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As an overview, low frequency (or tone) sensorineural hearing loss (LF SNHL or LT SNHL) is unusual, and mainly reported in Meniere's disease as well as related conditions such as low CSF pressure. Le Prell et al (2011) suggested that low frequency hearing loss was detected in 2.7% of normal college student's ears.
Oishi et al (2010) suggested that about half of patients with LTSNHL developed high or flat hearing loss within 10 years of onset. The new international criteria for Meniere's disease require observation of a low-tone SNHL.
Gatland et al (1991) reported fluctuation in hearing at low frequencies with dialysis was common, and suggested there might be treatment induced changes in fluid or electrolyte composition of endolymph (e.g. Although OAE's are generally obliterated in patients with hearing loss > 30 dB, for any mechanism other than neural, this is not always the case in the low-tone SNHL associated with Meniere's disease. The lack of universal correspondence between audios and OAE's in low-tone SNHL in at least some patients with Meniere's, suggests that the mechanism of hearing loss may not always be due to cochlear damage.
Of course, in a different clinical context, one might wonder if the patient with the discrepency between OAE and audiogram might be pretending to have hearing loss. Papers are easy to publish about genetic hearing loss conditions, so the literature is somewhat oversupplied with these.
Bespalova et al (2001) reported that low frequency SNHL may be associated with Wolfram syndrome, an autosomal recessive genetic disorder (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness).
Bramhall et al (2008) a reported that "the majority of hereditary LFSNHL is associated with heterozygous mutations in the WFS1 gene (wolframin protein). Eckert et al(2013) suggested that cerebral white matter hyperintensities predict low frequency hearing in older adults.
Fukaya et al (1991) suggested that LFSN can be due to microinfarcts in the brainstem during surgery.
Ito et al (1998) suggested that bilateral low-frequency SNHL suggested vertebrobasilar insufficiency. Yurtsever et al (2015) reported low and mid-frequency hearing loss in a single patient with Susac syndrome.
There are an immense number of reports of LTSNHL after spinal anesthesia and related conditions with low CSF pressure.
Fog et al (1990) reported low frequency hearing loss in patients undergoing spinal anesthesia where a larger needle was used. Waisted et al (1991) suggested that LFSNHL after spinal anesthesia was due to low perilymph pressure. Wang et al reported hearing reduction after prostate surgery with spinal anesthesia (1987). We have encountered a patient, about 50 years old, with a low-tone sensorineural hearing loss that occured in the context of a herpes zoster infection (Ramsay-Hunt). LTSNHL is generally viewed as either a variant of Meniere's disease or a variant of sudden hearing loss, and the same medications are used.
All children, especially children with visual impairments, should be screened for hearing impairment regularly. Because many mild or moderate hearing losses can be corrected or treated, good medical management is a must.
Modern surgical procedures have made it possible to correct problems with the ossicles in the middle ear.

