Pre- and Post-operative Speech Audiometry Evaluation in Patients with Chronic Otitis Media.

OBJECTIVES: The primary function of the human auditory system is to ensure proper speech comprehension. Speech audiometry enables the assessment of the conductive and the sensory aspects of the ears, providing some insight into the central auditory processing function. MATERIALS AND METHODS: We conducted an analysis of 79 patients with chronic otitis media (COM) undergoing surgery at the Department of Otolaryngology, Jagiellonian University Medical College, in Kraków between 2005 and 2014. Tonal audiometry and speech audiometry were used as part of the hearing assessment. The pre-operative and long-term post-operative findings were compared, focusing mainly on speech audiometry. RESULTS: At the end of the mean 10-year follow-up, a significant percentage worsening in speech comprehension from the baseline was demonstrated in group III (hearing loss > 70 dB(decibels)), as compared with the remaining groups. There was a significant (p = 0.017) difference in speech comprehension between the treated and contralateral ears, with the mean maximum speech comprehension rates of 80% in the treated ear versus 92% in the contralateral ear. CONCLUSION: We demonstrated a correlation between the findings of tonal audiometry and speech audiometry. The severe damage caused by chronic middle ear diseases not only leads to conductive hearing loss but also acts as a significant contributor to poor speech comprehension in a long-term follow-up. The speech comprehension in a healthy ear is significantly better than in a diseased ear. Middle ear reconstructive surgery offers the maximum improvement in speech comprehension at the hearing loss of 41 to 70 dB in speech audiometry.

Association between speech perception in noise and electrophysiological measures: an exploratory study of possible techniques to evaluate cochlear synaptopathy in humans.

Objective: The primary aim of this study was to investigate whether scores for a speech-in-noise test were associated with the results of two electrophysiological techniques mainly targeting low spontaneous rate, high-threshold auditory fibres.Design: Cross-sectional study. Participants were evaluated with the hearing-in-noise test (HINT), along with the Auditory Brainstem Response (ABR) with and without ipsilateral noise. The wave V/I amplitude ratio for the ABR without ipsilateral noise and ABR wave V latency shift in the presence of ipsilateral noise were obtained.Study sample: Twenty adults aged between 20 and 34 years (10 females) who did not report occupational exposure to noise were selected. All participants presented with normal hearing thresholds (0.250-8 kHz) and the presence of distortion product otoacoustic emissions, bilaterally.Results: A significant association between the wave V/I amplitude ratio for the left ear and the HINT scores for the left ear was found.Conclusions: Based on the results of this study, in normal-hearing listeners, the wave V/I ratio is associated with speech-in-noise performance, specifically in the left ear. This non-invasive procedure has the potential to be used in clinical populations who present with speech-in-noise difficulties despite having normal audiograms.

Validating self-reporting of hearing-related symptoms against pure-tone audiometry, otoacoustic emission, and speech audiometry.

OBJECTIVE: To validate self-reported hearing-related symptoms among personnel exposed to moderately high occupational noise levels at an obstetrics clinic. DESIGN: Sensitivity, specificity, and predictive values were calculated for questionnaire items assessing hearing loss, tinnitus, sound sensitivity, poor hearing, difficulty perceiving speech, and sound-induced auditory fatigue. Hearing disorder was diagnosed by pure-tone audiometry, distortion product otoacoustic emissions, and HINT (Hearing In Noise Test). STUDY SAMPLE: Fifty-five female obstetrics personnel aged 22-63 participated; including 26 subjects reporting hearing loss, poor hearing, tinnitus, or sound sensitivity, and 29 randomly selected subjects who did not report these symptoms. RESULTS: The questionnaire item assessing sound-induced auditory fatigue had the best combination of sensitivity ≥85% (95% CIs 56 to 100%) and specificity ≥70% (95% CIs 55 to 84%) for hearing disorder diagnosed by audiometry or otoacoustic emission. Of those reporting sound-induced auditory fatigue 71% were predicted to have disorder diagnosed by otoacoustic emission. Participants reporting any hearing-related symptom had slightly worse measured hearing. CONCLUSIONS: We suggest including sound-induced auditory fatigue in questionnaires for identification of hearing disorder among healthcare personnel, though larger studies are warranted for precise estimates of diagnostic performance. Also, more specific and accurate hearing tests are needed to diagnose mild hearing disorder.

[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.

Cochlear implantation in patients with Meniere's disease.

