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Around 15% of the general population is affected by tinnitus, but no real cure exists despite intensive research. Based on our recent causal model for tinnitus development, we here test a new treatment aimed at counteracting the perception. This treatment is based on the stochastic resonance phenomenon at specific auditory system synapses that is induced by externally presented near-threshold noise.This pilot study will investigate whether individually spectrally adapted noise can successfully reduce chronic tonal/narrow-band tinnitus during stimulation.Hearing loss (HL) as well as tinnitus pitch (TP) and loudness (TL) were audiometrically measured in 22 adults (46.6±16.3 years; 4 women) with tinnitus. Based on these measurements, up to eight different noise stimuli with five intensities (-20 to +20 dB SL) were generated. These were presented for 40 s each via audiologic headphones in a soundproof chamber. After each presentation, the change in TL was rated on a five-level scale (-2 to +2).We found patients (n = 6) without any improvement in their TL perception as well as patients with improvement (n = 16), where stimulation around the TP was most effective. The groups differed in post-hoc analysis of their audiograms: the effectiveness of our new therapeutic strategy obviously depends on the individual HL, and was most effective in normal-hearing tinnitus patients and those with mild HL.Subjective TL could be reduced in 16 out of 22 patients during stimulation. For a possible success of a future therapy, the HL seems to be of relevance.HINTERGRUND: Tinnitus betrifft ca. 15 % der Bevölkerung, jedoch existiert noch immer kein echtes Heilverfahren. Ein von uns entwickeltes neuartiges Erklärungsmodell erlaubt nun die Erprobung einer gezielten, an den Ursachen der Tinnitusentstehung ansetzenden Behandlung. Diese basiert auf stochastischen Resonanzphänomenen an bestimmten synaptischen Verbindungen im Hörsystem, welche gezielt durch extern zugeführtes schwellennahes Rauschen induziert werden sollen.Die vorliegende Pilotstudie soll zeigen, ob ein spektral individuell angepasstes Rauschen erfolgreich chronischen tonalen/schmalbandigen Tinnitus während der Stimulation abschwächen kann.Bei 22 volljährigen Tinnituspatienten (46.6±16.3 Jahre; 4 Frauen) wurden Hörverlust (HV) sowie Tinnitusfrequenzen (TF) und -lautstärken (TL) audiometrisch bestimmt. Darauf basierend wurden bis zu 8 verschiedene Rauschstimuli (RS) mit je 5 Lautstärken (−20 bis +20 dB SL) erzeugt. Diese wurden über audiologische Kopfhörer in einer Schallkammer für jeweils 40 s präsentiert. Nach jeder Präsentation wurde mithilfe einer 5‑stufigen Bewertungsskala (−2 bis +2) ermittelt, ob sich die TL verändert hat.Es fanden sich Patienten ohne Verbesserung der TL (n = 6) und solche mit Verbesserung (n = 16), wobei hier RS um die TF besonders effektiv waren. Die Gruppen zeigten post hoc deutliche Unterschiede in den Audiogrammen: Offenbar ist das hier getestete Verfahren insbesondere bei normalhörenden Tinnituspatienten und solchen mit geringgradigem HV effektiv.Die subjektiv wahrgenommene TL war bei 16 von 22 Probanden für die Dauer der Stimulation reduziert. Für den möglichen Erfolg einer zukünftigen Therapie scheint der HV relevant zu sein.

Hearing loss is frequently induced by occupational noise exposure and leads to rising hearing thresholds as well as reduced otoacoustic emissions (OAE), mostly caused by metabolic hair cell decompensation.Primary endpoint is the increase in average pure tone thresholds after noise exposure, secondary endpoints are loss of distortion product and click-evoked OAE as well as reduction of their contralateral suppression.The present study design describes the verification of the anti-oxidant and neuroprotective properties of EGb 761® by evaluation of cochlear protection from noise impact as well as its safety and tolerance in 202 healthy male participants distributed equally to verum and placebo groups in a double-blind manner. Participants were assessed, medicated, exposed to noise, and then examined at timepoints up to 10 min and 4 weeks thereafter.This summary of the verification study protocol highlights the complexity of diligent and precise planning according to the European Medicines Agency criteria for controlled trials (EudraCT). Key points are the intervention rationale, definitions of in- and exclusion criteria, estimation of subject numbers, and examination method setting in terms of optimum endpoint description.

