Association between hearing loss and gout based on National Health and Nutrition Examination Survey and Mendelian randomization analysis.

Hearing loss(HL) represents a significant public health concern. This study aimed to determine the association between hearing loss and gout and to elucidate the underlying causative mechanisms. Data for this study were obtained from the National Health and Nutrition Examination Survey (NHANES) and Mendelian randomization (MR) basic databases. Initially, baseline characteristics of individuals with and without gout were compared. A nonlinear relationship between pure tone audiometry (PTA) values and gout prevalence was confirmed through restricted cubic spline (RCS) curve analysis. Subsequently, hearing loss was categorized into different levels based on PTA values, and multiple logistic regression analysis was employed to calculate the impact of varying degrees of hearing loss on the risk of gout. Finally, MR analysis was conducted to further elucidate the causal relationship between hearing loss and gout. A total of 3,258 individuals were included in this study, with a gout prevalence of 3.7%. Significant differences were observed between the gout group and the non-gout group in variables such as age, gender, blood uric acid level, BMI, hypertension, and diabetes. RCS curve analysis revealed a significant nonlinear relationship between PTA values and gout risk, particularly when PTA values exceed a specific threshold, where the curve flattens. Based on different levels of hearing loss derived from PTA values, multiple logistic regression analysis demonstrated that mild and moderate hearing loss significantly increased the risk of gout, remaining statistically significant after adjusting for covariates (odds ratio (OR) = 2.10-3.48, P < 0.05). MR analysis further confirmed the causal relationship between hearing loss and gout. Inverse variance weighting (IVW) was employed as the primary method, revealing that both individuals with hearing difficulties (OR = 0.98, 95% confidence interval (CI) 0.96-0.999, P = 0.012) and those without hearing impairment (OR = 1.02, 95% CI 1.01-1.04, P = 0.012) exhibited a significant causal relationship with gout. Goodness-of-fit tests and sensitivity analyses were used to verify the reliability of the results. Hearing loss has a significant causal relationship with an increased risk of gout, providing a new perspective for the prevention and management of gout. Focused attention and prompt treatment of hearing loss, particularly mild and moderate hearing loss, may significantly reduce the risk of developing gout.

Performance and Reliability Evaluation of an Automated Bone-Conduction Audiometry Using Machine Learning.

To date, pure-tone audiometry remains the gold standard for clinical auditory testing. However, pure-tone audiometry is time-consuming and only provides a discrete estimate of hearing acuity. Here, we aim to address these two main drawbacks by developing a machine learning (ML)-based approach for fully automated bone-conduction (BC) audiometry tests with forehead vibrator placement. Study 1 examines the occlusion effects when the headphones are positioned on both ears during BC forehead testing. Study 2 describes the ML-based approach for BC audiometry, with automated contralateral masking rules, compensation for occlusion effects and forehead-mastoid corrections. Next, the performance of ML-audiometry is examined in comparison to manual and conventional BC audiometry with mastoid placement. Finally, Study 3 examines the test-retest reliability of ML-audiometry. Our results show no significant performance difference between automated ML-audiometry and manual conventional audiometry. High test-retest reliability is achieved with the automated ML-audiometry. Together, our findings demonstrate the performance and reliability of the automated ML-based BC audiometry for both normal-hearing and hearing-impaired adult listeners with mild to severe hearing losses.

Correlation of Air-Bone Gap on Pure Tone Audiometry with the Size of Perforation Assessed on Oto-Endoscopy.

