Some Observations on the Nature of the Audiometric 4000 Hz Notch: Data from 3430 Veterans

2011 ◽  
Vol 22 (01) ◽  
pp. 023-033 ◽  
Author(s):  
Richard H. Wilson
Keyword(s):  
Pure Tone ◽  
Noise Exposure ◽  
Medical Center ◽  
Age Groups ◽  
Pure Tone Audiometry ◽  
Extensive Literature ◽  
Simple Explanation ◽  
History Of ◽  
The Mean ◽  
Definition Of

Background: Pure-tone, air-conduction audiograms notched at 4000 Hz have long been considered the signature configuration for noise-induced hearing loss even though there is an extensive literature that does not mesh with this simple explanation. There are many reports of notched audiograms from individuals with no history of noise exposure and, conversely, reports of audiograms with no notches from individuals with a history of noise exposure. Recent reports increasingly suggest that unilateral 4000 Hz notches are common. The prevalence of notched audiograms at 4000 Hz is dependent on the definition of the notch and the population under study. Purpose: To examine the prevalence and characteristics of audiograms that are notched at 4000 Hz. Research Design: Retrospective, descriptive. Study Sample: The participants were 3430 veterans evaluated in the Audiology Clinic at the VA Medical Center, Mountain Home, Tennessee. The mean age was 62.3 yr. Data Collection and Analyses: The data were collected in the course of a 60 min, routine audiological evaluation. In addition to pure-tone audiometry, a history, otoscopy, speech audiometry in quiet and in noise, and aural-acoustic immittance measures were included in the clinic protocol but were not evaluated in this report. A notch was defined when the 4000 Hz threshold minus the 2000 Hz threshold and the 4000 Hz threshold minus the 8000 Hz threshold both were ≥10 dB. Results: Overall the mean LE (left ear) thresholds at 2000, 3000, and 4000 Hz were at hearing levels 2–3 dB higher than the hearing levels for the corresponding mean RE (right ear) thresholds; the differences were significant. A notched audiogram was observed in 40.6% of the participants in at least one ear with 15.4% having bilateral notches, 28.8% LE notches, and 27.1% RE notches. Unilateral 4000 Hz notches were almost twice as prevalent as bilateral 4000 Hz notches. Viewed as a function of age, notched audiograms were most common (˜35% of the participants) in the 40 and 50 yr groups with a diminishing prevalence in the 60–80 yr groups. The mean notch depth at 4000 Hz was consistently 20–26 dB across the seven age groups. In comparison to the thresholds of the audiograms that were not notched, the thresholds of the audiograms with 4000 Hz notches (1) at 250–2000 Hz were at hearing levels 2–3 dB lower, (2) at 3000 and 4000 Hz were at hearing levels 8–17 dB higher, and (3) at 8000 Hz were at hearing levels 3–4 dB lower; the threshold differences were significant at all frequencies for both ears. Conclusions: The data suggest that unilateral, 4000 Hz notched audiograms are as common or more common than bilateral notched audiograms and that unilateral notched audiograms are equally common for the LE and RE. The prevalence and characteristics of 4000 Hz notched audiograms in this veteran sample are similar to those observed in the population as a whole.

An Epidemiologic Study of Tinnitus in a Population in Jiangsu Province, China

2011 ◽  
Vol 22 (09) ◽  
pp. 578-585 ◽  
Author(s):  
Xia Xu ◽  
Xingkuan Bu ◽  
Ling Zhou ◽  
Guangqian Xing ◽  
Cheng Liu ◽  
...  
Keyword(s):  
Hearing Impairment ◽  
Rural Areas ◽  
Pure Tone ◽  
Noise Exposure ◽  
Epidemiologic Study ◽  
Pure Tone Audiometry ◽  
Jiangsu Province ◽  
Related Factors ◽  
Significant Difference ◽  
History Of

