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Hearing loss can be described in terms of when it occurs in the process of the development of speech. A pre-lingual hearing loss occurs where the hearing is lost before a child has completely developed speech and language.
A post-lingual hearing impairment is more common and means the hearing loss is acquired after speech and language have developed (usually considered to be after six years of age).
Often, the hearing loss develops gradually and may be noticed by family and friends before the person actually notices it. During routine diagnostic BAER testing of dogs of various breeds for private owners at the Western College of Veterinary Medicine in Saskatoon, it became evident that some individual dogs developed hearing loss as adults. Dogs at 5 years of age were often in the prime of their herding careers and then did not respond appropriately to distant commands.
Lay summaryAlthough congenital (from birth) deafness has been widely recognised and reported in dogs, little has been done to characterise or study adult and geriatric onset deafness. FindingsHerding trial resultsLoss of hearing was reported by owners in herding strains of Border Collies.
Histogram showing the results of 216 Border Collies that were BAER tested at two herding trials. 2) suggests that not all pups will necessarily be deaf, excluding an autosomal recessive pattern of inheritance.
Pedigrees of three families of Border Collies with multiple members that were deaf by BAER testing. DiscussionAlthough BAER hearing tests can be used to diagnose dogs with reduced hearing to an advanced stage and complete deafness, no diagnostic test is currently available for early identification of those Border Collies likely to become deaf.
1) and therefore should be excluded in screens to find genes associated with adult-onset deafness.
ConsentIn accordance with Canadian Animal Care Guidelines, signed written consent was obtained from all dog owners prior to BAER testing and DNA sampling. AcknowledgmentsThanks to Teresa Chu, DVM for BAER testing and to the Western College of Veterinary Medicine in Saskatoon for the use of their BAER machine.
A list of the autosomal dominant hearing loss conditions in humans based on the Heredity Hearing Loss website. Competing interestsAlthough the author has received funding from HealthGene in the past for some of her coat color research, this manuscript does not involve data that relates to coat colour or any diagnostic test.
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. There are two different types of hearing impairments, conductive hearing loss and sensorineural hearing loss. A conductive hearing loss is present when the sound is not reaching the inner ear, known as the cochlea.
Dysfunction of the three small bones of the middle ear, the hammer, anvil and stapes may result in conductive hearing loss. A sensorineural hearing loss is one resulting from dysfunction of the inner ear, the cochlea, the nerve that transmits the impulses from the cochlea to the hearing center in the brain or damage in the brain. Another common reason for hearing loss due to hair cell damage is noise-induced hearing loss. Total or near-total sensorineural deafness may be the result of congenital malformations, head trauma, inner ear infection, genetic factors, or long history of excessive noise exposure. The aim of this study was to determine the effects of various treatment modalities employed for patients with sudden sensorineural hearing loss (SHL). Sudden sensorineural hearing loss (SHL) is defined as hearing loss equal to or greater than 30 dB at three or more consecutive frequencies, the onset of which takes place over a period of 3 days or fewer [1]. Treatment is controversial and can involve anti-inflammatory drugs (steroids), vasodilators, antiviral agents, plasma expanders, diuretics, calcium channel antagonists, hyperbaric chamber use, carbogen, anticoagulants and, more recently, intratympanic corticosteroids [6-11].
The aim of this study was to observe the progression of SHL in patients who underwent different treatments at the SHL outpatient facility of our institution and to describe clinical and epidemiological aspects.
This retrospective study analyzed the records of patients treated in the sudden hearing loss section of the Otolaryngology Department, Clinic Hospital School of Medicine, University of Sao Paulo, Brazil, between 1996 and 2006. All patients underwent imaging tests (temporal bone magnetic resonance imaging or computed tomography) and complete blood cell counts. The patients underwent serial audiometric testing at baseline and after 30, 90, 120, and 180 days of treatment. Considering all the cases, we observed significant posttreatment reductions in low- and high-frequency PTA (Table 3). Estimates have shown that among patients with SHL, the mean age ranges from 43 to 53 years, the gender distribution is equivalent, and the hearing loss is unilateral in more than 95% of cases [2,4,11,13,14], similar to what we observed in our study. Approximately 25-40% of patients with SHL present with concomitant upper-airway infection [11].
