Pure-tone Audiometric Thresholds Research Articles

Effect of age-related extended high frequency hearing loss on the subjective impressions of dental drill noise

Fear and anxiety among patients are sometimes evoked in dental clinics due to the sound of dental drills. This study aimed to explore the impact of age-related hearing loss in the extended high frequency (EHF) range above 8 kHz on individuals' subjective discomfort towards dental drill noise. After measuring pure-tone audiometric thresholds at both conventional and extended high frequencies, we used a psychoacoustic approach to evaluate subjective impressions of four dental drill sound stimuli, which featured varying frequency components, in 62 participants (aged 12–67 years). We found a significant decrease in hearing sensitivity within the EHF range as age increased, with notable differences in hearing thresholds at 14 kHz between teenage and older adults exceeding 65 dB. Furthermore, significant differences were observed between younger and older (above 40 years) participants in the subjective impressions of dental drill noise, emphasizing age as a critical factor in the perception of high frequency components. Consequently, age may influence the unpleasantness of dental drilling noise. Compared to older individuals, young participants may exhibit increased fear of dental procedures owing to physiological factors. These results underscore the need for age-appropriate noise control strategies in dental clinics to mitigate anxiety and improve patient comfort.

Predicting Postoperative Speech Perception and Audiometric Thresholds Using Intracochlear Electrocochleography in Cochlear Implant Recipients.

Electrocochleography (ECochG) appears to offer the most accurate prediction of post-cochlear implant hearing outcomes. This may be related to its capacity to interrogate the health of underlying cochlear tissue. The four major components of ECochG (cochlear microphonic [CM], summating potential [SP], compound action potential [CAP], and auditory nerve neurophonic [ANN]) are generated by different cochlear tissue components. Analyzing characteristics of these components can reveal the state of hair and neural cell in a cochlea. There is limited evidence on the characteristics of intracochlear (IC) ECochG recordings measured across the array postinsertion but compared with extracochlear recordings has better signal to noise ratio and spatial specificity. The present study aimed to examine the relationship between ECochG components recorded from an IC approach and postoperative speech perception or audiometric thresholds. In 113 human subjects, responses to 500 Hz tone bursts were recorded at 11 IC electrodes across a 22-electrode cochlear implant array immediately following insertion. Responses to condensation and rarefaction stimuli were then subtracted from one another to emphasize the CM and added to one another to emphasize the SP, ANN, and CAP. Maximum amplitudes and extracochlear electrode locations were recorded for each of these ECochG components. These were added stepwise to a multi-factor generalized additive model to develop a best-fit model predictive model for pure-tone audiometric thresholds (PTA) and speech perception scores (speech recognition threshold [SRT] and consonant-vowel-consonant phoneme [CVC-P]) at 3- and 12-month postoperative timepoints. This best-fit model was tested against a generalized additive model using clinical factors alone (preoperative score, age, and gender) as a null model proxy. ECochG-factor models were superior to clinical factor models in predicting postoperative PTA, CVC-P, and SRT outcomes at both timepoints. Clinical factor models explained a moderate amount of PTA variance ( r2 = 45.9% at 3-month, 31.8% at 12-month, both p < 0.001) and smaller variances of CVC-P and SRT ( r2 range = 6 to 13.7%, p = 0.008 to 0.113). Age was not a significant predictive factor. ECochG models explained more variance at the 12-month timepoint ( r2 for PTA = 52.9%, CVC-P = 39.6%, SRT = 36.4%) compared with the 3-month one timepoint ( r2 for PTA = 49.4%, CVC-P = 26.5%, SRT = 22.3%). The ECochG model was based on three factors: maximum SP deflection amplitude, and electrode position of CM and SP peaks. Adding neural (ANN and/or CAP) factors to the model did not improve variance explanation. Large negative SP deflection was associated with poorer outcomes and a large positive SP deflection with better postoperative outcomes. Mid-array peaks of SP and CM were both associated with poorer outcomes. Postinsertion IC-ECochG recordings across the array can explain a moderate amount of postoperative speech perception and audiometric thresholds. Maximum SP deflection and its location across the array appear to have a significant predictive value which may reflect the underlying state of cochlear health.

Socioeconomic and ethnic disparities associated with access to cochlear implantation for severe-to-profound hearing loss: A multicentre observational study of UK adults.

