Incidence Of Conductive Hearing Loss Research Articles

OA073] A prospective study of dose–response relationship and NTCP of conductive hearing loss in patients undergoing head and neck radiotherapy

Purpose Head-and-neck (H&N) radiotherapy may cause hearing loss. Despite its negative effects on patients’ quality of life, little has been published on the dose–response relationship and normal tissue complication probability (NTCP) of the conductive subtype of hearing loss. The goals of this study were: (i) to observe the incidence of hearing loss in patients undergoing non-intensity-modulated H&N radiotherapy, (ii) to obtain the relationship between dose and conductive hearing loss, (iii) to test the current parameters of the Lyman-Kutcher-Burman (LKB) radiobiological model for estimating its NTCP, and (iv) to assess the need for considering the dose to middle and external ear as organ-at-risk when optimizing treatment plans. Methods In this prospective study, the dose–response relationship in the auditory system of 35 patients (70 ears) undergoing 3D conformal H&N radiotherapy was studied using the physical parameter of mean dose as well as the LKB NTCP model (with parameters TD50 = 40 Gy, M = 0.15, n = 0.10) calculated by BioSuite software. In order to include a wider dose range, the study was conducted at a clinic where, at the time, more advanced treatment delivery techniques were unavailable. The patients underwent routine external-beam megavoltage X-ray treatments following 3D treatment planning involving dose calculation using collapsed-cone convolution superposition. Prescribed doses were in the range 30–72 Gy, delivered 1.8–2.0 Gy per fraction. Hearing status was evaluated by pure tone audiometry one day before the start and one and three months after the end of the radiotherapy course. Results Nineteen ears (27%) suffered hearing loss. Sixteen ears (23%) had conductive hearing loss and 3 ears (4%) the sensorineural subtype (p 0.05). An approximately 40 Gy mean dose to the middle-ear planning organ-at-risk volume was predicted by the LKB NTCP model to cause a 50% risk of conductive hearing loss, which was also observed in the studied patients. Conclusions Incidence of conductive hearing loss in typical 3D conformal H&N radiotherapy can be significant. This suggests that the auditory system should also be considered in treatment plan optimization. The LKB model parameters provided a reasonably accurate NTCP. However, a study is underway to optimize its parameters.

Hearing Outcomes in Patients with Cleft Lip/Palate

Objective : Children with cleft lip and palate or cleft palate only have a high incidence of conductive hearing loss from otitis media with effusion. Studies demonstrating longitudinal results are lacking. This study was undertaken to investigate long-term longitudinal hearing outcomes of children with cleft lip and/or cleft palate and cleft palate only. Design : Retrospective chart review. Setting : Clinical charts of patients born with cleft lip and palate or cleft palate only in 1985 to 1994 who were referred to the cleft team in Bergen, Norway. Study findings include 15 years of follow-up. Participants : The study population consisted of 317 children of whom 159 had nonsyndromic cleft lip and palate and 158 had nonsyndromic cleft palate. Main Outcome Measures : Pure tone average calculated from pure tone audiometry at ages 4, 6, and 15 years. Results : The median pure tone average significantly improved with increasing age. For the cleft lip and palate group, the median pure tone average at ages 4, 6, and 15 years was 16 dB hearing level (HL), 13 dB HL, and 9 dB HL, respectively (P ≤ .001). In the cleft palate group the median pure tone average at ages 4, 6, and 15 years was 15 dB HL, 12 dB HL, and 9 dB HL, respectively (P ≤ .001). There was no significant difference in the hearing levels between the two groups. Patients who had surgical closure of the palate at age 18 months had a significantly better pure tone average outcome at age 15 compared with patients who had surgery at 12 months. Conclusions : Hearing improves significantly from childhood to adolescence in patients with cleft lip and palate and cleft palate only.

Identification of Hearing Loss in Pediatric Patients with Down Syndrome

To determine the type of hearing loss, incidence of the lost to follow-up rate, and the time to diagnose sensorineural hearing loss (SNHL) in children with Down syndrome (DS) identified from a statewide database. Case series with chart review. Pediatric referral center. Three hundred forty-four patients with DS born in Utah between January 2002 and December 2006 were identified using the Utah Department of Health's Newborn Hearing Screening database and birth defects registry. Three hundred thirty-two patients were included in the study. Eighty-seven infants (26.2%) did not pass their newborn hearing screening (NBS). Thirty-three of these children (37.9%) had a conductive hearing loss attributed to serous otitis media. Five infants had SNHL; 3 children were diagnosed with a mixed hearing loss (MHL). The average time to diagnose a sensorineural hearing loss was 485 ± 601 days. One child who passed his NBS was subsequently found to have an SNHL. More than 43% of the newborns with DS who passed their NBS developed a conductive hearing loss requiring insertion of ventilation tubes. Eighty-four percent of newborns with DS who did not undergo NBS did not have any apparent subsequent audiologic testing. Patients with DS present with a relatively high incidence of conductive hearing loss, MHL, and SNHL and a higher lost to follow-up rate compared to patients without DS. The authors were not able to diagnose SNHL within the 90-day period recommended by the Joint Committee on Infant Hearing.

