Differences in Hearing Devices and Speech Therapy Utilization Between Children With Permanent Unilateral Versus Bilateral Hearing Loss

OBJECTIVES

In this study, we aimed to describe differences in diagnosis and both auditory and speech/language intervention utilization between children with permanent unilateral hearing loss as compared with bilateral hearing loss.

DESIGN

A retrospective cohort study was performed of children evaluated in a multidisciplinary hearing loss clinic at a tertiary care pediatric hospital. Children aged 0 to 18 years with either permanent unilateral or bilateral hearing loss were included.

RESULTS

One hundred fourteen children with unilateral hearing loss and 268 children with bilateral hearing loss were studied for a total of 382 children. There were no demographic differences between children with permanent unilateral versus bilateral hearing loss. Rates of newborn hearing screening and referred screening results were similar between those with unilateral and bilateral hearing loss. Despite similar rates of referred newborn hearing screening, those with bilateral hearing loss were diagnosed at a younger age (mean 3.6 years, SD 3.8 years) as compared with those with unilateral hearing loss (mean 5.0 years, SD 4.2 years). Children with unilateral hearing loss had similar severity of hearing loss in their poorer hearing ear as compared with children with bilateral hearing loss, yet they were significantly less likely to be fitted with hearing devices (53% versus 78%) or receive speech/language therapy (36% versus 54%) as compared with children with bilateral hearing loss. Multivariate analysis found that bilateral hearing loss and earlier age of hearing loss diagnosis were associated with hearing device use.

CONCLUSIONS

Early diagnosis and intervention for childhood hearing loss have a significant impact on a child's educational success and social relationships. However, little is known about differences in diagnosis and resource utilization between children with permanent unilateral hearing loss versus bilateral hearing loss. Children with unilateral hearing loss were diagnosed at a later age and were less likely to utilize hearing devices or speech/language therapy compared with those with bilateral hearing loss, despite having similar severity of hearing loss in the poorer hearing ear. There is a strong body of evidence that children with unilateral hearing loss have improved hearing outcomes with hearing devices, which suggests there is room for improvement in identifying unilateral hearing loss and providing adequate services to optimize educational success. However, speech therapy is generally implemented in response to language delays. Therefore, children with unilateral loss may have lower rates of language delays as compared with those with bilateral hearing loss, thereby explaining differences in speech therapy utilization.

Association of noise exposure, plasma microRNAs with metabolic syndrome and its components among Chinese adults

AIMS

We aimed to evaluate the association of occupational noise with metabolic syndrome (MetS) and its components, and to assess the potential role of miRNAs in occupational noise-associated MetS.

METHODS

A total of 854 participants were enrolled in our study. Cumulative noise exposure (CNE) was estimated in conjunction with workplace noise test records and research participants' employment histories. Logistic regression models adjusted for potential confounders were used to assess the association of CNE and miRNAs with MetS and its components.

RESULTS

We observed linear positive dose-response associations between occupational noise exposure and the prevalence of MetS (OR: 1.031; 95 % CI: 1.008, 1.055). And linear and nonlinear relationship were also found for the association of occupational noise exposure with high blood pressure (OR: 1.024; 95 % CI: 1.007, 1.041) and reduced high-density lipoprotein (OR: 1.051; 95 % CI: 1.031, 1.072), respectively. MiR-200a-3p, miR-92a-3p and miR-21-5p were inversely associated with CNE, or the prevalence of MetS and its components (all P < 0.05). However, we did not find any statistically significant mediation effect of miRNAs in the associations of CNE with MetS. Furthermore, the prevalence of bilateral hearing loss in high-frequency increased (OR: 1.036; 95 % CI: 1.008, 1.067) with CNE level rising, and participants with bilateral hearing loss in high-frequency had a significantly higher risk of MetS (OR: 1.727; 95 % CI: 1.048, 2.819).

CONCLUSION

Our study suggests that occupational noise exposure is associated with MetS and its components, and the role of miRNAs in noise-induced increasing MetS risk needs to be confirmed in future studies.

Adult-onset mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS): a diagnostic challenge

Rare causes of stroke-like presentations can be difficult to diagnose. We report a case of a man in his 40s who first presented with stroke symptoms, but whose clinical course was not typical for a stroke. A detailed investigation of the patient's medical history revealed bilateral sensorineural hearing loss which prompted a wider diagnostic assessment.Furthermore, lack of vascular risk factors and a normal angiogram strengthened our suspicion of an unusual underlying condition. Raised lactic acid levels and genetic analysis confirmed a diagnosis of mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes syndrome.

Speech, Sign, or Both? Factors Influencing Caregivers' Communication Method Decision Making for Deaf/Hard of Hearing Children

PURPOSE

Caregivers of deaf/hard of hearing infants are faced with challenging decisions regarding their child's communication method. The purpose of the current research note is to characterize the advice that caregivers receive and value as well as the factors that influence caregivers' decision making.

METHOD

The current study enrolled 105 caregiver-child dyads, including children between 12 and 18 months of age with bilateral, congenital hearing loss. All children were exposed to spoken language, and 63.81% of children were also exposed to sign language. Caregivers completed the "Making Decisions About Sign, Speech, and Multilingualism Survey" (Crowe et al., 2014).

RESULTS

Caregivers most frequently received advice to use both speech and sign and highly valued advice from speech-language pathologists. When considering the use of speech, the factors that caregivers most frequently rated as very important were "My child's future academic success" (96.19%), "My child's future literary success" (95.24%), and "My child's future access to higher education" (95.19%). When considering the use of sign, the factors that caregivers most frequently rated as very important were "My child's ability to form friendships and future relationships" (82.52%), "My child's future literary success" (81.37%), and "My child's future academic success" (81.37%).

CONCLUSIONS

Results of the current study suggest that throughout the decision-making process, caregivers' highest priority is understanding how their decisions will influence their child's future access to opportunities and relationships. Providers may consider discussing these factors early in the decision-making process to support caregivers' ability to make an informed choice regarding their child's communication method.

Externalization of Speech When Listening With Hearing Aids

Subjective reports indicate that hearing aids can disrupt sound externalization and/or reduce the perceived distance of sounds. Here we conducted an experiment to explore this phenomenon and to quantify how frequently it occurs for different hearing-aid styles. Of particular interest were the effects of microphone position (behind the ear vs. in the ear) and dome type (closed vs. open). Participants were young adults with normal hearing or with bilateral hearing loss, who were fitted with hearing aids that allowed variations in the microphone position and the dome type. They were seated in a large sound-treated booth and presented with monosyllabic words from loudspeakers at a distance of 1.5 m. Their task was to rate the perceived externalization of each word using a rating scale that ranged from 10 (at the loudspeaker in front) to 0 (in the head) to -10 (behind the listener). On average, compared to unaided listening, hearing aids tended to reduce perceived distance and lead to more in-the-head responses. This was especially true for closed domes in combination with behind-the-ear microphones. The behavioral data along with acoustical recordings made in the ear canals of a manikin suggest that increased low-frequency ear-canal levels (with closed domes) and ambiguous spatial cues (with behind-the-ear microphones) may both contribute to breakdowns of externalization.

[Genetic characteristic analysis of slight-to-moderate sensorineural hearing loss in children]

Objective:To analyze genetic factors and phenotype characteristics in pediatric population with slight-to-moderate sensorineural hearing loss. Methods:Children with slight-to-moderate sensorineural hearing loss of and their parents, enrolled from the Chinese Deafness Genome Project, were studied. Hearing levels were assessed using pure tone audiometry, behavioral audiometry, auditory steady state response（ASSR）, auditory brainstem response（ABR） thresholds, and deformed partial otoacoustic emission（DPOAE）. Classification of hearing loss is according to the 2022 American College of Medical Genetics and Genomics（ACMG） Clinical Practice Guidelines for Hearing Loss. Whole exome sequencing（WES） and deafness gene Panel testing were performed on peripheral venous blood from probands and validations were performed on their parents by Sanger sequencing. Results:All 134 patients had childhood onset, exhibiting bilateral symmetrical slight-to-moderate sensorineural hearing loss, as indicated by audiological examinations. Of the 134 patients, 29（21.6%） had a family history of hearing loss, and the rest were sporadic patients. Genetic causative genes were identified in 66（49.3%） patients. A total of 11 causative genes were detected, of which GJB2 was causative in 34 cases（51.5%）, STRC in 10 cases（15.1%）, MPZL2 gene in six cases（9.1%）, and USH2A in five cases（7.6%）.The most common gene detected in slight-to-moderate hearing loss was GJB2, with c. 109G>A homozygous mutation found in 16 cases（47.1%） and c. 109G>A compound heterozygous mutation in 9 cases（26.5%）. Conclusion:This study provides a crucial genetic theory reference for early screening and detection of mild to moderate hearing loss in children, highlighting the predominance of recessive inheritance and the significance of gene like GJB2, STRC, MPZL2, USH2A.

