The History of Pediatric and Adult Hearing Screening.

OBJECTIVES/HYPOTHESIS: To document the history of hearing seeing in children and adults. STUDY DESIGN: A literature search in all languages was carried out with the terms of hearing screening from the following sources: Pub Med, Science Direct, World Catalog, Index Medicus, Google scholar, Google Books, National Library of Medicine, Welcome historical library and The Library of Congress. METHODS: The primary sources consisting of books, scientific reports, public documents, governmental reports, and other written material were analyzed to document the history of hearing screening. RESULTS: The concept of screening for medical conditions that, when found, could influence some form of the outcome of the malady came about during the end of 19th century. The first applications of screening were to circumscribe populations, schoolchildren, military personnel, and railroad employees. During the first half of the 20th century, screening programs were extended to similar populations and were able to be expanded on the basis of the improved technology of hearing testing. The concept of universal screening was first applied to the inborn errors of metabolism of newborn infants and particularly the assessment of phenylketonuria in 1963 by Guthrie and Susi. A limited use of this technique has been the detection of genes resulting in hearing loss. The use of a form of hearing testing either observational or physiological as a screen for all newborns was first articulated by Larry Fisch in 1957 and by the end of the 20th century newborn infant screening for hearing loss became the standard almost every nation worldwide. CONCLUSIONS: Hearing screening for newborn infants is utilized worldwide, schoolchildren less so and for adults many industrial workers and military service undergo hearing screening, but this is not a general practice for screening the elderly. LEVEL OF EVIDENCE: NA Laryngoscope, 131:S1-S25, 2021.

Osteoporosis, bisphosphonate use, and risk of moderate or worse hearing loss in women.

BACKGROUND: Osteoporosis and low bone density (LBD) may be associated with higher risk of hearing loss, but findings are inconsistent and longitudinal data are scarce. Bisphosphonates may influence risk, but the relation has not been studied in humans. We longitudinally investigated associations of osteoporosis and LBD, bisphosphonate use, vertebral fracture (VF), hip fracture (HF), and risk of self-reported moderate or worse hearing loss. DESIGN: Longitudinal cohort study. SETTING: The Nurses' Health Study (NHS) (1982-2016) and Nurses' Health Study II (NHS II) (1995-2017). PARTICIPANTS: Participants included 60,821 NHS women, aged 36-61 years at baseline, and 83,078 NHS II women, aged 31-48 years at baseline (total n = 143,899). MEASUREMENTS: Information on osteoporosis, LBD, bisphosphonate use, VF, HF, and hearing status was obtained from validated biennial questionnaires. In a subcohort (n = 3749), objective hearing thresholds were obtained by audiometry. Multivariable-adjusted Cox proportional hazards models were used to examine independent associations between osteoporosis (NHS), osteoporosis/LBD (NHS II), and risk of hearing loss. RESULTS: The multivariable-adjusted relative risk (MVRR, 95% confidence interval) of moderate or worse hearing loss was higher among women with osteoporosis or LBD in both cohorts. In NHS, compared with women without osteoporosis, the MVRR was 1.14 (1.09, 1.19) among women with osteoporosis; in NHS II, the MVRR was 1.30 (1.21, 1.40) among women with osteoporosis/LBD. The magnitude of the elevated risk was similar among women who did and did not use bisphosphonates. VF was associated with higher risk (NHS: 1.31 [1.16, 1.49]; NHS II: 1.39 [1.13, 1.71]), but HF was not (NHS: 1.00 [0.86, 1.16];NHS II: 1.15 [0.75,1.74]). Among participants with audiometric measurements, compared with women without osteoporosis/LBD, the mean multivariable-adjusted hearing thresholds were higher (i.e., worse) among those with osteoporosis/LBD who used bisphosphonates. CONCLUSION: Osteoporosis and LBD may be important contributors to aging-related hearing loss. Among women with osteoporosis, the risk of hearing loss was not influenced by bisphosphonate use.

