Hearing status in vitamin B12-deficient children.

AIM: The aim of this study is to investigate the effects of vitamin B12 deficiency on hearing in school-aged children by pure-tone audiometry. METHODS: Forty-three vitamin B12-deficient children and 37 age-matched control subjects were enrolled in the study. Tympanometric evaluations and pure-tone audiometry including high frequencies were performed on the subjects. The results were compared between the two groups. RESULTS: Both right and left ear pure-tone hearing thresholds (PTHTs) at 0.25-4 kHz, and four-frequency pure-tone average values were significantly better in the control group compared with the patient group (P < 0.05). However, PTHTs at 8-16 kHz were not different between the two groups (P > 0.05). Vitamin B12 level also did not show any significant correlation with the PTHTs at 0.25-16 kHz (P > 0.05). CONCLUSION: This study indicates that vitamin B12 deficiency may contribute to hearing impairment at low frequencies as a possible aetiological factor in children.

Hearing and Tinnitus Evaluation in Music Teachers.

PURPOSE: Music is an aesthetic whole consisting of sounds combined according to a certain purpose, method and understanding. Therefore, it also interacts with emotions in listeners. Music sounds are in the range of approximately 20-8000 Hz. This frequency range is within the frequency spectrum of the human cochlea. The aim of this research is to evaluate the hearing thresholds of music teachers and to determine whether they cause tinnitus. MATERIAL AND METHODS: This research was conducted in Turgut Özal University Medical Faculty Hospital Audiology and Speech Disorders clinic. A total of 35 people (17 music teachers, 18 control groups) participated in the research. In this research, 17 music teachers (11 females, 6 males) aged 24-39, and 18 volunteers (12 females, 6 males) participated in the control group. After the otoscopic examination of all participants, pure tone audiometry (in the range of 125-16,000 Hz), immitansmetric examination and Distortion Product Otoacoustic Emission (DPOAE) tests were performed. Tinnitus Handicap Inventory (THI) was used in the evaluation of tinnitus. RESULTS: There was no statistically significant difference between the music teachers and the control group in all pure tone hearing threshold averages of 125-16,000 Hz (p>0.05). The Uncomfortable Level (UCL) average of music teachers was 104.12 ± 3.83 dB for the right ear, 108.33 ± 3.83 dB for the control group, 107.78 ± 4.28 dB for the left ear, and 103.53 ± 4.28 for the control group. DPOAE results were found statistically significant at 3000 Hz only for the right and left ears (p=0.036; p=0.015, respectively). Also, for DPOAE test, the control group's OAE values were higher than the music teachers. According to the Tinnitus Handicap Inventory in music teachers, 1st degree tinnitus has emerged. CONCLUSION: According to the findings obtained, the low UCL value in music teachers compared to the control group suggests the tolerance problem. Continuous exposure to the sound was thought to create a noise effect on the cochlea, and as a result, tinnitus susceptibility appeared in music teaching.

Evaluation of Auditory Brainstem Response (ABR) in Vitamin B12 Deficiency.

PURPOSE: Changes in the central nervous system are observed due to vitamin B12 deficiency. The purpose of this study is to assess the effects of vitamin B12 deficiency on the central auditory tracks utilizing ABR. MATERIAL AND METHOD: 30 individuals (16 females, 14 males) with vitamin B12 deficiency and 30 individuals (17 females, 13 males) without any hearing problem and B12 deficiency have participated in the study. The ages of the individuals with vitamin B12 deficiency varied between 18 and 39, with a mean of 28±5.6, The ages of the individuals with normal hearing in the control group were between 18 and 42, with a mean of 30±6.2. The I, III and V. wave latencies and I-III, I-V and III-V inter-wave latencies and amplitudes of the participants with vitamin B12 deficiency and with normal hearing were evaluated using click stimulus. RESULTS: No statistically significant change was observed between the group with vitamin B12 deficiency and the normal group in the I, III and V. wave latencies and the I-III, I-V and III-V inter-latency values and amplitudes. CONCLUSION: Although vitamin B12 deficiency effects the central nervous system, normal latencies and amplitudes were obtained in the ABR test. It was especially observed that the brainstem region, where the I, III ve V. Waves originate, is not effected by vitamin B12 deficiency.

Evaluation of the Effect of Frequency-Shifting Technique Used in Hearing Aids for Speech Discrimination.

