Speech recognition with hearing aids for 10 standard audiograms : English version.

BACKGROUND: Improvement of speech perception in quiet is an important goal of hearing aid provision. In practice, results are highly variable. The aim of this study was to investigate the relationship between type and extent of hearing loss (audiogram type), maximum word recognition score, and aided speech perception. MATERIALS AND METHODS: Pure tone and speech audiometric data of 740 ears in 370 patients were reviewed. All subjects visited our hearing center for hearing aid evaluation between 2012 and 2017. The maximum word recognition score (WRSmax) and the monosyllabic speech recognition score with hearing aids, WRS65(HA) were analyzed for 10 different standard audiogram types. RESULTS: The WRS65(HA) with hearing aids for different degrees of hearing loss is, within error boundaries, comparable to previous investigations and shows a difference of 10-20 percentage points to the WRSmax. This difference tends to be larger for flat and moderately sloping audiograms compared to steep-sloping audiograms. The ratio WRS65(HA)/WRSmax can be interpreted as an efficiency factor for hearing aid provision, since it relates speech recognition with hearing aids to the maximally achievable information carrying capacity of the hearing impaired. CONCLUSION: The expectation regarding hearing aid provision has to be adjusted according to maximum word recognition score, the derived quality measures, degree of hearing loss, and audiogram type.

[Speech recognition with hearing aids for 10 standard audiograms]. / Sprachverstehen mit Hörgeräten für 10 Standardaudiogramme.

BACKGROUND: Improvement of speech perception in quiet is an important goal of hearing aid provision. In practice, results are highly variable. The aim of this study was to investigate the relationship between type and extent of hearing loss (audiogram type), maximum word recognition score, and aided speech perception. MATERIALS AND METHODS: Pure tone and speech audiometric data of 740 ears in 370 patients were reviewed. All subjects visited our hearing center for hearing aid evaluation between 2012 and 2017. The maximum word recognition score (WRSmax) and the monosyllabic speech recognition score with hearing aids, WRS65(HA) were analyzed for 10 different standard audiogram types. RESULTS: The WRS65(HA) with hearing aids for different degrees of hearing loss is, within error boundaries, comparable to previous investigations and shows a difference of 10-20 percentage points to the WRSmax. This difference tends to be larger for flat and moderately sloping audiograms compared to steep-sloping audiograms. The ratio WRS65(HA)/WRSmax can be interpreted as an efficiency factor for hearing aid provision, since it relates speech recognition with hearing aids to the maximally achievable information carrying capacity of the hearing impaired. CONCLUSION: The expectation regarding hearing aid provision has to be adjusted according to maximum word recognition score, the derived quality measures, degree of hearing loss, and audiogram type.

[Maximum monosyllabic score as a predictor for cochlear implant outcome]. / Das maximale Einsilberverstehen als Prädiktor für das Sprachverstehen mit Cochleaimplantat.

OBJECTIVE: This study investigated the speech perception of cochlear implant (CI) recipients with measurable preoperative ipsilateral speech perception. These data should support improved individual counselling of CI candidates. MATERIALS AND METHODS: Pre- and postoperative speech audiometric parameters were analyzed, including maximum score for phonemically balanced words (PBmax) and monosyllabic score at a normal conversational level of 65 dBSPL, with hearing aids one hand and CI on the other. Data of 284 experienced adult CI wearers were grouped and evaluated in terms of preoperative PBmax. RESULTS: The preoperative PBmax was exceeded by the postoperative monosyllabic score in 96% of cases. The overall median postoperative score was 72.5%. The groups with preoperative PBmax > 0% showed significantly better speech perception scores with CI than the group with PBmax = 0 %. Median improvement compared to the preoperative monosyllabic score with hearing aids was 65 percentage points, independent of preoperative PBmax. CONCLUSION: The preoperatively measured PBmax may be used as a predictor for the minimum speech perception obtained with CI. This is of high clinical relevance for CI candidates with a PBmax above zero.

Speech audiometry and data logging in CI patients : Implications for adequate test levels.