Newborn Hearing Screening in Infants With Cleft Palates

The high incidence of conductive hearing loss from serous effusion in patients with cleft palate is well known. This study investigates the results and interpretation of newborn hearing screening in infants with cleft palates. Retrospective cohort review. One hundred fourteen newborns with cleft palate, with or without cleft lip, born between 1999 and 2005 and referred to a craniofacial anomalies clinic. Tympanostomy tubes were placed in 102 newborns, and follow-up audiograms were available for 104 infants. Hearing screening outcomes were collected. Sex, gestational period, type of screening performed, the presence of hearing loss after tube placement, and the presence of associated syndromes were noted. Eighty-two (72%) of 114 of newborns with cleft palates passed their hearing screen. Of the 30 newborns who failed their hearing screen, and had tympanostomy tubes placed, 13 (43%) had persistent hearing loss after tube placement. Factors predicting persistent hearing loss include cleft palate alone, female infants, and the presence of an associated syndrome. Newborns with cleft palate are at higher risk of failing their newborn hearing screen compared with healthy neonates. Detection of sensorineural or conductive hearing loss unrelated to middle ear effusions is more difficult in this at-risk population with cleft palate because of the high prevalence of serous otitis media.

Conductive hearing loss and otopathology in cleft palate patients

Assess incidence of conductive hearing loss, ear pathology, and associated communicative disorders in cleft palate patients. Retrospective chart review of 101 patients all treated at a tertiary facility since birth. The median patient age was 19 years old (range 8-25) at last follow-up, 35% female. Median age of cleft palate repair was 16 months (range 12-60). Median number of myringotomy tubes was 3 (range 1-7). Conductive hearing loss (CHL) greater than 20 db PTA was found in 25% of patients at last follow-up. Severity of CHL was mild in 75%, moderate in 21%, and severe in 4%. Cholesteatoma was identified in 5.9%. The mean age at resolution of CHL was 5 years (range 3-19). Risk factors associated with CHL at last follow-up included middle ear surgery (P = 0.016), cholesteatoma (P = 0.003), and 4 or more myringotomy tube insertions (P = 0.030). Associations between CHL and age at cleft repair, speech impairment, or learning disabilities were not found. Children requiring increased number of myringotomy tubes and middle ear surgery and found to have cholesteatoma are at increased risk for long-standing CHL. C-4 SIGNIFICANCE: Cleft palate children requiring multiple tube insertions should be monitored closely for CHL.

Low prevalence of hearing impairment among very low birthweight infants as detected by universal neonatal hearing screening

Objectives: To (a) study the prevalence of hearing impairment in a cohort of very low birthweight (VLBW) infants and (b) evaluate the effectiveness of transient evoked otoacoustic emissions (TEOAE) as...

Conductive hearing loss and otopathology in cleft palate patients

Objectives: To assess incidence of conductive hearing loss, ear pathology, and associated communicative disorders in cleft palate patients. Methods: Retrospective chart review of 100 patients all treated at a tertiary facility since birth. Results: The median patient age was 19 years old (range, 7–25) at last follow up. Girls comprised 35% of group. The median age of cleft palate repair was 16 months (range, 12–60). Median number of myringotomy tubes placed was 3 (range, 1–7). Conductive hearing loss(CHL) >20 db PTA was found in 25% of patients at last follow-up. Severity of CHL was mild in 75%, moderate in 21%, and severe in 4%. Middle ear surgery was performed on 13%. Cholesteatoma was identified in 6%. The mean age at resolution of CHL was 5 years (range, 3–19). Developmental learning disorders were identified in 8%. Speech difficulties requiring surgical treatment occurred in 27%. Risk factors associated with CHL at last follow-up included middle ear surgery ( P = 0.016), cholesteatoma ( P = 0.003), and increased number of myringotomy tubes ( P = 0.030). Associations between CHL and age at cleft repair, speech impairment, or learning disabilities were not found. Conclusions: Otopathology in cleft palate patients continues to be a problem despite close observation. Children requiring increased number of myringotomy tubes, middle ear surgery, and found to have cholesteatoma are at increased risk for long-standing CHL. The impact of hearing on speech and developmental learning also underscore the importance of close audiologic monitoring in cleft palate patients.

