Technological Advances in Universal Neonatal Hearing Screening (UNHS)

Within the last decade, numerous new challenges have appeared in the UNHS arena, such as (i) the need to validate the automated OAE/ABR screeners; (ii) the need to qualify the responses from the automated devices; (iii) the need to obtain additional information (i.e., hearing threshold) for the subject under assessment, in a short period of time; (iv) and the need to integrate numerous measurements in a single portable automated device. To respond to these clinical demands, several new methodologies have been introduced to the UNHS clinical practice. In this context, the aim of this chapter is to provide information on these new technological trends

Validation of AQoL‑8D: a health‑related quality of life questionnaire for adult patients referred for otolaryngology

Purpose The purpose of the study was to validate the AQoL-8D questionnaire in the adult population of patients referred to an otolaryngology clinic. Methods AQoL-8D was translated into Polish. 463 patients (age18–80 years) with otolaryngological conditions were assessed with the AQoL-8D, SF-6D, and SWLS questionnaires. We investigated the item content-relevance, factor structure by means of Confirmatory Factor Analysis, corrected item-total correlations, Cronbach’s alpha, Pearson correlation of the AQoL-8D scores with results from SF-6D and from the SWLS questionnaires. Finally, ANOVA was used to test the AQoL- 8D ability to group the HRQoL of patients in terms of their otolaryngological management type. Results The median score of item content-relevance was 5.0 for all AQoL-8D items. Confirmatory Factor Analysis revealed the following fit indices: Comparative Fit Index = 0.81; Tucker–Lewis Index = 0.80; and Root Mean Square Error of Approximation = 0.07. Cronbach’s alpha for AQoL-8D dimensions ranged from 0.48 to 0.79. Mean item-total correlations over all dimensions, super dimensions, and the instrument overall were higher than 0.3. There was a significant Pearson correlation between the results obtained with AQoL-8D and SF-6D (r = 0.68), and with AQoL-8D and SWLS (r = 0.43). A one-way ANOVA showed a significant effect of management type on HRQoL as measured by AQoL-8D [F(4,458) = 6.12, p < 0.001] Conclusion AQoL-8D provides valid and reliable measures of HRQoL in patients undergoing otolaryngological treatment. Because it is a generic questionnaire, it is possible to make general comparisons of otolaryngology outcomes with those from other subspecialties

Hearing screening of school children in the Podkarpackie Voivodeship, Poland

IntroductionHearing screening is an important part of prevention. It allows early detection of hearing disorders, thus the treatment may begin early, and eliminates or minimises negative consequences. Children with hearing impairment often experience delayed speech development and cognitive abilities, which can result in learning disabilities and reduce school progress. Since 1999, the Institute of Physiology and Pathology of Hearing in Poland has provided a hearing screening program for school-age children in the country. The main aim of the program is the early detection of hearing disorders in children starting school, and increase in the awareness among parents of hearing problems.Materials and MethodsPure-tone air-conduction hearing thresholds were obtained at 0.5–8 kHz. The results of the hearing screening examination were regarded as positive if pure-tone thresholds were higher than 20 dB HL in one or both ears at one or more of the test frequencies. The audiometric results were supplemented by questionnaires completed by the parents. There were 8,091 first-grade children from the Podkarpackie Voivodeship enrolled in the program.ResultsBased on the audiogram, screening showed that hearing impairment was found in 1618 children (20% of the examined children).ConclusionOur study yielded a large group of children with hearing problems. We recommend that hearing screening in primary schools should be a routine procedure within a general framework of preventive pediatric health care

OAEs and Meniere Disease

Otoacoustic emissions (OAEs) are responses originating from the inner ear. Clinically they are evoked by different families of acoustic stimuli, such as transient acoustic clicks, tone pips, and pure tones. Upon stimulation, the acoustic energy is transformed in the middle ear at acoustic pressure acting upon the stapes footplate. The pressure wave inside the cochlea stimulates the OAE generators and a reverse acoustic energy (the OAE response) propagates from the inner ear, through the stapes and the middle ear structures, to the tympanic membrane. Considering that the acoustic energy has to cross the middle ear structures twice, the functional status of the middle ear can influence or attenuate considerably the OAE response. In this context, any vestibular alteration can influence the middle ear mechanics (mainly the middle ear impedance) and consequently the OAE response characteristics. The data in the literature indicate that OAEs are very sensitive to changes in the intracranial pressure. These pressure alterations during the Meniere’s hydrops phase are expressed as changes in the intralabyrinthine pressure. Other studies have presented data supporting the assumption that OAEs can adequately monitor middle ear changes induced by the presentation of the glycerol test. The data in the literature suggest that OAEs can monitor the progress of Meniere’s disease using reliable indices

