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To retrospectively analyze clinical and surgical data of a consecutive series of 26 patients with unilateral cystic vestibular schwannomas.Tumors were classified as type A (central cyst) and type B (peripheral cyst) and as small (tumor diameter3 cm) and large (tumor diameter3 cm). All patients underwent microsurgical removal via retrosigmoid approach. The course of the facial nerve (FN) was classified as anterior, anterior-inferior, anterior-superior, and dorsal to the tumor's surface.Mean patient age was 53.5 years. Mean tumor size was 3.2 cm. There were 22 cases classified as type A and only 4 as type B. Total or near-total resection (95%) was achieved in 16 cases (61.5%), subtotal removal (90%-95%) was achieved in 9 cases (34.6%), and partial removal (90%) was achieved in 1 case (3.9%). Position pattern of FN was anterior-inferior in 10 cases (38.4%), anterior-superior in 10 cases (38.4%), anterior in 23.2% of 6 cases. At hospital discharge, FN function was House-Brackmann grade I-V in 9 (36%), 10 (38%), 3 (12%), 3 (12%), and 1 (4%) patients; at final follow-up, House-Brackmann grades I, II, III, and IV accounted for 18 (72%), 6 (24%), 1, and 1 cases. During follow-up ranging from 6 months to 10 years, reoperation for growing of residue was never necessary.According to the literature and the results of our series, microneurosurgery of cystic vestibular schwannomas is associated with good outcomes in terms of extent of resection and FN function. In particular, long-term FN function is much more satisfactory than short-term function. In most cases, microsurgery represents the treatment of choice of cystic vestibular schwannomas.

BACKGROUND: When a pilot is referred for presbycusis, his flight fitness may be questionable. The objective of this retrospective study was to describe a case series of presbycusis in a pilot population and to discuss the decisions about their flight waivers.METHODS: There were 19 pilots who were referred to the ENT-Head and Neck Surgery Department of the National Pilot Expertise Center. Their medical files were retrospectively examined.RESULTS: Of the 19 patients, 5 did not obtain flight fitness waivers. Among the 14 who received waivers, 7 had no restrictions on their flight fitness.DISCUSSION: Flight fitness was based on the maximum percentage of speech recognition and the slope of the curve for speech recognition in speech audiometry in noise and the follow-up of these findings. The results made it possible to determine a patient’s fitness to fly with a waiver, which may be associated with restrictions. In our series, only 5 pilots out of 19 did not obtain a flight fitness waiver. The few published studies on the resumption of flight for patients who had presbycusis and our experience in France with similar waivers in commercial and military aviation suggest that under certain conditions and after relevant cochlear assessment, presbycusis may allow for a safe pursuit of aviation activity.Ballivet de Régloix S, Genestier L, Maurin O, Marty S, Crambert A, Pons Y. Presbycusis and fitness to fly. Aerosp Med Hum Perform. 2020; 91(5):403–408.

Akbulut, Ahmet Alperen/0000-0002-3273-6632; KARA, Eyyup/0000-0002-4015-4560; Kara, Halide Cetin/0000-0002-6747-7212; Karakol, Sare Nur/0000-0002-3481-5342; Aydin, Kubra/0000-0003-2746-1555 WOS:000531858400018 PubMed ID: 32209515 OBJECTIVES: To evaluate the functions of cochlear structures and the distal part of auditory nerve as well as dead regions within the cochlea in individuals with normal hearing with or without tinnitus by using electrophysiological tests. MATERIALS and METHODS: Nine individuals (ages: 21-59 years) with normal hearing with tinnitus were included in the study group. Thirteen individuals (ages: 25-60 years) with normal hearing without tinnitus were included in the control group. Immitancemetric examination, pure-tone audiometry (125Hz-16kHz), speech audiometry in quiet and noise environments, transient evoked otoacoustic emissions (TEOAEs), distortion product otoacoustic emissions (DPOAEs), threshold equalizing noise (TEN test (500Hz-4kHz), and ECochG tests, Beck Depression Questionnaire, Tinnitus Handicap Questionnaire, and Visual Analog Scale were performed. RESULTS:In the study group, three patients were found to have a minimal depression and six were found to have a mild depression. In pure-tone audiometry, the threshold (6-16 kHz) in the study group was significantly higher than that of the control group at all frequencies. In the study group, lower performance scores were obtained in speech discrimination in noise in both ears. In the control group, no dead region was detected in the TEN test whereas 75% of subjects in the study group had dead regions. DPOAE and TEOAE responses between study and control group subjects were not different. In the ECochG test, subjects in the study group showed an increase In the summating potential/action potential (SP/AP) ratio in both ears. CONCLUSION: Determination of the SP/AP ratio in patients with tinnitus may be useful in diagnosing hidden hearing loss. Detection of dead regions in 75% of patients in the TEN test may indicate that inner hair cells may be responsible for tinnitus.

Objective To assess the feasibility of immediate activation of cochlear implants. Material and methods A retrospective study compared speech audiometry results at 6 months post-implantation, implant fitting data and complications, on Student test, between 19 patients receiving day-1 implant activation (immediate activation: IA) and 10 patients with activation at 2 weeks (classical activation: CA). Results Mean speech comprehension, using Fournier bisyllabic word lists at 60 dB 6 months after implantation, was 61.58% in IA and 71% in CA (P > 0.05). Mean intelligibility thresholds for 50% word-recognition were respectively 39.74 dB and 36.5 dB (P > 0.05). Speech audiometry results at 6 months were not affected by immediate versus classical activation. Comfort-level settings at 1 month in IA were not significantly different (Student test: P > 005) from intraoperative neural response thresholds: i.e., were practically stable. One IA patient required delayed activation at 1 month because of hematoma interfering between the external and internal parts of the implant. There were no other complications. The mean number of fitting sessions during the first year was 6.05 in the IA group and 6.55 in the CA group (P > 0.05). Conclusion Given certain precautions during follow-up, immediate activation after cochlear implantation was feasible, and did not impair audiometric results.

Effects of temporal distortions on consonant perception were measured using locally time-reversed nonsense syllables. Consonant recognition was measured in both audio and audio-visual modalities for assessing whether the addition of visual speech cues can recover consonant errors caused by time reversing. The degradation in consonant recognition depended highly on the manner of articulation, with sibilant fricatives, affricates, and nasals showing the least degradation. Because consonant errors induced by time reversing were primarily in voicing and place-of-articulation (mostly limited to stop-plosives and non-sibilant fricatives), undistorted visual speech cues could resolve only about half the errors (i.e., only place-of-articulation errors).

People with normal hearing thresholds can nonetheless have difficulty with understanding speech in noisy backgrounds. The origins of such supra-threshold hearing deficits remain largely unclear. Previously we showed that the auditory brainstem response to running speech is modulated by selective attention, evidencing a subcortical mechanism that contributes to speech-in-noise comprehension. We observed, however, significant variation in the magnitude of the brainstem’s attentional modulation between the different volunteers. Here we show that this variability relates to the ability of the subjects to understand speech in background noise. In particular, we assessed 43 young human volunteers with normal hearing thresholds for their speech-in-noise comprehension. We also recorded their auditory brainstem responses to running speech when selectively attending to one of two competing voices. To control for potential peripheral hearing deficits, and in particular for cochlear synaptopathy, we further assessed noise exposure, the temporal sensitivity threshold, the middle-ear muscle reflex, and the auditory-brainstem response to clicks in various levels of background noise. These tests did not show evidence for cochlear synaptopathy amongst the volunteers. Furthermore, we found that only the attentional modulation of the brainstem response to speech was significantly related to speech-in-noise comprehension. Our results therefore evidence an impact of top-down modulation of brainstem activity on the variability in speech-in-noise comprehension amongst the subjects.

Growing evidence shows that partial auditory deprivation leads to extensive neural functional plasticity, which occurs not only in the auditory cortex but also in other sensory regions and cognitive areas. However, studies in structural topological properties are still limited, especially those investigating the relationship between structural connectome alterations and auditory abilities. To clarify this, we investigated white matter structural connectivity changes and the relationship between connection strength and hearing abilities in individuals with long-term single-sided deafness (SSD), a common form of partial hearing deprivation, using diffusion tensor imaging and network-based analysis. The results showed globally improved connection efficiency, locally weakened visual networks, and strengthened fronto-parietal sub-networks in SSD compared to normal hearing controls. Furthermore, a strong positive correlation between hearing abilities (including speech recognition in noise and sound localization) and connection strength, mainly in the fronto-parietal areas, was found in SSD. Our study reveals alteration of the structural network connections in SSD, especially in cognitive related networks, which showed close correlation with hearing abilities. Our findings provide new insights into topological white matter reorganization of the brain after partial sensory deprivation.