BACKGROUND: To evaluate the effect of frequency-shifting techniques recently used in hearing aids for speech discrimination scores and hearing thresholds. METHODS: Thirty individuals (16 men and 14 women) with sensorineural hearing loss who used normal fitting monaural hearing aids and frequency-shifting feature for at least 2 months and whose 4000-8000 Hz hearing threshold was over 70 dB participated. The average age was 69.73 ± 10 (range: 65-80 years). We detected the types and degree of each participant's hearing loss. Measurements with and without hearing aids were made in a free field. For speech discrimination scores, 6 listings consisting of 25 monosyllables have been used. It has been avoided to learn words thanks to presentation of words in different listings to subjects. RESULTS: Pure-tone averages of the participants were measured using a supra-aural headphone, normal fitting hearing aid, and frequency-shifting feature. The results were 55.93 ± 6.89, 40.47 ± 5.48, and 36.73 ± 5.72 dB, respectively (p˂0.05). Speech discrimination scores for hearing aids worn on the right ear were measured as 67.73 ± 12.42%, 77.33 ± 10.33%, and 82.13 ± 10.46% with supra-aural headphones, normal fitting hearing aids, and frequency-shifting feature, respectively. Scores for hearing aids worn on the left ear were 68 ± 7.56%, 76.80 ± 6.96%, and 82.13 ± 6.67% with supra-aural headphone, normal fitting hearing aid, and frequency-shifting feature, respectively (p˂0.05). CONCLUSION: Elderly individuals using hearing aids had low speech discrimination scores. The frequency-shifting feature recently used in hearing aids significantly increased the scores, making a significant contribution to the solution of speech reception and communication problems in cases of high-frequency hearing loss caused by presbyacusis in elderly individuals..

Evaluation of Central Auditory Processing in Musicians and Non-Musicians.

PURPOSE: Auditory processing is the analysis of sounds' attributions such as localization, lateralization, temporality, frequency, loudness, phase, auditory memory and auditory attention through primer and secondar central auditory paths. This study aims to show that music contributes on auditory processing by applying central auditory tests on two groups who are musicians and nonmusicians. MATERIALS AND METHODS: The participants in this study are aged between 20 and 40. The mean age of the musician participants is 24.40±3.811, when the mean age of non-musician participants is 26.07±4.525. Each group has 30 participants. All participants got examined for otorhinolaryngology and they were tested for pure tone audiometry and immitansmetric measurement. For musician participants, this study included people who have professional music career for at least 5 years and for non-musician participants, it has been included those who are capable of normal hearing. All participants tested for Frequency Patterns Test (FPT), Duration Patterns Test (DPT), Random Gap Detection Test (RGDT) and Staggered Spondaic Word Test (SSWT). RESULTS: The results of the FPT, DPT, RGDT and SSWT tests applied to musician and non-musician participants indicate that there is a statistical significance on auditory processing between these two groups (p<0.05). It is founded that there is a considerable difference as a result of statistical significance between the tests from right to left and from left to right (p<0.05). In addition, it is founded that musician participants have much more comprehension ability in the tests from left to right than the tests from right to lefts. CONCLUSION: This study indicates that people who are interested in music professionally have developed auditory processing skills and senses than people who does not show any professional interest in music.

Comparison of Neural Response Telemetry (NRT) results of cochlear implanted children in view of pre-operative Auditory Brainstem Response (ABR).

OBJECTIVES: To compare the Neural Response Telemetry (NRT) results of the cochlear implanted children who showed wave 5 and who could not, in preimplantation ABR. MATERIAL AND METHOD: 24 children (11 boys, 13 girls) with bilateral profound sensorineural hearing loss participated in this study. Age of children ranged between 13 and 60 months (mean 30 months). All participated children were implanted with Cochlear® Nucleus brand devices. In preoperative ABR evaluation with click stimulus in 100 dBnHL intensity level, 9 children showed wave V and 15 children did not. We compared intraoperative NRT results of 1st, 6th, 11th, 16th and 22nd electrodes, those were selected from 22 electrodes, of the two groups. RESULTS: There was no statistically significant difference between the children who showed wave V and who did not in preoperative ABR, when compared the intraoperative NRT results of 1st, 6th, 11th, 16th and 22nd electrodes (p>0,05). CONCLUSION: intraoperative NRT was obtained in all the implanted children with bilateral profound sensorineural hearing loss, even if they received wave V or not in preoperative ABR. There was no difference between any of the parameters of the test results of the two groups. Normal NRT results can be achievable when there is no wave V in preoperative ABR.

Evaluation of Vestibular Evoked Myogenic Potentials (VEMP) Individuals with Tinnitus and Normal Hearing.

