Determination and evaluation of clinically efficient stopping criteria for the multiple auditory steady-state response technique

Background: Although the auditory steady-state response (ASSR) technique utilizes objective statistical detection algorithms to estimate behavioural hearing thresholds, the audiologist still has to decide when to terminate ASSR recordings introducing once more a certain degree of subjectivity. Aims: The present study aimed at establishing clinically efficient stopping criteria for a multiple 80-Hz ASSR system. Methods: In Experiment 1, data of 31 normal hearing subjects were analyzed off-line to propose stopping rules. Consequently, ASSR recordings will be stopped when (1) all 8 responses reach significance and significance can be maintained for 8 consecutive sweeps; (2) the mean noise levels were ≤ 4 nV (if at this “≤ 4-nV” criterion, p-values were between 0.05 and 0.1, measurements were extended only once by 8 sweeps); and (3) a maximum amount of 48 sweeps was attained. In Experiment 2, these stopping criteria were applied on 10 normal hearing and 10 hearing-impaired adults to asses the efficiency. Results: The application of these stopping rules resulted in ASSR threshold values that were comparable to other multiple-ASSR research with normal hearing and hearing-impaired adults. Furthermore, in 80% of the cases, ASSR thresholds could be obtained within a time-frame of 1 hour. Investigating the significant response-amplitudes of the hearing-impaired adults through cumulative curves indicated that probably a higher noise-stop criterion than “≤ 4 nV” can be used. Conclusions: The proposed stopping rules can be used in adults to determine accurate ASSR thresholds within an acceptable time-frame of about 1 hour. However, additional research with infants and adults with varying degrees and configurations of hearing loss is needed to optimize these criteria

Hearing in young adults, part II : the effects of recreational noise exposure

Great concern arises from recreational noise exposure, which might lead to noise-induced hearing loss in young adults. The objective of the current study was to evaluate the effects of recreational noise exposure on hearing function in young adults. A questionnaire concerning recreational noise exposures and an audiological test battery were completed by 163 subjects (aged 18-30 years). Based on the duration of exposure and self-estimated loudness of various leisure-time activities, the weekly and lifetime equivalent noise exposure were calculated. Subjects were categorized in groups with low, intermediate, and high recreational noise exposure based on these values. Hearing was evaluated using audiometry, transient-evoked otoacoustic emissions (TEOAEs), and distortion-product otoacoustic emissions (DPOAEs). Mean differences in hearing between groups with low, intermediate, and high recreational noise exposure were evaluated using one-way analysis of variance (ANOVA). There were no significant differences in hearing thresholds, TEOAE amplitudes, and DPOAE amplitudes between groups with low, intermediate, or high recreational noise exposure. Nevertheless, one-third of our subjects exceeded the weekly equivalent noise exposure for all activities of 75 dBA. Further, the highest equivalent sound pressure levels (SPLs) were calculated for the activities visiting nightclubs or pubs, attending concerts or festivals, and playing in a band or orchestra. Moreover, temporary tinnitus after recreational noise exposure was found in 86% of our subjects. There were no significant differences in hearing between groups with low, intermediate, and high recreational noise exposure. Nevertheless, a long-term assessment of young adults hearing in relation to recreational noise exposure is needed

Tinnitus, medial olivocochlear system and music exposure in adolescents

The most common cause of tinnitus is the exposure to noise; in the case of adolescents, music is the main sound source they are exposed to. Currently, one of the hypotheses about the genesis of tinnitus is related to the deterioration in the functioning of the medial olivocochlear system (MOCS). The aim of this study was to determine the presence or absence of tinnitus in adolescents with normal hearing and to relate it to: (a) the functioning of the MOCS, by the contralateral suppression of the transient evoked otoacoustic emissions (TEOAEs) and (b) the musical general exposure (MGE). A cross-sectional descriptive correlational study was conducted. The sample was composed by adolescents with ages between 14 and 15. Two questionnaires were administered, one in relation to the subjective report of tinnitus and the other in relation to recreational activities to know the MGE. The results showed that the amplitude of frequencies (1000, 1500, 2000, and 3000 Hz) and global amplitude of TEOAEs, with and without acoustic contralateral stimulation, were higher in the group without tinnitus, with a statistically significant difference (P < 0.05). The suppressive effect was higher in the group without tinnitus; however, there was no statistically significant difference. Contrastingly, a significant association (P < 0.05) between exposure to music and tinnitus was observed; 72.41% of the adolescents with high exposure to music had tinnitus.Discussion and Conclusion:The results of the present investigation provide a contribution to the hypothesis of "the participation of the MOCS." Furthermore, a high MGE can be considered a risk factor for the onset of tinnitus.Fil: Hinalaf, María de Los Angeles. Universidad Nacional de Córdoba. Facultad de Medicina; Argentina. Centro de Investigación y Transferencia en Acústica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Maggi, Ana Luz. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro de Investigación y Transferencia en Acústica; ArgentinaFil: Hug, Mercedes Ximena. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Córdoba. Facultad de Psicología; Argentina. Centro de Investigación y Transferencia en Acústica; ArgentinaFil: Kogan, Pablo. Centro de Investigación y Transferencia en Acústica; ArgentinaFil: Perez Villalobo, Jorge Alejandro. Centro de Investigación y Transferencia en Acústica; ArgentinaFil: Biassoni, Ester Cristina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Centro de Investigación y Transferencia en Acústica; Argentin

