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PubMed1980

Auditory brainstem response and behavioral audiometry. Developmental correlates.

Development correlates of auditory brainstem evoked responses (ABRs) and behavioral audiometry in a total of 112 normal subjects consisting of 78 infants (age, 1 to 18 months), 24 children (age, 2 to 5 years), and ten adults (age, 18 to 22 years) were studied to provide normative data for audiological and neurological applications. Thresholds of ABR, as determined by minimum stimulus intensities evoking wave V, decreased with age. Neonates had the highest ABR thresholds, and adults had the lowest. A similar pattern was observed for behavioral sensitivity as that for the ABR thresholds. Response functions determined by both methods converged with age. They crossed between the ages of 2 and 3 years. There was a trend for all peak latencies to decrease with age. This effect was particularly pronounced for the later ABR components.

Acoustic Stimulation↗
PubMed1980

Altered objective audiometry in aminoglycosides-treated human neonates.

To detect the eventual ototoxicity of aminoglycoside treatments in neonates, we compared brain stem response audiometry (BSRA) recordings in 15 neonates treated i.m. with either Gentamicin or Tobramycin at conventional dosages to those of 14 neonates used as a control group. All babies were housed in incubators and were comparable in gestational age (from 29 to 42 weeks). At day 0, BSRA did not significantly differ in the two groups, 90 dB latencies of the prominent wave V measured at 8.51 +/- 0.99 ms in the treated babies and 7.89 +/- 0.84 ms in the controls (p > 0.10), respectively. After 5 days of aminoglycoside treatment, the latencies of the wave V dwelled on 9.13 +/- 1.90 ms while remaining at 7.75 +/- 1.11 ms in the control group (p < 0.01). At day 10 latencies reached 8.73 +/- 1.47 ms in treated babies as compared t 7.31 +/- 1.06 ms in controls (p < 0.01).

Aminoglycosides↗
PubMed1985

The importance of high-tone audiometry in monitoring for ototoxicity.

Early detection of ototoxicity is of vital importance in cases in which ototoxic drugs are administered. Ototoxicity as a result of cis-platinum administration is well documented. Auditory damage may be reduced by changes in dose, drugs or methods of treatment. As ototoxicity appears to be most pronounced in the higher frequencies of sound, any changes can be assessed at an earlier stage by using high-frequency audiometry to test patients at frequencies from 8 to 20 kHz. Our present study demonstrates the utility of monitoring auditory function at frequencies higher than conventionally tested in patients receiving cis-platinum.

Adult↗
PubMed1981

Brainstem evoked response audiometry in the premature infant population.

Auditory brainstem response (ABR) audiometry was performed on 76 non-selected premature infants from 32 to 40 weeks conceptional age. Follow-up ABR was completed on 45 infants at 4 months of age. The results were compared to data from selected, relatively low risk infants of comparable age. No significant differences were seen between the two groups, which indicates that normative data from non-selected premature infants can be obtained to identify ABR abnormality.

Audiometry↗
PubMed2005

Distortion-product otoacoustic emission spectra and high-resolution audiometry in noise-induced hearing loss.

Distortion product otoacoustic emissions (DPOAE) elicited by 60dB SPL pure tones at f1 and f2 were collected at 2f1-f2, in 1/10th octave steps, in a sample of 36 ears from 27 patients with noise-induced hearing loss (NIHL). They were analyzed in the frequency domain against the outcome of high-resolution pure-tone audiometry, performed with the help of a Békésy sweep-frequency automatic audiometer. The characteristics of DPOAE level plots as a function of frequency (the so-called DP-grams), relative to the DPOAE levels of a control age-matched group, were compared to their alleged counterparts on the audiograms, i.e., the lower and upper frequency boundaries of the interval with hearing loss. Ears with NIHL split into two subgroups, one (n = 25) with a notch in the DP-gram such that its lower boundary matched the lower limit of the audiometric notch (linear regression with a slope of 0.91, r(2) = 0.644, p < 0.001). Likewise, when it existed, its upper boundary matched its upper counterpart on the audiogram (linear regression with a slope of 0.96, r(2) = 0.89, p < 0.001). In this respect, DP-grams performed better than transient-evoked OAE spectra, which exhibited poor correlations with audiogram patterns. The second subgroup (n = 11) exhibited normal DPOAEs at all frequencies despite audiometric losses similar to those of the first subgroup. In all cases, DPOAE levels were poor predictors of the degree of hearing losses. It is hypothesized that NIHL in the second subgroup involves inner hair cells or auditory neurons, instead of outer hair cells in the first subgroup. Provided NIHL affected outer hair cells, DP-grams provided a comparatively accurate predictor of the spectral extent of hearing loss.

