Differences In Pure-tone Thresholds Research Articles

Comprehensive Analysis of the Contributing Factors to the Hearing Abilities of Patients With Vestibular Schwannoma

Background and Objectives This study aimed to comprehensively assess the factors influencing hearing ability in patients with vestibular schwannoma, focusing on tumor size, location, primary complaint, and contralateral hearing threshold.Subjects and Method This was a retrospective analysis of 50 patients diagnosed with vestibular schwannoma by magnetic resonance imaging (MRI) at Nowon Eulji Medical Center. Tumor size and location were evaluated using a 3-T MRI system, and pure-tone threshold and speech discrimination were retrieved. To investigate the relationship between tumor size and hearing, we conducted a multiple regression analysis with several variables, including tumor size, tumor location, patient age, and gender.Results When patients were categorized into groups according to their primary complaint at initial presentation, no significant differences were observed in pure tone thresholds but different speech discrimination were detected among the groups. When patients were classified according to the tumor location, the extrameatal group exhibited lower pure-tone thresholds and higher speech discrimination scores than the intrameatal group. Multiple regression analysis indicated that differences in pure tone thresholds and speech discrimination scores between affected and unaffected sides were more pronounced in cases with smaller tumor sizes and extrameatal tumor locations, emphasizing the greater impact of location over size.Conclusion Using both tumor size and location, it is possible to predict the differences in pure-tone thresholds and speech discrimination between the affected and unaffected sides. Extrameatal invasion of the tumor appears to be the most important factor among them.

Is jet fuel exposure associated with central auditory nervous system difficulties: An exploratory study in military personnel.

Central auditory nervous system dysfunction (CANSD) can manifest as hearing difficulty in the absence of audiometric abnormalities. Effects of noise or jet fuel exposure on the CANS are documented in animal models and humans. This study screened military personnel using the modified Amsterdam Inventory for Auditory Disability (mAIAD) to assess whether concurrent jet fuel and noise (JFN) exposures potentiate central auditory difficulties compared to noise only exposures. A total of 48 age- and sex-matched participants were recruited: 24 military bulk fuel specialists (JFN) and 24 military personnel without jet fuel exposure. All participants completed the mAIAD, the Noise Exposure Questionnaire, and basic audiological testing. Results revealed non-significant differences in pure-tone thresholds between groups, but the JFN group had higher noise exposures. Additionally, the JFN group revealed consistently lower mAIAD scores compared to the noise only group. Interestingly, a JFN stratified subgroup reporting more listening difficulty exhibited statistically significant lower mAIAD scores in the speech intelligibility in noise subdomain. These preliminary data suggest that jet fuel exposure may potentiate noise-induced CANSD, such as speech-in-noise difficulties. Such difficulties may be more prominent among specific military personnel with combined exposures. Hearing conservation programs could add CANSD screening by use of the mAIAD.

Combined Acupuncture-Hyperbaric Oxygen-Steroids Therapy for Idiopathic Sudden Sensorineural Hearing Loss: A Retrospective Observational Study.

Objectives: Acupuncture, widely used in Chinese society, has been studied as an adjunct treatment of idiopathic sudden sensorineural hearing loss (ISSNHL). The purpose of this study is to investigate the effectiveness of combined acupuncture and hyperbaric oxygen therapy (HBOT) with conventional steroid therapy for ISSNHL. Methods: This retrospective chart review enrolled 154 patients who met the ISSNHL criteria and were categorized into three groups according to the different treatment regimens. Among these patients, 43 underwent steroid therapy only (S) group, 74 received steroid and HBOT (S-H) group, and the remaining 37 were treated with combined acupuncture-HBOT in addition to steroid therapy (S-H-A) group. The outcome was determined by comparing the differences in pure-tone thresholds and absolute hearing gains after treatment calculated at each audiometric octave frequency or grouped frequencies of audiograms. Hearing recoveries classified into three grades: complete, partial, and poor were also analyzed and compared among different treatment groups. Results: All subjects presented with initial severe hearing loss with averaged hearing thresholds >70 dB. The S-H-A group exhibited good hearing improvement outcomes at each audiometric octave frequency and grouped frequencies of audiograms, with greater hearing gain and had more favorable outcomes in hearing recovery grades compared with the S group and the S-H group. Conclusions: The results obtained in this study revealed a preliminary finding of ISSNHL patients benefiting from combined acupuncture, HBOT, and conventional steroid therapy. Acupuncture is a safe and nonpharmacologic treatment option and can be considered as an initial treatment strategy in such a clinical scenario.

