Dissertations / Theses on the topic 'Conductive hearing loss'

Sclerosteosis is a rare genetic bone dysplasia disorder characterised by generalised craniotubular bone modelling. Alongside many clinical appearances marked in sclerosteosis, the auditory system is considerably compromised on several levels during the disease progression. Extensive otolaryngological research on the history of sclerosteosis, the clinical presentation of sclerosteosis, radiographic studies and the gene causing the condition had been documented. No studies had been found describing the audiological profiles, auditory functioning and abnormalities for subjects with sclerosteosis. Thus the object of this study aimed to describe the auditory profile of subjects with sclerosteosis. A cross-sectional descriptive research design and quantitative research approach was followed to investigate the auditory characteristics of subjects with sclerosteosis. Subjects were selected from a database of patients with confirmed diagnoses of sclerosteosis. Ten subjects responded and provided written informed consent. Test procedures included otoscopy, tympanometry, acoustic reflexes, diagnostic pure-tone airand bone-conduction audiometry, speech audiometry, distortion product otoacoustic emissions (DPOAE), auditory brainstem responses (ABR) and computed tomographic (CT) scans. The subjects were assessed with a comprehensive audiological test-battery within a single test session lasting approximately two hours. A CT scan was conducted on a separate occasion shortly after the audiological data were obtained. Normal type A tympanograms were obtained in 50% (n=10/20) of ears. All subjects presented with mixed hearing losses varying from moderate (5%; n=1), severe (55%; n=11) and profound (40%; n=8) degrees across ears. Hearing loss configurations ranged from rising (15%), sloping (35%) and air-conduction thresholds peaking at 2000 Hz (50%). Air bone gaps (ABG) were larger in older subjects, although not statistically significant (p>.05). The CT scans indicated anatomical abnormalities of the external auditory canal, tympanic membrane, middle ear space, ossicles, oval window, round window and the internal auditory canal. The progressive abnormal bone formation in sclerosteosis involved the middle ear, the round and oval windows of the cochlea and internal auditory canal. The progressive abnormal bony overgrowth, which is the hallmark of sclerosteosis, led to functional impairment at various levels in the auditory system. The current findings provided a comprehensive auditory profile for sclerosteosis. Results might be utilised alongside future research findings to direct criteria and audiological indications for surgical and audiological intervention.
Dissertation (MCommunication Pathology)--University of Pretoria, 2013.
gm2014
Speech-Language Pathology and Audiology
Unrestricted

Objective: To evaluate the long-term safety and performance of four different vibroplasty couplers (round window, oval window, CliP and Bell coupler) in combination with an active middle ear implant. Methods: This was a multicentre, prospective, long-term study including 5 German hospitals. Thirty adult subjects suffering from conductive or mixed hearing loss were initially enrolled for the study, 24 of these were included in the final analysis with up to 36 months of postsurgical follow-up data. Bone conduction and air conduction were measured pre- and postoperatively to evaluate safety. Postoperative aided sound field thresholds and Freiburger monosyllable word recognition scores were compared to unaided pre-implantation results to confirm performance. Additional speech tests compared postoperative unaided with aided results. To determine patient satisfaction, an established quality-of-life questionnaire developed for conventional hearing aid usage was administered to all subjects. Results: Mean postoperative bone conduction thresholds remained stable throughout the whole study period. Mean functional gain for all couplers investigated was 38.5 ± 11.4 dB HL (12 months) and 38.8 ± 12.5 dB HL (36 months). Mean word recognition scores at 65 dB SPL increased from 2.9% in the unaided by 64.2% to 67.1% in the aided situation. The mean postoperative speech reception in quiet (or 50% understanding of words in sentences) shows a speech intelligibility improvement at 36 months of 17.8 ± 12.4 dB SPL over the unaided condition. The signal-to-noise ratio (SNR) improved by 5.9 ± 7.2 dB SNR over the unaided condition. High subjective device satisfaction was reflected by the International Inventory for Hearing Aids scored very positively. Conclusion: A significant improvement was seen with all couplers, and audiological performance did not significantly differ between 12 and 36 months after surgery.

Objective: To evaluate the safety and effectiveness of round window (RW), oval window (OW), CliP and Bell couplers for use with an active middle ear implant. Methods: This is a multicenter, long-term, prospective trial with consecutive enrollment, involving 6 university hospitals in Germany. Bone conduction, air conduction, implant-aided warbletone thresholds and Freiburger monosyllable word recognition scores were compared with unaided preimplantation results in 28 moderate-to-profound hearing-impaired patients after 12 months of follow-up. All patients had previously undergone failed reconstruction surgeries (up to 5 or more). In a subset of patients, additional speech tests at 12 months postoperatively were used to compare the aided with the unaided condition after implantation with the processor switched off. An established quality-of-life questionnaire for hearing aids was used to determine patient satisfaction. Results: Postoperative bone conduction remained stable. Mean functional gain for all couplers was 37 dB HL (RW = 42 dB, OW = 35 dB, Bell = 38 dB, CliP = 27 dB). The mean postoperative Freiburger monosyllable score was 71% at 65 dB SPL. The postimplantation mean SRT 50 (speech reception in quiet for 50% understanding of words in sentences) improved on average by 23 dB over unaided testing and signal-to-noise ratios also improved in all patients. The International Outcome Inventory for Hearing Aids (IOI-HA) quality-of-life questionnaire was scored very positively by all patients. Conclusion: A significant improvement was seen with all couplers, and patients were satisfied with the device at 12 months postoperatively. These results demonstrate that an active implant is an advantage in achieving good hearing benefit in patients with prior failed reconstruction surgery.

Thesis (M.A.)--University of Toledo, 2009.
Typescript. "Submitted as partial fulfillment of the requirements for The Master of Arts in Psychology." "A thesis entitled"--at head of title. Bibliography: leaves 28-30.

