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There are few reports of the treatment for severe hearing loss due to otitis media with antineutrophil cytoplasmic antibody-associated vasculitis (OMAAV) achieved by cochlear implantation (CI). Here, we have reported the case of a patient with severe bilateral sensorineural hearing loss with low-frequency residual hearing by OMAAV. CI was performed in her right ear based on the results of contrast-enhanced magnetic resonance imaging (CE-MRI) and promontory stimulation test (PST). The residual hearing in her right ear was preserved after CI and utilized for combined electric acoustic stimulation (EAS). The combined EAS was used for 3 years until the residual hearing became stabilized. However, the usable hearing in low frequency worsened gradually, and the fitting strategy of cochlear implant was changed from combined EAS to CI alone 4 years after CI. Even when the speech discrimination score with CI no longer exceeds 50 %, the patient continued using CI because of its advantages in maintaining the quality of life of the patient. The combined EAS was found to be a feasible option even in an OMAAV patient with residual hearing. CE-MRI and PST may thus be helpful in deciding the side of CI surgery in a patient with OMAAV.

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

To evaluate the audiological effectiveness of Bonebridge implantation in patients with bilateral congenital malformation of the external and middle ear. Twenty-eight cases [17 boys and 11 girls; median age, 12 years (range 8–36 years)] had unilateral Bonebridge implantation. Audiological tests were performed preoperatively and postoperatively, and included the pure-tone audiometry test, speech discrimination score (SDS), and evaluation of the unaided and aided hearing thresholds in sound fields. For the group of patients aged > 12 years, Mandarin Speech Test Materials were used to determine the SDS. For the other cases, the Mandarin Lexical Neighborhood Test was used. The daily life efficacy was assessed using the Abbreviated Profile of Hearing Aid Benefit (APHAB) questionnaire postoperatively. The t and t′ tests were used in the statistical analyses. The hearing threshold with the Bonebridge improved by 25–35 dB HL, compared to that of the unaided condition. The SDS of patients aged > 12 years improved by about 50%; the SDS also improved by 10–20% in the three patients aged

A speech discrimination score (SDS) is a predictor for the successful use of hearing aids (HAs). This study is to evaluate the efficacy of HAs in patients with a low or poor SDS. We enrolled 186 ears using HAs, with an unaided SDS ≤ 64%. They were categorized into four groups by their unaided SDS: 0–16% for Group 1, 20–32% for Group 2, 36–48% for Group 3, and 52–64% for Group 4. Aided SDS was measured 1, 3, 6, and 12 months after the use. The Hearing In Noise Test (HINT), the Hearing Handicap Inventory for the Elderly (HHIE), and the International Outcome Inventory for Hearing Aids (IOI-HA) were assessed. The SDS increased by 27.4% (12.0 to 39.4%) in Group 1, 26.4% (26.9 to 53.3%) in Group 2, 24.6% (42.2 to 66.8%) in Group 3, and 10.5% (59.5% to 70.0%) in Group 4. HINT composite scores significantly decreased from 22.5 to 15.1 in Group 1, 9.4 to 7.0 in Group 2, and 4.4 to 2.4 in Group 4. Total HHIE score changed from 48.2 to 24.2 in Group 1, 64.0 to 32.8 in Group 2, 37.1 to 16.6 in Group 3, and 55.8 to 40.1 in Group 4 (P