Seroprevalence of ToRCH Pathogens among Children Admitted to a Tertiary Care Hospital in Eastern India for Cataract Surgery and Cochlear Transplantation

AIMS

The study aims to investigate the presence of TORCH infections in a child with bilateral cataracts and deafness and report the ToRCH-serology screening profile (Toxoplasma gondii (TOX), rubella (RV), cytomegalovirus (CMV), and herpes simplex virus (HSV-I/II)) in pediatric cataract and deafness.

METHODS

Cases that had a clear clinical history of congenital cataracts and congenital deafness were included in the study. The study population consisted of 18 bilateral cataracts and 12 bilateral deafness child who was admitted to AIIMS Bhubaneswar for cataract surgery and cochlear implantation, respectively. Sera of all children were tested qualitatively and quantitatively for IgG/IgM-antibodies against ToRCH agents in a sequential manner.

RESULTS

Anti-IgG antibodies against the torch panel were detected in all cataract and deafness patients. Anti-CMV IgG was detected in 17 of 18 bilateral cataract children and 11 of 12 bilateral deaf children. The rates of anti-CMV IgG antibody positivity were significantly higher. In the cataract group, 94.44% and in the deafness group, 91.66% of the patient was Anti-CMV IgG positive. Besides this, 77.7 % of the patient from the cataract group and 75% from the deafness group was anti- RV IgG antibody positive. In bilateral cataract patients, IgG-alone seropositive cases were mostly attributed to CMV (94.44%; 17/18), followed by RV (77.70%; 14/18), HSV-I (27.70%; 5/18), TOX (27.70%; 5/18), and HSV-II (16.60%; 3/18). In bilateral deafness patients, the spectrum of IgG alone seropositive cases was almost the same except for TOX (0/12).

CONCLUSION

The current study recommends interpreting ToRCH-screening in pediatric cataracts and deafness with caution. Interpretation should include both serial qualitative and quantitative assays in tandem with clinical correlation to minimize diagnostic errors. The sero-clinical-positivity needs to be tested in older children who might pose a threat to the spread of infection.

Cochleovestibular Phenotype in a Rare Genetic MED13L Mutation

The gene MED13 participates in transcription. The MED13L gene is a paralog of MED13 that is involved in developmental gene expression. Mutations in the gene have been shown to result in a heterogenous phenotype affecting several physiological systems. Hearing loss has been reported very rarely, and vestibular weakness has never been reported in the condition. In this report, we present a mutation of MED13L in c.1162A > T (p.Arg388Ter), where we detail and describe a cochleovestibular phenotype with objective vestibulometry for the first time. The child showed bilateral sloping sensorineural hearing loss, a bilateral vestibular weakness, and an inner ear vestibular structural abnormality on imaging. Early intervention with hearing aids and vestibular rehabilitation led to a favorable outcome in terms of speech, communication, and balance. We emphasize the importance of comprehensive audiovestibular assessment in children diagnosed with MED13L mutations for effective management of these children.

Postmeningitic pediatric hearing loss from non-type b Haemophilus influenzae

BACKGROUND

Postmeningitic hearing loss from Haemophilus influenzae (H. influenzae) is increasingly due to encapsulated serotypes other than type b (Hib) and nontypeable strains (collectively, nHiB H. influenzae). Pediatric hearing loss after nHib H. influenzae meningitis remains poorly described.

METHODS

Retrospecive case series of nHiB H. influenzae meningitis cases identified from a microbiologic database at Children's Hospital Colorado from 2000 to 2020. Literature regarding nHiB H. influenzae and H. influenzae postmeningitic hearing loss was also reviewed.

RESULTS

Eleven cases of nHib H. influenzae meningitis (median age 15.9 months) were identified due to serotype f (36 %), serotype a (27 %), and nontypable strains (36 %). Seven (64 %) patients were male, 55 % were white and 18 % were Hispanic or Latino. Hearing loss was initially identified in 4 children (40 %), with two patients with moderate conductive hearing loss (CHL) and one child with unilateral moderate sensorineural (SNHL) hearing loss patients recovering normal hearing. One patient with bilateral profound sensorineural hearing loss and associated labyrinthitis ossificans required cochlear implantation. All children (4) with identified hearing loss were noted to have additional intracranial sequelae, which included empyema (2), sinus thrombosis (2), and seizures (2). Of patients receiving steroids, 25 % had hearing loss on initial testing, compared to 66 % of those who did not receive steroids.

CONCLUSIONS

nHib H. influenzae can cause both transient and permanent postmeningitic hearing loss. Steroids may offer otoprotection in nHib H. influenzae meningitis similar to Hib meningitis. Given the limited literature, further study is needed to better characterize hearing outcomes after nHib H. influenzae meningitis.

Cervical vestibular evoked myogenic potential (cVEMP) findings in adults with sensorineural hearing loss (SNHL): comparisons between 500 Hz tone burst and narrowband CE-Chirp stimuli

There has been a growing interest in studying the usefulness of chirp stimuli in recording cervical vestibular evoked myogenic potential (cVEMP) waveforms. Nevertheless, the study outcomes are debatable and require verification. In view of this, the aim of the present study was to compare cVEMP results when elicited by 500 Hz tone burst and narrowband (NB) CE-Chirp stimuli in adults with sensorineural hearing loss (SNHL). Fifty adults with bilateral SNHL (aged 20-65 years) underwent the cVEMP testing based on the established protocol. The 500 Hz tone burst and NB CE-Chirp (centred at 500 Hz) stimuli were presented to each ear at an intensity level of 120.5 dB peSPL. P1 latency, N1 latency, and P1-N1 amplitude values were analysed accordingly. The NB CE-Chirp stimulus produced significantly shorter P1 and N1 latencies (p < 0.001) with large effect sizes (d > 0.80). In contrast, both stimuli elicited cVEMP responses with P1-N1 amplitude values that were not statistically different from one another (p = 0.157, d = 0.15). Additionally, age and hearing level were found to be significantly correlated (r = 0.56, p < 0.001), as were age and cVEMP amplitude for each stimulus (p < 0.001). To conclude, since both stimuli were presented at an equivalent intensity level (in dB peSPL), the shorter P1 and N1 latencies of cVEMP produced by the NB CE-Chirp stimulus (centred at 500 Hz) were unlikely due to enhanced saccular stimulation. Another more sensible reason is the temporal adjustment of the chirp stimulus.

The Association Between Family Resources and Language Among Young Children Who are Deaf and Hard of Hearing

OBJECTIVE

Our study (1) examined demographic factors in families with children with bilateral hearing loss and how they relate to Family Resource Scale (FRS) questionnaire data and (2) examined correlations between FRS data and measures of language.

METHODS

Children aged 6 months to 10 years with bilateral hearing loss were enrolled. Parents completed the FRS questionnaire to assess their access to socioeconomic resources at the first language measurement visit. Assessments measured receptive and expressive language, nonverbal intelligence quotient, and adaptive functioning.

RESULTS

Among the 85 children included in the analysis, approximately 40% had hearing loss classified as mild to moderate and 25% had a cochlear implant. Participants' mean FRS score was 130 (SD 16.6) (with the highest possible score of 150 and indicating better access to resources). Significant positive correlations ( p -value ≤ 0.05) were found between maternal education, paternal education, and family income and several FRS subscales (Growth and Support, Necessities in Health, Childcare, Personal Resources). Significant positive correlations were found between the Necessities in Health subscale and all the language measurements.

CONCLUSION

Children whose parents reported better access to socioeconomic resources related to health care had higher language performance scores. Although early access to intervention services has improved for deaf or hard-of-hearing children, there are other variables contributing to language development, including access to socioeconomic resources. This study highlights the need for further research addressing more specific and modifiable resources to improve language performance for deaf or hard-of-hearing children.

Normative Values for the Inner EAR Scale

OBJECTIVE

To determine normative values for the Inner Effectiveness of Auditory Rehabilitation (Inner EAR) scale, a validated instrument utilized to study the impact of hearing loss and potential treatments.

STUDY DESIGN

Observational outcomes study.

SETTING

Academic medical center and community care sites.

METHODS

We included patients who were at least 18 years of age and completed the Inner EAR scale, pure-tone audiometry, and word recognition score assessment. Based on audiometry results, patients were categorized as having: (1) normal bilateral hearing, (2) unilateral hearing loss, and (3) bilateral hearing loss. The distributions of Inner EAR scale scores were assessed within each category. Fisher's exact test was utilized to determine whether data-driven threshold values could discriminate among the 3 clinical groups.

