82例耳鸣患者半倍频程频率纯音测听的特征及意义

目的 :观察常规倍频程纯音测听听阈无异常的耳鸣患者的半倍频程频率测试结果并探讨其特征及临床意义。方法 :应用纯音听力计对 82例 (14 0耳 )倍频程纯音测听听阈无异常的耳鸣组患者和 30例 (6 0耳 )正常对照组进行半倍频程频率测试。结果 :耳鸣组 14 0耳中 ,发现 37.14 %存在听力下降 ;主要为高频下降 ;大多为轻度下降 ;下降的频率与耳鸣频率有高度一致性 ;耳鸣的强度 (dBSL)与听力下降与否无关。结论 :半倍频程频率测试方法可为倍频程纯音测听听阈无异常的耳鸣患者早期听力损害的检出提供直接参考依据 ,对临床早期发现其潜在的耳蜗病变有积极意义     

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.     

Effects of three contralateral maskers on pure-tone thresholds using manual audiometry

This study investigated how central masking associated with low-level maskers would affect thresholds obtained using a standard clinical technique. Signals included 500, 1,000, 2,000, and 4,000 Hz; maskers, presented at 40 dB SL, consisted of (a) a wideband masker (WBM), (b) a narrow-band masker (NBM) centered about each signal frequency, and (c) a pure-tone masker (PTM) identical to each signal. Only the PTMs caused significant threshold shifts, that is, poorer masked thresholds. The WBM and NBMs caused no shift 60% of the time and a 5-dB threshold improvement 16% of the time. The findings weigh against the clinical use of a central-masking correction when a low-level WMB or NBM is used.     

A comparison of pure-tone thresholds as measured by delayed feedback audiometry, electrodermal response audiometry, and voluntary response audiometry.

One hundred unselected patients seen for medical-legal evaluation were tested for pure-tone thresholds by delayed feedback audiometry (DFA), electrodermal response audiometry (EDRA), and voluntary response audiometry (VRA). The EDRA method was successful in 73% of the patients while the DFA method was successful in 88% of the patients. Eighty-six percent of the DFA thresholds obtained were within 10 dB of the patients' VRA thresholds. When both DFA and EDRA were successful, 88% of the DFA thresholds were within 10 dB of the EDRA thresholds. Ninety-six percent of the EDRA thresholds obtained were within 10 dB of the patients' VRA thresholds. Although DFA is not as precise in predicting threshold as is EDRA, it is successful in a significantly greater number of patients than is EDRA and is a useful clinical tool in medical-legal evaluation for hearing loss.     

Improving the reliability of speech audiometry

A necessary feature of good recorded speech material is that each list should be identical in respect of graded order of difficulty. Extensive validatory tests have been carried out upon 20 M.R.C. word lists re-recorded by a professional announcer. It can be shown that by various manipulative procedures appreciable improvements may be obtained in the confidence limits of the material. In addition studies have been carried out upon the relationship between Speech Detection Threshold (S.D.T.) Speech Reception Threshold (S.R.T.) and Hearing level (H.L.) in normal hearing subjects. The surprising finding is that both S.D.T. and S.R.T. appear to be relatively independent of H.L. An analysis has been made of the words comprising the material in respect of their ease of recognition and is presented as an appendix.     

Acoustic neuroma: deterioration of speech discrimination related to thresholds in pure-tone audiometry

Pure-tone and speech audiometry were performed in 231 patients with a unilateral acoustic neuroma. Tumor sizes were obtained through imaging. Audiometric parameters, such as the mean pure-tone thresholds, the maximum discrimination, the slope of the speech audiogram, the roll-over index and the difference between the speech reception threshold and the Fletcher index, were studied and compared with data in the literature. Results showed that patients with an acoustic neuroma have worse speech discrimination than can be expected from the pure-tone audiogram. However, the results presented here indicate that hearing impairments nowadays are not as severe as those described in earlier studies. More patients with a unilateral acoustic neuroma are detected, including even those with a minor hearing impairment. The roll-over index is not characteristic for patients with an acoustic neuroma.     

