Long-term evaluation and physical and mental effects of residual tinnitus following treatment of sudden hearing loss / 中华耳鼻咽喉头颈外科杂志

Objective: To clarify the long-term characteristics of tinnitus following treatment of sudden deafness and its long-term physical and mental effects on patients. Methods: A retrospective analysis was performed on 88 patients (46 males and 42 females; Age from 11 to 89 years) with sudden deafness treated in Department of Otoscope Surgery of Peoples's Libration Army General Hospital in Beijing from April 2020 to January 2021, and the occurrence of tinnitus and treatment effect of all patients were analyzed. Follow-up was conducted for patients with residual tinnitus after treatment for more than 1 year by the investigation and filling in the survey information collection form, Tinnitus Evaluation Questionnaire (TEQ) and Tinnitus Handicap Inventory (THI). Descriptive statistics and SPSS 22.0 software were used for statistical data analysis. Results: In this study, 93.2% (82/88) of patients with sudden deafness were accompanied by tinnitus at the onset, and the proportion of long-term tinnitus after treatment was 90.2% (74/82). After 1 year of treatment for sudden deafness, the improvement of tinnitus was significant in low-frequency sudden deafness compared with those of high-frequency, flat and total deafness sudden deafness (χ2 value was 6.801, 4.568 and 4.038, all P<0.05). In patients with residual tinnitus, 9 (12.2%) patients felt minimal loudness or even no loudness, 34 (46.0%) patients felt slight loudness, 28 (37.8%) patients felt tinnitus was relatively loud, and 3 (4.1%) patients felt tinnitus was loud or noisy. Nine (12.2%) patients's sleep was often affected, 41 (55.4%) patients's sleep was sometimes affected, 9 (12.2%) patients's sleep was rarely affected, 15 (20.3%) patients's sleep was almost not affected. Twenty-eight (37.8%) patients basically completely adapted to tinnitus and 46 (62.2%) patients did not completely adapted to residual tinnitus. Eight (10.8%) patients had no impact on life, 39 (52.7%) patients had slight impact, 22 (29.7%) patients had moderate impact, and the other 5 (6.8%) patients had greater impact. According to tinnitus evaluation questionnaire(TEQ), there were 12 cases (16.2%) of grade Ⅰ, 26 cases (35.1%) of grade Ⅱ, 28 cases (37.8%) of grade Ⅲ, 7 cases (9.5%) of grade Ⅳ and 1 case (1.4%) of grade Ⅴ. According to tinnitus handicap inventory(THI), tinnitus disability was classified into grade Ⅰ, 22 cases (29.7%), grade Ⅱ, 14 cases (18.9%), Grade Ⅲ, 27 cases (36.5%) and grade Ⅳ, 11 cases (14.9%). Conclusion: The rate of residual tinnitus following treatment of sudden deafness is high. Some of the patients can completely adapt residual tinnitus after one year, but some of them will be affected when sleep, work and study. Residual tinnitus can lead to tinnitus disability in different degrees.

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.

Analysis of verification results of protective effects of hearing protectors in different industries / 中华劳动卫生职业病杂志

Objective: To get insight into the current practice of noise reduction effect of workers as they wore hearing protectors in different domestic enterprises and the possible affected factors. Methods: From October 2020 to April 2021, using a random sampling method, 1197 workers exposed to noise in petrochemical factories, textile factories, and parts manufacturing factories were selected as the study subjects. The noise reduction effect of hearing protectors worn by workers in daily use was tested using a hearing protector suitability testing system. The personal sound attenuation level (PAR) was compared among workers in three enterprises, Targeted intervention and repetitive testing were conducted for workers who did not meet the noise reduction effect required by the enterprise, and the changes in PAR of workers before and after the intervention were compared. The comparison of baseline PARs between two or more groups was performed using the Mann Whitney test, the comparison of baseline PARs with post intervention PARs was performed using the Wilcoxon signed rank sum test, and the comparison of qualitative data between two or more groups was performed using the Chi square test. Results: The median baseline PAR for all workers was 15 dB. Men, age<30 years old, education level at or above college level, working experience of 5 to 15 years, and those who used hearing protectors for 5 to 15 years had higher PARs, with statistically significant differences (P<0.05). The median difference in baseline PAR among workers from three enterprises was statistically significant (H=175.06, P<0.01). The median PAR of subjects who did not pass the baseline increased from 3 dB to 21 dB after intervention (Z=-27.92, P<0.01) . Conclusion: Some workers wearing hearing protectors do not meet the required PAR, and low PARs may be related to incorrect wearing methods and incorrect selection of hearing protectors. As a tool for testing, training, and assisting in selection, the hearing protector suitability testing system is of great significance for worker hearing protection.

Research on early warning model of the hearing loss of workers exposed to noise / 中华劳动卫生职业病杂志

Objective: To explore the change of hearing threshold of workers exposed to noise, establish an individual-based hearing loss early warning model, accurately and differentiated the health of workers exposed to noise. Methods: In September 2019, all physical examination data of 561 workers exposed to noise from an enterprise were collected since their employment. Three indicators of average hearing threshold of the better ear, namely, at high frequency, 4000 Hz and speech frequency, were constructed. The generalized estimating equation (GEE) was used to adjust gender and age and establish the warning model of each indicator. Finally, sensitive indicators and warning models were screened according to AUC and Yoden index. Results: Among the 561 workers exposed to noise, 26 (4.6%) workers had hearing loss. The sensitivity indicators were the average hearing threshold at speech frequency ≥20 dB, high frequency ≥30 dB and 4000 Hz ≥25 dB. The AUC of each index was 0.602, 0.794 and 0.804, and the Youden indexes were 0.204, 0.588 and 0.608, respectively. In GEE of hearing loss warning models, high-frequency hearing threshold ≥20 dB and 4000 Hz hearing threshold ≥25 dB were the optimal models, with AUC of 0.862. Conclusion: Combined with the changes of individual hearing threshold over the years, can accurately assess the risk of individual hearing loss of workers exposed to noise.