RESULTS

Two hundred and twenty-two consecutive patients with hearing-related complaints met inclusion criteria. Mean Inner EAR scores for patients with bilateral hearing loss (29.2, interquartile range [IQR] 10-41.5), unilateral hearing loss (38.9, IQR 23-49), and normal hearing (46.6, IQR 31-62) were significantly different (analysis of variance F < 0.0001). An Inner EAR score threshold of 50 supported the ability to statistically significantly discriminate between bilateral hearing loss and normal hearing (p = .003), as well as between unilateral hearing loss and normal hearing (p = .015).

CONCLUSION

An Inner EAR score normative threshold value of 50 provides significant discriminatory ability between normal hearing and unilateral or bilateral hearing loss on audiometry. Normative values provide useful, frequently referenced data when assessing responses to treatment. Based on these data, this threshold may help distinguish patients with and without perceived functional impact from hearing loss.

The Impact of Patient Factors on Objective Cochlear Implant Verification Using Acoustic Cortical Auditory-Evoked Potentials

INTRODUCTION

Hearing loss is a major global public health issue that negatively impacts quality of life, communication, cognition, social participation, and mental health. The cochlear implant (CI) is the most efficacious treatment for severe-to-profound sensorineural hearing loss. However, variability in outcomes remains high among CI users. Our previous research demonstrated that the existing subjective methodology of CI programming does not consistently produce optimal stimulation for speech perception, thereby limiting the potential for CI users to derive the maximum device benefit to achieve their peak potential. We demonstrated the benefit of utilising the objective method of measuring auditory-evoked cortical responses to speech stimuli as a reliable tool to guide and verify CI programming and, in turn, significantly improve speech perception performance. The present study was designed to investigate the impact of patient- and device-specific factors on the application of acoustically-evoked cortical auditory-evoked potential (aCAEP) measures as an objective clinical tool to verify CI mapping in adult CI users with bilateral deafness (BD).

METHODS

aCAEP responses were elicited using binaural peripheral auditory stimulation for four speech tokens (/m/, /g/, /t/, and /s/) and recorded by HEARLab™ software in adult BD CI users. Participants were classified into groups according to subjective or objective CI mapping procedures to elicit present aCAEP responses to all four speech tokens. The impact of patient- and device-specific factors on the presence of aCAEP responses and speech perception was investigated between participant groups.

RESULTS

Participants were categorised based on the presence or absence of the P1-N1-P2 aCAEP response to speech tokens. Out of the total cohort of adult CI users (n = 132), 63 participants demonstrated present responses pre-optimisation, 37 participants exhibited present responses post-optimisation, and the remaining 32 participants either showed an absent response for at least one speech token post-optimisation or did not accept the optimised CI map adjustments. Overall, no significant correlation was shown between patient and device-specific factors and the presence of aCAEP responses or speech perception scores.

CONCLUSION

This study reinforces that aCAEP measures offer an objective, non-invasive approach to verify CI mapping, irrespective of patient or device factors. These findings further our understanding of the importance of personalised CI rehabilitation through CI mapping to minimise the degree of speech perception variation post-CI and allow all CI users to achieve maximum device benefit.

Audiological profile of deaf and hard-of-hearing children under six years old in the "HI HOPES cohort" in South Africa (2006-2011)

BACKGROUND

This study concerns deaf children under six years in the South African HI HOPES Cohort.

OBJECTIVE

To examine their audiological profile, aetiological risk factors for infant hearing loss as well as the relationship between identification, amplification and socio-economic influences.

DESIGN

Using a cohort design, secondary data analysis of a pre-existing dataset demonstrated adequate representation of South African demographic characteristics.

STUDY SAMPLE

A total of 532 deaf and hard-of-hearing infants enrolled in the HI HOPES early intervention programme in three provinces (2006-2011).

RESULTS

The median age of identification of children with bilateral hearing loss (n = 502) was 24.0 months (IQR = 12-36 months). Infants with aetiological risk factors were identified later than those without risk factors, and the latest age of identification (28.5 months) was for those with three aetiological risk factors (n = 42). The median age of amplification was 32 months with 102 children eligible for amplification at 31.1 months still unamplified. Early identification did not imply early amplification, and the more economically advantaged a Province the smaller the gap between ages of identification and amplification.

CONCLUSIONS

In a field with little population-level evidence, the size, and representativeness of this dataset makes a significant contribution to our understanding of infant hearing loss in South Africa.

Exome Sequencing Expands the Genetic Diagnostic Spectrum for Pediatric Hearing Loss

OBJECTIVES

Genetic testing is the standard-of-care for diagnostic evaluation of bilateral, symmetric, sensorineural hearing loss (HL). We sought to determine the efficacy of a comprehensive genetic testing method, exome sequencing (ES), in a heterogeneous pediatric patient population with bilateral symmetric, bilateral asymmetric, and unilateral HL.

METHODS

Trio-based ES was performed for pediatric patients with confirmed HL including those with symmetric, asymmetric, and unilateral HL.

RESULTS

ES was completed for 218 probands. A genetic cause was identified for 31.2% of probands (n = 68). The diagnostic rate was 40.7% for bilateral HL, 23.1% for asymmetric HL, and 18.3% for unilateral HL, with syndromic diagnoses made in 20.8%, 33.3%, and 54.5% of cases in each group, respectively. Secondary or incidental findings were identified in 10 families (5.52%).

CONCLUSION

ES is an effective method for genetic diagnosis for HL including phenotypically diverse patients and allows the identification of secondary findings, discovery of deafness-causing genes, and the potential for efficient data re-analysis.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:2417-2424, 2023.

Patient-Related Factors Do Not Predict Use of Computer-Based Auditory Training by New Adult Cochlear Implant Recipients

OBJECTIVE

The use of computer-based auditory training (CBAT) after cochlear implantation is associated with improved speech recognition and real-world functional abilities. However, patient-related factors associated with CBAT use remain unknown. This study seeks to identify such factors and recognize those at risk for not implementing CBAT.

STUDY DESIGN

Prospective natural experiment.

SETTING

Tertiary academic center.

PATIENTS

A total of 117 new adult cochlear implant (CI) recipients with bilateral moderate-to-profound hearing loss.

INTERVENTIONS/MAIN OUTCOME MEASURES

Patient demographic and lifestyle information, preimplantation aided speech recognition scores, Cochlear Implant Quality of Life (CIQOL) domain and global scores, CIQOL-Expectations scores, and CBAT use in the first 3 months after activation. Patient-related variables included age, sex, race, duration of hearing loss before implantation, hours of CI use per day, hearing-aid use before implantation, living arrangements/marital status, annual household income, employment, technology use, and education.

RESULTS

Overall, 33 new CI users (28.2%) used CBAT in the first 3 months after activation. On bivariate analysis of the pre-CI CIQOL scores, CIQOL-Expectations score, aided speech recognition scores, and demographic/lifestyle factors examined, regular use of smartphone, tablet, or computer technology was significantly associated with an increased likelihood of CBAT use (odds ratio, 9.354 [1.198-73.020]), whereas higher CIQOL-Expectations emotional domain scores were associated with a lower likelihood of CBAT use (d = -0.69 [-1.34 to -0.05]). However, using multivariable analysis to control for potential confounding factors revealed no significant associations between CBAT use in the first 3 months after cochlear implantation and any examined factor.

CONCLUSIONS

No associations between patient demographic, lifestyle, or pre-CI speech recognition and patient-reported outcome measures and CBAT use were identified. Therefore, discussions with all patients after implantation on the availability of CBAT and its potential benefits are warranted. In addition, given the limited overall use of CBAT and its association with improved CI outcomes, future studies are needed to investigate facilitators and barriers to CBAT use.

Association of noise exposure, plasma microRNAs with arterial stiffness among Chinese workers

Long-term noise exposure is reported to damage cardiovascular system, but the relationship between occupational noise exposure and arterial stiffness (AS) and the underlying mechanism is still unclear. We aimed to investigate the association of occupational noise exposure with arterial stiffness (AS), and further explore the mediation roles of microRNAs (miRNAs). A total of 838 workers were recruited from two companies in Wuhan, Hubei, China. Cumulative occupational noise exposure (CNE) was assessed through noise level of job title and work years in occupational noise. The AS for the participants were evaluated using brachial-ankle pulse wave velocity (baPWV) measured by an oscillometric device. Each 1-unit increase in CNE levels was significantly associated with a 0.002 (95% confidence interval (CI) = 0.001-0.003) unit increase in ln-transformed values of baPWV. In the sex-specific analysis, the association was significant in males (β = 0.002, 95%CI = 0.001-0.003). Meanwhile, the risk of bilateral hearing loss at high frequency was significantly higher in the high-exposed group than non-exposed group (OR = 1.895, 95%CI = 1.024-3.508), and participants with bilateral hearing loss at high frequency had a significantly higher level of ln-transformed baPWV (β = 0.032, 95%CI = 0.003-0.061). Occupational noise exposure and AS were both negatively associated with plasma miR-92a-3p and miR-21-5p, and the two miRNAs mediated 15.0% and 16.8% of the association of occupational noise with AS (P < 0.05). Our findings suggest that occupational noise exposure is positively associated with AS, and plasma miR-92a-3p and miR-21-5p may partly mediate such association.

