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Objetivo: Evaluar las diferencias en la percepción musical entre estimulación sonora eléctrica vs acústica. Materiales y métodos: Se recolectaron pacientes adultos con implante coclear unilateral, con oído contralateral sano o hipoacusia leve y tiempo de rehabilitación auditiva mayor a 12 meses. Se les aplicaron escalas de reconocimiento musical, de calidad de vida Glasgow Benefit Inventory (GBI), identificación de tono, ritmo, instrumentos y canciones. Resultados y conclusiones: Se recolectaron 6 pacientes, edades entre 37-73 años, promedio de tonos puros (PTA) en oído sano

Objectives The aim of the present study was to describe and evaluate the results of a new technique in endolymphatic sac decompression surgery. Methods Forty-three patients with intractable unilateral Meniere's disease were selected. Endolymphatic sac was identified after simple mastoidectomy, and its lateral layer was incised, using a sickle knife. Outer layer of the sac was turned around and placed under the anterior bony border. Results Mean duration of the follow-up was 24 months. Mean tinnitus handicap index, pure tone average (PTA) on thresholds at 500, 1000, 2000, and 4000 Hz, mean speech reception threshold, mean speech discrimination score, hearing stage, and mean vertigo score before and after surgery were evaluated. Conclusion The new marsupialization technique with anterior bony border is a safe and effective way to improve tinnitus, vertigo, and ear fullness among these patients. According to PTA and hearing stage, this surgery can control progressive hearing loss. Level of evidence 3.

OBJECTIVES: Effects of decreasing auditory activity on speech discrimination ability are not fully understood. To investigate influence of decrease in auditory activity due to conductive and sensorineural components of hearing loss (HL) on speech discrimination ability. MATERIALS AND METHODS: We retrospectively reviewed medical records of patients with suspected HL at Kitasato University Hospital in 2017 and 2018. Patients were divided according to pure-tone audiometry findings: no HL (N-HL), conductive HL (C-HL), sensorineural HL (S-HL), and mixed HL (M-HL) groups. RESULTS: In total, 149 patients (224 ears) were eligible. The maximum speech discrimination score (SDSmax) for all ears significantly negatively correlated with age (r = −0.29, p