Aspectos audiológicos e cognitivos em adultos com Diabetes Mellitus tipo 2 / Auditory and cognitive aspects in adults with type 2 Diabetes Mellitus / Aspectos auditivos y cognitivos en adultos con Diabetes Mellitus tipo 2

Introdução: A Diabetes Mellitus (DM) é um distúrbio metabólico causado pela ausência ou diminuição da secreção de insulina ou por alterações do funcionamento deste hormônio no organismo, podendo envolver alterações físicas e cognitivas. Objetivo: Analisar os aspectos audiológicos e cognitivos de adultos com Diabetes Mellitus tipo 2. Método: Estudo transversal realizado em pessoas com idade entre 18 e 59 anos, de ambos os gêneros. Os participantes foram divididos em dois grupos: Grupo Estudo (GE) - pessoas com diagnóstico de Diabetes Mellitus e o Grupo Controle (GC) - pessoas sem Diabetes. Todos foram submetidos à avaliação glicêmica, cognitiva e audiológica. Para análise estatística foi utilizado o teste de Mann-Whitney, sendo estipulado o nível de significância de 0,05. Resultados: Participaram do estudo 32 indivíduos sendo 19 (59,4%) no GE e 13 (40,6%) no GC. A média de idade dos participantes foi de 46,8 ± 8,3 anos, com escolaridade média de 6,8 ± 6 anos, sendo 25 (78,1%) do gênero feminino e 7 (21,9%) do masculino. Foi observada diferença estatisticamente significativa entre os grupos para a pontuação referente à atenção e cálculo, recordação e escore total do MEEM, com pior desempenho no GE. Não foi observada diferença estatisticamente significante entre os grupos nos aspectos audiológicos avaliados. Conclusão: Indivíduos com Diabetes Mellitus tipo 2 não apresentaram riscos para alterações audiológicas com os instrumentos utilizados, entretanto apresentaram um alto risco para alterações cognitivas. Os achados demonstram que o acompanhamento fonoaudiológico constante é essencial para identificar as alterações precocemente.

Introduction: Diabetes Mellitus (DM) is a metabolic disorder caused by the absence or reduction of insulin secretion or by changes in the functioning of this hormone in the body, which may involve physical and cognitive changes. Objective: To analyze the audiological and cognitive aspects of type 2 Diabetes Mellitus in adults. Method: Cross-sectional study carried out in people aged between 18 and 59 years, of both genders. Participants were divided into two groups: Study Group (SG) - people diagnosed with Diabetes Mellitus and the Control Group (CG) - people without Diabetes. All underwent glycemic, cognitive and auditory assessment. Mann-Whitney's test was used for statistical analysis, with a significance level of 0.05. Results: 32 individuals participated in the study, 19 (59.4%) in the EG and 13 (40.6%) in the CG. The mean age of the participants was 46.8 ± 8.3 years, with a mean education of 6.8 ± 6 years, with 25 (78.1%) females and 7 (21.9%) males. A statistically significant difference was observed between the groups for the score related to attention and calculation, recall and total Mini-Mental State Examination (MMSE) score, with worse performance in the EG. There was no statistically significant difference between the groups regarding the audiological aspects evaluated. Conclusion: Individuals with type 2 Diabetes Mellitus did not present risks for audiological alterations, however they presented a high risk for cognitive alterations. the findings demonstrate that constant speech therapy monitoring is essential to identify changes early.

Introducción: La Diabetes Mellitus (DM) es un trastorno metabólico causado por la ausencia o reducción de la secreción de insulina o por alteraciones en el funcionamiento de esta hormona en el organismo que puede implicar alteraciones físicas y cognitivas. Objetivo: Analizar los aspectos audiológicos y cognitivos de adultos con Diabetes Mellitus tipo 2. Método: Estudio transversal realizado en personas de entre 18 y 59 años, de ambos sexos. Los participantes se dividieron en dos grupos: Grupo de Estudio (GE) - personas diagnosticadas con diabetes mellitus y Grupo Control (GC) - personas sin Diabetes. Todos se sometieron a evaluación glucémica, cognitiva y audiológica. Para el análisis estadístico se utilizó la prueba de Mann-Whitney, con un nivel de significancia de 0.05. Resultados:Treinta y dos individuos participaron en el estudio, 19 (59,4%) en el GE y 13 (40,6%) en el GC. La edad media de los participantes fue de 46,8 ± 8,3 años, con una educación media de 6,8 ± 6 años, con 25 (78,1%) mujeres y 7 (21,9%) hombres. Se observó diferencia estadísticamente significativa entre los grupos para la puntuación relacionada con atención y cálculo, recuerdo y puntuación total del MEEM, con peor desempeño en el GE. No hubo diferencia estadísticamente significativa entre los grupos en los aspectos audiológicos evaluados. Conclusión: Los individuos con Diabetes Mellitus tipo 2 no presentaban riesgo de alteraciones audiológicas, sin embargo presentaban un alto riesgo de alteraciones cognitivas. Los resultados demuestran que el monitoreo constante de la terapia del habla es esencial para identificar cambios temprano.

Sordera neurosensorial congénita con malformación de oído interno ligada al X en una familia mexicana / Congenital sensorineural deafness X-linked, with inner ear malformation in a Mexican family

Introducción. Las sorderas o hipoacusias prelinguales son de etiología genética entre el 60 y el 68% de los casos; de estos, del 20 al 40% son malformaciones del oído interno. De los casos de hipoacusia no sindrómica ligada al X se han descrito siete tipos. De las malformaciones de oído interno, la partición coclear incompleta tipo III es la menos frecuente.Objetivo. Presentar el reporte clínico-genético de una familia mexicana, con indi-viduos varones afectados por sordera neurosensorial congénita con malformación de oído interno. Material y Métodos. Se realizó estudio de una familia en la que nueve miembros presentaban sordera. Se estudiaron cuatro de ellos y una madre sin manifestaciones, a través del estudio clínico general por médico genetista, el estudio audiológico (otos-copía y audiometría) por médico audiólogo y el estudio de tomografía computada (TC) por médico radiólogo.Resultados. Los pacientes estudiados presentaron sordera neurosensorial congéni-ta, de severa a profunda bilateral. A través de la TC, se evidenció malformación de oído interno. Tres pacientes presentaron partición coclear incompleta tipo III y un paciente partición incompleta tipo I. Debido al estudio clínico y al árbol genealógico, se definió diagnóstico de hipoacusia neurosensorial no sindrómica ligada al X. La TC de la madre sin manifestaciones no presentó evidencia de malformaciones en oído interno (MOI).Conclusión. El estudio de imagen es fundamental para definir presencia o no de MOI en todos los pacientes con hipoacusia y así poder guiar la terapéutica y el aseso-ramiento genético, así como realizar los estudios moleculares más adecuados

