Moderate Loss Research Articles

How Does Preoperative Pure Tone Audiometry Relate to the Findings at Surgery to Explain the Hearing Status in Chronic Otitis Media?

Pure tone audiometry (PTA) guides surgical decision-making in chronic otitis media (COM), and PTA values depend upon the type and extent of COM. Our cross-sectional study included patients with COM with/without cholesteatoma who were scheduled for surgery. Findings on examination of the middle ear under the microscope and at surgery which could explain the hearing loss were corroborated with preoperative PTA through appropriate statistical methods. The study included 114 patients (mean age: 31.07 years; range: 7-57). Following preoperative PTA, 50% of patients had moderate hearing loss and ~73% had air-bone gap (ABG) <35 dB. Conductive hearing loss affected 109 patients (97.61%); five had mixed hearing loss. At surgery, 27 patients (23.68%) had ossicular discontinuity, with the incus being the most affected. Twenty-one patients in this group had ABG ≥35 dB. Perforations involving the anterior and posterior halves of the pars tensa, and subtotal perforations, demonstrated the maximum mean hearing loss [45.39±8.29 dB HL (p=0.075), 51.08±12.51 dB HL (p=0.26), respectively]. The mean pure tone average in the intact ossicles group was 43.62±8.07 dB HL and that in the absent/eroded ossicles group was 58.15±11.05 dB HL (p<0.0001); the mean ABG was 27.89±4.77 dB and 38.88±6.47 dB, respectively (p<0.0001). Hearing loss was significantly associated with the size but not the site of the central perforation. With ossicular discontinuity, hearing loss and ABG deteriorated significantly. The findings re-establish the relationship between preoperative PTA and the middle ear status which should help surgeons plan surgery and counsel patients regarding hearing outcomes.

Atmospheric dryness thresholds of grassland productivity decline in China

Atmospheric dryness events are bound to have a broad and profound impact on the functions and structures of grassland ecosystems. Current research has confirmed that atmospheric dryness is a key moisture constraint that inhibits grassland productivity, yet the risk threshold for atmospheric dryness to initiate ecosystem productivity loss has not been explored. Based on this, we used four terrestrial ecosystem models to simulate gross primary productivity (GPP) data, analyzed the role of vapor pressure deficit (VPD) in regulating interannual variability in Chinese grasslands by focusing on the dependence structure of VPD and GPP, and then constructed a bivariate linkage function to calculate the conditional probability of ecosystem GPP loss under atmospheric dryness, and further analyzed the risk threshold of ecosystem GPP loss triggered by atmospheric dryness. The main results are as follows: we found that (1) the observed and modeled VPD of Chinese grasslands increases rapidly in both historical and future periods. VPD has a strongly negative regulation on ecosystem GPP, and atmospheric dryness is an important moisture constraint that causes deficit and even death to ecosystem GPP. (2) The probability of the enhanced atmospheric dryness that induced GPP decline in Chinese grasslands in the future period increases significantly. (3) When the VPD is higher than 40.07 and 27.65 percentile of the past and future time series, respectively, the risk threshold of slight ecosystem GPP loss can be easily initiated by atmospheric dryness. (4) When the VPD is higher than 82.57 and 65.09 percentile, respectively, the threshold of moderate ecosystem GPP loss can be exceeded by the benchmark probability. (5) The risk threshold of severe ecosystem GPP loss is not initiated by atmospheric dryness in the historical period, and the threshold of severe ecosystem GPP loss can be initiated when the future VPD is higher than 91.92 percentile. In total, a slight atmospheric dryness event is required to initiate a slight ecosystem GPP loss threshold, and a stronger atmospheric dryness event is required to initiate a severe ecosystem GPP loss. Our study enhances the understandings of past and future atmospheric dryness on grassland ecosystems, and strongly suggests that more attention be invested in improving next-generation models of vegetation dynamics processes with respect to the response of mechanisms of ecosystem to atmospheric dryness.

Aging and Speech-in-Noise Perception.

