Severe Degree Of Hearing Loss Research Articles

Speech-in-Noise Assessment in the Routine Audiologic Test Battery: Relationship to Perceived Auditory Disability.

Self-assessment of perceived communication difficulty has been used in clinical and research practices for decades. Such questionnaires routinely assess the perceived ability of an individual to understand speech, particularly in background noise. Despite the emphasis on perceived performance in noise, speech recognition in routine audiologic practice is measured by word recognition in quiet (WRQ). Moreover, surprisingly little data exist that compare speech understanding in noise (SIN) abilities to perceived communication difficulty. Here, we address these issues by examining audiometric thresholds, WRQ scores, QuickSIN signal to noise ratio (SNR) loss, and perceived auditory disability as measured by the five questions on the Speech Spatial Questionnaire-12 (SSQ12) devoted to speech understanding (SSQ12-Speech5). We examined data from 1633 patients who underwent audiometric assessment at the Stanford Ear Institute. All individuals completed the SSQ12 questionnaire, pure-tone audiometry, and speech assessment consisting of ear-specific WRQ, and ear-specific QuickSIN. Only individuals with hearing threshold asymmetries ≤10 dB HL in their high-frequency pure-tone average (HFPTA) were included. Our primary objectives were to (1) examine the relationship between audiometric variables and the SSQ12-Speech5 scores, (2) determine the amount of variance in the SSQ12-Speech5 scores which could be predicted from audiometric variables, and (3) predict which patients were likely to report greater perceived auditory disability according to the SSQ12-Speech5. Performance on the SSQ12-Speech5 indicated greater perceived auditory disability with more severe degrees of hearing loss and greater QuickSIN SNR loss. Degree of hearing loss and QuickSIN SNR loss were found to account for modest but significant variance in SSQ12-Speech5 scores after accounting for age. In contrast, WRQ scores did not significantly contribute to the predictive power of the model. Degree of hearing loss and QuickSIN SNR loss were also found to have moderate diagnostic accuracy for determining which patients were likely to report SSQ12-Speech5 scores indicating greater perceived auditory disability. Taken together, these data indicate that audiometric factors including degree of hearing loss (i.e., HFPTA) and QuickSIN SNR loss are predictive of SSQ12-Speech5 scores, though notable variance remains unaccounted for after considering these factors. HFPTA and QuickSIN SNR loss-but not WRQ scores-accounted for a significant amount of variance in SSQ12-Speech5 scores and were largely effective at predicting which patients are likely to report greater perceived auditory disability on the SSQ12-Speech5. This provides further evidence for the notion that speech-in-noise measures have greater clinical utility than WRQ in most instances as they relate more closely to measures of perceived auditory disability.

Analysis of audiological outcomes of children referred from a universal newborn hearing screening program over 9 years in Beijing, China

Universal newborn hearing screening (UNHS) and audiological diagnosis are crucial for children with congenital hearing loss (HL). The objective of this study was to analyze hearing screening techniques, audiological outcomes and risk factors among children referred from a UNHS program in Beijing. A retrospective analysis was performed in children who were referred to our hospital after failing UNHS during a 9-year period. A series of audiological diagnostic tests were administered to each case, to confirm and determine the type and degree of HL. Risk factors for HL were collected. Of 1839 cases, 53.0% were referred after only transient evoked otoacoustic emission (TEOAE) testing, 46.1% were screened by a combination of TEOAE and automatic auditory brainstem response (AABR) testing, and 1.0% were referred after only AABR testing. HL was confirmed in 55.7% of cases. Ears with screening results that led to referral experienced a more severe degree of HL than those with results that passed. Risk factors for HL were identified in 113 (6.1%) cases. The main risk factors included craniofacial anomalies (2.7%), length of stay in the neonatal intensive care unit longer than 5 days (2.4%) and birth weight less than 1500 g (0.8%). The statistical data showed that age (P < 0.001) and risk factors, including craniofacial anomalies (P < 0.001) and low birth weight (P = 0.048), were associated with the presence of HL. This study suggested that hearing screening plays an important role in the early detection of HL and that children with risk factors should be closely monitored.

