Greater Hearing Loss Research Articles

A controlled trial comparing three treatments for chronic otitis media with effusion

A randomized, controlled clinical trial was conducted in 76 children to evaluate the efficacy of trimethoprim-sulfamethoxazole for 4 weeks, prednisone for 2 weeks and aluminum ibuprofen suspension for 2 weeks in resolving chronic otitis media with effusion which had persisted for more than 8 weeks. After 2 weeks of treatment resolution rates of chronic otitis media with effusion in the prednisone and trimethoprim-sulfamethoxazole groups were significantly greater than those in the control (no treatment) and ibuprofen groups. After 4 weeks the differences in resolution rates between the control, trimethoprim-sulfamethoxazole and prednisone groups became smaller. After 12 months of follow-up, differences in hearing sensitivity among study groups were not statistically significant, although 83% of patients had a 15-dB or greater hearing loss. Therefore short term antimicrobial and antiinflammatory treatment did not appear to have a long lasting effect on chronic middle ear inflammation.

The effect of radiotherapy on hearing

The effect of radiotherapy on hearing was studied in 30 patients treated with surgery and radiotherapy for a marginal resected or recurrent pleomorphic adenoma of the parotid gland. The 30 patients were selected from a group of 209 patients treated between 1961 and 1987 in the Antoni van Leeuwenhoekhuis for a pleomorphic adenoma of the parotid gland. The audiometry values were analyzed, and the irradiated ear was compared with the untreated ear. Tympanometry revealed a small but significant loss in compliance. The hearing loss in the irradiated ear was more significant than the loss in compliance. With increasing frequency (up to 20 kHz) we saw a rise in the number of patients with a hearing loss of the irradiated ear. Above 8 KHz, 18 of the 30 patients showed a greater hearing loss in the irradiated ear. When the audiometry values were analyzed for each patient individually, 21 patients showed a hearing loss in the irradiated ear, 8 patients had a symmetrical hearing loss and one patient had a hearing loss on the untreated side. The hearing losses were sensorineural except for the frequencies 250 and 500 Hz. where a conductive loss was seen. This is partly due to the anatomical changes caused by the surgery, so that the headphone did not fit snugly around the ear. The audiometric results showed no relationship to the time which had elapsed since irradiation (1 to 14 years), to the radiation type (orthovolt, megavolt, electron beam or a combination of megavolt and electron beam). or to the dose (varying from 40 to 65 Grey). In conclusion, irradiation causes a significant, mainly sensorineural hearing loss. This confirms once more that a pleomorphic adenoma of the parotid gland should be treated surgically with at least a superficial parotidectomy so that irradiation becomes unnecessary.

Psychological characteristics of children with functional hearing loss

The terminology used to describe functional hearing loss (FHL) and some explanations of the phenomenon are discussed briefly. Previous studies of FHL in children are reviewed. Characteristics of 30 children seen for psychological assessment following diagnosis of FHL are described. There were twice as many girls as boys in the sample. A large proportion of the children had experienced middle ear problems. The mean IQ for the sample was below average, but the range of intellectual ability was wide. Nine children showed serious educational retardation. The children were assigned to one of three psychological problem groups depending on whether they had minor, school-based, or deeper, psychological problems. Those with deeper psychological problems tended to show greater hearing losses on pure tone audiometry. FHL seemed to be related to attentional factors in those with only minor or school-based problems but not for those with deeper psychological problems. These findings are discussed with reference to the need for psychological assessment of children with FHL.

Relationship of hearing impairment to dementia and cognitive dysfunction in older adults

We conducted a case-control study in 100 cases who had Alzheimer's-type dementia and 100 age-, sex-, and education-matched, nondemented controls to evaluate the hypothesis that hearing impairment contributes to cognitive dysfunction in older adults. The prevalence of a hearing loss of 30 dB or greater was significantly higher in cases than in controls (odds ratio, 2.0; 95% confidence interval, 1.2 to 3.4), even when adjusted for potentially confounding variables. In addition, we observed a dose-response relationship in which greater hearing loss was associated with a higher adjusted relative odds of having dementia. Hearing loss was also significantly and independently correlated with the severity of cognitive dysfunction, as measured by the Mini-Mental State Examination, in nondemented as well as demented patients. These results demonstrate an association between hearing impairment and dementia and lend support to the hypothesis that hearing impairment contributes to cognitive dysfunction in older adults. (<i>JAMA</i>. 1989;261:1916-1919)