The objective was investigating the effect of age on speech-in-noise perception (SINP) using word perception score in white noise (WPS in WN). This cross-sectional study was conducted on 76 participants, including 30 elderly (older than 61years) and 46 young adults (between 14 and 35years) with normal levels of stress, night sleep and mini-mental states. Audiological evaluations included acoustic immittance testing, pure tone audiometry, determination of speech reception threshold and WPS in WN. Data analysis were performed using Mann-Whitney and Tukey HSD tests. Based on the results of the tests, the participants were divided into three groups: (1) young adults with normal hearing (n = 30), (2) elderly adults with normal hearing (n = 16), (3) elderly adults with mild to moderate high frequency hearing loss (n = 14). In both groups of old adults, the means WPS in WN differences were significant only in the left ears (Pv = 0.008, 0.033, 0.025 for SNR = 0, +5, +10dB). In the three groups and in the right ears, there were the significant differences between the means of WPS in WN (Pv = 0.002, 0.000, 0.001 for SNR = 0, +5, +10dB), and also the left ears (Pv = 0.000, 0.002, 0.002 for SNR = 0,+5, +10dB).There is a relationship between increasing age and decreasing WPS in WN. The deleterious effects of aging on SINP decline are greater than that of hearing loss.

The natural course of otitis media with effusion in infants who failed universal newborn hearing screening: a retrospective cohort study.

To analyse the natural course of infants with otitis media with effusion who failed universal newborn hearing screening and to explore the appropriate observation period. This retrospective cohort analysis included infants with otitis media with effusion who failed universal newborn hearing screening every 3 months for 12 months. The average recovery time of the 155 infants was 7.08 ± 0.32 months after diagnosis. Multivariate Cox regression analysis confirmed that frequent reflux, maxillofacial deformities and initial hearing status were independent factors affecting recovery. Moreover, the cumulative recovery of most infants with mild hearing loss and infants with moderate hearing loss accompanied by frequent reflux was significantly higher at six months after diagnosis than at three months. For most infants with mild hearing loss, as well as those with moderate hearing loss accompanied by frequent reflux, the observation period can be extended to six months after diagnosis.

The longitudinal relationship between hearing loss and cognitive decline in tonal language-speaking older adults in China.

Previous longitudinal studies indicate that hearing loss and cognitive impairment are associated in non-tonal language-speaking older adults. This study aimed to investigate whether there is a longitudinal association between hearing loss and cognitive decline in older adults who speak a tonal language. Chinese-speaking older adults aged 60 years and above were recruited for baseline and 12 month follow-up measurements. All participants completed a pure tone audiometric hearing test, Hearing Impaired-Montreal Cognitive Assessment Test (HI-MoCA), and a Computerized Neuropsychological Test Battery (CANTAB). The De Jong Gierveld Loneliness Scale was used to measure loneliness, and the 21-item Depression Anxiety Stress Scale (DASS-21) was used to measure aspects of mental health. Associations between baseline hearing loss and various cognitive, mental and psychosocial measures were evaluated using logistic regression. A total of 71 (29.6%) of the participants had normal hearing, 70 (29.2%) had mild hearing loss, and 99 (41.2%) had moderate or severe hearing loss at baseline, based on mean hearing thresholds in the better ear. After adjusting for demographic and other factors, baseline moderate/severe audiometric hearing loss was associated with an increased risk of cognitive impairment at follow-up (OR: 2.20, 95% CI: 1.06, 4.50). When pure-tone average (PTA) was modeled continuously, an average difference of 0.24 in HI-MoCA scores for every 10 dB increase in BE4FA existed, and an average difference of 0.07 in the change of HI-MoCA scores in a 12 month period. The results revealed a significant longitudinal relationship between age-related hearing loss and cognitive decline in this cohort of tonal language-speaking older adults. Steps should also be taken to incorporate hearing assessment and cognitive screening in clinical protocols for older adults 60 years and above in both hearing and memory clinics.

EBNEO commentary: Fluid balance as a critical factor in neonatal outcomes.

