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.

Evaluation of Transient Evoked Otoacoustic Emission in the Newborn Hearing Screening Program in Neonatal Intensive Care Unit

BACKGROUND AND OBJECTIVES: Newborn Hearing Screening (NHS) program aims to identify babies at risk of hearing loss and provide appropriate rehabilitation within the crucial period for language development. The risk of hearing loss in increased in babies discharged from neonatal intensive care unit (NICU) compared to wellbaby nursery. Transient evoked otoacoustic emission (TEOAE) or automated auditory brainstem response tests are utilized. The purpose of this study is to assess the outcome of NHS using TEOAE as initial evaluation method in NICU graduates. SUBJECTS AND METHODS: TEOAE was performed as initial screening method for NHS in NICU neonates born between February 2010 and November 2011. Babies referred from TEOAE were reevaluated with repeated TEOAE or auditory brainstem response. Referral rates were estimated and quality indicators for screening (Joint Committee on Infant Hearing position statement, 2007) were evaluated. RESULTS: Among 149 neonates graduated from NICU, 50 (33.6%) babies failed initial TEOAE ('refer'). A second stage TEOAE testing was performed in 41 (82.0%) of these babies: 35 (85.4%) passed and 6 (14.6%) were referred for diagnostic testing. From 2-stage TEOAE screening program, 6 neonates were referred for diagnostic audiological evaluation: sensorineural hearing loss was identified in 2 babies and 3 babies were lost to follow up. Quality indicators for screening were as follows: 1) 94.0% of all newborn infants admitted to NICU completed screening by 1 month of age, and 2) 4.0% of all newborn infants who fail initial screening and fail any subsequent rescreening before comprehensive audiological evaluation. CONCLUSIONS: Timely and adequate screening of hearing loss is prerequisite for accurate diagnosis and appropriate rehabilitation in infants especially from NICU. Further refinement of the current NHS with additional reliable screening technology is required for more stable and successful screening program.

Evaluation of Transient Evoked Otoacoustic Emission in the Newborn Hearing Screening Program in Neonatal Intensive Care Unit

BACKGROUND AND OBJECTIVES: Newborn Hearing Screening (NHS) program aims to identify babies at risk of hearing loss and provide appropriate rehabilitation within the crucial period for language development. The risk of hearing loss in increased in babies discharged from neonatal intensive care unit (NICU) compared to wellbaby nursery. Transient evoked otoacoustic emission (TEOAE) or automated auditory brainstem response tests are utilized. The purpose of this study is to assess the outcome of NHS using TEOAE as initial evaluation method in NICU graduates. SUBJECTS AND METHODS: TEOAE was performed as initial screening method for NHS in NICU neonates born between February 2010 and November 2011. Babies referred from TEOAE were reevaluated with repeated TEOAE or auditory brainstem response. Referral rates were estimated and quality indicators for screening (Joint Committee on Infant Hearing position statement, 2007) were evaluated. RESULTS: Among 149 neonates graduated from NICU, 50 (33.6%) babies failed initial TEOAE ('refer'). A second stage TEOAE testing was performed in 41 (82.0%) of these babies: 35 (85.4%) passed and 6 (14.6%) were referred for diagnostic testing. From 2-stage TEOAE screening program, 6 neonates were referred for diagnostic audiological evaluation: sensorineural hearing loss was identified in 2 babies and 3 babies were lost to follow up. Quality indicators for screening were as follows: 1) 94.0% of all newborn infants admitted to NICU completed screening by 1 month of age, and 2) 4.0% of all newborn infants who fail initial screening and fail any subsequent rescreening before comprehensive audiological evaluation. CONCLUSIONS: Timely and adequate screening of hearing loss is prerequisite for accurate diagnosis and appropriate rehabilitation in infants especially from NICU. Further refinement of the current NHS with additional reliable screening technology is required for more stable and successful screening program.

