Factors related to uncomfortable loudness levels for patients seen in a tinnitus and hyperacusis clinic

Objectives: The aims were as follows: (1) to explore patterns of uncomfortable loudness levels (ULLs) across frequency and their associated factors for patients with tinnitus and hyperacusis, and (2) to re-evaluate the criteria for diagnosing hyperacusis based on ULLs and scores for the Hyperacusis Questionnaire (HQ). Design: This was a retrospective cross-sectional study. Study sample: 573 consecutive patients for whom ULLs had been measured were included. Results: A good correspondence between the diagnosis of hyperacusis based on the across-frequency average ULL for the ear with the lowest ULLs (ULLmin) and hyperacusis handicap based on HQ scores was obtained with cut-off values of ULLmin ≤77?dB HL and HQ score ≥?22. A regression model showed significant relationships between ULLmin and the score on the HQ and age. The mean HQ score for patients with a large interaural asymmetry in ULLs was significantly higher than for the remainder. Hyperacusis handicap was associated with strong across-frequency variations in ULLs. Conclusions: Appropriate cut-off values for diagnosing hyperacusis are ULLmin ≤77?dB HL and HQ score ≥22. Large interaural asymmetry and large across-frequency variations in ULLs are associated with higher HQ scores.     

Preliminary evidence of asymmetry in uncomfortable loudness levels after unilateral hearing aid experience: Evidence of functional plasticity in the adult auditory system

The aim of the study was to compare uncomfortable loudness levels (ULLs) in a group of adults before and after unilateral hearing aid experience. Twelve participants presented with a symmetrical hearing loss consistent with natural ageing. Pure tones were presented to each ear separately, commencing at 60?dB HL and increased in 5-dB step sizes until ULL was reached. The post-fitting ULLs were typically measured three years after fitting. Hearing thresholds were symmetrical and remained unchanged after fitting. Mean ULL values were symmetrical before fitting. The mean ULL values increased (i.e. greater tolerance) in both ears after fitting; however, the increase was greatest in the fitted ear: 14.5 and 7?dB at 2000–4000?Hz in the fitted and not-fitted ear, respectively. A separate two-factor repeated ANOVA (ear and frequency) was performed on the pre and post-fitting ULL data. There was no statistically significant difference for ear (p?>?0.05) when comparing the pre-fitting ULLs. However, there was a statistically significant difference for ear (p?<?0.01) when comparing post-fitting ULLs. The underlying mechanism for the asymmetry is unknown but it is consistent with learning induced reorganization within the auditory system.     

Preliminary evidence of asymmetry in uncomfortable loudness levels after unilateral hearing aid experience: evidence of functional plasticity in the adult auditory system

The aim of the study was to compare uncomfortable loudness levels (ULLs) in a group of adults before and after unilateral hearing aid experience. Twelve participants presented with a symmetrical hearing loss consistent with natural ageing. Pure tones were presented to each ear separately, commencing at 60 dB HL and increased in 5-dB step sizes until ULL was reached. The post-fitting ULLs were typically measured three years after fitting. Hearing thresholds were symmetrical and remained unchanged after fitting. Mean ULL values were symmetrical before fitting. The mean ULL values increased (i.e. greater tolerance) in both ears after fitting; however, the increase was greatest in the fitted ear: 14.5 and 7 dB at 2000-4000 Hz in the fitted and not-fitted ear, respectively. A separate two-factor repeated ANOVA (ear and frequency) was performed on the pre and post-fitting ULL data. There was no statistically significant difference for ear (p > 0.05) when comparing the pre-fitting ULLs. However, there was a statistically significant difference for ear (p < 0.01) when comparing post-fitting ULLs. The underlying mechanism for the asymmetry is unknown but it is consistent with learning induced reorganization within the auditory system.     

Uncomfortable loudness levels in experienced unilateral and bilateral hearing aid users: Evidence of adaptive plasticity following asymmetrical sensory input?