Pre-Operative Predictors of Ossicular Status in Chronic Supportive Otitis Media

Introduction: Chronic suppurative otitis media is associated with ossicular necrosis. Both safe and unsafe CSOM have incidence of ossicular necrosis. This study will provide the much-needed insight, into the factors which can act as significant predictors for the intra operative ossicular status, and help in better preparing the patient before the surgery and need for ossiculoplasty. Furthermore, narrowing down to the most significant ly related predictors, it may also be»possib1eto reduce the financial burden on the patient, something which is of prime importance in a resource limited country like ours. Objectives: pre-operative predictors of intra operative ossicular status in chronic suppurative otitis media and effect of duration of disease on hearing threshold and ossicular-status. Material and methods: A descriptive observational study was done in a Tertiary care referral center. A total number of 124 patients with the clinical diagnosis of CSOM were selected from outpatient department and admitted. All patients were subjected to otoendoscopy, X-raymastt), 1d (Schiller’s view) and pure tone audiometry. All patients underwent tympanomastoidectomy. Preoperative findings on the basis of history, examination and investigations were noted along with findings of intraoperative ossicular status. Findings were tabulated and statistical test were applied to determine significant preoperative predictors of iv intraoperative ossicular status. Results: Intraoperative ossicular necrosis was seen in a total number of 43 patients. On; univariate analysis, blood-stained discharge (P&lt;0.0001), purulent consistency of ear discharge (0&lt;0.0()01), associated symptoms of vertigo (p=0.0047), otalgia (p=0.0019), size(p=0.0042) and f site(p=0.004l), severity of hearing loss (p=0.004), sclerotic mastoid air cell (p=0.0001) had significant association with ossicular necrosis. The duration of disease and hearing threshold did not have statistically significant association (p=0.227). Conclusion: Ossicular necrosis is best indicated by the presence blood-stained and purulent discharge, vertigo, otalgia, total perforation, severe degree of hearing loss and sclerosed mastoid. Incus was the most common necrosed ossicle followed by malleus followed by stapes, Duration of disease did not have a significant connotation with hearing threshold.

The Relationship between Prenatal Risk Factors and The Incident of Sensorineural Deafness in Children at Polyclinic ENT- Head and Neck Zainoel Abidin Hospital Banda Aceh *,

Background: Sensorineural deafness is one of congenital disorders that caused by prenatal, natal, and postnatal factors. Sensorineural deafness is a public health problem in the world due to its high prevalence and highly negative impact on child development. Objective: To determine the relation between prenatal risk factors (family history of hearing loss, ototoxic drugs consumption, history of infection, history of Diabetes Mellitus, history of gestational hypertension) with sensorineural hearing loss in children at ENT- Head and Neck Polyclinic Dr. Zainoel Abidin Hospital. Methods: This study was analytic retrospective with cross sectional design. The sampling technique used was simple random sampling. The total samples are 47 children at the ENT-Head and Neck Polyclinic of RSUDZA who has been examined with OAE, BERA and ASSR from January 2020 to December 2021 and diagnosed with sensorineural hearing loss. Data were analyzed using SPSS which bivariate analysis using Chi- square and Fisher’s exact. Results: 47 children who had been diagnosed with sensorineural hearing loss included in the inclusion criteria. The mean age of children in this study was 3.44 years with male predominance of 55.3%. The most severe degree of hearing loss was found with the percentage of weight (93.6%) in right ear and (89.4%) in left ear. A history of maternal infection during pregnancy was the most common risk factor found in this study with profound hearing loss in both ears with p value = 0.05. Conclusion: No relation between prenatal risk factors and sensorineural hearing loss in children.

