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Background: The digit in the noise test is a simple hearing screening tool that can identify hearing loss at the early stage. This screening tool takes less time than traditional pure-tone audiometry. There is a scarcity of hearing health professionals with few resources for carrying out hearing screening on a large scale in India. Hence, a hearing screening tool for the Hindi-speaking population is needed., Aim and Objective: The study aimed to develop and validate the Digit in Noise test in Hindi (DIN-H)., Methods: A native Hindi female speaker recorded single digits from 1 to 9 made into triplet combinations, which were binaurally presented to 20 normal hearing subjects having hearing thresholds less than 25 dBHL from 250 to 8000 Hz in the presence of broadband speech-shaped noise. The digit triplets were homogenized using speech intelligibility function for similar difficulty levels across stimuli. The homogenized stimuli were evaluated by obtaining the Speech Recognition Threshold (SRT) of 20 normal hearing subjects., Results: The Mean SRT was - 10.4 and - 11.3 dB before and after homogenization. A strong positive correlation existed between test and retest SRTs (0.78). Mean SRT and slope obtained before and after optimization were comparable to other languages like Korean and English. This test can act as a reliable screening tool for assessing individuals. The test was administered to 106 normal hearing participants. The 95th percentile of the SRT value obtained was - 5.6 dB, which was kept as a cut-off score for the screening test., Conclusion: DIN-H can be used as a screening tool for assessing the integrity of the auditory system on a large scale in less time for the Hindi-speaking population., Competing Interests: Conflicts of InterestThe authors declare no potential conflicts of interest., (© Association of Otolaryngologists of India 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Objectives: The objectives of the present study were to understand the parental views regarding stress, and its affect language, and auditory outcomes. The study also aims to understand the relationship between parental stress, and child's age., Design, Setting and Participants: A retrospective study was performed at a tertiary medical hospital. 50 parents of cochlear implant recipients were recruited for the study. The parents were interviewed and the children were tested using a test battery. The average age of implantation was 4.29 years, and the average hearing age was 3.23 years., Main Outcome Measures: The parents were interviewed about their child's needs, and experience with the cochlear implant using the Strength, and Difficulty questionnaire in Hindi, Questionnaire on Resources, and Stress-Short Form, and the Family Environment Scale, Closed - format Questionnaire to understand parental views, and experiences. The language outcomes were studied using the Integrated Scales of Development (ISD), Revised Categories of Auditory Performance. Factor analysis, and Chi-square tests were performed to understand potential relationships between parental stress, and child language, and/or auditory outcomes., Results: The results provide five main factors that accounted for significant variance including financial stress (30.1%), hyperactivity (15.2%), lack of personal rewards (13%), peer problems (10.9%), and emotional problems (9.2%). Acquisition of language was highly influenced by stress and caregiver's 'lack of personal rewards. 'Financial stress', and 'hyperactive behavior' of the child significantly affected the receptive language acquisition of a HI child. The most concerning factors for parents were well-being, and happiness (0.885), followed by social relationships (0.830), communication (0.736), the process of implantation (0.695), and the decision to implant (0.681). The stress regarding finance among parents increased marginally (0.024) as the child's age progressed., Conclusion: Parental stress is ongoing. The impact on the expressive language development of the child is significant. The maximum concern of parents is regarding the financial aspects of a cochlear implant, and the lifespan care of their child. Hence, professionals should provide regular, and context-specific counseling to parents after implantation to understand the parents' concerns, and provide appropriate remediation., Competing Interests: Declaration of competing interest No conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The primary aim of the study was to develop phonemically balanced passage, Oral passage and Nasal passage in Punjabi language. Development of the passage : The words in the passage were chosen to represent the way sounds are distributed in spoken Punjabi language, and the relative phonemic distribution of each word inside each paragraph matched how frequently each sound occurs in Punjabi. The paragraph was constructed using words that were rated as extremely familiar and familiar. The developed passages were given to five speech-language pathologists for the purpose of content validation. 100 people with normal hearing between the ages of 18 and 25 were enrolled in the study (50 female and 50 male). Each subject's nasalence was measured using a Nasometer. The individuals were given passages written in Punjabi to read, and their nasalence scores for each text were recorded. The nasalance mean for Punjabi phonemically balanced passage was 36.41 ± 4.61% and 38.57 ± 4.22% in male and female subjects. The Punjabi oral passage mean were 27.36 ± 4.14% and 28.46 ± 4.01% in male and female subjects. The means for Punjabi nasal passage were 46.15 ± 4.09% in male subjects and 47.04 ± 4.91% in the female subjects. The Intraclass correlation coefficient for Female and male subjects for the Punjabi Phonemically balanced passage, Punjabi oral passage, Punjabi nasal passage were 0.904, 0.945; 0.807, 0.909, and 0.956, 0.913 respectively. The developed passages have good test retest reliability and their normative scores can be used for assessment of different resonance disorders., Competing Interests: Conflict of interestNone of the authors have any competing interests to declare., (© Association of Otolaryngologists of India 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Background: In India, facility-based surveillance for congenital rubella syndrome (CRS) was initiated in 2016 to estimate the burden and monitor the progress made in rubella control. We analyzed the surveillance data for 2016-2021 from 14 sentinel sites to describe the epidemiology of CRS., Method: We analyzed the surveillance data to describe the distribution of suspected and laboratory confirmed CRS patients by time, place and person characteristics. We compared clinical signs of laboratory confirmed CRS and discarded case-patients to find independent predictors of CRS using logistic regression analysis and developed a risk prediction model., Results: During 2016-21, surveillance sites enrolled 3940 suspected CRS case-patients (Age 3.5 months, SD: 3.5). About one-fifth (n = 813, 20.6%) were enrolled during newborn examination. Of the suspected CRS patients, 493 (12.5%) had laboratory evidence of rubella infection. The proportion of laboratory confirmed CRS cases declined from 26% in 2017 to 8.7% in 2021. Laboratory confirmed patients had higher odds of having hearing impairment (Odds ratio [OR] = 9.5, 95% confidence interval [CI]: 5.6-16.2), cataract (OR = 7.8, 95% CI: 5.4-11.2), pigmentary retinopathy (OR = 6.7, 95 CI: 3.3-13.6), structural heart defect with hearing impairment (OR = 3.8, 95% CI: 1.2-12.2) and glaucoma (OR = 3.1, 95% CI: 1.2-8.1). Nomogram, along with a web version, was developed., Conclusions: Rubella continues to be a significant public health issue in India. The declining trend of test positivity among suspected CRS case-patients needs to be monitored through continued surveillance in these sentinel sites., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Nijmegen Cochlear Implant Questionnaire is an HRQoL tool that was developed by Dutch researchers to assess the QoL in adult CI users in the English language. It is used to measure the impact of the use of CI on the daily life situations of its users, on the perception of speech sounds, and on the cost-benefit assessment CI in adult CI users. There is no specific instrument available to assess the QoL in adult CI users in India, hence there was a need to take up this study. The primary aim of the study was to adapt and translate NCIQ into Hindi with a secondary aim to describe the effect of CI on quality of life in adult CI users. For translation, permission was taken from the authors of the original tool. The Forward-backward translation method was utilized for translation. The final version of the NCIQ-H was administered to the study participants (25 no.) 25, aged 18-60 years; High School as the minimum level of education; post-lingual hearing impairment, and CI use ≥ 12 months. The Cronbach's α coefficient was calculated for all domains and subdomains in the NCIQ-H showed the overall reliability of the questionnaire (0.82), showing good internal consistency. The CI users reported high scores across all the domains indicating improved quality of life. No significant correlation was found between the CI usage time and NCIQ scores on Spearman's correlation test. Also, there was no significant difference in NCIQ-H scores between genders on the Kruskal-Wallis test. The NCIQ (H) can be used to assess QoL in adults with cochlear implants. The scores suggest improvement in physical, social and psychological domains of life. No correlation was observed between the NCIQ-H scores and duration of CI usage as well as with gender differences., Competing Interests: Conflict of interestThe authors declare that they have no conflict of interest., (© Association of Otolaryngologists of India 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Introduction: Hemoptysis presents as a primary complaint in 8-15% of chest clinic patients. The etiology of hemoptysis varies among different series according to the time of publication, geographic location, and diagnostic tests employed., Aim: To study the clinical profile of patients hospitalized with hemoptysis at a tertiary respiratory care center in New Delhi, India., Methods: The study was a cross-sectional, observational, hospital-based study. Patients admitted with hemoptysis in emergency from November 2017 to April 2018 were enrolled. A total of 129 patients were evaluated by a detailed clinical history and necessary investigations deemed required for arriving at the diagnosis. Subjects' hospitalized details were recorded using structured evaluation proforma. Data were evaluated using SPSS version 22.0. The 'p' value of less than 0.05 was considered statistically significant., Results: A total of 129 patients were recruited, with a mean age of 42.67 years, 59.7% were male. Mild, moderate, severe, and massive hemoptysis were seen in 15.5%, 46.5%, 25.6% and 12.4% cases, respectively. History of pulmonary tuberculosis treatment was present in 40.3%, recurrent hemoptysis in 38% and bilateral chest x-ray involvement in 62.6% cases. Tuberculosis (active and sequelae) was the most common cause (51.9%) of hemoptysis. Recurrent hemoptysis and low hemoglobin were found to be independent risk factors associated with the severity of hemoptysis., Conclusion: Tuberculosis remains a significant cause of hemoptysis in our country. Even one episode of hemoptysis should not be ignored and investigated properly as it can potentially cause massive hemoptysis and life-threatening complications in the future., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

