Growth behavior of the 2 f1-f2 distortion product otoacoustic emission in tinnitus

High-resolution hearing threshold and 2 f1-f2 distortion product otoacoustic emission (DP) were measured with the same in-the-ear sound probe and same calibration at 51 frequencies between 500 and 8000 Hz in 39 sensorineural hearing loss ears associated with tinnitus. Using a primary tone setting L1 = 0.4L2 + 39 that accounts for the nonlinear interaction of the two primary tones at the DP generation site at f2, DPs were elicited in a wide range from L2 = 65 to 20 dB SPL. We failed to find a uniform DP behavior in the 39 tinnitus ears tested. Seventeen of them behaved like impaired ears without tinnitus. In these ears a linearized DP growth was observed where the DP level decreased and the slope of the DP I/O functions steepened with increasing hearing loss and as a result both the DP level and the DP slope strongly correlated with hearing threshold. The other population, 22 tinnitus ears, exhibited a poor or even inverse relationship between DP level and hearing threshold, i.e., displayed an increase of DP level with increasing hearing loss. Despite the severe hearing loss but due to the high level, DPs could be recorded well in the frequency range that corresponded to the appearance of the tinnitus. The DP slope, however, increased with increasing hearing loss and, therefore, did still correlate with hearing threshold revealing pathological alteration. The data suggest that the DP level alone is hardly capable of assessing hearing impairment in tinnitus ears and may even be misleading. Thus just the DP slope seems to be the only reliable indicator of cochlear malfunction around the tinnitus frequency. The observed nonuniform DP behavior suggests different cochlear impairments in tinnitus ears. In those ears where the DP level decreases and the slope of the I/O functions increases with hearing loss, cochlear sensitivity and tuning are supposed to be diminished. In those ears where the DP level increases with increasing hearing loss, a reinforced mechanical distortion is hypothetized to be generated by cochlear hyperactivity that can be the source of both the abnormally high DP level and the tinnitus.     

Air-bone gap in patients with X-linked stapes gusher syndrome

It is often possible to elicit the stapedius reflex in patients suffering from recessive X-linked progressive mixed deafness syndrome with stapes gusher. The presence of an air-bone gap in the audiogram and the ability to elicit the stapedius reflex are conflicting. Measurements were performed on two patients who were suffering from this syndrome, to establish whether the hearing loss was of the mixed or purely sensorineural type. It was argued that, owing to congenital malformations, the audiovestibular system might act as a more than normally efficient transducer, to convert skull vibrations into inner ear fluid motions, leading to bone conduction thresholds that are better than expected. The results of tone and speech audiometry, stapedius reflex measurements, and brainstem evoked response audiometry in this study showed a pattern similar to that generally seen in patients with purely sensorineural hearing loss. This supports the hypothesis that the air-bone gap in the audiogram does not have the usual significance of a conductive hearing loss component.     

The acoustic reflex at low sensation levels

The acoustic stapedial reflex, which normally occurs at a hearing level of about 80 dB, can be detected at lower levels by means of preactivation. Two techniques are presented, which allow the detection of reflex activity at intensities from 30 to 50 dB HL. It was the authors' intention to find a way to determine the hearing threshold from the stapedius reflex threshold even in patients, in whom the hearing threshold was not horizontal.     

Effect of coating of aluminum carboxymethylcellulose beads on the release and bioavailability of diclofenac sodium

Menière's disease and fluctuating hearing loss are related to labyrinthine fluid pressure variations. The development of a new indirect method of analysis of the tympanic membrane displacement during the stapedial reflex, using the Marchbanks Measurements System (MMS 10), allows us to study inner ear fluid pressure during these pathological conditions. In this study, measurements with this method were made in four groups of patients: a control group with normal hearing (n=7), stable sensorineural hearing loss (n=9), fluctuating hearing loss (n=8), and Menière's disease (n=25). Results show, first, a good relationship between the recording of negative curves, suggesting a high pressure, and the acute episodes of fluctuating hearing loss; and, secondly, in the case of Menière's disease two types of situation: positive and negative curves suggesting normal and high pressures, respectively.     

