Sensorineural hearing loss in sickle cell crisis

Characterization of Sensorineural Hearing Loss in Adult Patients With Sickle Cell Disease: A Systematic Review and Meta-analysis

OBJECTIVES AND MAIN OUTCOME MEASURES

To determine the prevalence of sensorineural hearing loss (SNHL) attributable to sickle cell disease (SCD) in the global adult population and to identify factors contributing to its severity.

STUDY DESIGN

Systematic Review and Meta-analysis.

METHODS

We performed a comprehensive literature search for scientific articles in PubMed, Scopus, CINAHL, Web of Science, and the Cochrane Library that reported the incidence of hearing loss in populations over 18 years of age with SCD.

RESULTS

We identified 138 studies from the initial search, 12 of which met inclusion criteria and were utilized for data analysis. A total of 636 SCD patients and 360 controls were included in the Cochrane Review Manager 5.3 meta-analysis. There was a statistically significant increase in the prevalence of SNHL in adults with SCD compared with the general population with a cumulative risk ratio (RR) of 6.03.

CONCLUSIONS

This is the first systematic investigation of the relationship between SCD and SNHL in adult patients across the globe. SNHL is more prevalent in patients with SCD, specifically those of the HbSS genotype, than the general population likely due to the pathophysiology of the disease and its effects on labyrinthine microvasculature. The increased prevalence of SNHL in the adult SCD population warrants future research into the predictors of SNHL severity and merits routine audiometric monitoring of adult SCD patients.

Prevalence of Sensorineural Hearing Loss in Pediatric Patients with Sickle Cell Disease: A Meta-analysis

OBJECTIVES

To determine the prevalence of Sensorineural Hearing Loss (SNHL) attributable to Sickle Cell Disease (SCD) in the global pediatric population and to identify factors contributing to its severity.

STUDY DESIGN

Meta-analysis.

METHODS

We performed a comprehensive literature search for scientific articles in PubMed, Scopus, CINAHL, Web of Science, and the Cochrane Library that reported the incidence of hearing loss in populations under 18 years of age with excluding studies analyzing patients on iron chelation therapy, adults, or those without objective audiological analysis.

RESULTS

We identified 138 initial studies with 17 selected for analysis after applying the exclusion criteria. A total of 1,282 SCD patients and 553 controls were included in the meta-analysis. There was a statistically significant increase in the prevalence of SNHL in children with SCD compared to the general population with a cumulative risk ratio of 3.33.

CONCLUSION

This is the first systematic investigation of the relationship between SCD and SNHL in pediatric patients across the globe. The increased prevalence of SNHL in the pediatric SCD population warrants future research into the predictors of SNHL severity and merits routine audiometric monitoring of SCD patients to reduce the social and developmental morbidity of hearing loss at a young age. PROSPERO Registration #: CRD42019132601. Laryngoscope, 131:1147-1156, 2021.

The use of hyperbaric oxygen therapy in acute hearing loss: a narrative review

INTRODUCTION

Acute hearing loss can have a major impact on a patient's life. This holds true for both acute acoustic trauma (AAT) and idiopathic sudden sensorineural hearing loss (ISSHL), two devastating conditions for which no highly effective treatment options exist. This narrative review provides the rationale and evidence for HBOT in AAT and ISSHL.

METHODS

Narrative review of all the literature available on HBOT in acute hearing loss, studies were retrieved from systematic searches on PubMed and by cross referencing.

DISCUSSION

First, the etiological mechanisms of acute hearing loss and the mechanism of action of HBOT were discussed. Furthermore, we have provided an overview of 68 studies that clinically investigated the effect of HBOT in the last couple of decades. For future studies, it is recommend to start as early as possible with therapy, preferably within 48 h and to use combination therapy consisting of HBOT and corticosteroids.

IMPLICATIONS FOR PRACTICE

HBOT has been used quite extensively for acute hearing loss in the last couple of decades. Based on the amount of studies showing a positive effect, HBOT should be discussed with patients (shared decision making) as optional therapy in case of AAT and ISSHL.

Prevalence of Hearing Loss in High Risk Infants of Mediocre Socio-economic Background at Around One Year of Age and Their Correlation with Risk Factors

The present study tried to determine the hearing threshold by brainstem evoked response audiometry (BERA) in the high-risk infants from a mediocre socio-economic background at around 1 year of age and correlate different risk factors with hearing loss. BERA was done on 127 infants of 6-18 months age of which 87 were high risk. All were given monaural acoustic stimulus using Cz-M1/M2 Montage. Based on the appearance of wave V at minimum stimulus intensity, hearing threshold in decibels (dB) of each ear was determined. To study the association of the individual risk factor with hearing loss multiple logistic regression test was applied. Taking BERA threshold for 'Pass' as ≤40 dBnHL, out of 87 high risk infants 10.34 % (n = 9) had bilateral severe to profound hearing loss, 17.24 % (n = 15) had bilateral mild to moderate hearing loss and 12.64 % (n = 11) had impaired hearing in one ear. All of the control group infants had normal hearing threshold of 30 dBnHL. Twenty major risk factors were identified in the whole study group at an average of 2.3 factors per infant. Twelve factors were examined for correlation using Odd's ratio (OR) with >40 dBnHL threshold as the outcome variable. Factors with very high OR were family history of deafness, Ototoxic drugs and Cranio-facial abnormality followed by others. High risk infants have a persistent and definitive risk of hearing loss prompting early intervention.

