中国听力学教育新模式——在线教育

全世界听力障碍者相当于世界人口的4%以上,听力损失的影响将会持续上升,而我国听力从业人员数量不足,无法满足日益增加的听力服务需求,我国听力师的培养机制又不能满足现在对于人才的需求。在这样的大背景下中国听力学教育需要有新的模式突破才能满足我国对于听力学教育的需求,而在线教育正是我们需要的打破时间、空间限制的模式。     

听力学教学方法的思考与体会

以“培养具有科学精神、科研能力、临床技能的综合型人才”为教学宗旨,借鉴美国听力学教育的优秀经验,通过不断改进教学方法激发学生的学习兴趣、提高学生的参与度和主动性、培养科研意识、塑造科研能力,为进一步完善我国听力学教育的教学方式提供参考。     

耳声发射异常听性脑干反应正常的婴幼儿听力学分析

目的 探讨听力筛查异常而听性脑干反应(auditory brainstem response,ABR)正常的婴幼儿的听力学特点.方法 以瞬态声诱发性耳声发射听力筛查未通过而ABR正常的新生儿及婴幼儿53例(81耳)作为研究对象,对比各项听力检查结果,分析ABR与其他检查(40 Hz听觉相关电位、听觉稳态诱发反应、畸变产物耳声发射、鼓室声导抗及声反射)之间的相互关系.结果 81耳中所有检查结果均正常18耳(22.2%);其中至少有一项检查异常共63耳(77.8%).40Hz听觉相关电位和听觉稳态诱发反应分别测试36耳和45耳,异常分别为14耳(38.9%)和27耳(60.0%);畸变产物耳声发射测试68耳,异常50耳(73.5%);鼓室声导抗测试50耳,异常9耳(18.0%);声反射测试47耳,异常27耳(57.4%).结论 单纯以ABR作为婴幼儿听力正常的判断标准尚存在不足,综合的听力学评估非常有必要.     

Tinnitus and hearing survey: cultural adaptation to Brazilian Portuguese

IntroductionHearing loss is associated with several comorbidities and may be frequently associated with tinnitus. When patients complain of both tinnitus and hearing difficulties in audiology and otolaryngology clinics, there, is often great difficulty separating the two complaints. The tinnitus and hearing survey was specially developed for this purpose to identify the main complaint and help direct the choice of appropriate intervention.ObjectiveTo translate and culturally adapt the tinnitus and hearing survey for the Brazilian-Portuguese.MethodsSeventy patients who had previously completed a battery of audiological diagnostic exams were invited to complete the tinnitus and hearing survey and were categorized into four groups: normal hearing without tinnitus, normal hearing with tinnitus, hearing loss without tinnitus, and hearing loss with tinnitus. Cultural adaptation of tinnitus and hearing survey followed the steps indicated by Guillemin et al. (1993), including assessment of inter-researchers’ reproducibility, internal consistency, and reliability of the instrument.ResultsThere were no substantial changes to the content of the tinnitus and hearing survey questions, although a few adaptations were made to two-item sound tolerance section to facilitate participants’ understanding. Internal consistency and reliability tested by Cronbach’s α was considered good for all domains. The reproducibility of the tinnitus and hearing survey was measured by the Kappa coefficient at two different moments and agreement between evaluators 1 and 2 was considered almost perfect, indicating good reproducibility.ConclusionThe tinnitus and hearing survey was culturally adapted to Brazilian Portuguese and analyzed for internal consistency, reliability, and reproducibility. Results support this questionnaire as a useful tool to help professionals differentiate the main complaint of the individual, allowing the choice of a more appropriate intervention.     

Development and evaluation of an audiology app for iPhone/iPad mobile devices

Conclusion: The application described in this study appears to be accurate and valid, thus allowing calculation of a hearing handicap and assessment of the pure-tone air conduction threshold with iPhone/iPad devices. Objective: To develop and evaluate a newly developed professional, computer-based hearing handicap calculator and a manual hearing sensitivity assessment test for the iPhone and iPad (AudCal). Methods: Multi-center prospective non-randomized validation study. One hundred and ten consecutive adult participants underwent two hearing evaluations, a standard audiometry and a pure-tone air conduction test using AudCal with an iOS device. The hearing handicap calculation accuracy was evaluated comparing AudCal vs a web-based calculator. Results: Hearing loss was found in 83 and 84 out of 220 standard audiometries and AudCal hearing tests (Cohen’s Kappa = 0.89). The mean difference between AudCal and standard audiogram thresholds was ?0.21 ± 6.38 dB HL. Excellent reliability and concordance between standard audiometry and the application’s hearing loss assessment test were obtained (Cronbach’s alpha = 0.96; intra-class correlation coefficient = 0.93). AudCal vs a web-based calculator were perfectly correlated (Pearson’s r = 1).     