OBJECTIVES: Few studies have addressed the benefits of cochlear implantation for the small group of patients with bilateral, end-stage Meniere's disease, or unilateral disease with contralateral hearing loss from another cause. Our retrospective study evaluates the effectiveness and post-operative performance in these Meniere's disease patients and discusses these findings relative to other post-lingually deafened adults. METHODS: Among 456 adults who received cochlear implants, we identified eight (1.7%) patients with Meniere's disease who met clinical indications for implantation and a control group of seven non-Meniere's patients of comparable age and deafness. Data gathered included demographics, auditory and vestibular symptoms pre-implantation, and clinical course after implantation, including audiometric scores (consonant-nucleus-consonant (CNC), hearing-in-noise testing (HINT), and AzBio score) and audiologic evaluations. RESULTS: Comparing the Meniere's and non-Meniere's patients, pre- to post-implant scores averaged 15 and 16%-57 and 76% for CNC; and 4.5 and 40.5%-78 and 81% for AzBio and/or HINT tests, respectively; scores between groups did not statistically differ. Of note, five of eight patients had 0% word recognition scores pre-operatively. Fluctuations in CI performance were seen in five patients with Meniere's disease but not for those without the disease. CONCLUSIONS: Audiologic testing found a strong likelihood that CIs did benefit our subset of Meniere's patients with severe to profound sensorineural hearing loss. Fluctuations in hearing sensitivity (perhaps owing to physical changes relative to the implant array with the spiral ganglion neurons during an acute attack or changes in spiral ganglion neurons because of the hydropic state) can often be resolved by subsequent reprogramming.

The effect of audiovisual and binaural listening on the acceptable noise level (ANL): establishing an ANL conceptual model.

BACKGROUND: Little is known regarding the acoustic features of a stimulus used by listeners to determine the acceptable noise level (ANL). Features suggested by previous research include speech intelligibility (noise is unacceptable when it degrades speech intelligibility to a certain degree; the intelligibility hypothesis) and loudness (noise is unacceptable when the speech-to-noise loudness ratio is poorer than a certain level; the loudness hypothesis). PURPOSE: The purpose of the study was to investigate if speech intelligibility or loudness is the criterion feature that determines ANL. To achieve this, test conditions were chosen so that the intelligibility and loudness hypotheses would predict different results. In Experiment 1, the effect of audiovisual (AV) and binaural listening on ANL was investigated; in Experiment 2, the effect of interaural correlation (ρ) on ANL was examined. RESEARCH DESIGN: A single-blinded, repeated-measures design was used. STUDY SAMPLE: Thirty-two and twenty-five younger adults with normal hearing participated in Experiments 1 and 2, respectively. DATA COLLECTION AND ANALYSIS: In Experiment 1, both ANL and speech recognition performance were measured using the AV version of the Connected Speech Test (CST) in three conditions: AV-binaural, auditory only (AO)-binaural, and AO-monaural. Lipreading skill was assessed using the Utley lipreading test. In Experiment 2, ANL and speech recognition performance were measured using the Hearing in Noise Test (HINT) in three binaural conditions, wherein the interaural correlation of noise was varied: ρ = 1 (N(o)S(o) [a listening condition wherein both speech and noise signals are identical across two ears]), -1 (NπS(o) [a listening condition wherein speech signals are identical across two ears whereas the noise signals of two ears are 180 degrees out of phase]), and 0 (N(u)S(o) [a listening condition wherein speech signals are identical across two ears whereas noise signals are uncorrelated across ears]). The results were compared to the predictions made based on the intelligibility and loudness hypotheses. RESULTS: The results of the AV and AO conditions appeared to support the intelligibility hypothesis due to the significant correlation between visual benefit in ANL (AV re: AO ANL) and (1) visual benefit in CST performance (AV re: AO CST) and (2) lipreading skill. The results of the N(o)S(o), NπS(o), and N(u)S(o) conditions negated the intelligibility hypothesis because binaural processing benefit (NπS(o) re: N(o)S(o), and N(u)S(o) re: N(o)S(o)) in ANL was not correlated to that in HINT performance. Instead, the results somewhat supported the loudness hypothesis because the pattern of ANL results across the three conditions (N(o)S(o) ≈ NπS(o) ≈ N(u)S(o) ANL) was more consistent with what was predicted by the loudness hypothesis (N(o)S(o) ≈ NπS(o) < N(u)S(o) ANL) than by the intelligibility hypothesis (NπS(o) < N(u)S(o) < N(o)S(o) ANL). The results of the binaural and monaural conditions supported neither hypothesis because (1) binaural benefit (binaural re: monaural) in ANL was not correlated to that in speech recognition performance, and (2) the pattern of ANL results across conditions (binaural < monaural ANL) was not consistent with the prediction made based on previous binaural loudness summation research (binaural ≥ monaural ANL). CONCLUSIONS: The study suggests that listeners may use multiple acoustic features to make ANL judgments. The binaural/monaural results showing that neither hypothesis was supported further indicate that factors other than speech intelligibility and loudness, such as psychological factors, may affect ANL. The weightings of different acoustic features in ANL judgments may vary widely across individuals and listening conditions.

