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School Hearing Tests do not Detect Noise Exposure Hearing Loss

School hearing tests cannot effectively detect adolescent high-frequency hearing loss, which is typically caused by loud noise exposure, according to researchers at Penn State College of Medicine.

The Pennsylvania Department of Health mandates school-administered hearing screens for children in kindergarten to third, seventh and 11th grades.
The school screenings primarily focus on low-frequency hearing loss. This is logical for young children, who are more likely to develop low-frequency hearing loss due to fluid in the ear after a bad cold or an ear infection.

Adolescents, however, are more susceptible to high-frequency hearing loss, usually brought on by exposure to loud noises, but the same tests are used on adolescents and young children.

Deepa Sekhar, assistant professor of pediatrics, compared the results of a special hearing screening designed to detect noise-related high-frequency hearing loss with the results of the standard Pennsylvania school hearing test. The researchers reported their findings in the Journal of Medical Screening.

Both screenings test the ability to hear a tone at a specific loudness. The tone is played at different frequencies, or pitches. The screening for noise-related hearing loss tests the ability to hear higher pitches, up to twice the frequency of the Pennsylvania school screen.

Screening participants were 11th grade students at Hershey High School. Researchers administered both the statewide school screening and a high-frequency screening. Of the 282 participants, five failed the Pennsylvania school test and 85 failed the noise-related test. Of the group of 48 students returned for testing by an audiologist in a soundproof booth, nine were diagnosed with hearing loss.

“More participants failed the initial screening than we predicted,” said Sekhar. “Even with the effort and care put in by school nurses across the state, the current Pennsylvania school screen just isn’t designed to detect high-frequency hearing loss in adolescents.”

One in five adolescents experiences hearing loss, and most of this is high-frequency hearing loss related to continued exposure to noise hazards. Early detection and avoidance of loud noises can prevent hearing loss from progressing.

To efficiently detect adolescent hearing loss, schools across the U.S. may need to consider alternate tests that are better designed to detect noise-related high-frequency hearing loss.

“The results of this study have the potential to reach schools across the nation, as many use screens similar to those used in Pennsylvania schools,” said Sekhar. “We are currently working on a follow-up study at Lebanon High School in partnership with Penn State Nursing to further improve the high-frequency school hearing screen for use in the school.

Other Penn State College of Medicine researchers on the study were Tonya King, professor of biostatistics; Beth Czarnecki, audiologist; Shannon Grounds, audiologist; Ashley Barr, audiologist; and Ian Paul, professor of pediatrics and public health sciences.

Other researchers include Soha Ghossaini, associate professor of otolarynglogy, University of Illinois, Chicago; Thomas Zalewski, Bloomsburg University; Julie Rhoades, Impulse Monitoring, Inc.; and Barry Deese, Summit ENT & Hearing Services.

The Academic Pediatric Association/Maternal and Child Health Bureau Young Investigator Award funded this research.

 SOURCE: http://www.eurekalert.org/pub_releases/2014-03/ps-sht032014.php.

Read More About hearing tests.

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Music from the ear: Researchers show how an objective audiometric test can become even more reliable

Music from the ear: Researchers show how an objective audiometric test can become even more reliable.

Physikalisch-Technische Bundesanstalt (PTB). ,ScienceDaily, 10 Jan. 2013. Web. 11 Jan. 2013. 

Not only can the human ear detect sounds, it can also generate them. If the ear hears the two upper tones of a major triad, it produces the fundamental of the chord which can then be measured. This phenomenon, called “otoacoustic emission” (OAE), is used by otologists for objective audiometric tests, e.g. in newborns. Investigations at the Physikalisch-Technische Bundesanstalt (PTB) have shown that an OAE audiometric test becomes even more reliable if the two sounds are transmitted to the ear not via a loudspeaker, but by bone conduction.

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image from PTB

Combined stimulation of otoacoustic emissions: the first tone is transmitted via air conduction (probe speaker in the ear), the second tone is conveyed via bone conduction (bone vibrator behind the ear).

Regardless of where people come from, whether they are Europeans or Asians, the human ear is always tuned to a major scale. If the ear hears the two upper tones of a major triad, the ear itself produces the third, lowest, tone of the chord. This tone is called “distortion product otoacoustic emission (OAE)” and is generated due to anatomic and physical laws:

if the hair cells in the inner ear are healthy and sound, they are stimulated by the two matching tones to vibrate at a third frequency. This lower tone comes out of the ear again and can be measured by means of a highly sensitive microphone. With the aid of this phenomenon, it is possible to check objectively whether the hearing of newborns or infants is intact.

Such a test used to be performed using two tiny loudspeakers, each of which emitted a tone into the ear, as well as a miniaturized microphone, which recorded the third tone (if it came out at all).

If this tone is not generated, physicians have a first inkling that the baby might need therapy or a hearing aid.

However, it may be that the ear is healthy but does not “hum”. This can be caused by a badly calibrated loudspeaker, or due to the fact that the loudspeakers which are placed close to each other emit standing waves into the auditory canal which weaken one of the two tones.

To preclude such malfunctions, alternative tone generation methods have been investigated at PTB within the scope of a DFG project: so-called “bone vibrators” which, in analogy to a tuning fork set onto the bone, convey the tone directly to the bone located behind the ear.

The results have shown that both with two bone vibrators and in combination with a loudspeaker, correct otoacoustic emissions are generated. This not only allowed calibration errors to be reduced, but also provided physicians with improved differential diagnosis possibilities, since with the new procedure, they can test the function of the inner ear without a doubt and, potential damage of the middle ear, thus, has less influence. Clinical studies should follow.

