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Data and Picture Interpretation Stations: Cases 1–45
Published in Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar, ENT OSCEs, 2023
Peter Kullar, Joseph Manjaly, Livy Kenyon, Joseph Manjaly, Peter Kullar, Joseph Manjaly, Peter Kullar
Otitis Media with effusion, otherwise known as ‘glue ear’, is the commonest cause of new onset hearing loss in children aged 2–7, but can also affects adults. Diagnosis is made on otoscopic examination combined with flat trace (type B) tympanometry and a normal ear canal volume (0.6–2ml). Management options include hearing aids, bone conduction devices and grommet insertion, with or without adenoidectomy. It is estimated that with conservative management, 50% will resolve spontaneously at 3 months. NICE guidelines direct when surgical intervention is justified. The aim must always be to avoid prolonged auditory deprivation and the subsequent effects on speech and language development during childhood years. Certain conditions require more specific consideration due to the predisposition to more chronic effusion and hearing loss. These include Down syndrome, Cleft palate, Ciliary dyskinesias, Cranial anomalies and a history of radiotherapy. Grommets will typically be expelled spontaneously around 6–9 months. A small proportion has a resultant tympanic membrane perforation, and in others fluid re-accumulates requiring a subsequent set of grommets.
Psychoacoustic and Objective Assessment of Hearing
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Josephine Marriage, Marina Salorio-Corbetto
Tympanometry is used to assess middle ear function. The test is conducted by placing a probe in the ear canal, which is surrounded by a soft tip. The probe is composed of a loudspeaker, a microphone, and a pump. The soft tip should seal the ear canal so that the pump introduces controlled variations of the air pressure in the ear canal. The loudspeaker delivers a tone, usually 226 Hz, and the microphone monitors the sound level in the ear canal. With this probe, the compliance (or admittance) of the middle ear is measured as a function of the air pressure in the ear canal.
Pleasurable emotional response to music: A case of neurodegenerative generalized auditory agnosia
Published in Howard J. Rosen, Robert W. Levenson, Neurocase, 2020
Brandy R. Matthews, Chiung-Chih Chang, Mary De May, John Engstrom, Bruce L. Miller
Hearing sensitivity was assessed using insert headphones and standard audiometric techniques (Hattiangadi et al., 2005) with results compared to prior evaluation completed in 2002 at the same facility. Results were determined to represent fair reliability in the context of known multi-sensory deficits. Pure tone testing of the right ear revealed normal hearing at 250–2000 Hz sloping to a mild to moderate hearing loss in the 3000–8000-Hz range. Pure tone testing in the left ear revealed normal hearing at 250 Hz sloping to mild to moderate hearing loss in the 500–8000-Hz range. Tympanometry demonstrated bilaterally normal mobility, middle ear pressure, and ear canal volume. Acoustic reflexes were present bilaterally with negative reflex decay, consistent with a normal reflex arc with the exception of the 2000-Hz frequency ipsilaterally on the left. Distortion Product Otoacoustic Emissions were present 750–6000 Hz on the right and 750–4000 Hz on the left providing evidence of normal or near-normal outer hair cell cochlear function for much of the speech spectrum bilaterally. Word recognition ability was 0% during the audiometric examination in 2002 and was not repeated.
Sensory profiles, behavioral problems, and auditory findings in children with autism spectrum disorder
Published in International Journal of Developmental Disabilities, 2023
Ummugulsum Gundogdu, Ahmet Aksoy, Mehtap Eroglu
In the tympanometry test, which measures the pressure of the middle ear, air pressure is applied to the outer ear canal to measure the mobility of the middle ear and eardrum. By measuring the mobility in the middle ear and eardrum, information about the function of these structures can be obtained. During the tympanometry test, the eardrum should not be perforated (Demopoulos and Lewine 2016, Helenius et al.2012, Shanks and Shohet 2009). Five types of tympanogram can be seen Type A – Normal middle ear pressure, Type B – Little or no mobility, suggestive of fluid behind the tympanic membrane or perforation, Type C – Negative pressure in the middle ear, suggestive of a retracted tympanic membrane, Type As – A very stiff middle ear system that can be caused by myringosclerosis or otosclerosis, Type Ad – The highly compliant tympanic membrane seen in ossicular chain discontinuity
Evaluation of hearing protection device effectiveness for musicians
Published in International Journal of Audiology, 2023
Kathryn Crawford, Krista Willenbring, Faryle Nothwehr, Stephanie Fleckenstein, T. Renee Anthony
After the training, the clinician performed an otologic examination to evaluate the status of the ear canal and eardrum and performed tympanometry testing using a TympStar (Grason-Stadler, Eden Prairie, MN) to ensure no middle ear issues were present that potentially could affect threshold testing. Pure tone audiometric testing was performed to obtain baseline unoccluded hearing thresholds and hearing thresholds with each of the HPDs at the following frequencies: 125, 250, 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz. A modified Hughson–Westlake technique was employed using 2-dB increments. Audiometric testing occurred in a sound-treated booth with HDA 200 circumaural audiometric headphones (Sennheiser, Old Lyme, CT) using an Otometrics Madsen Astera (Natus, Shaumburg, IL) audiometer. Baseline hearing thresholds were recorded first. Participants were then instructed to insert the first set of HPDs and completed another round of threshold testing. All thresholds were recorded in Excel (Microsoft, Redmond, WA). The order for testing the HPDs was randomised.
Relative contributions of radiation and cisplatin-based chemotherapy to sensorineural hearing loss in head-and-neck cancer patients
Published in Acta Oto-Laryngologica, 2021
Nidhin Das, Darwin Kaushal, Sourabha Kumar Patro, Puneet Pareek, Abhinav Dixit, Kapil Soni, Nithin Prakasan Nair, Bikram Choudhury, Amit Goyal
The cochlea is an important organ at risk while treating head and cancers. The routine dose constraint prescribed is less than or equal to 35 Gy. In our study, with the VMAT technique, we were able to achieve lower doses to the cochlea compared to other modalities of RT. Primary diseases proximal to cochlea predicted higher mean radiation dose to the cochlea. There was no statistically significant threshold shift in a frequency-specific hearing in monotherapy, that is radiation alone. But along with cisplatin-based chemotherapy frequency-specific hearing loss was found at least dose of 9 Gy especially at high-frequency range (4 KHz–8 KHz). That is, we can speculate here that a tighter dose constraint to cochlea might be better suited when we are combining cisplatin with RT. The hearing loss was permanent and progressing till 12 months following RT. The risk of SNHL is independent of cumulative doses of cisplatin. There was permanent loss of OAEs in concurrent chemoradiation group but the RT dose constraints in our study was not associated with change in OAEs. Tympanometry variables also showed significant change at the end of treatment suggestive of middle ear disfunction due to radiation exposure.