A report of extended high frequency audiometry thresholds in school-age children with no hearing complaints

Extended high frequency audiometry thresholds in healthy school children

OBJECTIVES

Extended high frequency (EHF) audiometry is the recommended method for monitoring oxotoxic hearing loss in children. This study aims to provide high quality reference audiological data for the EHF range in healthy children.

METHODS

Participants were 126 healthy schoolchildren between 6 and 14 years of age. All participants were term born with normal birthweight, had not suffered severe neonatal illness and had no history of middle ear disease.

RESULTS

The averaged mean (SD) hearing threshold for the EHF 9, 10, 11.2, 12.5, 14 and 16 kHz was -0.4 (6.0) dB HL. The lowest mean hearing thresholds were observed at 14 kHz with -4.2 (8.7) dB and at 16 kHz with -6.4 (12.1) dB HL. We found significantly lower thresholds at 16 kHz for children aged 6-9 years (-8.7 dB HL) compared to age 10-14 years (-3.9 db HL), p 0.042. For both age groups the inter-subject variability increased in the highest frequencies. We found no significant differences in mean hearing thresholds between right and left ears at any frequency, and no gender differences in the EHF range.

CONCLUSION

Our findings support that decreased hearing sensitivity in the EHF's may start around or even before the age of 10 years. In order to use EHF audiometry for ototoxic monitoring in children, we suggest to establish an international reference standard for hearing levels in children under the age of 18. Specific references for different age groups are needed as hearing in the EHF range appears to gradually deteriorate from an early age.

CLINICAL TRIAL REGISTRATION

NCT03253614.

Prevalence of extended high-frequency hearing loss among adolescents from two rural areas in Colombia

OBJECTIVE

Worldwide research trends on the prevalence of hearing loss within young rural populations are scarce. Current evidence suggests extended high-frequency audiometry could be a sensitive predictor to detect subclinical hearing loss. This study aimed to determine the prevalence of hearing loss through conventional pure tone (0.25-8 kHz) and extended high-frequency (9-20 kHz) audiometry tests in a group of adolescents aged 13 to 19 years old from two rural areas of Colombia. A sociodemographic and associated factor for hearing loss questionnaire was applied.

DESIGN

Cross-sectional study.

STUDY SAMPLE

Three hundred sixty-six adolescents aged 13 to 19 years old from two rural municipalities in Colombia: Soracá, and Palmas del Socorro.

RESULTS

Hearing loss prevalence assessed through pure tone audiometry was 3.28% in right ears and 3.83% in left ears while through extended high-frequency audiometry was 14.21% and 13.11%, respectively. Associated factors found by the logistic regression were age (OR: 1.36; CI 95% 1.13-1.64) and obesity (OR: 3.74; CI 95% 1.07-13.11).

CONCLUSIONS

Using 15 dB as the normal hearing threshold parameter for audiometric frequencies, our results suggest that extended high-frequency hearing loss is already widespread among rural adolescents. This highlights the need for research on extended high-frequency audiometry in rural school-aged children.

Phonemic discrimination and reproduction in 4-5-year-old children: Relations to hearing

OBJECTIVE

The long-term objective of this research is to highlight the importance of speech perception assessment in children with developmental language disorder (DLD), and to investigate how hearing contributes to speech and language skills. As a first step in fulfilling this aim, the present study explored relations between phonemic discrimination and reproduction, and sensitive measures of hearing in young healthy children.

METHODS

The American Listen-Say test was developed and served as speech perception tool. This test reports speech discrimination of phonemic contrasts quantitatively for both quiet and in noise conditions, along with reproduction scores, all measured within one session. Speech tokens were perceptually homogenized in noise. Forty-one 4-5-year-old American children participated. Phonemic discrimination (quiet and speech shaped noise) and phonemic reproduction, audiometric thresholds in the conventional (1-8 kHz) and extended high frequency (EHF; 10-16 kHz) range, and distortion product otoacoustic emissions (DPOAEs) were examined.

