Pure Tone Audiometry Thresholds Research Articles

Validity of correction factors applied to auditory steady-state responses(ASSRs) in normal hearing adults in chartr EP system.

Even though many patients undergoing auditory steady-state response (ASSR) testing have some degree of hearing loss, some have normal hearing and ASSR often overestimates the behavioral thresholds in this group. In most commercial ASSR systems such as Chartr EP, a default correction factor is applied to compensate for this difference. Little is known, however, as how the correction factor compensates for the difference between ASSR and pure tone audiometry (PTA) thresholds as a function of carrier or modulation frequency (MF) in a commercial ASSR system. Our goal is to evaluate this relationship. Twenty-four normal hearing adults were examined for both PTA and ASSR (Chartr EP system, GN Otometrics). ASSR thresholds were obtained at three MFs (20, 40, and 80Hz). The difference scores were obtained by subtracting PTA from ASSR thresholds at each frequency for each subject. The corrected ASSR thresholds, then, were compared with the PTA thresholds across MFs and carrier frequencies. The default correction factors in the ASSR equipment differed significantly from the difference scores at all MFs and carrier frequencies (n = 24, p < 0.005). The correlation between corrected ASSR and PTA thresholds at most MFs and carrier frequencies were medium to poor. At most MFs and carrier frequencies, the default correction factors defined by the manufacturer do not compensate for the difference between ASSR and PTA thresholds in normal hearing adults. The use of the default correction factors in Chartr EP system for the normal hearing adults needs special considerations.

Central auditory processing in teenagers with non-cholesteatomatous chronic otitis media

IntroductionEvidences of possible effects of early age otitis media with effusion in the central auditory processing, emphasize the need to consider such effects also in subjects with chronic otitis media. AimTo investigate and analyze the impact of non-cholesteatomatous chronic otitis media on central auditory processing in teenagers. MethodsThis is a study in which 68 teenagers were recruited, 34 with a diagnosis of non-cholesteatomatous chronic otitis media (study group) and 34 without otological disease history (control group). The evaluation of the subjects consisted of: anamnesis, pure-tone threshold audiometry, speech audiometry and a behavioral test battery for assessment of central auditory processing. ResultsA statistically significant difference was found between the means observed in the study and control groups in all tests performed. An association was found between the control group and subgroups of the study group with unilateral alterations in all tests. An association was shown between the results for the control group and study group for family income, with a greater impact on subjects with a lower income. ConclusionsNon-cholesteatomatous chronic otitis media affects the central auditory processing in teenagers suffering from the disorder, and monaural low-redundancy hearing is the most affected auditory mechanism. Unilateral conductive changes cause more damage than bilateral ones, and lower family income seems to lead to more changes to the central auditory processing of subjects with non-cholesteatomatous chronic otitis media.

Quantitative analysis of cochlear signal intensity on three-dimensional and contrast-enhanced fluid-attenuated inversion recovery images in patients with Meniere's disease: Correlation with the pure tone audiometry test

The purpose of this study was to correlate the quantitative analysis of cochlear signal intensity (SI) on 3-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and contrast-enhanced (CE) 3D-FLAIR images with results of the pure tone audiometry (PTA) test in patients with Meniere's disease (MD). Over a 3-year period, 123 patients with MD underwent 3-Tesla (3 T) temporal magnetic resonance imaging (MRI), including 3D-FLAIR and CE-FLAIR sequences. The SI of membranous labyrinth of the cochlea in both ears of each patient was measured by drawing a region of interest (ROI) with a seed growing technique. The correlation between measured cochlear SIs on 3D-FLAIR and CE-FLAIR images, contrast enhancement index (CEI), and contrast enhancement ratio (CER) and clinical findings and pre- and post-treatment PTA results were assessed. Cochlear signal ratios of symptomatic ears on 3D-FLAIR and CE-FLAIR images were significantly higher than those of asymptomatic ears (P < 0.001). The area under the curve, from the receiver operating characteristic curve of cochlear SIs on 3D-FLAIR and CE-FLAIR images for discrimination between symptomatic and asymptomatic ears, was 0.729 and 0.728, respectively. Cochlear SIs on 3D-FLAIR and CE-FLAIR images were significantly correlated with patients' sex (P < 0.05 and P < 0.01, respectively), symptomatic ear (both P < 0.0001), and pre-treatment PTA (P < 0.0001 and P < 0.005, respectively), but were not significantly correlated with patients' age, post-treatment PTA or hearing threshold level at 0.5, 1.0, 2.0, or 4.0 kHz. Quantitative analysis of cochlear SI on 3D-FLAIR and CE-FLAIR images may be a helpful diagnostic adjunct for MD, but may be of little value in predicting the prognosis of MD.