In India, tuberculosis (TB) notification has been required since 2012. Notwithstanding, notification rates remain low. Non-reporting of tuberculosis cases not only results in an underestimation of cases, but also impedes the country's TB control strategy. Our research aims to assess practitioners' awareness, perception, and practice of tuberculosis case notification, as these factors can help reduce the TB burden. A cross-sectional study of 142 physicians was conducted between August 2018 and December 2019. Doctors were interviewed and given evaluation forms. Seventy-seven percent of the 142 physicians polled worked in medicine-related specialties, while 33% worked in surgery. Public sector physicians (64.7%) knew more about the Nikshay App than private practitioners (40.8%). The vast majority of public-sector doctors were only notified through their hospital's National Tuberculosis Elimination Programme (NTEP) center. However, the majority of private practitioners (47.8%) notified cases directly through the hospital, the local District Tuberculosis Officer (DTO) or NTEP medical officer (24 percent), or the Nikshay portal (28%), whereas the majority of public sector doctors notified only through the hospital NTEP center (85.9%). The primary reasons for non-notification are the high patient load on doctors, a lack of understanding about Nikshay App and its functionality, technological difficulties in using the Nikshay App, and the stigma associated with tuberculosis. The Nikshay App must be popularized as a notification mechanism through the NTEP program. To increase notification rates, practitioners must overcome the challenges they face. In terms of notification, more seminars and training, particularly hands-on training, should be held on a regular basis.

