Uncomfortable Loudness Levels Research Articles

Guidelines for the evaluation of hearing aid fitting (2010).

The methods to evaluate the efficacy of the adjusted hearing aid for a hearing-impaired person are fitting tests. The tests include those presently carried out for evaluating hearing aid fitting, and the methods of testing and evaluation have been published as "Guidelines for the evaluation of hearing aid fitting (2010)" by the Japan Audiological Society. Guidelines for the following 8 test methods are presented. (1) Measurements of speech performance-intensity functions and speech recognition scores; (2) Assessment of hearing aid fitting from the aspect of tolerance of environmental noise; (3) Measurement of real-ear insertion gain (measurement of sound pressure levels at the eardrum); (4) Measurement of the hearing threshold level and the uncomfortable loudness level (UCL) in sound pressure level (SPL) with an inserted earphone; (5) Aided threshold test in a sound field (functional gain measurement); (6) Prediction of insertion gain and aided threshold from hearing aid characteristics and the pure tone audiogram; (7) Measurement of speech recognition in noise; (8) Assessment of hearing aid fitting using questionnaires. In the above tests, (1) and (2) are mandatory tests, and (3) to (8) are informative tests. By performing test combinations properly selected from the above 8 tests, the benefits of a hearing aid could be determined. The above test methods were useful and valuable in determining the efficacy of the adjusted hearing aid for a hearing-impaired person during clinical practice.

Audiometric Profiles in Autism Spectrum Disorders: Does Subclinical Hearing Loss Impact Communication?

Rates of hearing impairment in individuals with Autism Spectrum Disorders (ASD) are higher than those reported in the general population. Although ASD is not caused by hearing impairment, it may exacerbate symptomatology. Participants with ASD (N = 60) and typically developing peers (N = 16) aged 5-18 years underwent a comprehensive audiological screening (pure tone audiometry, uncomfortable loudness level, tympanometry, acoustic reflexes, distortion product otoacoustic emissions, and auditory brainstem response) and assessment of communication abilities (expressive/receptive language, articulation, phonological awareness, and vocal affect recognition). Incidence of abnormal findings on at least one measure of audiological functioning was higher for the ASD group (55%) than controls (14.9%) or the general population estimate (6%). The presence of sound sensitivity was also considerably higher for the ASD group (37%) compared with controls (0%) or general population estimates (8-15%). When participants with ASD were dichotomized into groups with and without evidence of clinical audiological abnormality, no significant differences were identified on measures of communication; however, results of correlational analyses indicated that variability in hearing thresholds at middle range frequencies (2000 Hz) was significantly related to performance on all measures of speech articulation and language after correction for multiple comparisons (r = -0.48 to r = -0.53, P < 0.0045). These findings suggest that dichotomized classification of clinical audiology may not be sufficient to understand the role of subclinical hearing loss in ASD symptomatology and that treatment studies for mild/subclinical hearing loss in this population may be worthwhile.

517 聴覚路各部から生じる電気・磁気的反応の計測による不快レベル推定の試み(機械力学・計測制御III)

517 聴覚路各部から生じる電気・磁気的反応の計測による不快レベル推定の試み(機械力学・計測制御III)

Hyperacusis Questionnaire as a Tool for Measuring Hypersensitivity to Sound in a Tinnitus Research Population

Hypersensitivity to external sounds is often comorbid with tinnitus and may be significant for adherence to certain types of tinnitus management. Therefore, a clear measure of sensitivity to sound is important. The aim of this study was to evaluate the validity and reliability of the Hyperacusis Questionnaire (HQ) for use as a measurement tool using data from a sample of 264 adults who took part in tinnitus research. We evaluated the HQ factor structure, internal consistency, convergent and discriminant validity, and floor and ceiling effects. Internal consistency was high (Cronbach's alpha = 0.88) and moderate correlations were observed between the HQ, uncomfortable loudness levels, and other health questionnaires. Confirmatory factor analysis revealed that the original HQ three-factor solution and a one-factor solution were both a poor fit to the data. Four problematic items were removed and exploratory factor analysis identified a two-factor (attentional and social) solution. The original three-factor structure of the HQ was not confirmed. All fourteen items do not accurately assess hypersensitivity to sound in a tinnitus population. We propose a 10-item (2-factor) version of the HQ, which will need to be confirmed using a new tinnitus and perhaps nontinnitus population.

