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42 year-old male with no significant medical history presenting to ENT clinic after referral from PMD for perforated TM. Since then, the patient has not had any further ear pain or discharge but is left with persistent and constant hearing loss and ringing (high-pitched, non-pulsatile).
AD: Decreased acuity to finger rub, EAC with some cerumen, cleared to reveal central perforation in posterior-superior quadrant of tympanic membrane. The Mid Essex Clinical Commissioning Group has approved recommendations to delay a decision on proposals to stop funding hearing aids for mild hearing loss. Comments are not edited by Ipswich Star staff prior to publication but may be automatically filtered.
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Today, one in five teens suffer from some form of hearing loss, a 31% increase since the mid-90s. After my ear drum burst following an airline flight, I suffered a loss of hearing in one ear and had ringing in that ear for several weeks. While we can’t always prevent certain types of hearing damage, such as my ear drum bursting on that occasion, we definitely can prevent Noise Induced Hearing Loss.
If you or you child is continually exposed to loud noise over time, the symptoms of NIHL will appear gradually.
The degree of hearing loss will increase over time as sounds may become distorted or muffled, eventually making it hard for the person to understand speech.
For our kids, loud noise exposure often occurs at rock concerts and other types of recreational music and sporting events.
If you have a girl, suggest that she simply keep her hair down covering her ears and no one else will notice the ear plugs. As damaging as rock concerts are to teens’ hearing, another huge problem is the high volume they listen to music through earbuds and headphones. And make sure your kids aren’t sneaking earbuds into their ears while they go to sleep. Go for walks together as a family and enjoy the quiet and subtle sounds of birds and nature. While the statistics are scary, remember that knowledge is power and that Noise Induced Hearing Loss is completely preventable.
Explain to your kids about the dangers of listening to loud music or games for extended periods of time and help them set limits. 3.Conway H, Simmons J, Talbert TThe purposes of occupational medical surveillance in US industry and related health findings. The patient last had normal hearing approximately 1yr ago when he noted acute onset of right ear pain, discharge, hearing loss and ringing in the setting of fever and a productive cough. The patient describes a history suggestive of acute otitis media complicated by TM perforation.
As the damage occurs slowly over time, the person with NIHL may not even realize what is happening. While Tinnitus may subside over time, it can continue constantly or reoccur occasionally throughout your life. But I admit… it might be difficult to convince your teens to wear earplugs when they head off to a rock concert. Their ears are continually attached to devices blasting out music, movies, TV or the sounds of violent games. There is one type of headphone from Puro Sound Labs that limits the volume of their Child’s headphones to 85dB.
The closer the sound source is to the delicate working of the inner ear, the more damage loud sound can do. Without good attenuation, your child will crank up the volume to compensate for background noise.

The majority of damage to teens hearing is due to listening to loud music for extended periods of time. For true peace of mind, and to help get your kids on board, get them the Puro Sound BT2200 Studio Grade Children’s Bluetooth Headphones that limit the volume to a safe 85dB.
This number is expected to rise as the US population ages, and with the high popularity of personal listening devices. Prevalence of hearing loss and differences by demographic characteristics among US adults: Data from the national health and nutrition examination survey, 1999-2004.
Hearing difficulty attributable to employment by industry and occupation: An analysis of the national health interview survey-United States, 1997 to 2003. Exposure to hazardous workplace noise and use of hearing protection devices among US workers-NHANES, 1999-2004. Hearing conservation for farmers: Source apportionment of occupational and environmental factors contributing to hearing loss.
The impact of hearing impairment, perceptions and attitudes about hearing loss, and noise exposure risk patterns on hearing handicap among farm family members.
The relationship between self-reported difficulty with hearing in the worse ear and the better ear. A comparison of self-reported hearing and pure tone threshold average in the Iowa farm family health and hazard survey.
Factors influencing use of hearing protection among farmers: A test of the Pender health promotion model. He does not recall an inciting event (trauma, swimming) to this initial episode, and had no previous history of ear infections. Persistent perforation seen on examination today can result in the tinnitus and hearing loss the patient complains of. If you have any suggestions or experience problems with the web site, don't hesitate in contacting me.
Their constant use of earbuds and headphones listening to music and playing games on their smart phones, computers and TVs actually brings a huge risk of Noise Induced Hearing Loss (NIHL). We need to understand what it is, what the risks are, and how we can protect our children’s hearing from damage. He saw his PMD several days later, was told he had a perforated ear drum and was treated with antibiotics.
However the marked sensorineural component remains unexplained, particularly given the patient reported previously normal hearing. I was used to regularly attending rock concerts and felt like the ridiculously loud volume of the music was part of the experience. This condition is among the most common work-related diseases, and the second most self-reported occupational disease or injury. While there is some evidence that acute otitis media can lead to sensorineural hearing loss, it is typically only mild and only in high-frequency ranges.1,2  Plan for further evaluation with repeat audiogram and MRI IAC, RTC when studies completed. Its current annual budget from the Government is A?14m below its funding target for the current financial year. The USDA estimates that there are about 3,281,000 farm operators, [5] and over 1 million farm laborers. While audiometric testing is considered the gold standard, the equipment, personnel, and costs of administering these tests may be prohibitive in some settings. However, questionnaires are subject to bias, and there are few studies evaluating the validity of these measures, [16] and no such studies used a sample of farm operators.
Establishment of the validity of a self-reported measure of hearing ability would aid in the estimate of the prevalence of hearing loss among subpopulations, such as farm operators, and would provide useful information in the prioritization of health services and development of health policy.Results of selected investigations of self-reported measures of hearing ability are summarized in [Table 1]. Of these studies, [16],[17],[18],[19],[20] sample characteristics, questions used, and analysis methods are greatly varied, making comparisons between studies difficult.
Most studies used general samples of adults, with the exception of studies by Gomez [18] and Choi, [20] who used samples of farmers. The items included in the questionnaire are different from items used by other researchers.
However, a review of the literature failed to reveal any reports of studies establishing the validity of the questionnaire. The purpose of this study was to compare the results of the NIDCD questionnaire with audiometric screening as a method of identifying persons at risk for hearing impairment who may benefit from a medical referral.
Study participants included attendees of a regional farm show who were at least 18 years of age and active in farming operations at least 20 hours per week.