To develop a new, German, age-appropriate speech audiometry test for children, by using 26 nouns that are most likely part of the lexicon of 2-year-olds. The test is a picture-pointing task with a four-option non-forced choice method. In total, 179 children aged 2;11 to 6;9 y were included for standardizing and validating the speech test. Of these, 51 had a hearing impairment in both ears ranging up to 90 dB hearing level (HL). The normal-hearing collective was divided into three groups according to age. For each group, the speech reception threshold (SRT) and the slope of the psychometric function of intelligibility were determined. For validation, the test-retest reliability was measured in 85 ears, and the correlation between the pure tone average (PTA) at 0.5, 1, 2, and 4 kHz and the SRT was measured in 86 ears. The sound spectrum of the 26 items was in good accordance with the international long-term speech spectrum, and the relative frequency of phonemes matched the distribution of the 50 more frequent German phonemes. The SRTs ranged from 24.6 ± 0.6 dB sound pressure level (SPL) for the oldest group (> 5.5 y) to 29.3 ± 1.3 dB SPL for the youngest group (< 4.25 y). The slopes of the psychometric function ranged from 4.3 ± 0.5%/dB for the oldest group to 2.6 ± 0.4%/dB for the youngest. The test and retest showed good correlation (r = 0.89, p

Background Cochlear implantation in patients with functional residual low-frequency hearing is performed according to an established hearing-preserving surgical technique in order to cause minimal trauma of inner ear structures. Due to the increasing number of cochlear implants in children, the preservation of residual hearing is becoming increasingly important in this patient collective. Objectives Short- and mid-term hearing preservation outcome in pediatric patients is investigated. Materials and methods A group of 9 children (12 ears) between 5 and 12 years of age were examined after hearing-assisted cochlear implantation with respect to the pure tone audiometric thresholds. Retrospectively, short-term hearing preservation (up to 3 months after surgery) was examined. In a subgroup of 5 children, mid-term hearing preservation (7.5 to 16 months after surgery) was also analyzed. The mean values of hearing preserved (HL%) and hearing loss (HL) due to electrode insertion were calculated as measured values. Results In the whole group, the mean values of the preoperative PTAlow were 29.8 dB and the short-term postoperative PTAlow 42.6 dB. The mean value of the HL% was 73.6%, corresponding to an HL of 9.4 dB. In the subgroup, the mean PTAlow postoperatively was 46.0 dB in the mid-term and the HL% at 80.7% with a HL of 6.6 dB. Conclusions The results in children are consistent with the results in adults. Electric-acoustic stimulation (EAS) should be used in the treatment of children with existing low-frequency residual hearing, as good residual hearing preservation can also be achieved in children after implantation.

The HÖRSTAT study conducted in Northwest Germany found hearing impairment in approximately 16% of adults when applying the World Health Organization (WHO) criterion. However, the robustness of extrapolations to a national level might be questioned, as the epidemiological data were collected on a regional level.Independently from HÖRSTAT, the "Hearing in Germany" study examined adult hearing in Aalen, a town located in Southwest Germany. Both cross-sectional studies were based on stratified random samples from the general population. The average pure-tone threshold shift at 0.5, 1, 2, and 4 kHz (PTA4), the prevalence of hearing impairment (WHO criterion: PTA4 in the better ear25), and hearing aid uptake were compared. Data from the Aalen and HÖRSTAT studies were pooled (n = 3105) to extrapolate to the prevalence and the degree of hearing impairment for the years 2015, 2020, and 2025.Both studies yielded very similar results for PTA4. Weighted for official population statistics, the prevalence of hearing impairment according to the WHO criterion is 16.2% in adults, thus affecting 11.1 million persons in Germany. Owing to demographic changes, the prevalence is expected to increase in the medium term by around 1% per 5‑year period. With a similar degree of hearing loss, hearing aid provision differs from place to place.When adjusted for gender and age to the European Standard Population, the prevalence of hearing impairment observed both in HÖRSTAT and the Aalen sample is considerably lower than reported for international studies. Since the analysis refers to cross-sectional data only, possible cohort effects are not considered in the prevalence projection.

