effect of tympanic membrane perforation on real-ear to coupler difference acoustic transform function

Real-Ear-to Coupler Difference [RECD] is the difference in decibels, as a function of frequency, between the SPL at a specified measurement point in the ear canal and the SPL in a 2cc coupler, for a specified input signal. We investigated the effects of tympanic membrane perforation on the RECD. RECD was obtained using an insertion gain analyzer for 24 adult patients with dry tympanic membrane perforation [group 1] [31 ears] and 20 healthy adult control subjects [group 2] [40 ears]. Cases showed moderate conductive hearing loss in their mean hearing threshold level. There was no statistically significant difference between both anterior and posterior locations as regards the degree of hearing loss or as regards the RECD. There was a statistically significant difference of RECD at frequencies 250Hz, 500Hz and 750Hz, between both groups. The RECD was 3 to 6dB lower in group 1 than in group 2. There was a statistically significant difference on comparing RECD at frequencies 250Hz, 500Hz, 750Hz and l000Hz in right ears, and at frequencies: 250Hz and 500Hz and 750Hz in the left ears of both groups. In group 1, there was no statistically significant difference of RECD values at different frequencies between right and left sided perforations and there was no statistically significant difference of RECD values at different frequencies between both genders except at 1500Hz. There was no statistically significant correlation between the RECD and the age of the patients or their air-bone gap. RECD in patients with tympanic membrane perforation is lower than normal at frequencies [250Hz-750Hz]. We recommend that this discrepancy should be compensated for if average normal RECD are used in the preselection of target and gain to avoid under-amplification at lower frequencies. However, the large inter-subject variation strongly suggests the need for individual RECD measurements whenever possible in fitting aids for patients having tympanic membrane perforations

Directive counselling in tinnitus retraining therapy

Tinnitus retraining therapy [TRT] focuses on the behavioural retraining of the associations induced by tinnitus perception and on inducing and further facilitating the process of habituation of tinnitus perception. It has two main elements: directive counselling which is more important and sound therapy.To determine the effects [success or failure] of counselling in TRT as a habituation method in the management of patients suffering from tinnitus. Full history taking, clinical examination [otoscopic, audiologic and medical], and categorisation of patients according to TRT categories in 137 chronic tinnitus patients into: groups I: 52 patients receiving counselling only [TRT Category 0], group II: 21 patients receiving counselling and noise generators [TRT category 1], and III: 34 patients receiving counselling and hearing aids [TRT category 2] and group IV 30 patients receiving medication. The Tinnitus H and icap Inventory [THI] translated into Arabic was used for scoring. A pre- and post-treatment score difference of at least 20 points revealed effectiveness of TRT compared to medical treatment.But was not revealed if the patient changed to a less severe h and icap with a score difference of 18.56 +/- 10.48. Although THI exists an important guide in individual management and monitoring to evaluate tinnitus treatment outcome, comparing the results with other studies is difficult due to the non-st and ardized scoring of the real improvement as well as the different questionnaires used.

Monitoring of vestibular function during cisplatin therapy

Cisplatin is considered an indispensable chemotherapeutic agent inspite of its known ototoxicity. There is no generally accepted vestibular monitoring protocol that is efficient, cost effective and suitable for patients treated with cisplatin. The aim of this work was to study the vestibulo-ocular reflex [VOR] changes in an attempt for early identification and prevention of vestibular toxicity in patients receiving cisplatin chemotherapy. The final study group consisted of 39 patients. The pretherapy vestibular tests included electronystagmography and rotary chair tests which should be within normal. The vestibular monitoring procedure was scheduled one week after each cisplatin dose. Patients were re-evaluated at approximately 3 months after termination of therapy to assess the possible delayed residual effects [delayed ototoxicity or recovery patients]. After the first cisplatin dose, seven patients revealed bilateral canal paresis, reduced total eye speed and reduction in VOR gain at 0.01 and 0.02Hz. With successive cisplatin doses, the VOR gain showed significant reduction at higher frequencies. Three months after termination of therapy canal paresis and total eye speeds showed no change in the measured values. On the other h and, VOR gain was relatively improved

