was excluded. Moderate hearing impairment was defined as hearing loss with mean hearing thresholds >40 dB. All patients underwent four hearing tests performed by a board-certified audiologist: a smartphone-based air conduction audiometry self-test, smartphone-based bone conduction audiometry self-test, standard air-conduction pure-tone audiometry, and standard bone conduction pure-tone audiometry. We compared and analyzed the results of the smartphone-based air conduction and bone conduction audiometry self-tests with those of the standard air conduction and bone conduction pure-tone audiometry tests. The sensitivity of the smartphone-based air conduction audiometry self-test was 0.80 (95% confidence interval CI = 0.71–0.88) and its specificity was 0.84 (95% CI = 0.76–0.90), respectively. The sensitivity of the smartphone-based bone conduction audiometry self-test was 0.64 (95% CI = 0.53–0.75) and its specificity was 0.71 (95% CI = 0.62–0.78). Among all the ears, 24 were diagnosed with conductive hearing loss. The smartphone-based audiometry self-tests correctly diagnosed conductive hearing loss in 17 of those ears. The personalized smartphone-based audiometry self-tests correctly diagnosed hearing loss with high sensitivity and high specificity, and they can be a reliable screening test to rule out moderate hearing impairment among the population. It provided patients with moderate hearing impairment with personalized strategies for symptomatic control and facilitated individual case management for medical practitioners.

1489Hearing loss before and after COVID-19 pandemic

Abstract Background Hearing loss is a major issue in public health. It is caused by infections, loud sounds, chronic diseases, and aging. COVID-19 pandemic occurred in 2020 dramatically changed people’s lifestyle. People stay at home, more frequently use online materials and communication, thus may use an earphone continuously. This study aimed to examine whether COVID-19 pandemic has an impact on hearing ability in Japan. Methods The persons who attended annual health check-ups in a regional examination center in 2019 were compared to those attended in 2020. The study participants were taken an informed written consent. Hearing loss was defined as hearing threshold of &amp;gt; 30 dB at 1 kHz and 4 kHz in either ear with pure-tone air-conduction audiometry. The rates of hearing loss were compared with the adjustment of age and sex. Two-sided p value &amp;lt;0.05 was considered statistically significant. Results Among 3351 participants in 2019, and 3762 participants in 2020, males were 57.5% and 56.2%, median age was 48.0 and 48.5 years, respectively. Overall rate of hearing loss was 13.7% and 16.2% in 2019 and 2020, respectively. After controlling with age and sex, the rate of hearing loss showed significant increase in 2020 (p &amp;lt; 0.05). The increase was observed in both age groups of 18-49 and 50-70 years (p&amp;lt;0.05). Conclusions This study showed the prevalence of hearing loss was increased across ages after COVID-19 pandemic. Key messages Hearing ability may have been affected by lifestyle changes due to COVID-19 pandemic.

Acute Recreational Noise-Induced Cochlear Synaptic Dysfunction in Humans With Normal Hearing: A Prospective Cohort Study

ObjectivesThe objective of the study was to identify the acute high-intensity recreational noise-induced effects on auditory function, especially the cochlear synaptopathy-related audiological metrics, in humans with normal hearing.MethodsThis prospective cohort study enrolled 32 young adults (14 males and 18 females); the mean age was 24.1 ± 2.4 years (ranging from 20 to 29). All participants with normal hearing (audiometric thresholds ≤25 dB HL at frequencies of 0.25, 0.5, 1, 2, 3, 4, 6, and 8 kHz for both ears) had already decided to participate in the outdoor music festival. Participants were asked to measure the noise exposure dose and complete auditory examinations, including the air-conduction pure-tone audiometry (PTA), distortion product otoacoustic emission (DPOAE), contralateral suppression (CS) on transient evoked otoacoustic emission (TEOAE), auditory brainstem response (ABR) test and Mandarin Hearing in Noise Test (MHINT), at baseline and 1 day and 14 days after music festival noise exposure.ResultsThe mean time of attending the music festival was 7.34 ± 0.63 h (ranging from 6.4 to 9.5), the mean time-weighted average (TWA) of noise exposure dose was 93.2 ± 2.39 dB(A) (ranging from 87.9 to 97.7). At neither 1 day nor 14 days post exposure, there were no statistically significant effects on PTA thresholds, DPOAE amplitudes, CS on TEOAEs, or MHINT signal-to-noise ratios (SNRs) of acute outdoor music festival noise exposure, regardless of sex. While the ABR wave I amplitudes significantly decreased at 1 day after exposure and recovered at 14 days after exposure, the exposed/unexposed ABR wave I amplitude ratio was significantly correlated with MHINT SNR change at 1 day after exposure, although it was not correlated with the noise exposure dose.ConclusionIn young adults with normal hearing, we found the self-compared decrement of ABR wave I amplitudes at 1 day post acute recreational noise exposure at high intensity, which also contributes to the change in speech perceptual ability in noisy backgrounds. This study indicated that auditory electrophysiological metric changes might be a more sensitive and efficient indicator of noise-induced cochlear synaptic dysfunction in humans. More attention should be paid to the recreational noise-induced cochlear synaptopathy and auditory perceptual disorder.

