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PubMed2005

Specific findings in distortion product otoacoustic emissions and growth functions with chronic tinnitus.

Chronic tinnitus has a very high prevalence in industrialized countries. Latest studies found chronic tinnitus in 4% of the German population, with almost 2% suffering severely in their daily life. Because no curative therapeutic approach is available--neither pharmacological nor surgical--the main focus lies in treatments that enhance the habituation of tinnitus. Habituation occurs in almost 50% of affected patients as a normal process, leading to a complete compensation. This finding is based on the ability of the auditory perception to habituate random noise and focus on important acoustic information. According to our audiological data, 90% of tinnitus patients have deficits in inner-ear function as a generator of tinnitus, mainly in the outer hair cells. This occurrence can be verified by registration of distortion products of otoacoustic emissions. Thus, the main origin of tinnitus is peripheral, and most patients suffer from accompanying hearing loss, even though it is sometimes mild or subjectively not even noticed. In almost 50% of our patients, we find hyperfunction of outer hair cells, again recorded via distortion products of otoacoustic emissions and their growth functions. Normal efferent reduction of distortion products through contralateral acoustic stimulation does not take place in most tinnitus patients. This finding shows that central auditory functions are also disturbed in chronic tinnitus patients, leading to reduced efferent effects on the hair cells and thus impeding habituation. Tests to verify these more central pathological findings have yet to be developed. We have data on diminished ability to distinguish stimuli from random noise by bilateral sound processing: The so-called bilateral masking difference test results are pathological in almost 30% of patients suffering from chronic tinnitus. We concluded from our audiological data that chronic tinnitus is primarily a cochlear dysfunction, but habituation is impeded by accompanying or consecutive deficits of the central auditory pathway. Regarding therapeutic approaches, these central functions can be trained by hearing therapy, as we know from patients' rehabilitation.

Adolescent↗
PubMed1982

Auditory perceptual abilities of formerly misarticulating children.

12 children who recently had satisfactorily completed therapy for 4+ phonemes, and normal controls, were given tasks of auditory perception consisting of (a) repeating 5-word recorded sentences (0, 1st- and 2nd-order approximations) at 0 and at 60% time compression, and (b) diotic and dichotic presentations at 40 db SL of the WIPI test split into 2 bandwidths (500-580 and 1950-2080 c/s). Results showed that the performance of the experimental Ss was significantly poorer than that of age-matched controls on time-compressed speech, but not on the binaural fusion task. The greatest diagnostic potential for time-compressed speech was at 60% compression. Results contrasted with previous data showing significantly poorer performance of severely misarticulating children on a binaural summation task (Flowers and Costello, J. Aud. Res., 1963, 3, 133-140). There is a need to monitor the auditory perceptual abilities of formerly misarticulating children with a battery of more than a single test.

Articulation Disorders↗
PubMed2006

Interpreting parental proxy reports of (health-related) quality of life for children with unilateral cochlear implants.

OBJECTIVE: To examine what factors are associated with EuroQol EQ-5D scores in children after unilateral cochlear implantation and to explore parental conceptualisations of health-related quality of life (HRQL) and quality of life (QoL). METHODS: Face to face interviews were conducted with the parents of 222 implanted children, in an attempt to elicit information on their child's HRQL and QoL. Post-implant, the child's HRQL was measured using the EQ-5D, completed by parental proxy. Regression analysis was undertaken in order to estimate the association between the child EQ-5D score and child characteristics, child performance, and parental characteristics, in order to assess the construct validity of the EQ-5D. HRQL was also measured using the EuroQol visual analogue scale (VAS), where the endpoints were the best and worst imaginable health state, and a VAS was also used to measure QoL (endpoints: best/worst imaginable QoL). Parents were asked to estimate scores on both these VAS measures both post-implantation and (retrospectively) pre-implantation. Throughout the HRQL and QoL elicitation process, subjects' comments, and observations were noted. RESULTS: Children who had an additional disability (p<0.001), were male (p<0.05) or had a lower level of auditory perception (p<0.001) were estimated to have lower EQ-5D scores, as were children whose parents who left school before age 18 years (p<0.05). According to the EuroQol VAS the mean difference between pre- and post-implantation score was 0.14, compared to 0.35 for the QoL VAS, demonstrating that parents tended not to see HRQL and QoL as equivalent. As 67% of parents deemed there to be no difference between the pre- and post-implant EuroQol VAS scores we also infer that the majority of parents rejected the notion of deafness being a HRQL issue. CONCLUSION: The evidence relating to the construct validity of the EQ-5D is variable-though it was able to discriminate between children with certain levels of auditory performance, it could not discriminate between children who differed in other ways. By limiting outcome from cochlear implantation to HRQL, as opposed to QoL, the benefits of cochlear implants are likely to be underestimated.

