Distortion product otoacoustic emission for the screening of cochlear damage in children treated with cisplatin
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Abstract Objectives/Hypothesis: To detect subtle hearing changes by measuring otoacoustic emissions in patients treated with a first dose of cisplatin. Study Design: Prospective study. Methods: We recruited 26 patients (mean age at treatment, 11.3 years) into this prospective study conducted at a tertiary academic referral center. Audiograms and transient‐evoked otoacoustic emissions (TEOAEs) and distortion‐product otoacoustic emissions (DPOAEs) were measured before and after the first dose of cisplatin. Results: Baseline readings were compared with those recorded after the administration of the first dose of cisplatin. Two patients showed a loss of TEOAEs at high frequencies above 4 kHz, and this was consistent with the 25‐dB hearing loss of the high frequencies detected in their audiograms; there was a significant threshold shift for DPOAEs at a frequency >3 to 4 kHz ( P <.05). Conclusions: DPOAE testing appears to be a more sensitive method to detect cochlear damage than conventional pure‐tone audiometry. Our results suggest that the measurement of DPOAE thresholds is a useful approach to detect the early auditory changes induced by cisplatin therapy.Keywords:
Audiogram
Otoacoustic emission
Ototoxicity
Pure tone audiometry
Abstract Objective: To examine whether distortion product otoacoustic emissions can serve as a replacement for pure tone audiometry in longitudinal screening for occupational noise exposure related auditory deficit. Methods: A retrospective review was conducted of pure tone audiometry and distortion product otoacoustic emission data obtained sequentially during mandatory screening of brickyard workers ( n = 16). Individual pure tone audiometry thresholds were compared with distortion product otoacoustic emission amplitudes, and a correlation of these measurements was conducted. Results: Pure tone audiometry threshold elevation was identified in 13 out of 16 workers. When distortion product otoacoustic emission amplitudes were compared with pure tone audiometry thresholds at matched frequencies, no evidence of a robust relationship was apparent. Seven out of 16 workers had substantial distortion product otoacoustic emissions with elevated pure tone audiometry thresholds. Conclusion: No clinically relevant predictive relationship between distortion product otoacoustic emission amplitude and pure tone audiometry threshold was apparent. These results do not support the replacement of pure tone audiometry with distortion product otoacoustic emissions in screening. Distortion product otoacoustic emissions at frequencies associated with elevated pure tone audiometry thresholds are evidence of intact outer hair cell function, suggesting that sites distinct from these contribute to auditory deficit following ototrauma.
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Tone (literature)
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Noise-induced hearing loss
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This study evaluates the use of transient evoked otoacoustic emissions as an alternative to pure tone audiometry for the assesment of hearing after tympanostomy tube insertion. Otoacoustic emissions and pure tone audiometry were carried out in 32 patients in whom tympanostomy tubes had been inserted. Otoacoustic emissions were detected in 78% of patients, whereas pure tone audiometry testing was only possible in 59%. Of 13 children who were 3 years of age or under, otoacoustic emissions could be measured in 62%, compared to pure tone audiometry which was only possible in 8%. Otoacoustic emission testing took on average 3 min, which was less than half the time for pure tone audiometry testing which took 7 min.
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Intravenous aminoglycoside (IV AG) antibiotics, widely used in patients with cystic fibrosis (CF), are known to have ototoxic complications. Despite this, audiological monitoring is not commonly performed and if performed, uses only standard pure-tone audiometry (PTA). The aim of this study was to investigate ototoxicity in CF children, to determine the most appropriate audiological tests and to identify possible risk factors.Auditory assessment was performed in CF children using standard pure tone audiometry (PTA), extended high-frequency (EHF) audiometry and distortion-product otoacoustic emissions (DPOAE).70 CF children, mean (SD) age 10.7 (3.5) years, were recruited. Of the 63 children who received IV AG, 15 (24%) children had ototoxicity detected by EHF audiometry and DPOAE. Standard PTA only detected ototoxicity in 13 children. Eleven of these children had received at least 10 courses of IV AG courses. A 25 to 85 dBHL hearing loss (mean±SD: 57.5±25.7 dBHL) across all EHF frequencies and a significant drop in DPOAE amplitudes at frequencies 4 to 8 kHz were detected. However, standard PTA detected a significant hearing loss (>20 dBHL) only at 8 kHz in 5 of these 15 children and none in 2 subjects who had significantly elevated EHF thresholds. The number of courses of IV AG received, age and lower lung function were shown to be risk factors for ototoxicity.CF children who had received at least 10 courses of IV AG had a higher risk of ototoxicity. EHF audiometry identified 2 more children with ototoxicity than standard PTA and depending on facilities available, should be the test of choice for detecting ototoxicity in children with CF receiving IV AG.
