Diagnosis of sensorineural hearing loss with neural networks versus logistic regression modeling of distortion product otoacoustic emissions.

We investigated whether modeling with artificial neural networks or logistic regression of distortion product otoacoustic emissions (DPOAE), across diverse frequencies, may achieve an accurate diagnosis of sensorineural hearing loss (SNHL) of cochlear origin. 256 ears (90 with SNHL and 166 with normal hearing) were evaluated with pure-tone audiometry, impedance audiometry, speech audiometry and DPOAE. Ears were split into training (n = 176) and validation (n = 80) sets. Input variables included gender, age, examination time, DPOAE intensity at F(2) frequencies 593, 937, 1906, 3812 and 6031 Hz, and respective values corrected for noise levels. In the validation data set, an average network had an area under the receiver operating characteristic curve (AUC) of 0.86 (accuracy 84%). Logistic regressions including all these variables or those selected by backward elimination had AUC values of 0.91 and 0.92, respectively (accuracy 85% both). Eleven of 12 trained networks had better specificity than the backward elimination logistic regression, and the backward elimination logistic regression had a better sensitivity than 11 of the 12 networks. Both modeling approaches correctly identified all ears with sudden hearing loss, congenital hearing loss, head trauma, nuclear jaundice and ototoxicity, and 2-3 of 5 ears with acoustic trauma, but missed 1-3 of 3 ears with Ménière's disease and 4-6 of 8 ears with abnormal pure-tone thresholds on audiometry which had no accompanying findings. For SNHL exceeding 45 dB HL on a pure-tone threshold, sensitivity was 83% (15/18) by neural networks and 84 or 94% (16/18 or 17/18) by logistic regression. Both neural-network-based analysis and logistic regression modeling of the DPOAE pattern across a range of frequencies offer promising approaches for the objective diagnosis of moderate and severe SNHL.

Measuring of distortion product otoacoustic emissions using multiple tone pairs.

In order to reduce the examination time of the Distortion Product Otoacoustic Emissions (DPOAE) test, we investigated the applicability of the multiple-tone pairs method by comparing the DPOAE evoked by 4- and 3-tone pairs (Sim) with the conventional 1-tone pair (Seq) in 116 ears of human adults with normal hearing (NH) and 86 ears with sensorineural hearing loss (SNHL). We found that: (1) DPOAE amplitudes in the NH group obtained with the Sim method were strongly correlated with those of Seq. (2) DPOAE amplitude and noise level mean values obtained with the Seq method were significantly higher than those obtained with Sim. (3) DPOAE amplitude was independent of the stimulation side (right vs. left ears). (4) Both methods can equally distinguish ears with NH and a low degree of SNHL from those with higher degrees of SNHL. (5) Examination time was shorter with the Sim method in both groups. In conclusion, the Sim method produces results similar to those of Seq. However, a significant difference between the two methods in relation to DPOAE amplitudes and noise levels was found. Because of this, normal data for both the DPOAE amplitude and noise level are required to improve the sensitivity of the Sim method. The mean examination time in both groups (NH and SNHL) was shorter with the Sim method. Therefore, the multiple-tone pairs stimulation method seems to be more suitable when it is used as an auditory screening test.

Permanent bilateral acoustic trauma due to air bag deployment in a young female adult.

Air bag safety systems have significantly reduced the number of occupant injuries from road traffic accidents (RTA). However air bag deployment is also associated with unavoidable risks. We report the acoustic trauma incurred by a young female driver who was a heavy smoker as a consequence of air-bag deployment in a low speed RTA and the sparing of her child seated in the rear.

Effect of meteorological parameters on acute laryngitis in adults.

The aim of this study was to investigate the influence of weather conditions on the frequency of acute laryngitis in adults. The medical records of 825 patients with a diagnosis of acute laryngitis obtained over a 5-year period were reviewed. Meteorological data reviewed included the daily values of 13 parameters. The monthly distribution of the disease was assessed. In addition, a detailed 2-part statistical analysis was performed as follows: (i) the relationship between each meteorological parameter and the frequency of the disease was investigated, using contingency tables; and (ii) the 1825-day period was divided into 8 groups characterized by similar weather, using factor and cluster analysis, and the disease frequency in each group was assessed. Our observations were as follows: 1. Meteorological parameters, such as low temperature, low diurnal temperature range, low atmospheric pressure and low mean water vapor pressure, were associated with an increased occurrence of acute laryngitis. 2. Significant changes in maximum temperature or a significant drop in atmospheric pressure, as compared to the previous day's conditions, favored new cases of the disease. 3. The cold period of the year was associated with an almost two-fold increase in the frequency of disease cases, which peaked in March and reaching a minimum during August. 4. The peak frequency of cases was associated with winter weather conditions, which were characterized by high humidity readings. In conclusion, meteorological parameters, and their variation and covariation, are strongly associated with acute laryngitis in adults.

Prevalence of GJB2 mutations in prelingual deafness in the Greek population.