Background: Tinnitus is a common complaint and often of no clinical significance. There are a number of unresolved issues concerning the etiology, pathogenesis, and natural history of tinnitus. There are a few current population-based estimates of the prevalence of tinnitus done in representative large geographic areas, but there is little data from multi-area, large sample studies of tinnitus in China. Purpose: To investigate the prevalence of tinnitus and related factors in a Chinese population. These data would be used to plan and evaluate health-care services. Research Design: We carried out an epidemiologic study of tinnitus as part of an epidemiologic study of ear and hearing disorders that was undertaken in Jiangsu Province, China. A question about tinnitus history was included in a comprehensive questionnaire about hearing. All participants also had both pure tone audiometry and an otological examination. Study Sample: The sample consisted of 6333 people 10 yr of age or older, selected by the methods of probability proportional to size. Data Collection and Analysis: All participants answered a questionnaire concerning their tinnitus and had pure tone audiometry testing and an ear examination. All data were entered using EPIDATD 3.0 software and analyzed by a chi-squared test and test for trends. Results: The overall prevalence of tinnitus was 14.5%, and the standardized rates were 11.4% in the whole country and 12.4% in Jiangsu province. Its prevalence increased with age. The prevalence of tinnitus was 11.9 and 15.6% in urban and rural residents, respectively There was no significant difference in prevalence between men and women. Hearing impairment, history of middle ear infections, and noise exposure were the main risk factors for tinnitus. Conclusion: Tinnitus is a common problem in the population. With the aging of the population, the prevalence of tinnitus will increase. The prevention of tinnitus should focus on hearing impairment screening, otitis media treatment, and noise exposure reduction. Health services in rural areas should emphasize prevention more.

Sex, Race, Insurance, and Pain: Do Patient Sociodemographics Influence Postoperative Opioid Prescriptions Among Hand Surgeons?

Hand ◽  
2021 ◽  
pp. 155894472199802
Author(s):  
Connor J. Peck ◽  
Martin Carney ◽  
Alexander Chiu ◽  
Kitae E. Park ◽  
Alexandre Prassinos ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Medical Center ◽  
Carpal Tunnel Release ◽  
Private Insurance ◽  
Academic Medical Center ◽  
Age Groups ◽  
Postoperative Pain Management ◽  
Patient Treatment ◽  
Opioid Prescription ◽  
History Of

Background: Social and demographic factors may influence patient treatment by physicians. This study analyzes the influence of patient sociodemographics on prescription practices among hand surgeons. Methods: We performed a retrospective analysis of all hand surgeries (N = 5278) at a single academic medical center from January 2016 to September 2018. The average morphine milligram equivalent (MME) prescribed following each surgery was calculated and then classified by age, race, sex, type of insurance, and history of substance use or chronic pain. Multivariate linear regression was used to compare MME among groups. Results: Overall, patients with a history of substance abuse were prescribed 31.2 MME more than those without ( P < .0001), and patients with a history of chronic pain were prescribed 36.7 MME more than those without ( P < .0001). After adjusting for these variables and the type of procedure performed, women were prescribed 11.2 MME less than men ( P = .0048), and Hispanics were prescribed 16.6 MME more than whites ( P = .0091) overall. Both Hispanic and black patients were also prescribed more than whites following carpal tunnel release (+19.0 and + 20.0 MME, respectively; P < .001). Patients with private insurance were prescribed 24.5 MME more than those with Medicare ( P < .0001), but 25.0 MME less than those with Medicaid ( P < .0001). There were no differences across age groups. Conclusions: Numerous sociodemographic factors influenced postoperative opioid prescription among hand surgeons at our institution. These findings highlight the importance of establishing more uniform, evidence-based guidelines for postoperative pain management, which may help minimize subjectivity and prevent the overtreatment or undertreatment of pain in certain patient populations.

The Prevalence of Dementia in the Elderly: A Review

1994 ◽  
Vol 39 (5) ◽  
pp. 253-257 ◽  
Author(s):  
Kenneth Rockwood ◽  
Karen Stadnyk
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Age Groups ◽  
The Elderly ◽  
Community Studies ◽  
Prevalence Studies ◽  
Clinical Interviews ◽  
Dementia Prevalence ◽  
History Of ◽  
Definition Of

We reviewed the findings of the Canadian Study of Health and Aging in the context of studies published between January 1986 and June 1993 that documented dementia and Alzheimer's disease prevalence. Studies were identified using a MEDLINE literature search. Additional references were selected from the bibliography of identified articles. Most reports of all types of dementia prevalence are within a narrow range for each of the age groups 65+, 75+ and 85+ years. By contrast, two recent reports on the prevalence of Alzheimer's disease have reported much higher estimates (10.3% and 15.3%) in the elderly (65+ years). A variety of threats to both validity and generalizability of the estimates are present in all studies. In community studies which employed clinical interviews most subjects were only mildly affected; the natural history of impairment of this group requires further study if the consequences of these findings are to be understood. There is important variability in the definition of the functional consequences of cognitive impairment in the elderly which affects both the diagnosis and staging of dementia.

