Transient Evoked Otoacoustic Emissions Research Articles

Neonatal Hearing Screening Using Wideband Absorbance and Otoacoustic Emissions Measured Under Ambient and Pressurized Conditions

Background: The objective was to analyze wideband acoustic absorbance and transiently evoked otoacoustic emissions (TEOAEs) from newborns without risk indicators of hearing loss and test the effectiveness of measuring TEOAEs under pressurized ear canal conditions. Methods: Evaluation of 102 newborns from a maternity hospital, who stayed in the well-baby nursery and did not have risk indicators for hearing loss. The procedures involved wideband tympanometry and TEOAEs performed at ambient pressure (AP) and at a pressure corresponding to maximum compliance (PP). Newborns were then divided into three groups according to their AP and PP results: G1 (PASS/PASS), G2 (FAIL/PASS), and G3 (FAIL/FAIL). Results: Comparing the three groups, pressurization improved the pass rate for G2 only. For wideband absorbance, differences were statistically significant for frequencies of 2, 3, and 6 kHz, with lower values under the AP condition. For TEOAEs, the differences were statistically significant in all bands, with lower values under the AP condition. Conclusions: Pressurization was effective in detecting more TEOAEs in G2, thus reducing the number of failures in neonatal hearing screening and reducing the need to return for retesting.

The Effect of COVID-19 on the Efferent Auditory System in Adults.

This study evaluated the effects of coronavirus disease 2019 (COVID-19) on the cochlea and auditory efferent system with transient evoked otoacoustic emissions (TEOAE) and contralateral suppression (CS). We aimed to evaluate the pre- and post-COVID-19 TEOAE and CS results in the same participants to reveal the effect of COVID-19 on the efferent auditory system. The CS measurement was performed twice for each participant before a diagnosis of COVID-19 and after treatment for COVID-19 as a within-subjects study design. All participants exhibited hearing thresholds below 25 dB HL at all frequencies and all participants demonstrated bilateral Type A tympanograms. The tests were performed in the linear mode using a double probe on the Otodynamics ILO292-II device. The CS of the otoacoustic emissions was measured at 65 dB peSPL TEOAE stimulus and 65 dB SPL broadband noise. All parameters including reproducibility, noise, and stability were considered during the measurements. The study included 11 patients (eight females and three males) aged between 20 and 35 years (mean age, 26 ± 3.66). Wilcoxon signed rank test and Spearman's correlation test were used for statistical analysis using the Statistical Package for the Social Sciences version 23.0. The Wilcoxon signed rank test showed that there was no significant difference between the pre-and post-COVID-19 TEOAE CS results in all tested frequencies and measurement parameters, 1000 to 4000 Hz, Z = -0.356, -0.089, -0.533, -0.533, -1.156, and p < 0.05. Although not statistically significant, the CS results obtained post-COVID-19 at all frequencies, except 4000 Hz, were lower than those before COVID-19. According to the overall TEOAE results after COVID-19, a statistically significant decrease was observed at 3000 Hz (Z = -2.847, p < 0.01) and 4000 Hz (Z = -2.401, p < 0.05) compared with the premeasurement. The study findings show that severe acute respiratory syndrome coronavirus 2 can affect the cochlea and the auditory efferent system in adults. Post-COVID-19 audiological evaluation can also be considered part of a general medical examination.

Associations between the medial olivocochlear reflex, middle-ear muscle reflex, and sentence-in-noise recognition using steady and pulsed noise elicitors

The middle-ear muscle reflex (MEMR) and medial olivocochlear reflex (MOCR) modify peripheral auditory function, which may reduce masking and improve speech-in-noise (SIN) recognition. Previous work and our pilot data suggest that the two reflexes respond differently to static versus dynamic noise elicitors. However, little is known about how the two reflexes work in tandem to contribute to SIN recognition. We hypothesized that SIN recognition would be significantly correlated with the strength of the MEMR and with the strength of the MOCR. Additionally, we hypothesized that SIN recognition would be best when both reflexes were activated. A total of 43 healthy, normal-hearing adults met the inclusion/exclusion criteria (35 females, age range: 19–29 years). MEMR strength was assessed using wideband absorbance. MOCR strength was assessed using transient-evoked otoacoustic emissions. SIN recognition was assessed using a modified version of the QuickSIN. All measurements were made with and without two types of contralateral noise elicitors (steady and pulsed) at two levels (50 and 65 dB SPL). Steady noise was used to primarily elicit the MOCR and pulsed noise was used to elicit both reflexes. Two baseline conditions without a contralateral elicitor were also obtained. Results revealed differences in how the MEMR and MOCR responded to elicitor type and level. Contrary to hypotheses, SIN recognition was not significantly improved in the presence of any contralateral elicitors relative to the baseline conditions. Additionally, there were no significant correlations between MEMR strength and SIN recognition, or between MOCR strength and SIN recognition. MEMR and MOCR strength were significantly correlated for pulsed noise elicitors but not steady noise elicitors. Results suggest no association between SIN recognition and the MEMR or MOCR, at least as measured and analyzed in this study. SIN recognition may have been influenced by factors not accounted for in this study, such as contextual cues, warranting further study.

