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   Table of Contents - Current issue
Coverpage
July-December 2016
Volume 3 | Issue 2
Page Nos. 25-60

Online since Monday, March 20, 2017

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ORIGINAL ARTICLES  

Templates for speech-evoked auditory brainstem response performance in cochlear implantees Highly accessed article p. 25
Mona I Mourad, Mohamed Eid, Hicham G Elmongui, Mohamed M Talaat, Mirhan K Eldeeb
DOI:10.4103/2314-8667.202551  
Introduction Speech-evoked auditory brainstem response (ABR) has been used to assess the fidelity of encoding speech stimuli at the subcortical level in normal individuals in noise and in special populations such as learning-impaired children and musicians. The neural code generated by cochlear implants (CIs) in the auditory brainstem pathway and its similarity to stimulus may account for variable speech development in cochlear implantees. Objective The aim of this study was to describe speech ABR recorded in CI individuals and establish measurement parameters for the neural response and its reproducibility. Participants and methods Children between 5 and 10 years of age implanted in the right ear with fully inserted 12-electrode CIs were selected. All participants had normal morphology of the cochlea and auditory nerve in preoperative computed tomographic scan and MRI. Speech syllable 40 ms /da/ was used to elicit speech ABR. Response traces for intensity input/output functions were harvested. Grand averages were constructed for peak picking. Individual patient responses were analyzed for reproducibility, latency of wave V, root mean square amplitude of the response, and correlation to the stimulus. Results Grand averages showed wave V, followed by the frequency following response. Wave V is a vertex-positive peak, equivalent to that elicited by a click, which reflects the stimulation by the transient /d/. The mean latency of wave V was 2.59±0.7 ms at 70 dBHL. The frequency following response showed multiple sequenced troughs corresponding to the sustained vowel /a/. Individual responses collected for similar stimulus parameters showed high reproducibility, being 99.65% at 60 dBHL and 52.8% at 30 dBHL. Participants showed variable latency and root mean square amplitude-intensity input–output functions slopes. The mean stimulus-to-response correlation was 18.1±3.1%. Conclusion Speech ABR in CI participants shows similar morphology to that recorded in norms. CIs thus transcribe the speech signal with high fidelity to the brainstem pathways.
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School-based hearing screening program in children, four to seven years old, Quesnay City, Minufia, Egypt p. 35
Radwa Mahmoud, Mohammed Ibrahim Shabana, Ahmed Mohsen Seleit, Ahmed Ashraf Salah El-hamshary, Noha Ali Hosni
DOI:10.4103/2314-8667.202553  
Background Hearing is the most essential perceptive sense for individual development, especially during childhood, contributing to a child’s ability to interact with other people. Its deprivation can have serious consequences on various aspects, such as speech and language acquisition and prereading skills. This study aimed to perform hearing screening of school children aged 4 and 7 years to detect the prevalence, incidence, and degree of hearing loss (HL) in this age group. Participants and methods This study was a cross-sectional investigation that included all children aged 4–7 years from all primary schools in Quesnay City, Minufiyah governorate, Egypt, from November 2014 to March 2016 (number of children=4500). A total number of 9000 ears were studied. All children included in the study underwent otoscopic examination, followed by two stages of school-based hearing screening. All children who failed the second stage of school-based hearing rescreening were referred for full audiological evaluation. Results Otoscopic examinations revealed the following: 54.2% of ears had normal ears 21.3% had impacted wax, 13.6% had congested tm, and 10.8% had perforated tm. Twenty percent (1800 ears) failed the first stage of school-based hearing screening. Six percent (540 ears) failed the second stage of school-based hearing rescreening. A total of 529 ears were diagnosed as having HL as follows: 427 (80.7%) had conductive hearing loss, 81 (15.3%) had sensorineural hearing loss, and 21 (4%) had mixed HL of different degrees − 265 (50.1%) had mild, 132 (24.9%) had moderate, 85 (16.1%) had moderately severe, 40 (7.6%) had severe, and seven (1.3%) had profound degree of HL. Conclusion A systematic screening program with correct equipment, trained personnel, and adequate follow-up services will allow children with educationally significant HL to be accurately diagnosed and managed to provide them with equal hearing opportunities.
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Implementation of objective audiometery among Suez Canal Authority workers p. 43
Mostafa K Madi, Mohammed Shabana, Lobna Hamed, Noha A Hosny, Hedayat El Fouly
DOI:10.4103/2314-8667.202554  
