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Results for “Speech Reception Threshold Test”

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PubMed1983

Relations between auditory functions in impaired hearing.

Relations between auditory functions, as expressed by coefficients of correlation, were studied for a group of 22 sensorineurally hearing-impaired subjects with moderate losses. In addition to the audiogram, we measured frequency resolution, temporal resolution, and speech reception in quiet and in noise. Frequency resolution was derived from masking with comb-filtered noise and from the psychophysical tuning curve, for both paradigms in simultaneous and in nonsimultaneous masking. The critical ratio was also determined. Temporal resolution was determined with intensity-modulated noise and from backward and forward masking. All tests were performed at 1000 Hz. Correlations among tests were gathered in a matrix and subjected to a principal-components analysis. It turned out that tests on frequency resolution form a cluster, and are approximately independent of audiometric loss. Furthermore, hearing loss for speech in noise is closely allied to frequency resolution, whereas hearing loss for speech in quiet is governed by audiometric loss.

Adult↗

PubMed2006

Hearing loss in rheumatoid arthritis.

OBJECTIVE: The objective of this study was to evaluate whether patients with rheumatoid arthritis (RA) are more likely to have subclinical hearing loss compared with persons without RA. METHODS: This is a case-control cross-sectional study of 29 patients with RA with disease duration greater than 5 years. Five males and five females were recruited into each decade category (age 40-49, 50-59, and 60-69). These cases were matched in a 1:1 ratio by sex and age to 30 control subjects. A comprehensive set of audiometric and disease severity assessments were performed. RESULTS: Seventeen (59%) of 29 patients with RA had abnormal hearing for at least one frequency (four in one ear, 13 in two ears) by audiometry as did 14 (47%) of 30 control subjects (five in one ear, nine in two ears). The percentage of patients with hearing loss (% RA vs. % control subjects) was: 45% versus 40% sensorineural, 10% versus 7% conductive, and 3% versus 0% mixed hearing loss. In RA versus control subjects, acoustic reflex threshold was abnormal in 17% versus 7%; speech reception threshold was abnormal in 10% versus 3%. Tympanometry and otoacoustic emission findings were similar in both groups. Word recognition did not differ between patients with RA and control subjects. In patients with RA/control subjects, hearing handicap, dizziness, and health assessment questionnaires were abnormal in 28%/7%, 14%/3%, and 72%/7%, respectively. CONCLUSION: There was no difference found in objective audiometric measurements in patients with RA compared with non-RA control subjects. Subjectively patients with RA were more likely to perceive themselves as having hearing disturbances, which may be related to overall disease related functional impairment.

Acoustic Impedance Tests↗

PubMed2003

Otitis media and tympanostomy tube insertion during the first three years of life: developmental outcomes at the age of four years.

