Adolescent Hearing Research Articles

Lipid metabolism and hearing loss: association of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with adolescent hearing health

BackgroundThe ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) is a novel lipid measure for assessing the risk of cardiovascular disease. Lipid metabolism disorders are reportedly associated with hearing impairment. This study aimed to investigate the potential association between NHHR and hearing.MethodsThe data used in this study were obtained from the National Health and Nutrition Examination Survey (NHANES) cycles of 2005–2010 and 2017–2018, including 4,296 participants aged 6–19 years. The NHHR was calculated from lipid profiles, and hearing was assessed using pure-tone audiometry. Weighted multivariate logistic regression analyses were used to investigate the association between the NHHR and hearing loss. Subgroup and sensitivity analyses were performed to verify the robustness of the results.ResultsUnivariate analysis revealed significant associations between the NHHR and hearing threshold at all categorized frequency (low, speech, or high-frequency) (P < 0.001). Three models were used: an unadjusted model, a model adjusted for age, sex, and race, and a model further adjusted for PIR, BMI, and diabetes. Multiple regression analysis confirmed these associations consistently across all models. When considered as a continuous variable, NHHR had a significant association with enhanced hearing thresholds at all categorized frequencies: low-frequency (β:0.56, 95% CI: 0.36–0.75), speech-frequency (β:0.55, 95% CI: 0.36–0.7), and high-frequency (β:0.55, 95% CI: 0.36–0.74). The adjusted models showed persistent positive correlations after controlling for covariates. The NHHR was consistently positively associated with hearing loss. The NHHR and auditory thresholds showed a general dose-response association across all frequencies.ConclusionsNHHR is a promising biomarker for predicting adolescent hearing threshold shifts and hearing loss. The study highlights the importance of early lipid monitoring and management as strategies to prevent or reduce hearing impairment.

Adolescent-Centered mHealth Applications in a Collaborative Care Model: A Virtual Focus Group Study With Audiologists.

Technology-enabled care, including the use of mobile health (mHealth), is emerging as a viable hearing health care delivery method. While the integration of mHealth with adult populations currently supports a wide array of hearing services, a better understanding of the implementation across the lifespan is needed. Literature surrounding the unique population of adolescent hearing aid users is currently lacking. Research is needed to highlight factors important to the use and clinical integration of mHealth hearing aid applications (apps) with adolescents. This study explored two primary objectives: (a) audiologists' perceptions around the use of mHealth apps to enable collaborative, child-inclusive hearing aid personalization, and (b) person-centered ideation around potential app design components to benefit users aged 12 to 17 years. Twelve audiologists participated in virtual synchronous focus groups, across three group sessions using Cisco Webex. Sessions were recorded, transcribed, and analyzed using an inductive, codebook thematic analysis approach. Six main themes resulted from group discussion analyses: (a) client candidacy: characteristics impacting suitability for mHealth use; (b) clinical implementation: organizational, professional, or patient-level strategies for mHealth adoption; (c) collaboration: the use of two or more individuals working together; (d) empowerment: process of acquiring and using knowledge, skills, and strategies; (e) remote technology: technologies enabling remote hearing aid personalization; and (f) application functionality and design: features and characteristics important to an adolescent-focused app. Findings identified the potential for clinical integration of hearing aid apps with adolescents in a collaborative care model, including consideration of child-specific use patterns, outcomes, and key design and technology components to support real-world implementation and use. Results may guide development and tailoring efforts around existing and future hearing aid apps for use with adolescent populations.

Influence of music on the hearing and mental health of adolescents and countermeasures.

This review elaborates on the influence of music on the psychological well-being of adolescents, covering the potential advantages, drawbacks, and necessary strategic interventions associated with music exposure. Initially, we characterize music and delve into a multifaceted classification system. Music, as a pervasive art form, is categorized based on regional and national parameters, and it also distinguishes through the assorted genres and traits. The mental well-being of adolescents is significantly influenced by music through mechanisms such as the facilitation of emotional expression and regulation, fortification of social bonds and the sense of belonging, as well as the fostering of creativity and cognitive development. Nonetheless, music, if misused or associated with inappropriate content, could elicit a spectrum of issues ranging from auditory impairment, diversion of attention, addiction tendencies, to the induction of negative emotions. To counteract these potential hazards, we propose several mitigation strategies including the selection of appropriate music styles, the establishment of a wholesome music environment, the promotion of the constructive role of music education, and fostering active participation in music activities among the youth. In conclusion, we underscore the necessity of a collaborative endeavor from all sectors of society to ensure a healthy music environment for the youth, which in turn would enhance the positive influence of music on the mental health development of this population.