Audiological Profile of Yakshagana Artists.

Yakshagana is an India's traditional folk theatre musical dance drama. The purpose of the study is to profile audiological characteristics and document hearing-related symptoms in Yakshagana artists. A cross-sectional study was performed on 96 Yakshagana artists. Participants' demographic data were captured, and audiological evaluations, including high frequency audiometry (HFA), tympanometry, acoustic reflex threshold and transient evoked otoacoustic emission (TEOAE), were performed. The majority of the individuals had minimal and mild hearing loss. The mean scores of pure tone thresholds were greater at 4kHz and 8kHz. The majority of the HFA thresholds at 10kHz, 12.5kHz, and 16kHz indicated no responses, which can be accredited to the fact that noise-induced hearing loss (NIHL) first affects the higher frequencies. TEOAE analysis showed a greater percentage of failures in the higher frequencies, particularly at 3 and 4kHz in both ears, which can be an indicator of bilateral cochlear damage. These findings indicate that Yakshagana artists are at risk of hearing loss due to noise exposure. Hearing evaluation and regular monitoring of hearing thresholds is advisable for this population as it can impact their careers.

Revisiting the transient-evoked otoacoustic emissions passing criteria used for newborn hearing screening

Objective To assess transient-evoked otoacoustic emissions (TEOAE) data from 15 years of a newborn hearing screening program and evaluate how well various criteria separate ears with and without hearing loss. Design Retrospective review of TEOAE data using logistic regression, receiver operating characteristic curves, and cumulative percentage graphs. Study sample: Children with hearing loss who passed TEOAE screening as a newborn were compared to children who failed TEOAE screening and normal hearing children who either passed or failed. Exclusions were applied for acquired hearing loss or auditory neuropathy. Results Ears with hearing loss that passed screening had significantly lower TEOAE response levels compared to ears with normal hearing. Noise levels, test times, and number of sweeps were also lower. Most of these ears had mild hearing loss. Logistic regression results showed that high-frequency TEOAE response level is the best predictor of hearing loss. A multivariate “logit” score calculated from the regression was the best indicator for separating ears with hearing loss from ears with normal hearing. Conclusions TEOAE response levels or an algorithm which incorporates logit scores should be considered as a minimum passing criterion to increase the sensitivity of the TEOAE screening.

Re-evaluating the scoring criteria of the Interacoustics Sera Neonatal Hearing Screener

Abstract Introduction: Newborn hearing screeners via otoacoustic emissions (OAEs) have become the standard in audiological clinical practice. Despite the application of OAE protocols for more than 3 decades, there has been no consensus on the standardization of the recorded responses. Usually, manufacturers based the scoring criteria of the OAE responses on small scale samples and in many cases on data published in the literature. Since there are no standards in the OAE probe construction, the resulted OAE responses are quite different between OAE screeners. The project evaluated the scoring criteria used in the Interacoustics Sera OAE screener. Methods: Eight hundred and eleven infants were initially screened by the Accuscreen OAE screener for a Pass or a Fail outcome. Seven hundred and ninety-two infants resulted as Pass were re-evaluated with the Sera transient-evoked OAE (TEOAE) and distortion-product OAE (DPOAE) protocols. Results: In terms of screening efficiency, the DPOAE protocol performed better, showing results very similar to the Accuscreen performance (Fail %: 2.4 vs. 2.3). The data showed that the recordings of the TEOAE responses were more prone to noise corruption. Using 10th percentile normative distribution values, DPOAE-optimized scoring criteria were estimated as 3.1, 7.9, 9.9, and 8.9 dB for the tested frequencies of 2.0, 3.0, 4.0, and 5.0 kHz. Unfortunately, the TEOAE signal-to-noise (S/N) data resulted as too noisy (despite relatively large TEOAE responses); therefore, the TEOAE responses were considered as scoring criteria candidates. The latter were estimated as 4.61, 6.35, 7, 1 and 3, 35 dB at 1.4, 2.0, 2.8, 4.0 kHz. Conclusion: It is possible to improve the screening efficiency of the DPOAE Sera protocol using optimized scoring criteria, aiming the correct identification of at least 90% of all normal hearing subjects. The Sera TEOAE protocol needs further investigation to identify the source of the noise, which lowers significantly the reported S/N ratios. The collected OAE data confirm that there are differences among the responses obtained by various screeners; therefore, an OAE probe standardization is necessary.