Adult↗
PubMed2006

Behavioral audiometry: validity of audiometric measurements obtained using the "Delaroche protocol" in babies aged 4--18 months suffering from bilateral sensorineural hearing loss.

OBJECTIVE: Evaluation of the validity of the audiometric measurements obtained in babies aged from 4 to 18 months suffering from bilateral sensorineural hearing loss (SNHL) using an original behavioral audiometry (BA) protocol called the "Delaroche protocol" [IJPORL 68 (2004) 1233-1243]. METHODS: (1) We compared the auditory brainstem (ABR) threshold in the better ear with the mean of the BA thresholds obtained, bilaterally, at 2000 and 4000 Hz, both measurements being performed in the diagnostic phase. (2) We compared the BA thresholds obtained prior to the age of 18 months, bilaterally, at the frequencies of 500,1000, 2000 and 4000 Hz, with the thresholds of the better ear obtained at the same frequencies at the age of 3--4 years by BA. RESULTS: (1) Cross- sectional study (78 children). When there was no ABR at 100 db, there was no BA response at 100 dB in 84.2% of cases, resulting in a kappa coefficient of 0.72. When there were ABR, the difference between the ABR and the BA thresholds was equal to or less than 10 dB in 67% of cases and equal to or less than 20 dB in 95% of cases. (2) Longitudinal study (50 children). The difference between the behavioral thresholds obtained within 4 and 18 months (median age=12 months) and those obtained at 3 or 4 years old in the same children (median age=39 months) was equal to or less than 10 dB in 94% of cases at the frequencies of 1000, 2000 and 4000 Hz and in 78% of cases at 500 Hz. CONCLUSION: The two analysis evidence the validity of the behavioral measurements obtained at an early age using the protocol described.

Acoustic Impedance Tests↗
PubMed1984

Sedation in brainstem response audiometry.

In many children, sedation is virtually essential for reducing myogenic interference during brainstem response (BSR) audiometry. The most widely accepted sedative for young children is chloral hydrate. Children who are tired before the sedation is given fall asleep much more quickly with sedation, and in turn, require fewer doses of chloral hydrate. Instructing the parents to keep the child tired has produced significant increases in percent of those sleeping after the first dose (z = 2.08, P less than 0.05).

Audiometry↗
PubMed1981

Determining the pure tone frequencies to be used in identification audiometry.

Guidelines published by the American Speech-Language-Hearing Association (1975) recommended procedures for identification audiometry that were different from procedures used in Michigan. The difference involved the test frequency used in conjunction with 1000 and 2000 Hz. This study was undertaken to determine the relative value of 3000, 4000 and 6000 Hz at 20, 25 and 40 dB HL respectively, when used in conjunction with 1000 and 2000 Hz at 20 dB HL to identify children at risk of hearing loss. A total of 10,622 children was screened using these five frequencies with each ear, yielding 857 children who failed to respond to at least one frequency in either ear. Air conduction thresholds were completed on 809 of these children. Of this group, 466 (57.6%) showed a hearing loss of one or more frequencies for one or both ears. Only 8.3% to 23.9% of the variance in threshold results was related to specific frequency performance on screening, Using 4000 Hz was shown to be preferable to using 6000 Hz. The information provided by the 3000 Hz tone as a screening frequency was not useful in predicting hearing loss in this population. An increase in the percentage of children identified at risk of hearing loss has occurred since Michigan adopted the published guidelines for initial screening in July 1977. Similar increases, however, have been observed in past years.

Audiometry↗
PubMedDate not supplied

A computerized scoring procedure for auditory brainstem response audiometry.

A weakness of auditory brainstem response (ABR) audiometry is the highly subjective manner in which the tracings are scored. This article describes a computerized scoring technique which was devised to reduce the subjective decision making in ABR test analysis. This correlation technique assumes only that the ABR, whatever its latency or waveform, will be highly consistent when the same stimulus conditions are repeated. This consistency should result in high correlations when two suprathreshold tracings are compared. In contrast, low correlations should occur when one of the tracings is a control containing no ABR. The extent of differences between correlations is used as the response criterion.

Adult↗
PubMed1987

Brief tone audiometry: a review.

This paper reviews a number of studies on temporal integration of acoustic power at threshold. A wide variety of results for normal-hearing individuals and for hearing-impaired patients is revealed. This variability limits the current clinical application of brief tone audiometry.