Σκοπός μελέτης. Σκοπός της παρούσας μελέτης είναι η αξιολόγηση της ακουστικής ανίχνευσης και αντίληψης των βαρήκοων - κωφών ασθενών μετά την κοχλιακή εμφύτευση.Υλικό και μέθοδος. Στην παρούσα μελέτη εξετάστηκαν 123 τυχαιοποιημένοι ασθενείς (57 άνδρες και 66 γυναίκες ηλικίας από 6 μέχρι και 82 ετών) οι οποίοι χωρίστηκαν σε 4 κατηγορίες:Κατηγορία I: ενήλικες μεταγλωσσικά βαρήκοοι - κωφοί Κατηγορία II: παιδιά σχολικής ηλικίας από 6 έως 16 ετώνΚατηγορία III: παιδιά σχολικής ηλικίας από 6 έως 16 ετών με συνοδά νευρολογικά προβλήματαΚατηγορία IV: ενήλικες προγλωσσικά βαρήκοοι - κωφοί, που υποβλήθηκαν σε κοχλιακή εμφύτευση αργότερα, οι οποίοι πριν το χειρουργείο χρησιμοποιούσαν κάποιο ακουστικό βοήθημα, κάνοντας χρήση του προφορικού λόγου Όλοι οι εξεταζόμενοι είχαν υποβληθεί σε κοχλιακή εμφύτευση τουλάχιστον δύο χρόνια πριν από την ημερομηνία εξέτασης τόσο στο Κέντρο Κοχλιακών Εμφυτεύσεων της Β’ ΩΡΛ Πανεπιστημιακής Κλινικής του Νοσοκομείου “ΑΤΤΙΚΟΝ” όσο και στην Α’ Πανεπιστημιακή ΩΡΛ Κλινική του Νοσοκομείου “ΑΧΕΠΑ”. Για τη διεξαγωγή των μετρήσεων στην παρούσα μελέτη χρησιμοποιήσαμε την τονική ακοομετρία ελευθέρου πεδίου, τη δοκιμασία διάκρισης δισύλλαβων λέξεων / προτάσεων της ομιλητικής ακοομετρίας στην ελληνική γλώσσα (με τη χρήση ψηφιακού δίσκου και ζωντανά με τη βοήθεια λογοθεραπευτή) σε ένταση ακρόασης 65 dB HL. Για την καταγραφή της πραγματικής συνεισφοράς του κοχλιακού εμφυτεύματος στην καθημερινή ζωή των ασθενών μας μετά το χειρουργείο, χρησιμοποιήσαμε τα ειδικά ερωτηματολόγια CAP test (Categories of Auditory Performance) και GBI test (Glasgow Benefit Inventory). Αποτελέσματα. Στην κατηγορία Ι εξετάσαμε 29 ασθενείς. Ο μέσος όρος ανίχνευσης του ήχου στο τονικό ακοόγραμμα ελευθέρου πεδίου ήταν 26 dB HL και το ποσοστό διάκρισης λέξεων / προτάσεων στη δοκιμασία της ομιλητικής ακοομετρίας ήταν 87,72% / 82,55% (όταν τα σενάρια δίνονταν από τον ψηφιακό δίσκο) και 95,66% / 95,45% (όταν εκφωνούνταν ζωντανά από τη λογοθεραπεύτρια της ομάδας). Ομοίως οι μετρήσεις CAP μετά το χειρουργείο είχαν βελτιωθεί σημαντικά (Wilcoxon signed rank test, p - value < 0.001) από το επίπεδο ΙΙ στο επίπεδο VII όπως και o δείκτης οφέλους της Γλασκόβης (+47,88).Στην κατηγορία ΙΙ εξετάσαμε συνολικά 60 ασθενείς. Ο μέσος όρος ανίχνευσης του ήχου ήταν 21dB HL και το ποσοστό επιτυχίας στη διάκριση λέξεων / προτάσεων: 88% / 84,88% και 94,5% / 92,1%. αντίστοιχα. Οι μετρήσεις CAP μετά το χειρουργείο εμφάνισαν και αυτές σημαντική βελτίωση (Wilcoxon signed rank test, p - value < 0.001) από το επίπεδο Ι στο επίπεδο VII όπως και ο δείκτης οφέλους της Γλασκόβης (+51,47).Στην κατηγορία ΙΙΙ εξετάσαμε 20 ασθενείς. Ο μέσος όρος ανίχνευσης του ήχου 24dB HL και το ποσοστό διάκρισης των λέξεων / προτάσεων: 56,6% / 48,8% και 70,35% / 55,95% αντίστοιχα. Οι μετρήσεις CAP (Wilcoxon signed rank test, p - value < 0.001) μετά το χειρουργείο εμφάνισαν σημαντική βελτίωση από το επίπεδο 0 στο επίπεδο V όπως και o δείκτης οφέλους της Γλασκόβης (+41,52).Στην κατηγορία IV εξετάσαμε 14 ασθενείς. Ο μέσος όρος ανίχνευσης του ήχου 26dB HL και ποσοστό διάκρισης των λέξεων / προτάσεων: 45,14% / 33,64% και 60,57% / 51,29% αντίστοιχα. Οι μετρήσεις CAP (paired samples t-test, p - value < 0.001) μετά το χειρουργείο είχαν βελτιωθεί από το επίπεδο ΙI στο επίπεδο VI ενώ o δείκτης οφέλους της Γλασκόβης (GBI test) μετά τη χειρουργική επέμβαση παρουσίασε και αυτός θετική μεταβολή (+44,63).ΣυμπέρασμαΤο συμπέρασμα που προκύπτει από την παρούσα μελέτη αφορά τη σημαντική βελτίωση των όλων των κατηγοριών των εξεταζόμενων (σε επίπεδο σημαντικότητας 5%) τόσο στη δοκιμασία του τονικού ακοογράμματος ελευθέρου πεδίου (p-values < 0.001, τιμές ακοομετρικού διαγράμματος > 90 dB HL πριν από το χειρουργείο) όσο και στη δοκιμασία της ομιλητικής ακοομετρίας (p-values < 0.001, ποσοστό ακουστικής διάκρισης < 40% πριν από το χειρουργείο). Την καλύτερη διάκριση της ομιλίας φαίνεται να εμφανίζουν τα παιδιά της κατηγορίας ΙΙ μαζί με τους ενήλικες της κατηγορίας Ι (καθώς τα αντίστοιχα p values ήταν μικρότερα από 0,05). Αντίθετα οι εξεταζόμενοι της κατηγορίας ΙΙΙ και IV δεν είχαν ανάλογα αποτελέσματα (p-value = 0.000 < 0.05). Αυτό μπορεί να ερμηνευτεί από το γεγονός ότι οι μεν ασθενείς της κατηγορίας IV συνέχισαν να χρησιμοποιούν μετά το χειρουργείο τη νοηματική γλωσσά, ενώ οι ασθενείς της κατηγορίας ΙΙΙ είχαν καθυστερημένη λεκτική πρόοδο λόγω των συνοδών νευρολογικών προβλημάτων. Εντούτοις από το ερωτηματολόγιο CAP test (p-values < 0.001) προκύπτει ότι η ακουστική ικανότητα των κωφών ασθενών που συμμετείχαν στην μελέτη μας, ανεξαρτήτου κατηγορίας, παρουσίασε σημαντική βελτίωση μετά το χειρουργείο του κοχλιακού εμφυτεύματος. Όλοι οι παραπάνω εξεταζόμενοι επίσης επιβεβαίωσαν τη θετική επίδραση της επέμβασης στην ποιότητα της ζωής τους (p-value = 0.183 > 0.05), σύμφωνα με το ερωτηματολόγιο GBI test

Objective This study aimed to investigate the effect of hearing protection devices (HPDs) on speech intelligibility in Persian work environments. Three current earmuffs and three earplugs and one of the prototypes of molded earplug were tested on 15 male subjects which were randomly selected. The noise reduction of HPDs was measured based on the Real Ear Attenuation at Threshold (REAT) method. Speech intelligibility during using HPDs was determined based on the speech discrimination score (SDS) at two signal to noise (S/N) ratios (0 and + 5). Data were analyzed using SPSS 22. Results The actual to nominal noise reduction rating values were from 47 to 84% for HPDs. At two S/N ratios, no significant differences were observed in speech intelligibility using HPDs (p > 0.05). At S/N ratio = 0, the speech intelligibility descriptively has been only improved by using common earmuffs up to 9.07%. There was a significant difference up to 21.27% in speech intelligibility for proposed molded earplugs at S/N ratio = 0 (p

