Improvement In Speech Discrimination Research Articles

Management of Idiopathic Sudden Sensorineural Hearing Loss (ISSNHL) Intratympanic Platelet-Rich Plasma (PRP) Versus Intratympanic Steroid Injections: A Cross-Sectional Study

<b><br>Introduction:</b> Idiopathic sensorineural hearing loss of 30 decibels (dB) or more over at least three contiguous audiometric frequencies with an onset of less than 3 days is referred to as sudden sensorineural hearing loss (ISSNHL) and is known as an ENT (ear, nose, and throat) emergency. When a patient’s hearing suddenly deteriorates, they become confused, anxious, and worried. One of the primary therapies for sudden sensorineural hearing loss is intratympanic steroids. Intratympanic injections of platelet-rich plasma (PRP) improve inner ear hair cells, which enhances hearing.</br> <b><br>Aim:</b> To show the safety and efficacy of intratympanic PRP injection in the management of ISSNHL in comparison with intratympanic steroid injection.</br> <b><br>Methods:</b> The study group was comprised of 100 patients who had experienced ISSNHL within 30 days with no retrocochlear pathology, as demonstrated by a negative MRI scan. 50 patients received 6 intratympanic steroid injections, while the remaining 50 patients received 2 intratympanic injections of PRP at a 1-week interval.</br> <b><br>Results:</b> A total of 39 patients with PRP injection noted an improvement in their hearing of 25 db after 2 weeks and of 30 db after 2 months, with improved speech discrimination of 26% after 2 weeks and of 28% after 2 months. 31 patients with intratympanic steroid injection noted an improvement in their hearing of 18 db after 2 weeks and of 22 db after 2 months, with improved speech discrimination of 21% after 2 weeks and of 24% after 2 months.</br> <b><br>Conclusions:</b> PRP appears safe and efficient for the treatment of ISSNHL, with a low cost and no systemic side effects, as with oral steroids. Therefore, such research should be continued.</br>

Cochlear Implantation Outcomes in Patients With Retrocochlear Pathology: A Systematic Review and Pooled Analysis.

To review the current literature regarding cochlear implantation in patients with retrocochlear pathologies and extract speech perception scores between 6 months and 1 year after surgery. PubMed/MEDLINE, Embase and Cochrane CENTRAL via Ovid, CINAHL Complete via Ebsco, and Web of Science. The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search strategies included keywords and subject headings to maximize retrieval and reflect cochlear implants and retrocochlear pathologies. Patients with previously resected vestibular schwannoma (VS) were excluded. There were 2,524 abstracts screened against inclusion criteria, and 53 studies were included, with individual data available for 171 adult patients. Pathologies included were either observed or irradiated VS (previously operated tumors were excluded) (n = 99, 57.9%), superficial siderosis (n = 39, 22.8%), neurosarcoidosis (n = 11, 6.4%), and previous central nervous system or skull base radiation (n = 22, 12.9%). Mean (standard deviation) postoperative consonant-nucleus-consonant (CNC) word scores were 45.4% (24.2) for observed VS, 44.4% (20.8) for irradiated VS, 43.6% (21.0) for superficial siderosis, 89.5% (3.0) for neurosarcoidosis, and 30.0% (30.2) in patients with previous central nervous system or skull base irradiation. Irradiated compared with observed VS had similar postoperative CNC word scores (effect size, 0.06; p = 0.71). Age, sex, maximal tumor dimension, and neurofibromatosis type 2 status did not significantly impact cochlear implant performance in patients with VS. Eighty-two percent of patients with reported device usage were daily users, and overall, 82% of cases benefitted from cochlear implantation. Cochlear implantation in patients with concomitant retrocochlear pathology generally results in improved speech discrimination scores sustained over time.

The Impact of Personal Protective Equipment on Speech Discrimination and Verbal Communication in the Operating Room and the Role of Audio Communication Devices.

