The Prevalence and Severity of Misophonia in a UK Undergraduate Medical Student Population and Validation of the Amsterdam Misophonia Scale.

Misophonia is a condition of abnormal emotional responses to specific auditory stimuli. There is limited information available on the prevalence of this condition. This study aimed to estimate the prevalence of misophonia in an undergraduate medical student population at the University of Nottingham. A secondary aim of this study was to assess the psychometric validity of the Amsterdam Misophonia Scale (A-Miso-S) questionnaire tool in this population. The A-Miso-S was administered online to medical students at the University of Nottingham. To assess the validity of the A-Miso-S, a factor analysis was conducted. To determine prevalence and severity the results of the questionnaire were quantitatively analysed using SPSS. Actor analysis was conducted. Free text responses to one questionnaire item were analysed using a thematic approach. Responses were obtained from 336 individuals. Clinically significant misophonic symptoms appear to be common, effecting 49.1% of the sample population. This is statistically significantly higher prevalence than previous studies have found (p < 0.00001). Using the classification of the A-Miso-S, mild symptoms were seen in 37%, moderate in 12%, severe in 0.3% of participants. No extreme cases were seen. The A-Miso-S was found to be a uni-factorial tool, with good internal consistency. This study has provided new information on misophonia and validity of the A-Miso-S questionnaire in a sample population of UK undergraduate medical students. The results indicate that misophonia is a phenomenon that a significant proportion of medical students experience though only a small subset experience it severely.

Exploring perceptions, barriers, and enablers for delivery of primary ear and hearing care by community health workers: a photovoice study in Mukono District, Uganda.

BACKGROUND: Hearing loss is a prevalent but neglected disease, especially in low- or middle-income countries. The role of Community Health Workers (CHWs) to deliver primary ear and hearing care has been explored in several studies from a technical standpoint, but understanding perceptions, barriers, and enablers of such an approach from the perspective of CHWs themselves through a health equity lens has been less well documented. METHODS: This qualitative study used photovoice to explore the views and experiences of CHWs in the Seeta Nazigo Parish of Mukono District in the delivery of ear and hearing care in the community. CHWs were trained in ear and hearing care, and provided with digital cameras to capture photographs related to their work in the community over the following 3 months. Individual interviews regarding the photographs were held at the end of each month, in addition to one focus group discussion. A community workshop was convened at the end of the study to display the photos. Thematic analysis of photographs was conducted using Braune and Clarkes six-step framework. We also used the data to explore potential roles for key stakeholders in primary ear and hearing care, and how photovoice may facilitate their engagement. RESULTS: 13 CHWs participated in the study. Several themes were generated from analysis. CHWs perceived a high burden of ear and hearing disorders in their community and recognised the role they could play in tackling that burden. Potential barriers identified included a lack of equipment, training, and supervision of CHWs; logistical, financial, or psychological barriers to community participation; and the widespread use of traditional medicine. CHWs identified roles for the government and NGO bodies to enable and support delivery of ear and hearing care in the community. The community workshop was a useful method to engage key stakeholders in this topic. CONCLUSIONS: Photovoice is a powerful method to capture issues affecting CHWs. Here it was used to identify a number of perceptions, barriers and enablers to the delivery of ear and hearing care. Our results may inform future strategy in the field of ear and hearing care, and the potential use of photovoice to enact sociocultural change.

Prevalence and audiological profiles of GJB2 mutations in a large collective of hearing impaired patients.

Mutations in the GJB2 gene are known to represent the commonest cause of hereditary and congenital hearing loss. In this study, a complete sequencing of the GJB2 gene in a cohort of 506 patients from a single, large cochlear implant program in Europe was performed. Audiological testing for those patients who could actively participate was performed using pure tone audiometry (PTA). Those unable to undergo PTA were measured using click-auditory brainstem response (ABR). Data analysis was performed to determine genotype-phenotype correlations of the mutational status vs. audiological profiles and vs. age at the time of presentation. An overall prevalence of biallelic mutations of 13.4% was found for the total collective. When subsets of younger patients were examined, the prevalence increased to 27% of those up to age 18 and 35% of those up to age 5 at the time of testing, respectively. This increase was found to be highly significant (p < 0.001). Analysis of the mean PTA thresholds revealed a strong correlation between allele combination status and mean PTA (p = 0.021). The prevalence of simple heterozygotes was found to be approximately 10.1%, which is around 3.3 times the value expected in the general population. As GJB2 follows a recessive pattern of inheritance, the question arises as to why such a large fraction of simple heterozygotes was observed among the hearing impaired patients included in this study.

