Incidence and clinical value of prolonged I-V interval in NICU infants after failing neonatal hearing screening.

Infants admitted to neonatal intensive care units (NICUs) have a higher incidence of perinatal complications and delayed maturational processes. Parameters of the auditory brainstem response (ABR) were analyzed to study the prevalence of delayed auditory maturation or neural pathology. The prevalence of prolonged I-V interval as a measure of delayed maturation and the correlation with ABR thresholds were investigated. All infants admitted to the NICU Sophia Children's Hospital between 2004 and 2009 who had been referred for ABR measurement after failing neonatal hearing screening with automated auditory brainstem response (AABR) were included. The ABR parameters were retrospectively analyzed. Between 2004 and 2009, 103 infants were included: 46 girls and 57 boys. In 58.3% (60 infants) of our population, the I-V interval was recordable in at least one ear at first diagnostic ABR measurement. In 4.9%, the I-V interval was severely prolonged. The median ABR threshold of infants with a normal or mildly prolonged I-V interval was 50 dB. The median ABR threshold of infants with a severely prolonged I-V interval was 30 dB. In conclusion, in case both peak I and V were measurable, we found only a limited (4.9%) incidence of severely prolonged I-V interval (≥0.8 ms) in this high-risk NICU population. A mild delay in maturation is a more probable explanation than major audiologic or neural pathology, as ABR thresholds were near normal in these infants.

An initial overestimation of sensorineural hearing loss in NICU infants after failure on neonatal hearing screening.

OBJECTIVE: Infants admitted to neonatal intensive care units have a higher incidence of significant congenital hearing loss. We classified audiologic diagnoses and follow-up in infants who had been admitted to our neonatal intensive care unit. METHODS: We included all infants admitted to the neonatal intensive care unit at Sophia Children's Hospital between 2004 and 2009 who had been referred for auditory brainstem response measurement after failing neonatal hearing screening with automated auditory brainstem response. We retrospectively analyzed the results of auditory brainstem response measurement. RESULTS: Between 2004 and 2009 3316 infants admitted to our neonatal intensive care unit had neonatal hearing screening. 103 infants failed neonatal hearing screening: 46 girls and 57 boys. After first auditory brainstem response measurement we found 18% had normal hearing or a minimal hearing loss. The remainder had a type of hearing loss, distributed as follows: 15% conductive, 32% symmetric sensorineural, 14% asymmetric sensorineural, and 21% absent auditory brainstem responses. Repeated auditory brainstem response measurement showed a shift in hearing outcome. The main difference was an improvement from symmetric sensorineural hearing loss to normal hearing. However, in a small percentage of children, the hearing deteriorated. CONCLUSIONS: As many as 58% of infants in this high-risk population who failed the neonatal hearing screening were diagnosed with sensorineural hearing loss or absent auditory brainstem responses. An initial overestimation of sensorineural hearing loss of about 10% was seen at first auditory brainstem response measurement. This may be partially explained by a conductive component that has resolved. Finally, in a small percentage of children the hearing deteriorated.

Fitting model of ABR age dependency in a clinical population of normal hearing children.

The purpose of this study was to present a simple and powerful fitting model that describes age-dependent changes of auditory brainstem responses (ABR) in a clinical population of normal hearing children. A total of 175 children (younger than 200 weeks postconceptional age) were referred for audiologic assessment with normal ABR results. ABR parameters of normal hearing children between 2003 and 2008 were included. The results of the right ears recorded at 90 dB nHL were analyzed. A simple and accurate fitting model was formulated based on these data. A very similar age-dependent effect was found for peaks III and V, and I-III and I-V intervals; latencies decrease as postconceptional age increases. It shows that the total age-dependent effect will be completed after 1.5-2 years. The age-dependent effect can be modeled by a relatively simple and accurate exponential function. This fitting model can be easily implemented to analyze ABR results of infants in daily clinical practice. We speculate about the underlying physiological processes.

Risk factors for sensorineural hearing loss in NICU infants compared to normal hearing NICU controls.

OBJECTIVES: To evaluate independent etiologic factors associated with sensorineural hearing loss in infants who have been admitted to the neonatal intensive care unit compared to normal hearing controls. METHOD: Between 2004 and 2009, 3366 infants were admitted to the neonatal intensive care unit of Sophia Children's Hospital, of which 3316 were screened with AABR. A total of 103 infants were referred for auditory brainstem response analysis after failure on neonatal hearing screening. We included all infants diagnosed with sensorineural hearing loss. Each patient was matched with two normal hearing controls from the neonatal intensive care unit of the same gender and postconceptional age. The following risk factors were studied: birth weight, dysmorphic features, APGAR scores (at 1, 5 and 10 min), respiratory distress (IRDS), CMV infection, sepsis, meningitis, cerebral bleeding, cerebral infarction, hyperbilirubinemia requiring phototherapy, peak total bilirubin level, furosemide, dexamethason, vancomycin, gentamycin and tobramycin administration. RESULTS: Fifty-eight infants were diagnosed with sensorineural hearing loss: 26 girls and 32 boys. The incidence of dysmorphic features (P=0.000), low APGAR score (1 min) (P=0.01), sepsis (P=0.003), meningitis (P=0.013), cerebral bleeding (P=0.016) and cerebral infarction (P=0.000) were significantly increased in infants with sensorineural hearing loss compared to normal hearing controls (n=116). CONCLUSION: Dysmorphic features, low APGAR scores at 1 min, sepsis, meningitis, cerebral bleeding and cerebral infarction are associated with sensorineural hearing loss independent of neonatal intensive care unit admittance.

