Hearing loss

Hearing loss may be caused by either a conductive problem, such that the sound waves do not reach the tympanic membrane, ossicles or inner ear, or a sensorineural problem, in which the cochlea and/or auditory nerve are somehow damaged. A combination of the above may also occur. The various causes of hearing loss and the options in treatment will be presented.     

Hearing loss after spinal anesthesia. An audiological controlled trial

Audiological tests were conducted on 34 patients before and after undergoing an operation in spinal anaesthesia. One of these patients developed a considerable unilateral hearing loss in the low-frequency range, which persisted until an epidural blood-patch was given. Unexpectedly, we also found a general small but significant threshold shift at 500 Hz, which has never before been described in the literature. The biological mechanism is discussed, and the results suggest that the explanation of the hearing loss could be a condition similar to endolymphatic hydrops, resulting from perilymphatic hypotension due to loss of liquor during and after the spinal anaesthesia.     

Hearing loss from hemodialysis

A 47-year-old man with normal hearing had chronic progressive renal failure. He experienced hearing loss in additive increments with peritoneal dialysis and hemodialysis, until he was profoundly deaf in both ears. Postmortem studies showed collapse of the endolymphatic system and edema and atrophy of most of the specialized cell types of the auditory and vestibular sense organs. It is our interpretation that the alterations were caused by osmotic disequilibrium associated with hemodialysis.     

Hearing loss. The physician's responsibility

Hearing loss is a very important and common problem in the United States, affecting 13 to 14 million people. It is primarily a medical problem, requiring diagnosis and, when indicated, treatment by a physician, preferably in collaboration with an audiologist. History taking is the most important part of the diagnostic process, followed by a physical examination with special attention to the head, neck, and ears. The primary object of the workup is to exclude all possible extrinsic causes of hearing loss. Intrinsic or genetic deafness is a diagnosis of exclusion. After the hearing loss has been classified as congenital or delayed and as genetic or nongenetic, a differential or working diagnosis can be made in all cases and a specific diagnosis in most cases. The hearing loss must then be identified as stable, progressive, or fluctuant over time. Follow-up at least every two years is important to check for possible changes in status.     

Hearing loss secondary to lumbar puncture

Hearing complaints have been described in patients after lumbar puncture, although other symptoms like headache, nausea, and dizziness can easily obscure hearing disorders. Reduced cerebrospinal fluid pressure after lumbar puncture may explain the origin of this vestibulocochlear dysfunction. Two cases of hearing loss and tinnitus that appeared hours after otherwise uncomplicated diagnostic spinal puncture are reported. The pure tone audiogram showed a 40-50 dB bilateral sensorial hearing loss in the lower frequencies. Hearing recovered and tinnitus disappeared entirely within 7-10 days. Since permanent hearing loss has been reported after diagnostic or therapeutic lumbar puncture, we should be aware of the possibility of this adverse effect.     

Hearing loss in working life--some aspects of audiological rehabilitation

The association of Wegener's granulomatosis and pregnancy is rare and poses unique therapeutic challenges, particularly when active disease presents in early pregnancy. We describe a 22-yr-old woman who recovered successfully from her initial episode of Wegener's granulomatosis with a standard course of treatment with prednisolone and cyclophosphamide. Two and a half years later, she presented with relapse during the first trimester of pregnancy (primigravida). Since the clinical features suggested mild disease, she was started on prednisolone at a dose of 1 mg/kg/day, to which she seemed to respond very well for 3 months. Unfortunately, she had a spontaneous abortion at 5 months of gestation while on 25 mg/day of prednisolone. At this time, her disease flared further, with clinically manifest lung disease which was not part of her initial presentation. She was treated with another course of oral cyclophosphamide and prednisolone, and a remission was achieved in 4 months. There are no agreed guidelines on the treatment of Wegener's granulomatosis during pregnancy. In this report, the therapeutic issues are discussed against the background of the available literature.     