OBJECTIVE: To determine the correlation between the air-bone gap on pure tone audiometry with size of perforation oto-endoscopically.  Study Design: A descriptive study. Place and Duration of the Study: Department of ENT - Head and Neck Surgery, Dow University of Health Sciences (DUHS), from February 2020 to August 2021.  Methodology: A total of 43 patients with dry central pars tensa tympanic membrane perforation were diagnosed through oto-endoscopy during the study. The mean air-bone gap was calculated by assessing each air-bone gap through pure tone audiometry at different frequencies i.e., 250 Hz, 500 Hz, 1,000 Hz, 2,000 Hz, and 4,000 Hz. Air-bone gap was found to be the average value of these frequencies. The photograph of the tympanic membrane was taken oto-endoscopically, and the ratio between size of the perforation to the entire area of the tympanic membrane was measured. RESULTS: During the course of the study, a total of 43 patients agreed to provide consent for this study. Out of the 43 patients, 16 (37.2%) were males and 27 (62.8%) were females. The age range was from 18 to 50 years with average age of 38.302 ± 5.74 years. The mean perforation size was 28.255 ± 9.16% while the mean air-bone gap was 28.000 ± 3.89 dB. It was concluded that the Pearson's correlation coefficient is directly correlated to perforation size and air-bone gap (r = 0.898, p <0.001). Further, hearing loss decreases with decreased middle ear volume and mastoid pneumatisation. Moreover, no change was seen in the mean air-bone gap according to the location of perforation. CONCLUSION: The hearing loss due to perforation of the tympanic membrane was correlated to the size of the perforation. Further, hearing loss decreases with reduced middle ear volume and mastoid pneumatisation. KEY WORDS: Size of perforation, Hearing loss, Air-bone gap, Oto-endoscopy, Conductive deafness, Mastoid pneumatisation.

Sensorineural hearing loss in Lyme neuroborreliosis.

BACKGROUND: Sensorineural hearing loss (SNHL) has been suggested to occur in patients with Lyme neuroborreliosis (LNB); however, a clear association has never been documented. The present study prospectively investigated the development of SNHL in patients admitted for treatment of LNB using distortion-product-oto-acoustic emissions (DPOAE) as a measure of cochlear function. METHODS: DOAE were measured in patients with LNB on the day of diagnosis, during treatment, and 30-60 days after discharge. Frequencies were categorized as Low (1, 1.5, 2 kHz), Mid (3, 4, 5 kHz), Mid-high (6, 7, 8 kHz), and High (9, 10 kHz). Pure Tone Audiometry (PTA3) was performed at discharge and 60 days after. Patients were treated with i.v. ceftriaxone or oral doxycycline for 14 days according to guidelines. RESULTS: DPOAE measurements were obtained in 25 patients with LNB at admission and in 18 patients at follow-up. Median age was 56 years (IQR, 48-64 years), and 16 (67%) were men. Fourteen (78%) of 18 patients showed improvement in Emission Threshold Levels (ETL) from admission to follow-up in low, mid-, and mid-high frequency categories, where ETLs increased by median levels of 3.2 (-4.1 to 8.3), 7.5 (-2.8 to 9.8), and 4.7 dB (-4.3 to 10.1). A decline was observed in the high frequency category, median -3.3 dB (-9.1 to 6.7). SNHL defined by pure tone average (PTA3) >20 dB was present in 11 out of 23 (48%) at discharge and in 9 out of 16 patients (56%) 60 days after discharge, which differed significantly from matched controls (Mann-Whitney test, p = 0.036). CONCLUSION: LNB can lead to cochlear outer-hair cell dysfunction, resulting in temporary and long-term SNHL.

The effect of active rheumatoid arthritis on hearing impairment.

OBJECTIVE: To assess hearing loss in rheumatoid arthritis (RA) patients, and to explore its association with disease attributes and activity. METHODS: The cross-sectional case-control study was conducted from June to December 2022 at Al-Imamein Al- Kadhimein Hospital, Medical City, Baghdad, Iraq, and comprised rheumatoid arthritis patients and healthy controls of either gender aged 18-45 years. Data was collected using electronic instruments and a physical examination, including pure tone audiometry and tympanogram. Data was analysed using SPSS 24. RESULTS: Of the 90 subjects, 60(66.7%) were patients; 45(75%) female and 15(25%) males with mean age 32.9 1±7.21 years and mean body mass index 27.14±8.58kg/m2. There were 30(33.3%) controls; 18(60%) female and 12(40%) males with mean age 30.25±5.51 years and mean body mass index 26.92±6.66kg/m2. The control group had thresholds below 25dB for all frequencies in both ears, which were notably lower than those of the RA patients (p=0.005). The left ear showed significant variation at 2000Hz and 4000Hz, while the right ear showed substantial differences at all frequencies except 1000Hz. CONCLUSIONS: The risk of hearing loss was found to be increased in rheumatoid arthritis patients, and it seemed to be related to illness duration.

Lipid metabolism and hearing loss: association of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) with adolescent hearing health.

