Moderate Cochlear Hearing Loss Research Articles

The Effect of Cochlear Damage on the Sensitivity to Harmonicity.

A sum of simultaneous pure tones with harmonic relationships (i.e., simple frequency ratios) is normally heard as a single sound, with a single pitch, even when its components are fully resolved in the auditory periphery. This perceptual phenomenon called "harmonic fusion" is thought to play an important role in auditory scene analysis as listeners often have to segregate simultaneous harmonic sounds with different fundamental frequencies. The present study explored the consequences of mild or moderate cochlear hearing loss for the sensitivity to harmonicity and the detection of inharmonicity. The subjects were 12 normal-hearing (NH) listeners and 8 listeners with cochlear hearing loss amounting to 30 to 50 dB (mean: 42 dB) from 0.25 to 3 kHz. In each subject, thresholds for the detection of a change in the frequency ratio of simultaneous pure tones were measured with an adaptive forced-choice procedure. The standard frequency ratio was either harmonic (2:1, i.e., one octave) or inharmonic (0.8 or 1.2 octaves). The tones were presented at a low sensation level (at most 15 dB) within broadband noise, to minimize their cochlear interactions. In the main experimental conditions, the frequency register of the stimuli varied randomly within each trial, so that subjects were forced to process frequency ratios to achieve good performance; frequency discrimination was not sufficient. In other conditions, by contrast, frequency discrimination was sufficient to perform the task optimally. For both groups of subjects, thresholds in the main experimental conditions were lower (i.e., better) when the standard frequency ratio was harmonic than when it was inharmonic. This effect, revealing sensitivity to harmonicity, was weak for some members of the hearing-impaired group, but could be observed even in subjects showing a very poor frequency discrimination ability. The two groups, however, differed from each other with respect to the detection of inharmonicity: for the NH group, in agreement with previous results, negative deviations from one octave (i.e., compressions of this frequency ratio) were better detected than positive deviations (stretchings); for the hearing-impaired group, on the other hand, the sign of the deviations had no effect on performance. Sensitivity to harmonicity appears to be remarkably robust. However, it can be reduced in some listeners with mild or moderate cochlear damage. Moreover, as inharmonicity detection is asymmetric for NH listeners but apparently becomes symmetric in case of cochlear damage, it may be that listeners with cochlear damage do not detect inharmonicity in the same manner as NH listeners do. In some circumstances, inharmonicity can be detected on the basis of "beat" cues available in single frequency channels; however, the subjects tested here were unlikely to use cues of this type.

Behavioral Estimates of the Contribution of Inner and Outer Hair Cell Dysfunction to Individualized Audiometric Loss

Differentiating the relative importance of the various contributors to the audiometric loss (HL(TOTAL)) of a given hearing impaired listener and frequency region is becoming critical as more specific treatments are being developed. The aim of the present study was to assess the relative contribution of inner (IHC) and outer hair cell (OHC) dysfunction (HL(IHC) and HL(OHC), respectively) to the audiometric loss of patients with mild to moderate cochlear hearing loss. It was assumed that HL(TOTAL) = HL(OHC) + HL(IHC) (all in decibels) and that HL(OHC) may be estimated as the reduction in maximum cochlear gain. It is argued that the latter may be safely estimated from compression threshold shifts of cochlear input/output (I/O) curves relative to normal hearing references. I/O curves were inferred behaviorally using forward masking for 26 test frequencies in 18 hearing impaired listeners. Data suggested that the audiometric loss for six of these 26 test frequencies was consistent with pure OHC dysfunction, one was probably consistent with pure IHC dysfunction, 13 were indicative of mixed IHC and OHC dysfunction, and five were uncertain (one more was excluded from the analysis). HL(OHC) and HL(IHC) contributed on average 60 and 40 %, respectively, to the audiometric loss, but variability was large across cases. Indeed, in some cases, HL(IHC) was up to 63 % of HL(TOTAL), even for moderate losses. The repeatability of the results is assessed using Monte Carlo simulations and potential sources of bias are discussed.