Introduction. The pre-lingual deafness or hearing loss are of genetic cause in be-tween 60% and 68% of cases, among these, between 20% and 40% are malforma-tion of the inner ear. From the non-syndromic hearing loss cases that are linked to the X chromosome, seven types have been described. Among these inner ear malforma-tions, incomplete cochlear partition type III is the less frequent.Objective. Present the clinical genetical report of a Mexican family, with male in-dividuals affected by congenital neurosensory deafness with inner ear malformation.Materials and methodology. A study on a family in which nine members were affected by deafness was done. Four of them, plus a mother without manifestation, were studied through a general clinical study by a geneticist, an audiological study (otoscopy and audiometry) by an audiologist, and a computed tomography (CT) scan by a radiologist.Results. The studied patients presented congenital neurosensory deafness, from se-vere to deep bilateral. Via the CT, the inner ear malformation was made clear. Three of the patients presented incomplete cochlear partition type III and one patient in-complete cochlear partition type I. Due to the clinical study and the family tree, it was diagnosed non-syndromic neurosensory deafness linked to X. The CT of the mother without manifestation did not show evidence of inner ear malformations.Conclusion. The study by image is fundamental to define whether there is or not a presence of inner ear malformations in any patient with heading loss to be able to guide the therapeutics and the genetic counseling, as well as to make more accurate molecular studies

Hipoacusia sensorineural asimétrica en el diagnóstico de schwannoma vestibular / Asymmetric sensorineural hearing loss in the diagnosis of vestibular schwannoma

Introducción: se ha descrito que los pacientes con hipoacusia asimétrica cursan en un 2% con lesiones retrococleares. La conducta de escrutinio se ha basado en la audiometría. Existen varias definiciones de asimetría audiométrica descritas en la literatura, pero sin llegar a un consenso. Aunque la prueba de oro para el diagnóstico de schwannoma vestibular es la resonancia magnética con gadolíneo, la sospecha clínica se hace en base a la asimetría audiométrica. Objetivo: hacemos una revisión de los trabajos publicados al respecto en la literatu-ra y comentamos nuestra experiencia. Reflexión: queremos enfatizar en la importancia de estudiar a los pacientes con hipoacusia asimétrica con el fin de descartar patología retrococlear. Conclusión: a pesar de que no existe un consenso claro en la definición de hi-poacusia asimétrica, la sospecha clínica de un schwannoma vestibular se basa en la audiometría

Background: It is described that 2% of patients with asymmetric hearing loss have retrocochlear lesions. The scrutiny behavior has been based on audiometry. There are several definitions of audiometric asymmetry described in the literature, but without reaching a consensus. Although the gold standard for the diagnosis of vestibular schwannoma is gadolinium magnetic resonance imaging, the clinical sus-picion is based on audiometric asymmetry. Objective: we review the results published in this regard in the literature and com-ment on our own experience. Reflection: we want to emphasize the importance of studying asymmetric hearing loss patients in order to rule out retrocochlear etiology. Conclusions: although there is no clear consensus on the definition of asym-metric hearing loss, the clinical suspicion of a vestibular schwannoma is based on the audiometry.

Facteurs scannographiques influençant les résultats audiométriques post opératoires dans l'otospongiose / Computed tomographic factors influencing postoperative audiometric results in otosclerosis

Etudier les facteurs pronostiques scannographiques de l'otospongiose en corrélant les résultats audiométriques post opératoires aux données scannographiques préopératoires. Méthodes: Nous avons mené une étude rétrospective, descriptive et analytique entre Janvier 2013 et Décembre 2018. Elle a inclus 50 patients soit 54 oreilles opérées pour otospongiose, explorés en préopératoire par une tomodensitométrie (TDM) des rochers et en postopératoire par des audiogrammes. Les critères de succès fonctionnel étaient un rinne résiduel postopératoire (RRPO) ≤10 dB et une réserve cochléaire (RC) ≤0. Résultats: La sensibilité de la TDM pour le diagnostic d'otospongiose était de 94% et le type II de la classification de Veillon était le plus fréquent (41%). La confrontation des données de la TDM préopératoire aux résultats audiométriques a permis d'identifier comme facteurs tomodensitométriques de bon pronostic audiométrique: les stades radiologiques localisés type I et II de Veillon et l'absence d'effraction endostée. L'absence d'atteinte de la fenêtre ronde ainsi que l'absence de variantes anatomiques étaient corrélées à un meilleur taux de fermeture du rinne en postopératoire. L'étude multivariée n'a pas retenu de facteurs scannographiques indépendants de succès fonctionnel. Conclusion: D'après notre étude, il s'avère que la tomodensitométrie des rochers préopératoire ne prédit pas le résultat audiométrique de la chirurgie de l'otospongiose. Néanmoins, elle reste indispensable pour la confirmation diagnostique, la classification de la maladie et la détection des anomalies associées.

