Accuracy and use of the reflexive behavioral (“Baah”) test and risk factor questionnaire for hearing screening in infants six months old and below

Objective@#To determine the accuracy, sensitivity, specificity, positive predictive values, and use of the Reflexive Behavioral “Baah” Test and NHSRC Level 1 and Level 2 Questionnaires in detecting hearing impairment in rural health communities. @*Methods@#This was a prospective cross-sectional study conducted at the rural health unit of five municipalities. Infants less than six months old were screened for hearing impairments using the OAE device (standard), the Reflexive Behavioral “Baah” test, and the NHSRC Level 1 and Level 2 Questionnaires. The “Baah” test and the filling out of the NHSRC Level 1 and 2 Questionnaires were done by trained health workers while OAE was done by an audiologist. @*Results@#A total of 103 babies, with a mean age of 41.9 days at the time of testing and a male to female ratio of 1.02:1 (52 males and 51 females) were tested. A hearing impairment prevalence of 4.9% (5 out of 103) was noted. The “Baah” test showed to have a sensitivity of 60%, specificity of 97.96% and an accuracy rate of 96.12%. The NHSRC Level 1 and Level 2 Questionnaires showed sensitivity, specificity, and accuracy rate of 40%, 67.35% and 66.02%, respectively for the former and 40%, 85.71% and 83.50%, respectively for the latter. Analysis of the complimentary use of the NHSRC Level 1 and Level 2 Questionnaires with the “Baah” test also showed no significant improvement to using the “Baah” test as a stand-alone screening tool with sensitivity, specificity, and accuracy of 60%, 67.35% and 66.99%, respectively for the “Baah” test and Level 1 Questionnaire, and 60%, 83.67% and 82.52%, respectively for the “Baah” test and Level 2 Questionnaire. @*Conclusion@#The Reflexive Behavioral “Baah” test is a potentially accurate, sensitive, specific, and acceptable standalone hearing screening test to identify infants with higher risk of hearing impairment in the rural health community setting. On the other hand, the use of the NHSRC Questionnaires as a stand-alone or complementary tool for “Baah” is unnecessary as it results to more false positive and false negative results.

The effect of increase in blood glucose level on hearing loss

Abstract Objective: Previous studies have shown that hearing function is also vulnerable to the effects of diabetes mellitus which can be shown by brainstem auditory evoked potential and distortion product otoacoustic emission recordings. This study aimed to investigate the changes of brainstem auditory evoked potential and distortion product otoacoustic emission in hyperglycemia and whether there is a relationship between reactive oxygen substances production and hearing deterioration in the rat model. Methods: 25 streptozotocin induced diabetic rats were divided into three groups: control, high blood glucose, and diabetes mellitus. Brainstem auditory evoked potential and distortion product otoacoustic emission were recorded, and thiobarbituric acid reactive substances levels were measured in the brainstem tissue. Results: At 8 kHz, the latencies of I, II, III, IV, and V brainstem auditory evoked potential waves in high blood glucose and diabetes mellitus groups were elongated, at 16 kHz, only these wave latencies of the diabetes mellitus group were prolonged compared with the control group. A significant decrease was also found in distortion product otoacoustic emission amplitudes at 4, 6, 8, and 10 kHz in the high blood glucose and diabetes mellitus groups compared to the control group. There was a significant increase in thiobarbituric acid reactive substances values due to the increase in blood glucose levels in the high blood glucose and diabetes mellitus groups compared to the control group. Conclusion: These results suggested that high blood glucose levels may cause hearing impairment not only in the diabetic state but also in the period of hyperglycemia before the onset of manifest diabetes mellitus and reactive oxygen substances may play an important role in the pathophysiology of diabetes mellitus. We suggest that regulating high glucose levels even before the onset of manifest diabetes mellitus may prevent hazardous effects on hearing function. Level of evidence: Level 3.

Pesquisaje auditivo universal en recién nacidos de provincia Guantánamo, 2020-2021 / Triagem auditiva universal em recém-nascidos na província de Guantánamo, 2020-2021 / Universal newborn hearing screening in Guantanamo province, 2020-2021