Recent work has highlighted communication difficulties when wearing personal protective equipment (PPE) in the clinical setting, but currently, there are little objective data on its effects. We assessed the impact of PPE on verbal communication in a simulated operating room and evaluated use of an audio communication device. Frontline health professionals across specialties including surgery, anesthetics, and nursing undertook speech discrimination testing with and without standardized levels of PPE in a simulated operating room environment. Background noise (30- and 70-a-weighted decibel multitalker babble) at 2 distances (2 and 4 m) were selected representative of operating room environments. Bamford-Kowal-Bench (BKB) scoring (192 sentences per participant) was performed. A Digital Multichannel Transceiver System (DMTS) was evaluated. We assessed the effects of PPE use, distance, and use of the DMTS with pairwise comparisons, using a Bonferroni correction, and assessed participant experience via Likert scales. Thirty-one healthcare professionals were tested. Without PPE in 70-a-weighted decibel "babble," median BKB sentence scores were 90% and 76% at 2 and 4 m (adjusted P < 0.0005). The median BKB sentence scores dropped to 8% and 4% at 2 and 4 m in PPE (adjusted P < 0.0005). Improved speech discrimination was achieved with DMTS use to 70% and 76% at 2 and 4 m. Personal protective equipment led to a statistically significant reduction in BKB scores across all conditions compared with baseline. Overall participant confidence in PPE clinical communication was low. Addition of PPE dramatically impairs speech discrimination and communication in high levels of background noise characteristic of clinical environments, which can be significantly improved using DMTS. Measures should be taken by teams through both through reduction of background noise and consideration of assistive technologies maximizing patient safety. This may be further rehearsed in a simulation environment.

TIMELY APPLICATION OF HEARING AIDS HELPS PRESERVE SPEECH DISCRIMINATION ABILITY

Background Hearing damage has been related to certain brain conditions, particularly cognitive impairment. Hearing aids are commonly prescribed to compensate for hearing loss. In the current study, the time from when a hearing aid was first used by a patient was studied in terms of their speech discrimination ability in comparison with matched individuals who used no hearing aids. Material and methods Some 204 patients were enrolled and classified into two groups: 102 patients willing to use a hearing aid as soon as their hearing loss was diagnosed (Aided Group) and 102 patients who were also diagnosed with hearing loss but did not adopt hearing aids (Unaided group). The mean hearing threshold (HT) at octave intervals from 125 to 8000 Hz, speech reception threshold (SRT), and speech discrimination score (SDS) were compared between the two groups of patients at 18 and 36 months. Results According to measurements 36 months after a patient’s first attendance, patients who did not use a hearing aid immediately had significantly lower SDS scores compared to patients who decided to use hearing aids early on. This clearly demonstrates that timely application of hearing aids can prevent the loss of speech perception capabilities. Conclusions It is suggested that the golden time for hearing aid application is important. Hearing aids worn during the early stages of hearing loss can lead to improved speech discrimination ability. If there is hearing loss while discrimination is good (80% or higher), a hearing aid will be very useful. However, if discrimination is poor the results will not be as good.

Cochlear implant in patients with single sided deafness: hearing results and communicative benefits

Objective: Evaluate auditory results and communicative benefits in adult patients with single-sided deafness (SSD) treated with cochlear implantation.Study Design: Observational descriptive case series.Setting: Hospital Universitario Fundación Santa Fe de Bogotá.Patients: Ten patients with profound post-lingual SSD were treated with cochlear implantation between January 2011 and March 2016. Two patients were excluded because of incomplete follow-up.Interventions: Medical records included demographic information, pre and post-operative audiometric results, and binaural and monoaural speech discrimination tests in three sound-in-noise configurationswith the cochlear implant turned on and off, respectively. Subjective improvement was evaluated using the Abbreviated Profile of Hearing Aid Benefit (APHAB) and Speech, Spatial, and Qualities of Hearing Scale (SSQ-B).Main Outcome Measures: Pre and post-operative audiometric and speech discrimination results, post-operative binaural and monoaural speech discrimination in noise results, and APHAB and SSQ-B questionnaire results.Results: Significant improvement in speech discrimination in a noisy environment was found when the noise and signal were presented from the front, and when the signal was presented to the implanted ear and the noise to the healthy ear. SSQ-B questionnaire showed improvement in all subscales, while APHAB showed improvement in all subscales except sound aversion.Conclusion: Patients with SSD showed improvement regarding communication skills and sound discrimination in a noisy environment.

