High Frequency Sensorineural Hearing Loss Research Articles

Audio-vestibular findings in meningioma of the cerebello-pontine angle: a retrospective review.

The aim of this study was the determination of the incidence of symptoms of audio-vestibular dysfunction and of abnormalities on audio-vestibular testing in patients found to have a unilateral meningioma of the cerebello-pontine angle (CPA). The case notes of 25 patients diagnosed with unilateral, sporadic and histologically proven CPA meningioma were retrospectively reviewed. The age range of this series was 31-71 years, with a mean age of 50 years. Two patients were male (eight per cent) and 23 were female (92 per cent). The mean length of history was 44.7 months. The distribution of tumour size was skewed toward larger tumours, with 15 cases (60 per cent) having tumours with a maximum diameter greater than 3.5 cm on imaging. Pure tone audiometry was normal in five cases (20 per cent), and no patients exhibited the high frequency sensorineural hearing loss that is characteristic of vestibular schwannoma. Speech audiometry was normal in 50 per cent of cases. Caloric testing was abnormal in 77 per cent of the 18 cases tested, whilst auditory brainstem responses (ABR) were abnormal in 100 per cent of the 18 cases who had sufficient hearing for this test to be possible. The presence of normal audiometry in patients with a proven CPA lesion indicates that, if in a protocol for investigation, asymmetry of hearing is mandatory then some pathology will be missed. Any suspicion of a CPA lesion warrants investigation even in the absence of hearing loss. The investigation of choice for the identification of CPA lesions has become magnetic resonance imaging (MRI). If this technique is not available then this study indicates that ABR is a suitable and sensitive investigation. It should be borne in mind however that the data in this study has been derived from a series of predominantly large tumours, and the sensitivity of ABR to smaller CPA meningiomata may fall, as is the case for vestibular schwannoma.

Assessment of traffic Noise and its impact on certain personnel

The Noise measurements done during peak traffic hours in Chennai city in 1985, is compared with the levels prevailing in 1993 and the density of vehicles plying enumerated. The intensity of noise produced was found to be proportionate to the density of the vehicles. Noise levels at all points studied have shown a significant increase in the last eight years, varying from 2 dB to 10 dB. In most of the places the levels were found to be above 80 dB.A sample study of 100 individuals, selected from a survey comprising of 1100 traffic policemen, showed a high incidence (21 %) of noise induced hearing loss. Incidence of high frequency sensorineural hearing loss (18%) was also found to be high in these personnel.Possible causes for these findings are discussed and some remedial measures suggested.

Fenestration and occlusion of posterior semicircular canal for patients with intractable benign paroxysmal positional vertigo.

A series of 15 patients with intractable benign paroxysmal positional vertigo (BPPV) who had fenestration and occlusion of the posterior semicircular canal (FOP) surgery commencing in December 1990 are reported. Follow-up was from 14 to 40 months. All patients reported a cure of their positional vertigo. No patient regretted having the surgery. All patients had a negative Dix-Hallpike test post-operatively and the test remained negative for the duration of follow-up. Eight patients had a mild high frequency sensorineural hearing (SNHL) loss post-operatively which had almost recovered six months later. No patient reported any change in their hearing following surgery. Of the 10 patients who did not have pre-operative tinnitus, six developed tinnitus but it was not considered significant by them. All patients developed mild unsteadiness following surgery which gradually improved with mobilization and physiotherapy if necessary. The operation preserves hearing, is technically straightforward, well-tolerated and effective.

Auditory abnormalities, including 'precocious presbyacusis', in myotonic dystrophy.

Auditory function tests were performed on 13 patients with myotonic dystrophy (MD). Seven patients had a sensorineural high-frequency hearing loss (HFL) of 30-85 dB at 8 kHz in their pure-tone audiogram, which was in excess of that expected for their age and could be attributed to MD. Their hearing loss resembled 'precocious presbyacusis', i.e. if the patients had been considerably older (or 'functionally' older) than they really were, their HFL could (to some extent) have been attributed to presbyacusis alone. The HFL showed the phenomenon of (genetic) anticipation. Tympanograms and acoustic reflexes were normal. Brainstem auditory evoked potentials (BAEPs) showed a significant increase in the I-V interpeak interval (by 0.35-0.7 ms) and in the III-V interpeak interval (by 0.21-0.67 ms). There was no correlation between the BAEP and the audiometric findings. It should be noted that precocious presbyacusis may be linked to specific gene defects.