In communication situations with multiple speakers, speech recognition is adversely affected by energetic masking (EM) and informational masking (IM). IM characterizes masking effects caused by irrelevant information from competing speakers. This work investigates an approach to assess IM based on the Oldenburg Sentence Test (OLSA). Furthermore, the influence of interaural time differences (ITD) and aging effects on IM are considered. IM was measured by superimposing two sentences from the OLSA. The beginning of the target sentence was indicated by the keyword “Stefan”. To segregate between target and masker sentences, ITDs from 50 to 400 μs were included. The participants were asked to selectively attend to the target sentence and repeat the spoken words. Potential factors associated with speech recognition results were assessed by an auditory measure of temporal fine structure and a neuropsychological profile. The study comprised 16 normal-hearing listeners between 18 and 77 years of age. Despite the clinically normal hearing participants, the analysis showed a significant relationship between speech recognition outcome and pure tone thresholds. All participants benefited from small ITDs between the target and masker sentence with regard to the unmasking of IM. The magnitude of unmasking could not be explained by any of the factors assessed in this study. Error analysis and the comparison with the literature reveal that the OLSA could be a useful tool to assess IM. Also in line with the current literature is the relationship between speech recognition outcome and pure tone thresholds, as well as the strong effect of ITDs on the release from IM. Speech audiometric assessment of IM is of high relevance with regard to everyday communication situations. Due to its structure, the OLSA seems to be a useful tool for determining IM.

Patients with single-sided deafness (SSD) are limited by their asymmetric hearing in various areas of everyday life.The aim of this investigation was to perform an age-correlated comparison of the hearing threshold of the better ear of SSD patients with a normal-hearing (NH) reference cohort. In addition, the potential influence of etiology, duration of deafness, and cochlear implantation (CI) of the poorer ear on the peripheral hearing ability of the better ear was investigated.In a multicenter study, the mean bone conduction hearing threshold of the better ear of 413 adult SSD patients was compared with that of an NH cohort drawn from ISO 7029:2017 for the frequencies 0.5, 1, 2, and 4 kHz.SSD patients showed significantly poorer hearing in the better ear compared to the age-correlated group of NH subjects. CI, duration of deafness, and etiology had no significant effect on the hearing ability of the better ear.The origin of the poorer hearing of the better-hearing ear of SSD patients compared to an age-correlated NH cohort is still unclear. It is most likely a combination of different anatomical, immunological, etiological, and microcirculatory causes, which lead to poorer hearing of the better-hearing ear in SSD patients.

In the past, various simulation and measurement paradigms have been introduced and evaluated in order to improve frequency-specific measurement of the hearing threshold using early auditory evoked potentials (EAEP). A promising approach for improvement of detection of stimulus response is the usage of frequency-modulated chirp signals, which optimize the temporal synchrony of neuronal responses along a region of the basilar membrane.This study validated the performance of three generated narrow-band chirp stimuli in combination with a level-adaptive simultaneous masker on a collective of normally hearing subjects.In this study 25 normal hearing subjects took part after undergoing pure tone audiometry as well as an objective estimation of the auditory threshold using low, middle and high chirp stimuli. The characteristic EAEP parameters were visually identified before statistical analysis. The characteristic latency level function was conducted using measurements within a stimulus level range from 80 to 0 dB HL. Afterwards a comparison of objectively verified auditory threshold and subjective auditory threshold was conducted.All objectively determined thresholds of the frequency-specific evoked EAEP were on average below 10 dB HL: low chirp at 8.2 dB HL, middle chirp at 5.8 dB HL and high chirp at 5.4 dB HL. The mean difference compared to subjectively determined auditory thresholds at all frequencies was below 3 dB and was not significant.Brainstem evoked response audiometry (BERA) using a band-limited and level-specific masked chirp stimulus is an efficient method for the determination of frequency-specific excitation thresholds in the clinical routine. The small, insignificant difference compared to the subjectively determined auditory thresholds makes usage of correction factors mostly redundant. Confirming the study results concerning low chirp stimuli so far, the low chirp BERA currently seems to be the method of choice for estimation of auditory threshold at low frequency ranges around 500 Hz.

