Improving Accuracy and Reliability of Hearing Tests: An Exploration of International Standards

This study explores the internal standards for hearing tests and benefits of implementing international standard protocols, including the International Organization for Standardization (ISO) and International Electrotechnical Commission (IEC), and discusses how ISO and IEC standards provide a framework for designing, calibrating, assessing hearing test instruments and methods, and exchanging and comparing data globally. ISO and IEC standards for hearing tests improve accuracy, reliability, and consistency of test results by applying standardized methods and environments. Moreover, they promote international harmonization and data interoperability, enabling information exchange and research collaboration. Those standards for hearing tests are beneficial but have challenges and limitations, such as variation in equipment and calibration, lag in updating standards, variation in implementation and compliance, and lack of coverage of clinical aspects, cultural diversity, and linguistic diversity. These affect the quality and interpretation of test results. Adapting ISO or IEC standards locally would improve their applicability and acceptability, while balancing customization and compatibility with global standards.

The Gaps between Knowing and Doing in Hearing Aid Fitting Management

Evidence based practice has become an important aspect in many healthcare provisions to improve patient outcomes. Investigating the gaps between knowing and doing in audiology practice will provide future directions for successful service delivery. The purpose of this study was to explore “know-do” gaps related to professional awareness and attitude in hearing aid fitting management (HAFM) by analyzing data of a questionnaire. It consisted of 22 questions focusing on 11 HAFM components. Each component had two sub-questions involving levels of the importance and practice for HAFM. Respondents answered each question based on subjective judgments for their own hearing aid fitting services with a Visual Analogue Scale. A total of 51 responses from hearing care professionals were collected and the scores for knowing and doing were compared. The results showed overall high scores in doing and knowing responses; however, there were significant “know-do” gaps demonstrating higher knowing scores than doing scores across all HAFM components. The largest “know-do” gaps were observed in three components mostly implemented during follow-up sessions which indicate the need to improve their corresponding services and practical guidelines emphasizing the follow-up services.

A Systematic Review of Audiology Terminology

The present report provides an overview of terminology studies in audiology including topics and study characteristics, as well as categorizing the main issues. The goals are to improve the understanding of the current issues for terminology in audiology and to provide some basic information that will be useful to develop an international standard. Search procedures were completed over two phases. Phase 1 included a systematic electronic searches using MEDLINE (PubMed), Excerpta Medica Database, Cumulative Index to Nursing and Allied Health Literature, and International Organization for Standardization with keywords related to terminology of audiology. The studies were initially identified according to the titles of 2921 publications following careful abstract examination. Of these, whole texts of 16 publications were retrieved. Five papers met the inclusion criteria were further investigated. In phase 2, a manual search was conducted to collect additional publications with keywords related to terminology project in audiology. A total of 16 papers were found. The essential terminology issues classified included 'appropriateness,' 'classification/framework,' 'inconsistency of terminology,' 'multilingual and international aspects,' and 'service quality/delivery including communication and accessibility.' This was indicative of the paucity of terminology research in audiology, despite recurring terminology issues. Establishment of standardized terminology in audiology may minimize current challenging terminology issues by improving appropriateness and consistency of terminology as well as communication among relevant stakeholders at national and international levels.

General Framework of Hearing Aid Fitting Management

Hearing aids are one of the most widely used treatment options for the hearing impaired and optimal outcomes of hearing aids are supported by comprehensive hearing aid fitting protocols. Currently, the term 'hearing aid fitting' is prevalently used among service and industry sectors with its comprehensive procedures not systematically explicated. In addition, a variety of non-normalized guidelines for hearing aid fitting has led to non-uniform care, outcome variability, and dissatisfaction of the use of hearing aids. The main purpose of the present study is to suggest a general framework of standardized practice for hearing aid fitting management including its pre- and post-fitting stages. The management framework centers on its fitting process with its prior steps of assessment as well as its posterior steps of follow-up, thereby eliminating diverging interpretations and non-uniform practices. Outcomes of this study are also expected to improve potential benefits such as quality of hearing aid fitting, user satisfaction, and cost effectiveness across relevant stakeholders.