Application of intraoperative ABR during middle ear surgery to predict improvement in hearing

Abstract Objective The present study was aimed to develop an intraoperative hearing monitoring method for surgeons to evaluate hearing improvement in the operating room under general anesthesia. Method Pure tone audiometry (PTA) and chirp auditory brainstem response (ABR) were evaluated for ears with normal hearing and conductive hearing loss before, immediately after, and 4 weeks after surgery. Result Our result showed that for ears with normal hearing or conductive hearing loss, preoperative chirp ABR threshold measured in the operating room under general anesthesia was highly linear correlated to 1000 Hz pure tone threshold and PTA threshold measured in the sound-proof chamber. Most interestingly, postoperative chirp ABR measured in the operating room under general anesthesia was also highly correlated with PTA threshold 1 month after surgery, which indicated that intraoperative chirp ABR can predict hearing improvement immediately after surgery. Conclusion Our findings demonstrate an effective intraoperative intervention to assess hearing improvement under general anesthesia in real time which might help avoid revision surgery.

Pure Tone Audiometry Threshold Changes for 10 Years in the Same Individuals of General Population: A Retrospective Cohort Study.

The objectives of this study were to measure the changes in hearing thresholds in the same individuals during a period of 10 years and suggest a clinical reference for the threshold changes by aging. In this retrospective cohort study, we used regular health checkup data including 2 pure tone audiometry results with a 10-year interval in the same individuals from 1288 subjects. The subjects' data including demographics, smoking habits, and the diagnosis of chronic diseases were used. Age, male gender, smoking, and osteoporosis were identified as factors affecting age-related hearing loss (ARHL). The sole effect of aging on ARHL for 10 years according to age groups and genders was as follows: a loss of 1.4 dB in 20s, 4.0 dB in 30s, 5.0 dB in 40s, 8.2 dB in 50s, and 11.2 dB in 60s of males compared to a loss of 2.3 dB in 20s, 2.9 dB in 30s, 5.1 dB in 40s, 6.5 dB in 50s, and 9.4 dB in 60s of females. We could demonstrate the actual effect of aging on ARHL, and it can be used as a clinical reference. Hearing ability decreases more in males than females but seems to decrease exponentially with age in both males and females.

Comparison of thresholds estimation in adults with conductive hearing loss and normal hearing adults using auditory steady state response evoked by narrow band CE-chirps

