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PubMedDate not supplied

[A method for recording auditory evoked brain stem responses for use with objective audiometry and in neurology (author's transl)].

After defining the auditory evoked brain stem responses, the authors discuss the importance of the recording conditions and their influence on the recorded response. The choice of leads, frequency of stimulus repetition and strength of stimulus are all modifying factors. In objective audiometry it seemed preeferable to choose the technical conditions which would highlight wave V, which is identifiable even with stimuli close to threshold. The experimental conditions must be different for neurological investigation because one requires to visualise all the waves constituting the response.

Adolescent↗
PubMed1989

Two-level screening audiometry in public school.

The two-level screening audiometry has been performed every year since 1980 in Kobe City. The method is as follows. When a child fails to respond to 30 dB at 1 kHz or 25 dB at 4 kHz, he is tested at a level 20 dB higher. Thus one can obtain more information as to the grade and type of the hearing impairment of a child than by the usual one-level screening method. According to the two-level test the hearing status of each child was classified into 9 types, i.e., 0 (normal) to 8. Thus the hearing types of both ears of each child are described in two digits, for example 3--6. This method may be useful for statistical purposes as well as for individual care of hearing impaired school children, especially for children who need educational care but cannot consult the otological clinics for some reason. From the otological point of view, our method offers valuable information about the unawared sensorineural deafness in children of school age. (The children themselves, school teachers, and parents do not aware of its presence.)

Adolescent↗
PubMed1997

Comparison of TEOAE with Play audiometry for screening hearing problems in children.

To evaluate the usefulness of transiently evoked otoacoustic emissions (TEOAEs) for hearing screening of children at around 3 years of age, measurements were done together with Peep show test in a group of 47 children (n = 93 ears). A stimulus sound of 30 dB nHL was used as the screening intensity for the TEOAE measurement. All measurements were done with awake subjects. Twenty seven ears, all of which were revealed to have normal hearing (within 20 dB HL, assessed by Peep show test) and tympanograms, showed positive TEOAE results. Furthermore, TEOAEs were sensitive to the presence of middle ear conductive impairment, showing negative results. We conclude that, compared with Play audiometry, TEOAE measurements can not yield quantitative results, but can yield qualitative results for determining the presence of hearing impairment without sedative induced sleeping in this critical age of children.

Acoustic Impedance Tests↗
PubMed1975

Masking of the non-test ear in speech audiometry.

Masking of the non-test ear is often needed in speech audiometry but the methods for such masking have not been well defined. 'White' or 'speech' noise is commonly provided by audiometers for this purpose, and the many problems and uncertainties in their calibration and effectiveness are discussed; data on these aspects are presented with respect to some current audiometers and Fry's and AB(S) PB-word lists. Formulae are given for estimating the possible need for masking, calculating the required dial level of masking noise for a given dial level of speech signal, and assessing the extent to which cross-masking may be affecting the results. The formulae presented are applicable for earphone listening only.

Acoustics↗
PubMed1975

Masking of the non-test ear in tone decay, Békésy audiometry, and SISI tests.

Masking of the non-test ear is frequently required in tone decay, Békésy audiometry and SISI tests; without it, serious misdiagnoses can result. Methods are given for calculating the dial levels of masking noises to be delivered and the extent of possible cross-masking. The methods are subdivided according to whether the tests to be employed are fixed-frequency or sweep-frequency, and to whether masking function data are available from previous use of shadow masking. In difficult cases, careful preliminary shadow-masking procedures and subsequent use of fixed-frequency tests is recommended.

Acoustic Stimulation↗
PubMed2003

Visual reinforcement audiometry using digital video disc and conventional reinforcers.