On the relationship between functional hearing and depression.

OBJECTIVE: To establish the effect of self-rated and measured functional hearing on depression, taking age and gender into account. Additionally, the study investigates if hearing-aid usage mitigates the effect, and if other physical health problems and social engagement confound it. DESIGN: Cross-sectional data from the UK Biobank resource, including subjective and behavioural measures of functional hearing and multifactorial measures of depressive episodes and symptoms, were accessed and analysed using multi-regression analyses. STUDY SAMPLE: Over 100 000 community-dwelling, 39-70 year-old volunteers. RESULTS: Irrespective of measurement method, poor functional hearing was significantly (p < 0.001) associated with higher levels of depressive episodes (≤ 0.16 factor scores) and depressive symptoms (≤ 0.30 factor scores) when controlling for age and gender. Associations were stronger for subjective reports, for depressive symptoms, and the younger participants. Females generally reported higher levels of depression. Hearing-aid usage did not show a mitigating effect on the associations. Other physical health problems particularly partially confounded the effects. CONCLUSION: Data support an association between functional hearing and depression that is stronger in the younger participants (40-49 years old) and for milder depression. The association was not alleviated by hearing-aid usage, but was partially confounded by other physical health problems.

Deterioro del reflejo acústico en pacientes con diabetes mellitus tipo I / Acoustics reflex decay in patients with type 1 diabetes mellitus

Introducción: Diversas investigaciones tratan de explicar la asociación entre Diabetes Mellitus (DM) y alteraciones auditivas, relacionándola con el tiempo de evolución, control metabólico, entre otros, encontrando variados resultados. El parámetro menos investigado es el deterioro del reflejo acústico (ARD). Objetivo: Caracterizar el ARD en pacientes con DM tipo 1. Asimismo, relacionar el ARD con el tiempo de evolución de la enfermedad, el grado de control metabólico y la edad. Material y método: Estudio transversal de tipo descriptivo correlacional Se evaluaron 92 oídos en 500 Hz y 99 oídos en 1.000 Hz, con edades entre 4y 68 años, de ambos géneros, con un tiempo de evolución de la enfermedad entre un mes y 44 años. Se realizó un análisis frecuencial del ARD y estadística no paramétrica mediante el coeficiente Rho de Spearman. Resultados: En ambas frecuencias la mayoría no presenta ARD, mientras que 2,2% en 500 Hz y 3,0% en 1.000 Hz presenta ARD patológico. No existiendo correlación entre el ARD con tiempo de evolución de la enfermedad, el grado de control metabólico y la edad de los sujetos. Conclusión: Existe un bajo porcentaje de ARD patológico y una ausencia de correlación con características propias de la enfermedad coincidiendo con otras investigaciones que han utilizado otras herramientas evaluativas.

Introduction: Various studies try to explain the association between diabetes mellitus (DM) and impaired hearing, relating it to the time of evolution, metabolic control, among others, finding mixed results. The parameter under investigation is the acoustic reflex decay (ARD). Aim: To characterize the ARD in patients with type 1 DM. Also relate the ARD with time of evolution of the disease, metabolic control and age. Material and method: Cross-sectional descriptive correlational study. 92 ears were evaluated in 50 0Hz and 99 ears in 1000 Hz, with ages between 4 and 68 years, of both genders, with a time of evolution of the disease from one month to 44 years. Frequency analysis of the ARD were performed and nonparametric statistics by Spearman's Rho coefficient. Results: In both frequencies most ears do not have ARD, while 2.2% in 500 Hz and 3.0% in 1000 Hz showed ARD pathological features. No correlation exists between the ARD with time of evolution of the disease, metabolic control and age of subjects. Conclusion: There is a low percentage of ARD pathological and lack of correlation with disease characteristics, coinciding with other studies that have used differents assessment tools.

Chirp-evoked otoacoustic emissions in children.

