Recommended procedure: computer coding of audiometric thresholds.
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Audiometry↗
Biomedical subjects
S Gatehouse
Publications and source records attributed to S Gatehouse.
Relation between alcohol and nose bleeds.
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Adult↗
Application of quality standards to hearing aid services.
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Hearing Aids↗
Components and determinants of hearing aid benefit.
This study investigates the measured and perceived disabilities and handicaps and associated auditory performance in 309 first-time hearing aid candidates. The results suggest that both disability and hearing aid benefit may be divided into separate components having particular and separate relationships to predictor variables in terms of both auditory and nonauditory characteristics. This division leads to a better understanding of the problems associated with a hearing impairment and their alleviation (or lack of) by provision of a hearing aid. In addition, the results support the development of more appropriate speech identification measures and suggest a potentially important role for measures of the temporal properties of the impaired auditory system.
Acoustic Stimulation↗
Behavior problems in otitis media.
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Aggression↗
Estimation of the benefit of bone-anchored hearing aids.
Implantable bone conduction hearing aids are a valuable alternative to conventional aids for those who cannot use a conventional air conduction aid or find it difficult to use because of an aural discharge, most commonly due to chronic otitis media. Previously reported series of the use of a bone-anchored hearing aid (BAHA) come from the originators of this device, and an independent report of their benefit and use, especially in previous air conduction aid users, would be of value. Twenty-three patients were evaluated at least 6 months after implantation of a BAHA. All 7 previous bone conduction aid users were delighted with their BAHA, reporting increased comfort and hearing benefit that was backed by audiometric evidence. Of the 16 individuals who previously used an air conduction aid, 11 (69%) were delighted users of their BAHA. Unfortunately, the other 5 (31%) reverted to solely using their air conduction aid. There was no obvious predictor as to how these individuals might have been identified prior to implantation. In particular, their pure tone thresholds, especially the bone conduction thresholds, were no different from those of the 11 BAHA users. However, in free field audiometry, the users gained superior benefit from their BAHA compared to their air conduction aid, whereas the nonusers did not. In conclusion, in all series to date, previous users of a conventional bone conduction aid have been delighted users of a BAHA and have gained superior audiometric benefit. This is not necessarily the case with previous air conduction aid users.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Candidature for hearing aids: justification for the concept and a two-part audiometric criterion.
A definition of hearing aid candidature is required for planning and other purposes. The number of candidates in the population actually receiving an adequate fitting would provide the major index of whether audiology services achieve their major public health goal. Many diverse factors determine the benefit that an individual receives from a hearing aid, and hence could in principle be included in some composite criterion for appropriate candidature reflecting the cost-effectiveness of patterns of provision. However, the complexity of universal capture, on those fitted with hearing aids, of data giving full auditory and demographic characteristics is beyond current routine NHS information systems. The most powerful known determinant established to date both of auditory disability and benefit is average hearing threshold level (HTL). Hearing threshold levels are hence both a necessary part of the fitting process and, given the data from the National Study of Hearing, a sufficient basis for computing population prevalences of hearing characteristics and service uptake in the major demographic strata. We report epidemiological data on consultation about problems with ears or hearing and uptake of hearing aids, which lead us to recommend a two-part candidature criterion on hearing threshold levels (0.5-4.0 kHz average): EITHER (a) better ear HTL > or = 35 dB OR (b) (15 dB < or = better ear HTL < 35 dB) WHEN worse ear HTL > or = 45 dB. The asymmetric component (b) may appear contentious, but is directly supported both by the epidemiological data and by further clinical data on benefit measured as performance on speech-in-noise tests. The proposed criterion is not over-liberal in clinical or related technological terms, but against the high prevalence of impairments in the population, the current provision and uptake of hearing aids in the UK still appear modest (about 3.3% in the population, and just under one-third of those qualifying by our criterion). Whatever the means of providing hearing aids, authorities charged with meeting the needs of their populations require such statistical indicators to know whether service delivery is appropriately geared. They should not use such an indicator as a basis of entitlement, as there are certainly individuals outside the criterion who receive benefit from their hearing aids. Equally, technological progress could expand the boundaries of candidature.
