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PubMedDate not supplied

The loudness of tinnitus.

Although tinnitus causes considerable suffering to many patients, its loudness is small in most cases. Traditionally the loudness is measured with a binaural loudness balance procedure. It is stated that when there is recruitment in the ear to which the test tone is presented, the intensity of the test tone is smaller than its loudness. Therefore in the case of recruitment in the ear to which the test tone is presented, the loudness of tinnitus will be underestimated. In this study the loudness in a group with recruitment in the ear to which the test tone was presented was compared with the loudness in a group with a normal ear to which the test tone was presented. The present results show that although recruitment does have a certain effect, it is very small.

Adolescent↗
PubMed1994

Stapedius reflex and EABR thresholds in experienced users of the Nucleus cochlear implant.

Evoked auditory brainstem responses (EABR) and stapedius reflex thresholds were established in 7 experienced users of the Nucleus cochlear implant. Even using biphasic 400 microseconds/phase clicks for the EABR, responses were observed in only 5 patients; no stapedius reflex (SR) was seen in 3 patients, 2 of whom had a history of middle-ear disorder. The EABR threshold varied widely between subjective threshold and uncomfortable loudness level (ULL) for the same stimulus. The average SR threshold was found somewhat more consistently at 66% of the dynamic range between threshold and ULL, but grossly overestimated the most comfortable level (MCL) in most cases. To obtain equal loudness at the same current level we suggest that broad clicks (300 microseconds/phase) be used for EABR measurements, thus compensating for the lower repetition rate of EABR stimulus compared with the device fitting stimulus.

Acoustic Stimulation↗
PubMed1994

Tinnitus evaluation using the tinnitus grading system.

We developed a system to help evaluate the likelihood of a particular patient requiring intensive tinnitus treatment. The system is based on Vernon's tinnitus grading system, in which patients assign values from 1 to 5 to each of the three subjective complaints of loudness, annoyance, and interference with life activities. In our study, we collected data from 346 of our tinnitus patients and analyzed the relationship between the three values. On the basis of these results the patients were divided into five tinnitus-type groups. Scores on a tinnitus severity scale were also determined by adding the three values together. We similarly evaluated 87 patients whose tinnitus was severe enough to require hospitalization. It was found that patients who had high values for annoyance and life interference and who showed tinnitus severity scores of 9 or more tended to require careful observation and intensive treatment. These patients also tended to have physical and psychological problems in addition to their tinnitus.

Activities of Daily Living↗
PubMedDate not supplied

Critical bandwidth in Menière's disease.

The critical bandwidth in loudness summation was estimated in 20 patients with typical Menière's disease using noise bands centered around 1 kHz. A reduction of the normal loudness difference between broad-band noise and narrow-band noise was present at all except the highest levels. Judged individually, 7 of the 20 patients appeared to have a widened critical band, but in the pooled data the size of the critical band was normal. This was the case in patients with a hearing loss less than 50 dB HL as well as in patients with a hearing loss greater than or equal to 50 dB HL. Expressed in terms of the critical band mechanism as an internal filter system, the single filter appears to have normal bandwidth but the interaction between adjacent filters is defective. The anatomical localisation of this interaction is discussed.

Acoustic Stimulation↗
PubMed1980

The acoustic reflex pattern studied by the averaging technique.

The acoustic reflex threshold and its pattern in response to stimuli of different intensities, were investigated by means of the signal-averaging technique in 20 normal, 20 sensorineural-impaired and 10 successfully stapedectomized ears. Trains of tone bursts between 110 and 0 dB HL were used. The frequencies tested were 500, 1 000, 2 000 and 4 000 Hz. In all normal subjects, the pattern of the acoustic reflex for stimuli between 110 and 100 dB HL was biphasic with an initial positive plateau followed by a longer negative one. For stimuli below 80 dB HL, the pattern of the reflex was monophasic with a single positive peak. In the sensorineural-impaired ears, the same double pattern of the waveform was obtained. In the stapedectomized ears, no compliance changes were observed for any sound stimuli. By the averaging technique, the difference between the acoustic reflex threshold and the auditory threshold was found to be between 7.5 and 32.5 dB, in normal and sensorineural-impaired ears.

Acoustic Impedance Tests↗
PubMed1980

Significance of the SISI test and its relation to recruitment.