OBJECTIVE: The purpose of the study was to investigate the properties of otoacoustic emissions (OAEs) evoked by chirp stimuli and compare them with standard click-evoked OAEs. Differences between evoked OAEs in children with and without spontaneous otoacoustic emissions (SOAEs) were also assessed. METHODS: OAEs were first recorded from 54 children (age 4-10 years) in a screening setup. In each ear five OAE measurements were made using two types of chirps (7.5 ms and 10.5 ms) at around 70 dB pSPL; clicks at 70 and 80 dB pSPL; and a standard synchronized SOAE stimulation protocol. Tympanometry was also conducted. Pass/refer criteria based on signal to noise ratios (SNRs) were applied to all OAEs. Pass/refer rates from all methods (OAEs evoked by chirps and clicks, and tympanometry) were compared. Additionally, half-octave-band values of OAE SNRs and response levels were used to assess statistical differences. RESULTS: Chirp-evoked OAEs generated a similar number of passes to click-evoked OAEs when the same level of stimulus was used. When using lower stimulus levels, both chirp- and click-evoked OAEs diagnosed nearly all ears that failed tympanometry. The response levels and SNRs of OAEs evoked by clicks and chirps were very similar. The highest response levels were in the 1.4 kHz half-octave band. The SNRs for ears with SOAEs were highest at 1.4 kHz, whereas they were at 4 kHz for ears without SOAEs. Both response levels and SNRs were higher by about 5 dB for ears with SOAEs than ears without SOAEs. Also all ears with SOAEs generated a pass result in screening, while ears without SOAEs gave a pass less frequently (at least 30% fewer cases). CONCLUSIONS: The results suggest that performance of chirp-evoked OAEs for screening purposes is similar to click-evoked OAEs when the same stimulus level is applied. OAEs evoked with lower stimulus levels (70 vs. 80 dB pSPL) are more sensitive to middle ear pathology. The presence of SOAEs significantly influences the pass rates of OAEs evoked by chirps and clicks.

Auditory and otological manifestations in adults with HIV/AIDS.

OBJECTIVES: This study describes the prevalence and nature of auditory and otological manifestations in adults with HIV/AIDS through clinical examinations and self-reported symptoms across stages of disease progression. DESIGN: Descriptive cross-sectional group design. STUDY SAMPLE: Two hundred HIV positive adult patients (56.5% male; 43.5% female; mean age: 37.99 ± 6.66 years) attending the Infectious Disease Clinic of a tertiary referral hospital in Pretoria, South Africa were included. Patients were interviewed, medical files were reviewed, and clinical examinations, including otoscopy, tympanometry, pure-tone audiometry, and distortion product otoacoustic emissions, were conducted. A matched HIV negative control group was used to compare hearing loss prevalence. RESULTS: Tinnitus (26%), vertigo (25%) hearing loss (27.5%), otalgia (19%), and ear canal pruritis (38%) were prevalent self-reported symptoms. Abnormalities in otoscopy, tympanometry, and otoacoustic emissions were evident in 55%, 41%, and 44% of patients respectively. Pure-tone average (PTA) hearing loss > 25 dBHL was evident in 14% of patients and 39% for hearing loss > 15 dBHL (PTA). Significant differences across average thresholds in the HIV positive and HIV negative control group was present. An increase in self reported vertigo, self reported hearing loss, OAE abnormalities, and hearing loss (PTA > 15 dBHL and PTA > 25 dBHL) was seen with disease progression but was not statistically significant. A significant increase (p <.05) in sensorineural hearing loss was however evident with disease progression. CONCLUSIONS: Auditory and otological symptoms are more common in patients with HIV with a general increase of symptoms, especially sensorineural hearing loss, towards advanced stages of disease progression.

Audiogram configurations among older adults: prevalence and relation to self-reported hearing problems.

OBJECTIVE: There are only a few population-based epidemiological studies on audiogram configurations among adults. The aim of this study was to investigate the prevalence of different audiogram configurations among older adults. In addition, audiogram configurations among subjects reporting hearing problems were examined. DESIGN: Cross-sectional, population-based, unscreened epidemiological study among older adults. STUDY SAMPLE: The subjects (n = 850), aged 54-66 years, were randomly sampled from the population register. A questionnaire survey, an otological examination, and pure-tone audiometry were performed. RESULTS: The most prevalent audiogram configuration among men was high-frequency steeply sloping (65.3% left ear, 51.2% right ear) and among women, high-frequency gently sloping (33.0% left ear, 31.5% right ear). There were significantly more flat configurations among women than among men. Unclassified audiograms were common especially among women (17.5%). Subjects reporting hearing difficulties, difficulties in following conversation in noise, or tinnitus, more often had a high-frequency steeply sloping configuration than those not reporting. CONCLUSIONS: High-frequency sloping audiogram configurations were common among older adults, and a high-frequency steeply sloping configuration was common among those reporting hearing problems.