The aim the present study is to evaluate ocular and cervical Vestibular Evoked Myogenic Potentials (VEMPs) of adult individuals with and without tinnitus who have normal hearing. Thirty one patients who have normal hearing, complaining about unilateral or bilateral subjective tinnitus and 30 volunteers who without tinnitus and vestibular complains were enrolled into the present study. Following examination by of Ear Nose Throat (ENT) physician, Tinnitus Disability Questionnaire (TDQ), pure tone audiometry (125-16.000 Hz) speech tests, oVEMP and cVEMP tests were applied to all participants. Fourteen individuals with normal hearing and tinnitus were male (44%) and 17 (56%) were female with an age average of 35.8 ± 10.2.30 years; the control group consisted of 16 males (53%) and 14 females (47%) with an age average of 37.5 ± 12 years. Two individuals of the tinnitus group had bilateral tinnitus and 29 individuals had unilateral tinnitus. A statistically significant difference in individuals without tinnitus and tinnitus must be normal at work between test answers that are not available 125-16000 Hz range Air Conduction (AC) hearing thresholds, speech tests, cVEMP and oVEMP responses. Tinnitus may appear due to many reasons. Vestibular system is one of the conditions that can cause tinnitus. According to the findings obtained from adult individuals with normal hearing, the vestibular system does not cause tinnitus.

Satisfaction assessment with Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire on people using hearing aid having Real Ear Measurement (REM) eligibility.

AIM: Benefit and satisfaction from hearing aids can be measured in different ways. The aim of this study is to evaluate the benefits and satisfaction of the users from the hearing aids whose fitting are done suitably for hearing loss including ear mould. MATERIAL AND METHOD: In this study Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire which consists of 24 questions was used for hearing aid satisfaction assessment. Total 301 people having different type and degree hearing loss participated in the study. The ages of 141 men and 160 women participants were between 18-65 and the average age was 49.11 ± 13.89 year. 187 of the participants had hearing aid in only one ear and the 114 had in both ears. Degree of unilateral hearing loss was 31 slight, 64 moderate, 49 moderately severe, 35 severe and 8 profound. In the ear in which hearing aid was used, there was 134 sensorineural hearingloss, 53 mixture hearing loss. Degree of hearing loss of the people using hearing aid bilaterally was 24 slight, 79 moderate, 54 moderately severe, 48 severe and 23 profound. In 162 ears of people using hearing aid bilaterally there was sensorineural hearing loss and in 53 ears there was mixture hearing loss. RESULTS: In right ear average score of the maximum satisfaction was between 4.23-5.75 and in left ear it was between 4.20-5.72. While the degree of hearing loss was increasing, the average of satisfaction score was decreasing. In terms of using unilateral and bilateral hearing aid, statistically considerable difference was found. In terms of hearing loss statistically considerable difference couldn't be found. CONCLUSION: Satisfaction of hearing aid is decreasing inversely proportional with increasing of hearing loss (slight- profound degree) While the furthest satisfaction for right and left ear was slight degree, the least satisfaction was observed for profound hearing loss. Aid using satisfaction changes depend on using the aid in the right ear or in the left ear. Using bilateral hearing aid has increased patient satisfaction much more.

Peripheral and central vestibular system findings in Meniere's disease.

AIM: Meniere's Disease (MD) is a chronic disease that is characterized by intermittent episodes of tinnitus, vertigo, and progressivefluctuating sensorineural hearing loss together with aural fullness. The aim of this study is to evaluate Meniere's disease patients with vestibular test battery as Videonystagmography (VNG), Vestibular Evoked Myogenic Potentials (VEMPs) and Video Head Impulse Test (V-HIT) to assess peripheral and central vestibular systems. METHODS: 16 bilateral, 17 unilateral patients suffering from MD (mean age, 40.90 years, range, 23 to 66 years; 20 women and 13 men) comprised the study group, and 39 healthy (mean age, 38.10 years, range from 21 to 60 years; 22 women and 17 men) volunteers formed control group. Evaluation of peripheral and central vestibular systems changes with oculomotor tests, caloric test, C-VEMPs, O-VEMPs, and the evaluation of the vestibular ocular reflex (VOR) using the V-HIT. RESULT: Twenty-six ears out of the forty-nine ears that were affected by Meniere's disease were diagnosed as otolith or ampullary dysfunction. As to O-VEMPs testing, N1 and P1 waves could not be obtained from thirty of the forty-nine ears affected by Meniere's disease. As for obtained N1 and P1 waves, prolonged N1 and P1 wave latencies, and reduced amplitude was observed in Meniere's group. P1 and N1 waves were not observed in 5 bilateral and 2 unilateral Meniere's patients (12 ears out of 49 affected ears) in C-VEMPs recordings (23.9%). In Meniere's patients' group, 44.9% of the velocity gain values were obtained in the pathologic borders of v- HIT. In addition to lower velocity gain, higher ratios of asymmetry were obtained from the ears affected with Meniere's disease. CONCLUSION: According to these results, it can be concluded that Meniere's disease significantly affects the peripheral vestibular system but the functions of the central vestibular system were not affected.

