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PubMed1984

Magnitude estimation of loudness. II: Loudness perception in presbycusic listeners.

Because clinical methods most commonly used for assessing loudness are indirect measures that require one normal or near normal ear, loudness perception has not been studied thoroughly in listeners with symmetrical hearing loss. In this investigation, loudness perception was studied in three groups of listeners: normal listeners, listeners with asymmetrical sensorineural hearing loss, and individuals with bilaterally symmetrical hearing impairment due to presbycusis. In Experiment 1, a Magnitude Estimation of Loudness (ME) technique was compared to Alternate Binaural Loudness Balance ( ABLB ) results for subjects with asymmetrical hearing impairment. Results indicate that ME and ABLB measurements produce similar evidence of abnormally rapid growth of loudness in asymmetrically impaired listeners. In Experiment 2, loudness growth in individuals with normal hearing or with presbycusic hearing impairment was determined from ME measurements. Although presbycusic subjects tended to have steeper loudness functions than normal subjects, the differences did not reach statistical significance except at 6000 Hz, suggesting that, as a group, presbycusic listeners display little, if any, recruitment of loudness.

Adult↗
PubMed1987

A method for relating loudness-matching and intensity-discrimination data.

A method that allows direct comparisons between pure-tone loudness-matching and intensity-discrimination data in normal and hearing-impaired listeners is described. This method makes a minimal number of assumptions about the relations between loudness perception and intensity-discrimination performance. Loudness is considered to be related to overall, perceived stimulus magnitude and intensity-discrimination performance is considered to reflect the accuracy with which a loudness judgment can be made. Because pure-tone intensity-discrimination performance varies as a function of stimulus level in normal ears, the standard level required to produce a particular difference limen in an impaired ear can be inferred from normal-ear intensity-discrimination data. Thus, plotting standard levels yielding normal difference limens as a function of standard levels yielding the equivalent sized difference limens from a threshold-shifted ear produces a function directly comparable to loudness recruitment functions. If loudness-growth and intensity-difference limens were tightly coupled in threshold-shifted ears, then stimuli that yield equal size difference limens would be equally loud. This relation was tested by obtaining loudness-matching and intensity-discrimination data from normal-hearing listeners with thresholds shifted by a wideband noise and hearing-impaired listeners with cochlear-type hearing losses. The results from these listeners show similarities between the traditional loudness-recruitment functions and "intensity-recruitment" functions derived from the assumed relation between the two measures. The primary difference between the functions is at low and moderate sensation levels where loudness grows at a more rapid rate than the difference limen.

Audiometry, Pure-Tone↗
PubMed1990

Speech-recognition difficulties of the hearing-impaired elderly: the contributions of audibility.

The role that sensorineural hearing loss plays in the speech-recognition difficulties of the hearing-impaired elderly is examined. One approach to this issue was to make between-group comparisons of performance for three groups of subjects: (a) young normal-hearing adults; (b) elderly hearing-impaired adults; and (c) young normal-hearing adults with simulated sensorineural hearing loss equivalent to that of the elderly subjects produced by a spectrally shaped masking noise. Another approach to this issue employed correlational analyses to examine the relation between audibility and speech recognition within the group of elderly hearing-impaired subjects. An additional approach was pursued in which an acoustical index incorporating adjustments for threshold elevation was used to examine the role audibility played in the speech-recognition performance of the hearing-impaired elderly. A wide range of listening conditions was sampled in this experiment. The conclusion was that the primary determiner of speech-recognition performance in the elderly hearing-impaired subjects was their threshold elevation.

Adult↗
PubMed1998

Temporal analysis and stimulus fluctuation in listeners with normal and impaired hearing.

