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PubMed1998

Speech intelligibility in patients with complete dentures according to the material used.

The principal purpose of this study was to investigate the speech of two edentulous subjects fitted with a complete maxillary prosthesis made of three different palatal materials: aluminium, resin, stellite. The study was performed using two speakers fitted with a prosthesis (a man and a woman). They took part in the acoustic recording of logatoms read by themselves while wearing various prostheses. These recordings were tested from the auditory point of view by a series of six listeners (four men and two women) in an anechoic room. After 144 different tests, a speech reception threshold (SRT) was defined for each speaker and each different prosthesis. This SRT shows a level of speech intelligibility defined so that the lower the SRT, the more intelligible for the listener. The results show that: (i) both the material and the listener influence SRT: (P < 0.05); (ii) an interaction between the material factor and the speaker factor appears. (P < 0.05); (iii) The hierarchy factors influencing SRT are most important in the order: Listener --> material --> speaker; and (d) The group fitted with a metal prosthesis (aluminium, stellite) was more intelligible regarding the way they were perceived by others.

Acrylic Resins↗
PubMed1999

[Selection of a cochlear implant and results of implantation].

BACKGROUND: The cochlear implant is the therapy of choice for completely deaf patients. With this concept speech communication can be restored or developed. METHODS: The selection of the implant system may depend on different factors. As long as speech competence is thought to be of highest importance, a fast stimulation strategy involving a state of the art cochlear implant that provides 1500 Hz for every single electrode is close to the optimum. Further parameters include deep insertion into the cochlea (normally 30 mm) and other technical details. RESULTS: With these conditions fulfilled, about 2/3 of the adult deaf patients will later be able to use a telephone. Children who received implants in due time and do not have other cerebral defects will be partly able to meet with the requirements of normal schools.

Adolescent↗
PubMed1998

[The Vibrant Soundbridge System: a new kind of hearing aid for sensorineural hearing loss. 1: Function and initial clinical experiences].

INTRODUCTION: Patients suffering from moderate to severe cochlear hearing impairment can not be considered for cochlear implantation on account of their relatively good residual hearing. Conventional hearing aids, on the other hand, have considerable disadvantages which clearly limit the benefit for these patients, e.g. feedback, sound distortion, unfavorable conditions for frequency transfer, occlusion, and recurrent infections of the auditory canal. In addition, many patients complain about a poor speech intelligibility in noise. VIBRANT SOUNDBRIDGE HEARING PROSTHESIS: Implantable hearing aids offer a new approach for improved auditory rehabilitation. The Vibrant Soundbridge system is based on an electromagnetic system, which is linked directly to the intact ossicular chain. Due to the high sound quality and the high frequency characteristic this system is ideally suited for the above-mentioned patient group. The usual disadvantages of conventional hearing aids can be avoided. Externally visible is merely the audio processor, which is worn in the retroauricular area and covered by hair. This processor transfers data and power via magnetic attachment transcutaneously. PATIENT POOL: During a European multicenter clinical study, 19 patients were implanted at MHH since February 1997. No significant complications occurred. RESULTS: In all patients, postoperative unaided pure tone threshold was unaltered in comparison with the preoperative recordings. The use of the audio processor leads to a significant functional gain, particularly in the high frequencies. The patients report about undistorted hearing resulting in a better speech understanding even in situations with loud background noise. CONCLUSION: The preliminary results show a promising new approach to the use of hearing prostheses for patients suffering from moderate to severe sensorineural hearing loss.

Audiometry, Pure-Tone↗
PubMed1996

[Determination of hearing loss and disability assessment from pure tone audiometry and speech audiometry in occupational noise-induced hearing loss].

