Mean Pure Tone Average Research Articles

The Size of Internal Auditory Canal Diverticula Is Unrelated to Degree of Hearing Loss.

To explore the relationship between hearing loss and the internal auditory canal (IAC) diverticula. To determine whether diverticula exist within or medial to the otic capsule and the prevalence in a control population. Retrospective review of adult patients with radiologic evidence of an IAC diverticulum, no evidence of otosclerosis, and audiometric testing. Analyzed degree of hearing loss and width, length, height, and volume of diverticulum. Hounsfield unit (HU) measurements lateral and medial to the diverticulum. Pure tone average (PTA), air-bone gap, and WRS (word recognition score) did not correlate with length, width, height, and volume of the diverticula. In patients with a unilateral diverticulum, there was no difference in mean PTA or WRS when comparing the diverticulum and nondiverticulum sides. Mean HU lateral to the diverticulum (2104 HU) was found to be significantly higher than medial to the diverticulum (1818 HU). There is a 5.6% prevalence of IAC diverticula in patients who underwent high-resolution computed tomography (CT) scans for chronic sinusitis (control group). These data support the notion that hearing loss in this population is a product of sampling bias. The size of IAC diverticula does not correlate with the degree of hearing loss, and there is no statistically significant association between sensorineural hearing loss (SNHL) and the presence of an IAC diverticulum. IAC diverticula may exist medial to, rather than within, the otic capsule given the significant difference in mean HUs medial and lateral to the diverticula. 4 Laryngoscope, 130:1011-1015, 2020.

Hearing Results of Surgery for Acquired Atresia of the External Auditory Canal.

To evaluate short- and long-term hearing results of surgery for acquired atresia of the external auditory canal (EAC) in a large patient cohort and to define preoperative audiometric conditions useful for patient counseling. Retrospective cohort study. Academic tertiary referral center. Seventy-eight ears from 72 patients with postinflammatory acquired atresia of the EAC who underwent canal- and meatoplasty were included. Patients with involvement of the ossicular chain, (syndromic) external ear malformations, or congenital aural atresia were excluded. Canal- and meatoplasty. Mean pure-tone averages of thresholds at 0.5, 1, 2, and 3 kHz (PTA0.5,1,2,3) for air conduction (AC), bone conduction, and air-bone gap (ABG) were calculated preoperatively and at short-term (≤0.55 yr) and long-term follow-up (>0.55 yr). Additionally, the numbers of ears with a closed ABG ≤10 dB and ≤20 dB, and with Social hearing (defined as: AC PTA0.5,1,2,3 ≤35 dB) were assessed. At short-term follow-up AC PTA0.5,1,2,3 improved by 18 dB. Social hearing was obtained in 81% of the ears. Postoperatively, 35% of the ears had a closed ABG ≤10 dB, 83% was closed ≤20 dB. During follow-up, significant deterioration of 5 to 7 dB occurred for AC thresholds at 0.25, 0.5, and 1 kHz. Surgery for acquired atresia of the EAC is often beneficial. This study suggests overall advantageous surgery when the preoperative indication criteria ABG PTA0.5,1,2,3 >20 dB and AC PTA0.5,1,2,3 >35 dB are applied.

Acquired Hearing Loss, Anger, and Emotional Distress: The Mediating Role of Perceived Disability.

The aim of the study was to test whether acquired hearing loss (AHL)-related perceived disability mediates the association between AHL and psychological outcomes, including anger. Two-hundred ninety-seven consecutive outpatients with AHL assessed by pure tone average (PTA) loss completed the following: Hearing Handicap Inventory for Adults (HHIA), State-Trait Anger Expression Inventory-2 (STAXI-2), Brief Symptom Inventory (BSI), Diagnostic Criteria for Use in Psychosomatic Research (DCPR), and Social Functioning Questionnaire. In the sample, composed of 44.5% males with a mean age of 53.8 and a mean PTA of 30.7, AHL was associated to perceived hearing handicap, also correlating to all psychological measures except DCPR demoralization. Associations were stronger between the HHIA-Emotional Subscale, STAXI-2 State Anger and Feeling Angry, and BSI-Somatization, Interpersonal Sensitivity, Depression, and Psychoticism. Perceived disability predicted the presence of almost all psychosocial outcomes and confirms to be the most significant target of clinical action.

