Audiological Test Results Research Articles

Bilateral Vocal Cord Paralysis after Disc Battery Ingestion

ing head injury (in 63.5% of patients the tinnitus disappeared after vasoactive treatment), but in other groups tinnitus persisted in many cases - in 80% of patients after acoustic trauma, in 78% of patients after infection, and in 75% of patients after diving. CONCLUSION: The results of audiological tests in children with tinnitus were very variable. The tinnitus patients with head injuries usually had a large hearing loss (amounting to 35 to 80 dB across the whole frequency range) and unrecordable or very small otoacoustic emissions. In other tinnitus groups, hearing loss did not exceed 20 dB in any ear and evoked otoacoustic emissions (TEOAE, DPOAE) were either equal to or only slightly smaller than those measured in aged-matched controls. SOAE were present in 1/3 of ears regardless of the tinnitus group. The results of audiological tests in children with tinnitus demonstrate only a limited correlation with the origin of the tinnitus.

From hearing screening to cochlear implantation: cochlear implants in children under 3 years of age

Conclusions. Universal hearing screening gives a deaf child earlier diagnosis and intervention with a better chance for successful management of hearing and speech development. Objectives. Universal newborn hearing screening has a major impact on early identification of deafness in children. This study evaluated the outcome of cochlear implantation in screened and non-screened deaf children. Subjects and methods. Group 1 comprised 9 deaf children diagnosed by screening; group 2 comprised 21 children diagnosed by traditional methods. The following parameters were evaluated: age at the time of diagnosis, age at the time of the first hearing aid fitting, age at the time of cochlear implantation. In children who had been using a cochlear implant for more than 2 years the results of audiological tests, category of auditory performance (CAP), and development and quality of speech were also evaluated. Results. Hearing screening significantly reduced the age at the time of diagnosis (6.9 months vs 15.4 months) as well as the age at the time of the first hearing aid fitting (9.3 months vs 17 months) and age at the time of cochlear implantation (26 months vs 32 months). Children from the screening program had better results in speech audiometry (95% discrimination vs 84%), monosyllabic tests (62% vs 34%), CAP (level 6 vs level 5), evaluation of spontaneous speech (level 6 vs level 5), and intelligibility of speech (level 5 vs level 3.5). According to the statistical evaluation (Fisher's test) the functional results did not show significant difference.

Auditory processing disorders, verbal disfluency, and learning difficulties: A case study

This case study reports the findings of auditory behavioral and electrophysiological measures performed on a graduate student (identified as LN) presenting verbal disfluency and learning difficulties. Results of behavioral audiological testing documented the presence of auditory processing disorders, particularly temporal processing and binaural integration. Electrophysiological test results, including middle latency, late latency and cognitive potentials, revealed that LN's central auditory system processes acoustic stimuli differently to a reference group with normal hearing.

Audio‐Vestibular Disturbance in Patients With Behçet's Disease

The present study prospectively investigated the frequencies and characteristics of audio-vestibular disturbance and the results of audiologic and vestibular function tests in patients with Behçet's disease. A prospective study. Seventeen patients with Behçet's disease (mean age 41.2 [30-56] years, 5 males and 12 females), as well as age- and sex-matched healthy controls, were included in this study. All subjects satisfied the diagnostic criteria of the International Study Group for Behçet's Disease. Information on the subjects was obtained through questionnaires. Tests, including those for hearing impairment, tinnitus, ear fullness, and dizziness, pure-tone audiometry, and vestibular function, were performed. Auditory symptoms were reported by 7 (41.2%) and dizziness by 14 (82.4%) of the subjects. Sensorineural hearing loss was present in four (23.5%) subjects. One was treated with a cochlear implantation because of bilateral sudden deafness. Spontaneous nystagmus was detected in two (11.8%) subjects. Abnormal findings were noted in 1 (5.9%) in saccadic movement, 5 (29.4%) in the bithermal caloric tests, and 10 (58.9%) in the rotation chair tests. In total, audiologic or vestibular disturbance were noted in 16 (94.1%) of the subjects. However, audio-vestibular abnormalities were not noted in the healthy controls. Audio-vestibular disturbance is not rare in Behçet's disease patients compared with healthy controls. We believe that audio-vestibular assessment and management may be helpful for the diagnosis and treatment of patients with Behçet's disease.

