High-Frequency Cochlear Amplifier Dysfunction: A Dominating Contribution to the Cognitive-Ear Link

Objective: The objective of this study was to investigate the role of the high-frequency cochlear dysfunction in the cognitive-ear link.Methods: Seventy-four presbycusis patients (PC group) and seventy-one age-, sex-, and education-level matched normal hearing controls (NH group) were recruited in this study. Participants underwent a battery of cognitive tests estimated by Montreal Cognitive Assessment (MoCA), Stroop Color-Word Interference Test (Stroop), Symbol Digit Modalities Test (SDMT), Auditory Verbal Learning Test (AVLT), and Trail-Making Test (TMT-A and B), as well as auditory tests including distortion product otoacoustic emission (DPOAE), pure tone (PT) thresholds, and speech reception thresholds (SRT). Data were analyzed using the factor analysis, partial correlation analysis, multiple linear regression models, and mediation models.Results: Distortion product otoacoustic emission detection amplitudes and PT thresholds performed worse gradually from low to high frequencies in both the NH and PC groups. High-frequency DPOAE (H-DPOAE) was significantly correlated with cognitive domains in the PC group (AVLT: r = 0.30, p = 0.04; SDMT: r = 0.36, p = 0.01; Stroop: r = –0.32, p = 0.03; TMT-A: r = –0.40, p = 0.005; TMT-B: r = –0.34, p = 0.02). Multiple linear regression models showed that H-DPOAE predicted cognitive impairment effectively for aspects of memory (R2 = 0.27, 95% CI, 0.03 to 1.55), attention (R2 = 0.32, 95% CI, –6.18 to –0.40), processing speed (R2 = 0.37, 95% CI, 0.20 to 1.64), and executive function (TMT-A: R2 = 0.34, 95% CI, –5.52 to 1.03; TMT-B: R2 = 0.29, 95% CI, –11.30 to –1.12). H-DPOAE directly affected cognition and fully mediated the relationship between pure tone average (PTA)/SRT and cognitive test scores, excluding MoCA.Conclusion: This study has demonstrated that the high-frequency cochlear amplifier dysfunction has a direct predictive effect on the cognitive decline and makes a large contribution to the cognitive-ear link.

Evaluation of the effects of Covid-19 on cochleovestibular system with audiovestibular tests

Purpose The purpose of the present study was to investigate the effects of COVID-19 on audiovestibular system with Transiently Evoked Distortion Otoacoustic Emissions (TOAE), Distortion Product Otoacoustic Emissions (DPOAE), video head impulse test (vHIT) and caloric test. Methods Audiovestibular findings of 24 patients with moderate/severe COVID-19 and 24 healthy controls were compared using pure tone audiometry, tympanometry, TOAE, DPOAE, caloric test, and vHIT. Results On audiometry, the pure tone averages of the COVID-19 patients were higher than the controls ( P = .038). The TEOAE amplitudes at 4000 and 5000 Hz ( P = .006 and P < .01), and DPOAE amplitudes at 3000, 6000, and 8000 Hz ( P < .001, P = .003 and P < .001) were significantly lower in COVID-19 patients compared to the controls. On vestibular tests, there was no significant difference between the caloric test results of the patients and the controls ( P > .05). On vHIT testing, amplitudes of right semicircular canal was found to be significantly lower in COVID-19 group compared to the control group ( P = .008). Conclusion COVID-19 may affect inner ear functions causing a subtle damage in the outer hair cells and lateral semicircular canals. It must be kept in mind that COVID-19 may cause cochleovestibular problems.

Predicting speech discrimination scores from pure-tone thresholds—A machine learning-based approach using data from 12,697 subjects

Diagnostic tests for hearing impairment not only determines the presence (or absence) of hearing loss, but also evaluates its degree and type, and provides physicians with essential data for future treatment and rehabilitation. Therefore, accurately measuring hearing loss conditions is very important for proper patient understanding and treatment. In current-day practice, to quantify the level of hearing loss, physicians exploit specialized test scores such as the pure-tone audiometry (PTA) thresholds and speech discrimination scores (SDS) as quantitative metrics in examining a patient’s auditory function. However, given that these metrics can be easily affected by various human factors, which includes intentional (or accidental) patient intervention, there are needs to cross validate the accuracy of each metric. By understanding a “normal” relationship between the SDS and PTA, physicians can reveal the need for re-testing, additional testing in different dimensions, and also potential malingering cases. For this purpose, in this work, we propose a prediction model for estimating the SDS of a patient by using PTA thresholds via a Random Forest-based machine learning approach to overcome the limitations of the conventional statistical (or even manual) methods. For designing and evaluating the Random Forest-based prediction model, we collected a large-scale dataset from 12,697 subjects, and report a SDS level prediction accuracy of 95.05% and 96.64% for the left and right ears, respectively. We also present comparisons with other widely-used machine learning algorithms (e.g., Support Vector Machine, Multi-layer Perceptron) to show the effectiveness of our proposed Random Forest-based approach. Results obtained from this study provides implications and potential feasibility in providing a practically-applicable screening tool for identifying patient-intended malingering in hearing loss-related tests.

