Ossicular reconstruction of incudo-stapedial joint by glass ionomer—a study of 24 cases

Background Chronic otitis media is one of the major health issues worldwide resulting in partial or complete loss of conductive hearing mechanism including the tympanic membrane and ossicular assembly. The aim of the study is to assess hearing improvement after reconstructing the incudo-stapedial joint with glass ionomer cement. Here, a prospective observational study was done in a tertiary care hospital. Patients of chronic mucosal otitis media were operated, and intraoperatively incudo-stapedial joint discontinuity was restored using glass ionomer cement. Post-operative follow-up was done at 1-month, 3-month, 6-month, and 1-year intervals, and hearing was evaluated by doing pure tone audiometry with air conduction at 0.5, 1, 2, 3, 4, 6, and 8 kHz and bone conduction at 0.5, 1, 2, 3, and 4 kHz. Tabulation was done by calculating the air-bone gap in each patient. Results In our study, the patients showed statistically significant improvement in air conduction thresholds and near closure of air-bone gap post-operatively. The mean AC threshold is 15 dB with 91.67% patients having closure of ABG < 20 dB at the end of the 3rd month. Hearing was also evaluated at 6-month and 1-year intervals, which showed good improvement in hearing levels. Conclusions Glass ionomer is a simple, physiological, and cost-effective method of tympano-ossicular reconstruction with certain significant post-operative hearing improvement.

Validation of a Personalized Hearing Screening Mobile Health Application for Persons with Moderate Hearing Impairment

Hearing impairment is a frequent human sensory impairment. It was estimated that over 50% of those aged >75 years experience hearing impairment in the United States. Several hearing impairment–related factors are detectable through screening; thus, further deterioration can be avoided. Early identification of hearing impairment is the key to effective management. However, hearing screening resources are scarce or inaccessible, underlining the importance of developing user-friendly mobile health care systems for universal hearing screening. Mobile health (mHealth) applications (apps) act as platforms for personalized hearing screening to evaluate an individual’s risk of developing hearing impairment. We aimed to evaluate and compare the accuracy of smartphone-based air conduction and bone conduction audiometry self-tests with that of standard air conduction and bone conduction pure-tone audiometry tests. Moreover, we evaluated the use of smartphone-based air conduction and bone conduction audiometry self-tests in conductive hearing loss diagnosis. We recruited 103 patients (206 ears) from an otology clinic. All patients were aged ≥20 years. Patients who were diagnosed with active otorrhea was excluded. Moderate hearing impairment was defined as hearing loss with mean hearing thresholds >40 dB. All patients underwent four hearing tests performed by a board-certified audiologist: a smartphone-based air conduction audiometry self-test, smartphone-based bone conduction audiometry self-test, standard air-conduction pure-tone audiometry, and standard bone conduction pure-tone audiometry. We compared and analyzed the results of the smartphone-based air conduction and bone conduction audiometry self-tests with those of the standard air conduction and bone conduction pure-tone audiometry tests. The sensitivity of the smartphone-based air conduction audiometry self-test was 0.80 (95% confidence interval CI = 0.71–0.88) and its specificity was 0.84 (95% CI = 0.76–0.90), respectively. The sensitivity of the smartphone-based bone conduction audiometry self-test was 0.64 (95% CI = 0.53–0.75) and its specificity was 0.71 (95% CI = 0.62–0.78). Among all the ears, 24 were diagnosed with conductive hearing loss. The smartphone-based audiometry self-tests correctly diagnosed conductive hearing loss in 17 of those ears. The personalized smartphone-based audiometry self-tests correctly diagnosed hearing loss with high sensitivity and high specificity, and they can be a reliable screening test to rule out moderate hearing impairment among the population. It provided patients with moderate hearing impairment with personalized strategies for symptomatic control and facilitated individual case management for medical practitioners.

Implementation of Mobile Audiometry During the COVID-19 Pandemic

During the COVID-19 pandemic, the utility of portable audiometry became more apparent as elective procedures were deferred in an effort to limit exposure to health care providers. Herein, we retrospectively evaluated mobile-based audiometry in the emergency department and outpatient otology and audiology clinics. Air conduction thresholds with mobile audiometry were within 5 dB in 66% of tests (95% CI, 62.8%-69.09%) and within 10 dB in 84% of tests (95% CI, 81.4%-86.2%) as compared with conventional audiometry. No significant differences were noted between mobile-based and conventional audiometry at any frequencies, except 8 kHz ( P < .05). The sensitivity and specificity for screening for hearing loss were 94.3% (95% CI, 91.9%-96.83%) and 92.3% (95% CI, 90.1%-94.4%), respectively. While automated threshold audiometry does not replace conventional audiometry, mobile audiometry is a promising screening tool when conventional audiometry is not available.