Facteurs scannographiques influençant les résultats audiométriques post opératoires dans l'otospongiose

Objectif: Etudier les facteurs pronostiques scannographiques de l'otospongiose en corrélant les résultats audiométriques post opératoires aux données scannographiques préopératoires. Méthodes: Nous avons mené une étude rétrospective, descriptive et analytique entre Janvier 2013 et Décembre 2018. Elle a inclus 50 patients soit 54 oreilles opérées pour otospongiose, explorés en préopératoire par une tomodensitométrie (TDM) des rochers et en postopératoire par des audiogrammes. Les critères de succès fonctionnel étaient un rinne résiduel postopératoire (RRPO) ≤10 dB et une réserve cochléaire (RC) ≤0. Résultats: La sensibilité de la TDM pour le diagnostic d'otospongiose était de 94% et le type II de la classification de Veillon était le plus fréquent (41%). La confrontation des données de la TDM préopératoire aux résultats audiométriques a permis d'identifier comme facteurs tomodensitométriques de bon pronostic audiométrique: les stades radiologiques localisés type I et II de Veillon et l'absence d'effraction endostée. L'absence d'atteinte de la fenêtre ronde ainsi que l'absence de variantes anatomiques étaient corrélées à un meilleur taux de fermeture du rinne en postopératoire. L'étude multivariée n'a pas retenu de facteurs scannographiques indépendants de succès fonctionnel. Conclusion: D'après notre étude, il s'avère que la tomodensitométrie des rochers préopératoire ne prédit pas le résultat audiométrique de la chirurgie de l'otospongiose. Néanmoins, elle reste indispensable pour la confirmation diagnostique, la classification de la maladie et la détection des anomalies associées.

La surdité brusque résultats thérapeutique et facteurs pronostiques / Sudden sensorineural hearing loss: therapeutic outcome and prognostic factors

Objectifs: évaluer les résultats thérapeutiques et étudier les facteurs pronostiques de la surdité brusque.Patients et méthodes: Il s'agit d'une étude rétrospective à propos de 61 patients (39 hommes et 22 femmes) pris en charge pour surdité brusque dans le service d'Otorhinolaryngologie et de Chirurgie Cervico-Faciale de l'hôpital Bourguiba de Monastir durant une période de 16 ans (2001-2016). Une analyse statistique a été réalisée afin d'identifier les facteurs influençant le pronostic de la surdité brusque. Le seuil de significativité retenu était de 5%. Résultats:L'âge moyen était de 43 ans [16-80 ans]. Le taux global de récupération auditive était de 45%. Les facteurs pronostiques selon l'analyse uni variée étaient: un antécédent d'hypoacousie controlatérale, la présence d'un vertige associé, la sévérité de la perte auditive initiale, une courbe audiométrique de type E, l'absence du réflexe stapédien et le recours à l'oxygénothérapie hyperbare (OHB). En analyse multivariée, les seuls facteurs retenus étaient une perte auditive initiale supérieure ou égale à 70 dB, la présence d'un vertige et l'absence d'un épisode infectieux précédant la survenue de la surdité. Conclusion: Notre étude a permis de retenir comme facteurs de mauvais pronostic indépendants la perte auditive initiale supérieure ou égale à 70 dB, la présence d'un vertige et l'absence d'un épisode infectieux précédant la survenue de la surdité. Ceci nous incite à une réflexion quant au protocole thérapeutique adopté dans notre service et à indiquer l'OHB, qui est normalement prescrite en cas de non réponse, en première intention, afin d'optimiser la récupération auditive.

Audiología pediátrica: el arte de armar rompecabezas / Pediatric Audiology: The Art of Putting Puzzles Together

La audición funcional ­para fines prácticos­ consiste en la posibilidad de despertar sensaciones precisas en regiones específicas del cerebro, a partir del procesamiento y extracción de mensajes ocultos en los cambios en la presión de las moléculas del aire que nos rodea. Medir la funcionalidad de la audición en un ser humano se convierte en un reto titánico que implica que nuestra vida profesional transcurra analizando información tanto subjetiva como objetiva de nuestros pacientes, ambas con un valor diagnóstico innegable. En cuanto a la primera, la historia clínica, las observaciones de la conducta auditiva del paciente, los reportes de la casa, la escuela y la terapia, o de estudios como la audiometría tonal y la logoaudiometría, resultan fundamentales no solo para el diagnóstico, sino para el seguimiento de nuestros pacientes. Sin embargo, en el caso de los pacientes más pequeños, o ante la necesidad de evaluar aspectos como la presión del oído medio, la función de las células ciliadas, o la presencia de microfónica coclear, la utilidad de esas herramientas subjetivas se encuentra limitada y entonces los registros, trazos, curvas y cifras relativas a intensidades, presiones, latencias, frecuencias, amplitudes y demás datos obtenidos a través de estudios objetivos, son los recursos que usamos para diagnosticar e iniciar la habilitación o rehabilitación de nuestros pacientes.

Functional hearing ­ for practical purposes ­ consists of the possibility of awakening precise sensations in specific regions of the brain from the processing and extraction of hidden messages in changes in the pressure of the molecules of the air that surrounds us. Measuring the functionality of hearing in a human being becomes a titanic challenge that implies that our professional life is spent analyzing both subjective and objective information from our patients, both with an undeniable diagnostic value: as for the first, the clinical history, observations of the patient's listening behavior, reports from home, school and therapy, or studies such as pure tone audiometry and speech audiometry, are essential not only for diagnosis but also for the follow-up of our patients. However, in the case of smaller patients, or when faced with the need to evaluate aspects such as middle ear pressure, hair cell function, or the presence of cochlear microphonics; The usefulness of these subjective tools is limited and therefore the records, traces, curves and figures related to intensities, pressures, latencies, frequencies, amplitudes and other data obtained through objective studies are the resources we use to diagnose and start the investigation. rehabilitation or rehabilitation of our patients.

