Combined Amplification and Sound Therapy for Individuals With Tinnitus and Coexisting Hearing Loss: A Retrospective Cohort Study.

BACKGROUND: The heterogeneity of tinnitus perception and its impact necessitates a tailor-made management approach in everyone. The current study examined the effects of residual inhibition in combined amplification and sound therapy in individuals with tinnitus and coexisting hearing loss. METHODS: A retrospective analysis was performed on patients with tinnitus and coexisting hearing loss between 2016 and 2019. A total of 72 patients provided with combined amplification and sound therapy were divided into 3 groups based on residual inhibition: (i) complete residual inhibition, (ii) partial residual inhibition, and (iii) negative residual inhibition. Tinnitus severity was measured using the Tinnitus Functional Index before treatment and 1 and 6 months after the intervention. A multilevel mixed-effects model was used to examine the treatment effects including both the main and interaction effects of time and residual inhibition on the tinnitus severity. RESULTS: Of the 72 participants, 55 (76%) and 61 (85%) had clinically significant changes (13 points in Tinnitus Functional Index) at 1-month and 6-month postintervention, respectively. In the complete, partial, and negative residual inhibition groups, the reduction in tinnitus impact was 100%, 78%, and 74%, respectively. A multilevel mixed model analysis showed that the main effects of time and residual inhibition along with their interaction were significant. CONCLUSIONS: The study results suggest that combined amplification and sound therapy is beneficial in individuals with tinnitus and coexisting hearing loss in reducing their tinnitus severity, and this benefit was more in individuals with complete residual inhibition. However, these results need to be further confirmed by controlled trials.

Ototoxicity: A Challenge in Diagnosis and Treatment.

Ototoxicity is the pharmacological adverse reaction affecting the inner ear or auditory nerve, characterized by cochlear or vestibular dysfunction. The panorama of drug-induced hearing loss has widened over last few decades. Although ototoxic medications play an imperative role in modern medicine, they have the capacity to cause harm and lead to significant morbidity. Evidence has shown early detection of toxicity through prospective ototoxicity monitoring allows for consideration of treatment modifications to minimize or prevent permanent hearing loss and balance impairment. Although many ototoxicity monitoring protocols exist, their practicality is questionable due to several factors. Even though the existing protocols have proven to be effective, certain lacunae in practice have been encountered due to discrepancies among recommended protocols. Implementation of these protocols is mostly held back due to the incapacitated status of the patient. The choice of early ototoxicity identification techniques is still debatable due to variables such as high degree of sensitivity, specificity and reliability, less time consumption and less labour-intensive to the patient. Hence, the diagnosis and effective treatment of ototoxicity is challenging, even today. A stringent protocol with more practicality encompassing all elements aimed at profiling the effects of ototoxicity is greatly needed. This review describes an efficient application of ototoxicity monitoring and treatment protocol as an attempt to reduce the challenges in diagnosis and management of ototoxicity.

A Retrospective Study of the Clinical Characteristics and Post-treatment Hearing Outcome in Idiopathic Sudden Sensorineural Hearing Loss.

The purpose of this retrospective study was to analyze the clinical characteristics and document hearing recovery in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). 122 patients diagnosed with unilateral ISSNHL, from March 2009 to December 2014, were treated with oral steroids and pentoxifylline. Hearing change was evaluated by comparing pre-treatment and post-treatment pure-tone average (PTA) (500, 1K, and 2K Hz), and categorized into complete, partial, and no recovery of hearing. T-test, Wilcoxon Signed Rank test and Regression analysis were employed to analyze the statistical significance. Of the 122 patients, seventy-one (58%) had complete recovery and 34 (28%) had partial recovery. The average pre-treatment PTA was 78.3±16.9 dB whereas post-treatment average was 47.0±20.8 dB, showing statistically significant improvement (t=24.89, P≤0.001). The factors such as presence of tinnitus (P=0.005) and initial milder hearing loss (P=0.005) were found to be significant predictors for hearing recovery. Conventional steroid regimes produced a recovery rate in ISSNHL, which exceeds the spontaneous recovery rate. The current study results highlight the importance of medical treatment in the management of ISSNHL.

Preference to Patient-Centeredness in Undergraduate Audiology Students in Portugal.

