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PubMedDate not supplied

On the clinical relevance of mismatch negativity: results from subjects with normal hearing and cochlear implant users.

Mismatch negativity (MMN) provides an objective measure for evaluating subjects with problems related to speech processing. For a valid neurophysiological profile of speech-processing mechanisms, an efficient procedure to elicit MMNs is needed. In Experiment 1 of this study, MMN recordings were conducted in adults with normal hearing on the effects of decreasing the duration of the interstimulus interval (ISI). Shortening ISI duration does not seem to have a high impact on the individual MMN quality, whereas it does influence group MMN quality. In Experiment 2, MMNs were elicited in a group of cochlear implant users by using a speech sound contrast/ba/-/da/. A group of good performers produced a significant MMN, whereas a group of moderate performers did not. There seems to be a relation between speech perception ability and MMN quality. To fundamentally understand the effects of electrical stimulation of the inner ear and to clinically adjust rehabilitation, diverse data are needed on different aspects of auditory processing. Optimizing the procedure to elicit and MMN is therefore of great clinical value.

Adult↗
PubMed2004

Functional impairments due to unilateral deafness.

The authors investigated the impact of unilateral listening upon two central auditory functions: speech discrimination in a noisy environment, and the ability to process and clearly recognize modestly accelerated speech by 30% compression (shortened exposure). We determined that the negative impact of listening to speech in the milieu of noise was individually variable. The data revealed a wide range of impairment, from mild to relatively severe (ie, 0% to 60% [mean, 34%]; normative data, 4% to 36% [mean, 14%]). The performance scores for recognition of compressed sentences were not markedly influenced by unilateral deafness, but the functional results of the residual ear were correlated with a loss of high-frequency sensitivity (mean of 54% correct in severe unilateral deafness with an associated high-frequency loss versus 93% correct in normal controls). Reorganization of the central nervous system by "plasticity" or biological maturation over time failed to improve the performance of monaural listening. The currently recommended methods of remediation for this sensory deficit are discussed, and newer technologies under investigation are examined.

Adolescent↗
PubMed1996

Prevalence and mechanisms of hearing loss in patients with resistance to thyroid hormone.

Hearing impairment was anecdotally reported in resistance to thyroid hormone (RTH), a condition caused by mutations in the beta-thyroid hormone receptor (beta TR) gene. Because of its ontogenic distribution in the cochlea, the beta TR may have a pivotal role in the development of auditory function. To assess the prevalence and mechanisms of hearing impairment in RTH, 82 RTH-positive (RTH+) patients and 55 unaffected relatives (RTH-) underwent systematic audiological examination, including puretone and speech reception thresholds, and tests studying middle ear (tympanometry and acoustic reflexes), cochlear (otoacoustic emissions), and retrocochlear integrity (brain stem auditory evoked potentials). Significant hearing loss was present in 21% of RTH+ patients vs. none in RTH- patients. More RTH+ patients had abnormal tympanometry (34% vs. 12%) and abnormal acoustic reflexes (39% vs. 19%). Isolated conductive deficit was found in 7 of 17 RTH+ patients with hearing loss, isolated sensorineural deficit in 7 cases, and mixed deficit in 3 cases. Cochlear dysfunction was found in 50% of all RTH+ patients, with or without hearing loss. Retrocochlear function was normal. No morphological cochlear abnormalities were detected on computed tomography of the temporal bone. In conclusion, hearing loss is a significant problem in RTH, with an equal frequency of conductive (probably related to the frequent ear infections) and sensorineural deficits. Abnormal otoacoustic emissions suggest that the mutant beta TR has a specific negative impact on cochlear function.

Adult↗
PubMed1984

Bone conduction evaluation related to mastoid surgery.

The bone conduction threshold changes of 97 patients (100 ears) who underwent mastoid surgery were determined by comparing the last preoperative audiogram with the 1 year postoperative audiogram. Three types of mastoid surgery were evaluated: radical mastoidectomy, modified radical mastoidectomy, and intact wall atticomastoidectomy. The average three speech frequency preoperative bone conduction threshold was 17.4 dB (S.D. 11.5) in the radical mastoidectomy group, 10.1 dB (S.D. 9.6) in the modified radical mastoidectomy group, and 10.7 dB (S.D. 8) in the intact wall atticomastoidectomy group. The difference between the average three speech frequency preoperative bone conduction threshold of the radical mastoidectomy group differed significantly when compared to the modified radical mastoidectomy or intact wall atticomastoidectomy group. The postoperative average three speech frequency bone conduction threshold did not change significantly following the three surgical procedures evaluated.

Adult↗
PubMed1990

Delayed spontaneous return of hearing after acoustic tumor surgery: evidence for cochlear nerve conduction block.