According to Rauch [11], vestibular symptoms were identified in 28-57% of cases, as compared with 32-40% reported by Nakashima et al. The most common etiological factors identified for SHL were those that are not the most frequent but can be directly identified through clinical history, blood samples, or imaging studies, including autoimmune diseases, acoustic trauma, ototoxic drugs, Lyme disease, and ear malformations.
Theoretically, this anatomical presentation predisposes to hypoxia, spasms, thrombi, and hemorrhage, especially at the cochlear apex, primarily affecting the response to low frequencies [23].
When we analyzed the cases in which PTA normalized, we observed that in most cases baseline PTA was moderate and the etiology was unknown. Among the five treatment groups, the differences in ΔPTA were not statistically significant at any frequency. For low-frequency and high-frequency PTA, we observed an inverse linear correlation between time from onset to treatment and audiometric response presented by the patients. On the basis of our analysis, we can infer that plasma expanders do not improve the efficacy of the corticosteroidacyclovir combination used in managing SHL in patients. While the overall incident rate for cancer increased slightly in children ages =14 years between 2005 and 2009, the death rate decreased by more than half and the 5-year survival rate for many pediatric cancers in the United States has reached upwards of 80% or more (Siegel, Naishadhamc, & Jemal, 2013).
This article provides a brief overview of potentially ototoxic agents routinely prescribed to treat cancer in children.
The platinum-based compounds carboplatin and cisplatin are effective chemotherapy agents commonly used to treat a variety of childhood cancers. The following case studies are fictitious but represent typical treatment regimens and hearing losses seen in our clinic.
This patient was diagnosed and treated as an infant with six courses of carboplatin chemotherapy. Cranial radiation therapy is routinely used to treat a variety of childhood brain tumors and head and neck cancers. Radiation therapy can degrade the external ear and middle ear system, causing a temporary or permanent conductive hearing loss. A reported one-third of patients treated with cranial radiation involving the cochlea experience sensorineural hearing loss (Jereczek-Fossa et al., 2003).
Often, clinical trials and hospital-driven treatment protocols have specific time points for performing audiological assessments. While carboplatin is substantially less ototoxic than cisplatin, both can lead to serious hearing loss requiring the use of assistive listening technology, preferential classroom seating, additional educational resources, and hearing aids. Managing hearing loss in patients who receive radiation therapy for head and neck tumors can be complex. Pediatric oncology patients treated with platinum agents or cranial radiation are at risk for developing significant hearing loss.
The ASHA Action Center welcomes questions and requests for information from members and non-members.
Pre-lingual hearing loss may be congenital or acquired in the first few years of life, and can affect how well a child learns to speak.
Older adults with hearing impairment are likely to hold shorter conversations, use the telephone less, and increasingly ask people to repeat themselves.
Loneliness and depression can arise as a result of isolation from the inability to communicate with friends or work colleagues. Although inherited congenital deafness has been widely reported in dogs, this type of deafness had not. To determine the typical age that geriatric deafness might be expected, retired dogs were also recruited. This type of deafness is important to dog owners but is also a potential medical model for some forms of hearing loss in humans. The latter form of deafness is likely to represent a good model for human adult deafness (known as prebycusis).
Groups shown had normal hearing (205), bilateral deafness (5), unilateral deafness (1) or reduced hearing (5), sorted to the closest half year of age. Age of onset varied from childhood, often reported as postlingual, to about 50 years of age. We are grateful to the many Border Collie owners for completing the hearing loss survey and bringing their competitive and older dogs to trials in Virginia and Pennsylvania.