OBJECTIVE: In a long-term, prospective study, we set out to determine whether otitis media in the first 3 years of life persisting for periods currently considered developmentally threatening actually results in later impairments of children's cognitive, language, speech, or psychosocial development; whether prompt insertion of tympanostomy tubes prevents or lessens any such impairments; and whether, irrespective of causality, associations exist between persistent early-life otitis media and later developmental impairments. This report describes findings in study participants at the age of 4 years. METHODS: We enrolled 6350 healthy infants from 2 to 61 days of age at urban hospitals and 2 small-town/rural and 4 suburban private pediatric practices. We regularly evaluated the children for the presence of middle-ear effusion (MEE) throughout their first 3 years of life by pneumatic otoscopy, supplemented by tympanometry; we monitored the validity of the otoscopic observations on an ongoing basis; and we treated children for otitis media according to specified guidelines. In the clinical trial component of the study, we randomly assigned 429 children who met specified minimum criteria regarding the persistence of MEE to undergo tympanostomy tube insertion either promptly or after a defined extended period if MEE remained present. In the associational component of the study, we selected a representative sample of 241 children who ranged from having no MEE to having MEE the cumulative duration of which fell just short of meeting randomization criteria for the clinical trial. In 397 (92.5%) of the children in the clinical trial and in 234 (97.1%) of the children in the representative sample, we assessed cognitive, language, speech, and psychosocial development at the age of 4 years, using formal tests, conversational samples, and parent questionnaires. RESULTS: In children in the randomized clinical trial, there were no statistically significant differences in mean (+/-standard deviation) scores (higher denotes more favorable) favoring the early-treatment group over the late-treatment group on the General Cognitive Index of the McCarthy Scales of Children's Abilities (97 +/- 14 and 98 +/- 14, respectively); the Peabody Picture Vocabulary Test-Revised, a measure of receptive language (90 +/- 15 vs 92 +/- 16); the Nonword Repetition Test, a measure of phonological memory (66 +/- 12 vs 70 +/- 12); the Number of Different Words, a measure of word diversity (150 +/- 34 vs 150 +/- 31); the Mean Length of Utterance in Morphemes, a measure of sentence length and grammatical complexity (3.4 +/- 0.8 vs 3.4 +/- 0.7); or the Percentage of Consonants Correct-Revised, a measure of speech-sound production (92 +/- 5 vs 93 +/- 5). There were also no significant differences in ratings (higher denotes less favorable) on the Parenting Stress Index-Short Form (Total Stress scores: 68 +/- 18 vs 65 +/- 17) or the Child Behavior Checklist (Total Problem T scores: 50 +/- 10 vs 49 +/- 10). In the associational component of the study, correlations between the children's durations of MEE and their developmental outcomes were generally weak and, in most instances, nonsignificant. Exceptions, after adjustment for sociodemographic variables and for hearing thresholds at the time of developmental testing, consisted of a significant negative correlation between children's cumulative durations of MEE in their first 3 years of life and scores on the McCarthy Verbal subscale, and significant positive correlations between durations of MEE and scores on 2 measures of parent-child stress. The percentage of variance in these scores explained by time with MEE beyond that explained by sociodemographic variables ranged from 1.6% to 3.3%. In both the randomized clinical trial and the associational component, sociodemographic variables seemed to be the most important factors influencing developmental outcomes, and in both components, the results at 4 years of age were consistent with the results that had been obtained at 3 years of age. CONCLUSIONS: In otherwise healthy children who are younger than 3 years and have persistent MEE within the duration limits that we studied, prompt insertion of tympanostomy tubes does not measurably improve developmental outcomes at 4 years of age. In such children, persistent MEE within the duration limits that we studied is negligibly associated with and probably does not affect developmental outcomes at 4 years of age.

Child Behavior↗

PubMed2000

Use of temporal envelope cues by children with developmental dyslexia.

This study evaluates the ability to process auditory temporal-envelope cues in a group of 6 children with dyslexia (mean age: 10;10 years;months). To address this issue, we measured (a) temporal modulation transfer functions (TMTFs), that is, the detection thresholds of sinusoidal amplitude modulation (SAM) applied to a white noise carrier, as a function of modulation frequency, fm (fm was 4, 16, 64, 256, and 1,024 Hz) and (b) identification performance for vowel-consonant-vowel (VCV) stimuli over 5 sessions. VCV stimuli were either unprocessed or digitally processed to remove the original spectral information, resulting in a time-varying speech envelope amplitude modulating a noise carrier. The same tests were conducted in 6 normal control children (mean age: 11;6 years;months) and 6 normal control adults (mean age: 24;8 years;months). SAM thresholds were similar in normal children and adults. For both normal groups, TMTFs were low pass in shape and showed low between-listener variability. TMTFs measured in children with dyslexia showed higher between-listener variability: TMTFs were band pass in 2 children, flat in 1 child, and low pass in the 3 others. Overall, SAM thresholds were higher in children with dyslexia than in normal children at fm = 4 and 1,024 Hz. Unprocessed-speech identification performance was nearly perfect in normal children and adults, and impaired in children with dyslexia. "Speech-envelope noise" identification performance was poorer in normal children and children with dyslexia than in normal adults. Performance improved across sessions in normal children and adults, but remained constant in children with dyslexia. Compared to normal children, children with dyslexia showed poorer reception of voicing, manner, and place of articulation for unprocessed speech and poorer reception of voicing for "speech-envelope noise." Taken together, these results support the hypothesis that some children with dyslexia may show abnormal auditory temporal-envelope processing. Such a deficit, in turn, may explain the difficulties of children with dyslexia with speech perception.