RESUMEN Introducción: El pesquisaje auditivo neonatal es la evaluación que permite detectar o sospechar pérdidas auditivas, abordándose mediante un plan de habilitación o rehabilitación. Objetivo: Determinar la cobertura del pesquisaje auditivo universal en la provincia de Guantánamo, en el contexto epidemiológico de la COVID-19, durante el periodo marzo 2020 a marzo 2021. Método: Se realizó un estudio descriptivo, retrospectivo y de corte transversal. El universo estuvo constituido por 5 999 recién nacidos vivos. Las variables estudiadas fueron: sexo, recién nacidos con y sin factores de riesgo, y las emisiones otoacústicas, cuyos resultados permitieron la evaluación de cobertura. Se definió el indicador estándar (95 %) y el tiempo en que se realizó las primeras emisiones otoacústicas. Se estableció como indicador el porcentaje de recién nacidos pesquisados antes de un mes de vida. Resultados: De los 5 999 nacimientos, el 51,7 % correspondió al sexo masculino y el 48,3 perteneció al sexo femenino. Al 100 % de los recién nacidos sin factores de riesgo (5 838) se les realizó la primera exploración, mientras que a aquellos con factores de riesgo (151) no se les pudo realizar al 0,2 % (10). La pesquisa de los recién nacidos sin factores ocurrió entre 1 y 3 días de nacidos. Nunca se realizaron pesquisas después de los 30 días de nacido en los que presentaron factores de riesgo. La cobertura fue de 99,8 % y el índice de referencia de 0,2 %. Conclusiones: El Programa de Pesquisaje Auditivo Universal en la provincia de Guantánamo en el contexto de la COVID-19 muestra cumplimiento en el indicador de cobertura.

ABSTRACT Introduction: Universal neonatal hearing screening is a test that enables to identify or suspect hearing loss, performed via habilitation or rehabilitation plan. Objective: Determine the coverage of universal hearing screening in the epidemiological context of COVID-19 in Guantánamo province, during the period of march 2020 to march 2021. Method: A descriptive, retrospective cross-sectional study was carried out. A total of 5 999 newborns (as Universe) were involved in the study. Variables used were as follow: sex, newborns with or without risk factors, and otoacoustic emissions, which outcomes allowed for the evaluation of universal hearing screening coverage. The standard indicator (95%) and the time at which the first otoacoustic emissions were made were defined. The percentage of newborns detected before one month of life was established as indicator. Results: The 51.1% of the 5 999 newborns were male and 48.3% were female. The 100% of newborns (5 838) without risk factors underwent to the first examination, meanwhile, among those with risk factors (151 newborns) 0.2% (10) could not be tested. Screening of newborns without factors occurred between 1 and 3 days after birth. Screening was never performed after 30 days of birth in those who presented risk factors. Coverage was 99.8% and the reference rate was 0.2%. Conclusions: Universal Hearing Screening Program application in the context of COVID-19 pandemic in Guantanamo province shows a fulfillment in the coverage indicator.

RESUMO Introdução: A triagem auditiva neonatal é a avaliação para detectar ou suspeitar de perda auditiva, que é abordada por um plano de habilitação ou reabilitação. Objetivo: Determinar a cobertura da triagem auditiva universal na província de Guantánamo, no contexto epidemiológico da COVID-19, durante o período de março de 2020 a março de 2021. Método: Foi realizado um estudo descritivo, retrospectivo, transversal. O universo consistia de 5 999 recém-nascidos vivos. As variáveis estudadas foram: sexo, recém-nascidos com e sem fatores de risco, e emissões otoacústicas, cujos resultados permitiram a avaliação da cobertura. O indicador padrão (95%) e o momento em que as primeiras emissões otoacústicas foram feitas foram definidos. O indicador foi definido como a porcentagem de recém-nascidos examinados antes de um mês de idade. Resultados: Dos 5 999 nascimentos, 51,7% eram homens e 48,3% eram mulheres. 100% dos bebês sem fatores de risco (5.838) foram examinados pela primeira vez, enquanto aqueles com fatores de risco (151) não puderam ser rastreados por 0,2% (10). A triagem de recém-nascidos sem fatores de risco ocorreu entre 1 e 3 dias após o nascimento. A triagem nunca foi realizada após 30 dias de nascimento naqueles com fatores de risco. A cobertura foi de 99,8% e a taxa de base foi de 0,2%. Conclusões: O Programa Universal de Triagem Auditiva na província de Guantánamo no contexto da COVID-19 mostra a conformidade com o indicador de cobertura.

Esketamine may be an ideal substitute for ketamine during cochlear function measurement

The mixture of ketamine and xylazine is widely used for the auditory brainstem response (ABR) measurement. Esketamine is twice as potent as ketamine. Our objective was to assess the influence of esketamine in mice undergoing cochlear function measurement including ABR and distortion product otoacoustic emission (DPOAE) measurement. C57Bl/6J mice were treated with an equivalent dose of analgesia and received either a single intraperitoneal (ip) injection of 100 mg/kg ketamine and 25 mg/kg xylazine or 50 mg/kg esketamine and 25 mg/kg xylazine. Hearing thresholds, peak latencies of waves I and V, and DPOAE thresholds were recorded. Time to loss of righting and time to regain righting were also assessed. We found that hearing thresholds, the peak latencies of waves I and V, and DPOAE thresholds were similar between the two groups (all P>0.05). Time to regain righting was significantly shorter in the esketamine group (P<0.001) than in the ketamine group. We concluded that when using equivalent doses of analgesia, esketamine may be an ideal substitute for ketamine during cochlear function test.

