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PubMed1986

Spread of masking in normal subjects and in subjects with high-frequency hearing loss.

Upward spread of masking and remote masking were investigated in 4 subjects with closely matched high-frequency hearing losses. Masked thresholds in the presence of a high-frequency or a low-frequency bandpass noise were obtained using an adaptive-threshold procedure. 'Abnormal' upward spread of masking existed for the impaired subjects at some test frequencies when compared to the masking predicted on the basis of normal masking results and hearing-impaired quiet thresholds. Remote masking thresholds were usually shifted to the same absolute levels for normal and hearing-impaired subjects. These results demonstrate that speech reception in noise for listeners with high-frequency hearing loss could be affected by spread of masking and levels of hearing loss.

Acoustic Stimulation↗

PubMed1988

Open-set word recognition with the Duren/Cologne extracochlear implant.

The author visited Duren, West Germany and evaluated the performance of five patients implanted with the extracochlear Duren/Cologne implant who achieved better word recognition levels. Word and sentence speech reception tests were presented live-voice by a familiar German speaker. Performance ranged from 1% to 80% correct word recognition with sentence material, 0% to 63% correct word recognition with word lists, and 13% to 86% correct recognition for phonemes in words. One patient achieved high-level, open-set word recognition without visual cues, using single-channel, extracochlear stimulation. Preimplant auditory thresholds in her implanted ear were 60, 65, 90, and 105 dB HL at octave frequencies from 125 to 1,000 Hz, respectively. There was no measurable hearing at higher audiometric frequencies.

Adult↗

PubMed2005

The BAHA Softband. A new treatment for young children with bilateral congenital aural atresia.

OBJECTIVE: To evaluate the validity of a bone-anchored hearing aid (BAHA) Softband (fitted unilaterally and bilaterally) in young children with bilateral congenital aural atresia. SUBJECTS: Two children with severe bilateral congenital conductive hearing loss, who had been fitted with a transcutaneous BAHA Softband at the age of 3 and 28 months, respectively. The latter child had been fitted with a conventional bone-conduction hearing aid at the age of 3 months; at 28 months, this child had received the BAHA Softband and after 5 months of unilateral application, the BAHA Softband was fitted bilaterally. Follow-up in the two children was 31 and 17 months, respectively. METHODS: Using the artificial mastoid, gain and maximum output were studied in this new transcutaneous application of the BAHA, with the BAHA Classic and the BAHA Compact as sound processor. Results were compared to those obtained with a conventional bone-conduction device (Oticon E 300 P). Aided thresholds and sound lateralization scores were assessed with double visual reinforcement audiometry (VRA). To test the validity of the BAHA Softband, the speech and language development of the children was assessed by means of age-appropriate tests (the preverbal Symbolic play test and the Dutch non-speech test for receptive and expressive language and the Dutch version of the Reynell language test). RESULTS: The electro-acoustic measurements showed minor differences in gain between the three devices. At a reduced volume setting, the mean input level at which the output levelled off was largely comparable between the BAHA Classic and the conventional device, but somewhat poorer with the BAHA Compact. Both children showed speech and language development that was in accordance with their cognitive development. CONCLUSIONS: The BAHA Softband was a valid intervention in children with congenital bilateral aural atresia who were too young for percutaneous BAHA application.

Bone Conduction↗

PubMed1990

Titration streptomycin therapy for bilateral Meniére's disease. Follow-up report.

Initial reports of the use of parenteral streptomycin for bilateral Meniere's disease (MD) have demonstrated success in reducing the vestibular symptoms and, in some patients, stabilizing hearing. The long-term follow-up (mean, 5.1 years) of 19 patients treated with intramuscular streptomycin for bilateral MD is presented. The amount of streptomycin administered (5 to 50 g) was determined by clinical symptoms and by serial testing of the reduction in the slow-phase velocity on electronystagmography. Episodic vertigo was totally relieved in 12 patients and improved in severity and frequency in an additional 4 patients. Permanent posttreatment dysequilibrium occurred in 47% of the patients treated. The changes in hearing (speech reception threshold) were independent of the therapeutic effect of streptomycin on the vestibular system. The overall results suggest that the intramuscular titration of streptomycin should continue to be considered as one of the therapeutic options in patients with disabling vertigo due to bilateral MD.