Novel biallelic USH2A variants in a patient with usher syndrome type IIA- a case report

BackgroundUsher Syndrome is the commonest cause of inherited blindness and deafness. The condition is clinically and genetically heterogeneous, with no current treatment. We report a case carrying novel biallelic variants in USH2A causing progressive early adolescent onset visual and hearing impairment consistent with Usher Syndrome Type IIA.Case presentationOur patient presented at age 13 with progressive visual field loss and hearing loss, associated with early onset of cataract in her 40s requiring lens extraction. Now 52 years old, latest best corrected visual acuity (BCVA) stands at Logmar Right Eye (RE) 0.8 and Left Eye (LE) 0.2, with significantly constricted visual fields bilaterally. She was registered partially sighted age 46. Clinical and molecular genetic assessment of the proband was consistent with a diagnosis of Usher Syndrome Type IIA. Genetic testing identified two novel USH2A variants, resulting in the premature termination codon p.Leu30Ter and a missense mutation p.Cys3251Tyr. Segregation analysis confirmed that these variants were biallelic in the affected case. Comprehensive in silico analysis confirmed that these mutations are the probable cause of Usher Syndrome Type IIA in this individual.ConclusionsThe identification of novel mutations in USH2A increases the spectrum of genetic variations that lead to Usher Syndrome, aiding genetic diagnosis, assessment of patient prognosis, and emphasising the importance of genetic testing to identify new mutations in patients with undiagnosed progressive visual loss.

Hearing and Exposure to Music in Adolescents From Four Schools of Córdoba, Argentina.

Purposes The aims of this study are (a) to characterize the hearing of adolescents from four schools of Córdoba, Argentina, through the analysis of conventional and extended high-frequency audiometric thresholds and otoacoustic emissions (OAEs) and (b) to analyze the association between the mentioned hearing tests and exposure to music. Method It was a cross-sectional correlational descriptive study. Hearing thresholds (250-16000 Hz), transient evoked OAEs, and distortion product OAEs were evaluated in 225 adolescents (450 ears) aged 14 and 15 years. The ears were split into two groups: Group 1 had thresholds ≤ 21 dB HL in all frequencies, and Group 2 had thresholds > 21 dB HL in at least one. Exposure to music was evaluated through a questionnaire. Results Statistically significant differences were found in both ears between Groups 1 and 2. A notch at 3000-6000 Hz was noted in both groups. Group 2 showed a progressive threshold increase from 9000 Hz. Amplitude decrease, negative values, absent distortion product OAEs, and transient evoked OAEs were noted even in Group 1. A statistically significant association between Groups 1 and 2 and the presence/absence of OAEs was observed in most frequencies. Ears with moderate or high exposure to music had greater hearing thresholds compared to ears with low exposure at most frequencies; this was more evident in Group 1. Regarding exposure to music and OAEs, no significant differences were found between the exposure categories. Conclusions The findings highlight the value of implementing hearing conservation programs in Argentina, analyzing hearing tests correlated with questionnaires about recreational noise exposure in order to detect vulnerable ears early.

Effects of chemotherapy on the auditory system of children with cancer: a systematic literature review

ABSTRACT Purpose: to identify and analyze the effects of chemotherapy on the auditory system of children and/or adolescents with cancer treated with cisplatin and carboplatin, assessed through standardized audiological procedures. Methods: studies in Brazilian Portuguese and in English were searched for, as available in the databases Science Direct, PubMed, LILACS, BIREME, Embase, SciELO, Web of Science and Cochrane. The descriptors were: Hearing Loss, Audiology, Child Cancer, Chemotherapy, and Child. Articles with levels 1 and 2 of scientific evidence, published in the last 20 years (1997 to 2017), were considered, of which the audiological results were analyzed, as well as the prevalence of hearing loss in children with cancer undergoing chemotherapy. Results: 3,625 articles were found, of which only 23 were selected for analysis in the present review. Studies have shown a high incidence of sensorineural hearing loss and decrease or even loss of otoacoustic emissions in children and adolescents with cancer, even after the first dose of chemotherapy drugs, with high frequencies being the most affected. Conclusion: there is evidence that both carboplatin and especially cisplatin from the first doses may impair the hearing of children and adolescents, mainly affecting the cochlear function, thus, the importance of long-term audiological monitoring.

