Alternate Binaural Loudness Balance Test Research Articles

Diagnosis and treatment strategies of 56 cases of middle ear myoclonus

Objective: To analyze the clinical characteristics and treatment of middle ear myoclonus. Methods: Fifty-six cases of middle ear myoclonus were enrolled in Shandong Provincial ENT Hospital, Shandong University from September 2019 to August 2021, including 23 males and 33 females. The age ranged from 6 to 75 years, with a median age of 35 years; Forty-seven cases were unilateral tinnitus, nine cases were bilateral tinnitus. The time of tinnitus ranged from 20 days to 8 years. The voice characteristics, inducing factors, nature (frequency) of tinnitus, tympanic membrane conditions during tinnitus, audiological related tests, including long-term acoustic tympanogram, stapedius acoustic reflex, pure tone auditory threshold, short increment sensitivity test, alternate binaural loudness balance test, loudness discomfort threshold, vestibular function examination, facial electromyography, and imaging examination were recorded. Oral carbamazepine and/or surgical treatment were used. The patients were followed up for 6-24 months and the tinnitus changes were observed. Results: Tinnitus was diverse, including stepping on snow liking sound, rhythmic drumming, white noise, and so on. The inducing factors included external sound, body position change, touching the skin around the face and ears, speaking, chewing and blinking, etc. Forty-four cases were induced by single factor and 9 cases were induced by two or more factors. There was no definite inducing factor in 1 case. One patient had tinnitus with epilepsy. One case of traumatic facial paralysis after facial nerve decompression could induce tinnitus on the affected side when the auricle moved. Tympanic membrane flutter with the same frequency as tinnitus was found in 12 cases by otoscopy, and the waveform with the same frequency as tinnitus was found by long-term tympanogram examination. There were 7 patients with no tympanic membrane activity by otoscopy, the 7 cases also with the same frequency of tinnitus by long-term tympanogram examination, but the change rate of the waveform was faster than that of the patients with tympanic membrane flutter. All patients with tinnitus had no change in hearing. One case of tinnitus complicated with epilepsy (a 6-year-old child) was treated with antiepileptic drug (topiramate) and tinnitus subsided. One case suffered from tinnitus after facial nerve decompression for traumatic facial paralysis was not given special treatment. Fifty-four cases were treated with oral drug (carbamazepine), of which 10 cases were completely controlled and 23 cases were relieved; 21 cases were invalid. Among the 21 patients with no effect of carbamazepine treatment, 8 patients were treated by surgery, 7 patients had no tinnitus after surgery, 1 patient received three times of operation, and the third operation was followed up for 6 months, no tinnitus occurred again. The other 13 cases refused the surgical treatment due to personal reasons. Conclusions: Middle ear myoclonus tinnitus and the inducing factors manifestate diversity. Oral carbamazepine and other sedative drugs are effective for some patients, and surgical treatment is feasible for those who are ineffective for medication.

Detecting the recruitment phenomenon in adults using 80-Hz auditory steady-state response

ObjectivesThe ASSR is used widely as an objective measurement of hearing in clinical settings because of its high frequency specificity. The recruitment phenomenon is generally detected using subjective evaluations which require direct communication with the patient. If the recruitment phenomenon can be detected with ASSR, it would facilitate diagnosis in patients with developmental disorders and infants. Subjects and methodsWe examined 2 groups of subjects: 10 subjects with unilateral hearing impairment in whom the recruitment phenomenon was detected by the alternate binaural loudness balance test and 12 normal subjects. We compared the relationships between the ASSR response and the stimulus sound pressure level in the 2 groups using the 80-Hz ASSR. ResultsThe amplitude of ASSR was significantly higher in the impaired ear in hearing-impaired subjects compared to a normal ear in normal subjects. The latency of ASSR was significantly shorter in the impaired ear in hearing-impaired subjects than in the normal ear in the normal subjects. ConclusionThis study showed that the recruitment phenomenon caused the higher amplitude and the shorter latency observed in hearing-impaired subjects in the 80-Hz auditory steady-state response (ASSR) in comparison with normal subjects.

자동 ABLB 검사 소프트웨어 개발

ABLB(양측 귀 교대 평형) 검사는 누가현상에 기초한 감각신경성 난청의 세부 병변을 감별하기 위한 검사중 하나이다. 본 논문은 자동 ABLB 검사 소프트웨어를 기술한다. 이 소프트웨어는 ABLB 검사 주파수 및 검사 시작음을 자동으로 결정한다. 또한 검사 음에 대한 피검자의 반응을 분석하여 다음 검사를 결정하는 알고리즘을 지원한다. 또, 피검자의 ABLB 검사 제어 및 모니터링을 위한 인터페이스를 제공하고 검사 결과를 Ladder Diagram으로 나타낸다. 디지털 오실로스코프를 이용하여 ABLB 검사 음이 정확하게 출력되는지 확인하였다. ABLB(Alternate Binaural Loudness Balance) test is one of the medical assessments to diagnose detailed lesion of sensory-neural hearing loss based on a recruitment phenomenon. This paper describes an Auto ABLB test software. This software automatically decides test frequency and intensity of first test tone. And it supports an automatic algorithm that analyses the subject's reponses in the current step and then decides intensity of tone provided in next step. Also, this software supports an interface to control and monitor subject's ABLB test. The assessment result is represented by a ladder diagram. The output of this software has been verified using a digital oscilloscope.