BACKGROUND: As part of postoperative cochlear implant (CI) diagnostics, speech comprehension tests are performed to monitor audiological outcome. In recent years, a trend toward improved suprathreshold speech intelligibility in quiet and an extension of intelligibility to softer sounds has been observed. Parallel to audiometric data, analysis of the patients' acoustic environment can take place by means of data logging in modern CI systems. OBJECTIVES: Which speech test levels reflect the individual listening environment in a relevant manner and how can these be reflected in a clinical audiometric setting? PATIENTS AND METHODS: In a retrospective analysis, data logs of 263 adult CI patients were evaluated for sound level and the listening situation (quiet, speech in quiet, noise, speech in noise, music, and wind). Additionally, monosyllabic word comprehension in quiet was analyzed in experienced CI users at presentation levels of 40-80 dB. RESULTS: For the sound level in the acoustic environment of postlingually deafened adult CI users, data logging shows a maximum occurrence of speech signals in the range of 50-59 dB. This demonstrates the relevance of everyday speech comprehension at levels below 60 dB. CONCLUSION: Individual optimization of speech intelligibility with a CI speech processor should not be performed in the range of 65-70 dB only, but also at lower levels. Measurements at 50 dB currently seem to be a useful addition.

[Speech audiometry and data logging in CI patients : Implications for adequate test levels. German version]. / Sprachaudiometrie und Datalogging bei CI-Patienten : Überlegungen zu geeigneten Sprachpegeln.

BACKGROUND: As part of postoperative cochlear implant (CI) diagnostics, speech comprehension tests are performed to monitor audiological outcome. In recent years, a trend toward improved suprathreshold speech intelligibility in quiet and an extension of intelligibility to softer sounds has been observed. Parallel to audiometric data, analysis of the patients' acoustic environment can take place by means of data logging in modern CI systems. OBJECTIVES: Which test levels reflect the individual listening environment in a relevant manner and how can these be reflected in a clinical audiometric setting? PATIENTS AND METHODS: In a retrospective analysis, data logs of 263 adult CI patients were evaluated for sound level and the listening situation (quiet, speech in quiet, noise, speech in noise, music, and wind). Additionally, monosyllabic word comprehension in quiet was analyzed in experienced CI users at presentation levels of 40-80 dB. RESULTS: For the sound level in the acoustic environment of postlingually deafened adult CI users, data logging shows a maximum occurrence of speech signals in the range 50-59 dB. This demonstrates the relevance of everyday speech comprehension at levels below 60 dB. CONCLUSIONS: Individual optimization of speech intelligibility with a CI speech processor should not be performed in the range of 65-70 dB only, but also at lower levels. Measurements at 50 dB currently seem to be a useful addition.

[The age effect in evaluation of hearing aid benefits by speech audiometry]. / Der Einfluss des Alters bei der Evaluierung des funktionellen Hörgerätenutzens mittels Sprachaudiometrie.

BACKGROUND AND AIM: Hearing loss is one of the most common disabilities in the elderly. The aim of this study was to investigate the relationship between pure-tone hearing loss and maximum monosyllabic perception and speech perception with hearing aids. The focus of the investigation was elderly patients. MATERIALS AND METHODS: In this prospective study, 188 patients with sensorineural hearing loss were included. The pure-tone audiogram (4FPTA), the Freiburg speech intelligibility test with headphones and the word recognition score with hearing aids at 65 dB SPL were measured and evaluated. RESULTS: An increasing age was associated with higher discrepancy between the maximum speech perception and speech understanding with hearing aids. The mean difference between maximum monosyllabic perception and speech perception with hearing aids is about 20% in the elderly population. CONCLUSION: The intended goal of hearing aid prescription, the match between maximum monosyllabic perception and word recognition score with hearing aids within 5 to 10%, is not achieved in the elderly population.

[Speech perception with hearing aids in comparison to pure-tone hearing loss]. / Sprachverstehen mit Hörgeräten in Abhängigkeit vom Tongehör.