This study aimed to compare the difference in maximum speech discrimination score (SDSmax) of the worse-hearing ear in asymmetric hearing loss (ASHL) patients with that in symmetric hearing loss (SHL) patients. We retrospectively reviewed medical records of patients with suspected hearing loss (HL) who underwent audiometric examinations. Patients were divided into two groups according to the difference in air conduction (AC) threshold between the right and left ears: the SHL group and the ASHL group. Of the 102 patients (204 ears), 74 (148 ears) had SHL, and 28 had ASHL. The worse-hearing ear of ASHL patients exhibited a statistically significantly higher AC threshold and lower SDSmax, compared with ears of SHL patients and better-hearing ears of ASHL patients, and SDSmax exhibited a statistically significant negative correlation with AC threshold. The SDSmax was statistically significantly lower in the worse-hearing ear of the ASHL group than in moderate to severe HL ears of the SHL group, even though these groups had comparable AC thresholds. ASHL patients’ worse-hearing ear exhibited a lower SDSmax than SHL patients’ ears, despite a comparable AC threshold. Management of hearing impairment in ASHL patients should receive more attention.

Despite recent technological advances in the audiologic assessment of children, their hearing aid fitting remains a daunting task. Aims of study To assess effectiveness of amplification in children using aided sound field tests and Auditory Behavior in Everyday Life (ABEL) questionnaire and to elucidate factors contributing to poor outcomes. Methods Detailed medical history, otoscopic examination, basic audiological evaluation, aided sound field tests and ABEL questionnaire for 114 hearing impaired children aged 4–16 years. Results Congenital HL considered the commonest cause of HL (55.3%), 36% had unknown cause and 8.8% of HI had acquired cause. Profound loss in 67.5%, severe in 17% and 54.4% of them (54.4%) were fitted around the age of 3 years. Binaural HA in 88.6% and digital type for 61.4%. There were statistically significant differences between unaided and aided values in sound field tests for HI children. Poor performance in direct measures and ABEl in children with congenital and profound degree of hearing loss, better response when they were fitted earlier with digital aids. ABEL scores showed negative correlations with aided tonal sound field test and positive with aided speech discrimination score. Conclusions Inappropriate amplification, late age of fitting with no speech therapy were clinical red flags for poor outcomes. ABEL questionnaire was a valid procedure to assess the hearing aids appropriateness.

Results in studies concerning cortical changes in idiopathic sudden sensorineural hearing loss (ISSNHL) are not homogeneous, in particular due to the different neuroimaging techniques implemented and the diverse stages of ISSNHL studied. Considering the recent advances in state-of-the-art positron emission tomography (PET) cameras, the aim of this study was to gain more insight into the neuroanatomical differences associated with the earliest stages of unilateral ISSNHL and clinical-perceptual performance changes. After an audiological examination including the mean auditory threshold (mean AT), mean speech discrimination score (mean SDS) and Tinnitus Handicap Inventory (THI), 14 right-handed ISSNHL patients underwent brain [ 18 F]fluorodeoxyglucose (FDG)-PET within 72 h of the onset of symptoms. When compared to an homogeneous group of 35 healthy subjects by means of statistical parametric mapping, a relative increase in FDG uptake was found in the right superior and medial frontal gyrus as well as in the right anterior cingulate cortex in ISSNHL patients. Conversely, the same group showed a significant relative decrease in FDG uptake in the right middle temporal, precentral and postcentral gyrus as well as in the left posterior cingulate cortex, left lingual, superior, middle temporal and middle frontal gyrus and in the left insula. Regression analysis showed a positive correlation between mean THI and glucose consumption in the right anterior cingulate cortex and a positive correlation between mean SDS and glucose consumption in the left precentral gyrus. The relative changes in FDG uptake found in these brain regions and the positive correlation with mean SDS and THI scores in ISSNHL could possibly highlight new aspects of cerebral rearrangement, contributing to further explain changes in those functions that support speech recognition during the sudden impairment of unilateral auditory input.

Background The management of solely intracanalicular acoustic neurinoma (iAN) includes observation, microsurgical resection and radiation therapy. Treatment goals are long-term tumor control, hearing preservation and concurrently low side-effects. Stereotactic radiosurgery (SRS) has evolved as an alternative first-line treatment for small AN. Here we report about the long-term follow-up of a unique cohort of patients with iAN after LINAC or Cyberknife® based SRS. Methods In this single center retrospective analysis, we included all patients with iAN who underwent single session LINAC or Cyberknife® based SRS between 1993 and 2015, and who had a minimum follow-up period of six weeks. Patient data were analyzed in terms of radiological and clinical tumor control (no further treatment necessary), subjective preservation of serviceable hearing, objective change in pure tone averages (PTA), and adverse events rated by the Common Terminology Criteria for Adverse Events (CTCAE; v4.03). Results Forty-nine patients (f/m = 21/28, median age 54 ± 12, range 20–77 years) were identified. Mean tumor volumes were 0.24 ± 0.12 cm3 (range, 0.1–0.68 cm3), the mean marginal dose was 12.6 ± 0.6 Gy (range, 11.0–14.0 Gy) and the prescription isodose was 75 ± 7.4% (range, 47–86%). Mean follow-up time was 65 months (range, 4–239 months). Radiological tumor control was 100% during further follow-up. 17 (35%) out of 49 patients had lost serviceable hearing prior to SRS. Those with preserved serviceable hearing remained stable in 78% (n = 25/32) at the last follow-up (LFU). The median PTA (n = 16) increased from 25.6 dB prior to SRS to 43.8 dB at LFU. Mild adverse events were observed temporarily in two patients (4%): one with CTCAE grade 1 facial nerve disorder after 3 months, resolving three months later, and one with CTCAE grade 2 facial muscle weakness resolving after 12 months. Three patients described permanent mild symptoms CTCAE grade 1 without limiting daily life (facial weakness n = 1, vertigo n = 2). Conclusion SRS for iAN shows long-term reliable tumor control with a high rate of hearing preservation without considerable permanent side effects, and can be proposed as a safe and effective treatment alternative to microsurgical resection.