Adult↗

PubMed1985

Hearing acuity of children with otitis media with effusion.

Hearing levels are reported for a cohort of 222 infants (aged 7 to 24 months) and 540 older children (aged 2 to 12 years) with otitis media with effusion (OME). The infants had an average speech awareness threshold of 24.6 dB hearing level (HL). The older group had mean bone conduction thresholds less than 10 dB HL, and air conduction thresholds averaged 27 dB HL; however, acuity was 7 dB less impaired at 2,000 Hz. The mean three-frequency pure tone average and speech reception threshold were 24.5 and 22.7 dB, respectively. Hearing acuity was not significantly related to age or previous duration of OME. The otoscopic observation of an air-fluid level or bubbles was associated with less hearing impairment; however, a predictive relationship between hearing levels and tympanogram characteristics could not be demonstrated.

Acoustic Impedance Tests↗

PubMed2005

Speech recognition with amplitude and frequency modulations.

Amplitude modulation (AM) and frequency modulation (FM) are commonly used in communication, but their relative contributions to speech recognition have not been fully explored. To bridge this gap, we derived slowly varying AM and FM from speech sounds and conducted listening tests using stimuli with different modulations in normal-hearing and cochlear-implant subjects. We found that although AM from a limited number of spectral bands may be sufficient for speech recognition in quiet, FM significantly enhances speech recognition in noise, as well as speaker and tone recognition. Additional speech reception threshold measures revealed that FM is particularly critical for speech recognition with a competing voice and is independent of spectral resolution and similarity. These results suggest that AM and FM provide independent yet complementary contributions to support robust speech recognition under realistic listening situations. Encoding FM may improve auditory scene analysis, cochlear-implant, and audiocoding performance.

Cochlear Implants↗

PubMed1989

Electronystagmographic findings and recovery of cochlear and vestibular function in patients suffering from sudden deafness with a special reference to the effect of anticoagulation.

The study included 80 patients treated for sudden deafness over the last 5-7 years. Case history, laboratory findings, pure-tone audiogram and electronystagmography (ENG) findings were noted. If any abnormalities had been recorded in ENG studies, the studies were redone. ORL status was redefined and audiograms were obtained in all patients. When becoming ill, the 80 patients had not differed from the normal population in common cardiovascular risk factors. None of them had had signs of viral infection (paired serum samples had been taken at 2-week intervals; routine examinations had been done for common viral antigens). As many as 31 of the 80 patients with acute hearing loss had had abnormalities such as spontaneous nystagmus (PN), hypoexcitability (HE) and directional preponderance (DP) in the bithermal caloric tests (+44 degrees C, + 30 degrees C) of their ENG studies. Twenty of the 31 patients still had abnormal ENG studies after 5-7 years. Only 1 subject had positional nystagmus, and none had subjective vertigo. Patients with an abnormal ENG study showed a poor recovery of the speech reception threshold, whereas those with a normal ENG study showed slightly significant (p less than 0.05) recovery.

Administration, Oral↗

PubMed1977

Improving the reliability of speech audiometry.

A necessary feature of good recorded speech material is that each list should be identical in respect of graded order of difficulty. Extensive validatory tests have been carried out upon 20 M.R.C. word lists re-recorded by a professional announcer. It can be shown that by various manipulative procedures appreciable improvements may be obtained in the confidence limits of the material. In addition studies have been carried out upon the relationship between Speech Detection Threshold (S.D.T.) Speech Reception Threshold (S.R.T.) and Hearing level (H.L.) in normal hearing subjects. The surprising finding is that both S.D.T. and S.R.T. appear to be relatively independent of H.L. An analysis has been made of the words comprising the material in respect of their ease of recognition and is presented as an appendix.

