Auditory Performance in Late Implanted Congenitally Hearing Impaired Children: A Reality Check.

The present study aimed at determining auditory performance in children with congenital hearing impairment who underwent cochlear implant surgery unilaterally at or after age of 5 years. Study also aimed at studying association of factors such as chronological age (CA), implant age (IA), age at implantation (AAI), hearing age (HA), parental support, compliance to therapy, mode of therapy and parental satisfaction with auditory performance. It is a retrospective study. Files of 41 participants who fulfilled the inclusion criteria were reviewed for scores of Revised categories of auditory perception (CAP), Listening skills scale (LSS) and Speech intelligibility rating (SIR) along with other factors. Only 20 participants with complete data were included in the study. Researcher rated parental support and compliance to therapy while parental satisfaction was noted prospectively using a single yes-no type question. Participants showed improvement on CAP, LSS, SIR however they did not reach normal or near normal scores. CAP and LSS did not correlate with CA nor AAI or with IA. However CAP and LSS showed significant correlation with HA. SIR showed significant correlation with CA, AAI, IA and HA. Good auditory performance was associated with parental support and compliance to therapy but not with mode of therapy offered. 17 out of 20 parents were satisfied with outcomes of cochlear implant. Late implanted children showed improved auditory performance with implantation when they had previous hearing aid experience and parent support and compliance to therapy though they did not reach normal levels.

Role of Cervical Vestibular Evoked Myogenic Potentials (cVEMP) as Outcome-Measure of Glycerol Test.

Diagnosis of Meniere's disease is mainly clinical although many tests have been studied for efficacy in diagnosis of Meniere's disease. Glycerol test is a functional test to identify hydrops in Meniere's disease and can be done with PTA, Speech audiometry, otoacoustic emission, EcochG and cVEMP as its outcome measures. The study aimed to compare two outcome measures of glycerol test to identify Meniere's disease; to determine whether the stage of Meniere's disease affected glycerol outcomes; and to attempt to identify independent variables that could predict outcomes of glycerol test. 26 ears of 20 Meniere's disease participants were evaluated using PTA-based and cVEMP-based glycerol tests. Each test identified ten of 26 ears with Meniere's disease; and high agreement was noted in the two outcome measures. The stage of Meniere's disease based on four frequency hearing threshold average was not associated with outcome of glycerol test, but staging of Meniere's disease based on symptom duration was associated with glycerol test results. As the duration of symptoms increased there was lesser chance of positive outcomes on glycerol test; but intermediate stages of Meniere's disease showed positive outcomes. Variables such as age, gender, severity of hearing loss, duration of symptoms and pre-glycerol cVEMP measurements could not predict glycerol test outcomes. PTA-based and cVEMP- based glycerol tests hold promise in the test battery for identification of Meniere's disease. Positive findings on the test lead to confirmatory diagnosis but a negative glycerol test does not rule out Meniere's disease.

Role of cervical vestibular evoked myogenic potentials (cVEMP) and auditory brainstem response (ABR) in the evaluation of vestibular schwannoma / Papel dos potenciais evocados miogênicos vestibulares cervicais (cVEMP) e potencial evocado auditivo de tronco encefálico (PEATE) na avaliação do schwannoma vestibular

Abstract Introduction: Cervical vestibular evoked myogenic potentials (cVEMP) can assess the integrity of the inferior vestibular nerve thereby promising to be a useful tool in the audiological test battery to diagnose vestibular schwannoma. Objective: To ascertain the utility of cVEMP in diagnosis of vestibular schwannoma in conjunction with the ABR and to evaluate whether the size of lesion has any effect on the cVEMP measures. Methods: Case-files of 15 known cases of vestibular schwannoma whose pure tone audiometry, auditory brainstem response (ABR), cVEMP and radiological investigation findings were available, were included in the study. Patients were categorised as large or small tumours based on the size. The absolute and inter-peak latencies of ABR, amplitudes of waves V and I, and inter-aural latency difference of wave V of ABR; and latency of P1 and N1 of cVEMP and amplitude of P1-N1 complex were considered in the study. Results: There were eight large and nine small tumours. All the patients with large tumours showed significant severity of hearing loss whereas only three out of nine patients with small tumours showed severe to profound deafness in the affected ear. The rest showed hearing status ranging from normal hearing sensitivity to moderate hearing loss. Most of the patients with large tumours showed complete absence of ABR in the affected ears with no identifiable wave-peaks. ABR in small tumours exhibited delayed III-I and delayed V-I interpeak latency interval (IPL). Four out of five patients with large unilateral tumours revealed contralateral effects of reduced amplitude or absence of cVEMP. On the contrary, six out of eight unilateral small tumours showed a normal cVEMP response in the contralateral ear. Both the patients with NF2 in the present study demonstrated cVEMP abnormalities. Conclusion: ABR and cVEMP, when used in combination, can be of immense use in identification of neuro-otologic conditions such as vestibular schwannoma and bilateral tumours in NF2. In the evaluation of unilateral vestibular schwannoma, abnormal contralateral findings of cVEMP and ABR are strongly indicative of the tumour size >2.5 cm. In unilateral severe to profound loss wherein ABR in poorer ear cannot give information of site-of-lesion, cVEMP can help in the differentiation.

