Conductive Type Of Hearing Loss Research Articles

Meningioma in the Middle Ear: An Unusual Case of Hearing Loss

Meningioma in the Middle Ear: An Unusual Case of Hearing Loss

Temporal Bone Posterior Wall Defect, a New Clinic Entity?

To define clinical and audiological findings in patients with temporal bone posterior wall defects (TBPWD) and to investigate possible relationships between these findings and the characteristics of the defect. The computed tomography (CT) views of 1198 patients with vestibulocochlear symptoms between 2007 and 2012 were retrospectively evaluated, and TBPWD and associated anomalies were investigated. Patients who had TBPWD were called back, and clinical and audiological examinations (tympanometry, pure tone audiometry, acoustic reflexes, and otoacoustic emission) were performed. Twenty-eight (2.34%) patients had TBPWD. Twenty-three of them were eligible for the study. Size of the defect was significantly correlated with the presence of tinnitus and/or vertigo (p<0.005). The cut-off values for the largest size of TBPWD were 1.65 mm [sensitivity: 0.67 and specificity: 0.77 (95% CI: 0.58-0.97); p=0.04] in case of the presence of tinnitus and 1.85 for vertigo (sensitivity: 0.78 and specificity: 0.86 (95% CI: 0.67-0.99); p=0.006). In pure tone audiometry tests, mixed-type hearing loss was present in four (17%) patients, sensorineural hearing loss was present in three (13%) patients, and conductive-type hearing loss was present only in one (4%) patient. Otoacoustic emission tests revealed significant differences in signal/noise ratios at frequencies of 500, 750, 1000, and 6000 Hz. For the first time in the literature, we defined clinical and audiological findings in patients with TBPWDs. These defects seem to cause more prevalent symptoms of vertigo and tinnitus and disturb the audiological characteristics of patients.

Hearing assessment data in HIV-infected and uninfected children of Cape Town, South Africa

Researchers are showing that the rate of hearing loss in children with perinatal HIV infection (PHIV) is higher than in HIV-unexposed, uninfected children. These data, however, have been collected mostly in the USA; extensive hearing data from low- and middle-income countries are lacking. The purpose of this study was to collect audiometric data in PHIV and HIV-uninfected children living in Cape Town, South Africa. Questionnaire data along with distortion product otoacoustic emissions (DPOAEs) and pure-tone testing were completed. Hearing loss was determined using the pure-tone thresholds defined as a pure-tone average (PTA) of 500, 1000, 2000, and 4000 Hz of >15 dB HL in the poorer ear. All data were compared between PHIV and HIV-uninfected children. Sixty-one (37 PHIV and 24 HIV-uninfected) children had hearing data. HIV status was not significantly associated with DPOAEs. The rate of conductive hearing loss was 11.5%; five PHIV and two HIV-uninfected children. The rate of any hearing loss was higher in PHIV children, but this difference was not statistically significant. PHIV children had a significantly higher mean PTA in the poorer ear than HIV-uninfected children. Conductive type of hearing loss was more common than sensorineural hearing loss. The underlying cause of hearing loss in the present study therefore remains unclear. Future research should include an examination of auditory neural function in an effort to determine the possible reason for differences in hearing.

Down's syndrome with abnormal inner ear: Is it suitable for cochlear implantation?

Hearing loss is a common problem in Down's syndrome (DS). The majority of this population, up to 80%, are suffering from a conductive type hearing loss, whereas estimating 4-20% are due to sensorineural hearing loss. Over the years, the treatment of profound sensorineural hearing loss has been changed since the introduction of cochlear implants. We report a case of a 4 years and 5 months old child with DS and low Intelligence Quotient that had been referred to our centre for cochlear implants. In view of late referral and multiple additional handicaps, with addition of having Larged Vestibular Aqueduct Syndrome (LVAS), bilateral incomplete partition of cochlear Type II and abnormal periventricular white matter, she had been rejected for cochlear implantation.