To assess preoperative features that could predict the audiological outcome after cochlear implantation in the elderly, in terms of pure tone audiometry, speech audiometry, and speech perception performance. All available records of patients with cochlear implants aged 65 or more at the time of their implantation at our Institution were reviewed (50 patients, mean age 70.76 ± 4.03 years), recording preoperative clinical features. Pure tone audiometry, speech audiometry, and speech perception performance 1 year after cochlear implant activation and fitting were used as outcome measures. No statistically significant association emerged between clinical features and pure tone audiometry. On univariate analysis, progressive sensorineural hearing loss of unknown origin was associated with a better outcome in terms of speech audiometry and speech perception performance (p = 0.035 and p = 0.033, respectively). On multivariate analysis, progressive sensorineural hearing loss retained its independent prognostic significance in terms of speech perception performance (p = 0.042). The discriminatory power of a two-variable panel (age and etiology of hearing loss) featured an AUC (ROC) of 0.738 (an acceptable discriminatory power according to the Hosmer–Lemeshow scale). A progressive sensorineural hearing loss of unknown origin was associated with a better outcome in terms of speech perception in the elderly in our case study. Further features that can predict audiological outcome achievable with cochlear implants in the elderly are desirable to perform adequate counselling and rehabilitation programs.

The aim of this study was to assess the first outcomes of a fully implantable active middle ear device. Retrospective observational nonrandomized group study. Settings: Private hospital. Fifteen patients underwent device implantation between December 2014 and June 2017. The pre-operative and post-operative air conduction (AC) and bone conduction (BC) thresholds were evaluated. The functional gain, speech perception in silence and in noise, and localization abilities were also analyzed. Sixteen active middle ear implantations were performed. Post-operatively, the mean pure tone thresholds were 50.5 dB ( ± 12.64) for BC and 64.9 dB ( ± 15.36) for AC. No differences were found between the post-operative and pre-operative audiometric thresholds before activating the system (p > 0.05). Post-operatively, the mean thresholds in the free field after the device was activated were 46.8 dB, 45.75 dB, 42.6 dB, and 43.38 dB at 1, 3, 6, and 12 months, respectively. The global results of speech understanding in silence were 50.7 dB, 47.18 dB, 42 dB, and 42 dB for 1, 3, 6, and 12 months, respectively. Patients with mixed hearing loss had better results than those with sensorineural hearing loss. Speech discrimination in noise and localization was improved. Despite the small number of patients, our results confirmed that this fully implantable active middle ear device is a viable treatment for patients with moderate-to-severe sensorineural hearing loss who cannot or do not want to use traditional hearing aids for clinical or cosmetic reasons.

AIM To evaluate the efficacy of a newly developed auditory-cognitive training system on speech recognition, central auditory processing and cognition among older adults with normal cognition (NC) and with neurocognitive impairment (NCI). METHODS A double-blind quasi-experiment was carried out on NC (n = 43) and NCI (n = 33) groups. Participants in each group were randomly assigned into treatment and control programs groups. The treatment group underwent auditory-cognitive training, whereas the control group was assigned to watch documentary videos, three times per week, for 8 consecutive weeks. Study outcomes that included Montreal Cognitive Assessment, Malay Hearing in Noise Test, Dichotic Digit Test, Gaps in Noise Test and Pitch Pattern Sequence Test were measured at 4-week intervals at baseline, and weeks 4, 8 and 12. RESULTS Mixed design anova showed significant training effects in total Montreal Cognitive Assessment and Dichotic Digit Test in both groups, NC (P

Miglioramento della percezione del parlato in condizioni di silenzio e rumore mediante il metodo FAP (Frequency-Allocation Programming) personalizzato.L’obiettivo di questo studio è la valutazione della discriminazione verbale da parte di soggetti esperti portatori di impianto cocleare con impostazioni MAP standard, utilizzando le tabelle predefinite di allocazione di frequenza con un MAP di frequenza ottimizzato. Questo è uno studio osservazionale, trasversale e quantitativo su 50 adulti con impianto cocleare, 20 bilaterali e 30 monolaterali. 23 maschi (46%) e 27 femmine (54%). Tutti i soggetti erano maggiorenni. Le differenze tra i valori medi di soglia nell’audiometria tonale in campo libero sono risultati statisticamente significativi nei pazienti impiantati sia monolateralmente che bilateralmente; risultati simili sono stati ottenuti nei test bisillabici nei pazienti impiantati sia monolateralmente che bilateralmente (p0,005). I pazienti che hanno utilizzato il metodo di allocazione di frequenza, che assegna le frequenze sulla base di quelle fondamentali, hanno mostrato una percezione delle parole bisillabiche e delle frasi libere in quiete e nel rumore migliore rispetto ai pazienti con dispositivo precedentemente regolato con tecniche standard. Il metodo può essere applicato a diversi processori e utilizzato con differenti strategie di stimolazione. Permette la riduzione degli attuali livelli di intensità così come un aumento del range dinamico e migliora la qualità della rappresentazione del segnale.The objective of this study is the evaluation of speech recognition of experienced CI recipients with standard MAP settings using the default frequency-allocation tables with the optimised frequency-allocation MAP. This is an observational, cross-sectional and quantitative-approach study on 50 adult cochlear implant recipients, 20 bilateral and 30 unilateral implant recipients. 23 men (46%) and 27 women (54%). All subjects were ≥ 18 years old. Differences between the means of the thresholds in tone audiometry in free fields were statistically significant in both unilaterally and bilaterally implanted patients; similar results were obtained between average benefits in disyllabic for both unilaterally and bilaterally implanted patients (p0.005). The differences between the means of scores were statistically significant for unilaterally and bilaterally implanted patients, similarly occurred with the average in HINT test between standard SRT50% programming and frequency allocation fitting (p0.005). Patients using the frequency allocation method, which assigns frequencies based on fundamental frequencies, showed better perception of disyllabic words and open-set sentences in quiet and in noise than patients previously fitted with standard fitting techniques. The method can be applied to different processors and used with different strategies of stimulation. It allows reduction of current intensity levels as well as an increase in the dynamic range and improves the quality of the representation of the signal.

We compared our historical medium-term data obtained with an active semi-implanted bone conduction device and the hearing results of a new passive bone conduction hearing device to determine its predictive value for the hearing results with the semi-implanted device. The study sample was 15 patients with an active bone conduction implant (mean follow-up 26 months). Pure tone audiometry was performed with headphones, sound field speech audiometry was conducted unaided, and free-field speech audiometry was carried out with both the active bone conduction system and the passive device switched off. As compared with the unaided condition, speech reception was significantly improved with both devices. Comparison of speech reception threshold at 100% of word recognition showed no difference between the active and the passive device. At lower intensity the difference in speech perception was significant in the patients with monaural fitting (group A) and was non-statistically significant in those with binaural fitting (group B); the speech reception threshold at 50% of word recognition was 26.00 dB (± 10.22) with the active implant and 30.50 dB (± 7.98) with the passive device in group A (p = 0.047) and 24.00 dB (± 5.48) and 29.00 dB (± 2.24) in group B (p = 0.052), respectively. The hearing outcome after active bone conduction implant was comparable to published data. Compared with the unaided condition, speech recognition was significantly improved with the passive device. The device may also provide value to predict the hearing outcome with the implanted device, especially at higher intensities. IV.

Language impairment is common in children with autism spectrum disorders (ASDs). Previous research has shown that this disability may be, in part, due to atypical auditory processing of speech stimuli. However, how speech sounds are processed in children with ASD remains largely unknown. The present study assessed the developmental pattern of auditory information processing at the level of the brainstem in preschool children with ASD using speech-evoked auditory brainstem response (speech-ABR). Children with ASD (N = 15) and of typical developing (TD) (N = 20), both of preschool age, were enrolled. The speech-ABRs recorded at two different time points (T1 and T2; 9.68 months apart on average) were virtually identical in the TD group. However, in the ASD group, the wave V latency of speech-ABR was significantly shortened and the amplitudes of wave A and C were significantly larger at T2, compared to those recorded at T1 (10.78 months apart on average). Compared to the TD group, the wave V and A latencies were prolonged at T1, whereas the wave E amplitude decreased and wave F latency prolonged at T2. There was a positive partial correlation between the language performance and the wave A amplitude in the ASD group. These results indicate that auditory processing at the subcortical level is well-developed in the TD preschool children, but is immature and abnormal in the children with ASD at the same ages. Thus, aberrant speech processing at the brainstem level may contribute significantly to the language impairment in children with ASD at preschool ages. Autism Res 2019, 12: 1022-1031. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Language impairment is common in children with autism spectrum disorders (ASDs). We investigated the developmental pattern of subcortical auditory processing by monitoring changes in the speech-evoked auditory brainstem response (speech-ABR) over a period of 10 months in preschool children. Our results show that subcortical auditory processing is impaired and immature in children with ASD compared with age-matched, typically developing children. The results suggest that speech-ABR may be used as an objective measure in evaluating the language performance of children with ASD. The results also suggest that aberrant speech processing at the level of the brainstem may contribute significantly to the language impairment in preschool children with ASD.

