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Reliability of computer-automated hearing thresholds in cochlear-impaired listeners using ER-4B Canal Phone earphones.

This paper describes the second phase of a study to determine test-retest reliability of hearing thresholds using a computer-automated technique with ER-4B Canal Phone insert earphones. The first phase documented reliable hearing thresholds in 20 normal-hearing individuals. For this second phase, 20 individuals with cochlear hearing loss completed the same testing protocol as for phase one. During each of two sessions, hearing thresholds were obtained in one-third octave steps at 500 Hz to 16,000 Hz. The octave frequencies were immediately retested, followed by ear-tip reinsertion and further retesting at octave frequencies. Both groups showed overall good threshold reliability, with observable differences between groups. First, repeated testing resulted in improved hearing thresholds for the normal-hearing group, but not for the cochlear-loss group. Second, the normal-hearing group showed overall better response reliability, both within and between sessions, than the cochlear-loss group. These differences were small but consistent.

Adult↗

Hearing aid troubleshooting based on patients' descriptions.

Clinical audiologists were surveyed to determine the terms that their patients use to describe their reaction to hearing aid fitting problems. From this survey, a vocabulary of 40 frequently reported terms was developed. A second survey of hearing aid fitting experts was conducted to determine their methods of troubleshooting a hearing aid fitting when the patient reports one of the frequently reported terms. There was a high degree of agreement among the 24 experts. Principal components analysis resulted in ten components that explained 90.8% of the variance in the experts' responses. These results can be applied as an expert system for fine-tuning hearing aid fittings.

Correction of Hearing Impairment↗

Noise levels of closing sounds in vivo are equal for different bileaflet mechanical heart valves.

BACKGROUND AND AIM OF THE STUDY: Patients with mechanical heart valves must endure the valve's closing sounds for the rest of their life. Sound pressure levels (SPLs) recorded show wide patient-to-patient variation, even for the same type of valve. The variation was attributed to body constitution variability and differences in hemodynamic status. It was hypothesized that aortic mechanical valves generate closing clicks which correlate in magnitude with hemodynamic parameters, such as the rate of relaxation of the left ventricle (dp/dt) and potential energy stored in the aortic windkessel. METHODS: Three different aortic mechanical heart valves were investigated in a porcine model (n = 9), namely St. Jude Medical, CarboMedics and ATS. Closing sounds were measured with a microphone placed in a portable anechoic chamber 10 cm above the exposed heart. Left ventricular pressure (LVP) and cardiac output were also measured. Different hemodynamic conditions were produced by intravenous infusion of isotonic saline and dobutamine. Volume regulation and atrial pacing were also applied. RESULTS: Different hemodynamic situations were established (cardiac output, 1.2-6.5 l/min; heart rate, 99-171 bpm). The measured mean SPLs were 49.5-53.9 dB(A), and there were no statistically significant differences in noise between the valves (p = 0.8; one-way ANOVA). Likewise, only a weak relationship was identified between different hemodynamic parameters and the SPLs recorded. CONCLUSION: The SPLs of the investigated bileaflet mechanical heart valves did not differ significantly. Moreover, the SPL was only weakly related to LVP during closure and estimated stroke work.

Adaptation, Physiological↗

Characteristics of tinnitus and etiology of associated hearing loss: a study of 123 patients.

The aim of this study was to highlight the clinical characteristics of tinnitus and to attempt a quantitative assessment in relation to any underlying etiologies. We undertook to study a population of 123 patients attending a tinnitus clinic between 1998 and 2000. Their answers on a questionnaire allowed detailed evaluation of the characteristics of tinnitus, including such variables as the circumstances in which the tinnitus was first noticed and evaluation of its intensity and frequency. The patients each underwent a full neurootological examination with the aim of diagnosing an etiology. The great majority of tinnitus patients had an endocochlear deafness and, among these patients, acoustic trauma, endolymphatic hydrops, and presbyacusis were the commonest diagnoses (32%, 32%, and 23%, respectively). Of these patients, 93.7% with noise trauma an 86.9% with presbyacusis described their tinnitus as a stable, high-pitched whistling. Those patients with active Ménière's disease or Ménière's-like syndrome described a low-pitched buzzing tinnitus. Analysis of those patients with a stable high-pitched tinnitus associated with a high-frequency hearing loss shows a statistically significant correlation between the elevation of the audiometric thresholds and the loudness of the tinnitus. For a large majority of patients with tinnitus, therefore, audiometry provides an indirect test for evaluating the tinnitus.

