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Author: admin, 16.01.2016. Category: Cause Of Ringing In Ears

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. This article was presented at the 12th United European Gastroenterology Week, 2004, in Prague, Czech Republic. JavaScript is currently disabled, this site works much better if you enable JavaScript in your browser.
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 sample was made up of 214 teenagers from a high-school in Mexico City; subjects were selected randomly per strata.
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.
All patients and control subjects had normal otoscopy findings and tympanometry was unremarkable, excluding middle ear disease and conductive hearing loss. 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. We applied a questionnaire to identify risk factors for hearing loss and performed a battery of audiologic tests consisting of otoscopy, tympanometry, and pure-tone audiometry. 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. Analysis of each frequency examined showed that the average hearing thresholds were increased significantly in the study group compared to those of the control group at higher frequencies (2, 4, and 8 kHz). Roughly speaking, the frequency patterns of hearing loss are divided up into: Low-frequency, mid-frequency, high-frequency, notches, and flat. When these parameters were compared with the control group according to subgroups of IBD, a significant difference was determined for the UC group at frequencies of 2, 4, and 8 kHz and for the CD group only at the frequency of 4 kHz. Although there was a trend of increment in SNHL as the age of the patient and duration and extent of UC increased, no significant correlation was observed between SNHL and these parameters or sex, activity, involvement site, medication history of IBD, and coexistence of other extraintestinal manifestations. In conclusion, it was demonstrated that a subclinical SNHL may be associated with UC and somewhat with CD, affecting mainly the high frequencies. In light of this finding, it may be advisable to investigate labyrinth functions as well as other extraintestinal manifestations in patients with IBD. The high frequency of hearing loss in high school students from one Mexico City school (nearly one fifth of the sample) was found to be related to noise exposure mainly during recreational activities. La muestra estuvo constituida por 214 adolescentes de una escuela de la Ciudad de México. Different conclusions are drawn for each population studied depending on their socio-economic and geographic characteristics. In a country such as Mexico, sensorineural hearing loss may be more frequent among populations living in poverty. In rural Nicaraguan children, a sensorineural hearing loss prevalence of 18% was found and was related with middle-ear infections, family history of deafness, dysmorphism, maternal infection during pregnancy, neonatal distress, low birth-weight and ototoxic drug exposure 3.
Nonetheless, we observe in the literature that sensorineural hearing loss prevalence and associated risk factors in teenagers have not been studied.
In this case, the school selected represents a typical public, government-run high-school with students residing within the Mexico City area who are mainly from low- and middle-income families.
Inclusion criteria for the study included being a regular high-school student of either gender aged between 14 and 19 years.
If students did not understand the concept in the question, they received a comprehensive explanation prior to their response.
The otoscopic examination was conducted on the teenagers and each canal was cleaned out, where deemed necessary. Air conduction thresholds were measured for each ear at 0.5, 1, 2, 4, and 8 KHz using the Carhart-Jerger method as described previously 6.
A threshold value was defined as the lowest signal intensity that the child detected monoaurally at least 50% of the time with a minimum of four trials; stimuli were administered in 5-dB-steps. All students received information regarding the results obtained and indications concerning preventive measures to avoid noise-induced hearing loss; if these students already presented hearing loss, recommendations were given to avoid its worsening.
Student t tests and χ2 tests were used to compare quantitative and binomial variables respectively. Other drug consumption was reported by 31% of the study participants, with alcohol abuse predominating (Table 2). Half of the subjects played a ball sport and only 8% engaged in other sports, including swimming (Table 2). Analysis of recreational noise exposure in the three previously mentioned modalities indicates exposure to continuous noise during the past five years on average. No association was found with use of personal stereos and sensorineural hearing loss, in spite of the fact that 30 subjects had been using these for more than five years.
Moreover, in addition to exposure to recreational noise in the form of music, students experience unprotected exposure to considerable noise in school workshops; machinery and tool-making workshops were those with the highest attendance levels (13%). Tympanometry showed transient abnormal curves: Jerger's types "As" and "Ad" were found in 10% and 8% of subjects, respectively, but only 2% presented permanent conductive hearing loss (Jerger's type "C"). 39 subjects showed a mild noise-related sensorineural hearing loss, and five exhibited moderate noise-related hearing loss (Table 4) with bilateral affection in 23 and unilateral in 21 subjects. Of the 67 ears with noise-related sensorineural hearing loss, 48 were not involved in noisy school workshops and only 13 were exposed to machinery and tools workshop.
We measured strength-of-association between hearing-loss risk factors and acoustic trauma.
A moderate association was obtained with four factors, and the highest value was found for pop-music concert attendance and for combined exposure to recreational noise. A significant relationship was found for all three recreational-noise exposure modalities and for noise exposure in school workshops (Table 5). The hearing loss that we found was mainly related to noisy recreational activities, a fact that is a well-recognized risk factor for sensorineural hearing loss 11.
The sample used was proportional to gender and semester in course, and subjects' ages correspond with those of teenagers. Bilateral presentation of sensorineural hearing loss in 23 cases confirms exposure to intense and continuous noise.
The most frequent reported recreational activities among teenagers from our sample correspond to attendance at concerts and discotheques, as well as combining such an activity with the use of a personal stereo, which among other alterations produce changes in the Corti's organ 12,13,14,15,16,17,18,19,20,21,22,23,24. Noises that are greater than 120dB (A), such as those produced by several pop-music groups or those from personal stereos played at a loud volume can result in permanent hearing loss, with a single exposure in some cases.
Impact noise at levels > 140dB (A), such as that produced by drums in bands, can induce immediate hearing loss.
With regard to gender, women maintain better hearing, and characteristics of the environment including direct protection barriers such as the use of ear-plugs, and room conditions.