Individual Differences in Behavioral Estimates of Cochlear Nonlinearities

Psychophysical methods provide a mechanism to infer the characteristics of basilar membrane responses in humans that cannot be directly measured. Because these behavioral measures are indirect, the interpretation of results depends on several underlying assumptions. Ongoing uncertainty about the suitability of these assumptions and the most appropriate measurement and compression estimation procedures, and unanswered questions regarding the effects of cochlear hearing loss and age on basilar membrane nonlinearities, motivated this experiment. Here, estimates of cochlear nonlinearities using temporal masking curves (TMCs) were obtained in a large sample of adults of various ages whose hearing ranged from normal to moderate cochlear hearing loss (Experiment 1). A wide range of compression slopes was observed, even for subjects with similar ages and thresholds, which warranted further investigation (Experiment 2). Potential sources of variance contributing to these individual differences were explored, including procedural-related factors (test-retest reliability, suitability of the linear-reference TMC, probe sensation levels, and parameters of TMC fitting algorithms) and subject-related factors (age and age-related changes in temporal processing, strength of cochlear nonlinearities estimated with distortion-product otoacoustic emissions, estimates of changes in cochlear function from damage to outer hair cells versus inner hair cells). Subject age did not contribute significantly to TMC or compression slopes, and TMC slopes did not vary significantly with threshold. Test-retest reliability of TMCs suggested that TMC masker levels and the general shapes of TMCs did not change in a systematic way when re-measured many weeks later. Although the strength of compression decreased slightly with increasing hearing loss, the magnitude of individual differences in compression estimates makes it difficult to determine the effects of hearing loss and cochlear damage on basilar membrane nonlinearities in humans.

Spatial tuning curves from apical, middle, and basal electrodes in cochlear implant users

Forward-masked psychophysical spatial tuning curves (fmSTCs) were measured in 15 cochlear-implant subjects, 10 using monopolar stimulation and 5 using bipolar stimulation. In each subject, fmSTCs were measured at several probe levels on an apical, middle, and basal electrode using a fixed-level probe stimulus and variable-level maskers. Tuning curve slopes and bandwidths did not change significantly with probe level for electrodes located in the apical, middle, or basal region although a few subjects exhibited dramatic changes in tuning at the extremes of the probe level range. Average tuning curve slopes and bandwidths did not vary significantly across electrode regions. Spatial tuning curves were symmetrical and similar in width across the three electrode regions. However, several subjects demonstrated large changes in slope and/or bandwidth across the three electrode regions, indicating poorer tuning in localized regions of the array. Cochlear-implant users exhibited bandwidths that were approximately five times wider than normal-hearing acoustic listeners but were in the same range as acoustic listeners with moderate cochlear hearing loss. No significant correlations were found between spatial tuning parameters and speech recognition; although a weak relation was seen between middle electrode tuning and transmitted information for vowel second formant frequency.

Evaluation of the CAMEQ2-HF Method for Fitting Hearing Aids With Multichannel Amplitude Compression

A method for fitting multichannel compression hearing aids with an extended high-frequency response, called CAMEQ2-HF, was described by . This study describes an evaluation of the method, using a 16-channel behind the ear hearing aid incorporating slow-acting compression and providing gain for frequencies up to 7500 Hz. Eleven participants with mild to moderate cochlear hearing loss were fitted bilaterally using the gains prescribed by CAMEQ2-HF. The fittings were checked using real-ear measurements with swept sinusoidal signals, and adjustments were made so that the target gains at the center frequency of each channel were achieved with a typical tolerance of +/-3 dB for an input level of 65 dB and with a typical tolerance of +/-5 dB for levels of 50 and 80 dB SPL. Participants were asked to wear the hearing aids as much as possible in their everyday lives and to fill in questionnaires and a structured diary about their experience of loudness and their listening problems in everyday life, both for listening unaided and after a period of use of the aids. Scores obtained using the Profile of Aided Loudness (PAL) indicated that the hearing aids led to a clear increase in loudness (relative to unaided listening) for weak sounds and to smaller increases in loudness for sounds of medium and high intensity. For aided listening, strong sounds were typically rated as "loud, but OK." Satisfaction ratings for loudness obtained using the PAL showed only small differences between unaided and aided listening. Responses obtained via the structured diary (for aided listening only) indicated that target speech was usually judged as "loud enough" in a variety of situations. Clarity judgments ranged from "reasonably clear" to "OK" for most situations, but fell to "not very clear" for a noisy group situation. The loudness of background sounds was mostly judged as "OK," except for the noisy group situation in which the background was judged "bit loud." Results from the Abbreviated Profile of Hearing-Aid Benefit questionnaire indicated fewer problems with "ease of communication," "reverberation," and "background noise" for aided than for unaided listening, but more problems with "aversiveness." Nine of 11 ratings of overall sound quality fell in the categories "satisfied" or "very satisfied." The CAMEQ2-HF fitting method generally led to satisfactory loudness and sound quality in everyday life for people with mild to moderate hearing loss.

