Progression of Contralateral Hearing Loss in Patients with Unilateral Ear Involvement: A Scoping Review.

BACKGROUND: Progression of contralateral hearing loss following otologic and neuro-otologic surgeries is a distressing and rare complication. The aim of this study was to systematically review the suspected etiologies and audiological findings in adults who experienced contralateral hearing loss. METHODS: PubMed/MEDLINE, PsycINFO, CINAHL, ISI Web of Science, Cochrane Library, EMBASE, and Scopus databases were searched for this scoping review. The current review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. No limits were placed on language or year of publication. RESULTS: Of a total of 46 studies, 43 studies met the inclusion criteria reporting contralateral hearing loss. The included studies were classified into 3 different categories: contralateral hearing loss after skull base surgeries (n=21), contralateral hearing loss after middle ear surgeries (n=17), and contralateral hearing loss after traumatic lesions (n=5). The cerebrospinal fluid leakage and drill-generated noise were reported as the most reported etiology of contralateral hearing loss following skull base and middle ear surgeries, respectively. The onset of contralateral hearing loss varied from immediately to 18 months after surgery. The severity of contralateral hearing loss varied from a slight to a profound degree of hearing loss. CONCLUSION: Our results highlighted that contralateral hearing loss should be considered following the skull base and middle ear surgeries. Furthermore, this rare complication should be noticed after traumatic lesions.

The priority of audiological procedures during the COVID-19 pandemic.

Since the discovery of coronavirus disease 2019 (COVID-19), which started in Wuhan, China, the epidemic has not only swept through China but also spread throughout the world in spite of the concerted attempts from the governments to contain it. Thus, prevention and control of COVID-19 infection is very effective in ensuring the safety of medical specialists, health care workers, and patients. Audiology clinics are also crucial in the fight against the infection epidemic, as audiologists provide their diagnostic and rehabilitative services in an environment with different contaminated objects that come in either direct or indirect contact with multiple patients. The current article explains the importance of infection control in audiology and priority setting for audiologic evaluation in COVID-19 pandemic.

Neonatal Hearing Screening: Prevalence of Unilateral and Bilateral Hearing Loss and Associated Risk Factors.

INTRODUCTION: Newborn hearing screening is essential for early identification of hearing loss to decrease the adverse effects of hearing loss. The objective of this study was to determine the prevalence of hearing loss and risk factors of congenital hearing loss in newborns. METHODS: In this analytical case-control study, a hearing screening test was performed for all newborns aged 3-14 days. RESULTS: Of 5,500 newborns evaluated, 24 newborns had hearing loss. The prevalence of hearing loss was 4.36 per 1,000. Of 24 hearing-impaired newborns, 15 had bilateral hearing loss (BHL) (62.5%) and nine had unilateral hearing loss (UHL) (37.5%). Among the neonates with hearing loss, the prevalence of hearing loss was higher (77.8%) in the right ear. The main risk factors identified in this study were low gestational age (P=0.001), hospitalization in the neonatal intensive care unit (NICU) (P=0.008), exposure to ototoxic drugs (P=0.001), gestational diabetes P=0.01), craniofacial anomalies (P=0.01), convulsion (P=0.03), consanguineous marriage of parents (P=0.001), low birth weight (P=0.01), and hyperbilirubinemia (P=0.001). CONCLUSION: The prevalence of hearing loss was higher in the right ear than in the left ear. NICU stay, use of ototoxic drugs, low gestational age (<35 weeks), gestational diabetes, craniofacial anomalies, convulsion, consanguineous marriage of parents, low birth weight, and hyperbilirubinemia were significant risk factors for congenital hearing loss in studied newborns.

Clinical Characteristics of COVID-19 Infection in Newborns and Pediatrics: A Systematic Review.

