颞骨HRCT对儿童先天性耳聋的诊断价值

目的:了解河南省儿童先天性耳聋颞骨畸形的发生率及特点,为临床提供必要的依据。方法:225例听力障碍的婴儿及先天性耳聋的儿童人工耳蜗植入前行颞骨HRCT筛查常规行横断面薄层扫描和多平面重组。结果:CT共检出颞骨畸形79例(104耳),包括外耳畸形25例(30耳)、中耳畸形16例(20耳)、内耳畸形54例(74耳),其中16例为合并畸形;单纯鼓室积液30例(42耳);其余116例颞骨无异常。35.1%患儿颞骨有畸形,51.6%患儿颞骨结构正常。结论:HRCT能很好显示儿童先天性耳聋的颞骨解剖异常,为临床治疗方案的正确制定提供重要的参考依据。     

Zivil- und strafrechtliche Aspekte von Gehörschäden durch Silvesterfeuerwerkskörper

Every year several thousand people in Germany experience acute inner ear and middle ear damage due to exposure to New Year's Eve firecrackers.These affect all age groups and both sexes with a clear preponderance of children, teenagers and especially young adult males. In most cases these accidents are caused by an individual other than the patient.While sometimes hearing recovers completely, a large number of children, teenagers and adults will suffer from permanent inner ear damage or tinnitus.Because of the medical, psychological and economic importance of incurable sensorineural hearing loss, it is the task of public health services to promote effective prevention of irreversible damage to the hearing organ.This article reviews legal aspects of acoustic trauma due to New Year's firecrackers, specifically: licensing regulations, the use of firecrackers and its implications for civil and criminal law, and liability issues for import and distribution. The information about the legal status should contribute to effective prevention of irreversible damage to the hearing organ due to this type of leisure noise.     

新疆地区新生儿听力筛查未通过转诊婴儿听力学评估

目的 分析新疆地区听力筛查未通过婴儿的听力诊断结果,为早期干预提供依据。方法 2018-2019年对350例因新生儿听力复筛未通过而转诊至新疆维吾尔自治区人民医院的婴儿进行客观听力学评估,分别利用听性脑干反应、声导抗、畸变产物耳声发射进行评估。结果 350例婴儿(700耳)中听力正常者104例(29.71%),单耳听力损失者75例(21.43%),双耳听力损失者171例(48.86%),各民族间听力损失婴幼儿检出率差异无统计学意义(χ²=0.362,P>0.05)。700耳中轻、中、重、极重度听力损失分别为130耳(18.57%)、151耳(21.57%)、59耳(8.43%)、76耳(10.86%),轻中度听力损失婴儿中负峰型鼓室图检出率显著高于重度及以上听力损失婴儿(χ²=55.878, P<0.05)。感音神经性听力损失280耳,传导性听力损失136耳。结论 中耳问题是轻中度听力损失婴幼儿听力筛查未通过的重要影响因素。婴幼儿听力损失的评估是一个持续性的过程,需要多种检测方法定期复查和综合评定。     

新疆地区新生儿听力筛查未通过转诊婴儿听力学评估

目的 分析新疆地区听力筛查未通过婴儿的听力诊断结果,为早期干预提供依据。方法 2018-2019年对350例因新生儿听力复筛未通过而转诊至新疆维吾尔自治区人民医院的婴儿进行客观听力学评估,分别利用听性脑干反应、声导抗、畸变产物耳声发射进行评估。结果 350例婴儿(700耳)中听力正常者104例(29.71%),单耳听力损失者75例(21.43%),双耳听力损失者171例(48.86%),各民族间听力损失婴幼儿检出率差异无统计学意义(χ²=0.362,P>0.05)。700耳中轻、中、重、极重度听力损失分别为130耳(18.57%)、151耳(21.57%)、59耳(8.43%)、76耳(10.86%),轻中度听力损失婴儿中负峰型鼓室图检出率显著高于重度及以上听力损失婴儿(χ²=55.878, P<0.05)。感音神经性听力损失280耳,传导性听力损失136耳。结论 中耳问题是轻中度听力损失婴幼儿听力筛查未通过的重要影响因素。婴幼儿听力损失的评估是一个持续性的过程,需要多种检测方法定期复查和综合评定。     

Hearing loss in chronic renal failure-hearing threshold changes following haemodialysis.

