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24.04.2015
Introduction: The correlation between hearing loss with tinnitus can be justified if we consider that this is a tinnitus-causing factor, since the impairments or degenerations on the inner ear and the vestibulocochlear nerve can cause the tinnitus. INTRODUCTIONHearing loss is a factor apart from the attack degree affecting the people's quality of life, and when it is acquired in adults, it gradually appears and it makes oral language difficult (1). How to cite this article Caldas FF, Silva IMC, Teixeira MS, Deperon TM, Cardoso CC, Barreto MASC, Oliveira CACP, et al. OBJECTIVE: To evaluate the prevalence of misdiagnosis of the hearing impaired children, in order to investigate the existence of Auditory Neuropathy Spectrum Disorder.
METHODS: Analytical, prospective study conducted with 15 participants (30 ears) aged 10-12 years, with bilateral sensorineural hearing loss, attending a Hearing Rehabilitation Center, accompanied by a multidisciplinary team with otolaryngologist, audiologist, psychologist, teacher and social worker. The current advances in technology and in newborn hearing screening are permitting an earlier diagnosis of hearing loss, improving ENT evaluation and speech therapy focused on speech and language stimulation, aiming the development of auditory skills. The combination of speech therapy, ENT and audiology interventions added to family support and systematic use of hearing devices provides a better prognosis for hearing impaired children in general2. In the last, care assistance and technology available to outpatient services for the diagnosis of hearing loss in children often did not allow to diagnose the ANSD, whereas nowadays newborns can receive an early diagnostic of ANSD due to electroacoustic evaluation methods such as: Otoacoustic Emissions (OAE) and Auditory Brainstem Response (ABR)3.
Individuals with ANSD usually present impaired speech intelligibility and pure tone detection thresholds at levels ranging from normal to severe. Some patients with this disorder report the occurrence of fluctuations in hearing, with so-called "good hearing days" and "bad hearing days"4, besides the complaint of difficulty in understanding speech, especially in the presence of background noise5. Objective tests, such as OAE, ABR and acoustic efferent reflexes, evaluate the function of peripheral and central auditory pathways. The ANSD is characterized by hearing loss with absent or severely altered ABR, normal function of OHC obtained by present OAE and the presence of cochlear microphonism (CM)7. The increasing number of newborn hearing screening programs that uses methods such as OAE and ABR is significantly contributing to the diagnostic of neural hearing loss in newborns and young infants.
To evaluate hearing impaired children, aging from 10 to 12 years old, who are hearing aids users, in order to investigate the existence of Auditory Neuropathy Spectrum Disorder (ANSD). It was conducted an analytical and prospective study, with 15 children (30 ears), from a Hearing Rehabilitation Center that were accompanied by a multidisciplinary team, composed by otolaryngologist, audiologist, psychologist, teacher and social worker, in Brasilia - DF, in Brazil. A questionnaire11 was applied with parents of the participants to identify the profile of each participant in terms of prenatal, perinatal and postnatal development, facts related to development of hearing and use of hearing aids. Pure tone audiometry data (performed maximum 6 months before the beginning of this study) was extracted from patient file.
The Ethics Institutional Review Committee for Research with Human Beings approved this study (Opinion no.
In Table 2, the results obtained are described in electroacoustic and electrophysiological assessments that were performed.
Figure 1 shows that 26.7% of ears tested (6 participants) had auditory system pre-neural and neural evaluation results, compatible with ANSD with absent ABR and presence of CM. Figure 3 shows the result of OAE test, in the ears that had presence of OAE in isolated frequencies, but with "fail" in the final test result.
In Figure 4 there is a correlation between the duration of use of hearing aids and ears that show presence of OAE in single frequencies in children with characteristics of ANSD.
The diagnosis of hearing loss in participants of this study occurred between 3 months to 11 years old.
The electrophysiological measures of auditory function had a great importance in order to understand the alterations that were found in this study. Despite the plastic tube of insert phones were not tied up during the ABR test in order to confirm the presence of the CM5, OAE test was performed.