Hearing loss from combined exposures among petroleum refinery workers

Seventy-three consecutive cases of childhood acute lymphoblastic leukemia (ALL) diagnosed and managed in Queen Mary Hospital over a 10-year period from 1985 to 1994 were retrospectively analysed for their presenting features and treatment outcome. The 48 boys and 25 girls ranged in age from 0.4 to 14.2 years (median: 4.3 years). Bone and joint pain was a relatively common presenting feature besides fever, hepatosplenomegaly and lymphadenopathy. Immunophenotyping of blast cells showed: 51 B-cell precursor ALL, one B-ALL, 10 T-ALL and three myeloid-antigen positive ALL. Eight cases were unclassified since immunophenotyping had not been performed. Out of the 73 patients, treatment outcome was analysed in 20 cases treated with UKALL-VIII regimen and 28 cases treated with either the UKALL-XI regimen or the Hong Kong Children Cancer Study Group (HKCCSG) protocol which was modelled upon UKALL-XI. Although complete remission rates were similar between the two groups, patients treated with the former regimen that was less intensified suffered more relapses than the latter (56 per cent versus 21 per cent, P = 0.04). There were, however, no significant differences both in event-free survival (38.2 +/- 11.2 per cent versus 71.3 +/- 9.3 per cent, P = 0.12) and overall survival (70.0 +/- 10.2 per cent versus 79.6 +/- 8.3 per cent, P = 0.41) between the two groups at 3 years by long-rank test. With the use of risk-directed therapy and improved supportive care, two-thirds of our patients are able to enjoy long-term event-free survival.     

Hearing recovery in sudden deafness with profound hearing loss

To more completely describe acromion morphology and its relationship to impingement syndrome, we performed three-dimensional magnetic resonance imaging (N = 111) or computed tomography (N = 27) on 132 symptomatic shoulders. The mean patient age was 46.2 years (range, 14 to 86). Four parameters were evaluated: the angle of anterior slope of the acromion in the midsagittal and lateral-sagittal planes, lateral acromial angulation in the coronal plane, and the presence or absence of medial encroachment in the acromioclavicular joint. Twenty-five asymptomatic age-matched shoulders were used as controls. All imaging data were combined because no significant differences existed between the two imaging techniques. The mean acromion angle was 19.4 degrees in the midsagittal plane and 20 degrees in the lateral-sagittal plane. In the coronal plane, 97 (73%) acromions were neutral and 35 (27%) were downward sloping. Medial encroachment was present in 31 (24%) shoulders. Age distribution from the 2nd to 8th decade demonstrated a consistent and gradual transition from a flat acromion in the younger decades to a more hooked acromion in the older decades that was significant in both the midsagittal and lateral-sagittal planes. Furthermore, a greater percentage of patients were found to have downward angulating acromions with increasing age. Ninety-eight patients (74%) had stage II or III impingement. Of these shoulders, 39 (40%) had type I acromions, 51 (52%) type II, and 8 (8%) type III. Twenty-eight of 33 acromions with coronal lateral downward sloping had impingement, and all 31 shoulders with medial encroachment had impingement.     

Hearing findings in subjects after meningitis

INTRODUCTION: It was proposed to ascertain the occurrence of individuals who present hearing loss, due to contracting meningitis, as well as to characterize the diagnosed loss as far as the type, degree and the audiometric configuration are concerned. MATERIAL AND METHOD: The methodology used comprised a survey of 949 references of patients attended at the Hearing Disturbance Center of the HPRLLP/USP, in order to select those who presented hearing loss after meningitis and, from the analysis of the hearing evaluation to which they were submitted, achieve the proposed goal. RESULTS AND CONCLUSION: The results indicated a 6.2 percent occurrence as regards hearing loss due to meningitis in relation to other causes and the characteristic of this hearing loss was predominantly sensorineural, symmetrical, al linear and to a profound degree.     

