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PubMed2003

Rehabilitation for high-frequency sensorineural hearing impairment in adults with the symphonix vibrant soundbridge: a comparative study.

OBJECTIVE: To assess and compare the benefits for patients with high-frequency hearing loss obtained from an implantable middle ear implant, the Symphonix Vibrant Soundbridge using the SIGNIA processing circuitry, to those derived from conventional amplification using the same integrated circuitry and to those derived from a variety of preoperatively worn hearing aids. STUDY DESIGN: A single-subject, repeated-measures study design was used for a comparative evaluation of the benefits derived from the Symphonix Vibrant Soundbridge and conventional amplification. Objective audiometric measures were performed postoperatively to compare the Symphonix Vibrant Soundbridge (404) and SIGNIA hearing aid, both using the SIGNIA processing chip. Tests were performed under three conditions: unaided, aided Symphonix Vibrant Soundbridge (404), and aided SIGNIA hearing aid. Subjective self-assessment scales, standardized and nonstandardized, were completed for the Symphonix Vibrant Soundbridge (404) and the preoperative hearing aid to compare the personally perceived benefits. Statistical comparison of the data sets with each device type was performed using the nonparametric Wilcoxon test. SETTING: One tertiary teaching hospital and one hearing aid specialist fitting office. SUBJECTS: Six patients displaying a high-frequency hearing loss who had the Symphonix Vibrant Soundbridge implanted for an average of 17 months. INTERVENTION: Rehabilitative. RESULTS: Aided thresholds with the Symphonix Vibrant Soundbridge (404) and the SIGNIA hearing aid showed no significant difference. Speech comprehension scores in quiet and in noise were significantly improved with each device type over the unaided condition scores. Individual performance on speech test measures was equivalent or superior with the Symphonix Vibrant Soundbridge (404) in comparison with that with the SIGNIA hearing aid. When using the Symphonix Vibrant Soundbridge (404) in quiet, the group achieved 50% speech comprehension at significantly softer presentation levels (p = 0.027) than when wearing the SIGNIA hearing aid. Similarly, in noise, 50% speech comprehension was achieved at significantly lower (more difficult) signal-to-noise ratios (p = 0.028) with the Symphonix Vibrant Soundbridge (404) than with the SIGNIA hearing aid. The level of satisfaction for various aspects of the device and performance and listening ease, particularly in the presence of aversive sounds and in reverberant conditions, was reported as significantly better with the Symphonix Vibrant Soundbridge (404) than with the preoperative hearing aid. CONCLUSIONS: Despite similar gain with each device type using the same SIGNIA processing technology, the patient group demonstrated significant advantages for speech comprehension in quiet and in noise when using the Symphonix Vibrant Soundbridge (404). Such an effect may be attributed to higher fidelity sound transmission by means of the direct-drive mechanism used by the implant. Subjective reports support the results from the objective assessments, both being in favor of the implant over conventional amplification. In conclusion, the Symphonix Vibrant Soundbridge (404) is a suitable treatment option offering advantages over conventional amplification to the hearing-impaired person with a high-frequency hearing loss.

Adult↗
PubMed2003

Recovery from prior stimulation: masking of speech by interrupted noise for younger and older adults with normal hearing.