Consistency of two versions of hearing handicap inventory for elderly (HHIE and HHIE-S) with degree of hearing loss (HL)

Objective Using self-assessment methods to assess hearing handicap in the elderly can play an important role in understanding their disease status and taking action to improve it. Thus, the present study was performed to determine the consistency of two versions hearing handicap inventory for elderly, namely HHIE and HHIE-S, with the degree of hearing loss(HL). Methods This is a cross-sectional study conducted on 110 elderly aged 60 years and above who referred to hearing clinics in province Khuzestan, Iran in 2019. In order to collect data, HHIE (including 25 questions) and HHIE-S (including 10 questions) were used. Data analysis was done using SPSS ver. 24. Independent sample t-test was used to compare HHIE and HHIE-S scores in terms of the degree of HL. Results The prevalence of mild, moderate and severe degrees of HL was 21.82%, 48.18% and 30.0%, respectively. The majority of the patients suffered from sensorineural hearing loss (77.28%). Comparison of HHIE/HHIE-S total score among patients with different degrees of HL showed statistically significant differences, and patients with a higher degree of hearing loss reported higher hearing handicaps. HHIE and HHIE-S total scores showed a positive large significant correlation (r = 0.815, p < 0.001).Our findings revealed a significant large positive association of the PTA with the total score of HHIE (r = 0.69, p < 0.001) and HHIE-S (r = 0.76, p < 0.001). Conclusions The large correlation between HHIE and HHIE-S measures observed in the current data supports that these two scales can be used interchangeably. These patient reported outcome inventories are congruent with hearing loss level, so they can be used as proper criteria for referring patients to audiologists in health system.

AUDIOLOGICAL EVALUATION IN HYPERTENSIVE PATIENTS

Every fifth person is affected by impaired hearing. Hearing loss, regardless of commitment, has an impact on people's quality of life, and even when acquired later in life, it develops gradually and impairs spoken communication, affecting sociability, employment, and earning potential. Instead of receiving social sympathy, the person is ridiculed. Among vascular diseases, arterial hypertension is the most common, causing pathological structural changes in the heart and blood vessels. By affecting the vascular system, high blood pressure can produce inner ear bleeding and alter perfusion, resulting in progressive or sudden hearing loss. The present research project is undertaken to serve as a basis for greater awareness of prevention and restoration of hearing loss occurring in association with systemic infirmities like silently progressing arterial hypertension. The purpose of this study is to evaluate the hearing functions of patients of both sexes with hypertension and compare it with normal individuals. To assess the possibility of reversibility of hearing loss with control of hypertension. A prospective comparative study including all patients with hypertension in one group and normal subjects in another who fulfilled the inclusion criteria in Nepalgunj Medical College during the time period of 1st December 2014 to 30th January 2016 was carried out. All the individuals were subjected to a thorough E.N.T. examination. The audiological evaluation was done with Special tests of audiometry. Blood pressure level was estimated at the primary visit and 3 subsequent visits. mild to severe degree of hearing loss was found in 16 subjects (32%) as compared to control cases (statistically significant). There was sensorineural hearing loss in 28 ears (13 Rt. Ears and 15 Lt. Ears) amongst hypertensives (statistically significant). Overall, moderately severe and severe hearing losses were more often associated with stage 1 hypertension than stage 2 as is observed for both ears which are statistically significant. The mean threshold of the hearing was 28.84±16.84 and 24.16±11.31 amongst stage 1 and stage 2 hypertensives respectively. There was no statistically significant alteration of the hearing status of the hypertensives on subsequent follow-up, baring 3 cases that showed some recovery on the last follow-up. Hypertension as compared to control cases has a statistically significant influence on the hearing status of subjects above 31 years of age. Present data show that they have only marginally raised threshold for speech frequencies and it is at 4 kHz and 8 kHz that they are most often affected with hypertension. Keywords: Hearing loss, Hypertension, Pure Tone Audiometry, Sensorineural Hearing Loss.

Factors associated withspontaneous nystagmus changes in acute Ménière's disease.

