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PubMed1992

[A recommendation for calibration and choice of masking noises used in speech audiometry].

Tests to evaluate speech recognition ability against background noise have still not been adequately standardized. This is due in part to the lack of a calibration procedure for the various noises used in testing. In the present study, a psychoacoustic method for the calibration of fluctuating background noises was evaluated. Three types of noise were used: babble noise, stationary noise and fluctuating speech simulating noise in accordance with (CCITT Rec. G 227). Following calibration, the masking effect of each type of noise was evaluated. Results indicated that stationary and fluctuating speech simulating noise had similar effect on speech understanding ability. The steepness of the intensity-intelligibility function was significantly greater using babble noise as compared with stationary or fluctuating speech simulating noise. Babble noise was well accepted by our subjects. However, since its measurement can be calibrated, stationary speech simulating noise may also be used in speech audiometry.

Adult↗
PubMed1995

[Self assessment and actual intelligibility of speech audiometry test material].

Self-estimated and measured intelligibility were compared using different instructions in speech audiometric tests. The results of 69 tested persons reveal that there exist speech levels in both test procedures where the intelligibility reaches 0% or 100%, respectively. In general, self-estimated intelligibility was significantly higher than real identification. Therefore, the self-estimation of intelligibility does not appear as an appropriate procedure to automated speech audiometry. The results are a speech audiometric equivalent of the subject's to have correctly understood speech in daily life in which in fact was misunderstood. Connections to central speech processing seem to be possible. Audiologists might be influenced by the effect of overestimation of speech intelligibility as well. However, preliminary investigations concerning pseudohypacusis show different results.

Adolescent↗
PubMed1991

[Observations on documentation and recording of audiometry results].

The article deals with various aims of documentation of results in audiometry and the influence of audiometer design on the outcome or execution of documentation and graphical representations. Recorded data should always be complete and unequivocal in respect of the intended aims. Didactic purposes and proof of plausibility may require more data than just the final results. External users of audiograms may require additional legends. Documentation by computer can be only as variable as the scope of the equipment permits. It seems that at the present time manual recording still has its merits.

Audiometry↗
PubMed1989

[Brain stem evoked response audiometry study with a bone conduction receiver in atresia of the auditory canal and microtia].

Conductive hearing loss may be determined from the latency delay of the brainstem auditory evoked response Jewett V, if other reasons that may prolong latency are ruled out. Therefore it is important to determine the bone conduction threshold when examining infants. Two bone vibrators have been chosen, which, with the help of "inverse filtering", provide the possibility of a good sound conduction of the click stimulus and thus a measurement near the hearing threshold. When applying bone vibrators to infants it must be borne in mind, that the sound transfer is reduced because the cranial sutures are not yet closed. The measurement of bone conduction is suitable for securing the result of high-grade combined hearing defects. In two cases of atresia of the external auditory canal and microtia brainstem evoked response audiometry is presented with evaluation of both air and bone conduction.

Adult↗
PubMed2000

Acoustic neuroma: deterioration of speech discrimination related to thresholds in pure-tone audiometry.

Pure-tone and speech audiometry were performed in 231 patients with a unilateral acoustic neuroma. Tumor sizes were obtained through imaging. Audiometric parameters, such as the mean pure-tone thresholds, the maximum discrimination, the slope of the speech audiogram, the roll-over index and the difference between the speech reception threshold and the Fletcher index, were studied and compared with data in the literature. Results showed that patients with an acoustic neuroma have worse speech discrimination than can be expected from the pure-tone audiogram. However, the results presented here indicate that hearing impairments nowadays are not as severe as those described in earlier studies. More patients with a unilateral acoustic neuroma are detected, including even those with a minor hearing impairment. The roll-over index is not characteristic for patients with an acoustic neuroma.

Adult↗
PubMed1999

Hypersensitivity to sound--questionnaire data, audiometry and classification.

