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PubMed1998

Is the presence of transient evoked otoacoustic emmissions in ears with acoustic neuroma significant?

One hundred sixty-eight patients admitted for acoustic neuroma removal were involved in this study. In all cases, the size of the tumor and the presence or absence of tinnitus and vertigo or dizziness were evaluated. Investigated functional procedures included bilateral measures of pure-tone audiometry (PTA), auditory brainstem response (ABR), electronystagmography (ENG), and transient evoked otoacoustic emissions (TEOAEs). Thirty-five patients (21%) had normal preoperative TEOAEs in the affected ear, whereas 133 patients (79%) failed to show reproducible responses. The aims of this study were 1. to evaluate what distinguishes patients with preoperative TEOAEs in the pathological ear (group A) from those who had no TEOAE (group B); and 2. to determine in cases of attempted hearing preservation whether preoperative TEOAE presence in the neuroma ear (group C) was predictive of postoperative hearing preservation compared with the group of patients without TEOAEs (group D). The presence of vertigo or dizziness was significantly less frequent, the age was lower, and preoperative mean PTA loss in both ears was lower in group A compared with group B. Frequency of the other studied parameters and ABR threshold were similar in both groups. When hearing preservation was attempted, the mean preoperative PTA loss of group C patients was lower in both ears compared with group D. However, postoperative mean PTA loss did not significantly differ in the two groups. In group C, the percentage of hearing preservation (66.6%) was significantly higher than the percentage of deafness (33.4%), whereas in group D the percentage of postoperative preserved audition and deafness did not significantly differ (respectively 44.4% and 55.6%). The findings suggest that 1. TEOAEs in ears with acoustic neuromas are found in younger patients with a lower preoperative mean PTA loss and are accompanied by fewer functional complaints, perhaps because preserved TEOAEs indicate a better preservation of inner ear vasculature; and, 2. along with radiological and electrophysiological investigations, TEOAE presence in the pathological ear could provide an additional criterion or predictive factor for the successful outcome of attempted hearing-conservation surgery in ears with acoustic neuromas.

Age Factors↗
PubMed1977

Review of four new indices of susceptibility to noise-induced hearing loss.

The potential use of four new measures of susceptibility to acoustic trauma has been discussed. Each has the advantage, unlike TTS methodology, of not requiring a prior exposure stimulus. The use of an exposure sound has proven to be the major drawback to verification of Temkin's original hypothesis. A disadvantage inherent to the speech discrimination procedures involves the use of difficult-to-standardize speech materials and techniques. Consequently, one of the first three techniques, aural overload, threshold of octave masking, and brief-tone audiometry, is more desirable with aural overload having the most data to substantiate its use as a predictor of vulnerability to ear damage from acoustic overstimulation. None of these tests, on the other hand, has been correlated to permanent threshold shift (PTS). This necessitates the use of experimental animals or the long-term monitoring of the hearing sensitivity of industrial workers. Such data should prove invaluable in the search for an effective predictor of eventual noise-induced hearing loss.

Audiometry↗
PubMed2003

Round window atresia and its effect on sound transmission.

OBJECTIVE: To document isolated round window atresia and to discuss its impact on current theories of inner ear function. PATIENTS AND STUDY DESIGN: Retrospective analysis of isolated round window atresia suggesting an autosomal dominant inheritance pattern and review of current concepts of cochlear macromechanics. SETTING: Tertiary referral center. RESULTS: The unexpected finding of isolated round window atresia in two female patients of the same family was confirmed intraoperatively as well as postoperatively using high-resolution computed tomography. The current audiograms and the review of the literature highlight a mixed, but predominantly conductive, hearing impairment with thresholds at 30 to 40 dB. Implying that there is no pressure release mechanism for inner ear fluid displaced by the stapes footplate, a total conductive hearing loss would be expected. CONCLUSIONS: The rare finding of round window atresia can be overlooked at surgery because of insufficient exposure of the round window niche. High-resolution computed tomography confirms the round window obliteration. It seems that an alternative way of cochlear stimulation takes place besides the concept of fluid bulk shifting. Surgery seems not to guarantee favorable results.

Auditory Pathways↗
PubMed2003

Cochlear implantation in human immunodeficiency virus-infected patients.