Outcomes of Triple-Combination Therapy for Chronic Tinnitus.

Patients with tinnitus suffer not only from auditory dysfunction but also physical, mental, and social difficulties. Our aim was to investigate the outcomes of our triple-combination therapy for chronic tinnitus, which includes narrow-band noise masking, auricular acupuncture and cognitive behavioral therapy. The tinnitus handicap inventory (THI) scores of 78 adults with chronic tinnitus who received triple-combination therapy for 12 weeks were analyzed retrospectively. There were 39 females and 39 males in this study. The mean age was 60.5 years [standard deviation (SD)=13.0, range=27-88 years] for all subjects. Mean pure tone average=39.5 decibel hearing level (SD=23.09). Pre-treatment mean THI score was 41.4 (SD=21.13), functional (F) subscore was 17.9 (SD=10.69), emotional (E) subscore was 10.6 (SD=6.87), and catastrophic (C) subscore was 12.9 (SD=4.85). Post-treatment THI total score was significantly lower compared to pre-treatment THI total score. Also, post-treatment subscores were significantly lower compared to pre-treatment subscores in F and C subsocres, but not in E subscore. In addition, multivariate logistic regression analysis showed that coffee and tea consumption was significantly positively associated with a reduction of THI total score. Triple-combination therapy could be helpful for chronic tinnitus patients. It seemed that coffee and tea consumption may elicit increased improvement in conjunction with combined therapy for chronic tinnitus.

Ossicular chain defects in adults with chronic otitis media.

Chronic otitis media (COM) is a common condition characterized by the perforation of the tympanic membrane and inflammation of the mucosal lining the hollow space in the middle ear and airy spaces of the temporal bone for at least 2-6 week. This study was carried out to find out the status of the middle ear ossicles in patients with COM and to correlate their status with clinical parameters. This retrospective clinical study was conducted on 107 COM patients (52 males and 55 females; age range: 18 to 75 years) submitted to surgery in the Otology Clinic at Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Iran. Initially, a comprehensive case-history was obtained from patients and their hearing thresholds were recorded. Then, ossicles status and their junction condition were evaluated intraoperatively. The malleus was found intact in 70 (65.42%), absent in 10 (9.34), and eroded in 27 (25.24%) patients. Our results revealed that the incus was intact in 33 (30.84%), eroded in 55 (51.41%) and absent in 19 (17.75%) subjects. Stapes was found intact in 54 (50.46%) cases and eroded in 53 (49.54%) cases. The mean Pure Tone Average (PTA) and Air-Bone Gap (ABG) comparisons in "intact" and "discontinuous" ossicular chain groups was not significant (Independent sample t-test, p>0.05). Our results demonstrated that incus was the most susceptible middle ear ossicle to erosion in COM, whereas the malleus was the most resistant ossicle. Furthermore, ABG and PTA values cannot be considered as a potential preoperative predictor for ossicular chain status.

Prevalence of Perforated Graft in Underlay and Pop-in Technique Myringoplasty

Underlay technique myringoplasty is most commonly used technique to repair tympanic membrane perforation by temporalis fascia graft and Trans-tympanic pop-in technique is an another technique that allows temporalis fascia graft placement medial to tympanic membrane remnant through the perforation without the need for tympano-meatal flap elevation. This study was undertaken to find the prevalence of perforated graft in underlay and Pop-in Technique Myringoplasty. This descriptive cross-sectional study was done at Manipal teaching hospital, Pokhara, Nepal and comprises of 86 patients between January 2014 and June 2015. Patients undergoing Underlay Trans-canal approach by tympano-meatal flap elevation and Trans-canal, Trans-tympanic pop-in technique were included. Sample size calculation was done and convenient sampling method was applied. Point estimate at 95% CI was done for binary data along with frequency and proportion. The descriptive statistical analysis was done. The prevalence of perforated graft was 15 (17.4%) at 95% Confidence Interval (39.75-60.25%). In underlay technique there were 8 (18.60 %) perforation and 35 (81.39%) were intact while in pop-in technique there were 7 (16.27%) perforation and 36 (83.72%) were intact. The postoperative mean Pure Tone Average (PTA) of underlay was 9.53 and pop-in was 8.31. The mean Pure Tone Average (PTA) gain after underlay technique was 16.095 and pop in technique was 16.87. Trans-tympanic pop-in myringoplasty gives similar hearing & graft uptake results when compared with tympano-meatal flap method of underlay myringoplasty done by trans-canal.

