Air Conduction Thresholds Research Articles

Optimizing Clinical Interpretation of Distortion Product Otoacoustic Emissions in Infants.

The purpose of this study was to analyze distortion product otoacoustic emission (DPOAE) level and signal to noise ratio in a group of infants from birth to 4 months of age to optimize prediction of hearing status. DPOAEs from infants with normal hearing (NH) and hearing loss (HL) were used to predict the presence of conductive HL (CHL), sensorineural HL (SNHL), and mixed HL (MHL). Wideband ambient absorbance was also measured and compared among the HL types. This is a prospective, longitudinal study of 279 infants with verified NH and HL, including conductive, sensorineural, and mixed types that were enrolled from a well-baby nursery and two neonatal intensive care units in Cincinnati, Ohio. At approximately 1 month of age, DPOAEs (1-8 kHz), wideband absorbance (0.25-8 kHz), and air and bone conduction diagnostic tone burst auditory brainstem response (0.5-4 kHz) thresholds were measured. Hearing status was verified at approximately 9 months of age with visual reinforcement audiometry (0.5-4 kHz). Auditory brainstem response air conduction thresholds were used to assign infants to an NH or HL group, and the efficacy of DPOAE data to classify ears as NH or HL was analyzed using receiver operating characteristic (ROC) curves. Two summary statistics of the ROC curve were calculated: the area under the ROC curve and the point of symmetry on the curve at which the sensitivity and specificity were equal. DPOAE level and signal to noise ratio cutoff values were defined at each frequency as the symmetry point on their respective ROC curve, and DPOAE results were combined across frequency in a multifrequency analysis to predict the presence of HL. Single-frequency test performance of DPOAEs was best at mid to high frequencies (3-8 kHz) with intermediate performance at 1.5 and 2 kHz and chance performance at 1 kHz. Infants with a conductive component to their HL (CHL and MHL combined) displayed significantly lower ambient absorbance values than the NH group. No differences in ambient absorbance were found between the NH and SNHL groups. Multifrequency analysis resulted in the best prediction of HL for the SNHL/MHL group with poorer sensitivity values when infants with CHL were included. Clinical interpretation of DPOAEs in infants can be improved by using age-appropriate normative ranges and optimized cutoff values. DPOAE interpretation is most predictive at higher F2 test frequencies in young infants (2-8 kHz) due to poor test performance at 1 to 1.5 kHz. Multifrequency rules can be used to improve sensitivity while balancing specificity. Last, a sensitive middle ear measure such as wideband absorbance should be included in the test battery to assess possibility of a conductive component to the HL.

Endoscopic Transcanal Autologous Cartilage Ossiculoplasty.

This was a randomized clinical trial, of thirty-two patients undergoing endoscopic ossiculoplasty, as a second look surgery, at 6months after primary endoscopic cholesteatoma surgery, in a duration of 9years. All patients underwent trans-canal endoscopic ossiculoplasty under local anesthesia. Prosthesis used were (1) Titanium partial ossicular replacement prosthesis (PORP) in fourteen, (2) Titanium total ossicular replacement prosthesis (TORP) in six and (3) Autologous cartilage in twelve cases. Puretone audiometry (PTA) were done preoperatively and postoperatively at 2months and 3years. Out of twenty-four cases, which presented only with stapes superstructure; fourteen underwent PORP ossiculoplasty and twelve had cartilage short columella ossiculoplasty (SCC). Out of eight cases, which had only mobile stapes footplate, six underwent TORP ossiculoplasty and only two underwent long columella cartilage ossiculoplasty (LCC). Pre-operative average air conduction threshold (AC) of pure tone audiometry were 45.47dB (PORP), 66.10dB (TORP), 49.15dB (SCC) and 59.15dB (LCC) groups. The post-operative AC at 2months were respectively 27.37dB (PORP), 45.83dB (TORP), 29.99dB (SCC) and 39.15dB (LCC) groups. The gap of air and bone conduction (ABG) at 2months post-operative stage were 19.05dB (PORP), 20dB (TORP), 20.32dB (SCC) and 39.15dB (LCC) groups and not much changed after 3years. Extrusion occurred in three PORPs and four TORPs at 4-8years after surgery. Four cases were lost to follow up. No extrusion occurred in cartilage ossiculoplasty. Trans-canal endoscopic autologous cartilage ossiculoplasty shows encouraging results comparable to titanium prosthesis in repairing ossicles in cholesteatoma disease.