The first experiment investigated the effects of mild to moderate sensorineural hearing impairment on temporal analysis for noise stimuli of varying bandwidth. Tasks of temporal gap detection, amplitude modulation (AM) detection, and AM discrimination were examined. Relatively high levels of stimulation were used in order to reduce the possibility that the results of the listeners with hearing impairment would be influenced strongly by audibility. A general summary of results was that there was relatively great interlistener variation among the listeners with hearing impairment, with most listeners showing normal performance and some showing degraded performance, regardless of the bandwidth of the stimulus carrying the temporal information. A second experiment investigated the hypothesis that listeners with sensorineural hearing impairment might have poor gap detection due to loudness recruitment. Here, gap markers were presented at levels where loudness growth was steeper for the listeners with hearing impairment than for the listeners with normal hearing. Although gap detection was sometimes poorer in listeners with hearing impairment than in listeners with normal hearing, there was no clear relation between gap detection performance and loudness recruitment in listeners with mild to moderate sensorineural hearing impairment.

Acoustic Stimulation↗
PubMed1999

Sumatriptan nasal spray: a dose-ranging study in the acute treatment of migraine.

This multicentre, randomized, double-blind, placebo-controlled, parallel group dose-ranging study compared the efficacy and tolerability of four doses of sumatriptan nasal spray (2.5, 5, 10 and 20 mg) with a placebo, in the acute treatment of a single migraine attack. In total, 544 patients received the study medication as a single spray in one nostril, to treat a single migraine attack in the clinic. Efficacy assessments included the measurement of headache severity, clinical disability, and the presence/absence of associated symptoms. The incidence of headache recurrence was also assessed. The three highest doses of sumatriptan (5 mg 49%, 10 mg 46%, 20 mg 64%) were significantly better than the placebo (25%) at providing headache relief (moderate or severe headache improving to mild or none) 120 min after treatment (P </= 0. 01). Also, the 20 mg dose was significantly superior to both the 10 and 5 mg doses at this time point (P < 0.05). The proportion of patients who were headache-free 120 min after treatment, was also higher following 20 mg (42%) rather than following any other sumatriptan dose (14-24%, P < 0.005 20 vs 10 mg) or placebo (11%). Headache recurrence in patients who had responded to initial treatment was reported by 30-41% of patients who received sumatriptan, compared with 33% of patients in the placebo group. Sumatriptan nasal spray was well tolerated, the incidence of adverse events with each dose of sumatriptan being similar to the placebo (20-27 and 23%, respectively). Apart from bad/bitter taste, the events were comparable with those reported following sumatriptan treatment by other routes of administration.

Adult↗
PubMed1999

Treatment of severe, disabling migraine attacks in an over-the-counter population of migraine sufferers: results from three randomized, placebo-controlled studies of the combination of acetaminophen, aspirin, and caffeine.

OBJECTIVE: To examine the benefits of acetaminophen, aspirin, and caffeine (AAC) in the treatment of severe, disabling migraine attacks, in a population of migraine sufferers for whom over-the-counter (OTC) medications are appropriate. BACKGROUND: Subjects (n = 1220) who met the International Headache Society criteria for migraine with or without aura were included in three independent clinical studies. DESIGN/METHODS: Post-hoc analysis of 172 subjects who met the criteria for severe, disabling migraine reported a history of migraine attacks characterized by at least severe pain and severe disability, and treated attacks with severe pain and at least severe disability. Subjects who usually vomited with 20% or more of their migraine attacks, and those with incapacitating disability (subjects who required bed rest for more than 50% of their attacks) were not eligible for enrollment. RESULTS: From 1 h and continuing through 6 h postdose, the proportion of responders was significantly greater (p< or =0.01) for AAC than placebo. The pain intensity difference from baseline was significantly greater (p< or =0.05) for AAC than placebo from 0.5 h through 6 h. The proportion of subjects reporting improvement in functional disability, photophobia, and phonophobia was significantly greater for AAC than placebo from 2 h through 6 h postdose. CONCLUSIONS: The nonprescription combination of AAC was well tolerated and effective.

Acetaminophen↗
PubMed2000

Visual, long-latency auditory and brainstem auditory evoked potentials in migraine: relation to pattern size, stimulus intensity, sound and light discomfort thresholds and pre-attack state.

