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.

“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.

Noise Induce Hearing Loss among Peshmerga in Erbil City Participated in Daesh War

Background: The aim of the study was to know noise induces hearing loss and the effect of the noise on peshmerga that participated in the Daesh war in Erbil city. One of the health problems or most common forms of sensorineural is the noise induced-hearing loss. depending on the exposure noise induce cause damaging of the cochlea. So, one of the causes of noise induced hearing loss is exposure to the excessive noise. Objective: To determine noise induce hearing loss among peshmerga participated in the Daesh war in Erbil city. Patients and Methods: In the present study, a total of (253) Peshmerga of four special brigades who exposed to noise in the Daesh war in Erbil city was performed, also pure tone audiogram was done for each peshmerga in the Auditory department at Hawler teaching hospital. Also, pure tone audiogram and firearm noise levels for the right and left ear for each degree of hearing loss for the range of the noise induced hearing loss (4000Hz) performed and hearing loss range in dB. Slight/Mild from 16-40dB, Moderate/Moderate severe from 41-70dB, and Severe/ Severe profound from 71-120 dB. were evaluated for each peshmerga in the auditory department at Hawler teaching hospital to know the cause of inducing hearing loss. Subjects answered a questionnaire and underwent threshold tonal audiometry. Results: Two hundred and fifty-three peshmerga who participated in the Daesh war, was enrolled in this study that subdivided into four age groups (20-29), (30-39), (40-49), (50-59) years, pure tone audiogram was done for each peshmerga for right and left ear. Conclusion: Because of the nature of the profession military, the common disease in the military is induce hearing loss is caused by noise. Hearing is the vital origin during exposure to loud noise. So, prevention is needed and to be a learner with care to the use of hearing protection device. Keywords: Peshmerga, noise, audiogram, daesh

ROLE OF VESTIBULAR EVOKED MYOGENIC POTENTIALS (VEMP) IN PREDICTING THE OUTCOME OF STAPEDOTOMY- A PROSPECTIVE OBSERVATIONAL STUDY

Vestibular evoked myogenic potentials (VEMP) is an objective and non-invasive measure of saccule function that primarily respond to linear acceleration in any direction. Stapedotomy is a procedure done for otosclerosis to improve hearing. The aim of this study was to correlate the VEMPresults with pure tone audiogram pre- and post- stapedotomy in otosclerotic patients. Aprospective observational study was conducted from 2017-2020 in a tertiary care hospital of south India. Patients who underwent stapedotomy for otosclerosis and satised the study criteria were included. Atotal of 22 patients were included in the study. All patients underwent pure tone audiogram (PTA) and VEMP preoperatively and postoperatively. The results were compared and analysed. The mean pre-operative and post-operative ABG were 26.32±9.36 dB and 18.10 ±8.06 dB respectively. (P=0.001). There was no signicant change in VEMP positivity rates, latency and amplitude. The results showed that there was no correlation between the PTAvalues and VEMPpositivity rate in otosclerotic patients. The VEMPpositivity rate was also not affected signicantly by stapedotomy. Based on above ndings we conclude that stapedotomy is a safe and effective procedure with no signicant inner ear trauma.

Tinnitus Assessment : Chinese Version of Tinnitus Primary Function Questionnaire

OBJECTIVE: The aim of the study was to evaluate the Chinese version of Tinnitus Primary Function Questionnaire (TPFQ).DESIGN: Tinnitus patients were administered the TPFQ, the Tinnitus Handi­cap Inventory (THI), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI), and the Pittsburgh Sleep Quality Index (PSQI). Additionally, the magnitude estimate of tinnitus loudness, pure tone audiogram and tinnitus matching were obtained. The factor structure was measured by Kaiser-Meyer-Olkin. The internal consistency was examined using Cron­bach coefficient alpha. The relationships between the TPFQ scores and other measurements were compared with Spearman rank correlation coefficient.STUDY SAMPLE：116 patients whose tinnitus lasting longer than 3 months were included in this study.RESULTS: The Cronbach’s α of the 20-item version TPFQ was 0.94, and the 12-item version TPFQ was 0.92. Both the 20-item and 12-item version TPFQ were significantly correlated with magnitude estimation of tinnitus loudness, THI, PSQI, BDI and BAI. The average pure tone hearing thresholds were significantly correlated with the hearing subscale. CONCLUSIONS: The 20-item and 12-item versions of Chinese TPFQ are a reliable and valid measures of tinnitus. The TPFQ can be used in the assessment and management of tinnitus among the Chinese speaking population.