Resumo Introdução: Os potenciais evocados miogênicos vestibulares cervicais (cVEMP) podem avaliar a integridade do nervo vestibular inferior, prometem assim ser uma ferramenta útil na bateria de testes audiológicos para o diagnóstico de schwannoma vestibular. Objetivo: Determinar a utilidade de cVEMP no diagnóstico de schwannoma vestibular em conjunto com PEATE e avaliar se o tamanho da lesão tem qualquer efeito sobre as medidas do cVEMP. Método: Quinze casos diagnosticados com schwannoma vestibular cujos exames de audiometria tonal pura, potencial evocado auditivo de tronco encefálico (PEATE), cVEMP e investigação radiológica estavam disponíveis foram incluídos no estudo. Os pacientes foram classificados como portadores de tumores grandes ou pequenos. As latências absolutas e interpico de PEATE as amplitudes das ondas V e I e a diferença de latência interaural da onda V da PEATE e a latência de P1 e N1 de cVEMP e amplitude do complexo P1-N1 foram consideradas no estudo. Resultados: Havia oito tumores grandes e nove pequenos. Todos os pacientes com tumores grandes apresentavam perda auditiva grave enquanto apenas três dos nove pacientes com pequenos tumores apresentaram surdez grave a profunda na orelha acometida. O restante apresentou audição que variou de normal a perda auditiva moderada. A maioria dos pacientes com tumores grandes demonstrou ausência completa de PEATE nas orelhas acometidas sem picos de onda identificáveis. O PEATE em tumores pequenos apresentou intervalo de latência interpico (ILI) tardia III-I e tardia V-I. Quatro em cada cinco pacientes com tumores grandes unilaterais revelaram efeitos contralaterais de amplitude reduzida ou ausência de cVEMP. Ao contrário, seis dos oito tumores pequenos unilaterais apresentaram resposta de cVEMP normal na orelha contralateral. Ambos os pacientes com NF2 no presente estudo demonstraram anormalidades na cVEMP. Conclusão: PEATE e cVEMP, quando usadas em combinação, podem ser úteis na identificação de condições neuro-otológicas como schwannoma vestibular e tumores bilaterais em NF2. Na avaliação de schwannoma vestibular unilateral, achados contralaterais anormais de cVEMP e PEATE são fortemente indicativos de tumor >2,5 cm. Na perda unilateral grave a profunda, na qual o PEATE na orelha mais prejudicada não fornece informações do local da lesão, cVEMP pode ajudar na diferenciação.

Role of cervical vestibular evoked myogenic potentials (cVEMP) and auditory brainstem response (ABR) in the evaluation of vestibular schwannoma.

INTRODUCTION: Cervical vestibular evoked myogenic potentials (cVEMP) can assess the integrity of the inferior vestibular nerve thereby promising to be a useful tool in the audiological test battery to diagnose vestibular schwannoma. OBJECTIVE: To ascertain the utility of cVEMP in diagnosis of vestibular schwannoma in conjunction with the ABR and to evaluate whether the size of lesion has any effect on the cVEMP measures. METHODS: Case-files of 15 known cases of vestibular schwannoma whose pure tone audiometry, auditory brainstem response (ABR), cVEMP and radiological investigation findings were available, were included in the study. Patients were categorised as large or small tumours based on the size. The absolute and inter-peak latencies of ABR, amplitudes of waves V and I, and inter-aural latency difference of wave V of ABR; and latency of P1 and N1 of cVEMP and amplitude of P1-N1 complex were considered in the study. RESULTS: There were eight large and nine small tumours. All the patients with large tumours showed significant severity of hearing loss whereas only three out of nine patients with small tumours showed severe to profound deafness in the affected ear. The rest showed hearing status ranging from normal hearing sensitivity to moderate hearing loss. Most of the patients with large tumours showed complete absence of ABR in the affected ears with no identifiable wave-peaks. ABR in small tumours exhibited delayed III-I and delayed V-I interpeak latency interval (IPL). Four out of five patients with large unilateral tumours revealed contralateral effects of reduced amplitude or absence of cVEMP. On the contrary, six out of eight unilateral small tumours showed a normal cVEMP response in the contralateral ear. Both the patients with NF2 in the present study demonstrated cVEMP abnormalities. CONCLUSION: ABR and cVEMP, when used in combination, can be of immense use in identification of neuro-otologic conditions such as vestibular schwannoma and bilateral tumours in NF2. In the evaluation of unilateral vestibular schwannoma, abnormal contralateral findings of cVEMP and ABR are strongly indicative of the tumour size >2.5cm. In unilateral severe to profound loss wherein ABR in poorer ear cannot give information of site-of-lesion, cVEMP can help in the differentiation.

Audiometric profile in patients with chronic renal failure.

OBJECTIVES: To determine the occurrence of hearing loss and to establish audiometric profiles and patterns of hearing impairment in patients with chronic renal failure (CRF). METHODS: A retrospective study examined the relationship between the different stages of CRF and corresponding audiologic findings in those patients. Twenty-three subjects (46 ears) in the age range of 25 to 60 years were included in the study. These subjects were arranged into groups ranging from the second to fifth stages of CRF. Audiologic assessment in each subject was performed using a battery of tests, which included pure-tone audiometry, transient otoacoustic emission (TOAE), distortion product otoacoustic emission, and brainstem evoked response audiometry (BERA). RESULTS: Significant differences in the degree of hearing loss were observed among patients with different stages of CRF. It was noted that almost all (95.65%) patients with CRF did not pass the TOAEs. It was important to notice that none of the patients with CRF showed findings on BERA that pointed to retrocochlear involvement. Thus, the present study found that most patients (65.21%) had a cochlear pathology. CONCLUSIONS: We observed that (a) there is a high incidence of hearing loss among patients with CRF; (b) the methods of treatment (hemodialysis and conservative treatment) may not influence the impact of the disease on hearing; (c) levels of serum electrolytes and biochemical constituents of blood do not seem to correctly reflect the audiologic status of a CRF patient; and (d) hearing loss in patients with CRF has a distinct audiologic pattern. Given that CRF involves hearing loss, routine audiologic assessment in patients with this condition is essential.