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[Comparative study of tonal liminal audiometry and evoked otoacoustic emissions in school screening programs].

Early diagnosis of deafness is an important objective during the pediatric age. This study compares two different audiological techniques, otoacoustic emissions (OEA) and tonal audiometry (AUD), to be used as screening methods in school revisions programmed for 6 years olds. The correlation between techniques is very good (97% of the positives and 92% of the negatives). The OEA method is objective and faster if the environmental noise is low; if not, AUD seems to be more reliable. At this age (6 years), the otoacoustic emissions have characteristics of the adult age.

Audiometry↗

Status of sound field audiometry among audiologists in the United States.

Results of a national survey on sound field usage and sound field calibration are presented. Respondents to the survey were 418 ASHA certified audiologists, who answered questions on demographic variables, sound field testing conditions, and sound field calibration procedures. Demographic characteristics of the respondents indicate that they were representative of ASHA certified audiologists. Eighty-one percent of the respondents use sound field audiometry as part of their audiologic practice. Electroacoustic calibration of the sound field stimuli is done most often by an equipment technician, and only a small percentage of the respondents knew how the calibration was done. Results show a lack of standardization among sound field test rooms, great diversity in the stimuli used for sound field testing, and inconsistent calibration methods. Results indicate the need for standards and improved preservice and in-service training in sound field calibration techniques.

American Speech-Language-Hearing Association↗

Adaptive speech audiometry and speech discrimination space in hearing-impaired subjects.

Phonemic discrimination difficulties in a small group of patients with sensorineural hearing loss have been mapped using a new form of speech audiometry which is au automated, adaptive, audio-visual system, using a binary forced-choice response mode. Phonemic confusion patterns have been displayed in directed graph form and the cases presented here have been chosen to illustrate the potentialities of the test method for obtaining detailed information on the fine structure of speech reception in these patients.

Aged↗

Utility of auditory brainstem response audiometry in diagnosis of acoustic neuromas.

Auditory brainstem response (ABR) audiometry is said to be 90% sensitive in the diagnosis of acoustic neuromas. Since gadolinium-DTPA was introduced, magnetic resonance imaging (MRI) is capable of detecting acoustic neuromas as small as 3 mm. Early diagnosis is important, because hearing can frequently be preserved with resection of tumors smaller than 2 cm. At the same time, cost-containment has become a pressing issue in medicine. Auditory brainstem response, although considerably less expensive than MRI, may not be as sensitive as previously thought, particularly for small tumors. Of 753 acoustic neuromas treated at the House Ear Clinic from January 1988 through March 1993, 197 had ABR data available. The 98 males and 99 females ranged in age from 13 to 78 years with a mean of 48 years. The overall sensitivity of ABR was 92.3% using an interaural latency difference for wave V of more than 0.2 ms, and was 81.6% using waveform morphology. There was a statistically significant difference in sensitivity with respect to tumor size. Auditory brainstem response interaural latency difference sensitivity ranged from 100% in tumors larger than 3.0 cm to 83.1% in tumors 1.0 cm or smaller. Waveform morphology was abnormal in 100% of tumors larger than 2.0 cm but in only 76.5% of tumors 1.0 cm or smaller.

Adolescent↗

Effects of listener sophistication on respiration audiometry.

Thirty normal-hearing college-age adults were tested by standard and respiration audiometry (RA) at 1000 Hz to investigate the effects of subject knowledge of the RA procedure. Three levels of sophistication were employed: (1) no knowledge, (2) full knowledge, and (3) deception. No significant effects on RA thresholds were revealed as a function of subject knowledge. RA itself was found to be less satisfactory as a means of measuring auditory threshold because of the difficulty in obtaining responses from some subjects and the degree of subjectivity required to judge responses.

Audiometry↗

[Audiometry in wide frequency range in early diagnosis of occupational partial hearing loss in locomotive drivers].

Audiometry of 100 locomotive drivers of different age and duration of the service showed that only 32 subjects had elevated thresholds both in conventional audiogram and wide range audiogram in bone conduction. Out of the other 68 examinees 41 had hearing defects only in wide frequency range. Thus, it is possible to reveal hearing disorders early, before appearance of occupational hypoacusis and to prevent it early.

Adult↗

[The significance of tympanometry in pediatric audiometry (author's transl)].

Audiological findings through tympanometry and audiometry were correlated with pathological findings involving the tympanic membranes and the nasopharynx in 232 patients (406 ears) with various hearing disorders in order to determine the probability of a conductive hearing deficit when only tympanogram and clinical findings are known. These measures hold special import to patients in whom exact evaluations of pure tone hearing thresholds are not possible (ie, in small infants and in patients with severe hearing losses in low frequency ranges).

Audiometry↗

Impedance audiometry in serous otitis media.

The relationship between the results of impedance audiometry and middle ear effusion in serous otitis media was examined in 76 ears immediately prior to myringotomy. Tympanometry and acoustic reflex threshold showed the highest correlation with the operative findings relative to middle ear effusion. The combination of tympanometry and acoustic refex threshold was superior to the use of either component alone. Results are discussed in terms of clinical implications with specific consideration of hearing screening programs.

