Bell’s palsy workup:Does audiometry add value?

Objective:To investigate if routine audiometry in Bell’s palsy patients has prognostic value.Methods:Retrospective case review was conducted on all Bell’s palsy patients(n紏191)seen at the tertiary otolaryngology specialist outpatient clinic from 2015 to 2017.Correlation of ipsilesional audiometric thresholds with patients’time-to-recovery and initial clinical severity(measured by House-Brackmann(HB)scoring)were used for the prognostic outcome measure.Audiometry results were analyzed using three contiguous frequency pure-tone average(1kHz,2kHz,4kHz).Statistical analysis was done via Stata(v13.1),significance tests were 2-sided at 5%significance level.Results:There was no significant difference between audiometric thresholds between the ipsilesional ear and the contralateral ear(p=0.87).Time-to-recovery was significantly longer for patients with severe initial presentation as compared to mild and moderate severity(p<0.01).There was no correlation found between the audiometry results and HB score at presentation(p=0.39).There was no correlation found between ipsilesional audiometric thresholds and time-to-recovery(p=0.58).Conclusion:Our study suggests that routine audiometry has limited prognostic value in Bell’s palsy patients.

An Investigation on Feasibility of Pure Tone Sound Field Audiometry

It′s generally believed that the appropriate stimuli for sound field tests are warble tones and narrow band noise, while pure tone can only be a signal used in the free field and earphone listening conditions. In this study, we take a measurement of sound pressure distribution, sound field variability, and effects of frequency shifting on sound pressure levels (SPLs) at reference points of pure tone in an audiometric test room. It was found that the pure tone SPLs were also distributed uniformly at some sound field areas although it was not so well as warble tones. This indicated that the test results were relatively stable to head movement and/or frequency shifting in those regions, which was confirmed by the clinical measurements on 20 subjects with severe sensorineural hearing loss. Our study concluded that pure tones could also be suitable for sound field audiometry if subjects were seated at a proper location on the basis of the sound field calibrations.

Evaluation of SON’OR^(█),a Medical Device for Provoked Otoacoustic Emissions and Brainstem Evoked Response Audiometry Made in Cameroon

Background: There is a huge gap in the audiological care in Africa by comparison with Western countries. Its main reason is the prohibitive cost of the medical devices used to screen or diagnose patients. A Cameroonian team tackled this problem by developing a medical device (SON’OR&copy;) which integrates a new instrumentation amplifier structure dedicated to perform otoacoustic emissions (OAE) and brainstem evoked response audiometry (BERA). The major technical challenges to perform OAE and BERA are the synchronization and the amplification of signals of very low amplitude. In this work, we emphasize on the general criteria necessary and indispensable to achieve an optimal amplification. The application of a novel instrumentation amplifier structure characterized by its optimized noise factor in the case of BERA and OEA emissions provides simulations and experimental results fully in line with forecasts. The design of SON’OR&copy;is based on general techniques of electronic instrumentation to which we associated the new instrumentation amplifier structure. Objective: To report the clinical evaluation of SON’OR&copy;as a screening and diagnostic tool. Methods: We conducted a cross sectional comparative study in Centre Hospitalier d’Essos in Yaoundé. We tested SON’OR&copy;on two sets of subjects, one for OAE with OTODYNAMICS Echoport ILO 292-II as gold standard and the other for BERA with NEUROSOFT NEURO AUDIO&copy;as gold standard. Each patient was tested with both devices and then we studied the inter device differences and calculated the sensitivity, specificity, positive predictive value and negative predictive value for each test. Results: We got 52 subjects for OEA and 51 for BERA testing. Sex ratio was 1 woman for 2 men in both groups. Mean age was 24.86(SD = 10.53) and 26.33 (10.55) for OAE and BERA groups respectively. SON’OR&copy;had good performances, showing sensitivity of 92.85%/95%, specificity of 96.77%/90.47%, positive predictive value of 95.21%/93.44% and negative predictive value of 95.23%/92.68% for OAE/ BERA respectively. Conclusion: SON’OR&copy;has good characteristics as a medical diagnostic tool. Furthermore its stability and performances in poor electrical conditions make it a robust device really suited for resource limited settings.