Development and accuracy of a hearing screening application / Desenvolvimento e acurácia de um aplicativo para rastreio auditivo

Abstract Introduction: Hearing impairment, or hearing loss, can be caused by several factors and the implications vary according to the type, degree, cause and age of occurrence. Hearing screening should be a common procedure, allowing the pre-clinical identification and necessary referrals, avoiding the consequences of auditory deprivation. Mobile apps have shown to be a good alternative for hearing assessment. Objective: The objective was to develop an app and assess its performance in identifying hearing loss by comparing it with another validated screening tool. Methods: The application, called Ouviu, was created using audiological knowledge and tools available on the iOS platform. We evaluated 185 people, aged between 6 and 96 years, distributed into 5 age groups, performing audiometry and hearing screening using two tools: HearCheck and the application. Results: The results showed that the sensitivity of the application in identifying hearing loss was approximately 97%, while that of HearCheck was 79%. The positive predictive value of the application showed that the probability of a person being identified with this tool and actually having a hearing loss was 94%, while for HearCheck it was 96%. False negatives, which failed hearing loss identification, were fewer in the app (3%) than in HearCheck (21%). Conclusion: Consequently, the developed application was shown to be effective as a hearing screening tool, surpassing HearCheck in identifying mild hearing loss. In addition to being portable, easy to apply, low cost and rapidly performed, the application has the advantage of assessing environmental noise to perform the exam, as well as the fact that it is not necessary to attach any hardware to the mobile device.

Resumo Introdução: O comprometimento da audição, ou perda auditiva, pode ser ocasionado por diversos fatores e as implicações variam de acordo com o tipo, grau, causa e idade de acometimento. A triagem auditiva deveria ser um procedimento usual que possibilitasse a identificação pré-clínica e os encaminhamentos necessários, evitaria as consequências da privação desse sentido. Aplicativos móveis mostram-se uma boa opção. Objetivo: Desenvolver um aplicativo e verificar seu desempenho na identificação de perda auditiva comparado com outro instrumento de rastreio validado. Método: O aplicativo, chamado Ouviu, foi criado com o conhecimento audiológico e as ferramentas disponíveis na plataforma iOS. Avaliamos 185 pessoas, entre 6 e 96 anos, distribuídas em 5 grupos, fizemos audiometria e rastreio auditivo por meio de dois instrumentos: HearCheck e aplicativo. Resultados: Ficou evidenciado que a sensibilidade do aplicativo para identificar perda auditiva foi aproximadamente 97%, enquanto a do HearCheck foi 79%. O valor preditivo positivo do aplicativo mostrou que a probabilidade de uma pessoa ser identificada com esse instrumento e realmente ter perda auditiva foi 94%, o HearCheck foi de 96%. Os falsos negativos, que deixaram de identificar perda auditiva, foram menores no aplicativo (3%) que no HearCheck (21%). Conclusão: O aplicativo desenvolvido mostrou-se eficaz como uma ferramenta de rastreio auditivo. É melhor do que HearCheck na identificação de perda auditiva leve. Além de ser portátil, de fácil aplicação, baixo custo e rápida execução, o aplicativo tem a vantagem de avaliar o ruído ambiental para fazer o exame e também a não necessidade de quaisquer hardwares para acoplar ao dispositivo móvel.

Impacto en la calidad de vida por la comprensión del tinnitus / The Quality of Life impaction by Tinnitus Comprehension

El tinnitus es la sensación de sonido en ausencia de cualquier fuente externa. Nuestro objetivo fue evaluar la repercusión del tinnitus en la calidad de vida. Se inscribieron 25 pacientes con tinnitus con una amplia gama de umbrales de pérdida auditiva (HLT) y estado de gravedad de tinnitus. La gravedad, la ansiedad y la depresión del tinnitus se evaluaron mediante el inventario de discapacidades por tinnitus (THI), el índice funcional de tinnitus (TFI) y la escala de ansiedad y depresión hospitalaria (HADS), respectivamente. Se realizó una audiometría de conducción aérea de tono puro. El impacto de la percepción del tinnitus en la calidad de vida se encontró más alto en el grupo de sufrimiento. La escala de ansiedad y depresión figuraba en 40% y 60%, respectivamente. El uso de la mano fue de 20 diestros y 5 zurdos. El tinnitus bilateral se está experimentando en el 76%. El LH se presentó en 17 (68%) de los pacientes con tinnitus. La descripción del sonido del tinnitus como silbido (40%), siseo (24%), pulsante (16%), timbre (8%) y ruidos de tono alto (12%). Con respecto al cuestionario THI, los sujetos con tinnitus se dividen en 60% (leve), 30% (moderado) y 10% (grave). Mientras que el cuestionario TFI, el 50% mostró un (leve), el 25% (moderado) y el 25% mostró (severo). Postulamos una fuerte asociación positiva significativa entre HADS y la gravedad del tinnitus: THI (P = 0,000) y TFI (P = 0,001). Esos datos revelaron que la percepción del tinnitus tiene impactos negativos en la calidad de vida mientras que la gravedad puede verse alterada por la lateralidad

Tinnitus is the sensation of sound in the absence of any external source, and the aim is to assess the impaction of tinnitus on QoL. 25-tinnitus sufferers were enrolled with a wide range of hearing loss thresholds (HLT) and tinnitus severity status. Tinnitus severity, anxiety and depression were assessed using tinnitus handicap inventory (THI), tinnitus functional index (TFI), and the hospital anxiety and depression scale (HADS), respectively. Pure tone air conduction audiometry was performed. The impaction of tinnitus perception on QoL was found higher in suffering group. The anxiety and depression scale figured in 40%, and 60%, respectively. The handed use was 20 rights handed and 5 left-handed. Bilateral tinnitus is experiencing in 76%. The HL occurred in 17(68%) of tinnitus patients. The description of tinnitus sound as whistling (40%), hissing (24%), pulsating (16%), ringing (8%), and high pitch noises (12%). Regarding THI questionnaire, tinnitus subjects are divided to 60% (mild), 30% (moderate), and 10% (severe). While TFI questionnaire, 50% showed a (mild), 25% (moderate), and 25% showed (severe). We postulated a strong significant positive association between HADS and tinnitus severity: THI (P=0.000) and TFI (P= 0.001). Those data revealed that tinnitus perception has negative impacts on QoL, and the severity may be altered by laterality.