Evaluation of phoneme compression schemes designed to compensate for temporal and spectral masking in background noise.

The effect of phonemic compression has been studied on speech intelligibility in background noise in hearing-impaired listeners with moderate-to-severe high-frequency losses. One configuration, anti-upward-spread-of-masking (anti-USOM) focuses on a release from spectral masking of high-frequency speech cues by selective spectral tilting. Release from temporal masking is the main goal of a second configuration, high-pass filtered compression (HFC), which reduces the speech modulations within a high-pass filtered compression channel. Speech intelligibility was measured with consonant-vowel-consonant (CVC) words in a multi-talker babble and a single-talker background noise. Anti-USOM has a significant negative effect on the phoneme scores in background noise. HFC compression tends to improve vowel intelligibility in a single-talker background noise, especially for the listeners with a relatively poor speech score. In a multi-talker babble noise the effects of HFC compression tend to be negative. It can be concluded that no significant release from spectral or temporal masking is obtained by the applied processing.

Effects of single-channel phonemic compression schemes on the understanding of speech by hearing-impaired listeners.

The effect of digital processing on speech intelligibility was studied in hearing-impaired listeners with moderate to severe high-frequency losses. The amount of smoothed phonemic compression in a high-frequency channel was varied using wide-band control. Two alternative systems were tested to compensate for upward spread of masking (USOM) and to reduce modulations in the high-frequency channel effectively. Consonant-vowel-consonant tests were conducted in a group of 14 subjects using eight different speech-processing settings. Speech intelligibility improved significantly with compression, mainly due to positive effects on the initial-consonant score. Surprisingly, listeners with a smaller residual dynamic range tended to profit less from compression. Compensation for USOM gave an additional improvement of vowel intelligibility. In background noise, consistently negative effects of speech processing were found. The combined use of phonemic compression and USOM compensation is promising in conditions without background noise.

Compression and its effect on the speech signal.

Compression systems are often used in hearing aids to increase the wearing comfort. A patient has to readjust frequently the gain of a linear hearing aid because of the limited dynamic hearing range and the changing acoustical conditions. A great deal of attention has been given to the static parameters but very little to the dynamic parameters. We present a general method to describe the dynamic behavior of a compression system by comparing modulations at the output with modulations at the input. The use of this method resulted in a single parameter describing the temporal characteristics of a compressor, the cut-off modulation frequency. In this paper its value is compared with known properties of running speech. A limitation of this method is the use of only small modulation depths, and the consequence of this limitation is tested. The use of this method is described for an experimental digital compressor developed by the authors, and the effects of some temporal parameters such as attack and release time are studied. This method shows the rather large effects of some of the parameters on the effectiveness of a compressor on speech. This method is also used to analyze two generally accepted compression systems in hearing aids. The theoretical method is next compared to the effects of compression on the distribution of the amplitude envelope of running speech, and it could be shown that single-channel compression systems do not reduce the distribution width of speech filtered in frequency bands. This finding questions the use of compression systems for fitting the speech banana in the dynamic hearing range of impaired listeners.

In vitro classification of gallstones by quantitative echography.

Gallstones (n = 20) were classified by dual energy Computer Tomography (CT) into three main classes: pure cholesterol stones (I), combination stones (II) and calcium stones (III). Further subclassification was possible by using morphological criteria. The acoustic measurements that were performed were measurements of the velocity of sound, the attenuation coefficient slope with frequency and intercept at 4.5 MHz, the attenuation coefficient slope per unit of time, the backscattering characteristics, and the appearance of B-mode echograms. The velocity of sound in calcium stones (c = 1695 +/- 107 m/s) was distinctly lower than in those containing some cholesterol (c > 2000 m/s). The attenuation coefficient slope ranged from 4.3 to 16.2 dB/cm MHz, the 4.5 MHz intercept from 21 to 66.2 dB/cm. The lowest values were found for the pure cholesterol stones (class IA), the highest values for subclass IIB (combination stones with shell). The attenuation coefficient slope per unit of time was distinctly lower (< 0.50 dB/microseconds MHz) for the cholesterol stones than for the combination and calcium stones (>0.64 dB/microseconds MHz). The backscattering spectrum was approximated by a straight line fit, and the slope for the cholesterol stones was lower than for the combination and calcium stones (<0.75 dB/MHz vs. >1.0 dB/MHz, respectively). The latter two parameters were assessed by in vivo applicable methods. The front echo level was found to be more than 5 dB higher for class IIB as compared to the other classes, while the spectral backscatter level at 4.5 MHz was considerably higher for both classes IIB and III. The B-mode echograms showed that a strong front echo in combination with a strong attenuation of the remaining echo signals was mainly found for stones of classes IIB and III. A significant difference between the group of stones that are suitable for lithotripsy and dissolution treatment (classes IA, IB and IIA) and the nontreatable calcium-containing stones (classes IIB and III) was found for the velocity of sound (p <0.01), the attenuation coefficient slope per time unit (p <0.10), the slope of the backscattering spectrum (p <0.05) and the 4.5 MHz intercept (p <0.01). B-mode classification yielded no complete distinction of these two groups of stones. It can be concluded that in vivo assessment of quantitative characteristics (front reflection, backscattering characteristics, attenuation coefficient slope per unit of time) in combination with the B-mode characteristics might be useful for in vivo gallstone classification.