Recording otoacoustic emissions in expert evaluation of chronic noise-induced hearing loss

In order to assess occupational hearing loss, damage to outer hair cell function must be demonstrated. Measurements of transiently evoked otoacoustic emissions (TEOAE) and distortion products (DPOAE) allow clinicians to investigate objectively the cochlear amplification process. In this prospective study, 50 persons with suspected occupational hearing losses were tested with pure-tone and speech audiometry. Additionally, TEOAE and DPAOE were determined. Significant linear correlations were observed when comparing hearing thresholds and speech discriminations with evoked emissions. Three groups were formed based on the OAE results: group A, TEOAE- and DPOAE-positive; group B, TEOAE-negative, DPOAE positive; group C, TEOAE- and DPOAE-negative. The groups were compared with regard to the weighted and simple discrimination scores and percentage of hearing loss computed according to the Boenninghaus-R?ser tables. Analysis of variance showed significant differences in hearing losses among the three groups, allowing an objective statement to be made about the degree of work compromise: group A, < 10%; group B, 10-15% group C, > or = 20%.     

Speech audiometry using the American Word Lists for Japanese subjects with normal hearing

The characteristics of listening to English words for Japanese people were studied in ten normal hearing subjects who had taken English classes to the level of college graduates and had opportunities to learn English continuously. Following pure tone audiometry, speech audiometry was performed using the Central Institute for the Deaf (CID) W-1 and W-22 word lists for English and the 67-S word lists for Japanese. The speech reception thresholds (SRTs) for the CID W-1 lists were significantly higher than average pure tone threshold (PTT), although the SRTs for the 67-S lists were equal to the average PTT. The difference in average SRT between the CID W-1 lists and the 67-S lists was about 15dB, which is statistically significant. The speech discrimination rate for the CID W-22 lists ranged from 78 to 100 percent with an average of 89.5 percent, while all subjects achieved the discrimination rate of 100 percent for the 67-S lists. Analysis with transient matrices of the perceived words demonstrated that the articulation rates were below 90 percent for the consonants /m/, /n/, /p/ and /delta/ . The observed variation in the speech discrimination score and the pattern of confusion among the subjects was assumed to be much more pronounced in noisy conditions.     

A modification of play audiometry to assess speech discrimination ability in severe-profoundly deaf 2- to 4-year-old children

OBJECTIVE: The aim was to develop an assessment procedure that was independent of language and speech production ability, to test speech feature discrimination in severe-profoundly deaf children 2 to 4 yr of age. DESIGN: The procedure being trialed was adapted from existing procedures. The child was required to respond with a game-like motor response to a "change" in a speech stimulus that was being presented repeatedly through a speaker. The change occurred at randomly determined times, and false alarm responses were measured during the waiting periods (while the child waited for the change). Two- to four-yr-old normally hearing children and hearing-impaired children using hearing aids and a group of 4-yr-old hearing-impaired children using cochlear implants were assessed on the task. RESULTS: More than 82% of the 3- and 4-yr-old normally hearing and hearing-impaired children were able to complete the testing for the eight speech sound contrasts within three 20 minute sessions. Fifty percent of the 2-yr-old normally hearing and hearing-impaired children were able to condition and complete the task. All of the normally hearing children who completed the task successfully discriminated all speech sound contrasts. The performance of the hearing-impaired children using hearing aids was influenced by the degree of hearing loss and the type of speech contrast being tested. Similarly, the average performance of the children using cochlear implants was better for easier contrasts such as /ba/bi/ with contrasting vowel formant cues. CONCLUSIONS: This procedure has potential for use as a reliable clinical and research tool for assessing the development of auditory discrimination ability in 2- to 4-yr-old severe-profoundly deaf children.     

