Prevalence of Age-Related Sensorineural Hearing Loss and Related Factors in Elderly Patients Attending Tertiary Hospital in Tanzania

PURPOSE

Age-related sensorineural hearing loss (SNHL), is a progressive, usually bilateral hearing loss that occurs in elderly. It is correctable using rehabilitative hearing devices, which can vastly improve the older person's quality of life. This study aimed to find out the prevalence and related factors of age-related sensorineural hearing loss among elderly patients in Tanzania.

METHODS

A total of 380 elderly patients who received Otorhinolaryngology (ORL) services at Muhimbili tertiary hospital were enrolled. Participants were screened for hearing loss and interviewed by the structured questionnaire followed by otoscopic examination and Pure tone Audiometry (PTA).

RESULTS

This study included 182(47.9%) males, and 198 (52.1%) females. The prevalence of SNHL was 27.6%, males were mostly affected 57(31.3%) p = 0.574. Bilateral SNHL was found 90 (85.7%) p = 0.026, and the severity of age-related SNHL was found to increase as age increases.

CONCLUSION

Sensorineural hearing loss among the elderly was prevalent, mostly bilateral, and the severity increases with age. Confounding factors such as hypertension, diabetes mellitus (DM), cigarette smoking, and ototoxic medication may have contributed. Elderly should be screened for hearing loss especially on the individuals with other co-morbidities for early diagnosis and management in order to improve the quality of life of the elderly.

Evaluating the inclusion of tympanometry in population-based surveys of hearing loss

Objective

This study aimed to determine the implications of including tympanometry in the Rapid Assessment of Hearing Loss survey protocol. A comparative study design was employed, with findings from otoscopy compared with the results of tympanometry.

Method

A population-based survey of the prevalence and causes of hearing loss among adults aged over 35 years in The Gambia was conducted. Clinical assessments included air conduction audiometry, otoscopy and clinical history. Otoscopy outcome was recorded and for those with hearing loss, a probable cause was assigned. Following otoscopy, tympanometry was completed. Otoscopy outcome was not changed as a result of tympanometry. Clinician assigned cause was compared to the results of tympanometry. The proportion of causes potentially misclassified by excluding tympanometry was determined.

Results

Among people with hearing loss, including tympanometry led to a higher proportion diagnosed with middle-ear conditions.

Conclusion

The value of adding tympanometry to population-based survey protocols is a higher estimated proportion of hearing loss being attributed to middle-ear disease rather than sensorineural causes. This can inform service needs as more people will be classified as needing medical or surgical services, and a slightly lower number will need rehabilitative services, such as hearing assistive devices. It is highly recommended that tympanometry is included in the protocol.

Assessment of Behavioral Problems in Children Pre- and Post-Cochlear Implant: An Egyptian Study

OBJECTIVE

The present study aimed to detect the behavioral problems pre- and post-cochlear implantation in comparison to normal hearing group to be able to manage these problems to get more benefit from using cochlear implants.

METHODS

A case-control study included 53 children was done. They were divided into 2 groups, the control group included 28 healthy volunteers with normal hearing and the case group included 25 children with severe to profound hearing loss, fitted for cochlear implantation. The Arabic Child Behavior Checklist (CBCL) was used to detect different behavioral problems in both groups. Case group children were followed up and reassessed again by CBCL 3 months later after cochlear implantation.

RESULTS

There were highly significant differences regarding total scores of internalizing and externalizing domains of empirically based CBCL between the control group and the case group after cochlear implants (p=0.001). There were non-significant differences in children within case group (pre- and post-cochlear implantation) regarding emotional and behavioral problems on both empirically based and Diagnostic and Statistical Manual of Mental Disorders-based CBCL.

CONCLUSION

For better results, it is necessary to include a specialist of psychosomatic medicine in the cochlear rehabilitation teamwork.

