Audiol. Res., Volume 10, Issue 2 (December 2020) – 9 articles

Background: Tympanometry is a routine clinical test ordered at the Department of Otolaryngology, Ear, Nose and Throat (ENT) at Changi General Hospital (CGH). In combination with the pure tone audiogram, tympanograms aid in the diagnostic value of various middle ear disorders. However, its diagnostic value depends on the physician and audiologist’s accuracy of classifying and interpreting the tympanograms. Presently, Caucasian normative values are used in the classification of tympanograms, which could be inaccurate without population specific norms. Therefore, there is a need to understand ethnic differences in tympanometry parameters in order to usefully interpret the tympanogram. Thus far, there are no local studies on the differences in tympanometric parameters among multiethnic groups. Previous studies also had conflicting results on the effects of ethnicity with direct or indirect comparison only between two ethnic groups. To our knowledge, this is the first preliminary investigation on the effects of demographic and anthropometric measurements on tympanometric parameters. Materials and Methods: 90 patients’ medical charts were randomly selected and reviewed to extract demographic, anthropometric and clinical information. Tympanogram characteristics among ethnic groups were investigated using univariate and multivariate analyses. The mean ages of males and females in the study were 41.9 years ± 17.4 and 46.1 ± 19.2, respectively. Results: Gender significantly influenced ear canal volume (ECV). Chinese had marginally significant lower static admittance (SA) as compared to non-Chinese. There were, however, no effects of age or anthropometric measurements on tympanometric results. Conclusion: Further prospective large cohort analyses are warranted to expand this investigation to better elucidate differences observed in tympanometric parameters and establish population specific norms for appropriate and accurate tympanogram classifications. Full article

To gain insight into the broader implications of the occlusion effect (OE—difference between unoccluded and occluded external canal thresholds), the OE in response to pure tones at 0.5, 1.0, 2.0 and 4.0 kHz to two bone conduction sites (mastoid and forehead) and two soft tissue conduction (STC) sites (under the chin and at the neck) were assessed. The OE was present at the soft tissue sites and at the bone conduction sites, with no statistical difference between them. The OE was significantly greater at lower frequencies, and negligible at higher frequencies. It seems that the vibrations induced in the soft tissues (STC) during stimulation at the soft tissue sites are conducted not only to the inner ear and elicit hearing, but also reach the walls of the external canal and initiate air pressures in the occluded canal which drive the tympanic membrane and excite the inner ear, leading to hearing. Use of a stethoscope by the internist to hear intrinsic body sounds (heartbeat, blood flow) serves as a clear demonstration of STC and its relation to hearing. Full article

Tinnitus often described as sound in the ear in absence of any external stimulus. It poses a challenge to the psychological and mental wellbeing of the patient and professional unsatisfaction to the clinician. The patient often an old aged individual usually approaches the outpatient department with various sounds in the ear, making him feel ill or unable to have a sound sleep. The middle-aged patient often complains of professional incapability and lack of concentration due to tinnitus. Despite vast academic research and advances, the efficiency of available treatment is debatable, often compelling the clinician to convey the message that “you may have to learn to live with it”. In the present overview of reviews, we tend to look into the management of tinnitus and present a comprehensive outlook of various evidence-based reviews from Cochrane and augmented with various studies from PubMed. Full article

Introduction—Although auditory brainstem response (ABR) testing is among the most frequently used investigations in pediatric audiology and it often requires sedation or general anesthesia. In recent years, melatonin has been successfully used as an alternative way of inducing sleep, particularly in children undergoing magnetic resonance imaging (MRI) or electroencephalography (EEG). Purpose—To assess the effectiveness of orally administered melatonin as an alternative to sedation or general anesthesia during ABR testing. Method—In total, 33 children with suspected hearing loss underwent ABR tests in melatonin-induced sleep. Each patient received an initial dose of 5 mg, which was re-administered in case of failure to obtain sleep. Click-induced ABR tests were performed on both ears. Results—ABR tests were successfully performed in 72.7% of the patients. The average total length of time needed to obtain sleep and complete the ABR testing was 45 min. There was no significant difference between the patients who completed the examination and those who did not in terms of age or psychomotor development. There was a statistically significant association between receiving a maintenance dose and successful completion of the test (p < 0.001). There was also a significant connection between the degree of hearing loss and the success rate of the ABR tests (p < 0.001). Conclusions—Melatonin-induced sleep is a good and safer alternative to anesthesia to perform ABR testing in young children. It is easily administered, tolerated by the patients, and accepted by parents. Full article

