Air Conduction Pure-tone Averages Research Articles

Management of incus necrosis in revision stapedectomy using hydroxyapatite bone cement.

Review audiological outcomes after revision stapedectomy using hydroxyapatite cement. Retrospective case review. Tertiary neurotological referral center. Thirty-seven cases of previously treated otosclerosis where incus erosion was observed during revision stapedectomy. Hydroxyapatite cement was used to rebuild the eroded incus and stabilize the prosthesis during revision stapedectomy. Pre- and postoperative bone conduction (BC) and air conduction (AC) pure-tone averages (PTA) (0.5, 1, 2, 3 kHz) including high tone BC (1, 2, 4 kHz), air-bone gap (ABG), and speech discrimination scores were measured. Short-term (3 wk) and longer-term (average 12 mo) hearing outcomes were measured. Data are reported according to the most recent guidelines of the AAO-HNS Committee on Hearing and Equilibrium. Among 37 ears undergoing revision stapedectomy with hydroxyapatite cement, the AC PTA was 59.8 dB preoperatively and 34.6 dB postoperatively (p < 0.0001) at latest follow-up. The mean postoperative ABG was 8.8 dB (SD = 8.6, range -1.3-36.3 dB) while a mean improvement of 2.1 dB (SD = 6.5, range -8.33-15.0 dB) of the high tone BC PTA was observed. One revision case was noted during the follow-up period. Hydroxyapatite cement is useful to reconstruct and stabilize the prosthesis in revision stapedectomy when erosion of the long process is encountered. Short- and longer-term hearing results are favorable when compared to previously reported results of revision stapedectomy.

Outcomes following Semicircular Canal Plugging.

To examine audiometric outcomes, symptom control rates, and complication rates following semicircular canal plugging for superior semicircular canal dehiscence syndrome. Retrospective chart review. Private, neurotologic tertiary referral center. Patients undergoing semicircular canal plugging for superior semicircular canal dehiscence syndrome from January 1, 2007, to December 31, 2012. Pre- and postoperative audiometry, vestibular testing, operative findings, and clinical symptoms were assessed through chart review. A total of 24 ears underwent a canal plugging procedure during the study period for superior canal dehiscence syndrome. Pre- and postoperative air conduction pure-tone averages were 21.1 and 22.5 dB (P = .42, not significant [NS]). The average pre- and postoperative word recognition scores were 95.8% and 95.1% (P = .48, NS). Vestibular evoked myogenic potential data showed reduced thresholds in 7 patients with canal dehiscence. Complications were limited to a single, temporary facial weakness. Complete symptom improvement was noted in 35.7% of all patients, while at least partial symptom improvement was found in over 80% of patients. Semicircular canal plugging procedures are associated with excellent hearing outcomes and may reduce preoperative symptoms in patients with superior semicircular canal dehiscence.

Preliminary Functional Results and Quality of Life After Implantation of a New Bone Conduction Hearing Device in Patients With Conductive and Mixed Hearing Loss

To review functional results and quality of life of the first patients implanted with a newly introduced bone conduction implant system. Retrospective chart analysis of 6 patients (6 ears) implanted for conductive hearing loss (CHL) and mixed hearing loss (MHL) in 1 tertiary referral center between July 2012 and February 2013. Implantation of a new bone conduction hearing device. Pure tone audiometry (air conduction and bone conduction thresholds, pure tone average, air-bone gap, and functional gain), speech audiometry (Freiburg Monosyllabic Test), intraoperative and postoperative complication rate, and patient satisfaction (Glasgow benefit inventory [GBI]) were assessed. Air-conduction pure tone average (PTA) was 58.8 ± 8.2 dB HL. Unaided average air-bone gap (ABG) was 33.3 ± 6.2 dB. Aided air-conduction PTA in sound field was 25.2 ± 5.1 dB HL. Aided average ABG was -0.3 ± 7.3 dB. Average functional gain was 33.6 ± 7.2 dB. Mean improvement of GBI was +36.1. No intraoperative complications occurred. During a follow-up period of 8.5 ± 2.2 months, no device failure and no need for revision surgery occurred. Audiometric results of the new bone conduction hearing system are satisfying and comparable to the results of devices that have been applied previously for CHL and MHL. Intraoperatively and postoperatively, no complications were noted.