Peripheral Auditory Function in Young HIV-Positive Adults With Clinically Normal Hearing

Objective Little is known about peripheral auditory function in young adults with HIV, who might be expected to show early evidence of hearing loss if HIV infection or treatment does affect peripheral function. The goal of this study was to compare peripheral auditory function in 2 age- and gender-matched groups of young adults with clinically normal hearing with and without HIV. Study Design Matched cohort study with repeated measures. Setting Infectious disease center in Dar es Salaam, Tanzania. Methods Participants included HIV-positive (n = 38) and HIV-negative (n = 38) adults aged 20 to 30 years who had clinically normal hearing, defined as type A tympanograms, air conduction thresholds ≤25 dB HL bilaterally from 0.5 to 8 kHz, and distortion product otoacoustic emissions (DPOAEs) >6 dB above the noise floor bilaterally from 1.5 to 8 kHz. Participants were tested multiple times over 6-month intervals (average, 2.7 sessions/participant) for a total of 208 observations. Primary outcome measures included tympanograms, air conduction audiograms, DPOAEs, and click-evoked auditory brainstem responses. Results HIV groups did not significantly differ in age, static immittance, or air conduction thresholds. HIV-positive status was independently associated with approximately 3.7-dB lower DPOAE amplitudes from 2 to 8 kHz (95% CI, 1.01-6.82) in both ears and 0.04-µV lower (95% CI, 0.003-0.076) auditory brainstem response wave I amplitudes in the right ear. Conclusion Young adults living with HIV have slightly but reliably smaller DPOAEs and auditory brainstem response wave I amplitudes than matched HIV-negative controls. The magnitude of these differences is small, but these results support measuring peripheral auditory function in HIV-positive individuals as they age.

Asymptomatic hearing loss-a missed symptom of COVID-19

<p class="BodyA"><strong>Background: </strong>COVID-19 pandemic is caused by SARS CoV2. The last reference of pandemic was Spanish flu in 1918 which caused hearing loss in many patients. The effect of COVID-19 is an interesting issue in audiology. Not much studies have been done; therefore, this kindled our interest to have a study on audiological profile of asymptomatic COVID-19 patients.<strong></strong></p><p class="BodyA"><strong>Methods:</strong> The 20 cases in the age group of 20 and 50 years who were confirmed positive for COVID-19 formed the study group. 20 subjects who had normal hearing (Audiometric threshold at or better than 15 db HL) were used as control group. Pure-tone audiometry (PTA) was done for both the group on day 7 and 30. Air conduction and Bone conduction were measured. The audiometric thresholds were measured using the modified Hughson-Westlake method.</p><p class="BodyA"><strong>Results:</strong> High frequency hearing impairment was found in 9 out of 20 patients in the study group on day 7. Out of the 9 affected patients 7 patients showed improvement upon further testing done on day 30.</p><p class="BodyA"><strong>Conclusions: </strong>Like anosmia and ageusia, hearing loss can be considered as one of the clinical features in COVID-19 patients. This study was recorded to find a significant hearing loss in asymptomatic COVID-19 patients and thus sheds light on the auditory problem that people are experiencing during these difficult times and for future reference on pandemic research.</p>

Effect of High Jugular Bulb on the Hearing Loss Characteristics in Patients With LVAS: A Pilot Study

ObjectiveBoth large vestibular aqueduct syndrome (LVAS) and high jugular bulb (HJB) are regarded as abnormalities commonly seen on the temporal bone CT. High jugular bulb has been found to erode the vestibular aqueduct, and there are several studies on jugular bulb vestibular aqueduct dehiscence. However, there is no study that specifically reports LVAS with concurrent HJB and its hearing loss relatedness. This study presents the pure tone audiometry differences between LVAS with HJB, and LVAS without HJB.MethodsThis was a case control study involving 36 bilateral LVAS with concurrent unilateral HJB patients, total of 72 ears. Intra-person comparison was done, by dividing ears into two groups: the case group, 36 ears (LVAS with HJB); and the control group, 36 ears (LVAS without HJB). Air conduction thresholds (250–4000 Hz), bone conduction thresholds (250–1000 Hz), and air bone gap (250–1000 Hz) were analyzed and compared between groups.ResultThere were statistically significant differences in AC thresholds at 250, 500, 2000, and 4000 Hz between the groups, p &lt; 0.05. But there was no statistical significant difference at 1000 Hz, p &gt; 0.05. There were statistical significant differences in BC thresholds at 250 and 500 Hz, p &lt; 0.05, but there was no statistical difference at 1000 Hz. There were no significant differences in air bone gap at 250, 500, and 1000 Hz between the two groups.ConclusionLVAS with concurrent HJB was found to have higher air conduction thresholds, especially at 250, 500, 2000, and 4000 Hz. Bone conduction thresholds were higher at 250 and 500 Hz. Air bone gap at 250, 500, and 1000 Hz, were not significantly higher in LVAS with concurrent HJB.