A retrospective review of 34 patients was done who had idiopathic sudden sensorineural hearing loss and were administered intratympanic corticosteroid in the form of dexamethasone (4 mg/ml). The results were interpreted based on pure tone audiometry and Speech discrimination score of the patient before commencing the treatment and after the treatment.

Objective To assess possible delayed recovery of the maximum speech discrimination score (SDS) when the audiometric threshold ceases to change. Methods We retrospectively examined 20 patients with idiopathic sudden sensorineural hearing loss (ISSNHL) (gender: 9 males and 11 females, age: 24–71 years). The findings of pure-tone average (PTA), maximum SDS, auditory brainstem responses (ABRs), and tinnitus handicap inventory (THI) were compared among the three periods of 1–3 months, 6–8 months, and 11–13 months after ISSNHL onset. Results No significant differences were noted in PTA, whereas an increase of greater than or equal to 10% in maximum SDS was recognized in 9 patients (45%) from the period of 1–3 months to the period of 11–13 months. Four of the 9 patients showed 20% or more recovery of maximum SDS. No significant differences were observed in the interpeak latency difference between waves I and V and the interaural latency difference of wave V in ABRs, whereas an improvement in the THI grade was recognized in 11 patients (55%) from the period of 1–3 months to the period of 11–13 months. Conclusion The present study suggested the incidence of maximum SDS restoration over 1 year after ISSNHL onset. These findings may be because of the effects of auditory plasticity via the central auditory pathway.

Transcranial direct current stimulation (tDCS) can alter cortical excitability, and has been effective in treating some neurological disorders. This case report describes the use of tDCS in a 13-year-old female who developed bilateral hearing impairment after brainstem encephalitis when she was 6 years old. Her auditory function was more impaired in her right ear than her left. Anodal stimulation (1 mA) was applied for 10 min to the left auditory cortex once per day for 4 consecutive days to improve her right ear speech discrimination score. Sustained and significant improvement in maximum speech discrimination was observed after the four tDCS treatments. To our knowledge, this is the first case report of improvement in speech discrimination after anodal stimulation of the auditory cortex. These results encourage further studies investigating the beneficial effects of tDCS in patients with hearing impairments.

Objective: To assess the outcomes of intratympanic steroids in the management of idiopathic sudden sensorineural hearing loss. Study Design: Retrospective study. Setting: Academic tertiary care medical centre. Materials and Methods: A total of 67 patients with idiopathic sudden sensorineural hearing loss were included in our study. Pre- and post-injection audiograms were taken to assess the outcomes in improvement in hearing. Hearing outcomes were assessed with respect to duration of onset of treatment and age of the patient. Improvement in the speech discrimination score was also assessed. Results: A total of 67 patients were included in our study of which unilateral cases were 59 and bilateral cases were 8. Subjectively 35 patients reported improvement in hearing after the therapy while objectively we found 44 ears [41 patients] had improvement. The mean PTA pre ITS was 62.7 and after ITS it was 56.3. Maximum improvement was noted at 2000 Hz and 1000 Hz. Conclusion: Intratympanic steroids can be offered as a first line therapy for idiopathic sudden sensorineural hearing loss as it is minimally invasive, and can be performed as an office based procedure with no systemic side effects. No major complications have been reported in our study and results have been satisfactory.

Background: Patients with hearing disturbance will generally undergo pure tone audiometry and speech audiometry in a quiet room, but those examinations cannot evaluate the ability to understand speech in daily environment with a noisy background. Words in noise test will provide valuable information regarding patient’s hearing problem in noise. Purpose: To evaluate the hearing threshold using words in noise test in adults with normal hearing. Method: This cross-sectional study was conducted in Cipto Mangunkusumo Hospital from January to April 2017. All subjects who fulfilled the inclusion and exclusion criteria underwent pure tone audiometry, speech audiometry, and words in noise test. Results: A total of 71 individuals with normal hearing were recruited for this study. Words in noise test showed the median value of 67 dB and 100 dB for Speech Recognition Threshold (SRT) 50% and Speech Discrimination Score (SDS) 100%, respectively. The SRT 50% and SDS 100% were significantly higher in the age group 40–60 years compared to the age group 18–39 years. There was also a statistically significant difference between males and females at SRT 50% assessed by words in noise audiometry. Conclusion: Words in noise test showed a statistically significant difference in SRT 50% and SDS 100% between two age groups, but no difference was found between genders. The result of this study can be used as a reference for SRT and SDS values of speech audiometry test in noise. Keywords: words in noise, speech audiometry, speech recognition threshold, speech discrimination score ABSTRAK Latar belakang: Pasien dengan gangguan pendengaran umumnya menjalani pemeriksaan audiometri nada murni dan audiometri tutur di ruangan yang sunyi, tetapi pemeriksaan ini tidak dapat menggambarkan kemampuan pemahaman wicara di lingkungan sehari-hari yang ramai. Tes tutur dalam bising dapat mengevaluasi masalah pendengaran pasien dalam keadaan bising. Tujuan: Untuk mengevaluasi ambang pendengaran menggunakan tes tutur dalam bising pada orang dewasa dengan pendengaran normal. Metode: Penelitian potong lintang ini dilakukan di Rumah Sakit Cipto Mangunkusumo dari Januari hingga April 2017. Semua subjek yang memenuhi kriteria inklusi dan eksklusi menjalani pemeriksaan audiometri nada murni, audiometri tutur, dan tes tutur dalam bising. Hasil: Sebanyak 71 orang dengan pendengaran normal diikutsertakan dalam penelitian ini. Tes tutur dalam bising menunjukkan nilai median masing-masing 67 dB dan 100 dB pada Speech Recognition Threshold (SRT) 50% dan Speech Discrimination Score (SDS) 100%. SRT 50% dan SDS 100% secara signifikan lebih tinggi pada kelompok usia 40–60 tahun dibandingkan dengan kelompok usia 18–39 tahun. Hasil pemeriksaan tes tutur dalam bising menunjukkan perbedaan yang signifikan antara laki-laki dan wanita pada nilai SRT 50%. Kesimpulan: Tes tutur dalam bising menunjukkan perbedaan yang bermakna secara statistik pada SRT 50% dan SDS 100% antara dua kelompok umur, tetapi tidak ada perbedaan signifikan diantara jenis kelamin. Hasil penelitian ini dapat digunakan sebagai acuan untuk nilai SRT dan SDS pada pemeriksaan audiometri tutur dalam bising.