Sickle cell anemia and hearing loss among children and youngsters: literature review

Sickle cell anemia is still a significant public health issue in underdeveloped and developing countries. Sickle cell disease is one of the most common inherited diseases in Brazil. It affects mainly the mixed race population. Approximately 1 African-Brazilian child is affected with sickle cell disease for every 37,400 children born alive. Hearing loss has been considered one of the main clinical manifestations, especially in children. However, to date, there are just a hand full of studies in Brazil and the Brazilian state of Bahia has the largest African-descended population, attempting to establish the frequency of this event.

Objectives

To analyze the major studies associated with the subject, published in the last twenty years in the main indexed databases.

Methods

To use MEDLINE to identify the main papers published in English in medical literature, between January of 1989 and January of 2009; associating sickle cell anemia and hearing loss, with its clinical outcomes.

Conclusion

Given that it is always possible to attempt to prevent disabilities, understanding hearing loss in children with sickle cell anemia enables to maximize quality of life and provides for a broader school attendance.

Improved diagnostic effectiveness with a sequential diagnostic paradigm in idiopathic pediatric sensorineural hearing loss

OBJECTIVES

To determine whether a stepwise diagnostic paradigm is more diagnostically efficient and cost-effective than a simultaneous testing approach in the evaluation of idiopathic pediatric sensorineural hearing loss (SNHL).

DESIGN

Prospective prevalence study.

SETTING

Tertiary referral children's hospital.

PATIENTS

Consecutive children (n = 150) presenting with idiopathic SNHL in the last 2 years.

INTERVENTIONS

All children were evaluated with full diagnostic evaluations including GJB2 screens, temporal bone computed tomography scans, and laboratory investigations.

MAIN OUTCOME MEASURES

1) Diagnostic yields of GJB2 screens, imaging, and laboratory results per SNHL category; 2) Cost analysis comparing a sequential versus a simultaneous testing approach.

RESULTS

Overall, 12.0% of patients had biallelic mutations in the GJB2 gene, whereas 30% of patients had an abnormality on temporal bone scan. Laboratory testing did not reveal the SNHL etiology in any patient. While maintaining diagnostic accuracy, significant cost savings were inferred by using a sequential diagnostic algorithm. Our data show children with severe to profound SNHL should first be tested with a GJB2 screen, as opposed to those with milder SNHL, who should undergo imaging as the initial testing step. In patients with initially positive GJB2 or imaging screens, logistic regression analysis significantly predicted negative results on further testing.

CONCLUSIONS

A stepwise diagnostic paradigm tailored to the level of the hearing loss in children with bilateral SNHL is more diagnostically efficient and cost effective than the more commonly used full, simultaneous testing approach. Laboratory investigation should not be routine but based on clinical history.

Hearing loss and auditory function in sickle cell disease

Sickle cell disease was first reported in 1910 by J. Herrick, and since then, various associated conditions and complications have been described. Sickle cell disease is a hereditary disorder characterized by abnormality of the hemoglobin in the red blood cell. During periods of decreased oxygen tension in the red blood cell's environment, the abnormal hemoglobin within the red blood cell polymerizes and causes it to assume its sickled shaped. This morphological change and its associated physiological changes drastically reduce the ability of red blood cells to navigate and deliver oxygen throughout the body. Sickle cell disease is a significant health problem affecting 1 in 400 African-Americans in the United States. One in 10 African-Americans in the United States has sickle cell trait. A variety of hemoglobinapathies are classified as sickle cell disease. Variants that simultaneously occur with hemoglobin S in high frequency are hemoglobins C and beta Thalassemia, and less frequently hemoglobin E. Sickle cell disease is characterized by chronic hemolytic anemia, end-organ damage, a heightened susceptibility to infections, and intermittent episodes of vascular occlusion causing both acute and chronic pain. Neurological symptoms are frequent in patients diagnosed with sickle cell disease. Considering the vaso-occlusive nature of sickle cell disease, the potential for auditory damage is not unexpected. However, the incidence of subjective hearing impairment among sickle cell anemia subjects is very low; therefore, the interest in hearing loss associated with the disease is not in its symptomatology, but in its pathogenesis. The relationship between sickle cell anemia and hearing loss is documented, but little is known about the relationship. Numerous investigations have assessed peripheral auditory sensitivity with a wide disparity of results. In the article, we will discuss: In view of the diversity of results and speculative etiology presented here and in the literature, the relationship between sickle cell anemia, auditory sensitivity, and auditory function warrants additional investigation.

