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PubMed1997

Management of congenital atresia of the external auditory canal.

The management of a unilateral congenital atresia of the external auditory canal is nonuniform and debated. Various surgical approaches, timing, coordination with microtia repair, and variable hearing improvements all contribute to the debate regarding management of this entity. This paper outlines our craniofacial team approach to the congenital unilateral atresia and microtia in children. Selection criteria, timing of repair, coordination with microtia repair, surgical results, and pitfalls will be discussed. The results of surgery in 16 patients with unilateral congenital atresia of the external auditory canal and 2 children with bilateral atresia will be presented. Repair of the atresia was undertaken in children 5 years or older who had pneumatized mastoids and middle ears. Replacement of the malleus/incus complex with a partial ossicular reconstruction prosthesis improved closure of the air-bone gap. Drawbacks included meatal stenosis and deepithelization of the split thickness skin graft lining the external auditory canal. Repair of the unilateral congenital atresia is a demanding and challenging problem but one in which excellent results are achievable.

Adolescent↗
PubMed1999

Cholesteatoma otitis media with intact ossicular chain.

Thirty-one cases of cholesteatoma with intact ossicular chain were reviewed to examine the extension of cholesteatoma, operation procedures, pre- and postoperative hearing levels, and postoperative condition of the ear drum. They were operated on at Departments of Hyogo College of Medicine and Osaka University Medical School from 1989-1996, which were 20.4% of all of the primary cholesteatoma cases (n = 152). Twelve cases located at attic were operated by atticotomy or canal wall up and scutumplasty, 17 cases located at attic/antrum were operated by canal wall down and reconstruction, and two cases located around stapes were operated through the ear canal. Preoperative hearing level was mild (34.2 +/- 18.4 dB) and postoperative one was slightly improved (28.7 +/- 11.2 dB). In ossicular reconstruction, modified Wullstein type III method showed better hearing gain than Wullstein type I method. Postoperative attic retraction and/or pocket occurred in 15 cases (48.4%), but no recurrent cholesteatoma was found during the present follow-up period. These findings suggested that cholesteatoma with intact ossicular chain showed good postoperative hearing results, but postoperative retraction of the ear drum should be followed up for a long time.

Adolescent↗
PubMed2005

Evaluation of speech perception in noise in cochlear implanted adults.

AIM: To evaluate the effects of different signal-to-noise ratios on speech recognition obtained by the use of cochlear implant (CI); to compare the speech recognition in noise with different types of multichannel cochlear implants (CIs) and to evaluate the degree of difficulty for speech understanding in noise in daily life situations. STUDY DESIGN: Cohort transversal. MATERIAL AND METHOD: Forty adults with post-lingual hearing loss implanted with Nucleus 22, Nucleus 24, Combi 40, Combi 40+ and Clarion. We evaluated the recognition for CPA sentences in quiet and in S/N +15, +10 and +5 dB. We also applied the Social Hearing Handicap Index (SHHI) questionnaire for self-assessment in daily life. RESULTS AND CONCLUSION: All the implanted adults presented a significant reduction in the scores for sentences recognition as the S/N decreased. The medians' curve for sentence recognition reached 50% in the signal-to-noise ratio of +10 dB. There was no statistically significant difference in sentences' recognition scores and difficulty scores obtained with the SHHI, for all types of implants. The difficulties of implanted adults were rare in quiet and occasional in noisy situations according to SHHI questionnaire.

Adult↗
PubMed1986

Silastic coated incus in tympanoplasty: a preliminary report.

In 54 ears lacking the stapedial arch and the long process of the incus, ossiculoplasty was performed with a shaped auto- or homologous incus as columella. In 29 of the ears, the deep, slender part of the columella was coated with a silastic tube in order to prevent adhesions and dislocation. One year after the operation the functional results were similar in patients with silastic coating of the incus to those without. It is concluded that the less satisfactory results of tympanoplasty in such ears are primarily caused by factors outside the niche of the oval window. Possible ways of improving the results are discussed.

Adolescent↗
PubMed2006

Polyarteritis nodosa and cochlear implantation.

Polyarteritis nodosa is a systemic disease which affects the small to medium-sized muscular arteries. Sudden or progressive, bilateral hearing loss is a presenting otologic manifestation. To date, no case of cochlear implantation in patients with polyarteritis nodosa has been reported. The authors present a case of polyarteritis nodosa (confirmed by biopsy) in a 71-year-old man with progressive, bilateral sensorineural hearing loss who underwent cochlear implantation. A successful full insertion of the Nucleus 3G electrode array was achieved without surgical or post-operative complications. The patient immediately showed a positive subjective response and, at three month post-operative evaluation, had gained useful open-set speech perception. A review of five temporal bone cases with hearing loss and polyarteritis nodosa revealed the possibility of fibrosis and ossification in the basal turn of the cochlea, of which the surgeon should be aware prior to cochlear implantation.