17例耳硬化症患者的临床与影像学分析

目的分析17例耳硬化症患者的临床特征、影像学表现及手术治疗效果。方法收集2020年5月~2023年5月在湖州市中心医院接受手术治疗的17例(17耳)耳硬化症患者临床、影像学资料,分析其临床表现、颞骨CT影像学表现及手术前后纯音测听结果变化。结果17例(17耳)患者中,11耳(64.71%)为前庭窗型,表现为进行性传导性听力损失,其中9耳有耳鸣,3耳有轻微平衡问题;混合型6耳(35.29%)显示混合性听力损失,5耳有耳鸣,3耳有偶发性平衡障碍。影像学上,前庭窗型显示镫骨底板区域骨质增厚、前庭窗密度增加;混合型则显示镫骨底板增厚及耳蜗周围密度减低,1耳可见“双环征”,两种类型耳硬化症患者骨密度差异无统计学意义(P>0.05)。术后均未见耳鸣加重或其他严重并发症,仅2例(11.76%)出现暂时性头晕,术后随访显示术区恢复良好,无感染或其他迟发性并发症;术后听力测试显示气导阈值、气骨导差较术前显著改善(P均<0.05)。结论前庭窗型和混合型耳硬化症的影像学和临床表现各有特点,镫骨成形术可显著改善听力,降低气导阈值和气骨导差,且手术安全、并发症少。

Clinical characteristics and analysis of vestibular-evoked myogenic potentials in patients with sudden sensorineural hearing loss in different ages

BACKGROUND Numerous studies have found that patients experiencing sudden sensorineural hearing loss(SSHL),with or without accompanying vertigo,often show impaired vestibular function.However,there is a dearth of studies analyzing vestibularevoked myogenic potentials(VEMPs)in SSHL patients across various age groups.AIM To investigate vestibular condition in SSHL patients across various age demographics.METHODS Clinical data of 84 SSHL patients were investigated retrospectively.Audiometry,cervical vestibular evoked myogenic potentials(c-VEMPs),and ocular vestibular evoked myogenic potentials(o-VEMPs)were conducted on these patients.Parameters assessed included the latencies of P1 and N1 waves,as well as the amplitudes of P1–N1 waves.Moreover,the study evaluated the influence of factors such as sex,affected side,configuration of hearing loss,and presence of accompanying vertigo.RESULTS Among the 84 SSHL patients,no significant differences were observed among the three groups in terms of gender,affected side,and the presence or absence of vertigo.Group II(aged 41–60 years)had the highest number of SSHL cases.The rates of absent o-VEMPs in the affected ears were 20.83%,31.58%,and 22.72%for the three age groups,respectively,with no statistically significant difference among them.The rates of absent c-VEMPs in the affected ears were 8.3%,34.21%,and 18.18%for the three age groups,respectively,with significant differences.In the unaffected ears,there were differences observed in the extraction rates of o-VEMPs in the unaffected ears among the age groups.In the three age groups,no significant differences were noted in the three age groups in the latencies of P1 and N1 waves or in the amplitude of N1–P1 waves for c-VEMPs and o-VEMPs,either on the affected side or on the unaffected side,across the three age groups.CONCLUSION The extraction rate of VEMPs is more valuable than parameters.Regardless of the presence of vertigo,vestibular organs are involved in SSHL.Notably,SSHL patients aged 41–60 appear more susceptible to damage to the inferior vestibular nerve and saccule.

