Peripheral and brainstem auditory evaluation in post-COVID-19 individuals.

PURPOSE: The purpose of this study was to investigate the peripheral and central auditory pathways in adult individuals after COVID-19 infection. METHOD: A total of 44 individuals aged between 19 and 58 years, of both genders, post-COVID-19 infection, confirmed by serological tests, with no previous hearing complaints and no risk factors for hearing loss, were assessed. All the participants underwent the following procedures: pure tone audiometry, logoaudiometry, immitanciometry, and Brainstem Auditory Evoked Potentials (BAEP), in addition to answering a questionnaire about auditory symptoms. RESULTS: Thirteen individuals (29.5 %) had some hearing threshold impairment, mainly sensorineural hearing loss. In the BAEP, 18 individuals (40.9 %) presented longer latencies, mainly in waves III and V. According to the questionnaire answers, 3 individuals (9.1 %) reported worsened hearing and 7 (15.9 %) tinnitus that emerged after the infection. As for the use of ototoxic drugs during treatment, 7 individuals (15.9 %) reported their use, of which 5 showed abnormalities in peripheral and/or central auditory assessments. CONCLUSION: Considering the self-reported hearing complaints after COVID-19 infection and the high rate of abnormalities found in both peripheral and central audiological assessments, it is suggested that the new COVID-19 may compromise the auditory system. Due to the many variables involved in this study, the results should be considered with caution. However, it is essential that audiological evaluations are carried out on post-COVID-19 patients in order to assess the effects of the infection in the short, medium, and long term. Future longitudinal investigations are important for a better understanding of the auditory consequences of COVID-19.

The word-with-noise test: development, validation and reference values. / Teste de palavras no ruído: desenvolvimento, validação e valores de referência.

PURPOSE: To propose an instrument for assessing speech recognition in the presence of competing noise. To define its application strategy for use in clinical practice. To obtain evidence of criterion validity and present reference values. METHODS: The study was conducted in three stages: Organization of the material comprising the Word-with-Noise Test (Stage 1); Definition of the instrument's application strategy (Stage 2); Investigation of criterion validity and definition of reference values for the test (Stage 3) through the evaluation of 50 normal-hearing adult subjects and 12 subjects with hearing loss. RESULTS: The Word-with-Noise Test consists of lists of monosyllabic and disyllabic words and speech spectrum noise (Stage 1). The application strategy for the test was defined as the determination of the Speech Recognition Threshold with a fixed noise level at 55 dBHL (Stage 2). Regarding criterion validity, the instrument demonstrated adequate ability to distinguish between normal-hearing subjects and subjects with hearing loss (Stage 3). Reference values for the test were established as cut-off points expressed in terms of signal-to-noise ratio: 1.47 dB for the monosyllabic stimulus and -2.02 dB for the disyllabic stimulus. Conclusion: The Word-with-Noise Test proved to be quick to administer and interpret, making it a useful tool in audiological clinical practice. Furthermore, it showed satisfactory evidence of criterion validity, with established reference values.

OBJETIVO: Propor um instrumento para a avaliação do reconhecimento de fala na presença de ruído competitivo. Definir sua estratégia de aplicação, para ser aplicado na rotina clínica. Obter evidências de validade de critério e apresentar seus valores de referência. MÉTODO: Estudo realizado em três etapas: Organização do material que compôs o Teste de Palavras no Ruído (Etapa 1); Definição da estratégia de aplicação do instrumento (Etapa 2); Investigação da validade de critério e definição dos valores de referência para o teste (Etapa 3), por meio da avaliação de 50 sujeitos adultos normo-ouvintes e 12 sujeitos com perda auditiva. RESULTADOS: O Teste de Palavras no Ruído é composto por listas de vocábulos mono e dissilábicos e um ruído com espectro de fala (Etapa 1). Foi definida como estratégia de aplicação do teste, a realização do Limiar de Reconhecimento de Fala com ruído fixo em 55 dBNA (Etapa 2). Quanto à validade de critério, o instrumento apresentou adequada capacidade de distinção entre os sujeitos normo-ouvintes e os sujeitos com perda auditiva (Etapa 3). Foram definidos como valores de referência para o teste, os pontos de corte expressos em relação sinal/ruído de 1,47 dB para o estímulo monossilábico e de -2,02 dB para o dissilábico. CONCLUSÃO: O Teste de Palavras no Ruído demonstrou ser rápido e de fácil aplicação e interpretação dos resultados, podendo ser uma ferramenta útil a ser utilizada na rotina clínica audiológica. Além disso, apresentou evidências satisfatórias de validade de critério, com valores de referência estabelecidos.

Auditory Electrophysiological Thresholds With Different Chirps and Their Correlation With Behavioral Thresholds in Hearing-Impaired Children.

