Limitation of Conventional Audiometry in Identifying Hidden Hearing Loss in Acute Noise Exposure

Purpose@#The concept of hidden hearing loss can explain the discrepancy between a listener’s perception of hearing ability and hearing evaluation using pure tone audiograms. This study investigated the utility of the suprathreshold auditory brainstem response (ABR) for the evaluation of hidden hearing loss in noise-exposed ear with normal audiograms. @*Materials and Methods@#A total of 15 patients (24 ears) with normal auditory thresholds and normal distortion product otoacoustic emissions were included in a retrospective analysis of medical records of 80 patients presenting with histories of acute noise exposure. The control group included 12 subjects (24 ears) with normal audiograms and no history of noise exposure. Pure tone audiometry and suprathreshold ABR testing at 90 dB peSPL were performed. The amplitudes and latencies of ABR waves I and V were compared between the noise-exposed and control groups. @*Results@#We found no significant difference in the wave I or V amplitude, or the wave I/V ratio, between the two groups. The latencies of ABR wave I, V, and I–V interpeak interval were compared, and no significant intergroup difference was observed. @*Conclusion@#The results suggest that either hidden hearing loss may not be significant in this cohort of patients with acute noise exposure history, or the possible damage by noise exposure is not reflected in the ABRs. Further studies are needed to inquire about the role of ABR in identification of hidden hearing loss.

Limitation of Conventional Audiometry in Identifying Hidden Hearing Loss in Acute Noise Exposure

Purpose@#The concept of hidden hearing loss can explain the discrepancy between a listener’s perception of hearing ability and hearing evaluation using pure tone audiograms. This study investigated the utility of the suprathreshold auditory brainstem response (ABR) for the evaluation of hidden hearing loss in noise-exposed ear with normal audiograms. @*Materials and Methods@#A total of 15 patients (24 ears) with normal auditory thresholds and normal distortion product otoacoustic emissions were included in a retrospective analysis of medical records of 80 patients presenting with histories of acute noise exposure. The control group included 12 subjects (24 ears) with normal audiograms and no history of noise exposure. Pure tone audiometry and suprathreshold ABR testing at 90 dB peSPL were performed. The amplitudes and latencies of ABR waves I and V were compared between the noise-exposed and control groups. @*Results@#We found no significant difference in the wave I or V amplitude, or the wave I/V ratio, between the two groups. The latencies of ABR wave I, V, and I–V interpeak interval were compared, and no significant intergroup difference was observed. @*Conclusion@#The results suggest that either hidden hearing loss may not be significant in this cohort of patients with acute noise exposure history, or the possible damage by noise exposure is not reflected in the ABRs. Further studies are needed to inquire about the role of ABR in identification of hidden hearing loss.

Assessment of Attentional Demand in Patients with Dizziness Using Dual Task Test / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Even patients with compensated peripheral vestibular dysfunction may report a sense of disequilibrium during daily activities, which often fail conventional vestibular function tests as attentional demand required for postural control may increase in these patients. The study aims to assess the feasibility of dual task test using concurrent cognitive tasks in a modified clinical test of sensory interaction on balance (mCTSIB) to measure increased attentional demand for posture control. SUBJECTS AND METHOD: Nineteen patients suspected with chronic dizziness were recruited by history reviews and physical examinations. Data for center of pressure (COP) variability and mean velocity during mCTSIB on a force long plate were analyzed, and time taken to react to the auditory stimuli were used to measure the attentional demand required for adequate postural control during platform perturbation. RESULTS: The mean COP range and velocity during mCTSIB were comparable between single and dual task conditions in patients with dizziness. Reaction time (RT) to auditory stimulus of 1 kHz pure tone in patients with chronic dizziness was also comparable to normal subjects. Interestingly, there was a tendency for increased RT in patients with documented caloric weakness, suggesting that attentional demand is increased in these patients. CONCLUSION: RT of dual task tests using auditory stimuli during mCTSIB may provide additional information about increased attentional demand for postural control in patients with vestibular dysfunction.

