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European Annals of Otorhinolaryngology,... Oct 2017Electrophysiologic hearing tests have been developed since the 1960s to determine hearing thresholds objectively. They are now implemented in newborn hearing screening.... (Review)
Review
Electrophysiologic hearing tests have been developed since the 1960s to determine hearing thresholds objectively. They are now implemented in newborn hearing screening. While they determine thresholds, interpretation requires subjective pure-tone and speech audiometry to determine the type of hearing loss. Each examination tests a different anatomic region, enabling the auditory system to be explored from the organ of Corti to the auditory cortex. Thus, the various objective audiometric examinations are complementary.
Topics: Audiometry, Evoked Response; Audiometry, Pure-Tone; Auditory Threshold; Evoked Potentials, Auditory, Brain Stem; Hearing Loss; Hearing Loss, Sensorineural; Humans; Infant, Newborn; Neonatal Screening; Prognosis; Time Factors
PubMed: 28330595
DOI: 10.1016/j.anorl.2017.02.011 -
American Journal of Ophthalmology Aug 2022To characterize the frequency, severity, and resolution of hearing dysfunction in patients treated with teprotumumab for thyroid eye disease (TED). (Observational Study)
Observational Study
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.
Topics: Antibodies, Monoclonal, Humanized; Audiometry; Female; Graves Ophthalmopathy; Hearing; Hearing Loss; Hearing Loss, Sensorineural; Humans; Male; Middle Aged
PubMed: 35227694
DOI: 10.1016/j.ajo.2022.02.015 -
International Journal of Environmental... Mar 2021Audiometric booths are used to reduce background noise levels at testing locations to below values specified in the standards. As such, they are considered inherent... (Review)
Review
Audiometric booths are used to reduce background noise levels at testing locations to below values specified in the standards. As such, they are considered inherent parts of the audiometric testing equipment. This paper presents the results from a literature search of solutions that could ensure that background noise levels are acceptable outside booths. The technology used is especially valuable for survey tests and for locations where booths are unavailable or cannot be used for different reasons. However, its use is recommendable for only screening hearing tests but not for clinical or research applications.
Topics: Audiometry, Pure-Tone; Humans; Mass Screening
PubMed: 33802657
DOI: 10.3390/ijerph18063073 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Jul 2020The symptoms of hidden hearing loss(HHL) are concealed, mainly manifested as defects in the threshold upper auditory function, which are related to noise exposure,... (Review)
Review
The symptoms of hidden hearing loss(HHL) are concealed, mainly manifested as defects in the threshold upper auditory function, which are related to noise exposure, aging and drug damage. There is no definite evidence to prove that whether the three factors participate in mechanism of synaptic damage in the cochlea. The clinical audiological characteristics of HHL are mostly as follows: the normal threshold of PTA and the wave response of ABR; the amplitude of the CAP of ABR wave Ⅰ or ECochG is lower at medium and high stimulation intensity; the lower speech recognition rate under noise, etc. Ultra-high frequency pure tone audiometry, a series of objective audiological examinations, such as ABR, ECochG and frequency-following response, speech audiometry under noise, noise exposure questionnaire evaluation were applied to detect HHL at early stage.
Topics: Acoustic Stimulation; Audiometry, Pure-Tone; Auditory Threshold; Evoked Potentials, Auditory, Brain Stem; Hearing Loss, Noise-Induced; Humans; Noise
PubMed: 32791650
DOI: 10.13201/j.issn.2096-7993.2020.07.023 -
Journal of Global Health Aug 2022We aimed to investigate the effectiveness of using minimally trained community health workers (CHW) to screen schoolchildren in rural Nicaragua for hearing loss using a... (Review)
Review
BACKGROUND
We aimed to investigate the effectiveness of using minimally trained community health workers (CHW) to screen schoolchildren in rural Nicaragua for hearing loss using a tablet-based audiometric system integrated with asynchronous telehealth evaluations and mobile health (mHealth) appointment reminders.