The prevalence of sensorineural hearing loss, measured by pure tone audiometry, was determined in 66 patients with chronic renal failure and threshold changes following haemodialysis were measured in 31 patients. The incidence of hearing loss was 41% in the low, 15% in the middle and 53% in the high frequency ranges respectively. No correlations with weight changes, haematocrit, metabolic bone disease or ototoxic drug history were found. Of 62 ears studied, 38% had a decrease in low frequency threshold after dialysis and 9% had an increase. Threshold in 22/31 ears with pre-existing low frequency loss altered after dialysis with little change in other frequencies and no correlation with weight changes. In conclusion, we find a high incidence of low and high frequency hearing losses in chronic renal failure patients. Fluctuation in low frequencies with dialysis is common. Possible mechanisms include treatment induced changes in fluid and electrolyte composition of endolymph.     

Hyperbaric oxygen as a method of therapy of sudden sensorineural hearing loss

Sudden hearing loss is a sensorineural hearing impairment, which develops over a period of few hours to a few days. Several theories have been proposed regarding the development of sudden sensorineural hearing loss. The incidence of sudden sensorineural hearing loss has been reported to range from 5 to 20 per 100,000 persons per year. Hearing loss is treated with drugs that provide better blood supply to the inner ear and decrease inflammation. The aim of this study is to examine the influence of hyperbaric oxygen therapy in treating sudden sensorineural hearing loss. The beneficial effects of HBO2 on sudden sensorineural hearing loss are probably achieved by an increase in the distribution of O2 dissolved per volume unit of blood circulating trough the regions affected by the lack of oxygen. Sessions were performed on 17 patients, with sudden sensorineural hearing loss that began within 10 days prior to the tests. In the hyperbaric chamber, all patients breathed 100% oxygen at 2.8 bars, for 60 minutes twice a day, either until recovered or for a maximum of 30 sessions. Of the total number of study participants, 12 were male and 5 were female, and their average age was 35.3 years (range: 18 to 68). Before the therapy, an average hearing value was obtained out of five basic frequencies. Hearing was found to be in the range of 61-93 dB in 12 patients, while 5 patients had hearing in the range of 41-60 dB. Following therapy with hyperbaric oxygen, the hearing level of 14 patients was within the range of 0-26 dB, two patients' hearing level increased to 27-40 dB, and one patient's hearing level remained in the range of 41-60 dB. The average hearing level for all patients and for all five basic frequencies was 67.8 dB before therapy, in comparison with 21.6 dB after oxygen therapy (p=0.0003). The average number of sessions in the hyperbaric chamber was 11.9 (range: 5 to 20). The therapy was taken well by all patients. The results of this study, as well as the results of similar studies performed by other authors, indicate for the necessity of performing an additional prospective, random, double-blind study of the effects of hyperbaric oxygen therapy on sudden sensorineural hearing loss, on a large number of patients.     

自动听性脑干反应联合声导抗鼓室图在疑似听力障碍婴幼儿中的应用

目的 探讨自动听性脑干反应(AABR)联合声导抗鼓室图在听力筛查中的应用价值,以寻求更适合于基层单位推广的新生儿听力筛查方案。方法 2013年1月-2016年12月选取本院门诊疑似听力障碍婴幼儿558例,同时接受AABR和鼓室图的联合筛查,疑似感音神经性耳聋患者进行听力诊断。结果 1 116耳同时接受AABR与鼓室声导抗联合筛查,504耳为一次性通过两项联合筛查,79耳为一月后复查通过两项联合筛查,20耳为通过听力诊断判为正常。最终共诊断分泌性中耳炎11耳,咽鼓管功能障碍46耳,感音神经性耳聋456耳。结论 AABR联合声导抗鼓室图检测可以有效提高听力筛查的准确性,有利于听力障碍患儿的早发现早干预,建议基层单位进行推广。     