Background: Narrowband CE Chirps (NB CE-chirps) were used to provide the characteristics of compensation for the cochlear traveling wave delay and frequency specificity.Aim: The aim was to compare the objective frequency-specific hearing thresholds estimation by the use of NB CE-chirps ASSR and behavioural thresholds in normal hearing subjects and patients with the conductive hearing loss.Subjects and methods: The cases group comprised 35 ears of 25 patients with the conductive hearing loss with varying degree from mild to severe in severity and their age ranging from 15 to 60 years. They were compared with 20 ears of 10 adult control subjects with normal hearing thresholds, whose age ranged from 19 to 42 years. All cases and controls were subjected to pure-tone audiometry (PTA), tympanometry and auditory steady-state response (ASSR), using 4 NB CE-chirp for air conduction (AC) and bone conduction (BC) threshold estimation.Results: AC-ASSR estimated thresholds were statistically significantly higher than AC PTA thresholds at 500, 1000, 2000 and 4000 Hz in both the cases and the control groups. BC ASSR estimated thresholds were statistically significantly lower than BC PTA thresholds only at 500 Hz in the cases and statistically significantly higher than BC PTA thresholds only at 2000 Hz in the controls. There was a statistically significant positive correlation between AC-ASSR and AC PTA, and between ABG-ASSR and ABG PTA in the cases group.Conclusions: Auditory steady-state responses with NB CE-chirps is suitable tool for objective frequency-specific hearing threshold detection, that can be used for estimation of behavioural bone conduction thresholds in adults with conductive hearing loss, with more accuracy in the mid frequencies, and can estimate behavioural air conduction thresholds and air-bone gap more accurately in the higher frequencies 2000, 4000 Hz more than at 500 and 1000 Hz.

Presbycusis: Comparison between the Auditory Brainstem Response (ABR) and the Pure Tone Audiometry (PTA) in Presbycusis Patient

Background: Presbycusis is a complex phenomenon resulting from an elevation hearing levels as well as changes in auditory processing. Chronic diseases such as diabetes (D), arterial hypertension (H) may act as an accelerating factor in agerelated degeneration of the auditory system. The most used diagnostic test is PTA, ABR is recorded when the pure tone audiometry cannot be access. Objective: to compare the relation between ABR and PTA threshold in presbycusis patients and evaluate the influence of diabetes and/or hypertension on the relationship between ABR and PTA threshold. Material and methods: This is a prospective hospital-based study on the comparison between ABR and PTA of presbycusis patients (≥ 50 years old) composed of 35 females and 21 males. The participants were divided into groups, set as follows group 1 composed of 21 patients, group 2 comprising 12 patients, group 3 made of 14 patients and group 4 composed of 9 patients. Results: The comparison between the mean threshold difference of ABR and PTA in group I and II was significant at each frequency with the mean difference in decibel was 20 dB at 0.5 and 1 kHz in group 2,while in group 2 a mean difference 20 dB at 0.5, 1, and 2 kHz. However, group IV showed no significant difference between ABR and PTA thresholds, the mean threshold difference was>20 dB at each frequency. Conclusion: it was found that there is a positive relationship between ABR and PTA, threshold, which appear to be insignificant in presbycusis patients with both hypertension and diabetes; this may be probably related to synergic effects of the two chronic illnesses on the cochlea.

FreeHear: A New Sound-Field Speech-in-Babble Hearing Assessment Tool.

Pure-tone threshold audiometry is currently the standard test of hearing. However, in everyday life, we are more concerned with listening to speech of moderate loudness and, specifically, listening to a particular talker against a background of other talkers. FreeHear delivers strings of three spoken digits (0–9, not 7) against a background babble via three loudspeakers placed in front and to either side of a listener. FreeHear is designed as a rapid, quantitative initial assessment of hearing using an adaptive algorithm. It is designed especially for children and for testing listeners who are using hearing devices. In this first report on FreeHear, we present developmental considerations and protocols and results of testing 100 children (4–13 years old) and 23 adults (18–30 years old). Two of the six 4 year olds and 91% of all older children completed full testing. Speech reception threshold (SRT) for digits and noise colocated at 0° or separated by 90° both improved linearly across 4 to 12 years old by 6 to 7 dB, with a further 2 dB improvement for the adults. These data suggested full maturation at approximately 15 years old SRTs at 90° digits/noise separation were better by approximately 6 dB than SRTs colocated at 0°. This spatial release from masking did not change significantly across age. Test–retest reliability was similar for children and adults (standard deviation of 2.05–2.91 dB SRT), with a mean practice improvement of 0.04–0.98 dB. FreeHear shows promise as a clinical test for both children and adults. Further trials in people with hearing impairment are ongoing.

The effect of diabetes on 4-year changes of hearing thresholds in male workers exposed to noise in a single company: a longitudinal study.