Cost-effectiveness of implementing routine hearing screening using a tablet audiometer for pediatric cystic fibrosis patients receiving high-dose IV aminoglycosides.

BACKGROUND: Cystic fibrosis (CF) patients who receive high-dose aminoglycosides can acquire inner ear damage and subsequent hearing loss. There is no current standard protocol for assessing ototoxicity in CF centers in the United States. OBJECTIVE: To evaluate the cost-effectiveness of a pharmacist-implemented routine hearing screening for ototoxicity among pediatric patients using a clinically validated tablet audiometer to allow for earlier detection of hearing loss in an exploratory analysis. METHODS: A Markov decision-analytic model was developed to assess the cost-effectiveness of implementing routine screening with monthly cycles over a 3-year time horizon. The model measured the difference in promptly detected hearing loss, delayed detected hearing loss, and undetected hearing loss, compared with current screening practices. Model inputs were obtained through a comprehensive literature review. Primary model outcomes included total health care costs and quality-adjusted life-years (QALYs) gained with a 3% yearly discount. One-way, two-way, and probabilistic sensitivity analyses were conducted to evaluate model uncertainty. RESULTS: In a hypothetical cohort of 100 patients, routine screening using a tablet audiometer increased promptly detected hearing loss by 8 patients. There was an incremental gain of 3.2 QALYs at an increased cost of $333,826 compared with current screening practices. This resulted in an incremental cost-effectiveness ratio (ICER) of $103,771 per QALY. In the 1-way sensitivity analysis, the ICER ranged between $64,345 and $258,830 per QALY. CONCLUSIONS: Using a tablet audiometer for routine hearing screening appears to be a cost-effective option at a $150,000 per QALY willingness-to-pay threshold when only considering the immediate benefits gained. This analysis did not examine the long-term effects of early detection in language development for pediatric patients. DISCLOSURES: Huang reports funding from the University of North Carolina and GlaxoSmithKline Health Outcomes Fellowship. GlaxoSmithKline had no involvement in the study creation, analysis, or manuscript composition. The other authors have nothing to disclose.

Comprehensive Community Screening of Otological Patients by Trained Technicians Using a Telemedicine Device: An Efficient and Cost-Effective Way to Triage Patients With Ear Diseases.

OBJECTIVE: To emphasize the benefits of tele-otology in community screening of patients with ear diseases. METHODS: A retrospective study of all patients screened and treated under the Shruti tele-otology program between 2013 and 2019 was conducted. It involved screening, diagnosis, medical management, surgical intervention, and rehabilitation using hearing aid. The study focused on underprivileged and underserved community of rural and urban slums across 12 states of India. The study was conducted using a telemedicine device called ENTraview, that is, a camera-enabled android phone integrated with an otoscope and audiometry screening. RESULT: A total of 810 746 people were screened, and incidence of various ear diseases was recorded. Ear problems were found in 265 615 (33%) patients, of which 151 067 (57%) had impacted wax, 46 792(18%) had chronic suppurative otitis media, 27 875 (10%) had diminished hearing, 12 729 (5%) had acute otitis media and acute suppurative otitis media (ASOM), and 27 152 (10%) had problems of foreign body, otomycosis, and so on. Of the total 265 615 referred patients, 20 986 (8%) reported for treatment and received treatment at a significantly reduced cost through Shruti program partners. The conversion rate of nonsurgical and surgical procedure was also compared, and it was found that, while 9% of the patients opted for nonsurgical treatment, only 3% opted for surgery in the intervention group giving a significant P value of .00001. CONCLUSION: The potential for telemedicine to reduce inequalities in health care is immense but remains underutilized. Shruti has largely been able to bridge this gap as it is an innovative, fast, and effective programs that address the ear ailment in the community.

Validation of a Bilateral Simultaneous Computer-Based Tympanometer.

