OBJECTIVES:This study aimed to investigate age-related changes in middle-ear sound transmission using wideband acoustic immittance (WAI), distortion product otoacoustic emissions (DPOAE), and air-bone gap (ABG) measurements. DESIGN:A cross-sectional study was conducted with 30 young adults (18 to 25 years) and 34 older adults (65 to 89 years), each meeting strict inclusion criteria for normal middle ear function. WAI measures, including resonant frequency, absorbance at ambient pressure, and at tympanometric peak pressure (TPP), were measured. DPOAE responses were evaluated at six frequencies (1000 to 6000 Hz), and ABG values were calculated from pure-tone audiometry. Correlation analyses were performed to examine associations between WAI parameters, DPOAE outcomes (signal to noise ratio [SNR] and DPOAE amplitude), and ABG values. RESULTS:Compared with young adults, older adults showed higher absorbance at lower frequencies and lower absorbance at higher frequencies (at both ambient and TPP), together with lower resonant frequency. DPOAE SNRs and DPOAE amplitudes were significantly lower in older adults at all tested frequencies. Absorbance at ambient pressure and TPP was positively associated with DPOAE SNR only at 4 kHz. In addition, ABG values were significantly higher at 4000 Hz in older adults, while absorbance at ambient pressure and at TPP showed no significant correlation with ABG at any frequency. CONCLUSIONS:Our findings suggest that age-related changes affect middle-ear sound transmission. Although an association between absorbance and DPOAE SNR at 4 kHz was observed, evidence for a conductive contribution to age-related hearing loss remains inconclusive. Further research with larger samples and, ideally, longitudinal designs is needed to clarify the clinical significance of these findings and their potential diagnostic and rehabilitative implications.

Mental fatigue (MF) occurs when a demanding cognitive-task is performed over a long period of time, making it difficult to continue daily tasks and maintain balance. The aim of this investigation was to determine whether the Stroop test induces mental fatigue and to examine its effects on static balance. The study is a quasi-experimental design with pre-post testing. Twenty participants (19-44) were included. Static posturography was used to evaluate balance at baseline following a 25-min relaxation period of rest and in the MFC (mental-fatigue condition) following the induction of MF with the Stroop test. The other measurements were the Multidimensional Fatigue Inventory (MFI), Fatigue Severity Scale (FSS), and Visual Analogue Scale (VAS). The study found that mental fatigue significantly increased at MFC compared to baseline, as indicated by MFI (p=.031) and FSS (p=.007) results with moderate effect sizes (d = 0.52, d = 0.67, respectively). Similarly, the study found a statistically significant increase in mental fatigue as measured by VAS results (p=.000, d = 0.95). However, the study did not find any statistically significant impairment in static balance due to mental fatigue in healthy young subjects. The results suggest that the Stroop test can induce mental fatigue, but it does not impair static balance.

PURPOSE:Our review aims to analyze the effect of dual-task training (DTT) on balance in healthy older adults. METHODS:PubMed, EbscoHost, Web of Science (WOS), Scopus, Cochrane Library, MEDLINE, EBSCO Open Dissertations, ULAKBIM (TR Index) and YOK (Council of Higher Education Thesis Center) databases and the gray literature were searched. The quality of the studies was assessed with the Cochrane Risk of Bias tool and statistical analysis of the data was performed with Comprehensive Meta-Analysis (CMA) software. A funnel plot and Egger's test were used to detect publication bias. Fourteen studies with 691 participants were included. RESULTS:According to the results of our study, DTT was found to have a significant benefit on balance in older adults than the non-intervention group (standardized mean difference (SMD): -0.691: -1.153, -0.229, 95 % confidence interval (CI)). Furthermore, DTT was superior to different intervention groups in improving balance in older adults (SMD: -0.229: -0.441, -0.016, 95 % CI). CONCLUSION:The findings of this review suggest that DTT may be an effective intervention to improve balance in healthy older adults.

To present a case with IP-II that had unilaterally refer result in newborn hearing screening and had progressive hearing loss by demonstrating the diagnosis and intervention processes. Design: Case Report. Setting: A University Hospital. Subjects: A 6-year-old boy with bilateral IP-II who has a history of failed newborn hearing screening on one side. Methods: Pure tone hearing thresholds, Auditory Brainstem Response and Magnetic Resonance Imaging results investigated. A progressive hearing loss and IP-II were noted. The developmental characteristics, diagnosis process including radiological evaluation, hearing intervention and follow-up were presented. This case report revealed the importance of follow-up of referred children in newborn hearing screening, the importance of radiological imaging in the diagnosis and intervention process of hearing loss, the approach to progressive hearing loss and the necessity of auditory intervention due to the hearing needs.

