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Bader K, Zelle D, Gummer AW, Dalhoff E. Pulsed DPOAEs in serial measurements : Combined analysis paradigm of simultaneously occurring changes in hearing thresholds and DPOAEs. HNO 2024:10.1007/s00106-024-01478-z. [PMID: 38958758 DOI: 10.1007/s00106-024-01478-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND To date, there is no consensus on how to standardize the assessment of ototoxicity in serial measurements. For the diagnosis of damage to the cochlear amplifier, measurement methods are required that have the highest possible test-retest reliability and validity for detecting persistent damage. Estimated distortion-product thresholds (LEDPT) based on short-pulse distortion-product otoacoustic emission (DPOAE) level maps use individually optimal DPOAE stimulus levels and allow reliable quantitative estimation of cochlea-related hearing loss. MATERIALS AND METHODS Hearing thresholds were estimated objectively using LEDPT and subjectively using modified Békésy tracking audiometry (LTA). Recordings were performed seven times within three months at 14 frequencies (f2 = 1-14 kHz) in 20 ears (PTA4 (0.5-4 kHz) < 20 dB HL). Reconstruction of the DPOAE growth behavior as a function of the stimulus levels L1, L2 was performed on the basis of 21 DPOAE amplitudes. A numerical fit of a nonlinear mathematical function to the three-dimensional DPOAE growth function yielded LEDPT for each stimulus frequency. For the combined analysis, probability distributions of hearing thresholds (LTA, LEDPT), DPOAE levels (LDP), and combinations thereof were determined. RESULTS LTA and LEDPT each exhibited a test-retest reliability with a median of absolute differences (AD) of 3.2 dB and 3.3 dB, respectively. Combining LEDPT, LDP, and LTA into a single parameter yielded a significantly smaller median AD of 2.0 dB. CONCLUSION It is expected that an analysis paradigm based on a combination of LEDPT, suprathreshold LDP, and fine-structure-reduced LTA would achieve higher test performance (sensitivity and specificity), allowing reliable detection of pathological or regenerative changes in the outer hair cells.
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Affiliation(s)
- Katharina Bader
- Klinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Tübingen, Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Germany.
- Section of Physiological Acoustics and Communication, Universitäts-HNO-Klinik Tübingen, Tübingen, Germany.
| | - Dennis Zelle
- Section of Physiological Acoustics and Communication, Universitäts-HNO-Klinik Tübingen, Tübingen, Germany
- Earlab GmbH, Tübingen, Germany
| | - Anthony W Gummer
- Section of Physiological Acoustics and Communication, Universitäts-HNO-Klinik Tübingen, Tübingen, Germany
| | - Ernst Dalhoff
- Section of Physiological Acoustics and Communication, Universitäts-HNO-Klinik Tübingen, Tübingen, Germany
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Bader K, Zelle D, Gummer AW, Dalhoff E. [Pulsed DPOAEs in serial measurements : Combined analysis paradigm of simultaneously occurring changes in hearing thresholds and DPOAEs. German version]. HNO 2024:10.1007/s00106-024-01477-0. [PMID: 38801424 DOI: 10.1007/s00106-024-01477-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND To date, there is no consensus on how to standardize the assessment of ototoxicity in serial measurements. For the diagnosis of damage to the cochlear amplifier, measurement methods are required that have the highest possible test-retest reliability and validity for detecting persistent damage. Estimated distortion-product thresholds (LEDPT) based on short-pulse distortion-product otoacoustic emission (DPOAE) level maps use individually optimal DPOAE stimulus levels and allow reliable quantitative estimation of cochlea-related hearing loss. MATERIALS AND METHODS Hearing thresholds were estimated objectively using LEDPT and subjectively using modified Békésy tracking audiometry (LTA). Recordings were performed seven times within three months at 14 frequencies (f2 = 1-14 kHz) in 20 ears (PTA4 (0.5-4 kHz) < 20 dB HL). Reconstruction of the DPOAE growth behavior as a function of the stimulus levels L1, L2 was performed on the basis of 21 DPOAE amplitudes. A numerical fit of a nonlinear mathematical function to the three-dimensional DPOAE growth function yielded LEDPT for each stimulus frequency. For the combined analysis, probability distributions of hearing thresholds (LTA, LEDPT), DPOAE levels (LDP), and combinations thereof were determined. RESULTS LTA and LEDPT each exhibited a test-retest reliability with a median of absolute differences (AD) of 3.2 dB and 3.3 dB, respectively. Combining LEDPT, LDP, and LTA into a single parameter yielded a significantly smaller median AD of 2.0 dB. CONCLUSION It is expected that an analysis paradigm based on a combination of LEDPT, suprathreshold LDP, and fine-structure-reduced LTA would achieve higher test performance (sensitivity and specificity), allowing reliable detection of pathological or regenerative changes in the outer hair cells.
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Affiliation(s)
- Katharina Bader
- Klinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Tübingen, Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Deutschland.