Purpose This study aimed to investigate the accuracy of bilateral simultaneous tympanometric measurements using a tympanometer with two pneumatic systems inside circumaural ear cups. Method Fifty-two adults (104 ears), with a mean age of 32 years (SD = 12.39, range: 18-60 years) were included in this study. A within-subject repeated-measures design was used to compare tympanometric measurements yielded with the investigational device in unilateral and bilateral simultaneous conditions compared with an industry-standard tympanometer. Results No significant bias (p > .05) was found between the mean of the differences of tympanometric measurements yielded by the two devices, except for a significant bias (p < .05) of the mean of the differences for ear canal volume measurements (0.05 cm3). The Bland-Altman plots showed overall good agreement between the tympanometric measurements between the two instruments. In all 104 ears, the tympanogram types of the KUDUwave TMP were compared with the reference device. The results were highly comparable with a sensitivity and specificity of 100% (95% CI [86.8%, 100%]) and 92.3% (95% CI [84.0%, 97.1%]), respectively. Conclusions The investigational device is a suitable instrument for unilateral or bilateral simultaneous tympanometric measurements in adults and demonstrates the potential of decentralized and accessible tympanometry services.

Hearing Vital Signs: Mobile Audiometry in the Emergency Department for Evaluation of Sudden Hearing Loss.

Emergency departments (EDs) are a common location for patients to present with sudden hearing loss (SHL). Unfortunately, high-quality, rapid quantitative measurement of hearing loss is challenging. Herein, we aim to evaluate the accuracy of tablet-based audiometry in patients complaining of SHL. Prospective tablet-based testing was completed in the ED in patients complaining of SHL. Air conduction thresholds (ACTs) obtained via tablet-based audiometry were compared to same-day measurements with a clinical-grade audiometer. Hearing loss (HL) was defined as >20 dB ACT for any frequency. In participant-level analysis, 30+ dB HL in 3 consecutive frequencies was used to define SHL. In the ED, mobile audiogram ACTs were within 5 dB (77%) and 10 dB (89.6%) of those determined by conventional audiometry. The sensitivity and specificity for mobile audiometry to detect 3 or more consecutive thresholds with 30+ dB HL were 100% and 62.5%, respectively. Findings have implications for increasing access to high-quality audiometry.

One Step Closer towards a Reliable Tinnitus Pitch-Match Frequency Determination Using Repetitive Recursive Matching.

INTRODUCTION: The determination of the tinnitus pitch-match (PM) frequency is not straightforward but an important audiological assessment recommended for clinical and research purposes. We evaluated repetitive recursive matching using an iPod-based matching procedure as a method to estimate a patient's PM frequency without audiometric equipment. METHODS: One hundred and seventeen patients with chronic tonal tinnitus (uni- and bilateral tinnitus) measured their tinnitus in 10 sessions using a self-administered automated iPod-based procedure comprising a recursive 2 interval forced-choice test. RESULTS: Mean SD of the PM frequency of all participants across sessions was 0.41 octaves. The internal consistency measured by Cronbach's α was very high (0.8->0.95). As an example, 7 PMs obtained excellent internal consistency (α = 0.93). The exclusion of the first and/or second session led to more definite PMs with a decreased SD. Outliers were identified by PMs departing 2 SDs (i.e., 0.94 octaves) from the mean variability (n = 5). CONCLUSION: Repetitive recursive matching together with recommendations for the exclusion of initial and redundant sessions as well as outlier identification and treatment can enable a reliable estimation of the PM frequency.

Improving the High-Frequency Response of PEI-Based Earphone with Sodium Copper Chlorophyllin.