Bone conduction hearing aids can be worn as noninvasive devices using a clip or soft band that exerts pressure on the skin, or they can be surgically implanted. ADHEAR (MED-EL GmbH, Innsbruck, Austria) is a novel noninvasive bone conduction hearing aid that is attached behind the ear using an adhesive adapter and does not exert pressure on the skin. ADHEAR is indicated for patients with conductive hearing loss and normal inner ear function. The aim of this study was to evaluate the achievable hearing improvement with ADHEAR.Twelve subjects with normal hearing participated in this study. To mimic conductive hearing loss, the participants' ear canals were occluded unilaterally with a foam ear plug. The resultant conductive hearing loss was assessed with pure tone air- and bone-conduction threshold audiometry. Hearing ability was tested with and without ADHEAR via free-field tone audiometry, number perception, and monosyllable perception, with the contralateral ear plugged depending on test requirements.Using ADHEAR, the free-field hearing threshold improved by 13.7 dB at 500 Hz, by 17.9 dB at 1 kHz, by 17.2 dB at 2 kHz, and by 9.8 dB at 4 kHz. In the higher frequencies, a significant pure-tone gain of 14.4 dB at 6 kHz and of 16.5 dB at 8 kHz was observed. Number perception with ADHEAR was mean 69.2% at 35 dB, 97.9% at 50 dB, 100% at 65 dB, and 100% at 80 dB. Monosyllable perception with the ADHEAR was mean 35.0% at 35 dB, 72.3% at 50 dB, 93.5% at 65 dB, and 98.8% at 80 dB.Hearing performance was significantly better with ADHEAR under all test conditions except those where maximum perception was already achieved without ADHEAR.

Due to demographic change and altered recreational behavior, a rapid increase in hearing deficits is expected in the next 20-30 years. Consequently, the risk of age-related loss of speech discrimination, tinnitus, hyperacusis, or-as recently shown-dementia, will also increase. There are increasing indications that the loss of specific hearing fibers in humans and animals is involved in various hearing disorders. This fiber loss can be caused by cochlear synaptopathy or deafferentation and does not necessarily lead to clinically measurable threshold changes. Animal experiments have shown that reduced auditory nerve activity due to acoustic trauma or aging can be centrally compensated by disproportionately elevated and faster auditory brainstem responses (ABR). The analysis of the suprathreshold amplitudes of auditory evoked brain stem potentials and their latency in combination with non-invasive imaging techniques such as magnetic resonance imaging can help to identify the central compensatory ability of subjects and to assign defined hearing deficits.

A fundamental prerequisite for successful application of auditory brainstem responses (ABR) in paedaudiological diagnostics is to ensure a high quality of the measurement. This is commonly quantified by means of the residual noise. Key factors are the averaging number and the magnitude of spontaneous electroencephalogram (EEG). This is the first study to quantify the influence of different forms of sedation (anaesthesia, sedation with chloral hydrate or melatonin, natural sleep) on the individual EEG magnitude in children.ABR measurements of 80 children aged between 1 month and 6 years were analysed retrospectively. Individual mean EEG amplitude was calculated from the averaging number and the residual noise. The results were analysed statistically with the type of sedation as a factor. From the mean EEG amplitudes, a theoretical recording time for a residual noise level of 35 nV was estimated.The spontaneous EEG activity is, on average, 2.5-times larger in awake children than in naturally sleeping children and more than 4‑times larger than in sedated children. Although the EEG amplitude in intubation anaesthesia was smaller than with the other three types of sedation, this difference was not significant. The theoretical measurement time for 35 nV of residual noise was 10-times larger in awake than in sedated children.The large difference in spontaneous EEG activity between awake and sedated children indicates that sedation should be used for estimation of hearing thresholds on the basis of ABR. Only in rare cases is a reliable estimate of hearing thresholds likely to be obtained from ABR in awake children. Since different types of sedation do not influence the measurement time significantly, selection can be made solely on the basis of age and medical indication.