Visual reinforcement audiometry (VRA) is a test procedure routinely used to evaluate hearing in infants and young children (6 months to 2 years). Most research and current clinical practice uses flashing lights and/or animated toys to provide reinforcement to a child during VRA. New technology capable of generating a moving video image is now available for providing visual reinforcement to infants during VRA testing. It is reasonable to expect that video images, with presumed greater novelty and complexity, would be more interesting and rewarding to children than conventional, animated mechanical toy reinforcers. On the other hand, in today's society, children are frequently exposed to video images in the home and elsewhere. Therefore, three-dimensional animated toys may present with greater novelty than video images. The purpose of this study was to compare auditory localization behavior, as defined by the number of head turn responses until habituation, during VRA with 2-year-old children using two types of reinforcers: (a) moving images generated by a digital video disc player/monitor and (b) a conventional, animated mechanical toy. Twenty children were selected randomly from a total group of 40 and tested using conventional reinforcement. The remaining 20 children were tested using video reinforcement. The average number of head turn responses prior to habituation was approximately 15 for the video-reinforced group and approximately 11 for the conventional toy-reinforced group, suggesting that during VRA a video image may be more reinforcing than a conventional animated toy.

Audiometry↗
PubMed2004

Continuous versus pulsed tones in audiometry.

The purpose of this study was to compare auditory thresholds obtained for continuous and pulsed tones in listeners with normal hearing. Auditory thresholds, test-retest reliability, false-positive responses, and listener preference were compared for both signals. Hearing thresholds and test-retest reliability were comparable for the 2 signals, and there were no significant differences in the number of false positives or the number of presentations required to reach threshold. Listener preference, however, indicated that pulsed tones were preferred over continuous tones by 67% of the listeners when listening to low-level or high-frequency tones. These findings, coupled with previous reports demonstrating the benefits of using automatically pulsed tones in threshold assessment for listeners with tinnitus, support the general use of pulsed tones in clinical audiometry.

Acoustic Stimulation↗
PubMed2005

A multisite study to examine the efficacy of the otoacoustic emission/automated auditory brainstem response newborn hearing screening protocol: results of visual reinforcement audiometry.

PURPOSE: This 3rd of 4 articles on a study of the efficacy of the 2-stage otoacoustic emission/automated auditory brainstem response (OAE/A-ABR) newborn hearing screening protocol describes (a) the behavioral audiometric protocol used to validate hearing status at 8-12 months of age, (b) the hearing status of the sample, and (c) the success of the visual reinforcement audiometry (VRA) protocol across 7 sites. METHOD: A total of 973 infants who failed OAE but passed A-ABR, in one or both ears, during newborn screening were tested with a VRA protocol, supplemented by tympanometry and OAE screening at age 8-12 months. RESULTS: VRA audiograms (1.0, 2.0, and 4.0 kHz) were obtained for 1,184 (82.7%) of the 1,432 study ears. Hearing loss was ruled out in another 100 ears by VRA in combination with OAE, for a total of 88.7% of the study sample. Permanent hearing loss was identified in 30 ears of 21 infants. Sites differed in their success with the VRA protocol. CONCLUSIONS: Continued monitoring of hearing beyond the newborn period is an important component of early detection of hearing loss. Using a structured protocol, VRA is an appropriate test method for most, but not all, infants. A battery of test procedures is often needed to adequately delineate hearing loss in infants. Examiner experience appears to be a factor in successful VRA.

Acoustic Impedance Tests↗
PubMed1977

Electrophysiologic response audiometry: state of the art.

Electrophysiologic response audiometry (ERA) is based upon recording neuroelectric potentials from sites extending from the cochlea to the cortex. These recordings rely on the use of averaging computers to extricate desired neuroelectric responses from the ongoing background electrical activity of the human auditory system and brain. The different neuroelectric responses are distinguished by response latency, response waveform, and probable site of origin. Responses which occur within the latency range of 1 to 5 msec originate from the cochlea and auditory nerve. Responses in the 4- to 8-msec latency range have the brain stem as their origin. Responses with latencies from about 8 to 50 msec presumably arise from the upper brain stem and primary projection areas. Responses with a fast waveform include those with latencies between 1 and 50 msec. Slow wave responses from about 50 to 300 msec originate as a secondary discharge from the primary cortical projection areas and surrounding secondary and association areas. The longest latency potentials (300 msec) are slow shifts that appear to arise from the prefrontal and secondary or association areas of the cortex. These response classes are discussed in terms of their clinical utility for threshold estimation and diagnostic value.