Depression, anxiety and stress among caregivers of adolescents with cerebral palsy in rural Bangladesh

Purpose Prior studies indicate high risk of mental health problems among caregivers of adolescents with cerebral palsy although limited consideration is given to caregivers in low- and middle-income countries. This study aimed to compare the burden of depression, anxiety and stress among caregivers of adolescents with cerebral palsy to caregivers of adolescents without disability in rural Bangladesh; and to identify factors unique to low- and middle-income countries that predict caregiver’s mental health. Methods Observational study comparing caregivers of adolescents with cerebral palsy identified through the Bangladesh Cerebral Palsy Register and caregivers of adolescents without disability from neighboring dwellings. Caregiver mental health was assessed using the Depression, Anxiety and Stress Scale-21, adolescent mental health using the Strengths and Difficulties Questionnaire and adolescent health-related quality of life using Kidscreen-27. Hierarchical multivariable regression analysis was performed. Results Participants were 154 caregivers of adolescents with cerebral palsy and 173 caregivers of adolescents without disability, matched on adolescent age and sex. Caregivers of adolescents with cerebral palsy reported significantly higher risk of depression and stress than caregivers of adolescents without disability (Effect Size 0.1 to 0.2, p < 0.05) although no difference on anxiety. Caregiver age, adolescent mental health, household overcrowding and adolescent hearing impairment were significant predictors of depression, anxiety and/or stress (0.1 to 2.2, p < 0.05). Conclusions Caregivers of adolescents with cerebral palsy in rural Bangladesh are at high risk of depression and stress. Initiatives to improve caregiver mental health are required; we recommend initiatives address adolescent mental health problems and include poverty reduction measures to improve social and economic capital. Improved understanding of the factors predicting caregiver depression, anxiety and stress unique to low and middle-income countries are necessary to guide policies and public health infrastructure development. Implications for rehabilitation Caregivers of adolescents with cerebral palsy in rural Bangladesh are at significantly higher risk of depression and stress than caregivers of adolescents without disability. We recommend interventions to improve caregiver mental health give specific consideration to older caregivers, those whose adolescent report mental health problems, families living in crowded households, and/or whose child has hearing impairment. We recommend interventions include poverty reduction measures to improve social and economic capital and target both caregivers and adolescents with CP to enhance long term outcomes.

Structural neuroimaging of the altered brain stemming from pediatric and adolescent hearing loss-Scientific and clinical challenges.

There has been a spurt in structural neuroimaging studies of the effect of hearing loss on the brain. Specifically, magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) technologies provide an opportunity to quantify changes in gray and white matter structures at the macroscopic scale. To date, there have been 32 MRI and 23 DTI studies that have analyzed structural differences accruing from pre- or peri-lingual pediatric hearing loss with congenital or early onset etiology and postlingual hearing loss in pre-to-late adolescence. Additionally, there have been 15 prospective clinical structural neuroimaging studies of children and adolescents being evaluated for cochlear implants. The results of the 70 studies are summarized in two figures and three tables. Plastic changes in the brain are seen to be multifocal rather than diffuse, that is, differences are consistent across regions implicated in the hearing, speech and language networks regardless of modes of communication and amplification. Structures in that play an important role in cognition are affected to a lesser extent. A limitation of these studies is the emphasis on volumetric measures and on homogeneous groups of subjects with hearing loss. It is suggested that additional measures of morphometry and connectivity could contribute to a greater understanding of the effect of hearing loss on the brain. Then an interpretation of the observed macroscopic structural differences is given. This is followed by discussion of how structural imaging can be combined with functional imaging to provide biomarkers for longitudinal tracking of amplification. This article is categorized under: Developmental Biology > Developmental Processes in Health and Disease Translational, Genomic, and Systems Medicine > Translational Medicine Laboratory Methods and Technologies > Imaging.