Speech processor upgrade increases speech comprehension in patients with cochlear implants

Hearing rehabilitation of patients with severe hearing loss by cochlear implant (CI) enhances their opportunities for communication immensely with regard to their normal-hearing social environment. The degree of participation depends decisively on speech discrimination. This study examines whether speech discrimination can be improved by equipping patients with next-generation speech processors (SP). The changes in speech discrimination of 420CI patients upon receiving anewer SP from 2003-2012 were retrospectively analyzed. Audiometry comprised the Freiburg number and monosyllable tests and the Oldenburg sentence test in quiet and noise, with apresentation volume of 70 dB. In all audiometric tests, the newer SP showed asignificant improvement compared to the preceding SP. This improvement was attainable for the majority of patients and was independent of age. Upgrade of the SP results in improved speech discrimination. This holds true for several test settings. We therefore recommend earlier upgrades and that the costs for new SP be met.

Performance of cochlear implant patients while using bimodal stimulation and FM system

Objectives: To study the effectiveness of bimodal stimulation coupled to FM system on the speech discrimination in noise, temporal discrimination and temporal resolution in patients with unilateral cochlear implant.Method: A total number of 28 subjects were examined in this study, they were divided into group I (19 subjects) with pre-lingual hearing loss and group II (9 subjects) with post-lingual hearing loss. Both groups had a residual hearing in the non-implanted ear that permits benefit from amplification. Full history taking, Questionnaire, Aided warble tone response, Arabic monosyllabic word test in quiet and in presence of background noise, Pitch discrimination test, Pitch pattern sequence test and Auditory fusion test-subtest 3.Results: There is significant statistical difference in CI patients' performance in most of tests while using bimodal stimulation with FM system coupled to CI than with bimodal stimulation alone or CI alone condition.Conclusions: It is recommended to use hearing aid in non-implanted ear in order to improve speech discrimination in noise, temporal discrimination and temporal resolution abilities.

Using a Bone-Conduction Headset to Improve Speech Discrimination in Children With Otitis Media With Effusion

The recommended management for children with otitis media with effusion (OME) is ‘watchful waiting’ before considering grommet surgery. During this time speech and language, listening skills, quality of life, social skills, and outcomes of education can be jeopardized. Air-conduction (AC) hearing aids are problematic due to fluctuating AC hearing loss. Bone-conduction (BC) hearing is stable, but BC hearing aids can be uncomfortable. Both types of hearing aids are costly. Given the high prevalence of OME and the transitory nature of the accompanying hearing loss, cost-effective solutions are needed. The leisure industry has developed relatively inexpensive, comfortable, high-quality BC headsets for transmission of speech or music. This study assessed whether these headsets, paired with a remote microphone, improve speech discrimination for children with OME. Nineteen children aged 3 to 6 years receiving recommended management in the United Kingdom for children with OME participated. Word-discrimination thresholds were measured in a sound-treated room in quiet and with 65 dB(A) speech-shaped noise, with and without a headset. The median threshold in quiet (N = 17) was 39 dB(A) (range: 23–59) without a headset and 23 dB(A) (range: 9–35) with a headset (Z = −3.519, p < .001). The median threshold in noise (N = 19) was 59 dB(A) (range: 50–63) without a headset and 45 dB(A) (range: 32–50) with a headset (Z = −3.825, p < .001). Thus, the use of a BC headset paired with a remote microphone significantly improved speech discrimination in quiet and in noise for children with OME.

Basic knowledge on the efficacy of hearing aids depending on the type of hearing impairment for Ear, Nose & Throat specialists

For Ear, Nose & Throat specialists, the physiological and psychoacoustical deficits related to hearing impairment and the compensatory capabilities of hearing aids are topics of prime importance. In conductive hearing loss, the foremost deficit is decreased audibility, for which hearing aids can compensate almost entirely through the use of level independent gain. In the instance of sensorineural hearing loss, however, the irreversible loss of outer and inner hair cells causes a distorted sound perception, which is particularly troublesome when trying to understand speech in noisy environments. Unfortunately, this distortion cannot be compensated through the use of hearing aids. Nevertheless, in particular listening environments, its effects can be lessened by reducing background noise levels through the use of directional microphones and, to a lesser extent, digital noise reduction. Noise reduction is in many cases also the main effect to improve speech discrimination in retrocochlear hearing loss.