In human hearing, frequency resolution is a term used to determine how well the ear can separate and distinguish two sounds that are close in frequency. This capability of breaking speech sounds into various frequency components plays a key role in processing and understanding speech information. In this paper, a piecewise-linear frequency shifting algorithm for digital hearing aids is proposed. The algorithm specifically aims at improving the frequency resolution capability. In the first step, frequency discrimination thresholds are processed by a computer testing software. Then, the input signal is parsed through the proposed piecewise-linear frequency shifting algorithm, which comprises of linearly stretching and compressing the frequency content at different frequency ranges. Experimental results showed that by using the proposed frequency shifting algorithm, the separation of formant tracks was increased in the stretching region and slightly squeezed in the adjacent compression region. Subjective assessment on six hearing-impaired persons with V-shaped audiograms demonstrated that nearly a 10% improvement of speech discrimination score was achieved for monosyllabic word lists tested in a quiet acoustic setting. In addition, the speech reception threshold was also improved by 2~8 dB when disyllabic word listswere tested in a noisy acoustic scenario.

Various prescriptive procedures have been developed, for calculating the real ear insertion gain of a digital hearing aid based either on loudness equalization or speech intelligibility. But the problem for audiologists lies in selecting an appropriate procedure for particular types of hearing impairment. The aim of this work is to analyze various linear and nonlinear prescriptive procedures, by performing various audiological investigations on hearing impaired subjects, so as to select an optimum procedure for a specific type of impairment. An audiological test was carried out on 237 hearing impaired subjects in the age group of 23 to 75 years, and they were given appropriate hearing aids with gain recommendations, using different formulae by audiologists. The degrees of success of the recommended formulae were analyzed, based on the speech discrimination score. Subjects with mild and moderate losses were found satisfied with the gain suggestions of linear prescriptive procedures, in addition to procedures based on loudness equalization NAL-RP (National Acoustics Laboratory-Revised Profound), POGO II (prescription of Gain Output), and DSL (Desired Sensation Level). Subjects with sensorineural loss were satisfied only with the gain recommendations of non linear prescriptive procedures NAL-NL1 (National Acoustics Laboratory-Non Linear), NAL-NL2 and DSL I/O (Desired Sensation Level Input/Output). An appropriate prescriptive procedure for a specific audiogram could be successfully suggested in future based on the results obtained from the total population on whom the study was carried out. In the case of those subjects who were not satisfied with the suggested procedure, a revised formula would be arrived at, by suitably varying the gains by the audiologists.

The aim of the study was to explore the effect of vents on the speech discrimination scores and electroacoustic characteristics of body level hearing aids. The Nineteen adults who participated in the study had mild to moderate sloping sensori-neural hearing loss and were in the age range of 18-70 years. Apart from 19 hearing aids users additional 11 hearing aids were also taken for the study of electro-acoustic characteristics only. Major changes in the electroacoustic characteristics of the body worn hearing aids was observed on HFA OSPL90, FOG and EINL which reduced to 7.31%, 9.19% and 7.72% when parallel vent of 2mm were bored in the regular ear moulds respectively. Parallel/ Diagonal vents improved the Speech Discrimination score by 9%. The cumulative impact of venting can be seen on improvement of speech discrimination scores and subjective impression of clear speech.DOI: http://dx.doi.org/10.3329/bjo.v18i1.10420 Bangladesh J Otorhinolaryngol 2012; 18(1): 59-62