scholarly journals High incidence of asymptomatic SARS-CoV-2 infection, Chongqing, China

2020 ◽  
Author(s):  
Yang Tao ◽  
Panke Cheng ◽  
Wen Chen ◽  
Peng Wan ◽  
Yaokai Chen ◽  
...  
Keyword(s):  
Asymptomatic Patient ◽  
Medical Center ◽  
Age Groups ◽  
The Elderly ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Asymptomatic Patients ◽  
Imported Cases ◽  
History Of ◽  
Epidemiological Characteristics

SummaryBackgroundSARS-CoV-2 has been a global pandemic, but the emergence of asymptomatic patients has caused difficulties in the prevention of the epidemic. Therefore, it is significant to understand the epidemiological characteristics of asymptomatic patients with SARS-CoV-2 infection.MethodsIn this single-center, retrospective and observational study, we collected data from 167 patients with SARS-CoV-2 infection treated in Chongqing Public Health Medical Center (Chongqing, China) from January to March 2020. The epidemiological characteristics and variable of these patients were collected and analyzed.Findings82.04% of the SARS-CoV-2 infected patients had a travel history in Wuhan or a history of contact with returnees from Wuhan, showing typical characteristics of imported cases, and the proportion of severe Covid-19 patients was 13.2%, of which 59% were imported from Wuhan. For the patients who was returnees from Wuhan, 18.1% was asymptomatic patients. In different infection periods, compared with the proportion after 1/31/2020, the proportion of asymptomatic patient among SARS-CoV-2 infected patient was higher(19% VS 1.5%). In different age groups, the proportion of asymptomatic patient was the highest(28.6%) in children group under 14, next in elder group over 70 (27.3%). Compared with mild and common Covid-19 patients, the mean latency of asymptomatic was longer (11.25 days VS 8.86 days), but the hospital length of stay was shorter (14.3 days VS 16.96 days).ConclusionThe SARS-CoV-2 prevention needs to focus on the screening of asymptomatic patients in the community with a history of contact with the imported population, especially for children and the elderly population.

scholarly journals Clinical features and outcome of Covid-19 in individuals without Comorbidities. Do children have the advantage?

2021 ◽  
Vol 8 (2) ◽  
pp. 88-93
Author(s):  
Dr. Abhishek Kumar ◽  
◽  
Dr. Nilu Kumari ◽  
Dr. Ranjeet Kumar Singh ◽  
Dr. Alok Kumar ◽  
...  
Keyword(s):  
Severe Disease ◽  
Age Groups ◽  
Asymptomatic Infection ◽  
Healthy Individuals ◽  
Adult Group ◽  
Middle Aged ◽  
History Of ◽  
Adults And Children ◽  
The Mean ◽  
Respiratory Complaints

Objective: Information regarding clinical characteristics and the natural course of COVID-19amongst individuals without comorbidities is scarce. We therefore conducted a retrospectiveobservational study to decipher the disease profile in two different age groups, middle-aged (40-59years) and children (up to 12 years). Method: Study was conducted by reviewing the medicalrecords of all patients in the desired age groups and excluding all those with preexisting illness(called comorbidities). Result: A total of 154 and 27 patients were enrolled and studied in themiddle-aged adults and children group respectively. Males dominated in both groups with a sex ratioof 2.9 in adults and 1.7 in children. Most of the children (92.5%) had a history of exposure from aninfected family member, while in the adult group history of contact was present in 71.4% ofpatients.62.9% of children had an asymptomatic infection which was significantly higher than 22.8%in adults. Cough and fever were the most common symptoms in both age groups, but adults weremore likely to have respiratory complaints when compared with children.11 (7.1%) patients in theadult group had severe disease while in the children group none had severe disease. Similarly in theadult group 11 patients required ICU admission, but none in the children group. The mean durationof RTPCR positivity was similar in both groups. There was 1 (0.6%) expiry in the adult groupwhereas none in children. Conclusion: Healthy individuals in both middle-aged and children grouptend to have milder disease and both harbour the virus for the almost same duration but adults aremore symptomatic in comparison to children and hence children are more likely to be potentialasymptomatic carrier and transmitter of infection.