OBJECTIVES: Research focusing on changes in the clinical practice of audiological diagnosis has become increasingly necessary, particularly in pediatric audiology. The pursuit of accurate and reliable examinations has intensified given the importance of early detection and intervention in cases of childhood hearing loss. Thus, this study aims to investigate the correlation between electrophysiological auditory thresholds, as obtained through frequency-specific auditory brainstem responses with two distinct chirp stimuli (narrow-band CE-Chirp Level Specific and narrow-band iChirp), in children with hearing impairments. In addition, this research set out to correlate these thresholds with behavioral responses while simultaneously comparing the examination durations relative to the type of stimuli and the degree of hearing loss. DESIGN: A cohort of 20 children (aged 6 months to 12 years) with varying degrees of hearing impairment (ranging from mild to profound) were recruited. The participants underwent bilateral measurement of their electrophysiological thresholds via auditory brainstem responses across different frequencies (500, 1000, 2000, and 4000 Hz), and the timeframe for determining these thresholds was carefully recorded. Subsequently, behavioral thresholds were ascertained using pure-tone audiometry or visual reinforcement audiometry based on the child's age. The data collected was subsequently analyzed using Pearson and Spearman correlation coefficients. To compare examination times, the Student t test and the Kruskal-Wallis test were used. RESULTS: There was a pronounced correlation between the thresholds obtained through both narrow-band chirp stimuli. Moreover, a substantial correlation was found between electrophysiological and behavioral thresholds at 1000, 2000, and 4000 Hz, especially when compared with pure-tone audiometry. The mean differences between the electrophysiological and behavioral thresholds were below 6 dB nHL, and the exam duration was relatively consistent across both devices, averaging 47.63 (±19.41) min for the narrow-band CE-Chirp Level Specific and 52.42 (±26) min for the narrow-band iChirp. Notably, variations in exam duration did not relate to varying degrees of hearing loss when using the narrow-band CE-Chirp Level Specific. Nevertheless, the narrow-band iChirp indicated significantly shorter durations in instances of profound degree measurements, demonstrating a statistically significant difference. CONCLUSIONS: The narrow-band CE-Chirp Level Specific and narrow-band iChirp stimuli provided similar estimates of electrophysiological auditory thresholds in children with hearing impairments, giving accurate estimations of behavioral thresholds. The time it took to complete the assessment is comparable between both stimuli. For the narrow-band iChirp, the degree of hearing loss was shown to impact the testing time, and children with profound hearing loss underwent faster exams. Ultimately, this study exhibits significant clinical implications as it reveals that the narrow-band CE-Chirp Level Specific and narrow-band iChirp stimuli could be remarkably promising for clinically exploring electrophysiological thresholds in children with hearing impairments.

Standard and Extend High-Frequency Audiometry in Sudden Sensorineural Hearing Loss: Impacts on Tinnitus and Mental Health.

OBJECTIVE: To analyze the results of auditory assessment in standard (SA) and extended high-frequency (EHF) audiometry, associating the findings with sudden tinnitus and mental health of patients with unilateral sudden sensorineural hearing loss (SSNHL). STUDY DESIGN: Prospective, cohort study. SETTING: Outpatient otology clinic in a tertiary care hospital. SUBJECTS AND METHODS: Patients experiencing unilateral SSNHL were evaluated with pure-tone audiometry performed at frequencies of 250 to16,000 Hz, tinnitus pitch and loudness matching tests, Tinnitus Handicap Inventory (THI), Analog and Visual Scale (AVS) for bothersome tinnitus, and the Hospital Anxiety and Depression Scale (HADS). RESULTS: Eighteen patients with unilateral SSNHL were assessed. After starting treatment, there was a significant improvement in the SA (71.1 dB to 50 dB; p < 0.001*) and EHF audiometry (64.5 dB to 54.4 dB; p < 0.001*) thresholds at 15 days, and this persisted at 30 days of follow-up. Significant improvements were seen for tinnitus in loudness, VAS, and THI and for mental health in the realms of anxiety and depression by HADS. Despite improvements in SA, persistent EHF hearing loss was accompanied by persistent tinnitus, but it was of diminished loudness. CONCLUSION: Despite improvement in pure-tone thresholds by SA, a subset of unilateral SSNHL patients did not experience hearing recovery in EHF thresholds and reported persistent tinnitus. We postulate that their diminished anxiety and better mental health may be related to both hearing improvement in standard audiometry and reduction in tinnitus loudness. This pilot prospective study investigates the utility of performing EHF audiometry to better understand outcomes in patients with SSNHL.

Is the spread of excitation different between adults and children cochlear implants users?