Relationship of Hearing Impairment to Dementia and Cognitive Dysfunction in Older Adults

We conducted a case-control study in 100 cases who had Alzheimer's-type dementia and 100 age-, sex-, and education-matched, nondemented controls to evaluate the hypothesis that hearing impairment contributes to cognitive dysfunction in older adults. The prevalence of a hearing loss of 30 dB or greater was significantly higher in cases than in controls (odds ratio, 2.0; 95% confidence interval, 1.2 to 3.4), even when adjusted for potentially confounding variables. In addition, we observed a dose-response relationship in which greater hearing loss was associated with a higher adjusted relative odds of having dementia. Hearing loss was also significantly and independently correlated with the severity of cognitive dysfunction, as measured by the Mini-Mental State Examination, in nondemented as well as demented patients. These results demonstrate an association between hearing impairment and dementia and lend support to the hypothesis that hearing impairment contributes to cognitive dysfunction in older adults.

Influences of temporal spacing of impulse noise on temporary and permanent threshold shifts

Chinchillas were exposed to impulse noise conditions with equal acoustic energy and spectra but with three different temporal patterns and two different amplitude levels (135 and 150 dB SPL, counterbalanced by 15‐dB trade‐offs in number of events). Auditory‐evoked responses were used to measure TTS and PTS. Degree of hearing loss and pattern of recovery were not uniform among the groups, contrary to assumptions related to the equal energy hypothesis. Relative to hearing loss after exposure to one impulse/second: (1) less hearing loss was seen after exposures to bursts of 1 impulse/50 ms and (2) greater hearing loss was seen when high‐level impulses occurred in salvos (pairs of impulses presented at 1‐s intervals, with 50‐ms interpulse interval in each pair). Findings will be compared to reports of a possible “period of vulnerability,” during which hearing loss may be more extreme if the ear is exposed to additional impulse noise while the ear is still recovering. [Work supported by NIOSH and the Department of the Army.]

Hearing loss and desferrioxamine in homozygous beta-thalassemia.

The authors present the results obtained during an audiometric screening of 153 children aged 5-18 years, affected by beta-thalassemia and treated with regular blood transfusions and iron overload chelation by means of desferrioxamine. Thirty-eight percent of the patients showed a significant sensorineural hearing loss at high frequencies with recruitment. Younger patients had a greater hearing loss, indicating that cochlear damage was not due to the disease itself. Furthermore, hearing loss appeared to be correlated with the mean and peak desferrioxamine doses administered and was higher in subjects with lower iron load. Thus, the ototoxic effect seems to have been higher when a good iron chelation had been obtained. Among our patients, conductive hearing loss was not more frequent than in patients without beta thalassemia.

Influence of age, sex, hearing loss, and balance on kicking development by deaf children.

The ability to kick a stationary or moving ball successfully is requisite to several games and sports. A previous study (2) suggested that many deaf children may be delayed in their development of this important skill. The present smdy was designed to investigate the influence of age, sex, hearing loss, and balance on the development of mature kicking form among deaf children. Seventy-five boys and 57 girls bemeen the ages of 3 and 14 yr. participated in the study. Within this group, 125 (95%) had a hearing loss of at least 60 dB in the better ear. The remaining 7 children had hearing losses ranging from 30 dB to 55 dB. To determine level of kicking development, subjects were individually assessed on the Ohio State University Scale of Intra Gross Motor Assessment (OSU-SIGMA) (4). Sratic and dynamic balance were measured by Items 2 and 7 of Subtest 2 of the Short Form of the Bruininks-Oseretsky Test of Motor Proficiency (1). The basic design for this study was a cross-sectional correlation design whereby a set of predictor variables (age, sex, hearing loss, static balance, and dynamic balance) were correlated with kicking level (Lv 1, 2, 3, 4 of the OSU-SIGMA) the criterion variable. Data from the kicking and balance tests were subjected to linear discriminant analysis (3). From this analysis, structure coefficients were interpreted for the significant discriminant functions. A structural coefficient is an estimate of relationship between a variable and a function. Only structure coefficients with a value greater than .30 were used in the interpretation. The result for kicking was significant for the first function (Wilks's Lambda = .GI, p < .001). Suucrure coefficients for age (.82), hearing loss (.32), static balance (.45), and dynamic balance (.43) gave meaning to the function. These results imply that balance proficiency is predictive of mature form in kicking among deaf children. Children with the greatest hearing loss were also more likely to achieve mature kicking form; however, there is no present explanation to account for this finding. Sex (-.22) did not appear to influence development of kicking among the deaf children of this study.

