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Lateralization of bone-conducted sounds.

Lateralization of bilaterally applied bone-conducted signals could be accomplished by variation of time (delta t) or intensity (delta I) differences between signals. The task was relatively easy with clicks and with tone pips with short rise times. When rise times were made longer than 1 msec the ability to localize deteriorated, indicating that it depended, within limits, on the steepness of the signal wavefront. Consequently, localization of continuous, pure-tone signals was much more difficult. It improved, with training, after subjects noticed small loudness increments on the side of the leading signal as soon as the phase between signals (delta phi) deviated from zero. Thus, localization of pure-tone signals was aided both by delta phi and delta I. The loudness increments were found to be caused by mechanical interference of ipsi- and contralateral signals at each cochlea, a type of interference peculiar to bone-conducted signals. There were also indications of slight degrees of neural interaction (mutual masking) so long as delta t between short-lasting signals was near zero. The tactile input at the point of contact between vibrators and skin did not significantly contribute to lateralization of bone-conducted signals.

Audiometry, Pure-Tone

Repeatability of high-frequency bone conduction thresholds.

The purpose of this study was to determine the repeatability of high-frequency, bone conduction thresholds and to increase the data base concerning high-frequency, bone conduction threshold levels. Bone conduction thresholds were obtained on 30 subjects having normal, low, and mid frequency (0.25 to 8 kHz) hearing thresholds within and across five test sessions using a Pracitronic KH 70 bone vibrator referenced to a Brüel and Kjaer 4930 mechanical coupler at 1, 4, 8, 10, 12, 14, and 16 kHz. Within and across sessions, the bone conduction thresholds were not significantly (p greater than 0.05) different at each frequency indicating that repeated testing without replacing the bone vibrator (within session) and with replacing the bone vibrator (across session) did not influence the threshold measurements. Clinical implications concerning high-frequency, bone conduction audiometry are discussed.

Adult

High-frequency audiometry: air- and electric bone-conduction.

Normative values have been obtained for high-frequency air- and electric bone-conduction thresholds in different age groups. Reproducibility with both methods is of the same order of magnitude as with conventional audiometry. The two thresholds can be compared and the air-conduction/electric bone-conduction gap obtained by transforming the electric bone-conduction values to a dB notation by means of a formula containing a frequency-dependent constant.

Adult

Auditory brainstem response thresholds to air and bone conducted clicks in neonates and adults.

Auditory brainstem response (ABR) thresholds to air and bone conducted clicks were investigated in 20 full-term neonates and 20 normal-hearing young adults. Results showed mean ABR thresholds to air and bone conducted clicks for neonates to be 3.75 dB nHL (40.75 peak SPL) and 1.25 dB nHL (36.25 dB peak re: 1 microN), respectively, and for adults 3.75 dB nHL (40.75 peak SPL) and 18.75 dB nHL (53.75 peak re: 1 microN), respectively. A significant difference was observed in mean ABR thresholds to bone conducted stimuli between neonates and adults (p < 0.0001) and among mean adult ABR thresholds to air and bone conducted stimuli (p < 0.0001). Nonsignificant differences were observed in mean ABR thresholds to air and bone conducted stimuli among neonates (p > 0.05) and in mean ABR thresholds to air conducted stimuli between neonates and adults (p = 1.00). It is speculated that the dissimilarity in the relationship of thresholds to air and bone conducted stimuli between neonates and adults reflects, in part, a difference in efficiency of signal delivery to the cochlea.

Acoustic Stimulation

Assessment of bone conduction prosthesis in situ.

Conventional and bone anchored bone conduction hearing aids can be tested with skull simulating devices and the individual adjustment rely on time consuming psychoacoustic audiometry in free-field which can be quite demanding for the patient. A method is presented in which the hearing aid induced skull vibrations are collected with an acceleromotor and recorded on a digital audio tape. The recordings are analysed with Fast Fourier 'Transformation (FFT) by using a signal processor. The free-field test signal can be either narrow-band or white noise. Changes in frequency characteristics can be easily monitored with white noise as signal, harmonic distortion and dynamic response can be analysed reliably by using pure tones. The inter-individual comparisons can be made when calibration is based on skull vibrations at the individual bone-conduction hearing thresholds. Two case reports are presented and discussed.

