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PubMed2005

[Audiological effect of bone-anchored hearing aid].

The bone-anchored hearing aid (BAHA) has proved to be a valuable alternative to conventional air and bone conduction hearing aids for patients suffering from chronic otitis media or bilateral aural atresia. The BAHA gave better sound quality and greater comfort than conventional hearing aids (HAs), but only 1 study has been done in Japan. We implanted BAHAs in 6 hard-of-hearing patients in the last 2 years. One patient suffered skin problems around the abutment and used the BAHA only briefly. Free-field audiometry, the speech discrimination test (SDT), and the speech recognition test (SRT) were conducted in all subjects. They were evaluated either with the HA or BAHA. The SDT and SRT showed better hearing results in quiet for the BAHA than the conventional HA, but there was a minimum difference in SDT and SRT in noise. Subjects assessed the HA and BAHA using questionnaires. Subjects reported that the BAHA offers a number of important advantages, including greater cosmetic acceptability, improved speech intelligibility, and better sound quality.

Adolescent↗
PubMed2006

Cervical dystonia responsive to acoustic and galvanic vestibular stimulation.

We examined the effects of acoustic and galvanic vestibular stimulation in a patient with cervical dystonia. Acoustic stimulation consisted of three conditions: "baseline" (no stimulation), "vestibular" (500 Hz bone-conducted tone bursts), and "control" (5,000 Hz tone bursts). Rectified electromyographic activity in the sternocleidomastoid was measured. Galvanic stimulation (1.5-2.5 mA current steps) was delivered to the mastoids, and head acceleration was measured. Vestibular acoustic stimulation reduced neck muscle activity between 16% and 44% (P < 0.001), and galvanic stimulation reduced head acceleration by 22.5% (P = 0.028). The patient reported subjective improvement in head control. Vestibular stimulation can reduce neck muscle activity in cervical dystonia and give symptomatic relief.

Acoustic Stimulation↗
PubMed1975

The early descriptions of the so-called tuning-fork tests of Weber, Rinne, Schwabach, and Bing. II. The "Rhine Test" and its first description by Polansky.

Concerning the first description of the so-called tuning-fork test of Rinne the literature refers to a publication by him in 1855. In this work Rinne describes, among many other observations, a method to compare air and bone conduction hearing, and adds the remark that the technique could be used for the diagnosis of deafness. It appears, however, that long before Rinne, Polansky (1842) gave a complete account of the test and its practical use. Polansky's description seems to have been forgotten. Rinne's report, too, was lost for a long period until 25 years later when Lucae (1882) and Schwabach (1885) confirmed the usefulness of the test which - in spite of its earlier discovery by Polansky - has born Rinne's name ever since.

Auditory Cortex↗
PubMed1989

Effect of external auditory canal pressure upon the hearing threshold in patients with Menière's disease.

Fluctuation of hearing at low frequencies is one of the most characteristic findings in Meniere's disease and seems to be a phenomenon closely related to changes of endolymphatic pressure and volume. In the present study, pressure was applied to the external auditory canal of patients with Meniere's disease, and the effect on the bone conduction threshold was examined at times of depressed and improved hearing. In more than half of these cases, it was found that the pressure effect was marked at the time of improved hearing acuity, but not at the time of depressed hearing. This effect was also confirmed in more objective experiments with guinea pigs. It is concluded that the fluctuation of hearing in Meniere's disease seems to be a phenomenon accompanying the endolymphatic pressure change in the scala media.

Animals↗
PubMed1987

Clinical experience with the bone-anchored hearing aid.

Patients operated on for chronic otitis media sometimes have problems with persistent discharge from the ear when using a conventional hearing aid with an ear mould located in the ear canal. A new technique where a hearing aid for bone-conducted sound is mounted on an osseointegrated titanium screw located in the mastoid area is available. The method was evaluated in a routine clinical setting outside the centre of development. Eight patients were fitted with the new hearing aid. All improved regarding the drainage from the ears. The patients were all very satisfied with the hearing results and with the hearing aid, from a practical as well as from a cosmetic point of view. No complications were noted during an observation period of minimum 12 months.

Adult↗
PubMed1985

Hearing acuity of children with otitis media with effusion.

Hearing levels are reported for a cohort of 222 infants (aged 7 to 24 months) and 540 older children (aged 2 to 12 years) with otitis media with effusion (OME). The infants had an average speech awareness threshold of 24.6 dB hearing level (HL). The older group had mean bone conduction thresholds less than 10 dB HL, and air conduction thresholds averaged 27 dB HL; however, acuity was 7 dB less impaired at 2,000 Hz. The mean three-frequency pure tone average and speech reception threshold were 24.5 and 22.7 dB, respectively. Hearing acuity was not significantly related to age or previous duration of OME. The otoscopic observation of an air-fluid level or bubbles was associated with less hearing impairment; however, a predictive relationship between hearing levels and tympanogram characteristics could not be demonstrated.

