Early Identification Of Hearing Loss Research Articles

Postponement of the Newborn Hearing Screening during the COVID-19 Pandemic; Parental Experiences and Worries.

Early identification of hearing loss through newborn hearing screening followed by an early start of intervention has proven to be effective in promoting speech and language development in children with hearing loss. During the COVID-19 pandemic, newborn hearing screening was postponed for a group of newborns in the Netherlands. Therefore, meeting the guidelines for early identification was at risk. In this study, we examine parental attitudes, beliefs, and experiences concerning the hearing screening during the COVID-19 pandemic. Our results indicated that parents (n = 1053) were very positive about newborn hearing screening and their experiences with the screening, even during the COVID-19 pandemic. Parents' beliefs on the information provision around newborn hearing screening were more inconsistent. The results showed that parents with a postponed hearing screening felt less informed about the hearing screening than parents without a postponed screening. Furthermore, child and family characteristics affected how parents experienced newborn hearing screening. Parents with a premature child were more worried about the hearing abilities of their child before the screening took place. The results also indicate that deafness in the family might lead to parental worries around newborn hearing screening.

Retesting of Neonatal Hearing Screening Before and During the COVID-19 Pandemic: A Longitudinal Study

Introduction: Universal Newborn Hearing Screening (UNHS) plays an essential role in the early identification of hearing loss in neonates. Risk factors for hearing impairment may include family history, prematurity, and exposure to ototoxic substances. Coronavirus Disease 2019 (COVID-19) might be a significant contributing factor affecting the structures of the inner ear. Objective: To assess the auditory follow-up process of retesting for UNHS before and during the COVID-19 pandemic among neonates from an Outpatient Auditory Health Service (SASA) in the state of Santa Catarina with SUS (Unified Health System) assistance. Methods: A retrospective longitudinal study analyzed data from neonates attended at a SUS Auditory Health Service (SASA) from January 2018 to December 2022. Information related to UNHS and retest outcomes was assessed. Data were analyzed using Microsoft Excel® and MedCalc® Statistical Software version 22.006, utilizing statistical measures and regression analyses to identify factors associated with UNHS failures and retesting. Results: A failure to retest rate of 2.6% in the right ear and 2.2% in the left ear was observed among evaluated neonates. The average age of mothers of neonates who did not pass the test was 33 years, while the overall average was 27 years. Failure to pass the retest and a longer interval between UNHS and retesting were associated with UNHS Initial Retest Default (IRD). There was an increase in dropout rates for UNHS retesting, and the time interval between UNHS and retesting was extended during the pandemic. Conclusion: Several factors, including the interval between tests, mothers' age, and medical conditions, influenced the retest outcomes. The pandemic led to a significant increase in dropout rates and extended time for retesting.

Hearing Loss among Children Treated with Chemotherapy at Paediatric Oncology Department in Tanzania

Chemotherapy-induced hearing loss bears significant impairment of skills, language development, and cognitive performance in children. Hearing loss pattern is mostly bilateral and sensorineural, affecting high frequencies above 8 kHz, which is important in speech discrimination and background noise perception. Pathophysiology is related to damage to the basal cochlea outer hair cell, which can progress to those in the apical turn. Despite challenges encountered during monitoring chemotherapy ototoxicity in children, monitoring is very advantageous since it guides in the early identification of hearing loss and provides proper intervention such as treatment interruption, dose modification, and suspension of drugs. This study aimed to determine the prevalence and pattern of hearing loss among children treated with chemotherapy at the paediatric department in a Tertiary hospital. This was a prospective longitudinal study. A total of 52 participants were enrolled, whereby hearing assessment was done before and after receiving two cycles of chemotherapy. Tympanometry was done after otoscopic examination in all participants, play and pure tone audiometry for participants aged 2 to 6 years and 7 years, respectively, and a destruction test for those below 2 years of age. Statistical Package for Social Science (SPSS) version 26 was used to obtain cross-tabulations. Fifty-two participants with a mean age of 6.6±2.3 years were enrolled in the study. There was a male preponderance with a male-to-female ratio of 3:1. Prevalence of hearing loss after chemotherapy was 15.4%. The pattern of hearing loss was predominantly bilateral, high frequency, and sensorineural type of hearing loss. Nasopharyngeal tumours were related to hearing loss as compared to other tumour sites. Hearing loss was frequently associated with the use of cisplatin as compared to vincristine and carboplatin. The commonly used chemotherapies such as cisplatin, carboplatin, and vincristine can cause hearing loss, which can affect the quality of life and therefore require audiological monitoring