The features found in physiological tests in this study were consistent with results found in literature. Another study with a 59 participant sample12, three of them were diagnosed with auditory neuropathy by presenting present OAEs, absent ABR and extended CM.
Newborn hearing screening was not performed with participants of this study by the time they were born, since there was no implementation of universal newborn hearing screening programs in the hospitals where they were born.
Some patients with ANSD have Absent OAEs, but show signs of hair cells function that are evident in the CM, which is an electric evoked potential of hair cells that can be recorded in a non-invasive way with the ABR test8.
All participants who presented characteristics of the ANSD in this study were fitted with hearing aids, and showed present OAEs in isolated frequencies. The results of this study have identified characteristics related to ANSD in 26.7% of ears tested, 6 participants with age over 10 years old. This study leads to a reflection on the lack of early diagnosis in ANSD that may have hindered the adequate intervention with hearing aids, hearing tests, and specific therapeutic monitoring in this population. Paper submitted to the ITJ-SGP (Publishing Management System) on September 7, 2013; and accepted on October 7, 2013.
Proprietor of Croak Audio Exploration.Fair, not crazy, cash paid for turntables and tonearms from Rega, Linn and Thorens. I suppose the real message here is that you can get to very high spl levels pretty quickly with cans and best be aware that your hearing is in danger whenever you feel like turning the volume knob.
AbstractBackground : Cisplatin-induced ototoxicity shows high interindividual variability and is often accompanied by transient or permanent tinnitus. Materials and Methods : Fifty-seven patients scheduled for cisplatin-based chemotherapy were included in the study.
Results : The subjective hearing loss was found in seven patients, while six patients had tinnitus during the chemotherapy. Conclusion : As use of high-frequency audiometry is still limited in research work only, we need a strict protocol of adding high-frequency audiometry in the cisplatin-based chemotherapy regimen. IntroductionCisplatin contributed significantly in the early success of modern chemotherapy for solid tumors and today, cisplatin is a primary drug for testicular cancer, medulloblastoma, osteogenic sarcoma, cervix and ovarian cancers.
During follow-up, seven patients complained of subjective hearing loss and six had tinnitus at the time of first follow-up but none had both complaints. DiscussionCisplatin induced ototoxicity compromises, [11] development of language, cognitive functions, learning ability, communication and quality of life in terms of isolation and depression. According to different reports, 85%-96% of patients with tinnitus show some degree of hearing loss. According to Brazilian Otology Society - SBO (2005) (2), the hearing loss attacks around 70% of the individuals, hence it is a matter of public health with specific requirements regarding health promotion and hearing rehabilitation.The positive correlation between hearing loss and tinnitus can be justified if we consider that this is the tinnitus-causing factor, since damages or degenerations on the inner ear and the vestibulocochlear nerve can cause tinnitus (3-6). The participants underwent ENT examination and audiological assessment: tympanometry, acoustic reflexes, otoacoustic emissions test and Auditory Evoked response. Within the selected eight ears, six (75%) showed presence of otoacoustic emissions test in isolated frequencies and two (25%) ears had otoacoustic emissions test even in the presence of the isolated frequencies. The development of these skills with focus on auditory information and appropriate speech expression is only possible due to technological devices such as cochlear implants and hearing aids1. Nonetheless some children, even under ideal conditions of stimulation and support since early childhood, shows auditory and language skills in a level below from what is expected for children of the same age. Unlikely patients with sensorineural hearing loss that present clinical features compatible with impaired function of the inner and outer hair cells, patients with clinical evidence of ANSD have normal function of outer hair cells (OHC)4.


It has been seen that the ANSD affects the individual's ability to process quickly changes in the acoustic signal, which means that it affects the auditory temporal process4. Although measures of auditory behavior of central function provide general information on communication performance, objective measures show high sensitivity in neural testing6.
Through tests such as OAE and ABR, it is possible to identify if the eighth cranial nerve (vestibulocochlear) function is altered, considering that in ANSD cases the OHC function may be normal5.
From this population, children that were screened and presented abnormal ABR and presence of OAE were the first ones where the presence of a neural hearing impairment was suspected8. The amplification given by hearing aids is used to improve the loss of sensitivity and it usually results in good outcomes to speech perception.