INTRODUCTION: World Health Organization has declared COVID-19 a pandemic and a global health emergency. Thus, it is necessary to clearly characterize clinical manifestations and management of COVID-19 infection in children to provide accurate information for healthcare workers. Accordingly, the present study was designed to review articles published on clinical manifestations and characteristics of children and infants with COVID-19. METHODS: In this systematic review, medical databases including Cochrane Library, Web of Science, Embase, Scopus, SID, Medline, WHO and LitCovid were searched using English and Persian keywords including COVID-19, Pediatrics, Newborn, Coronavirus 2019, 2019-nCoV, SARS-CoV-2. Finally, data of 14 related articles were included in the study. RESULTS: A total of 2228 children, newborns and infants were studied. Clinical manifestation in children may be mild (72%), moderate (22%) or severe (6%), and the most common symptoms include dry cough (91%) and fever (96%). According to the included articles, two children had died, one of which was a 14-year-old boy and his exposure history and underlying disease were unclear, and the other was a male newborn with gestational age of 35 weeks and 5 days, birth weight of 2200, Apgar score of 8, 8 (1 min and 5 min) and his first symptom was increased heart rate. No differences were found between male and female children regarding infection with COVID-19. CONCLUSION: Most pediatrics were infected with COVID-19 due to family cluster or history of close contact. Infected children have relatively milder clinical symptoms compared to infected adults. We should pay special attention to early diagnosis and early treatment in children infected with COVID-19.

Intranasal versus Intramuscular/Intravenous Naloxone for Pre-hospital Opioid Overdose: A Systematic Review and Meta-analysis.

CONTEXT: The present systematic review and meta-analysis aims to perform an extensive search in databases to compare the efficacy of the intranasal administration of naloxone with its intramuscular/intravenous administration in the pre-hospital management of opioid overdose. EVIDENCE ACQUISITION: This meta-analysis included controlled trials conducted on the efficacy of naloxone administration in the pre-hospital management of opioid overdose. A search was carried out in electronic databases on relevant articles published by the end of 2018. After data collection, analyses were performed in STATA 14.0 software and the efficacy and side-effects of the two administration routes of naloxone, i.e. intranasal and intramuscular/intravenous, were compared. An overall effect size with 95% confidence interval (95% CI) was provided for each section. RESULTS: Eventually, data from six studies were included in this meta-analysis. The success rate of the intranasal and intramuscular/intravenous administration of naloxone in the management of opioid overdose in pre-hospital settings was 82.54% (95% CI: 57.97 to 97.89%) and 80.39% (95% CI: 57.38 to 96.04%), respectively. There was no difference between injectable (intramuscular/intravenous) naloxone and intranasal naloxone in the pre-hospital management of opioid overdose (Odds Ratio=1.01; 95% CI: 0.42 to 2.43; P=0.98). The onset of action of intranasal naloxone, however, was slightly longer than injectable naloxone (Standardized Mean Difference=0.63; 95% CI: 0.07 to 1.19; P=0.03). Additionally, the odds of needing a rescue dose was 2.17 times higher for intranasal naloxone than intramuscular/intravenous naloxone (OR=2.17; 95% CI: 1.53 to 3.09; P<0.0001). The prevalence of major side-effects was non-significant for both intranasal (0.00%) and intramuscular/intravenous (0.05%) routes of naloxone administration and there was no difference in the prevalence of major (OR=1.18; 95% CI: 0.38 to 3.69; P=0.777) and minor (OR=0.64; 95% CI: 0.17 to 2.34; P=0.497) side-effects between the two routes. CONCLUSION: The present meta-analysis demonstrated that intranasal naloxone is as effective as injectable naloxone in the pre-hospital management of opioid overdose complications. Consequently, intranasal naloxone may be an appropriate alternative to injectable naloxone.

A New Speech-in-Noise Test for Measuring Informational Masking in Speech Perception Among Elderly Listeners.

Introduction Elderly listeners have reported concerns about speech perception in noisy environments. This partly occurs because of their increased informational masking (IM). This study aimed to develop a Persian coordinate response measure (CRM) corpus and a novel speech-in-noise test for measuring IM. Material and methods A cross-sectional validation study was conducted in two parts. Part one was the determination of the validity and reliability of the Persian CRM corpus. Part two consisted of measuring the IM at five signal-to-noise ratio (SNR; -6,-3, 0, +3, and +6) in two conditions: one with the target and masker speaker of the same sex and one with the target and masker speaker of different sexes. In each condition, the IM measurements were performed at a 45° separation angle of target and maskers and as a co-location of the speakers. A group of young listeners aged 20 to 40 years and a group of elderly listeners aged 60 to 75 years were recruited (50 study participants in part one and 47 in part two). The study was conducted from July 2018 to March 2019 at the Iran University Medical Sciences audiology clinic. Content validity ratio, content validity index, impact score, Spearman's test, and Mann-Whitney's test were used for statistical analysis. Results The Persian CRM corpus showed acceptable validity and reliability in each group (p < 0.001). The results suggested that in both azimuth locations and at SNRs of 0, -3, and -6, the IM amount in the elderly group was significantly higher (p < 0.003) than in the young group at conditions of target and masker speakers of opposite-sex. However, in cases where both target and masker speakers were of the same sex, a significant difference was observed at an SNR of 0 in angular separation and SNRs of +3 and 0 at co-located situations (p < 0.001). Conclusion A validated Persian CRM corpus has been collected for use in IM measurement studies. Overall, the IM of elderly listeners was higher than younger listeners in low-cue situations such as lower SNR. Therefore, a novel speech-in-noise test for measuring IM was validated to use in speech perception studies in the elderly population.

