Limited Audiological Assessment Results in Children With Otitis Media With Effusion.

OBJECTIVES: Clinical practice guidelines predicate the need for evaluation of hearing in children with otitis media with effusion (OME). The objective of this work was to characterize the completeness of hearing assessment results in children with OME. DESIGN: Forty participants with OME completed two full audiological assessments, one in a clinical setting and a second in a research setting. An additional 14 participants without OME completed a single audiological assessment in the research setting as a control group. The success of various behavioral and objective audiometric tests in each setting was quantified and evaluated. RESULTS: Findings indicate that ear-specific behavioral audiometric information is substantially limited in children with OME, particularly in clinical settings. In contrast, objective testing including tympanometry and otoacoustic emission testing was largely successful. CONCLUSIONS: Ear-specific behavioral audiometric information is limited in children with OME and, consequently, consideration of these data for use as part of clinical decision making is also limited. Objective tests were more successful but are not direct measures of hearing.

[Clinical protocol: audiological assessment of infants in Russian Federation. Part I]. / Protokol audiologicheskogo obsledovaniya detei pervogo goda zhizni v Rossiiskoi Federatsii. Chast' I.

The clinical protocol of audiological assessment in infants was prepared by the workgroup of Russian pediatric audiologists from different regions. The goal of the protocol is unification approaches to audiological diagnosis of the infants. The protocol has been developed according the evidence based medicine principles, by reviewing current scientific publications on the topic and taking into account the order of providing medical services and other clinical practice guidelines. When direct evidence was not available, both indirect evidence and consensus practice were considered in making recommendations. This guideline is not intended to serve as a standard to dictate precisely how the child should be diagnosed. This guideline is meant to provide the evidence base from which the clinician can make individualized decisions for each patient. The first part of the protocol covers following sections: equipment, staff requirements, timing of the diagnostics, case history and risk factors, preparing the child for the appointment, sedation and general anesthesia, otoscopy, tympanometry and acoustic reflex, otoacoustic emissions, skin preparing, electrode montage, choosing the stimulators, auditory brainstem responses on broadband and narrow-band stimuli, on bone conducted stimuli, auditory steady-state responses, masking, combined correction factors.

An Absorbance Peak Template for Clinical Assessment of Sound Conduction in Newborn Ears.

PURPOSE: Power absorbance measures recorded over a wide range of frequencies allow for clinical inferences about the outer/middle ears' acoustic mechanics. A frequency-dependent feature in the newborn wideband absorbance response, the prominent mid-frequency absorbance peak, has been linked to middle-ear resonance. However, current normative methods were not designed to assess subtle changes in such features. This work aims to develop and validate an absorbance peak template (APT) for assessment of absorbance peaks in newborns. Additional objectives are to compare test performance of absorbance peaks and APTs to existing normative methods, to demonstrate APT-based methods for categorization of abnormal absorbance peaks, and to describe absorbance peak test-retest variability. METHOD: Peak absorbance and peak frequency were analyzed in a training data set (490 measurements in 84 newborn ears who passed transient evoked otoacoustic emissions [TEOAEs] screenings), and an APT was developed by computing normal limits on these two absorbance peak variables. Split-set analysis evaluated the reproducibility of APT, and test-retest analysis was performed. Test performance analysis, conveyed by area under the receiver operating characteristic curve (AROC) and 95% confidence intervals (CIs), compared absorbance peak variables to absorbance area indices (AAIs) in a validation data set (359 ears that passed distortion-product OAE [DPOAE] screening and 64 ears that failed). APT-based assessment paradigms for normal and abnormal ears were compared to the common absorbance normative range paradigm. RESULTS: Split-set analysis demonstrated a good reproducibility of APT, and test-retest of absorbance peak variables showed that they were stable measures for clinical assessment. Test performance of peak absorbance (AROC = 0.83; 95% CI [0.77, 0.88]) was comparable to the top-performing AAI variables (AROC = 0.85; 95% CI [0.80, 0.90]). APT-based assessment categorized measurements based on their peak absorbance and peak frequency and enhanced the detection of subtle frequency changes that were missed by the normative range method. CONCLUSION: Analysis of absorbance peaks guided by APT has the potential to simplify and improve assessments of sound conduction pathways in newborn ears and can be used together with or in-place of current methods for analysis of wideband absorbance data.

