The characteristics of Audioscan and DPOAE measures in tinnitus patients with normal hearing thresholds.

OBJECTIVES: To investigate auditory dysfunction in patients with tinnitus and normal hearing thresholds using two sensitive audiological measures. DESIGN: The study was designed to investigate the characteristics of Audioscan and DPOAE tests in tinnitus patients with normal hearing thresholds. Audioscan and DPOAE notches were analysed and compared. All tests were performed in a sound-treated chamber or in a sound-treated room. STUDY SAMPLE: Forty-five tinnitus patients with normal hearing thresholds were examined following a written clinical protocol. RESULTS: The averaged hearing levels obtained from tinnitus participants were significantly worse at high frequencies than those derived from the normative data. There was a significantly higher prevalence of Audioscan and DPOAE notches, whose central frequencies matched tinnitus frequencies in the mid-frequency regions, but not in the low- and high-frequency regions. A significant correlation was found between the centre frequencies of the Audioscan notches and the DPOAE notches from 500 to 4000 Hz. CONCLUSION: Tinnitus in different frequency regions may be associated with different underlying mechanisms of tinnitus generation. Some negative results on the Audioscan and DPOAE notches matching tinnitus pitches may be due to a limited set of discrete frequencies used for the tinnitus pitch matching test.

The relationship between patients' perception of the effects of neurofibromatosis type 2 and the domains of the Short Form-36.

OBJECTIVES: To investigate the relationship between those issues concerning quality of life in patients with neurofibromatosis type 2 (NF2) as identified by the closed set NF2 questionnaire and the eight norm-based measures and the physical component summary (PCS) and mental component summary (MCS) scores of the Short Form-36 (SF-36) Questionnaire. DESIGN: Postal questionnaire study. SETTING: Questionnaires sent to subjects' home addresses. PARTICIPANTS: Eighty-seven adult subjects under the care of the Manchester Multidisciplinary NF2 Clinic were invited to participate. MAIN OUTCOME MEASURES: Sixty-two (71%) completed sets of closed set NF2 questionnaires and SF-36 questionnaires were returned. RESULTS: Subjects with NF2 scored less than the norm of 50 on both the physical component summary and mental component summary scores and the eight individual norm-based measures of the Short Form-36 questionnaire. Correlations (using Kendall's tau) were examined between patients' perceptions of their severity of difficulty with the following activities and the eight norm-based measures and the physical component summary and mental component summary scores of the Short Form-36 questionnaire: Communicating with spouse/significant other (N = 61). The correlation coefficients were significant at the 0.01 level for the mental component summary score, together with three of the norm-based scores [vitality (VT), social functioning and role emotional]. Social communication (N = 62). All 10 correlations were significant at the 0.01 or 0.001 level. Balance (N = 59). All 10 correlations were highly significant at the P < 0.001 level. Hearing difficulties (N = 61). All correlations were significant at either the 0.01 level or less apart from the mental component summary score and three of the norm-based scores (role physical, VT and mental health). Mood change (N = 61). All correlations were significant at the 0.01 level or less, apart from one norm-based score (role physical). CONCLUSIONS: The Short Form-36 questionnaire has allowed us to relate patients' perceptions of their difficulties, as identified by the closed set NF2 questionnaire, to the physical and mental domains measured by this validated and widely used scale, and has provided further insight into areas of functioning affected by NF2.

Tinnitus rehabilitation: a mindfulness meditation cognitive behavioural therapy approach.

BACKGROUND: Chronic tinnitus is a frequent symptom presentation in clinical practice. No drug treatment to date has shown itself to be effective. The aim of the present study was to investigate the effects of cognitive behavioural therapy and meditation in tinnitus sufferers. METHODOLOGY: Patients were selected from a dedicated tinnitus clinic in the Welsh Hearing Institute. A waiting list control design was used. Twenty-five chronic tinnitus sufferers were consecutively allocated to two groups, one receiving a cognitive behavioural therapy/meditation intervention of four one hour sessions with the other group waiting three months and subsequently treated in the same way, thereby acting as their own control. The main outcome was measured using the Hallam tinnitus questionnaire. A four to six month follow up was conducted. RESULTS: These showed significant statistical reductions in tinnitus variables both in the active and also in the control group. Post-therapy, no significant change was found after the waiting list period. The improvement was maintained at the four to six month period. CONCLUSION: The positive findings give support for the use of cognitive behavioural therapy/meditation for chronic tinnitus sufferers.