Audiometry↗
PubMed2006

Cortical electric response audiometry hearing threshold estimation: accuracy, speed, and the effects of stimulus presentation features.

OBJECTIVES: A number of stimulus presentation features of the tone burst-evoked N1-P2 cortical response were investigated to identify any advantage over simple stimulation when the test is used for hearing threshold estimation. The speed of establishing objective thresholds at 1, 3, and 8 kHz in both ears was also measured in what was designed to be an efficient test protocol, together with the precision of the threshold estimates with reference to subjects' conventional audiograms. DESIGN: Twenty-four volunteer subjects were recruited and tested by both behavioral and electrophysiological methods. A low-intensity, 3-kHz stimulus was used when the stimulus features were studied. The parameter was the N1-P2 amplitude. RESULTS: Changing the side of presentation (randomly or by alternating ears), varying the interstimulus interval and inserting a 10-second recovery period midway though an averaging run had no demonstrable effect on response amplitude, both individually or in combination, contrary to earlier reports. Establishing the 6 threshold estimates took an average 20.6 minutes. The mean error in the N1-P2 threshold estimate was 6.5 dB, with no significant effect of frequency. After correcting for this bias, 94% of individual threshold estimates were within 15 dB of the behavioral threshold and 80% were within 10 dB. CONCLUSIONS: This study suggests that cortical electric response audiometry has a performance that is as good as or better than the auditory brain stem response for threshold estimation in adults and that sophisticated stimulation techniques do not appear to be required. An efficient test protocol that automates many laborious tasks reduces the test time to less than half that previously reported in the literature for this response.

Acoustic Stimulation↗
PubMed2005

Serial audiometry in a clinical trial of AIED treatment.

OBJECTIVE: We analyzed pure-tone and speech audiometric results from a prospective trial of anti-inflammatory treatment of subjects with active autoimmune inner ear disease (AIED). We sought to characterize the pattern and size of the treatment effect as reflected in clinical audiometry and to identify audiometric predictors of response to steroid treatment of AIED. SUBJECTS: Adult participants demonstrated clinically established criteria for AIED (n = 116). Eligibility required audiometric evidence of active AIED as indicated by idiopathic sensorineural hearing loss with threshold elevations within 3 months of enrollment. METHODS: We evaluated audiometric changes after 4 weeks of treatment with pharmacologic doses (60 mg/day) of prednisone. We examined the relationship between audiometric pure-tone thresholds at baseline and changes in word intelligibility score (WIS) using parametric and nonparametric analyses. Magnitudes of change were assessed using independent or paired t-tests. Separate analyses were performed on subgroups that did or did not show improved WIS score with steroid treatment. RESULTS: Overall mean pure-tone averages improved from baseline to closeout of prednisone treatment in better hearing ears from 52.4 to 48.3 dB (p < .0001). Mean WIS improved in the better ear from 71.4% to 78.1% (p < .0001). Of pure-tone measures, only the six-tone average showed significant correlation with both the absolute improvements in WIS and with the percentage change in WIS after treatment. Individual frequencies at baseline showed no significant relationship with changes in WIS score after treatment. In 69 (59.5%) of 116 subjects, WIS improved (range, 2-80%) in the better ear. In these subjects, the baseline pure-tone thresholds and pure-tone averages correlated significantly and positively with improvement in WIS. CONCLUSIONS: Steroid treatment in AIED-mediated hearing loss produce variable but significant hearing gains. Neither a focal, cochleotopic region of greatest vulnerability to AIED nor frequency-specific amenability to treatment were evident. We did observe that analysis of predictors and the degree of treatment effect vary with different approaches to measuring change in the WIS. Depending on the approach adopted, the size of the treatment effect may be greatest across intermediate hearing levels at baseline. These observations offer an audiometric database that may enable greater precision in judging clinically meaningful parameters for future studies of AIED treatment and other interventions for sensorineural hearing loss.

Adolescent↗
PubMed1981

Electrical response audiometry: a survey of its effect on the diagnosis and management of deafness in children.

The effect of the use of electric response audiometry (ERA) on the diagnosis and management of children has been investigated. A retrospective method was employed using the notes of the first 102 hearing assessments in 1978 where an ERA test was performed. The results show that the effect on diagnosis has been to improve the degree of certainty rather than to re-classify patients as deaf or normal. The effect on management has been to reduce by 24% the number of patients that require repeat assessment. These effects are more pronounced in the '0--1 age group' as opposed to the 'above 1 year' age group.