Audiometry↗

PubMed2004

Speech reception in noise: an indicator of benefit from otitis media with effusion surgery.

To determine possible selection criteria for ventilation tubes (VTs - grommets), in otitis media with effusion (OME), a randomized trial on 68 children was undertaken. To provide both a baseline predictor and outcome measure in auditory disability, speech-in-noise thresholds were obtained with the IHR-McCormick Automated Toy Test (SiN ATT). Children allocated to surgery (n = 32) and control (n = 36) were followed-up at 3 and 12 months postintervention. Baseline SiN ATT score provided a significant by-treatment interaction in predicting the performance at +3 months, establishing it as an evidence-based indicator. Although average benefits on hearing level score (HL) were also shown, baseline HL was not a valid indicator (no significant interaction). The 40% of the sample with worst baseline SiN experienced high benefit from VTs. In children over 3 years of age, baseline SiN performance can indicate those with OME most likely to benefit from VTs.

Auditory Threshold↗

PubMed1995

Villchur revisited: another look at automatic gain control simulation of recruiting hearing loss.

An algorithm to simulate the effects of sensorineural hearing impairment on speech reception was investigated. Like that described by Villchur [J. Acoust. Soc. Am. 62, 665-674 (1977)], this simulation employs automatic gain control in independent frequency bands to reproduce the elevated audibility thresholds and loudness recruitment that are characteristic of this type of loss. In the present implementation, band gains are controlled in an effort to simulate loudness recruitment directly, using recruitment functions that depend only on the magnitude of hearing loss in the band. In a preliminary evaluation, two normal-hearing subjects listened to the simulation matched to hearing losses studied previously [Zurek and Delhorne, J. Acoust. Soc. Am. 82, 1548-1559 (1987)] with noise-masking simulations. This evaluation indicated that the present automatic gain control simulation yielded scores roughly similar to those of both the hearing-impaired listeners and the masked-normal listeners. In the more-detailed evaluation, the performance of three listeners with severe sensorineural hearing loss on several speech intelligibility tests was compared to that of normal-hearing subjects listening to the output of the simulation. These tests included consonant-vowel syllable identification and sentence keyword identification for several combinations of speech-to-noise ratio, frequency-gain characteristic, and overall level. Generally, the simulation algorithm reproduced speech intelligibility well, though there was a clear trend for the simulation to result in better intelligibility than observed for impaired listeners when high-frequency emphasis placed more of the speech spectrum above threshold at higher frequencies. Also, the hearing-impaired listener with the greatest loss showed the largest discrepancies with the simulation. Overall, however, the simulation provides a very good approximation to speech reception by hearing-impaired listeners. The results of this study, together with previous studies of noise-making simulation, suggest that threshold elevation and recruitment, which are necessary features of a simulation of cochlear hearing loss, can also be largely sufficient for simulating the speech-reception performance of listeners with moderate to severe hearing impairments.

Adult↗

PubMed2005

Binaurality in middle ear implant recipients using contralateral digital hearing AIDS.

