Audiological Monitoring Research Articles

Assessing the hearing of children exposed to zika virus with an initially normal newborn hearing screen: a longitudinal cohort study

Background Zika virus (ZIKV) infection can result in hearing loss in babies, consequently, audiological monitoring is necessary. Aims This study aimed to evaluate the frequency of hearing impairment in neonates and children exposed to ZIKV during the intrauterine period. Materials and methods A cohort of 30 children born to mothers infected with ZIKV during pregnancy (March 2016–January 2017) underwent repeated hearing assessments performed 48 h after birth. Universal Newborn Hearing Screening revealed normal results in all children at 6, 13, 24, and 36 months. Children were divided into two subgroups based on real-time polymerase chain reaction: RT-PCR(+) and RT-PCR(-). Results At 24 months, the cumulative incidence of hearing alteration was 57.1%. There was no significant difference in the detection of hearing alteration between RT-PCR(+) and (-) groups. None of the children had sensorineural hearing loss; Conclusions and significance None of the children had sensorineural hearing loss. Total incidence conductive type (per 1000 live births), RT-PCR ZIKV (-) 2.2, prevalence 20% and RT-PCR ZIKV 3.1, prevalence 35.7%.The incidence of hearing alteration was highest at 24 months of age (57.1%, n = 8; only conductive type).

Состояние слуховой функции у детей-воспитанников детских домов, эвакуированных из зоны военных действий

In this study, the structure and frequency of hearing impairment in children who lived at various times in the territories of military operations were studied. The high prevalence of otorhinolaryngological diseases, combined with low detectability, entails formidable complications, leads to a decrease in the quality of life of the child and the family as a whole, and negatively affects the general level of public health. In total, during the study, 398 children aged 5 to 16 years old were examined, who were in the temporary accommodation center of the Romashka children’s resting camp. The children are students of orphanages in the Donetsk People’s Republic (DPR) and the Luhansk People’s Republic (LPR) evacuated from the war zone in the first days of the Special Operation. There were 216 girls (54.3%) and 182 boys (45.7%) among them. The average age of children was 8.5 years. Hearing loss was detected in 33 children (8.3%). Two children (0.5%) had a severe form of sensorineural hearing loss of 3–4 degrees. Two children (0.5%) had a mild form of sensorineural hearing loss of 1–2 degrees. Four children (1%) had unilateral chronic sensorineural hearing loss. The diagnosis of otitis media with effusion was established in 20 children (5%), tubo-otitis, in three patients (0.8%). Suspicion of an anomaly in the development of the middle ear, in 2 children (0.5%). Examination of children in orphanages evacuated from the DPR and LPR did not reveal a high prevalence of hearing impairment. Sensoneural hearing loss: 2%, conductive hearing loss: 6.3%. The results of the work demonstrate a wide potential for improving hearing health in the examined children. Active diagnostics of hearing pathology is shown to all children in orphanages. After treatment of conductive hearing pathology, mandatory audiological monitoring is indicated, despite the subjective improvement in hearing.

Neonatal bacterial meningitis: hearing screening and audiological monitoring outcomes

Objective This study reviewed the outcomes of universal newborn hearing screening (UNHS) and ongoing hearing monitoring in children following recovery from neonatal bacterial meningitis to determine (a) whether screening may be a suitable alternative to diagnostic audiology for detecting permanent childhood hearing loss (PCHL) and (b) whether infants who pass UNHS should be monitored throughout childhood. Design Retrospective analysis of a UNHS database. Study sample Data were extracted from the state-wide UNHS database for all children born in Queensland Australia between 1 September 2004 and 30 June 2020 with the risk factor of bacterial meningitis (in isolation or in combination with other risk factors) identified at the time of the UNHS. This cohort included 231 children. Results Results showed that all post-meningitic infants diagnosed with PCHL had a refer result on the UNHS or were medically excluded from screening. Additionally, no cases of PCHL were identified through the targeted surveillance program following a pass result on UNHS. Conclusions UNHS may be sufficient to detect PCHL in post-meningitic neonates and routine audiological monitoring may not be required for children who pass the screen.