Speech-in-noise perception ability can be related to auditory efferent pathway function: a comparative study in reading impaired and normal reading children / Capacidade de percepção da fala no ruído pode estar relacionada à função da via auditiva eferente: estudo comparativo de crianças com dificuldade de leitura e com leitura normal

Abstract Introduction: Deficient auditory processing can cause problems with speech perception and affect the development and evolution of reading skills. The efferent auditory pathway has an important role in normal auditory system functions like speech-in-noise perception, but there is still no general agreement on this. Objective: To study the performance of the efferent auditory system in a group of children with reading impairment in comparison with normal reading and evaluation of its relationship with speech-in-noise perception. Methods: A total of 53 children between the ages of 8-12 years were selected for the study of which 27 were with reading impairment and 26 were normal reading children. Transient evoked otoacoustic emissions suppression and auditory recognition of words-in-noise test were performed for all the children. Results: The average amplitude of transient evoked otoacoustic emissions suppression showed a significant difference between the two groups in the right (p = 0.004) and in the left ear (p = 0.028). Assessment of the relationship between transient evoked otoacoustic emissions suppression and monaural auditory recognition of words-in-noise scores showed a significant moderate negative relationship only in the right ear (p = 0.034, r = −0.41) of the normal reading children. Binaural auditory recognition of words-in-noise scores were significantly correlated with the amplitude of transient evoked otoacoustic emissions suppression in the right ear (p < 0.001, r = −0.75) and in the left ear (p < 0.001, r = −0.64) of normal reading children. In the reading impaired group, ?a weaker correlation was observed between binaural auditory recognition of words-in-noise scores and transient evoked otoacoustic emissions suppression in the right (p = 0.003, r = −0.55) and in the left ear (p = 0.012, r = −0.47). Conclusions: Transient evoked otoacoustic emissions suppression pattern in the reading impaired group was different compared with normal reading children, and this difference could be related to efferent system performance. Words-in-noise scores in children with impaired reading were lower than in normal reading children. In addition, a relationship was found between transient evoked otoacoustic emissions suppression and words-in-noise scores in both normal and impaired reading children.

Resumo Introdução: O processamento auditivo deficiente pode causar problemas na percepção da fala e afetar o desenvolvimento e a evolução das habilidades de leitura. A via auditiva eferente tem um papel importante nas funções do sistema auditivo normal, como a percepção da fala no ruído, mas ainda não há um consenso sobre isso. Objetivo: Estudar o desempenho do sistema auditivo eferente em um grupo de crianças com dificuldade de leitura em comparação às com leitura normal e avaliação de sua relação com a percepção da fala no ruído. Método: Foram selecionadas para o estudo 53 crianças entre oito e 12 anos, das quais 27 tinham dificuldade de leitura e 26 apresentavam leitura normal. A avaliação por emissões otoacústicas evocadas transientes e o teste auditory recognition of words-in-noise foram feitos em todas as crianças. Resultados: A amplitude média da supressão das emissões otoacústicas evocadas transientes mostrou diferença significante entre os dois grupos na orelha direita (p = 0,004) e esquerda (p = 0,028). A avaliação da relação entre a supressão das emissões otoacústicas evocadas transientes e os escores monoaurais do teste auditory recognition of words-in-noise mostrou uma relação negativa moderadamente significante apenas na orelha direita (p = 0,034, r = -0,41) das crianças com leitura normal. Os escores binaurais do auditory recognition of words-in-noise foram significantemente correlacionados com a amplitude de supressão das emissões otoacústicas evocadas transientes na orelha direita (p < 0,001, r = -0,75) e na orelha esquerda (p < 0,001, r = -0,64) das crianças com leitura normal. No grupo com dificuldade de leitura, uma correlação mais fraca foi observada entre os escores binaurais do auditory recognition of words-in-noise e supressão das emissões otoacústicas evocadas transientes, na orelha direita (p = 0,003, r = -0,55) e na esquerda (p = 0,012, r = -0,47). Conclusões: O padrão de supressão das emissões otoacústicas evocadas transientes no grupo com dificuldade de leitura foi diferente em comparação com as crianças com leitura normal e essa diferença pode estar relacionada ao desempenho do sistema eferente. Os escores de palavras no ruído em crianças com dificuldade de leitura foram menores do que nas crianças com leitura normal. Além disso, foi encontrada uma relação entre a supressão das emissões otoacústicas evocadas transientes e os escores de palavras no ruído tanto em crianças com leitura normal quanto nas com dificuldade de leitura.