Adolescent↗
Role of perceptual acclimatization in the selection of frequency responses for hearing aids.
Previous work concerning the late-onset auditory deprivation and/or acclimatization effect in adult hearing-aid users has suggested that the benefits of a particular frequency response from a hearing aid may not become apparent until material exposure to that frequency response has been achieved. The generality of that finding was tested further. A group of subjects who were established users (12 to 15 months) of a particular frequency response (limited at high frequencies by the system of provision) were re-prescribed with a theoretically advantageous frequency response according to the NAL prescription. Using a speech-in-noise test (word identification) and a sentence verification test, the benefits of the re-prescription were not (or at best only marginally) evident upon immediate testing but became statistically significant and of material clinical magnitude following experience with the represcription for 8 and 16 weeks. These results suggest that comparative selection regimes and research designs based upon little or no experience of the listening environment through the hearing aid are likely to seriously misrepresent the benefits available to the hearing-impaired listener.
Audiometry, Pure-Tone↗
Spectral contrast enhancement of speech in noise for listeners with sensorineural hearing impairment: effects on intelligibility, quality, and response times.
This paper describes a series of experiments evaluating the effects of digital processing of speech in noise so as to enhance spectral contrast, using subjects with cochlear hearing loss. The enhancement was carried out on a frequency scale related to the equivalent rectangular bandwidths (ERBs) of auditory filters in normally hearing subjects. The aim was to enhance major spectral prominences without enhancing fine-grain spectral features that would not be resolved by a normal ear. In experiment 1, the amount of enhancement and the bandwidth (in ERBs) of the enhancement processing were systematically varied. Large amounts of enhancement produced decreases in the intelligibility of speech in noise. Performance for moderate degrees of enhancement was generally similar to that for the control conditions, possibly because subjects did not have sufficient experience with the processed speech. In experiment 2, subjects judged the relative quality and intelligibility of speech in noise processed using a subset of the conditions of experiment 1. Generally, processing with a moderate degree of enhancement was preferred over the control condition, for both quality and intelligibility. Subjects varied in their preferences for high degrees of enhancement. Experiment 3 used a modified processing algorithm, with a moderate degree of spectral enhancement, and examined the effects of combining the enhancement with dynamic range compression. The intelligibility of speech in noise improved with practice, and, after a small amount of practice, scores for the condition combining enhancement with a moderate degree of compression were found to be significantly higher than for the control condition. Experiment 4 used a subset of conditions from experiment 3, but performance was assessed using a sentence verification test that measured both intelligibility and response times. Scores on both measures were improved by spectral enhancement, and improved still more by enhancement combined with compression. The effects were statistically more robust for the response times. When expressed as equivalent changes in speech-to-noise ratio, the improvements were about twice as large for the response times as for the intelligibility scores. The overall effect of spectral enhancement combined with compression was equivalent to an improvement of speech-to-noise ratio by 4.2 dB.
Adult↗
Cis-platinum ototoxicity and eye colour.
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Cisplatin↗
The prevalence of middle ear disease in the adult British population.
The UK National Study of Hearing set out to ascertain the prevalence of hearing impairments of various magnitudes, the prevalence of ear disease and the associated risk factors, and to estimate the percentage of individuals requiring some form of management. A stratified sample of 2708 British adults, aged 18-80 years, was chosen from a sample of 48,313 adults, randomly selected from the electoral roll, for a full otological and audiological assessment. This paper deals primarily with the middle ear results. Otoscopically, 2.6% of British adults had inactive and 1.5% had active chronic otitis media. This condition was more common in older individuals and in those in manual occupations. For this purpose, presumptive otosclerosis was defined as a conductive component to the impairment (average air bone gap over 0.5, 1 and 2 kHz of 15 dB or greater) and with an intact tympanic membrane. The population prevalence for presumptive otosclerosis was 2.1%, for healed OM 1.7% and for Eustachian tube dysfunction 0.9%. This prevalence of otosclerosis was higher in those over 40 years, but only in those with air bone gaps of 30 dB or greater were women more likely to have the condition than men, by a factor of three. At most, 20% of individuals with any of the above middle ear conditions will have had ear surgery.