Spectro-Temporal Characteristics of Speech at High Frequencies, and the Potential for Restoration of Audibility to People with Mild-to-Moderate Hearing Loss

It is possible for auditory prostheses to provide amplification for frequencies above 6 kHz. However, most current hearing-aid fitting procedures do not give recommended gains for such high frequencies. This study was intended to provide information that could be useful in quantifying appropriate high-frequency gains, and in establishing the population of hearing-impaired people who might benefit from such amplification. The study had two parts. In the first part, wide-bandwidth recordings of normal conversational speech were obtained from a sample of male and female talkers. The recordings were used to determine the mean spectral shape over a wide frequency range, and to determine the distribution of levels (the speech dynamic range) as a function of center frequency. In the second part, audiometric thresholds were measured for frequencies of 0.125, 0.25, 0.5, 1, 2, 3, 4, 6, 8, 10, and 12.5 kHz for both ears of 31 people selected to have mild or moderate cochlear hearing loss. The hearing loss was never greater than 70 dB for any frequency up to 4 kHz. The mean spectrum level of the speech fell progressively with increasing center frequency above about 0.5 kHz. For speech with an overall level of 65 dB SPL, the mean 1/3-octave level was 49 and 37 dB SPL for center frequencies of 1 and 10 kHz, respectively. The dynamic range of the speech was similar for center frequencies of 1 and 10 kHz. The part of the dynamic range below the root-mean-square level was larger than reported in previous studies. The mean audiometric thresholds at high frequencies (10 and 12.5 kHz) were relatively high (69 and 77 dB HL, respectively), even though the mean thresholds for frequencies below 4 kHz were 41 dB HL or better. To partially restore audibility for a hearing loss of 65 dB at 10 kHz would require an effective insertion gain of about 36 dB at 10 kHz. With this gain, audibility could be (partly) restored for 25 of the 62 ears assessed.

Limiares de reconhecimento de sentenças no silêncio em campo livre versus limiares tonais em fone em indivíduos com perda auditiva coclear

OBJETIVO: investigar a correlação existente entre os limiares tonais e os Limiares de Reconhecimento de Sentenças no Silêncio (LRSS) e verificar, se é possível, através do audiograma estabelecer um prognóstico deste paciente sobre a sua habilidade de reconhecer a fala. MÉTODOS: foram analisados 42 indivíduos com perda auditiva coclear de grau moderado, 18 do sexo feminino e 24 do masculino, com idades entre 41 e 76 anos. Primeiramente foi realizada avaliação audiológica básica e, em seguida, a pesquisa dos Limiares de Reconhecimento de Sentenças no Silêncio, em campo livre, por meio do teste Listas de Sentenças em Português. RESULTADOS: a análise estatística evidenciou correlação significante entre o limiar de reconhecimento de sentenças no silêncio e a média das freqüências de 0,5, 1 e 2 kHz. Por sua vez, ao correlacionar os Limiares de Reconhecimento de Sentenças no Silêncio com a média das freqüências de 3, 4 e 6 kHz, não houve correlação significante. CONCLUSÃO: o prognóstico provável da habilidade de reconhecimento de fala no silêncio, pode ser feito apenas com base nos limiares das freqüências de 0,5, 1 e 2 kHz em perdas auditivas cocleares.