Background Datalogging feature of the cochlear implant audio processor has been utilized to calculate the average daily wearing hours for cochlear implant devices by patients. Objectives To assess the relationship between the time use of cochlear implant audio processor and speech development as well as to identify the lowest acceptable duration of audio processor use to achieve an acceptable language development. Methods A retrospective study design including prelingual thirty-four ears (24 patients) who received the same electrode array of cochlear implant with 2 years follow up. The audiological and speech evaluations were done for all patients postoperatively and the last postoperative follow-up visit was used for analysis in this study. Results The average daily use of the audio processor was 11.3 ± 2.7 h per day. The pure tone average was 30.55 ± 4.64 dB whereas the speech reception threshold was 30.88 ± 6.12 dB. The average speech discrimination score at 65 dB was 68.59 ± 16.80%. A significant positive correlation (r = 0.54, p value = 0.0009) was found between the daily use of the audio processor and the speech discrimination score. The lowest wearing time needed to have more than 60% of the speech discrimination score was 8.3 h/day. Conclusion The present study revealed a positive correlation between the daily duration of the audio processor usage and speech performance. Moreover, we found that pediatric patients need to use their cochlear implant device for at least 8.3 h/day to achieve acceptable language development.

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.

The Envoy Esteem and the Carina system are the 2 totally implantable hearing devices. The Esteem is designed for patients with bilateral moderate to severe sensorineural hearing loss who have an unaided speech discrimination score of greater than and equal to 40%. The Carina system is designed for patients with moderate to severe sensorineural hearing loss or those with mixed hearing loss. The Esteem offers a technologically advanced method to provide improvements in hearing and is available in the United States, whereas the Carina system is currently not available in the United States.

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.

Mismatch negativity (MMN) has been widely used to study the function of central auditory processing in the elderly. However, current research has not yet considered the effect of noise and high-frequency hearing threshold on MMN in the elderly. The aim of this study was to evaluate the effect of aging and high-frequency hearing loss on speech-related MMN in noisy backgrounds. Additionally, the possible mechanisms of central auditory processing dysfunction in the elderly were investigated. Fifty people aged 61-80 (70 ± 5.8) years were recruited for this study. They were divided into a 61- to 70-year-old group and a 71- to 80-year-old group. Fifty younger adults aged 21-40 (31 ± 5.3) years were recruited as healthy controls. Pure-tone hearing thresholds were recorded. A speech discrimination score (SDS) and a speech-evoked MMN under white noise with a bandwidth from 125 to 8,000 Hz background condition were recorded. The relationships between SDS and MMN latency and amplitude were analyzed. The effects of age and binaural 2,000-, 4,000- and 8,000-Hz pure-tone hearing thresholds on MMN latency and amplitude were analyzed. We found that the hearing thresholds of 2,000, 4,000 and 8,000 Hz in the 61- to 70-year-old and 71- to 80-year-old groups were higher than those in the control group. The SDS in a noisy background in the 61- to 70-year-old and 71- to 80-year-old groups were lower than those in the control group. Speech-evoked MMN latency was longer in the 61- to 70-year-old and in the 71- to 80-year-old groups than in the control group (215.8 ± 14.2 ms). SDS and speech-evoked MMN latency were negatively correlated. Age and speech-evoked MMN latency were positively correlated, as were the binaural 4,000- to 8,000-Hz pure-tone hearing thresholds and speech-evoked MMN. This study suggests that in elderly subjects, the function of preattentive central auditory processing changes. Additionally, increasing age and high-frequency hearing thresholds create a synergy in neurons that is weakened in the MMN time window, which may be a cause of central auditory processing disorders in elderly subjects in noisy background conditions.

Objectives To assess the audiological outcomes and speech performance among children with simultaneous bilateral cochlear implants (CIs). Methods This was a retrospective case review of 41 patients with prelingual deafness who failed a hearing aid trial and received simultaneous bilateral CIs. Ear-specific responses in terms of pure tone average (PTA), speech reception thresholds (SRTs), and speech discrimination score (SDS) were recorded for both ears of all patients. Results The PTA and SRT for the right and left CIs were comparable (P-value = 0.861 and P-value = 0.524, respectively). The SDS was slightly higher for the right ear, although it was not significantly different from that for the left ear (P-value = 0.375), yielding only a 2.42% difference. Conclusion We found no significant side preference in all assessment scores for children with simultaneous bilateral CIs. Therefore, we cautiously advise implanting the CI in the right ear in case of symmetrical hearing loss when other prognostic factors do not favor the left ear.