Hearing Health Awareness and the Need for Educational Outreach Amongst Teachers in Malawi

A Pre-Survey, followed by an educational intervention, and a Post-Survey were completed by teacher participants. A similar World Health Organization-derived survey was also administered to compare to our locally adapted survey. Trends related to efficacy, performance, and survey improvement were evaluated. A total of 387 teachers participated. The average score on the Post-Survey was significantly improved compared to the Pre-Survey (71% to 97% correct responses) with the educational intervention. The only predictive variable related to performance was the location of the school within the capital of Lilongwe compared to rural sites outside of the capital. Our locally adapted survey compared favorably to the WHO survey. The results suggest that there is a statistically significant improvement in the implementation of an educational program to increase the knowledge and awareness of hearing health care among teachers. Some topics were more poorly understood than others, suggesting the need for targeted awareness interventions. Location within the capital city had some effect on performance but a high rate of correct responses was achievable across the participants independent of age, teaching experience, or gender. Our data support the idea that hearing health awareness interventions can be an effective and low-cost option to equip teachers to effectively serve as an advocate for improved identification, early diagnosis and appropriate referral of students with hearing loss.

The relationship between hearing status, listening effort, and the need for recovery in employees of a manufacturing company

ObjectiveHearing screening can be used to detect hearing loss, but its value for identifying employees with work functioning difficulties is unclear. The objective of this study was to assess the association between the hearing status measured with an occupational hearing-in-noise screening test, Listening Effort (LE), and Need For Recovery (NFR) in employees of a manufacturing company, and to examine whether these associations depend on the perceived noise level at the workplace.MethodsEmployees of coatings and paints manufacturing company were included. Their hearing status was assessed with an occupational hearing-in-noise screening test. An online survey was used to assess their LE, NFR, and the perceived noise level at the workplace. Responses from 143 employees were analyzed (mean age = 53 years) using hierarchical multiple regression analysis with the outcomes LE and NFR.ResultsRegression analysis—with adjustments for gender, age, educational level, health status, pace/amount of work, job variety, and work pleasure—revealed that hearing status was significantly associated with LE, but the interaction between hearing status and the perceived noise level was not. Hearing status nor the interaction between hearing status and the perceived noise level was significantly associated with NFR.ConclusionThe results confirm that poorer hearing is associated with higher LE, but not with higher NFR. These associations were unrelated to the perceived noise level at the workplace. Therefore, the value of occupational hearing screening appears to be early identification of hearing loss in employees, but not identification of work functioning difficulties.

A comparative study of OAE (OTO acoustic emission) and BERA (brainstem evoked response audiometry) / ASSR (auditory steady state response) as a screening of hearing loss among the children (<12 years of age) for hearing assessment in ENT OPD

Normal speech and language development depend upon a child’s ability to hear spoken language. The most important period for language and speech development is generally regarded as the first 3 years of life. Pediatric hearing loss is a major concern in India due to high incidence of hearing loss in this age, high birth rate, lack of facilities and awareness for early diagnosis. Therefore, early detection and early identification of hearing loss is very important. The study was carried out in ENT Department, Sir T Hospital, Bhavnagar. A total of 100 children <12 years of age with hearing loss who were screened with OAE (OTO acoustic emission) and BERA (brainstem evoked response audiometry). Among 100 children (<12 years of age), majority of the cases were in age group of 6 to 12 yrs. Male patients are predominantly affected than other patients. The earlier intervention, better were results. It is important to have more awareness programs focusing on importance of early hearing screening in children. This current study indicated the importance of screening for hearing loss among children.

