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To do this, you must have Adobe Acrobat® Reader (version 4 or higher) installed on your computer. This medical discussion paper will be useful to those seeking general information about the medical issue involved.
Each medical discussion paper is written by a recognized expert in the field, who has been recommended by the Tribunala€™s medical counsellors. A mixed hearing loss occurs when both a sensorineural and conductive hearing loss are present at the same time. According to the 1990 Noise and Hearing Loss Consensus Conference, a€?Noise Induced Hearing Loss (NIHL) results from damage to the ear from sounds of sufficient intensity and duration that a temporary or permanent sensorineural hearing loss is produced. PTS refers to a permanent loss of sensorineural hearing which is the direct result of irreparable injury to the organ of Corti.
The 4000 Hz a€?notcha€? or a€?dipa€? in sensorineural hearing has been a classic finding in NIHL over the years.
Why the 4000 Hz frequency appears more affected than other frequencies continues to generate some controversy. Individuals vary in their susceptibility to noise and the damage it may cause to the cochlea. Of interest, one universal finding is that on average hearing threshold levels (HTLs) in the right ear are better than the left ear by about 1dB. Whether one ear is more resilient to noise in the same individual (the so- called a€?tough vs. Please remember that when an asymmetric sensorineural hearing loss exists steps often need to be taken to exclude pathologic causes (i.e. The following statements tend to reflect what is agreed upon by the majority of scientists and physicians who deal with NIHL.
Noise induced hearing loss (NIHL) may produce a temporary threshold shift (TTS), permanent threshold shift (PTS) or a combination of both. A PTS is caused by destruction of certain inner ear structures that cannot be replaced or repaired.
The amount of hearing loss produced from a given noise exposure varies from person to person.
NIHL initially affects higher frequency hearing (3-6 kHz range, for nearly all occupational exposures) than those frequencies essential for communication (i.e. Daily noise exposure (8hrs) > 90 dB for over 5 years (or equivalent) causes varying degrees of hearing loss in susceptible individuals. NIHL is a decelerating process; the largest changes occur in the early years with progressively smaller changes in the later years (so-called Corso's theorem). NIHL first affects hearing in the 3-6 kHz range, for nearly all occupational exposures; the lower frequencies are less affected.
Once the exposure to noise is discontinued, there is no substantial further worsening of hearing as a result of noise unless other causes occur. Continuous noise exposure over the years is more damaging than interrupted exposure to noise which permits the ear to have a rest period.
The pathologic basis for presbycusis appears to be one of gradual devascularization of the cochlea and loss of functioning hair cells. Clinically hearing loss from presbycusis appears to be an accelerating process unlike hearing loss in NIHL. Unfortunately, there is no specific treatment available that will prevent age related hearing loss at present. In the adjudication process of an occupational NIHL claim it is often difficult to separate the total amount of hearing loss from noise and age related change. For example, not everyone as they age will experience age-related presbycutic change (changes from presbycusis are variable with some individuals experiencing greater degrees of age related change than others).
Moreover, exposure to high level noise early on may produce hearing loss more rapidly than aging such that the aging process has a negligible effect (i.e. The effects of noise exposure and aging on hearing when not combined are reasonably well-understood. Although it seems logical to a€?subtracta€? the age-related effects from the total hearing loss in order to quantitate the amount of hearing loss due to noise, this is really quite simplistic when one considers that aging effects and noise exposure effects can at times be practically indistinguishable for the most part audiometrically. Because compensation claims have required some consideration of presbycusis and its role in the total hearing loss of an individual various correction factors have been applied.
Dobiea€™s theorem states that the total hearing loss from noise and age are essentially additive (this is the theory put into practice when a standard correction factor for age after 60 years is applied in the Province of Ontario). Corsoa€™s theorem on the other hand states that any correction for age should be based on a variable ratio (as individuals age the assumption is that the effects of presbycusis variably accelerate by decade). Nevertheless the quantification of hearing loss attributable to age when occupational NIHL is present is really quite a complex phenomenon.
This is an inner ear disorder characterized by episodes of vertigo (an illusion of movement) lasting minutes to hours, fluctuating hearing loss and tinnitus (unwanted head noise).
Usually one ear is involved initially although over time the other ear becomes affected in nearly 50% of cases.
Treatment is medical in most cases involving a low salt diet and diuretics and vestibular sedatives. Otosclerosis usually results in a conductive hearing loss from stapes footplate fixation due to new bone growth in this area.
The diagnosis of cochlear otosclerosis is usually made when a family history of otosclerosis exists and other rare causes for a chronic progressive loss can be excluded. Although no medical treatment can ever reverse the sensorineural hearing loss, treatment with oral sodium fluoride may minimize and possibly stabilize an individuala€™s hearing. Physical injury to the ear is usually the result of blunt trauma in the circumstances of a significant head injury. When physical trauma is severe enough to cause a temporal bone fracture (the temporal bone is the larger part of the skull bone that houses all the structures of the ear), two types of fractures occur; longitudinal and transverse. In general terms longitudinal fractures are much more common and tend to result in a fracture line through the roof of the middle ear and ear canal. Transverse fractures of the temporal bone occur when the fracture lines run directly through the hard bone of the otic capsule. Ototoxicity is defined as the tendency of certain substances to cause functional impairment and cellular damage to the tissues of the inner ear, especially to the cochlea and the vestibular apparatus. Aminoglycoside antibiotics are powerful weapons in the treatment of certain bacterial infections.
Antimalarial drugs such as quinine and chloroquin unfortunately have ototoxicity as a side effect if taken in excess. This is a pathologic misnomer since this tumour is strictly a schwannoma of the vestibular nerve. Although benign this tumour has serious health implications for the patient and is sought for by otolaryngologists when there is an undiagnosed asymmetry in the hearing. This diagnosis is given to the individual who experiences a sudden hearing loss in one ear. An individual's threshold hearing to pure tones at different frequencies (250 - 8000 Hz) is performed.
Air conduction (AC) thresholds are delivered via headphones and the individual is asked to respond to the sound of the lowest intensity (in dB) they hear at the frequency being tested.
The pure tone audiogram forms the basis for assessing if an individual qualifies for Workplace Safety and Insurance Board (WSIB) benefits in the Province of Ontario. Complex words with equal emphasis on both syllables (so called spondaic words such as a€?hotdoga€?, a€?uptowna€?, a€?baseballa€? etc.) are given an individual at the lowest intensity they can hear. A list of phonetically balanced single syllable words (these are words commonly found in the English language in everyday speech such as a€?fata€?, a€?asa€?, a€?doora€? etc.) are presented to an individual at 40 dB above their speech reception threshold (SRT) in the ear being tested. In this test a probe is placed into the ear canal that both emits a sound and can vary pressure within the canal which causes the ear drum to move. This tells whether the pressure in the middle ear is within normal limits and provides some indirect measurement of Eustachian tube function. Stiffening of the ear drum from loud noise occurs when the stapedius muscle contracts in the middle ear. Absent stapedial reflexes are usually seen in middle ear pathology such as otitis media with effusion or otosclerosis. If one measures how the ear drum moves when pressure is changed in the external ear canal from negative to positive a series of curves can be attained.
The ability to measure minute electrical potentials following sound stimulation of the cochlea (i.e.
Electrocochleography (ECoG) - This test measures electrical activity in the cochlea during the first 2 msec of cochlear stimulation. Auditory Brainstem Response (ABR) - This term is synonymous with the term brainstem evoked potential (BEP) or the brainstem evoked response audiogram (BERA). Threshold Evoked Potentials (TEP) - These electrical waveforms are usually identified between 50 - 200 msec following cochlear stimulation and are thought to represent cortical pathways of electrical activity.
If AC thresholds are greater than BC thresholds this usually implies there is a conductive component to hearing loss from pathology involving the external or middle ear.
If BC thresholds are greater than AC thresholds this would typically suggest an exaggerated hearing loss or malingering. In its classic presentation a notched sensorineural hearing loss is noted at 4000 Hz that should be relatively symmetric. Age related hearing loss typically presents with a bilateral symmetrical high frequency sensorineural hearing loss.
There are often numerous discrepancies noted such as the presence of acoustic reflexes at levels below volunteered pure tone thresholds, discrepancies between volunteered pure tone average and speech reception thresholds etc. Subjective tinnitus can only be appreciated by the affected individual, is usually associated with a sensorineural hearing loss of some type and is the most common type noted. Objective tinnitus, on the other hand, is quite rare but by definition is a noise that can be appreciated by an observer. Regardless of cause tinnitus can be quite disturbing for many individuals and can certainly affect their well-being. Treatment for tinnitus includes the use of more pleasurable competing background noise (i.e. The individual affected has undergone treatments to try to alleviate their perceived unwanted head noise (i.e. Evidence to support a personality change or a sleep disorder as a result of the tinnitus.
Hyperacusis is a curious phenomenon where an individual describes an uncomfortable, sometimes painful hypersensitivity to sounds that would be normally well tolerated in daily life. Treatment usually requires the gradual introduction of increasing sound intensity that becomes better tolerated with time.
American Academy of Otolaryngology-Head and Neck Surgery Foundation Subcommittee on the Medical Aspects of Noise. American Academy of Otolaryngology-Head and Neck Surgery Foundation: Guide for Conservation of Hearing in Noise. Noise Induced Hearing Loss by Lonsbury-Martin BL, Martin GK and Telischi FF, Volume 4, Chapter 126 in Otolaryngology-Head and Neck Surgery 3rd Edition. Permanent Impairment of Hearing - When any anatomic or functional abnormality produces a permanent reduced hearing sensitivity.
Permanent Handicap for Hearing - The disadvantage imposed by an impairment sufficient to affect the individuala€™s efficiency in the activities of daily living (ADL).
Permanent Disability - A person is permanently disabled or under permanent disability when the actual presumed ability to engage in gainful activity is reduced because of handicap and no appreciable improvement can be expected. Acoustic Neuroma (Vestibular Schwannoma) - A benign brain tumour that arises on the vestibular nerve usually within the internal auditory canal (IAC). Menierea€™s Disease - A classic inner ear disorder associated fluctuant sensorineural hearing loss, tinnitus and episodic attacks of vertigo lasting minutes-hours. Otitis Media with Effusion - An encompassing term that describes the presence of fluid behind the TM.
Otosclerosis- Genetically inherited condition (approximately 1 in 20 people carry the otosclerosis gene) associated with the development of new, immature bone which primarily involves the stapes footplate leading to a progressive conductive hearing loss. Tympanosclerosis - Calcification of the middle layer of the eardrum that looks like a patch of white chalk. Mastoidectomy - Procedure designed to exteriorize disease in the mastoid air cells and adjoining middle ear. Ossiculoplasty - Procedure where the ossicular chain is repaired in order to try and improve hearing. Tympanoplasty - When used in its most simplistic context it means the repair of a previous TM perforation.
Ventilation (myringotomy) Tube - The placement of an open ended tube or a€?grommeta€? into the TM acts like an artificial Eustachian tube which helps ventilate the middle ear space. Decibel (dB) - A decibel is an accepted measure of sound pressure level used to describe sound intensity. Evoked Response Audiometry - Measures electrical responses within the inner ear, cochlear nerve and central nervous system that are generated by loud repetitive clicks. This test is typically performed as one of the tests to confirm or exclude whether an exaggerated hearing loss (malingering) is present. Otoacoustic Emissions (OAEs) - Evoked test that measures minute responses to sound thought to arise from the contractile elements of the outer hair cells. Recruitment - Perceived abnormal progressive loudness of noise in an individual with a sensorineural hearing loss. Speech Discrimination Score (SDS) - The percentage score an individual correctly identifies when presented with a list of phonetically balanced (PB) words usually tested at 40dB above their hearing threshold. Tympanometry - Formal tracing of how the TM moves when pressure is altered in the external auditory canal. Acoustic Trauma - Damage to the ear caused by a single exposure to an impulse nose of high density.