PURPOSE: While cochlea is adult size at birth, etiologies and bone density may differ between children and adults. Differences in neural response thresholds (tNRT) and the spread of excitation (SOE) width may impact the use of artificial intelligence algorithms in speech processor fitting. AIM: To identify whether neural response telemetry threshold and spread of excitation width are similar in adults and children. METHODS: Retrospective cross-sectional study approved by the Ethical Board. Intraoperative tNRT and SOE recordings of consecutive cochlear implant surgeries in adults and children implanted with Cochlear devices (Cochlear™, Australia) were selected. SOE was recorded on electrode 11 (or adjacent, corresponding to the medial region of the cochlea) through the standard forward-masking technique in Custom Sound EP software, which provides SOE width in millimeters. Statistical comparison between adults and children was performed using the Mann-Whitney test (p ≤ 0.05). RESULTS: Of 1282 recordings of intraoperative evaluations, 414 measurements were selected from children and adults. Despite the tNRT being similar between adults and children, SOE width was significantly different, with lower values in children with perimodiolar arrays. Besides, it was observed that there is a difference in the electrode where the SOE function peak occurred, more frequently shifted to electrode 12 in adults implanted. In straight arrays, there was no difference in any of the parameters analyzed on electrode 11. CONCLUSION: Although eCAP thresholds are similar, SOE measurements differ between adults and children in perimodiolar electrodes.

Recognition of Speech With Dynamic Pitch Manipulation in Noise: Effects of Manipulation Methods.

PURPOSE: Dynamic pitch, which is defined as the variation in fundamental frequency in speech, is one of the acoustic cues that affect speech recognition in noise. Built on the evidence that a symmetrical manipulation of dynamic pitch led to poorer speech recognition, the present study examined the effect of an asymmetrical manipulation method on speech recognition in noise by younger and older adults. METHOD: Speech recognition accuracy in noise was measured from younger adults with normal hearing in Experiment 1, and speech reception threshold (in dB SNR) from older adults with normal hearing to mild-moderate hearing loss in Experiment 2. The dynamic pitch contours of the speech stimuli were manipulated using both symmetrical and asymmetrical methods. RESULTS: Younger adults recognized speech better in noise with asymmetrical than symmetrical manipulation, and with weakened than strengthened dynamic pitch. A substantial amount of variability was observed in a group of older listeners. This variability was predominately predicted by the listeners' age but not hearing thresholds or their ability to perceive dynamic pitch in fluctuating noise. CONCLUSIONS: The asymmetrical manipulation of dynamic pitch had a less negative effect than the symmetrical manipulation. This effect also interacted with pitch-change direction. These findings suggest the influence of perceptual naturalness on speech recognition with signal modification. Directions for future research are also discussed.

Occupational Lead Exposure Ototoxicity Evaluated With Distortion-Product Otoacoustic Emissions.

OBJECTIVES: To evaluate the extent of hearing loss among pottery workers in Mexico exposed to lead. DESIGN: The authors conducted a cross-sectional study including 315 adult pottery workers. Auditory function was evaluated by air conduction pure-tone audiometry (pure-tone average) and distortion-product otoacoustic emission (DPOAE) levels (amplitude and signal-to-noise ratio). Lead exposure was assessed with a single blood sample test and classified as low, medium, and high according to blood lead tertiles. Logistic regression models were calculated for the association between blood lead levels, pure-tone average, and DPOAE records. RESULTS: Median (25th-75th) blood lead levels were 14 µg/dL (7.5-22.6 µg/dL). The audiometric pattern and DPOAE records were similar across blood lead levels groups in all frequencies, and no statistically significant differences were found. Adjusted logistic regression models showed no increase in the odds for hearing thresholds >25 dB (HL) and DPOAE absence associated with blood lead levels, and no dose-response pattern was observed ( p > 0.05). CONCLUSIONS: Given the results from this cross-sectional study, no association was found between blood lead levels and hearing loss assessed with DPOAE. Future longitudinal work should consider chronic lead exposure estimates among underrepresented populations, which can potentially inform safer work practices to minimize the risk of ototoxicity.

Multi-channel and multi-harmonic analysis of Auditory Steady-State Response detection.

The Auditory Steady-State Response (ASSR) is a type of auditory evoked potential (AEP) generated in the auditory system that can be automatically detected by means of objective response detectors (ORDs). ASSRs are usually registered on the scalp using electroencephalography (EEG). ORD are univariate techniques, i.e. only uses one data channel. However, techniques involving more than one channel - multi-channel objective response detectors (MORDs) - have been showing higher detection rate (DR) when compared to ORD techniques. When ASSR is evoked by amplitude stimuli, the responses could be detected by analyzing the modulation frequencies and their harmonics. Despite this, ORD techniques are traditionally applied only in its first harmonic. This approach is known as one-sample test. The q-sample tests, however, considers harmonics beyond the first. Thus, this work proposes and evaluates the use of q-sample tests using a combination of multiple EEG channels and multiple harmonics of the stimulation frequencies and compare them with traditional one-sample tests. The database used consists of EEG channels from 24 volunteers with normal auditory threshold collected following a binaural stimulation protocol by amplitude modulated (AM) tone with modulating frequencies near 80 Hz. The best q-sample MORD result showed an increase in DR of 45.25% when compared with the best one-sample ORD test. Thus, it is recommended to use multiple channels and multiple harmonics, whenever available.

Self-reported hearing difficulties and speech-in-noise test performance - what can we find behind a "normal" audiogram? / Autorrelato de dificuldades auditivas e desempenho em teste de fala com ruído - o que podemos encontrar por trás de um audiograma "normal"?

