Identifying Subclinical Hearing Loss: Extended Audiometry and Word Recognition in Noise

<b><i>Introduction:</i></b> Normal-hearing people often have complaints about the ability to recognize speech in noise. Such disabilities are not typically assessed with conventional audiometry. Suprathreshold temporal deficits might contribute to reduced word recognition in noise as well as reduced temporally based binaural release of masking for speech. Extended high-frequency audibility (&#x3e;8 kHz) has also been shown to contribute to speech perception in noise. The primary aim of this study was to compare conventional audiometric measures with measures that could reveal subclinical deficits. <b><i>Methods:</i></b> Conventional and extended high-frequency audiometry was done with 119 normal-hearing people ranging in age from 18 to 72. The ability to recognize words in noise was evaluated with and without differences in temporally based spatial cues. A low-uncertainty, closed-set word recognition task was used to limit cognitive influences. <b><i>Results:</i></b> In normal-hearing listeners, word recognition in noise ability decreases significantly with increasing pure-tone average (PTA). On average, signal-to-noise ratios worsened by 5.7 and 6.0 dB over the normal range, for the diotic and dichotic conditions, respectively. When controlling for age, a significant relationship remained in the diotic condition. Measurement error was estimated at 1.4 and 1.6 dB for the diotic and dichotic conditions, respectively. Controlling for both PTA and age, EHF-PTAs showed significant partial correlations with SNR50 in both conditions (<i>ρ</i> = 0.30 and 0.23). Temporally based binaural release of masking worsened with age by 1.94 dB from 18 to 72 years old but showed no significant relationship with either PTA. <b><i>Conclusions:</i></b> All three assessments in this study demonstrated hearing problems independently of those observed in conventional audiometry. Considerable degradations in word recognition in noise abilities were observed as PTAs increased within the normal range. The use of an efficient words-in-noise measure might help identify functional hearing problems for individuals that are traditionally normal hearing. Extended audiometry provided additional predictive power for word recognition in noise independent of both the PTA and age. Temporally based binaural release of masking for word recognition decreased with age independent of PTAs within the normal range, indicating multiple mechanisms of age-related decline with potential clinical impact.

The effect of caffeine on tinnitus: Randomized triple-blind placebo-controlled clinical trial

Objective To test the hypothesis that caffeine can influence tinnitus, we recruited 80 patients with chronic tinnitus and randomly allocated them into two groups (caffeine and placebo) to analyze the self-perception of tinnitus symptoms after caffeine consumption, assuming that this is an adequate sample for generalization. Methods The participants were randomized into two groups: one group was administered a 300-mg capsule of caffeine, and the other group was given a placebo capsule (cornstarch). A diet that restricted caffeine consumption for 24 hours was implemented. The participants answered questionnaires (the Tinnitus Handicap Inventory—THI, the Visual Analog Scale—VAS, the profile of mood state—POMS) and underwent examinations (tonal and high frequency audiometry, acufenometry (frequency measure; intensity measure and the minimum level of tinnitus masking), transient otoacoustic emissions—TEOAE and distortion product otoacoustic emissions—DPOAE assessments) at two timepoints: at baseline and after capsule ingestion. Results There was a significant change in mood (measured by the POMS) after caffeine consumption. The THI and VAS scores were improved at the second timepoint in both groups. The audiometry assessment showed a significant difference in some frequencies between baseline and follow-up measurements in both groups, but these differences were not clinically relevant. Similar findings were observed for the amplitude and signal-to-noise ratio in the TEOAE and DPOAE measurements. Conclusions Caffeine (300 mg) did not significantly alter the psychoacoustic measures, electroacoustic measures or the tinnitus-related degree of discomfort.