Subjective versus objective hearing screening results of rural elementary school-aged children

The present study compared the pass/refer results of traditional ASHA recommended hearing screenings to transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), and screening tympanometry among young students at a rural, medically underserved population at an elementary school. Sixty-seven students (31 boys and 36 girls) from kindergarten to 3rd grade participated in this study. Ten were Hispanic and had English as a second language. Each child had his/her hearing screened at 500 Hz and by the ASHA recommended method for pure tone screenings and by TEOAEs and DPOAEs. Tympanometry was also performed on 53 students. The results revealed that of the 67 children screened: 9% passed the ASHA recommend pure tone screening with the addition of 500 Hz, 58% passed the ASHA recommended pure tone audiometry, 53% passed tympanometry, 78% passed the TEOAE, and 87% passed the DPOAE screenings. Early identification of hearing impairment is crucial for academic success; therefore, the screening process must be increased sensitivity and specificity. As shown by this study, the inclusion of objective measures increased the sensitivity and specificity, and decreased the evaluation time per child. These results should encourage audiologists and school personnel to examine the substitution of objective screening tools for subjective screening tools in the future, or at the very least incorporate them into the screening protocol

On the threshold of effective well infant nursery hearing screening in Western Sicily

Objective: To determine the feasibility and effectiveness of well-infant nursery hearing screening programme for the early identification of hearing impairment, based on transient evoked otoacoustic emission (TEOAE) with a high “screen sensitivity” reducing the number of more expensive secondary level exams. Methods: The newborns were screened by non-specialist health workers in well babies nursery at the twentieth day of life for 6 years consecutive. Based on PASS/FAIL criteria and presence/absence of audiological risk factors the newborns were divided into four groups each one with its personal step program: G1- PASS without risk factor, free to go home; G2 - PASS with risk factor, retest at the age of 7 months; G3 - FAIL without risk factor, re-screening after 2 weeks for a maximum of four times before audiology assessment; G4 - FAIL with risk factor, retest after 2 weeks. Results: The coverage rate increased progressively from 89.8% to 92%. The referral rate was 1.51% after second stage with a specificity value of 98.78%. The four-stage screening performed for G3 reduced the numbers of global audiology assessment to 0.91% with a final global specificity of 99.4+0.4%. Conclusion: Less than 1% of infants underwent audiological assessment; the false positives resulted 0.62% with hearing loss global incidence of 2.95/1000 and a mean age of confirmation of 3.5 months of age. It is reasonable to think that this screening program could be implement to overall forty-two Western Sicily birth centres within few years

Hearing Characteristics of Stroke Patients: Prevalence and Characteristics of Hearing Impairment and Auditory Processing Disorders in Stroke Patients

BACKGROUND: Stroke survivors may suffer from a range of hearing impairments that may restrict their participation in postacute rehabilitation programs. Hearing impairment may have a significant impact on listening, linguistic skills, and overall communication of the affected stroke patient. However, no studies sought to systematically characterize auditory function of stroke patients in detail, to establish the different types of hearing impairments in this cohort of patients. Such information would be clinically useful in understanding and addressing the hearing needs of stroke survivors. PURPOSE: The present study aimed to characterize and classify the hearing impairments, using a detailed audiological assessment test battery, in order to determine the level of clinical need and inform appropriate rehabilitation for this patient population. RESEARCH DESIGN: A case‐control study. STUDY SAMPLE: Forty-two recruited stroke patients who were discharged from a stroke unit and 40 control participants matched for age. DATA COLLECTION AND ANALYSIS: All participants underwent pure-tone audiometry and immittance measurements including acoustic reflex threshold, transient-evoked otoacoustic emissions, auditory-evoked brainstem response, and a central auditory processing assessment battery, performed in a single session. Hearing impairments were classified as peripheral hearing loss (cochlear and neural type), central auditory processing disorder (CAPD), and as a combination of CAPD and peripheral hearing loss. RESULTS: Overall mean hearing thresholds were not significantly different between the control and stroke groups. The most common type of hearing impairment in stroke patients was the combination type, “peripheral and CAPD,” in the 61- to 80-yr-old subgroup (in 55%), and auditory processing deficits in 18- to 60-yr-olds (in 40%), which were both significantly higher than in controls. CONCLUSIONS: This is the first study to examine hearing function in detail in stroke patients. Given the importance of hearing for the efficiency of communication, it is essential to identify hearing impairments and differentiate peripheral and central deficits to define an appropriate intervention plan