Continuous Noise - A noise that remains relatively constant in sound level for at least 0.2 seconds.
Dosimeter - An instrument that integrates a function of constant varying sound pressure over a specified time period in such a manner that it directly indicates a noise dose and estimates the hazard of an entire exposure period. Permanent Threshold Shift (PTS) - The permanent depression in hearing sensitivity resulting from exposure to noise at damaging intensities and durations. Temporary Threshold Shift (TTS) - The temporary (usually several hours) depression in hearing sensitivity resulting from exposure to noise at damaging intensities and durations. Time Weighted Average (TWA) - The sound level or noise equivalent that, if constant over an eight hour day would result in the same exposure as the noise level in question (assuming a 5 dB doubling rule). The ear is a complex organ that has dual responsibility for hearing and balance (vestibular) function.
The ear canal (external auditory canal) originates from the concha (so-called bowl) of the auricle and extends medially to the tympanic membrane. The ear canala€™s primary function is to provide a conduit for airborne sound waves to reach the tympanic membrane.
The middle ear cleft is a more extensive designation of the middle ear that has three main components which include the middle ear cavity, mastoid air cell system and the Eustachian tube. The mastoid air cell system consists of a series of small mucosal lined air cells interconnected with each other and the middle ear proper.
Important structures of the middle ear include the tympanic membrane and the ossicular chain. The ossicular chain consists of the three small interconnected mobile bones known as the malleus (hammer), incus (anvil) and stapes (stirrup). The inner ear is the sensory end organ within the hardest bone of the body known as the petrous portion of the temporal bone. The cochlea specifically refers to the sensory portion of the inner ear responsible for hearing. The vestibular portion of the inner ear consists of three fluid lined semicircular (superior, lateral and posterior) canals and the area called the vestibule which houses the otolithic macular endorgans. Sound vibrations are picked up by the pinna and transmitted down the external auditory canal where they strike the TM causing it to vibrate.
When the mechanical vibrations of the stapes footplate reach the inner ear they create traveling waves in the cochlea. Although the vast majority of the cochlear nerve fibres are termed afferent (ie nerves that carry electrical activity from the inner ear to the brain), within the cochlear nerve itself we have a small number of nerve fibres designated as efferent (nerves that carry electrical activity from the brain to the inner ear).
Of interest when the outer hair cells become injured or affected by pathology they also lose their ability to a€?fine tunea€? the electrical responses arising from the inner ear. Although an individual may have apparently normal hearing it does not necessarily mean the cochlear nerve is undamaged. Sound is the propagation of pressure waves through a medium such as air and water for example. This is a very relevant question that is based on the definition of how hearing loss causes a handicap for the affected individual in their ability to identify spoken words or sentences under everyday conditions of normal living.
Although the higher frequencies are initially affected in NIHL an individual will really only begin to demonstrate a significant handicap to hearing to everyday speech in a quiet surrounding when the average of the hearing thresholds at 500, 1000, 2000 ( + 3000) Hz is above 25 dB.
The inclusion of the 3000 Hz threshold value for NIHL awards is not always required depending on the jurisdiction. In the province of Ontario the Workplace Safety and Insurance Board (WSIB)a€™s Operational Policy Manual (OPM) Document No.
A presbycusis (aging) correction factor of 0.5 dB is deducted from the measured hearing loss (averaged over the 500, 1000, 2000 and 3000 Hz frequencies) for every year the worker is over the age of 60 at the time of the audiogram. It is important to also appreciate that decisions can also be made on an exceptional basis which the WSIB has recognized. Since individual susceptibility to noise varies, if the evidence of noise exposure does not meet the above exposure criteria, claims will be adjudicated on the real merits and justice of the case, having regard to the nature of the occupation, the extent of the exposure, and any other factors peculiar to the individual case. A comprehensive list of US comparisons for NIHL and benefits can be found in Table 35.1 pages 797-799 in the Chapter concerning State and Federal Formulae Differences in Occupational Hearing Loss, 3rd Edition.
It is likely that the two effects are not additive (Corsoa€™s theorem) but from a practical point of view this is how they are usually viewed with regards to compensation claims (Dobiea€™s theorem).
At any given age for frequencies above 1000 Hz men will have more age related hearing loss than women.
Age related hearing loss affects all frequencies although the higher frequencies are usually more affected. Age related hearing loss is an accelerating process where the rate of change increases with age.
One can speculate that this might be one of the reasons an individual early on in their exposures may not be aware of a hearing loss, only to appreciate a hearing loss later in life when other factors such as presbycutic change occur. Although we think of presbycusis as an age related event not all individuals will develop this condition. Future genetic studies may provide us with further information concerning those at greater risk for progressive hearing loss from presbycusis in future. A TTS is considered to represent a pathological metabolically induced fatigue of the hair cells or other structures within the Organ of Corti.
In a PTS the destruction and eventual cochlear hair cell loss is thought to arise from direct mechanical destruction from high-intensity sound and from metabolic decompensation with subsequent degeneration of sensory elements.
While one would normally expect full recovery of hearing function after a TTS there is one important consideration that needs to be taken into account. The position in the world literature continues to support that any progressive hearing loss from acute trauma ceases unless the individual is re-exposed to more acute acoustic trauma or some other factor (s) occurs ( i.e. The classic studies of acute acoustic trauma by Segal et al (1988) and Kellerhals (1991) are often used to support this position. In the cohort study by Segal et al, 841 individuals from either the regular US army or military reserve sustained a permanent sensorineural hearing loss from acute acoustic trauma without subsequent re-exposure.
The importance of the Segal study is that after 1 year one would not expect further worsening of hearing in subjects who ceased to have further noise exposure. Kellerhalsa€™ study reviewed a much smaller series of individuals who were exposed to acute acoustic trauma but looked at them over a 20 year duration. This study evaluated the interference of tinnitus on the quality of life for noiseexposed workers enrolled in a hearing conservation program. Most tinnitus research has focused on effective treatments and the mechanisms of the cause, detection, and perception of tinnitus. In addition to its medical and audiological aspects, the psychosocial consequences of tinnitus can be of significance and have also been investigated. Tinnitus is a common complaint among noise-exposed workers, and in some countries it is even recognized as a work-related condition for compensation purposes. The objective of our study is to evaluate the impact of tinnitus on the quality of life of workers who are exposed to noise and enrolled in a corporate hearing conservation program. We enrolled participants from a meat-packing facility in the state of Rio Grande do Sul, Brazil. We administered a questionnaire to all the employees of the company (N = 372) at the beginning of the training sessions of their hearing conservation program. To assess the workers' hearing status, we performed otoscopy and pure-tone audiometry, according to the requirements of the Brazilian legislation [10]. We administered to the 52 participants the Brazilian version of the Tinnitus Handicap Inventory (THI) questionnaire, elaborated by Newman et al. We calculated Pearson coefficients of linear correlation and tested their significances via the Student's t -test and Fisher's exact test, using a significance level of 5%.
Eighty-two workers (22%) of the total population of 372 workers in the studied company reported tinnitus in the first interview of this study.
Company records also indicated that 15% of the participants who were exposed to noise were also exposed to other hazards.
The results of the relationship between tinnitus and the three THI scales are presented in Figure 2.
Table 2 displays the correlations between the functional, emotional, and catastrophic scales and medical history. Table 3 presents the correlations of the THI results with the health problems described by the participants (n = 52). We separated the participants into two groups: The first was composed of 37 participants with normal hearing (71%), and the second included 6 participants (12%) with a bilateral high-frequency notch. Twenty-two percent of the noise-exposed participants complained of tinnitus, a finding comparable to rates of 25% reported by Sahley and Nodar [14] and 15.5% reported by Zimmermann [15]. Seventy-one percent of the participants with tinnitus complaints presented normal audiometric results, which suggests that tinnitus can be an early indicator of auditory risk from exposure to noise.
The application of the Brazilian version of the THI was both easy and expedient, as indicated by Newman et al. In Table 2, we found significant results involving the functional scale results with the use of prescription drugs and the catastrophic scale results with consumption of coffee. Concerning the degree of severity of tinnitus, 44% presented degree 1 or "slight" tinnitus according to the classification by McCombe et al. We observed a significant correlation between tinnitus severity and exposure to noise and chemical pollutants, predominantly CO. We observed a significant correlation between the duration of noise exposure and the emotional scale for the participants with high-frequency notches, suggesting an extra-auditory effect of noise. The results of this study demonstrated that the prevalence of tinnitus was high (22%) in this population, despite the fact that study participants were young individuals who had a short duration of noise exposure. The Brazilian version of the THI proved to be an easy instrument to use for evaluating the impact of tinnitus on the quality of life of noise-exposed workers. INTRODUCTION: Gestational malaria is related to very bad perinatal outcomes and antimalarial drugs used during pregnancy can be ototoxic to the fetus.
OBJECTIVE: To determine the prevalence of hearing loss in newborns of mothers who had malaria and treated with antimalarial drugs during pregnancy. CONCLUSION: The prevalence of hearing loss in newborns of mothers who had vivax malaria and used chloroquine during pregnancy was 3%. Hearing is one of the noblest of senses since its main function is related to the acquisition and development of oral language1,2.
Hearing impairment is considered to be highly disabling due to its consequences on human communication, as well as its impact on cognitive and psychosocial development and the development of oral and written language6.
The occurrence of malaria during pregnancy, particularly in the last trimester, can be determinant for infant health, with implications for fetal or neonatal development. In Brazil, the occurrence of malaria during pregnancy is common in endemic areas such as the states of Roraima, Rondonia, Para, Mato Grosso, Acre, and Amazonas11. In the municipality of Porto Velho (RO) malaria in pregnancy has been shown to be related to poor perinatal outcomes such as preterm birth, extremely low, very low and low birth weight, and death13.
In another study, 12 children born to mothers who had been treated with antimalarial drugs during pregnancy had sensorineural hearing loss.
In view of the above considerations, the objective of the present study was to verify the prevalence of hearing loss in newborns of mothers who had malaria and treated with antimalarial drugs during pregnancy and to characterize the audiologic findings according to newborn gestational age, birth weight, risk factors for hearing loss, type of malaria infection, type of medication used, and gestational period of malaria occurrence and drug treatment.
A cross-sectional, quantitative, descriptive-analytical, observational study was conducted using a multifactorial approach.
The number of women with malaria during pregnancy, who were admitted to the hospital during the period of data collection, was taken as the basis for sample size calculation.
