Audiometric Testing Research Articles

Effects of Stimulus Type on 16-kHz Detection Thresholds.

Audiometric testing typically does not include frequencies above 8 kHz. However, recent research suggests that extended high-frequency (EHF) sensitivity could affect hearing in natural communication environments. Clinical assessment of hearing often employs pure tones and frequency-modulated (FM) tones interchangeably regardless of frequency. The present study was designed to evaluate how the stimulus chosen to measure EHF thresholds affects estimates of hearing sensitivity. The first experiment used standard audiometric procedures to measure 8- and 16-kHz thresholds for 5- to 28-year olds with normal hearing in the standard audiometric range (250 to 8000 Hz). Stimuli were steady tones, pulsed tones, and FM tones. The second experiment tested 18- to 28-year olds with normal hearing in the standard audiometric range using psychophysical procedures to evaluate how changes in sensitivity as a function of frequency affect detection of stimuli that differ with respect to bandwidth, including bands of noise. Thresholds were measured using steady tones, pulsed tones, FM tones, narrow bands of noise, and one-third-octave bands of noise at a range of center frequencies in one ear. In experiment 1, thresholds improved with increasing age at 8 kHz and worsened with increasing age at 16 kHz. Thresholds for individual participants were relatively similar for steady, pulsed, and FM tones at 8 kHz. At 16 kHz, mean thresholds were approximately 5 dB lower for FM tones than for steady or pulsed tones. This stimulus effect did not differ as a function of age. Experiment 2 replicated this greater stimulus effect at 16 kHz than at 8 kHz and showed that the slope of the audibility curve accounted for these effects. Contrary to prior expectations, there was no evidence that the choice of stimulus type affected school-age children more than adults. For individual participants, audiometric thresholds at 16 kHz were as much as 20 dB lower for FM tones than for steady tones. Threshold differences across stimuli at 16 kHz were predicted by differences in audibility across frequency, which can vary markedly between listeners. These results highlight the importance of considering spectral width of the stimulus used to evaluate EHF thresholds.

Prevalence of platinum-induced ototoxicity among patients suffering from hematological malignancies - a systematic review.

Platinum-based compounds used for treating hematologic malignancies can lead to various side effects. One such side effect is ototoxicity, which is characterized by permanent bilateral sensorineural hearing loss or tinnitus. Initially, it mainly affects high frequencies, but as the condition progresses, it may also affect low frequencies. Occurrence of ototoxicity has been reported in up to 80% of patients. However, the precise incidence among hematology patients remains unknown. Following Preferred Reporting Items for Systematic Reviews and meta- analyses guidelines, a systematic review was conducted to assess the incidence of ototoxicity among hematology patients undergoing platinum compound-based chemotherapy. Four databases - PubMed, Scopus, Embase, and Web of Science - were searched to identify relevant articles published in the period 2000-2023. Initially, 538 articles were screened, with only 5 meeting the criteria for inclusion in the analysis. The systematic review included a total of 77 patients, the majority of whom had Hodgkin's lymphoma (65 patients, 84.4%). Only one patient had leukemia. Of all patients, 16 (20.8%) developed ototoxicity. It is crucial for hematologic patients to undergo regular monitoring and audiometric tests even up to 10 years after treatment. Conducting prospective studies to evaluate hearing before, during, and after treatment is necessary to enhance the management of hematological patients.

A study of auditory acuity in patients with essential hypertension using pure tone audiometry

