1,075 research outputs found

    Validity of diagnostic pure-tone audiometry without a sound-treated environment in older adults

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    Objective: To investigate the validity of diagnostic pure-tone audiometry in a natural environment using a computer-operated audiometer with insert earphones covered by circumaural earcups incorporating real-time monitoring of environmental noise. Design: A within-subject repeated measures design was employed to compare air (250 to 8000 Hz) and bone (250 to 4000 Hz) conduction pure-tone thresholds measured in retirement facilities with thresholds measured in a sound-treated booth. Study sample: 147 adults (average age 76 ± 5.7 years) were evaluated. Pure-tone averages were normal in 59%, mildly (>40 dB) elevated in 23% and moderately (>55 dB) elevated in 6% of ears. Results: Air-conduction thresholds (n=2259) corresponded within 0 to 5 dB in 95% of all comparisons between the two test environments. Bone-conduction thresholds (n=1669) corresponded within 0 to 5 dB in 86% of comparisons. Average threshold differences (-0.6 to 1.1) and standard deviations (3.3 to 5.9) were within typical test-retest reliability limits. Thresholds recorded showed no statistically significant differences (Paired Samples T-test:p˃0.01) except at 8000 Hz in the left ear. Conclusion: Valid diagnostic pure-tone audiometry can be performed in a natural environment with recently developed technology, offering the possibility of access to diagnostic audiometry in communities where sound-treated booths are unavailable.http://www.tandf.co.uk/journals/titles/14992027.asphb201

    Screening methods for age-related hearing loss in older patients with cancer: A review of the literature

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    © 2018 by the authors. As people grow older, they may experience loss in hearing sensitivity. Age-related hearing loss may negatively affect the patient's quality of life as it may lead to social isolation. In older patients with cancer, hearing loss can seriously interfere with the patient's ability to deal properly with all aspects of their disease, and may have a cumulative effect on their already decreased quality of life. Therefore, the proper screening of those conditions is essential in order to optimise the patient's comfort during and after treatment. This review article aims at providing a concise image of the nature of age-related hearing loss, and provides an overview of the screening methods that could be used in older patients with cancer

    Hearing loss in the developing world : evaluating the i-Phone mobile device as a screening tool

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    Background: Hearing loss is a global health burden affecting 360 million people. The highest prevalence is in the Developing World where hearing screening programmes are scarce, and failure to address growing high-risk populations will result in new deaf communities. In resource stretched communities such as these, new strategies to alleviate this burden are necessary. Advances in technology have led to innovative mobile digital devices like smartphones and tablets with the potential to test hearing through audiometric applications. Given the recent upsurge of mobile technology in Africa, it is befitting to determine whether the implementation of science can translate to health service delivery. Objectives: To validate the Apple iPhone mobile device using the uHearâ„¢ application "app" as a possible hearing screening tool in the Developing World

    Prevalence of hearing impairment and auditory pathology in the Limpopo Province, South Africa

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    Submitted in fulfilment of requirements for the degree Masters in Audiology In the Department of Speech Pathology and Audiology School of Human and Community Development Faculty of Humanities University of the Witwatersrand Johannesburg February 2015The lack of prevalence data for hearing impairment (HI) in South Africa may negatively impact on the type of audiological services currently available to individuals residing in the rural areas of South Africa. Without relevant prevalence data, the government is unable to plan and budget for appropriate, comprehensive ear and hearing health services. Objective: The aim of this study was therefore to obtain epidemiological data on the prevalence and distribution of auditory pathology and HI in the Elias Motsoaledi Local Municipality of the Limpopo Province. Method: A quantitative, non-experimental, cross-sectional survey design was used for this study. Using a random multi-stage cluster sampling strategy, 357 households were selected in seven wards using the probability proportional to size method. The Ear and Hearing Disorders Survey developed by the World Health Organisation was used to gather information. Participants: All individuals living in the households selected who gave consent and/or assent to participate in the study were included in the study. In total the hearing of 850 individuals from 357 households were tested. The mean age of participants was 27.9 years (range: 1 month to 94.5 years; SD – 22.08). Results: The overall prevalence of disabling HI (> 40 dB) in this rural population is 8.9% (95% CI: 0.08 - 0.12). The age group 65 years and older presented with the highest prevalence of disabling HI at 74.65% (95% CI: 0.62 - 0.83). The prevalence of auditory pathology is 27.53% (95% CI: 0.26 - 0.32) with undetermined causes, impacted cerumen and otitis media occurring most often. Conclusion: The study provided evidence-based data on the prevalence on HI and auditory pathology in the rural context in South Africa. This information will assist all stakeholders in the ear and hearing health care sector to plan for, prioritize, allocate adequate resources and initiate programmes to ameliorate the impact of HI and auditory pathology in the EMLM of the Limpopo Province. Keywords: prevalence; hearing impairment, auditory pathology; Ear and Hearing Disorders Survey, rural, South Afric

