Comparison of the Degree of Handicap Between Different Types of Vestibular Disorders.

Vestibular disorders have had a disabling effect because of the symptoms they cause. The aim of this study was to evaluate the degree of disability associated with vertigo in patients with different vestibular disorders using a handicap questionnaire and to investigate the possible relationship between some factors with different types of vestibular disorders and vertigo-related handicap scores. 462 subjects aged 12-90 years old with symptoms of vertigo, dizziness, or imbalance were recruited from several public and private centers. After taking the medical history, the patients fillled out the Vertigo Handicap Questionnaire (VHQ). There was a significant difference between the VHQ mean scores of vestibular disorders (p = 0.002). There was also a significant relationship between the male sex and BPPV and blood supply problems, between women with endolymphatic hydrops, vestibular neuritis, VM, CNS disorders, concomitant BPPV, and hydrops, between vestibular disorders and various ranges of hearing. BPPV, neuritis, VM, were also significantly correlated with blood pressure, concomitant BPPV and hydrops, with diabetes and hydrops, and concomitant BPPV and hydrops were significantly correlated with cholesterol. The coexistence of various vestibular disorders may cause additional handicaps and should be considered. Some comorbidities may also affect the degree of handicap, although their effects may not be the same. Various factors in addition to the type of vestibular disorder, such as personality, culture, education level, income, and strategies for coping with the disease, may also determine the level of patient-reported vertigo handicap.

Efficacy of tailor-made notched music training (TMNMT) in the treatment of tinnitus: a systematic review and meta-analysis.

INTRODUCTION: Numerous treatment modalities have been suggested for managing tinnitus. Tailor-Made Notched Music Training (TMNMT) is a viable strategy in music therapy for tinnitus management. Many research studies have examined the effectiveness and potential benefits of this intervention. This study aims to assess the effectiveness of TMNMT in treating chronic tinnitus. METHODS: This systematic review and meta-analysis study used a research methodology that covered up until February 2023. The search was conducted across academic databases including Google Scholar, PubMed, Scopus, and Web of Science. A total of 234 papers were evaluated, and seven relevant clinical trials were included. RESULTS: The meta-analysis, which included five studies using the tinnitus handicap inventory (THI), showed no statistically significant effect of TMNMT on tinnitus handicap after 3 and 6 months of intervention (dppc2: - 0.99, 95%CI - 2.94 to 0.96; I2 = 79.96%, p = 0.00), (dppc2 - 1.81, 95%CI - 5.63 to 2.01; I2 = 79.96%, p = 0.00). However, four out of five studies using the total Visual Analogue Scale (VAS) or its subscale showed positive effects of TMNMT on chronic tinnitus. Unfortunately, there were not enough articles to conduct a meta-analysis on this outcome. CONCLUSION: Although the meta-analysis did not show a statistically significant effect of TMNMT on tinnitus handicap, the large effect size observed after at least 3 months of intervention suggests that this method may potentially decrease tinnitus handicap if more studies are conducted. Due to the limited number of studies, subgroup analysis could not be performed to analyze potential causes of heterogeneity. Therefore, further high-quality clinical trials are necessary to draw a definitive conclusion and evaluate the impact of different variables, techniques, and outcomes.

Omega-3 fatty acids and health of auditory and vestibular systems: a comprehensive review.

PURPOSE: The purpose of this study was to comprehensively review animal and human studies that explore the role of omega-3 PUFAs in maintaining the health of the auditory organ across all life stages. METHODS: This narrative review involved searching Scopus, PubMed, Google Scholar, and Cochrane Library databases for relevant articles from December 1980 to July 2023. RESULTS: some animal and human studies suggest that both deficiency and excessive intake of long-chain omega-3 PUFAs, particularly docosahexaenoic acid (DHA), can lead to auditory neural conduction impairment and reduced hearing acuity from fetal development to old age (presbycusis). These effects are likely to be dependent on the dosage. Some research indicates that an excessive intake of omega-3, rather than a deficiency, can result in nutritional toxicity and hearing impairments. Animal studies highlight the positive impact of omega-3 supplements with high DHA content in addressing hearing damage, but human research on this subject is limited. Furthermore, certain studies propose that omega-3 PUFAs may prevent or delay age-related hearing loss, with high plasma omega-3 concentration, particularly long-chain omega-3 PUFA, linked to reduced hearing loss. Additionally, consuming fish more than twice a week may be associated with a lower risk of hearing loss in adulthood, with these effects potentially influenced by age and gender. However, the majority of studies have been conducted on animals, and clinical trials are scarce. Research on the influence of omega-3 PUFAs on the peripheral and central vestibular systems remains limited. CONCLUSION: This article delves into the impact of omega-3 on the auditory-vestibular system, exploring its influence on neurodevelopment, protection, and treatment. It not only highlights specific research gaps but also offers valuable insights for potential future studies.

