Estudio retrospectivo de 544 timpanoplastias con cartílago y pericondrio: resultados anatómicos y funcionales / A retrospective study of 544 tympanoplasty with cartilage and perichondrium: anatomical and functional results

Introducción: el cierre de las perforaciones timpánicas se realiza con diferentes materiales, entre ellos el cartílago y el pericondrio. En este estudio se compararon los resultados anatómicos y funcionales obtenidos con ambos materiales, y se evaluaron posibles factores asociados con los buenos resultados. Material y métodos: estudio retrospectivo en pacientes intervenidos de timpanoplastia sin mastoidectomía entre el 1 de enero de 2001 y el 31 de diciembre de 2018. Resultados: se incluyeron 544 timpanoplastias. En la mayoría se utilizó cartílago (78,5 %) y en el resto pericondrio. El cartílago se utilizó con mayor frecuencia en los menores de 18 años (p=0,001), perforaciones totales y subtotales (p=0,000) y timpanoplastias secundarias y terciarias (p=0,008). No hubo diferencias en el tiempo de seguimiento (15,68 ± 22,18 meses frente al 12,86 ± 14,9 meses, p=0,169). La tasa de éxito anatómico fue mayor en el grupo de cartílago, sin diferencias en los resultados auditivos (82 % con cartílago y 78,3 % con pericondrio). El éxito anatómico se relacionó con la técnica utilizada para la reconstrucción con cartílago, mientras que los resultados auditivos se asociaron significativamente con el estado de la mucosa del oído medio y la cadena de huesecillos en el momento de la cirugía y el éxito anatómico posquirúrgico. Conclusiones: con el cartílago se consiguieron mejores resultados anatómicos que con el pericondrio, sin diferencias a nivel funcional. Sin embargo, los resultados funcionales empeoraron si había patología a nivel del oído medio y en ausencia de restauración anatómica.

Introduction: Different materials are used to close tympanic perforations. This stu-dy aimed to compare anatomical results obtained with cartilage and perichondrium and evaluate factors associated with successful results. Material and method: Re-trospective study of patients who underwent tympanoplasty without mastoidectomy between January 1, 2001, and December 31, 2018. Demographic data, ear pathology, surgical intervention, and anatomical and functional results were collected. Results:544 tympanoplasty were included. Cartilage was the most used (78.5%). Cartilage was used more frequently in children under 18 years (p = 0.001), to reconstruct total and subtotal perforations (p = 0.000) and in secondary and tertiary tympanoplasty (p = 0.008). Follow-up time did not differ between the two groups (15.68 ± 22.18 months vs. 12.86 ± 14.9 months, p = 0.169). The anatomical success rate was higher in the cartilage group, with no significant differences in hearing outcomes (82% with cartilage and 78.3% with perichondrium). Anatomical success was related to the technique used for cartilage reconstruction (monoblock or palisade). Hearing re-sults were significantly associated with the state of middle ear mucosa at the time of surgery, the state and mobility of the ossicle chain, and post-surgical anatomical suc-cess. Conclusions: Cartilage achieved better anatomical results than perichondrium. Both materials were comparable on a functional level. However, the functional re-sults worsen if there is pathology of the middle ear (mucosa or chain of ossicles) and anatomical restoration is not achieved.

Effect of Vitiligo on Auditory Functions: Is There Any Association?

Abstract Introduction Vitiligo is an acquired pigmentary disorder of unknown etiology, clinically characterized by whitish macules caused by selective loss of melanocytes. There are many melanocytes in the human cochlea. Recent studies have suggested a direct relation between cochlear dysfunction and decreased amounts of melanin. Objective To determine the effect of vitiligo on auditory function. Methods The present prospective, case control study was performed over a period of 1 year in patients between 15 and 40 years old with nonsegmental disease and the same number of controls. Pure tone audiometry (PTA) and Otoacoustic emission (OAE) were performed to analyze the correlation between vitiligo and auditory function. Results The mean pure tone audiometric threshold in the right ear at 0.5, 8 kHz, and in the left ear at the frequency of 8 kHz in the case group were significantly higher as compared with controls. The average band reproducibility (%) in the right and left ear of controls was significantly higher at the frequency of 4 kHz as compared with cases. It has been observed that signal to noise ratio was statistically higher at the frequency of 5kHz in the right ear and at 2, 3, and 5kHz in the left ear in controls as compared with cases. On the basis of disease type and duration of disease; mean pure tone audiometric threshold, average band reproducibility and signal to noise ratio, no significant effect was observed in the present study. Conclusion Vitiligo has an effect on cochlear function irrespective of the duration or distribution of the disease.