Scientific publication

Zebian, M.: Calibration of Distortion Product Otoacoustic Emission Probes. Dissertation, TU Braunschweig (2012)

Diabetics have More Chances of Hearing Loss

Most common causes of Hearing Loss are Aging, Heredity, loud noises and ototoxic medicines but studies suggest that diabetes also makes more prone for hearing loss.

Patients with diabetes routinely receive blood exams, kidney function evaluations, feet examination and eye exams, but routine ear and hearing examination is hardly known thing.

On “World Diabetes Day” we recommend hearing tests should be norm for diabetics.

 Reason for hearing loss in diabetics:

There are changes in the nerves themselves and it hypothesized that hearing loss in diabetics is because of damage to nerves and blood vessels in the inner ear.

Sign and symptoms of Hearing loss:

Self hearing Check  at neoalta.com

  • Often turn up the volume of T.V. or radio.
  • Find it difficult to follow a conversation in a noisy area or crowded room.
  • Feel people are mumbling or not speaking clearly.
  • Misunderstand what others are saying and respond inappropriately.
  • Ask others to speak up or to repeat themselves.
  • Sometimes miss birds chirping, doorbell or telephone ringing

How Hearing Loss is diagnosed ?

ENT consultation and hearing tests (Audiometry) by audiologist can diagnose hearing problem. DP OAE (distortion product otoacoustic emissions-test used for newborn hearing screening) can detect early hearing loss in diabetic patients.

Read in detail about Tests of Hearing

What is the treatment of hearing loss?

Treatment will depend on the type of hearing loss. Diabetics usually have sensorineural Hearing Loss which cannot be cured. However, most cases of sensorineural hearing loss can be treated with hearing aids.

Read more about treatment of Hearing Loss.

Protection of Hearing in diabetics:

  • Control of diabetes, Hb A1c should be kept under 7%, diet and exercise are vital
  • Protect your sensitive ears from noise and ototoxic medicine
  • Regular Ear and Hearing Screening : along with your eyes, feet, and kidneys, your ears need regular screening.

If you or a loved one has diabetes, we recommend to  visit hearing clinic to take a hearing test,

visit Audicco.com  ENT and hearing center at Vashi Navi Mumbai to know more.

Hearing Screening in Newborn

When Mishi (name changed) was born her parents were extra cautious for her hearing as her elder sister now 4 years old has cochlear implantation done.

They visited audiologist for hearing evaluation. Their worst fears was confirmed, Mishi now 6 months has severe to profound hearing loss and is fitted with hearing aids. But there is hope, as she is young she will most probably lead normal life like her elder sister which was intervened early and appropriately.

On the other hand khushi is 3 and ½ years old, pediatrician immediately referred her to audiologist for delayed speech, thanks to increasing awareness in Navi Mumbai. But even after confirmation of hearing loss, they are not willing for intervention as her father thinks she will start talking with time.

 

Importance of assessing hearing in a new-born child:

Two out of every 100 children under 6 years of age have permanent moderate deafness and 1-4 out of every 1,000 newborns have significant hearing loss.

Birth to 3 years are critical for speech and language development and if child does not hear the sound, he can not speak, even a mild or one sided hearing loss can affect speech language skills, academic & intellectual skills, and it affects individual for the rest of his life.

“American Academy of Pediatrics recommends new born hearing screening and periodic hearing testing for first three years of life. Joint Committee on Infant Hearing (JCIH, 1994) recommends that all infants with hearing loss should be identified by 3 months of age, and should be fitted with hearing aids or cochlear implant and receive services to help them learn to listen and speak by 6 months of age.

 

Importance of OAE hearing screening:

Newborns, infants and children below 5 years are difficult to diagnose by routine tests. Traditional subjective methods of behavioral observation to ringing bells and hand clapping are not fully reliable as child may respond to some sound because of residual hearing or they may take cues from visual prompts, at the same time child with normal hearing may not respond.

Prior to Objective tests such as OAE, infants with hearing loss typically remained unidentified until 2 ½ years of age. – far too late for optimal language development.

Advances in technology make it possible to assess the hearing of infants even while they are asleep.

 

Method for hearing screening Otoacoustic Emission (OAE):  

A small probe is placed in the child’s ear canal. This probe delivers a low-volume sound stimulus into the ear, which travels from middle ear to inner ear. If hearing is good this sound will bounce back as echo generated by outer hair cells of cochlea (called OAE)  and is measured with a microphone.

In approximately 30 seconds, the result is displayed on the screening unit as a “pass” or “refer.”

It is very important to remember that fail OAE  does not mean child have haring loss it just indicates that further  tests are required for full hearing evaluation. (BERA and ASSR test).

 

Newborn hearing screening in India:

 In developed countries like US it is mandatory to check hearing of each and every newborn within 48 hours of birth. But currently there are no mandatory rules or regulations for Newborn Hearing Screening in India and hence the identification of hearing loss is mostly at later ages.

 

Conclusion:

OAE screening is proved to be reliable method of screening. If hearing screening is made mandatory for the newborns at the time of birth or within the first month of life many more cases of hearing & speech impairment could be avoided.

Hearing impairment must be corrected before the child reaches six months of age. Late intervention of the hearing loss will yield very poor results as the plasticity of the brain reduces drastically as the child grows older. Undetected hearing loss is big obstacle to educational achievement and socialization.

Mother’s instinct should never be ignored and probable hearing loss in the child should be subjected to audio logical assessment.  It should not be ignored withIt shall improve in the next few years” or ‘child did not hear because he was busy playing or watching television’.

For more information about OAE screening visit hearing screening protocol at Audicco

or mail at info@audicco.com