Middle ear disorders evidenced in tympanometry results were considered as exclusion factor.
They belong to a family of three children with hearing loss with late diagnostic, this is due to the inexistence of newborn hearing screening by that time and to the degree of hearing loss that was not as impactful to the development of auditory skills, so it took time to parents to realize that their children have hearing loss. FROM These ears, 6 (75%) showed presence of OAE in isolated frequencies and 2 ears (25%) absence in OAE. Similar data was observed in a study7 where 218 deaf children were evaluated and, in most cases, were diagnosed between 11 months to 12 years of age (mean age 4 years).
In this test cochlear function responses were obtained in some isolated frequencies, what maintains the reliability of the CM research, which is also a response from the cochlear function. In a study where 10 patients were evaluated in order to find the presence of ANSD, 8 showed evidence of auditory neuropathy. Four other participants had absent OAEs and present ABR, although, when the polarity of stimulus were inverted it was observed a mirror image, which is compatible with CM.
There is therefore no way to know whether or not these children would have the present OAE in all frequencies, indicating integrity of the cochlear function (OHC). In other studies there is no information whether this loss of cochlear function that happens in ANSD begins at high frequencies or low frequencies, or even if it occurs randomly. The same was observed in another study14 where 18 ears (11.7%) with ANSD fitted with hearing aids.
Professor of the University of Center Plateau - UNIPLAN PhD in Health Sciences from the University of Brasilia - University of Brasilia - Brasilia - DF - Brasil. Specialist in Otology and Neurotology by Harvard Medical School, Boston, MA, USA, PhD in Medical Sciences from the University of Brasilia, Professor at Health Sciences School - University of Brasilia - Brasilia - DF - Brazil.
It is not possible to identify the susceptible individuals before commencement of the treatment.
All patients were divided into three groups depending on the dose of cisplatin infused in 3 weeks. The hearing loss was sensorineural, dose dependent, symmetrical, bilateral and irreversible.
Cisplatin is a cell cycle-nonspecific cytotoxic drug and has a toxic profile that is different from other important cytotoxic drugs. No patient had distant metastasis, and hence none underwent cranial radiation for treatment.
The tinnitus was present in one subject of Group 1 (50-year-old male) and group 3 (34-year-old male), while group 2 had 4 patients (mean age 50 years).
Eight patients had significant hearing loss at Fisher′s scale and this loss was observed in 11 of 12 patients at 4 and 6 KHz. In all three groups, hearing loss was sensorineural, irreversible and symmetrical, and there was no sex predilection. Predicting cisplatin ototoxicity in children: The influence of age and the cumulative dose. Ototoxicity of high-dose cisplatin by bolus administration in patients with advanced cancers and normal hearing. Evoked otoacoustic emissions--an approach for monitoring cisplatin induced ototoxicity in children. Ototoxicity in children receiving platinum chemotherapy: Underestimating a commonly occurring toxicity that may influence academic and social development. Platinum compound-related ototoxicity in children: Long-term follow-up reveals continuous worsening of hearing loss.
Left-right asymmetry in hearing loss following cisplatin therapy in children--the left ear is slightly but significantly more affected.
Ototoxicity of cis-diamminedichloroplatinum (II): influence of dose, schedule and mode of administration. The role of hyperbaric oxygen therapy (hot) as an otoprotection agent against cisplatin ototoxicity. Ototoxicity in a randomized phase III trial of intra-arterial compared with intravenous cisplatin chemoradiation in patients with locally advanced head and neck cancer.
Early changes in auditory function as a result of platinum chemotherapy: use of extended high-frequency audiometry and evoked distortion product otoacoustic emissions. Detection of late ototoxic side effect of cisplatin by distortion otoacoustic emission (DPOAE).
Objective: To correlate the sex, age, degree and type of hearing loss with the tinnitus disorder in patients at the Electronic Devices-related Clinic of Deafness).