Sensorineural hearing loss in children with sickle cell disease

IntroductionSensorineural hearing loss (SNHL) has been reported to occur at increased frequency in the pediatric sickle cell disease (SCD) population, likely secondary to ototoxic medication regimens and repeat sickling events that lead to end organ damage. Risk and protective factors of SNHL in this population are not fully characterized. The objective of this study was to describe audiology results in children with SCD and the prevalence and sequelae of SNHL. MethodsA comprehensive clinical database of 2600 pediatric SCD patients treated at 1 institution from 2010-16 was retrospectively reviewed to identify all patients who were referred for audiologic testing. Audiologic test results, patient characteristics, and SCD treatments were reviewed. Results181 SCD children (97 male, 153 HbSS) underwent audiologic testing, with 276 total audiology encounters, ranging 1–9 per patient. Mean age at first audiogram was 8.9 ± 5.2 years. 29.8% had prior cerebrovascular infarct and an additional 25.4% had prior abnormal transcranial Doppler screens documented at time of first audiogram. Overall, 13.3% had documented hearing loss, with 6.6% SNHL. Mean pure tone average (PTA) among patients with SNHL ranged from mild to profound hearing loss (Right: 43.3 ± 28.9, Left: 40.8 ± 29.7), sloping to more severe hearing loss at higher frequencies. ConclusionsHearing loss was identified in a significant subset of children with SCD and the hearing loss ranged from normal to profound. Though the overall prevalence of SNHL in SCD patients was low, baseline audiology screening should be considered.

Blast injury to the ear: management and long term follow up at a tertiary care hospital in a terrorism affected area of North India

<p class="abstract"><strong>Background:</strong> A large proportion of blast victims suffers ear injuries; however, these injuries are often overlooked.</p><p class="abstract"><strong>Methods:</strong> We assessed 411 blast victims to detect ear injury employing detailed history, otological examination, pure tone audiometry, auditory steady state response and distortion product otoacoustic emissions. TM perforations were managed by thorough cleaning of ear by suctioning, edges approximation and gelfoam splinting in group A and only suctioning in group B. Prednisolone in tapering doses was prescribed for managing hearing loss in all except those in whom it was contraindicated. </p><p class="abstract"><strong>Results:</strong> Out of 411 blast victims, 228 (55.47%) had aural trauma. All cases were males (being serving soldiers) between ages of 21 and 57 years. (Mean 37.77 years, SD 10.38). 285 ears had a perforated TM. Of these, 145 were assigned to group A while 140 were in group B. There was no significant difference in spontaneous healing of perforation between the two groups but at 5 years’ follow up group A had significantly higher number of unscarred, healthy TMs than group B (Z score=2.2111, p=0.0271). Mean pure tone average was 51.16 dB (SD 8.79 dB) at presentation and 38.91 dB (SD 7.86 dB) at 5 years. Recovery of SNHL component was significantly better in steroid treated patients.</p><p class="abstract"><strong>Conclusions:</strong> Edges approximation and gelfoam splinting helped in reducing scarring of TM on healing, on long follow up. Steroid treated group showed better recovery of hearing loss.</p>

The effect of hearing status on speechreading performance of Chinese adolescents

ABSTRACT The effect of hearing status on the ability to speechread is poorly understood, and current findings are inconclusive regarding differences in speechreading performance between children and adults with hearing impairment and those with normal hearing. In this study, we investigated the effect of hearing status on speechreading skills in Chinese adolescents. Thirty seven severely deaf students with a mean pure-tone average of 93 dB hearing threshold level and 21 hearing controls aged 16 completed tasks measuring their speechreading of simplex finals (monophthongs), complex finals (diphthongs or vowel + nasal constellations) and initials (consonants) in Chinese. Both accuracy rate and response time data were collected. Results showed no significant difference in accuracy between groups. By contrast, deaf individuals were significantly faster at speechreading than their hearing controls. In addition, for both groups, performance on speechreading simplex finals was faster and more accurate than complex finals, which in turn was better than initial consonants. We conclude that speechreading skills in Chinese adolescents are influenced by hearing status, characteristics of sounds to be identified, as well as the measures used.

