An audiological profile of a cohort of school-aged children with HIV and AIDS attending an antiretroviral clinic in South Africa.

BACKGROUND: Recent estimates reveal that there are approximately 280 000 children between the ages of birth and 14 years who are living with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) in South Africa. These children are living with a compromised immune system, are vulnerable to opportunistic infections and subsequent hearing loss. However, there is limited research on the nature and extent of this sensory impairment amongst school-aged children. OBJECTIVE: This study aimed to determine an audiological profile of a cohort of school-aged children attending an antiretroviral (ARV) clinic, describing the occurrence of hearing loss and nature in terms of degree, type, configuration and symmetry. METHODS: A non-experimental descriptive exploratory study was conducted, where 30 children aged between 6 and 12 years underwent diagnostic audiological assessments. Audiological procedures included case history, medical record review, otoscopic examination, immittance audiometry, pure-tone audiometry, speech audiometry, distortion product otoacoustic emissions (DPOAEs) and neurological auditory brainstem response (ABR) testing. The results were analysed descriptively using SPSS version 22 software. RESULTS: The results indicated abnormal otoscopic findings in half the participants, and consequently type C tympanograms were the most common. Of the 28 participants who could be assessed with pure-tone audiometry, 15 (54%) showed a hearing loss. A bilateral rising mild, conductive hearing loss was predominant. Thirteen (43%) of the participants could not be tested using DPOAE because of outer and middle-ear pathology. Neurological ABR testing revealed an abnormality in 18 (60%) of the participants suggesting the sensitivity of the ABR to detect subtle neurological changes. CONCLUSION: Half the children in this study showed hearing loss, which has serious implications for the holistic management of the children within the health and educational contexts. Therefore, there is a need for audiological monitoring of children with HIV and AIDS.

The effects of oral supplements with Sambucus nigra, Zinc, Tyndallized Lactobacillus acidophilus (HA122), Arabinogalactans, vitamin D, vitamin E and vitamin C in otitis media with effusion in children: a randomized controlled trial.

OBJECTIVE: To evaluate the ability of oral supplements with immune-stimulating molecules (Sambucus nigra, Zinc, Tyndallized Lactobacillus acidophilus (HA122), Arabinogalactans, vitamin D, vitamin E and vitamin C) to reduce the inflammation of the upper airway tract and improve the outcome of otitis media with effusion (OME) in children. PATIENTS AND METHODS: Randomized controlled trial. One-hundred ninety-eight children (CI 95%: 12-96 months) were divided into four groups. Group 1 (48 subjects) received 10 ml of oral supplements (OS) with immune-stimulating molecules for three months (20 days consecutively, then 10 days of suspension - the therapeutic scheme was repeated three times); Group 2 (54 children) underwent treatment with 10 ml of OS for 90 consecutive days; Group 3 (48 subjects) received 15 ml of OS for 45 consecutive days; a control group (48 children) underwent the standard treatment for rhinitis and OME. Outcome measures included otoscopy, tympanometry, fibroendoscopy, and the pure tone audiometry (PTA) at T0 (before treatment), T1 (45 days after treatment), and T2 (90 days after treatment). RESULTS: All children treated with OS showed a reduction of Upper Airway Infection (UAI) episodes and OME compared to the control group independent of the administration method and posology. The three groups treated with OS showed statistically significant differences between T0 and T2 for otoscopy, tympanometry, fibroendoscopy, and PTA. In Group 2, the otoscopy and the tympanometry scores improved at T1. Group 2 and 3 had better PTA results than Group 1. CONCLUSIONS: OS with immune-stimulating molecules should be considered as a supporting therapy in children affected by recurrent episodes of UAI associated with OME due to their capacity to improve the immune response and reduce the inflammatory phenomena. OS can improve the fibroendoscopic findings by restoring middle ear ventilation, in addition to their ability to reduce inflammation in the middle ear.

The effect of compression rate and slope on the incidence of symptomatic Eustachian tube dysfunction leading to middle ear barotrauma: a Phase I prospective study.

