Evaluation of self-esteem in hearing aid and cochlear implant users.

PURPOSE: We investigated the relationship between hearing aid or cochlear implant use and self-esteem, quality of life, hearing quality, and speech perception. METHODS: Of the 120 participants studied, 29 were cochlear implant users, 26 were hearing aid users, 33 were non-device users with hearing loss, and 32 had normal hearing. Each individual included in the study WHOQOL-BREF Quality-of-Life Scale, Rosenberg Self-Esteem and Speech, Spatial Perception and Qualities of Hearing Scale was applied. RESULTS: We found that the self-esteem level of the group with hearing loss, but without a device, was significantly lower than that of the group with a cochlear implant/hearing aid. There was a moderately statistically significant relationship between self-esteem, quality of life, speech perception, and hearing quality. CONCLUSIONS: Using hearing aid and cochlear implants increases self-esteem among people with hearing impairments. Self-esteem is associated with quality of life, speech perception, and hearing quality.

Behavioural and Electrophysiological Evaluation of Loudness Growth in Clinically Normal Hearing Tinnitus Patients with and without Hyperacusis.

INTRODUCTION: The common mechanism of tinnitus, hyperacusis, and loudness perception is hypothesized to be related to central gain. Although central gain increases with attempts to compensate hearing loss, reduced input can also be observed in those with clinically normal hearing. This study aimed to evaluate the loudness growth function of tinnitus patients with and without hyperacusis using behavioural and electrophysiological methods. METHODS: The study consists of three groups with a total of 60 clinically normal hearing subjects, including the control group (10 men and 10 women; mean age 39.8, SD 11.8 years), tinnitus group (10 men and 10 women; mean age 40.9, SD 12.2 years), and hyperacusis group (also have tinnitus) (7 men and 13 women; mean age 38.7, SD 14.6 years). Loudness discomfort levels (LDLs), categorical loudness scaling (CLS), and cortical auditory evoked potentials were used for the evaluation of loudness growth. N1-P2 component amplitudes and latencies were measured. RESULTS: LDL results of 500, 1,000, 2,000, 4,000, and 8,000 Hz showed a significant difference between the hyperacusis group and the other two groups (p < 0.001). In the loudness scale test performed with 500 Hz and 2,000 Hz narrow-band noise (NBN) stimulus, a significant difference was observed between the hyperacusis group and the other two groups in the "medium," "loud," and "very loud" categories (p < 0.001). In the cortical examination performed with 500 Hz and 2,000 Hz NBN stimulus at 40, 60, and 80 dB nHL intensities, no significant difference was observed between the groups in the N1, P2 latency, and N1-P2 peak-to-peak amplitude. CONCLUSION: Although the hyperacusis group is significantly different between groups in behavioural tests, the same cannot be said for electrophysiological tests. In our attempt to differentiate tinnitus and hyperacusis with electrophysiological tests over the loudness growth function, N1 and P2 responses were not seen as suitable methods. However, it appears to be beneficial to use CLS in addition to LDLs in behavioural tests.

Standardization of the TEOAE Contralateral Suppression Test in Terms of Stimulus Intensity and Contralateral Noise Duration in Individuals with Normal Hearing.

BACKGROUND: A standard method and parameter study were performed for the contralateral suppression test. PURPOSE: Our study aimed to determine the contralateral transient-evoked otoacoustic emission (TEOAE) suppression test method and stimulus-noise parameters that have a standard procedure and will enable the efferent system to be easily evaluated in clinics. RESEARCH DESIGN: This study was conducted in two parts with two different groups of participants as a within-subjects design. In the first part, the signal-to-noise ratio at which maximum suppression obtained was investigated with 29 participants. In the second part, the optimal contralateral noise presentation method (in terms of noise-time or noise-sweep) was examined with 21 participants. STUDY SAMPLE: In the first part 29 young adults aged between 18 and 32 (23.03 ± 2.84), 20 females and 9 males, and in the second part 21 young adults aged between 19 and 34 years (mean age: 23.71 ± 3.48 years), 16 females and 5 males, participated in the second part. All participants had normal hearing. DATA COLLECTION AND ANALYSIS: To obtain maximum OAE suppression, different parameters were tested with the Otodynamics ILO292-II OAE device at both parts of the study in a double-walled audiometric test booths. Multirepeated analysis of variance, pairwise comparison, Friedman test, and Wilcoxon signed-rank tests were used for statistical analysis. RESULTS: In the first part, maximum suppression was achieved at 65 dB peSPL (decibel peak-equivalent sound pressure level) TEOAE stimulus and 65 dB SPL broadband noise. In the second part, maximum suppression was obtained in noise-time method with 30 seconds "duration." CONCLUSIONS: To provide standardization in clinics, it can be recommended that the contralateral suppression of OAEs was measured at 65 dB peSPL TEOAE stimulus and 65 dB SPL broadband noise in the linear stimulation mode with Otodynamics ILO 292-II double-probe OAE device. To obtain maximum suppression, the noise-time method with 30 seconds duration can be used.