The study flow chart contains data regarding infant gender, date of birth, type of malaria infection, gestational period of infection, type of medications used, and presence of risk factors for hearing loss established by the Joint Committee on Infant Hearing (JCIH)16 and by the Multiprofessional Committee on Auditory Health (Comite Multiprofissional em Saude Auditiva - COMUSA)17. The puerperal women were contacted by the researcher while still in the maternity ward in order to investigate the occurrence of malaria during pregnancy. After signing the informed consent, the interview was conducted with the puerperal participants. The tests were performed in a quiet room in the presence of the mother or an accompanying person. The step of diagnostic evaluation was performed at the clinic responsible for the NHS program after hospital discharge. After this procedure, the diagnostic ABR test was performed to quantify and identify hearing impairment. Newborns who have had the electrophysiological threshold for tone bursts at 2000 Hz with bilateral 30 dBHL were considered patients with normal hearing and remained in auditory monitoring the NHS program up to 24 months. For data analysis, the distribution of the occurrence of the type of infection and of the gestational period when malaria occurred was first determined, followed by the determination of the distribution of the type of antimalarial medication used for treatment and the gestational period during which the medication was administered, using the test for equality of two proportions. As for the risk factors for hearing loss found in association with the occurrence of malaria and the use of antimalarial drugs in pregnancy, the use of ototoxic medication by the newborn was the most frequent risk factor and this finding was significant when compared to the other risk factors, except for extracorporeal oxygenation (Table 4). No relationship was observed between the NHS result and type of medication, risk factors for hearing loss, gestational period of infection, use of medication, or type of malaria infection (Table 5). The prevalence of hearing loss in our sample was 3% (n = 1), taking into account that two newborns did not undergo the audiological diagnosis.
In the present study, Plasmodium vivax was the most frequent species found in women during pregnancy, as also reported in other studies10,13,19-21. The antimalarial drug most frequently used was chloroquine as recommended by the Brazilian Ministry of Health for the treatment of vivax malaria in pregnancy25. In a study conducted in Porto Velho (RO) on 66 newborns of mothers who used antimalarial drugs during pregnancy, three infants were born to mothers who were treated with primaquine and one was diagnosed with unilateral profound hearing loss21. As for the gestational period during which the antimalarial drug was used, no difference was observed between trimesters. In the present study, the number of "pass" results in NHS was higher than the number of "failed" results, in agreement with other studies conducted in the same municipality14,21. Two of the four newborns who failed the screening test and who were referred to the clinic responsible for the program for diagnostic evaluation did not attend the assessment. The socioeconomic conditions of the families who participate in the NHS program and the lack of knowledge of the consequences of hearing loss are some factors that could explain the evasion in the population studied, considering that the results of the study showed a low educational level of the women who mainly had incomplete elementary school. No relationship was found between the NHS results and the variables weight at birth and gestational age, despite having knowledge that gestational malaria is related to very bad perinatal outcomes, including low birth weight13 which could have enhanced the occurrence of hearing loss in newborns. The most frequent risk factor for hearing loss associated with malaria and antimalarial drug use in pregnancy was the use of ototoxic medication by the newborn, in agreement with other studies21,34. Urinary tract infection is common among young women and is the most frequent complication during pregnancy30, especially among primiparous women35.
The high level of bilirubin requiring blood transfusion was a risk factor for hearing loss in the infant diagnosed in the present study. Elevated serum levels of bilirubin are considered toxic to the auditory pathways and central nervous system39. Hyperbilirubinemia is one of the risk factors for neonatal deafness and for the development of encephalopathies39, since high levels of bilirubin can damage the auditory system at the peripheral level by altering cochlear hair cells and at the central level in the cochlear, olivary and inferior olivary nuclei41. In addition to blood transfusion, the infant was exposed to ototoxic medication (gentamicin) which can cause different degrees of damage, with cochlear hair cells damage being typical42.
The prevalence of hearing loss obtained in this study was more than evident in research conducted at the same hospital5, and the value obtained could have been higher, since two newborns did not undergo the audiological diagnosis. In addition, it highlights the need for audiological follow these children in order to evaluate the occurrence of possible progressive alterations as demonstrated in another study which found 12 cases of hearing loss in children born to mothers who had malaria and used antimalarial drugs in pregnancy15.
The main limitation of the present study, which is common in studies involving populations recruited from NHS programs, is failure to attend a visit for diagnostic evaluation. The prevalence of hearing loss in newborns of mothers who had malaria and treated with antimalarial drugs during pregnancy was 3% (n = 1), the mothers' newborn diagnosed infected with Plasmodium vivax in the first trimester and treated with chloroquine throughout pregnancy. In addition, it was observed that there is no relationship between the NHS findings with the variables weight of the newborn at birth, gestational age, type of medication, IRDA, pregnancy infection, medication use and infection type. Paper submitted to the ITJ-SGP (Publishing Management System) on September 24, 2014; and accepted on July 6, 2015. Tinnitus disturbs lives and negatively affects the quality of life of about 2% of the adult world population.
AcknowledgmentsThis study was made possible by the Charite - Universitatsmedizin Berlin Research Funds. Pure tone audiogram measured on the left and right ear of the male and female tinnitus patients with hearing loss in the upper frequency range.
Tinnitus frequency (A) and tinnitus loudness (B) measured in the right and left ear of the male and female tinnitus patients with hearing loss. Hearing loss measured in the right and left ears of patients with compensated and decompensated tinnitus. Total TQ scores (A) and scores of the subscale “somatic complaints” (B) measured in patients with left-side, right-side or bilateral tinnitus. Rieger syndrome is a dysembryogenetic disease in which labyrinthic damage can be associated with other genetic anomalies.
Dysembryogenetic labyrinthopathies are either congenital (already present at birth) or occur subsequently in the course of years. Lyndsay [1] subdivided the structural alterations of the inner ear on the basis of the period of embryogenesis in which they appear. Another classification of the congenital malformations of the inner ear arises from the radiological image of the bony malformations of the labyrinthic capsule. However, these nosologic criteria of the labyrinthic disembryopathies do not always correspond to the semeiological and clinical points of view.
Rieger syndrome is one of these clinical forms in which labyrinthic damage can be associated with other genetic anomalies, among the most important of which are ocular alterations. Rieger syndrome is an autosomal dominant condition associated with mutations in the PITX2 gene at chromosomes 4q25-4q26-13q14 [17-21], in the PAX6 gene at chromosome 11 [22], and in the FKHL7 gene at chromosome 6p25 [23]. Computed tomography (CT) scanning of the temporal bone disclosed a bilateral dysmorphism of the inner acoustic channels, whereas the bony structures of the labyrinthic capsule appeared to be normal (Fig.
The patient does not present any malformation of the craniofacial structures (prognathism, hypodontia), of the periumbilical skin, or of the skeletal bones.
Most authors agree that the typical features of Rieger syndrome involve morphogenetic anomalies of the anterior chamber of the eye, the craniofacial bones, the incisors, and the periumbilical skin.
Clinical data do not prove the presence of congenital anomalies of other organs and systems. Today, no genetic interpretation accounts for the involvement of cochlear function in the chromosomal anomaly responsible for the Axenfeld-Rieger syndrome.
Classic stigmata of congenital syphilis SNHL, interstitial keratitis, Hutchinson teeth (notched incisors), mulberry molars, Clutton joints (bilateral painless knee effusions), nasal septal perforation & saddle deformity& frontal bossing. The Occupational Safety and Health Administration (OSHA)2 and the National Institute for Occupational Safety and Health (NIOSH)3 regulate permissible noise exposure levels for workers in order to reduce these harmful effects. Forestry workers may have noise exposure originating from the use of heavy equipment, power saws, and other devices.
Forestry and wildlife management students participate in hunting, target shooting, agriculture, and other practices with potentially harmful noise levels that entail greater noise exposure than other disciplines. College students also may have music exposure from attending concerts, using portable listening devices (PLDs), and frequenting establishments such as bars and nightclubs.
The primary purpose of the present study was to examine noise exposure and hearing health choices of students taking forestry and wildlife management courses. During a fall semester at West Virginia University (WVU), noise exposure and perceptions of hearing health were assessed through a survey of 344 college students in forestry (FOR) and wildlife management (WMAN) courses. Participants were asked to complete a researcher-generated questionnaire containing questions related to listening habits, self-perceptions, knowledge, attitudes, and beliefs about hearing loss, hearing health, noise exposure, and hearing conservation (see Appendix A). In addition, students were asked about self-perceptions of hearing loss and tinnitus, as well as their education regarding the importance of hearing health, hearing preservation, importance of wearing hearing protection in potentially hazardous levels of noise, and, if applicable, when the education occurred. Parent education level and parental household income were factors used to provide an indication of the students’ socio-economic status. Students’ self-perception of their hearing status was addressed by asking students if they had noticed a change (decrease) in their hearing after participating in any of the 15 activities.


Most forestry and wildlife management students in this study are young adult male Caucasians with normal BMI.
In instances where potentially hazardous noise levels are likely to be reached, the majority of students indicated that they did not wear hearing protection.
Although most of the surveyed students reported some previous education in high school, junior high school, or elementary school on the importance of hearing health, hearing preservation, and wearing HPDs in potentially hazardous levels of noise, very few report education in college.
Additionally, annual audiometric evaluations of students to monitor changes in hearing should be encouraged throughout their course of study.
Exploration of ways to reduce potential risks to hearing, such as decreasing exposure time and implementing environmental modifications rather than solely relying on HPD use, also should be encouraged.
Promotion of NIHL prevention programs, along with recommendations for annual audiometric evaluations, safe listening habits, and appropriate use of hearing protection, may reduce the risk of NIHL in forestry and wildlife management students. It is intended to provide a broad and general overview of a medical topic that is frequently considered in Tribunal appeals. Each author is asked to present a balanced view of the current medical knowledge on the topic. A vice-chair or panel may consider and rely on the medical information provided in the discussion paper, but the Tribunal is not bound by an opinion expressed in a discussion paper in any particular case. This is the type of hearing loss that is found in routine unprotected daily exposure to loud noise potentially injurious to hearing in the occupational work force. This type of loss might be found in an individual, for example, with a large tympanic membrane (TM) perforation where mechanical vibrations along the ossicular chain are dampened.
For example an individual with a large TM perforation who received topical antibiotic ear drops for the treatment of a middle ear infection that caused inadvertent toxicity to the inner ear in addition (i.e. The hearing loss may range from mild to profound, may result in tinnitus (unwanted head noise) and is cumulative over a lifetimea€?. Noise induced deafness generally affects hearing between 3000-6000 Hz with maximal injury centering around 4000 Hz initially, an important point to remember. There is good pathologic evidence however that demonstrates maximal cochlear hair cell loss in the tonal areas where the 4000 Hz hair cells normally reside in both animals and humans. In susceptible individuals the early effects of presbycusis are occasionally seen around age 40. Secondary to hair cell loss one can often see progressive neuronal dropout along the cochlear nerve.
In this regard the effects of aging in the absence of other factors cause a loss of hearing at all frequencies whose rate of growth becomes more rapid as age increased (especially after 60 years): an important point to remember in this context. To a large degree hearing loss with age is genetically primed; in other words the hearing your parents had as they aged is often passed on to you. When the two processes are combined the resultant pathology and its effects upon hearing are not as well understood.
This certainly generates a more complicated mathematical model but probably more closely approaches what is happening physiologically.
The hearing loss is typically a low-frequency sensorineural loss that fluctuates initially often reverting close to normal between attacks in the early stages. The presence of a pink-flamingo hue to the middle ear on otoscopy (so-called Schwartzea€™s sign), absent stapedial reflexes on audiometry and bone density changes involving the surrounding bone of the inner ear best appreciated on high-resolution CT scanning also helps in the diagnosis. Most patients suffering deafness by this mechanism will have had at least transient unconsciousness and have been admitted to hospital.
A fracture through this bone (which is the hardest bone in the body) implies the force of the injury was severe and often incompatible with survival.