Moderate cochlear hearing loss leads to a reduced ability to use temporal fine structure information

The ability of normally hearing and hearing-impaired subjects to use temporal fine structure information in complex tones was measured. Subjects were required to discriminate a harmonic complex tone from a tone in which all components were shifted upwards by the same amount in Hz, in a three-alternative, forced-choice task. The tones either contained five equal-amplitude components (non-shaped stimuli) or contained many components, but were passed through a fixed bandpass filter to reduce excitation pattern changes (shaped stimuli). Components were centered at nominal harmonic numbers (N) 7, 11, and 18. For the shaped stimuli, hearing-impaired subjects performed much more poorly than normally hearing subjects, with most of the former scoring no better than chance when N=11 or 18, suggesting that they could not access the temporal fine structure information. Performance for the hearing-impaired subjects was significantly improved for the non-shaped stimuli, presumably because they could benefit from spectral cues. It is proposed that normal-hearing subjects can use temporal fine structure information provided the spacing between fine structure peaks is not too small relative to the envelope period, but subjects with moderate cochlear hearing loss make little use of temporal fine structure information for unresolved components.

Cochlear nonlinearity between 500 and 8000 Hz in listeners with moderate cochlear hearing loss

For two listeners with flat hearing loss, temporal masking curves (TMCs) were measured for probe frequencies (Fp) of 0.5, 1.0, 2.0, 4.0, and 8.0 kHz and masker frequencies of 0.5, 0.6, 0.7, 0.9, 1.0, 1.05, 1.1, and 1.2 Fp. From these, basilar membrane (BM) input/output (IO) functions and psychophysical tuning curves (PTCs) were derived and compared with corresponding data for normal-hearing listeners. Linear IO functions were observed for one ear only and for probe frequencies of 4 kHz and above. This result is consistent with the consequences of severe outer hair cell (OHC) damage on the BM response. Elsewhere, however, IO functions showed residual compression, with slopes in the compression region close to normal. This suggests that either the impairment relates mostly to inner hair cell (IHC) dysfunction, or that OHC dysfunction reduces the gain of the BM at low levels while maintaining the degree of maximum compression. The data suggest that the active and the passive BM mechanisms have different relative positions (in frequency) in the apical and the basal regions of the cochlea. Across probe frequencies, the slopes of the TMCs for off-frequency maskers are shallower for the impaired ears. It is considered that this possibly reflects IHC-related compression.

Effects of masker component phase on the forward masking produced by complex tones in normally hearing and hearing-impaired subjects

For normally hearing subjects, harmonic complex tones that give “peaky” waveforms on the basilar membrane (Schroeder-positive phase, sine phase or cosine phase) lead to less forward masking than complex tones that give less peaky waveforms (Schroeder-negative phase or random phase), but have the same power spectrum. This difference has been attributed mainly to the combined effects of peripheral compression and suppression, both of which depend on the operation of the active mechanism in the cochlea. If this explanation is correct, the phase effect should be reduced or absent for subjects with moderate cochlear hearing loss. We measured growth-of-masking functions for forward maskers containing the first 40 harmonics of a 100-Hz fundamental, with components added either in cosine phase or random phase, using both normally hearing subjects and subjects with moderate cochlear hearing loss. The signal frequency was 1 or 2 kHz. For the normally hearing subjects, the mean slopes of the growth-of-masking functions at 1 and 2 kHz, respectively, were 0.53 and 0.44 for the random-phase masker and 0.31 and 0.26 for the cosine-phase masker. For high masker levels, the former produced considerably more masking than the latter. The phase effect was smaller for the hearing-impaired than for the normally hearing subjects, which is consistent with the idea that it is partly caused by peripheral compression and suppression. However, three of the five hearing-impaired subjects showed a significant effect of masker phase for at least one signal frequency. In one case, this occurred when the hearing loss at the signal frequency was 65 dB. The slopes of the growth-of-masking functions were consistently less than one for the hearing-impaired subjects. Further testing suggested that the efferent system was not involved in producing the phase effect.