The DFNA number, gene, authors, human and canine chromosomal locations of the gene are provided. 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. The mobility of these bones, or ossicles, may be impaired for different reasons and disruption of the ossicular chain due to trauma, infection or other process may also result in hearing loss.
Chronic ear infection can result in a defective eardrum or middle ear cavity, and often in addition to the conuctive hearing loss the individual may have a sensorineural hearing impairment. We retrospectively evaluated the records of patients treated in the sudden hearing loss section of the Otolaryngology Department at Clinic Hospital, School of Medicine, University of Sao Paulo, Brazil, between 1996 and 2006. Approximately one-third of affected patients improve spontaneously, most within the first 2 weeks of disease progression [1,3].
The inclusion criterion was SHL of sudden onset over a 72-hour period, equal to or greater than 30 dB at three or more consecutive frequencies. Group II included patients who had a 0- to 15-day history of SHL and in whom the use of plasma expanders was contraindicated owing to systemic hypertension, cardiopathy, coagulation disorder, or renal failure.
The laboratory exams included erythrocyte sedimentation rate, fasting glucose, cholesterol, triglycerides, free thyroxine and thyroid-stimulating hormone, circulating immunocomplex, complement, rheumatoid factor, and antinuclear factor. The only epidemiological study of SHL published to date was performed in Japan in three different years and different decades [13]. However, other authors [2] observed that, unlike our finding, only 11% of their SHL patients presented with concomitant upper-airway infection.

The autoimmune diseases that can lead to SHL are autoimmune inner-ear disease and immunemediated systemic disease leading to a secondary innerear injury. One piece of evidence supporting this hypothesis is the fact that various authors have reported among patients with SHL seropositivity for a number of viruses, including herpes simplex, varicella zoster, cytomegalovirus, influenza, parainfluenza, rubella, and mumps [9, 18-20]. Studies involving patients with SHL have shown evidence of sudden-onset cochlear ischemia and an association between SHL and systemic vascular diseases [23]. In fact, vascular etiology is a very promising theory, but confirming and explaining it is difficult. Despite the lack of a control group, the findings of our study can be compared with those presented in the literature. Among the remaining cases, the most common etiology was diabetes mellitus, followed by viral causes. The improvement in PTA was less pronounced in patients in groups IV and V (who started treatment at least 15 days after the onset of SHL) than in the other patients, although the difference was not statistically significant. This finding is in agreement with those of other studies showing that earlier initiation of treatment improves prognosis [1,4,25].
Advancements in the diagnosis and treatment of childhood cancers have led to these increased long-term survival rates.
A case study approach using fictional audiological test results representative of actual cases seen in our clinic will be used to describe various types of hearing loss caused by platinum-based chemotherapeutic agents and cranial radiation therapy. Conductive hearing loss can be the result of skin reactions, otitis externa, cerumen occlusion, chronic eustachian tube dysfunction, and middle ear effusion. These time points are predicted based on several factors, such as diagnosis, treatment plan, patient age, and ototoxicity risk. Audiologists have a unique opportunity to implement an ototoxicity monitoring protocol for these patients and to promote early intervention (i.e.
All congenital (present at birth) hearing loss is pre-lingual, but not all pre-lingual hearing loss is congenital. Five of the 10 Border Collies 12 years of age or older had hearing loss (1 bilaterally deaf and 4 had reduced hearing). This report also suggests that geriatric hearing loss is common in dogs older than 12 years.
This study examines adult hearing loss in herding strains of Border Collies, a breed where owners have previously anecdotally reported adult onset deafness in their dogs. None of these four dogs were deaf with BAER testing at 70 dB, which is considered the estimated loudness of an alarm clock These dogs are likely in the early stages of hearing loss.
A Natural Science and Engineering Council of Canada Discovery Grant to SMS provided the funding.
The auditory area affected, other symptoms, frequency, and age of onset have been added by the author when these were reported in the related manuscripts.
Hearing impairments are categorized by their type - conductive, sensorineural or both, by their severity, and by the age of onset.