Neuro-otological factors that influence changes in spontaneous nystagmus (SN) during vertigo attacks in Ménière's disease (MD) remain unclear. To identify neuro-otological factors that might influence the initial direction of SN and the directional change of SN. A prospective, observational study of 22 patients with definite MD to evaluate the initial direction and directional change of SN during vertigo attacks, endolymphatic hydrops (EH) volume, and the function of horizontal semicircular canal and hearing levels. SN consistently began as irritative in 17 of 22 cases, and 9 of 17 cases showed a definite change in direction after onset. SN consistently began as paralytic in 5 of 22 cases, and 3 of 5 cases showed a definite change in direction after onset. Subjects in the irritative initial SN group had less severe degrees of hearing loss, smaller cochlear and vestibular EH volume than the paralytic initial SN group (P = 0.017, < 0.001, and 0.009, respectively). Subjects in the SN direction change group had significantly smaller maximum slow phase velocity, percentage of caloric weakness and canal paresis than the no SN direction change group (P = 0.001, 0.006, and 0.001, respectively). Simple logistic regression analysis showed that smaller EH volume was significantly associated with initial irritative SN (OR = 0.867, 95% CI 0.762-0.988, P = 0.032) and that the degree of canal paresis was negatively associated with the presence of directional change of SN (OR = 0.022, 95% CI 0.002-0.289, P = 0.004). The morphology of EH and canal paresis may independently affect the characteristics of SN in patients with MD.

Association Between Expanded Genomic Sequencing Combined With Hearing Screening and Detection of Hearing Loss Among Newborns in a Neonatal Intensive Care Unit

Hearing loss is a global social burden. Early identification of hearing loss missed by newborn hearing screening tests in the neonatal intensive care unit is crucial. To assess the association between expanded genomic sequencing combined with hearing screening and detection of hearing loss as well as improvement in the neonatal intensive care unit. This cohort study was performed between August 8, 2016, and December 31, 2020, among 8078 newborns admitted to the neonatal intensive care unit of the Children's Hospital of Fudan University in Shanghai, China. Follow-up for hearing status was performed via telephone interviews between September 1 and November 30, 2021. A hearing screening test and the expanded genomic sequencing targeting 2742 genes were administered to each patient. Those who failed the hearing screening test or had positive genetic findings were referred for diagnostic audiometry at a median of 3 months of age. The primary outcome was hearing loss missed by hearing screening test. Secondary outcomes were genetic findings and benefits associated with the expanded genomic sequencing for clinical management of patients in the neonatal intensive care unit. Of 8078 patients (4666 boys [57.8%]; median age, 6.3 days [IQR, 3.0-12.0 days]), 52 of 240 (21.7%) received a diagnosis of hearing loss. Expanded genomic sequencing combined with hearing screening was associated with a 15.6% increase (7 of 45 patients) in cases of diagnosed hearing loss that were missed by hearing screening. Of the 52 patients with hearing loss, genetic factors were identified for 39 patients (75.0%); GJB2 and SLC26A4 were the most common genes identified. Patients with genetic findings experienced a more severe degree of hearing loss than those without genetic findings (21 profound, 4 severe, 7 moderate, and 7 mild vs 2 severe, 4 moderate, and 7 mild; P = .005), with more bilateral hearing loss (39 of 39 [100%] vs 9 of 13 [69.2%]; P = .003). Clinical management strategies were changed for patients who underwent genomic sequencing combined with hearing screening. This study suggests that expanded genomic sequencing combined with hearing screening may be effective at detecting hearing loss among patients in the neonatal intensive care unit.

Correlation between duration of noise exposure and severity of hearing loss

Background and Objective: Noise pollution is one of the commonest occupational and environmental health hazard. The extent of damage to hair cells is determined by the intensity of noise to which a person is exposed, and the duration of noise exposure [1]. Prolonged exposure to high intensity noise >85dB(A) or more, for eight hours can lead to permanent hearing loss. This exposure can be reduced significantly by using simple ear protection devices. NIHL can be easily prevented through the use of simple and economical tools, but are not used by people due to different reasons.3Our study aimed at determining the relation between the duration of exposure to loud noise on the severity of noise-induced hearing loss. The subjects of our study were train drivers working in an extremely noisy environment for long hours, without using any ear protection tool. Materials and Method: This study involved 60 subjects, who were all train drivers. They were working in an extremely noisy environment for more than eight hours a day for more than ten years. The responses to brainstem evoked response audiometry were recorded and evaluated for severity of hearing loss. Result: 60% subjects reported positive for sensorineural deafness. 18.3% of the subjects were having mild degree of hearing loss, 23.3% were having moderate degree of hearing loss and 18.3% were having severe degree of hearing loss. Conclusion: It was found that the duration of exposure to noise has a positive correlation with the degree of severity of hearing loss (p