Sound quality perception of cochlear implant recipients: low-frequency information and foreign-language effect.

OBJECTIVE: This study aimed to adapt a method used in sound quality measurements named CI-MUSHRA (the multiple stimuli with hidden reference and anchor for cochlear implant users) to the Turkish language. The effect of low-frequency information and non-native musical stimuli on sound quality perception was investigated. DESIGN: Subjects completed the Turkish version of the MUSHRA test, called TR-MUSHRA, and the original CI-MUSHRA test. Participants also completed the Turkish monosyllabic word recognition test and the spectral temporal modulated ripple test (SMRT). STUDY SAMPLE: 19 cochlear implant (CI) users and 16 normal-hearing (NH) adults were included. RESULTS: CI users demonstrated a lack of ability to detect the sound quality differences between original stimuli and stimuli with omitted low-frequency information up to 600 Hz in both tests. There was no significant main effect of the test version on sound quality ratings for the two groups. No significant correlation was found between mean sound quality scores, SMRT, and speech recognition in quiet and noise conditions. CONCLUSIONS: Our study suggests that CI users perform poorly in discriminating high-pass filtered musical sounds regardless of the language of the musical stimuli. The TR-MUSHRA can be used as a reliable research tool to evaluate the perceived sound quality.

The possibility of cochlear synaptopathy in young people using a personal listening device.

OBJECTIVE: To evaluate the association of listening to music loudly through personal listening devices with cochlear synaptopathy in young adults. METHODS: Fifty healthy young adults selected among 109 volunteers were included in the study. Participants of high risk (n=25) and low risk (n=25) groups estimated according to ETDNL (estimated total daily noise level) were evaluated using pure tone audiometry, tympanometry, matrix test, electrocochleography (EcochG) and auditory brainstem response (ABR) to evaluate the occurrence of cochlear synaptopathy. RESULTS: Audiometric thresholds between the groups were not significantly different (p>0.05). High risk group participants showed poorer performance than the low-risk group on the TurMatrix test, in non-adaptive noise with -5 SNR and -7.5 SNR, and at the 50% understanding SNR level with headphones (p<0.01). There was no difference in the adaptive free field in noise test at which 50% understanding was achieved (p>0.05). The AP amplitudes on EcochG and wave V amplitudes on ABR were significantly smaller in the high-risk group (p<0.05). There was no association between ETDNL and I/V ratio on ABR. CONCLUSION: Poorer performance in TurMatrix and other electrophysiologic tests revealed the negative effect of personal listening devices on the auditory system. Our findings support the hypothesis that personal listening devices could cause cochlear synaptopathy. Long-term studies are needed to determine the effects of binaural hearing and duration of noise exposure on the auditory system.

Turkish Adaptation of Khalfa Hyperacusis Questionnaire.

OBJECTIVE: The aim of this study is to adapt Khalfa Hyperacusis Questionnaire (HQ) into Turkish for the use in the diagnosis and treatment of patients with hyperacusis. METHOD: HQ and Beck Anxiety Inventory (BAI) were administered to a total of 529 participants (320 female, 209 male), aged 18 to 73 (mean age: 29.76±10.59) years who were randomly selected from the general population. For the evaluation of the data, confirmatory and exploratory factor analysis, correlation analysis, descriptive statistics, t-test, analysis of variance, and Sidak correction test were used. RESULTS: In the reliability analysis, the Cronbach's alpha (aC) internal consistency coefficient was found to be 0.81. Factor analysis revealed three subdimensions (attentional, social, and emotional). The total variance of these three subdimensions were 63%, and the internal consistency of the subdimensions was also high (αC >0.70). Confirmatory factor analysis and structural equation modeling results indicated that three-factor solutions with 14 items met the criteria for the adequacy of fit among the Turkish patients. The mean score for hyperacusis was estimated as 15.69±6.63 points.There was a positive, weak, but significant association between hyperacusis and anxiety (r=0.357, p=0.01, p<0.05). The patients who were exposed to noise were found to have higher levels of hyperacusis, compared to those who were not (t=6.78, p=0.01, p<0.05). The patients who had decreased noise tolerance over time were found to be higher hyperacusis levels than those without (t=4.83, p=0.01, p<0.05). CONCLUSION: Based on these measurements, 14 questions and three-factor solutions were found to be a valid and reliable tool.

Temporal Processing and Speech Perception Performance in Postlingual Adult Users of Cochlear Implants.