Central Auditory Gain Secondary to Hearing Deprivation and Its Role in Hyperacusis

Objectives: Determine the characteristics of the auditory central gain due to bilateral hearing deprivation, and its relationship with circadian variations as a function of cortical activity. Methods: The study was designed as a prospective observational research, in a national referral center. A total of 28 volunteers ranging between 18 and 30 years old underwent bilateral earplugging with Merocel, previous medical examination, anthropometry, author developed questionnaire, Hamilton anxiety and depression inventory, speech and pure tone audiometry, tympanometry and middle ear reflex (MER), distortion products otoacoustics emissions input/output(DPOAE-I/O), and uncomfortable loudness levels (ULLs) in 0.5-4 kHz. Subjects were randomly divided in 2 groups: Group A, starting at 8:00 am and finishing at 8:00 pm; Group B, starting at 4:00 pm ending at 4:00 am. Serum cortisol levels and audiological test were obtained at the beginning and at the end of the session. A 24-hour free urinary cortisol levels were measured. Results: We observed an air conduction drop in right ears (AD) at 1 kHz ( P = .036) and 0.125, 4 y 8 kHz frequencies in left ears(AS) ( P = .013, .003, .003), respectively. The ULLs in Group A showed a decline in AD/AS thresholds in all frequencies. Contralateral AD MER thresholds presented a decline on 0.5 to 1 kHz. AS DPOAE-I/O fell by 25 and 45 dB ( P = .046, .461) in group B, and 25 dB in Group A ( P = .047). In group B, serum cortisol levels increased by 19.28 ± 4.37 µg/µL ( P = .018). Conclusions: We report an association between the increase of serum cortisol and auditory gain and an indirect relationship with normal cortical activity. Thus, bilateral hearing deprivation can potentially be used as a convenient model for the study of hyperacusis.

Optimized loudness-function estimation for categorical loudness scaling data

Individual loudness perception can be assessed using categorical loudness scaling (CLS). The procedure does not require any training and is frequently used in clinics. The goal of this study was to investigate different methods of loudness-function estimation from CLS data in terms of their test–retest behaviour and to suggest an improved method compared to Brand and Hohmann (2002) for adaptive CLS. Four different runs of the CLS procedure were conducted using 13 normal-hearing and 11 hearing-impaired listeners. The following approaches for loudness-function estimation (fitting) by minimising the error between the data and loudness function were compared: Errors were defined both in level and in loudness direction, respectively. The hearing threshold level (HTL) was extracted from CLS by splitting the responses into an audible and an inaudible category. The extracted HTL was used as a fixed starting point of the loudness function. The uncomfortable loudness level (UCL) was estimated if presentation levels were not sufficiently high to yield responses in the upper loudness range, as often observed in practise. Compared to the original fitting method, the modified estimation of the HTL was closer to the pure-tone audiometric threshold. Results of a computer simulation for UCL estimation showed that the estimation error was reduced for data sets with sparse or absent responses in the upper loudness range. Overall, the suggested modifications lead to a better test–retest behaviour. If CLS data are highly consistent over the whole loudness range, all fitting methods lead to almost equal loudness functions. A considerable advantage of the suggested fitting method is observed for data sets where the responses either show high standard deviations or where responses are not present in the upper loudness range. Both cases regularly occur in clinical practice.

Fitting and verification of frequency modulation systems on children with normal hearing.