In a previous study [Dubno et al, J. Acoust. Soc. Am. 111, 2897-2907 (2002)], older subjects benefitted less than younger subjects from momentary improvements in signal-to-noise ratio when listening to speech in interrupted maskers. It has been hypothesized that the benefit derived from interrupted maskers may be related to recovery from forward masking, i.e., the recovery of a response to a suprathreshold signal from prior stimulation by a masker. The effect of interrupted maskers on speech recognition may be well suited to test hypotheses regarding recovery from prior stimulation, given that both involve the perception of signals following a masker. Here, younger and older adults with normal but not identical audiograms listened to nonsense syllables at moderate and high levels in a speech-shaped noise that was modulated by a 2-, 10-, 25-, or 50-Hz square wave. An additional low-level noise was always present that was shaped to produce equivalent masked thresholds for all subjects. To assess recovery from forward masking, forward-masked thresholds were measured at 0.5 and 4.0 kHz as a function of the delay between the speech-shaped masker and the signal. Speech recognition in interrupted noise was poorer for older than younger subjects. Small but consistent age-related differences were observed in the decrease in score with interrupted noise relative to the score without interrupted noise. Forward-masked thresholds of older subjects were higher than those of younger subjects, but there were no age-related differences in the amount of forward masking or in simultaneous masking. Negative correlations were observed between speech-recognition scores in interrupted noise and forward-masked thresholds. That is, the benefit derived from momentary improvements in speech audibility in an interrupted noise decreased as forward-masked thresholds increased. Stronger correlations with forward masking were observed for the higher frequency signal, for higher noise interruption rates, and when the signal-to-noise ratio was poor. Comparisons of speech-recognition scores at moderate and high levels for younger and older subjects were not consistent with the hypothesis of an age-related difference in the contribution of low-spontaneous-rate fibers to speech recognition in interrupted noise.

Adult↗
PubMed2005

Preservation of residual hearing with cochlear implantation: how and why.

CONCLUSIONS: Hearing may be conserved in adults after implantation with the Nucleus Contour Advance perimodiolar electrode array. The degree of hearing preservation and the maximum insertion depth of the electrode array can vary considerably despite a defined surgical protocol. Residual hearing combined with electrical stimulation in the same ear can provide additional benefits even for conventional candidates for cochlear implantation. OBJECTIVES: We present preliminary results from a prospective multicentre study investigating the conservation of residual hearing after implantation with a standard-length Nucleus Contour Advance perimodiolar electrode array and the benefits of combined electrical and acoustic stimulation. MATERIAL AND METHODS: The subjects were 12 adult candidates for cochlear implantation recruited according to national selection criteria. A "soft" surgery protocol was defined, as follows: 1-1.2-mm cochleostomy hole anterior and inferior to the round window; Nucleus Contour Advance electrode array inserted using the "Advance-off-stylet" technique; and insertion depth controlled by means of three square marker ribs left outside the cochleostomy hole. These procedures had been shown to reduce insertion forces in temporal bone preparations. Variations in surgical techniques were monitored using a questionnaire. Pure-tone thresholds were measured pre- and postoperatively. Patients who still retained thresholds <90 dB HL for frequencies up to 500 Hz were re-fitted with an in-the-ear (ITE) hearing aid. Word recognition was tested in quiet and sentence perception in noise for the cochlear implant alone and in combination with an ipsilateral hearing aid. RESULTS: Hearing threshold level data were available for 12 patients recruited from 6 of the centres. Median increases in hearing threshold levels were 23, 27 and 33 dB for the frequencies 125, 250 and 500 Hz, respectively. These median increases include the data for two patients who had total loss of residual hearing due to difficulties encountered during surgery. "Cochlear view" X-ray images indicated that the depth of insertion varied between 300 and 430 degrees, despite modest variations in the length of the electrode inserted (17-19 mm). The insertion angle had some influence on the preservation of residual hearing at frequencies of 250-500 Hz. Six of the 12 patients retained sufficient hearing for effective use of an ipsilateral ITE hearing aid (< or = 80 dB HL at 125 and 250 Hz; < or = 90 dB HL at 500 Hz). Word recognition scores in quiet were improved from 10% to 30% with the cochlear implant plus ipsilateral hearing aid in 3 patients who had at least 3 months postoperative experience. Signal:noise ratio thresholds for sentence recognition were improved by up to 3 dB. Patients reported that they experienced greatly improved sound quality and preferred to use the two devices together.

Adult↗
PubMed2002

Evaluation of context effects in sentence recognition.