BACKGROUND: The ratio of non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol (NHHR) is a novel lipid measure for assessing the risk of cardiovascular disease. Lipid metabolism disorders are reportedly associated with hearing impairment. This study aimed to investigate the potential association between NHHR and hearing. METHODS: The data used in this study were obtained from the National Health and Nutrition Examination Survey (NHANES) cycles of 2005-2010 and 2017-2018, including 4,296 participants aged 6-19 years. The NHHR was calculated from lipid profiles, and hearing was assessed using pure-tone audiometry. Weighted multivariate logistic regression analyses were used to investigate the association between the NHHR and hearing loss. Subgroup and sensitivity analyses were performed to verify the robustness of the results. RESULTS: Univariate analysis revealed significant associations between the NHHR and hearing threshold at all categorized frequency (low, speech, or high-frequency) (P < 0.001). Three models were used: an unadjusted model, a model adjusted for age, sex, and race, and a model further adjusted for PIR, BMI, and diabetes. Multiple regression analysis confirmed these associations consistently across all models. When considered as a continuous variable, NHHR had a significant association with enhanced hearing thresholds at all categorized frequencies: low-frequency (ß:0.56, 95% CI: 0.36-0.75), speech-frequency (ß:0.55, 95% CI: 0.36-0.7), and high-frequency (ß:0.55, 95% CI: 0.36-0.74). The adjusted models showed persistent positive correlations after controlling for covariates. The NHHR was consistently positively associated with hearing loss. The NHHR and auditory thresholds showed a general dose-response association across all frequencies. CONCLUSIONS: NHHR is a promising biomarker for predicting adolescent hearing threshold shifts and hearing loss. The study highlights the importance of early lipid monitoring and management as strategies to prevent or reduce hearing impairment.

Detection of mild sensory hearing loss using a joint reflection-distortion otoacoustic emission profile.

Measuring and analyzing both nonlinear-distortion and linear-reflection otoacoustic emissions (OAEs) combined creates what we have termed a "joint-OAE profile." Here, we test whether these two classes of emissions have different sensitivities to hearing loss and whether our joint-OAE profile can detect mild-moderate hearing loss better than conventional OAE protocols have. 2f1-f2 distortion-product OAEs and stimulus-frequency OAEs were evoked with rapidly sweeping tones in 300 normal and impaired ears. Metrics included OAE amplitude for fixed-level stimuli as well as slope and compression features derived from OAE input/output functions. Results show that mild-moderate hearing loss impacts distortion and reflection emissions differently. Clinical decision theory was applied using OAE metrics to classify all ears as either normal-hearing or hearing-impaired. Our best OAE classifiers achieved 90% or better hit rates (with false positive rates of 5%-10%) for mild hearing loss, across a nearly five-octave range. In summary, results suggest that distortion and reflection emissions have distinct sensitivities to hearing loss, which supports the use of a joint-OAE approach for diagnosis. Results also indicate that analyzing both reflection and distortion OAEs together to detect mild hearing loss produces outstanding accuracy across the frequency range, exceeding that achieved by conventional OAE protocols.

Effect of Age on Distortion Product Otoacoustic Emissions at Extended High Frequencies.

The inner ear is most susceptible to the aging effects. Distortion product otoacoustic emissions (DPOAEs) are a good indicator for interpreting the age effects but are usually recorded at up to 8000 Hz frequencies in routine audiologic testing. The present study was designed to assess and compare the DPOAEs at conventional frequencies and at extended high frequencies (EHFs) across different age groups. Extended high-frequency audiometry (9000-16000 Hz) and DPOAEs from 500-16000 Hz were recorded on 80 adult (160 ears) participants (15-55 years) with normal hearing sensitivity. The participants were categorized into 4 groups: group I (15-<25 years), group II (25-<35 years), group III (35-<45 years), and group IV (45-55 years). A statistically significant reduction in EHF thresholds was observed from group III onward. However, the thresholds were comparatively better for group III at frequencies 9000, 10000, and 11500Hz than group IV. No significant difference was observed for EHF DPOAEs in groups I and II (except at 16000 Hz) and III and IV. Distortion product otoacoustic emissions at conventional frequencies in group IV were significantly poorer than the other 3 groups. A weak negative correlation was observed between the DPOAE parameters and EHF thresholds. The effect of age was more pronounced on EHF DPOAEs than EHF thresholds for frequencies 9000, 10000, and 11500 Hz. Distortion product otoacoustic emissions at EHF started deteriorating below the age of 30 years and showed a rapid decline above 35 years. Extended high-frequency DPOAEs can be used as screening tools to assess the function of the basal part of the cochlea.