PURPOSE: To investigate complaints of difficulty understanding speech in the presence of noise in subjects without hearing loss and their performance on a speech-in-noise test. METHODS: Thirty-nine subjects aged 18 to 59 years and 11 months were divided into four groups according to their decade of life. They underwent audiometry, tympanometry, auditory processing tests, the Mini-Mental State Examination, a self-report on auditory perception combined with the Amsterdam Inventory for Auditory Disability and Handicap (Pt-AIADH), and a sentence test in silence and in noise. RESULTS: All groups scored high on the Pt-AIADH domains, with the highest average score obtained for the noise intelligibility domain. There were differences between G18 vs. G40, G18 vs. G50, and G30 vs. G50 for auditory self-perception in noise intelligibility, and differences between the youngest and all other groups on the speech-in-noise test in particular, with a lower signal-to-noise ratio for older adults. We also identified a moderate and significant correlation between intelligibility in noise and the speech-in-noise test. CONCLUSION: Normal hearers of all age groups complained of intelligibility in noise. We found that the higher an individual's auditory difficulty in this domain, the worse their performance on the speech-in-noise test; this is especially true for middle-aged adults.

OBJETIVO: Investigar a queixa de dificuldade de inteligibilidade na presença de ruído, em sujeitos sem perda auditiva e compará-la com o desempenho em um teste de fala no ruído. MÉTODO: A casuística foi constituída por 39 sujeitos de 18 a 59 anos e 11 meses foram divididos em quatro grupos em função da década de vida. Estes foram submetidos à audiometria, timpanometria, testes de processamento auditivo, mini exame do estado mental, autorrelato da percepção auditiva com o Pt-AIADH e a um teste de sentenças no silêncio e no ruído. RESULTADOS: Todos os grupos pontuaram para os domínios do Pt-AIADH, com maior pontuação média para o domínio de inteligibilidade no ruído. Houve diferenças entre o G18 vs G40, G18 vs G50, e G30 vs G50 para a autopercepção auditiva na inteligibilidade no ruído; e diferenças entre o G18 e os demais grupos no teste de fala com ruído, com menor relação sinal-ruído para os adultos mais velhos. Houve correlação moderada e significativa para a inteligibilidade no ruído e o teste de fala no ruído. CONCLUSÃO: Normo-ouvintes de todas as faixas etárias estudadas apresentaram queixa de inteligibilidade no ruído. Quanto maior a dificuldade auditiva neste domínio pior o desempenho no teste de fala com ruído, sendo mais significativo em adultos de meia idade.

Cochlear synaptopathy and hidden hearing loss: a scoping review. / Sinaptopatia coclear e perda auditiva oculta: uma revisão de escopo.

PURPOSE: To identify the pathophysiological definitions adopted by studies investigating "cochlear synaptopathy" (CS) and "hidden hearing loss" (HHL). RESEARCH STRATEGIES: The combination of keywords "Auditory Synaptopathy" or "Neuronal Synaptopathy" or "Hidden Hearing Loss" with "etiology" or "causality" or "diagnosis" was used in the databases EMBASE, Pubmed (MEDLINE), CINAHL (EBSCO), and Web of Science. SELECTION CRITERIA: Studies that investigated CS or HHL in humans using behavioral and/or electrophysiological procedures were included. DATA ANALYSIS: Data analysis and extraction were performed with regard to terminology, definitions, and population. RESULTS: 49 articles were included. Of these, 61.2% used the CS terminology, 34.7% used both terms, and 4.1% used HHL. The most-studied conditions were exposure to noise and tinnitus. CONCLUSION: CS terminology was used in most studies, referring to the pathophysiological process of deafferentiation between the cochlear nerve fibers and inner hair cells.

OBJETIVO: Identificar as definições fisiopatológicas adotadas pelos estudos que investigaram a "sinaptopatia coclear" (SC) e "perda auditiva oculta" (PAO). ESTRATÉGIA DE PESQUISA: Utilizou-se a combinação de unitermos "Auditory Synaptopathy" or "Neuronal Synaptopathy" or "Hidden Hearing Loss" com "etiology" or "causality" or "diagnosis" nas bases de dados EMBASE, Pubmed (MEDLINE), CINAHL (EBSCO) e Web of Science. CRITÉRIOS DE SELEçÃO: Incluiu-se estudos que investigaram a SC ou PAO em humanos com procedimentos comportamentais e/ou eletrofisiológicos. ANÁLISE DOS DADOS: Realizou-se a análise e extração de dados quanto a terminologia, definição e população estudada. RESULTADOS: Foram incluídos 49 artigos. Destes, 61,2% utilizaram a terminologia SC, 34,7% ambos os termos e 4,1% utilizaram PAO. As condições mais estudadas foram exposição ao ruído e zumbido. CONCLUSÃO: A terminologia SC foi empregada na maioria dos estudos, com referência ao processo fisiopatológico de desaferenciação entre as fibras do nervo coclear e as células ciliadas internas.

