Treatment of otitis media with effusion based on politzerization with an automated device.

This study evaluated the efficacy of politzerization with an automated, hand-held device that controls volume velocity (airflow) in the treatment of 20 children with otitis media with effusion. These patients underwent politzerization twice a week for up to 6 weeks. Another 20 children with otitis media with effusion who were not treated with politzerization served as controls. Following treatment, resolution of the average air-bone gap to within normal limits was achieved in 70% of the treated group and 20% of the controls, which eliminated the need for grommet insertion in these patients. Improvement in tympanometric peak pressure was also significantly greater in the treated group. Politzerization was efficiently and successfully performed in all patients. The automated device's ease of administration and its ability to control airflow suggests that it has the potential to be an effective home treatment that can be administered by the parents or guardians of children who have otitis media with effusion.

Central auditory processing disorders and reduced motivation: three case studies.

The central auditory test results for three normal-hearing children who were initially diagnosed as having a central auditory processing disorder and learning disability are presented. They were referred to the authors for second-opinion consultations. Central auditory processing retesting was performed by the authors under the condition of no reinforcement and then the condition of reinforcement with the child's favorite food, hobby, or toy. For all three cases, the central auditory test scores improved markedly bilaterally under the condition of reinforcement as compared with the condition of no reinforcement. We hypothesize that the improvement was related to increased motivation associated with the reinforcement and that these children represented false-positive results on the central auditory test battery. Large-sample studies are needed to investigate the effect of reinforcement on test performance in children with reduced central auditory test scores.

Efficacy of a modified politzer apparatus in management of eustachian tube dysfunction in adults.

This study evaluates the efficacy of politzeration on eustachian tube dysfunction following airplane travel using an automated, hand-held device that controls the volume velocity of air flow. Fourteen adults with eustachian tube dysfunction following airplane travel comprised the experimental group. They received politzeration over a period of 6 weeks on a twice-a-week basis. Fourteen adults with eustachian tube dysfunction following airplane travel comprised the control group. They were untreated. Complete audiologic and otolaryngologic evaluations were performed at the pretest and after politzeration treatment was completed. The results revealed a substantial, significant improvement in the mean tympanometric peak pressure from pretest to final post-treatment retest in the experimental, but not the control, subjects. The mean air-bone gap increased significantly from pretest to final post-treatment retest in the control, but not the experimental, subjects. Of the experimental subjects with abnormal tympanometric peak pressures at the pretest, resolution to within normal limits occurred in 71 percent of the experimental subjects versus 21 percent of the control subjects. These results suggest the potential feasibility of treatment of aerotitis media in adults with this modified Politzer method using the automated apparatus.

Asymmetric suprathreshold speech recognition and the telephone ear phenomenon.

We compared interaural suprathreshold speech recognition scores in 62 adults with sensorineural hearing loss. Subjects were tested at two sites, 25 at the Baylor College of Medicine, Houston, TX and 37 at Brooklyn College, Brooklyn, NY. Ears were categorized according to telephone usage. Results showed, at both sites, a small but significant difference in speech understanding scores between the ear habitually used on the telephone and the opposite, nontelephone ear. The average speech recognition score was approximately 5 percent better on the telephone ear. Results are interpreted in relation to the theories of auditory deprivation and auditory acclimatization.

Report of the Eriksholm Workshop on auditory deprivation and acclimatization.

The terminology used in studies documenting changes in auditory performance following fitting of hearing aids has been diverse. Definitions for the auditory deprivation effect and auditory acclimatization are offered as a first step in rationalization. Two statements summarize current knowledge concerning auditory deprivation effects and auditory acclimatization, as well as considering the potential implications for research, field trial and clinical practice applications. Potential areas for future research are identified.

Acoustic-immittance characteristics of children with middle-ear effusion: longitudinal investigation.

The purpose of this investigation was to describe, in a longitudinal prospective study, the acoustic-immittance profile during sessions with effusion and during sessions without effusion in children with recurrent middle-ear effusion (MEE). The static-acoustic middle-ear admittance, tympanometric width (TW), tympanometric peak pressure (TPP), and ipsilateral acoustic reflex (IAR) were evaluated in 36 ears of 18 children with recurrent MEE and 24 ears of 12 children without a history of MEE. Recurrent MEE was operationally defined as MEE diagnosed by microtoscopy and/or pneumotoscopy at four or more sessions over the first year of investigation. Subjects in the recurrent MEE group were followed over a time span of 1.1 to 3.0 years with an average intersession interval of 3.0 months. The results revealed that MEE was present at 78.3 percent of the sessions. A pure-tone average (PTA) exceeding 25 dB HL was present at 80 percent of the effusion sessions in the recurrent MEE group. The false-alarm rate for each of the individual acoustic-immittance measures, especially the TPP and IAR, was markedly higher during the otoscopically normal sessions of the recurrent MEE group than in the control group. This suggests that even when MEE is absent at a particular session, recurrent episodes of MEE appear to alter the acoustic-immittance characteristics of the middle ear. Negative findings on all or three of the four acoustic-immittance measures occurred in only 1 percent of the effusion sessions in the total recurrent MEE group as compared with 76 percent of the normal sessions in the control group.(ABSTRACT TRUNCATED AT 250 WORDS)