The effect of hemodialysis on hearing using pure-tone audiometry and distortion-product otoacoustic emissions

Patients under treatment of hemodialysis (HD) frequently exhibit some degree of sensorineural hearing loss. Fifteen subjects and 10 controls were tested by using pure-tone audiometry (PTA) and distortion-product otoacoustic emissions (DPOAEs) before and after a HD treatment. Other parameters (blood pressure, body weight, blood chemistries) were also evaluated before and after HD: The purpose of this study was to determine the acute effect of HD on hearing level by measuring PTA and DPOAE before and after one HD session. The results from PTA and DPOAE testings showed that hearing was unaffected by HD. However, all 15 subjects revealed significantly poorer hearing, especially in the higher frequencies, compared to that of the controls (p < 0.0001). It was concluded then that HD is a safe treatment, and that the sensorineural hearing loss in these patients may be attributed to the preexisting renal disease.     

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.     

Aided speech recognition abilities of adults with a severe or severe-to-profound hearing loss

Adults with severe or severe-to-profound hearing losses constitute between 11% and 13.5% of the hearing-impaired population. A detailed investigation of the speech recognition of adults with severe (n = 20) or severe-to-profound (n = 14) hearing loss was conducted at The University of Melbourne. Each participant took part in a series of speech recognition tasks while wearing his or her currently fitted hearing aid(s). The assessments included closed-set tests of consonant recognition and vowel recognition, combined with open-set tests of monosyllabic word recognition and sentence recognition. Sentences were presented in quiet and in noise at +10 dB SNR to replicate an environment more typical of everyday listening conditions. Although the results demonstrated wide variability in performance, some general trends were observed. As expected vowels were generally well perceived compared with consonants. Monosyllabic word recognition scores for both the adults with a severe hearing impairment (M = 67.2%) and the adults with a severe-to-profound hearing impairment (M = 38.6%) could be predicted from the segmental tests, with an allowance for lexical effects. Scores for sentences presented in quiet showed additional linguistic effects and a significant decrease in performance with the addition of background noise (from 82.9% to 74.1% for adults with a severe hearing loss and from 55.8% to 34.2% for adults with a severe-to-profound hearing loss). Comparisons were made between the participants and a group of adults using a multiple-channel cochlear implant. This comparison indicated that some adults with a severe or severe-to-profound hearing loss may benefit from the use of a cochlear implant. The results of this study support the contention that cochlear implant candidacy should not rely solely on audiometric thresholds.     

Communication and noise. Speech intelligibility of airplane pilots with and without active noise compensation

Noise exposure measurements were performed with pilots of the German Federal Navy during flight situations. The ambient noise levels during regular flight were maintained at levels above a 90 dB A-weighted level. This noise intensity requires wearing ear protection to avoid sound-induced hearing loss. To be able to understand radio communication (ATC) in spite of a noisy environment, headphone volume must be raised above the noise of the engines. The use of ear plugs in addition to the headsets and flight helmets is only of limited value because personal ear protection affects the intelligibility of ATC. Whereas speech intelligibility of pilots with normal hearing is affected to only a smaller degree, pilots with pre-existing high-frequency hearing losses show substantial impairments of speech intelligibility that vary in proportion to the hearing deficit present. Communication abilities can be reduced drastically, which in turn can affect air traffic security. The development of active noise compensation devices (ANC) that make use of the "anti-noise" principle may be a solution to this dilemma. To evaluate the effectiveness of an ANC-system and its influence on speech intelligibility, speech audiometry was performed with a German standardized test during simulated flight conditions with helicopter pilots. Results demonstrate the helpful effect on speech understanding especially for pilots with noise-induced hearing losses. This may help to avoid pre-retirement professional disability.     

Audiological correlates of speech understanding deficits in elderly listeners with mild-to-moderate hearing loss. II. Correlation analysis

OBJECTIVE: The study was conducted to determine the relationship between measures of auditory performance in elderly individuals. Specifically, its goal was to uncover a set of measures correlated with the set of measures of speech understanding under specific conditions of interference to gain a better understanding of decline of the "cocktail party effect" in aging. DESIGN: Audiological status and auditory performance of a group of elderly (60- to 81-yr-old) individuals were determined through a test battery. When present, the hearing loss of elderly subjects was symmetrical in the two ears and, at most, moderate. The battery included tests of speech intelligibility on the word and sentence levels, with and without the presence of interfering speech. In addition pure-tone and speech reception thresholds, perception of spectrally or temporally distorted speech and auditory resolution of frequency, time, and space were tested. Two tests received special consideration: the Speech Perception In Noise Test and the Modified Rhyme Reverberation Test. RESULTS: Results indicated that, despite the nearly normal hearing levels that characterized much of the subject group, auditory sensitivity measures showed persistent correlation to all other measures, with the exception of auditory resolution regarding frequency, time, and space. As a set, sensitivity measures accounted for more than 85% of the variance. When auditory sensitivity was controlled for, other factors underlying speech processing in the presence of interfering stimuli were uncovered, factors most likely related to the ability to perceptually segregate one speech signal from another. CONCLUSIONS: The findings suggest that, to determine the relationship between audiological/auditory test results of an elderly population, it is important to remove the effects of hearing loss through appropriate statistical methods.     