The polyetherimide diaphragm, sodium copper chlorophyllin (SCC), and copper ion coating composite used on earphones were observed to improve the high-frequency (10k-14k Hz) performance. This reinforcement phenomenon was expected to make the sound experience brighter and more diverse. By SEM observation, the mixed coating of SCC/Cu2+ on the polyethylenimine (PEI) diaphragm exhibited a planar blocky structure and was tightly bonded to the surface of the PEI polymer without the aid of colloids. The endothermic process of SCC and metal ion complexation was analyzed by isothermal titration calorimetry. The association ratios of SCC/Cu2+ and SCC/Ni2+ were 4/1 and 6/1, respectively, and the SCC/Cu2+ association yielded a stronger binding constant and more free energy. It was expected that the SCC/Cu2+(4/1) mixed liquid would be immobilized on the PEI polymer by multivalent interaction, including hydrogen-bonding networks between carboxyl groups of SCC and amine groups of PEI, and cross-linking of bridging copper ions. We used dimethylethylenediamine (DME) monomer instead of PEI polymer to analyze this multivalent interaction and observed a two-stage exothermic association of SCC/Cu2+(4/1) and DME with a total Gibbs free energy of 15.15 kcal/mol. We observed that the binding energy could be used to explain that the SCC/Cu2+ mixed formulation could be fixed on the surface of the PEI polymer and could enhance the strength of the PEI film. Compared with graphene films, which can continuously improve the performance of high and ultrasonic frequencies, this study was devoted to and was initiated for the purpose of applying porphyrin compounds to improve music performance.

Sudden deafness and tuning fork tests: towards optimal utilisation.

The tuning fork tests have been under attack since their first use in clinical examination. However, the tuning fork is small and fits into every white coat, and tuning fork tests for hearing are easy, accurate and inexpensive. They should be used in patients with an acute unilateral hearing loss if an electric audiometer is not available. After more than 100 years, the tuning fork is not obsolete; tuning fork tests are very useful if used correctly and for the appropriate indication.

Effect of hyperbaric oxygen therapy and corticosteroid therapy in military personnel with acute acoustic trauma.

INTRODUCTION: Acute acoustic trauma (AAT) is a sensorineural hearing impairment due to exposure to an intense impulse noise which causes cochlear hypoxia. Hyperbaric oxygen therapy (HBO) could provide an adequate oxygen supply. The aim was to investigate the effectiveness of early treatment with combined HBO and corticosteroid therapy in patients with AAT compared with corticosteroid monotherapy. METHODS: A retrospective study was performed on military personnel diagnosed with AAT between November 2012 and December 2017. Inclusion criteria for HBO therapy were hearing loss of 30 dB or greater on at least one, 25 dB or more on at least two, or 20 dB or more on three or more frequencies as compared with the contralateral ear. RESULTS: Absolute hearing improvements showed significant differences (independent t-test) between patients receiving HBO and the control group at 500 Hz (p=0.014), 3000 Hz (p=0.023), 4000 Hz (p=0.001) and 6000 Hz (p=0.01) and at the mean of all frequencies (p=0.002). Relative hearing improvements were significantly different (independent t-test) at 4000 Hz (p=0.046) and 6000 Hz (p=0.013) and at all frequencies combined (p=0.005). Furthermore, the percentage of patients with recovery to the functional level required by the Dutch Armed Forces (clinical outcome score) was higher in the HBO group. CONCLUSIONS: Early-stage combination therapy for patients with AAT was associated with better audiometric results at higher frequencies and better clinical outcome score.

Adult validation of a self-administered tablet audiometer.

BACKGROUND: There is evidence to suggest that rates of hearing loss are increasing more rapidly than the capacity of traditional audiometry resources for screening. A novel innovation in tablet, self-administered portable audiometry has been proposed as a solution to this discordance. The primary objective of this study was to validate a tablet audiometer with adult patients in a clinical setting. Secondarily, word recognition with a tablet audiometer was compared against conventional audiometry. METHODS: Three distinct prospective adult cohorts underwent testing. In group 1 and group 2 testing with the automated tablet audiometer was compared to standard sound booth audiometry. In Group 1, participants' pure tone thresholds were measured with an automated tablet audiometer in a quiet clinic exam room. In Group 2, participants completed monosyllabic word recognition testing using the NU-6 word lists. In Group 3, internal reliability was tested by having participants perform two automated tablet audiometric evaluation in sequence. RESULTS: Group 1 included 40 patients mean age was 54.7 ± 18.4 years old and 60% female; Group 2 included 44 participants mean age was 55.2 ± 14.8 years old and 68.2% female; Group 3 included 40 participants with mean age of 39.4 + 15.9 years old and 60.5% female. In Group 1, compared to standard audiometry, 95.7% (95% CI: 92.6-98.9%) of thresholds were within 10 dB. In Group 2, comparing word recognition results, 96.2% (95% CI: 89.5-98.7%) were clinically equivalent and within a critical difference range. In Group 3, One-way Intraclass Correlation for agreement for the both left- and right-ear pure tone average was 0.98. The mean difference between repeat assessments was 0 (SD = 2.1) in the left ear, and 0.1 (SD = 1.1) in the right ear. CONCLUSION: Puretone audiometry and word recognition testing appears valid when performed by non-healthcare experts using a tablet audiometer outside a sound booth in a quiet environment. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02761798. Registered April, 2016 < https://clinicaltrials.gov/ct2/show/NCT02761798>.