- Sektion für Physiologische Akustik und Kommunikation, Universitäts-HNO-Klinik Tübingen, Tübingen, Deutschland.
| | - Dennis Zelle
- Sektion für Physiologische Akustik und Kommunikation, Universitäts-HNO-Klinik Tübingen, Tübingen, Deutschland
- Earlab GmbH, Tübingen, Deutschland
| | - Anthony W Gummer
- Sektion für Physiologische Akustik und Kommunikation, Universitäts-HNO-Klinik Tübingen, Tübingen, Deutschland
| | - Ernst Dalhoff
- Sektion für Physiologische Akustik und Kommunikation, Universitäts-HNO-Klinik Tübingen, Tübingen, Deutschland
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王 子, 曹 麒, 胡 少, 范 新, 吕 俊, 王 会, 王 武, 李 华, 舒 易. [Study on gene therapy for DPOAE and ABR threshold changes in adult Otof-/- mice]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2024; 38:49-56. [PMID: 38297849 PMCID: PMC11116155 DOI: 10.13201/j.issn.2096-7993.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Indexed: 02/02/2024]
Abstract
Objective:This study aims to analyze the threshold changes in distortion product otoacoustic emissions(DPOAE) and auditory brainstem response(ABR) in adult Otof-/- mice before and after gene therapy, evaluating its effectiveness and exploring methods for assessing hearing recovery post-treatment. Methods:At the age of 4 weeks, adult Otof-/- mice received an inner ear injection of a therapeutic agent containing intein-mediated recombination of the OTOF gene, delivered via dual AAV vectors through the round window membrane(RWM). Immunofluorescence staining assessed the proportion of inner ear hair cells with restored otoferlin expression and the number of synapses.Statistical analysis was performed to compare the DPOAE and ABR thresholds before and after the treatment. Results:AAV-PHP. eB demonstrates high transduction efficiency in inner ear hair cells. The therapeutic regimen corrected hearing loss in adult Otof-/- mice without impacting auditory function in wild-type mice. The changes in DPOAE and ABR thresholds after gene therapy are significantly correlated at 16 kHz. Post-treatment,a slight increase in DPOAE was observeds,followed by a recovery trend at 2 months post-treatment. Conclusion:Gene therapy significantly restored hearing in adult Otof-/- mice, though the surgical delivery may cause transient hearing damage. Precise and gentle surgical techniques are essential to maximize gene therapy's efficacy.
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Affiliation(s)
- 子菁 王
- 南华大学附属第二医院耳鼻喉科(湖南衡阳,421001)Department of Otolaryngology, Second Affiliated Hospital of South China University Hengyang, 421001, China
- 复旦大学附属眼耳鼻喉科医院耳鼻喉科Otolaryngology Department of Fudan University Affiliated Eye, Ear, Nose and Throat Hospital
| | - 麒 曹
- 南华大学附属第二医院耳鼻喉科(湖南衡阳,421001)Department of Otolaryngology, Second Affiliated Hospital of South China University Hengyang, 421001, China
- 复旦大学附属眼耳鼻喉科医院耳鼻喉科Otolaryngology Department of Fudan University Affiliated Eye, Ear, Nose and Throat Hospital
| | - 少伟 胡
- 复旦大学附属眼耳鼻喉科医院耳鼻喉科Otolaryngology Department of Fudan University Affiliated Eye, Ear, Nose and Throat Hospital
| | - 新泰 范
- 复旦大学附属眼耳鼻喉科医院耳鼻喉科Otolaryngology Department of Fudan University Affiliated Eye, Ear, Nose and Throat Hospital
| | - 俊 吕
- 复旦大学附属眼耳鼻喉科医院耳鼻喉科Otolaryngology Department of Fudan University Affiliated Eye, Ear, Nose and Throat Hospital
| | - 会 王
- 复旦大学附属眼耳鼻喉科医院耳鼻喉科Otolaryngology Department of Fudan University Affiliated Eye, Ear, Nose and Throat Hospital
| | - 武庆 王
- 复旦大学附属眼耳鼻喉科医院耳鼻喉科Otolaryngology Department of Fudan University Affiliated Eye, Ear, Nose and Throat Hospital
| | - 华伟 李
- 复旦大学附属眼耳鼻喉科医院耳鼻喉科Otolaryngology Department of Fudan University Affiliated Eye, Ear, Nose and Throat Hospital
| | - 易来 舒
- 南华大学附属第二医院耳鼻喉科(湖南衡阳,421001)Department of Otolaryngology, Second Affiliated Hospital of South China University Hengyang, 421001, China
- 复旦大学附属眼耳鼻喉科医院耳鼻喉科Otolaryngology Department of Fudan University Affiliated Eye, Ear, Nose and Throat Hospital
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Le Prell CG. Prevention of Noise-Induced Hearing Loss Using Investigational Medicines for the Inner Ear: Previous Trial Outcomes Should Inform Future Trial Design. Antioxid Redox Signal 2022; 36:1171-1202. [PMID: 34346254 PMCID: PMC9221155 DOI: 10.1089/ars.2021.0166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 11/13/2022]
Abstract
Significance: Noise-induced hearing loss (NIHL) is an important public health issue resulting in decreased quality of life for affected individuals, and significant costs to employers and governmental agencies. Recent Advances: Advances in the mechanistic understanding of NIHL have prompted a growing number of proposed, in-progress, and completed clinical trials for possible protections against NIHL via antioxidants and other drug agents. Thirty-one clinical trials evaluating prevention of either temporary or permanent NIHL were identified and are reviewed. Critical Issues: This review revealed little consistency in the noise-exposed populations in which drugs are evaluated or the primary outcomes used to measure NIHL prevention. Changes in pure-tone thresholds were the most common primary outcomes; specific threshold metrics included both average hearing loss and incidence of significant hearing loss. Changes in otoacoustic emission (OAE) amplitude were relatively common secondary outcomes. Extended high-frequency (EHF) hearing and speech-in-noise perception are commonly adversely affected by noise exposure but are not consistently included in clinical trials assessing prevention of NIHL. Future Directions: Multiple criteria are available for monitoring NIHL, but the specific criterion to be used to define clinically significant otoprotection remains a topic of discussion. Audiogram-based primary outcome measures can be combined with secondary outcomes, including OAE amplitude, EHF hearing, speech-in-noise testing, tinnitus surveys, and patient-reported outcomes. Standardization of test protocols for the above primary and secondary outcomes, and associated reporting criterion for each, would facilitate clinical trial design and comparison of results across investigational drug agents. Antioxid. Redox Signal. 36, 1171-1202.