Acoustic Impedance Tests↗

[The importance of the "contingent negative variation" (CNV) for audiometry (author's transl)].

Previous proofs of "central processes" in hearing were based on the determination of the late "auditory evoked potentials" (AEP's: 50--300 ms) in EEG. The appearance of AEP's in different sleep stages raises the question, if the AEP actually conscious hearing. Since the discovery of the "Contingent Negative Variation" (CNV), as a potential depending on conscious and cognitive factors, an appropriate "instrument" is available to solve this problem. Using the CNV-technique three proofs of central auditory perception are described and discussed: a) "The objective proof of the perception of pure-tones", useful for threshold determination, test in the case of simulation and central hearing disorders. b) "The objective proof of the perception of stimulus-changes", useful for exact determination of differential thresholds for frequencies or intensities. c) "The objective speech audiometry", proof of speech comprehension, useful in case of aphasia and simulation.

Auditory Perception↗

Specificity of auditory brainstem response audiometry criteria in acoustic neuroma screening as a function of deviations of reference values in patients with cochlear hearing loss.

On the basis of 79 patients with cochlear hearing loss, the statistical distribution of two criteria commonly used in auditory brainstem response audiometry (ABR) was analyzed: the interaural V latency difference (ILD V) and the interaural difference of I-V interpeak interval (ID I-V). The distribution of both criteria was Gaussian. By evaluating their standard deviations the percentages of statistical false-positives were estimated. The estimated results were 24% false-positive findings using the decision criterion ILD V greater than 0.2 ms and 5.4% false-positive findings using ID I-V greater than 0.3 ms. This corresponds closely to the actual false-positive ABR rates obtained in this sample: 21.5% and 6.3%, respectively. In a separate series of 301 unselected cases with asymmetric sensorineural hearing loss, 29 ABRs were suspect for retrocochlear pathology. In 20 patients, ABRs were absent due to severe hearing loss. Retrocochlear pathology could be confirmed in only 2 cases (both from the group with ABR present). Thus, 47 ABRs (15.7% of 299) were false-positive.

Cochlear Diseases↗

Brainstem evoked response audiometry (BAER) in neonates with hyperbilirubinemia.

OBJECTIVES: To evaluate Brainstem Evoked Response Audiometry (BAER) as an objective testing of hearing assessment in icteric babies and correlate the abnormalities with serum bilirubin levels. METHODS: BAER recordings were taken in 30 icteric ferm neonates at birth, at peak of serum bilirubin levels and on a follow-up visit at 2-4 months of age. RESULTS: Mean latency of waves and interwave intervals on the BAER records were prolonged in icteric babies compared to the control group suggesting early bilirubin encephalopathy. Abnormal records were obtained in 73.3% cases and the abnormality persisted in the follow-up tracings of 23.3% of the study group. CONCLUSION: BAER is a sample, reliable and effective technique for determining auditory functions in the neonates especially changes of early bilirubin toxicity.

Bilirubin↗

Evaluation of brainstem auditory evoked response audiometry findings in children with tuberculous meningitis at admission.

OBJECTIVE: To determine the characteristics of Brainstem auditory evoked response (BAER) findings in children with tuberculous meningitis (TBM) at admission. METHODS: Twenty-seven children with highly probable TBM were admitted to the University Hospital. The control group was 23 healthy, age and sex matched subjects. Brainstem response audiometry recording was performed in all patients and controls. Ninety dB sound pressure level (SPL) was used for comparisons. The main BAER measurements analysed were the I-III, III-V, I-V interpeak intervals. In statistical analysis, t-test for independent groups were performed. At the same time, for interpeak intervals, values exceeding 2.5 standard deviations (S.D.) above the means of the normal controls were considered abnormal. To the result of BAER findings, HL was classified as mild (until 40 dBHL), severe (until 80 dBHL) and total HL (no hearing was detected). RESULTS: The latencies of interpeak intervals (except III-V latency at 10 per s) have significantly prolonged in comparison with controls. Mild HL was detected in four ears. In eight ears, any wave form could not be obtained at 110 dBSPL. Abnormal BAER result was seen in 13 of 54 ears (24%) at the click of 10 per s and five ears (12%) at the click of 50 per s. CONCLUSION: Abnormal BAER result was seen in 24% of patients with TBM before treatment. Depending on these findings, it can be inferred that hearing impairments must be lower than those values which was detected by BAER during the acute phase of TBM, since the abnormal BAER may be reversible following the illness, returning to normal with recovery.

Child, Preschool↗

The origin of impedance audiometry.

Impedance audiometry is performed every day in nearly every ENT department, office and, audiology clinic all over the world. But hardly anyone occupied with these measurements has any idea of the origin of this Danish contribution to otolaryngology.

Acoustic Impedance Tests↗

Electric response audiometry in young children before cochlear implantation: a short latency component.

