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PubMedDate not supplied

The application of the theory of signal detection to the assessment of speech perception.

Traditional audiological measures of speech recognition ability have failed to correlate well with self-assessments of communication difficulty. In this tutorial, an approach to the evaluation of speech perception is described that uses quantities derived from the theory of signal detection. The basics of the theory are reviewed briefly, and its relevance to communication processes is discussed. The measures of performance accuracy and decision criterion provided by the theory of signal detection offer a way of quantifying the ability of a listener to assess the accuracy of his or her own identifications of spoken messages. It is hoped that these quantities will provide new information about communication processes and help to characterize communication difficulties encountered in everyday life.

Audiometry, Speech↗

PubMed1988

Effects of an adaptive filter hearing aid on speech recognition in noise by hearing-impaired subjects.

In a digitally controlled adaptive filter, ongoing detection and spectral analysis of quasi steady state noise are performed, and analog filter parameters are adjusted to provide greatest attenuation in frequency regions where noise energy is greatest. Attenuation introduced by the filter affects both speech and noise signals in the attenuation region. Effects of a master hearing aid incorporating an adaptive filter chip were assessed by measuring aided speech recognition threshold in noise with and without the filter. Performance of four hearing-impaired subjects showed that filter effects were related both to the frequency spectrum of the noise and to the distribution of speech information by frequency. No improvement in speech recognition threshold was seen for broadband speech materials in broadband noise. Better performance was observed for low-frequency noise in combination with speech materials for which the important information was confined to high frequencies.

Adolescent↗

PubMed1991

Spondaic word detection and recognition functions for female and male speakers.

The Department of Veterans Affairs recently produced a compact disc of speech audiometry materials. The compact disc, which is available commercially, includes the W-1 spondaic words recorded by a female speaker. Two experiments were conducted. The purposes of experiment 1 were to obtain normative detection and recognition data on the female recording of the spondaic words and to compare the detection and recognition functions for the original male speaker version of the W-1 words. No significant differences were found between the recognition functions for each speaker. The recognition functions for both speakers were displaced to higher sound-pressure levels by 8 dB above the detection functions. Clinically, the two versions of the W-1 spondaic words should produce equivalent results. In experiment 2, slopes of the individual spondaic word recognition functions for the female speaker were obtained from two listeners and are discussed in terms of interstimulus, intertrial, and intersubject variability.

Adult↗

PubMed1991

Individual differences in speech recognition ability: implications for hearing aid selection.

Hearing-impaired listeners with similar audiometric configurations often demonstrate varying abilities to understand speech in the presence of noise and/or reverberation. To date, however, it is unclear which auditory mechanisms are responsible for these perceptual deficits. This lack of information is unfortunate, as individual susceptibility to noise and reverberation may explain why hearing-impaired listeners receive varying degrees of benefit from rehabilitative strategies. The present discussion will examine: (1) individual speech recognition susceptibility to noise and reverberation in hearing-impaired listeners and (2) auditory and cognitive hypotheses to explain individual differences in speech recognition performance. Theoretical and clinical implications for hearing aid selection procedures will be discussed.

Hearing Aids↗

PubMed1991

Exploration of factors beyond audibility that may influence speech recognition.

The effects of reduced ability to differentiate acoustic information on speech reception are difficult to separate from the effects of reduced absolute sensitivity. One possible way is to explore abilities to differentiate acoustic information while holding absolute sensitivity constant. Two auditory phenomena known as enhancement and suppression, which are thought to be related to speech reception ability, were evaluated in persons with normal absolute sensitivity who had either normal or reduced speech recognition in noise. Results of forward masking experiments do not support the notion that enhancement or suppression is reduced in persons with reduced speech recognition in noise. However, their pattern of performance differed from that of listeners with normal speech recognition in noise when the duration of certain complex maskers was varied.

Adult↗

PubMed1992

Noise reduction hearing aids: release from masking and release from distortion.

Automatic frequency response (AFR) hearing aids usually reduce their low-frequency gain in the presence of noise; several investigators have reported improved recognition of high-frequency speech information in low-frequency band-limited noise with AFR versus non-AFR hearing aids. In this work, masking patterns (masked threshold for frequency-modulated probe tones as a function of probe frequency) were obtained for a narrowband low-frequency noise. Speech recognition threshold for a set of high-frequency loaded monosyllables also was obtained in the presence of the same noise. Aided speech and masking pattern data for one normal and two hearing-impaired subjects wearing a master hearing aid incorporating a commercially available AFR circuit showed modest AFR effects. Moreover, masking noise spectra measured in ear canals of subjects wearing the master hearing aid showed evidence of substantial hearing aid-generated distortion products in the AFR-off condition. Results obtained from the normal subject listening with a low-distortion laboratory simulation of an AFR hearing aid showed greater release from masking for the same low-frequency attenuation as provided by the hearing aid. Improvements of speech recognition in noise observed with AFR hearing aids may result from some combination of release from upward spread of masking and reduction of distortion products generated by the hearing aid in the non-AFR setting.