Binaural interference in multiple sclerosis: case study.

A case report of a young, adult male with multiple sclerosis who demonstrates binaural interference is presented. Binaural interference was demonstrated on behavioral and physiologic measures during the active stage. Binaural interference was present, although reduced, during the stage of remission. During remission, binaural interference occurred despite the absence of interaural asymmetry in the audiometric configuration or suprathreshold speech-recognition score. A trial period of left ear amplification was introduced. A possible explanation for the improvement in soundfield suprathreshold speech-recognition score with amplification is the reduction of the binaural-interference effect with monaural amplification of the affected ear when there is bilateral normal-hearing sensitivity.

Pure-tone assessment and screening of children with middle-ear effusion.

The purpose of this prospective investigation was to evaluate the sensitivity of pure-tone screening of children with middle-ear effusion (MEE) and to describe the short-term audiometric and otologic follow-up of children with MEE who pass versus fail a pure-tone screen. Eighty-two ears of 54 children with MEE based on pneumotoscopy/microtoscopy were investigated. A complete otolaryngologic evaluation, pure-tone screen, then complete audiologic evaluation were performed at the initial test. Retesting was done at 6-8 weeks post initial test. The sensitivity of the ASHA (1985) pure-tone screen to MEE was 54 percent when 500 Hz was excluded, 85 percent when 500 Hz was included, and 89 percent when 250 Hz was also included. Significant air-bone gaps were present in 100 percent of the MEE group that failed and in 92 percent of the MEE group that passed the screen (excluding 500 Hz). Of the cases with MEE at the initial test that returned for the retest, 53 percent to 54 percent continued to show MEE. The mean speech-recognition threshold (SRT) was in best agreement with the hearing-threshold levels at the low frequencies, regardless of the pure-tone screen outcome. The results suggest that 500 Hz, as well as 1000-4000 Hz, should be used in a pure-tone screen at 20 dB HL for detection of MEE. The results also question the assumption in the ASHA (1985) screening guidelines that passing a pure-tone screen at 1000-4000 Hz puts one at low risk for hearing impairments that "interfere with or have the potential for interfering with communication" (ASHA, 1985).

Apparent auditory deprivation in children: implications of monaural versus binaural amplification.

This study investigated the effects of monaural versus binaural amplification upon the speech recognition scores (SRSs) of children with bilateral moderate sensorineural hearing loss after more than 4 years of hearing aid use. There was a significant decrease in SRSs for the unaided ears of the monaural hearing aid users, but there were no significant differences between initial and retest SRSs for their aided ears, or for both ears of those using binaural amplification. The SRS reduction was found to be large enough to be significant on an individual ear basis (by exceeding 95% confidence limits of the binomial model) in five of the ten unaided ears of the monaurally fitted children, but this did not occur for any of the initial-retest SRS differences in the aided ears of either group. These findings demonstrate that the auditory deprivation effect, which has been reported for adults using monaural hearing aids, is also found in children.

Detecting and remediating external meatal collapse during audiologic assessment.

We present a case study in which the jaw/mouth-open procedure during air-conduction testing is employed to both detect and remediate external auditory meatal collapse. A prospective investigation was also conducted to compare the efficacy of the proposed jaw/mouth-open procedure with that of the traditional insert receivers in remediating meatal collapse during audiologic assessment. Meatal collapse was present in 6 of the 136 subjects evaluated. In these 6 subjects, the air-conduction thresholds under supra-aural headphones in the jaw/mouth-open condition were similar to those under insert receivers. We discuss the implications of this finding in clinical settings where insert receivers are not available.

Case studies in binaural interference: converging evidence from behavioral and electrophysiologic measures.