Background: The ability to communicate is a crucial aspect of human life and auditory sense is very important for communication of any kind. It has been hypothesized that hypertension is an independent risk factor for hearing loss is arterial hypertension. It is hypothesised that hypertension causes the degeneration of inner ear due to alteration in microcirculation. This study is undertaken to identify the role of hypertension in auditory acuity. Aims and Objectives: The aim of the study was to assess the association between high blood pressure and hearing function, after excluding the influence of noise pollution on hearing impairment and to see the association of duration of hypertension with hearing impairment, by performing pure tone audiometric tests on normotensives and hypertensives. Materials and Methods: 50 hypertensives visiting Hesaraghatta PHC and 50 normotensives residing in the same area were chosen for the study. After selecting the subjects from appropriate inclusion-exclusion criteria, informed consent was taken. Then blood pressure was measured followed by audiometric assessment for hearing acuity in each using standard guidelines. The results were compiled and statistically analysed. Results: Hypertensives have a higher threshold in all frequencies for both air conduction and bone conduction. Significant P-values were found in both ears for all frequencies in both air conduction and bone conduction in both ears. Thresholds are increased but were within normal limits since cases are on treatment, resulting in mild hypertension. Conclusions: There was a significant increase in hearing thresholds at all frequencies in hypertensives than normotensives. In the current study, no significant correlation was found between duration of hypertension and auditory thresholds.

Association of Sleep Characteristics with Tinnitus and Hearing Loss.

The impact of poor sleep on tinnitus has been mainly attributed to central processes. There is an association between sleep disorders and hearing loss, but whether hearing levels mediate the association between sleep disorders and tinnitus is unknown. This study investigates the association between sleep characteristics, tinnitus, and hearing loss. Cross-sectional. National Health and Nutrition Examination Survey (NHANES). Study cohort includes 9693 adults (≥20 years) from the NHANES 2005 to 2018 who completed audiometric testing and questionnaires on tinnitus and sleep characteristics. Multivariable regression analyses were performed to quantify associations between sleep characteristics, tinnitus, and hearing loss. In this cohort, 29% (95% confidence interval [CI]: 28%-31%) reported trouble sleeping and 9% (95% CI: 8%-10%) reported being diagnosed with sleep disorders. Negative sleep characteristics (less hours of sleep, diagnosis of a sleep disorder, trouble sleeping, or OSA symptoms) were not associated with audiometry-measured hearing loss in multivariable models adjusted for demographics and comorbidities but were significantly associated with bothersome tinnitus. This association remained significant without substantial attenuation in multivariable models additionally adjusting for hearing levels: sleeping <8 h/day (vs≥8) (odds ratio [OR]: 1.28 [95% CI: 1.08-1.52]), trouble sleeping (OR: 1.78 [95% CI: 1.45-2.19]), diagnosis of sleep disorders (OR: 1.57 [95% CI: 1.14-2.15]), and report of OSA symptoms (OR: 1.42 [95% CI: 1.08-1.88]). Negative sleep characteristics were associated with tinnitus while there was no clinically meaningful association between sleep and hearing loss. Our findings suggest that the relationship between poor sleep and tinnitus is likely contributed by central processes without a major role of mediation via the peripheral auditory system.

A Novel COCH p.D544Vfs*3 Variant Associated with DFNA9 Sensorineural Hearing Loss Causes Pathological Multimeric Cochlin Formation.

COCH (coagulation factor C homology) is one of the most frequently mutated genes of autosomal dominant non-syndromic hearing loss. Variants in COCH could cause DFNA9, which is characterized by late-onset hearing loss with variable degrees of vestibular dysfunction. In this study, we report a Chinese family with a novel COCH variant (c.1687delA) causing p.D544Vfs*3 in the cochlin. Comprehensive audiometric tests and vestibular function assessments were taken to acquire the phenotypic profile of the subjects. Next-generation sequencing was conducted and segregation analysis was carried out using Sanger sequencing. The proband presented mild vestibular symptoms and normal functional assessment results in almost every test, while the variant co-segregated with hearing impairment in the pedigree. The variant was located beyond the vWFA2 domain, which was predicted to affect the post-translational cleavage of the cochlin via molecular modeling analysis. Notably, in the overexpressing study, by transient transfecting the HEK 293T cells, we found that the p.D544Vfs*3 variant increased the formation of multimeric cochlin. Our result enriched the spectrum of DFNA9-linked pathological COCH variants and suggested that variants, causative of cochlin multimerization, could be related to DFNA9 with sensorineural hearing loss rather than serious vestibular symptoms.

