Pure-tone audiometric and impedance measurements in school-aged children in Finland

Pure-tone audiometric and impedance examinations were performed in 687 Finnish school children in the first, fourth and eighth grades (ages, 7, 10 and 14 years old) to study the sensitivity and usability of hearing and tympanometric screening examinations in schools. There were 138 children (20.1%) with a hearing loss > 15 dB in at least one frequency. Among these children, 103 were found to have pure sensorineural losses while 35 children had conductive losses. Of all the sensorineural losses, 118 of the cases involved slight high-frequency changes. Six children had hearing losses at speech range and all had been previously diagnosed. Six other children had 20–30 dB losses at 3–6 kHz, with 5 of these children diagnosed for the first time. Twenty-four of the children with conductive losses had middle ear effusions that were found at a 15 dB screening level for hearing. When the limit of normal tympanometric peak pressure was -150 daPa, 36 of 38 ears with middle ear effusions were found tympanometrically. Judging by the findings of the present study, we recommend that routine pure-tone audiometric screening for 7- and 10-year-old children in schools could be discontinued but should be continued for 14-year-old children. In contrast, tympanometry with a tympanometric peak pressure limit at -150 daPa should be used as a screening procedure for 7-year-old children on school entry.     

Transient evoked otoacoustic emissions in newborn infants: Effects of ear asymmetry, gender, and age

Our aim was to examine the effects of gender, ear asymmetry, and age of infants on various parameters of transient evoked otoacoustic emissions (TEOAEs). Three hundred thirty-two infants (181 males, 151 females) were tested using the ILO292 Otodynamics Analyzer (Otodynamics Ltd, England) as a screening procedure. The subjects were divided into two age groups: group 1, newborn infants prior to hospital discharge (mean age of 4 days), and group 2, infants at the 1-month-old health checkup (mean age of 35 days). Responses to TEOAE stimuli were recorded at 1.0, 1.5, 2.0, 3.0, and 4.0 kHz. There were significant effects of gender and ear (left/right) on the signal-to-noise ratio, response level, and whole-wave and band reproducibility values in TEOAEs. The right ear had higher values of whole-wave reproducibility, response level, signal-to-noise ratio, and band reproducibility than the left ear. Females displayed higher whole-wave reproducibility, response level, band reproducibility, and signal-to-noise ratio values than males. There was no significant difference in response level, signal-to-noise ratio, and band reproducibility between the two age groups. The findings of the present investigation may contribute toward future improvements in neonatal hearing screening based on the community.     

Bilaterally Preserved Otoacoustic Emissions in Four Children with Profound Idiopathic Unilateral Sensorineural Hearing Loss

Severe to profound unilateral sensorineural hearing loss of the left ear was discovered by screening in four healthy children without any family history of hearing loss. Three of the children were four years old and one child was seven years old at the time of discovery. The PTA0.5–2 was 66–75 dB HL for three of the children and one child was without any hearing reactions on the affected ear. The hearing of the right ear was normal in all four cases. The hearing thresholds have been stable during an observation period of 3–12 years. No certain auditory-evoked brainstem responses were recorded with stimulation of the affected ear. Electronystagmography was normal in all cases and magnetic resonance imaging gave no explanation of the hearing loss. Repeated recordings of the transiently evoked otoacoustic emissions (TEOAE) have shown clear bilateral responses using different instrumentation systems. Recently the hearing levels were unchanged and the TEOAE responses of the affected ears were 6.7–19.9 dB SPL (waveform reproducibility: 88–98 per cent) recorded on the ILO88 OAE Analyser (stimulus: 82.2–83.4 dB peak). The collected results suggest that the children suffer from a similar disorder with a unilateral affection of the cochlea, involving the inner hair cells and/or the first neuron. The TEOAE recordings indicate substantially preserved outer hair cell function independent of the profound hearing loss.     

Transient evoked otoacoustic emissions in two-month-old infants: a normative study.

Researchers have recently reported the effects of age, sex, ear asymmetry, and subject's activity status on transient evoked otoacoustic emissions (TEOAEs). The present study aimed to expand upon such reports by describing the characteristics of TEOAE spectra obtained from a cohort of 607 two-month-old infants in community child health clinics. Results indicated significant sex, ear and activity state effects on the signal:noise ratio, response, whole wave and band reproducibility values. These findings suggest the need for TEOAE normative data to be expressed as a function of sex, ear, and activity state of infants. These characteristics of TEOAE spectra may shape future investigations into appropriate pass fail criteria for two-month-old infants.     