Birthweight and the risk of childhood sensorineural hearing loss

The aim of this study was to estimate the impact of birthweight on the risk of sensorineural hearing loss in children. The study was a nested case-control study. Cases (n = 327) were identified through the Norwegian county registers of children with hearing loss, and controls (n = 391 992) were all children without hearing loss born in the same counties, identified through the Norwegian Medical Birth Registry of Norway. Case definition was mean sensorineural hearing loss (MHL) > or =35 decibel (dB) hearing level (HL) in the better-hearing ear averaged over the pure-tone hearing thresholds at 500, 1000 and 2000 Hz, diagnosed before the age of 5 years. Birthweight <1500 g, as compared with 3500-3999 g, gave an adjusted odds ratio for sensorineural hearing loss of 6.3 [95% CI 2.4, 16.4], controlled for gestational age, gender, parity, maternal age and concurrent birth defects. The risk of hearing loss decreased with increasing birthweights, with adjusted odds ratios of 4.4, 3.8, 1.7 and 1.4 for the birthweights 1500-1999, 2000-2499, 2500-2999 and 3000-3499 g respectively. The risk of both mild to moderate (MHL 35-70 dBHL) and severe/profound hearing losses (MHL >70 dBHL) were influenced by birthweight.     

Hearing impairments caused by genetic and environmental factors

Impairments of hearing and balance are major problems in the field of occupational and environmental health. Such impairments have previously been reported to be caused by genetic and environmental factors. However, their mechanisms have not been fully clarified. On the other hand, the inner ear contains spiral ganglion neurons (SGNs) in the organ of Corti, which serve as the primary carriers of auditory information from sensory cells to the auditory cortex in the cerebrum. Inner ears also contain a vestibule in the vicinity of the organ of Corti—one of the organs responsible for balance. Thus, inner ears could be a good target to clarify the pathogeneses of sensorineural hearing losses and impaired balance. In our previous studies with c-Ret knock-in mice and Endothelin receptor B (Ednrb) knock-out mice, it was found that syndromic hearing losses involved postnatal neurodegeneration of SGNs caused by impairments of c-Ret and Ednrb, which play important roles in neuronal development and maintenance of the enteric nervous system. The organ of Corti and the vestibule in inner ears also suffer from degeneration caused by environmental stresses including noise and heavy metals, resulting in impairments of hearing and balance. In this review, we introduce impairments of hearing and balance caused by genetic and environmental factors and focus on impairments of SGNs and the vestibule in inner ears as the pathogeneses caused by these factors.     

Management of risk of glucocorticoid-induced osteoporosis due to systemic administration in general practice in Denmark

Abstract

We describe a case of ear candling presenting as hearing loss, and review the literature. Ear candling is considered as an alternate medical therapy for dewaxing the ears, discomfort in ears and sinuses, rhinitis, sinusitis, glue ear, colds, flu, migraines, poor or “muffled” hearing, high stress, and ringing in the ear. There is no evidence of its effectiveness, and it can actually cause damage to the ears.     

