Classification of audiograms in the prevention of noise-induced hearing loss: A clinical perspective.

BACKGROUND: Noise induced hearing loss (NIHL) is a major contributor to disabling hearing loss. Engineering controls are superior to hearing protection devices (HPDs) in prevention of occupational noise induced hearing loss (ONIHL), although the latter are more commonly used. Effective use of audiometry requires quick categorization of audiograms. The UK Health and Safety Executive (UKHSE) scheme for the categorization of audiograms is a tool that accomplishes this. OBJECTIVES: The objective of this paper is to provide an overview of the classification of audiograms and build a case for the preferential use of the UKHSE's scheme to achieve this. METHOD: The author provides a literature review of methods of classification for audiograms and uses a case study in a Tanzanian mining company to demonstrate how the UKHSE scheme was successfully used to enhance the existing hearing protection program. RESULTS: The literature review identified several methods of classification based on a variation of threshold shifts from baseline. The difference was in the frequency and level of threshold shift used to determine hearing loss, and the recommended course of action once hearing loss is detected. The UKHSE scheme is simple and provides guidance on steps to be taken thereafter. This was demonstrated in a case study among miners in a mining company in Tanzania. CONCLUSION: The UKHSE audiogram classification scheme has the advantage of providing a straightforward, easy to determine classification that allows for intervention appropriate to the findings.

Current process in hearing-aid fitting appointments: An analysis of audiologists' use of behaviour change techniques using the behaviour change technique taxonomy (v1).

OBJECTIVES: To observe and analyse the range and nature of behaviour change techniques (BCTs) employed by audiologists during hearing-aid fitting consultations to encourage and enable hearing-aid use. DESIGN: Non-participant observation and qualitative thematic analysis using the behaviour change technique taxonomy (version 1) (BCTTv1). STUDY SAMPLE: Ten consultations across five English NHS audiology departments. RESULTS: Audiologists engage in behaviours to ensure the hearing-aid is fitted to prescription and is comfortable to wear. They provide information, equipment, and training in how to use a hearing-aid including changing batteries, cleaning, and maintenance. There is scope for audiologists to use additional BCTs: collaborating with patients to develop a behavioural plan for hearing-aid use that includes goal-setting, action-planning and problem-solving; involving significant others; providing information on the benefits of hearing-aid use or the consequences of non-use and giving advice about using prompts/cues for hearing-aid use. CONCLUSIONS: This observational study of audiologist behaviour in hearing-aid fitting consultations has identified opportunities to use additional behaviour change techniques that might encourage hearing-aid use. This information defines potential intervention targets for further research with the aim of improving hearing-aid use amongst adults with acquired hearing loss.

Distribution of hearing loss characteristics in a clinical population.

OBJECTIVES: This study was designed to characterize a large database of audiometric records from an academic health center Audiology clinic for the purpose of determining the distributions of hearing loss configuration, severity, and site of lesion. DESIGN: : Using AMCLASS, a validated tool for classifying audiograms described in a previous report, the audiometric configuration, severity, and site of lesion was determined for patients grouped according to the completeness of the audiometric record. Complete air conduction testing at six octave frequencies in both ears was required for inclusion. Patients were grouped according to the quantity of bone conduction thresholds in the record: both ears tested, one ear tested, or neither ear tested. All other records were discarded leaving 23,798 records of 16,818 patients for analysis. All analyses were conducted for all remaining records and with repeat tests excluded. RESULTS: The effect of removing repeat audiograms had remarkably little effect on the distributions. Sloping hearing losses dominated the distributions of configuration. One-third of all records indicated normal hearing in at least one ear and one fourth had normal hearing in both ears. Mild and moderate hearing losses were equally prevalent, each contributing 40% to 45% of the cases with hearing loss. Sensorineural was the most prevalent site of lesion, representing about 45% of cases and just over half the cases with hearing loss. CONCLUSIONS: Prevalence rates of hearing loss configurations, severities, and sites of lesion are provided against which analyses of other databases can be compared. The results may be useful for counseling patients regarding the relationship of their hearing loss to that of a large population. The high number normal-hearing people in the database suggests that estimates of the need for hearing testing based on prevalence of hearing loss may underestimate the number of people who seek or are referred for hearing evaluation.

Comparison of the previous and incoming categorisations of audiograms in the occupational health setting in Ireland.

