Haya Levi

Follow-Up of 40 000 Infants Screened for Hearing Defect

During a 7-year period beginning in 1967, approximately 40,000 infants born in Jerusalem were screened for hearing impairment. The hearing of all infants who visited the well-baby clinics at the age of 7-9 months (85% of the child population) was tested and a set of selective criteria was applied to them to detect the children at risk of hearing impairment. Those children suspected of having a hearing impairment were followed up at the Speech and Hearing Center of the Hadassah University Hospital. 69 children were identified as having substantial hearing impairment (moderate to profound); the distribution of risk factors among them is presented. Rehabilitation was carried out from infancy to preschool age, at which time the children were enrolled in suitable educational frameworks. The role of the parents was crucial. At the age of 6 years, many of the hearing-impaired children were integrated into the elementary school system; others attended the School for the Deaf or special institutions. The distribution of the hearing-impaired children in the various school systems is discussed.

Effect of Cyclosporine a on the Hearing Loss in Behçet's Disease:

Thirty-five patients with Behçets disease (20 under cyclosporine A [CyA] treatment and 15 under the conventional therapy), 12 patients suffering from endogenous uveitis, and 35 normal subjects were evaluated audiologically before entering the study and were followed up for at least a year. Twenty-eight Behçet patients (80%) showed some degree of hearing loss. The averaged pure tone audiogram of the Behçet group showed statistically significant auditory deficits in comparison with that of the control group. None of either the Behçet group or the uveitis group showed any hearing deterioration during the follow-up period. Five Behçet patients under CyA therapy demonstrated improvement in their hearing. The difference between the two groups of Behçet patients (CyA versus conventional treatment) was found to be statistically significant (p < .05). Thus, CyA might serve as an important mode of treatment of sensorineural hearing loss on an inflammatory “autoimmune” background.

Transient Evoked Otoacoustic Emissions in Newborns in the First 48 Hours After Birth

Newborns are often discharged from hospital at the age of about 48 hours. At this age, transient evoked otoacoustic emissions (TEOAEs) are not necessarily recordable in all healthy newborns. In order to determine the factors which would enable the successful recording of TEOAEs before discharge to facilitate screening for hearing, 65 fullterm newborns under 48 hours of age were tested, the youngest being 10 hours old. The ears of those neonates in whom TEOAEs could not be obtained (N = 7 neonates bilaterally, 6 unilaterally) were examined otoscopically, cleaned of vernix and retested for TEOAEs. We were thus able to record in at least one ear in all neonates tested, if the ears were clean, if they were asleep and if the testing room was quiet.

Auditory Nerve and Brain Stem Evoked Response Thresholds in Infants Treated with Gentamicin as Neonates

Thirty-two infants (18 full-term and 14 premature) who had been treated with gentamicin as neonates were examined to ascertain whether this drug induced hearing loss, even of low severity. Objective thresholds to clicks were obtained using auditory nerve and brain stem evoked responses. In addition, behavioral audiometry was performed. Serum concentrations before and after gentamicin treatment were at therapeutic levels. All infants were examined at least 1 1/4 months after cessation of therapy. Normal thresholds were obtained in all ears, with the exception of two with demonstrable middle ear effusion. It appears that gentamicin in therapeutic doses and serum concentrations, in the absence of renal insufficiency, does not cause hearing loss in neonates.

Comparison of two hearing screening programs in the same population: Oto-acoustic emissions (OAE) screening in newborns and behavioral screening when infants

OBJECTIVE Hearing screening programs in infancy should identify hearing impairment as early as possible. The two common programs utilize either objective neonatal tests (oto-acoustic emissions (OAE) or automatic auditory brainstem responses (aABR)) or behavioral screening at 7-9 months of age. Most countries employ only one of these options. The uniqueness of this study is the comparison of both hearing screening programs on the same group of children. METHODS The study was conducted on 1545 children born between the years 1999 and 2003 who were followed up in public well baby clinics in the Jerusalem district. The children were tested with transient oto-acoustic emissions (TEOAE) before discharge from the neonatal ward, and later, at the age of 7-9 months, underwent a behavioral hearing screening test in a public well baby clinic. The results of both hearing screening programs were compared. RESULTS The compliance rates were 99.7% for the neonatal testing and 83% for the 7-9 months behavioral testing (p=0.0001). The failure rate was 4-6% in both screening programs; failure of OAE testing was unilateral in 65% of newborns; at 7-9 months bilateral failure was more common (56%). There was an 11.2% disagreement (kappa coefficient 0.03) between the outcomes of both tests. In another group of 49 known hearing-impaired children, 27 who had undergone newborn screening were diagnosed before the age of behavioral testing. Twelve children had failed either both tests or the only test they underwent. In nine cases, the children had passed one of the hearing screening tests and had failed the other, and one child had passed both tests. CONCLUSIONS Newborn hearing screening has the advantages of objectivity, early identification, and higher compliance. The major advantage of the later behavioral test is identification of later onset or progressive hearing impairment as well as auditory neuropathy spectrum disorder. Each screening test is testing different entities; hence they are complementary and not interchangeable or superfluous. We recommend a comprehensive two-step hearing screening plan (newborn and later behavioral) with close cooperation between the health care providers involved.

