RESUMEN
Severe hearing impairment (SHI) is an impairment of hearing in which the air conduction mean over 0.5-4 kHz in the better hearing ear lies between 70 and 90 dB. Masking of bone and air conduction thresholds is seldom possible with SHI, leading to difficulties in assessing the pure tone audiogram whenever there is a potential air bone gap in either ear. An audiological survey of 83 patients with severe hearing impairment was conducted. In 16 per cent of patients there was no possibility of a material air bone gap in either ear and no difficulty in interpreting the audiogram. In 23 (28 per cent), the audiogram was consistent with, but did not prove the presence of, an air bone gap in the poorer hearing ear. In 25 patients (30 per cent of 108) the better hearing ear could not be determined, and in 22 (27 per cent) a profound sensorineural impairment in the poorer hearing ear could not be excluded. The implications of this for the otologist are discussed.
Asunto(s)
Audiometría de Tonos Puros , Conducción Ósea/fisiología , Pérdida Auditiva Bilateral/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Errores Diagnósticos , Femenino , Pérdida Auditiva Bilateral/fisiopatología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
The object of this study was to compare the effect on the hearing of the insertion of a grommet, with or without adenoidectomy, against a non-surgically managed control ear in children with persistent hearing impairment due to otitis media with effusion. Seventy-eight children (44 boys, 34 girls, mean age 5.8 years) with documented bilateral otitis media with effusion associated with a bilateral hearing impairment (pure tone average air conduction thresholds over 0.5, 1 and 2 kHz of > or = 25 dB HL) over a three month period were admitted to a randomized, controlled trial. Each child was randomized to have or not to have an adenoidectomy. The ears in each child were then randomly allocated to have a grommet (tympanostomy tube) inserted. The children's hearing status was reviewed six and 12 months post-operatively. During follow-up, should a child redevelop a persistent bilateral hearing impairment (as defined above) for three months they were managed with a hearing aid. Thus no child had repeat insertion of a grommet. Surgery of each type had an effect on the hearing and the presence of otitis media with effusion at six months post-operatively but not at 12 months when it was no different from natural resolution. If resolution of the otitis media with effusion is the outcome measure, then adenoidectomy alone is significantly better than no surgery but only in boys rather than in girls. Even in boys it only resolves about 60 per cent of effusions. However, when combined with a grommet (one insertion) adenoidectomy gives no greater resolution (89 per cent compared with 86 per cent).(ABSTRACT TRUNCATED AT 250 WORDS)