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Affiliation(s)
- Colleen G. Le Prell
- Department of Speech, Language, and Hearing Science, University of Texas at Dallas, Richardson, Texas, USA
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Sonstrom Malowski K, Gollihugh LH, Malyuk H, Le Prell CG. Auditory changes following firearm noise exposure, a review. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2022; 151:1769. [PMID: 35364940 DOI: 10.1121/10.0009675] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/10/2022] [Indexed: 06/14/2023]
Abstract
Firearms produce peak sound pressure levels (peak SPL) between ∼130 and 175 dB peak SPL, creating significant risk of noise-induced hearing loss (NIHL) in those exposed to firearm noise during occupational, recreational, and/or military operations. Noise-induced tinnitus and hearing loss are common in military service members, public safety officers, and hunters/shooters. Given the significant risk of NIHL due to firearm and other noise sources, there is an interest in, and demand for, interventions to prevent and/or treat NIHL in high-risk populations. However, research and clinical trial designs assessing NIHL prevention have varied due to inconsistent data from the literature, specifically with end point definitions, study protocols, and assessment methodologies. This article presents a scoping review of the literature pertaining to auditory changes following firearm noise exposure. Meta-analysis was not possible due to heterogeneity of the study designs. Recommendations regarding audiologic test approach and monitoring of populations at risk for NIHL are presented based on critical review of the existing literature.
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Affiliation(s)
| | - Lindsay H Gollihugh
- School of Speech-Language Pathology and Audiology, The University of Akron, Akron, Ohio 44325, USA
| | - Heather Malyuk
- School of Speech-Language Pathology and Audiology, The University of Akron, Akron, Ohio 44325, USA
| | - Colleen G Le Prell
- Department of Speech, Language, and Hearing, The University of Texas at Dallas, Richardson, Texas 75080, USA
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Noise-Induced Hearing Loss and its Prevention: Current Issues in Mammalian Hearing. CURRENT OPINION IN PHYSIOLOGY 2020; 18:32-36. [PMID: 32984667 DOI: 10.1016/j.cophys.2020.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Noise-induced hearing loss (NIHL) has been well investigated across diverse mammalian species and the potential for prevention of NIHL is of broad interest. To most efficiently develop novel therapeutic interventions, a good understanding of the current state of knowledge regarding mechanisms of injury is essential. The overarching goals of this review are to 1) concisely summarize the current state of knowledge, and 2) provide opinions on the most significant future trends and developments.
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Le Prell CG, Hammill TL, Murphy WJ. Noise-induced hearing loss and its prevention: Integration of data from animal models and human clinical trials. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2019; 146:4051. [PMID: 31795668 PMCID: PMC7195863 DOI: 10.1121/1.5132951] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/19/2019] [Indexed: 05/07/2023]
Abstract
Animal models have been used to gain insight into the risk of noise-induced hearing loss (NIHL) and its potential prevention using investigational new drug agents. A number of compounds have yielded benefit in pre-clinical (animal) models. However, the acute traumatic injury models commonly used in pre-clinical testing are fundamentally different from the chronic and repeated exposures experienced by many human populations. Diverse populations that are potentially at risk and could be considered for enrollment in clinical studies include service members, workers exposed to occupational noise, musicians and other performing artists, and children and young adults exposed to non-occupational (including recreational) noise. Both animal models and clinical populations were discussed in this special issue, followed by discussion of individual variation in vulnerability to NIHL. In this final contribution, study design considerations for NIHL otoprotection in pre-clinical and clinical testing are integrated and broadly discussed with evidence-based guidance offered where possible, drawing on the contributions to this special issue as well as other existing literature. The overarching goals of this final paper are to (1) review and summarize key information across contributions and (2) synthesize information to facilitate successful translation of otoprotective drugs from animal models into human application.
