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Biomedical subjects

H von Wedel

Publications and source records attributed to H von Wedel.

At least 19 recordsLinked to original sources

Maturation of binaural interaction components in auditory brainstem responses of young guinea pigs with monaural or binaural conductive hearing loss.

Reversible conductive hearing loss created during the first 4 weeks post partum caused marked alterations in the maturation of binaural interaction components in the auditory brainstem responses of guinea pigs. In untreated control animals all three components investigated demonstrated postnatal development in terms of latency shortening that was completed during the first 3 weeks of life. Plugging of both external ear canals caused a significant delay in the maturation of the late component DN2, where latency values of the controls were reached only 2 weeks after the end of the treatment, i.e. after 6 weeks of life. Monaural deprivation likewise led to a retarded development of peak latencies during the phase of imbalanced sensory input. After the end of the one-sided conductive hearing loss the maturation process was markedly enhanced, even resulting in latency values for DN2 and DP1 that were significantly shorter than those of the controls. This phenomenon persisted until the end of the study period and was the case for both plugged and untreated ears in this group of animals. The time course of latencies in two other groups of experimental animals which were deprived in the same way as adults suggests that the effects observed are due to a sensitive period in the maturation process of the auditory pathway.

Age Factors

[Rehabilitative measures in hearing-impaired children].

On the basis of certain fundamental data on the maturation processes of the central auditory pathways in early childhood the importance of early intervention with hearing aids is discussed and emphasized. Pathological hearing, that is acoustical deprivation in early childhood will influence the maturation process. Very often speech development is delayed if diagnosis and therapy or rehabilitation are not early enough. Anamnesis, early diagnosis and clinical differential diagnosis are required before a hearing aid can be fitted. Selection criteria and adjustment parameters are discussed, showing that the hearing aid fitting procedure must be embedded in a complex matrix of requirements related to the development of speech as well as to the cognitive, emotional and social development of the child. As a rule, finding and preparing the "best" hearing aids (binaural fitting is obligatory) for a child is a long and often difficult process, which can only be performed by specialists who are pedo-audiologists. After the binaural fitting of hearing aids an intensive hearing and speech education in close cooperation between parents, pedo-audiologist and teacher must support the whole development of the child.

Auditory Pathways

Selective hearing in the aged with regard to speech perception in quiet and in noise.

Most listening environments contain some noise which is mixed up with the speech. The effects of noise on speech perception depend on the parameters of the noise (long term spectrum, fluctuations of the intensity in time and average intensity relative to the intensity of speech) and on the speech material (sentences, monosyllables, CV-, CVC-, VC-syllables). The most effective at masking are noises with spectra similar to the speech spectrum, such as the speech simulating noise (CCITT-noise) or cocktail-party-noise. The cocktail-party situation is judged to be a difficult communication situation not only by the hearing impaired but also by patients with presbycusis. We examined different age-dependent changes of the speech discrimination in noise ability. Using sentences and CV-syllables (rhyme test) the critical signal-to-noise ratios (S/N-dB) for a speech discrimination of 35%-45% were investigated for monaural and binaural noise representations for different age groups. The results are compared to several types of hearing loss and to those of similar studies in literature. The data of this study prove that hearing impaired and elderly patients are greatly affected by noise. While younger patients with moderate high-tone hearing loss may profit from a special hearing aid device with an integrated noise suppression-system, an improvement of speech discrimination in noise for the elderly can be achieved only by enhancing the signal-to-noise ratio by more than 10 dB. This is possibly because of the reduced capacity for frequency-, intensity- and time-resolution in the peripheral and central pathways of the hearing organ of the aged.

Adult

Tinnitus diagnosis and therapy in the aged.

We report on a study of tinnitus in more than 400 patients 20 to 80 years old who had suffered from tinnitus for more than one year. Quality of tinnitus, localization, frequency range, severity, masking and residual inhibition effects show no age dependence. The possible causes of tinnitus, is onset and duration and factors that increase or reduce tinnitus also show no age dependence. Regarding the grade of annoyance judged from a subjective scaling, younger patients seen to suffer more from tinnitus than do older subjects, who seem to compensate their tinnitus more often. With regard to the different therapeutic methods used in this study (transtympanal electrostimulation, iontophoresis, biofeedback, tinnitus masker, hearing aid), the stable benefit over more than one year experienced by those patients fitted with a hearing aid was encouraging for young and old subjects. In both groups, about 3% of the patients could be successfully equipped with a tinnitus masker. Independent of age, the improvement by the other methods is less than 1%. Our results show that sufficient prognostic data on the efficiency of a therapeutic method cannot be perceived from the different tinnitus measurements for either the young or the old subjects.