This study included consecutive case histories and audiometry of 100 patients with hypersensitivity to sounds. There are several different conditions with the symptom of hypersensitivity to sounds. Hyperacusis is one of those and is seldom described in the literature. The term hyperacusis is often used synonymously with hypersensitivity to sound. We propose that there is a specific condition that could be termed hyperacusis. Hyperacusis is often elicited by loud sounds or by a number of other traumata or diseases. It is not typical of occupational noise exposure (with the exception of exposure to music). The typical patient is relatively young, the mean age being approximately 10 years less than for a population of patients with tinnitus or noise-induced hearing loss. In addition to hypersensitivity to sound, the patients often suffer from tinnitus (86%). Sounds are frequently painful and exposure to loud sounds worsens the condition for some time. The patients often have headaches. Pure tone audiograms show normal hearing or a slight high tone loss. The uncomfortable loudness level is markedly decreased, mostly less than 90 dB HL. Patients with hyperacusis may also be divided into those hypersensitive to the loudness of sounds with a decreased pure tone uncomfortable loudness level and those hypersensitive to certain specific sounds irrespective of loudness showing relatively high pure tone uncomfortable loudness levels and decreased uncomfortable loudness levels to specific sounds. With a careful history other conditions with the symptom of hypersensitivity to sound can be excluded.

Adolescent↗
PubMed2004

The effect of initial stimulus type for visual reinforcement audiometry.

Visual reinforcement audiometry (VRA) is routinely used with infants to assess hearing level. It is an operant procedure based on the association of auditory and visual stimuli. There are several recommended test procedures for VRA. One clinical VRA procedure involves presenting the initial auditory stimulus without activation of the visual reward. If the infant generates a head orientation response, the visual reward is then activated. The aim of this study was to investigate the unconditioned response rates (head orientation towards loudspeaker) to two different sound-field-presented stimuli, 1000-Hz narrowband noise (NBN) and 1000-Hz frequency-modulated tones (FMTs), using this VRA procedure. For each stimulus type, 100 infants presenting for VRA were assessed (age range 6-30 months, mean age 13 months). Of the infants presented with NBN, 69% responded, compared to 25% of infants presented with FMTs. Chi-squared analysis revealed a highly significant statistical difference in favour of NBN. In conclusion, this study demonstrated the effectiveness of using a 1000-Hz NBN stimulus over a 1000-Hz FMT stimulus in securing an unconditioned head orientation response in infants presenting for VRA.

Audiometry↗
PubMed2006

Reliability of electric response audiometry using 80 Hz auditory steady-state responses.

The reliability of the Auditory Steady State Response (ASSR) has not been thoroughly evaluated despite its recent application as a clinical tool for threshold estimation. The purpose of this study was to examine test-retest (TR) reliability of ASSR threshold estimates in an empirical research design. The ASSR, tested using modulation frequencies approximately 80 Hz and above, was evaluated against pure tone audiometry (PTA), and the slow vertex potential (SVP, N1-P2). Sixteen normal-hearing young female adults were tested twice, one week apart. Varying degrees of sensorineural hearing loss of a notched configuration were simulated with filtered masking noise. Test-retest reliability was assessed using Pearson-product moment correlation analysis, supplemented by other post-hoc analyses. Results demonstrated moderately strong TR reliability for ASSR at 1000, 2000 and 4000 Hz (r = 0.83-0.93); however, the reliability of ASSR at 500 Hz was weaker (r = 0.75). Results suggest that ASSR-ERA is a reliable test at mid-high frequencies, at least with the configuration and degrees of simulated sensorineural hearing loss examined in this study.

Adolescent↗
PubMed2003

Internet-based tele-audiometry system for the assessment of hearing: a pilot study.

The application of tele-audiology is in its infancy. Several systems have been developed to screen hearing, yet the application of real-time diagnostic audiology to a remote location is new. This paper describes a tele-audiometric system developed for the application of realtime diagnostic audiometry via the Internet. A pilot study evaluated 31 adult participants in a double-blind study of two different systems (i.e., conventional versus Internet-based) for assessing auditory thresholds. The threshold data show substantial agreement between the two systems. Mean thresholds varied by no more than 1.3 dB, well within established variability of audiometric testing. This pilot study demonstrated the feasibility of real-time Internet-based assessment of hearing. The system allows this remote assessment of hearing without an audiologist on site. Further investigation will assess of outcomes and costs.

Audiometry↗
PubMedDate not supplied

Speech audiometry in the young child.

