Normal hearing and verbal discrimination in real sounds environments.

INTRODUCTION: Human beings are constantly exposed to complex acoustic environments every day, which even pose challenges for individuals with normal hearing. Speech perception relies not only on fixed elements within the acoustic wave but is also influenced by various factors. These factors include speech intensity, environmental noise, the presence of other speakers, individual specific characteristics, spatial separatios of sound sources, ambient reverberation, and audiovisual cues. The objective of this study is twofold: to determine the auditory capacity of normal hearing individuals to discriminate spoken words in real-life acoustic conditions and perform a phonetic analysis of misunderstood spoken words. MATERIALS AND METHODS: This is a descriptive observational cross-sectional study involving 20 normal hearing individuals. Verbal audiometry was conducted in an open-field environment, with sounds masked by simulated real-word acoustic environment at various sound intensity levels. To enhance sound emission, 2D visual images related to the sounds were displayed on a television. We analyzed the percentage of correct answers and performed a phonetic analysis of misunderstood Spanish bisyllabic words in each environment. RESULTS: 14 women (70%) and 6 men (30%), with an average age of 26 ±â€¯5,4 years and a mean airway hearing threshold in the right ear of 10,56 ±â€¯3,52 dB SPL and in the left ear of 10,12 ±â€¯2,49 dB SPL. The percentage of verbal discrimination in the "Ocean" sound environment was 97,2 ±â€¯5,04%, "Restaurant" was 94 ±â€¯4,58%, and "Traffic" was 86,2 ±â€¯9,94% (p = 0,000). Regarding the phonetic analysis, the allophones that exhibited statistically significant differences were as follows: [o] (p = 0,002) within the group of vocalic phonemes, [n] (p = 0,000) of voiced nasal consonants, [r] (p = 0,0016) of voiced fricatives, [b] (p = 0,000) and [g] (p = 0,045) of voiced stops. CONCLUSION: The dynamic properties of the acoustic environment can impact the ability of a normal hearing individual to extract information from a voice signal. Our study demonstrates that this ability decreases when the voice signal is masked by one or more simultaneous interfering voices, as observed in a "Restaurant" environment, and when it is masked by a continuous and intense noise environment such as "Traffic". Regarding the phonetic analysis, when the sound environment was composed of continuous-low frequency noise, we found that nasal consonants were particularly challenging to identify. Furthermore in situations with distracting verbal signals, vowels and vibrating consonants exhibited the worst intelligibility.

Power output and hearing performance in osseointegrated auditory devices.

BACKGROUND AND OBJECTIVE: Osseointegrated auditory devices are hearing gadgets that use the bone conduction of sound to produce hearing improvement. The mechanisms and factors that contribute to this sound transmission have been widely studied, however, there are other aspects that remain unknown, for instance, the influence of the processor power output. The aim of this study was to know if there is any relationship between the power output created by the devices and the hearing improvement that they achieve. MATERIALS Y METHODS: 44 patients were implanted with a percutaneous Baha® 5 model. Hearing thresholds in pure tone audiometry, free-field audiometry, and speech recognition (in quiet and in noise) were measured pre and postoperatively in each patient. The direct bone conduction thresholds and the power output values from the processors were also obtained. RESULTS: The pure tone average threshold in free field was 39.29 dB (SD = 9.15), so that the mean gain was 29.18 dB (SD = 10.13) with the device. This involved an air-bone gap closure in 63.64% of patients. The pure tone average threshold in direct bone conduction was 27.6 dB (SD = 10.91), which was 8.4 dB better than the pure tone average threshold via bone conduction. The mean gain in speech recognition was 39.15% (SD = 23.98) at 40 dB and 36.66% (SD = 26.76) at 60 dB. The mean gain in the signal-to-noise ratio was -5.9 dB (SD = 4.32). On the other hand, the mean power output values were 27.95 dB µN (SD = 6.51) in G40 and 26.22 dB µN (SD = 6.49) in G60. When analysing the relationship between bone conduction thresholds and G40 and G60 values, a correlation from the frequency of 1000 Hz was observed. However, no statistically significant association between power output, functional gain or speech recognition gain was found. CONCLUSIONS: The osseointegrated auditory devices generate hearing improvement in tonal thresholds and speech recognition, even in noise. Most patients closed the air-bone gap with the device. There is a direct relationship between the bone conduction threshold and the power output values from the processor, but only in mid and high frequencies. However, the relationship between power output and gain in speech recognition is weaker. Further investigation of contributing factors is necessary.