Primary Stapedectomy: A Retrospective Review of Surgical Results Using a Cold Steel Technique and Pre-Operative CT Correlates.

IMPORTANCE: Stapedectomy is an effective treatment option for patients with symptomatic otosclerosis. A common surgical technique today is laser stapedotomy, although the equipment required adds a significant cost to the procedure and may not be available in certain, particularly remote, centers. This study aimed to evaluate cold steel stapedectomy in a modern otology practice as a cost-effective and versatile alternative. OBJECTIVE: The primary objective was to evaluate the efficacy and safety of cold steel stapedectomy. The secondary objectives included characterizing the prevalence of relevant computed tomography (CT) findings and evaluating other factors such as piston size. DESIGN: A retrospective case series from April 2006 to November 2021. SETTING: A single tertiary care hospital in Montreal, QC, Canada. PARTICIPANTS: Patients with suspected otosclerosis and no prior stapes surgery. INTERVENTION: Cold steel primary stapedectomy. MAIN OUTCOME MEASURES: In primary analysis, change in pure tone thresholds, pure tone average (PTA), and complication rates were obtained. Secondary analysis measures included rates of relevant CT findings and change in PTA with piston size. RESULTS: A total of 302 cases were included in the analysis. The average change in air conduction PTA was a decrease of 27 dB, with 91% (276/302) having over 10 dB of improvement. The air-bone gap was closed to within 10 dB in 82% (248/302) of cases and within 20 dB in 96% (290/302) of cases. Overclosure occurred in 19% of cases, while only 4% resulted in worsened PTA bone conduction thresholds. In secondary analysis, 74% of CT scans demonstrated radiologic otosclerosis. Other findings included suspected superior semicircular canal dehiscence in 1.8%. CONCLUSION: Cold steel stapedectomy was demonstrated to be a safe and effective technique, with audiometric results comparable to laser and drill studies in recent literature. It should be considered as a cost-effective and global health accessible alternative. Additionally, CT scans can provide valuable information in the pre-operative workup.

Hearing and balance functions in patients with systemic lupus erythematosus.

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic, inflammatory, autoimmune disease, characterized by multiple organ involvement, which is seen more often in young females. OBJECTIVES: To evaluate the hearing and balance functions in SLE patients. MATERIALS AND METHODS: Twenty-four SLE patients, 24 healthy controls underwent pure tone audiometry (0.125-16 kHz), VNG, vestibular evoked myogenic potential (VEMP), and video head impulse test (vHIT). RESULTS: A statistically significant difference was determined between the control group and the SLE group at 0.125, 0.25, 0.5, 1.0, 6.0, 8.0, 10, 12, 14, and 16 kHz frequencies. Sensorineural hearing loss was observed in 37.5% of the SLE group. The pursuit test was pathological at the rate of 25% in the SLE group. No response was obtained in six SLE patients in the oVEMP test and four SLE patients in the cVEMP test. The mean posterior SCC VOR gain values were 0.64 ± 0.2 in the SLE group. A significant difference was determined between the groups with respect to posterior SCC VOR gains. CONCLUSIONS AND SIGNIFICANCE: Our findings show that SLE disease may negatively affect the hearing system and the vestibular system as well. The current study is the first study to comprehensively evaluate SLE patients with VNG, VEMP, and vHIT tests.

Effects of Ultrasonic Use on Hearing Loss in Dental Hygienists: A matched pairs design study.

Purpose Dental professionals are exposed to hazardous noise levels on a daily basis in clinical practice. The purpose of this study was to compare the hearing status of dental hygienists who utilize ultrasonic scalers in the workplace compared to age-matched control participants (non-dental hygienists) who were not exposed to ultrasonic noise.Methods A convenience sample of nineteen dental hygienists (experimental) and nineteen non-dental hygienists (control) was recruited for this study. A matched pairs design was utilized; participants in each group were matched based on age and gender to eliminate confounding variables. The testing procedure consisted of an audiologist performing a series of auditory tests including otoacoustic emissions test, pure-tone audiometry, and tympanometry on the experimental and control groups.Results In the right ear, there were notable differences from 1000 Hz - 10,000 Hz and in the left ear from 6000 Hz - 10,000 Hz, with higher hearing thresholds in the experimental group of dental hygienists. While 56% of the univariate tests conducted on how many days were worked per week showed statistical significance, the regression line slope indicated those that worked more days had better hearing statuses. The variables for years in practice for dental hygienists, how many of those years were full-time employment, and how many years the dental hygienist had used an ultrasonic scaling device, also had many significant univariate tests for the experimental group only. These variables were more likely to serve as proxies representing true noise exposure. The paired t-test between the groups demonstrated statistically significant differences between the experimental and control group at 9000 Hz in both ears.Conclusion While results from this study demonstrated various qualitative differences in hearing status of the control group (non-dental hygienists) and experimental group (dental hygienists), age was found to be the most critical variable. Furthermore, this data demonstrated differences in hearing status based on various frequencies between dental hygienists and age-matched controls that should be further explored with a larger population.