White matter structural network alterations in congenital bilateral profound sensorineural hearing loss children: A graph theory analysis

Functional magnetic resonance imaging (fMRI) studies have revealed a functional reorganization in patients with sensorineural hearing loss (SNHL). The structural basement of functional changes has also been investigated recently. Graph theory analysis brings a new understanding of the structural connectome and topological features in central neural system diseases. However, little is known about the structural network connectome changes in SNHL patients, especially in children. We explored the differences in topologic organization, rich-club organization, and structural connection between children with congenital bilateral profound SNHL and normal hearing under the age of three using graph theory analysis and probabilistic tractography. Compared with the normal-hearing (NH) group, the SNHL group showed no difference in global and nodal topological parameters. Increased structural connection strength were found in the right cortico-striatal-thalamus-cortical circuity. Decreased cross-hemisphere connections were found between the right precuneus and the left auditory cortex as well as the left subcortical regions. Rich-club organization analysis found increased local connection in the SNHL group. These results revealed structural organizations after hearing deprivation in congenital bilateral profound SNHL children.

Benefit of sequential bilateral cochlear implantation in children between 5 to 18 years old: A prospective cohort study

Objective

To determine the benefit of sequential cochlear implantation after a long inter-implantation interval in children with bilateral deafness receiving their second implant between 5 and 18 years of age.

Study design

Prospective cohort-study.

Setting

Tertiary multicenter.

Patients

85 children with bilateral deafness and unilateral implantation receiving a contralateral cochlear implant at the age of 5 to 18 years.

Method

The primary outcomes were speech recognition in quiet and noise (CVC) scores. The secondary outcomes were language outcomes and subjective hearing abilities, all measured before and 12 months after sequential bilateral cochlear implantation. Medians of the paired data were compared using the Wilcoxon signed-rank test. Univariable linear regression analyses was used to analyze associations between variables and performance outcomes.

Results

A significant benefit was found for speech recognition in quiet (96% [89–98] vs 91% [85–96]; p < 0.01) and noise (65% [57–75] vs 54% [47–71]; p = 0.01) in the bilateral CI condition compared to unilateral (n = 75, excluded 10 non-users). No benefit was seen for language outcomes. The subjective sound quality score was statistically significant higher in bilateral compared to the unilateral CI condition. Pre-operative residual hearing level in the ear of the second implant, the inter-implant interval and age at time of second implantation was not significantly associated with performance scores.

Conclusion

After 12 months of use, sequential bilateral cochlear implantation showed improved speech perception in quiet and noise and improved subjective sound quality outcomes in children despite a great inter-implantation interval (median of 8 years [range 1–16 years]).

Follow-up on children with suspected bilateral congenital hearing loss identified through universal newborn hearing screening program in Taiwan: A national-based population study

OBJECTIVE

This investigation was to ascertain the performance of the UNHS in Taiwan.

METHODS

The predefined questionnaire was delivered on the phone in 2016. The descriptive analysis was applied to the research data. 941 neonates in birth cohorts 2013-2014 who were documented as a bilateral referral in the national UNHS tracking system were targeted. The respondents were either caregivers or family members.

RESULTS

40.3% of 941 children were lost to follow-up, and 66.24% of 363 children were diagnosed with SNHL. 45.15% of 163 children used hearing amplification device(s). 77.46% of hearing amplification device users and 7.51% of non-users participated in the auditory training courses. By six months of age, 38.51% and 22.58% of children diagnosed with bilateral SNHL commenced the hearing amplification device fitting and the auditory training courses, respectively.

CONCLUSIONS

More efforts are needed to enhance the performance of the UNHS to achieve national goals stated in the 2014 Taiwan UNHS Revised Guidelines and the well-known benchmarks set by the JCIH in 2007. The development of an electronic tracking system for storing and sharing information on the follow-up on children with congenital hearing loss was as significant as the improvements in the understanding of early hearing detection and intervention of the public and stakeholders.

Bilateral Sudden Sensorineural Hearing Loss: A Distinct Phenotype Entity

OBJECTIVE

To investigate the clinical phenotype and hearing prognosis of patients with unilateral and bilateral (simultaneous and nonsimultaneous) sudden sensorineural hearing loss (SSNHL).

STUDY DESIGN

Retrospective cohort.

SETTING

Otology outpatient clinic of a tertiary university hospital.

PATIENTS

Three hundred eighty-five medical records from patients with SSNHL.

MAIN OUTCOME MEASURES

Comparison of demographic, clinical, and audiometric (pretreatment and posttreatment) data of patients with unilateral and bilateral SSNHL.

RESULTS

Our final analysis comprised of 239 medical records of patients with SSNHL. Most patients had unilateral SSNHL (186, 77.82%). We identified a potential underlying cause for the SSNHL in 105 (43.9%) of the cases, being more frequent in cases of bilateral simultaneous SSNHL (100%) as compared with unilateral (45.6%) and nonsimultaneous bilateral SSNHL (22.7%). Cases of simultaneous bilateral SSNHL presented more frequently with severe or profound hearing loss (89%; unilateral SSNHL 50.5%; nonsimultaneous bilateral SSNL, 59.1%) and had a significantly worse hearing recovery prognosis as compared with unilateral or nonsimultaneous bilateral SSNHL (p = 0.002).

CONCLUSION

We observed a high heterogeneity of clinical presentations of SSNHL, the most common being unilateral SSNHL. Our results demonstrate that the clinical and audiological prognosis of simultaneous bilateral SSNHL differed significantly from unilateral and nonsimultaneous bilateral SSNHL, suggesting that simultaneous cases of bilateral SSNHL may be a part of a different disease process. The presence of a simultaneous, bilateral SSNHL indicates the need to investigate the presence of an underlying systemic disease.

Parent-Reported Stress and Child Behavior for 4-Year-Old Children with Unilateral or Mild Bilateral Hearing Loss

Children with unilateral or mild bilateral hearing loss are increasingly identified in early childhood. Relatively little is known about how hearing loss affects their developmental trajectory or whether it contributes to parenting stress for these parents. This study aimed to examine child behavior and parenting stress in parents of children with unilateral/mild bilateral hearing loss compared to children with typical hearing. This prospective study involved 54 children with unilateral/mild bilateral hearing loss identified at a median age of 4.5 months (IQR 2.6, 6.5) and 42 children with typical hearing. At age 48 months, child behavior and parenting stress were measured. Auditory and language results were also analyzed in relation to child behavior and parenting stress. Parents of these children did not report significantly more parenting stress or behavior problems than parents of children with typical hearing. However, both parenting stress and child behavior were related to functional hearing in noise.

Hearing-Related Quality of Life in 75 Patients With a Percutaneous Bone Conduction Device

OBJECTIVE

To evaluate long-term hearing-related quality of life (HRQoL) and device use in bone conduction (BCD) users. Furthermore, to assess differences between indications and changes in HRQoL over time.

STUDY DESIGN

Prospective questionnaire survey.

SETTING

Tertiary referral center.

PATIENTS

Seventy-five patients with a percutaneous BCD.

MAIN OUTCOME MEASURES

Glasgow Benefit Inventory (GBI) at 3 and 12 months postoperatively, Glasgow Health Status Inventory (GHSI) preoperatively, and 6 and 36 months postoperatively, device use at 6, 12, and 36 months. Changes over time were assessed and outcomes were compared between indications.

RESULTS

After implantation, 97% of all patients reported a positive benefit on the GBI total. The GHSI total had improved with median 15 points (Interquartile range [IQR] 12). At 36 months, median device use was 15 hours/day (IQR 10) and one nonuser was reported. Patients with bilateral hearing loss (BHL) showed greater improvement on the GHSI total (median 18 vs 14, p < 0.0001) and used their devices more frequently (median 16 vs 8 h/day, p < 0.0001) than patients with unilateral HL (UHL). Postoperative GHSI and GBI scores were consistent over time, in the entire patient population and for every indication. Between 6 and 36 months, device use was stable over time, except for patients with single-sided deafness (SSD; median -6.4 h/day, p = 0.009).

CONCLUSION

The BCD improves HRQoL in patients with BHL, in patients with unilateral conductive/mixed hearing loss and in patients with SSD. Patients with BHL experienced a greater improvement in hearing status compared to patients with UHL. Although use decreased over time in SSD patients, device use was high for every indication.