L’audiometria con risposte motorie nello screening uditivo di soggetti adulti.Lo scopo dello studio è di testare l’efficacia di un nuovo test di audiometria vocale a risposte motorie (VTMR) nel rumore da utilizzare per determinare l’handicap uditivo in programmi di screening per soggetti adulti. La VTMR consiste nell’esecuzione manuale di 5 comandi verbali ricevuti dal paziente a diverse intensità di segnale e fornisce un punteggio relativo alla comprensione nel rumore. In questo studio osservazionale prospettico 916 su 1.300 volontari (605 maschi, 695 femmine, età media 56 ± 17 anni), sono stati sottoposti a uno screening uditivo con audiometria tonale liminare e VTMR ad un rapporto segnale/rumore (S/N) di 0 e –10 dB HL. Risultati: la differenza tra soggetti normo- e ipoacusici, in funzione di tutte le variabili considerate, è risultata statisticamente significativa per la combinazione di audiometria tonale e VTMR. Il test VTMR con S/N di –10 dB è risultato essere uno strumento rapido, pratico ed efficiente nel differenziare tra soggetti normo- e ipoacusici con un cut-off di 4 su 5 comandi verbali eseguiti correttamente. Nel sottogruppo dei pazienti con riferita limitazione della partecipazione sociale, la sensibilità e la specificità del test VTMR sono rispettivamente del 90% e del 62%. La VTMR può essere utilizzata singolarmente nello screening di soggetti adulti per testare sia l’impairment uditivo che la limitazione sociale che ne consegue.The aim of this study was to test the efficacy of Verbal Tasks and Motor Responses (VTMR) speech audiometry in providing a rapid and true-to-life assessment of hearing-related problems as a single test in adult hearing screening programmes. The VTMR consists in manual execution of 5 verbal commands received by patients at different signal intensity levels and fixed masking noise; it provides a score of speech comprehension in noise. This was a prospective observational study in 916 individuals out of 1,300 volunteers (605 males, 695 females, aged 56 ± 17 years) who completed adult hearing screening. VTMR speech audiometry was performed at signal to noise (S/N) ratios of 0 dB and –10 dB. The difference between normal and hearing impaired subjects in terms of all the considered variables was statistically significant for pure-tone audiometry and VTMR testing. VTMR testing at a S/N ratio of –10 dB with a cut-off of four correctly executed tasks and was a rapid, feasible and efficient means of differentiating between normal and hearing impaired subjects. When used to screen hearing impaired subjects with participation restrictions, the sensitivity and specificity of the VTMR test rose to 90% and 62%, respectively. The VTMR test in noise could be used as a stand-alone tool when screening for impairment and self-perceived participation restriction together.

This study was aimed to investigate whether wideband tympanometry (WBT) can distinguish among various kinds of conductive hearing loss and provide additional information.We recruited normal subjects and patients with conductive hearing loss due to the following reasons: tympanic membrane perforation only, ossicular chain problem only, and one or other of those conditions combined with mastoid problems. Wideband absorbance at ambient pressure, peak pressure, resonance frequency, and averaged tympanogram data were measured by WBT and compared between the normal, tympanic membrane perforation only, ossicular chain problem only, and combined with mastoid problems groups.The normal subjects showed an average peak pressure of -19.51daPa and an average resonance frequency of 965.94Hz. Tympanic membrane perforation only patients showed a very low peak pressure (-124.93daPa) and resonance frequency (73.12Hz). When patients have ossicular chain problems, they showed slightly low peak pressures (43.08daPa) without changes in the resonance frequency (1024.8Hz). Mastoid problem subjects showed slightly decreased resonance frequencies (787.71Hz). Tympanic membrane perforation subjects showed decreased absorbance at low frequencies and ossicular chain problem subjects showed decreases at high frequencies. When comparing the perforation only and ossicular chain subjects by absorbance at 707Hz, the area under the ROC curve was 0.719 (P0.022). Mastoid problems subjects showed decreased absorbance at all frequencies.WBT can help to distinguish tympanic membrane perforation only and ossicular chain problem patients. WBT may provide additional information on "combined with mastoid problems" patients.

Questionnaires, e. g. the APHAB, and speech-audiometry are the most used elements in measuring the success of hearing aid fitting (HAF). This study investigates the correlations between the results of the Freiburg monosyllabic word test without and with noise (FBE, FBE-S) and the results of the APHAB before and after HAF.Data of the FBE, the FBE-S, and the APHAB, generated within HAF of 156 subjects were analyzed. After exclusion of a normal distribution of the data, Spearman's correlation and Cohen's effect size were determined.73 (46.8 %) of the 156 subjects were females, and 83 (53.2 %) males. No significant correlation could be found between the EC-, the RV-, and the cumulative ECBNRV-subscale and the benefit of HAF in the FBE and FBE-S (EC: ease of communication, BN: background noise, RV: reverberation). Most of the remaining coefficients of correlation had a weak positive effect size. A middle positive effect size could only be demonstrated for 6 combinations, for the EC-subscale mostly.The not strong effect sizes could assume that the results in speech-audiometry and the APHAB are not independent and complementing each other as parameters of hearing loss and benefit in HAF. The effect size could be explained by individually different possibilities for the compensation of hearing loss.Frageninventare, z. B. der APHAB, stellen zusammen mit sprachaudiometrischen Untersuchungen die beiden wesentlichen Elemente zur Messung des Erfolgs einer Hörgeräteversorgung (HGV) dar. Diese Studie untersucht die Korrelationen zwischen den Messergebnissen im Freiburger Einsilbertest ohne und mit Störschall (FBE, FBE-S) und den APHAB-Ergebnissen vor und nach einer HGV.Es wurden die Daten zum FBE und FBE-S sowie der zugehörigen APHAB-Fragebögen von 156 Probanden, die im Rahmen einer HGV erhoben wurden, aus einer Datenbank analysiert. Nach Ausschluss einer Normalverteilung wurden mögliche Korrelationen zwischen den Ergebnissen nach Spearman und der Effektstärke nach Cohen ermittelt.Von den 156 Probanden waren 73 (46,8 %) weiblich und 83 (53,2 %) männlich. Keine signifikante Korrelation zeigte sich zwischen der EC-, der RV- und der kumulierten ECBNRV-Skala und dem Gewinn durch eine HGV im FBE und FBE-S (EC: Hören in ruhiger Umgebung, BN: Hören mit Hintergrundgeräuschen, RV: Hören in hallenden/echoreichen Räumen). Für die meisten übrigen Korrelationskoeffizienten zeigte sich ein schwach positiver Effekt, ein mittlerer Effekt ließ sich nur für 6 untersuchte Kombinationen ermitteln; besonders ausgeprägt war dies für die EC-Skala.Da die Korrelationen durchweg nicht stark sind, ergibt sich, dass sowohl die sprachaudiometrischen Ergebnisse als auch die APHAB-Bewertung des Hörvermögens einander ergänzende, jedoch nicht ganz unabhängige Parameter zur Beschreibung des Hörverlustes und der Hörverbesserung im Rahmen einer HGV darstellen. Die Effektstärke der Korrelationen ließe sich mit den individuell unterschiedlichen Fähigkeiten zur Kompensation von Hörverlusten erklären.

Background Many of the Arabic monosyllabic word lists that are currently available in the literature have some limitations and drawbacks. Some of these available lists include word structures that are not consonant-nucleus-consonant (CNC) such as cluster and disyllabic word structures. Other lists have poor phonetic or phonemic distribution balance and do not represent some phoneme appropriately in each list. Purpose The purpose of the present study is to create and validate eight digitally recorded lists of phonemically balanced CNC words that represent all Arabic phonemes, to be used in the evaluation of word recognition score (WRS) of Jordanian Arabic-speaking adults. These lists should be easily adapted by other Arab countries because of the simplicity of the words, and the balanced inclusion of all the Arabic phonemes. Research Design The present study is a prospective cross-sectional study. Study Sample Thirty-one (23 females, 8 males) normal hearing and healthy young adults (18–29 years old) participated in the present study. All participants were native speakers of Jordanian Arabic and had no history of ear disease or surgery. Lists The authors created all possible combinations of Arabic CNC words, and then created eight phonemically balanced lists with 26 words in each list. Each consonant was presented only once at the beginning of a word and once at the end of a word in each list. The lists were recorded using a Jordanian male voice and the intensity of each word was digitally calibrated. Data Collection and Analysis The pure tone average (PTA) of 0.5, 1, 2, 4 kHz was calculated for each participant, and the WRS was obtained for each intensity level in the range of –10 to 55 dB SL (ref. PTA) in 5 dB steps. Results No significant difference between right and left ear WRS was found at any intensity level. The WRSs from both ears were averaged and used in the repeated measure analysis of variance. Performance-intensity functions for all the lists showed some small but statistically significant differences between lists. However, none of these differences were clinically significant ( Conclusion The present study provides eight lists of recorded and calibrated CNC word lists. The obtained PI functions showed that these lists are suitable for Jordanian Arabic speaking adults. These lists can be easily generalized to other Arab countries after conducting the required follow-up research.