Patients with severe-to-profound hearing loss may benefit from management with cochlear implants. These patients need a referral to a cochlear implant team for further assessment and possible surgery. The referral pathway may result in varied access to hearing healthcare. This study aimed to explore referral patterns and whether there were any socioeconomic or ethnic associations with the likelihood of referral. The primary outcome was to determine factors influencing referral for implant assessment. The secondary outcome was to identify factors impacting whether healthcare professionals had discussed the option of referral. A multicentre multidisciplinary observational study was conducted in secondary care Otolaryngology and Audiology units in Great Britain. Adults fulfilling NICE (2019) audiometric criteria for implant assessment were identified over a 6-month period between 1 July and 31 December 2021. Patient- and site-specific characteristics were extracted. Multivariable binary logistic regression was employed to compare a range of factors influencing the likelihood of implant discussion and referral including patient-specific (demographics, past medical history, and degree of hearing loss) and site-specific factors (cochlear implant champion and whether the hospital performed implants). Hospitals across all 4 devolved nations of the UK were invited to participate, with data submitted from 36 urban hospitals across England, Scotland, and Wales. Nine hospitals (25%) conducted cochlear implant assessments. The majority of patients lived in England (n = 5,587, 86.2%); the rest lived in Wales (n = 419, 6.5%) and Scotland (n = 233, 3.6%). The mean patient age was 72 ± 19 years (mean ± standard deviation); 54% were male, and 75·3% of participants were white, 6·3% were Asian, 1·5% were black, 0·05% were mixed, and 4·6% were self-defined as a different ethnicity. Of 6,482 submitted patients meeting pure tone audiometric thresholds for cochlear implantation, 311 already had a cochlear implant. Of the remaining 6,171, 35.7% were informed they were eligible for an implant, but only 9.7% were referred for assessment. When adjusted for site- and patient-specific factors, stand-out findings included that adults were less likely to be referred if they lived in more deprived area decile within Indices of Multiple Deprivation (4th (odds ratio (OR): 2·19; 95% confidence interval (CI): [1·31, 3·66]; p = 0·002), 5th (2·02; [1·21, 3·38]; p = 0·05), 6th (2·32; [1·41, 3·83]; p = 0.05), and 8th (2·07; [1·25, 3·42]; p = 0·004)), lived in London (0·40; [0·29, 0·57]; p < 0·001), were male (females 1·52; [1·27, 1·81]; p < 0·001), or were older (0·97; [0·96, 0·97]; p < 0·001). They were less likely to be informed of their potential eligibility if they lived in more deprived areas (4th (1·99; [1·49, 2·66]; p < 0·001), 5th (1·75; [1·31, 2·33], p < 0·001), 6th (1·85; [1·39, 2·45]; p < 0·001), 7th (1·66; [1·25, 2·21]; p < 0·001), and 8th (1·74; [1·31, 2·31]; p < 0·001) deciles), the North of England or London (North 0·74; [0·62, 0·89]; p = 0·001; London 0·44; [0·35, 0·56]; p < 0·001), were of Asian or black ethnic backgrounds compared to white patients (Asian 0·58; [0·43, 0·79]; p < 0·001; black 0·56; [0·34, 0·92]; p = 0·021), were male (females 1·46; [1·31, 1·62]; p < 0·001), or were older (0·98; [0·98, 0·98]; p < 0·001). The study methodology was limited by its observational nature, reliance on accurate documentation of the referring service, and potential underrepresentation of certain demographic groups. The majority of adults meeting pure tone audiometric threshold criteria for cochlear implantation are currently not appropriately referred for assessment. There is scope to target underrepresented patient groups to improve referral rates. Future research should engage stakeholders to explore the reasons behind the disparities. Implementing straightforward measures, such as educational initiatives and automated pop-up tools for immediate identification, can help streamline the referral process.

Cortical Auditory Evoked Potential Indices of Impaired Sensory Gating in People With Chronic Tinnitus.

The primary aim of this study was to evaluate whether there is cortical auditory evoked potential (CAEP) evidence of impaired sensory gating in individuals with tinnitus. On the basis of the proposed mechanism of tinnitus generation, including a thalamocortical inhibitory deficit, it was hypothesized that individuals with tinnitus would lack the normal inhibitory effect on the second CAEP response in a paired-click sensory gating paradigm, resulting in larger sensory gating ratios in individuals with tinnitus relative to age-, sex-, and hearing-matched controls. Further, this study assessed the relative predictive influence of tinnitus presence versus other related individual characteristics (hearing loss, age, noise exposure history, and speech perception in noise) on sensory gating. A paired-click CAEP paradigm was used to measure sensory gating outcomes in an independent group's experimental design. Adults who perceived chronic unilateral or bilateral tinnitus were matched with control group counterparts without tinnitus by age, hearing, and sex (n = 18; 10 females, eight males in each group). Amplitude, area, and latency sensory gating ratios were determined for measured P1, N1, and P2 responses evoked by the first and second click in the paradigm and compared between groups by independent t tests. The relative influence of tinnitus (presence/absence), age (in years), noise exposure history (subjective self-report), hearing loss (pure-tone audiometric thresholds), and speech perception in noise (signal to noise ratio-50) on sensory gating was determined based on the proportional reduction in error associated with each variable using multiple regression. A significantly larger was identified in the tinnitus group relative to the control group, consistent with the hypothesis of poorer sensory gating and poorer thalamocortical inhibition in individuals with chronic tinnitus. On the basis of the proportional reduction in error, the influence of tinnitus presence better predicted compared with other related individual characteristics (age, noise exposure history, hearing loss, and speech perception in noise). Results consistent with poorer sensory gating, including a larger , were found for the tinnitus group compared with the controls. This finding supported a thalamocortical inhibitory deficit in the tinnitus group and suggests that individuals with tinnitus may have poorer sensory gating. However, the tinnitus group did differ from controls in meaningful ways including having worse pure-tone thresholds in the extended high-frequency region, lower high-frequency distortion product otoacoustic emissions, and poorer speech perception in noise. Although tinnitus best predicted sensory gating outcomes, the specific effects of tinnitus presence versus absence and other individual characteristics on sensory gating cannot be completely separated.