New research in animal models indicates that even at lower intensities, noise exposure can induce defects in the synapses of the auditory pathway. However, only very high levels of noise exposure lead to mechanical hair cell damage with lesions of the inner ear and measurable hearing loss (audiogram; distortion product otoacoustic emissions, DPOAE). This paper revises the literature, starting with a case study.A 41-year-old patient suffered from hearing loss and tinnitus in the right ear following a car accident with airbag deployment. Hearing loss recovered partially, tinnitus and difficulties in speech discrimination persisted. Audiometry showed typical high-frequency hearing loss (40 dB) and tonal tinnitus (8 kHz). Although DPOAE and ABR potentials (auditory brainstem response, wave III and V) were completely normal 6 months after the accident, there was no detectable cochlear action potential (CAP) in electrocochleography (ECochG).These findings indicate recovery of initial hair cell damage, whereas synaptic transformation remains reduced and slight hearing loss and poor speech perception in complex listening situations persist. This phenomenon has been described as "hidden hearing loss" in newer literature. Although similar retrocochlear lesions in the auditory pathway could be detected in animal models, valid data in humans are currently lacking because no adequate diagnostic methods are available.Noise trauma initially results in hair cell damage. After recovery, hearing loss may persist, which can be due to synaptic lesions in the first neuron. An adequate testbattery has to be developped.

Test procedures used in clinical routine are often not sufficiently accurate to evaluate the auditory benefit of hearing systems and the improvements brought by new signal preprocessing algorithms.The aim of the study was to realize and evaluate a sound reproduction system for simulation of everyday listening conditions.A sound reproduction system was developed using 128 loudspeakers. By appropriate superposition of the loudspeaker signals (so-called wave field synthesis), it is possible to create almost arbitrary everyday listening conditions in a reproducible laboratory setting. Auditory scenes can be changed in real time. The sound reproduction system was mechanically evaluated by measuring the sound field with a microphone array. To validate the system, speech reception thresholds (SRT) were measured in bilateral cochlear implant (CI) users in moving and diffuse noise conditions. Furthermore, the impact of different types of directional microphones on speech perception was assessed.With a moving noise source in the dorsal half-space, CI users showed significant SRT improvements by using directional microphones with higher directional sensitivity (2.5 dB improvement) as well as with adaptive directional sensitivity (8.5 dB). The benefit of adaptive directional microphones is reduced in environments with diffuse noise.Wave field synthesis is a useful tool to simulate everyday listening conditions in a reproducible laboratory environment. This technique can complement established clinical methods to assess the benefit of a hearing device fitting or of signal preprocessing algorithms in dynamic listening conditions.

Cochlear implantation in patients with functional residual low-frequency hearing is performed according to an established hearing-preserving surgical technique in order to cause minimal trauma of inner ear structures. Due to the increasing number of cochlear implants in children, the preservation of residual hearing is becoming increasingly important in this patient collective.Short- and mid-term hearing preservation outcome in pediatric patients is investigated.A group of 9 children (12 ears) between 5 and 12 years of age were examined after hearing-assisted cochlear implantation with respect to the pure tone audiometric thresholds. Retrospectively, short-term hearing preservation (up to 3 months after surgery) was examined. In a subgroup of 5 children, mid-term hearing preservation (7.5 to 16 months after surgery) was also analyzed. The mean values of hearing preserved (HL%) and hearing loss (HL) due to electrode insertion were calculated as measured values.In the whole group, the mean values of the preoperative PTAThe results in children are consistent with the results in adults. Electric-acoustic stimulation (EAS) should be used in the treatment of children with existing low-frequency residual hearing, as good residual hearing preservation can also be achieved in children after implantation.