Early Hearing Detection and Intervention for Children with Craniofacial Anomalies

Early Hearing Detection and Intervention for Children with Craniofacial Anomalies

Predictors of hearing technology use in children

Objective To identify and describe predictors of daily hearing technology (HT) use in children. Design Retrospective review of clinical records. Multiple regression analyses were performed to identify predictors. Study sample The sample included 505 children (<11 years of age) using hearing aids (HAs), cochlear implants (CIs), and bone conduction hearing devices (BCHDs). Results Average HT use was 9.4 h a day. Bivariate analyses yielded 31 potential predictors from the 42 variables included. The general linear model (p < 0.01, R 2 = 0.605) identified 10 interacting factors that significantly associated with increased HT use. Intrinsic predictors of increased HT use included older chronological age, more severe degrees of hearing loss and older ages at diagnosis and initial HA fitting. Extrinsic predictors included the child’s ability to independently use HT, at least one CI as part of the HT fitting, coordinated onsite audiological management, self-procured batteries, auditory-oral communication mode and regular caregiver intervention attendance. Conclusions Average HT use was high, approximating hearing hours of peers with normal hearing. CI recipients demonstrated higher HT use compared to children using other HT. The newly identified factors can predict and increase HT use in children while contributing to evidence-based intervention services that promote optimal auditory-based outcomes.

Clinical Importance of Sound-Field Speech Recognition Test for Measurement of Hearing Aid Benefit

Background and Objectives Although sound-field speech recognition test is an essential evaluation method to verify the benefit of hearing aids, the aided sound-field speech recognition test has not been used as a standard audiometric protocol. This study investigated whether a traditional measure of unaided speech recognition measured at an individual’s most comfortable level (MCL) can predict aided speech recognition performance and the benefit of hearing aids.Subjects and Method One hundred twenty-one ears (72 adult hearing aid users) with moderate, moderately severe, and severe degrees of hearing loss were tested. The word recognition score (WRS) and sentence recognition score (SRS) were measured at MCLs using earphones (earphone WRS and earphone SRS). From the sound-field speech audiometry, both unaided and aided WRS and SRS were evaluated at an average conversational speech level (at 65 dB SPL) using a loudspeaker (located at 0° azimuth, 1 m). This study determined the differences between earphone scores (at MCL) and aided recognition scores (at 65 dB SPL), which is known as earphone to aided difference (EAD). Also, the hearing aid benefit was simply derived by differences between the unaided and aided scores, both measured at 65 dB SPL.Results The differences between the unaided and aided scores were significantly lower with a higher degree of hearing loss, yet the earphone scores measured at MCLs did not differ across varied hearing loss. More than half of the tested ears had the EAD of greater than ±10%. The ears with a higher degree of hearing loss tended to have +EAD (earphone score&gt;aided score), whereas the ears with less hearing loss showed -EAD (earphone score≤aided score). The earphone score measured at MCLs was not a predominant contributor to predict either aided performance or hearing aid benefit.Conclusion Clinicians should not assume that the unaided speech recognition score measured with earphones at MCL can accurately predict aided speech recognition or the benefit of hearing aids. Instead, it is crucial to directly assess aided sound-field speech recognition performance at a conversational speech level.