Community health workers obtain similar results using cell-phone based hearing screening tools compared to otolaryngologists in low resourced settings.

OBJECTIVE: To establish community health workers as reliable hearing screening operators in a technology-based pre-surgical hearing screening program in a low and middle-income country (LMIC). METHODS: This is a cross sectional study that evaluated community health worker driven hearing screening that took place in semi-rural Malindi, Kenya during an annual two-week otolaryngology surgical training mission in October 2017. At five separate locations (four schools) near Malindi, Kenya, children between the ages of 2-16 underwent hearing screening using screening audiometry (Android-based HearX Group). Children were screened by a community health worker who underwent a short training course, a senior otolaryngology resident, or both. Hearing screening results were compared to determine the reliability and concordance between independent, blinded community health worker and otolaryngology resident testing. RESULTS: One hundred and four participants (53% males) underwent hearing screening. Hearing screening pass rate was 93%. Community health workers obtained a similar result to otolaryngology residents 96% of the time (McNemar test: p = 0.16, OR 0.96, 95% CI 0.9-1.0). CONCLUSION: Community health workers can obtain reliable results using a technology-based, pre-surgical hearing screening platform when compared to otolaryngology residents. This finding has profound implications in low-resourced settings where hearing healthcare specialists (audiologists and otolaryngologists) are limited and can ultimately improve the surgical yield of patients presenting to local otolaryngologists in these settings.

High Altitude Performance of Loudspeakers and Potential Impact on Audiometric Findings.

BACKGROUND: The evaluation of how air rarefaction can affect a loudspeaker performance at altitude implies the need for characterization of earphones during hypobaric conditions. The aim of this study was phonometric analysis at different altitudes of the acoustic output of a widely used earphone model, along with its consequences on audiological investigations conducted under such environmental conditions.METHODS: The transfer function of a TDH-39P earphone was analyzed with an artificial ear under nine different altitude levels, from sea level up to 35,000 ft, inside a hypobaric chamber. A specific phonometric system not sensitive to environmental pressure changes was used. Other potentially confounding factors, such as environmental temperature and humidity, were continuously monitored.RESULTS: No relevant temperature or humidity changes were detected. The sound pressure level generated by the earphone under hypobaric conditions was found considerably affected by air density changes. These data produced a correction table aiming at recalibrating the earphone's output at each audiometric octave test frequency within the 250-8000 Hz range. Quite different characteristics of response were observed at different audiometric frequencies. Such findings were particularly evident for altitudes exceeding 12,000 ft.DISCUSSION: The development of a frequency-selective and altitude-related correction factor for acoustic stimuli is an essential aspect when hearing threshold measurements in hypobaric environments are performed.Lucertini M, Botti T, Sanjust F, Cerini L, Autore A, Lucertini L, Sisto R. High altitude performance of loudspeakers and potential impact on audiometric findings. Aerosp Med Hum Perform. 2019; 90(7):655-659.

Compensated active noise cancellation earphone for audiometric screening tests in noisy environments.