    Hearing loss in the developing world: Evaluating the iPhone mobile device as a screening tool

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    BACKGROUND: Developing countries have the world's highest prevalence of hearing loss, and hearing screening programmes are scarce. Mobile devices such as smartphones have potential for audiometric testing. OBJECTIVES: To evaluate the uHear app using an Apple iPhone as a possible hearing screening tool in the developing world, and to determine accuracy of certain hearing thresholds that could prove useful in early detection of hearing loss for high-risk populations in resource-poor communities. METHODS: This was a quasi-experimental study design. Participants recruited from the Otolaryngology Clinic, Groote Schuur Hospital, Cape Town, South Africa, completed a uHear test in three settings - waiting room (WR), quiet room (QR) and soundproof room (SR). Thresholds were compared with formal audiograms. RESULTS: Twenty-five patients were tested (50 ears). The uHear test detected moderate or worse hearing loss (pure-tone average (PTA) >40 dB) accurately with a sensitivity of 100% in all three environments. Specificity was 88% (SR), 73% (QR) and 68% (WR). It was highly accurate in detecting high-frequency hearing loss (2 000, 4 000, 6 000 Hz) in the QR and SR with 'good' and 'very good' kappa values, showing statistical significance (p40 dB). It is highly sensitive for detecting threshold changes at high frequencies, making it reasonably well suited to detect presbycusis and ototoxic hearing loss from HIV, tuberculosis therapy and chemotherapy. Portability and ease of use make it appropriate to use in developing world communities that lack screening programmes

    EFFICACY OF AUTOMATED WIRELESS HEARING TEST SYSTEM IMPLEMENTED IN AN EXERCISE-BASED CANCER REHABILITATION PROGRAM

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    Cancer patients are at risk of hearing loss due to the ototoxicity of chemotherapeutics and radiation treatments. Gaining clinical access to ototoxic monitoring is a challenge for patients, and physicians are often hesitant to burden their patients with more travel and appointment scheduling to obtain hearing testing. The current pilot study evaluated the feasibility of utilizing the newly developed Creare Wireless Automated Hearing Test System (WAHTS) in an exercise-based cancer rehabilitation center setting. Nine cancer patients were recruited for hearing testing. Hearing tests were conducted using an automated testing algorithm (WAHTS) in an open room and then tested again using manual audiometry conducted in a clinical sound booth test environment. Statistical analysis (t-test) revealed no significant difference between the hearing tests conducted in an open room in the exercise center and those conducted in the clinical setting (p\u3e.05). Future research is needed to investigate the implementation of the WAHTS as a means of monitoring cancer patients for ototoxicity while receiving chemotherapeutics or radiation treatments and simultaneously participating in an exercise-based cancer rehabilitation program

    Pure-tone audiometry outside a sound booth using earphone attentuation, integrated noise monitoring, and automation

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    OBJECTIVE : Accessibility of audiometry is hindered by the cost of sound booths and shortage of hearing health personnel. This study investigated the validity of an automated mobile diagnostic audiometer with increased attenuation and real-time noise monitoring for clinical testing outside a sound booth. DESIGN : Attenuation characteristics and reference ambient noise levels for the computer-based audiometer (KUDUwave) was evaluated alongside the validity of environmental noise monitoring. Clinical validity was determined by comparing air and bone conduction thresholds obtained inside and outside the sound booth (23 subjects). Test-retest reliability was established for a sub-group of 11 subjects. RESULTS : Improved passive attenuation and valid environmental noise monitoring was demonstrated. Clinically, air conduction thresholds inside and outside the sound booth, corresponded within 5 dB or less >90% of instances (mean absolute difference 3.3 ± 3.2SD). Bone conduction thresholds corresponded within 5 dB or less in 80% of comparisons between test environments, with a mean absolute difference of 4.6 dB (3.7SD). Threshold differences were not statistically significant. Mean absolute testretest differences outside the sound booth was similar to those in the booth. CONCLUSION : Diagnostic pure tone audiometry outside a sound booth using automated testing, improved passive attenuation, and real-time environmental noise monitoring demonstrated reliable hearing assessments.http://www.tandfonline.com/loi/iija202016-10-31hb2016Speech-Language Pathology and Audiolog