The results of recent animal studies have suggested that cochlear synaptopathy may be an important factor involved in presbycusis. Therefore, here, we aimed to examine whether cochlear synaptopathy frequently exists in patients with presbycusis and to describe the effect of cochlear synaptopathy on speech recognition in noise. Based on the medical history and an audiological examination, 94 elderly patients with bilateral, symmetrical, sensorineural hearing loss were diagnosed as presbycusis. An electrocochleogram, auditory brainstem responses, auditory cortical evoked potentials, and speech audiometry were recorded to access the function of the auditory pathway. First, 65 ears with hearing levels of 41-50 dB HL were grouped based on the summating potential/action potential (SP/AP) ratio, and the amplitudes of AP and SP were compared between the two resulting groups. Second, 188 ears were divided into two groups: the normal SP/AP and abnormal SP/AP groups. The speech recognition abilities in the two groups were compared. Finally, the relationship between abnormal electrocochleogram and poor speech recognition (signal-to-noise ratio loss ≥7 dB) was analyzed in 188 ears. The results of the present study showed: (1) a remarkable reduction in the action potential amplitude was observed in patients with abnormal SP/AP ratios; this suggests that cochlear synaptopathy was involved in presbycusis. (2) There was a large proportion of patients with poor speech recognition in the abnormal SP/AP group. Furthermore, a larger number of cases with abnormal SP/AP ratios were confirmed among patients with presbycusis and poor speech recognition. We concluded that cochlear synaptopathy is not uncommon among elderly individuals who have hearing ability deficits, and it may have a more pronounced effect on ears with declining auditory performance in noisy environments.

Coronavirus disease 2019 (COVID-19) is an infectious respiratory disease caused by the severe acute respiratory syndrome coronavirus 2, brings with it a plethora of health concerns. Although most people have mild symptoms, which are respiratory in nature, some experience neurological symptoms, central nervous system manifestations, peripheral nervous manifestations, and skeletal muscle manifestations. But the damaging impact of COVID-19 virus on the hearing organs in the inner ear is a new finding yet to be explored. Currently, there is little evidence published connecting novel coronavirus and tinnitus directly. But according to the American Tinnitus Association, preexisting behavioral conditions make it more likely for patients to experience tinnitus due to the stress and depression associated with social isolation and infection avoidance. Hearing loss and Tinnitus is a common pathology seen in otolaryngology and there are numerous papers in literature describing its associations with other infections. However, this is the first reported case of hearing loss and tinnitus in a COVID-19 patient, in the State of Qatar, and this case report strives to contribute to the ocean of literature highlighting the need for otorhinolaryngologists to be aware of its correlation with COVID-19 virus.

Assessment of the incidence and results of bilateral cochlear implantation in adults and children in France.Multicenter retrospective study of data in the French national registry of cochlear implantations from January 1st 2012 to December 31st 2016. Functional results from CAP (Category of Auditory Performance) questionnaires and speech audiometry tests, with mono- and di-syllabic word-lists, were compared before and after implantation. Speech audiometry tests were carried out against a noisy background, except before simultaneous implantations.Nine hundred and forty two bilateral cochlear implantations were performed during this period, that is, 16.4% of all cochlear implantations. Five hundred and eighty eight bilateral implantations were performed sequentially. 59% of the bilateral implantations were performed in children. Bilateral implants significantly improved CAP scores in all cases (P0.001). Auditory performance, with the two types of word-list, were significantly improved after simultaneous implantation (P0.01). After sequential implantation, the speech discrimination score, already very good with the first implant, reached 63±26% [0-100] with monosyllabic word lists, and 72±28% [0-100] with dissyllabic words. There were more complications due to surgery in bilateral cases than in the entire population of cochlear recipients (9.1% vs 6.4%, P0.02).Hearing is significantly improved by simultaneous cochlear implantation. For sequential implantation, at one year, when auditory results were already excellent from the first implant, in the bimodal condition CAP scores were significantly improved, although there was no further change in speech audiometry in noise.

Evaluate in France the outcomes of cochlear implantation outside the selection criteria, off-label.This is a prospective cohort study including adults and children having received a cochlear implant (CI) in an off-label indication, that is outside the criteria established by the "Haute Autorité de santé (HAS)" in 2012. The data was collected from the "EPIIC" registry on recipients who received CIs in France between 2011 and 2014. Speech audiometry was performed at 60dB preimplantation and after one year of CI use, as well as an evaluation of the scores of the quality of life with the APHAB questionnaire, the scores for CAP and the professional/academic status in pre- and post-implantation conditions. Major and minor complications at surgery have been recorded.In total, 590 patients (447 adults and 143 children) with an off-label indication for CIs were included in this study from the EPIIC registry (11.7% of the whole cohort of EPIIC). For adults, the median percentage of comprehension using monosyllabic word lists was 41% in preimplantation condition versus 53% after one year of CI use (P0.001) and 60% versus 71% in dissyllabic word lists (P0.001). The CAP scores were 5 versus 6 in pre- and post-implantation conditions respectively (P0.001) and the APHAB scores were statistically lower after implantation (P0.001). In the children cohort, the median percentage of comprehension using monosyllabic word lists was 51% in preimplantation condition and 65% after CI (P0.001), and 48% versus 82% (P0.001) for dissyllabic word lists. The CAP scores were 5 versus 7 respectively in pre- and post-CI conditions (P0.001). Thirty-two minor complications (5.4%) and 17 major complications (2.8%) were reported in our panel of off-label indication patients.These results suggest that a revision of the cochlear implantation candidacy criteria is necessary to allow more patients with severe or asymmetric hearing loss to benefit from a CI when there is an impact on quality of life despite the use of an optimal hearing aid.

Purpose The purpose of this study was to construct and validate a recorded word recognition test for monolingual Spanish-speaking children utilizing a picture board and a picture-pointing task. Design The Spanish Pediatric Picture Identification Test was developed and validated in this study. Test construction steps included (a) producing new digital recordings of word lists created by Comstock and Martin (1984) using a bilingual Spanish–English female, (b) obtaining list equivalency, (c) creating digitally illustrated pictures representing the word lists, (d) validating the pictures using monolingual Spanish-speaking and bilingual Spanish–English children, and (e) re-establishing list equivalency and obtaining performance–intensity functions using a picture-pointing task with monolingual Spanish-speaking children and bilingual Spanish–English adults. Results Normative data for three Spanish word recognition lists were established. Performance–intensity functions at sensation levels from 0 to 40 dB SL in 8-dB steps were obtained, establishing list equivalency for Lists 1, 2, and 3. Conclusions The Spanish Pediatric Picture Identification Test was developed and validated as a picture-pointing task for word recognition with monolingual Spanish-speaking children. The two validated channel recordings include an English translation for ease of testing by clinicians lacking Spanish language skills. Future validation will be conducted with bilingual Spanish–English children with normal hearing and with hearing loss.

Background Although hearing aids (HAs) and cochlear implants (CIs) can provide significant benefits to persons with hearing loss, users frequently report difficulty hearing in noisy environments, particularly when there are multiple talkers. Little is known about the benefits provided by currently available wireless microphones in multitalker situations. Purpose The purpose of this study was to compare the benefits received in speech recognition in noise by adults with hearing loss when using two different wireless microphone types in a simulated group setting. Research Design A quasi-experimental, repeated-measures design was used where performance in a control condition, HA/CI alone, was compared with performance in two wireless microphone intervention conditions. Study Sample Participants included ten listeners, aged 20-92 years, with bilateral sensorineural hearing loss who were experienced HA or CI users. Intervention The two wireless microphones by Phonak, Roger Pen, and Roger Select used the same digital modulation protocol to transmit the signal to compatible receivers. However, the Roger Pen operated in a fixed omnidirectional mode, whereas the Roger Select operated in an adaptive directional mode. Data Collection and Analysis Participants were asked to repeat Hearing in Noise Test sentences presented in restaurant noise in three conditions: HA/CI alone, HA/CI with a Roger Pen, or HA/CI with a Roger Select microphone placed in the center of a round table. Sentences were presented from one of five loudspeakers equally spaced with the participant, while restaurant noise was presented on each side at four signal-to-noise ratios (SNRs), including +5, 0, −5, and −10 dB. A two-way, repeated-measures analysis of variance was performed with main effects of listening condition and noise level. Results Significantly greater speech recognition performance was achieved with the wireless microphones than with listening with just the HA or CI. Furthermore, at the −5- and −10-dB SNR conditions, the Roger Select resulted in significantly better performance than the Roger Pen microphone. Conclusions The results suggest that the Roger Select microphone can provide significant benefits in speech recognition in noise over the use of HA/CI alone (61%) and also significant benefits over the use of a Roger Pen (16%) in a simulated group dining experience.