Análisis de la potencia de salida y del rendimiento auditivo de los dispositivos auditivos osteointegrados / Power output and hearing performance in osseointegrated auditory devices

Antecedentes y objetivos: Los dispositivos auditivos osteointegrados utilizan la transmisión del sonido por vía ósea para producir una mejoría auditiva. Los mecanismos y factores que intervienen en esta transmisión han sido ampliamente estudiados, sin embargo, existen otros aspectos que no conocemos, por ejemplo, la influencia que tiene la potencia de salida del procesador. El objetivo principal de este estudio fue conocer si existe alguna relación entre la potencia que emiten estos dispositivos y la mejoría auditiva que producen. Materiales y métodos: Hemos realizado un estudio en 44 pacientes portadores de un Baha® 5 percutáneo. De cada paciente se obtuvieron los umbrales de vía aérea y ósea en audiometría tonal liminar, en audiometría en campo libre, y en audiometría verbal en silencio y con ruido de fondo, tanto previa como posteriormente a la implantación. También se recogieron los umbrales de conducción ósea directa a través del procesador y los valores de ganancia en la potencia de salida del procesador. (AU)

Background and objective: Osseointegrated auditory devices are hearing gadgets that use the bone conduction of sound to produce hearing improvement. The mechanisms and factors that contribute to this sound transmission have been widely studied, however, there are other aspects that remain unknown, for instance, the influence of the processor power output. The aim of this study was to know if there is any relationship between the power output created by the devices and the hearing improvement that they achieve. Materials and methods: Forty-four patients were implanted with a percutaneous Baha® 5 model. Hearing thresholds in pure tone audiometry, free-field audiometry, and speech recognition (in quiet and in noise) were measured pre and postoperatively in each patient. The direct bone conduction thresholds and the power output values from the processors were also obtained. (AU)

Power output and hearing performance in osseointegrated auditory devices. / Análisis de la potencia de salida y del rendimiento auditivo de los dispositivos auditivos osteointegrados.

BACKGROUND AND OBJECTIVE: Osseointegrated auditory devices are hearing gadgets that use the bone conduction of sound to produce hearing improvement. The mechanisms and factors that contribute to this sound transmission have been widely studied, however, there are other aspects that remain unknown, for instance, the influence of the processor power output. The aim of this study was to know if there is any relationship between the power output created by the devices and the hearing improvement that they achieve. MATERIALS AND METHODS: Forty-four patients were implanted with a percutaneous Baha® 5 model. Hearing thresholds in pure tone audiometry, free-field audiometry, and speech recognition (in quiet and in noise) were measured pre and postoperatively in each patient .The direct bone conduction thresholds and the power output values from the processors were also obtained. RESULTS: The pure tone average threshold in free field was 39.29dB (SD 9.15), so that the mean gain was 29.18dB (SD 10.13) with the device. This involved an air-bone gap closure in 63.64% of patients. The pure tone average threshold in direct bone conduction was 27.6dB (SD 10.91), which was 8.4dB better than the pure tone average threshold via bone conduction. The mean gain in speech recognition was 39.15% (SD 23.98) at 40dB and 36.66% (SD 26.76) at 60dB. The mean gain in the signal-to-noise ratio was -5.9dB (SD 4.32). On the other hand, the mean power output values were 27.95dB µN (SD 6.51) in G40 and 26.22dB µN (SD 6.49) in G60. When analysing the relationship between bone conduction thresholds and G40 and G60 values, a correlation from the frequency of 1,000Hz was observed. However, no statistically significant association between power output, functional gain or speech recognition gain was found. CONCLUSIONS: The osseointegrated auditory devices generate hearing improvement in tonal thresholds and speech recognition, even in noise. Most patients closed the air-bone gap with the device. There is a direct relationship between the bone conduction threshold and the power output values from the processor, but only in mid and high frequencies. However, the relationship between power output and gain in speech recognition is weaker. Further investigation of contributing factors is necessary.

Primeras experiencias con el dispositivo osteointegrado Ponto(TM) SuperPower / First experiences with the Ponto(TM) SuperPower osseointegrated device

Los dispositivos auditivos osteointegrados (DAO) Power y SuperPower presentan indicaciones para umbrales en vía ósea de 55 y 65dB, respectivamente. Realizamos un estudio observacional prospectivo de una serie de 6 casos con hipoacusia mixta en los que se realizó implantación del DAO Ponto(TM) SuperPower. Se realizaron previo a la implantación y 6 meses tras la adaptación valoraciones tonales y verbales sin y con ruido de fondo (HINTS). Todos los participantes mostraron mejoría en los resultados tonales y verbales, variando según el grado de hipoacusia contralateral. Cabe destacar los resultados verbales con ruido de fondo donde la mayoría de los pacientes obtuvieron una relación señal ruido entre 2 y 4 dB. Los resultados en los cuestionarios APHAB y GBI mostraron una reducción de la percepción del problema y una mejoría en la calidad de vida, respectivamente. Los resultados presentados reflejan la posibilidad de tratamiento de hipoacusias mixtas con el dispositivo DAO Ponto(TM) SuperPower

