Cis-platinum ototoxicity and eye colour.
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Cisplatin↗
Biomedical subjects
S Gatehouse
Publications and source records attributed to S Gatehouse.
The prevalence of middle ear disease in the adult British population.
The UK National Study of Hearing set out to ascertain the prevalence of hearing impairments of various magnitudes, the prevalence of ear disease and the associated risk factors, and to estimate the percentage of individuals requiring some form of management. A stratified sample of 2708 British adults, aged 18-80 years, was chosen from a sample of 48,313 adults, randomly selected from the electoral roll, for a full otological and audiological assessment. This paper deals primarily with the middle ear results. Otoscopically, 2.6% of British adults had inactive and 1.5% had active chronic otitis media. This condition was more common in older individuals and in those in manual occupations. For this purpose, presumptive otosclerosis was defined as a conductive component to the impairment (average air bone gap over 0.5, 1 and 2 kHz of 15 dB or greater) and with an intact tympanic membrane. The population prevalence for presumptive otosclerosis was 2.1%, for healed OM 1.7% and for Eustachian tube dysfunction 0.9%. This prevalence of otosclerosis was higher in those over 40 years, but only in those with air bone gaps of 30 dB or greater were women more likely to have the condition than men, by a factor of three. At most, 20% of individuals with any of the above middle ear conditions will have had ear surgery.
Adult↗
Multiple primary malignant tumours in patients with head and neck cancer: the implications for follow-up.
The pattern of second primary cancer occurrence in 518 Scottish patients with head and neck cancer was determined by a retrospective study. The overall incidence of second cancers was 9% but the true incidence increased steadily in the years following initial diagnosis to reach a maximum of 21% at 11 years. After 4 years of follow-up patients were more likely to die from a second primary cancer than from the effects of the initial tumour. The Scottish cohort differed from previously reported, overseas, study groups in having a high incidence of second primary cancers in sites outside the upper aerodigestive tract. This potential demographic difference suggests a need for local audit prior to design and implementation of screening protocols for second primary cancers.
Adolescent↗
The time course and magnitude of perceptual acclimatization to frequency responses: evidence from monaural fitting of hearing aids.
At high presentation levels, normally aided ears yield better performance for speech identification than normally unaided ears, while at low presentation levels the converse is true [S. Gatehouse, J. Acoust. Soc. Am. 86, 2103-2106 (1989)]. To explain this process further, the speech identification abilities of four subjects with bilateral symmetric sensorineural hearing impairment were investigated following provision of a single hearing aid. Results showed significant increases in the benefit from amplifying speech in the aided ear, but not in the control ear. In addition, a headphone simulation of the unaided condition for the fitted ear shows a decrease in speech identification. The benefits from providing a particular frequency spectrum do not emerge immediately, but over a time course of at least 6-12 weeks. The findings support the existence of perceptual acclimatization effects, and call into question short-term methods of hearing aid evaluation and selection by comparative speech identification tests.
Aged↗
Clinical pure-tone versus three-interval forced-choice thresholds: effects of hearing level and age.
Hearing threshold levels were measured at 2 kHz using both a standard clinical procedure and a three-interval forced-choice procedure. The 240 subjects (aged 50-75 years) embraced both normal hearing and symmetrical sensorineural hearing impairment. The sample was carefully constructed to dissociate hearing threshold level from age, by oversampling the young impaired and the older normally hearing. The forced-choice threshold was found to be generally acuter than the clinical threshold. This was related to increasing severity of hearing loss at 1.7 dB per 10 dB HL and to age at 1.6 dB HL per 10 years. Hearing threshold accounted for 12% of the variance in the discrepancy between the two types of threshold, while age accounted for only 4% due to the narrow range used. After control for these thresholds and age, there were also significant associations with a self-estimate of hearing ability and with the neuroticism score from a personality questionnaire. When interpreting epidemiological findings, particularly in longitudinal studies, the separation between sensory and cognitive factors in threshold measures needs to be considered. The obtained discrepancies as a function of hearing level and age were applied to a statistical model for population prevalences for hearing impairment. The results suggested that the choice of method could have material effects on overall prevalence estimates and on the magnitude of the apparent age effect.
Age Factors↗
Clinical and financial audit of diagnostic protocols for lesions of the cerebellopontine angle.