Adolescent Hearing Loss: Rising or Not, It Remains a Concern.

* Abbreviation: NHANES — : National Health and Nutrition Examination Survey In this issue of Pediatrics , Barrett and White1 report on the prevalence of adolescent hearing loss using data from the National Health and Nutrition Examination Survey (NHANES). Specifically, they extend the findings of Shargorodsky et al’s2 2010 publication, which compared the prevalence of adolescent hearing loss in the third NHANES (1988–1994) to NHANES 2005–2006. Shargorodsky et al2 reported a significant rise in the prevalence of adolescent hearing loss from 14.9% to 19.5% using these 2 time points, but when the 2008 and 2010 data are included, the prevalence does not appear to have significantly changed since 1994.1 Barrett and White1 conclude that Shargorodsky’s often cited manuscript on the rising prevalence of adolescent hearing loss is not substantiated when subsequent NHANES data cycles are included. In considering the … Address correspondence to Deepa L. Sekhar, MD, MSc, Department of Pediatrics, Penn State College of Medicine, 500 University Dr, HS83, Hershey, PA 17033. E-mail: dsekhar{at}pennstatehealth.psu.edu

Trends in Hearing Loss Among Adolescents.

Our aim with this article is to evaluate whether the prevalence of hearing loss is increasing among adolescents living in the United States. All available data about hearing loss among adolescents from the large, federally funded National Health and Nutrition Examination Survey (NHANES) were analyzed. By using the 4 data releases between 1994 and 2010 (a total of 6891 adolescents), the prevalence of adolescent hearing loss >15 and ≥25 dB at low frequencies (0.5, 1, and 2 kHz) and high frequencies (3, 4, 6, and 8 kHz) for bilateral, unilateral, and any loss were calculated. Only 13 of 90 comparisons of prevalence across combinations of degree, frequency, and laterality of hearing loss revealed a statistically significant increase at P < .05. Among the 18 subgroups of degree, frequency, and laterality, 61% had a lower prevalence of hearing loss in 2010 than in 1994, and 100% of the subgroups had a lower prevalence in 2010 than in 2006. With previous analyses of NHANES data from 1994 to 2006, researchers showed that hearing loss among US adolescents was increasing. Based on the NHANES data from 1994 to 2010 that are now available, there is no consistent evidence that hearing loss among adolescents in the United States is increasing. Results reveal that conclusions about trends using data from 2 time points can be misleading. NHANES should resume collecting audiometric data as part of their data collection protocol so that trends in the prevalence of childhood hearing loss can be documented.

The Sensitivity of Adolescent Hearing Screens Significantly Improves by Adding High Frequencies

PurposeOne in 6 US adolescents has high-frequency hearing loss, often related to hazardous noise. Yet, the American Academy of Pediatrics (AAP) hearing screen (500, 1,000, 2,000, 4,000 Hertz) primarily includes low frequencies (<3,000 Hertz). Study objectives were to determine (1) sensitivity and specificity of the AAP hearing screen for adolescent hearing loss and (2) if adding high frequencies increases sensitivity, while repeat screening of initial referrals reduces false positive results (maintaining acceptable specificity). MethodsEleventh graders (n = 134) participated in hearing screening (2013–2014) including “gold-standard” sound-treated booth testing to calculate sensitivity and specificity. ResultsOf the 43 referrals, 27 (63%) had high-frequency hearing loss. AAP screen sensitivity and specificity were 58.1% (95% confidence interval 42.1%–73.0%) and 91.2% (95% confidence interval 83.4–96.1), respectively. Adding high frequencies (6,000, 8,000 Hertz) significantly increased sensitivity to 79.1% (64.0%–90.0%; p = .003). Specificity with repeat screening was 81.3% (71.8%–88.7%; p = .003). ConclusionsAdolescent hearing screen sensitivity improves with high frequencies. Repeat testing maintains acceptable specificity.