BackgroundRecently, several studies have assessed the association between diabetes and hearing impairment. However, the effect of diabetes on hearing impairment is not well known in diabetic patients exposed to noise, a typical cause of hearing impairment. The aim of this study is to longitudinally analyze the effect of diabetes on hearing impairment in workers exposed to similar noise levels from 2013 to 2017 who had experienced little change in their working conditions.MethodsThe study subjects included 2,087 male workers exposed to noise in a single company and who underwent health examinations at the same hospital in Ulsan city in 2013 and 2017. Hearing impairment was defined that a pure-tone average of pure-tone audiometry (PTA) thresholds at 1,000, 2,000, 3,000, and 4,000 Hz was 25 dB and over in both ears. Statistical analyses were conducted using χ2 tests, ANOVA, and Cox proportional hazard models. We analyzed covariates that might affect hearing impairment, including age; working period; levels of total cholesterol, triglyceride, and serum creatinine; smoking and alcohol history; and noise level.ResultsThe average PTA thresholds and their average changes between 2013 and 2017 were significant in the diabetes mellitus (DM) group than those in the normal and impaired fasting glucose group. Among the subjects with the same status of fasting glucose group in 2013 and 2017, the adjusted hazard ratios for incident hearing impairment among those in the DM group compared to normal group were 3.35 (95% confidence interval [CI], 1.54–7.29) in the left ear and 5.66 (95% CI, 2.01–15.98) in the right ear.ConclusionsThis study suggested that the risk of hearing impairment in the DM group was significantly higher than that in the normal group in both ears, even when exposed to similar noise levels.

The evaluation of the sense of hearing in patients with carotid artery stenosis within the extracranial segments

Stenosis of arteries that supplies blood to the brain is one of the main causes of ischemic stroke which is the third most common cause of deaths in Europe. Atherosclerosis of carotid and vertebral arteries is responsible for 20% of the ischemic stroke cases. Stenosis may be either asymptomatic or manifested with typical neurological symptoms including motor and sensory disturbances as well as disturbances in vision and speech. However, discrete non-specific symptoms of ischemia, including headaches and vertigo, tinnitus and hearing loss, are also quite common. These symptoms may be indicative of a clinically significant stenosis of carotid and vertebral arteries, particularly within the internal carotid artery region, as well as of a risk of ischemic stroke. To date, research reports were unable to provide exact explanation of correlations between impaired hearing and the stenosis of carotid and vertebral arteries. Despite this, numerous articles list these symptoms as one of the first non-specific symptoms of this disorder. The ischemic mechanism within the inner ear region may lead to early symptoms of atherosclerosis of large vessels. However, no evidence of relationship and no explanation could be provided with this regard. The objective of the study was to assess the effect of carotid and vertebral artery stenosis on the function of the hearing and equilibrium organ on the basis of diagnostic audiological examinations including pure-tone threshold audiometry, impedance audiometry, otoacoustic emission tests and brainstem auditory evoked potential tests. The study was conducted in 63 patients (32 males, 31 females) aged 45–75 years, presenting with carotid and vertebral artery stenosis and treated at the Vascular Surgery Clinic of the University Clinical Hospital in Wrocław. Patients were stratified into two subgroups according to their age (45–60 years, 61–75 years). Patients were also divided into subgroups according to the stenotic arteries and to the symptomatic/asymptomatic status of the disorder. All patients were homogeneous in terms of the degree of artery stenosis. The control group consisted of 32 healthy persons (14 males, 18 females) aged 48–75 years. Patients qualified to the control group reported no history of middle or inner ear disorders, disturbed hearing, vertigo and balance disorders, as well as cardiovascular diseases; they also presented with unremarkable ultrasound scans of the arteries. All patients were subjected to precise audiological examinations. Prior to being qualified for the study, patients were subjected to the assessment of arteries by means of Doppler ultrasonography. The hearing organ function was assessed by means of pure-tone threshold audiometry, impedance audiometry, otoacoustic emission tests and brainstem auditory evoked potential tests. Reduction of the flow through the carotid arteries causes problems in the organ of hearing; abnormalities are reported especially in tone threshold audiometry, examinations of the stapedius muscle reflexes and brainstem auditory evoked potentials, which prove the presence of receptive cochlear–extracochlear hearing damage. Disturbances of the organ of hearing have similar severity in stenosis of the internal carotid artery and vertebral artery. Abnormalities found in audiologic examinations in patients with carotid artery stenosis are not always explicitly clinically expressed in patients with hearing loss; we should consider diagnostics for carotid artery stenosis.