Several recent investigations support the use of frequency modulation (FM) systems in children with normal hearing and auditory processing or listening disorders such as those diagnosed with auditory processing disorders, autism spectrum disorders, attention-deficit hyperactivity disorder, Friedreich ataxia, and dyslexia. The American Academy of Audiology (AAA) published suggested procedures, but these guidelines do not cite research evidence to support the validity of the recommended procedures for fitting and verifying nonoccluding open-ear FM systems on children with normal hearing. Documenting the validity of these fitting procedures is critical to maximize the potential FM-system benefit in the above-mentioned populations of children with normal hearing and those with auditory-listening problems. The primary goal of this investigation was to determine the validity of the AAA real-ear approach to fitting FM systems on children with normal hearing. The secondary goal of this study was to examine speech-recognition performance in noise and loudness ratings without and with FM systems in children with normal hearing sensitivity. A two-group, cross-sectional design was used in the present study. Twenty-six typically functioning children, ages 5-12 yr, with normal hearing sensitivity participated in the study. Participants used a nonoccluding open-ear FM receiver during laboratory-based testing. Participants completed three laboratory tests: (1) real-ear measures, (2) speech recognition performance in noise, and (3) loudness ratings. Four real-ear measures were conducted to (1) verify that measured output met prescribed-gain targets across the 1000-4000 Hz frequency range for speech stimuli, (2) confirm that the FM-receiver volume did not exceed predicted uncomfortable loudness levels, and (3 and 4) measure changes to the real-ear unaided response when placing the FM receiver in the child's ear. After completion of the fitting, speech recognition in noise at a -5 signal-to-noise ratio and loudness ratings at a +5 signal-to-noise ratio were measured in four conditions: (1) no FM system, (2) FM receiver on the right ear, (3) FM receiver on the left ear, and (4) bilateral FM system. The results of this study suggested that the slightly modified AAA real-ear measurement procedures resulted in a valid fitting of one FM system on children with normal hearing. On average, prescriptive targets were met for 1000, 2000, 3000, and 4000 Hz within 3 dB, and maximum output of the FM system never exceeded and was significantly lower than predicted uncomfortable loudness levels for the children. There was a minimal change in the real-ear unaided response when the open-ear FM receiver was placed into the ear. Use of the FM system on one or both ears resulted in significantly better speech recognition in noise relative to a no-FM condition, and the unilateral and bilateral FM receivers resulted in a comfortably loud signal when listening in background noise. Real-ear measures are critical for obtaining an appropriate fit of an FM system on children with normal hearing.

Tinnitus pitch and minimum masking levels in different etiologies

Objective: We sought to determine whether the results of audiological tests and tinnitus characteristics, particularly tinnitus pitch and minimum masking level (MML), depend on tinnitus etiology, and what other etiology-specific tinnitus characteristics there are. Design: The patients answered questions concerning tinnitus laterality, duration, character, aggravation, alleviation, previous treatment, and circumstances of onset. The results of tympanometry, pure-tone audiometry, distortion-product otoacoustic emissions, tinnitus likeness spectrum, MML, and uncomfortable loudness level were evaluated. Study sample: Patients with several tinnitus etiological factors were excluded. The remaining participants were divided into groups according to medical history: acute acoustic trauma: 67 ears; chronic acoustic trauma: 82; prolonged use of oral estrogen and progesterone contraceptives: 46; Ménière's disease: 25; congenital hearing loss: 19; sensorineural sudden deafness: 40; dull head trauma: 19; viral labyrinthitis: 53; stroke: 6; presbycusis: 152. Data of 509 ears were analysed. Results: Tinnitus pitch was highest in patients with acute acoustic trauma and lowest in patients receiving estrogen and progesterone. MML was lowest after acute acoustic trauma and in congenital hearing loss, and highest after a stroke and in the case of presbytinnitus. Conclusions: Tinnitus pitch and MML are etiology dependent.

Amplification Options for Patients With Mixed Hearing Loss

To compare amplification options for patients with mixed hearing loss. Devices tested include percutaneous and transcutaneous bone conductors (BCDs) and middle ear implants with their actuator directly coupled to the cochlea. Tertiary academic medical center. Maximum output was studied with simulators. As simulators are lacking for the middle ear implants (the Vibrant Soundbridge [VSB] and the Cochlear's Direct Acoustic Cochlear Stimulator [Codacs]), the maximum output had to be measured in patients (4 and 5 patients, respectively). The maximum output averaged at 0.5, 1, and 2 kHz was the main outcome measure, which was expressed in dB HL, using appropriate transformation tables. The maximum output was the highest for the Codacs device and was above the patients' uncomfortable loudness levels. The maximum output of the VSB varied between 65 and 85 dB HL, and that of percutaneous BCD varied between 68 and 80 dB HL depending on the type of device. The transcutaneous BCD, the Sophono device, had the lowest output. Only with the Codacs device can the complete dynamic range be used. The maximum output of the VSB is lower and variable owing to the coupling to the cochlea. For patients with a sensorineural hearing loss component up to 50 dB HL, a percutaneous BCD forms a good treatment option that is completely independent of the middle ear status. The transcutaneous Sophono BCD is suitable for patients with a (sub-)normal sensorineural hearing loss component of 20 dB or less.