Acoustic Impedance Tests↗
PubMed2001

[Developments in the area of hearing aids].

During the past 10-15 years, several techniques have been developed and refined for the treatment of hearing impairment and deafness. The size of hearing aids has been reduced and the sound processing has become more advanced. In the next 20 years sound processing will improve substantially. Although the reduction of size will not continue, the technical possibilities of small hearing aids will improve considerably. These developments will by and large remedy the present shortcomings of hearing aids. The functionality of cochlear implants has improved considerably in recent years, mainly due to improvements in sound processing and it is in this area in particular that improvements are expected during the next 20 years. In the area of bone conducting implants considerable improvements in the apparatus and operating techniques have been made. Minor developments are expected during the next 20 years. As a result of population growth and the aging of the population, the number of hearing aid users will probably multiply in the next 20 years from 380,000 to 523,000. The number of implant users will probably increase in this period. The bulk of the total costs for hearing devices will continue to be the supply of hearing aids.

Bone Conduction↗
PubMed2006

Anterior atticoantrostomy for cholesteatoma surgery.

OBJECTIVES: We aimed to investigate the long-term results of anterior atticoantrostomy in adult patients with cholesteatoma. METHODS: A total of 83 ears in 78 patients were operated on by the anterior atticoantrostomy technique, supported by a periosteal flap, between 1991 and 2002. RESULTS: Cholesteatoma recurred in only 4 ears (4.8%). In the 79 ears without recurrence, re-perforation was observed in 3 ears (3.8%), and retraction pockets developed in the attic of 5 ears (6.3%), 2 of which needed ventilation tubes. Absorption or migration of cartilage grafts was not seen in any of the patients. The mean air-bone gap was 34.8 +/- 13.4 dB and 16.9 +/- 14.7 dB, and the mean high-tone bone conduction was 19.0 +/- 6.2 dB and 21.1 +/- 6.6 dB, in the preoperative and postoperative periods, respectively. CONCLUSIONS: In the reconstruction of the posterior canal wall, a cartilage graft supported by a periosteal flap prevents attic retraction and may increase the vascularization of the graft. After anterior atticoantrostomy, the recurrence rate and the probability of leaving residual tissue are low. Therefore, we believe that anterior atticoantrostomy is a relatively safe and effective technique that can be used in the management of cholesteatoma.

Adolescent↗
PubMed1983

A psychophysical evaluation of the dependence of hearing protector attenuation on noise level.

The attenuation characteristics of ten commercially available hearing protectors (five muffs and five plugs) were examined for 1/3-octave bands of noise centered at 1000, 2000, 3150, 4000, and 6300 Hz in ten normal-hearing young adults utilizing four psychophysical procedures. One of these procedures, the real-ear attenuation at threshold procedure described in the American standard for the evaluation of hearing protectors, is designed for use at 1/3-octave band noise levels below approximately 50 dB SPL. Three real-ear psychophysical procedures were also developed and evaluated. These procedures were: (1) a reaction-time paradigm; (2) a loudness magnitude-estimation procedure; and (3) a masked bone-conduction threshold technique. Each procedure was designed to evaluate protectors for 1/3-octave bands of noise having levels ranging from approximately 50 to 90 dB SPL. Mean data indicated that: (1) attenuation was linear over the range investigated, although some exceptions to this generalization were apparent; (2) attenuation estimates derived with the reaction-time and magnitude-estimation paradigms were typically less than those obtained with the other two methods; and (3) all attenuation estimates, regardless of procedure, were less than manufacturer's specifications for the majority of the protectors. Implications for existing standards are discussed.

Auditory Threshold↗
PubMed1983

Influence of physiological noise and the occlusion effect on the measurement of real-ear attenuation at threshold.

The most commonly alleged experimental artifact associated with real-ear attenuation at threshold (REAT) measurements of hearing protection devices (HPDs) was examined: Masking of the protected thresholds due to physiological noise amplified by the occlusion effect. An ear canal mounted subminiature microphone was used to obtain objective measures of physiological noise in occluded and unoccluded test conditions and of the insertion loss (IL) of insert, semi-aural, supra-aural and circumaural HPDs when exposed to broadband noise with a sound pressure level of 93 dB. Measurements spanned 1/3 octave bands from 125 Hz to 2 kHz. Attenuation was also measured via a subjective REAT procedure and the magnitude of the occlusion effect was examined via bone conduction audiometry. The IL data confirmed the accuracy of the REAT results except at the lowest frequencies tested, where the degree to which the REAT values were spuriously inflated was quantified and found to be device related. Furthermore, the magnitude of the error (which never exceeded 5 dB) could be predicted by measuring the physiological noise in the occluded ear and calculating how much this would mask the occluded threshold. It was noted that no evidence was found in the data to suggest a dependency of HPD attenuation on sound level.