Normal children between 3 and 6 yrs old generated word and sentence messages for use in a pediatric speech intelligibility (PSI) test. Word materials did not differ as a function of chronological age (CA), vocabulary skills, or receptive language (RL) ability. Elicited sentence materials, however, did reflect differences in CA, vocabulary skills, and RL ability. To represent differences in the children's responses, two different types of test sentences, subsequently referred to as format I and format II sentences, were formed. Performance for format I and format II sentences was significantly different in normal children between 3 and 6 yrs old. Performance differences were related to CA and RL ability. However, performance for format I sentences in children with relatively low RL age and performance for format II sentences in children with relatively high RL age was equivalent. This observation yielded an algorithm that determines the sentence format as a function of a child's RL age in order to yield "language equivalent" norms for speech audiometry. In contrast to performance for PSI sentence materials, performance for PSI word materials was not influenced by differences in RL skill. Reliability coefficients for PSI word and sentence test-retest measures ranged from about 0.85 to 0.95 in normal-hearing and hearing-impaired children. Illustrative PSI results in children with confirmed central auditory disorders are presented.

Age Factors↗
PubMed1987

Improving behavior observation audiometry testing and scoring procedures.

The need exists for improving behavioral testing of low-functioning children, particularly profoundly involved multiply handicapped children. In this study, behavior observation audiometry (BOA) was modified for systematic evaluation of childrens' responses to sound without observer bias. The data were analyzed statistically and a minimum response level was computed. This BOA technique was used to test the hearing of 82 profoundly involved handicapped children. Results suggested that BOA can be helpful in evaluating the hearing of low-functioning children.

Adolescent↗
PubMed1989

Automatic immittance audiometry on children with transtympanic ventilation tubes.

The use of automatic immittance audiometers for detection of middle ear abnormalities in children is becoming a popular practice in pre-schools, headstart programs, and elementary schools. Oftentimes the screening is being performed by personnel who are not clinical audiologists and who do not routinely otoscopically examine the ear prior to testing. This report tells of a clinical case in which the use of automatic immittance audiometry on a child with transtympanic ventilation tubes resulted in the occlusion of one of the tubes. An explanation of the events causing the occlusion and a word of caution are given.

Audiometry↗
PubMed1992

Auditory responsiveness of premature infants utilizing visual reinforcement audiometry (VRA).

The purpose of this investigation was to study the relationship between visual reinforcement audiometry (VRA) performance and age (i.e., corrected and mental) with 60 premature infants. VRA performance was classified as unacceptable, marginal, or acceptable based on conditionability and number of responses obtained before habituation to the task. The results indicated that mental age and corrected age were significantly related to VRA performance. It was found that a corrected age of 8 mo and/or a mental age of 6 mo is typically required for acceptable performance using VRA. A lack of responsiveness to the VRA procedure at these ages would most likely be due to hearing loss as opposed to a general developmental delay. The data from this study would not support a large scale behavioral hearing screening program for premature infants below 8 mo corrected age or 6 mo mental age.

Acoustic Stimulation↗
PubMed1992

Strategies for increasing response behavior of 1- and 2-year-old children during visual reinforcement audiometry (VRA).

This study investigated strategies for increasing the number of responses that can be obtained from young children during visual reinforcement audiometry. Subjects included normal 1- and 2-yr-old children. Responses before habituation were studied as a function of age, reinforcer conditions, and test sessions. It was found that: (1) using two reinforcers led to more responses before habituation than use of a single reinforcer; (2) after habituation in test session 1 and a 10-min break, most 1-yr-olds demonstrated a minimum of five additional responses in test session 2; and (3) 2-yr-olds habituated more rapidly than 1-yr-olds.

Acoustic Impedance Tests↗
PubMed1993

Ambient noise levels in audiometric test rooms used for clinical audiometry.

Recently, the American National Standards Institute (ANSI) has specified (ANSI S3.1-1991) maximum permissible ambient noise levels (MPANLs) allowed in an audiometric test room that would produce negligible masking of pure tones presented down to O-dB HL for two test conditions (ears covered, ears not covered) and three test frequency ranges (125-8000 Hz, 250-8000 Hz, 500-8000 Hz). In the present study, octave band ambient noise sound pressure levels were measured in 136 audiometric test rooms used for clinical audiometry and compared with the ANSI octave band MPANLs for each test condition and frequency range. For the ears covered condition, about 50% of the rooms were in compliance (passed) with the MPANLs for the 125-8000 Hz and 250-8000 Hz range and 82% for the 500-8000 Hz range. For the ears not covered condition, only about 14% of the rooms passed for the 125-8000 Hz and 250-8000 Hz range and 37% passed for the 500-8000 Hz range. The primary cause of the low pass rate for each test condition and frequency range was attributed to low frequency (125-500 Hz) ambient noise presumably from the ventilation system.