Risks of Novel Coronavirus Disease (COVID-19) in Pregnancy; a Narrative Review.

INTRODUCTION: The outbreak of the new Coronavirus in China in December 2019 and subsequently in various countries around the world has raised concerns about the possibility of vertical transmission of the virus from mother to fetus. The present study aimed to review published literature in this regard. METHODS: In this narrative review, were searched for all articles published in various databases including PubMed, Scopus, Embase, Science Direct, and Web of Science using MeSH-compliant keywords including COVID-19, Pregnancy, Vertical transmission, Coronavirus 2019, SARS-CoV-2 and 2019-nCoV from December 2019 to March 18, 2020 and reviewed them. All type of articles published about COVID-19 and vertical transmission in pregnancy were included. RESULTS: A review of 13 final articles published in this area revealed that COVID-19 can cause fetal distress, miscarriage, respiratory distress and preterm delivery in pregnant women but does not infect newborns. There has been no report of vertical transmission in pregnancy, and it has been found that clinical symptoms of COVID-19 in pregnant women are not different from those of non-pregnant women. CONCLUSION: Overall, due to lack of appropriate data about the effect of COVID-19 on pregnancy, it is necessary to monitor suspected pregnant women before and after delivery. For confirmed cases both the mother and the newborn child should be followed up comprehensively.

The Relationship between Orotracheal Intubation Difficulty Scoring Systems and Anthropometric Factors.

INTRODUCTION: Although rare, but it is very important to understand that intubation will be difficult for which of the patients. Some scoring systems are available in this regard that influenced by many factors such as body anthropometric factors. OBJECTIVE: This study was conducted to investigate the relationship between Mallampati score, biting the upper lip as well as 2-3-3 maneuver with body anthropometric factors in different population of society. METHOD: This cross-sectional study was conducted during the years 2014-2015 in Yazd, Iran. The subjects using simple randomized sampling method, and they were included in study after obtaining their informed consent. Demographic (age and gender) as well as anthropometric parameters of body, including weight, height, neck, waist circumference, hip circumference, body mass index (BMI) and waist-to-hip ratio (WHR) were collected in a pre-prepared checklist. Then, Mallampati score, biting the upper lip score, maneuver 2-3-3 were examined and calculated by researchers. The results of these examinations were recorded for each person in checklist. RESULTS: In this study, 498 people with mean age of 42.1 ± 16.1 were enrolled (51% female). Based on results of this study, although all three methods significantly correlated with age but none had any relation with gender. Significant relationship was found between upper lip biting and Mallampati score and all body anthropometric factors evaluated in this study (p < 0.05). By increasing the mean of these factors, Mallampati score increases, while this relationship is reverse in the case of height. In addition, significant correlation was found between maneuver 2-3-3 and weight, height, waist circumference, hip circumference and BMI, while it showed no correlation with neck circumference (p = 0.328) and WHR (p = 0.121). CONCLUSION: Based on findings of current study, it is likely that upper lip biting test and Mallampati score have significant relation with all body anthropometric factors evaluated in this study. But maneuver 2-3-3 has no correlation with neck circumference and WHR.

The effects of auditory spatial training on informational masking release in elderly listeners: a study protocol for a randomized clinical trial.

Background: Regarding the strong auditory spatial plasticity capability of the central auditory system and the effect of short-term and long-term rehabilitation programs in elderly people, it seems that an auditory spatial training can help this population in informational masking release and better track speech in noisy environments. The main purposes of this study are developing an informational masking measurement test and an auditory spatial training program. Protocol: This study will be conducted in two parts. Part 1: develop and determine the validity of an informational masking measurement test by recruiting two groups of young (n=50) and old (n=50) participants with normal hearing who have no difficulty in understanding speech in noisy environments. Part 2 (clinical trial): two groups of 60-75-year-olds with normal hearing, who complain about difficulty in speech perception in noisy environments, will participate as control and intervention groups to examine the effect of auditory spatial training. Intervention: 15 sessions of auditory spatial training. The informational masking measurement test and Speech, Spatial and Qualities of Hearing Scale will be compared before intervention, immediately after intervention, and five weeks after intervention between the two groups. Discussion: Since auditory training programs do not deal with informational masking release, an auditory spatial training will be designed, aiming to improve hearing in noisy environments for elderly populations. Trial registration: Iranian Registry of Clinical Trials ( IRCT20190118042404N1) on 25 th February 2019.