Abstract

Munro and Trotter [Inter J Audiol 45, 684-688, 2006] reported an asymmetry in uncomfortable loudness levels (ULLs) in a preliminary study using 12 experienced unilateral hearing aids users. The aim of the present study was to investigate ULLs in a larger sample of listeners with unilateral and bilateral hearing aid experience. Participants were adults with symmetrical high-frequency hearing impairment. There were 48 listeners with unilateral experience, 13 listeners with bilateral experience and a control group of 47 listeners with no hearing aid experience. The minimum duration of hearing aid experience was 2 years. ULLs were measured at 0.5, 1, 2 and 4 kHz. The unilateral group showed a statistically significant inter-aural asymmetry of 3-5 dB. Compared to the controls, there was a non-significant trend of higher ULLs in the fitted ear and lower ULLs in the not-fitted ear. ULLs in the bilateral group were symmetrical and similar to the control group. The findings suggest that changes in ULL may be a feature of asymmetrical sensory input and are consistent with a central gain mechanism.

Sumario

Munro y Rotter [Inter J Audiol 45, 684-688, 2006] reportaron asimetría en los niveles de molestia de intensidad subjetiva (ULLs) en un estudio preliminar, en el que participaron 12 usuarios experimentados unilaterales de auxiliares auditivos. El objetivo de este estudio fue investigar los ULLs en una muestra grande de usuarios, con experiencias uni o bilaterales. Los participantes fueron adultos con pérdida auditiva simétrica en frecuencias agudas y fueron 48 personas con experiencia unilateral, 13 con experiencia bilateral y un grupo control de 47 personas sin experiencia con auxiliares auditivos. La duración minima del uso de los auxiliares auditivos fue de 2 años. Se midieron las ULLs en 0.5, 1, 2 y 4 kHz. El grupo unilateral mostró una asimetría inter-aural de 3-5 dB, estadísticamente significativa. En comparación con los controles no hubo una tendencia significativa hacia mayores ULLs en el oído adaptado y menores ULLs en el oído sin auxiliar. Los ULLs en el grupo bilateral fueron simétricos y similares a los del grupo control. Estos hallazgos sugieren que los cambios en los ULL pueden ser un rasgo de estimulación sensorial asimétrico y que son consistentes con un mecanismo central de ganancia.     

Self-reported and behavioral sound avoidance in tinnitus and hyperacusis subjects,and association with anxiety ratings

Abstract

Objective: The purpose of the study was to analyse the role of sound avoidance and anxiety in tinnitus subjects with hyperacusis, defined as hypersensitivity to low to moderate intensity sounds. Design: A group of tinnitus subjects with hyperacusis was compared to tinnitus subjects without hyperacusis, and healthy controls. For assessing noise avoidance, a questionnaire was developed (noise avoidance questionnaire, NAQ) and the duration of self-exposure to a pure tone was assessed as a behavioral index. Different self-rating instruments concerning tinnitus (STI, TF-12), hyperacusis (GÜF), and anxiety (BAI, STAI-T) were used, as well as a psychoacoustic indicator of hyperacusis (ULL). Study sample: Fifty-six tinnitus subjects with/without hyperacusis and 30 controls without tinnitus and hyperacusis participated in the experiment. Results: The findings indicate that subjects with hyperacusis reported significantly more noise-related avoidance in daily life and show significantly shorter exposure to a pure tone than non-hyperacusic subjects, while discomfort was at the same level for each individual. Self-reported avoidance behavior correlated significantly with distress attributed to hyperacusis (r =0.81), and with anxiety ratings. Conclusions: These results suggest that hyperacusis is associated with noise-related avoidance behavior and anxiety. Systematic exposure to sound could play a significant role in the treatment of hyperacusis.     