BACKGROUND AND AIM: Speech perception is the most important social task of the auditory system. Consequently, speech audiometry is essential to evaluate hearing aid benefit. The aim of the study was to describe the correlation between pure-tone hearing loss and speech perception. In particular, pure-tone audiogram, speech audiogram, and speech perception with hearing aids were compared. MATERIALS AND METHODS: In a retrospective study, 102 hearing aid users with bilateral sensorineural hearing loss were included. Pure-tone loss (PTA) was correlated to monosyllabic perception at 65 dB with hearing aid and with maximum monosyllabic perception with headphones. RESULTS: Speech perception as a function of hearing loss can be represented by a sigmoid function. However, for higher degrees of hearing loss, substantial deviations are observed. Maximum monosyllabic perception with headphones is usually not achieved with hearing aids at standard speech levels of 65 dB. CONCLUSION: For larger groups, average pure-tone hearing loss and speech perception correlate significantly. However, prognosis for individuals is not possible. In particular for higher degrees of hearing loss substantial deviations could be observed. Speech performance with hearing aids cannot be predicted sufficiently from speech audiograms. Above the age of 80, speech perception is significantly worse.

[Influence of mixing ratios of a FM-system on speech understanding of CI-users]. / Untersuchungen zum Einfluss des Mischungsverhältnisses der FM-Anlage auf das Sprachverständnis im Störschall bei CI-Patienten.

BACKGROUND: At school we find two major acoustic situations: (first) the "teacher is talking" being disturbed by the pupils making noise and (second) another "pupil is talking" disturbed by other pupils. The understanding of words and sentences in hearing impaired patients with a cochlear implant (CI) in a noisy situation can be improved by using a FM system. The aim of this study is to test speech understanding depending on mixing ratios between FM input and microphone input to the speech processor in different circumstances. METHODS: Speech understanding was evaluated using the adaptive Oldenburger sentence test (OLSA) in background noise. CI patients used the FM system Microlink for Freedom CIs together with a Campus transmitter (Phonak AG). PATIENTS: 17 postlingually deafened adults were tested, using unilateral Freedom cochlear implant systems (Cochlear Ltd). A group of eight normally hearing adults was used as a control group in the same setup. RESULTS: We found that the median value of L (50)=1.6 dB in CI patients without a FM system is higher than the median value of L(50)=-13 dB in normally hearing subjects. The sentence recognition in CI patients with FM system increased with increasing mixing ratio. The benefit using the FM system to understand the teacher is of high advantage in any mixing ratio. The difference between the L(50) values in situations with or without a FM-system is 15 dB for the mixing ratio 3:1 (FM to microphone). If we take into account an increase of 15% per dB in the OLSA (at L(50)) in CI patients, the difference of 15 dB means a calculated advantage of 225%. The speech understanding during the second condition ("pupil is talking") however remained nearly the same in all used mixing ratios. The calculations showed no statistical difference between these situations with and without a FM system. CONCLUSION: The speaker comprehension for the two investigated listening conditions showed different results. Understanding in the "teacher is talking" situation increased with increasing mixing ratio (FM to microphone) and in the "pupil is talking" situation remained on the same level. We could not find an optimal FM setting for both listening conditions. This leads to different suggestions for different listening conditions. All patients showed an increased speech understanding in noisy environments. This result strongly encourages the use of a FM-system in a classroom.

[The interesting case -- case no. 68. Metastasis of a small-cell bronchial carcinoma to the parotid gland]. / Der interessante Fall Nr. 68. Metastase eines kleinzellingen Bronchialkarzinoms in der Glandula parotidea.

We present a case of a metastasis to the parotid gland from a small cell carcinoma of lung. The patient noted swelling in right parotid region without pain and saw an otorhinolaryngologist. There was no facial nerve palsy. He was admitted to our hospital. The total parotidectomy with facial nerve preserving was performed. The pathological findings indicated small cell carcinoma. After receipt of this report, we examined the lungs. An abnormal shadow could be found in the chest X-rays. CT revealed a lung tumor on a left site which was determined to be small cell carcinoma by transbronchial lung biopsy. Metastasis to the parotid glands from any distant primary site is quite unusual. In most cases of secundary parotid involvement of malignant tumors primary tumors originated from the head and neck region. Primary tumors in the neighborhood are the skin of the head and neck and the mucosa of the upper airway and digestive tract. Distant metastases to the parotid gland have been reported to arise from bronchial carcinoma, renal carcinoma, colonic carcinoma, prostat and breast. The distinction between primary salivary glands tumors and metastases of other primary tumors is difficult often. Histologic and immunhistological methods can be helpful.