Peripheral Auditory Pathway and ABR Characterization in Adults with Williams Syndrome.

Introduction Williams syndrome (WS) is a genetic disorder caused by a microdeletion in chromosome 7, affecting ∼ 28 genes. Studies have demonstrated conductive losses seemingly related to the absence of the elastin gene and mild to profound sensorineural losses due to cochlear fragility. Objective To characterize and compare the peripheral auditory system and auditory brainstem response (ABR) of adults with WS and neurotypical adults matched by age and gender. Methods We conducted a cross-sectional observational study with 30 individuals of both sexes, aged 18 to 37 years - 15 of them with WS (study group) and 15 with neither the syndrome nor hearing complaints (control group), matched for sex and age. The subjects underwent pure-tone and speech audiometry, acoustic immittance, transient-evoked otoacoustic emissions (TEOAEs), and ABR. Results Early-onset sensorineural hearing loss was found in 53.3% of the study sample, mostly mild, occurring above 3 kHz. The TEOAEs were absent in 53.3% of assessed subjects; for those in whom they were present, the signal-to-noise responses were significantly lower than in the control group. In the ABR, increased absolute latencies were observed in waves I and III. Conclusion Individuals with WS have early and progressive cochlear impairments, mainly affecting the basal region of the cochlea. They may have low brainstem changes which seem to begin in adulthood.

The Origin Along the Cochlea of Otoacoustic Emissions Evoked by Mid-Frequency Tone Pips.

Tone-pip-evoked otoacoustic emissions (PEOAEs) are transient-evoked otoacoustic emissions (OAEs) that are hypothesized to originate from reflection of energy near the best-frequency (BF) cochlear place of the stimulus frequency. However, individual PEOAEs have energy with a wide range of delays. We sought to determine whether some PEOAE energy is consistent with having been generated far from BF. PEOAEs from 35 and 47dB SPL tone pips were obtained by removing pip-stimulus energy by subtracting the ear-canal sound pressure from scaled-down 59dB SPL tone pips (which evoke relatively small OAEs). PEOAE delays were measured at each peak in the PEOAE absolute-value waveforms. While measuring PEOAEs and auditory-nerve compound action potentials (CAPs), amplification was blocked sequentially from apex to base by cochlear salicylate perfusion. The perfusion time when a CAP was reduced identified when the perfusion reached the tone-pip BF place. The perfusion times when each PEOAE peak was reduced identified where along the cochlea it received cochlear amplification. PEOAEs and CAPs were measured simultaneously using one pip frequency in each ear (1.4 to 4kHz across 16 ears). Most PEOAE peaks received amplification primarily between the BF place and 1-2 octaves basal of the BF place. PEOAE peaks with short delays received amplification basal of BF place. PEOAE peaks with longer delays sometimes received amplification apical of BF place, consistent with previous stimulus-frequency-OAE results. PEOAEs provide information about cochlear amplification primarily within ~ 1.5 octave of the tone-pip BF place, not about regions > 3 octaves basal of BF.

Silent Hearing Loss in Kidney Transplant Patients Receiving Tacrolimus: A Fact or a Myth?