Achievements, Problems, and Future Direction of the Quality Control Program for Special Periodic Health Examination Agencies in Republic of Korea

The ultimate goal of the quality control program for special periodic health examination agencies is to diagnose the health condition of a worker correctly, based on accurate examination and analysis skills, leading to protect the worker’s health. The quality control program on three areas, chemical analysis for biological monitoring since 1995, and pneumoconiosis, audiometric testing since 1996, has contributed to improve the reliability of occupational health screenings by improving the issues including standardization of testing methods, tools, diagnostic opinions, and reliability of analysis for biological monitoring. It has contributed to improving the reliability of occupational health monitoring by rectifying the following issues associated with previous monitoring: absence of standardized testing methods, testing tools that are not upgraded, mismatching diagnostic opinions, and unreliable results of biological specimen analysis. Nevertheless, there are issues in need of further improvement such as lack of expertise or the use of inappropriate method for health examination, and passive and unwilling participation in the quality control. We suggested solutions to these problems for each area of quality control program. Above all, it is essential to provide active support for health examiners to develop their expertise, while encouraging all the health screening agencies, employers, and workers to develop the desire to improve the system and to maintain the relevance.

Modelamiento predictivo de la pérdida auditiva laboral, relacionada con el tratamiento de absorción acústica en una industria metal-mecánica en Chile / Predctive modeling of labor hearing loss, related to the treatment of acoustic absorption in metal-mechanic industry in Chile

La presente investigación evalúa el impacto que tiene en la protección de la audición de los trabajadores, la incorporación del tratamiento acústico del entorno laboral correspondiente al sector metal-mecánico de la industria Inchalam, ubicada en Santiago de Chile, cuyo entorno es tratado con materiales absorbentes certificados, ubicados estratégicamente en las zonas de mayor exposición al ruido en dicha industria, considerado este sector productivo como el más vulnerable en cuanto a patologías auditivas. Los resultados de la investigación evidencian que diversos escenarios propuestos para el tratamiento acústico absorbente pueden llegar a valores de reducción máximos de 2 dB en la exposición a ruido de algunos puestos de trabajo, concluyéndose que es una alternativa efectiva en términos de reducción de la exposición ocupacional a ruido de los trabajadores, cuando la actividad laboral y maquinarias no permite tratar acústicamente la fuente ni el receptor. Respecto de la proyección de la Pérdida Auditiva, según los criterios de la Norma ISO1999 (Determination of occupational noise exposure and estimation of noise induced hearing impairment) y Prexor (Protocolo de Exposición Ocupacional al Ruido), se modeló una población de trabajadores varones de 50 años de edad y 30 años de exposición al ruido. La configuración diseñada permite predecir una disminución de hasta 5 dB en la banda más crítica, lo que implica una disminución de 3 dB promedio en la curva audiométrica, que a su vez incide en el 50% de disminución de la energía acústica recibida en 30 años de exposición y que para el caso estudiado aleja a esta población de un daño médico-legal y con ello de las eventuales indemnizaciones.

The investigation will assess the impact on hearing protection for workers, a metal mechanic sector Inchalam industry located in Santiago of Chile, the incorporation of acoustic treatment of the working environment, with certified absorbent materials, strategically located in areas greater exposure to noise in the industry. The project includes the use and acquisition of acoustic software Rap-One a Soft-dB Canadian Company, that allows input measurements Sound Pressure Level Equivalent directly to software from the activity measured. The results of the research conducted show that various scenarios proposed for the absorbent acoustic treatment, can reach maximum values of 2dB reduction in noise exposure of some jobs, concluding that it is an effective alternative in terms of reduction occupational noise exposure of workers when the work activity and machinery does not allow acoustically treat to the source or receiver. About the projection of Hearing Loss, according to the criteria of the Standard ISO1999 and Prexor, a population of male workers 50 years old and 30 years working, was modeled noise exposure, the configuration modeled to predict a decrease of up to 5 dB in the most critical band, which implies a decrease of 3 dB average audiometric curve, corresponding to 50% decrease of the acoustic energy received by 30 years of exposure and for the case studied this population away from harm legal medical and thus of any indemnities.