Age-related hearing loss: An updated and comprehensive review of the interventions.

Aging causes progressive degenerative changes in many organs, particularly the auditory system. Several attempts have been conducted to investigate preventive and therapeutic strategy/strategies for age-related auditory dysfunction, such as maintaining a healthy lifestyle through good nutrition, lower anxiety levels, and noise exposure, different pharmacological approaches, gene and cell therapy, and other strategies. However, it is not clear which approach is the best to slow down these dysfunctions because several different underlying mechanistic pathways are associated with presbycusis which eventually leads to different types of this disease. A combination of several methods is probably required, whereas the effectiveness for some people needs to be monitored. The effectiveness of treatments will not be the same for all; therefore, we may need to have a unique and personalized approach to the prevention and treatment of ARHL for each person. In addition, each method needs to specify what type of presbycusis can prevent or treat and provide complete information about the extent, duration of treatment, persistency of treatment, side effects, and whether the approach is for treatment or prevention or even both. This paper reviews the updated literature, which targets current interventions for age-related hearing loss.

Hearing handicaps, communication difficulties and depression in the older adults: a comparison of hearing aid users and non-users.

BACKGROUND AND AIM: Age-related hearing loss has potential effects on communication, cognitive, emotional, and social aspects of the older person's life. Evaluating the role of hearing aids in reducing these difficulties is important. This study aimed to evaluate communication difficulties, self-perceived handicaps, and depression in hearing-impaired older adults who are either hearing aid users or non-users. METHODS: A total of 114 older adults in the age range of 55-85 years with moderate to moderately severe hearing loss (two hearing-matched groups; hearing aid users: n = 57; hearing aid non-users: n = 57) took part in this study during the COVID-19 pandemic. Self-perceived hearing handicaps and communication were evaluated using the Hearing Handicap Inventory in the Elderly-Screening (HHIE-S) and Self-Assessment Communication (SAC) questionnaires. Depression was assessed using the geriatric depression scale (GDS). RESULTS: The average score of HHIE-S was significantly higher in the hearing aid users than the non-users (16.61 ± 10.39 vs. 12.49 ± 9.84; p = 0.01). Differences between groups were not significant for SAC or GDS scores (p ≥ 0.05). There were strong positive correlations between HHIE-S and SAC scores in both groups. Moderate correlations were found between SAC and GDS scores in the hearing aid users and between the duration of using hearing aid with SAC and HHIE-S scores. CONCLUSION: It seems that self-perceived handicaps, communication difficulties and depression are affected by many factors, and only receiving hearing aids without subsequent support such as auditory rehabilitation and programming services cannot bring the expected output. The effect of these factors was clearly observed due to reduced access to services in the COVID-19 era.

Modulation of auditory temporal processing, speech in noise perception, auditory-verbal memory, and reading efficiency by anodal tDCS in children with dyslexia.

Dyslexia is a neurodevelopmental disorder that is prevalent in children. It is estimated that 30-50% of individuals diagnosed with dyslexia also manifest an auditory perceptual deficit characteristic of auditory processing disorder (APD). Some studies suggest that defects in basic auditory processing can lead to phonological defects as the most prominent cause of dyslexia. Thus, in some cases, there may be interrelationships between dyslexia and some of the aspects of central auditory processing. In recent years, transcranial direct current stimulation (tDCS) has been used as a safe method for the modulation of central auditory processing aspects in healthy adults and reading skills in children with dyslexia. Therefore, the objectives of our study were to investigate the effect of tDCS on the modulation of different aspects of central auditory processing, aspects of reading, and the relationship between these two domains in dyslexic children with APD. A within-subjects design was employed to investigate the effect of two electrode arrays (the anode on the left STG (AC)/cathode on the right shoulder and anode on the left STG/cathode on the right STG) on auditory temporal processing; speech-in-noise perception, short-term auditory memory; and high-frequency word, low-frequency word, pseudoword, and text reading. The results of this clinical trial showed the modulation of the studied variables in central auditory processing and the accuracy and speed of reading variables compared to the control and sham statuses in both electrode arrays. Our results also showed that the improvement of the accuracy and speed of text reading, as well as the accuracy of pseudoword reading were related to the improvement of speech in noise perception and temporal processing. The results of this research can be effective in clarifying the basis of the neurobiology of dyslexia and, in particular, the hypothesis of the role of basic auditory processing and subsequently the role of the auditory cortex in dyslexia. These results might provide a framework to facilitate behavioral rehabilitation in dyslexic children with APD.