Computed tomography evaluation of the inner ear as a diagnostic, counselling and management strategy in patients with congenital sensorineural hearing impairment.

The value of computed tomography (CT) of the petrous bone in the investigation of congenital sensorineural hearing impairment has been questioned. We have conducted a study to establish the usefulness of CT of the temporal bone in the evaluation and management of a consecutive series of unselected adolescent patients with congenital sensorineural hearing impairment of greater than 50 dB HL. Seventy-one patients (142 ears) were identified and images reviewed to establish the incidence of inner ear malformations. Fifteen ears were found to be abnormal in eight patients (seven bilateral and one unilateral abnormality). Three patients had Mondini abnormalities and one of these also had dilatation of the lateral semicircular canals. There were five patients with dilatation of the vestibular aqueduct. One patient had a unilateral dysplasia of the middle and external ear. A variety of incidental intracranial abnormalities were also discovered. We conclude that CT does have a valuable role in the management of SNHI.

An analysis of the communication tactics used by hearing-impaired adults.

The aim of this study was to establish whether and to what degree certain types of communication strategies (hearing tactics) used by hearing-impaired adults could be shown to co-occur, and to find out which strategies were more likely to be used in which type of communicative situations. A consecutive series of 100 patients attending an audiological rehabilitation clinic was given a questionnaire asking how often they used each of five different hearing tactics in 11 different situations. 'Avoidance' and 'request for repetition' were the tactics used most commonly. 'Pretending to hear/understand' and 'positioning self to improve hearing' were used less frequently, with 'interruption' the least commonly used. There was some association between tactics and situations but no clear picture emerged. In a reassessment of our methodology and results, we suggest that the future research of communication strategies would benefit from a sociolinguistic approach based on the qualitative analysis of naturally occurring discourse (conversation) of hard-of-hearing people, focusing on the use of different strategies in relation to communicators' goals in interaction.

TEOAE-based estimation of the auditory threshold in the mid-octave frequencies.

The purpose of this study was to estimate the hearing levels, at the mid-frequencies, of 233 ears with sensorineural hearing loss by classifying the corresponding transiently evoked otoacoustic emissions (TEOAE) recordings into three threshold groups. A classification algorithm was based upon a discriminant analysis of fast Fourier transform (FFT) data, evoked by non-linear click stimuli of 80 (+/-2) dB SPL per ear. To validate the efficiency of the proposed methodology TEOAE recordings were initially grouped by mean hearing level values of the 1 kHz and 2 kHz octaves into three threshold ranges according to two strategy schemes: in the first, TEOAE data were assigned into 10-19 dB HL, 20-39 dB HL or > or = 40 dB HL groups. In the second, TEOAE data were assigned into 10-29 > dB H >, 30-39 dB HL or > or = 40 dB HL groups. The most accurate prediction estimates were obtained from the second strategy scheme with a 90.9% accuracy in the 10-29 dB HL group, 82% in the 30-39 dB HL group and 71.4% in the > or = 40 dB HL group.

The use of qualitative questionnaires in patients having and being considered for cochlear implants.

Within this study we have examined the particular hearing complaints of patients being considered for a cochlear implant and the specific benefits/shortcomings experienced by implanted patients using open-ended questionnaires. As we expected, the difficulty of hearing general conversation was the most common individual hearing complaint. However, 45% of complaints were concentrated in the 'psychosocial' category, which was significantly higher than that found among general audiological rehabilitation patients. The average number of benefits listed by patients having implants was significantly higher than that of the shortcomings. Moreover, the main benefits listed were focused on the acoustical and psychological factors, e.g. 'environmental sound awareness', 'general conversation easier' and 'feeling of self-confidence'. The main shortcomings were related to the acoustical and practical areas, e.g. hearing difficulty in noisy background, processor being cumbersome.

Storage stability of screwpress-extracted oils and residual meals from CELSS candidate oilseed crops.

The efficacy of using screwpress extraction for oil was studied with three Controlled Ecological Life-Support System (CELSS) candidate oilseed crops (soybean, peanut, and canola), since use of volatile organic solvents for oil extraction likely would be impractical in a closed system. Low oil yields from initial work indicated that a modification of the process is necessary to increase extraction efficiency. The extracted oil from each crop was tested for stability and sensory characteristics. When stored at 23 degrees C, canola oil and meal were least stable to oxidative rancidity, whereas peanut oil and meal were least stable to hydrolytic rancidity. When stored at 65 degrees C, soybean oil and canola meal were least stable to oxidative rancidity, whereas peanut oil and meal were least stable to hydrolytic rancidity. Sensory evaluation of the extracted oils used in bread and salad dressing indicated that flavor, odor intensity, acceptability, and overall preference may be of concern for screwpress-extracted canola oil when it is used in an unrefined form. Overall results with screwpress-extracted crude oils indicated that soybean oil may be more stable and acceptable than canola or peanut under typical storage conditions.