Comparative Study of Hearing Assessment in Diabetic Patients and Non-Diabetic Patients using Otoacoustic Emission and Pure Tone Audiometry at Sree Gokulam Medical College, Trivandrum, Kerala, South India

Introduction: The association between diabetes and hearing loss has been a topic of discussion since many years. Type 2diabetes mellitus (DM) which is the most predominant form of diabetes worldwide, accounts for 90% of cases globally. DMis a chronic metabolic disorder characterized by high blood glucose level, associated with insulin resistance and relativeinsulin deficiency. DM is associated with a lot of complications; a lesser known complication is auditory organ dysfunction.The International Diabetes Federation estimated in 2014 that 387 million people have diabetes worldwide and that by 2035this number will rise to 592 million. Among these, 179 million are undiagnosed. In the United States, the Centers for DiseaseControl and Prevention estimated in 2014 that 29.1 million people had diabetes and that 8.1 million of them (27.8%) wereundiagnosed. These data reflect the late detection of hearing loss due to undiagnosed diabetes. Studies have indicated thatvascular changes which include thickening of capillary walls in the stria vascularis, neural changes in the cochlea, and loss ofouter hair cells are the causes of hearing changes in DM.Objective: The objectives are as follows: (1) Primary objective: To assess the prevalence of hearing loss in patients with Type 2DM when compared to non-diabetic patients and (2) secondary objective: To analyze the effect of age, glycemic control (HbA1c),and duration of diabetes on auditory acuity and to assess whether otoacoustic emission (OAE) can be used as a screeningtest for hearing assessment in diabetics.Materials and Methods of Study: The design of this study was hospital based observational prospective study carried outfrom February 2017 to July 2018. A total of 100 patients who presented to the ENT OP Department Sree Gokulam MedicalCollege and Research Foundation were studied by dividing into two groups; Group A consisted of 50 type 2 diabetic patientsand Group B consisted of 50 age- and gender-matched non-diabetic patients. The age group of the patients was between 30and 50 years. All the patients were subjected to Pure Tone Audiometry for the quantitative and qualitative assessment of hearingloss. Transient OAE (transient evoked OAEs [TEOAE]) was also done to know whether it can be used as a screening test forthe early detection of hearing loss. HbA1c was done in diabetic patients to detect any association with the hearing loss. Ageand duration of diabetes and its correlation with hearing loss were also assessed.Results: Our study confirmed the existence of sensorineural hearing loss (SNHL) in type II diabetic patients, mostly bilateralmoderate SNHL. Age and duration of diabetics had an association with SNHL. As the age increases, there is increase in theauditory thresholds and amount of hearing loss (AHL). Type 2 diabetic patients with long duration of diabetes also had higherauditory thresholds at all frequencies from 250 to 8000 Hertz (Hz), when compared to non-diabetic patients and the AHL wasalso higher as the duration of diabetes increased. HbA1clevel had no significant correlation with hearing loss. Theresult of TEOAE was refer, i.e. abnormal in all the patientswith hearing loss.Conclusion: The present study reports SNHL in 68% of type IIdiabetic subjects and 2% of healthy non-diabetic subjects.The majority of the patients had bilateral moderate SNHL.The diabetic patients had increased hearing threshold at all frequencies with gradual increase in hearing loss from 250 Hz to 8000 Hz. Age and duration of diabetes had a positive correlationwith hearing loss. As the age increased AHL also increased. Similarly, as duration of diabetes increased, AHL also increased.HbA1c had no relation with auditory threshold and AHL. TEOAE can be used as a screening test for the early detection ofhearing loss in Type 2 diabetic patients, as the result was abnormal in all the patients with hearing loss. Since hearing loss canbe considered to be a consequence of diabetes, a metabolic assessment may be useful for patients presenting with hearingloss so as to reduce the high rate of undiagnosed diabetes mellitus in the community. The use of audio logical tests to monitorhearing in diabetic patients should be considered as a routine procedure so that quality of life can be improved for long standingdiabetics with needed therapeutic interventions for hearing improvement.