Complex auditory musical hallucinations with ambivalent feelings

A 78-year-old woman with hypertension, diabetes mellitus type 2 and bilateral sensorineural hearing loss was referenced to geriatric psychiatry consultation. She presented cognitive dysfunction, erotomanic delusion and complex musical hallucinations (MH), described as hearing her neighbour singing a familiar church song along with bells in the background, making comments and talking to her. A computed tomography (CT) of the brain detected small right nucleocapsular and bilateral external capsules hypodensities of presumed vascular aetiology during hospitalisation. MH are a rare phenomenon with heterogeneous aetiology. Most frequently, the cause is hearing impairment; other causes include social isolation, cognitive dysfunction, vascular risk factors and medication. Studies suggest that some brain areas related to musical memory circuitry might be related and not fully mapped. Auditory verbal hallucinations with a voice that either comments, talks or sings to the patient have never been described in the literature, making this clinical case attractive.

Influence of aided audibility on speech recognition performance with frequency composition for children and adults

OBJECTIVE

The primary purpose of this project was to evaluate the influence of speech audibility on speech recognition with frequency composition, a frequency-lowering algorithm used in hearing aids.

DESIGN

Participants were tested to determine word and sentence recognition thresholds in background noise, with and without frequency composition. The audibility of speech was quantified using the speech intelligibility index (SII).

STUDY SAMPLE

Participants included 17 children (ages 6-16) and 21 adults (ages 19 to 72) with bilateral mild-to-severe sensorineural hearing loss.

RESULTS

Word and sentence recognition thresholds did not change significantly with frequency composition. Participants with better aided speech audibility had better speech recognition in noise, regardless of processing condition, than those with poorer aided audibility. For the child participants, changes in the word recognition threshold between processing conditions were predictable from aided speech audibility. However, this relationship depended strongly on one participant with a low SII and otherwise, changes in speech recognition between frequency composition off and on were not predicable from aided speech audibility.

CONCLUSION

While these results suggest that children who have a low-aided SII may benefit from frequency composition, further data are needed to generalise these findings to a greater number of participants and variety of stimuli.

Extended Middle Cranial Fossa Approach for Placement of Auditory Brainstem Implants

OBJECTIVE

Traditionally, auditory brainstem implants (ABIs) have been placed via the translabyrinthine or retrosigmoid approaches. In select patients, a modified extended middle cranial fossa (xMCF) approach with tentorial ligation may be advantageous for vestibular schwannoma (VS) resection and auditory rehabilitation. This manuscript describes the application of this modification of the MCF approach for simultaneous VS resection and ABI placement.

PATIENTS

Patients with neurofibromatosis type 2, profound bilateral sensorineural hearing loss, single functioning sigmoid/jugular venous system, and giant (>4 cm) VS.

INTERVENTIONS

Simultaneous VS resection and ABI placement via a modified xMCF approach with tentorial ligation.

MAIN OUTCOME MEASURES

Extent of tumor removal and brainstem decompression, access to lateral recess of the fourth ventricle, functional hearing improvement, surgical complications.

RESULTS

Two patients met indications and underwent surgery. There were no immediate or delayed surgical complications. Both had subtotal tumor removal with significant decompression of the brainstem and ABI placement. One patient achieved voice and environmental sound awareness at 35 to 55 dbHL across frequencies. The second patient presented with failure to thrive and multiple lower cranial neuropathies in addition to the above-listed indications. She was hospitalized multiple times after surgery due to failure to thrive and recurrent aspiration pneumonia. Her device was never activated, and she expired 1 year after surgery.

CONCLUSIONS

The xMCF with tentorial ligation is an additional approach for tumor resection and ABI placement in selected patients with neurofibromatosis type 2. Future studies will further define when this approach is most applicable as well as the challenges and pitfalls.

COVID-19 caused hearing loss

Purpose

The objective of this cross-sectional study was to determine if there is a potential link between COVID-19 infection and hearing loss.

Methods

The prospective study was conducted in the COVID Hospital Clinical Centre Niš, Serbia. We performed tonal audiometry and used a custom questionnaire and medical histories to determine the incidence of hearing loss in COVID-19 positive patients.

Results

There were 74 patients with COVID-19 that met the inclusion criteria of this study and they composed our experimental group. Fifty-four (73%) were men and 20 (27%) women. There were 30 (40.5%) patients with hearing loss. Seventeen patients had unilateral and 13 had bilateral hearing loss. Significant differences between hearing loss groups and control group were found across all age groups, but not at all frequencies. No important differences were found when unilateral hearing loss and bilateral hearing loss groups were compared. There were no significant differences in distributions of comorbidities between the patients with hearing loss and normal hearing patients.

Conclusions

We found that 30 (40.5%) of the COVID-19 positive patients had sensorineural type of hearing loss. Across all age groups, there were statistically significant differences in frequencies between the COVID-19 positive patients and the control group. There were no significant differences in distributions of comorbidities between the patients with hearing loss and normal hearing patients. Distribution of unilateral and bilateral hearing loss and audiogram types was also not significantly different between the age groups.

Cost-Utility Analysis of Bilateral Cochlear Implantation in Adults With Severe to Profound Sensorineural Hearing Loss in Poland

OBJECTIVE

The aim of the study was to develop a Markov model and apply it for the evaluation of three different treatment scenarios for adult patients with severe to profound bilateral sensorineural hearing loss.

STUDY DESIGN

Prospective Observational Study.

SETTINGS

Hospital.

PATIENTS

A clinical group of 22 adult patients (59.1% men, 40.9% women) aged from 59.13 ± 8.9 years were included in the study. The study comprised two arms: patients in group 1 received the second cochlear implant one to three months after the first implant; while patients in group 2 got the second cochlear implant approximately one year after the first implant.

MAIN OUTCOME MEASURES

All participants were first asked to complete an AQoL-8D questionnaire. For the cost-effectiveness analyses, a Markov model analyzed as microsimulation was developed to compare the different treatment options.

RESULTS

The analyses show that bilateral cochlear implantation strategies are cost-effective compared to the 'no treatment' alternative when having a 10-year model time horizon. When all three model scenarios are compared, the bilateral simultaneous cochlear implantation strategy (Scenario 3) compared to the 'no treatment' option is even more cost-effective than the Scenarios 1 and 2, compared with the 'no treatment' alternative.

CONCLUSIONS

The model results summarize that bilateral (sequential and simultaneous) cochlear implantation that are represented in the model scenarios, are cost-effective strategies for Polish adult patients with bilateral severe to profound sensorineural hearing loss.

Association of occupational noise exposure, bilateral hearing loss with atherosclerotic cardiovascular disease risk in Chinese adults

We aimed to explore the association of occupational noise exposure with atherosclerotic cardiovascular disease (ASCVD) risk in Chinese adults. We included 21,412 participants from the Dongfeng-tongji Cohort Study, occupational noise exposure was evaluated through workplace noise level and/or the job titles, hearing loss was defined as a pure-tone mean of 25 dB or higher at 0.5, 1, 2, and 4 kHz in any ear. Compared with participants without occupational noise exposure, the 10-year ASCVD risk was significantly higher for noise exposure duration ≥20 years (OR = 1.20, 95%CI = 1.05-1.32) after adjusting for potential confounders. In the subgroup analysis, the association was only statistically significant in males (OR = 1.86, 95%CI = 1.12-3.14) and participants aged equal to or over 60 years old (OR = 1.20, 95%CI = 1.05-1.33), but not in females (OR = 1.15, 95%CI = 0.71-1.92) and aged below 60 (OR = 1.51, 95%CI = 0.75-2.85). In the subsample analyses (N = 10,165), bilateral hearing loss was associated with a higher risk of 10-year ASCVD (OR = 1.72, 95%CI = 1.30-2.30), especially for participants who were males (OR = 2.40, 95%CI = 1.61-3.42) and aged equal to or over 60 (OR = 1.85, 95%CI = 1.40-2.44). The present study suggests that occupational noise exposure may be a potential risk factor for ASCVD, especially for males and older participants.