BACKGROUND: Occupational hearing loss is the most accepted occupational disease. The assessment should be conducted in accordance with the "Königsteiner Merkblatt" which appeared in the fourth completely revised edition in 1996. Determination of degree of disability is mainly based on speech audiometry. Adapted complete word understanding is most important. In special cases only sinus-tone audiometry is used for the assessment. Knowledge about common and uncommon schedules is important for the assessment. METHODS AND PATIENTS: The results of 200 audio metrical examinations in case of professional hearing loss have been evaluated with eight different schedules. Four of these schedules for determination of hearing loss are based on sinus tone audiometry. Boenninghaus and Röser's schedule uses speech audiometry under consideration of simple and adapted complete word understanding. Lehnhardt's schedule uses sinus-tone and speech audiometry for determination of degree of disability. Further on it is shown that the complete word understanding is the most important parameter for the quantitative determination of permanent noise induced hearing loss. It is even possible to determine the degree of disablement only using the complete word understanding. For all cases, the eight schedules were used to calculate the average hearing loss and the average degree of disability. Further on it was shown in how many cases-according to each schedule-a degree of disability of less than 10%, 10 to 15%, 20%, and more than 20% was calculated. RESULTS AND CONCLUSION: Comparing these eight schedules, it was shown that the use of adaptec complete word understanding increases the number of cases with 10% and 20% degree of disability. Using Röser's schedule of 1980, the number of minimal handicap increases. With the new "Königsteiner Merkblatt" a 10% degree of disability is reached more easily than it was previously.

Audiometry, Pure-Tone↗
PubMed2001

Efficacy of evaluation of audiometric results after stapes surgery in otosclerosis. I. The effects of using different audiologic parameters and criteria on success rates.

The Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery proposed guidelines to provide more uniformity in reporting hearing results after middle ear surgery. One of the proposals was to include the hearing thresholds at 0.5, 1, 2, and 3 kHz in a 4-frequency pure-tone average (PTA) and to use post-operative bone-conduction (BC) levels rather than preoperative BC levels in describing postoperative air-bone gaps (ABGs). The hearing results of 451 stapes operations were evaluated to analyze to what extent the choice of different audiologic criteria affects success rates. It appeared that choice of PTA significantly affects postoperative gain in air-conduction thresholds and ABG levels. If one takes the improvements in speech-reception thresholds as the gold standard, the gain in air-conduction correlates best with a gain in speech-reception threshold if a higher frequency, such as 3 or 4 kHz, is included in a 4-frequency PTA. Also, choice of preoperative or postoperative BC in computing postoperative ABGs had a significant effect on the mean postoperative ABG levels, showing more favorable results with the use of preoperative BC thresholds.

Adolescent↗
PubMed2003

Efficacy of surgical treatment of chronic otitis media.

This article presents our results of surgical treatment of chronic otitis media (COM) and discusses its efficacy regarding the control of disease and hearing results. A retrospective chart review of 84 ears was performed. Forty-one ears with noncholesteatomatous COM underwent tympanomastoidectomy, 43 ears with cholesteatoma were managed according to the extension of the disease, closed mastoidectomy was indicated in 19 cases, and open mastoidectomy was performed in 24 ears. In the group without cholesteatoma, a stable ear with closed tympanic membrane was obtained in 85% of cases after the first procedure. The speech response threshold before and after surgery was 38 and 26 dB. In patients with cholesteatoma, a dry ear was achieved in 79% of cases on both techniques after the first intervention. The recurrence rate of cholesteatoma was 10% for the closed technique and 4% for the open technique. The mean preoperative and postoperative SRTs for the closed technique were 30 and 29 dB and for the open technique were 50 and 54 dB. The surgical treatment for COM can be a rewarding procedure if a correct technique is indicated. The surgery should be tailored regarding the clinical stage and intraoperative findings in each case.

Adolescent↗
PubMed2000

Vestibular schwannoma growth--long-term results.