Use of Wideband Acoustic Immittance in Neonates and Infants.

With widespread agreement on the importance of early identification of hearing loss, universal newborn hearing screening (UNHS) has become the standard of care in several countries. Despite advancements in screening technology, UNHS and early hearing detection and intervention programs continue to be burdened by high referral rates of false-positive cases due to temporary obstruction of sound in the outer/middle ear at birth. A sensitive adjunct test of middle ear at the time of screening would aid in the interpretation of screening outcomes, minimize unnecessary rescreens, and prioritize referral to diagnostic assessment for infants with permanent congenital hearing loss. Determination of middle ear status is also an important aspect of diagnostic assessment in infants. Standard single-frequency tympanometry used to determine middle ear status in infants is neither efficient nor accurate in newborns and young infants. A growing body of research has demonstrated the utility of wideband acoustic immittance (WAI) testing in both screening and diagnostic settings. Wideband power absorbance (WBA), a WAI measure, has been shown to be more sensitive than tympanometry in the assessment of outer/middle ear function in newborns. Furthermore, age-graded norms also support successful application of WBA in young infants. Despite its merits, uptake of this technology is low among pediatric audiologists and hearing screening health workers. This report describes normative data, methods for assessment and interpretation of WBA, test-retest variations, and other factors pertinent to clinical use of WAI in newborns and infants. Clinical cases illustrate the use of WAI testing in newborn and infant hearing assessment.

Newborn hearing screening in the UK

The newborn hearing screening programme (NHSP) exists to identify permanent childhood hearing impairment (PCHI) in babies born in the UK. Early identification of hearing loss facilitates the provision of hearing aids or a prompt referral for cochlear implantation to ensure children optimise speech, language and communication skills, with the hope that this translates to the best possible educational, mental health, social and quality of life outcomes. Diagnosis of hearing impairment allows aetiological investigations to be offered to look for a potential cause of the PCHI, and given the recent advances in genomic testing, this can facilitate testing for additional family members and future children if a genetic cause is identified. In this article, the authors describe the structure of the NHSP and illustrate referral pathways into the programme from primary care for the few babies that may have been missed or fallen outside the remit of the programme.

Screening for hearing loss using the electronic whisper test: A prospective cross-sectional study.

Hearing screening is a method for early identification of hearing loss. Hearing screening is widely used in hospitals as part of physical examination. However, some of them are difficult to operate outside the hospitals regarding portability and user-friendliness. Therefore, we developed a simple yet easy-to-use portable electronic whisper test (EWT) for field deployment, particularly on many subjects. The EWT validity is a hearing screening method compared to pure-tone audiometry. This study was a cross-sectional comparative with a prospective approach. The subjects were outpatients at the Audiology Clinic of Dr. Soetomo Academic Medical Center, Surabaya, Indonesia, who met the inclusion and exclusion criteria. Statistical analysis made sensitivity and specificity tables using a 2 × 2 table, positive and negative predictive values. Samples of 50 participants (100 ears) obtained a sensitivity value of 83%, specificity of 78%, positive predictive value of 45%, and negative predictive value of 95%. The EWT is valid for use as a hearing screening method.

Early Identification of Hearing Loss and Language Development at 32 Months of Age.