Adult

Masked high-frequency bone-conduction audiometry: test reliability.

The present study examines the reliability of masked high-frequency bone-conduction threshold measurements in 95 normal-hearing subjects. High-frequency pure-tone air-and bone-conduction thresholds were measured with a dedicated laboratory high-frequency auditory evaluation system using matched, modified Koss Pro/4X Plus earphones, and the Pracitronic KH 70/5 bone vibrator. A 400-Hz wide band masking noise centered at the frequency of the test tone was used to mask the nontest ear. Monaural masked bone-conduction threshold measurements were obtained at the ipsilateral mastoid of the ear with better high-frequency hearing. Two measurements were performed in each session, and each subject participated in two sessions. In several comparisons for test-retest consistency, high-frequency bone-conduction threshold measurements were as repeatable as air-conduction thresholds of identical frequency, or bone-conduction thresholds for frequencies of 4 kHz and less. High-frequency bone-conduction threshold measurement appears to be a sufficiently reliable tool for diagnosis of auditory disorders.

Adolescent

Air and bone conduction brain stem responses in adults and infants.

Air and bone conduction brain stem responses were recorded in 20 adults and 20 infants (16-20 months postconceptional age) with normal hearing. The stimuli were administered using a shielded TDH-39 headphone and a standard B-70A vibrator. Our results show that adults and infants have similar air and bone conduction brain stem thresholds. The comparison of input latency functions obtained with air and bone conduction clicks indicates that the acoustic stimulus generated by the bone vibrator excites more apical regions than that stimulated by the air conduction transient. This is related to the spectrum of the bone conduction click which has an energy peak at 1-2 kHz. Furthermore we found that the difference in latency between adults and infants for air-conducted clicks decreases along with the stimulus intensity and the latencies tend to overlap near the threshold.

Adult

Objective real ear measurements of bone-conduction hearing aid performance.

Conventional bone-conduction and bone-anchored hearing aids are tested with skull simulator devices; individual adjustments are reliant on psychoacoustic free-field audiometry, which can be quite demanding for the patient. A method is presented in which the induced skull vibrations are measured with an accelerometer and then analysed with Fast Fourier Transformation (FFT). With this method, frequency characteristics, harmonic distortion and dynamic response can be analysed.

Bone Conduction

Bone conduction masking for brainstem auditory-evoked potentials (BAEP) in pediatric audiological evaluations. Validation of the test.

A brainstem auditory-evoked potential (BAEP) protocol for testing pediatric patients at risk for conductive hearing impairment was evaluated. The protocol used was: air-conducted click stimuli masked by bone-conducted wide-band noise. The specificity and sensitivity values for the test were determined by means of a blind cross-sectional trial including an active group of patients with an aural malformation and an age-matched control group with a sensorineural impairment. The bone-conducted masking of air-conducted BAEP showed high specificity and sensitivity and was easily administered despite pediatric difficulty. It was useful in differentiating sensorineural from conductive impairment and provided a rough estimate of the cochlear reserve in presumptive conductive hearing loss as great as 60 dB hearing loss. It is concluded that the bone-conducted masking procedure appears to be a great help in the binary decision whether middle ear surgery should be performed in patients at risk for conductive hearing loss, specially children with aural malformations.

Adolescent

[Bone conduction hearing aids with fluid medium].