Background: Stapedectomy and stapedotomy are the standard techniques for stapes fixation surgery. Both techniques depend on the size of window opening (total, partial stapedectomy and small-hole stapedotomy) and the type of prosthesis used. Outcome of technique and prosthesis are controversy. Objective: Evaluate the outcomes of the two surgical techniques (stapedectomy/stapedotomy) and two sizes of prosthesis (Cawthorn 0.6mm/0.3mm) in terms of effectiveness and safety. Material and methods: Sixty-four medical records of patients undergoing stapedectomy or stapedotomy between the year 1995 and 2005 were reviewed. The subjects were classified into three groups including 0.6-mm stapedectomy, 0.6-mm and 0.3-mm stapedotomy group. The pre and post operative air-conduction threshold (AC) and air-bone gap (A-B gap) were compared for each group. The pre-and post-operative differences in pure tone average of AC, pure tone average of bone conduction threshold (BC), AB gap, AC at 4KHz, BC at 4KHz, AC at 8KHz, and speech discrimination score (SDS) were analyzed. The surgical complications were also compared. Results: Means of post-operative AC, and A-B gap were significantly better in all three groups. The mean of postoperative AC at 4KHz was significantly improved only in stapedotomy groups (0.6-mm and 0.3-mm stapedotomy). To compare the hearing outcomes among the three groups, there were no statistically significant differences between 0.6-mm stapedectomy vs. 0.6-mm stapedotomy, and between 0.6- mm vs. 0.3-mm stapedotomy. The complications were found in all three groups. The 0.3-mm stapedotomy had the lowest rate. Conclusion: Stapedectomy versus stapedotomy yields comparable hearing outcomes but stapedotomy results had a better success rate than the stapedectomy. For 0.6-mm stapedotomy vs. 0.3-mm stapedotomy, the overall results in both groups are not significantly different, in terms of both the hearing outcomes and the success rate. In terms of complication rate, 0.6-mm stapedectomy had the highest rate, while 0.3-mm stapedotomy had the lowest. Keyword: Otosclerosis, stapedectomy, stapedotomy, stapes

OBJECTIVE: To evaluate the validity of cochlear implantation (CI) on prelingually deafened adults who have been trained by auditory-verbal/oral communication since childhood. METHODS: Preoperative and postoperative data was investigated regarding the rehabilitation, hearing level, and educational experience of eight prelingually deafened adults. All eight patients were diagnosed with severe to profound sensorineural hearing loss (preoperative hearing levels were over 100 dB). All used hearing aids (HA) before the age of two and were trained by auditory-verbal/oral communication since childhood. The average age of the patients at the time of their CI operations was 23.3 ranging from 18 to 29 years of age. The average postoperative observation time was 55.4 months ranging from 11 to 90 months. RESULTS: Improvement was achieved not only on the pure-tone hearing threshold, but also in speech perception on tests using the Japanese video speech discrimination score (SDS) system. All of them now use CI very well in their daily lives and play important roles in society. CONCLUSION: It was demonstrated that even prelingually deafened adult patients could achieve considerable improvement through CI when they were trained well by auditory-verbal/oral communications since childhood. The indications of CI for prelingually deafened adults must be determined carefully, but all of them do not have to be rejected only because they are prelingually deafened. In other words, CI could be recommended for prelingually deafened adult patients if they received habilitation well with consistent auditory-verbal/oral training using well-fitted HAs., Auris Nasus Larynx, 35(3), pp.349-352; 2008

Objectives: The aim of this study was to evaluate the change of hearing and tinnitus in a group of conservatively managed unilateral vestibular schwannomas (VS). Design: Retrospective case series review. Setting: Tertiary referral otoneurological and skull base surgery department. Participants: Seventy patients affected by unilateral VS with at least two audiograms available were retrospectively evaluated. Main outcome measures: Changes in pure tone average (PTA), speech discrimination score (SDS), and tinnitus were analyzed. Results: At diagnosis 16 patients (22.9%) had a PTA of 0 to 30 dB and 38 (54.4%) a PTA of 0 to 50 dB. At the end of the follow-up period, 9 patients (12.9%) had a PTA of 0 to 30 dB and 27 (38.7%) had a PTA of 0 to 50 dB, representing a hearing preservation rate of 56% and 70%, respectively. Of patients with both tonal and speech audiometry, 71.4% with class A hearing (PTA 70%) maintained their initial hearing and 60% with class A or B hearing (PTA 50%) maintained this useful hearing. Forty-two patients (60%) did not show a significant growth in their tumor over the period of observation. In this group of patients the mean PTA after a mean follow-up time of 40 months decreased from 44 dB HL to 50.8 dB HL, with a yearly rate of 2.47 dB HL. The chance of maintaining a PTA of 0 to 30 dB in this group of patients was 57.1% and a PTA of 0 to 50 dB was 81.4%. Conclusions: In this group of patients affected by VS and managed conservatively with a mean follow-up of 33.3 months, the risk of losing eligibility for hearing preservation surgery was lower than 30%.

We report two cases of pseudohypacusis with organic hearing loss in which useful diagnostic information could be obtained from otoacoustic emission (OAE) testing.Case 1 was a 12-year-old female who had complained of fluctuating hearing loss for a few years. Although her initial pure-tone audiogram indicated moderate hearing loss in both ears, speech audiometry strongly suggested that the hearing of her left ear was considerably better than anticipated based on the pure-tone testing. Since the wave V thresholds of auditory brainstem response (ABR) were 70 and 20dBnHL in the right and left ear, respectively, it was suspected that she had moderate hearing loss in the right ear and normal hearing sensitivity in the left ear. However, OAE testing subsequently performed revealed moderate to severe hearing loss in all frequency regions except between 1.5 and 5kHz in her left ear, and this finding was also confirmed by follow-up pure-tone audiometry.Case 2 was a 54-year-old male whose complaints were left-sided hearing loss and tinnitus developing after a traffic accident. His initial pure-tone audiogram showed moderate to severe hearing loss in the left ear. However, his speech discrimination score for the left ear suggested much better hearing than expected from the pure-tone testing results, and mild hearing loss in the left ear was suspected based on ABR examined later. OAE testing was subsequently performed and revealed moderate to severe hearing loss in the frequency region above 3kHz in the left ear, a finding subsequently confirmed by pure-tone audiometry.The diagnosis of pseudohypacusis is sometimes difficult in patients with organic hearing loss, as in the two cases presented here. In such cases, frequency-specific information about cochlear function provided by OAE might be helpful for assessment of true hearing loss. From this perspective, OAE testing is considered useful as a diagnostic tool for pseudohypacusis.