The growth of vestibular schwannoma (VS) was investigated in a series of 123 patients with 127 tumours during 3 periods: 1973 to 1993 (mean observation period 3.4 years), 1973 to 1996 (mean observation period 3.8 years) and 1973 to 1999 (mean observation period 4.2 years). Three sets of growth results were obtained. At the end of the first period, 94 tumours (74%) exhibited measurable growth, 23 tumours (18%) no measurable growth and 10 tumours (8%) negative growth. Tumour growth was observed in 104 tumours (82%), no tumour growth in 15 tumours (12%) and negative growth in 8 tumours (6%) at the end of the extended observation period. Growth was observed in 108 tumours (85%), no growth in 11 tumours (9%) and negative growth in 8 tumours (6%) subsequent to the third observation period. However, the results can be interpreted in another way: 52 patients (42%) are alive, tumour growth required no intervention; 23 patients (19%) died due to non-tumour-related causes; and 35 patients (28%) were previously treated and alive by the end of the third observation period. Together with other factors, the results reported here should be considered when timing of surgery is to be decided.

Adolescent↗
PubMed2003

Hearing deterioration in patients with a non-growing vestibular schwannoma.

OBJECTIVE: The aim of this study was to document and analyse the course of several audiometric parameters in 49 patients with a non-growing unilateral vestibular schwannoma (VS). MATERIAL AND METHODS: Patients received conservative management and absence of tumour growth was ascertained by means of serial magnetic imaging studies. Pure-tone audiometry and speech audiometry were performed at yearly intervals. RESULTS: Pure-tone audiometry revealed a significant increase in thresholds at all frequencies, except for 8.0 kHz. The maximum yearly threshold increase was 2.4 dB hearing level at 1.0 and 2.0 kHz. Speech audiometry revealed a significant decrease in maximum discrimination over the course of time. No significant changes were observed in the following parameters: the intensity level at which maximum discrimination was achieved; the roll-over index; the speech reception threshold; and the slope of the curve in the speech audiogram. No change was observed in the relation between pure-tone audiometry thresholds and speech audiometry scores. Apparently, the deterioration of pure-tone perception and speech discrimination ran parallel courses. CONCLUSIONS: The results of this study indicate that hearing loss is a predominant symptom in patients with a non-growing VS, as is also known in patients with a growing lesion. Moreover, it seems unlikely that the hearing loss in VS patients is merely the result of mechanical influences on retrocochlear neural or vascular structures.

Adult↗
PubMed2003

Cochlear implantation in a patient with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes syndrome.

OBJECTIVE: The aim of this study was to investigate the usefulness of a Nucleus C124M cochlear implant in a patient with mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) syndrome. MATERIAL AND METHODS: A 29-year-old woman with MELAS syndrome presented with sensorineural hearing loss and diabetes mellitus and underwent multichannel cochlear implantation. The follow-up period was 10 months. The case history, assessment of mitochondrial disease, indications for the cochlear implant and the benefits of cochlear implantation were evaluated. RESULTS: Nine months after the surgery the patient could use the telephone and was quite satisfied with the improvement in communication due to the cochlear implant. CONCLUSION: Cochlear implantation can be recommended for patients with MELAS syndrome if they have residual retrocochlear function. Single photon emission computerized tomography was found to be very useful for evaluating retrocochlear function.

Adult↗
PubMed1998

Masking effects and tinnitus as explanatory variables in hearing disability.

In cases of substantial auditory handicap, the degree of pure-tone hearing loss or hearing loss for speech is seen as the primary determining factor. Sometimes the presence of tinnitus complaints and disproportionate masking effects of noise on speech reception are seen as aggravating factors. To investigate the relevance of tinnitus and masking effects in the context of hearing disability, four factorial designs with self-perceived hearing disability as the dependent variable were submitted to an analysis of variance. Impact of masking and tinnitus complaints were treated as independent variables with two levels and were each combined with a second independent variable to form a 2 x 2 fixed factor statistical model. This second independent variable was either hearing loss for pure tones (first and second model) or speech reception ability (third and fourth model). Both hearing loss for pure tones and speech reception capability were found to be significant explanatory factors for hearing disability. Impact of masking, if juxtaposed to average pure-tone hearing loss (first model), also came out of the analysis as a significant factor in hearing disability, whereas the tinnitus factor did not reach significance levels. No significant interactions between factors were found. The results support the idea of the differentiating audiogram-based disability estimates by taking noise susceptibility into account. The findings also suggest in an equivocal relation of tinnitus with hearing disability, which prevents it from being a straightforward disability predictor.