Introduction: Distal renal tubular acidosis (dRTA) is a disease that may develop either primarily or secondarily, resulting from urinary acidification defects in distal tubules. Hearing loss may accompany primary forms of dRTA. This study aims to determine the characteristics of hearing loss due to different gene mutations in patients with dRTA. Methods: Behavioral and electrophysiological audiological evaluations were performed after otolaryngology examination in 21 patients with clinically diagnosed dRTA. Radiological imaging of the inner ear (n = 9) was conducted and results of genetic analyses using next-generation sequencing method (n = 16) were included. Results: Twenty-one patients with dRTA from 20 unrelated families, aged between 8 months and 33 years (median = 12, interquartile range = 20), participated. All patients with ATP6V1B1 mutations (n = 9) had different degrees of hearing loss. There was one patient with hearing loss in patients with ATP6V0A4 mutations (n = 6). One patient with the WDR72 mutation had normal hearing. Large vestibular aqueduct syndrome (LVAS) was detected in 6 (67%) of 9 patients whose radiological evaluation results were available. Conclusions: LVAS is common in patients with dRTA and may influence the type and severity of hearing loss in these patients. The possibility of both congenital and late-onset and progressive hearing loss should be considered in dRTA patients. A regular audiological follow-up is essential for the early detection of a possible late-onset or progressive hearing loss in these patients.

Demirtas, B Genc Yetiskinlerde Video Head Impulse Test (Vhit) Normalizasyon Calismasi , Hacettepe Universitesi Saglik Bilimleri Enstitusu Odyoloji Programi Yuksek Lisans Tezi, Ankara, 2019. Periferik ve santral patolojilerin ayiriminda onemli bir klinik degere sahip olan Head Impulse Test (HIT), Halmagyi ve Curthoys tarafindan 1988 yilinda gelistirilmistir. Sayisal bir veri tasimamasi ve degerlendirilmesinin subjektif olmasi nedeniyle HIT testi, sinirliliklari olan bir degerlendirme araci olmustur. Teknolojik gelismeler, yuksek hizli video kayitlarinin alinabilmesi ve goz pozisyonlarinin hassas sekilde belirlenmesinin onunu acmis boylece HIT olcumlerinin sayisal olarak ifade edilebilmesine olanak saglayan, video head impulse test (v-HIT) gelistirilip kullanilmaya baslanmistir. Video head impulse test, uygulanmasi kolay, objektif, alti semisirkuler kanalin(SSK) degerlendirilmesine ve vestibulo-okuler refleks(VOR )sirasinda meydana gelen gizli sakkadlarin gorulebilmesine olanak saglayip, degerlendirmede sayisal verilerin elde edilmesine imkan taniyan onemli bir testtir. Calismaya genc yetiskin (18-30 yas araliginda) bireylerin normalizasyon degerlerinin belirlenmesi amaciyla 130 kisi dahil edilmistir. Verilerin analizinde tum bireylerde sag ve sol kulak lateral SSK kanallarda kazanc acisindan anlamli fark elde edilmezken (p>0.05), vertikal kanallarda anlamli fark elde edilmistir (p<0.05). Kadin ve erkek bireylerden elde edilen verilerin analizinde ise sag anterior kanalda anlamli fark elde edilmistir(p<0.05). Klinik kullanimda normatif veri olmasi acisindan degerli olan calisma bulgulari, vestibuler patolojisi bulunan bireyler icin de onemli bir temel veri olusturmaktadir.

