Pilot implementation of newborn hearing screening programme at four hospitals in southern Thailand.

OBJECTIVE: To determine the effectiveness and benefit of a universal newborn hearing screening programme at four different hospitals in southern Thailand, between January and July 2017. METHODS: One screener per hospital recorded demographic data of all newborns and their exposure to risk of hearing loss, and evaluated their hearing by transient otoacoustic emission technology. Those who demonstrated bilateral moderate to profound hearing loss at both a first and second screening were referred for diagnostic assessment. Those with confirmed hearing loss received treatment and regular follow-up appointments, and their speech development was assessed at 1 year of age. We determined effectiveness by comparing our achieved coverage and proportion of follow-up and referrals with benchmarks set by the American Academy of Pediatrics (≥ 95%, ≥ 95% and ≤ 4%, respectively), and determined benefit by calculating the composite language scores of hearing-impaired infants who received early intervention. FINDINGS: We screened 6140 eligible newborns, and achieved a screening coverage of 95.4% (5859/6140), lost 25.7% (63/245) and 22.0% (9/41) to follow-up at the second screening and diagnostic assessment stages, respectively, and obtained an overall proportion of referrals of 0.7% (41/6140). Twelve infants were confirmed as having hearing loss and received early intervention; nine (75%) demonstrated normal speech development by their first birthday. Our universal hearing screening yielded a prevalence of sensorineural hearing loss of less than 0.1% (3/6140). CONCLUSION: Although ineffective by American Academy of Pediatrics standards, we demonstrated the benefit of early intervention in infants diagnosed with hearing loss.

Endoscope-Assisted Stapedotomy with Microdrill: Comparison with a Conventional Technique.

Objective: To compare endoscope-assisted microdrill stapedotomy with the conventional technique. Material and Method: A retrospective comparative study of 37 otosclerosis stapes fixation surgeries performed with the conventional technique or the endoscope-assisted microdrill stapedotomy were evaluated. Audiometric data and intraoperative and postoperative complications were recorded. Results: The mean operating time was 128 min in the endoscopic group and 132 min in the conventional group, (p = 0.72). Residual air-bone gaps of ≤10 decibels were obtained in 83.3% and 47.4% of the patients in the endoscopic group and the conventional group, respectively, (p = 0.04). No footplate fractures and incidences of postoperative vertigo and chorda tympani nerve injuries were found in the endoscopic group. Postoperative vertigo was found in 31.6% of the conventional group, and 26.3% of the patients in the conventional group had undergone an endaural surgical approach owing to inadequate exposure under the microscope. Conclusion: An endoscope-assisted microdrill stapedotomy was associated with significantly better hearing results, a lower postoperative vertigo rate, and fewer footplate fractures and chorda tympani nerve injuries than the conventional technique.

Malignant tumors of temporal bone in Songklanagarind Hospital: management and results.

OBJECTIVE: To evaluate the clinical course and treatment in patients with carcinoma of temporal bone MATERIAL AND METHOD: The authors retrospectively reviewed the patients treated for primary carcinoma of temporal bone in Otolaryngology Head and Neck Surgery department, at Songklanagarind Hospital between 2002 and 2013. Thirty-two patients, including 10 cancer ofpinna and 22 carcinoma of the External Auditory Canal (EAC), were included in this study. The treatment modality was lateral temporal bone resection and postoperative radiotherapy and palliative radiotherapy for advanced stage tumors (T4). Twelve patients were excluded due to difference in modality. Twenty patients remained in the study. RESULTS: Twenty patients had carcinoma of EAC, early stage (T1, T2) 36.4% and late stage (T3, T4) 63.6%. The overall survival of this group was 46.9%. The median survival period was 22 months (0.286-0.769, 95% CI). CONCLUSION: The complete resection is the treatment of choice in primary cancer of temporal bone. Postoperative radiotherapy for a microscopic residual tumor is highly recommended. The most important thing is early diagnosis.

The characteristic differences of benign paroxysmal positional vertigo among the elderly and the younger patients: A 10-year retrospective review.

OBJECTIVE: To compare the clinical characteristics of benign paroxysmal positional vertigo (BPPV) between the elderly and the younger patients. MATERIAL AND METHOD: The medical records of BPPV patients with positive testing result on the Dix-Hallpike or supine roll test between January 2002 and December 2012 at Songklanagarind hospital, Thailand were retrospectively reviewed. RESULTS: Of the 951 BPPV patients, 595 patients were in the younger group (age < or =60-year-old, mean age = 46.9+/-8.9 years) and 356 patients were in the elderly group (age >60-year-old, mean age = 69.3+/-6. 7years). The most common etiology of BPPV was idiopathic. No significant difference was found regarding gender and semicircular canals that were involved in both groups. The most involved semicircular canal was the posterior canal. The most common described symptom of BPPV was vertigo. Patients in the elderly group were less likely to describe vertigo as the presenting symptom of BPPV compared to those in the younger group (OR = 0.22; 95% CI, 0. 12-0.41; p< 0. 001). The elderly group usually complained of imbalance and dizziness (OR = 15.83; 95% CI, 8.7-28.8; p<0. 001 and OR = 10.12; 95% CI, 5.23-19.59; p<0. 001, respectively). The duration of the symptom before diagnosis was longer in the elderly, when compared to the younger group (30 days, median; IQR = 7, 61 versus 5 days, median; IQR = 2, 7), respectively (p<0. 001). The ability to describe the trigger event precisely was less in the elderly group (63.8% versus 82.2%, p<0.001). The elderly group significantly underwent brain imaging studies more than the younger group (8.4% versus 3.5%, p = 0.02). Outcome of the treatment after the repositioning procedure was comparable in both groups (p = 0.58). Approximately 80% of patients in both groups had complete recovery from BPPV during their last visit. CONCLUSION: Dizziness and imbalance were the common presenting symptoms of BPPV in the elderly. The younger patients tended to describe the classic symptom of vertigo that was specific to BPPV more precisely than the elderly. These may contribute to underestimate BPPV, do unnecessary brain imaging study, and take more time to get the correct diagnosis of BPP V among elderly patients.