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Ototoxicity
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Objective: To evaluate the role of otoacoustic emission in children with middle-ear effusion and grommets. Materials and methods: A prospective study was carried out on a total of 90 ears. All children listed for grommet insertion had a pre-operative and post-operative (three to six months after grommet insertion) pure tone audiometry, tympanometry and otoacoustic emission recorded. A comparison was made between pure tone audiometry and otoacoustic emission both pre-operatively and post-operatively. Results: Pre-operatively, 63 ears had an abnormal pure tone audiometry of which 59 had absent otoacoustic emission. Therefore the sensitivity of otoacoustic emission in detecting a conductive loss was 59/63 = 94 per cent (95 per cent confidence interval 85 to 98 per cent). All 27 ears with normal hearing pre-operatively had normal otoacoustic emission. The specificity of otoacoustic emission was 27/27 = 100 per cent, (95 per cent confidence interval, 88 to 100 per cent). The positive predictive value was 59/59 = 100 per cent (95 per cent confidence interval, 94 to 100 per cent). After three to six months all post-operative patients with grommets had a normal pure tone audiometry and otoacoustic emission. So both pure tone audiometry and otoacoustic emission were strongly related both in patients with middle-ear effusion and in patients with grommets. Conclusion: As the demonstration of hearing in young and difficult-to-test children can be problematic and time-consuming, we suggest that otoacoustic emission can be used as an alternative to pure tone audiometry in patients with middle-ear effusion and grommets.
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INTRODUCTION Divers may sustain subclinical inner ear barotrauma (IEBT) that is not identified on pure-tone audiometry (PTA) but is potentially an important contributor to chronic sensorineural hearing loss (SNHL). Otoacoustic emission (OAE) testing, which identifies transient emission shifts (TESs) stemming from noise-induced inner ear injury, may be a more sensitive measure than PTA. Recognizing the salubrious health implications in mitigating the incidence and severity of SNHL in divers with earlier detection, we performed a pilot study investigating the potential of OAEs to identify clinical and subclinical IEBT (defined as a TES without an accompanying transient threshold shift) in divers subject to a provocative repetitive diving protocol. METHODS Eight US Navy-trained male divers participated in a repetitive diving protocol encompassing up to a maximum of 10 weeks of diving. All subjects received an otoscopic examination, tympanometry, and OAE testing on both ears prior to and immediately after each dive. Audiometry was evaluated prior to and after each week of repetitive diving. RESULTS There were 212 data pairs for comparison in the OAE testing. The average group wideband transient-evoked OAE shift was -1.24 dB. Only 25 significant threshold shifts were identified in over 1000 comparisons via audiometry. CONCLUSIONS OAE testing identified significant TES in a provocative repetitive diving protocol, supporting the assertion that both clinical and subclinical IEBT may contribute to chronic SNHL in divers. Exploiting this technology as an integral component of diving medical surveillance may identify those at risk for subsequent IEBT and hearing loss, facilitating opportunities for interventions to mitigate its severity or circumvent its development.
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Subclinical infection
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Ototoxicity
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Auditory brainstem response
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It has been suggested that otoacoustic emissions, particularly transient-evoked otoacoustic emissions (TEOAE), might be more sensitive in assessment of changes to the cochlea caused by noise than pure-tone audiometry (PTA). The aim of the study was to compare temporary threshold shifts with the changes in TEOAE following a six-hour exposure to industrial noise at the intensity of 85-97 dB (A). Thirty two male employees of a metal factory were screened. TEOAE, PTA and tympanometry were included in the hearing test battery. Both, PTA and TEOAE showed significant reduction due to noise exposure, but no correlation between temporary threshold shifts and decreases in either the overall TOAE level or the level of otoacoustic emission in the frequency bands was found. Our results confirm the high sensitivity of TEOAE to short exposure to industrial noise. This study may recommend this measurement as a method of evaluation for TTS conditions for hearing conservation programme purposes, in addition to pure-tone audiometry.
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