Assessment and Outcome in Non-Traditional Cochlear Implant Candidates

The objectives of this study were to assess: (i) patient expectations met as a measure of outcome in early-deafened, late-implanted (non-traditional) cochlear implant recipients and (ii) pre-implantation predictive factors for postoperative speech perception. The notes of 13 recipients were retrospectively reviewed. The mean age at onset of profound deafness was 1.5 years (range 0-6). The mean age at implantation was 37 years (range 22-51 years). Patient expectations were assessed pre-operatively and 1 year after implantation. They were met or exceeded in 129/140 (92%) domains overall. A higher Speech Intelligibility Rating and audiovisual City University of New York sentence score before implantation were found to be positive predictive factors for improved speech discrimination after cochlear implantation.

Increased activity in frontal motor cortex compensates impaired speech perception in older adults.

Understanding speech in noisy environments is challenging, especially for seniors. Although evidence suggests that older adults increasingly recruit prefrontal cortices to offset reduced periphery and central auditory processing, the brain mechanisms underlying such compensation remain elusive. Here we show that relative to young adults, older adults show higher activation of frontal speech motor areas as measured by functional MRI during a syllable identification task at varying signal-to-noise ratios. This increased activity correlates with improved speech discrimination performance in older adults. Multivoxel pattern classification reveals that despite an overall phoneme dedifferentiation, older adults show greater specificity of phoneme representations in frontal articulatory regions than auditory regions. Moreover, older adults with stronger frontal activity have higher phoneme specificity in frontal and auditory regions. Thus, preserved phoneme specificity and upregulation of activity in speech motor regions provide a means of compensation in older adults for decoding impoverished speech representations in adverse listening conditions.

Surgical and Technical Modalities for Hearing Restoration in Ear Malformations.

Malformations of the external and middle ear often go along with an aesthetic and functional handicap. Independent of additional aesthetic procedures, a successful functional hearing restoration leads to a tremendous gain in quality of life for affected patients. The introduction of implantable hearing systems (bone conduction and middle ear devices) offers new therapeutic options in this field. We focus on functional rehabilitation of patients with malformations, either by surgical reconstruction or the use of different implantable hearing devices, depending on the disease itself and the severity of malformation as well as hearing impairment. Patients with an open ear canal and minor malformations are good candidates for surgical hearing restoration of middle ear structures with passive titanium or autologous implants. In cases with complete fibrous or bony atresia of the ear canal, the most promising functional outcome and gain in quality of life can be expected with an active middle ear implant or a bone conduction device combined with a surgical aesthetic rehabilitation in a single or multi-step procedure. Although the surgical procedure for bone conduction devices is straightforward and safe, more sophisticated operations for active middle ear implants (e.g., Vibrant Soundbridge, MED-EL, Innsbruck, Austria) provide an improved speech discrimination in noise and the ability of sound localization compared with bone conduction devices where the stimulation reaches both cochleae.

Expanding pediatric cochlear implant candidacy: A case study of electro-natural stimulation (ENS) in partial deafness treatment

BackgroundSome adolescents have hearing impairments characterized by normal or slightly elevated thresholds in the low and mid-frequency bands (below 1500Hz) and nearly total deafness in the high frequency range. These patients often remain beyond the scope of effective hearing aid treatment. Case reportThis study presents the case of a 16-year-old adolescent with good hearing in the range 125–1500Hz and deafness at other frequencies. An implant was used to restore hearing at high frequencies, while preserving low and mid frequency acoustic hearing in the implanted ear. This is described as electro-natural stimulation (ENS) of the inner ear. ConclusionsThe results demonstrate that low and mid frequency hearing (up to 1500Hz) can be preserved using the round window surgical technique. A substantial improvement in speech discrimination was also observed when electrical stimulation on one side was combined with acoustic stimulation on both sides. There is scope to extend qualifying criteria for cochlear implantation to include adolescents who are suited to ENS.