Clinically significant hearing loss in renal allograft recipients treated with intravenous erythromycin

BACKGROUND: Hearing loss is generally regarded as a rare side effect of erythromycin therapy. However, our own clinical experiences in erythromycin-treated patients led us to suspect that this complication may be more common among renal allograft recipients. The purpose of this study was to evaluate the incidence, predisposing factors, clinical characteristics, and outcomes of erythromycin-induced hearing loss among renal allograft recipients. METHODS: We reviewed medical records of renal transplant patients treated for pneumonia with intravenous erythromycin lactobionate. Patients were evaluated for the occurrence of clinically significant hearing loss (including onset, duration, and reversibility), other signs and symptoms of ototoxicity (vertigo and tinnitus), daily erythromycin dose and duration of treatment, concurrent ototoxic drug therapy, renal and hepatic function, and history of previous otic disease. RESULTS: Eleven (32%) of 34 courses of intravenous erythromycin therapy resulted in hearing loss. The incidence of hearing loss was 53% (eight of 15 courses) in patients treated with 4 g of erythromycin daily compared with 16% (three of 19 courses) among those receiving 2 g/d (P = .05). In addition, courses of erythromycin were longer in those suffering auditory toxicity (9.6 +/- 4.7 days) than in nontoxic patients (5.7 +/- 3.6 days) (P < .05). Hepatic and renal function did not differ between toxic and nontoxic patients. All episodes of erythromycin-induced hearing loss were reversible. CONCLUSIONS: We conclude that clinically significant hearing loss occurs in more than 30% of renal allograft recipients treated for pneumonia with intravenous erythromycin lactobionate. Patients who require prolonged courses of erythromycin and those treated with 4 g/d are at particular risk for the development of auditory toxicity. With prompt recognition and modification of therapy, erythromycin-induced hearing loss appears to be completely reversible.     

Transdermal delivery of erythromycin lactobionate--implications for the therapy of gastroparesis

BACKGROUND: The treatment of many diseases may be complicated by abnormalities in gastric emptying. Gastric motor dysfunction may lead to unpredictable food and medication delivery to the small intestine, their site of absorption. Prokinetic agents improve gastric motility, but orally administered drugs are unreliably absorbed, thereby limiting their effectiveness. A method of delivering prokinetic agents which bypasses the gastrointestinal tract could lead to more effective treatment. METHODS: Skin samples from rat, hairless mouse and man were placed in an in vitro diffusion chamber. The epidermal side of the skin was exposed to erythromycin lactobionate and passage of the drug across the skin sample monitored and quantitated by high-performance liquid chromatography with UV detection. RESULTS: Erythromycin passes across all skin types tested. Steady-state flux across hairless mouse skin was greater than for rat, full thickness human skin and human epidermis. In the first 3 h following introduction of erythromycin lactobionate, 1.85 mg/cm2 crossed human epidermis. Given that a dose of 50 mg may exert prokinetic effects in vivo in man, increasing the patch size to approximately equal to 28 cm2 should provide therapeutic levels of drug within 3 h. CONCLUSIONS: Erythromycin lactobionate, when administered transdermally, can be delivered at levels sufficient to treat gastroparesis. This technique warrants in vivo investigation.     

Effect of cessation of erythromycin therapy on diffuse panbronchiolitis]

The effect of cessation of erythromycin (EM) therapy against diffuse panbronchiolitis was studied. Nine cases were examined. After cessation of EM therapy, the manifestations of disease were stable in five cases, but worsened in the other four. In the former five, the period from the onset of disease until EM therapy began was relatively short; when EM therapy was stopped the manifestations of disease had almost completely disappeared and chest roentgenography revealed resolution of diffuse, small, nodular opacities without remarkable bronchiectasis. In contrast, in the latter four cases, the clinical manifestations of disease did not disappear, and chest-roentgenographic evidence of bronchiectasis was common before the cessation of EM therapy. In conclusion, EM therapy for diffuse panbronchiolitis may be stopped if the clinical manifestations of disease (especially purulent sputum) disappear, if diffuse, nodular opacities resolve almost completely and if there is no evidence of bronchiectasis.     