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Affiliation(s)
- Colleen G Le Prell
- School of Behavioral and Brain Sciences, University of Texas at Dallas, Dallas, Texas 75080, USA
| | - Tanisha L Hammill
- Department of Defense, Defense Health Agency, Falls Church, Virginia 22042, USA
| | - William J Murphy
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Cincinanati, Ohio 45226-1998, USA
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Kreitmayer C, Marcrum SC, Picou EM, Steffens T, Kummer P. Subclinical conductive hearing loss significantly reduces otoacoustic emission amplitude: Implications for test performance. Int J Pediatr Otorhinolaryngol 2019; 123:195-201. [PMID: 31129459 DOI: 10.1016/j.ijporl.2019.05.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/16/2019] [Accepted: 05/19/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Distortion product otoacoustic emissions (DPOAEs) are a time-efficient, non-invasive means of assessing the integrity of active inner ear mechanics. Unfortunately, the presence of even relatively minor conductive hearing loss (CHL) has been suggested to reduce the clinical utility of DPOAEs significantly. The primary aims of this study were to systematically evaluate the impact of CHL on DPOAE amplitude and to determine if ear-specific primary tone level manipulations can be used to mitigate CHL impact and recover DPOAE measurability. METHODS For 30 young adults (57 ears) with normal hearing, DPOAEs were obtained for f2 = 1-6 kHz. Observed DPOAE amplitudes were used to generate ear- and frequency-specific models with the primary tone levels, L1 and L2, as inputs and predicted DPOAE amplitude, LDP, as output. These models were then used to simulate the effect of CHL (0-15 dB), as well as L1 manipulations (0-15 dB), on DPOAE measurability. RESULTS Mean LDP for every CHL condition was significantly different from that for all other conditions (p = <.001), with a mean LDP attenuation of 8.7 dB for every 5 dB increase in CHL. Mean DPOAE measurability in response to a standard clinical stimulation paradigm of L1/L2 = 65/55 (dB SPL) was determined to be 99%, 84%, 37%, and 9% in the presence of 0, 5, 10, and 15 dB CHL, respectively. In the presence of 10 dB CHL, altering L1 resulted in an approximately 25% increase in DPOAE responses. CONCLUSION Subclinical CHL loss is sufficient to significantly impair DPOAE measurability in a meaningful proportion of otherwise healthy ears. However, through strategic alteration of primary tone levels, the clinician can mitigate CHL impact and at least partially recover DPOAE measurability.
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Affiliation(s)
- Christoph Kreitmayer
- Department of Otolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Steven C Marcrum
- Department of Otolaryngology, University Hospital Regensburg, Regensburg, Germany.
| | - Erin M Picou
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, USA
| | - Thomas Steffens
- Department of Otolaryngology, University Hospital Regensburg, Regensburg, Germany
| | - Peter Kummer
- Department of Otolaryngology, University Hospital Regensburg, Regensburg, Germany
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Tomiazzi JS, Pereira DR, Judai MA, Antunes PA, Favareto APA. Performance of machine-learning algorithms to pattern recognition and classification of hearing impairment in Brazilian farmers exposed to pesticide and/or cigarette smoke. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:6481-6491. [PMID: 30623325 DOI: 10.1007/s11356-018-04106-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 12/27/2018] [Indexed: 06/09/2023]
Abstract
The use of pesticides has been increasing in agriculture, leading to a public health problem. The aim of this study was to evaluate ototoxic effects in farmers who were exposed to cigarette smoke and/or pesticides and to identify possible classification patterns in the exposure groups. The sample included 127 participants of both sexes aged between 18 and 39, who were divided into the following four groups: control group (CG), smoking group (SG), pesticide group (PG), and smoking + pesticide group (SPG). Meatoscopy, pure tone audiometry, logoaudiometry, high-frequency thresholds, and immittance testing were performed. Data were evaluated by artificial neural network (ANN), K-nearest neighbors (K-NN), and support vector machine (SVM). There was symmetry between the right and left ears, an increase in the incidence of hearing loss at high frequency and of downward sloping audiometric curve configuration, and alteration of stapedial reflex in the three exposed groups. The machine-learning classifiers achieved good classification performance (control and exposed). The best classification results occur in high type (I and II) datasets (about 90% accuracy) in k-NN test. It is concluded that both xenobiotic substances have ototoxic potential; however, their combined use does not present additive or potentiating effects recognizable by the algorithms.
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Affiliation(s)
- Jamile Silveira Tomiazzi
- Graduate Program in Environment and Regional Development, University of Western São Paulo - UNOESTE, Presidente Prudente, SP, Brazil
| | - Danillo Roberto Pereira
- Graduate Program in Environment and Regional Development, University of Western São Paulo - UNOESTE, Presidente Prudente, SP, Brazil
| | - Meire Aparecida Judai
- Faculty of Health Sciences, University of Western São Paulo - UNOESTE, Presidente Prudente, SP, Brazil
| | - Patrícia Alexandra Antunes
- Graduate Program in Environment and Regional Development, University of Western São Paulo - UNOESTE, Presidente Prudente, SP, Brazil
| | - Ana Paula Alves Favareto
- Graduate Program in Environment and Regional Development, University of Western São Paulo - UNOESTE, Presidente Prudente, SP, Brazil.