Síndrome de Down con oído interno anómalo: ¿es apto para un implante coclear?

Hearing loss is a common problem in Down's syndrome (DS). The majority of this population, up to 80%, are suffering from a conductive type hearing loss, whereas estimating 4-20% are due to sensorineural hearing loss. Over the years, the treatment of profound sensorineural hearing loss has been changed since the introduction of cochlear implants. We report a case of a 4 years and 5 months old child with DS and low Intelligence Quotient that had been referred to our centre for cochlear implants. In view of late referral and multiple additional handicaps, with addition of having Larged Vestibular Aqueduct Syndrome (LVAS), bilateral incomplete partition of cochlear Type II and abnormal periventricular white matter, she had been rejected for cochlear implantation.

Audiometric characteristics of a Dutch family with Muckle-Wells syndrome

Description of the audiometric and vestibular characteristics of a Dutch family with Muckle-Wells syndrome (MWS). Examination of all family members consisted of pure tone audiometry, otoscopy and genetic analysis. In addition, a selected group underwent speech audiometry, vestibulo-ocular examination, acoustic reflex testing and tests assessing loudness scaling, gap detection, difference limen for frequency and speech perception in noise. Linear regression analyses were performed on the audiometric data. Six clinically affected family members participated in this study and all were carriers of a p.Tyr859His mutation in the NLPR3 gene. Most affected family members reported bilateral, slowly progressive hearing impairment since childhood. Hearing impairment started at the high frequencies and the low- and mid-frequency threshold values deteriorated with advancing age. Annual threshold deterioration (ATD) ranged from 1.3 to 1.9 dB/year with the highest values at the lower frequencies. Longitudinal linear regression analysis demonstrated significant progression for a number of frequencies in five individuals. Speech recognition scores were clearly affected. However, these individuals tended to have higher speech recognition scores than presbyacusis patients at similar PTA 1,2,4 kHz levels. The loudness growth curves were steeper than those found in individuals with normal hearing, except for one family member (individual IV:6). Suprathreshold measurements, such as difference limen for frequency (DL f), gap detection and particularly speech perception in noise were within the normal range or at least close to data obtained in two groups of patients with a so-called conductive type of hearing loss, situated in the cochlea. Hearing impairment in MWS is variable and shows resemblance to previously described intra-cochlear conductive hearing impairment. This could be helpful in elucidating the pathogenesis of hearing impairment in MWS. Other associated symptoms of MWS were mild and nonspecific in the present family. Therefore, even without any obvious syndromic features, MWS can be the cause of sensorineural hearing impairment, especially when combined with (mild) skin rash and musculoskeletal symptoms. An early diagnosis of MWS is essential to prevent irreversible damage from amyloidosis. The effect of IL-1β inhibitors on hearing impairment is more controversial, but an early start of treatment seems to be essential. Therefore, our results are of importance in patient care and counselling.

Myringoplasty [Risk factors and the effect of post operative follow up on the outcome of success rate in Erbil / Kurdistan of Iraq

Background and objective: The presence of a perforated tympanic membrane with intermittent discharge and hearing loss of conductive type are the indication for myringoplasty. The purpose of this study was to determine risk factors in candidates for myringoplasty and to evaluate the post operative myringoplasty success rate results in our local region in Erbil/Kurdistan, Iraq. The second objective is to appraise and assess the effect of close observation and post operative treatment and follow up on this result, to increase the success rate. Methods: A prospective study, randomly taken 68 patients with unilateral perforated tympanic membrane, who are candidates for myringoplasty; patients of different age groups ranging [16 -55] years old, of different gender 30 males and 38 females., having dry unilateral perforated tympanic membrane of more than 3 months, underwent myringoplasty [underlay] between may 2006 and April 2009 at Rizgary teaching Hospital. Measurement of the post operative results and outcome were depend on the take rate and the hearing level at the last follow up visit in different time postoperatively and with dry clean non infected operated ear. Results: Small, dry posterior perforation, with postauricular approach in well pneumatized mastoid and in well educated non-smoker patient with close observation post-operatively using BIPP has better success rate. The success rate increased from 72% in the 1st postoperative visit to 88% in the last postoperative visit. Conclusion:-To increase the success rate, its necessary to determine the factors that affect the success rate preoperatively, also close observation with meticulous toilet of the operated ear post-operatively using BIPP is necessary to increase the success rate.