Comparison of Acceptable Noise Levels Using Korean and Non-Semantic Speech Signals in Normal Hearing Subjects / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The acceptable noise level (ANL) test measures the maximum noise level that a subject can tolerate while following speech. Given the limited investigation of ANL across different languages, this study aimed to compare ANLs using both Korean semantic speech and non-semantic speech signals (reversed Korean speech and international speech test signal, ISTS) in normal-hearing subjects. SUBJECTS AND METHOD: Twenty-five subjects with normal hearing (9 males, 16 females, with the mean age of 28.5±3.15 years) were included in the study. ANLs were obtained using three speech materials (Korean speech, reversed Korean speech, and ISTS) as the target speech material and an eight-talker babble noise as the competing background noise. RESULTS: Generally, the inter-subject variability was large. The ANLs did not differ statistically regardless of the type of speech signal. CONCLUSION: The ANLs seemed to be unaffected by the meaningfulness or semantic contents of the target speech, at least in normal-hearing adults. Thus, non-meaningful speech signals or non-semantic material can be considered as the target signal for the implementation of ANL test.

Evaluation of Transient Evoked Otoacoustic Emission in the Newborn Hearing Screening Program in Neonatal Intensive Care Unit

BACKGROUND AND OBJECTIVES: Newborn Hearing Screening (NHS) program aims to identify babies at risk of hearing loss and provide appropriate rehabilitation within the crucial period for language development. The risk of hearing loss in increased in babies discharged from neonatal intensive care unit (NICU) compared to wellbaby nursery. Transient evoked otoacoustic emission (TEOAE) or automated auditory brainstem response tests are utilized. The purpose of this study is to assess the outcome of NHS using TEOAE as initial evaluation method in NICU graduates. SUBJECTS AND METHODS: TEOAE was performed as initial screening method for NHS in NICU neonates born between February 2010 and November 2011. Babies referred from TEOAE were reevaluated with repeated TEOAE or auditory brainstem response. Referral rates were estimated and quality indicators for screening (Joint Committee on Infant Hearing position statement, 2007) were evaluated. RESULTS: Among 149 neonates graduated from NICU, 50 (33.6%) babies failed initial TEOAE ('refer'). A second stage TEOAE testing was performed in 41 (82.0%) of these babies: 35 (85.4%) passed and 6 (14.6%) were referred for diagnostic testing. From 2-stage TEOAE screening program, 6 neonates were referred for diagnostic audiological evaluation: sensorineural hearing loss was identified in 2 babies and 3 babies were lost to follow up. Quality indicators for screening were as follows: 1) 94.0% of all newborn infants admitted to NICU completed screening by 1 month of age, and 2) 4.0% of all newborn infants who fail initial screening and fail any subsequent rescreening before comprehensive audiological evaluation. CONCLUSIONS: Timely and adequate screening of hearing loss is prerequisite for accurate diagnosis and appropriate rehabilitation in infants especially from NICU. Further refinement of the current NHS with additional reliable screening technology is required for more stable and successful screening program.

Evaluation of Transient Evoked Otoacoustic Emission in the Newborn Hearing Screening Program in Neonatal Intensive Care Unit

BACKGROUND AND OBJECTIVES: Newborn Hearing Screening (NHS) program aims to identify babies at risk of hearing loss and provide appropriate rehabilitation within the crucial period for language development. The risk of hearing loss in increased in babies discharged from neonatal intensive care unit (NICU) compared to wellbaby nursery. Transient evoked otoacoustic emission (TEOAE) or automated auditory brainstem response tests are utilized. The purpose of this study is to assess the outcome of NHS using TEOAE as initial evaluation method in NICU graduates. SUBJECTS AND METHODS: TEOAE was performed as initial screening method for NHS in NICU neonates born between February 2010 and November 2011. Babies referred from TEOAE were reevaluated with repeated TEOAE or auditory brainstem response. Referral rates were estimated and quality indicators for screening (Joint Committee on Infant Hearing position statement, 2007) were evaluated. RESULTS: Among 149 neonates graduated from NICU, 50 (33.6%) babies failed initial TEOAE ('refer'). A second stage TEOAE testing was performed in 41 (82.0%) of these babies: 35 (85.4%) passed and 6 (14.6%) were referred for diagnostic testing. From 2-stage TEOAE screening program, 6 neonates were referred for diagnostic audiological evaluation: sensorineural hearing loss was identified in 2 babies and 3 babies were lost to follow up. Quality indicators for screening were as follows: 1) 94.0% of all newborn infants admitted to NICU completed screening by 1 month of age, and 2) 4.0% of all newborn infants who fail initial screening and fail any subsequent rescreening before comprehensive audiological evaluation. CONCLUSIONS: Timely and adequate screening of hearing loss is prerequisite for accurate diagnosis and appropriate rehabilitation in infants especially from NICU. Further refinement of the current NHS with additional reliable screening technology is required for more stable and successful screening program.