With this study, Starr and colleagues add to the growing body of literature recognising the importance of fluid status in neonates.1-3 Utilising the weight-change method for estimating fluid balance, which is the preferred method in neonates,4 they found that fluid balance is independently associated with the need for mechanical ventilation at post-natal day 14 and the composite outcome of severe bronchopulmonary dysplasia (BPD) or death. All neonates undergo a period of adaptation of fluid and electrolyte homeostasis after birth, with a contraction of the extracellular fluid (ECF) compartment, driven by natriuretic diuresis and transepidermal losses in preterm infants. This phase ends with maximum weight loss or negative fluid balance.5 Very low birth weight and extremely low birth weight infants can experience 10%–15% negative fluid balance, with this phase lasting up to 8 days.5, 6 Clinicians should allow for ECF contraction while maintaining intravascular fluid volume, achieving a negative sodium balance, maintaining normal serum electrolyte levels and providing sufficient calories to meet maintenance needs.5, 6 Achieving this requires close monitoring of daily intake and output, weight changes and electrolyte concentrations, while thoughtfully adjusting prescribed fluid intake. In the same patient cohort as the present study, Valentine and colleagues analysed weight loss and fluid administration.7 They found that a maximum weight loss of 5–15% within the first post-natal week was associated with decreased odds of developing necrotising enterocolitis (NEC), while an average total fluid administration of >150 mL/kg BW/day over the first post-natal week was associated with increased risk of NEC and patent ductus arteriosus (PDA) requiring surgery. They suggested cautious limitation of total fluid administration and allowing for moderate weight loss in the first post-natal week.7 A 2014 Cochrane review recommended careful restriction of fluid intake in preterm neonates to meet physiological needs without causing dehydration rather than a practice of liberal fluid intake, citing that restricted fluid intake significantly reduced the risks of PDA and NEC, with trends towards reduced risk of BPD, intra-ventricular haemorrhage and death.8 No discussion about fluid status is complete without addressing electrolytes, specifically sodium. Dysnatremias are common in critically ill patients and are associated with mortality and hospital length of stay.9 Preterm infants are at particular risk for dysnatremias given immature renal tubules, fluid shifts, insensible losses and exposure to parenteral nutrition. In an analysis of a contemporary large neonatal cohort, dysnatremias were common in the first week of life, occurring in half of the cohort.9 In adjusted models, the occurrence of hypernatremia and combined hypo- and hypernatremia in the first week of life was associated with an increased risk of mortality in neonates with normal renal function.9 Weight changes, fluid intake, electrolyte status—this is quite the fine balance. When does physiologic weight loss become pathologic? Clearly, there are many variables and outcomes to consider. Starr and colleagues provide potential targets for this complex problem. In efforts to reduce rates of BPD and other neonatal morbidities, fluid balance is emerging as a critical factor. URL LINK: https://ebneo.org/ebneo-commentary-fluid-balance-and-neonatal-outcomes/ None. None.

Incidence and risk factors of hearing loss in patients with Turner Syndrome.

Hearing loss (HL) is one of the main medical complications for Turner Syndrome (TS) patients, with an earlier presentation and higher incidence than normal women. However, the etiology of HL in TS is unclear. The aim of this study was to investigate the hearing status of TS patients in China and the influencing factors, so as to provide a theoretical basis for early intervention treatment for TS patients with HL. In total 46 female patients aged 14-32 diagnosed with TS received tympanic membrane and audiological examinations, including pure tone audiometry and tympanometry. In addition, the effects of karyotype, sex hormone levels, thyroid function, insulin, blood lipids, bone mineral density, age and other factors on hearing levels were analyzed, and the possible risk factors associated with HL in TS patients were explored. In 9 patients (19.6%) had HL, including 1 (2.2%) with mild conductive hearing loss, 5 (10.9%) with mild sensorineural hearing loss, 3 (6.5%) with moderate sensorineural hearing loss. TS is often associated with age-related mid-frequency and high-frequency HL, and the incidence of HL increases with age. Compared with other karyotypes, patients with 45, X haplotype have an increased risk of mid-frequency HL. Therefore, karyotype may be a predictor of hearing problems in TS.

The Correlation between Binaural Interaction Component of the Auditory Brainstem Response and Total Score of the Persian Version of the Spatial Hearing Questionnaire

Background and Aim: People with spatial hearing impairment have difficulty perception of speech in the presence of noise, sound localization, and estimating the distance from the sound source. In this study, the comparison between amplitude and latency of the Binaural Interaction Component of the Auditory Brainstem Response (ABR-BIC) with the total score of the Persian version of the Spatial Hearing Questionnaire (SHQ) in adults with normal hearing and moderate sensorineural hearing loss (SNHL) was evaluated. Methods: In this cross-sectional comparative study 55, 18–45-year-old individuals including 35 of normal hearing and 20 moderate SNHL participated. All participants underwent the assessments of medical history, otoscopy, conventional audiometry, tympanometry, SHQ questionnaire, and auditory brainstem response (ABR). Results: There was no significant correlation between the amplitude and latency of the ABR- BIC and the Persian version of the SHQ in normal groups (r=–0.085, r=0.116) and in moderate SNHL groups (r=0.030, r=0.119). The mean value of ABR-BIC range of people with normal hearing and SNHL is statistically significant (p=0.001). Conclusion: The results showed that the amplitude and latency of ABR-BIC were not correlated with the Persian version of the SHQ in people with normal hearing and with moderate SNHL but statistically significant between the mean amplitude and latency of ABR- BIC in people with normal hearing and people with hearing loss. Keywords: Auditory brainstem response; spatial hearing questionnaire; binaural interaction component; spatial hearing; spatial hearing disorder