This study examines the relationship between the early identification of hearing loss and language outcomes for deaf/hard of hearing (D/HH) children, with bilateral or unilateral hearing loss and with or without additional disabilities. It was hypothesized that hearing loss identified by 3 months of age would be associated with better language outcomes. Using a prospective, longitudinal design, 86 families completed developmental instruments at two time points: at an average age of 14.8 months and an average age of 32.1 months. Multiple regression examined how hearing loss identified by 3 months of age contributed to later language outcomes while controlling for developmental level at the first time point. Hearing loss identified by 3 months of age was positively associated with better language outcomes for D/HH children at 32 months of age; however, D/HH children still exhibited language delays, compared to normative scores for same-aged hearing peers for reported measures. Language outcomes of children with unilateral hearing loss were not better than those of children with mild-to-moderate bilateral hearing loss. Children with additional disabilities and more severe bilateral hearing loss had lower language scores than those without.

A study of hearing loss in infants using brain stem evoked response audiometry

<p class="abstract"><strong>Background:</strong> Hearing is necessary to learn languages and speech and to develop cognitive skills. Unfortunately, many children with severe hearing loss from birth are not diagnosed until 21/2-3 years. of age. Implementing high-risk neonatal screening, detecting hearing loss before 3 months, and intervention before 6 months will result in a better speech performance of neonates.</p><p class="abstract"><strong>Methods:</strong> Detailed history taking and general and ear, nose and throat (ENT) examination were done to rule out external ear and middle ear pathology. Brainstem evoked response audiometry (BERA) was done in a dust-free, sound-proof, airconditioned room. Feed was given 10–15 min before the procedure. Syrup pedichloryl 20 mg/kg was given to sedate the baby half an hour before the procedure. Intelligent hearing system BERA instrument was used. The study included a total of 60 infants. 30 were in the high-risk group and 30 were in the normal group. There were 14 males and 16 females in each group. </p><p class="abstract"><strong>Results:</strong> 21 infants had hearing loss out of the 30 infants in the high-risk group on initial screening. On doing a repeat BERA after 3 mins on the affected infants, 3 were detected to have normal hearing, i.e., 18 out of 30 infants were affected. All the infants in the normal or no risk factor group had normal hearing.</p><p class="abstract"><strong>Conclusions:</strong> The present study emphasizes the importance of using ABR as a screening tool for the detection of hearing impairment at an early stage which would have otherwise go unnoticed for about 2-3 years. Since it is an objective test, it is useful in the early identification of hearing loss.</p><p> </p>

An audiological profiling in metachromatic leukodystrophy: a case study

<p class="abstract">Metachromatic leukodystrophy (MLD) is a lysosomal storage disease, which is characterized by damage of the myelin sheath that covers most of nerve fibers of the central and peripheral nervous systems. The disease occurs due to a deficiency of the lysosomal enzyme arylsulfatase A (ARSA) or its sphingolipid activator protein saposin B (SapB). Audiological test batteries were carried out, i.e.; behavioural observation audiometry (BOA), impedance audiometry, otoacoustic emission (OAE) and brainstem evoked response audiometry (BERA). Result showed there was no changes in behaviour towards the stimulus, has been noticed in BOA, bilateral A type tympanogram with absence of acoustic reflexes in all frequencies on Ipsi and contra-lateral stimulations and no wave Vth was found at 90 dBnHL in both ears even at repeated trials in BERA. Early identification of hearing loss offers children the opportunity to develop significantly improved language skills. Otologist and audiologist need to be taken care and to provide medical treatment as well as amplification device to the patients.</p>

Audio-vestibular manifestations in Kawasaki disease (KD): a rare atypical case presentation