Clear speech adaptations in spontaneous speech produced by young and older adults.

The study investigated the speech adaptations by older adults (OA) with and without age-related hearing loss made to communicate effectively in challenging communicative conditions. Acoustic analyses were carried out on spontaneous speech produced during a problem-solving task (diapix) carried out by talker pairs in different listening conditions. There were 83 talkers of Southern British English. Fifty-seven talkers were OAs aged 65-84, 30 older adults with normal hearing (OANH), and 27 older adults with hearing loss (OAHL) [mean pure tone average (PTA) 0.250-4 kHz: 27.7 dB HL]. Twenty-six talkers were younger adults (YA) aged 18-26 with normal hearing. Participants were recorded while completing the diapix task with a conversational partner (YA of the same sex) when (a) both talkers heard normally (NORM), (b) the partner had a simulated hearing loss, and (c) both talkers heard babble noise. Irrespective of hearing status, there were age-related differences in some acoustic characteristics of YA and OA speech produced in NORM, most likely linked to physiological factors. In challenging conditions, while OANH talkers typically patterned with YA talkers, OAHL talkers made adaptations more consistent with an increase in vocal effort. The study suggests that even mild presbycusis in healthy OAs can affect the speech adaptations made to maintain effective communication.

Transcutaneous Osseointegrated Implants for Pediatric Patients With Aural Atresia

Patients with aural atresia typically have maximal conductive hearing loss, which can have negative academic and social consequences. Transcutaneous osseointegrated implants (TOIs) can potentially restore hearing on the affected side. To review the demographic, audiological, and surgical outcomes of TOI placement in pediatric patients with aural atresia and to describe a modification in incision technique in anticipation of later auricular reconstruction. This retrospective case series reviewed 41 cases of TOI placement in pediatric patients between January 1, 2014, and September 30, 2016, at Lurie Children's Microtia and Aural Atresia Clinic. Patients, all younger than 18 years and with atresia or microtia, received at least 6 months of follow-up and underwent testing before and after surgery. Patient age, indication for procedure, ear sidedness, case length, incision type, complications, and other postoperative events. Audiological outcomes before and after implantation were measured using pure-tone averages and the Hearing In Noise Test for Children, presented in variable signal to noise ratios. In total, 46 TOIs were performed in 38 pediatric patients, but only 41 implantations in 34 patients were included in this study. Of the 34 patients, 13 (38%) were males and 21 (62%) were females, with a mean age of 8.9 (range, 5-17) years at the time of TOI placement. Microtia on the implanted side was present in 39 cases (95%). A modified posterior-superior scalp incision technique was used in 30 (73%) of 41 ears, all in cases of microtia. One perioperative surgical complication occurred: a seroma requiring drainage. Two patients developed minor skin irritation and erythema at the magnet site related to the overnight use of the processor, which resolved when removed while sleeping. The mean (SD; range) score for the Speech In Noise test at 5 dB signal to noise ratio improved from 75.3% (14.4%; range, 50%-92%) correct in unaided/preoperative condition to 93.6% (6.95%; range, 80%-100%) correct in the aided/postoperative condition. The mean improvement in score was 18.3% (95% CI, 10.8%-25.9%), with an effect size of 1.62 (95% CI, 0.95-2.29). The mean pure-tone averages (SD; range) similarly improved from 63.7 (13.2; range, 25-11) dB to 9.6 (4.9; range, 5-15) dB. Transcutaneous osseointegrated implantation has a low complication rate among pediatric patients with atresia or microtia and can provide excellent audiological results. It should be included as a treatment option for this population of patients who meet audiological criteria.

The Role of High Dose Intratympanic Dexamethasone as Salvage Therapy for Idiopathic Sudden Sensorineural Hearing Loss.