Adolescent↗

Reliability, sensitivity and validity of magnitude estimation, category scaling and paired-comparison judgements of speech intelligibility by older listeners.

This study investigated the reliability, sensitivity, and validity of speech intelligibility judgments for hearing aid evaluation. Subjects aged 60-87 years judged the intelligibility of sentences using either magnitude estimation, category scaling or paired comparisons. The 60+ age group was chosen as representative of the majority of hearing aid wearers. Speech recognition scores for Central Institute for the Deaf (CID) sentences and Northwestern University Auditory Test No. 6 (NU-6) words were also obtained. The speech was bandpass filtered using filter settings that produce a monotonic increase in predicted intelligibility based on articulation index theory. Speech recognition scores and intelligibility judgments were obtained for each of eight filter conditions. Test-retest reliability was poorest for paired comparisons and CID sentence scores. There were no differences in sensitivity among the three psychophysical procedures. Intelligibility judgments and NU-6 scores were more sensitive than CID sentence scores to differences among conditions. The results indicated that intelligibility judgments are valid measures of speech recognition.

Acoustic Stimulation↗

Patient experiences with multiband full dynamic range compression.

This investigation compared performance for 18 experienced hearing aid patients with a multiband full dynamic range compression hearing device and their previously worn linear or automatic gain control hearing aids. Performance was evaluated using a variety of clinical tests. These included functional gain and dynamic range measurements, speech recognition, and real ear measurements. Patients rated their performance with the multiband compression device and their previously worn aids on a rating scale pertaining to a variety of real life listening situations. Statistical analysis of data derived from test results shows significantly improved performance on all measures using the multiband compression aid over their conventional aids. Patients rated their performance higher with the compression instrument than with the conventional aids. Differences in performance on clinical tests and subjective patient responses appear to be related to the different signal processing schemes used in the two groups of devices.

Adolescent↗

Measures of tinnitus: step size, matches to imagined tones, and masking patterns.

Measures of the pitch (0.2% step) and loudness (2 dB step) of tinnitus were obtained using a forced-choice double-staircase procedure. In the first experiment, for seven subjects with tinnitus, the difference limen of pitch and loudness matches made to tinnitus within a single block of trials was not significantly different from that of the same measurements made to comparable external stimuli. In the second experiment, subjects matched the pitch of real and imagined tones. For 3 of 7 subjects with tinnitus and for 2 of 14 normal-hearing subjects, the difference limens were nearly equal. In the first experiment, therefore, three of the subjects with tinnitus might have matched to an imagined tone and not to their tinnitus. In the third experiment, thresholds of tones near the presumed tinnitus frequency were measured. Thresholds were approximately equal in the presence of the tinnitus. However, in the presence of a masking tone at the presumed tinnitus frequency and level, thresholds were unequal. Thus, tinnitus did not behave as a tonal masker.

Acoustic Stimulation↗

Noise, noise sensitivity and psychiatric disorder: epidemiological and psychophysiological studies.