Testing the effects of a message framing intervention on intentions towards hearing loss prevention in adolescents

Adolescent hearing loss is a public health problem that has eluded effective intervention. A persuasive message strategy was tested for its effectiveness on adolescents' intention to listen to music at a reduced volume. The messages manipulated both type of message frame [positive consequences of listening to music at a reduced volume (gain-framed) versus negative consequences of not listening to music at a reduced volume (loss-framed)] and type of temporal context (short-term versus long-term consequences). Participants were recruited from four vocational and secondary education schools in the Netherlands and message exposure took place online during class hours. Two weeks prior to message exposure, adolescents provided data on intention and risk perception towards hearing loss and use of (digital) music players. After message exposure, 194 adolescents (mean age = 14.71 years, SD = 1.00, 37.8% males) provided immediate follow-up data on intention. Results revealed that intention to listen to music at a reduced volume increased in those exposed to a loss-framed message with short-term consequences. No changes were found in the other conditions. Messages that emphasize negative short-term consequences of not listening to music at a moderate volume have the ability to influence adolescents' intention towards hearing loss prevention.

Current office-based hearing screening questions fail to identify adolescents at risk for hearing loss.

There is a rising prevalence of hearing loss among adolescents in the United States. Current paediatric preventive care recommendations by the Bright Futures guidelines and the American Academy of Pediatrics suggest that clinicians should ask adolescents ten hearing screening questions to identify those who are at high risk of hearing loss for further objective hearing testing. We assessed the utility of these subjective risk assessment questions to distinguish those adolescents with objectively documented hearing loss. A single public high school in Pennsylvania. We compared results from a prospective study evaluating objective hearing assessments with the use of the ten Bright Futures hearing screening questions plus additional adolescent-specific questions to predict adolescent hearing loss. In relation to the questions used in this study, adolescents who were referred following objective hearing screens were more likely to report "trouble following the conversation when two or more people are talking at the same time" and a "past experience of slight hearing loss". Referrals from sound treated booth testing were more likely to report "trouble hearing over the phone" and have a diagnosis or history of hearing loss. Most Bright Futures questions were not associated with adolescent hearing loss. An objective adolescent hearing screen should be considered in the recommended schedule of preventive care, instead of the current risk-based subjective assessment.

Parental perspectives on adolescent hearing loss.

Importance: Data indicate that 1 in 6 adolescents has high-frequency hearing loss, which is typically noise related and preventable. Parental participation improves the success of adolescent behavioral interventions, yet little is known about parental perspectives regarding adolescent noise-induced hearing loss. Objective: To perform a survey to determine parental knowledge of adolescent hearing loss and willingness to promote hearing conservation to discern information that is critical to design adolescent hearing loss prevention programs.

Increased prevalence of early cochlear damage in young patients with type 1 diabetes detected by distortion product otoacoustic emissions

Objective: To evaluate the hearing of adolescents with diabetes mellitus type 1(DM1) by otoacoustic emissions (OAEs), and by comparing different tests with pure-tone audiometry to identify potential early cochlear impairments. Design: Pure-tone audiometry, transient evoked otoacoustic emissions (TEOAEs), and distortion product otoacoustic emissions (DPOAEs) were performed in a group of adolescents with and without DM1. Clinical characteristics, disease duration, and glycated haemoglobin levels were studied. Study sample: Participants were 40 adolescents with DM1 and 40 healthy subjects. Results: Sensorineural hearing loss, affecting frequencies of 6000 and 8000 Hz, was found only in DM1 subjects when compared to the controls (7.7% vs. 0%, p < 0.05). A higher prevalence of cochlear damage was detected by DPOAE responses, 32% belonging from the diabetic group, vs. 3.7% in the control group. Absent TEOAE responses were observed in only three individuals, all from the diabetic group (5.1% of the tests performed in the diabetic group). Additionally, hearing thresholds were better in diabetic subjects with good control when compared to ones with regular or poor control (p = 0.00). Hearing thresholds were higher in poorly controlled diabetics when compared to subjects with good (p = 0.000) or regular control (p = 0.006). Conclusion: Early evidence of cochlear damage was detected in adolescents with DM1 leading to hearing loss at high frequencies. Abnormal DPOAEs responses were found more frequently than the alterations in TEOAEs and pure-tone audiometry, suggesting that DPOAEs evaluation is the most sensitive and it could be used for monitoring the progression of cochlear damage during the early stages of hearing impairment.