The aim of this study was to assess the efficacy of a single high dose intratympanic (IT) dexamethasone (DEX) as salvage therapy for idiopathic sudden sensorineural hearing loss (ISSNHL) after unsuccessful treatment with oral corticosteroid (CS). This was a prospective open-label study of 59 patients treated with IT DEX after systemic CS therapy has failed. All patients received high dose (24 mg/mL) IT DEX in a single injection through myringotomy. Of the 59 patients, 40.7% showed improvement in their mean pure tone average (PTA) with IT DEX (p=0.005). The difference in the mean PTA after oral CS treatment only from baseline was not statistically significant (p=0.074). The time from onset of hearing loss to the start of therapy was significantly associated with the outcome (p=0.03). We determined that high dose IT DEX as salvage therapy was beneficial when the primary treatment with oral CS had failed. An early start of the treatment significantly influenced the improvement of hearing.

Sudden Sensorineural Hearing Loss: Comparative Study of Different Treatment Modalities.

Introduction Idiopathic sudden sensorineural hearing loss (ISSNHL) is hearing loss of at least 30 dB in at least 3 contiguous frequencies within at least 72 hours. There are many different theories to explain it, and many different modalities are used for its management, such as: systemic steroids (SSs), intratympanic steroid injection (ITSI), hyperbaric oxygen therapy (HOT), antiviral drugs, and vasodilators or vasoactive substances. Objectives This study aims to evaluate the efficacy of the combination of the most common treatment modalities of ISSNHL and to compare the results if HOT was not one of the treatment modalities administered. Methods The study was conducted with 22 ISSNHL patients with ages ranging from 34 to 58 years. The patients were divided into 2 groups; group A included 11 patients managed by SSs, ITSI, antiviral therapy, and HOT simultaneously, and group B included 11 patients exposed to the aforementioned modalities, with the exception of HOT. Results After one month, all of the patients in group A showed total improvement in hearing in all frequencies, with pure tone average (PTA) of 18.1 ± 2.2, while in group B, 5/11 (45.5%) patients showed total improvement, and 6 /11 (54.5%) patients showed partial improvement, with a total mean PTA of 28.1 ± 8.7. Conclusion The early administration of HOT in combination with other clinically approved modalities (SSs, ITSI, antiviral therapy) provides better results than the administration of the same modalities, with the exception of HOT, in the treatment of ISSNHL.

Auditory and otologic profile of Alström syndrome: Comprehensive single center data on 38 patients.

Alström syndrome (AS) is a rare autosomal recessive ciliopathy caused by mutations in the ALMS1 gene. Hallmark characteristics include childhood onset of severe retinal degeneration, sensorineural hearing loss, obesity, insulin-resistant diabetes, and cardiomyopathy. Here we comprehensively characterize the auditory and otologic manifestations in a prospective case series of 38 individuals, aged 1.7-37.9 years, with genetically confirmed AS. Hearing loss was preceded by retinal dystrophy in all cases, and had an average age of detection of 7.45 years (range 1.5-15). Audiometric assessments showed mean pure tone averages (0.5, 1, 2, 4 kHz) of 48.6 and 47.5 dB HL in the right and left ears, respectively. Hearing was within normal limits for only 8/74 ears (11%). For the 66 ears with hearing loss, the degree was mild (12%), moderate (54%), or severe (8%). Type of hearing loss was predominantly sensorineural (77%), while three ears had mixed loss, no ears had conductive loss, and type of hearing loss was indeterminate for the remaining 12 ears. Serial audiograms available for 33 patients showed hearing loss progression of approximately 10-15 dB/decade. Our data show that hearing loss associated with AS begins in childhood and is a predominantly symmetric, sensory hearing loss that may progress to a severe degree. Absent otoacoustic emissions, intact speech discrimination, and disproportionately normal auditory brainstem responses suggest an outer hair cell site of lesion. These findings indicate that individuals with AS would benefit from sound amplification and if necessary, cochlear implantation.

Psychometrically equivalent bisyllabic words for speech recognition threshold testing in Vietnamese

Objective: This study identified, digitally recorded, edited and evaluated 89 bisyllabic Vietnamese words with the goal of identifying homogeneous words that could be used to measure the speech recognition threshold (SRT) in native talkers of Vietnamese. Design: Native male and female talker productions of 89 Vietnamese bisyllabic words were recorded, edited and then presented at intensities ranging from −10 to 20 dBHL. Logistic regression was used to identify the best words for measuring the SRT. Forty-eight words were selected and digitally edited to have 50% intelligibility at a level equal to the mean pure-tone average (PTA) for normally hearing participants (5.2 dBHL). Study sample: Twenty normally hearing native Vietnamese participants listened to and repeated bisyllabic Vietnamese words at intensities ranging from −10 to 20 dBHL. Results: A total of 48 male and female talker recordings of bisyllabic words with steep psychometric functions (>9.0%/dB) were chosen for the final bisyllabic SRT list. Only words homogeneous with respect to threshold audibility with steep psychometric function slopes were chosen for the final list. Conclusions: Digital recordings of bisyllabic Vietnamese words are now available for use in measuring the SRT for patients whose native language is Vietnamese.

