Decreased Sound Tolerance in Tinnitus Patients

(1) Background: Decreased sound tolerance is a significant problem in tinnitus sufferers. The aim of the study was to evaluate the relationship between tinnitus and decreased sound tolerance (hyperacusis and misophonia). (2) Methods: The study sample consisted of 74 patients with tinnitus and decreased sound tolerance. The procedure comprised patient interviews, pure tone audiometry, impedance audiometry, measurement of uncomfortable loudness levels, and administration of the Hyperacusis Questionnaire, Tinnitus Handicap Inventory, and Visual Analogue Scales. (3) Results: The majority (69%) of the patients reported that noise aggravated their tinnitus. The correlation between tinnitus and hyperacusis was found to be statistically significant and positive: r = 0.44; p < 0.01. The higher the tinnitus severity, the greater the hyperacusis. There was no correlation between misophonia and hyperacusis (r = 0.18; p > 0.05), or between misophonia and tinnitus (r = 0.06; p > 0.05). (4) Conclusions: For tinnitus patients the more significant problem was hyperacusis rather than misophonia. The diagnosis and treatment of decreased sound tolerance should take into account not only audiological, but also psychological problems of the patients.

A clinical study to determine the effects of adenoidectomy in cases of secretory otitis media in school going children

Introduction: Secretory Otitis media (SOM) is the leading cause of hearing loss in children. Despitenumerous studies on the prevention and treatment of SOM during the past decades, itsmanagement remains challenging and controversial. A study was conducted to find the effect ofadenoidectomy in cases of SOM with hypertrophied adenoids and to determine the effect ofadenoidectomy on hearing as assessed by the pure tone and impedance audiometry. Material andMethods: Children aged 5 – 12 years, diagnosed as SOM with adenoid hypertrophy were included.The study was conducted from April 2019 to May 2020, in the department of ENT, GSL MedicalCollege. A detailed history and clinical examination were done. Investigations such as pure toneaudiogram, impedance audiometry, X-ray nasopharynx, and diagnostic nasal endoscopy were carriedout to confirm the diagnosis. Results: Out of the 50 participants, a maximum (60%) belonged tothe 5 – 7 years age group, the male-female ratio was 1.2. Hard of hearing was a common symptomin 66%, tonsillitis, and sinusitis in 36% and 18% respectively. On pure tone audiometry, the averagehearing loss was 24.95dB. Conclusion: Adenoidectomy in children having hypertrophied adenoidswith SOM, not only relieves Eustachian tube obstruction but also removes the source of infection.This leads to clearance of middle ear effusion and improvement in hearing postoperatively.

Karhart’s notch in ear diseases

According to the literature and our research, Karhart’s notch, as a local increase in bone conduction thresholds at frequencies of 500-3000 Hz, is observed not only in otosclerosis, but also in other diseases of the middle ear, especially – with adhesive and secretory otitis. Therefore, it is not appropriate to use the presence of a Karhart’s notch as a pathognomonic sign of otosclerosis. Audiometric diagnostics of non-purulent ear diseases should definitely be supplemented with impedance audiometry.

Changes in the hearing threshold using high frequency audiometry in medical personnel exposed to ionizing radiation

<p class="abstract"><strong>Background:</strong> Effect on sensorineural hearing loss by low dose ionizing radiation exposure in radiation workers has been rarely evaluated. A case control study was done among the radiation associated workers and normal subjects.</p><p class="abstract"><strong>Methods:</strong> The study was designed in low dose of radiation exposing healthy medical personnel. Age and sex matched healthy control group of subjects were selected. Groups were evaluated by normal otoscopic evaluation; normal tuning fork test and normal standard pure tone audiogram at frequencies from 250 to 8000 Hz. They underwent impedance audiometry, transient evoked otoacoustic emissions, and high frequency audiometry (from frequencies 10000 to 20000 Hz) was done. </p><p class="abstract"><strong>Results:</strong> No statistically significant difference was found in the results of impedance audiometry, transient evoked otoacoustic emissions and standard pure tone audiogram from 250 to 8000 Hz between cases and controls. In the high frequency range, statistically significant difference was observed (p=0.0001). Mean thresholds were higher at all frequencies in cases compared to controls, except at 4000 Hz. A statistically significant correlation was found between duration of exposure and thresholds at 500 Hz (p=0.014) and 10000 Hz (p=0.048). Tinnitus, vertigo, ear block, hard of hearing and loss of appetite were seen more in cases, but was not significant.</p><p class="abstract"><strong>Conclusions:</strong> Taking account of the very low incidence of nerve and parathyroid injury in this series, the authors suggest that meticulous capsular dissection is superior to dissection of the entire nerve in avoiding transcient nerve damage as well as temporary hypocalcemia. However it is stated that a deliberate search for the nerve is definitely indicated in cases where there is likely to be distorted anatomy, as in infiltrating malignancies and recurrent thyroidectomies.</p>

A clinical study to determine the effects of adenoidectomy in cases of secretory otitis media in school going children

<p><strong>Background: </strong>Secretory otitis media (SOM) is common otological symptom in children. If left untreated it leads to hearing and speech impairment. Surgical management is effective in serious cases. The present study was done with the objective<strong> </strong>to assess the effect of adenoidectomy by pure tone and impedance audiometry in cases of SOM with hypertrophied adenoids.</p><p><strong>Methods: </strong>This study comprised 50 cases, who were aged 5-12 years and diagnosed as SOM with adenoid hypertrophy. It was carried out for a period one and half years from December 2015 to July 2017 at Mamata Medical College and Research Hospital, Khammam, Telangana. After detailed history and clinical examination, investigations such as pure tone audiogram, impedance audiometry, X-ray nasopharynx and diagnostic nasal endoscopy were carried out to confirm the diagnosis. All patients were posted for adenoidectomy and when indication was present tonsillectomy was also done. They were followed up at 1st, 3rd and 6th month for pure tone audiometry and impedance was done at 6th month of surgery.</p><p><strong>Results: </strong>In this study, maximum number (60%) of cases belonged to 5-7 years age group, with slight male preponderance (56%). On pure tone audiometry 68% had 16-25 dB and 32% had 26-40 dB hearing loss and average being 24.95 dB. On impedance only 14% had peak preoperatively. Postoperatively, no peak/peak conversion was seen in 33% of cases and mean A-B gap improvement at 1st, 3rd and 6th month was 13 dB, 13.2 dB and 12.7 dB respectively (p value is 0.0001,&lt;5%) when compared to preoperative findings.</p><p><strong>Conclusion: </strong>Adenoidectomy is effective in the management of middle ear infection in children having hypertrophied adenoids.</p>

Impedance audiometry

This chapter discusses Jerger’s 1970 paper on clinical experience with impedance audiometry including the design of the study (outcome measures, results, conclusions, and a critique).