OBJECTIVES:To determine the temporal order, resolution, and perception of prosody skills in Single-Sided Deafness (SSD) compared to an age- and sex-matched normal hearing group's same side ear and both ears.METHODS:This was a Case-Control study including 30 subjects with SSD, and age- and sex-matched 30 subjects with bilateral normal hearing (total of 60 subjects- mean age: 38.7 ± 11.6 years). The Montreal Cognitive Assessment (MoCA), Frequency Pattern Test (FPT), Duration Pattern Test (DPT), Random Gap Detection Test (RGDT), Evaluation of Motor Response Time and Emotional Prosody Assessment were performed on the clinically normal ear in the SSD group, the same side ear in the normal hearing group, and both ears of the normal hearing group (the SSD, MNH, and BNH groups, respectively).RESULTS:Individuals with SSD had worse results in DPT (p < .001), gap detection at 0.5 kHz (p < .001), gap detection at 4 kHz (p < .001), and composite score (p < .001) than the BNH group. For reaction time measurements, the SSD group had slower performance scores than the BNH group for DPT (p < .001) and FPT (p < .001).CONCLUSIONS:Poor temporal processing ability and reduced reaction times may help explain the difficulties in those with SSD in performing daily living activities such as speech understanding in noise and requires more processing efforts. However, there were no significant differences between the groups in frequency pattern performance and emotional prosody skills, supporting the claim that fundamental frequency is one of the most important measures of perception in emotional prosody. We demonstrated that unilateral hearing is adequate to analyze frequency patterns to aid in prosody perception. Analysis of reaction times in temporal processing and emotional prosody could provide different perspectives of auditory processing. Slower reaction time of SSD should be considered for habilitation purposes.

Objective: The deficits in the cochlea which is at the one end of the ear sound transfer system, may effect middle ear functions. Wideband typanometry (WBT) is frequently used to evaluate these transfer functions which play a crucial role in setting the impedance matching between the external ear and the cochlea. To this end, the aim of this study was to investigate the ear transfer functions in inner ear malformations via WBT, and to question whether these functions change depending on the types of inner ear malformation. Methods: This prospective case-control study was conducted in a university hospital. One hundered-fifty-seven ears (aged 3-37 years) under the groups of cochlear hypoplasia, incomplete partition I, incomplete partition II, cochlear aplasia and complete labyrinthine aplasia were evaluated. In the control group, 30 ears with normal hearing were enrolled and WBT was carried out. Tympanometric peak pressure, equivalent middle ear volume, static admittance, tympanogram width, resonance frequency, average wideband tympanometry and absorbance measurements were analyzed. Results: The inner ear malformation groups demonstrated statistically significant differences than the control group and from each other in terms of traditional tympanometric parameters and WBT test parameters (p < 0.05). The most remarkable difference was between the group of complete labyrinthine aplasia and the control group, most probably because of complete labyrinthine aplasia's structural effects. However, on some parameters, incomplete partition II and the control group showed similarities. In absorbance measurements, there was significant difference between all patient groups and the control group, especially at high frequencies (p < 0.05). The largest difference was between the control group and the group of complete labyrinthine aplasia which has revealed the lowest absorbance values (p < 0.05). In averaged-wideband tympanogram analysis, all patient groups obtained a lower amplitude peak than the control group; complete labyrinthine aplasia group had the flattest peaked amplitude, while the incomplete partition II group had a near-normal curve. Conclusion: The results of the study revealed the distinctive effects of inner ear malformations in middle ear transfer functions. It is concluded that the absence of inner ear structures causes negative effects on energy absorbance and the other transfer functions of the middle ear. WBT may provide additional information on diagnosis of patients with inner ear malformations. (C) 2019 Elsevier B.V. All rights reserved.

The aim of this study is to evaluate otolaryngologic problems (upper airway obstruction, obstructive sleep apnea, restriction of mouth opening, middle ear effusion, hearing and breathing problems) and their treatments on mucopolysaccharidoses (MPS) patients and to investigate accumulation of glucosaminoglycans (GAG) in the upper airway biochemically and pathologically. 76 MPS patients were evaluated. Forty-two MPS patients underwent polysomnography (PSG) for obstructive sleep apnea (OSA). Pre- and postoperative PSG results of 18 patients were compared. The success and complications of treatments for OSA in MPS were evaluated. Biochemical and histopathological accumulation of GAG in tonsil and adenoid tissue and middle ear effusion were analyzed and compared with the control group. Forty patients out of 42 tested with PSG had OSA (95%). Adenoid grade, Mallampati grade, restricted mouth opening, rate of difficult intubation were significantly different among MPS subtypes. MPS types III and IV had significantly lower Mallampati scores; type VI had significantly worse mouth opening; and type III had significantly better mouth opening and higher rate of easy intubation when compared to other MPS types. There was no significant difference between MPS subtypes according to tonsil grade, adenoid grade, rate of otitis media with effusion and OSA severity. Statistically significant difference was found between GAG accumulation in adenoid tissue and middle ear effusion of MPS and control group (p < 0.05). However, GAG accumulation in tonsil was not significantly different between MPS and control group. There was a statistically significant improvement in postop Apnea–Hypopnea Index (AHI) compared to preop AHI (p < 0.05). Most MPS patients have airway obstruction and OSA due to adenotonsillar hypertrophy. Most of these children benefit from adenotonsillectomy, after which OSA significantly improves. They experience high recurrence rate after adenoidectomy; though this is not clinically problematic. They also suffer from conductive hearing loss due to OME, which has to be treated with ventilation tube insertion. However, such operations are usually complicated by difficult endotracheal intubation and restricted mouth opening. Sometimes tracheotomy may be necessary. Tracheotomy is also highly complicated in MPS patients. Significant accumulation of GAG in middle ear fluid and adenoid tissue is present; however, GAG appears not to accumulate in tonsillar tissue.