Background: It has been claimed that tacrolimus may have harmful effects on the auditory system, where it has been linked to ototoxicity and sensorineural hearing loss (SNHL). We evaluated silent SNHL in kidney transplant recipients (KTRs) receiving tacrolimus and the different factors affecting it compared to healthy controls. Materials and Methods: In this case control study, hearing functions were studied in 42 KTRs receiving tacrolimus as maintenance immunosuppressive therapy for more than 3 months in comparison to 27 age- and gender-matched healthy subjects using tympanometry, pure-tone audiometry (PTA), extended high frequency audiometry (EHFA), and transient evoked oto-acoustic emissions (TEOAEs). Also, different factors were studied in relation to SNHL. Results: PTA showed that 23.8%, 21.4%, and 4.8% had mild, moderate, and severe SNHL, respectively. One-fifth of KTRs had severe SNHL, according to EHFA. According to TEOAEs, 28.6% of KTRs had abnormal hearing. There was a significant positive correlation between the tacrolimus trough levels and the results of both the PTA (P = 0.002) and EHFA (P = 0.035) tests. Conclusion: SNHL was detected in about half of the studied KTRs. Silent SNHL in KTRs might be associated with higher tacrolimus trough levels.

Covid-19 infection in pregnant women: Auditory evaluation in infants.

Recent studies showed that COVID-19 infection can affect cochleo-vestibular system. The possibility of a vertical transmission is controversial. Some studies suggested that it is possible but unlikely, others find no evidence of vertical transmission. The objective of this study was to investigate whether exposure to COVID-19 during pregnancy or at birth has an impact on the hearing of the offspring. As part of the national hearing screening program, we performed in all newborns between January 2022 and February 2023, TEOAEs (Transient Evoked Otoacoustic Emissions) at birth and at 3 months. For those "REFER" at the third month test, we performed aABR (Automatic Auditory Brainstem Response) at 6 months. We analysed separately result between infants born to COVID-positive mothers during pregnancy and those born to COVID-negative mothers. To statistical verify differences we performed "Chi-square test". We enrolled a total of 157 infants, of whom 16 were born to mothers who had a molecular PCR test positive for COVID-19. In the latter we tested a total of 32 ears and only 1 ear (3,1%) resulted "REFER". On the other hand, in the control group we tested a total of 282 ears and 22 (7,8%) were found to be "REFER". Our study showed no significant differences in audiological assessment between newborns exposed to COVID-19 infection during pregnancy or at birth compared to the unexposed group. However, further studies with a larger patient's sample will be necessary for a more comprehensive evaluation.

Psychometric Validation of a Hearing Screening Questionnaire for Preschoolers Based on Language Development Evaluation by Caregivers

Introduction: This study aimed to validate three age-adjusted versions of a Hearing Screening Questionnaire for Preschoolers, in Brazilian Portuguese, based on parents’ perception of their children’s hearing and oral language. Methods: Psychometric validation was conducted on three questionnaires, each comprising nine items with yes/no responses. Three items focused on hearing screening at birth, and six assessed hearing and oral language. The study included 152 parents and their children, who attended daycare centers in Belo Horizonte, Brazil. The children were categorized into three age bands: 12–18 months, 19–35 months, and 36–48 months. Audiological assessments, including tympanometry, transient-evoked otoacoustic emissions (TEOAE), and pure-tone audiometry (when applicable), were performed on the children. In case of abnormal findings in the previous exams, auditory brainstem response (ABR) testing was conducted. Descriptive data, false alarm, and false-negative analyses were carried out. Results: Considering any type of hearing loss, whether unilateral or bilateral, the questionnaires showed a false-negative rate of 41.17% (7/17 children). However, when considering only bilateral hearing loss, the questionnaire showed a false alarm rate of 31.69% (45/142) and a false-negative rate of 30.0% (3/10). When focusing exclusively on sensorineural hearing loss, the questionnaire identified two children (1.31%), with a false-negative rate of 0% but a false-positive rate of 33.33%. Conclusion: Language-development-oriented questionnaires allowed quick screening of potential hearing loss in preschoolers. This study found a robust hit rate with these questionnaires. Their validation signifies a promising and cost-effective tool for conducting hearing screenings in preschool children, especially in nations lacking a comprehensive school screening policy. The validated questionnaire affords an easy-to-apply, low-cost, and effective instrument for preschool hearing screening.