The correlation between the hyperacusis questionnaire and uncomfortable loudness levels is dependent on emotional exhaustion

Abstract

Objective: To validate the hyperacusis questionnaire (HQ) in different strata of emotional exhaustion (EE). Design: HQ-scores and uncomfortable loudness levels (ULLs) were assessed in 348 individuals (140 men and 208 women) with low, intermediate, and high EE-levels. Results: Four individuals (1.1%) met the critical value for hyperacusis according to the HQ. An exploratory factor analysis extracted three factors from the HQ accounting for 57.6% of the variance. Internal consistency was acceptable for all subscales and for the total score, with Crohnbach's alpha ranging from 0.65 to 0.86. When controlling for hearing loss, significant correlations between the HQ and ULLs were found on both ears in those with intermediate (right: ?0.328; left: ?0.320) and high EE (right: ?0.349; left: ?0.393), but not with low EE (right: ?0.204; left: ?0.196). All correlations were negative, indicating that higher HQ-scores are correlated with lower ULLs. The strongest correlations were found for the social dimension, indicating that social aspects may correspond best to audiological parameters (ULLs) of hyperacusis. Conclusions: The results emphasize the need to take other factors, such as emotional exhaustion (long-term stress), into consideration when assessing hyperacusis with a questionnaire.     

甲状腺功能异常导致恐声症——对《恐声症鉴别和患病率》一文的验证

目的 分析1例甲状腺功能异常导致恐声症患者的病因机制、临床特征和听力学特点.方法 对患者连续1年的甲状腺功能及听力学检查结果 (包括纯音听阈及不舒适阈、声导抗、耳声发射、听性脑干反应)进行分析,观察患者恐声症与甲状腺功能变化的相关性,并进行颞骨CT、耳蜗内听道水成像核磁共振、甲状腺彩超、心脏彩超及生化检查.结果 甲状腺功能亢进(血清游离甲状腺素FT4升高、高灵敏度血清促甲状腺素3rd-TSH降低)时,听阈正常,但听觉过敏发生,不舒适阈降低,双耳各个频率受累,尤其不舒适阈4000 和8000 Hz分别为30和35 dB HL(右耳),30和25 dB HL(左耳),最少相差仅10 dB.而当甲状腺功能减低(3rd-TSH降低)时,同样出现听觉过敏,不舒适阈也很接近正常听阈.而镫骨肌反射阈无降低,与听阈之差>60 dB.耳声发射、电反应测听未见异常.结论 患者连续1年的听力学检测结果 证明患者甲状腺功能异常是发生恐声症的原因之一,提示甲状腺功能异常与听觉不舒适阈降低具有相关性.甲状腺功能异常可能导致内耳微循环缺血而诱发恐声症.     

Hearing thresholds,tinnitus, and headphone listening habits in nine-year-old children

Objective: Investigate hearing function and headphone listening habits in nine-year-old Swedish children. Design: A cross-sectional study was conducted and included otoscopy, tympanometry, pure-tone audiometry, and spontaneous otoacoustic emissions (SOAE). A questionnaire was used to evaluate headphone listening habits, tinnitus, and hyperacusis. Study sample: A total of 415 children aged nine years. Results: The prevalence of a hearing threshold?≥20?dB HL at one or several frequencies was 53%, and the hearing thresholds at 6 and 8?kHz were higher than those at the low and mid frequencies. SOAEs were observed in 35% of the children, and the prevalence of tinnitus was 5.3%. No significant relationship between SOAE and tinnitus was found. Pure-tone audiometry showed poorer hearing thresholds in children with tinnitus and in children who regularly listened with headphones. Conclusion: The present study of hearing, listening habits, and tinnitus in nine-year old children is, to our knowledge, the largest study so far. The main findings were that hearing thresholds in the right ear were poorer in children who used headphones than in children not using them, which could be interpreted as headphone listening may have negative consequences to children’s hearing. Children with tinnitus showed poorer hearing thresholds compared to children without tinnitus.     