Inner Ear Complications in Children and Adolescents with Sickle Cell Disease

Hearing impairment is a reported complication of sickle cell disease, yet inner ear pathology is not fully understood. The study purpose was to examine the patterns of inner ear involvement in patients with sickle cell disease by magnetic resonance imaging (MRI) and to assess its association with auditory functions. A cross-sectional study included 22 children with sickle cell disease examined for inner ear pathology by audiogram, MRI inner ear and transcranial Doppler (TCD) with revision of their hospital records for transfusion, chelation and hydroxyurea (HU) therapy. Abnormal MRI in the form of intrinsic T1 hyperintensity within the lumen of inner ear structures and cochlear neuropathy was found in five (22.7%) patients; left middle cerebral artery (MCA) flow velocity was higher in patients with abnormal MRI (83.4 ± 5.3 cm/sec) compared to normal MRI (68.2 ± 11.1 cm/sec) (p = 0.015), however, none of the patients had TCD of >170 cm/sec. There was no significant difference between patients with normal and abnormal MRI as regards hearing level and speech audiometry. Sensorineural hearing loss (SNHL) was present in two (9.1%) and conductive hearing loss (CHL) in two (9.1%) patients. There was a significant negative correlation between right ear mean hearing level and right MCA flow velocity and significant negative correlation between left ear mean hearing level and basilar artery (BA) flow velocity. We concluded that inner ear pathology is not uncommon in asymptomatic patients with sickle cell anemia, yet it did not correlate with hearing impairment and may occur with normal TCD results.

Validity and reliability of the Arabic version of the "Personal Wellbeing Index-Adults" on adults with hearing impairment

Background: The Personal Wellbeing Index-Adults (PWI-A) is the most widely used instrumentfor measuring subjective-quality of life (QoL). The current study seeks to investigate the constructvalidity and reliability of the Arabic version of the PWI-A on adults with bilateral hearingimpairment by comparing the single-factor solution with the two-factor solution.

Methods: A cross-sectional study was conducted at the Audio-Vestibular Medicine Unit of Alexandria University from July-2017 to January-2018. A total of 205 adults were interviewed tomeasure the subjective-QoL using the PWI-A instrument. Internal consistency was determinedusing both Cronbach’s alpha and composite reliability (CR). Validity was assessed by constructvalidity, including ordinal regression, ordinal exploratory factor analysis (OEFA), and ordinalconfirmatory factor analysis (OCFA).

Results: The first four items of the PWI-A which are: satisfaction with living standard, health,achievements, and relationships were the most important indicators of subjective-wellbeing(Part r² 0.0547, 0.0324, 0.0361, and 0.0225, respectively). OEFA suggested that the two-factormodel contributes better than the single-factor model. OCFA validated this suggested solution;(two-factor: RMSEA=0.084 (90% CI=0.01-0.14); CFI=0.964; AIC=52.64; single-factor: RMSEA=0.119 (90% CI=0.07-0.17); CFI=0.922; AIC=62.77). Good internal consistency wasalso presented (two-factor: Cronbach’s alpha=0.719, 0.693; single-factor: Cronbach’s alpha =0.750).

Conclusion: The Arabic version of the PWI-A is a multidimensional scale that consists of twodimensions: the first is related to subjective-QoL, and the second is related to satisfaction withthe community. Thus, it is recommended to use the short version of the PWI-A with only fouritems to measure subjective-QoL, as it achieved sufficient reliability and construct validity.

Morphosyntactic profile of Egyptian children after 5 years of using unilateral cochlear implants

OBJECTIVE

to assess the morphosyntactic aspect of language in Egyptian children after 5 years of using unilateral cochlear implants and studying the factors that affect their progress: the chronological age, the age of implantation, the gender, and the duration of using cochlear implant. Also, to assess which of the subcategories of the morphosyntax are affected to help in designing a suitable rehabilitation program.