Objective: The acceptable noise level (ANL) test is used for quantification of the amount of background noise that subjects are willing to accept when listening to speech. Earlier studies including subjects with normal hearing and/or mixed types of sensorineural hearing losses have shown that ANL is not affected by hearing sensitivity. The purpose of this study was to investigate possible within-subject ANL differences between ears in subjects with unilateral Meniere's disease. Study design: ANL was measured in three conditions in both ears of 11 Danish adult subjects diagnosed with unilateral Meniere's disease. Both speech and noise signals were presented through earphones. The Wilcoxon signed rank test was utilized to determine if there were significant differences between ANLs measured in the unaffected and the ears affected by Meniere's disease. Spearman's rank correlation coefficient was calculated to determine if an association exists between the speech discrimination score and ANL in the af...

The dehydration test using isosorbide is well tolerated when used to detect endolymphatic hydrops and may also be used to improve the sensitivity of ECoG performed on patients with MD, especially in poor hearing at low-frequency.This prospective study was to explore the diagnostic utility of a dehydration test, administering oral isosorbide, which has been used to treat Meniere's disease (MD).Electrocochleography (ECoG) and the dehydration test with isosorbide were performed on 32 patients diagnosed with definite diagnosed MD. Isosorbide (120 mL) was orally administered after baseline audiometric testing, and the testing was repeated 3 h later. The dehydration test was considered positive when improvements in hearing thresholds of 10 dB or more were evident at two or more frequencies, or the speech discrimination score increased by 12% or more. An abnormal ECoG finding was defined as an SP/AP (summating potential/action potential) ratio ≥0.4.The dehydration test using isosorbide was positive in 10 of 32 patients (31.3%). The test was not associated with development of any serious side-effect. Abnormal ECoG findings were noted in 14 of 32 patients (43.8%). When endolymphatic hydrops was defined as an abnormal ECoG or a positive dehydration test, the condition was detected in 21 of 32 patients (65.6%). The positive result in dehydration test was significantly higher in patients with above moderate hearing loss at low-frequency.

Conclusion: Vibrant Soundbridge (VSB) application to the middle ear windows yields better functional outcomes than conventional hearing aids. However, speech discrimination scores obtained with VSB and conventional hearing aids are similar. Objective: To assess audiological outcomes of round and oval window applications of VSB in comparison with conventional hearing aids. Methods: Nineteen adult patients were included in the study. The patients had mild to moderate, moderate or moderate to profound conductive or mixed hearing loss. During surgery the floating mass transducer (FMT) was placed on the round (n = 14) or oval (n = 5) window. After the surgery, audiometric evaluation and free field audiometric evaluation of both ears was carried out. Results: The hearing thresholds in the low frequencies were not significantly different between the conventional hearing aids and VSB. The functional gains obtained with oval and round window approaches were similar except for 500 Hz. The hearing thresholds in the mid and high frequencies were significantly better with VSB than the conventional hearing aids. The functional gain in the low frequencies was not significantly different between VSB and conventional hearing aids. The functional gain in the other frequencies was significantly better with VSB than conventional hearing aids.

We studied the cost-effectiveness and relative performance of numerical examinations in diagnosing vestibular schwannoma (VS), and problems in VS treatment. We checked VS prevalence in 1,860 suspected subjects, clinical examination sensitivity and specificity such as auditory brainstem response (ABR), X-ray imaging, equilibrium test, speech discrimination score, computed tomography (CT), and magnetic resonance imaging (MRI). VS prevalence in the 1,860 was 1.7%. ABR sensitivity and specificity were superior to other clinical examinations but CT and/or MRI, making ABR the most efficient, economical screening for diagnosing VS. The 5% occurrence of false-negative ABR cases must, however, be taken into careful account. Our treatment implements ultrasonic bone curettage to open the internal auditory canal to remove VS. We also reviewed types of post-treatment follow-up.