Estimating the United States Patient Population Size Meeting Audiologic Candidacy for Cochlear Implantation.

This study aimed to estimate the size of the United States candidacy pool meeting expanded Center for Medicare Services criteria for cochlear implantation. Retrospective cross-sectional. Tertiary care center. Preimplantation audiometric data from 486 patients seen at a single academic medical center were collected retrospectively and used to generate a predictive model of AzBio score based on audiometric pure tone thresholds. This model was then used to estimate nationally representative cochlear implantation (CI)-candidacy using pure tone averages included in the National Health and Nutrition Examination Survey. Qualitative and quantitative analyses were performed. We find that the estimated prevalence of CI candidacy in individuals 65 years of age or older is expected to more than double with a change in the CI candidacy criteria from ≤40% to ≤60% (from 1.42%, 95% confidence interval [1.33, 1.63] to 3.73% [2.71, 6.56]) on speech testing. We also found the greatest absolute increase in candidacy in the 80+ age group, increasing from 4.14% [3.72, 5.1] of the population meeting the ≤40% criteria to 12.12% [9.19, 18.35] meeting the ≤60% criteria. The United States population size meeting expanded CMS audiologic criteria for cochlear implantation is estimated to be 2.5 million adults and 2.1 million age 65 or older. Changing the CI candidacy criteria from ≤40% to ≤60% on CI testing has the greatest effect on the eligible patient population in the >65-year-old age group. The determination of utilization rates in newly eligible patients will require further study.

Longitudinal Electrocochleography as an Objective Measure of Serial Behavioral Audiometry in Electro-Acoustic Stimulation Patients.

Minimally traumatic surgical techniques and advances in cochlear implant (CI) electrode array designs have allowed acoustic hearing present in a CI candidate prior to surgery to be preserved postoperatively. As a result, these patients benefit from combined electric-acoustic stimulation (EAS) postoperatively. However, 30% to 40% of EAS CI users experience a partial loss of hearing up to 30 dB after surgery. This additional hearing loss is generally not severe enough to preclude use of acoustic amplification; however, it can still impact EAS benefits. The use of electrocochleography (ECoG) measures of peripheral hair cell and neural auditory function have shed insight into the pathophysiology of postimplant loss of residual acoustic hearing. The present study aims to assess the long-term stability of ECoG measures and to establish ECoG as an objective method of monitoring residual hearing over the course of EAS CI use. We hypothesize that repeated measures of ECoG should remain stable over time for EAS CI users with stable postoperative hearing preservation. We also hypothesize that changes in behavioral audiometry for EAS CI users with loss of residual hearing should also be reflected in changes in ECoG measures. A pool of 40 subjects implanted under hearing preservation protocol was included in the study. Subjects were seen at postoperative visits for behavioral audiometry and ECoG recordings. Test sessions occurred 0.5, 1, 3, 6, 12 months, and annually after 12 months postoperatively. Changes in pure-tone behavioral audiometric thresholds relative to baseline were used to classify subjects into two groups: one group with stable acoustic hearing and another group with loss of acoustic hearing. At each test session, ECoG amplitude growth functions for several low-frequency stimuli were obtained. The threshold, slope, and suprathreshold amplitude at a fixed stimulation level was obtained from each growth function at each time point. Longitudinal linear mixed effects models were used to study trends in ECoG thresholds, slopes, and amplitudes for subjects with stable hearing and subjects with hearing loss. Preoperative, behavioral audiometry indicated that subjects had an average low-frequency pure-tone average (125 to 500 Hz) of 40.88 ± 13.12 dB HL. Postoperatively, results showed that ECoG thresholds and amplitudes were stable in EAS CI users with preserved residual hearing. ECoG thresholds increased (worsened) while ECoG amplitudes decreased (worsened) for those with delayed hearing loss. The slope did not distinguish between EAS CI users with stable hearing and subjects with delayed loss of hearing. These results provide a new application of postoperative ECoG as an objective tool to monitor residual hearing and understand the pathophysiology of delayed hearing loss. While our measures were conducted with custom-designed in-house equipment, CI companies are also designing and implementing hardware and software adaptations to conduct ECoG recordings. Thus, postoperative ECoG recordings can potentially be integrated into clinical practice.

Effect of a CI Programming Fitting Tool with Artificial Intelligence in Experienced Cochlear Implant Patients.