Cortical bone total ossicular replacement prosthesis

Objectives: Evaluate an autologous cortical bone total ossicular replacement prosthesis (B TORP) made of cortical bone for cost effective and sustainable hearing results. Materials and Methods: A prospective study was undertaken in the patients who underwent tympanoplasty with new B-TORP from January 2011 to December 2011. All patients had an absent superstructure of the stapes and long process of the incus due to chronic otitis media. Totally 40 patients were evaluated. Hearing results were evaluated using four-frequency average pure tone air conduction and air-bone gap (ABG) measured at 0.5, 1, 2, and 3 kHz after a period of 12 months. Pre- and post-operative continuous variables were compared using a paired t-test and data from unequal groups were assessed for significant differences using unpaired t-test. Results: Successful rehabilitation of the ABG to 20 dB or less was achieved in 95% of patients. Overall mean improvement in ABG was 25.8 ± 5.6 dB, which was statistically significant (t = 26.8, P 0.5). Conclusion: The new autologous B-TORP provides sustainable hearing improvement and is bio-compatible, stable, and magnetic resonance imaging compatible.

Dual Sensory Impairment and Hearing Aid Use Among Clients Attending Low-Vision Services in Australia

To report the frequency of hearing impairment among vision rehabilitation clients, and to identify patterns of hearing service and aid use. In the Vision-Hearing Project, 300 participants (65+ years) completed interviews and a hearing test at low-vision clinics. Visual impairment was defined as visual acuity <20/40 (better eye) wearing glasses if owned, and hearing impairment as average pure-tone air conduction threshold >25 dB hearing level (HL) over four frequencies (500, 1000, 2000, 4000 Hz, better ear). Dual sensory impairment (DSI) was defined as presence of both impairments. Bilateral hearing impairment was identified in 79.7% of participants and DSI in 62.1%. Only 59.8% of hearing impaired participants owned hearing aids and 33.8% reported low use (<1 hr/day). Four in five low-vision clients experience hearing impairment, and many have unmet needs. New models of sensory assessment that take account of hearing and vision are needed to support early detection and timely rehabilitation for DSI.

Association between diet quality with concurrent vision and hearing impairment in older adults.

Published literature shows that individual nutrients could influence the risk of developing vision and hearing loss. There is, however, a lack of population-based data on the relationship between overall patterns of food intake and the presence of concurrent vision and hearing impairment. We aimed to assess the associations between diet quality with the prevalence and 5-year incidence of dual sensory impairment (DSI). Cross-sectional and 5-year longitudinal analyses. Blue Mountains, Sydney, Australia. 2443 participants aged ≥50 from baseline were examined and followed over 5 years. Dietary data were collected using a semi-quantitative food frequency questionnaire. A modified version of the Healthy Eating Index for Australians was developed to determine total diet score (TDS). Visual impairment was defined as visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold greater than 25 dB HL (500-4000 Hz, better ear). After adjusting for age, sex, education, noise exposure, current smoking, and type 2 diabetes, participants in the lowest compared to the highest quintile of TDS had a 2-fold increased likelihood of having prevalent DSI, odds ratio, OR, 2.62 (95% confidence intervals, CI, 1.08-6.36), P-trend=0.04. Significant associations were not observed between TDS and the prevalence of having a single sensory impairment (vision or hearing loss). Baseline TDS was not significantly associated with the 5-year incidence of DSI. Adherence to dietary guidelines was associated with a reduced likelihood of having DSI in cross-sectional, but not in longitudinal analyses. Further studies with adequate power are warranted to assess the prospective relationship between diet quality and DSI.