Octylcyanoacrylate: a new medical-grade adhesive for otologic surgery.

The adhesive octylcyanoacrylate is not associated with significant inner ear toxicity in a guinea pig model. Many cyanoacrylate adhesives have been investigated for use in otologic surgery, but variable ototoxicity has been reported. Octylcyanoacrylate is a medical-grade adhesive with many properties that make it ideal for use in the ear. It is free of contaminants; it forms a strong, flexible bond; and it inhibits the growth of gram-positive organisms in culture. This is the first study to assess the ototoxicity of this new adhesive. Fourteen adult guinea pigs were used. Preoperative auditory brainstem responses (ABRs) were determined. Bilateral antrotomies were performed, and the ears were randomized to adhesive and control (saline) groups. In the adhesive ears. 0.5 or 0.1 mL of octylcyanoacrylate was instilled into the middle ear. Eight weeks later, postoperative ABRs were determined, the animals were killed, and the temporal bones were removed. Middle ear changes were noted, and the ossicular chain was assessed. Cochlear hair cell analyses were performed. Histologic assessment of the middle ear mucosa was performed. There was a higher incidence of conductive hearing loss in the adhesive group secondary to fixation of the ossicular chain, but there was no significant difference in bone conduction thresholds. The median postoperative bone conduction thresholds (dB peak sound pressure level) was 15.0 in the control group and 17.5 in the adhesive group, p = 0.89. There was also no significant difference in inner hair cell counts (0.4% vs. 0.5% median hair cell loss, p = 0.72) or outer hair cell counts (3.7% vs. 3.0% median hair cell loss, p = 0.23) for the adhesive and control groups, respectively. Histopathologic analysis of the middle ear mucosa demonstrated variable mild to moderate foreign body reaction with no evidence of mucosal ulceration or necrosis. A large amount of octylcyanoacrylate placed in the middle ear of the guinea pig did not cause any morphologic or functional evidence of inner ear toxicity. This new adhesive is a promising tool for otologic surgery.

Peripheral hearing loss following head trauma in children.

The purpose of this prospective study was to determine the incidence and type of hearing loss occurring in children who suffered head injuries. Fifty children admitted to the neurosurgical service after sustaining head trauma were studied. Neurologic, otologic, and audiologic evaluations were performed. Diagnostic studies included skull roentgenograms and computerized tomography scans. A 32% incidence of conductive hearing loss and a 16% incidence of high-frequency sensorineural hearing loss was found in this group. All patients with temporal bone fractures had conductive hearing losses, but the presence of a skull vault fracture did not correlate with the presence, type, or degree of hearing loss. In addition, there was no correlation between either cause of injury, loss of consciousness, or Glasgow Coma Scale scores and the presence, type, or degree of hearing loss. There was a significant incidence of both sensorineural and conductive hearing loss in this series of patients, which indicates that close audiologic and otologic follow-up is necessary for all head injury patients.

Osteogenesis Imperfecta: A Study of 160 Family Members

Osteogenesis imperfecta, a genetic disease characterized by blue sclera, fragile bones, and hearing loss, was studied in 160 descendants of a single, affected individual. One hundred twenty family members in four generations were at risk of inheriting the gene for osteogenesis imperfecta. Fifty-six percent (68/120) had blue sclera, and, of this group, 66% had fragile bones, and 47% of those tested had hearing loss. The onset of hearing loss was usually in the second or third decade, and was primarily of the conductive type. The incidence of sensorineural hearing loss was only slightly less than the incidence of conductive hearing loss. To out knowledge, this is the largest reported kindred study of osteogenesis imperfecta. The genetic transmission of this disease as an autosomal dominant was confirmed.

Hearing loss in infectious and tropical diseases

(1) A study was undertaken to study the role the infectious, tropical and nutritional diseases play in the etiology of hearing loss. A review of the literature revealed that there was very little information available on the effects on hearing of these diseases. These diseases have a world wide distribution though they are more prevalent is Asia, Middle East and South America. The diseases studied were Typhoid, Chicken Pox, Small Pox and Mumps. (2) The incidence of hearing loss in each of these diseases has been described. The incidence of conductive hearing loss is high is all these diseases — 14.58 percent is typhoid 23.4 percent in small pox, 14.29 percent is mumps. No case with sensorineural hearing loss was found in mumps. In typhoid it was 2.08 percent, in chicken pox it was 4.17 percent and in small pox it was 6.38 percent. From this study it appears that the infectious, tropical and nutritional diseases prevalent is this region are responsible for a large number of cases of hearing loss. The majority of these cases have a conductive hearing loss.