Children frequently experience fluctuating conductive hearing loss during and following episodes of otitis media with effusion. With the prevalence of the disease increasing in the non-Aboriginal population in Australia, many children may be at risk of long-term learning and behavioural problems. There are conflicting findings in the research literature regarding the effects of this type of hearing loss. Although it is expected that the insertion of tympanostomy tubes (grommets) will reduce the duration and prevalence of both the disease and the conductive hearing loss, this does not always happen. For some primary school aged children it appears that experience with otitis media with effusion with or without grommet insertion is associated with various education problems including poor academic achievement and inappropriate behaviour. A current concern is whether or not these possible effects would continue to influence the learning and behaviour of children as they continue into their high school years. A review of the literature suggests that multiple factors including interrelationships between experience of otitis media with effusion, family and childcare environments may be involved in explaining why some students do not achieve as expected at school (Roberts et al., 2000). The literature further suggests there may be a cumulative effect in these factors, which introduces both quantitative and qualitative aspects to the discussion. A study was undertaken to identify the impact of otitis media with effusion and its associated sequelae on the learning and behaviour of high school students. Information from parents of high school students in Years 8 and 9 was used to identify students for inclusion in the study and to provide information on their medical and educational history as well as the parents' perceptions of various aspects of the students' learning and behaviour (including social skills). Three groups were formed: a Non-OME/Non-Grommet Group (n = 28), an OME/Grommet Group (n = 17) and an OME/Non-Grommet Group (n = 32). The TORCH, WRAT 3 and the Test of Syntactic Abilities (Screening Test) were administered to the students who also provided their own perceptions of specific aspects of their own learning and behaviour on a survey form. Teachers' perceptions on these areas were also collected. School academic records as well as data from school behavioural records were used. Analysis of the results revealed a range of mild effects. These included poorer academic results particularly for girls with a history of grommets, who also exhibited a lack of confidence in their social skills. An increase in behaviour problems for boys with a history of the disease (with or without grommets) was also found. The study identifies a number of associated teaching and learning issues including noise levels in childcare environments and school classrooms, current teaching and learning methodology and the training of new teachers. It recommends a number of areas for future research including more in-depth questioning of parents regarding their awareness of hearing problems in their children, the use of more fine-grained measures to assess learning outcomes and the identification of possible gender differences associated with the disease and experiences with grommets.

Children frequently experience fluctuating conductive hearing loss during and following episodes of otitis media with effusion. With the prevalence of the disease increasing in the non-Aboriginal population in Australia, many children may be at risk of long-term learning and behavioural problems. There are conflicting findings in the research literature regarding the effects of this type of hearing loss. Although it is expected that the insertion of tympanostomy tubes (grommets) will reduce the duration and prevalence of both the disease and the conductive hearing loss, this does not always happen. For some primary school aged children it appears that experience with otitis media with effusion with or without grommet insertion is associated with various education problems including poor academic achievement and inappropriate behaviour. A current concern is whether or not these possible effects would continue to influence the learning and behaviour of children as they continue into their high school years. A review of the literature suggests that multiple factors including interrelationships between experience of otitis media with effusion, family and childcare environments may be involved in explaining why some students do not achieve as expected at school (Roberts et al., 2000). The literature further suggests there may be a cumulative effect in these factors, which introduces both quantitative and qualitative aspects to the discussion. A study was undertaken to identify the impact of otitis media with effusion and its associated sequelae on the learning and behaviour of high school students. Information from parents of high school students in Years 8 and 9 was used to identify students for inclusion in the study and to provide information on their medical and educational history as well as the parents' perceptions of various aspects of the students' learning and behaviour (including social skills). Three groups were formed: a Non-OME/Non-Grommet Group (n = 28), an OME/Grommet Group (n = 17) and an OME/Non-Grommet Group (n = 32). The TORCH, WRAT 3 and the Test of Syntactic Abilities (Screening Test) were administered to the students who also provided their own perceptions of specific aspects of their own learning and behaviour on a survey form. Teachers' perceptions on these areas were also collected. School academic records as well as data from school behavioural records were used. Analysis of the results revealed a range of mild effects. These included poorer academic results particularly for girls with a history of grommets, who also exhibited a lack of confidence in their social skills. An increase in behaviour problems for boys with a history of the disease (with or without grommets) was also found. The study identifies a number of associated teaching and learning issues including noise levels in childcare environments and school classrooms, current teaching and learning methodology and the training of new teachers. It recommends a number of areas for future research including more in-depth questioning of parents regarding their awareness of hearing problems in their children, the use of more fine-grained measures to assess learning outcomes and the identification of possible gender differences associated with the disease and experiences with grommets.
Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Cognition, Language and Special Education
Full Text

Objetivo: Verificar o desempenho de crianças diagnosticadas com deficiência auditiva, de grau leve, condutiva e sensorioneural, no Teste da Habilidade de Atenção Auditiva Sustentada (THAAS) visando constatar se este teste sofre influência da presença de uma deficiência auditiva. Modelo: Estudo do Teste da Habilidade de Atenção Auditiva Sustentada-THAAS em três grupos: grupo 1 (G1) grupo controle, formado por crianças com audição normal; grupo 2 (G2) crianças com deficiência auditiva sensorioneural bilateral de grau leve e grupo 3 (G3) composto por crianças com perda auditiva condutiva bilateral de grau leve. Local: Divisão de Saúde Auditiva ? Hospital de Reabilitação de Aanomalias Craniofaciais ?Universidade de São Paulo (HRAC/USP). Participantes: 90 crianças com idade entre 7 e 11 anos de idade, sendo 30 de cada grupo. Intervenções: Audiometria Tonal Limiar, Imitanciometria e THAAS Resultados: não houve indícios estatisticamente significativos entre sexo e idade, em todos os grupos estudados. Os grupos sensorioneural e condutivo apresentaram desempenho inferior ao grupo controle, em todas as respostas do THAAS. Conclusões: o teste THAAS sofreu influência das perdas auditivas de grau leve, condutivas e sensorioneurais na população estudada, sendo o pior comprometimento para perdas sensorioneurais.
Objective: To verify the performance of children diagnosed with a hearing loss of mild degree, conductive and sensorineural, at Sustained Auditory Attention Ability Test (SAAAT), aiming to observe if this test suffers the influence of the presence of a hearing loss. Model: A study of the Sustained Auditory Attention Ability Test ? SAAAT in three groups: group 1 (G1) control group comprising children with normal hearing, group 2 (G2) children with a bilateral sensorineural hearing loss of a mild degree and group 3 (G3), comprising children with a bilateral conductive hearing loss of a mild degree. Place: Division for Hearing Health ? Craniofacial Anomaly Rehabilitation Hospita, University of São Paulo (HRAC/USP). Participants: 7 to 11 year old children, 30 for each group. Interventions: Pure Tone Audiometry, Immitance Acoustic and SAAAT. Results: There were not any statistically significant indications between sex and age in all studied groups. Sensorineural and conductive groups showed a lower performance related to control group in all answers for SAAAT. Conclusions: SAAAT test suffered the influence of conductive and sensorineural hearing losses of light degree in studied population, the worse compromise occurring for sensorineural losses.

