Ann Mary Augustine

Neonatal hearing screening — Experience from a tertiary care hospital in Southern India

ObjectiveTo implement a neonatal hearing screening program using automated auditory brainstem response audiometry in a tertiary care set-up and assess the prevalence of neonatal hearing loss.DesignDescriptive study.SettingTertiary care hospital in Southern India.Participants9448 babies born in the hospital over a period of 11 months.InterventionThe neonates were subjected to a two stage sequential screening using the BERAphone. Neonates suspected of hearing loss underwent confirmatory testing using auditory steady state response audiometry. In addition, serological testing for TORCH infections, and connexin 26 gene was done.Main outcome measuresFeasibility of the screening program, prevalence of neonatal hearing loss and risk factors found in association with neonatal hearing loss.Results164 babies were identified as suspected for hearing loss, but of which, only 58 visited the audiovestibular clinic. Among 45 babies who had confirmatory testing, 39 were confirmed to have hearing loss and were rehabilitated appropriately. 30 babies had one or more risk factors; 6 had evidence of TORCH infection and 1 had connexin 26 gene mutation.ConclusionNeonatal hearing screening using BERA phone is a feasible service. The estimated prevalence of confirmed hearing loss was comparable to that in literature. Overcoming the large numbers of loss to follow-up proves to be a challenge in the implementation of such a program.

Subjective Visual Vertical and Horizontal in Vestibular Migraine

OBJECTIVE To assess the functional status of the otolithic pathway in vestibular migraine by comparing the results of static and dynamic subjective visual vertical and horizontal [subjective visual vertical (SVV) and subjective visual horizontal (SVH)] testing in patients with vestibular migraine with that of normal individuals. MATERIALS AND METHODS This hospital-based prospective study was conducted in 82 normal adults and 66 adults with vestibular migraine. The SVV and SVH angles were measured under static and dynamic conditions using a software-based test protocol. The arithmetic mean of six readings in each situation was considered. The results were further analyzed by stratifying cases and controls into two age groups 20-40 years and 41-60 years and into gender. RESULTS The clinical profile of the patients with vestibular migraine was comparable to the available literature. The dynamic SVV and SVH in both age groups and the static SVH in the 41-60 years age group were significantly higher compared to normal individuals (p<0.05). The dynamic SVV and SVH were significantly higher in the cases compared to controls among both males and females (p<0.05). CONCLUSION There is evidence of otolithic pathway abnormalities in individuals with vestibular migraine. The inclusion of SVV and SVH testing for the evaluation of patients with vestibular migraine may be useful in the interpretation and rehabilitation of symptoms in these patients.

Subjective visual vertical and horizontal: Normative values using a software-based test in the Indian population

Aims and Objectives: To determine the normative values for static and dynamic subjective visual vertical and horizontal (SVV and SVH) in a group of Indian volunteers. Materials and Methods: This hospital-based, prospective, cross-sectional study was done on 82 normal adults. The SVV and SVH angles were measured under static and dynamic conditions using the software MUS_VS-V1.3.2.Rev B (Synapsis, France). Six readings each were taken for SVV and SVH in both static and dynamic situations. Results: The obtained mean value for static SVV, dynamic SVV, static SVH, and dynamic SVH were 1.52° ± 0.70°, 1.96° ± 0.65°, 1.64° ± 0.81°, and 1.99° ± 0.78°, respectively. Static SVV for females was 1.4° ± 0.68°; static SVV for males was 1.58° ± 0.71°; dynamic SVV for females was 1.82° ± 0.64°; dynamic SVV for males was 2.04° ± 0.65°; static SVH for females was 1.63° ± 0.76°; static SVH for males was 1.65° ± 0.84°; dynamic SVH for females was 1.80° ± 0.60°, and dynamic SVH for males was 2.1° ± 0.86°. There was no significant difference between the sexes and between the age groups 20–40 years and 41–60 years. Conclusions: This is the only study in the Indian population, and the normative data obtained in this study can serve as a reference for future studies and vestibular testing, especially in those suffering from chronic vertigo and suspected to have otolithic pathway abnormalities.

Auditory function in vestibular migraine

Introduction: Vestibular migraine (VM) is a vestibular syndrome seen in patients with migraine and is characterized by short spells of spontaneous or positional vertigo which lasts between a few seconds to weeks. Migraine and VM are considered to be a result of chemical abnormalities in the serotonin pathway. Neuhauser′s diagnostic criteria for vestibular migraine is widely accepted. Research on VM is still limited and there are few studies which have been published on this topic. Materials and Methods: This study has two parts. In the first part, we did a retrospective chart review of eighty consecutive patients who were diagnosed with vestibular migraine and determined the frequency of auditory dysfunction in these patients. The second part was a prospective case control study in which we compared the audiological parameters of thirty patients diagnosed with VM with thirty normal controls to look for any significant differences. Results: The frequency of vestibular migraine in our population is 22%. The frequency of hearing loss in VM is 33%. Conclusion: There is a significant difference between cases and controls with regards to the presence of distortion product otoacoustic emissions in both ears. This finding suggests that the hearing loss in VM is cochlear in origin.

Automated auditory brainstem response: Its efficacy as a screening tool for neonatal hearing screening in the postnatal ward

Introduction: This observational study was carried out to determine the sensitivity and specificity of MB11 BERAphone® , when used for neonatal hearing screening in a postnatal ward setting in comparison against the gold standard, auditory brainstem response (ABR). Materials and Methods: Thirty-seven consecutive newborns (74 ears) who either unilaterally or bilaterally failed hearing screening with MB11 BERAphone in the postnatal ward were recruited and a second screening with BERAphone was performed after 1 week along with confirmatory testing using ABR. Results: MB11 BERAphone showed sensitivity of 92.9%, specificity of 50%, positive predictive value of 30.23%, and negative predictive value of 96.77% for the diagnosis of hearing loss. The prevalence of confirmed hearing impairment was 18.9%. The rate of unilateral impairment was 10.8%, and the rate of bilateral impairment was 13.5%. The average ambient noise levels in the postnatal ward setting was 62.1 dB. Conclusion: Although the sensitivity of MB11 BERAphone is good, the specificity is significantly lower when the test is performed in the postnatal ward setting with high ambient noise. Neonates who fail the two-step screening should undergo auditory response for confirming the diagnosis of hearing loss.