Hearing loss prediction by the acoustic reflex in a young population: comparison of seven methods

Seven methods of hearing loss prediction by the acoustic reflex were compared in 869 subjects, aged 1 to 20 years. The seven methods were two versions of Sensitivity Prediction by Acoustic Reflex (SPAR), four regression equations, and a bivariate plot technique. While accuracy rate for each of the seven methods generally exceeded 64%, hearing loss was most accurately identified by the bivariate plot system. The proportions of predictive errors among methods, however, ranged from 22 to 31%; moderate errors predominated while severe predictive errors were rare. Accuracy of hearing loss prediction was not significantly affected by chronologic age. However, all methods produced a substantial (31-67%) proportion of predictive errors in patients with minor, clinically insignificant, tympanometric abnormalities. In children with normal impedance findings, the methods permit reasonably accurate identification of hearing loss, categorization of degree of loss, or prediction of hearing loss in dB.     

Clinical impressions of acoustic reflex measures in an adult population

The implications of the use of sensitivity predictions from acoustic reflex (SPAR) measures are increasing through clinical application of the test. Jerger and associates have suggested the importance of SPAR in the examination of children. Our use of SPAR with a primarily adult population has supported other important applications of this procedure, including the the use of predictions in legal cases and in examining elderly or foreign-speaking patients who often respond poorly on subjective tests. Discussion and recommendations regarding such applications are based on a study of SPAR involving 681 ears.     

The efficacy of tympanic electrocochleography in the diagnosis of endolymphatic hydrops

Electrocochleography (ECoG), an objective electrophysiologic test, is useful in the clinical diagnosis of endolymphatic hydrops. The purpose of this study was further to define the role of ECoG in the diagnosis of this disease. A retrospective chart review of 100 patients undergoing tympanic ECoG was undertaken comparing symptoms, degree of hearing loss, duration of disease, and diagnosis with ECoG results. The apparent sensitivity and specificity of ECoG in the diagnosis of endolymphatic hydrops were determined to be 57% and 94%, respectively. Three of 30 positive ECoG results were falsely positive. Fluctuating hearing loss and the degree of hearing loss (< 40 dB) and duration of disease (< 48 months) were statistically significant in predicting positive ECoG results. We conclude that a positive ECoG result is helpful in objectively confirming the disease. However, a negative result does not rule out hydrops.     

Basilar membrane nonlinearity and loudness

Loudness matching functions for tones for persons with one shifted-threshold ear (hearing loss and noise-shifted thresholds) and one ear within normal limits were used to derive the presumed basilar membrane (BM) input-output (I/O) function in a normal ear. The comparison was made by assuming that the BM I/O function for the ear with the cochlear threshold shift has a slope of one (a linearized cochlea). The function for the normal ear was derived from the loudness matching function based on this assumption. Comparisons were made for archival basilar membrane data [M. A. Ruggero, N. C. Rich, A. Recio, S. S. Narayan, and L. Robles, J. Acoust. Soc. Am. 101, 2151-2163 (1997)] for chinchilla and archival loudness matches for long-duration tones for persons with various degrees of cochlear hearing loss [F. Miskolczy-Fodor, J. Acoust Soc. Am. 32, 486-492 (1960)]. Comparisons were made also between BM I/O functions and ones derived from loudness matches for persons with unilateral hearing loss simulated by broadband noise. The results show a close resemblance between the basilar membrane I/O function and the function derived from loudness matches for long-duration tones, even though the comparison was between human and chinchilla data. As the degree of threshold shift increases from 40 to 80 dB, the derived BM I/O functions become shallower, with slopes for losses of 60 dB or more falling in the range of values reported for physiological data. Additional measures with short-duration tones in noise show that the slope of the loudness function and the slope of the derived basilar membrane I/O function are associated with the behavioral threshold for the tone. The results for long-duration tones suggest a correspondence between BM displacement and loudness perception in cases of recruitment, but the relation between the degree of loss and the amount of BM compression and the relation between signal duration and compression suggests that other factors, such as the neural population response, may play a role.     

Cochlear compression estimates from measurements of distortion-product otoacoustic emissions