METHODS
A population-based survey was conducted using community health workers (CHWs) to perform tablet-based audiometry, asynchronous telehealth evaluations, and mHealth reminders to screen 3398 school children (7-9 years of age) in 92 rural Nicaraguan communities. The accuracy of screening, test duration, testing efficiency, telehealth data validity, and compliance with recommended clinic visits were analyzed.
RESULTS
Minimally trained CHWs successfully screened children within remote rural schools with automated audiometry (test duration = 5.8 minutes) followed by manual audiometry if needed (test duration = 4.3 minutes) with an estimated manual audiometry validity of 98.5% based on a review of convergence patterns. For children who were referred based on audiometry, the otoscopy and tympanometry obtained during telehealth evaluations were high quality (as reviewed by 3 experts) in 44.6% and 80.1% of ears, respectively. A combination of automated short message service (SMS) text messages and voice reminders resulted in a follow-up compliance of 75.2%. No families responded to SMS messages alone.
CONCLUSIONS
Tablet-based hearing screening administered by minimally trained CHWs is feasible and effective in low- and middle-income countries. Manual audiometry was as efficient as automated audiometry in this setting. The physical exam tasks of otoscopy and tympanometry require additional training. Mobile phone messages improve compliance for confirmatory audiometry, but the utility of SMS messaging alone is unclear in this population.
Topics: Audiometry; Child; Community Health Workers; Hearing; Humans; Telemedicine; Text Messaging
PubMed: 35938885
DOI: 10.7189/jogh.12.04060 -
PloS One 2023The purpose of this study was to verify the accuracy of the web-based audiometer HEARZAP in determining hearing thresholds for both air and bone conduction. (Comparative Study)
Comparative Study
AIM
The purpose of this study was to verify the accuracy of the web-based audiometer HEARZAP in determining hearing thresholds for both air and bone conduction.
METHOD
Using a cross-sectional validation design, the web-based audiometer was compared to a gold standard audiometer. Participants in the study totaled 50 (100 ears), of which 25 (50 ears) had normal hearing sensitivity and 25 (50 ears) had various types and degrees of hearing loss. All subjects underwent pure tone audiometry, including air and bone conduction thresholds, using the web-based and gold standard audiometers in a random order. A pause between the two tests was allowed if the patient felt comfortable. The testing for the web-based audiometer and gold standard audiometer was done by two different audiologists with similar qualifications in order to eliminate tester bias. Both the procedures were performed in a sound treated room.
RESULTS
For air conduction thresholds and bone conduction thresholds, respectively, the mean discrepancies between the web-based audiometer and the gold standard audiometer were 1.22 dB HL (SD = 4.61) and 0.8 dB HL (SD = 4.1). The ICC for air conduction thresholds between the two techniques was 0.94 and for the bone conduction thresholds was 0.91. The Bland Altman plots likewise indicated excellent reliability between the two measurements, with the mean difference between the HEARZAP and the gold standard audiometry falling within the top and lower limits of agreement.
CONCLUSION
The web-based audiometry version of HEARZAP produced precise findings for hearing thresholds that were comparable to those obtained from an established gold standard audiometer. HEARZAP, has the potential to support multi-clinic functionality and enhance service access.
Topics: Humans; Audiometry; Audiometry, Pure-Tone; Auditory Threshold; Cross-Sectional Studies; Internet; Reproducibility of Results
PubMed: 36976819
DOI: 10.1371/journal.pone.0283519 -
PloS One 2023To evaluate two user-operated audiometry methods, the AMTASTM PC-based audiometry and a low-cost smartphone audiometry research application (R-App).
OBJECTIVE
To evaluate two user-operated audiometry methods, the AMTASTM PC-based audiometry and a low-cost smartphone audiometry research application (R-App).
DESIGN
A repeated-measures within-subject study design was used to compare both user-operated methods to traditional manual audiometry and to evaluate test-retest reliability of each method.