Examination of Insert Ear Interaural Attenuation (IA)Values in Audiological Evaluations.

PURPOSE: The purpose of this study was to evaluate Interaural Attenuation (IA) in frequency base in the insert earphones that are used in audiological assessments. METHODS: Thirty healthy subjects between 18-65 years of age (14 female and 16 male) participated in our study. Otoscopic examination was performed on all participants. Audiological evaluations were performed using the Interacoustics AC40 clinical audiometer and ER-3A insert earphones. IA value was calculated by subtracting good ear bone conduction hearing thresholds of the worst airway hearing threshold. RESULTS: In our measuring for 0.125-8.0 kHz frequency were performed in our audiometry device separately for each frequency. IA amount in the results we found in 1000 Hz and below frequencies about 75-110 dB range avarage is 89±5dB, in above 1000 Hz frequencies in 50-95 dB range and avarage it is changed to 69±5dB. CONCLUSION: According to the obtained findings the quantity of melting in the transition between the ears are increasing with the insert earphones. The insert earphone should be beside supraaural earphone that is routinely used in clinics. Difficult masking applications due to the increase in the value of IA can be easily done with insert earphones.

Retrospective air bone gap evaluation of patients with tympanic membrane central perforation.

PURPOSE: The purpose of this study was to evaluate hearing recovery and air-bone gap (ABG) before and after tympanoplasty surgery in patients with tympanic membrane central perforation. METHODS: Histories and audiological assessments of 160 cases (total of 26 ears from 22 patients; 11 men and 11 women) from patients who had undergone tympanoplasty surgery and hearing reconstruction due to tympanic membrane central perforation were evaluated. Pre-postoperative audiograms and the pure tone, air-bone hearing thresholds and ABG gains were evaluated. RESULTS: The mean age of the patients was 38.6 years (± 16.04). The mean postoperative follow-up period was 13.4 months (± 15.5). The mean preoperative ABG was 25.36 dB (± 9.9) and postoperative ABG was 17.36 dB (± 11.68) (p = 0.001). When four groups were compared before surgery and after surgery period as 0-6 months, 6-12 months, 1-2 years and 2 years in terms of pre- and postoperative ABG values, no statistically significant difference was observed (p>0.05). All patients were divided into three groups: < 20 years of age; between the ages of 21-40; and, >41 years of age, and no statistically significant difference were found between the groups (p> 0.05). Surgeries of the patients 21-40 years of age were more successful (ABG gain) than other age groups. No statistically significant gender differences were found in ABG averages (p = 0.33), but clinical results were significantly better in women as compared with men. CONCLUSION: In patients with central tympanic membrane perforation, tympanoplasty surgery with temporal fascia is beneficial in terms of hearing recovery.

Does Tinnitus Lead to Depression?

PURPOSE: The aim of the study was to investigate the correlation between THI (Tinnitus Handicap Inventory) and BDS (Beck Depression Scale). MATERIALS AND METHODS: High frequency thresholds and PTA (Pure Tone Audiometer) thresholds for the patients were measured in 44 patients with tinnitus (bilateral=13; unilateral=31). Tinnitus frequency and intensity were measured using one-pair method with high frequency audiometer Interacoustic AC40. Applied BDS and THI scores are evaluated for all patients. Our findings are analysed statistically with SPSS v.21 and BDS and THI correlation with tinnitus intensity and frequency was executed. RESULTS: The mean value of tinnitus frequency was 10 kHz (min 0.25 kHz, max16 kHz and SD 4.26), mean tinnitus intensity was 50.6 dB (min 15 dB, max 110 dB and SD 26.9 dB) mean THI score was 38.04 (min 10, max 86 and SD 20.03) and mean BDS score was 9.45 (min 0, max 28 and SD 6.49). There was no statistical correlation between THI score and tinnitus frequency (r=0.055, p=0.787). Moderate correlation is obtained between tinnitus frequency and depression (r=0.6, p=0.001). There were weak correlations between tinnitus intensity and THI score and (r=0.3, p=0.09) and between tinnitus intensity and BDS score (r=0.28, p=0.13). Although a statistically significant difference was observed between THI scores of patients with bilateral and unilateral tinnitus (p0.05). High frequency thresholds and UCL scores of ears with tinnitus were not statistically different from ears with no tinnitus (p>0.05). CONCLUSION: No correlation was seen between THI and tinnitus frequency, but a moderate correlation was seem between BDS score and tinnitus frequency. There were also weak correlations between tinnitus intensity and THI and BDS scores.