Child↗
PubMed2002

Auditory peripersonal space in humans.

In the present study we report neuropsychological evidence of the existence of an auditory peripersonal space representation around the head in humans and its characteristics. In a group of right brain-damaged patients with tactile extinction, we found that a sound delivered near the ipsilesional side of the head (20 cm) strongly extinguished a tactile stimulus delivered to the contralesional side of the head (cross-modal auditory-tactile extinction). By contrast, when an auditory stimulus was presented far from the head (70 cm), cross-modal extinction was dramatically reduced. This spatially specific cross-modal extinction was most consistently found (i.e., both in the front and back spaces) when a complex sound was presented, like a white noise burst. Pure tones produced spatially specific cross-modal extinction when presented in the back space, but not in the front space. In addition, the most severe cross-modal extinction emerged when sounds came from behind the head, thus showing that the back space is more sensitive than the front space to the sensory interaction of auditory-tactile inputs. Finally, when cross-modal effects were investigated by reversing the spatial arrangement of cross-modal stimuli (i.e., touch on the right and sound on the left), we found that an ipsilesional tactile stimulus, although inducing a small amount of cross-modal tactile-auditory extinction, did not produce any spatial-specific effect. Therefore, the selective aspects of cross-modal interaction found near the head cannot be explained by a competition between a damaged left spatial representation and an intact right spatial representation. Thus, consistent with neurophysiological evidence from monkeys, our findings strongly support the existence, in humans, of an integrated cross-modal system coding auditory and tactile stimuli near the body, that is, in the peripersonal space.

Aged↗
PubMed1993

Insular stroke causing unilateral auditory processing disorder: case report.

This case presentation describes a patient with a strategically placed lesion involving the right insula and adjacent white matter. The most remarkable finding associated with this case is the presence of a unilateral auditory processing disorder when presenting speech materials to the left ear. Intervention for this patient is described in addition to a discussion of possible explanations for the unique pattern of auditory dysfunction.

Audiometry, Pure-Tone↗
PubMed2005

Quality of life in postlingually deaf patients following cochlear implantation.

Most cochlear implant studies are focused on improvement of speech perception associated with implantation. The goal of this study was to assess the impact of cochlear implantation on quality of life changes in Spanish users. Thirty postlingually deaf patients fitted with a cochlear implant completed the Glasgow Benefit Inventory, a questionnaire dealing with communication abilities, and an open-ended questionnaire. The Glasgow Benefit Inventory revealed a positive effect in 93% of patients. The use of a cochlear implant significantly enhanced discrimination ability, telephone use and self-confidence. A high degree of satisfaction was achieved in all situations except with background noise. Ninety-six percent of patients would recommend the operation to a friend. A dramatic improvement in quality of life following cochlear implantation is revealed by a great majority of patients. The results cannot only be explained by enhancements to auditory perception.

Adolescent↗
PubMed2004

Auditory neglect: what and where in auditory space.

A sound that we hear in a natural setting allows us to identify the sound source and to localise it in space. Several lines of evidence indicate that the two aspects are processed in anatomically distinct cortical networks. Auditory areas that are part of the What or Where processing streams have been identified recently in man and in non-human primates. Comparison between anatomical and activation studies suggests that processing within either stream can be modulated by specific attentional factors. Attending to auditory events can be affected in neglect. Bisiach et al. (1984) described systematic directional errors to the ipsilesional space, which was considered a manifestation of hemispatial neglect and interpreted as a disruption of the neural network providing the internal representation of egocentric space. The other manifestation of auditory neglect is contralesional extinction in dichotic listening condition (Heilman and Valenstein, 1972). Recently two types of auditory neglect have been described, one corresponding to a primarily attentional deficit associated with basal ganglia lesions and the other to distortions of auditory space representations associated with parieto-prefrontal lesions (Bellmann et al., 2001). Based on studies of sound detection and sound recognition following hemispheric lesions we argue that the two types of neglect correspond to disturbed processing in either the What or the Where stream.

Attention↗
PubMed2003

Crossmodal temporal processing acuity impairment aggravates with age in developmental dyslexia.