    Distortion product otoacoustic emissions: towards reliable and valid early identification and monitoring of hearing in adults receiving ototoxic medication

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    Background: Multidrug-resistant tuberculosis (MDR-TB) patients receive aminoglycosides as part of their treatment. These drugs are ototoxic, and can cause permanent damage to the cochlea, resulting in a debilitating hearing loss, which has a negative impact on an individual's quality of life. Early detection and management of an ototoxic hearing loss can minimise the impact of the hearing loss on the person's social, emotional, and vocational wellbeing. While patients with MDR-TB are often very ill, it might be ideal to use an objective test that does not require active participation from the patient. In this way, the reliability and validity of the test will not be affected by the patient's state. Distortion product otoacoustic emissions (DPOAEs) at 2f1-f2 are a viable option, as it evaluates cochlear function, specifically the outer hair cells, which are affected first by ototoxic medication. Method: This thesis used a sequential study design aimed to determine the DPOAE stimulus parameters that yield (a) the highest level and the most reliable, sensitive and specific DPOAEs reported in the literature, (b) the highest level and the most reliable DPOAEs in healthy, normally hearing adults, and (c) the most sensitive and specific DPOAEs in participants with MDR-TB patients receiving ototoxic medication. High frequency pure tone audiometry (defined in this thesis as frequencies > 8 kHz) was used as the gold standard. Descriptive statistics, the intraclass correlation coefficient, Pearson's correlation coefficient and mixed model analyses were used to analyse the data. Results: Systematic review: The results of the systematic review indicated an L1/L2 setting of 75/75 dB SPL and f2/f1 value from 1.20 to 1.22 yielded the highest level DPOAEs. The systematic review results for stimulus parameters that yielded the highest test-retest reliability, sensitivity and specificity were inconclusive. Preliminary study with healthy normal hearing participants: The results of the preliminary study in healthy, normal-hearing participants indicated that the highest levels of DPOAEs were elicited with L1/L2 intensity levels of 65/65 and 65/55 dB SPL, and f2/f1 ratios of 1.18, 1.20 and 1.22, as determined by mixed model analyses (p < 0.05). These same stimulus parameters yielded the most reliable DPOAEs in both ears, as determined by intraclass correlation coefficient analysis. Main study with healthy, normal-hearing participants: Descriptive statistics and mixed model analysis showed stimulus intensity levels L1/L2 of 65/55 dB SPL, and f2/f1 ratios of 1.18 and 1.20, elicited the largest DPOAEs. The ratio of 1.20 yielded the largest DPOAEs < 5000 Hz and f2/f1 ratio of 1.18 the largest DPOAEs ≥ 5000 Hz. The second highest DPOAE levels were elicit by L1/L2 = 65/65 dB SPL and f2/f1 = 1.18. The test-retest reliability in this sample was not influenced by changing the stimulus parameters, and DPOAEs were only unreliable at an f2 frequency of 8 000 Hz. Study in participants with MDR-TB: Results in participants with MDR-TB receiving ototoxic medication indicated that the highest levels of DPOAEs were elicited with L1/L2 = 65/55 and an f2/f1 ratio of 1.18 at f2 ≥ 5000 Hz, followed by 65/65 and 1.18. For f2 < 5000 Hz, stimulus intensities of L1/L2 = 65/55 and an f2/f1 ratio of 1.20 yielded the largest DPOAE levels. Relating to sensitivity and specificity, the stimulus parameter combination of 65/55 dB and 1.18 detected the highest number of ears with outer hair cell damage in participants with MDR-TB receiving ototoxic medication. Conclusion: It should be considered to use an f2/f1 ratio of 1.18 for f2 ≥ 5000 Hz and 1.20 for f2 < 5000 Hz when monitoring for ototoxicity, to assist with early identification of outer hair cell damage, in conjunction with high frequency pure tone audiometry. This finding needs to be confirmed in a larger sample of participants with MDR-TB receiving ototoxic medication

    Effect of the ear canal occlusion on pure tone thresholds and its clinical applicability in validation of the contralateral occlusion test