RESULTS

All children had normal hearing thresholds within the conventional range (mean PTA bilaterally 8.6 dB HL). Ten (24.3%) of the children had elevated EHF thresholds (> 20 dB HL) for one or more frequencies or ears, and six (14.6%) had DPOAE signal to noise ratios (SNR) < 6 dB. EHF thresholds and DPOAE SNRs were significantly associated. Children's phonemic discrimination was impaired in noise, relative to quiet. There was a moderate, significant correlation between overall phonemic discrimination in noise and EHF audiometric thresholds.

CONCLUSIONS

Overall, the present study showed that sensitive hearing measures enabled the detection of subtle hearing difficulties in young healthy children. In particular, phonemic discrimination in noise showed associations with hearing. Implications of including sensitive hearing measures in children with DLD are discussed.

Assessment and Management of Platinum-Related Ototoxicity in Children Treated for Cancer

Platinum compounds are a group of chemotherapeutic agents included in many pediatric and adult oncologic treatment protocols. The main platinum compounds are cisplatin, carboplatin, and oxaliplatin. Their use in clinical practice has greatly improved long-term survival of pediatric patients, but they also cause some toxic effects: ototoxicity, myelosuppression, nephrotoxicity, and neurotoxicity. Hearing damage is one of the main toxic effects of platinum compounds, and it derives from the degeneration of hair cells of the ear, which, not having self-renewal capacity, cannot reconstitute themselves. Hearing loss from platinum exposure is typically bilateral, sensorineural, and permanent, and it is caused by the same mechanisms with which platinum acts on neoplastic cells. According to available data from the literature, the optimal timing for the audiological test during and after treatment with platinum compounds is not well defined. Moreover, no substances capable of preventing the onset of hearing loss have been identified.

Hearing in Schoolchildren After Neonatal Exposure to a High-Dose Gentamicin Regimen

OBJECTIVE

To assess the association between gentamicin exposure in the neonatal period and hearing in school age.

METHODS

This study included children exposed to a high-dose (6 mg/kg) gentamicin regimen as neonates (2004-2012), invited for follow-up at school age, and a healthy age-matched control group. We assessed hearing with pure tone audiometry including the extended high-frequency (EHF) range. Outcomes were average hearing thresholds in the midfrequencies (0.5-4 kHz) and the EHFs (9-16 kHz). The measures of gentamicin exposure were cumulative dose and highest trough plasma concentration. We used linear regression models to assess the impact of gentamicin exposure, and other peri- and postnatal morbidities, on hearing thresholds.

RESULTS

A total of 219 gentamicin-exposed and 33 healthy-control children were included in the audiological analysis. In the gentamicin cohort, 39 (17%) had a birth weight <1500 g. Median cumulative doses and trough plasma concentrations were 30 (interquartile range 24-42) mg/kg and 1.0 (interquartile range 0.7-1.2) mg/L, respectively. Median hearing thresholds for the midfrequencies and the EHFs were 2.5 (0 to 6.3) dB hearing level and -1.7 (-5.0 to 5.0) dB hearing level, both of which were within the normal range. In an adjusted analysis, increasing hearing thresholds were associated with lower birth weight and postnatal middle-ear disease but not level of gentamicin exposure. After adjusting for birth weight, there was no difference in hearing threshold between the gentamicin-exposed cohort and healthy controls.

CONCLUSIONS

Exposure to a high-dose gentamicin regimen in the neonatal period was not associated with an increase in hearing thresholds in schoolchildren being able to complete audiometry.

Auditory Outcomes in Patients Who Received Proton Radiotherapy for Craniopharyngioma

PURPOSE

Compared to photon-based radiotherapy, protons deliver less radiation to healthy tissue resulting in the potential reduction of late complications such as sensorineural hearing loss (SNHL). We report early auditory outcomes in children treated with proton radiotherapy (PRT) for craniopharyngioma.