THE ASSOCIATION OF HEARING LOSS AND FRAILTY AMONG OLDER ADULTS IN THE US

Abstract Frailty is common in older adults and increases the risk of functional limitations and death. Hearing loss affects ~2/3 of older adults in the U.S. and is associated with poorer physical and cognitive function and social isolation, which may increase the risk for frailty. We aimed to determine if hearing loss is associated with higher odds of being frail or pre-frail versus robust and if hearing aid use is protective. We analyzed data from 2,361 participants from the National Health and Aging Trends Study (NHTAS), a U.S. nationally representative sample of older adults, collected in 2021. Hearing was assessed by pure-tone audiometric testing, and we used a speech-frequency (0.5-4 kHz) better hearing ear’s pure-tone average (BPTA) to categorize participants into no hearing loss (BPTA≤25 dB HL), mild (26-40), and moderate or greater (&amp;gt;40) hearing loss. Physical frailty was categorized according to the presence of the frailty phenotype components (unintentional weight loss, exhaustion, low physical activity, weakness, slow walking speed) into robust (0), pre-frail (1-2), and frail (≥3). In our study population (mean age=81, 56% female, 19% Black), there were 1,724 (73%) participants with hearing loss. Using multinomial logistic regression, we found that participants with moderate or greater hearing loss (vs. those without) had higher odds of being frail versus robust (OR=1.82, 95% CI 1.11, 2.99, p-trend=0.016). Hearing loss may be a risk factor for frailty. Future studies on the impact of hearing interventions in preventing and managing frailty will have significant public health and clinical importance.

Hearing loss in Takayasu's arteritis.

Neurosensory hearing loss is well-documented in chronic autoimmune conditions such as systemic lupus erythematosus (SLE). However, the literature lacks data on the prevalence and characteristics of hearing impairment in Takayasu's arteritis (TAK). In this cross-sectional study, our principal objective was to systematically assess the auditory function of individuals diagnosed with TAK, against SLE patients and healthy controls (HC). Age and gender matched TAK and SLE patients followed up in a tertiary centre along with healthy controls were included in a two-phase study. In the first phase, a questionnaire on ENT symptoms was administered to the patient (TAK: n=104 and SLE: n= 151) and HC (n=174) groups. In the second phase, patients (TAK: n=53 and SLE: n=33) and HC (n=45) underwent audiometric tests. The questionnaire survey revealed that both TAK and SLE patients reported hearing loss (27.9%, 25.8%, 7.4%, p<0.001), tinnitus (49%, 35.8%, 13.8%, p<0.001) and vertigo (46.2%, 33.8%, 16.7%, p<0.001) at significantly higher rates than HC. Audiometry results indicated that both TAK (30.2%) and SLE patients (18.2%) had increased hearing loss compared to HC (8.9%), however, only TAK patients were found to have significantly increased risk in age adjusted logistic regression analysis (OR= 3.915, 95%CI: 1.179-12.998, p=0.026). Hearing loss was mainly neurosensory in all groups. TAK patients were affected at both low (<6000 Hz) and high (>6000 Hz) frequencies, whereas SLE patients were affected only at high frequencies. Hearing loss was significantly associated only with older age. No association was observed with the anatomical location of vascular involvement or history of stroke. Our study reveals an increased prevalence of hearing loss in TAK. Further research is crucial to uncover the underlying causes.

Cerebellopontine angle tumor presenting as acute audiovestibular syndrome

Background Acute audiovestibular deficits may be a harbinger of vestibular schwannoma (VS). Objective To investigate clinical and laboratory features of 25 consecutive patients with VS presenting with acute audiovestibular deficits. Methods A symptomatic combination of acute audiovestibular deficits was investigated. Audiometric and vestibular function tests, and internal auditory canal magnetic resonance imaging (IAC MRI) results were evaluated. Results Varying combinations of symptoms may develop in VS patients with acute audiovestibular deficits, of whom sudden hearing loss (HL) without acute vertigo or acute facial nerve palsy (FNP) was most common. The most common audiometric configuration was high-tone hearing loss, and no patient showed low-tone hearing loss. IAC MRI demonstrated that the tumor had an intracanalicular portion and attachment to the bony IAC wall in all patients and widened the IAC wall in some patients. Conclusion Different symptomatic combinations of acute audiovestibular deficits may develop in patients with VS. Awareness about the possibility of VS as a cause of sudden HL, acute vertigo, and acute FNP, as well as subsequent IAC MRI scanning is vital to earlier diagnosis of VS in these patients.