We aimed to estimate primary sensory evoked potential (EP) amplitude, amplitude-intensity functions and habituation in migraine patients compared with healthy control subjects and to investigate the possible relation to check size, sound and light discomfort thresholds, and the time to the next attack. Amplitudes of cortical visual evoked potentials (VEP, check size 8' and 33'), cortical long latency auditory evoked potential (AEP NIP1; 40, 55 and 70 dB SL tones) and brainstem auditory evoked potential (BAEP wave IV-V; 40, 55 and 65 dB SL clicks) were recorded and analysed in a blind and balanced design. The difference between the response to the first and the second half of the stimulus sequence was used as a measure of habituation. Twenty-one migraine patients (16 women and five men, mean age 39.3 years, six with aura, 15 without aura) and 22 sex- and age-matched healthy control subjects were studied (18 women and four men, mean age 39.5 years). Low sound discomfort threshold correlated significantly with low levels of BAEP wave IV-V amplitude habituation (r = -0.30, P = 0.05). VEP an AEP amplitudes, habituation, and amplitude-intensity function (ASF) slopes did not differ between groups when ANOVA main factors were considered. Control group VEP habituation was found for small check stimuli (P = 0.04), while potentiation was observed for medium sized checks (P = 0.02). The eight migraine patients who experienced headache within 24 h after the test tended to have increased BAEP wave IV-V ASF slopes (P = 0.08). This subgroup did also have a significant VEP habituation to small checks (P = 0.04). No correlation was found between different modalities. These results suggest that: (i) VEP habituation/potentiation state and brainstem activatio state may depend on the attack-interval cycle in migraine; (ii) VEP habituation/ potentiation may depend on spatial stimulus frequency; (iii) phonophobia (and possibly photophobia) may depend more on subcortical (brainstem) function than on cortical mechanisms; (iv) low cortical preactivation in migraine could not be confirmed; (v) EP habituation and ASF analysis may reflect sensory modality-specific, not generalized, central nervous system states in migraine and healthy control subjects.

Acoustic Stimulation↗
PubMed2002

Zolmitriptan is effective and well tolerated in Japanese patients with migraine: a dose-response study.

This phase II study investigated the efficacy, tolerability and dose-response relationship of oral zolmitriptan in the treatment of a single migraine attack in Japanese patients. A bridging analysis then assessed the validity of extrapolating western clinical data to these Japanese patients. In this multicentre, randomized, double-blind, placebo-controlled study, patients received a single dose of placebo or zolmitriptan 1, 2.5 or 5 mg. The primary endpoints were 2-h headache response and the tolerability of zolmitriptan. A statistically significant dose-response relationship was observed for the 2-h headache response (P=0.003). The 2.5 mg group had significantly greater 2-h headache response than the placebo group (P=0.032). The adverse event profile was similar to that reported in western patients, and no adverse events unique to the Japanese population were observed. The bridging analysis report confirmed similar efficacy and tolerability of zolmitriptan in Japanese and western populations. In the Japanese patients, the estimated response rates were 34.3%, 45.2%, 57.7% and 66.2% for placebo, and zolmitriptan 1, 2.5 and 5 mg, respectively, while in the western population the corresponding rates were 39.9%, 49.6%, 61.2% and 71.7%. Zolmitriptan is effective and well tolerated in the acute treatment of migraine in Japanese patients. The optimal dose was 2.5 mg, although the 5 mg dose may provide further benefit for some patients. The bridging analysis supports extrapolation of data from western to Japanese patients.

Adult↗
PubMed1999

Use of cluster analysis to validate IHS diagnostic criteria for migraine and tension-type headache.