Adult

Monitoring the efficiency of hearing aid fitting in the aged by the Social Hearing Handicap Index.

The unsatisfactory results obtained from tone and speech audiometric studies in identifying the effects of hearing disability, in particular the psychosocial factors, prompted us to adopt a psychological test to determine the "social hearing ability". The test consists of 20 questions which all relate to "social hearing ability" in urban society. Ten questions concern hearing ability in situations where background noise plays either a negligible role or none at all. The remaining 10 questions concern selectivity ability, that is hearing with additional background noise. The evaluation of the questionnaire results in a classification of the so-called Social Hearing Handicap Index (SHHI) in percentages together with a breakdown of the deafness components and the selectivity components into percentages. This differentiation provides additional information about the demands placed on the hearing ability of humans in quiet or noisy surroundings. The information obtained from the test enables longitudinal studies on the course of a hearing disability or the effectivity of a particular therapy, e.g. hearing aid, to be carried out in the elderly.

Adult

Monaural and binaural time resolution ability in the aged. A psychoacoustic and electrophysiological study.

Time resolution ability is an important factor of auditory processing, especially in binaural hearing. In psychoacoustical and electrophysiological studies the time resolution of brief modulations of signal amplitude and frequency in monaural hearing, including gap detection ability, was analysed. To reveal the time resolution ability of the binaural hearing system, brief interaural modulations of signal amplitude, short changes of interaural time delay or noise coherence in broadband noise bursts were generated. The sensation levels of these short-lasting changes in the noise structure and the cortical evoked potentials were investigated in young normal hearing subjects and in the elderly. Thus age-dependent changes in monaural and binaural time resolution ability could be detected. For the monaural experiments, lengthened time constants of between 2-20 ms, depending on the degree of intensity or frequency modulation could be derived for older subjects. The binaural experiments were characterized by prolongation between 4-26 ms for short interaural signal delay changes. For both groups the time constants derived from the electrophysiological investigations were more prolonged, which might be explained by masking effects or habituation. Further electrophysiological investigations will be required to differentiate between time resolution processes of brief signal changes within the peripheral and central parts of the auditory system.

Acoustic Stimulation

Fine structure analysis of speech signals. Hearing aids and perceptual training.

Transition and gap detection experiments with synthetic speech stimuli in normal and pathological hearing were carried out to investigate the feasibility of some form of feature-analysing mechanism in speech perception. Identification experiments were performed before the hearing aid fitting, directly thereafter and half a year later to evaluate the important individual cues of speech perception with regard to perceptual training. Possible distortions in the temporal structure of the speech signals by the hearing aids were considered. For our experiments we generated a series of synthetic speech stimuli such as the ba-da-ga sequence, which are identical in their acoustic cues except for the transition of the second formant. The start frequency was changed in nine 200-Hz steps from 800 Hz to 2,400 Hz thus producing a ba at one end of the series and a ga at the other. The phenomenon of categorical perception could be investigated with this set of synthesized speech stimuli. In a second experiment the influence of silent intervals on the identification of plosives was analysed increasing the artificial silent interval in 10 ms steps from 0 ms to 120 ms in speech stimuli like schal thus producing stahl for the 120 ms silent interval. The results of patients with different types of hearing loss fitted with hearing aids are compared with normal hearing. Our investigations show that it will be possible to achieve an integration of fine-structure analysing mechanisms in speech perception into the management and rehabilitation of people with impaired hearing using special speech processors in modified hearing aids and developing special speech and hearing training programs.

Hearing Aids

[Effect of binaural conductive hearing loss on maturation of acoustically evoked potentials (auditory brain stem response, middle latency response) in guinea pigs].