The objective was to measure the effect of various face masks on speech recognition threshold and the word recognition score in the presence of varying background noise levels. 20 normal-hearing adult subjects (a total of 40 ears) participated. Pure tone audiometry followed by speech recognition threshold and word recognition score at the most comfortable level in varying signal-to-noise ratios (SNR0, SNR10, and SNR15) using surgical, pleated cloth, and N95 masks. Using surgical, cloth, and N95 masks, speech recognition thresholds increased by 1.8 dB, 4.4 dB, and 5.05 dB, respectively. Word recognition scores decreased by 32% without a mask, 43.7% in a surgical mask, 46.3% in a cloth mask, and 46.7% in N95 mask conditions, between SNR15 and SNR0. The speech recognition threshold was negatively affected with cloth and N95 masks. Surgical masks do not affect the word recognition scores at lower background noise levels. However, as the signal-to-noise ratio decreased, even the surgical, cloth, and N95 masks significantly impacted the word recognition score even in normal-hearing individuals., Competing Interests: No potential conflict of interest relevant to this article was reported. All authors affirm that there is no actual or potential conflict of interest. The institute also does not provide any financial or funds for the research work., (© 2022 PLA General Hospital Department of Otolaryngology Head and Neck Surgery. Production and hosting by Elsevier (Singapore) Pte Ltd.)