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    RESUMO: Introdução e objetivos: Os testes de cabeceira podem diminuir o tempo de resposta clínica, melhorar a tomada de decisões e permitir uma rápida avaliação qualitativa da perda auditiva. Este estudo descreve o desenho e a validação dum novo teste de cabeceira com diapasão que permite quantificar a perda auditiva, na presença de surdez de condução unilateral. O estudo considerou três fases distintas: a primeira fase avaliou os efeitos da oclusão completa do canal auditivo externo sobre a audição, a fim de decidir qual a frequência de diapasão mais adequada para quantificar a hipoacusia com o teste de oclusão contralateral (TOC). A reprodutibilidade do método de oclusão entre examinadores também foi estudada nesta fase. A segunda fase avaliou o efeito da oclusão nos limiares auditivos de acordo com a idade, em indivíduos de idades distintas, para apurar qual o diapasão mais adequado na realização do TOC. A terceira fase avaliou a precisão do teste na previsão do grau de perda auditiva. Métodos: Nas três fases distintas do estudo consideraram-se populações com idade e tamanho da amostra diferentes. Na primeira fase do estudo, 20 adultos (40 ouvidos) com audição normal (21-30 anos de idade) foram submetidos a uma audiometria tonal em campo livre, com e sem oclusão do canal auditivo externo. Cada ouvido foi testado com as frequências standard (250, 500, 1000, e 2000 Hz) em tons de warble. O ouvido contralateral foi suprimido por mascaramento. A oclusão do ouvido foi realizada independentemente por 2 examinadores. Na segunda fase, 42 adultos (84 ouvidos) com audição normal (21-67 anos de idade) foram divididos em três grupos etários: 20-30, 40- 50, e 60-70 anos. Os participantes foram avaliados por audiometria tonal em campo livre, nas mesmas condições descritas para a primeira fase do estudo. Na terceira fase, 53 indivíduos com surdez de condução unilateral foram recrutados num departamento de otorrinolaringologia dum hospital terciário. O TOC foi realizado para determinar a lateralização com diapasões de 128 Hz, 256 Hz, 512 Hz, 1024 Hz e 2048 Hz e com a oclusão total do ouvido não afetado. A audiometria tonal foi então realizada, separadamente e cega em relação aos resultados do TOC, para determinar o gap aéreoósseo (ABG) e a o limiar auditivo médio (PTA). Por fim, as respostas do TOC foram comparadas com o ABG e o PTA para determinar a sua precisão na quantificação do grau da perda auditiva. Resultados: Na primeira fase do estudo, a oclusão do canal auditivo externo determinou uma elevação nos limiares auditivos com o aumento da frequência, desde 19.94 dB (250 Hz) até 39.25 dB (2000 Hz). A diferença dos limiares entre as condições de oclusão e não oclusão foi estatisticamente significativa, tendo aumentado de 10.69 dB (250 Hz) a 32.12 dB (2000 Hz). Não se verificaram diferenças estatisticamente significativas em relação ao género, ou entre examinadores. Na segunda fase do estudo, verificou-se uma elevação dos limiares auditivos com o aumento da frequência, de 20.85 dB (250 Hz, grupo 20–30 anos) a 48 dB (2000 Hz, grupo 60–70 anos). A diferença nos limiares auditivos entre as condições de oclusão e de não-oclusão foi estatisticamente significativa em todas as frequências; e aumentou de forma diretamente proporcional com a frequência, de 11.1 dB (250 Hz, grupo 20–30 anos) a 32 dB (2000 Hz, grupo 20–30 anos). Foram encontradas diferenças estatisticamente significativas para os três grupos etários, em todos os parâmetros, exceto na diferença a 500 Hz e na diferença total média. A perda auditiva média resultante da oclusão aos 500 Hz foi de 19 dB. Não se encontraram diferenças estatisticamente significativas entre o ouvido direito e o esquerdo, e entre géneros. Na terceira fase do estudo o TOC mostrou uma forte associação entre surdez e lateralização utilizando o diapasão de 512 Hz (p = .001). A sensibilidade do diapasão de 512 Hz na deteção de um PTA igual ou maior do que 35.6 dB foi de 94.6% e a especificidade foi de 75% para um valor preditivo positivo de 89.7% e um valor preditivo negativo de 85.7%, assumindo uma prevalência pré-teste de 69.8%. Conclusão: O método de oclusão do canal auditivo externo utilizado demonstrou reprodutibilidade entre examinadores e com a idade. A oclusão elevou os limiares auditivos, sendo este efeito mais evidente nas frequências mais elevadas. O TOC permitiu predizer o grau de hipoacusia de condução unilateral. Se ocorrer lateralização para a ouvido afetado, é quase certa a evidência de hipoacusia de condução moderada ou grave. No TOC podem utilizar-se diapasões de 256 ou 512 Hz para o diagnóstico de hipoacusia ligeira, e o diapasão de 2018 Hz para a hipoacusia moderada. Contudo, no estudo do efeito da idade e com a validação do teste foi possível concluir que a utilização do diapasão de 512 Hz é a mais adequada para o TOC. A utilização deste teste pode permitir aos clínicos, em ambiente de consulta e de forma rápida, a distinção entre uma hipoacusia de condução de grau ligeiro e uma hipoacusia de condução de grau moderado