Routine Audiological Tests Research Articles

Audiological and Other Factors Predicting the Presence of Misophonia Symptoms Among a Clinical Population Seeking Help for Tinnitus and/or Hyperacusis.

This paper evaluates the proportion and the audiological and other characteristics of patients with symptoms of misophonia among a population seeking help for tinnitus and/or hyperacusis at an audiology clinic (n = 257). To assess such symptoms, patients were asked “over the last 2 weeks, how often have you been bothered by any of the following problems? Feeling angry or anxious when hearing certain sounds related to eating noises, lip-smacking, sniffling, breathing, clicking sounds, tapping?”. The results of routine audiological tests and self-report questionnaires were gathered retrospectively from the records of the patients. Measures included: pure tone audiometry, uncomfortable loudness levels (ULLs), and responses to the tinnitus impact questionnaire (TIQ), the hyperacusis impact questionnaire (HIQ), and the screening for anxiety and depression in tinnitus (SAD-T) questionnaire. The mean age of the patients was 53 years (SD = 16) (age range 17 to 97 years). Fifty four percent were female. Twenty-three percent of patients were classified as having misophonia. The presence and frequency of reporting misophonia symptoms were not related to audiometric thresholds, except that a steeply sloping audiogram reduced the likelihood of frequent misophonia symptoms. Those with more frequent misophonia symptoms had lower values of ULLmin (the across-frequency average of ULLs for the ear with lower average ULLs) than those with less frequent or no reported symptoms. The reported frequency of experiencing misophonia symptoms increased with increasing impact of tinnitus (TIQ score ≥9), increasing impact of hyperacusis (HIQ score >11), and symptoms of anxiety and depression (SAD-T score ≥4). It is concluded that, when assessing individuals with tinnitus and hyperacusis, it is important to screen for misophonia, particularly when ULLmin is abnormally low or the TIQ, HIQ or SAD-T score is high. This will help clinicians to distinguish patients with misophonia, guiding the choice of therapeutic strategies.

The comprehensive audiological evaluation in young violinists: the medial olivocochlear system, high frequency thresholds, and the auditory figure ground test.

The aim of this study was to examine whether the medial olivocochlear hearing system functions, the high frequency hearing thresholds and speech discrimination in noise performance can guide us in assessing the risk of hearing loss among violinists. It is aimed to investigate possible hearing damage that is not reflected in pure tone hearing thresholds in violinists. The participants (n = 50) who have normal hearing and the ages of 18-30 were included in this study in two groups: violinists and controls who are unrelated to music. High frequency audiometer, auditory figure ground test (AFG) for speech discrimination in noise performance, Distortion Product Otoacoustic Emission (DPOAE) and contralateral suppression on DPOAE for medial olivocochlear system function tests were applied to all participants as well as routine audiological tests. The high frequency hearing thresholds were obtained higher in violinists compared to the controls. In violinists, the AFG test scores and the suppression amount at 1kHz were lower than the controls. In addition, DPOAE responses at 4-6kHz were obtained lower in violinists (p < 0.05). The reason for high frequency hearing loss, decreased DPOAE response amplitudes, and poor medial olivocochlear function in violinists can be explained by the long-term exposure to high-level noise caused by the violin, one of the closest musical instruments. Routine and comprehensive audiological follow-up is crucial for musicians.

Ambient Pressure Tympanometry Wave Patterns in Patients With Superior Semicircular Canal Dehiscence.

Importance: Superior semicircular canal dehiscence (SSCD) is a treatable condition, but current diagnostic modalities have numerous limitations. Clinicians would benefit from an additional tool for diagnostic workup that is both rapid and widely available.Objective: To assess the utility of ambient pressure tympanometry (APT) in the diagnostic workup of SSCD by determining the sensitivity and specificity of APT for SSCD in comparison to other diagnostic modalities.Design: Retrospective cohort study of patients who underwent APT and temporal bone computerized tomography (CT) scans from May 2017 to July 2018.Setting: Tertiary referral center.Participants: APT was performed as part of routine audiological testing on adult patients. We retrospectively analyzed all patients who received both APT and temporal bone CT scans, and divided ears into SSCD and non-SSCD groups based on the presence or absence of radiographic SSCD. Ears with other radiographic findings that could affect tympanic membrane compliance were excluded.Exposures: All patients in this study underwent APT and temporal bone CT scans. Some patients also underwent pure tone audiometry and vestibular evoked myogenic potentials (VEMPs).Main Outcomes and Measures: The primary outcome measures were sensitivity, specificity, and risk ratio of APT for SSCD. Secondary outcome measures include sensitivity of VEMPs and supranormal hearing thresholds.Results: We describe 52 patients (70 ears) who underwent APT and CT imaging (mean age 47.1 years, 67.1% female). APT detected SSCD with 66.7% sensitivity and 72.1% specificity. In symptomatic patients, sensitivity was 71.4% and specificity was 75%. VEMPs performed best at detecting SSCD when defining a positive test as oVEMP amplitude >17 μV, with a sensitivity of 68.2%, similar to APT (p > 0.99). The combination of APT and VEMPs increased sensitivity to 88.9%, better than APT alone (p = 0.031) and trending toward better than VEMPs alone (p = 0.063).Conclusions and Relevance: Rhythmic wave patterns on APT are associated with SSCD and may raise suspicion for this condition in conjunction with consistent results on other diagnostic modalities. Although clinical utility requires confirmation in a larger prospective study, APT is a simple, rapid, and widely available tool warranting further study.