Adult↗

PubMed1994

Effect of peak clipping on speech recognition threshold.

Speech recognition thresholds (SRTs) were measured for a closed set of spondees that had been processed by peak clipping and compression. Both hearing-impaired and normal-hearing subject groups showed progressively higher SRTs with increasing levels of peak clipping, with significant threshold shifts occurring for clipping levels greater than 18 to 24 dB. Neither subject group showed significantly elevated SRTs for the compression processed stimuli. Magnitude-squared coherence analysis of the speech stimuli revealed high levels of distortion generated by peak clipping and relatively low levels generated by the compression processing. Subsequent analysis suggested that the addition of distortion products and not the alteration of the speech waveform envelope was responsible for the observed threshold shifts, and that coherence analysis may be a valuable tool for predicting the effects of distortion on speech intelligibility. Judgments of sound quality showed that the clipping level where SRTs began to be significantly affected coincided with the clipping level at which the quality of the speech was judged to be unacceptable.

Adult↗

PubMed1994

Effects of intensity on speech recognition in high- and low-frequency bands.

OBJECTIVE: This study investigated the intensive effects of a low-frequency (200 to 400 Hz) and a high-frequency (1000 to 5000 Hz) band of speech presented jointly and in isolation. DESIGN: Each band was presented at a reference intensity level equivalent to the average normal conversational level. To investigate intensive effects, the low-frequency band was presented at 20 dB and 36 dB, and the high-frequency band at 20 dB above the reference level. Each band was presented at a fixed signal-to-noise ratio. Subjects were four normal-hearing adult females. The AI was used to predict performances and to determine audibility of each band. RESULTS: The best performance occurred for a joint band presentation with each band at the reference level. Increasing intensity of one band by 20 dB, for joint band conditions, did not significantly affect performance. However, increasing the low-frequency band by 36 dB or both bands by 20 dB resulted in a significant decrease in performance. CONCLUSIONS: Reduced performance with the low-frequency band at 36 dB and the high-frequency band at the reference level is attributed primarily to upward spread of masking by speech. Performance decrements for other joint band conditions are attributed to combined effects of high intensity.

Adult↗

PubMed1997

Childhood hearing impairment: processing dependencies in multidimensional speech perception for an auditory level of analysis.

OBJECTIVE: Our purpose was to determine whether the influence of childhood hearing impairment (HI) on multidimensional speech processing is a purely linguistic effect or whether childhood HI also affects the processing of speech dimensions representing an auditory level of analysis. DESIGN: The processing dependencies characterizing the two dimensions of talker-gender and spatial location were studied in 40 children with HI and in two normal-hearing (NH) comparison groups representing similar chronological ages (N = 30) or similar vocabulary skills (N = 70). The processing interactions were assessed with a speeded selective-attention task requiring listeners to attend selectively to the gender of the talker and to ignore the spatial location and vice versa. The logic is that performance for the target dimension will not be affected by what is happening on the nontarget dimension if the dimensions are processed independently. On the other hand, if the dimensions are not processed independently, listeners will not be able to attend selectively and performance for the relevant dimension will be affected by what is happening on the irrelevant dimension. In the latter case, results may be analyzed in terms of Garner interference (the effect on performance of irrelevant variability in the to-be-ignored dimension) (Garner, 1974a) and Simon interference (the effect on performance of an irrelevant spatial source) (Simon, 1990). RESULTS: Overall results in all listeners, those with NH or HI, showed significant interference when the participants were attending to the gender of the talker and ignoring spatial location and vice versa. The talker-gender and spatial-location dimensions of speech were not processed independently by these children. When the processing interactions were compared between the NH and HI groups, the presence of childhood HI as a general rule significantly diminished the degree of interference from spatial location. The degree of interference from the gender of the talker, on the other hand, remained normal in the presence of childhood HI. All listeners seemed stimulus bound by the gender of the talker. The degree of Garner interference did not show age-related or degree of loss-related change. The degree of Simon interference showed significant change as a function of age in the children with mild-moderate HI, but not in the children with severe HI. The developmental function for Simon interference in the children with mild-moderate HI was delayed to a degree that corresponded to the duration of the auditory deprivation. CONCLUSIONS: The overall pattern of results indicates that the influence of childhood HI on multidimensional speech processing is not a purely linguistic effect.