Adolescent↗

PubMed2007

Intratympanic dexamethasone for sudden sensorineural hearing loss after failure of systemic therapy.

OBJECTIVE: Intratympanic steroids are increasingly used in the treatment of inner ear disorders, especially in patients with sudden sensorineural hearing loss (SNHL) who have failed systemic therapy. We reviewed our experience with intratympanic steroids in the treatment of patients with sudden SNHL to determine overall success, morbidity, and prognostic factors. HYPOTHESIS: Intratympanic steroids have minimal morbidity and the potential to have a positive effect on hearing recovery in patients with sudden SNHL who have failed systemic therapy. STUDY DESIGN: The authors conducted a retrospective review. METHODS: Patients presenting with sudden SNHL defined as a rapid decline in hearing over 3 days or less affecting 3 or more frequencies by 30 dB or greater who underwent intratympanic steroids therapy (24 mg/mL dexamethasone) were reviewed. Excluded were patients with Meniere disease, retrocochlear disease, autoimmune HL, trauma, fluctuating HL, radiation-induced HL, noise-induced HL, or any other identifiable etiology for sudden HL. Patients who showed signs of fluctuation of hearing after injection were excluded. Pretreatment and posttreatment audiometric evaluations including pure-tone average (PTA) and speech reception threshold (SRT) were analyzed. Patient variables as they related to recovery were studied and included patient age, time to onset of therapy, status of the contralateral ear, presence of diabetes, severity of HL, and presence of associated symptoms (tinnitus, vertigo). A 20-dB gain in PTA or a 20% improvement in SDS was considered significant. RESULTS: : Forty patients fit the criteria for inclusion in the study. The mean age of the patients was 54.8 years with a range from 17 to 84 years of age. Overall, 40% (n = 16) showed any improvement in PTA or SDS. Fourteen (35%) men and 26 (65%) women were included. Using the criteria of 20-dB improvement in PTA or 20% improvement in SDS for success, 27.5% (n = 11) showed improvement. The mean number of days from onset of symptoms to intratympanic therapy was 40 days with a range of 7 days to 310 days. A statistically significant difference was noted in those patients who received earlier injection (P = .0008, rank sum test). No patient receiving intratympanic dexamethasone after 36 days recovered hearing using 20-dB PTA decrease or a 20% increase in discrimination as criteria for recovery. Twelve percent (n = 5) of patients in the study had diabetes with 20% recovering after intratympanic dexamethasone (not significantly different from nondiabetics at 28.6%, Fisher exact test, P = 1.0). Comparison to other studies that used differing steroid type, concentration, dosing schedule, inclusion criteria, and criteria for success revealed, in many instances, a similar overall recovery rate. CONCLUSIONS: Difficulty in proving efficacy of a single modality is present in all studies on SNHL secondary to multiple treatment protocols, variable rates of recovery, and a high rate of spontaneous recovery. Forty percent of patients showed some improvement in SDS or PTA after treatment failure. When criteria of 20-dB PTA or 20% is considered to define improvement, the recovery rate was 27.5%. Modest improvement is seen with the current protocol of a single intratympanic steroid injection of 24 mg/mL dexamethasone in patients who failed systemic therapy. Dramatic hearing recovery in treatment failures was rarely encountered. No patient showed significant benefit from intratympanic steroids after 36 days when using this protocol for idiopathic sudden SNHL. If patients injected after 6 weeks are excluded from the study, the improvement rate increases from 26.9% to 39.3%. Earlier intratympanic injection had a significant impact on hearing recovery, although with any therapeutic intervention for sudden SNHL, early success may be attributed to natural history. If we further exclude seven patients treated with intratympanic steroids within 2 weeks of the onset of symptoms (i.e., study only those patients treated with intratympanic dexamethasone between 2 and 6 weeks after onset of symptoms), still, 26% improved by 20 dB or 20% SDS. The recovery rates after initial systemic failure are higher than would be expected in this treatment failure group given our control group (9.1%) and literature review. These findings indicate a positive effect from steroid perfusion in this patient population.

