Mean Hearing Loss Research Articles

The otological profile of a cohort of Dutch 7.5-8-year-olds.

The otological characteristics of a birth cohort of 7.5-8-year-old Dutch children are reported. Questionnaire information was available for 1004 children, while otomicroscopic, tympanometric and pure-tone audiometric data were available for 946 children. Twenty-nine per cent of the children had been treated surgically for various ENT diseases. Fifty-five per cent of the children had normal tympanic membranes, 19% mild abnormalities, and 26% moderate to severe abnormalities. At this age the prevalence of bilateral otitis media with effusion (OME), as shown by a type B tympanogram was 2.5%, while that of unilateral OME was 7%. A pure-tone average hearing level of > or = 15 dB in the better-hearing ear was found in 4% of the children. The presence of OME was associated with a mean hearing loss of 20 dB. This study shows that structural and functional middle-ear abnormalities are highly prevalent in Dutch school children.

Brainstem auditory evoked potentials in young children before and after tympanostomy tube placement

Tp evaluate the effect of tympanostomy tube placement upon the hearing function of infants and young children, brainstem auditory evoked potentials (BAEP) were recorded in a group of young children (mean age 22 mos) receiving this treatment for otitis media with effusion (OME). For comparison, a group of healthy infants with normal behavioral audiometry were also tested with BAEP. Hearing loss was estimated for each ear using peak V latency-intensity curves. To evaluate the immediate effect of tube placement, 98 ears in 52 children were tested immediately before and after tube insertion. The 63 ears with effusion had prolonged peak latencies that decreased significantly ( P < 0.001) immediately after tube placement and a mean hearing loss estimate of 22 dB that improved significantly ( P < 0.0001) to 11 dB immediately after tube insertion. The 35 ears without effusion at myringotomy had a mean hearing loss estimate of 8 dB that did not change significantly after tube insertion. To evaluate the short-term effect of tube presence, 39 ears in 25 children were tested 3 weeks to 18 months after tube insertion. The 28 ears with dry tubes had a mean hearing loss estimate of 3 dB, and the 11 ears with otorrhea had a mean hearing loss estimate of 31 dB. The magnitude of mean hearing loss estimates in these young children with OME and the improvement in hearing function with tube placement is similar to that reported in older children studied with BAEP and audiometry. The study groups with a history of otitis media that had resolved by the time of testing had isolated prolongation of mean III–V interpeak latencies compared to normals ( P < 0.01). These studies show that BAEP techniques are useful in estimating hearing loss in children with OME who are difficult to test by behavioral audiometry and show changes in rostral brainstem transmission in very young children with a history of OME.

Reading abilities and speech intelligibility of integrated hearing‐impaired children

Summary The New Macmillan Reading Analysis (1985) was administered to 14 integrated hearing‐impaired children, with a mean hearing loss of 58.8 dB, and to 14 age‐matched hearing controls. Both groups read equally well in terms of accuracy, but the hearing had superior comprehension. The hearing‐impaired and the hearing controls were retarded in terms of the published norms. Their speech intelligibility was rated and compared with that in other studies. All of the hearing‐impaired were educated orally with the support of the Salford Education Service for the Hearing‐Impaired.

Otologische Befunde bei erwachsenen Patienten mit Lippen-, Kiefer-, Gaumenspalten*

In a clinical study 27 adults with cleft lip and palate (mean age 21.9 years) were examined to look for long-term results of hearing and pathology of the tympanic membrane. 69.2% of the ears showed normal hearing; the threshold of mean hearing loss never exceeded the 20 dB-level. Slight changes of the tympanic membrane could be seen in 48.2%, severe changes in 16.7%.

