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PubMed1981

The effects of early middle ear pathology on auditory perception and academic achievement.

Two groups of children were compared to determine the effects of early middle ear pathology on the development of auditory perceptual skills and academic achievement. The conductive loss (CL) group consisted of 15 children, aged seven to nine years, with histories of middle ear pathology. The normal control (NC) group was matched for age, sex, and socioeconomic status and had negative histories of middle ear pathology. Both groups were from a suburban community of primarily mild socioeconomic status. A test battery consisting of 12 auditory perceptual tests as well as measures of academic achievement, non-verbal intelligence and visual perception was administered. Results showed that the overall performance of the CL group on the test battery was significantly lower than that of the NC group. Performance of the CL group was also significantly lower in specific auditory perceptual areas. No significant differences were found on test of non-verbal intelligence or visual perception. Although scores were not significantly different on academic achievement tests, school records indicate that the CL loss group had received more special support services than the controls. This investigation suggests that early middle ear pathology may produce secondary effects that can persist well beyond the episodes of temporary conductive hearing loss.

Achievement↗
PubMed2005

Spoken word recognition in children with cochlear implants: a five-year study on speakers of a tonal language.

OBJECTIVES: To study the effects of age at implantation and duration of implant use on the performance of spoken word recognition of pediatric cochlear implantees in a tonal language setting over a period of 5 years. DESIGN: Sixty-four children, given implants between the ages 1:01 and 14:09 (years:months), were divided into three age groups. They were tested on open-set word recognition ability at seven time intervals from before surgery to 5 years after surgery. Analyses of variance with repeated measurements were used to examine the effect of their age at implantation and the duration of implant use. RESULTS: Duration of implant experience was significant in spoken word recognition across the three age groups (p < 0.01). Children given implants below the age of 3 years caught up with the performance of the older children at 12 months after implantation. The difference in score reached statistical significance at 2 and at 3 years after surgery (p = 0.03, p = 0.00). CONCLUSIONS: The performance of Cantonese-speaking children was similar to that of English-speaking children in that better outcomes were associated with longer implant experience as well as when implantation occurred at a younger age. The children implanted before the age of 3 and who had an implant experience of more than 2 years outperformed the children who were given implants after the age of 6 and also sustained these higher scores throughout 5 years of postimplant testing.

Adolescent↗
PubMed1994

Analysis of longitudinal data with unequally spaced observations and time-dependent correlated errors.

A linear model for repeated measurements is proposed in which the correlation structure includes a transformation of the time scale. This transformation can produce nonstationary covariance structures within subjects with stationarity as a special case. Restricted maximum likelihood methods for parameter estimation are discussed. The method is applied to simulated data as well as speech recognition data from the Iowa Cochlear Implant Project. The growth curve for this audiologic performance measure is shown together with estimates of the standard errors of predictions at given months.

Audiology↗
PubMed1997

Audiological correlates of speech understanding deficits in elderly listeners with mild-to-moderate hearing loss. II. Correlation analysis.

OBJECTIVE: The study was conducted to determine the relationship between measures of auditory performance in elderly individuals. Specifically, its goal was to uncover a set of measures correlated with the set of measures of speech understanding under specific conditions of interference to gain a better understanding of decline of the "cocktail party effect" in aging. DESIGN: Audiological status and auditory performance of a group of elderly (60- to 81-yr-old) individuals were determined through a test battery. When present, the hearing loss of elderly subjects was symmetrical in the two ears and, at most, moderate. The battery included tests of speech intelligibility on the word and sentence levels, with and without the presence of interfering speech. In addition pure-tone and speech reception thresholds, perception of spectrally or temporally distorted speech and auditory resolution of frequency, time, and space were tested. Two tests received special consideration: the Speech Perception In Noise Test and the Modified Rhyme Reverberation Test. RESULTS: Results indicated that, despite the nearly normal hearing levels that characterized much of the subject group, auditory sensitivity measures showed persistent correlation to all other measures, with the exception of auditory resolution regarding frequency, time, and space. As a set, sensitivity measures accounted for more than 85% of the variance. When auditory sensitivity was controlled for, other factors underlying speech processing in the presence of interfering stimuli were uncovered, factors most likely related to the ability to perceptually segregate one speech signal from another. CONCLUSIONS: The findings suggest that, to determine the relationship between audiological/auditory test results of an elderly population, it is important to remove the effects of hearing loss through appropriate statistical methods.