A Study on Satisfaction Levels among Hearing Aid Users in Gangetic Plains

Introduction Outcome assessments have emerged as an effective method for determining whether or not hearing aids are working to achieve positive results in rehabilitating the hearing impaired. Present study aims to assess the satisfaction level of clientele using hearing aids. Material and Methods One hundred and fourteen (114) hearing handicapped patients, fitted with government-provided hearing aids at various clinics spread over Gangetic plains were included in this prospective observational study for outcome analysis. Follow up was done at 2 weeks and 45 days when they were further motivated to continue using the aid, comfortable fitting of mould was ensured along with minor trouble shooting. Four and half months later, their satisfaction level was assessed by analysing their response to Clientele Satisfaction Questionnaire. Results Fifty percent of the patients were motivated by their family members to try the aid whereas 50% were self motivated. Better communication with family members and immediate social circle was the common motive. Majority (85%) reported high level of satisfaction in terms of hearing benefit. Patients with severe degree of hearing loss were more satisfied and used the aid for longer duration in a day. Handling the aid was not as much of a problem as tolerating the noise produced by aid itself. Cost of battery was a concern for 80% of our clientele. Conclusion Proper fitting of hearing aid improved the quality of life of majority of our hearing handicapped clientele by overcoming their psychosocial problems.

PORÓWNANIE SŁUCHOWYCH POTENCJAŁÓW KOROWYCH N1P2 I POTENCJAŁU STANU USTALONEGO GENEROWANEGO WĄSKOPASMOWYM BODŹCEM TYPU CHIRP W ROZPOZNANIU PROGU SŁYSZENIA U OSÓB DOROSŁYCH

BackgroundVarious auditory evoked potential techniques have been explored as a means of objectively predicting the behavioral audiogram in groups of subjects who cannot provide reliable or accurate behavioral results. The tone-evoked auditory brainstem response (ABR) cannot differentiate between severe and profound SNHL, whereas the auditory steady state response (ASSR) can provide threshold information in a frequency-specific manner at intensity levels of 120 dBSPL. The cortical auditory evoked potential (N1P2 CAEP) has shown advantages over the ABR and ASSR.ObjectivesTo assess the ability of the N1P2 cortical auditory evoked potential (CAEP) to estimate the hearing threshold level at different frequencies, in normal hearing adults and adults with different degrees of sensorineural hearing loss (SNHL); and to compare it to the auditory steady state response (ASSR).MethodsThis study included 90 subjects (180 ears), grouped into 6 groups according to the degree of hearing obtained by pure tone audiometry (PTA). Hearing threshold was then measured using N1P2 CAEP and ASSR.ResultsN1P2 CAEP and ASSR were highly correlated to PTA at all frequencies. However, N1P2 CAEP predicted behavioral thresholds more accurately than ASSR at all frequencies, especially at 500 and 1000 Hz in the normal hearing group and for all degrees of SNHL. N1P2 CAEP was equally accurate at all frequencies and predicted behavioral thresholds better at more severe degrees of SNHL at 1, 2, and 4 kHz.ConclusionsThe N1P2 CAEP can be reliably used as an objective method for estimating the behavioral hearing threshold, yielding more accurate results than the ASSR, especially at lower frequencies and with more severe degrees of hearing loss. We therefore recommend using the N1P2 CAEP in estimating the behavioral threshold in difficult-to-test adults.

Effect of time since diagnosis of type 2 diabetes mellitus and glycemic control on distortion-product otoacoustic emissions

Objectives: The objective of this study is to analyze the effect of glycemic control and factors like time since the diagnosis of type 2 diabetes mellitus on hearing. Materials and Methods: Hearing of 75 type 2 diabetes mellitus patients aged 40–55 years categorized into three groups of 25 patients based on their glycemic control (HbA1c %) and also based on time since the diagnosis was assessed using pure-tone audiometry (PTA) and distortion-product otoacoustic emissions (DPOAE). Results: Of 68% of the study population showing hearing loss, 40 patients (76.92%) had sensorineural hearing loss (SNHL) and 11 patients showed mixed hearing loss. The highest incidence of SNHL was seen in patients with poor glycemic control (45%) (P = 0.01) and in those with longer duration of diabetes >10 years (50%). Maximum patients showed moderate-to-moderately severe degree of hearing loss, affecting higher frequencies (P