STUDY SAMPLE
58 subjects were recruited in the study of which 83 ears had normal hearing thresholds and 33 ears had hearing loss (pure-tone average > 25 dB HL). Average age of participants was 44.8 years, with an age range of 11-85.
RESULTS
Standard deviation of absolute differences ranged between 3.9-6.9 dB on AMTASTM and 4.5-6.8 dB on the R-App. The highest variability was found at the 8000 Hz frequency (R-App and AMTASTM test) and 3000 Hz frequency (AMTASTM retest). Evaluation of test-retest reliability of AMTASTM and R-App showed SD of absolute differences ranging between 3.5-5.8 dB and 3.1-5.0 dB, respectively. The mean threshold difference between test and retest was within ±1.5 dB on AMTASTM and ±1 dB on the R-App.
CONCLUSION
Accuracy of AMTASTM and the R-App was within acceptable limits for audiometry and comparable to traditional manual audiometry on all tested frequencies (250-8000 Hz). Evaluation of test-retest reliability showed acceptable variation on both AMTASTM and R-App. Both user-operated methods could be reliably performed in a quiet non-soundproofed environment.
Topics: Adult; Humans; Audiometry; Deafness; Mobile Applications; Reproducibility of Results; Smartphone; Child; Adolescent; Young Adult; Middle Aged; Aged; Aged, 80 and over
PubMed: 37708125
DOI: 10.1371/journal.pone.0291412 -
Journal of Medical Internet Research Feb 2022Hearing loss affects 1 in 5 people worldwide and is estimated to affect 1 in 4 by 2050. Treatment relies on the accurate diagnosis of hearing loss; however, this first... (Review)
Review
BACKGROUND
Hearing loss affects 1 in 5 people worldwide and is estimated to affect 1 in 4 by 2050. Treatment relies on the accurate diagnosis of hearing loss; however, this first step is out of reach for >80% of those affected. Increasingly automated approaches are being developed for self-administered digital hearing assessments without the direct involvement of professionals.
OBJECTIVE
This study aims to provide an overview of digital approaches in automated and machine learning assessments of hearing using pure-tone audiometry and to focus on the aspects related to accuracy, reliability, and time efficiency. This review is an extension of a 2013 systematic review.
METHODS
A search across the electronic databases of PubMed, IEEE, and Web of Science was conducted to identify relevant reports from the peer-reviewed literature. Key information about each report's scope and details was collected to assess the commonalities among the approaches.
RESULTS
A total of 56 reports from 2012 to June 2021 were included. From this selection, 27 unique automated approaches were identified. Machine learning approaches require fewer trials than conventional threshold-seeking approaches, and personal digital devices make assessments more affordable and accessible. Validity can be enhanced using digital technologies for quality surveillance, including noise monitoring and detecting inconclusive results.
CONCLUSIONS
In the past 10 years, an increasing number of automated approaches have reported similar accuracy, reliability, and time efficiency as manual hearing assessments. New developments, including machine learning approaches, offer features, versatility, and cost-effectiveness beyond manual audiometry. Used within identified limitations, automated assessments using digital devices can support task-shifting, self-care, telehealth, and clinical care pathways.
Topics: Audiometry, Pure-Tone; Hearing; Hearing Loss; Humans; Machine Learning; Reproducibility of Results
PubMed: 34919056
DOI: 10.2196/32581 -
Ear and Hearing 2019A confluence of recent developments in cloud computing, real-time web audio and machine learning psychometric function estimation has made wide dissemination of...
OBJECTIVES
A confluence of recent developments in cloud computing, real-time web audio and machine learning psychometric function estimation has made wide dissemination of sophisticated turn-key audiometric assessments possible. The authors have combined these capabilities into an online (i.e., web-based) pure-tone audiogram estimator intended to empower researchers and clinicians with advanced hearing tests without the need for custom programming or special hardware. The objective of this study was to assess the accuracy and reliability of this new online machine learning audiogram method relative to a commonly used hearing threshold estimation technique also implemented online for the first time in the same platform.