Acromegalia à uma doenÃa endÃcrina rara. Poucos estudos avaliaram sua associaÃÃo com deficiÃncia auditiva (DA) ou distÃrbios de conduÃÃo do impulso neural auditivo.Osresultados sÃo conflitantes. O objetivo à avaliar a transmissÃo auditiva central e perifÃrica em pacientes com acromegalia. AlÃm disso, avaliar a prevalÃncia e caracterÃsticas da DA em pacientes com acromegalia. Foi feito um estudo transversal com 36 pacientes com acromegalia de um ambulatÃrio especializado em Fortaleza-CearÃ. Foram excluÃdos pacientes com otoscopia anormal ou com histÃria familiar de deficiÃncia auditiva, uso de ototÃxicos ou exposiÃÃo a ruÃdo ocupacional. Inicialmente, o grupo foi avaliado por meio de audiometria tonal limiar. Considerou-se deficiÃncia auditiva (DA) quando a mÃdia dos tons puros foi > 25DbNA para baixas freqÃÃncias (250, 500, 1000 e 2000 Hz) ou altas freqÃÃncias (3000, 4000, 6000 e 8000 Hz).O grupo foi dividido em: acromegalia com DA (Acro DA) e sem DA (Acro NDA) e comparados quanto aos nÃveis hormonais e parÃmetros metabÃlicos. Posteriormente, este grupo de pacientes com acromegalia foi dividido em 2 subgrupos: com (n=16) e sem (n=20) diabetes ou intolerÃncia à glicose de jejum (DM/IGJ). Os resultados foram comparados entre os subgrupos e grupo controle (n=20) quantos aos parÃmetros dos potenciais evocados auditivos de tronco encefÃlico (PEATE). Para avaliar a normalidade da distribuiÃÃo foi utilizado o teste de Kolmogorov-Smirnov quando necessÃrio. Utilizou-se os testes qui-quadrado, t de Student e coeficiente de correlaÃÃo de Pearson. O nÃvel de significÃncia estatÃstica escolhido foi p<0.05 (statistical package for social sciences-SPSS 12.0). Dos 36 pacientes estudados, 14 (38,9%) mostraram DA sensorioneural (Acro DA), sendo em 9 casos bilateral e 5 unilateral. Nenhum apresentou DA mista ou condutiva. A prevalÃncia de DM/IGJ foi similar entre os grupos. As frequÃncias de 250, 3000, 4000, 6000 e 8000 Hz foram as mais afetadas e com padrÃo similar em ambos os lados.O grupo com acromegalia apresentou latÃncia da onda I em orelha direita aumentada em comparaÃÃo ao grupo controle (p=0,007), sem diferenÃa quanto aos intervalos interpicos em nenhum dos lados. Esse padrÃo foi o mesmo quando se comparou o subgrupo com DM/IGJ com o controle.TambÃm houve aumento da latÃncia da onda I na orelha direita em relaÃÃo à orelha esquerda no grupo com acromegalia. Em conclusÃo, mostrou-se uma elevada prevalÃncia de DA sensorioneural em pacientes com acromegalia.No entanto, nÃo se observou relaÃÃo dessa deficiÃncia com caracterÃsticas clÃnicas e metabÃlicas da doenÃa.Pacientes com acromegalia associada DM/IGJ mostraram um retardo no impulso neural no nervo auditivo unilateralmente à direita, evidenciando um efeito neuropÃtico nÃo homogÃneo dos distÃrbios do metabolismo dos carboidratos sobre o nervo auditivo.
Acromegaly is a rare endocrine disease. Few studies have evaluated its association with hearing loss (HL) or disturbance in conduction of the auditory neural impulse. The results are conflicting. The aim is to evaluate central and peripheral auditory transmission in acromegalic patients. Besides, to evaluate the prevalence and characteristics of HL in patients with acromegaly. A cross-sectional study was carried out on 36 patients with acromegaly in a specialized ambulatory in Fortaleza-CearÃ. Patients with abnormal otoscopy, family history of hearing loss, use of ototoxic drugs or occupational noise exposure were excluded. Initially, the group was evaluated by pure tone audiometry. HL was considered when pure tone average was > 25 DBHL for low frequencies (250, 500, 1000 e 2000 Hz) or high frequencies (3000, 4000, 6000 e 8000 Hz). The whole group was divided in: acromegaly with HL (Acro HL) and without HL (AcroNHL) and compared in regards to hormonal levels and metabolic parameters. Additionally that group of patients with acromegaly was divided into 2 subgroups: with (n=16) and without (n=20) diabetes mellitus/impaired glucose tolerance (DM/IGT). The results were compared among these subgroups and a control group (n=20) regarding the brainstem auditory evoked potentials (BAEP) parameters.Kolmogorov-Smirnov test was used to evaluate the normality of distribution when necessary. Qui-quadrado, Student t test and Pearson correlation coefficient were carried out. The level of statistical significance chosen was at p<0.05 (statistical package for social sciences-SPSS 12.0). Among 36 patients evaluated, 14 (38,9%) showed sensorioneural HL (Acro HL), being 9 bilateral and 5 unilateral cases. No one had mixed or conductive HL. The prevalence of diabetes/impaired glucose tolerance was similar between the groups. The frequencies 250, 3000, 4000, 6000 and 8000 Hz were the most affected and with a similar pattern in both ears. The group with acromegaly showed a prolonged peak I latency in the right ear in comparison to the control group (p=0,007), with no difference regarding the interpeak intervals in any sides. This pattern was the same when comparing the DM/IGT subgroup to controls. Also, we found a prolonged peak I latency in the right ear in relation to the left ear in the group with acromegaly.In conclusion, a high prevalence of sensorineural HL was shown in patients with acromegaly. Nevertheless, no correlation was observed between this dysfunction and clinical or metabolic characteristics of the disease. Patients with acromegaly associated with DM/IGT showed a delayed neural impulse in the auditory nerve unilaterally in the right side, evidencing a non-homogenous neuropathic effect of the carbohydrate metabolism disturbances on the auditory nerve.

