A series of articles discussing advanced diagnostics that can be used to assess noise injury and associated noise-induced hearing disorders (NIHD) was developed under the umbrella of the United States Department of Defense Hearing Center of Excellence Pharmaceutical Interventions for Hearing Loss working group. The overarching goals of the current series were to provide insight into (1) well-established and more recently developed metrics that are sensitive for detection of cochlear pathology or diagnosis of NIHD, and (2) the tools that are available for characterizing individual noise hazard as personal exposure will vary based on distance to the sound source and placement of hearing protection devices. In addition to discussing the utility of advanced diagnostics in patient care settings, the current articles discuss the selection of outcomes and end points that can be considered for use in clinical trials investigating hearing loss prevention and hearing rehabilitation.

Noise-induced hearing disorders: Clinical and investigational tools.

This study aimed to scope the literature, identify knowledge gaps, appraise results, and synthesize the evidence on the audiological evaluation of workers exposed to solvents. We searched Medline, PubMed, Embase, CINAHL, and NIOSHTIC-2 up to March 22, 2021. Using Covidence, two authors independently assessed study eligibility, risk of bias, and extracted data. National Institute of Health Quality Assessment Tools was used in the quality evaluation of included studies; the Downs and Black checklist was used to assess the risk of bias. Of 454 located references, 37 were included. Twenty-five tests were studied: two tests to measure hearing thresholds, one test to measure word recognition in quiet, six electroacoustic procedures, four electrophysiological tests, and twelve behavioral tests to assess auditory processing skills. Two studies used the Amsterdam Inventory for Auditory Disability and Handicap. The quality of individual studies was mostly considered moderate, but the overall quality of evidence was considered low. The discrepancies between studies and differences in the methodologies/outcomes prevent recommending a specific test battery to assess the auditory effects of occupational solvents. Decisions on audiological tests for patients with a history of solvent exposures require the integration of the most current research evidence with clinical expertise and stakeholder perspectives. 

Audiological Tests Used in the Evaluation of the Effects of Solvents on the Human Auditory System: A Mixed Methods Review

ABSTRACT A fundamental property of first-order sensory neurons is the ability to alter their response properties as a function of change in the statistical parameters of an input signal. Such neural adaptation shapes the performance features of contiguous neural circuits that ultimately drive sensory discrimination. The current study focused on whether combined exposure to jet fuel and noise might alter the capacity of the auditory nerve to adapt to stimulus presentation speed. Young hooded Long-Evans 4–5 weeks old male rats were grouped and used in the current experiment. One group was exposed via inhalation to 1000 mg/m3 of jet propulsion fuel for 6 hr per day, 5 days per week for 4 weeks. Another group was exposed to a 5.5–11.3 kHz band-pass noise at 85 dB SPL for 6 hr per day, 5 days per week for 4 weeks. An additional group was simultaneously exposed to both jet fuel and noise. An age-matched group served as control and was not exposed to either jet fuel or noise. After experimental exposures, animals were given 4 weeks to recover and then assessed for neural adaptation. Both slow and fast rectangular voltage pulses were employed to elicit neuroelectric activity from the animals. Data demonstrated significant neural adaptation (1.46 μV shift) among controls, where neural activity decreased as the stimulus presentation speed rose from 10 to 100 per sec. This effect might also be observed in animals in the jet fuel treated and rats in the noise-exposed group. However, animals who were simultaneously exposed to both jet fuel and noise failed to exhibit neural adaptation. This abnormality appeared to be masked because independent slow and fast stimuli produced similar neural activity between controls and rats exposed to both jet fuel and noise. Therefore, neural adaptation assays may further be developed to unmask silent neurotoxicity consequent to physiochemical exposures.

Abnormal neural adaptation consequent to combined exposure to jet fuel and noise

Abstract Objective The objective of this study was to evaluate the efficacy of anti-reflux therapy on the idiopathic vocal process granulomas. Method This was a prospective case series study. The patients with vocal process granulomas who met the inclusion criteria were analysed. Proton pump inhibitors and vocal hygiene education were conducted for 8–20 weeks. Results Of the 16 patients with vocal process granulomas, 5 (31.25 per cent) patients achieved complete remission. The complete remission rate of granulomas was not significantly related to age (p = 1.000), sex (p = 0.296), side (p = 0.299), position (p = 0.100), endoscopic morphology (p = 0.263) or proton pump inhibitor treatment course (p = 0.543) but was significantly associated with granuloma location (p = 0.001) and granuloma size (p = 0.012). Conclusion Granulomas in the vocal cord and the margin of the vocal process had an excellent response to proton pump inhibitors, but granulomas on the surface of vocal process and arytenoid cartilage body had little response to proton pump inhibitors. The prolonged period of proton pump inhibitor treatment did not increase the complete remission rate of vocal process granulomas.

Can vocal process granuloma location forecast the efficacy of anti-reflux treatment?


 
 Ototoxic medications and chemical agents in the workplace can put individuals' hearing and vestibular health at risk for permanent injury. Proactive ototoxicity management (OtoM) strategies aim to minimize exposure, avoid onset of symptoms, provide ongoing monitoring, and manage auditory and vestibular changes as the clinical needs of the patient evolve. During a 2021 American Speech-Language-Hearing Association Special Interest Groups Open House, members of the International Ototoxicity Management Group discussed how best to integrate OtoM into routine clinical practice, what tools to use, and what special considerations need to be understood to best support patients and their families. Here, we have summarized their viewpoints to encourage widespread adoption of improved OtoM services for at-risk individuals.
 