It was investigated whether the model for context effects, developed earlier by Bronkhorst et al. [J. Acoust. Soc. Am. 93, 499-509 (1993)], can be applied to results of sentence tests, used for the evaluation of speech recognition. Data for two German sentence tests, that differed with respect to their semantic content, were analyzed. They had been obtained from normal-hearing listeners using adaptive paradigms in which the signal-to-noise ratio was varied. It appeared that the model can accurately reproduce the complete pattern of scores as a function of signal-to-noise ratio: both sentence recognition scores and proportions of incomplete responses. In addition, it is shown that the model can provide a better account of the relationship between average word recognition probability (p(e)) and sentence recognition probability (p(w)) than the relationship p(w) =p(e)j, which has been used in previous studies. Analysis of the relationship between j and the model parameters shows that j is, nevertheless, a very useful parameter, especially when it is combined with the parameter j', which can be derived using the equivalent relationship p(w,0) = (1 - p(e))(j'), where p(w,0) is the probability of recognizing none of the words in the sentence. These parameters not only provide complementary information on context effects present in the speech material, but they also can be used to estimate the model parameters. Because the model can be applied to both speech and printed text, an experiment was conducted in which part of the sentences was presented orthographically with 1-3 missing words. The results revealed a large difference between the values of the model parameters for the two presentation modes. This is probably due to the fact that, with speech, subjects can reduce the number of alternatives for a certain word using partial information that they have perceived (i.e., not only using the sentence context). A method for mapping model parameters from one mode to the other is suggested, but the validity of this approach has to be confirmed with additional data.

Adolescent↗
PubMed2007

Estimates of basilar-membrane nonlinearity effects on masking of tones and speech.

OBJECTIVE: The aim of this experiment was to assess the contribution of cochlear nonlinearities to speech recognition in noise for individuals with normal hearing and a range of quiet thresholds. For signals close to the characteristic frequency (CF) of a place on the basilar membrane, the normal growth of response of the basilar membrane is linear at lower signal levels and compressed at medium to higher signal levels. In contrast, at moderate to high CFs, the basilar membrane responds more linearly to stimuli at frequencies well below the CF regardless of input level. Thus, for moderate-level speech and a lower frequency masker, the response to the masker grows linearly whereas the response to the speech is compressed, which may result in changes in the effectiveness of the masker on speech recognition with increases in masker level. To test this hypothesis, observed speech-recognition scores were compared with scores predicted using an audibility-based model, which did not include nonlinear effects that may influence masker effectiveness. DESIGN: Growth of simultaneous masking was measured for moderate-level bandpass-filtered nonsense syllables and for 350-msec pure tones at frequencies within the speech passband. Masker frequencies were within (on-frequency) or below (off-frequency) the speech passband. Estimates of basilar-membrane nonlinearities were derived from growth-of-masking functions for 10-msec, 2.0- and 4.0-kHz tones in narrowband, off-frequency maskers presented simultaneously. Subjects were 26 adults with normal hearing with approximately a 20-dB range of average quiet thresholds. RESULTS: Breakpoints (i.e., the levels corresponding to the transitions from linear to nonlinear responses) were strongly associated with quiet thresholds but slopes measured above the breakpoints were independent of quiet thresholds. Individual differences were substantially larger for off-frequency masking of pure tones and speech than for on-frequency masking of pure tones and speech. Using an audibility-based predictive model, the change in speech audibility resulting from the compressed response to speech with increasing off-frequency masker level (and the resulting decline in scores) was well predicted from nonlinear growth of masking for pure tones measured in the same off-frequency masker. However, absolute speech-recognition predictions were generally inaccurate and were a function of how well pure-tone signal levels at masked threshold estimated masker effectiveness for speech. That is, subjects with lower off-frequency masked thresholds had less accurate predictions of speech recognition in off-frequency maskers. CONCLUSIONS: Large individual differences in off-frequency masking of pure tones and speech are consistent with the assumption that small changes in the shape of the basilar-membrane input-output function result in large changes in the amount of off-frequency masking but small (if any) changes in on-frequency masking where the signal and masker are subject to a similar compression. Growth of off-frequency masking of pure tones and speech were correlated with each other, consistent with the underlying basilar-membrane response, and consistent with changes in breakpoints for subjects with normal hearing and a range of quiet thresholds. These results provide support for a role of nonlinear effects in the understanding of speech in noise.