Development of SC-10: A psychometrically equivalent Singapore Mandarin disyllabic word list for clinical speech audiometry use

Objective::The aim of this study is to develop and evaluate a set of psychometrically equivalent disyllabic wordlist(SC-10)in Singapore Mandarin for clinical use.Study design::A preliminary set of 1000 words were obtained from a dictionary of frequently used words by Singapore students.Ten native judges rate the familiarity level of each word.This is followed by a face-to-face public survey to rank the shortlisted word set from most to least familiar.The final 108 disyllabic words were recorded by a native female talker.20 normal hearing subjects were used to obtain the percentage of correct word recognition at 24 intensity levels(-10 dB HL to 26 dB HL in 2 dB increment).Psychometric function slopes were calculated for each word.100 words were eventually chosen and assigned into ten 10-word lists based on a psychometric balancing protocol.Minor digital adjustments were made to the intensity of each wordlist to improve their auditory homogeneity.Results::The calculated regression slopes in the psychometric functions for the ten lists are between 8.0 and 9.8%/dB.Single factor ANOVA analysis showed no significant difference in both the mean intensity required to obtain 50%recognition score(f=0.109,df=9,p=0.999)and the slopes of the psychometric functions(f=0.078,df=9,p=0.999)between the ten word lists.List validation on 25 normal hearing participants(PTA=11.0 dB HL,SD=4.3)showed a mean speech recognition threshold(SRT)of 9.3 dB HL(SD=3.5)and regression slope of 8.395%/dB.Quadratic regression analysis showed a positive correlation(r^(2)=0.923)between presentation level and word recognition score(WRS).The difference between PTA and SRT of each subject all fall within the clinically acceptable difference of 10 dB HL.Test-retest reliability,carried out on 20 subjects at three levels(SRT-5,SRT,and SRT+5 dB),showed no significance difference between word recognition score when the same participant is tested again at the same intensity level using a different wordlist.Conclusion::All in all,it shows that the SC-10 speech materials are valid for clinical use for Mandarin speech audiometry in Singapore.

The value of the speech audiometry in diagnosis of X-linked adrenoleukodystrophy

To the editor: Sir,X-linked adrenoleukodystrophy (X-ALD) is a hereditary metabolic disease with an incidence rate of 1:16,800.1 Mutations in the ABCD1 gene in X-q28 causes the presence of high levels of very long chain fatty acids (VLCFA) in the serum and tissues.X-ALD presents with adrenal insufficiency as well as severe cognitive and neurologic disability.

Auditory function in symptomatic patients recovered from SARS-CoV-2 and unexposed patients:An analytical cross-sectional study

Objective:To describe audiological symptoms,audiometric profile,and distortion product otoacoustic emission in symptomatic patients recovering from SARS-CoV-2 infection(positive RT-PCR test)and asymptomatic patients(negative RT-PCR test).Methods:An analytical cross-sectional study was conducted using data obtained from clinical charts,physical examination,audiometry,and distortion product otoacoustic emission on 40 patients[case patients(CP)]recovering from SARS-CoV-2 infection diagnosed by a positive RT-PCR test and 22asymptomatic participants with a negative RT-PCR test[non-case(NC)].Results:Sixty-two patients(mean age:31.1 and 28.2 years in the CP and NC groups,respectively)were included.All participants were young without significant comorbidities,risk factors for hearing loss or otological history.Vertigo(5%),tinnitus(17.5%)and aural fullness/hearing loss(35%)were found in the CP group.A statistically significant difference was found in specific frequencies(1000,4000,and 8000 Hz)and pure tone average(low and high conversational frequencies with increased threshold in the PC group compared with the NC group),which was not found in distortion product otoacoustic emission.Conclusion:Audiovestibular symptoms are frequent in symptomatic patients recovering from SARS-CoV-2 infection.SARS-CoV-2 infection was consistently associated with an increased audiometric hearing threshold at specific frequencies and low tone average.