Pilot study of a high-frequency school-based hearing screen to detect adolescent hearing loss

Like most of the United States, school-based hearing screening in Pennsylvania focuses on low-frequency, conductive hearing losses typical for young children, rather than the high-frequency, noise-induced hearing loss more prevalent among adolescents. The objective of this study was to compare the sensitivity and specificity of current school hearing screening in Pennsylvania with hearing screening including high frequencies, designed to detect adolescent hearing loss. A single public high school. In the Autumn of 2011 the high-frequency screen was delivered alongside the Pennsylvania school screen for students in the 11(th) grade. Screening referrals and a subset of passes returned for "gold standard" testing with audiology in a sound treated booth, in order to determine the sensitivity and specificity of the screening tests. Of 282 participants, five (2%) were referred on the Pennsylvania school screen, and 85 (30%) were referred on the high-frequency screen. Of the 48 who returned for gold standard testing with audiology, hearing loss was diagnosed in 9/48 (19%). Sensitivity of the Pennsylvania and high-frequency screens were 13% (95% confidence interval [CI] 0-53%) and 100% (95% CI 66-100%) respectively. Specificity of the Pennsylvania and high-frequency screens were 97% (95% CI 87-100%) and 49% (95% CI 32-65%) respectively. Current school hearing screens have low sensitivity for detection of adolescent hearing loss. Modifying school-based protocols may be warranted to best screen adolescents, and make optimal use of school nurse time and effort.

Parental Perspectives on Adolescent Hearing Loss Risk and Prevention

Data indicate that 1 in 6 adolescents has high-frequency hearing loss, which is typically noise related and preventable. Parental participation improves the success of adolescent behavioral interventions, yet little is known about parental perspectives regarding adolescent noise-induced hearing loss. To perform a survey to determine parental knowledge of adolescent hearing loss and willingness to promote hearing conservation to discern information that is critical to design adolescent hearing loss prevention programs. A cross-sectional, Internet-based survey of a nationally representative online sample of parents of 13- to 17-year-olds. A survey conducted with the C.S. Mott Children's Hospital National Poll on Children's Health, a recurring online survey. Parental knowledge of adolescent hearing loss and willingness to promote hearing conservation. Of 716 eligible respondents, 96.3% of parents reported that their adolescent was slightly or not at all at risk of hearing problems from excessive noise, and 69.0% had not spoken with their adolescent about noise exposure, mainly because of the perceived low risk. Nonetheless, to protect their adolescents' hearing, more than 65.0% of parents are either willing or very willing to consider limiting time listening to music, limiting access to excessively noisy situations, or insisting on the use of hearing protection (earplugs or earmuffs). Higher parental education increased the odds of promoting hearing-protective strategies. Parents were less likely to insist on hearing protection for older adolescents. Parents who understood that both volume and time of exposure affect hearing damage were more likely to have discussed hearing loss with their adolescent (odds ratio [OR], 1.98; 95% CI, 1.29-3.03). The odds of discussing hearing loss were also increased for those who were willing or very willing to limit time listening to music (OR, 1.88; 95% CI, 1.19-2.26) and to insist on hearing protection (OR, 1.92; 95% CI, 1.15-3.18) compared with parents who were very unwilling, unwilling, or neutral. Despite the rising prevalence of acquired adolescent hearing loss, few parents believe their adolescent is at risk. Those with higher education are more willing to promote hearing conservation, especially with younger adolescents. To create effective hearing conservation programs, parents need better education on this subject as well as effective and acceptable strategies to prevent adolescent noise exposure.

Health Teachers' Perceptions and Teaching Practices Regarding Hearing Loss Conservation

Background Limited research has examined the role of school health personnel in the prevention and early identification of hearing impairment. Purpose This study assessed high school health teachers' perceptions and teaching practices regarding hearing loss conservation. Methods A 26-item survey based on selected components of the health belief model and self-efficacy was developed on hearing loss in students and their teaching practices regarding hearing loss conservation. A national random sample of 600 health teachers was obtained from the US Department of Education. Results A 3-wave mailing was used to achieve a 47% response rate (n = 281). One in 7 (15%) health teachers felt very confident in providing information regarding noise-induced hearing loss and 9% felt very confident in providing referral for students. Common hearing loss prevention topics taught were potential damaging effects of music/other sounds (30%), anatomy and physiology of hearing (16%), impact of hearing loss (15%), and sources of personal protection (15%). Discussion Results suggest that more training and information on hearing is needed and desired by health educators. Translation to Health Education Practice School health teachers need to assess threats to adolescent hearing loss and incorporate hearing loss conservation into the curriculum and serve as a resource person to others regarding this topic.