Prognostic Factors of Hearing Improvement for EES and MES in Attic Cholesteatoma.

OBJECTIVE: The surgical strategy of cholesteatomas is still controversial. This study aimed to compare the hearing improvement and determine the prognostic factors between endoscopic and microscopic ear surgery for attic cholesteatoma via a multicenter retrospective study. METHODS: This retrospective study included 169 patients with attic cholesteatoma who received endoscopic ear surgery (EES) or microscopic ear surgery (MES) from 12 otorhinolaryngology centers. Hearing improvement between EES and MES was evaluated, including the postoperative pure tone average (PTA) and air-bone gap (A-B Gap), as well as the hearing threshold across the low-, mid-, and high-frequency. The success rate of grafts was collected. Linear regression was performed to access the prognostic value of preoperative PTA and A-B Gap. Patients were followed up for at least 3 years. RESULTS: The graft success rate of EES was 89.66% (78/87) versus 80.49% (66/82) for MES. The postoperative PTA and A-B Gap demonstrated significant improvement in EES compared to MES (Post-PTA: t = 3.281, P = .001; Post-A-B Gap: t = 2.197, P = .029). In the EES group, there were 59 ears (67.82%) with a postoperative A-B Gap ≤20 dB HL, which revealed a higher rate of successful hearing outcomes in EES as opposed to MES (χ2 = 9.904, P = .019). There were significantly better hearing improvement, shorter surgical times, and lower hospital stays in EES for epitympanic cholesteatoma without stapes superstructure involvement. The preoperative AC ≤79 dB and/or preoperative A-B Gap ≤52 dB was associated with a better prognosis in EES for epitympanic cholesteatoma with stapes superstructure involvement. CONCLUSIONS: EES showed higher graft success rate, better hearing improvement, shorter surgical times and hospital stays for attic cholesteatoma, particularly without stapes superstructure involvement. The range of preoperative PTA and A-B Gap have shown the prognostic value, which maybe a favorable surgical indication for EES or MES.

Evaluation of the audiovestibular system before and after treatment in patients with Idiopathic intracranial hypertension.

BACKGROUND: Idiopathic intracranial hypertension (IIH) can affect both hearing and balance due to increased inner ear pressure. AIMS/OBJECTIVES: This study aimed to evaluate the impact of increased inner ear pressure on hearing and balance in patients with IIH using auditory and vestibular tests. MATERIAL AND METHODS: Twenty-four IIH patients and 28 healthy controls underwent oVEMP, pure tone audiometry, tympanometry, and acoustic reflex tests pre-lumbar punctures. IIH patients received acetazolamide. Pre- and post-treatment results, tinnitus, and vertigo scores were compared. Post-treatment oVEMP and audiometry results were compared between groups. RESULTS: Pre-treatment oVEMP showed a significant left N1 latency difference (p = 0.049). Post-treatment, left ear amplitude (p = 0.035) and both ear amplitude ratios (p = 0.044 and p = 0.047) increased significantly. Audiometry had no significant changes (p < 0.05). Tinnitus and vertigo scores decreased significantly (p ≤ 0.001). CONCLUSION: Prolonged oVEMP latency suggests IIH may impact the brain stem and vestibular nerve, while increased amplitude values indicate peripheral vestibular involvement. IIH affects hearing across all frequencies, especially at 4000 Hz, impacting both hearing and balance. SIGNIFICANCE: Understanding the effects of IIH on auditory and vestibular functions can guide effective treatments, improving quality of life for patients by addressing both hearing and balance issues.

Association of contrast-enhanced MRI of inner ear and caloric response in patients with clinically diagnosed ipsilateral delayed endolymphatic hydrops.