LEARNING OUTCOMES

As a result of this activity, the participant will read descriptions of the genetic and pathophysiological characteristics of sickle cell disease. The participant will examine evidence of the prevalence of hearing loss and auditory dysfunction in the sickle cell population, as well as the overall hearing health risk for sickle cell patients in comparison to the risk for the normal hemoglobin population. The participant will examine a model for appropriate audiological assessment of treatment of patients with sickle cell disease.

Kindergarten readiness skills in children with sickle cell disease: evidence of early neurocognitive damage?

Young children with sickle cell disease are at risk of brain damage, including stroke. We tested the hypothesis that such patients are also at risk of cognitive impairment. We characterized the cognitive ability of kindergarten children to minimize the effect of disease-related school absence. The Memphis City Schools use the Developing Skills Checklist, a teacher-administered test given in the classroom, to assess kindergarten-appropriate skills. Data were obtained for 34 patients, who were matched to controls by gender, race, date of birth, school, and approximate income. Two controls were selected for each patient, and paired t-tests were used to compare patient's scores to composite control scores. Patients scored lower than controls in auditory discrimination (P < .01), and there was a trend (P < .10) toward lower patient scores in language. Deficits cannot be attributed to school absence and may predict academic problems for patients with sickle cell disease.

Distortion product otoacoustic emissions in normal-hearing children with homozygous sickle cell disease

The purpose of this study was to investigate distortion product otoacoustic emissions (DPOAEs) in young normal-hearing children with sickle cell disease (SCD). It was hypothesized that the prevalence of DPOAEs and response amplitudes would be lower than those in children with normal hemoglobin due to suspected compromised cochlear function as a result of vaso-occlusive events characteristic of SCD. Twenty African-American children with SCD and 15 African-American children with normal hemoglobin participated. Distortion product OAEs were evoked by 13 primary tone pairs with f2 frequencies ranging from 1000 to 4500 Hz. The primary tones were presented at L1 and L2 levels of 70 and 60 dB SPL (high) and 50 and 40 dB SPL (low), respectively. The findings of this study were completely unexpected and contrary to our original hypotheses. The likelihood of detecting a DPOAE response was not related to the clinical status of the children. Distortion product OAE amplitudes were significantly larger for children with SCD (p =.01).

Sensorineural hearing loss among sickle cell disease patients from southern Brazil

PURPOSE

A case-control study was done to confirm the higher prevalence of sensorineural hearing loss (SNHL) among sickle cell patients (HbSS) from southern Brazil.

PATIENTS AND METHODS

Twenty-eight patients and 28 matched normal controls were studied. Besides complete anamneses and physical otolaryngological examination, all individuals had audiometric and tympanometric testings to determine the presence of SNHL or middle ear problems. The only significant difference between groups was the presence of a positive history of otologic symptoms (hearing loss, dizziness or tinnitus) and neurological sequelae in the HbSS patients.

RESULTS

Six patients (21.4%) presented with SNHL compared with one control (3.6%) (Fisher's one-tailed P = .05; OR, 7.36 (95% CI, 0.82, 65.83). The average age of HbSS diagnosis was higher among the patients with SNHL (10 years +/- 8.3) than those without SNHL (5.43 years +/- 5.65), but this was not significant (analysis of variance P > .05). More patients 25 years and older on the examination date had SNHL than younger patients (Fisher's 2-tailed P < .05). Sixty-seven percent of the patients with SNHL had alterations in the acoustic reflex, and a surprising 27% of the patients without NSHL also presented with some elevation or an absence of acoustic reflex.

CONCLUSIONS

These data indicate that patients with HbSS from southern Brazil are more predisposed to the development of sensorineural hearing problems than the general population.

Otologic findings in a pediatric cohort with sickle cell disease

OBJECTIVE

Sensorineural hearing loss (SNHL) has been associated with sickle cell disease (SCD) in older children and adults. Few studies have investigated this association in younger children.

DESIGN

In a cohort of pediatric patients followed at our sickle cell clinic, with a mean age of 7.8 years, 154 audiograms were completed on 84 patients.

RESULTS

This produced 22 subjects with abnormal audiograms. Middle ear effusion was the etiology of 19 subjects' audiometric findings. Three children were found to have mild SNHL. None of the subjects had hearing loss of severity which would warrant amplification. The prevalence rate for SNHL in our cohort of pediatric patients was 3.5%.

CONCLUSION

This differs from past reports, and may reflect an age dependent prevalence of SNHL in this disease.

Extramedullary hematopoiesis of the middle ear

A 22-year-old man with sickle cell disease developed a conductive hearing loss as a result of extramedullary hematopoiesis in the right middle ear. This is the first reported case of conductive hearing loss from extramedullary hematopoiesis and only the second report of extramedullary hematopoiesis in the middle ear.