Universal hearing screening in newborns: experience in a tertiary care hospital of Mangalore, Karnataka, India

Background: The aim of the study was to do universal hearing screening of all newborns using otoacoustic emission (OAE), to know the incidence and risk factors of hearing loss in neonates.Methods: This was a prospective observational study done in a tertiary care hospital in Mangalore city in Karnataka. 950 neonates were screened with distortion product otoacoustic emission (DPOAE) during the study period of one year from 2017 to 2018. A repeat test was done at one and a half months of age if the first test failed. Auditory brain stem evoked response (ABER) was performed at 3 months of age if both the tests failed. Babies with hearing loss were referred to ENT specialist for further management. Comparison of the variables was done by student's t test and Chi-square test. P-value <0.05 was considered statistically significant.Results: Out of the 950 newborns screened with DPOAE test, 204 (21.4 %) babies had abnormal screen either in single or both ears. 7 out of 204 (3.43%) babies had abnormal OAE on repeat testing at one and half months. 2 out of 7 babies (0.96 %) had significant hearing loss ABER was performed at 3 months of age.Conclusions: Early identification by screening of hearing loss prevents a significant public health concern. Early recognition and intervention prior to 6 months have a significant positive impact on development.

Evaluation of the newborn hearing screening program in The Medical City based on Joint Commission on Infant Hearing (JCIH) 2007 position statement quality indicators

Objective@#The objective of this study is to evaluate the newborn hearing screening program in The Medical City based on the Joint Committee on Infant Hearing (JCIH) 2007 Position Statement Quality Indicators. @*Methods@#Study Design: Cross - Sectional Survey. Setting: Tertiary Private Hospital. Participants: All newborns who underwent newborn hearing screening in The Medical City for the year 2015. @*Results@#Of 2,010 patients delivered in the hospital in year 2015, 1,986 (98.8%) were screened. Among the 59 babies with initial “refer” results, 15 (25.42%) “referred” a second time while 24 (40.68%) “passed” the rescreening. Twenty (33.89%) did not undergo rescreening (10 were classified as dropouts, while another 10 did not undergo rescreening for various reasons. Of those who “referred” during rescreening, only 9 (60%) had further evaluation done with ABR/ASSR. Among these, 4 (26.66%) had hearing loss and proceeded with the appropriate monitoring and management while 5 (33.33%) had normal hearing. @*Conclusion@#The current newborn hearing screening program in the Medical City was able to reach JCIH 2007 quality indicators for screening but not for confirmation of hearing Loss. All patients with hearing loss were managed with early rehabilitation.

Safety of Autologous Umbilical Cord Blood Therapy for Acquired Sensorineural Hearing Loss in Children

BACKGROUND AND OBJECTIVES: Sensorineural hearing loss (SNHL) in children is associated with neurocognitive morbidity. The cause of SNHL is a loss of hair cells in the organ of Corti. There are currently no reparative treatments for SNHL. Numerous studies suggest that cord blood mononuclear cells (human umbilical cord blood, hUCB) allow at least partial restoration of SNHL by enabling repair of a damaged organ of Corti. Our objective is to determine if hUCB is a safe treatment for moderate to severe acquired SNHL in children. SUBJECTS AND METHODS: Eleven children aged 6 months to 6 years with moderate to severe acquired SNHL were treated with intravenous autologous hUCB. The cell dose ranged from 8 to 30 million cells/kg body weight. Safety was assessed by measuring systemic hemodynamics during hUCB infusion. Infusion-related toxicity was evaluated by measuring neurologic, hepatic, renal and pulmonary function before and after infusion. Auditory function, auditory verbal language assessments and MRI with diffusion tensor imaging (DTI) were obtained before and after treatment. RESULTS: All patients survived, and there were no adverse events. No infusionrelated changes in hemodynamics occurred. No infusion-related toxicity was recorded. Five subjects experienced a reduction in auditory brainstem response (ABR) thresholds. Four of those 5 subjects also experienced an improvement in cochlear nerve latencies. Comparison of MRI with DTI sequences obtained before and after treatment revealed increased fractional anisotropy in the primary auditory cortex in three of five subjects with reduced ABR thresholds. Statistically significant (p < 0.05) reductions in ABR thresholds were identified. CONCLUSIONS: TIntravenous hUCB is feasible and safe in children with SNHL.

Ototoxicity: A Challenge in Diagnosis and Treatment

Ototoxicity is the pharmacological adverse reaction affecting the inner ear or auditory nerve, characterized by cochlear or vestibular dysfunction. The panorama of drug-induced hearing loss has widened over last few decades. Although ototoxic medications play an imperative role in modern medicine, they have the capacity to cause harm and lead to significant morbidity. Evidence has shown early detection of toxicity through prospective ototoxicity monitoring allows for consideration of treatment modifications to minimize or prevent permanent hearing loss and balance impairment. Although many ototoxicity monitoring protocols exist, their practicality is questionable due to several factors. Even though the existing protocols have proven to be effective, certain lacunae in practice have been encountered due to discrepancies among recommended protocols. Implementation of these protocols is mostly held back due to the incapacitated status of the patient. The choice of early ototoxicity identification techniques is still debatable due to variables such as high degree of sensitivity, specificity and reliability, less time consumption and less labour-intensive to the patient. Hence, the diagnosis and effective treatment of ototoxicity is challenging, even today. A stringent protocol with more practicality encompassing all elements aimed at profiling the effects of ototoxicity is greatly needed. This review describes an efficient application of ototoxicity monitoring and treatment protocol as an attempt to reduce the challenges in diagnosis and management of ototoxicity.