Effectiveness of using the program “Frequency of audiological monitoring in children of the first year of life with risk factors for hearing loss and deafness”

Purpose. To present data on testing the program, which allows optimizing audiological monitoring in children with risk factors for the development of hearing loss and deafness.Characteristics of children and research methods. 217 children who underwent audiological monitoring at the consultative аnd diagnostic center in Morozov Children’s City Clinical Hospital were examined. The research was a prospective longitudinal study with cross-sectional elements. The children were divided into 2 groups. The first group (main) consisted of 136 children who underwent audiological monitoring based on the developed program, and the second (comparison) included 81 children (the program was not applied). Statistical software packages SPSS and Epi info were used to process the obtained data.Results. In the main group, the most common age of children with primary treatment was (3.0 ± 0.5) months, and in the comparison group — (6.0 ± 0.5) months. In the main group, in the period of (3.0 ± 0.5) months of life, out of 129 children, neurosensory hearing loss was detected in 27 (21.0%), in the period of (6.0 ± 0.5) in 19 of 134 (14.0%), and in the periods of (9.0 ± 0.5) and (12.0 ± 0.5) in 19 (13.4%) and 5 of 136 children, respectively. In 22 children out of 136, hearing decline was transient. In the comparison group at the age of (3.0 ± 0.5) months, neurosensory hearing loss was detected in 2 children, at (6.0 ± 0.5) months in 4 out of 15, at (9.0 ± 0.5) in 1 child out of 25, and at (12.0 ± 0.5) in 9 patients out of 35 children.Conclusion. The application of the developed program will allow neonatologists and primary care physicians to fully comply with the deadlines for audiological monitoring.

Cisplatin-induced ototoxicity in patients receiving concurrent chemoradiation in carcinoma cervix

Background: Weekly cisplatin at 40mg/m2 is the most common regimen followed in our institution. However, patients receiving cisplatin can experience high-frequency hearing loss due to its expansive toxicity profile, a side effect known as ototoxicity. The dearth of information on the extent and severity of cisplatin-associated ototoxicity prevents implementing a context-specific audiological monitoring program. The study aimed to determine the extent and severity of cisplatin ototoxicity in patients receiving concurrent chemoradiation in carcinoma cervix. Methods: Otoscopic examinations and audiological investigations were undertaken at regular intervals in patients undergoing concurrent chemoradiation for carcinoma cervix with single-agent cisplatin in the Department of Radiation Oncology, with the aid of the Department of ENT. All the audiological investigations were provided free of cost. Sixty-six patients who met the inclusion criteria were sent for audiological evaluation before the start of chemotherapy, immediately after chemotherapy completion and after one month following chemotherapy. Results: The study found that cisplatin was associated with high frequency, predominantly bilateral sensorineural hearing loss. Among 66 patients, seven patients (11%) developed cisplatin-induced hearing loss. However, most of the patients developed mild and minimal hearing loss. Conclusion: The study concluded that patients receiving concurrent chemoradiation for carcinoma cervix with cisplatin developed predominantly bilateral, high-frequency sensorineural hearing loss. However, most patients developed minimal or mild hearing loss.

Hearing Instability in Children with Congenital Cytomegalovirus: Evidence and Neural Consequences.