[Therapy of acute mastoiditis]. / Die Mastoiditis als Folge einer akuten Otitis media -- Eine retrospektive Studie.

BACKGROUND: Acute otitis media is a common disease, mostly contracted at childhood. The development of acute mastoiditis has been decreased since the introduction of antibiotics. Currently it is only developed in 0.004 % cases of acute otitis media. But despite of this fact, even today one should not neglect this condition as the complications such as intracranial spread and lateral sinus thrombosis are still life threatening. METHODS AND PATIENTS: In a retrospective study from 01/96 - 09/00 we reviewed the cases of acute mastoiditis as a result of acute otitis media at our department. Additionally we compared study results out of 1972 until 1989 with our current results. RESULTS: Altogether mastoidectomy has been carried out at 157 patients. The cases have steadily increased since 1996. This is confirmed by comparison with study results of previous years. The majority of the patients were between 8 months and 3 years old (60 %). When the patients first presented at our department, the first signs of otitis media were 19.5 days ago in average. 38 % of the patients received no antibiotic treatment before admission. A thickened mucous membrane was seen by the mastoidectomy mostly (58 %). A subperiostal abscess we noted in 8.5 %. The most common isolated bacteria were Streptococcus pneumoniae (33 %) and Streptococcus pyogenes (11 %). The patients stayed at the department about 10 days. In comparison to recent study results the "typical" mastoiditis has decreased. The causative pathogens have not changed. CONCLUSIONS: In the last years we realised an increasing number of mastoiditis at our department. The isolated bacteria are the same as presented in the literature. Early surgery combined with an effective antibiotic treatment can avoid the known complications of mastoiditis.

Amplitude modulation following responses in awake and sleeping humans--a comparison for 40 Hz and 80 Hz modulation frequency.

There have been several studies, which suggest that the amplitude of amplitude modulation following responses (AMFR) is correlated to the state of vigilance, similar to the 40 Hz event-related potentials. The aim of the present study was to compare the dependency of the AMFR-amplitude from the state of sleep for 40 Hz and 80 Hz modulation frequency. Eight normal hearing adults were investigated during natural and drug-induced sleep. The stimuli used were sinusoidally amplitude-modulated tones of 1 kHz carried frequency and 40 or 80 Hz modulation frequency at 60 dB nH stimulation level. For 40 Hz modulation frequency an increase of EEG-activity in the Delta-and Theta-band during periods of sleep correlates significantly with a decreased AMFR-amplitude whereas for 80 Hz no significant relation between stage of sleep and AMFR-amplitude could be found. The results suggest that in audiological use of 40 Hz-AMFR the state of vigilance should be monitored and stabilized at a high level.

On the frequency spectrum of Amplitude Modulation Following Responses.

Objective detection of Amplitude Modulation Following Responses (AMFR) is based on statistics applied after signal transformation from the time to the frequency domain by means of Discrete Fourier Transformation. In theory the frequency resolution of such transformation depends only on the analysed time window. In practise frequency resolution is also limited by the error caused by minimal difference between the clocks used for stimulus generation and Analogue/Digital-conversion. Small differences in clock frequencies may cause a spread of energy to neighbouring bins. In order to avoid this error we derived the sample clock for the A/D-conversion from the stimulator clock. By means of this technique the frequency structure of the AMFR was investigated. It is shown that if technical induced errors are excluded, the energy of the AMFR-response is limited to a very narrow frequency band. No physiologically induced disturbances of the phase locking of the AMFR to the modulation frequency could be observed. Additionally it is demonstrated that an increase of frequency resolution leads to an improved signal to noise ratio similar to the increase of averages in the time domain.

Resonant frequency pattern in multifrequency tympanograms: results in normally-hearing subjects.

This paper presents experimental data on the evaluation of middle ear resonances by multifrequency tympanometry. Multifrequency tympanograms (MFTs) of 18 normally-hearing subjects were recorded with a frequency resolution of 15 Hz. The fine structure found in the MFT patterns was compared with findings in literature. A first approach for the evaluation of this fine structure was made explaining the great variability of the main ossicular resonance frequencies described in previous publications. The consequence of the present investigation is that the concept of the main ossicular resonance has to be revised critically.