Asymmetric Hearing Loss Prompting MRI Referral in a Military Population: Redefining Audiometric Criteria

2018 ◽  
Vol 158 (4) ◽  
pp. 695-701 ◽  
Author(s):  
Anthony M. Tolisano ◽  
Ricardo M. Burgos ◽  
Michael B. Lustik ◽  
Lex A. Mitchell ◽  
Philip D. Littlefield
Keyword(s):  
Hearing Loss ◽  
Military Service ◽  
Noise Exposure ◽  
Medical Center ◽  
Tertiary Care ◽  
Military Population ◽  
Retrospective Case ◽  
Referral Criteria ◽  
Diagnosis Rate ◽  
History Of

Objective To reevaluate asymmetric sensorineural hearing loss (ASNHL) criteria used to justify magnetic resonance imaging (MRI) in the evaluation of retrocochlear tumors in a military population. Study Design Retrospective case-control study. Setting Tertiary care military medical center. Subjects and Methods Patients with military service and a history of ASNHL prompting referral for MRI, with or without retrocochlear tumors, were compared between 2005 and 2016. Predictor variables included pure tone ASNHL, speech audiometry, and a history of noise exposure. Logistic regression models for hearing asymmetries were performed, and receiver operator curves were used to calculate sensitivity and specificity. Results Thirty-eight retrocochlear tumors were identified. The MRI diagnosis rate for patients with ASHNL was 0.85%. Patients with tumors were slightly older (42 vs 37 years, P = .021) and had less noise exposure (47% vs 85%, P < .001). A sensitivity of 0.83 and a specificity of 0.58 were calculated for asymmetries ≥10 dB at 2000 Hz without adjusting for noise exposure. Instituting this imaging threshold would have reduced the number of MRI scans by half while missing 16% of tumors. Conclusion The tumor diagnosis rate among those undergoing MRI for ASNHL is low in the military population, likely because service-related noise exposure commonly causes ASNHL. Optimal MRI referral criteria should conserve resources while balancing the risks of over- and underdiagnosis. For those with a history of military service, an asymmetry ≥10 dB at 2000 Hz among patients meeting current ANSHL referral criteria is most predictive of a retrocochlear tumor.

LONG-TERM SEQUELAE OF HEMOPHILUS INFLUENZAE MENINGITIS

PEDIATRICS ◽  
1972 ◽  
Vol 49 (2) ◽  
pp. 206-211
Author(s):  
Sarah H. W. Sell ◽  
Robert E. Merrill ◽  
Emanuel O. Doyne ◽  
Edmond P. Zimsky
Keyword(s):  
Antibiotic Therapy ◽  
Pure Tone ◽  
Medical Center ◽  
Pure Tone Audiometry ◽  
Acute Episode ◽  
Long Term Effects ◽  
Intelligence Scale ◽  
General Physical

The long-term effects of H. influenzae meningitis were studied in 86 patients who were treated with acceptable antibiotic therapy during acute episode in 1950 to 1964 in Nashville, Tennessee. Follow-up revealed that 11 were dead (eight died within first 24 hours of hospitalization). Fifty-six of them returned to Vanderbilt Medical Center for the following appraisals: history, general physical and neurological examinations; pure tone audiometry evaluation; and psychological testing by Wechsler Intelligence Scale for Children. Nineteen others sent information by questionnaire. Results indicated that 26 (29%) survivors had severe or significant handicaps; 12 (14%) had possible residuals; and 37 (43%) were free of detectable deficits. It was concluded that prevention of this disease should now be a prime goal.

Outcomes after Application of Active Bone Conducting Implants

2019 ◽  
Vol 24 (4) ◽  
pp. 197-205 ◽  
Author(s):  
Eleonor Koro ◽  
Mimmi Werner
Keyword(s):  
Hearing Aids ◽  
Pure Tone ◽  
Care Center ◽  
Pure Tone Audiometry ◽  
Sound Field ◽  
Hearing Gain ◽  
Mixed Hearing Loss ◽  
Glasgow Benefit Inventory ◽  
The Mean ◽  
Single Sided Deafness

