Hearing Pathology Research Articles

Pedagogic experience of using controlled info media in physical training of children with hearing impairment

The article provides pedagogic foundations of physical training with hearing pathology by means of audiovisual exposure

Audiology Makes Rapid Advances in Poland

Audiology Makes Rapid Advances in Poland

Aspectos fonoaudiológicos na síndrome de Crouzon: estudo de caso

TEMA: descrever os aspectos fonoaudiológicos de um caso de Síndrome de Crouzon, com idade de 6:4 anos, submetendo-o às avaliações das áreas de fala, linguagem, cognição, sistema estomatognático e audição. PROCEDIMENTOS: o sujeito foi submetido às seguintes avaliações: ABFW, Prova de Vocabulário Receptivo, Avaliação do Desenvolvimento de Linguagem-Cognição, Avaliação de Estruturas e Funções do Sistema Estomatognático, Audiometria Tonal Limiar, Imitanciometria e Logoaudiometria. RESULTADOS: a Audiometria Tonal identificou perda auditiva condutiva de grau moderado bilateralmente, apresentando compatibilidade com a Logoaudiometria e a Imitanciometria. A Avaliação de Sistema Estomatognático indicou tônus de estruturas diminuído, com postura e mobilidade alteradas. As funções de sucção, mastigação, deglutição e respiração mostraram-se alteradas. Na avaliação da Fonologia, identificaram-se simplificação do encontro consonantal, plosivação de fricativa e outros. Em Fluência, os dados estavam abaixo do esperado para a mesma faixa etária e sexo. Na prova de Pragmática o número de atos por minuto foi 14,4, apresentando como meio comunicativo predominante o gestual. Na prova de Vocabulário Receptivo, o valor total de designações usuais estava 7,1% abaixo do valor de referência. No Vocabulário Expressivo, os dados apontaram para referência entre 4 e 5 anos, abaixo dos parâmetros esperados para a idade do sujeito do estudo. Em Linguagem e Cognição, as análises indicaram defasagem em relação à fase de desenvolvimento. CONCLUSÃO: os comprometimentos causados pela síndrome são difusos e interligados, tendo a importância desse estudo apresentar os aspectos fonoaudiológicos de um caso de Síndrome de Crouzon e fornecer dados para aprofundar a investigação fonoaudiológica e o processo terapêutico.

Wyniki badań przesiewowych słuchu u wybranej populacji dzieci szkół podstawowych na Śląsku

The aim of this study was analysis of results of audiologic evaluation in the group of 191 children with hearing loss. Children were selected from the group of 8885 pupils of primary schools in Silesia by screening test "Słysze" in 2002. Universal Screening Program of Hearing in Children and Teenage "Słysze" was created and introduced in to the clinic practice by Institute of Physiology and Pathology of Hearing in Warsaw in 1999. The screening program consists of: pure tone examination and speech audiometry in noise. Children with hearing loss detected by this test in 2002 were followed laryngological and audiological examination. Special attention was paid on articulation disturbances, communicational and educational problems in children with hearing loss. The authors focused also attention on "discreet signs of hearing deficiency" (not reacting to commands, turning up a TV-set, loud speech). The validation of screening test "Słysze" was also conducted. In the selected population of primary schoolchildren in Silesia hypoacusis occurred in 6% of examined children, in "city" schools the percentage proved to be higher than in "village" schools. In the group aged 6 to 10 the conductive hearing loss occurred considerable more frequently. Eustachian tube dysfunctions in children with conductive hearing loss occurred more frequently in the group of the younger ones. Older than 10 years old in most cases proved to have perceptive-type of hearing loss. The hearing loss hinders a child's psycho-intellectual development, it is important to detect it as early as possible. The evaluations showed that despite frequent occurrence of "discreet symptoms of hypoacusis", only 17.8% of parents suspected hearing loss in their own child. According to the frequency of parents' signals of "discreet symptoms of hypoacusis" it was found that the fact of turning up TV sound was the most powerful sign indicating the probability of hearing loss (45.5%). The most common risk factors of hearing loss in schoolchildren were also estimated. A characteristic, homogenous group of 34 children (17.8%) was the group with MSHL minimal sensorineral hearing loss of high frequencies (6-8 kHz). Results obtained give evidence of low level of awareness in the society concerning the problem of hypoacusis, which confirms the necessity to screening of hearing in schoolchildren and improving of health care in this respect. Diagnosing hypoacusis in case of children is an interdisciplinary problem, requiring cooperation of medical circles but also teachers, speech therapists and parents.