OBJECTIVE: For some patients, conventional hearing aids might have disadvantages that clearly limit the benefit of using them. The middle ear implant, Vibrant Soundbridge hearing prosthesis offers an approach to help such patients. Our study's objective was to identify the binaurality in a well-fitted digital hearing aid worn in the contralateral ear in recipients experienced with use of the Vibrant Soundbridge middle ear implant device. STUDY DESIGN: In a prospective study, warble-tone thresholds and stereophony were evaluated for the following conditions: (1) binaural unaided-with the middle ear implant inactive and the behind-the-ear hearing aid removed; (2) middle ear implant alone-middle ear implant active, behind-the-ear hearing aid removed; (3) middle ear implant plus behind-the-ear omnidirectional-middle ear implant active, behind-the-ear active; and (4) behind-the-ear omnidirectional alone-middle ear implant inactive, behind-the-ear omnidirectional active. Behind-the-ear omnidirectional and behind-the-ear is defined as the behind-the-ear active in the omnidirectional or directional response, respectively. Behind-the-ear is a contralateral digital hearing aid to the middle ear implant. Benefits such as improved sound detection, speech perception in quiet and in noise, and sound quality were investigated. The evaluation of subjective hearing benefit was based on the Abbreviated Profile of Hearing Aid Benefit (APHAB) test. Paired t tests (subject) were used to analyze the differences between mean thresholds for the different test conditions. SETTING: Tertiary referral center. PATIENTS: Eight adults (aged 45-68 yr) had undergone implantation with a single Vibrant Soundbridge at least 12 months before starting the study. These eight subjects presented no contraindication for contralateral hearing aid use. Patients were fitted 5 weeks before testing with a Siemens Signia digital behind-the-ear hearing aid in the side contralateral to the Vibrant Soundbridge. RESULTS: Five weeks after use of the contralateral hearing aid together with the middle ear implant, mean differences in warble-tone thresholds between Conditions 2 and 3 and between Conditions 3 and 4 were both statistically significant. The mean differences in speech reception thresholds were in line with the mean differences in average warble-tone thresholds. The mean speech reception threshold for the middle ear implant plus behind-the-ear omnidirectional condition was slightly worse (3 dB) than that for the middle ear implant alone condition; however, this difference was not statistically significant. Whereas speech reception threshold difference between Condition 1 and Condition 4 was not statistically significant (60 dB and 61 dB, respectively). The mean difference for the 0-degree azimuth alone was statistically significant (p < 0.05) for the conditions middle ear implant alone and middle ear implant plus behind-the-ear omnidirectional. The middle ear implant alone appears to give good sensitivity at 2 kHz for any direction. Increasing scores indicate greater percentages of problems. Percentages of problems were on average lower for the middle ear implant when used with the contralateral digital hearing aid based on the global score. CONCLUSION: The use of a middle ear implant Vibrant Soundbridge together with a contralateral digital hearing aid improved functional gain and speech perception thresholds in quiet, especially for the sound coming from the front of the patient. The use of a middle ear implant together with a contralateral digital hearing did not significantly improve hearing in noise.

Acoustic Stimulation↗

PubMed1999

Benefits of linear amplification and multichannel compression for speech comprehension in backgrounds with spectral and temporal dips.

People with cochlear hearing loss have markedly higher speech-receptions thresholds (SRTs) than normal for speech presented in background sounds with spectral and/or temporal dips. This article examines the extent to which SRTs can be improved by linear amplification with appropriate frequency-response shaping, and by fast-acting wide-dynamic-range compression amplification with one, two, four, or eight channels. Eighteen elderly subjects with moderate to severe hearing loss were tested. SRTs for sentences were measured for four background sounds, presented at a nominal level (prior to amplification) of 65 dB SPL: (1) A single female talker, digitally filtered so that the long-term average spectrum matched that of the target speech; (2) a noise with the same average spectrum as the target speech, but with the temporal envelope of the single talker; (3) a noise with the same overall spectral shape as the target speech, but filtered so as to have 4 equivalent-rectangular-bandwidth (ERB) wide spectral notches at several frequencies; (4) a noise with both spectral and temporal dips obtained by applying the temporal envelope of a single talker to speech-shaped noise [as in (2)] and then filtering that noise [as in (3)]. Mean SRTs were 5-6 dB lower (better) in all of the conditions with amplification than for unaided listening. SRTs were significantly lower for the systems with one-, four-, and eight-channel compression than for linear amplification, although the benefit, averaged across subjects, was typically only 0.5 to 0.9 dB. The lowest mean SRT (-9.9 dB, expressed as a speech-to-background ratio) was obtained for noise (4) and the system with eight-channel compression. This is about 6 dB worse than for elderly subjects with near-normal hearing, when tested without amplification. It is concluded that amplification, and especially fast-acting compression amplification, can improve the ability to understand speech in background sounds with spectral and temporal dips, but it does not restore performance to normal.

Aged↗

PubMed1998

Comprehension of language in congenitally deaf children with and without cochlear implants.