Audiometry↗
PubMed1994

Effects of reinforcer duration on the response behavior of preterm 2-year-olds in visual reinforcement audiometry.

The purpose of this study was to investigate the effects of reinforcer duration (0.5, 1.5, and 4.0 sec) on response behavior to a 50-dB HL complex noise bandpass signal in visual reinforcement audiometry (VRA). Sixty preterm 2-year-olds (corrected age 24-30 mo) met the selection criteria and were used as subjects. Data indicated that decreasing the duration of a subject's exposure to the visual reinforcer resulted in more responses, with significantly slower habituation rates presented by subjects receiving brief (0.5 sec) versus long (4.0 sec) reinforcer duration. These results suggest that audiologists may increase the amount of audiometric information obtained from children in the upper age bracket of VRA by decreasing their exposure to the visual reinforcer.

Acoustic Stimulation↗
PubMed1996

Frequency-specific audiometry using steady-state responses.

OBJECTIVE: To evaluate the audiometric usefulness of steady-state responses to multiple simultaneous tones, amplitude-modulated at 75 to 110 Hz. DESIGN: Steady-state responses to multiple tones amplitude-modulated at different rates between 75 and 110 Hz and presented simultaneously were recorded at different intensities in normal adults, well babies, normal adults with simulated hearing loss, and adolescents with known hearing losses. Response thresholds were compared with behavioral thresholds. RESULTS: In normal adults the thresholds for steady-state responses to tones of 0.5, 1, 2, and 4 kHz were 14 +/- 11, 12 +/- 11, 11 +/- 8, and 13 +/- 11 dB, respectively, above behavioral thresholds for air-conducted stimuli, and 11 +/- 5, 14 +/- 8, 9 +/- 8, and 10 +/- 10 dB above behavioral thresholds for bone-conducted stimuli. In well babies tested in a quiet environment, the thresholds were 45 +/- 13, 29 +/- 10, 26 +/- 8, and 29 +/- 10 dB SPL. In adolescents with known hearing losses, the steady-state responses thresholds predict behavioral thresholds with correlation coefficients (r) of 0.72, 0.70, 0.76, and 0.91 at 0.5, 1, 2, and 4 kHz, respectively. CONCLUSION: Steady-state responses to tone amplitude-modulated at 75 to 110 Hz can be used for frequency-specific objective audiometry. The multiple-stimulus technique allows thresholds to be estimated for eight different stimuli at the same time.

Adolescent↗
PubMed2000

Identification of neonatal hearing impairment: hearing status at 8 to 12 months corrected age using a visual reinforcement audiometry protocol.

OBJECTIVES: 1) To describe the hearing status of the at-risk infants in the National Institutes of Health-Identification of Neonatal Hearing Impairment study sample at 8 to 12 mo corrected age (chronologic age adjusted for prematurity). 2) To describe the visual reinforcement audiometry (VRA) protocol that was used to obtain monaural behavioral data for the sample. DESIGN: All neonatal intensive care unit infants and well babies with risk factors (including well babies who failed neonatal tests) were targeted for follow-up behavioral evaluation once they had reached 8 mo corrected age. Three thousand one hundred and thirty-four (64.4%) of the 4868 surviving infants returned for at least one behavioral hearing evaluation, which employed a well-defined VRA protocol. VRA thresholds or minimum response levels (MRLs) were determined for speech and pure tones of 1.0, 2.0, and 4.0 kHz for each ear using insert earphones. RESULTS: More than 95% of the infants were reliably tested with the VRA protocol; 90% provided complete tests (four MRLs for both ears). Ninety-four percent of the at-risk infants were found to have normal hearing sensitivity (MRLs of 20 dB HL) at 1.0, 2.0, and 4.0 kHz in both ears. Of the infants, 2.2% had bilateral hearing impairment, and 3.4% had impairment in one ear only. More than 80% of the impaired ears had losses of mild-to-moderate degree. CONCLUSIONS: This may be the largest study to attempt to follow all at-risk infants with behavioral audiometric testing, regardless of screening outcome, in an effort to validate the results of auditory brain stem response, distortion product otoacoustic emission, and transient evoked otoacoustic emission testing in the newborn period. It is one of only a few studies to report hearing status of infants at 1 yr of age, using VRA on a clinical population. Successful testing of more than 95% of the infants who returned for the VRA follow-up documents the feasibility of obtaining monaural behavioral data in this population.

Age Factors↗