听力筛查阳性患儿听觉稳态反应的测试

【目的】利用听觉稳态反应(audition steady-state response,ASSR)测试听力筛查未通过的婴幼儿听反应阈,了解听力筛查未通过婴幼儿的听力损失情况,对ASSR的临床应用价值作出评价。【方法】对186例听力筛查未通过的婴幼儿272只耳进行ASSR测试和脑干听觉诱发电位(auditory biainstemrespomse,ABR)测试,对记录到的数据进行统计分析。【结果】经听力初筛、复筛未通过的272耳,41.5%的反应阈≤30dB,轻中度听力损失占49.6%;AS-SR0.5,1,2,4kHz4个测试频率的反应阈值与ABR结果的相关系数分别为0.616,0.749,0.795,0.713,有极显著相关性。【结论】ASSR和ABR阈值有较高相关性,是一种具有频率特性的客观测听方法。因此,ASSR测试对新生儿听力筛查后续的听力学评估有较高的临床应用价值。     

南通市电焊工人高频听力损失及其影响因素分析

目的 了解南通市噪声接触电焊工人的听力损失（尤其是高频听力损失）情况,为其防控提供科学依据。
方法 将南通市3 265名噪声接触电焊工人作为研究对象,收集其2017年在岗职业健康检查相关资料,分析其听力损失情况。
结果 3 265名电焊工人的高频听力损失检出率（13.94%）高于语频听力损失检出率（9.40%）,差异有统计学意义（P < 0.01）。左耳各个频率听阈、语频平均听阈和高频平均听阈异常的检出率均高于右耳（P < 0.01）。左耳的500 Hz听阈、2 000 Hz听阈、3 000 Hz听阈、6 000 Hz听阈、语频平均听阈和高频平均听阈均大于右耳（P < 0.05）。多因素logistic回归分析结果发现:男性发生高频听力损失的危险性高于女性（OR=1.840,P < 0.01）。年龄增加为电焊工人发生高频听力损失的危险因素（OR=1.073,P < 0.01）;相比噪声接触工龄 < 5年组,接触噪声10~年为电焊工人发生高频听力损失的危险因素（OR=1.490,P < 0.01）。
结论 南通市电焊工人左耳的听力损失较右耳严重。企业应降低生产性噪声来源,加强对工人的健康教育,为工人配备合格的个人噪声防护用品,定期进行健康监护,以保护工人的听力。
     

Evidence of a Common Pathway in Noise-Induced Hearing Loss and Carboplatin Ototoxicity

In spite of the differences in the nature of the insult, the hearing loss from ototoxic drugs and noise exposure share a number of similarities in cochlear pathology. This paper explores the common factors between noise-induced hearing loss and ototoxicity by experimentally manipulating cochlear glutathione (GSH). In the first experiment, chinchillas were treated with a drop of saline (50 &mgr;l) on the round window of one ear and a drop of buthionine sulfoximine (BSO, 50 &mgr;l of 200 mM) on the other ear. BSO is a drug that blocks GSH synthesis and it was hypothesised that GSH-depressed ears would be more vulnerable to noise. Six hours after treatment, the animals were exposed to a 105 dB 4 kHz octave band noise for 4 hours, then a second dose of BSO was applied 2 hours later. The BSO treated ears showed more temporary threshold shifts and reduced GSH staining at day 4 post exposure, but there was no BSO effect in terms of greater permanent threshold shift (PTS) or hair cell loss. In the second experiment, chinchillas were pretreated with BSO and 3 days later were given either a single dose of carboplatin (25 mg/kg i.p.), a double dose (day 3 and 7) or only BSO. Chinchillas that received BSO and the double dose of carboplatin had significantly greater loss of inner and outer hair cells than the carboplatin chinchillas. In addition, the BSO and carboplatin chinchillas also had larger decreases in evoked response amplitudes suggesting that GSH depletion potentiated the ototoxicity of carboplatin. These results are discussed in terms of the role of reactive oxygen species in creating hearing loss and the potential protective role of glutathione.     

