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[Progressive noise induced hearing loss caused by hearing AIDS, a dilemma for the worker and the expert alike].

BACKGROUND: Investigating cases of noise induced hearing loss the expert is often confronted with the situation that the hearing loss is progressive although the noise exposure has been reduced to almost non-damaging levels. Other causes such as age, hereditary deafness, head injuries, blasts, internal diseases can be excluded. Hearing aids as sources of damaging noise? By consulting the protocol of the hearing-aid acoustician and by own examinations the expert should obtain the following data: loudness level that yields best discrimination score of speech; level of discomfort for tones and speech, discrimination score that is achieved under free field condition with a speech level of 65 dB, using the hearing aids. Furthermore he should explore the circumstances under which the hearing aids are used: how many hours per day, at what occasions etc.? INTERPRETATION: It is likely that in using the hearing aids they are adjusted to emit an intensity level identical to the one yielding the optimal discrimination score. If this e. g. is 100 dB and the hearing aids are used for 2 hours per day this would be equivalent to an exposure to industrial noise of 94 dB (A) for 8 hours daily without ear protection. DISCUSSION: Among all individuals working under industrial noise exposure today only about 1 - 2 % having unusually vulnerable inner ears will suffer a noise induced hearing loss. On the other hand workers in industrial noise are accustomed to loud noise levels, usually have a raised threshold of discomfort and therefore are likely to adjust their hearing aids to such high intensities. The expert will have to decide whether in an individual case the industrial noise exposure or the use of the hearing aids is the dominant risk for further damage. The consequences in respect to the regulations of the workers' health insurance are discussed.

Auditory Threshold↗

Cartilage palisades in type III tympanoplasty: anatomic and functional long-term results.

OBJECTIVE: To evaluate the long-term anatomic and functional results after partial and total autologous cartilage palisade type III tympanoplasties to assess the efficacy of cartilage palisades in preventing recurrent cholesteatoma. STUDY DESIGN: Retrospective data bank and patient review. SETTING: Tertiary referral center. PATIENTS: The study population included all patients with more than 36 months follow-up who underwent tympanoplasty or tympanomastoidectomy for previously untreated cholesteatoma using partial or total autologous cartilage palisade graft associated with a reconstruction of the ossicular chain from October 1, 1992, to October 31, 1998. INTERVENTION: Tympanoplasty or tympanomastoidectomy using autologous cartilage palisade graft for partial or total reconstruction of the tympanic membrane and the ossicular chain. MAIN OUTCOME MEASURES: Anatomic results, i.e., closure of the perforation, rate of retraction pockets, recurrent cholesteatoma, and reperforation rate related to the use of autologous cartilage were clinically evaluated. Postoperative speech reception thresholds, speech discrimination scores, and postoperative air-bone gap were compared with preoperative levels. The outcomes of canal wall up and canal wall down procedures were compared. RESULTS: Closure of the tympanic membrane was achieved in 98.3% of patients. Speech reception thresholds did not change significantly. Speech discrimination scores were stable or improved in all patients. Postoperative air-bone gap was less than 10 dB in 29.8% of patients and between 11 and 20 dB in 32.3%. The complication rate of the tympanoplasty in general was 0.67%. The rate of recurrences of cholesteatoma was 2.2%. No complications could be related to the use of cartilage. CONCLUSIONS: The cartilage palisade technique is effective for the reconstruction of the tympanic membrane and also prevents new retractions and recurrences of cholesteatoma. The functional results show that autologous cartilage grafts are able to transmit sound.

Audiometry, Pure-Tone↗

Function of a hearing aid under stressful conditions.

The auditory function of individuals with normal hearing was compared with that of hearing-aided subjects of similar age to determine whether amplification remediates hearing impairment under stressful auditory situations. The specific tests of listening in a competitive noise environment and identifying moderately compressed speech were introduced to adequately aided individuals. The data indicate that noise had an impact on auditory function to a much greater degree in aided individuals than in matched counterparts with normal hearing. The data derived from acceleration of simple sentences delivered to the aided group suggested that contrary to basic tonal sensitivity, the capacity to understand the stimulus was greatly compromised. The authors discuss cochlear damage and central auditory impairment as they relate to the limitations of amplification for sensorineural hearing loss.

Adult↗

Effect of noise on word discrimination by subjects with impaired hearing, compared with those with normal hearing.