Evidence of the compressive growth of basilar-membrane displacement can be seen in distortion-product otoacoustic emission (DPOAE) levels measured as a function of stimulus level. When the levels of the two stimulus tones (f1 and f2) are related by the formula L1 = 39 dB + 0.4 x L2 [Kummer et al., J. Acoust. Soc. Am. 103, 3431-3444 (1998)] the shape of the function relating DPOAE level to L2 is similar (up to an L2 of 70 dB SPL) to the classic Fletcher and Munson [J. Acoust. Soc. Am. 9, 1-10 (1933)] loudness function when plotted on a logarithmic scale. Explicit estimates of compression have been derived based on recent DPOAE measurements from the laboratory. If DPOAE growth rate is defined as the slope of the DPOAE I/O function (in dB/dB), then a cogent definition of compression is the reciprocal of the growth rate. In humans with normal hearing, compression varies from about 1 at threshold to about 4 at 70 dB SPL. With hearing loss, compression is still about 1 at threshold, but grows more slowly above threshold. Median DPOAE I/O data from ears with normal hearing, mild loss, and moderate loss are each well fit by log functions. When the I/O function is logarithmic, then the corresponding compression is a linear function of stimulus level. Evidence of cochlear compression also exists in DPOAE suppression tuning curves, which indicate the level of a third stimulus tone (f3) that reduces DPOAE level by 3 dB. All three stimulus tones generate compressive growth within the cochlea; however, only the relative compression (RC) of the primary and suppressor responses is observable in DPOAE suppression data. An RC value of 1 indicates that the cochlear responses to the primary and suppressor components grow at the same rate. In normal ears, RC rises to 4, when f3 is an octave below f2. The similarities between DPOAE and loudness compression estimates suggest the possibility of predicting loudness growth from DPOAEs; however, intersubject variability makes such predictions difficult at this time.     

Intensity and frequency discrimination monitored by evoked response audiometry: clinical application

Delta 1 and delta f repetitive stimuli superimposed on continuous 0.5-, 1- and 4-kHz carrier tones were administered to 20 normally hearing persons, 8 adults with sensorineural hearing loss, 10 adults with conductive hearing loss and 22 children subjected to evoked response audiometry (ERA) for assessment of hearing acuity. The intensity modulation depth ranged from + 1 to 10 dB. In the subjects with normal hearing and in the adult patients, three carrier tone levels were used whenever possible: 20, 40, and 60 dB SL. The frequency modulation depth ranged from -1 to -10% of the carrier tone frequency. The same levels for the carrier tone were used: 20, 40, and 60 dB SL. With a carrier tone level of 20 dB SL, a clear-cut vertex response was noted in 80% of the tests carried out in the normal adults with 5-dB delta i stimuli and with delta f stimuli of -3 to -5% in magnitude; the same figures are valid for the patients with sensorineural and conductive hearing loss. The patients with sensorineural hearing loss showed a tendency to give vertex responses with lower delta i stimuli than subjects with normal hearing. However, this difference was not statistically significant. According to our results, the children tested can be roughly divided into two groups, the first including subjects with responses to delta i stimuli of +5 and +10 dB and delta f stimuli of -5% and -10%; the second group including subjects with no clear-cut responses to these stimuli.     

The effects of cochlear hearing loss, age and sex on the auditory brainstem response

This study analyzed the effects of auditory impairment, age and sex on the auditory brainstem response (ABR) wave latencies. ABR wave I, wave V and I-V interval measures were extracted from the clinical records of 201 patients with cochlear hearing loss. Females had consistently earlier wave V latencies and shorter I-V intervals than males. No age effects were observed. Degree of impairment had a systematic effect on ABR wave latencies and I-V intervals. Wave I displayed latency extension with increasing levels of high-frequency hearing loss, whilst for wave V increases in latency were dependent upon both degree and slope of the hearing loss. Present results suggest that many of the previously reported sex differences and variable interactions seen for the ABR can be accounted for by differences in the underlying distribution of audiogram shapes within and between study populations. Different audiometric configurations were found to produce consistent differential effects on both wave I and wave V latency and thus influence the I-V interval. This study underlines the need to develop a more detailed model of impairment effects if correction factors are to be employed more effectively in ABR testing for retrocochlear pathology.     

An evaluation of three neuroleptanalgesic combinations in rabbits

In this study, novel combinations of analgesics and neuroleptics were used in the rabbit in an attempt to produce a surgical level of anesthesia. A commercially available mixture of fentanyl (0.06 mg/kg) and droperidol (3.0 mg/kg; F/D) was evaluated alone and in combination with either the benzodiazepine derivative, diazepam (2 mg/kg) or the alpha-2 adrenoceptor agonist, detomidine (20 micrograms/kg). Rabbits were anesthetized on consecutive weeks with one of the three regimens. Heart rate, respiratory rate, blood pressure, and arterial blood gases (pH, PCO2, PO2) were measured throughout each trial. The times of loss and return of palpebral, righting, and pedal reflexes were recorded. The addition of diazepam to the F/D combination caused marked prolongation of the duration of reflex loss for all reflexes. If the duration of reflex loss for F/D is considered to be 100%, then F/D plus diazepam (F/D/diazepam) prolonged the duration of reflex loss to 547% and 204% for righting and pedal reflex, respectively. The combination of F/D/diazepam produced significantly different results from those for either of the other combinations for righting reflex and palpebral reflex. The results for F/D/diazepam were also markedly different from F/D for pedal reflex, but were not significantly different from those for F/D/detomidine. Prolongation of the duration of reflex loss was more moderate with the addition of detomidine (148% and 174% for righting and pedal reflexes, respectively). Reflexes persisted in some rabbits for each anesthetic regimen. Palpebral reflex was preserved in one of the rabbits given F/D/diazepam, four of five rabbits given F/D, and in two rabbits given F/D/detomidine.(ABSTRACT TRUNCATED AT 250 WORDS)     