Factors associated with severity and anatomical distribution of diabetic foot ulcer in Uganda: a multicenter cross-sectional study

BackgroundDiabetic foot ulcer (DFU) is a devastating complication of diabetes mellitus (DM) that is associated with increased mortality, morbidity, amputation rate and economic burden. This study aimed at identifying the anatomical distribution and factors associated with severity of DFU in Uganda.MethodologyThis was a multicenter cross-sectional study conducted in seven selected referral hospitals in Uganda. A total of 117 patients with DFU were enrolled in this study between November 2021 and January 2022. Descriptive analysis and modified Poisson regression analysis were performed at 95% confidence interval; factors with p-value < 0.2 at bivariate analysis were considered for multivariate analysis.ResultsThe right foot was affected in 47.9% (n = 56) of patients, 44.4% (n = 52) had the DFU on the plantar region of the foot and 47.9% (n = 56) had an ulcer of > 5 cm in diameter. The majority (50.4%, n = 59) of patients had one ulcer. 59.8% (n = 69) had severe DFU, 61.5% (n = 72) were female and 76.9% had uncontrolled blood sugar. The mean age in years was 57.5 (standard deviation 15.2 years). Primary (p = 0.011) and secondary (p < 0.001) school educational levels, moderate (p = 0.003) and severe visual loss (p = 0.011), 2 ulcers on one foot (p = 0.011), and eating vegetables regularly were protective against developing severe DFU (p = 0.03). Severity of DFU was 3.4 and 2.7 times more prevalent in patients with mild and moderate neuropathies (p < 0.01), respectively. Also, severity was 1.5 and 2.5 higher in patients with DFU of 5–10 cm (p = 0.047) and in those with > 10 cm diameter (p = 0.002), respectively.ConclusionMost DFU were located on the right foot and on the plantar region of the foot. The anatomical location was not associated with DFU severity. Neuropathies and ulcers of > 5 cm diameter were associated with severe DFU but primary and secondary school education level and eating vegetables were protective. Early management of the precipitating factors is important to reduce the burden of DFU.

Visual Characteristics of Adults with Long-Standing History of Dietary Exposure to Mercury in Grassy Narrows First Nation, Canada.

Since the 1960s, Grassy Narrows First Nation (Ontario, Canada) has been exposed to methyl mercury (Hg) through fish consumption, resulting from industrial pollution of their territorial waters. This cross-sectional study describes the visual characteristics of adults with documented Hg exposure between 1970 and 1997. Oculo-visual examinations of 80 community members included visual acuity, automated visual fields, optical coherence tomography [OCT], color vision and contrast sensitivity. Median age was 57 years (IQR 51-63) and 55% of participants were women. Median visual acuity was 0.1 logMAR (Snellen 6/6.4; IQR 0-0.2). A total of 26% of participants presented a Visual Field Index inferior to 62%, and qualitative losses assessment showed concentric constriction (18%), end-stage concentric loss (18%), and complex defects (24%). On OCT, retinal nerve fiber layer scans showed 74% of participants within normal/green range. For color testing with the Hardy, Rand, and Rittler test, 40% presented at least one type of color defect, and with the Lanthony D-15 test, median color confusion index was 1.59 (IQR 1.33-1.96). Contrast sensitivity showed moderate loss for 83% of participants. These findings demonstrate important loss of visual field, color vision, and contrast sensitivity in older adults in a context of long-term exposure to Hg in Grassy Narrows First Nation.

Acoustic change complex for assessing speech discrimination in normal-hearing and hearing-impaired infants

ObjectiveThis study examined (1) the utility of a clinical system to record acoustic change complex (ACC, an event-related potential recorded by electroencephalography) for assessing speech discrimination in infants, and (2) the relationship between ACC and functional performance in real life. MethodsParticipants included 115 infants (43 normal-hearing, 72 hearing-impaired), aged 3–12 months. ACCs were recorded using [szs], [uiu], and a spectral rippled noise high-pass filtered at 2 kHz as stimuli. Assessments were conducted at age 3–6 months and at 7–12 months. Functional performance was evaluated using a parent-report questionnaire, and correlations with ACC were examined. ResultsThe rates of onset and ACC responses of normal-hearing infants were not significantly different from those of aided infants with mild or moderate hearing loss but were significantly higher than those with severe loss. On average, response rates measured at 3–6 months were not significantly different from those at 7–12 months. Higher rates of ACC responses were significantly associated with better functional performance. ConclusionsACCs demonstrated auditory capacity for discrimination in infants by 3–6 months. This capacity was positively related to real-life functional performance. SignificanceACCs can be used to evaluate the effectiveness of amplification and monitor development in aided hearing-impaired infants.