Rhythmic Wave Patterns on Ambient Pressure Tympanometry in Patients With Objective Tinnitus-associated Pathologies.

To introduce the concept of ambient pressure tympanometry (APT) and its association with pathologies that may present with objective tinnitus. Retrospective case series. Tertiary referral center. Audiologists performed APT on adult patients as part of routine audiological testing. Ears with myoclonus and patulous Eustachian tube (PET) were identified via review of patient history and physical examination. All other conditions were verified via computed tomography (CT) temporal bone imaging. Ears with conditions that could impair tympanic membrane compliance, such as otosclerosis or tympanic membrane perforation, were excluded. APT findings were analyzed via a novel algorithm. A radiographic finding associated with objective tinnitus was confirmed in 67 ears that underwent CT imaging; 45 (67%) of these ears displayed rhythmic APT wave patterns. These included 28 ears with superior semicircular canal dehiscence, 4 ears with sigmoid sinus dehiscence, 6 ears with internal carotid artery dehiscence, 4 ears with glomus tumor, and 3 ears with encephalocele. In addition, we identified three ears with myoclonus and one ear with PET. In a subset of 30 ears with objective tinnitus symptoms that underwent CT imaging, 22 displayed rhythmic waves; of these 22 ears, 20 (91%) had a radiographic finding associated with objective tinnitus. Rhythmic APT wave patterns are common and may be associated with numerous temporal bone pathologies that may present with objective tinnitus. APT is a simple, rapid, and widely available tool that warrants further study to determine its value in screening of these otologic conditions.

Gender differences in audio-vestibular disorders.

In the last years, the attention to the role of gender in physiopathology and pharmacology of diseases in several medical disciplines is rising; however, the data on the relationship between gender and audio-vestibular disorders are still inconclusive and sometimes confusing. With this letter to the editor, we would like to review the role of gender in audio-vestibular disorders. Literature data show that anatomic variances of the inner ear do exist in men and women and that the different physiology and/or hormonal influence between genders could produce different clinical outcome of routine audiological and vestibular tests. Beyond the epidemiological gender-related differences, the clinical data suggest that the gender has a potential role as an etiopathogenetic factor in audio-vestibular disorders and it is probably responsible for the different clinical features observed between male and female subjects.

Evaluation of Saccule Function in Patients with Vitamin D Deficiency.

Background and ObjectivesConsidering important role of vitamin D in many physiological processes including vestibular system in the ear, aim of present study is to evaluate saccule function via cervical vestibular evoked myogenic potential (cVEMP), in patients with vitamin D deficiency.Subjects and MethodsAfter routine audiological tests, cVEMP were recorded in 15 patients with vitamin D deficiency and 16 normal subjects. The short tone burst (95 dB nHL, 500 Hz) was presented to ears. cVEMP was recorded with surface electromyography over the contracted ipsilateral sternocleidomastoid muscle.ResultsMean of p13, n13, interpeak latencies and amplitude ratios were measured in both groups. Statistical analysis did not show differences between two groups.ConclusionsMaybe serum 25-hydroxyvitamin D concentration was not low enough to have effect on saccule in the patients in present study or saccule have had low susceptibility to effects of vitamin D deficiency. For better judgment about effect of vitamin D deficiency on saccular function planning studies with high sample size is recommended.