MATERIALS AND METHODS

36 Egyptian children using unilateral cochlear implants regularly were enrolled in this cross-sectional study. During the assessment, the chronological age of all children was ranged from 6 years, 7 months to 11 years, 9 months, the duration of using cochlear implants of all children was at least 5 years. The morphosyntactic aspect of language as a part of the REAL scale (Receptive Expressive Arabic Language Scale) was applied by expert Phoniatricians.

RESULTS

Morphosyntactic score was affected negatively by the chronological age, on the other hand, it was not affected by the age of implantation, the gender, or the duration of using cochlear implant.

CONCLUSION

After 5 years of regular rehabilitation of Egyptian children using unilateral cochlear implants, the morphosyntactic profile can be described as still low compared to normal children. These children have developed many items in morphosyntactic aspects like possessiveness, derivative adjectives, and passive tense but still have a defect especially in male plural formation, past tense, adjectives, and irregular plural formation.

Sensorineural hearing loss (SNHL) as an adverse event following immunization (AEFI): Case definition & guidelines for data collection, analysis, and presentation of immunization safety data

This is a Brighton Collaboration case definition of the term "Sensorineural Hearing Loss" to be utilized in the evaluation of adverse events following immunization. The case definition was developed by a group of experts convened by the Coalition for Epidemic Preparedness Innovations (CEPI) in the context of active development of vaccines for Lassa Fever and other emerging pathogens. The case definition format of the Brighton Collaboration was followed to develop a consensus definition and define levels of diagnostic certainty, after an exhaustive review of the literature and expert consultation. The document underwent peer review by the Brighton Collaboration Network.

Quantitative criteria for age-related hearing loss using audiometric configuration analysis

OBJECTIVES

To suggest the most adaptable criteria of age-related hearing loss (ARHL) using prevalence matching with population-based data.

METHODS

We chose 30, 25, 20, and 15 dB as gap ranges of cutoff values of the descending type of hearing loss, between an average of low (500 Hz, 1 kHz) and high (4 kHz, 6 kHz) frequencies. Interaural difference was defined as 10 or 15 dB. Hearing loss was defined over 25 dB. We compared the prevalence results of the cross-matching criteria. We used population-based data from the Korea National Health and Nutrition Examination Survey. We assumed that the prevalence of ARHL ranged from 25 to 35%, and this prevalence will increase gradually with age.

RESULTS

Among the eight possible criteria, age ≥ 65 years, average of all frequencies > 25 dB at the each sides, gap between low- and high frequencies ≥ 20 dB, and interaural difference ≤ 10 dB were the most suitable criteria to suggest a quantitative definition of ARHL audiometrically.

CONCLUSION

In the current study, we recommend the new, quantitative ARHL criteria. The suggested criteria for ARHL might be easily accessed by other researchers to demonstrate their own hypotheses.

Tablet-based tele-audiometry: Automated hearing screening for schoolchildren

Introduction

To assess the performance of a tablet-based tele-audiometry method for automated hearing screening of schoolchildren through a comparison of the results of various hearing screening approaches.

Methods

A total of 244 children were evaluated. Tablet-based screening results were compared with gold-standard pure-tone audiometry. Acoustic immittance measurements were also conducted. To pass the tablet-based screening, the children were required to respond to at least two out of three sounds for all the frequencies in each ear. Several hearing screening methods were analysed: exclusively tablet-based (with and without 500 Hz checked) and combined tests (series and parallel). The sensitivity, specificity, positive and negative predictive values and accuracy were calculated.

Results

A total of 9.43% of children presented with mild to moderate conductive hearing loss (unilateral or bilateral). Diagnostic values varied among the different hearing screening approaches that were evaluated: sensitivities ranged from 60 to 95%, specificities ranged from 44 to 91%, positive predictive values ranged from 15 to 44%, negative predictive values ranged from 95 to 99%, accuracy values ranged from 49 to 88%, and area under curve values ranged from 0.690 to 0.883. Regarding diagnostic values, the highest results were found for the tablet-based screening method and for the series approach.