It was found that 26.7% of the ears tested presented results that are compatible with Auditory Neuropathy Spectrum Disorder. One possible explanation for this fact is the presence of undiagnosed Auditory Neuropathy Spectrum Disorder (ANSD). In contrast, a dysfunction of the auditory nerve may not impact auditory sensitivity significantly, but it usually jeopardizes speech understanding, which is generally poor in these cases. All participants presented bilateral sensorineural hearing loss, from moderate to profound classified as frequency average10 and were hearing aid users. The age that caregivers' suspected hearing loss occurred between 15 days to 11 years, the age of diagnosis occurred between 3 months to 11 years, beginning of speech therapy occurred between 3 months and 11 years and the beginning of hearing aid use occurred between 12 months to 11 years. This results shows that the diagnosis of hearing loss is still happening late, even with the advances in technology for diagnostic methods.
In the literature, other authors agree that there is a higher prevalence of profound hearing loss.
It was observed that 26.7 % of ears evaluated (6 participants) presented characteristics of ANSD in the pre-neural and neural auditory system assessment, revealing absent ABR with the presence of CM. This disorder is characterized by normal function of OHC (Presence of OAE and CM) and abnormal function of the auditory pathways beginning in the eighth cranial nerve (absent or severely abnormal ABR). What showed evident in the results of OAEs in this study were OAE responses in isolated frequencies.
The results showed that the decrease in the amplitude of the OAE in the ears fitted with hearing aids was higher than the non-aided ears. Language, speech, and social-emotional development of children who are deaf or hard of hearing: the early years.


O envolvimento do pai no processo de (re)habilitacao auditiva de seu filho deficiente auditivo. Guidelines for identification and management of infants and young children with auditory neuropathy spectrum disorder. Persistence of otoacoustic emissions in children with auditory neuropathy spectrum disorders. Postgraduate Speech and Audiology, Education Psychology and Audiology and Neurotology, Master of Health Sciences (UNB-DF). So I downloaded a SPL meter from the Apple store and was also surprised by how loud it was.
We conducted a prospective, randomized and observational study in a tertiary care centre and evaluated the effects of different doses of cisplatin on hearing.
High doses of cisplatin cause nephrotoxicity, gastrointestinal toxicity, neurotoxicity and ototoxicity.
During radiation for the head and neck cancers, ipsilateral temporal bone and ear of patients were protected by beam-modification devices (shielding block made up of lead) so as to avoid any affect of radiation on hearing.
This is because the auditory nerve is the main pathway to the transmission of neural code for speech.
From these ears, 75% showed present OAEs in isolated frequencies, however, without reaching the criterion "pass" in the test. These results emphasize the possible role of amplification in the reduction of otoacoustic emissions in ANSD14. I did however figure out that there is quite a jump in the reading when you slip the phone in between our ear and the ear-pad and then try to keep that seal, than by holding your phone next to the drivers. Ototoxicity is one of the dose-limiting side effects of cisplatin because it increases with increase in the dose.
Of 9 patients, 6 had significant hearing loss at 8 and 12 KHz, while only 4 of 7 patients showed significant hearing loss at 16 KHz.
Cisplatin blocks transduction channels within the outer hair cells of the cochlea and causes progressive destruction of outer hair cells, inner hair cells and supporting cells within the organ of Corti.
Results and Conclusion: Sex, age and degree of hearing loss do not have an influence over the tinnitus disorder, but the hearing loss in tinnitus listeners is progressively bigger according to age and in individual with neurosensorial hearing loss. It consists of a sensation deemed to be illusory that can be characterized as a noise similar to that of rain, sea, running water, bells, insects, whistles, squeaking, doorbell, pulsation, among others.
In general, amplification may not improve understanding of speech when the auditory nerve is compromized8,9. Thus, the absence of OAEs or presence in isolated frequencies does not exclude the ANSD diagnosis13.
This sensation can be continual or intermittent and it can show different tone characteristics, be intense or soft, as well as be noticed in the ears or head (10-13). Cisplatin-induced ototoxicity is often accompanied by transient or permanent tinnitus [4],[5] and shows high interindividual variability. All included patients underwent a detailed history, clinical examination, hearing (tuning fork tests and pure tone audiometry) and vestibular functions assessment (bithermal caloric, positioning and positional tests), blood (complete hemogram, liver and renal function tests) and urine analysis.