DESIGN
The authors performed air conduction pure-tone audiometry on 21 participants between the ages of 19 and 79 years (mean 41, SD 21) exhibiting a wide range of hearing abilities. For each ear, two repetitions of online machine learning audiogram estimation and two repetitions of online modified Hughson-Westlake ascending-descending audiogram estimation were acquired by an audiologist using the online software tools. The estimated hearing thresholds of these two techniques were compared at standard audiogram frequencies (i.e., 0.25, 0.5, 1, 2, 4, 8 kHz).
RESULTS
The two threshold estimation methods delivered very similar threshold estimates at standard audiogram frequencies. Specifically, the mean absolute difference between threshold estimates was 3.24 ± 5.15 dB. The mean absolute differences between repeated measurements of the online machine learning procedure and between repeated measurements of the Hughson-Westlake procedure were 2.85 ± 6.57 dB and 1.88 ± 3.56 dB, respectively. The machine learning method generated estimates of both threshold and spread (i.e., the inverse of psychometric slope) continuously across the entire frequency range tested from fewer samples on average than the modified Hughson-Westlake procedure required to estimate six discrete thresholds.
CONCLUSIONS
Online machine learning audiogram estimation in its current form provides all the information of conventional threshold audiometry with similar accuracy and reliability in less time. More importantly, however, this method provides additional audiogram details not provided by other methods. This standardized platform can be readily extended to bone conduction, masking, spectrotemporal modulation, speech perception, etc., unifying audiometric testing into a single comprehensive procedure efficient enough to become part of the standard audiologic workup.
Topics: Adult; Aged; Audiometry, Pure-Tone; Female; Hearing Loss; Humans; Internet; Machine Learning; Male; Middle Aged; Reproducibility of Results; Severity of Illness Index; Young Adult
PubMed: 30358656
DOI: 10.1097/AUD.0000000000000669 -
European Archives of... Nov 2021Stapes surgery, despite the introduction of lasers and endoscopes, still represents a challenging procedure. Recently introduced 3-dimensional exoscopes have known...
PURPOSE
Stapes surgery, despite the introduction of lasers and endoscopes, still represents a challenging procedure. Recently introduced 3-dimensional exoscopes have known advantages in otological surgery. This study aims to evaluate exoscopes role in stapes surgery, both from a surgical perspective and on the educational profile.
METHODS
Seven consecutive otosclerosis patients underwent single-sided endaural laser stapedotomy with a 4K 3-dimensional exoscope. The surgical setting allowed all operating room personnel 3-dimensional vision. Pre- and postoperative pure tone audiometry and air-bone gaps, and information on the postoperative course and complications were systematically collected. An informal ergonomic evaluation was carried out by the operating room personnel and an informal didactic evaluation was provided by the trainees. A comparable group of microscope-assisted stapedotomy patients undergoing the same procedures and evaluations was chosen as a control group.
RESULTS
Outcomes were solid in all patients, median air-bone gap decreased from 26.5 to 10 dB at the 3-month evaluation (p = 0.01, Wilcoxon's test). No vertigo, tinnitus, or facial palsy was reported. The median operating time was 40 min. The compact design and configuration of the exoscope allowed more practical management of the operating theater. All personnel had the chance for a better understanding of the procedure and trainees felt more confident when asked to identify surgical landmarks and procedure steps. Audiological outcomes, operative times, and complication rates were not different between study and control groups.
CONCLUSION
Though further validation and systematic comparison with microscope- and endoscope-assisted stapedotomy are required, the exoscope proved a safe, practical, and educational tool.
Topics: Audiometry, Pure-Tone; Humans; Lasers; Operating Rooms; Otosclerosis; Retrospective Studies; Stapes Surgery; Treatment Outcome
PubMed: 33594470
DOI: 10.1007/s00405-021-06672-1