Objective: Newborn hearing screening (NHS) works well for babies with bilateral hearing loss. However, for those with unilateral loss, it has yet to be established some standard rules like age of diagnose, risk factors, hearing loss degree. The aim of this study is to identify the demographic characteristics of newborns with unilateral hearing loss to obtain evidence based data in order to see what to be done for children with unilateral hearing loss (UHL).Method: Newborn hearing screening data of 123 babies with unilateral hearing loss, 71 (57.7%) male and 52 (42.3%) female, were investigated retrospectively. Data provided from the archives of six referral tertiary audiology centers from four regions in Turkey. Data, including type of hearing loss; age of diagnosis; prenatal, natal and postnatal risk factors; familial HL and parental consanguinity was analyzed in all regions and each of the Regions 1-4 separately.Result: The difference between data obtained in terms of gender and type of hearing loss was detected as statistically significant (p < 0.05). While UHL was significantly higher in females at Region I, and in males at other Regions of 2-4; SNHL was the most detected type of UHL in all regions with the rate of 82.9-100.0%. There were not significant differences between regions in terms of the degree of hearing loss, presence of risk factors, family history of hearing loss, age at diagnosis and parental consanguinity (p > 0.05). Diagnosis procedure was completed mostly at 3-6 months in Region 4; whereas, in other regions (Regions 1-3), completion of procedure was delayed until 6 months-1 year.Conclusion: This study indicates that the effect of postnatal risk factors, i.e. curable hyperbilirubinemia, congenital infection and intensive care is relatively high on unilateral hearing loss, precautions should be taken regarding their prevention, as well as physicians and other health personnel should be trained in terms of these risks. For early and timely diagnosis, families will be informed about hearing loss and NHS programme; will be supported, including financial support of diagnosis process. By dissemination of the NHS programme to the total of country by high participation rate, risk factors can be determined better and measures can be increased. Additionally, further studies are needed with more comprehensive standard broad data for more evidence based consensus. (c) 2012 Elsevier Ireland Ltd. All rights reserved.

Early childhood caries (ECC) is a progressive dental caries in children that may cause premature loss of the anterior primary teeth. In this study, the aim was to investigate the effects of primary anterior tooth loss and removable dentures on the speech of children with ECC. Materials and methods: Included in the study were 15 patients with ECC who required extraction of the primary anterior teeth and needed dentures (case group), and 15 healthy children (control group). The articulation of the control group was evaluated once and that of the case group was evaluated before and after extraction, before and after dentures, and at the follow-up exam. The errors of both groups and those among the case group for 5 periods were compared statistically. Results: It was found that tooth loss did not influence articulation. However, dentures temporarily effected articulation of the [s], [\int], and [z] speech sounds. Conclusion: It was concluded that although dentures may cause articulation disorders, children have an ability to compensate for the differences and articulate speech sounds correctly.