Multi-variant analysis of otoacoustic emissions and estimation of hearing thresholds: transient evoked otoacoustic emissions

Evaluation of cochlear hearing loss by means of transiently evoked otoacoustic emissions is already established in clinical practice. However, accurate prediction of pure-tone thresholds is still questioned and is still regarded as troublesome. Both click- and tone-burst-evoked otoacoustic emissions at several intensity levels were measured and analysed in 157 ears from normally hearing and 432 ears from patients with different degrees of pure sensory hearing loss using the ILO88/92 equipment. Results of otoacoustic emissions (OAE), elicited by clicks and tone-bursts at centre frequencies from 1 to 5 kHz, were analysed using two different statistical methods. Both multivariate discriminant analysis and forward multiple regression analysis were used to determine which OAE variables were most discriminating and best at predicting hearing thresholds. We found that a limited set of variables obtained from both tone-burst and click measurements can accurately predict and categorize hearing loss levels up to a limit of 60 dB HL. We found correct classification scores of pure-tone thresholds between 500 and 4000 Hz up to 100 per cent when using combined click and tone-burst otoacoustic measurements. Prediction of pure-tone thresholds was correct with a maximum estimation error of 10 dB for audiometric octave frequencies between 500 and 4000 Hz. Measurements of multiple tone-bursts OAEs have a significant clinical advantage over the use of clicks alone for clinical applications, and a good classification and prediction of pure-tone thresholds with otoacoustic emissions is possible.     

Hearing findings in subjects after meningitis

INTRODUCTION: It was proposed to ascertain the occurrence of individuals who present hearing loss, due to contracting meningitis, as well as to characterize the diagnosed loss as far as the type, degree and the audiometric configuration are concerned. MATERIAL AND METHOD: The methodology used comprised a survey of 949 references of patients attended at the Hearing Disturbance Center of the HPRLLP/USP, in order to select those who presented hearing loss after meningitis and, from the analysis of the hearing evaluation to which they were submitted, achieve the proposed goal. RESULTS AND CONCLUSION: The results indicated a 6.2 percent occurrence as regards hearing loss due to meningitis in relation to other causes and the characteristic of this hearing loss was predominantly sensorineural, symmetrical, al linear and to a profound degree.     

Low prevalence of hearing aid use among older adults with hearing loss: the Epidemiology of Hearing Loss Study

OBJECTIVES: To measure the prevalence of hearing aid use among older adults with hearing loss and to identify factors associated with those currently using hearing aids. DESIGN: Population-based cohort study. SETTING: The south-central Wisconsin community of Beaver Dam. PARTICIPANTS: A total of 1629 adults, aged 48 to 92 years, who have hearing loss and are participating in the Epidemiology of Hearing Loss Study and the Beaver Dam Eye Study. MEASUREMENTS: A hearing-related risk factor and medical history questionnaire, the Hearing Handicap Inventory for the Elderly (screening version), screening tympanometry, pure-tone air- and bone-conduction audiometry, and word recognition tests were administered by trained examiners using standard protocols. RESULTS: The prevalence of current hearing aid use among those with a hearing loss (pure-tone average > 25 decibels hearing level over 500, 1000, 2000, and 4000 Hertz, worse ear) was 14.6%. The prevalence was 55% in a subset of the most severely affected participants. In univariate analyses, current hearing aid use was associated with age, severity of loss, word recognition scores, self-reported hearing loss, self-perceived hearing handicap, and history of noise exposure. Factors associated with current hearing aid use in multivariate logistic regression models were age, severity of loss, education, word recognition scores, Hearing Handicap Inventory for the Elderly (screening version) score, and self-report of a hearing loss. CONCLUSIONS: Few older adults with hearing loss are currently utilizing hearing aids. Improved screening and intervention programs to identify older adults who would benefit from amplification are needed to improve hearing-related quality of life for this large segment of the population.     