Aged↗
PubMed2003

Evaluating the benefit of speech recoding hearing aids in children.

Children with significant high-frequency hearing loss may be difficult to fit with hearing aids using conventional amplification. Frequency-lowering hearing aids using dynamic speech recoding (DSR) technology have been proposed as a possible means to achieve full speech audibility. The current study investigated 78 children from ages 1.3 to 21.6 years (M = 10.6 years) who wore DSR hearing aids. These hearing aids provided significant improvements in pure-tone average (PTA; mean improvement for the aided versus unaided condition of 49 dB) and high-frequency PTA (mean improvement for the aided versus unaided condition of 56 dB). A subgroup of 19 children were previous users of conventional hearing aids. These participants demonstrated a mean improvement of 11 dB in PTA and 12.5% in word recognition scores for DSR versus conventional amplification. However, DSR hearing aids required repair 3 times as often as conventional hearing aids. The greatest benefit was observed in children whose word recognition scores were poorest using conventional hearing aids.

Adolescent↗
PubMed2006

Speech Recognition in noise in children with cochlear implants while listening in bilateral, bimodal, and FM-system arrangements.

PURPOSE: Speech recognition performance in noise was examined in children with cochlear implants (CIs) when using (a) a second CI (bilateral group), (b) a hearing aid (HA) on the nonimplant ear (bimodal group), and (c) a frequency modulation (FM) system on 1 or both sides. METHOD: While always maintaining use of the first CI, 2 groups participated in 6 conditions each using various listening arrangements with the second CI, HA, or FM system. Speech-in-noise thresholds were determined using simple phrases, classroom noise, and a method-of-limits approach. RESULTS: No group differences were detected across any conditions. In the no-FM-system conditions, no significant benefit of bilateral or bimodal input was found relative to a single CI. In the FM-system conditions, thresholds were significantly lower (up to 20 dB) relative to all other conditions when FM-system input was provided to the first-implanted side or to both sides simultaneously. CONCLUSIONS: Children's speech-in-noise thresholds did not improve when providing input to the second side with a CI or an HA relative to a single CI. However, children with CIs had better speech recognition in noise with the use of an FM system on one or both sides relative to the conditions with no FM system. Binaural conditions with a single FM receiver on the second CI or HA yielded significantly poorer performance than any other FM condition.

Child↗
PubMed2001

Hearing-aid outcome measured following one month of hearing aid use by the elderly.

This study reports the results of a large number of hearing-aid outcome measures obtained from 173 elderly hearing-aid wearers following one month of hearing-aid use. All participants in this study were fit binaurally with identical full-concha in-the-ear (ITE) hearing aids having linear Class-D amplifiers with output-limiting compression. Outcome measures included several measures of speech recognition, as well as several self-report measures of hearing-aid performance, benefit, satisfaction, and use. Comparison of mean data from this sample of hearing-aid wearers to other larger sets of data, obtained previously for several of these measures of hearing-aid outcome evaluated in isolation, indicated that the participants in this study were representative of the participants in other larger-scale studies. Subsequent principal-components factor analysis of the data from this study indicated that there were seven distinct dimensions of hearing-aid outcome. Attempts to document the effectiveness and efficacy of hearing aids for elderly persons with impaired hearing will be most complete when assessing performance along all seven dimensions of hearing-aid outcome. Clinically efficient procedures for doing so are discussed.

Aged↗
PubMed2005

Perception of spectral contrast by hearing-impaired listeners.