Middle Ear Implant for Sensorineural and Conductive Hearing Loss: Indications and Audiological Results

Background and Objectives Middle ear implants (MEI) have been reported to be an effective and safe alternative for the treatment of sensorineural hearing loss (SNHL) and conductive hearing loss (CHL). This study aimed to compare the functional outcomes between SNHL and CHL in terms of audiological gains.Subjects and Method The medical records of 14 consecutive SNHL and CHL patients who underwent MEI surgeries from 2015 to 2019 by a single surgeon were retrospectively reviewed. Audiological changes using hearing aids (HA) and MEI were compared.Results In SNHL, the mean unaided air-conduction pure tone audiometry (PTA), (57.7 dB HL) decreased significantly using HA and MEI (44.7 and 41.4 dB HL), but with no significant difference from each other. Unaided word recognition score (WRS) at 65 dB HL (45.1%) was significantly improved using HA and MEI (72.6% and 76.6%), with no significant difference. In CHL, the mean unaided air-conduction and bone-conduction PTA were 77.1 (57.5-93.8) and 44.1 (26.3-57.5) dB HL. Three patients could not use conventional HAs due to otorrhea and deformity of the external auditory canal by previous surgeries and 4 patients had used conventional HAs before MEI. Though both HA and vibrant soundbridge (VSB) showed improvement of hearing thresholds (32.0 and 48.8 dB HL) and WRS (80.0% and 94.9%), it was significant only when using VSB. There was no significant difference between HA and VSB.Conclusion MEI can be an effective treatment option for both SNHL and CHL patients, especially for those who suffered from problems using conventional HA.

Endoscopic Tympanoplasty: Inlay Cartilage Versus Underlay Cartilage Graft

Aim: Several graft placement methods have been described in tympanoplasty. The aim of this study is to assess the surgical effects of the endoscopic tympanoplasty utilizing inlay cartilage or underlay cartilage graft. Methods: We reviewed medical records of 123 patients who experienced endoscopic tympanoplasty for chronic otitis media with a minimum twelve-month follow-up period. Perforations were divided into central, posterior, and anterior ones based on the place of the perforation to malleus handle. Graft success rate, air conduction pure tone audiometry (PTA) before surgery and after surgery, hearing gain and air bone gap (ABG) reduction were calculated following surgery. Results: No significant difference was found between the groups in terms of the distribution of the follow-up period, age, perforation location, and gender (p&gt;0.05). The average air conductions (AC) before surgery and after surgery for the inlay group were 36.3 ± 13.7 dB and 25.4 ± 12.3 dB 6 months after surgery and 22.5 ± 10.5 dB 12 months after surgery. They were 35.6 ± 13.3 dB and 24.8 ± 12.4 dB 6 months after surgery and 22.7 ± 9.7 12 months after surgery for the underlay group. A significant difference was found between the two groups in terms of ABG (P=0.037). There was no significant difference in the mean ABG in each group (small perforation P =0.473, medium perforation P=0.876 and large perforation P=0.341). Conclusion: The inlay method can be used with high graft success rate, low risk of complications among the appropriate patients, and shorter operation time as a reliable surgical option for treatment.

Serum per- and polyfluoroalkyl substances in relation to hearing loss

Background: Studies have shown that per- and polyfluoroalkyl substances (PFAS) are potential ototoxicants. However, no epidemiologic study has been conducted. We conducted a cross-sectional study to examine the associations of PFAS with hearing impairment. Methods: This study included data from the National Health and Nutrition Examination Survey (NHANES) 1999-2000, 2003-06, and 2009-14 because only these year cycles contained all the information we needed. Perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA) were measured in serum samples. Participants were divided into quartiles for each PFAS. Air conduction pure-tone audiometry was administered. Hearing impairment was defined as an average hearing threshold of more than 25dB at each hearing frequency. We assessed the relation of serum PFAS with hearing impairment by the generalized linear mixed model with a logit link and binary distribution. Tests for linear trend across quartiles of serum PFAS were conducted using the median serum PFAS in each quartile as a continuous variable. Results: A total of 2525 participants (women = 53.4%) aged 20 or above were included into the final analysis. After adjusted for age, sex, body mass index, education, ethnicity group, family income, and sampling weights, we found positive correlations between PFOA and hearing impairment at 2000 Hz (p-trend = 0.02) and 3000 Hz (p-trend = 0.01); between PFOS and hearing impairment at 2000 Hz (p-trend &lt; 0.01) and 3000 Hz (p-trend = 0.01); between PFNA and hearing impairment at 3000 Hz (p-trend &lt; 0.01), 4000 Hz (p-trend &lt; 0.01), and 8000 Hz (p-trend = 0.03); between PFHxS and hearing impairment at 500 Hz (p-trend = 0.02), 1000 Hz (p-trend = 0.01), 2000 Hz (p-trend &lt; 0.01), and 3000 Hz (p-trend = 0.03). Conclusion: Background serum PFASs are correlated with hearing impairment in the United States adult population.