Clinical characteristics and psychoacoustic analysis of acute and chronic subjective tinnitus.

This study aimed to understand the demographics, clinical characteristics, and psychoacoustic status of subjective tinnitus patients to explore the factors associated with acute and chronic tinnitus in the general hospitals of Shanghai. A cross-sectional study was conducted to investigate the clinical characteristics and psychoacoustic status of subjective tinnitus patients with history greater than 1month. Data were collected during January 2021 and January 2022 from eight general hospitals in five districts of Shanghai, China. All patients accepted questionnaires and acoustic examination, then SPSS 22.0 and GraphPad Prism 8.0.2 were applied for data analysis. Among the 359 tinnitus patients, 126 cases were diagnosed with acute tinnitus, 58 cases were subacute tinnitus, and 175 cases were chronic tinnitus. Patients with acute and chronic tinnitus differed in terms of side of tinnitus, hearing loss, frequency of tinnitus, severity of tinnitus, anxiety, depression, and sleep status. Different characteristics were included in the multivariate ordinal logistic regression analysis. Persistent tinnitus (OR=2.00, p=.008), high frequency hearing loss (OR=4.77, p < .001), depression (OR=1.23, p < .001) were found to be positively associated with the course of tinnitus. Unilateral tinnitus (OR=0.48, p=.003), mild (OR=0.29, p=.001) and moderate (OR=0.46, p=.038) hearing loss, VAS scores (OR=0.82, p=.032), anxiety (OR=0.81, p < .001), THI scores (OR=0.98, p=.002), and sleep disorders (OR=0.94, p=.025) were found to be negatively associated with the course of tinnitus. Patients with acute tinnitus were at greater risk for anxiety, sleep disturbances, and exacerbation of tinnitus perception, and those with chronic tinnitus were at greater risk for depression. Our study demonstrated that patients with acute tinnitus were at greater risk for anxiety, sleep disturbances, and exacerbation of tinnitus perception, and those with chronic tinnitus were at greater risk for depression.

Diagnostic Accuracy of Mobile Health-Based Audiometry for the Screening of Hearing Loss in Adults: A Systematic Review and Meta-Analysis.

Background: Hearing loss is one of the most prevalent chronic health conditions. Traditional pure tone audiometry (PTA) is the gold standard for hearing loss screening, but is not widely available outside specialized clinical centers. Mobile health (mHealth)-based audiometry could improve access and cost-effectiveness, but its diagnostic accuracy varies widely between studies. Therefore, we aimed to evaluate the diagnostic accuracy of mHealth-based audiometry for hearing loss screening in adults compared with traditional PTA. Methods: Ten English and Chinese databases were searched from inception until April 30, 2022. Two researchers independently selected studies, extracted data, and appraised methodological quality. The bivariate random-effects model was adopted to estimate the pooled sensitivity and specificity for each common threshold (i.e., the threshold to define mild or moderate hearing loss). The hierarchical summary receiver operating characteristic model was used to assess the area under the receiver operating characteristic curve (AUC) across all thresholds. Results: Twenty cohort studies were included. Only one study (n = 109) used the mHealth-based speech recognition test (SRT) as the index test. Nineteen studies (n = 1,656) used mHealth-based PTA as the index test, and all of them were included in the meta-analysis. For detecting mild hearing loss, the pooled sensitivity and specificity were 0.91 (95% confidence interval [CI] 0.80-0.96) and 0.90 (95% CI 0.82-0.94), respectively. For detecting moderate hearing loss, the pooled sensitivity and specificity were 0.94 (95% CI 0.87-0.98) and 0.87 (95% CI 0.79-0.93), respectively. For all PTA thresholds, the AUC was 0.96 (95% CI 0.40-1.00). Conclusions: mHealth-based audiometry provided good diagnostic accuracy for screening both mild and moderate hearing loss in adults. Given its high diagnostic accuracy, accessibility, convenience, and cost-effectiveness, it shows enormous potential for hearing loss screening, particularly in primary care sites, low-income regions, and settings with in-person visit limitations. Further work should evaluate the diagnostic accuracy of the mHealth-based SRT tests.