Introduction: Symptomatic Eustachian tube dysfunction (ETD) and middle ear barotrauma (MEB) are the most common reported complications during hyperbaric oxygen (HBO2) treatment. There is no standardized rate of compression (ROC) reported to decrease the incidence rates of ETD and MEB during hyperbaric treatments. Few studies actually demonstrate that the ROC decreases the incidence of ETD or MEB. Methods: Our study was designed to determine an optimal hyperbaric chamber compression rate that might reduce the incidence of symptomatic ETD leading to MEB during the compression phase of treatment in a multiplace hyperbaric chamber. Data was collected prospectively over 2,807 elective patient treatments compressed using a U.S. Navy Treatment Table 9 (USN TT9) with a modified ROC. ROC was assigned using two variables, time (10 vs.15 minutes) and slope (linear vs. non-linear compression). Patients were exposed to all four compression schedules in a consecutive daily fashion. We recorded any patient requiring a stop during initial compression due to ear discomfort. Anyone requiring a stop was evaluated post treatment for MEB. Findings were compared to our standard 10-minute linear ROC. Evaluation of the tympanic membrane was accomplished using video otoscopy. Barotrauma when present was classified using both the Teed and O'Neill grading systems. Data was analyzed using basic statistical methods. Results: When comparing four different rates of compression during an elective USN TT9 in a multiplace (Class A) chamber there is a decreased incidence for symptomatic ETD when using a 15-minute linear compression schedule (p-value ⟨0.05). Conclusion: Using a 15-minute linear compression schedule is associated with less symptomatic ETD and less MEB when performing an elective 45 fsw (USN TT9) hyperbaric treatment in a Class A chamber. Asymptomatic ETD and MEB were not considered in this study.

Objective Binaural Loudness Balancing Based on 40-Hz Auditory Steady-State Responses. Part II: Asymmetric and Bimodal Hearing.

In Part I, we investigated 40-Hz auditory steady-state response (ASSR) amplitudes for the use of objective loudness balancing across the ears for normal-hearing participants and found median across-ear ratios in ASSR amplitudes close to 1. In this part, we further investigated whether the ASSR can be used to estimate binaural loudness balance for listeners with asymmetric hearing, for whom binaural loudness balancing is of particular interest. We tested participants with asymmetric hearing and participants with bimodal hearing, who hear with electrical stimulation through a cochlear implant (CI) in one ear and with acoustical stimulation in the other ear. Behavioral loudness balancing was performed at different percentages of the dynamic range. Acoustical carrier frequencies were 500, 1000, or 2000 Hz, and CI channels were stimulated in apical or middle regions in the cochlea. For both groups, the ASSR amplitudes at balanced loudness levels were similar for the two ears, with median ratios between left and right ear stimulation close to 1. However, individual variability was observed. For participants with asymmetric hearing loss, the difference between the behavioral balanced levels and the ASSR-predicted balanced levels was smaller than 10 dB in 50% and 56% of cases, for 500 Hz and 2000 Hz, respectively. For bimodal listeners, these percentages were 89% and 60%. Apical CI channels yielded significantly better results (median difference near 0 dB) than middle CI channels, which had a median difference of -7.25 dB.

Auditory function in Pelizaeus-Merzbacher disease.

Pelizaeus-Merzbacher disease (PMD; MIM 312080), an inherited defect of central nervous system myelin formation, affects individuals in many ways, including their hearing and language abilities. The aim of this study was to assess the auditory abilities in 18 patients with PMD by examining the functional processes along the central auditory pathways using auditory brainstem responses (ABR) and cortical auditory evoked potentials (CAEP) in response to speech sounds. The significant ABR anomalies confirm the existence of dyssynchrony previously described at the level of the brainstem in patients with PMD. Despite the significant auditory dyssynchrony observed at the level of the brainstem, CAEPs were present in most patients, albeit somehow abnormal in terms of morphology and latency, resembling a type of auditory neuropathy spectrum disorder.

[Diagnostics and Therapy of Idiopathic Sudden Sensorineural Hearing Loss]. / Diagnostik und Therapie des Hörsturzes.