Is COPD associated with alterations in hearing? A systematic review and meta-analysis.

Background and aimsCOPD is an irreversible or persistent airflow obstruction, which affects up to 600 million people globally. The primary purpose of this systematic review was to explore the COPD-based alteration in the auditory system function by conducting a quantitative analysis of presently published data.Materials and methodsWe systematically searched seven diverse electronic databases and manual searching of references to identify relevant studies. Data from the selected studies were rated by two investigators independently in a blinded fashion. Meta-analysis was done on pooled data using Cochrane’s Review Manager 5.3.ResultsSixteen articles received suitable scores and were thus included for further processes. Hearing loss (HL) was defined as a change in pure tone audiometry (PTA) thresholds, auditory brainstem response (ABR), and auditory P300 parameters. ABR wave was significantly elongated in patients with COPD than in controls (standardized mean difference [SMD]=0.27, 95% CI: 0.05–0.48, P=0.02). PTA was significantly higher in patients with COPD when compared with controls (SMD=1.76, 95% CI: 0.43–3.08, P=0.0004). We found that patients with COPD had a significantly higher latency than controls (SMD=1.30, 95% CI: 0.79–1.80, P=0.0001).ConclusionCOPD patients had considerably greater incidence of HL when compared with controls. Interestingly, although the mean PTA thresholds at every frequency for COPD patients were higher than those for controls, these values were still in the slight to mild HL ranges. Prolonged ABR wave latencies in the COPD patients suggest retro-cochlear involvement. Thus, COPD most frequently clusters with HL, but it is worth noting that alteration in hearing is not always recognized by medical experts as a frequent comorbidity associated with COPD.

Assessment of auditory function and lipid levels in patients receiving oral isotretinoin (13-cis retinoid) therapy for acne vulgaris.

IntroductionIsotretinoin (13-cis retinoid) is a synthetic retinoid. It was approved by the FDA in 1982 for use of oral isotretinoin in severe acne. It is also used in moderate-severe acne that does not respond to conventional treatments. Isotretinoin is the only available drug that affects all stages of acne pathogenesis.AimTo prospectively investigate whether there is an effect of isotretinoin therapy on auditory function and, if so, to demonstrate its association with simultaneous blood lipid levels.Material and methodsThirty patients (60 ears) with acne vulgaris, who received 0.5 mg/kg of isotretinoin therapy, were included in the study. Distortion product otoacoustic emissions (DPOAEs) and pure tone audiometry tests were performed to evaluate auditory function at the beginning of the procedure and the 6th month of treatment. In addition, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total cholesterol, triglyceride, high-density lipoproteins (HDL) and low-density lipoproteins (LDL) cholesterol levels were recorded.ResultsThere was no statistically significant difference between pre-treatment and post-treatment mean pure tone audiometry threshold and DPOAE values; however, the increase in total blood cholesterol, triglyceride and LDL levels and the decrease in HDL levels were statistically significant.ConclusionsAccording to our study findings, isotretinoin did not cause worsening of the bilateral hearing threshold, but increased blood lipid levels. There is no need for follow-up auditory functions in routine practice during therapy, but blood lipid levels should be monitored.

Endoscopic Transcanal Autologous Cartilage Ossiculoplasty.