Study on multi-area universal newborn hearing screening in countryside of China / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate the feasibility of universal newborn hearing screening in countryside in order to provide reliable evidence in launching this program all over the countryside of China. Method:Subjects were 12 638 infants who were born in 9 counties from Jan 2004 to Dec 2005. TEOAE was used for the fast hearing screening. Infants were screened on the 2-7 days after the birth. The re-screening was conducted in 4-6 weeks if failed in the initial screening,and follow-up were provided continually if they also failed in the re-screening. Result; Ten thouand eight hundred and forty-five of 12 638(85. 8%) were screened including 9 963(91. 9%) normal newborns and 882(8. 1%) newborns with high-risk. Seven thouand four hundred and fifty (68. 7%) newborns passed the initial screening, and 3 395 (31. 3%) people failed. One thouand seven hundred and ninty-three (14. 2%) infants were refused to be screened.Only 2 536 (74. 7%) were re-screened on time, and 859(25. 3%) did not receive re-screening. One hundred and twenty were failed in the re-screening or first screening, and 79 (65. 8%)of them received diagnostic assessment. Among the infants received diagnostic assessment, 6(7.6%)ca-ses were found to have profound hearing loss in both ears, 9(11. 4%)cases were found to be severe hearing loss(7 in both ears and 2 in single ear) , 11(13. 9%)cases were found to be moderate hearing loss (5 in both ear and 6 in single ear), 26 (32. 9%) were found to have slight hearing loss (11 in both ear and 15 in single ears), and 27 (34.2%) were normal. Fifty-two infants were diagnosed as hearing loss with a prevalence of congenital hearing loss(in binaural and monaural) of 0. 5%(52/10845)and a prevalence of bilateral hearing loss of 0. 3%(29/10845). A prevalence of congenital hearing loss was 0. 2% (22/9 963) in well infants and 3. 4% (30/882) in high risk infants. Among the 13 cases of children with severe and profound hearing loss in both ears children, 8(61. 5%)cases were fitted with hearing aids and 1 (7. 7%) case was implanted with cochlear implants. Conclusion:It is necessary and feasible to conduct hearing screening program in the rural area. However, the suitable model to perform the program in the countryside needs to be set up as soon as possible in order to get more poor infants to participate into the hearing screening program for free and increase the screening rate.

Properties of SOAEs and Their Correlation with TEOAEs in Neonates / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Transient evoked otoacoustic emissions (TEOAEs) have been used as a screening test for early detection of hearing loss in newborns and infants, because most of the normal hearing show TEOAEs. But the lack of understanding about the properties of spontaneous otoacoustic emissions (SOAEs) has limited their usefulness on the clinical basis. This study was designed with the purpose to find out the properties of SOAEs and their correlation with TEOAEs. MATERIALS AND METHODS: TEOAE and SOAE tests were performed in 95 neonates (190 ears, male:female=47:48) of well baby clinic in DKUH. RESULTS: 1) The prevalence of SOAEs were 86.8% (165/190 ears):87.2% (82/94 ears) in male and 86.5% (83/96 ears) in female, 91% (86/95 ears) in the right ears and 83% (75/95 ears) in the left ears. 2) The number of peaks in SOAEs was 4.14+/-1.92 overally, 4.38+/-2.01 in right ears, 3.87+/-1.79 in left ears, and 4.34+/-1.95 in males and 3.94+/-1.88 in females. There was a significant difference between the right and the left ears. 3) The level of SOAEs was -18.4 to 22.6 dB SPL. The highest amplitude of SOAEs in each subject was 3.69+/-8.87 dB SPL. 4) The SOAE frequency was mainly between 1000 Hz and 4000 Hz, and most frequently between 3000 Hz and 4000 Hz. The mean frequency of the highest amplitude of SOAE was 2907+/-1092 Hz. 5) The highest amplitude of SOAE was correlated with the overall response amplitude of TEOAE (r=0.619, p<0.01), but not the number of peaks (r=0.086, p=0.272). CONCLUSION: Neonates have robust SOAEs, which correlated with their TEOAEs.

Transient Evoked Otoacoustic Emission in China Rural Primary School Children Hearing Screening / 听力学及言语疾病杂志

Objective To investigate the clinical meaning and feasibility of transient evoked otoacoustic emission (TEOAE) in China rural primary school children hearing screening.Methods TEOAE was recorded with Madsen Celesta 503 in 317 (634 ears) primary school children,then the results were compared with gold standard test group,including otoscopy, pure tone audiometry and tympanogram.Results In 317 (634 ears) pupils, the presence of TEOAE was 94.64% (600/634); the presence of gold standard was 94.48% (599/634). The consistency rate was (96.69?0.71)%; sensitivity (Sen) was 0.69?0.078;specificity (Spe)=0.98?0.0052, the false positive rate (FPR), that was ?, was 0.31; ? = 0.02; Youden's index J = 0.67?0.078, LR_+=34.5, LR_-=0.32, PV_+=0.71(71%),PV_-=0.98(98.%),AZ=0.8.Conclusion The TEOAE test is simple, quick, harmless, sensitive and objective. It can be used in hearing screening program in rural primary school children.