Outcomes following Semicircular Canal Plugging

Objectives: 1) Examine audiometric outcomes following semicircular canal plugging for either superior semicircular canal dehiscence syndrome or refractory positional vertigo. 2) Review symptom control rates and complication rates for canal plugging procedures. Methods: Retrospective chart review at a private neurotologic tertiary referral center. Patients undergoing semicircular canal plugging for superior semicircular canal dehiscence syndrome or refractory positional vertigo from January 1, 2007, to December 31, 2012, were included. Pre- and postoperative audiometry, operative findings, and clinical symptoms were assessed through chart review. Acoustic reflex testing, vestibular testing, and canal dehiscence size were examined in superior canal dehiscence patients. Results: A total of 28 patients underwent a canal plugging procedure during the study period: 24 superior canal dehiscence syndrome patients and 4 posterior canal occlusion patients. Postoperative air conduction pure-tone averages were 22.5 and 13.0 dB for these two groups, respectively, compared to their preoperative values of 21.1 and 11.0 dB. The average pre- and postoperative word-recognition scores for the entire cohort were 96.2% and 94.0%. Vestibular evoked myogenic potential data showed reduced thresholds in 7 canal dehiscence patients. The average size of the canal dehiscence, based on preoperative radiological measurements, was 3.4 mm. Surgical complications were limited to one temporary facial weakness (Grade 2). Complete symptom improvement was noted in 35.7% of all patients, while 16.7% of canal dehiscence patients reported no change in symptoms. Conclusions: Semicircular canal plugging procedures are associated with excellent hearing outcomes and may reduce preoperative symptoms in patients with canal dehiscence and refractory positional vertigo.

Dual Sensory Impairment in Older Adults Increases the Risk of Mortality: A Population-Based Study

Although concurrent vision and hearing loss are common in older adults, population-based data on their relationship with mortality is limited. This cohort study investigated the association between objectively measured dual sensory impairment (DSI) with mortality risk over 10 years. 2812 Blue Mountains Eye Study participants aged 55 years and older at baseline were included for analyses. Visual impairment was defined as visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold greater than 25 dB HL (500–4000 Hz, better ear). Ten-year all-cause mortality was confirmed using the Australian National Death Index. After ten years, 64% and 11% of participants with DSI and no sensory loss, respectively, had died. After multivariable adjustment, participants with DSI (presenting visual impairment and hearing impairment) compared to those with no sensory impairment at baseline, had 62% increased risk of all-cause mortality, hazard ratio, HR, 1.62 (95% confidence intervals, CI, 1.16–2.26). This association was more marked in those with both moderate-severe hearing loss (>40 dB HL) and presenting visual impairment, HR 1.84 (95% CI 1.19–2.86). Participants with either presenting visual impairment only or hearing impairment only, did not have an increased risk of mortality, HR 1.05 (95% CI 0.61–1.80) and HR 1.24 (95% CI 0.99–1.54), respectively. Concurrent best-corrected visual impairment and moderate-severe hearing loss was more strongly associated with mortality 10 years later, HR 2.19 (95% CI 1.20–4.03). Objectively measured DSI was an independent predictor of total mortality in older adults. DSI was associated with a risk of death greater than that of either vision loss only or hearing loss alone.

New Closed Skin Bone-Anchored Implant

To report preliminary results of a new closed-skin, transcutaneous bone conduction device (BCD) in 6 children with high-grade ear atresia. Tertiary care center; prospective study; we evaluated the gain with masking of the contralateral ear and the benefit of hearing rehabilitation with the transcutaneous BCD in noise: speech-in-noise tests, conducted in real life condition (with contralateral ear unmasked and fitted with a hearing device if done before implantation), with and without BCD, with determination of the speech reception threshold (SRT). Children and parent's satisfaction was assessed. Patients' ages ranged from 6 to 9 years. All had high-grade ear atresia with a preoperative mean pure-tone average (PTA) loss of 71.46 +/- 6.59 dB on air conduction and 14 +/- 4.98 dB on bone conduction. At M6, all children used the implant 5 to 12 hours daily (mean, 10) without pain or cutaneous complications. At M6, the mean air conduction PTA with transcutaneous BCD was 28.45 +/- 1.68 dB, the mean gain 43 +/- 6.96 dB, and the mean SRT gain 33.33 +/- 10.75 dB. Using speech-in-noise tests in real-life conditions, the mean SRT was statistically improved with the transcutaneous BCD (-8 +/- 2.83 dB, p = 0.0313). Both children and parents reported being satisfied or very satisfied. These preliminary results show satisfactory functional gain, cutaneous tolerance, and patients' satisfaction with the new transcutaneous BCD.