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Garinis AC, Keefe DH, Hunter LL, Fitzpatrick DF, Putterman DB, McMillan GP, Gold JA, Feeney MP. Chirp-Evoked Otoacoustic Emissions and Middle Ear Absorbance for Monitoring Ototoxicity in Cystic Fibrosis Patients. Ear Hear 2019; 39:69-84. [PMID: 28708814 PMCID: PMC5741529 DOI: 10.1097/aud.0000000000000464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The goal of this study was to investigate the use of transient-evoked otoacoustic emissions (TEOAEs) and middle ear absorbance measurements to monitor auditory function in patients with cystic fibrosis (CF) receiving ototoxic medications. TEOAEs were elicited with a chirp stimulus using an extended bandwidth (0.71 to 8 kHz) to measure cochlear function at higher frequencies than traditional TEOAEs. Absorbance over a wide bandwidth (0.25 to 8 kHz) provides information on middle ear function. The combination of these time-efficient measurements has the potential to identify early signs of ototoxic hearing loss. DESIGN A longitudinal study design was used to monitor the hearing of 91 patients with CF (median age = 25 years; age range = 15 to 63 years) who received known ototoxic medications (e.g., tobramycin) to prevent or treat bacterial lung infections. Results were compared to 37 normally hearing young adults (median age = 32.5 years; age range = 18 to 65 years) without a history of CF or similar treatments. Clinical testing included 226-Hz tympanometry, pure-tone air-conduction threshold testing from 0.25 to 16 kHz and bone conduction from 0.25 to 4 kHz. Experimental testing included wideband absorbance at ambient and tympanometric peak pressure and TEOAEs in three stimulus conditions: at ambient pressure and at tympanometric peak pressure using a chirp stimulus with constant incident pressure level across frequency and at ambient pressure using a chirp stimulus with constant absorbed sound power across frequency. RESULTS At the initial visit, behavioral audiometric results indicated that 76 of the 157 ears (48%) from patients with CF had normal hearing, whereas 81 of these ears (52%) had sensorineural hearing loss for at least one frequency. Seven ears from four patients had a confirmed behavioral change in hearing threshold for ≥3 visits during study participation. Receiver operating characteristic curve analyses demonstrated that all three TEOAE conditions were useful for distinguishing CF ears with normal hearing from ears with sensorineural hearing loss, with an area under the receiver operating characteristic curve values ranging from 0.78 to 0.92 across methods for frequency bands from 2.8 to 8 kHz. Case studies are presented to illustrate the relationship between changes in audiometric thresholds, TEOAEs, and absorbance across study visits. Absorbance measures permitted identification of potential middle ear dysfunction at 5.7 kHz in an ear that exhibited a temporary hearing loss. CONCLUSIONS The joint use of TEOAEs and absorbance has the potential to explain fluctuations in audiometric thresholds due to changes in cochlear function, middle ear function, or both. These findings are encouraging for the joint use of TEOAE and wideband absorbance objective tests for monitoring ototoxicity, particularly, in patients who may be too ill for behavioral hearing tests. Additional longitudinal studies are needed in a larger number of CF patients receiving ototoxic drugs to further evaluate the clinical utility of these measures in an ototoxic monitoring program.
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Affiliation(s)
- Angela C Garinis
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, Oregon, USA
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, Oregon, USA
| | - Douglas H Keefe
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, Oregon, USA
| | - Lisa L Hunter
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, Oregon, USA
| | - Denis F Fitzpatrick
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, Oregon, USA
| | - Daniel B Putterman
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, Oregon, USA
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, Oregon, USA
| | - Garnett P McMillan
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, Oregon, USA
| | - Jeffrey A Gold
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, Oregon, USA
| | - M Patrick Feeney
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, Oregon, USA
- National Center for Rehabilitative Auditory Research (NCRAR), VA Portland Health Care System, Portland, Oregon, USA
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Konrad-Martin D, Poling GL, Garinis AC, Ortiz CE, Hopper J, Bennett KO, Dille MF. Applying U.S. national guidelines for ototoxicity monitoring in adult patients: perspectives on patient populations, service gaps, barriers and solutions. Int J Audiol 2018; 57:S3-S18. [PMID: 29157038 PMCID: PMC6450095 DOI: 10.1080/14992027.2017.1398421] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 10/05/2017] [Accepted: 10/20/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To promote establishment of effective ototoxicity monitoring programs (OMPs), this report reviews the U.S. national audiology guidelines in relation to "real world" OMP application. Background is provided on the mechanisms, risks and clinical presentation of hearing loss associated with major classes of ototoxic medications. DESIGN This is a non-systematic review using PubMed, national and international agency websites, personal communications between ototoxicity experts, and results of unpublished research. Examples are provided of OMPs in various healthcare settings within the U.S. civilian sector, Department of Defense (DoD), and Department of Veterans Affairs (VA). STUDY SAMPLE The five OMPs compared in this report represent a convenience sample of the programs with which the authors are affiliated. Their opinions were elicited via two semi-structured teleconferences on barriers and facilitators of OMP, followed by a self-administered questionnaire on OMP characteristics and practices, with responses synthesized herein. Preliminary results are provided from an ongoing VA clinical trial at one of these OMP sites. Participants were 40 VA patients who received cisplatin chemotherapy in 2014-2017. The study arms contrast access to care for OMP delivered on the treatment unit versus usual care as provided in the audiology clinic. RESULTS Protocols of the OMPs examined varied, reflecting their diverse settings. Service delivery concerns included baseline tests missed or completed after the initial treatment, and monitoring tests done infrequently or only after cessation of treatment. Perceived barriers involved logistics related to accessing and testing patients, such as a lack of processes to help patients enter programs, patients' time and scheduling constraints, and inconvenient audiology clinic locations. Use of abbreviated or screening methods facilitated monitoring. CONCLUSIONS The most effective OMPs integrated audiological management into care pathways of the clinical specialties that prescribe ototoxic medications. More OMP guidance is needed to inform evaluation schedules, outcome reporting, and determination of actionable ototoxic changes. Guidance is also lacking on the use of hearing conservation approaches suitable for the mass testing needed to support large-scale OMP efforts. Guideline adherence might improve with formal endorsement from organizations governing the medical specialty stakeholders in OMP such as oncologists, pulmonologists, infectious disease specialists, ototolaryngologists and pharmacists.