A Prospective Study on Hearing Loss in Hypothyroidism

Thyroid hormone regulates the metabolism of all the cells of human body. The role of thyroid hormone is very essential in bodily growth and maturation of the nervous system. If thyroid gland decreases its secretion, it can affect any system of the body. The decreased from thyroid gland affects the auditory system. Thyroid hormone is very essential for not only the development but also functioning of cochlea. In addition to other systems, the auditory system is very sensitive to thyroid hormone. Hypothyroidism causes mild to severe degree of hearing loss leading to auditory dysfunction. The objectives of the study was to measure the prevalence of hearing impairment among hypothyroid patients and to assess the hearing loss via tests among these patients. Thyroid disorder constitutes a spectrum of disease that occurs due to increase or decrease in thyroid hormones. Among these, the two important categories are due to thyroid over activity which is called as hyperthyroidism and thyroid lower activity which is called as hypothyroidism. Impairment with mild degree and it affects cochlea. Strict maintenance of thyroid hormone levels within normal range would help in reducing the cochlear damage, as evident from present study that longer the duration of hypothyroidism more is the proportion of hearing impairment.

Effect of Stimulation Rate on Speech Understanding in Older Cochlear-Implant Users.

Cochlear implants (CIs) are considered a safe and effective intervention for more severe degrees of hearing loss in adults of all ages. Although older CI users ≥65 years of age can obtain large benefits in speech understanding from a CI, there is a growing body of literature suggesting that older CI users may not perform as well as younger CI users. One reason for this potential age-related limitation could be that default CI stimulation settings are not optimal for older CI users. The goal of this study was to determine whether improvements in speech understanding were possible when CI users were programmed with nondefault stimulation rates and to determine whether lower-than-default stimulation rates improved older CI users' speech understanding. Sentence recognition was measured acutely using different stimulation rates in 37 CI users ranging in age from 22 to 87 years. Maps were created using rates of 500, 720, 900, and 1200 pulses per second (pps) for each subject. An additional map using a rate higher than 1200 pps was also created for individuals who used a higher rate in their clinical processors. Thus, the clinical rate of each subject was also tested, including non-default rates above 1200 pps for Cochlear users and higher rates consistent with the manufacturer defaults for subjects implanted with Advanced Bionics and Med-El devices. Speech understanding performance was evaluated at each stimulation rate using AzBio and Perceptually Robust English Sentence Test Open-set (PRESTO) sentence materials tested in quiet and in noise. For Cochlear-brand users, speech understanding performance using non-default rates was slightly poorer when compared with the default rate (900 pps). However, this effect was offset somewhat by age, in which older subjects were able to maintain comparable performance using a 500-pps map compared with the default rate map when listening to the more difficult PRESTO sentence material. Advanced Bionics and Med-El users showed modest improvements in their overall performance using 720 pps compared with the default rate (>1200 pps). On the individual-subject level, 10 subjects (11 ears) showed a significant effect of stimulation rate, with 8 of those ears performing best with a lower-than-default rate. Results suggest that default stimulation rates are likely sufficient for many CI users, but some CI users at any age can benefit from a lower-than-default rate. Future work that provides experience with novel rates in everyday life has the potential to identify more individuals whose performance could be improved with changes to stimulation rate.

Relationship of Preoperative Hearing loss with Peroperative Ossicular Discontinuity in Chronic Otitis Media