Long Term Changes of Electrical Stimulation Levels in Children with Cochlear Implant / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The goal of mapping after cochlear implantation (CI) is to find a proper range of acoustic signals for the implantees. In young children or infants, however, it is more difficult to obtain reliable responses during mapping procedure. The purpose of this study was to observe the changes of the proper electrical stimulation levels (threshold levels, comfortable levels and dynamic range) in children with the Nucleus 24 cochlear implant system by analyzing postoperative mapping results. SUBJECTS AND METHOD: The maps of 23 children with normal inner ear who received CI were examined at 7 time intervals (1, 6, 12, 24, 36, 48 and 60 months post-connection). RESULTS: The mean value of C levels and DR of 23 children gradually increased according to time from 1 month to 60 months post-connection. The value of T level increased up to 6 months post-connection and then stabilized. CONCLUSION: This study emphasized the need for frequent mapping in the first 6 months of implant use in children. Protocol for regular mapping schedule from 1 year to 5 year post-connection would be necessary.

Cochlear Implantation in the Cochlear Nerve Hypoplasia or Aplasia as Suggested by Temporal Bone Magnetic Resonance Imaging / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Identifying cochlear nerve hypoplasia or aplasia is dependent on temporal bone magnetic resonance imaging (TBMRI) providing information on the cochlea, internal auditory canal, and the cochlear nerve. The purpose of this study was to review the results of cochlear implantation (CI) in ears with cochlear nerve hypoplasia or aplasia as suggested by TBMRI. SUBJECTS AND METHOD: From April 1999 to April 2005, 321 patients were fitted with cochlear implants in our department by two surgeons. The present study focused on four prelingual patients who underwent CI in ears with cochlear nerve hypoplasia or aplasia as suggested by TBMRI. The perceptive and linguistic results were evaluated based on speech perception and production at preimplantation and at 1, 3, 6, 9, 12, and 24 months postimplantation. RESULTS: Pre-operative auditory brainstem responses were absent at 90 dB nHL in all patients. At least 10 months after implantation all patients were able to detect consonants and vowels in 100% and their categories of auditory performance scores were 4 or above. CONCLUSION: We confirmed cochlear nerve presence in cases of cochlear nerve hypoplasia or aplasia as suggested by TBMRI and made their auditory habilitation possible with cochlear implantation. However, even in cases of cochlear nerve hypoplasia or aplasia suggested by TBMRI, physicians need to confirm cochlear nerve presence before implantation and to predict the outcome of cochlear implantation.

Comparison of Neural Response Telemetry Threshold with Behavioral Response in Cochlear Implant / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Electrically evoked compound action potential thresholds recorded using neural response telemetry can be used to set MAP thresholds (T-levels) and maximum comfort levels (C-levels) especially in children implanted with the Nucleus 24 device. However, the thresholds and C-levels change over time and the relationship between neural response telemetry (NRT) measurements and behavioral levels in children may also change. The purpose of this study was to apply the neural response threshold to the behavioral levels at the beginning (up to first 6 months). SUBJECTS AND METHOD: The neural response telemetry test was administered in 23 patients (mean age was 16.8) with Nucleus 24 device. Four intra-cochlear electrodes (electrodes 5, 10, 15, and 20) were tested. The behavioral threshold and the maximum comfort level at immediate, 1, 2, 3 and 6 months post-implantation were compared with the neural response threshold. RESULTS: Among 23 patients, 15 had their NRT thresholds within their dynamic range in the 6 months post-mapping period. Although the time when NRT thresholds comes within the dynamic range may differ from patient to patient, it was common finding that this occurred after 2 months of post-mapping in most of the patients. CONCLUSION: During the first few months of post-implantation, care must be exercised when interpreting NRT measurements.