Congenital Ossicular Chain Anomalies Associated with a Mobile Stapes Footplate: Surgical Results for 23 Ears

We describe the audiometric results following surgery in a consecutive series of patients with a congenital ossicular middle ear disorder that was associated with a mobile stapes footplate. We performed a retrospective analysis of patient charts from a tertiary referral center. A total of 23 patients (23 ears) underwent exploratory tympanotomy and ossicular reconstruction between 1986 and 2001. The main outcome measure was the audiometric results. Overall, we observed a mean gain in air conduction pure tone average of 17 dB (from 47 dB to 30 dB), a sensorineural deterioration of 3 dB, and a mean postoperative air-bone gap of 19 dB (mean preoperative air-bone gap of 38 dB). The air-bone gap closure was 20 dB or less in 15 of the 23 cases (65%), in agreement with the few results reported in the literature. Moreover, the audiometric results remained stable. In the syndromic group, the mean gain in air conduction was only 13 dB, which was worse than that observed for the nonsyndromic ears. Surgery for congenital ossicular chain anomalies with a concomitant mobile stapes footplate provides positive audiometric outcomes. Most ears had some sensorineural impairment (10 to 20 dB), which influenced the final hearing level attained after surgery. Preoperative assessment is mandatory to search for syndromal diagnoses, which might be important for patient counseling and prognosis.

Effectiveness of Intratympanic Dexamethasone in Otitis Media with Effusion Resistant to Conventional Therapy

The aim of this study was to determine the efficiency of intratympanic dexamethasone (ITD) injections as a new treatment modality in otitis media with effusion resistant to conventional therapy. We planned a nonrandomized prospective study to determine the safety and effectiveness of the direct administration of dexamethasone into middle ear cavity with chronic eustachian tube dysfunction. This study was applied on 75 ears of 64 patients aged from 12 to 60years. ITD received 47 ears of 41 patients who had previously been treated by medical or surgical therapy middle ear effusion without resolution classified as study group. They were taken conventional medical therapy again 28 ears of 23 patients classified as a control group. ITDs were administered 0.5ml/4mg per mm directly in antero-superior quadrant of tympanic membrane. These injections were repeated once a week for 4weeks. Results were evaluated by using audiometric and tympanometric measurements 1 and 3months after the treatments. Audiometric measurement shows that 9.91dB improvement in the mean air-bone gap 15.17dB in air conduction (AC) pure-tone averages (PTA) and 5.25dB bone conduction (BC) PTA. But the control group data showed only 2dB improvement in the mean air-bone gap, 3dB AC-PTA and 1.36dB BC-PTA. Tympanometric improvement was found. In 28 ears of patients (59.6%) like type B or C converted to type A in study group without complication but only in three ears (10.7%) of control group. ITD administration to the middle ear is safe and effective for the treatment of otitis media with effusion or chronic eustachian tube dysfunction. No complications like tympanic membrane perforation and/or sensorineural hearing loss have occurred.

“One-shot” CO2 versus Er:YAG laser stapedotomy: is the outcome the same?

To assess and compare the functional results obtained by means of multiple-shot Erbium: yttrium-aluminum-garnet (Er:YAG) laser to those obtained using "one-shot" CO(2) laser stapedotomy in patients affected by otosclerosis. A retrospective case review was performed. Of the total number of 123 patients (114 ears) who underwent primary small-fenestra stapedotomy from January 2006 to September 2008, seven patients who received multiple-shot laser CO(2) stapedotomy were excluded from the study. The remaining 116 patients (104 ears) were sorted, and "one-shot" CO(2) laser stapedotomy (group A) was performed in 35/104 and Er:YAG laser stapedotomy (group B) in 69/104. After surgery, air conduction-pure tone average (AC-PTA) and air-bone gap (ABG) improved significantly in both groups, whereas sensorineural hearing loss (SNHL) and bone conduction (BC)-PTA did not change in both the groups. In group A, the postoperative ABG was significantly better (12.63 vs. 14.86 dB). Moreover, after "one-shot" stapedotomy, the AC-PTA significantly improved in all tested frequencies. On the contrary, in group B the AC-PTA improved significantly only in two frequencies (0.5 and 1 kHz). Consistent with previous reports, our findings confirm that laser stapedotomy is a safe and effective surgery, regardless of the technique. Based on our functional results, the "one-shot" CO(2) laser technique seems to be associated with a significantly better postoperative ABG if compared to Er:YAG laser stapedotomy.