Hearing loss progression and continuous exposure to noise could lead the teenagers of today to troubles with language comprehension, academic failures, and the use of hearing aids at an average age of 50 which is 20 years earlier than their parents would have had to do the same. Regarding certain hearing loss-associated risk factors, the sample of teenagers studied comprised a special group at risk of sensorineural hearing loss in terms of age. Calculating the association with the pathology revealed that there is a 1.5-times higher probability of suffering a hearing loss among men. In our study, sports showed no significant association; this may be explained because the favorite game of teenagers in Mexico were ball games such as soccer and basketball, sports in which high-level noise-exposure is not-significant.
Exposure to noise in pop-music concerts and to the three modalities of high-level loudness exposure in music by the same subject had a significant relationship that has been reported in the medical literature 12,13,14,15,16,17,18,19,20,21,22,23,24.
Moreover, we must take into account the exposure of teenagers to other noise sources, such as noisy school workshops and fireworks explosions, the first of which showed a significant correlation. More recently, novel methods to assess hearing loss as a result of noise exposure are being employed, such as otoacoustic emissions that can predict lesions prior to their being disclosed by a clinical audiometry, and these are used more frequently to assess exposure to work-related noise 29.
Additional research is difficult to perform due to the lack of resources allotted to this risk group; but teenagers total around 8 million of the population of Mexico, and 60% are high-school students, so further research is necessary.
To search for these antecedents requires the prospective use of otoscopies and tympanometries in personal stereo users to determine alterations in middle ear integrity and function. We must perform larger prospective studies to confirm results from the data of this study, due to the small size and geographic limitations of our sample.
The presence of a high background noise may be the most dangerous factor that impairs discrimination of language sounds in Mexican teenagers with sensorineural hearing loss. We propose that these factors can act alone or in a combined manner to impair cognitive abilities, which depend mainly on hearing in young individuals with sensorineural hearing loss. Several recent studies have shown that sensorineural hearing loss is the most frequently occurring preventable disability and that it can be caused by recreational or occupational sources 34,35. Nearly 22 million Americans between 20 and 69 years of age have suffered irreversible damage. However, no data about sensorineural hearing loss prevalence at these ages in Mexican studies are available. Studies carried-out on the use of hearing protection have demonstrated an increase in hearing trouble for children at ever younger ages 36, suggesting that many sources of noise may already be impacting the hearing of young people. Individuals suffering from sensorineural hearing loss often exhibit reduced psychosocial functions and, increased feelings of isolation, depression, loneliness, anger, fear, frustration, and disappointment in their most productive years of life. These facts must be changed in order to develop hearing conservation programs in teenagers, educating participants on the dangers of exposure to high-noise levels and on ways to protecting their auditory system. Unfortunately, there remains a paucity of educative and health authorities in Mexico for the development of programs of hearing health conservation. Moreover, Mexican teenagers have negative attitudes toward the use of measures of hearing protectors such as ear-plugs, and toward avoiding high levels of music in their leisure time. Thus, data from this study may contribute to alerting both teenagers and authorities to take preventive measures against sensorineural hearing loss in teenagers. We performed a cross-sectional study instead of a prospective follow-up with a more statistical power.
The sample size is small, thus in future studies our team must utilize larger samples in more schools in the Mexico City area. These data merit concern on the part of Health Department authorities, because they reveal that hearing loss in teenagers is a major public health concern in Mexico City.
Prevalence and risk factors for hearing disorders in secondary school students in Ismailia, Egypt. Epidemiological evaluation of hearing damage related to strongly amplified music (personal cassette player, discotheques, rock concerts): high definition audiometric survey on 1364 subjects. Risk of hearing loss caused by high volume music: presenting an educational concept for preventing hearing loss in adolescents.
Noise exposure and hearing loss among student employees working in university entertainment venues. Output levels of commercially available portable compact disc players and the potential risk to hearing. The World Health Organization and the prevention of deafness and hearing impairment caused by noise.
Evaluation of noise-induced hearing loss in young people using a web-based survey technique.
Contributions of non-occupational activities to total noise exposure of construction workers. Hearing deficits in young adults who had a history of otitis media in childhood: use of personal stereos had no effect on hearing. Hearing loss and use of personal stereos in young adults with antecedents of otitis media. Evaluation of acoustical conditions for speech communication in working elementary school classrooms. Hear today, gone tomorrow: an assessment of portable entertainment player use and hearing acuity in a community sample.



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