Hearing Dysfunction After Treatment With Teprotumumab for Thyroid Eye Disease.

PURPOSE: To characterize the frequency, severity, and resolution of hearing dysfunction in patients treated with teprotumumab for thyroid eye disease (TED). DESIGN: Prospective observational case series. METHODS: Ophthalmic examination and adverse event assessment, including otologic symptoms, were performed at baseline, after infusions 2, 4, and 8, and at 6-month follow-up in consecutive patients who received at least 4 teprotumumab infusions. Laboratory test results were collected at baseline and during treatment. Audiometry, patulous eustachian tube (PET) testing, and otolaryngology evaluation were obtained for patients with new or worsening otologic symptoms, with a subset obtaining baseline and posttreatment testing. RESULTS: Twenty-seven patients were analyzed (24 females, 3 males, average 56.3 years old). Twenty-two patients (81.5%) developed new subjective otologic symptoms, after a mean of 3.8 infusions (SD 1.8). At 39.2-week average follow-up after the last infusion, most patients with tinnitus (100%), ear plugging/fullness (90.9%), and autophony (83.3%) experienced symptom resolution, whereas only 45.5% (5 of 11) of patients with subjective hearing loss/decreased word comprehension experienced resolution. Six patients underwent baseline and posttreatment audiometry, 5 of whom developed teprotumumab-related sensorineural hearing loss (SNHL) and 1 patient also developed PET. Three of the 5 patients with teprotumumab-related SNHL had persistent subjective hearing loss at last follow-up. A prior history of hearing loss was discovered as a risk factor for teprotumumab-related SNHL (P = .008). CONCLUSIONS: Hearing loss is a concerning adverse event of teprotumumab, and its mechanism and reversibility should be further studied. Until risk factors for hearing loss are better understood, we recommend baseline audiometry with PET testing and repeat testing if new otologic symptoms develop. Screening, monitoring, and prevention guidelines are needed.

Audiometric data analysis for prevention of noise-induced hearing loss: A new approach.

Compliance with noise regulations in the past three decades has significantly reduced workplace noise exposures, particularly in the loudest industries and occupations. However, the overall effectiveness of hearing conservation programs in preventing occupational noise-induced hearing loss remains uncertain and unquantified, while the incidence and cost of occupational hearing loss remain inexplicably high. This review/commentary critically explores this paradox by examining why the billions of annual audiograms conducted worldwide have not been aggregately utilized or applied to predict early NIHL in groups of workers or to measure the efficacy of exposure controls. Principal contributory reasons include regulation of noise as a safety standard rather than as a health standard, the inherent complexity of audiometric data, and the lack of a standardized method of interpretation for audiograms. The unsuccessful history of efforts to develop and adopt methods and tools to analyze aggregate audiometric data is described. Consequently, the Standard Threshold Shift-a regulatorily defined, lagging indicator of individual, irreversible hearing loss that is not an effective preventive metric-remains the de facto standard of care. A population-based Best Practices approach is proposed to leverage the raw audiometric data already available and turn it into actionable data for effective secondary prevention to strategically manage and reduce occupational hearing loss risk. This approach entails statistical methods and information management tools necessary to transform audiometry from a compliance-driven, individual screening test with limited preventive capability into a medical surveillance process directly linked to aggregate corrective and prevention actions.

Audiological involvement in patients with systemic sclerosis.

OBJECTIVES: The aim of the present study was to evaluate hearing loss in patients diagnosed with systemic sclerosis (SSc) and to investigate the relation between hearing loss, subtypes of the disease, its duration and clinical findings, and antibody positivity. METHODS: The study included 47 patients with SSc and 44 healthy controls. Audiometric, tympanometric, and otoacoustic emission measurements were applied to both groups. RESULTS: The evaluation of the participants medical history showed that among the patients with SSc, 19.1% experienced ear fullness, 27.7% experienced vertigo, and 36.2% experienced tinnitus. Hearing loss was detected in 23.4% of the patients with SSc. The corresponding result was 4.3% in the control group with a statistically significant difference (p = 0.001). Transient-evoked otoacoustic emission amplitude values were significantly lower in the patients' both ears with SSc than the control group (p < 0.005). Duration of disease was significantly longer, and diffusing capacity of the lungs for carbon monoxide values were significantly higher in the patients with SSc and sensorineural hearing loss. CONCLUSIONS: The present study found that the incidence of hearing loss was significantly higher in the study group than in the healthy control group. In addition to other organ involvements, cochlear involvement occurs in these patients, and further studies are required.