The consequences of profound early deafness on oral language in children are drastic. The modern cochlear implant (CI) has been shown to enhance speech production skills in prelingually deaf children. Many factors may contribute to a poor or an excellent outcome, making it difficult to compare groups of children wearing or not wearing cochlear implants. The present study compared receptive language levels in matched pairs of children from CI group and non-CI groups. The pre-op receptive language development curve suggest a possible growth over time with the maturation and the speech therapy. Comparison showed that the slope for post-op CI children to be greater than for non-CI children, and that this difference is statistically significant, and that the slope for CI children to be greater post- than pre-operatively. The main conclusion is that receptive language scores grow significantly higher over time after surgery in CI than in pair-matched non-CI children, despite better initial pure tone audiometric thresholds of the latter.

Age Factors↗

PubMed2000

Binaural sluggishness in the perception of tone sequences and speech in noise.

The binaural system is well-known for its sluggish response to changes in the interaural parameters to which it is sensitive. Theories of binaural unmasking have suggested that detection of signals in noise is mediated by detection of differences in interaural correlation. If these theories are correct, improvements in the intelligibility of speech in favorable binaural conditions is most likely mediated by spectro-temporal variations in interaural correlation of the stimulus which mirror the spectro-temporal amplitude modulations of the speech. However, binaural sluggishness should limit the temporal resolution of the representation of speech recovered by this means. The present study tested this prediction in two ways. First, listeners' masked discrimination thresholds for ascending vs descending pure-tone arpeggios were measured as a function of rate of frequency change in the NoSo and NoSpi binaural configurations. Three-tone arpeggios were presented repeatedly and continuously for 1.6 s, masked by a 1.6-s burst of noise. In a two-interval task, listeners determined the interval in which the arpeggios were ascending. The results showed a binaural advantage of 12-14 dB for NoSpi at 3.3 arpeggios per s (arp/s), which reduced to 3-5 dB at 10.4 arp/s. This outcome confirmed that the discrimination of spectro-temporal patterns in noise is susceptible to the effects of binaural sluggishness. Second, listeners' masked speech-reception thresholds were measured in speech-shaped noise using speech which was 1, 1.5, and 2 times the original articulation rate. The articulation rate was increased using a phase-vocoder technique which increased all the modulation frequencies in the speech without altering its pitch. Speech-reception thresholds were, on average, 5.2 dB lower for the NoSpi than for the NoSo configuration, at the original articulation rate. This binaural masking release was reduced to 2.8 dB when the articulation rate was doubled, but the most notable effect was a 6-8 dB increase in thresholds with articulation rate for both configurations. These results suggest that higher modulation frequencies in masked signals cannot be temporally resolved by the binaural system, but that the useful modulation frequencies in speech are sufficiently low (<5 Hz) that they are invulnerable to the effects of binaural sluggishness, even at elevated articulation rates.

Auditory Threshold↗

PubMed1991

Comparison of objective and subjective measures of speech intelligibility in elderly hearing-impaired listeners.

Three experiments were performed to evaluate the use of subjective intelligibility estimations as a method for measuring hearing aid benefit. Subjective and objective speech intelligibility scores were compared for young normal-hearing and elderly hearing-impaired listeners. Objective intelligibility scores were obtained using the Connected Speech Test (CST). This test consists of conversationally produced passages of speech that the listener repeats sentence by sentence. To provide subjective intelligibility scores, listeners estimated the percentage that they understood of each CST passage. Comparison of the two types of scores revealed that they were closely related in both groups of subjects (r = .82-.92). Although the two types of scores were essentially equal for normal-hearing subjects, the hearing-impaired listeners tended to produce subjective estimations of intelligibility that were significantly lower than their objective scores. Manipulation of visual cues and amplification, in an attempt to influence the hearing-impaired listeners' expectation of understanding speech, had no effect on the subjective-objective score differential. The difference between subjective and objective scores in the hearing-impaired group was not related to audiometric variables such as speech reception threshold, audiogram, or duration of hearing loss. It was concluded that comparative hearing aid evaluations using subjective intelligibility estimates would usually produce the same relative outcome as evaluations using the objective intelligibility measurement procedure. However, scores obtained with the objective procedure had smaller critical differences. Thus, when both types of scores are based on the same number of passages, the objective measurement procedure would be the more sensitive to differences among hearing aids.

