Uncomfortable Loudness Levels Research Articles

Multichannel Compression Hearing Aids: Perceptual Considerations

Multichannel Compression Hearing Aids: Perceptual Considerations

High-frequency sensorineural hearing loss in patients with ankylosing spondylitis: is it an extrarticuler feature of disease?

The aim of this study was to investigate the ear involvement, especially at extended higher frequencies than those previously studied, in patients with ankylosing spondylitis (AS). We prospectively evaluated 45 consecutive patients with AS. All patients underwent a complete physical examination of the ear, nose, and throat and an audiologic evaluation that included pure-tone audiometry at conventional and extended high frequencies, the determination of a speech discrimination score and the uncomfortable loudness level, and impedance audiometry. Thirty healthy volunteers were included as controls. The mean age of the patients was 39.6 +/- 9.1 years (range 19-63 years) and that of the controls was 10.6 +/- 8.1 years (range 1-30 years). There was no statistically significant difference between the two groups with respect to conventional frequency air conduction threshold and bone conduction threshold. There was a statistically significant difference at 14,000-16,000 Hz at extended high frequencies in 32 patients with AS (71.1%) versus 12 controls (40%). At 14,000-16,000 Hz, eight patients demonstrated a sensorineural hearing loss caused by extraspinal involvement. There was a significant difference between the patients with or without extraspinal involvement, and a positive correlation was noted between the duration of disease and the hearing level at 10,000-16,000 Hz. Sensorineural hearing loss, especially at extended high frequencies, is common in patients with AS and may be an extra-articular feature of that disease. A long duration of disease and extraspinal involvement are important parameters for ear involvement in patients with AS.

Effects of Auditory Distraction on Cognitive Processing of Young Adults

Objective: The effects of interference, competition, and distraction on cognitive processing are unclearly understood, particularly regarding type and intensity of auditory distraction across a variety of cognitive processing tasks. Method: The purpose of this investigation was to report two experiments that sought to explore the effects of types of distraction (4-talker babble; word repetition; combined 4-talker babble with word repetition) when compared to a control condition of quiet on a range of computerized measures (simple reaction time; choice reaction time; serial pattern matching; lexical decision-making; visual selective attention; response reversal and rapid visual scanning; and form discrimination) in 40 young adults (Experiment 1). Results: Few distraction effects were found on cognitive processing at the comfortable loudness level (40dB SL). In Experiment 2, statistically significant differences for choice reaction time and serial pattern matching (working memory) were found in both speed and accuracy when distractions were presented at perceived uncomfortable loudness levels (ULL) and compared with conditions of quiet and comfortable loudness level (40dB SL). Conclusion: Cognitive resource allocation models may be useful in interpreting the effects of auditory distraction on cognitive-linguistic processing, and this model may help to explain differential distraction effects in clinical populations with attention deficits. (J. of Att. Dis. 2007; 10(4) 398-409)

Development and achievement of hearing-aid fitting strategy based on loudness model

The purpose of this study was to develop a hearing‐aid fitting strategy (named NYMU strategy), which aimed to compensate the loudness perception of hearing‐impaired individuals as that of normal‐hearing individuals. The loudness growth curve of normal‐hearing individuals was derived by the equal loudness contour. The loudness growth curve of hearing‐impaired individuals was constructed by fitting the curve through three points, which were the uncomfortable loudness level, the most comfortable loudness level, and the pure‐tone threshold of hearing‐impaired individuals for each frequency band. The NYMU strategy primarily calculated the hearing‐aid gain for each frequency band according to the differences between the loudness growth curve of normal‐hearing individuals and that of hearing‐impaired individuals; the gain was set to guarantee the audibility of the lowest boundary of speech intensity with normal vocal effort. Furthermore, the NYMU strategy adopted an innovative approach, which adjusted the point of the most comfortable loudness level to fine‐tuning the loudness growth curve, and it resulted in the fine‐tuning gain of each band. The preliminary results reveal that the NYMU strategy provides more gain above 4,000 Hz and under 500 Hz, compared with the NAL‐NL1 strategy. In addition, three of five subjects get higher word recognition scores when they were fitted by the NYUM strategy rather than the NAL‐NL1 strategy.