Adult↗
Multiple primary malignant tumours in patients with head and neck cancer: the implications for follow-up.
The pattern of second primary cancer occurrence in 518 Scottish patients with head and neck cancer was determined by a retrospective study. The overall incidence of second cancers was 9% but the true incidence increased steadily in the years following initial diagnosis to reach a maximum of 21% at 11 years. After 4 years of follow-up patients were more likely to die from a second primary cancer than from the effects of the initial tumour. The Scottish cohort differed from previously reported, overseas, study groups in having a high incidence of second primary cancers in sites outside the upper aerodigestive tract. This potential demographic difference suggests a need for local audit prior to design and implementation of screening protocols for second primary cancers.
Adolescent↗
The time course and magnitude of perceptual acclimatization to frequency responses: evidence from monaural fitting of hearing aids.
At high presentation levels, normally aided ears yield better performance for speech identification than normally unaided ears, while at low presentation levels the converse is true [S. Gatehouse, J. Acoust. Soc. Am. 86, 2103-2106 (1989)]. To explain this process further, the speech identification abilities of four subjects with bilateral symmetric sensorineural hearing impairment were investigated following provision of a single hearing aid. Results showed significant increases in the benefit from amplifying speech in the aided ear, but not in the control ear. In addition, a headphone simulation of the unaided condition for the fitted ear shows a decrease in speech identification. The benefits from providing a particular frequency spectrum do not emerge immediately, but over a time course of at least 6-12 weeks. The findings support the existence of perceptual acclimatization effects, and call into question short-term methods of hearing aid evaluation and selection by comparative speech identification tests.
Aged↗
Clinical pure-tone versus three-interval forced-choice thresholds: effects of hearing level and age.
Hearing threshold levels were measured at 2 kHz using both a standard clinical procedure and a three-interval forced-choice procedure. The 240 subjects (aged 50-75 years) embraced both normal hearing and symmetrical sensorineural hearing impairment. The sample was carefully constructed to dissociate hearing threshold level from age, by oversampling the young impaired and the older normally hearing. The forced-choice threshold was found to be generally acuter than the clinical threshold. This was related to increasing severity of hearing loss at 1.7 dB per 10 dB HL and to age at 1.6 dB HL per 10 years. Hearing threshold accounted for 12% of the variance in the discrepancy between the two types of threshold, while age accounted for only 4% due to the narrow range used. After control for these thresholds and age, there were also significant associations with a self-estimate of hearing ability and with the neuroticism score from a personality questionnaire. When interpreting epidemiological findings, particularly in longitudinal studies, the separation between sensory and cognitive factors in threshold measures needs to be considered. The obtained discrepancies as a function of hearing level and age were applied to a statistical model for population prevalences for hearing impairment. The results suggested that the choice of method could have material effects on overall prevalence estimates and on the magnitude of the apparent age effect.
Age Factors↗
Clinical and financial audit of diagnostic protocols for lesions of the cerebellopontine angle.