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Affiliation(s)
- Dawn Konrad-Martin
- VA Portland Health Care System, VA National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Gayla L. Poling
- Mayo Clinic, Department of Otorhinolaryngology, Division of Audiology, Rochester, MN
| | - Angela C. Garinis
- VA Portland Health Care System, VA National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Candice E. Ortiz
- Walter Reed National Military Medical Center, National Military Audiology and Speech Pathology Center, Bethesda, MD
| | - Jennifer Hopper
- Department of Otolaryngology, Yale University School of Medicine, New Haven, CT
| | - Keri O’Connell Bennett
- VA Portland Health Care System, VA National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR
| | - Marilyn F. Dille
- VA Portland Health Care System, VA National Center for Rehabilitative Auditory Research, Portland, OR
- Department of Otolaryngology/Head and Neck Surgery, Oregon Health & Science University, Portland, OR
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Rincón-Álvarez OJ, Neira-Torres LI. Alteraciones auditivas en artritis reumatoide, lupus eritematoso sistémico y síndrome de Sjögren. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n3.60636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. En la actualidad no hay cifras sobre las personas que padecen artritis reumatoide (AR), lupus eritematoso sistémico (LES) o síndrome de Sjögren (SS) ni información sobre las alteraciones auditivas que puede causar el tratamiento farmacológico utilizado para controlar dichas enfermedades.Objetivo. Evidenciar las posibles afectaciones y alteraciones audiológicas y vestibulares producidas por AR, LES y SS o su tratamiento farmacológico.Materiales y métodos. Se analizaron los hallazgos clínicos de herramientas diagnósticas y procedimientos de prevención e intervención de alteraciones auditivas en artículos de investigación publicados en español, inglés, francés y portugués en bases de datos científicas entre los años 2000 y 2016.Resultados. Se extrajeron 62 artículos de investigación (31 de AR, 5 de LES, 12 de SS, 5 de Hipoacusia inmunomediada, 9 de medicamentos ototóxicos), 1 tesis doctoral sobre AR, 1 tesis doctoral sobre AR y LES y 1 guía de práctica clínica para la detección temprana, diagnóstico y tratamiento de AR. Se evidenció que las pérdidas auditivas con mayor reporte son hipoacusia neurosensorial, lesiones en cadena osicular y vestíbulo-coclear.Conclusiones. Se confirmó la relación entre las lesiones audiológicas y AR, LES y SS, pero aun no es claro el desarrollo de los ototóxicos.
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Brungart D, Schurman J, Konrad-Martin D, Watts K, Buckey J, Clavier O, Jacobs PG, Gordon S, Dille MF. Using tablet-based technology to deliver time-efficient ototoxicity monitoring. Int J Audiol 2017; 57:S25-S33. [DOI: 10.1080/14992027.2017.1370138] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Douglas Brungart
- Walter Reed National Military Medical Center, Bethesda, MD, USA,
| | - Jaclyn Schurman
- Walter Reed National Military Medical Center, Bethesda, MD, USA,
- Army Public Hearing Center, Aberdeen Proving Ground, Aberdeen, MD, USA,
| | - Dawn Konrad-Martin
- United States Department of Veterans Affairs (VA), Office of Rehabilitation Research and Development (RR&D) Services, National Center for Rehabilitative Auditory Research, Portland, OR, USA,
- Department of Otolaryngology/HNS, Oregon Health and Science University, Portland, OR, USA,
| | - Kelly Watts
- DoD Hearing Center of Excellence, Lackland AFB, San Antonio, TX, USA,
- Naval Submarine Medical Research Laboratory, Naval Base New London, Groton, CT, USA,
- Core Business Solutions, Round Rock, TX, USA,
| | - Jay Buckey
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA,
| | | | - Peter G. Jacobs
- Department of Biomedical Engineering School of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Samuel Gordon
- United States Department of Veterans Affairs (VA), Office of Rehabilitation Research and Development (RR&D) Services, National Center for Rehabilitative Auditory Research, Portland, OR, USA,
| | - Marilyn F. Dille
- United States Department of Veterans Affairs (VA), Office of Rehabilitation Research and Development (RR&D) Services, National Center for Rehabilitative Auditory Research, Portland, OR, USA,
- Department of Otolaryngology/HNS, Oregon Health and Science University, Portland, OR, USA,