Objective: This study investigated hearing screening tests by using a custom-designed compensated hybrid active noise cancellation (ANC) earphone and compared it with TDH39 and Audiocups audiometric earphones under conditions of quiet, 45 dB HL masking narrowband, wideband speech-shaped, and white noise. Design: The hearing screening tests were conducted to characterise the shifts of screening results under noisy conditions, and real-ear attenuations at thresholds were assessed to quantify real-ear noise reduction performance. Study sample: Twenty-four normal-hearing adults, aged 20-25 years, participated in this study. Results: The ANC earphone exhibited significantly lower/better mean screening results than those of the TDH39 earphone at 250 and 500 Hz and those of the Audiocups earphone at 250 Hz under conditions of narrowband, speech-shaped, and white noise. Compared with the TDH39 earphone at 250 and 500 Hz, applying a hybrid ANC earphone reduced the shifts in screening results by 14.2 and 12.3 dB, respectively, under the narrowband noise condition. Conclusion: This study demonstrated that the compensated hybrid ANC earphone provided lower shifts of screening results than the TDH39 and Audiocups earphones and that it was capable of screening at 250 and 500 Hz from 20 dB HL under 45 dB HL masking narrowband and wideband noise.

An evaluation of the Sennheiser HDA 280-CL circumaural headphone for use in audiometric testing.

Objective: Evaluation of the Sennheiser HDA 280-CL circumaural headphone for the determination of (1) equivalent threshold sound pressure levels (ETSPL) for 125-18,000 Hz.; (2) real ear attenuation (250-8000 Hz); (3) insertion loss (63-18,000 Hz); (4) frequency response (125-18,000 Hz); (5) total harmonic distortion (THD) (125-10,000 Hz); and, (6) linearity (11,200-18,000 Hz).Study Sample: Twenty-five normal hearing adults aged 18-25 participated in (1) and (2).Design: (1) Hearing thresholds were measured using the Sennheiser HDA 280-CL. Frequency specific ETSPL values were calculated in an artificial ear. (2) Sound field thresholds were measured with the ears open and covered with the headphone to obtain the real ear attenuation thresholds (REAT). These values were used to determine the maximum permissible ambient noise levels (MPANL). (3) A B&K HATS mannequin recorded the output levels of a broadband pink noise with the ears open and covered with the headphones. (4, 5) The frequency response, THD and linearity were measured in an artificial ear.Results: Values for ETSPL, REAT, MPANL, insertion loss, as well as measures of frequency response, THD and linearity are presented.Conclusions: The Sennheiser HDA 280-CL meets the requirements for audiometric testing and the values presented can be used for calibration.

Automated Smartphone Audiometry: A Preliminary Validation of a Bone-Conduction Threshold Test App.

OBJECTIVE: To develop and validate an automated smartphone app that determines bone-conduction pure-tone thresholds. METHODS: A novel app, called EarBone, was developed as an automated test to determine best-cochlea pure-tone bone-conduction thresholds using a smartphone driving a professional-grade bone oscillator. Adult, English-speaking patients who were undergoing audiometric assessment by audiologists at an academic health system as part of their prescribed care were invited to use the EarBone app. Best-ear bone-conduction thresholds determined by the app and the gold standard audiologist were compared. RESULTS: Forty subjects with varied hearing thresholds were tested. Sixty-one percent of app-determined thresholds were within 5 dB of audiologist-determined thresholds, and 79% were within 10 dB. Nearly all subjects required assistance with placing the bone oscillator on their mastoid. CONCLUSION: Best-cochlea bone-conduction thresholds determined by the EarBone automated smartphone audiometry app approximate those determined by an audiologist. This serves as a proof of concept for automated smartphone-based bone-conduction threshold testing. Further improvements, such as the addition of contralateral ear masking, are needed to make the app clinically useful.

Novel Use of Portable Audiometry to Track Hearing Fluctuations in Menière's Disease: A Pilot Study.