Audiological evaluation of very low birthweight infants.

A population of consecutively surviving very low birthweight (VLBW) infants comprising 41 infants (24 female) birthweight less than 1000 g and 108 infants (63 female) birthweight 1000-1500 g received detailed audiological evaluation. The audiological test battery comprised auditory brainstem evoked response (ABR) prior to hospital discharge, behavioural audiometry and tympanometry at 8-12 months and monitoring as necessary. The ABR results were interpreted with reference to a normative group of 36 full-term infants (birthweight 2.4-4.5 kg). Of the 142 VLBW infants completing audiological evaluation, one (0.7%) had evidence of moderate-severe high frequency sensorineural hearing loss, 83 (58.5%) evidence of conductive dysfunction (18 severe, 42 moderate and 23 mild) and only 58 (40.8%) normal hearing. The 19 infants with severe auditory impairment were more likely to have suffered moderate-severe apnoea, greater than or equal to two courses of mechanical ventilation, prolonged oxygen therapy and recurrent upper respiratory tract infections in the first year of life than infants without severe impairment (P less than 0.05). Because of the incidence of conductive pathology, difficulties occurred when attempting to compare ABR status at 36-42 weeks postmenstrual age with peripheral hearing status at 8-12 months as assessed by visual reinforcement orientation audiometry (VROA) and impedance audiometry. The most useful ABR test parameters as screening measures of peripheral auditory status were Wave I-III-V morphology, wave V threshold levels and wave V absolute latency values when used in combination as a test battery.(ABSTRACT TRUNCATED AT 250 WORDS)

Dependence of auditory brainstem response on click polarity and high-frequency sensorineural hearing loss.

An investigation is presented on the effect of click polarity upon the auditory brainstem response (ABR) in cases of simulated high-frequency hearing loss. A high-frequency hearing loss was stimulated in 12 normal subjects by applying a high-pass noise masker, the noise cutoff frequency being varied in half-octave steps through the range of audiometric frequencies. With this paradigm, the effects of click polarity on the ABR are similar to those reported in patients with high-frequency hearing loss, including changes in waveform morphology and substantial peak latency shifts. To evaluate the role of individual cochlear frequency channels in a more direct way, half-octave narrow-band responses were determined by pair-wise subtraction of the high-pass-noise-masked responses. As far as ABR peak latencies are concerned, stimulus polarity effects tend to increase towards the lower frequency bands. Thus, the selective elimination of the contribution to the ABR of cochlear high-frequency channels can be held responsible for the increased dependence of ABR on click polarity observed in high-frequency hearing loss. However, statistical evaluation of peak I, III and V latencies, both in high-pass-noise-masked and in narrow-band ABRs, reveals that the latency effects are not systematic between subjects. Mechanisms producing the observed rarefaction-condensation differences, possible explanations for the large intersubject variability and the consequences for clinical interpretation of ABR are discussed.

Effect of high-frequency hearing loss on compound action potentials recorded from the intracranial portion of the human eighth nerve

Compound action potentials (CAP) were recorded from the exposed intracranial portion of the eighth nerve to stimulation with click sounds in patients with sensorineural high-frequency hearing loss who underwent microvascular decompression (MVD) operations to treat trigeminal neuralgia (TN). In patients with normal hearing the CAP recorded in that way is characterized by a negative peak, preceded by a small positivity and followed by a positivity and sometimes a second negative peak. In patients with high-frequency hearing loss the CAP also usually had an initial sharp negative peak in response to clicks of high intensity (105 to 110 dB Pe SPL), similar to findings in patients with normal hearing, but in patients with high-frequency hearing loss the initial negative peak was often followed by a slow negative deflection. The latency of the initial negative peak in the CAP in patients with high-frequency hearing loss was longer than the latency of this peak in patients with normal hearing, but the difference in latencies of this peak to condensation and rarefaction clicks was small. When the stimulus intensity was lowered the amplitude of the initial peak decreased, and the CAP became dominated by a broad negative peak with a latency of 6 to 8 ms. In 11 of 15 patients with severe high-frequency hearing loss, a series of quasiperiodic waves was superimposed on the CAP. The frequency of these waves varied between 500 and 1200 Hz, and the waves could be detected between 6 and 16 ms after presentation of the click stimulus. These waves were usually present in the response to stimuli in the intensity range from 75 to 110 dB Pe SPL. Only 4 of 17 patients with normal hearing had similar waves.