This article reviews recent aspects of diagnostics, differential diagnostics and evidence in systemic and local therapy of idiopathic, sudden, sensorineural hearing loss (ISSHL). Since a number of disorders can be accompanied by sudden hearing loss a meaningful and targeted diagnostic strategy is of utmost importance. An important differential diagnosis of sudden hearing loss are intralabyrinthine schwannomas (ILS). The incidence of ILS is probably significantly underestimated. This may be due to the lack of awareness or lack of explicit search for an intralabyrinthine tumor on MRI or an inappropriate MRI technique ('head-MRI' instead of 'temporal bone-MRI' with too high slice thickness) for the evaluation of sudden hearing loss. Therefore, the request to the radiologist should specifically include the question for (or exclusion of) an ILS. With special MRI techniques, it is today possible to visualize an endolymphatic hydrops. The evidence in the therapy of ISSHL is - with respect to quality not quantity of studies - unsatisfying. The value of systemically (low dose) or intratympanically applied corticosteroids in the primary treatment of ISSHL is still unclear. In order to investigate the efficacy and safety of high dose corticosteroids in primary treatment for ISSHL a national, multicenter, three-armed, randomized, triple-blind controlled clinical trial is currently performed in Germany (http://hodokort-studie.hno.org/). After insufficient recovery of threshold with systemic therapy of ISSHL, intratympanic corticosteroid therapy appears to be associated with a significantly higher chance of improvement of hearing threshold than no therapy or placebo. Both, hearing gain and final hearing thresholds, however, appear to be independent of the start of secondary therapy. Based on the currently available data from clinical studies, no recommendation can be made with respect to type of corticosteroid and specifics of the intratympanic application protocol.

[The current views of the treatment of diffuse external otitis].

The objective of the present study was to evaluate the clinical effectiveness and safety of the local application of triderm for the treatment of diffuse external otitis. The study included 68 patients presenting with bacterial and fungal diffuse external otitis. The treatment in the form of local empiric therapy was continued till the results of microbiological treatment became apparent. The beneficial outcome achieved in 91.2% of the patients was clinically manifest as the regression of the inflammatory process in the external auditory meatus. No complications, such as ototoxic events, either local or systemic allergic reactions, were documented. The authors substantiate the possibility of the application of the medication under consideration for the treatment of diffuse external otitis based on the knowledge of the mechanism of the actin of its constituent components, viz. betamethasone, dipropionate, gentamicin sulfate, and clotrimazole, taking into account the occurrence of the most common causative agents of diffuse external otitis. It is concluded that triderm is a safe medication for the local application and, probably, for the initial empiric therapy of diffuse external otitis to be continued till the results of the microbiological treatment become apparent.

Hearing thresholds, tinnitus, and headphone listening habits in nine-year-old children.

OBJECTIVE: Investigate hearing function and headphone listening habits in nine-year-old Swedish children. DESIGN: A cross-sectional study was conducted and included otoscopy, tympanometry, pure-tone audiometry, and spontaneous otoacoustic emissions (SOAE). A questionnaire was used to evaluate headphone listening habits, tinnitus, and hyperacusis. STUDY SAMPLE: A total of 415 children aged nine years. RESULTS: The prevalence of a hearing threshold ≥20 dB HL at one or several frequencies was 53%, and the hearing thresholds at 6 and 8 kHz were higher than those at the low and mid frequencies. SOAEs were observed in 35% of the children, and the prevalence of tinnitus was 5.3%. No significant relationship between SOAE and tinnitus was found. Pure-tone audiometry showed poorer hearing thresholds in children with tinnitus and in children who regularly listened with headphones. CONCLUSION: The present study of hearing, listening habits, and tinnitus in nine-year old children is, to our knowledge, the largest study so far. The main findings were that hearing thresholds in the right ear were poorer in children who used headphones than in children not using them, which could be interpreted as headphone listening may have negative consequences to children's hearing. Children with tinnitus showed poorer hearing thresholds compared to children without tinnitus.

Tympanic membrane bleeding complications during hyperbaric oxygen treatment in patients with or without antiplatelet and anticoagulant drug treatment.