Hearing aid rehabilitation of hearing disorders in adults

Hearing-aid provision is still partly a medical task, in spite of technological progress and a confusing variety of types and models of devices. The diagnosis of the underlying disease, the appreciation of the consequences of hearing loss and the counseling of the hearing impaired person are prerequisites of the treatment. The physician should try to determine the etiology of the hearing loss. Also, a state-of-the-art otologic examination should be performed and the physician should be sensitive to the psychological and social consequences of the patient's hearing loss. For the assessment of fitted hearing aids, basic knowledge of the technical background is required. To measure hearing-aid benefit in the ENT office, suprathreshold and speech audiometry are indispensable tools.     

Hearing handicap--an addition to audiometric hearing loss. Results of an exploratory study of auditory communication disorders in the elderly

Hearing problems in elderly patients cannot be evaluated completely with conventional audiological tests in most cases. Two hundred and one subjects aged 60 years or more complaining of hearing problems were studied. The following tests were employed: pure-tone audiometry, the "Basler Satztest" (a German version of the SPIN-test assessing speech perception in noise), and a German version of a "Hearing Handicap Inventory for the Elderly" (HHIE). These latter versions were developed in our institution. An auditory handicap was found in one-third of subjects with mild hearing losses (PTA < 30 dB; n = 135) and in two-thirds of subjects with greater hearing losses (PTA > and = 30 dB; n = 65). The relatively weak correlations of the pure-tone audiogram (r = 0.49) or speech audiometry (r = 0.41) with HHIE indicate that more than 50% of the variance of the hearing handicap was due to non-audiologic factors. For this reason, we recommend that the handicap questionnaire be added to the audiometric evaluation.     

Cigarette smoking and hearing loss: the epidemiology of hearing loss study

CONTEXT: Clinical studies have suggested that cigarette smoking may be associated with hearing loss, a common condition affecting older adults. OBJECTIVE: To evaluate the association between smoking and hearing loss. DESIGN: Population-based, cross-sectional study. SETTING: Community of Beaver Dam, Wis. PARTICIPANTS: Adults aged 48 to 92 years. Of 4541 eligible subjects, 3753 (83%) participated in the hearing study. MAIN OUTCOME MEASURES: The examination included otoscopy, screening tympanometry, and pure-tone air-conduction and bone-conduction audiometry. Smoking history was ascertained by self-report. Hearing loss was defined as a pure-tone average (0.5, 1, 2, and 4 kHz) greater than 25-dB hearing level in the worse ear. RESULTS: After adjusting for other factors, current smokers were 1.69 times as likely to have a hearing loss as nonsmokers (95% confidence interval, 1.31-2.17). This relationship remained for those without a history of occupational noise exposure and in analyses excluding those with non-age-related hearing loss. There was weak evidence of a dose-response effect. Nonsmoking participants who lived with a smoker were more likely to have a hearing loss than those who were not exposed to a household member who smoked (odds ratio, 1.94; 95% confidence interval, 1.01-3.74). CONCLUSIONS: These data suggest that environmental exposures may play a role in age-related hearing loss. If longitudinal studies confirm these findings, modification of smoking habits may prevent or delay age-related declines in hearing sensitivity.     