INTRODUCTION: Menière's Disease (MD) is a disorder of the inner ear consisting of episodic attacks of vertigo associated with aural fullness, tinnitus, and fluctuating hearing loss. Hearing levels in MD can often fluctuate over time, and may eventually decline permanently in a step-wise fashion. There are no current studies examining daily hearing fluctuations for prolonged periods in patients with MD. Portable audiometry has the potential to allow the patient to monitor their hearing on a daily basis without attending a center for formal audiology. The objective of this pilot study was to assess feasibility of using iPad-based audiometry on a daily basis to capture hearing fluctuations in a small sample of adult patients with active MD. METHODS: We recruited five patients with active MD as defined by current diagnostic criteria (International Classification of Vestibular Disease 2015). "Active" MD was defined as the patient having had at least one typical Menière's episode within the last 4 weeks. Patients were trained on how to use the portable audiometer and asked to perform at least daily audiograms for 3 months. Patients were asked to manually track vertigo attacks in a diary. Qualitative feedback was obtained from each patient at each monthly visit. For each patient, individual pure tone thresholds at each frequency and pure-tone averages (PTA) were analyzed for maximum and minimum values and interquartile ranges. RESULTS: There were four women and one man, with an average age of 49.8 years. Duration of MD ranged from 4 months to 5 years. None of the patients experienced any technical difficulties performing the testing at home. The average duration of each test was 4.2 minutes, with the longest test taking 19.2 minutes. Patients completed between 45 and 102 tests, with an average of 72. The interquartile range for the PTA ranged from 2.5 to 25 dB for affected ears, and 0 to 6.25 dB for unaffected ears with maximums ranging from 5 to 35 dB in affected ears, and 0 to 10 dB in unaffected ears. CONCLUSIONS: Daily portable audiometry is feasible in patients with MD. Future studies are planned to further analyze hearing fluctuations in MD with respect to frequencies affected, relationship to vertigo attacks, and response to treatments. Understanding hearing fluctuations in MD may aid refinement of diagnostic criteria and improve prognostication for long-term hearing loss, with a goal of informing treatments that might improve final hearing outcome.

Sensitivity and Specificity of Automated Audiometry in Subjects with Normal Hearing or Hearing Impairment.

OBJECTIVE: To investigate the sensitivity and specificity in an automatic computer-controlled audiometric set-up, used for screening purposes. DESIGN: Comparison between standardized audiometry and automated audiometry performed in the same participants. STUDY SAMPLE: In total, 100 participants (51 females and 49 males) were recruited to take part of this study the same day they visited the hearing clinic for clinical audiometry. Ages varied between 18 and 84 years (mean 45.9 in females, 52.3 in males). RESULTS: The participants were divided into groups, dependent of type of hearing. A total of 23 had normal hearing, 40 had sensorineural hearing loss, 19 had conductive hearing loss and 18 showed asymmetric hearing loss. The sensitivity for the automated audiometry was 86%-100% and the specificity 56%-100%. The group with conductive hearing loss showed the poorest sensitivity (86 %) and specificity (56 %). The group with sensorineural hearing loss showed the smallest variation in difference between the two methods. CONCLUSIONS: The results show that automated audiometry is a method suitable to screen for hearing loss. Screening levels need to be selected with respect to cause of screening and environmental factors. For patients with asymmetric hearing thresholds it is necessary to consider the effect of transcranial routing of signals.

Evaluation of Two Circumaural Earphones for Audiometry.