In patients with chronic otorrhoea or middle ear pathology, traditional hearing aids which depend on air conduction are of little use. In these situations a bone conduction hearing aid is preferable. Such devices by-pass the middle ear cleft and ossicular chain by conducting sound waves through bone to the cochlea. To date, bone conduction hearing aids have transmitted sound via a vibrating transducer applied either to skin (transcutaneous) or to bone (percutaneous). Unfortunately, these hearing aids possess a number of disadvantages, which include: cost, aesthetic appeal, a general anaesthetic for percutaneous aids, and most notably pressure discomfort to the side of the head. To overcome some of these problems a new bone conducting hearing aid is being developed which differs from conventional aids in that sound transmission is through a liquid medium. This has been tentatively named the "Hydro-Hearing Aid" and a prototype is now being tested.

Adult

Elevation of bone conduction threshold in children with middle ear effusion.

A retrospective study of children having otitis media with effusion revealed fluctuations in bone conduction thresholds as well as in air conduction thresholds. Previous investigations in this area presented both low- and high-tone bone conduction hearing loss which were reversible. We conducted a detailed study including complete otologic, audiologic and tympanometric evaluation of 27 (41 ears) children who had fluctuating bone conduction hearing loss. From these audiologic examinations, 3 types of bone conduction hearing loss could be classified: high-tone, low-tone and flat-type bone conduction hearing loss. We observed the shift of bone conduction thresholds in children after removal of middle-ear fluids by the appropriate medical management.

Audiometry

[Prognostic value of the study of direct bone conduction in patients with otospongiosis].

The actual "early" improvement of hearing thresholds following stapedectomy were measured in 100 patients with otospongiosis by use of direct (intraoperative promontory bone stimulation) and conventional bone conduction audiometry prior to surgery. The direct bone conduction technique was usually more predictive in hearing improvement following stapedectomy than conventional bone conduction audiometry. The direct bone conduction seems to be a superior method for assessing hearing in patients with severe otospongiosis compared with conventional bone conduction which does not reflect actual cochlear reserve.

Audiometry, Pure-Tone

Binaural masking effects in bone-conducted noise.

When pure tones are masked by bone-conducted noise presented at the midline of the forehead, it is possible that binaural unmasking may occur due to the interaural phase relations of the noise. To study this possibility, the amount of masking produced in bone-conducted noise, in correlated air-conducted noise, and in monaural noise was determined using narrow bands of noise centered at 240, 500, 910, and 1900 Hz as markers and a block up-down two-interval forced choice procedure. The subjects were four women under 30 years of age with 10 dB HTL or better (ANSI, 1969) for the frequencies tested. The amount of unmasking (the masking-level difference) was determined by subtracting the masking levels obtained under each noise condition at each frequency from those obtained in the comparable monaural noise-monaural signal condition. Levels of binaural unmasking obtained in correlated air-conducted noise agreed with those in previously reported experiments. Comparable binaural unmasking effects were demonstrated for midline presentation of bone-conducted noise. Some clinical implications of the findings are discussed.

Acoustic Stimulation

Neonatal auditory brainstem response thresholds to air- and bone-conducted clicks: 0 to 96 hours postpartum.

Auditory brainstem response (ABR) thresholds to air- and bone-conducted clicks were investigated in 40 full-term neonates. Subjects were divided into two groups of 20 according to postpartum age: less than 48 hours and between 49 and 96 hours. Mean ABR thresholds to air- and bone-conducted clicks for neonates less than 48 hours postpartum were 14.5 dB nHL (51.5 dB peak SPL) and 1.8 dB nHL (36.8 peak re: 1 microN), respectively, while those for neonates between 49 and 96 hours were 3.8 dB nHL (40.8 dB peak SPL) and 1.5 dB nHL (36.5 dB peak re: 1 microN), respectively. A significant difference was found between the two group mean ABR thresholds to air-conducted stimuli (p < .0001) but not for the bone-conducted stimuli (p < .8959). A statistically significant within-group difference was found between the ABR thresholds to air- and bone-conducted stimuli for only the neonates less than 48 hours of age (p < .0001). When the data was collapsed across groups, simple linear regression analyses revealed a statistically significant relation between postpartum age and ABR threshold to air-conducted stimuli (p < .0001) and a nonsignificant relation between postpartum age and ABR threshold to bone-conducted stimuli (p < .9744). These findings support the notion that some resolution of fluids and residuals in the middle ear occurs during the first 48 hours postpartum and that air-conducted stimuli are attenuated during that period. As such, a physiologic conductive deficit among the younger neonates is suggested.