BACKGROUND: In health care, the model of patient-centered care is growing; and improved outcomes have been linked to patient-centeredness. Practicing audiologists have been found to strongly prefer a patient-centered approach as years in practice increase. It is unknown whether patient-centeredness begins during education and training. PURPOSE: The current study was aimed at understanding the preference to patient-centeredness in undergraduate audiology students in Portugal. RESEARCH DESIGN: The study used a cross-sectional survey design. STUDY SAMPLE: One hundred and thirty-seven undergraduate audiology students completed patient-practitioner orientation scale (PPOS) and provided some demographic details. DATA COLLECTION AND ANALYSIS: The data were analyzed using one-way analysis of variance and one-sample t tests. RESULTS: A significant difference was found for sharing subscale (p ≤ 0.001), caring subscale (p = 0.033), and the PPOS full scale (p ≤ 0.001) among different undergraduate groups. Further, post hoc tests showed that the difference between year 1 and with years 2, 3, and 4 were significant for sharing subscale and PPOS full scale, but not for caring subscale. No significant differences were observed among the years 2, 3, and 4 for sharing subscale, caring subscale, and for PPOS full scale. When compared audiologists' preferences from a previous study on audiologists with students' preferences in the current study, significant difference for both subscales and full scale was found between year 1 students and audiologists (p ≤ 0.001), with higher preference to patient-centeredness was reported by qualified audiologists. Also, significant difference was found between audiologists and overall undergraduate group for caring subscale (p = 0.001). CONCLUSIONS: The current study suggests that audiology education influences preference to patient-centeredness. Within a year of undergraduate coursework, students tend to develop high preference to patient-centeredness, which stays stable during four years of undergraduate studies. These results provide useful insights to audiology education and training, particularly in the context of audiological rehabilitation.

Evaluation of IL-6, CRP and hs-CRP as Early Markers of Neonatal Sepsis.

INTRODUCTION: Bacterial sepsis is a life threatening crisis with high mortality and morbidity in neonates. Due to non-specific clinical presentation, diagnosis of sepsis is still a challenge. It can be diagnosed by blood culture but it is time consuming. So, a reliable marker is needed for the diagnosis of neonatal sepsis so that early treatment can be initiated. Various cytokines, chemokines, acute phase reactants, cell surface markers and interferons have been evaluated to find out the effective marker for early diagnosis of neonatal sepsis. In this study, levels of IL-6, CRP and hs-CRP have been analysed which would favour the diagnosis of neonatal sepsis. AIM: This study aimed to detect the levels of IL-6, CRP and hs-CRP in clinically suspected cases of neonatal sepsis and to evaluate and analyze the above parameters as the early markers of neonatal sepsis in comparison with blood culture. MATERIALS AND METHODS: Eighty neonates were included in this study of which 40 were clinically suspected cases of neonatal sepsis who met the inclusion criteria and the other 40 were normal healthy neonates that were taken as controls. After obtaining written informed consent from either parent of all neonates, venous blood samples were collected. Blood culture was performed by conventional method. Estimation of serum IL-6 was done by ELISA method and serum CRP and hs-CRP were done by immunofluorescence assay. RESULTS: The CRP level >13.49 mg/l showed sensitivity and specificity of 80% and 65.70% respectively. The IL-6 >51.29 pg/ml showed sensitivity of 100% and specificity of 62.86% and hs-CRP showed sensitivity of 90% and specificity of 32.86%. Combination of IL-6 and CRP showed sensitivity and specificity of 100% and 75.71% respectively. CONCLUSION: Our study suggests that IL-6 is a highly sensitive marker and CRP is a more specific marker for the diagnosis of neonatal sepsis. hs-CRP is a less reliable marker. So, the combination of IL-6 and CRP are the better predictors of neonatal sepsis.

A Rare Case of Hearing Impairment due to Cerebello-Pontine Angle Lesion: Trigeminal Schwannoma.

Schwannoma of the trigeminal nerve is a rare condition. Even rarer is hearing loss occurring as a result of this lesion. The aim of this study is to highlight this rare cause of hearing impairment. Here we report the clinical features and findings of the imaging and audiological investigations of a case of trigeminal schwannoma diagnosed at our institution. Our patient presented with headache, giddiness, tinnitus, left-sided facial weakness, left-sided hearing loss, right-sided hemiplegia, and unintelligible speech. Radiological studies revealed a large well-defined mass lesion in the left cerebellopontine angle with a significant mass effect on posterior fossa structures, suggestive of trigeminal nerve tumor. Audio-vestibular assessment was done with pure tone audiometry, impedance audiometry, otoacoustic emission, brainstem-evoked response audiometry, and electronystagmography, which pointed toward a retrocochlear pathology for hearing loss and imbalance.