Adult↗
PubMed2006

[The ti-epiplating system in bone anchored hearing AIDS].

The advent of bone-anchored hearing aids with titanium implants has markedly improved patient management. There are two systems on the market for performing the requisite osseointegration. The aim of our study was to evaluate the Ti-Epiplating system, since no data have been published on this in the literature thus far. Between November 2002 and March 2005, we anchored the BAHA snap coupling via the Ti-Epiplating system in 8 patients in a single session. The patients were followed-up at regular intervals to assess clinical and audiometric results and subjective satisfaction. The postoperative hearing threshold with the BAHA was in the former bone conduction range. In the Freiburg speech test, a significant improvement was found for monosyllables (free-field), and the hearing loss for numbers showed a mean reduction from 75 to 30 dB. There has been no implant loss in our collective thus far. Good to very good results were evaluated for the quality of life in the "International Inventory of evaluation of hearing aids" (IIEH). Clinics that use Medicon's osteosynthesis system can safely and reliably achieve inexpensive and audiometrically successful BAHA management by a comparatively simple surgical procedure.

Aged↗
PubMed1979

Stapes surgery at the Otologic Medical Group.

We reviewed the records of 498 primary stapedectomy cases in regard to duration of disease, age at surgery, oval window pathology, hearing results, dizziness, and tinnitus. Ninety percent of the cases in which a tissue graft had been used as an oval window covering obtained a postoperative hearing level within 10 dB of the preoperative bone conduction. Postoperative sensorineural hearing impairment occurred infrequently and was two to three times more common in cases in which Gelfoam had been used as an oval window covering as compared to tissue grafts. Postoperative dizziness of one degree or another persisted at four months in 2 percent of the cases and was a problem for the patient in two cases (0.4%). This dizziness was likewise more common in Gelfoam cases. We concluded that tissue grafts are a better covering for the oval window than Gelfoam both in regard to hearing improvement and lack of postoperative complications.

Adult↗
PubMed1993

Reporting the benefits from middle ear surgery using the Glasgow Benefit Plot.

In the past, otologists have reported the results of middle ear surgery to improve hearing, either by tympanoplasty or by stapes surgery, mainly in terms of closure of the air-bone gap. This is valid as a measure of the technical success of the operation provided any change in the bone conduction thresholds, particularly at the higher frequencies, is also reported. Unfortunately, technical success in surgery does not always equate with patient benefit, primarily because, in most conditions, listening is a binaural condition. Disability in such circumstances is dictated by the hearing in the better hearing ear, which, quite correctly, is usually the nonoperated ear. Hence, it is important to define the relationship, before and after surgery, between the hearing in the operated and that in the nonoperated ear. This is the basis of the Glasgow Benefit Plot, which is drawn up from pure-tone audiometric data before and after surgery.

Audiometry, Pure-Tone↗
PubMed1998

Sensorineural hearing loss associated with otitis media with effusion in children.

Sensorineural hearing loss (SNHL) is known to occur in various types of otitis media. Although the mechanism by which SNHL develops in association with otitis media with effusion (OME) is unknown, several hypotheses have been advocated up to now. We reviewed the clinical records of children with otitis media with effusion (OME) to reveal the association with sensorineural hearing loss. The material consisted of 71 children (119 ears) who were diagnosed as having OME and gave reliable audiograms in our clinic during an 11 month period from February 1997 through January 1998. From these cases those which showed bone conduction loss of 25 dB or higher at any one of the frequencies of 250 through 4 kHz were selected and considered to be cases of SNHL. Eight cases (9%) which had temporary threshold shift (TTS) or permanent threshold shift (PTS) were considered to be etiologically related to OME. The clinical course in each of these cases with SNHL was reviewed and evaluated in detail. We noted that all children with TTS improved completely. The result of this study indicates that we have to be aware of a possible development of SNHL during the course of OME.

Adolescent↗
PubMed2005

First experience with a new stapes clip piston in stapedotomy.