Topographic diagnosis of hearing loss in patients with ischemic heart disease. Use of high-rate brain stem evoked response audiometry

Hearing loss in patients with ischemic heart disease traditionally has been attributed to atheromatous cerebral vascular disease. In this study, the site of the auditory lesion was sought in patients with ischemic heart disease and perceptive hearing loss. Standard brainstem evoked response audiometry (BSER) with increased stimulation rate (ISR) were performed. Sixty-seven patients admitted for coronary artery disease were examined. Fifty-seven recordings were complete and evaluable. All the cases of hearing loss were endocochlear. In 4 patients. BSER and ISR detected subclinical retrocochlear lesions that were compatible with ischemic disease. The results suggest that selective early cochlear ischemia can occur in young persons with heart disease. The sensitivity of BSER with ISR for detecting ischemic brainstem lesions was confirmed.     

Adaptive speech audiometry and speech discrimination space in hearing-impaired subjects

Phonemic discrimination difficulties in a small group of patients with sensorineural hearing loss have been mapped using a new form of speech audiometry which is au automated, adaptive, audio-visual system, using a binary forced-choice response mode. Phonemic confusion patterns have been displayed in directed graph form and the cases presented here have been chosen to illustrate the potentialities of the test method for obtaining detailed information on the fine structure of speech reception in these patients.     

Auditory perception with level-dependent hearing protectors. The effects of age and hearing loss

Auditory perception with hearing protectors was assessed in three groups of subjects, two with normal hearing, but differing in age, and one with moderate bilateral sensorineural hearing loss. Individuals were tested with the ears unoccluded, and fitted with each of two level-dependent ear muffs and their conventional level-independent counterparts. One of the former devices provided limited amplification. In each of these five ear conditions, the threshold of audibility for one-third octave noise bands centered at 500, 1,000, 2,000 and 4,000 Hz, consonant discrimination, and word recognition were measured in quiet and in a continuous impulse noise background. The results showed that the attenuation of sounds (i.e. the difference between protected and unoccluded thresholds) in quiet did not vary as a function of age or hearing loss for any of the four protectors. In noise, the difference between protected and unoccluded listening was close to zero, as long as hearing was normal. With hearing loss as a factor, there was a significant increment in the protected threshold, the amount determined by the device. Word recognition in quiet was adversely affected in normal-hearing listeners by the three attenuating devices but improved in noise relative to unoccluded listening. Amplification had a deleterious effect for both consonant discrimination and word recognition in noise. In hearing-impaired listeners, speech perception was impeded by all four muffs but less so in quiet with limited amplification.     

An implantable hearing aid for inner ear hearing loss. Short-term implantation of microphone and transducer

A microphone constructed for implantation in the posterior wall of the auditory canal and a piezoelectric transducer serving as the main components of an implantable hearing aid were temporally implanted in five patients during middle ear surgery under local anesthesia. The microphone was positioned beneath the skin of the auditory canal such that it completely covered the microphone membrane. The vibratory element of the transducer was coupled to the malleus in four patients with normal ossicular chains and directly to the stapes in one patient with missing incus. The microphone and transducer were electrically connected with an external battery-driven signal amplifier. Speech material and music were presented in the operation room at a sound level of 65 dB SPL under free-field conditions. The patients had to estimate the quality of speech, music, and their own voice as well as the effects of bone-conducting noises. All patients were able to hear with the system. An intraoperative talk without vision contact was possible without any problems, as was understanding of numerals ("Freiburger Zahlentest"). Perception of music was judged as "clear and undistorted with all broadband component." The estimation was also valid for one patient with a sensorineural hearing loss. One patient declared the music to be "a little of unnatural." Bone-conducted sound was estimated as normal in two patients, better than without an implant in one patient with sensorineural hearing loss, and "somewhat metallic" in another patient. Hearing the own voice was considered "normal" in two cases "monotonous" in one case, and "a little bit roaring" in another case. An amplification factor that can be technically realized in an implantable hearing aid was necessary for one of the patients with sensorineural hearing loss to perceive music at a pleasant volume. On the basis of this study, essential requirements for the construction of a fully implantable hearing aid are fulfilled.     