The Effect of Primary Levels and Frequencies on the Contralateral Suppression of Distortion Product Otoacoustic Emission

BACKGROUND AND OBJECTIVES: Changes in distortion product otoacoustic emission (DPOAE) caused by contralateral suppression (CS) allow the function of the auditory efferent system to be evaluated. Parameters affording maximum CS are preferred in terms of clinical application. Our objective was to evaluate the effects of primary levels and frequencies on DPOAE-mediated CS. SUBJECTS AND METHODS: Sixteen subjects with normal hearing participated. DPOAEs were recorded with and without contralateral acoustic stimulation; we delivered broadband noise of 65 dB SPL at f2 frequencies between 1,000 Hz and 6,727 Hz, at 8 pt/octave. The L2 was varied between 40 dB SPL and 80 dB SPL in 10-dB steps. RESULTS: L2 did not significantly affect DPOAE-mediated CS. Higher L2 levels significantly reduced the fine structure depth of both the baseline and suppressed DPOAE datasets. The amount of CS was greatly affected by the f2 frequency; lower and higher frequency ranges afforded significantly stronger suppression than did mid-frequencies within the studied range. CONCLUSIONS: Our findings suggest that DPOAE CS should be measured over a wide range of frequencies as the amount of CS seems to be highly dependent on f2. The use of a higher L2 level may be optimal when it is sought to evoke strong DPOAE-mediated suppression while simultaneously minimizing DPOAE fine structure. Our findings may assist in optimization of clinical procedures evaluating the integrity of the auditory efferent system.

The Effect of Endoscopic Tympanoplasty on Cochlear Function

OBJECTIVES: The aim of this prospective clinical study was to measure the audiologic outcomes of the patients that underwent endoscopic transcanal cartilage tympanoplasty, and to investigate the effects on cochlear function. METHODS: Thirty-three patients (33 ears) who were diagnosed with noncomplicated chronic otitis media and underwent endoscopic transcanal cartilage tympanoplasty technique were included. Pre- and postoperative first month distortion product otoacoustic emission (DPOAE) signal-to-noise ratio (SNR), bone conduction hearing levels and air bone gap (ABG) values were measured and total endoscope usage time was noted. RESULTS: Preoperative median SNR measurements at 0.5, 1, 2, and 4 kHz were 6 dB (1–11; interquartile range [IQR], 1), 6 dB (4–20; IQR, 1), 7 dB (3–26; IQR, 5) and 5.50 dB (0–9; IQR, 3), respectively. Postoperative median SNR measurements at 0.5, 1, 2, and 4 kHz were 6 dB (3–9; IQR, 1), 6 dB (2–21; IQR, 3), 7 dB (2–20; IQR, 3), and 6 dB (0–10; IQR, 7), respectively. Regarding the DPOAE measurements, there was no statistically significant difference between the SNR values of all given frequencies (P>0.05). Regarding the pure tone audiometry (PTA) measurements, bone conduction was significantly better at 0.5 and 1 kHz, postoperatively (P 0.05). Additionally, no statistically significant correlation was found between the SNR and PTA measurements and the endoscope usage time (P>0.05). CONCLUSION: We suggested that cochlear functions and sensorineural hearing remained stable after endoscopic transcanal cartilage tympanoplasty and cold light source doesn’t cause significant adverse effects cochlear functions.

Analysis of Distortion Product Otoacoustic Emissions in Hepatitis B Carrier and Chronic Hepatitis B Patients with Normal Pure Tone Findings / 听力学及言语疾病杂志

Objective To investigate the characteristics of distortion products otoacoustic emission (DPOAE) in hepatitis B carriers and chronic hepatitis B patients with normal pure tone results .Methods DPOAE was detected in 29 hepatitis B carriers (58 ears) ,30 chronic hepatitis B patients (60 ears)and 30 normal controls .The three groups had normal pure tone results .The detection rate and amplitude difference of DPOAE at 553～6250 Hz were compared between the two groups .Results The incidence of the DPOAE in HBV carriers for all the frequencies was higher than that in the chronic hepatitis B group ,but there was no significant difference (P>0 .05) .The level of the DPOAE in HBV carriers for all the frequencies was higher than that in chronic hepatitis B group ,and there were significant differences at 1105 ,1560 ,2211 ,3125 ,4416 ,6250 Hz (P<0 .05) ,and at 1560 ,2211 ,6250 Hz(P<0 .01) ,except at 553 ,783 Hz (P>0 .05) .Conclusion There is a potential loss of cochlear functions in the chronic hepatitis B group compared with the HBV carrying group .We suspect that the progress of liver disease is related to the potential hearing loss .