Chronic Myeloid Leukaemia with Sudden Bilateral Deafness and Leg Ulcer Associated with Hydroxyurea Therapy

Deafness occurs rarely in patients with chronic myeloid leukaemia. Hydroxyurea-induced leg ulcer has been found in patients on long-term hydroxyurea therapy. We present a 53 year old man who developed spontaneous bilateral deafness shortly after he was diagnosed with chronic myeloid leukaemia and subsequently developed hydroxyurea induced leg ulcer in the course of treatment. A 53 year-old male presented to our clinic with six months history of left abdominal mass, associated with easy satiety, occasional fever, night sweats, loss of appetite, weight loss, easy fatiguability and bilateral leg swelling. Physical examination showed a middle-aged man in no obvious distress, afebrile, anicteric, pale, with no peripheral lympadenopathy but had bilateral pitting pedal edema to the lower third. There was no significant finding on the chest. Abdominal examination showed hepatosplenomagaly. Full blood count showed anaemia, hyperleucocytosis and thrombocytosis. Peripheral blood film and bone marrow aspiration examinations were in keeping with chronic myeloid leukaemia. The BCR/ABL-1 transcript was negative, thus he was started on hydroxyurea in addition to other supportive treatment. Before commencement of hydroxyurea therapy, he spontaneously developed bilateral sensorineural deafness. Subsequently, he also developed leg ulcers, having been on hydroxyurea therapy for seven years which healed within eight weeks on discontinuation of hydroxyurea. Spontaneous deafness can occur in patients with chronic myeloid leukaemia due to hyperleucocytosis and urgent cytoreduction may help to prevent this complication. In addition, leg ulcer due to long-term hydroxyurea therapy can occur and usually do not respond to the conventional treatment but discontinuation of hydroxyurea.

Cochlear implantation for tinnitus in adults with bilateral hearing loss: protocol of a randomised controlled trial

INTRODUCTION

Tinnitus is the perception of sound without an external stimulus, often experienced as a ringing or buzzing sound. Subjective tinnitus is assumed to origin from changes in neural activity caused by reduced or lack of auditory input, for instance due to hearing loss. Since auditory deprivation is thought to be one of the causes of tinnitus, increasing the auditory input by cochlear implantation might be a possible treatment. In studies assessing cochlear implantation for patients with hearing loss, tinnitus relief was seen as a secondary outcome. Therefore, we will assess the effect of cochlear implantation in patients with primarily tinnitus complaints.

METHOD AND ANALYSIS

In this randomised controlled trial starting in January 2021 at the ENT department of the UMC Utrecht (the Netherlands), patients with a primary complaint of tinnitus will be included. Fifty patients (Tinnitus Functional Index (TFI) >32, Beck's Depression Index <19, pure tone average at 0.5, 1, 2 and 4 kHz: bilateral threshold between 50 and ≤75 dB) will be randomised towards cochlear implantation or no intervention. Primary outcome of the study is tinnitus burden as measured by the TFI. Outcomes of interest are tinnitus severity, hearing performances (tinnitus pitch and loudness, speech perception), quality of life, depression and patient-related changes. Outcomes will be evaluated prior to implantation and at 3 and 6 months after the surgery. The control group will receive questionnaires at 3 and 6 months after randomisation. We expect a significant difference between the cochlear implant recipients and the control group for tinnitus burden.

ETHICS AND DISSEMINATION

This research protocol was approved by the Institutional Review Board of the University Medical Center (UMC) Utrecht (NL70319.041.19, V5.0, January 2021). The trial results will be made accessible to the public in a peer-review journal.

TRIAL REGISTRATION NUMBER

Trial registration number NL8693; Pre-results.

Association of occupational noise exposure, bilateral hearing loss with hypertension among Chinese workers

OBJECTIVE

To evaluate the relationship of occupational noise, bilateral hearing loss with blood pressure and hypertension among a Chinese population.

METHODS

We included 15 422 individuals from a cross-sectional survey of the key occupational diseases in 2017 in Wuhan, Hubei Province, China. Occupational noise exposure was evaluated through workplace noise level and/or the job titles. Hearing loss was defined as a pure-tone average of 25 dB or higher at speech frequency (0.5, 1, 2 kHz) or high frequency (3, 4, 6 kHz) in both ears. Hypertension was defined as blood pressure at least 140/90 mmHg or self-reported current use of antihypertensive medication.

RESULTS

Compared with participants without occupational noise exposure, the prevalence of hypertension was significantly higher for noise exposure duration of 5 to less than 10 years [odds ratio (OR) = 1.13, 95% confidence interval (CI) = 1.04-1.27] and at least 10 years (OR = 1.17, 95% CI = 1.09-1.30). In the sex-specific analysis, the association was significantly pronounced in male (OR = 1.18, 95% CI = 1.06-1.32 for duration of 5 to <10 years; OR = 1.25, 95% CI = 1.12-1.38 for duration ≥10 years), but not in female (OR = 1.01, 95% CI = 0.80-1.11 for duration of 5 to <10 years; OR = 1.06, 95% CI = 0.90-1.20 for duration ≥10 years). In the subsample analyses, bilateral hearing loss was associated with a higher prevalence of hypertension, no matter for speech frequency hearing loss (OR = 1.12, 95% CI = 1.02-1.30 for mild; OR = 1.35, 95% CI = 1.20-1.50 for severe) or for high-frequency hearing loss (OR = 1.24, 95% CI = 1.03-1.50 for mild; OR = 2.40, 95% CI = 1.80-3.17 for severe). The sex-subgroup analysis of hearing loss with hypertension was similar as occupational noise and hypertension.

CONCLUSION

Our study has suggested occupational noise exposure is a potential risk factor for hypertension.

Cochlear Implantation in Infants: Evidence of Safety

The aim of this study was to investigate surgical, anesthetic, and device-related complications associated with cochlear implantation (CI) in children younger than 1 year of age. This was a multicenter, retrospective chart review of all children with severe-to-profound sensorineural hearing loss who underwent cochlear implantation with a Cochlear Nucleus Implant System before 1 year of age. Endpoints included perioperative course, major and minor surgical, anesthetic and device-related complications, and 30-day readmission rates. One hundred thirty-six infants (242 ears) met criteria. The mean age at implantation was 9.4 months (standard deviation 1.8). Six-month follow-up was reported in all patients. There were no major anesthetic or device-related complications. Adverse events were reported in 34 of implanted ears (14%; 7 major, 27 minor). Sixteen adverse events occurred ≤30 days of surgery, and 18 occurred >30 days of surgery. The 30-day readmission rate was 1.5%. The rate of adverse events did not correlate with preexisting medical comorbidities or duration under anesthesia. There was no significant difference detected in complication rate for patients younger than 9 months of age versus those 9 to 11 months of age. This study demonstrates the safety of CI surgery in infants and supports reducing the indication for cochlear implantation to younger than 1 year of age for children with bilateral, profound sensorineural hearing loss obtaining a Cochlear Nucleus Implant System.

Compression Fitting of Hearing Aids and Implementation

A compressor in hearing aid devices (HADs) is responsible for mapping the dynamic range of input signals to the residual dynamic range of hearing-impaired (HI) patients. Gains and parameters of the compressor are set according to the HI patient's preferences. In different surroundings depending upon noise level, the patient may seek to tune the parameters to improve performance. Traditionally, fitting of the hearing aids is done by an audiologist using hearing aid software and the HI patient's opinion at a clinic. In this paper, we propose a frequency-based multi-band compressor implemented as a smartphone application, which can be used as an alternative to that of the traditional HADs. The proposed solution allows the user to tune the compression parameters for each band along with a choice of compression speed and fitting strategy. Exploiting smartphone processing and hardware capabilities, the application can be used for bilateral hearing loss. The performance of this easy-to-use smartphone-based application is compared with traditional HADs using a hearing aid test system. Objective and subjective evaluations are also carried out to quantify the performance.

[A clinical analysis of 27 cases of simultaneous bilateral sudden sensorineural hearing loss]

Objective:To compare the clinical characteristics and therapeutic effects between simultaneous bilateral sudden sensorineural hearing loss（Si-BSSHL） and unilateral sudden sensorineural hearing loss（USSHL）. Method:The clinical data of 27 cases of Si-BSSHL were retrospectively analyzed, including the characteristics of the disease, clinical manifestations, audiological examination, hematological examination, and therapeutic effect, and compared with those of 139 cases of USSHL. Result:There was a statistically significant difference in the age（65.85±9.17 vs 56.95±13.18, P<0.01） and no significant difference in sex ratio（P>0.05） between the two groups. The proportion of Si-BSSHL patients with vertigo, ear fullness, hypertension, diabetes, coronary heart disease and stroke had no statistical difference compared with those of USSHL（P>0.05）, the proportion of patients with tinnitus in Si-BSSHL group was significantly lower than that in USSHL group（P<0.05）. The distribution of hearing loss degree and the type of audiometry in Si-BSSHL group were significantly different from those in USSHL group, PTA before treatment and the proportion of profound hearing loss in Si-BSSHL group was significantly lower than that in USSHL group（P<0.05）, descending audiometry type was more common in Si-BSSHL group compared to USSHL（P<0.01）. Fibrinogen in Si-BSSHL group was significantly higher than that in USSHL group（P<0.05）. No significant difference was found between the two groups with respect to mean platelet volume, blood lipid and folic acid（P>0.05）. The total treatment effective rate in Si-BSSHL group was 44.44%, while that in USSHL group was 41.73%, there was no significant difference between the two groups（P>0.05）. Conclusion:Si-BSSHL has a female preponderance and tends to occur in advanced age in our cohort. Compared to USSHL patients, Si-BSSHL patients have less profound hearing loss and more descending audiograms, and the proportion of patients with extremely severe deafness is relatively small. There is no significant difference in the therapeutic effect between the two groups.