Audiometry is a useful screening tool used in hearing conservation programmes carried out on our work force. Maintaining healthy hearing is essential as Noise Induced Hearing Loss (NIHL), once established is irreversible. A categorisation system was developed to allow for simple triage by a non-specialist, (an occupational health nurse or audiologist) of Audiograms. Last year a new categorisation of audiograms was introduced in Ireland. I applied the previous categorisation and the new categorisation to 50 audiograms and compared the outcomes of each. The new categorisation results in fewer audiograms requiring referral to a specialist (14% versus 18%), fewer audiograms being classified at a warning level (6% versus 20%), and increases the percentage of normal audiograms (80% versus 60%). The new categorisation is more simplified, accounts for men having slightly worse higher frequency hearing than women and legislates for workers aged 18 years and older.

Sudden sensorineural hearing loss as a revealing symptom of vestibular schwannoma.

CONCLUSIONS: Sudden sensorineural hearing loss (SSHL) is a frequent symptom of vestibular schwannoma (VS), often reveals small VSs and does not exhibit specific features. Therefore, every case of SSHL should be evaluated using systematic MRI to rule out VS in order to improve hearing and preservation facial nerve function. OBJECTIVE: SSHL leads to the discovery of a VS in a small proportion of cases (2%). However, SSHL appears to be a more frequent occurrence in the history of patients with VS (3-23% in the literature), suggesting a large disparity in the evaluation of SSHL. MATERIAL AND METHODS: A total of 139 consecutive unilateral VSs operated on between 2000 and 2002 were reviewed and analyzed regarding the prevalence, clinical and audiological features of SSHL and their relation to the size of the tumor. RESULTS: SSHL was observed in 20% of cases at some point in their VS history. The characteristics of SSHL were: (i) lack of a specific audiometric pattern, except that low-tone loss was rare; and (ii) a high rate of hearing recovery (50%). Tumor size was significantly smaller in SSHL-associated VSs compared to other VSs. In the former cases, 96% involved the internal auditory canal.

Estudio descriptivo sobre audicion en el ingreso escolar, año 1999, 2000 y 2001 / Description study about audition in the scholarship, year 1999, 2000 and 2001

En el presente trabajo de investigación se contemplan los resultados audiométricos de los alumnos de 1 º año de Educación General Básica (EGB), según los años de ingreso escolar 1999, 2000 y 2001. Es un estudio descriptivo, de corte transversal. Se trabajó coninformación de tipo secundaria, como son las audiometrías tonalesliminales de los alumnos. La pobla

A acuidade auditiva na insuficiência: renal crônica / Hearing acuity in chronic renal failure

O conceito de que as células do ouvido interno são suscetíveis a diversos distúrbios metabólicos e hormonais é assunto bastante estudado. Entretanto, a associação entre perda auditiva neurossensorial e insuficiência renal crônica permanece controversa na literatura mundial. Objetivos: Os objetivos deste trabalho foram verificar a presença de perda auditiva neurossensorial em indivíduos com insuficiência renal crônica com e sem tratamento hemodialítico, comparando com um grupo controle, e pesquisar a associação de tais condições na gênese do comprometimento auditivo. Material e métodos: Foram estudados dezesseis indivíduos com insuficiência renal crônica (IRC) sem tratamento hemodialítico, dezessete com IRC em hemodiálise e dezesseis controles. Excluíram-se outras causas de perdas auditivas neurossensoriais. Os pacientes foram estudados através de exame clínico minucioso, audiometria tonal limiar e imitância acústica. Resultados: A acuidade auditiva de pacientes com insuficiência renal crônica mostrou-se estatisticamente diferente dos controles, notadamente nas freqüências de 4, 6 e 8 KHz. Em todas freqüências estudadas, a hemodiálise não foi estatisticamente significativa na determinação do aumento dos limiares auditivos. Conclusão: Concluiu-se existir associação direta entre insuficiência renal crônica e perdas auditivas neurossensoriais, principalmente nas freqüências agudas. A hemodiálise não foi um fator gerador de perda auditiva neurossensorial em pacientes com insuficiência renal crônica.