Acute Stress Induces Hyperacusis in Women with High Levels of Emotional Exhaustion

BackgroundHearing problems is one of the top ten public health disorders in the general population and there is a well-established relationship between stress and hearing problems. The aim of the present study was to explore if an acute stress will increase auditory sensitivity (hyperacusis) in individuals with high levels of emotional exhaustion (EE).MethodsHyperacusis was assessed using uncomfortable loudness levels (ULL) in 348 individuals (140 men; 208 women; age 23–71 years). Multivariate analyses (ordered logistic regression), were used to calculate odds ratios, including interacting or confounding effects of age, gender, ear wax and hearing loss (PTA). Two-way ANCOVAs were used to assess possible differences in mean ULLs between EE groups pre- and post-acute stress task (a combination of cold pressor, emotional Stroop and Social stress/video recording).ResultsThere were no baseline differences in mean ULLs between the three EE groups (one-way ANOVA). However, after the acute stress exposure there were significant differences in ULL means between the EE-groups in women. Post-hoc analyses showed that the differences in mean ULLs were between those with high vs. low EE (range 5.5–6.5 dB). Similar results were found for frequencies 0.5 and 1 kHz. The results demonstrate that women with high EE-levels display hyperacusis after an acute stress task. The odds of having hyperacusis were 2.5 (2 kHz, right ear; left ns) and 2.2 (4 kHz, right ear; left ns) times higher among those with high EE compared to those with low levels. All these results are adjusted for age, hearing loss and ear wax.ConclusionWomen with high levels of emotional exhaustion become more sensitive to sound after an acute stress task. This novel finding highlights the importance of including emotional exhaustion in the diagnosis and treatment of hearing problems.

聴覚過敏に対する不快閾値検査の有用性

聴覚過敏に対する不快閾値検査の有用性

Comparison of the Uncomfortable Loudness Level with the Acoustic Reflex Threshold in Normal Children and Adults

It has been well known that the selection of maximum power output in hearing aids fitting is important. In general, it was determined through the uncomfortable loudness level (UCL) test. The purpose of this study was to measure and compare the UCL and acoustic reflex threshold (ART) in young normal children and adults for early intervention and aural rehabilitation, including hearing aids fitting for hearing-impaired children. Pure tone hearing threshold, UCL and ART were measured in 40 ears of children and adults with normal hearing respectively. In results, UCL was higher than ART by 8.9 dB in children and was similar to ART in adults. And UCL, dynamic range (DR) and ART of children was higher than that of adults by 12.0 dB and 3.6 dB. In conclusion, we would suggest to monitor environmental noises properly and thoroughly for children's hearing based on the our results.

The correlation between the hyperacusis questionnaire and uncomfortable loudness levels is dependent on emotional exhaustion

Objective: To validate the hyperacusis questionnaire (HQ) in different strata of emotional exhaustion (EE). Design: HQ-scores and uncomfortable loudness levels (ULLs) were assessed in 348 individuals (140 men and 208 women) with low, intermediate, and high EE-levels. Results: Four individuals (1.1%) met the critical value for hyperacusis according to the HQ. An exploratory factor analysis extracted three factors from the HQ accounting for 57.6% of the variance. Internal consistency was acceptable for all subscales and for the total score, with Crohnbach's alpha ranging from 0.65 to 0.86. When controlling for hearing loss, significant correlations between the HQ and ULLs were found on both ears in those with intermediate (right: −0.328; left: −0.320) and high EE (right: −0.349; left: −0.393), but not with low EE (right: −0.204; left: −0.196). All correlations were negative, indicating that higher HQ-scores are correlated with lower ULLs. The strongest correlations were found for the social dimension, indicating that social aspects may correspond best to audiological parameters (ULLs) of hyperacusis. Conclusions: The results emphasize the need to take other factors, such as emotional exhaustion (long-term stress), into consideration when assessing hyperacusis with a questionnaire.