Who prompts patients to consult about hearing loss?

Amongst the patients who are seen in audiology clinics about their hearing loss, many factors must exist which determine the outcome of subsequent rehabilitation. In this pilot study, 95 patients were seen in two audiology centres (London and Cardiff), and were questioned as to who primarily motivated them to first seek help for their hearing loss. It was found that only a minority of patients reported that they were self-motivated and that in the majority, especially with the older patients and those not working outside the home, it was a family member who persuaded the patient to consult his doctor. Possible implications of these findings with regard to the design and outcome of subsequent rehabilitation are discussed. The extension of this work, in order to compare the outcome of rehabilitation in self-motivated patients with that in non-self-motivated patients, is outlined.

Patients' reports of the effect of alcohol on tinnitus.

One hundred chronic sufferers attending a tinnitus outpatient clinic completed self-report questionnaires assessing the quantity of alcohol they consumed weekly and its effect on tinnitus. The results showed a mixed effect of alcohol on tinnitus with 22% of the sample reporting that drinking worsened tinnitus, 62% reporting no effect of alcohol on tinnitus and 16% reporting that alcohol improved tinnitus. The reported effect of alcohol on tinnitus significantly influenced the reported change in the level of alcohol intake since tinnitus onset, with significantly more units of alcohol being consumed by those sufferers who reported that alcohol improved their tinnitus. However, for the sample as a whole, drinking behaviour was not significantly different to that of the general population.

An approach to the audit of tinnitus management.

This study examines the advantages and internal consistency of an open-ended questionnaire (Benefit-problem questionnaire), over the Tinnitus questionnaire used by Jakes et al. (1985) in the auditing of a stress management programme. The Tinnitus questionnaire showed very little difference pre- and post-treatment, while the Benefit/problem questionnaire showed good improvement over a number of variables. This included some of the more traditional orthogonal values of tinnitus complaint. The clinical assessment made blindly and over a different time scale to the Benefit/problem questionnaire matched these positive results quite closely.

Alport's syndrome: can carriers be identified by audiometry?

Alport's syndrome is characterized by familial nephropathy with haematuria, sensorineural hearing loss and ocular abnormalities. It is transmitted as an X-linked dominant condition. In the affected males the symptoms are severe compared with females who show a more variable clinical picture due to the effect of lyonization of the X-chromosome. The diagnosis of carriers of genetic disease is extremely valuable for the purpose of counselling the patients as well as their relatives. A number of attempts have been made in the past to diagnose these carriers. Some studies have shown that it is possible to diagnose carriers of conditions where hearing loss is a symptom, by sensitive audiometric techniques. In this study we examined obligate and possible carriers of Alport's syndrome with pure-tone audiometry (PTA) and the audioscan method. We found that all obligate carriers and a predictable proportion of possible carriers had either a hearing loss on PTA or a mid frequency notch in the audioscan.

Compositional and toxicological evaluation of the diazotrophic cyanobacterium, Cyanothece sp. strain ATCC 51142.

Compositional analyses of Cyanothece sp. strain ATCC 51142 showed high protein (50-60%) and low fat (0.4-1%) content, and the ability to synthesize vitamin B12. The amino acid profile indicated that Cyanothece sp. was a balanced protein source. Fatty acids of the 18:3n-3 type were also present. Mineral analyses indicated that the cellular biomass may be a good source of Fe, Zn and Na. Caloric content was 4.5 to 5.1 kcal g dry weight-1 and the carbon content was approximately 40% on a dry weight basis. Nitrogen content was 8 to 9% on a dry weight basis and total nucleic acids were 1.3% on a dry weight basis. Short-term feeding studies in rats followed by histopathology found no toxicity or dietary incompatibility problems. The level of uric acid and allantoin in urine and tissues was low, suggesting no excess of nucleic acids, as sometimes reported in the past for a cyanobacteria-containing diet. The current work discusses the potential implications of these results for human nutrition applications.