Sensorineural hearing loss (SNHL) is a common sequela of congenital cytomegalovirus (cCMV), potentially exacerbating neurocognitive delay. The objectives of this study were to assess: (1) age at which SNHL in children with cCMV; (2) stimulability of the auditory system in children with cCMV following cochlear implantation (CI); and (3) whether features of magnetic resonance imaging (MRI) potentially are predictive of hearing outcomes. In this retrospective study of a prospectively acquired cohort, 123 children with cCMV who were referred for hearing loss at a single tertiary referral hospital over 20 years were compared with an unmatched comparative group of 90 children with GJB2-related deafness. Outcome measures were results of newborn hearing screening (NHS), behavioral audiograms, and, in a subgroup of cochlear implant (CI) users, responses from the auditory nerve and brainstem evoked by CI at initial activation, as well as lesional volume of FLAIR-hyperintense signal alterations on MRI. All but 3 of 123 children with cCMV had confirmed and persistent SNHL. At birth, 113 children with cCMV underwent NHS, 31 (27%) passed in both ears and 23 (20%) passed in one ear (no NHS data in 10 children). At the first audiologic assessment, 32 of 123 (26%) had normal hearing bilaterally; 35 of 123 (28%) had unilateral SNHL; and 57 of 123 (46%) had bilateral SNHL. More than half (67 of 123, 54%) experienced hearing deterioration in at least one ear. Survival analyses suggested that 60% of children who developed SNHL did so by 2.5 years and 80% by 5 years. In the children who passed NHS in one or both ears, 50% developed hearing loss by 3.5 years in the ear, which passed unilaterally (n=23 ears), and 50% by 5 years in bilateral passes (n=62 ears). Hearing loss was significant enough in all but one child with isolated high-frequency loss for rehabilitation to be indicated. Hearing thresholds in individual ears were in the CI range in 83% (102 of 123), although duration of deafness was sufficient to preclude implantation at our center in 13 children with unilateral SNHL. Hearing aids were indicated in 16% (20 of 123). Responses from the auditory nerve and brainstem to initial CI stimulation were similar in children with cCMV-related SNHL compared with GJB2-related SNHL. Characteristic white matter changes on MRI were seen in all children with cCMV-related SNHL (n=91), but the lesion volume in each cortical hemisphere did not predict degree of SNHL. cCMV-related SNHL is often not detected by NHS but occurs with high prevalence in early childhood. Electrophysiological measures suggest equivalent stimulability of the auditory nerve and brainstem with CI in children with cCMV and GJB2-related SNHL. Hyperintense white matter lesions on FLAIR MRI are consistently present in children with cCMV-related SNHL but cannot be used to predict its time course or degree. Combined, the data show early and rapid deterioration of hearing in children with cCMV-related SNHL with potential for good CI outcomes if SNHL is identified and managed without delay. Findings support universal newborn screening for cCMV followed by careful audiological monitoring. 3 Laryngoscope, 132:S1-S24, 2022.

Auditory changes following firearm noise exposure, a review.

Firearms produce peak sound pressure levels (peak SPL) between ∼130 and 175 dB peak SPL, creating significant risk of noise-induced hearing loss (NIHL) in those exposed to firearm noise during occupational, recreational, and/or military operations. Noise-induced tinnitus and hearing loss are common in military service members, public safety officers, and hunters/shooters. Given the significant risk of NIHL due to firearm and other noise sources, there is an interest in, and demand for, interventions to prevent and/or treat NIHL in high-risk populations. However, research and clinical trial designs assessing NIHL prevention have varied due to inconsistent data from the literature, specifically with end point definitions, study protocols, and assessment methodologies. This article presents a scoping review of the literature pertaining to auditory changes following firearm noise exposure. Meta-analysis was not possible due to heterogeneity of the study designs. Recommendations regarding audiologic test approach and monitoring of populations at risk for NIHL are presented based on critical review of the existing literature.

Monitoramento audiológico de lactentes em diferentes programas de triagem auditiva neonatal: uma revisão sistemática

ABSTRACT Purpose To search the literature for guidelines on infant’s audiological monitoring, most commonly used procedures, the age at which they are performed, which population should be monitored and the countries that study the subject the most. Besides, the importance and effectiveness of these measures will be discussed. Research strategy The review was conducted based on the PRISMA recommendations, registered on the PROSPERO platform. The studies were searched for in the electronic databases Medline (Pubmed), Web of Science and SciELO, using the descriptors hearing, neonatal screening and follow up. Selection criteria studies reporting the audiological monitoring were included. No filters on year and language of publication were used. Results A total of 432 articles were found and 21 were included in this study, mostly produced in developed countries. The Auditory Brainstem Response and the Behavioral Assessment were the most frequently used procedures. As to age and population, most infants are subjected to audiological monitoring up to three years of age and have Risk Factors for Hearing Loss in their clinical history. Conclusion The studies pointed that there is no standard among the protocols for performing audiological monitoring, but it was possible to identify agreement as to the age at which such monitoring takes place and which population should be monitored. However, although there is some disagreement, the assessment methods used in the studies are effective in detecting mild, progressive and/or late hearing loss, in addition to false negative cases.

Investigation of the Interaction between Hearing Function and Comorbidities in Adults Living with Human Immunodeficiency Virus.