Hearing impairment and risk of dementia in The HUNT Study (HUNT4 70+): a Norwegian cohort study

Hearing impairment is strongly associated with future dementia. No studies have reported objectively measured hearing impairment in a cohort with a long period of follow-up (>20 years), and few have reported follow-up over 10 years. Hence, there is a need for high quality studies with sufficient follow-up time and data to account for reverse causality and confounding. We aimed to address this knowledge gap. This cohort study used individual participant data from The Trøndelag Health Study (HUNT) in Norway. All current residents aged at least 20 years in the former Norwegian Nord-Trøndelag County were invited to participate in four decennial surveys: HUNT1 (1984-1986), HUNT2 (1995-1997), HUNT3 (2006-2008), and HUNT4 (2017-2019) with individuals aged at least 70 years included in a substudy, known as HUNT4 70+. Here, we report the findings of this substudy. HUNT4 70+ comprised 7135 participants who were assessed for dementia using the Diagnostic and Statistical Manual of Mental Disorders 5 criteria and who had audiometry between 1996 and 1998. The primary objective was to investigate, with gold standard audiometric testing and dementia diagnostic assessment, whether hearing impairment was an independent risk factor for all-cause dementia. The secondary objective was to investigate if a risk also applied to Alzheimer dementia and non-Alzheimer dementia. We analysed the association using Poisson regression and adjusted for confounders. This study is registered with ClinicalTrials.gov (NCT04284384). At baseline, 1058 (15%) individuals had acquired hearing impairment with a hearing threshold of at least 25 decibel (dB) and, at follow-up, 1089 (15%) had dementia. In the total group, people with hearing impairment had a relative risk (RR) 1.04 (95% confidence interval (CI) 1.00-1.09) per 10dB increase in hearing thresholds. For individuals younger than 85 years at follow-up the RR was 1.12 (95% CI 1.05-1.21). Associations between hearing impairment and Alzheimer dementia and non-Alzheimer dementia were similar. There was no association for individuals aged at least 85 years. We found a moderate association between objectively measured hearing impairment and dementia in the younger age group (<85 years). The findings of no association in the older age group (≥85 years) might be due to the competing risk of death. The present study adds to the literature showing that acquired hearing impairment is a risk for dementias over a period which is too long for reverse causation, and with thorough consideration of confounders. Further research is needed to investigate associations between the different aetiologies of hearing loss and dementia subtypes, and risk differences for sexes. The Norwegian National Centre for Ageing and Health with a grant from Health South-East.

Speech processing in the brain at risk for dementia

AbstractBackgroundGiven the close relationship between hearing and cognitive function in older age, characterization of speech processing deficits along the auditory pathway is of great importance for the brain at risk of dementia. In the ascending, primary auditory pathway, signals pass through subcortical relay stations in the brainstem and midbrain before being integrated into cortical areas. A recent study suggests that the pathophysiology of MCI extends to speech encoding in the brainstem and that both cortical and subcortical markers of speech processing have predictive potential for putative Mild Cognitive Impairment (MCI). In this project, we are testing these neural speech processing markers to see if they can distinguish healthy older adults with age‐related hearing loss from those at risk for dementia.MethodsElectroencephalography (EEG, 32 channels, sampling rate = 16 384 Hz) will be recorded from N = 40 older participants (age ≥ 60 years, retired) while listening to excerpts from an audiobook. We use a novel EEG paradigm that allows us to simultaneously measure cortical and subcortical responses to natural running speech. Based on their Montreal Cognitive Assessment (MoCA) score, participants are divided into an experimental group with “putative MCI” (MoCA &lt; 26) and a control group (MoCA ≥ 26). In addition, we perform audiometric testing with pure tones (PTA) and speech‐in‐noise (SiN) tests to assess participants' hearing function.ResultsWe are currently in the middle of data collection and will be able to present preliminary results at AAIC. We expect to see altered speech processing in the experimental group, particularly driven by slower and weaker encoding at the subcortical level. In a next step, we aim to use the neural markers of speech processing that emerge from this framework as features for a diagnostic model that predicts MCI using a binary classifier, considering the hearing status of the participants.ConclusionThe main goal of this study is to investigate neural markers of speech processing for their differential diagnostic potential for the brain at risk for dementia. Depending on the results, such neurophysiological markers could prove useful for early diagnosis in the clinic in the longer term.