INTRODUCTION: Middle ear barotrauma (MEBt) is a frequently occurring complication of hyperbaric oxygen treatment (HBOT). High-grade MEBt may involve tympanic membrane (TM) haemorrhaging. Although many patients undergoing HBOT use antiplatelet or anticoagulant drugs, it is unknown whether these drugs increase the risk of MEBt and particularly TM bleeding complications. METHODS: This multicentre, prospective cohort study investigates the prevalence of MEBt and TM bleeding during HBOT in patients using antiplatelet/anticoagulant drugs, compared with control patients not on such medications. MEBt was assessed by video otoscopy of the TM pre and post HBOT and scored according to the modified Teed score. Any complications from previous HBOT sessions were retrospectively documented. RESULTS: Of 73 patients receiving HBOT, 34 used antiplatelet/anticoagulant drugs. Mild MEBt (Teed score 1 or 2) occurred in 23 of these 34 patients and in 31 of the 39 controls. Teed score 3 MEBt occurred in only two of the control-group patients and none of the patients using antiplatelet/anticoagulant drugs. Two patients using anticoagulant drugs reported epistaxis during a previous HBOT session, epistaxis was not reported by any control patients. CONCLUSION: Low-grade MEBt is common during HBOT, however, high-grade barotrauma is rare with current chamber operating procedures. Patients using antiplatelet/anticoagulant drugs potentially may be prone to MEBt-associated haemorrhagic complications, but we did not observe any such increase in this cohort. Only mild epistaxis occurred in patients using anticoagulant drugs.

The Effect of Contralateral Pure Tones on the Compound Action Potential in Humans: Efferent Tuning Curves.

BACKGROUND: The compound action potential (CAP) has been suggested in the literature as an alternative to otoacoustic emissions for evaluating the efferent auditory system. However, very few studies have examined efferent influence on auditory nerve potentials in humans. PURPOSE: This study examines the effects of presenting contralateral pure tones on the ipsilateral CAP onset and offset amplitudes as a potential clinical tool for the assessment of efferent auditory function. RESEARCH DESIGN: CAPs for 1- and 4-kHz tone pips (TPs) and clicks were recorded from 9, 9, and 8 participants, respectively. Contralateral tones were presented at levels ranging from 20 to 70 dB HL in 10-dB steps. The frequencies of the contralateral tones were 0.5, 1, 2 kHz for the 1-kHz TP CAP; 2, 4, 8 kHz for the 4-kHz TP CAP; and 0.5, 1, 2, 4, 8 kHz for the click CAP. DATA ANALYSIS: The CAP onset and offset amplitudes in all experimental conditions were analyzed and compared to the CAP amplitude without contralateral stimulation (i.e., baseline). RESULTS: Maximum suppression of 1-kHz TP CAP onset amplitude was obtained in seven out of nine participants by the 1-kHz contralateral pure tone at 40 dB HL. The 4-kHz TP CAP onset amplitude was maximally suppressed in eight out of nine participants by the 8-kHz contralateral pure tone at 30 dB HL. The click CAP offset amplitude was maximally suppressed in four out of eight participants by the 8-kHz contralateral tone presented at 40 dB HL. The 1- and 4-kHz TP CAP offset and click CAP onset amplitudes were not affected by contralateral stimulation. CONCLUSIONS: These results along with the previous studies may suggest that the efferent system is maximally stimulated by moderate signal-level tones (i.e., 30-40 dB HL), and that efferent activity is dependent on frequency cues of both the stimulus and suppressor tones. Other factors that might be affecting efferent influence on the CAP in humans such as sound duration, phase, bandwidth, and periodicity need to be further investigated.

A review of the diagnosis and management of sudden hearing loss in the military population.

Sudden hearing loss can be both an immediately debilitating and long-term career-threatening condition within the military population. Careful assessment is key, particularly in an environment where heightened occupational risk factors may contribute to or confound diagnoses, and where access to basic investigation may be limited. This article looks at the patient with a new presentation of sudden hearing loss in a military setting and, by providing key features and a structured approach to examination and basic investigation, how to consider key diagnoses through clinical assessment alone. The acute management of sudden sensorineural hearing loss (SNHL) remains a difficult issue, particularly regarding the efficacy of treatment regimes to restore hearing. We have reviewed the evidence to help military medical personnel make well-informed decisions when treating and making occupational assessment of those they have diagnosed with sudden hearing loss.

Otological complications associated with hyperbaric oxygen therapy.