Age Factors↗
PubMed1979

Optimum threshold crossings and time-window validation in threshold pure-tone computerized audiometry.

Two versions of the "10 dB down-5 dB up" rule were computerized: (1) with a "lax" time-window response validation in which a subject had to press and release a button within the window of 15-3750 ms after onset of a 1-s tone in his earphone (this was designed to stimulate the condition often found in manual audiometry) and (2) with a "strict" condition in which he had to respond within 60-795 ms after onset of the tone and release the button within 15-750 ms following the tone. A threshold-seeking run was continued using 5-dB steps until the threshold had been crossed six times. With 24 subjects it was found that 13 of 288 runs did not yield the "ASHA" criterion (three ascending series ending on the same hearing level (HL), out of any six or fewer consecutive series), but of these 13 runs all but one run did meet the "ANSI" criterion (two ascending series ending on the same HL, out of any three or fewer consecutive series). The ANSI Hearinnd yielded essentially the same means. An ANSI HTL was established within four or fewer ascending series for 95% or more of the runs, while an average of five extra stimuli was needed to pursue the run until an ASHA HTL was achieved (a savings of nearly 5 min per person). It was recommended that the ANSI Criterion for HTL be adopted for many audiometric situations, that a maximum of four ascending series be completed in any single threshold-seeking run, and that rather strict time windows be set within which onset and offset responses may register.

Adolescent↗
PubMed2005

Serial audiometry and speech recognition findings in Finnish Usher syndrome type III patients.

Audiometric features, evaluated by serial pure tone audiometry and speech recognition tests (n = 31), were analysed in 59 Finnish Usher syndrome type III patients (USH3) with Finmajor/Finmajor (n = 55) and Finmajor/Finminor (n = 4) USH3A mutations. These patients showed a highly variable type and degree of progressive sensorineural hearing impairment: from normal to moderate USH2A-like hearing impairment at young ages to profound or even USH1B-like hearing impairment at more advanced ages. Compound heterozygous patients generally showed a milder phenotype. The highest progression was seen during the first two decades of life, gradually slowing down with further ageing. This type of non-linear progression may be unique amongst the Usher syndromes. Speech recognition started to deteriorate at highly variable ages. In some patients, it jeopardised normal speech and language development, whereas in others it was still remarkably good at advanced ages.

Adolescent↗
PubMed1986

Pure-tone audiometry of patients with auditory brainstem response abnormalities.

To determine the pure-tone thresholds of patients with brainstem disorders, pure-tone audiometry was done on 22 patients with partial auditory brainstem response wave disappearance (including wave I response, wave I-III response, and wave I-IV response). This group of patients was selected since partial wave disappearance indicates pathology of the auditory nerve and/or the brainstem auditory pathway. The pure-tone threshold of these patients was essentially normal or very mildly impaired, except for patients with an acoustic tumor or an other cerebellopontine angle tumor.

Audiometry↗
PubMedDate not supplied

Brainstem evoked response audiometry.

Brainstem evoked response audiometry is useful in the identification of threshold levels as well as in the diagnosis of eighth nerve tumors. The instrumentation is a modification of the electroencephalograph and an averaging computer; 3,000 clicks, 16/s, are presented and averaged for each printed response. Evoked responses can be obtained from a patient who is unable or unwilling to respond to conventional behavioral testing; best results are obtained from quiet or asleep patients.

Audiometry↗
PubMed1983

Intracochlear electrical stimulation of normal and deaf cats investigated using brainstem response audiometry.

Brainstem response audiometry for intracochlear electrical stimulation of normal-hearing and deafened cats was investigated. In normal cochleas the brainstem response amplitude grew slowly near threshold as a current-amplitude dependent process, identified as electrophonic in origin. This terminated in a rapidly growing charge-dependent process at approximately 20 dB above threshold, identified as direct electrical stimulation of the auditory nerve. Small levels of white noise (25-35 dB SPL) were sufficient to mask most of the electrophonic response, leaving the direct stimulation process essentially unmodified. In cochleas damaged with d.c. currents and loud sounds, only a rapidly growing charge-dependent process was observed which grew similarly to that in normal-hearing cats but occurred at lower currents. This indicates that possibly the electrical properties of the cochlea were altered in the deafening process, suggesting the inadequacy of normal animals as deaf models for electrical stimulation. Using the technique of derived brainstem responses, it was shown that direct electrical stimulus components were localized to the vicinity of the stimulus electrode with electrophonic components distributed more widely. However, at high currents there was some evidence of the stimulus spreading into the internal auditory meatus.

Animals↗