The Freiburg monosyllabic test (FBE) has been an important German speech audiometry test for years. It is nowadays also used to assess the benefit of hearing aids in noise (FBE-S). This study investigates hearing in noise using the FBE at different sound pressure levels and a signal to noise ratio of 5 dB to generate a recognition curve.In autumn 2018, 60 normal-hearing German native speakers (age 18-31 years) participated in the study at the military hospital in Hamburg. Using one FBE test list, speech intelligibility was measured from sound pressure levels of 15 to 90 dB in 5‑dB steps with a noise level 5 dB lower in each case. Subsequently, the average of all intelligibility rates and 95% confidence intervals (CI) were determined.Participants comprised 29 female and 31 male subjects. Average age was 24.32 years (±3.29 years). The fixed effects analysis of variance with recognition as the dependent variable demonstrated a highly significant correlation between the levels of sounds/noise and the intelligibility of speech (p 0.0001). The average intelligibility rates with 95% CI and the frequency distributions were presented tabularly and graphically.In comparison to the normative curve, the FBE‑S recognition curve is shifted to the right. The average values of the FBE‑S reach the saturation area at a volume of 70/65 dB with an intelligibility rate of 90% (for comparison: the point of saturation for 100% intelligibility of the FBE without noise is reached at 55 dB). Using these averaged values of the FBE‑S enables better interpretation of individual results without and with hearing aids. In the future, the benefit of hearing aids should be measured at lower noise levels than it is today.

Objectives The primary function of the human auditory system is to ensure proper speech comprehension. Speech audiometry enables the assessment of the conductive and the sensory aspects of the ears, providing some insight into the central auditory processing function. Materials and methods We conducted an analysis of 79 patients with chronic otitis media (COM) undergoing surgery at the Department of Otolaryngology, Jagiellonian University Medical College, in Krakow between 2005 and 2014. Tonal audiometry and speech audiometry were used as part of the hearing assessment. The pre-operative and long-term post-operative findings were compared, focusing mainly on speech audiometry. Results At the end of the mean 10-year follow-up, a significant percentage worsening in speech comprehension from the baseline was demonstrated in group III (hearing loss > 70 dB(decibels)), as compared with the remaining groups. There was a significant (p = 0.017) difference in speech comprehension between the treated and contralateral ears, with the mean maximum speech comprehension rates of 80% in the treated ear versus 92% in the contralateral ear. Conclusion We demonstrated a correlation between the findings of tonal audiometry and speech audiometry. The severe damage caused by chronic middle ear diseases not only leads to conductive hearing loss but also acts as a significant contributor to poor speech comprehension in a long-term follow-up. The speech comprehension in a healthy ear is significantly better than in a diseased ear. Middle ear reconstructive surgery offers the maximum improvement in speech comprehension at the hearing loss of 41 to 70 dB in speech audiometry.

ObjectivesTo identify predictive factors for falls in patients with bilateral vestibulopathy (BV). Specific variables contributing to the general work-up of a vestibular patient were compared between BV patients experiencing falls and those who did not.DesignProspective multi-centric cohort study.SettingDepartment of Otorhinolaryngology & Head and Neck Surgery at two tertiary referral centers: Antwerp University Hospital and Maastricht University Medical Center.ParticipantsIn total, 119 BV patients were included. BV diagnosis was defined in accordance with the diagnostic BV criteria, established by the Barany Society in 2017.Main outcome measuresPatients were divided into fallers and non-fallers, depending on the experience of one or more falls in the preceding 12 months. Residual vestibular function on caloric testing, rotatory chair testing, video head impulse test (vHIT) and cervical vestibular evoked myogenic potentials (cVEMP) was evaluated as a predictive factor for falls. Furthermore, hearing function (speech perception in noise (SPIN)), sound localization performance, etiology, disease duration, sport practice, scores on the Dizziness Handicap Inventory (DHI) and the Oscillopsia Severity Questionnaire (OSQ) were compared between fallers and non-fallers.ResultsForty-five (39%) patients reported falls. In a sub-analysis in the patients recruited at UZA (n = 69), 20% experienced three or more falls and three patients (4%) suffered from severe fall-related injuries. The DHI score and the OSQ score were significantly higher in fallers. Residual vestibular function, SPIN, sound localization performance, etiology, disease duration, age and sport practice did not differ between fallers and non-fallers.ConclusionsFalls and (severe) fall-related injuries are frequent among BV patients. A DHI score > 47 and an OSQ score > 27.5 might be indicative for BV patients at risk for falls, with a sensitivity of 70% and specificity of 60%. Residual vestibular function captured by single vestibular tests (vHIT, calorics, rotatory chair, cVEMP) or by overall vestibular function defined as the number of impaired vestibular sensors are not suitable to distinguish fallers and non-fallers in a BV population.

Objective: The primary aim of this study was to investigate whether scores for a speech-in-noise test were associated with the results of two electrophysiological techniques mainly targeting low sp...

School-aged children with hearing impairment (HI) listen and learn in noisy environments. On-going monitoring of speech understanding in noise is essential to adjust clinical interventions accordingly.The aim of this study was to assess Dantale II in a paediatric population. The secondary aims were identification of differences and similarities between groups of children with HI and normal hearing and between different hearing technologies; investigation of possible associations between Dantale II and verbal working memory. This was a longitudinal, prospective study comparing groups of children (n = 70) using the Dantale II with five-word sentences and verbal working memory with the Clinical Evaluation of Language Functioning-4.Dantale II seems clinically feasible from the age of six years. Children with NH outperformed children with HI both on completion of the tests and dB signal-to-noise ratio (SNR) scores. Children with hearing aids outperformed children with cochlear implants on dB SNR scores. A significant and moderately strong association between speech understanding in noise and verbal working memory was identified.Our study produced knowledge about a new generation of children with HI, who showed potentials not previously described. Future research on cognitive development of paediatric populations with HI is essential, as knowledge from adult populations cannot be transferred directly to paediatric populations.The project received funding from the Innovation Foundation, the Oticon Foundation, Decibel and The Capital Region of Denmark.not relevant.

Background: Bone conductive implants (BCI) represent one possible solution for rehabilitation of single-sided deafness (SSD).Aims: The aim of the present study was to verify the efficacy of bone conduction implantation in subjects with unilateral severe-to-profound hearing loss and contralaterally impaired hearing, that is, asymmetric hearing loss (AHL), and to compare it with known BCI indications for SSD.Material and methods: Twenty-one subjects received BCI for either SSD or AHL. All of the subjects underwent a battery of audiological and subjective tests, Data were collected and statistically evaluated within and between the SSD group and the AHL group.Results: A PTA threshold gain was observed in AHL patients along with improved values in speech audiometry in quiet and noise. The two visual analogue scale evaluations (QoL and QoS) and the GBI showed significantly better scores in AHL patients compared to SSD patients.Conclusions: BCI provided improvement for auditory or speech recognition in AHL subjects, as compare to SSD. From these findings, it is possible to predict a positive role of BCI for some audiological aspects of AHL subjects that are generally not present or not detectable in SSD cases.

Background Fetal alcohol spectrum disorders (FASD) are a highly prevalent spectrum of patterns of congenital defects resulting from prenatal exposure to alcohol. Approximately 90% of the cases involve speech impairment. Yet, to date, no detailed symptom profiles nor dedicated treatment plans are available for this population. Purpose This study set out to chart the speech and speech motor characteristics in boys with FASD to profile the concomitant speech impairment and identify possible underlying mechanisms. Method Ten boys with FASD (4.5–10.3 years old) and 26 typically developing children (4.1–8.7 years old; 14 boys, 12 girls) participated in the study. Speech production and perception, and oral motor data were collected by standardized tests. Results The boys with FASD showed reduced scores on all tasks as well as a deviant pattern of correlations between production and perception tasks and intelligibility compared with the typically developing children. Speech motor profiles showed specific problems with nonword repetition and tongue control. Conclusions Findings indicate that the speech impairment in boys with FASD results from a combination of deficits in multiple subsystems and should be approached as a disorder rather than a developmental delay. The results suggest that reduced speech motor planning/programming, auditory discrimination, and oral motor abilities should be considered in long-term, individually tailored treatment.