Audiometría de altas frecuencias en adolescentes expuestos a ruidos / High frequency audiometry in adolescents exposed to noises

Introducción: La audiometría de altas frecuencias (9000-20 000 Hz) puede ser de gran utilidad en el diagnóstico precoz de hipoacusia inducida por ruidos en contraste con la audiometría convencional (125-8000 Hz). Objetivo: Evaluar la utilidad de la audiometría de altas frecuencias en el diagnóstico precoz de la hipoacusia inducida por ruidos en adolescentes. Métodos: Estudio descriptivo, observacional y transversal en 85 adolescentes expuestos a ruidos; 45 cursaban el décimo grado en un preuniversitario de la provincia La Habana, en el curso escolar 2013-2014 y 40, el primer año de la carrera de medicina, en una facultad de La Habana en el curso escolar 2015- 2016. A todos se le realizó una encuesta, examen físico de otorrinolaringología, audiometría convencional y audiometría de alta frecuencia. Resultados: La audiometría convencional fue normal en todos los casos. En la audiometría de altas frecuencias en todos los adolescentes estudiados comenzó a disminuir la audición a partir de los 13 000 Hz y se apreció una hipoacusia neurosensorial en aumento hasta 85 decibeles en oído derecho y 78 decibeles en oído izquierdo en 20 000 Hz de frecuencia. Conclusiones: Los adolescentes evaluados tienen hábitos auditivos que pueden perjudicar su audición, todos ya poseen signos de daño que no se manifiestan a través de la audiometría convencional pero sí a través de la audiometría de alta frecuencia en las diferentes exposiciones a ruidos de altos decibeles. Lo anterior demuestra la utilidad de esta audiometría, no solo dentro del campo de la audiología, sino también en la medicina preventiva(AU)

Introduction: High frequency audiometry (9000-20 000 Hz) can be really useful in the early diagnosis of deafness induced by noises, in contrast with conventional tonal audiometry (125-8000 Hz). Objective: Assess the usefulness of high frequency audiometry in the early diagnosis of deafness induced by noises in adolescents. Methods: Descriptive, observational and cross-sectional study in 85 adolescents exposed to noises; 45 of them were studying the 10th grade in a high school of Havana province, and 40 of them were in the first year of Medicine in a faculty of Havana province during school year 2015-2016. All of them took a survey, a physical examination of otolaryngology, liminar total audiometry and high frequency audiometry. Results: Tonal audiometry was normal in all the cases. In high frequency audiometry of all the studied adolescents started to decrease audition from 13000 HZ and it was noticed an increasing neurosensorial deafness up to 85 decibels in the right ear and 78 decibels in the left ear in 20 000 Hz of frequency. Conclusions: The adolescents assessed have auditive habits that can jeopardize their audition; all of them already have signs of damage that are not noticed in the tonal audiometry but in the high frequency audiometry in the different exposures to noises of high decibels. This proves the usefulness of this kind of audiometry not only in the field of audiology, but also in preventive medicine(AU)

Fatores associados ao desempenho de idosos nos testes de ordenação temporal / Factors related to the performance of elderly people in temporal ordering tests

RESUMO Objetivo Investigar os fatores associados e descrever o desempenho no teste padrão de frequência e teste padrão de duração em idosos. Método Estudo observacional, seccional, conduzido com idosos de 60 a 79 anos. Os participantes realizaram teste de rastreio cognitivo, entrevista contendo dados sociodemográficos e de saúde geral, avaliação audiológica e testes de avaliação do processamento auditivo temporal (padrão de frequência e padrão de duração). Foi conduzida análise descritiva da associação entre o desempenho nos testes de processamento temporal e as variáveis: sexo, idade, nível de escolaridade e alterações audiométricas, por meio da regressão linear múltipla. Resultados Participaram do estudo 86 idosos, sendo a maioria do sexo feminino, com idade entre 60 e 69 anos. O desempenho para ambos os testes foi melhor nos homens e nos idosos com maior nível de escolaridade e similar nas diferentes faixas etárias. No teste padrão de frequência, idosos com alteração auditiva apresentaram pior desempenho do que aqueles com média nas frequências de 0.5 a 4 kHz normal. Conclusão O sexo masculino e maior nível de escolaridade estão associados ao melhor desempenho nos testes de ordenação temporal, enquanto a alteração audiométrica apresenta associação com o pior desempenho apenas no teste padrão de frequência.

ABSTRACT Purpose To describe the performance of elderly individuals in Pitch Pattern Sequence (PPS) and Duration Pattern Sequence (DPS) tests and research related factors. Methods An observational, cross-sectional study conducted with elderly people aged 60 to 79 years. The participants underwent cognitive screening tests, interviews containing socio-demographic data and general health, as well as audiologic evaluation and temporal auditory processing (PPS and DPS) evaluation tests. A descriptive analysis of the association between the performance in temporal processing and the variables gender, age, level of education and audiometric alterations was conducted through multiple linear regression. Results 86 elderly people participated in the study, most of them female, with ages between 60 and 69. Male participants performed better in both tests as well as the participants with higher education, whereas no difference in performance was observed across the different age ranges. In the DPS, the participants with auditory alteration performed worse in relation to the ones with average frequencies of 0.5 to 4 kHz. Conclusion The male gender and higher level of education were associated with better results in the temporal ordering tests, whereas auditory alteration was associated with worse performance only in the pitch pattern sequence test.

Auditory effects of recreational and occupational noise exposure among dental students: a cross-sectional study / Efectos auditivos producto de la exposición a ruido recreacional y dental en estudiantes de odontología: un estudio transversal

ABSTRACT Purpose: to determine the auditory effects of noise exposure from recreational and occupational sources among dentistry students. Methods: forty-two dentistry students, routinely exposed to occupational noise, and 72 students from other health science schools were recruited (control group). Audiometric testing, otoacoustic emissions and questionnaires to assess recreational and occupational noise were applied to the sample. The presence of a notch was determined for each participant audiometry´s test based on the criteria proposed by Coles et al. Differences in notch prevalence were analyzed by applying univariate regression models as well as a multivariate model adjusted by covariates. Results: non-significant differences in auditory thresholds between groups were found. The controls exhibited a significantly higher prevalence of a notch at 4 kHz than the group exposed to noise. However, the differences were not statistically significant in the multivariate model adjusted by recreational noise exposure. Conclusions: the occupational noise exposure was not significantly associated to auditory system dysfunction. In addition, the differences in notch prevalence could be related to recreational noise exposure.