Neonatal cochlear function: measurement after exposure to acoustic noise during in utero MR imaging.

PURPOSE: To establish whether fetal exposure to the operating noise of 1.5-T magnetic resonance (MR) imaging is associated with cochlear injury and subsequent hearing loss in neonates. MATERIALS AND METHODS: The study was performed with local research ethics committee approval and written informed parental consent. Neonatal hearing test results, including otoacoustic emission (OAE) data, were sought for all neonates delivered in Sheffield who had previously undergone in utero MR imaging between August 1999 and September 2007. The prevalence of hearing impairment in these neonates was determined, with corresponding 95% confidence intervals calculated by using the binomial exact method, and mean OAE measurements were compared with anonymized local audiometric reference data by using the t test. RESULTS: One hundred three neonates who had undergone in utero MR imaging were identified; 96 of them had completed hearing screening assessment. Thirty-four of these babies were admitted to the neonatal intensive care unit (NICU), and one of them had bilateral hearing impairment. The prevalence of hearing impairment was 1% (one of 96; 95% confidence interval: 0.03%, 5.67%), which is in accordance with the prevalence expected, given the high proportion of babies in this study who had been in the NICU (ie, NICU graduates). In addition, for the well babies, there was no significant difference in mean OAE cochlear response compared with that for a reference data set of more than 16,000 OAE results. When NICU graduates were included in the comparison, a significant difference (P = .002) was found in one of four frequency bands used to analyze the cochlear response; however, this difference was small compared with the normal variation in OAE measurements. CONCLUSION: The findings in this study provide some evidence that exposure of the fetus to 1.5-T MR imaging during the second and third trimesters of pregnancy is not associated with an increased risk of substantial neonatal hearing impairment.

Factors affecting the use of health examinations by the elderly in Taiwan.

This study evaluated the factors associated with use of health examinations by the elderly. Data were obtained from the 2005 National Health Interview Survey (NHIS) in Taiwan for 2,482 individuals aged 65 years or older. The Andersen model was used as the analytic framework, and all variables were categorized into four factors: predisposing, need, health-related behavioral, and enabling factors. The chi(2)-test and a hierarchical multiple logistic regression model were used to examine the association between these variables and the use of health examinations. Nearly half (46.8%) of the elderly had used the service previously. In the final model, those with older age, a spouse, Hakka origin, higher educational level, hypertension, bodily pain, and moderate to high exercise were more likely to use health examinations. On the other hand, older adults who usually used alternative medicine, were missing cognitive test results, were current smokers, and had functional limitations were less likely to use the service. The study results showed that the utilization rate of health examinations was low, suggesting that there is a need to increase its utilization through health education. Furthermore, the factors found in the study may be further used for promoting health examinations.

Effects of background noise on recording of portable transient-evoked otoacoustic emission in newborn hearing screening.

Transient-evoked otoacoustic emission (TEOAE) is a well-established screening tool for universal newborn hearing screening. The aims of this study are to measure the effects of background noise on recording of TEOAE and the duration required to complete the test at various noise levels. This study is a prospective study from June 2006 until May 2007. The study population were newborns from postnatal wards who were delivered at term pregnancy. Newborns who were more than 8-h old and passed a hearing screening testing using screening auditory brainstem response (SABRe) were further tested with TEOAE in four different test environments [isolation room in the ward during non-peak hour (E1), isolation room in the ward during peak hour (E2), maternal bedside in the ward during non-peak hour (E3) and maternal bedside in the ward during peak hour (E4)]. This study showed that test environment significantly influenced the time required to complete testing in both ears with F [534.23] = 0.945; P < 0.001 on the right ear and F [636.54] = 0.954; P < 0.001 on the left. Our study revealed that TEOAE testing was efficient in defining the presence of normal hearing in our postnatal wards at maternal bedside during non-peak hour with a specificity of 96.8%. Our study concludes that background noise levels for acceptable and accurate TEOAE recording in newborns should not exceed 65 dB A. In addition, when using TEOAE assessment in noisy environments, the time taken to obtain accurate results will greatly increase.