Purpose The goal of this study was to examine the role of carrier cues in sound source segregation and the possibility to enhance the intelligibility of 2 sentences presented simultaneously. Dual-carrier (DC) processing (Apoux, Youngdahl, Yoho, & Healy, 2015) was used to introduce synthetic carrier cues in vocoded speech. Method Listeners with normal hearing heard sentences processed either with a DC or with a traditional single-carrier (SC) vocoder. One group was asked to repeat both sentences in a sentence pair (Experiment 1). The other group was asked to repeat only 1 sentence of the pair and was provided additional segregation cues involving onset asynchrony (Experiment 2). Results Both experiments showed that not only is the “target” sentence more intelligible in DC compared with SC, but the “background” sentence intelligibility is equally enhanced. The participants did not benefit from the additional segregation cues. Conclusions The data showed a clear benefit of using a distinct carrier to convey each sentence (i.e., DC processing). Accordingly, the poor speech intelligibility in noise typically observed with SC-vocoded speech may be partly attributed to the envelope of independent sound sources sharing the same carrier. Moreover, this work suggests that noise reduction may not be the only viable option to improve speech intelligibility in noise for users of cochlear implants. Alternative approaches aimed at enhancing sound source segregation such as DC processing may help to improve speech intelligibility while preserving and enhancing the background.

The objectives of this study were to investigate the effects of place of stimulation on cortical auditory evoked potentials in relation to speech performance in cochlear implant listeners. It was designed that cortical responses were recorded for single-electrode bursts at apical, medial and basal portions of the electrode array with varying inter-stimulus intervals ranging from 300 ms to 5 s. Latency and amplitude of N1 and P2 peaks were analysed in relation to monosyllabic word scores. The study sample was 44 adult cochlear implant users ranging in age from 28 to 86 years. N1, P2 and N1-P2 amplitudes declined significantly from apical to basal electrodes. The most robust and pronounced responses were recorded for slower stimulation rates (5 s). Speech recognition correlated positively with N1 and N1-P2 amplitudes at the medial electrode. P2 latency showed a significant negative correlation with speech performance at the apical electrode. At last, cortical responses varied significantly depending on the stimulation site and rate. We can objectively quantify speech performance with the N1, N1-P2 amplitude and P2 latency in cochlear implant users. Deafness-related neural degeneration persists even after the cochlear implantation and is more distinct at the base than the apex of the cochlea.

We examined the frequency specificity of amplitude envelope patterns in 4 frequency bands, which universally appeared through factor analyses applied to power fluctuations of critical-band filtered speech sounds in 8 different languages/dialects [Ueda and Nakajima (2017). Sci. Rep., 7 (42468)]. A series of 3 perceptual experiments with noise-vocoded speech of Japanese sentences was conducted. Nearly perfect (92–94%) mora recognition was achieved, without any extensive training, in a control condition in which 4-band noise-vocoded speech was employed (Experiments 1–3). Blending amplitude envelope patterns of the frequency bands, which resulted in reducing the number of amplitude envelope patterns while keeping the average spectral levels unchanged, revealed a clear deteriorating effect on intelligibility (Experiment 1). Exchanging amplitude envelope patterns brought generally detrimental effects on intelligibility, especially when involving the 2 lowest bands ( ≲ 1850 Hz; Experiment 2). Exchanging spectral levels averaged in time had a small but significant deteriorating effect on intelligibility in a few conditions (Experiment 3). Frequency specificity in low-frequency-band envelope patterns thus turned out to be conspicuous in speech perception.

Background Pitch perception of complex tones relies on place or temporal fine structure-based mechanisms from resolved harmonics and the temporal envelope of unresolved harmonics. Combining this information is essential for speech-in-noise performance, as it allows segregation of a target speaker from background noise. In hybrid cochlear implant (H-CI) users, low frequency acoustic hearing should provide pitch from resolved harmonics while high frequency electric hearing should provide temporal envelope pitch from unresolved harmonics. How the acoustic and electric auditory inputs interact for H-CI users is largely unknown. Harmonicity and inharmonicity are emergent features of sound in which overtones are concordant or discordant with the fundamental frequency. We hypothesized that some H-CI users would be able to integrate acoustic and electric information for complex tone pitch perception, and that this ability would be correlated with speech-in-noise performance. In this study, we used perception of inharmonicity to demonstrate this integration. Methods Fifteen H-CI users with only acoustic hearing below 500 Hz, only electric hearing above 2 kHz, and more than 6 months CI experience, along with eighteen normal hearing (NH) controls, were presented with harmonic and inharmonic sounds. The stimulus was created with a low frequency component, corresponding with the H-CI user's acoustic hearing (fundamental frequency between 125 and 174 Hz), and a high frequency component, corresponding with electric hearing. Subjects were asked to identify the more inharmonic sound, which requires the perceptual integration of the low and high components. Speech-in-noise performance was tested in both groups using the California Consonant Test (CCT), and perception of Consonant-Nucleus-Consonant (CNC) words in quiet and AzBio sentences in noise were tested for the H-CI users. Results Eight of the H-CI subjects (53%), and all of the NH subjects, scored significantly above chance level for at least one subset of the inharmonicity detection task. Inharmonicity detection ability, but not age or pure tone average, predicted speech scores in a linear model. These results were significantly correlated with speech scores in both quiet and noise for H-CI users, but not with speech in noise performance for NH listeners. Musical experience predicted inharmonicity detection ability, but did not predict speech performance. Conclusions We demonstrate integration of acoustic and electric information in H-CI users for complex pitch sensation. The correlation with speech scores in H-CI users might be associated with the ability to segregate a target speaker from background noise using the speaker's fundamental frequency.

Objective The electrical dynamic range (EDR) has been suggested to be related to auditory performance in cochlear implant (CI) users. However, few reports have evaluated postlingual CI users who have used CIs for long periods in comparison with prelingual CI users. Here, we evaluated auditory perception and speech performance in terms of the EDR in long-term CI users. The EDR, and auditory and speech performances, were compared between pre- and post-lingual CI users. Methods We enrolled all patients who received CIs from April 2000 to December 2010 at Seoul National University Hospital, and who had ≥5 years of experience with CIs. The EDRs affording subjective responses at the threshold level (T-level) and comfortable level (C-level) were analyzed in terms of their relationships with pure tone audiometry levels, speech evaluation scores, including those on the Phonetically Balanced (PB) Word List test, vowel and consonant tests, a sentence test, and the Korean version of the Central Institute for the Deaf (K-CID) test; we also calculated Category in Auditory Performance (CAP) scores. Results We found no significant difference in the average EDR, CAP, K-CID, PB word, consonant, or vowel scores between pre- and post-lingual CI users. The EDR was weakly associated with the PB word (P = 0.003, r = 0.462) and consonant scores (P = 0.005, r = 0.438). Other speech evaluations, such as the CAP, K-CID, and vowel scores, were not significantly associated with the EDR T-level. We found no association between pure tone thresholds at 0.5, 1, or 2 kHz, and the speech evaluation scores or EDRs of low-, middle-, or high-frequency channels. Conclusions The EDR was only weakly associated with speech performance, such as scores on consonant and PB word tests in long-term CI users, irrespective of pre- or post-lingual deafness status.

Segregating and understanding speech in complex environments is a major challenge for hearing-impaired (HI) listeners. It remains unclear to what extent these difficulties are dominated by direct interference, such as simultaneous masking, or by a failure of the mechanisms of stream segregation. This study compared HI listeners’ performance with that of young and age-matched normal-hearing (NH) listeners in stream segregation tasks involving speech sounds. Listeners were presented with sequences of speech tokens, each consisting of a fricative consonant and a voiced vowel (CV). The CV tokens were concatenated into interleaved sequences that alternated in fundamental frequency (F0) and/or simulated vocal tract length (VTL). Each pair of interleaved sequences was preceded by a “word” consisting of two random tokens. The listeners were asked to indicate whether the word was present in the following interleaved sequences. The word, if present, occurred within one of the interleaved sequences, so that performance improved if the listeners were able to perceptually segregate the two sequences. Although HI listeners’ identification of the speech tokens in isolation was poorer than that of the NH listeners, HI listeners with both mild and moderate hearing loss were generally able to use both F0 and VTL cues to segregate the interleaved sequences. The results suggest that the difficulties experienced by HI listeners in complex acoustic environments cannot be explained by a loss of basic stream segregation abilities.