Aged↗
PubMed1991

Vowel and consonant recognition with the aid of a multichannel cochlear implant.

In this report we review the vowel and consonant recognition ability of patients who use a multichannel cochlear implant and who achieve relatively good word identification scores. The results suggest that vowel recognition is accomplished by good resolution of the frequency of the first formant (F1) combined with poor resolution of the frequency of the second formant (F2). The results also suggest that consonant recognition is accomplished (1) by using information from the amplitude envelope, including periodicity/aperiodicity, as cues to manner and voicing, (2) by using F1 as an aid to the identification of manner and voicing, and (3) by using information from cochlear place of stimulation to provide a very crude indication of the shape of the frequency spectrum above 1 kHz.

Adult↗
PubMed2004

The effect of presentation level and compression characteristics on sentence recognition in modulated noise.

The effect of fast-acting compression on speech recognition in fully modulated (FUM) noise in listeners with normal and impaired hearing was investigated in two experiments We wanted to determine the relationships between the benefit from compression and some audiological factors. Furthermore, the sensitivity to changes in compression parameters was also evaluated. The results showed that two-thirds of the listeners performed worse with fast-acting compression than with linear processing. Normal-hearing listeners showed the most benefit from compression. A significant relationship was found between benefit from compression and speech-to-noise ratio at threshold (SNRT) in slightly modulated (SM) noise. Pure-tone threshold was found to be a weak predictor of benefit from compression. No relationship was found between benefit from compression and the release of masking for the FUM noise. The variability in the results across different compression parameters was related to SNRT in SM noise. The results suggest an inverse relationship between benefit from compression and the severity of the suprathreshold hearing loss

Adult↗
PubMed2005

Hearing threshold levels and speech recognition in noise in 7-year-olds.

International standards define normal hearing threshold levels (HTLs) and many studies describe speech recognition in noise (SRN) for adults. Less has been published on these characteristics for children. This study aims to establish ranges of HTLs and SRN for otologically normal 7-year-olds. Air conduction HTLs were measured in 189 7-year-olds within an audiometric booth. Speech recognition was measured adaptively for BKB sentences in noise presented binaurally through headphones, determining the speech-to-noise ratio (SNR) required to score 71% correct. The mean HTLs of otologically normal 7-year-olds were significantly lower (better) than those published for young adults at 1 and 2 kHz. Speech recognition in noise was unrelated to HTLs and was higher (worse) for 7-year-olds (SNR = -4 dB) than has been found for young otologically normal adults (SNR = -6 dB). It is concluded that although the HTLs of 7-year-old children are generally better than those of young adults, their speech recognition in noise is worse. This confirms that their ability to recognise speech in noise is not fully developed at this age.

Audiometry, Pure-Tone↗
PubMed2005

Binaural redundancy and inter-aural time difference cues for patients wearing a cochlear implant and a hearing aid in opposite ears.

We investigated speech perception advantages arising from the use of inter-aural time difference cues, and from the provision of redundant information by the use of a hearing aid contralateral to a cochlear implant (bimodal hearing devices). Thirty-eight subjects (14 normally hearing and 23 hearing-impaired) participated in this study. The effect of binaural redundancy was assessed by comparing the signal-to-noise ratio (SNR) required for 50% correct identification of sentences in noise when listening monaurally to that when listening binaurally. The use of inter-aural time difference cues was determined by comparing the binaural SNRs obtained with or without a noise delay of 700 micros between ears. Results indicated adults who used bimodal hearing devices benefited from binaural redundancy, but children did not. Whereas normally hearing subjects used inter-aural time difference cues to improve speech perception in noise, neither adults nor children who used bimodal hearing devices were able to do so.

