A Novel Tablet-Based Approach for Hearing Screening of the Pediatric Population, 516-Patient Study.

OBJECTIVE: Assess a tablet hearing game as a screening instrument for pediatric hearing loss. METHODS: All children age 3 to 13 presenting to the ENT clinic of a tertiary hospital clinic over a 3-month period were eligible for study. Five hundred sixteen were entered by completing the tablet screen with calibrated tablet/headphones. All had full standard audiometry or otoacoustic emission testing to assess hearing status. Tablet game data was analyzed to find the best correlation to the air conduction audiogram. The appropriate pass threshold of the tablet game was established and the statistical accuracy of the tablet game versus the air conduction audio was assessed. RESULTS: The overall rate of hearing loss was 29.7% (153 subjects). Conductive hearing loss predominated and was present in 128 children. The tablet game pure tone average from 500- 4000 Hz correlated best with the air conduction audiogram, and was most predictive of hearing loss. Setting the pass level at 20 dB for the tablet screen prioritized detection of hearing loss, yielding a sensitivity of 91% and corresponding specificity of 73.5% for ages 4 and older. Specificity progressively improved with increasing age and was over 90% for all ages 7 and older. CONCLUSION: Tablet game audiometry as a screening tool performs well in a controlled setting. Based on these results, it can be considered as a reliable screening method for school-age children and to monitor resolution of otitis media. LEVEL OF EVIDENCE: 4, case series Laryngoscope, 130:2245-2251, 2020.

Oral and intratympanic steroid therapy for idiopathic sudden sensorineural hearing loss.

OBJECTIVE: To investigate the role of intratympanic (IT) therapy in the treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). METHODS: This study was a retrospective review. Patients were treated for ISSNHL from January 1, 2011 to April 12, 2015 with the following: pre/posttreatment audios, treatment initiated ≤90 days and idiopathic etiology. Fifty-three ISSNHL patients were analyzed in the following subgroups: oral steroids (n = 8), combination oral+IT (n = 39), and IT (n = 6). Main outcomes measured were pre/posttreatment pure tone average (PTA) scores. RESULTS: The PTA changes for all treatment groups improved by 8.0 ± 19.5 dB (P = .004); for 31 patients treated ≤2 weeks after onset, PTA improved by 13.8 ± 16.6 dB (P < .001). Multivariable generalized linear model for repeated measures was conducted to investigate the association between PTA changes for treatment groups adjusted for age, gender, time-to-treatment, and vertigo. Earlier time-to-treatment and older age were statistically correlated towards improved outcomes. As time-to-treatment increased by each day, change in PTA decreased by 0.324 (95% CI [0.12, 0.52], P = .002). As age increased by each year, PTA changes increased by 0.802 (95% CI [0.36, 1.24], P < .001). For the oral+IT group, PTA changes for concurrent oral+IT (n = 20, 7.10 dB) and delayed/salvage oral+IT (n = 19, 5.43 dB) were not statistically different (P = .79); earlier time-to-treatment (P = .001), and older age (P = .006) remained statistically correlated towards improved outcomes. CONCLUSION: Results suggest outcomes can be improved with early identification and oral steroid therapy by primary care providers. Poorer prognosis for younger patients potentially suggests a need for more aggressive diagnostic and therapeutic management for this subgroup. LEVEL OF EVIDENCE: 3b.

Sudden Sensorineural Hearing Loss: Primary Care Update.

The primary care physician's role in recognizing sudden sensorineural hearing (SSNHL) loss and delivering initial treatment is critical in the management of the syndrome. This role involves recognizing its clinical symptoms, distinguishing it from conductive hearing loss with the Weber tuning fork or the Rauch hum test, and urgent administration of high dose oral corticosteroids. Diagnosis and treatment should not be delayed for audiometric testing or referral to otolaryngology. This paper provides an update on the initial evaluation and treatment of this syndrome based on the literature and clinical guideline recommendations.