Action Potentials↗
PubMed1978

Physical and physiological constraints on the use of bone-conduction speech audiometry.

Several authors have recommended the use of bone-conduction speech audiometry, and the literature supports the clinical value of this procedure. It has been claimed that bone-conduction output for speech can be increased to 110-dB HL with the Radioear B-70-A vibrator through supplementary amplification, but this claim is unsubstantiated by objective measurements. Available technical data indicate that the maximum output level attainable with this virbator without incurring serious distortion is 65- to 70-dB HL at midfrequencies and substantially less at lower frequencies. Both behavioral and electromechanical data are presented which show, not only that 70-dB HL is the absolute maximum hearing level for speech attainable through the B-70-A vibrator without serious deterioration of speech-discrimination scores in normal listeners, but also that this appears to be very close to the maximum vibratory level that human observers can comfortably tolerate.

Audiometry↗
PubMed1978

Visual reinforcement audiometry (VRA) with young Down's syndrome children.

Visual Reinforcement Audiometry (VRA) was investigated with 41 Down's syndrome subjects between the ages of six months and six years. The VRA procedure involved monitoring a head-turn response to a complex noise signal presented in a sound field with an ascending presentation paradigm and reinforced by a complex visual reinforcer. Twenty-four of the infants and young children also were evaluated with the Bayley Scales of Infant Development (BSID) to allow for analysis of the efficacy of VRA as a function of developmental age. Results were as follows: (1) 28 (68%) of the infants and young children initially oriented towards the source of the auditory stimulus, (2) only a few of the subjects who did not initially orient could be taught to respond, (3) of the children who initially oriented or were taught to respond, thresholds were obtained on a large number (81%) in one visit, and (4) a systematic relationship was demonstrated between consistency of subject response using the VRA technique and BSID Mental Age Equivalent with 10 months being the critical age for determining the potential success of the procedure. In addition, the results implied a higher incidence of hearing loss in the Down's syndrome subjects than found in normal pediatric population.

Age Factors↗
PubMed1979

Application of visual reinforcement audiometry (VRA) to low-functioning children.

Visual reinforcement audiometry (VRA) was studied on a group of low-functioning children in an ongoing clinical program. After establishing the specific reinforcing value of the visual stimulus, threshold assessments were made. VRA was an effective test procedure for most of the children tested, providing their developmental ages reached approximately the 10-month level or higher. On the basis of VRA thresholds and tympanometry, 52% of the children seen were referred for medical evaluation. A variation of VRA was used to assess syllable-discrimination performance on a pilot basis. Results are discussed in terms of the potential use of VRA to assess infant spedch-sound discrimination in addition to its current use as an indicator of hearing sensitivity.

Audiometry↗
PubMed1984

A comparison of two conditioning procedures in the use of visual reinforcement audiometry (VRA).

This study compared the effects of two conditioning procedures in the use of visual reinforcement audiometry (VRA) with 1- and 2-year-old high-risk infants. One conditioning procedure used a relatively soft initial stimulus presentation level (30 dB HL) and only two conditioning trials prior to minimum-response-level (MRL) exploration. The other procedure used a 60-dB HL initial presentation level and five conditioning trials prior to MRL exploration. Results indicated no significant differences between conditioning procedures in regard to obtained MRLs, number of stimulus presentations required to establish MRL (discounting conditioning trials), and number of false-positive responses observed during control trials. Age was a significant factor only in regard to the number of stimulus presentations required to establish MRL. 2-year-olds required fewer presentations than 1-year-olds. Results are discussed in relation to the auditory stimulus used to obtain responses and in regard to individual clinical circumstances which may dictate the use of one procedure over the other.

Acoustic Stimulation↗
PubMed1988

Infant thresholds with enhanced attention to the signal in visual reinforcement audiometry.