PromBERA: A preoperative eABR: An update

Abstract Prior to cochlear implantation, audiological tests are performed to determine candidacy in subjects with a hearing loss. This is usually done by measuring the acoustic auditory brainstem response (ABR). Unfortunately, for some subjects, a reproducible ABR recording cannot be obtained, even at high acoustic levels. Having a healthy stimulating auditory nerve is required for cochlear implantation in order to benefit from the electrical pulses that are generated by the implant and to improve speech comprehension. In some subjects, this prerequisite cannot be measured using routine audiological tests. In this study, the feasibility of recording electrically evoked auditory brainstem responses (eABR) using a stimulating transtympanic electrode, placed on the round window niche, together with MED-EL clinical system is investigated. The results show that it is possible to record reproducible eABR measurements using PromBERA. The response was also confirmed with intraoperative eABR measurements that were stimulated using the implanted CI electrode array. Similarities between the intraoperative measurements and the preoperative recorded waveforms were observed. In summary, the integrity and excitability of the auditory nerve can be objectively measured using the PromBERA in subjects where standard clinical testing procedures are unable to provide the information required.

Normative data for diagnosing auditory processing disorder in Norwegian children aged 7–12 years

Objective: The main purpose of this research was to obtain normative data for auditory processing tests for Norwegian speaking children. Design: Participants were administered routine audiological tests and an auditory processing test-battery consisting of Filtered Words, Competing Words, Dichotic Digits, Gaps In Noise, Duration– and Frequency Pattern, Binaural Masking Level Difference and HIST Speech in Noise test. A group of 10-year-old children were retested after two weeks. The effects ear, age and gender and the test–retest reliability were investigated. Study sample: There were 268 normal hearing children aged 7–12 years who participated in the study. Results: Results revealed no differences between genders. The children showed improving performance by age on all tests, except from the Gaps In Noise and Binaural Masking Level Difference. As expected, the children showed a right ear advantage on dichotic speech tests that decreased with age. The test–retest reliability for the tests was good, with a small learning effect on the Filtered Words test. Conclusion: Normative data were established and the preferred tests for diagnosing Auditory Processing Disorder were suggested for Norwegian children aged 7–12 years.

A Study on Effects of Diabetes Mellitus on Auditory System

Abstract Background and aims: Auditory dysfunctions in diabetes are known but are difficult to identify. Role of clinical tests and routine audiological tools are still to be established in early detection of diabetes-related auditory complication. The study aims to establish a link between diabetes and auditory dysfunction and assess the role of clinical examination and audiological investigations as a sensitive indicator of auditory dysfunctions in diabetics. Material and Methods: The auditory functions of 100 diabetic patients and 100 non-diabetics were assessed by clinical otological examination including free-field hearing and pure tone audiometry (PTA) in this descriptive study. The data for diabetic and non-diabetic groups and effect of age on auditory functions were analyzed with suitable statistical tests using SPSS 2.0 software with an error margin of 10%. Results: The demographical variables were comparable in both groups. The results showed a decline in free field hearing, which are furthur adversely affected by duration of diabetes and patient’s age. Overall pure tone thresholds were not significantly higher in diabetics, however the thresholds were higher in diabetics in older age groups. The hearing loss appears at an early age in diabetics but gradually becomes indistinguishable from age-related hearing loss. Conclusions: The auditory dysfunction can be linked to diabetes. It is usually not detectable at earliest stages with routine clinical and audiological tests but the clinical tests and pure tone audiometry can have a utility in monitoring the auditory dysfunction.

Exploring (central) auditory processing deficits in individuals with Broca's aphasia: Based on case study

It is well known fact that persons with lesions involving either the right or left temporal lobe tended to show impaired performances for complex auditory task and showed auditory processing disorder symptoms. Present study was aimed to find out whether auditory processing deficit exists in individuals with Broca's aphasia due to stroke based on case studies outcomes through detailed behavioral and electrophysiological audiological assessment. There were two participants (case 'A' and case 'B') diagnosed as having Boca's aphasia taken for the study. Case 'A' and 'B' were 39 and 29 year old male participated in the study. They were assessed for routine audiological and detailed auditory processing disorders tests like pitch pattern test, gap detection test and dichotic digit test. Further, they were also assessed for electrophysiological tests like click evoked auditory brainstem response and auditory late latency response. The routine audiological tests reveal no peripheral hearing loss in both the cases. However, details behavioral (C)APD tests results revealed overall poorer performance for different tasks in both cases. In addition to that, electrophysiological tests results also revealed abnormal brainstem and cortical responses in both cases. Hence, preliminary report of the present study suggests that cases with lesion (strokes) should be evaluated in detail for auditory processing deficit.