Preservation of stapedius muscle and incudo-stapedial joint during stapedotomy for otosclerosis is the motto of the dat. The Study was carried out in 500 patients. In Group A (n = 140), the stapedius muscle and incudostapedial joint were preserved. In Group B (n = 360), the stapedius muscle was cut. One month after surgery in Group A patients, the Stapedius-Reflex (SR) was evoked in 75% and three months later in 90%. The mean Loudness Discomfort Level (LDL) after one month of surgery in Group A was 95dB while three months after it was increased to 110dB. Speech discrimination score (SDS) in Group A with 80 dB suprathreshold is 93% and in Group B it is only 72%. This study established the fact that the preservation of stapedial muscle and incudo stapedial join is beneficial and essential, whenever possible, in the surgery for otosclerosis.

Identification of the specific pathophysiological processes and correlation with post-operative hearing are the prerequisites for utilizing electrophysiological audio monitoring techniques in preventing damage to auditory structures during vestibular Schwannoma (VS) surgery. The present paper compares the value of auditory brainstem responses (ABRs), electrocochleography (ECochG) and directly recorded cochlear nerve action potentials (CNAPs) in detecting damage to auditory structures during VS surgery and predicting post-operative hearing. Eighteen consecutive patients operated on for VS, in an attempt at hearing preservation, participated in the investigation. The ipsilateral hearing level (pure tone average [PTA] 0.5-3 kHz) ranged from 10 to 50 dB HL (mean: 30.7 dB HL), with a speech discrimination score equal to or better than 50 per cent. CNAPs furnished the highest predictive score for post-operative hearing. In particular, when a permanent loss of CNAPs occurred the sensitivity and specificity were 100 per cent. The discrepancies between the ECochG and CNAP findings were attributable to high prevalence of cochlear nerve damage, capable of 'disconnecting' the ear from the central auditory pathways, causing persistence of peripheral auditory function and no propagation of the neural input. ABR monitoring was highly sensitive in detecting auditory damage but its prognostic utility was marred by its poor specificity.

純音聴力レベルに比べて語音弁別能の著しく低下した一側性感音難聴の中で, 画像上, 聴神経腫瘍などの小脳橋角部腫瘍を否定できた症例の経過観察を行った。 これらの症例は, 同様に純音聴力レベルに比べて語音弁別能の著しく低下した両側性感音難聴である本態性後迷路難聴とは, 細別診断所見が異なり, 補充現象陽性などの内耳性の所見を示すものと, 内耳性の所見をほとんど示さず, 合成母音検査の結果からも後迷路性難聴を示唆するものとが混在した。突発性難聴として発症しているものが多く, 経過観察で平均純音聴力レベルの改善しているものがほとんど認められないことから, 突発性難聴として診断・治療されるものの中でも予後の悪い一群の一部をとらえている可能性がある。

補聴器を日常生活で常用しているレクルートメント現象陽性の感音難聴症例を対象として, 実耳挿入利得と子音明瞭度の関係を検討した。 対象を60歳以上の高齢者に限定したため, 1回の検査の負担が大きい57式語表は用いず67式語表を2回施行しその結果から子音明瞭度を検討した。 また今回は裸耳でもある程度は聞き取れる語音を補聴器装用によりどの程度聞き取りが良くなるかを検討する目的で, 検査語音の基準音を測定耳の平均聴力+10dBに設定した。 その結果有声子音群の明瞭度の改善には1500Hzの実耳挿入利得, 無声子音群の明瞭度の改善には3000Hz, 4000Hzの実耳挿入利得が必要であることを示唆する結果を得た。 補聴器装用に伴う有声子音群の明瞭度の改善は語音や症例により異なった傾向を示すものと考えた。

A new method for assessing the selected hearing aids was developed and applied 53 patients with hearing impairment. Our previous paper showed that the average confusion distance which was introduced in this method was useful for estimating the hearing aids. We carried out a follow-up survey in order to measure the usefulness of this method after 3 or 4 years practical hearing aid use. There were 34 patients out of 53 from whom we could obtain adequate information about their hearing aids. They were asked to rate their satisfaction with the recommended instrument in five degrees. Fifteen of the 34 patients who had purchased the recommended hearing aid rated it very satisfactory; four rated the aid satisfactory; eight rated the aid helpful; six rated the aid sometimes helpful; and one rated the aid unsatisfactory. The Spearman's rank correlation coefficient between the change in the speech discrimination score with and without a hearing aid and the user's evaluation was 0.34. The Spearman's rank correlation coefficient between the change in the average confusion distance and user's evaluation was 0.41. The value 0.34 is not significant, but the value 0.41 is significant at the 1% level of significance. Therefore, we think that the average confusion distance should be taken into consideration as well as the speech discrimination score at least for predicting successful hearing aid use. Finally we feel that there is need for the inclusive system which is able to estimate both the speech mediated communication ability and user's satisfaction.