OBJECTIVE: To evaluate the efficacy of cochlear implants in human immunodeficiency virus-infected individuals and correlate these results with a proposed pathophysiological mechanism of human immunodeficiency virus-associated hearing loss. STUDY DESIGN: Retrospective case series and temporal bone analysis of deceased human immunodeficiency virus-positive patients. SETTING: Tertiary care hospital. PATIENTS: Seven human immunodeficiency virus-positive individuals with profound sensorineural hearing loss. INTERVENTION: Cochlear implantation at New York University Medical Center. METHODS: The surgical outcomes and complications were analyzed. Additionally, electron microscopic and immunohistochemical findings of cadaver temporal bone specimens of other known human immunodeficiency virus-positive individuals were reviewed. The performance results of the human immunodeficiency virus-positive cochlear implant patients were then correlated with the previously hypothesized pathophysiological mechanism of human immunodeficiency virus-associated hearing loss. RESULTS: The patients had a varied performance with cochlear implantation, and as a group performance was good. There were no surgical complications or postoperative complications. The good performance of these patients supports the hypothesis that the mechanism of human immunodeficiency virus-associated deafness involves infiltration, malfunction, and premature degeneration of the hair cells and supportive cells of the cochlea. CONCLUSIONS: Human immunodeficiency virus-positive individuals benefit from cochlear implantation without increased surgical risk.

Adult↗
PubMed2003

Middle fossa versus retrosigmoid-transmeatal approach in vestibular schwannoma surgery: a prospective study.

OBJECTIVE: To compare the advantages, disadvantages, and results obtained with the middle fossa and retrosigmoid-transmeatal approaches during pure intracanalar vestibular schwannoma surgery in an attempt to preserve hearing. STUDY DESIGN: Prospective study of patients treated from 1998 to 2001. SETTING: Tertiary care referral center. PATIENTS: Patients with intracanalar vestibular schwannoma (size ranging from 4 to 12 mm), 25 operated on with the retrosigmoid-transmeatal technique and 25 via the middle fossa route. MAIN OUTCOME MEASURES: Facial nerve and auditory function were examined at 1 year with both techniques. Auditory results were also evaluated as a function of tumor size, distance from the internal auditory canal fundus, and internal auditory canal enlargement. RESULTS: The results indicated no significant difference in facial nerve and auditory function results between the two techniques. The retrosigmoid-transmeatal approach, however, yielded better facial nerve function results at discharge. Postoperative hearing was better when the distance from the fundus was greater than 3 mm, when the size of the vestibular schwannoma was equal to or less than 7 mm, and when the internal auditory canal enlargement was less than 3 mm. CONCLUSIONS: The middle fossa approach does not afford any particular advantages over the retrosigmoid-transmeatal approach in terms of auditory results. Facial nerve function is less satisfactory in the short term, when the middle fossa route is used, but can be improved by decompression and gentle displacement of the facial nerve in its labyrinthine portion.

Auditory Perception↗
PubMed2003

Identifying dead regions in the cochlea: psychophysical tuning curves and tone detection in threshold-equalizing noise.

OBJECTIVE: Recent studies indicate that high-frequency amplification may provide little benefit for listeners with moderate-to-severe high-frequency hearing loss, and may even reduce speech recognition. Moore and colleagues have proposed a direct link between this lack of benefit and the presence of regions of nonfunctioning inner hair cells (dead regions) in the basal cochlea and have suggested that psychophysical tuning curves (PTCs) and tone detection thresholds in threshold-equalizing noise (TEN) are psychoacoustic measures that allow detection of dead regions ([Moore, Huss, Vickers, Glasberg, & Alcántara, 2000]; [Vickers, Moore, & Baer, 2001]). The experiments reported here examine the consistency of TEN and PTC tasks in identifying dead regions in listeners with high-frequency hearing loss. DESIGN: Seventeen listeners (18 ears) with steeply sloping moderate-to-severe high-frequency hearing loss were tested in PTC and TEN tasks intended to identify ears with high-frequency dead regions. In the PTC task, pure-tone signals of fixed level were masked by narrowband noise that slowly increased in center frequency. For a range of signal frequencies, noise levels at masked threshold were determined as a function of masker frequency. In the TEN task, masked thresholds for pure-tone signals were determined for a fixed-level, 70 dB/ERB TEN masker (for some listeners, 85 or 90 dB/ERB TEN was also tested at selected probe frequencies). RESULTS: TEN and PTC results agreed on the presence or absence of dead regions at all tested frequencies in 10 of 18 cases (approximately 56% agreement rate). Six ears showed results consistent with either mid- or high-frequency dead regions in both tasks, and four ears did not show evidence of dead regions in either task. In eight ears, the TEN and PTC tasks produced conflicting results at one or more frequencies. In instances where the TEN and PTC results disagreed, the TEN results suggested the presence of dead regions whereas the PTC results did not. CONCLUSIONS: The 56% agreement rate between the TEN and PTC tasks indicates that at least one of these tasks was only partially reliable as a diagnostic tool. Factors unrelated to the presence of dead regions may contribute to excess masking in TEN without producing tip shifts in PTCs. Thus it may be appropriate to view tuning curve results as more reliable in cases where TEN and PTC results disagree. The current results do not provide support for the TEN task as a reliable diagnostic tool for identification of dead regions.