Relationship between hearing handicap inventory for the elderly (HHIE) and pattern of hearing aid utilization by elderly hearing‐impaired listeners

The differences in perceived handicap among elderly who reported various degrees of hearing aid utilization were assessed. Three groups of 15 listeners each (mean age 74 years, similar mean hearing loss) were: (1) full‐time hearing aid users, (2) part‐time users, and (3) nonusers. The listeners responded to ten questions of the hearing handicap inventory for the elderly (HHIE) [B. E. Weinstein, ASHA, May, 41–45 (1986)] that quantifies self‐perceived handicap. First, groups 1, 2, and 3 responded as if they were not wearing hearing aids. Group 1 assessed themselves as more handicapped than group 3, indicating that people who perceive themselves as handicapped are more likely to rely on hearing aids than people who perceive themselves as marginally handicapped. Second, groups 1 and 2 responded as if they were wearing hearing aids. The full‐time users, but not the part‐time users, assessed themselves as less handicapped in everyday functions when they wore hearing aids than when they did not wear their hearing aids. Apparently, the HHIE reflected the usefulness of hearing aids for the full‐time users. These results will be discussed in reference to background noise levels tolerated by elderly hearing‐impaired listeners. [Work supported by AARP Andrus Foundation.]

The importance of diagnostic procedures to ensure quality of health care in geriatric medicine. Examples from recent studies.

Within the health care of the elderly with prevention, diagnosis, therapy, rehabilitation, nursing care and social service, diagnostic procedures are of great importance to avoid under- and over-diagnosis. Many diagnostic difficulties exist in elderly patients such as changed reference values, changed normal values and changed signs and symptoms. Well-known examples of conditions which are likely to be under-diagnosed include depression and urinary incontinence. Examples are given from the cardiopulmonary field where e.g. dyspnoea showed to be very common, but in only 36% of males and 52% in females related to cardiac failure or pulmonary disease. The most common symptom of acute myocardial infarction in elderly patients was shown to be dyspnoea, whereas chest pain occurred in only one fifth of the cases. In another study of patients with ulcer disease loss of appetite and weight, nausea and anemia were more common than abdominal pain and heartburn. In peritonitis patients, abdominal pain was observed in only just more than half of the cases and guarding and/or abdominal rigidity in about one third. In patients with suspect age dementia a detailed investigation showed the prevalence of organic dementia to be 89% whereas 3% had treatable dementia and 8% non-dementia conditions. In geriatric long-term patients the mean hearing loss in the speech area was about 50 dB, in spite of the fact that only about 10% of the patients had hearing aids. The need for nursing diagnosis is also obvious. It is concluded that a detailed multidisciplinary diagnostic investigation procedure is very important in geriatric medicine.

A randomised controlled trial of surgery for glue ear.

To assess the effect of five different surgical treatments for glue ear (secretory otitis media) on improvement in hearing and, assuming one or more treatments to be effective, to identify the appropriate indications for surgery. Randomised controlled trial of children receiving (a) adenoidectomy, bilateral myringotomy, and insertion of a unilateral grommet; (b) adenoidectomy, unilateral myringotomy, and insertion of a unilateral grommet; (c) bilateral myringotomy and insertion of a unilateral grommet; and (d) unilateral myringotomy and insertion of a grommet. Children were followed up at seven weeks, six months, 12 months, and 24 months by symptom history and clinical investigations. Otolaryngology department in an urban hospital. 149 Children aged 4-9 years who were admitted for surgery for glue ear and who had no history of previous operations on tonsils, adenoids, or ears and no evidence of sensorineural deafness. Inadequate follow up information on levels of hearing and on middle ear function was obtained from 22. Mean hearing loss (dB) of the three worst heard frequencies between 250 and 4000 Hz, results of impedance tympanometry, and parental views on their child's progress. In the 127 children for whom adequate information was available ears in which a grommet had been inserted performed better in the short term (for at least six months) than those in which no grommet had been inserted, irrespective of any accompanying procedure. Most of the benefit had disappeared by 12 months. Adenoidectomy produced a slight improvement that was not significant, though was sustained for at least two years. The ears of children who had had an adenoidectomy with myringotomy and grommet insertion, however, continued to improve so that two years after surgery about 50% had abnormal tympanometry compared with 83% of those who had had only myringotomy and grommet insertion, and 93% of the group that had had no treatment. Logistic regression analyses identified preoperative hearing level as the single best predictor of good outcome from surgery. Other variables contributed little additional predictive power. If the principal objective of surgery for glue ear is to restore hearing then our study shows that insertion of grommets is the treatment of choice. The addition of an adenoidectomy will increase the likelihood of restoration of normal function of the middle ear but will not improve hearing. When deciding appropriate indications for surgery, a balance has to be made between performing unnecessary operations and failing to treat patients who might benefit from surgical intervention. Preoperative audiometry scores might be the best predictor in helping to make this decision.

