Frequency -Specific Air- Conduction and Bone - Conduction Outcomes after Stapedotomy.

Introduction: The aim of this study was to investigate hearing outcome of stapes surgery, considering the post-operative air and bone conduction (AC&BC) changes, in a frequency specific approach. Materials and Methods: This was a retrospective cohort study. A total of 245 ears (231 patients), who underwent Stapedotomy at our tertiary referral center in a period of 5 years were enrolled in the study. Pure tone audiometry (PTA) was evaluated preoperatively and one month postoperatively. AC, BC, and Air-bone gap (ABG) were documented. Moreover, one-year post-op PTA was also recorded for more than a quarter of the cases. Results: Overall, significant improvements were observed in AC thresholds with a mean AC gain of 20.44±13.64 dB. At higher frequencies the results were poorer (AC gain of 27 dB at 250 Hz vs 7 dB at 8000 Hz). ABG significantly improved at all frequencies after one month. BC thresholds were typically better after surgery. However, there appears to be a worsening trend in BC thresholds at frequencies higher than 2000 Hz. In 68 patients with 1-year follow-up, BC thresholds were slightly worse (but not statistically significant) at most frequencies, in comparison to the one-month results. Conclusions: Stapes surgery significantly improves air and bone conduction hearing, particularly at lower frequencies. Nonetheless, there exists a potential for sensorineural hearing loss (SNHL) at high frequencies. However, the changes are insignificant and not within the speech frequencies. Therefore, patients are typically satisfied with the hearing outcome of the surgery.

Psychometric Properties of the Persian Dizziness Handicap Inventory - Screening Version.

OBJECTIVES: The Dizziness Handicap Inventory (DHI) is the most popular and widely used questionnaire in evaluating patients with vertigo. This questionnaire has a screening version with a high correlation with DHI. This study aimed to assess the psychometric properties of the Persian DHI - Screening version (DHI-S). METHODS: This cross-sectional and methodological study was conducted on 300 patients at the central vestibular clinic in Mashhad, Iran, from 2020 to 2021. First, the DHI-S was translated into Persian using the backward-forward translation method. Subsequently, the following types of validity and reliability were examined: content validity based on content validity index and content validity ratio, face validity based on impact score, construct validity based on confirmatory factor analysis, internal consistency based on Cronbach's α and Ω, and test-retest stability based on intraclass correlation coefficient and smallest detectable change. RESULTS: The DHI-S had high content and face validity. Score 8 was selected for the cutoff point between patients and the normal group with a sensitivity of 63.67% and specificity of 96.08%. The construct validity indicated that the questionnaire is one-dimensional. The Cronbach's α and Ω for internal consistency were 0.855 and 0.851, respectively. The intraclass correlation coefficient was 0.981 and the smallest detectable change was 5.521. CONCLUSIONS: The DHI-S in the Persian language has high and acceptable psychometric properties. This questionnaire can be used in research and clinical settings.

Early Hearing Detection and Intervention Results in Northeastern of Iran from 2005 to 2019: A Repeated Cross-Sectional Study.

Background: Hearing loss is one of the most common congenital disorders. The Early Diagnosis and Intervention Process is designed for the early diagnosis and intervention of hearing loss in infants. The present study aimed to examine the results of Early Hearing Detection and Intervention (EHDI) in northeastern Iran from 2005 to 2019. Setting: Northeastern Iran. Methods: In most cases, the two-stage protocol (otoacoustic emissions [OAE] and automated auditory brainstem response [AABR]) has been used. Infant assessment methods included the use of OAE, ABR, auditory steady-state response, high-frequency tympanometry, and behavioral audiometry. Interventions included medical interventions, hearing rehabilitation, hearing aids, and cochlear implants. Results: 1,162,821 infants were screened. The screening coverage increased from less than 1% in 2005 to about 99% in 2018. The referral rate has been about 1%. 2.17 out of every 1000 infants are hearing impaired, and the most common cases are bilateral hearing loss and mild to moderate hearing loss. Conclusions: During 2005 to 2019 the coverage rate reached to more than 95% of live births. To improve the EHDI process in this population, better follow-up of diagnosed neonates and expansion of diagnostic and intervention services are needed.