BACKGROUND: Patients with delayed endolymphatic hydrops (DEH) often show caloric hypofunction and endolymphatic hydrops (ELH) on gadolinium (Gd) enhanced magnetic resonance imaging (MRI) of the inner ear. OBJECTIVES: We aimed to investigate the relationship between the ELH in vivo and caloric results in ipsilateral DEH. MATERIAL AND METHODS: Twelve patients with ipsilateral DEH were included, who underwent delayed MRI following intratympanic Gd application, pure-tone audiometry, caloric test, and video head impulse test (vHIT). RESULTS: For the affected ears, the overall prevalence of inner ear hydrops was 91.7%, including 75% in the cochlear and 50% in vestibular compartment. For the non-affected ears, the overall prevalence of inner ear hydrops was 25%, including 25% in cochlear and 16.7% in vestibular region. Caloric hypofunction was demonstrated in 75% of the affected ears. No pathologic vHIT were found. Caloric results were in agreement with the radiological evidence of inner ear hydrops on affected and non-affected ears in 9 cases. There was fair concordance between inner ear hydrops and canal paresis abnormality on the affected side. CONCLUSIONS AND SIGNIFICANCE: MRI provides auxiliary evidence of ELH in vivo in the ipsilateral DEH-affected ears. The association between morphological alterations and caloric hypofunction warrants further investigation.

[Treacher Collins Syndrome 2 caused by a novel pathogenic variant in PLOR1D: clinical report and literature review].

Objective: To investigate the clinical features, molecular etiology, and treatment of a family with Treacher Collins Syndrome 2 (TCS2). Methods: Information of the proband (female, 8 years old) including medical history and family history was collected. Physical examination and examinations concerning laboratory, audiology, and radiology were performed on the proband. Physical examination was also performed on the family members. Genomic DNA of proband was extracted for whole exome sequencing, and then the genomic DNA of family members was extracted for Sanger sequencing. POLR1D and TCS2 related literatures published before August 31,2023 were searched and sifted in PubMed and CKNI databases. The clinical characteristics of TCS2 were summarized. Results: The proband had poor hearing since childhood, with pure tone audiometry indicating conductive hearing loss. She had a smaller jaw, bilateral preauricular fistulas and cup-shaped ear deformities. Temporal bone CT scan revealed deformities in the left external ear canal, bilateral middle ear and inner ear. A bone-conduction hearing aid device was surgically implanted, resulting in restoration of almost normal hearing levels. The proband's mother also had a slightly smaller jaw. Genetic analysis revealed a novel heterozygous variant NM_015972.4:c.38_47del in the POLR1D gene in the proband, which was inherited from her mother. A review of the literature revealed no clear evidence of genotype-phenotype correlation in TCS2. Conclusions: Molecular diagnosis plays a vital role in the diagnosis of TCS2. Patients with normal facial phenotype may be carriers of pathogenic variants in the POLR1D gene and have the risk of passing it to the offsprings with complete penetrance. Proper bone conductive hearing devices can improve the quality of life of TCS2 patients.

The Audible Contrast Threshold (ACT) test: A clinical spectro-temporal modulation detection test.

Over the last decade, multiple studies have shown that hearing-impaired listeners' speech-in-noise reception ability, measured with audibility compensation, is closely associated with performance in spectro-temporal modulation (STM) detection tests. STM tests thus have the potential to provide highly relevant beyond-the-audiogram information in the clinic, but the available STM tests have not been optimized for clinical use in terms of test duration, required equipment, and procedural standardization. The present study introduces a quick-and-simple clinically viable STM test, named the Audible Contrast Threshold (ACT™) test. First, an experimenter-controlled STM measurement paradigm was developed, in which the patient is presented bilaterally with a continuous audibility-corrected noise via headphones and asked to press a pushbutton whenever they hear an STM target sound in the noise. The patient's threshold is established using a Hughson-Westlake tracking procedure with a three-out-of-five criterion and then refined by post-processing the collected data using a logistic function. Different stimulation paradigms were tested in 28 hearing-impaired participants and compared to data previously measured in the same participants with an established STM test paradigm. The best stimulation paradigm showed excellent test-retest reliability and good agreement with the established laboratory version. Second, the best stimulation paradigm with 1-second noise "waves" (windowed noise) was chosen, further optimized with respect to step size and logistic-function fitting, and tested in a population of 25 young normal-hearing participants using various types of transducers to obtain normative data. Based on these normative data, the "normalized Contrast Level" (in dB nCL) scale was defined, where 0 ± 4 dB nCL corresponds to normal performance and elevated dB nCL values indicate the degree of audible contrast loss. Overall, the results of the present study suggest that the ACT test may be considered a reliable, quick-and-simple (and thus clinically viable) test of STM sensitivity. The ACT can be measured directly after the audiogram using the same set up, adding only a few minutes to the process.