Otologic history,audiometry and tympanometry as a case finding procedure for school screening

An algorithm for identification of hearing loss and middle ear effusion based on otologic history, audiometry and tympanometry was designed and tested on 771 first grade school children. Each ear was profiled as being normal, at risk, at high risk, or in need of otologic referral based on test-retest screening. In addition, each child was categorized on the basis of the worse ear. Results showed 57 percent of the children as being normal; otologic referral was indicated in 14 percent. The remaining children (29 percent) were at risk or at high risk. The combination of medical history, audiometry and tympanometry constitutes an excellent case finding procedure for screening the otologic status of young school children. Through the utilization of specific criteria, optimal referrals can be made, thereby providing better health care.     

Auditory brainstem responses and usefulness of hearing aids in hearing impaired children with Cornelia de Lange syndrome

OBJECTIVE: To examine auditory brainstem evoked responses (ABRs) of children with Cornelia de Lange syndrome (CDLS) to evaluate hearing and the utility of hearing aids in hearing impaired cases. SUBJECTS AND METHODS: Thirteen Japanese infants and children with CDLS were studied. Behavioral observation audiometry and ABR were used to evaluate hearing. RESULT: Four different ABR patterns at 85 dB clicks were observed: no response in either ear (6 patients); clear ABRs in both ears (2 patients); no response in one ear but ABRs recorded in the other ear (3 patients); and no peaks after wave III in one ear and ABRs recorded in the other ear (2 patients). However, in 2 patients with no response in either ear at the first measurement, ABRs were recorded in one ear within 2 years. Three out of 13 patients exhibited better responses to sound through the use of hearing aids and auditory training. CONCLUSIONS: The fitting of hearing aids and early consistent training have a significant effect on auditory development in CDLS children in terms of making them aware of sound localization and the different types of environmental sound.     

Hearing loss and ear disorders in Malaysian school children

In Malaysia 1,307 randomly selected primary school children were screened to find out the prevalence of hearing loss and middle ear disorders. Seventy-six students (5.81%) failed the screening audiometric test. There were 95 students (7.26%) with middle ear disorders. History of ear discharge was absent in 24 out of 57 cases with CSOM (42.11%) (P less than 0.001). Forty-three out of 95 children having middle ear disorders passed the screening audiometric test (P less than 0.01 Fisher exact test). Screening audiometric test fails to detect about 46% of cases with middle ear disorders. Screening audiometric test and otological examination if conducted by the school health medical officers regularly will be able to detect almost all the cases with hearing loss and middle ear disorders.     

Ear disease and hearing loss among Navajo children--a mass survey

A team of trained technicians in a specially equipped mobile van conducted a mass screening effort on the Navajo Reservation from 1978 to 1980 to detect and refer individuals with ear disease and hearing loss; 15,890 school children were examined. The prevalence data and correlations of hearing level with ear disease are presented: 4.0% of the children had TM perforations, 2.3% middle ear effusions, 1.9% TM atelectasis, and 0.4% had sensorineural hearing loss. Microtia was found in 1:935, with a cluster on the Western one-fourth of the reservation. Cholesteatoma was rare. The patterns of ear disease are contrasted with other groups.     

Results of audiometrical screening in Finnish schoolchildren

The results of pure tone screening in Finnish schoolchildren in the Helsinki University Central Hospital District (Finland) during the years 1978-81 were assessed. 40,824 children were screened at a screening level of 20 dB (HL) (ISO). 11.4% of the children failed the first screening procedure. A control screening in these children was performed at 2- to 4-week intervals. A total of 1563 children did not pass the second screening (3.8% of the whole screened population). 1485 schoolchildren were then referred to an otologist. 32% of the children referred had normal hearing. In total, 2.5% of the population screened really had impaired hearing. The hearing loss was conductive in 41%. Negative middle ear pressure (less than -150 daPa) occurred in 7% of the referred children. In the middle ear cleft, fluid was noticed in 11%. High-frequency losses comprised 25% of the cases referred. Sensorineural hearing impairment affecting speech frequencies was present in 8%. The pure tone screening is considered important, because even slight abnormalities in hearing acuity can reduce the intelligibility of speech message and cause learning problems. Surgically manageable middle ear disorders should be detected. Occasionally, a sensorineural loss was discovered, requiring fitting of a hearing aid.     