Asociaciones entre clase social e hipoacusia laboral / Associations between social class and labor hipoacusia

Introducción: la exposición a ruidos forma parte de nuestros hábitos cotidianos, culturales y de ocio. En el entorno de trabajo aparecen diferentes sonidos que puedenser perjudiciales para los oídos. El presente escrito trata de identificar la influencia que existe entre clase social e hipoacusia laboral en trabajadores de la ciudad de Cú-cuta, en edades comprendidas entre los 17 y los 70 años. Métodos: observacional, analítico y transversal; la población estudiada incluyó tra-bajadores del sector público y privado del municipio de Cúcuta, a quienes se les reali-zó un examen audiométrico ocupacional por parte del programa de Fonoaudiología. Resultados: se encontró que la mayoría de los trabajadores, un 54.05%, pertenece a una clase social baja; el 65% se expone a ruido en el trabajo, el 60% no utiliza ele-mentos de protección personal y el 30% presenta hipoacusia.Análisis y discusión: hay una asociación significativa entre la actividad laboral y la actividad extra laboral del grupo etario. Predomina el sexo masculino con una representación del 63%. Esto puede explicarse dado el contexto cultural en el que se realizó el estudio.Conclusiones: en Colombia, existe escasa información sobre la relación entre clase social e hipoacusia laboral. Se debe realizar un análisis de segregación socio-espacial tanto de los hogares como de la enfermedad, para así determinar qué enfermedades se asocian con la actividad laboral

Introduction: exposure to noise is part of our daily, cultural and leisure habits. In the work environment different sounds can be harmful to the ears. The present text tries to identify the influence that exists between social class and work-related hearing loss in the city of Cúcuta, aged between 17 and 70 years Methods: It is observational, analytical and cross-sectional. The studied population consisted of individuals working in the public and private sector of the municipality of Cúcuta. They underwent an occupational audiometric examination by the Speech-Audiology program.Results: It was determined that most of the workers, 54.05%, are members of a low social class; 65% of workers are exposed to noise at work, 60% of workers do not use personal protection elements and 30% of evaluated workers have hearing loss. Analysis and discussion: there is a significant association between work activity and non-work activity of the age group, predominant in males with a representation of 63%, this can be explained given the cultural context in which the study was conducted. Conclusions: in Colombia, there is little information on social class and work-related hearing loss. An analysis of socio-spatial segregation of both households and the disease must be carried out in order to determine which diseases are associated to work activity

Aspectos epidemiológicos del trauma acústico en personal expuesto a ruido intenso / Epidemiological aspects of acoustic trauma found in the staff exposed to intensive noise

Introducción: el trauma acústico, ligado a las enfermedades profesionales, comenzó a estudiarse con profundidad a raíz de la segunda guerra mundial, y por los alarmantes resultados se implantaron una serie de medidas de prevención para evitar esta agresión. No obstante, estas no fueron eficaces debido a la falta de educación y de concientización del personal al cual iban dirigidas. Objetivos: determinar las manifestaciones auditivas en pacientes expuestos a ruidos intensos, teniendo en cuenta la edad, el sexo y el tiempo de exposición, y tomando como base los resultados audiométricos. Métodos: se realizó una encuesta epidemiológica a un grupo de 50 casos expuestos a ruidos intensos, en el período comprendido de enero de 2007 a enero de 2008. La muestra estuvo compuesta por pacientes entre los 20 y 55 años, en los cuales la manifestación auditiva más frecuente fue la hipoacusia. Resultados: en los resultados audiométricos se observó que la gran mayoría de los casos presentó una hipoacusia de tipo neurosensorial, con predominio del sexo masculino. Conclusiones: el sexo masculino fue el más afectado y la edad de 41 a 55 años, además, la intensidad de la hipoacusia fue mayor en correspondencia con el tiempo de exposición más prolongado(AU)