Hearing Loss in Children With Otitis Media With Effusion: Actual and Simulated Effects on Speech Perception.

Conductive hearing loss simulations have attempted to estimate the speech-understanding difficulties of children with otitis media with effusion (OME). However, the validity of this approach has not been evaluated. The research aim of the present study was to investigate whether a simple, frequency-specific, attenuation-based simulation of OME-related hearing loss was able to reflect the actual effects of conductive hearing loss on speech perception. Forty-one school-age children with OME-related hearing loss were recruited. Each child with OME was matched with a same sex and age counterpart with normal hearing to make a participant pair. Pure-tone threshold differences at octave frequencies from 125 to 8000 Hz for every participant pair were used as the simulation attenuation levels for the normal-hearing children. Another group of 41 school-age otologically normal children were recruited as a control group without actual or simulated hearing loss. The Mandarin Hearing in Noise Test was utilized, and sentence recall accuracy at four signal to noise ratios (SNR) considered representative of classroom-listening conditions were derived, as well as reception thresholds for sentences (RTS) in quiet and in noise using adaptive protocols. The speech perception in quiet and in noise of children with simulated OME-related hearing loss was significantly poorer than that of otologically normal children. Analysis showed that RTS in quiet of children with OME-related hearing loss and of children with simulated OME-related hearing loss was significantly correlated and comparable. A repeated-measures analysis suggested that sentence recall accuracy obtained at 5-dB SNR, 0-dB SNR, and -5-dB SNR was similar between children with actual and simulated OME-related hearing loss. However, RTS in noise in children with OME was significantly better than that for children with simulated OME-related hearing loss. The present frequency-specific, attenuation-based simulation method reflected the effects of OME-related hearing loss on speech perception impairment in quiet environments. In noisy environments, the simulation method could only approximately estimate the effects of OME-related hearing loss on speech perception in typical classroom noise levels. Children with OME-related hearing loss may develop compensatory strategies to reduce the effects of hearing loss in adverse listening environments.

Evaluation of Magnetic Resonance Imaging Diagnostic Approaches for Vestibular Schwannoma Based on Hearing Threshold Differences Between Ears: Added Value of Auditory Brainstem Responses.

This study investigates the most appropriate audiometric criterion in deciding which patients with asymmetric hearing loss should be referred to MRI to exclude a lesion in the cerebellopontine angle (CPA). Careful selection of patients could improve resource utilization while preventing unnecessary investigations with accompanying burden and costs. Retrospective case review. Tertiary referral center. Of all the patients who were referred to our clinic between 1997 and 2012, the records were reviewed of those who underwent pure-tone audiometry, auditory brainstem response (ABR) testing, and had a Gadolinium-enhanced MRI of the CPA. Regarding interaural pure-tone threshold differences at single or multiple (averaged) frequencies, we assigned multiple possible cut-off values (dB) defining an aberrant result, suggestive for CPA lesions. Results were compared with MRI to calculate sensitivity and specificity for every cut-off value. These were visualized as ROC curves enabling qualitative comparison. Added value of ABR was assessed as well. Sensitivity and specificity of various criteria to decide which patients with asymmetric hearing loss to send to MRI to exclude a CPA lesion. In total, 1016 records were reviewed. Two hundred ninety-four subjects (29%) were diagnosed with a CPA lesion on MRI. Sensitivity and specificity for audiometry results differed greatly depending on the predefined cut-off value for hearing threshold difference (40-95% sensitivity and 20-90% specificity). Best ROC curves were obtained when threshold differences at two or three higher frequencies were averaged. Adding results of ABR to the threshold criterion yielded a slightly better ROC curve, although sensitivity decreased. The best criterion to decide which patient with asymmetric hearing loss should be referred to MRI is based on the average bone conduction threshold difference at multiple (two or three) higher frequencies. The extent of the average threshold difference between ears that is used as a cutoff will mainly depend on treatment modality and (eventually) on resource costs and on the burden of Gadolinium-enhanced magnetic resonance imaging. Results of ABR can have little added value when only patients with a unilateral abnormal ABR at the worse hearing ear are referred to MRI. However, a lower sensitivity must then be accepted.