Unfortunately these antibiotics can cause varying degrees of cochlear, vestibular and renal toxicity. The Auditory Brainstem Response (ABR) is used as a screening test while a gadolinium enhanced Magnetic Resonance Imaging (MRI) study is the gold standard investigation. The extent of the loss varies from a partial loss at one frequency right up to a profound loss at all frequencies with a profound discrimination loss. For the purposes of compensation, the most reliable audiograms will likely be performed by an audiologist who typically has a mastersa€™ degree or doctorate in audiology. The audiometer used to test hearing has been especially calibrated so that each frequency of sound tested for hearing has been normalized where 0 dB represents the lowest intensity of sound that the majority of people with normal hearing can hear from large population studies. When a conductive hearing loss is suspected the ear canal and inner ear mechanisms for transmission of sound energy to the inner ear are bypassed by placing a bone vibrator over the mastoid which directly stimulates the inner ear. A weighted pure tone average from frequencies at 500, 1000, 2000 and 3000 Hz is required for this determination from AC thresholds if a pure sensorineural hearing loss is present or from BC thresholds if any conductive element to hearing loss is present.
As a general rule the SRT value should roughly equal the pure tone average in the speech frequencies at 500, 1000 and 2000 Hz.
Most individuals with normal sensorineural hearing should get over 80% of the words correct at this level. Most individuals with normal sensorineural hearing will exhibit a reflex at 70-80 dB above their hearing threshold level at the frequency being tested.
When reflexes occur at less than a difference than 70-80 dB above hearing threshold at the frequency tested this is indirect evidence of a phenomenon called recruitment which is usually seen in cochlear pathology (i.e. ECoGa€™s chief value lies in its ability to demonstrate wave 1 of the auditory brainstem response (ABR) and whether waveform morphology is suggestive of changes thought to occur in endolymphatic hydrops, the pathophysiologic substrate of MeniA?rea€™s disease. This test measures electrical waveforms obtained in the first 10 msec from cochlear stimulation.
Middle ear pressures should be normal, stapedial reflexes present and a normal tympanogram noted. In some instances it can be quite disabling for the affected individual who tends to withdraw from any exposure to uncomfortable noise. Cognitive behavioural therapy (CBT) has also demonstrated promise in a recent randomized controlled study. The Relative Contributions of Occupational Noise and Aging in Individual Cases of Hearing Loss. Specialized treatment based on cognitive behavior therapy versus usual care for tinnitus: a randomized controlled trial. Diabetes and hearing impairment in the United States: Audiometric evidence from the National Health and Nutrition Examination Survey (1999-2004). The pathology is thought to arise from excess fluid in the inner ear leading to membrane ruptures (so-called endolymphatic hydrops).
Certain antibiotics (especially the aminoglycoside class), antimalarials, chemotherapeutic agents and even excessive doses of ASA can be toxic to the inner ear. Although changes may take place as early as age 40, hearing loss due to aging usually starts to accelerate around ages 55-60 yrs and continues with age.
Auditory Brainstem Response (ABR) - Synonymous with the term BERA (brainstem evoked response audiometry) or auditory BEPa€™s (brainstem evoked potentials). Cortical Evoked Response Audiometry - Synonymous with Threshold Evoked Potential (TEP) testing.
Depending on the frequency of the sound certain parts of the cochlea will emit an a€?echoa€? in response.
This occurs to a loud noise typically 70-80 dB above an individuala€™s hearing level at the frequency tested which causes stiffness of the ossicular chain and tympanic membrane Absent stapedial reflexes are usually seen in otosclerosis due to stapes footplate fixation for example. Conceptually it has three distinct anatomical components which include the external, middle and inner ear. The auricle is a flattened, funnel shaped appendage that contains a cartilage framework covered by skin. The anatomy favours the transmission of sound waves typically between 500-8,000 Hz which interestingly represents the common speech frequencies of most individuals. Proper function of the Eustachian tube which connects the middle ear cavity to the back of the nose (nasopharynx) is important for the normal middle ear aeration and function. The tympanic membrane or ear drum is an ovoid, pale gray, semi-transparent membrane positioned obliquely at the medial end of the ear canal. The tensor tympani and stapes muscles help stabilize the bones along with suspensory ligaments of connective tissue inside the middle ear. Covered by an otic capsule its membranous portion (or labyrinth) contains a delicate system of fluid-filled canals lined with sensory neuroepithelium necessary for hearing and balance perception.
It is a three chambered organ containing anatomical spaces known as the scala media, scala vestibuli and scala tympani. The scala vestibuli and scala tympani (T) by comparison contain fluid rich in sodium called perilymph.
Within each semicircular canal is an area called the ampulla which contains hair cells sensitive to low frequency bidirectional fluid displacement that occurs with angular acceleration type movements of the head. The sound vibrations are then transmitted across the air-filled middle ear space by the 3 tiny linked bones of the ossciular chain: the malleus, incus and stapes . The hair cells change these mechanical vibrations from the waves into electrochemical impulses that can interpreted by the central nervous system (CNS). It can be a simple sound commonly known as a pure tone or it may be complex when we think of speech, music and noise.
The prediction of a handicap did not appear to be improved by the inclusion of other frequencies > 4000 Hz.
What do other jurisdictions consider to be disabling hearing loss (provincial, national and international)? The hearing loss that remains after the presbycusis adjustment is then used to determine entitlement to benefits. It is generally thought that if an ear has suffered a permanent threshold shift from a noise induce etiology further noise exposure will cause less damage than would occur in a normal ear to a similar exposure. As previously noted the effects of noise exposure and aging on hearing when not combined are reasonably well understood. One however has to qualify this by saying that there is a significant amount of redundancy within the inner ear as it pertains to hearing. Moreover we really dona€™t have a lot of good prospective longterm studies over 4-5 decades that can ultimately answer this question completely.
Can moderate workplace noise exposure causing a TTS and repeated exposures later cause a PTS?
Repeated noise exposure that causes a temporal threshold shift (TTS) can ultimately lead to a permanent threshold shift (PTS) with repeated exposures.
Some of this is based on the redundancy principle within the inner ear: not all hairs cells possibly recover following a TTS but enough do as to prevent hearing loss. Following acute acoustic trauma what is the natural history of the subsequent hearing loss? Audiometric evaluations were performed on these individuals at 6 months, 1, 2 and 4 years after initial exposure. In his study cohort only 1% of individuals following acute acoustic trauma demonstrated deterioration of hearing of more than 20 dB in at least 1 frequency. Noise measurements, a questionnaire, a Brazilian version of the Tinnitus Handicap Inventory (THI), and pure-tone audiometry were conducted with 52 participants (mean age, 29 years) who suffered from tinnitus. Among the risk factors for tinnitus, the most prominent are age, gender, various diseases (otological, metabolic, neurological, and vascular alterations and dental factors), hearing loss, and exposure to noise, ototoxic drugs, caffeine, nicotine, and alcohol [1-4]. Tinnitus can alter an individual's ability to function in professional, social, and leisure activities and in family relationships, hence affecting the quality of life [5,6].
In addition to being beneficial for clinical applications, the tinnitus questionnaires are valuable for understanding the relationship between personality and the psychopathology of tinnitus, its impact on the daily life of persons who suffer from tinnitus, the difficulties and the perception of social support in relation to the problem, and the incapacities and the difficulties produced by tinnitus that can seriously affect quality of life [7-9].
Occupational hearing loss prevention initiatives rarely focus on the prevention and management of tinnitus. The company employs 372 workers (120 female, 252 male) working in two fixed 8-hour and 48-minute shifts. The questionnaire gathered information on demographics and occupational and medical histories for each worker. We also used Spearman's rank correlations to examine the results of exposure information versus the outcome. Because of attrition, we were able to study only 52 workers (14% of total population of the plant).
Of those, 62% were exposed to carbon monoxide (CO), 13% to CO and vibration, 12% to hydrochloric acid, and 13% to sodium hydroxide. We observed that of the 52 participants, 71% had normal audiometric results, whereas 12% presented a bilateral high-frequency notch and 17% presented audiometric configurations of hearing loss due to causes other than noise, such as unilateral losses and flat audiometric configuration.
Median of hearing thresholds for the groups with normal hearing (all thresholds 25 dB hearing level [HL]), hearing loss configurations suggestive of noise-induced hearing loss (NIHL), and hearing loss from various causes. The distribution of poorest scores across scales of the Tinnitus Handicap Inventory, in percent (n = 52). We observed a significant correlation between headaches (p = .0458) and the duration of tinnitus. We did not include the remaining 9 individuals (17%), who displayed other audiometric configurations of hearing loss in the statistical analysis. The prevalence of tinnitus complaints in male subjects was 16% and in female subjects was 9%, similar to what has been reported [16-18]. Schleuning [2] explained that caffeine and nicotine could aggravate tinnitus because they are stimulants and can induce the constriction of blood vessels. The participants of the study who had such combined exposure had a higher degree of tinnitus severity.
Moreover, a negative impact of tinnitus on the subjects' quality of life could de detected.
The 22% tinnitus rate among workers, most of whom nonetheless had normal hearing, suggests a need to address tinnitus in occupational hearing loss prevention initiatives. Rick Davis and Robert Randolph (National Institute for Occupational Safety and Health, USA) and Alberto Behar (University of Toronto, Canada) provided helpful critiques of the manuscript. Prevalence of hearing loss in newborns of mothers who had malaria and were treated with antimalaric drugs in pregnancy. All underwent neonatal hearing screening with otoacoustic emissions combined with automatic auditory brainstem response.
Auditory sensory deprivation interferes with the ability to interpret speech sounds and results in economic and educational disadvantages2. The malaria parasites can easily cross the placental barrier or are transmitted through maternal-fetal transfusion9. The latest survey regarding the proportion of positive slides in pregnant women from the municipality of Porto Velho, Rondonia (RO), was performed in 2010 and revealed 331 cases of malaria in rural and urban areas, including 48 cases caused by P.
In a study conducted in the same municipality, two newborns of mothers who had malaria and used antimalarial drugs in pregnancy were diagnosed with mild unilateral sensorineural hearing loss14.
This hearing loss was irreversible in eight of these children, with seven presenting profound hearing loss. All puerperal women received information about the objectives and methodology of the study and agreed to the procedures by signing the free informed consent form. Transient otoacoustic emissions (TOAE) and automated auditory brainstem responses (AABR) were measured with an Accuscreen instrument (Madsen). The results obtained during hearing screening and diagnostic evaluation were recorded on the study flow chart. Women who confirmed the presence of the disease were invited to participate in the study and received information about the objective and importance of the study and the procedures used. When necessary, the records of the women and their newborns were accessed to complement the information if the mother could not answer the question or was in doubt. For electrophysiological assessment of hearing, the infants remained lying in the crib or on the mother's lap during natural non-sedated sleep. For this test, a probe microphone with a latex bulb was introduced into the external auditory canal of the newborn and emissions were evoked with a broadband click at an intensity of 80 dB SPL. For this test, the skin in the areas of electrode placement (high forehead and mastoids) was cleaned to permit adequate impedance. Diagnostic evaluation consisted of tympanometry, diagnostic TOAE, diagnostic ABR, and an appointment with the otorhinolaryngologist.
The NHS results were correlated with birth weight and gestational age by analysis of variance (ANOVA). Two of the four infants that failed the NHS and that were referred to the clinic responsible for the program for further tests abandoned the program.
The audiologic findings of this newborn included the bilateral presence of TOAE; absence of waves I, III and V at 90 dB in the click ABR test accompanied by the presence of cochlear microphonism, and tympanometry revealed normal mobility of the tympano-ossicular system. In addition to the fact that the mother had malaria and made use of antimalarial drugs during pregnancy, the newborn was exposed to ototoxic medication (gentamicin) for 9 days and required exchange transfusion due to hyperbilirubinemia. This finding was statistically significant when compared to the occurrence of the disease in the third trimester.