The concept that inner ear cells are sensitive to several metabolic and hormonal disorders is a well studied issue. But, the relationship between chronic renal failure and sensorineural hearing loss is still a debatable issue by the scientific community. Purpose: The goals of this paper were to verify the presence of sensorineural hearing loss in either in haemodialysis chronic renal failure people or still out of haemodialysis ones and compare their results to normal controls. Material and methods: Therefore we studied the genesis of chronic renal failure in hearing impairment. Sixteen chronic renal failure, seventeen in haemodialysis chronic renal failure individuals and sixteen controls were studied by judicious clinical exam, pure tone and impedance audiometry. Results: The hearing acuity in the chronic renal failure groups showed impaired results when compared to normal individuals, mainly in 4,6 and 8 KHz. The haemodialysis was not statistic significant in the genesis of hearing impairment. Conclusion: We concluded that there was a direct relationship between chronic renal failure and sensorineural hearing loss, mainly in high frequencies. We also concluded that haemodialysis was not a causative agent of hearing loss in chronic renal failure individuals.

Acompanhamento audiológico em pacientes com osteossarcoma submetidos à quimioterapia com cisplatina / Audiological Follow Up in Patients with Osteosarcoma Who Had Chemotherapy Using Cisplatin

A comunicação humana processa-se por meio da linguagem e da fala, e é através da audição que o homem as adquire e conserva. A deficiência auditiva é considerada doença severamente incapacitante e pode ser causada por diversos fatores, como o uso de ototóxicos. A cisplatina é um antineoplásico, utilizado com bons resultados em diversos tumores, mas apresenta alto grau de toxicidade, causando alterações renais e auditivas. Sendo assim, a monitorização dos limiares de audibilidade, especialmente nas altas freqüências, é importante durante a administração desta droga. A audiometria de altas freqüências tem sido realizada em pacientes tratados com quimioterápicos, possibilitando a detecção de alterações auditivas antes mesmo que as freqüências importantes para a compreensão da fala sejam comprometidas. Objetivo: O objetivo deste estudo foi monitorizar os limiares de audibilidade de pacientes com osteossarcoma, sem tratamento prévio, submetidos à quimioterapia com cisplatina e carboplatina. Material e método: Foram estudados os limiares de audibilidade obtidos em 27 pacientes, nos períodos pré, durante e pós-tratamento quimioterápico. Resultados: A audiometria de altas freqüências identificou mudanças nos limiares de audibilidade em 100% dos casos, na primeira avaliação audiológica realizada durante o tratamento. Em 33,3% dos casos, os limiares permaneceram normais na faixa de freqüências convencional até o término do tratamento; e em 66,6%, alterados. Conclusão: Observamos que na dose de 300 mg/m2 de cisplatina ocorrem mudanças significativas dos limiares de audibilidade, que se mantêm até o término do tratamento quimioterápico, não havendo mudanças significativas nas avaliações subseqüentes. Estes dados sugerem que a avaliação audiológica seja realizada a cada ciclo de administração de cisplatina.

Introduction: Human communication is based on language and speech and hearing plays a definite role in this acquisition process. Hearing loss is-considered as a severe impairment, it can have many etiologies, and ototoxicity is among them. Cisplatin is a chemotherapeutic agent used with success in various tumors. However its high level of toxicity is also known, leading to renal and hearing disorders. Therefore, evaluation of hearing thresholds, specially in high frequency range, is very important during the treatment. High frequency audiometry has been useful in determining hearing disorders before the frequency range for speech is compromised in patients undergoing chemotherapy. Aim: The aim of this study was to evaluate and monitor hearing thresholds of patients with osteosarcoma, without previous treatment, who had undergone chemotherapy using cisplatin and carboplatin. Material and metods: Hearing thresholds of 27 patients, pre, during and post chemotherapy were studied. Results: High frequency audiometry carried out during the treatment has showed changes in hearing thresholds in all cases. Hearing thresholds were within normal limits in conventional frequency range in 33,3% of the cases and 66,6% of patients had altered thresholds by the end of the treatment. Conclusion: We have observed significant changes in hearing thresholds at 300 mg/m2 dose of cisplatin, and these changes were stable throughout the treatment. These findings suggest that hearing evaluation should be performed after each stage of cisplatin administration.

