Vestibular functions in patients with idiopathic sudden sensorineural hearing loss and its relation to prognosis.

OBJECTIVE: Because of the anatomically close relationship between the cochlea and the vestibular organs, cochlear function disorders may be accompanied by vestibular disorders. This study aimed to evaluate vestibular functions in patients with idiopathic sudden sensorineural hearing loss using VEMP, caloric test, and VNG test battery and its relation to prognosis. MATERIALS AND METHODS: For this study, 42 patients aged 18-55 years with idiopathic sudden sensorineural hearing loss and 30 volunteers who had no hearing and balance problems were included. Audiometry, cVEMP, oVEMP, caloric tests, and VNG tests were performed. Moreover, the effects of age, sex, time of admission, degree and configuration of hearing loss, accompanying vertigo, tinnitus, and ear fullness on improvement in hearing were evaluated. RESULTS: Of the 42 patients in the study group, 26 (56.52%) were male, 20 (43.48%) were female, and the mean age was 41.54 ± 12.23 years. Of the 30 individuals in the control group, 19 (63.3%) were male, 11 (36.7%) were female, and the mean age was 39.53 ± 13.03 years. There was no significant difference in the incidence of sudden sensorineural hearing loss in terms of sex and age, and the prognosis was better for female patients. Early admission to treatment was a factor of good prognosis; profound hearing loss, bilateral hearing loss and vertigo were factors of poor prognosis. Prognosis was better in patients with rising type audiogram configuration, while the prognosis was worse in patients with flat, descending and total hearing loss. Tinnitus and ear fullness had no effect on the prognosis. No anomalies were observed in VNG findings. Moreover, abnormal caloric response was higher in patients with profound hearing loss and total hearing configuration. Shortening was observed in cVEMP / oVEMP P1 and N1 latency after treatment. Furthermore, there was an improvement in abnormal responses after treatment. CONCLUSION: In this study, vestibular function was affected in patients with idiopathic sudden sensorineural hearing loss. The present study can help the development of a clinical strategy in the evaluation of the vestibular system in idiopathic SSNHL, patient follow-up, patient information, and the implementation of vestibular rehabilitation. Note that additional studies involving larger patients series are required.

Does 3 Tesla Magnetic Resonance Imaging Have Adverse Effect on Cochlear Functions?

OBJECTIVE: The aim of this study was to investigate the effects of 3 Tesla (3T) magnetic resonance imaging (MRI) noise on cochlear functions. METHODS: The distortion product otoacoustic emission (DPOAE) test was applied to patients who were scheduled to have 3T MRI in the tertiary care center. Patients who revealed emission amplitudes at all frequencies (1, 1.5, 2, 3, 4, 6, and 8 kHz) in the DPOAE test before MRI were included in the study. After MRI, the DPOAE test was performed twice on 17 patients (33 ears) (immediately after MRI and 30 minutes after MRI). The changes in the results of the tests taken before MRI (pre-MRI), immediately after MRI (post-MRI 1), and at 30 minutes after MRI (post-MRI 2) in the DPOAE amplitudes at all frequencies were compared statistically. RESULTS: There was a significant difference between pre-MRI, post-MRI 1, and post-MRI 2 measurements at 3, 6, and 8 kHz. In pairwise comparisons; post-MRI 1 was statistically lower than post-MRI 2 at 3 kHz, and post-MRI 1 was statistically lower than pre-MRI and post-MRI 2 at 6 and 8 kHz. In addition, post-MRI 2 was significantly lower than pre-MRI at 8 kHz. CONCLUSION: According to these results, 3T MRI noise does not have any permanent negative impact on hearing functions. It can only cause DPOAE amplitude changes at high frequencies. This is a clinically negligible effect. Therefore, it can be considered that the 3T MRI examination with protective headphones does not cause any adverse side effects in terms of hearing functions.

Normalization of Bone Conduction Auditory Brainstem Evoked Responses in Normal Hearing Individuals.