OBJECTIVE: Hearing results after 23 implantations of a newly designed titanium-clip stapes piston prosthesis (the àWengen Clip Piston prosthesis) in patients with otosclerosis were evaluated. This new type of stapes piston was designed to avoid the crimping onto the incus in stapedotomy. This one clip fits all designs and enables solid fixation by clicking the prosthesis onto the long process of the incus without crimping. STUDY DESIGN: A retrospective pilot study was carried out by microcomputer of the preoperative and postoperative audiological results of patients in whom the titanium-clip stapes piston prosthesis was implanted. SETTING: Ear, nose and throat department of Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. PATIENTS: 23 Patients underwent a stapedotomy for hearing improvement suffering from otosclerosis. implantations of a newly designed titanium-clip stapes piston prosthesis (the àWengen Clip Piston prosthesis) in patients with otosclerosis were evaluated. INTERVENTION(S): The stapedotomy was performed with the àWengen Clip Piston prosthesis. MAIN OUTCOME MEASURE(S): Pre and postoperative audiograms were used to evaluate the hearing gain improvement with the new stapes piston. Especially we looked at the airbone gap closure and the sensorineural hearing after the surgical procedure and compared these with the ones before surgery. RESULTS: The hearing results showed a closure of the pure-tone average air-bone gap to within 10 dB in 56.6% of cases (10 of 23 implantations) and to within 20 dB in 100% (23 of 23 implantations). A residual air-bone gap of greater than 20 dB was seen in the present pilot study. Postoperative overclosure of bone-conduction thresholds was discovered only for the frequency of 2 kHz. Sensorineural hearing loss greater than 10% did not occur, and there was no decline in the speech discrimination. CONCLUSIONS: The use of a newly designed titanium-clip stapes piston prosthesis with a diameter of 0.4 mm gives good results in cases of stapedotomy for otosclerosis. The titanium-clip design is a new development in the evolution of stapes piston prostheses. Surgical introduction, placement, and fixation are not always easy, depending on the anatomy of the middle ear and the thickness of the fixation area on the long process of the incus.

Audiometry↗
PubMed2001

Is the Er:YAG laser damaging to inner ear function?

OBJECTIVE: To assess whether the use of the Er:YAG laser in middle ear surgery has negative effects on inner ear function. STUDY DESIGN: Prospective. PATIENTS: Forty-nine patients with a 4- to 18-month postoperative audiologic follow-up were included in the study (24 stapedotomies, 23 malleostapedotomies, 1 surgery for congenital ear atresia, and 1 tympanoplasty). Twenty patients with conventional stapedotomy formed a control group. RESULTS: No statistically significant differences in preoperative and postoperative bone conduction thresholds and no impairment of postoperative air conduction thresholds were found. There was no significant difference between the results of the laser and the conventional stapedotomy. In addition, no relevant correlation between applied laser energy and postoperative hearing results were found. In summary, the authors were unable to find a negative effect of the Er:YAG laser on inner ear function at the 4- to 18-month audiometric follow-up. CONCLUSION: The clinical use of the Er:YAG laser with the system used in this study poses no risk to inner ear function if the total amount of energy is kept within the limits applied in this study.

Adolescent↗
PubMedDate not supplied

The absence of hearing loss in otologically asymptomatic recreational scuba divers.

We undertook a retrospective cohort study of 16 experienced recreational scuba divers and 16 matched non-diver controls to determine the prevalence of hearing loss and, if present, the likely causes of this loss. Each subject was required to be aged 55 years or less and to have no history or likelihood of hearing loss. An audiologist, blinded to each subject's group status, undertook all examinations. There were no significant differences in group demographics. All divers were highly experienced (median number of dives 725). Comparison of mean hearing thresholds (range 250-8000 Hz) revealed no significant differences between divers and non-divers for both air and bone conduction studies. The only exception was at 6000 Hz where the air conduction threshold was significantly higher in divers than in non-divers (p = 0.03). However, there were no significant differences in Pure Tone and High Frequency averages. We conclude that experienced recreational scuba divers do not have elevated hearing threshold levels overall when compared to non-diver controls. This conclusion differs from that of investigators who have examined the hearing of experienced professional divers. Further investigation is indicated to further investigate this discrepancy and to determine whether the apparent hearing loss among the divers at 6000Hz was an isolated departure from normal hearing thresholds or, in fact, the result of diving.

Adult↗
PubMedDate not supplied

Experiences with implantable hearing devices and a presentation of a new device.

Following animal experiments, anatomic examinations, and histologic studies, an implantable hearing device was developed. This device, the temporal bone stimulator (TBS), uses an inductive coil without percutaneous connection that transmits bone-conducted vibrations to the inner ear. Ten patients have been implanted and followed by the Central Ear Research Institute. The TBS is effective and may have wide application in producing amplification in good sound fidelity when used in patients who have external canal, middle ear, or eustachian tube disease that is poorly corrected by surgery or conventional hearing aids. The utilization of similar principles of electromagnetic transfer of energy directly to the ossicles appears reasonable and is potentially highly rewarding for those who have sensorineural hearing impairments with thresholds greater than 40 dB. The enormous potential benefits derived from the application of these implantable hearing devices is worthy of the greatest effort in future otologic investigation.

Animals↗