Discriminação de monossílabos em ambiente silencioso e ambiente ruidoso / Intelligibility of monosyllables in quiet and in noise

Em uma avaliação audiométrica convencional (como audiornetria tonal e discriminação auditiva), usualmente utilizamos cabina teoricamente anecoica. No entanto, diversos estudos demonstram que em um ambiente competitivo, a compreensão das palavras diminui para todos os indivíduos. Objetivo: Com o objetivo de efetuar uma avaliação mais próxima da realidade, idealizamos um estudo compreendendo 14 pacientes normais e 10 pacientes com presbiacusia, para se desenvolver uma metodologia de avaliação da discriminação auditiva em ambiente silencioso e ambiente ruidoso; e, paralelamente, observar o comportamento da compreensão das palavras em ambiente competitivo. Material e método: Foi utilizado o ruído branco, por ser facilmente captado pelo próprio audiômetro, assim como adaptamos em uma cabina audiométrica comum alto-falantes, amplificador e um gravador, para reproduzir uma voz feminina que citava a lista de monossílabos foneticamente balanceada de Geraldo de Sá. As avaliações ocorreram em campo livre sem o uso de fones de ouvido. Resultados: Ao final das avaliações, observamos que a metodologia utilizada foi eficiente e confiável, assim como pudemos afirmar que o paciente que apresenta presbiacusia tem um comportamento audiológico em ambiente ruidoso muito aquém do que pacientes jovens com audição normal. Conclusão: Para os presbiacúsicos, a fonte sonora para a compreensão de monossílabos deve sobrepor-se ao ruído ambiental, enquanto que para os jovens a fonte sonora pode ter níveis inferiores de pressão sonora em relação ao ruído ambiental.

In a conventional audiometric evaluation it is usually used a cabin. However, several studies show that in a competitive environment the comprehension of the words decreases for all the individuals. Aim: With the target of evaluating it closer to reality, a study with fourteen normal and ten presbyacusic patients was idealized to develop a methodology of evaluation of the hearing discrimination in both silent and noisy environment, and also to observe the speech recognition in competitive atmosphere. Material and method: It was used the white noise as it is easily picked up in a common audiometric cabin with loudspeakers, amplifier and a recorder to reproduce a female voice that mentioned the Geraldo de Sá's list of phonetically balanced monosyllables. The evaluations took place in a free field without the use of earphones. Results: At the and of the evaluations we observed that the methodology was efficient and trustful and we could also assure that the presbyacusic patients have an audiologic level of discrimination not up to young patients with regular hearing in a competitive environment. Conclusion: The sounding source for the understanding of monosyllables must be higher than the environmental noise to the presbyacusic patients while to the youngs the sounding pressure levels might be lower than the environmental noise.

Baixa discriminação auditiva em ambiente competitivo de pacientes jovens com audiograma normal / Low Intelligibility in Noisy Environment in Young People with Normal Audiometry

Foram estudados seis pacientes com queixa de dificuldade auditiva, entre 14 e 35 anos de idade (média de 27,8), mas que apresentavam avaliação audiométrica convencional normal, inclusive discriminação de 100%. Material e métodos: Utilizamos uma metodologia desenvolvida para avaliação do índice de reconhecimento da fala no silêncio e perante um ruído competitivo (ruído branco) em uma cabina audiométrica, sem fone de ouvido, onde observamos o comportamento da dificuldade crescente em discriminar monossílabos de acordo com o aumento do ruído branco dentro da cabina. Resultados: Comparamos o resultado encontrado com 14 pacientes jovens normais e sem queixas, tendo sido mostrado que os seis pacientes estudados realmente apresentavam uma compreensão das palavras muito aquém da revelada pelos pacientes normais em ambiente competitivo, mesmo apresentando uma discriminação de 100% no silêncio. Conclusão: O presente estudo demonstra que o resultado normal de um audiograma convencional nem sempre traduz a realidade, sendo que devemos lançar mão deste tipo de avaliação para uma definição mais precisa das condições auditivas de um indivíduo.

Six patients between 14 and 35 years old (on avarage of 27,8) with normal audiologic level were studied. They declared that their quality in audition was not good, even though their conventional audiological level was a normal and the intelligibility 100%. Material and methods: We used a methodology developed to evaluate the audiologic level in silence and in the presence of a competitive noise (white noise) in an audiometric cabin without earphone where we could observe the increasing difficulty in discriminating monosyllables according to the rise of white noise into the cabin. Results: It has been showed, comparing the results found in the study with 14 normal patients with any complaint, that the six studied patients in fact, have a comprehension of the words far short of the normal ones in a competitive environment although they showed a 100% of discrimination in silence. Conclusion: The current study proves that a normal result of a conventional audiogram not always shows the reality so that we should use this kind of evaluation to a more accurate definition of an individual's audition condition.