The objective of the present study was to clarify the features of otological complications for hyperbaric oxygen therapy (HBOT) and the risk factors for these complications. We enrolled 1115 patients (776 males and 339 females; age 5-89 years) who underwent HBOT. All otological symptoms experienced during HBOT sessions were evaluated, and risk factors were analysed using multivariate logistic regression analysis. Otoscopic findings and interventions for otological complications were assessed in 58 symptomatic patients who visited the Otolaryngology Department. Otological symptoms were experienced by 165 (14.8 %) of the 1115 patients. The multivariate logistic regression analysis identified ages of >60 years and female sex as independent risk factors, whereas patients with sports injuries were at lower risk than those with other primary diseases, except for severe infectious disease. Eighty-two patients (49.7 %) suffered from symptoms at the first HBOT session. The most prevalent symptoms were otalgia (157/165), followed by ear fullness (13/165), hearing loss (12/165) and tinnitus (3/165). One patient experienced vertigo and deterioration of the bone-conduction pure-tone thresholds, suggesting inner ear barotrauma. In 116 ears of the 58 symptomatic patients, abnormal otoscopic findings were recognized in 58 ears (50.0 %). Twenty-seven of the 58 ears required myringotomy or tube insertion, and HBOT was stopped in eight ears in four patients. Of the remaining 58 ears with normal otoscopic findings, 51 received no treatment. Physicians should be aware of both middle and inner ear barotrauma as potential complications of HBOT.

Evaluación de la eficacia de la técnica de bombeo para la trompa de eustaquio en otitis media y su relación con la mejora de la hipoacusia / No disponible

Introducción: La otitis media (OM) es la inflamación del oído medio caracterizada por la presencia de edema y exudado inflamatorio en esa cavidad. La OM puede ser asintomática, cursar con fiebre y dolor de oído y, en cualquier caso, puede desencadenar hipoacusia. Objetivos: Describir las características de la patología de OM, su relación con la hipoacusia y las alternativas al tratamiento quirúrgico (TQ). Material y métodos: Se realizó una revisión sistemática usando las palabras clave otitis media children, otitis media treatment, otitis media acute y osteopathic manipulative treatment for otitis media, realizamos una búsqueda bibliográfica en la base de datos Pubmed (MEDLINE) complementado con búsquedas de información en las secciones de fisiología, anatomía, patología y microbiología de la biblioteca biosanitaria de la Facultad de Medicina de la Universidad Complutense de Madrid (UCM).Resultados: Se incluyeron en la revisión 47 artículos (n=47) que cumplieron los criterios de selección en dos fases de análisis, lo cual supone el 23,97 % del total de artículos seleccionados (n=196) y el 55,95 % de los artículos que cumplieron los criterios de selección (n=84) (inclusión y exclusión). La OM es una enfermedad con etiología diversa en la cual la Trompa de Eustaquio (TE) puede obstruirse por múltiples causas. Los síntomas más frecuentemente observados son la aparición de dolor, fiebre e hipoacusia, ya que pueden modificarse de modo permanente las características tisulares de la membrana timpánica afectando con ello a la capacidad auditiva del sujeto. Dicha patología tiene alta prevalencia durante la infancia. En la actualidad los criterios diagnósticos dependen de la presencia de sintomatología asociada así como de los resultados obtenidos en los exámenes al otoscopio y las audiometrías. Conclusiones: Habitualmente el tratamiento de la OM es médico y se basa en disminuir la intensidad de los síntomas y la infección mediante la administración de antibióticos. Ante el fracaso del tratamiento farmacológico la medicina recurre al TQ. La administración de antibióticos resuelve la infección pero no consigue desobstruir la TE para que el exudado estancado en el oído medio drene hacia la orofaringe. La osteopatía plantea alternativas con técnicas de abordaje manual que pretenden restablecer la funcionalidad de la TE evitando así la administración repetida de fármacos o llegar al TQ

No disponible

The development of a fast method for recording Schroeder-phase masking functions.