Acoustic reflex threshold and loudness in patients with unilateral hearing losses

The relationship between the acoustic reflex threshold (ART) and loudness was examined in patients with unilateral hearing losses and subjects with simulated hearing losses using a masking method. Significant differences in the ART between the two ears of patients with unilateral hearing losses were correlated with differences in loudness at the level of the ART with differences in loudness determined by the alternate binaural loudness balance test. A similar relationship of ART and the sensation of loudness was also observed in ears with simulated hearing losses. The results obtained in the present study suggest a positive relationship between the ART and loudness, and provide some support for the assumption that a common neuronal information pathway plays an important role both in producing the loudness and eliciting the acoustic reflex.

Recruitment detection--a comparison of category loudness scaling and classical supra-threshold audiometry

The assessment and localization of hearing impairments require reliable and valid recruitment indicators. Although many diagnostic tests are available, which of these tests are most important is still the subject of controversy. To compare the efficacy of various diagnostic audiometric tests, 51 subjects with monaural sensorineural hearing loss were submitted to the following tests at 500 and 2000 Hz: category loudness scaling of narrowband noise bursts, alternate binaural loudness balance (ABLB), intensity difference limen test, SISI test, fixed frequency Békésy audiometry, and contralateral determination of the acoustic reflex threshold for pure tones. Using the findings of the ABLB test as reference, the results of the present study revealed that category loudness scaling and acoustic reflex audiometry are reliable quantitative recruitment indicators. This holds for the intensity difference limen test to a lesser extend as well. However, the recruitment selectivity of the SISI test and Békésy audiometry turned out to be considerably poorer. Category loudness scaling has proven to be a valuable element in the conventional recruitment test battery particularly for patients with symmetrical hearing loss. Therefore, category loudness scaling, ABLB test (when feasible), acoustic reflex measurement, and to a lesser extend the intensity difference limen test should be given the highest priority when selecting appropriate diagnostic audiometric tests. The efficacy of the SISI test and Békésy audiometry should be comprehensively reevaluated on the basis of expanded data. Until such material is available and a final judgement of the clinical value is possible, both these tests should be used and interpreted carefully.

Cross-modal matching of loudness and brightness as a recruitment test for hearing-impaired children.

Normal 5-year-olds have been reported to be able, in a simple game situation, to match brightness to loudness in the same way as a control group of adults. This study investigated supplanting the normal ear in an alternate binaural loudness balance test (ABLB) with the visual modality, as a recruitment test designed especially for bilaterally hearing-impaired children. The results of normal 10-year-olds, with simulated hearing losses, suggest that category scaling was adopted naturally as a simplifying strategy in preference to ratio scaling (absolute judgements). No proportional increase in the matching function slope was evident, despite the amount of recruitment measured with an ABLB. The instructions needed to combat this strategy render the test unfeasible with hearing-impaired children.

Auditory test results in 500 cases of acoustic neuroma.

Auditory test results in the first 53 causes of this series of 500 acoustic neuromas were reported in 1964. Subsequent studies involving larger numbers of patients detailed new results based on these additional cases. Five hundred cases of surgically confirmed acoustic neuromas were analyzed. Pure-tone loss configurations, speech discrimination, auditory adaptation as measured by the modified tone decay test, Bekesy audiometry, short increment sensitivity index test, and alternate binaural loudness balance test data were evaluated. The results of this investigation in general confirm previous studies, although percentage figures for positive tests differed in the large series. Acoustic reflex results were reported for those patients evaluated more recently. Slightly more than half of the cases had inconsistent audiometric results in one or more aspects. Inconsistencies to the tests were examined in detail. Consistent responses to the tests appear to be related to the size of the lesion. The full battery of audiologic tests is of importance in the differential diagnosis of acoustic neuromas.

Loudness balance procedures for the measurement of recruitment

COLES and PRIEDE have recommended that in the alternate binaural loudness balance test use of the normal ear as the reference standard be now abandoned in favour of the worse ear. Their data are critically reviewed and shown to be subject to cumulative errors of methodology and interpretation.

Subjective and Electrophysiologic Tests in Brain-Stem Lesions

A battery of subjective and electrophysiologic auditory and vestibular tests were administered to 22 patients with neurologically confirmed brain-stem lesions to investigate the interrelationships between the test results. Acoustic-reflex and simultaneous midplane binaural loudness-balance abnormalities were related to N2 and N3 abnormalities on the brain-stem evoked-response measures. Unilateral abnormalities in low-redundancy speech tests, prolonged auditory reaction times, and reduced loudness growth on the alternate binaural loudness-balance test were related to ipsilateral N4 abnormalities or contralateral N5 abnormalities on the brain-stem evoked-response measures.