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PubMed1994

ABR audiometry in evaluation of hearing organ in neonates from high-risk pregnancy.

In a group of 130 tested newborns, pathological brain stem responses derived from acoustic stimulus was achieved in 28 (21.5%) cases. 85.2% of newborns from this group of birthed babies comparised a high-risk pregnancy group. Based on the criteria of evaluating ABR parameters of the achieved responses, three categories of hearing dysfunctions were distinguished: conductive hearing loss in 7 cases, sensori-neural in 12 cases and neurological dysfunctions in 9 cases. Control testing which was carried out after three months following the initial evaluation, allowing for the elimination of 12 children in a group of 19 for the further testing and observation. This represents 42.8% of children initially evaluated as possessing a hearing disorder and 9.2% from the total of those tested. Results obtained during successive control testing were carried-out in a 3-6 month period following the initial examination an allowed for decisions to be made. Conforming to: 4 children (3.07%) were supplied with hearing aids and rehabilitation begun, 1 child (0.76%) was referred to rehabilitation the deaf, whereas the 2 remaining children (1.53%) are currently under neurological observations.

Auditory Threshold↗
PubMed1994

Stability of hearing preservation following acoustic neuroma surgery.

Identification of small acoustic neuromas has become commonplace. Frequently, affected individuals are identified prior to the development of significant hearing loss. Whereas many studies have focused on hearing preservation surgery, few have reported on stability of hearing results after resection of acoustic neuroma. Between 1985 and 1991, 36 patients underwent resection of an acoustic neuroma via a retrosigmoid, internal auditory canal approach with attempted hearing preservation. Hearing was preserved in 24 patients; 17 were available for testing for the present study. Follow-up ranged from 1.5 to 8 years. All patients underwent complete audiologic assessment; most patients also underwent auditory brainstem response testing. There was an average 6 dB increase in pure-tone average between early (1 month) postoperative and long-term postoperative test results. A binomial single subject statistic was used to assess for significant changes in speech recognition scores over time. In two subjects there was a significant decrease; however, speech recognition also improved significantly in two subjects. Five of the 17 subjects demonstrated either a significant (at least 15 dB) increase in pure-tone average or a significant decrease in speech recognition over the time-course of the study. All patients maintained usable hearing. We conclude that long-term hearing preservation is a realistic goal in selected acoustic neuroma operations.

Audiometry, Pure-Tone↗
PubMedDate not supplied

Bilaterally preserved otoacoustic emissions in four children with profound idiopathic unilateral sensorineural hearing loss.

Severe to profound unilateral sensorineural hearing loss of the left ear was discovered by screening in four healthy children without any family history of hearing loss. Three of the children were four years old and one child was seven years old at the time of discovery. The PTA0.5-2 was 66-75 dB HL for three of the children and one child was without any hearing reactions on the affected ear. The hearing of the right ear was normal in all four cases. The hearing thresholds have been stable during an observation period of 3-12 years. No certain auditory-evoked brainstem responses were recorded with stimulation of the affected ear. Electronystagmography was normal in all cases and magnetic resonance imaging gave no explanation of the hearing loss. Repeated recordings of the transiently evoked otoacoustic emissions (TEOAE) have shown clear bilateral responses using different instrumentation systems. Recently the hearing levels were unchanged and the TEOAE responses of the affected ears were 6.7-19.9 dB SPL (waveform reproducibility: 88-98 per cent) recorded on the ILO88 OAE Analyser (stimulus: 82.2-83.4 dB peak). The collected results suggest that the children suffer from a similar disorder with a unilateral affection of the cochlea, involving the inner hair cells and/or the first neuron. The TEOAE recordings indicate substantially preserved outer hair cell function independent of the profound hearing loss.

Auditory Threshold↗
PubMed1987

Development of the middle latency response in an animal model and its relation to the human response.

Although the clinical use of the middle latency response (MLR) in adults is fairly straightforward, its use is complicated by maturational changes that continue throughout the first decade of life. In order to telescope the time period of this long developmental course, we have approached the study of MLR maturation using the gerbil as an animal model. The course of MLR obtained over the temporal lobe development was characterized in the Mongolian gerbil ranging in age from 10 days to 3 months of life. The adult gerbil MLR consists of two positive peaks (A and C) at 11 and 25 ms, respectively, and a negative component (B) at 16 ms. These components emerge in a systematic fashion as a function of age. The present work supports a strong age effect of increased MLR detectability in the gerbil, similar to findings reported for humans. Wave A was infrequently detected in young animals, but when present, it occurred at adult latencies. The latency of waves B and C decreased systematically with age. The amplitude of all components increased with age, similar to findings in humans. The fact that adult-like thresholds were obtained shortly after birth indicates that when present, MLRs may be a good index of hearing threshold. Effects of stimulating across a wide range of intensities were described. The gerbil model appears appropriate for the study of development of the central auditory system function.