CVEMP, oVEMP and Caloric Test Results in Individuals with Meniere’s Disease

Objective : The present study aimed to characterize cVEMP, oVEMP and caloric test findings in individuals with Meniere’s disease. Methods : 29 participants with Meniere’s disease and 29 participants with normal hearing were enrolled for the study. Out of 29 participants in the experimental group, 25 of them had unilateral Meniere’s disease and 4 of them had bilateral Meniere’s disease (Total 33 ears diagnosed with Meniere’s and 25 ears with non-Meniere’s disease). All the participants underwent routine audiological, cVEMP, oVEMP and Caloric testing. Results : Out of 33 ears with Meniere’s disease, 29 ears had absent responses on cVEMP, 23 ears showed absent oVEMP responses, 27 ears had hypo-activity, five ears showed hyper activity and one ear showed normal response to caloric stimulation. In the contralateral ear (25 ears with non-Meniere’s disease) both cVEMP and oVEMP were absent in 5 of the ears, cVEMP was absent and oVEMP was present in 13 ears, cVEMP was present and oVEMP was absent in 1 ear, whereas both cVEMP and oVEMP were present in 6 ears in individuals with Meniere’s disease. However, the caloric responses were present normally in the contralateral ear in individuals with Meniere’s disease. Conclusions : The combination of cVEMP, oVEMP and caloric test provides valuable information regarding localization of hydrops in individuals with Meniere’s disease.

Pure tone audiometry and otoacoustic emissions in hypertensive subjects

Pure tone audiometry and otoacoustic emissions in hypertensive subjects

Audio-vestibular findings in Vestibular Paroxysmia

Vestibular paroxysmia (VP) is attributed to neurovascular cross-compression due to vascular loops around the Vestibulocochlear nerve. The exact audio-vestibular profile of individuals with VP is uncertainly reported in literature. Thus, the study was aimed at reporting the results of audio-vestibular test battery in VP. A 37 year-old-female and a 30 year-old-male with tinnitus, giddiness, and positional vertigo underwent routine audiological testing, oto-acoustic emissions, auditory brainstem response, vestibular evoked myogenic potentials, and chochlear hydrops analysis masking procedure which produced normal results. The Dix-Hallpike maneuver revealed positional vertigo and nystagmus while symptoms such as oscillopsia and giddiness were reported during central vestibular tests. The magnetic resonance imaging (MRI) report revealed labyrinthine artery loops around the VII and VIII cranial nerves. We conclude that subtle symptoms like oscillopsia, giddiness, or vomiting sensation on central vestibular tests should be carefully noted to enhance the identification of VP using audio-vestibular tests battery and MRI should be done for all cases presenting with symptoms of non-fatigable positional vertigo.

Gaps-in-noise (GIN©) test results in children with and without reading disabilities and phonological processing deficits

Objective: To determine if the gaps-in-noise (GIN©) test could differentiate children with dyslexia and significant phonological awareness deficits from a group of children with normal reading skills. Design: A prospective study of GIN test performance in two groups of children. Participants were administered routine audiological tests, a phonological processing test, and an auditory temporal resolution test (GIN test). Statistical testing was completed to determine if significant differences existed between groups on GIN test results and phonological processing measures, and to examine potential relationships between these test measures. Routine clinical analysis procedures examined the performance of the two groups from a clinical perspective. Study sample: Participants included 61 children between the ages of 8 years, 1 month and 9 years, 11 months, separated into two groups: children with dyslexia and significant phonological deficits (Group I); normal-reading peers with age-appropriate phonological skills (Group II). Results: Children in Group I showed longer gap detection (GD) thresholds and lower gap identification scores than did the children in Group II. Results of statistical and clinical testing revealed significant differences between the groups. Conclusion: An auditory temporal processing deficit is a factor to be considered in children presenting with dyslexia and phonological processing disorders.

Noise-induced tinnitus: A comparison between four clinical groups without apparent hearing loss