Inclusion of special needs students in health area courses at a private university in Campinas region

ObjectiveTo assess the current state of inclusive education in private universities from the point of view of health college teachers of a private university under study. MethodSurvey (2004), a questionnaire with closed questions, was applied to a random cluster selected among faculty members of health courses at a private university. The data collected will be submitted to Chi Square Test and Fisher Exact Test applied to contingency tables. ResultsSome attempts have been made to insure inclusion at the private university under investigation regarding special teaching methods. Availability of access by means of elevator and ramp were noted. There seemed to be a consensus among teachers as to the need for inclusion and the responsibility of all citizens, including public and private organizations. The course that showed the greatest preparation to receive special students was physiotherapy. Faculty members of both physiotherapy and speech and hearing pathology courses indicated that a psychological support service should be made available by this private university for students with special needs. The participants referred no knowledge about the fact that the courses in their institute might represent some type of barrier to this sort of student, even among courses including content about pathologies which cause disabilities. ConclusionsDespite the available resources and the accessibility requirements established by law, the teaching methodology is not yet an effective conquest for inclusive education among teachers in this private university. However, this conclusion can only be generalized for cities of comparable size and universities of similar characteristics.

Pitch perception and the number of electrodes vs. long-term development of speech perception ability in auditory brainstem implants

Auditory brainstem implants (ABIs) are modern method of treatment of total bilateral deafness in cases of extracochlear origin. The Programme of Auditory Brainstem Implants started in Poland in the Institute of Physiology and Pathology of Hearing in January 1998. The material consisted of three ABI patients implanted until now. Study on pitch perception was conducted on all usable electrodes applying pitch ranking and pitch scaling procedures. Clear tonotopy and wide range of pitch perception were demonstrated in two patients. The poor general health condition of the third patient did not allow participation in pitch perception tests.

Donnell F. Johns, Ph.D., 1934 to 2002

Donnell F. Johns, Ph.D., 1934 to 2002

Program of early identification of hearing loss in newborns in Poland

For 12 years, the team of the Institute of Physiology and Pathology of Hearing has been conducting a program of early identification of hearing impairments in newborns and infants, as well as investigations concerning epidemiology and etiology of hearing loss. The authors present the program conducted in Poland based on many years of experience of the Institute including the most significant results achieved in collaboration with over 100 centers.The program effected in identification of a significant group of children with hearing loss, selecting and defining the high-risk group, significantly lowering the average age of identification of hearing impairment, and making the grounds for implementation of the universal hearing screening realized by the Foundation of the Grand Orchestra of Holiday Aid.In the past decade, hearing screening of newborns has achieved a solid position among the recognized clinical procedures worldwide. However, only a few countries are close to practical implementation of that idea. In Poland, we are starting the countrywide program based on 12 years of experience of the Institute of Physiology and Pathology of Hearing in Warsaw with social funds gathered by the Foundation of the Grand Orchestra of Holiday Aid.The aim of this report is to present the program of hearing screening of newborns and infants conducted in Poland for the last 12 years.

