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Objective: To evaluate the diagnostic application of external ear canal sound measurements in pulsatile tinnitus (PT)., Study Design: Retrospective chart review on a prospective series of sound measurements., Setting: Tertiary referral center., Patients: A cohort of 171 PT patients with sound measurements during diagnostic workup for PT (2016-2023)., Main Outcome Measure: The percentages of PT patients per pathology and diagnosis, with PT objectified by sound measurements., Results: In 57% of the patients, an identifiable etiology that could explain the PT was identified using various imaging modalities. The PT could be detected with a sound measurement in the ear canal in 48% of these patients. In absence of an identifiable etiology, an objective PT was found in only 15% of the cases. PT was more often detected for patients with arterial pathologies than venous or nonvascular pathologies (73% vs 50% and 22%, respectively). Particularly, in PT patients with a DAVF, an objective PT was found for all patients (100%). The sound measurements were found to be more sensitive than auscultation in detecting bruits in PT patients., Conclusion: A sound recording can objectify PT in almost half of the cases with a diagnosis as determined by imaging. In patients where the PT cannot be detected, arterial pathologies (particularly DAVFs) are less likely. Combined with a thorough clinical evaluation and proper imaging studies, sound measurements can be of added value in the clinical pathway of PT patients., Competing Interests: Conflict of interest and source funding: none declared., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of Otology & Neurotology, Inc.)

Objectives: This study aims to determine how prevalent suspected cognitive impairment is in older people visiting hearing aid dispensers, and to assess whether hearing aid dispensers' judgment on cognition was in accordance with the outcome of a cognitive screening., Design: This observational study was conducted between April and May 2022., Setting and Participants: Four private hearing aid retail stores in the Netherlands, where cognitive impairment was screened in people aged ≥60 years., Methods: The Mini-Cog was used for cognitive screening. In addition, hearing aid dispensers were asked to provide their professional judgment if they suspected cognitive impairment., Results: Of the total 239 older individuals screened, 133 were men [56%, mean age: 79 years (SD 8.6)], and 51 (21.3%) had abnormal outcomes on the Mini-Cog test. The recognition of possible cognitive impairment by the hearing aid dispensers compared to the outcome of the Mini-Cog resulted in correct predictions for 183 of the 239 individuals., Conclusion and Implications: Cognitive screening in hearing-impaired older adults who visit a hearing aid dispenser suggests that cognitive impairment might be present in approximately 1 in 5 individuals. Hearing aid dispensers' response to the presence of a cognitive impairment was in 2 of 3 in accordance with an abnormal outcome on cognitive screening. To improve hearing care for people with cognitive impairment, it might be important to enhance hearing care professionals' recognition of cognitive impairment in older individuals., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Patients with pulsatile tinnitus (PT) are often referred for digital subtraction angiography (DSA) to exclude cranial dural arteriovenous fistula (DAVF). Because DSA is not without risk, the authors studied the sensitivity and specificity of an automated detection algorithm that analyses external ear canal sound measurements to evaluate the presence of DAVF in PT patients., Methods: Between 2015 and 2021, external ear canal sound measurements of 72 PT patients were collected prospectively at our tertiary tinnitus clinic preceding referral of these patients to the neurosurgical department for counseling about DSA. The measurements were analyzed with an algorithm that objectifies a pulsatile sound as a PT coherence index (PTCI) per frequency band., Results: Ultimately, DSA was performed in 49 PT patients. DAVF was revealed in 15 patients (31%). PTCI cutoff values of 0.7 (at 250 Hz) and 0.6 (at 1000 Hz) resulted in sensitivity of 100% (78%-100%) and specificities of 62% (44%-78%) and 68% (49%-83%), respectively, for detecting DAVF on DSA., Conclusions: Analysis of external ear canal sound measurements in PT patients showed 100% sensitivity for detecting DAVF on DSA. This analysis can potentially be used as a screening tool to help clinicians and PT patients to decide on the necessity of DSA. Retrospectively, the use of sound measurement in our cohort would have narrowed the indication for DSA to 23 of 49 cases (47%) without missing a DAVF.

Objectives: In this paper we describe an automated detection algorithm that objectively detects pulsatile tinnitus (PT) and investigate its performance., Design: Sound measurements were made with a sensitive microphone placed in the outer ear canal in 36 PT-patients referred to our tertiary clinic, along with a registration of the heart rate. A novel algorithm expressed the coherence between the recorded sound and heart rate as a pulsatility index. This index was determined for 6 octave bands of the recorded sound. We assessed the performance of the detection algorithm by comparing it with the judgement of 3 blinded observers., Results: The algorithm showed good agreement compared with the majority judgement of the blinded observers (ROC AUC 0.83). Interobserver reliability for detecting PT in sound recordings by the three blinded observers was substantial (Fleiss's κ=0.64)., Conclusions: The algorithm may be a reliable alternative to subjective assessments of in-canal sound measurements in PT-patients, thus providing clinicians with an objective measure to differentiate between subjective and objective pulsatile tinnitus., Competing Interests: Authors have no conflicts of interest or financial disclosure to report., (Copyright © 2022 The Authors. Ear & Hearing is published on behalf of the American Auditory Society, by Wolters Kluwer Health, Inc.)