OBJECTIVE: To assess the diagnostic efficiency and costs of protocols used for investigating patients with suspected lesions of the cerebellopontine angle. DESIGN: Prospective evaluation of tests of auditory brain stem responses and acoustic reflex thresholds, electronystagmography, and calorics. Positive test results were confirmed or refuted by high resolution computed tomography with intravenous enhancement. SETTING: Single general otolaryngology clinic in a teaching hospital. PATIENTS: 270 consecutive patients with sensorineural hearing loss requiring investigation to exclude a lesion of the cerebellopontine angle. MAIN OUTCOME MEASURES: Estimated costs of various diagnostic protocols and performance in detecting tumours of the cerebellopontine angle. RESULTS: Protocols including tests of auditory brain stem responses and acoustic reflex thresholds as sifting tests before computed tomography were clinically acceptable and presented considerable savings over the use of computed tomography in all patients (74,000 pounds or 84,000 pounds v 122,000 pounds). The use of electronystagmography and calorics could not be justified on clinical or financial grounds. CONCLUSIONS: Audiological tests of auditory brain stem responses and acoustic reflex thresholds followed by computed tomography constitute the most cost effective protocol for determining suspected lesions of the cerebellopontine angle. IMPLICATIONS: The cost effectiveness of diagnostic protocols should be evaluated throughout the health service.
Caloric Tests↗
Frequency resolution as a function of hearing threshold level and age.
Frequency resolution ability was measured using a psychoacoustical tuning curve (PTC) or a notch-noise technique in two population samples. The first sample incorporated 1764 subjects with various degrees of sensorineural hearing impairment and ranging in age from 17-80 years. The second sample included 240 subjects aged between 50 and 75 years, carefully balanced in terms of impairment and age to avoid confounding between these two variables. In both samples, frequency resolution ability declined with increasing hearing threshold level (HTL), as measured by either method. In a subsample tested with both methods, the correlation between the two was only modest. After accounting for HTL, there was a minor dependence of frequency resolution on age, older subjects having poorer frequency resolution once HTL had been accounted for. No addition to the explained variance was achieved by taking sex, occupational group, or audiogram slope into account. Despite the documented reproducibility of the measures, much of the variance in the frequency resolution measurements remained unrelated to HTL or age.
Adolescent↗
The Glasgow Benefit Plot: a new method for reporting benefits from middle ear surgery.
Conventionally, the results of middle ear surgery are reported in terms of postoperative closure of the air-bone gap or the improvement in air-conduction thresholds. While these are relevant in that they assess the technical success of the procedure and the lessening of monaural disability, they do not necessarily assess whether the patient has benefited. This is determined by many factors, not least of which is the hearing in the nonoperated ear. In this paper, we suggest that preoperative and postoperative plots of the air-conduction thresholds in both ears be used as an additional method of presenting the results. First, the proportion of patients that fall into each of three main preoperative impairment groups are identified. This is important, as the potential benefits from surgery are not the same in each group. Thereafter, the percentages of patients that achieve various postoperative hearing categories can be calculated, allowing surgeons to audit their results and make comparisons between series.
Adult↗
Reliability of patient choice between hearing aid systems.
Various hearing aid provision strategies have been suggested but it is important to compare patient benefit from these, not only in the laboratory, but in everyday life. The latter can only be assessed by patient report. The false positive report rate of a difference between aids and the reproducibility of patient choice of aids was assessed in two groups of patients. The first received the same system on two occasions and were asked to report if they had any preference. The second group received two different systems on two occasions and the reproducibility of any preference was assessed. Of the 22 patients who were given the same hearing aid system on each visit, eight (36%) reported no differences, 10 (45%) a little and four (18%) a moderate or large difference between them when, in fact, there was none. Of the 34 patients who were asked to compare two acoustically different aids, 32 chose an aid on both occasions but only 22 (65%) chose the same aid, of whom 11 (32%) reported a moderate or large difference on both occasions. If reports of a little difference between aids are discounted and only moderate or large differences are accepted, it is concluded that the false positive report rate of a difference is approximately 20%. In addition, when patients are being asked to compare two NHS hearing aid systems, the rules of chance, order effect and reproducibility of patient choice have all to be controlled for, before decisions regarding patient preference can be made.
Aged↗
Costs of investigative protocols for cerebellopontine angle lesions in Scotland.
Efficient use of resources demands evaluation of current practices. This paper presents a prospective evaluation of investigative protocols for cerebellopontine angle lesions. Commonly used protocols vary greatly in their clinical effectiveness and in their costs. The use of appropriate protocols would increase the number of tumours correctly diagnosed each year while also limiting the costs of investigation.