A comparison was made of the discrimination ability of different groups of hearing-impaired and normal-hearing subjects in noisy conditions. Four groups of subjects having a sensorineural hearing loss with various audiogram configurations, one group of subjects having a conductive hearing loss and one group of normal-hearing subjects were chosen. The submaster tapes were recorded in quiet and in pink noise with signal-to-noise ratios of -3, -8, and -13 dB. The test subjects heard the test words monaurally via earphones. The best speech discrimination was achieved in quiet, anechoic conditions. As the noise level increased, speech discrimination decreased. Subjects with sensorineural hearing loss were more adversely affected by noise than subjects with normal hearing or with conductive hearing loss. However, at high noise levels, their speech discrimination was poorer than that of normal-hearing subjects. Persons with a high-frequency hearing loss, cut-off point 1 kHz, suffered in noise similarly to those with sloping or flat hearing losses. In quiet and in moderate noise, the speech discrimination of subjects with a conductive hearing loss and subjects with normal hearing was similar, while at high noise levels, subjects with conductive hearing losses achieved better discrimination than normal-hearing subjects.

Adolescent↗

The use of single-channel compression for the improvement of speech intelligibility.

In this study, speech perception with commercially available linear and single-channel input- and output-dependent compression aids was investigated. Although compression has been introduced as a method of limiting the maximum output, theoretically expectations have been raised that a gain in speech intelligibility could also be obtained by a better use of the reduced dynamic range of the patient. It turned out that there was no significant difference in speech reception thresholds obtained both in quiet and in noise between the aids used for a group of 12 hearing-impaired hearing-aid users as a whole, or for different subgroups thereof.

Adult↗

On the cross hearing of spondaic words.

Twelve adults with unilateral hearing losses were tested to determine interaural attenuation for spondaic words. Low-pass and band-pass filters were used to simulate hearing loss at the normal ear. Results suggest that in deciding on the possibility of cross hearing, the spondee threshold at the test ear should be compared to the most sensitive bone-conduction threshold at the nontest ear, excluding .25 kc/s.

Adolescent↗

Serotonin reuptake inhibitors in auditory processing disorders in elderly patients: preliminary results.

OBJECTIVE/HYPOTHESIS: One mechanism associated with degeneration in the elderly is the decrease of neurotransmitters. In the central auditory pathway serotonin, can be found from cochlear nucleus to the auditory cortex, and it constitutes one of the most important neuromodulatory circuits in hearing processing. The present study analyzed the action of citalopram, a selective inhibitor of serotonin reuptake, in aged patients with normal to moderate sensorineural hearing loss (HL) and low performance on auditory processing. STUDY DESIGN/METHOD: Prospective, double-blind, randomized, placebo-controlled study. Thirty-eight selected patients were randomly divided into two groups. Nineteen patients made up group A and received placebo for 60 days. Nineteen patients of Group B received 20 mg per day of citalopram for 60 days. Hearing evaluation was performed initially and after 60 days and included pure-tone audiometry, speech discrimination test (SDT), emittanciometry (acoustic impedance audiometry), identification of synthetic sentences with an ipsilateral competitive message (SSI/ICM), tests of pitch-pattern sequences (PPS), and the staggered spondaic words test (SSW). RESULTS: Comparisons of tests of auditory processing pre- and posttreatment in each group showed a statistical improvement in performance on all tests in group B after 2 months of therapy. Comparisons pre- and posttreatment between groups showed that patients who received citalopram presented statistically significantly better results in the SSI/ICM test (P < .0001) after treatment. The same comparison in results for the PPS test and the SSW test revealed a tendency (P = .09 and 0.058, respectively) toward better performance in the group receiving citalopram. CONCLUSION: These preliminary results suggest that the use of citalopram can have a positive impact on auditory processes in elderly patients with low performance in auditory process.

Aged↗

[Experiences with the distorted Freiburg Speech Test--diagnosis and rehabilitation of hearing disorders].

In accordance with the description of an extended technique of distorted speech at different values - 15 dB, - 10 dB, - 5 dB and 0 dB with the plotted frequency characteristic, we used the procedure with different kinds of sensorineural hearing loss. The method analyse the peripheral hearing system very simply. In cases of acoustic tumours the quotient is very large and it is better to reduce the degree of distortion (-10, -5 and 0 dB). Generally, it is possible to detect the phase of degeneration of the inner hair-cells and afferent nerve fibres in all cases of sensorineural hearing loss. The test is also of very good help in fitting hearing aids because method picks out the hard hearing persons with very disturbed discrimination of speech.

Adult↗

Hearing disorders in patients with insulin-dependent diabetes mellitus.