Deaf Children's Referential Messages to Mother

Deaf children 6-10 years of age, from oral or bimodal educational programs, were tested in 2 tasks. In the first, they were required to describe a designated picture from a set of 4 pictures so that their mother could identify the intended referent from the 4 alternatives. In the second, they studied a single picture and were subsequently required to identify it from a set of 4 related pictures. Despite greater hearing loss, bimodally educated children provided more differentiated messages than did orally educated children. Bimodally educated children also provided better reformulations of messages that were initially inadequate. Although mothers of orally educated children received inferior messages, they were as successful at selecting the correct referent as were mothers of bimodally educated children. Both groups of deaf children performed at near perfect levels on the picture recognition task, suggesting that performance differences were attributable to differential message formulation skill as opposed to differential visual processing of the referential array.

中耳真珠腫に対する段階的鼓室形成術

Forty-three ears that underwent planned staged tympanoplasty were compared with 52 ears that underwent one-stage tympanoplasty for cholesteatoma. Planned staged tympanoplasty was mainly performed in children, compared with one-stage tympanoplasty; The rate of planned staged tympanoplasty was 64% in children under 9 years, and 59% in teenagers, but it was only 30% in patients over twenty years old.Patients who underwent planned staged tympanoplasty generally had greater hearing loss than those who underwent one-stage tympanoplasty. Preoperative hearing was within 40 dB in 64% of those in the one-stage tympanoplasty group, but only in 29% of those in the planned staged tympanoplasty group.In one-stage tympanoplasty, the closed method was performed in two-thirds of the cases and open method was performed in remaining cases. In planned staged tympanoplasty, the open method was performed in two-thirds of the cases.Residual cholesteatoma was found in 13.2% at the second-stage operation, and it was found more frequently in children under 9 years (27.3%) than in patients over 10 years (7.4%). Residual cholesteatoma appeared in 8.0% treated by the open method and in 23.0% treated by the closed method.In patients followed for more than 1 year, postoperative hearing level was remained within 40 dB or showed a gain of over 20 dB in 75.0% of those receiving planned staged tympanoplasty and in 68.3% of those receiving one-stage tympanoplasty.

Association between vibration-induced white finger and hearing loss in forestry workers.

The present investigation was a case-referent study in which age and hours of vibrating tool operation were matched for the cases and referents in an effort to confirm the earlier reported difference in hearing loss between workers with vibration-induced white finger (VWF) and those without VWF. Thirty-seven pairs were formed from 51 men with VWF and 228 without it. The greatest hearing loss was at 4 kHz in both the case and reference groups, as is usually found in typical noise-induced hearing loss. The case group had a higher hearing threshold than the reference group at every frequency, and the difference was significant at 4 and 8 kHz and almost so at 2 kHz. As corroboration for this association, the subjects were divided into three groups by recovery rate of skin temperature 5 min after cold provocation at 10 degrees C for 10 min, a procedure which is one of the valid objective tests for VWF. The subjects with the most delayed recovery reached the highest age-corrected median hearing level at 4 kHz, and those with the promptest recovery marked the lowest. The cause of this increased damage of hearing in relation to VWF is not known. However, the association between VWF and hearing loss is interesting in view of the effects of vibration on parts of the body other than the hand and arm.

Hearing damage in military service. A study on 38,294 conscripts.