Co-relation of audiometric configurations and auditory difficulties in adults with acquired sensori-neural hearing loss

Introduction: Hearing impairment is one of the most common handicapping problems in this country. There are millions of individuals in this country with varying degrees and types of hearing impairment including children, adults and elders. Hearing is important for speech and language development. Even minor degrees of hearing impairment, especially pre-lingual can affect overall development. Aim: To correlate the different audiogram configurations in adults with acquired sensori-neural hearing loss with the self reported auditory difficulties (which rules out biased reports). Materials and methods: The research design was exploratory and the sampling was purposive. The sampling selection was prospective. All the subjects we selected were according to the following criteria. Inclusion criteria were the patients selected should have minimum 3 years of sensori-neural hearing loss, age range was between 18 to 60 years, pure-tone average (500, 1000 and 2000 Hz) hearing loss was > 25 dB HL and ˂70 dB. Results: Audiogram Pattern wereFlat Pattern, Gradual Sloping, Sharply sloping, Precipitously sloping. Conclusion: Irrespective of audiogram configurations speech intelligibility in noise is most severely affected and discrimination of sound is least severely affected. The patients with similar looking audiograms had similar perception of auditory difficulties (Flat and gradual sloping patterns had similar difficulties. Trough/ saucer and notch also had similar auditory difficulties).

Audiometric analysis of different causes of hearing loss in patients attending a tertiary level hospital in India

Background: We sought to understand the audiometric profile of various causes of hearing loss in our patients. Patients were classified as conductive and sensorineural hearing loss along with their specific etiopathological causes. Materials and methods: After approval of the ethics committee, we enrolled patients from our outpatient clinic that presented with complaints of hearing loss. All patients underwent general and systemic examination to ascertain the etiopathological cause of their hearing loss, followed by audiometric analysis. The data was analysed using appropriate statistical methods. Results: 100 patients were included in our study, of which 16 had mild, 36 moderate, 28 severe and 15 had profound hearing loss. Chronic suppurative otitis media was the commonest cause of conductive hearing loss, with majority having moderate level hearing loss. Congenital causes were the commonest in sensorineural hearing loss, of which 12 had profound hearing loss. Conclusion: Audiometric analysis helps in determining the prognostic evaluation of the patients. This study calls for similar research in different geographical locations

THE EFFECT OF NOISE POLLUTION ON HEARING IN MARBLE FACTORY WORKERS OF AJMER, RAJASTHAN: A CASE STUDY

Introduction: The noise pollution is defined as the unwanted sound which is released into the environment. Noise induced hearing loss in an increasingly prevalent disorder that result from exposure to high intensity sound, especially over a long period of time. Materials & Methods: The present study has been conducted in the Department of Physiology and E.N.T. in a group of 60 subjects with 30 marble factory workers and 30 normal individuals. Results: Audiometric values were consistently lower in Normal than in marble factory workers. The differences were statistically significant among both sexes and that too for the parameters of Right and Left ear. Discussion and conclusion: In this study mild hearing loss was 20%, moderate hearing loss was 16.67%, moderately severe hearing loss was 36.67% and severe hearing loss 26.66%.This study also concludes that the presence of impact noise is more Hz to hearing irrespective of the duration of exposure but in workers exposed to continuous noise, the duration of exposure had a more prominent effect on the hearing loss.

Environment Arrangement for Test Booth of Audiometry / 中国康复理论与实践

This paper represented a recommended arrangement of audiometric test environment, including decoration of sound-isolated room or booth, displacement of the furniture and equipment, optimal location of subjects and audiologists, etc.