Acoustic Stimulation

Bone conduction impairment in uncomplicated chronic suppurative otitis media.

PURPOSE: To study the effect of uncomplicated chronic suppurative otitis media on bone conduction thresholds and its relationship to the disease type and duration. PATIENTS AND METHODS: The differences in bone conduction thresholds of diseased and contralateral ears were compared in 218 patients with unilateral uncomplicated chronic suppurative otitis media. Pure tone audiometry was carried out after successful surgery on 93 patients. RESULTS: The study showed bone conduction threshold elevations ranging in frequency from 9.2 to 14.1 dB in the diseased ears. Approximately 39% of the patients had an average difference of more than 10 dB for bone conduction, and 12% had an average difference of 20 dB or more. Significant relationships were found between threshold elevation and the disease type and its duration. Postoperative audiograms showed no significant improvement in the bone conduction thresholds in most of the tested patients. CONCLUSION: This study suggests that chronic otitis media may result in clinically significant bone conduction threshold elevations that should be considered when managing uncomplicated chronic suppurative otitis media.

Adult

[Changes in the auditory threshold for air and bone conduction in relation to middle ear pressure in probands with normal hearing].

Under pressure in the tympanic cavity causes increased impedance of the middle ear. Gellé was the first to describe increased bone conduction levels following alteration of ear canal pressure in healthy ears. Up to now, no investigation which quantitatively describes the elevation of the hearing threshold induced by various levels of under pressure in the middle ear has been published. In a pressure chamber, we induced relative under pressure in the middle ears of 15 adults with normal hearing. We measured hearing thresholds and calculated medium values at four separate levels of under pressure. At an under pressure of 3.3 kPa, air conduction was reduced by a few dB at 500 and 1000 Hz. Alterations of bone conduction were first seen at 6.6 kPa accompanied by increased deterioration of air conduction. Both effects became more obvious at 10 kPa; and at a maximum under pressure of 13.3 kPa, a deterioration of air conduction by more than 25 dB was seen at 250, 500, and 1000 Hz. Bone conduction deteriorated by more than 10 dB at 500 and 1000 Hz. There was no uniformity in the development of bone conduction threshold in the condition of under pressure: Several ears expressed only slight changes, but in some ears we saw an increase of bone conduction at the same rate as air conduction. Minor alterations were observed in frequencies above 1000 Hz. These results may be only partially explained by middle ear effects like the reduction of the ostio-tympanic component of bone conduction caused by increased stiffness of the ossicles. We believe that disturbances of inner ear mechanics play a role in the deterioration of bone conduction levels, too.(ABSTRACT TRUNCATED AT 250 WORDS)

Acoustic Impedance Tests

Audiologic management of bilateral external auditory canal atresia with the bone conducting implantable hearing device.

The hearing impairment associated with congenital external auditory canal atresia has been managed with early bone conduction hearing aid placement and surgical reconstruction in selected patients. However, many patients do not wear a bone conduction hearing aid because of physical or social considerations and surgical reconstruction of the external auditory canal and middle ear may be difficult or contraindicated. This report details the use of implantable bone conducting hearing devices in five children with bilateral external auditory canal atresia. Each patient had bilateral conductive hearing impairment with normal bone conduction thresholds. Four of the five patients had associated craniofacial anomalies including three cases of microtia. The average preoperative sound field speech reception threshold improved from 63 dB to 13 dB with the implant. Patients experienced a definite preference for the implanted hearing device over the bone conduction hearing aid.

Adolescent