The Vibrant Soundbridge in Children and Adolescents: Preliminary European Multicenter Results.

Evaluation of safety and efficacy of the Vibrant Soundbridge in the treatment of hearing loss in children and adolescents with primary focus on improvement in speech discrimination. Prospective, single-subject repeated-measures design in which each subject serves as his/her own control. Tertiary referral center. Nineteen patients aged 5 to 17 years. Implantation of an active middle ear implant. Improvement in word recognition scores, speech reception thresholds, and signal-to-noise ratios (SNRs) were evaluated, in addition to air and bone conduction. Oldenburger Kids Satztest/Oldenburger Satztest sentences and Göttinger/Freiburger monosyllables at 65-dB hearing level were tested in two age groups. Significant speech discrimination improvement was seen in all patients after 6 months. In children 5 to 9 years old, mean monosyllable recognition improved from 28.9% (unaided) to 95.5% (Soundbridge-aided). Aided 50% sentence discrimination at 44.1 dB and SNR of -4.9 dB were measured. In patients 10 to 17 years old, mean word recognition improved from 18.5% to 89.0%, sentence reception threshold improved to 40.2 dB, and SNR to -3.6 dB. Comparison between age groups indicated a slight trend toward quicker adaptation by older subjects. However, after initial adjustment, a higher level of overall benefit was seen at 6 months in younger children. Currently, the only middle ear implant approved for pediatric patients, the Vibrant Soundbridge, provides an option in cases of congenital aural atresia or disease-induced defects, when surgical intervention and reconstruction is indicated. The 6-month results in this comparatively large study population validated conclusions found in previous trials.

Hearing Outcomes after Surgical Drainage of Petrous Apex Cholesterol Granuloma.

Objective This study aims to assess the hearing outcomes of patients undergoing surgical management of petrous apex cholesterol granuloma and to discuss the role of otic capsule-sparing approaches in drainage of petrous apex cholesterol granulomas. Design Retrospective case series. Setting Tertiary care medical center. Participants Eight patients underwent surgery for presumed or definitive cholesterol granuloma between 2002 and 2011 and met the inclusion criteria for this study. Main Outcome Measures Pre- and postoperative audiogram results as measured by pure tone thresholds and word recognition scores. Results Four patients (50%) demonstrated improvement in speech discrimination. One patient had an increase from 0 to 67% in word recognition scores. Four patients (50%) demonstrated worsening of pure tone thresholds, including two patients with anacusis. Conclusion Perilabyrinthine drainage of petrous apex cholesterol granulomas may result in hearing preservation or hearing improvement, even in the setting of otic capsule erosion. Patients should be counseled about the potential risk of significant hearing loss.

STYMULACJA ELEKTRO-NATURALNA (ENS) W LECZENIU CZĘŚCIOWEJ GŁUCHOTY: STUDIUM PRZYPADKU

BackgroundThere is a significant group of elderly patients whose hearing impairment is characterized by normal or slightly elevated thresholds in the low and mid frequency bands (below 1500 Hz) with nearly total deafness in the high frequency range. These patients very often remain beyond the scope of effective treatment by hearing aids.Case ReportThis study presents the case of a 75-year-old patient with good hearing in the range 125–1500 Hz and deafness at other frequencies. An implant was used to restore hearing at high frequencies, while preserving low and mid frequency acoustic hearing in the implanted ear. This can be described as electro-natural stimulation (ENS) of the inner ear.ConclusionsThe results demonstrate that low and mid frequency hearing (up to 1500 Hz) can be preserved using the round window surgical technique. A substantial improvement in speech discrimination was also observed when electrical stimulation on one side was combined with acoustic stimulation on both sides. There is scope to extend qualifying criteria for cochlear implantation to include elderly patients suitable for ENS.

Hearing preservation cochlear implantation in adolescents.