The aim of the present article is to reconsider critically some arguments currently used to support the significance of the SISI test. The first topic discussed is the possible relationship between a positive SISI result (i.e. a small difference limen for intensity) and the presence of recruitment. It is concluded that there is no relationship between these via the loudness function. The second topic concerns some statistical factors which have a bearing on the utility of the SISI test. It is argued that the significance of the SISI test may be largely determined by the prevalence rates of cochlear and retrocochlear disorders.

Humans↗
PubMed1981

Phase reversal in brain stem responses: its use in the detection of asymmetry in the auditory pathways.

Electrode placement is an important consideration in the recording of a large-amplitude stable response. In this study, brain stem auditory-evoked potentials (BAEP) were obtained from subjects and patients under two electrode configurations, namely 'vertex-mastoid' and 'mastoid-mastoid'. The BAEP waveforms to ipsilateral, contralateral and binaural stimulation were examined for their phase relation with respect to stimulation. In the mastoid-mastoid recording mode, a complete polarity reversal was shown upon changing stimulation from the ipsilateral (with respect to the active input) to the contralateral ear. On simultaneous binaural stimulation, the response was shown to summate to zero. This observation has led to the objective assessment of asymmetry of hearing. Several patients exhibiting recruitment were tested under the mastoid-mastoid recording configuration with binaural stimulation. The results show that a summated 'null' response only occurs at an intensity level where loudness equality is attained at the two ears and recruitment is complete. Applied in this way the technique has promising application in the determination of the presence or absence of recruitment and hence in the differential diagnosis of cochlear and retrocochlear lesions.

Auditory Pathways↗
PubMed1985

Threshold sensitivity and frequency specificity in auditory brainstem response audiometry.

Frequency-specific electric response audiometry can be performed on difficult to test young children if the child is sedated and proper choices are made of acoustic stimuli and recording parameters, although certain compromises are necessary. A very satisfactory sedative is secobarbital, administered intramuscularly in doses related to the weight of the child. As stimuli we recommend '2-1-2' tone bursts at 500, 1 000, 2 000, and 4 000 Hz: i.e., with a rise and fall of two periods and a plateau of one period of the modulated tone. A very robust and sensitive response that is not significantly modified by the sedation and is effective for all four frequencies is the P6-SN10 of the early brainstem sequence. To record this complex favorably requires a bandpass input filter of the Butterworth type with pass-band (at -3 dB) from 50 to 1 700 Hz and rejection rates of 24 dB/octave. With this combination, polarity of stimulus is unimportant and sweep time, rate of stimulation and number of responses averaged may be selected for convenience and simplicity. A routine that requires about an hour of testing time is described and the necessary correction factors are given for estimating a child's behavioral pure-tone thresholds. We believe that our threshold estimates are generally correct within 10 dB, and are sufficiently frequency-specific for proper selection of a hearing aid.

Acoustic Stimulation↗
PubMed1990

Frequency specificity of the auditory brainstem response elicited by 1,000-Hz filtered clicks.

In normal-hearing subjects and in subjects with a flat cochlear hearing loss, auditory brainstem responses (ABR) were recorded at various levels of a 1,000-Hz filtered click stimulus with and without high-pass filtered masking noise. The difference in latency of the major peak in the ABR for the masked and unmasked condition was zero at the ABR threshold. We regard this as proof of the frequency specificity of the 1,000-Hz filtered click-stimulated ABR threshold. The difference between ABR threshold and the subjective puretone threshold at 1,000 Hz amounted to 19 dB in normal-hearing subjects and to 10 dB in subjects with a flat cochlear hearing loss. This is probably related to loss of temporal integration and an abnormal loudness growth (recruitment).

Acoustic Stimulation↗
PubMedDate not supplied

Relationships among psychoacoustic judgments, speech understanding ability and self-perceived handicap in tinnitus subjects.

Tinnitus is often a disturbing symptom which affects 6-20% of the population. Relationships among tinnitus pitch and loudness judgments, audiometric speech understanding measures and self-perceived handicap were evaluated in a sample of subjects with tinnitus and hearing loss (THL). Data obtained from the THL sample on the audiometric speech measures were compared to the performance of an age-matched hearing loss only (HL) group. Both groups had normal hearing through 1 kHz with a sloping configuration of < or = 20 dB/octave between 2-12 kHz. The THL subjects performed more poorly on the low predictability items of the Speech Perception in Noise Test, suggesting that tinnitus may interfere with the perception of speech signals having reduced linguistic redundancy. The THL subjects rated their tinnitus as annoying at relatively low sensation levels using the pitch-match frequency as the reference tone. Further, significant relationships were found between loudness judgment measures and self-rated annoyance. No predictable relationships were observed between the audiometric speech measures and perceived handicap using the Tinnitus Handicap Questionnaire. These findings support the use of self-report measures in tinnitus patients in that audiometric speech tests alone may be insufficient in describing an individual's reaction to his/her communication breakdowns.