Analysis of aided thresholds in children who have undergone cochlear reimplantation: a ten-year follow-up. / Análise de limiares tonais de crianças submetidas ao reimplante: seguimento de 10 anos.

PURPOSE: To characterize hearing thresholds at frequencies of 500, 1000, 2000 and 4000 Hz in children undergoing reimplantation with a follow-up of at least 10 years. METHODS: Retrospective review of medical records of children who underwent reimplantation surgery for at least 10 years. The auditory thresholds obtained in free-field pure tone audiometry with the cochlear implant were evaluated at frequencies of 500, 1000, 2000 and 4000 Hz at four different times: 1 (before failure), 2 (activation), 3 (five years after reimplantation) and 4 (ten years after reimplantation, regardless of the time of use of the 2nd CI) in patients with a follow-up of at least 10 years. RESULTS: Evaluating patients who underwent reimplantation, it was observed that the thresholds of 500, 1000, 2000, 4000 Hz were similar in the long term to those obtained in patients who were implanted only once, thus not presenting damage in the detection of sounds. CONCLUSION: Reimplantation had no long-term effect on the hearing thresholds obtained in children who underwent this surgery due to internal component failure.

OBJETIVO: Caracterizar os limiares auditivos nas frequências de 500, 1000, 2000 e 4000 Hz em crianças submetidas ao reimplante com follow-up de no mínimo 10 anos. MÉTODO: Revisão retrospectiva de prontuários de crianças submetidas a cirurgia de reimplante há pelo menos 10 anos. Foram avaliados os limiares auditivos obtidos na audiometria tonal liminar em campo livre com o implante coclear nas frequências de 500, 1000, 2000 e 4000 Hz em quatro momentos distintos: 1 (antes da falha), 2 (ativação), 3 (cinco anos após o reimplante) e 4 (dez anos após o reimplante, independentemente do tempo de uso do uso do 2o IC) em pacientes com follow-up de no mínimo 10 anos. RESULTADOS: Avaliando-se pacientes submetidos ao reimplante, observou-se que os limiares de 500, 1000, 2000, 4000 Hz apresentaram-se a longo prazo semelhante àqueles obtidos nos pacientes implantados somente uma única vez, não apresentando prejuízo assim na detecção dos sons. CONCLUSÃO: O reimplante não teve efeito de longo prazo sobre os limiares auditivos obtidos em crianças que se submeteram a esta cirurgia por falha do componente interno.

Infrasound tones at sensation threshold level elicit measurable Frequency-Following responses.

Even barely detectable levels of infrasound are often reported to cause annoyance and complaints. We carefully measured the individual sensation threshold of a pure tone and recorded immediately after the brain's frequency-following response (FFR) at this intensity using the same stimulator. In contrast to 87-Hz tones, 8-Hz tones elicit an FFR already at sensation threshold. Control stimuli with trains of 1-kHz tone pips having the repetition rate of the infrasound tone frequency and sensation threshold intensities evoked no significant FFR. Thus, slow periodicity, causing synchronous activation of auditory nuclei, is not explaining the FFR to low-level infrasound alone.

Limiar Diferencial de mascaramento e potencial evocado auditivo de tronco encefálico em adultos normo-ouvintes com zumbido / Masking Level Difference and Auditory Brainstem ResponseIn Normal Hearing Adults With Tinnitus / Umbral de enmascaramiento diferencial y potencial evocado auditivo del tronco encefálico en adultos con audición normal y tinnitus

Introdução: O zumbido é uma ilusão auditiva consciente, uma sensação sonora não relacionada com uma fonte externa de estimulação. Objetivos: Caracterizar a Acufenometria, Limiar Diferencial de Mascaramento, o questionário de qualidade de vida Inventário de Desvantagem do Zumbido e Potencial Auditivo de Tronco Encefálico em adultos normo-ouvintes com zumbido, com a finalidade de comparar seus achados. Método: Vinte indivíduos do sexo feminino e masculino, entre 20 e 60 anos de idade, normo-ouvintes com queixa de zumbido, foram submetidos ao Acufenometria, Limiar Diferencial de Mascaramento, Inventário de Desvantagem do Zumbido e Potencial Evocado Auditivo de Tronco Encefálico. Resultados: AAcufenometriarevelou que o pitch médio foi de 4,3 KHz à orelha direita e 4,6 KHz à orelha esquerda. O loudness médio foi de 21,7 dBNS à orelha direita e 23,5 dBNS à orelha esquerda. O Limiar Diferencial de Mascaramento médio mostrou-se alterado. O Inventário de Desvantagem do Zumbido médio correspondeu à classificação de grau leve. O Potencial Evocado Auditivo de Tronco Encefálico apresentou parâmetros dentro da normalidade bilateralmente. Conclusão: Constatou-se que adultos normo-ouvintes com queixa de zumbido apresentam zumbido de pitch agudo bilateral com discreto impacto na qualidade de vida, condução adequada das vias auditivas até o tronco encefálico e comprometimento na identificação de sons na presença de ruído, demonstrando que o zumbido pode ter repercussões nas habilidades auditivas centrais. (AU)