Effects of ipsilateral, contralateral, and bilateral noise precursors on psychoacoustical tuning curves in humans.

Cochlear tuning and hence auditory frequency selectivity are thought to change in noisy environments by activation of the medial olivocochlear reflex (MOCR). In humans, auditory frequency selectivity is often assessed using psychoacoustical tuning curves (PTCs), a plot of the level required for pure-tone maskers to just mask a fixed-level pure-tone probe as a function of masker frequency. Sometimes, however, the stimuli used to measure a PTC are long enough that they can activate the MOCR by themselves and thus affect the PTC. Here, PTCs for probe frequencies of 500 Hz and 4 kHz were measured in forward masking using short maskers (30 ms) and probes (10 ms) to minimize the activation of the MOCR by the maskers or the probes. PTCs were also measured in the presence of long (300 ms) ipsilateral, contralateral, and bilateral broadband noise precursors to investigate the effect of the ipsilateral, contralateral, and bilateral MOCR on PTC tuning. Four listeners with normal hearing participated in the experiments. At 500 Hz, ipsilateral and bilateral precursors sharpened the PTCs by decreasing the thresholds for maskers with frequencies at or near the probe frequency with minimal effects on thresholds for maskers remote in frequency from the probe. At 4 kHz, by contrast, ipsilateral and bilateral precursors barely affected thresholds for maskers near the probe frequency but broadened PTCs by reducing thresholds for maskers far from the probe. Contralateral precursors barely affected PTCs. An existing computational model was used to interpret the results. The model suggested that despite the apparent differences, the pattern of results is consistent with the ipsilateral and bilateral MOCR inhibiting the cochlear gain similarly at the two probe frequencies and more strongly than the contralateral MOCR.

[Confirmatory factor analysis of the Chinese version of tinnitus handicap inventory].

Objective: To explore the validity of the Chinese version of tinnitus handicap inventory (THI-CM) using confirmatory factor analysis. Methods: A cross-sectional study was carried out. The patients who complained of tinnitus and visited the Department of Otolaryngology, Head and Neck Surgery at West China Hospital of Sichuan University from March 15 to June 28, 2023 were included. All participants underwent pure tone audiometry and acoustic impedance testing before filling out THI-CM, and the results were subjected to confirmatory factor analysis. Results: A cross-sectional study was carried out. A total of 300 patients aged (47±13) years participated in this study. There were 175 females (58.3%) and 125 males (41.7%). The confirmatory factor analysis showed that χ2/df was 1.597<3.00, root mean square error of approximation (RMSEA) was 0.039<0.05, and standardized root mean square residual (SRMR) was 0.091>0.08. The incremental fit index (IFI), Tucker-Lewis index (TLI), comparative fit index (CFI), and goodness of fit index (GFI) were 0.960, 0.954, 0.960, and 0.902, respectively. The overall model fitted well. Except for one item with a load of 0.493, the load values of the other items were between 0.553 and 0.771. The composite reliability (CR) values of the three dimensions of the scale were between 0.769 and 0.901 (all CR>0.7). The average variance extracted (AVE) values ranged from 0.403 to 0.505 (all AVE<0.7), indicating poor convergent validity of the scale. The square value of AVE in each dimension of the scale was smaller than the correlation coefficient between factors, indicating poor discriminant validity of the scale. Conclusions: The THI-CM has good structural validity, which can be used as an effective tool to evaluate the overall severity of tinnitus. However, its convergent validity and discriminant validity are poor.

[Selection of inner ear fenestration strategy and surgical effect of patients with oval window atresia accompanied by facial nerve aberration].