The use of primaquine is contraindicated for the treatment of pregnant women, irrespective of the Plasmodium species involved and gestational period, and during the breast-feeding period until 6 months25. This infant had no associated risk factor for hearing loss, suggesting that the medication administered possibly caused or potentiated the occurrence of hearing impairment.
However, the frequency of antimalarial drug use was higher in the second trimester, although the frequency of malaria occurrence was higher in the first trimester of gestation.
Despite an attempt to perform an active search, as routinely done, the mothers could not be contacted by telephone. The infant can be infected at the time of delivery, through hematogenic dissemination, or postpartum36. Neonatal hyperbilirubinemia is toxic to the auditory pathways and central nervous system29 and newborns submitted to exchange transfusion are considered to be at high risk for the development of auditory neuropathy38. In the latter, the yellow color is more intense in the subthalamic nucleus and globus pallidus and may be present in the hippocampus, geniculate bodies, vestibular, cochlear and oculomotor nuclei, cerebellum and spinal cord40. Other studies have demonstrated a close relationship between hearing impairment and hyperbilirubinemia5,39,40. A close relationship between hearing impairment and use of ototoxic medication has been reported for newborns30,43,44.
The chance of these newborns have hearing loss is high, since the NHS was performed with use of combined technical (OAE and AABR), which reduces the chance of false positives.
Active search was necessary in various cases of the present sample, but contacting the participants was unsuccessful in two cases. Audiological findings highlighted in this newborn indicate the presence of alteration in retrocochlear auditory pathways that are compatible with the auditory neuropathy spectrum.
The IRDA, concomitant with malaria and the use of antimalarial drugs during pregnancy, most common was the use of ototoxic medication by the newborn, but hyperbilirubinemia with exchange transfusion was one of the risk indicators found in newborns diagnosed with hearing loss.
The authors thank Nina Zirke and Theresa Morgenstern for collecting the data.ReferencesJastreboff, PJ.
The case presented here is of a patient who has bilateral dysgenesis of the iris, with bulbar atrophy and dyscoria.
Various classifications of these clinical forms have been proposed, but none is free from criticism. On one hand, these are the bony anomalies limited to the anterior labyrinth that, in some cases, can also be absent, although the bony structures of the posterior labyrinth appear normal or slightly altered; on the other hand, the malformations of the inner ear center on the posterior bony labyrinth, although the anterior one appears normal [2]. In fact, the results of the otoneurological tests do not always reflect correctly the functional deficit of the labyrinthic district altered by the damage. The hereditary origin of this syndrome, known since the last century (1983), was recognized by Rieger [3] in 1935.
This nosologic definition does not change if, in some cases, other dysmorphogenetic alterations are associated with the main signs, rendering multiform the original features of the disease. Instead, a sensorineural hearing loss is present, which started in the left ear at age 23 and progressively worsened. Nevertheless, the presence of a bilateral cochleopathy in a patient suffering from the AxenfeldRieger syndrome could be the expression of a genetic "disorder" that, as often occurs, is not limited to a specific mal formative alteration but produces a variety of anomalies as expressions of more extensive chromosomal damage. Skeletal findings osteochondritis& periostitis of long bones SNHL, interstitial keratitis, Hutchinson teeth (notched incisors), mulberry molars, Clutton joints (bilateral painless knee effusions), nasal septal perforation & saddle deformity& frontal bossing. Noise-induced hearing loss (NIHL), tinnitus (ringing or buzzing in the ears), hyperacusis (loudness intolerance), diplacusis (difficulty in pitch perception), and other changes in auditory function can be caused from high-intensity sound exposure during occupational or recreational activities. For example, a recent study of college students revealed that 64% experience temporary threshold shifts, 73% have perceived tinnitus, and 69% indicate having ear pain after noise exposure.15 Of the students surveyed, few admitted using HPDs for most recreational activities, with the exception of using firearms, in which the majority (65%) did use hearing protection. This study also examined student participation in different types of activities with potentially hazardous noise levels, the frequency of HPD use for these activities, their perception of changes in hearing following these activities, and their reasoning behind HPD nonuse.
All procedures are on file with the WVU Institutional Review Board for the Protection of Human Subjects (IRB). The BMI classification was used to view body mass as a factor relating to hearing health habits. Students’ noticed decrease in hearing after participating in “noisy” recreational activities. The most frequent activity in which a change was reported was after attending concerts (61.8%), as shown in Figure 3. The most frequently reported reason for HPD nonuse (Table 2) was that students felt that HPDs were “not needed” (33.4%). Self-perceptions of hearing along with the perceived presence of tinnitus and level of personal listening device volume were addressed by asking students to provide a rating for statements (eg,“When you are listening to your iPod or MP3 player headphones, other people can hear the music”) using a five-point Lickert scale. Forestry and wildlife management students’ responses to the statement “When you are listening to your iPod or MP3 player headphones, other people can hear the music. Forestry and wildlife management students’ previous education in hearing health, hearing preservation, and importance of wearing HPDs.
Education about hearing health, hearing preservation, and importance of wearing HPDs in potentially hazardous levels of noise also were addressed, with the majority (76.0%) of respondents reporting some previous education. Over half of the students report being raised by college-educated caregivers in households with reported incomes of more than $51,000. Most students reported PLD use, with nearly 20% agreeing that other people can hear the music when they are listening through their PLD headphones.
The exception is target shooting, in which case the majority of students who participated in this activity did wear HPDs.
The infrequent use of HPDs during many of the recreational activities in this study may put these young adults at risk for permanent damage to their hearing, as well as other auditory problems including tinnitus, hyperacusis, and diplacusis. Moreover, despite their reported hearing health education, hearing protection use and concern about hearing loss and tinnitus remain low among student respondents. The dilemma is how to reach this population through effective hearing conservation programs before occupational and recreational noise exposures begin to diminish hearing acuity.
These measures would provide specific recommendations for limitations in the type and duration of noise exposure along with providing determination of when hearing protection is needed. If declines in hearing are noted on annual audiometric evaluations, students may be more likely to incorporate recommendations to prevent excessive noise exposure. Occupational NIHL and presbycusis (degenerative hearing from aging change) represent the two most common causes of sensorineural hearing loss in society today.
For this reason workers ideally should be out of noise for at least 24 hours if not 48 hours prior to audiometric testing to avoid the effects of TTS on hearing. Noise exposure from chipping machines and jackhammers characteristically damage the higher frequencies severely before affecting the lower frequencies. Nevertheless some individuals exposed to noise not infrequently demonstrate some asymmetry to their hearing loss. The majority of changes histopathologically are noted in the basal turn of the cochlea where the high frequency hair cells and their corresponding cochlear nerve neurons are found. When the distended membranes rupture the resulting admixture of inner (endolymph) and outer (perilymph) fluids causes electrolyte disturbances (i.e. When the foci primarily affect the cochlea the patient may present with a chronic progressive sensorineural hearing loss in one or both ears.
As otosclerosis is a lifelong condition, the sensorineural hearing loss from cochlear otosclerosis is often superimposed on hearing loss from advancing age (i.e. The hearing loss noted is usually conductive and usually arises from discontinuity of the ossicular chain although any combination of conductive and sensorineural hearing loss can occur. If the individual survives there is usually complete loss of hearing and vestibular function on the involved side.
Persistence of a conductive loss after the TM has healed would suggest continued problems with the ossicular chain. Careful and regular monitoring of auditory function (especially in the ultra high frequencies > 8000 Hz) and serum antibiotic levels may help the physician predict when ototoxic effects are occurring. Pressure on or devascularization of the acoustic nerve or inner ear causes hearing loss, usually a high-frequency loss with reduced speech discrimination.
Patients can sometimes identify the moment of occurrence or wake with it or appreciate it only when they go to use the phone. If there is a significant discrepancy this could imply an exaggerated hearing loss is present as well. When speech discrimination scores are especially poor this implies that there may be a lesion involving the cochlear nerve (i.e. In general terms if the Eustachian tube is functioning normally pressure on both sides of the ear drum should be similar (i.e. Waveform morphology is thought to arise from the cochlear nerve and the various relay stations in the brainstem the electrical response has to travel through.
The test is often indicated in an individual if there are concerns regarding an exaggerated hearing loss. Tinnitus maskers are noise generators worn like a hearing aid that produces a sound of similar frequency to an individuala€™s tinnitus. The problem with tinnitus however is that it is difficult to quantify objectivity and to fully appreciate how it affects an individuala€™s well-being.
This test measure electrical activity along the cochlear nerve and at the various relay stations in the brainstem between 1-10 msec of stimulation.
This test looks at electrical waveforms in the cortical areas of the brain between 50-200 msec after cochlear stimulation. In humans the auricle has rudimentary functions for gathering sounds and in sound localization which is much more important in animals. The first part of the ear canal is cartilaginous and is lined by thick, hair bearing skin that contains numerous sebaceous and ceruminous glands. Malfunction of the Eustachian tube remains the leading cause for most middle ear disorders. The air cell system is typically underdeveloped or even absent (sclerotic) in individuals with a past history of recurrent ear disease. It is a three layered structure whose outer epithelial layer is contiguous with the skin of the external auditory canal, its middle layer is fibrous and its inner layer is composed of the same mucosal lining found throughout the middle ear cleft. Clinically the malleus is attached by its handle to the tympanic membrane and is readily visible in most individuals on otoscopic examination. The separate but intimately related perilymphatic and endolymphatic compartments of the inner ear and their ionic constituents are efficiently controlled by the stria vascularis of the cochlea and the dark cells of the vestibular apparatus.
This ionic difference between these chambers forms the basis of the endocochlear electrical potential which is necessary for the conversion of mechanical activity from fluid movement within the cochlea to electrical activity arising from the hair cells. The hair cells of the otolithic endorgans (utricle and saccule) are covered by otoliths ( literally a€?little stonesa€? or crystals of calcium carbonate ). The mechanical vibrations are transmitted to the inner ear via the vibrations of the stapes footplate. The tiny cilia (little hairs) on top of the hair cells (both inner and outer) are covered by a gelatinous membrane called the tectorial membrane. This apparent internal a€?feedback loopa€? is thought to be responsible for a€?fine tuninga€? by inhibiting some unwanted electrical impulses and by changing the mechanical properties of the basilar and tectorial membranes. Distortion of certain sounds arises when enough hair cells are damaged such that the hearing threshold is reduced.
A cycle of a pure tone is represented by a sine wave appearance with an area of compression followed by rarefaction. Low sounds tend to have a long wavelength relative to higher pitched sounds which have shorter wavelengths by comparison.
Entitlement to health care and rehabilitation benefits is available when the adjusted hearing loss is at least 22.5 dB in each ear. When the two processes are combined, the resultant pathology and its effects upon aging are not as well understood.
In other words many hair cells in a similar region of the cochlea will produce a certain frequency response to sound stimulation. Upon saying this however we can actually demonstrate that many individuals will start to show early changes in hearing as early as age 40 years (in subjects screened to rule out other ear disease and noise exposure).
It is agreed that hearing loss and injury to the ear increases with the noise level, the duration of exposure, the number of exposures and the susceptibility of the individual.
The findings also indicate that the late progression of hearing loss following a single episode of acute acoustic trauma did not exist. THI results indicated that tinnitus had the greatest influence in the functional scale (54%). We used the overall result to identify the degree of severity of tinnitus for each individual and for completing an analysis of the total scores by scales. Of all noise-exposed female workers in the plant, 11 (9%) reported having experienced tinnitus, and 41 (16%) of the noise-exposed male workers reported the condition. Spearman's rank correlation coefficient results indicated a significant correlation between noise levels and how often workers experience tinnitus (p = .01). We also observed a significant correlation between the duration of noise and the functional scale (p = .039).