Adolescent↗

PubMed2002

The learning curve revisited: stapedotomy.

OBJECTIVE: To determine whether the outcome of stapedotomy changes with experience. STUDY DESIGN AND SETTING: Retrospective case review of an academic otologic practice of a fellowship-trained otologist that consisted of 50 consecutive patients who underwent primary stapedotomy. The main outcome measures were preoperative and postoperative audiograms for both the operated ear and the opposite ear (control). RESULTS: There were no major complications or loss of hearing among the 50 patients. Minor complications included 1 middle ear infection, 2 torn flaps, and 1 tympanic membrane perforation. One patient had worse conductive hearing loss after surgery. The hearing of 2 patients was unchanged. Hearing for the entire group improved (P > 0.001) from a speech reception threshold of 55 dB (SD, 17 dB) to 30 dB (SD, 19 dB). Complete closure of the air-bone gap was achieved in 20% of the first 10 patients and 30% of the last 10 patients. CONCLUSIONS: The results of stapedotomy improve with experience, although the learning curve seems less steep than has been reported for total or near-total footplate removal. SIGNIFICANCE: Stapedotomy can be successfully performed early in surgical experience, but the learning curve should be acknowledged and discussed with the patient.

Adolescent↗

PubMed1989

DANTALE: a new Danish speech material.

A new Danish speech material (DANTALE) for clinical and experimental speech audiometry is digitally recorded on compact disc (CD). The speech material is designed to meet present audiological requirements at Danish hearing centres. One channel of the CD contains the speech signals and the other a masking noise. The CD also contains various calibration signals recorded on both channels at the end of the CD. The speech material compromises: 1) Digit triplets for the measurement of speech reception threshold (SRT). 2) Lists of monosyllabic words for the measurement of discrimination score (DS) for adults, children and small children. The word lists for the adults are equalized with regard to important phonetic and "visual" elements and the word lists for the children consist of minimal pairs. 3) Continuous speech for the measurement of the most comfortable loudness level (MCL), assessment of hearing aid fitting and the like. The masking noise is an amplitude-modulated, speech-shaped noise signal, which is designed to simulate a 4-person speech babble in order to assess both the frequency selectivity and the temporal resolution. The speech material is described and the long-term power spectra and modulation spectra are given.

Audiometry, Speech↗

PubMed1993

Effect on the speech reception threshold in noise of the recovery time of the compressor in the high-frequency channel of a two-channel aid.

This paper describes two experiments in a series evaluating and optimising a hearing aid incorporating two forms of automatic gain control (AGC). The first form is a front-end AGC which is normally slow acting and which compensates for variations in the overall level of speech from one situation to another. The second form of AGC follows the front-end AGC. The signal is split into two frequency bands, and fast-acting AGC is applied in the upper band only. The bands are then recombined. The two experiments described here were aimed at determining the optimum value of the recovery time of the AGC in the high-frequency channel. Speech reception thresholds (SRTs) were measured in the presence of speech-shaped noise as a function of the recovery time, for subjects with mild-to-moderate sensorineural loss. In the first experiment the recovery time was varied over the range 10-80 ms. SRTs tended to be lowest (best) at the shorter recovery times but the effects were small. In the second experiment, the recovery time was varied over the range 5-320 ms. In this case, there was a clear trend for SRTs to increase with increasing recovery time. A recovery time of about 20 ms appears to be optimal.

Aged↗

PubMed1998

Dexamethasone inner ear perfusion for the treatment of Meniere's disease: a prospective, randomized, double-blind, crossover trial.