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

In patients with total sudden sensorineural hearing loss (SSNHL), oral prednisone (OP) alone or intratympanic dexamethasone (ITD) alone have comparable results. The addition of salvage ITD following OP does not seem to add over either single modality treatment.To study the effect of steroid-based treatments in patients with total SSNHL.The medical charts of 59 patients with total loss of hearing, defined as pure tone thresholds in the profound range (90 dB) with an unobtainable speech reception threshold (SRT) that were treated with OP (n = 20), ITD (n = 13), or OP followed by salvage ITD (n = 26) were analyzed. Response to treatment was evaluated by means of pure tone thresholds, SRT, and speech discrimination score (SDS), immediately after treatment and on a follow-up visit.Forty-nine patients (83%) responded to treatment, with mean significant improvements of 36, 34, 31, and 25 dB at 500, 1000, 2000, and 4000 Hz, respectively. The mean improvement in SRT was 33 dB, and SDS improved by 32%. There were no differences in improvement in pure tone thresholds and SRT among the three treatment groups. The late effect of OP was similar to the effect of salvage ITD.

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.

In the quest for hearing preservation in patients with acoustic schwannomas it is essential that surgeons do not lose sight of the concept of ‘useful’ hearing. There is an important difference between hearing preservation which pleases the surgeon and that which will be appreciated by the patient.Tumour size, pure tone audiogram average differences between ears and speech discrimination scores have been recorded in a series of 114 patients with unilateral acoustic schwannomas. Criteria for useful hearing are presented in terms of pure tone audiogram average difference and speech discrimination scores.There were 11 patients (10 per cent) with a speech discrimination score of 50 per cent or more, a pure tone audiogram average difference of 30 dB or better and a tumour size of no more than 2 cm. Only one patient (0.9 per cent) had a speech discrimination score of 50 per cent or more, a pure tone audiogram average difference of 20 dB or better and a tumour size of no more than 1 cm.It is concluded that hearing preservation techniques may be applicable to between 1 and 10 per cent of patients with unilateral acoustic schwannomas.

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.

Received August 19, 2014 Revised October 7, 2014 Accepted October 23, 2014 Address for correspondence Jeong Hun Jang, MD Department of OtorhinolaryngologyHead and Neck Surgery, School of Medicine, Kyungpook National University, 130 Dongdeok-ro, Jung-gu, Daegu 700-721, Korea Tel +82-53-420-5781 Fax +82-53-423-4524 E-mail jangjh@knu.ac.kr Background and ObjectivesZZThe aim of this study was to compare the degree of satisfaction of the patients, hearing loss type and severity, and satisfactory and unsatisfactory factors between closed fit hearing aid (HA) and receiver in the canal (RIC) HA. Subjects and MethodZZSeventeen patients with hearing loss participated in this study. All patients had used closed fit HAs prior to the study, with the ratio of those using in the canal (ITC) types and completely in the canal (CIC) types being 4:13. After a 2-week trial period of using RIC HAs, patients were evaluated for their satisfaction of using RIC HAs by filling out the questionnaire on the Korean version International Outcome Inventory for hearing aids (K-IOI-HA). ResultsZZThe visual analogue scale (VAS) score of closed fit HA was higher in the RIC-HAdissatisfied group (≤5, n=8) than in the RIC-HA-satisfied group (>5, n=9). The K-IOI-HA score of closed fit HA was higher than that of RIC HA in the RIC-HA-dissatisfied group and similar in the RIC-HA-satisfied group. Audiologically, air conduction and bone conduction thresholds at 500 Hz were lower in the RIC-HA-satisfied group than in the RIC-HA-dissatisfied group. In addition, the VAS score of RIC HA was negatively correlated with air and bone conduction thresholds and the K-IOI-HA score of RIC HA was positively correlated with speech discrimination score, whereas the VAS and K-IOI-HA scores of closed fit HA were not. ConclusionZZAmong the patients with closed fit HA, some patients indicated RIC HA to be suitable and showed intention to change. The HA should be prescribed firstly based on audiologic criteria, which could increase the subjective satisfaction and prevent poor compliance due to incongruity. Korean J Otorhinolaryngol-Head Neck Surg 2015;58(4):249-56