Earplug fit-testing system applying pure-tone audiometer

As for the sound attenuation measurement method of hearing protectors, such as earplugs and earmuffs, the real-ear attenuation at threshold (REAT) method is established by some standards such as ISO, ANSI, AS, etc. As known, however, sound attenuation differences between workers wearing protectors in real occupational noise fields are not small due to personal size-fitness or wearing conditions of hearing protectors. Although personal hearing protector fit-testing systems have been developed and standardized in Western countries, the systems have not yet been standardized in Japan, so they are not applicable easily. The authors tried to apply the pure-tone audiometric system equipped with circumaural earphones used for a medical check-up to the fitting system for earplugs on this occasion, where the Japanese guidelines for preventing noise-induced impairments were revised for the first time in about 30 years. This paper describes the overview of the earplug fit-test system applying the audiometer and trial test results of sound attenuation ratings by the proposed system.

Sudden Sensorineural Hearing Loss from a Jugular Bulb Diverticulum

A 19-year-old woman presented with an 11-month history of sudden-onset left sided hearing loss accompanied by vertigo and headache. Audiometric testing revealed profound left- sided hearing loss. A contrast-enhanced MRI of the internal auditory canal performed 5 months after symptom onset was interpreted as showing a vascular loop, probably the anterior inferior cerebellar artery, abutting and indenting on the left vestibulocochlear nerve; and a prominent and high-riding left jugular bulb. In this study, the internal auditory canals were assessed to be of normal width, with walls that were smooth and sharply defined. A cerebral CT angiogram subsequently performed did not show any abnormal findings related to the previously identified vascular loop. On the basis of these radiologic findings, the patient was advised surgery by physicians at a tertiary- care institution, presumably to address the identified vascular loop. A second opinion was sought by the patient.&#x0D; Review of the MRI initially focused on the axial high-resolution T2-weighted sequence (T2-DRIVE), as the fast spin-echo T2-weighted sequence has been recommended as a reliable and cost-effective MR screening protocol for the detection of masses in the IAC.1 In contrast to the official radiology report, stenosis of the left internal auditory canal by a protrusion (Figure 1, white asterisk) originating from the posteromedial wall of the internal auditory canal was noted. This protrusion, which had no MR signal intensity, appeared to abut and compress the cranial nerves within the IAC. Reconstruction of the images in non-orthogonal planes aligned with the orientation and direction of the left 8th cranial nerve showed the protrusion causing upward compression on and distortion of the nerve. (Figure 2, white arrows)&#x0D; Attention was directed to the axial high-resolution T1-weighted sequence (T1W-3D FFE), which revealed that the protrusion contained an isointense soft tissue structure (Figure 3, white asterisk) located within the petrous bone medial to the posterior semicircular canal. This structure appeared to be an upward extension of the jugular bulb.&#x0D; The axial high-resolution contrast-enhanced T1-weighted sequence (T1W-3D TFE Gd) showed smooth, vivid enhancement of the identified structure (Figure 4, black asterisk), which connected with the sigmoid sinus in lower cuts. This confirmed the presence of a high-riding jugular bulb that encroached on the internal auditory canal.&#x0D; Any doubt as to its true nature was dispelled by a review of the temporal bone structures on high-resolution CT which was fortunately available in the cerebral CT angiogram. This revealed a protrusion of the high-riding jugular bulb with a waist-like margin (Figure 5A and B, black arrows), allowing further characterization of the lesion as a jugular bulb diverticulum.2&#x0D; A high-riding jugular bulb that projects into the middle ear is not an uncommon anatomic variation. On the other hand, a jugular bulb diverticulum, which is an outpouching of the jugular bulb that can extend superiorly, medially, and posteriorly in the petrous bone, is a true venous anomaly that has been described rarely in the medical literature.3,4 When symptomatic, patients with this anomaly can present with sensorineural hearing loss, tinnitus, vertigo and auricular pain.3-5 Proper identification of a jugular bulb diverticulum in the evaluation of a patient with neurotologic symptoms is necessary to avoid inappropriate medical and surgical intervention.&#x0D; As demonstrated in this patient, a jugular bulb diverticulum may not be identified by a screening MRI that utilizes only a T2-weighted sequence. T1-weighted MRI sequences with and without contrast are necessary to demonstrate its soft tissue imaging characteristics. Although not the initial imaging study of choice for sudden sensorineural hearing loss, high-resolution bone-window CT may be necessary to delineate the bony anatomy of the jugular foramen and confirm the presence of this anomaly.