Cluster analysis was used to validate headache diagnostic criteria of the International Headache Society (IHS). Structured diagnostic interviews were conducted on 443 headache sufferers from a community sample, which was randomly split to allow replication. Hierarchical cluster analysis of symptoms in both subsamples revealed two distinct (P<.001) clusters: (1) unilateral pulsating pain, pain aggravated by activity, and photophobia and phonophobia, and (2) bilateral pressing/tightening pain, mild to moderate intensity, and absence of nausea/vomiting. These clusters were consistent with IHS migraine and tension-type classifications, respectively. Replication using a non-hierarchical clustering technique, k-means cluster analysis, revealed a migrainelike patient cluster, reflecting more frequent pulsating, unilateral pain; more severe pain; and pain aggravated by activity; nausea, vomiting, photophobia, and phonophobia. A tensionlike patient cluster was also identified, reflecting more frequent pressing/tightening pain, mild to moderate pain, bilateral location, and absence of nausea/vomiting. These patient clusters were consistent across subsamples. International Headache Society diagnoses corresponded with classification based upon statistically derived clusters (P<.001). These results indicate that headache symptoms cluster empirically in a manner consistent with IHS criteria for migraine and tension-type headaches. Criterion overlap problems regarding pain intensity and duration were identified. Overall, these data support migraine and tension-type headache as distinct entities, and provide support for the IHS diagnostic criteria with minor modifications.

Adult↗
PubMed2003

Factors associated with migraine-related quality of life and disability in adolescents: a preliminary investigation.

OBJECTIVES: This study examined factors associated with impaired quality of life and functioning in a sample of treatment-seeking adolescent migraineurs. Subjects.-The 37 participants were 51.4% female, and averaged 14.3 years of age and 4.1 migraines per month for the previous 36 months. PROCEDURE: The Migraine-Specific Quality of Life Questionnaire, questionnaire items inquiring about missed activities, and headache diary recordings of missed and impaired activity time served as dependent measures. Variables studied were age; gender; migraine frequency, duration, and severity; presence of nausea, photophobia, or phonophobia; and number of visits to an emergency department in the previous year. RESULTS: Three hierarchical forward regressions and one logistic regression, controlling for age and gender, revealed that the presence of nausea and at least one emergency department visit predicted poorer quality of life and a greater number of missed activities in these adolescent migraineurs. The presence of migraine-related missed activity hours from headache diaries was predicted by being male, having higher combined photophobia and phonophobia sensitivity scores, as well as more frequent and severe migraines. Greater impairment was predicted by having longer average duration attacks. CONCLUSIONS: These preliminary findings suggest that the continued development of effective treatment approaches to alleviate pain, suffering, and disability in adolescent migraineurs is required. In particular, evidence for the impact of nausea and sensitivities suggests that they may be important targets for treatment. As well, adolescent migraineurs with a history of a visit to an emergency department in the previous year likely experience greater individual and family distress, more disability, and poorer quality of life that require thoughtful, comprehensive treatment to prevent the development of more severe headache difficulties.

Adolescent↗
PubMed2001

[Detection of loudness recruitment in patients with retrocochlear lesions using the "Würzburger Hörfeld" loudness scaling].

BACKGROUND: The pathogenesis of hearing loss caused by cerebellopontine angle tumors such as acoustic neuromas is unknown. The lack of loudness recruitment is thought to be one of the features of retrocochlear hearing impairment. In contrast to conventional suprathreshold tests, the categorial loudness scaling using the "Würzburger Hörfeld" is a valuable tool to describe the individual perception of sound. The aim of the present study was to analyze the loudness growth rate in patients with acoustic neuroma. PATIENTS AND METHOD: Pure tone and speech audiometry as well as auditory brainstem response and bilateral categorial loudness scaling were performed preoperatively in 54 patients with acoustic neuroma. Loudness scaling was done in free field switching off the contralateral ear by using an ear-plug. RESULTS: An abnormal rapid loudness growth function was found in 38 of the 54 patients (70.4%) at least at one frequency on the tumor side. The contralateral side was effected only in 57.4% of the patients. The incidence of a recruitment depended on the frequency with a maximum at 4 kHz. The slope of the loudness function showed a tendency to increase with increasing hearing loss. CONCLUSIONS: Loudness recruitment is not a rare phenomenon in patients with acoustic neuroma. The underlying cause (a preexisting hair cell damage, hair cell changes resulting from an obstruction of the cochlear blood supply or a disruption of the cochlear efferents) still remains unclear.