Background: Reports on childhood neurodevelopmental and neurosensory outcomes following acute bilirubin encephalopathy from low- and middle-income countries are scarce., Aim: This study aimed to analyze the neurodevelopmental and neurosensory outcomes of survivors of acute bilirubin encephalopathy., Study Design: Retrospective cohort., Subjects: Neonates with admission diagnosis of acute bilirubin encephalopathy were followed up and assessed for neuromotor, neurodevelopmental and neurosensory functions between 18 m and 12.5 years of age., Results: In 67 neonates with acute bilirubin encephalopathy, a composite outcome of cerebral palsy or death was observed in 33 (49%) subjects. Choreo-athetoid cerebral palsy [19 (73%)] was the most common type observed. Sensori-neural hearing loss was observed in 46 (79%) subjects. Subjects with cerebral palsy had significantly low Developmental profile-3 scores in all assessed domains. Neonates with an early-stage acute bilirubin encephalopathy (aOR (95% C.I): 0.12 (0.05-0.71); p = 0.02) and those with a normal neurological examination at discharge (aOR (95% C.I): 0.11 (0.06-0.7); p = 0.049) had significantly lower odds of the primary outcome., Conclusions: Majority of survivors of acute bilirubin encephalopathy had adverse outcomes during childhood in the form of cerebral palsy and sensory-neural hearing loss. Cognitive functions were better preserved than the language and general development in the affected children., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Government of India is committed to eliminate measles and control rubella/congenital rubella syndrome (CRS) by 2020. In 2016, CRS surveillance was established in five sentinel sites. We analyzed surveillance data to describe the epidemiology of CRS in India., Methodology/principal Findings: We used case definitions adapted from the WHO-recommended standards for CRS surveillance. Suspected patients underwent complete clinical examination including cardiovascular system, ophthalmic examination and assessment for hearing impairment. Sera were tested for presence of IgM and IgG antibodies against rubella. Of the 645 suspected CRS patients enrolled during two years, 137 (21.2%) were classified as laboratory confirmed CRS and 8 (1.2%) as congenital rubella infection. The median age of laboratory confirmed CRS infants was 3 months. Common clinical features among laboratory confirmed CRS patients included structural heart defects in 108 (78.8%), one or more eye signs (cataract, glaucoma, pigmentary retinopathy) in 82 (59.9%) and hearing impairment in 51. (38.6%) Thirty-three (24.1%) laboratory confirmed CRS patients died over a period of 2 years. Surveillance met the quality indicators in terms of adequacy of investigation, adequacy of sample collection for serological diagnosis as well as virological confirmation., Conclusions/significance: About one fifth suspected CRS patients were laboratory confirmed, indicating significance of rubella as a persistent public health problem in India. Continued surveillance will generate data to monitor the progress made by the rubella control program in the country., Competing Interests: The authors have declared that no competing interests exist.

Background: Drug-Resistant Tuberculosis (DR-TB) patients for whom a WHO recommended regimen along with Bedaquiline (BDQ) cannot be prescribed, Delamanid (DLM) was added along with other drugs to provide a "Salvage Regimen". The experience of the Institute in respect of early efficacy and safety of both drugs given together is presented., Objective: To ascertain the early efficacy, safety and tolerability of Bedaquline and Delamanid given together as a part of salvage regimen., Methods: BDQ and DLM were used together to make regimens along with other drugs where four effective anti TB drugs could not be prescribed as per WHO recommendations. Patients were followed up for sputum smear and culture conversion and adverse events during the treatment., Results: In this cohort study, 53 DR-TB patients (Median age-24) were initiated on regimens containing both BDQ and DLM. Sputum smear conversion was seen in 35% and 94% patients at the end of 1st week and 3rd month respectively. 84% patients had culture conversion at the end of 4th month. 29 adverse events (AE) were reported among 17 patients and there were 11 deaths. QTc prolongation more than 500 MS was seen in only 1 patient., Conclusion: BDQ and DLM given together in a salvage regimen is efficacious with low rate of adverse events. The combination provides hope to DR-TB patients with limited treatment options and should be provided as a life saving option., (Copyright © 2019 Tuberculosis Association of India. Published by Elsevier B.V. All rights reserved.)