Osseointegrated hearing devices Power and SuperPower present indications for bone thresholds of 55 and 65 dB respectively. We conducted a prospective observational study of a series of six cases with mixed hearing loss for whom implantation of the DAO Ponto(TM) Super-Power was performed. Tonal and verbal evaluations without and with background noise (HINTS) were performed prior to implantation and six months after adaptation. All the participants showed improvement in tonal and verbal results, varying according to the degree of contralateral hearing loss. The verbal results with background noise were noteworthy, where most of the patients obtained a signal-to-noise ratio between 2 and 4 dB. The results in the APHAB and GBI questionnaires showed a reduction in the perception of the problem and an improvement in quality of life respectively. The results presented reflect the possibility of treatment of mixed hearing loss with the Ponto(TM) SuperPower device

First experiences with the Ponto™ SuperPower osseointegrated device. / Primeras experiencias con el dispositivo osteointegrado Ponto™ SuperPower.

Osseointegrated hearing devices Power and SuperPower present indications for bone thresholds of 55 and 65 dB respectively. We conducted a prospective observational study of a series of six cases with mixed hearing loss for whom implantation of the DAO Ponto™ Super-Power was performed. Tonal and verbal evaluations without and with background noise (HINTS) were performed prior to implantation and six months after adaptation. All the participants showed improvement in tonal and verbal results, varying according to the degree of contralateral hearing loss. The verbal results with background noise were noteworthy, where most of the patients obtained a signal-to-noise ratio between 2 and 4 dB. The results in the APHAB and GBI questionnaires showed a reduction in the perception of the problem and an improvement in quality of life respectively. The results presented reflect the possibility of treatment of mixed hearing loss with the Ponto™ SuperPower device.

Estudio comparativo entre implantación coclear uni y bilateral en niños de 1 y 2 años de edad / Comparative study between unilateral and bilateral cochlear implantation in children of 1 and 2 years of age

Introducción: Los estudios que han evaluado la efectividad de los implantes cocleares bilaterales en niños sugieren una mejoría de la capacidad auditiva en cuanto a la localización del sonido y la discriminación del lenguaje. En este trabajo mostramos las diferencias en los logros audio-lingüísticos con la implantación coclear bilateral precoz frente a la unilateral, así como las diferencias entre la implantación bilateral secuencial y simultánea. Material y métodos: Presentamos 88 niños diagnosticados de hipoacusia neurosensorial profunda bilateral tratados mediante implantación coclear bilateral en 32 casos, y unilateral en 56 casos, durante los primeros 12 meses (27 niños) y entre los 12 y 24 meses (61 niños). Se compararon los resultados en la audiometría tonal, en las escalas IT-Mais, Nottingham y LittlEars, así como en las pruebas logoaudiométricas. Resultados: No se detectan diferencias significativas en los umbrales auditivos y en los cuestionarios IT-Mais, Nottingham y LittlEars entre los niños implantados bilateral y unilateralmente, tanto en el primer como en el segundo año. Las pruebas verbales sí que muestran diferencias estadísticamente significativas, ya que los niños con un implante coclear bilateral alcanzan antes el 100% en el reconocimiento de bisílabos y frases, sin que los niños con un solo implante lleguen a igualar dichos resultados a los 5 años de la cirugía. No existen diferencias entre implantación bilateral simultánea y secuencial. Conclusión: Con este estudio remarcamos la importancia de asegurar un buen cribado audiológico precoz, para poder llevar a cabo una implantación coclear temprana, a ser posible bilateral, logrando así un desarrollo de las habilidades audio-lingüísticas equiparable al de los normooyentes (AU)

Introduction: The studies that have evaluated the effectiveness of bilateral cochlear implantation in children suggest an improvement in hearing about sound localization and speech discrimination. In this paper we show the differences in audio-linguistic achievements with early bilateral cochlear implantation versus unilateral, and differences between simultaneous and sequential bilateral implantation. Material and methods: We present 88 children with bilateral profound sensorineural hearing loss, treated with bilateral cochlear implantation in 32 cases and unilateral in 56 cases, during the first 12 months (27 children) of life and between 12 and 24 months (61 children). We conducted a statistical comparison of both groups in the audiometry, IT-Mais, Nottingham, LittlEars scales and verbal tests. Results: No significant differences in hearing thresholds and questionnaires between unilateral and bilateral implantation were detected in either the first or second year. Verbal tests do show statistically significant differences: children with bilateral cochlear implant obtain 100% recognition of disyllabic and phrases within 2-3 years after implantation whilst children with one implant do not obtain those results at 5 years after surgery. No differences between simultaneous and sequential bilateral implantation were detected. Conclusion: We emphasize the importance of ensuring good early audiological screening, to carry out an early and bilateral cochlear implantation with the consequent development of audio-language skills similar to normal hearing children (AU)