This will often interfere with speech understanding, as it is in the high frequency range that we find the consonant sounds that are most important especially in noisy surroundings. Our study included patients with SHL of sudden onset (occurring over a 72-hour period) at equal to or greater than 30 dB at three consecutive frequencies. Approximately one-third of cases are accompanied by complaints of tinnitus, dizziness, and ear fullness [2,3].
Risk factors associated with poor prognosis include time of disease progression prior to the initiation of treatment, extreme age (being very young or very old), severe initial hearing loss, concomitant vestibular symptoms, and a descending pure-tone audiometry curve [1,4,12]. The treatment regimen was the same as that used in group I patients, minus dextran or minus dextran and acyclovir if the SHL onset was greater than 5 days.
Serological tests were also conducted for herpes simplex virus type I, cytomegalovirus, syphilis, rubella, measles, Lyme disease, and the human immunodeficiency virus. Nevertheless, none of those authors compared their results with the prevalence observed in epidemiological studies of upper-airway infection in the corresponding populations. However, those authors found that prevalence of these disorders among patients with SHL was lower than that reported for patients with dizziness [15], which is in agreement with the findings by Cadoni et al. In our study, the etiology was vascular in 4.3% of the cases of SHL, one of which was very severe. We cannot state with confidence that the likelihood of complete recovery is greater in such cases of SHL, as other factors such as gender and age at SHL onset might exert some influence. In groups I, II, and III, treatment was initiated within the first 15 days after the onset of SHL. We observed a genderbased difference in ΔPTA, with a tendency toward statistical significance, suggesting that the SHL prognosis is poorer for men. Oral steroid treatment of sudden sensorineural hearing loss: A ten year retrospective analysis. Sudden complete or partial loss of function of the octavus system in apparently normal persons.
Antiviral treatment of idiopathic sudden sensorineural hearing loss: A prospective, randomized, double-blind clinical trial. Treatment of idiopathic sudden sensorineural hearing loss with antiviral therapy: A prospective, randomized, double-blind clinical trial. Prognosis for sudden sensorineural hearing loss: A retrospective study using logistical regression analysis.
Clinicoepidemiologic features of sudden deafness diagnosed and treated at university hospitals in Japan. The implication of viruses in idiopathic sudden hearing loss: Primary infection or reactivation of latent viruses?
The relationship of the herpesvirus family to sudden hearing loss: A prospective clinical study and literature review.
Unfortunately, a number of adverse side effects, including hearing loss, continue to be a concern for all involved. Ototoxicity monitoring before, during, and after treatment is an important component in the early detection and management of hearing loss in young cancer patients. Cranial radiation can potentially damage any of the auditory structures extending from the external ear to the higher auditory pathways. Hua and colleagues (2008) demonstrated that pediatric patients did not experience hearing loss when the mean cochlear radiation dose was less than 35 Gy.
Thus, long-term audiological follow-up is recommended for patients considered high risk (cochlear exposure >35 Gy) for radiation-induced hearing loss. This protocol was adapted from the ototoxicity monitoring guidelines issued by the American Speech-Language-Hearing Association (1994) and the American Academy of Audiology (2009). Of course, the patient should be evaluated at any time during or after therapy if a noticeable change in hearing occurs. Patients with serious high-frequency hearing loss typically benefit from hearing aids and assistive listening devices.
These recommendations are based on the extent of the conductive hearing loss and are made in collaboration with an ENT physician. Analysis of ototoxicity in young children receiving carboplatin in the context of conservative management of unilateral or bilateral retinoblastoma. Hearing loss that occurs at this stage can have a far-reaching impact on verbal and social skill development.
The adult onset deafness which exhibited in three families, did not usually occur until 5 years of age, too young to be geriatric deafness. Border collies were examined using a standard established method to measure deafness in dogs (Brainstem Auditory Evoked Response (BAER)).