Use of the open-ended questionnaire with patients and their significant others.

One hundred and twenty-one hearing impaired people and their accompanying adult significant other answered an open-ended questionnaire. It asked them to list the difficulties they had as a result of hearing loss. As expected, the most common difficulties which patients report are those dealing with understanding speech, yet these complaints comprise only 58.5% of all the specific responses made by patients. These speech-related difficulties fell into only two of the eight categories of complaints. This would clearly indicate that there are more subtle difficulties occurring that need to be addressed and which would be missed by more standard disability/handicap questionnaires largely based on speech disability. The number of specific difficulties related to loudness of TV and radio and to the psychosocial aspects of hearing loss (such as withdrawal and unsociable behaviours) was reported by greater numbers of significant others than patients. The patient, however, was significantly more apt to list a non-specific problem related to the radio and TV. Specific medical problems were reported by a greater number of patients than significant others.

Tinnitus and suicide.

A retrospective study of tinnitus sufferers who had committed suicide was undertaken. A questionnaire was compiled, and circulated world-wide. Adequate information was obtained on 28 suicides. An association between suicide and left-sided tinnitus reported previously, was not conclusively replicated. In fact, no particular tinnitus parameter, or associated audiological symptom was over-represented in the suicide series. Demographically, tinnitus suicide victims were characterized by being male, elderly, and socially isolated. There was a high prevalence of psychiatric morbidity, in particular depression (70%). A suicide attempt within the year preceding suicide occurred in five individuals.

Prescription of hearing aids for the elderly: the views of general practitioners.

A questionnaire survey was carried out to examine the views of general practitioners in one Northern city regarding whether or not they thought that hearing aids should be prescribed from general practice, who they thought should prescribe them and whether or not additional resources and training would be needed if the responsibility for hearing aid prescription for the elderly was placed upon general practitioners. The survey indicated that whereas many general practitioners would be in favour of prescribing hearing aids from Health Centres, many would need extra training and resources to enable them to do so.

An investigation of normally hearing subjects with tinnitus.

The hearing sensitivity and psychological profile of 18 young subjects with tinnitus and normal hearing were investigated by pure-tone and high-frequency audiometry, notched-noise tests, auditory-brainstem responses, evoked otoacoustic emissions and Crown-Crisp experiential index. Psychoacoustical and brainstem tests were comparable to those of 19 normally hearing subjects without tinnitus. Otoacoustic emissions were worse in ears of tinnitus subjects. Neurotic personality traits were stronger in the tinnitus subjects. These traits may be secondary to otological dysfunction, or may contribute to complaint behaviour.

A controlled trial of azapropazone in tinnitus.

A single-blind placebo-controlled trial of azapropazone, a non-steroidal anti-inflammatory drug, is presented in 10 patients with tinnitus. Seventeen variables were assessed by questionnaire and six by a daily diary. In none of these was there a significant difference between placebo and drug. A larger trial is probably therefore not justified.

Assessing hearing problems within a community survey.

Community surveys are increasingly being used as a method of collecting health and lifestyle data. This report describes the use of a simple question on hearing difficulties within such a survey. A systematic sample of 2.5% of the electoral register of the four Parliamentary constituencies of Cardiff, Wales, was drawn. Of the 5145 individuals in the sample, 83% responded. Age and social class explained much of the variability in reported hearing difficulties. A recent fall and cigarette consumption were associated with hearing problems, but the contribution of alcohol consumption while potentially important did not reach statistical significance. This self-administered community survey provided hearing data which are consistent with other specialized studies and is a viable route for the assessment of community needs.

Clinical investigation of hearing loss in the elderly.

The prevalence of hearing loss increases with age. Epidemiological and histopathological studies relating hearing loss to age are reviewed and clinical evidence presented suggesting that hearing loss is due not only to age but also to disease processes known to be associated with hearing threshold deterioration. 80 elderly patients presenting with a hearing problem at hospital have been studied and compared with 287 'non-complainers'. 83% of the study group were found to have factors, additional to age, contributing to their hearing loss; 50% had a medical condition previously unrecognized; 30% were taking potentially ototoxic drugs. Audiometric measurements indicate that hearing thresholds of the elderly are influenced by numerous disease processes. Patients attending hospital with hearing impairment are at greater risk of having a vascular or biochemical abnormality than a group of elderly 'non-complainers'. Elderly patients presenting with hearing loss should therefore be adequately investigated before being labelled as having presbyacusis.