Comprehensive vestibular evaluation in patients with Otosclerosis: a case control study.

Aim: Otosclerosis is one of the common otologic diseases. The mechanism and the probable site of vestibular involvement are not yet fully understood. The present study aimed to perform a comprehensive vestibular evaluation in patients with otosclerosis, compared to the cases without otosclerosis. Materials and methods: patients underwent a comprehensive cochleovestibular evaluation, including audiometry, ocular and cervical vestibular evoked myogenic potential (o-VEMP and c-VEMP), video head impulse (vHIT) and caloric tests. The results were compared with those obtained from the non-otosclerosis control group. Results: A total of 61 individuals were included in the study who were divided into two groups of the case (50.82%) and control (49.18%). The results showed that there was a significant difference in the mean vHIT gain between the case and control groups (P < 0.05). However, the mean gain was still within the normal range. Besides, the patients with otosclerosis had significant bilateral or unilateral weaknesses according to caloric test results. Moreover, their o-VEMP and c-VEMP results were significantly abnormal as well (P < 0.05). Conclusion: Based on the results of the present study, the vestibular system even in asymptomatic cases, is affected by otosclerosis. Furthermore, it seems that the otolithic system has a higher chance of involvement, compared to the semicircular canals. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03147-5.

Vestibular Assessment in Patients with Persistent Symptoms of Mild Traumatic Brain Injury.

Aim: The estimated worldwide incidence of TBI is 10 million cases per year. Dizziness and imbalance are two common symptoms in mild TBI (mTBI). In about 10-15% of TBI patients, these symptoms remain for a long time and may show no recovery. These persistent symptoms may relate to different factors including vestibular abnormalities. The aim of this study is a vestibular assessment of patients with persistent symptoms of mTBI by different tests including computerized dynamic posturography. Materials and Methods: 21 patients with mTBI evaluated in this study. Patients were civilians with persistent symptoms. TBI did cause by blunt force trauma (mainly from falling) in the past 6 months. They had normal neurologic and musculoskeletal assessments and no temporal bone fracture. Several auditory and vestibular evaluations were performed for each patient. They included: case history, otoscopy, pure tone and speech audiometry, tympanometry, vestibular bedside examination (spontaneous nystagmus, gaze, saccade, pursuit, Dix-Hallpike maneuver, side-lying maneuver, roll, and Romberg test), cervical Vestibular Myogenic Evoked Potential (c-VEMP), Computerized Dynamic Posturography (CDP) and Dizziness Handicap Inventory (DHI). Results: Patients showed hearing loss in 10 (47.6%) and tinnitus in 4 (19.0%) cases. In ocular motor tests, patients had the most abnormal results in the pursuit test. 6 patients also had Benign Paroxysmal Positional Vertigo (BPPV) in the posterior canal. c-VEMP showed abnormal saccular function in 14 patients. In CDP, the composite scores were decreased relative to normal populations. Conclusion: vestibular tests showed abnormal results in most patients. Vestibular abnormality could relate to persisting symptoms of mTBI patients.

The perception of family members regarding patient's vertigo and imbalance.

INTRODUCTION AND OBJECTIVES: Family members play a major role in the assessment and final result of the treatments of patients. The goal of the present study was to evaluate how much the perception of patients' family members could be trusted regarding the vertigo and imbalance which they experienced. MATERIALS AND METHODS: A cross-sectional study was conducted on 110 patients and their family members who were referred to the Central Vestibular Clinic in Mashhad from April 2018 to September 2019. Family members were categorized as spouses, children, and other relatives of patients. Patients and their family members separately completed the Dizziness Handicap Inventory (DHI) by the paper and pencil method. DHI has a high reliability, validity, and internal consistency. RESULTS: Mean DHI scores of patients and their family members were 45.35±20.24 and 42.01±22.83, respectively. The correlation between DHI scores of patients and family members, except children, were significant (p<.05). CONCLUSION: A relatively weak to moderate relationship between the perception of patients and their family members, except children, was found. They were more aware of the physical aspects of vertigo and imbalance than the emotional ones.

