Sanjay Munjal

Relationship between severity of traumatic brain injury (TBI) and extent of auditory dysfunction

Objective: To find out the relationship between severity of traumatic brain injury (TBI) and extent of auditory dysfunction Background: Most of the studies have taken the subjects with TBI as one group without taking into account the extent of head injury viz. mild, moderate and severe. Combining all the three groups has resulted in presenting an incomplete picture of auditory deficits following TBI. Methods and procedures: The sample population consisted of 290 subjects with TBI (study group) and 50 otologically normal subjects as controls. The subjects in the study group were further sub-divided into mild (n = 150), moderate (n = 100) and severe (n = 40) TBI. The audiological assessment consisted of pure tone audiometry, speech audiometry, tympanometry, acoustic reflex testing, auditory brainstem response and middle latency response audiometry. Results and conclusions: An association was observed between the extent of auditory dysfunction and severity of TBI. This association was more pronounced for hearing status at high frequencies and ABR/MLR components. ABR Wave V absolute latency and I–V interpeak latency increased with severity of TBI. Amplitude of MLR wave Na and Pa decreased with increasing severity. It is suggested that subjects should be evaluated for hearing difficulties based on their severity of TBI.

Audiological deficits after closed head injury.

BACKGROUND Damage to the peripheral auditory structures has long been recognized as a common component of head injury. It is estimated that a majority of patients with skull trauma have resultant hearing impairment. Damage to the peripheral and/or central auditory pathways can occur as a primary or secondary injury. Considering the high incidence of hearing loss, it was considered worthwhile to conduct an in-depth investigation by administering a comprehensive audiological test battery on head-injured patients. METHOD The sample population consisted of 290 subjects with closed head injury (study group) and 50 subjects with otologically normal subjects (control group). The subjects in the study group were further divided into mild (n = 150), moderate (n = 100), and severe (n = 40) category on the basis of Glasgow Coma Scale score. The audiological assessment consisted of pure tone audiometry, speech audiometry, tympanometry, acoustic reflex testing, auditory brain stem response audiometry, and middle latency response audiometry. RESULTS AND CONCLUSIONS It is concluded that there is higher prevalence of hearing impairment in the study group compared with control group. Majority of the patients who incur hearing loss after closed head injury have mild degree of hearing impairment. A significant difference between the study and control group observed on majority of the auditory brain stem response and middle latency response parameters studied.

Auditory Changes in Mobile Users Is Evidence Forthcoming

Objective. Genuine concerns are being raised as to the potential health risks posed by electromagnetic frequency exposure secondary to mobile phone usage. This study was undertaken to assess and compare potential changes in hearing function at the level of the inner ear and central auditory pathway due to chronic exposure to electromagnetic waves from both global system for mobile communications (GSM) and code division multiple access (CDMA) mobile phone usage. Design. Cohort study. Setting. Tertiary referral center. Subjects and Methods. One hundred twenty-five subjects who were long-term mobile phone users (more than 1 year; 63 GSM and 62 CDMA) and 58 controls who had never used mobile phones underwent audiological investigations including pure tone audiometry (250-12 kHz), tympanometry, distortion product otoacoustic emissions (DPOAE), auditory brain responses (ABR), and middle latency responses (MLRs). The changes in various parameters were studied in mobile-using and non-mobile-using ears of both GSM and CDMA subjects and corresponding ears of the controls to ascertain the effects of electromagnetic exposure. Results. GSM and CDMA users were found to be at a significantly higher risk of having DPOAE absent as compared with controls (P < .05). They were found to have higher speech frequency thresholds and lower MLR wave and Na and Pa amplitudes. More than 3 years of mobile phone usage emerged as a risk factor (P < .05). The damage done was bilateral, with the quantum of damage being the same for both GSM and CDMA. Conclusion. Long-term and intensive GSM and CDMA mobile phone use may cause damage to cochlea as well as the auditory cortex.