BACKGROUND: Cochlear implant (CI) listeners had some hearing problems, including catching clues from speech context, persist, particularly in complex listening environments. Among these hearing problems, temporal resolution is considered to be one of the most affected aspects of hearing. PURPOSE: The aim of the study is to assess and compare the temporal resolution ability of CI users and individuals with normal hearing using the Gaps-in-Noise (GIN) test. This study also aims to investigate whether there are any differences in speech recognition and temporal resolution performance between groups separated according to the implanted ear, gender, CI type, or sound processor strategies. RESEARCH DESIGN: Case-control study. STUDY SAMPLES: 18 adults (9 males, 9 females) with normal hearing, ranging in age between 18 and 55 years (mean: 30.64 ± 8.59 years) and 18 postlingual adults (10 males, 8 females) with bilateral CIs ranging in age between 19 and 59 years (mean: 36.64 ± 16.59 years) were included in the current study. DATA COLLECTION AND ANALYSIS: Hearing thresholds, word recognition scores (WRS), and GIN test were conducted for each participant. Two parameters of GIN test were determined: the GIN threshold and total percentage score (TPS). Mann-Whitney U test was used to test the significance of the differences between the groups in terms of GIN threshold, WRS, and TPS. RESULTS: CI group showed significantly (p < 0.001) poorer performance in terms of WRS than normal hearing group. However there were no significant differences in WRS between groups which were divided according to the implanted ear, gender, CI type, and sound processor strategies. The mean GIN threshold was 3.33 ± 1.2 msec, whereas it was 9.56 ± 3.49 msec in CI users. Moreover the mean value of TPS was 90.77% in the normal group and 47.22% in the CI group. These differences between the two groups were also found statistically significant (p < 0.001). CONCLUSIONS: Our results show that CI users do not discriminate GIN as well as normal-hearing individuals, although their hearing levels with CIs are very close to normal hearing limits at all frequencies.

Effects of residual speech and auditory deprivation on speech perception of adult cochlear implant recipients.

OBJECTIVE: Possible predictive factors of cochlear implant (CI) outcomes have been extensively reported in literature for different user groups such as prelingual pediatric or postlingual adult users. However, there remains unexplained outcome variability among adult CI users; therefore, research concerning these patients continues and many different variables have been reported. This study aimed at evaluating the relationship between preoperative speech reception capacity, residual hearing, duration of deafness, age of implantation, and postoperative monosyllabic word recognition scores (WRSs) in postlingual CI users. METHODS: Effect of onset age of hearing loss, duration of hearing loss, cochlear implantation age, pre CI speech reception thresholds (SRT) and pre CI WRS on the post-CI WRS of 76 adults were analyzed. RESULTS: There are statistically significant relationships between hearing loss duration, pre-CI WRS, residual hearing and the post CI WRS. We observed that patients with shorter auditory deprivation with measurable speech perceptions and residual hearing might perform better with CI. CONCLUSION: Ear selection in cases of unilateral CI should be considered on an individual basis with respect to the speech perception abilities.

[Publication rates of audiology master and doctoral theses in peer-reviewed journals]. / Odyoloji alaninda yapilan yüksek lisans ve doktora tezlerinin bilimsel dergilerde yayinlanma oranlari.

OBJECTIVES: Theses are the prime indicators of the scientific productivity of a country and one of the main and strongest resources for the emergence of scientific articles. This study aims to examine, by using the survey method, how many of the audiology master and/or doctoral theses in Turkey were turned into a scientific work. PATIENTS AND METHODS: Individuals who received a master's degree in audiology were surveyed whether their theses had been reviewed as a paper or publication. RESULTS: Forty-five of the 230 audiology specialists and 22 audiologists with a doctorate degree working in Turkey participated in the study by answering the survey questions. In general, while 45.4% of master theses were presented orally or as a poster presentation in a national convention, 20.4% were presented orally or as a poster presentation in an international convention. While 18.1% of theses were published as an article in a national journal, 15.9% were published as an article in an international SCI or SCI-E journal. The distribution of the doctoral theses is 26.6%, 33.3%, 13.3% and 26.6%, respectively. CONCLUSION: We found the rate of theses in audiology turning into a scientific article to be below the desired level, as in other fields. The reasons for this should be emphasized and efforts should be made to raise these rates to the desired level.

Association between Family History and Idiopathic Sudden Sensorineural Hearing Loss.