A Novel Unsupervised Spectral Clustering for Pure-Tone Audiograms towards Hearing Aid Filter Bank Design and Initial Configurations

The current practice of adjusting hearing aids (HA) is tiring and time-consuming for both patients and audiologists. Of hearing-impaired people, 40–50% are not satisfied with their HAs. In addition, good designs of HAs are often avoided since the process of fitting them is exhausting. To improve the fitting process, a machine learning (ML) unsupervised approach is proposed to cluster the pure-tone audiograms (PTA). This work applies the spectral clustering (SP) approach to group audiograms according to their similarity in shape. Different SP approaches are tested for best results and these approaches were evaluated by Silhouette, Calinski-Harabasz, and Davies-Bouldin criteria values. Kutools for Excel add-in is used to generate audiograms’ population, annotated using the results from SP, and different criteria values are used to evaluate population clusters. Finally, these clusters are mapped to a standard set of audiograms used in HA characterization. The results indicated that grouping the data in 8 groups or 10 results in ones with high evaluation criteria. The evaluation for population audiograms clusters shows good performance, as it resulted in a Silhouette coefficient >0.5. This work introduces a new concept to classify audiograms using an ML algorithm according to the audiograms’ similarity in shape.

Adapting Audiology Procedures During the Pandemic: Validity and Efficacy of Testing Outside a Sound Booth

Purpose: This investigation aims to provide outcomes from a clinical perspective on the validity and efficacy of a wireless automated audiometer system that could be used in multiple settings when a sound booth is not accessible. Testing was conducted in a clinical setting under modified protocols meeting safety precautions during the COVID-19 pandemic. Method: Four doctoral students in audiology served as examiners. Participants were 69 adults between the ages of 20 and 69 years, with normal hearing (≤ 25 dB HL; n = 110 ears) or hearing loss (> 25 dB HL; n = 25 ears). Two versions of a pure-tone air-conduction threshold test following a modified Hughson-Westlake approach were performed and compared at 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz (a) in a sound-treated test booth using standard manual audiometry and (b) in a quiet, nonsound-treated clinical room (sound booth free) using automated KUDUwave audiometry. Participants were asked to complete a five-item feedback questionnaire, and examiners were interviewed to report on their experience. Results: Clinical validity to within ±10 dB of standard audiometry was demonstrated for 94.5% of the total thresholds ( n = 937) measured with the sound booth–free approach. Less accuracy (73.3%) was observed using a ±5 dB comparison. When comparing the mean thresholds, there were significant differences ( p < .01) between the mean thresholds at most frequencies, with mean sound booth thresholds being higher than the sound booth–free mean thresholds. A strong threshold correlation (.91–.98) was found between the methods across frequencies. Participant and examiner feedback supported the efficacy of the sound booth–free technology. Conclusions: Findings support sound booth–free, automated software-controlled audiometry with active noise monitoring as a valid and efficient procedure for pure-tone hearing threshold assessment. This method offers an effective alternative when circumstances require more transportable hearing assessment technology or do not allow for standard manual audiometry in a sound booth.

AUDIOMETRIC ASSESSMENT IN POST COVID-19 PATIENTS: A CROSS-SECTIONAL STUDY IN A TERTIARY CARE HOSPITAL OF KARACHI - PAKISTAN

Objective: To assess audiometry investigations in patients having complaint of tinnitus, vertigo or hearing impairment after recovery from COVID-19 disease, having no external or middle ear diseases. Study Design: Cross-sectional study. Place and Duration of Study: United Medical and Dental College, Creek General hospital, Korangi, Karachi Pakistan, from March to May 2021. Methodology: A total of 60 patients were included in this study who had recovered from the primary COVID-19 infection and reported with the complaints of tinnitus, vertigo and hearing loss. Pure tone audiogram was assessed for sensorineural deafness, its severity and frequencies affected. Pearson Chi square test was used to see the relation of symptoms with severity of hearing loss. Results: There were 42 (70%) males and 18 (30%) female patients with age range from 18-50 years with mean age of 28.4 ± 8.1 years. Tinnitus was the most common complaint (83.3%) followed by hearing loss (28.3%) and vertigo (23.3%) patients. None of the patients with complaint of hearing loss had normal pure tone audiogram in either right or left ear (p=0.000). Patients with all the three complaints had more hearing impairment where majority had moderate or severe hearing loss (p=0.000). All patients with isolated complaint of vertigo (9 patients) had normal audiogram in both ears (p=0.000). Conclusion: Auditory and vestibular system involvement in reasonably common in COVID-19 patients. Tinnitus is the most frequent symptom and it should be investigated with full audiological investigations.