OBJECTIVE: To investigate the benefits of intratympanic administration of dexamethasone in the treatment of unilateral Meniere's disease, with particular attention to the symptoms of hearing loss and tinnitus. STUDY DESIGN: A prospective, randomized, double-blind, crossover study comparing improvements in hearing loss, tinnitus, aural fullness, and caloric vestibular response secondary to intratympanic dexamethasone and sodium hyaluronate injection versus placebo consisting of saline and sodium hyaluronate. SETTING: A private otology/neurotology practice. PATIENTS: Twenty patients diagnosed with either definite or probable Meniere's disease as defined by the American Academy of Otolaryngology Head and Neck Surgery Committee on Hearing and Equilibrium. All patients were < or =21 years old and were not receiving any other form of treatment for their Meniere's disease. Each patient's primary symptoms of concern were hearing loss, aural fullness, and roaring tinnitus. INTERVENTIONS: Three consecutive daily administrations of intratympanic dexamethasone or placebo to the involved ear. MAIN OUTCOME MEASURES: Changes in audiometric pure-tone averages, speech reception thresholds, caloric vestibular responses, scores on the tinnitus handicap inventories, questionnaires, and telephone interview responses. RESULTS: No significant changes were observed in any measured parameter. Patients were unable to consistently identify which medication was dexamethasone and which was placebo. CONCLUSIONS: Intratympanic administration of dexamethasone in a group of patients with unilateral Meniere's disease (Shea's stage IV) showed no benefit over placebo for the treatment of hearing loss and tinnitus.

Adult↗

PubMed2000

Acoustic neuroma: deterioration of speech discrimination related to thresholds in pure-tone audiometry.

Pure-tone and speech audiometry were performed in 231 patients with a unilateral acoustic neuroma. Tumor sizes were obtained through imaging. Audiometric parameters, such as the mean pure-tone thresholds, the maximum discrimination, the slope of the speech audiogram, the roll-over index and the difference between the speech reception threshold and the Fletcher index, were studied and compared with data in the literature. Results showed that patients with an acoustic neuroma have worse speech discrimination than can be expected from the pure-tone audiogram. However, the results presented here indicate that hearing impairments nowadays are not as severe as those described in earlier studies. More patients with a unilateral acoustic neuroma are detected, including even those with a minor hearing impairment. The roll-over index is not characteristic for patients with an acoustic neuroma.

Adult↗

PubMed1998

Hearing results in pediatric patients after canal-wall-up and canal-wall-down mastoid surgery.

Hearing results were studied in pediatric patients after canal-wall-up and canal-wall-down mastoid surgery in a private practice setting. A retrospective chart review was performed on 69 patients who underwent surgery from 1991-1995. Twenty-six patients underwent canal-wall-up mastoidectomies, and 43 patients underwent canal-wall-down mastoidectomies. Various types of ossicular reconstruction were performed in patients in both groups. Hearing was evaluated for preoperative and postoperative pure-tone averages, speech-reception thresholds, and air-bone gaps for the various types of ossicular reconstruction. Patients with canal-wall-up mastoidectomies and an intact ossicular chain had an average postoperative air-bone gap of 15 dB, whereas reconstruction of the ossicular chain (regardless of technique) resulted in an average postoperative air-bone gap of 19 dB. Patients with canal-wall-down mastoidectomies and an intact ossicular chain had an average air-bone gap of 15 dB, while all techniques of ossicular reconstruction had an average air-bone gap of 29 dB. Canal-wall-up and canal-wall-down mastoid surgeries in pediatric patients have similar hearing results. Variables other than hearing should be used to make treatment decisions regarding the canal wall in pediatric candidates for mastoid surgery.

Adolescent↗

PubMedDate not supplied

Hearing sensitivity in patients with myxoedema before and after treatment with l-thyroxine.