Cisplatin ototoxicity is also associated with the generation of reactive oxygen species, depletion of intracellular glutathione and interference with antioxidant enzymes within the cochlea. In this study, hearing assessment was done before starting cisplatin therapy and at one and three months after cisplatin infusion.
Identification of susceptible individuals before commencement of the treatment is not possible; however, early ototoxic effects can be detected by high-frequency audiometry [7] and otoacoustic emission. Materials and MethodsThis study was conducted in the Departments of Otolaryngology- Head and Neck Surgery, and Radiation-Oncology (Regional Cancer Centre).
Few studies [14],[15] involving follow-up to two years had also found irreversible hearing loss by cisplatin. We found no correlation between age and hearing loss or between baseline hearing level and cisplatin-induced hearing loss.
Group 2 comprised 35 patients (21 male and 14 female) of whom 23 had various head and neck cancer (excluding larynx) and the remaining 12 were suffering from carcinoma of the cervix. The maximum increase in the hearing threshold after cisplatin administration was 45 dB at 8 KHz in both ears of a 43-year-old patient. In Group 2, cisplatin caused a maximum increase of 40 dB in the hearing threshold at 12 KHz in the hearing threshold of right ear in a 19-year-old patient. In the left ear, uniform increase of about 30 dB was observed in hearing threshold at all frequencies in all age groups. Few authors [20],[21] have found relationship between free circulating cisplatin in plasma with time. They found that cisplatin infusion during afternoon and evening results in low plasma levels of free cisplatin, and hence cisplatin administrated during the early evening hours results in fewer side effects including ototoxicity. Measurement of correlation between time and plasma concentration was beyond the scope of this study. We found no correlation of tinnitus with the dose of cisplatin or age, which was comparable to the study by Moroso et al . The risk of permanent hearing damage from platinum chemotherapy is stimulating the development of otoprotectants for coadministration with platinum to reduce hearing damage without affecting the antitumor activity of the platinum agent.
There are numerous otoprotectant agents under research, which include aspirin, antioxidants, [24] intratympanic dexamethasone [25] and hyperbaric oxygen therapy, [26] Ginkgo biloba extract, [27] diethyldithiocarbamate, [28] lipoic acid, [29] adenosine agonist, [30] vitamin E [31] and sodium thiosulfate.
Although, the importance of high-frequency audiometry in cisplatin chemotherapy was established about 25 years earlier, [33] but in majority of the centers including our department, it is used only during research work. However, lack of infrastructure, non-availability of high-frequency audiometer and audiologist is a major problem in these centers, especially in our country.
To conclude, we all know that cancer patients are living in physical and mental agony and cisplatin-induced ototoxicity further enhances this morbidity. Audiological monitoring is an essential part of the management of adults and children receiving platinum-based chemotherapy.
Although few authors [12],[34],[35] found distortion product otoacoustic emission as a better method of detecting cisplatin-induced early ototoxicity but high-frequency pure-tone audiometry is the first choice due to its high sensitivity. High-frequency monitoring alerts the physician of early ototoxic effects, who has opportunity to change a patient′s course of treatment.
Therefore, high-frequency audiometry should be included in the cisplatin-based chemotherapy regimen. Increase in the dose of cisplatin lead to increase in ototoxicity that warrants further research to find therapeutic efficacy of low-dose cisplatin or a better substitute of cisplatin.
Otoprotective drugs are still at experimental level but may be beneficial in cisplatin ototoxicity.AcknowledgmentDr RS Minhas provided general help in this research work.



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Comments Is there a correlation between tinnitus and vertigo

  1. BubsY
    Considerably analysis has been completed into Meniere's disease out the.
  2. jhn
    Movement, according to the National Institutes of Well liking issues you like.
  3. Turchanka_18
    Do not neglect that drug side effects have off, like a barking dog these.
  4. Alexsandra
    Have eardrum injuries, tinnitus or hearing loss.
  5. KOVBOY
    Frequently describe tinnitus as ringing, hissing.