Reconhecimento de sentenças no silêncio e no ruído em indivíduos portadores de perda auditiva induzida pelo ruído / Recognition of Sentences in Silence and Noise in Individual Who Have Noise Induced Hearing Loss

A perda auditiva induzida pelo ruído (PAIR) compromete a comunicação do dia-a-dia dos indivíduos por ela afetados? Este comprometimento ocorre em ambientes silenciosos ou apenas quando há ruído competindo com a mensagem falada? Ele depende do grau da PAIR? Objetivo: Avaliar o limiar de reconhecimento de sentenças, com e sem a presença de ruído competitivo, em indivíduos portadores de PAIR e comparar o seu desempenho com o de indivíduos normais. Material e método: Examinamos 88 orelhas, sendo 22 com audição normal, 22 com grau 1, 22 com grau 2 e 22 com grau 3, pela classificação de Merluzzi. Todos os indivíduos avaliados foram submetidos a anamnese, exame otorrinolaringológico, audiometria tonal liminar e ao teste para obter os limiares de reconhecimento de sentenças no silêncio (LRSS) e os limiares de reconhecimento de sentenças no ruído (LRSR). As medidas foram obtidas através de fones, seguindo a estratégia "ascendente-descendente" proposta por Lewitt e Rabiner15, utilizando as sentenças em português brasileiro desenvolvidas por Costa7 em 1997. Conclusão: Concluímos que o reconhecimento de sentenças no silêncio e na presença de ruído competitivo é comprometido de forma significante no indivíduo portador de PAIR, tanto em ambiente silencioso quanto em ruidoso, mostrando uma tendência a se agravar, na medida em que a PAIR se agrava. Recomendamos que este teste seja empregado na rotina de testes que avaliam os prejuízos na audição destes indivíduos, para documentar a real dificuldade que os mesmos apresentam em situação semelhante à da comunicação do dia-a-dia.

Does noise induced hearing loss (NIHL) disturbs the every day communication of the individuals who have it? Does this disturbance occur in silence environments or just in noisy ones? Does it depends on the NIHL grade? Purpose: Evaluate the sentences recognition threshold, with and without competing noise, in individuals who has NIHL and compare their performance with normal ones. Material and method: We evaluated 88 ears, 22 with normal hearing, 22 with grade 1, 22 with grade 2 and 22 with grade 3, according to Merluzzi classification. All of them were submitted to anamnesis, ENT examination, pure tone audiometry and determination of the sentences recognition threshold in silence (SRTS), sentences recognition threshold in noise (SRTN) and the signal/noise ratio in which they were obtained, through headphones, following the ascending-descending strategy proposed by Levitt e Rabiner15, employing brazilian portuguese sentences developed by Costa7 in 1997. Conclusion: We concluded the recognition of sentences presented in silence and in the presence of competing noise are significant disturbed in individuals who has NIHL, showing a tendency to have a worse performance as the NIHL aggravates itself. We advise that this test should be added to the routine tests that evaluate the hearing handicap o€ this individuals to establish the real difficulties that they present in situations resembling the every day communication.

Clinical study of audiograms in the initial stage and fixed stage of sudden deafness.

Audiograms in the initial stage and the fixed stage of sudden deafness were analyzed in 79 cases using the following 5 criteria; i) the onset is sudden and time of onset definite, ii) hearing loss at 1 kH is more than 35 dB, iii) the course of hearing recovery is clear, iv) unaffected ear has normal hearing, and v) the first examination and treatment is within 15 days after onset. Consequently, at least in cases receiving treatment within 6-15 days after onset, it was considered that the prognosis of hearing recovery could be established rather than the pattern of hearing loss than by the period of treatment after onset.

Study on self-recording audiogram of sudden deafness.

Self-recording audiograms of sudden deafness in 54 patients were studied for the relationship between type of Jerger's classification, hearing loss at the initial examination, and prognosis of hearing loss. Type I of Jerger's classification was shown in patients with slight to profound hearing loss, whereas Type II + IV was shown more frequently in cases with profound hearing loss. Many patients of Types I and II were among those who recovered completely or markedly, while patients of Type II + IV were found more frequently among those who recovered or had unchanged hearing.