Serum Per- and Polyfluoroalkyl Substances Are Associated with Increased Hearing Impairment: A Re-Analysis of the National Health and Nutrition Examination Survey Data.

Although studies have shown that per- and polyfluoroalkyl substances (PFAS) are potential environmental ototoxicants, epidemiologic study has been limited. I conducted a cross-sectional study to re-examine the associations between PFAS and hearing impairment. Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999–2000, 2003-06, 2009-12, and 2015-16. Perfluorooctanoic acid (PFOA), perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA) were measured in serum samples. Participants were divided into quartiles for each PFAS. Air conduction pure-tone audiometry was administered. Hearing impairment (1: yes, 0: no) was defined as a hearing threshold of more than 25 dB at 500, 1000, 2000, 4000, and 8000 Hz in the worse ear. I assessed the relation of serum PFAS with hearing impairment by the generalized linear mixed model with a logit link and binary distribution. Tests for linear trend across quartiles of serum PFAS were conducted using the median serum PFAS in each quartile as a continuous variable. After adjusting for age, sex, body mass index, education, ethnicity group, and family income, I found positive correlations between PFOA and hearing impairment at 2000 Hz (p-trend < 0.01) and 3000 Hz (p-trend = 0.02); between PFOS and hearing impairment at 500 Hz (p-trend < 0.01), 2000 Hz (p-trend < 0.0001) and 3000 Hz (p-trend = 0.02); between PFNA and hearing impairment at 2000 Hz (p-trend = 0.05), 3000 Hz (p-trend < 0.01), 4000 Hz (p-trend = 0.02), and 8000 Hz (p-trend < 0.01); between PFHxS and hearing impairment at 500 Hz (p-trend = 0.04), 1000 Hz (p-trend = 0.03), and 2000 Hz (p-trend < 0.01). However, some of the findings were not significant when only comparing the highest with the lowest quartile of PFASs. In conclusion, several background serum PFASs are positively correlated with hearing impairment in the United States adult population.

White-matter integrity and hearing acuity decline in healthy subjects: Magnetic resonance tractography.

The association between hearing acuity and white-matter (WM) microstructure integrity was evaluated in a normal healthy population with a variety of hearing acuity using an automated tractography technique known as TRACULA (TRActs Constrained by UnderLying Anatomy) in order to investigate whether hearing acuity decline is correlated with brain structural connectivity. Forty healthy controls were recruited to this study, which used a Siemens 3T Trio with a standard eight-channel head coil. Hearing acuity was assessed using pure-tone air conduction audiometry (Amplivox 2160, with Audiocups to eliminate noise and allow accurate pure-tone audiometry). Handedness and anxiety and depression were assessed for all participants in this study using the Edinburgh Handedness Inventory and the Hospital Anxiety and Depression Scale, respectively. This study showed a significant reduction in WM volume of the left cingulum angular bundle (CAB; t = 2.32, p = 0.02) in the mild to moderate hearing-loss group (238 ± 223 mm2) compared to the group with normal hearing (105 ± 121 mm2). The WM integrity of the left CAB was found to be significantly different (t = 2.06, p = 0.04) in the mild to moderate hearing-loss group (0.18 ± 0.06 mm2/s) compared to the group with normal hearing (0.22 ± 0.05 mm2/s). The WM integrity of the left anterior thalamic radiation (ATR) was found to be significantly different (t = 2.58, p = 0.014) in the mild to moderate hearing-loss group (0.33 ± 0.05 mm2/s) compared to the group with normal hearing (0.37 ± 0.03 mm2/s). A significant negative correlation was found between age and the WM integrity of the right ATR (r = -0.33, p = 0.038), and between hearing acuity and the WM integrity of the right ATR (r = -0.38, p = 0.013) and left CAB (r = -0.36, p = 0.019). Discussion and conclusion: An important finding in this study is that brain structural connectivity changes in the left hemisphere seem to be associated with age-related hearing loss found mainly in the ATR and CAB tracts.

Hearing thresholds and cognitive flexibility in young healthy individuals with normal hearing

Objective: Pure tone audiometry may seem to be a relatively easy task for the participant but it may involve cognitive as well as sensory abilities. The aim of this study is to examine the relationship between hearing thresholds in the frequency range 0.125–8 kHz and the core executive function cognitive flexibility in healthy individuals with normal hearing.Design: Experimental study measuring correlations between different pure-tone hearing threshold measures and cognitive flexibility. Pure tone air conduction audiometry (frequencies 0.125–8.0 kHz) and two tests of cognitive flexibility (information updating and shifting ability) were conducted.Study sample: Seventy-two subjects (aged between 21 and 36) with normal hearing (<20 dB HL) for the tested frequencies.Results: Four measures of average pure tone hearing thresholds were negatively correlated with cognitive flexibility.Conclusions: Pure-tone air conduction hearing thresholds seem to be related to cognitive flexibility in healthy individuals with normal hearing.