Adult↗
PubMed2001

Elevation of internal auditory canal pressure by vestibular schwannomas.

OBJECTIVE: The exact mechanism of hearing loss, the most common presenting symptom in patients with vestibular schwannomas, remains unclear. To test whether increased pressure in the internal auditory canal from tumor growth is responsible for this clinical finding, the intracanalicular pressure in patients harboring these tumors was measured. STUDY DESIGN: Prospective study. SETTING: Tertiary referral hospital. PATIENTS: Fifteen consecutive patients undergoing a retrosigmoid approach for resection of vestibular schwannomas were included in the study. INTERVENTION: The intracanalicular pressure in every patient was measured by introducing a pressure microsensor into the internal auditory canal. The pressure readings, which were performed before tumor resection, were then correlated with tumor size and respective preoperative hearing status. RESULTS: Placement of the pressure monitor into the internal auditory canal revealed a biphasic waveform in every patient. Whereas the mean intracanalicular pressure was 20 mm Hg, there was significant variability among patients (range, 1-45 mm Hg). The intracanalicular pressure directly correlated with the amount of tumor in the internal auditory canal (r > 0.63, p < 0.012) but not with the total tumor size (r </= 0.40, p > 0.075). Furthermore, eight patients with class A preoperative hearing (American Academy of Otolaryngology-Head and Neck Surgery classification) had lower intracanalicular pressures than did five patients with class B hearing (16 +/- 5 vs. 28 +/- 4). Although this observation suggested an inverse correlation between the intracanalicular pressure and hearing function, the difference between the two groups was not statistically significant (p = 0.14). CONCLUSION: Pressure on the cochlear nerve as a result of tumor growth in the internal auditory canal may be responsible for hearing loss in patients with vestibular schwannomas. Modification of surgical techniques to address the elevated intracanalicular pressure may be beneficial in improving hearing preservation in these patients.

Cochlear Nerve↗
PubMed1999

Carbamazepine-induced sensorineural hearing loss.

Carbamazepine is a commonly prescribed anticonvulsant medication that affects various levels of the nervous system. We report a case of temporary sensorineural hearing loss in a patient after overdosing with 36 g of carbamazepine. Six days after the overdose, the patient complained of bilateral hearing loss and tinnitus. Audiograms revealed a 30- to 40-dB sensorineural hearing loss bilaterally. Another audiogram 2 weeks later showed a complete recovery in both ears accompanied by a clinical resolution in audiovestibular symptoms. Carbamazepine is used to treat partial and generalized seizures, trigeminal neuralgia, and bipolar illness. Adverse effects are not common but most frequently include dizziness, drowziness, nausea, and skin rashes; rare complications are agranulocytosis, bradycardia, and heart block. Documented hearing loss as a side effect of carbamazepine has not been reported, to our knowledge.

Adult↗
PubMed1988

Hearing recovery following suboccipital excision of acoustic neuroma.

Improvement of hearing after excision of an acoustic neuroma has been observed infrequently. We present a case of dramatic recovery of hearing in a patient with a 1-cm acoustic neuroma whose pure-tone thresholds and speech discrimination had profoundly deteriorated while she awaited surgical therapy. Postoperatively, her hearing in the affected ear is equal to that in her other ear, and her speech discrimination exceeds that of her best preoperative audiogram. Issues related to hearing preservation and improvement after acoustic tumor surgery are discussed.

Female↗
PubMed1997

Sudden sensorineural hearing loss following nonotologic, noncardiopulmonary bypass surgery.