 
 
 The field of audiology needs to move to a place where we better understand the full extent of ototoxicity and can agree on expanding minimum guidelines that can be implemented more universally to mitigate, detect, and manage the damage from ototoxic exposures. Only recently has our field seen a therapeutic drug that can protect against ototoxicity; however, the population served is restricted only to children receiving treatment for nonmetastatic carcinoma. This is hopefully just the beginning of future therapeutic interventions to come, but, in the meantime, ototoxicity resulting from other medications in different patient populations and chemical agents persists.


What's New in Ototoxicity Management?

Central auditory nervous system dysfunction (CANSD) can manifest as hearing difficulty in the absence of audiometric abnormalities. Effects of noise or jet fuel exposure on the CANS are documented in animal models and humans. This study screened military personnel using the modified Amsterdam Inventory for Auditory Disability (mAIAD) to assess whether concurrent jet fuel and noise (JFN) exposures potentiate central auditory difficulties compared to noise only exposures. A total of 48 age- and sex-matched participants were recruited: 24 military bulk fuel specialists (JFN) and 24 military personnel without jet fuel exposure. All participants completed the mAIAD, the Noise Exposure Questionnaire, and basic audiological testing. Results revealed non-significant differences in pure-tone thresholds between groups, but the JFN group had higher noise exposures. Additionally, the JFN group revealed consistently lower mAIAD scores compared to the noise only group. Interestingly, a JFN stratified subgroup reporting more listening difficulty exhibited statistically significant lower mAIAD scores in the speech intelligibility in noise subdomain. These preliminary data suggest that jet fuel exposure may potentiate noise-induced CANSD, such as speech-in-noise difficulties. Such difficulties may be more prominent among specific military personnel with combined exposures. Hearing conservation programs could add CANSD screening by use of the mAIAD.

Is jet fuel exposure associated with central auditory nervous system difficulties: An exploratory study in military personnel.

To describe the changes in the quality of the Otolaryngology‐Head and Neck Surgery (OTOHNS) literature over the last decade, and compare it to other surgical‐based fields.

https://onlinelibrary.wiley.com/doi/pdfdirect/10.1002/lary.30446

The Quality of Otolaryngology‐ Head and Neck Surgery Literature over the Last Decade

Objectives: Chronic sinusitis (CS) has been suspected to be a risk factor for voice disorders, although studies confirming this relationship are not available. This study demonstrates both the incidence of vocal dysfunction in CS patients and the correlation between vocal dysfunction and CS symptoms. Methods: The Sino-Nasal Outcome Test (SNOT-22), a 22-item validated quality-of-life (QOL) instrument, was distributed to CS patients along with the voice-related QOL (V-RQOL), a 10-item validated voice QOL instrument. The SNOT-22 and V-RQOL total scores were used to find the correlation between vocal dysfunction and CS. Lower scores denote worse function on the V-RQOL and better function on the SNOT-22. Results: A total of 182 consecutive CS patients were asked to complete the V-RQOL and SNOT-22. A total of 136 patients, 61 women and 75 men, completed both forms. Using a cutoff score of <91.25 as an indication of abnormal health on the V-RQOL, 33 of the 136 patients who completed both forms, or 24.3%, were abnormal. Of the 61 women who completed the forms, 19 (31.1%) were abnormal, and of the 75 men who completed the forms, 14 (23.0%) were abnormal. Spearman and Pearson correlation coefficients between the total SNOT-22 and V-RQOL total scores were −0.38 (P = .001) and −0.39 (P = .001), respectively. The Spearman and Pearson correlation coefficients between patients with a SNOT22 score >62 (n = 9) and their V-RQOL scores were −0.78 (P = .01) and −0.66 (P = .05), respectively. Conclusions: This study shows that patients with increasing severity of CS have significantly higher degrees of vocal dysfunction. Abnormal vocal function in the CS population occurs in about 1 in 5 patients. Patients with CS suffer from diminished V-RQOL.

Otology/Neurotology

A 47-year-old man presented to the otolaryngology service with complaint of 6 months of intermittent globus sensation. He reported constant throat clearing and subjective lowering of his voice. Flexible nasolaryngoscopy revealed a large pedunculated mass originating from the left vocal process of the arytenoid, lying superior to the vocal fold. The patient was treated conservatively with an anti-reflux regiment and speech language therapy for 2 months, however he noted marginal worsening in voice over the proceeding interval with an increasing raspy quality. He underwent suspension microlaryngoscopy with biopsy. Microscopic examination demonstrated mucosal epithelium with surface ulceration and considerable fibrinoid necrosis, a mixed inflammatory infiltrate, and abundant granulation tissue with reactive endothelial cells. The diagnosis of laryngeal contact ulcer was rendered. The patient was treated with KTP (potassium titanyl phosphate) laser ablation and corticosteroid microinjection; he tolerated the procedures well and on follow-up noted reduced cough, improving voice quality and no residual dysphagia.

Laryngeal Contact Ulcer.

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Is jet fuel exposure associated with central auditory nervous system difficulties: An exploratory study in military personnel.

The Quality of Otolaryngology‐ Head and Neck Surgery Literature over the Last Decade

Otology/Neurotology

Laryngeal Contact Ulcer.