Prevalence, risk factors and causes of hearing loss among adults 50 years and older in Santiago, Chile: results from a rapid assessment of hearing loss survey.

OBJECTIVE: Among a representative sample of adults aged 50 years and older too (i) determine the prevalence of hearing loss, (ii) evaluate probable causes and risk factors of hearing loss, and (iii) assess the association between hearing loss measured by audiometry and self-report. DESIGN: A population-based survey of adults aged 50 and older in Santiago, Chile using the Rapid Assessment of Hearing Loss (RAHL) survey. STUDY SAMPLE: 538 participants completed a questionnaire, which included questions on socio-demographic and health characteristics and self-reported hearing loss. Hearing and possible cause of hearing loss was assessed using pure tone audiometry (0.5-4.0 kHz), tympanometry, and otoscopy. RESULTS: The prevalence of any level of hearing loss in adults aged 50 years and older was 41% (95% CI 33.2, 49.2). In terms of aetiologies, 89.3% of ears with mild or worse hearing loss were classified as sensorineural. Otoscopy was abnormal in 10.7% of subjects with impacted earwax being the most common finding (4.4%) followed by chronic otitis media (3.5%). Hearing aid usage was 16.6%. Older age, lower socioeconomic position, lack of education, and solvent exposure were significantly associated with hearing loss. CONCLUSION: Hearing loss among individuals aged over 50 years was common in Santiago, Chile.

Wideband absorbance for the assessment of pressure equalizing tubes patency in children.

OBJECTIVES: To analyze the feasibility of using wideband absorbance to verify the patency of pressure equalizing tubes (PETs) in clinical practice and to present the response pattern of this measure for ears with patent PET. METHODS: This observational case-control type study evaluated 48 ears of 30 children with severe or profound hearing loss, aged 10-44 months, of both sexes. The subjects were subdivided into two groups: 24 ears with Sheppard type PET (experimental group - EG) and 24 ears with normal middle ear (control group - CG), paired with the EG, according to age, sex, and ear evaluated. To obtain the wideband absorbance, a Middle-Ear Power Analyzer, version 5.0 (Mimosa Acoustics), was used, and absorbance values for pure tone and chirp stimuli were analyzed. RESULTS: There was no influence of ear (right or left) on the measurements obtained. The EG showed higher absorbance values at low frequencies. Although the two stimuli made it possible to identify the difference in acoustic transfer function between the groups studied, compared to pure tone, the chirp stimulus allowed identification of differences in a higher number of frequencies. CONCLUSIONS: Ears with a patent PET present an acoustic transfer pattern that differs from that obtained for normal middle ears, with a higher absorbance at low frequencies. Both pure tone and chirp stimuli can be used to identify such differences, nevertheless, the use of chirp stimulus is recommended, since it allows differentiation over a wider frequency range.

Assessment of Hearing in Children with Cerebral Palsy.

The objective of this study is to identify the prevalence and nature of auditory analyzer pathology in children with different forms of infant cerebral palsy by recording otoacoustic emission and recording short latency brainstem auditory evoked potentials. The subject group consisted of 75 children, 40 (53%) males and 35 (47%) were females, ranging from 3 to 14 years of age with a confirmed diagnosis of cerebral palsy on the basis of a psycho-neurological hospital in Tashkent. (Uzbekistan). The examination of children was carried out by the following methods: clinical examination of patients (general and otorhinolaryngological) and functional research methods of the auditory analyzer. All children underwent acoustic impedancemetry, including tympanometry with determination of the type of tympanogram and acoustic reflex. The data obtained revealed a bilateral lesion of the peripheral part of the auditory analyzer. Beilateral sensorineural hearing loss was detected in 21 - I - II degree, in 12 - III degree and in 15 - IV degree. Marked changes in the main parameters of BAEP were detected in the study of the stem structures of the auditory analyzer in children with cerebral palsy. Thus, disorganization, configuration disturbances of the component composition (I, III, V) were noted. Thus, the study revealed a disorder of auditory function by sound-detecting type and justified the need for hearing correction in these children. Evaluation of auditory function made it possible to determine the level of auditory analyzer injury and localization of the process from the results of a complex, objective examination.