In an audiometric study on 38,294 conscripts, noise-induced high-frequency hearing deterioration during basic training (mean 245 days) was studied. On reporting for training, 29% were found to have hearing defects, predominantly in the high-frequency area. After training, high-frequency deterioration, predominantly unilateral or asymmetrical, was found in 5%. In 0.5%, this deterioration had reached a symptomatic level, causing minor handicap. In 0.03% (12 conscripts), it fulfilled the criterion of "10% hearing disability" applied in Swedish industrial insurance. The incidence of high-frequency deterioration rose from 3% in conscripts having 'normal' hearing on reporting, to 17% among those with the greatest hearing loss on reporting. This means that the presence of sensorineural hearing loss implies an increased risk of noise-induced hearing deterioration. No correlation was found between hearing status on reporting and magnitude of deterioration during training. The results imply that hearing data obtained on reporting for training should be taken into account in deciding the assignability of conscripts to noisy training courses and posts.

An alternate method for determining functional gain of hearing aids.

The functional gain of a hearing aid typically is determined by comparing aided and unaided behavioral thresholds. With this method, however, true gain may be underestimated in frequency regions of normal or near-normal hearing sensitivity (i.e., in cases of sloping, rising, or trough-shaped audiograms). Internal hearing-aid noise and/or amplified room noise imposes a lower limit on obtainable aided thresholds. In these cases, comparing aided and unaided acoustic-reflex thresholds may be a valuable clinical alternative to traditional means of determining real-ear gain. This study compared sound-field behavioral threshold and acoustic-reflex threshold estimates of functional gain for individuals with a variety of audiometric configurations. The sound-field behavioral threshold measurements were found to underestimate functional gain if unaided thresholds approached the normal hearing range. In regions of greater hearing loss, behavioral and acoustic-reflex estimates of functional gain were in good agreement.

Tinnitus asymmetry.

In the present study, the relationship between the location of tinnitus and the location of the greater hearing impairment was investigated. 62 subjects suffering from tinnitus underwent audiometric testing and were required to identify the location of their tinnitus. All of the subjects had a history of exposure to loud noise. The results of the study showed an asymmetric relationship between the variables examined. Most of the subjects with a greater hearing loss on the right side reported right-sided tinnitus, while the majority of subjects with a greater loss in the left ear reported tinnitus heard identically in both ears or tinnitus heard louder on the right side. An assumption was made that this phenomenon is related to differential hemispheric responsiveness to abnormal neural activity arising in the peripheral parts of the auditory system as a result of cochlear damage, activity which is the presumed origin of neurogenic tinnitus.

Glycerin and Urea Tests in Meniere’s Disease: A Multifactorial Analysis Using a Quantification Method

By using the quantification method for multidimensional qualitative data, 13 variables were analyzed. The younger the patient, the stronger was the correlation between age and positive glycerin and urea tests. At ages over 50 years no correlation with positive test results was found. The longer the duration of disease, the stronger was the correlation between this duration and a positive urea test. The glycerin test showed no correlation with the duration of the disease. Hearing losses of 40 to 69 dB. were correlated with both a positive glycerin test and a positive urea test. Greater hearing losses were correlated only to a positive glycerin test. Hearing losses less than 39 dB. were not correlated with positive results in either the glycerin or the urea test.

The clinical picture of Meniere's disease in the light of glycerin and urea tests.

A mathematical-statistical analysis of the role of glycerin and urea tests in patients with Meniere's disease is presented. Using the quantification method for multidimensional qualitative data, 13 variables were analysed. The younger the patient the stronger was the correlation between age and positive glycerin and urea tests. At ages over 50 years, no correlation to positive test results was found. The longer the duration of disease, the stronger was the correlation between this duration and a positive urea test. The glycerin test showed no correlation to the duration of the disease. Hearing losses of 40-69 dB were correlated both to a positive glycerin test and to a positive urea test. Greater hearing losses were correlated only to a positive glycerin test. Hearing losses of less than 39 dB were not correlated to positive results of either the glycerin or the urea test. Directional preponderance in the caloric test showed a correlation to a positive urea test. On the basis of these results a hypothesis has been formulated to explain how glycerin and urea might affect the internal ear.