Visual analog scale in hearing loss.

To determine if visual analog scale (VAS) that has been used to measure magnitude of internal states such as pain, mood and various functional capabilities can be applied for patients with hearing loss. One hundred and sixty patients, aged 12-80 years with unilateral hearing loss were studied using a VAS (1-10) and pure tone audiometry (PTA) of responses to 500, 1,000 and 2,000 Hz to determine degree and type of hearing loss. The results of both were compared to determine if VAS can be used in measuring hearing loss. Patients with mild, moderate hearing loss correlate well with corresponding VAS but other degrees of hearing loss (severe and profound) have poor correlation. The best correlation between PTA and VAS were found in conductive type of hearing loss. This study suggest that there may be a role for VAS in mild and moderate hearing loss. This may be more applicable in rural setting as a screening procedure when audiometry is not available and can enhance clinical hearing assessment especially in mild-to-moderate conductive hearing loss.

Frequency Dependence of Hearing Loss with Perforations

This cross-sectional study was conducted in different sizes of pars tensa perforation in patients with chronic suppurative otitis media (CSOM) tubo-tympanic type undergoing myringoplasty. A total of 50 patients were recruited from the outpatient Department of Otorhinolaryngology - Head and Neck Surgery in TU Teaching Hospital from June 2003 to May 2004. Cases of CSOM tubo-tympanic type with dry central perforation, conductive type of hearing loss were subjected to myringoplasty. Preoperative audiometric evaluations were done. While operating under microscope diameter of perforations were measured and perforations were grouped according to the size. This study showed that the hearing loss was found to be more at lower frequencies and less as the frequencies increased. Hearing loss is more marked at lower frequencies as compared to higher frequencies, irrespective any size or location of perforation of pars tensa.

Correlation of hearing impairment with site of tympanic membrane perforation

Objective: This prospective study was done to assess the level of preoperative hearing impairment in different sites of pars tensa perforation in patients with chronic suppurative otitis media (CSOM) tubo-tympanic type undergoing myringoplasty. Materials and Methods: A total of 50 patients were recruited from the outpatient Department of Otorhinolaryngology and Head and Neck Surgery from June 2003 to May 2004. Cases of CSOM tubo-tympanic type with dry central perforation, with conductive type of hearing loss were subjected to myringoplasty. Preoperative audiometric evaluations were done. Just prior to operation, examination under microscope was performed. Exact site of perforation was noted. During operation, those found to have ossicular discontinuity or fixation were excluded from this study. Results: It was observed that the greatest hearing loss was found in big central (45dB) and posterior central (43dB); whereas least in those of anterior central (31dB) and central malleolar (34dB) perforations. The average hearing loss at 500Hz, 1000Hz and 2000Hzwas 46.40 dB, 30.90 dB and 31.9 dB respectively. This showed that the hearing loss is maximum at the lowest frequencies and minimum as the frequencies increase. Conclusion: This study shows that the posterior-central perforations cause more hearing loss than anterior-central ones. The hearing loss is maximum at the lowest frequencies and minimum as the frequencies increase. Journal of Institute of Medicine Vol.27(2) 2005