Hearing loss and cognition in the Baltimore Longitudinal Study of Aging.

Objective: To determine the relationship between hearing loss and cognitive function as assessed with a standardized neurocognitive battery. We hypothesized a priori that greater hearing loss is associated with lower cognitive test scores on tests of memory and executive function. Method: A cross-sectional cohort of 347 participants ≥55 years in the Baltimore Longitudinal Study of Aging without mild cognitive impairment or dementia had audiometric and cognitive testing performed in 1990–1994. Hearing loss was defined by an average of hearing thresholds at 0.5, 1, 2, and 4 kHz in the better-hearing ear. Cognitive testing consisted of a standardized neurocognitive battery incorporating tests of mental status, memory, executive function, processing speed, and verbal function. Regression models were used to examine the association between hearing loss and cognition while adjusting for confounders. Results: Greater hearing loss was significantly associated with lower scores on measures of mental status (Mini-Mental State Exam), memory (Free Recall), and executive function (Stroop Mixed, Trail Making B). These results were robust to analyses accounting for potential confounders, nonlinear effects of age, and exclusion of individuals with severe hearing loss. The reduction in cognitive performance associated with a 25 dB hearing loss was equivalent to the reduction associated with an age difference of 6.8 years. Conclusion: Hearing loss is independently associated with lower scores on tests of memory and executive function. Further research examining the longitudinal association of hearing loss with cognitive functioning is needed to confirm these cross-sectional findings. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Hearing loss due to the mitochondrial A1555G mutation in Italian families

A 68-year old woman presented with a frontal fibrosing alopecia and lesions of the buccal mucous membranes typical for lichen planus. Postmenopausal frontal fibrosing alopecia (PFFA) has recently been described by Kossard as a distinct entity characterized by progressive recession of the frontotemporal and parietal hair margins leading to permanent alopecia in the form of a symmetrical band-like area of scanning in postmenopausal women. The histology (perifollicular lymphocytic infiltration and fibrosis, increase of apoptosis of hair follicle keratinocytes) is indistinguishable from that of lichen planopilaris. The localization and age- and sex-related characteristics of PFFA are not sufficient to delineate it as a discrete entity from lichen planopilaris. Our observation of oral lichen planus in a postmenopausal woman with frontal fibrosing alopecia points to the possibility that PFFA actually may represent a variant of lichen planopilaris with a predilection for the frontotemporal hairline. Other variants of lichen planopilaris include multifocal lichen planopilaris, disseminated lichen planopilaris (Lassueur-Graham-Little syndrome), lichenoid pseudopelade, and any combination of these ("mixed type"). An effective therapy of PFFA is not known. Also, treatment of lichen planopilaris forms in which fibrosis predominates over inflammation is similarly problematic, but the natural course of these diseases seems to be self-limited.     

Hearing in the elderly. Relation of hearing loss, loneliness, and self-esteem

1. The prevalence of hearing impairment increases with age. Hearing handicap resulting from hearing loss may lead to psychosocial problems in elders. 2. Previous studies have shown relations among hearing handicap, loneliness and low self-esteem, but those studies focused on populations other than elders. 3. Early detection of hearing handicap and appropriate interventions promote increased independence and preserve the ability of elders to interact with their environment.     

Hearing loss and vestibular dysfunction in childhood from the use of streptomycin in Albania