This was a randomized clinical trial, of thirty-two patients undergoing endoscopic ossiculoplasty, as a second look surgery, at 6months after primary endoscopic cholesteatoma surgery, in a duration of 9years. All patients underwent trans-canal endoscopic ossiculoplasty under local anesthesia. Prosthesis used were (1) Titanium partial ossicular replacement prosthesis (PORP) in fourteen, (2) Titanium total ossicular replacement prosthesis (TORP) in six and (3) Autologous cartilage in twelve cases. Puretone audiometry (PTA) were done preoperatively and postoperatively at 2months and 3years. Out of twenty-four cases, which presented only with stapes superstructure; fourteen underwent PORP ossiculoplasty and twelve had cartilage short columella ossiculoplasty (SCC). Out of eight cases, which had only mobile stapes footplate, six underwent TORP ossiculoplasty and only two underwent long columella cartilage ossiculoplasty (LCC). Pre-operative average air conduction threshold (AC) of pure tone audiometry were 45.47dB (PORP), 66.10dB (TORP), 49.15dB (SCC) and 59.15dB (LCC) groups. The post-operative AC at 2months were respectively 27.37dB (PORP), 45.83dB (TORP), 29.99dB (SCC) and 39.15dB (LCC) groups. The gap of air and bone conduction (ABG) at 2months post-operative stage were 19.05dB (PORP), 20dB (TORP), 20.32dB (SCC) and 39.15dB (LCC) groups and not much changed after 3years. Extrusion occurred in three PORPs and four TORPs at 4-8years after surgery. Four cases were lost to follow up. No extrusion occurred in cartilage ossiculoplasty. Trans-canal endoscopic autologous cartilage ossiculoplasty shows encouraging results comparable to titanium prosthesis in repairing ossicles in cholesteatoma disease.

Anatomical and functional long-term results of endoscopic butterfly inlay myringoplasty.

The aim of this study was to evaluate the long-term anatomical (graft success) and functional (audiological) results of endoscopic butterfly inlay myringoplasty. The files of 56 patients (29 female, 27 male) who were diagnosed with noncomplicated chronic otitis media and underwent endoscopic butterfly inlay myringoplasty in 2014-2016at a tertiary referral center were reviewed. Age, gender, follow-up time, perforation location (anterior, posterior and central), perforation size (small, medium), pre- and postoperative pure tone audiometry (PTA) thresholds, pre- and postoperative air-bone gaps (ABG) and complications were noted. Graft success rate was 98.2% in postoperative 12th month and 94.6% in postoperative 24th month. In all patients, mean PTA for air conduction was 35.2 ± 3.9 dB preoperatively and 27.5 ± 4.3 dB in postoperative 6th month, 25.1 ± 3.5 dB in postoperative 12th month and 20.4 ± 3.2 in postoperative 24th month. Preoperative mean ABG was 24.2 ± 3.8 dB, whereas 19.5 ± 4.3 dB 6 months after surgery, 17.1 ± 3.5 dB 12 months after surgery and 12.4 ± 3.1 dB 24 months after surgery. There was significant difference between pre- and postoperative PTA and ABG in all 6th, 12th, 24th month follow-up (p = 0.001 for all measurements). Three patients (5%) had myringitis after surgery. Two patients (3%) had total graft resorption. We suggested that endoscopic butterfly inlay myringoplasty is a safe surgical method with high graft success and effective hearing reconstruction. Follow-up is necessary for at least 2years for precise anatomical and functional evaluation of the surgery.

Evaluation the Effect of Low Level Laser on Sensori-neural Hearing Loss

Low Level Laser Therapy (LLLT) is one of biotechnology its useful as produced treatment for diseases that were previously difficult to treat. Some studies claim that an improvement in hearing threshold and tinnitus symptoms by Low Level Laser therapy and others set no significant effect of laser treatment. The aim of this project was to evaluation effect of low level laser (LLLT) treatment on senserinurail hearing loss. The study including 16 patients divided into two groups each group consists of 8patients (first group consist of 14 ear and second group consist of 16 ears), and each group has λ=650nm+532nm and 2.78mW/cm2. The result of this project found statistically significant differences in each group ( before and after laser application) as well as a significant change in the threshold of pure tone audiometry for patients having hearing degree (40-75)dB in each group.