OBJECTIVES: To report 3 cases of sudden sensorineural hearing loss (SSHL) following nonotologic surgery in which cardiopulmonary bypass (CPB) surgery was not involved and to review reports in the literature of similar cases. DATA SOURCES: Clinical records and MEDLINE and Healthstar databases. STUDY SELECTION: Reports in the world literature of cases of SSHL following nonotologic, non-CPB surgery. DATA SYNTHESIS: While said to be more common after CPB surgery, fewer than 20 cases of SSHL following non-otologic, non-CPB surgery have been reported. A number of proposed causes of SSHL temporally related to non-otologic, non-CPB surgery have been theorized; however, the true cause is unknown. This report presents 3 cases of SSHL following nonotologic, non-CPB surgery. Two patients had profound unilateral loss; 1 had moderate bilateral loss. None of the patients demonstrated recovery despite diuretic and prednisone therapy; in approximately 30% of the cases reported to date, the patients experienced significant improvement. CONCLUSIONS: Sudden sensorineural hearing loss following nonotologic, non-CPB surgery is rare, and its cause remains unknown. The scarcity of reports of SSHL following nonotologic, non-CPB surgery raises the possibility that the apparent association may be spurious.

Aged↗
PubMed1982

The relationship of idiopathic sudden hearing loss to diabetes mellitus.

A diabetic subgroup identified from a base population who have experienced idiopathic sudden hearing loss (ISHL) has been studied. In order to assess the relationship between diabetes and ISHL, two non-diabetic control groups were formed, and a comparison of the audiological data between the diabetic and non-diabetic ISHL patient was made. Mean degree of hearing loss and recovery, as well as the mean hearing level of the contralateral ear were analyzed. No statistically significant differences were noted in the audiological pattern of ISHL in diabetics and controls. A similar incidence of recovery was noted for the two groups throughout the mid frequencies; however, diabetic ISHL patients fail to recover as well as in the high frequencies. Preliminary data, while not statistically significant, suggest an increased hearing loss in both the affected and unaffected ear of the older diabetic patient.

Adult↗
PubMed1993

Atypical hearing loss in acoustic neuroma patients.

Audiologic data from 126 patients treated at the University of California, San Francisco for newly diagnosed acoustic neuromas (ANs) from 1986 to 1990 were reviewed. Subjectively normal hearing was present in 15% of patients and was most frequent in patients with small (< 1 cm) tumors. Only 4% had objectively normal hearing on the basis of speech reception threshold (SRT), speech discrimination score (SDS), and high-frequency pure-tone loss. This was most frequent in patients with < 1 cm tumors. Abnormal but symmetrical hearing is usually not considered to be indicative of a unilateral AN. In the present series, 7% of patients with ANs possessed symmetrical hearing. High-frequency asymmetry was a more sensitive indicator of the presence of an AN than differences in either SRT or SDS. The clinician must be aware of the relatively high incidence of atypical audiologic findings in acoustic tumor patients.

Adolescent↗
PubMed1999

Developmental course of auditory processing interactions: Garner interference and Simon interference.

Previous research suggests that with increasing age children become more efficient in inhibiting conflicting responses and in resisting interference from irrelevant information. We assessed the abilities of 100 children (ages 3-16 years) and 20 adults to resist interference during the processing of 2 auditory dimensions of speech, namely the speaker's gender and spatial location. The degree of interference from irrelevant variability in either dimension did not vary with age. Apparently, young children do not have more difficulty in resisting interference when the nontarget and the target are both perceptual attributes. We also assessed the participants' abilities to inhibit conflicting task-irrelevant information from spatial location and to resist interference from spatial variability in the context of conflict. In the presence of conflicting task-irrelevant information, both interference effects declined significantly with age. Developmental change in auditory processing seems to vary as a function of (1) the nature of the target-nontarget combination and (2) the presence/absence of conflicting task-irrelevant information.

Adolescent↗
PubMed1997

Stapes surgery in osteogenesis imperfecta patients.