RESUMEN Objetivo: determinar los efectos auditivos producto de la exposición a ruido recreacional y ocupacional en estudiantes de Odontología. Métodos: se reclutó a 42 estudiantes de odontología expuestos rutinariamente a ruido ocupacional, y a 72 estudiantes de otras carreras del área de la salud (grupo control). Se evaluó mediante audiometría, emisiones otoacústicas, junto con aplicar cuestionarios para determinar la exposición a ruido ocupacional y recreacional. A partir de los umbrales audiométricos e determinó la presencia de escotoma usando el criterio de Coles et al. Se analizaron las diferencias en prevalencia de escotomas entre los grupos mediante regresiones logísticas, ajustando por otras variables. Resultados: no existieron diferencias significativas en los umbrales audiométricos entre los grupos estudiados. El grupo control mostró mayor prevalencia de escotoma en 4 kHz al ajustar por sexo y edad, sin embargo, dejó de ser significativa al ajustar adicionalmente por exposición a ruido recreacional. Conclusiones: la exposición a ruido ocupacional no se asoció a alteraciones auditivas. Además, las diferencias en prevalencia de escotomas estarían relacionadas a exposición a ruido recreacional.

Posturografía en niños entre 6 -11 años con edad auditiva no compensada / Posturography in children between 6 -11 years old with non-compensated hearing age

La posturografía permite evaluar la integración de los tres sistemas sensoriales que intervienen en el control postural y del equilibrio: el vestibular, el visual y el somatosensorial (Ronda, 2002). La presente investigación describe y analiza los resultados de la posturografía en niños entre seis y once años con pérdida auditiva quienes no han compensado su edad auditiva con respecto a su edad cronológica. Fueron evaluados dos grupos: el grupo control conformado por 32 niños con sensibilidad auditiva periférica normal y el grupo de estudio, conformado por 16 niños con pérdida auditiva, quienes usan amplificación auditiva y asisten a la Fundación CINDA para terapia auditiva con el fin de cerrar el GAP existente entre su edad cronológica y su edad auditiva. En la evaluación audiológica se aplicó anamnesis, revisión de historia clínica, audiometría tonal para la verificación de la sensibilidad auditiva periférica y posturografía, con un equipo de la marca NeuroCom, se realizaron las siguientes pruebas: Integración sensorial en balance-modificado (CTSIB), límites de estabilidad (LOS) y distribución de peso (WHT). En los resultados se encontraron diferencias estadísticamente significativas entre los dos grupos de estudio para las tres pruebas en distintas variables. Como conclusión se pudo determinar que existen diferencias estadísticamente significativas entre el grupo control y el grupo de estudio. La intervención con terapia ocupacional influenció positivamente los resultados en la posturografía, sobre todo en el grupo de 10 a 11 años. Se observaron diferencias sucesivas en los tres grupos de edad, indicando un componente de neuromaduración.

Posturography allows evaluating the integration of the three sensory systems involved in postural and balance control: vestibular, visual and somatosensory (Ronda, 2002). This research describes and analyzes the results of posturography in children between six and eleven years old with hearing loss who have not compensated their hearing age with respect to their chronological age. Two groups were evaluated: the control group made up of 32 children with normal peripheral hearing sensitivity and the study group, made up of 16 children with hearing loss, who use hearing amplification and attend the CINDA Foundation for hearing therapy in order to close the hearing loss. GAP between your chronological age and your hearing age. In the audiological evaluation, anamnesis, review of clinical history, tonal audiometry were applied to verify peripheral hearing sensitivity and posturography, with a NeuroCom brand equipment, the following tests were performed: Modified-balance sensory integration (CTSIB), stability limits (LOS) and weight distribution (WHT). In the results, statistically significant differences were found between the two study groups for the three tests in different variables. In conclusion, it was possible to determine that there are statistically significant differences between the control group and the study group. The occupational therapy intervention positively influenced the results in posturography, especially in the 10 to 11-year-old group. Successive differences were observed in the three age groups, indicating a neuromaturation component.

Traumatic perforations of the tympanic membrane: immediate clinical recovery with the use of bacterial cellulose film / Perfurações traumáticas da membrana timpânica: recuperação clínica imediata com o uso de fragmento de celulose bacteriana

Abstract Introduction: Perforation of the tympanic membrane is a reasonably frequent diagnosis in otorhinolaryngologists' offices. The expectant management is to wait for spontaneous healing, which usually occurs in almost all cases in a few weeks. However, while waiting for healing to be completed, the patients may experience uncomfortable symptoms. Although some research suggests the use of various materials to aid in the recovery of the tympanic membrane, none presented robust evidence of improvement in the cicatricial process. Nevertheless, the occlusion of the perforation with some material of specific texture and resistance can alleviate the patients' symptoms and accelerate the healing process. Objective: To evaluate the clinical (symptomatic and functional) improvement after the placement of bacterial cellulose film (Bionext®) on tympanic membrane perforations (traumatic). Methods: We evaluated 24 patients, victims of traumatic perforations of the tympanic membrane, who were evaluated in the Otorhinolaryngology Emergency Room. Following otoscopy and audiometric examination was performed, before and after the use of cellulose film occluding the tympanic membrane perforation. Results: Twenty-four patients were included, whose degree of overall discomfort caused by the tympanic membrane perforation and the presence of symptoms of autophonia, ear fullness and tinnitus were investigated. The mean score attributed to the overall annoyance caused by tympanic membrane perforation was 7.79, decreasing to a mean value of 2.25 after the film application. Symptom evaluation also showed improvement after using the film: autophonia decreased from a mean value of 6.25 to 2.08, tinnitus from 7 to 1.92 and ear fullness from 7.29 to 1.96. The auditory analysis showed mean threshold values still within the normal range at low and medium frequencies, with slight hearing loss at acute frequencies, but with significant improvement at all frequencies, with the exception of 8000 Hz, after film use. Conclusion: The use of bacterial cellulose film fragment on traumatic perforations of the tympanic membrane promoted immediate functional and symptomatic recovery in the assessed patients.