Unlike the eventual resolution of facial paralysis in most patients with intact facial nerves, delayed hearing return after acoustic tumor resection is rare. This discrepancy in recovery has been ascribed to the inherent resilience of the facial nerve (a special visceral efferent nerve) to injury versus the cochlear nerve (a special somatic afferent nerve). In the presence of an intact cochlear nerve, hearing loss has been attributed to transection or spasm of the internal auditory artery or to direct mechanical trauma to the cochlear nerve during manipulation of the tumor. The possibility of a reversible conduction block in the cochlear nerve has not been considered. A review of three instances of delayed spontaneous hearing recovery several months after acoustic tumor resection suggests that a conduction block phenomenon can exist. This report describes the pathophysiology and the possible intraoperative predisposing features of this condition.

Adult↗
PubMed1991

Stapedectomy: long-term hearing results.

The initial improvement in hearing following stapedectomy usually deteriorates with the passage of time. We studied the long-term results of stapedectomies performed on 42 patients (49 ears) between 1959 and 1969 who had a minimum follow-up of 18 years. Both air conduction (AC) and bone conduction (BC) thresholds progressively deteriorated over the long term. The degree of BC loss paralleled that expected from presbycusis alone. A greater deterioration was noted in the AC levels, producing a recurrent conductive hearing loss in the speech frequencies. Age at the time of surgery had no effect on the long-term outcome. Comparison of the average preoperative speech discrimination scores (SDS) to the 1-year postoperative SDS and the long-term SDS revealed a 1.1% and 16.7% drop, respectively. The improvement in the average speech reception threshold (SRT) obtained 1 year postoperatively deteriorated by less than 1 dB per year over the long term. Patients with a higher SDS (more than 95%) preoperatively fared better in the maintenance of speech discrimination than those with a lower SDS (less than 95%). The preoperative SRT level was predictive of the timing for the requirement of hearing amplification. The postoperative SRT level was predictive of the timing for the requirement of hearing amplification. The caused by presbycusis, combined with a recurrent conductive loss in the speech frequencies rather than cochlear otosclerosis. Although the decline in hearing following stapedectomy exceeds the rate of hearing loss due to presbycusis, many individuals, after successful stapes surgery, are able to delay the need for hearing amplification for longer periods than had been previously reported.

Audiometry, Pure-Tone↗
PubMed1993

Multichannel (Ineraid) cochlear implant update.

From April 1984 to May 1991, 49 profoundly deaf patients received implantation of the Ineraid multichannel cochlear implant at the University of Utah. The auditory results of 48 patients indicated improvement in mean pure-tone performance to 500 Hz (32.9 +/- 10.1 dB), 1000 Hz (27.1 +/- 10.0 dB), and 2000 Hz (30.1 +/- 9.8 dB). This group of patients had mean performances of 61.2% on auditory-only environmental sounds (Minimum Auditory Capabilities [MAC] battery), 48.8% on auditory-only CID sentences, and 95.5% on auditory-plus-visual CID sentences. The percutaneous pedestal has been well-tolerated. Changes in the surgical skin incisions have been made. A home use speech therapy program has been developed on VHS tapes.

Adult↗
PubMed1994

Intraoperative monitoring of auditory function: experimental observations and new applications.

The three different methods of intraoperative monitoring, namely, auditory brainstem response evaluation (ABR), electrocochleography (ECoG), and direct eighth nerve compound action potentials monitoring are reviewed. Both ECoG and direct eighth nerve monitoring surpass the ABR in their ability to provide fast, almost instantaneous, large, reproducible potentials in response to click stimuli. Changes in the amplitude and the latency of these potentials alert the surgeon of an impending eighth nerve injury. Human clinical observations revealed instances of persistence of the ECoG despite a total eighth nerve section in the cerebellopontine angle. Animal and human experiments were conducted to evaluate the effectiveness of ECoG and direct eighth nerve monitoring in hearing preservation. Twelve cats underwent progressive sectioning of the eighth nerve with simultaneous monitoring of changes in their ECoG and direct eighth nerve potentials. ECoG thresholds were obtained intraoperatively in eight patients undergoing surgery for conductive hearing loss. The results of these experiments suggest that recording directly from the eighth nerve is a more accurate technique during cerebellopontine angle and eighth nerve surgery. ECoG, however, appears to have a promising role in the intraoperative monitoring of middle ear reconstruction procedures under general anesthesia.

Action Potentials↗
PubMed1995

Congenital aural cholesteatoma: results of surgery in 60 cases.

From 1978 to 1993, 59 patients (60 ears) with congenital middle ear cholesteatoma were treated at the House Ear Clinic. The median patient age at presentation was 5 years, and the period of postoperative follow-up was 4.8 years. An intact canal wall was maintained in 58 of 60 cases and a closed middle ear space in all cases. In 12 operations, lateral graft tympanoplasty eradicated the cholesteatoma in one stage; 32 patients required a second-stage surgery to rule out recurrence, and the remaining 16 cases required three or more operations to eradicate disease and reconstruct the hearing mechanism. Thirty-five (63%) of 56 patients had a postoperative air-conduction threshold pure-tone average (PTA) within 10 dB of the best bone-conduction PTA; 91% were within 20 dB. Average speech reception threshold improved from 32 dB hearing level (HL) preoperatively to 20 dB HL postoperatively.

