Tablet and web-based audiometry to screen for hearing loss in adults with cystic fibrosis.

INTRODUCTION: Individuals with chronic lung disease (eg, cystic fibrosis (CF)) often receive antimicrobial therapy including aminoglycosides resulting in ototoxicity. Extended high-frequency audiometry has increased sensitivity for ototoxicity detection, but diagnostic audiometry in a sound-booth is costly, time-consuming and requires a trained audiologist. This cross-sectional study analysed tablet-based audiometry (Shoebox MD) performed by non-audiologists in an outpatient setting, alongside home web-based audiometry (3D Tune-In) to screen for hearing loss in adults with CF. METHODS: Hearing was analysed in 126 CF adults using validated questionnaires, a web self-hearing test (0.5 to 4 kHz), tablet (0.25 to 12 kHz) and sound-booth audiometry (0.25 to 12 kHz). A threshold of ≥25 dB hearing loss at ≥1 audiometric frequency was considered abnormal. Demographics and mitochondrial DNA sequencing were used to analyse risk factors, and accuracy and usability of hearing tests determined. RESULTS: Prevalence of hearing loss within any frequency band tested was 48%. Multivariate analysis showed age (OR 1.127; (95% CI: 1.07 to 1.18; p value<0.0001) per year older) and total intravenous antibiotic days over 10 years (OR 1.006; (95% CI: 1.002 to 1.010; p value=0.004) per further intravenous day) were significantly associated with increased risk of hearing loss. Tablet audiometry had good usability, was 93% sensitive, 88% specific with 94% negative predictive value to screen for hearing loss compared with web self-test audiometry and questionnaires which had poor sensitivity (17% and 13%, respectively). Intraclass correlation (ICC) of tablet versus sound-booth audiometry showed high correlation (ICC >0.9) at all frequencies ≥4 kHz. CONCLUSIONS: Adults with CF have a high prevalence of drug-related hearing loss and tablet-based audiometry can be a practical, accurate screening tool within integrated ototoxicity monitoring programmes for early detection.

Sensory dysmodulation in vestibular migraine: an otoacoustic emission suppression study.

OBJECTIVES/HYPOTHESIS: To seek evidence of sensory dysmodulation in auditory brainstem reflexes in patients with vestibular migraine by studying suppression of otoacoustic emissions (OAEs) by contralateral noise. STUDY DESIGN: A prospective case-control study. METHODS: The authors measured contralateral suppression of OAEs in a group of 33 interictal patients with definite vestibular migraine (migrainous vertigo) according to the strict diagnostic criteria of Neuhauser (2001), and compared them with 31 nonmigrainous controls with matching age and sex distributions. Suppression values were then compared with previously published departmental normative data. In three patients, recordings were compared in the ictal and interictal states. RESULTS: OAE suppression was reduced in 11/33 patients, and 3/31 controls (P = .022 chi(2) test). Binary logistic regression analysis confirmed that the presence of vestibular migraine was significantly associated with abnormal suppression, but no such relationship was seen for symptoms of phonophobia or disease duration. The amplitude of variability between the ictal and interictal state was out of the normal range in 2 out of the 3 patients in whom such recordings were made. CONCLUSIONS: These results provide support for the notion of interictal auditory sensory dysmodulation in an as yet unidentified subset of migraineurs with vestibular migraine.