Aged↗
PubMed1989

Clinical role of informal tests of hearing.

Clinical tests of hearing are regularly used in adults but their role, now that pure-tone audiometry is almost universally available, has not been evaluated by modern methods of analysis including sensitivity and specificity. Free-field voice testing was carried out in 101 patients and the Rinne tuning-fork test in a different group of 127 patients prior to clinical or audiometric evaluation. The results were subsequently compared to air and bone conduction pure-tone thresholds assessed using rigorous standards. Depending on the audiometric definition as to what constitutes a hearing impairment, the sensitivity of free-field voice testing to identify such an impairment because of an inability to hear a whispered voice at two feet (60 cm.) was 86 per cent or better with the specificity being in the region of 90 per cent. In the Rinne test the 256 Hz fork was superior to the 512 Hz fork (p less than 0.05) and the loudness comparison method superior to the threshold decay method (p less than 0.01) in detecting an air-bone gap. Combining the responses to the two forks did not improve the results. The Rinne test with the 256 Hz fork will identify correctly 48 per cent of individuals with a 15 dB, 69 per cent with a 20 dB, 87 per cent with a 25 dB, and 95 per cent with a 30 dB conductive impairment. In all instances the specificity is greater than 90 per cent.

Audiometry, Pure-Tone↗
PubMed1990

The effect of guessing on the speech reception thresholds of children.

Speech audiometry is an essential part of the assessment of hearing impaired children and it is now widely used throughout the United Kingdom. Although instructions are universally agreed upon as an important aspect in the administration of any form of audiometric testing, there has been little, if any, research towards evaluating the influence which instructions that are given to a listener have on the Speech Reception Threshold obtained. This study attempts to evaluate what effect guessing has on the Speech Reception Threshold of children. A sample of 30 secondary school pupils between 16 and 18 years of age with normal hearing was used in the study. It is argued that the type of instruction normally used for Speech Reception Threshold in audiometric testing may not provide a sufficient amount of control for guessing and the implications of this, using data obtained in the study, are examined.

Adolescent↗
PubMed1998

Hearing preservation in neurofibromatosis type 2.

OBJECTIVE: The aim of the study was to provide a clinical review of the middle fossa approach for hearing preservation in patients with neurofibromatosis type 2 (NF2). STUDY DESIGN: The study design was a prospective case review. SETTING: The study was conducted at a private practice tertiary neurotologic referral center. PATIENTS: Eighteen patients diagnosed with NF2 underwent 23 middle fossa procedures between 1992 and 1996 for removal of an acoustic neuroma. The nine males and nine females ranged in age from 11-73 years with a mean age of 28 years. Tumor size ranged from 0.5-2.5 cm with a mean of 1.1 cm. MAIN OUTCOME MEASURES: House-Brackmann facial nerve grade was measured. In addition, hearing level was classified both by the American Academy of Otolaryngology-Head and Neck Surgery criteria for reporting results of hearing preservation surgery and by comparison with preoperative level (15 dB/15%). RESULTS: Measurable hearing was preserved in 65%, 48% within 15 dB of preoperative pure-tone average (PTA) and within 15% of preoperative speech discrimination. Bilateral hearing preservation occurred in five patients. Excellent facial nerve function (House-Brackmann grades I-II) was obtained in all patients with normal preoperative facial nerve function. CONCLUSIONS: In this series of patients with NF2, outcomes in hearing and preservation of preoperative facial nerve function are similar to results seen in patients suffering a sporadic unilateral acoustic neuroma. However, early intervention is crucial in obtaining such favorable outcomes.