Vestibular Testing-New Physiological Results for the Optimization of Clinical VEMP Stimuli.

Both auditory and vestibular primary afferent neurons can be activated by sound and vibration. This review relates the differences between them to the different receptor/synaptic mechanisms of the two systems, as shown by indicators of peripheral function-cochlear and vestibular compound action potentials (cCAPs and vCAPs)-to click stimulation as recorded in animal studies. Sound- and vibration-sensitive type 1 receptors at the striola of the utricular macula are enveloped by the unique calyx afferent ending, which has three modes of synaptic transmission. Glutamate is the transmitter for both cochlear and vestibular primary afferents; however, blocking glutamate transmission has very little effect on vCAPs but greatly reduces cCAPs. We suggest that the ultrafast non-quantal synaptic mechanism called resistive coupling is the cause of the short latency vestibular afferent responses and related results-failure of transmitter blockade, masking, and temporal precision. This "ultrafast" non-quantal transmission is effectively electrical coupling that is dependent on the membrane potentials of the calyx and the type 1 receptor. The major clinical implication is that decreasing stimulus rise time increases vCAP response, corresponding to the increased VEMP response in human subjects. Short rise times are optimal in human clinical VEMP testing, whereas long rise times are mandatory for audiometric threshold testing.

Increasing Hearing Readiness Using Boothless Audiometry

ABSTRACT Introduction U.S. Army regulations require all soldiers to undergo annual audiometric testing to maintain hearing readiness. The standard method of monitoring hearing in the DoD is via multi-person testing in sound-treated booths using the Defense Occupational and Environmental Health Readiness System—Hearing Conservation. COVID-19 significantly hindered the standard method, resulting in alarming declines in hearing readiness. In response, the Army Hearing Program initiated a pilot program to use boothless audiometers to supplement standard methods to increase hearing readiness. Materials and Methods Funding from the Coronavirus Aid, Relief, and Economic Security Act was used to purchase 169 boothless audiometers and increase staffing at dozens of Army Hearing Program clinics. Standard operating procedures were established for audiometric testing outside the booth using a process matching standard test parameters (i.e., test frequencies, tone characteristics, and interstimulus intervals). Additional capabilities developed to leverage this new technology during the annual hearing exam include the administration of automated contralateral masking, enhanced tinnitus screening, and hearing health education and training. Results Monitoring audiometry using boothless audiometers has been conducted for nearly 12,000 service members worldwide. Thresholds obtained via boothless audiometers are comparable to follow-up thresholds obtained from the standard test methods in the booth (mean difference 95% CI, −1.2, 0.9), and hearing readiness has returned to pre-pandemic levels at installations where this novel technology is being used regularly. Conclusions Significant reductions in patient encounters as a direct result of the COVID-19 pandemic have led to innovative solutions leveraging boothless audiometers. While this has aided the primary mission to maintain a medically ready force, innovations from this endeavor highlight several additional improvements relative to current standards of care that should be considered for permanent inclusion in DoD Hearing Conservation Programs.