Feasibility of an objective electrophysiological loudness scaling: A kernel-based novelty detection approach

The objective of our research is to structure a foundation for an electrophysiological loudness scaling measurement, in particular to estimate an uncomfortable loudness (UCL) level by using the hybrid wavelet-kernel novelty detection (HWND). Late auditory evoked potentials (LAEPs) were obtained from 20 normal hearing adults. These LAEPs were stimulated by 4 intensity levels (60 decibel (dB) sound pressure level (SPL), 70 dB SPL, 80 dB SPL, and 90 dB SPL). We have extracted the habituation correlates in LAEPs by using HWND. For this, we employed a lattice structure-based wavelet frame decompositions for feature extraction combined with a kernel-based novelty detector. The group results showed that the habituation correlates degrees, i.e., relative changes within the sweep sequences, were significantly different among 60 dB SPL, 70 dB SPL, 80 dB SPL, and 90 dB SPL stimulation level, independently from the intensity related amplitude information in the averaged LAEPs. At these particular intensities, 60% of the subjects show the correlation between the novelty measures and the stimulation levels resembles a loudness scaling function, in reverse. In this paper, we have found a correlation in between the novelty measures and loudness perception as well. We have found that high ranges of loudness levels such as loud, upper level and too loud show generally 4.88% of novelty measures and comfortable ranges of loudness levels, i.e., soft, comfortable but soft, comfortable loud and comfortable but loud are generally have 12.29% of novelty measures. Additionally, we demonstrated that our sweep-to-sweep basis of post processing scheme is reliable for habituation extraction and offers an advantage of reducing experimental time as the proposed scheme need less than 20% of single sweeps in comparison to the amount that are commonly used in arithmetical average for a meaningful result. We assessed the feasibility of habituation correlates for an objective loudness scaling. With respect to this first feasibility study, the presented results are promising when using the described signal processing and machine learning methodology. For the group results, the novelty measures approach is able to discriminate 60 dB, 70 dB, 80 dB and 90 dB stimulated sweeps. In addition, a correlation between the novelty measures and the subjective loudness scaling is observed. However, more loudness perception and frequency specific experiments need to be conducted to determine the UCL novelty measures threshold as well as clinically oriented studies are necessary to evaluate whether this approach might be used in the objective hearing instrument fitting procedures.

Assessment of Hyperacusis in Egyptian patients: Evaluation of the Arabic version of the Khalfa questionnaire

AbstractObjectives: Hyperacusis appears to be a subjective phenomenon, which is not easily defined or quantified by objective measurements. The primary aim of this work was to evaluate the Arabic version of the Khalfa questionnaire for hyperacusis on a sample of normal hearing Egyptians complaining of hyperacusis. The secondary aim was to compare the audiological criteria of this group of hyperacusis patients (with or without tinnitus) with a control group of similar age and gender. Study design: The study group comprised 60 adult patients (age range 19–45 years) having normal hearing and complaining of hyperacusis with or without tinnitus. The control group comprised 20 normal hearing age and gender-matched individuals. All patients were subjected to full history-taking, otological examination, pure tone audiometry, immittance audiometry, uncomfortable loudness levels (ULLs) assessment, a transient evoked otoacoustic emissions (TEOAEs) test and, in addition, to the Arabic version of the Khalfa hyperacusi...

Hypersensitivity to sound in tinnitus patients: An analysis of a construct based on questionnaire and audiological data

The purpose of this study was to analyse the Questionnaire on Hypersensitivity to Sound (GÜF; ) and to improve its validity based on the analysis of intercorrelations (single item level) with other methods of assessing hyperacusis (uncomfortable loudness level, individual loudness function, self-rated severity of hyperacusis). Subjects consisted of 91 inpatients with tinnitus and hyperacusis. The GÜF showed a good reliability (α = .92). The factorial structure of the questionnaire reported by was not completely supported by the evidence in this study. The total score and the single items showed small to moderate correlations with the other modes of measuring hyperacusis. Evidence for convergent and discriminant validity were found, but overall the results corroborate the conceptual heterogeneity of the construct hyperacusis and its dependency on the assessment method. Four items of the GÜF with particularly low correlations were excluded from the questionnaire. The revised GÜF total score showed slightly but not statistically significant higher convergent and discriminant validity.SumarioEl propósito de este estudio fue analizar el cuestionario sobre hipersensibilidad al ruido (GÜF, ) y mejorar su validez basados en el análisis de las correlaciones (nivel de ítem único) con otros métodos para evaluar la hiperacusia (nivel inconfortable de sensación auditiva, función de la sensación auditiva individual, severidad de la hiperacusia autoevaluada). Los sujetos fueron 91 pacientes con acúfeno e hiperacusia. El GÜF mostró buena confiabilidad (a = .92). La estructura factorial del cuestionario reportada por no fue completamente apoyada por la evidencia en este estudio. La calificación total y los ítems individuales mostraron una correlación pequeña a moderada con los otros modos para medir la hiperacusia. Se encontró evidencia de la validez convergente y discriminante , pero sobretodo los resultados corroboran la heterogeneidad conceptual de la hiperacusia de constructo y su dependencia en el método de evaluación. Se excluyeron del cuestionario cinco ítems del GÜF con correlación particularmente baja. La calificación final del GÜF revisado muestra en la convergencia y la validez discriminante, una leve mejoría, pero no estadísticamente significativa.