The cochlear and retrocochlear hearing function was evaluated in patients with long- and short-term insulin-dependent diabetes mellitus (IDDM) by means of psychoacoustic testing and auditory brain stem responses (ABR). Twenty patients with diabetic microangiopathy (median age 41 years, range 25-66 years) were examined. The median duration of their diabetes was 26 years (range 13-46 years). In addition, 19 patients without microangiopathy (median age 27 years, range 17-42 years) and with a median duration of the diabetes of 2 years (range 0-6 years) were examined. The metabolic control estimated by blood glucose concentration and glycosylated haemoglobin was identical in the two groups of IDDM patients. After correction for age and sex, no significant differences in hearing thresholds or discrimination scores were present between the two diabetic groups, or between the diabetic patients and an age- and sex-matched normal background population. In the patients with long-term IDDM, ABR produced abnormal responses in 40%, indicating the presence of diabetic encephalopathy, whereas ABR were abnormal in only 5% of the patients with short-term IDDM.

Acoustic Impedance Tests↗

Use of a monosyllabic adaptive speech test (MAST) with young children.

Sixty children aged 3, 5, and 7 years were tested using a simple up-down adaptive speech threshold procedure. The test stimuli were familiar monosyllabic words presented as a closed set with a picture-pointing response. The results indicate that monosyllabic adaptive speech test (MAST) procedures can be used reliably with children as young as 3 years of age. Thirty of the children also received a different randomization of the same speech stimuli presented at a constant level, equal to their MAST threshold. The results confirmed the accuracy of the MAST estimate of the children's 50% speech threshold. Further support for the validity of the MAST threshold procedure with young children was obtained using a group of 10 children with conductive hearing loss. Their results show a significant correlation between the MAST threshold and pure-tone loss. The data also indicated significant improvement in MAST thresholds over the three age groups investigated. These developmental changes are discussed in terms of a word frequency effect.

Audiometry, Pure-Tone↗

Hearing preservation after acoustic tumor removal: long-term results.

This report examines the durability of preserved postoperative hearing in 25 middle fossa acoustic tumor patients with a minimum follow-up of 3 years. The mean follow-up time for this group was more than 8 years, with a maximum of almost 20 years. The initial postoperative audiogram was compared to the most recent audiogram for each patient, with change in the nonoperated ear serving as the control. Fourteen of the patients (56%) had a significant loss of the preserved hearing in the operated ear over time. The mean loss of speech discrimination was 25%, and the mean loss of speech reception threshold was 12 dB. Only one of the 14 patients had a similar loss in the contralateral ear. No recurrent tumors were identified. Good preoperative hearing is an obvious criterion for selection of candidates for hearing preservation surgery. Results of this study emphasize that a good initial postoperative hearing level is necessary to offset the potential deterioration of hearing that may occur over time.

Adolescent↗

Range of intensities yielding PB Max and the threshold for monosyllabic words for hearing-impaired subjects.

Characteristics of the range of intensities yielding PB Max and of the threshold for monosyllabic words (PBT) were investigated in 110 elderly subjects with mild-to-moderate sensorineural hearing loss. Word recognition functions were generated using the Auditec recordings of the CID W-22 words with 50 words per level. The results indicated that (a) the range of intensities yielding PB Max was approximately 33 dB at a level corresponding to 12% below PB Max, (b) the PB Max range decreased as the magnitude of hearing loss increased, (c) testing at the loudness discomfort level was likely to provide a more accurate estimate of PB Max than testing at most comfortable listening level, (d) word recognition scores should be obtained at a minimum of two intensities in order to estimate PB Max, (e) the PBT in dB SL re the spondaic threshold increased as the steepness of the audiogram increased, and (f) the PBT should not be considered unusual unless it exceeds the predicted value by about 14 dB.

Aged↗

Combined retrosigmoid retrolabyrinthine vestibular nerve section: results of our experience over 10 years.

OBJECTIVE: We aimed to evaluate the results of our experience in vestibular nerve sectioning (VN), which was performed using combined retrosigmoid-retrolabyrinthine approach. STUDY DESIGN: Medical records of 280 patients who were consecutively operated on for incapacitating peripheral vertigo were retrospectively evaluated, and 210 patients who completed 2 years follow-up and had adequate follow-up data were found to be suitable for inclusion in the study. METHODS: Hearing results, vertigo control rates, and complications of the retrosigmoid-retrolabyrinthine VN were evaluated. RESULTS: The patients were suffering from vertigo for a mean period of 32.2 months. Bilateral Meniere's disease occurred in 5.7% of the patients in the follow-up period. A complete or substantial vertigo control could be achieved in 94.4% of the patients (191 [90.1%] in Class A and 9 [4.3%] in Class B). Preoperative speech reception threshold, pure-tone average, and speech discrimination score of the patients were 56.5 dB, 47.4 dB, and 73.6%, respectively. Postoperative corresponding values were 62.2 dB, 43.4 dB, and 68.5%, respectively (p > 0.05). The complication rate was low (2.5%). Most common complication was abdominal hematoma, which was seen in 4.5%. CONCLUSION: VN performed using retrosigmoid-retrolabyrinthine approach has low complication and high vertigo control and hearing preservation rates. It can be applied as an initial surgery or reserved as the last step when the other surgical treatments have failed to control vertigo.