Progressive Sensorineural Hearing Impairment in Maternally Inherited Diabetes Mellitus and Deafness (MIDD)

To study the progression of hearing impairment (HI) and audiological features in patients with the mitochondrial A to G mutation in the tRNA(LEU(RUU)) gene at position 3,243 associated with maternally inherited diabetes and deafness. Retrospective phenotype genotype family study. Tertiary referral center. Six adult family members with the mitochondrial tRNA(LEU(RUU)) gene mutation at location 3,243. Data were obtained on medical history, otological examination, and pure tone and speech audiometry. Peripheral leukocytes were analyzed for the presence of the mutation, and heteroplasmy levels were determined. Selected patients underwent vestibular testing, brainstem-evoked response audiometry and neurological examination. One patient showed relatively normal hearing, whereas in the others, HI had started at 27 to 79 years of age. All the patients showed progression in HI of approximately 1.4 dB/yr on average at 0.25 and 8 kHz. In the frequency range 0.5 to 2 kHz, progression was approximately 2 dB/yr; at 4 kHz, progression was 2.4 dB/yr. Vestibular and brainstem-evoked response audiometry test results were normal. All the patients achieved the maximum speech recognition score, as was expected based on their pure-tone average at 1, 2, and 4 kHz. Our six adult patients with the mitochondrial tRNA(LEU(RUU)) gene mutation at location 3,243 showed almost normal to severe HI which was progressive beyond presbyacusis. Data from the literature and our findings suggest a cochlear localization of the HI.

Neurotological and Neuroanatomical Changes in the Connexin-26-Related HID/KID Syndrome

The phenotype of the HID (hystrix-like ichthyosis, deafness)/KID (keratitis, ichthyosis, deafness) syndrome is primarily characterized by skin changes. However, the connexin 26 (Cx 26) autosomal dominant mutation underlying this syndrome is of special neurotological interest. In the present paper, the clinical pattern, audiovestibular and neuroimaging findings and the detailed genetic analysis of 4 patients with identical HID/KID-associated mutation D50N of Cx 26 are reported. The audiological test results demonstrated profound sensorineural hearing loss in all of the patients. Neurotological testing revealed inconsistent abnormalities in dynamic posturography (sensory organization test), but the vestibular ocular reflex upon caloric irrigation was normal in all patients. Vestibular-evoked myogenic potential testing for otolith function (saccule) showed a regular response in 1 patient and pathologic responses in 3 patients, while subjective haptic vertical (utricular function) testing was normal in all of the patients. CCT showed an extended (in length), but very thin (in diameter) bony lining between the basal portion of the internal auditory canal and the vestibule in the 3 scanned patients. Our study provides evidence for functionally intact semicircular canals and normal utricular function in subjects with the autosomal dominant D50N mutation of Cx 26, in contrast to saccular function which was generally compromised and hearing loss which was profound.

Prevalence and audiological characteristics in individuals with auditory neuropathy/auditory dys-synchrony

The objectives of this study were to (a) estimate the prevalence of auditory dys-synchrony in Mysore, a city of one million population in Southern India and, (b) present the results of audiological testing of this clinical population as well as the relationship between these figures. A register-based study design was employed wherein the results of audiological tests of all patients who visited the Department of Audiology, All India Institute of Speech and Hearing between January 2000 and December 2003 were reviewed. Results showed that the prevalence of auditory dys-synchrony was around 1 in 183 in individuals with sensory neural hearing loss. Behavioural thresholds and speech identification scores were variable. Around 60% of the individuals had no measurable speech identification scores. There was no relation between the hearing thresholds and speech identification scores or between otoacoustic emissions and speech identification scores. These results indicate that auditory dys-synchrony is not an extremely rare disorder.