Schroeder-phase masking complexes have been used in many psychophysical experiments to examine the phase curvature of cochlear filtering at characteristic frequencies, and other aspects of cochlear nonlinearity. In a normal nonlinear cochlea, changing the "scalar factor" of the Schroeder-phase masker from -1 through 0 to +1 results in a marked difference in the measured masked thresholds, whereas this difference is reduced in ears with damaged outer hair cells. Despite the valuable information it may give, one disadvantage of the Schroeder-phase masking procedure is the length of the test - using the conventional three-alternative forced-choice technique to measure a masking function takes around 45 min for one combination of probe frequency and intensity. As an alternative, we have developed a fast method of recording these functions which uses a Békésy tracking procedure. Testing at 500 Hz in normal hearing participants, we demonstrate that our fast method: i) shows good agreement with the conventional method; ii) shows high test-retest reliability; and iii) shortens the testing time to 8 min.

The O'Neill grading system for evaluation of the tympanic membrane: A practical approach for clinical hyperbaric patients.

Eustachian tube dysfunction (ETD) and middle ear barotrauma (MEB) are the two most common complications of clinical hyperbaric oxygen (HBO2) treatment. The current grading system, the Teed's Classification, was first described in 1944 with modifications to this system over the years, but none are specific for the evaluation and treatment of patients undergoing clinical HBO2 therapy. Currently, the standard of care is a baseline otoscopic examination performed prior to starting HBO2 therapy. Repeat otoscopy is required for patients having ETD, pain or other symptoms during the compression and/or decompression phase of the treatment. Results from these examinations are used to determine the proper course of treatment for the ETD or MEB. The Teed's classification was not intended to correlate with the consistency of diagnosis, the clinical approach to relieving symptoms or the treatment of the inflicted trauma. It is not a practical tool for the modern hyperbaric team. We describe a newer grading system, the O'Neill Grading System (OGS), which allows simple, practical and consistent classification of ETD and MEB by all members of the clinical hyperbaric medicine team. Based on the O'Neill Grade assigned, evidence supported suggestions for appropriate actions and medical interventions are offered.

Comparison of traditional otoscope to iPhone otoscope in the pediatric ED.

OBJECTIVE: Acute otitis media (AOM) is a common diagnosis under age 5 years. The primary objective was to determine if the CellScope Oto (CSO) improves tympanic membrane (TM) visualization and diagnostic precision compared to traditional otoscope. The secondary objective was to determine physician, patient, and parent device preference. METHODS: This is a prospective cross-sectional study of patients younger than 18 years presenting with ear pain, fever, or upper respiratory infection symptoms. Patients were examined by a resident then attending physician with a traditional wall-mounted otoscope followed by CSO. Each was blinded to the other's findings. Intrarater and interrater diagnostic agreement was compared. Physicians, parents, and patients were surveyed regarding their experience. RESULTS: A total of 51 patients completed the study. There was substantial intrarater agreement between traditional otoscope and CSO for residents: right ear (κ = 0.74) and left ear (κ = 0.74); CSO use changed reported view for 16 of 102 TM examinations (16%), of which 7 (7%) had clinically relevant change in diagnosis to/from AOM. There was substantial to almost-perfect agreement for attending physicians: right: (κ = 0.86) and left (κ = 0.79); CSO use changed reported view for 12 (12%), with 6 (6%) clinically relevant. Resident/attending physician interrater agreement was moderate for both traditional otoscope (κ = 0.40) and CSO (κ = 0.47). Physicians agreed CSO was easy to use, enhanced TM visualization and diagnostic precision, and was a good teaching tool. Patients and parents also found the CSO images very helpful. CONCLUSION: CellScope Oto was preferred by physicians, patients, and parents. Use of the CSO changed final diagnosis a significant number of times, including clinically relevant changes to/from AOM.

Cribado auditivo mediante potenciales evocados auditivos de estado estable obtenidos por estimulación simultánea de la vía aérea y la ósea / Hearing screening using auditory steady state responses obtained by simultaneous air- and bone-conduction stimuli