Many children with mild or moderate hearing loss can benefit greatly from the use of hearing aids and auditory trainers.
Remember, in order for auditory information to be useful to us, we not only need to be aware of the sound but need to be able to attach meaning to that sound. The UK P&I Club PEME Programme provides an enhanced medical screening service for all crew.
Over the last ten years, the incidence of hearing defects as the main reason for failure has increased by 40%.Hearing defects are now the third main cause of PEME failure. Typically, crew with poor audiometry results also display signs of mild to moderate high frequency hearing loss. To us, this seems a little overly stringent, compared to the earlier 1995 AAO criteria that just required any kind of hearing loss, but criteria are better than no criteria. That being said, genetic conditions should not be your first thought when you encounter a patient with LTSNHL. One would think that diabetes insipidus is so rare that hearing loss is probably not the main reason these individuals are seeking attention. These patients are extremely rare because there isn't much microsurgery done close to the brainstem.
We are dubious about the conclusion of this paper because it is different than nearly every other paper in the literature. We are dubious that this has any applicability to humans and we have never seen a patient with lithium toxicity with any LFSNHL. We have observed this occasionally ourselves, but of course, the usual pattern is a conductive hyperacusis. We find this somewhat plausible as pregnancy and delivery might be associated with spinal anesthesia, with changes in collagen, and with gigantic changes in hormonal status.
These pictures are placed on the audiogram according to the loudness (Decibles) and pitch or frequency (Hertz) of the sound. Many schools provide hearing screenings from time to time, but parents shouldn't rely on these screenings alone. Ear infections usually require medication, and if they are chronic, the insertion of tubes in the eardrum to keep fluid from impeding the movement of the middle ear bones.
It is important that these devices are monitored daily to assure that they are working properly. The difference between the loudness of the sound and the loudness of the other noises in a listening situation is called the signal-to-noise ratio. We may think that constantly talking about everything that is happening is beneficial to the child with hearing loss and especially vision loss.
When a child is visually impaired the need to attach meaning to the sound becomes more important. As part of the PEME examination, crew are screened on all the major body organs and functions.
Seafarers working in engine rooms have a higher tendency to experience hearing disabilities. It is the only diagnostic evaluation relevant to indicate noise-induced hearing loss (NIHL).The screening is performed by an audiometric testing machine within a sound proof booth, which provides an accurate measure of any damage.
A baseline audiometry test to be performed within six months of exposure for all seafarers.The test should ideally be performed when the seafarer has not been exposed to hazardous noise for at least 14 hours.

Seafarers exposed to higher noise levels may be required to attend training on the effects of loud noises on hearing, the purpose of audiometric testing and protective devices available to mitigate the effects of noise damage.
There is a large literature about genetic causes, mainly in Wolfram's syndrome ( diabetes insipidus, diabetes mellitus, optic atrophy, and deafness), probably because it is relatively easier to publish articles about genetic problems. He defined LTSNH as that the sum of the three low frequencies (125, 250, 500) was more than 100 dB, and the sum of the 3 high frequencies (2, 4, 8) was less than 60 dB. In other words, Wolfram's is probably not diagnosed mainly by ENT's or audiologists, but rather by renal medicine doctors, as DI is exceedingly rare, while LTSNHL is not so rare in hearing tests. That being said, it is very rare to encounter any substantial change in hearing after pregnancy. Decibles (dB) is shown on the vertical side of the audiogram and frequency (Hz) is shown on the horizontal top of the audiogram. Rather than a constant chatter, clear and simple statements about what has or is about to happen may be more helpful to the child.
Auditory training for children with identified hearing impairment should be included as a part of each child's educational goals in school. Data collected from the medical examinations is regularly analysed and the results used for identifying trends in crew health.
The Club has noted the largest group of seafarers who are affected by abnormal audiometry results work in engine rooms.
This is especially true for crew who do not use precautionary measures High levels of ambient noise, typically above 85 dBA cause noise-induced hearing loss (NIHL).The negative effects of such levels of noise and higher, depend upon individual physiology and the duration of exposure.
Roughly speaking, the frequency patterns of hearing loss are divided up into: Low-frequency, mid-frequency, high-frequency, notches, and flat.
Speech sounds lie within a area of the audiogram that when outlined resembles the shape of a banana and is refered to as the speech banana.
Specific training to help the child build tolerance for the device and to learn to use the improved signal provided by the device is critical. Carpeting rooms, adding acoustical ceilings, closing doors to noisy hallways, and using study carols are a few of the things that can improve the signal to noise ratio.
This is especially true if the child has multiple disabilities or seems to have trouble processing auditory information. However, parents can also be a major force in the development of these skills through the everyday activities at home. The speech banana is used to help determine what and speech sounds a child may hear with his degree of hearing loss.
Many homes and some classrooms may constantly have a radio, record player or television playing. Too much information makes it even more difficult to sort out what needs to be attended to auditorily. Simply turning off these noise makers can greatly improve a child's ability to function auditorily.

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04.10.2013 admin

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