Discussion

Compared with the results obtained by conventional audiometry and considering the diagnostic values of the different hearing screening approaches, the highest diagnostic values were generally obtained using the automated hearing screening method (including 500 Hz). Thus, this application, which was developed for the tablet computer, was shown to be a valuable hearing screening tool for use with schoolchildren. Therefore, we suggest that this hearing screening protocol has the potential to improve asynchronous tele-audiology service delivery.

The prevalence of hearing impairment within the Cape Town Metropolitan area

BACKGROUND

There is a lack of data on the prevalence of hearing impairment in South Africa. Current data is unreliable as it is based on national census information which tends to underestimate the prevalence of hearing impairment.

AIM

The aim of this study was to estimate the prevalence of hearing impairment in the Cape Town Metropolitan area and to determine factors associated with hearing impairment.

METHOD

A cross-sectional household survey involving 2494 partcipants from 718 households was conducted between the months of February and October 2013. Random cluster sampling was used to select four health sub-districts from eight health sub-districts in the Cape Town Metropolitan area using a method of probability proportional to size (PPS). The survey was conducted according to the World Health Organization (WHO) Ear and Hearing Disorders Survey Protocol and the classifcation of hearing impairment matched the WHO's criteria for the grading of hearing impairment.

RESULTS

The overall prevalence of hearing impairment in the population of this study was 12.35% (95%CI: 11.06% - 13.64%) and prevalence of disabling hearing impairment was 4.57% (95% CI: 3.75% - 5.39%) amongst individuals ≥ 4 years old. The following factors were found to be associated with hearing impairment; male gender, age, hypertension, a history of head and neck trauma and a family history of hearing impairment.

CONCLUSION

Based on the data from communities surveyed during this study, hearing impairment is more prevalent than previously estimated based on national population census information. Interventions for the prevention of hearing impairment in these communities should focus on individuals with associated risk factors.

Age- and Gender-Related Mean Hearing Threshold in a Highly-Screened Population: The Korean National Health and Nutrition Examination Survey 2010-2012

Background

In evaluating hearing disability in medicolegal work, the apportionment of age- and gender-related sensorineural hearing loss should be considered as a prior factor, especially for the elderly. However, in the literature written in the English language no studies have reported on the age- and gender-related mean hearing threshold for the South Korean population.

Objective

This study aimed to identify the mean hearing thresholds in the South Korean population to establish reference data and to identify the age- and gender-related characteristics.

Methods

This study is based on the Korea National Health and Nutrition Examination Survey (KNHANES) 2010–2012, which was conducted by the Korean government, the data of which was disclosed to the public. A total of 15,606 participants (unweighted) representing 33,011,778 Koreans (weighted) with normal tympanic membrane and no history of regular or occupational noise exposure were selected and analyzed in this study. The relationship between the hearing threshold level and frequency, age, and gender was investigated and analyzed in a highly-screened population by considering the sample weights of a complex survey design.

Results

A gender ratio difference was found between the unweighted and the weighted designs: male:female, 41.0%: 59.0% (unweighted, participants) vs. 47.2%:52.8% (weighted, representing population). As age increased, the hearing threshold increased for all frequencies. Hearing thresholds of 3 kHz, 4 kHz, and 6 kHz showed a statistical difference between both genders for people older than 30, with the 4 kHz frequency showing the largest difference. This paper presents details about the mean hearing threshold based on age and gender.

Conclusions

The data from KNHANES 2010–2012 showed gender differences at hearing thresholds of 3 kHz, 4 kHz, and 6 kHz in a highly-screened population. The most significant gender difference in relation to hearing threshold was observed at 4 kHz. The hearing thresholds at all of the tested frequencies worsened with increasing age. The mean hearing thresholds suggested in this study will be useful for the formulation of healthcare-related hearing policies and used as reference data for disability ratings for hearing loss due to various causes.