Adolescent↗

[Speech audiometry using the American Word Lists for Japanese subjects with normal hearing].

The characteristics of listening to English words for Japanese people were studied in ten normal hearing subjects who had taken English classes to the level of college graduates and had opportunities to learn English continuously. Following pure tone audiometry, speech audiometry was performed using the Central Institute for the Deaf (CID) W-1 and W-22 word lists for English and the 67-S word lists for Japanese. The speech reception thresholds (SRTs) for the CID W-1 lists were significantly higher than average pure tone threshold (PTT), although the SRTs for the 67-S lists were equal to the average PTT. The difference in average SRT between the CID W-1 lists and the 67-S lists was about 15dB, which is statistically significant. The speech discrimination rate for the CID W-22 lists ranged from 78 to 100 percent with an average of 89.5 percent, while all subjects achieved the discrimination rate of 100 percent for the 67-S lists. Analysis with transient matrices of the perceived words demonstrated that the articulation rates were below 90 percent for the consonants /m/, /n/, /p/ and /delta/ . The observed variation in the speech discrimination score and the pattern of confusion among the subjects was assumed to be much more pronounced in noisy conditions.

Adult↗

Monitoring of the glycerol test with sinusoidal harmonic acceleration in Menière's disease patients.

Changes in auditory pure tone threshold and speech discrimination and the phase and gain in the sinusoidal harmonic acceleration test were measured in subjects with endolymphatic hydrops (Meniere's disease) following the administration of glycerol. Although all subjects showed a marked improvement in auditory function, a comparable change in vestibular function, as measured by the sinusoidal harmonic acceleration test, was not observed.

Acceleration↗

The effect of varying the slope of the amplitude-frequency response on the masked speech-reception threshold of sentences.

Within the framework of a study on the merits of a frequency-dependent automatic gain control in hearing aids, the effect of varying the slope of the amplitude-frequency response on the speech-reception threshold (SRT) for sentences in noise was studied for normal-hearing listeners. Speech and noise were both subjected to the same amplitude-frequency response. In the first experiment, the effect of a constant slope was investigated (20 listeners). Over a range of about -7 to +10 dB/oct, the SRT in noise remained constant. In the second experiment, a single change in the slope of the amplitude-frequency response was introduced halfway through the sentence. The effect of varying the transition time over a range down to 0.125 s appeared to be very small. In the third experiment, the slope varied continuously with range and variation frequency (0.25-2 Hz) as the parameters. The masked SRT increased gradually with variation frequency. The results indicate that the masked SRT for sentences is remarkably resistant to dynamic variations in the slope of the amplitude-frequency response.

Hearing Aids↗

Partial vs. total footplate removal in stapedectomy: a comparative study.

A comparative study of the postoperative stapedectomy results for 264 ears with partial footplate removal (PFR) and for 106 ears with total footplate removal (TFR) was performed with reference to decibel gain in three specific frequency ranges, air-bone gap closure, speech threshold and speech discrimination and incidence of postoperative complications. The data confirm a small but consistently greater decibel gain for PFR cases in the 2000-8000 Hz range; the decibel gain in the 250-1000 Hz range is virtually identical for PFR and TFR cases. Air-bone gap closure and speech results also indicate a somewhat better average result in PFR as compared TFR cases. The permanency of speech discrimination results is examined.

Bone Conduction↗

Preservation of hearing and facial nerve function in resection of acoustic neuroma.

The surgical results in 78 recent cases of total removal of unilateral acoustic neuroma in which an attempt was made to preserve cochlear function have been added to the authors' previous series of 66 cases to evaluate the factors influencing the ability to preserve useful hearing. Useful hearing was defined by speech reception threshold no poorer than 70 dB and a discrimination score of at least 15%. Analysis using a logistic regression model showed that certain preoperative clinical parameters such as tumor size, speech discrimination score, and gender were significantly correlated with hearing outcome. Favorable outcome was significantly correlated with smaller tumor size, higher preoperative speech discrimination score, and male sex. From this data, an explicit formula was devised for predicting hearing outcome for an individual patient. In four cases with useful hearing preserved, there was improvement of greater than 15 percentage points in speech discrimination scores. While preoperative auditory brainstem responses were not predictive of hearing preservation, monitoring of intraoperative auditory evoked potentials was predictive of hearing outcome in selected cases. Specifically, when wave V was unchanged at the end of the operation, even if it may have been transiently lost during surgery, useful hearing was invariably preserved.

Audiometry, Evoked Response↗