[The effects of wireless audio microphones on sentences recognition threshold for hearing aid users in noise]

Objective:This study was aimed to observe the effects of wireless audio microphone on hearing aids effect in noise at different listening distances. Method:Twenty-three subjects with bilateral sensorineural hearing loss, including 17 males and 6 females were fitted with binaural hearing aids. These patients did sentences recognition tests at two different listening distance（1.5 and 3 meters） in noise. The subjects were tested under three conditions, ①with hearing aids alone; ②with the wireless audio microphone alone; ③with hearing aid microphone and mini audio microphone simultaneously. Result:The sentence recognition threshold at 3 meters listening distance is significantly higher than it at 1.5 meters listening distance with hearing aids alone（P<0.05）. There is no significant difference in the sentence recognition threshold between two listening distances when the wireless audio microphone was switched on（P>0.05）. Conclusion:Mini audio microphone can significantly improve hearing aids effect in long distance listening in noise.

Assessing the Benefit-Risk Profile for Pediatric Implantable Auditory Prostheses

BACKGROUND/AIMS

Children with congenital cochleovestibular abnormalities associated with profound hearing loss have few treatment options if cochlear implantation does not yield benefit. An alternative is the auditory brainstem implant (ABI). Regulatory authority device approvals currently include a structured benefit-risk assessment. Such an assessment, for regulatory purposes or to guide clinical decision making, has not been published, to our knowledge, for the ABI and may lead to the design of a research program that incorporates regulatory authority, family, and professional input.

METHODS

Much structured benefit-risk research has been conducted in the context of drug trials; here we apply this approach to device studies. A qualitative framework organized benefit (speech recognition, parent self-report measures) and risk (surgery- and device-related) information to guide the selection of candidates thought to have potential benefit from ABI.

RESULTS

Children with cochleovestibular anatomical abnormalities are challenging for appropriate assessment of candidacy for a cochlear implant or an ABI. While the research is still preliminary, children with an ABI appear to slowly obtain benefit over time. A team of professionals, including audiological, occupational, and educational therapy, affords maximum opportunity for benefit.

CONCLUSIONS

Pediatric patients who have abnormal anatomy and are candidates for an implantable auditory prosthetic require an individualized, multisystems review. The qualitative benefit-risk assessment used here to characterize the condition, the medical need, potential benefits, risks, and risk management strategies has revealed the complex factors involved. After implantation, continued team support for the family during extensive postimplant therapy is needed to develop maximum auditory skill benefit.

Heterozygous Mutations in MAP3K7, Encoding TGF-β-Activated Kinase 1, Cause Cardiospondylocarpofacial Syndrome

Cardiospondylocarpofacial (CSCF) syndrome is characterized by growth retardation, dysmorphic facial features, brachydactyly with carpal-tarsal fusion and extensive posterior cervical vertebral synostosis, cardiac septal defects with valve dysplasia, and deafness with inner ear malformations. Whole-exome sequencing identified heterozygous MAP3K7 mutations in six distinct CSCF-affected individuals from four families and ranging in age from 5 to 37 years. MAP3K7 encodes transforming growth factor β (TGF-β)-activated kinase 1 (TAK1), which is involved in the mitogen-activated protein kinase (MAPK)-p38 signaling pathway. MAPK-p38 signaling was markedly altered when expression of non-canonical TGF-β-driven target genes was impaired. These findings support the loss of transcriptional control of the TGF-β-MAPK-p38 pathway in fibroblasts obtained from affected individuals. Surprisingly, although TAK1 is located at the crossroad of inflammation, immunity, and cancer, this study reports MAP3K7 mutations in a developmental disorder affecting mainly cartilage, bone, and heart.

Binaural release from masking with single- and multi-electrode stimulation in children with cochlear implants

Cochlear implants (CIs) provide children with access to speech information from a young age. Despite bilateral cochlear implantation becoming common, use of spatial cues in free field is smaller than in normal-hearing children. Clinically fit CIs are not synchronized across the ears; thus binaural experiments must utilize research processors that can control binaural cues with precision. Research to date has used single pairs of electrodes, which is insufficient for representing speech. Little is known about how children with bilateral CIs process binaural information with multi-electrode stimulation. Toward the goal of improving binaural unmasking of speech, this study evaluated binaural unmasking with multi- and single-electrode stimulation. Results showed that performance with multi-electrode stimulation was similar to the best performance with single-electrode stimulation. This was similar to the pattern of performance shown by normal-hearing adults when presented an acoustic CI simulation. Diotic and dichotic signal detection thresholds of the children with CIs were similar to those of normal-hearing children listening to a CI simulation. The magnitude of binaural unmasking was not related to whether the children with CIs had good interaural time difference sensitivity. Results support the potential for benefits from binaural hearing and speech unmasking in children with bilateral CIs.

[Cochlear implantation in bilateral traumatic severe to profound sensorineural deafness]

OBJECTIVE

To analyze the audiologic results of cochlear implantation in bilateral severe to profound sensorineural hearing loss following head trauma.

METHODS

A retrospective study of our cochlear implantation cases in bilateral severe to profound sensorineural hearing loss following head trauma (with or without temporal bone fractures). Four patients in second hospital of Shandong university were analyzed in this study.

RESULTS

All the patients received unilateral cochlear implantation and gained open-set speech perception ranging from 92% to 100%. The aided hearing threshold ranged from 30 dBHL to 35 dBHL. None of them experienced a decrease in the hearing performance in the follow-up (1-2 years).

CONCLUSION

With sufficient preoperative assessment, cochlear implantation is an effective management for hearing rehabilitation in bilateral severe to profound sensorineural hearing loss following head trauma.

[Efficacy of softband Ponto in young children with bilateral congenital microtia with aural atresia]

OBJECTIVE

To evaluate auditory developments and the effectiveness of children with congenital bilateral aural atresia after using softband Ponto and to compare them with children with normal hearing.

METHOD

Twenty patients (age ranging from 3 months to 21 months ) with bilateral aural atresia were studied. The air and bone auditory thresholds were assessed by auditory brain stem response (ABR). The infant-todder meaning auditory integration scale (IT-MAIS) was used to evaluate the auditory development at three time levels: baseline, 3 months and 6 months.

RESULT

The average unaided bone conduction hearing thresholds of patients is (17.5 ± 5.9)dB nHL,and the average air conduction hearing thresholds is (72.5 ± 9.3)dB nHL. The average VRA hearing thresholds of 5 patients is (30.5 ± 5.9) dB HL. The IT-MAIS total, detection and perception scores are improved specifically after wearing softband Ponto and approaching the normal level.

CONCLUSION

Softband Ponto is suitable for infants with bilateral atresia. Results from these auditory development testing are encouraging. Softband Ponto should be used as a bridge for surgical implantations when temporal bone is thick enough.

[Early diagnosis and intervention in 0-9 months old infants with hearing loss]

OBJECTIVE

To investigate the current situation of early diagnosis and intervention in 0-9 months old infants with hearing loss and analysis factors that will affect early diagnosis and intervention.

METHOD

One hundred and eighty-six infants referred to the West China hospital from February 2014 to September 2014 were included. All 186 children were referred due to the fact that either they failed infant hearing screening or outer ear malformation. Early diagnosis and/or intervention were performed on those 186 children and their records of early diagnosis and intervention were analyzed.

RESULT

Among the 186 infants, 167 (89.8%) were diagnosed with an average age at (4.0 ± 1.4) months. Among the 167 infants with final diagnosis, there were 31 (18.6%) infants diagnosed as conductive hearing loss (CHL), and 99 cases (59.3%) diagnosed as sensorineural hearing loss (SNHL), among whom, there were 75 (44.9%) bilateral SNHL and 24 (14.4%) unilateral SNHL. There were 2 cases (1.20%) with SNHL on one side and atresia on the other side. 5 (2.99%) of all conductive hearing loss cases with unilateral atresia and 2 cases with auditory neuropathy (AN) were found. 33 infants (19.8%) were found to have normal hearing. 30.7% (23/75) infants diagnosed as bilateral SNHL and 8.3% (2/24) infants diagnosed as unilateral SNHL were fitted with hearing aids. The fitting rate in infants with bilateral SNHL with mild, moderate, severe to profound degrees were 0 (0/23), 24.0% (6/25), 66.7% (6/9), 61.1% (11/18) respectively. The average intervention age was (5.0 ± 2.1) months.