Cerebellopontine Angle Meningiomas

Object. The aim of this study was to analyze a subgroup of patients harboring cerebellopontine angle meningiomas originating from the posterior petrous bone in regard to clinical presentation, surgical anatomy, complications, and long-term functional postoperative results. Methods. Data in a series of 51 patients with meningiomas of the posterior petrous bone who had undergone microsurgical treatment at the authors' institution between 1989 and 2002 were retrospectively reviewed. The patient population consisted of 46 women and five men with a mean age of 53 years (range 22-70 years). The main symptom on first admission was impaired hearing in 41%, dizziness in 20%, and tinnitus in 18% of the patients. Results of physical examination and audiological testing revealed hypacusis in 65% of patients, cerebellar ataxia in 31%, and impairment of the fifth cranial nerve in 26%. All patients underwent surgical treatment via a lateral suboccipital approach. Intraoperatively, the tumor was found to be attached to the postmeatal dura in 37%, the premeatal dura in 27.5%, the suprameatal dura in 19.6%, the inframeatal dura in 7.8%, and centered on the porus acusticus in 5.9% of cases. Tumor extension into the internal acoustic meatus was present in seven patients. Tumor resection was categorized as Grade I in 14 patients, Grade II in 29, Grade III in six, and Grade IV in two patients, according to the Simpson classification system. The site of displacement of the cranial nerves was predictable in up to 84% of patients, depending on the dural origin of the tumor as depicted on preoperative magnetic resonance (MR) imaging studies. Postoperatively, a new and permanent facial paresis was observed in five patients (9.8%). In 38 patients in whom both pre- and postoperative audiological data were available, hearing function deteriorated after surgery in 18.4% and improved in 7.9%. Clinical and MR imaging postsurgical data from a mean period of 5.8 years (range 13 months-13 years) were available in all patients. Forty-four patients (86%) resumed normal daily activity. Tumor recurrence was observed in two patients (3.9%), and both underwent a second surgery. Conclusions. Preoperative detailed analysis of MR imaging data gives the surgeon a clue about the dislocation of critical neurovascular structures, particularly the cranial nerves. Nonetheless, the exact relationship of the cranial nerves to the tumor (dislocation, adherence, infiltration, and splaying of nerves) can only be fully appreciated during surgery.

Cerebellopontine Angle Meningiomas

Object. The aim of this study was to analyze a subgroup of patients harboring cerebellopontine angle meningiomas originating from the posterior petrous bone in regard to clinical presentation, surgical anatomy, complications, and long-term functional postoperative results. Methods. Data in a series of 51 patients with meningiomas of the posterior petrous bone who had undergone microsurgical treatment at the authors' institution between 1989 and 2002 were retrospectively reviewed. The patient population consisted of 46 women and five men with a mean age of 53 years (range 22-70 years). The main symptom on first admission was impaired hearing in 41%, dizziness in 20%, and tinnitus in 18% of the patients. Results of physical examination and audiological testing revealed hypacusis in 65% of patients, cerebellar ataxia in 31%, and impairment of the fifth cranial nerve in 26%. All patients underwent surgical treatment via a lateral suboccipital approach. Intraoperatively, the tumor was found to be attached to the postmeatal dura in 37%, the premeatal dura in 27.5%, the suprameatal dura in 19.6%, the inframeatal dura in 7.8%, and centered on the porus acusticus in 5.9% of cases. Tumor extension into the internal acoustic meatus was present in seven patients. Tumor resection was categorized as Grade I in 14 patients, Grade II in 29, Grade III in six, and Grade IV in two patients, according to the Simpson classification system. The site of displacement of the cranial nerves was predictable in up to 84% of patients, depending on the dural origin of the tumor as depicted on preoperative magnetic resonance (MR) imaging studies. Postoperatively, a new and permanent facial paresis was observed in five patients (9.8%). In 38 patients in whom both pre- and postoperative audiological data were available, hearing function deteriorated after surgery in 18.4% and improved in 7.9%. Clinical and MR imaging postsurgical data from a mean period of 5.8 years (range 13 months-13 years) were available in all patients. Forty-four patients (86%) resumed normal daily activity. Tumor recurrence was observed in two patients (3.9%), and both underwent a second surgery. Conclusions. Preoperative detailed analysis of MR imaging data gives the surgeon a clue about the dislocation of critical neurovascular structures, particularly the cranial nerves. Nonetheless, the exact relationship of the cranial nerves to the tumor (dislocation, adherence, infiltration, and splaying of nerves) can only be fully appreciated during surgery.

Neurotological status in Behçet’s disease and its ophthalmological correlates

Objective: To assess neurotological status and its ophthalmological correlates in Behçet’s disease. Study design: A cross sectional study in which 17 patients with Behçet’s disease and 13 healthy controls were...