Introduction: acoustic trauma is linked to professional diseases and began to be studied in depth after the Second World War. Due to the alarming results obtained, a number of preventive measures to avoid this aggression were implemented; however, they were not effective because of the lack of education and awareness of the staff to which they were directed. Objectives: to find out the auditory manifestations in patients exposed to intensive noise, taking age, sex, time of exposure and the audiometric results into consideration. Methods: an epidemiological survey was carried out in a group of 50 cases exposed to intensive noises from January 2007 to January, 2008. The sample was made up of 20-55 years-old patients and the most common auditory manifestation was hypoacusis. Results: the audiometric results showed that most of patients presented with neurosensory hypoacusis, being the males predominant. Conclusions: males were the most affected along with the 41-55 years-old age group; the hypoacusis intensity increased as the time of exposure was longer(AU)

Safe and reliable sound threshold measures with direct vibration of the ossicular chain.

OBJECTIVES: The aim of the study was to evaluate the safety and feasibility of piezoelectric malleus vibration audiometer (MVA), which presents micromechanical vibrations to the umbo membranae tympani. STUDY DESIGN: Phase I study performed in a tertiary referral center (University Hospital). METHODS: The coupling rod of the MVA was moved slowly through the outer ear canal toward the eardrum with a micromanipulator. Coupling was completed when the rod tip touched the umbo membranae tympani. Basic audiologic measures of sound threshold obtained with direct stimulation of the malleus are presented. We used MANOVA (multivariate repeated measures ANOVA) to investigate the repeatability of MVA thresholds from one day to the other and when decoupling and retracting the coupling rod 2 mm off the umbo. We also selected the MANOVA to test for unwanted bone-conduction threshold shifts after MVA application. We assessed normality of the data by quantile-quantile plots of the residuals. RESULTS: Twenty-eight male and 10 female subjects with normal hearing, 22.2 to 34.6 years old (median age, 27.2 yr) underwent an examination. Thirty-six subjects underwent MVA, because 2 of the 38 subjects who volunteered for the study have not undergone the procedure due to the external auditory canal anatomy preventing application of the MVA. The results show that it is possible to safely and reliably measure thresholds of direct vibration of the ossicular chain. Using pure tone audiograms, no pure tone bone- and/or air-conduction threshold shifts occurred after the procedure. None of the subjects reported any other ear-related symptoms such as vertigo, tinnitus, or dizziness. Geometric mean vibratory displacements at threshold ranged from 0.55 nm at 250 Hz to 0.03 nm at 6 kHz. MANOVA demonstrated a repeatability of MVA thresholds. CONCLUSION: Malleus vibration audiometry will not allow exact linkage of actual implantable hearing aid. But the present study demonstrates that MVA can provide an audiometric tool for assessing ossicular function and integrity prior to implantation of an electronic hearing amplifier.

Automatic immittance audiometry on children with transtympanic ventilation tubes.

The use of automatic immittance audiometers for detection of middle ear abnormalities in children is becoming a popular practice in pre-schools, headstart programs, and elementary schools. Oftentimes the screening is being performed by personnel who are not clinical audiologists and who do not routinely otoscopically examine the ear prior to testing. This report tells of a clinical case in which the use of automatic immittance audiometry on a child with transtympanic ventilation tubes resulted in the occlusion of one of the tubes. An explanation of the events causing the occlusion and a word of caution are given.

Preventing collapse of external auditory meatus during audiometry.

Occlusion of the external auditory meatus resulting from earphone pressure can produce a pseudoconductive hearing loss. I describe a method for detecting ear canal collapse by otoscopy and I suggest a method of correcting the problem with a polyethylene tube prosthesis.