Adult↗
PubMedDate not supplied

Effect of signal duration on categorical loudness scaling in normal and in hearing-impaired listeners.

The present study sought to determine whether the duration of white-noise bursts affects their loudness category rating in the same way for hearing-impaired as for normally-hearing subjects. Twelve normally-hearing and 12 hearing-impaired subjects took part. Categorical loudness growth functions were obtained for 16.25 ms, 32.5 ms, 75 ms, 150 ms and 300 ms white noise bursts. Temporal integration of loudness was defined as the intensity difference needed for stimuli of different durations to result in identical category ratings. In normally-hearing subjects, temporal integration of loudness occurred mainly with the short-duration (16.25 ms and 32.5 ms) stimuli, whereas it was found with almost every stimulus duration in hearing-impaired subjects. In other words, temporal integration of loudness between 16.25 ms and 300 ms stimulus duration was greater in hearing-impaired listeners and there was a difference between normal and hearing-impaired subjects regarding change in loudness perception with stimulus duration. Consequently, the use of fixed-duration stimuli hinders loudness normalization.

Adolescent↗
PubMed1982

Auditory brainstem responses (ABR) in the aged.

86 male subjects, aged between 60 and 86 years (M = 69.5), underwent pure-tone audiometry, impedance tests and brainstem response audiometry (BRA). Subjects have been classified into four age-related groups: 1) 34 subjects, aged between 60 and 65; 2) 22, aged between 66 and 70; 3) 22 aged between 71 and 75; 4) 8, aged between 76 and 86. They have also been classified into four groups on the basis of their mean auditory threshold at 0.5, 1, 2, 4 and 8 kHz: 1) 14 subjects with mean auditory threshold less than or equal to 30 dB HL; 2) 16, between 31 and 40; 3) 24, between 41 and 50; 4) 32, with mean auditory threshold greater than or equal to 51 dB HL. 19 normally hearing adults, aged between 28 and 42, were chosen as controls. Statistically significant correlations have been found between age and mean auditory threshold (P less than or equal to 0.001), between wave latency V and age (P less than or equal to 0.001), between wave latency V and the mean pure-tone auditory threshold at 0.5, 1, 2, 4 and 8 kHz (P less than or equal to 0.001) and between the V-I interval and age (P less than or equal to 0.001). The discrepancy between the mean auditory threshold and the ABR waveform, the overall amplitude's reduction of ABR waves and the progressive lengthening of V-I interval values, seem to indicate that age-related changes involve not only the end organ but also the brainstem auditory structures.

Age Factors↗
PubMed1996

Auditory deficits and hearing loss associated with focal brainstem haemorrhage.

Four cases of central pontine haemorrhage are described in which auditory dysfunction was documented. Two cases had a hearing loss, in one of which there was recovery of the low frequencies. This case provides support for the tonotopic organization of the auditory pathways in the caudal pontine area, with the lowest frequencies being encoded medially. In all cases, there were abnormalities of the auditory brainstem responses, wave V being consistently involved, while wave III was abnormal in only one patient. In three cases, the masking level differences and crossed acoustic reflex thresholds were abnormal. The ipsilateral reflex thresholds were normal at least on one side in all cases. In the patient with the most significant hearing loss, loudness recruitment, assessed both psychophysically and with the acoustic reflex thresholds, was evident. These data are interpreted in terms of there being damage to the medial superior olivary nuclei and trapezoid body involving both afferent and efferent fibres.

Adult↗
PubMed1997

A compact disc containing simulations of hearing impairment.

The author has produced a compact disc (CD) which contains a series of simulations of the effects of cochlear hearing loss. The following aspects are simulated: threshold elevation combined with loudness recruitment; reduced frequency selectivity; and threshold elevation, loudness recruitment and reduced frequency selectivity all together. The effects are demonstrated using speech in quiet and in a background of noise, and using a piece of music with a wide dynamic range. The CD also includes simulations of the effect of having a conventional 'linear' hearing aid, and of having aid incorporating dual-channel fast acting compression. Finally, the CD contains demonstrations of the 'occlusion effect' and the benefits of having a deeply fitting earmould or hearing aid. The purpose of this note is to describe some of the uses of the CD for teaching and educational purposes and to indicate which tracks will be most effective for specific purposes.