Cerebellar Neoplasms↗
The output characteristics of an implanted bone conduction prosthesis.
So far, the published guidelines for patient selection for the Audiant implanted bone conduction device have been derived from clinical trial rather than experimental study. Theoretical considerations suggest that the guidelines should be frequency specific; the need for this was investigated in a laboratory study. Two independent measures of the maximum output of the Audiant device using both the body-worn and ear-level amplifiers have been performed on two subjects. These lead to maximum output figures for the device ranging from 15 dB HL at 250 Hz to 60 dB HL at 6000 Hz for the body-worn amplifier, and from 6 dB HL at 250 Hz to 42 dB HL at 6000 Hz for the ear-level amplifier. These results suggest that the ear-level amplifier is suitable only for candidates with essentially normal bone conduction thresholds at frequencies of 1000 Hz and below.
Adult↗
Whole blood viscosity and red cell filterability as factors in sensorineural hearing impairment in the elderly.
Deficiencies in blood supply can lead to impairments in cochlear function. We have reported significant associations of both measures of whole blood viscosity and derived measures of red cell rigidity with hearing threshold levels in individuals with sensorineural hearing impairments. This paper describes direct measures of red cell filterability in a group balanced across the variables of hearing threshold level and age to facilitate dissociation of the effects of factors correlated with age. After controlling for effects of age, sex and social class, there were strong correlations between whole blood viscosity at high shear rate and hearing threshold levels at 250, 500, and 1,000 and 2,000 Hz. At 4,000 and 8,000 Hz, hearing threshold level was related to red cell filterability. When the data are divided into subgroups by age, the younger age group exhibited a pattern similar to the overall one, but in the older age group the effect of red cell filterability was more apparent, extending down to 1,000 Hz. The data support a strong association between aspects of blood rheology and sensorineural hearing impairment, but in a more complex manner than suggested by previous studies. They imply that there are two processes associated with sensorineural hearing impairment, one of which can be considered as due to bulk rheological properties, while the other appears more related to the properties of individual red cells. The bulk properties are more important at lower frequencies, while the cellular properties are more influential at higher frequencies.
Aged↗
The contribution of central auditory factors to auditory disability.
Auditory disability increases with both hearing threshold level and age. It is often suggested that some or most of the age effect in auditory disability is underpinned by deficits in central auditory function. A sample of 240 individuals aged between 50 and 75 years was examined to provide a balance across the major variables of hearing level and age. The central auditory indices investigated were: the binaural masking difference, the effects of dichotic competition on the staggered spondaic word tests, the binaural advantage for dichotically presented words, the binaural advantage for dichotically presented sentences, the effect of increasing the rate of presentation of speech, and the effect of nonsense as opposed to sensible sentences. In addition, the non-auditory variables of verbal and non-verbal IQ and the peripheral auditory factors of frequency and temporal resolution were assessed. Auditory disability was assessed using a performance index derived from a sentence identification-in-noise procedure and a procedure containing sense or nonsense sentences. Aspects of self-reported disability were determined using the MRC Institute of Hearing Research's Hearing Disability Questionnaire and the American Hearing Performance Inventory. There were significant correlations between the derived central variables and measured disability after control for hearing threshold levels and age. Central variables were correlated with self-reported disability for only the specific sub-score reflecting disability in localisation. On a multiple regression, the central variables explained 11.1% of the variance in performance index of disability above the 21.1% explained by hearing threshold levels and age.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Factors that influence the benefit from amplification in the elderly.
Many factors have been proposed as potential determinants of the benefit that an individual receives from wearing a hearing aid. In this study, to quantify their relative importance, 54 individuals with symmetrical sensorineural hearing impairment were presented with and without simulated hearing aid characteristics on two measures of disability that were based on identifying words in sentences. Benefit was defined as the difference between the percentage of correct scores with and without the aid characteristics switched into the audio circuit. The factors investigated were age, various peripheral auditory functions, central auditory factors and non-auditory factors such as IQ and personality. Initial correlations suggested a strong relationship between the benefits of amplification and four types of variable: hearing threshold level, frequency resolution, aspects of central function, and the discrepancy in auditory threshold between two methods--a robust psychometric three alternative forced-choice procedure and a conventional audiometric procedure. When the effects of hearing threshold level were partialled out, there remained strong correlations with frequency resolution, co-modulation masking release, and the threshold discrepancy measure. Frequency resolution and threshold discrepancy accounted for a further 21.1% of the variance over the 26.5% of the variance accounted for by hearing threshold level. There were no correlations in this sample of benefit with age, once other aspects had been accounted for. The results indicate a strong role for frequency resolution in the potential benefits from amplification, in addition to central factors such as co-modulation masking release.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
Factors influencing consultation for management of hearing disability.