Cochlear implants (CIs) are the treatment of choice for patients with severe to profound hearing loss. The hearing results, however, considerably vary across patients. This may partly be due to variability in the CI fitting. We investigated the effect of FOX, a software tool to program CIs using artificial intelligence (AI), on hearing outcomes. Forty-seven experienced CI patients who came to our tertiary CI center for their annual follow-up between 2017 and 2020 were recruited for this study. They received a new CI map created by the AI software tool. CI parameters and auditory outcomes obtained with this new map were compared with those of the initial manual map after 15 days of take-home experience. Within-patient differences were assessed. At the end of the study, the patients were offered a choice to continue using the AI map or to revert to their old manual map. Several auditory outcomes improved with the AI map, namely, pure tone audiometric threshold at 6,000 Hz (median improvement 10 dB, range = -20 to 50 dB, Z = -2.608, p = 0.008), phonemic discrimination scores (median improvement 10%, range = 0% to 30%, Z = -4.061, p = 0.001), and soft-intensity (median improvement of 10%, range = -20% to 90%, Z = -4.412, p < 0.001) to normal-intensity (median improvement of 10%, range = -30% to 60%, Z = -3.35, p < 0.001) speech audiometric scores. The AI-assisted CI mapping model as a potential assistive tool may improve audiological outcomes for experienced CI patients, including high-frequency pure tone audiometry and audiometric speech scores at low and normal presentation levels.Clinical trial registration: NCT03700268.

Postmastoidectomy Hyperacusis Syndrome: Clinical Features and Treatment.

We report a novel postmastoidectomy hyperacusis syndrome (PMHS) in patients who have had cortical mastoidectomies and experience hyperacusis to stimuli involving touch of the pinna and periauricular area. This report aims to describe the clinical characteristics of patients predisposed to this disabling complication after mastoid surgery and describes surgical treatment with mastoid cortex resurfacing with hydroxyapatite bone cement. Three patients who have undergone intact canal wall mastoidectomies for nonchronic middle ear-related pathologies all reported a similar constellation of postoperative symptoms. None of the patients had any ossicular chain or middle ear abnormalities, and none had preoperative conductive hearing loss. All patients reported disabling hyperacusis related to light touch stimuli in the periauricular area. On examination, all three patients demonstrated synchronous movement of the tympanic membrane when the postauricular area was palpated. After a period of observation, none of the patients noted any improvement to their symptoms. Resurfacing of the mastoid cortex with hydroxyapatite bone cement was performed in all patients. Presence of touch-induced hyperacusis and audiometry was assessed postoperatively. Patients were also examined for synchronous movement of the tympanic membrane with palpation of the postauricular area. All patients experienced complete resolution of touch-induced hyperacusis postoperatively. Pure-tone audiometric hearing thresholds remained unchanged after mastoid cortex resurfacing, and there was no longer tympanic membrane movement with palpation of the postauricular area. PMHS can occur in patients after cortical mastoidectomy when there is no history of ossicular chain or history of chronic middle ear disease or middle ear abnormalities. PMHS can cause significant distress to patients and remain underrecognized unless synchronous tympanic membrane movement is specifically examined for. Treatment via mastoid cortex surfacing with hydroxyapatite bone cement is safe and effective.

Clinical Efficacy of Retroauricular Injection of Methylprednisolone Sodium Succinate in the Treatment of Sudden Deafness with Type 2 Diabetes.

Background The etiology of sudden deafness is still unclear. In recent years, people's life rhythm is getting faster and faster. Fatigue, environment, diet, psychology, and other factors have increased the morbidity rate of sudden deafness and improved the quality of life of patients. And work efficiency is greatly affected. Aims A study to investigate the clinical efficacy of postauricular injection of methylprednisolone sodium succinate in the treatment of sudden deafness with type 2 diabetes. Materials and Methods Sixty patients with sudden deafness who were treated in our hospital from January 2018 to October 2020 were selected as the subjects of this prospective study and divided into 30 cases each in the comparison group and the observation group according to the random number remainder grouping method. The comparison group was treated conventionally, and the observation group was treated with postauricular injection of methylprednisolone sodium succinate on the basis of the comparison group. Patients in the two groups were observed and compared on the 3rd, 6th, and 9th days after treatment with pure-tone hearing threshold checks and regular monitoring of blood glucose, blood rheology, and other indexes. Results On the 7th, 14th, and 30th days after treatment, the pure-tone audiometric thresholds of the two groups were gradually decreased, and the changes in the pure-tone audiometric thresholds in the observation group were greater than those in the control group. After lunch on the 6th day and after lunch on the 9th day, it was lower than that in the control group, and the difference was statistically significant (P < 0.05). 30 days after treatment, the blood viscosity, fibrin, and platelet aggregation rate of the observation group were significantly lower than those of the control group. After treatment, the clinical efficacy rate of the observation group was 96%, which was significantly higher than that of the control group, 80%, and the above differences were statistically significant (P < 0.05). Conclusion Treatment with postauricular injection of methylprednisolone sodium succinate has shown better therapeutic recovery in patients with sudden deafness, improved pure-tone hearing threshold, reduced risk of blood glucose elevation, and improved clinical outcomes for patients with sudden deafness, providing some reference for the treatment of patients with sudden deafness.