Purpose: The purpose of this study was to validate the Greek version of the Tinnitus Handicap Inventory. Method: Eighty-six adult patients with chronic tinnitus participated in the study. Sociodemographic data and medical history were recorded during the interview. The patients underwent audiological examination and they were asked to fill in three questionnaires: the Greek version of the THI (THI-GR), the Greek version of the State-Trait Anxiety Inventory (STAI) and the brief Tinnitus Severity Scale Questionnaire (TSSQ). Results: The THI-GR showed good internal consistency, comparable to the original version. Cronbach’s alpha was equal to 0.92, which suggests a robust reliability. All THI-GR subscales along with total score were significantly and positively correlated with the TSSQ grade and the audiogram results indicating the existence of convergent validity. Furthermore, THI-GR’s subscales were significantly correlated with both State and Trait subscales, which indicates a correlation between tinnitus and stress. Conclusions: This study highlighted the high reliability and validity of the THI-GR as a self-report measure for the evaluation of tinnitus-related annoyance and psychological distress in clinical practice. Full article

Vestibular neuritis (VN) is one of the most common causes of acute vestibular syndrome (AVS). Quantifying the vestibulo-ocular reflex (VOR) gain by the video Head Impulse Test (vHIT) could provide useful information to diagnose VN. This study aims to retrospectively evaluate the VOR gain values during the acute and subacute stages of the VN and to correlate these values with the patients’ dizziness-related handicap. Medical record of 28 patients with VN were reviewed. Patients were assigned to two groups according to the time since the acute vestibular syndrome (AVS). One group with patients assessed within seventy-two hours since the AVS (AVSg) and one group with patients evaluated from four days to six weeks since the AVS (PAVSg). VOR gain was evaluated in all selected patients and correlated to Dizziness Handicap Inventory (DHI). Significant differences were found in the between-subjects analysis in DHI score (p = 0.000) and in the ipsilesional hVOR gain values (p = 0.001). The correlation analysis showed significant results (p = 0.017) between DHI score (40 ± 16.08) and ipsilesional VOR gain (0.54 ± 0.09) in the PAVSg. Patients evaluated within 72 h since the AVS showed anticompensatory saccades (AcS) turning the head toward the contralesional side. Patients with unilateral Superior VN (SVN) could have dissimilar hVOR gain values and DHI score according to the damage of the VIII pair of cranial nerves. AcS in the contralesional side is a sign of acute phase in patients with unilateral SVN. Full article

Background/Objective: Slow-Phase Eye Velocity Time constant (SPEV TC) and Perceived Rotational Duration (PRD) are measurable objective outcomes of rotational chair step-velocity test. These two variables are dependent on the efficacy of the central velocity storage. If sensory conflict from the step-velocity of the rotational chair elicits motion sickness, the SPEV TC and PRD in individuals with varying susceptibility to motion sickness should be affected. We determined if Central Vestibular Sensitivity (CVS) characteristics differ among individuals with a range of Motion Sickness Susceptibility (MSS). Methods: Participants were allocated to two groups based on MSS (low and high) as identified on the short version of the Motion Sick Susceptibility Questionnaire (MSSQ-S). We evaluated the specific relationship between MSS and the characteristics of CVS through the SPEV TC and PRD from the step-velocity test. Results: Results showed significant differences in the PRD between these two groups. 180°/s Per-rotatory PRD is most significantly different (p = 0.005) followed by 50°/s post-rotatory PRD (CCW, p = 0.007; CW, p = 0.021) and log of 180°/s post-rotatory PRD (p = 0.042). Multiple regression analysis indicated that CCW post-rotatory PRD at 50°/s was a strong predictor of MSS. Conclusions: High MSS individuals were observed with elevated PRD in general, indirectly suggesting greater velocity storage efficiency, hence, greater CVS; CVS is therefore positively correlated with MSS. PRD could be a reliable clinical indicator of motion sick susceptibility and may help with the selection of personnel working in motion sick environments and with the verification of motion sickness therapeutic interventions. Full article