Meningiomas of the posterior petrous bone: functional outcome after microsurgery.

The aim of this study was to analyze a subgroup of patients harboring cerebellopontine angle meningiomas originating from the posterior petrous bone in regard to clinical presentation, surgical anatomy, complications, and long-term functional postoperative results. Data in a series of 51 patients with meningiomas of the posterior petrous bone who had undergone microsurgical treatment at the authors' institution between 1989 and 2002 were retrospectively reviewed. The patient population consisted of 46 women and five men with a mean age of 53 years (range 22-70 years). The main symptom on first admission was impaired hearing in 41%, dizziness in 20%, and tinnitus in 18% of the patients. Results of physical examination and audiological testing revealed hypacusis in 65% of patients, cerebellar ataxia in 31%, and impairment of the fifth cranial nerve in 26%. All patients underwent surgical treatment via a lateral suboccipital approach. Intraoperatively, the tumor was found to be attached to the postmeatal dura in 37%, the premeatal dura in 27.5%, the suprameatal dura in 19.6%, the inframeatal dura in 7.8%, and centered on the porus acusticus in 5.9% of cases. Tumor extension into the internal acoustic meatus was present in seven patients. Tumor resection was categorized as Grade I in 14 patients, Grade II in 29, Grade III in six, and Grade IV in two patients, according to the Simpson classification system. The site of displacement of the cranial nerves was predictable in up to 84% of patients, depending on the dural origin of the tumor as depicted on preoperative magnetic resonance (MR) imaging studies. Postoperatively, a new and permanent facial paresis was observed in five patients (9.8%). In 38 patients in whom both pre- and postoperative audiological data were available, hearing function deteriorated after surgery in 18.4% and improved in 7.9%. Clinical and MR imaging postsurgical data from a mean period of 5.8 years (range 13 months-13 years) were available in all patients. Forty-four patients (86%) resumed normal daily activity. Tumor recurrence was observed in two patients (3.9%), and both underwent a second surgery. Preoperative detailed analysis of MR imaging data gives the surgeon a clue about the dislocation of critical neurovascular structures, particularly the cranial nerves. Nonetheless, the exact relationship of the cranial nerves to the tumor (dislocation, adherence, infiltration, and splaying of nerves) can only be fully appreciated during surgery.

Pathophysiological Changes of the Central Auditory Pathway after Blunt Trauma of the Head

It is the aim of the present paper to correlate clinical symptoms of auditory dysfunction (tinnitus, hyperacusis, hearing loss) one year on average after a blunt trauma of the head with objective audiological test results (otoacoustic emission and auditory brainstem response testing, impedance audiometry) and to compare these findings to controls without history of head trauma. Thirty-one patients (24-56 years) were included. They were largely female (n = 26). The clinical and otolaryngological examination (including otoscopy) of all patients revealed no pathological abnormalities. Pure-tone audiograms were normal with one exception (pre-existing noise-induced hearing loss) as well as tympanograms. The main auditory symptoms were tinnitus (n = 9), hyperacusis (n = 2) and a reported transient hearing loss immediately after the trauma (n = 16) (which had improved at the time of examination). The results of testing the central auditory pathway showed that the transiently evoked otoacoustic emissions (otoemissions) revealed statistically significant differences between amplitude differences of all patients as well as patients with tinnitus and controls in the linear, but not in the non-linear stimulation mode. A complete loss of stapedial reflex responses was found in 12 of the patients and a partial (irregular) loss (in at least more than two frequencies) in four additional patients. Auditory brainstem responses (ABR) were normal in all patients, but 76% had lowered loudness discomfort levels (LDL). Blunt trauma of the head can lead to auditory dyfunction, probably as a result of diffuse axonal injury of the central auditory pathway. An initial sensorineural hearing loss after the trauma (as a result of the inner ear fluid concussion) was transiently reported only. Auditory symptoms play a minor role in the so-called "postconcussive syndrome," but should be considered and evaluated fully.

Effects of a Single Session of Hemodialysis on Hearing Abilities

A prospective study was designed to evaluate the effects of a single session of hemodialysis on the parameters of hearing. We carried out serial audiological tests (tympanometry, pure-tone, speech and high frequency audiometry) in 19 patients with chronic renal failure undergoing hemodialysis. Tests were performed on patients 1 h before and 2 and 24 h after a randomly selected session of hemodialysis. The results of audiological tests indicated no significant adverse effect of a single session of hemodialysis on hearing.