OBJECTIVE: To assess the diagnostic efficiency and costs of protocols used for investigating patients with suspected lesions of the cerebellopontine angle. DESIGN: Prospective evaluation of tests of auditory brain stem responses and acoustic reflex thresholds, electronystagmography, and calorics. Positive test results were confirmed or refuted by high resolution computed tomography with intravenous enhancement. SETTING: Single general otolaryngology clinic in a teaching hospital. PATIENTS: 270 consecutive patients with sensorineural hearing loss requiring investigation to exclude a lesion of the cerebellopontine angle. MAIN OUTCOME MEASURES: Estimated costs of various diagnostic protocols and performance in detecting tumours of the cerebellopontine angle. RESULTS: Protocols including tests of auditory brain stem responses and acoustic reflex thresholds as sifting tests before computed tomography were clinically acceptable and presented considerable savings over the use of computed tomography in all patients (74,000 pounds or 84,000 pounds v 122,000 pounds). The use of electronystagmography and calorics could not be justified on clinical or financial grounds. CONCLUSIONS: Audiological tests of auditory brain stem responses and acoustic reflex thresholds followed by computed tomography constitute the most cost effective protocol for determining suspected lesions of the cerebellopontine angle. IMPLICATIONS: The cost effectiveness of diagnostic protocols should be evaluated throughout the health service.
Caloric Tests↗
Frequency resolution as a function of hearing threshold level and age.
Frequency resolution ability was measured using a psychoacoustical tuning curve (PTC) or a notch-noise technique in two population samples. The first sample incorporated 1764 subjects with various degrees of sensorineural hearing impairment and ranging in age from 17-80 years. The second sample included 240 subjects aged between 50 and 75 years, carefully balanced in terms of impairment and age to avoid confounding between these two variables. In both samples, frequency resolution ability declined with increasing hearing threshold level (HTL), as measured by either method. In a subsample tested with both methods, the correlation between the two was only modest. After accounting for HTL, there was a minor dependence of frequency resolution on age, older subjects having poorer frequency resolution once HTL had been accounted for. No addition to the explained variance was achieved by taking sex, occupational group, or audiogram slope into account. Despite the documented reproducibility of the measures, much of the variance in the frequency resolution measurements remained unrelated to HTL or age.
Adolescent↗
The Glasgow Benefit Plot: a new method for reporting benefits from middle ear surgery.
Conventionally, the results of middle ear surgery are reported in terms of postoperative closure of the air-bone gap or the improvement in air-conduction thresholds. While these are relevant in that they assess the technical success of the procedure and the lessening of monaural disability, they do not necessarily assess whether the patient has benefited. This is determined by many factors, not least of which is the hearing in the nonoperated ear. In this paper, we suggest that preoperative and postoperative plots of the air-conduction thresholds in both ears be used as an additional method of presenting the results. First, the proportion of patients that fall into each of three main preoperative impairment groups are identified. This is important, as the potential benefits from surgery are not the same in each group. Thereafter, the percentages of patients that achieve various postoperative hearing categories can be calculated, allowing surgeons to audit their results and make comparisons between series.
Adult↗
Reliability of patient choice between hearing aid systems.
Various hearing aid provision strategies have been suggested but it is important to compare patient benefit from these, not only in the laboratory, but in everyday life. The latter can only be assessed by patient report. The false positive report rate of a difference between aids and the reproducibility of patient choice of aids was assessed in two groups of patients. The first received the same system on two occasions and were asked to report if they had any preference. The second group received two different systems on two occasions and the reproducibility of any preference was assessed. Of the 22 patients who were given the same hearing aid system on each visit, eight (36%) reported no differences, 10 (45%) a little and four (18%) a moderate or large difference between them when, in fact, there was none. Of the 34 patients who were asked to compare two acoustically different aids, 32 chose an aid on both occasions but only 22 (65%) chose the same aid, of whom 11 (32%) reported a moderate or large difference on both occasions. If reports of a little difference between aids are discounted and only moderate or large differences are accepted, it is concluded that the false positive report rate of a difference is approximately 20%. In addition, when patients are being asked to compare two NHS hearing aid systems, the rules of chance, order effect and reproducibility of patient choice have all to be controlled for, before decisions regarding patient preference can be made.
Aged↗