Background Verification of the hearing level in the malinger workers is a long-standing problem. Otolaryngologists and audiologists are often called upon to evaluate the auditory thresholds of workers who file claims for compensation as a result of noise-induced hearing loss. Although objective diagnostic methods tend to dominate modern medical science, behavioral pure-tone audiometry (PTA) remains the golden standard for identifying hearing threshold levels. A number of auditory-evoked potential techniques have been implemented for this purpose over the past three decades. The most widely used of these techniques has been the auditory brainstem response (ABR) and more recently another auditory-evoked potential, the auditory steady-state response (ASSR). We also used old techniques such as postauricular myogenic potential and late cortical-evoked potential P100 as an alternative technique for objective audiometry. Rationale Integration of different objective hearing tests is deficient in the literature on high-risk adult population. Objectives To implement an objective protocol for assessing hearing in adult patients and for those difficult to test by routine PTA in Suez Canal Authority. Materials and methods This study was designed as a case–control study to collect and analyze data from September 2012 to be finished on June 2014. Sixty adult patients divided into two groups: those suffering from normal hearing and those suffering from sensorineural hearing loss. All patients in this research were submitted to the following: full history taking and otologic examination; basic audiological evaluations (PTA, speech audiometry and immittacemetry); tone burst ABR recorded using 500, 1000, 2000, and 4000 Hz stimulus; and ASSR stimulus using carrier frequencies 500, 1000, 2000, and 4000 Hz; postauricular myogenic potential response using 1000 and 4000 Hz; and late cortical-evoked potential P100 using 1000, 2000, and 4000 Hz. Results In the normal hearing group, ASSR and ABR thresholds are closer to PTA thresholds than posterior auricular muscle (PAM) thresholds, the difference decrease with increasing frequency being closer at 4000 Hz than 500 Hz results. In the study group ASSR and ABR thresholds are approximated to PTA thresholds but still the ASSR thresholds are closer to PTA thresholds than ABR thresholds and PAM threshold but much higher in the case of P100. In the study group, ABR and ASSR thresholds show the best level of prediction of PTA thresholds. We found that the mean difference between all test and pure-tone thresholds had a tendency to be smaller with increasing frequency in both groups. However, the mean difference in the study group was statistically significantly lower than the control group. There are statistically significant positive correlation between PTA threshold and both ABR and ASSR threshold at all frequencies. A statistically significant correlation was found only at 1000 Hz in PAM test and a statistically significant correlation was found only at 1000 and 2000 Hz in P100 test. Conclusion ASSR is more accurate at higher frequencies, making ASSR more suitable in accessing auditory thresholds in patients with noise-induced hearing loss.
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Cervical vestibular evoked myogenic potential: its age-related changes p. 51
Mohamed Shabana, Maha Hassan, Sherif El-Manawee, Nermeen El-Kilany
DOI:10.4103/2314-8667.202555  
Objective: The purpose of this work is to assess the possible effect of aging on cVEMP in the Egyptian subjects to be compared with the international published response findings. Methods: After excluding subjects with previous history of dizziness, middle ear disorders or neuromuscular diseases, Forty subjects were equally divided into two age groups; group A: 20-40 years old (control group), group B: >60 years old (study group). VEMP was recorded for all subjects using tone burst 500 Hz stimuli at the threshold level and 95 dB n HL intensity level through air conduction stimulation. Results: There was a significant difference in the cVEMP response threshold (p< 0.001), P13 wave latency (p<0.001) between the two age groups. No significant difference was found between the right and left ears, N23 wave latency or in P13-N23 amplitude between the two groups. Conclusions: This study confirmed a significant increase in cVEMP thresholds and a significant prolongation of P13 latency with age. Normative age related data may be necessary to properly interpret cVEMP recordings when evaluating aging populations.
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CASE REPORT Top

Importance of re-evaluating hearing loss in children, case study p. 58
Khairy Abulnasr
DOI:10.4103/2314-8667.202552  
Case study of 5 years old boy presenting with unilateral hearing loss. the importance of combing the results of oto-acoustic emission and ABR test is crucial to reach diagnosis. the MRI brings the radiological image which concludes the diagnosis.
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