OBJECTIVES: Auditory brainstem responses (ABR) are used to evaluate the peripheral and central functions of the auditory tract. Air and bone-conduction auditory stimuli are used to evaluate the type and degree of hearing loss. The wave latencies and interpeak latencies (IPLs) are the important diagnostic data in ABR tests. Gender and age of the patients are some of the factors affecting these latencies. This study investigated the effects of age and gender on the wave and IPLs of bone-conduction ABR. MATERIALS AND METHODS: One hundred healthy individuals (50 women and 50 men) aged between 10 and 60 years were enrolled into this study, and both ears of all subjects (200 ears total) were included in the assessments. Based on their age, the subjects were equally divided into five groups, and each group consisted of 10 men and 10 women. RESULTS: The findings showed a significant difference in wave latencies and IPLs between the two genders (p<0.05). Depending on stimulus intensity, wave latencies also showed statistically significant differences between the age groups (p<0.05). However, no significant difference was noted between the age groups regarding IPLs. CONCLUSION: Normative values that covered wave latencies and IPLs evoked at stimulus intensities of 50, 30, and 10 dB nHL were established for the clinical use and use as a reference for the bone-conduction ABR testing procedure.

Regional differences of Turkey in risk factors of newborn hearing loss.

OBJECTIVE: The aim of this study was to discover Turkish regional differences in the risk factors of newborn hearing loss. METHOD: A multi-centered retrospective design was used. A total of 443 children, registered to the national newborn hearing screening programme, with bilateral hearing loss, from five different regions of Turkey, were evaluated in terms of the types of hearing loss, the degree of hearing loss, the types of risk factors, parental consanguinity, age at diagnosis and age of auditory intervention, respectively. RESULTS: There was no significant difference in the prevalence of hearing loss between regions (χ2 = 3.210, P = 0.523). Symmetric Sensorineural Hearing Loss (SSHL) was the most common type of HL in all regions (91.8%). Profound HL was the most common degree of HL in all regions (46.2%). There were statistically significant differences between regions in terms of types of HL (χ2 = 14.151, P = 0.000). As a total, 323 (72.9%) of subjects did not have any risk factors. There were statistically significant differences between regions in terms of the types of risk factors (pre, peri and post-natal) for SSNHL (χ2 = 16.095, P = 0.000). For all regions, the age of diagnosis was convenient with the JCIH criteria. However the age of hearing aid application was prolonged in some regions. There were statistically significant differences between regions in terms of the age of diagnosis (χ2 = 93.570, P = 0.000) and the age of auditory intervention (χ2 = 47.323, P = 0.000). The confounding effects of gender, age of diagnosis, age of hearing aids applications, HL in the family, types of risk factors for HL on SSNHL were detected. CONCLUSION: To reach the goal of a high quality newborn hearing screening, there is a need to develop an evidence-based standard for follow up guideline. In addition, risk factors should be re-evaluated according to regional differences and all regions should take their own precautions according to their evidence based data.

Evaluation of the Relationship Between the Air-Bone Gap and Prolonged ABR Latencies in Mixed-Type Hearing Loss.

OBJECTIVE: The aim of this study was to determine the air-bone gaps in adults with mixed-type hearing loss using air-conduction auditory brainstem response (ABR) latencies. MATERIALS AND METHODS: Thirty adults with mixed-type hearing loss (study group) and 30 adults with normal hearing (control group) were included in this study. Before performing ABR measurements, ear, nose, and throat examinations, pure tone audiometry, speech audiometry, acoustic immittance audiometry, and transient evoked autoacoustic emission testing were performed for all participants. Absolute latencies of I, III, and V waves and interpeak latencies (IPL) at 90 decibel hearing level dB nHL were evaluated and compared with air-bone gap results. RESULTS: ABR latencies using click and tone-burst stimulation were obtained and found to be longer in the mixed-type hearing loss group than in the normal hearing group (p<0.05). A moderate positive relationship was detected between the air-bone gap and wave III/V latencies at 0.5/1 kHz, I-V/I-III/III-V IPL at 1 kHz. Only one strong relationship was found between 1 kHz air-bone gap and I-V IPL. CONCLUSION: In this study, the magnitude of the air-bone gap could not determined using prolonged ABR latencies. Delays in ABR latencies were observed, but prolonged ABR latencies was not helpful for calculating the air-bone gap on mixed-type hearing loss.

What Is the Audiological Evaluation Time for those Aged 0-5 Years and Older?