It is important to notice that the average age of the population of our study (29.2 years) is younger than in other studies, which reported results from groups whose mean ages varied from 40 to 50 years and who had a short duration of noise exposure (average, 7 years)[18-21] . According to that author, doctors believe that 50% of patients with complaints of tinnitus improve significantly when they stop smoking or reduce caffeine intake. In recent decades, studies have demonstrated that simultaneous chronic exposure to CO and noise represents a potential risk to hearing, but reports of tinnitus exist only for cases of intense poisoning from CO [24].
This supports the inclusion of tinnitus prevention initiatives alongside workplace hearing loss prevention initiatives because of shared causal factors.
Information on tinnitus prevention and treatment could have a measurable, positive impact on a person's quality of life. The authors thank all those who participated in the study for their time, interest, and cooperation. Guidelines for the grading of tinnitus severity: The results of a working group commissioned by the British Association of Otolaryngologists. Those who failed were referred to audiological diagnosis with evoked otoacoustic emissions and brainstem auditory evoked potential associated with tympanometry (1000 Hz). Furthermore, hearing is essential for interpersonal relationships and relationships with the environment2. Any type of hearing loss can compromise language, learning, cognitive development and social inclusion of the child7, and it is therefore important that hearing impairment is detected as early as possible. A study demonstrated that pregnant women infected with Plasmodium falciparum present clinical and laboratory alterations, such as altered hemoglobin, hematocrit, creatinine, urea, bilirubin, and glucose.
The treatment indicated for the mothers was chloroquine, chloroquine combined with quinine, and quinine combined with Fansidar.
The study was conducted at the maternity unit of a referral hospital for high-risk pregnancies in the capital of Rondonia. The following eligibility criteria were established for formation of the sample: newborns of women who had malaria in pregnancy, newborns participating in the NHS Program, and newborns born or hospitalized in the maternity unit of the state referral hospital for high-risk pregnancies in Porto Velho (RO) whose mothers agreed to participate in the study by signing the free informed consent form. Adopting a level of significance of 95% and a sampling error of 6%, the estimated sample size was 35 newborns.
Personal data for subsequent contact were also recorded in case it was necessary to schedule a day and time for a new assessment during both the screening and diagnostic evaluation phases. Mothers who agreed to participate in the study signed two copies of the free informed consent form, one was given to them and the other was kept by the responsible researcher. Infants presenting normal outer hair cell function obtained a "pass" result, which occurs automatically.
Tympanometry, which investigates tympano-ossicular system function, excluding possible middle ear alterations, was performed using a 1000-Hz probe tone since it is more sensitive in identifying these alterations in infants aged 0 to 4 months18.
The frequency of risk factors for hearing loss was analyzed by the test for equality of two proportions and the NHS results were correlated with variables such as type of malaria infection, gestational period when malaria occurred, type of antimalarial agent and gestational period when it was used. The otorhinolaryngologist requested imaging exams to evaluate possible involvement of the central auditory pathway.
The Plasmodium species contracted by the mother during the first trimester of gestation was the vivax type. This result differs from that reported in another study21 conducted in the same city, in which the distribution of malaria was homogenous across the three trimesters. In contrast, the World Health Organization recommends the use of primaquine under medical supervision26. In the present study, the participants reported the use of antimalarial drugs in more than one trimester, as recommended by the Brazilian Ministry of Health that indicate chloroquine as chemoprophylaxis against P. In this respect, it is important for the mother to have a minimum educational level, financial resources and harmony in social and marital relationships to seek the best health measures for her child31. Authors said that the lower the birth weight, the greater the chances of failure in the NHS32,33, which was not observed in this study. This result highlights the need to develop other studies with this population, but in larger samples.
In addition, the rapid discharge of the participants, which is a major obstacle of NHS programs, may have contributed to the small sample size. O conhecimento, a valorizacao da triagem auditiva neonatal e a intervencao precoce da perda auditiva.


Hearing aids fitting process in users that are seen in a federal public institution: part I--results and implications with the amplification device.
Avaliacao eletrofisiologica de recem-nascidos de maes que fizeram uso de antimalaricos na gestacao. Estudio de los efectos ototoxicos en 725 pacientes tratados con antimalaricos en el hospital central de Maputo (Mozambique). Year 2007 position statement: Principles and guidelines for early hearing detection and intervention programs. Accoustic immitance measures in infants with 226 and 1000 hz probes: correlation with otoacoustic emissions and otoscopy examination. Retardo no crescimento intrauterino, baixo peso ao nascer e prematuridade em recem-nascidos de gravidas com malaria, na Colombia.
Achados audiologicos de recem-nascidos de maes que fizeram uso de antimalaricos no periodo gestacional [Resumo n. Fatores de riscos associados a transmissao de malaria humana, em areas de ressacas, nos bairros Novo Horizonte e Zerao, Macapa, Amapa, Brasil. Determinants of intermittent preventive treatment of malaria during pregnancy (IPTp) utilization in a rural town in Western Nigeria.
Indicadores de risco para perda auditiva em neonatos e lactentes atendidos em um programa de triagem auditiva neonatal.
Triagem auditiva em um hospital publico de Belo Horizonte, Minas Gerais, Brasil: deficiencia auditiva e seus fatores de risco em neonatos e lactantes. Analysis of transient otoacoustic emissions and brainstem evoked auditory potentials in neonates with hyperbilirubinemia.
Perda auditiva neonatal associada a hiperbilirrubinemia por deficiencia de glicose-6-fosfato desidrogenase: relato de caso. Sequelas auditivas e neuropsicomotoras em recem-nascidos de termo ictericos tratados pelos metodos convencionais. Comparacao das alteracoes auditivas em recem-nascidos da UTI neonatal expostos e nao expostos a antibioticos. Medico do Setor de Saude Auditiva e Implante Coclear Universidade de Brasilia - UnB, Professor Substituto Otorrinolaringologia Universidade de Brasilia - UnB. Professor e orientador do programa de pos-graduacao em Ciencias da Saude e Ciencias Medicas da Universidade de Brasilia - UnB. To analyze a possible association of the degree of hearing loss with the severity of tinnitus, we have performed a retrospective study using admission data on 531 patients suffering from chronic tinnitus.
This perception can be induced by various dysfunctions on several levels of the peripheral or central auditory pathway [1].
The patient does not present any malformation of the craniofacial structures, of the periumbilical skin, or of the skeletal bones. Those of the Michel type, which appear during the first 3 weeks of pregnancy, are characterized by a complete block of the development of the otic capsule and nerve VIII.
Moreover, what must be remembered is that not all the anomalies of the inner ear depend on a genetic malformation. From a clinical point of view, ocular malformations are the most typical characteristic of this disease [4,5].
Subsequent audiometric controls revealed, besides the increased hearing deficit in the left ear, the presence of a sensorineural hearing loss prevalent more considerable for the low frequency in the right ear (Fig. The diagnosis of Rieger syndrome, as our case demonstrates, is often complicated by the variety of dysmorphogenetic anomalies associated with ocular damage characterized mainly by iridogoniodysgenesis. In contrast, authors hold divergent opinions regarding definition of the clinical features in which the malformative damage involves only the anterior chamber of the eye, with consequent glaucoma and visual deficit [24]. No vertiginous symptomatology, posture disturbance, or hypervagotonic neurovegetative symptoms were felt by the patient. We cannot exclude the possibility that this genetic anomaly is responsible also for the bony dysmorphism of the inner-ear channels shown by CT scan of the temporal bone.
Autosomal dominant iridogoniodysgenesis with associated somatic anomalies:Fourgeneration family with Rieger syndrome. Association of cephalic neural crest with cardiovascular development, particularly that of semilunar valves. Familial Axenfeld-Rieger anomaly, atrial septal defect, and sensorineural hearing loss:A possible new genetic syndrome.
Sibs with Axenfeld-Rieger anomaly, hydrocephalus and leptomeningeal calcifications:A new autosomal recessive syndrome? Closing in on the Rieger syndrome gene on 4q25:Mapping translocation breakpoints within a 50-kb region.
PITX2 regulates procollagen Iysyl hydroxylase (PLOD) gene expression:Implications for the pathology of Rieger syndrome. Exclusion of epidermal growth factor and high-resolution physical mapping across the Rieger syndrome locus.
Pitx2 is required at multiple stages of pituitary organogenesis:Pituitary primordium formation and cell specification. Unique phenotype associated with a pericentric inversion of chromosome 6 in three generations.
For example, noise levels of combines without an insulating cab can range from 85 to 90 dBA.10 For many of these activities, the use of hearing protection devices (HPDs) may be the only means to prevent NIHL.
This population of students was chosen due to their potential risk of noise exposure specific to their occupational training and recreational activities. Students were asked whether they perceive changes in hearing after participating in the activity and whether they wore HPDs during the activity, as well as the frequency of HPD use in these specific situations.
Although the findings cannot be generalized to all young adults, the data can provide insight into the attitudes and behaviors of many college students in the United States. In addition, students did not report HPD use even when perceived decreases in hearing occurred after concert attendance. The majority of surveyed students knew that hearing loss can happen from listening to loud music and that all NIHL is not temporary, reversible, or isolated to occurring only in “old age”; yet they continue to be unconcerned about hearing loss or tinnitus. Recording sound levels in both occupational and recreational settings as well as monitoring of time spent in these activities will provide the necessary information for making specific hearing conservation recommendations. Hearing, use of hearing protection, and attitudes toward noise among young American adults. Lass, PhD, is a professor in the Department of Communication Sciences and Disorders at West Virginia University in Morgantown, WVa.
Tribunal adjudicators recognize that It is always open to the parties to an appeal to rely on or to distinguish a medical discussion paper, and to challenge it with alternative evidence: see Kamara v. Constant or steady state noise by comparison remains relatively constant and lasts longer although fluctuations in sound intensity may occur. This is however usually related to the fact that one ear receives a greater exposure to the noise than another. Nevertheless the changes seen in presbycusis are typically non-specific and can also be seen in a vast number of pathologies including the effects of noise upon the inner ear.
Occasionally both a low-frequency and a high-frequency loss occurs but not usually the type of high frequency loss seen following noise exposure.
When vertigo is incapacitating the balance function of the inner ear may be attenuated or ablated by the trans-tympanic instillation of gentamicin with relative preservation of hearing. If the footplate as well as the cochlea is involved then a mixed (conductive and sensorineural) loss might result.
The pathognomic sign of a longitudinal temporal bone fracture is the so-called a€?step deformitya€? in the deep ear canal. Facial paralysis from an injury to the facial nerve (a nerve that runs in close approximation to the inner ear) typically occurs. The prolonged use of topical aminoglycoside antibiotics to treat middle ear pathology in the presence of a TM perforation is not without some risk which should always be kept in mind.
In fact some people with a€?superhumana€? hearing can even hear sound intensities less than this relative value of sound pressure.
In complex situations (mixed hearing losses) it may also be necessary to a€?maska€? the ear not being tested (to prevent crossover of sound to the other ear).