Analysis of audiological features in infants with unilateral hearing loss

Objective:To investigate the audiological characteristics and possible causes of unilateral hearing loss in infants and young children. Methods:105 infants from Beijing Maternal and Child Health Care Institution who failed the newborn hearing screening and were referred to the Children's Hearing Diagnosis Center of PLA General Hospital for hearing diagnosis. They were diagnosed with unilateral hearing loss and underwent clinical data collection. A full set of audiological examinations included ABR, 40 Hz auditory event related potential, ASSR, DPOAE, tympanometry. Results:①In initial diagnosis, 45 cases（42.86%） had mild hearing loss, 19 cases（18.10%） had moderate hearing loss, 14 cases（13.33%） had severe hearing loss, and 27 cases（25.71%） had severe hearing loss; Among them, 65 cases（61.90%） were conductive hearing loss or mixed hearing loss, and 40 cases（38.10%） were sensorineural hearing loss. ②83 of 105 cases had follow-up visits: 24 cases were normal, 15 cases with mild hearing loss, 4 cases with moderate hearing loss, 12 cases with severe hearing loss, and 26 cases with extremely severe hearing loss, 2 cases of hearing loss in both ears. ③From the initial diagnosis to the follow-up diagnosis, the change of mild hearing loss was the largest, followed by moderate hearing loss, severe and extremely severe hearing loss basically did not change; the number of mild and severe conductive hearing loss which recovered to normal hearing was most, the number of sensorineural hearing loss changed little. Conclusion:The infants who failed the newborn hearing screening and were diagnosed with unilateral hearing loss were mainly mild to moderate conductive hearing loss and severe to extremely severe sensorineural hearing loss. The hearing of children with hearing loss gradually improved, and severe and extremely severe sensorineural hearing loss remained unchanged.

Analysis of clinical audiological characteristics in 868 children referred from maternal and child institutions

Objective:To investigate the clinical audiological characteristics of children referred from maternal and child institutions and analyze the high risk factors of hearing loss, so as to provide scientific basis for further improvement of children's ear and hearing care. Methods:The subjects of this study were 868 children who were referred by maternal and child institutions in Beijing to the otology outpatient of Beijing Tongren Hospital, Capital Medical University for hearing diagnosis. All subjects underwent acoustic immittance, auditory brainstem response, distortion products otoacoustic emission and other audiological tests. Children were divided into groups according to the age of diagnosis: 0-<3 months group（242 cases）, 3-<6 months group（328 cases）, 6-<12 months group（180 cases）, ≥12 months group（118 cases）, the results of hearing diagnosis, hearing loss degree and types, the relationship between high risk factors and hearing loss in each group were compared and analyzed. Results:The age of diagnosis of 868 children was（7.13±8.29） months. 488 cases with hearing loss accounted for 56.22% and 380 cases with normal hearing accounted for 43.78%. Proportion of different degree of hearing loss of 792 ears from high to low was as follows: mild, 366 ears（46.21%）; moderate, 214 ears（27.02%）; severe, 151 ears（19.07%）; profound, 61 ears（7.70%）. There were statistically significant differences in the proportion of different hearing loss degree among 0-<3 months group, 3-<6 months group, 6-<12 months group and ≥12 months group（P<0.001）. Pairwise comparison between groups showed that the proportion of mild hearing loss of 0-<3 months group was higher than that in the other three groups（P<0.05）, there was no significant difference of moderate hearing loss among all groups（P>0.05）, the proportion of severe hearing loss of ≥12 months group was higher than that of 0-<3 months group（P<0.05）. The proportion of profound hearing loss with 0-<3 months group was lower than the other three groups（P<0.05）. In 792 ears with hearing loss, sensorineural hearing loss accounted for 67.42%, conductive hearing loss accounted for 20.71% and mixed hearing loss accounted for 11.87%. Among 98 cases with high risk factors for hearing loss, 58 cases（59.18%） were diagnosed with hearing loss. The incidence of hearing loss with high risk factors ranked from high to low was: craniofacial malformation（93.75%）, family history/congenital genetic syndrome（61.11%）, neonatal intensive care unit（NICU） hospitalization（46.43%） and others（20.00%）. Conclusion:Referrals from maternal and child institutions play an important role in the early detection of children with mild to moderate sensorineural hearing loss. Children with craniofacial malformation, family history/congenital genetic syndrome, hospitalization history of NICU and other high risk factors have a high incidence of hearing loss and should be attached with great importance.