The ability to discriminate the spectral shapes of complex sounds is critical to accurate speech perception. Part of the difficulty experienced by listeners with hearing loss in understanding speech sounds in noise may be related to a smearing of the internal representation of the spectral peaks and valleys because of the loss of sensitivity and an accompanying reduction in frequency resolution. This study examined the discrimination by hearing-impaired listeners of highly similar harmonic complexes with a single spectral peak located in 1 of 3 frequency regions. The minimum level difference between peak and background harmonics required to discriminate a small change in the spectral center of the peak was measured for peaks located near 2, 3, or 4 kHz. Component phases were selected according to an algorithm thought to produce either highly modulated (positive Schroeder) or very flat (negative Schroeder) internal waveform envelopes in the cochlea. The mean amplitude difference between a spectral peak and the background components required for discrimination of pairs of harmonic complexes (spectral contrast threshold) was from 4 to 19 dB greater for listeners with hearing impairment than for a control group of listeners with normal hearing. In normal-hearing listeners, improvements in threshold were seen with increasing stimulus level, and there was a strong effect of stimulus phase, as the positive Schroeder stimuli always produced lower thresholds than the negative Schroeder stimuli. The listeners with hearing loss showed no consistent spectral contrast effects due to stimulus phase and also showed little improvement with increasing stimulus level, once their sensitivity loss was overcome. The lack of phase and level effects may be a result of the more linear processing occurring in impaired ears, producing poorer-than-normal frequency resolution, a loss of gain for low amplitudes, and an altered cochlear phase characteristic in regions of damage.

Adult↗
PubMed2005

An across-frequency processing deficit in listeners with hearing impairment is supported by acoustic correlation.

It has been recently suggested that listeners having a sensorineural hearing impairment (HI) may possess a deficit in their ability to integrate speech information across different frequencies. When presented with a task that required across-frequency integration of speech patterns, listeners with HI performed more poorly than their normal-hearing (NH) counterparts (E. W. Healy & S. P. Bacon, 2002; C. W. Turner, S.-L. Chi, & S. Flock, 1999). E. W. Healy and S. P. Bacon (2002) also showed that performance of the listeners with HI fell more steeply when increasing amounts of temporal asynchrony were introduced to the pair of widely separated patterns. In the current study, the correlations between the fluctuating envelopes of the acoustic stimuli were calculated, both when the patterns were aligned and at various between-band asynchronies. It was found that the rate at which acoustic correlation fell as a function of asynchrony closely matched the rate at which intelligibility fell for the NH listeners. However, the intelligibility scores produced by the listeners with HI fell more steeply than the acoustic analysis would suggest. Thus, these data provide additional support for the hypothesis that individuals having sensorineural HI may have a deficit in their ability to integrate speech information present at different frequencies.

Auditory Perceptual Disorders↗
PubMed2006

Stability of low-frequency residual hearing in patients who are candidates for combined acoustic plus electric hearing.

The purpose of this study was to investigate the stability over time of low-frequency auditory thresholds to better determine if the new technique of using a short-electrode cochlear implant that preserves residual low-frequency acoustic hearing can be a long-term solution for those with severe-to-profound hearing loss at high frequencies. The present study determined the long-term rate of decline in acoustic hearing in patients who have a preexisting hearing loss yet have not been implanted with a cochlear implant. A retrospective analysis of patients' audiograms that fit into the range for candidacy for the short-electrode device was performed to calculate the rate of change of threshold over time. The analysis of adult patients' data indicated that there was an average of only 1.05 dB hearing deterioration per year in the low frequencies and that presbycusis accounted for approximately one third to one half of this decline. The average deterioration of hearing threshold for pediatric patients was 1.2 dB per year; however, the rates of change in pediatric patients were considerably more variable (across individuals and across frequencies) than in adults. These data provide support for the idea that the short-electrode cochlear implant may be a practical solution for most adults in the long run, but this may not be the case for all pediatric patients.

Acoustic Stimulation↗
PubMed1982

Detection and recognition masking-level differences for the individual CID W-1 spondaic words.

The detection and recognition masking-level differences for the 36 individual CID W-1 spondaic words (Technisonic Studios) were established on 36 listeners with normal hearing. The masking for two conditions, SoNo and S pi No, was accomplished with 70-dB-SPL speech-spectrum noise. The word lists were administered in 2-dB decrements with the 36 words presented at each signal-to-noise ratio, which ranged from 9 dB to -19 dB for SoNo and from 3 dB to -25 dB for S pi No. The detection and recognition thresholds determined for each spondaic word under both masking conditions are presented. Additionally, the slopes of the psychometric functions for each word under both conditions are given. The mean masking-level difference (SoNo-S pi No) for the detection-response task was 9.4 dB (SD = .7 dB). The mean masking-level difference for the recognition task was 7.2 dB (SD = 1.4 dB). The recognition masking-level differences for the individual spondaic words ranged from 4.4 dB (stairway) to 10.0 dB (oatmeal). A list of 10 words that had the largest masking-level differences for recognition is suggested to enhance the clinical utility of the masking-level difference for speech.