Acoustic immittance measures and middle ear assessment: Current practice by South African audiologists.

BACKGROUND: Limited research exists regarding South African audiologists' practice with acoustic immittance. This study was part of a bigger study titled 'Wideband acoustic immittance in adults living with human immunodeficiency virus'. OBJECTIVES: The purpose of the study was to explore current practice of South African audiologists regarding acoustic immittance measures, and to explore their perceived knowledge and views on acoustic immittance advancements. METHOD: A quantitative survey with a cross sectional design was employed. An electronic questionnaire was distributed to participants via professional associations of audiologists. Data was analysed through descriptive and inferential statistics. RESULTS: Most audiologists worked in private practice and conducted tympanometry with 226Hz probe tone and ipsilateral acoustic reflexes. There was no association between clinical setting, levels of qualification, and the use of tympanometry. None of the participants included multifrequency and multicomponent tympanometry (MFT) and/or wideband acoustic immittance (WAI) in their test battery. Most of the participants were not familiar with MFT and WAI. Familiarity with MFT and WAI were only associated with the level of qualification. Limited training and lack of equipment were major barriers to conducting some of the acoustic immittance measures. Most participants believed that they would include MFT and/or WAI in their test battery if they had access to the equipment. CONCLUSION: Current findings raise training and clinical implications for the South African audiologists, including training institutions. These findings provide motivation for strategic resource allocation, planning and distribution of audiology clinics in the country if positive preventive audiology outcomes are to be achieved.

Test-Retest Reliability of Audiometric Assessment in Individuals With Mild Dementia.

Importance: Accurate assessment of hearing is critically important regardless of a person's cognitive ability. The degree to which hearing can be reliably measured in adults with mild dementia has not been determined. Objective: To obtain quantitative measures of reliability to evaluate the degree to which audiologic testing can be accurately conducted in older adults with mild dementia. Design, Setting, and Participants: This repeated-measures cross-sectional study consisted of a comprehensive audiologic assessment on 2 occasions separated by 1 to 2 weeks performed in the department of otolaryngology at the Washington University School of Medicine from December 3, 2018, to March 4, 2020. Participants were 15 older adults with a verified diagnosis of mild dementia and 32 older adults without a verified diagnosis of mild dementia who were recruited from the Knight Alzheimer Disease Research Center at Washington University in St Louis. Main Outcomes and Measures: Test-retest reliability was assessed for tympanometry, acoustic reflex thresholds, otoacoustic emissions, hearing sensitivity, speech reception threshold, speech perception in noise, and hearing handicap, using standard clinical audiology measures. Results: A total of 47 older adults (26 women; mean [SD] age, 74.8 [6.0] years [range, 53-87 years]), including 32 with normal cognitive function and 15 with very mild or mild dementia, completed the study protocol. For participants with mild dementia, high test-retest reliability (Spearman ρ > 0.80) was found for most measures typically included in a comprehensive audiometric evaluation. For acoustic reflex thresholds, agreement was moderate to high, averaging approximately 83% across frequencies for both groups. Scores for the screening Hearing Handicap Inventory for the Elderly at time 1 and time 2 were highly correlated for the group with normal cognitive function (r = 0.84 [95% CI, 0.70-0.93]) and for the group with mild dementia (r = 0.96 [95% CI, 0.88-0.99]). For hearing thresholds, all rank-order correlations were above 0.80 with 95% CIs at or below 15% in width, with the exception of a moderate correlation of bone conduction thresholds at 500 Hz for the group with normal cognitive function (r = 0.69 [95% CI, 0.50-0.84]) and slightly wider 95% CIs for low-frequency bone conduction thresholds for both groups. For speech reception thresholds, correlations were high for groups with normal cognitive function (r = 0.91 [95% CI, 0.84-0.95]) and mild dementia (r = 0.83 [95% CI, 0.63-0.94]). Conclusions and Relevance: Test-retest reliability for hearing measures obtained from participants with mild dementia was comparable to that obtained from cognitively normal participants. These findings suggest that mild cognitive impairment does not preclude accurate audiologic assessment.