OBJECTIVE:This study aims to evaluate the psychological attitudes of patients with tinnitus by using The Symptom Checklist-90-Revised and to investigate the relationship between hearing loss and attributed psychological attitudes.MATERIALS AND METHODS:142 subjects (73 female, 69 male) divided into 4 groups: Group 1 (32 patients with tinnitus and hearing loss-), Group 2 (38 patients with tinnitus), Group 3 (36 patients with hearing loss), Group 4 (36 healthy subjects without tinnitus and hearing loss-control group). The Symptom Checklist-90-Revised (SCL-90-R) test was used to detect the subjects' tendency for psychological problems due to tinnitus and/or hearing loss.RESULTS:Mean values of Somatization (SOM), Obsessive-Compulsive (O-C) and Additional Scale (AS) were higher than cut-off points of 1.00 for Groups 1 and 2 (tinnitus and/or hearing loss). In patients with tinnitus and/or hearing loss, SOM, O-C, Depression (DEP), AS and Global Severity Index (GSI) were significantly higher than patients with hearing loss and control group. By multiple linear regression analysis, tinnitus was the significantly detected confounding factor for increase of SOM, O-C, Interpersonal Sensitivity (I-S), DEP, Hostility (HOS), Paranoid Ideation (PAR), AS and GSI parameters.CONCLUSION:It was concluded that tinnitus could induce some psychological symptoms such as depression; and this is independent of hearing loss. Tinnitus with or without hearing loss is the essential factor for causing psychological problems in patients. Tinnitus duration is not important in the scene of psychological status of the patients. This result shows that, age, gender (male, female), chronic or acute tinnitus experience, and having hearing loss did not cause too much problems in patients. But tinnitus experience in every form (for the present study, intermediate level subjective tinnitus) is significantly important confounding factor for affecting psychological status of the patients.

Objectives: The study aims at comparing the development areas of newborns/children who have been diagnosed with congenital hearing loss through newborn hearing screening at earlier stages with newborns/children in the same age group who do not have hearing loss. Material and Methods: Fifty newborns/children diagnosed with congenital hearing loss through newborn hearing screening and 50 newborns/children in the same age group who have normal hearing were included in the study. The development of both groups was assessed with the Ankara Developmental Screening Inventory (AGTE) and Vineland Behavior Adaptation Scale. Results: The AGTE-Language Cognitive (Dil-Bilissel-DB) and AGTE-General Development (Genel gelisim-GG) and V-Communication, V-Socialization and V-Compatibility Level test scores of infants/children with hearing loss were significantly low compared to infants/children with normal hearing (p<0.05). Regarding the aims of the newborn hearing screening, comparison between infants/children who have been diagnosed early (0-6 months of age) and late (7 months of age and above) revealed significantly higher scores in AGTE-DB, AGTE-GG, V-Communication and V-Compatibility Level tests in the early diagnosed group (p<0.05). Infants/children with profound hearing loss had lower scores in AGTE-DB, V-Receptive Language, V-Expressive Language and V-Socialization tests (p<0.05) than the normal hearing group. The AGTE and VUDO test scores (p>0.05) did not show a significant difference between infants who used hearing aids at early (3-6 months of age) and late (7 months of age and above) stages. Conclusion: Newborn hearing screening allows early diagnosis, early use of hearing aids and auditory habilitation at an earlier age, as well as intervention within the critical period for infants with hearing loss, in terms of the development of cortical perception. Although infants/children with hearing loss have delays in language development and developmental areas based on language in comparison to their peers, infants/children who have been diagnosed early show better performance in language development and general development areas compared to infants/children who have been diagnosed late. Newborn hearing screening is of major importance in decreasing the negative effects of hearing loss and in the early intervention to hearing loss.

Objective: Congenital hearing loss is one of the most common major abnormalities present at birth. Early diagnose is very important. In this study a comparison of five different newborn hearing screening protocols are made to determine the most suitable screening protocol which can form a model for newborn hearing screenings in Turkey's maternity hospitals.Methods: Newborn hearing screening tests (TEOAE and AABR) were performed on 500 newborns. Five test protocols were used and compared. In the first protocol, TEOAE was only used. In the second protocol AABR was only used. In the third protocol automatic tympanometry, TEOAE and AABR were used. In the fourth protocol TEOAE and AABR were used. In the fifth protocol automatic tympanometry and TEOAE were used.Results: Congenital bilateral hearing loss is found 2/1000 in this study. There was high consistency among second (A-ABR used only), the third (Automatic tympanometry TEOAE and A-ABR were used) and the fourth (TEOAE and AABR were used) protocols. On accounts of high population number and rapid population growth, it is vital to conduct national newborn hearing screening in Turkey.

Children with symptoms of profound biotinidase deficiency with null mutations are more likely to have hearing loss develop than those with missense mutations, even if not treated for a period of time. Hearing loss appears to be preventable in children with null mutations if treatment is initiated soon after birth.