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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.

The present study evaluates whether hearing deterioration during observation reduces serviceable hearing preservation rates after stereotactic radiosurgery (SRS) in vestibular schwannoma (VS) patients with useful hearing. We retrospectively analyzed 1447 VS patients who underwent SRS between 1992 and 2017. We identified 100 VS patients who had Grade I Gardner- Robertson (GR) hearing at initial diagnosis but were observed without surgery or SRS. We compared hearing after SRS in 67 patients who retained GR Grade I hearing from initial diagnosis to SRS (the hearing maintenance or HM group) to 33 patients whose hearing worsened from GR grade I to grade II (the hearing deterioration or HD group). We also investigated whether a decline in pure tone average (PTA) or speech discrimination score (SDS) before SRS affected hearing preservation after SRS. The serviceable hearing (GR I and II) preservation in HM patients was 80%s, 63%, and 51% at 3, 5, and 10 years, respectively. The serviceable hearing preservation in HD patients was 40%, 33%, and 20% at 3, 5, and 10 years, respectively. In multivariate analysis, younger age (

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

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

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

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

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

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

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

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.

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

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

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

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

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.

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

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

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.

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

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

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

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.

Objective The hearing level is a major point to take into account for managing a patient with an acoustic neuroma. The Gardner–Robertson classification is the most frequently reported as well as the AAO-HNS classification. It combines the use of pure tone audiometry and speech audiometry. The goal of this study is to determine the effect of the level of presentation for the speech material and the effect of the type of list selected for the determination of the speech discrimination score. Methods The speech determination score has been determined for 94 patients with different type of lists of 20 items: sentences, bi and monosyllabic words at two levels of presentation: at speech recognition threshold level plus 35 dB and at the most comfortable level. The impact of the choice of the frequencies selected to determine the pure tone average, especially 3000 Hz or 4000 Hz has been also evaluated. Results There is a statistical difference when the frequency 4000 Hz is selected rather than 3000 Hz in the determination of the pure tone average. The speech discrimation score obtained with the use of monosyllabic word lists is statistically different than those obtained with bisyllabic words. Conclusion To classify a patient's hearing whatever the classification, the speech discrimination score should be determined using monosyllabic word lists. Any other type of lists (sentences, spondees) leads to a significantly different score.

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

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.

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

Background: Sensorineural hearing loss (SNHL) is commonly seen worldwide and affects the quality life of people. In this study, we aimed to decrease the degree of hearing the loss in patients with SNHL. We also wanted to reduce the treatment cost and duration of the disease. Materials and Methods: Newly diagnosed 30 patients with sensorineural hearing loss were included in the study. We applied a new solution to all patients for treatment. Before and after the treatment, the patients were asked about tinnitus. Also, PTA (pure tone audiometry) and SDS (speech discrimination score) were performed to all patients. We compared pre and post-treatment audiological findings and tinnitus of the patients. Results: Post-treatment PTA values of the patients' right and left ears were significantly lower than pre-treatment ones (p

Objectives: To present an unusual way of cochlear implant electrode insertion and discuss the audiological as well as the speech outcome. Study Design: Case report. Method: Will be reviewing a file of a deaf patient who underwent retrograde insertion of cochlear implant array. Once the audiological and speech findings are evaluated then the literature for similar cases and alternative techniques will be discussed. Results: A case of a 24-year-old male patient that underwent cochlear implantation due to post meningitis deafness. Considering an ossified cochlea a cochlear implant array was inserted in a retrograde manner from the apex toward the basal turn of the cochlea. There was neither an intraoperative nor postoperative complication. The post implantation audiological outcome was comparable with those subjects who have no ossification in the cochlea. The patient started to use a mobile phone 4 months post- op. 76% speech discrimination score at 60 dB has been achieved within 5 months post implantation. Conclusion: The apical cochleostomy with descending cochlear implant array insertion is an efficient procedure that has very good postoperative results.