Two families with phenotypically different hereditary low frequency hearing impairment: longitudinal data and linkage analysis.

Two families with low frequency hearing impairment have been described previously. Family A (Danish) presented a sensorineural hearing impairment most pronounced for frequencies below 2 kHz and a pedigree typical for an autosomal dominant trait with complete penetrance (Königsmark type). Family B, originating from the Faroe Islands, showed conflicting audiological test results, making a valid classification impossible. The pedigree suggested autosomal dominant inheritance with incomplete penetrance. The objectives of the present study are to acquire longitudinal audiometric data, to clarify the mode of transmission, and to localize the mutant gene by reevaluation of the two families. The methods used are evaluation of the family history, audiological examination and linkage analysis. In family A, update of the pedigree fitted the assumption of an autosomal dominant mode of transmission. In six examined subjects audiological data were available from the previous study. The median progression over a 13-21-year period was 13.8 dB HL for the thresholds, averaged across 0.5, 1, 2 and 4 kHz and 17.5 dB HL for the thresholds, averaged across 2 and 4kHz. In family B, the probable mode of transmission is autosomal dominant with reduced penetrance. In this family no progression of the hearing impairment was found. Linkage analysis of family A showed a lod score of 3.53, indicating significant linkage to the loci DFNA6 and DFNA14 on chromosome 4, previously found to be involved in low frequency hearing impairment. Family B was not linked to the region on chromosome 4, further adding to the genetic heterogeneity in low frequency sensorineural hearing impairment.

Outcomes after Laser Stapedotomy with and without Preservation of the Stapedius Tendon

Our goal was to investigate the postoperative differences in hearing between patients who had their stapedius tendon sacrificed and those whose stapedius tendon was preserved during laser stapes surgery for otosclerosis. To that end, we performed a retrospective review by mailing extensive questionnaires to patients who had been operated on between 1994 and 1997. We also performed routine and special audiometric testing to augment the subjective data. Seventy-nine of 124 questionnaires (64%) were returned. Of the respondents, 75 patients had undergone additional pre- and/or postoperative audiometric testing, including tests to evaluate "hearing in noise" and to determine the "uncomfortable loudness level" (dynamic range). We found no statistically significant differences between the two groups with respect to their subjective responses and their audiologic test results. The responses to the questionnaire indicated that in most cases, hearing was improved by stapes surgery. We conclude that the stapedius tendon should be preserved whenever possible during stapes surgery, provided that it does not jeopardize the exposure or outcome.

Stapes surgery in a residency training program.

Determine parameters for successful stapedectomy and whether this procedure can be performed safely by residents in a teaching hospital. Retrospective analysis of techniques and results for 71 stapedectomy procedures. Charts were reviewed for technique, audiological test results, complications, operative time, and anesthetic used. Overall, closure of the air-bone gap at 10 dB was achieved in 87% of patients. Use of general anesthesia and a laser-assisted, small-fenestra technique allowed residents to complete more operations. No severe sensorineural hearing loss was noted. Residents can safely and successfully perform stapes surgery using a laser-assisted, small-fenestra technique.

小脳橋角部腫ようの臨床的検討

Clinical studies of forty cerebellopontine angle tumors including thirty-one vestibular schwannomas were performed. The results of audiological and radiological testing were analyzed and screening methods for Cerebellopontine angle tumors were evaluated. Although auditory brainstem response (ABR) tests reveal the highest positive rate of detection in vestibular schwannoma patients, ABR tests are difficult to perform routinely in hospitals, especially in private clinics. The combination of conventional radiographs (Stenvers views) and caloric tests had a higher positive rate of detection than ABR tests, whereas these testing methods alone both had lower positive rates. Our data shows the high efficiency of routine radiographs and caloric tests for detection of patients with suspected acoustic neurinomas. Further evaluation including ABR tests and magnetic resonance imaging (MRI) should be performed after initial testing. In our study, all of the other cerebellopontine angle tumors showed abnormalities in ABR tests. ABR tests are also efficient in the investigation of patients with other cerebellopontine angle tumors.

Ménière's disease and autoimmunity.