Simultaneous bilateral butterfly tympanoplasty using tragal cartilage from one ear

ObjectiveTo evaluate the outcomes of simultaneous bilateral inlay butterfly cartilage tympanoplasties (BIBCT) using tragal cartilage from one ear in patients with bilateral chronic otitis media (BCOM). Methods33 patients (66 ears) who underwent bilateral inlay butterfly cartilage tympanoplasties between June 2013 and September 2016 in Department of Otolaryngology–Head and Neck Surgery of Adiyaman University Education and Research Hospital, Adiyaman, Turkey — a tertiary care university teaching hospital. Anatomical success and functional success were assessed postoperatively. Air-bone gap (ABG), air-conduction thresholds, and bone-conduction thresholds were all assessed. The preoperative and postoperative averages of 0.5, 1, 2, and 3kHz of pure-tone thresholds were used for the mean air- and bone-conduction thresholds according to the guidelines of the Committee on Hearing and Equilibrium. ResultsAnatomical success could be demonstrated in 57 of 66 ears (86.3%). The overall mean of ABG improved from 23.97±8.63dB preoperatively to 10.42±4.82dB postoperatively (p<0.05). The ABG gain was 13.55±8.17dB. Postoperative percentages of patients with ABG less than 20dB and 10dB were excellently achieved to 98% (41% preoperatively) and 56% (10.6% preoperatively), respectively. The average length of operation time for both ears was 57.42±9.39min. ConclusionWhen compared with conventional two-staged tympanoplasty in patients with BCOM, simultaneous BIBCT using tragal cartilage from one ear is an advantageous approach for multiple reasons which include single hospital stay with resultant decreased risk of complications associated with anesthesia and surgery, less morbidity like cosmetic and hearing discomfort, time-savingness and cost-effectiveness.

Anxiety and depression in patients with sudden one-sided hearing loss.

Sudden sensorineural hearing loss is a hearing loss of >30 dB in at least three consecutive frequencies that occurs in 3 days. The aim of this study was to investigate anxiety and depression caused by sudden, idiopathic, one-sided hearing loss. The levels of anxiety and depression in patients with this type of hearing loss were determined using the Beck Anxiety Scale (BAS) and the Beck Depression Inventory (BDI) at the time of the patient's first visit. In total, 56 patients (32 men and 24 women) with a mean age of 32.8 ± 9.9 years (range: 20 to 58 years) were selected as the patient group and 45 individuals without symptoms of anxiety and depression were selected as the control group. The mean pretreatment air-conduction threshold and bone-conduction threshold were 61.1 ± 26.1 and 49.4 ± 13.8, respectively. In the patient group, the pretreatment mean anxiety, depression, and hopelessness scores were 19.5 ± 10.7, 11.6 ± 8.4, and 6.2 ± 4.7, respectively. The control group's mean anxiety, depression, and hopelessness scores were 4.1 ± 3.0, 3.8 ± 2.1, and 1.8 ± 1.0, respectively. For all the tests, the difference between the patient group and the control group was statistically significant (p < 0.001 for all). Hearing levels were not correlated with scores on the BAS, BDI, and Beck Hopelessness Scale (p = 0.1, p = 0.6, and p = 0.4, respectively). In conclusion, the results of this study show that sudden hearing loss can cause anxiety and depression. Questioning patients with sudden hearing loss about symptoms associated with anxiety and depression might be useful, and a psychiatric consultation should be requested if necessary.

Audiologic profile in patients with ankylosing spondylitis: A controlled study of 30 patients.