Introduction: Tinnitus is a conscious auditory illusion, a sound perception unrelated to any external stimulus source. Objectives: To characterize the Acuphenometry, Masking Level Difference, the quality of life questionnaire Tinnitus Handicap Inventory and Auditory Brainstem Response in normal hearing adults with tinnitus, with the purpose of comparing the findings. Method: Twenty female and male individuals, between 20 and 60 years of age, normal hearing with complaints of tinnitus, underwent Acuphenometry, Masking Level Difference, Tinnitus Handicap Inventory and Auditory Brainstem Response. Results: The Acuphenometry showed the average pitch was 4.3 KHz to the right ear and 4.6 KHz to the left ear. The average loudness was 21.7 dBSL to the right ear and 23.5 dBs to the left ear. The average Masking Level Difference was altered. The average Tinnitus Handicap Inventory corresponded to the classification of mild grade. Auditory Brainstem Response showed parameters within normal range bilaterally. Conclusion: It was found that normal hearing adults with tinnitus complaints have bilateral acute pitch tinnitus with a slight impact on quality of life, appropriate conduction of auditory pathways to the brainstem and impaired identification of sounds in the presence of noise, demonstrating that tinnitus can have repercussions on central auditory skills. (AU)

Introducción: El tinnitus es una ilusión auditiva consciente, una sensación de sonido no relacionada con una fuente externa de estimulación. Objetivos: Caracterizar la coincidencia de tono y volumen, el umbral de enmascaramiento diferencial, el inventario de minusvalía para acúfenos y el potencial auditivo del tronco encefálico en adultos normoyentes con acúfenos, con el fin de comparar sus hallazgos. Método:Veinte sujetos masculinos y femeninos, con edades entre 20 y 60 años, audición normal con tinnitus, fueron sometidos a acúfenos, Umbral de Enmascaramiento Diferencial, Inventario de Desventajas de Tinnitus y Potenciales Evocados Auditivos del Tronco Encefalico. Resultados: La combinación de tono y volumen reveló que el tono promedio era de 4,3 KHz en el oído derecho y de 4,6 KHz en el oído izquierdo. Mientras que el volumen medio fue de 21,7 dBNS para el oído derecho y de 23,5 dBNS para el oído izquierdo. Se modificó el umbral diferencial de enmascaramiento promedio. El Inventario de Desventajas de Tinnitus promedio correspondió a la clasificación de grado leve. El Potenciales Evocados Auditivos del Tronco Encefalico presentó parámetros dentro del rango normal bilateralmente. Conclusión:Se encontró que los adultos normooyentes con quejas de tinnitus presentan tinnitus de tono alto bilateral con leve impacto en la calidad de vida, conducción adecuada de las vías auditivas al tronco encefálico y deterioro en la identificación de sonidos en presencia de ruido, demostrando que Tinnitus puede tener repercusiones en las habilidades auditivas centrales. (AU)

Study of auditory pathways in type 1 diabetes mellitus through brainstem auditory evoked potentials and contralateral acoustic reflex.

PURPOSE: To investigate the functionalities of the neural pathways through the auditory evoked potentials of the brainstem and the contralateral stapedial acoustic reflexes in normal-hearing individuals with type 1 diabetes mellitus, in order to detect possible alterations in the central auditory pathways. METHODS: This is a cross-sectional study with a comparison group and a convenience sample, consisting of 32 individuals with type 1 diabetes mellitus and 20 controls without the disease. All subjects had hearing thresholds within normal limits and type A tympanometric curves. The acoustic reflex arc and brainstem auditory potentials were investigated. Statistical analyses were performed using the SPSS 17.0. The Chi-square test, Student´s t-test, and Multiple linear regression were used. RESULTS: The auditory thresholds of the acoustic reflex were statistically lower in the group with the disease at frequencies of 0.5 kHz and 1.0 kHz in the left ear (p=0.01 and p=0.01, respectively). The absolute latencies III and V of the auditory potentials of the brainstem in the right ear and V in the left ear were increased in subjects with type 1 diabetes mellitus (p=0.03, p=0.02 and p=0.03, respectively). CONCLUSION: The findings suggest that subjects with type 1 diabetes mellitus are more likely to present alterations in the central auditory pathways, even with auditory thresholds within normal limits.