Adults living with the human immunodeficiency virus (HIV) have a high prevalence of co-existing comorbidities. While research indicates that adults living with HIV are at risk of developing hearing impairment, limited research exists on the interaction between hearing function and comorbidities in this population. The objective of this study was to determine and compare the hearing function of a group of adults living with HIV and comorbidities and those without comorbidities. A sample of 132 adults living with HIV underwent a basic audiological test battery to assess their hearing function. Participants with comorbidities were 1.23 times more likely to develop hearing loss, with crude odds of 1.236 (95%CI 0.5467 to 2.795), while those with three comorbidities were 2.52 times more likely to develop hearing loss. Participants with hypertension were 93% more likely to develop hearing loss when compared to nonhypertensive participants (OR = 1.928; 95%CI: 0.7856 to 4.7345). There was only a marginal association between hypercholesterolemia and sensorineural hearing loss (SNHL), with no association between other comorbidities and the type of hearing loss. The current findings raise a need for prioritizing patients with comorbidities in audiological assessment and monitoring in resource-constrained contexts, where capacity versus demand challenges might prevent the provision of audiological services to all adults living with HIV. These findings also highlight the importance of preventive care in this population with regard to the burden of the disease, as it may lead to worse ear and hearing outcomes for affected individuals.

The cumulative incidence of cisplatin-induced hearing loss in young children is higher and develops at an early stage during therapy compared with older children based on 2052 audiological assessments.

Ototoxicity is a common adverse event of cisplatin treatment. The authors investigated the development of cisplatin-induced hearing loss (CIHL) over time in children with cancer by age and examined the influence of other clinical characteristics on the course of CIHL. Data from Canadian patients with childhood cancer were retrospectively reviewed. Hearing loss was graded according to International Society of Pediatric Oncology criteria. The Kaplan-Meier method was applied to estimate the cumulative incidence of CIHL for the total cohort and according to age. Cox regression models were used to explore the effects of independent variables on CIHL development up to 3 years after the start of therapy. In total, 368 patients with 2052 audiological assessments were included. Three years after initiating therapy, the cumulative incidence of CIHL was highest in patients aged ≤5 years (75%; 95% confidence interval [CI], 66%-84%), with a rapid increase observed to 27% (95% CI, 21%-35%) at 3 months and to 61% (95% CI, 53%-69%) at 1 year, compared with patients aged >5 years (48%; 95% CI, 37%-62%; P < .001). The total cumulative dose of cisplatin at 3 months (per 100 mg/m2 increase: hazard ratio [HR], 1.20; 95% CI, 1.01-1.41) vincristine (HR, 2.87; 95% CI, 1.89-4.36) and the total duration of concomitantly administered antibiotics (>30 days: HR, 1.85; 95% CI, 1.17-2.95) further influenced CIHL development over time. In young children, the cumulative incidence of CIHL is higher compared with that in older children and develops early during therapy. The course of CIHL is further influenced by the total cumulative dose of cisplatin and other ototoxic (co-)medication. These results highlight the need for audiological monitoring at each cisplatin cycle.

Recommendations for Age-Appropriate Testing, Timing, and Frequency of Audiologic Monitoring During Childhood Cancer Treatment: An International Society of Paediatric Oncology Supportive Care Consensus Report.

Ototoxicity is an irreversible direct and late effect of certain childhood cancer treatments. Audiologic surveillance during therapy as part of the supportive care pathway enables early detection of hearing loss, decision-making about ongoing cancer treatment, and, when applicable, the timely use of audiologic interventions. Pediatric oncologic clinical practice and treatment trials have tended to be driven by tumor type and tumor-specific working groups. Internationally accepted standardized recommendations for monitoring hearing during treatment have not previously been agreed on. To provide standard recommendations on hearing loss monitoring during childhood cancer therapy for clinical practice. An Ototoxicity Task Force was formed under the umbrella of the International Society of Paediatric Oncology, consisting of international audiologists, otolaryngologists, and leaders in the field of relevant pediatric oncology tumor groups. Consensus meetings conducted by experts were organized, aimed at providing standardized recommendations on age-directed testing, timing, and frequency of monitoring during cancer treatment based on literature and consensus. Consensus statements were prepared by the core group, adapted following several videoconferences, and finally agreed on by the expert panel. The consensus reached was that children who receive ototoxic cancer treatment (platinum agents, cranial irradiation, and/or brain surgery) require a baseline case history, monitoring of their middle ear and inner ear function, and assessment of tinnitus at each audiologic follow-up. As a minimum, age-appropriate testing should be performed before and at the end of treatment. Ideally, audiometry with counseling before each cisplatin cycle should be considered in the context of the individual patient, specific disease, feasibility, and available resources. This is an international multidisciplinary consensus report providing standardized supportive care recommendations on hearing monitoring in children undergoing potentially ototoxic cancer treatment. The recommendations are intended to improve the care of children with cancer and facilitate comparative research on the timing and development of hearing loss caused by different cancer treatment regimens.