BackgroundKawasaki disease (KD) is an acute febrile, usually self-limiting illness of infancy and childhood, that can show audiological manifestation of sensorineural hearing loss (SNHL, 36% of patients), usually bilateral in nature.Case presentationWe report a 12-year-old female diagnosed with KD at 6 years, showing atypical manifestation of asymmetrical SNHL since 1.5 years after the episode of febrile illness. The patient was administered Immune Globulin intravenously and aspirin, which were tapered to a low dose. The patient later reported reduced hearing sensitivity, ear pain, blocking in both ears, and tinnitus (intermittent) in the left ear. The audio-vestibular manifestations in the case using test battery approach (Pure tone audiometry, speech audiometry, tympanometry, reflexometry, otoacoustic emissions, auditory brainstem response, and behavioral and objective vestibular tests) is discussed. The rehabilitative measures taken, and the need for sensitization of school teachers for early identification of hearing loss in children with KD is highlighted.ConclusionsThis case presentation concentrates on the rare asymmetrical SNHL and vestibular finding post-KD and emphasizes the need for health care professionals to refer patients with KD to an audiologist to trace the possible sequelae including hearing loss and vestibular disorders. The atypical manifestations of KD in hearing domain is suggestive of the need for early identification, adequate profiling of not just hearing but also balance-related manifestations, instigation of appropriate rehabilitative measures, effective counselling of parents and school teachers to facilitate better academic learning, and communication opportunities.

Association Between Expanded Genomic Sequencing Combined With Hearing Screening and Detection of Hearing Loss Among Newborns in a Neonatal Intensive Care Unit

Hearing loss is a global social burden. Early identification of hearing loss missed by newborn hearing screening tests in the neonatal intensive care unit is crucial. To assess the association between expanded genomic sequencing combined with hearing screening and detection of hearing loss as well as improvement in the neonatal intensive care unit. This cohort study was performed between August 8, 2016, and December 31, 2020, among 8078 newborns admitted to the neonatal intensive care unit of the Children's Hospital of Fudan University in Shanghai, China. Follow-up for hearing status was performed via telephone interviews between September 1 and November 30, 2021. A hearing screening test and the expanded genomic sequencing targeting 2742 genes were administered to each patient. Those who failed the hearing screening test or had positive genetic findings were referred for diagnostic audiometry at a median of 3 months of age. The primary outcome was hearing loss missed by hearing screening test. Secondary outcomes were genetic findings and benefits associated with the expanded genomic sequencing for clinical management of patients in the neonatal intensive care unit. Of 8078 patients (4666 boys [57.8%]; median age, 6.3 days [IQR, 3.0-12.0 days]), 52 of 240 (21.7%) received a diagnosis of hearing loss. Expanded genomic sequencing combined with hearing screening was associated with a 15.6% increase (7 of 45 patients) in cases of diagnosed hearing loss that were missed by hearing screening. Of the 52 patients with hearing loss, genetic factors were identified for 39 patients (75.0%); GJB2 and SLC26A4 were the most common genes identified. Patients with genetic findings experienced a more severe degree of hearing loss than those without genetic findings (21 profound, 4 severe, 7 moderate, and 7 mild vs 2 severe, 4 moderate, and 7 mild; P = .005), with more bilateral hearing loss (39 of 39 [100%] vs 9 of 13 [69.2%]; P = .003). Clinical management strategies were changed for patients who underwent genomic sequencing combined with hearing screening. This study suggests that expanded genomic sequencing combined with hearing screening may be effective at detecting hearing loss among patients in the neonatal intensive care unit.

Emerging Data from a Newborn Hearing Screening Program in Sharjah, United Arab Emirates.

Objectives Newborn hearing screening (NHS) plays a critical role in early identification of hearing loss and subsequent early habilitation. Active parental involvement influences the success of NHS, particularly the initial NHS and follow-up. The current study reports the results of an NHS program in a cohort of babies born in a tertiary care hospital in Sharjah, United Arab Emirates (UAE). Further, it explores a two-stage NHS model to reduce false responses, thereby alleviating parental anxiety. Methods Retrospective observational study was conducted for a period of five years from January 2017 to December 2020. NHS was done as a two-stage model. All the healthy newborn babies were screened using Automated Auditory Brainstem Response (AABR) by trained audiology professionals. Babies who failed the first NHS were followed up after two weeks. Further, babies that failed the follow-up NHS were sent for diagnostic hearing evaluation and intervention as necessary. Results A total of 1821 newborn babies were screened during the study period. Eighty-one percent of babies passed the initial NHS. Four hundred and twenty-three (23.22%) babies were referred on the first NHS and were followed up after 2 weeks. Among these babies, 7.03% (24) failed second NHS. Nine (37.50%) of the 24 babies were confirmed to have hearing loss in both ears. The incidence of hearing loss in our cohort was 4.94 per 1000. Confirmed hearing loss was statistically higher in boys than girls (p < 0.05) Conclusion Current study was an attempt to report the emerging NHS data as part of the implementation of an NHS program. The study findings emphasize the need for a two-stage model of NHS to rule out false responses.