Uncomfortable loudness levels in experienced unilateral and bilateral hearing aid users: Evidence of adaptive plasticity following asymmetrical sensory input?

Munro and Trotter [Inter J Audiol 45, 684-688, 2006] reported an asymmetry in uncomfortable loudness levels (ULLs) in a preliminary study using 12 experienced unilateral hearing aids users. The aim of the present study was to investigate ULLs in a larger sample of listeners with unilateral and bilateral hearing aid experience. Participants were adults with symmetrical high-frequency hearing impairment. There were 48 listeners with unilateral experience, 13 listeners with bilateral experience and a control group of 47 listeners with no hearing aid experience. The minimum duration of hearing aid experience was 2 years. ULLs were measured at 0.5, 1, 2 and 4 kHz. The unilateral group showed a statistically significant inter-aural asymmetry of 3-5 dB. Compared to the controls, there was a non-significant trend of higher ULLs in the fitted ear and lower ULLs in the not-fitted ear. ULLs in the bilateral group were symmetrical and similar to the control group. The findings suggest that changes in ULL may be a feature of asymmetrical sensory input and are consistent with a central gain mechanism.SumarioMunro y Rotter [Inter J Audiol 45, 684-688, 2006] reportaron asimetría en los niveles de molestia de intensidad subjetiva (ULLs) en un estudio preliminar, en el que participaron 12 usuarios experimentados unilaterales de auxiliares auditivos. El objetivo de este estudio fue investigar los ULLs en una muestra grande de usuarios, con experiencias uni o bilaterales. Los participantes fueron adultos con pérdida auditiva simétrica en frecuencias agudas y fueron 48 personas con experiencia unilateral, 13 con experiencia bilateral y un grupo control de 47 personas sin experiencia con auxiliares auditivos. La duración minima del uso de los auxiliares auditivos fue de 2 años. Se midieron las ULLs en 0.5, 1, 2 y 4 kHz. El grupo unilateral mostró una asimetría inter-aural de 3-5 dB, estadísticamente significativa. En comparación con los controles no hubo una tendencia significativa hacia mayores ULLs en el oído adaptado y menores ULLs en el oído sin auxiliar. Los ULLs en el grupo bilateral fueron simétricos y similares a los del grupo control. Estos hallazgos sugieren que los cambios en los ULL pueden ser un rasgo de estimulación sensorial asimétrico y que son consistentes con un mecanismo central de ganancia.

Preliminary Evaluation of a Novel Bone-Conduction Device for Single-Sided Deafness

A new intraoral bone-conduction device has advantages over existing bone-conduction devices for reducing the auditory deficits associated with single-sided deafness (SSD). Existing bone-conduction devices effectively mitigate auditory deficits from single-sided deafness but have suboptimal microphone locations, limited frequency range, and/or require invasive surgery. A new device has been designed to improve microphone placement (in the ear canal of the deaf ear), provide a wider frequency range, and eliminate surgery by delivering bone-conduction signals to the teeth via a removable oral appliance. Forces applied by the oral appliance were compared with forces typically experienced by the teeth from normal functions such as mastication or from other appliances. Tooth surface changes were measured on extracted teeth, and transducer temperature was measured under typical use conditions. Dynamic operating range, including gain, bandwidth, and maximum output limits, were determined from uncomfortable loudness levels and vibrotactile thresholds, and speech recognition scores were measured using normal-hearing subjects. Auditory performance in noise (Hearing in Noise Test) was measured in a limited sample of SSD subjects. Overall comfort, ease of insertion, and removal and visibility of the oral appliance in comparison with traditional hearing aids were measured using a rating scale. The oral appliance produces forces that are far below those experienced by the teeth from normal functions or conventional dental appliances. The bone-conduction signal level can be adjusted to prevent tactile perception yet provide sufficient gain and output at frequencies from 250 to 12,000 Hz. The device does not damage tooth surfaces nor produce heat, can be inserted and removed easily, and is as comfortable to wear as traditional hearing aids. The new microphone location has advantages for reducing the auditory deficits caused by SSD, including the potential to provide spatial cues introduced by reflections from the pinna, compared with microphone locations for existing devices. A new approach for SSD has been proposed that optimizes microphone location and delivers sound by bone conduction through a removable oral appliance. Measures in the laboratory using normal-hearing subjects indicate that the device provides useful gain and output for SSD patients, is comfortable, does not seem to have detrimental effects on oral function or oral health, and has several advantages over existing devices. Specifically, microphone placement is optimized for reducing the auditory deficit caused by SSD, frequency bandwidth is much greater, and the system does not require surgical placement. Auditory performance in a small sample of SSD subjects indicated a substantial advantage compared with not wearing the device. Future studies will involve performance measures on SSD patients wearing the device for longer periods.