Background: Hearing aid prescriptive recommendations for hearing losses having a conductive component have received less clinical and research interest than for losses of a sensorineural nature; as a result, much variation remains among current prescriptive methods in their recommendations for conductive and mixed hearing losses (Johnson and Dillon, 2011). Purpose: The primary intent of this brief clinical note is to demonstrate differences between two algebraically equivalent expressions of hearing loss, which have been approaches used historically to generate a prescription for hearing losses with a conductive component. When air and bone conduction thresholds are entered into hearing aid prescriptions designed for nonlinear hearing aids, it was hypothesized that that two expressions would not yield equivalent amounts of prescribed insertion gain and output. These differences are examined for their impact on the maximum power output (MPO) requirements of the hearing aid. Subsequently, the MPO capabilities of two common behind-the-ear (BTE) receiver placement alternatives, receiver-in-aid (RIA) and receiver-in-canal (RIC), are examined. Study Samples: The two expressions of hearing losses examined were the 25% ABG + AC approach and the 75% ABG + BC approach, where ABG refers to air-bone gap, AC refers to air-conduction threshold, and BC refers to bone-conduction threshold. Example hearing loss cases with a conductive component are sampled for calculations. The MPO capabilities of the BTE receiver placements in commercially-available products were obtained from hearing aids on the U.S. federal purchasing contract. Results: Prescribed gain and the required MPO differs markedly between the two approaches. The 75% ABG + BC approach prescribes a compression ratio that is reflective of the amount of sensorineural hearing loss. Not all hearing aids will have the MPO capabilities to support the output requirements for fitting hearing losses with a large conductive component particularly when combined with significant sensorineural hearing loss. Generally, current RIA BTE products have greater output capabilities than RIC BTE products. Conclusions: The 75% ABG + BC approach is more appropriate than the 25% ABG + AC approach because the latter approach inappropriately uses AC thresholds as the basis for determining the compression ratio. That is, for hearing losses with a conductive component, the AC thresholds are not a measure of sensorineural hearing loss and cannot serve as the basis for determining the amount of desired compression. The Australian National Acoustic Laboratories has been using the 75% ABG + BC approach in lieu of the 25% ABG + AC approach since its release of the National Acoustic Laboratories—Non-linear 1 (NAL-NL1) prescriptive method in 1999. Future research may examine whether individuals with conductive hearing loss benefit or prefer more than 75% restoration of the conductive component provided adequate MPO capabilities to support such restoration.

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Objetivo: verificar a ocorrência das alterações auditivas em recém nascidos que participaram do Programa de triagem auditiva neonatal de um Hospital Público (UNIFESP- Brasil) no período de 2005 a 2007 e verificar se os recém nascidos que falharam na triagem auditiva por comprometimento condutivo tem mais episódios de perda condutiva durante os primeiros anos de vida do que aqueles que não falharam. Métodos: 0 estudo foi dividido em duas partes. A primeira parte foi retrospectiva analisando-se 0 diagnóstico audiol6gico de 231 (de mil novecentos e noventa e seis) recém nascidos que falharam na triagem auditiva e sua associação com a idade gestacional, 0 peso ao nascimento e as principais intercorrências neonatais. Na segunda parte compararam-se os 62 recém nascidos que falharam na triagem auditiva por comprometimento condutivo com os 221 recém nascidos que passaram na triagem auditiva. Foi feito 0 acompanhamento por meio de EOAT, imitanciometria e avaliação comportamental. Foram utilizados para analise estatística 0 teste Exato de Fisher e modelos de Regressão Logística. Resultados: A incidência de alterações auditivas na população estudada foi de 11,5%, sendo 8,4% de perda condutiva, 1 % de perda neurossensorial, 2% de alteração central. As crianças que falharam na triagem por alteração condutiva tiveram mais episódios de perda condutiva (estatisticamente significante) durante 0 primeiro ano de vida que as crianças que não falharam. Conclusões: Houve maior ocorrência de perda auditiva condutiva dentre as alterações auditivas estudadas. Os neonatos que falharam na triagem auditiva neonatal no primeiro mês de vida por alteração condutiva tem maior chance de terem perda auditiva condutiva ao longo do primeiro ano de vida.
TEDE
BV UNIFESP: Teses e dissertações

