Listening to Sentences in Noise: Revealing Binaural Hearing Challenges in Patients with Schizophrenia

OBJECTIVE: The present, case-control, study investigates binaural hearing performance in schizophrenia patients towards sentences presented in quiet and noise. METHODS: Participants were twenty-one healthy controls and sixteen schizophrenia patients with normal peripheral auditory functions. The binaural hearing was examined in four listening conditions by using the Malay version of hearing in noise test. The syntactically and semantically correct sentences were presented via headphones to the randomly selected subjects. In each condition, the adaptively obtained reception thresholds for speech (RTS) were used to determine RTS noise composite and spatial release from masking. RESULTS: Schizophrenia patients demonstrated significantly higher mean RTS value relative to healthy controls (p=0.018). The large effect size found in three listening conditions, i.e., in quiet (d=1.07), noise right (d=0.88) and noise composite (d=0.90) indicates statistically significant difference between the groups. However, noise front and noise left conditions show medium (d=0.61) and small (d=0.50) effect size respectively. No statistical difference between groups was noted in regards to spatial release from masking on right (p=0.305) and left (p=0.970) ear. CONCLUSION: The present findings suggest an abnormal unilateral auditory processing in central auditory pathway in schizophrenia patients. Future studies to explore the role of binaural and spatial auditory processing were recommended.

The Hyperactivity of Efferent Auditory System in Patients with Schizophrenia: A Transient Evoked Otoacoustic Emissions Study

OBJECTIVE: Electrophysiological studies, which are mostly focused on afferent pathway, have proven that auditory processing deficits exist in patients with schizophrenia. Nevertheless, reports on the suppressive effect of efferent auditory pathway on cochlear outer hair cells among schizophrenia patients are limited. The present, case-control, study examined the contralateral suppression of transient evoked otoacoustic emissions (TEOAEs) in patients with schizophrenia. METHODS: Participants were twenty-three healthy controls and sixteen schizophrenia patients with normal hearing, middle ear and cochlear outer hair cells function. Absolute non-linear and linear TEOAEs were measured in both ears by delivering clicks stimuli at 80 dB SPL and 60 dB SPL respectively. Subsequently, contralateral suppression was determined by subtracting the absolute TEOAEs response obtained at 60 dBpe SPL during the absence and presence of contralateral white noise delivered at 65 dB HL. No attention tasks were conducted during measurements. RESULTS: We found no significant difference in absolute TEOAEs responses at 80 dB SPL, in either diagnosis or ear groups (p>0.05). However, the overall contralateral suppression was significantly larger in schizophrenia patients (p<0.05). Specifically, patients with schizophrenia demonstrated significantly increased right ear contralateral suppression compared to healthy control (p<0.05). CONCLUSION: The present findings suggest increased inhibitory effect of efferent auditory pathway especially on the right cochlear outer hair cells. Further studies to investigate increased suppressive effects are crucial to expand the current understanding of auditory hallucination mechanisms in schizophrenia patients.

Otoscopic Changes Before and After Shooting Amongst Military Army Personnel

The effect of loud noise to the army personnel is often identifi ed when hearing loss had already developed. Acoustic trauma during shooting training can also lead to acute changes in the ear which is shown on otoscopic examination. This study was undertaken to determine the effectiveness of hearing protective device (earplug) on the prevalence of external ear changes amongst military personnel during shooting. This is a prospective cross sectional study that was conducted among 76 military personnel, who were divided into two groups: those with and without earplugs during shooting. Each participant underwent 3 otoscopic examinations: (a) pre-shooting, (b) immediate post-shooting (within 48 hours) and (c) 2 weeks after shooting. A total of 78 army personnel who were scheduled to undergo shooting training were otoscopically examined. Eighty three percent of them did not wear earplugs before. The percentage of infl ammation of external auditory canal and tympanic membrane dullness increased tremendously among subjects from non–earplug group less than 48 hours post-shooting. Assessment after 2 weeks showed improvement in around 30% of the subjects. Loud noise has become an occupational hazard not only to the inner ear but it also predisposes the external and middle ear structures to some form of injury. Although improvement is seen after some period, a protective device such as an earplug should be recommended and the usage should be reinforced among the army personnel involved in shooting.