OBJECTIVE: Evaluation of a short latency component (SLC) observed in profoundly deaf young children during recordings of the auditory brain stem response (ABR) before cochlear implantation. DESIGN: Seventy young children (ages 2 to 11 yr) were investigated as part of their routine audiologic and diagnostic assessment, before cochlear implantation. The ABR was evoked using click stimuli and tone pips (500 Hz and 1 kHz) at intensity levels up to 105 dB nHL. The incidence of the SLC arising at a latency of 3 msec with high level click stimuli, in addition to residual ABR waves, was assessed. RESULTS: An SLC was observed in a total of 18 of the 70 children investigated. It was present in 15 out of 31 congenitally deaf children (48%) compared with only 2 out of 33 children deafened after meningitis (6%). A chi-squared test employing a 2 x 2 contingency table shows that this dependency on etiology of deafness is highly statistically significant (p < 0.001). The presence of the SLC in the congenitally deaf children is related to age at the time of the Electric Response Audiometry test and is more likely to be observed in the younger child (p < 0.01). CONCLUSIONS: Interpretation of the ABR in profoundly deaf children should take into consideration the possible presence of the SLC. An evoked potential arising from stimulation of the vestibular system, particularly the vestibular nuclei, is proposed as a likely origin for this component. Damage to sensory cells in the vestibular portion of the labyrinth might explain why an SLC is seen rarely in cases of deafness after meningitis.

Artifacts↗

Hearing deterioration in shipyard workers. Serial audiometry over a four-year period.

The hearing thresholds of a total of 58 workers aged 20 to 65 years were measured annually over a period of 4 years using Békésy sweep-frequency audiometry. Using these data, accurate values of the yearly rate of change of hearing threshold level were calculated. The rate of change of hearing threshold level due to presbyacusis was obtained from several data sets, and the rate of change of hearing threshold level due to noise was calculated. When the average hearing threshold level over the frequency range 2-8 kHz was considered, it was found to be possible to establish a significant rate of threshold shift caused by exposure to noise for yearly changes as small as approximately 2 dB. In the cases investigated about 30% of the ears showed a significant deterioration in hearing ability due to noise. When comparing the permanent threshold shift caused by noise in groups of younger and older workers, it was found that the younger workers exhibited less threshold shift than expected, whereas the older workers showed a greater threshold shift than expected.

Adult↗

Speech pattern audiometry in hearing impaired children.

The aim of this study was to investigate the use of speech pattern audiometry (SPA) in assessing speech perception abilities of a group of 25 children with sensorineural hearing loss, and to compare their aided performance on SPA tests of four different phoneme contrasts with scores achieved on recorded Manchester Junior Word Lists (MJWL) at their most comfortable listening level (MCLL). The listeners were 25 children, 19 with congenital and six with acquired hearing loss aged between eight and 14 years. They were classified into three groups according to the severity of the hearing loss in the better hearing ear (20-60 dB HL, 61-80 dB HL and >81 dB HL). The SPA tests evaluated listeners' ability to identify word-initial plosives differing in the phonetic features of voicing and place of articulation. The main outcome measures were the SPA gradient measures, the SPA labelling function configuration and MJWL scores. The group with the most severe hearing loss (>81 dB HL) showed significantly poorer performance on the SPA tests and MJWL tests than the groups with mild (20-60 dB HL) to moderate (61-80 dB HL) hearing losses. There was significantly better performance on the two plosive voicing contrast tests than the two plosive place contrasts. For the MJWL, the performance of the group with the more severe hearing loss was also significantly different from the mild and moderate hearing loss groups. A MJWL score of up to 75% was associated with the random labelling configuration on all four SPA tests, emphasizing the different aspects of speech perception that were being examined with each type of test. This study suggests that there is a place for SPA as part of the test battery for speech perception testing in hearing-impaired children.

Child↗

[Parameters of high-frequency audiometry in patients with vocal defects, vascular diseases or exposed to noise, radiation].

High-frequency audiometry was performed in 100 patients with vascular diseases, vocal defects, exposed to noise or radiation. In normal hearing these patients had in normal frequency range elevated auditory thresholds for higher-frequency tones. The strongest abnormalities were registered in patients with vocal problems and Chernobyl wreckers. Examination of hearing in wide range of frequencies in patients with vocal problems can detect subclinical hearing defects and help in assessment of vocal defects severity and in issues of occupational expertise.

Adolescent↗

The Physical Volume Test in impedance audiometry.

Impedance audiometry offers a clinically practical method for measuring the physical volume in cc of air space medial to the hermetically sealed probe tip. Knowledge of the air space volume is meaningful when average norms are known, either when the TM is intact or, more significantly, when the TM is perforated. With the latter, the temporally dynamic space changes during external, middle ear and/or mastoid disease, the size of the total air space measured offers objective information when determined over time. The resultant volume can offer an indirect mirror readout of progression or regression of a disease process. Likewise, historically there may be a close relationship between eustachian tube function and the overall air cell space within the petrotympanomastoid bone. In such conditions, the smaller the air cell space, the poorer the eustachian tube function. The PVT offers a more expedient clinical tool over roentgenography for measuring the viable air space of the middle ear and petromastoid air cell system. Since the PVT is used primarily with an open system (i.e. with a perforated TM) electroacoustic volumetric determinations with a 220 Hz acoustic input more reliably represents the actual volume present.

Acoustic Impedance Tests↗