Temporal processing has been found to be impaired in developmental dyslexia. We investigated how aging affects crossmodal temporal processing impairment with 39 dyslexic and 40 fluent 20-59-year-old readers. Cognitive temporal acuity was measured at millisecond levels in six tasks. They consisted of order judgments of two brief non-speech stimulus pulses, the stimuli being audiotactile, visuotactile and audiovisual, and of simultaneity/nonsimultaneity detection of the pulses in two parallel three-pulse trains. Temporal acuity declined with age in both reading groups and its impairment was observed in developmental dyslexia. A new finding was that the crossmodal temporal impairment, directly relevant to reading, increased with age. The age-related exacerbation suggests a developmental neuronal deficit, possibly related to magnocells, which exists before dyslexia and is its ontogenetic cause.

Acoustic Stimulation↗
PubMedDate not supplied

Use of 35 words for evaluation of hearing loss in signal-to-babble ratio: A clinic protocol.

Data from earlier studies that presented 70 words at 24 to 0 dB signal-to-babble (S/B) ratios indicated that most young listeners with normal hearing required 0 to 6 dB S/B ratios to attain 50% correct word recognition. Older listeners with hearing loss often required a >12 dB S/B ratio to attain 50% correct word recognition. In our study, we converted the Words in Noise test from one 70-word list into two 35-word lists for quicker administration by clinicians. Using baseline data from previous studies, we used two strategies to randomize the 35-word lists: based on recognition performance at each S/B ratio and based on recognition performance only. With the first randomization strategy, the 50% correct word-recognition points on the two lists differed by 0.5 dB for 72 listeners with hearing loss. With the second randomization strategy, 48 listeners with hearing loss performed identically on the two lists.

Adult↗
PubMed2001

Isolating the auditory system from acoustic noise during functional magnetic resonance imaging: examination of noise conduction through the ear canal, head, and body.

Approaches were examined for reducing acoustic noise levels heard by subjects during functional magnetic resonance imaging (fMRI), a technique for localizing brain activation in humans. Specifically, it was examined whether a device for isolating the head and ear canal from sound (a "helmet") could add to the isolation provided by conventional hearing protection devices (i.e., earmuffs and earplugs). Both subjective attenuation (the difference in hearing threshold with versus without isolation devices in place) and objective attenuation (difference in ear-canal sound pressure) were measured. In the frequency range of the most intense fMRI noise (1-1.4 kHz), a helmet, earmuffs, and earplugs used together attenuated perceived sound by 55-63 dB, whereas the attenuation provided by the conventional devices alone was substantially less: 30-37 dB for earmuffs, 25-28 dB for earplugs, and 39-41 dB for earmuffs and earplugs used together. The data enabled the clarification of the relative importance of ear canal, head, and body conduction routes to the cochlea under different conditions: At low frequencies (< or =500 Hz), the ear canal was the dominant route of sound conduction to the cochlea for all of the device combinations considered. At higher frequencies (>500 Hz), the ear canal was the dominant route when either earmuffs or earplugs were worn. However, the dominant route of sound conduction was through the head when both earmuffs and earplugs were worn, through both ear canal and body when a helmet and earmuffs were worn, and through the body when a helmet, earmuffs, and earplugs were worn. It is estimated that a helmet, earmuffs, and earplugs together will reduce the most intense fMRI noise levels experienced by a subject to 60-65 dB SPL. Even greater reductions in noise should be achievable by isolating the body from the surrounding noise field.

Adult↗
PubMed2004

Sequential streaming and effective level differences due to phase-spectrum manipulations.

Roberts et al. [J. Acoust. Soc. Am. 112, 2074-2085 (2002)] demonstrated that sequential stream segregation occurs with stimuli that differ only in phase spectrum. We investigated if this was partly due to differences in effective excitation level. Stimuli were harmonic complexes with a 100 Hz fundamental, 1250-2500 Hz passband, and cosine, alternating, or random component phase. In experiment 1, the complex tones were used as forward maskers of 20-ms probe tones at 1000, 1250, 1650, 2050, 2500, and 3000 Hz. While there was no significant difference in the masking produced by the cosine- and alternating-phase stimuli, the random-phase stimulus produced significantly greater masking, equivalent to a difference in overall effective excitation level of 12.6 dB. Experiments 2 and 3 used the asynchrony detection and subjective streaming tasks of Roberts et al. Successive stimuli had identical phase, but differed in level by 0, 1, 3, 5, 10, or 15 dB. Stream segregation increased once the level difference reached 5 dB. While some of the stream segregation observed by Roberts et al. may have been due to a difference in effective excitation level, this does not account for the stream segregation between cosine- and alternating-phase stimuli.

Acoustic Stimulation↗