Abstract P2-06-01: Improving the health of women on Aromatase Inhibitors: A pilot controlled dietary and exercise intervention trial

Abstract Background: In spite of aromatase inhibitors reducing risk of recurrence and mortality, painful side effects often cause women to discontinue use of the drug. Side effects of aromatase inhibitors include joint and muscle pain, loss of bone mineral density, and impairment of heart functioning. Discontinuation of aromatase inhibitors due to these side effects occur in up to 40% of breast cancer survivors, and consequently risks of recurrence and mortality increase. Objective: We developed two interventions designed to reduce inflammation, alleviate pain and stabilize bone mineral density. Methods: We are currently conducting a pilot parallel intervention trial that is targeted toward alleviating side effects from aromatase inhibitors through dietary and exercise controlled interventions lasting for three months. The dietary intervention is an anti-inflammatory Mediterranean diet designed to decrease inflammation and lessen joint and muscle pain. Participants randomized to the Mediterranean dietary intervention are exclusively consuming food provided by Territory Foods®, an outside food preparation and delivery service, local to Los Angeles. Our exercise intervention is designed to mobilize the joints, and strengthen and reduce bone loss. Participants are visiting the UCLA Kinross gym for three days per week and are undergoing tailored exercise sessions delivered from personal trainers following our bone strengthening intervention protocol. Anthropometric measures, muscle strength, DXA scanning of bone mineral density, peripheral arterial tonometry, pulse wave velocity and biomarkers of inflammation, bone turnover and heart functioning are conducted at baseline, mid- and end of intervention. Results: Our trial is targeted to accrue 20 participants. Thus far we enrolled six participants, with three participants completing the trial. Analysis is ongoing and preliminary results will be presented at the San Antonio Breast Cancer Symposium in December, 2022. Post intervention reports from participants have noted a reduction in pain symptoms, moderate weight loss and increase in muscle strength. Citation Format: Catherine L. Carpenter, Aashini K. Master, Olivia Julian, Dina Ben-Nissan, Michele Rakoff, Gail Thames, Zhaoping Li. Improving the health of women on Aromatase Inhibitors: A pilot controlled dietary and exercise intervention trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-06-01.

Is social appearance anxiety a reason for rejecting a hearing aid in geriatric patients?

Hearing impairment is a global health problem due to its impact on quality of life and communication problems between individuals. Hearing aids are the recommended intervention, but use of hearing aids is low. In this study, the effect of social appearance anxiety on the decision to use a hearing aid was investigated. The study comprised 107 individuals aged 65-81 years who were offered hearing aids due to bilateral severe or moderate sensorineural hearing loss. The patients were divided into three groups, according to their hearing aid preferences and usage decisions. Social appearance anxiety scale was applied to all patients. The mean age of the 107 patients included in the study was 70.19±5.35 years. The social appearance anxiety scores of those who did not want to use a hearing aid were much higher than those of whom desired to use a behind-the-ear or in-canal hearing aid. The social appearance anxiety scores of the patients who wanted to use in-canal hearing aids were also higher than the group who wanted to use behind-the-ear hearing aids. In this study, which focused on the hearing aid candidate group who had never obtained a device, rather than why they stopped using a hearing aid, it was assumed that social appearance concern was relevant in the phase of receiving a hearing aid.

Abstract PD12-01: PD12-01 Impact of obesity and post-diagnosis weight change on survival in women with breast cancer diagnosed at Smilow Cancer Hospital from 2013-2019