Hearing threshold estimation by auditory steady state responses (ASSR) in children.

SUMMARYHearing threshold identification in very young children is always problematic and challenging. Electrophysiological testing such as auditory brainstem responses (ABR) is still considered the most reliable technique for defining the hearing threshold. However, over recent years there has been increasing evidence to support the role of auditory steady-state response (ASSR). Retrospective study. Forty-two children, age range 3-189 months, were evaluated for a total of 83 ears. All patients were affected by sensorineural hearing loss (thresholds ≥ 40 dB HL according to a click-ABR assessment). All patients underwent ABRs, ASSR and pure tone audiometry (PTA), with the latter performed according to the child’s mental and physical development. Subjects were divided into two groups: A and B. The latter performed all hearing investigations at the same time as they were older than subjects in group A, and it was then possible to achieve electrophysiological and PTA tests in close temporal sequence. There was no significant difference between the threshold levels identified at the frequencies tested (0.25, 0.5, 1, 2 and 4 kHz), by PTA, ABR and ASSR between the two groups (Mann Whitney U test, p < 0.05). Moreover, for group A, there was no significant difference between the ASSR and ABR thresholds when the children were very young and the PTA thresholds subsequently identified at a later stage. Our results show that ASSR can be considered an effective procedure and a reliable test, particularly when predicting hearing threshold in very young children at lower frequencies (including 0.5 kHz).

Is Chronic Obstructive Pulmonary Disease Associated with Alterations in Hearing? A Systematic Review and Meta-Analysis

Background and Aims: Chronic obstructive pulmonary disease (COPD) affects up to 600 million people worldwide and it is currently one of the leading causes of morbidity and mortality in patients suffering from chronic diseases. The primary purpose of this study was to conduct a systematic review in order to explore the effects of COPD on the auditory system function by performing a quantitative analysis of currently available published data on this subject. Methods: We systematically searched seven diverse electronic databases and manual searching of references to identify relevant studies. Data from the selected studies were rated by two investigators independently in a blinded fashion. Meta-analysis was done on pooled data using Cochrane's Review Manager 5. Results: Sixteen articles received suitable scores and were thus included for further processes. Hearing loss (HL) was defined by all studies as change in pure tone audiometry (PTA) thresholds, auditory brainstem response (ABR) and auditory P300 parameters. ABR waves was significantly elongated in patients with COPD than in controls (SMD = 0.27; 95%CI: 0.05-0.48; P = 0.02). PTA was significantly higher in patients with COPD when compared with control cases (SMD = 1.76; 95%CI: 0.43-3.08; P=0.0004). We found that patients with COPD had a significantly higher latency than controls (SMD = 1.30; 95%CI: 0.79-1.80; P=0<0001). Conclusions: COPD patients had considerably greater incidence for HL when compared with controls. Interesting, although the mean PTA thresholds at every frequency for COPD patients was higher than those for controls, these values were still in the slight to mild hearing loss ranges. Prolonged ABR wave latencies in the COPD patients suggest retro-cochlear involvement. Thus COPD most frequently clusters with HL, which is worth noting that alteration in hearing is not always recognized by medical experts as frequent comorbidity associated with COPD. Funding: None Conflict of interest: None

Factors influencing degree of hearing loss at presentation, hearing aid choice, and usage in first time hearing aid users in Singapore