Eustachian Tube Function Assessment after Radiofrequency Turbinate Reduction in Atopic and Non-Atopic Patients.

(1) Background: Inferior turbinates' hypertrophy is often associated with Eustachian tube dysfunction (ETD); radiofrequency turbinate reduction (RTR) may provide a long-term improvement of nasal obstruction and ETD-related symptoms. (2) Aim: The study aimed to compare ETD in atopic and non-atopic patients before and after RTR and to investigate the correlation between tympanometry and Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7). (3) Methods: Ninety-seven patients, ranging from 33 to 68 years old, were screened by skin tests and divided into atopic (G1) and non-atopic (G2). Eustachian tube function (ETF) was evaluated through tympanometry, William's test and ETDQ-7. (4) Results: A moderate to severe subjective ETDQ-7 was found in the 35.42% of G1 and in the 22.45% of G2 patients before RTR. William's test resulted normal in 141 ears (72.68%), partially impaired in 15 (7.73%), and grossly impaired in 38 (19.59%) before surgery. A grossly ETD was evidenced in the 19.59% of cases before surgery and decreased to 6.18% after surgery with a significant difference among atopic patients (p < 0.001). (5) Conclusion: RTR may be considered a treatment option in patients suffering from ETD and inferior turbinates' hypertrophy; RTR reduced the percentage of grossly impaired ET function (p < 0.001). ETDQ-7 and William's test may represent valuable tools to assess ET function before and after surgery.

Tubomanometry: An effective and promising assessment of Eustachian tube dysfunction in chronic rhinosinusitis patients.

AIMS: Obstructive eustachian tube (ET) dysfunction involves otologic complications, including cholesteatoma, and requires specific treatment. A causal relationship between obstructive ET dysfunction and chronic rhinosinusitis has only been suspected so far. Tubomanometry (TMM) is a new tool in ET dysfunction diagnosis and description. It has mainly been studied in chronic otitis patients but never in chronic rhinosinusitis (CRS). The aim of this work was to obtain TMM results from a CRS patient population presenting clinical ET dysfunction. MATERIALS AND METHODS: A prospective monocentric non-blinded study was performed between November 1 2015 and February 29 2016, involving all adult patients (>18 years; n=294) suffering from bilateral chronic rhinosinusitis who consulted at the rhinology unit at our referral ENT university center; 129 patients were included. An obstructive ET dysfunction clinical screening questionnaire (ETDQ-7) was obtained from all patients. When the mean ETDQ-7 score was≥2.1, a more extensive clinical assessment was performed including clinical maneuvers, otoscopy, transnasal endoscopy, audiometry, tympanometry and TMM for the diagnosis of ET dysfunction. RESULTS: Forty-seven per cent (n=61) had a positive ETDQ-7, 64% (n=39) of which had pathologic tubomanometric results: thirty-two (52.5%) had obstructive ET dysfunction TMM results and the remaining 7 (11.5%) patients had patulous ET TMM results. CONCLUSIONS: Tubomanometry is a promising new tool for the evaluation of ET dysfunction and could be added to clinical assessment of chronic rhinosinusitis patients.

Assessment of Pediatric Middle Ear Effusions With Wideband Tympanometry.