Auditory behavioral and evoked potential measures in migraineurs during attack-free period

Migraineurs often experience auditory-related symptoms such as increased sensitivity to sounds and difficulty in processing auditory information. There is some evidence that there may be abnormalities in certain brain regions; thus, there is impetus to use auditory assessment tools that probe different regions in the brain. The goals of this study were to identify whether innate differences exist in auditory measures between migraineurs during attack-free periods and non-migraineurs, and if asymmetries exist between the ears in migraineurs. The migraine group consisted of 10 adult female subjects with a history of migraine headaches, and the control group consisted of 10 adult female subjects with no history of migraine headaches. Results on pure tone audiometry, immittance audiometry and uncomfortable loudness level tests indicated no significant differences between the groups. However, the amplitude growth from 40 to 80dB nHL for auditory brainstem response (ABR) peak V and middle latency response (MLR) peak Na-Pa was larger for the migraine group. The SCAN-A test (a screening test of auditory processing) showed overall lower mean scores for the migraine group, with a significantly poorer score on the competing sentences subtest. The discriminant analysis indicated that the three measures – right ear amplitude growth of ABR peak V, right ear amplitude growth of MLR peak Na-Pa, and the competing sentences subtest contributed towards nearly all of the differences between the migraine and the control groups. These results may suggest subtle, but enduring, abnormalities in the central auditory system in migraineurs.

The behavior of the distortion product otoacoustic emissions in response to contralateral stimulation by stationary and nonstationary signals

The main aim of the study was to determine the DPOAE of the cochlea in the case of contralateral stimulation by stationary and nonstationary signals. The analysis was performed for 3f1−2f2, 2f1−f2, 2f2−f1 intermodulation distortion products on a group of 20 normal hearing subjects (NH) and ten patients with low UCL (uncomfortable loudness level). The optimized primary tone level setting (L1=0.4L2+39 dB) was used. Each NH subject was characterized by the I/O function of otoacoustic emission (40–90 dB SPL) and dp‐grams for the three levels of two‐tone (85/75, 75/65, and 65/55 dB SPL) for frequencies between 1 and 12 kHz. Parameters for subjects with UCL were individually selected. The suppression of otoacoustic distortion products and the intergroup correlation of the slopes of I/O function with various contralateral stimulators were discussed. Results obtained from the experiment were compared between the two groups studied.

Hearing in Nonprofessional Pop/Rock Musicians

The purpose of this study was to evaluate the hearing and subjective auditory symptoms in a group of nonprofessional pop/rock musicians who had experienced repeated exposures to intense sound levels during at least 5 yr of musical activity. An evaluation of both ears in 42 nonprofessional pop/rock musicians included pure-tone audiometry in the conventional and extended high-frequency range, the measurement of uncomfortable loudness levels, and an assessment of tinnitus and hypersensitivity to sound. Exclusion criteria were (a) the occurrence of acoustic trauma, (b) excessive noise exposure during occupational activities, (c) a history of recurrent otitis media, (d) previous ear surgery, (e) a fracture of the cranium, (f) ingestion of potentially ototoxic drugs, and (g) reported hearing difficulties within the immediate family. These audiometric results were then compared with a control group of 20 otologically normal young adults with no history of long-term noise exposure. After adjusting for age and gender, relative to ISO 7029, the mean hearing threshold in the frequency range of 3 to 8 kHz was 6 dB in the musicians and 1.5 dB in the control group. This difference was statistically significant (Mann-Whitney rank sum test, p < 0.001). A significant difference was also observed between musicians using regular hearing protection during their activities (average 3 to 8 kHz thresholds = 2.4 dB) and musicians who never used such hearing protection (average 3 to 8 kHz thresholds = 8.2 dB), after adjusting for age and gender (Mann-Whitney rank sum test, p = 0.006). Eleven of the musicians (26%) were found to be hypersensitive to sound, and seven (17%) presented with tinnitus. Tinnitus assessment, however, did not reveal any clinically significant psychological distress in these individuals. Tinnitus and hypersensitivity to sound were observed in a significant minority within a group of nonprofessional pop/rock musicians who had experienced repeated exposure to intense sound levels over at least 5 yr but with minimal impact on their lives. Moreover, hearing loss was minimal in the subjects who always used ear protection, being only 0.9 dB higher than the control group. In contrast, hearing loss was significantly more pronounced, at 6.7 dB higher than the control group, in those musicians who never used ear protection. Continued education about the risk to hearing and the benefits of the persistent use of ear protection is warranted for musicians who are exposed frequently to intense sound levels.