Do antithyroid antibodies affect hearing outcomes in patients with pediatric euthyroid Hashimoto's thyroiditis?

ObjectivesHashimoto's thyroiditis (HT) is the most common autoimmune thyroid disease in children. HT is a multifaceted disease with a variable clinicopathological presentation, including hearing impairment. It is known that hearing function is negatively affected in patients with thyroid disorders. The literature includes a very limited number of studies on hearing function in euthyroid pediatric patients with HT. The aim of this study was to determine the relationship between cochlear function and HT, independent of thyroid function. Materials and MethodsThe study included 48 children and adolescents (42 females and 6 males) aged 9–18 years that were diagnosed as HT, and 30 gender- and age-matched healthy controls. Hearing was assessed via otoscopy, tympanometry, pure-tone audiometry, and measurement of distortion product otoacoustic emissions. ResultsThere weren't any significant differences in pure tone thresholds between the 2 groups based on pure-tone audiometry, except in the right ear at 6kHz and 8kHz. Distortion product otoacoustic emissions signal to noise ratios were significantly lower in the HT group than in the control group at 4 different frequencies (6kHz [left ear], 8kHz [left ear], 1.5kHz [right ear], and 6kHz [right ear]) (P<0.05). The signal to noise ratios at all frequencies were <6dB in 3% of left ears and 2.5% of right ears in the control group, versus 12.5% of left ears and 9.6% of right ears in the HT group. Distortion product amplitudes were significantly lower in the HT group than in the control group for both left and right ears at 1kHz, 1.5kHz, 3kHz, and 8kHz, and at 2kHz for left ears only (P<0.05). ConclusionsThe present findings show that cochlear function was lower in the HT group than in the control group. Accordingly, we think that hearing in patients with HT should be monitored periodically, even if their hearing thresholds are within normal limits. Thyroid autoimmunity appears to play an important role in a decrease in cochlear activity in pediatric HT patients.

The Effect of Noise Exposure on the Cervical Vestibular Evoked Myogenic Potential

The purpose of this study was to investigate the effects of noise exposure on the cervical vestibular evoked myogenic potential (cVEMP) in individuals with asymmetric noise-induced sensorineural hearing loss (NIHL). A cross-sectional observational study was used to compare cVEMP characteristics in 43 individuals with a history of noise exposure greater in one ear (e.g., the left ear of a right-handed rifle shooter) and asymmetric sensorineural hearing loss consistent with the history of noise exposure and in 14 age-matched controls. The characteristics of hearing loss were examined further for the noise-exposed participants with abnormal cVEMPs and the noise-exposed participants with normal cVEMPs. Thirty-three percent of the noise-exposed participants had abnormal cVEMPs, whereas cVEMPs were present and symmetrical in 100% of the age-matched controls, and cVEMP threshold was greater in the noise-exposed group than in the control group. Abnormal cVEMPs occurred most often in the ears with poorer hearing (or greater NIHL), and the noise-exposed participants who had abnormal cVEMPs had poorer high-frequency pure-tone thresholds (greater NIHL) and greater interaural high-frequency pure-tone threshold differences than the noise-exposed participants with normal cVEMPs. These findings are consistent with previous studies that suggest that the sacculocollic pathway may be susceptible to noise-related damage. There is emerging evidence that the severity of NIHL is associated with the presence or absence of cVEMPs.