Otoesclerosis: Aspectos histopatológicos y resultados auditivos de la estapedostomía / Otosclerosis: Histopathological features and stapedostomy hearing results

Introducción: La otoesclerosis es una enfermedad que produce hipoacusia de conducción que histopatológicamente corresponde a un proceso focal de remodelación ósea denominado otoespongiosis. Varios estudios describen el inicio y las características de este proceso, pero no existen trabajos que correlacionen el grado de afección histológica con el nivel de deterioro auditivo. Objetivo: Correlacionar observaciones anatomopatológicas con variables clínicas, intraoperatorias, audiométricas y evaluar el resultado de la estapedostomía. Material y método: Estudio retrospectivo incluyendo los pacientes sometidos a estapedostomía entre 1995 y 2011, con estudio histopatológico de estribo y evaluación audiométrica pre y posquirúrgica. Estadísticamente, se hizo análisis univariado de variables categóricas y continuas, para luego ajustar modelo logístico para identificar predictores de éxito quirúrgico. Para la tabulación de datos, obtención de resultados y análisis se utilizó el software estadístico Stata® 12 (StataCorp. 2011. College Station, TX: StataCorp LP). Resultados: Se reclutaron 204 estapedostomías, sólo el 24,51% tuvo estribos anormales. El aspecto macroscópico de la platina no tuvo relación con el resultado microscópico (p =0,476), no se encontró asociación estadística entre umbrales audiométricos prequirúrgicos aéreos (p =0,291) y óseos (p =0,824) con el grado de severidad histopatológica. La mejoría vía aérea posquirúrgica (p =0,326) y cierre del gap aéreo-óseo (p =0,23) no se correlacionó con el grado histológico. Conclusión: El impacto primario de la estapedostomía fue significativo en el mejoramiento del nivel de audición del paciente. El estudio rutinario anatomopatológico de estribo en estapedostomía carece de valor pronóstico a diferencia de otros factores analizados en este estudio.

Introduction: Otosclerosis causes conductive hearing loss that histologically corresponds to a bone remodeling process called otoespongiosis. Although multiple pathological studies describing onset and the characteristics of this process, there are no articles in literature that correlate histological disease with hearing impairment and surgical outcomes. Aim: Correlate pathological disease with clinical, intraoperative and audiometric variables and evaluate the stapedostomy outcome. Material and method: Retrospective study including patients undergoing stapedostomy between 1995 and 2011, with histopathologic evaluation of stapes bone and pre and postoperative audiometric evaluation. Statistically, univariate analysis for categorical and continuous variables was used, then a logistic model to identify predictors of surgical success was adjusted. For data tabulation and analysis Stata®12 (StataCorp. 2011. College Station, TX: StataCorp LP) statistical software was used. Results: 204 stapedectomies were assessed, 24.51%% with abnormal stapes bones, the gross appearance of the stage was not related to the microscopic result (p =0.476), no association between pre-surgical air audiometric thresholds (p =0.291) and bone (p =0.824) with histopathologic severity was found. The improved postoperative airway threshold (p =0.326) and air-bone gap closure (p =0.23) did not correlate with histology. Conclusion: Stapedostomy primary outcome, ie, improvement in hearing thresholds, as well as the air-bone gap, were significant. Routine pathological stapes bone study had no prognostic value in contrast to other factors analyzed in this study.

Ambient Noise Levels in the Audiometric Test Rooms Used for Special Periodic Health Examination / 대한산업의학회지

OBJECTIVES: The ambient noise levels in the test rooms affect the workers's hearing threshold. The present study was designed to assess the ambient noise levels in the test rooms to determine if valid hearing tests, both pure-tone air conduction and bone-conduction, could be performed in these environments. METHODS: In the present study, third octave band ambient noise sound pressure levels were measured in 124 audiometric test rooms used for clinical audiometry, and the results were compared with the ANSI third octave band maximum permissible ambient noise levels (MPANLs) for each test condition and frequency range. RESULTS: The ambient noise SPLs were highest in the lower frequencies, and this decreased as the frequency increased. For the "ears covered"condition, about 24.2% of the rooms were in compliance (pass) with the MPANLs for the 125-8000 Hz, 35.5% were in compliance for the 250-8000 Hz range and 55.6% were in compliance for the 500-8000 Hz range. For the "ears not covered"condition, only about 8.1% of the rooms passed for the 125-8000 Hz, 13.7% of the rooms passed for the 250-8000 Hz range and 34.7% of the rooms passed for the 500-8000 Hz range. All 124 rooms met the OSHA MPANLs. CONCLUSIONS: The results of this study strongly indicate that clinical audiometry is being conducted in test rooms having unacceptable or excessive ambient noise levels.