A noise trauma induces central nervous system pathologies, which generate deficits in hearing and perception of sound.Are degenerative mechanisms in the central auditory system a direct impact of overstimulation or an effect of acoustic deprivation?Detection of cell death in a mouse model of noise-induced hearing loss at different times after single or repeated noise exposure.A single noise exposure (3 h, 115 dB SPL, 5-20 kHz) induces acute (≤1 day) and long-term (observation period 14 days) degeneration, particularly in subcortical structures. Repeated noise trauma is followed by pathologies in the auditory thalamus and cortex.Noise has a direct impact on basal structures of the central auditory system; a protection of cortical areas is possibly due to inhibitory neuronal projections. Degenerative mechanisms in higher structures of the pre-damaged system point to an increased impairment of complex processing of acoustic information.

For Ear, NoseThroat specialists, the physiological and psychoacoustical deficits related to hearing impairment and the compensatory capabilities of hearing aids are topics of prime importance. In conductive hearing loss, the foremost deficit is decreased audibility, for which hearing aids can compensate almost entirely through the use of level independent gain. In the instance of sensorineural hearing loss, however, the irreversible loss of outer and inner hair cells causes a distorted sound perception, which is particularly troublesome when trying to understand speech in noisy environments. Unfortunately, this distortion cannot be compensated through the use of hearing aids. Nevertheless, in particular listening environments, its effects can be lessened by reducing background noise levels through the use of directional microphones and, to a lesser extent, digital noise reduction. Noise reduction is in many cases also the main effect to improve speech discrimination in retrocochlear hearing loss.

Distortion product otoacoustic emissions (DPOAEs) and transient evoked otoacoustic emissions (TEOAEs) are sound waves generated as byproducts of the cochlear amplifier. These are measurable in the auditory canal and represent an objective method for diagnosing functional disorders of the inner ear. Conventional DPOAE and TEOAE methods permit detection of hearing impairment, but with less than desirable accuracy.By accounting for DPOAE generation mechanisms, the aim is to improve the accuracy of inner-ear diagnosis.DPOAEs consist of two components, which emerge at different positions along the cochlea and which may cause artifacts due to mutual interference. Here, the two components are separated in the time domain using short stimulus pulses. Optimized stimulus levels facilitate the acquisition of DPOAEs with maximum amplitudes. DPOAE and Békésy audiograms were recorded from 41 subjects in a clinically relevant frequency range of 1.5 to 6 kHz.The short stimulus pulses allowed artifact-free measurement of DPOAEs. Semilogarithmic input-output functions yielded estimated distortion product thresholds, which were significantly correlated with the subjectively acquired Békésy thresholds. In addition, they allowed detection of hearing impairment from 20 dB HL, with 95 % sensitivity and only a 5 % false-positive rate. This accuracy was achieved with a measurement time of about 1-2 min per frequency.Compared to conventional DPOAE and TEOAE methods, separation of DPOAE components using short-pulse DPOAEs in combination with optimized stimulus parameters considerably enhances the accuracy of DPOAEs for diagnosing impairment of the cochlear amplifier.

Within the context of treatment with cochlear implants (CIs), different electrical and electrophysiological diagnostic procedures are applied both intra- and postoperatively. These assess electrical measures from the CI and electrophysiological measures from CI patients, respectively. The electrophysiological diagnostic procedures comprise measurement of electrically evoked compound action potentials of the auditory nerve, the registration of electrically evoked auditory brainstem potentials and the assessment of electrically evoked auditory cortical potentials. These potentials reflect auditory nerve excitation and stimulus processing in different parts of the ascending auditory pathway for intracochlear electrical stimulation via a CI. For current CIs, assessment of electrode position and examination of the implant's coupling to the auditory nerve are important domains of application for electrophysiological diagnostic procedures. Another substantial application area is the examination of stimulus processing in the auditory pathway. However, the main field of application of these procedures is supporting the fitting of CI speech processors in infants and toddlers on the basis of electrophysiological thresholds.