Extended high‐frequency audiometry in patients with acoustic trauma

The aim of this study was to examine extended high-frequency (EHF) hearing in patients with acoustic trauma. A prospective, case-control study in a group of soldiers with acoustic trauma caused by shooting practice during basic training. Tertiary referral centre. A total of 39 young soldiers hospitalized for hearing loss and tinnitus following exposure to weapon impulse noise were studied. Conventional audiometry in the frequency range 0.25-8 kHz and EHF audiometry in the frequency range 9-20 kHz were performed, both on admittance and before discharge. Thirty healthy recruits of similar age and sex were used as controls. Pure-tone threshold changes documented by conventional and EHF audiometry. The most significant differences in pure-tone thresholds on initial testing were found in the frequency range 0.25-11.2 kHz, and especially in the 4-8 kHz region. Reduction in thresholds across most frequencies was observed after treatment, although recovery was partial in most cases. The EHF audiometry adds no significant additional information to conventional pure-tone audiometry in assessing and monitoring noise-induced hearing loss.

The effects of age on hearing and middle ear function.

Audiometric test results from 933 community dwelling males and females were presented to obtain the norm for each generation after middle age. Three aspects were adopted in this analysis; the cross-sectional aging transition of pure tone thresholds, the comparison in the self-perceived hearing difficulty among generations and the evaluation of middle ear function using multifrequency tympanometry. Subjects were divided into four age groups; 40s, 50s, 60s and 70s. There were statistically significant differences in pure tone thresholds between almost any two age groups at each frequency in both genders, especially at higher frequencies. The pure tone thresholds were also discussed in regard to gender difference and laterality. A contradiction between self-perceived hearing difficulty and auditory accuracy was observed in the elderly generation. Analysis of tympanometric measurements was performed on static admittance at 226 Hz, tympanometric peak pressure at 226 Hz and resonance frequency of the middle ear. These variables did not show any systematic aging change. However, it was considered they represented the reference values of each generation.

Distortion product otoacoustic emission and auditory brain stem response measures of pediatric sensorineural hearing loss with islands of normal sensitivity.

To assess the accuracy of: 1) distortion product otoacoustic emission (DPOAE) measures for the identification of frequencies at which auditory sensitivity is normal or near normal; and 2) click and nonmasked tone burst-evoked auditory brain stem response (ABR) thresholds for behavioral threshold estimation for children with sensorineural hearing loss characterized by islands of normal sensitivity. DPOAEs and ABRs were recorded from five hearing-impaired and eight normal-hearing pediatric ears. The accuracy with which DPOAEs permitted identification of frequencies at which elevated hearing thresholds were present was examined. ABR and pure-tone threshold differences for the impaired ears were calculated. For three of the five hearing-impaired ears, significant impairments would have been missed based on click-evoked ABR thresholds. One of those hearing-impaired ears provided an essentially normal 500 Hz tone burst-evoked ABR threshold as well. Four of the hearing-impaired ears provided a 500 Hz tone burst-evoked ABR threshold within 10 dB of the respective pure-tone threshold. However, click-evoked ABR and 500 Hz tone burst-evoked ABR threshold data did not adequately delineate the hearing loss configuration for hearing aid frequency response selection. DPOAEs were present at three out of four frequencies from 1000 to 4000 Hz at which sensitivity was normal or near normal (< or =25 dB HL) and absent at 10 out of 11 frequencies at which sensitivity was impaired. The use of DPOAEs to identify frequencies at which sensitivity was normal and the use of tone burst ABR thresholds at frequencies where DPOAEs were absent provided a better estimate of these pure-tone audiograms than was provided by click-evoked and 500 Hz tone burst-evoked ABR thresholds.

Audiologic Findings in Hyperacusic and Nonhyperacusic Subjects

This study compared pure-tone threshold data, acoustic reflex threshold data, and loudness growth data for a group of 25 hyperacusic male subjects vs. a group of 13 nonhyperacusic male subjects. Pure-tone thresholds and acoustic reflex thresholds were obtained in 5-dB steps, using revised Hughson-Westlake procedures. Loudness growth functions were obtained with a fractionation (method of adjustment) procedure whereby the subjects doubled loudness, using a 1-dB step attenuator. Results suggest that loudness growth was significantly different for the hyperacusic subjects compared to the nonhyperacusic subjects, but no significant differences in pure-tone thresholds or acoustic reflex thresholds were observed. When the hyperacusic group was divided into subgroups, however, the endocrine disorder subgroup had significantly lower acoustic reflex thresholds compared to the other subgroups of hyperacusic subjects. No other significant differences among the subgroups were noted.