When tinnitus is severe enough to affect an individuala€™s well-being a trial of pharmacological treatment is generally recommended. Investigations such as a magnetic resonance imaging (MRI) are generally required to exclude the remote possibility of central nervous system pathology. Because of the brains proximity possible life-threatening complications can occur if left untreated (i.e. This test is typically performed when an asymmetric sensorineural hearing loss is present when there is concern a retrocochlear lesion such as an acoustic neuroma or MS might be present. The presence of waveforms following stimulation with the lowest intensity sound an individuala€™s cochlea hears provides us with a reasonable estimation of an individuala€™s hearing (usually within 5-10 dB of the anticipated threshold hearing at the frequency tested). The deeper part of the ear canal is bony, lacks skin appendages and is lined by thinner skin densely adherent to the periosteal lining of the bone. It is anatomically divided into 2 parts: the pars tensa and the pars flaccida (located in what is called the attic region of the tympanic membrane). Medially the arch (crura) of the stapes attaches to the inner ear via its footplate (which is a thin, flat oval piece of bone approximately 7mm X 3mm in dimension). Series of generation potentials culminate to form action potentials that transmit this electrical activity along the cochlear nerve fibres to the brainstem and onto the higher centers of auditory processing. The hair cells of the vestibular macula respond primarily to gravity and linear accelerations. The presence of active non-muscular contractile elements within the outer hair cells and their effects on movement of the basilar membrane is used to explain the concept of otoacoustic emission (OAE) testing. When the sound gets loud enough the inability to a€?fine tunea€? sound becomes lost and more nearby hair cells are drawn into the firing needed to create an electrical signal; hence the distortion of a loud sound. Hair cell loss can continue until a certain critical point is breeched with the individual unaware of a hearing deficit.
Follow-up beyond the 1 year mark did not reveal any further deterioration of hearing in any individual. Eighty-two individuals (22% of the total population) had experienced tinnitus and were invited to participate in the study. The equipment used was an Interacoustics audiometer, model AD 229, with TDH-39 earphones, calibrated according to ISO 8253.
The average age of the sample was 29.2 years, and the average duration of noise exposure was 7 years. Moreover, significant results were found for the degree of tinnitus and exposure to chemical pollutants (p = .02).
The THI indicated that even the degree 1 "slight" tinnitus experienced by most of the participants who reported tinnitus nevertheless had an impact on their quality of life. For instance, lesions in the neck and the middle ear and sinusitis and headaches increase the risk of tinnitus from 28% to 35%. The findings underscore the need for noise control and other effective strategies to mitigate causal factors. The use of an instrument designed to evaluate the impact of tinnitus on a person's life, such as the THI, can contribute to a greater understanding of the needs of a specific person or group (or both). Experiencia do hospital das clinicas da faculdade de medicina da Universidade de Sao Paulo. Data were obtained through interviews with the mothers' and analyzing the patient chart and the newborn, and underwent to statistical tests analysis of variance, equality of two proportions and Chi-square test (p = 0.05).
Therefore, hearing impairment during the first years of life of a child can interfere with the acquisition and development of speech and language3-5. Newborn hearing screening (NHS) continues to be the only strategy able to detect early hearing alterations that could interfere with the quality of life of an individual5,8. At this hospital, an NHS Program is provided by a private clinic accredited by the National Health System (Sistema Unico de Saude - SUS), where diagnosis and intervention are performed. Excluded were infants born to mothers who were unable to report the occurrence and gestational period of malaria infection and infants born in other maternity units who were therefore not seen at the NHS service of the maternity unit where the study was conducted.
It was not possible to include more subjects because the period scheduled was not sufficient to continue the process.
Disposable insert earphones and electrodes were used for the two instruments, as well as disposable gloves, gauze and 70% alcohol to clean the infant's face and for fixation of the electrodes. Risk factors were analyzed by the chi-squared test in order to determine the relationship between the findings and the variables mentioned.
Antimalarial drug use was more frequent in the second trimester of gestation, but most participants reported use of the medication in more than one trimester (Table 2). The results of these exams indicated the presence of bilateral impairment of the retrocochlear auditory pathways, findings compatible with the spectrum of auditory neuropathy. This divergence may be explained by the difference in the period of data collection between the two studies, since the present study was conducted during the dry season (June to November), with the occurrence of malaria being related to climatic22-24 and environmental factors and an increase in transmission being observed at the end of the rainy season22. However, this indication has become rare as observed in the present study and other studies in which pregnant women had malaria during pregnancy and were treated with chloroquine14,27. No relationship between the NHS results and gestational age agrees with evidenced by other researchers29.
Even if NHS is performed daily, including weekends and holidays, the large number of births per day in the maternity unit where the study was conducted leads to early discharge and the consequent loss of some newborns.
Ary Pinheiro (Porto Velho- RO) causados pela malaria durante a gestacao no periodo de 2001 a 2003 em usuarias do SUS. We have found that 83% of our tinnitus patients had a high frequency hearing loss corresponding to a noise-induced hearing loss (NIHL). Regardless of the original cause, all patients complain of hearing a tinnitus tone on either one (unilateral) or both sides (bilateral) of the head or ears. Often they can follow pathological events that appear during germinal, embryological, or fetal life because of various etiological factors:Rh factor incompatibility or viral, toxic, dysendocrinal, or dysmetabolic diseases, and the like. At the age of 23, the patient reported a progressive sensation of auricular fullness in the left ear. Once graduated, these college students will likely be working in the forestry and wildlife management fields. The majority of students did report the perception of decreased hearing after concert attendance, but not for other activities in which they participate. Hearing health education along with increasing student awareness of NIHL due to these common recreational activities may diminish their probability of future hearing loss. For example, truck drivers in North America not infrequently have a greater degree of hearing loss in their left ear (when the window is rolled down the left ear would be exposed to more sound from the engine). In the last resort the whole inner ear can be destroyed surgically by a procedure called a labyrinthectomy. Exploration of the middle ear surgically with correction of the ossicular chain or insertion of a prosthesis is called an ossiculoplasty.
On examination blood is usually seen in the middle ear behind the ear drum (a hemotympanum). The resultant hearing loss depending on the mechanism can be conductive, sensorineural or a combination thereof.
Of interest the first course of cisplatinum often demonstrates which patients are vulnerable to cochlear damage and what may happen in future if continued treatment courses are required. ANs are overwhelmingly unilateral, but in association with a rare genetic disorder, neurofibromatosis type 2, they may be bilateral. Another concept to appreciate is that the dB scale is a logarithmic (an exponentially increasing) rather than arithmetic (linear increasing) scale which makes it difficult to apply a percentage hearing loss to any individual. Certain anti- depressants (especially the tricyclic or SSRI classes) and anti-convulsants (medications used for seizure control) have been effective for some individuals.
Mean comfort levels (MCLa€™s) and uncomfortable loudness levels (ULLa€™s) during audiometry provide some information concerning the threshold intensity of sound an individual can tolerate. One general maxim in medicine is that a€?an unexplained unilateral sensorineural hearing loss should be considered an acoustic neuroma until proven otherwisea€?. Continuous migration of epithelium from the deeper to the lateral portion of the ear canal tends to keep the ear clean. The pars tensa or lower four-fifths of the ear drum is conically shaped and has a strong fibrous middle layer which provides strength.
The blood supply to the incus can be tenuous compared to other structures of the middle ear. Abnormalities in vestibular end organ function often result in the patient experiencing the subjective complaint of vertigo.
In general terms the greater the frequency the higher the pitch of the sound and the greater the intensity the louder we hear it. Of interest, in a parallel series of control patients who were further exposed to repeated episodes of acute acoustic trauma during the same study period by the end of 4 years 30% of these individuals had demonstrated significant hearing deterioration. Twenty (24%) of the 82 were not able to participate because they lost their jobs before collection of data, 5 (6%) declined to participate saying that they no longer had symptoms of tinnitus, and 5 (6%) were on vacation at the time of data collection.
We performed puretone audiometry for all subjects at frequencies of 0.5, 1, 2, 3, 4, 6, and 8 kHz. The functional subscale, composed of 11 questions, evaluates the limitations that tinnitus induces in the mental, social, occupational, and physical areas. Table 1 displays the findings pertaining to the health problems and auditory and medical histories described by the participants. In the THI, tinnitus was shown to have the greatest relationship to the functional scale (54%), indicating that its impact is more noticeable in social, daily, and reading activities involving concentration, auditory acuity, attention, and rest.
The analysis of the THI results along with the audiometric results indicated that a considerably greater number of significant correlations were verified in the group with altered hearing, which was expected because the two conditions-compromised hearing and tinnitus-are often associated. Information dissemination on the risks and prevention alternatives is of great importance, as is the management of tinnitus. Finally, it could be used in the design of appropriate strategies to manage tinnitus in the workplace. Cochlear damage initially involves the outer hair cells, generally affecting high-frequency hearing.
The final sample consisted of 35 mothers who had malaria and used antimalarial drugs in pregnancy and their children.
Subjects who needed to complete the diagnostic phase were referred to the clinic responsible for the NHS program. Infants who failed the test were directly referred for diagnostic evaluation, a procedure adopted by the program to prevent abandonment by the mothers, in addition to the fact that ABR is not affected by vernix which would justify retesting within 15 days.
Infection occurred more frequently in the first trimester of gestation and this result was significant when compared to the third trimester (Table 1).
Depending on the case, tinnitus tone may have low, medium or high frequency and be either relatively quiet (0–3 dB), going up to relatively loud (more than 16 dB).
The patient reported a progressive sensation of auricular fullness, and liminal audiometry revealed a sensorineural hearing loss. The Mondini-Alexander types of malformation are caused by a subtotal dysplasia of the bony labyrinth or cochlear membrane. For all these reasons, labeling the malformative anomalies of the inner ear with the term of hereditary labyrinthopathies was suggested recently, without any eziological or topodiagnostic reference to the damage, with the thought that this criterion of classification could better indicate the typology of these malformations. Other ocular abnormalities, such as microcornea, megalocornea, corneal opacity, and strabismus, have been reported. The pure-tone audiogram, conducted in May 1991, revealed a sensorineural hearing loss in that ear (Fig. Liminal and speech audiometry and brain stem evoked responses have confirmed the cochlear site of the damage. Martinelli, BS, and Rachel Szepelak-Bell, BS, are students in the AuD program at West Virginia University.
All things being equal most noise in industry however is a combination of primary continuous and superimposed impact type noise. Those who fire guns often demonstrate a greater degree of hearing loss in the ear closest to the barrel (the left ear in a right-handed shooter) because that ear would be closest to the explosion and the other ear would be protected by a a€?head shadowa€?. However the natural history is enigmatic with unpredictable periods of exacerbation and remission. For example the difference between 10 and 40 dB in sound pressure intensities is not a 4xa€™s increase but actually an increase by a factor of 1,000 or 103 in sound pressure intensities!
An experienced tester, typically an audiologist, is required to perform these technically demanding tests. Wax and debris can collect in the ear canal when this migratory mechanism fails or is overloaded from infectious or inflammatory conditions.
The pars flaccida or upper one-fifth is less distinct and has a poorly developed middle fibrous layer. When pathology affects its blood supply it can lead to the erosion of its long process which is attached to the stapes. Therefore, the final sample of the study consisted of 52 participants: 11 females (9% of the total of 120 noiseexposed female workers in the studied plant) and 41 males (16% of the total of 252 noise-exposed male workers in the studied plant). The emotional subscale, composed of 9 questions, includes affective answers for tinnitus (anger, frustration, irritability, and depression). All participants exposed to noise levels greater than 85 dB are required to use ear muffs, and information on their use and maintenance are given when workers are hired.
The emotional scale was the second most affected and is related to manifestations of nervousness, frustration, irritation, depression, anxiety, insecurity, and difficulty in relationships with family and friends.