The number of people with normal hearing thresholds seeking medical help for tinnitus and other hearing problems is increasing. For diagnostic purposes, existence/nonexistence of lesions or combinations of lesions in the inner ear not reflected in the audiogram was evaluated with advanced hearing tests applied to tinnitus patients with certain backgrounds, including noise exposure. For forty-six patients with pronounced tinnitus, and other symptoms, tentative diagnoses were established, including judgments of the influence of four causative factors: (1) acoustic trauma, (2) music, (3) suspected hereditary, and (4) nonauditory, for example, stress or muscular tension. They were analyzed with a test battery sensitive to lesions involving the outer hair cells, damage from impulse noise, and dysfunction of the efferent system. There were significant differences in test results between groups with individuals with the same most likely causative factor. Most patients claiming acoustic trauma had a specific type of result, 'hyper-PMTF' (psychoacoustical modulation transfer function), and abnormal test results of the efferent system. Everyone in the hereditary group had dysfunction of the efferent system. All patients working with music, except one, had some abnormality, but without specific pattern. The nonauditory group mostly had normal test results. The investigation shows that it is possible to diagnose minor cochlear lesions as well as dysfunction of the efferent system, which might be causing the tinnitus. Those abnormalities could not be detected with routine audiological tests. Malfunctioning caused by impulse noise is an obvious example of this. These findings facilitate choice of treatment, rehabilitation programs, and medicolegal decisions.

The Prevalence of Perilymphatic Hypertension in Subjects with Tinnitus: a Pilot Study

This study investigated the prevalence of perilymphatic hypertension (raised perilymphatic pressure) in a population of subjects with tinnitus. A review of the literature showed how changes in perilymphatic pressure could affect tympanic membrane displacement measurements. This review also revealed that perilymphatic hypertension was more likely to occur in young females (less than 45 years) than in other subjects. An experiment was designed to test 32 subjects, who were divided into four groups according to their age and sex. These subjects underwent several routine audiological tests and were then tested with the tympanic membrane measurement system to determine the perilymphatic pressure of both ears. Statistical analysis of the experimental results showed that the young females had raised perilymphatic pressure. This was significantly higher than the perilymphatic pressure of the other test groups and of that of a normal population. The young females also exhibited other symptoms indicative of raised perilymphatic pressure. The raised pressure was thought to be due to an increase in fluid pressure which is more likely to occur in females due to variations in the levels of circulating hormones with menstrual irregularities, pregnancy and the menopause.

Blood Viscosity and Sensorineural Hearing Loss

Two groups of 33 subjects each, one experimental and one control, matched one-to-one for age and occupation, were chosen from a large number of subjects who were covered by special insurance for annual medical control at our hospital. The periodical checkups included cardiovascular, nervous, and renal systems, as well as vision and hearing. In addition routine blood tests, including whole blood viscosity, were also performed. The experimental group consisted of subjects in whom a bilateral, slight, and unexplained sensorineural loss of hearing was detected in the routine audiological testing, without any known reason. In the control group, the routine hearing tests demonstrated normal hearing. The differences between the two groups were statistically significant in pure-tone threshold level and in speech discrimination score, when the test was performed at a -5dB signal-to-noise ratio. The results of the vestibular tests were normal in both groups. Hematocrit and whole blood viscosity were slightly but significantly higher in the experimental group if compared with the control group. The number of subjects with abnormal whole blood viscosity results was higher in the experimental group. The whole blood viscosity as the etiological factor responsible for the hearing deterioration is described.

Interhemispheric Suppression

Two groups of brain damaged adults, those with cerebrocranial injury (CCI) and victims of cerebrovascular accident (CVA) were tested with the competing sentences test of Willeford (In: Central Auditory Dysfunction. New York: Grune and Stratton, 1977: Chap 2). The main purpose was the exposure of functional disorders of communication in such patients who test within normal or near-normal limits on routine audiological testing and also on tests for aphasia. Of 142 serially admitted CCI patients, 43%, many with diffuse lesions, gave abnormal responses, mostly at the left ear, with 19 of them showing total extinction at that ear. On two sound field competing message tests the CCI patients were significantly poorer than normal controls. CVA patients with confirmed right hemisphere lesions tended strongly toward left ear suppression, while left hemisphere damaged patients often showed bilateral drop in scores. It is clear that brain damaged patients can have central dysfunction of auditory processing despite normal findings on routine audiological tests and tests for aphasia. The implications for activities of daily living and for habilitation are discussed.

The otolaryngologist and learning disabilities.

Learning disabilities, or perceptual defects resulting in the inability to perceive or classify various symbols, may involve many systems including the auditory pathways. Perceptually handicapped children are most often characterized by poor attention to auditory stimuli and limited auditory memory. Medical history and an examination which includes simple motor tests are important in proper diagnosis. Routine audiological testing, special discrimination tests, such as the Wepman, and auditory memory assessment should be done. The differential diagnosis includes high-frequency hearing impairment, psychopathologic effects, and mental retardation. The otolaryngologist should be prepared to recognize and direct a child with suspected abnormalities to appropriate evaluation. Therapy in general is based on special educational situations and the use of stimulant drugs. Long-term results are yet to be fully evaluated.