Online Simulation Education for Audiometry Training

Purpose: The purpose of this clinical focus article was to describe a new online simulation program for pure-tone audiometry. Method: Fictional but realistic patient profiles and testing environments were created to teach students about hearing screening protocols and pure-tone audiology. The diversity of the demographics of the United States is represented throughout the program. The web app was created using HTML/JS/CSS with a Flask server backend and MySQL database. Results: The program allows students to learn the process of conducting a hearing screening and measuring audiometric thresholds using a web-based virtual clinical audiometer. The virtual audiometer includes standard audiometer features and allows for instruction based on standard guidelines. The diversity of the patients within the simulation program allows for discussions of diversity to be woven throughout the curriculum. Conclusions: The new simulation program is designed for use as a clinical training tool enabling undergraduate and graduate students to actively participate in hearing screening testing and pure-tone audiometry using any web browser. The program is also designed with the intent to improve pedagogical outcomes at the undergraduate and graduate level for communication sciences and disorders education for pure-tone audiometry by providing instructors with content that focuses on the diversity that is represented in the demographics of the United States.

Change in Self-Evaluation of Hearing Status According to Age: A Population-Based Study

Background and Objectives Self-reported hearing levels determined by self-report questionnaires are not always correlated with the audiometric hearing level. It is necessary to ascertain the subjectively perceived normal hearing threshold to determine the need for hearing aids at the appropriate time. The objective is to identify the level of correlation between the self-reported hearing level and the audiometric hearing level and ascertain the subjectively perceived normal hearing threshold for each age group.Subjects and Method This cross-sectional study, using the data from the Korea National Health and Nutrition Examination Survey V, looked at participants with hearing loss who were aged ≥40 years. Pure tone audiometry was conducted bilaterally. Self-reported hearing level was ascertained via survey enquiring about hearing loss. The level of correlation between self-reported hearing level and audiometric hearing level, age-specific patterns of hear-ing self-evaluation and subjectively perceived normal hearing values at which participants complained of hearing loss were main outcomes.Results Mean audiometric thresholds (MATs) increased with the age and degree of self-reported hearing level. The accuracy of self-reported hearing level compared to the audiometric threshold decreased with age both in the better-ear and worse-ear groups. Younger participants tended to overestimate their hearing impairment, while older participants tended to underestimate it. Subjectively perceived normal hearing thresholds increased with age and they were very close to the MATs for each age group.Conclusion Results can be useful for devising different age-group specific pure tone audi-ometry-based diagnostic criteria for self-reported hearing loss, which can be used to determine the need for hearing aid in a timely manner.

“Clinical Profile & Prognostic Factors In Patients with Sudden Sensorineural Hearing Loss”

Introduction: Idiopathic sudden sensorineural hearing loss (ISSNHL) is an emergency disease requiring immediate diagnosis and treatment. The incidence of ISSNHL in the Western countries’ population was estimated to 5–20 per 100,000 inhabitants. The etiology of ISSNHL remains unknown. Its pathogenesis is most often suggested to be due to a disturbed microcirculation and infection. Objective: To study the clinical profile & prognostic factors in patients with sudden sensorineural hearing loss. Material and Methods: A retrospective study was carried out from patients of sudden sensineural hearing loss (SSNHL) presenting to ENT Department ofNorthern Private Medical College, Rangpur, Bangladesh from January to June-2020. All patients were given intravenous steroids as treatment modality for 14 days and pure tone audiogram was done every 3 days during hospital admission. It was followed by oral steroids in tapering dose for further 14 days. After 1 month, audiogram was done again. After 1 month if hearing threshold was decreased by more than 50% of presenting one, then it was labeled as improved. Results:Total 51 patients (55ears) with age ranging from 6-70 years (average-38.5 years) were included. Three fourth were male. Presentation was 1-14days after onset of hearing loss (average- 3.7days) with pure tone audiogram (PTA) of 38-117dB (average 83.1dB). The flat audiogram (62.3%) was most common type. Smoking was present in 14 patients and tinnitus in 30 ears. Hemoglobin ranged from 7.3-18.7gm %( average- 15.3gm/dl). PTA post treatment was 8-73dB (average- 56dB). Average age of improved patient was 39.8years which was lower than non-improved patients (42.3years). In improved patients, average PTA at presentation was 77.9dB while it was 86.6dB in non-improved patients. Conclusion: Our study demonstrates that the age distribution and clinical characteristics of ISSNHL patients vary according to levels of hearing loss. Moreover, ISSNHL patients with vertigo tend to sufer from a more severe hearing loss. Further studies are needed to obtain better knowledge about the etiopathogenesis of SSNHL. SSNHL is more commonly seen in male patients with polycythaemia and is commonly presented in winter season and is frequently associated with tinnitus. Young age and lower audiogram threshold at presentation favor prognosis.