Otitis Media, Behavioral and Electrophysiological Tests, and Auditory Rehabilitation

For speech and language to develop, an intact and active auditory system is of fundamental importance. The central auditory nervous system (CANS) can be hampered by several occurrences, including otitis media (OM) originating from inflammation in the middle ear and which is often associated with the accumulation of infected (or sometimes noninfected) fluid. OM can have a diffuse effect on cognitive and linguistic abilities, affecting both speech and phoneme perception through a failure to discriminate, store, and reproduce the acoustic contrasts necessary for comprehension. It is especially common in the first years of school. In addition, OM can generate internal noise from the presence of middle ear fluid near the cochlea, which can lead to changes in speech perception, distortion in acoustic images, and a reduction in the speed and accuracy of decoding speech. Evaluating the effectiveness of the CANS is recommended in cases where there have been repeated episodes of OM. Very useful information can be gained from behavioral and electrophysiological tests. The tests allow functional diagnoses to be made and can also reveal clinical and subclinical changes. In this way, they allow information to be collected, which can help in making a prognosis and planning intervention strategies

Congenital toxoplasmosis and auditory disorders: a literature review

BackgroundCongenital toxoplasmosis (CT) occurs mainly by primary maternal infection during pregnancy. It is estimated that the incidence of vertical transmission to the fetus is 20% and that infected women are more likely to have a premature birth or low birth weight neonate since there is an association between CT and the rate of premature birth and low birth weight. In addition to severe neurological and ophthalmic consequences, hearing disorders such as hearing loss are also among the clinical manifestations seen in children with CT. Given the above, the objective of this study is to verify what are the auditory disorders seen in children with CT.MethodsThis literature review was structured according to the PRISMA statement and based on the terms of Study Target Population, Intervention, Comparison, Outcomes, and Study Types (PICOS). To obtain the studies, the following electronic databases were consulted: PubMed, Web of Science, Scopus, and Lilacs. The combined terms used for the search were: (“auditory evoked potentials” OR “hearing” OR “hearing loss”) AND (“congenital toxoplasmosis”). The selection of articles was carried out independently, blindly, by two of the authors, to minimize risk of bias.ResultsThe search in the databases identified 172 articles, after excluding duplicate articles, 105 studies were identified. From the selection made by reading the titles and abstracts, 11 studies were selected for full-text reading. A total of 94 studies were excluded. An article was selected from the list of references. Therefore, 12 studies were included in the final analysis. It was observed that a significant percentage of studies sought to study the peripheral auditory pathway, verifying the occurrence or association between hearing loss and the presence of congenital infection. Only two studies evaluated the central auditory pathway, using the Brainstem Auditory Evoked Potential (BAEP) and the Frequency Following Response (FFR).ConclusionToxoplasmosis affects not only the peripheral areas but central areas as well. Most studies suggest this pathology as a risk factor for both peripheral and central impairment. Research has found a greater association between CT and mild to moderate hearing loss, in addition to alterations in exams such as BAEP and FFR. These data recommend that CT be reported as a global public health problem and can help assess complications and impacts of hearing disorders as a result of CT. There is a gap about studies that retract the co-occurrence between CT and other Risk Indicators for Hearing Loss (RIHL), such as prematurity, permanence in the intensive care unit, and use of ototoxic medications, lack of longitudinal studies, that accompany the development of hearing and language of children with CT, since the consequences of this infection may be late