Age Factors↗
PubMed2004

Hearing threshold elevation precedes hair-cell loss in prestin knockout mice.

Our previous characterization of prestin knockout (-/-) mice demonstrated that prestin is required for the eletromotility of outer hair cells (OHCs) and for the cochlear amplifier. Because hair-cell loss was observed in the basal 25% of cochleae in adult prestin-/- mice, it remained unclear how hair-cell loss progressed, whether hearing thresholds were elevated, and whether OHCs had normal ultra-structure in young prestin-/- mice. We report here that in prestin-/- mice, no significant hair-cell loss occurred before postnatal day 28 (P28); apoptosis of hair cells began at P28; and the loss of inner hair cells lagged behind that of OHCs. The prestin-/- mice had hearing thresholds that were significantly elevated (by approximately 25 dB) as early as P14; their thresholds at high frequencies were significantly elevated (by approximately 50 dB) at P21. The prestin heterozygous (+/-) mice displayed a significant threshold elevation (approximately 3.5 dB) at P21. In addition, transmission electronic microscopy shown that no obvious abnormality occurs in the sterocilla, lateral wall, tight junction and synapses of the outer hair cells. Our results demonstrate that the absence of prestin, not hair-cell loss, is the primary cause of high-frequency hearing threshold elevation in prestin-/- and +/- mice.

Aging↗
PubMed1982

Diagnosis of abnormal hearing adaptation by brainstem potentials.

Adaptation of the human brainstem potentials was investigated using three types of stimulation: paired clicks, varied click rates, and a gap in a continuous tone. Brainstem responses to the second of a pair of clicks is hardly influenced by pathological adaptation. In patients with a normal subjective threshold decay (Carhart test) peak V latencies of the brainstem potential for high click rates and for the tone gap were within the normal range. For a threshold decay of more than 20 dB, latencies were significantly prolonged. In cases of an unlimited Békésy decay the brainstem response was missing for the tone gap stimulus. Fast rate and tone gap stimulation are suitable for a sensitive illustration of the threshold tone decay.

Adaptation, Physiological↗
PubMed1982

Group delay measurements from spiral ganglion cells in the guinea pig cochlea.

Measurements of group delay were made extracellularly from spiral ganglion cells in the basal turn of the guinea pig cochlea, using sinusoidally amplitude modulated tones, with constant modulating frequency and modulation depth at the microphone input. Threshold cochlear tuning was accompanied by a frequency dependent group delay, with relative peak proportional to Q10. For sensitive units with steep intensity functions, the group delay decreased with increasing sound pressure level above threshold, without a significant change of Q10.

Animals↗
PubMed2001

Clinical relevance of distortion product emissions by means of receiver operating characteristic (ROC) analysis.

The clinical use of distortion product otoacoustic emissions (DPOAE) stems from the observation that the outer hair cells are the most vulnerable part of the cochlea, and damage to these cells is associated with hearing loss and loss of DPOAE. The purpose of this study is to evaluate the applicability of DPOAE in predicting hearing thresholds under clinical conditions. DPOAE measurements (L1 = L2 = 70 dB SPL. f2/f1 = 1.20) of 219 hearing-impaired and normal hearing ears were analyzed. Recordings were acquired for DPOAE at 2 f1-f2 varying from 635 to 4052 Hz. The detectability of DPOAE in hearing-impaired subjects exhibited a strong hearing threshold dependence. Receiver operating characteristic (ROC) analysis yielded the highest sensitivity and specificity for threshold levels of about 30 dB at low frequencies and for threshold levels of about 60 dB at high frequencies. In addition, the separability of groups with different hearing status was more reliable at high frequencies as compared to low frequencies. The DPOAE provide an objective assessment of cochlear function. However, prognosis of hearing thresholds on the basis of DPOAE measurements depends strongly on the test frequency and is associated with large errors. Hence, the clinical use of DPOAE in predicting hearing thresholds is limited.

Adult↗
PubMedDate not supplied

Effectiveness of middle ear electrical stimulation for activating central auditory pathways.

Electrical stimulation of afferent auditory elements through electrodes placed in the middle ear was investigated in acute guinea pig preparations. Thresholds for auditory activation were current dependent for low frequencies (less than 1 kHz) and charge-dependent at higher frequencies. Threshold currents were 3-5 times those for intracochlear stimulation. Mechanisms of activation were examined with removal of cochlear fluids and injection of neomycin, Xylocaine, saline, and artificial perilymph with different calcium concentrations. Neurons of the spiral ganglion are indicated as mediators of this stimulation.

Animals↗
PubMed1991

Recovery time of the temporary threshold shift for delayed evoked otoacoustic emissions and tone bursts.