Auditory Threshold↗
PubMed1984

Speech processing for cochlear implant prostheses.

The transformation of speech into electrical signals which can stimulate the auditory nerve in order to create hearing sensations that carry speech information depends on many factors. These include the limitations imposed by the current state-of-the-art in otological surgery, microelectronic and micromechanical technology, and knowledge of the functioning of the auditory system under both acoustic and electrical stimulation. Sufficient advances have been made in all these areas to enable several research centers to develop cochlear prostheses which give some hearing to certain totally deaf persons. The work of these centers towards the goal of full unaided speech perception via the prosthesis is examined and evaluated.

Adolescent↗
PubMed1992

Normal-hearing and hearing-impaired subjects' ability to just follow conversation in competing speech, reversed speech, and noise backgrounds.

The performance on a conversation-following task by 24 hearing-impaired persons was compared with that of 24 matched controls with normal hearing in the presence of three background noises: (a) speech-spectrum random noise, (b) a male voice, and (c) the male voice played in reverse. The subjects' task was to readjust the sound level of a female voice (signal), every time the signal voice was attenuated, to the subjective level at which it was just possible to understand what was being said. To assess the benefit of lipreading, half of the material was presented audiovisually and half auditorily only. It was predicted that background speech would have a greater masking effect than reversed speech, which would in turn have a lesser masking effect than random noise. It was predicted that hearing-impaired subjects would perform more poorly than the normal-hearing controls in a background of speech. The influence of lipreading was expected to be constant across groups and conditions. The results showed that the hearing-impaired subjects were equally affected by the three background noises and that normal-hearing persons were less affected by the background speech than by noise. The performance of the normal-hearing persons was superior to that of the hearing-impaired subjects. The prediction about lipreading was confirmed. The results were explained in terms of the reduced temporal resolution by the hearing-impaired subjects.

Audiometry↗
PubMed2000

Effects of age and hearing sensitivity on the use of prosodic information in spoken word recognition.

It is well known that spoken words can often be recognized from just their onsets and that older adults require a greater word onset duration for recognition than young adults. In this study, young and older adults heard either just word onsets, word onsets followed by white noise indicating the full duration of the target word, or word onsets followed by a low-pass-filtered signal that indicated the number of syllables and syllabic stress (word prosody) in the absence of segmental information. Older adults required longer stimulus durations for word recognition under all conditions, with age differences in hearing sensitivity contributing significantly to this age difference. Within this difference, however, word recognition was facilitated by knowledge of word prosody to the same degree for young and older adults. These findings suggest, first, that listeners can detect and utilize word stress in making perceptual judgments and, second, that this ability remains spared in normal aging.

Adolescent↗
PubMed1999

The BAHA HC200/300 in comparison with conventional bone conduction hearing aids.

A retrospective study was performed on 89 patients from a consecutive series who received a BAHA HC200/300 after having previously used conventional bone conduction hearing aids. The patients' performance with the BAHA HC 200/300 was compared to their performance with conventional bone conduction hearing aids. The patients were divided into two groups, depending on the time of implantation (before or after May 1992). The patients in group 1 (long-term users) were asked to fill in a questionnaire, the same one as they had filled in at the initial BAHA fitting more than 5 years previously. The answers were compared to their original opinions and difference scores were calculated. The long-term clinical results from group 1 are also presented. Although they are encouraging, the patients' opinion about the BAHA deteriorated somewhat over time. The audiometric results of group 2 were highly comparable with those of group 1. This confirms the positive results with the BAHA found in previous studies.

Acoustic Stimulation↗
PubMed1999

Stapedotomy: does prosthesis diameter affect outcome?

Two hundred ears with otosclerosis have been operated upon using a 0.4-mm diameter Teflon platinum piston in 100 ears and a 0.6-mm diameter Teflon piston in the other 100 ears. The postoperative air-bone gap, calculated as the difference between the postoperative air and bone conduction levels, was smaller in the 0.6 mm group for all frequencies except at 2000 Hz, the differences were statistically insignificant except at 4000 Hz. The mean postoperative air-bone gap was 8.6 dB and 7.4 dB for the 0.4 and 0.6 mm groups, respectively, which is statistically insignificant. We found no postoperative loss of bone conduction exceeding 15 dB, there was a deterioration of more than 10 dB in three ears, one in the 0.4 mm group and two in the 0.6 mm group. According to our results, we conclude that the 0.4 mm and the 0.6 mm Teflon prostheses produce the same hearing improvement in stapes surgery for otosclerosis.

Adult↗