Child↗
PubMedDate not supplied

Speech signals used to evaluate functional status of the auditory system.

This review presents a brief history of the evolution of speech audiometry from the 1800s to present day. The two-component aspect of hearing loss (audibility and distortion), which was formalized into a framework in past literature, is presented in the context of speech recognition. The differences between speech recognition in quiet and in background noise are discussed as they relate to listeners with normal hearing and listeners with hearing loss. A discussion of the use of sentence materials versus word materials for clinical use is included as is a discussion of the effects of presentation level on recognition performance in quiet and noise. Finally, the effects of age and hearing loss on speech recognition are considered.

Aging↗
PubMed1979

Long-term results of open cavity and tympanomastoid surgery of the chronic ear.

The results of surgery for chronic middle ear infection in 307 patients (347 ears) are reported. All ears were operated on according to one of two procedures: (i) the operative cavity was left open after removal of the posterior canal wall, or (ii) a tympanomastoidectomy with intact canal wall was done. When necessary, removal of disease in the tympanum with or without reconstruction of the sound-conducting mechanism of the middle ear was performed. Cholesteatoma was present in 56% of the ears. Open cavity surgery with no reconstruction was done in 53%. In the remaining 47%, tympanomastoidectomy was performed and in approx. half of these ears reconstruction was undertaken. The postoperative follow-up period averaged 9 years. Residual cholesteatoma was found in 9%. In 4% of the ears undergoing tympanomastoidectomy a retraction pocket cholesteatoma developed. During the follow-up period 13% of the ears required revision surgery. Nineteen per cent of the ear with open cavities were discharging and, in addition, crusts were observed in 13%. In the tympanomastoidectomy group, discharing ears were seen in 26%. As a rule, hearing was not affected by surgery. The mean elevation of the pure tone threshold was 6.5 dB on account of sensorineural loss, while the speech reception threshold shift was 11 dB. The results testify to the importance of removing the posterior canal wall in ears with chronic middle ear infection associated with cholesteatoma.

Audiometry, Pure-Tone↗
PubMed1990

Effects of reverberation and noise on speech recognition by adults with various amounts of sensorineural hearing impairment.

Speech recognition was assessed under three levels of room reverberation, each in quiet and noise, for subjects with varying amounts of sensorineural hearing impairment. The three acoustic environments were: sound suite, reverberant room with a reverberation time (T) = 0.54 s and reverberant room with T = 1.55 s. Three groups of subjects were utilized: normal hearing, mild sensorineural hearing impairment and moderate-to-severe sensorineural hearing impairment. Speech recognition ability for each of the three groups of subjects significantly differed from the other two groups for each of the three reverberant conditions. The detrimental influences of noise and reverberation increased with the magnitude of hearing impairment. In addition, there was an interaction between noise and room reverberation, where the detrimental effects of room reverberation were compounded by the addition of noise.

Adult↗
PubMed1991

Advantages of directional hearing aid microphones related to room acoustics.

In this study, two types of hearing aids were used. Both aids had the same frequency characteristics for frontal sound, but one employed an omnidirectional microphone and the other a directional microphone. The frequency characteristics of both hearing aids were measured for five azimuths on KEMAR and in situ in 12 normal-hearing subjects. For these subjects we also determined the speech reception threshold (SRT) with background noise in two rooms with different reverberation times. The direction of the speech stimuli was always frontal; the direction of the noise was varied. Additionally, directional hearing was measured with short noise bursts from eight loudspeakers surrounding the subject. In the less reverberant room, sounds coming from behind were less amplified by the hearing aid with the directional microphone than by the one with the omnidirectional microphone. In this room the monaural SRT values were largely determined by the level of the background noise. For the directional hearing aids there was an extra binaural advantage which depended on the direction of the background noise. Only for low-frequency noise bursts was directional hearing better with directional hearing aids. In the more reverberant room, no distinct differences between the frequency characteristics of the two hearing aid types were measured. However, a systematic difference between monaural SRT values measured through the two hearing aids was found. This difference was independent of noise azimuth. In conclusion, hearing aid(s) with a directional microphone showed no disadvantages and clear advantages under specific conditions.

Acoustics↗
PubMed1992

Technical possibilities in the school situation for the education of hearing-impaired children.

For hearing-impaired children, the main problem in the classroom is the signal-to-noise ratio. To improve the signal-to-noise ratio, several class systems have been developed, three of which have been investigated in this study. The systems are shown to be equivalent in a situation without a channel for pupil response. Application of such pupil response channels will decrease the improvement in signal-to-noise ratio brought about by the class system. It is argued that the choice among several combinations of class system and pupil response channel is governed by the primary goal of education and how this goal is to be achieved.

Adolescent↗