Tinnitus in elderly rural population of Salem district Tamilnadu

Background: Most patients with both tinnitus and hearing loss report that the frequency of the tinnitus correlates with the severity and frequency characteristics of their hearing loss, and that the intensity of the tinnitus is usually less than 10 dB above the patient's hearing threshold at that frequency. Some patients who have central auditory processing disorders and have difficulties understanding speech in noise report experiencing tinnitus even though their pure-tone audiometric thresholds are normal. Less prevalent forms of tinnitus, such as those involving well-known musical tunes or voices without understandable speech, occur among older people with hearing loss and are believed to represent a central type of tinnitus involving reverberatory activity within neural loops at a high level of processing in the auditory cortex. Methodology: Present study is a longitudinal study conducted at ENT OPD, VMKV MEDICAL COLLEGE AND HOSPITAL, SALEM among 500 patients attending ENT OPD for complaints of tinnitus for a period of 2 years. Data entry and analysis: Data collected was entered in Microsoft excel and analyzed using SPSS version 20.0.Qualitative variables were expressed in percentage and Quantitative variables were expressed in mean and standard deviation.

Contralateral Suppression of Transient-evoked Otoacoustic Emissions in Leisure Noise Exposed Individuals.

Leisure noise may have a significant impact on hearing thresholds and young adults are often exposed to loud music during leisure activities. This behavior puts them at risk of developing noise-induced hearing loss (NIHL). A frequent initial indication of NIHL is reduced hearing acuity at 4 kHz. The objective of the current study was to assess the role of the medial olivocochlear reflex (MOCR) in leisure noise-exposed individuals with and without a 4-kHz notch. Audiological evaluation, including pure-tone and immittance audiometry, was performed for 156 college-going, young adults between May 2019 to December 2019. All participants had averaged pure-tone audiometric thresholds within normal limits, bilaterally. Annual individual exposure to personal listening devices (PLDs) was calculated using the Noise Exposure Questionnaire. The participants were then categorized into exposed (with and without audiometric 4 kHz notch) and nonexposed groups. Transient-evoked otoacoustic emission amplitude and its contralateral suppression were measured using linear and nonlinear click stimuli to study the effect of leisure noise exposure on MOCR. A significantly reduced overall contralateral suppression effect in participants exposed to PLD usage (P = 0.01) in both linear and nonlinear modes. On the contrary, significantly increased suppression was observed in linear mode for the 4 kHz frequency band in the PLD-exposed group without an audiometric notch (P = 0.009), possibly suggesting an early biomarker of NIHL. Measuring contralateral suppression of otoacoustic emissions may be an effective tool to detect early NIHL in leisure noise-exposed individuals.

Factors influencing performance on the modified rhyme test by noise-exposed service members

Two speech-in-noise experiments using stimuli from the modified rhyme test (MRT) were conducted on service members (SMs) in conjunction with their annual hearing tests. The first experiment, involving roughly 3200 SMs, compared performance in the standard diotic headphone-presented MRT test to the performance level that could be achieved if the same MRT stimuli were presented from a single wall-mounted speaker in one of two different clinical sound booths. The second experiment, involving roughly 2000 SMs, examined performance in a headphone-presented MRT paradigm where the target talker was presented monaurally and the ITD ofthe masker alternated between −800 μs and + 800 μs at a 4 Hz rate. Pure-tone audiometric thresholds, N0Sπ detection thresholds, and subjective surveys of hearing difficulty and noise exposure were collected for all participants in both studies. The results show that MRT scores and response times both vary systematically with subjective hearing difficulty, suggesting that a composite time-accuracy score might be the most effective way to evaluating performance on the MRT. The results also provide insights into the hearing difficulties frequently experienced by noise- and blast-exposed service members with normal or near-normal hearing thresholds. [The views expressed in this abstract are those of the author and do not reflect the official policy of the Department of Defense or U.S. Government.]

Safe and Sound: The Effects of Experimentally Priming the Sense of Attachment Security on Pure-Tone Audiometric Thresholds Among Young and Older Adults

Attachment security has consistently been found to correlate with relaxed exploration, openness, and mindful attention to incoming information. The present studies explored whether contextually infusing a sense of attachment security (security priming) can improve hearing in young and older adults. In Study 1, participants (29 young, 30 older) performed a standardized pure-tone audiometric-thresholds test twice. In the security-priming condition, a picture of a participant’s security-enhancing figure was presented throughout the task. In the control condition, a picture of an unknown person (matched in sex, age, and facial expression) was used as a neutral prime. Study 2 (14 young, 14 older) was almost identical, except that it was preregistered and the neutral prime was a circle. In both studies, participants performed better (had lower hearing thresholds) in the security-priming condition. The current study is the first to show that attachment security improves sensory perception, and these results have meaningful implications for theory and clinical hearing tests.