Assessment of noise pollution in and around a sensitive zone in North India and its non-auditory impacts

Noise pollution in hospitals is recognized as a serious health hazard. Considering this, the current study aimed to map the noise pollution levels and to explore the self reported non-auditory effects of noise in a tertiary medical institute. The study was conducted in an 1800-bedded tertiary hospital where 27 sites (outdoor, indoor, road side and residential areas) were monitored for exposure to noise using Sound Level Meter for 24h. A detailed noise survey was also conducted around the sampling sites using a structured questionnaire to understand the opinion of the public regarding the impact of noise on their daily lives. The equivalent sound pressure level (Leq) was found higher than the permissible limits at all the sites both during daytime and night. The maximum equivalent sound pressure level (Lmax) during the day was observed higher (>80dB) at the emergency and around the main entrance of the hospital campus. Almost all the respondents (97%) regarded traffic as the major source of noise. About three-fourths (74%) reported irritation with loud noise whereas 40% of respondents reported headache due to noise. Less than one-third of respondents (29%) reported loss of sleep due to noise and 8% reported hypertension, which could be related to the disturbance caused due to noise. Noise levels in and around the hospital was well above the permissible standards. The recent Global Burden of Disease highlights the increasing risk of non communicable diseases. The non-auditory effects studied in the current work add to the risk factors associated with non communicable diseases. Hence, there is need to address the issue of noise pollution and associated health risks specially for vulnerable population.

Cortical mastoidectomy in surgery of tubotympanic disease. Are we overdoing it

BACKGROUND AND PURPOSE OF THE STUDY the role of cortical mastoidectomy in the surgical treatment of tubotympanic type of otitis media has remained controversial especially when there is no evidence of active infection. Though literature is replete with studies for and against the requirement of mastoidectomy, there is a paucity of prospective studies in this regard. A randomized controlled trial was conducted to assess the impact of mastoidectomy in the management of mucosal chronic otitis media. METHODS 62 patients with uncomplicated mucosal chronic otitis media were randomly allotted to two groups of 31 each. Patients in group A underwent tympanoplasty with mastoidectomy and group B underwent tympanoplasty without mastoidectomy. All the patients were followed up for a minimum of three months and results were assessed in terms of graft uptake, hearing improvement and need for repeat procedure. RESULTS no significant difference in outcome was observed between the two groups in all parameters compared. The residual air-bone gap was 12.55 ± 12.98 in group A and 12.71 ± 11.54 in group B. Graft uptake rate was 93.55% in group A and 96.775% in group B. 2 patients in group A and one patient in group B underwent repeat procedures. CONCLUSIONS there is little evidence in favour of cortical mastoidectomy in surgery of tubotympanic disease.

Correlation of Tinnitus Loudness and Onset Duration with Audiological Profile Indicating Variation in Prognosis

Purpose. Subjective tinnitus has different forms and degrees of severity. Many studies in the literature have assessed psychoacoustic characteristics of tinnitus but hardly any of them had focused on the association of audiological profile with onset duration and loudness perception. The aim of this study was to evaluate existence of any association between tinnitus loudness/onset duration and audiological profile to explain differences in prognosis. Method. Study design was prospective. The sample consisted of 26 subjects having tinnitus, which was divided into tinnitus and nontinnitus ears. Audiological profile included pure-tone audiometry, speech audiometry, tympanometry, acoustic reflex test, and auditory evoked potentials (early and middle latency). Unpaired t-test was applied to compare two subgroups. Correlation and association between tinnitus onset duration/loudness perception and audiological profile were also assessed by calculating Spearmans coefficient and Fischer exact value. Results. The two subgroups had significant differences for pure-tone and speech audiometry hearing thresholds. A significant association was observed between the high frequency/extended high frequency and tinnitus loudness/onset duration. Conclusion. The changes in hearing thresholds and auditory pathway are associated with an increase in tinnitus loudness and its onset duration. This knowledge would be helpful to differentiate between severity and chronicity of the patients for planning therapeutic management and predicting prognosis.

Dynamics of Hearing Status in Closed Head Injury

Hearing impairment can be one of the more subtle deficits seen after closed head injury (CHI), and it may not be diagnosed until late in the recovery phase if at all. Most studies have assessed patients immediately after CHI. Repeated assessments at regular intervals were not performed in the majority of studies done to assess whether any initial hearing loss regressed or progressed. Follow-up at later stages will shed more light on the audiological consequences of CHI. The aim of this study was to analyze the long-term audiological consequences of CHI. A total of 290 subjects with CHI were chosen and followed-up at 3, 6, and 12 months. The audiological test battery comprised pure tone audiometry (PTA), speech audiometry, tympanometry, auditory brainstem response (ABR), and middle latency response (MLR), and was administered to all subjects. The data from 96 subjects who completed all three follow-ups were analyzed for tympanometry, ABR, and MLR. However, for PTA and speech audiometry, data from only 76 subjects were analyzed, as unconscious and disoriented subjects could not undergo these tests at initial testing. The results revealed that hearing status after CHI varies, and that at follow-up significant changes in hearing were seen. Hearing of low frequencies improved, due primarily to improvements in middle ear function. Significant changes in ABR latencies and MLR amplitudes were also observed. This reflects the unequal rates of recovery observed in the different parts of the central auditory nervous system.

