Limitations of Pure-Tone Audiometry in the Detection of Nonorganic Hearing Loss: A Case Study

AbstractObjectivesSodium bromate is a strong oxidant, and bromate intoxication can cause irreversible severe-to-profound sensorineural hearing loss. This paper reports the first case in the English literature of bromate-induced hearing loss with hearing recovery measured by formal audiological assessment.Case reportA 72-year-old woman was admitted to hospital with complaints of profound hearing loss, nausea, diarrhoea and anuria after bromate ingestion in a suicide attempt. On admission, pure tone audiometry and auditory brainstem responses showed profound bilateral deafness. Under the diagnosis of bromate-induced acute renal failure and sensorineural hearing loss, continuous haemodiafiltration was performed. When dialysis was discontinued, pure tone audiometry and auditory brainstem responses showed partial threshold recovery from profound deafness.ConclusionSevere-to-profound sensorineural hearing loss is a common symptom of bromate intoxication. Bromate-induced hearing loss may be partially treated, and early application of continuous haemodiafiltration might be useful as a treatment for this intractable condition.

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Cochlear function in patients with chronic kidney disease

South African Journal of Communication Disorders ◽

10.4102/sajcd.v60i1.10 ◽

2013 ◽

Vol 60 (1) ◽

Author(s):

Samantha Marlanie Govender ◽

Cyril Devdas Govender ◽

Glenda Matthews

Keyword(s):

Chronic Kidney Disease ◽

Hearing Loss ◽

Kidney Disease ◽

Otoacoustic Emissions ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Drug Intake ◽

Cochlear Function ◽

Distortion Product ◽

Cochlear Dysfunction

Objective: To evaluate cochlear functioning in patients (18 - 45 years old) with varying stages of chronic kidney disease (CKD). Using purposive sampling, 50 participants, 10 in each of the 5 stages of CKD, were selected and underwent pure tone audiometric testing and distortion product otoacoustic emissions (DPOAEs).Results: Significant differences (p<0.05) were found between pure tone audiometry and DPOAEs in detecting early cochlear dysfunction in the high-frequency range in stages 3 (6 000/5 000 Hz; p=0.00), 4 (6 000/5 000 Hz; p<0.03) and 5 (4 000/3 333 Hz; p<0.01, 8 000/6 667 Hz:p<0.05) with DPOAEs being more sensitive in identifying early cochlear dysfunction. Patients in stages 1 and 2 presented with normal puretone thresholds and DPOAEs, suggesting that cochlear functioning in these patients was normal. Early cochlear dysfunction, thereby indicating a subclinical hearing loss, was identified in stages 3, 4 and 5 by DPOAE testing. In addition, blood test results, drug intake and concomitant conditions were recorded and analysed which suggested a relationship between reduced cochlear functioning and increased electrolyte levels, treatment regimens and concomitant conditions.Conclusion: Participants in the later stages of CKD presented with early cochlear dysfunction, presenting with subclinical hearing loss. It was postulated that this subclinical hearing loss resulted from a combination of electrolytic, urea and creatinine imbalances, together with concomitant medical conditions and ototoxic drug intake. It was concluded that audiological monitoring be included in the management of patients with CKD and that DPOAEs be introduced as part of the test battery to monitor cochlear function in patients with varying degrees of CKD.

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Correlation of the Puretone Audiometry Findings with Intraoperative Findings in Patients with Chronic Suppurative Otitis Media

MVP Journal of Medical Sciences ◽

10.18311/mvpjms/2015/v2/i1/790 ◽

2015 ◽

Vol 2 (1) ◽

pp. 4

Author(s):

Devashri Uday Patil ◽

Kiran S. Burse ◽

Shreeya Kulkarni ◽

Vandana Sancheti ◽

Chaitanya Bharadwaj

Keyword(s):

Hearing Loss ◽

Otitis Media ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Ossicular Chain ◽

Chronic Suppurative Otitis Media ◽

Suppurative Otitis Media ◽

Number Of Patients ◽

Operative Findings ◽

Air Conduction

Chronic suppurative otitis media is one of the common otological conditions in India for which patients seek advice from an otorhinolaryngologist. Chronic suppurative otitis media is recurrent and progressive disease which is characterized with tympanic membrane perforation and suppurative discharge. Pure tone audiometry is the most common test used to evaluate auditory sensitivity. Since hearing loss is a common complication of chronic suppurative otitis media, we designed this study to evaluate preoperative pure tone audiometry findings in patients with chronic suppurative otitis media and its correlation with the intra-operative findings. Aims and Objectives: 1] To assess the intra-operative findings in patients with chronic suppurative otitis media. 2] To evaluate the correlation between the preoperative pure tone audiometry findings and intra-operative findings in patients with chronic suppurative otitis media. 3] To assess the type of hearing loss and degree of hearing loss in patients with chronic suppurative otitis media. Materials and Methods: This is an Observational study carried over a period of 3 years from August 2011 to August 2013. Total number of patients included in this study was 100. Result: Out of 100 patients studied 69 % of patients had Tubo-Tympanic type of CSOM, 31 % of patients had Attico-antral type of CSOM. In patients of Safe CSOM; Central perforation was seen in maximum cases 46.4 %, anterior central perforations was seen in 8.7 % cases, posterior central perforations seen in 20.2 % cases, and subtotal perforations seen in 24.63 % cases. In patients of Unsafe CSOM posterosuperior cholesteatoma was seen in maximum cases 67.74 %, and attic cholesteatoma was seen in 32.2 % cases. In safe CSOM patients all ossicles were intact and mobile whereas in unsafe CSOM patients only 4 patients had intact ossicular chain, while maximum patients had ossicular defect. Conclusion: Hearing loss depends on size of perforation. Hearing loss increases as the size of perforation increases. Average air conduction threshold and air bone gap did not differ significantly between various groups of ossicular defect. This shows us that neither air conduction nor air bone gap are reliable parameters on basis of which we can predict ossicular status preoperatively.