Neonatal Hearing Screening: Prevalence of Unilateral and Bilateral Hearing Loss and Associated Risk Factors.

Introduction: Newborn hearing screening is essential for early identification of hearing loss to decrease the adverse effects of hearing loss. The objective of this study was to determine the prevalence of hearing loss and risk factors of congenital hearing loss in newborns.Methods: In this analytical case-control study, a hearing screening test was performed for all newborns aged 3-14 days.Results: Of 5,500 newborns evaluated, 24 newborns had hearing loss. The prevalence of hearing loss was 4.36 per 1,000. Of 24 hearing-impaired newborns, 15 had bilateral hearing loss (BHL) (62.5%) and nine had unilateral hearing loss (UHL) (37.5%). Among the neonates with hearing loss, the prevalence of hearing loss was higher (77.8%) in the right ear. The main risk factors identified in this study were low gestational age (P=0.001), hospitalization in the neonatal intensive care unit (NICU) (P=0.008), exposure to ototoxic drugs (P=0.001), gestational diabetes P=0.01), craniofacial anomalies (P=0.01), convulsion (P=0.03), consanguineous marriage of parents (P=0.001), low birth weight (P=0.01), and hyperbilirubinemia (P=0.001).Conclusion: The prevalence of hearing loss was higher in the right ear than in the left ear. NICU stay, use of ototoxic drugs, low gestational age (<35 weeks), gestational diabetes, craniofacial anomalies, convulsion, consanguineous marriage of parents, low birth weight, and hyperbilirubinemia were significant risk factors for congenital hearing loss in studied newborns.

Early Identification of Hearing Loss in New-Borns - A Challenging Process

Early Identification of Hearing Loss in New-Borns - A Challenging Process

UNHS: A Decade Long Feasibility and Sustenance Study from a Tertiary Care Hospital in India.

Objective The aim of this study is to estimate the incidence of hearing loss in neonates at a tertiary referral center, to assess the associated risk factors in those identified with hearing loss and to explore the challenges of starting and continuing a universal neonatal hearing screening programme in a tertiary care hospital over a decade. Materials and Methods It is a cohort prospective observational study conducted from January 2008 to January 2018. Five thousand five hundred and forty neonates underwent screening for hearing loss, of which 2688 were well babies and 2854 babies had one or more risk factors causing hearing loss. Otoacoustic emissions (OAE) is employed as the first level of screening within one month of birth. Brainstem evoked response audiometry (BERA) is done at 3months of gestational age for all the well babies who were referred on OAE testing and all the high risk babies irrespective of the result of the OAE screening. The High risk criteria are based on the set criteria by the Joint Committee on Infant Hearing (2007) and American Academy of Pediatrics (1994). Results In our study the incidence of hearing impairment is 5.41 per 1000 neonates screened. In well babies and at risk babies it is 1.49 and 9.11 per 1000 respectively.The common neonatal risk factors associated with hearing loss in our study are babies admitted to neonatal intensive care units (NICU), intrauterine growth retardation (IUGR), birth weight less than 1500g, respiratory distress syndrome (RDS) and hyperbilirubinemia. Conclusion The incidence of hearing loss in our study is comparable to that reported in literature (Bachmann KR, ArvedsonJC (1998) Early identification and intervention for children who are hearing impaired. Pediatr Rev. 1998 May; Vol. 19. No.5. pp. 155-165. http://www.ncbi.nlm.nih.gov/pubmed/9584525 Accessed from May 1998, Nagapoornima P, Ramesh A, Srilakshmi, Rao S, Patricia PL, Gore M, et al. Universal hearing screening. Indian J Pediatr. 2007 Jun 18; 74(6):545-9., Augustine AM, Jana AK, Kuruvilla KA, Danda S, Lepcha A, Ebenezer J, et al. (2014) Neonatal hearing screening-experience from a tertiary care hospital in southern India. Indian Pediatr. Vol. 51. No.3. pp 179-183. http://www.ncbi.nlm.nih.gov/pubmed/24277966 Accessed from Mar 2014). Hearing loss is more common in those babies with risk factors as reported in literature (Nagapoornima P, Ramesh A, Srilakshmi, Rao S, Patricia PL, Gore M, et al. Universal hearing screening. Indian J Pediatr. 2007 Jun 18; 74(6):545-9. http://www.ncbi.nlm.nih.gov/pubmed/21654001 Paul AK (2011) Early identification of hearing loss and centralized newborn hearing screening facility-the Cochin experience. Indian Pediatr. Vol. 48. No. 5. pp 355-359. Accessed from May 2011). Implementation of neonatal hearing screening program at a tertiary care hospital using a two tier system with OAE and BERA is a feasible but challenging service.