Experimental data show a discrepancy between adult auditory thresholds and best estimates of infant thresholds. The source of the discrepancy has not been determined. Attentional differences between infants and adults and procedural differences to accommodate infant attentional behavior may account at least in part for the discrepancy. A standard operant procedure, Visual Reinforcement Audiometry (VRA), was modified to enhance infant attention to impending auditory signals. Results on 16 infants evaluated with conventional VRA and modified VRA revealed an average 5.5 dB improvement in threshold with the modified technique. Correction for adult performance in similar tasks indicated a 3.3 dB attentional effect between infant and adult thresholds. The shift in threshold reflects on the adequacy of VRA as a threshold procedure.

Adult↗
PubMed1992

The role of localization in visual reinforcement audiometry.

The response task employed in visual reinforcement audiometry (VRA) has been characterized both as a localization response and, alternatively, as a pure operant conditioning behavior independent of localization. This study examined the role of localization in VRA conditioning and threshold procedures by varying the localization information provided to normal infants. Results indicate (a) that the VRA response is not contingent on localization but (b) that performance may be significantly influenced by localization. The findings suggest that any variable that alters proper localization cues, including equipment arrangement or impaired auditory function, may degrade response performance.

Audiometry, Speech↗
PubMed2000

Systematic errors in bone conduction audiometry.

Air and bone conduction audiometry was carried out on two separate groups of 12 normal hearing volunteers. One group was tested at St Mary's hospital, the other at Charing Cross hospital. The results from both centres showed evidence of a systematic error in bone conduction resulting in a pattern of 'notching' at 2 kHz. We argue that the effect is likely to be more apparent in conductive deafness and that a significant distortion of the audiogram occurs in about 17% of such cases. Since the problem appears not to be restricted to the centres involved in the study, we strongly recommend that the issue be addressed by the appropriate professional bodies.

Adult↗
PubMed2004

[The use of melatonin as an alternative to sedation in children undergoing brainstem audiometry].

BACKGROUND: Though one of the most important investigations in paediatric audiology, brainstem evoked response audiometry (BERA) often necessitates sedation or general anaesthetics, especially in newborn and infants. In paediatric neurology, melatonin has been successfully used for some years to induce sleep prior to EEG investigations. Melatonin as a hormone regulating the circadian rhythm induces natural sleep without the risks of sedation. Side effects are not known. METHODS: Click-induced BERA was first performed in 10 adults with normal hearing with and without previous melatonin administration, and click thresholds and latencies of evoked potentials were compared. 50 children then underwent BERA in melatonin-induced sleep. RESULTS: Click thresholds in adults were mostly identical (r = 0,88), while the mean latencies of evoked potentials seemed to be minimally prolonged (r from 0,82 to 0,95). Click-induced BERA was successful in 45 of the 50 children, and notched-noise BERA in at least 2 frequencies in 38 of 43 children. CONCLUSIONS: Offering a high success rate with no side effects, melatonin-induced sleep seems to be a good alternative to sedation. This method is widely accepted by parents and permits earlier diagnosis of hearing impairment in the routine clinical setting.

Adolescent↗
PubMed2005

[Development of a new test for speech audiometry in children and results in CI children].

BACKGROUND: Speech audiometry plays an important role for hearing evaluation in children. Hearing impaired children, such as those with cochlear implant (CI) who frequently undergo testing, learn the test words by heart. Furthermore, the standard tests use words of former time. PATIENTS AND METHODS: Using the most frequently words of modern children's literature a speech assessment test was developed for children between 1 to 8 years. The material was first evaluated on normal hearing children. In a second step the phoneme and word perception scores of 35 CI children were measured using 60 - 100 dB SPL according to the most comfortable level (MCL) in free sound field. RESULTS: The performance-intensity function for the single words were highly comparable with those of the Freiburger or Göttinger speech perception test. The average speech reception threshold in CI children was 44 % (test I), 36 % (test II), 63 % (test III) and 69 % (test IV), respectively. Compared to the Mainzer and Göttinger speech perception test the new words were more difficult to understand than those of the known tests. However, a statistically significant difference could be noted only for test II. CONCLUSIONS: The new developed "Würzburger speech perception test" appears to be a useful additional tool for the evaluation of hearing impaired children in addition to the standard test procedures.

Audiometry, Speech↗