Teprotumumab and Hearing Loss: Case Series and Proposal for Audiologic Monitoring.

To present a protocol for audiologic monitoring in the setting of teprotumumab treatment of thyroid eye disease, motivated by 4 cases of significant hearing loss, and review the relevant literature. Cases of hearing loss in the setting of teprotumumab were retrospectively elicited as part of a multi-institutional focus group, including oculoplastic surgeons, a neurotologist and an endocrinologist. A literature review was performed. An aggregate of 4 cases of teprotumumab-associated hearing loss documented by formal audiologic testing were identified among 3 clinicians who had treated 28 patients. Teprotumumab may cause a spectrum of potentially irreversible hearing loss ranging from mild to severe, likely resulting from the inhibition of the insulin-like growth factor-1 and the insulin-like growth factor-1 receptor pathway. Due to the novelty of teprotumumab and the lack of a comprehensive understanding of its effect on hearing, the authors endorse prospective investigations of hearing loss in the setting of teprotumumab treatment. Until the results of such studies are available, the authors think it prudent to adopt a surveillance protocol to include an audiogram and tympanometry before, during and after infusion, and when prompted by new symptoms of hearing dysfunction.

Audiological monitoring of patients undergoing multidrug resistant tuberculosis treatment at Jigme Dorji Wangchuk National Referral Hospital and Gidakom Hospital, Bhutan

BackgroundHearing impairment due to ototoxicity is one common cause adding to global burden of disability. Amikacin and kanamycin are two common Aminoglycosides used to treat multidrug resistant tuberculosis which results in ototoxicity. The mean prevalence rate of multidrug resistant tuberculosis in Bhutan stood at 16%. ObjectiveThe study is aimed to establish prevalence rate of hearing impairment due to ototoxicity and secondary side effects which may ascertain specific early intervention. MethodA total of 42 Patients undergoing multidrug resistant tuberculosis treatment participated in the study conducted at Jigme Dorji Wangchuk National Referral Hospital and Gidakom Hospital over a period of one year. Audiological tests were conducted once every month. The severity of ototoxicity was being graded using Brock's hearing loss grades. ResultThe study found 45.23% participants with some degree of hearing loss consequent to multidrug resistant tuberculosis treatment. Around 9.5% of the total participants developed potential disabling hearing loss. Around 30.09% of participants had experienced subjective tinnitus during the course of treatment. Study found no significant association (p-value 0.88, 95%CI 0.93–1.00) between referred test result of DPOAE (distortion product Otoacoustic emission) screener and the ototoxicity. ConclusionStudy showed with significant prevalence of ototoxicity. Since hearing impairment have negative impact on psychosocial wellbeing and communication abilities, it is paramount importance to put in place the various preventative measures. With current guidelines by World Health Organisation on replacement of second-line injectable by oral regimens while treating patients withMDR-TB, it is expected to address ototoxicity and related issues.

Avaliação audiológica de pacientes com doença falciforme

Objetivos: Os objetivos deste estudo foram avaliar a prevalência de perda auditiva em pacientes diagnosticados com doença falciforme (DF) acompanhados no Ambulatório de Hematologia do Conjunto Hospitalar de Sorocaba e correlacionar os achados com o tipo de hemoglobinopatia. Métodos: Neste estudo, foram incluídos 19 pacientes com diagnóstico de DF, sendo 68% da forma homozigota da hemoglobina S (SS); 16% do tipo hemoglobinopatia SC; e 16%, S-β-talassemia. Em cada paciente, foram realizados anamnese direcionada, exame físico otorrinolaringológico e avaliação audiológica com audiometria tonal, vocal e imitanciometria. Do total da amostra, 37% apresentou alguma alteração na audiometria tonal e a média dos limiares mostrou tendência a ser maior nas altas frequências. Resultados: Na amostra, foram encontrados um paciente (5%) com perda auditiva de grau leve a moderado bilateralmente e seis pacientes (32%) com limiares &amp;#62;25 dB em frequências de 250, 6.000 ou 8.000 Hz em um ou ambos os ouvidos. Não foi observada alteração do Índice de Reconhecimento de Fala (IRF) em nenhum paciente e a imitanciometria mostrou-se com curva Tipo A em 100% dos ouvidos avaliados. A relação do tipo de hemoglobinopatia e a presença ou não de perda auditiva não foram significantes. Conclusão: Assim como descrito na literatura, observou-se, neste estudo, a presença de perda auditiva neurossensorial, principalmente em altas frequências, nos pacientes com DF avaliados. Portanto, conclui-se que é de extrema importância o monitoramento audiológico desses pacientes.