Evaluation of cochlear and auditory brainstem functions in COVID-19 patients; a case control study

BackgroundMany viral infections can cause hearing loss due to affection of cochlear hair cells or neurogenic pathway. Although, the damage secondary to viral infections is mainly cochlear affection; auditory brainstem can be affected as well. It was predicted that SARS-COV-2 infection can similarly affect the auditory system. This study aimed to detect affection in auditory system and if present investigate the possible site of lesion (up to the level of the brain stem) in relation to COVID-19 infection.MethodsThis is a case control study, where the study group constituted of thirty adults, diagnosed with COVID-19 at least 2 weeks prior to testing and up to 6 months, without previous auditory complaints pre-COVID-19 or other risk factors that could affect the auditory pathway. Fifteen adult participants that were age and gender matched to the study group with no previous history of covid-19 infection constituted the control group. Audiological evaluations done to all participants were pure-tone and speech audiometry, tympanometry, transient-evoked otoacoustic emission with and without contralateral suppression and auditory brainstem response measurements.ResultsThe study group showed significantly worse pure tone thresholds at high frequencies 4 and 8 kHz (p < 0.01), significantly worse transient-evoked otoacoustic emission signal to noise ratio at 2800 Hz and 4000 Hz (p < 0.05) and significantly lower total suppression index (p<0.05). On the other hand, there was no significant difference between both groups in auditory brainstem response wave latencies (p > 0.05).ConclusionCOVID-19 had subtle effect on cochlear basal turn, and it is shown that the auditory efferent system may also be affected, while the auditory nerve and afferent brainstem pathways seems to be spared. Moreover, the absence of the symptoms of auditory dysfunction postcovid-19 does not guarantee normal auditory functions.

Audiologic and vestibular assessment in children and adolescents with transfusion dependent beta thalassemia major: The era of deferasirox film coated tablet

BackgroundHearing impairment has frequently been described in β-thalassemia patients with a significant impact on the patients’ quality of life. Most studies provided evidence of deferoxamine (DFO) dose-related ototoxicity, however, the data is scarce regarding deferasirox (DFX) as a sole iron chelator. AimWe aimed to assess the prevalence and risk factors of sensorineural hearing loss (SNHL) and vestibular dysfunction in regularly transfused β-thalassemia patients who had been treated with DFX film coated tablets. MethodsWe conducted a case control study on 57 transfusion dependent β-thalassemia patients with a mean age of 15.3 years who received DFX FCT as monotherapy for at least one consecutive year, and 57 healthy age and sex-matching controls. Comprehensive audiological evaluations using pure tone audiometry (PTA) and transient evoked otoacoustic emission (TEOAE) as well as vestibular evaluation using Video-nystagmography (VNG) were done. ResultsSNHL was identified in 12 patients (21.1 %) using PTA and a statistically significant difference was detected between controls and patients at 6 KHz and 12 KHz frequencies. A higher incidence of SNHL was detected using TEOAE, 22 patients (43.1 %) failed to pass TEOAE, with a statistically significant decrease in the signal at frequencies 1, 4 KHz bilaterally and at frequencies 1.5, 2 KHz in the right ear compared to controls. Canal paresis was detected in 21 (36.8 %) of thalassemic children using bithermal caloric test with significantly more unilateral weakness than control children (P = 0.008). We found no significant correlation between audio-vestibular dysfunction and age, sex, serum ferritin, frequency of blood transfusion and dose of DFX FCT in thalassemic children. ConclusionWe conclude that the incidence of SNHL and vestibular dysfunction was high among transfusion dependent β-thalassemia patients. Therefore, we recommend performing pre-treatment baseline audio-vestibular assessment and yearly audio-vestibular monitoring to early detect high risk patients and initiate timely management to prevent permanent damage.

Correlação entre os limiares auditivos e a amplitude de resposta das emissões otoacústicas em adultos pós-COVID-19

ABSTRACT Purpose: to verify the auditory acuity and correlate auditory thresholds of pure tone audiometry (PTA) with transient-evoked otoacoustic emissions (TEOAE) and distortion-product otoacoustic emissions (DPOAE) in post-COVID-19 adults. Methods: an analytical cross-sectional study, conducted between October 2021 and October 2022, with 63 post-COVID-19 adults (age range 20-53 years old). The following were performed: PTA, TEOAE, and DPOAE. The results were presented descriptively, and Spearman’s correlation test was used. Results: no hearing loss was identified. Most frequency bands were present in both emissions tests. There was a negative and significant correlation between the PTA and TEOAE thresholds in the frequency bands of 500-1500 Hz and 1500-2500 Hz on the left and between the PTA and DPOAE thresholds in the frequency bands of 1000, 2000, and 4000 Hz on the right and 1000, 2000, 3000, 4000, 6000, and 8000 Hz on the left. Conclusion: post-COVID-19 adults presented auditory thresholds within normal limits, with a response to TEOAE and DPOAE. There was a negative correlation between TEOAE and DPOAE and the PTA air threshold, indicating that higher PTA thresholds are associated with lower emission response amplitude.