Recent studies have identified sensorineural hearing loss as a possible manifestation of ankylosing spondylitis. We conducted a study of 30 patients with ankylosing spondylitis to characterize their audiologic profile and to correlate their disease activity and functional indices with their hearing thresholds. The study group was made up of 18 men and 12 women, aged 25 to 58 years (mean: 46.5), who were diagnosed with ankylosing spondylitis. We compared their findings with a socially and demographically matched group of 30 healthy controls. All 60 participants underwent an audiologic assessment, consisting of pure-tone audiometry, speech audiometry, and tympanometry. We used validated indices to assess disease activity and functional status, and we compiled information on the time of diagnosis and the types of medications used to treat the ankylosing spondylitis. We found that the average of the mean air-conduction thresholds at 0.5, 1, 2, and 4 kHz in the ankylosing spondylitis group was significantly worse than that of the controls (p = 0.004). A statistically significant difference was observed at frequencies greater than 3 kHz (p < 0.05). A subgroup of case patients who used only a tumor necrosis factor-alpha inhibitor exhibited better hearing thresholds than patients who used other drugs (p = 0.01). Differences in functional and disease activity scores between case patients with and without hearing loss were not statistically significant. We found that patients with ankylosing spondylitis did indeed have a greater prevalence of sensorineural hearing loss but that it was not correlated with either disease activity or functional status.

Evaluation of hearing loss by pure tone audiometry in chronic suppurative otitis media patients

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Hearing loss associated with the CSOM affects the patients’ communication with others and results in poor quality of life. Degree and type of hearing loss can be assessed by pure tone audiometry, which helps in predicting the status of tympanic membrane, ossicular chain, and inner ear and also helps in preoperative planning.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Patients with CSOM aged 10 years and above were included in the study. All patients underwent pure tone audiometry. With the help of air and bone conduction threshold, the degree and type of hearing loss in each ear was determined. The data collected was evaluated and results are reported as rates and proportions (%). &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Most of the ears (83%) had mild to moderate hearing loss. Average ABG observed was 31 dB. Maximum ABG observed was 55dB on right side and 50 dB on the left side. There was mixed hearing loss in 10.9% cases.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; This study reinforces the idea of using preoperative pure tone audiometry, which not only helps in planning surgery but also helps in documenting the preoperative status of patients’ sensorineural hearing loss, if present.&lt;/p&gt;

Hearing Improvement in Interposition Ossiculoplasty and Myringostapediopexy.

Chronic otitis media (COM) may lead to partial or complete loss of tympanic membrane and erosion of the ossicles. Ossicular chain reconstruction may be done by interposition ossiculoplasty or myringostapediopexy.The aim of our study was to determine the hearing outcome in interposition ossiculoplasty and myringostapediopexy using autologous incus or cortical bone graft in intact canal wall tympanoplasty. 64 patients with COM, who underwent interposition ossiculoplasty or myringostapediopexy were included in the study. Audiometric evaluation was done after 3months after surgery and all patients were followed up for a period of 1year. The hearing results were compared in terms of mean pre-op and post-op Air conduction thresholds, Air-Bone gap (ABG) and hearing gain or ABG closure. In this study the mean ABG closure for interposition ossiculoplasty and myringostapediopexy was 15.4dB and 21.8dB, respectively. Hearing gain with cortical bone graft was higher than hearing gains with incus in both the groups, but not statistically significant. Myringostapediopexy provides marginally better hearing gain compared to interposition ossiculoplasty. Aulogous incus, and cortical bone graft are suitable autologous materials for ossicular reconstruction and provide similar hearing outcome.

Stapes Surgery for Otosclerosis in Patients Presenting with Mixed Hearing Loss

Objectives: To evaluate the efficacy of stapes surgery in patients presenting with a preoperative mixed hearing loss (bone conduction thresholds ≥40 dB; 40 < air conduction thresholds (AC) < 85 dB). Patients and Methods: A total of 30 patients (32 ears) with mixed hearing loss who underwent primary stapedotomy were evaluated. Audiometric parameters were assessed before and after surgery. Contralateral thresholds were also reported. The need for a hearing aid (HA) after surgery and its impact on quality of life were also measured. Results: AC and word recognition at 40, 55 and 70 dB were significantly improved after stapes surgery. Only 16.6% of the patients needed an HA after surgery and reported being satisfied with the aid. Conclusion: Stapes surgery improved auditory function in patients with mixed hearing loss, allowing most patients to delay the need for an HA without worsening their quality of life.

Tablet-based Hearing Screening in Children Aged 5 to 17 in Rural Dominican Republic.