Ketorolac versus Magnesium Sulfate in Migraine Headache Pain Management; a Preliminary Study.

INTRODUCTION: Migraine is a common cause of emergency department (ED) visits. To date, there is no recommended drug of choice for pain management of these patients. In the present study, we aimed to evaluate the effectiveness of ketorolac and magnesium sulfate in this regard. METHODS: This is a cross-sectional study performed on all 18 - 60 year-old patients, visiting two different EDs with complaint of moderate to severe migraine headache. Patients were treated with 30 mg ketorolac in one hospital and 1 gram magnesium sulfate in the other. Pain scores were assessed on arrival, 1 and 2 hours after drugs administration and quality of pain management was compared between two groups using SPSS 22. RESULTS: 70 patients with the mean age of 36.4 ± 11.4 years were enrolled (51.4% male). The two groups were similar regarding baseline characteristics (p > 0.05). The improvement in pain score in magnesium sulfate group was greater than Ketorolac group after both one hour (6 vs 3; p < 0.001) and two hours (7 vs 5; p < 0.001). CONCLUSION: It seems that both ketorolac and magnesium sulfate are significantly effective in pain control of patients with migraine headache presenting to the emergency department. Magnesium sulfate was superior to ketorolac both one and two hours after drug administration.

The Veracity of Troponin Test Requests for Patients Presenting to the Emergency Department with Chest Pain; a Clinical Audit.

INTRODUCTION: Troponin test is one of the methods for diagnosing acute coronary syndrome, but the overuse and misuse of this test has increased the costs imposed on the health system and the patients. OBJECTIVE: The present study was conducted to investigate the veracity of troponin test requests for patients presenting to an emergency department with chest pain and examine the effectiveness of training emergency medicine assistants in reducing unnecessary and inappropriate requests in emergency departments. METHODS: This clinical audit was conducted in the emergency department of Imam Hossein Hospital, Tehran, Iran, in 2014. Sampling was carried out using the census method and all the cases presenting to the emergency department for whom a troponin test was requested by the emergency medical assistants were included in the research. First, the veracity of the current troponin test requests was assessed; then, training was given to the personnel, and the veracity of the troponin test requests was once again verified after the training was completed. The rate of veracious troponin requests for the patients was measured based on two factors, including the interval between the patients' admission and the troponin test request, and the interval between the onset of pain and the troponin test request. The veracity of the troponin test request was compared before and after training using the Phi test and Cramer's V test in IBM SPSS-21. RESULTS: This study examined a total of 500 patients (250 before training and 250 after), who had a mean age of 57.65±18.15 years, including 51.6% men. Significant differences were observed between the mean time of the patients' admission and the overall and post-training troponin test results (P=0.000), and also between the mean time of the onset of pain and the overall and post-training troponin test results (P=0.000). The number of positive troponin test results did not differ significantly between the patients in either of the two stages (P=0.39). CONCLUSION: Unnecessary troponin test requests reduced significantly after this clinical audit in the examined emergency department.

Depression and Hypothyroidism in a Population-Based Study of Iranian Women.

BACKGROUND: Recent biochemical and physiological investigations have focused on the fundament of mood disorders in thyroid dysfunction. The present study aimed to address depressive disorder in a sample of Iranian hypothyroid women compared to euthyroid individuals. METHODS: Thirty consecutive hypothyroid female patients aged 25 to 40 years who referred to the Endocrinology and Metabolism Clinic at Rasoul-e-Akram Hospital in Tehran within a four-month period in 2015 were assessed. Thirty healthy euthyroid subjects matched for sex, age, and educational level were selected as the control. For assessment of depression status, Depression Anxiety Stress Scale-21 (DASS-21) was employed. RESULTS: The study showed higher mean depression score in hypothyroid patients when compared to euthyroid ones (13.8 ± 9.5 versus 5.8 ± 5.2, p = 0.010). No significant association was revealed between mean depression score and patients' education level (p = 0.627), age (p = 0.967), occupation status (p = 0.211), and marital status (p = 0.556). CONCLUSION: Hypothyroid women are predisposed to depressive symptoms independent of their baseline demographic and socioeconomic characteristics.