Five cases of hearing loss were found in dogs aged 7 to 11 and are believed to be of the adult onset type. Furthermore, a hearing impairment may exist in only one ear (unilateral) or in both ears (bilateral). Head trauma, ear infections, tumors and toxic medications such as certain strong antibiotics and chemotherapeutics are other reasons for sensorineural hearing loss. We divided patients into five groups by profile and treated them with dextran, dexamethasone, acyclovir, nicotinic acid, and papaverine hydrochloride (with or without vitamin A).
Group III included patients who had a 6- to 15-day history of SHL and who were hospitalized and treated with the same treatment used in group I minus acyclovir.
If no improvement occurred in the auditory threshold after 3 days, treatment was discontinued and the patient was discharged. No statistically significant difference was noted among the treatment groups in terms of audiometric progression determined by calculating the difference between the low- and high-frequency PTAs seen at baseline and after 180 days (Table 7).
Owing to differences in design and population, we cannot directly compare our sample with theirs.
However, despite advances, serological diagnosis remains difficult, as most tests are nonspecific and have a low accuracy rate [17]. Blood circulation in the inner ear is of the terminal type, the cochlear artery running from the base to the apex of the cochlea. In that case, SHL was detected after an episode of aplastic anemia (severe erythrocytopenia and thrombocytopenia) resulting from prolonged use of a nonsteroidal antiinflammatory drug (potassium diclofenac used daily for more than 1 year to treat acne). To our knowledge, no previous studies have attempted to identify the etiologies that are most often associated with audiometric normalization in patients with SHL.
However, the greatest improvement in PTA was observed in group II patients, who were the only ones not treated by dextran.
A recent study demonstrated a statistically significant association between less recovery of hearing loss and male gender [16].
For these reasons, long-term follow-up is essential in pediatric patients exposed to platinum chemotherapy.
At the conclusion of treatment, conditioned play audiometry revealed normal hearing sensitivity at 500 Hz, sloping from a mild to severe hearing loss at 1000-8000 Hz, bilaterally (Figure 1c).
Thus, hearing loss can present as conductive, mixed, sensorineural, or retrocochlear in nature (Jereczek-Fossa, Jarowski, Milani, & Orecchia, 2003). Acute complications to the middle ear system, resulting in otitis media and eustachian tube dysfunction, have been documented in 40% of patients treated with radiation therapy (Jereczek-Fossa et al., 2003). However, risk for hearing loss significantly increased when the mean cochlear radiation dose rose above 35 Gy (Hua et al., 2008).
As shown in Figure 3a, a baseline audiological evaluation prior to cranial radiation revealed normal hearing sensitivity, bilaterally. This protocol serves as a guideline only (Figure 4 [PDF], Ototoxicity monitoring protocol for platinum chemotherapy and cranial radiation therapy).

Patients diagnosed with severe or fluctuating hearing loss should be followed more frequently than the ototoxicity protocol indicates, at least until hearing loss stabilizes. Hearing aids that offer open fitting options and frequency compression technology have improved hearing aid acceptance and long-term use in our patient population.
Managing patients diagnosed with radiation-induced sensorineural hearing loss can be more challenging. In cases when cancer treatment cannot be altered, audiologists play an integral part in providing counseling, aural rehabilitation, and coordination of services in educational settings. She participates in direct patient care, mainly ototoxic monitoring and aural rehabilitation in the pediatric oncology population. Platinum compound-related ototoxicity in children: long-term follow-up reveals continuous worsening of hearing loss.
The efficacy of early identification and intervention for children with hearing impairment.
Ototoxicity due to cis-diamminedichloroplatinum in the treatment of ovarian cancer: influence of dosage and schedule of administration. Most pre-lingual hearing impairment is due to an acquired condition, usually either disease or trauma. Within a group of 216 dogs, five dogs over the age of 12 years had hearing loss, suggesting that a geriatric onset may be common in this cohort of dogs.