Speech addressed to hearing-impaired children by their mothers

In this cross-sectional study, some characteristics of the maternal language of a large group of hearing-impaired children are described (n = 74). The children had mean bilateral sensori-neural hearing loss of 25-123 dB HL in the better ear; they were monolingual, suffered no additional handicaps, and at the time of the study were aged 3-7 years old. The language data reported here were obtained by transcribing video-recorded play sessions. Both quantitative and syntactic analyses were applied to the maternal language. The aims of the study were: (1) to describe the distribution of the measures; (2) to establish whether any relationships exist between the children's characteristics (language level, degree of hearing loss, social class, IQ) on the one hand and the type of language used by the mother on the other; and (3) to draw comparisons with maternal language to hearing children. The implications of the findings are discussed and suggestions for further investigation are given.

Incidence, Prevalence and Etiology of Hearing Impairment in Children in the County of VÄsterbotten, Sweden

During the period 1964-83, 63,463 children were born in the county of Västerbotten, Sweden. Of these children, 160 had a hearing impairment greater than or equal to 30 dB HL mean hearing loss for the frequencies 0.5, 1.0 and 2.0 kHz in the better-hearing ear. The mean annual incidence of hearing impairment was 2.5 per 1,000 and the prevalence was 2.6 per 1,000. Hereditary factors were present in 46% and no etiology could be established in 34% of the cases. The incidence of hearing impairment was greater than has been presented in studies from other areas in Europe.

Hearing disorders in obliteration of the carotid artery. 2. Contribution to hearing loss in the aged

Otologic-audiologic examination was carried out in 75 patients (between 42 and 86 years of age; average age: 65 years) with confirmed internal angiologic obliteration of the carotid artery, either unilateral or bilateral. There were 51 unilateral and 24 bilateral stenoses/occlusions. Diseases of the ear were excluded clinically and audiologically. - The mean hearing loss shows a sensorineural high tone loss in the tone audiogram. The range of scatter of high tone loss increases proportionally to the increase of frequency. - Compared with the physiological examination of geriatric patients, the total word comprehension and especially the minimal discrimination loss point towards a pathologic impairment of hearing. The total word comprehension amounts to 250.79% in the 51-60 age group, 237.79% in the 61-70 age group, 175.83% in persons aged 71-80 years, and 118.33% for those over 80 years of age. The minimal discrimination loss comprises 5.83% in the 51-60 age group, 9.79% in the 61-70 age group, 22.50% in patients between 71 and 80 years, and 48.00% in those over 80 years. - No connection between the extent of loss of hearing and the stage of obliteration of the carotid artery can be shown. However, the decompensation of total word comprehension and especially the minimal discrimination loss is a very important sign. - These findings contribute towards a differentiation of physiologic and pathologic hearing diseases in old age with particulas reference to the underlying arteriosclerotic disease.

Vestibular investigations in acoustic neuroma.

Forty-eight patients with surgically proven acoustic neuroma were examined preoperatively with a comprehensive battery of vestibular tests. In 87% of the patients, reduced caloric responses were measured on the side of the lesion. In 60% of the patients a non-responsive labyrinth was found. Spontaneous nystagmus was observed in 29% of the patients. A significant correlation with the size of the tumour was found in the occurrence of abnormal saccades in the calibration test, pathological smooth pursuit movements and the occurrence of gaze nystagmus, respectively. There was no correlation between the magnitude of the caloric response reduction and the mean hearing loss, which suggests that the hearing loss and the vestibular function loss do not occur synchronously. This study shows that in most cases of acoustic neuroma, the peripheral part of the vestibular system is severely disturbed. Abnormalities in the central and peripheral part of the vestibular system are more easily recognized with increasing tumour size. We conclude that a complete battery of vestibular tests is essential in combination with audiometric, neurologic and radiologic analysis for the early clinical diagnosis of acoustic neuroma.

