Comparing the diagnostic accuracy of audiometric Weber test and tuning fork Weber test in patients with conductive hearing loss.

Objectives: Weber test is typically conducted using tuning forks, but an audiometer can also be used for a similar purpose. Compared to the tuning fork Weber (TFW) test, performing the audiometric Weber (AW) test offers many advantages. Nevertheless, AW and TFW tests' performance compared to pure-tone audiometry (PTA) has yet to be studied. The present study aimed to determine the accuracy and agreement between the AW and TFW tests compared to PTA. Methods: In this observational cross-sectional study, 74 participants (aged 12-67 years) with unilateral conductive hearing loss (CHL) or bilateral asymmetrical CHL were enrolled. The TFW test was performed according to the established protocol at 256 and 512 Hz. For the AW test, the bone vibrator was placed in the middle of the forehead, where 250 and 500 Hz frequencies were tested. TF and AW test results were then compared with the expected lateralization from the respective PTA results. Results: At 256 Hz (or 250 Hz), the overall accuracy values of TFW and AW tests were 81.1% and 86.5%, respectively. At 512 Hz (or 500 Hz), the overall accuracy results of TFW and AW tests were 85.1% and 82.4%, respectively. In addition, the kappa statistics revealed substantial agreements between the two tests and PTA (k = .63-.72). Conclusion: Both AW and TFW tests are reasonably accurate in assessing patients with CHL. It is recommended for audiologists to perform the simple AW test to verify incomplete or questionable audiograms that are commonly encountered in clinical practice. Level of evidence: Level 3b.

Tubotympanic cholesteatoma.

Chronic suppurative otitis media is defined as a chronic inflammation of the mucoperiosteal lining of the middle ear cleft. It is described as a persistent disease that is insidious in onset, often capable of causing severe destruction with irreversible sequelae, and clinically present with hearing loss and discharge. It has been classified into tubotympanic (safe) and atticoantral (unsafe) perforation. Cholesteatoma always occur in the atticoantral type and in marginal perforation. We report a case of cholesteatoma that occurred as a tubotympanic type of perforation.

Extended high frequency hearing loss in tinnitus-positive chronic suppurative otitis media patient.

OBJECTIVES: To determine the association between extended high frequency hearing loss and tinnitus in normal cochlear function based on a conventional audiometry chronic suppurative otitis media (CSOM) patient. DESIGN AND METHODS: A cross-sectional study was conducted on 220 ears diagnosed as having CSOM with an equal number of tinnitus and without tinnitus groups. Only those with normal cochlear function based on conventional pure tone audiometry (250 Hz to 8 kHz) were included. They were further tested for hearing at extended high frequencies of up to 16 kHz. The severity of tinnitus was tested using a tinnitus questionnaire. RESULTS: The prevalence of extended high frequency hearing loss in the normal cochlear function CSOM patients with tinnitus was 81.8% (95% CI 74.5%, 89.1%), whereas the prevalence in the tinnitus negative group was 30.0% (95% CI 21.3%, 38.7%). There was a significant association between extended high frequency hearing loss and tinnitus in CSOM patients (P < .001). The average thresholds were significantly higher in the tinnitus group at all extended high frequencies tested with an increasing trend of significance toward the higher frequencies. However, this study did not observe any association between the severity of tinnitus and extended high frequency hearing loss. CONCLUSION: The development of tinnitus among normal cochlear function CSOM patients indicates that the damage has occurred at a higher frequency level. However, the severity of tinnitus does not predict the degree of higher frequency hearing loss. Therefore, the presence of tinnitus warrants more aggressive monitoring and treatment to prevent sensorineural hearing loss from developing into the speech frequencies. LEVEL OF EVIDENCE: 4.

Does the location of electrode on tympanic membrane matter when recording electrocochleography?

BACKGROUND: The non-invasive tympanic electrocochleography (TM-ECochG) is useful for clinical diagnoses. Nevertheless, the influence of the electrode location on tympanic membrane (TM) on ECochG results needs to be studied. OBJECTIVE: The aim of the present study was to compare the TM-ECochG results obtained when the electrode was placed on the superior region versus the inferior region of TM. MATERIALS AND METHODS: Forty healthy adults (aged 29 to 50 years) participated in this comparative study. The TM-ECochG testing was conducted with the electrode placed on the superior and inferior regions of TM. RESULTS: SP and AP amplitudes were statistically higher for the inferior region of TM (p < .05). In contrast, SP/AP ratios were comparable between the two regions of TM (p = .417). CONCLUSIONS AND SIGNIFICANCE: In TM-ECochG recording, when the electrode was placed on the inferior region of TM, SP and AP amplitudes were greater than when the electrode was placed on the superior region of TM. On the other hand, SP/AP amplitude ratio was not affected by the location of electrode on TM. The findings from the present study could be useful to guide clinicians in optimizing TM-ECochG recording when testing their respective patients.

Early Detection of High-frequency Presbycusis Among Normal Hearing Individuals.