社区老年人群纯音听阈测试结果分析

目的获得社区老年人群纯音听阈的正常值，为选取敏感频率测试老年人听阈提供参考依据。方法采用整群随机抽样方法，选取60岁以上社区老年人845例，按平均听阈（0．5、1、2和4kHz听阈平均值）≤40dBHL为正常或轻微损失，筛选205人，按60～65岁、66～70岁、71～75岁和76岁以上分组，计算各年龄组在0．5、1、2、3、4和8kHz的听阈及听阈检出率，采用SPSSl3．0软件进行）x^x检验和方差分析。结果听力正常老年人群不同年龄组听阈值存在显著差异（P〈0．01），随着年龄增长，听阈值呈增高趋势；不同频率听力测试显示不同频率组听阈值存在显著差异（P〈0．01）。各年龄组的听阈随频率的增高而增高，随频率、年龄增高，听阈检出率呈下降趋势。结论高频较低频测听能够早诊断老年人听力损失，可作为检测老年人早期听力损失的客观手段。     

Delayed feedback audiometry: reliability of repeated measures

The test-retest reliability of hearing thresholds at 1000 Hz measured by a delayed auditory feedback procedure was compared with the reliability of thresholds obtained with voluntary responses to the same signal in 10 adults with normal hearing sensitivity. Thresholds for each procedure were obtained three times on each of 5 different days. Although the delayed feedback procedure yielded estimates of threshold which averaged 4.6 dB greater than those estimated by voluntary responses (p less than 0.05), there was no evidence that experience over time resulted in a change for the poorer in the precision of the test.     

Comparison between thresholds obtained with pure-tone audiometry and the 40-Hz middle latency response

Threshold determinations were performed with the 40-Hz MLR method on 20 individuals of varying age, from one month to adult age. The total number of threshold measurements was 105 in the frequency range from 0.25 to 8.0 kHz. Eighty determinations were performed on persons with hearing loss of 40 dB HL or more and the remaining 25 on normal-hearing persons. One of the investigators estimated the MLR thresholds without any knowledge of the results of the psychoacoustical tests. The MLR thresholds were nevertheless in good concordance with those obtained with behavioural tests. The sensitivity of MLR audiometry for detecting a hearing loss was 100%, and the specificity for recognizing normal hearing was 91%. In 27% of the measurements the thresholds obtained with both methods were identical; in 67% the difference was +/- 15 dB. When the MLR thresholds were estimated by the dependent investigator the corresponding figures were 34 and 74% respectively. When the MLR test was performed on children who were sound a sleep, the MLR thresholds were elevated by about 40 dB.     

A comparison of 2-dB and 5-dB step size in pure-tone audiometry

With the purpose of comparing test-retest reliability, pure-tone audiometry with a step size of 2 and 5 dB using the ascending technique was performed on two groups of subjects. One group consisted of 10 normal-hearing subjects and the other of 10 subjects with moderate cochlear hearing loss. The statistical analysis of the overall estimation of standard deviation obtained with the different step sizes showed no significant difference in any group. However, at 3 000 and 4 000 Hz in the cochlear group a significantly lower standard deviation was obtained with the smaller step size. The number of threshold crossings required to fulfil the threshold criterion increased significantly with the smaller step size.     

Preoperative speech and pure-tone audiometry in four types of patients with acoustic neuroma

PURPOSE: The goal of this study was to compare pure-tone and speech audiometry in 4 groups of patients with confirmed unilateral acoustic neuroma in which auditory brainstem responses and transient-evoked otoacoustic emissions were either both normal, abnormal, or one of the tests was abnormal.Material and methods: This study was realized during a preoperative assessment of 65 patients (29 men, 36 women) from 25 to 78 years of age suffering from unilateral acoustic neuroma. The assessment, preceded by tympanometry, included recordings of auditory brainstem responses, transient-evoked otoacoustic emissions, pure-tone audiometry, speech recognition thresholds, and speech discrimination. RESULTS: Some discrepancies between objective and behavioral test results were noticed. Subjects with no otoacoustic emissions but present auditory brainstem responses did not show any significant difference in their speech scores as compared with subjects with both auditory brainstem responses and otoacoustic emissions. CONCLUSIONS: In summary, this study showed that comparable audiometric findings in acoustic neuroma patients can be found regardless of the presence of transient otoacoustic emissions (TEOAEs). TEOAEs are a good screening tool and have been used, like auditory brainstem-evoked responses, as a predictive measure before hearing preservation procedures but cannot predict the audiogram or give information about speech perception. The findings confirm that even if auditory brainstem responses are an extremely useful diagnostic tool for identifying acoustic neuroma, this test provides only giving pieces of information regarding auditory abilities. Also, the pure-tone audiogram gives useful information but has to be used in conjunction with speech audiometry to get an accurate picture of the patient's true auditory abilities.     

Paediatric auditory brainstem response and pure-tone audiometry: threshold comparisons. A study of 142 difficult-to-test children

Auditory brainstem response (ABR) thresholds have been determined in 142 anaesthetized 'difficult-to-test' children. The stimuli employed were 2-kHz tone bursts. Pneumatic otomicroscopy was carried out prior to the ABR assessment in all cases, and diagnostic myringotomy was performed when there was the slightest suspicion of abnormality. Long-term follow-up pure-tone audiograms were obtained in 56 patients. A comparison was made between ABR and pure-tone thresholds in the 2-4 kHz range both in healthy middle ears and in ears having middle ear effusion (MEE) at the time of ABR measurement. A correction factor for prediction of behavioural threshold from the ABR threshold both in healthy and in MEE ears is proposed.     