Application of Intra-operative Neural Response Telemetry in Cochlear Implant / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Neural response telemetry (NRT) has been used as one of the most useful tools to measure neural responses ranging from spiral ganglion cells to electrical stimulation via the Nucleus 24 cochlear implant. The purpose of this study was to assess and analyze the result of NRT measured intraopertively and apply the result in postoperative mapping. SUBJECTS AND METHOD: The NRT test was administered to 72 patients (49 children and 23 adults) with the Nucleus 24 cochlear implant. After inserting of the electrode array into the scala tympani, an impedance test was administered to check the integrity of each inserted electrode. In cases of partial insertion, the electrodes outside the cochlear were excluded along with those proven to be short circuited. The electrically evoked action potential (EAP) was recorded using version 3.0 of NRT software. One intra-cochlear electrode (electrode 2, 4, 6, 8, 10, 12, 14, 16) with MP1 as reference was chosen for the stimulating pair. The recording electrode was located 3 electrodes away apically from the stimulating intracochlear electrode and referenced to MP2. The amplifier gain and sampling delay were optimized for each subject using electrode 4 and these same parameters were used throughout the test. RESULTS: Out of 72 implantees, 56 patients (78%) were observed to produce reliable responses: 16 (70%) of 23 adults and 40 (82%) of 49 children responded. The patients who failed to produce NRT response had higher T levels than patients who had NRT response. CONCLUSION: Eighty percent of the implantees without any inner ear anomaly showed reliable response to intraopertive NRT measurement. The intra-operarative NRT data may be used to predict electrical stimulation levels in programming.

Chromoblastomycosis Treated with Occlusive Dressing of Amphotericin B Cream / 대한의진균학회지

We report a case of chromoblastomycosis in a 65 year-old woman. She had a 3x4 cm sized, annular, erythematous, plaque with crusts and ulcers on the right lower arm. The lesion had grown slowly for 2 years. In fungal and histopathologic examinations, several muriform cells were found in dermis as well as in scales and crusts on the lesional skin surface. Isolated fungus was identified as Fonsecaea pedrosoi. We treated the patient occlusive dressing of amphotericin B (3%) ointment for 8 weeks and achieved a good response without any evidence of recurrence. We propose that the occlusive dressing therapy of amphotericin B cream is a good modality among the various treatments of small localized chromoblastomycosis.

Three Cases of Kerion Celsi Caused by Trichophyton tonsurans / 대한의진균학회지

We report three cases of kerion celsi caused by Trichophyton tonsurans in 16-year-old students of one high school wrestling team. The first case presented a 10x5cm and several 3~4cm sized, markedly inflammatory, boggy lesions on the scalp for 5 months. Other cases showed several 2~4cm sized, erythematous, follicular pustules and nodules with partial alopecia on the scalp for 2 months. Histopathology and results of mycologic study were consistent with kerion celsi due to Trichophyton tonsurans. All lesions were successfully treated with griseofulvin 500mg daily for 7~15weeks and short term therapy of low dose of prednisolone and cephadroxil.

A Case of Block Dot Ringworm Caused by trichophyton tonsurans / 대한피부과학회지

Trichophyton tonsurans is a major causative agent of tinea capitis in the United States, Canada, Mezico and other Latin American countries, but the infection of T.tonsurans has not been reported in Korea. We report a case of tinea capitis caused by T. tonsurans in a 15-year-old student wrestler. He had a 3*3cm sized non-inflammatory alopecia with black dots on the right occipital area of the scalp. The diagnosis was established by a hght microscopic examination of the affected hairs and by mycological studies from cultures. To our knowledge, this is the first case in which T. tonsurans has been isolated in Korea, It is likely that the student acquired the infection through contact with a foreign wrestler during interaational games and practice. We should be concerned about the potential of spread of this infection in our country.