Rubella infection during pregnancy can result in miscarriage, fetal death, stillbirth, or a constellation of congenital malformations known as congenital rubella syndrome (CRS). The 11 countries in the World Health Organization (WHO) South-East Asia Region are committed to the elimination of measles and control of rubella and CRS by 2020. Until 2016, when the Government of India's Ministry of Health and Family Welfare and the Indian Council of Medical Research initiated surveillance for CRS in five sentinel sites, India did not conduct systematic surveillance for CRS. During the first 8 months of surveillance, 207 patients with suspected CRS were identified. Based on clinical details and serologic investigations, 72 (34.8%) cases were classified as laboratory-confirmed CRS, four (1.9%) as congenital rubella infection, 11 (5.3%) as clinically compatible cases, and 120 (58.0%) were excluded as noncases. The experience gained during the first phase of surveillance will be useful in expanding the surveillance network, and data from the surveillance network will be used to help monitor progress toward control of rubella and CRS in India., Competing Interests: All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Introduction: Chronic subjective tinnitus is associated with cognitive disruptions affecting perception, thinking, language, reasoning, problem solving, memory, visual tasks (reading) and attention., Objective: To evaluate existence of any association between tinnitus parameters and neuropsychological performance to explain cognitive processing., Materials and Methods: Study design was prospective, consisting 25 patients with idiopathic chronic subjective tinnitus and gave informed consent before planning their treatment. Neuropsychological profile included (i) performance on verbal information, comprehension, arithmetic and digit span; (ii) non-verbal performance for visual pattern completion analogies; (iii) memory performance for long-term, recent, delayed-recall, immediate-recall, verbal-retention, visualretention, visual recognition; (iv) reception, interpretation and execution for visual motor gestalt. Correlation between tinnitus onset duration/ loudness perception with neuropsychological profile was assessed by calculating Spearman's coefficient., Results: Findings suggest that tinnitus may interfere with cognitive processing especially performance on digit span, verbal comprehension, mental balance, attention & concentration, immediate recall, visual recognition and visual-motor gestalt subtests. Negative correlation between neurocognitive tasks with tinnitus loudness and onset duration indicated their association. Positive correlation between tinnitus and visual-motor gestalt performance indicated the brain dysfunction., Conclusion: Tinnitus association with non-auditory processing of verbal, visual and visuo-spatial information suggested neuroplastic changes that need to be targeted in cognitive rehabilitation.

Purpose. Subjective tinnitus has different forms and degrees of severity. Many studies in the literature have assessed psychoacoustic characteristics of tinnitus but hardly any of them had focused on the association of audiological profile with onset duration and loudness perception. The aim of this study was to evaluate existence of any association between tinnitus loudness/onset duration and audiological profile to explain differences in prognosis. Method. Study design was prospective. The sample consisted of 26 subjects having tinnitus, which was divided into tinnitus and nontinnitus ears. Audiological profile included pure-tone audiometry, speech audiometry, tympanometry, acoustic reflex test, and auditory evoked potentials (early and middle latency). Unpaired t-test was applied to compare two subgroups. Correlation and association between tinnitus onset duration/loudness perception and audiological profile were also assessed by calculating Spearman's coefficient and Fischer exact value. Results. The two subgroups had significant differences for pure-tone and speech audiometry hearing thresholds. A significant association was observed between the high frequency/extended high frequency and tinnitus loudness/onset duration. Conclusion. The changes in hearing thresholds and auditory pathway are associated with an increase in tinnitus loudness and its onset duration. This knowledge would be helpful to differentiate between severity and chronicity of the patients for planning therapeutic management and predicting prognosis.

Hearing loss has been reported as a complication following cardiac surgery with extracorporeal circulation. Preoperative hearing testing is not commonly done in these procedures, so preoperative and postoperative hearing loss, if any, may occur unnoticed. 30 subjects in the age range of 50-70 with a mean age of 60.16 years with myocardial infarction and scheduled to undergo cardiopulmonary bypass surgery underwent detailed audiological assessment comprising of pure tone audiometry with extended high frequency audiometry, speech audiometry and otoacoustic emissions (OAE) testing. The audiological testing was done preoperatively and at 2 weeks after the surgery. On pure tone audiometry, the difference between pre- and postsurgery mean values for both ears at 10, 12, and 16 KHz showed highly significant differences (P < 0.0001). On OAE testing, a significant difference (P < 0.05) between pre- and postvalues of signal to noise ratio (SNR) was found. It is hypothesised that CPB surgery makes blood redistribution to other organs easy, deviating from internal ear, which is highly susceptible as it lacks collateral circulation and its cells have high energy metabolism. Epithelial damage on internal ear microcirculation causes reduction of the cochlear potentials and hence hearing loss.

The objective of the present study was to determine the status of extended high frequencies in subjects with secretory otitis media. The study evaluated 30 ears of 20 subjects with secretory otitis media in the age group of 15-30 years. This data was compared with 20 ears of 10 volunteers of the same age group with clinically normal hearing. Pure tone air conduction thresholds were analyzed in three frequency groups: low frequency (LF: 0.25, 0.5, and 1 kHz), high frequency (HF: 2, 4, and 8 kHz) and extended high frequency (EHF: 10, 12, and 16 kHz). The results showed elevated extended high frequency thresholds (EHFG) as compared to control group and comparatively better thresholds at high frequencies(HFG)s as compared to low (LFG)and extended high frequencies(EHFG) in the study group. This validates the importance of including an extended high frequency audiometry in the test battery of patients with secretory otitis media.