Hearing outcomes following myringoplasty for patients from developing countries with chronic otitis media

Objective: The purpose of this study is to compare hearing outcomes following myringoplasty for chronic otitis media for patients from developing counties with those of urban Australian patients. Subjects & Methods: This study is a retrospective review of 110 patients (118 ears) with non-cholesteatomatous chronic suppurative otitis media who underwent myringoplasty at The Royal Victorian Eye & Ear Hospital from 2003 to 2007. Patients who had emigrated from a developing country were analysed as one group and Australian born patients were analysed as another. Patients were excluded from the study if their hearing was normal or only mildly impaired in the affected ear pre-operatively. Outcomes are expressed in terms of tympanic membrane closure, improvement in air conduction (AC) pure tone average (PTA) and achievement of AC PTA ≤ 40 dB HL post-operatively. Results: Patients from developing countries demonstrated greater improvements in hearing following myringoplasty, mean gain in AC PTA 16.6 dB, than urban Australian patients, 9.6 dB. This difference was statistically significant (unpaired t-test; t = 2.66, p < 0.05). Conclusion: Patients from developing countries with hearing impairment secondary to chronic otitis media can achieve hearing outcomes following myringoplasty at least comparable to urban Australian patients. This paper was presented at the 2009 Australian Society of Otolaryngology Head and Neck Surgery Annual Scientific Meeting, Gold Coast, QLD.

Atherosclerosis-Related Genes, Low-Level Lead Exposure and Age-Related Hearing Loss: The Normative Aging Study

ISEE-0798 Background and Objective: Although age-related hearing loss (ARHL) is one of the leading chronic health conditions experienced by the older adults, little is known about the impact of environmental toxicants and gene-environment interaction. Our recent study has shown associations between cumulative low-level lead exposures and ARHL in a community-based cohort. However, underlying biological mechanisms are still unknown. This study examined whether those associations were modified by genes related to atherosclerosis, including apolipoprotein-E (APOE: rs7412, rs429358, rs405509, rs440446, rs449647, rs769446), lipoprotein lipase (LPL: rs268, rs328, rs1801177), nitric oxide synthase-3 (NOS3: rs1799953, rs1800779), and vascular endothelial growth factor A (VEGFA: rs2010963), given that atherosclerosis which leads to cochlea ischemia and therefore elevate the risk of ARHL may be attributed by lead exposure. Methods: Bone lead levels, markers of cumulative lead exposure, were measured using K-x-ray fluorescence in 563 middle-aged and elderly men in the Normative Aging Study. Pure-tone audiometric examinations were conducted to measure air and bone conduction hearing thresholds. We calculated a pure-tone average (PTA) of thresholds at 500, 1000, 2000, and 4000 Hz. Results: After controlling for potential confounders, an interquartile range increase in tibia lead (14 mg/g) was associated with a 1.7 (95% confidence interval (CI), 0.44, 2.9) dB increase in the air conduction PTA among persons with at least one copy of the minor allele in APOE rs449647, whereas no association was found among persons with homozygous major alleles (−0.85 dB, 95% CI, −2.2, 0.54; P-interaction = 0.005). We also found significant effect modification by APOE rs769446. No effect modification by LPL, NOS3 and VEGFA genetic polymorphisms was found. The results with patella lead and those in the bone conduction PTA were similar but less significant. Conclusion: This study suggests that some SNPs in the promoter region of the APOE gene modify the chronic effects of lead on ARHL.