Analysis of epidemiological and otological aspects of surgical treatment performed in the Institute of Physiology and Pathology of Hearing in the year 2001

The Institute of Physiology and Pathology of Hearing in Warsaw is a reference center for diagnosis, treatment and rehabilitation of hearing and speech disorders in Poland. There is a large amount of clinical material: in the year 2001, almost 4000 hospitalizations, over 38,000 patients in ambulatory follow-up, 48,000 school age children screened in Program “I can hear” allow for epidemiological and statistical analysis. This is also a very strong background for the creation of therapeutic strategies and algorithms. In our opinion, reference centers must supervise early detection programs and provide complex therapy for all patients with advanced pathologies. An adequate level of medical service can be secured, thanks to close cooperation of multidisciplinary teams and regular training in most modern diagnostic and therapeutic methods and tools.

“I can hear”: a system for universal hearing screening in school age children. Organization and first results

Hearing screening programs in school age children are necessary for early detection and treatment of hearing impairments in this population. The Institute of Physiology and Pathology of Hearing have developed and implemented hearing screening program at schools in Poland based on multimedia hearing screening system “I can hear”. The system consists of a computer program installed on PC, an acoustic calibrator and earphones. The testing procedure involves automated questionnaire analysis, pure tone audiometric test and the evaluation of speech intelligibility in noise. The tests are conducted in schools under a supervision of specially trained screeners. In the years 1999–2001, 125,248 children were screened in Poland. A total of 71,940 results from selected regions were statistically analyzed. Eighteen percent of them did not pass the screening test. Only 29% of the children referred for diagnostic evaluation appeared at audiological centers. In one third of them, hearing impairment was confirmed.

Three-year experience in the rehabilitation of brainstem implant patients

Three patients have been provided with auditory brainstem implants at the Institute of Physiology and Pathology of Hearing in the years 1998–2001. Combi 40+ implant systems were applied. This modern auditory prosthesis can be used in the case of bilateral total hearing losses resulting from neurofibromatosis type II. After activation of the implant system, the patients took part in a 2-year rehabilitation program, which is obligatory for adult patients and provided within the Warsaw Brainstem Implant Program [Med. Sci. Monit. 4 (1998) 40].

Teaching hearing science to undergraduate nonscientists

For those students interested in potential clinical careers in Speech Pathology, or Audiology, a knowledge of some of the scientific bases is important, but should not create a distaste for science. The authors have addressed themselves to these goals: (1) calculation of period, Hz, summation of two sine waves, phase and dB; (2) anticipating undergraduate Speech Science; (3) simple examples of hearing pathology; and (4) basic psycho-acoustical issues. The classic material of Harry Helson was used to elucidate issues of context in experimental science, and that of S.S. Stevens was used to exemplify psycho-acoustical formulas of common use. Four texts that have been tried on approximately 200 students were evaluated. Surprisingly, the best provided the fewest formulas, short study questions with answers, good examples, and a list of common terms. The next best was aimed at slightly more advanced students, but each chapter contained introductory material, examples, and definitions suitable for naïve undergraduates. The least satisfactory text provided excerpts of technical material with abrupt transitions, no examples, and only part of the definitions needed for the naïve student. Perhaps the most difficult teaching issue is to avoid demanding graduate-level science from those undergraduates with clinical aspirations.

NEW PRODUCT DEVELOPMENTS

Hearing screening programs in school age children are necessary for early detection and treatment of hearing impairments in this population. The Institute of Physiology and Pathology of Hearing have developed and implemented hearing screening program at schools in Poland based on multimedia hearing screening system “I can hear”. The system consists of a computer program installed on PC, an acoustic calibrator and earphones. The testing procedure involves automated questionnaire analysis, pure tone audiometric test and the evaluation of speech intelligibility in noise. The tests are conducted in schools under a supervision of specially trained screeners. In the years 1999–2001, 125,248 children were screened in Poland. A total of 71,940 results from selected regions were statistically analyzed. Eighteen percent of them did not pass the screening test. Only 29% of the children referred for diagnostic evaluation appeared at audiological centers. In one third of them, hearing impairment was confirmed.