Background: A bone conducting implant is a treatment option for individuals with conductive or mixed hearing loss (CHL, MHL) who do not tolerate regular hearing aids, and for individuals with single-sided deafness (SSD). An active bone conducting implant (ABCI) was introduced in 2012 with indication in CHL, MHL, and SSD, and it is still the only ABCI available. With complete implantation of the active transducer and consequent intact skin, a decrease in infections, skin overgrowth, and implant losses, all common disadvantages with earlier passive bone conducting implants, could be expected. Our Ear, Nose and Throat Department, a secondary care center for otosurgery that covers a population of approximately 365,000 inhabitants, was approved to implant ABCIs in 2012. Objectives: Our aim was to conduct an evaluation of audiological and subjective outcomes after ABCIs. Method: A cohort study with retrospective and prospective data collection was performed.The first 20 consecutive patients operated with an ABCI were asked for informed consent. The main outcome measures werepure tone and speech audiometry and the Glasgow Benefit Inventory (GBI). Results: Seventeen patients accepted to participate and 15 were able to complete all parts. Six patients had CHL or MHL. In this group the pure tone audiometry tests are comparable with an average functional hearing gain of 29.8 dB HL. With bilateral hearing, the mean Word Recognition Score (WRS) in noise was 35.7% unaided and 62.7% aided. Ten patients had the indication SSD. With the hearing ear blocked, the pure tone average was >101 dB HL, compared to 29.3 dB HL in sound field aided. With bilateral hearing, the mean WRS in noise was 59.7% unaided and 72.8% aided. The mean of the total GBI score was 42.1 in the group with CHL or MHL and 20.6 in the group with SSD. Conclusions: The patients benefit from their implants in terms of quality of life, and there is a substantial hearing gain from the implant for patients with conductive or MHL. Patients with SSD benefit less from the implant than other diagnoses but the positive outcomes are comparable to other options for this group.

Size variation of mastoid air cell system in Indian people at different age groups: a radiographic planimetric study

1990 ◽  
Vol 104 (8) ◽  
pp. 603-605 ◽  
Author(s):  
D. Chatterjee ◽  
T. B. Ghosh ◽  
B. B. Ghosh
Keyword(s):  
Human Subjects ◽  
Age Groups ◽  
Size Variation ◽  
Cell System ◽  
X Rays ◽  
Indian People ◽  
History Of ◽  
Normal Human ◽  
The Mean ◽  
Age And Sex

AbstractA radiographic planimetric study of mastoid air cell system was carried out on 100 normal human subjects of which 50 were males and 50 females–who were further subdivided into five age groups. They had no history of past ear disease or any other clinical ENT abnormality. The mean area of the mastoid air cell system was measured planimetrically on X-rays and the data analysed according to age and sex. It was 12.05±0.67 cm2 in males and 11.45±0.70 cm2 in females (which are more or less the same as that of Western people).The size of the cranial bones has no apparent role in the size variation of the mastoid air cell system. The development of the latter was very rapid up to 10 years of age in both sexes and it continued even after 20 years of age but at a much slower rate.

Comparison of distortion product otoacoustic emissions and pure tone audiometry in occupational screening for auditory deficit due to noise exposure

2015 ◽  
Vol 129 (12) ◽  
pp. 1174-1181 ◽  
Author(s):  
N Wooles ◽  
M Mulheran ◽  
P Bray ◽  
M Brewster ◽  
A R Banerjee
Keyword(s):  
Otoacoustic Emissions ◽  
Pure Tone ◽  
Noise Exposure ◽  
Outer Hair Cell ◽  
Cell Function ◽  
Pure Tone Audiometry ◽  
Otoacoustic Emission ◽  
Distortion Product Otoacoustic Emissions ◽  
Distortion Product Otoacoustic Emission ◽  
Distortion Product

AbstractObjective:To examine whether distortion product otoacoustic emissions can serve as a replacement for pure tone audiometry in longitudinal screening for occupational noise exposure related auditory deficit.Methods:A retrospective review was conducted of pure tone audiometry and distortion product otoacoustic emission data obtained sequentially during mandatory screening of brickyard workers (n = 16). Individual pure tone audiometry thresholds were compared with distortion product otoacoustic emission amplitudes, and a correlation of these measurements was conducted.Results:Pure tone audiometry threshold elevation was identified in 13 out of 16 workers. When distortion product otoacoustic emission amplitudes were compared with pure tone audiometry thresholds at matched frequencies, no evidence of a robust relationship was apparent. Seven out of 16 workers had substantial distortion product otoacoustic emissions with elevated pure tone audiometry thresholds.Conclusion:No clinically relevant predictive relationship between distortion product otoacoustic emission amplitude and pure tone audiometry threshold was apparent. These results do not support the replacement of pure tone audiometry with distortion product otoacoustic emissions in screening. Distortion product otoacoustic emissions at frequencies associated with elevated pure tone audiometry thresholds are evidence of intact outer hair cell function, suggesting that sites distinct from these contribute to auditory deficit following ototrauma.

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