A otite média, afecção comum na infância, acarreta uma perda auditiva condutiva flutuante, pois uma vez tratada os limiares auditivos voltam aos valores normais. Preocupação ocorre quando estes episódios tornam-se recorrentes levando a criança a receber uma estimulação sonora inconsistente do sistema nervoso auditivo central, dificultando a percepção dos sons da fala. O objetivo do presente estudo foi investigar se crianças com episódios recorrentes e comprovados de otite média com efusão apresentam alterações das habilidades auditivas que compõe o processamento auditivo. Foram avaliadas 59 crianças com idade entre 6 e 10 anos, divididas em dois grupos: grupo experimental composto por 29 crianças de ambos os gêneros com histórico documentado de otite media com efusão, perda auditiva condutiva nos primeiros anos de vida e com e sem história de cirurgia para colocação de tubo de ventilação na idade pré-escolar e escolar; e grupo controle, composto por 30 crianças, pareadas em idade e gênero com o grupo experimental, mas sem história da afecção. Na avaliação das habilidades auditivas que compõe o processamento auditivo foram utilizados o teste fala com ruído (TFR), teste dicótico de dígitos (TDD) e teste Gaps-in-noise (GIN). Todas as crianças no momento da avaliação estavam livres de perda auditiva condutiva. Os resultados mostraram que: os dois grupos não apresentavam diferenças dos limiares tonais, no momento da avaliação; o grupo experimental apresentou resultados inferiores no TFR e GIN, tanto na análise quantitativa quanto na qualitativa; o TDD apenas na análise qualitativa diferenciou os dois grupos. Pode-se concluir, no presente estudo, , que crianças com história de otite média com efusão recorrente e persistente, nas fases pré-escolar e escolar, apresentaram transtorno do processamento auditivo.
Otitis media, a common affection in childhood, causes a fluctuating conductive hearing loss, because once treated the hearing thresholds back to normal values. Concern occurs when these episodes become recurring leading the child to receive an inconsistent sound stimulation auditory central nervous system, it difficult for the perception of speech sounds. The aim of this study was to investigate whether children with recurrent episodes of proven otitis media with effusion present alterations of auditory skills that composes the auditory processing. We evaluated 59 children with ages between 6 and 10 years, divided into two groups: the experimental group comprised of 29 children of both genders with documented history of otitis media with effusion, conductive hearing loss in the early years of life and with and without history of surgery for ventilation tube placement in preschool and school age; and the control group, consisting of 30 children, paired in age and gender with the experimental group, but no history of the disease. In the assessment of auditory skills that make up the auditory processing was used Speech in Noise Test (SNT), Dichotic Digits Test (DDT) and Gaps in Noise test (GIN). All children had at the time of assessment were free of conductive hearing loss. The results showed that: the two groups showed no differences in tonal thresholds, at the time of the assessment; the experimental group showed results below the SNT and GIN, both in qualitative and in quantitative analysis; DDT only in qualitative analysis differentiated the two groups. It can be concluded, with the results of the work, that children with a history of otitis media with effusion recurrent and persistent, pre-school and school phases, may have auditory processing disorder.

Introdução: A atresia congênita de orelha constitui uma deformidade presente ao nascimento, de prevalência unilateral, decorrente da alteração no desenvolvimento das estruturas das orelhas externa e média. Geralmente, provoca perda auditiva condutiva, e pode ser acompanhada por componente sensorioneural. Dentre as formas de tratamento disponíveis, encontra-se o implante de orelha média Vibrant Soundbridge (VSB), que tem se mostrado eficaz no tratamento deste tipo de alteração. A literatura mostra melhora nos limiares tonais e nos resultados dos testes de percepção auditiva da fala, realizados com o uso do processador de fala após a cirurgia. Considerando que os indivíduos com este tipo de malformação podem passar por um período de privação sensorial auditiva anterior à reabilitação, torna-se interessante avaliar o estágio maturacional das estruturas auditivas corticais e o processamento das informações auditivas em nível central, bem como, verificar o benefício da indicação do VSB unilateral em situação de escuta difícil. Não foram encontrados estudos que abordam este aspecto e o emprego dos potenciais evocados auditivos corticais (PEAC) e do P300 em usuários de VSB. Objetivo: Analisar o impacto da perda auditiva condutiva e mista nos PEAC e P300 em usuários de VSB unilateral, com atresia de orelha bilateral, e verificar as habilidades auditivas, em situação de escuta difícil, considerando a indicação do VSB unilateral. Casuística e método: Vinte indivíduos, divididos em dois grupos, pareados em idade, sexo e grau de escolaridade. G1: dez indivíduos com perda auditiva condutiva ou mista bilateral, usuários de VSB unilateral, atendidos na Instituição de realização da pesquisa. Todos fizeram uso de aparelhos auditivos convencionais antes do VSB. G2: Dez indivíduos normo-ouvintes. Realização de audiometria em campo livre com o uso do VSB (apenas o G1), avaliação das habilidades auditivas pelo Hearing in Noise Test, pesquisa dos componentes P1, N1, P2, N2 e P300, em campo calibrado. Resultados: A média dos limiares tonais nas frequências de 500 a 3000 Hz, de 20 a 36 dB NA, mostrou que o VSB possibilitou o acesso aos sons da fala. Não foi observada diferença estatisticamente significante entre os valores de latência dos PEAC e P300 entre os grupos. Foi observada diferença estatisticamente significante entre o limiar de reconhecimento de sentenças e a relação sinal/ruído entre os grupos, sendo os melhores resultados apresentados pelo G2. Conclusão: Indivíduos com atresia de orelha e perda auditiva condutiva ou mista bilateral, quando adequadamente reabilitados, podem atingir a maturação das vias auditivas centrais e o processamento da informação auditiva em nível cortical. As habilidades de reconhecimento auditivo, sem e com ruído competitivo, mostraram-se defasadas quanto à normalidade, apontando para a indicação do VSB bilateral
Introduction: Congenital aural atresia is a congenital deformity. It is unilaterally prevalent due to alterations in the development of the external and middle ear structures. Congenital aural atresia causes conductive hearing loss and can be accompanied by sensorineural component. Among the available forms of treatment is the middle ear implant, Vibrant Soundbridge (VSB), which has been shown to be effective in treating this type of alteration. The literature shows improvement in tonal thresholds and in the results of tests of auditory perception of speech that were performed using the speech processor after surgery. Individuals with this type of malformation often experience a period of auditory sensory deprivation prior to rehabilitation. Hence, it is important to evaluate the maturation stage of the cortical auditory structures, the processing of auditory information at the central level, and to verify the benefit of unilateral VSB in difficult listening situations. There are no previous data on this aspect and with the use of cortical auditory evoked potentials (CAEP) and event-related potential (P300) in users of VSB. Aim: To analyze the impact of conductive and mixed hearing loss on CAEP and P300 in unilateral VSB users with bilateral ear atresia. To verify the auditory abilities in a difficult listening situation considering the indication for unilateral VSB. Materials and methods: Twenty individuals were divided into two groups matched for age, sex, and educational level. G1 comprised ten individuals with bilateral conductive or mixed hearing loss and users of unilateral VSB, who visited the research institution. All subjects used conventional hearing aids prior to VSB. G2 comprised ten normal hearing individuals. Audiometry in the free field was performed with the use of VSB (G1 only) and evaluation of hearing skills by the Hearing in Noise Test was conducted; components P1, N1, P2, N2, and P300 in a calibrated field were recorded. Results: Evaluation of the mean tonal thresholds in the frequencies between 500 and 3000 Hz, from 20 to 36 dB HL, demonstrated that VSB allowed access to speech sounds. There was no statistically significant difference in the CAEP and P300 latency values between the two groups. A statistically significant difference was observed in the sentence recognition threshold and the signal-to-noise ratio between the groups, with best results presented by G2. Conclusion: Individuals with congenital aural atresia and bilateral conductive or mixed hearing loss may reach maturation of the central auditory pathway and achieve adequate processing of auditory information at the cortical level, when rehabilitated. The auditory recognition skills, with and without competitive noise, were shown to be out of phase with normality, indicating the need for a bilateral VSB