Assessment of the risk of hearing loss in children with cystic fibrosis

Cystic fibrosis (CF) is a severe hereditary disease with a multisystem lesion. Manifestations of CF include severe infectious purulent lesions of all parts of the respiratory tract, including purulent rhinosinusitis with nasal polyps. The involvement of the sinonasal region and the need for systemic use of ototoxic drugs (primarily aminoglycosides to treat resistant bacterial infection) potentially create a risk of both conductive and sensorineural hearing loss (SNHL). The available data on the epidemiology of hearing disorders in CF is contradictory. Currently, genetic determinants of the development of aminoglycoside SNHL have been identified. For 136 CF patients (75 girls, 61 boys) aged 3 to 17 (9.4±3.9) years were performed audiological examination: tympanometry, transient-evoked otoacoustic emission and the pure tone threshold audiometry (standard frequency range) (n=126). History of systemic therapy with aminoglycosides was evaluated for each patient. Sequencing of c.35delG mutations in the GJB2 gene (nuclear DNA) and A1555G in the 12S rRNA gene (mitochondrial DNA) was performed in 215 patients with cystic fibrosis (the group partially overlaps with the audiological group), and as a control - 106 children with bronchial asthma and 103 healthy children, their age ranged from 3 to 17 (8.8±3.8) years. Audiological examination of CF children reveled a prevalence of conductive hearing loss comparable to the general population (2.4%). The frequency of SNHL was 1.6%, wich exceeds that of non-CF children. A genetic study revealed one case of heterozygous carriage of the c.35delG mutation in the GJB2 gene in a patient with bronchial asthma. In the group of patients with CF (n=215), mutations in the connexin 26 gene were not detected. No A1555G mutation was detected either in the group of patients with CF or in the control groups. Children with CF are at risk for the development of sensorineural, but not conductive hearing loss. Routine total screening for A1555G and c.35delG mutations probably seems not to be recommended.

BRAK NASTĘPSTW INFEKCJI COVID-19 W ODNIESIENIU DO STANDARDOWYCH TESTÓW AUDIOLOGICZNYCH

IntroductionCoronavirus disease (COVID-19), considered to be caused by a novel coronavirus (SARS-CoV-2), is an acute respiratory disease which was declared a pandemic by the World Health Organization. Previously published reports have shown contradictory findings on the involvement of the auditory system in individuals infected with COVID-19. The present study aims to assess auditory system functioning in individuals post-COVID-19 infection and compare the results with individuals without COVID-19 infection.Material and methodsParticipants in this study were 30 individuals who had experienced mild COVID-19 infection and 30 individuals who never had COVID-19. Participants were aged between 18 and 40 years. Testing was done 1 to 6 months after infection, and involved conventional and extended high-frequency audiometry, speech perception in quiet and at different signal-to-noise ratios (SPIN), transient evoked otoacoustic emissions (TEOAEs) in quiet and in the presence of contralateral noise, and auditory brainstem response (ABR) in the ipsilateral and contralateral mode.ResultsNone of the tests – pure-tone thresholds, speech perception in quiet and in noise, TEOAE with and without contralateral noise, and ABR – showed any significant difference between individuals who never had COVID-19 infection and those who had recovered from the infection. Both afferent and efferent auditory pathways showed normal findings in individuals post-COVID-19 infection.ConclusionsIndividuals who have been infected with mild COVID-19 did not show any significant deficit in any of the audiological tests, suggesting that the disease does not cause any permanent harm to the auditory system after the infection has subsided.

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.

Hearing Loss and Risk Factors in Very Low Birth Weight Infants.