OBJECTIVE: To determine if wideband tympanometry (WBT) can differentiate types of middle ear effusion (MEE): serous, mucoid, and purulent. STUDY DESIGN: Prospective cohort study. SETTING: Tertiary care children's hospital. METHODS: Children who met American Academy of Otolaryngology-Head and Neck Surgery's guidelines for ventilation tube insertion had WBT after anesthesia induction but before tympanotomy. MEE was categorized into 1 of 4 comparison groups: serous effusion, mucoid effusion, purulent effusion, or no effusion. WBT measurements were averaged to 16 one-third octave frequency bands, and comparison of the absorbance patterns for each MEE type was performed through a linear mixed effects model. RESULTS: A total of 118 children (211 ears) were included: 47 females (39.8%) and 71 males (60.2%). The mean age was 2.73 years (95% CI, 2.25-3.22); mean weight, 14.35 kg (95% CI, 12.85-15.85); and mean Z score, 1.13 (95% CI, -0.64 to 2.33). Effusions included 61 mucoid (28.9%), 30 purulent (14.2%), and 14 serous (6.6%), with 106 (50.2%) having no effusion. No significant differences were found for sex, race, age, weight, or Z score among the 4 types of effusion (P < .05). WBT showed a significant difference in median absorption among the effusion groups (P < .001), with a medium effect size of 0.35. CONCLUSIONS: WBT has potential use to differentiate types of MEE and should be studied further as a tool for investigating how the natural history and management of serous and mucoid effusions may differ.

Cervical vestibular evoked myogenic potential testing for assessment of vestibular functions in cochlear implant patients.

This study aims to investigate the vestibular function status of cochlear implant patients using cervical vestibular evoked myogenic potential (cVEMP) testing and estimate the effects of cochlear implants on vestibular function. The cVEMPs of 50 cochlear implant patients were measured preoperatively, and at one and six months postoperatively. Then, implanted ears and non-implanted ears were compared in terms of p13/n23 wave response rates, latency, amplitude and threshold. Preoperatively, the binaural cVEMP response rate was 92%, while the cVEMP response rates of implanted ears vs. non-implanted ears at postoperative one and six months were 24% vs. 80% and 52% vs. 82%, respectively. No significant difference between implanted and non-implanted ears was found preoperatively, in terms of latent period, amplitude, or threshold. However, significant changes were found in amplitude and threshold for implanted ears after the operation, but not in latency. No significant postoperative change was found in amplitude, latent period, or threshold for non-implanted ears. Significant differences between implanted and non-implanted ears were found in both amplitude and threshold. Cochlear implants affect vestibular function, especially saccular function, and reduce the cVEMP amplitude and threshold of implanted ears.

Protocol for Rapid, Accurate, Electrophysiologic, Auditory Assessment of Infants and Toddlers.

BACKGROUND: Audiologists often lack confidence in results produced by current protocols for diagnostic electrophysiologic testing of infants. This leads to repeat testing appointments and slow protocols which extend the time needed to complete the testing and consequently delay fitting of amplification. A recent publication (Sininger et al50) has shown how new technologies can be applied to electrophysiologic testing systems to improve confidence in results and allow faster test protocols. Average test times for complete audiogram predictions when using new technologies and protocols were found to be just over 32 minutes using auditory brainstem response (ABR) and just under 20 minutes using auditory steady-state response (ASSR) technology. PURPOSE: The purpose of this manuscript is to provide details of expedited test protocols for infant and toddler diagnostic electrophysiologic testing. SUMMARY: Several new technologies and their role in test speed and confidence are described including CE-Chirp stimuli, automated detection of ABRs using a technique called F MP, Bayesian weighting which is an alternative to standard artifact rejection and Next-Generation ASSR with improved response detection and chirp stimuli. The test protocol has the following features: (1) preliminary testing includes impedance measures and otoacoustic emissions, (2) starting test levels are based on Broad-Band CE-Chirp thresholds in each ear, (3) ABRs or ASSRs are considered present based on automated detection rather than on replication of responses, (4) number of test levels is minimized, (5) ASSR generally evaluates four frequencies in each ear simultaneously with flexibility to change all test levels independently. CONCLUSIONS: Combining new technologies with common-sense strategies has been shown to substantially reduce test times for predicting audiometric thresholds in infants and toddlers (Sininger et al50). Details and rationales for changing test strategies and protocols are given and case examples are used to illustrate.

Tympanostomy tube insertion practice in under-18-year-olds in the South African private healthcare sector insured by Discovery Health.