Hyperbaric Oxygen Therapy for Patients With Sudden Sensorineural Hearing Loss

Sudden sensorineural hearing loss (SSNHL) is an acute, usually unilateral deficit. Systemic and intratympanic steroids are accepted treatments. Although evidence suggests that hyperbaric oxygen therapy (HBOT) may be beneficial, it is not widely offered. To review and evaluate recent evidence of the association of HBOT with hearing outcomes in SSNHL and to determine if HBOT should be a single or part of a combination treatment regimen. Cochrane Central Register of Controlled Trials, PubMed, EMBASE, CINAHL, Web of Science, CAB, ICTRP, Google Scholar, Clinicaltrials.gov, and ISRCTN databases were searched for randomized controlled trials (RCTs) published in English from January 1, 2000, and April 30, 2020. Prospective RCTs involving only adult participants (≥18 years) with SSNHL and comparing HBOT, as a single or combination therapy, with control therapies, such as steroids and/or placebo. Only RCTs that used the American Academy of Otolaryngology-Head and Neck Surgery's diagnostic criteria for SSNHL were included. Data were extracted independently by 2 researchers. A fixed-effects model was used for analysis and performed from November 30, 2020, to May 20, 2021. The mean difference in absolute hearing gain recorded by pure-tone audiometric (PTA) thresholds averaged across 4 low (0.5, 1, 2, and 3 or 4 kHz) or 3 high (3 or 4, 6, and 8 kHz) frequencies was the primary outcome. The secondary outcomes were the odds ratio of hearing recovery defined as a hearing gain of ≥10 decibels (dB) in PTA average and treatment-related adverse effects. Of the 826 records initially identified, 358 duplicates and 451 articles were excluded based on article type, title, and abstract. The full texts of 17 articles were reviewed, of which 14 were excluded because they were either not prospective RCTs (11 articles), the participants were less than 18 years old (2 articles), or the PTA was not reported at frequencies of interest (1 article). Three prospective RCTs with a total of 88 participants who received HBOT in the intervention groups and 62 participants who received only medical therapy in the control groups were studied. The intergroup difference in mean absolute hearing gain (mean difference, 10.3 dB; 95% CI, 6.5-14.1 dB; I2 = 0%) and the odds ratio of hearing recovery (4.3; 95% CI, 1.6-11.7; I2 = 0%) favored HBOT over the control therapy. In this systematic review and meta-analysis, HBOT as part of a combination treatment was significantly associated with improved hearing outcomes in patients with SSNHL over control treatments. PROSPERO Identifier: CRD42020193191.

Acoustic component programming in children with cochlear implants using electrocochleography

Objective Objective measurements improve reliability and effectiveness of hearing assessment and cochlear implant (CI) programming in young children. In CI recipients with acoustic hearing in the implanted ear, electrocochleography (ECochG) can be conducted using intracochlear electrodes. The cochlear microphonic (CM) portion of ECochG has been shown to correlate with pure-tone audiometric thresholds in adult and paediatric CI recipients. Our goal was to determine if ECochG thresholds can be used to appropriately fit the acoustic component to the implanted ear in children. Design Prospective. Study sample Eight children (aged 3.5–15.5 years, 10 ears) implanted with Advanced Bionics HiFocus Mid-Scala electrode array were recruited. CI ear acoustic thresholds were measured behaviourally and via ECochG. Two acoustic component enabled CI programs were created using the two sets of thresholds. Age and language appropriate speech outcomes and subjective feedback were obtained. Results Speech scores were equivalent with the behavioural and ECochG thresholds programs. Subjectively, the ECochG thresholds program was preferred by 7/8 subjects. One subject preferred to use an electric only program. Conclusion Our data suggest that ECochG thresholds can be used to supplement the behavioural clinical methods and aid the reliable fitting of the acoustic component in paediatric CI recipients.

Surgical and audiological results of bone-anchored hearing aids: comparison of two surgical techniques