Auditory processing following consecutive right temporal lobe resections: a prospective case study.

BACKGROUND: The role of the right temporal lobe in processing speech is not well understood. Although the left temporal lobe has long been recognized as critical for speech perception, there is growing evidence for right hemisphere involvement. To investigate whether the right temporal lobe is critical for auditory speech processing, we studied prospectively a normal-hearing patient who underwent consecutive right temporal lobe resections for treatment of medically intractable seizures. PURPOSE: To test the hypothesis that the right temporal lobe is critical for auditory speech processing. RESEARCH DESIGN: We used a prospective, repeated-measure, single-case design. Auditory processing was evaluated using behavioral tests of speech recognition (words, sentences) under multiple listening conditions (e.g., quiet, background noise, etc.). Auditory processing of nonspeech sounds was measured by pitch pattern sequencing and environmental sound recognition tasks. DATA COLLECTION: Repeat behavioral testing was performed at four time points over a 2 yr period: before and after consecutive right temporal lobe resection surgeries. RESULTS: Before surgery, the patient demonstrated normal speech recognition in quiet and under real-world listening conditions (background noise, filtered speech). After the initial right anterior temporal resection, speech recognition scores declined under adverse listening conditions, especially for the left ear, but remained largely within normal limits. Following resection of the right superior temporal gyrus 1 yr later, speech recognition in quiet and nonspeech sound processing (pitch patterns, environmental sounds) remained intact. However, speech recognition under adverse listening conditions was severely impaired. CONCLUSIONS: The right superior temporal gyrus appears to be critical for auditory processing of speech under real-world listening conditions.

Evaluación de la discriminación de habla en preescolares: comparación de las pruebas ABX y AX / Assessment of speech discrimination in preschool children: comparison of AX and ABX tasks

El objetivo del presente estudio fue averiguar si la información que proporcionan las pruebas ABX y AX sobre la percepción de sonidos del habla en una muestra de niños con trastornos del habla es la misma o no. Participaron 86 niños de edades comprendidas entre los 3 años y 2 meses y los 5 años y 11 meses, siendo la media de 4 años y 7 meses. Fueron seleccionados de entre una muestra de 1.283 niños procedentes de 11 colegios diferentes de la Comunitat Valenciana cuya lengua materna era el español. En primer lugar se evaluó la producción del habla. En función de los errores cometidos por cada niño, se construyeron y aplicaron las pruebas ABX y AX, utilizando los criterios de Locke para la evaluación de la percepción del habla de niños con trastornos del desarrollo del lenguaje. Se analizó si los resultados entre ambas pruebas estaban relacionados o no y se determinó la fuerza de la concordancia entre los resultados de las 2 pruebas. Los resultados avalan la hipótesis de que ambas pruebas están relacionadas en las mediciones realizadas en la muestra, aunque el grado de concordancia solo se sitúa en un nivel aceptable. Es posible que las 2 pruebas midan aspectos distintos de la percepción de habla. La alternativa de aplicar ambas pruebas, teniendo en cuenta la escasa inversión de tiempo, puede ser un criterio de prudencia en la práctica clínica (AU)

The aim of this study was to determine whether the AX and ABX tasks provide the same or different information on perception of speech sounds in a sample of children with speech sound disorders. The participants consisted of 86 children with an age range of 3 to 5 years (mean, 4 years and 7 months). The children had speech sound disorders and were selected from a sample of 1283 children from 11 different schools in Valencia (Spain) whose first language was Spanish. First, we assessed speech production. Depending on the errors made by each child, ABX and AX tasks were constructed and applied, using Locke criteria for assessing speech perception in children with developmental language disorders. We analyzed whether the results of the two tasks were related and we determined the strength of the agreement between the results of the two tasks. The results support the hypothesis that both tasks are related when they measure speech perception in children. However, the degree of agreement was only acceptable, perhaps because the two tasks evaluate different aspects of speech perception. Given the low time investment, application of both tasks may be a prudent approach in clinical practice (AU)

[Evaluation of the Freiburg monosyllabic speech test in background noise]. / Evaluation des Freiburger Einsilbertests im Störschall.