OBJECTIVE: To analyze which factors, including gynecological surgery in particular, contribute to the occurrence of pelvic relaxation. METHOD: A retrospective analysis of 711 consecutive patients treated surgically for pelvic relaxation from 1983 to 1989 at the Department of Obstetrics and Gynecology of Turku University Central Hospital was undertaken. RESULT: The patients who underwent surgery for recurrent pelvic relaxation were significantly older (66.8 vs. 62.1 years) and suffered significantly less (20% vs. 41%) from urinary stress incontinence than patients undergoing primary surgery for pelvic relaxation. Anterior vaginal segment relaxation (i.e. cysto- and urethrocele) was common in patients undergoing the initial operation (n = 684), and posterior vaginal segment relaxation (i.e. rectocele and perineal laceration) in recurrent operations (n = 58). Of the patients studied, 87 had pelvic relaxation, which had developed after partial (n = 46), total abdominal (n = 16) or vaginal (n = 25) hysterectomy. CONCLUSION: Care must be taken in the treatment of the posterior vaginal segment during the initial operation for pelvic relaxation in order to avoid late sequelae. Moreover, when the removal of the uterus is planned, the matter of a stable vaginal vault must be taken into account especially when partial hysterectomy should be performed.     

Hair loss after routine immunizations

CONTEXT: Alopecia is a recognized adverse effect of numerous medications, but vaccines are not normally considered a cause for unexpected loss of hair. OBJECTIVE: To describe case reports of hair loss after routine vaccines and to assess the hypothesis that vaccinations might induce hair loss. DESIGN: Case series with telephone follow-up. METHODS: Review of spontaneous reports to the Food and Drug Administration, the Centers for Disease Control and Prevention, and the Vaccine Adverse Event Reporting System. MAIN OUTCOME MEASURE: Loss of hair following immunization. RESULTS: A total of 60 evaluable reports submitted since 1984 and coded for "alopecia" after immunizations included 16 with positive rechallenge (hair loss after vaccination on more than 1 occasion), 4 of which were definite and 12 possible or probable. Of the 60 cases, 46 had received hepatitis B vaccines. Both of the currently available recombinant products, as well as the former plasma-derived product, were represented. Females predominated in all age groups. The majority of patients recovered, but clinical features, such as intervals from vaccination until onset and the extent and reversibility of hair loss, varied widely. Nine patients reported previous medication allergy. CONCLUSION: There may be an association, probably very rare, between vaccinations and hair loss. More than 1 pathophysiologic mechanism may be responsible. Since apparently nonrandom distributions by vaccine, age, and sex could reflect biased case ascertainment, further research will be needed in defined populations with consistent case detection.     

Hearing loss in community-dwelling older persons: national prevalence data and identification using simple questions

OBJECTIVE: To estimate the prevalence of hearing loss among community-dwelling older persons according to clinical criteria and to develop a brief self-report screening instrument to detect hearing loss. DESIGN: Survey. SETTING: National probability sample of noninstitutionalized older persons. PARTICIPANTS: A total of 2506 persons aged 55 to 74 who participated in the National Health and Nutrition Examination Survey. MAIN OUTCOME MEASURES: Hearing loss as defined by Ventry and Weinstein (VW) criteria and by the High Frequency Pure-Tone Average (HFPTA) scale. RESULTS: Hearing loss by VW criteria was present in 14.2% and by HFPTA criteria in 35.1% of those surveyed. The prevalence increased with advancing age and was higher among men and those with less education. A logistic regression model identified six independent factors for hearing loss by VW criteria: age > or = 70 years (adjusted odds-ratio (AOR) 2.7, 95% confidence interval (95% CI) 1.6, 4.4), male gender (AOR 3.0, 95% CI 1.9, 4.8), < or = 12th grade education (AOR 3.8, 95% CI 1.8, 7.7), having seen a doctor for deafness or hearing loss (AOR 8.9, 95% CI 5.3, 14.9), unable to hear a whisper across a room (AOR 3.2, 95% CI 2.0, 5.1), and unable to hear a normal voice across a room (AOR 6.2, 95% CI 2.6, 14.9). A clinical scale based on the logistic model had 80% sensitivity and 80% specificity in predicting hearing loss using VW criteria and 59% sensitivity and 88% specificity in predicting hearing loss using HFPTA criteria. CONCLUSIONS: Hearing loss, as defined by two clinical criteria, is common and can be screened for accurately using simple questions that assess sociodemographic and hearing-related characteristics.