Syndromic hearing loss: An update

Hearing impairment is one of the commonest clinical conditions. It has been estimated that approximately 1 in 10 persons has hearing concerns. Further epidemiological studies have found that the percentage of the general population with hearing loss greater than 45 dB HL and 65 dB HL is 1.3% and 0.3%, respectively, between 30 and 50 years of age; and 2.3% and 7.4% between 60 and 70 years of age. The prevalence of childhood and adolescent hearing loss is around 3%. At birth, between one and two out of 1000 newborns are affected by hearing loss of such a degree as to require treatment (auditory training and rehabilitation, hearing aids or cochlear implantation). To summarize, hearing impairment affects up to 30% of the international community and estimates indicate that 70 million persons are deaf. The causes of hearing loss differ and they can vary in severity and physiopathology. In many cases it is not possible to define a definite aetiology. Nevertheless, it is known that most are due to a genetic cause and among these the majority appear in a non-syndromic form. The aetiology of hearing loss in children is unknown in 40% of cases, genetic non-syndromic in 30%, and genetic syndromic in 3–5%. The two most common genes involved in hearing loss are GJB2 and SLC26A4. Mutations in these genes can be responsible for syndromic hearing loss, as keratitis ichthyosis deafness (KID) and Pendred syndromes, respectively, or non-syndromic hearing loss (as DFNB1 and DFNB4, respectively). DFNB1 with GJB2 mutations is the most common non-syndromic form and Pendred syndrome is the most common syndromic form. Neither of these last two is usually characterized by congenital macroscopic dysmorphic features, and affected children can be generally considered as well babies. Nonetheless, 2–4% of live births have congenital malformations, most commonly caused by multifactorial defects, followed by chromosomal disorders, single gene mutations and teratogens (alcohol, drugs).Some of these conditions could directly affect the auditory system and be responsible for sensorineural, conductive or mixed hearing loss. The London Dysmorphology Database lists approximately 400 syndromes that include hearing loss among the clinical features. Other conditions such as cystic fibrosis are not usually responsible for hearing loss but they can indirectly affect the auditory system as a consequence of the management of the disease. Other systemic disorders can lead to hearing impairment when the disease involves a part of the auditory system from the external ear to the auditory cortex. From this standpoint there are a huge number of syndromes or conditions that can directly or indirectly cause hearing impairment. They can be responsible for congenital or prelingual, progressive and post-lingual hearing loss, with sensorineural, mixed or conductive deficits. In this updating research we have focused on syndromic forms that are known to be associated with hearing loss or that directly affect the auditory system. Some conditions of particular interest, or with high incidence, are also included.

A Case of Underdiagnosed Brucella Meningitis Presented With Hearing Loss

Abstract: Brucellosis is a widespread zoonosis in many parts of theworld. Neurologic complications including meningitis, meningoencepha-litis, brain abscess, myelitis, radiculoneuritis, peripheral and cranial neu-ropathies,andpsychiatricmanifestationsarerarelyencountered,especiallyin children. In this report, we present a 13-year-old adolescent boy withchronic Brucella meningitis and hearing loss who was given anti-brucellosis treatment for 6 months and subsequently underwent cochlearimplantation.Key Words: chronic Brucella meningitis, child, hearing loss,cochlear implantation(Infect Dis Clin Pract 2013;21: 136Y138) B rucellosis is a multisystemic disease with nonspecific man-ifestations caused by gram-negative bacteria, Brucella spe-cies.Brucellosisremainsapublichealthprobleminmostcountriesof the Mediterranean, including Turkey, and in the Balkans, theMiddleEast,andCentralandSouthAmerica. 1 Neurobrucellosisis a rare complication of brucellosis in children. The mostcommon presentations of neurobrucellosis are meningitis andmeningoencephalitis.Cranialnerveinvolvementsareamongthemajor complications of neurobrucellosis.