OBJECTIVE: Mutations in the gene encoding the gap junction protein connexin 26 (GJB2) have been shown as a major contributor to prelingual, sensorineural, nonsyndromic, recessive deafness. One specific mutation, 35delG, has accounted for the majority of the mutations detected in the GJB2 gene in Caucasian populations. The aim of our study was to determine the prevalence and spectrum of GJB2 mutations in prelingual deafness in the Greek population. METHODS: In a collaboration with the major referral centers for childhood deafness in Greece, patients were examined by an extensive questionnaire to exclude syndromic forms and environmental causes of deafness and by allele-specific polymerase chain reaction (PCR) for the detection of the 35delG mutation. Patients heterozygous for the 35delG mutation were further analyzed by direct genomic sequencing of the coding region of the GJB2 gene. RESULTS: The 35delG mutation was found in 42.2% of the chromosomes in 45 familial cases of prelingual, nonsyndromic deafness (18 homozygotes and 2 heterozygotes) and in 30.6% of the chromosomes in 165 sporadic cases (45 homozygotes and 11 heterozygotes). Direct genomic sequencing in heterozygous patients revealed the L90P (2 alleles), W24X (2 alleles), R184P (2 alleles), and 291insA (1 allele) mutations. CONCLUSION: Mutations in the GJB2 gene are responsible for about one third of prelingual, sensorineural, nonsyndromic deafness in the Greek population, and allele-specific PCR is an easy screening method for the common 35delG mutation.

Weather conditions and sudden sensorineural hearing loss.

BACKGROUND: Climatic or meteorological condition changes have been implicated in the pathogenesis of Idiopathic Sudden Sensorineural Hearing Loss (ISSHL). We investigated the seasonal distribution of ISSHL and evaluated the influence of meteorological parameters (such as temperature, humidity, and atmospheric pressure), their variation and covariation on the incidence of the disease. METHODS: A total of 82 cases of ISSHL, admitted to our department over a five-year period, were enrolled in the study. Seasonal distribution of the disease was investigated by dividing the year in four seasons. Meteorological data included daily values of 13 distinct parameters recorded at the meteorological station of the University of Ioannina during this period. A relationship between each meteorological variable and the incidence of ISSHL was investigated by applying (chi2) test on data from 13 contingency tables as well as by using logistic regression and t-test approaches. In addition, the influence of different weather types on the incidence of ISSHL was investigated using Cluster Analysis in order to create eight clusters (weather types) characteristic for the prefecture of Ioannina. RESULTS: The results of the study could not indicate any seasonal distribution of the disease. The incidence of ISSHL could not be significantly correlated either to any distinct meteorological parameter or to any specific weather type. CONCLUSIONS: Meteorological conditions, such as those dominating in the Northwestern Greece, and/or their changes, have no proven effect on the incidence of ISSHL.

Squamous cell vocal cord carcinoma and synchronous small cell lung carcinoma: a case report.

According to various authors the incidence of multiple primary tumors in the aerodigestive tract can be considered high. However, most of these tumors are metachronous and of the same histological type. The occurrence of a small cell lung carcinoma synchronous with a squamous cell vocal cord carcinoma is a very rare phenomenon. In this report we present the second case in the English literature.

Ear involvement in systemic lupus erythematosus patients: a comparative study.

Ear damage in systemic lupus erythematosus (SLE) patients has been occasionally reported but the frequency and the mechanisms of ear involvement are not well documented. In an attempt to investigate the presence of hearing loss and the possible causes for it we prospectively evaluated 43 SLE patients. All patients underwent a complete ear-nose-throat physical examination and audiological evaluation with pure tone, impedance and speech audiometry. In addition, systemic manifestations of the disease and drug therapy were recorded. Finally, all patients were tested for the presence of autoantibodies. The results were compared with those of 50 age-matched healthy subjects. Hearing loss (HL) was found in nine patients (22.5 per cent). More specifically, eight patients presented sensorineural hearing loss (SNHL) (21.5 per cent) and only one had conductive hearing loss (CHL) (2.63 per cent). From the patients with SNHL, one had bilateral symmetrical damage, four had bilateral but no symmetrical damage and three patients showed unilateral SNHL. Finally, the patient with CHL had unilateral involvement. There were no statistically significant differences between patients with HL and those without regarding age, disease duration, clinical disease manifestations, autoantibody profile and drug therapy. In conclusion, one fourth of our SLE patients presented HL, expressed as SNHL affecting mainly the middle and high frequencies, while only one patient had CHL. This is a lower percentage of ear involvement in SLE than that reported by other investigators. The mechanism of ear damage remains unknown. Thus, additional prospective studies are needed to elucidate its pathogenesis.

Recurrent facial pain due to Pseudomonas aeruginosa sinusitis.

Pseudomonas (P) aeruginosa has been rarely reported as a causative agent of chronic sinusitis in otherwise healthy individuals, mostly as part of polymicrobial infections, while it has been frequently described among immunocompromised patients. We report a case of chronic maxillary sinustitis due to P. aeruginosa presenting as recurrent facial pain in a previously healthy middle-aged woman. Bacteriological diagnosis was established by tissue cultures and definitive treatment was achieved by surgical intervention and postoperative antibiotic treatment along with topical care.