听神经病患者纯音听阈及声导抗分析

听神经病（auditory neuropathy,AN）是一种具有特殊临床及听力学特征表现的听功能障碍性疾病。能对AN患者作出最初认识和判断的应首推纯音听力检查和声阻抗检查。我们对51例AN患者的临床表现特点及纯音听阈、声导抗进行总结,报道如下。

耳鸣患者全频纯音听阈测试观察

耳鸣虽然不是一种独立疾病,但它给患者带来了不尽的烦恼。其原因非常复杂,还有许多问题未被认知,尚需进一步探讨。我们对40例（70耳）耳鸣患者进行全频纯音听阈测试,试图通过耳鸣患者听阈的改变,来了解听力的相应变化特点。1资料与方法我科自2008年10月～2009年11月,对40例（70耳）无耳疾史及噪声接触史,无耳毒性药物应用史的耳鸣患者进行全频纯音听阈测试。其中男26例,女14例,年龄19～49岁,平均31.07岁。常规纯音听阈（0.5～8.0kHz）≤25dB HL。

背景噪声下言语测听

本文在对中枢听觉神经系统功能的解剖、生理及其检查开展的必要性进行略述后,提出语言的最基本、最主要的形式是“言语”。能否听懂言语,是判断听功能状态的最主要指标。通过对言语测听及背景噪声下言语测听的历史、现状进行概述后,对背景噪声下言语测听的影响因素及其作为听处理套查方法之一的临床应用前景、在中枢听处理障碍检查中的灵敏性进行展望。

Audiovestibular functioning of post-menopausal females with osteoporosis and osteopenia

Introduction:Osteoporosis and osteopenia are progressive disorders characterized by decreased bone mass,especially in postmenopausal women.These can be associated with body pain,fractures,hearing loss and balance disorders.The present study aims to evaluate audio-vestibular function in postmenopausal patients with osteopenia or osteoporosis.Methods:The study included 48 postmenopausal women(new subjects)diagnosed with osteoporosis(n=23)or osteopenia(n=25)in the age range of 50e66 years,as well as 28 normal women as controls.Audiological testing included pure tone audiometry(conventional and extended high-frequency audiometry),speech audiometry,impedance audiometry and otoacoustic emissions,including both transient evoked otoacoustic emissions(TEOAEs)and distortion product otoacoustic emissions(DPOAEs).All subjects also underwent vestibular evoked myogenic potentials testing(both ocular and cervical VEMPs).Results:In the present study,hearing was worse at all frequencies in the osteoporosis group in comparison with the osteopenia and control groups,with worse speech recognition and discrimination scores and OAEs.Vestibular function was affected in 95.65%of women with osteoporosis and 76%of those with osteopenia.Conclusion:Osteoporosis and osteopenia are risk factors for vestibular dysfunction and hearing deficits in postmenopausal women.Thus,hearing and vestibular function should be monitored by audiological and vestibular testing periodically in these individuals.

Intratympanic dexamethasone injection for sudden sensorineural hearing loss in pregnancy

BACKGROUND As sudden sensorineural hearing loss(SSNHL)rarely occurs in pregnant women,there is a lack of knowledge and relevant research on its management.AIM To investigate the effect of intratympanic dexamethasone injection in the treatment of pregnant patients with SSNHL.METHODS A retrospective chart review was made for the period between June 2017 and August 2019 at our Department of Otorhinolaryngology-Head and Neck Surgery.Pregnant women who met the criteria for SSNHL were included and grouped based on the therapeutic modalities.The treatment group received intratympanic dexamethasone(2.5 mg)q.o.d.for a total of four times,while the control group received no medication other than bed rest and medical observations.All the patients were under close care of obstetricians.Pure-tone audiograms were performed before and after treatment.RESULTS Eleven patients who met the inclusion criteria were assigned to the treatment group(n=7)and the control group(n=4).The mean age of patients was 31.2±3.8 years;the right ear was affected in seven(63.64%)cases.Two patients(18.2%)suffered from vertigo,10(90.9%)suffered from tinnitus and 6(54.5%)suffered from aural fullness.The time from onset to clinic visit was relatively short,with a mean time of 1.3±0.9 d.All the women were within the second or third trimester;the average gestation period was 26.0±6.2 wk.The pure-tone averages at onset between the two groups were similar.After one wk of therapy,the treatment group had a curative rate of 57.1%and a significantly better hearing threshold and greater improvement compared to the control group(all P<0.05).Some patients experienced transient discomfort from intratympanic injections that disappeared after getting rest,while none had permanent complications.All patients delivered healthy full-term neonates with an average Apgar score of 9.7±0.5.CONCLUSION Intratympanic dexamethasone injections can be used as a first-line therapy in pregnant women with SSNHL.