BACKGROUND: The reported rates of tympanostomy tube insertion (TTI) in children vary significantly internationally. Lack of adherence to evidence-based clinical guidelines may contribute to these differences. OBJECTIVES: To study the rates of TTI in South Africa (SA) in children ≤18 years old in the private healthcare sector, both nationally and regionally, to compare these with international TTI rates, and to determine the use of preoperative audiometry and tympanometry. METHODS: A retrospective analysis was done of data obtained from the Discovery Health database. Rates of TTI were analysed nationally and regionally and in different age groups, as was the use of tympanometry and audiograms. RESULTS: The SA TTI rates were much higher than published international rates except for the 0 - 1-year age group in Canada and Denmark and the 0 - 15-year age group in Denmark. There was a statistically significant regional variation in TTI rates as well as in the use of preoperative audiometry and tympanometry. CONCLUSIONS: SA private sector TTI rates are high by international standards. Significant regional variations may indicate over- or underservicing in certain regions. Further investigation of causes for the high TTI rate and regional variations is recommended. Education of healthcare professionals on recognised indications for TTI may improve patient selection.

Large-scale otoscopic and audiometric population assessment: A pilot study.

OBJECTIVE: Large-scale otoscopic and audiometric assessment of populations is difficult due to logistic impracticalities, particularly in low- and middle-income countries (LMIC). We report a novel assessment methodology based on training local field workers, advances in audiometric testing equipment and cloud-based technology. METHODS: Prospective observational study in Bohol, Philippines. A U.S. otolaryngologist/audiologist team trained 5 local nurses on all procedures in a didactic and hands-on process. An operating otoscope (Welch-AllynR) was used to clear cerumen and view the tympanic membrane, images of which were recorded using a video otoscope (JedMedR). Subjects underwent tympanometry and distortion product otoacoustic emission (DPOAE) (Path SentieroR), and underwent screening audiometry using noise cancelling headphones and a handheld Android device (HearScreenR). Sound-booth audiometry was reserved for failed subjects. Data were uploaded to a REDCap database. Teenage children previously enrolled in a 2000-2004 Phase 3 pneumococcal conjugate vaccine trial, were the subjects of the trainees. RESULTS: During 4 days of training, 47 Filipino children (M/F = 28/19; mean/median age = 14.6/14.6 years) were the subjects of the trainee nurses. After the training, all nurses could perform all procedures independently. Otoscopic findings by ears included: normal (N = 77), otitis media with effusion (N = 2), myringosclerosis (N = 5), healed perforation (N = 6), perforation (N = 2) and retraction pocket/cholesteatoma (N = 2). Abnormal audiometric findings included: tympanogram (N = 4), DPOAE (N = 4) and screening audiometry (N = 0). CONCLUSION: Training of local nurses has been shown to be robust and this methodology overcomes challenges of distant large-scale population otologic/audiometric assessment.

On the Cost of Introducing Speech-Like Properties to a Stimulus for Auditory Steady-State Response Measurements.

Validating hearing-aid fittings in prelingual infants is challenging because typical measures (aided audiometry, etc.) are impossible with infants. One objective alternative uses an aided auditory steady-state response (ASSR) measurement. To make an appropriate measurement, the hearing aid's signal-processing features must be activated (or deactivated) as if the ASSR stimulus was real speech. Rather than manipulating the hearing-aid settings to achieve this, an ASSR stimulus with speech-like properties was developed. This promotes clinical simplicity and face validity of the validation. The stimulus consists of narrow-band CE-Chirps®, modified to mimic the International Speech Test Signal (ISTS). This study examines the cost of introducing the speech-like features into the ASSR stimulus. Thus, 90 to 100 Hz ASSRs were recorded to the ISTS-modified stimulus as well as an equivalent stimulus without the ISTS modification, presented through insert phones to 10 young normal-hearing subjects. Noise-corrected ASSR magnitudes and clinically relevant detection times were estimated and analyzed with mixed-model analyses of variance. As a supplement, the observed changes to the ASSR magnitudes were compared with an objective characterization of the stimuli based on modulation power. The main findings were a reduction in ASSR magnitude of 4 dB and an increase in detection time by a factor of 1.5 for the ISTS-modified stimulus compared with the standard. Detection rates were unaffected given sufficient recording time. For clinical use of the hearing-aid validation procedure, the key metric is the detection time. While this varied considerably across subjects, the observed 50% mean increase corresponds to less than 1 min of additional recording time.

