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Hearing impairment after subarachnoid hemorrhage

Hearing impairment after subarachnoid hemorrhage
Hearing impairment after subarachnoid hemorrhage
Background

Subarachnoid hemorrhage (SAH) survivors experience significant neurological disability, some of which is under‐recognized by neurovascular clinical teams. We set out to objectively determine the occurrence of hearing impairment after SAH, characterize its peripheral and/or central origin, and investigate likely pathological correlates.

Methods

In a case‐control study (n = 41), participants were asked about new onset hearing difficulty 3 months post‐SAH, compared with pre‐SAH. Formal audiological assessment included otoscopy, pure tone audiometry, a questionnaire identifying symptoms of peripheral hearing loss and/or auditory processing disorder, and a test of speech understanding in noise. A separate cohort (n = 21) underwent quantitative susceptibility mapping (QSM) of the auditory cortex 6 months after SAH, for correlation with hearing difficulty.

Results

Twenty three percent of SAH patients reported hearing difficulty that was new in onset post‐SAH. SAH patients had poorer pure tone thresholds compared to controls. The proportion of patients with peripheral hearing loss as defined by the World Health Organization and British Audiological Society was however not increased, compared to controls. All SAH patients experienced symptoms of auditory processing disorder post‐SAH, with speech‐in‐noise test scores significantly worse versus controls. Iron deposition in the auditory cortex was higher in patients reporting hearing difficulty versus those who did not.

Conclusion

This study firmly establishes hearing impairment as a frequent clinical feature after SAH. It primarily consists of an auditory processing disorder, mechanistically linked to iron deposition in the auditory cortex. Neurovascular teams should inquire about hearing, and refer SAH patients for audiological assessment and management.
1-11
Campbell, Nicci
fde07dcf-4874-4bab-ab3a-c3bc3c0015da
Verschuur, Carl
5e15ee1c-3a44-4dbe-ad43-ec3b50111e41
Mitchell, Sophie
9fdadc95-b97d-4fb3-be76-c847d1418932
McCaffrey, Orlaith
321adfb7-644c-46b4-b2a2-12b93cc87aae
Deane, Lewis
2cba6bb2-c599-46e4-9669-b2bf8d52cdfd
Taylor, Hannah
e63b0fae-eb6e-4e4b-bc07-9e5054e0a33c
Smith, Rory
c8144e56-d98a-44d7-8605-178176f629c8
Foulkes, Lesley
afe14fc0-cc8d-4477-b3c6-6abacb56f1a6
Glazier, James
6b1a50ca-5a3a-403d-bb43-bcef38302611
Darekar, Angela
62e6b511-a358-4e5d-a4ea-03890ba7c2c7
Haacke, Mark E.
4b668aaf-5f78-4654-a3ed-5c1416d451e4
Bulters, Diederik
d6f9644a-a32f-45d8-b5ed-be54486ec21d
Galea, Ian
66209a2f-f7e6-4d63-afe4-e9299f156f0b
Campbell, Nicci
fde07dcf-4874-4bab-ab3a-c3bc3c0015da
Verschuur, Carl
5e15ee1c-3a44-4dbe-ad43-ec3b50111e41
Mitchell, Sophie
9fdadc95-b97d-4fb3-be76-c847d1418932
McCaffrey, Orlaith
321adfb7-644c-46b4-b2a2-12b93cc87aae
Deane, Lewis
2cba6bb2-c599-46e4-9669-b2bf8d52cdfd
Taylor, Hannah
e63b0fae-eb6e-4e4b-bc07-9e5054e0a33c
Smith, Rory
c8144e56-d98a-44d7-8605-178176f629c8
Foulkes, Lesley
afe14fc0-cc8d-4477-b3c6-6abacb56f1a6
Glazier, James
6b1a50ca-5a3a-403d-bb43-bcef38302611
Darekar, Angela
62e6b511-a358-4e5d-a4ea-03890ba7c2c7
Haacke, Mark E.
4b668aaf-5f78-4654-a3ed-5c1416d451e4
Bulters, Diederik
d6f9644a-a32f-45d8-b5ed-be54486ec21d
Galea, Ian
66209a2f-f7e6-4d63-afe4-e9299f156f0b

Campbell, Nicci, Verschuur, Carl, Mitchell, Sophie, McCaffrey, Orlaith, Deane, Lewis, Taylor, Hannah, Smith, Rory, Foulkes, Lesley, Glazier, James, Darekar, Angela, Haacke, Mark E., Bulters, Diederik and Galea, Ian (2019) Hearing impairment after subarachnoid hemorrhage. Annals of Clinical and Translational Neurology, 1-11. (doi:10.1002/acn3.714).

Record type: Article

Abstract

Background

Subarachnoid hemorrhage (SAH) survivors experience significant neurological disability, some of which is under‐recognized by neurovascular clinical teams. We set out to objectively determine the occurrence of hearing impairment after SAH, characterize its peripheral and/or central origin, and investigate likely pathological correlates.

Methods

In a case‐control study (n = 41), participants were asked about new onset hearing difficulty 3 months post‐SAH, compared with pre‐SAH. Formal audiological assessment included otoscopy, pure tone audiometry, a questionnaire identifying symptoms of peripheral hearing loss and/or auditory processing disorder, and a test of speech understanding in noise. A separate cohort (n = 21) underwent quantitative susceptibility mapping (QSM) of the auditory cortex 6 months after SAH, for correlation with hearing difficulty.

Results

Twenty three percent of SAH patients reported hearing difficulty that was new in onset post‐SAH. SAH patients had poorer pure tone thresholds compared to controls. The proportion of patients with peripheral hearing loss as defined by the World Health Organization and British Audiological Society was however not increased, compared to controls. All SAH patients experienced symptoms of auditory processing disorder post‐SAH, with speech‐in‐noise test scores significantly worse versus controls. Iron deposition in the auditory cortex was higher in patients reporting hearing difficulty versus those who did not.

Conclusion

This study firmly establishes hearing impairment as a frequent clinical feature after SAH. It primarily consists of an auditory processing disorder, mechanistically linked to iron deposition in the auditory cortex. Neurovascular teams should inquire about hearing, and refer SAH patients for audiological assessment and management.

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More information

Submitted date: 2018
Accepted/In Press date: 2 December 2018
e-pub ahead of print date: 8 January 2019

Identifiers

Local EPrints ID: 421057
URI: https://eprints.soton.ac.uk/id/eprint/421057
PURE UUID: 7e0e8c63-6a81-4dc8-9a5d-7ce76e40f7b5
ORCID for Ian Galea: ORCID iD orcid.org/0000-0002-1268-5102

Catalogue record

Date deposited: 21 May 2018 16:30
Last modified: 14 Mar 2019 05:08

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Contributors

Author: Nicci Campbell
Author: Carl Verschuur
Author: Sophie Mitchell
Author: Orlaith McCaffrey
Author: Lewis Deane
Author: Hannah Taylor
Author: Rory Smith
Author: Lesley Foulkes
Author: James Glazier
Author: Angela Darekar
Author: Mark E. Haacke
Author: Diederik Bulters
Author: Ian Galea ORCID iD

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