Tinea Barbae due to Trichophyton verrucosum: Report of 3 Cases / 대한의진균학회지

Although there has been recently noted a nation-wide spread of Trichophyton verrucosum infection in cattle associated with promoted stock raising and dairy farming, there were no case reports in Korean dermatologic literature describing the characteristic clinical features of tinea barbae caused by that particular fungus. We report 3 cases of tinea barbae due to T. verrucosum that developed in male stock farmers breeding cattle. One Patient acted 37, experienced acutely inflamed bo99y tumors on the chin and sub-mandible. The others aged 43 and 46 experienced inflammatory lesions with multiple follicular pustules, crusts and loss of hairs on their upper lips. They were successfully treated with oral griseofulvin and local antifungal ointment combined with short-term oral antibiotics or corticosteroid for about one month.

A Case of Primary Subcutaneous Phaeohyphomycosis Caused by Drechslera Dematioidea / 대한피부과학회지

Phaeohyphomycosis refers to subcutaneous and systemic fungal infections characterized by dematiacious septate mycerial elements in tissue, We are discribing the first report of subcutaneous phaeohyphomycosis by Drechslera dematioidea in a 9-year-old boy who presented a slow-growing 4x5.5cm erythematous plaque with somewhat verrucous and eczematous lesion on the dorsal aspect of his right foot after receiving a burn by boiling liquid at 2 years of age. Biopsy of the lesion revealed granulomatous inflammation, brownish spores in chain and planate-deviding sclerotic bodies in the epidermis and upper dermis. Findings by microscopic examination and consecutive cultures of scales and biopsy specimen were consistent with Drechslera dematioidea. The lesion was successfully treated with itraconazole.

The Clinical and Epidemiological Studies of Microsporum canis Infections (1983-1992) / 대한의진균학회지

BACKGROUND: Microsporum(M.) canis infection was first discovered in 1957 in Korea, but it did not spread and disappeared after 1960. It was iscovered again in 1975, and rapidly spread all over the country. In the 1980's, M. canis became one of the most important dermatophytes that infected humans. OBJECTIVE: The purpose of this study is to evaluate the clinical and epidemiological characteristics of M. canis infections. METHODS: We observed the clinical and epidemiological status in 2,256 cases of M. canis infections that were mycologically diagnosed at the Catholic Skin Disease Clinic from 1983 to 1992. RESULTS: The rate of M. canis infections compared to total dermatophytoses(25,907 patients) was 8.7%. The annual number of patients with M. canis infection increased gradually from 1983 and was highest frequency in 1986. Then the number of patients with M. canis infection was markedly decreased till 1992. The ratio of male to female patients was 0.85: 1(male:1,039, female:1,217), but the ratio in children (age16) was 0.33: 1. Children were chiefly involved as 82.6% of the patients. There were more patients in winter(35.3%) and followed by fall, summer and spring. M. canis infections were mostly composed of tinea(T.) capitis(64.2%), T.faciale(17.7%) and T. corporis(14.6%). In the seasonal distribution of M. canis infections, T. capitis was the most common in winter(38.8%) and was the lowest in summer(15.4%), but T. corporis was the most common in summer(42%). There was a difference in disease pattern between children and adults in M. canis infections; In children, M. canis infections were T. capitis(73.6%), T. faciale(16.3%),7 corporis(9%), but in adults, those were 7. corporis(41.3%), 7. faciale(24.5%), T. capitis(19.4%) in the order of decreasing frequency. CONCLUSION: We observed a gradual decrease in number of patient with M. canis infection after 1986. We suggest that M. canis infections would decrease more and more in the future in Korea.

Two Cases of Hyperkeratosis of the Nipple and Areola / 대한피부과학회지

We report two cases of hyperkeratosis of the nipple and areola which occurred in 22-year-old woman and 13-year-old girl. The former was suffered from mild pruritic, verrucous thickening and brownish discoloration of both nipples and areolae for 5 years. The latter had asymptomatic, verrucous thickening and dark brownish hyper- pigmentation of the right nipple and areola for 3 years. Both showed mild to marked hyperkeratosis and papillomatosis with increased pigmentation in the basal cell layer histopathologically. In both cases, the lesions were not responsive to the topical medications including steroids and keratolytic agents. Therefore we recommended surgical excision because the patients are greatly disturbed by the appearance of the lesions.