Slight High-Frequency Hearing Loss, Effect of COVID-19 or Hydroxychloroquine Usage?

BACKGROUND AND OBJECTIVES: Concerns about ototoxic and vestibulotoxic effects have been raised with the use of antiviruses in the treatment of COVID-19. This study aimed to determine the effect of hydroxychloroquine (HCQ) and examine the auditory system and its associated auditory and vestibular symptoms in patients with COVID-19. STUDY DESIGN: Prospective study. PATIENTS: Thirty patients with a history of HCQ (HCQ+) and 30 patients without drug use (HCQ-), and 30 healthy adults as the control group participated. MAIN OUTCOME MEASURES: Audiological assessments and evaluation of audio-vestibular symptoms. Evaluations were also repeated 1 month later. RESULTS: Both HCQ+ and HCQ- groups showed poor pure-tone audiometry (PTA) thresholds and decreased transient evoked otoacoustic emission amplitudes at high frequencies in comparison to the healthy group. Despite the lack of significant differences in PTA between the two groups of patients, the differences in transient evoked otoacoustic emission amplitudes were significant. PTA thresholds and otoacoustic emission showed improvement after 1 month. Dizziness was the most common symptom that was reduced after 1 month. CONCLUSION: Slight hearing loss was seen in patients with COVID-19 with or without HCQ. Also, hearing thresholds in the HCQ+ group did not show a significant difference compared with the HCQ- group. Nevertheless, it seems that more damage is done to the hair cells of patients with HCQ intake than in other patients. Hence, the ototoxicity effect of high doses of HCQ use in the COVID-19 patients should be considered. A relative improvement in the hearing was seen over time in both patient groups.

The Effect of Cognitive Tasks on the Ocular Vestibular Evoked Myogenic Potentials in Healthy People.

INTRODUCTION: The majority of the daily life activities involve the concurrent performance of simultaneously challenging motor and cognitive activities, such as talking while walking, which requires the vestibular system for balance. Functional balance allows the brain to interpret and integrate the sensory information from our physical and social environment. This study aimed to investigate the effect of cognitive activities on the vestibular system function. MATERIALS AND METHODS: This study investigated the otolith system as a sensory organ that is responsible for linear acceleration by recording ocular vestibular evoked myogenic potential (oVEMP) in 28 healthy participants (11 males and 17 females) with the age range of 18-26 years under a cognitive condition. The rest and intervention states were compared in terms of oVEMP n1-p1 amplitude, n1-p1 latencies, and gender. RESULTS: The results showed that the oVEMP n1-p1 amplitude in both ears significantly decreased, and the asymmetry increased after cognitive tasks, compared to the rest state in females (P≤0.02). Moreover, there was no significant difference between the rest state and numeric subtraction task in terms of oVEMP n1-p1 latencies in males and females (P>0.05). CONCLUSION: These results suggest that an augmented cognitive load causes an alteration in the oVEMPs; therefore, it is suggested that the structures associated with the cognitive processing are connected with the vestibular system in the brain. These findings demonstrate the importance of non-vestibular factors in balance, especially in females.

Modulation of temporal resolution and speech long-latency auditory-evoked potentials by transcranial direct current stimulation in children and adolescents with dyslexia.

In recent years, transcranial direct current stimulation (tDCS) has been used as a safe and non-invasive method for children and adolescents with dyslexia. Our aim in this study was to investigate the effect of tDCS on variables of temporal resolution and speech long-latency auditory-evoked potentials with two electrode arrays on superior temporal gyrus (STG). A total of 17 children and adolescents with dyslexia (age 9-12 years) were included in our study. All participants underwent the gap in noise (GIN) test and long-latency auditory-evoked potentials recording at baseline without applying tDCS, sham (placebo), and after 20 min of exposure to two different tDCS polarities: anode of tDCS on left STG/cathode on the right shoulder and anode on the left STG/cathode on right STG to enhance left lateralization. Our results showed significant decreases in the threshold value and increases in the percentages of correct responses in the GIN test. We also found reduced latency and increased amplitude of the P1, N1, and P2 waves in two stimulation polarities compared with baseline and sham. Our findings indicate the potential role of tDCS on improving the characteristics of central auditory processing, especially temporal information processing in children and adolescents with dyslexia, and could introduce a new strategy to facilitate the rehabilitation of central auditory processing disorders in future.

Improving universal newborn hearing screening outcomes by conducting it with thyroid screening.