Adolescent↗
PubMed1987

The threshold-of-interference test: a new test of interhemispheric suppression in brain injury.

A new procedural version of the Willeford competing sentences test (Willeford. Audiol Hear Educ 1976;2:12-20) is introduced here for use with brain damaged patients. The threshold-of-interference test seeks the minimal level of the competing sentences at which the patient can no longer repeat the message at the test ear. Findings are reported for normal controls and for brain damaged adults, with clinical data and computerized axial tomography scan evidence. The threshold-of-interference test appears to be efficient, quick in administration, and particularly useful in exposing auditory processing anomalies, especially in right hemisphere damage.

Aged↗
PubMed2004

Trade-offs between better hearing and better cosmetics.

A case study is reported of an adult bilateral cochlear implant patient who owns both a pair of ear-level and body-worn speech processors and chooses to wear them in unique configurations, knowingly compromising his auditory performance. The aim was to determine if differences in hearing could be quantified between these devices and to examine the size of these effects that would lend themselves to trading between performance and cosmetics. The patient reported wearing bilateral ear-level speech processors (programmed with the Cochlear Corporation spectral PEAK [SPEAK] coding strategy) 75% of the time for cosmetic and convenience reasons even though he "heard the best" with bilateral body-worn speech processors (programmed with the Cochlear Corporation advanced combination encoder strategy [ACE]). Speech perception and localization tests confirmed that this patient performed significantly better on monosyllabic phonemes in quiet (a difference from 60% to 75%) and localization (a total root-mean-squared-error difference from 22 degrees to 12degrees ) with bilateral body-worn speech processors and consistently rated various speech sounds as more clear than with bilateral ear-level units. There was a 2-dB difference in sentence reception threshold in noise, which was not statistically significant. These results suggest that clinicians should consider and provide options to patients when there are trade-offs to be made regarding understanding performance and cosmetics. Some individuals may choose better speech perception over cosmetics, and the ability to choose might result in greater compliance. The observations made here are relevant to hearing aid users as well.

Adult↗
PubMed1998

Audiologic assessment and amplification.

The basic audiologic tests (audiogram, speech recognition, and acoustic-immittance), special audiologic tests (otoacoustic emissions and auditory-evoked potentials), and screening protocols, including universal hearing screening, are discussed. Hearing and acoustic-immittance screeners are evaluated. This article also reviews advances in hearing and sensory aids and assistive-listening devices.

Acoustic Impedance Tests↗
PubMed1996

Word recognition in continuous and interrupted broadband noise by young normal-hearing, older normal-hearing, and presbyacusic listeners.

OBJECTIVE: Word recognition performance in continuous and interrupted broadband noise was examined in young normal-hearing (YNH), older normal-hearing (ONH), and presbyacusic (older hearing-impaired [OHI]) listeners. DESIGN: Participants (N = 36) were presented with identical Northwestern University Auditory Test No. 6 stimuli at 30 dB sensation level re their respective speech reception thresholds. The speech stimuli were presented in quiet and in both competing noise conditions with signal to noise ratios (S/Ns) of 10, 5, 0, -5, -10, -15, and -20 dB. RESULTS: In general performance was superior in quiet, improved with increasing S/N, and was greater in the interrupted broadband noise than in the continuous broadband noise. Significant main effects of group and S/N were found in both competing noises (p < 0.0001). Post hoc pairwise comparisons revealed all groups performed differently, with superior performance being displayed by the YNH group followed by the ONH and OHI groups, respectively (p < 0.05). A significant group by S/N interaction was observed in only the interrupted noise condition (p = 0.019). The degree of change in word recognition performance as a function of S/N was greatest in the OHI group followed by the ONH group and the YNH group. CONCLUSIONS: Group effects observed in the interrupted noise would imply that the two older groups of listeners had an auditory temporal deficit relative to the YNH listeners. The paradigm reveals the patency of the temporal processes that are responsible for the perceptual advantage (i.e., a release from masking) a listener has in interrupted competing stimulus.