During the early development of the acoustic system a conductive hearing loss may alter the maturation of acoustically evoked potentials and affect the development of hearing. The present experiments were carried out in newborn guinea pigs with binaural conductive hearing loss. The external ear canals were plugged over a period of one month from the first day postpartum. During and after deprivation click-evoked Auditory Brainstem Responses (ABR) and Middle Latency Responses (MLR) were collected to analyze changes in the maturation of these potentials in comparison to untreated animals. This type of deprivation is characterized by threshold elevations of about 40 dB over a wide frequency range. In young deprived animals, ABR Latencies (PIII, PV) and interpeak latencies exhibited a significant delay with a maximum between day 13 and 19, which disappeared within 10 days after the end of the treatment. MLR latencies were also significantly affected after three to four weeks of the deprivation phase. In contrast to the ABR, the recovery of the latencies was completed within four to six weeks. These results therefore indicate that a conductive hearing loss may alter the maturation of the acoustically evoked responses in the sensitive phase after birth. This type of partial deprivation may affect the development of hearing and speech perception in children with chronically occurring otitis media.

Age Factors

[Hearing aid selection and fitting from the pediatric audiology viewpoint].

On the basis of certain fundamental data for pathological hearing in children and its effects on speech development an attempt is made to summarise the most important considerations regarding the primary choice of a device and the subsequent procedures of fitting to optimise the benefits over a range of ages, from the small infant to school age children. Selection criteria and adjustment parameters are discussed, showing that the hearing aid fitting procedure must be embeded in a complex matrix of requirements related to the development of speech as well as to the cognitive, emotional and social development of the children. As a rule, finding and preparing the "optimal" hearing aid for a child is a prolonged and often difficult process, which cannot be schemantically performed. The limitations of the available devices and the different procedures and philosophies of hearing aid selection and fitting strategies represented by various groups active in the field of pedaudiology in Germany and in other institutions are discussed, underlining the magnitude of task still to be fulfilled in the Federal Republic of Germany.

Child

[Effectiveness of various non-medicinal therapeutic measures in tinnitus. A long-term study].

To compare the benefits of different therapeutic methods in patients suffering from tinnitus persisting for more than one year, the results of a study with 462 patients are presented. Transtympanal electrical stimulation at the promontory, iontophoresis of lidocaine, EMG biofeedback and masking by hearing aids or tinnitus maskers are compared with regard to their therapeutic efficiency directly after the test period and half a year later. The results indicate the importance of controlling for placebo effect in assessing the therapeutic value of the first three methods (electrical stimulation, iontophoresis and biofeedback). For these therapies an improvement by only less than 10% could be attained compared to success rates of 60% reported in the literature. About 30% of the patients could be successfully equipped with hearing aids or tinnitus maskers, 60% showing a stable benefit over a period of three years. To compare the benefits of the different methods the features of tinnitus (pitch, loudness, type and stability of masking, residual inhibition) and the subjective scaling of the therapeutic efficiency are examined. With regard to other even more recent therapies, the fitting of hearing aids in patients with tinnitus plus hearing loss seems to be of utmost importance in combatting tinnitus.

Acoustic Stimulation

[Hearing screening in neonates and infants using brain stem evoked acoustic potentials].

Reported failure rates of screening using the conventional brainstem auditory response (BAER), audiometry range from 5% to 60% with about 30% of the babies having normal hearing sensitivity on follow-up. The results of testing by an automated infant screener using advanced evoked response technology are compared with those of a conventional evoked response system operated by skilled personnel. 50 newborn were tested at a gestational age of 40-42 weeks. Normal results were obtained in all 25 newborn (50 ears) of the control group using both testing procedures. Out of 25 newborn (50 ears) at risk for congenital perinatal or postnatal hearing disorder, abnormal results for either screening or conventional BAER recording were seen in 6 ears with both methods.

Audiometry, Evoked Response

Short-time course of adaptation pattern after noise exposure: electrophysiological studies in man.

Tone burst and click-evoked potentials were recorded in both humans and guinea pigs to determine whether responses associated with the cochlea and brainstem regions show a pattern of recovery from noise exposure similar to the polyphasic changes found for the pattern of early recovery from temporary threshold shift reported by Hirsh and Ward in 1952 [J. Acoust. Soc. Am. 24, p. 131]. During the 'post-stimulatory' phase following exposure for 5 min to broad-band noise at various intensity levels between 90 and 110 dB SPL, changes in amplitude and latency of the dominant complexes of the cortical and brainstem-evoked potentials were monitored for 5 min with 1.5- and 60-second time resolution. There was clear evidence of polyphasic processes at the cortical level, whereas in the brainstem region, large post-stimulatory amplitude shifts were generally accompanied by an asymptotic recovery. The relevance of the results to the different stations in the auditory pathway is evaluated by comparison with published electrophysiological data on activities at the different levels of the brainstem and the brain as reflected in evoked responses and single-unit recordings.