Extended high-frequency audiometry in healthy adults with different age groups

Background It was well-documented that extended high-frequency (EHF, above 8 kHz) hearing test could be more sensitive comparing with the conventional measurement on frequency below 8 kHz, regarding the early prediction of auditory damage in certain population. However, hardly any age-specific thresholds of EHF in population with normal hearing ability were observed. This study aims to monitor the age-dependent hearing thresholds at EHF (from 9 to 20 kHz) in healthy hearing population. Methods A total of 162 healthy participants (from 21 to 70 years) with normal conventional pure tone audiograms were recruited and separated into five groups by age. Conventional pure tone average was performed with frequencies from 0.25 to 8 kHz under air conduction and from 0.25 to 4 kHz under bone conduction. EHF audiometry from 9 to 20 kHz was determined under air conduction. Results The effects of aging on hearing were evident at frequencies above 4 kHz. The hearing thresholds of EHF were less than 26 dB HL before 30 years-olds. Hearing abilities in EHF were deteriorated starting from the 31 ~ 40 group and were most obvious in the 51 ~ 60 group and the 61 ~ 70 group with the maximum thresholds of 75 dB HL. Sensitivity of EHF was inversely proportional to the frequency within each age group, and to age among groups. Subjects under 30 years old were totally responsive up to 16 kHz, and 52.2% could respond to 20 kHz. Meanwhile, no responsiveness was recorded to 20 kHz in the 51 ~ 60 group and even to 18 kHz in the 61 ~ 70 group. No gender differences in hearing threshold was observed within each age group, except an obvious decline at frequencies of 4, 6, 8, and 9 kHz in male participants of the 41 ~ 50 group. Conclusions Hearing thresholds at EHF from 9 to 20 kHz were more sensitive than at frequencies below 8 kHz for hearing measurement, and aging inversely affected hearing ability at EHF in healthy population. Hearing thresholds at EHF deteriorated with age and raising frequency, while the upper frequency limit decreased with aging. Graphical abstract

The effect of coronavirus disease 2019 on the hearing system

Objective This study aimed to evaluate different auditory regions with audiological tests, based on the presumption that there may be damage to the structures in the hearing system after coronavirus disease 2019. Methods Twenty individuals with no history of coronavirus disease 2019 and 27 individuals diagnosed with coronavirus disease 2019 were compared. Pure tone, speech and extended high-frequency audiometry, acoustic immitansmetry, transient evoked and distortion product otoacoustic emissions testing, and auditory brainstem response testing were conducted. Results The pure tone audiometry and extended high-frequency mean threshold values were higher in the coronavirus disease 2019 group. The transient evoked otoacoustic emissions signal-to-noise ratios were bilaterally lower at 4 kHz in individuals with a coronavirus disease 2019 history. In the auditory brainstem response test, only the interpeak latencies of waves III–V were significantly different between groups. Conclusion Coronavirus disease 2019 may cause damage to the hearing system. Patients should be followed up in the long term with advanced audiological evaluation methods in order to determine the extent and level of damage.

Applications of extended high-frequency audiometry: a narrative review

Background and Aim: Hearing loss assessment is typically done using the conventional pure tone audiometry (125 Hz to 8000 Hz). Extended high-frequency audiometry (EHFA), which covers the frequency range of 9000 Hz to 20000 Hz, is a very useful tool for detecting early hearing loss before engaging middle and low frequencies. The involvement of these frequencies significantly affects hearing sensitivity. The purpose of the present study was to review the literature on the early diagnosis of hearing impairment using EHFA. Recent Findings: EHFA has been suggested as a low utilization tool in clinical evaluation. How­ever, in recent years, a great deal of information has been provided in this area. This evaluation has proven to be useful in a variety of areas, including ototoxicity, noise-exposed individuals, and users of personal music devices, hidden hear­ing loss (HHL), middle ear infections, rheuma­toid arthritis, and Sjogren’s syndrome. Conclusion: Given the importance and appli­cation of this clinical tool in the early detection of hearing loss and its use in conjunction with other evaluations, better care planning and pre­vention can be offered to patients in some areas. Keywords: Extended high-frequency audiometry; middle ear infections; hidden hearing loss; ototoxic medications; noise exposure; personal music player