Adult↗
PubMed1992

Cochlear microphonics and recruitment.

In this study, bilateral cochlear microphonics (CM) were evoked by tone burst simultaneously. A speaker was put in head-food axis 2 m from the mid-point of a given line connecting the bilateral external meatus. Five normal persons and 68 cases (34 cases of Meniere's disease, 27 cases of sudden hearing loss, and 7 cases of low-tone sensory hearing loss without vertigo) with unilateral sensory hearing loss and recruitment, in addition to 2 cases of bilateral Meniere's disease with recruitment were examined. CM shifted in normal and hearing loss ears and was absent in profound and totally deaf ears. When recruitment was present, CM at corresponding frequencies were enlarged and prolongated in 60 cases. Some of the enlarged and prolongated CM decayed slowly, others quickly. Meanwhile the CM of the opposite normal ear decreased obviously. The presence of enlarged and prolongated CM may indicate an increase of abnormal excitability of the hair cells caused by some pathological stimulations. This would cause excitability of the hair cells in the opposite cochlea to be inhibited by the effect of the efferent system. In such a condition, the patients complained that the stimulating sound was heard louder in the disordered ear than that in the opposite normal ear. CM was slightly enlarged during sleep.

Adult↗
PubMed1999

Temporal loudness integration and spectral loudness summation in normal-hearing and hearing-impaired listeners.

The aim of this study was to test for differences between normal-hearing and hearing-impaired listeners regarding two fundamental aspects of intensity perception: loudness integration and loudness summation. Loudness functions for three different stimuli were measured using categorical loudness scaling in 8 normal-hearing and 12 hearing-impaired subjects. The results indicated that temporal loudness integration, defined as the difference in SPL between 16.25-ms and 300-ms noise bursts of equal loudness, was larger in the hearing-impaired than in the normal-hearing listeners. Loudness summation, defined as the difference in SPL between a 300-ms, 1,600-Hz tone pip and a white noise burst of the same duration and loudness, did not differ between the two groups. Implications of these results for hearing aid fitting strategies based on loudness normalization are discussed.

Adult↗
PubMed1999

Loudness growth functions and EABR characteristics in Digisonic cochlear implantees.

Electrically evoked auditory brainstem responses (EABRs) and loudness functions were measured in 14 subjects equipped with an MXM Digisonic cochlear implant. EABRs were evoked by 75-Hz pulse trains presented on the apical electrode. Loudness functions at the same rate and at a rate more conventional for psychoacoustic measurements (300 Hz) were measured using a categorical loudness-scaling procedure. The results revealed a significant difference in the loudness functions measured at 75 and 300 Hz, loudness increasing more steeply with stimulus intensity for the latter rate. Significant correlations between EABR wave V thresholds and perceptual thresholds measured at both 75 and 300 Hz were observed. Furthermore, in 8 out of the 14 patients, EABR wave V saturated at a stimulus level corresponding precisely to the loudest bearable, i.e. "Too loud" level for the 300-Hz stimulation rate; this same level corresponded to the "Comfortable" loudness level for the 75-Hz stimulation rate. On average, an almost linear relationship was observed over the first half of the loudness range between the stimulus intensity, expressed as a pulse duration in log units, and wave V amplitude in dB. Although further investigation is required before maximum comfort levels can be predicted reliably from EABR measures in individual subjects, these results indicate new directions regarding the estimation of perceptual dynamic range limits on the basis of EABR measures in cochlear implantees.

Adult↗
PubMed2001

Effects of slow- and fast-acting compression on the detection of gaps in narrow bands of noise.