The prevalence of noise-induced occupational hearing loss in dentistry personnel.

Occupational hearing loss is the second most common health problem in the industrialized world. Dental personnel exposed to occupational noise may experience hearing loss. This article compares the prevalence of hearing loss in the general population to that of dental personnel exposed to noise during work hours and identifies risk factors for hearing loss among workers at a dental school. This prospective study included 76 dental personnel on the faculty of dentistry at a major university in Asia who were exposed to noise and 76 individuals in a control group. Nearly 16% of the study group and 21% of the control group had lost hearing, a nonsignificant difference (p = .09). Hearing loss was significantly related to work tenure longer than 15 years and age older than 40 years (p < .001 ).

Therapy of idiopathic sudden sensorineural hearing loss with intratympanic steroid injection.

OBJECTIVE: To evaluate the efficacy of intratympanic steroid injection in patients with idiopathic sudden sensorineural hearing loss (SSNHL) who are not responding to systemic steroids. MATERIAL AND METHOD: A prospective cohort study of 31 patients, with idiopathic SSNHL refractory to oral steroid therapy, who were treated with intratympanic steroid injection. The injections were performed once a week for three consecutive weeks. Pure tone audiometry (PTA) and speech discrimination score (SDS) was performed before and two months after intratympanic steroid injection had been completed. Successful treatment was defined as a decrease in PTA by 10 dB or more, or an increase in SDS by 20% or more. RESULTS: Thirty-one patients were treated with intratympanic steroid injection, 22 women and 9 men. The average age was 53 years. Overall success was 14 patients (45.2%). Eleven of the patients (35.5%) showed either improvement in PTA or SDS, among these there were two patients who had improvement in only PTA and nine patients had improvement only in SDS. Besides, three of the patients (9.7%) had improvement in both PTA and SDS. CONCLUSION: Intratympanic steroid injection effectively improves hearing in patients with SSNHL after treatment failure with oral systemic steroid and is not associated with side effects. Therefore, it can be used as salvage therapy after failed conventional treatment. Further studies are required to consider whether intratympanic steroid injection might be used as the first line treatment in SSNHL.

The high-risk neonatal hearing screening program in Songklanagarind Hospital.

OBJECTIVES: Determine the prevalence and risk factor of neonatal hearing loss in the high-risk group. MATERIAL AND METHOD: A prospective descriptive study, using the criteria of "high-risk" as defined by the Joint Committee of Infant Hearing 1994, American Academy of Pediatrics, 465 newborn in Songklanagarind Hospital were screened with portable otoacoustic emissions (OAEs) before being discharged between July 1st, 2004 and December 31st, 2006. Based on the examinations, the results were divided into two groups, "pass" and "refer". The neonates who failed the screening test were referred for further checks with conventional OAEs and if they failed again, then the authors reassessed them with auditory brainstem responses (ABR). RESULTS: Four hundred fifty eight infants (98.5%) in the high-risk group passed the primary screen for both ears. One infant (0.21%) was confirmed with unilateral sensorineural hearing loss and three infants (0.64%) were confirmed with bilateral hearing impairment above 30 dB. Three infants (0.64%) were lost to follow up. High-risk factors of hearing loss in the present study included 226 infants from premature birth (48.6%), 159 infants exposed to ototoxic medications (34.2%), and 61 infants with respiratory distress syndrome that required mechanical ventilation for at least five days (13.1%). CONCLUSION: Otoacoustic emissions are a very quick and noninvasive technique, and suitable for hearing screening in infants.

Meningioma of the internal auditory canal: a case report.

Meningioma of the internal auditory canal is very rare. There are only 15 previous reports of intracanalicular meningioma. The authors add a case report of a patient with meningioma of the internal auditory canal. A 31-year-old woman presented with a one-year history of headache, dizziness, hearing loss and left facial paralysis. An MRI of the temporal bone demonstrated a tiny isointense intracanalicular tumor with inhomogeneous enhancement. In the operative field carried out by translabyrinthine approach, the tumor was found in the IAC without intracranial involvement. Pathology revealed a meningioma. The patient was followed up for 2 years without recurrence.