Mobile tablet audiometry in fluctuating autoimmune ear disease

BackgroundAutoimmune inner ear disease (AIED) is a rare condition characterized by bilateral fluctuating sensorineural hearing loss (SNHL). The labile nature of this hearing loss makes it difficult to accurately quantify with conventional methods, and therefore it is challenging to rehabilitate.MethodsOver a 9-month period one pediatric patient with severe AIED was monitored and conducted home audiograms using a previously validated testing system (Shoebox Audiometry). During this period he also underwent several clinical audiograms. The correlation between clinical and home audiograms was analyzed with a Pearson coefficient, and the range and frequency of fluctuations was recorded.ResultsSixty-four automated home audiograms and nine clinical audiograms were conducted. When tested at home using a calibrated system the pure tone average (PTA) fluctuated between 12 dB and 72 dB indicating large variability in hearing. Fluctuations were frequent: on 28 occasions the PTA varied by at least 5 dB when retested within 4 days. The mean PTA was 50 dB and 95% of the thresholds were within 36 dB of the mean. Clinical audiograms obtained on the same day or within 1 day of home testing were highly concordant (with a Pearson coefficient of 0.93).ConclusionAIED can result in significant fluctuations in hearing over short periods of time. Home testing enables a more granular look at variations over time and correlates well with clinical testing, and thus facilitates rapid action and informed rehabilitation.

Prevalence of 2.2 per mille of significant hearing loss at school age suggests rescreening after NHS

ObjectivesThe study aims to determine the prevalence of different degrees of significant hearing loss in a complete sample of Austrian school-age children born between 1997 and 2001 living in the federal state of Carinthia and to evaluate the role of Newborn Hearing Screening (NHS) in the identification of later hearing loss. MethodsIn Carinthia, all school-age children with significant hearing loss (mean pure tone average in the better ear above 40 dB) are registered by the Department of Education. From five complete birth cohorts from 1997 to 2001 (n = 28.171) all the children with sensorineural hearing loss (n = 61, mean age 10.5, age range 7.5–13.6 years) were assessed for their hearing threshold and level of cognitive functioning. Socio-demographic data, including information about NHS and amplification with hearing devices, were collected from parents and teachers using structured interviews. Results2.2 children per thousand (49.2% male) were found to be affected by significant bilateral hearing loss at school age, with 36.1% of them having a moderate hearing loss, 34.4% severe, and 29.5% profound. Fourteen children (23.0%) used cochlear implants. Their mean nonverbal IQ was 93.4 (SD 23.1), including 13.1% of children with intellectual disabilities (IQ < 70). Of those who had undergone NHS (85.2%), 50.0% had passed the screening according to parents' reports. ConclusionsA rate of significant hearing loss in school-age children was observed which was twice the rate found in newborns. Ongoing awareness of late-onset hearing loss to improve identification and hearing screening at school entry are recommended.

A nationwide study on enlargement of the vestibular aqueduct in Japan.