Percepción de los familiares del vértigo y el desequilibrio del paciente / The perception of family members regarding patient's vertigo and imbalance

Introduction and objectives: Family members play a major role in the assessment and final result of the treatments of patients. The goal of the present study was to evaluate how much the perception of patients’ family members could be trusted regarding the vertigo and imbalance which they experienced. Materials and methods: A cross-sectional study was conducted on 110 patients and their family members who were referred to the Central Vestibular Clinic in Mashhad from April 2018 to September 2019. Family members were categorized as spouses, children, and other relatives of patients. Patients and their family members separately completed the Dizziness Handicap Inventory (DHI) by the paper and pencil method. DHI has a high reliability, validity, and internal consistency. Results: Mean DHI scores of patients and their family members were 45.35±20.24 and 42.01±22.83, respectively. The correlation between DHI scores of patients and family members, except children, were significant (p<.05). Conclusion: A relatively weak to moderate relationship between the perception of patients and their family members, except children, was found. They were more aware of the physical aspects of vertigo and imbalance than the emotional ones. (AU)

Introducción y objetivos: Los familiares juegan un papel principal en la evaluación y resultado final de los tratamientos de los pacientes. El objetivo del presente estudio fue evaluar cuánta percepción de los familiares del paciente merece confianza en cuanto al vértigo y el desequilibrio que experimentan los pacientes. Materiales y métodos: Se realizó un estudio transversal en 110 pacientes y sus familiares, que fueron derivados a la Clínica Vestibular Central de Mashhad de abril de 2018 a septiembre de 2019. Los familiares fueron categorizados como esposos, hijos, y otros familiares de los pacientes. Los pacientes y sus familiares completaron separadamente el Dizziness Handicap Inventory con lápiz y papel. Dicho inventario tiene una gran fiabilidad, validez y consistencia interna. Resultados: Las puntuaciones medias del Dizziness Handicap Inventory de los pacientes y sus familiares fueron de 45,35±20,24 y 42,01±22,83, respectivamente. La correlación entre las puntuaciones de Dizziness Handicap Inventory de los pacientes y sus familiares, exceptuando los hijos, fue significativa (p<0,05). Conclusión: Se encontró una relación de relativamente débil a moderada entre la percepción de los pacientes y sus familiares, exceptuando los hijos. Ellos fueron más observadores de los aspectos físicos del vértigo y el desequilibrio, en comparación con los aspectos emocionales. (AU)

Vestibular Hypersensitivity in Patients with Chronic Noise Exposure.

It has been demonstrated that high-intensity noise exposure adversely affects the human balance function. The Tullio phenomenon (TP) refers to sound-induced imbalance which is resulted from hypersensitivity of vestibular end organs to normal acoustic stimuli. Although different etiologies have been attributed to TP, evidence on the role of excessive noise exposure in the development of this symptom is limited. The present study aims to assess the vestibular functions in patients manifesting TP symptom who were exposed to long-term excessive noise levels. This was an analytic cross-sectional study conducted on 17 males diagnosed with TP with a history of chronic noise-induced hearing loss (TP group) and 17 healthy individuals. All subjects in both groups underwent complete otological, videonystagmography (VNG), and cervical vestibular myogenic potential (cVEMP) assessments. The most common complaint in TP subjects was vertigo and imbalance. During the VNG assessment, we found abnormal positional nystagmus and caloric irrigation (vestibular hyperfunction) results in 4 (23.53%) and 9 (52.94%) patients, respectively. Seven (41.17%) patients indicated cVEMP thresholds which were abnormally lower than the normal values ( ≤ 70 dB HL). However, when both VNG and cVEMP results were considered together, the abnormal rate reached 70.58% (12 of 17 cases). Our findings showed that both the semicircular canal as well as otolith stuctures could be affected in TP patients with a history of chronic noise exposure.