Estabelece diretrizes e parametros minimos para avaliacao e acompanhamento da audicao dos trabalhadores expostos a niveis de pressao sonora elevados. Interestingly, patients suffering from decompensated chronic tinnitus had a greater degree of hearing loss than the patients with compensated form of tinnitus. Tinnitus may take acute (up to 3 months), sub-acute (4–12 months) or a chronic turn (longer than a year).
Computed tomography scanning of the temporal bone revealed a bilateral dysmorphism of the acoustic channels.
They appear about the seventh week of pregnancy and almost totally concern the cochlear labyrinth. By age 20, some 50% of affected patients present an increased intraocular pressure that tends to increase with age.
In fact, from an early age our patient has experienced ocular disturbances characterized by increased pressure and visual deficit that worsened over the course of years. During subsequent years, a hearing deficit occurred in the right ear as well, with a progressive increase in the audiometric threshold for the low frequencies, as at the onset of the hearing loss in the opposite ear.
The presence in our patient of such a loss confirms the possible association of labyrinthic damage with the other anomalies of the hereditary origin of this syndrome.
This makes the pars flaccida especially susceptible to negative middle ear pressure and prone to retractions that can lead to the formation of retraction pockets.
Another structure called Reissnera€™ s membrane (R) forms the roof of the scala media (M) which separates this from the scala vestibuli (V). In complex sounds the interaction of its pure tone components forms the basis of its complexity or its psychological counterpart known as timbre.
We also performed daily biological calibration checks on the audiometer immediately before testing subjects.
Last, the catastrophic subscale is composed of 5 questions and examines the most severe reactions from tinnitus (desperation, loss of control, inability to face problems, inability to escape tinnitus, and fear of having a serious ailment)[12]. Walkthrough observations suggest that use of the hearing protection is high, but no information exists on the consistency of hearing protection use.
The catastrophic scale demonstrated alterations related to desperation, intolerance to tinnitus, and loss of control in situations when experiencing tinnitus (see Fig. In addition, we demonstrate that the degree of hearing loss positively correlates with the two subscales (“intrusiveness” and “auditory perceptional difficulties”) of the Tinnitus Questionnaire. Regarding the level of disturbance, tinnitus can be classified as compensated (low-level distress) or decompensated (high-level distress) [2]. A modified version of tinnitus retraining therapy: observing long-term outcome and predictors. The presence of a bilateral cochleopathy in a patient suffering from the Axenfeld-Rieger syndrome could be the expression of a genetic "disorder." We cannot exclude the possibility also that this genetic anomaly is responsible for the bony dysmorphism of the inner ear channels shown by the computed tomography scan of the temporal bone. The Scheibe malformation is the most frequent; it involves the membranous labyrinth at the level of the cochlear and saccular ducts and the spiral ganglion, although the bony structures of the posterior labyrinth are preserved. In fact, it is often associated with dysembryogenetic alterations that involve other anatomical districts as well.
Control of glaucoma is difficult, and this disorder may lead to significant damage to the optic nerve and to blindness.
The brainstem evoked responses demonstrated repeatable waves, with latencies of wave V within normal limits and without interaural asymmetries.
In our case, therefore, the congenital ocular malformation, typical of the Axenfeld-Rieger syndrome, does not stand alone but is associated with a sensorineural hearing loss. The lack of clinical signs related to the vestibular structures is not surprising, even in the presence of signs related to the cochlear labyrinth. When retraction pockets fail to be self-cleansing they fill with debris and desquamated skin that can lead to secondary infection and bone erosion better known as cholesteatoma.
In our study, factors such as gender, age, tobacco, and exposure to firearms were not significantly associated with tinnitus. Our retrospective study provides indirect evidence supporting the hypothesis that the degree of noise-induced hearing loss influences the severity of tinnitus.
The major problem in patients with decompensated tinnitus is sleep interference, because the tinnitus tone keeps the patients awake. Thus, multiform clinical features can be observed, whether for the variability of the type or for the site of the damage.
Another characteristic anomaly of Rieger syndrome is the presence of midfacial hypoplasia, accompanied sometimes by a cleft palate, mandibular prognathism, and a reduced number of incisors and superior and inferior premolars (hypodontia), which appear to be altered in their form [6,7].
A year and a half later (1993), the patient underwent another audiometric checkup:He noted a worsening of the hearing loss in the left ear, although hearing in the right ear remained normal (Fig. It is, therefore, a variant of this syndrome, owing to the presence of a hearing deficit that has the characteristics of a hereditary labyrinthopathy. Coles [26], among several authors, reported that the worse the hearing is, the more probable is the occurrence of tinnitus. Other diseases that follow include depression, a variety of phobias, anxiety disorders, problems with concentration and in extreme cases—suicide. The clinical feature is completed by the presence of skin malformations of the periumbilical area, wherein a congenital hernia may be observed in some cases. Subsequently, other dysembryogenetic skeletal alterations may appear, as may hypospadias [5], anal stenosis [8], Meckel's diverticulum, cardiac defects [9-13], leptomeningeal calcifications, and psychomotor disturbances [14-16]. Speech audiometry revealed an increase in the speech discrimination threshold, which reached 100 dB. Approximately 20% of the patients with hearing loss present complaints of tinnitus, whereas 90% of those with severe tinnitus had hearing loss. Approximately 30 per 100 adults experience tinnitus, whereas about 1–5 persons per 100 suffer from tinnitus and seek medical help [3,4].
In the Western world, tinnitus has a big economic impact [5].The onset of tinnitus can have various basis such as neurologic, traumatic, infectious or drug-related [6], however, the major cause of tinnitus is a hearing loss [5].
Hearing loss is usually caused by the aging process (presbycusis) or by the overexposure to noise (noise-induced hearing loss, NIHL). Occupational noise, together with environmental noise pollution, are two major factors contributing to the NIHL [7].
These, and a lot of other data, strongly indicate coexistence of both hearing dysfunctions. Based on the above data we put forward a hypothesis that the degree of hearing loss could negatively influence the severity of tinnitus.To test our hypothesis we used a retrospective study using data acquired from 531 tinnitus patients.
This data were randomly collected on the admission of patients who reported to the day ward of Tinnitus Center at the Charite - Universitatsmedizin in Berlin between January 2008 and March 2010. ParticipantsWe have obtained the data from 531 tinnitus patients (sub-acute and chronic) admitted to a 7-day multimodal tinnitus therapy.
In addition, tinnitus frequency (kHz) and tinnitus loudness (dB HL) were matched for each patient. Psychometry (Tinnitus Questionnaire)Tinnitus-related distress was assessed using validated standard German version of the tinnitus questionnaire (TQ). Influence of environmental factors on the evolution of industrial noise-induced hearing loss. The TQ is composed of 52 items allocated to six scales: emotional distress, cognitive distress, intrusiveness, auditory perceptual difficulties, sleep disturbances and somatic complaints [12].
The severity level of tinnitus was assigned as “compensated” (low-level distress) with TQ score ? 46 points and “decompensated” (high-level distress) with TQ score > 46 points.
Spearman's rank correlation was used to test the statistical relationship between hearing loss and tinnitus parameters or tinnitus severity. Predominant Number of Patients with Chronic Tinnitus Has a Hearing LossOf all 531 tinnitus patients tested, 441 (83%; 220 men and 221 women) had a hearing loss in the upper frequencies (Figure 1), corresponding to a pattern found in the NIHL [13]. Assessing audiological, pathophysiological and psychological variables in tinnitus patients with or without hearing loss.
There were no significant differences in the hearing loss between the left and the right ear and between male and female patients in this group. The mean age of tinnitus patients with NIHL-like audiogram was 50 years (SD = 13, min 16, max 79), with patients most frequently ranging between 40–60 years of age.
Tinnitus Characteristics in Patients with Hearing LossOf 441 tinnitus patients with NIHL-like audiogram, 319 patients had pure tone tinnitus whereas 122 patients had noise tinnitus. The values did not differ between female and male patients except for the subscale “somatic complaints” with woman having significantly greater scores than the male patients (Table 1). Of the 441 patients, 335 patients suffered from compensated tinnitus (TQ ? 46 points) and 106 patients suffered from decompensated tinnitus (TQ > 46 points). 3.4 The Degree of Hearing Loss Correlates with Some of the Psychometric Parameters Measured by TQHearing loss was of significantly higher degree in patients with decompensated tinnitus than in patients with compensated tinnitus (Figure 3). This means that tinnitus patients with greater hearing loss experience higher tinnitus-related distress.
We found no correlation between tinnitus frequency or loudness and distress caused by tinnitus. Influence of Age on the Psychometric ScoresOur recent study [14] revealed that the age of patients may influence their TQ values. Consequently, in the present study, we have subdivided the patients into three age groups and analyzed their TQ scores as a function of age. Influence of Tinnitus Lateralization on the Psychometric ScoresWe compared the tinnitus-related distress between the patients with left-sided, right-sided and bilateral tinnitus. DiscussionOur present work was aimed at analyzing the association between noise, the grade of the noise-induced hearing loss and the severity of tinnitus.
Our results partially corroborate the findings of others by demonstrating a strong bond between the noise-induced hearing loss and tinnitus [10]. In fact, we have shown that 83% of patients with chronic and sub-acute forms of tinnitus have a high-frequency hearing loss, which is a substantially higher percentage than the 57% reported by Savastano or the 63% reported by Martines et al. The sample size in all studies was roughly similar, as were the age and gender distribution. However, there was a major difference in the duration of tinnitus between our and the other studies. In the Savastano study, 49% of tinnitus patients had suffered from tinnitus for a time shorter than one year – a group classified as acute and sub-acute tinnitus.
Based on the above evidence, one is tempted to cautiously speculate that the tinnitus associated with hearing loss has a greater chance of chronification than the tinnitus without hearing loss.
In the other study, Attias and colleagues have indentified a subgroup of patients with tinnitus, who were actively looking for a remedy.
Our study gives a base for the explanation of how the degree of noise-induced hearing loss indirectly affects the severity of tinnitus by influencing negatively the loudness of tinnitus.
In agreement with this, the degree of hearing loss correlated positively with two subscales (“intrusiveness” and “auditory perceptional difficulties”) of the Tinnitus Questionnaire. These particular items of TQ regard the ability to communicate, which is an integral part of the quality of life.
With the increased distress of tinnitus, patients withdraw from their normal social life and avoid contacts with others, consistent with the decompensated form of tinnitus.
Interestingly, we found that the patients suffering with decompensated tinnitus had a greater degree of hearing loss than the patients with compensated tinnitus.Noise pollution and occupational noise were demonstrated to induce asymmetric hearing loss, with the left side being affected more than the right one [13]. Although our analyses demonstrated no statistically significant differences in the hearing loss between the left and the right sides, we found that left-sided tinnitus is more distressing than the right-sided one.
Moreover, patients with the left-sided tinnitus had more complaints in the somatic subscale than the right-sided tinnitus patients. This could be attributed to neuroanatomic differences between the left and right parts of the auditory system.Noise—either occupational or environmental noise pollution—is a major preventable cause of the hearing loss and therefore of chronic tinnitus. The consequences of noise exposure last for life, as the sensory auditory epithelium never regenerates. The price to pay for the noise exposure includes not only a limited ability to hear but also increased chance to develop chronic decompensated tinnitus, which separates the affected persons from normal social activities and significantly decreases the quality of life. ConclusionsOur study demonstrates that the chain of events started by overexposure to noise not only induces the hearing loss but also tinnitus with its co-morbidities, finally resulting in a decreased quality of life.



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