Noise, a prototypical environmental stressor, has clear health effects in causing hearing loss but other health effects are less evident. Noise exposure may lead to minor emotional symptoms but the evidence of elevated levels of aircraft noise leading to psychiatric hospital admissions and psychiatric disorder in the community is contradictory. Despite this there are well documented associations between noise exposure and changes in performance, sleep disturbance and emotional reactions such as annoyance. Moreover, annoyance is associated with both environmental noise level and psychological and physical symptoms, psychiatric disorder and use of health services. It seems likely that existing psychiatric disorder contributes to high levels of annoyance. However, there is also the possibility that tendency to annoyance may be a risk factor for psychiatric morbidity. Although noise level explains a significant proportion of the variance in annoyance, the other major factor, confirmed in many studies, is subjective sensitivity to noise. Noise sensitivity is also related to psychiatric disorder. The evidence for noise sensitivity being a risk factor for psychiatric disorder would be greater if it were a stable personality characteristic, and preceded psychiatric morbidity. The stability of noise sensitivity and whether it is merely secondary to psychiatric disorder or is a risk factor for psychiatric disorder as well as annoyance is examined in two studies in this monograph: a six-year follow-up of a group of highly noise sensitive and low noise sensitive women; and a longitudinal study of depressed patients and matched control subjects examining changes in noise sensitivity with recovery from depression. A further dimension of noise effects concerns the impact of noise on the autonomic nervous system. Most physiological responses to noise habituate rapidly but in some people physiological responses persist. It is not clear whether this sub-sample is also subjectively sensitive to noise and whether failure to habituate to environmental noise may also represent a biological indicator of vulnerability to psychiatric disorder. In these studies noise sensitivity was found to be moderately stable and associated with current psychiatric disorder and a disposition to negative affectivity. Noise sensitivity levels did fall with recovery from depression but still remained high, suggesting an underlying high level of noise sensitivity. Noise sensitivity was related to higher tonic skin conductance and heart rate and greater defence/startle responses during noise exposure in the laboratory. Noise sensitive people attend more to noises, discriminate more between noises, find noises more threatening and out of their control, and react to, and adapt to noises more slowly than less noise sensitive people.(ABSTRACT TRUNCATED AT 400 WORDS)

Acoustic Stimulation↗

[Evaluation of frequency selectivity from psychoacoustic tuning curves].

Psychoacoustic tuning curves (PTC) can be regarded as filter curves, whereas their forms represent hair cell activity. Different influences--for example, noise, toxins, pharmacological causes and age--can change the PTC as a consequence of changed frequency selectivity without indication of deterioration in the audiogram. The objective of this investigation was to determine the visually perceivable change in the PTC as a quantifiable result. In so doing, the PTC was transformed into a hyperbola characterized by a parameter Q5. An example demonstrates the temporal change of Q5 under the influence of pharmacological drugs.

Auditory Threshold↗

Probe tube systems: effects of equalization on real ear insertion and aided gain.

In probe tube measures, the method used to equalize the sound field will determine the reference value used in calculating real ear insertion gain (REIG) and real ear aided gain (REAG). Several equalization methods are available with current probe tube systems. This study determined the effects of three equalization methods (substitution, modified comparison, and ipsilateral comparison) on REIG and REAG measures using open and closed earmolds for ear canals varying in circumference. Twelve subjects were selected representing a wide range of ear canal circumferences. Results revealed significant differences for REIG and REAG among the three equalization methods. These differences appear to be due to the different acoustic components included or excluded for each method. The results of this study suggest that the sound field equalization method used for probe tube measures needs to be considered when interpreting the hearing aid gain reported among various probe microphone units. Also, canal circumference may be a quick method for categorizing canal cavity size and appears to influence measured hearing aid gain.

Adult↗

Psychoacoustic quantification of mechanical heart valve noise.

BACKGROUND AND AIM OF THE STUDY: Mechanical heart valves produce short clicking sounds during closure. These closing sounds are annoying for some patients and their partners by causing sleeping disorders or social embarrassment. Various methods for measuring the sounds have been developed both in vitro and in vivo using calculation of A-weighted sound pressure level or loudness according to ISO 532 B. The study aim was to evaluate the relevance of different psychoacoustic parameters in the evaluation of closing sounds. METHODS: Closing sounds were recorded from patients with ATS valves (n = 13), On-X valves (n = 18) and St. Jude Medical heart valve prostheses (n = 16). The sounds were recorded 5 cm above the chest of patients in a supine position, in a sound-insulated chamber. The mean peak values of loudness and sharpness were calculated and used to determine the psychoacoustic annoyance using a modification of the Widmann formula. This was verified by a listening test for ranking closing sounds of different level and sharpness by annoyance. RESULTS: There was no statistically significant independence between loudness difference or psychoacoustic annoyance difference and agreement among the test persons. For the valves, loudness ranged from 0.07 to 2.57 sone, and the psychoacoustic annoyance from 0.1 to 5.4. CONCLUSION: The results of this study showed that both sharpness and loudness have a significant influence on annoyance from closing sounds from mechanical heart valves, and indicated that the substantial variation in the parameters may be due to individual patient physiology.

Adult↗

Self-reported tinnitus and noise sensitivity among adolescents in Sweden.