Are conversation and whispered voice hearing tests comparable to pure tone audiometry for assessment of hearing loss? A retrospective analysis

BackgroundPure tone audiometry (PTA) is considered the standard method of hearing assessment. However, technical and logistical challenges preclude its usage for hearing screening at primary healthcare facilities. Free field hearing (FFH) tests such as conversation voice (CV) and whispered voice (WV) tests have been used for hearing assessment. However, their correlation to PTA and accuracy in detection of hearing loss are doubtful. This study aims to determine if FFH tests can be used for estimation of hearing thresholds. MethodsA retrospective analytical study was conducted at the otorhinolaryngology department. Spearman's correlation coefficient (ρ) was determined between FFH recognition distance and average air conduction PTA thresholds. A statistical regression model was developed to estimate hearing thresholds from the FFH recognition distance. The FFH tests were studied for their accuracy in detection of hearing loss. ResultsThe audiometric records of 437 persons (874 ears) were analysed. The CV and WV tests were found to have a high correlation (ρ = −0.757 and −0.758, respectively) with average PTA thresholds in persons with hearing loss. The WV test was found to have a 94.7% sensitivity, 90.8% specificity, 97.6% positive predictive value, 80.9% negative predictive value, and 93.9% accuracy in detection of hearing loss. ConclusionFFH tests such as WV test can be used to estimate the hearing thresholds and screen for hearing loss when audiometric tests are not logistically feasible, such as at primary-level healthcare facilities, remote locations, and in schools. However, such tests should not be regarded as a substitute to PTA.

Pediatric tracheostomy audiometric outcomes - A quality improvement initiative.

Pediatric tracheostomy patients disproportionately experience hearing loss and are at risk for delayed identification due to their medical complexity. Nonetheless, protocols to monitor hearing in these children are lacking. This quality improvement (QI) initiative aimed to increase the rates of audiometric testing within 12 months of pediatric tracheostomy placement. A retrospective cohort study included children who underwent tracheostomy under 18 months of age between 2012 and 2020. Rates of audiometric assessments before and after QI project implementation (2015) were reported along with hearing loss characteristics. A total of 253 children met inclusion. Before project initiation (2012-2014), 32% of children (28/87) obtained audiometric testing within 12 months after tracheostomy. During the first three years of implementation (2015-2017), 39% (38/97) were tested, while 55% (38/69) were tested during the subsequent three years (2018-2020) (P=.01). A passing newborn hearing screen was obtained for 70% of the 210 children with a recorded result, and 198 survived at least 12 months to receive audiometric testing at a median of 11.3 months (IQR: 6.2-22.8) after tracheostomy. Hearing loss was identified for 44% of children (N=88), of which 42 children initially passed newborn hearing screen. A second assessment was obtained for 62% of children (123/198) at a median of 11.3 months (IQR: 4.5-17.5) after the initial test. In this group, 23% with a previously normal audiometric exam were found to have hearing loss (15/66). QI initiatives designed to monitor hearing loss in children with a tracheostomy can result in improved rates of audiometric assessments. This population has disproportionately high rates of hearing loss, including delayed onset hearing loss making audiometric protocols valuable to address speech and language development delays.

Complications in patients with transfusion dependent thalassemia: A descriptive cross-sectional study.

One of the most common hemoglobinopathies globally related to blood transfusion and iron overload in the body is thalassemia syndrome. Increasing ferritin levels can cause severe damage to the patient's body organs. This study aims to evaluate the complications of iron overload on vital body organs in patients with transfusion-dependent beta-thalassemia. This descriptive cross-sectional study was performed in Iran University of Medical Sciences Hospitals on patients with a beta-thalassemia major with frequent blood transfusions. To evaluate the effect of iron overload on vital body organs, hematologic and blood analysis, echocardiography with measurement of pulmonary artery pressure (PAP) and ejection fraction (EF) tests, bone densitometry, and audiometric tests were performed for all patients. Of the 1010 patients participating in this study, 497 (49%) were males, 513 were (51%) females aged 5-74 years, and the majority of participants (85%) were over 20 years old. This study demonstrated that increasing ferritin levels had no notable correlation with sex, cholesterol, low-density lipoprotein, parathyroid hormone, T4, and aspartate aminotransferase. However, elevating ferritin levels had significant correlations with increasing triglyceride, phosphorus, thyroid stimulating hormone, alkaline phosphatase, alanine transaminase, and PAPlevels, age, hearing disorders, splenectomy, osteoporosis, and decreasing high-density lipoprotein, body mass index, calcium, and EFlevels. Improvement in beta-thalassemia patients' survival and quality of life can be due to multidisciplinary care in a comprehensive unit through regular follow-up and early complication detection.