Correlation between hyperacusis measurements in daily ENT practice

The aim of this study was to investigate hyperacusis measurement tools and to assess the correlation between diagnostic methods for hyperacusis in daily ENT practice. We studied two hyperacusis questionnaires: the Hyperacusis Questionnaire (HQ) and the Multiple-Activity Scale for Hyperacusis (MASH), audiometric measurements (uncomfortable loudness level (ULL) and dynamic range (DR)), and the questions ‘Do you have a lower tolerance for noise… ?’ and ‘Are you afraid of noise?’ Hyperacusis was assessed in 46 patients presenting with primary complaints of tinnitus. A validated Dutch version of the HQ is provided. A correlation was found between scores on the HQ and the MASH (p=0.000, R2=0.34). Significantly higher scores for both questionnaires were found in patients reporting decreased sound tolerance (p=0.000 and 0.002, respectively) or fear of noise (p=0.002 and 0.004, respectively). Overall, no correlations were found between scores on questionnaires and audiometric values including ULL and DR. The HQ and MASH were confirmed to be valid measurement tools for hyperacusis complaints. No correlations were found between audiometric measurements and hyperacusis complaints.SumarioEl objetivo de este estudio fue investigar las herramientas para mediar la hiperacusia y evaluar la correlación entre métodos diagnósticos para hiperacusia en la práctica diaria otorrinolaringológica. Estudiamos dos cuestionarios para hiperacusia: El Cuestionario de Hiperacusia (HQ) y la Escala de Multi-actividades para Hiperacusia (MASH), mediciones audiométricas (el nivel molesto de intensidad (ULL) y el rango dinámico (DR); y las preguntas ¿Tiene usted poca tolerancia al ruido?, y ¿Le da miedo el ruido?. La hiperacusia se evaluó en 46 pacientes cuya principal molestia era el acufeno. Se presenta una versión validada de HQ en holandés. Se encontró una correlación entre las puntuaciones del HQ y del MASH (p=0.000, R2=0.34). Se encontraron puntuaciones significativamente más altas para ambos cuestionarios en pacientes que reportaban una tolerancia disminuida al ruido (p=0.000 y 0.002, respectivamente) o miedo al ruido (p=0.002 y 0.004 respectivamente). En general, no se encontraron correlaciones entre la puntuación en los cuestionarios y los valores audiométricos de ULL y DR. Se confirmó que el HQ y el MASH son herramientas válidas para la medición de las quejas de una hiperacusia. No se encontró correlación entre las mediciones audiométricas y las quejas de una hiperacusia.

N1m amplitude growth function for bone-conducted ultrasound

Conclusion: N1m growth indicates the differences in central auditory processing between bone-conducted ultrasound and air-conducted audible sound. Objectives: Bone conduction enables ultrasound to be heard by the human ear. Despite many studies, the perceptual mechanism of bone-conducted ultrasound has not yet been clarified completely. Therefore, this study investigated the ultrasonic perception of humans, especially as regards the effects of stimulus intensity or loudness. Subjects and methods: The effect of the stimulus level on N1m amplitude was measured over the psycho-acoustical dynamic range. Results: The dynamic range for 30 kHz bone-conducted ultrasound (18.2±3.3 dB) was found to be significantly narrower than that for 1 kHz air-conducted sound (85.9±11.9 dB). As the stimulus level increased, the N1m amplitude in response to bone-conducted ultrasound grew faster than that to air-conducted sound. Although the growth of the N1m amplitude for air-conducted sound saturated below the uncomfortable loudness level (UCL), that for bone-conducted ultrasound continued to grow above the UCL.