Diagnostic Value of the Audiometric Tests in the Acoustic Neuroma / 대한이비인후과학회지

BACKGROUND: With the advance of diagnostic technology such as the magnetic resonance imaging, small sized acoustic neuroma has been detected more early and easily. However, the significance of the audiologic examinations could not be ignored because of simplicity of the test procedures as a screening for the acoustic neuroma. OBJECTIVES: This study analyzed the results of preoperative audiologic tests in the surgically confirmed acoustic tumors and compared the diagnostic accuracy and clinical significances. MATERIALS AND METHODS: From May 1990 to April 1997, histopathologically confirmed 26 cases of acoustic neuromas were retrospectively reviewed and analyzed. All the patients were examined pure tone, speech, and auditory brainstem response audiometry. Special audiometric tests for the differential diagnosis of the retrocochlear lesion were performed in selected patents. RESULTS: Tumor size and correlation of the pure tone and speech audiometry were analyzed. The correlations were poor both in pure tone audiometry(p=0.3987 r2=0.03) and speech discrimination score(p=0.3932, r2=0.043). Diagnostic significance of the other audiometric tests showed various results: Suprathreshold adaptation was positive in 5 among 7(71.4%): Roll over phenomenon were showed in 2 among 3: Tone decay test was positive in 4 among 8(50%): Stapedial reflex was decayed in 2 among 5 patients. In the auditory brainstem response(ABR), 16(61.6%) patients showed any waves and 5(19.2%) patients showed only wave I or wave I and II. In five patients(19.2%) showed delayed I-V inter-peak latency. CONCLUSIONS: Among series of the audiologic tests in the acoustic neuroma, ABR was the most valuable diagnostic test and other audiologic tests were showed less sensitivity for the diagnosis of retrocochlear lesion.

The Changes of Hearing Threshold Level in Noise-exposed Workers / 대한산업의학회지

Using audiometric test data, noise exposed workers were followed up to assess the activities for hearing conservation from 1989 to 1992. The subjects of study were 71 workers who could be followed up at least two years during this follow-up period. In all subjects, increasing trend of hearing threshold levels (HTLs) was observed after three years of follow-up at all testing frequencies in audiometry and this increase was statistically significant at 8KHz(p<0.05). Also, HTLs increased significantly(p<0.05) in the workers who complained tinnitus(at 0.25, 8KHz), who ws below 90 dB (at 8KHz). Effectiveness of the activities for hearing conservation, assessed by sequential test-retest comparisons, was lower in the workers who complained tinnitus, who had past history of ear disease, and whose workplace noise level was below 90 dB. These findings suggest that the activities for hearing conservation at workplace may have been unsatisfactory until now and more stringent measures may be necessary, especially in the workers who complain tinnitus, who have past history of ear disease, and whose workplace noise level is below 90dB.

Cross-sectional audiometric study among cane sugar factory workers.

Cross-sectional audiometric study among 1219 cane sugar factory workers from 13, factories in the year 1988 has shown relationship between noise exposure and hearing loss with X21.d.f. = 37.02 (When X21.d.f. = 3.84 for p = 0.05). Both unilateral and bilateral loss have been found closely among the exposed. Among the non-exposed, unilateral loss is twice of bilateral loss. Fifty percent of hearing loss is mild. The another half is moderate and severe. About eighty five percent o hearing loss has been detected at high frequencies (4.8 kHz). Above ninety percent of workers with hearing loss have been on the job for 5 years or longer. Most of hearing loss workers experienced on job classifications such as juice extractions, boilers, sugar spinning machines, electroturbine and evaporators. The relationship between hearing loss and average area noise levels is not detected by regression analysis.