单侧耳蜗性聋患者对侧耳耳声发射的表现

目的 :探讨致聋因素在致单耳发病时对对侧耳潜在的影响。方法 :利用OtodynamicILO96耳声发射分析仪 ,对 35例单侧耳蜗性聋患者 (分为 5组 :发病 2个月以内的突发性聋 9例为S1组 ,发病 1年以上的突发性聋 6例为S2 组 ,梅尼埃病 13例分为M1、M2 组 ,不明机理的耳蜗性聋 7例为UNK组 )对侧耳瞬态诱发性耳声发射 (TEOAE)的反应幅值、反应重复率及频带的重复率 ,畸变产物耳声发射 (DPOAE)曲线特点及 1～ 5kHz反应幅值进行分析比较。结果 :S1组、M2 组TEOAE的反应幅值、反应重复性、频带重复性明显低于正常值 ,DPOAE幅值明显降低 ;S2 组、M1组、UNK组TEOAE和DPOAE正常。结论 :在不同致聋因素中 ,有的对单耳产生损伤作用 ,有的对双耳产生损伤作用。     

Transient evoked otoacoustic emissions in children studying in special schools

OBJECTIVES: The present study aimed to investigate the feasibility and practicalities of testing children in special school settings using transient evoked otoacoustic emissions (TEOAE) and tympanometry. Children studying in special schools, particularly those with intellectual impairment, may be highly susceptible to hearing pathologies and can be difficult to assess using traditional test batteries. Researchers have recently suggested the possible applicability of TEOAE testing, in lieu of conventional behavioral methods, as a hearing screening device for persons with intellectual impairment. However, to date, few publications have detailed the particulars and results of such testing. METHODS: A total of 489 children, with a mean age of 9.6 years, were tested in 15 special schools. Case information was obtained regarding birth history, medical history and type/degree of impairment, for later comparison with screening results. TEOAEs were collected using Quickscreen mode of the ILO292 Otodynamics Analyzer, whilst tympanometry was performed utilizing a Madsen Zodiac 901 Middle Ear Analyzer. RESULTS: In total, 80% of students were able to be tested using TEOAEs. Average test time per ear was 2 min. However, a large proportion (40% of those able to be tested) failed TEOAE testing in at least one ear. No significant effects were found between could-not-test (CNT) cases and case history factors. A significant difference in TEOAE failure rates was found across history of neonatal special care nursery residency and history of parental concern regarding possible hearing impairment. Failure rates were higher for those who indicated positive histories. A total of 74% of subjects could be tested using tympanometry, with 25% of those able to be tested failing in at least one ear. Notably, neither type nor degree of impairment had any significant bearing on CNT or failure rates for tympanometry or TEOAE screening. CONCLUSIONS: Findings of the present investigation lend support to the review of hearing screening programs for children in special schools, with TEOAEs presenting as a potential alternative procedure. Further examination of the performance measures of protocols incorporating TEOAEs would now be advantageous.     

Alternatives in screening at school entry: comparison of the childhood middle ear disease and hearing questionnaire (CMEDHQ) and the pure tone sweep test

Some health authorities in the UK are discontinuing hearing screening at school entry, mainly because the pure tone sweep test is under-specific (i.e. fails too many children) and thus leads to unnecessary and costly, but unproductive, follow-up assessment. A screening method with different properties such as a questionnaire could be a more cost-effective method of mass screening children. The MRC Institute of Hearing Research has developed and evaluated through several stages such a screening questionnaire (the Childhood Middle Ear Disease and Hearing Questionnaire (CMEDHQ), containing 11 scored questions under two broad headings: history and presentation of the disease, and consultation/treatment history. In a service-based evaluation, 2860 mainstream reception-year school children from two consecutive years, attending schools in south west Cumbria in the North-West Regional Health Authority received the sweep test and the CMEDHQ. (Although predominantly designed to detect middle ear problems, the questionnaire also has some potential to detect permanent hearing loss; thus providing a useful backstop for detection of permanent losses either missed or not present in earlier infancy.) The screening CMEDHQ obtained a very high response rate (90%). Follow-up included 235 control cases as well as all pure tone sweep test failures. Analysis, by use of a definition of cases conservative with respect to the sensitivity of the questionnaire, showed that the CMEDHQ has better specificity, but slightly lower sensitivity, than the pure tone sweep test for composite system decision (where 'case' = treated at ENT; 'non-case' = pass at whatever stage was reached before discharge). Follow-up indicated that the limited method available for assessing sensitivity might give an over-favourable view of the pure tone sweep test. Possible improvement of questionnaire sensitivity by further refinements is under examination. The findings show that it is worth conducting a fully parallel multi-district cost-effectiveness comparison of the pure tone sweep test versus the CMEDHQ.     