Realidad nacional de los programas de detección auditiva temprana con miras a la cobertura universal / Nationwide status of early hearing detection programs: aiming for universal coverage

RESUMEN Introducción: El 50% de los recién nacidos hipoacúsicos no presenta ningún factor de riesgo, por lo que la pesquisa universal y temprana puede cambiar el pronóstico de estos pacientes. La detección auditiva precoz universal es la realización de un examen para descartar hipoacusia a todos los recién nacidos vivos de un centro determinado. Objetivo: Describir y analizar la presencia de programas de pesquisa auditiva universal en Chile y las características de los programas implementados. Material y método: Se identificó a los centros con programas de detección auditiva universal en Chile y se les envió una encuesta electrónica acerca de la estructuración de cada programa. Resultados: 34 hospitales cuentan con programas establecidos; 31 contestaron la encuesta; 73% inició el programa después de 2010; 46% se encuentra financiado por el Ministerio de Salud; la gran mayoría está a cargo de fonoaudiólogos y tecnólogos médicos. Los principales métodos de detección disponibles son emisiones otoacústicas por producto de distorsión y potenciales evocados auditivos de tronco cerebral auto-matizado. En cuanto al diagnóstico definitivo el 71% realiza con potenciales evocados auditivos de tronco cerebral estímulo click más impedanciometría. Conclusión: Los hospitales con detección auditiva precoz universal corresponden al 50% de los hospitales con maternidad y se encuentran principalmente en la zona central. A pesar de que existe interés y avance por parte de algunos centros hospitalarios en responder a la necesidad de estos programas, aún queda mucho por hacer, siendo el objetivo principal una cobertura universal a nivel nacional.

ABSTRACT Introduction: 50% of hearing-impared newborns do not have any associated risk factors; so early universal detection programs can change the prognosis of these patients. Universal newborn hearing screening consists in studying all newborns in a particular area, regardless of the presence of risk factors. Aim: Describe and analyze the presence of universal newborn hearing screening programs in Chile and its characteristics. Material and method: We identify establishments that have universal newborn hearing screening programs and sent them An electronic survey focusing on the structure of each program. Results: 34 hospitals have universal newborn hearing screening. Of these, 31 answered the survey. 73% begun the program after 2010. The Ministry of Health provides financing in 46%. Audiologists and medical technicians majoring in otolariyngology are in charge of the vast majority of the programs. Available screening methods are distortion product otoacoustic emissions (90%) and automated Brainsteam evoked response audiometry (67.8%). As for the definitive diagnosis, 71% use Brainsteam evoked response audiometry click plus impedanciometry. Conclusion: 50% of the hospitals with maternities have universal hearing screening; most of them are in Chile's central area. Even though some hospitals show interest and have made advances in this regard, there is still much to be done, being universal coverage the main objective.

The use of uHear™ to screen for hearing loss in older patients with cancer as part of a comprehensive geriatric assessment.

OBJECTIVE: We previously validated uHear™ to screen for hearing loss in older patients with cancer without a known hearing loss, as part of a comprehensive geriatric assessment (CGA). In view of low specificity, we tested a new modified uHear™ scoring system as described by Handzel. METHODS: Patients, aged ≥70 years, were evaluated by uHear™ and conventional audiometry, which is considered the gold standard, as part of a CGA. The pass or fail screening cut-off for uHear™ was defined as having ≥2 consecutive hearing grades starting from the moderate-severe threshold zone ranging from 0.5 to 2.0 kHz (modified Handzel-uHear™ scoring system). To accept the modified Handzel-uHear™ as screening tool, it was predefined that the combined sensitivity (S) and specificity (Sp) of the test (S + Sp/2) was at least 80% and that an actual combined (S + Sp)/2 of 90% would be found. RESULTS: Ninety ears (45 subjects) were tested. Of those ears, 24.4% were identified as impaired by conventional audiometry. Modified Handzel-uHear™ identified 26.7% of tested ears as impaired. The combined (S + Sp)/2 of the modified Handzel-uHear™ was calculated as 77.5%, while in previous cohort, this was retrospectively calculated as 94.6%. A new uHear™ scoring system was proposed and tested in current and previous cohort. A (S + Sp)/2 of 80.2 and 78.8%, respectively, were obtained. CONCLUSION: uHear™ is a feasible tool for use within the CGA and shows promising results. However, further research is warranted to optimize the cut-off method before it could be routinely implemented within geriatric oncology.