Four of the 6 dogs between 12 and 15 years of age were ascribed as having geriatric hearing loss. Depending on the definition it could be estimated that more than 50% of the population over the age of 70 has impaired hearing.
Worldwide, SHL accounts for approximately 1% of all cases of deafness, and 15,000 new cases occur annually [1,4]. Patients were divided into five treatment groups on the basis of SHL duration and clinical profiles that indicated the use or absence of the current drugs prescribed. Group IV included patients with a 16- to 30-day history of SHL and who were treated with the group I regimen minus dextran and acyclovir.
However, the fact that the time to first medical visit was longer in our study might be attributed to patients' lack of knowledge concerning the symptoms or difficulty in patients' gaining access to treatment.
In our sample, tinnitus was much more prevalent (95% of cases) and was often the main reason for the disturbance, leading us to recommend that future clinical trials investigate therapeutic possibilities in preventing and managing this symptom in SHL patients. In our sample, diagnoses were made by determining erythrocyte sedimentation rates and levels of antinuclear factor and rheumatoid factor.
Intracochlear hemorrhage can be revealed through the use of magnetic resonance imaging, showing the importance of this procedure in making the diagnosis [24].
The authors estimated that audiometric recovery resulting from treatment translated to an increase in mean PTA of approximately 25 dB, similar to what we observed for low-frequency PTA. However, we agree with Mattox and Simmons [25], who reported a fundamental difference between hearing losses at low frequencies and those affecting high frequencies, stating that low-frequency losses are more easily reversed.
Although some underlying diseases can impair innerear microcirculation and hinder clinical improvement of SHL, the comorbidities presented by patients in group II were not indicators of poor prognosis.
The better prognosis in women merits further analyses, given a possible bias that might be related to indicators of good prognosis.
High-frequency hearing is affected first, with hearing loss eventually progressing to the lower frequencies with increasing cumulative doses (Li et al., 2004). This hearing loss example is typical of high dose cisplatin treatment, particularly in children diagnosed and treated at less than 5 years of age. This example demonstrates the increased risk of ototoxicity being present at a young age (<6 months) and the delayed onset of hearing loss sometimes seen in patients receiving carboplatin. Cranial radiation has also been shown to exacerbate hearing loss when administered with concurrent or adjuvant platinum-based chemotherapies (Low, Toh, Wee, Fook-Chong, & Wang, 2006).
Audiological testing 2 years post treatment indicated normal hearing sensitivity, bilaterally (Figure 3b). At this time, cochlear implantation for this population is rare, as hearing loss is typically contained in the high-frequency range, sparing the low frequencies. Generally, hearing aids and assistive listening devices are recommended for these patients. She is active in clinical research involving the effects of ototoxic agents and the efficacy of otoprotective drugs. Predicting cisplatin ototoxicity in children: the influence of age and the cumulative dose. A genetic component contributing to this form of deafness in dogs is suggested and discussed in the context of previous studies. Thus this type of deafness appears to be nonsyndromic.Family studiesIn another portion of this study, three families of Border Collies showed a pattern of adult onset deafness.
We determined outcome as the difference between day-0 and day-180 pure-tone averages (PTAs).
Since SHL was first described 62 years ago [5], various etiologies have been proposed, including the infectious, traumatic, neoplastic, immune, ototoxic, vascular, ischemic, neurological, and metabolic.
Group V included patients with more than a 30-day history of SHL who were treated with nicotinic acid, papaverine hydrochloride, and vitamin A. If audiometric improvement occurred, the treatment regimen was maintained for up to 10 days.
Possibly these discrepancies in the prevalence of upper-airway infection accompanying SHL are the result of geographical differences. In two patients, the diagnoses were made based on a clinical history of vasculitis (Churg-Strauss syndrome) and thrombophilia, respectively.