An Analysis of Hearing Screening Results from 616 Preschool Children / 听力学及言语疾病杂志

Objective To explore the feasibility and effectiveness of otoacoustic emission (OAE) in hearing screening for preschool children .Methods A total of 616 preschool children aged 3～6 (mean age 4 .6 years old) were included in this study .All the subjects received transiently evoked otoacoustic emission (TEOAE) test by trained personnel .The children who failed the hearing screening received diagnostic examination in the hearing ex-amination center .Results Of 616 children ,66 (10 .71％ ) failed the hearing screening and 16 children received audi-ological assessment .In these 16 children ,8 had otitis media with effusion (5 with mild conductive hearing loss ) ,5 had impacted cerumen ,3 had normal hearing ,and none had sensorineural hearing loss .Conclusion OAE can be used effectively in the hearing screening for preschool children .But how to improve the referral rate of children who failed the hearing screening needs further discussion .

Functional Significance of Medial Olivocochlear System Morphology in the Mouse Cochlea

OBJECTIVES: Baso-apical gradients exist in various cochlear structures including medial olivocochlear (MOC) efferent system. This study investigated the cochlear regional differentials in the function and morphology of the MOC system, and addressed the functional implications of regional MOC efferent terminals (ETs) in the mouse cochlea. METHODS: In CBA/J mice, MOC reflex (MOCR) was assessed based on the distortion product otoacoustic emission in the absence and presence of contralateral acoustic stimulation. High, middle, and low frequencies were grouped according to a mouse place-frequency map. Cochlear whole mounts were immunostained for ETs with anti-α-synuclein and examined using confocal laser scanning microscopy. The diameters of ETs and the number of ETs per outer hair cell were measured from the z-stack images of the basal, middle and apical regions, respectively. RESULTS: The middle cochlear region expressed large, clustered MOC ETs with strong MOCR, the base expressed small, less clustered ETs with strong MOCR, and the apex expressed large, but less clustered ETs with weak MOCR. CONCLUSION: The mouse cochlea demonstrated regional differentials in the function and morphology of the MOC system. Strong MOCR along with superior MOC morphology in the middle region may contribute to ‘signal detection in noise,’ the primary efferent function, in the best hearing frequencies. Strong MOCR in spite of inferior MOC morphology in the base may reflect the importance of ‘protection from noise trauma’ in the high frequencies.

Analysis of Hearing Screening Results in 1 045 Newborns / 中国医科大学学报

Objective To evaluate factors influencing pass rates for newborn hearing screening under the same test conditions and using the same test methods.Methods Newborn hearing screening was carried out in 1 045 randomly selected newborns in Shengjing Hospital from January to June 2014.The newborns were screened at 2 days of age using transient evoked otoacoustic emissions (TEOAE).Related factors,including the number of embryos,birth weight,gestational age,gender,and mode of delivery were recorded.Data were analyzed using SPSS 19.0 software.Results Of 1 045 newborns,860 (82.3％) passed the hearing screening test and 185 failed.The number of embryos,ear-side tested,gestational age,and birth weight significantly influenced the pass rate using TEOAE.Term infants had a higher pass rate than premature ones (P ＜ 0.001).Heavier infants were more likely to pass (P =0.003).Right ears had a higher pass rate than left ears (P ＜ 0.001).Single babies had a higher pass rate than twins (P ＜ 0.001).Gender (P =0.361) and delivery mode (P =0.892) did not affect the pass rate.Conclusion The number of embryos,birth weight,gestational age,and ear-side tested affect newborn hearing screening results,but gender and mode of delivery show no significant effects on screening.