Fifteen patients with confirmed myxoedema, median age 76 years, were consecutively referred for audiological evaluation. The diagnosis of myxoedema was based on the symptomatology, typical clinical appearance, increased TSH level and decreased T4. The audiological evaluation included routine ENT-examination, pure-tone octave audiometry, determination of speech reception threshold and discrimination score. The function of the middle ear was evaluated by impedance audiometry, indicating both middle ear pressure and stapedial reflex thresholds elicited by contralateral stimulation. All patients were evaluated in the myxoedematous state before treatment with l-thyroxine and reevaluated when treated and found euthyroid, both by the clinical investigation and as judged by chemical thyroid parameters. Bilateral symmetrical or nearly symmetrical sensorineural hearing loss was demonstrated in all patients before treatment. The results indicate that in elderly patients with myxoedema no improvement in hearing sensitivity can be demonstrated upon l-thyroxine medication. Patients with myxoedema at this age demonstrate neither more nor less degree of hearing loss when related to an age-matched group of hearing impaired patients. In patients with myxoedema the hearing impairment is found to be equal to that of an age and sex matched control group exhibiting true age-related hearing loss.

Acoustic Impedance Tests↗

PubMed1993

[Relation between pure tone audiometry and speech audiometry in various hearing-impaired listeners].

Pure tone audiometry and speech audiometry were performed in 30 normal-hearing listeners and 75 listeners suffering from conductive, sensorineural hearing loss or presbyacusia. The results were as follows: (1) For listeners with conductive or mild sensorineural hearing loss, or with mild presbyacusia, the difference between speech reception thresholds (SRT) and pure tone averages (PTA) was not significant (P > 0.05). (2) For listeners with profound sensorineural hearing loss or presbyacusia, the SRT were about 10 dB greater than the PTA. (3) The maximum discrimination score (PBXax) measurements should be made at a comfortable intensity for each listener, some 30 dB above the SRT in general. We conclude that the PTA can replace the SRT directly for the listeners described in (1) or that the PTA, by adding 10 dB, can also be used as a replacement of the SRT for the listeners described in (2).

Adolescent↗

PubMed2006

Prediction of speech intelligibility in spatial noise and reverberation for normal-hearing and hearing-impaired listeners.

Binaural speech intelligibility of individual listeners under realistic conditions was predicted using a model consisting of a gammatone filter bank, an independent equalization-cancellation (EC) process in each frequency band, a gammatone resynthesis, and the speech intelligibility index (SII). Hearing loss was simulated by adding uncorrelated masking noises (according to the pure-tone audiogram) to the ear channels. Speech intelligibility measurements were carried out with 8 normal-hearing and 15 hearing-impaired listeners, collecting speech reception threshold (SRT) data for three different room acoustic conditions (anechoic, office room, cafeteria hall) and eight directions of a single noise source (speech in front). Artificial EC processing errors derived from binaural masking level difference data using pure tones were incorporated into the model. Except for an adjustment of the SII-to-intelligibility mapping function, no model parameter was fitted to the SRT data of this study. The overall correlation coefficient between predicted and observed SRTs was 0.95. The dependence of the SRT of an individual listener on the noise direction and on room acoustics was predicted with a median correlation coefficient of 0.91. The effect of individual hearing impairment was predicted with a median correlation coefficient of 0.95. However, for mild hearing losses the release from masking was overestimated.

Acoustic Stimulation↗

PubMed1998

Profile of hearing in patients with unilateral acoustic neuromas: the importance of the contralateral ear.

OBJECTIVE: The aim of this study was to describe hearing in patients with a unilateral acoustic neuroma in relation to the sort and duration of symptoms. STUDY DESIGN: The study design was a retrospective clinical study. SETTING: The study was conducted at a tertiary referral center. PATIENTS: A total of 171 patients with a unilateral acoustic neuroma participated. INTERVENTION: Diagnostic measures were performed. MAIN OUTCOME MEASURES: The subjective experience of symptoms, a number of audiometric parameters of the affected and the contralateral side, tumor size, and their mutual relations were measured. RESULTS: No significant correlation was found between tumor size and audiometric parameters. Significant correlations could be shown between the duration of hearing loss and thresholds in the pure-tone audiogram, the speech reception threshold, and the maximum discrimination in the speech audiogram. Thresholds in the pure-tone audiogram of the contralateral ear were significantly worse than those of the international standard. A significant difference in age between men and women with unilateral acoustic neuromas was found. CONCLUSIONS: Hearing is not worse in patients with larger tumors. The longer the duration of subjective hearing loss, the more severe is hearing impairment. The hearing loss of the contralateral ear might be responsible for the composition of the category of patients in whom an acoustic neuroma is diagnosed effectively. Presumably, demographic features result in an age difference between male and female patients.