On the cognitive neurodynamics of listening effort: a phase clustering analysis of large-scale neural correlates.

An increased listening effort represents a major problem in humans with hearing impairment. Neurodiagnostic methods for an objective listening effort estimation could revolutionize auditory rehabilitation. However the cognitive neurodynamics of listening effort is not understood and research related its neural correlates is still in its infancy. In this paper we present a phase clustering analysis of large-scale listening effort correlates in auditory late responses (ALRs). For this we apply the complex wavelet transform as well as tight Gabor Frame (TGF) operators. We show (a) that phase clustering on the unit circle can separate ALR data from auditory paradigms which require a graduated effort for their solution; (b) the application of TGFs for an inverse artificial phase stabilization at the alpha/theta-border enlarges the endogenously driven listening effort correlates in the reconstructed time- domain waveforms. It is concluded that listening effort correlates can be extracted from ALR sequences using an instantaneous phase clustering analysis, at least by means of the applied experimental pure tone paradigm.

The effects of aging on distortion-product otoacoustic emissions in adults with normal hearing.

OBJECTIVES: The focus of this study was to determine whether deterioration in cochlear function, as evaluated by distortion-product otoacoustic emission (DPOAE), exists before the elevation of audiometric thresholds occurs during the course of aging. In previous research, variability in normal audiometric thresholds likely contributed to the aging effect on OAE data. Therefore, in selecting subjects, we applied the stringent criterion in pure-tone thresholds (PTT) to limit dispersion among normal-hearing thresholds. DESIGN: We evaluated 331 subjects (136 men and 195 women) of a population-based sample of 2259 adults aged 40 to 82 yr who took part in the Longitudinal Study of Aging. We chose subjects according to the audiometric criterion that thresholds at any of five frequencies, namely 500, 1000, 2000, 4000, and 8000 Hz, did not exceed 15 dB HL. The mean age of our subjects was 48.3 +/- 7.4 yr (range, 41 to 72 yr) in men and 49.6 +/- 7.6 yr (range, 41 to 80 yr) in women. In a univariate analysis, analysis of variance was performed on DPOAE amplitudes and noise estimates at 22 test frequencies, as well as on the PTT. Age groups (40s, 50s, 60s, and above) were considered separately for men and women, without adjustment for any confounding variables. In a multivariate approach, general linear model analyses were performed to focus attention on the impact of age as a continuous variable, and on the influence of PTT on DPOAE levels. The multivariate analysis was conducted separately for men and women. DPOAE amplitudes at nine test frequencies were set as objective variables. Age (continuous variable), PTT at the corresponding test frequency, and interaction between age and PTT at the corresponding test frequency were evaluated as explanatory variables with adjustment for static admittance, history of ear disease (yes = 1), and history of occupational noise exposure (yes = 1). RESULTS: Of the 22 test frequencies, we found a statistically significant difference in DPOAE amplitudes among age groups at four test frequencies in men, ranging from 4761 to 6165 Hz, and at all but the 3088 Hz test frequency in women. Despite the stringent audiometric inclusion criterion, statistically significant differences in the mean PTT among the age groups were observed at 4000 Hz in men and at all five tested frequencies in women. Multivariate analyses demonstrated a significant negative effect of age on DPOAE levels at 1086 Hz f2 frequency in men and at the 1184, 2002, 2185, 4004, and 4358 Hz f2 frequencies in women. Regarding PTT, neither main nor interactive effect on DPOAE amplitude was statistically significant at any of nine test frequencies. The goodness-of-fit of the model, in terms of R2, ranged from 0.05 to 0.11 in men and from 0.11 to 0.18 in women. CONCLUSIONS: The present analyses substantiated the hypothesis DPOAEs deteriorate with age independently of hearing sensitivity. The aging effect on DPOAE measures was observed more in women than in men. We conclude that DPOAE measurements in audiometrical normal-hearing elderly may provide early indications of cochlear damage because of aging.

Characteristics of youths with hearing loss admitted to substance abuse treatment.