Hearing impairment and ear diseases among children of school entry age in rural South India

OBJECTIVE: To find out the prevalence and causes of hearing impairment among children of school-entry age, in rural areas of coastal south India. METHODS: The study adopted the World Health Organization (WHO) guidelines viz., "The Prevalence of Ear and Hearing Disorders Protocol". A total of 855 children studying in the first year of school were examined using a Portable Pure Tone Audiometer and an Otoscope. Children with hearing impairment were re-examined to find out the type of hearing impairment. Mothers of all children were interviewed in their homes, in order to obtain details of socio-economic status, family history and history of consanguinity. RESULTS: Hearing impairment was detected in 102 children (11.9%) and impacted wax was found to be the most common cause of hearing impairment (86.3%). On re-testing, it was predominantly conductive hearing impairment (81.6%) observed among 74 of these children. The prevalence of hearing impairment was significantly lower among children belonging to high socio-economic status (P=0.0036). CONCLUSIONS: Hearing impairment and preventable ear diseases were found to be important health problems among children of school-entry age group in this region. Regular screening of children of school-entry age will ensure that children begin their school-life without this disability.     

Transient-evoked otoacoustic emissions in a group of professional singers who have normal pure-tone hearing thresholds

OBJECTIVES: The objective of this study was to determine whether transient-evoked otoacoustic emissions (TEOAEs) measured in a group of normal-hearing professional singers, who were frequently exposed to high-level sound during rehearsals and performances, differed from those measured in age- and gender-matched normal-hearing non-singers, who were at minimal risk of hearing loss resulting from excessive sound exposure or other risk factors. DESIGN: Twenty-three normal-hearing singers (NH-Ss), 23 normal-hearing controls (NH-Cs), and 9 hearing-impaired singers (HI-Ss) were included. Pure-tone audiometry confirmed normal-hearing thresholds (>or=15 dB HL) at 0.5, 1.0, 2.0, 3.0, 4.0, 6.0, and 8.0 kHz in NH-Ss and NH-Cs, and confirmed mild, high frequency, sensorineural hearing loss in HI-Ss (HI-Ss were included only to estimate sensitivity and specificity values for preliminary pass or fail criteria that could be used to help identify NH-Ss at risk for music-induced hearing loss). TEOAEs were measured twice in all ears. TEOAE signal to noise ratio (S/N) and reproducibility were examined for the whole wave response, and for frequency bands centered at 1.0, 1.4, 2.0, 2.8, and 4.0 kHz. RESULTS: Moderate to high correlations were found between test and retest TEOAE responses for the three groups. However, absolute test-retest differences revealed standard deviations that were two to three times larger than those reported previously, with the majority of the variability occurring for the 1.0 kHz band. As such, only the best TEOAE response (B-TEOAE) from the two measurements in each ear was used in further analyses, with data from the 1.0 kHz band excluded. With one exception, within-group comparisons of B-TEOAE S/N and reproducibility across ears and gender revealed no statistically significant differences for either NH-Ss or NH-Cs. The only significant within-group difference was between left and right ears of NH-C females for S/Ns measured in the 2.0 kHz band, where median responses from right ears were found to be higher than left ears. Across-group comparisons of B-TEOAEs revealed lower median S/N and reproducibility values for NH-Ss compared with NH-Cs for the whole wave response and 1.4 kHz band. For the 2.0 kHz band, reproducibility was similar for the normal-hearing groups but median S/N was found to be lower for NH-Ss. No significant differences in S/N or reproducibility were found between normal-hearing groups for the 2.8 and 4.0 kHz bands. Using data from NH-Cs and HI-Ss to establish sensitivity and specificity values for various TEOAE pass or fail criteria, six preliminary criteria were identified as having sensitivity and specificity values >or=90%. When these criteria were applied to NH-Ss, the number of NH-S ears passing ranged from 57% to 76%, depending on the criteria used to judge the NH-S ears, which translates into 24% to 43% of ears failing. CONCLUSIONS: Although TEOAE responses were measurable in all singers with normal audiometric thresholds, responses were less robust than those of NH-Cs. The findings suggest that subtle cochlear dysfunction can be detected with TEOAE measurement in a subset of normal-hearing professional singers. Although preliminary, the study findings highlight the importance of pass or fail criterion choice on the number of ears that will be identified as "at risk" for music-induced hearing loss.     

Passive smoking and middle ear problems in Kansas public school children

Survey data from parents of Kansas school children identified as having middle ear problems were compared to data obtained from parents of children who passed their school's hearing screening tests. The results of the investigation revealed that there were no differences between the two groups of children for the presence of smoking, the amount and type of smoking, and the number of smokers in the home. Exposure to cigarette smoke in the home apparently was not a risk factor for middle ear problems in children.     