High-Frequency Audiometry in Women with and without Exposure to Workplace Noise

For this study, high-frequency audiometry was used to compare the hearing thresholds, with respect to age, among women exposed to noise in their working environment, as well as those not exposed to such noise. The cohort comprised 243 women (average age 36.2 years), of which 88 women were employed in a noisy (LAeq,8h 85–105 dB) workplace, while 155 women did not experience noise. Age categories were determined according to the World Health Organization (Geneva, Switzerland). Hearing thresholds were measured at frequencies of 0.125–16 kHz. Higher hearing thresholds were found in the youngest age groups (18–29 and 30–44 years) among those exposed to noise, as compared to those who were not. The difference in hearing thresholds between the exposed and unexposed groups increased with age, as well as with the frequencies. The highest difference in hearing thresholds for these age categories was measured at 11.25 kHz. The oldest age group (45–63 years) exposed to noise showed lower hearing thresholds than the unexposed group at all frequencies from 4 kHz to 16 kHz. High-frequency audiometry can be used for the early detection of increased hearing thresholds at high frequencies. High-frequency audiometry could be included in preventive programs, especially for younger people exposed to noise, in order to enable earlier detection of noise-induced hearing loss.

POS0784 AUDIOLOGIC EVALUATION IN SYSTEMIC LUPUS ERYTHEMATOSUS PATIENTS AND IMPACT OF HYDROXYCHLOROQUINE THERAPY

Background:Hydroxychloroquine (HCQ) is a commonly used agent in the treatment of rheumatic diseases including systemic lupus erythematosus (SLE). [1]Objectives:The aim of this study was to evaluate the hearing function in SLE patients and assess the impact of chronic HCQ.Methods:This study was carried out on 60 individuals (48 SLE and 12 healthy controls). The SLE patients were divided into HCQ group (n=36) and non-HCQ group (n=12) according to the chronic administration of HCQ. All participants were assessed by full audiological history and extended high frequency audiometry at frequencies 9, 10, 11, 2, 12.5, 14, 16,18 and 20 KHz.Results:When comparing the study SLE patients with healthy controls,there was a statistically significant difference regarding patient reported otological manifestations such as tinnitus (p=.021), vertigo (p=.002) and hearing impairment (p=.042) while there was no significant difference regarding deafness or ear buzzing in one or both ears. HCQ group showed more hearing impairment at frequency 9000 and 20000 Hz than non-HCQ group (p=.004, <.001 respectively).Conclusion:Otological symptoms and sensorineural hearing loss are prevalent among SLE patients. Chronic administration of HCQ may have an ototoxic effect.References:[1]Fiehn, C., et al. “Safety management in treatment with antimalarials in rheumatology. Interdisciplinary recommendations on the basis of a systematic literature review.” Zeitschrift für Rheumatologie (2020): 1-9.Figure 1.Otological manifestations in the study SLE patients (n=48) and the healthy controls (n=12)Disclosure of Interests:None declared

High-Frequency Audiometry for Early Detection of Hearing Loss: A Narrative Review

The WHO considers hearing loss to be a major global problem. A literature search was conducted to see whether high-frequency audiometry (HFA) could be used for the early detection of hearing loss. A further aim was to see whether any differences exist in the hearing threshold using conventional audiometry (CA) and HFA in workers of different age groups exposed to workplace noise. Our search of electronic databases yielded a total of 5938 scientific papers. The inclusion criteria were the keywords “high frequency” and “audiometry” appearing anywhere in the article and the participation of unexposed people or a group exposed to workplace noise. Fifteen studies met these conditions; the sample size varied (51–645 people), and the age range of the people studied was 5–90 years. Commercial high-frequency audiometers and high-frequency headphones were used. In populations unexposed to workplace noise, significantly higher thresholds of 14–16 kHz were found. In populations with exposure to workplace noise, significantly higher statistical thresholds were found for the exposed group (EG) compared with the control group (CG) at frequencies of 9–18 kHz, especially at 16 kHz. The studies also showed higher hearing thresholds of 10–16 kHz in respondents aged under 31 years following the use of personal listening devices (PLDs) for longer than 5 years. The effect of noise-induced hearing loss (NIHL) first became apparent for HFA rather than CA. However, normative data have not yet been collected. Therefore, it is necessary to establish a uniform evaluation protocol accounting for age, sex, comorbidities and exposures, as well as for younger respondents using PLDs.