Cochleotoxicity due to Mianserin hydrochloride

AbstractA patient who developed bilateral tinnitus and symmetrical high frequency sensorineural hearing loss due to therapy with the anti-depressant Mianserin hydrochloride is presented together with a short review of available literature.

Distortion-Product Otoacoustic Emissions in Humans with High Frequency Sensorineural Hearing Loss

Distortion-product otoacoustic emissions (DPOAEs) and pure-tone behavioral thresholds were compared in 20 ears with normal hearing and in 20 ears with high-frequency sensorineural hearing loss. The purpose was to determine if DPOAE amplitude is associated with pure-tone behavioral threshold. Comparison of results from the two groups of ears indicated that DPOAEs were reduced in amplitude or were absent in ears with high-frequency hearing loss. The differences occurred at frequencies above 1,500 Hz. Comparing results from 750 to 8,000 Hz within the same ear revealed a frequency-related correspondence of elevated behavioral threshold to reduced DPOAE amplitude. When behavioral thresholds were better than 20 dB HL, DPOAE amplitude was within the range (+/- 2 SDs) determined for the ears with normal hearing. When pure-tone threshold was greater than 50 dB HL, DPOAEs were absent or were significantly attenuated in 16/17 subjects (94%). The association of emission level with behavioral threshold level was variable when threshold was between these two extremes. Results imply that the measurement of DPOAEs has clinical potential as a means of detecting hearing loss by frequency.

Distinctive Feature Scoring of the California Consonant Test

The purpose of this study was to evaluate a distinctive feature (DF) scoring technique for List 1 of the California Consonant Test (CCT) for the purpose of improving test reliability. The CCT was presented to 50 subjects with high-frequency sensorineural hearing loss (HFSNHL). The DF scoring technique resulted in a split-half correlation of .86 compared to .78 for standard percentage-correct scoring. A partial correlation of .50 was found for DF scoring with the effect of standard scoring held constant, indicating that DF scoring accounted for 25% of the variance in scores unaccounted for by standard scoring. DF scoring also led to smaller percentage differences between the two halves of the CCT (p less than .0005). An analysis of individual feature error patterns suggests that DF scoring may provide a more effective means of differentiating among listeners with HFSNHL than traditional scoring.

Sensorineural high-frequency hearing loss after drill-generated acoustic trauma in tympanoplasty.

Tympanoplasty can cause a sensorineural hearing loss by a mechanism of acoustic trauma. Although this lesion appears to be relatively infrequent in clinical practice, we believe that its low apparent incidence is caused when clinicians fail to assess the auditory frequencies above 8000 Hz. Twenty-four patients with normal bone-conduction audiometric thresholds scheduled for tympanoplasty were assessed with an electro-stimulation, bone-conduction high-frequency audiometer which can measure hearing frequencies up to 20 kHz before and after surgery. A measurable hearing loss was found in the upper limits of the audible frequencies in 9 patients (37.5%), and was considered important in 4 of them (16.7%). This hearing loss was recorded above the upper frequency limit of conventional audiometers. The findings in this study indicate that drilling of the temporal bone can impair the hearing level in the high frequencies in a significant number of patients. High-frequency audiometry is a very sensitive tool to assess any damage caused to the inner ear by surgical procedures carried out in the middle ear and temporal bone.