Exploring the effect of sound scene on self-directed hearing-aid gain adjustment

Self-directed gain adjustments may present a plausible solution for fitting a hearing-aid (HA) without the requirement of audiometric tests. In the current experiment, users interacted with their hearing aids using a touchscreen-enabled mobile device while a continuous speech stimulus with background noise was played in the sound field, simulating real-world sound scenes. They explored different settings by dragging a cursor on the touchscreen, experiencing real-time audio changes, and identifying their preferred amplification level. Thirteen older adults with self-identified hearing difficulties participated in the study (RHHI score ≥6). The self-fitting procedure was conducted in two sound scenes: Restaurant and Traffic. The speech level was set at 60 dB-A in both sound scenes, and the signal-to-noise ratios were 5 and 10 dB for the Restaurant and Traffic scenes, respectively. Following the self-fitting procedure, real-ear aided responses were measured for the amplification profiles obtained using the two sound scenes. The real-ear aided responses for the two scenes resembled each other, with a median correlation coefficient across participants of 0.81. Nevertheless, a marginally significant difference was found between them, mostly driven by higher or lower frequency regions. This suggests that scene-specific adjustments of hearing-aid fitting may be beneficial for some users.

Limited Audiological Assessment Results in Children With Otitis Media With Effusion.

Clinical practice guidelines predicate the need for evaluation of hearing in children with otitis media with effusion (OME). The objective of this work was to characterize the completeness of hearing assessment results in children with OME. Forty participants with OME completed two full audiological assessments, one in a clinical setting and a second in a research setting. An additional 14 participants without OME completed a single audiological assessment in the research setting as a control group. The success of various behavioral and objective audiometric tests in each setting was quantified and evaluated. Findings indicate that ear-specific behavioral audiometric information is substantially limited in children with OME, particularly in clinical settings. In contrast, objective testing including tympanometry and otoacoustic emission testing was largely successful. Ear-specific behavioral audiometric information is limited in children with OME and, consequently, consideration of these data for use as part of clinical decision making is also limited. Objective tests were more successful but are not direct measures of hearing.

Clinical Standardization for the Detection of Hemispheric Dominance for Steady-State Auditory Evoked Fields (SSAEFs) in Normal Hearing.

Steady-state auditory evoked responses (SSAERs) are promising indicators of major auditory function. The improvement in accessibility in the clinical setting depends on the standardization and definition of the characteristics of SSAERs. There have been some insights into the changes in the interhemispheric dominance of SSAERs in some clinical entities. However, the hemispheric asymmetry of SSAERs in healthy controls remains inconclusive. Twelve right-handed healthy volunteers with normal hearing were recruited. Steady-state auditory evoked fields (SSAEFs) were measured binaurally using magnetoencephalography (MEG) under pure-tone auditory stimuli at 1000 Hz with an amplitude modulation frequency of 43 Hz. The laterality index, based on the ratio of SSAEF strength over the right hemisphere to that over the left hemisphere, was also analyzed. The SSAEFs source was localized bilaterally on the superior temporal plane, with an orientation centripetal to the auditory cortex. The laterality index ranged from 1.1 to 2.3, and there were no sex differences. In all subjects, the strength of the SSAEFs was significantly weaker in the left hemisphere than in the right hemisphere (p=0.014). Right-sided dominance of the SSAEFs was verified in subjects with normal hearing. Acoustic sources clinically available in audiometric tests were used as stimuli. Such a simplification of parameters would be helpful for the standardization of precise production and the definition of the characteristics of SSAERs. Since MEG is still not easily accessible clinically, further studies using electroencephalography with larger sample sizes are necessary to address these issues.