OBJECTIVE: The Sennheiser HDA 200 earphone, a standard circumaural earphone used in audiometry for many years, is out of production and is replaced by the RadioEar DD450. The Sennheiser HD 280 Pro earphone is a consumer product that has characteristics that may be suitable for audiometry and may be a low-cost alternative to the DD450. The DD450 and HD 280 Pro earphones were compared with the HDA 200 for use in audiometry. DESIGN: RadioEar DD450 and Sennheiser HD 280 Pro earphones were evaluated for reference equivalent threshold sound pressure levels (RETSPLs), ambient-noise attenuation, and occlusion effects. Audiometric thresholds measured on a group of normal-hearing adults were used to determine RETSPLs. Ambient-noise attenuation was determined by measuring the sound pressure in the ear canal produced by a broadband signal from a loudspeaker with and without occlusion by the earphone. Acoustic occlusion effects were determined by measuring the ear-canal sound pressure produced by a bone-conducted source with and without occlusion by the earphone. The results were compared with measurements obtained from the HDA 200 earphone. RESULTS: Audiometric thresholds obtained using the DD450 earphone did not differ from those obtained with the HDA 200 earphones, indicating that the HDA 200 RETSPLs provided in the audiometer standards (ANSI S3.6-2010; ISO 389-8-2004) are transferable to the DD450. New RETSPLs for the HD 280 Pro earphone were determined from the threshold measurements. Ambient-noise attenuation provided by the DD450 was equivalent to the attenuation provided by the HDA 200. The HD 280 Pro provided less ambient-noise attenuation than the other circumaural earphones, but more than the supra-aural earphones commonly used in audiometry. The DD450 produced an occlusion effect 5 dB larger than that of the HDA 200 at 0.25 and 0.5 kHz; both earphones produced negligible occlusion effects at higher frequencies. The HD 280 Pro produced larger occlusion effects in the low frequencies than the other two earphones, with negligible occlusion effects at 1.0 kHz and above. CONCLUSIONS: The HDA 200 RETSPLs are transferable to the DD450. Ambient-noise attenuation and occlusion effects are similar for these two earphones. RETSPLs for the HD 280 Pro are provided. The HD 280 Pro has less ambient-noise attenuation and larger occlusion effects than the DD450 but is a viable low-cost alternative.

Nível de Ruído de Peças de Mão de Alta Velocidade Usadas em Odontologia como Fator de Risco Auditivo / Noise Level of High-Speed Handpieces Used in Dentistry as Hearing Hazard Factor

Introdução: O ruído é um sinal acústico descrito como som indesejável ou desagradável. A exposição prolongada a níveis elevados de ruído configura um risco físico ocupacional relevante. Objetivos: Esta pesquisa teve como objetivos: avaliar o nível de ruído produzido por canetas de alta rotação utilizadas em odontologia; comparar os resultados com o limite máximo recomendado e níveis toleráveis conforme legislação; comparar resultados entre marcas e modelos. Materiais e Métodos: O nível de ruído de 152 turbinas foi medido com um decibelímetro digital, posicionado em uma câmara acústica. Resultados: O nível de pressão sonora produzido pelas peças de mão de alta velocidade avaliadas teve média de 62,92±2,99 dB; Vinte e três amostras (15,54%) apresentaram ruído acima de 65 dB, enquanto 125 (84,45%) não ultrapassaram o nível máximo de conforto acústico recomendado pela NR-17, apesar de terem atingidos resultados bem próximos do limite. Canetas de marcas e modelos diferentes não apresentaram diferenças significantes de níveis de ruído (p=0,25). Conclusão: O nível de pressão sonora provocado pelo uso de canetas de alta rotação situa-se próximo do limite máximo do conforto acústico quando avaliado isoladamente. Canetas de marcas e modelos diferentes não apresentaram diferenças significantes de níveis de ruído. (AU)

Introduction: Noise is an acoustic signal described as undesirable or unpleasant sound. Prolonged exposure to high noise levels is a relevant occupational physical hazard. Objectives: The aims of this research was: to evaluate the noise level produced by high speed hand pieces used in Dentistry; to compare the results with the recommended maximum limit and tolerable levels according to legislation; to compare results between brands and models. Material and Methods: The noise level of 152 turbines was measured with a digital sound level meter, positioned in an acoustic chamber. Results: The sound pressure level produced by the samples reached a mean of 62.92 dB (A) and standard deviation of 2.99; Twenty-three samples (15.54%) presented noise above 65 dB, while 125 (84.45%) did not exceed the maximum level of acoustic comfort recommended by the NR-17, although results were very close to the limit. High speed hand pieces of different brands and models did not present significant differences in noise levels (p = 0.25). Conclusion: The sound pressure level caused by the use of high-speed Handpieces is close to the maximum limit of acoustic comfort when evaluated in isolation. Handpieces of different brands and models showed no significant differences in noise levels. (AU)