CONCLUSION

Although the early diagnosis and intervention situation in this study are very close to international standard, there are still infants without final diagnosis and infants with hearing loss without hearing aid fitting. Further studies and efforts to promote early diagnosis and intervention in infants with hearing loss are needed.

[The study of the pure tone audiometry characteristics and curative effect in sudden hearing loss patients with hypertension]

OBJECTIVE

To investigate the pure tone audiometry characteristics and curative effect in sudden hearing loss patients with hypertension.

METHOD

One hundred and fifty-seven inpatients (168 ears) with hypertension suffered from sudden hearing loss were included in this study. We retrospectively analyzed the audiological index of these patients by comparing the pure tone audiometry (PTA) among patients in the aspects of gender, age, affected side, duration of hypertension, with or without inducement, concomitant symptoms and other combined diseases. The hearing threshold at different frequency was also compared, as well as the curative effect among patients with diverse audiological characteristics.

RESULT

Of the contemporaneous sudden hearing loss patients (874 cases), the prevalence of hypertension was 17.96%, where the male ones accounted for. 28.69% (103/359) and the female ones accounted for 19.42% (54/278) respectively with statistically significant difference between genders (P < 0.01). The prevalence of hypertension in 34-44 years old group, 45-49 years old group, 60-69 years old group and over 70 years old group was 12.69% (25/197), 22.51% (70/311), 47.62% (40/84), 48.89% (22/45) respectively, which were statistically different (P < 0.01). The number of impaired ears with audiogram configuration characterized by rise type, downslope type, flat type and completely deafness type was 18 (10.71%), 61 (36.31%), 41 (24.40%), and 48 (28.57%), respectively. The decrease of hearing threshold in PTA were increasingly severe as the increasing impaired-frequency, and the difference of the degree of hearing impairment among these three types of frequencies was statistically significant (P < 0.01). The hearing threshold means of each frequency had no significant difference among patients with various gender, age and Cardiovascular Risk Stratification (P > 0.05). The hearing threshold means of each frequency of unilateral hearing loss patients was significantly higher than that of bilateral hearing loss patients (P < 0.05). The hearing threshold means at 125 Hz, 250 Hz, 500 Hz and 1 kHz showed significant difference among patients with different duration of hypertension (P < 0.05). The total effective rate of sudden hearing loss in patients with hypertension was significantly lower than that in the sudden hearing loss patients without hypertension (19.64%, 61.57% respectively, P < 0.01). The total effective rate presented significant difference among patients with different duration of hypertension and different Cardiovascular Risk Stratification (P < 0.05).

CONCLUSION

The prevalence of sudden hearing loss in hypertension patients was higher in male than in female, which rose with age and combined disease. The hearing threshold means at mid-frequency and high-frequency were higher than that at low-frequency. The total effective rate of sudden hearing loss was relatively low in patients with hypertension. The longer the duration of hypertension and the higher the Cardiovascular Risk Stratification, the lower the total effective rate. Comprehensive understanding of audiological characteristics and hypertension condition plays a crucial role in type-specific treatment of sudden hearing loss.

Comparison of two nonverbal intelligence tests among children who are deaf or hard-of-hearing

The primary goal of the current study is to evaluate the concurrent validity of the Leiter International Performance Scale-Revised (Leiter-R Brief IQ) and Differential Ability Scales - Second Edition (DAS-II Nonverbal Reasoning Index) in a group of children who are deaf or hard-of-hearing. Knowing the breadth of cognitive tools appropriate for use in children who are deaf or hard-of-hearing is highly beneficial, given that clinical and school psychologists are often challenged to reliably assess cognitive functions in the context of hearing loss. Participants included 54 children between three and six years of age with permanent bilateral hearing loss. As part of the study, neurocognitive assessments were conducted by a pediatric neuropsychologist or licensed clinical psychologist with extensive experience administering assessments to children with developmental disabilities, including children with hearing loss. The Leiter-R Brief IQ score was similar to the DAS-II nonverbal reasoning index, with no significant difference in the mean scores across the two assessments. The severity of hearing loss was not correlated to either the Leiter-R or the DAS-II nonverbal IQ. Nearly a quarter of the children evaluated had meaningful intra-individual differences between scores on the Leiter-R and DAS-II that were more than one standard deviation from one another. Conducting accurate intellectual assessments in children who are deaf and hard-of-hearing is fundamental in determining and designing interventions and educational services. More comprehensive neuropsychological test batteries utilizing several tasks to assess a single domain (such as nonverbal reasoning) may be warranted for children who are deaf or hard-of-hearing.

Gradual Recovery from Bilateral Severe Sensorineural Hearing Loss post Motor Vehicle Accident

Sensorineural hearing loss following trauma is a common finding in daily clinical practice and usually associated with a poor prognosis. Our case illustrates a patient who was involved in motor vehicle accident sustaining bilateral severe to profound sensorineural hearing loss but subsequently recovered fully after two years. Unless there is clear trauma to the cochlea or auditory nerve, a substantial duration of follow up is needed in the treatment of such cases.

Orale Sprachentwicklung bilateral schallempfindungsgestörter Kinder - ein empirischer Längsschnitt

OBJECTIVE

The aim of this study was to assess the oral language development of children with permanent bilateral hearing loss without additional disabilities longitudinally (5 time points t1-t5).

METHOD

The present follow-up study evaluated both receptive and expressive language developmental quotients (DQ; desired value 1.0) with standardised developmental scales and receptive and expressive vocabulary size with standardised tests (results in T-scores; m=50, SD=10). Mean follow-up duration was 38.1 (SD 4.8) months.

SAMPLE

A cohort of n=18 sensorineural hearing-impaired children was recruited from the German Göttinger Hör-Sprachregister. Mean diagnosis age was 21.4 (SD 16.6) months and mean age of amplification with hearing aids was 21.7 (SD 16.5) months.

RESULTS

The mean DQs slowly increased from t1 to t4 (DQ receptive 0.37/0.48/0.55/0.56; DQ expressive: 0.51/0.51/0.55/0.55) and remained norm deviant. The diagnosis age of hearing loss and both the developmental quotients for receptive (-0.41/-0.42/-0.53; p<0.05/-0.80; p<0.01) and expressive language (-0.77; p<0.01/-0.55; p<0.05/-0.66; p<0.01/-0.79; p<0.01) were significantly correlated. The mean receptive vocabulary size apparently increased and came up to the lower norm range (29.6-34.2-43.8), however the mean expressive vocabulary remained far below the norm (26.8-29.8). Children with a hearing loss from 71-90 dB scored on average mostly higher than children with a loss > 90 dB who all had received a cochlear-implant up to t3. Children who were identified as hearing-impaired before the age of 18 months exhibited on average generally greater DQs.

CONCLUSION

The individual best available amplification of hearing loss did not compulsively cause an age-adequate spoken language development, at least not in case of a hearing loss > 40 dB. So a newborn hearing screening must be the first step in identification, intervention and habilitation of an infant with hearing loss. Use of a cochlear implant seemed to have a great impact on the oral language development of children with a bilateral loss > 90 dB.

Children's speech recognition in noise using omni-directional and dual-microphone hearing aid technology

OBJECTIVE

The purpose of this study was to examine children's speech recognition abilities for words and sentences presented in background noise when the children used omni-directional and dual-microphone hearing aid technology.

DESIGN

Twenty children (ten 4- to 6-yr olds; ten 7- to 11-yr-olds) with bilateral cochlear hearing loss (average four-frequency hearing loss = 57.25 dB HL; range: mild to severe) were included in the study. An adaptive test procedure was used to estimate a signal to noise ratio (SNR) that reduced individual speech recognition ability to 50% in multi-talker background competition. Testing was completed with the child seated in a conventional audiologic test suite. A fixed level of the speech signal was delivered through a loudspeaker located at 0 degrees; noise varying in 2 dB steps was presented at 180 degrees. SNR was estimated for two types of speech materials (closed-set words and sentences). Children wore binaural programmable hearing aids (Phonak PiCS) and were tested in conventional omni-directional and dual-microphone ("Audio Zoom") conditions.

RESULTS

Significant effects of microphone condition, speech material type (words and sentences), and age group ("younger" and "older") were revealed by mixed design analysis of variance. Overall, children received a mean advantage of 4.7 dB from listening in the dual-microphone condition. Children's performance was correlated with their chronological age and language age (receptive vocabulary) but not with their degree of hearing loss (except in one condition). Younger children required a more advantageous SNR to achieve the same performance criteria as older children.

CONCLUSIONS

Under the specific test conditions used in this investigation, dual-microphone hearing aid technology provided a significant listening advantage in background competition over conventional omni-directional microphones for children with mild to severe cochlear hearing loss for both word and sentence test materials.