Umbrales auditivos en pacientes con enfermedad de Méniere manejados con corticoides transtimpánicos / Hearing thresholds in Ménière's disease patients managed with transtympanic dexametasone

Introducción: Pese a que el uso de corticoides transtimpánicos en pacientes con enfermedad de Méniere es habitual en muchos centros, la evidencia respecto de su efecto sobre los umbrales auditivos es aún controversial. Objetivo: Estudiar los umbrales auditivos de pacientes con enfermedad de Méniere que recibieron corticoides transtimpánicos en el Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile. Material y Método: Estudio retrospectivo de pacientes con enfermedad de Méniere que consultaron entre los años 2015 y 2021. Se estudiaron los umbrales auditivos, antes y después de 3 inyecciones de dexametasona transtimpánica. Resultados: Se obtuvieron datos completos de 27 pacientes. Al comparar el promedio tonal puro antes y después del tratamiento, no se observaron diferencias significativas. A nivel individual, la variación de cambio de los umbrales auditivos con dexametasona se correlaciona en forma significativa con los umbrales auditivos previos a las inyecciones y con el tiempo transcurrido desde la última inyección, pero no con la edad. Conclusión: La terapia con dexametasona transtimpánica en pacientes con enfermedad de Méniere no altera los umbrales auditivos. Sin embargo, se requieren más estudios, para comprobar, si existe un efecto transitorio en los umbrales auditivos de los primeros días posterior al procedimiento.

Introduction: Although transtympanic corticosteroids are proposed in Méniere's disease patients refractory to standard medical therapy, the evidence regarding the effect of transtympanic corticosteroids on hearing thresholds is still controversial. Aim: To study the hearing thresholds of patients with Méniere's disease who were administrated with transtympanic corticosteroids at the Otorhinolaryngology Service of the University of Chile's Clinical Hospital. Material and Method: Retrospective study of Méniere's disease patients who consulted between 2015 and 2021. Demographic variables and hearing thresholds were studied before and after three transtympanic injections of dexamethasone. Results: A total of 27 patients were studied. There were non-significant differences in pure-tone hearing threshold averages before and after the injections. Individual variation in hearing thresholds correlates significantly with the pre-injection hearing thresholds and the period since the last injection, but not with age. Conclusion: Transtympanic dexamethasone therapy in patients with Meniere's disease does not alter hearing thresholds. However, more studies are needed to verify whether there is a transitory effect on hearing thresholds in the first days after the procedure.

Test-Retest repeatability of automated threshold audiometry in Nicaraguan schoolchildren.

OBJECTIVE: Automated threshold audiometry (ATA) could increase access to paediatric hearing assessment in low- and middle-income countries, but few studies have evaluated test-retest repeatability of ATA in children. This study aims to analyse test-retest repeatability of ATA and to identify factors that affect the reliability of this method. DESIGN: ATA was performed twice in a cohort of Nicaraguan schoolchildren. During testing, the proportion of responses occurring in the absence of a stimulus was measured by calculating a stimulus response false positive rate (SRFP). Absolute test-retest repeatability was determined between the two trials, as well as the impact of age, gender, ambient noise, head circumference, and SRFP on these results. STUDY SAMPLE: 807 children were randomly selected from 35 schools in northern Nicaragua. RESULTS: Across all frequencies, the absolute value of the difference between measurements was 5.5 ± 7.8 dB. 89.6% of test-retest differences were within 10 dB. Intra-class correlation coefficients between the two measurements showed that lower SRFP was associated with improved repeatability. No effect of age, gender, or ambient noise was found. CONCLUSIONS: ATA produced moderate test-retest repeatability in Nicaraguan schoolchildren. Participant testing behaviours, such as delayed or otherwise inappropriate response patterns, significantly impacts the repeatability of these measurements.

High-resolution computed tomography and pure-tone audiometry in patients with otosclerosis in the spongiotic phase.

OBJECTIVE: There is no consensus in the literature regarding the relationship between high-resolution computed tomography findings and hearing thresholds in pure-tone audiometry in otosclerosis. This study evaluated the association between high-resolution computed tomography findings and pure-tone audiometry in otosclerosis in the spongiotic phase. METHODS: A cross-sectional study was conducted of 57 ears with surgically confirmed stapes fixation and tomographic findings. Air conduction and bone conduction thresholds on audiometry, and air-bone gap, were analysed. RESULTS: There were no correlations between sites affected by otospongiosis and air conduction threshold, bone conduction threshold or air-bone gap in the analysed tomographic images, but the diameter of the otospongiotic focus was greater in the presence of extension of the otospongiotic foci to the cochlear endosteum. CONCLUSION: There were no relevant associations between high-resolution computed tomography findings and pure-tone audiometric measurements. However, the diameter of the otospongiotic focus was greater in the presence of extension of the otospongiotic foci to the cochlear endosteum.

The effectiveness of berberine on noise-induced hearing loss: a rat model.

OBJECTIVE: Noise-induced hearing loss is a preventable form of hearing loss that has serious social and economic impacts. This study aimed to investigate the protective effect of berberine, a potent antioxidant and anti-inflammatory agent, against Noise-induced hearing loss. METHODS: After applying distortion product otoacoustic emission, 28 female Sprague-Dawley rats were randomly divided into four groups. Group 1 was designated as acoustic trauma group, and rats in this group were exposed to white noise for 12 h at an intensity of 4 kHz 110 dB sound pressure level. Group 2 was the control group. Group 3 was designated as the berberine group, and 100 mg/kg of berberine was administered to rats in this group by intragastric lavage for five consecutive days. Group 4 was designated as the acoustic trauma+berberine group. distortion product otoacoustic emission was repeated on the 6th day of the study and cochlear tissues of rats were dissected for histopathological and immunohistochemical analyses after sacrificing rats. RESULTS: The distortion product otoacoustic emission results showed a significant decrease in signal-noise ratio values at higher frequencies in rats of the trauma group compared to those in other groups. Acoustic trauma caused severe histopathological impairment at cochlear structures together with severe 8-hydroxy-2-deoxyguanosine expression. Rats in the acoustic trauma+berberine group showed mild histopathological changes with mild 8-hydroxy-2-deoxyguanosine expression and better signal-noise ratio values. CONCLUSION: The histopathological and audiological findings of this experimental study showed that berberine provides protection in Noise-induced hearing loss and may have the potential for use in acoustic trauma-related hearing losses.

