Epidemiology of Hearing Loss

Epidemiology no longer concerns itself only with infectious diseases. Now it deals with the commoner non-infectious diseases in a population. In epidemiology, we deal with populations and this is the centre of the problem.

Data on more than 30 000 cases of hearing loss were statistically analysed for the period 1966–1971. The number of males was higher than that of females in spite of the fact that, in the population, there is an inverse ration. The ratio of males to females increased as a function of age.

The most frequent diseases were presbyacusis noise-induced hearing loss, sensorineural hearing loss of unknown origin, the different forms of chronic otitis and the consequence of these (cicatrisation, adhesive process, tympanosclerosis).

The grades of hearing loss were determined in the different pathological processes and the distribution of these grades was calculated according to age.

As regards sensorineural hearing loss, it was found that, among the patients older than 40 years, not only did the number of cases increase but the severity of the loss also.

The number of hearing losses due to chronic otitis increased only up to the age group of 20–30 years. The number of cicatrisations, adhesions and tympanosclerosis increased among the older patients also.

The grade of hearing loss caused by different conductive hearing increased with age. This was also observed in cases of tympanosclerosis in spite of the fact that these were clinically healed processes.

The majority of the hearing levels in cases of sensorineural hearing loss remained stationary. Amongst the treated cases, improvement was noted in 8%.

Most cases of sudden hearing loss occurred amongst the older patients (47% improved; 11.7% deteriorated; 41.3% remained unchanged).

Among the cases of sensorineural hearing loss caused by bacterial or viral agents, there was a greater chance for children and for the aged to sustain total deafness.     

Dosimetric parameters associated with conductive or sensorineural hearing loss 5 years after intensity-modulated radiation therapy in nasopharyngeal carcinoma

Background: Most previous studies are separate dosimetric analyses of conductive or sensorineural hearing loss, and they are not conducive to a comprehensive assessment of auditory radiation damage.

Aims/objectives: Our study aimed to evaluate the long-term incidence of sensorineural hearing loss (SNHL) or conductive hearing loss (CHL) in patients with nasopharyngeal carcinoma (NPC) after intensity-modulated radiation therapy (IMRT), and to investigate the relationship between SNHL or CHL and patient factors, treatment-related factors, and radiation dose parameters.

Material and methods: Seventy patients (117 ears) with NPC, who were also treated with IMRT in our hospital from 2006 to 2014, were retrospectively analyzed. Radiation doses to the Eustachian tube (ET), middle ear (ME), cochlear (Co), and internal auditory canal (IAC) were assessed. Pure tone audiometry and impedance audiometry were performed before and during the follow-up period. The relationships between low-frequencies (0.5–2?kHz) or high-frequency (4?kHz) SNHL/CHL and radiotherapy dose parameters were analyzed.

Results: Of the 117 ears studied, 7.69% had low-frequency SNHL, 35.9% had high-frequency SNHL, 23.93% had low-frequency CHL, and 18.80% had high-frequency CHL. The incidence of high-frequency CHL was higher in the T4 group than in the T (1–3) group (p?<?.05). When IAC D_max?>?42.13?Gy or IAC D_mean?>?32.71?Gy, the risk of high-frequency SNHL increased in NPC patients. When ME D_max?>?44.27?Gy, ME D_mean?>?29.28?Gy, or ET D_max?>?57.23?Gy, the risk of high-frequency CHL in NPC patients increased.

Conclusions and significance: SNHL and CHL remain common ear complications after IMRT for NPC. IAC D_max, IAC D_mean, ME D_max, ME D_mean, and ET D_max all need to be carefully considered during the IMRT treatment protocol.     