The screening protocol provided the immediate referral of persons with the listed concerns. Pure tones were presented in each ear in the following order: 1000, 2000, 4000, 6000, 8000, and 500 Hz. Each frequency was presented at 5 dB and progressed by 5 dB increments until participants indicated they heard the tone. Testing took place in a quiet room using a recently calibrated manual audiometer (Maico model MA20 series 102, Maico, Eden Prairie, MN).
Following administration of the screening audiometry, results of the test were interpreted for the client, and an individually tailored educational session addressing the person's risk for NIHL and implications for self-care was provided. Low frequency hearing loss was defined as binaural hearing thresholds (non-weighted mean of both ears) averaging greater than 25 dB at 500, 1000, and 2000 Hz.
Mid-frequency hearing loss was defined as binaural hearing thresholds averaging greater than 25 dB at 1000, 2000 and 4000 Hz.
High-frequency hearing loss was defined as binaural hearing thresholds averaging greater than 25 dB at 4000, 6000, and 8000 Hz.Hearing questionnaire responses were coded and scores were calculated using the NIDCD criteria (three or more positive responses qualify a failure) and SPSS (version 17) software.
Measured hearing status was determined for each of the three separate definitions of hearing loss. Chi-square analysis and Kappa statistic were conducted for each of the 10 hearing questionnaire items for each of the three frequency ranges tested. ROC curves were used to analyze the relationships between sensitivity and specificity of the questionnaire. Most respondents were men (88%), White (97%), working on family-owned farms, and producing crops. The item receiving the lowest number of affirmative responses was, "Do you have a problem hearing over the telephone," with 24% of the sample responding yes.
Pure tone audiometryMean binaural threshold averages for three frequency ranges were calculated, and are displayed in [Table 4]. Conversely, the percentage of non-hearing impaired people who would be correctly identified as not having hearing loss ranged from 37 to 43. ROC curves incorporate sensitivity and specificity measures, indicating the ability of the questionnaire to correctly classify those with and without the disease. ROC curve analysis of this sample suggested that the level of performance of the questionnaire was fair to poor. Three items (1, 4, and 7) showed moderate agreement with mid-frequency audiogram results, suggesting these items may be more useful as screening questions. These findings suggest the potential to select items from the NIDCD questionnaire to develop a revised version that may be useful as an alternative screening method to detect risk of hearing loss and identify the need for medical evaluation of hearing sensitivity, particularly among at-risk and underserved populations.The results of the study reported here can be compared to those of other researchers. Sindhusake's [17] one-item ("Do you feel you have a hearing loss?") questionnaire also had higher sensitivity (but lower specificity) than the NIDCD questionnaire. Other studies found smaller AUC, [19] and lower sensitivity [16],[20] than the NIDCD questionnaire.The sample showed a high rate of risk for hearing loss, with 28 to 57% of participants demonstrating screening threshold averages above 25 dB, depending on frequency range.
This high rate of risk for hearing loss is not unexpected, given the high rate of work-related noise exposure of this worker group, the high rate of hearing loss reported in previous studies, [8],[12],[13],[14],[15] and the low rate of use of hearing protection reported in this population. Moreover, most farm operators experience hearing loss before their risk for NIHL is identified.
While development of policies to deliver hearing health services to this high risk group is indicated, implementation of this is not anticipated in the near future.
Meanwhile, the use of a self-administered questionnaire may present a simple, low cost opportunity to assess the hearing health of workers not included in a hearing conservation program, and to initiate a referral for medical evaluation of hearing.
The results of the study reported here suggest that the performance of screening questionnaires vary significantly, and while less desirable than audiometry, the Gomez and Sindhusake instruments might perform the best in this group.This study used a small, convenience sample of farm operators, limiting the generalizability of results.
Screening audiometry was conducted in field conditions that were less controlled than that found in clinical settings where diagnostic testing is conducted. Consequently, the screening audiometry results may have included some biases resulting from measurement or other errors such as occasional background noise. Further, the qualifications of examiners were not comparable to that of licensed and experienced professional audiologists or other hearing specialists, possibly introducing additional errors of measurement. The study should be repeated using standardized clinical equipment and procedures with licensed audiologists, and should include an evaluation of its cost effectiveness.

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