Auditory and Vestibular Assessment of Patients with Type Two Diabetes Mellitus: A Case-Control Study.

INTRODUCTION: Type two diabetes mellitus may relate to auditory and vestibular dysfunction. This relationship was frequently observed in elders. The present study aimed to evaluate the auditory and vestibular function of diabetic patients and compare the results with those of a healthy adult control group. MATERIALS AND METHODS: Patients were asked to complete demographic characteristics form. Moreover, fasting blood sugar, as well as hemoglobin A1C tests, were carried out on them. Both the patients and control group were evaluated using several auditory and vestibular tests including Pure Tone Audiometry (PTA), video Head Impulse Test (v-HIT), ocular Vestibular Evoked Myogenic Potential (o-VEMP), and cervical Vestibular Evoked Myogenic Potential (c-VEMP). RESULTS: The PTA showed a significant difference in some frequencies between the two groups. These differences were minimal in lower frequencies and become greater at 8000Hz. The v-HIT was abnormal for some patients and also showed a significant difference between the two groups. The o-VEMP and c-VEMP results were normal in most patients. CONCLUSION: Based on the obtained results, auditory and vestibular dysfunctions are related to Diabetes. Patients with type two diabetes mellitus showed mild auditory and vestibular dysfunctions compared to the healthy control group.

Vestibulo ocular reflex in multiple sclerosis patients without any optic neuritis

Purpose: To investigate vestibulo ocular reflex (VOR) in MS patients without any history of optic neuritis. Methods: 26 MS patients without any previous history of optic neuritis and 13 age- matched control subjects were included in this study. Their age ranged from 22 to 50 years old. We evaluated monocular visual evoked potential (VEP), monocular and binocular best corrected static and dynamic visual acuity, near and distance phoria and VOR gain. Results: Mean spherical equivalent (SE) was – 0.40 ± 0.93 D and – 0.04 ± 0.14 D for study and control group, respectively (P = 0.060). There was a significant difference in dynamic visual acuity (DVA) between two groups (P = 0.029). VOR gain was not significantly different in both groups through vHIT measurements (P = 0.338). Duration of MS had a mean of 78.38 ± 75.94 months (ranged from 6 to 336 months). We found no significant correlation between disease duration and VOR (Rho 0.277, P = 0.171) or DVA (Rho 0.782, P = 0.057). Conclusion: Our study showed that although vHIT results decreased in MS patients, there was no significant differences between two groups. (AU)

The perception of family members regarding patient's vertigo and imbalance.

INTRODUCTION AND OBJECTIVES: Family members play a major role in the assessment and final result of the treatments of patients. The goal of the present study was to evaluate how much the perception of patients' family members could be trusted regarding the vertigo and imbalance which they experienced. MATERIALS AND METHODS: A cross-sectional study was conducted on 110 patients and their family members who were referred to the Central Vestibular Clinic in Mashhad from April 2018 to September 2019. Family members were categorized as spouses, children, and other relatives of patients. Patients and their family members separately completed the Dizziness Handicap Inventory (DHI) by the paper and pencil method. DHI has a high reliability, validity, and internal consistency. RESULTS: Mean DHI scores of patients and their family members were 45.35±20.24 and 42.01±22.83, respectively. The correlation between DHI scores of patients and family members, except children, were significant (p<.05). CONCLUSION: A relatively weak to moderate relationship between the perception of patients and their family members, except children, was found. They were more aware of the physical aspects of vertigo and imbalance than the emotional ones.

Vestibulo ocular reflex in multiple sclerosis patients without any optic neuritis.