Hearing Loss Related to Some Signs and Symptoms in Older People

Hearing loss measured by pure tone audiometry was compared, for two sound frequencies in the better ear, with subjective deafness in a random sample of older people (215 men, 272 women). Although median values with 95% confidence limits showed significantly greater hearing loss in the groups with subjective deafness, the definition of deafness as hearing loss greater than 30 dB at 1,000 c.p.s. revealed a substantial proportion who complained of deafness with hearing loss of 30 dB or less and a smaller proportion, unaware of deafness, with hearing loss greater than 30 dB. Subjective deafness alone is therefore not an adequate screening test. Tinnitus, vertigo and abnormalities of the ear drum were found to be associated with deafness in the elderly while wax and nasal catarrh were not. None of these symptoms or signs showed age effects on prevalence except subjective deafness which increased with increasing age.

Pattern and degree of hearing loss in chronic suppurative otitis media

Objectives: To assess the pattern and degree of hearing loss in CSOM. Methods: A prospective study was carried out from January, 2007 to December, 2008 at the department of Otolaryngology-Head &amp; Neck Surgery, BSMMU, Dhaka This study included 150 cases with 198 ears of CSOM including both tubo-tympanic and attico-antral variety excluding intracranial complications if any. Results: There were 81.31% cases of tubo-tympanic and 18.69% cases of attico-antral patients. Age of the patients was between 5-60 years, where male were 59.33% and female were 44.67%. Highest number of patients was in the age group of 21-30 years. Out of 198 ears, 102 had unilateral perforation and 96 had bilateral perforation. Most of the patients (53.33%) came from low income family and majority of them used to take their bath in the pond (29.34%) followed by tube-well (24.44%). Most of the patients had cleaning habit with clothes with sticks (53.5%).Majority of them resided in katcha house (52%) with poor hygienic condition. Central melleolar perforations were maximum (41.41%) and anterior central perforations were minimum (18.69%). According to sized of perforation, medium size central perforations were common (26.67%) It was shown that the site and sized of perforation affects the degree of hearing loss. Posterior central and attic perforations had greater hearing loss, 51.5 dB and 57.36 dB accordingly. On the basis of size, subtotal perforation had more hearing loss (54.54dB). It was also shown that posterior central perforation had greater hearing loss (51.5dB) than anterior- central (33.64dB) perforation. Hearing loss was more marked in patients with long duration of disease. In a history of 21-25years of disease, mean air conduction thresholds was 59 dB whereas of 0-5 years were 38.18 dB. Difference between them was statistically significant (t=5.88, p&lt;0.001). Among the pattern of hearing loss, most of patients had conductive type (80.8%) hearing loss followed by mixed (17.17%) and sensorineural types (2.01%). Conclusion: Site of perforation, size of perforation and duration of disease affects the degree of hearing loss in CSOM . Key words: Hearing loss; CSOM; Tubo-tympanic; Attico-antral. DOI: 10.3329/bjo.v16i2.6844Bangladesh J Otorhinolaryngol 2010; 16(2): 96-105

Auditory function in diabetics.

Assessments of the hearing in diabetics by means of simple clinical tests and at times also by pure tone audiometry have yielded the most conflicting results. In published surveys the frequency of sensorineural hearing impairment has varied between 0 and 80%. It was therefore felt desirable to investigate this clinical problem applying modern audiological tests, which so far has not been done. Ninety-nine relatively young known diabetics have been examined. Pure tone audiograms were normal considered as group means. A small but definite degree of hearing impairment was noted when the patients were tested by speech and distorted speech audiometry as well as by Bekesy and directional audiometry. In view of the psychoacoustic nature of the latter tests, all results were critically evaluated. No correlations were noted between the recorded hearing loss and the duration or severity of diabetes. Greater hearing losses were, however, directly related to higher age. The sexes were similarly affected. The signific...

Successful binaural hearing aid users.

Previous investigations^1-3have called attention to the probable role of psychological factors underlying the acceptance or rejection of hearing aids despite technological advances in design, style, and concealability. The basic assumption that a 30-40 db. or greater hearing loss in the better ear automatically qualifies an adult as a successful candidate for a hearing aid may be untenable for a number of reasons. One may hypothesize that poor physical health, senility, decreased life span, narcissism, rigidity, poor learning ability, and pride (in the forms of vanity or sensitivity) are prime factors which greatly reduce the number of successful, adult hearing aid users. To overstate the point, it would be hazardous to extrapolate from the degree of organic hearing loss and the status of the ears, nose, and throat to the above-mentioned variables. Yet, as a first step, one cannot deny the importance of the ENT examination and the audiological