To document the clinical features and associated pure-tone audiometry data in patients with enlargement of the vestibular aqueduct (EVA), and to identify risk factors for fluctuating hearing loss (HL) and vertigo/dizziness in EVA patients. In this nationwide survey in Japan, a first survey sheet was mailed to 662 board-certified otolaryngology departments to identify the ones treating EVA patients. A second survey sheet, which contained solicited clinical information and the results of the hearing tests, was mailed to all facilities that reported treating EVA cases. We analyzed clinical information, including age at the time of the most recent evaluation, gender, EVA side, age at onset, initial symptoms, precipitating factors, and etiology from survey responses, and assessed 4-frequency (500, 1000, 2000, and 4000Hz) pure-tone average (PTA) from accompanying pure-tone audiometry data. A multivariate logistic regression analysis was utilized to identify the possible risk factors for fluctuating HL and vertigo/dizziness. In total, 513 hospitals (response rate, 77.5%) responded to the first survey, and 113 reported treating patients with EVA. Seventy-nine out of the 113 hospitals (response rate 69.9%) responded to the second survey, and the data of 380 EVA patients were registered and analyzed. Of the 380 patients, 221 (58.2%) were female, suggesting female preponderance. The patient age ranged from 0 to 73 years (mean, 16.7 years; median, 13 years; interquartile range, 6-24 years). EVA was bilateral in 91.1% of the patients (346/380). The most prevalent initial symptom was HL (341/380), followed by vertigo/dizziness/imbalance (34/380). Sudden HL occurred secondary to head trauma in 5.3% of the patients and upper respiratory infection in 5.0%. Pure-tone audiometry showed profound HL (PTA >91dB) in 316 (52.0%) of the 608 ears in the 304 patients tested, and asymmetric HL, defined as >10dB, in 147 (48.4%) of the 304 patients. The mean PTA was 83.7dB (median, 91.3dB; interquartile range, 71.3-103.8dB), and the severity in PTA did not correlate with age. Multivariate logistic regression identified age ≥10 years (compared to age of 0-9 years), bilateral HL (compared to unilateral HL/normal hearing), a history of head trauma, and Pendred syndrome (compared to the other EVA-associated disorders) as significant risk factors for fluctuating HL and/or vertigo/dizziness. The present nationwide survey of 380 EVA patients provided a more precise description of the clinical features, including risk factors for fluctuating HL and vertigo/dizziness.

Effect of intratympanic steroid administration on sensorineural hearing loss associated with acute otitis media.

To evaluate a small cohort of patients who presented with symptoms and signs consistent with acute infective sensorineural hearing loss who were treated with intratympanic steroids. Seven patients received a 7-day course of oral antibiotics and oral prednisolone followed by 3 intratympanic injections of methylprednisolone and 1 week of topical dexamethasone drops. Hearing improved in 57 per cent of patients (four out of seven). The mean improvement in this group was 24 dB (range, 10-52 dB). The magnitude of the sensorineural hearing loss at presentation was less in those who responded to intratympanic steroid therapy than in non-responders (mean pure tone average of 30 dB versus 65 dB pre-intratympanic steroids, and 14 dB versus 83 dB post-intratympanic steroids, respectively). The results of our study suggest that intratympanic steroids provide a valuable contribution to the treatment of acute infective sensorineural hearing loss and may provide additional benefit by virtue of a concentrated local steroid effect in patients who do not respond to antibiotics.

The Accuracy of IOS Device-based uHear as a Screening Tool for Hearing Loss: A Preliminary Study From the Middle East.

To determine and explore the potential use of uHear as a screening test for determining hearing disability by evaluating its accuracy in a clinical setting and a soundproof booth when compared to the gold standard conventional audiometry. . Seventy Sultan Qaboos University students above the age of 17 years who had normal hearing were recruited for the study. They underwent a hearing test using conventional audiometry in a soundproof room, a self-administered uHear evaluation in a side room resembling a clinic setting, and a self-administered uHear test in a soundproof booth. The mean pure tone average (PTA) of thresholds at 500, 1000, 2000 and 4000 Hz for all the three test modalities was calculated, compared, and analyzed statistically. . There were 36 male and 34 female students in the study. The PTA with conventional audiometry ranged from 1 to 21 dB across left and right ears. The PTA using uHear in the side room for the same participants was 25 dB in the right ear and 28 dB in the left ear (3-54 dB across all ears). The PTA for uHear in the soundproof booth was 18 dB and 17 dB (1-43 dB) in the right and left ears, respectively. Twenty-three percent of participants were reported to have a mild hearing impairment (PTA > 25 dB) using the soundproof uHear test, and this number was 64% for the same test in the side room. For the same group, only 3% of participants were reported to have a moderate hearing impairment (PTA > 40 dB) using the uHear test in a soundproof booth, and 13% in the side room. . uHear in any setting lacks specificity in the range of normal hearing and is highly unreliable in giving the exact hearing threshold in clinical settings. However, there is a potential for the use of uHear if it is used to rule out moderate hearing loss, even in a clinical setting, as exemplified by our study. This method needs standardization through further research.