It seems to be a common opinion among researchers within the field of audiology that the prevalence of tinnitus will increase as a consequence of environmental factors, for example exposure to loud noise. Young people are exposed to loud sounds, more than any other age group, especially during leisure time activities, i.e. at pop concerts, discotheques and gyms. A crucial factor for the prevention of hearing impairments and hearing-related symptoms in the young population is the use of hearing protection. The focus of the present study is use of hearing protection and self-reported hearing-related symptoms, such as tinnitus and noise sensitivity in a young population of high-school students (N=1285), aged 13 to 19 years. The results show that the prevalence of permanent tinnitus and noise sensitivity, reported in the total group, was 8.7% and 17.1% respectively. Permanent tinnitus was not significantly related to level of socio-economic status, but age-related differences in the prevalence rates of experienced tinnitus and noise sensitivity were found to be significant. Older students reported such symptoms to a greater extent than younger students did. Those who reported tinnitus and other hearing-related symptoms protected their hearing to the highest extent and were the ones most worried.

Adolescent↗

The influence of socio-economic status on adolescent attitude to social noise and hearing protection.

The focus of the present study, of 1285 adolescents, was young people's attitudes towards noise and their use of hearing protection at discos and pop concerts. Comparisons were made between adolescents from different age groups, and with different socio-economic status. Logistic regressions indicated that "worry before attending noisy activities" and "hearing symptoms" such as tinnitus and noise sensitivity could, to some degree, explain the use of hearing protection in noisy environments. Another conclusion to be drawn from this study was that adolescents' attitudes and behaviours regarding hearing protection use differed between levels of socio-economic status. Individuals with high SES expressed more negative attitudes and used ear protection to a greater extent than those with lower SES. This result might indicate differences in the development of future auditory problems among individuals with different levels of socio-economic status. The cause of hearing impairment and tinnitus may not be restricted merely to noise exposure. Psychological aspects, such as attitudes towards noisy environments and the individual's behaviour regarding the use of hearing protection may be considered as important factors in the understanding of why the prevalence of hearing related problems has increased among adolescents.

Adolescent↗

Comparison of SSPL90 selection procedures.

Recommended SSPL90 values were determined at 500, 1000, and 2000 Hz for 16 subjects with mild-to-moderate sensorineural hearing losses using six different selection procedures, including an Upper Limit of Comfortable Listening (ULCL) and threshold-based procedure by Cox (1988), a threshold-based procedure by Seewald and Ross (1988), and loudness discomfort procedures by Berger (1988), McCandless and Lyregaard (1983), and Hawkins et al (1987) and Libby (1985). Statistically significant differences were found among the procedures at 500 and 2000 Hz. Analysis of individual data showed that while some subjects obtained similar recommended SSPL90s across the procedures, others showed dramatically different values.

Adult↗

[Sequence effects in absolute judgment? Critical comments on the method].

Several methods for demonstrating sequential effects in psychophysical judgments are discussed. None of them is free of problems. Simple simulations show that pseudosequential effects occur whenever some subjects judge the stimuli higher or lower than they should. Such effects may also be produced by response drifts during the course of an experiment. Breaks in the psychophysical function might be another source of pseudosequential effects. Contrary to a wide-spread opinion, it still remains to be shown that genuine sequence effects really exist.

Arousal↗

The effect of equating loudness on audibility-based hearing aid selection procedures.

Recently the articulation index (AI) has received a great deal of attention as a means to select hearing aid characteristics and to evaluate the merits of different hearing aid selection methods. These evaluations were based on the seldom modified assumption that the listening condition producing the largest AI is the best condition. The negative consequences of the differences in hearing aid conditions were seldom considered. In this paper it is shown that higher AIs are often achieved at the cost of substantially greater loudness. When gain adjustments are made to equate loudness across conditions, very different conclusions are reached about the relative merits of selection methods and the value of certain frequency-gain response modifications.

Algorithms↗

Adaptive procedures for hearing aid prescription and other audiologic applications.

A class of adaptive procedures is described. These procedures are relatively easy to implement and have many useful properties for audiologic applications. Recent advances in programmable hearing aids enable these techniques to be used effectively in adaptive prescriptive fitting of a hearing aid. All of the procedures are based on the simple up-down technique that, in addition to its simplicity, is both efficient and reliable.

Adaptation, Physiological↗