Inferior Vestibular Neuritis: Absence of Vestibular Evoked Myogenic Potentials in the Presence of Normal Caloric Responses / 대한평형의학회지

BACKGROUND AND OBJECTIVES: To report the clinical features of six patients diagnosed with cases of inferior vestibular neuritis based on abnormal vestibular evoked myogenic potential (VEMP) responses with normal caloric test results. MATERIALS AND METHODS: We retrospectively reviewed 62 patients presenting with dizziness. All patients underwent a battery of audiovestibular testing, including hearing tests, caloric test and VEMP test. RESULTS: Six patients were diagnosed as inferior vestibular neuritis. All patients presented with acute onset of prolonged vertigo. The pure tone audiograms and caloric test results were normal. VEMP response was absent unilaterally, and normal in the contralateral ear. CONCLUSION: Inferior vestibular neuritis should be considered in patients presenting with acute vertigo, but normal caloric responses. Comprehensive vestibular testing including VEMP is necessary.

Cyclosporine Induced Breast Fibroadenoma in Kidney Transplanted Patient / 대한신장학회지

A 43-year-old woman who had received kidney transplantation 2 years before was admitted for masses on both axilla. Masses had variable sizes, and were round or oval-shaped with echogenicity on breast ultrasound. Pathologic examination using fine needle aspiration showed masses were fibroadenoma, fibroadenoid hyperplasia, and fat necrosis. We switched cyclosporine to tacrolimus. After 6 months of conversion, breast masses decreased in size on the follow-up breast USG.

Clinical Features of Ischemic Colitis in Patients with Chronic Kidney Disease / 대한신장학회지

PURPOSE: Hemodialysis patients are at an increased risk of ischemic colitis because of accelerated arterial vascular disease rate and hypotension during dialysis. But few data exist on the clinical features of ischemic colitis in patients with chronic kidney disease including dialysis patients in Korea. The aim of this study is to identify the clinical features of ischemic colitis in patients with chronic kidney disease (CKD). METHODS: We retrospectively reviewed total 68 patients (63.9+/-16.2 years) with ischemic colitis. We analyzed medical history, colonoscopic findings, clinical characteristics, and compared them according to kidney function. RESULTS: Twenty-two (33.9%) patients had CKD stage > or =3 at diagnosis of ischemic colitis. Prevalence of hypertension and diabetes was higher in patients with CKD than those with normal kidney function. High leukocyte count and low hemoglobin level were demonstrated at diagnosis in CKD patients. In addition, duration of hospitalization in patients with CKD was longer than patients with normal kidney function. However, there was no significant difference in right colonic involvement, cardiovascular diseases, surgical intervention, and mortality. Hospitalization days was positively correlated with increased leukocyte count (p=0.015) and decreased albumin level (p=0.002), while that was negatively correlated with age-adjusted estimated glomerular filtration rate (p=0.002). CONCLUSION: Ischemic colitis in patients with CKD had longer hospitalization than in those with normal kidney function. However, there was no significant difference in surgical intervention and mortality.

A Case of Bronchial Artery Aneurysm Demonstrating Hilar Mass / 결핵및호흡기질환

A bronchial artery aneurysm is a rare condition, which needs optimal treatment due to the possibility of a life-threatening hemorrhage by rupture. The surgical removal of the aneurysm is the standard treatment. However, there are a few reports of coil embolization with a transcatheter. A 69 year-old man was referred for a further evaluation of a mass in the right hilum on chest radiography. He denied any respiratory symptoms. A chest CT scan showed a 3 x 3 x 4.5 cm sized vascular mass with strong contrast enhancement on the right hilar area that originated from the bronchial artery. On the angiogram, the bronchial artery originated from the descending thoracic aorta at the T8 level. A bronchial artery aneurysm was catheterized selectively. and embolized successfully with a coil. After coil embolization, the selective bronchial arteriography confirmed complete occlusion. We report this case of bronchial aneurysm that was treated successfully with coil embolization.