IntroductionThe bone-anchored hearing system has become the most viable treatment option for subjects with conductive or mixed hearing loss, who are unable to benefit from conventional hearing aids or middle ear surgery. ObjectiveTo compare the surgical and audiological outcomes between the minimally-invasive Ponto surgery and a linear incision with soft tissue preservation techniques in bone-anchored hearing system recipients. MethodsA retrospective study was carried out from January 2017 to June 2018. Forty-two adult patients eligible for unilateral bone-anchored hearing system surgery with the Ponto system were included in the study. The implant and abutment lengths used varied from 3 to 4mm and from 6 to 14mm, according to the bone and skin thickness of the participants, respectively. ResultsTwenty-two surgeries were performed using the minimally invasive Ponto surgery technique (52.4%) and 20 (47.6%) using the linear incision. The mean age of the subjects implanted with minimally invasive Ponto surgery and linear incision techniques were 42.0 and 33.3 years old, respectively. Ten male (45,5%) and 14 (70%) female patients were implanted using minimally invasive Ponto surgery and the linear incision techniques, respectively. There were no differences between pure tone audiometric thresholds and monosyllabic word recognition scores of the subjects, when comparing both surgical techniques. The minimally invasive Ponto surgery technique significantly reduced the surgical time compared to the linear incision technique. There were no differences between both surgical techniques for skin-related complications; (Holgers 3 and 4) which occurred in 18.8% for MIPS and in 25% for linear incision. Subjects included in the minimally invasive Ponto surgery technique group showed a superior cosmetic outcome, with no surgical scar or additional sutures. ConclusionThe surgical and audiological outcomes were satisfactory and were not correlated to the surgical technique selected in all subjects. When compared to the linear incision, the minimally invasive Ponto surgery technique showed reduced surgical time and superior esthetic outcomes in the postoperative follow-up.

Association Between Nonoptimal Blood Pressure and Cochlear Function.

The association between hearing loss and risk factors for cardiovascular disease, including high blood pressure (BP), has been evaluated in numerous studies. However, data from population- and laboratory-based studies remain inconclusive. Furthermore, most prior work has focused on the effects of BP level on behavioral hearing sensitivity. In this study, we investigated cochlear integrity using distortion product otoacoustic emissions (DPOAEs) in persons with subtle elevation in BP levels (nonoptimal BP) hypothesizing that nonoptimal BP would be associated with poorer cochlear function. Sixty individuals [55% male, mean age = 31.82 (SD = 11.17) years] took part in the study. The authors measured pure-tone audiometric thresholds from 0.25 to 16 kHz and computed four pure-tone averages (PTAs) for the following frequency combinations (in kHz): PTA0.25, 0.5, 0.75, PTA1, 1.5, 2, 3, PTA4, 6, 8, and PTA10, 12.5, 16. DPOAEs at the frequency 2f1-f2 were recorded for L1/L2 = 65/55 dB SPL using an f2/f1 ratio of 1.22. BP was measured, and subjects were categorized as having either optimal BP (systolic/diastolic <120 and <80 mm Hg) or nonoptimal BP (systolic ≥120 or diastolic ≥80 mm Hg or use of antihypertensives). Between-group differences in behavioral thresholds and DPOAE levels were evaluated using 95% confidence intervals. Pearson product-moment correlations were run to assess the relationships between: (1) thresholds (all four PTAs) and BP level and (2) DPOAE [at low (f2 ≤ 2 kHz), mid (f2 > 2 kHz and ≤10 kHz), and high (f2 > 10 kHz) frequency bins] and BP level. Linear mixed-effects models were constructed to account for the effects of BP status, stimulus frequency, age and sex on thresholds, and DPOAE amplitudes. Significant positive correlations between diastolic BP and all four PTAs and systolic BP and PTA0.25, 0.5, 0.75 and PTA4, 6, 8 were observed. There was not a significant effect of BP status on hearing thresholds from 0.5 to 16 kHz after adjustment for age, sex, and frequency. Correlations between diastolic and systolic BP and DPOAE levels were statistically significant at the high frequencies and for the relationship between diastolic BP and DPOAE level at the mid frequencies. Averaged across frequency, the nonoptimal BP group had DPOAE levels 1.50 dB lower (poorer) than the optimal BP group and differences were statistically significant (p = 0.03). Initial findings suggest significant correlations between diastolic BP and behavioral thresholds and diastolic BP and mid-frequency DPOAE levels. However, adjusted models indicate other factors are more important drivers of impaired auditory function. Contrary to our hypothesis, we found that subtle BP elevation was not associated with poorer hearing sensitivity or cochlear dysfunction. We consider explanations for the null results. Greater elevation in BP (i.e., hypertension itself) may be associated with more pronounced effects on cochlear function, warranting further investigation. This study suggests that OAEs may be a viable tool to characterize the relationship between cardiometabolic risk factors (and in particular, stage 2 hypertension) and hearing health.

Sensorineural Hearing Loss Diminishes Use of Temporal Envelope Cues: Evidence From Roving-Level Tone-in-Noise Detection.