Towards Auditory Profile-Based Hearing-Aid Fitting: Fitting Rationale and Pilot Evaluation

Background—The clinical characterization of hearing deficits for hearing-aid fitting purposes is typically based on the pure-tone audiogram only. In a previous study, a group of hearing-impaired listeners completed a comprehensive test battery that was designed to tap into different dimensions of hearing abilities. A data-driven analysis of the data yielded four clinically relevant patient sub-populations or “auditory profiles”. The purpose of the current study was to propose and pilot-test profile-based hearing-aid settings in order to explore their potential for providing more targeted hearing-aid treatment. Methods—Four candidate hearing-aid settings were developed and evaluated by a subset of the participants tested previously. The evaluation consisted of multi-comparison preference ratings that were carried out in realistic sound scenarios. Results—Listeners belonging to the different auditory profiles showed different patterns of preference for the tested hearing-aid settings that were largely consistent with the expectations. Conclusions—The results of this pilot evaluation support further investigations into stratified, profile-based hearing-aid fitting with wearable hearing aids.

Pleomorphic adenoma in the external auditory canal: Arising at an atypical location

Pleomorphic adenoma is a common, benign neoplasm typically located in the major salivary glands. The external auditory canal is an atypical location for a pleomorphic adenoma to originate. Wide surgical excision is essential in cases of pleomorphic adenoma due to its tendency to recur and change into malignancy. We report a case of pleomorphic adenoma emerging in the external auditory canal, which is an atypical location for it to originate. A 23-year-old male presented with swelling and decreased hearing in the left ear for 2 months. On examination, there was a smooth, pink, firm swelling in the cartilaginous part of external auditory canal. Pure tone audiogram and computed tomography of temporal bone were performed. The patient underwent excision biopsy and the diagnosis of pleomorphic adenoma was confirmed after histopathology. Long-term follow-up is recommended as pleomorphic adenoma has the potentiality to recur or transform into malignancy.

Misophonia: An Evidence-Based Case Report

Purpose Misophonia is a sound tolerance disorder condition in certain sounds that trigger intense emotional or physiological responses. While some persons may experience misophonia, a few patients suffer from misophonia. However, there is a dearth of literature on audiological assessment and management of persons with misophonia. The purpose of this report is to discuss the assessment of misophonia and highlight the management option that helped a patient with misophonia. Method A case study of a 26-year-old woman with the complaint of decreased tolerance to specific sounds affecting quality of life is reported. Audiological assessment differentiated misophonia from hyperacusis. Management included retraining counseling as well as desensitization and habituation therapy based on the principles described by P. J. Jastreboff and Jastreboff (2014). A misophonia questionnaire was administered at regular intervals to monitor the effectiveness of therapy. Results A detailed case history and audiological evaluations including pure-tone audiogram and Johnson Hyperacusis Index revealed the presence of misophonia. The patient benefitted from intervention, and the scores of the misophonia questionnaire indicated a decrease in the severity of the problem. Conclusions It is important to differentially diagnose misophonia and hyperacusis in persons with sound tolerance disorders. Retraining counseling as well as desensitization and habituation therapy can help patients who suffer from misophonia.

Clinical study to compare the effect of intratympanic injection of lidocaine and dexamethasone in tinnitus of cochlear origin

<p class="abstract"><strong>Background:</strong> Due to various aetiologies and the less known mechanism involved in tinnitus no treatment modality gives consistent results. Here, we are comparing the efficacy of intratympanic injections of lidocaine and dexamethasone. </p><p class="abstract"><strong>Methods:</strong> Out of 100 selected patients, consecutive patients who fulfilled the inclusion and exclusion criteria are randomly allocated into one of the 2 study groups (50 members each). Intratympanic injection of lidocaine and dexamethasone are given to respective group weekly for 3 consecutive weeks and response is assessed at 1 month and 2nd month of injection. </p><p class="abstract"><strong>Results:</strong> In our study, maximum patients were in the age group of 56-65 yrs. When the effect of lidocaine and dexamethasone on tinnitus (based on THI-tinnitus handicap inventory questionnaire) is compared, dexamethasone is found to be more efficacious than lidocaine with a p value&lt;0.005. Out of total, 96% of dexamethasone group and 68% of lignocaine group have got improved THI score during second follow up. While assessing the effect of lidocaine and dexamethasone on pure tone audiogram (PTA) it is found that, dexamethasone is showing more improvement when compared to lignocaine (p value&lt;0.05). Regarding the adverse effects of injection, side effect is more with lidocaine (50%) than that of dexamethasone (36%), most common adverse effect which we came across was burning type of pain, followed by giddiness which last only for few seconds. </p><p class="abstract"><strong>Conclusions:</strong> Dexamethasone is effective in reducing the overall THI score hence reduces handicap when compared with that of lidocaine with added advantage on hearing.</p>