Phase effects in forward masking for normally hearing and hearing-impaired subjects

The forward masking produced by harmonic complex tones depends on the phases of the masker components; phases giving ‘‘peaky’’ waveforms on the basilar membrane result in less forward masking than phases giving less peaky waveforms. This difference has been attributed to the effects of peripheral compression and suppression, which depend on the active mechanism in the cochlea. Hence, no phase effect would be expected for subjects with moderate cochlear hearing loss. Growth-of-masking functions were measured for forward maskers containing the first 40 harmonics of a 100-Hz fundamental, with components added in cosine (C) or random (R) phase. The signal frequency was 1 or 2 kHz. For three normally hearing subjects, the R masker produced considerably more masking than the C masker, at high masker levels. Of four subjects with moderate cochlear hearing loss, one showed no effect of masker phase, but for the other three there was a significant effect for at least one signal frequency. It is suggested that peripheral compression and suppression play a role in the phase effect, but other factors, possibly depending on the operation of the efferent system, are involved. [Work supported by MRC (UK).]

Phenotype of DFNA11: a nonsyndromic hearing loss caused by a myosin VIIA mutation.

To characterize the audiovestibular phenotype of DFNA11, an autosomal dominant nonsyndromic hearing impairment caused by a mutation in the myosin VIIA gene (MYO7A), including whether DFNA11-affected subjects have retinal degeneration as is characteristic of Usher syndrome type 1B, caused by different MYO7A mutations. Retrospective study of audiovestibular and ophthalmological data in a Japanese family linked to DFNA11. Otoscopic examination and pure-tone audiometry were performed in all participants in the family. Selected subjects underwent additional examinations including speech discrimination scoring, acoustic reflex measurements, Békésy audiometry, evoked and distortion-product otoacoustic emissions, auditory brainstem responses, and bithermal caloric testing; visual acuity, ocular tonometry, slit-lamp examination, ophthalmoscopy, and electroretinography; and computed tomography of the temporal bone. Most affected individuals had moderate cochlear hearing loss beginning in the second decade and progressing at all frequencies. Variable degrees of asymptomatic vestibular dysfunction were present. Computed tomography showed normal inner and middle ear structures. No evidence suggested retinitis pigmentosa. The phenotype of DFNA11 is postlingual, nonsyndromic sensorineural hearing loss with gradual progression. Showing moderate hearing loss with asymptomatic variable vestibular dysfunction and no retinal degeneration, the DFNA11 phenotype is mildest among phenotypes caused by MYO7A mutations.

Temporal modulation transfer functions obtained using sinusoidal carriers with normally hearing and hearing-impaired listeners.

Temporal modulation transfer functions were obtained using sinusoidal carriers for four normally hearing subjects and three subjects with mild to moderate cochlear hearing loss. Carrier frequencies were 1000, 2000 and 5000 Hz, and modulation frequencies ranged from 10 to 640 Hz in one-octave steps. The normally hearing subjects were tested using levels of 30 and 80 dB SPL. For the higher level, modulation detection thresholds varied only slightly with modulation frequency for frequencies up to 80 Hz, but decreased for high modulation frequencies. The decrease can be attributed to the detection of spectral sidebands. For the lower level, thresholds varied little with modulation frequency for all three carrier frequencies. The absence of a decrease in the threshold for large modulation frequencies can be explained by the low sensation level of the spectral sidebands. The hearing-impaired subjects were tested at 80 dB SPL, except for two cases where the absolute threshold at the carrier frequency was greater than 70 dB SPL; in these cases a level of 90 dB was used. The results were consistent with the idea that spectral sidebands were less detectable for the hearing-impaired than for the normally hearing subjects. For the two lower carrier frequencies, there were no large decreases in threshold with increasing modulation frequency, and where decreases did occur, this happened only between 320 and 640 Hz. For the 5000-Hz carrier, thresholds were roughly constant for modulation frequencies from 10 to 80 or 160 Hz, and then increased monotonically, becoming unmeasurable at 640 Hz. The results for this carrier may reflect "pure" effects of temporal resolution, without any influence from the detection of spectral sidebands. The results suggest that temporal resolution for deterministic stimuli is similar for normally hearing and hearing-impaired listeners.