The purpose of this study is to provide a profile of youths with hearing loss admitted to substance abuse treatment facilities. Intake data on 4,167 youths (28% female; 3% reporting a hearing loss) collected via the Global Appraisal of Individual Need-I assessment was used for the analyses. Information on demographics, environmental characteristics, substance use behaviors, and symptoms of co-occurring psychological problems for youths with and without a hearing loss was analyzed via Pearson chi-square tests and effect sizes. The groups reported similar backgrounds and comparable rates of marijuana and alcohol use. However, youths in the hearing loss group reported substance use behaviors indicative of a more severe level of involvement. Across all measures of co-occurring symptoms, youths with hearing loss reported greater levels of distress and were more often victims of abuse. Results of this study will help inform treatment needs of youths with hearing loss and define a baseline for future research.

Neonatal hearing screening: a combined click evoked and tone burst otoacoustic emission approach.

OBJECTIVE: This study evaluated an alternative transient evoked otoacoustic emissions method for screening hearing in newborn babies that may reduce the referral rate of initial screening. METHODS: A total of 1,033 neonates (2,066 ears) from two hospitals were recruited. Subjects had their hearing screened in both ears using a combined approach-both click evoked OAEs (CEOAEs) and 1kHz tone burst evoked OAEs (TBOAEs). RESULTS: 1kHz TBOAEs were more robust than CEOAEs in terms of emission response level and signal-to-noise ratio (SNR) at both 1 and 1.5kHz frequency bands. The prevalence rate for CEOAE and TBOAE responses in these two frequency bands was significantly different. The combined protocol significantly reduced the referral rate-by almost 2 percentage points for first time screening. CONCLUSIONS: The implementation of a combined 1kHz TBOAE/CEOAE screening protocol is a feasible and effective way to reduce referral rates, and hence false positive rates, in neonatal hearing screening programs.

Comparison of transient evoked otoacoustic emissions and distortion product otoacoustic emissions when screening hearing in preschool children in a community setting.

OBJECTIVE: The first purpose of this study was to compare transient evoked otoacoustic emissions (TEOAE) with distortion product otoacoustic emissions (DPOAE) to determine if they resulted in equivalent signal-to-noise ratios (SNRs) when used for hearing screening in a preschool population in a community setting. The second purpose was to determine if the OAE methods would result in equivalent pass/refer rates. The third purpose was to determine the agreement between the pass/refer rates from a tympanometric screening and the pass/refer rates from each OAE method. METHODS: Thirty-three preschool children ages 4 months to 4 years, 4 months were tested using DPOAE and TEOAE. The frequencies 800-4000Hz were compared. The tympanometric gradient was obtained from a tympanogram done on each ear. A multivariate statistic was used to compare the emission SNR from both methods. A chi(2) statistic was used to compare the pass/refer rates from both methods. The agreement between the pass/refer rates from the OAE screens and from the tympanometric gradient were compared. RESULTS: TEOAE and DPOAE SNRs were significantly different in the low frequency however, there were no significant differences found in the high frequencies. There were no significant pass/refer differences found between the methods at any frequency. When comparing the agreement between the OAE methods with the tympanometry, both methods produced nearly equivalent agreement with tympanometric gradient. However, the overall correspondence between OAE findings and tympanometry was not perfect. CONCLUSIONS: Both methods are effective and especially equivalent in the high frequencies and can be recommended for use in a preschool population in the field. Tympanometric gradient disagreed with both OAE screening results about 25% of the time. Finally, our study also found that higher refer rates can be expected when young (<3 years) preschool children are included in the screen.

Benefits and costs of universal hearing screening programme.

Hearing loss affects 1-3 out of 1000 newborns. A programme of universal newborn hearing screening (UNHS) was implemented in our ENT department in February 2000. In 2001, the programme was extended to all the hospitals of the canton Geneva. The programme is based on the recording of transient evoked otoacoustic emissions (TEOAE) from all newborns. In addition, automated auditory brainstem responses (aABR) are recorded in high-risk neonates. In the report, we compare the mean age at which rehabilitation of hearing was undertaken during a 5-year period before and after the screening programme was instituted. We also identify some causes of delayed diagnosis and intervention and the pitfalls of universal hearing screening. The price of the UNHS programme is estimated at 26 Swiss francs (17 Euros; 21 US dollars) per infant screened, including the material required, the personal involved to run the programme, and the follow-up.

MB11 BERAphone and auditory brainstem response in newborns at audiologic risk: comparison of results.