Abstract Background: The association between obesity and breast cancer risk is well documented, but fewer studies have explored the impact of post diagnosis weight changes on survival especially in more contemporary contexts. The existing evidence has mainly focused on weight gain, been limited by small sample sizes and has evaluated prospective cohorts with restrictive eligibility criteria rather than population-based samples. Our study uniquely contributes to the literature by using a population-based approach and recent clinically measured weight data from the electronic health record (EHR) to explore the impact of weight change following a breast cancer diagnosis on survival. Methods: EHR weight measurements were extracted for women diagnosed with stages I-IV breast cancer at CT’s Smilow Cancer Hospital and Care Network between 2013-2019 (N=6,934). During the follow-up period through April 26, 2020 (mean=3.2 years, standard deviation=1.8), there were 497 deaths. We used multivariable Cox regression models, adjusting for age at diagnosis, race/ethnicity, chemotherapy, radiation therapy, ER/PR subtype, to estimate the association between body mass index (BMI) at diagnosis and all-cause mortality from time since first post-diagnosis clinic visit (within 6 months of diagnosis). Percent weight change at 1-year post-diagnosis was categorized as a 5-level variable (weight stable – change within 5% of weight at diagnosis, moderate weight loss – 5% to &amp;lt; 10% change, large weight loss – ≥10% change, moderate weight gain – 5% to &amp;lt; 10% change, and large weight gain – ≥10% change) and evaluated in relation to all-cause mortality. A non-linear relationship between percent weight change at 1-year post-diagnosis and mortality was evaluated by comparing linear and cubic spline models. Results: Among these 6,934 breast cancer cases, the mean age was 61±13 years, BMI at diagnosis was 29±7 kg/m2 and weight change from diagnosis to 1-year post-diagnosis was -0.47±5.4 kg. Being underweight (BMI&amp;lt; 18.5) or having class II obesity (BMI&amp;gt;35) at diagnosis were statistically significantly independently associated with higher all-cause mortality compared with normal BMI (Hazard Ratio [HR]=1.43, 95% Confidence Interval [CI]=1.11-1.85 and HR=3.32, 95% CI=1.90-5.80, respectively). At 1-year post-diagnosis, 64% of women remained weight stable since diagnosis, 12% gained moderate body weight, 5% had large weight gain, 12% lost moderate weight and 7% experienced a large weight loss. Compared with the weight stable group, there was a positive, non-significant association between moderate weight gain at 1-year post-diagnosis and overall mortality (HR=1.24, 95% CI=0.84-1.81). Greater than 10% weight loss at 1-year post-diagnosis was statistically significantly associated with higher mortality (HR=2.87, 95% CI=2.13-3.87). The test for curvature suggested a non-linear relationship between percent weight change at 1-year and mortality (p&amp;lt; 0.001). Conclusion: In this contemporary, population-based study of women with breast cancer from one large academic medical center, underweight and obesity at diagnosis were associated with poorer survival. Weight loss during the first-year post-diagnosis was also strongly associated with an increased risk of mortality. To further inform weight management strategies and future interventions for breast cancer survivors, we need to better understand changes in body composition in the post-diagnosis period. Citation Format: Leah Puklin, Fangyong Li, Brenda Cartmel, Tara B. Sanft, Alexa Lisevick, Eric Winer, Maryam Lustberg, Mona Sharifi, Melinda L. Irwin, Leah Ferrucci. PD12-01 Impact of obesity and post-diagnosis weight change on survival in women with breast cancer diagnosed at Smilow Cancer Hospital from 2013-2019 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD12-01.

Achieving Effective Weight Loss for Type 2 Diabetes Mellitus Control: From Evidence to Practice

Type 2 diabetes mellitus (T2DM) poses a significant public health concern in Singapore. It is well established that T2DM is strongly associated with obesity. In Singapore, the prevalence of obesity and overweight in adults has been increasing over the last two decades. By 2050, the prevalence of obesity in the nation is predicted to reach 15.9 percent, a rise from 4.3 percent in 1990. The total prevalence of T2DM is also projected to rise to 15 percent in 2050, which was 7.3 percent in 1990, in tandem with the rise in obesity prevalence. Moderate and sustained weight loss (5-10 percent) improves glycaemic control and cardiovascular risk factors in overweight or obese patients with T2DM. Disease-modifying effects in T2DM and improvement in long-term cardiovascular outcomes and mortality are associated with larger and sustained weight losses (&gt;10 percent). In this article, we highlight the growing burden of T2DM and its complications in Singapore and the role of weight loss in T2DM control. This article aims to provide an overview of multidisciplinary/multipronged strategies (lifestyle interventions, patient-centred approach with preferential use of glucose-lowering medications of weight neutral/weight loss effect, consideration of pharmacotherapy for weight loss and metabolic surgery) to achieve effective weight loss for T2DM control.

Influence of Wearing a Face Mask on Subjective Communication Difficulties According to Hearing Level

Background and Objectives The aim of this study was to assess the effect of wearing face masks on communication according to hearing levels using a questionnaire.Subjects and Method Individuals who underwent pure-tone audiometry at the otolaryngology department were invited to participate from September to December 2021. Each participant was asked to answer a questionnaire consisting of visual analog scales and open-ended questions about the experience of interactions involving face masks and the impact wearing face masks had on communication regarding listening, speaking and emotional exchange. The items of questionnaires were analyzed according to their hearing levels.Results A total of 119 subjects completed the questionnaire. The mean age of the subjects was 57.13±17.43 and the mean hearing threshold was 39.31±22.52 dB HL. Among them, 15.1% wore hearing aids. Across subjects, from those with the normal hearing level to those with moderate hearing loss, the average scores for subjective listening and speaking difficulty during conversation were significantly higher when individuals were wearing face masks than when they were not (p&lt;0.001). There was no significant difference in scores when asked about difficulty in exchanging emotion while wearing a mask.Conclusion Wearing a face mask might have a negative impact particularly on listening and speaking aspects of communication. There was no statistically significant difference in subjective difficulty scores according to hearing levels.