Intra-articular lidocaine versus intravenous sedative and analgesic for reduction of anterior shoulder dislocation.

OBJECTIVE: This prospective clinical trial was performed to compare the safety and efficiency of intra-articular lidocaine (IAL) versus intravenous sedative and analgesic (IVSA) in reduction of anterior shoulder dislocation. MATERIALS AND METHODS: Patients with anterior shoulder dislocation were randomly divided into 2 groups to receive IAL and IVSA. One group patients received an intravenous dose of 0.05 mg/kg midazolam and 1 µg/kg fentanyl, while the other group received 20 mL intra-articular lidocaine (1%). Patient satisfaction (via a standard 5-choice questionnaire), pain score (based on visual analog scale ranging from 0 to 10 points), comfort reduction, recovery time, and side effects were recorded and compared between the two groups before, during and after the reduction procedure. RESULTS: Totally 104 patients with acute anterior shoulder dislocation and the mean age of 28.75 ± 7.24 years were included (86.5% male). There was no statistically significant difference between IAL and IVSA groups regarding age (p = 0.45) and gender (p = 0.25). A total of forty-seven (45.2%) patients, distributed in both groups, had a history of anterior shoulder dislocation. A significant difference was seen with regard to diminished pain intensity during reduction in IAL group (p < 0.001); Complications including nausea, apnea, hypoxia and headache were only observed in IVSA group, and there was no adverse effect in IAL group; increased patient satisfaction in IVSA group (p = 0.007); similar success rate at first attempt of reduction in both groups, and a shorter time to discharge in IAL group (p < 0.001). CONCLUSION: It seems that the use of intra-articular lidocaine for reduction of anterior shoulder dislocation is effective, safe, and time saving in the emergency department and has few complications. It can be considered as the first line analgesia in managing anterior shoulder dislocation.

The Role of Caffeine in Pain Management: A Brief Literature Review.

CONTEXT: Caffeine is the most commonly used psychoactive legal drug in the world. Caffeine's role in controlling pain has received less attention in the past, yet is being increasingly considered. This article briefly reviewed the literature to clarify the role of caffeine as a drug for pain control and attract investigators to this topic. EVIDENCE ACQUISITION: The data on Caffeine as an adjuvant therapy or as a main component for pain modulation has been narratively reviewed. RESULTS: Caffeine plays an important role in pain modulation through their action on adenosine receptors which are involved in nociception. The use of caffeine as adjuvant treatment was well-established in the literature and caffeine is currently available in some over the counter medications. Studies showed controversial results about the interaction between caffeine and morphine for pain relief in patients with terminal stage cancer. As a main component for pain modulation, Caffeine can be used for hypnic headache and postdural puncture headache. CONCLUSIONS: Caffeine has a potential role for pain modulation. Current evidence on caffeine use for migraine and terminal stage cancer is not well-established. Future studies should address the use of caffeine alone for different types of pain with dose escalation and standardization of outcome measurement.

Study of the reliability and validity of objective structured clinical examination (OSCE) in the assessment of clinical skills of audiology students.

INTRODUCTION: Audiology students should possess clinical competence and skills. To achieve this, their clinical skills must be properly assessed. The Objective Structured Clinical Examination (OSCE) is a standard and fair examination of clinical competence. The goal of this study is to devise a checklist of OSCE examination criteria and study their validity and reliability for assessing the clinical competence of Audiology students. METHODS: Among the various procedures in which audiology students should possess demonstrated competence, 10 specific skills were selected and checklists were prepared. Faculty members of university's Audiology Department were consulted to determine the validity of the checklists. Subsequently, the examination was administered to all 14 fourth-year audiology students in their final semester of study at Ahvaz Jundishapur University of Medical Sciences. The examination consisted of three question stations and seven procedure stations. Each station was managed by two examiners who independently used a checklist to score each student's performance in a given procedure. To determine reliability, the Spearman test was used. RESULTS: The correlation between each examiner's scores of students at question stations was 0.908. The correlation between each examiner's scores at procedure stations was 0.857 (p=0). The site of lesion test had the highest correlation (0.948) and immittance audiometry had the lowest correlation (0.585). CONCLUSION: The prepared checklists had good validity and reliability and can be used to evaluate the clinical competence of audiology students in their final semester of study.