Introduction: Tinnitus is a disturbing symptom and is often the main reason for otology referral. It is usually associated with hearing loss of varying aetiology, and is thought to begin in the cochlea, with later abnormal central activity. We hypothesise that tinnitus without hearing loss may be caused by central and subcortical abnormalities and altered outer hair cell function., Aim: To compare the auditory brainstem responses, middle latency responses and otoacoustic emissions in normal-hearing individuals with and without tinnitus., Methodology: The audiological test results of 25 normal hearing subjects with tinnitus (age 18-45 years) were determined, and compared with those of a control group., Results: A statistically significant difference was found between study group tinnitus ears vs control group ears, as regards wave I latency prolongation, shortening of wave V and absolute I-III and I-V interpeak latency, enlargement of wave Na and Pa amplitude, and distortion product and transient evoked otoacoustic emission signal-to-noise ratios. There was no statistically significant difference between unilateral vs bilateral tinnitus ears., Conclusion: The pathogenesis and optimum management of tinnitus are still unclear. It often occurs with primary ear disease, usually associated with hearing loss, but may occur in patients with normal hearing. Observed changes in auditory brainstem and middle latency responses indicate central auditory alterations. Tinnitus involves both peripheral and central activity, and complete audiological and neurophysiological investigation is required. Management should be based on both audiological and neurophysiological findings.

Hearing impairment can be one of the more subtle deficits seen after closed head injury (CHI), and it may not be diagnosed until late in the recovery phase if at all. Most studies have assessed patients immediately after CHI. Repeated assessments at regular intervals were not performed in the majority of studies done to assess whether any initial hearing loss regressed or progressed. Follow-up at later stages will shed more light on the audiological consequences of CHI. The aim of this study was to analyze the long-term audiological consequences of CHI. A total of 290 subjects with CHI were chosen and followed-up at 3, 6, and 12 months. The audiological test battery comprised pure tone audiometry (PTA), speech audiometry, tympanometry, auditory brainstem response (ABR), and middle latency response (MLR), and was administered to all subjects. The data from 96 subjects who completed all three follow-ups were analyzed for tympanometry, ABR, and MLR. However, for PTA and speech audiometry, data from only 76 subjects were analyzed, as unconscious and disoriented subjects could not undergo these tests at initial testing. The results revealed that hearing status after CHI varies, and that at follow-up significant changes in hearing were seen. Hearing of low frequencies improved, due primarily to improvements in middle ear function. Significant changes in ABR latencies and MLR amplitudes were also observed. This reflects the unequal rates of recovery observed in the different parts of the central auditory nervous system.

Objective: To find out the relationship between severity of traumatic brain injury (TBI) and extent of auditory dysfunction., Background: Most of the studies have taken the subjects with TBI as one group without taking into account the extent of head injury viz. mild, moderate and severe. Combining all the three groups has resulted in presenting an incomplete picture of auditory deficits following TBI., Methods and Procedures: The sample population consisted of 290 subjects with TBI (study group) and 50 otologically normal subjects as controls. The subjects in the study group were further sub-divided into mild (n = 150), moderate (n = 100) and severe (n = 40) TBI. The audiological assessment consisted of pure tone audiometry, speech audiometry, tympanometry, acoustic reflex testing, auditory brainstem response and middle latency response audiometry., Results and Conclusions: An association was observed between the extent of auditory dysfunction and severity of TBI. This association was more pronounced for hearing status at high frequencies and ABR/MLR components. ABR Wave V absolute latency and I-V interpeak latency increased with severity of TBI. Amplitude of MLR wave Na and Pa decreased with increasing severity. It is suggested that subjects should be evaluated for hearing difficulties based on their severity of TBI.