Development of a script of phonemically balanced monosyllable lists of Mandarin-Chinese

Objectives To develop a set of monosyllable audiometry test material that can be used in speech recognition testing in Mandarin Chinese. Materials and Methods In an effort to improve reliability and efficiency in clinical practice, a set of 30 test lists of 25 monosyllable test items each was designed with consideration of the following: length of the list, phonemical balance (PB), word utility frequency, coverage of common words, and equivalency among lists. The 30 lists contained 750 monosyllabic words and were constructed on the basis of Chinese phoneme distribution probability summarized in the Manual of Acoustic. The occurrence incidence of the 22 consonants, 36 vowels, and 4 tones of the Chinese Mandarin characters in the 30 test lists were calculated. To achieve PB, 489 monosyllables were selected from the 2500 most commonly used Chinese characters and the 4000 most commonly used Chinese phrases to compile the 30 monosyllable test lists using a computer algorithm with manual adjustment. Results Thirty phonemical balanced word lists of common Mandarin Chinese monosyllabic words were compiled. Each list consisted of 25 monosyllables. A total of 489 phonemes (consonants, vowels and tones) were included in the set. Conclusions This set of lists can potentially be used as the basic lists for future development of Mandarin PB monosyllable speech test materials.

Objective frequency-specific hearing thresholds definition for medicolegal purposes in case of occupational NIHL: ASSR outperforms CERA

Audiological use of the 40 Hz-ASSR (auditory steady state responses) could be valuable for objectivelyestimating the frequency-specific threshold in adults undergoing an expertise examination for medicolegal and/or compensation purposes. The present prospective study was set up to clarify the relationship between the thresholds obtained by cortical evoked response audiometry (CERA) and by 40 HzASSR, in the same ears, within a large homogeneous sample of 164 subjects (328 ears) with NIHL andwell documented exposure to noise. All these subjects claimed financial compensation for occupationalNIHL, and there was a suspicion of exaggeration of the reported NIHLs. ASSR thresholds show a goodcorrelation with the CERA thresholds. However, a systematic shift is noticed, ASSR thresholds being onaverage (1e2 e 3 kHz) 4.38 dB lower (i.e. showing less hearing loss) than CERA thresholds. Moreover, thebinaural multiple ASSR technique allows a considerable time gain when compared to the CERA.

Does dyslipidemia worsen the hearing level in diabetics?

Objective: To identify the effect of dyslipidemia on auditory function detected by Pure Tone Audiometry. To check if dyslipidemia worsens the hearing level in diabetics.Design: This was a comparative study where 120 subjects between the age group of 20 and 50 years underwent pure tone audiometry, lipid profile and blood sugars. Group 1 consisted of 30 subjects with type 2 diabetes and dyslipidemia; Group 2 had 30 subjects with isolated diabetes;Group 3 had 30 with isolated dyslipidemia and Group 4 included 30 normal subjects as control.Results: Significant hearing loss was seen only in the group with isolated diabetes(63%). The most common type of hearing loss was high frequency sensorineural hearing loss. When comparison was made between the combinations of different lipid profiles, no association was found to the level of hearing.Conclusions: Diabetics are more prone to high frequency hearing loss. Altered lipid profile has no role in causing hearing loss.