Modified Bondy's Technique

To evaluate the short- (6 mo) and long-term (5 yr) outcomes of modified Bondy technique, with particular reference to hearing results. Retrospective study. Quaternary referral otology and cranial base center. Two hundred thirty ears of 222 patients were operated on, using a modified Bondy technique between 1983 and 2005. All patients had primary acquired epitympanic cholesteatomas with intact pars tensa and intact ossicular chain in normal or good-hearing ear. Preoperative audiometric results revealed a mean air conduction pure-tone average of 27.7 +/- 9.6 dB (range, 10-65 dB) and a mean bone conduction pure-tone average of 14.2 +/- 6.4 dB (range, 5-50 dB). The mean preoperative air-bone gap was 13.5 +/- 6.7 dB (range, 0-25 dB). The average length of follow-up was 7.8 years (range, 5-16 yr). There was no recurrent cholesteatoma in the present series. A pearl-like residual cholesteatoma was found in the cavity in 7.4% of ears. Two patients (0.8%) developed stenosis of meatoplasty. Three ears (1.3%) exhibited retraction pockets extending to the attic. Postoperative discharging ear was observed in 3% of cases and was successfully treated with topical drops. At the long-term follow-up, the air-bone gap was unchanged or improved from the preoperative level in 88% of cases. The mean postoperative short- and long-term air-bone gaps were 14.6 +/- 8.5 dB (range, 0-55 dB) and 14.1 +/- 8.2 dB (range, 0-50 dB), respectively. Postoperative high-frequency sensorineural hearing loss with bone conduction worsening between 20 and 30 dB at 4 kHz was observed in 4 cases (1.7%). No dead ears were encountered postoperatively. A modified Bondy operation is recommended in selected cases of epitympanic cholesteatoma in normal or good-hearing ear with an intact pars tensa and ossicular chain. Modified Bondy technique ensures complete eradication of disease while preserving a good preoperative hearing in 1-stage operation.

Hearing outcomes after mobile ear surgery for chronic otitis media in Greenland

Objectives. Chronic otitis media (COM) with hearing loss (HL) occurs frequently in many populations with limited access to specialized treatment. This article reports on the hearing outcomes following mobile ear surgery in Greenland. Study design. The study was longitudinal and prospective with pre-and post-operative followup data compiled at 1-and 2-year intervals.Methods. Selection criterion included individuals with COM with or without suppuration (CSOM) and with associated HL. Hearing tests were obtained by using a simple air-conduction (AC) audiometry. The median age of the 274 participants was 27 years (8–60 years), and 45% were males. Sixty-one percent had COM and 34% had CSOM. Myringoplasty or tympanoplasty type I was performed in 88% of the cases. Results. The median pre-operative AC pure-tone average was 38 dB. The follow-up rate was 75% and 61% at 1-and 2-years. Hearing gain was found in 78% at both follow-ups and was ≥10 dB in 62% and 56%, respectively. The median hearing gain was 15 dB and 12 dB, respectively. Independent predictors of hearing gain were pre-operative tympanic membrane atrophy and closure of perforations.Conclusions. Long-term hearing gain can be achieved with mobile ear surgery and this, in addition to tympanic membrane closure, is important for hearing rehabilitation in populations with poor access to health care.

Simultaneous bilateral stapes surgery

Conclusions. The patients recovered from the surgery as after unilateral surgery. The success rate for hearing improvement was good both subjectively and objectively, and this was also displayed in the quality of life. According to our study, simultaneous bilateral stapes surgery can be performed safely in selected patients with bilateral conductive hearing loss. Objectives. Otosclerosis is bilateral in the majority of patients. In this study we evaluated the outcome of simultaneous bilateral stapes surgery. Subjects and methods. Eighteen patients suffering from bilateral otosclerosis or osteogenesis imperfecta were prospectively included. After operation, hearing and vestibular function were followed by audiometry and visual feedback posturography (VFP). Patients estimated their hearing gain, the intensity of vestibular symptoms and quality of life score with a questionnaire during the follow-up period of 1 year. Results. The mean improvement in pure-tone average (PTA) air conduction (PTA-AC) was 18 dB (range 1–41 dB). The mean air–bone gap (AB-GAP) diminished from 22 dB (range 10–41 dB) to 7 dB on both sides (range 0–18 dB). The mean preoperative score of 2.3 for hearing improved significantly to 4.1 (p<0.001). Vestibular symptoms were mild and temporary. The VFP was not permanently impaired in any of the patients. The quality of life score improved significantly from 3.4 to 1.3 postoperatively (p<0.001).