The objective of our study is to understand how listeners with and without sensorineural hearing loss (SNHL) use energy and temporal envelope cues to detect tones in noise. Previous studies of low-frequency tone-in-noise detection have shown that when energy cues are made less reliable using a roving-level paradigm, thresholds of listeners with normal hearing (NH) are only slightly increased. This result is consistent with studies demonstrating the importance of temporal envelope cues for masked detection. In contrast, roving-level detection thresholds are more elevated in listeners with SNHL at the test frequency, suggesting stronger weighting of energy cues. The present study extended these tests to a wide range of frequencies and stimulus levels. The authors hypothesized that individual listeners with SNHL use energy and temporal envelope cues differently for masked detection at different frequencies and levels, depending on the degree of hearing loss. Twelve listeners with mild to moderate SNHL and 12 NH listeners participated. Tone-in-noise detection thresholds at 0.5, 1, 2, and 4 kHz in 1/3 octave bands of simultaneously gated Gaussian noise were obtained using a novel, two-part tracking paradigm. A track refers to the sequence of trials in an adaptive test procedure; the signal to noise ratio was the tracked variable. Each part of the track consisted of a two-alternative, two-interval, forced-choice procedure. The initial portion of the track estimated detection threshold using a fixed masker level. When the track continued, stimulus levels were randomly varied over a 20-dB rove range (±10 dB with respect to mean masker level), and a second threshold was estimated. Rove effect (RE) was defined as the difference between thresholds for the fixed- and roving-level tests. The size of the RE indicated how strongly a listener weighted energy-based cues for masked detection. Participants were tested at one to three masker levels per frequency, depending on audibility. Across all stimulus frequencies and levels, NH listeners had small REs (≈1 dB), whereas listeners with SNHL typically had larger REs. Some listeners with SNHL had larger REs at higher frequencies, where pure-tone audiometric thresholds were typically elevated. RE did not vary significantly with masker level for either group. Increased RE for the SNHL group was consistent with simulations in which energy cues were more heavily weighted than envelope cues. Tone-in-noise detection thresholds in NH listeners were typically elevated only slightly by the roving-level paradigm at any frequency or level tested, consistent with the primary use of level-independent cues, such as temporal envelope cues that are conveyed by fluctuations in neural responses. In comparison, thresholds of listeners with SNHL were more affected by the roving-level paradigm, suggesting stronger weighting of energy cues. For listeners with SNHL, the largest RE was observed at 4000 Hz, for which pure-tone audiometric thresholds were most elevated. Specifically, RE size at 4000 Hz was significantly correlated with higher pure-tone audiometric thresholds at the same frequency, after controlling for the effect of age. Future studies will explore strategies for restoring or enhancing neural fluctuation cues that may lead to improved hearing in noise for listeners with SNHL.

Subjective Hearing Difficulty and Fall Risk.

Purpose Hearing loss is a risk factor for falls. The purpose of this study was to investigate the relation between subjective hearing difficulty and risk of falls. Method Community-dwelling older adults, aged 60 years and older, completed a case history; three questionnaires, including the Hearing Handicap Inventory for the Elderly (HHIE), Dizziness Handicap Inventory (DHI), Activities-Specific Balance Confidence Scale (ABC); and one functional balance measure, the Timed Up and Go (TUG) test. Pearson and Spearman correlations were calculated, and average scores were plotted according to group and HHIE score category for DHI, ABC, TUG, the number of medications, and the number of recent falls. Results Seventy-four participants were included in this analysis: 28 nonaudiology patients, 18 audiology patients with hearing aids, and 28 audiology patients without hearing aids. Significant positive correlations were noted between HHIE and DHI scores for audiology patients without hearing aids and between HHIE score and number of recent falls for audiology patients with hearing aids. When average scores were plotted for DHI, ABC, TUG, the number of medications, and the number of recent falls according to group and category, there were clear trends toward increased fall risk as HHIE score categories increased (i.e., mild to moderate to severe) based on previously used criteria. Conclusions Overall, a trend was noticed such that, for increasing HHIE score categories, fall risk increased. Significant correlations existed between HHIE score and some of the measures used to indicate fall risk (i.e., DHI score, number of recent falls). Future fall risk research should investigate subjective hearing difficulty as a risk factor, as well as pure-tone audiometric thresholds.

Effect of Vitiligo on Auditory Functions: Is There Any Association?

Introduction Vitiligo is an acquired pigmentary disorder of unknown etiology, clinically characterized by whitish macules caused by selective loss of melanocytes. There are many melanocytes in the human cochlea. Recent studies have suggested a direct relation between cochlear dysfunction and decreased amounts of melanin. Objective To determine the effect of vitiligo on auditory function. Methods The present prospective, case control study was performed over a period of 1 year in patients between 15 and 40 years old with nonsegmental disease and the same number of controls. Pure tone audiometry (PTA) and Otoacoustic emission (OAE) were performed to analyze the correlation between vitiligo and auditory function. Results The mean pure tone audiometric threshold in the right ear at 0.5, 8 kHz, and in the left ear at the frequency of 8 kHz in the case group were significantly higher as compared with controls. The average band reproducibility (%) in the right and left ear of controls was significantly higher at the frequency of 4 kHz as compared with cases. It has been observed that signal to noise ratio was statistically higher at the frequency of 5kHz in the right ear and at 2, 3, and 5kHz in the left ear in controls as compared with cases. On the basis of disease type and duration of disease; mean pure tone audiometric threshold, average band reproducibility and signal to noise ratio, no significant effect was observed in the present study. Conclusion Vitiligo has an effect on cochlear function irrespective of the duration or distribution of the disease.