Age Factors↗

PubMed2005

Pharmacological enhancement of aural habilitation in adult cochlear implant users.

OBJECTIVE: The purpose of this report was to examine the preliminary data collected under a larger on-going feasibility study conducted with cochlear implant patients exploring the potential benefit of pharmacologically-enhanced aural rehabilitation therapy as a means of increasing speech tracking skills. DESIGN: Eight adult cochlear implant participants participated in a randomized, double-blind study and received either 10 mg d-amphetamine (Treatment group, N = 4) or a placebo (Placebo group, N = 4) 60 minutes prior to a 1.5 hour intensive aural rehabilitation session occurring twice a week for two months. Treatment consisted of a multi-step rehabilitation program individualized for each participant to develop auditory-only speech tracking skills. Prior to and at the conclusion of the therapy sessions, SPECT rCBF imaging and speech tracking assessments were conducted. RESULTS: Speech tracking scores of the placebo and treatment groups were similar before the aural habilitation intervention. In the placebo group, speech tracking performance increased 13.5% for visual plus auditory and auditory only presentations as a function of aural habilitation alone. The 10 mg d-amphetamine-facilitated program resulted in minimal increases in visual plus auditory tracking scores (2%) but led to a 43% increase for auditory-only speech tracking. Regional cerebral blood flow measures indicated no substantial improvement of brain activation in the placebo group while both the extent and magnitude of primary and associative auditory cortex activations increased significantly with the pharmacologically enhanced treatment program. CONCLUSIONS: These data support previous studies indicating an accelerated acquisition of speech and language abilities in stroke patients receiving traditional speech therapy in combination with d-amphetamine. Data, however, are preliminary and further study is warranted.

Adult↗

PubMed1997

Interaction between hypertension and diabetes mellitus in the pathogenesis of sensorineural hearing loss.

The purpose of this study is to support the hypothesis that diabetic end-organ damage of the cochlea is augmented in the setting of hypertension. A historical perspective reviewing the effects of diabetes and hypertension as causative factors in the development of sensorineural hearing loss, as well as the basic epidemiology and pathophysiology of the renal and vascular effects of diabetes and hypertension, is presented. The results of audiologic findings in insulin-dependent diabetic patients, both normotensive and hypertensive, were analyzed and correlated with the results of animal studies to support the hypothesis that sensorineural hearing loss in patients and cochlear hair cell loss in animal studies result from the effects of hypertension in conjunction with insulin-dependent diabetes mellitus.

Adult↗

PubMed1998

Familial Mondini dysplasia.

OBJECTIVES/HYPOTHESIS: To determine the mode of inheritance of familial nonsyndromic Mondini dysplasia. STUDY DESIGN: Correlative clinical genetic analysis of a single kindred. METHODS: Clinical history, physical examination, audiologic analysis, computed tomography of the temporal bones, and cytogenetic analysis. RESULTS: The male proband, three affected sisters, and an affected brother are offspring of unaffected parents. The mother and an unaffected brother have audiologic findings suggestive of heterozygous carrier status for a recessive hearing loss gene. CONCLUSIONS: Pedigree analysis indicates autosomal recessive inheritance in this family. The observed inheritance and clinical, audiologic, and radiologic findings are different from those previously described for another family with nonsyndromic Mondini dysplasia. The phenotype in this study family therefore represents a distinct subtype, indicating clinical and genetic heterogeneity of this disorder. This information should facilitate future molecular linkage analyses and genetic counselling of patients with inner ear malformations.

Adult↗

PubMed1998

Congenital aural atresia: stability of surgical results.

OBJECTIVES/HYPOTHESIS: To compare early (<1 y) and longer-term (1.0-7.5 y; mean follow-up, 2.8 y) hearing results following surgery for congenital aural atresia and to analyze revision cases for cause of failure, time of occurrence, and outcome. STUDY DESIGN: Retrospective study of 55 consecutive patients (59 ears) undergoing surgery during an 11-year period for congenital aural atresia. METHODS: The best speech reception threshold (SRT) during the first postoperative year was compared with the most recent SRT beyond the first postoperative year. The complication rate and long-term hearing results (>1 y) for initial and revision surgeries were compared. RESULTS: In the early postoperative period, an SRT of < or =25 dB was achieved in 60% and an SRT of < or =30 dB in 70%. With longer follow-up (mean, 2.8 y), 46% of patients maintained an SRT < or =25 dB. Revision surgery was necessary in approximately one third of patients. Longer-term hearing results following initial surgery only or after revision surgery showed an SRT < or =25 dB in 53% and an SRT < or =30 dB in 64%. For primary and revisions surgeries the incidence of temporary facial paralysis was 1.5% and for significant hearing loss, 3.0%. CONCLUSIONS: Some degradation in hearing does occur as patients are followed beyond the first postoperative year. Revision surgery will be necessary in approximately one third of cases. With revisions, an SRT < or =25 dB can be expected in half of cases and an SRT < or =30 dB in two thirds of cases. The ability to provide these hearing results supports this surgery in unilateral cases.