Audiologic and otologic phenotype in children with Duane's Retraction Syndrome: A rare ophthalmologic disorder

ObjectiveThe focus of this study was to evaluate the prevalence, type, and severity of hearing impairment in patients with Duane's Retraction Syndrome and to relate these measures to patient demographics and other otologic and audiologic factors.Study designRetrospective AudGen Database analysisSettingTertiary academic referral centerPatientsPediatric patients in AudGenDB with a diagnosis of Duane's Retraction Syndrome (DRS).InterventionsAppropriate audiologic, otologic, and demographic data were recorded.Main outcome measureSeventy-nine patients (n = 79) met inclusion criteria. The first encounter with available audiometric data or the first encounter with hearing loss were documented. Audiograms were stratified by type and severity of hearing loss, and common associated medical issues were documented.Results57 children had normal hearing; 22 had hearing loss. 9 ears had pure conductive hearing loss, 1 had pure sensorineural, 14 ears had components of both, and 79 had hearing loss that could not be specified. Multivariate regression revealed episodes of chronic otitis and craniofacial anomalies are associated with worse hearing loss.ConclusionThis study presents a detailed characterization of hearing loss in patients with Duane's retraction syndrome. Conductive and sensorineural hearing loss are both prevalent among these children. Careful and early audiologic evaluation of all patients with DRS is important.     

Patterns of nasalance in a sample of normal gerontologic subjects

The purpose of this investigation was to evaluate velopharyngeal adequacy in gerontologic subjects using an acoustic analysis strategy. Sixty normal older subjects (30 male, 30 female), ranging in age from 50 to 80, read three passages developed by Fletcher (1976) that differ in number of nasal sounds. In addition, all subjects sustained the vowel //. The speech samples were analyzed using TONAR II, which calculates the ratio of nasal sound pressure level to nasal + oral sound pressure level (nasalance). Tonagrams (plots of nasalance over time) were obtained from all subjects. Results demonstrated that older subjects generally evidenced abnormally high nasalance values for the Zoo Passage (contains no nasal sounds). In addition, females exhibited significantly higher nasalance values than males. Inspection of the tonagrams revealed three abnormal acoustic patterns: (1) pervasively high nasalance, (2) momentary loss of velar control, (3) progressive deterioration in velar control. These results are discussed with reference to known neuroanatomical changes associated with advancing age.     

听觉稳态诱发电位研究近展

听觉稳态诱发电位(SSEP)是由调制声信号引起的,反应相位与刺激信号的相位具有稳定关系的听觉诱发电位。它快速、无创、频率特异性好、与行为听阈相关性好、测试方法客观,结果判定客观。在调制频率>60Hz时,不受醒觉状态影响,是儿童特别是婴幼儿理想的听力损失定量诊断方法。多频SSEP在前者的基础上,双耳多个测试频率同时刺激,同时记录反应。不影响测试准确性,但大大提高了测试效率。     

中青年与老年慢性化脓性中耳炎及中耳胆脂瘤患者听力学特点及区别

目的 探讨中青年与老年慢性化脓性中耳炎及中耳胆脂瘤患者听力学特点及区别。方法 回顾性研究单侧慢性化脓性中耳炎或中耳胆脂瘤中青年(18～59岁)患者74例、老年(≥60岁)患者68例(语频段0.5、1.0、2.0、4.0 kHz)纯音测听结果, 分析其患耳与对侧耳、不同年龄组间患者听力学特征和区别。结果 中青年患者患耳各语频气、骨导阈值均高于对侧耳, 老年患者患耳气导、除4.0 kHz外的骨导高于对侧耳。老年患者各语频气、骨导耳间差均明显大于中青年患者。非胆脂瘤组、听骨链正常组老年患者耳间差在0.5、1.0、2.0 kHz气导、4.0 kHz骨导高于中青年患者。胆脂瘤组、听骨链中断组老年患者各语频气、骨导耳间差均明显大于中青年患者。结论 慢性化脓性中耳炎及中耳胆脂瘤对中青年、老年患者的气、骨导均可产生损害, 对老年患者的损害比中青年患者严重。中耳病变越严重, 老年患者比中青年患者听力受损的程度越高。     

Bone-anchored hearing aid A single-stage procedure in children

Objective

The bone-anchored hearing aid (BAHA) is an essential part of the armamentarium of the modern otolaryngologist dealing with ear disorders. A two-stage approach for implantation in children is recommended by the manufacturers. In our practice we implant BAHA in children as a single procedure. We describe our technique and results.

Method

We performed a review of all children having a BAHA between 1997 and 2005. Surgery was performed by taking a post-auricular split skin graft and excising the underlying soft tissues. Drilling, tapping and fixture placement were performed as per the manufacturer's instructions. The skin graft was then sutured in place and perforated in its centre and the abutment placed. Ten to twelve weeks were allowed for osseointegration before the hearing aid attachment.

Results

Thirty children were implanted. Age at implantation ranged from 3 to 15 years (mean 9.1 and median 8.1 years). Main indications included recurrent otorrhoea, conductive hearing loss and aural atresia. Follow-up was at 4-6 weeks review initially, curtailing to 6 monthly reviews and then annual review. Early complications of skin infection occurred in two patients. Late complications such as skin hypertrophy and chronic infection occurred in two patients. Two patients lost the fixture due to trauma, both were subsequently reimplanted. There was no incidence of implant failure to osseointegrate. Twenty-eight children (93%) implanted wear their BAHAs.

Conclusion

Our results show that a single-stage technique is associated with a low rate of early complications, with no reports of fixture loss due to osseointegration failure.