BACKGROUND: The Freiburg speech test has been the gold standard in speech audiometry in Germany for many years. Previously, however, this test had not been evaluated in assessing the effectiveness of a hearing aid in background noise. Furthermore, the validity of particular word lists used in the test has been questioned repeatedly in the past, due to a suspected higher variation within these lists as compared to the other word list used. PATIENTS AND METHODS: In this prospective study, two groups of subjects [normal hearing control subjects and patients with SNHL (sensorineural hearing loss) that had been fitted with hearing aid] were examined. In a first group, 113 control subjects with normal age- and gender-related pure tone thresholds were assessed by means of the Freiburg monosyllabic test under free-field conditions at 65 dB. The second group comprised 104 patients that had been fitted with hearing aids at least 3 months previously to treat their SNHL. Members of the SNHL group were assessed by means of the Freiburg monosyllabic test both with and without hearing aids, and in the presence or absence of background noise (CCITT-noise; 65/60 dB signal-noise ratio, in accordance with the Comité Consultatif International Téléphonique et Télégraphique), under free-field conditions at 65 dB. RESULTS: The first (control) group exhibited no gender-related differences in the Freiburg test results. In a few instances, inter-individual variability of responses was observed, although the reasons for this remain to be clarified. Within the second (patient) group, the Freiburg test results under the four different measurement conditions differed significantly from each other (p>0.05). This group exhibited a high degree of inter-individual variability between responses. In light of this, no significant differences in outcome could be assigned to the different word lists employed in the Freiburg speech test. CONCLUSION: The Freiburg monosyllabic test is able to assess the extent of hearing loss, as well as the effectiveness of a fitted hearing aid, in the presence or absence of background-noise (CCITT-noise). The present study could not evidence statistically significant differences in outcome when using the different word lists in this test battery.

Intertester reliability of the acceptable noise level.

BACKGROUND: The acceptable noise level (ANL) serves to accurately predict the listener's likelihood of success with amplification. It has been proposed as a pre-hearing aid fitting protocol for hearing aid selection and counseling purposes. The ANL is a subjective measure of the listener's ability to accept background noise. Measurement of ANL relies on the tester and listener to follow the instructions set forth. To date, no research has explored the reliability of ANL as measured across clinicians or testers. PURPOSE: To examine the intertester reliability of ANL. RESEARCH DESIGN: A descriptive quasi-experimental reliability study was completed. ANL was measured for one group of listeners by three testers. STUDY SAMPLE: Three participants served as testers. Each tester was familiar with basic audiometry. Twenty-five young adults with normal hearing served as listeners. DATA COLLECTION/ANALYSIS: Each tester was stationed in a laboratory with the needed equipment. Listeners were instructed to report to these laboratories in a random order provided by the experimenters. The testers assessed most comfortable listening level (MCL) and background noise level (BNL) for all 25 listeners. RESULTS: Intraclass correlation coefficients were significant and revealed that MCL, BNL, and ANLs are reliable across testers. Additionally, one-way ANOVAs for MCL, BNL, and ANL were not significant. These findings indicate that MCL, BNL, and ANL do not differ significantly when measured by different testers. CONCLUSIONS: If the ANL instruction set is accurately followed, ANL can be reliably measured across testers, laboratories, and clinics. Intertester reliability of ANL allows for comparison across ANLs measured by different individuals. Findings of the present study indicate that tester reliability can be ruled out as a factor contributing to the disparity of mean ANLs reported in the literature.

[Correlation of pure tone thresholds and hearing loss for numbers. Comparison of three calculation variations for plausibility checking in expertise]. / Korrelation von Tonschwellenaudiogramm und Hörverlust für Zahlen. Vergleich dreier Rechenvarianten zur gutachterlichen Plausibilitätsprüfung.

BACKGROUND: The present study analyzes the best combination of frequencies for the calculation of mean hearing loss in pure tone threshold audiometry for correlation with hearing loss for numbers in speech audiometry, since the literature describes different calculation variations for plausibility checking in expertise. Three calculation variations, A (250, 500 and 1000 Hz), B (500 and 1000 Hz) and C (500, 1000 and 2000 Hz), were compared. METHODS: Audiograms in 80 patients with normal hearing, 106 patients with hearing loss and 135 expertise patients were analyzed in a retrospective manner. Differences between mean pure tone audiometry thresholds and hearing loss for numbers were calculated and statistically compared separately for the right and the left ear in the three patient collectives. RESULTS: We found the calculation variation A to be the best combination of frequencies, since it yielded the smallest standard deviations while being statistically different to calculation variations B and C. The 1- and 2.58-fold standard deviation (representing 68.3% and 99.0% of all values) was ±4.6 and ±11.8 dB for calculation variation A in patients with hearing loss, respectively. CONCLUSIONS: For plausibility checking in expertise, the mean threshold from the frequencies 250, 500 and 1000 Hz should be compared to the hearing loss for numbers. The common recommendation reported by the literature to doubt plausibility when the difference of these values exceeds ±5 dB is too strict as shown by this study.