ou superior.ABSTRACT: Introduction and goals: Bedside testing may accelerate clinical decision by making a quick qualitative assessment of hearing loss. This study described the design and validation of a bedside test with tuning forks that allow some quantitative evaluation of hearing loss in the presence of unilateral conductive hearing loss. Three distinct phases were considered: the first phase of the study quantified the effects of complete external auditory canal occlusion on hearing, in order to decide which tuning fork frequency is more appropriate to use for quantifying the hearing loss with the novel contralateral occlusion test (COT). The reproducibility of occlusion between examiners was also explored in this phase of the study. The second phase of the study evaluated the effects of external auditory canal occlusion on hearing thresholds with aging, in order to decide which tuning fork is more appropriate to use for the COT in individuals of different ages. The third phase of this study evaluated the accuracy of the test in predicting the degree of hearing loss. Methods: Over the study period, the three distinct phases considered population numbers of different age/size classes. At the first phase, 20 normal-hearing adults (40 ears) between 21-30 years old underwent sound field pure tone audiometry with and without ear canal occlusion. Each ear was tested with the standard frequencies (250, 500, 1000, and 2000 Hz) with warble tones. The contralateral ear was suppressed with the use of masking. Ear occlusion was performed by two examiners. In the second phase, 42 normal hearing subjects (84 ears) between 21 and 67 years were divided into three age groups (20–30 years, 40–50 years, and 60–70 years). Participants underwent sound field audiometry tests as described to the first phase of the study. In the third phase, 53 subjects with unilateral conductive hearing loss were recruited from an otolaryngology department of a tertiary hospital. The COT was performed to determine lateralization using 128, 256, 512, 1024 and 2048 Hz tuning forks with the non-affected ear meatus totally occluded. Pure-tone audiometry was then performed, separately and blinded of the tuning fork test results, to establish the presence and degree of the air-bone gap (ABG) and the pure-tone average (PTA). The tuning fork responses were finally correlated with the ABG and the PTA to determine their accuracy in quantifying the degree of hearing loss. Results: In the first phase of the study, occlusion of the external auditory canal determined an increase in hearing thresholds with increasing frequencies, from 19.94 dB (250 Hz) to 39.25 dB (2000 Hz). The difference on hearing thresholds between occluded and unoccluded conditions was statistically significant and increased from 10.69 dB (250 Hz) to 32.12 dB (2000 Hz). There were no statistically significant differences according to gender or between examiners. The second phase of the study demonstrated that hearing thresholds increased with higher frequencies from 20.85 dB (250 Hz, 20–30 years group) to 48 dB (2000 Hz, 60–70 years group). The difference on hearing thresholds between occluded and unoccluded conditions were statistically significant and increased, ranging from 11.1 dB (250 Hz, 20–30 years group) to 32 dB (2000 Hz, 20–30 years group). Statistically significant differences were found for the three age groups and for all evaluations except to 500 Hz difference and average difference. The mean hearing loss produced by occlusion at 500 Hz was approximately 19 dB. No statistically significant differences were found between right and left ears and gender for all measurements. In the third phase of the study COT showed a stronger association between hearing loss and the lateralization response using the 512 Hz tuning fork (p = 0.001). The sensitivity of the 512 Hz fork in detecting a PTA equal or greater than 35.6 dB was 94.6% and the specificity was 75.0% for a positive predictive value of 89.7% and a negative predictive value of 85.7%, assuming a pretest prevalence of 69.8%.Conclusions: The occlusion method as performed demonstrated reproducibility between examiners and with aging. The occlusion effect increased the hearing thresholds and became more evident with higher frequencies. The COT was accurate in predicting the degree of unilateral conductive hearing loss. If lateralization to the affected ear occurred, it was almost certain that the affected ear has a moderate or severe conductive hearing loss. 256 Hz or 512 Hz tuning forks were the more appropriate for diagnosis of mild hearing loss, and the 2048 Hz tuning fork was the more appropriate for moderate hearing loss; but aging and accuracy studies demonstrated that the use of the 512 Hz tuning fork is the most suitable for COT. The use of this test may allow clinicians to distinguish mild from moderate or greater than moderate unilateral conductive hearing loss

    Screening measures to detect cognitive and auditory dysfunctions in (older) cancer patients

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