New clinical finding in vestibular neuritis: high-frequency audiometry hearing loss in the affected ear.

Twenty-one patients with established vestibular neuronitis were examined otoneurologically and audiologically. High-frequency audiometry up to 20,000 Hz was performed on all the patients. In 17 cases a high-frequency hearing loss was greater in the ear with vestibular neuritis. The mean hearing loss difference varied from 14 dB to 24 depending on the frequency. Our results reveal that in most cases of vestibular neuritis there are no isolated vestibular lesions, but most cases also involve an auditory end-organ lesion. This finding is in unison with the anatomic conditions of the cochlea and the vestibular end-organ.

Erste Erfahrungen mit einer Compact-Disc-Aufnahme des Freiburger Sprachtests*

Speech audiometric results of 45 sensorineural hearing impairments (mean hearing loss in Fig. 1) are compared for magnetic tape and compact-disc reproduction. In both cases the standardised Freiburg Test (DIN 45 621) is used. As a result mean speech hearing loss determined by compact disc application (32 +/- 15 dB) is in good agreement with the value for magnetic tape use (29 +/- 15 dB). This finding is confirmed by linear regression analysis (Fig. 2). Even mean discrimination scores for monosyllables are nearly the same up to 100 dB for compact-disc as well as magnetic tape recording (Fig. 3). At higher speech levels above 100 dB magnetic tape results show insignificant (p = 0.05) lower scores than compact disc use. The "total word discrimination", defined as the sum of intelligibility scores at 60, 80 and 100 dB, is highly correlated using magnetic tape and digital recorded speech material (Fig. 4). The same holds for percentage hearing loss determined after Boenninghaus and Röser (1973) as shown in Fig. 5. If the compact-disc version of the Freiburg Speech Test will prove its worth in an representative group of subjects, it can be recommended to stabilise reproduction quality and to shorten the duration of examination until new speech audiometric tests that meet actual requirements are developed and standardised.

Prognosis of Sudden Deafness

One hundred and twenty-two cases (130 ears) of sudden deafness were treated with combined stellate ganglion block and steroid therapy. They were analyzed from the following factors: days after onset, mean hearing loss, major symptoms, audiogram types and prognosis.The remarkable improvement was obserbed in 82 cases (80%) of sudden deafness of which treatment was started within the two weeks after onset. The hearing recovery was worse in the cases of severe hearing loss. In the cases that mean hearing loss of 250, 500, 1000, 2000, 4000Hz was above 80dB, prognosis was poor. The hearing recovery was poorer in the cases with vertigo than without it.Clinical result of stellate ganglion block therapy of sudden deafness were reported. The prognosis of sudden deafness were also discussed on referring to the previous clinical reports.

The stapedius reflex tests in retrocochlear hearing disorders.

The commonly used parameters of the stapedius reflex responses in the diagnosis of sensorineural hearing disorders are the reflex threshold level and the persistence of the reflex response on prolonged stimulation, i.e., the reflex decay test. With the object of establishing the sensitivity of these reflex parameters to identify tumours affecting the eighth nerve in the early stages, a series of 97 such cases were examined. The mean hearing loss of the affected ears was 32 dB; 28 of the cases still had normal thresholds of hearing; 95 of the ears demonstrated elevated reflex thresholds and/or pathologic reflex decay. To check the specificity of the test, a control series with sensorineural hearing loss and reflex threshold elevation or pathologic reflex decay was analysed with respect to clinical diagnoses. In every third case of reflex threshold elevation and in every second case of reflex decay, the medical diagnosis confirmed a disease known to be associated with retrocochlear dysfunction. It was also noted that none of the cases with brain stem lesion demonstrated reflex decay--an observation which supports the idea of the reflex decay phenomenon as specifically associated with eighth-nerve lesions.