Background: Chronic Otitis Media (COM) is a common disease in our country. COM with or without cholesteatoma may lead to ossicular discontinuity. However, the discontinuity of the ossicular chain is usually confirmed during operation. The purpose of the study was to find out the correlation between preoperative hearing loss and the status of ossicular chain at surgery.&#x0D; Methods: This cross-sectional study was conducted in the department of otolaryngology- Head &amp; neck surgery, Bangabandhu Sheikh Mujib Medical University from January 2013 to June 2014. At least 113 patients of COM were selected as per inclusion and exclusion criteria. Relevant data were collected in a predesigned data collection sheet and analyzed with standard statistical method. Statistically significant inferred for P value &lt;0.05. No groups whose ability to give voluntary informed consent questionable was not included. No potential risks exist in designed this study.&#x0D; Results: Out of 34 patients with mild degree of hearing loss 31(39.7%) had intact ossicular chain whereas discontinuity was seen in 3(8.6%) cases, 37 patients with moderate degree of hearing loss 16(45.7%) had ossicular discontinuity. Among 23 patients with moderate to severe degree of hearing loss 14(17.9%) had intact ossicular chain whereas ossicular discontinuity was found 9(25.7%), 9 patients of severe degree of hearing loss 7(20%) had ossicular discontinuity. Cases with moderate and severe degree of hearing loss had significant ossicular discontinuity (p&lt;0.05). Air-bone gap &gt; 40 dB was found in 60% cases of ossicular discontinuity, followed by air bone gap 31-40 dB(17.14%), 21-30 dB(14.29%) and 11-20 dB( 8.57%) respectively. So ossicular discontinuity was in higher air-bone gap group and it was statistically significant (p&lt;0.001).&#x0D; Bangladesh J Otorhinolaryngol; October 2019; 25(2): 94-101

Frequency of Noise Induced Hearing Loss Among Traffic Wardens of Lahore

Background: Noise-induced hearing loss (NIHL) is a major cause of disability throughout the world. It is the most common irreversible job-related hazard in the world with a higher burden in the developing regions of the world. Certain occupations are at high risk for NIHL. Traffic wardens could be considered highly vulnerable group as they are exposed to long hours of traffic noise. The objective of this study was to determine the frequency of noise induced hearing loss among traffic wardens of Lahore city.Material and Methods: It was a cross-sectional, descriptive study, carried out from 1st December 2018 to 31st May 2019, in which 329 traffic wardens appointed in 34 beats/sectors of Lahore city were included. Data was collected through a structured questionnaire, followed by Pure Tone Audiometry (PTA) of all the subjects.Results: A total of 329 traffic wardens were selected for this study. Mean age of the traffic wardens was 35.35 ± 1.21 years. NIHL was present in 174 (52.9%) traffic wardens, out of which, 138 (79.3%) had mild, 32 (18.4%) moderate, and 4 (2.3%) had moderately severe degree of hearing loss. Among the 329 traffic wardens, 165 (50.2%) had exposure to noise between 7am to 3pm (morning shift) and 42 (12.8%) had some problem with their hearing. Only 12 (3.6%) had ringing in the ears or tinnitus, 140 (42.6%) wore any hearing protection during duty hours and 42 (12.8%) said they had difficulty in hearing and frequently asked people to repeat themselves.Conclusion: In this study a high frequency of noise induced hearing loss was reported among traffic wardens of Lahore city with most of them having mild to moderate degree of hearing loss.

Ototoxic effect of anti-tubercular treatment on multi-drug resistant tuberculosis patient

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Multi-drug resistant tuberculosis (MDR-TB) is defined as tuberculosis caused by &lt;em&gt;Mycobacterium tuberculosis&lt;/em&gt; resistant in vitro to the effects of isoniazid and rifampicin, with or without resistance to any other drugs. Regimen for MDR-TB&lt;strong&gt; &lt;/strong&gt;comprises of 6 drugs - kanamycin, levofloxacin, ethionamide, pyrazinamide, ethambutol and cycloserine during 6-9 months of the intensive phase and 4 drugs levofloxacin, ethionamide, ethambutol and cycloserine during the 18 months of the continuation phase. The aim of our study was to document the incidence and severity of ototoxicity in MDR-TB patient receiving category IV treatment under the revised national tuberculosis control program.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Prospective cohort study was carried out on proven case of MDR-TB patients. Total 61 patients were evaluated for the development of ototoxicity, for a period of one year. First three months of study pre-treatment baseline audiogram were recorded by pure tone audiometry, and repeat audiogram was done after six months and nine months. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Out of 61 patients 21 patients developed ototoxicity with incidence of 34.42%. Incidence of high frequency hearing loss was 21.31% and flat loss was 13.11%.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; MDR-TB patients, due to effect of aminoglycoside may develop mild to severe degree of hearing loss. As hearing loss in these patients is permanent, careful audiological monitoring should be done regularly.&lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;