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SÁNCHEZ-MARTÍNEZ A, BENITO-OREJAS JI, TAVÁREZ-RODRÍGUEZ JJ, HERNÁNDEZ-SANTOS ML, MORAIS-PÉREZ D, SOTO-PRADO D. Monitorización de la ototoxicidad por cisplatino. REVISTA ORL 2017. [DOI: 10.14201/orl.16774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Estimation of Minor Conductive Hearing Loss in Humans Using Distortion Product Otoacoustic Emissions. Ear Hear 2017; 38:391-398. [DOI: 10.1097/aud.0000000000000415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Noise-induced cochlear synaptopathy: Past findings and future studies. Hear Res 2017; 349:148-154. [DOI: 10.1016/j.heares.2016.12.008] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 11/08/2016] [Accepted: 12/08/2016] [Indexed: 01/12/2023]
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Charaziak KK, Shera CA. Compensating for ear-canal acoustics when measuring otoacoustic emissions. THE JOURNAL OF THE ACOUSTICAL SOCIETY OF AMERICA 2017; 141:515. [PMID: 28147590 PMCID: PMC5848844 DOI: 10.1121/1.4973618] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Otoacoustic emissions (OAEs) provide an acoustic fingerprint of the inner ear, and changes in this fingerprint may indicate changes in cochlear function arising from efferent modulation, aging, noise trauma, and/or exposure to harmful agents. However, the reproducibility and diagnostic power of OAE measurements is compromised by the variable acoustics of the ear canal, in particular, by multiple reflections and the emergence of standing waves at relevant frequencies. Even when stimulus levels are controlled using methods that circumvent standing-wave problems (e.g., forward-pressure-level calibration), distortion-product otoacoustic emission (DPOAE) levels vary with probe location by 10-15 dB near half-wave resonant frequencies. The method presented here estimates the initial outgoing OAE pressure wave at the eardrum from measurements of the conventional OAE, allowing one to separate the emitted OAE from the many reflections trapped in the ear canal. The emitted pressure level (EPL) represents the OAE level that would be recorded were the ear canal replaced by an infinite tube with no reflections. When DPOAEs are expressed using EPL, their variation with probe location decreases to the test-retest repeatability of measurements obtained at similar probe positions. EPL provides a powerful way to reduce the variability of OAE measurements and improve their ability to detect cochlear changes.
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Affiliation(s)
- Karolina K Charaziak
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, Massachusetts 02114, USA
| | - Christopher A Shera
- Eaton-Peabody Laboratories, Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, Massachusetts 02114, USA
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Dreisbach L, Ho M, Reid E, Siegel J. Effects of Oxaliplatin, Carboplatin, and Cisplatin Across Treatment on High-Frequency Objective and Subjective Auditory Measures in Adults. ACTA ACUST UNITED AC 2017. [DOI: 10.1044/persp2.sig6.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Platinum chemotherapies are often ototoxic, initially affecting the basal end of the cochlea. Thus, monitoring high-frequency auditory function is advised to reveal early damage. Objective measures of high-frequency auditory function are repeatable over time, but the sensitivity of these measures for monitoring patients receiving platinum derivatives have not been established. We monitored 13 patients across oxaliplatin, carboplatin, or cisplatin treatment using the highest frequencies with responses for each individual. Behavioral thresholds and distortion product otoacoustic emission (DPOAE) gross frequency (f2=16–2 kHz) and concentrated frequency (1/48 octave steps at the highest frequency with a present DPOAE) sweeps were monitored. DPOAE results indicated changes during treatment within individuals using absolute change criteria, as well as statistically significant differences across trial when analyzing group data. Changes varied depending on the drug administered. Behavioral thresholds changed less often than DPOAE measures and when changes were noted, they initially occurred at the highest frequencies monitored. Often, DPOAE changes occurred at frequencies which conventional equipment could not monitor (>8 kHz). Additionally, some changes were characterized by DPOAE level enhancements at conventional frequencies (<8 kHz), while levels at higher frequencies were reduced. Overall, objective high-frequency measures were sensitive to auditory changes in adults undergoing platinum chemotherapy treatment.