The ideas about advanced life support and affecting factors at the end-stage of life in a hospital in Turkey.

BACKGROUND: The participation of the people in health decisions may be structured in various levels. One of these is participation in decisions for the treatment. "Advanced directives" is one of the examples for the participation in decisions for the treatment. AIM: We wanted to determine the decisions on advanced life support at the end-stage of life in case of a life-threatening illness for the people themselves and their first degree relatives and the factors effecting these decisions. DESIGN AND SETTING: The cross-sectional study was conducted with volunteers among patients and patient relatives who applied to all polyclinics of the Ankara Numune Training and Research Hospital except the emergency, oncology and psychiatry polyclinics between 15.12.2012 and 15.03.2013. METHOD: A questionnaire, the Hospital Anxiety Depression (HAD) scale, and Templer's Death Anxiety Scale (TDA) were applied to all individuals. SPSS for Win. Ver. 17.0 and MS-Excel 2010 Starter software bundles were used for all statistical analysis and calculations. RESULTS: The participants want both themselves and their first degree relatives included in end-stage decision-making process. Therefore, the patients and their families should be informed adequately during decision making process and quality communication must be provided. CONCLUSION: Participants who have given their end-stage decisions previously want to be treated according to these decisions. This desire can just be possible by advanced directives.When moral and material loads of end-stage process are taken into consideration, countries, in which advanced directives are practiced, should be examined well and participants' desire should be evaluated in terms of practicability.

Evaluation of Acoustic Reflex and Reflex Decay Tests in Geriatric Group.

OBJECTIVE: To determine average acoustic reflex thresholds in geriatric groups by assessing ipsilateral and contralateral acoustic reflex and reflex decay tests. METHODS: A total of 25 elders between ages 65-84 years (74.3±5.4) and 25 individuals between ages 18-45 years (30.4±4.2) were recruited for the study. After ear, nose, and throat examination, ipsilateral and contralateral acoustic reflex thresholds at 500, 1000, 2000, and 4000 Hertz (Hz) were determined and a reflex decay test at contralateral 500 Hz was conducted. Ipsilateral acoustic reflex thresholds were obtained with high-frequency band, low-frequency band, and wide band noise, and the results were compared with ipsilateral acoustic reflexes at 500, 1000, 2000, and 4000 Hz. RESULTS: There was no statistically significant difference between the two groups in ipsilateral and contralateral acoustic reflex measurements at 500, 1000, 2000, and 4000 Hz (p>0.05). Negative reflex decay was obtained in all participants and no statistically significant difference between the two groups was observed in terms of reflex decay thresholds (p>0.05). Acoustic reflex with high-frequency band noise was observed in five of nine elders whose acoustic reflexes were not obtained at 2000 and 4000 Hz, whereas acoustic reflex with low-frequency band noise was observed in one of six elders who did not show reflexes at 500 and 1000 Hz. CONCLUSION: It was concluded that although some changes were observed due to age, middle ear and stapes muscles work normally in geriatric group. In the reflex decay test, reliable results were obtained at contralateral 500 Hz. Acoustic reflex measurements with low- and high-frequency band noise may also be used to assess middle ear functions.

Evaluation of the effects of phototherapy on cochlear function in newborns.

OBJECTIVE: This study aimed to evaluate any potential effects of phototherapy on cochlear function in newborns using transient evoked otoacoustic emissions (TEOAEs). METHODS AND MATERIALS: Fifty-seven newborns, undergoing phototherapy for hyperbilirubinemia without any other risk factors, and a control group of 53 healthy newborns, were administered the TEOAE test prior to and following phototherapy. In the newborns undergoing phototherapy, otoacoustic emission (OAE) measurements obtained at baseline and following phototherapy were compared. Moreover, pre-phototherapy OAE measurements obtained in the newborns undergoing phototherapy were compared with the OAE measurements of the control group. RESULTS: In newborns undergoing phototherapy, there was no significant difference between pre- and post-phototherapy TEOAE amplitudes, nor in the reproducibility ratios. Similarly, no difference was found in the pre-treatment measurements of amplitude and reproducibility ratios between phototherapy-receiving newborns and controls (p>0.05). CONCLUSION: The normal TEOAE results observed in the newborns undergoing phototherapy suggest that phototherapy does not exert negative effects on the cochlea.