Maternal emotional reactions towards results of newborn hearing screening: A cross sectional survey

@#<p style="text-align: justify;"><strong>OBJECTIVES:</strong> This study aims to determine the maternal reactions and emotions towards an initial "refer" result in the newborn hearing screening test and to determine the proportion of mothers who fully comprehended the test results of the newborn hearing screening test.<br /><strong>METHODS:</strong> In this study, mothers of newborns with a "refer" result in the Universal Newborn Hearing Screening (UNHS) are given questionnaires which cover their understanding of the hearing screening test, the emotions they felt and attitude towards the results.<br /><strong>RESULTS:</strong> Our findings showed that the UNHS program protocol was properly understood by almost all the respondent mothers. Of the emotions listed from the questionnaire, being "worried" was the most persistently felt emotion.<br /><strong>CONCLUSION:</strong> It is important that the results of the newborn hearing screening test be properly understood by the mothers. Mothers who experienced negative emotions brought about by the hearing screening test still believed that the newborn hearing screening test was important, were glad that their child underwent the newborn hearing screening test and will request it for their future offspring.</p>

The Hearing Screening Results from 2 025 Preschool Childrens in Huangshi City / 听力学及言语疾病杂志

Objective To obtain suitable hearing screening methods for preschool children.Methods A total of 2025 children aged 2~6 years old in 30 kindergartens in Huangshi City were selected by random sampling method.Acoustic impedance and otoacoustic emission tests(transiently evoked otoacoustic emissions and distortion product otoacoustic emissions) were performed in two stages of preliminary hearing screening.The children who failed the hearing screening needed to do the re-creening with the same methods;the children who failed the rescreening needed to receive audiological tests including ABR, ASSR examination and imaging examinations.Results The total screening pass rate was 94.02%, of which 1 842 passed the preliminary hearing screening(90.96%, 1 842/2 025).The 183 children who failed the preliminary hearing screening received the re-screening, 62 children passed the re-screening(33.88%,62/183).121 children failed the re-screening(5.98%,121/2 025), and finally 72 children(3.56%,72/2 025)were diagnosed with hearing loss, including 47 cases of otitis media,22 cases of sensorineural hearing loss(8 cases were moderate, 4 cases were severe hearing loss,10 cases were profound);18 cases were unilateral hearing loss while 4 cases were bilateral hearing loss.Conclusion Acoustic impedance and otoacoustic emission tests can be used for hearing screening in preschool children.The hearing problems of preschool children in Huangshi City were concentrated mainly in the middle ear secretory otitis media and different degree of sensorineural hearing loss.

The audiological profile of adults with and without hypertension

OBJECTIVE: To determine whether there is any influence of systemic arterial hypertension on the peripheral auditory system. METHODS: This was a cross-sectional study that investigated 40 individuals between 30 and 50 years old, who were divided into groups with and without systemic arterial hypertension, using data from high-frequency audiometry, transient-evoked otoacoustic emissions and distortion-product otoacoustic emissions. The results were compared with those from groups of normal-hearing individuals, with and without systemic arterial hypertension, who underwent the pure-tone audiometry test. All individuals also underwent the following procedures: otoscopy, acoustic immittance measures, pure-tone audiometry at frequencies from 250 to 16000 Hz, transient-evoked otoacoustic emissions test and distortion-product otoacoustic emissions test. RESULTS: No statistically significant difference was observed between the groups with and without systemic arterial hypertension in either conventional or high-frequency audiometry. Regarding transient-evoked otoacoustic emissions, there was a trend toward statistical significance whereby the systemic arterial hypertension group showed lower results. Regarding distortion-product otoacoustic emissions, the systemic arterial hypertension group showed significantly lower results at the following frequencies: 1501, 2002, and 3003 Hz. A discriminant analysis indicated that the distortion-product otoacoustic emissions variables best distinguished individuals with and without systemic arterial hypertension. CONCLUSION: Data from this study suggest cochlear dysfunction in individuals with systemic arterial hypertension because their otoacoustic emission results were lower than those in the systemic arterial hypertension group.

Auditory Neuropathy/Dyssynchrony: A Retrospective Analysis of 15 Cases

Introduction Auditory neuropathy/dyssynchrony (AN/AD) comprises a spectrum of pathology affecting the auditory pathways anywhere from the inner hair cells to the brainstem. It is characterized by an absent or atypical auditory brainstem response (ABR) with preservation of the cochlear microphonics and/or otoacoustic emissions (OAEs). Objective Retrospective analysis of patients with AN/AD. Methods Fifteen patients with AN/AD were included in this study and their records were retrospectively investigated. Results Possible etiology of AN/AD was neonatal hyperbilirubinemia in three patients, family history of hearing loss in three patients, consanguineous marriage in two patients, head trauma in two patients, mental motor retardation in one patient, cerebrovascular disease in one patient, and there was no apparent cause in three patients. Conclusion Otolaryngologists should keep in mind the diagnosis of AN/AD especially in patients complaining of difficulty in hearing and speech and audiological evidence of disassociation between pure tone and speech audiometry. ABR and OAE testing is recommended in these patients for AN/AD diagnosis. .