Resumo Introdução: A perfuração da membrana timpânica é uma condição clínica relativamente frequente em consultórios de otorrinolaringologistas. A conduta é quase sempre expectante, aguardando cicatrização espontânea, que costuma ocorrer na quase totalidade dos casos em algumas semanas. No entanto, enquanto não se completa, os pacientes mantêm sintomas desconfortáveis. Embora algumas pesquisas sugiram o uso de materiais diversos para auxiliar na recuperação da membrana timpânica, nenhuma apresentou evidência substancial de melhoria no processo cicatricial. Por outro lado, a oclusão da perfuração com alguns materiais de textura e resistência específicas poderia aliviar os sintomas dos pacientes durante o processo cicatricial. Objetivo: Avaliar a melhoria clínica (sintomática e funcional) após a colocação de película de celulose bacteriana (Bionext®) sobre a perfuração da membrana timpânica (traumática). Método: Foram avaliados pacientes com perfurações traumáticas da membrana timpânica que deram entrada no pronto-socorro de otorrinolaringologia. Eles foram avaliados em relação a suas queixas e exame audiométrico, antes e após a aplicação de película de celulose que oclui a perfuração da membrana timpânica. Resultados: Foram incluídos 24 pacientes, nos quais foram pesquisados o grau de incômodo global causado pela perfuração da membrana timpânica e a presença de sintomas de autofonia, plenitude auricular e tinnitus. A média da nota atribuída ao incômodo global causado pela perfuração foi de 7,79; caiu para valor médio de 2,25 após a aplicação da película. A avaliação dos sintomas também apresentou melhoria após uso da película, autofonia caiu de valor médio de 6,25 para 2,08; zumbido de 7 para 1,92 e plenitude auricular de 7,29 para 1,96. A análise auditiva apresentou um valor médio de limiares ainda dentro da normalidade em frequências baixas e médias, com perda de audição leve em frequências agudas, porém com melhoria significante em todas as frequências, com exceção de 8000 Hz, após a colocação da película. Conclusão: A aplicação de fragmento de película de celulose bacteriana sobre perfurações traumáticas da membrana timpânica promoveu recuperação funcional e sintomática imediata nos pacientes estudados.

Perda auditiva na hemoglobinopatia SC (HbSC): relato de caso / Hearing loss in SC hemoglobinopathy (HbSC): case report

Introdução: Doença falciforme (DF) engloba um conjunto de hemoglobinopatias marcadas pela hemoglobina (Hb) anormal S (HbS). A HbS possui um formato de foice e aumento de rigidez, culminando em hemólise. Além disso, dificulta a passagem pela microcirculação sanguínea, causando vaso-oclusão e lesão isquêmica em diversos órgãos e tecidos. Na orelha interna, tem sido descrita como os responsável por danos auditivos. Objetivo: apresentar um relato de caso de paciente do sexo feminino com doença falciforme, acometida de perda auditiva sensorioneural (PASN) bilateral assimétrica. Relato do caso: paciente do sexo feminino, destra, 45 anos, compareceu para avaliação, queixando se de diminuição da audição e zumbido na orelha esquerda. Foi submetida à avaliação audiológica, constituída por audiometria tonal limiar, logoaudiometria, imitanciometria, emissões otoacústicas por produto de distorção (EOAPD) e potencial evocado auditivo do tronco encefálico (PEATE). Resultados: constatou-se: perda auditiva sensorioneural bilateral de grau leve na orelha direita e severo na orelha esquerda; presença dos reflexos estapedianos contralaterais na orelha direita e ausência na orelha esquerda; curvas timpanométricas tipo A; ausência de emissões otoacústicas bilateralmente; e os potenciais auditivos evocados do tronco encefálico dentro dos padrões de normalidade. Discussão: diversos mecanismos estão envolvidos na relação DF e PASN, como a falta de oxigenação e infarto do órgão de Corti, hemorragia labiríntica e labirintite ossificante, bem como uma associação entre o nível de viscosidade sanguínea, disfunção endotelial e hipertensão sistêmica. E ainda deve ser considerada a questão de dominância hemisférica na assimetria da perda. Conclusão: os conhecimentos sobre as características dos danos auditivos na HbSC ainda não são conclusivos e merecem mais investigações. A implementação de avaliações periódicas da função auditiva tem contribuído para prevenir a progressão dos danos e auxiliado no tratamento precoce.

Introduction: Sickle cell disease (SCD) comprises a set of hemoglobinopathies marked by abnormal hemoglobin (Hb) S (HbS). HbS has a sickle shape and increased stiffness culminating in hemolysis, in addition to making it difficult to pass through the blood microcirculation, causing vessel-occlusion and ischemic damage in various organs and tissues. In the inner ear, they have been described as responsible for hearing damage. Objective: describing a case report of a female patient with sickle cell disease affected by asymmetric bilateral sensorineural hearing loss (SNHL). Case report: a 45-year-old female patient, right-handed, came for evaluation, complaining of decreased hearing and tinnitus in her left ear. She underwent audiological evaluation consisting of pure tone audiometry, logoaudiometry, immittance testing, distortion product otoacoustic emissions (DPOAE) and brainstem auditory evoked potential (BAEP). Results: bilateral mild sensorineural hearing loss in the right ear and severe in the left ear, presence of contralateral stapedial reflexes in the right ear and absence in the left ear, type A tympanometric curves, absence of bilateral otoacoustic emissions and the brainstem auditory evoked potentials within the normality patterns. Discussion: Several mechanisms are involved in the SCD and SNHL relationship, such as the lack of oxygen and infarction of the Organ of Corti, labyrinthine hemorrhage and ossifying labyrinthitis, as well as an association between the level of blood viscosity, endothelial dysfunction and systemic hypertension. And the question of hemispheric dominance in the loss asymmetry must still be considered. Conclusion: knowledge about the characteristics of hearing damage in HbSC is not yet conclusive and deserves further investigation. Implementation of periodic auditory function assessments has helped to prevent the progression of damage and has helped in early treatment.