Audiological findings of shunt-treated hydrocephalus in children

47 hydrocephalic children (mean age 10.4 years) were examined on average 7.9 years after initial shunting. The etiology of hydrocephalus was classified into 5 groups as follows: perinatal intraventricular hemorrhage 19, congenital obstructive hydrocephalus 15, intracranial cysts 5, severe intracranial anomalies 4 and central nervous system infections 4 children. Audiological examination included pure-tone audiometry, tympanometry, registration of stapedius reflex thresholds and adaptation. A sensorineural high-frequency hearing loss was found in 18 (38%) of 47 examined shunt-treated hydrocephalic children, and 11 of the losses could be classified as the retrocochlear type. The differences of the mean hearing thresholds between the etiological groups of childhood hydrocephalus were minimal.

The applicability of the modified bivariate plotting procedure to subjects with functional hearing loss.

The applicability of the modified bivariate plotting procedure proposed by Silman, Silverman, Showers, and Gelfand, 1984, was evaluated on a group of functional hearing-loss subjects under age 44 years. The false-positive rate was 17% and the false-negative rate was 0% for both significant and mild or high frequency sensorineural hearing loss.

Frequency masking patterns and “excess masking” in normal‐hearing and hearing‐impaired listeners

The presence of “excessive upward spread of masking” in high‐frequency sensorineural hearing‐loss (HFSNHL) subjects has been previously demonstrated by other investigators. This excess masking, defined by predictions from a “noise” model of hearing loss, occurs in the transition region between normal and impaired hearing. To examine this phenomenon further, frequency masking patterns (FMPs) were obtained from two normal‐hearing subjects and one HFSNHL subject. Using a 200‐Hz narrow‐band noise (NBN) masker (90 dB SPL) with an upper edge at 520 Hz, FMPs from the impaired ear demonstrated excess masking, which it was hypothesized might be explained by an inability to “listen in the valleys” of the masker envelope because of poor temporal resolution. To test this notion, the experiment was repeated using a 40‐Hz NBN masker (90 dB SPL), which has less rapid envelope fluctuations. No differences in the upward spread of masking were seen between the 200‐ and 40‐Hz bandwidth‐equal SPL maskers. When the experiment was repeated with equal spectrum level maskers, the 40‐Hz NBN masker produced less upward spread of masking in both normal‐hearing and hearing‐impaired ears. These data suggest that, for the HFSNHL subject, excessive upward spread of masking cannot be completely explained by an inability to “listen in the valleys.” [Work supported by NINCDS.]

Amelioration of Cisplatin‐Induced ototoxicity by fosfomycin

The continued chemotherapeutic application of cisplatin (cis-diamminedichloroplatinum [II]) necessitates reduction of its dose-limiting toxicity without decreasing its tumoricidal effect. This research project evaluated the efficacy of fosfomycin, a phosphonic acid antibiotic, in decreasing or ameliorating the ototoxicity (high frequency sensorineural hearing loss) and nephrotoxicity (renal tubular necrosis and interstitial nephritis) of cisplatin. Experimentally, fosfomycin effectively inhibits aminoglycoside-induced ototoxicity and nephrotoxicity in animals and humans. The efficacy of fosfomycin in blocking platinum-induced toxicity in the guinea pig was evaluated histologically and functionally using cytocochleography and light microscopy of the organ of Corti and the auditory brain stem evoked response (ABR), and light microscopy of renal corticomedullary tissues, small bowel, liver, lung, and peripheral nerve. The results demonstrate that fosfomycin ameliorates the acute renal tubular necrosis and interstitial nephritis and markedly inhibits the elevation of ABR thresholds and simultaneous outer hair cell loss that can result from cisplatinum administration. Fosfomycin should be considered a potential antidote for the dose-limiting ototoxicity and nephrotoxicity of cisplatin chemotherapy.

Sensorineural hearing loss in otitis media.