Adult↗

PubMed1991

Sound quality and speech reception for prescribed hearing aid frequency responses.

Four different prescriptions of hearing aid insertion gain versus frequency were validated with a group of 26 moderately hearing-impaired, elderly hearing aid users. Three prescriptions were based on calculating the loudness and articulation index (AI) for aided speech, and ranged from a frequency response with moderate high-frequency emphasis, restoring normal loudness for speech peaks, to a response with the greatest high-frequency emphasis, maximizing the AI. The fourth prescription was a well-established formula of the half-gain type. The frequency responses were evaluated by paired comparison ratings of the pleasantness and intelligibility of speech in noise, and by speech identification tests in noise. The subjects rated the flattest response as significantly more pleasant than the other responses, and significantly more intelligible than the prescription with maximal high-frequency emphasis. There were no detectable differences in signal/noise ratios required for 50% speech identification. These results indicate that a prescription that restores normal loudness for speech peaks in each critical band is probably more easily accepted than either a procedure which is intended to make all speech bands equally loud, or a prescription which maximizes the AI.

Aged↗

PubMed1985

Preservation of hearing in patients undergoing excision of acoustic neuromas and other cerebellopontine angle tumors.

Microsurgical techniques have made it possible to identify and preserve the cochlear nerve from its origin at the brain stem and along its course through the internal auditory canal in patients undergoing removal of small or medium-sized acoustic neuromas or other cerebellopontine angle (CPA) tumors. In a consecutive series of 100 patients with such tumors operated on between 1975 and 1981, an attempt was made to preserve the cochlear nerve in 23. The decision to attempt to preserve hearing was based on tumor size and the degree of associated hearing loss. In cases of unilateral acoustic neuroma, the criteria for attempted preservation of hearing were tumor size (2.5 cm or less), speech reception threshold (50 dB or less), and speech discrimination score (60% or greater). In patients with bilateral acoustic neuromas or tumors of other types, the size and hearing criteria were significantly broadened. All patients were operated on through a suboccipital approach. Hearing was preserved postoperatively in six (31.6%) of the 19 patients with unilateral acoustic neuromas, although the cochlear nerve was preserved in 16. Of the six patients with postoperative hearing, three retained excellent hearing, and the other three had only sound awareness and poor discrimination. Hearing was preserved in three cases with other CPA tumors, including an epidermoid cyst and small petrous meningiomas in the internal auditory canal. Of the two cases with bilateral tumors, hearing was preserved in one. Of the 23 patients in whom hearing preservation was attempted, nine (39.1%) had some postoperative hearing, which in six was equal to or better than the preoperative level. Thus, it is worthwhile to attempt hearing preservation in selected patients with CPA tumors.

Brain Neoplasms↗

PubMed1982

A model for the speech-reception threshold in noise without and with a hearing aid.

This paper presents a summary of the main results of our current research programme on the speech-reception threshold for sentences as a function of the sound-pressure level of interfering noise. The experimental results agree with a simple quantitative model in which every hearing loss for speech is interpreted as the sum of a class-A loss (attenuation), characterized by a reduction in the levels of both speech signal and noise, and a class-D loss (distortion), comparable to a reduction in S/N ratio. The experiments confirm the model's prediction that a hearing aid can compensate for class-A hearing losses but, generally, not for class-D hearing losses. The implies that the problem of having difficulties in understanding speech in a noisy environment, which is the primary handicap of hearing-impaired subjects, is not solved by the hearing aid.

Audiometry, Speech↗