OBJECTIVE: The purpose of this study was to determine the time taken to perform audiological evaluation under routine clinical test conditions. We also aimed to investigate relevant variables and reasons for increases in test time. MATERIALS AND METHODS: The total test times of 300 patients were recorded and calculated using an "Audiological Evaluation Time Calculation Form." Behavioral and objective test times were determined and calculated separately. The patients were divided into groups on the basis of age, educational status, cooperation, and coordination in order to determine the effects of these factors on the test time. RESULTS: The mean time for behavioral tests was 41.85 min for children below the age of 6 years and 36.2 min for those above that age. The times for transient evoked otoacoustic emission, distortion product otoacoustic emission, automated auditory brainstem response, and auditory brainstem response tests were 6.4/4.3 min, 4.8/6.9 min, 14.4 min, and 48.0/47.5 min, respectively, for the two age groups. The shortest total test times were obtained from the 15-29 age group, high school/university levels, and patients who cooperated. Conversely, the longest total test times were found in 6-14 age group, those with no literacy, and who hardly cooperated. CONCLUSION: Although audiological evaluation methods have well-defined international standards, numerous factors, including patient conditions, clinician experience, and equipment, may have an adverse effect on test times. Determining the optimum patient number in one working day can help reduce workload and work stress and prevent possible errors of diagnosis/treatment. It will also help determine staff numbers needed in audiology clinics.

[Examination of relationship between level of hearing and written language skills in 10-14-year-old hearing impaired children]. / Isitme engelli 10-14 yas arasi çocuklarda isitme düzeyi ile yazili dil becerileri arasindaki iliskinin incelenmesi.

OBJECTIVES: This study aims to review the relationship between written language skills and factors which are thought to affect this skill such as mean hearing loss, duration of auditory deprivation, speech discrimination score, and pre-school education attendance and socioeconomic status of hearing impaired children who attend 4th-7th grades in primary school in inclusive environment. PATIENTS AND METHODS: The study included 25 hearing impaired children (14 males, 11 females; mean age 11.4±1.4 years; range 10 to 14 years) (study group) and 20 children (9 males, 11 females; mean age 11.5±1.3 years; range 10 to 14 years) (control group) with normal hearing in the same age group and studying in the same class. Study group was separated into two subgroups as group 1a and group 1b since some of the children with hearing disability used hearing aid while some used cochlear implant. Intragroup comparisons and relational screening were performed for those who use hearing aids and cochlear implants. Intergroup comparisons were performed to evaluate the effect of the parameters on written language skills. RESULTS: Written expression skill level of children with hearing disability was significantly lower than their normal hearing peers (p=0.001). A significant relationship was detected between written language skills and mean hearing loss (p=0.048), duration of auditory deprivation (p=0.021), speech discrimination score (p=0.014), and preschool attendance (p=0.005), when it comes to socioeconomic status we were not able to find any significant relationship (p=0.636). CONCLUSION: It can be said that hearing loss affects written language skills negatively and hearing impaired individuals develop low-level written language skills compared to their normal hearing peers.

Are computed tomography and densitometric measurements useful in otosclerosis with mixed hearing loss? A retrospective clinical study.

The objective of the study was to investigate the relationship between extent of otosclerotic foci and audiological findings in otosclerotic patients with mixed hearing loss using high-resolution computed tomography (HRCT) and also to measure the density of bony labyrinth in otosclerotic patients and compared with control group. This was a retrospective study. Twenty-five patients with clinical otosclerosis and mixed hearing loss were included in the study. The average threshold of air-bone conductions (AC, BC) within the 0.5-4 kHz frequency range, and average air bone gap (ABG) were calculated. Eleven patients with normal HRCT who received cochlear implant were included in the study as the control group. The lesions in HRCT were staged according to their extension. Eight different points of the otic capsule in each patient were measured using HRCT. Fifty ears total, from 25 patients, had bilateral otosclerosis. The mean AC of all the ears was 63 dB, mean BC was 35.2 dB, and mean ABG was 27.8 dB. HRCT staging indicated 22 ears had Grade 1, 21 ears had Grade 2, and 7 ears had Grade 3 lesions. There was a statistically significant difference between the mean AC, BC of ears with Grade 1 and Grade 2 when compared with the mean AC, BC of ears with Grade 3. When comparing the densitometric measurements of fissula ante fenestram localizations, a statistically significant difference was observed. HRCT examination and densitometric measurements in otosclerotic patients with mixed hearing loss presented significant results. We were unable to show a significant relationship between early stage and hearing thresholds, but there was a significant relationship in advanced stage. Densitometric measurements may provide significant results for otosclerosis, particularly for the FAF region when comparing with control group.

Features of unilateral hearing loss detected by newborn hearing screening programme in different regions of Turkey.