Auditory Threshold↗
PubMed1998

Development and evaluation of a procedure for fitting multi-channel compression hearing aids.

Hearing aids with multi-channel compression are often fitted on the basis of loudness scaling data obtained using narrow bands of noise or tones. Here, we report the development and evaluation of an alternative fitting procedure based on the use of speech signals. The parameters of the hearing aid (the gains in each channel for high and low input levels) are adjusted adaptively under computer control on the basis of the listener's responses. The goal is that speech at 85 dB SPL should be judged as 'loud', speech at 60 dB SPL should be judged as 'quiet', and speech at both levels should be judged as 'neither tinny nor boomy'. The procedure was evaluated using a two-channel compression hearing aid, the remote control of which allowed two programs to be stored. One program was based on our fitting procedure. The other was either based on the manufacturer's recommended full fitting procedure (which included loudness scaling with bands of noise), or was based on the audiogram alone, using the manufacturer's algorithm. After an acclimatization period of at least two weeks, subjects were then asked to fill in a questionnaire about their experiences with the two programs in different listening situations. The results generally indicated a preference for the program based on our adaptive fitting procedure. We also conducted laboratory measurements of speech intelligibility, in quiet and in a background of a single competing talker. These showed no clear difference between programs, although scores overall were very high. We conclude that our adaptive procedure gives very satisfactory results in everyday life. Parameter values giving good comfort also give good intelligibility. The procedure typically takes between five and 10 minutes per ear, which is quicker than most loudness scaling procedures.

Hearing Aids↗
PubMed1983

A comparison of behind-the-ear high-fidelity linear hearing aids and two-channel compression aids, in the laboratory and in everyday life.

Eight patients suffering from sensorineural hearing losses with recruitment took part in a trial comparing their own hearing aids (or no aid if they did not normally wear one) with 'high-fidelity' linear aids and with aids incorporating two-channel syllabic compression. All aids were worn behind the ear. Speech intelligibility was measured both in quiet and in noise, and the patients were given questionnaires enquiring about the effectiveness of the aids in everyday situations. Both the intelligibility tests and the questionnaires indicated that the linear aids were substantially better than own/no aid, and the compressor aids were substantially better than the linear aids, allowing good speech discrimination over a wide range of sound levels. Six out of the eight patients derived significant benefit from being fitted with two aids rather than one. The use of directional microphones in the linear and compressor aids allowed a significant improvement for speech intelligibility in noise when the speech and noise were spatially separated.

Adult↗
PubMed1985

Improvements in speech intelligibility in quiet and in noise produced by two-channel compression hearing aids.

Eight subjects suffering from bilateral sensorineural hearing losses with recruitment were fitted binaurally with two-channel compression hearing aids, worn behind the ear. After they had worn the aids for some time, measures of speech intelligibility were compared for two conditions: listening unaided, and listening aided. the dynamic range for speech, defined as the difference in level between the speech reception threshold in quiet and the highest comfortable level for speech, was substantially increased in the aided condition for seven of the eight subjects (the exception was a subject with almost normal low-frequency hearing). Speech reception thresholds were also measured in two levels of background noise ('babble'), 60 and 75 dB SPL. Seven of the eight subjects showed a reduced speech reception threshold (i.e. an improvement) in the aided condition for at least one of the two noise levels, although the size of the improvement differed considerably from one subject to another. The subjects were also given a battery of psycho-acoustical tests in an attempt to better characterise their hearing loss, and to gain more insight into individual differences. Results of measurements of frequency selectivity, frequency discrimination, temporal acuity and temporal masking are described and related to the measures of speech intelligibility.

Aged↗
PubMed1986

Preference for potential tinnitus maskers: results from annoyance ratings.

Using the method of magnitude estimation, annoyance ratings of thirty-six different masking sounds obtained from a group suffering from tinnitus were compared with ratings from a normal-hearing group in an attempt to assess the acceptability of potential tinnitus maskers. The key findings were as follows: In both groups bandpass noise was rated as less annoying than tones or triangular waves. The annoyance value of bandpass maskers increased with bandwidth. Interrupted maskers were rated as more annoying than continuous maskers. Most of the differences between the tinnitus and normal group could be explained in terms of the high-frequency hearing loss and loudness recruitment associated with the tinnitus group. Control over the centre frequency and the bandwidth of a noise masker was important in optimising the acceptability of the tinnitus masker.

Adult↗