A simple diagnostic scale based on the analysis and screening of clinical parameters in paediatric obstructive sleep apnoea hypopnea syndrome.

OBJECTIVE: This study aimed to develop a simple and accurate method to diagnose paediatric obstructive sleep apnoea hypopnea syndrome. METHODS: A total of 311 children with suspected paediatric obstructive sleep apnoea hypopnea syndrome were included in the study. Multiple clinical parameters, including sex, age, body mass index, history of snoring or gasping, history of nasal obstruction, history of running nose, palatine tonsil size, adenoid to nasopharynx ratio, and tympanogram type, were compared with polysomnography results using relevant correlation and regression analyses. A diagnostic scale was established using the regression equation and the correlation between the polysomnography result and scale result was determined. RESULTS: The apnoea-hypopnea index correlated significantly with a history of snoring or gasping, palatine tonsil size, and tympanogram type. Stepwise logistic regression analysis revealed that the polysomnography result correlated significantly with a history of snoring or gasping, palatine tonsil size, and the adenoid to nasopharynx ratio. The percentage correlation between the scale and polysomnography results was 77.8 per cent. CONCLUSION: The diagnostic scale can be used to diagnose paediatric obstructive sleep apnoea hypopnea syndrome for clinical application when polysomnography cannot be performed. However, it is not suitable for assessing the severity of paediatric obstructive sleep apnoea hypopnea syndrome.

Assessment of the Brainstem-Mediated Stapedius Muscle Reflex in Andean Children Living at High Altitudes.

Counter, S. Allen, Leo H. Buchanan, Fernando Ortega, Anthony B. Jacobs, and Göran Laurell. Assessment of the brainstem-mediated stapedius muscle reflex in Andean children living at high altitudes. High Alt Med Biol. 18:37-45, 2017.-This study examined the physiological thresholds, amplitude growth, and contraction duration of the acoustic stapedius reflex (ASR) in Andean children aged 2-17 years living at altitudes of 2850 m (Altitude I Group) and 3973 m (Altitude II Group) as part of a general medical assessment of the health status of the children. The brainstem-mediated ASR reveals the integrity of the neuronal components of the auditory reflex arc, including the cochlea receptors, eight cranial nerves, and brainstem neural projections to the cochlear nuclei, bilateral superior olivary nuclei, facial nerve nuclei, and facial nerve and its stapedius branch. Uncrossed (ipsilateral) and crossed (contralateral) ASR thresholds (ASRT), ASR amplitude growth (ASRG) function, and ASR muscle contraction duration (decay/fatigue) (ASRD) were measured noninvasively with 500, 1000 Hz and broadband (bandwidth = 125-4000 Hz) noise stimulus activators using a middle ear immittance system. Oxygen saturation (SaO2) level and heart rate were measured in a subsample of the study group. Statistical analyses revealed that the Altitude I and Altitude II groups had ASRT, ASRG function, and ASRD rates comparable to children at sea level and that the two groups were not significantly different for any of the ASR measures. No significant association was found between SaO2 or heart rate and ASRT, growth, and muscle fatigue rate. In conclusion, the assessment of the ASR in children in the high-altitude groups revealed normal function. Furthermore, the results indicate no adverse oto-physiological effects of altitude on the brainstem-mediated ASR at elevations between 2850 and 4000 m and suggest normal middle ear and auditory brainstem function.