Sensorineural hearing loss in children: The association with Apgar score. A registry-based study of 392 371 children in Norway

ObjectivesThe causes of congenital permanent hearing loss in children are insufficiently understood. We studied the association of Apgar score 5 min after birth with sensorineural hearing loss diagnosed before the age of 5 years.MethodsWe performed an epidemiological cohort study with data obtained by linkage between The Medical Birth Registry of Norway and the Norwegian County Registry of Children with Hearing Loss. Cases were 327 children born in Norway during the period 1978–1998 with sensorineural hearing loss. Controls were all children in Norway without sensorineural hearing loss born in the same counties and during the same period as the cases (n = 392 044). The associations of Apgar score 5 min after birth with sensorineural hearing loss were estimated as odds ratios (OR) with 95% confidence intervals (CI) by applying logistic regression analyses.ResultsAmong children with sensorineural hearing loss 0.9% (3/327) had Apgar score <3, whereas that was true for 0.1% (304/392 044) of children without hearing loss (p = 0.001, chi square test). The aOR for sensorineural hearing loss was 7.5 [95% CI 2.3–, 24.2] comparing Apgar score <3 to Apgar score 10, after adjustment for birthweight and concurrent birth defects. Most children with sensorineural hearing loss (90%) had Apgar score >8 five minutes after birth.ConclusionsLow Apgar score was associated with childhood sensorineural hearing loss. However, most children with sensorineural hearing loss, had Apgar score >8.     

Is it necessary to screen for hearing loss in the paediatric population with osteogenesis imperfecta?

Is it necessary to screen for hearing loss in the paediatric population with osteogenesis imperfecta? The aim of the study was to assess the necessity of a screening service to detect early hearing loss in the paediatric population with osteogenesis imperfecta. Twenty‐two children were assessed over a 5‐year period. Five children (22.7%) had normal hearing. Fourteen (63.6%) had conductive hearing loss, with 12 children in this group having otitis media with effusion (OME); all had resolution of hearing loss with appropriate therapy. Two children had persistent conductive losses unrelated to OME. Three children (13.6%) had sensorineural hearing loss, with one being detected at the age of 1 year. Existing evidence suggests that hearing loss associated with osteogenesis imperfecta has its onset in the second to third decade of life. Contrary to this, hearing loss was detected in 77.3% (17) of this population with a median and mean age of 9 years. This study would suggest that routine screening is worthwhile in children with osteogenesis imperfecta.     

Auditory brainstem response and otoacoustic emission assessment of hearing-impaired children of mothers who contracted rubella during pregnancy

Conclusions Based on the auditory brainstem response (ABR) results obtained in this study, the incidence of deafness in children whose mothers had rubella during pregnancy is high (29.5%), and deafness is profound in most cases (80%). Vaccinating women of childbearing age against rubella is essential to reduce the number of cases of childhood sensorineural hearing loss caused by gestational rubella.

Objective It has been shown in the literature that, in Brazil, gestational rubella is responsible for ≈21% of cases of deafness in children. The purpose of this study was to assess the incidence of deafness in children whose mothers had rubella during pregnancy.

Material and methods Between February and July 2001, we conducted a prospective study assessing hearing status in 17 children (mean age 6 months). The mothers had serologically (ELISA) confirmed gestational rubella. We recorded ABRs and analysed distortion product otoacoustic emissions (DPOAEs).

Results In 5 children (29.5%), ABRs revealed sensorineural hearing loss, which was moderate to severe in 1 (20%) and profound in 4 (80%). The hearing loss was bilateral in 3 children (60%) and asymmetrical in 4 (80%). Regarding DPOAEs, 7 children (41%) presented no response, and this occurred bilaterally in 4 (57%). All children with abnormal ABRs also presented abnormal DPOAEs. Two children with normal ABRs presented abnormal DPOAEs.     

Chronic suppurative otitis media and sensorineural hearing loss: Is there a correlation?