Distortion-Product Otoacoustic Emissions as a Screening Tool for Noise-Induced Hearing Loss

Noise-induced hearing loss includes both temporary (TTS) and permanent (PTS) threshold shifts. Although TTS and PTS have many similarities, their underlying mechanisms are different. Both TTS and PTS are seen in hearing-conservation programs, making it important to consider both when making physiological measurements of inner-ear damage in applied settings. There are many ways that physiological mechanisms could be useful in screening for NIHL. Can normal-hearing and NIHL ears be differentiated from one another? Can the physiological measure be used in place of behavioural hearing-threshold measures of TTS and PTS? Can it be used to indicate sub-clinical damage (i.e., noise-induced permanent alterations to the inner ear without a corresponding hearing decrement)? Can it be used to indicate pre-clinical hearing loss (i.e., the sub-clinical damage eventually turns into hearing loss)? Finally, can the physiological measure be used to predict susceptibility to NIHL? Evoked otoacoustic emissions (EOAEs) depend on normal outer hair cells for their generation. Because this is the site in the inner ear in humans that is most susceptible to noise, there has been considerable interest in the application of EOAEs to NIHL screening. In this review, the application of distortion-product EOAEs (DPOAEs) is considered for this purpose, emphasizing work from our laboratory, but including that of others as well. Wherever possible, we compare the performance of DPOAEs as a screening tool to transient-evoked otoacoustic emissions (TEOAEs). We emphasize the importance of how well DPOAEs perform in screening for NIHL in individuals rather than for groups of people; the importance of using large numbers of subjects; and the importance of longitudinal studies.     

Early occupational hearing loss of workers in a stone crushing industry: our experience in a developing country

Noise-induced hearing loss (NIHL) is an irreversible sensorineural hearing loss associated with exposure to high levels of excessive noise. This paper aims to assess the prevalence of early NIHL and the awareness of the effects of noise on health among stone crushing industry workers. This was a comparative cross-sectional study in Ghana of 140 workers from the stone crushing industry compared with a control group of 150 health workers. The stone workers and controls were evaluated using a structured questionnaire, which assessed symptoms of hearing loss, tinnitus, knowledge on the health hazards associated with work in noisy environment and the use of hearing protective device. Pure tone audiometric assessment was carried out for stone workers and controls. Noise levels at the work stations of the stone workers and of the controls were measured. Statistical Analysis of data was carried out using SPSS package version 16. The mean age of stone workers and controls was 42.58±7.85 and 42.19±12 years, respectively. Subjective hearing loss occurred in 21.5% of the workers and in 2.8% of the controls. Tinnitus occurred in 26.9% of stone workers and 21.5% of controls, while 87.5% stone workers had sound knowledge on the health hazards of a noisy environment. Early NIHL in the left ear occurred in 19.3% of the stone workers compared with 0.7% in controls and in the right ear, it occurred in 14.3% of the stone workers and in 1.3% of the controls; P<0.005. In conclusion, the prevalence rate of early NIHL among stone crushing workers is about 19.3% for the left ear and 14.3% for the right ear.     

Chronic in utero alcohol exposure affects auditory function in rats and in humans

In one experiment, brainstem auditory evoked potentials (BAEPs) were used to study the postnatal development of the peripheral and brainstem auditory pathways in rat pups prenatally exposed to alcohol. The results indicated that prenatal alcohol exposure retards development of the peripheral and brainstem auditory pathways and that prolonged auditory transmission times, despite a "catch-up" trend, persist in maturity. BAEP latency-intensity profiles demonstrated that a significant proportion (19%) of the alcoholized rats had recruitment-type sensorineural hearing loss. In a second study, a group of 12 fetal alcohol syndrome (FAS) children were evaluated for auditory function. These children showed unusually high incidence rates of sensorineural hearing loss (33%) and conductive hearing loss secondary to recurrent serous otitis media (92%). A final study used the cortical auditory evoked potential (CAEP) and found evidence of dysfunctional processing of auditory information at the cortical level in rats prenatally exposed to alcohol. The implications of these findings for the evaluation and treatment of FAS children and for evoked potential studies on children of alcoholics and learning disabled children are discussed.     