The recovery time of temporary threshold shift after 1-kHz tone bursts delayed evoked otoacoustic emissions (DEOE) after the same stimulus were studied after auditory fatigue (AF) with a pure tone (0.75 kHz, 10 min, 95 dB HL) in 20 normal-hearing subjects aged 19-23 years. Close similarities were observed in the two experimental conditions. Since DEOE are transmitted to the outer ear via structures independent of the fibers of the afferent acoustic pathway and their synapses, it may be supposed that changes in the motile activity of the outer hair cells caused by AF could be partly responsible for their production and could constitute an active intracochlear mechanism taking part in this phenomenon. It may also be supposed that the effects of this active mechanism could be superimposed on those produced by a passive intracochlear mechanism consisting of the traveling wave induced in the basilar membrane by the perilymph owing to the movements of the stapes.

Adolescent↗
PubMed2003

Tinnitus suppression with threshold and subthreshold sound stimuli.

In this preliminary report, we present the results from our investigation of 34 tinnitus patients for tinnitus suppression with frequency-specific sound stimuli within the auditory spectrum. Of this number, 22 (64.7%) experienced suppression, 5 (14.7%) had partial suppression, and 7 (20.6%) were nonresponders. Suppression of peripheral tinnitus may result when mechanosensitive outer hair cells are recruited by sound stimuli that can remain at subthreshold level. The suppression mechanism is possibly explained by the electromodel of the auditory system. This physiological model could be the basis of tinnitus suppression therapy in which a low-intensity, frequency-specific and tinnitus-suppressing sound stimulus is introduced instead of a wide-band masking noise.

Acoustic Stimulation↗
PubMed1995

Afferent synaptic changes in auditory hair cells during noise-induced temporary threshold shift.

This study presents evidence in support of the hypothesis that one of the sites of failure during noise-induced temporary threshold shift (TTS) is the afferent synapse between auditory hair cells and auditory nerve fibers. Our results show clear evidence indicating changes in the quantity of afferent synapses and the morphology of presynaptic structures in the alligator lizard auditory hair cells during TTS. In TTS hair cells there are statistically significant decreases in: 1) the number of afferent synapses, 2) the number of synaptic vesicles at the afferent synapses, 3) the size of synaptic bodies, and 4) the packing density of synaptic vesicles around the synaptic body. These results suggest that the presynaptic components of the afferent synapse reflect the functional state of the synapse, and that the reduction of these synapses, both in number and component size, contributes to TTS.

Acoustic Stimulation↗
PubMed1987

Evoked potentials: computer-automated threshold-tracking procedure using an objective detection criterion.

A computer-automated, threshold-tracking procedure was developed for measuring evoked response thresholds on-line. The procedure utilizes an objective detection criterion (correlation) to evaluate whether a response is absent or present. Sound intensity is adjusted according to a modified PEST (parameter estimation by sequential testing) procedure in order to estimate threshold. The computer-automated procedures were used to obtain objective estimates of evoked response thresholds in normal and hearing-impaired chinchillas. The evoked response waveforms stored in the computer were also used to obtain visual judgments of threshold. The objective thresholds determined by the computer were virtually identical to the visual detection thresholds. Thus, the computer-automated procedure provides a reliable, objective, and efficient method of estimating evoked response thresholds.

Animals↗
PubMed2006

AutoNR: an automated system that measures ECAP thresholds with the Nucleus Freedom cochlear implant via machine intelligence.

OBJECTIVE: AutoNRT is an automated system that measures electrically evoked compound action potential (ECAP) thresholds from the auditory nerve with the Nucleus Freedom cochlear implant. ECAP thresholds along the electrode array are useful in objectively fitting cochlear implant systems for individual use. This paper provides the first detailed description of the AutoNRT algorithm and its expert systems, and reports the clinical success of AutoNRT to date. METHODS: AutoNRT determines thresholds by visual detection, using two decision tree expert systems that automatically recognise ECAPs. The expert systems are guided by a dataset of 5393 neural response measurements. The algorithm approaches threshold from lower stimulus levels, ensuring recipient safety during postoperative measurements. Intraoperative measurements use the same algorithm but proceed faster by beginning at stimulus levels much closer to threshold. When searching for ECAPs, AutoNRT uses a highly specific expert system (specificity of 99% during training, 96% during testing; sensitivity of 91% during training, 89% during testing). Once ECAPs are established, AutoNRT uses an unbiased expert system to determine an accurate threshold. Throughout the execution of the algorithm, recording parameters (such as implant amplifier gain) are automatically optimised when needed. RESULTS: In a study that included 29 intraoperative and 29 postoperative subjects (a total of 418 electrodes), AutoNRT determined a threshold in 93% of cases where a human expert also determined a threshold. When compared to the median threshold of multiple human observers on 77 randomly selected electrodes, AutoNRT performed as accurately as the 'average' clinician. CONCLUSIONS: AutoNRT has demonstrated a high success rate and a level of performance that is comparable with human experts. It has been used in many clinics worldwide throughout the clinical trial and commercial launch of Nucleus Custom Sound Suite, significantly streamlining the clinical procedures associated with cochlear implant use.

Algorithms↗