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A Smartphone-Based Approach to Screening for Sudden Sensorineural Hearing Loss: Cross-Sectional Validity Study

JMIR mhealth and uhealth ◽

10.2196/23047 ◽

2020 ◽

Vol 8 (11) ◽

pp. e23047

Author(s):

Heng-Yu Haley Lin ◽

Yuan-Chia Chu ◽

Ying-Hui Lai ◽

Hsiu-Lien Cheng ◽

Feipei Lai ◽

...

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Gold Standard ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Sudden Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Clinical Settings ◽

Cross Sectional ◽

Scale Difference

Background Sudden sensorineural hearing loss (SSNHL) is an otologic emergency that warrants urgent management. Pure-tone audiometry remains the gold standard for definitively diagnosing SSNHL. However, in clinical settings such as primary care practices and urgent care facilities, conventional pure-tone audiometry is often unavailable. Objective This study aimed to determine the correlation between hearing outcomes measured by conventional pure-tone audiometry and those measured by the proposed smartphone-based Ear Scale app and determine the diagnostic validity of the hearing scale differences between the two ears as obtained by the Ear Scale app for SSNHL. Methods This cross-sectional study included a cohort of 88 participants with possible SSNHL who were referred to an otolaryngology clinic or emergency department at a tertiary medical center in Taipei, Taiwan, between January 2018 and June 2019. All participants underwent hearing assessments with conventional pure-tone audiometry and the proposed smartphone-based Ear Scale app consecutively. The gold standard for diagnosing SSNHL was defined as the pure-tone average (PTA) difference between the two ears being ≥30 dB HL. The hearing results measured by the Ear Scale app were presented as 20 stratified hearing scales. The hearing scale difference between the two ears was estimated to detect SSNHL. Results The study sample comprised 88 adults with a mean age of 46 years, and 50% (44/88) were females. PTA measured by conventional pure-tone audiometry was strongly correlated with the hearing scale assessed by the Ear Scale app, with a Pearson correlation coefficient of .88 (95% CI .82-.92). The sensitivity of the 5–hearing scale difference (25 dB HL difference) between the impaired ear and the contralateral ear in diagnosing SSNHL was 95.5% (95% CI 87.5%-99.1%), with a specificity of 66.7% (95% CI 43.0%-85.4%). Conclusions Our findings suggest that the proposed smartphone-based Ear Scale app can be useful in the evaluation of SSNHL in clinical settings where conventional pure-tone audiometry is not available.

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Hearing Screening for Residents in Long-Term Care Homes Who Live with Dementia: A Scoping Review

Journal of Alzheimer s Disease ◽

10.3233/jad-215087 ◽

2021 ◽

pp. 1-24

Author(s):

Fiona Höbler ◽

Katherine S. McGilton ◽

Walter Wittich ◽

Kate Dupuis ◽

Marilyn Reed ◽

...

Keyword(s):

Older Adults ◽

Hearing Loss ◽

Nursing Staff ◽

Scoping Review ◽

Pure Tone ◽

Long Term Care ◽

Pure Tone Audiometry ◽

Care Homes ◽

Term Care

Background: Hearing loss is highly prevalent in older adults, particularly among those living with dementia and residing in long-term care homes (LTCHs). Sensory declines can have deleterious effects on functioning and contribute to frailty, but the hearing needs of residents are often unrecognized or unaddressed. Objective: To identify valid and reliable screening measures that are effective for the identification of hearing loss and are suitable for use by nursing staff providing care to residents with dementia in LTCHs. Methods: Electronic databases (Embase, Medline, PsycINFO, CENTRAL, and CINAHL) were searched using comprehensive search strategies, and a stepwise approach based on Arksey & O’Malley’s scoping review and appraisal process was followed. Results: There were 193 scientific papers included in the review. Pure-tone audiometry was the most frequently reported measure to test hearing in older adults living with dementia. However, measures including self- or other-reports and questionnaires, review of medical records, otoscopy, and the whisper test were found to be most suitable for use by nurses working with older adults living with dementia in LTCHs. Conclusion: Although frequently used, the suitability of pure-tone audiometry for use by nursing staff in LTCHs is limited, as standardized audiometry presents challenges for many residents, and specific training is needed to successfully adapt test administration procedures and interpret results. The whisper test was considered to be more suitable for use by staff in LTCH; however, it yields a limited characterization of hearing loss. There remains an urgent need to develop new approaches to screen hearing in LTCHs.