Adult↗
PubMed1992

Underlay tympanoplasty with the graft lateral to the malleus handle.

In conventional underlay tympanoplasty the graft is placed medial to the malleus handle. The present study evaluates the results of a modification of this technique, in which the graft is placed lateral to the malleus handle, which has been dissected from the drum remnants. 39 ears with predominantly large or anterior pars tensa perforations were operated upon in this manner. After a median observation time of 20 months one ear was found to have a small reperforation. All ears had normal tympanomeatal angles, but 12 ears showed a small degree of laterofixation of the graft from the malleus handle. Analysis of the hearing showed good hearing improvement and no adverse effects attributable to the dissection of the ossicular chain. It is concluded that the technique is a good alternative to conventional underlay myringoplasty in ears with perforations involving the area anterior to the malleus handle.

Adolescent↗
PubMed1990

Difficulties with speech intelligibility in noise in spite of a normal pure-tone audiogram.

A group of 15 patients with complaints of having difficulties in understanding speech, especially in noisy surroundings in spite of (nearly) normal pure-tone audiograms, was subjected to a battery of speech-audiometric tests. The results showed that these subjects had a statistically significantly higher speech reception threshold (SRT) for sentences in noise than a reference group of 10 normal-hearing subjects. This difference was most clear for a fluctuating masking noise. In conditions with much reverberation, the patients also proved to be handicapped more than the control group. Binaural hearing gain was equal for both groups. The pathogenesis of the speech-hearing loss is not known, but assessment of the SRT in noise proves to be a valuable asset in objectifying these patients' complaints.

Adult↗
PubMed1990

The occlusion effect created by custom canal hearing aids.

There has recently been a dramatic increase in the demand for custom canal hearing aids. One of the significant limitations sometimes created by these instruments is the increased sensitivity to bone-conducted stimuli known as the occlusion effect. A large occlusion effect is often cited as the reason for rejection of these devices. This investigation tested a method of measuring the occlusion effect through bone-conducted speech reception thresholds (SRTs). The results indicated that the bone conducted SRT procedure is sensitive enough to differentiate between the occlusion effect created by shell earmolds versus canal hearing aids.

Bone Conduction↗
PubMed1981

Factors influencing hearing after stapedectomy.

Surgical results of stapes surgery have been evaluated postoperatively after 3 years, in 834 subjects with otosclerosis. The following audiological tests were used: (1) the air-bone gap; (2) pre- and postoperative speech reception thresholds (SRT); (3) postoperative SRT related to the air-bone gap; (4) the BC loss at 4000 Hz.

Bone Conduction↗
PubMed2001

Similarities and differences in distortion-product otoacoustic emissions among four FDA-approved devices.

Similarities and differences in distortion-product otoacoustic emissions (DPOAEs) among four Food and Drug Administration (FDA) approved devices were assessed quantitatively. DPOAEs were recorded from 42 adult subjects (84 ears) ranging in age from 19 to 40 years. All subjects had hearing thresholds of 20 dB HL or better for the test frequencies from 0.25 to 8.0 kHz and normal acoustic immittance findings. DPOAEs were collected in a quiet non-sound-treated room. DPOAE measurement parameters included an f2/f1 ratio of approximately 1.2, with f1 at 65 dB SPL (L1) and f2 at 55 dB SPL (L2). There were no significant differences in the mean emissions levels among the four devices. This investigation showed that validity criteria, pass criteria, and strategies for DPOAE measurements interact to produce varying pass and refer results. However, when DPOAEs are obtained with consistent validity criteria, pass criteria, and strategies for measurement, the results are remarkably consistent.

Adult↗