Preservation of Residual Hearing in Children and Post-Lingually Deafened Adults after Cochlear Implantation: An Initial Study

Objective: To investigate whether the residual hearing of severely hearing-impaired children and adults could be preserved using the soft surgery approach. Patients and Methods: This project employed a prospective study design. All testing and surgery took place in the Institute of Physiology and Pathology of Hearing, Warsaw, Poland. Twenty-six patients (7 children and 19 post-lingually deafened adults) with residual hearing were assessed. Subjects were assessed using conventional pure-tone audiometry at least 1 month prior to surgery. Cochlear implant surgery with a Med-El Combi 40/40+ standard electrode array was conducted, using the soft surgery approach. Pure-tone audiometry thresholds were re-assessed at least 1 month after surgery. The researchers assessed change in auditory thresholds using pure-tone audiometry to determine preservation of residual hearing. Results: Sixteen of 26 patients (62%) retained their residual hearing within 5 dB HL of pre-operative scores. Only 5 of 26 patients (19%) lost all measurable residual hearing after cochlear implantation. This suggests that surgeons are often able to preserve residual hearing during cochlear implant surgery using the soft surgery technique. Conclusions: Preservation of residual hearing is an important consideration in cochlear implantation in the light of changing selection criteria for cochlear implant candidates, and as younger children are receiving implants. This is important, as we do not know yet the long-term effects of inner ear damage due to traumatic insertions of electrodes. This finding suggests a good prognosis for future possibilities of re-implantation.

Results of total deafness treatment in young pre- and postlingually deafened children.

Developing a cochlear implant program is one of the most difficult problems we need to solve concerning young children. Application of cochlear implants to this group of patients gives hope for better speech and language development than using conventional hearing aids. Children comprise approximately 40% of all implanted patients at the Institute of Physiology and Pathology of Hearing in Warsaw. They are provided with different types of cochlear implants, 16 of which are included in the international comparative study EARS (Evaluation of Auditory Responses to Speech). In this paper results are presented of auditory speech perception in pre-, peri-and postlingual children using the multichannel cochlear implant systems COMBI 40 and 40+. All the children were regularly evaluated following the EARS procedure with a number of perception tests. Monitoring of auditory perception development is fundamental and allows prognosis of speech and language development in children.

Mild Hearing Impairment Can Reduce Verbal Memory Performance in a Healthy Adult Population

We studied to what extent immediate and delayed recall in an auditory verbal learning paradigm was affected by basic information processing speed (digit copying) and hearing acuity (average hearing acuity at 1, 2 and 4 KHz at the better ear). A group of 453 individuals in the age between 23 and 82 years with no overt hearing pathology was recruited from a larger study of cognitive aging (Maastricht Aging Study, MAAS). After controlling for age, sex, educational level, and processing speed it was found that a mild to moderate hearing loss predicted lower verbal memory performance. Auditory administered verbal memory tests can underestimate true memory performance, particularly in older individuals with unknown hearing status.

Meningeal Carcinomatosis of the Cerebellopontine Angle and Internal Auditory Canal

Most CPA and IAC region neoplasms are benign. Malignant tumour represent about 2% of the lesions and metastatic lesions account for 0.2 to 2% of all neoplasms of this region. In a group of 82 patients with meningeal carcinomatosis, 11 patients (16%) with PCA and IAC metastatic lesions were identified. In three cases the original tumour was a breast carcinoma, while in the other eight cases it was a sarcoma, PNET, glioma, leukaemia, lymphoma, medulloblastoma and one tumour of unknown origin. In five cases both PCA and IAC presented abnormal contrast enhancement of nodular type; in four patients only IAC and in two only PCA were involved. IACs were involved bilaterally or monolaterally in four cases each, while PCAs presented bilateral involvement in five cases and monolateral in one. In two cases bilateral Vth cranial nerves and cavernous sinuses were present and all the patients had dural or leptomeningeal carcinomatosis outside the PCAs and IACs. Unlike literature reports in which only 25% of IACs carcinomatosis have a negative clinical picture, we found clinically tested hearing pathology, in only 1/11 patients, and involvement of other cranial nerves in only 2/11 patients. From the MR point of view, CPA and IAC carcinomatosis is characterized by bilateral or, less frequently monolateral nodular or linear contrast enhancement inside the IAC and along the dural lining of the CPA and it usually not visible in non contrast SE T1 and T2 sequences. Carcinomatosis is always associated with more diffuse dural or leptomeningeal secondary neoplastic involvement, but the association with other cranial nerve carcinomatosis is not the rule. The more frequent involvement of these regions may depend on the length of the VIIth and VIIIth cranial nerves (and this observation may also explain the more frequent association with Vth cranial nerve carcinomatosis) and on the volume of the CPA cistern, that allows a more diffuse and longer contact between the nerves and the meninges and the metastatic lesions floating in the cerebrospinal fluid.