Adolescent↗

PubMed1987

Relations between speech intelligibility and psychoacoustical modulation transfer function (PMTF).

The modulation transfer function, MTF, has proved to be a powerful measure for predicting speech intelligibility in speech transmission channels. We extended it to include the ear, by measuring the psycho-acoustical MTF, i.e. the PMTF. Tone thresholds of 11 normal-hearing and 20 hearing-impaired subjects were measured in presence of unmodulated and intensity modulated noise. Octave frequencies from 500 to 4,000 Hz were used. The noise was octave filtered around the frequency of the probe tone. Six modulation frequencies from 1 to 50 Hz were used. From these results the PMTFs were calculated, as well as the corresponding psycho-acoustical speech transmission indices, i.e. the PSTIs. The subjects' speech discrimination scores in quiet and speech reception thresholds in noise were also measured. A correlation coefficient of 0.85 between the speech discrimination score in quiet and the PSTI was obtained. For the speech reception threshold in noise and the PSTI, the correlation was 0.71. The first of these two figures is promising, but our method needs some improvement, as it gave some problems due to fatigue effects.

Hearing Loss, Sensorineural↗

PubMed1978

[Early and late functional hearing results from a modified technique for tympanoplasty (author's transl)].

This paper is a comparative study of the early and late functional results of tympanoplastic operations, as modified by Khan. Following such surgery, we examined 494 patients who had been operated on between 1970--1972 in the ENT Clinic of the Free University of Berlin (Klinikum Westend). Preliminary and final hearing results were recorded with the aid of sound audiograms, which were critically assessed by two different types of evaluations. These included the results of pure-tone changes and speech reception thresholds as achieved by the tympanoplastic operations. On the basis of socially useful hearing improvements, the functional results of cases operated in our clinic are above average. The hearing gain shown from post-operative controls to the final studies is especially satisfactory, since this also includes an improvement in bone conduction.

Acoustic Impedance Tests↗

PubMed2004

Communication abilities of children with aided residual hearing: comparison with cochlear implant users.

OBJECTIVE: To compare the communication outcomes between children with aided residual hearing and children with cochlear implants. DESIGN: Measures of speech recognition and language were administered to pediatric hearing aid users and cochlear implant users followed up longitudinally as part of an ongoing investigation on cochlear implant outcomes. The speech recognition measures included the Lexical Neighborhood Test, Phonetically Balanced-Kindergarten Word Lists, and the Hearing in Noise Test for Children presented in quiet and noise (+5 dB signal-to-noise ratio). Language measures included the Peabody Picture Vocabulary Test: Third Edition (PPVT-III), the Reynell Developmental Language Scales, and the Clinical Evaluation of Language Fundamentals-Revised. Subjects The experimental group was composed of 39 pediatric hearing aid users with a mean unaided pure-tone average threshold of 78.2 dB HL (hearing level). The comparison group was composed of 117 pediatric cochlear implant users with a mean unaided pure-tone average threshold of 110.2 dB HL. On average, both groups lost their hearing at younger than 1 year and were fitted with their respective sensory aids at 2 to 2.6 years of age. Not every child was administered every test for a variety of reasons. RESULTS: Between-group performance was equivalent on most speech recognition and language measures. The primary difference found between groups was on the PPVT-III, in which the hearing aid group had a significantly higher receptive vocabulary language quotient than the cochlear implant group. Notably, the cochlear implant group was substantially younger than the hearing aid group and had less experience with their sensory devices on this measure. CONCLUSION: Data obtained from children with aided residual hearing can be useful in determining cochlear implant candidacy.

Audiometry, Pure-Tone↗