The principal aim of this study was to examine the feasibility of hearing screening using tablet audiometry among a cohort of school-aged children in rural Dominican Republic. The authors hypothesized that the tablet audiometer would serve as an expeditious means for hearing loss screening in various remote locations. Cross-sectional. Twenty-three remote locations in and around the city of La Romana, Dominican Republic. The quietest location available in each site was used for testing. Inclusion criteria comprised children aged 5 to 17 currently residing in the testing location. Children aged <5 years or >18 years were excluded. Screening. For each subject, air conduction thresholds were obtained bilaterally at 500, 1000, 2000, and 4000 Hz; testing duration was also measured. Hearing loss was suspected if any threshold measured ≥30 dB. In this cohort of 423 subjects, 44 (10.4%) failed the screening protocol. The mean thresholds for 500, 1000, 2000, and 4000 Hz frequencies were 26.05, 22.73, 17.57, and 17.15 dB, respectively. Of the 658 thresholds obtained at ≥30 dB, the majority were at 500 or 1000 Hz. The mean testing duration was 494 seconds. These results suggest that children living in remote communities can be screened quickly for hearing loss using a tablet audiometer. However, significant background noise during testing negatively impacted the low-frequency measurements, thus compromising test reliability. Despite extending the reach of existing audiological services, the value of tablet audiometry is not entirely clear in rural environments with uncontrollable background noise.

Changes to Hearing Levels Over the First Year After Stapes Surgery: An Analysis of 139 Patients.

Stapes surgery is performed for hearing restoration in patients with otosclerosis. Results from stapes surgery are good, although a small proportion will have a persistent conductive hearing loss and will consider revision surgery. The timing of such surgery depends on expected changes to hearing thresholds during the postoperative period. We performed a retrospective case series analysis of a database of outcomes from stapes surgery performed between July 26, 2013 and March 11, 2016 at one center. Hearing outcomes over the year subsequent to surgery were recorded. There was a significant improvement in hearing outcomes between the postoperative visit at 6 weeks (mean air-bone gap 6.0 dB) and the hearing outcome at 6 months (mean air-bone gap 3.3 dB) (p < 0.01). This improvement was maintained at 12 months (mean air-bone gap 3.1 dB), although there were individual patients whose hearing outcome improved or deteriorated during this period. Improvements in air conduction thresholds mirrored improvements in air-bone gap measurements. Patients with an initial suboptimal or poor result after stapes surgery may observed improvement in their hearing thresholds in the year after surgery. These patients may have large preoperative air-bone gaps, and have a trend to have obliterated footplates. Revision surgery should not be considered until at least 6 months after primary surgery.

Outcomes of same-day bilateral endoscopic tympanoplasty

Objective:To investigate the feasibility of simultaneous bilateral endoscopic for tympanoplasty in patients with bilateral chronic suppurative otitis media. Method:Fifteen patients (30 ears) with bilateral chronic suppurative otitis media who underwent bilateral endoscopic transcanal tympanoplasty on the same day were enrolled in this study. The ear with worse-hearing was selected as the first operation side, the contralateral ear as the second one. The operation group consisted of 22 ears of Type 1 tympanoplasty, 5 ears of Type 2 tympanoplasty and 3 ears of Type 3 tympanoplasty. All second sides(15 ears) underwent Type 1 tympanoplasty. The cartilage-perichondrium graft was harvested from the tragal of the first side and was cut in two halves which could be used for the both sides. The graft success and hearing improvement were evaluated at the postoperative 6th month according to the follow up results of the endoscopic image and the pure-tone audiometry. Result:The graft take rate was 96.7%(27/30) without any retraction pockets or displaced grafts. The graft take rate of the first side was 93.3%(14/15), and the one of the second side was 100.0%(15/15). The average air conduction thresholds were (50.9±9.1) dB HL preoperatively and (32.0±6.0) dB HL postoperatively(P<0.01). The average air-bone gap overall improved from (30.2±7.9) dB HL preoperatively to (13.7±6.0) dB HL postoperatively(P<0.01). Conclusion:Bilateral same-day endoscopic tympanoplasty are safe and cost effective in appropriately selected patients. It can offer favorable out-comes in selected patients with chronic suppurative otitis media.

Bonebridge transcutaneous bone conduction implant in children with congenital aural atresia: surgical and audiological outcomes.