Ototoxicity Due to Cis-diamminedichloro-platinum in the Treatment of Ovarian Cancer

Ototoxicity associated with administration of cisplatin was assessed in four groups of patients suffering from advanced ovarian carcinoma. The purpose was to determine the influence of dosage, schedule of administration, and long-term treatment on pure-tone thresholds and other auditory parameters. One hundred and forty-five serial audiograms were obtained in 60 patients and compared with baseline audiograms. The treatment protocol consisted of two different dosages (low--50 mg/m2 and high--100 mg/m2) and three different schedules of administration (short--6 months, extended--12 months, and treatment in blocks--intervening months in which cisplatin was withheld). Using a conservative definition of auditory toxicity and statistical analyses of pure-tone threshold differences between groups, the results indicated that the low dose-short treatment regimens with either monthly administration of cisplatin, or administration in blocks, were the least ototoxic. Ototoxicity was found to increase with increasing cumulative dosages. Hearing loss was primarily in the high frequencies. The most severe ototoxic effects, which include tinnitus and hearing loss in the speech frequency range, were associated with the administration of high dosages over a short period of time. Individual variability in susceptibility to ototoxicity necessitates systematic audiometric monitoring throughout therapy.

Changes in pure-tone thresholds in individuals aged 70-81: results from a longitudinal study.

The results of audiometric evaluation of 376 randomly selected men and women, 70 years old and born in 1901, are reported. The investigation is part of a large study on a gerontological population in which the original participants were tested again with pure-tone and speech audiometry at ages 75, 79 and 81. We also report audiometric results obtained at ages 70 and 75 from a second group, consisting of 297 men and women born in 1906. Hearing loss was most pronounced at higher frequencies for both sexes, and men had an average of 10 dB greater hearing loss at 8 kHz than women. The decrease in hearing threshold in men between the ages of 70 and 81 was more pronounced at 2 kHz (27 dB) than at 4 and 8 kHz (15 and 20 dB, respectively). The average hearing loss in women increased at a constant rate between the ages of 70 and 79 (15 dB), while between the ages of 79 and 81 the changes in pure-tone threshold was minimal. There were no significant differences in pure-tone thresholds for women born in 1901 when compared to those born in 1906 at the ages of 70 and 75. However, men born in 1906 had a more pronounced hearing loss at the age of 75 than those born in 1901.

Age and Sex Differences in Pure-Tone Thresholds

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Age and sex differences in pure-tone thresholds. Survey of hearing levels from 18 to 65 years.

Age and sex differences in pure-tone thresholds. Survey of hearing levels from 18 to 65 years.

Age and Sex Differences in Pure-Tone Thresholds

In recent years there has been an increased emphasis on medicolegal problems involving the assessment of hearing loss due to noise exposure. One of the attendant difficulties, however, has been the problem of separating the factors of noise exposure and of age as contributors to hearing disabilities. The present study was performed to determine the normal thresholds of hearing for pure tones for an age-stratified sample of subjects drawn from a population exposed to minimal levels of industrial noise. Audiometric measurements from 250 to 8000 cps were made on a total of 500 subjects divided into four age groups: 18 to 24, 26 to 32, 34 to 40, and 43 to 49 years, inclusive. The results of this study indicate that, in general, only minor differences (less than 5 db) exist between the average thresholds of right and left ears, but that women have more sensitive hearing than men and show less intersubject variability. This sex difference is independent of age and is more marked at the higher frequencies. For both men and women, there is a decrease in hearing sensitivity with increasing age and a progressive spreading of the loss from the higher to the lower frequencies. Men are more affected than women, with the hearing loss occurring at an earlier age and producing a greater degree of auditory impairment. The threshold curves of the present study are considered to yield a more valid estimate of the “pure” effects of age on hearing than previously available. It is recommended that future audiometric standards be specified independently for men and for women according to particular age levels.