The influence of bilateral cochlear implants (CI) and unilateral CI on the self-reported listening effort in standardized situations is being assessed.The sample consisted of 34 bilateral and 38 unilateral adult CI users. Unilateral CI users had at least severe hearing loss in the non-implanted ear and had been fitted with a hearing aid. The listening effort has been defined as a subjectively perceived effort in understanding a speaker. Patients were administered a customized questionnaire containing nine examples of listening situations with different demands. The listening effort expended in each situation had to be rated on a six-step scale. Answers were analyzed using repeated measures ANOVA, including the factors "level of background noise," "listening duration," and the covariates "patient age" and "time since CI implantation."Only the factors "level of background noise" and "listening duration" were significant (p = 0.024 and p = 0.001 respectively). Unilateral versus bilateral CI was not significant (p = 0.17). Nevertheless, bilateral CI users reported a lower degree of listening effort than unilateral users in all of the nine situations asked about in the questionnaire (binomial test: p = 0.002).We conclude that bilateral CI use has some effect on reducing listening effort, but compared with unilateral use the effect is possibly not very great.

Although the modern technique of otosclerosis surgery introduced by John Shea on 1st May 1956 has already been used throughout the world for almost fifty years it has not been possible to bring in line the differing opinions of surgeons concerning the optimum operation technique, the problems of the fenestration of the footplate, material and form of stapes replacement prosthetics and kind and place of their anchoring on the incus. Moreover, there is considerable disagreement among surgeons on a realistic evaluation of the findings of early and late results. During the last few decades otosclerosis surgery has become the hallmark of modern ear surgery and has been practiced in very highly specialized departments as well as in outpatient departments. The author, who has been very active in otosclerosis surgery since 1959-since 1979 with a modified personal technique-, wishes to prove that it is both meaningful and essential to modify the operation technique further, which is based on his own experiences and on more than 100 international publications. In this paper he presents his modified method, which has been tested on 1800 ears since 1979, as well as the results, achieved in this way.

Unlike pure tone thresholds that assess both peripheral and central sound processing, distortion-product otoacoustic emissions (DPOAEs) selectively mirror the functioning of the cochlear amplifier. High resolution DPOAEs are missing in the toolbox of routine audiometry due to the fact that high resolution DPOAE measurements are more time-consuming when compared to normal clinical DP grams with rough frequency resolution. Measurements of high resolution DPOAEs allow an early assessment of beginning sensory cell damage due to sound overexposure or administration of ototoxic drugs. When using a rough grid, sensory cell damage would be overlooked as in the early state damage only appears at some distinct cochlear sites. A review is given on the method and application of high resolution DPOAEs.

A specific quality assurance questionnaire concerned with the provision of hearing aids was introduced that assesses elements of patient satisfaction within Germany's statutory healthcare system. A questionnaire-based assessment is now relevant for all physicians involved in the care of statutorily insured patients in Germany. The APHAB (Abbreviated Profile of Hearing Aid Benefit) questionnaire is the most widely used. The APHAB assesses several different situations: the normal hearing situation, hearing in noise, comprehension of speech in situations of echo or reverberation and hearing in loud situations. The APHAB questionnaire-based patient evaluation of the benefit of hearing aids represents the third pillar of audiological diagnostics, alongside classical pure-tone and speech audiometry. The objective of the APHAB database is to allow evaluation of individual patient data on the basis of a larger volume of data.

Before the era of objective audiometric procedures, the primary aim of subjective audiometric procedures was determination of the hearing threshold, e.g. to assess hearing aid indications. Nowadays, the results of objective audiometric procedures play a major role in hearing threshold determination in children. Contrastingly, subjective audiometric procedures are also employed in order to verify, or acquire an objective picture of, social hearing abnormalities evident from the children's anamneses.A selective literature search was conducted in the PubMed and Scopus databases and current textbooks were also considered.Subjective audiometric procedures for children employ both nonlinguistic and linguistic stimuli. Procedures can differ in many ways and it can be differentiated between, for example, observational or behavioural audiometry and procedures in which the children are explicitly instructed on how to react to signals.Several subjective audiometric procedures have been developed to examine the hearing and listening skills of children. Some of these tests differ significantly in terms of their intended application, test construction and test quality criteria. Only a detailed understanding of the particular subjective audiometric procedure being applied enables formulation of the"correct" questions; which, providing the child is willing to cooperate, can also be specifically answered using the test.