To investigate the surgical and audiological outcomes of the Bonebridge transcutaneous bone conduction hearing implant among children with congenital aural atresia. Six children were recruited and underwent Bonebridge transcutaneous bone conduction implant surgery. The patients' audiometric thresholds for air conduction, bone conduction and sound-field tests were assessed pre-operatively and at six months post-operatively. Patients' satisfaction was assessed at six months post-operatively with the Hearing Device Satisfaction Scale. No major complications were reported. Mean aided sound-field thresholds improved post-operatively by more than 30 dB for 0.5-4 kHz (p 0.05). All patients were satisfied (scores were over 90 per cent) with the implant in terms of functional outcome and cosmetic appearance. Bonebridge transcutaneous bone conduction implant surgery is safe and effective among children with congenital aural atresia with conductive hearing loss.

The South African English Smartphone Digits-in-Noise Hearing Test: Effect of Age, Hearing Loss, and Speaking Competence.

This study determined the effect of hearing loss and English-speaking competency on the South African English digits-in-noise hearing test to evaluate its suitability for use across native (N) and non-native (NN) speakers. A prospective cross-sectional cohort study of N and NN English adults with and without sensorineural hearing loss compared pure-tone air conduction thresholds to the speech reception threshold (SRT) recorded with the smartphone digits-in-noise hearing test. A rating scale was used for NN English listeners' self-reported competence in speaking English. This study consisted of 454 adult listeners (164 male, 290 female; range 16 to 90 years), of whom 337 listeners had a best ear four-frequency pure-tone average (4FPTA; 0.5, 1, 2, and 4 kHz) of ≤25 dB HL. A linear regression model identified three predictors of the digits-in-noise SRT, namely, 4FPTA, age, and self-reported English-speaking competence. The NN group with poor self-reported English-speaking competence (≤5/10) performed significantly (p < 0.01) poorer than the N and NN (≥6/10) groups on the digits-in-noise test. Screening characteristics of the test improved with separate cutoff values depending on English-speaking competence for the N and NN groups (≥6/10) and NN group alone (≤5/10). Logistic regression models, which include age in the analysis, showed a further improvement in sensitivity and specificity for both groups (area under the receiver operating characteristic curve, 0.962 and 0.903, respectively). Self-reported English-speaking competence had a significant influence on the SRT obtained with the smartphone digits- in-noise test. A logistic regression approach considering SRT, self-reported English-speaking competence, and age as predictors of best ear 4FPTA >25 dB HL showed that the test can be used as an accurate hearing screening tool for N and NN English speakers. The smartphone digits-in-noise test, therefore, allows testing in a multilingual population familiar with English digits using dynamic cutoff values that can be chosen according to self-reported English-speaking competence and age.

Comparison of click auditory brainstem response and chirp auditory steady-state response thresholds in children

ObjectivesDuring the last twenty years, auditory steady-state responses (ASSRs) are being used as an alternative and adjunct to the auditory brainstem response (ABR) for threshold estimation. This study aims at comparing and finding correlations between air-conduction thresholds using the traditional click ABR and the relatively recently used chirp ASSR test methods, for a large pediatric population. MethodsOne hundred and thirty children referred to our Clinic from Hospitals and Clinics of Western Greece ranging in age from 5 to 79 months (mean age = 32.7 ± 14.0 months) participated prospectively. ResultsStrong and statistically significant correlations were found between the average of the 1000, 2000 and 4000 Hz chirp ASSR thresholds and click ABR thresholds (rs = .826, p < .001), and the average of the 2000 and 4000 Hz chirp ASSR and click ABR thresholds (rs = .824, p < .001). Additionally, there have been measurements for some children with hearing loss in the severe-to-profound range during the ASSR test, but no ABR at the upper limits of the equipment. Click ABR and chirp ASSR thresholds averaged at 2000 and 4000 Hz were within 20 dB in 90% of the ears tested. ConclusionsThe results of this study support the inclusion of chirp ASSRs into the pediatric test battery and indicate that they may provide an essential adjunct to the click ABR, especially in the management of very young children with severe-to-profound hearing loss.