Measurement of the Temporal-Modulation Transfer Function for a Single Listener with Cochlear Hearing Loss and Left-Hemisphere Damage

The modulation depth required for the detection of sinusoidal amplitude-modulation applied to a white noise carrier was measured as a function of modulation frequency, giving temporal modulation transfer functions (TMTFs). Five adult listeners with normal hearing (mean age 52 years), five elderly listeners with moderate cochlear hearing loss (mean age 66 years) and a single elderly listener (aged 73 years) with moderate cochlear hearing loss and left-hemisphere damage were tested in the right ear at 50 dB SL. The five elderly listeners were matched in audiogram with the brain-damaged listener. Modulation detection was systematically poorer than normal in the five elderly listeners with cochlear hearing loss. However, their TMTFs were lowpass in shape, as for the five normal-hearing adult listeners. Modulation detection was much poorer in the elderly listener with cochlear hearing loss and left-hemisphere damage compared to the five normal-hearing adults and the five elderly listeners with cochlear hearing loss. Moreover, modulation detection was poorer at 4, 64 and 128 Hz than at 8, 16 and 32 Hz in the brain-damaged listener, giving his TMTF a bandpass appearance. These results are in agreement with the hypothesis that the main factors limiting the ability to detect changes in the temporal-envelope of sounds are located at a central (retro-cochlear) level of the auditory system rather than at a peripheral (cochlear) level. They also suggest that the TMTF approach may prove useful in distinguishing peripheral and central hearing losses.

Evidence for the distortion product frequency place as a source of distortion product otoacoustic emission (DPOAE) fine structure in humans. II. Fine structure for different shapes of cochlear hearing loss.

Distortion product otoacoustic emissions (DPOAE) were recorded from eight human subjects with mild to moderate cochlear hearing loss, using a frequency spacing of 48 primary pairs per octave and at a level L1 = L2 = 60 dBSPL and with a fixed ratio f2/f1. Subjects with different shapes of hearing thresholds were selected. They included subjects with near-normal hearing within only a limited frequency range, subjects with a notch in the audiogram, and subjects with a mild to moderate high-frequency loss. If the primaries were located in a region of normal or near-normal hearing, but DP frequencies were located in a region of raised thresholds, the distortion product 2 f1-f2 was still observable, but the DP fine structure disappeared. If the DP frequencies fell into a region of normal thresholds, fine structure was preserved as long as DPOAE were generated, even in cases of mild hearing loss in the region of the primaries. These experimental results give further strong evidence that, in addition to the initial source in the primary region, there is a second source at the characteristic place of fDP. Simulations in a nonlinear and active computer model for DPOAE generation indicate different generation mechanisms for the two components. The disappearance of DPOAE fine structure might serve as a more sensitive indicator of hearing impairment than the consideration of DP level alone.

Gap detection with sinusoids and noise in normal, impaired, and electrically stimulated ears.

Thresholds for the detection of temporal gaps were measured using two types of signals to mark the gaps: bandpass-filtered noises and sinusoids. The first experiment used seven subjects with relatively flat unilateral moderate cochlear hearing loss. The normal ear of each subject was tested both at the same sound-pressure level (SPL) as the impaired ear, and at the same sensation level (SL). Background noise was used to mask spectral "splatter" associated with the gap. For the noise markers, gap thresholds tended to be larger for the impaired ears than for the normal ears when the comparison was made at equal SPL; the difference was reduced, but not eliminated, when the comparison was made at equal SL. Gap thresholds for both the normal and impaired ears decreased as the center frequency increased from 0.5 to 2.0 kHz. For the sinusoidal markers, gap thresholds were often similar for the normal and impaired ears when tested at equal SPL, and were larger for the normal ears when tested at equal SL. Gap thresholds did not change systematically with frequency. Gap thresholds using sinusoidal markers were smaller than those using noise markers. In the second experiment, three subjects with single-channel cochlear implants were tested. Gap thresholds for noise bands tended to increase with increasing center frequency when the noise bandwidth was fixed, and to decrease with increasing bandwidth when the center frequency was fixed. Gap thresholds for sinusoids did not change with center frequency, but decreased markedly with increasing level. Gap thresholds for sinusoids were considerably smaller than those for noise bands.(ABSTRACT TRUNCATED AT 250 WORDS)