Aged↗
PubMed2004

Recording auditory steady-state responses in young infants.

OBJECTIVES: This study examined the auditory steady-state responses evoked by amplitude-modulated (AM), mixed-modulated (MM), exponentially-modulated (AM2), and frequency-modulated (FM) tones in 50 newborn infants (within 3 days of birth) and in 20 older infants (within 3-15 wk of birth). Our hypothesis was that MM and AM2 tonal stimuli would evoke larger responses than either the AM or FM tones, and that this increased size would make the responses more readily detectable. DESIGN: Multiple auditory steady-state responses were recorded to four tonal stimuli presented simultaneously to each ear at 50 dB SPL. The carrier frequencies of the stimuli were 500, 1000, 2000, and 4000 Hz and the modulation rates were between 78 and 95 Hz. Recordings lasting 12 minutes were obtained for each of the three types of modulation: 100% AM, MM (100% AM and 20% FM) and AM2. In six infants, responses to 20% FM were also recorded. RESULTS: In newborn infants, MM and AM2 stimuli produced responses that were on average 15% larger than AM stimuli. For AM, MM, and AM2 stimuli, the percentage of significant responses was 67%, 73%, 76%, respectively. Responses to FM stimuli were clearly evident in newborn infants and were about half the amplitude of the AM responses. Responses recorded in the older infants were 17% larger when evoked by MM and AM2 stimuli, rather than AM stimuli. Responses in the older infants were, on average, 32% larger and showed a higher incidence of significant responses than for infants in the first 3 days of life. For AM, MM, and AM2 stimuli, the percentage of significant responses was 82%, 82%, 84%, respectively. In both newborn and older infants, the overall percentage of significant responses was decreased by the 500 Hz results, which showed lower amplitudes and were less frequently detected than responses evoked by other frequencies. CONCLUSIONS: The responses to MM and AM2 tones were larger than those evoked by AM tones. Using these stimuli will increase the reliability and efficiency of evoked potential audiometry in infancy. Responses at 50 dB SPL are more easily detected at 3-15 wk of age than in the first few days after birth. Comprehensive frequency-specific testing of hearing using steady-state responses will likely be more accurate if postponed until after the immediate neonatal period.

Auditory Perception↗
PubMed2006

Peripheral audition of children on the autistic spectrum.

OBJECTIVE: To determine whether the peripheral audition of a group of children comprehensively diagnosed as being on the autistic spectrum was quantitatively different from that of a matched group of typically developing children. METHODS: Thirty-seven children with autism and an equal number of control participants matched for chronological age within 6 mo were examined by means of behavioral and physiologic measures of auditory function. All participants had normal hearing (thresholds <15 dB HL; 0.25 to 8 kHz) and normal middle ear function by quantitative tympanometry. Conventional behavioral audiometry, a computer-assisted threshold assessment procedure, acoustic middle ear muscle reflex thresholds, and evoked otoacoustic emissions (both transient and distortion product) tests were administered to both groups. RESULTS: No significant differences between children with autism and those developing typically on any behavioral or physiologic measure of peripheral auditory function were found. CONCLUSIONS: There was no evidence of intrinsic differences in the peripheral auditory mechanism of children with autism that would account for the auditory processing disorders and sound sensitivity that are commonly reported in this population.

Acoustic Impedance Tests↗
PubMed2006

Reduction of inhibition in the inferior colliculus after inner hair cell loss.

Effects of carboplatin-induced partial loss of inner hair cells on rate-level functions of neurons in the central nucleus of the inferior colliculus of the same chinchillas before and 1-3 months after carboplatin treatment were examined. Partial inner hair cell loss caused only a small elevation of response thresholds but induced a significant increase in the proportion of monotonic and a significant decrease in the proportion of non-monotonic rate-level functions at the characteristic frequency of 210 multiunits. This indicates that inhibition in the inferior colliculus is reduced after sensory deafferentation. We conclude that some of the functional changes reported in the auditory cortex after peripheral deafferentation are already realized at the level of the inferior colliculus.