Traditionally, it has been accepted that chronic suppurative Otitis media is associated with a breakdown in meekanical conduction of sound leading to conductive hearing loss, On;the contrary, there are two schools of thought when it come, to the issue of cpchlear involvement leading to sensorineural hearing loss (SNIIL) in chronic suppura the Otitis media. The present study was undertaken to find out whether a sensorineural component exists in hearing loss associated with chronic suppurative otitis media, A sample of 100 patients of unilateral chronic suppurative otitis media was selected for the Study and their bone conduction thresholds Mere analyzed in relation to the duration of disease using audiometric data. A 24 per cent incidence of sensoineural hearing loss was found in this series, garticularly involving the higher frequencies. Moreover, the incidence of sensorineural hearing loss progressively increased with the increase in duration of chonic suppurative Ouns meadia     

An auditory health program for neonates in ICU and/or intermediate care settings

Auditory screening and early identification and management of patients with hearing loss improve the development prospects of infants.ObjectiveTo analyze the outcomes produced by an Auditory Health Program in neonates managed in an intensive care unit.MethodThis prospective cross-sectional study enrolled neonates referred to the neonatal care unit at hospital CAISM/Unicamp with stays lasting for 48 hours and more within a period of 13 months.Automated monitoring of brainstem auditory evoked potentials was used in the auditory screening of neonates at the time of discharge. Children with poor BAEPs were sent to undergo audiological, otorhinolaryngological, and genetic tests.ResultsAuditory screening was performed for 84.7% of the live births; 39.7% were screened at 30 days or more of age. Diagnostic tests revealed that 63.8% of the children had normal hearing. Incidence of hearing loss was 4%; sensorineural hearing loss was observed in 1.4% of the subjects; 0.24% had auditory neuropathy spectrum disorder; and 2.2% had conductive hearing loss.ConclusionNeonatal auditory screening was not offered universally, and nor was it carried out, in many cases, within the child's first month of life. Screening must be performed before neonates are discharged and in more than one stage. A high incidence of hearing loss was observed.     

Lyme borreliosis, an etiological factor in sensorineural hearing loss?

The incidence of Lyme borreliosis was studied prospectively in 165 patients with acute idiopathic sensorineural hearing loss. The prevalence of positive levels of antibodies against Borrelia burgdorferi was sixfold higher in patients with sensorineural hearing loss than in the general population in Finland. Four patients fulfilled the criteria for Lyme borreliosis. No specific risk factors were found with which to predict the occurrence of Lyme borreliosis among patients with hearing loss. In logistic regression modeling the poor outcome of hearing loss was best explained by advanced age, high-frequency or flat-type hearing loss, and absence of positive levels of antibodies against B. burgdorferi. Although the causal relationship between Lyme borreliosis and sensorineural hearing loss is difficult to verify, we suggest that Lyme borreliosis is a rare but potentially treatable cause of sudden deafness. We propose that in endemic areas antibodies against Lyme borreliosis should be determined in patients with idiopathic sensorineural hearing loss. Received: 22 March 1999 / Accepted: 14 September 1999     

Newborn hearing screening on infants at risk

Objectives

This article presents the results of newborn hearing screenings on infants at risk of hearing impairment at the French University Hospital of Besançon from 2001 to 2007.

Materials and methods

All newborns at risk of hearing impairment were tested according to the method recommended by the Joint Committee on Infant Hearing (JCIH): a two-step automated oto-acoustic emissions (AOAE) program, completed by an auditory brainstem response (ABR) for the positive diagnosis of hearing impairment. The screening started with AOAE on the third day of life, at the earliest. If one or both ears did not have AOAE, the infant was re-tested at which time, should the AOAE again be positive, ABR was performed. When the ABR threshold was 40 dB or more, the infant was referred to an audiologist specialized in infant deafness for diagnosis confirmation and management.

Results

Over the period, 1461 infants were screened, among whom 4.55% were diagnosed as deaf or hard of hearing. Nearly 10% of the infants were lost to follow up. Forty-six children had a sensorineural hearing impairment, of which 34 were bilateral and were managed before the age of 6 months. The risk factors for sensorineural hearing loss were (in order of statistical significance): severe birth asphyxia; neurological disorder; syndromes known to be associated with hearing loss; TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes) infections; family history of deafness; age at the time of screening; and the association of 2 or more risk factors. However, birth weight inferior to 1500 g and premature birth before the 34th week of pregnancy did not show a statistically significant influence on sensorineural hearing loss. Craniofacial anomalies (mostly cleft palate and ear aplasia) were a significant factor for conductive hearing loss.