Electronystagmographic findings in idiopathic sudden hearing loss

The electronystagmographic findings for 116 patients with unilateral idiopathic sudden hearing loss (ISHL) were analyzed. For the purpose of the study, three groups were formed: patients with normal electronystagmographic (ENG) findings; patients with mild to moderate vestibular injuries consisting of spontaneous horizontal nystagmus or directional preponderance; and patients with severe vestibular injuries indicated by reduced vestibular responses, including paresis of the semicircular canal or lack of response to caloric testing. Clinical and audiologic findings were compared. High correlations were found between both subjective vertigo and abnormal ENG findings and the presence of profound hearing loss at the onset of ISHL. There was an inverse relationship between recovery from ISHL and the ENG findings, namely, as the severity of the vestibular injury increased, the percentage of patients who achieved recovery decreased. Patients with abnormal ENGs had a greater mean hearing loss at onset of ISHL and less mean recovery of hearing than did patients who had normal ENG findings. In addition, patients who had abnormal ENG findings recovered less fully from hearing loss in the high frequencies than from those in the low frequencies owing to the proximity of the basilar turn of the cochlea to the vestibular sense organ.

Aetiological factors relating to childhood deafness in the European community.

A multinational collaborative study on deaf children was carried out in 1977. The intention was to include all children aged 8 years with a hearing loss of 50 dB or worse, residing in the nine countries of the European Economic Community. Information was obtained on the prevalence of deafness, the distribution of mean hearing loss, aetiology and associated disabilities.

Metaphor and conservation in deaf and hard-of-hearing children.

Eight profoundly deaf and six hard-of-hearing children participated in the study. The deaf children had hearing losses of 90dB or greater with a mean hearing loss of 98dB, and the hard-of-hearing children had losses ranging from 27db-85dB with a mean hearing loss of 65dB. All children had a bilateral loss in the speech range 500-2000 Hz (ISO). All of the children ranged in age from 11 years to 16 years 9 months (mean = 13 years) and ranged in IQ from 90-124 (mean = 107). The average language grade level of the hard-of-hearing children was 5.0, and their average reading grade level was 5.4. The average language grade level of the deaf children was 3.2, and their average reading grade level was 3.6. All of the children were presented conservation of liquid and weight problems and 12 metaphor items. The results suggest that hearing loss does not affect the solution of either conservation or metaphor. Intelligence and age factors both affected conservation and metaphor performance; however, the ability to conserve appeared to be the best predictor of metaphor comprehension.

Vestibular investigations in Meniere's disease.

151 patients with unilateral Meniere's disease were investigated with a vestibular test battery in the interval between vertigo attacks, and the results were compared with those obtained in a control group. In 73.5% of the patients a caloric response reduction of the afflicted ear was observed. The mean caloric response reduction was 34.3%; a major response reduction or a total absence of the caloric response of the afflicted ear was rare. A correlation was found between the amount of caloric response reduction and the duration of the disease. Spontaneous nystagmus was found in 47% of the cases (mean value 3 degrees/sec) and a mainly direction fixed positional nystagmus in 78% (mean value 4.0 degrees/sec). No correlation was found between the mean hearing loss and the magnitude of caloric response reduction on the day of investigation.

Application of Word Intelligibility Test by Picture Identification to Hearing-Impaired Children

This work is a part of the research on standardization of speech audiometry for hearingimpaired children.In the first phase, the experiment was made on children in nursery classes (aged 3-6 years) at a school for the deaf in order to evaluate a test word list and the procedure for word intelligibility test by picture identification. From the results of the experiment the following suggestions were made:1) The test word list should be consisted of concrete nouns which can be pictorially presented.2) A test sheet with 6 pictures is used for every test word. Therefore 25 test sheets are needed to 25 test words.3) Before the test, it is necessary to ascertain whether each test word is within the recognition vocabulary of each subject.In the second phase, according to the first experiment a test word list was made, and the intelligibility test was carried out on 90 children, aged 3-15 years at a school for the deaf. The results were as followed:1) Mean hearing loss more than 95dB (ASA-1951) was associated with lower score of this test.2) This test was easier than the monosyllabic intelligibility test (67-list of Japan Audiological Society) which has been widely used in Japan, and the test scores distributed over the wider range than those of 67-list. Therefore this test can be utilized for evaluating the speech recognition ability of severely impaired hearing children.