Wideband Tympanometry

The wideband tympanometry (WBT) assesses the middle ear function with a transient wideband stimulus in order to capture the middle ear behavior at a wide range of frequencies. Data in the literature suggest that the WBT has more sensibility to detect middle ear disorders than the traditional tympanometry. In this context, pathologies, which might be more easily identified/monitored by WBT, include otosclerosis, flaccid eardrums, ossicular chain discontinuity with semicircular canal dehiscence, and negative middle ear pressure with middle ear effusion. The chapter presents information on classical tympanometry, the multifrequency tympanometry equivalent coded as WBT, clarification of terms used in WBT measurements, and a short overview of clinical applications in infants and adults

The Frequency Following Response: Evaluations in Different Age Groups

In this chapter, recent data on the clinical application of the frequency following response (FFR) in different age groups will be presented. The chapter begins with the importance of using speech sounds in electrophysiological assessments. Then the FFR methodology is presented, giving normative data and the expected responses in different age groups: infants and young children, children and adolescents, and adults and the elderly. Finally, the unique responses of each age group are presented in order to show how this new technology can be an extremely useful tool for diagnosing hearing dysfunction

Otoacoustic Emissions in Smoking and Nonsmoking Young Adults

ObjectivesThe present study investigates the usefulness of transiently evoked otoacoustic emissions (TEOAEs) and distortion product OAEs (DPOAEs) in detecting small changes in the hearing of young smoking adults.MethodsOtoacoustic emissions were acquired from the ears of 48 young adults (age, 20 to 27 years). The dataset was divided into two groups, smoking (24 persons/48 ears) and nonsmoking (24 persons/48 ears). The level of smoking was relatively small in comparison to previous studies, an average of 3.8 years and 8.7 cigarettes per day. In each ear three OAE measurements were made: TEOAEs, DPOAEs, and spontaneous OAEs (SOAEs). Pure tone audiometry and tympanometry were also conducted. Audiometric thresholds did not differ significantly between the datasets. Half-octave-band values of OAE signal to noise ratios and response levels were used to assess statistical differences.ResultsAveraged data initially revealed that differences between the two study groups occurred only for TEOAEs at 1 kHz. However when the datasets were divided into ears with and without SOAEs more differences became apparent, both for TEOAEs and DPOAEs. In ears that exhibited SOAEs, both smokers and nonsmokers, there were no statistically significant differences between evoked OAEs; however in all ears without SOAEs, evoked OAEs were higher in the ears of nonsmokers, by as much as 5 dB. These differences were most prominent in the 1-2 kHz range.ConclusionA general decrease in OAE levels was found in the group of smokers. However, in ears which exhibited SOAEs, there was no difference between the evoked OAEs of smokers and nonsmokers. We conclude that smoking had not yet measurably affected the ears of those with acute hearing (i.e., those who exhibit SOAEs). However, in ears without SOAEs, smokers exhibited smaller evoked OAE amplitudes than nonsmokers, even though their audiometric thresholds were within the norm

Alteration of distortion product otoacoustic emission input/output functions in subjects with a previous history of middle ear dysfunction

Background: The aim of this study was to investigate the effects of sub-clinical alterations on the amplitudes and slopes of the DPOAE input-output responses from subjects with previous history of middle ear dysfunction. Material/Methods: The study included 15 subjects with and 15 subjects without a history of otitis media in the last 10 years. All participants were assessed with acoustic immittance, pure-tone audiometry, and DPOAEs. For the later, I/O functions and I/O slopes were estimated at 1501, 2002, 3174, 4004 and 6384Hz. Results: No statistically significant differences were found between the 2 groups in terms of behavioral thresholds. The group with a previous history of middle ear dysfunction presented significantly lower mean DPOAE amplitudes at 2002, 3174 and 4004 Hz. In terms of DPOAE slopes, no statistically significant differences were observed at the tested frequencies, except at 3174 Hz. Conclusions: Middle ear pathologies can produce subclinical alterations that are undetectable with traditional pure-tone audiometry. The data from the present study show that reduced amplitude DPOAEs are associated with a previous history of middle ear complications. The corresponding DPOAE slopes were affected at only 1 tested frequency, suggesting that the cochlear non-linearity is preserved. Considering these results, it remains to be elucidated to what degree the DPOAE amplitude attenuation interferes with higher-order auditory tasks.FAPESP - Fundo de Amparo a Pesquisa do Estado de Sao Paulo [2008/05151-9