Identifying the etiopathogenesis of MtniBre’s disease (MD) has been the object of several studies since Prosper MCnikre first described the main symptoms of this disease in 1861 : fluctuating hearing loss, vertigo, and tinnitus. Endolymphatic hydrops is considered the main pathological finding associated with MD and a good deal of research has been directed toward the identification and understanding of its underlying mechanisms. Because the sensory neural elements of the inner ear cannot be visualized in their diseased state in vivo, diagnosis of MD has been based mainly on the evaluation of the clinical symptoms and results of audiological tests. Since Rask-Andersen and Stahle’ first recognized the inner ear as having an immunological function, several authors have added their support to the idea of a multifactorial origin by hypothesizing a possible role of the immunological system in MD pathogenesis. In fact, in 1983 Shea described the possible role of autoimmune mechanisms in patients with typical MD who responded favorably to steroid treatment or plasmapheresis.* Immunohistochemical studies also revealed the presence of an immunological reaction within the inner-ear tissues, such as stria vascularis, supporting connective tissues and blood vessels, in only a small number of patients inve~tigated.~-~ Although these studies are certainly affected by technical problems mainly linked to tissue preservation and processing, they are still suggestive of the idea that certain types of MD are caused by immunological factors of the inner ear. Immune inner-ear disease is a comparatively new area of clinical research, and over time different immunological reactions have been recognized and this has led to the introduction of several laboratory tests in the clinical evaluation of these patients. The pathogenetic mechanisms underlying inner-ear disorders seem to be mainly due to either type 2 cytotoxic interaction of autoantibodies with tissue-bond antigen or a type-3 IgGand IgM-mediated reaction that creates circulating immune complexes. The generic mechanism inducing tissue damage is a specific T-cell clonal expansion, specific autoantibody formation, complement cascade activation with inflammatory cell recruitment. Inner-ear damage and the resultant symptoms could depend upon the type of antigen and tissues as well as the anatomical site involved in the inflammatory reaction, which could be critical in determining endolymphatic hydrops. One of the main issues is the factor that triggers a Tand B-lymphocytes reaction and the production of autoantibodies against inner-ear structure in patients with

Benign Recurrent Vertigo—True or Artificial Diagnosis?

The etiology of many diseases involving vertigo is still unknown although the same etiologic factors have been suggested for several diseases. In most cases the diseases are diagnosed on the basis of exclusion—other possible causes being ruled out before the diagnosis can be confirmed. Benign recurrent vertigo (BRV) has been defined as spells of vertigo characteristic of Menieres disease without auditory or clinical neurologic symptoms and signs. The etiology of this condition is also unknown. BRV has been linked to migraine and viral diseases. In a prospective study we collected the clinical history and the signs and results of neurotologic and audiologic tests from 33 patients with a BRV diagnosis. The clinical characteristics truly mimicked the vertigo seen in Menieres disease. The concept of vestibular Menieres disease is not widely accepted, and without auditory signs BRV is the only diagnosis that can be given to these patients. In other studies up to 25% of the patients initially diagnosed with BRV subsequently developed another peripheral vestibular disorder. Until the etiology of diseases involving vertigo is more clearly understood, artificial diagnoses like BRV, must be accepted.

Evaluation of the E2L Toy Test as a screening procedure in clinical practice

Early identification of hearing loss in young children is essential in order to avoid the potentially disabling effects of deafness. This necessitates effective screening measures with proven positive predictive value (McCormick 1977, 1988; Mahon et al., 1993). Previous studies (Marcuson et al., 1988; Bellman and Marcuson, 1991) have indicated that the E2L Toy Test, designed as a word discrimination test for evaluating the hearing of children who have English as a second language (E2L), could be such a measure. The results of diagnostic audiological testing, including the E2L test, are reported in 264 children. Comparison of E2L results with audiometric testing shows the E2L test to have a sensitivity of 87% and specificity of 90% in identifying children with an average hearing threshold of greater than 25 dB HL (and 78% sensitivity: 94% specificity where the average hearing threshold level is above 20 dB HL). This is the case for both E2L children and for children whose first language is English, suggesting that the E2L Toy Test would be useful in hearing screening test batteries throughout the UK. The results of screening hearing using the E2L Toy Test in 500 children aged 2-7 years from a wide geographical area in the UK are also presented.