Conclusion

Our selected hearing screening on infants at risk allowed 60 deaf children access to early management. However, too many children were lost to follow up; which revealed that better information regarding risk of hearing loss must be provided to parents and paramedics and universal newborn screening needs to be performed. The most important result of this study is that in a population of hearing impaired children, with an impairment incidence close to what is commonly reported, the association of several risk factors proves to be a significant additional risk factor for hearing impairment.     

Peripheral hearing loss following head trauma in children

The purpose of this prospective study was to determine the incidence and type of hearing loss occurring in children who suffered head injuries. Fifty children admitted to the neurosurgical service after sustaining head trauma were studied. Neurologic, otologic, and audiologic evaluations were performed. Diagnostic studies included skull roentgenograms and computerized tomography scans. A 32% incidence of conductive hearing loss and a 16% incidence of high-frequency sensorineural hearing loss was found in this group. All patients with temporal bone fractures had conductive hearing losses, but the presence of a skull vault fracture did not correlate with the presence, type, or degree of hearing loss. In addition, there was no correlation between either cause of injury, loss of consciousness, or Glasgow Coma Scale scores and the presence, type, or degree of hearing loss. There was a significant incidence of both sensorineural and conductive hearing loss in this series of patients, which indicates that close audiologic and otologic follow-up is necessary for all head injury patients.     

Identification and diagnostic evaluation of hearing impairments in early childhood in German-speaking infants

The present study was devised to gather epidemiological information to aid in understanding the etiology, identification, and management of children with permanent hearing losses in Lower Saxony as a defined geographical area of Germany. All infants and preschool children were identified in the Department of Phoniatrics and Pediatric Audiology during a 1-year period (October 1994 until October 1995). Forty-four hearing-impaired children were identified, of whom 41 (93%) had sensorineural losses and 3 had pure conductive losses. Thirty-two children (73%) had bilateral hearing impairments. The causes of hearing loss were unknown in 17 children (39%). The median age of identification for the study group was 32 months, with a median age of 35.5 months when fitting hearing aids. Severity of hearing loss was inversely associated with age of identification. Prelingually deaf children had the worst comprehension levels of all children tested psychologically. Results were tabulated and special references to other studies were discussed. Our findings show again that the successful outcome of speech and language development depends on early identification and management of the hearing loss, and on continued assessment of the progress of habilitation. These require a basic assessment of the stage of language development (in perception and expression) as relevant rehabilitation measures. The next step is the treatment of existing linguistic deficits followed by retests at regular intervals.     

Aspirin-induced hearing loss as a model of sensorineural hearing loss

Performance in forward-masking, temporal-integration, and gap-detection tasks was measured in five normal-hearing subjects before and during a five-day period of aspirin use. The drug regimen was 3.9 g per day, taken in four equal doses at 6-h intervals. In the subjects showing substantial temporary hearing loss induced by the aspirin. (1) forward masking declined at about a normal rate as the masker-to-signal interval was increased. (2) the temporal-integration functions were flatter than normal, and (3) detection of a temporal gap was worse than normal at low sound-pressure levels (SPLs) but was essentially normal at levels above about 60 dB SPL. These aspirin-induced changes in performance are similar to the differences observed between normal listeners and listeners with mild sensorineural hearing loss. Thus, temporary, aspirin-induced hearing loss offers promise as a model condition for sensorineural hearing loss. The advantages offered by this model include all those typically attributed to within-subjects experimental designs, as well as the ability to manipulate the amount of hearing loss. Its primary disadvantages are that the hearing loss is not asymmetrically distributed toward the high-frequency region, as it typically is with sensorineural deafness, and there are large individual differences in the amount of temporary hearing loss induced by fixed doses of aspirin.     

Hearing loss in bullous myringitis

Objective

To evaluate the incidence of sensorineural and mixed hearing loss in patients with bullous myringitis.