PURPOSE: To investigate vestibulo ocular reflex (VOR) in MS patients without any history of optic neuritis. METHODS: 26 MS patients without any previous history of optic neuritis and 13 age- matched control subjects were included in this study. Their age ranged from 22 to 50 years old. We evaluated monocular visual evoked potential (VEP), monocular and binocular best corrected static and dynamic visual acuity, near and distance phoria and VOR gain. RESULTS: Mean spherical equivalent (SE) was - 0.40 ±â€¯0.93 D and - 0.04 ±â€¯0.14 D for study and control group, respectively (P = 0.060). There was a significant difference in dynamic visual acuity (DVA) between two groups (P = 0.029). VOR gain was not significantly different in both groups through vHIT measurements (P = 0.338). Duration of MS had a mean of 78.38 ±â€¯75.94 months (ranged from 6 to 336 months). We found no significant correlation between disease duration and VOR (Rho 0.277, P = 0.171) or DVA (Rho 0.782, P = 0.057). CONCLUSION: Our study showed that although vHIT results decreased in MS patients, there was no significant differences between two groups.

Bilateral Carotid Artery Occlusion and Cochlear Oxidative Stress and Hearing Loss in Rats.

INTRODUCTION: This study aimed to evaluate the effects of bilateral carotid artery occlusion on cochlear oxidative stress and hearing status in rats. METHODS: The rats were divided into two sets. The first set was used for electrophysiological recording (click and 4 kHz tone burst auditory brainstem responses and electrocochleography) on the day before surgery and then on the first, fourth, and seventh days after surgery. Animals of the second set were used for biochemical analysis. The cochlea of animals in the second set was collected on the first, fourth, and seventh days after carotids occlusion for biochemical analysis. For the control groups, no carotids occlusion was done. For ischemia induction, both common carotid arteries were occluded for 20 minutes. RESULTS: Electrophysiological analysis showed that burst auditory brainstem thresholds significantly elevated after common carotid arteries occlusion on the first, fourth, and seventh days after surgery with abnormal electrocochleography results at 75%, 70%, and 85% on the first, fourth, and seventh days after surgery, respectively. The electrophysiological finding confirmed by biochemical results that showed malondialdehyde and nitric oxide levels increased and superoxide dismutase and catalase activities decreased after occlusion in cochlea tissue. CONCLUSION: This study showed that bilateral common carotid artery occlusion increases cochlear oxidative stress and induces hearing loss in rats.

Evaluation of Bilateral Vestibular Dysfunction in Iranian Adults and Elderlies by Electronystagmography and Video Head Impulse Test.

INTRODUCTION: Vestibular abnormalities are common problems in the whole world, which can lead to bilateral vestibular dysfunction (BVD). That results in symptoms, such as vertigo, unsteadiness, falling, oscillopsia, and lower quality of life. The Objective of this study was to determine BVD in adults and elderlies with vertigo and unsteadiness. MATERIALS AND METHODS: This study was conducted on 384 patients in two categories of adults (age range of 18-64 years) and elderlies (65 years old and above) through Electronystagmography (ENG), including caloric test and video head impulse test (vHIT). Patients called bilateral vestibular dysfunction when they have an abnormal bilateral weakness (summation of nystagmus response less than 20 for 4 stimulations and less than 12 for each ear) in caloric test and their vHIT has a gain lower than 0.6. The results of caloric tests were categorized into four groups, including normal, unilateral weakness, bilateral weakness, and central abnormalities. RESULTS: The obtained results revealed that the frequency of BVD is higher than previously reported data in the medical literature. The frequency of BVD was 10.9% for the investigated patients (39.1% abnormal caloric, 12.5% abnormal vHIT, and 10.9% abnormal in both tests). The 38.5% of elderly patients had bilateral abnormal results in both tests. CONCLUSION: The results of this study showed BVD in some cases by caloric and vHIT tests. Elderlies showed more cases of BVD compared to adult patients.

Relationship between Electrically Evoked Compound Action Potential Thresholds and Auditory, Language, and Speech Progress after Cochlear Implant Surgery.