Acoustic Stimulation↗
PubMed1992

Modulation discrimination interference and auditory grouping.

The detection of a change in the modulation pattern of a (target) carrier frequency, fc (for example a change in the depth of amplitude or frequency modulation, AM or FM) can be adversely affected by the presence of other modulated sounds (maskers) at frequencies remote from fc, an effect called modulation discrimination interference (MDI). MDI cannot be explained in terms of interaction of the sounds in the peripheral auditory system. It may result partly from a tendency for sounds which are modulated in a similar way to be perceptually 'grouped', i.e. heard as a single sound. To test this idea, MDI for the detection of a change in AM depth was measured as a function of stimulus variables known to affect perceptual grouping, namely overall duration and onset and offset asynchrony between the masking and target sounds. In parallel experiments, subjects were presented with a series of pairs of sounds, the target alone and the target with maskers, and were asked to rate how clearly the modulation of the target could be heard in the complex mixture. The results suggest that two factors contribute to MDI. One factor is difficulty in hearing a pitch corresponding to the target frequency. This factor appears to be strongly affected by perceptual grouping. Its effects can be reduced or abolished by asynchronous gating of the target and masker. The second factor is a specific difficulty in hearing the modulation of the target, or in distinguishing that modulation from the modulation of other sounds that are present. This factor has effects even under conditions promoting perceptual segregation of the target and masker.

Acoustic Stimulation↗
PubMed1992

The psychophysics of concurrent sound segregation.

To perceptually separate concurrent complex sounds, normally hearing listeners simultaneously combine information across a wide range of frequency components. Three psychoacoustical experiments are described which investigate different forms of this across-frequency processing. The first two experiments investigate the role of coherence of frequency modulation (FM) between widely separated frequency components of a complex sound. The first experiment bolsters existing evidence that, for harmonic sounds, listeners can discriminate coherent from incoherent FM, but only by detecting the mistuning that arises from incoherent FM. The second demonstrates that, for inharmonic sounds, coherence of FM has no effect on the phenomenon of modulation detection interference (see Moore & Shailer, this symposium) once within-channel cues (combination tones and beating) are masked by background noise. It is concluded that there is not an across-frequency mechanism specific to the detection of FM incoherence. The third experiment investigates the extent to which the detection of mistuning of one component of a harmonic complex is impaired by an interfering sound (the 'interferer') with a frequency spectrum similar to that of the mistuned component. When the interferer is gated on and off with the harmonic complex, it has only a small effect provided that its level is more than 3 dB below that of the target. However, when the interferer starts before and ends after the complex, thresholds are elevated more, and this elevation occurs even for low-level interferers. Explanations of this effect in terms of adaptation and of auditory streaming are discussed.

Acoustic Stimulation↗
PubMed1990

A non-invasive electrophysiological technique for the measurement of 'tuning'.

The frequency selectivity of the auditory system is mainly determined by the activity of the cochlea. A method of measuring this selectivity has been developed by recording the extratympanic compound auditory nerve action potential using non-simultaneous masking. This provides a non-invasive 4-point tuning curve centered at 4 kHz which demonstrates the typical features expected from animal experiments. The non-interactive nature of the test makes it easy to perform and normative data has been collected on 10 subjects.

Adult↗
PubMed2006

Prepulse inhibition of acoustic startle response in mild cognitive impairment and mild dementia of Alzheimer type.

Amnestic mild cognitive impairment (MCI) describes the condition of memory-impaired individuals who otherwise function well and do not meet the clinical criteria for dementia. Such individuals are considered to represent a transitional stage between normal aging and dementia of Alzheimer type (DAT). Neurobiologic changes in amnestic MCI, and their significance for psychophysiologic function, are poorly understood. In this study, the authors compared acoustic prepulse inhibition (PPI) between subjects with amnestic MCI and mild DAT to characterize sensorimotor gating. The acoustic startle reflex, which the authors measured using an accelerometer and electromyogram, involves whole-body movement and eye blink in response to a sudden loud noise (115 dB). PPI is inhibition of this reflex by a softer noise (prepulse; 85 dB) preceding the startle stimulus by 30 ms. PPI was examined in 30 controls, 20 subjects with amnestic MCI, and 20 subjects with mild DAT. Neither amnestic MCI nor mild DAT affected startle movement amplitude. Subjects with amnestic MCI showed significantly enhanced PPI (gating facilitation), while subjects with mild DAT exhibited significantly less PPI than controls (gating deficit). This pattern of PPI changes suggests that neuropathologic changes in the limbic cortex, mainly the entorhinal cortex, at the earliest stage of DAT might be responsible for PPI abnormalities via disturbed regulation of the limbic cortico-striato-pallido-pontine circuitry. Startle PPI changes could be used as a biologic marker for amnestic MCI and mild DAT.