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Assessing hearing loss in older adults with a single question and person characteristics; Comparison with pure tone audiometry in the Rotterdam Study

PLoS ONE ◽

10.1371/journal.pone.0228349 ◽

2020 ◽

Vol 15 (1) ◽

pp. e0228349 ◽

Cited By ~ 1

Author(s):

Berthe C. Oosterloo ◽

Nienke C. Homans ◽

Rob J. Baatenburg de Jong ◽

M. Arfan Ikram ◽

A. Paul Nagtegaal ◽

...

Keyword(s):

Older Adults ◽

Hearing Loss ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Rotterdam Study ◽

Person Characteristics ◽

Single Question

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Pure-tone audiometry without bone-conduction thresholds: using the digits-in-noise test to detect conductive hearing loss

International Journal of Audiology ◽

10.1080/14992027.2020.1783585 ◽

2020 ◽

Vol 59 (10) ◽

pp. 801-808 ◽

Cited By ~ 1

Author(s):

Karina C. De Sousa ◽

Cas Smits ◽

David R. Moore ◽

Hermanus Carel Myburgh ◽

De Wet Swanepoel

Keyword(s):

Hearing Loss ◽

Pure Tone ◽

Conductive Hearing Loss ◽

Bone Conduction ◽

Pure Tone Audiometry ◽

Noise Test ◽

Conductive Hearing

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SUBCLINICAL AGE-RELATED HEARING LOSS IS INVERSELY ASSOCIATED WITH DEPRESSIVE SYMPTOMS

Innovation in Aging ◽

10.1093/geroni/igz038.2034 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S552-S552

Author(s):

Justin S Golub ◽

Katharine K Brewster ◽

Adam Brickman ◽

Adam Ciarleglio ◽

José Luchsinger ◽

...

Keyword(s):

Hearing Loss ◽

Depressive Symptoms ◽

Pure Tone ◽

Depression Scale ◽

Pure Tone Audiometry ◽

Normal Hearing ◽

Health Study ◽

Late Life Depression ◽

Age Related ◽

Age Related Hearing Loss

Abstract Age-related hearing loss (HL), defined by a pure-tone average (PTA) >25 decibels (dB) has been associated with depressive symptoms. We aimed to assess whether this association is present when hearing is better than the arbitrary, but widely-used, 25 dB threshold. The sampled population was the multicentered Hispanic Community Health Study (n=5,165). Cross-sectional data from 2008-2011 were available. Hearing was measured with pure tone audiometry. Clinically-significant depressive symptoms (CSDS) were defined by a score ≥10 on the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Participants’ mean age was 58.3 years (SD=6.2, range=50-76). Among those with classically-defined normal hearing (PTA ≤25 dB), a 10 dB increase in HL was associated with 1.26 times the odds (95% CI=1.11, 1.42) of CSDS, adjusting for age, gender, education, vascular disease, and hearing aid use (p25 dB; p<0.001). Results held even for a stricter HL cutpoint of 15 dB. Among subjects with strictly normal hearing (PTA ≤15 dB), a 10 dB increase in HL was associated with 1.47 (1.14, 1.90) times the odds of CSDS, adjusting for confounders (p<0.01). Results also held when defining CSDS by an alternative CESD-10 score ≥16. In conclusion, increasing hearing thresholds were independently associated with CSDS among adults with subclinical HL (PTA ≤25 dB). Studies investigating whether treating HL can prevent late life depression should consider a lower threshold for defining HL.

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Neuro-Otologic Abnormalities in Myelopathy Associated with Human T-Cell Lymphotropic Virus Type 1

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949310200507 ◽

1993 ◽

Vol 102 (5) ◽

pp. 359-362 ◽

Cited By ~ 1

Author(s):

Kengo Uno ◽

Satoshi Noguchi ◽

Ryosei Minoda ◽

Takeru Ishikawa

Keyword(s):

Hearing Loss ◽

T Cell ◽

Brain Stem ◽

Virus Type ◽

Pure Tone ◽

Pure Tone Audiometry ◽

Caloric Test ◽

Human T Cell ◽

Auditory Brain Stem

Auditory testing (pure tone audiometry, auditory brain stem response), and vestibular tests (eye tracking test, optokinetic pattern test, and caloric test) were performed to define neuro-otologic abnormalities in myelopathy associated with human T-cell lymphotropic virus type 1. Of the eight patients tested, seven showed sensorineural hearing loss and one showed mixed hearing loss on pure tone audiometry. The auditory brain stem responses of five patients showed increases of the I-III and I-V interpeak latencies. Two patients showed fast superimposed saccadic movements on the smooth pursuit test, and one other patient showed canal paresis on the caloric test. These findings suggest both the presence of neuro-otologic abnormality and involvement of the brain stem in myelopathy associated with human T-cell lymphotropic virus type 1.

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