Preliminary evidence of asymmetry in uncomfortable loudness levels after unilateral hearing aid experience: Evidence of functional plasticity in the adult auditory system

The aim of the study was to compare uncomfortable loudness levels (ULLs) in a group of adults before and after unilateral hearing aid experience. Twelve participants presented with a symmetrical hearing loss consistent with natural ageing. Pure tones were presented to each ear separately, commencing at 60 dB HL and increased in 5-dB step sizes until ULL was reached. The post-fitting ULLs were typically measured three years after fitting. Hearing thresholds were symmetrical and remained unchanged after fitting. Mean ULL values were symmetrical before fitting. The mean ULL values increased (i.e. greater tolerance) in both ears after fitting; however, the increase was greatest in the fitted ear: 14.5 and 7 dB at 2000–4000 Hz in the fitted and not-fitted ear, respectively. A separate two-factor repeated ANOVA (ear and frequency) was performed on the pre and post-fitting ULL data. There was no statistically significant difference for ear (p > 0.05) when comparing the pre-fitting ULLs. However, there was a statistically significant difference for ear (p < 0.01) when comparing post-fitting ULLs. The underlying mechanism for the asymmetry is unknown but it is consistent with learning induced reorganization within the auditory system.

Evaluation of auditory processing disorders after whiplash injury

Whiplash patients often have many subjective complaints, such as headaches, concentration difficulties, fatigue, neck pain and vertigo. Objective assessment of these complaints is difficult and neurological and neuropsychological signs of damage are not obvious. Other complaints frequently expressed after whiplash injury are diminished speech intelligibility in noisy environments and decreased tolerance to ‘loud’ sounds. In the present study, the latter complaints were evaluated with behavioural auditory tests. A test battery for auditory processing disorders was administered to 22 chronic whiplash patients with normal peripheral hearing. The test battery consists of seven tests: a sentences-in-noise test, pattern recognition tests, words-in-noise test, dichotic digit test, filtered speech test, binaural fusion test and backward masking tests. The uncomfortable loudness level (UCL) was also assessed using speech material. In addition, a questionnaire on auditory handicap was administered. The results were...

Aversion, awareness, and attraction: investigating claims of hyperacusis in the Williams syndrome phenotype

Williams syndrome (WS), a neurodevelopmental disorder, is characterized by pervasive cognitive deficits alongside a relative sparing of auditory perception and cognition. A frequent characteristic of the phenotype is adverse reactions to, and/or fascination with, certain sounds. Previously published reports indicate that people with WS experience hyperacusis, yet careful examination reveals that the term 'hyperacusis' has been used indiscriminately in the literature to describe quite different auditory abnormalities. In an effort to clarify and document the incidence of auditory abnormalities in and among people with WS we collected data from parents of people with WS (n = 118) and comparison groups of people with Down syndrome, autism, and normal controls. Our findings revealed four phenomenologically separate auditory abnormalities, all of which were significantly more prevalent in WS than the three comparison groups. Among people with WS, we found relatively few reports of true hyperacusis (lowered threshold for soft sounds) or auditory fascinations/fixations, whereas 80% reported fearfulness to idiosyncratically particular sounds, and 91% reported lowered uncomfortable loudness levels, or 'odynacusis.' Our results confirm anecdotal reports of an unusual auditory phenotype in WS, and provide an important foundation for understanding the nature of auditory experience and pathology in WS. We conclude by reviewing the ways in which the present findings extend and complement recent neuroanatomical and neurophysiological findings on auditory function in people with WS.

Most Comfortable and Uncomfortable Loudness Levels

This article critically reviews the influence of such factors as psychophysical testing method, stimulus type, and instructional set on most comfortable loudness (MCL) and uncomfortable loudness (UCL) levels. Generally, research indicates that test methods and instructions strongly affect both MCL and UCL while stimulus conditions affect them less substantially. Overall, the data suggest lower reliability for MCL than for UCL and lower reliability for pure-tone MCLs than for speech MCLs. Lower MCLs are typically obtained when measured by an ascending approach, in contrast to a descending approach. Results suggest that audiological efforts should be directed toward the development of a standardized test procedure that yields adequately reliable and valid MCLs and UCLs for routine clinical use.

Effects of Test Order on Most Comfortable and Uncomfortable Loudness Levels for Speech

This study examined test-order effects on most comfortable loudness (MCL) and uncomfortable loudness (UCL) levels for spondaic words in 2 groups of 30 normal hearing listeners each. For Group 1, MCL was measured first, followed by UCL. For Group 2, UCL was measured first, and then MCL. A retest was conducted for both groups. Results showed that MCL was significantly elevated for Group 2, but not for Group 1. There was no effect on UCL for either group. In a follow-up experiment, the magnitude of the test-order effect on MCL increased significantly when MCL measurements followed UCL measurements closely in time. These results argue for management of the ordering and temporal spacing of MCL and UCL testing in clinical loudness measurements.