This was also observed in our study in which low-frequency PTA normalized in 28 cases as compared with 15 cases of high-frequency PTA normalization. In our study, dextran was not found to act as an adjuvant to dexamethasone or acyclovir in the treatment of SHL, as the patients presenting the best response to treatment were those in the group not treated by dextran. Re-evaluation 3 years post treatment revealed significant bilateral hearing loss (Figure 3c). Occasionally, some patients experience progressive hearing loss, creating the need for cochlear implantation. However, it has been our experience that many patients with sensorineural hearing loss from radiation exposure exhibit significantly poor speech understanding, typically poorer than would be expected in the presence of better pure tone thresholds. Delayed onset and progressive hearing loss have been documented in patients treated with platinum-based chemotherapy and cranial radiation therapy. White's research interests include the long-term effects of ototoxic medications, specifically hearing loss progression.
Her audiological interests include diagnostic audiology, ototoxic monitoring, and clinical research. Ototoxicity in children receiving platinum chemotherapy: Underestimating a commonly occurring toxicity that may influence academic and social development.
Late onset hearing loss: a significant complication of cancer survivors treated with cisplatin containing chemotherapy regimens. A DNA cheek brush sample was taken from each dog for possible future study.Two hundred and sixteen Border Collies were tested with the Brainstem auditory evoked response (BAER) hearing test at two herding trial events, one in Virginia and one in Pennsylvania. This case represents a patient who was exposed to radiation levels above 35 Gy but did not experience hearing loss until approximately 3 years after treatment. Thus, the patient may not perceive benefit from conventional hearing aids and ultimately reject amplification. For these reasons, long-term monitoring is imperative to ensuring proper management of patients exposed to ototoxic agents. Sensorineural hearing loss after radiotherapy and chemoradiotherapy: a single, blinded, randomized study. A survey was developed which was completed by the dog owners, that indicated that the hearing loss was gradual, not sudden. The stimulus intensity used was between 70 and 80 dB which is within the range recommended by the Orthopedic Foundation for Animals for their certification program.
We observed significant improvements in PTAs after 180 days of treatment and noted a significant linear correlation between time from SHL onset to initial visit and recovery. The low-frequency PTA was determined by averaging the pure tones of the 250-, 500-, and 1,000-Hz frequencies, and the high-frequency PTA was based on those of the 2,000-, 4,000-, and 8,000-Hz frequencies. While high frequencies are typically affected initially, some patients present with atypical hearing loss configuration as evident in this example.
The BAER testing was performed at 21 Hz, which is within the effective range reported by Wilson et al. We determined audiometric evolution of the responses in the different treatment groups by subtracting baseline PTA from final PTA (after 180 days of treatment). Pitkaranta and Julkunen [21] investigated the protein MxA (a specific marker of systemic viral infection) in patients with SHL and found evidence of viral etiology in 6.5% of the cases. Qaddoumi and colleagues (2012) demonstrated that infants treated with carboplatin at less than 6 months of age were at greater risk for developing ototoxicity compared with older children treated similarly. Trial use of other options, such as FM technology or CROS hearing devices, is often recommended and can be successful, particularly for patients with asymmetrical hearing loss. In the treatment of SHL, dextran provided no more benefit than did dexamethasone or acyclovir.
We found mumps (paramyxovirus) to be the most common etiology, although we did not test for influenza or parainfluenza. Ongoing counseling and coordination of services with educational audiologists, specialists with hearing impairment, speech-language pathologists, and other professionals are important in helping patients return to the classroom and receive the appropriate resources they need to succeed.
Long-term sensorineural hearing deficit following radiotherapy in patients suffering from nasopharyngeal carcinoma: a prospective study. Severe ototoxicity following carboplatin-containing conditioning regimen for autologous marrow transplantation for neuroblastoma. These discrepancies can be attributed to the difficulty of making the viral diagnosis, given that the time to the first medical visit (interval between the onset of SHL and blood collection) varied from study to study, which can influence seropositivity. Of note in our study and in a previous study [22] is that some of the patients presented seropositivity for the bacterium that causes Lyme disease.

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