Prediction of post-operative profits in cochlear implanted people using electrical stimulation test results

There are few techniques adequate for assessing the remaining sensitivity of a hearing nerve in deaf people or those with a severe hearing loss. The procedures developed at the Institute of Physiology and Pathology of Hearing in Warsaw allow the determination of some vital characteristics of the hearing sense that help to make decisions regarding the cochlear implantation. The post-operative profits evaluation is also very important in the case of cochlea implanted persons. Apart from standard preexamination procedures, a test based on the electrical stimulation via the external auditory canal filled with saline can be performed. In order to evaluate the test results, both the dynamics range defined by the auditory threshold and the uncomfortable loudness level and the time difference limen test are considered. However, usually the results of electrical stimulation tests are highly diversified, depending on a patient’s age and condition, thus there was a need to create a database allowing one to find and to study the correlation between obtained test results and patients’ ability to receive and understand sounds. In this way, the interpretation of the electrical stimulation test results for the new diagnosed cases was made more reliable. [Work supported by KBN, Poland, Grant No. 4 P05C 082 12.]

Clinico-rheoencephalographic correlations in deaf children

The reasons of hearing disorder in children are studied. The neurologic and rheoencephalographic examination of 37 girls from the Medical and Pedagogical Center for children with hearing pathology aged 1011 is performed. The signs of unheavy lesion of the cervical part of vertebral column and brain are revealed in 18 children. The signs of circulatory insufficiency in vertebrobasilar basin are revealed on rheoencephalograms in these children. It is proposed that the reason of deafness in many children is the natal trauma of the cervical part of vertebral column and vertebral arteries.

Otoacoustic emissions in ears with hearing loss

Fifty ears of 37 patients demonstrating several common types of hearing impairment were examined for the presence of spontaneous and evoked otoacoustic emissions to investigate the relationship of acoustic emissions to hearing pathology. Of the 50 ears, 44 exhibited various degrees of sensorineural hearing loss. Evoked otoacoustic emissions to clicks were detected in 34 of 35 sensorineural hearing loss ears with a subjective click threshold less than 55 dB SPL (25 dB nHL). None of nine ears with sensorineural hearing impairment and a subjective click threshold greater than 55 dB SPL demonstrated click-evoked emissions. Spectral analyses revealed that the constituent frequency components of evoked emissions were always within the frequency range where audiometric thresholds were less than 35 dB HL, and in the majority (94%) of cases, thresholds were less than 25 dB HL. In ears with relatively well-preserved hearing within the frequency range of click or 1.5-kHz toneburst stimuli, the basic features of evoked emissions were similar to those described for normal ears. Similarly, for ears demonstrating spontaneous otoacoustic emissions, estimated audiometric thresholds at the emitted frequencies were always less than 20 dB HL. The influence of the type of otologic pathology on acoustic emissions was studied in a subset of ears exhibiting typical high-frequency hearing losses. Ears with a noise-induced impairment showed a significant reduction in the incidence of both spontaneous emissions and spectral peaks in evoked emissions that was not evident in ears with similar patterns of hearing loss caused by other factors.