BACKGROUND: Presbycusis is an age-related sensorineural hearing loss and it may reduce quality of life. We conducted a study to establish the prevalence of high-frequency presbycusis in normal hearing individuals and to validate the role of extended high-frequency distortion product otoacoustic emission (DPOAE) in the screening. METHOD: A cross-sectional study was conducted among 205 normal hearing adult participants with an age range between 25 and 54 years old. Hearing analysis with extended high-frequency pure-tone audiometry (PTA) and high-frequency DPOAE was carried out for all eligible participants. High-frequency presbycusis was considered to be present when the impairment of more than 25 dB occurs at higher than 8 kHz frequencies on both ears. RESULTS: Prevalence of high-frequency presbycusis using extended PTA was 31.7 (95% CI: 25.3, 38.1) and using high-frequency DPOAE was 57.4 (95% CI: 50.7, 64.4). The sensitivity and specificity of high-frequency DPOAE in detecting high-frequency presbycusis were 72.3 and 49.3% respectively with positive predictive value of 39.8% and negative predictive value of 79.3%. The association between age and high-frequency presbycusis was significant based on high-frequency DPOAE (p = 0.029). CONCLUSIONS: The prevalence of high-frequency hearing loss is higher with increasing in age. High-frequency DPOAE may be used as a screening tool followed by confirmation using extended PTA. The early detection of presbycusis is important so that measures can be taken to prevent more severe problems developing.

The Influence of Stimulus Repetition Rate on Tone-Evoked Post-Auricular Muscle Response (PAMR) Threshold.

OBJECTIVES: Post-auricular muscle response (PAMR) is a large myogenic potential that can be useful in estimating behavioral hearing thresholds when the recording protocol is optimal. The main aim of the present study was to determine the influence of stimulus repetition rate on PAMR threshold. DESIGN: In this repeated-measures study, 20 normally hearing adults aged between 18 and 30 years were recruited. Tone bursts (500, 1000, 2000, and 4000 Hz) were used to record PAMR thresholds at 3 different stimulus repetition rates (6.1/s, 11.1/s, and 17.1/s). RESULTS: Statistically higher PAMR thresholds were found for the faster stimulus rate (17.1/s) compared with the slower stimulus rate (6.1/s) (p < 0.05). For all stimulus rates and frequencies, significant correlations were found between PAMR and pure-tone audiometry thresholds (r = 0.62 to 0.82). CONCLUSIONS: Even though the stimulus rate effect was significant at most of the tested frequencies, the differences in PAMR thresholds between the rates were small (<5 dB). Nevertheless, based on the correlation results, we suggest the use of 11.1/s stimulus rate when recording PAMR thresholds.

Gender Disparities in Speech-evoked Auditory Brainstem Response in Healthy Adults.

OBJECTIVES: Gender disparities in speech-evoked auditory brainstem response (speech-ABR) outcomes have been reported, but the literature is limited. The present study was performed to further verify this issue and determine the influence of head size on speech-ABR results between genders. METHODS: Twenty-nine healthy Malaysian subjects (14 males and 15 females) aged 19 to 30 years participated in this study. After measuring the head circumference, speech-ABR was recorded by using synthesized syllable /da/ from the right ear of each participant. Speech-ABR peaks amplitudes, peaks latencies, and composite onset measures were computed and analyzed. RESULTS: Significant gender disparities were noted in the transient component but not in the sustained component of speech-ABR. Statistically higher V/A amplitudes and less steeper V/A slopes were found in females. These gender differences were partially affected after controlling for the head size. CONCLUSIONS: Head size is not the main contributing factor for gender disparities in speech-ABR outcomes. Gender-specific normative data can be useful when recording speech-ABR for clinical purposes.

Electrocochleographic recording in Asian adults: Preliminary normative data and demographic analyses.

OBJECTIVE: Electrocochleography (ECochG) is valuable to diagnose Meniere's disease objectively. The aim of the present study was to provide preliminary normative data for ECochG among Asian adults. The influences of ethnicity (Malay versus Chinese) and gender on ECochG results were also studied. METHODS: Twenty-two Malay adults (10 men and 12 women) and twenty Chinese participants (10 men and 10 women) aged between 20 and 49 years participated in this study. Extratympanic ECochG (ET-ECochG) was recorded according to standard non-invasive procedure. Summating potential (SP) amplitude, action potential (AP) amplitude and SP/AP ratio were analyzed accordingly. RESULTS: ET-ECochG results were found to be comparable between left and right ears (p > 0.05). No notable differences in ET-ECochG results were found between Malay and Chinese groups (p > 0.05). No significant influence of gender on ET-ECochG outcomes was also noted (p > 0.05). The derived normative data for Asian adults (84 ears) are consistent with previous reports. CONCLUSION: The present study provides preliminary normative data for ET-ECochG among Asian adults. The ECochG components do not appear to be influenced by either ethnicity or gender. The derived normative data can be used for clinical applications and as the reference for future studies involving Asian population.