A Narrative Review of Pharmacologic Treatments for COVID‐19: Safety Considerations and Ototoxicity

Objective/HypothesisThe purpose of this review is to summarize evidence‐based data regarding the ototoxic effects of potential COVID‐19 therapeutics to treat patients suffering from SARS‐CoV‐2.MethodsMedications under investigation as novel therapeutics to treat COVID‐19 were identified using the search term coronavirus therapeutics, COVID therapeutics, and SARS‐CoV‐2 therapeutics on ClinicalTrials.gov and the PubMed Database. A literature review was performed using the PubMed Database for each proposed COVID‐19 therapeutic to identify relevant articles. Search criteria included Medical Subject Headings (MeSH) and key word search terms for ototoxicity, vestibulotoxicity, hearing disorders, and vertigo.ResultsSix proposed COVID‐19 therapeutics were identified as possessing ototoxic side effects including chloroquine and hydroxychloroquine, azithromycin, lopinavir‐ritonavir, interferon, ribavirin, and ivermectin.ConclusionsAvailable evidence suggests that ototoxic effects may be improved or mitigated by stopping the offending agent. Recognition of hearing loss, tinnitus, or imbalance/vertigo is therefore crucial to facilitate early intervention and prevent long‐term damage. Hospitals should consider the inclusion of audiologic monitoring protocols for patients receiving COVID‐19 therapeutics with known ototoxicity, especially in high‐risk patient groups such as the elderly and hearing impaired. Laryngoscope, 131:1626–1632, 2021

Temporal analysis of hearing aids provision by the Brazilian Unified Health System.

To analyze the outpatient production of aspects of hearing aids (HA) provision by the Brazilian Unified Health System (SUS) between 2005 and 2018. This is an ecological time-series study, based on data from the Outpatient Information System of the SUS and the Brazilian Institute of Geography and Statistics. The HA provision rates were analyzed with Joinpoint software. Descriptive analyses were carried out for technological categories, funding, HA replacement and audiological monitoring. The South (9.96/10,000 inhabitants) and North (3.20/10,000 inhabitants) regions recorded the highest and lowest average rates, respectively. There were significant upward trends in HA provision in Brazil, in the North, Southeast and Midwest regions, with subsequent significant downward trends in the Southeast and Midwest. In the country, HA concession by technological categories was A (39.26%), B (36.93%) and C (23.81%), increasing funding. The Midwest (24.78%) and Northeast (14.22%) regions had the highest and lowest proportion of HA replacement, respectively. The audiological monitoring predominated in the Southeast (45.88%), with the lowest occurrence in the North (4.18%). Between 2005 and 2018, trends fluctuated and discrepancies between geographic regions were observed in HA provision by the SUS, in addition to mismatches in the provision of technological categories and funding, a considerable proportion of replacements and insufficient audiological monitoring for HA users.

Systematic Review of Interventions to Prevent Occupational Noise-Induced Hearing Loss - A Follow-up.

To conduct a systematic review of the effectiveness of interventions to prevent occupational hearing loss, following up on the findings of the most recent version of Cochrane systematic review on the same topic. Searches were carried out in PubMed, Web of Science and Scopus databases. The following interventions were considered: engineering/administrative controls; hearing protection devices (HPD); and audiological monitoring. For bias risk analysis, each study was assessed according to randomization, allocation, blinding, outcomes, other sources of bias. 475 references were obtained. Of these, 17 studies met the inclusion criteria: one randomized, one interrupted time series, and 15 before and after studies. Most studies were conducted in industries; three in military and/or shooting training environments; one in an orchestra, and one in construction. Most studies showed a high risk of bias. Six studies found a reduction in short-term exposure to noise through engineering/administrative controls; one found a positive impact due to changes in legislation; five studies have found positive effects of HPD in reducing exposure to noise and of educational trainings in the use of HPD; lastly, two studies found a reduction in noise levels and an increase in the using of HPD due to the implementation of hearing conservation programs. Todos os estudos analisados concluíram que as intervenções utilizadas resultaram em efeitos positivos sobre a audição e/ou sobre a exposição ao ruído. Em relação aos efeitos de longo termo, a grande maioria dos estudos limitou-se a avaliar efeitos imediatos ou de curto termo, reforçando que estudos incluindo follow-up de longo termo devem ser desenvolvidos.