Correlation of semi-quantitative findings of endolymphatic hydrops in MRI with the audiometric findings in patients with Meniere's disease

Purpose:To investigate the correlation between vestibular hydrops(VH),cochlearhydrops(CH),vestibular aqueduct non-visibility(VANV),and visually increased perilymphatic enhancement(VIPE)with the findings of pure-tone audiometry(PTA)in Meniere’s disease(MD)patients.Methods:In this cross-sectional study,53 ears belonging to 48 patients were divided into two groups and evaluated.In group“MD patients,”there were 24 ears of 19 patients diagnosed with the definite MD(14 patients with unilateral and 5 patients withbilateral involvements).The“control group”consisted of 29 non-symptomatic ears belonging to patients diagnosed with unilateral sudden sensory-neural hearing loss or unilateral schwannoma.All the patients underwent 2 sessions of temporal bone MRI using the same 3T system:an unenhanced axial T1,T2,and 3D-FLAIR MRI,an intravenous gadoliniumenhanced axial T1 fat-sat,and 4 h after the injection,an axial 3D-T2 cube and 3D-FLAIR session.VH,CH,VANV,and VIPE were assessed.Subsequently,the correlation between EH indices and PTA findings(in three frequency domains of low,middle,and high)were evaluated,and the predictive value of MRI was calculated.Results:VH was significantly correlated with the hearing threshold in the low,middle,and highfrequency domains.CH was also correlated with the hearing threshold in the low and middle domains.Contrarily,VIPE was not associated with hearing thresholds,and VANV was only correlated with the hearing threshold in low frequencies.Conclusion:The grade of VH,CH,and VANV were significantly correlated with the hearing thresholds in PTA.

Newborn Hearing Screening—Experience at a Tertiary Hospital in Northwest India

Objective: To determine the incidence of hearing impairment in a standardized population of neonates seeking care in a tertiary hospital in Northwest India. Universal hearing screening is implemented in many developed countries. However, neither universal screening, nor high risk screening, exists in India. The incidence of hearing loss in India is found to be 1 to 6 per 1000 newborns screened [1-3]. Screening only the high risk neonates misses 50% of babies with hearing loss [4,5], hence a cost effective universal screening is the viable option to sustain such a program. In our study, the possible burden of hearing disability was evaluated in babies born at a tertiary care hospital in Northwest India. One thousand newborns were screened using Transient Evoked OtoAcoustic Emissions (TEOAE) and 28.6% of them had risk factors. Four out of One Thousand were detected with hearing loss. Brain Stem Evoked Response (BERA) was used to confirm and determine the extent and the type of deafness in the neonates who were screened positive.

Role of Cartilage as a Graft Material for Tympanic Membrane and in Middle Ear Reconstruction

Objective: The work was planned to evaluate the results of cartilage graft in the surgical treatment of chronic suppurative otitis media. Study Design: A prospective study. Materials and Methods: The present study was a prospective study of tympanoplasties and tympanomastoid surgeries performed on 100 patients. The main outcome measures were both anatomical and functional in form of graft incorporation and postoperative hearing function. Results: Cartilage was used as tympanic membrane and/or ossicle graft in the cases. There were no immediate postoperative or long term complications of surgery except for 10 cases in which there was a failure of graft uptake. There was a 7.6-decibel (dB) improvement in mean air conduction threshold post-operatively. A mean closure of average air bone gap of 8.4 decibels (dB) was noted which was statistically significant. Conclusion: The cartilage graft is a very effective option for the repair of the conducting mechanism of the ear with good take-up rates, less chances of rejection or extrusion and very few significant complications. The thickness of cartilage creates stiffness that is more resistant than the fascia to the anatomic deformities caused by negative middle ear pressure thus improving the long term integrity of the graft.