Role of ossiculoplasty in canal wall down tympanoplasty for middle-ear cholesteatoma: hearing results

The aim of this study was to evaluate the hearing results of ossiculoplasty in canal wall down tympanoplasty in one stage middle-ear cholesteatoma surgery. We carried out a retrospective review of a consecutive series of 142 cases which had undergone type two or three canal wall down tympanoplasty with ossicular reconstruction, between January 1995 and December 2002, due to chronic otitis media with cholesteatoma.Pre-operative audiometric testing revealed a mean air conduction pure tone average (PTA) of 50.97 dB and a mean bone conduction PTA of 22.14 dB. The mean post-operative result for air conduction PTA was 37.62 and for bone conduction PTA was 23.37 dB. The mean pre- and post-operative air-bone gaps (ABGs) were 28.83 and 13.94 dB, respectively, with a gain of 14.89 dB. Almost 62.67 per cent of patients closed their ABGs to within 20 dB. Our functional results are comparable with those of other authors. In the present study, we show that hearing improvement is possible following cholesteatoma surgery with canal wall down tympanoplasty and ossicular chain reconstruction.

Association Between Vision and Hearing Impairments and Their Combined Effects on Quality of Life

To assess associations between age-related vision and hearing impairments and whether combined sensory losses magnify effects on health-related quality of life. Seventy-five percent of survivors (n = 2334) were reexamined at Blue Mountains Eye Study 5-year examinations and 86.3% (2015) attended hearing assessments. Visual impairment was defined as visual acuity less than 20/40 (better eye), and hearing impairment as average pure-tone air conduction threshold greater than 25 dB (500-4000 Hz, better ear). Persons with visual impairment, compared with those without visual impairment, had lower mean audiometric thresholds across all frequencies (P< or =.05). For each 1-line (5-letter) reduction in best-corrected visual acuity and presenting visual acuity, hearing loss prevalence increased by 18% and 13%, respectively. Cataract and age-related maculopathy were also associated with hearing loss (respectively, multivariate-adjusted odds ratio, 1.3 and 1.6; 95% confidence interval, 1.0-1.7 and 1.1-3.1). The association between age-related maculopathy and hearing loss was stronger at younger ages (<70 years). Combined impairments were associated with poorer health-related quality of life than were single impairments (multivariate-adjusted 36-Item Short-Form Health Survey mean physical and mental component scores; Ptrend = .001 and <.001, respectively). Older persons with visual impairment were also more likely to have hearing loss in this study, which suggests that these sensory impairments could share common risk factors or biologic aging markers. Combined sensory impairments also cumulatively affect health-related quality of life.

Hearing impairment and cardiovascular disease risk factors in the Georgia Older Americans Nutrition Program

Hearing impairment is the third most common chronic health condition in older adults and is associated with impaired physical, emotional, and social function. Some researchers have suggested that cardiovascular risk factors are related to hearing impairment (Gates et al., 1993; Rosen & Olin, 1965). Therefore, we investigated these possible relationships in 147 older adults at senior centers. More than 70% had hearing impairment, defined as air conduction pure-tone average (1, 2, and 4 kHz) threshold greater than 25 dB hearing level in the worse ear. In a series of logistic regression analyses controlled for age, gender, and race, participants with hearing impairment had non-significant trends for lower mean HDL cholesterol levels (53 mg/dl vs. 61 mg/dl, p=0.08), higher prevalence of HDL cholesterol < 40 mg/dl (20% vs. 11%, p=0.47) and total cholesterol/HDL cholesterol ratio >3.5 (67% vs. 53%, p=0.32), greater ratio of total cholesterol/HDL cholesterol (4.1 vs. 3.7, p=0.43), and higher mean triglycerides (182 mg/dl vs. 158 mg/dl, p=0.25). In this sample, CVD risk factors were not generally associated with hearing impairment, perhaps because of the relatively small sample size, the advanced age of the participants, and the severity of their hearing loss. Funding: USDA-NRICGP #2000-01327, HATCH GA-AES #GEO00916.