Hearing loss among Egyptian children with neonatal jaundice

Jaundice is a relatively common neonatal disorder. Hyperbilirubinemia is one of the risk factors that are known to affect the auditory pathway. The aims of this work were to evaluate the prevalence of hearing loss among children who suffered from neonatal and to evaluate the auditory pathway trying to establish the site of affection in the auditory system. The study included 117 subjects [97 patients and 20 normal as a control group]. For all of tem, ABR, OAE and tympanogram were done. Behavioral audiometer was performed was possible. The study revealed that 25 out of the 97 participant infants had suffered hearing loss. Hyperbilirubinemia affects the peripheral or central auditory pathway but it's residual effects affect mainly the central auditory pathway

Benign paroxysmal positional vertigo clinical, oculographic and postural features

Benign paroxysmal positional vertigo [BPPV] is the most common cause of vertigo of peripheral origin. Clinical, oclulographic and postural features in 212 patients with BPPV were reported. For all participants, history taking, Frenzel glass visualization of nystagmus, electronystagmograph [ENC] and sensory organization test [SOT] were performed. Females outnumbered males. The peak of incidence occurs in the six decade of age. The majority of cases belong to the idiopathic group. Abnormaities in calric testing were found in 42% of participants. Only 2 patients had central ENG results. SOT quantifies the patient's ability to maintain balance when visual and/or somatosensory cues are either absent or inappropriate

Efficacy of Epley maneuver for treatment of posterior canal benign paroxysmal positional vertigo

Presently, the treatment of choice for benign paroxysmal positional vertigo [BPPV] resulting from posterior canalithiasis [PC-BPPV] is the Epley maneuver. The aim of this work was t evaluate the short and long-term results of the Epley canalith maneuver as a treatment modality for PC-BPPV. Sixty-two patients with acute untreated PC-BPPV were recruited. They were divided into two groups. The first group [n=31] were treated by Epley maneuver. The second [n=31] received placebo treatment in the form of sugar capsules. For 32 subjects with posture and gait complaint, sensory organization test [SOT] was performed. All were followed up for one year. The results indicated that the Epley maneuver recovery rate was 87%. Three cases had deterioration of symptoms [one converted to later canal and two to anterior canal BPPV]. Out of the 31 patients [group, 2] 13 had spontaneous recovery and four remained symptomatic till the end of the year follow up. Regarding SOT results, out of the 25 participants with initial positive results, 15 [60%] had total improvement. On the other hand, four and six patients had partial and on improvement respectively and they required a further appropriate vestibular rehabilitation program

Management of posterior canal benign paroxysmal positional vertigo: comparative study

Benign paroxysmal positional vertigo [BPPV] is classically described by positioning induced vertigo and nystagmus. In view of the conflicting published results comparing the success of different treatment modalities, the aim of those work was to evaluate the results of the most popular three methods, Epley maneuver with and without using mastoid virbator and the Brandt and Dar off exercises [BDE]. Also, to study the role of the mastoid vibrator in facilitating the diagnosis in cases with a positive history and negative initial Dix-Hallpike test who require repetition of the test on other occasions. Ninety-two patients with acute, untereated unilateral posterior canal benign paroxysmal positional vertigo [PC-BPPV] were recruited. The patients were randomly divided into three groups. The first [31 patients] were tested [Dx-Hallpike] and treated by Epley maneuver without using mastoid oscillator. The second [31patients] were tested and treated by Epley maneuver using the mastoid oscillator. While the third group [30 patients] was instructed to perform the Brandt and Dar off exercise. It was concluded that the Epley maneuver particularly with mastoid oscillation has become the first line treatment for PC-BPPV