INTRODUCTION: Electrically evoked compound action potential (ECAP) is an objective auditory response that can be used in the programing of cochlear implants. The aims of this study were to monitor ECAP thresholds and auditory, language and speech progress for 6 months after cochlear implant surgery and to evaluate any relationship between them. MATERIALS AND METHODS: Ten children with a mean age of 4.2 (±0.6) years and bilateral congenital and profound sensorineural hearing loss underwent cochlear implant surgery and post-operation auditory and speech training. The auditory, language, and speech abilities (Newsha level) and ECAP thresholds (for apical, medial and basal region of cochlea) were evaluated 1, 3 and 6 months after surgery. RESULTS: ECAP threshold showed no significant improvement in any of the evaluated areas in the 6 months after surgery (P>0.05); however, the Newsha level improved for all patients (P=0.00). CONCLUSION: There was no relationship between ECAP thresholds and auditory, language, and speech abilities (Newsha level) in the first 6 months after surgery. ECAP thresholds may be a poor indicator of improvement in auditory, language, and speech abilities, and depend on many factors.

The Effects of the Vestibular Rehabilitation on the Benign Paroxysmal Positional Vertigo Recurrence Rate in Patients with Otolith Dysfunction.

BACKGROUND AND OBJECTIVES: Although repositioning maneuvers have shown remarkable success rate in treatments of benign paroxysmal positional vertigo (BPPV), the high recurrence rate of BPPV has been an important issue. The aims of present study were to examine the effects of otolith dysfunction on BPPV recurrence rate and to describe the effect of vestibular rehabilitation exercises on BPPV recurrence in BPPV patients with concomitant otolith dysfunction. Subjects and. METHODS: Forty-five BPPV patients included in this study (three groups). Patients in group 1 had no otolith dysfunction and patients in groups 2 and 3 had concomitant otolith dysfunction. Otolith dysfunction was determined with ocular/cervical vestibular evoked myogenic potential (oVEMP and cVEMP) abnormalities. Epley's maneuver was performed for the patients in all groups but patients in group 3 also received a 2-month vestibular rehabilitation program (habituation and otolith exercises). RESULTS: This study showed that BPPV recurrent rate was significantly higher in patients with otolith dysfunction in comparison to the group 1 (p<0.05). Vestibular rehabilitation resulted in BPPV recurrence rate reduction. Utricular dysfunction showed significant correlation with BPPV recurrence rate. CONCLUSIONS: Otolith dysfunction can increase BPPV recurrence rate. Utricular dysfunction in comparison to saccular dysfunction leads to more BPPV recurrence rate. Vestibular rehabilitation program including habituation and otolith exercises may reduce the chance of BPPV recurrence.

The Challenge of Vestibular Rehabilitation in a Patient with Bilateral Vestibular Dysfunction Following Surgery: A Case Report.

INTRODUCTION: Bilateral vestibular dysfunction (BVD) is an uncommon finding in vestibular assessment, and the combination of BVD and orthopedic problems represents a rare and challenging case for treatment. CASE REPORT: The patient had several previous back surgeries and received gentamycin after surgery. After 6 months, she experienced continuous dizziness, unsteadiness and oscillopsia. The patient underwent complete vestibular assessment and received an individualized vestibular rehabilitation program for 9 months. She achieved a complete recovery from all symptoms and returned to active social function. CONCLUSION: Vestibular rehabilitation could be an effective treatment for complicated cases of BVD. Adaptation exercises may be useful in young patients with BVD.

Effect of Early Vestibular Rehabilitation on Vertigo and Unsteadiness in Patients with Acute and Sub-Acute Head Trauma.