Changing the time intervals between cisplatin cycles alter its ototoxic side effect

Various methods have been tested and deployed clinically to identify and minimize cisplatin ototoxicity. Upon early identification of hearing loss, one of the possible approaches to reducing future ototoxicity is to increase the gaps or breaks between cycles or doses of cisplatin. However, recent findings about the retention of cisplatin in the cochlea and the potential for its long-term ototoxic effects call into question whether such an approach is effective in reducing hearing loss. The current study was undertaken to determine whether increasing the rest intervals between cycles of cisplatin altered the resulting ototoxicity. CBA/CaJ mice were exposed to a cumulative dose of 48 mg/kg cisplatin delivered in three cycles of 16 mg/kg (4 mg/kg per day for 4 consecutive days). The cycles were separated by either 10, 17, or 87 days to determine if the inter-cycle rest intervals affected resulting ototoxicity. Ototoxicity was measured using auditory brainstem response threshold shifts and hair cell losses. Results indicated that longer intervals between cycles of cisplatin led to lower threshold shifts and outer hair cell lesions. The results support the principle that ‘slowing down’ cisplatin dosing by increasing rest intervals between doses can reduce the ototoxic side effect. Further testing is needed to optimize the timing and to determine the impact of longer inter-cycle intervals on cisplatin's anti-tumor efficacy.

Development and validation of a digits-in-noise hearing test in Persian

Objective The prevalence of unrecognised and late-diagnosed hearing loss is higher in low- and middle-income than in high-income countries, due in part to lack of access to hearing services. Because hearing screening is important for early identification of hearing loss, development of an accessible, self-screening test that can detect hearing loss reliably and quickly would provide significant benefits, especially for underserved populations. This study aimed to develop and validate a new version of the digits-in-noise (DIN) test for Persian speaking countries. Design Recordings of Persian digits 0–9 were binaurally presented in broadband speech-shaped noise. Using fitted speech intelligibility functions, digits were homogenised to achieve equal perceptual difficulty across stimuli. The evaluation was established by reference to existing English DIN tests. Study sample Thirty Persian speaking young adults with normal hearing thresholds (≤20 dB HL, 0.25–8 kHz). Results Speech intelligibility functions produced a mean speech reception threshold (SRT) of −7.7 dB, corresponding closely to previously developed DIN tests. There was no significant difference between test and retest SRTs, indicating high reliability of the test. Our findings suggest that language-specific factors need to be considered for cross-language comparison of DIN-SRTs. Conclusion This study introduces a convenient tool for future hearing screening in Persian speaking countries with limited access to audiology services.