OBJECTIVE: To compare the diagnostic effectiveness of Automated Auditory Brainstem Responses (MB11 technique) with that of standard Auditory Brainstem Responses (ABR) in a sample of newborns evaluated after the second month of life. METHODS: From October 2002 to February 2005, audiologic evaluations were performed in full-term newborns who presented altered otoacoustic emissions and in newborns considered at audiologic risk admitted to the ENT (Ear Nose Throat) Unit of Giannina Gaslini Institute, Genoa, Italy. Our sample included 201 children (104 males and 97 females) who underwent on the same day an audiologic test using MB11 BERAphone Maico and standard ABR test. RESULTS: Out of the 388 ears examined, 378 (97.4%) showed agreement between the two techniques, whereas in 10 (2.6%) there was no agreement. Interobserver agreement was excellent (kappa=0.92+/-0.02 S.E., p=0.0001). The MB11 test yielded no false negatives and 10 false positives which resulted normal at ABR. The MB11 test showed very good specificity 96.8% (95% CI 94.8-98.7%) and sensitivity 100% (95% CI 93.9-100%), positive predictive value 88.2% (95% CI 79-93.9%) and negative predictive value 100% (95% CI 98.4-100%) for diagnosis of hearing loss. CONCLUSIONS: The results obtained confirm the absolute validity of MB11 screening test in subjects at audiologic risk. Furthermore, the test can be used to esclude normal hearing subjects (threshold 40 dB HL) and to refer hearing loss subjects to subsequent ABR for diagnosis.

Effects of maturation on parameters used for pass/fail criteria in neonatal hearing screening programmes using evoked otoacoustic emissions.

We aimed to investigate the incidence of false alarms that occurred with the pass/fail criteria used in a published series of neonatal hearing screening programmes, as a function of age. We analysed the database of 19137 normally hearing babies (38274 ears) tested in the Wessex Universal Neonatal Hearing Screening Project. Otoacoustic emissions were recorded prior to discharge from maternity units, using IL088 equipment. We assessed the pass/fail rate using the Wessex criteria and 10 other pass/fail criteria published in the literature. Using Pearson's correlation coefficient, a statistically significant correlation between signal-to-noise ratio at each of the frequency bands 1, 2, 3, 4 and 5 kHz and babies' age in hours at the 0.01 level was identified. The correlation was also significant (0.01 level) between age and frequency reproducibility in each of the bands at 1, 2, 3, 4 and 5 kHz as well as the whole reproducibility. The number of false alarms reduced significantly after the first 24 h of life with all the criteria examined. We conclude that in the first hours after birth due to insufficient maturation of the otoacoustic emission, there is a high rate of false alarms. This increase in the false alarm rate, whilst dependent on the criteria used, occurs with all criteria. This leads to the consideration of whether the establishment of age-dependent pass/fail criteria could reduce the false alarm rate and the subsequent strain on diagnostic centres.

Use of bedside sound generators by patients with tinnitus-related sleeping difficulty: which sounds are preferred and why?

CONCLUSIONS: Most tinnitus patients who have difficulty sleeping experience some improvement in sleep after short-term use of bedside sound generators (BSSGs), although this study does not allow conclusions to be drawn as to how much other factors contribute. Many patients seem to find BSSGs helpful in reducing autonomic arousal. Further research is needed, but these findings raise the possibility that the emotional effects of sound enrichment have an important role to play in improving sleep among tinnitus patients. OBJECTIVES: This study investigated which sounds out of the options available on BSSGs are commonly chosen by patients and the reasons behind these choices. It also aimed to provide an indication as to whether BSSGs improve sleep quality in the short term. PATIENTS AND METHODS: A consecutive series of 39 tinnitus clinic patients who made a subjective complaint of sleep disturbance took part in the study. All participants were given a Naturecare BSSG to use at night. The Pittsburgh Sleep Quality Index (PSQI) and a semi-structured interview were used as outcome measures. RESULTS: Among the 35 participants who attended for follow-up there was a significant improvement in PSQI scores (p=0.001). 'Brook' and 'birds' were the most popular sounds, while 'white noise' proved the least popular. Most BSSG users listened to one sound only and most said that they chose their sound because of a pleasant emotional effect. A minority gave the quality of sound or its perceived effect on tinnitus as a reason for their choice.