Additional evidence is presented to support the hypothesis that both acute purulent otitis media (POM) and chronic suppurative otitis media (COM) can cause high frequency sensorineural hearing loss. In selected patients and in animals (chinchillas) in a pilot study using electrophysiological methods, both temporary threshold shifts and permanent threshold shifts of basal cochlear turn involvement were demonstrated in POM. Data of cochlear involvement in 475 ears with bilateral COM, 607 ears with unilateral COM, and 607 ears serving as controls were obtained from six centers in five countries. In group 1 (15 dB or greater), 43% of ears with unilateral COM and 42% of ears with bilateral COM showed losses, for a combined odds ratio eight times that in controls. In group 2 (30 dB or greater), 16% of ears with unilateral COM and 17% of ears with bilateral COM demonstrated, respectively, seven and ten times that in controls. These statistically significant findings influence clinical considerations.

Frequency specificity of simultaneously recorded early and middle latency auditory evoked potentials

Early and middle latency auditory evoked potentials were recorded simultaneously with a 2-channel wide-band recording technique. Latency and amplitude distributions of components V, N a and P a were determined in 20 normal hearing adults for 3 different stimuli (click, plop, 500 Hz tone burst) presented at 70, 30 and 20 dB HL. Normative latency data of the middle latency components are presented. The detectability and amplitude of the N a-P a complex were considerably larger than those of wave V at 20 and 30 dB HL for the two low frequency stimuli. Ten ears exhibiting high frequency sensorineural hearing loss were examined. In these cases, only click-evoked N a and P a, but not wave V, were observed down to 20 dB HL. Also, the click latency-intensity function of N a-P a was found to be similar to the normal low frequency latency functions. The results consistently suggested that the low frequency contributions to wave V cancel in phase because of short duration, whereas the duration of the N a-P a complex allows for a positive superimposition of all frequency bands. Since these differences in frequency specificity of the EAEP and the MAEP affect latency, care is advised for the interpretation of inter-peak latencies.

Midfrequency dysfunction in listeners having high-frequency sensorineural hearing loss.

Two-tone unmasking, psychophysical tuning curves and pure-tone masking patterns were measured at 500 and 1000 Hz in 17 listeners having high-frequency sensorineural hearing loss due to noise exposure. Results were compared to similar data obtained from 20 normal-hearing young adults. In addition, measures of word-recognition ability were obtained in quiet and in noise for both groups. The primary findings were as follows: (a) 29% (n = 5) of the hearing-impaired subjects exhibited abnormal results on at least one of the psychoacoustic tasks investigated; (b) the observed abnormalities were reliable; and (c) there appeared to be a relation between the presence of midfrequency dysfunction and degree of difficulty on word-recognition tasks. These results and their implications are discussed.

Hearing defects of noise trauma type with lack of noise exposure.

Screening audiometry in children not infrequently reveals a 4 kHz dip. Evidence for noise trauma as the etiological background of this 4 kHz dip have been presented in the literature. Thirty children with hearing defects of this characteristic type and no history of noise exposure were studied. Their mean age was 14 years and the average observation time 4.2 years. Slight progression of hearing impairment (greater than 15 dB at two frequencies) was noted in 3 children (10%). A history of hearing defects in the family was found in 76%, as against 17% in a control group. Abnormal elevation of stapedius reflex thresholds was observed in 83% of the material. It is concluded that in children with a 4 kHz dip and no history of significant exposure to noise, genetic disposition is the predominant etiological element underlying the hearing defect. There was no indication of increased sensitivity to general noise exposure, but as always in sensorineural high frequency hearing loss avoidance of significant exposure to noise is to be recommended.

Sickle cell anemia and hearing.

The present investigation examined the effects of sickle cell anemia on threshold hearing. The study included 43 homozygous sickle cell anemia patients, ages 7-18 years, and 23 age-matched controls with documented normal hemoglobin. Both the study and control groups received otologic and audiologic examinations. Bilaterally normal hearing was found in 88% of the sickle cell subjects. Unilateral or bilateral mild high frequency sensorineural hearing loss was demonstrated in 12% (5 of 43). The control subjects revealed no hearing loss. The sickle cell group, therefore, exhibited a higher than usual incidence of hearing loss. Further, three of the five subjects with hearing loss evidenced central nervous system involvement, resulting in a probability of < 0.025 that this relation might occur by chance. Periodic hearing evaluations of children with sickle cell anemia should be performed to identify those with auditory complications and those who possibly may have CNS involvement.