The inherent amplitude fluctuations in narrow bands of noise may limit the ability to detect gaps in the noise; 'dips' in the noise may be confused with the gap to be detected. For people with cochlear hearing loss, loudness recruitment may effectively magnify the fluctuations and this could partly account for the reduced ability to detect gaps in noise bands that is usually found for such people. Previously, we tested these ideas by processing the envelopes of noise bands to alter the amount of envelope fluctuation. We showed that instantaneous compression, implemented via processing of the Hilbert envelope, led to smaller (that is, better) gap detection thresholds for subjects with cochlear hearing loss. In the present experiment, we determined whether fast-acting compression of the type sometimes used in hearing aids could also lead to improved gap detection. A behind-the-ear (BTE) digital hearing aid was programmed to implement multi-band compression, either fast-acting or slow-acting (control condition). A reference condition using unaided listening was also used. Stimuli were delivered via an earphone placed over the hearing aid. Overall stimulus levels at the output of the hearing aid were similar across conditions. Thresholds for detecting gaps in noise bands centred at 4 kHz were measured as a function of noise bandwidth (10-500 Hz). To prevent the detection of spectral changes introduced by the gap, stimuli were presented in a broad-band background noise. Three normally hearing subjects and three subjects with bilateral cochlear hearing loss were tested. Gap thresholds varied non-monotonically with noise bandwidth, being maximal around 50 Hz. Gap thresholds were generally higher for the hearing-impaired than for the normally hearing subjects. For the latter, gap thresholds were similar for the three conditions. For the hearing-impaired subjects, gap thresholds were similar for the unaided condition and the condition using slow compression. However, fast compression led to smaller gap thresholds, especially for noise bandwidths up to 50 Hz. The results show that fast compression can improve the ability of hearing-impaired subjects to detect gaps in sounds with slowly fluctuating envelopes.

Adult↗
PubMed2000

Effect of frequency content on categorical loudness normalization.

In this study, increases in loudness with increases in bandwidth, termed loudness summation, were derived from loudness growth functions estimated using a loudness-scaling procedure. The results revealed that at equal loudness category, categorical loudness summation was generally larger in normal-hearing than in hearing-impaired subjects; furthermore, the increase in loudness summation at intermediate loudness levels observed in the former, was absent in the latter. These results, in broad agreement with recent data from the literature, can be explained in the light of physiological data on cochlear compression. One implication of these results regarding hearing aid fitting was that channel-by-channel loudness normalization was effective only when the incoming sound was closed in bandwidth to one of the test stimuli.

Adult↗
PubMed1999

An efficient, adaptive method of measuring loudness growth functions.

This paper presents a new categorical loudness scaling procedure that differs from previously published loudness scaling procedures by (i) adaptively selecting a new set of levels for each new sequence, (ii) deriving levels that are equispaced on the loudness scale, and (iii) using a continuous scale with few labels. A major advantage of the adaptive procedure is that the individual dynamic range need not be measured prior to loudness testing. The adaptive procedure proved to be time efficient and to produce complete loudness functions from Not heard to Uncomfortably loud for normal hearing and hearing impaired subjects. The pattern of short-term and long-term reliability was similar to that reported for non-adaptive loudness scaling procedures. Three presentations produced a stable loudness function. Normative curves for one octave babble-noise at six test frequencies are presented and compared to normative data obtained with a selection of published categorical scaling procedures.

Adolescent↗
PubMed2001

Use of antecedent control to improve the outcome of rehabilitation for a client with frontal lobe injury and intolerance for auditory and tactile stimuli.

KM, a single 23-year-old male, sustained a severe traumatic brain injury in a motor vehicle accident. Aggressive and uncooperative behaviour, resulting from the client's cognitive deficits and hypersensitivity to stimuli, made him unmanageable in a subacute rehabilitation setting. Minimizing sources of agitation reduced the client's outbursts and facilitated the completion of functional tasks, such as bathing and dressing. Modifying his environment also increased the client's participation in social and leisure activities. These changes improved the outcome of the client's rehabilitation.

Accidents, Traffic↗