Adaptation, Physiological

[Suitability of speech audiometry study procedures for current demands in clinical and general practice].

The quality of the recorded audiometric test material (the "Freiburg" and "Marburg" language test) meets the High Fidelity standards of the 1960's. In the light of current technology (digital technique, compact disc, etc.), the question arises whether speech-audiometry can still contribute to diagnosis, medico-legal assessment and fitting of hearing aids. Results of the "Freiburg" language test are presented, which analyse the comparability of the individual groups in quiet and in noisy surroundings, the technical and technological aspects of the sound systems, orthophonic reproduction and the practical performance of audiometric speech tests. Finally, recommendations of the commission for speech-audiometry and hearing aids of the ADANO are presented and discussed. These may explain present and future demands and possibilities of a broad-band audiometric investigation spectrum in hospital and practice.

Audiometry, Pure-Tone

The influence of moderate-intensity noise on the click-evoked compound action potential of the guinea pig, Cavia porcellus.

Noise-induced alterations of the click-evoked compound potential (CAP) were studied by means of electrodes chronically implanted near the round window in 15 pigmented guinea pigs aged 3-6 months. The potentials were recorded before, during and after exposure to continuous pink noise maintained at an intensity of 80, 90 or 100 dB SPL for 120 h. During the exposure phase the CAP thresholds of all the animals tested increased exponentially, nearly leveling out by approximately 48 h to form an asymptotic threshold shift. Recovery after the end of exposure also occurred exponentially, with a return to the original threshold for neural excitation after at most 72 h. There was no detectable change in amplitude, latency or inter-peak interval of the CAP when correlated with the change in threshold.

Acoustic Stimulation

The influence of moderate-intensity noise on the compound action potential evoked by tone bursts in the guinea pig, Cavia porcellus.

Noise-induced changes in the compound action potential (CAP) evoked by tone bursts in the frequency range 0.5-24 kHz were studied in 15 pigmented guinea pigs by means of chronically implanted electrodes positioned near the round window. The animals were exposed for 120 h to continuous pink noise at the intensities 80, 90 and 100 dB SPL. During the exposure period, all the animals exhibited an exponential rise in CAP threshold, leveling out after 24-72 h (asymptotic threshold shift, ATS). The largest threshold shifts were recorded during exposure to 100 dB SPL, for frequencies in the range 8-12 kHz. In the recovery phase, after the end of noise exposure, the threshold to tones at all frequencies tested fell exponentially, reaching the original level in about 72 h in all cases.

Animals

[Speech discrimination in environment-specific noise].

Taking into account the changes in language discrimination due to specific environmental noise of varying quality, we determined the influence of cocktail party noise, traffic noise and factory noise by means of free field adjusted headphones, thus analysing the discrimination of monosyllables for different types and degrees of noise in normal and pathological hearing. The results confirm that language discrimination without specially considering noise interference does not satisfactorily describe actual communication conditions in the everyday life of those with disturbed hearing. Even noise interference using a speech-related spectral distribution or white noise cannot sufficiently simulate the actual interference quality in everyday life. Cocktail party noises proved useful to register frequent selection interference in language-similar surroundings. For specific interference influence, additional street noise or factory noise may be used. With regard to standardisation of noise interference, comparative examination of language-simulating noise available as test noise on every normal language cassette should be performed. The present study underlines, to say the least, that for comprehension of language discrimination disturbances in the presence of noise interference, a broad-spectrum range of possible noise should be available for a comprehensive coverage of the manifold communications situations that can arise.

Auditory Threshold

[Electrophysiologic studies on the course of the adaptation phase following noise stress].

It was the aim of this study to settle the problem whether the post-stimulatory pattern of the extent of excitation (amplitude, latency) registered with the cortical evoked potentials can be verified in the recovery phase via leads from the brain stem region and cochlea. In this context electrophysiological measurements with human and animal material were performed. After a five-minute stimulation with a wide-band noise of various intensity we examined in the post-stimulation phase the specific stimulus pattern of the evoked potentials during an interval of 5 minutes with a resolution of 5 sec. We determined the change in response patterns of evoked potentials. Finally, the relevance of the results with regard to various nuclei of the auditory pathway is compared with corresponding electrophysiological measurements of the cochlear microphonics potentials, the VIII nerve compound action potential, and evoked potentials of different units of the brain stem and brain.

Animals