Objective: To examine the factors associated with late presentation at first hearing aid (HA) fitting, HA choice and usage among users in Singapore.Design: Retrospective cross-sectional study.Study sample: 1068 subjects issued with HAs at a tertiary hospital from 2001 to 2013.Results: Half of the subjects presented with more severe (>55 dB) hearing loss (HL) in their better ear. In multivariable analysis, older age, Malay ethnicity, conductive and mixed HL, and combination type of HL were associated with more severe HL at first presentation. Over 70% of subjects were older than 65 years. Worse pure tone audiometry (PTA) thresholds of the better ear, gradual onset and sensorineural HL were associated with older age presentation. For unilaterally fitted subjects, PTA thresholds were the only determinant of having the better ear aided. Better PTA thresholds, younger age and sensorineural HL were associated with choosing in ear compared to behind the ear HAs. Younger age and worse PTA of the better ear were associated with ≥4 h of daily HA usage.Conclusions: Age, ethnicity and type of HL were important determinants for more severe HL at first HA fitting. Older patients and those with better hearing were less likely to use their HAs regularly.

Comparison of VEMPs, VHIT and caloric test outcomes after vestibular neurectomy in Menière’s disease

ObjectiveSelective unilateral vestibular neurectomy (VN) is considered a reliable surgical treatment in case of recurrent vertigo in Menière’s disease (MD) because of hearing preservation and a minimally invasive posterior fossa retrosigmoid approach. The present study aimed to assess the quality of life and the long-term vestibular function in patients submitted to yearly follow-up after VN because of intractable MD. MethodsRetrospective series of 15 MD patients undergoing retrosigmoid VN for recurrent vertigo. Outcome measures included cVEMPs and oVEMPs (cervical and ocular vestibular evoked myogenic potentials), VHIT (Video Head Impulse Test) and caloric test, besides to DHI (Dizziness Handicap Inventory) and PTA (Pure Tone Audiometry). ResultsMean DHI score resulted within normal values in 74% of patients, significantly correlated to the duration of the follow-up. In the operated side, cVEMPs and oVEMPs have not been elicited respectively in 11 patients (73%) and 13 patients (87%), whereas it was not possible to evoke any response at bithermal caloric test in 4 cases. The gain of VOR from VHIT resulted always below normal values after VN except in one patient, who has also undergone an episode of posterior BBPV. The difference between average PTA threshold before and after VN resulted not significant. ConclusionThe vestibular outcomes prove VN to be an effective and safe surgery in MD; furthermore, the unexpected occurrence of BPPV after VN can justify the presence of neural anastomosis between the inferior vestibular nerve and the cochlear nerve, allowing to still perceive vestibular symptomatology despite of a proper neurectomy.

Idiopathic sudden sensorineural hearing loss in dialysis patients

Although sudden sensorineural hearing loss (SSNHL) affects chronic kidney disease (CKD) patients more frequently than non-CKD patients, few reports have described SSNHL in dialysis patients. We aimed to review the characteristics of SSNHL in chronic dialysis patients and evaluate treatment responses to steroid therapy. We retrospectively reviewed the records of dialysis patients diagnosed with idiopathic SSNHL at Asan Medical Center between January 2000 and December 2014. Pure tone and speech audiometry analyzes were performed before and 2 weeks and 2 months after treatment onset to evaluate outcomes. Twenty-two patients (11 men, 11 women; mean age: 49.9 ± 11.7 years) were included; 16 (72%) and 6 (28%) had undergone hemodialysis and peritoneal dialysis, respectively, for a median of 49.2 ± 41.4 (1–144) months. End-stage renal disease was most frequently caused by diabetic nephropathy (11 cases), chronic glomerulonephritis (1 case) and unknown factors (7 cases). Common accompanying symptoms included tinnitus (68.2%), ear fullness (45.5%) and vertigo (27.3%). The mean pure tone audiometry threshold at the initial presentation was 82.6 ± 22.4 dB. At 2 months post-steroid treatment, 4 (18.2%), 4 (18.2%) and 6 (27.3%) patients exhibited a complete, partial, or slight recovery, respectively; 8 patients (36.3%) showed no improvement. Although we could not identify the specific cause of SSNHL in this population, our relatively large case series elucidates the precise clinical features of SSNHL in this population and demonstrates the outcomes of steroid treatment.