Automatic audiometry using auditory steady-state response and sequential test strategy applied to volunteers with normal hearing.

PURPOSE: In the present study, a new procedure to perform automatic audiometry using multifrequency Auditory Steady-State Response (ASSR) is proposed. METHODS: The automatic audiometry procedure consists of detecting the presence of multifrequency ASSR in real-time using the sequential test strategy and by adjusting the stimulus intensity independently. The ASSR audiometric thresholds of 18 adult volunteers with normal hearing were determined by automatically (four simultaneous frequencies per ear) at modulation frequencies in the 80 Hz range. The exam time and the difference between ASSR thresholds and pure-tone behavioural hearing thresholds were estimated as performance measures. RESULTS: The results showed that automatic audiometry can reduce the number of intensity levels used to obtain the ASSR threshold by up to 58% when compared to audiometry without using the techniques applied in automatic audiometry. In addition, the average of the difference between ASSR thresholds and Pure-Tone Behavioural Hearing thresholds was around 19 dB, which is similar to the results reported in similar studies. CONCLUSIONS: The audiometric procedure proposed in this study is fully automatic, i.e., does not require any human supervision throughout the exam, and is able to significantly reduce the conventional exam time.

Digits-in-noise test in Brazilian Portuguese: how demographic and socioeconomic variables influence normal-hearing subjects. / Teste de dígitos no ruído no Português Brasileiro: influência das variáveis demográficas e socioeconômicas em normo-ouvintes.

PURPOSE: Verify how demographic and socioeconomic variables on the in-noise speech recognition threshold (SRT) from the digits-in-noise test (DIN) in Brazilian Portuguese influence normal-hearing subjects. METHODS: Cross-sectional, prospective study. The convenience sample had 151 normal-hearing subjects between 12 and 79 years (mean=34.66) who underwent pure tone audiometry and digits-in-noise test with white noise using a sequence of three numbers in diotic stimulus (in-phase) on the same day. The DIN was performed using a Motorola Z3 Play smartphone with internet access and in-ear headphones. In-noise digit speech recognition threshold (SRT) was analyzed for gender, age, educational levels, and socioeconomic status. We used the non-parametric version of the Kruskal-Wallis and Mann-Whitney U tests to compare independent samples adopting a significance level of 5%. RESULTS: The mean SRT was -8.47 dBNA (SD -3.89) with a median of -9.6 dBNA. The SRT was proportionally inverse to educational levels and socioeconomic status and more negative (better) with lower age groups. Gender did not influence the DIN SRT. CONCLUSION: Age, educational levels, and socioeconomic status influenced the DIN threshold. These variables must be considered when analyzing DIN performance in Brazilian Portuguese in normal-hearing subjects.

OBJETIVO: Verificar a influência das variáveis demográficas e socioeconômicas no limiar de reconhecimento de fala no ruído (LRF) obtidos no teste de dígitos no ruído (TDR) no Português Brasileiro em normo-ouvintes. MÉTODO: Estudo transversal e prospectivo. A amostra de conveniência foi composta por 151 sujeitos normo-ouvintes com idade entre 12 e 79 anos (média =34,66) que realizaram audiometria tonal liminar e teste de dígitos no ruído branco com sequência de trios numéricos em estímulo diótico (inphase) no mesmo dia. O TDR foi realizado com um smartphone Motorola Z3 play com acesso à internet com fones de ouvido intra-auriculares. Os limiares de reconhecimento dos dígitos no ruído (LRF) foram analisados em função do sexo, idade, escolaridade e nível socioeconômico. Foi utilizado para comparar as amostras independentes, o teste não-paramétrico Kruskal-Wallis e Mann-Whitney, adotando-se o nível de significância de 5%. RESULTADOS: A média do LRF foi de -8,47 dBNA (dp -3,89), com mediana de -9,6 dBNA. O LRF foi proporcionalmente inverso à escolaridade e nível socioeconômico e mais negativo (isto é, melhor) com menor faixa-etária. Não houve evidência de influência do sexo no LRF do TDR. CONCLUSÃO: Idade, escolaridade e nível socioeconômico mostraram influenciar o limiar no TDR; essas variáveis devem ser consideradas na análise de desempenho do TDR no Português Brasileiro em sujeitos normo-ouvintes.