In rodents, noise exposure can destroy synapses between inner hair cells and auditory nerve fibers (“cochlear synaptopathy”) without causing hair cell loss. Noise-induced cochlear synaptopathy usually leaves cochlear thresholds unaltered, but is associated with long-term reductions in auditory brainstem response (ABR) amplitudes at medium-to-high sound levels. This pathophysiology has been suggested to degrade speech perception in noise (SPiN), perhaps explaining why SPiN ability varies so widely among audiometrically normal humans. The present study is the first to test for evidence of cochlear synaptopathy in humans with significant SPiN impairment. Individuals were recruited on the basis of self-reported SPiN difficulties and normal pure tone audiometric thresholds. Performance on a listening task identified a subset with “verified” SPiN impairment. This group was matched with controls on the basis of age, sex, and audiometric thresholds up to 14 kHz. ABRs and envelope-following responses (EFRs) were recorded at high stimulus levels, yielding both raw amplitude measures and within-subject difference measures. Past exposure to high sound levels was assessed by detailed structured interview. Impaired SPiN was not associated with greater lifetime noise exposure, nor with any electrophysiological measure. It is conceivable that retrospective self-report cannot reliably capture noise exposure, and that ABRs and EFRs offer limited sensitivity to synaptopathy in humans. Nevertheless, the results do not support the notion that noise-induced synaptopathy is a significant etiology of SPiN impairment with normal audiometric thresholds. It may be that synaptopathy alone does not have significant perceptual consequences, or is not widespread in humans with normal audiograms., Highlights • Study of adults with impaired speech perception in noise (SPiN) and normal audiograms. • A subset of those with reported SPiN impairment exhibited measurable SPiN deficits. • SPiN-impaired participants were matched with controls for age, sex, and audiogram. • Impaired SPiN was not associated with ABR or EFR measures of cochlear synaptopathy. • Impaired SPiN was not associated with a detailed measure of lifetime noise exposure.

OBJECTIVE: Deaf children with cochlear implants (CIs) show poorer verbal working memory compared to normal-hearing (NH) peers, but little is known about their verbal learning and memory (VLM) processes involving multi-trial free recall. DESIGN: Children with CIs were compared to NH peers using the California Verbal Learning Test for Children (CVLT-C). STUDY SAMPLE: Participants were 21 deaf (before age 6 months) children (6–16 years old) implanted prior to age 3 years, and 21 age-IQ matched NH peers. RESULTS: Results revealed no differences between groups in number of words recalled. However, CI users showed a pattern of increasing use of serial clustering strategies across learning trials, whereas NH peers decreased their use of serial clustering strategies. In the CI sample (but not in the NH sample), verbal working memory test scores were related to resistance to the build-up of proactive interference, and sentence recognition was associated with performance on the first exposure to the word list and to the use of recency recall strategies. CONCLUSIONS: Children with CIs showed robust evidence of VLM comparable to NH peers. However, their VLM processing (especially recency and proactive interference) was related to speech perception outcomes and verbal WM in different ways from NH peers.

Objective Although many studies have investigated sudden sensorineural hearing loss (SSNHL) in adults, there were few studies on SSNHL in the pediatric population; especially research on treatment and prognosis of pediatric SSNHL was limited. The aim of this study was to evaluate clinical characteristics, treatment outcomes and prognostic factors in children and adolescents with SSNHL. Methods A retrospective review of medical records of 67 pediatric patients (67 ears) who had diagnosed with SSNHL at our hospitals was performed to analyze patients’ clinical manifestations and audiograms. All patients were treated with high-dose systemic prednisolone (1 mg/kg), and 17 of them underwent intratympanic steroid injection therapy. Audiological evaluation was carried out before and after treatment, and hearing recovery was defined as complete recovery and partial recovery according to Siegel’s criteria. Patients were divided into two groups: childhood group (ages between 4 and 12 years old) and adolescence group (age > 12 years), and clinical characteristics and treatment outcomes were investigated. In addition, patients were divided into two groups according to degree of hearing recovery, and evaluation was made regarding possible prognostic factors. Results The recovery rate in total 67 patients was 55.2%. The recovery rate of the childhood group was significantly lower than that of the adolescence group ( p = 0.038). While the presence of vertigo did not significantly correlate with prognosis ( p = 0.219), the presence of tinnitus was significantly associated with hearing recovery ( p = 0.005). Audiological assessment revealed that a low initial hearing threshold, high speech discrimination score, and descending type of audiogram were positively associated with hearing recovery ( p = 0.002, p = 0.003, and p = 0.029, respectively). Conclusion The childhood group had worse treatment outcomes than the adolescence group. High initial hearing threshold and absence of tinnitus were poor prognostic factors of hearing recovery. Active treatment is required for patients with these poor prognostic factors and childhood patients with SSNHL.

Objectives Cochlear implantation (CI) has been the most successful procedure for restoring hearing in a patient with severe and profound hearing loss. However, possibly owing to the variable brain functions of each patient, its performance and the associated patient satisfaction are widely variable. The authors hypothesize that peripheral and cerebral circulation can be assessed by noninvasive and globally available methods, yielding superior presurgical predictive factors of the performance of CI in adult patients with postlingual hearing loss who are scheduled to undergo CI. Design Twenty-two adult patients with cochlear implants for postlingual hearing loss were evaluated using Doppler sonography measurement of the cervical arteries (reflecting cerebral blood flow), flow-mediated dilation (FMD; reflecting the condition of cerebral arteries), and their pre-/post-CI best score on a monosyllabic discrimination test (pre-/post-CI best monosyllabic discrimination [BMD] score). Correlations between post-CI BMD score and the other factors were examined using univariate analysis and stepwise multiple linear regression analysis. The prediction factors were calculated by examining the receiver-operating characteristic curve between post-CI BMD score and the significantly positively correlated factors. Results Age and duration of deafness had a moderately negative correlation. The mean velocity of the internal carotid arteries and FMD had a moderate-to-strong positive correlation with the post-CI BMD score in univariate analysis. Stepwise multiple linear regression analysis revealed that only FMD was significantly positively correlated with post-CI BMD score. Analysis of the receiver-operating characteristic curve showed that a FMD cutoff score of 1.8 significantly predicted post-CI BMD score. Conclusions These data suggest that FMD is a convenient, noninvasive, and widely available tool for predicting the efficacy of cochlear implants. An FMD cutoff score of 1.8 could be a good index for determining whether patients will hear well with cochlear implants. It could also be used to predict whether cochlear implants will provide good speech recognition benefits to candidates, even if their speech discrimination is poor. This FMD index could become a useful predictive tool for candidates with poor speech discrimination to determine the efficacy of CI before surgery.

Objective To investigate the hearing performance of adult patients presenting unilateral deafness with contralateral fluctuating hearing loss who received a cochlear implant on the deaf side. Study Design Case series with chart review. Setting University tertiary referral center. Subjects and Methods Preoperatively and at 6 and 12 months postoperatively, 23 patients underwent pure tone audiometry and speech audiometry with disyllabic and monosyllabic words in a quiet environment and sentences in quiet and noisy (signal-to-noise ratio +10 dB SPL) environments under best-aided conditions. The Abbreviated Profile of Hearing Aid Benefit (APHAB) inventory was evaluated preoperatively and at 6 and 12 months postoperatively. Results No difference was found between pre- and postoperative tests for disyllabic and monosyllabic words. For sentences in quiet and noisy environments, a difference between pre- and postoperative performance was present at 1 year ( P = .002 and P = .02, respectively). In a noisy environment, a difference was present at 6 and 12 months postoperatively as compared with the preoperative value (mean ± SD: 6 months: 42% ± 7.1% vs 61% ± 6.5%, P = .016). A significant improvement in the APHAB score was found at 6 and 12 months postimplantation (Friedman's 2-way analysis of variance by ranks, P < .001). The number of years of hearing deprivation of the deaf ear was not correlated with performance. Conclusion When incapacitating fluctuating hearing loss occurs in patients presenting a contralateral deaf ear, a cochlear implant is indicated in the latter ear, significantly improving performance in noisy conditions and allowing a better quality of communication to be achieved.