We present four case reports of elderly hearing-impaired persons demonstrating a binaural interference effect. Performance measures were poorer when stimulation was binaural than when it was monaural. In the first case the effect is shown for aided speech recognition scores. In the second case it is shown in topographic brain maps of the middle-latency auditory evoked potential. In the third and fourth cases it is shown for both aided speech recognition and the middle-latency response. The effect may be analogous to the phenomenon of binocular rivalry in the visual domain.

Functional components and resolved thresholds in patients with unilateral nonorganic hearing loss.

This study expanded upon previous work (Gelfand & Silman, 1985) on the relationship between functional components (the difference between the nonorganic and resolved thresholds) and the underlying organic hearing levels. The nature of nonorganic hearing loss (NOHL) was studied with respect to hearing sensitivity after resolution of the nonorganic components in 25 patients with unilateral NOHLs. Most of the subjects had an organic hearing loss underlying the functional components. The configuration of the functional components as a function of frequency was related to that of the resolved hearing levels in a manner similar to that reported for bilateral NOHLs. The strategy employed to exaggerate the loss in the ear with the nonorganic overlay appeared to be unrelated to the nature of the loss in the opposite ear, but the perception of an interaural difference might in some way bias the patient to 'choose' a unilateral NOHL as opposed to a bilateral one. The findings confirm and expand upon the prior ones, suggesting the use of an internalized loudness-based anchor by patients with NOHLs. Thus, the pure tone configuration of NOHL is consistently accounted for on the basis of known and explainable auditory factors regardless of whether the hearing levels are exaggerated in one or both ears.

Effects of prolonged lack of amplification on speech-recognition performance: preliminary findings.

The purposes of this investigation were two-fold: 1) to prospectively investigate the effect of prolonged lack of binaural amplification in the unaided ears of adults with bilaterally symmetrical sensorineural hearing impairment (BSSHI) fitted monaurally; and, 2) to prospectively investigate the effects of amplification on speech-recognition performance in the aided ears of monaurally and binaurally fitted subjects. Subjects consisted of 19 monaurally aided adults, 28 binaurally aided adults, and 19 control adults. Both ears of the experimental subjects (binaurally and monaurally aided adults) had BSSHI. The speech measures included the W-22 CID suprathreshold speech-recognition test, nonsense syllable test, and speech-perception-in-noise test. Initial testing was done between 6 and 12 weeks following hearing-aid fitting. Retests were performed approximately 1 year following the initial test. The results revealed that the mean aided minus unaided ear score for the nonsense syllable and W-22 tests increased significantly from the initial test to retest, reflecting a slight improvement in speech performance in the aided ear and a slightly greater decrement in the unaided ear. The findings were interpreted with respect to the theories of auditory deprivation and acclimatization.

Adult-onset auditory deprivation.

Adult-onset auditory deprivation following prolonged lack of amplification in the unaided ears of persons with bilaterally symmetrical sensorineural hearing impairment was first reported in 1984. This article on the phenomenon includes a review of the literature on adult-onset auditory deprivation in relation to etiology, pathophysiology, hearing-loss manifestations, typical audiologic profile, amplification strategies, contraindications or challenges to conventional hearing-aid fitting, and future research. A case study illustrates the phenomenon of auditory deprivation from monaural amplification with recovery following binaural amplification. The results of a complete audiologic and acoustic-immittance evaluation are presented for a bilaterally sensorineural hearing-impaired male with adult-onset auditory deprivation who initially was fit monaurally and later was fit binaurally. A significant decrement in the suprathreshold word-recognition scores occurred only in the unaided ear following monaural amplification, illustrating the phenomenon of adult-onset auditory deprivation. Following binaural amplification, the suprathreshold word-recognition scores for the formerly unaided ear improved significantly, illustrating the phenomenon of recovery from the adult-onset auditory deprivation with binaural amplification.

Acoustic-immittance screening for detection of middle-ear effusion in children.

The purpose of this investigation was to evaluate the sensitivity and specificity of the following acoustic-immittance protocols and their constituent measures for detection of middle-ear effusion in children: (a) tympanometric width; (b) absent ipsilateral acoustic reflex; (c) ASHA guidelines; (d) tympanometric peak pressure; and (e) static-acoustic middle-ear admittance. The middle-ear sample was composed of 82 ears of 54 subjects ranging in age from 3 to 11 years. The control (normal-hearing, normal middle-ear) sample was composed of 53 ears of 53 subjects ranging in age from 3 to 10 years. Each subject was given a complete otolaryngologic evaluation (including pneumotoscopy and/or microtoscopy) and audiologic (including acoustic-immittance) evaluation. In the group of middle ears with normal-hearing sensitivity, the sensitivity and specificity of the ASHA guidelines were 63 percent and 79 percent, respectively. An acoustic-immittance screening protocol, based on all of the individual acoustic-immittance measures, and characterized by high sensitivity and specificity, is proposed.