Causes and results of reoperations following stapedectomy

The records of 145 patients who underwent revision stapedectomy were analysed to determine the causes of failure of the previous operation, the hearing results and the postoperative complaints. Displacement of the prosthesis was the most common cause of failure (49%). Other surgical findings, sometimes in combination, were a short prosthesis (35%), middle ear adhesions (23%), otosclerotic regrowth (14%) and eroded incus (10%). No specific cause of failure was identified in 6% of the revisions. Thirty-eight per cent of revision operations resulted in a hearing gain to a level less than 10 dB conduction loss and 61% to less than 20 dB. Slight sensorineural hearing loss after revision surgery occurred in 5%. 'Dead ears' were encountered in 2% as against 0.6% in the primary cases. Tinnitus was the most common complaint (21%) at the 3 week postoperative follow-up, declining to 7% four months postoperatively.     

Report of an isolated mid-frequency hearing loss following inner ear barotrauma

A case describing an isolated mid-frequency hearing loss as a result of inner ear barotrauma is presented. The onset of symptoms was insidious but progressed to a profound total-range hearing loss in the right ear. This loss resolved rapidly with cessation of diving activity, bed rest, and head elevation, leaving only an isolated 20-dB hearing decrement at 1000 Hz. Since the diver was participating in evaluation of experimental decompression tables, differentiation had to be made between barotrauma and inner ear decompression sickness.     

Factors affecting the use of hearing protectors among classical music players

Classical musicians are often exposed to sound levels that exceed the Finnish national action limit value of 85 dB(A). Still, the use of hearing protectors is uncommon among musicians. The purpose of this study was to find out musician's attitudes towards hearing protectors, and under which conditions hearing protectors are used. The study group consisted of five major classical orchestras in the Helsinki region. The players were asked to fill out a questionnaire with questions on hearing protection, ear symptoms, including tinnitus, hearing loss, pain in the ears, and temporary ringing in the ears. Also, questions concerning stress and working environments were asked. Of those who responded, 94% were concerned about their hearing to some degree. Only 6% of the musicians always used hearing protector devices (HPDs). Self-reported hearing loss was quite common, with 31% of the musicians reporting some hearing loss. Temporary tinnitus was even more common at 37%. There were 15% of women, and 18% of men reporting permanent tinnitus. Hyper-acousis was reported by 43% of the musicians. The ear symptoms affected the usage rate. Hearing protectors were used more often among musicians having ear symptoms (20%) than those reporting no symptoms (6%). Further, the 43% of the musicians found their work to be interesting and meaningful. Stress was experienced to some extent by 60%, and musicians with ear symptoms had three to nine times more stress and felt their working environment noisier. The study shows that musicians seldom use hearing protectors before symptoms begin. Symptoms increased usage rate, but the usage levels are still far from ideal. Motivation and training is needed to improve hearing protector use among musicians.     

Effects of occupational exposure to a mixture of solvents on the inner ear: a field study

Some clinical and laboratory studies indicate that industrial solvents such as toluene, styrene, xylene, trichloroethylene and carbon disulfide or their mixtures may affect the inner ear, although the mechanism of this process is still not well understood. The aim of this investigation was to assess the incidence of hearing and vestibular disorders (using modem audiological and vestibular tests) in 61 workers exposed to a mixture of organic solvents at the production of paints and varnishes; the control group included 40 age-matched non-exposed subjects. Environmental and biological monitoring revealed that the most significant exposure can be attributed to the following mixture constituents: ethylbenzene, xylene and trimethylbenzene isomers such as pseudocumene, mesitylene and hemimellitene. Electronystagmographic examinations showed the symptoms of vestibular dysfunction, as well as the decreased duration, amplitude and slow phase angular velocity of induced nystagmus in 47.5% of the subjects exposed versus 5% of controls. This was accompanied by sensorineural high frequency hearing loss, identified by means of pure tone audiometry in 42% of those exposed versus 5% controls, and reduced amplitudes of transiently evoked and distortion-product otoacoustic emissions. The findings closely correspond with the rate of the total exposure to the solvent mixture. A possible mechanism responsible for ototoxicity of solvents is discussed.