Acoustic Stimulation↗
PubMed2005

Balanced inhibition and excitation underlies spike firing regularity in ventral cochlear nucleus chopper neurons.

Ventral cochlear nucleus stellate cells respond to characteristic frequency (CF) tones with sustained (C(S)), transient (C(T)) or onset chopping (O(C)) activity. The mechanisms underlying these different response patterns are not fully understood, and the present study used in vivo intracellular recordings (n = 42) in urethane-anaesthetized rats to examine the possible influence of inhibition on action potential regularity. Hyperpolarization following the offset of a CF tone burst was used as a measure of on-CF inhibition. A cluster analysis based on several membrane potential features, including on-CF inhibition, discriminated three groups in addition to the C(S) response type - two types of C(T) responses and the O(C) type. The different patterns of firing regularity exhibited by C(S/T) neurons reflected different thresholds or degrees of overlap between these cells' narrowly tuned excitatory and inhibitory inputs. C(T) cells with closely matched inhibitory and excitatory response areas showed substantial on-CF inhibition and the greatest decline in firing regularity during a CF tone, whereas those with a mismatch between their response areas showed lateral inhibition and a less marked decline in firing regularity. The presence of inhibition in C(S) neurons did not alter their firing regularity, possibly because of the lower threshold for excitation compared with inhibition. The latency, duration and frequency extent of sustained hyperpolarization in C(S/T) cells is inconsistent with the response properties of O(C) neurons, suggesting that another source(s) of inhibition influences firing regularity, and presumably response magnitude, in these neurons.

Acoustic Stimulation↗
PubMed2005

The dependence of the auditory evoked N1m decrement on the bandwidth of preceding notch-filtered noise.

The auditory evoked response is known to be changed by a preceding sound. In this study we investigated by means of magnetoencephalography how a preceding notch-filtered noise (NFN) with different bandwidths influences the human auditory evoked response elicited by the following test stimulus. We prepared white noise (WN) and four NFNs which were derived from WN by suppressing frequency regions around 1 kHz with 1/8-, 1/4-, 1/2- and 1-octave bandwidths. Stimulation for 3 s with this set of noises resulted in differences in responsiveness to a 1-kHz test tone presented 500 ms after the offset of the noises. The N1m response to the 1-kHz test tone stimulus was at a minimum when the preceding NFN had 1/4-octave stop-band frequencies as compared with 1/8-, 1/2- and 1-octave NFN and WN. This N1m decrement is explained by the imbalanced neural activities caused by habituation and lateral inhibition in the auditory system. The results contribute to understanding of the inhibitory system in the human auditory cortex.

Acoustic Stimulation↗
PubMed1994

Does lithotripsy cause hearing loss?

OBJECTIVE: To determine whether lithotripsy with the Dornier MPL9000 has any significant effect on the hearing of either patients or operators, as determined by pure tone audiometry. PATIENTS AND METHODS: Twenty patients had audiometry prior to a single exposure to lithotripsy and one hour after treatment. Staff were monitored on a 3 monthly basis. RESULTS: No evidence was found to suggest that single or repeated exposure to the noise emitted by this Dornier lithotripter was associated with any hearing loss. CONCLUSIONS: These results suggest that the risk to the hearing of patients exposed to lithotripter noise is negligible. Cochlear damage resulting from excessive noise depends on both the intensity of the sound and the duration of exposure. The acoustic properties of the building housing the machine may also be important and can significantly influence the intensity of the sound at the ear. At marginal levels it may be years before the deficit reaches a level that can be detected by subjective audiometry. In addition, susceptibility to noise induced hearing loss is difficult to predict. Although these results suggest that there is minimal risk to the hearing of staff members exposed to lithotripter noise, the authors recommend that staff exposed to repeated lithotripter noise over long periods undergo regular audiometric assessment (including a preemployment baseline assessment) to identify evidence of noise induced auditory trauma, and that protective equipment be worn by staff members to reduce the possibility of long-term damage.

Audiometry↗