Adolescent↗

PubMed1999

Hearing preservation in microvascular decompression for trigeminal neuralgia.

OBJECTIVE/HYPOTHESIS: Sensorineural hearing loss is a disturbing complication of microvascular decompression (MVD) for trigeminal neuralgia with an incidence of 1% to 23.8%. Cerebellar retraction with increasing I-V interpeak latency (IPL) during intraoperative brainstem auditory evoked potentials (BAEP) has been identified as the chief cause of acoustic injury. This study was designed to eliminate cerebellar retraction by a modification of the standard suboccipital craniectomy. STUDY DESIGN: Nine consecutive patients undergoing surgery for trigeminal neuralgia were prospectively selected for this study between 1994 and 1995. METHODS: Preoperative and postoperative audiograms were obtained. Preoperative and intraoperative BAEPs were performed. The surgical modification describes initiating a partial mastoidectomy to enhance early recognition and delineation of the sigmoid and transverse sinuses crucial to maximizing the lateral extent of the craniectomy. The additional exposure gained by this technique allows for improved visualization of the brainstem without cerebellar retraction. RESULTS: All patients were relieved of neuralgic pain. Postoperative IPL values were not significantly different from preoperative values (4.9+/-0.6 vs. 4.7+/-0.3 ms). Maintaining IPL of less than 1.5 ms is considered critical for preventing injury to the auditory nerve. In this study the average increase in postoperative IPL was 0.25 ms for the ipsilateral ear and 0.1 ms for the contralateral ear. CONCLUSIONS: The authors offer a surgical modification of the standard suboccipital craniectomy and furnish intraoperative neurophysiologic data to demonstrate how cerebellar compression can be eliminated and hearing preserved in MVD for trigeminal neuralgia.

Adult↗

PubMed2000

Hearing results in pediatric patients with chronic otitis media after ossicular reconstruction with partial ossicular replacement prostheses and total ossicular replacement prostheses.

OBJECTIVE: To examine hearing results in pediatric patients after ossicular reconstruction with partial ossicular replacement prostheses (PORPs) and total ossicular replacement prostheses (TORPs) in children with chronic otitis media. METHODS: A retrospective chart review was performed on 55 pediatric patients with chronic otitis media who underwent ossicular reconstruction from 1991 to 1998. Patients' audiograms were evaluated preoperatively and postoperatively for pure-tone average (PTA), air-bone gap (ABG), speech reception threshold (SRT), method of ossicular reconstruction, and management of the mastoid. RESULTS: Twenty-seven patients underwent ossicular reconstruction with TORPs. The average preoperative ABG was 40.1 dB, and the average postoperative ABG was 31.6 dB. Forty-one percent of the children improved their PTA greater than 10 dB postoperatively, and 52% of children did not change their ABG by more than 10 dB postoperatively. Nineteen percent of children with TORPs had a postoperative ABG less than 20 dB, and 44% of children with TORPs had a postoperative ABG less than 30 dB. Twenty-eight patients underwent ossicular reconstruction with PORPs. The average preoperative ABG was 29.7 dB, and the average postoperative ABG was 22.5 dB. Thirty-two percent of patients improved their PTA by greater than 10 dB, while 57% of children with PORPs did not change their ABG by more than 10 dB postoperatively. Forty-three percent of children with PORPs had an ABG of less than 20 dB postoperatively, and 71% of children with PORPs had a postoperative ABG less than or equal to 30 dB. CONCLUSIONS: Children who underwent ossicular reconstruction with PORPs had slightly better postoperative hearing than did children with TORPs. Postoperative hearing was essentially unchanged in approximately 55% of both groups. Preoperative hearing levels may be the most important factor determining postoperative hearing in nonstaged surgery for children with chronic otitis media Long-term hearing results in children with single-stage surgery were not as good as those reported in the literature for staged surgery. Severe mucosal disease and eustachian tube dysfunction may contribute to poorer hearing results in children.

Audiometry, Pure-Tone↗

PubMed2001

Smoking and tympanoplasty: implications for prognosis and the Middle Ear Risk Index (MERI).