This study describes our experience of cochlear implantation (CI) with hearing preservation in adolescents. Our aim was to determine if hearing preservation is successful in this population, if the preserved hearing is maintained, and what the potential benefit of preserving hearing in this population is. Fourteen profoundly deaf adolescents with preservation of low-frequency hearing (125, 250, and 500 Hz). Twelve adolescents had a single-sided CI, and two had bilateral CI. All were having their first implantation, and all patients had hearing preservation surgery (soft surgery). Hearing preservation was measured with preoperative and postoperative pure-tone audiograms. Speech audiometry was performed before implantation and at subsequent follow-up appointments. Hearing preservation (measurable hearing thresholds) was achieved in 13 of 14 patients. Average follow-up was 2 years 10 months (range, 4 mo-4 yr 9 mo). Three of 13 patients with initial successful hearing preservation had deterioration of their hearing at subsequent follow-up. The addition of naturally preserved hearing to the cochlear implant improved speech audiometry scores compared with using the implants in isolation. This study demonstrates that residual hearing can be consistently preserved and maintained in adolescents during the short-/medium-term using a soft surgical technique to insert standard-length electrodes. The potential benefit of preserving residual low-frequency hearing seems to be improvement in speech discrimination in challenging hearing conditions, although larger studies are required.

Comparison of three fitting rationales in adults in an artificial intelligence parallel processing hearing aid

EnAbstract Introduction Hearing rehabilitation using nonlinear hearing aid (HA) fitting formulae provides hearing-impaired individuals with the audibility, comfort, and speech intelligibility for a better life. Objective To compare three nonlinear HA fitting formulae in adults in a Channel Free artificial intelligence parallel processing HA. Materials and methods The study included 19 adults with bilateral moderate to severe sensorineural hearing loss, monaurally fitted with nonlinear HA. Comparisons were made on the basis of aided speech intelligibility in quiet and in noise, aided sound field thresholds, and functional performance in real life using APHAB, COSI, and GHABP questionnaires. Results The three formulae have significantly improved speech discrimination in adults, with no significant difference among the formulae for speech intelligibility in quiet or in noise, with no sex or HA experience differences. The three formulae have significantly improved functional performance in real-life speech communication, with the NAL-NL1-based formula showing the greatest degree of benefit and improvement in listening needs, followed by NAL-NL1 and then DSL [I/O]. However, amplification with the three formulae increased aversiveness to environmental sounds. Participants reported significant benefits using NAL and NAL-NL1-based formulae. Experienced HA users, using the NAL-NL1-based formula, showed significantly less difficulty in listening quality in large spaces and greater capacity to recognize speech within competitive noise and better tolerance to environmental sounds than nonexperienced users. The SPIN test correlated well with real-life speech communication. Conclusion The three fitting rationales have equally improved intelligibility, with variable degrees of improvement in real-life speech communication with preferences for NAL-NL1 and the manufacture-specific NAL-NL1-based formula.

Improving Hearing Aid Function in Noisy Situations

Improving Hearing Aid Function in Noisy Situations

Coenzyme Q10 in combination with steroid therapy for treatment of sudden sensorineural hearing loss: a controlled prospective study

To evaluate the therapeutic efficacy of coenzyme Q10 added to systemic steroid in patients with idiopathic sudden sensorineural hearing loss. A controlled prospective study. Asan medical center, University of Ulsan College of Medicine. Between August 2007 and October 2008, the first 60 patients diagnosed with sudden sensorineural hearing loss were managed with systemic steroid treatment for 2 weeks including 5-day hospitalisation. And the second 60 patients were managed with coenzyme Q10 for 2 weeks added to previous management. We evaluated auditory function by pure tone audiometry and speech discrimination score. Auditory evaluations were performed before and 3 months after treatment using Siegel's criteria. The degree of improvement in four-tone average hearing and speech discrimination score was calculated from the results before and after treatment. The total hearing improvement rate after the treatment was 75.0% (90/120 patients) in this study. Although 47 patients (78.3%) of coenzyme Q10 group showed better hearing improvement than 43 patients (71.7%) of control group, there was no significant difference. However, the coenzyme Q10 group showed significantly higher improvement in speech discrimination score. From this study, we suggest that coenzyme Q10 may have beneficial effects in the treatment of sudden sensorineural hearing loss.