Prevalence and Risk Factors of Hearing Impairment Among Primary-School Children in Shebin El-Kom District, Egypt

Purpose

This study examined the feasibility of screening hearing loss in rural and urban schools in Egypt, and investigated the prevalence and causes of hearing impairment (HI) in Egyptian primary-school students.

Method

A total of 555 children (6–12 years of age) from a rural and an urban school in the Shebin El-Kom District of Egypt were screened for HI at their schools. A 2-stage screening procedure was used, and positive cases were referred for a diagnostic hearing assessment at a regional medical facility. Risk factors were investigated through a parent questionnaire and an environmental study consisting of noise, ventilation, and crowding measurements at the schools.

Results

The screening failure rate was 25.6%, and the prevalence of confirmed HI was 20.9%. The rate of HI did not differ across the schools. Conductive hearing loss of minimal to mild severity was the most common type of HI. The most important predictors for HI were parent suspicion, otitis media, household smoking, low socioeconomic status, and postnatal jaundice.

Conclusions

The prevalence of HI did not differ across settings and was more common than reported in children from developed countries. The screening results also suggest that professionals with limited audiology background can be trained to implement hearing screening programs in Egyptian schools.

Prevalência de deficiência auditiva referida e causas atribuídas: um estudo de base populacional

Objetivou-se verificar a prevalência de deficiência auditiva referida pela população urbana de quatro localidades do Estado de São Paulo, Brasil, e estudar as causas atribuídas e variáveis sócio-demográficas. Foi realizado um estudo transversal de base populacional com dados referentes à população com 12 anos ou mais residente nas quatro localidades, em 2001 e 2002. Participaram 5.250 sujeitos selecionados por amostragem probabilística, estratificada e selecionada por conglomerados, em dois estágios. A análise dos dados foi exploratória, incluindo análise bivariada e regressão logística múltipla. A prevalência de deficiência auditiva foi 5,21%, mais acentuada nas faixas etárias acima de 59 anos (18,7%), que referiram doenças nos 15 dias anteriores à entrevista (8,4%), com transtorno mental comum (8,85%) e que fizeram uso de medicamentos nos últimos 3 dias (8,45%). O estudo dos fatores que se associam à deficiência auditiva direcionam intervenções de saúde para que atendam as reais necessidades da população, principalmente na atenção primária. Há necessidade de mais estudos populacionais com enfoque na audição, visto que esta é uma área escassa de publicações no Brasil.

Ruído e idade: análise da influência na audição em indivíduos com 50 - 70 anos

TEMA: entre os fatores que podem causar alterações auditivas em adultos estão a idade e a exposição ao ruído. Estes fatores são considerados aditivos, pois seus efeitos causam danos nas células ciliadas do órgão de Corti. OBJETIVO: verificar se a exposição ao ruído ocupacional é um risco importante para as alterações auditivas em adultos na faixa etária de 50 a 70 anos, além do desgaste auditivo próprio do fator idade. MÉTODO: foram estudados (estudo coorte histórico) os audiogramas de 71 homens, de 50 a 70 anos, divididos em 2 grupos (Grupo 1 com histórico de exposição ocupacional ao ruído e Grupo 2 sem histórico de exposição ao ruído) para comparar-se os perfis auditivos. RESULTADOS: os grupos não apresentam diferenças significativas em relação à idade (p = 0,321) e há predomínio (48) de sujeitos entre 50 e 55 anos de idade,14 sujeitos com audição normal bilateral e os demais com perda auditiva neurossensorial. Encontrou-se associação entre ruído e alteração auditiva, com diferenças significativas entre os grupos para os limiares auditivos a partir de 3000Hz, sendo que no Grupo 1 estes foram piores (p < 0,05). CONCLUSÃO: os limiares auditivos dos sujeitos com idade entre 50 e 70 anos estão piores no grupo exposto ao ruído. O ruído é um fator de risco maior do que a idade nas alterações auditivas neurossensoriais.