OBJECTIVES: One of the most important factors that can improve hearing screening indicators is testing infants after 48 h of birth. The neonatal thyroid screening program is done during the third to fifth day after birth in many countries. So this screening is done at the appropriate time for hearing screening. The aim of the present study was to evaluate hearing screening outcomes (the referral rate, false positive rate, and positive predictive value) conducted with the thyroid screening at the healthcare centers and compare the results with hospital before discharge the infant. METHODS: This was a prospective exploratory cohort study. The study population included all the newborns at a hospital (group 1) and newborns who were referred to healthcare centers for thyroid screening (group 2), except for infants with risk factors, from March 2012 to December 2017. Transient evoked otoacoustic emissions (TEOAE) and automatic auditory brainstem response (AABR) were used for the evaluation. The results were compared between the two groups. RESULTS: Of the 4729 newborns, who participated in the study, 3001 were referred from a hospital (group 1) and 1728 from two healthcare centers (group 2). The referral rate in group 1 and 2 was 16.1% and 7.6%, respectively. Also, the false positive rate in group 1 and 2 was 15.9% and 7.6%, respectively. Our study showed that the referral rate and false positive rate of hearing screening in group 2 were significantly lower than that in group 1 (p < 0.001). The positive predictive value in group 1 was significantly higher than that in group 2 (p < 0.05). There was no significant sex difference in any of the variables. CONCLUSIONS: Our results showed that performing the hearing screening during the thyroid program, instead of the hospital could be significantly improved screening outcomes and suggest that hearing and thyroid screening together after discharge from the hospital could be a good opportunity to introduce new framework for hearing screening in many countries.

The Effect of Low Omega-3/Omega-6 Ratio on Auditory Nerve Conduction in Rat Pups.

The biological effects of omega-3 and omega-6 fatty acids are determined by their mutual interactions. This interaction extremely affects various functions. Lower consumption of omega-3 during gestation leads to various disorders, even in hearing. We aimed to assess the effect of low omega-3/omega-6 ratios on auditory nerve conduction. In this experimental study, the auditory brainstem response test was performed on 24-day-old rat (n=14). The rats were divided into case (low omega-3/omega-6 ratio during gestation and lactation) and control groups. Variables such as P1, P3, and P4 absolute latency period, interpeaks (P3-P4, P1-P3, and P1-P4), and P4/P1 amplitude ratio were measured. We found an increased P4 omega-3/omega-6 ratio in the group with a low omega-3/omega-6 ratio (P<0.01). No significant difference was observed in the P1 and P3 absolute latency period between the studied groups  (P>0.05).  Also, no significant difference was observed between the groups with respect to the P1-P3 interpeak latency (IPL) periods (P>0.05); while the P1-P4 and P3-P4 IPLs were significantly increased in the group with a low omega-3/omega-6 ratio (P<0.05). The P4/P1 amplitude ratio significantly decreased in the group with a low omega-3/omega-6 ratio (P<0.05). Results confirmed the negative effects of low omega-3/omega-6 ratio on the auditory system and hearing.

Effects of Fish Oil Supplementation during the Suckling Period on Auditory Neural Conduction in n-3 Fatty Acid-Deficient Rat Pups.

INTRODUCTION: Omega-3 fatty acid, particularly in the form of fish oil, has a structural and biological role in various systems of the body. The auditory and nervous systems are both influenced by omega-3 fatty acids, with omega-3 deficiency having devastating effects on both systems. Numerous studies have attempted to investigate this further. This study aimed to evaluate neural conduction in n-3 fatty acid-deficient rat pups following supplementation with fish oil during the suckling period. MATERIALS AND METHODS: In this interventional and experimental study, omega-3 fatty acids from fish oil (FO) were fed to rat pups of n-3 polyunsaturated fatty acid (PUFA)-deficient dams. Changes in auditory neural conduction were compared with those of control and n-3 PUFA-deficient groups using auditory brainstem response (ABR). The parameters of interest were P1, P3, and P4 absolute latency, P1-P3, P1-P4, and P3-P4 interpeak latency (IPL), and P4/P1 amplitude ratio. The rat pups were given oral FO, 5 ml/g weight for 17 days, between the age of 5 and 21 days. RESULTS: No significant group differences were observed in P1 and P3 absolute latency (P>0.05), but there was a significant difference in P4 (P≤0.05). The n-3 PUFA-deficient + vehicle group had the most prolonged (the worst) P1-P4 IPL and P3-P4 IPL compared with control and n-3 PUFA-deficient + FO groups. There was no significant difference in P1-P4 IPL and P3-P4 IPL between the n-3 PUFA-deficient + FO group and the control group (P>0.05). There was a significant effect of diet on P1-P4 IPL and P3-P4 IPL between groups (P≤0.05). CONCLUSION: The results of present study showed the effect of omega-3 deficiency on auditory neural structure during pregnancy and the lactation period. Additionally, we observed reduced reduction in devastating effects on neural conduction in n-3 fatty acid-deficient rat pups following the supplementation of FO during the suckling period.