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Biomedical subjects

S Jerger

Publications and source records attributed to S Jerger.

15 recordsLinked to original sources

Evaluation of higher-level auditory function in children with asymptomatic congenital cytomegalovirus infection.

Higher-level auditory/cognitive functions were evaluated in 16 children: eight with asymptomatic congenital cytomegalovirus (CMV) infections and eight children documented not to have asymptomatic congenital CMV infections. Hearing sensitivity was within normal limits in all subjects. Results in both groups were within the normal range on the screening measures of verbal abilities, visual perception, social behavior, and memory span. In contrast, results of the auditory measures revealed abnormal dichotic speech perception, delayed latencies on auditory brainstem evoked responses, and disproportionately slow reaction times in a difficult listening condition (Stroop task). With the exception of dichotic speech perception, however, the pattern of auditory results suggested subtle disorders that were difficult to discern unequivocally with the small subject sample. Further studies are encouraged to determine the status of higher-level auditory/cognitive functions in children with asymptomatic congenital CMV infections.

Child

Correlational analysis of speech audiometric scores, hearing loss, age, and cognitive abilities in the elderly.

A battery of speech audiometric measures and a battery of neuropsychological measures were administered to 200 elderly individuals with varying degrees of pure-tone sensitivity loss. Results were analyzed from the standpoint of the extent to which variation in speech audiometric scores could be predicted by knowledge of pure-tone hearing level, age, and cognitive status. For the four monotic test procedures (PB, SPIN-Low, SPIN-High, and SSI) degree of hearing loss bore the strongest relation to speech recognition score. Cognitive status accounted for little of the variance in any of these four speech audiometric scores. In the case of the single dichotic test procedure (DSI), both degree of hearing loss and speed of mental processing, as measured by the Digit Symbol subtest of the WAIS-R, accounted for significant variance. Finally, age accounted for significant unique variance only in the SSI score.

Aged

Central auditory processing disorder: a case study.

We carried out extensive audiologic, electrophysiologic, and neuropsychologic testing on a young woman who complained that she had difficulty hearing in her educational environment. Conventional audiometric results, including pure-tone, speech, and immittance audiometry, were all within normal limits. The subject performed normally on tests involving the processing of rapidly changing temporal information, interaural time and intensity difference detection, and both absolute and relative sound localization. Early, middle, late and task-related auditory evoked potentials were essentially normal, although some asymmetry was observed in the middle latency (MLR) and late (LVR) responses. There was, however, a consistent left-ear deficit on dichotic sentence identification, on threshold and suprathreshold speech measures in the left sound field when various types of competition were delivered in the right sound field, and on cued-target identification in the left sound field in the presence of multitalker babble. Results suggest a central auditory processing disorder characterized by an asymmetric problem in the processing of binaural, noncoherent signals in auditory space. When auditory space was structured such that the target was directed to the left ear, and the competition to the right ear, unwanted background was less successfully suppressed than when the physical arrangement was reversed.

Acoustic Impedance Tests

Evaluation of adult aphasics with the Pediatric Speech Intelligibility test.

Results of conventional adult speech audiometry may be compromised by the presence of speech/language disorders, such as aphasia. The purpose of this project was to determine the efficacy of the speech intelligibility materials and techniques developed for young children in evaluating central auditory function in aphasic adults. Eight adult aphasics were evaluated with the Pediatric Speech Intelligibility (PSI) test, a picture-pointing approach that was carefully developed to be relatively insensitive to linguistic-cognitive skills and relatively sensitive to auditory-perceptual function. Results on message-to-competition ratio (MCR) functions or performance-intensity (PI) functions were abnormal in all subjects. Most subjects served as their own controls, showing normal performance on one ear coupled with abnormal performance on the other ear. The patterns of abnormalities were consistent with the patterns seen (1) on conventional speech audiometry in brain-lesioned adults without aphasia and (2) on the PSI test in brain-lesioned children without aphasia. An exception to this general observation was an atypical pattern of abnormality on PI-function testing in the subgroup of nonfluent aphasics. The nonfluent subjects showed substantially poorer word-max scores than sentence-max scores, a pattern seen previously in only one other patient group, namely young children with recurrent otitis media. The unusually depressed word-max abnormality was not meaningfully related to clinical diagnostic data regarding the degree of hearing loss and the location and severity of the lesions or to experimental data regarding the integrity of phonologic processing abilities. The observations of ear-specific and condition-specific abnormalities suggest that the linguistically- and cognitively-simplified PSI test may be useful in the evaluation of auditory-specific deficits in the aphasic adult.

Adult

Speech understanding in the elderly.

Both auditory and cognitive status were determined in 130 elderly persons, in the age range from 51 to 91 years. Data were analyzed from the standpoint of the congruence of auditory and cognitive deficits. The prevalence of central auditory processing disorder was 50%, and the prevalence of cognitive deficit was 41%. Findings in the two areas were congruent, however, in only 63% of the total sample. Central auditory status was abnormal in the presence of normal cognitive function in 23% of subjects. Central auditory status was normal in the presence of cognitive deficit in 14% of subjects. In general, results did not support the hypothesis that decline in speech understanding in the elderly can be explained as the consequence of concomitant cognitive decline.

Aged

Dichotic listening in a child with a cerebral lesion: the "paradoxical" ipsilateral ear deficit.