ＴＲＴによる耳鳴治療―継続例と非継続例の比較―

Sixty-three patients (29 men and 34 women) complaining of severe tinnitus were seen at the Department of Otolaryngology, Nippon Koukan Hospital, during a 1 year period (April 2004 to March 2005). Thirty-seven patients (19 men and 18 women) underwent Tinnitus Retraining Therapy (TRT) and were followed for more than 6 months after the end of treatment (continued group). The remaining 26 patients (10 men and 16 women) discontinued TRT after one month (discontinued group). We compared the age, type of hearing loss, origin of tinnitus, Tinnitus Handicap Inventory (THI) score and Visual Analogue Scale (VAS) score, mean hearing level, and tinnitus loudness and pitch match at the time of the first examination between these two groups. One reason for the discontinuation of TRT was thought to be the cost of the Tinnitus Control Instrumentis (TCI). Dip-type hearing loss was observed in many patients in the continued group, while conductive-type hearing loss was observed in many patients in the discontinued group. Regarding the origin of tinnitus, sudden deafness and otitis media were common in the discontinued group. Meanwhile, many of the patients in the continued group had a pitch match of greater than 4kHz. The VAS score, mean hearing level, and tinnitus loudness were also higher in the discontinued group. These results may help physicians to predict whether the use of a TCI will be effective.

Radiology Quiz Case 3

A 2-YEAR-OLD GIRL PRESENTED WITH INTRACtable otorrhea of the left ear that had started about 3 months after she was born. She also had been receiving antibiotics for more than 6 months. Otoscopy showed a small perforation of the tympanic membrane in her left ear, and a whitish mass was seen through the hole. Audiometry demonstrated a 45-dB conductive-type hearing loss in the patient’s left ear. Computed tomography of the temporal bone (Figure 1 and Figure 2) and magnetic resonance imaging (Figure 3 and Figure 4) were performed. What is your diagnosis?

A.B.R. in Nager type acrofacial dysostosis syndrome

The acrofacial dysostosis of nager is a very rare hereditary syndrome in which findings of mandibulofacial dysostosis are associated with defects of the limbs. The developmental defects of the mesoderm if accompany the neurectodermal malformations, result in mental retardation and sensorineural hearing impairment. The conductive type of hearing loss is mostly encountered in Nager's syndrome but here we present a case with sensorineural involvement, along with its analysis of auditory brainstem evoked response audiometry (ABR).

Brainstem auditory-evoked potential evaluation in children with meningitis

Brainstem auditory-evoked potential (BAEP) was performed on 101 children with meningitis to assess the incidence of hearing impairment. Fifty-two (51.5%) children had bacterial meningitis, six (5.9%) had viral meningitis, and 43 (42.6%) had aseptic meningitis. Fifty-one (50.5%) patients were assessed before discharge and 50 (49.5%) 9 days to 17 months later (mean = 4 months). BAEP impairment was found in 28 (27.7%) of 101 patients; 24 had sensorineural and four had conductive type of hearing loss, and 17 (60.7%) had unilateral and 11 (39.3%) had bilateral impairment. Hearing threshold was elevated in 22 (21.8%) patients, and the other six had increased latency and interpeak latencies with normal threshold. Frequency of BAEP impairment or hearing loss associated with bacterial meningitis was 34.6% and 30.8%, respectively; frequency associated with aseptic meningitis was 20.9% and 13.9%, respectively. One child with viral meningitis (coxsackie virus) had mild BAEP impairment. Most of the BAEP impairment in the bacterial meningitis group was associated with H. influenzae. Prospective BAEP study was performed in 20 patients randomly at 0.3 to 18 months to assess hearing status after antibiotic treatment, 10 with normal and 10 with abnormal BAEP. All the initially normal BAEP patients remained normal. Of the 10 patients with abnormal BAEP results initially, four returned to normal, two improved, three remained unchanged, and one deteriorated. The incidence of hearing loss after bacterial and aseptic meningitis is high. BAEP is useful to screen for possible hearing loss in children with meningitis, and follow-up BAEP is necessary for those patients with initially abnormal BAEP.