Hearing loss and ossicular status in cholesteatoma

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic otitis media with cholesteatoma is associated with hearing loss. Cholesteatoma causes bone erosion leading to ossicular chain defects. These ossicular lesions are only detected intraoperatively. If the ossicular status could be detected preoperatively by audiometric parameters, it would aid in better information to the patient, surgeon and preparation for the surgery. The aim of this study is to describe the intraoperative ossicular status, preoperative hearing status and to correlate them in patients with cholesteatoma.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a retrospective case series study conducted in a tertiary care centre. Data was collected from inpatient files of 47 patients who underwent surgery for cholesteatoma from January 2016 to December 2017. Air and bone conduction thresholds, air- bone gaps from pure tone audiometry (PTA) reports were collected. The status of the ossicles was collected from the operative notes. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; PTA revealed hearing loss in all the patients, predominantly conductive loss (83%). Ossicular defects were noted in 87% with incus most frequently involved (78.7%). Ossicular lesions were significantly associated with worse air conduction, bone conduction thresholds and air bone gap.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Cholesteatoma is frequently associated with ossicular defects. PTA shows worse parameters in ossicular defects. But, it doesn’t reflect the status of ossicle involved or the number of ossicles involved.&lt;/p&gt;

Audiological Results of Total Ossicular Replacement Prosthesis with Cartilage Shoe Technique.

The aim of this study was to investigate functional results of total ossicular replacement prosthesis (TORP) shaft stabilization with a cartilage shoe in chronic otitis media patients with cholesteatoma who had undergone canal wall down tympanomastoidectomy (CWDT). In addition, it was determined whether the presence of granular and edematous mucosa in middle ear altered functional outcomes. Sixty patients, who had undergone CWDT with the use of TORP for the reconstruction of ossicular chain, were divided into two groups. Patients with cartilage shoe were classified as Group 1 (n=30) and those without the shoe were classified as Group 2 (n=30). Patients in both groups were classified into "A" and "B" subgroups according to the middle ear risk index (MERI). Air conduction (AC) and bone conduction thresholds were evaluated preoperatively and postoperatively. There was no statistically significant change between preoperative AC thresholds of the groups and subgroups (p>0.05). There were statistically significant differences regarding AC thresholds and air-bone gap (ABG) values between Groups 1 and 2 at the postoperative 12th month (p<0.05). Postoperative AC thresholds and ABG values of Group 1B patients with a high MERI score were statistically significant at all frequencies than those of Group 2B patients (p<0.05). When ABG values were compared, it was observed that functional results were better in Group 1B, but a statistically significant difference was observed only at 2000 Hz (p<0.01). The cartilage shoe method for titanium TORP stabilization that is used for ossicular reconstruction during CWDT has been found to have a beneficial effect on auditory outcomes. Cartilage shoe application increases positive effects on hearing outcomes, particularly if the middle ear mucosa is granular and edematous.

Factors Associated With the Benefits of Concurrent Administration of Intratympanic Steroid Injection With Oral Steroids in Patients With Acute Acoustic Trauma.

To analyze the factors associated with the benefits of concurrent administration of intratympanic steroid injection (ITSI) and oral steroids in patients with acute acoustic trauma (AAT) incurred during military training. Retrospective analysis. Nineteen patients eligible under the criteria established concerning treatment for AAT were retrospectively reviewed in this study. ITSI treatments were administered simultaneously alongside oral prednisolone. Patients were categorized into two groups depending on the time elapsed between exposure to the noise and treatment initiation: 1) "Early Treatment initiation," defined as the treatment being initiated between 3 and 7 days; and 2) "Delayed treatment initiation," defined as the treatment being initiated in >7 days. Pure-tone air conduction threshold audiometry, to record the pure-tone average (PTA) at 2, 4, and 8 kHz, was conducted upon each patient's initial visit, and 1 month after starting treatment. The degree of hearing gain (hearing gain [dB] = [initial PTA] - [final PTA]) was calculated and used as the metric for determining the treatment's outcome. The initial PTA and treatment onset were adopted as possible associated factors. The mean ages of each group were 22.00 ± 2.12 years and 22.83 ± 2.64 years, respectively (p = 0.28). The initial PTAs were 46.41 ± 12.73 dB and 47.22 ± 14.74 dB, respectively (p = 1.00).In the multivariable linear regression analysis, the initial PTA and the treatment initiation showed a significant association (R = 0.37). The unstandardized regression coefficient of the initial PTA was 0.37 (p = 0.04). Patients with early treatment initiation showed significant improvement in the degree of hearing gain compared with delayed treatment initiation (unstandardized regression coefficient = 12.63, p = 0.01). We demonstrated the importance of early treatment onset for maximizing the benefits of concurrent administration of ITSI with oral steroids in patients with AAT suffered during military training. Further evaluation is needed to confirm the factors associated with the efficacy of concurrent ITSI with oral steroids.