Comparative study between unilateral and bilateral cochlear implantation in children of 1 and 2 years of age. / Estudio comparativo entre implantación coclear uni y bilateral en niños de 1 y 2 años de edad.

INTRODUCTION: The studies that have evaluated the effectiveness of bilateral cochlear implantation in children suggest an improvement in hearing about sound localization and speech discrimination. In this paper we show the differences in audio-linguistic achievements with early bilateral cochlear implantation versus unilateral, and differences between simultaneous and sequential bilateral implantation. MATERIAL AND METHODS: We present 88 children with bilateral profound sensorineural hearing loss, treated with bilateral cochlear implantation in 32 cases and unilateral in 56 cases, during the first 12 months (27 children) of life and between 12 and 24 months (61 children). We conducted a statistical comparison of both groups in the audiometry, IT-Mais, Nottingham, LittlEars scales and verbal tests. RESULTS: No significant differences in hearing thresholds and questionnaires between unilateral and bilateral implantation were detected in either the first or second year. Verbal tests do show statistically significant differences: children with bilateral cochlear implant obtain 100% recognition of disyllabic and phrases within 2-3 years after implantation whilst children with one implant do not obtain those results at 5 years after surgery. No differences between simultaneous and sequential bilateral implantation were detected. CONCLUSION: We emphasize the importance of ensuring good early audiological screening, to carry out an early and bilateral cochlear implantation with the consequent development of audio-language skills similar to normal hearing children.

Experiencia inicial con el implante osteointegrado Alpha 1 de Sophono / Initial experience with the Sophono Alpha 1 osseointegrated implant

En los últimos años los implantes osteointegrados han probado su utilidad en el tratamiento de la hipoacusia de transmisión mixta, uni o bilateral, y la neurosensorial unilateral. El implante Alpha 1 de Sophono ofrece una ventaja sustancial, la falta de acoplador externo y su unión al receptor por medio de magnetismo. Presentamos el caso de 3 niños que padecen malformaciones de oído externo y medio de origen congénito. Los estudios audiométricos revelan hipoacusias de transmisión de carácter moderado. En los 3 pacientes se propuso la colocación del implante Alpha 1 de Sophono. Los pacientes evolucionaron de forma satisfactoria. A los 30 días se les aplicó el procesador, y en las audiometrías de control se evidenció una notable mejoría de los umbrales auditivos, aunque sin conseguir un cierre completo del umbral diferencial auditivo. Con cuidados mínimos, la piel sobre el implante se mantuvo en excelentes condiciones, siendo el resultado estético inmejorable (AU)

In the last several years, bone anchored hearing aids have proven to be useful in treating conductive and mixed unilateral or bilateral hearing loss, as well as for sensorineural unilateral hearing loss. The Sophono Alpha 1 model has the advantage of not requiring an abutment, with it being coupled by magnetism instead. We report the cases of 3 infants with congenital malformations of external and middle ear. Audiometry showed conductive hearing loss. All 3 patients were implanted with Alpha 1 model (Sophono). Patients evolved satisfactorily. After 30 days we applied the processor and the control audiometry showed a marked improvement of hearing thresholds, although without a complete closure of the gap. With minimal care, the skin over the implant remained in excellent condition, with a very satisfactory cosmetic outcome (AU)

Initial experience with the Sophono Alpha 1 osseointegrated implant.

In the last several years, bone anchored hearing aids have proven to be useful in treating conductive and mixed unilateral or bilateral hearing loss, as well as for sensorineural unilateral hearing loss. The Sophono Alpha 1 model has the advantage of not requiring an abutment, with it being coupled by magnetism instead. We report the cases of 3 infants with congenital malformations of external and middle ear. Audiometry showed conductive hearing loss. All 3 patients were implanted with Alpha 1 model (Sophono). Patients evolved satisfactorily. After 30 days we applied the processor and the control audiometry showed a marked improvement of hearing thresholds, although without a complete closure of the gap. With minimal care, the skin over the implant remained in excellent condition, with a very satisfactory cosmetic outcome.