[Indication for and verification of hearing aid benefit using modern methods of speech audiometry in German]. / Hörgeräteindikation und -überprüfung nach modernen Verfahren der Sprachaudiometrie im Deutschen.

The current guidelines for hearing aid supply in Germany employ the often criticised Freiburg monosyllabic speech test (FBE) in quiet. This test can be replaced with the monosyllabic rhyme test by von Wallenberg and Kollmeier (WaKo) in quiet and by the measurement of a speech reception threshold in an interfering noise at a moderate level (45 dB SPL) using either the Göttingen or the Oldenburg sentence test (criterion: 2 dB improvement in SNR, "signal-to-noise ratio"). This procedure was investigated in a group of 38 participants with a sensorineural hearing impairment (mild, moderate or severe hearing loss) and 11 volunteers with normal hearing. On average, comparable indications were achieved. Participants with a mild hearing loss and a selective problem with listening in interfering noise were assessed more fairly.

Development and evaluation of a computerized Mandarin speech test system in China.

OBJECTIVES: This study reports the development and evaluation of a Computerized Mandarin Speech Test System (CMSTS). METHODS: Taking into account the rules for developing speech materials and the unique linguistic characteristics of Mandarin, we designed and digitally recorded a set of materials comprised of seven lists of monosyllabic words, nine lists of disyllabic words, and fifteen lists of sentences with a high degree of subject familiarity. The CMSTS was developed with Visual Studio 2008, Access 2003 and DirectX 9. The system included five functions: listener management, a speech test, list management, data management, and system settings. We used the system to measure the speech recognition threshold (SRT) of 76 participants with normal hearing (age range: 20-28 years), and measured performance-intensity functions (PI) for all stimuli. RESULTS: The SRT results were in accord with pure-tone results obtained by pure-tone audiometry. In a speech recognition score (SRS) test, changing the presentation level had the strongest effect on sentence recognition, followed by the presence of disyllabic words. Monosyllabic words were least affected by changes in presentation level. The slopes of the linear portion of the PI using the system were in accord with the findings of previous studies using audiometers and CDs with similar materials. CONCLUSION: The CMSTS has sufficient sensitivity, and can facilitate the wider use of speech audiometry in Chinese audiology clinics.

Non-verbal visual reinforcement affects speech audiometry in the elderly.

The purpose of this study was to investigate how non-verbal visual reinforcement provided by the audiologist during speech testing influences performance in the elderly. Thirty-two volunteers with age-related hearing loss with or without dual sensory-impairment (DSI), were administered a speech audiometry test in which they repeated lists of ten disyllabic words in two different conditions, namely with and without visual reinforcement. In the conditions of "with visual reinforcement", the tester provided non-verbal cues to acknowledge the response of each participant. The "visual reinforcement" condition did not apparently provide any significant variation in the results. However, when we considered the group of patients without DSI, the non-verbal "visual reinforcement" resulted in better scores (p < 0.001). Non-verbal visual reinforcement may influence speech audiometry results in the elderly. During speech testing of elderly people with age-related hearing loss, audiologists should always remember to administer visual reinforcement to the patients in order to remove a possible confounding factor from audiological evaluation.

[Normative data of disyllabic Mandarin speech test materials for normally hearing people].

OBJECTIVE: To analyze the reliability of disyllabic Mandarin speech test materials (MSTM) which had previously been evaluated the equivalence of difficulty, and to establish the performance-intensity function (P-I function) for people with normal hearing. METHOD: Thirty-five subjects (the age-range 18-25 years) with normal hearing who speak Mandarin well in their daily lives were enrolled in this study. Five of them participated the pilot study, which aimed to identify a presentation level for the formal test. The other thirty subjects participated in the formal speech perception test. The results were analyzed statistically using SPSS 11.0 software. Nine lists of the Mandarin disyllabic materials with equal difficulty were utilized. RESULT: P-I function was y = -200.9 + 13.4x - 0.14x2. The sound pressure level of speech corresponding to a 50% recognition score was 26.4 dB SPL, or 6.4 dB HL. CONCLUSION: This study has established the P-I function of the Mandarin disyllabic materials with equal difficulty, which provides the normative data for identifying the normal hearing in a clinical setting.