Objective: The aim of this study is to describe the long-term outcome of preserved hearing after vestibular schwannoma surgery. Methods : Subjects are 20 unilateral vestibular schwannoma patients whose class A hearing of the AAO-HNS classification was preserved successfully after tumor removal. Hearing preservation surgery was attempted via the middle cranial fossa (MCF) or the extended MCF approach. The follow-up periods ranged from 2 to 16 years. The outcome measures included the pure tone average (PTA) and speech discrimination score (SDS). Results: PTA was maintained in less than 30 dB in 11 out of 20 patients within 2 years follow-up, six out of 13 patients within 4 years follow-up, and two out of five patients within 6 years follow-up, respectively. SDS was maintained in more than 70% in 17 out of 20 patients within 2 years follow-up, ten out of 13 patients within 4 years follow-up, and three out of five patients within 6 years follow-up, respectively. Conclusions: The preserved hearing maintained about more than 40% of the patients with the class A hearing in every 2 years follow-up. From this result, we can conclude that the hearing preservation surgery could be one of the best treatments for vestibular schwannoma patients with class A hearing. However, further study will be needed to clarify the mechanism of the deterioration in hearing after hearing preservation surgery.

A sudden or progressive hearing loss in the only hearing ear is an otologic emergency, in which therapeutic possibilities are limited. We describe results of immunosuppressive therapy in 10 patients with one deafened ear either due to cochlear hydrops or Meniere's disease, who developed progressive or fluctuant hearing loss in the only hearing ear. The perilymphatic fistula was excluded with tympanoscopy. Azathioprine (25 mg t.i.d.) with prednisone (initial dose 20-40 mg with daily dose of 5-15 mg/day) was used. The hearing of 6 subjects responded to treatment. The initial pure tone audiogram (PTA) at speech frequencies of the "only hearing ear" was 57.3 dB HL with speech discrimination score (SDS) of 85%. The hearing improvement occurred successively within days or weeks. The average improvement of PTA was 22.4 dB HL after the mean treatment period of 5 weeks. In contralateral ear (the average PTA and SDS were 72.5 dB HL and 28%, respectively) the mean improvement in PTA was insignificant (4.4 dB). In 5 patients with vertigo it was improved in 3 cases. Cortisone alone or with combination of cyclophosphamide or ciclosporine was not effective in our hands.

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/.

Audiologic data from 126 patients treated at the University of California, San Francisco for newly diagnosed acoustic neuromas (ANs) from 1986 to 1990 were reviewed. Subjectively normal hearing was present in 15% of patients and was most frequent in patients with small (< 1 cm) tumors. Only 4% had objectively normal hearing on the basis of speech reception threshold (SRT), speech discrimination score (SDS), and high-frequency pure-tone loss. This was most frequent in patients with < 1 cm tumors. Abnormal but symmetrical hearing is usually not considered to be indicative of a unilateral AN. In the present series, 7% of patients with ANs possessed symmetrical hearing. High-frequency asymmetry was a more sensitive indicator of the presence of an AN than differences in either SRT or SDS. The clinician must be aware of the relatively high incidence of atypical audiologic findings in acoustic tumor patients.