Noise-induced hearing loss in young adults: the role of personal listening devices and other sources of leisure noise

CONCEPT: No consensus exists regarding the magnitude of the risk of noise-induced hearing loss (NIHL) associated with leisure noise, in particular, personal listening devices in young adults. OBJECTIVE: Examine the magnitude of hearing loss associated with personal listening devices and other sources of leisure noise in causing NIHL in young adults. STUDY DESIGN: Prospective auditory testing of college student volunteers with retrospective history exposure to home stereos, personal listening devices, firearms, and other sources of recreational noise. METHODS: Subjects underwent audiologic examination consisting of estimation of pure-tone thresholds, speech reception thresholds, and word recognition at 45 dB HL. RESULTS: Fifty subjects aged 18 to 30 years were tested. All hearing thresholds of all subjects (save one-a unilateral 30 dB HL threshold at 6 kHz) were normal, (i.e., 25 dB HL or better). A 10 dB threshold elevation (notch) in either ear at 3 to 6 kHz as compared with neighboring frequencies was noted in 11 (22%) subjects and an unequivocal notch (15 dB or greater) in either ear was noted in 14 (28%) of subjects. The presence or absence of any notch (small or large) did not correlate with any single or cumulative source of noise exposure. No difference in pure-tone threshold, speech reception threshold, or speech discrimination was found among subjects when segregated by noise exposure level. CONCLUSION: The majority of young users of personal listening devices are at low risk for substantive NIHL. Interpretation of the significance of these findings in relation to noise exposure must be made with caution. NIHL is an additive process and even subtle deficits may contribute to unequivocal hearing loss with continued exposure. The low prevalence of measurable deficits in this study group may not exclude more substantive deficits in other populations with greater exposures. Continued education of young people about the risk to hearing from recreational noise exposure is warranted.     

Reliability of monosyllabic discrimination tests in white noise for differentiating among hearing aids

In spite of criticism, monosyllabic discrimination tests are widely employed for hearing aid selection. The current study was designed to investigate the following questions: (1) How reliable is aided speech discrimination of monosyllables in a background of white noise? (2) Can differences among hearing aids be reliably demonstrated by measuring intelligibility of monosyllables in a background of white noise? and (3) Do hearing aids interact with hearing loss? Twenty subjects with mild-moderate sensorineural hearing losses participated in two experimental sessions. Four hearing aids were evaluated using the NU-6 monosyllables in a background of white noise (s/n = +20 dB). Since the standard deviation of the test-retest differences was 6%, differences between aids were not considered significant unless they exceeded 12%. An interaction between subjects and hearing aids was found; that is, the best aid for one person was not the best for all. Measuring monosyllabic word intelligibility in a background of white noise does not reliably identify a single best aid. However, one or more inferior aids were consistently eliminated in 80% of the subjects.     

Antibiotics in bone

Word lists used for speech audiometry should fulfill a number of conditions in order that the results of hearing tests be unambiguous and directly interpretable not only in terms of possible hearing loss but also in terms of the neurolinguistic decoding process. In order to construct a proper word list, it was decided to attempt to estimate the subjective probability of word occurrence in schoolchildren. Nine different lists of over 300 words each were prepared, containing words of all assumed degrees of familiarity. In the preliminary stage, the lists were presented to 600 children in primary and secondary schools. The children were asked to mark each word with a number indicating their relative familiarity with the word. The answers were examined for homogeneity.     

Otoacoustic emissions in full-term newborns at risk for hearing loss

Distortion product otoacoustic emissions (DPOEs) and click-evoked otoacoustic emissions (CEOEs) characteristics of the normal newborn population have been previously reported in the literature. There is little information about DPOE evaluations in the newborn population at risk for hearing loss. The authors now report the DPOE and/or CEOE data from six full-term subjects at risk for hearing loss or with highly suspected hearing loss. These subjects were less than 1 year of age and at risk for hearing loss secondary to a history of hereditary hearing loss, meningitis, hyperbilirubinemia, and ototoxic drug exposure. Audiometric evaluation included auditory brainstem responses (ABR), behavioral observation audiometry, and tympanometry. The CEOEs and DPOEs were found to be decreased or absent in the subjects with suspected hearing loss secondary to cochlear pathology; they were found to be normal in a subject with a suspected central hearing loss. This study's data suggest that otoacoustic emissions when combined with ABR can provide a frequency-specific evaluation of cochlear function and help determine the anatomic site of a pathologic lesion.