Osteogenesis imperfecta (OI), or the Van der Hoeve-de Kleyn syndrome, is a heterogeneous group of connective tissue disorders. The key features in this disease are bone fragility with a tendency to spontaneous fractures and deformations. The classical traid of symptoms involves a conductive and/or sensorineural hearing impairment together with a tendency to spontaneous bone fractures and blue sclerae. Between January 1988 and December 1994, ear surgery was performed on eight ears of six OI patients who presented with mixed hearing loss preoperatively. Pathological changes observed in the middle ear were atrophy and/or fractures of the stapedial crura in combination with thickening and fixation of the stapes footplate. Partial stapedectomy was performed in seven cases and a neo-window was created in the promontory of one patient when an overhanging facial canal obscured visualization of the oval window niche. Pre- and postoperative bone conduction thresholds did not differ in any of the patients. Postoperatively, mean values of the air-bone gap in the main speech frequency range were below 10 dB. Functional results following stapes surgery in patients with otosclerosis during the same time interval (n = 857) did not differ significantly. These data indicate that stapes surgery in OI patients can be performed with the same functional predictability as in otosclerosis patients, even though the underlying etiology is considerably different.

Adult↗
PubMed2004

[Speech perception. The basis for speech audiometry examinations].

Speech recognition measurements are widely used in clinical applications. Usually, either a speech recognition threshold is determined, being defined as the speech level or signal-to-noise ratio that enables the patient to understand 50% of the target words or target sentences. In other cases, a discrimination curve, describing speech recognition as function of the presentation level, is recorded. For the interpretation of these findings, it is important to keep in mind that speech perception is affected by many interacting sensory, perceptual and cognitive processes.Here, our current knowledge of these processes is outlined and theories that model speech perception in general are briefly reviewed.

Audiometry, Speech↗
PubMed2006

[A multicentre comparative study of the ESPrit and the Nucleus 22].

BACKGROUND: Cochlear implant recipients often report additional difficulty in comprehension of speech in noisy conditions and of softly spoken speech. The aim of this clinical study was to evaluate and compare the performance advantages offered by the ear level ESPrit 3G for experienced Nucleus Mini 22 cochlear implantees. PATIENTS AND METHODS: Twenty-eight German-speaking implanted subjects, who had had experience with either the Spectra 22 or the ESPrit 22 for at least 6 months, were evaluated with their current processor and the ESPrit 3G (on microphone, M, and whisper, W, settings) following a 4-week trial. Freiburger monosyllabic words (FMW) were used at soft and conversational levels in quiet conditions and Oldenburger sentences (OLSA) were used in noisy conditions to compare performance. Subjective impressions of sound quality and user aspects were evaluated and combined with data from 31 English-speaking subjects from a parallel study. RESULTS: In comparison to the previously worn processor, statistically significantly superior performance (p<0.001) was observed at soft and conversational levels in quiet conditions for FMW in 15 subjects when using the W setting and in noisy conditions for the OLSA in 21 subjects when using the M setting (p<0.001). The ESPrit 3G was preferred by 86% of subjects (51/59). CONCLUSION: The ESPrit 3G for Nucleus 22 users has the potential to further improve speech understanding in quiet conditions at soft intensity levels and also in noisy conditions at conversational levels relative to the currently worn speech processor, the Spectra 22 or the ESPrit 22, for the majority of subjects. Subjectively, together with the improvement in sound quality, the majority of subjects also reported improved ease of use and wearer comfort.

Adolescent↗
PubMed2006

[Diagnosis and therapy of auditory synaptopathy/neuropathy].

Pathological auditory brainstem responses (lack of responses, elevated thresholds and perturbed waveforms) in combination with present otoacoustic emissions are typical audiometric findings in patients with a hearing impairment that particularly affects speech comprehension or complete deafness. This heterogenous group of disorders first described as "auditory neuropathy" includes dysfunction of peripheral synaptic coding of sound by inner hair cells (synaptopathy) and/or of the generation and propagation of action potentials in the auditory nerve (neuropathy). This joint statement provides prevailing background information as well as recommendations on diagnosis and treatment. The statement focuses on the handling in the german language area but also refers to current international statements.

Brain Stem↗