A novel immunology-based point-of-care test has been designed to assess the activated form of matrix metalloproteinase-8 (aMMP-8) for diagnosis and monitoring of periodontal diseases. The test has been automated using an analyzer, which quantitatively measures aMMP-8 in 18 min in gingival crevicular fluid (GCF). Fluid samples were collected from healthy, gingivitis-, and periodontitis-affected teeth. The test results from the analyzer were compared with quantitative aMMP-8 immunofluorometric assay (IFMA) and in-house enzyme-linked immunosorbent assay (ELISA) as well as with the periodontal state. Preliminary results of analyzer measurements of these 34 clinical samples showed a good agreement with the results from IFMA and in-house ELISA and with the clinical picture.

In a first pilot field study 64 gingival crevicular fluid (GCF) samples were collected from patients of dental practitioners. The dentists (one orthodontist one periodontist, and one general practitioner) were asked to monitor the respective clinical status of the sites of sampling and to collect, if possible, sulcus fluid samples from healthy as well as affected sites from the same patient. The concentration of activated matrix metalloproteinase-8 (aMMP-8) in the GCF was recorded using a set of monoclonal antibodies and a novel DentoAnalyzer. From all three dental offices the distribution of the aMMP-8 values in GCF showed a congruent pattern, where healthy and periodontitis-affected inflamed sites were clearly disparate.

The diagnosis of subclinical paratuberculosis is still considered a major problem worldwide. As part of investigating diagnostic strategies for the paratuberculosis infection, sequential results of various diagnostic methods in a progressive experimental infection in goats were evaluated. Twenty-three goat kids were divided into three groups: the infected, contact and control, comprising 10, five and eight goats respectively. Animals of the infected group were orally inoculated on seven occasions with 5 ml of inoculum containing 2 x 10(9)Mycobacterium avium ssp. paratuberculosis per ml. Lymphoycte proliferation test using johnin PPD detected paratuberculosis infection from 60 days post-infection (DPI) onwards. The johnin PPD was found to be a better antigen for the proliferative assays as compared with the sonicated antigen. The faecal smear examination with acid-fast staining detected more goats as positive than bacterial culture and polymerase chain reaction (PCR). Lipoarabinomannan enzyme-linked immunosorbent assay (ELISA) started detecting infected goats from 150 DPI onwards followed by indirect ELISA and agar gel immunodiffusion from 180 DPI onwards. Histological examination was confirmatory and detected five infected goats as positive.

A dose of 10(10) Mycobacterium avium subspecies paratuberculosis was administered orally on seven occasions to produce experimental paratuberculosis infection in 10 5-8-week-old goat kids. Bacteriological, immunological, and histopathological changes, their relationships, and the efficacy of the commonly used diagnostic methods were studied during the progressive disease up to 270 days postinfection (DPI). Significant lymphocyte proliferative responses in the peripheral blood of five goats were detected as early as 60 DPI. A lymphoproliferative test was also performed on lymphocytes purified from different compartments of the guts of five infected and five control goats. Significant proliferative responses were observed in lymphocytes of jejunal compartments of all five goats, of which four had also significant lymphocyte proliferation in the blood. The ileal lymphocytes from two goats, one each at 120 and 270 DPI, had significant proliferation. The histological lesions were mainly observed in the gut-associated lymphoid tissues of the ileocecal valve, the ileum, and the terminal jejunum. Acid-fast bacilli were demonstrated in the lesions of two goats at 60 and 210 DPI. Bacterial culture showed poor sensitivity, detecting positive results for only one goat in the fecal and tissue samples at 210 DPI, whereas polymerase chain reaction (PCR) detected one goat in fecal sample at 210 DPI and two goats in tissue samples at 60 and 210 DPIs, respectively. Enzyme-linked immunosorbent assay and agar gel immunodiffusion test were found to be 100% sensitive from 180 and 210 DPI onwards, respectively.

A milk and serum ELISA containing lipoarabinomanan (LAM) antigen was evaluated in sheep and goats versus agar gel immunodiffusion (AGID) test and polymerase chain reaction (PCR) using milk and lymph nodes. Milk and serum samples were obtained from six, two, and four flocks with unknown, negative and positive status of infection, respectively. By comparison of serum ELISA activity and PCR results, the positive and negative predictive values were calculated. Receiver operation characteristic (ROC) analysis was used for calculating the specificity and sensitivity at different cut-offs.

Serum adenosine deaminase (ADA) levels were estimated in a group of 40 patients with head and neck cancer. The mean value was significantly higher in patients compared to controls. The increase was higher in cases of ulcerative growths than of proliferative growths, and activity was increased with advancement in the stage of the cancer. After radiotherapy, a gradual and significant decrease in serum ADA activity was observed.