OBJECTIVES/HYPOTHESIS: The objectives of this study are to review the effects of smoking on preoperative middle ear disease severity, long-term surgical outcome, type and extent of surgery required, the need for ossicular chain reconstruction, and the long-term hearing results. STUDY DESIGN: A retrospective chart review. MATERIALS AND METHODS: The charts of 74 smokers and non-smokers who underwent over-under tympanoplasty were reviewed. An analysis of the disease severity (using the Middle Ear Risk Index [MERI]) at presentation and type of surgery was performed. A review of graft take and delayed failure (late perforation or atelectasis after 6 mo) and audiologic data were performed. RESULTS: Fifteen patients smoked a mean of 20 cigarettes daily for a mean of 15 years. The MERI was well matched for both groups. There was a trend toward smokers having a higher incidence of otorrhea preoperatively and requiring a more extensive surgical procedure. All patients had full take of the tympanic membrane graft at 6 months; however, delayed surgical failure was seen in 20% of non-smokers compared with 60% of smokers (P = .050). No statistically significant difference was seen in hearing outcome. CONCLUSIONS: Cigarette smoking is associated with more severe middle ear disease preoperatively. More extensive surgery is often needed in smokers to eradicate the disease. Most significantly, smoking is associated with a threefold increase in the chance of long-term graft failure. Based on the results of this study, the MERI has been revised to include smoking as a risk factor.

Adolescent↗

PubMed2003

Tympano-ossiculoplasty utilizing the Spiggle and Theis titanium total ossicular replacement prosthesis.

OBJECTIVE: Since 1993, titanium prostheses have been used in Europe as a biocompatible implant for ossicular reconstruction. More recently, the titanium ossicular prosthesis has become more widely available in the United States as a newer means of surgical restoration of hearing. We will review the hearing results of patients who have undergone tympano-ossiculoplasty using a titanium total ossicular replacement prosthesis (TOP). We will compare these results to our previously published results using the porous polyethylene TOP. METHODS: Retrospective review in a tertiary otologic practice. RESULTS: Eighteen patients underwent tympano-ossiculoplasty with a titanium TOP. Among these patients, 10 cases involved revision of a previously placed ossicular prosthesis. Hearing results showed that 16 of 18 patients (89%) had closure of the postoperative air-bone gap to within 20 dB, and the average air-bone gap improvement was 23 dB. The average follow-up time was 8 months (range, 2-21 months). The results of this initial evaluation compare favorably with the results that we obtained using a porous polyethylene TOP in which 67% of 133 patients closed the air-bone gap to within 20 dB. CONCLUSION: We have recently begun using the titanium TOP, which has resulted in improved postoperative hearing when compared with the porous polyethylene TOP. In the future, longer follow-up and increased patient numbers will strengthen our conclusions.

Adolescent↗

PubMed1999

Dose reduction improves hearing preservation rates after intracanalicular acoustic tumor radiosurgery.

OBJECTIVE: To assess the potential for long-term serviceable hearing preservation in intracanalicular acoustic tumor patients who underwent stereotactic radiosurgery. METHODS: Between August 1987 and December 1997, 29 patients with intracanalicular acoustic tumors underwent stereotactic radiosurgery at our center using the Leksell gamma knife (Elekta Instruments, Inc., Atlanta, GA). Fifteen assessable patients had serviceable preradiosurgery hearing (pure tone average, < or = 50 dB; speech discrimination score, > or = 50%). We retrospectively analyzed our hearing results and compared hearing preservation in patients who received a minimal tumor dose of 14 Gy or less versus those who received more than 14 Gy to the tumor margin. RESULTS: No perioperative patient morbidity or mortality was observed. Serviceable hearing was preserved in 11 (73%) of 15 assessable patients (actuarial rate, 65%). Long-term follow-up demonstrated serviceable hearing preservation in 10 (100%) of 10 patients who received marginal tumor doses of 14 Gy or less but in only one of five patients who received more than 14 Gy. Preradiosurgery Gardner-Robertson class was preserved in 49%, and testable hearing was present in 68% of patients who had any testable hearing at presentation. Five patients demonstrated improvement in hearing (three had serviceable and two had nonserviceable hearing before radiosurgery). No patient developed a facial or trigeminal neuropathy. Seven of 13 patients with preoperative tinnitus continued to experience tinnitus in follow-up. Episodic vertigo continued in 3 of the 11 patients who presented with vertigo. CONCLUSION: Gamma knife radiosurgery (using conformal dose planning, small-beam geometry, and < or = 14 Gy to the margin) prevents tumor growth and achieves excellent hearing preservation rates.

Audiometry, Pure-Tone↗