OBJECTIVE: Newborn hearing screening (NHS) works well for babies with bilateral hearing loss. However, for those with unilateral loss, it has yet to be established some standard rules like age of diagnose, risk factors, hearing loss degree. The aim of this study is to identify the demographic characteristics of newborns with unilateral hearing loss to obtain evidence based data in order to see what to be done for children with unilateral hearing loss (UHL). METHOD: Newborn hearing screening data of 123 babies with unilateral hearing loss, 71 (57.7%) male and 52 (42.3%) female, were investigated retrospectively. Data provided from the archives of six referral tertiary audiology centers from four regions in Turkey. Data, including type of hearing loss; age of diagnosis; prenatal, natal and postnatal risk factors; familial HL and parental consanguinity was analyzed in all regions and each of the Regions 1-4 separately. RESULT: The difference between data obtained in terms of gender and type of hearing loss was detected as statistically significant (p<0.05). While UHL was significantly higher in females at Region 1, and in males at other Regions of 2-4; SNHL was the most detected type of UHL in all regions with the rate of 82.9-100.0%. There were not significant differences between regions in terms of the degree of hearing loss, presence of risk factors, family history of hearing loss, age at diagnosis and parental consanguinity (p>0.05). Diagnosis procedure was completed mostly at 3-6 months in Region 4; whereas, in other regions (Regions 1-3), completion of procedure was delayed until 6 months-1 year. CONCLUSION: This study indicates that the effect of postnatal risk factors, i.e. curable hyperbilirubinemia, congenital infection and intensive care is relatively high on unilateral hearing loss, precautions should be taken regarding their prevention, as well as physicians and other health personnel should be trained in terms of these risks. For early and timely diagnosis, families will be informed about hearing loss and NHS programme; will be supported, including financial support of diagnosis process. By dissemination of the NHS programme to the total of country by high participation rate, risk factors can be determined better and measures can be increased. Additionally, further studies are needed with more comprehensive standard broad data for more evidence based consensus.

[Self and significant other assessment of hearing device aided communication skills in the elderly with hearing loss]. / Isitme kaybi olan yaslilarda isitme cihazi destekli iletisim becerilerinin kendileri ve yakinlari tarafindan degerlendirilmesi.

OBJECTIVES: This study aims to evaluate the communication problems of elderly before and after using hearing aids. PATIENTS AND METHODS: Thirty hearing aid users and 10 normal hearing control subjects with their relatives were enrolled in the study. Hearing aid users were divided into three subgroups based on the duration of use. Self Assessment of Communication (SAC) and Significant Other Assessment of Communication (SOAC) questionnaires were administered to hearing aid users, control subjects, as well as to their relatives for the evaluation of communication difficulties due to hearing loss. Intra-group comparisons were carried out in the patients using hearing aids, while inter-group comparisons were performed to evaluate the effects of different aided periods on communication skills. RESULTS: It was found that the communication difficulties reduced in the patients who used hearing aid for minimum one month. For the patients with hearing loss, hearing aid use of six months or more increased SAC and SOAC scores to a level comparable with control subjects. CONCLUSION: The present study conclude that the elderly patients of 60 years of age or more with moderate sensorineural hearing loss could catch up their normal hearing peers in their communication skills within six months only if they prescribed and used proper hearing aids.

[Evaluation of high frequency hearing thresholds in smokers]. / Sigara kullananlarda yüksek frekans isitme esiklerinin degerlendirilmesi.

OBJECTIVES: We investigated whether high frequency hearing thresholds differed between smokers and nonsmokers. SUBJECTS AND METHODS: The study was carried out in 50 individuals including 20 nonsmokers (mean age 29 years; range 25 to 37 years) and 30 smokers (mean age 34 years; range 25 to 50 years). The smokers group was comprised of individuals who had been smoking at least a pack a day for more than 10 years. High frequency hearing thresholds (8-18 kHz) were compared between the two groups. RESULTS: The mean hearing thresholds of smokers at 16 kHz were 50.66 dB HL and 49.50 dB HL in the left and right ears, respectively; the corresponding figures for nonsmokers were 31.00 dB HL and 33.25 dB HL, respectively (p=0.005). The mean hearing thresholds of smokers and nonsmokers at 18 kHz were 57.33 dB HL and 41.25 dB HL for the left ears, and 59.33 dB HL and 42.52 dB HL for the right ears, respectively (p=0.005). Analyses between the two groups after exclusion of subjects over 40 years of age showed significant differences at 16 kHz and at 18 kHz for the left ears, and at 18 kHz for the right ears (p=0.005). CONCLUSION: Our results suggest that smoking can be considered one of the factors that plays a role in high frequency hearing loss.