AUDIOMETRIC THRESHOLD MEASUREMENT IN CHILDREN WITH INTELLECTUAL DISABILITY: PREFERRED RESPONSE MODE

Background The accuracy of pure tone audiometry is important for the success of auditory assessments and in monitoring rehabilitation programs for auditory disorders. Studies have reported that pushing a button as a response mode has a significant effect on pure tone thresholds in subjects with normal and impaired hearing. We therefore assumed that a push-button response mode may negatively impact pure tone threshold measurement in subjects with intellectual disability (ID) owing to their impaired cognition and poor motor coordination. The current study compares in persons with ID the number of presentations, number of false alarms, test duration, and participant preference across three response modes during audiometry. Material and Methods Air-conduction thresholds were measured for each response mode – push button, hand raise, and verbal – at octave intervals between 500 and 2000 Hz in the right ear of 14 children with intellectual disability. The order of the response mode was randomly assigned to three subgroups. Results The results indicated that among ID subjects a verbal response yielded a threshold in significantly less time. There was a significant preference for using the verbal response. Children who were assigned a push button or hand raise also responded with a verbal response. For push button participants, this occurred before the button was pushed and for the hand raising participants, a verbal response occurred before the button push. Conclusions The study finds verbal responses more beneficial in measuring auditory thresholds in children with ID.

Post-operative Sensorineural Hearing Loss After Middle Ear Surgery.

Chronic suppurative otitis media is managed by tympanomastoid surgery often requires mastoid drilling. Sometimes patients develop sensorineural hearing loss after middle ear surgery. Objective of the study was to compare pre and post operative bone conduction thresholds after middle ear surgeries. The study was conducted on 90 patients who had undergone middle ear surgeries, 30 patients of tympanoplasty (group I), modified intact canal wall mastoidectomy and tympanoplasty type-I (group II) and modified radical mastoidectomy (group III) each ware included. Demographic and clinical data were reviewed. Duration of surgery, ossicular and middle ear status and drilling time noted. Pre operative and post operative (after 3-4months) bone conduction thresholds were compared statistically. A value of p < 0.05 was considered statistical significant. The average pre-operative hearing loss of study group was 43.78 ± 14.22dB. Though postoperatively mean air conduction threshold improved to 36.07 ± 13.05dB, six patients presented with deterioration of hearing. Mastoidectomy has been performed in all six. Post-operative worsening of bone conduction was seen in three patients (13.75-21.5dB), one patient of group II and two patients of group III developed postoperative worsening of bone conduction thresholds. Significant hearing losses may occur after tympanomastoid surgery in few patients. While we are evaluating the results besides reporting average results such individual patient should be identified.

Resultados auditivos del sistema activo de conducción ósea Bonebridge® en hipoacusias conductivas o mixtas

ObjectiveThe active transcutaneous bone conduction implant Bonebridge®, is indicated for patients affected by bilateral conductive/mixed hearing loss or unilateral sensorineural hearing loss, showing hearing outcomes similar to other percutaneous bone conduction implants, but with a lower rate of complications. The aim of this study was to analyze the hearing outcomes in a series of 26 patients affected by conductive or mixed hearing loss and treated with Bonebridge®. Methods26 of 30 patients implanted with Bonebridge® between October 2012 and May 2017, were included in the study. We compared the air conduction thresholds at the frequencies 500, 1000, 2000, 3000, 4000Hz, the SRT50% and the percentage of correct answers at an intensity of 50dB with and without the implant. Results“Pure tone average” with the implant was 34.91dB showing an average gain of 33.46dB. Average SRT 50% with the implant was 34.33dB, whereas before the surgery no patient achieved 50% of correct answers at a sound intensity of 50dB. The percentage of correct answers at 50dB changed from 11% without the implant to 85% with it. We only observed one complication consisting of an extrusion of the implant in a patient with a history of 2 previous rhytidectomies. ConclusionsThe hearing outcomes obtained in our study are similar to those published in the literature. Bonebridge® represents an excellent alternative in the treatment of conductive or mixed hearing loss, and with a lower rate of complications.