METHOD

Conventional frequency (CF = 0.25-8.0 kHz) audiometry, extended high-frequency (EHF = 9.0-16.0 kHz) audiometry, distortion product otoacoustic emission (DPOAE) testing, and speech-in-noise (SIN) assessments were prospectively and longitudinally conducted on 74 children with a median of 2 post-PRT evaluations (range, 1-5) per patient. The median age at PRT initiation was 10 years, and median follow-up time was 2 years. Ototoxicity was classified using the Chang Ototoxicity Grading Scale (Chang & Chinosornvatana, 2010) and the American Speech-Language-Hearing Association (ASHA) criteria (ASHA, 1994). Comparisons were made between baseline and most recent DPOAE levels, with evidence of ototoxicity based on criterion reductions of ≥ 6 dB. The critical difference values for comparing SIN scores between two conditions (i.e., pre- and post-PRT) were used to determine a significant change between test scores.

RESULTS

At last evaluation, no patients had SNHL in the CF range, and 2 patients had SNHL (Chang Grade 1a) in the EHF range. Based on the ASHA criteria, a decrease in hearing was observed in 0 patients in the CF range alone, in 9 patients in the EHF range alone, and in 15 patients in both the CF and EHF ranges. DPOAE levels decreased at a faster rate at higher versus lower frequencies. For 41 evaluable patients, SIN perception did not decline over time (p = .6463).

CONCLUSION

At a median follow-up time of 2 years post-PRT, normal hearing was maintained within the CF range. However, subclinical decreases in hearing were observed, particularly in the EHF range and in the DPOAE level; thus, long-term follow-up is recommended to monitor for potential auditory late effects from PRT.

High-frequency auditory thresholds in normal hearing adults

PURPOSE

Evaluate high-frequency auditory thresholds, seeking to compare responses between the ears, to verify the correlation between hearing level and aging and analyze frequency responses in normal hearing adults.

METHODS

This is a prospective, quantitative, transversal study conducted with a convenience sample. Study participants were 60 individuals aged 18 to 58 years (mean=25.82) with auditory thresholds within normality standards (250-8000 Hz) and normal results in acoustic immittance measurements. High-frequency pure-tone hearing thresholds were determined using an Interacoustics AS10HF audiometer with electrodynamic high-fidelity KOSS R/80 headphones, with thresholds expressed in dBNPS.

RESULTS

Hearing thresholds showed an increase for the right ear with statistical significance at the 10, 11 and 14 kHz frequencies and a tendency to significance at 13 kHz. As of the 14 kHz frequency, a progressive increase directly proportional to the frequency was observed bilaterally, with the thresholds increasing proportionally to age advancement for all frequencies.

CONCLUSION

High-frequency auditory thresholds progressively increase proportionally to frequency and age advancement in normal hearing individuals, with higher values ​​for the right ear.

High-frequency profile in adolescents and its relationship with the use of personal stereo devices

OBJECTIVE

To analyze and correlate the audiometric findings of high frequencies (9-16 kHz) in adolescents with their hearing habits and attitudes, in order to prevent noise-induced hearing loss.

METHOD

This was a descriptive cross-sectional study, which included 125 adolescents in a sample of normal-hearing students, at a state school. The subjects performed high-frequency audiometry testing and answered a self-administered questionnaire addressing information on sound habits concerning the use of personal stereo devices. The sample was divided according to the exposure characteristics (time, duration, intensity, etc.) and the results were compared with the observed thresholds, through the difference in proportions test, chi-squared, Student's t-test, and ANOVA, all at a significance level of 0.05.

RESULTS

Average high-frequency thresholds were registered below 15 dB HL and no significant correlation was found between high frequency audiometric findings and the degree of exposure.

CONCLUSION

The prevalence of harmful sound habits due to the use of personal stereo devices is high in the adolescent population, but there was no correlation between exposure to high sound pressure levels through personal stereos and the high-frequency thresholds in this population.