Clinical use of Malay Version of Vertigo Symptom Scale (MVVSS) in Patients with Peripheral Vestibular Disorder (PVD)

Introduction:The Vertigo symptom scale (VSS) is a well established tool for the evaluation of vestibular disorders and the associated symptoms of autonomic arousal and somatosensation. By using a validated Malay version of vertigo symptom scale (MVVSS) questionnaire, the severity of the vertigo from patients’ perspective can be determined and rated. Before MVVSS can be applied clinically among Malaysians, it was of interest to determine its clinical value in identifying vestibular disorders. Method: Forty normal and 65 PVD subjects participated in this cross-sectional study. Normal subjects were recruited amongst Universiti Sains Malaysia (USM) staff and students who had no history of ear and vestibular disorders. Results: Mean total score of MVVSS in normal and PVD subjects were 13.9 ± 11.1 and 30.1 ± 20.9, respectively. When the total scores of normal and PVD group were compared, the Mann-Whitney U test showed that there was a significant difference between the two groups (p<0.05). This is consistent with previous studies. It was also of interest to see if subtypes of PVD [benign paroxymal positional vertigo (BPPV), Meniere’s disease, labyrinthitis and unknown] have different MVVSS results. However, analysis of variance (ANOVA) found no significant difference in term of outcomes of MVVSS among the different PVD pathologies. Using receiver operating characteristic curve (ROC) method, the sensitivity and specificity of MVVSS were 71% and 60%, respectively. Conclusion: MVVSS is able to discriminate clinically among the normal and PVD subjects. However, it is not a good indicator for differential diagnosis of PVD subtypes, at least in this study. Its sensitivity and specificity in clinical diagnosis are reasonably high. Perhaps a bigger sample size would be useful to further study the clinical usefulness of MVVSS.

Radiographic evaluation of enlarged adenoids in children with chronic adenoiditis

To evaluate the use of soft tissue neck x-ray in the assessment of enlarged adenoids in children with chronic adenoiditis. Tertiary referral centre of Malaysia. Prospective study. We performed a soft tissue neck x-ray [lateral view] for adenoids in children with chronic adenoiditis admitted for adenoidectomy under general anaesthesia. Only those children whose parents /guardian agreed for imaging were included. The enlarged adenoids were graded from 1+ to 4+ where 1+ is the normal adenoids with normal nasopharyngeal airway and 4+ is massive enlargement of adenoids with totally occluded nasopharyngeal airway. RESULTS: Fifty children were accrued from June 1999 to September 2001. The ages of the children were from 3-12 years old. All of them had adenoidectomy successfully without any complications. The soft tissue neck x-ray showed 8% of the patients have 1+, 38% have 2+, 42% have 3+ and 12% have 4+ adenoids enlargement. Lateral soft tissue neck x-ray is a good method to demonstrate adenoids enlargement in children with chronic adenoiditis and convenient for the busy otorhinolaryngologists. It may help to determine that the symptoms are due to adenoids enlargement and exclude other causes

Outcome of a newborn hearing screening program in a tertiary hospital in Malaysia: the first five years

Universal newborn hearing screening [UNHS] was started in the Hospital Universiti Sains Malaysia [HUSM] in January 2003. To comply with international standards, we determined the outcome of the newborn hearing screening program for the first 5 years of its implementation, from January 2003 to December 2007. The program screened all infants who were delivered in HUSM. In a retrospective review, the outcomes in terms of coverage, prevalence of hearing impairment, referral rate for each screening, age at detection of hearing impairment and at hearing aid-fitting were analyzed. Ninety-eight percent of newborns were screened. The study included 16 100 randomly selected newborns. The initial screening referral rate was 25.5%. The prevalence of default for second and third screening was 33.9% and 40.7%, respectively. The mean [SD] age at detection of hearing impairment was 3.3 months [0.86]. The mean [SD] age at fitting of a hearing aid was 13.6 [4.8] months. The prevalence of hearing impairment was 0.09%. A newborn hearing screening program is an important tool for early diagnosis and treatment. Even though the prevalence of hearing impairment may be low, the problem needs to be addressed early as the development of infants requires normal hearing

Clinical and audiological profiles in children with chronic otitis media with effusion requiring surgical intervention

To determine the characteristic presenting symptoms, otoscopic findings, audiological profiles and the intraoperative findings of children with chronic otitis media with effusion who required surgical intervention. A prospective cross sectional study was undertaken in the otorhinolaryngology clinic of USM Hospital (HUSM) involving 25 cases (50 ears) of children with chronic otitis media with effusion requiring surgical intervention from June 1999 to September 2001. Their ages ranged from 3 to 12 years old. The gender distribution included males at 72 % and females at 28 %. The presenting symptoms noted were hearing impairment (52%), otalgia (18%), ear block (16%) and tinnitus (14%). The otoscopic findings were fluid in the middle ear (40%), dullness (32%) and retraction of the tympanic membrane (28%). On audiometry, 24 ears had moderate deafness (48%), 16 ears had mild deafness (32%) while 4 ears had severe deafness (8%). With tympanometry, 42 ears out of the total 50 had a flat type B curve (84%) while 6 ears had type As curve (12%). During myringotomy, middle ear secretion was seen in 38 ears (76%) out of the 50 ears; 22 ears had mucoid secretion while 16 ears had serous secretion. Clinically, the commonest presenting symptom was hearing impairment (52%) while the most common otoscopic finding was fluid in the middle ear (40%). Audiologically, most patients had moderate conductive hearing loss (48%) and a type B curve (84%) on tympanometry. On myringotomy middle ear fluid was found in 76 % of the ears.