The incidence of sensorineural hearing loss (SNHL) is still high in very low birth weight (VLBW) infants. The purpose of our study was to provide the prevalence rates of SNHL and to analyze the risk factors of hearing impairment and changes in hearing thresholds in a cohort of VLBW infants. A retrospective observational study was conducted in our neonatal intensive care unit (NICU) from 2012 to 2016. All VLBW infants included were screened by transient evoked otoacoustic emissions (TEOAEs) and diagnostic auditory brainstem response (ABR). In total, we enrolled 316 infants and SNHL was diagnosed in 68, leading to an early incidence of 21.5% as 36 infants out of 68 improved. Finally, SNHL was confirmed in 20 patients (6.3%) who needed hearing aids. They were significantly smaller, sicker, had longer hospitalizations, and received more ototoxic therapies. Logistic regression analysis showed that gestational age (GA) influenced the association between drugs and SNHL. The results underlined how the total exposure to antibiotics is significantly associated with SNHL, even after GA correction. In conclusion, GA, birth weight and, above all, the length and complexity of NICU stay quantify the risk of SNHL and should be considered at the individual level for parent counseling.

Heightened OAEs in young adult musicians: Influence of current noise exposure and training recency

Otoacoustic emissions (OAEs) are a non-invasive metric of cochlear function. Studies of OAEs in musicians have yielded mixed results, ranging from evidence of diminished OAEs in musicians—suggesting noise-induced hearing loss—to no difference when compared to non-musicians, or even a trend for stronger OAEs in musicians. The goal of this study was to use a large sample of college students with normal hearing (n = 160) to compare OAE SNRs in musicians and non-musicians and to explore potential effects of training recency and noise exposure on OAEs in these cohorts. The musician cohort included both active musicians (who at the time of enrollment practiced at least weekly) and past musicians (who had at least 6 years of training). All participants completed a questionnaire about recent noise exposure (previous 12 months), and a subset of participants (71 musicians and 15 non-musicians) wore a personal noise dosimeter for one week to obtain a more nuanced and objective measure of exposure to assess how different exposure levels may affect OAEs before the emergence of a clinically significant hearing loss. OAEs were tested using both transient-evoked OAEs (TEOAEs) and distortion-product OAEs (DPOAEs). As predicted from the literature, musicians experienced significantly higher noise levels than non-musicians based on both subjective (self-reported) and objective measures. Yet we found stronger TEOAEs and DPOAEs in musicians compared to non-musicians in the ∼1–5 kHz range. Comparisons between past and active musicians suggest that enhanced cochlear function in young adult musicians does not require active, ongoing musical practice. Although there were no significant relations between OAEs and noise exposure as measured by dosimetry or questionnaire, active musicians had weaker DPOAEs than past musicians when the entire DPOAE frequency range was considered (up to ∼16 kHz), consistent with a subclinical noise-induced hearing loss that only becomes apparent when active musicians are contrasted with a cohort of individuals with comparable training but without the ongoing risks of noise exposure. Our findings suggest, therefore, that separate norms should be developed for musicians for earlier detection of incipient hearing loss. Potential explanations for enhanced cochlear function in musicians include pre-existing (inborn or demographic) differences, training-related enhancements of cochlear function (e.g., upregulation of prestin, stronger efferent feedback mechanisms), or a combination thereof. Further studies are needed to determine if OAE enhancements offer musicians protection against damage caused by noise exposure.

Do Flights Affect Hearing in Hot Air Balloon Pilots?

This study aimed to reveal occupational effects on the hearing of hot air balloon (HAB) pilots and examine the relationship between the duration of experience and these effects. This study included 31 male HAB pilots and a control group of 32 male participants. Tympanometry, eustachian tube function (ETF) test, pure-tone audiometry, and transient evoked otoacoustic emission (TEOAE) tests were performed. Pure-tone audiometry results were significantly worse at 125, 500, and 6000 Hz in the right ear and 125, 500, 4000, and 6000 Hz in the left ear in the HAB group than the control group. Although tympanometry evaluation parameters did not differ between the HAB and control groups, ETF test was significantly worse in the HAB group than the controls bilaterally. TEOAE results were significantly worse at 1000, 2000, and 4000 Hz in the right ear and 4000 Hz in the left ear in the HAB group than the controls. There was a significant positive correlation for 125, 4000, 6000, and 8000 Hz between the duration of experience and right ear hearing thresholds. For the left ear, the duration of experience showed a significant positive correlation at 3000, 4000, 6000, and 8000 Hz. When the relationship between the duration of experience and TEOAE results was evaluated, a significant negative correlation was found at 4000 Hz in the left ear. In HAB pilots, in whom eustachian tube dysfunction is quite common, noise and high altitude affected hearing, especially low and high frequencies, and the duration of experience was found to be associated with hearing thresholds.