Fifty-five ear of 49 patients with otosclerosis were operated on with either large fenestra stapes (stapedectomy; SDE) or small fenestra stapes (stapedotomy; STO) surgery. Pre-operative average hearing levels for the speech frequency ranges (0.5,1,2 kHz) were 56.1 dBHL for SDE and 61.0 dBHL for STO. These improved to 39.0 dBHL and 35.0 dBHL. Statistically, significant hearing recovery was obtained for a frequency range from 0.125 to 2 kHz for SDE and from 0.125 to 4 kHz for STO (p < 0.05, Dunnett's multiple variance test). The degree of post-operative hearing improvement for STO was significantly higher at 0.5, 2 and 8 kHz than that for SDE (p < 0.05, Student's t-test). A pre-operative speech discrimination score of 80% was obtained at 68.9 dB for SDE and at 76.0 dB for STO. These values improved to 56.1 dB and 49.5 dB post-operatively. Thus, it was proved that STO results in better hearing than SDE does.

For the purpose of clarifying whether or not the possibility of hearing preservation can be predicted preoperatively, we compared clinical characteristics and preoperative test results between hearing preserved and hearing unpreserved patients. Based on an analysis of this study, we conclude that duration of symptoms, ABR findings and caloric test results, in addition to hearing level, speech discrimination score and tumor size should be considered as prognostic signs of hearing preservation. Although all factors do not suggest a definite possibility of hearing preservation, candidates for hearing preservation surgery should be selected according to these prognositc factors.

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.

Otologic symptoms, audiometric data, and operative findings were reviewed in 200 consecutive patients who had surgically treated unilateral chronic otitis media. Bone conduction thresholds were analyzed in relation to extent of perforation, frequency of otorrhea, duration of disease, and extent of pathologic change. Median bone conduction threshold differences between diseased and uninvolved ears were within 5 dB at all frequencies. The mean speech discrimination score between affected and unaffected ears was equal. Patients with prolonged disease and more extensive pathologic alterations were more likely to experience cochlear changes and hence sensorineural hearing loss, though not to the extent others have described. Our findings indicate that chronic otitis media has little effect on cochlear function in the majority of patients.

Selection of hearing aid has been a controversial problem in clinical audiology. Message to competion (noise) ratios is a procedure with a new philosophy that attracted popularity in many a place. A group of sixty hearing handicapped persons (with 55–90 dB loss) were studied with this technique using 4-different types of aids. Its applicability was evaluated in 44 persons while in 16 others it could not be done. Its indication and use were reviewed. The efficacy of Conventional procedures were also compared with this technique. It was, no doubt, found to have great potential in predicting the possible results of using a particular hearing aid and thus helps the patient as well as the doctor and audiologist in dispensing an aid in the clinical practice.

Preservation of hearing in patients with acoustic nerve tumors can be a goal when tumor size is small and residual hearing is intact. Overall success rates for preservation have been reported to be 20% to 40%. The overall success rate in this series is 30.7%. However, indicators of intact auditory brain stem response (waves I-III-V), good speech discrimination score, and intact acoustic (stapedial) reflex were associated with a 68.2% rate of success. Thus, a comprehensive audiologic evaluation is a guideline for selecting and counselling patients with acoustic tumors before hearing preservation procedures.

Audiological screening was performed in 164 patients, aged 32-89 (median 71) years, in a department for long-term medical treatment. 45% of the patients had a hearing loss exceeding 30 dB HL in the frequency range 500-2 000 Hz (pure-tone average, PTA). The aetiology of the hearing loss was in most cases presbycusis, as the pure-tone thresholds were closely related to the age of the patients. The speech discrimination score for the better ear was impaired (less than 90%) in about 50% of the patients. Nevertheless, only 15% of the patients felt they had a significant hearing handicap. On average, these patients had a hearing loss exceeding 50 dB HL (PTA). The nursing staff estimated about two-thirds of the patients as having normal hearing and only 6% of the patients as having a severe hearing loss. The otologists also underestimated the number of patients with audiometrically impaired hearing. 11% of the patients had a hearing aid, but in nearly half of the patients, the function of the device was defective, either due to flat batteries, incorrect mounting or similar minor defects. A positive effect was observed subsequent to annual 2-hour courses for nurses, focusing on problems in communication with elderly people and on assisting patients who use a hearing aid.