Auditory measures in clinically depressed individuals. I. Basic measures and transient otoacoustic emissions

This is the first paper in a series of two papers addressing possible differences in auditory function between individuals with and without clinical depression. Clinical depression is a common yet serious medical condition diagnosed based on the patient's symptoms. Selective serotonin reuptake inhibitors (SSRIs) are widely prescribed if the symptoms are determined to be consistent with low serotonin levels. Three groups of individuals were tested: the control group consisted of subjects with no depression; the medicated group consisted of subjects with depression who were on SSRIs for at least a month; the unmedicated group consisted of subjects with depression who were unmedicated for at least a month. The results indicated no significant differences between the groups in pure-tone threshold, uncomfortable loudness levels, dynamic range of hearing, and acoustic reflex thresholds. However, the unmedicated group exhibited higher amplitudes of transient otoacoustic emissions compared to the control group, especially in the right ear.

Comparison of an ‘intuitive’ NHS hearing aid prescription method with DSL 4.1 targets for amplification: Comparación de un metodo “intuitivo” de prescripción de auxiliares auditivos en el NHS, con las metas de amplificación DSL 4.1

This study aimed to evaluate current practice in a National Health Service Trust in setting hearing aid output to meet amplification targets prescribed by desired sensation level (DSL) using a range of NHS hearing aids. A consecutive sample of 33 patients was drawn from the hearing aid waiting list of the Royal Devon & Exeter Hospital (RD&E). The age range was 33–83 years. Patients not giving written consent and those with complex hearing losses were excluded. At review, pure-tone audiogram, uncomfortable loudness levels, real-ear coupler difference, user gain and maximum output were recorded. Data were entered into DSL 4.1 prescription software. Wilcoxon tests were used to compare the measured user gain and maximum output with DSL 4.1-generated targets. The results demonstrate significant differences (p < 0.05) at 0.25, 0.5, 0.75, 1.5, 2, 3, 4 and 6 kHz between target and measured values for user gain. This study reveals that the routine intuitive method for prescribing hearing aids at the RD&E is not effective in meeting targets for amplified speech as prescribed by DSL.SumarioEl objetivo de este estudio fue evaluar la práctica actual del fideicomiso del Servicio Nacional de Salud (NHS) al calibrar la salida de los auxiliares auditivos según el nivel “meta” calculado por nivel deseado de sensación (DSL), utilizando la variedad de auxiliares del NHS. Una muestra consecutiva de 33 pacientes se extrajo de la lista de espera para obtener un auxiliar auditivo del Hospital Royal Devon & Exeter (RD&E). La edad fluctuaba entre 33 y 38 años. Se excluyeron aquellos pacientes que no firmaron el consentimiento informado y aquellos cuya hipoacusia tuviera alguna complejidad. Se realizó audiometría tonal, obtención de niveles de molestia, curvas de diferencia de ganancia por inserción, ganancia y salida maxima. Se ingresaron estos resultados al programa de prescripción DSL 4.1. Por medio de la prueba de Wilcox se compararon las mediciones de ganancia del usuario con la salida máxima que generó el programa DSL 4.1. Los resultados demostraron diferencias significativas (pø0.05) a 0.25, 0.5, 0.75, 1.5, 2, 3, 4 y 6 kHz entre los niveles “meta” y los valores de ganancia del usuario. Este estudio revela que el método rutinario intuitivo de prescripción DSL de auxiliares auditivos RD&E no es efectivo y no alcanza la meta deseada de amplificación para el lenguaje.

Effects of Selective Serotonin Reuptake Inhibitors on Auditory Processing: Case Study

Auditory sensitivity and processing ability were evaluated in a patient who suffered from hyperacusis, difficulty understanding speech, withdrawn depression, lethargy, and hypersensitivity to touch, pressure, and light. Treatment with fluvoxamine and fluoxetine (selective serotonin reuptake inhibitors) reversibly alleviated complaints. Testing while medicated and unmedicated (after voluntary withdrawal from medication for several weeks) revealed no difference in pure-tone thresholds, speech thresholds, word recognition scores, tympanograms, or acoustic reflex thresholds. Medicated SCAN-A (a screening test for central auditory processing disorders) results were normal, and unmedicated results were abnormal. Unmedicated transient otoacoustic emissions and auditory brainstem response waves I, III, and V were significantly larger bilaterally. Uncomfortable loudness levels indicated greater tolerance during the medicated condition. Central processing and vigilance were evaluated with analog-synthesized three-formant consonant-vowel syllables. While medicated, responses to stimuli at each ear revealed well-defined, labeling crossovers of about 90 msec. Vowel identification matched normal subject responses; labeling of /gE/jE/ and /bE/wE/ continua was well defined but all crossover points differed from normals (p < .0001). During unmedicated testing, responses to /gE/jE/ began at medicated levels but approached chance levels for the entire continuum within 10 min; labeling of /bE/wE/ was consistent with medicated responses throughout with earlier than normal crossover points.