INTRODUCTION: Vestibular rehabilitation is a treatment option for the management of vertigo and unsteadiness, which are very common in head trauma patients and more challenging in the early months after trauma. This study evaluated the effectiveness of a vestibular rehabilitation program in the recovery of acute and sub-acute head trauma patients. The goal of this study was evaluation of the effect of early vestibular rehabilitation on patients with acute and sub-acute head trauma. MATERIALS AND METHODS: This study was performed in 20 head trauma patients with vertigo and unsteadiness. The patients were randomly divided into two groups: one group received medical therapy (Betaserc) and the other received rehabilitation and medical therapy. An individualized vestibular rehabilitation program was designed that was then revised and verified by a joint committee of vestibular rehabilitation groups. The effectiveness of interventions was measured using the Dizziness Handicap Inventory (DHI) by comparing the results before and after therapy. RESULTS: The physical conditions and DHI scores of patients in both groups were similar at baseline. After 1 month of rehabilitation, patients receiving vestibular rehabilitation and medication showed greater progress than patients receiving medication only (P=0.000). CONCLUSION: Vestibular rehabilitation can aid in the recovery from vertigo and increase the stability of head trauma patients. Simultaneous treatment with medicine and vestibular rehabilitation exercises can result in quicker and better therapeutic effects.

Ocular Motor Function in Patients with Bilateral Vestibular Weakness.

INTRODUCTION: Patients with bilateral weakness (BW) have many difficulties in gaze stability that interfere with their normal function. The aim of this study was to evaluate ocular motor functions in patients with BW to better understand the problem of gaze instability in these patients. MATERIALS AND METHODS: Patients were referred from the Otolaryngology Department for Vestibular Assessment to our clinic between November 2014 and March 2015. We assessed ocular motor function (gaze, saccade, and smooth pursuit) in patients over the age of 18 years with BW, as verified by a caloric test. RESULTS: Seventy-eight patients completed all the tests. The mean age of patients was 51.9 (±15.9) years, and 47 (60%) were female. Abnormal results were found in five (6.4%), 32 (41%), and seven (9%) patients with respect to gaze, smooth pursuit, and saccade, respectively. There were positive but relatively weak relationships between age and ocular motor results. CONCLUSION: Patients with BW suffer from dizziness and unsteadiness. These patients have abnormal function in ocular motor (especially smooth pursuit) tests. The ocular motor dysfunction is responsible for gaze instability in static positions such as standing.

Auditory steady-state response thresholds in adults with conductive and mild to moderate sensorineural hearing loss.

BACKGROUND: The Auditory steady state response (ASSR) provides a frequency-specific and automatic assessment of hearing sensitivity and is used in infants and difficult-to-test adults. OBJECTIVES: The aim of this study was to compare the ASSR thresholds among various types (normal, conductive, and sensorineural), degree (normal, mild, and moderate), and configuration (flat and sloping) of hearing sensitivity, and measuring the cutoff point between normal condition and hearing loss for different frequencies. PATIENTS AND METHODS: This clinical trial was performed in Iran and included patients who were referred from Ear, Nose, and Throat Department. A total of 54 adults (27 with sensorineural hearing loss, 17 with conductive hearing losses, and 10 with normal hearing) were randomly chosen to participate in our study. The type and degree of hearing loss were determined through testing by otoscopy, tympanometry, acoustic reflex, and pure tone audiometry. Then the ASSR was tested at carrier frequencies of 500, 1000, 2000, and 4000 Hz. RESULTS: The ASSR accurately estimates the behavioral thresholds as well as flat and sloping configurations. There was no correlation between types of hearing loss and difference of behavioral and ASSR thresholds (P = 0.69). The difference between ASSR and behavioral thresholds decreased as severity of hearing loss increased. The 40, 35, 30, and 35 dB could be considered as cutoffs between normal hearing and hearing loss for 500, 1000, 2000, and 4000 Hz, respectively. CONCLUSIONS: The ASSR can accurately predict the degree and configuration of hearing loss and discriminate the normal hearing from mild or moderate hearing loss and mild from moderate hearing loss, except for 500 Hz. The Air-conducted ASSR could not define the type of hearing loss.