From 1966 through 1983, 408 patients underwent primary removal of an acoustic neuroma at the Mayo Clinic. Of these, 21 had preoperative pure tone hearing levels of 25 dB hearing loss or better at 500, 1000, and 2000 Hz, which for this study was defined as normal pure tone hearing. Fourteen patients (67%) had dysequilibrium and 13 (62%) had subjective hearing impairment. Nystagmus was the most common physical finding. Five patients (23%) had completely symmetric pure tone hearing levels through all frequencies tested. The mean speech discrimination score was 90%. Mean tumor size was 2.4 cm. Brain stem evoked response audiometry was the most helpful of the special tests in the evaluation of these patients with normal pure tone hearing levels. Our results suggest that 5% of patients with acoustic neuromas have normal pure tone hearing levels. A careful history, a thorough physical examination, and an appropriate selection of tests will identify these patients.

This study was undertaken to determine the stability of hearing in patients over an eight-year period following a wire-vein graft stapedectomy procedure for otosclerosis. The method was to compare the four-month and eight-year postoperative hearing test results for a population of 76 patients who had undergone this procedure. No significant decrements in pure-tone thresholds were shown over the eight years for the speech frequencies (500, 1000, 2000 Hz). Decrements of approximately 0.5 dB and 1 dB per year over the eight-year period occurred for 4000 and 8000 Hz, respectively. These decrements did not seem to be associated with aging. A slight decrement of 2.8 percentage points in mean speech discrimination score was shown over the eight-year period, while no change occurred in mean speech reception threshold. There were no serious postoperative complications for this group of patients. These results indicated good stability of hearing over the eight years.

The existing neuro-otological battery to recognise labyrinthopathy namely the recruitment of loudness and hyporeflexy of induced vestibular nystagmus, are inadequate to pinpoint the topographical localisation to the labyrinth. They are at the best positive in 95% cases. Those relatively more often positive are, the nonspecific signs of vestibulocochlear disorders. Apart from the stage and extent of lesion of the labyrinth, the validity of these tests also depends upon the aetiology of labyrtinthopathy. For the accurate diagnosis of labyrinthopathy, therefore, the circumstantial, clinical, biochemical and radiological factors are to be taken into consideration.

I. Introduction TRADITIONALLY, a speech discrimination score is the percentage of test items a person can identify correctly by ear. Two decades ago lists of monosyllabic words, the PB-50 tests, were adapted to the measurement of the speech discrimination of the hearing impaired. These materials have since become thoroughly entrenched in otological and audiological practice. unfortunately, a number of confusions regarding their use has persisted to the present. Our purpose is to review some of the factors that contribute to these confusions. The goal is to examine problems which, when kept in mind, can help otologists stabilize measurement of speech discrimination and unify their interpretation of its results. II. Test Materials The first problem is, "Which test materials shall one use?" A test of discrimination for speech, as opposed to a threshold test, must consist of relatively nonredundant items. Otherwise, the multiplicity of clues available to the patient will obscure

Effect of transcutaneous electrotherapy on Brains items evoked response have been studied in patients with tinnitus.

During 1984, six patients have been implanted with a 22-channel cochlear prosthesis. The device features a programmable wearable speech processor using a speech feature encoding strategy. A strict clinical protocol was followed, and no patients have been lost to follow-up. All patients are regular users of the device and have shown a restoration of hearing sensation in response to acoustic stimuli. Pure tone averages ranged from 20 to 47 dB HL and speech detection thresholds varied from 15 to 32.5 dB HL. All patients have shown a recognition of a large variety of environmental sounds, and an improvement in speech recognition ability when the device is used in conjunction with lipreading. Speech reception thresholds using spondee words without lipreading were obtained in three patients at levels of 27.5 to 55 dB HL and one patient had an open-set speech discrimination score (w-22 word list) of 42% without lipreading. In addition, two of the patients show an ability to have limited interactive conversation without the use of lipreading.