Behavioral testing is reported for a child with a deep, left cerebral lesion that displaced the third ventricle across midline and compressed and elevated the lateral ventricle, presumably disrupting interhemispheric auditory pathways. The onset of the lesion was before 2 1/2 years of age. Cognitive screening tests indicated normal nonverbal (visual perceptual) and semantic (confrontation naming) abilities, but impaired syntactic skills. Audiological testing showed an isolated ipsilateral ear abnormality on dichotic testing only. All other audiological results, including monotic testing with the same speech materials, were normal. Results were comparable to findings in adults with similar lesions.

Auditory Pathways

Distinguishing auditory and speech-specific perceptual deficits.

The ability to discriminate speech and nonspeech auditory stimuli was tested in a learning disabled child. The perception of speech stimuli was normal when the stimuli were presented in quiet but below normal when the stimuli were presented in noise. Although the perception of pure tone stimuli and environmental sounds was normal both in quiet and noise, the perception of nonspeech stimuli with rapid changes in acoustic information was impaired in noise. These findings illustrate the importance of relating performance for speech and complex nonspeech stimuli in investigating the basis of speech perceptual deficits. Whereas abnormal performance for speech stimuli coupled with normal performance for complex nonspeech stimuli argues for the existence of specialized speech processing mechanisms, abnormal performance for both types of stimuli, as was found in the present subject, argues for the existence of more generalized auditory processing mechanisms.

Adolescent

A new acoustic reflex pattern.

A new crossed-vs-uncrossed acoustic reflex pattern has been observed in four patients with retrocochlear disorder. The new reflex pattern is characterized by a unique "uni-box" configuration. Reflexes are abnormal with sound to the affected ear on crossed stimulation only. In one additional patient, a variation of the uni-box pattern was found on suprathreshold reflex amplitude measures. WE observed a large ear difference between reflex amplitude functions in the crossed condition, but not in the uncrossed condition. This observation suggests that reflex amplitude measures may be a valuable addition to threshold measures in some patients.

Adolescent

Diagnostic value of crossed vs uncrossed acoustic reflexes: eighth nerve and brain stem disorders.

Acoustic reflexes to crossed (sound in one ear; probe in opposite ear) and uncrossed (sound and probe in the same ear) stimulation were obtained from 17 patients with eighth nerve or brain stem disorders and 20 normal control subjects. Comparison of crossed and uncrossed reflex thresholds provided an important diagnostic tool for differentiating the eighth nerve from the brain stem site. Egihth nerve disorders were usually characterized by diagonal reflex patterns. In contrast, brain stem disorders were usually characterized by horizontal reflex patterns. Detailed evaluation of the reflex time course in two selected patients with intra-axial brain stem disorder showed unusual abnormalities in the crossed acoustic reflex.

Acoustic Stimulation

Estimating speech threshold from the PI-PB function.

Speech thresholds were determined from the performance intensity function for phonetically balanced (PB) words in 2,117 patients with varying types and degrees of hearing loss. Comparison of this threshold for PB words (PBT) with both pure-tone sensitivity (PTA) and the conventional threshold for spondee words (ST) shows that PBT not only provides a cross-check on pure-tone level, but also conveys additional information about audiometric contour.

Adolescent

Recovery of crossed acoustic reflexes in brain stem auditory disorder.

Crossed acoustic reflexes were serially monitored in a patient receiving radiotherapy for an intra-axial brain stem tumor. Analysis revealed a pattern of systematic recovery as the brain stem lesion responded to therapy. Crossed reflexes were observed at more and more test frequencies, until responses were present on both ears for all test signals. Pure-tone sensitivity and speech intelligibility remained within the normal range throughout the observation period.

Auditory Pathways

A simplified tone decay test.

This report describes a simplified suprathreshold tone decay test procedure (STAT). The sustained test signal is presented for 60 seconds at 110 dB sound pressure level. The patient is asked to respond as long as he hears the sound. If the patient responds for the full 60-second test period, the result is negative. If, however, he fails to respond for the full 60 seconds, the result is considered positive for eighth-nerve site. Clinical experience with the new test procedure suggests that it minimizes false alarms without sacrificing accuracy of identification of eighth-nerve site.

Adolescent

Extra- and intra-axial brain stem auditory disorders.

Auditory symptoms of brain stem disorder depend on the nature of the lesion. This study compared auditory test results in 28 patients with extra-axial, 11 patients with intra-axial, and 6 patients with combined extra-axial and intra-axial brain stem disorders. Patients with extra-axial lesions usually demonstrated (1) sensitivity loss, (2) marked adaptation on Békésy audiometry, (3) impairment in PBmax scores, and (4) auditory symptoms on the ear ipsilateral to the radiographic abnormality. Patients with intra-axial brain stem lesions usually showed (1) slight, if any, sensitivity loss, (2) normal Békésy audiograms, (3) relatively good PBmax scores, and (4) suditory symptoms on both ears or on the ear contralateral to the radiographic disorders. In the patients with combined extra-axial and intra-axial disorders, auditory findings varied in relation to the extent of extra-axial involvement.

Acoustic Stimulation

Quantifying auditory handicap. A new approach.

This report describes a new audiovisual test procedure for the quantification of auditory handicap (QUAH). The QUAH test attempts to recreate in the laboratory a series of everyday listening situations. Individual test items represent psychomotor tasks. Data on 53 normal-hearing listeners described performance as a function of the message-to-competition ratio (MCR). Results indicated that, for further studies, an MCR of 0 dB represents the condition above which the task seemed too easy and below which the task appeared too difficult for normal-hearing subjects. The QUAH approach to the measurement of auditory handicap seems promising as an experimental tool. Further studies are needed to describe the relation of QUAH results (1) to clinical audiologic measures and (2) to more traditional indices of auditory handicap.

Adolescent