Methods

Prospective observational study was conducted in a tertiary care medical center.Patients diagnosed as having bullous myringitis in our medical center between 2007 and 2009, underwent pure-tone audiometry upon presentation and were treated according to physicians’ preferences

Results

Bullous myringitis was diagnosed in 43 patients (16 males, 27 females) with a mean age of 30.9 years (range 15–92). Thirty-six (83.7%) had unilateral infection (24 right, 12 left), and 7 (16.3%) had bilateral involvement. The most common type of hearing loss was mixed, detected in 24 patients (55.8%) and involving 27 of the 50 affected ears (54%). Seven patients (16.3%) had a conductive hearing loss, involving 9 ears (18%). Three patients (6.9%) presented with sensorineural hearing loss involving 5 ears (10%). The mean air-bone gap was 20.6 ± 8.8 dB. Down-slope audiometry was noted in 68.7% of the affected ears, followed by a U-shaped curve (25%). The sensorineural component mainly involved the high frequencies and the hearing loss ranged from slight to severe.

Conclusion

The results of the present study demonstrate a high incidence of mixed or sensorineural hearing loss in bullous myringitis patients, and emphasize the need for routine early audiometric evaluation and appropriate follow up for individuals diagnosed as having bullous myringitis.     

Increased incidence in hospitalised patients with sudden sensorineural hearing loss: a 14-year nationwide population-based study

Abstract

Objective: To conduct a 14-year nationwide study on the epidemiologic incidence in patients with sudden sensorineural hearing loss (SSNHL).

Design: Retrospective cross-sectional design.

Study sample: Data of patients hospitalised with the diagnosis of SSNHL from 2000 to 2013, extracted from the Taiwan National Health Insurance Research Database.

Results: In total, 31,258 patients were included. The mean age was 50.30?±?16.70?years. Males (53.5%) were more commonly diagnosed with SSNHL than females (46.5%). The patients most commonly presented with SSNHL were in the age group of 45–64?years. The crude incidence of SSNHL from 2000 to 2013 was 9.76 per 100,000 people per year. The annual incidence rate shows a steady increased from 5.15 in 2000 to 13.97 per 100,000 people in 2013 with a statistical significance (p?<?0.001).

Conclusion: This 14-year nationwide study indicated an increased incidence rate of SSNHL. This necessitates the development of additional treatment modalities to enhance the prognosis and the clarification of the underlying mechanism of this enigmatic disease.     

Profile of audiometric thresholds and tympanometric curve of elderly patients

Aim: to analyze the audiological profile of elderly patients seen in a clinic from an audiology school clinic in the city of Belo Horizonte.Methodswe studied all the charts from the patients who underwent audiologic assessment from April of 2004 and August of 2007 in an audiology clinic in the city of Belo Horizonte.ResultsWe studied the 313 audiological tests from patients 60 years of age or over. The results from the audiological evaluations as to the type of hearing loss were: auditory thresholds within normal standards - 22.28%; sensorineural hearing loss - 60.62%; mixed hearing loss - 14.70%, conductive hearing loss - 2.40%. The level varied between normal and profound. As to the tympanometry, 83.22% had the type A curve, and the other types of curves obtained made up a total of 16.3%. The percentage of individuals who did not undergo the test was 0.48%. 1.76% of the patients who had unilateral hearing loss and 98.24% had bilateral hearing loss.Conclusionswe found a greater prevalence of sensorineural hearing loss, and the degree of the loss varied from mild to profound, with a prevalence of the moderate degree.     