Использование задержанной вызванной отоакустической эмиссии в качестве скринингового метода оценки слуха после воздействия шума высокой интенсивности

Hearing organ damage caused by high-intensity noise continues to be one of the actual problems of modern otorhinolaryngology. This study aims to evaluate the effectiveness of transient evoked otoacoustic emissions (TEOAEs) as a screening method for hearing research. 15 patients (men aged 18 to 28 years) were examined before and after exposure to high-intensity noise of artillery weapons. All patients passed a set of diagnostic tests: otoscopy, whispered voice test, tonal threshold audiometry, and TEOAE. Hearing thresholds according to audiometry did not exceed normal values. However, the number of people who passed the test TEOAE after noise exposure was 46.6% in the right ear and 40.0% in the left ear, which was statistically significantly different from the data obtained before the shooting. The authors conclude that TEOAE allows evaluation of the functional state of the hearing organ better than tonal threshold audiometry. This technique can be used for mass screening of individuals who are most sensitive to the effects of high-intensity noise, as well as for their further in-depth audiological monitoring.

OCENA AUDIOLOGICZNA URAZOWEGO USZKODZENIA MÓZGU – STUDIUM PRZYPADKU

BackgroundTraumatic brain injury (TBI) is a pathology frequently causing mortality or serious sequelae. About 20% of individuals with TBI will have some degree of auditory alteration. The aim of the present study was to use behavioural and electrophysiological assessments to analyse the hearing of a patient with TBI.Case reportA young male adult who had suffered severe TBI caused by a motorcycle accident was evaluated. The patient underwent a peripheral hearing evaluation and electrophysiological assessment. Pure tone audiometry revealed profound sensorineural hearing loss in the left ear and normal hearing in the right. In the electrophysiological assessment, an ABR click test showed the presence of a response in the right ear at 80 dB HL but no response in the left ear at 90 dB HL. Evaluation of the Middle Latency Response revealed the presence of both an electrode effect (C3) and an ear effect (A1). The P300 wave showed an event-related potential within normal limits in the right ear and no responses in the left.ConclusionsThe present case study verifies the importance of assessing the peripheral and central auditory nervous system in cases of patients with a history of TBI. It reinforces the need for diagnosis and audiological monitoring of these patients.

ENT Manifestations of Celiac Disease: A Scholarly Review.

Celiac disease is a common multisystemic autoimmune disorder. It is now increasingly recognized that it may present with extraintestinal manifestations which contribute to the difficulty in its diagnosis. The objective of this scholarly review was to examine the extraintestinal ENT manifestations of celiac disease and its pathophysiology and management, in order to highlight that some patients with celiac disease may present initially to the otolaryngologist. Improving awareness of celiac disease among otolaryngologists may aid in the correct diagnosis and correct management plan. A literature review was conducted using the PubMed database to identify original articles related to celiac disease and ENT manifestations between the years 2000 and 2020. The search was performed using the search string: ("coeliac disease" OR "celiac disease") AND ("ENT manifestations" OR "hearing loss" OR "epistaxis" OR "nasal septal perforation" OR "obstructive sleep apnoea" OR "vertigo" OR "tonsillitis" OR "sinusitis"). Only articles written in English were reviewed. A total of 17 papers met the inclusion criteria. Extraintestinal ENT manifestations of celiac disease include sensorineural hearing loss, obstructive sleep apnea, nasal septal perforation, epistaxis, and vertigo with nystagmus. Sensorineural hearing loss, obstructive sleep apnea, nasal septal perforation, vertigo, and nystagmus are thought to result from immunologically mediated mechanisms, with intestinal malabsorption resulting in epistaxis. Celiac disease can cause extraintestinal ENT manifestations and requires a high index of suspicion from the otolaryngologist to diagnose and suitably manage. A gluten-free diet may result in sufficient symptom resolution for most manifestations. Sensorineural hearing loss due to celiac disease appears to be progressive and permanent and may require frequent audiological monitoring.