OBJECTIVE: Sudden sensorineural hearing loss (SSNHL) is defined as hearing loss of at least 30 dB occurring within three days over at least three contiguous frequencies. The etiology of SSNHL cannot always be precisely determined; in such cases, this condition is termed idiopathic SSNHL (ISSNHL). This unique study investigates the relationship between ISSNHL and positive family history for ISSNHL. MATERIALS AND METHODS: In total, 125 patients diagnosed with ISSNHL were retrospectively reviewed. The presence of ISSNHL in the family medical history and degree of kinship of family members diagnosed with ISSNHL were determined. For univariate analysis, a chi-squared test and/or Fisher's exact test was used for between-group comparisons of qualitative variables; a t-test was used for quantitative variables. Significant variables in the univariate analysis were introduced into stepwise logistic regression for multivariate analysis. P<0.05 indicated statistical significance. RESULTS: Fifty-nine (47.2%) patients were male and 66 (52.8%) were female. Statistical analysis revealed no significant difference between sex and development of ISSNHL (p=0.04). Forty-two (33.6%) patients had a family medical history of ISSNHL, whereas 83 (66.4%) did not. A statistically significant association between the development of ISSNHL and a family history of ISSNHL was observed (p<0.05). CONCLUSION: Our study supports an association between ISSNHL and genetic predisposition. Proving genetic susceptibility to ISSNHL will lead to improvements in the prediction, early diagnosis, and treatment of this disease.

Cochlear implantation: is hearing preservation necessary in severe to profound hearing loss?

OBJECTIVES: The goal of the cochlear implant surgery is to place the electrode array with minimal damage to preserve the residual hearing. Round-window insertion can be performed in a manner that is potentially less traumatic than the standard cochleostomy. The purpose of the study was to investigate audiological results of the round-window approach using standard electrode. METHODS: A retrospective study was performed to evaluate our experience in patients with implanted through round window between January 2007 and March 2009. Sixty patients had undergone cochlear implant surgery through the round window with full insertion of a standard electrode array. Preoperative and postoperative pure-tone thresholds were measured for implanted ears in the range of 250 to 4000 Hz. RESULTS: Within these 60 cases, 31 patients had been evaluated. The population comprised 16 women and 15 men. The mean age was 15.96 years (range, 4-64 years). Follow-up times ranged from 6 to 26 months. Preservation of low-frequency hearing (250 and 500 Hz) was achieved in 27 (87%) of 31 patients. Complete hearing preservation (all frequencies) was accomplished in 11 patients (35.48%). No hearing could be determined postoperatively in 4 patients (12.9%), having preoperative thresholds of 120 dB at 250, 500, and 1000 Hz. CONCLUSIONS: Round-window approach has been widely used for preservation of residual hearing. In our patients with severe to profound hearing loss, we preserved residual hearing. Although the residual hearing cannot be sufficient for using additional acoustic stimulation, the preserved residual hearing means minimal damage and a more convenient cochlea, so this is promising for future development.

Incus augmentation with glass ionomer cement in primary and revision stapes surgery.

In stapedotomy, augmentation of the long process of the incus is necessary when the structure is too short or thin or when the bone has been eroded to the point that it is not possible to satisfactorily attach a piston prosthesis to it. One substance that has been used to augment the long process is glass ionomer cement (GIC). GIC is a dental bone cement that is finding new uses in otologic procedures. We conducted a retrospective study of 10 stapedotomies (6 primary and 4 revision cases) that included the use of GIC to augment an insufficient long process. In all 10 cases, surgery was successful and without complication. A comparison of pre- and postoperative audiometry revealed significant improvements in mean air-conduction threshold and air-bone gap following surgery. Our findings suggest that GIC is safe and effective in augmenting the long process of the incus during both primary and revision stapedotomy.

Cochlear implantation in patients with bilateral cochlear trauma.

PURPOSE: Temporal bone fracture, which involves the otic capsule, can lead to complete loss of auditory and vestibular functions, whereas the patients without fractures may experience profound sensorineural hearing loss due to cochlear concussion. Cochlear implant is indicated in profound sensorineural hearing loss due to cochlear trauma but who still have an intact auditory nerve. MATERIAL AND METHODS: This is a retrospective review study. We report 5 cases of postlingually deafened patients caused by cochlear trauma, who underwent cochlear implantation. Preoperative and postoperative hearing performance will be presented. These patients are cochlear implanted after the cochlear trauma in our department between 2001 and 2006. RESULTS: All patients performed very well with their implants, obtained open-set speech understanding. They all became good telephone users after implantation. Their performance in speech understanding was comparable to standard postlingual adult patients implanted. CONCLUSION: Cochlear implantation is an effective aural rehabilitation in profound sensorineural hearing loss caused by temporal bone trauma. Preoperative temporal bone computed tomography, magnetic resonance imaging, and promontorium stimulation testing are necessary to make decision for the surgery and to determine the side to be implanted. Surgery could be challenging and complicated because of anatomical irregularity. Moreover, fibrosis and partial or total ossification within the cochlea must be expected.