Bone conduction transmission and head‐shadow effects were determined with transcranial completely‐in‐the‐canal (TCCIC) CROS hearing aids. Five subjects with documented profound unilateral hearing loss and experience with traditional CROS/BICROS fittings (TCROS) were tested with a CIC hearing aid placed in their poorer ear. Peak SPL was measured at the tympanic membrane and ranged from 105–115 dB SPL at 2000 Hz. Pure‐tone crossover thresholds and functional gain tested at frequencies from 250–8000 Hz varied considerably more than the SPL measures. The pure‐tone results indicated that sensitivity in the better ear was moderately associated with functional gain across frequency. Speech recognition was then tested in the sound field in two conditions: direct (noise in the poorer ear, speech in the better ear) and indirect (noise in the better ear, speech in the poorer ear) at S/Ns of −6, 0, +6, +12, and quiet. The TCCIC fittings were more effective than TCROS aids across S/Ns, particularly in the direct condition. In the indirect condition, the two fittings performed similarly. When data were pooled across conditions, the TCCIC aids provided better word recognition than the TCROS aids, particularly for those subjects with greater sensitivity in the better ear.

The escalating cost of claims for Noise Induced Hearing Loss (NIHL) in the Canadian Armed Forces (CAF) supports the need to review and upgrade current hearing conservation practices. The rise of these escalating costs and the need to protect the military personnel when training in extreme noise conditions has initiated an engineering investigation within the Department of National Defence (DND) and in collaboration with the University of Ottawa, to review the existing standards in the field of hearing protection test and evaluation, to propose technical recommendations and to identify the possible technical problems and gaps impacting the quality of the existing procedures. This study dealt with the estimation of the protection capability of Hearing Protection Devices (HPDs) in the case of high-level impulse noise from small firearms weapons that are a particularly damaging source of noise in military environments, representing an important cause of NIHL. Testing and evaluation based on a system engineering approach have been used in this work introducing: - A new testing approach, based on ANSI/ASA S12.42-2010, for testing HPDs when the impulse noise is generated by a small firearm; - A new evaluation approach for HPD performance, introducing a characterization approach using a sub-band analysis for dealing with impulse noise generated by a small firearm. The effectiveness of HPDs, taking into account the physiological human limitations induced by Bone Conduction (BC), is computed by using an innovative method attempting to better prevent the risk of NIHL when using small firearms.

碩士
國立台北護理學院
聽語障礙科學研究所
96
The purpose of this study was to evaluate the speech discrimination of patient with unilateral conductive hearing loss under quiet and noise environment. Taiwan Version of Mandarin Hearing in Noise Test (MHINT-T) was used to investigate the reception thresholds of sentences (RTS) in sound field. There were 42 individuals involved in this study. Twenty five individuals with normal hearing threshold were refer as control group, and the rest with unilateral conductive hearing loss were referred as test group. The study was to test the RTSs in each group under quiet and noise environment. In the control group, the average RTS in quiet was 22.5 dBA (SD = 2.54 dB). There were three different situations when testing under noise: noise front, noise right and noise left. In order to achieve 50% sentence discrimination score, noise front averaged signal to noise ratio was -6.9 dB (SD = 0.95 dB). Noise right was -15.7 dB (SD = 1.19 dB) and noise left was -12.6 dB (SD = 1.85 dB), respectively. Noise composite was -10.6 dB (SD = 0.95 dB), which represented the total performance under noise situation for individuals. In the test group, RTS in quiet was 29.9 dBA (SD = 3.54 dB). According to the thresholds from both ears of individuals, separated noise source into three direction: noise front, noise form bad side and noise from normal side. The averaged SNR of noise front was -5.7 dB (SD = 0.90 dB), -9.3 dB (SD = 2.44 dB) for the noise form bad side, and -5.7 dB (SD = 2.51 dB) for noise form normal side and noise composite was -6.6 dB (SD = 1.06 dB), respectively. There was a normal ear in patients who had unilateral conductive hearing loss, but their speech discrimination were worse than person who had normal hearing in all test situation. We should not ignored the speech discrimination under quiet and noise environment effected by mild or moderate hearing loss. Treatment would be suggested to elevate thresholds of the bad ear in order to improve speech discrimination under quiet and noise environment.