Adolescent↗
PubMed2006

Fitting range of the BAHA Cordelle.

The performance of the most powerful Bone-Anchored Hearing Aid (BAHA) currently available, the BAHA Cordelle, was evaluated in 25 patients with severe to profound mixed hearing loss. Patients showed bone conduction thresholds at 500, 1000 and 2000 Hz, ranged between 30 and 70 dB HL, and an additional air-bone gap of about at least 30 dB. With the BAHA Cordelle, free-field thresholds improve relative to bone-conduction thresholds with 1.5, 5.0, 17.8, and 4.3 dB at 500, 1000, 2000, and 4000 Hz, respectively, with substantial inter-individual variability. The differences in unaided air conduction thresholds and aided free-field thresholds amount to 45.3, 45.8, 47.5, and 43.5 dB at 500, 1000, 2000, and 4000 Hz, respectively. Speech perception, measured both with monosyllables of the consonant-vowel-consonant type and with bisyllables, showed highly similar results. The fitting range of a (linear) hearing aid is determined by its gain characteristics. Requiring aided speech reception thresholds at or better than 65 dB SPL results in an upper limit of the fitting range of the BAHA Cordelle for bone-conduction thresholds of 51, 56, 67, and 58 dB HL at 500, 1000, 2000, and 4000 Hz, respectively. The dynamic range provided by the BAHA Cordelle was estimated from loudness growth functions at 500, 1500, and 3000 Hz employing 7-point categorical scaling. On average, aided loudness growth functions exhibit normal slopes but they level off at input levels of about 80, 70, 65 dB SPL for 500, 1500, and 3000 Hz stimuli, respectively. Measurements with a skull simulator demonstrated that the levelling-off reflects saturation of the output of the Cordelle. The relatively low saturation levels of the device suggest that increasing maximum output levels may be a worthwhile consideration for candidates with more profound sensorineural loss.

Acoustic Stimulation↗
PubMed2006

Treatment of mixed hearing losses via implantation of a vibratory transducer on the round window.

Early clinical findings are reported for subjects implanted with the Vibrant Med-El Soundbridge (VSB) device. The present criteria for the VSB, limiting its application to patients with normal middle ear function, have been extended to include patients with ossicular chain defects. Seven patients with severe mixed hearing loss were implanted with the transducer placed onto the round window. All had undergone previous surgery: six had multiple ossiculoplasties, and one had the VSB crimped on the incus with unsuccessful results. Round window implantation bypasses the normal conductive path and provides amplified input to the cochlea. Post-operative aided thresholds of 30 dB HL were achieved for most subjects, as compared with unaided thresholds ranging from 60-80 dB HL. Aided speech reception thresholds at 50% intelligibility were 50 dB HL, with most subjects reaching 100% intelligibility at conversational levels, while unaided thresholds averaged 80 dB HL, with only one subject reaching 100% intelligibility. These results suggest that round window implantation may offer a viable treatment option for individuals with severe mixed hearing losses who have undergone unsuccessful ossiculoplasties.

Acoustic Stimulation↗
PubMedDate not supplied

A reexamination of the one-half gain rule.

A one-half gain rule for hearing aid fitting based on the unaided average hearing threshold level was first proposed by S. F. Lybarger. From records on almost 500 clients with sensorineural loss for whom hearing aids were prescribed and fitted, the functional gain for speech reception threshold, 500 Hz, and the average of 1000 and 2000 Hz was examined. The one-half gain rule was found to be valid for speech reception threshold except with mild hearing losses where the gain obtained was a little less than one-half the unaided hearing threshold level. The one-half gain rule is easily computed and provides a good first-order approximation of operating gain needs.

Auditory Threshold↗