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

Hearing Impairment and Audiological Alterations in Euthyroid Hashimoto’s Thyroiditis

<b><i>Introduction:</i></b> Hearing loss may be associated with autoimmune diseases, but it was less studied in Hashimoto’s thyroiditis (HT). We aimed to evaluate hearing impairment and audiological alterations in adults with euthyroid HT. <b><i>Methods:</i></b> Adult patients with euthyroid HT (normal thyroid functions, positive antithyroid peroxidase (anti-TPO)/anti-thyroglobulin, and sonographic findings) were compared with controls. We excluded pregnant or older patients (&#x3e;40 years), those with a history of otological/audiological disease or surgery, otitis media, acoustic trauma, chronic illnesses, use of alcohol, cigarette, medications, rheumatoid factor, antinuclear, antimitochondrial, antiparietal, antineutrophil cytoplasmic, anti-smooth muscle, or antigliadin antibodies, abnormal biochemical or otological findings. Tympanometry which indicates tympanic peak pressure (TPP, daPa), acoustic reflex testing (ART), pure-tone average (PTA), and transient evoked otoacoustic emission (TEOAE) were performed. We grouped the participants according to ART (positive/negative), TEOAE (normal/undetected), and PTA (≤20/&#x3e;20 decibel). <b><i>Results:</i></b> Air conduction thresholds on the right ear at 500, 4,000, 6,000, and 8,000 Hz, PTA, and the left ear at 250, 4,000, 6,000, and 8,000 Hz were higher in euthyroid HT (<i>n</i> = 36) than in controls (<i>n</i> = 40) (<i>p</i> &#x3c; 0.05). We found less negative TPP and a higher ratio of negative ART in euthyroid HT (<i>p</i> &#x3c; 0.05). Euthyroid HT predicted undetected TEOAE and increased hearing threshold on the right ear at 500 and 8,000 Hz (<i>p</i> &#x3c; 0.001). TEOAE detected audiological abnormality at a higher rate. Anti-TPO was positively correlated with TPP and air conduction thresholds, except the right ear at 8,000 Hz. <b><i>Discussion/Conclusion:</i></b> Hearing and audiological tests may be impaired in euthyroid HT. We recommend close monitoring of audiological functions in these patients. TE­OAE more specifically indicates audiological abnormality.

Experience in endoscopic stapedotomy technique and its audiological outcome: a case series

Background Stapedotomy is being performed endoscopically for otosclerosis in Sudan since 2011 with increasing number of patients. This prospective hospital-based study from Nov 2016 to Nov 2020 states the clinic-demographic features of otosclerosis; it describes this surgical technique and hearing outcome following endoscopic stapedotomy. Results Total number included in the study was 91 patients. Females were 48, and males were 43 with a female to male ratio of 1.1:1. Age ranged from 19 years to 52 with a mean age of 30.6± 7 SD years. The main symptom was decreased hearing in all patients (100%); in 82 patients (90%), it was bilateral, followed by tinnitus in 80 patients (88%) while two patients (2.2%) had vertigo. Family history was stated by 2 patients (2.2%) only. Audiological assessment by pure tone audiogram (PTA) for each ear (total of 182) revealed that conductive hearing loss (CHL) is the commonest type of hearing loss in 148 ears (81.3%), mixed type in 30 ears (16.5%), while 4 ears (2.2%) were normal. Endoscopic stapedotomy was performed for 74 patients; this technique was safe; few complications were managed successfully: one gusher and one revision, with no facial nerve injury. Majority of complications happened during the first year. Mean air bone gap (ABG) gain was 23.3± 7.2 dB, air conduction (AC) gain was 18.3 ± 8 dB, and Carhart notch disappeared in 79.5%. Conclusions Endoscopic stapedotomy is a safe and effective procedure with a steep learning curve and a satisfactory hearing outcome. The air bone gap (ABG) gain was comparable to international studies.