Speech recognition performance on a modified nonsense syllable test.

A modification of the City University of New York nonsense syllable test (CUNY NST) has been developed in which (a) the several subtests of the original test are replaced with a 22-item consonant-vowel (CV) subtest and a 16-item vowel-consonant (VC) subtest; and, (b) the response choices for each target syllable include all 22 initial and all 16 final consonants, respectively. In addition, the test tokens are presented as isolated syllables without a carrier phrase. These changes enable the resolution of confusions not possible on the original NST, and also the construction of a single confusion matrix each for CVs and VCs, respectively. The modified nonsense syllable test (MNST) provides results that compare favorably to those of the original NST.

Apparent auditory deprivation from monaural amplification and recovery with binaural amplification: two case studies.

The suprathreshold word-recognition scores for 2 young, adult males with bilateral, symmetrical sensorineural hearing impairment were evaluated following monaural and then binaural hearing-aid fitting. Subjects were obtained by retrospective review of records. Subject 1 was followed over an approximately 11.5-year time period and Subject 2 was followed over an approximately 6-year period. Results revealed that a significant decrement occurred in the unaided ear following the monaural hearing-aid fitting. Then, significant improvement in the formerly unaided ear occurred following the binaural hearing-aid fitting. The implications with respect to recovery from apparent auditory deprivation after binaural amplification are discussed.

Acoustic reflex thresholds in normal and cochlear-impaired ears: effects of no-response rates on 90th percentiles in a large sample.

Ninetieth percentile cutoffs for acoustic reflex thresholds (ARTs) were determined for a sample of 2,748 ears of 1,374 subjects with normal hearing and sensorineural loss of cochlear origin. All subjects had measurable hearing (less than or equal to 110 dB HL, ANSI-1969) at all three activator frequencies (500, 1000, and 2000 Hz). Cutoff values including "no responses" ("absent" reflexes at 125 dB HL) were higher than those excluding no responses when hearing losses were greater than about 55 dB. The 90th percentiles including the effects of no responses identified ears with retrocochlear involvement for hearing losses as great as about 756 dB. For greater hearing losses at the activator frequency, the no-response rate for both cochlear and retrocochlear cases is too high to enable them to be differentiated by acoustic reflex thresholds. The 90th percentiles are derived at each activator frequency collapsed across ears. It is therefore necessary to determine the probabilities that normal or cochlear-impaired ears will have one, two, or three frequencies at which the ARTs exceed their respective 90th percentiles. It was found that among normal and cochlear-impaired ears, 12.2% have one ART elevated above the 90th percentile, but only 5.6% have two or three elevated ARTs. Clinical implications are discussed.

Some effects of signal bandwidth and spectral density on the acoustic-reflex threshold in the elderly.

The acoustic-reflex thresholds (ART) for multicomponent tonal complexes of varying bandwidth and spectral density were obtained from 20 normal-hearing (air-conduction thresholds less than or equal to 20 dB HL at 250-8000 Hz) young adults ranging in age from 20-30 years and 20 normal-hearing, old subjects ranging in age from 60-71 years. The results revealed that the ART decreased with spectral density, plateauing after seven components in the young group and after five components in the old group; the decrease in the acoustic-reflex threshold as a result of the increase in spectral density was less in the old than in the young group. The bandwidth effect (when bandwidth was plotted in hertz or octaves) on the acoustic-reflex threshold was present in the young adults, but substantially reduced in the elderly, as evidenced by the statistically significant interaction between subject group and signal bandwidth. The spectral density results are discussed in terms of their theoretic implications for the energy summation capacity and frequency resolution of the auditory system. The bandwidth results are discussed in terms of their theoretic implications for the frequency-resolving power of the auditory system.

Contralateral acoustic-reflex growth function in a patient with a cerebellar tumor: a case study.

The contralateral acoustic-reflex growth functions (ARGFs) for 500-Hz and 1000-Hz tonal activators were obtained pre- and postsurgery in a patient with a right cerebellar tumor. The acoustic-reflex magnitude was quantified as the change in equivalent air volume at the tympanic membrane during acoustic-reflex contraction. The presurgical ARGFs were shallow in the right ear and steep in the left ear at both activator frequencies. The postsurgical ARGFs were steep, bilaterally, reflecting a return to normal in the right ear. The implications with respect to the use of the ARGF measure in differential diagnosis are discussed.