Conductive hearing loss (otitis media) in young children can effect speech and language development. However, little is known about the effects of conductive loss on neural activity in the auditory system. Hypothesis: Conductive hearing loss will change resting activity levels at the inner hair cell synapse, and lead to auditory deprivation of central auditory pathways. A conductive loss was produced by blocking the ear canals in mice. Resting neural activity patterns were quantified in brainstem and midbrain using c-fos immuno-labelling. Experimental subjects were compared to normal hearing controls and subjects with cochlear ablation. Conductive loss subjects showed a trend in reduction in c-fos labelled cells in cochlear nucleus and the central nucleus of inferior colliculus compared to normal controls. Results seen in this study may indicate the influence of conductive hearing loss on the developing auditory brain during early postnatal years when the system is highly plastic.

Children have difficulty with reading for a number of reasons. One of these reasons may be temporary conductive hearing loss (TCHL) in preschool, which can be caused by otitis media (persistent fluid build-up in the middle ear), one of the most frequent medical issues in preschool children (Burt & Schappert, 2004). While otitis media can be treated medically, the duration of hearing loss and the age at which the hearing loss occurred may contribute to future reading difficulties (Easterbrooks, Lederberg, Miller, Bergeron & Connor, 2008). The literature surrounding the connection between otitis media, TCHL, and reading development is inconclusive. In addition, the nature of interdisciplinary communication to discuss the potential future challenges for children who have had TCHL is unclear. Little is known about how professionals communicate with parents about these challenges, and about how parents can best support their children. This research focused on providing detailed descriptions of how medical and educational professionals reported they communicated with each other and with parents about the potential reading risks associated with TCHL. This study followed standard qualitative research methods to conduct in-depth interviews with six medical and educational professionals and with two parents of children with TCHL. Results from this study have revealed important aspects that characterize what, when, and how professionals inform parents of children with TCHL about potential future reading problems. The knowledge gained through this research can guide future research and have practical implications for medical and educational professionals and provides recommendations for how parents are informed about potential future reading difficulties.
Thesis (Master, Education) -- Queen's University, 2011-09-27 11:48:59.805