Using a well-established binaural-listening paradigm the ability to intentionally switch auditory selective attention was examined under anechoic, low reverberation (0.8 s) and high reverberation (1.75 s) conditions. Twenty-three young, normal-hearing subjects were tested in a within-subject design to analyze influences of the reverberation times. Spoken word pairs by two speakers were presented simultaneously to subjects from two of eight azimuth positions. The stimuli consisted of a single number word, (i.e., 1 to 9), followed by either the direction “UP” or “DOWN” in German. Guided by a visual cue prior to auditory stimulus onset indicating the position of the target speaker, subjects were asked to identify whether the target number was numerically smaller or greater than five and to categorize the direction of the second word. Switch costs, (i.e. reaction time differences between a position switch of the target relative to a position repetition), were larger under the high reverberation condition. Furthermore, the error rates were highly dependent on reverberant energy and reverberation interacted with the congruence effect, (i.e. stimuli spoken by target and distractor may evoke the same answer (congruent) or different answers (incongruent)), indicating larger congruence effects under higher reverberation times.

Sentence understanding scores for patients with cochlear implants (CIs) when tested in quiet are relatively high. However, sentence understanding scores for patients with CIs plummet with the addition of noise.To assess, for patients with CIs (MED-EL), (1) the value to speech understanding of two new, noise-reducing microphone settings and (2) the effect of the microphone settings on sound source localization.Single-subject, repeated measures design. For tests of speech understanding, repeated measures on (1) number of CIs (one, two), (2) microphone type (omni, natural, adaptive beamformer), and (3) type of noise (restaurant, cocktail party). For sound source localization, repeated measures on type of signal (low-pass [LP], high-pass [HP], broadband noise).Ten listeners, ranging in age from 48 to 83 yr (mean = 57 yr), participated in this prospective study.Speech understanding was assessed in two noise environments using monaural and bilateral CIs fit with three microphone types. Sound source localization was assessed using three microphone types.In Experiment 1, sentence understanding scores (in terms of percent words correct) were obtained in quiet and in noise. For each patient, noise was first added to the signal to drive performance off of the ceiling in the bilateral CI-omni microphone condition. The other conditions were then administered at that signal-to-noise ratio in quasi-random order. In Experiment 2, sound source localization accuracy was assessed for three signal types using a 13-loudspeaker array over a 180° arc. The dependent measure was root-mean-score error.Both the natural and adaptive microphone settings significantly improved speech understanding in the two noise environments. The magnitude of the improvement varied between 16 and 19 percentage points for tests conducted in the restaurant environment and between 19 and 36 percentage points for tests conducted in the cocktail party environment. In the restaurant and cocktail party environments, both the natural and adaptive settings, when implemented on a single CI, allowed scores that were as good as, or better, than scores in the bilateral omni test condition. Sound source localization accuracy was unaltered by either the natural or adaptive settings for LP, HP, or wideband noise stimuli.The data support the use of the natural microphone setting as a default setting. The natural setting (1) provides better speech understanding in noise than the omni setting, (2) does not impair sound source localization, and (3) retains low-frequency sensitivity to signals from the rear. Moreover, bilateral CIs equipped with adaptive beamforming technology can engender speech understanding scores in noise that fall only a little short of scores for a single CI in quiet.

Short-time processing was employed to manipulate the amplitude, bandwidth, and temporal fine structure (TFS) in sentences. Fifty-two native-English-speaking, normal-hearing listeners participated in four sentence-recognition experiments. Results showed that recovered envelope (E) played an important role in speech recognition when the bandwidth was > 1 equivalent rectangular bandwidth. Removing TFS drastically reduced sentence recognition. Preserving TFS greatly improved sentence recognition when amplitude information was available at a rate ≥ 10 Hz (i.e., time segment ≤ 100 ms). Therefore, the short-time TFS facilitates speech perception together with the recovered E and works with the coarse amplitude cues to provide useful information for speech recognition.

Objective After 20 years of experience with different types of middle ear implants, we analyzed our database about the Vibrant Soundbridge (VSB) to know the rate of complications, the effect on the residual hearing and the audiometric gain in our center. Method The study was retrospective and included all VSB implants bound to the long process of the incus in our tertiary medical center between january 1999 and february 2015. We observed the effect of surgery on residual hearing by comparing bone and air conduction thresholds before and after implantation. The functional results of the implant were quantified by measuring, at several post-operative intervals, the thresholds with the VSB in pure tone audiometry and speech audiometry, in quiet and in noise. Results 53 VSB were implanted in 46 patients aged between 22 and 81 years old (average 53.9). 48 patients (90%) suffered from a sensorineural hearing loss, and 5 patients from a mixed hearing loss due to an otosclerosis (but only 3 of them have undergone stapedotomy). There were no major complications (e.g. facial palsy, dead ear or postoperative infection). The placement of the implant created an insignificant deterioration of the air conduction thresholds (5,6 dB HL) and bone conduction thresholds (2.2 dB HL) at 6 weeks post-implantation. The bone conduction thresholds increased by 4.7 dB HL 2.5 years after surgery in comparison with the preoperative results, which is also considered clinically insignificant. With the implant turned on, the pure tone audiometry thresholds in open field, in quiet, were significantly improved (gain of 13.9 dB on average on frequencies from 250 to 8000 Hz), particularly at frequencies of 1000, 2000 and 4000 Hz as the average gain on these frequencies amounted to 19.4 dB. The speech intelligibility in a cocktail party noise was also improved by 18.3% on average at 6, 52 and 104 weeks post-implantation. Conclusion The Vibrant Soundbridge with the electromagnetic vibrator fixed to the long process of the incus is a safe active middle ear implant with no major complications; it has no significant impact on the residual hearing. The VSB is particularly suitable for patients who are unable to wear conventional hearing aids due to anatomical or infectious problems in the external ear canal, or in case of poor audiometric results with conventional hearing aids. The VSB brings significant hearing gain, as it is particularly efficient in frequencies for the speech range and higher, resulting especially in better speech intelligibility in noisy environments.

This study reconsiders the number of effective channels in contemporary cochlear implants. Subjects listened to matrix sentences with a competing talker using their clinical map (up to 22 electrodes) and reduced-channel maps using 12, 8, and 4 electrodes. Spectro-temporal modulation thresholds and reading span were measured to explore intersubject variability. Results show that speech understanding significantly improved with increasing active electrodes up to 22, particularly for subjects with better spectro-temporal resolution. These findings suggest some listeners may be able to utilize the full electrode array and may not be limited to eight channels of information as indicated in previous studies.

This study introduces an improved method to investigate the effects of reverberation using the speech-evoked auditory brainstem response (ABR) that more realistically captures the influence of self- and overlap-masking induced by room reverberation. Speech-evoked ABR was measured under three acoustic scenarios: anechoic, mild reverberation with dominance of early reflections, and severe reverberation with dominance of late reverberation. Responses were significantly weaker and had longer latencies with severe reverberation relative to anechoic and mild reverberation. Although larger responses and shorter latencies were observed with mild reverberation than anechoic, possibly due to early reflections, these reached significance in only one of six ABR response measures.

Listeners' speech perception abilities vary extensively in challenging listening conditions. There is little evidence as to whether this variability is a result of true, stable individual differences or just variability arising from measurement error. This study examines listeners' word recognition abilities across multiple sessions and a variety of degraded speech tasks (noise-vocoded, time-compressed, and speech in babble noise). Participants transcribed isolated single syllable words presented in all three degradation types and repeated these tasks (with different words) on a separate day. Correlations of transcription accuracy demonstrate that individual differences in performance are reliable across sessions. In addition, performance on all three degradation types was correlated. These results suggest that differences in performance on degraded speech perception tasks for normal hearing listeners are robust and that there are underlying factors that promote the ability to understand degraded speech regardless of the specific manner of degradation. Uncovering these general performance factors may provide insight into the salient performance variance observed in listeners with hearing impairment.

The study investigated improvements in maximal speech intelligibility after Vibrant Soundbridge (VSB) implantation and analyzed the effect of the hearing loss pattern on maximal speech intelligibility represented by a phonetically balanced word score (PBmax). The effect of middle ear implants on PBmax has not been evaluated yet.Study.Tertiary academic medical center.Sixty patients who underwent VSB from December 2011 to January 2016 were retrospectively reviewed. All the patients had hearing aids preoperatively.Pure-tone and speech audiometry were checked with and without hearing aids and then with the VSB. The patients were divided into two groups: flat and down-sloping type of hearing loss. PBmax score was evaluated at the most comfortable listening level before and after VSB implantation and compared with scores with/without HA.PBmax for both conventional HA and VSB were significantly higher compared with the unaided condition. The improvement in speech recognition was significantly better using VSB than using HA (p = 0.003). However, there was no significant difference in the improvement provided by VSB and HA in patients with a flat hearing loss. Patients with a down-sloping audiogram showed significantly better improvement with VSB than with HA (p = 0.003). Moreover, patients with greater preoperative high-frequency hearing loss had greater improvement in PBmax after VSB implantation.Speech intelligibility can be significantly improved by VSB implantation, especially in patients with a down-sloping hearing loss. This finding can help select patients who will benefit most from VSB implantation.