Early Detection of Hearing Loss in Infants by Auditory Nerve and Brain Stem Response

Auditory-nerve and brain-stem-evoked responses (ABR) have been used alongside standard behavioral hearing tests for the early detection of hearing loss in infants and young children. Two comparisons are presented. The first concerns a group of 65 hearing-impaired children for whom we now have complete pure-tone and speech audiograms. There is a good correlation between the two types of hearing tests in 61 children; the lack of correlation in 4 children is discussed. The second comparison was conducted on neonates. Because ABR testing provides information which is far more accurate than behavioral testing, it is recommended for use in high-risk neonates, especially when mass behavioral screening is not feasible.

Characteristics of the Type B Tympanogram Can Predict the Magnitude of the Air-Bone Gap in Otitis Media with Effusion

Tympanometry is well established as a means of assessing the presence of fluid in the middle ear. The type B tympanogram is usually considered a unique entity. However, its shape may vary from a rounded type B with a “pseudopeak” to a completely flat response. The aim of this study was to compare the characteristics of the B curve (maximum admittance, tympanometric peak pressure, and area under the curve) to the viscosity of the middle ear fluid and to the air-bone gap (ABG). In 67 children (93 ears) who underwent ventilation tube insertion, no correlation was found between the viscosity of the middle ear fluid and the characteristics of the B curve. However, these characteristics were able to differentiate between a low ABG (0 to 20 dB) and a high ABG (>20 dB). A statistical difference was also found for the three parameters (maximum admittance, p < .0025; pressure, p < .025; and area under the curve, p < .0005). Tympanometry may be used as an objective measure to estimate the extent of conductive hearing loss, especially in young children.

Progressive hearing loss in hard-of-hearing children.

A group of 92 children with bilateral sensorineural hearing loss has been followed up over a period of up to 15 years from the time that an initial reliable audiogram was obtained. This group was studied in order to determine the frequency of occurrence of progressive hearing loss and the relationship of the progressive to the presumed etiology of hearing loss. Progression of hearing loss was demonstrated in 21 children out of the 92 children studied. This progression of hearing loss was either bilateral or unilateral, and no evident relationship could be found between the presumed etiology of hearing loss and its progressivity.

Can Tinnitus Mask Hearing? A Comparison between Subjective Audiometric and Objective Electrophysiological Thresholds in Patients with Tinnitus: Est-ce que les acouphènes peuvent masquer l'audition? Comparaison des seuils audiométriques et électrophysiologiques chez des sujets ayant des acouphènes

Very little has been written in the literature about the masking effect of tinnitus on hearing. This possibility arose from the clinical observations of hearing fluctuating with the intensity of tinnitus. To explore this hypothesis, a group of 19 patients suffering from hearing loss and tinnitus underwent a complete audiological evaluation and their audiometric and ABR thresholds were compared. Two other groups who were examined in the same manner, served as control groups. The first group consisted of 19 age- and sex-matched subjects with relatively normal hearing and no tinnitus. The second control group was composed of 8 patients suffering from sensorineural hearing loss without tinnitus. The differences between the subjective and ABR thresholds within each group and between the groups were statistically analyzed. The objective thresholds in the tinnitus group were found to be lower than the subjective thresholds.

ABR Interpeak Latencies in Rats are Shorter at Low Click Intensities

There are conflicting findings concerning whether auditory nerve-brainstem evoked response (ABR) interpeak latencies (e.g. brainstem transmission time - BTT) are constant in response to different stimulus intensities. In order to study the effects of click intensity on the BTT, and to try to determine the mechanism of such an effect, ABR was recorded from 10 adult white Sabra rats in response to different click intensities. The stimulus intensity was reduced from the highest intensity generated by the equipment until no responses could be obtained. Band-reject (notched) noise was presented simultaneously with the clicks in order to restrict the region of basilar membrane activation. BTT decreased with decreasing click intensity and this was accompanied by a prolongation of the latency of wave I to a greater extent than that of wave IV. At high and intermediate intensities, wave I appeared as two split peaks. These effects were not abolished by the restricting notched noise. Possible mechanisms of these latency changes are considered.