Objective: To summarize the clinical features and postoperative efficacy of patients with oval window atresia accompanied by facial nerve aberration. Methods: The clinical data of patients with congenital middle ear malformation with facial nerve aberration admitted to our hospital from January 2015 to March 2023 were retrospectively analyzed. There were 97 cases (133 ears) in total. Among them, 39 patients (44 ears) had complete follow-up data, including 27 male patients and 12 females, aged 7-48 years old, with an average age of 17.8 years old. Of these, 14 cases (16 ears) were patients combined with facial nerve aberration, and 25 cases (28 ears) were without facial nerve aberration. The results of imaging examination, pure-tone audiometry, selection of surgical strategy, intraoperative findings and postoperative hearing improvement were summarized and analyzed. The malformations of malleus, incus, stapes, oval window and facial nerve were recorded. Prism 9 software was used to statistically analyze the mean bone conductance and air-bone gap of patients before and after surgery. Results: All the 14 patients (16 ears) with middle ear malformation accompanied by facial nerve aberration and oval window atresia showed poor hearing and no facial palsy since childhood. High resolution CT (HRCT) examination of temporal bone, pure tone audiometry and Gelle test were performed before surgery. The malformations of malleus, incus, stapes, oval window and facial nerve were recorded. Preoperative high-resolution CT (HRCT) examination of temporal bone found 12 ears with 4 or more deformities, accounting for 75.00%, in the group of patients with facial nerve malformation. The preoperative average bone conductive threshold was (15.3±10.4) dB and the average air-bone gap was (46.3±10.6) dB in pure-tone audiometry (0.5, 1, 2, 4kHz). According to the different degrees of facial nerve and ossicle malformation, we performed three different hearing reconstruction strategies for the 14 patients (16 ears) with facial nerve aberration and oval window atresia, including 7 ears of incus bypass artificial stape implantation, 7 ears of Malleostapedotomy (MS) and 2 ears of Malleus-cochlear-prothesis (MCP). After 3 months to 18 months of follow-up, all patients showed no facial paralysis. The postoperative mean bone conductive threshold was (15.7±7.9) dB and air-bone gap was (19.8±8.5) dB. There were significant differences in mean air-bone gap before and after operation (t=7.766, P<0.05), and there was no significant difference between the mean bone conductive threshold before and after surgery (t=0.225, P=0.824). There was no significant difference of mean reduction of air-bone gap between patients with and without facial nerve aberration (t=1.412, P=0.165). There was no significant difference between the three hearing reconstruction strategies. There was no significant displacement of the Piston examined by U-HRCT. Conclusion: For patients of middle ear malformation whose facial nerve cover the oval window partially, incus bypass artificial stape implantation or Malleostapedotomy (MS) can be selected according to the specific condition of auditory ossis malformation, and for patients whose facial nerve completely covers the oval window area, Malleus-cochlear-prothesis (MCP) can be selected. Three types of stapes surgery are safe and reliable for patients with oval window atresia accompanied by facial nerve aberration. There was no significant difference in efficacy between them. Preoperative HRCT assessment of middle ear malformation is effective. There is no significant difference of surgical effect with or without facial nerve aberration. The U-HRCT can be used to evaluate the middle ear malformation before surgery and the Piston implantation status after surgery. Due to the risks of surgery, those who do not want to undergo surgery can choose artificial hearing AIDS, such as hearing aid, vibrating soundbridge, bone bridge or bone-anchored hearing aid.

Masking level differences under two different measurement conditions: A normative study of young adults.

OBJECTIVE: The objective of this study was to determine the gender-specific normative values of masking level difference (MLD) in healthy young adults for two different measurement conditions. METHODS: One hundred young adults between the ages of 19 and 25 were included. Tympanometry, pure tone audiometry, and MLD were performed. In the first MLD measurement condition, the threshold level where the signal was out of phase and the noise was in phase (SπNo) was subtracted from the threshold level where the signal and noise were in phase (SoNo). In the second MLD measurement condition, the threshold level where the signal was in phase and the noise was out of phase (SoNπ) was subtracted from the threshold level where the signal and noise were in phase (SoNo). The mean test scores were obtained in decibels. Comparisons were made in terms of gender and conditions. RESULTS: The mean MLD for SoNo-SπNo condition was 10.3 ± 1.99 dB. For SoNo-SoNπ condition, the mean MLD was 6.72 ± 2.38 dB. A significant difference was determined between the MLD under two different measurement conditions (p <.05). There was no significant difference in terms of gender (p >.05). CONCLUSION: Mean normative values of MLD test scores in gender-specific healthy young adults for two different measurement conditions are presented.