Stapedectomy in profound cochlear loss

Stapedectomy can be used in certain patients with profound sensorineural hearing loss and stapes fixation to improve hearing to a level at which a hearing aid may be effective. This study reviews the outcomes of 11 patients with profound cochlear loss secondary to otosclerosis who underwent stapes surgery performed by the senior author (M.E.G.) over a 25-year period. Postoperative hearing aid usage was effective in 9 of 11 patients. Preoperatively, these patients derived no benefits from hearing aids. Stapedectomy may be of immense value in patients with the proper history and profound cochlear loss.     

Aging, hearing acuity, and the attentional costs of effortful listening.

A dual-task interference paradigm was used to investigate the effect of perceptual effort on recall of spoken word lists by young and older adults with good hearing and with mild-to-moderate hearing loss. In addition to poorer recall accuracy, listeners with hearing loss, especially older adults, showed larger secondary task costs while recalling the word lists even though the stimuli were presented at a sound intensity that allowed correct word identification. Findings support the hypothesis that extra effort at the sensory–perceptual level attendant to hearing loss has negative consequences to downstream recall, an effect that may be further magnified with increased age. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hearing loss in community-dwelling older persons: national prevalence data and identification using simple questions

OBJECTIVE: To estimate the prevalence of hearing loss among community-dwelling older persons according to clinical criteria and to develop a brief self-report screening instrument to detect hearing loss. DESIGN: Survey. SETTING: National probability sample of noninstitutionalized older persons. PARTICIPANTS: A total of 2506 persons aged 55 to 74 who participated in the National Health and Nutrition Examination Survey. MAIN OUTCOME MEASURES: Hearing loss as defined by Ventry and Weinstein (VW) criteria and by the High Frequency Pure-Tone Average (HFPTA) scale. RESULTS: Hearing loss by VW criteria was present in 14.2% and by HFPTA criteria in 35.1% of those surveyed. The prevalence increased with advancing age and was higher among men and those with less education. A logistic regression model identified six independent factors for hearing loss by VW criteria: age > or = 70 years (adjusted odds-ratio (AOR) 2.7, 95% confidence interval (95% CI) 1.6, 4.4), male gender (AOR 3.0, 95% CI 1.9, 4.8), < or = 12th grade education (AOR 3.8, 95% CI 1.8, 7.7), having seen a doctor for deafness or hearing loss (AOR 8.9, 95% CI 5.3, 14.9), unable to hear a whisper across a room (AOR 3.2, 95% CI 2.0, 5.1), and unable to hear a normal voice across a room (AOR 6.2, 95% CI 2.6, 14.9). A clinical scale based on the logistic model had 80% sensitivity and 80% specificity in predicting hearing loss using VW criteria and 59% sensitivity and 88% specificity in predicting hearing loss using HFPTA criteria. CONCLUSIONS: Hearing loss, as defined by two clinical criteria, is common and can be screened for accurately using simple questions that assess sociodemographic and hearing-related characteristics.     

Relatively Rough Flow Resistance Equations

The definitions of depth and hydraulic radius become ambiguous when bed roughness is large relative to flow depth. Various statistics are currently used to describe bed roughness and many different flow resistance formulas have been developed. The volumetric hydraulic radius Rv and the standard deviation of bed surface elevations dz are rational and unambiguous measures suitable for large relative roughness conditions. Their influence on flow resistance is investigated using conceptual models and digital elevation models of natural alluvial beds. The results show that head-losses for large-scale relative roughness beds can be related to (Rv/dz); the (Rv/dz) exponent of power-law flow resistance equations increases from 1/6 to more than 1/2 as relative roughness increases, and flow velocity can be determined from boundary topography measures, water level and slope, without any calibrated coefficients. An overlooked form of the log law, using standard deviation dz, performs as well as power laws for predicting flow resistance with high relative roughness and it reverts to the conventional log law when relative roughness is low. A field technique for determining Rv and dz is described.     

Gap detection deficits in rats with tinnitus: A potential novel screening tool.

The study describes a novel method for tinnitus screening in rats by use of gap detection reflex procedures. The authors hypothesized that if a background acoustic signal was qualitatively similar to the rat's tinnitus, poorer detection of a silent gap in the background would be expected. Rats with prior evidence of tinnitus at 10 kHz (n = 14) exhibited significantly worse gap detection than controls (n = 13) when the gap was embedded in a background similar to their tinnitus. No differences between tinnitus and control rats were found with 16 kHz or broadband noise backgrounds, which helped to rule out explanations related to hearing loss or general performance deficits. The results suggest that gap detection reflex procedures might be effective for rapid tinnitus screening in rats. (PsycINFO Database Record (c) 2010 APA, all rights reserved)