Handedness effects on transient evoked otoacoustic emissions in schoolchildren

Handedness, as a potentially influencing, nonpathologic factor, has not been investigated in relation to transient evoked otoacoustic emissions (TEOAEs). The present study aimed to examine the effects of handedness on the TEOAE spectrum in entry-level schoolchildren, with attention also to possible ear asymmetry. A total of 228 subjects (114 males, 114 females, mean age = 6.3 years) were tested using the ILO292 Otodynamics Analyzer (Quickscreen mode) in quiet rooms in 22 schools. For statistical analysis, subjects were matched for factors such as handedness, gender, age, and history of recent ear infection. The results from subjects with passing TEOAE, pure-tone screening, and tympanometry revealed no significant handedness effect overall, although a significant ear asymmetry effect on the measurement parameters of AB difference, noise level, response level, whole-wave reproducibility, band reproducibility, and signal-to-noise ratios was found.     

Long-term effects of ventilation tubes for persistent otitis media with effusion in children

The otological, auditory and developmental effects of treatment with ventilation tubes were studied in a sample of 7–8-year-old Dutch children screened for otitis media with effusion (OME) serially at preschool age. Children treated with ventilation tubes were matched retrospectively for OME history, sex, and age with children who were not treated surgically. At the age of 7–8, abnormalities of the tympanic membrane were more prevalent in treated than in untreated ears. No significant differences were found in middle ear function and hearing in both groups. Some positive effects of early surgical intervention on specific developmental measures were found.     

Incidence of auditory neuropathy among the deaf school students

OBJECTIVE: We aimed to determine the incidence of auditory neuropathy (AN) among the deaf school students that have severe hearing loss. METHOD: All students having severe hearing loss constituting a total of 75 at Deafness school in Afyon Province of Turkey were enrolled in the study. The etiological factors about the hearing loss were determined by performing an individual file survey and by interviewing the teachers and parents. First, all the children were subjected to an otolaryngologic examination. Then, auditory brainstem response (ABR) and transient evoked otoacoustic emissions (TEOAE) tests were done to all students enrolled in the study. RESULTS: The ages of the children were between 6 and 17 (mean age 11.9) and 32 (42.9%) of them were girls and 43 (57.1%) were boys. Three cases (4%) were diagnosed as AN in our study, however, no risk factors were determined in two of them. A history of hearing loss following a vaccination was found in only one patient. CONCLUSION: Our data show that the incidence of AN in the children with severe hearing loss is not negligible. Therefore, our results suggest that automatic ABR should be also used with OAE as a routine application in the neonatal screening programmes, since the solely use of OAE in the neonatal screening programmes may result in the delay of the diagnosis of the children with AN.     

Bilateral sensorineural hearing disorders in children: etiology of deafness and evaluation of hearing tests

OBJECTIVE: The purpose of this study was to determine the etiology of bilateral sensorineural hearing disorders in children and to evaluate the performed hearing tests by comparison of the results of the objective and subjective tests. METHODS: The medical history and the hearing tests (behavioral observation audiometry, acoustic evoked potentials and pure tone audiometry) of 106 bilaterally hearing impaired children were analyzed in a retrospective follow-up study. RESULTS: The total group included 52 males and 54 females. The ages at first diagnosis ranged from 4 months to 11 years with a mean age of 42 months and a median of 33 months. The degree of hearing loss for the better hearing ear was mild in one child, moderate in 28 children, severe in 29 children, profound in 32 children and total in 16 children. The delay between the first examination and diagnosis ranged from 0 to 597 days with a mean of 83 days and a median of 28 days. In 47 children (44%) no cause of hearing impairment could be determined. Nineteen children (18%) had a history of familial hearing loss, 40 (38%) suffered from acquired hearing loss (seven children had prenatal causes, 21 perinatal and 12 postnatal). A comparison between behavioral observation audiometry and brainstem evoked response audiometry revealed a statistically good agreement. Twenty-nine children (32%) showed progressive hearing loss, which was defined as a threshold shift of +10 dB or more in the pure tone average in at least one ear. CONCLUSIONS: In a significant number of children with early hearing impairments the etiology still remains uncertain. Further research in the field of genetic disorders will diminish this number. Evaluation of hearing tests showed that behavioral observation audiometry still is an excellent tool in the hands of an experienced examiner. The age at identification of hearing disorders in industrialized countries still is unacceptably high. To obtain ideal care of hearing impaired children, universal neonatal hearing screening programs are mandatory.