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Affiliation(s)
- Laura Dreisbach
- School of Speech, Language, and Hearing Sciences, San Diego State University San Diego, CA
| | - Melissa Ho
- School of Speech, Language, and Hearing Sciences, San Diego State University San Diego, CA
| | - Erin Reid
- School of Medicine, University of California, San Diego La Jolla, CA
| | - Jonathan Siegel
- Department of Communication Sciences and Disorders, Northwestern University Evanston, IL
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Speech-in-Noise Tests and Supra-threshold Auditory Evoked Potentials as Metrics for Noise Damage and Clinical Trial Outcome Measures. Otol Neurotol 2016; 37:e295-302. [DOI: 10.1097/mao.0000000000001069] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Meta-Analysis of Distortion Product Otoacoustic Emission Retest Variability for Serial Monitoring of Cochlear Function in Adults. Ear Hear 2016; 36:e251-60. [PMID: 25985018 DOI: 10.1097/aud.0000000000000176] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Distortion product otoacoustic emissions (DPOAEs) have long been heralded as a means to objectively monitor cochlear function and increasingly are becoming a key component in hearing surveillance programs for individuals at risk for ototoxic- and occupational noise-related hearing loss. Yet clinicians are unsure how to define clinically meaningful shifts in DPOAE level. In this study, a meta-analysis approach is used to synthesize the DPOAE level test-retest literature to construct a set of DPOAE level shift reference limits that can be used clinically to define a statistically significant emission change. DESIGN The authors reviewed all published articles identified through a Medline search using the terms "Otoacoustic Emission Variability," "Otoacoustic Emission Reliability," "Otoacoustic Emission Repeatability," and "Otoacoustic Emission Test Retest" restricted to DPOAEs, adults, and English language. Articles with DPOAE level data elicited by moderate stimulus levels for f2 frequencies of 1000, 2000, 4000, or 6000 Hz were selected because these stimulus parameters were relatively well represented in the literature. The authors only included articles that reported the standard error of the measurement (SEM) or from which the SEM could be calculated. Meta-analysis was used to estimate the population mean SEM over the included studies. Models were fit separately for each f2 primary and included days since baseline and study-specific random effects. RESULTS Ten DPOAE test-retest studies met inclusion criteria for this meta-analysis. The SEM values varied widely across published studies (0.57 to 3.9 dB) and were provided for relatively short time intervals (less than 15 days on average). Time, or days since baseline, was statistically significant at higher f2 frequencies (4000 and 6000 Hz). From the model results, 90% reference limits specific to the f2 and elapsed time between baseline and follow-up measurements were established. Reference limits provided correspond to negative (emission decrement) and positive (emission enhancement) shifts indicative of the amount of measurement variability that, using this approach, must be tolerated as "normal" fluctuations over time. Changes larger than the reference limits are considered significant and warrant follow-up testing. CONCLUSIONS The meta-analysis presented provides reference limits that are appropriate for a set of specific f2 frequencies and time intervals. The meta-analysis concerns the SEM statistic directly, so that any preferred reference limit can be computed from the results and should be predicated upon the screening application. The presumed advantage of this meta-analytic approach is increased precision relative to limits suggested by any of the individual studies included in the analysis.
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Konrad-Martin D, Reavis KM, McMillan G, Helt WJ, Dille M. Proposed comprehensive ototoxicity monitoring program for VA healthcare (COMP-VA). ACTA ACUST UNITED AC 2015; 51:81-100. [PMID: 24805896 DOI: 10.1682/jrrd.2013.04.0092] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Indexed: 11/05/2022]
Abstract
Prevention and rehabilitation of hearing loss and tinnitus, the two most commonly awarded service-connected disabilities, are high priority initiatives in the Department of Veterans Affairs (VA). At least 4,000 Veterans, most with significant hearing loss, will receive cisplatin this year, with more than half sustaining permanent hearing shift and nearly 40% developing new tinnitus. With improved survivability following cancer treatment, Veterans treated with cisplatin are approached with the dual goals of effective treatment and preserved quality of life. This article describes COMP-VA, a comprehensive ototoxicity monitoring program developed for VA patients receiving cisplatin. The program includes an individualized pretreatment prediction model that identifies the likelihood of hearing shift given cisplatin dose and patient factors. It supports both manual and automated hearing testing with a newly developed portable audiometer capable of performing the recommended procedures on the chemotherapy unit during treatment. It also includes objective methods for identifying outer hair cell changes and predicting audiogram changes using distortion-product otoacoustic emissions. We describe this program of evidence-based ototoxicity monitoring protocols using a case example to give the reader an understanding of how this program would be applied, along with a plan for future work to accomplish the final stages of program development.
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Affiliation(s)
- Dawn Konrad-Martin
- Portland VA Medical Center, National Center for Rehabilitative Auditory Research, 3710 SW US Veterans Hosp Rd, P5-NCRAR, Portland, OR 97239.
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Strategies for Evaluating Antioxidant Efficacy in Clinical Trials Assessing Prevention of Noise-Induced Hearing Loss. FREE RADICALS IN ENT PATHOLOGY 2015. [DOI: 10.1007/978-3-319-13473-4_9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Husain FT. Effect of tinnitus on distortion product otoacoustic emissions varies with hearing loss. Am J Audiol 2013; 22:125-34. [PMID: 23800808 DOI: 10.1044/1059-0889(2012/12-0059)] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The aim of this study was to measure the effect of tinnitus, while accounting for the effect of hearing loss and aging, on distortion product otoacoustic emissions (DPOAEs). METHOD DPOAEs were measured twice in both ears in 5 groups of participants: young adults with normal hearing, middle-age adults with normal hearing, adults with high-frequency sensorineural hearing loss, age-matched adults with similar hearing loss and tinnitus, and adults with normal hearing and chronic tinnitus. RESULTS Multivariate analysis revealed a main effect of hearing loss and age, but no effect of tinnitus, across all 5 groups. Separate tests revealed significant effects of age and tinnitus in the normal-hearing groups and hearing loss in adults with or without tinnitus, but no effect of tinnitus in those with hearing loss. CONCLUSION DPOAE levels in the group of adults with hearing loss and tinnitus were diminished, but those in the group with normal hearing and tinnitus were enhanced, relative to DPOAE levels in the controls. Outer hair cell function, as indexed by DPOAEs, exhibits a complex association with tinnitus, and this has implications in the use of DPOAEs as a tool both for testing for tinnitus presence and for creating a model of neural mechanisms underlying tinnitus.
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