The aim of this study was to compare individuals referred to an Audiology Clinic (consulters) with hearing-impaired individuals in the population who have never sought advice (non-consulters) in order to identify factors which lead some individuals with hearing problems to seek management while others with apparently similar impairments do not seek advice. Two hundred and sixty nine consulters referred to the Audiology Clinic at Glasgow Royal Infirmary were compared with 289 individuals identified in the MRC National Study of Hearing who had never sought advice as an adult about hearing problems. Age, sex, socio-economic group and better-ear hearing threshold were controlled for in all analyses. Consulters were found to have more asymmetrical hearing than non-consulters. They had greater measured disability and reported more disability when their measured disability and impairment were controlled for. They were also more handicapped when impairment and disability were controlled for.
Adult↗
Response times to speech stimuli as measures of benefit from amplification.
The benefits of management of hearing disability, in particular by provision of a hearing aid, are traditionally assessed by the percentage improvement in performance on a speech identification task. To provide precise and stable results, such procedures require more time than is available in most clinical settings. In any stressed performance, e.g. an impaired individual trying to listen in noise, there is a trading relationship between accuracy and effort (the cost at which accuracy is achieved). If the control of performance naturally spends effort to stabilize high performance, then benefit from amplification may essentially comprise and be measurable as reduction in effort rather than improvement in accuracy. Certainly complaints of hearing disability emphasize fatigue from careful listening. Hence a hearing aid may not only enable hearing impaired persons to hear more of speech but may enable them to hear it more easily, thus reflecting a second dimension to disability and benefit. Ease of listening was investigated using auditory response times to speech stimuli of two levels of structure: single words and sentences. The speech material was presented to 44 experienced hearing aid users (mild to moderate sensorineural hearing impairment). The speech was presented both unaided and aided at presentation levels of 60, 70 and 80 dB SPL and signal-to-noise ratios of quiet and + 5 dB. Response times were taken to the tokens within each list that were correctly identified. Benefit is defined as the decrease in response time from the unaided to the aided condition.(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
The role of non-auditory factors in measured and self-reported disability.
The effect of age per se on auditory disability in relation to other non-auditory factors, including personality and IQ, is unclear because of the close link with hearing threshold level. Auditory disability may be assessed in terms of either performance or self-report. It was measured using two tasks identifying words in sentences: (1) sentence identification in noise for spatially separated signal sources, and (2) identification of sensible and nonsensical sentences given at normal and artificially accelerated rates. Self-reported disability was assessed using the MRC Institute of Hearing Research's Hearing Disability Questionnaire and the American Hearing Performance Inventory. The sample of 240 individuals aged 50-75 years was constructed to provide a balance across the major stratification parameters of hearing level and age. In accordance with much of the published literature, the performance indices exhibited significant age effects: for a given hearing threshold level, older individuals are more disabled. Conversely, the indices of self-reported disability exhibit a trend whereby individuals with a given hearing threshold level, report a lower degree of disability with increasing age. There were no significant effects of personality, verbal or non-verbal IQ on the performance indices. However, these variables had large effects on reported disability, increasing the explained variance by approximately 20% more than the variance explained by hearing threshold level and age. Thus, the effect of age has the expected direction for performance-based disability, but for reported disability has the counter-intuitive direction. This finding, together with the additional large significant effects of other nonauditory variables, implies that indices of self-reported disability have to be controlled for these other major determinants if they are to be useful in an overall assessment of auditory disability.
Aged↗
Determinants of self-reported disability in older subjects.
The effects of hearing threshold levels, age, personality, and IQ on indices of self-reported disability/handicap derived from the Hearing Performance Inventory and the Institute of Hearing Research Hearing Disability Questionnaire have been investigated in a sample of 240 individuals with bilateral, symmetric sensorineural hearing, which was efficiently balanced across hearing threshold level and age. The results show significant effects of age, IQ, and, in particular, personality on many aspects of reported disability/handicap, with different relative contributions for females and males. It is possible to account for between 42 and 50% of the variance in most of the disability/handicap indices. Around 5% is accounted for by age and between 12 and 22% by aspects of personality. These findings suggest that the effects of age, IQ, and personality should be considered and incorporated into any practical application using self-assessment instruments.
Age Factors↗