Ototoxic impact of cisplatin in pediatric oncology patients

OBJECTIVE: To describe hearing changes in a group of 28 children (age range, 8-180 mo) undergoing protocol-based cisplatin therapy. METHODS: Conventional, play audiometry, visual reinforcement audiometry (VRA), immittance audiometry, transient click evoked otoacoustic emissions (OAEs), and auditory brainstem response (ABR) evoked potentials were used to assess peripheral sensitivity and for threshold determination. RESULTS: Bilateral symmetrical high-frequency sensorineural hearing loss was noted in 9 of the 28 children (26%). Hearing loss was evident as early as 1 month after chemotherapy and as late as 50 months and was not dependent on individual or cumulative dosage of cisplatin. CONCLUSIONS: 1) Presence of sensorineural hearing loss was independent of individual and/or cumulative dosage of cisplatin; 2) audiologic assessment should be incorporated into a child's periodic medical evaluations after chemotherapy treatment, as onset of sensorineural hearing loss cannot be predicted; 3) personal hearing aids may be indicated for those children with hearing loss affecting the low- to mid-frequencies; a personal assistive listening device (frequency modulated system) may be more appropriate for losses above 3000 Hz; and 4) evaluation and intervention by a speech-language pathologist may be indicated to address possible articulation or language development problems consequent to hearing loss.     

Idiopathic sudden sensorineural hearing loss and acute low-tone sensorineural hearing loss: a comparison of the results of a nationwide epidemiological survey in Japan

Abstract

Objectives: The aim of this study was to investigate the differences between idiopathic sudden sensorineural hearing loss (SSNHL), and acute low-tone sensorineural hearing loss (ALHL) using the results of a nationwide survey database in Japan and to analyze the variables associated with their clinical features and the severity of hearing impairment, treatment, and prognosis.

Methods: Participants were patients registered between April 2014 and March 2016 in a multicenter epidemiological survey database involving 30 university hospitals and medical centers across Japan. Statistical analysis was performed to clarify the factors associated with their clinical characteristics and the severity of hearing impairment, treatment, and prognosis.

Results: Idiopathic SSNHL and ALHL differed significantly in terms of male-to-female ratio, age distribution, and time from onset to start of treatment. The treatment methods and hearing prognosis also differed markedly between the two diseases. A majority (92%) of idiopathic SSNHL patients were administered some type of corticosteroid, while half of the ALHL patients received corticosteroids and a diuretic agent.

Conclusion: The results suggested that idiopathic SSNHL and ALHL belonged to different categories of inner ear disease.     

Hearing loss among prison inmates in India — a pilot study

Aims  This study was done to assess the pattern of hearing loss and the types of ear diseases causing hearing loss among prisoners in an Indian prison. Materials and methods  A total of 102 inmates were studied by subjecting them to a complete ENT evaluation and pure tone audiometry. Results  Seventy inmates had normal bilateral peripheral hearing sensitivity while 32 had some degree of hearing impairment. Almost 50% of the hearing loss among the inmates was found to be sensorineural. Conclusion  This study supports earlier reports of high incidence of hearing loss among prison inmates. The majority with sensorineural hearing loss were in the younger age group but since this study was not designed to determine the cause or risk factors, this cannot be commented upon. Infective ear diseases were found to be a significant etiological factor for conductive hearing loss.     

The management of children with Down syndrome and profound hearing loss

Introduction: Although, the association between Down syndrome (DS) and conductive hearing loss is well recognized, the fact that a small proportion of these children may have a severe to profound sensorineural hearing loss that could benefit from cochlear implantation (CI) is less well understood. The management of significant co-morbidities in children with DS can delay initial diagnosis of hearing impairment and assessment of suitability for CI can likewise be challenging, due to difficulties conditioning to behavioural hearing tests.

Methods: We performed a retrospective case note review of three children with DS referred to the Manchester Cochlear Implant Programme.

Results: Three illustrative cases are described including CI in a 4 years old. Using conventional outcome measurement instruments, the outcome could be considered to be suboptimal with a Categories of Auditory Performance score of 4 at 6 months post-op and at last follow up. In part, this is likely to reflect the delay in implantation, but the role of cognitive impairment must be considered. The cases described emphasize the importance of comprehensive radiological and audiological assessment in children with DS being considered for CI.

Conclusion: The influence of cognitive impairment upon outcome of CI must be taken into account, but should not be considered a contra-indication to implantation in children with DS. Benefit that might be considered limited when quantified using existing general outcome measurement instruments, may have a significant impact upon psychosocial development and quality of life in children with significant cognitive impairment, or other additional needs.