Introducción y objetivos: Minimizar los falsos positivos constituye un objetivo de los programas de cribado auditivo universal. Una manera de lograrlo sería diferenciar entre los trastornos neurosensoriales (verdaderos positivos) y los conductivos transitorios (falsos positivos) mediante un método que permita estudiar la respuesta del sistema auditivo ante la estimulación tanto por vía aérea como por vía ósea. El objetivo de este trabajo es evaluar la eficiencia diagnóstica de una prueba automatizada de cribado basada en el registro de potenciales evocados auditivos de estado estable obtenidos por estimulación simultánea de vía aérea y vía ósea. Métodos: Se estudiaron 80 bebés menores de 2 meses de edad. A todos se les realizó la prueba de cribado, siendo posteriormente citados para el estudio confirmatorio, cuyo resultado se consideró como criterio de verdad del estado audiológico del bebé. Resultados: Con esta prueba se obtuvo una eficiencia diagnóstica equivalente (un 100% de sensibilidad y un 97,7% de especificidad) a la reportada para otras pruebas utilizadas en el cribado (emisiones otoacústicas y potenciales evocados de tronco cerebral), con la ventaja adicional de que la introducción de la vía ósea en el cribado permitió reducir la cifra de falsos positivos del 13,3 al 2,2%. La duración de la prueba fue de 5,3 (± 1,9) min, siendo suficiente en el 34% de los casos una sola repetición para llegar al resultado. Conclusiones: Esta prueba automatizada de cribado basada en el registro de potenciales evocados auditivos de estado estable permitió discriminar entre los trastornos conductivos transitorios y los neurosensoriales, reduciendo así los falsos positivos y elevando la eficiencia diagnóstica de esta metodología (AU)

Introduction and objectives: Minimising false positives rates is an important goal of universal newborn hearing screening programmes. An adequate way for reaching that goal could be differentiating between transient conductive hearing losses (false positives) and permanent sensorineural hearing impairments (true positives) by means of a methodology that studies electrophysiological responses obtained using both air- and bone-conduction stimuli. Our objective was to evaluate the efficiency of an automated hearing screening test based on auditory steady state responses obtained using simultaneous air- and bone-conduction stimuli. Methods: A sample of 80 high risk babies lees than 2 months of born were screened using the automatic screening test. A confirmatory clinical and electrophysiological evaluation was used as the gold standard. Results: The estimated diagnostic efficiency of this screening test was equivalent (100% sensitivity and 97.7% specificity) to the efficiency reported for otoacoustic emissions and automated auditory brainstem responses. The introduction of bone conduction in the screening reduced the false positive rate from 13.3% to 2.2%. The test duration was 5.3 (± 1.9) min. In 34% of babies only one repetition of the test was needed to raising the result. Conclusions: The screening test performed quite well in this initial clinical trial, differentiating transient conductive hearing losses from permanent neurosensory impairments and improving the diagnostic efficiency of auditory steady state responses (AU)

Medical ozone therapy for the inner ear acoustic trauma.

OBJECTIVES: The goal of the study was to look at the potential protective effect of ozone therapy by studying its antioxidant and vasodilatation effects against hearing loss caused by acoustic trauma. METHODS: Thirty-two male Wistar Albino rats were divided into four groups of eight. The 1st group was exposed to acoustic trauma, the 2nd group was treated with ozone initially, and was exposed to acoustic trauma 24 h later, the 3rd group received ozone without trauma, while the 4th group was the control group. The 1st and 2nd groups were exposed to acoustic trauma with 105 dB SPL white band noise for 4h. DPOAE and ABR tests were conducted in all groups on the 1st, 5th, and 10th days after trauma. RESULTS: In the 1st group, the effects of acoustic trauma continued on days 1, 5 and 10. The 2nd group's DPOAE and ABR results on days 5 and 10 showed significant improvement at all frequencies compared to deterioration on day 1, and the readings were comparable to baseline measurements. CONCLUSION: Acoustic trauma is a pathology that is experienced frequently and leads to many problems in terms of health and cost. Ozone was demonstrated to be a reparative substance against acoustic trauma and, in addition, it can be supplied and applied easily.

Otitis media.

Acute otitis media (AOM) is diagnosed based on visualization of a full or bulging tympanic membrane with middle ear effusion. The distribution of bacteria causing AOM in North America under the influence of pneumococcal conjugate vaccination and antibiotic selection pressure has resulted in a predominance of ß-lactamase-producing Haemophilus influenzae followed by penicillin-resistant Streptococcus pneumoniae. Although guidelines continue to endorse amoxicillin as the preferred treatment, amoxicillin/clavulanate in high dosage would be the preferred treatment based on the otopathogen mix currently. Antibiotic prophylaxis has fallen into disfavor as a preventative strategy for AOM recurrences.