Deeper insertion of electrode array result in better rehabilitation outcomes - Do we have evidence? §

OBJECTIVE To study the outcome analysis in cochlear implantees in relation to depth of insertion. METHODS 30 patients of non-syndromic congenital profound hearing loss in the age range of 2-12 years received cochlear implantation by a posterior tympanotomy round window approach. Depth of insertion was calculated using post-operative X-rays (modified Stenvers view) and categorized into four groups, viz. fair insertion (Group A <180°), good insertion (Group B 180-<270°), very good insertion(Group C 270-360°), excellent insertion (Group D >360°). The outcome analysis of each implantee was carried out in a follow up interval of every 3 months using Meaningful Auditory Integration Scale (MAIS), Infant Toddler Meaningful Auditory Integration Scale (IT-MAIS), Category of Auditory Performance (CAP), and Speech Intelligibility Rating (SIR). RESULTS Overall 30, 29, 25, and 22 patients have completed 3, 6, 9, and 12 months follow up respectively. The MAIS scores in Group C were significantly better than Group B at 6, 9, and 12 months (P<0.05). The mean CAP score of Group C was more than rest of the groups with significant difference between Group C and Group D at 12 months (P<0.05). The mean SIR scores were maximum in Group C with significant difference between Group C and Group B at 9 and 12 months (P<0.05). CONCLUSION The study demonstrates that insertion from 270° to 360° gives optimum hearing outcomes as compared to deeper insertion, although larger sample and long term follow-up is warranted for definite conclusions.

Demographic Variations in Tinnitus Subjects with and without Hearing Loss: A Study of 175 Subjects.

OBJECTIVES This research was conducted to investigate the presenting features of tinnitus in subjects with normal hearing thresholds as compared to the ones with hearing loss. METHODOLOGY Sample population comprised of 175 subjects with tinnitus, in the age range of 18 to 55 years, segregated into two groups: G1 (75 subjects) having normal hearing with tinnitus and G2 (100 subjects) having hearing loss with tinnitus. All the subjects underwent conventional audiometric testing along with a thorough evaluation of all the parameters of tinnitus. RESULTS AND CONCLUSION Significantly large number of males reported with tinnitus as compared to females. Tinnitus was most prevailing in left ear and these subjects sought intervention earlier than right tinnitus subjects. G1 subjects reported earlier as compared to G2 subjects. Males looked out for specialists advice earlier than females in both the groups. Large number of subjects in both groups reported with sudden onset and continuous tinnitus.

Association of Chronic Subjective Tinnitus with Neuro-Cognitive Performance

INTRODUCTION Chronic subjective tinnitus is associated with cognitive disruptions affecting perception, thinking, language, reasoning, problem solving, memory, visual tasks (reading) and attention. OBJECTIVE To evaluate existence of any association between tinnitus parameters and neuropsychological performance to explain cognitive processing. MATERIALS AND METHODS Study design was prospective, consisting 25 patients with idiopathic chronic subjective tinnitus and gave informed consent before planning their treatment. Neuropsychological profile included (i) performance on verbal information, comprehension, arithmetic and digit span; (ii) non-verbal performance for visual pattern completion analogies; (iii) memory performance for long-term, recent, delayed-recall, immediate-recall, verbal-retention, visualretention, visual recognition; (iv) reception, interpretation and execution for visual motor gestalt. Correlation between tinnitus onset duration/ loudness perception with neuropsychological profile was assessed by calculating Spearmans coefficient. RESULTS Findings suggest that tinnitus may interfere with cognitive processing especially performance on digit span, verbal comprehension, mental balance, attention & concentration, immediate recall, visual recognition and visual-motor gestalt subtests. Negative correlation between neurocognitive tasks with tinnitus loudness and onset duration indicated their association. Positive correlation between tinnitus and visual-motor gestalt performance indicated the brain dysfunction. CONCLUSION Tinnitus association with non-auditory processing of verbal, visual and visuo-spatial information suggested neuroplastic changes that need to be targeted in cognitive rehabilitation.