感音性難聴者329例にたいし, 語音明瞭度検査を行い, 語音明瞭度について難聴の程度と年齢の関係, 補聴器の使用について検討した。 同一の聴力レベルにおいて, 症例が示す明瞭度の範囲は広く, 明瞭度の良い症例と悪い症例が連続的に分布していた。 年齢別に明瞭度を検討すると, 症例の年齢が80歳代になると明瞭度が顕著に低下していた。 加齢とともに補聴器使用率が低下したのは, 軽度難聴で明瞭度が良好な症例であったが, その使用率は75%と高かった。 補聴器適合のさいには補聴器の効果を語音明瞭度検査にて予測し, 患者の個人差に合わせた指導をすることが必要である。 さらに, 高齢者で軽度難聴や明瞭度の低い症例では補聴器使用率が低いことから, とくに積極的な指導が必要である。

Comparing 127 individuals with deaf-blind (Group DB) and 2482 individuals with only hard of hearing (Group HH), I analyzed their social participation rates by considering their hearing levels, speech discrimination scores, family backgrounds, ages, and given diagnoses. The main results were as follows : (a) The social participation rate in Group DB was found to be significantly lower than that in Group HH. (b) The speech discrimination score had a significant effect on the social participation rates in both groups. Furthermore, the poor ability in speech discrimination was more detrimental for Group DB than for Group HH. (c) Individuals above 65 years old showed smaller rates of social participation than individuals under 65 years old in both groups.

The effects of the frequency responses of hearing aids on speech discrimination scores were studied in 100 patients with sensori-neural hearing loss. Consonant discrimination scores of /s, z, m/ in frequency responses with high frequency amplification were better than those with low frequency amplification. On the other hand, consonant discrimination scores of /g/ were better in frequency responses with low frequency amplification. The discrimination scores of the other consonants were not affected by the frequency responses. In the fitting of the frequency response of a hearing aid, low frequency amplification is effective for improving sound quality through the hearing aid. However, there is a risk of decreasing the discrimination scores of /s, z, m/.

The results of 248 cases of acoustic neuroma surgery carried out mainly by the extended middle cranial fossa approach during a 16-year period from 1976 to 1991 are analyzed. Hearing preservation was attempted in 69 cases and successfully achieved in 35 (51%) cases. Hearing was preserved in 24 (57%) of 42 cases in which a tumor was 20 mm or smaller in diameter, pure-tone hearing level was 50 dB or lower, and speech discrimination score was 50% or higher. The hearing preservation rate (76%) in the cases with a tumor extending 3 mm or less from the internal auditory canal was much higher than in cases with a larger tumor. Hearing was preserved in three of seven cases with a tumor of 21 mm or larger and in two of four cases of neurofibromatosis type 2. The evaluation of postoperative hearing is also discussed.

Objective To investigate the postoperative auditory and facial nerve function results after cerebellopontine angle meningioma removal. Design Retrospective chart review. Setting Tertiary care referral center. Patients Twenty-one patients undergoing surgical removal of cerebellopontine angle meningiomas by the senior author (R.J.W.). Interventions Translabyrinthine or retrosigmoid approach for tumor extirpation. Main Outcome Measures Postoperative auditory (pure-tone average and speech discrimination score) and facial (House-Brackmann scale) function within 1 year of follow-up. Results Twenty-three operations were performed on 21 patients. Hearing preservation through the retrosigmoid approach was attempted in 11 patients (48%). Normal hearing (class A) was preserved in 9 of 10 patients. Normal postoperative facial nerve function (House-Brackmann grade I) was conserved in 11 (65%) of 17 patients. Conclusions This review demonstrates that successful hearing preservation is possible with meningiomas. Therefore, the retrosigmoid approach should be used whenever serviceable hearing is present preoperatively. Normal facial nerve function can also be preserved in the majority of patients.

It is well known that the earmold with a vent attenuates low frequency amplification of hearing aid. This low frequency attenuation by vented earmold is utilized for hearing aid in persons with a high frequency hearing loss. We are also beginning to apply this vented earmold to the children with a high frequency hearing loss.According to our experience, the earmold with a 3mm vent in diameter appears to be effective in decreasing the noisy that hearing aid delivered, while speech discrimination score is uneffected.

It is generally known that sensorineural hearing impairment has not only decreased hearing ability but also disorders in various hearing function and for this reason, with the conventional hearing aid which merely loudens sound, failure to catch or miss hearing a consonant often occurs. We have thought to improve audibility by separating a consonant and vowel of a monosyllable then synthesizing each to form an emphasized sound. This synthesized monosyllable was tested for speech discrimination score by 20 sensorineural hearing‐impaired subjects. The results show that in the case of voiceless plosives such as /pa/, /ta/, and /ka/, when amplitude of a consonant was increased by 10–20 dB and a silent pause of 30–60 ms was inserted between a consonant and vowel to prevent masking by a following vowel, recognition improved by 46.7%. The improvement is remarkable in the case of /ka/ where original sound was recognized by 40% and synthesized sound by all the subjects. On the other hand, in the case of nasal sound such as /ma/ and /na/, by repetition of consonant and of amplified consonant the audibility improved to 70% from the original recognition of 22.5%. Now we are developing a computer hearing aid which gives the best synthesized monosyllable for bearing‐impaired subjects based on speech analysis.