RESUMO: Introdução e objetivos: Os testes de cabeceira podem diminuir o tempo de resposta clínica, melhorar a tomada de decisões e permitir uma rápida avaliação qualitativa da perda auditiva. Este estudo descreve o desenho e a validação dum novo teste de cabeceira com diapasão que permite quantificar a perda auditiva, na presença de surdez de condução unilateral. O estudo considerou três fases distintas: a primeira fase avaliou os efeitos da oclusão completa do canal auditivo externo sobre a audição, a fim de decidir qual a frequência de diapasão mais adequada para quantificar a hipoacusia com o teste de oclusão contralateral (TOC). A reprodutibilidade do método de oclusão entre examinadores também foi estudada nesta fase. A segunda fase avaliou o efeito da oclusão nos limiares auditivos de acordo com a idade, em indivíduos de idades distintas, para apurar qual o diapasão mais adequado na realização do TOC. A terceira fase avaliou a precisão do teste na previsão do grau de perda auditiva. Métodos: Nas três fases distintas do estudo consideraram-se populações com idade e tamanho da amostra diferentes. Na primeira fase do estudo, 20 adultos (40 ouvidos) com audição normal (21-30 anos de idade) foram submetidos a uma audiometria tonal em campo livre, com e sem oclusão do canal auditivo externo. Cada ouvido foi testado com as frequências standard (250, 500, 1000, e 2000 Hz) em tons de warble. O ouvido contralateral foi suprimido por mascaramento. A oclusão do ouvido foi realizada independentemente por 2 examinadores. Na segunda fase, 42 adultos (84 ouvidos) com audição normal (21-67 anos de idade) foram divididos em três grupos etários: 20-30, 40- 50, e 60-70 anos. Os participantes foram avaliados por audiometria tonal em campo livre, nas mesmas condições descritas para a primeira fase do estudo. Na terceira fase, 53 indivíduos com surdez de condução unilateral foram recrutados num departamento de otorrinolaringologia dum hospital terciário. O TOC foi realizado para determinar a lateralização com diapasões de 128 Hz, 256 Hz, 512 Hz, 1024 Hz e 2048 Hz e com a oclusão total do ouvido não afetado. A audiometria tonal foi então realizada, separadamente e cega em relação aos resultados do TOC, para determinar o gap aéreoósseo (ABG) e a o limiar auditivo médio (PTA). Por fim, as respostas do TOC foram comparadas com o ABG e o PTA para determinar a sua precisão na quantificação do grau da perda auditiva. Resultados: Na primeira fase do estudo, a oclusão do canal auditivo externo determinou uma elevação nos limiares auditivos com o aumento da frequência, desde 19.94 dB (250 Hz) até 39.25 dB (2000 Hz). A diferença dos limiares entre as condições de oclusão e não oclusão foi estatisticamente significativa, tendo aumentado de 10.69 dB (250 Hz) a 32.12 dB (2000 Hz). Não se verificaram diferenças estatisticamente significativas em relação ao género, ou entre examinadores. Na segunda fase do estudo, verificou-se uma elevação dos limiares auditivos com o aumento da frequência, de 20.85 dB (250 Hz, grupo 20–30 anos) a 48 dB (2000 Hz, grupo 60–70 anos). A diferença nos limiares auditivos entre as condições de oclusão e de não-oclusão foi estatisticamente significativa em todas as frequências; e aumentou de forma diretamente proporcional com a frequência, de 11.1 dB (250 Hz, grupo 20–30 anos) a 32 dB (2000 Hz, grupo 20–30 anos). Foram encontradas diferenças estatisticamente significativas para os três grupos etários, em todos os parâmetros, exceto na diferença a 500 Hz e na diferença total média. A perda auditiva média resultante da oclusão aos 500 Hz foi de 19 dB. Não se encontraram diferenças estatisticamente significativas entre o ouvido direito e o esquerdo, e entre géneros. Na terceira fase do estudo o TOC mostrou uma forte associação entre surdez e lateralização utilizando o diapasão de 512 Hz (p = .001). A sensibilidade do diapasão de 512 Hz na deteção de um PTA igual ou maior do que 35.6 dB foi de 94.6% e a especificidade foi de 75% para um valor preditivo positivo de 89.7% e um valor preditivo negativo de 85.7%, assumindo uma prevalência pré-teste de 69.8%. Conclusão: O método de oclusão do canal auditivo externo utilizado demonstrou reprodutibilidade entre examinadores e com a idade. A oclusão elevou os limiares auditivos, sendo este efeito mais evidente nas frequências mais elevadas. O TOC permitiu predizer o grau de hipoacusia de condução unilateral. Se ocorrer lateralização para a ouvido afetado, é quase certa a evidência de hipoacusia de condução moderada ou grave. No TOC podem utilizar-se diapasões de 256 ou 512 Hz para o diagnóstico de hipoacusia ligeira, e o diapasão de 2018 Hz para a hipoacusia moderada. Contudo, no estudo do efeito da idade e com a validação do teste foi possível concluir que a utilização do diapasão de 512 Hz é a mais adequada para o TOC. A utilização deste teste pode permitir aos clínicos, em ambiente de consulta e de forma rápida, a distinção entre uma hipoacusia de condução de grau ligeiro e uma hipoacusia de condução de grau moderado ou superior.
ABSTRACT: Introduction and goals: Bedside testing may accelerate clinical decision by making a quick qualitative assessment of hearing loss. This study described the design and validation of a bedside test with tuning forks that allow some quantitative evaluation of hearing loss in the presence of unilateral conductive hearing loss. Three distinct phases were considered: the first phase of the study quantified the effects of complete external auditory canal occlusion on hearing, in order to decide which tuning fork frequency is more appropriate to use for quantifying the hearing loss with the novel contralateral occlusion test (COT). The reproducibility of occlusion between examiners was also explored in this phase of the study. The second phase of the study evaluated the effects of external auditory canal occlusion on hearing thresholds with aging, in order to decide which tuning fork is more appropriate to use for the COT in individuals of different ages. The third phase of this study evaluated the accuracy of the test in predicting the degree of hearing loss. Methods: Over the study period, the three distinct phases considered population numbers of different age/size classes. At the first phase, 20 normal-hearing adults (40 ears) between 21-30 years old underwent sound field pure tone audiometry with and without ear canal occlusion. Each ear was tested with the standard frequencies (250, 500, 1000, and 2000 Hz) with warble tones. The contralateral ear was suppressed with the use of masking. Ear occlusion was performed by two examiners. In the second phase, 42 normal hearing subjects (84 ears) between 21 and 67 years were divided into three age groups (20–30 years, 40–50 years, and 60–70 years). Participants underwent sound field audiometry tests as described to the first phase of the study. In the third phase, 53 subjects with unilateral conductive hearing loss were recruited from an otolaryngology department of a tertiary hospital. The COT was performed to determine lateralization using 128, 256, 512, 1024 and 2048 Hz tuning forks with the non-affected ear meatus totally occluded. Pure-tone audiometry was then performed, separately and blinded of the tuning fork test results, to establish the presence and degree of the air-bone gap (ABG) and the pure-tone average (PTA). The tuning fork responses were finally correlated with the ABG and the PTA to determine their accuracy in quantifying the degree of hearing loss. Results: In the first phase of the study, occlusion of the external auditory canal determined an increase in hearing thresholds with increasing frequencies, from 19.94 dB (250 Hz) to 39.25 dB (2000 Hz). The difference on hearing thresholds between occluded and unoccluded conditions was statistically significant and increased from 10.69 dB (250 Hz) to 32.12 dB (2000 Hz). There were no statistically significant differences according to gender or between examiners. The second phase of the study demonstrated that hearing thresholds increased with higher frequencies from 20.85 dB (250 Hz, 20–30 years group) to 48 dB (2000 Hz, 60–70 years group). The difference on hearing thresholds between occluded and unoccluded conditions were statistically significant and increased, ranging from 11.1 dB (250 Hz, 20–30 years group) to 32 dB (2000 Hz, 20–30 years group). Statistically significant differences were found for the three age groups and for all evaluations except to 500 Hz difference and average difference. The mean hearing loss produced by occlusion at 500 Hz was approximately 19 dB. No statistically significant differences were found between right and left ears and gender for all measurements. In the third phase of the study COT showed a stronger association between hearing loss and the lateralization response using the 512 Hz tuning fork (p = 0.001). The sensitivity of the 512 Hz fork in detecting a PTA equal or greater than 35.6 dB was 94.6% and the specificity was 75.0% for a positive predictive value of 89.7% and a negative predictive value of 85.7%, assuming a pretest prevalence of 69.8%.Conclusions: The occlusion method as performed demonstrated reproducibility between examiners and with aging. The occlusion effect increased the hearing thresholds and became more evident with higher frequencies. The COT was accurate in predicting the degree of unilateral conductive hearing loss. If lateralization to the affected ear occurred, it was almost certain that the affected ear has a moderate or severe conductive hearing loss. 256 Hz or 512 Hz tuning forks were the more appropriate for diagnosis of mild hearing loss, and the 2048 Hz tuning fork was the more appropriate for moderate hearing loss; but aging and accuracy studies demonstrated that the use of the 512 Hz tuning fork is the most suitable for COT. The use of this test may allow clinicians to distinguish mild from moderate or greater than moderate unilateral conductive hearing loss.