Effect of noise on transient-evoked otoacoustic emissions and pure-tone screening audiometry

Currently, the American Speech-Language Hearing Association (ASHA) recommends pure-tone audiometry as the preferred audiometric screening method of school-aged children; however, background noise is often present and can result in high referral rate. The current study\u27s goal was to examine the effect of noise on the pass rate on transient-evoked otoacoustic emissions (TEOAEs) and pure-tone audiometric screening measures. Twenty normal hearing adults (M = 22.85), eighteen females and two males, were screened with TEOAEs and pure-tone audiometry in quiet and in different levels of noise (i.e., 40 dB SPL, 50 dB SPL, 60 dB SPL) in a sound-treated booth. Pure-tone audiometry and TEOAEs were present at 40 dB SPL. At 50 dB SPL, a 90% pass rate was recorded for TEOAEs and 60% pass rate for pure-tone audiometry. In 60 dB SPL noise, a 70% pass rate was found for TEOAE screenings and a 15% pass rate was found for pure-tone screenings. The amplitude was not found to be significantly different for the right or left ear, suggesting participants had similar TEOAE amplitudes in all noise levels. A significant difference for the right ear TEOAE reproducibility was found for the quiet to 60 dB level, but no other noise level was found to be significant. The reproducibility for the left ear TEOAE was found to be significant at the 40 to 60 dB noise levels and the 50 to 60 dB noise conditions

The utilization of transient evoked otoacoustic emissions and tympanometry in hearing screening of hearing-impaired children

Thesis (B.Sc)--University of Hong Kong, 1999"A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, May 14, 1999."Also available in print.published_or_final_versionSpeech and Hearing SciencesBachelorBachelor of Science in Speech and Hearing Science

An overview of pharmacotherapy-induced ototoxicity

This article provides an overview of ototoxic medication, as well as different pharmacological and audiological monitoring strategies. Although ototoxic medications play an important role in modern medicine, they also have the capacity to do great harm and lead to significant morbidity. Physicians have to be aware of the potential effects of medication in order to identify patients who are at increased risk of developing ototoxicity. Precaution should be taken to prevent any auditory impairment that might occur through  appropriate administration and monitoring. Although some otoprotective substances have been used successfully in certain studies, further trials must be performed to assess their clinical utility. The clinical pharmacist and audiologist form an important part of the ototoxicity management healthcare team

The audiological profile of adults with and without hypertension

OBJECTIVE: To determine whether there is any influence of systemic arterial hypertension on the peripheral auditory system. METHODS: This was a cross-sectional study that investigated 40 individuals between 30 and 50 years old, who were divided into groups with and without systemic arterial hypertension, using data from high-frequency audiometry, transient-evoked otoacoustic emissions and distortion-product otoacoustic emissions. The results were compared with those from groups of normal-hearing individuals, with and without systemic arterial hypertension, who underwent the pure-tone audiometry test. All individuals also underwent the following procedures: otoscopy, acoustic immittance measures, pure-tone audiometry at frequencies from 250 to 16000 Hz, transient-evoked otoacoustic emissions test and distortion-product otoacoustic emissions test. RESULTS: No statistically significant difference was observed between the groups with and without systemic arterial hypertension in either conventional or high-frequency audiometry. Regarding transient-evoked otoacoustic emissions, there was a trend toward statistical significance whereby the systemic arterial hypertension group showed lower results. Regarding distortion-product otoacoustic emissions, the systemic arterial hypertension group showed significantly lower results at the following frequencies: 1501, 2002, and 3003 Hz. A discriminant analysis indicated that the distortion-product otoacoustic emissions variables best distinguished individuals with and without systemic arterial hypertension. CONCLUSION: Data from this study suggest cochlear dysfunction in individuals with systemic arterial hypertension because their otoacoustic emission results were lower than those in the systemic arterial hypertension group