Categorical loudness scaling within the scope of hearing aid management

The loudness perception of patients with hearing aids was measured with a one-stage category loudness scaling procedure. Data were obtained from 102 ears and were studied primarily in older patients who represented the majority of patients with hearing disorders evaluated in our department. In all, 75% of the patients were older than 45 years and had a mean age of 58 years. The reduction of dynamics at high frequencies was considered to be typical for age-related hearing disorders and was easily quantified with loudness scaling. Findings demonstrated that prediction of recruitment was not possible from pure-tone thresholds or even together with uncomfortable loudness levels, since the slopes of the level-loudness functions revealed a high interindividual variability. In contrast, the desired compression ratio can be easily calculated with data from the loudness scaling. In this study the loudness perception of patients with mainly non-linear hearing aids fitted with customary procedures was evaluated. The benefit from the hearing aids was proven with the outcome from the loudness scaling, with testing also allowing for a better fitting of the aids.

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.

Field Trial Evaluations of a Switched Directional/Omnidirectional In-the-Ear Hearing Instrument

The use of directional microphones is one of the few methods available for hearing aids to increase the signal-to-noise ratio. The smaller microphones available with today's technology have increased the viability of their application for in-the-ear (ITE) hearing aids. This study evaluated an ITE hearing aid containing two nondirectional microphones that provides wearer-selectable omnidirectional/directional operating modes. Ten sensorineural hearing-impaired patients were fitted binaurally. During the first trial period, the low-frequency gain decrease produced by the directional mode was not compensated for. The frequency responses were matched during the second trial period. For both trial periods, Hearing in Noise Test results using two uncorrelated noise sources indicated significant speech recognition improvements for the directional mode relative to the omnidirectional mode. Responses on Abbreviated Profile of Hearing Aid Benefit questionnaires, paired-comparison judgments, and interview data revealed that most subjects preferred the directional mode in noisier environments, but many also preferred the omnidirectional mode in quiet listening.

Prediction of post-operative profits in cochlear implanted people using electrical stimulation test results

There are few techniques adequate for assessing the remaining sensitivity of a hearing nerve in deaf people or those with a severe hearing loss. The procedures developed at the Institute of Physiology and Pathology of Hearing in Warsaw allow the determination of some vital characteristics of the hearing sense that help to make decisions regarding the cochlear implantation. The post-operative profits evaluation is also very important in the case of cochlea implanted persons. Apart from standard preexamination procedures, a test based on the electrical stimulation via the external auditory canal filled with saline can be performed. In order to evaluate the test results, both the dynamics range defined by the auditory threshold and the uncomfortable loudness level and the time difference limen test are considered. However, usually the results of electrical stimulation tests are highly diversified, depending on a patient’s age and condition, thus there was a need to create a database allowing one to find and to study the correlation between obtained test results and patients’ ability to receive and understand sounds. In this way, the interpretation of the electrical stimulation test results for the new diagnosed cases was made more reliable. [Work supported by KBN, Poland, Grant No. 4 P05C 082 12.]

Hypersensitivity to sound--questionnaire data, audiometry and classification.

This study included consecutive case histories and audiometry of 100 patients with hypersensitivity to sounds. There are several different conditions with the symptom of hypersensitivity to sounds. Hyperacusis is one of those and is seldom described in the literature. The term hyperacusis is often used synonymously with hypersensitivity to sound. We propose that there is a specific condition that could be termed hyperacusis. Hyperacusis is often elicited by loud sounds or by a number of other traumata or diseases. It is not typical of occupational noise exposure (with the exception of exposure to music). The typical patient is relatively young, the mean age being approximately 10 years less than for a population of patients with tinnitus or noise-induced hearing loss. In addition to hypersensitivity to sound, the patients often suffer from tinnitus (86%). Sounds are frequently painful and exposure to loud sounds worsens the condition for some time. The patients often have headaches. Pure tone audiograms show normal hearing or a slight high tone loss. The uncomfortable loudness level is markedly decreased, mostly less than 90 dB HL. Patients with hyperacusis may also be divided into those hypersensitive to the loudness of sounds with a decreased pure tone uncomfortable loudness level and those hypersensitive to certain specific sounds irrespective of loudness showing relatively high pure tone uncomfortable loudness levels and decreased uncomfortable loudness levels to specific sounds. With a careful history other conditions with the symptom of hypersensitivity to sound can be excluded.