Absence of Sensorineural Hearing Loss in Treated Infants and Children with Congenital Toxoplasmosis

Educationally significant hearing loss has been reported in 10% to 15% of children with congenital toxoplasmosis. As part of a pilot study to assess feasibility and safety of prolonged therapy for congenital toxoplasmosis, 30 congenitally infected infants and children were evaluated for auditory function. Serial testing, beginning within 2 months of birth, was performed. Availability of auditory brainstem response (ABR) testing made evaluation at an earlier age than previously possible. Six (20%) of the 30 infants had mild to moderate conductive type hearing loss associated with otitis media. No infant or child had sensorineural hearing loss. The better outcome we observed compared to previous reports of a 15% to 26% incidence of sensorineural hearing loss and 10% to 15% incidence of educationally significant, bilateral hearing impairment may be related to early initiation and/or prolonged institution of antimicrobial therapy. Continued followup to exclude progressive hearing impairment and study of larger numbers of children are needed to verify these preliminary findings.

Wildervanck’s syndrome

Four out of ten members of the family affected with preauricular pits, malformed auricles and conductive type of hearing loss, are reported in this study because of the rarity of incidence.

Auditory brainstem responses in infants recovering from bacterial meningitis. Audiologic evaluation.

Auditory brainstem response (ABR) was used to assess possible hearing loss in 60 patients recovering from bacterial meningitis. The ABR results were consistent with either unilateral or bilateral hearing loss in 35% of the cases tested. Of these, 15% were conductive-type hearing loss. Twelve percent had sensorineural hearing losses and normal brainstem function. The remaining 8% had elevated ABR thresholds coincident with findings suggestive of neuropathology of the auditory brainstem pathways. A case of reversible sensorineural hearing loss was documented. Various clinical and demographic factors were examined to determine their predictive value with regard to hearing loss. As expected, otitis media occurred significantly with conductive hearing loss. Type of pathogen (Streptococcus pneumoniae) and hospitalization greater than two weeks were significantly correlated with sensorineural hearing loss. As meningitis typically affects young children who are difficult to test with conventional audiometry, ABR provides an effective means of testing hearing in this population.

Petrosquamosal suture and lamina.

The junction of the petrosal and squamosal portions of the temporal lobe has important relationships that are of interest to the otologist. The resultant suture extends from the glaserian fissure across the top of the middle ear cleft and into the mastoid portion of the temporal bone. It may permit quick passage of infection from the middle ear to the middle cranial fossa. The petrosa may override the squama, forcing it down into the tympanum, where it could cause malleus fixation and a conductive type hearing loss. In the mastoid the suture is identifiable on the surface, but in the interior it is represented by the petrosquamosal lamina. The deeper portion in the petrosal portion of the mastoid may be easily overlooked in surgery of the mastoid and may lead to facial nerve injury.

Unusual audiological findings in cranial metaphyseal dysplasia.

C ranial metaphyseal dysplasia is a rare congenital abnormality characterized by increased density and thickness of the vault, facial bones, base of the skull, and diaphyses of the long bones. Other descriptive terms, such as leontiasis ossea and osteopetrosis may be variants of this disease. Inheritance may occur as an autosomal dominant or recessive trait. The neurologic sequelae may be late motor development, mental retardation,cranial nerve paralyses from atroatropphyd by the overgrowth of the foraminaforamina. 1 some type of hearing loss associated with thiproba-blysorsorineural, ecause the cochlear nerves become compressed as they pass through narrowed internal auditory canals. Less frequently, there can be a conductive type hearing loss as a result of deformities of the external auditory meatus or fixation of the stapes in the oval window. However, the literature has not reported the possibility of hearing loss deterioration or an apparent change in the status of the loss over

Observation of changes in the acoustic impedance of the ear as an aid to the diagnosis of paralysis of the stapedius muscle.

1. Cochlear stimulation at insufficient intensity levels on the opposite side (e.g. hearing loss of conductive type).