Frequency discrimination for pure-tone and modulated stimuli: an evaluation of automatic and computerized test versions

Monaural differential frequency discrimination (delta f/f) was investigated in the 32 ears of 16 normal-hearing young adults, using an automated test of pitch-memory (the AFTD of Grisanti, Boll. Ital. Audiol. Foniatr., 1978, 1, 166-169) wherein S, in analogy with Bekesy audiometry, continuously adjusts the frequency of alternating pure-tone bursts between discriminable-nondiscriminable, and using a computer-driven test of discrimination of frequency modulation (the CTFD of Biondi, E. et al, Comm. LXV Congr. Soc. Ital. ORL Modena, 1978), wherein S presses a button, within a criterion time window, to a brief episode of frequency modulation in a pure tone. F was either 0.5, 1, or 2 kc/s at 40 db HL. An estimate of delta f/f for every test by the CTFD was printed out by the apparatus, while 4 indices of delta f/f by the ATFD were abstracted by hand from various features of the Bekesy-type tracings. Estimates of delta f/f by the CTFD were close to those of the classic study of Shower and Biddulph, but those by the ATFD were rather larger than reported in previous studies of pitch-memory. Student "t" tests revealed that only 5 of 24 comparisons between tests (4 ATFD variables vs 1 CTFD estimate X 2 ears X 3 frequencies) reached the 95% confidence level, while Pearson r's also showed little evidence of significant relationships between the two tests. While the CTFD yields a more precise delta f/f and has other virtues as a research tool, it demands 40-200 min to explore a listener's discriminability in both ears at 5 frequencies. Thus, although the ATFD yields less precise data, and has inherent within it the possibility of the intrusion of undesired psychological factors, it is to be preferred for clinical use since it demands only 15 min of experimental time.     

Comparison of hearing thresholds obtained using pure-tone behavioral audiometry, the Cantonese Hearing in Noise Test (CHINT) and cortical evoked response audiometry

CONCLUSION: Speech thresholds measured using Cantonese Hearing in Noise Test (CHINT) and cortical evoked response audiometry (CERA) thresholds were highly correlated with pure-tone behavioral results. Both tests are considered to provide good estimates of hearing thresholds and can be employed to confirm the degree of hearing loss in Cantonese-speaking communities. OBJECTIVES: This study aimed to evaluate how well a speech threshold obtained using a newly developed speech assessment tool (the CHINT) and CERA thresholds relate to pure-tone behavioral results and how the results compared in terms of their ability to predict hearing thresholds. SUBJECTS AND METHODS: Thirty adults with normal hearing to profound sensorineural hearing loss were tested. Speech thresholds were measured using the CHINT in four conditions: quiet, noise from the front, noise from the right, and noise from the left. CERA thresholds were measured at 0.5, 1, 2, and 4 kHz in both ears. RESULTS: Most participants had speech thresholds in quiet within+/-10 dB of pure-tone averages, and had CERA thresholds within+/-15 dB of pure-tone thresholds. Speech and CERA thresholds were highly correlated (p<0.01) with pure-tone behavioral thresholds.     

The ASSR: clinical application in normal-hearing and hearing-impaired infants and adults, comparison with the click-evoked ABR and pure-tone audiometry

The objective of this study was to investigate the clinical application of the ASSR (GSI Audera). It was completed in two parts: Study 1. Correlation between the ASSR-based threshold estimations and the conventional pure-tone thresholds in adults; and Study 2. Correlation between the average of the 2-4 kHz ASSR-based threshold estimations and c-ABR thresholds in children. The ASSRs were recorded in awake adults and sleeping infants with a range of hearing loss at CFs of 0.5 to 4 kHz and MFs between 46 and 95 Hz. The results show that in hearing-impaired adults (thresholds > 40 dBHL) good correlations can be observed between the behavioural thresholds and the ASSR-based threshold estimations. For the normal- to near-normal-hearing adults, a significant correspondence exists between the ASSR-based threshold estimations and FPTA. In children, strong correlations were found between the c-ABR and the 2-4 kHz ASSR-based threshold estimation average. These studies illustrate that the GSI Audera ASSR can accurately predict the behavioural audiogram in hearing-impaired subjects. In subjects with normal hearing the individual ASSR-based threshold estimations scatter too much. Instead the average of the ASSR-based threshold estimations corresponds well with the FPTA.