Measurement of Loudness Discomfort Levels as a Test for Hyperacusis: Test-Retest Reliability and Its Clinical Value

ObjectivesThe aims of this study were to investigate the test-retest reliability of measurements of loudness discomfort levels (LDLs), to suggest cut-off values for diagnosing patients with hyperacusis, and to evaluate the clinical value of-LDL measurements as a test for monitoring hyperacusis.MethodsFor the test-retest reliability of LDL measurements (study 1), a total of 68 patients who sought consultations at our clinic were subcategorized into four groups: patients with tinnitus (group 1), tinnitus and hearing loss (group 2), hyperacusis (group 3), and normal controls (group 4). Inter-hour and inter-day test-retest reliability values using different stimuli were investigated. For study 2, the clinical value of LDL measurements using pure tone stimuli was analyzed by comparing changes after sound generator use in patients with hyperacusis.ResultsIn study 1, the group 3 patients showed significantly lower LDLs than the other groups. High test-retest reliability of LDL tests was demonstrated, regardless of the type of stimulus used. The cut-off values for screening patients with hyperacusis were 90 dB HL using pure tone stimuli and 62 dB HL using white-band noise stimuli. In study 2, significantly increased LDLs were correlated with improved symptoms and improved scores on tinnitus questionnaires after sound generator use, indicating that LDL measurement is a reliable test for monitoring hyperacusis during an intervention.ConclusionLDL measurement is a reliable diagnostic tool to reflect the condition of hyperacusis, especially during the course of treatment.     

Hearing in a 54- to 66-year-old population in northern Finland

Abstract

There are only a few large, population-based epidemiological studies on hearing impairment (HI) in adults. The objective of this study was to investigate the prevalence of HI and possible differences between ears in older adults. The subjects (n = 850), aged 54–66 years, were randomly sampled from the population register. A questionnaire survey, an otological examination, and pure-tone audiometry were performed. Another questionnaire was mailed to collect information on non-participants. The prevalence of HI averaged over the frequencies of 0.5, 1, 2, and 4 kHz for the better ear ≥20 dB HL was 26.7% (men: 36.8%, women: 18.4%). There was no difference between left and right ear pure-tone averages over the frequencies 0.5, 1, 2, and 4 kHz (PTA_{0.5–4 kHz}), but a significant difference of ?0.8 dB HL was found for the low frequencies 0.125, 0.25, and 0.5 kHz (PTA_{0.125–0.5 kHz}), and 4.4 dB HL for the high frequencies over 4, 6, and 8 kHz (PTA_{4–8 kHz}). In conclusion, HI was a highly prevalent finding in this age group.

Sumario

Existen pocos estudios epidemiológicos grandes, basados en la población, sobre impedimentos auditivos (HI) en adultos. El objetivo de este estudio fue investigar la prevalencia de HI y posibles diferencias entre los oídos de adultos mayores. La muestra de sujetos (n = 850), con edades de 54–66 años, se hizo al azar, a partir de registros de población. Se aplicó un cuestionario y se realizó un examen otológico y una audiometría de tonos puros. Otro cuestionario fue enviado por correo para colectar información de los no participantes. La prevalencia de HI promediada en las frecuencias de 0.5, 1, 2, y 4 kHz en el mejor oído, >20 dB HL, fue de 26.7% (hombres: 36.8%; mujeres: 18.4%). No hubo diferencia entre los promedios con tonos puros en oídos derecho o izquierdo en las frecuencias de 0.5, 1, 2, y 4 kHz (PTA 0.5–4 kHz), pero si una diferencia significativa de -0.8 dB HL, encontrada en las frecuencias graves de 0.125, 0.25 y 0.5 kHz (PTA 0.125–0.5 kHz), y 4.4 dB HL en las frecuencias agudas de 4, 6 y 8 kHz (PTA 4–8 kHz). En conclusión, el HI fue un hallazgo altamente prevalente en este grupo de edad.     

Long-term results of atresiaplasty in patients with congenital aural atresia

Objectives: To evaluate long-term benefits of atresiaplasty on hearing and the impact of surgery on quality of life (QoL) in congenital aural atresia (CAA) patients.

Methods: We evaluated the long-term hearing results, the impact of atresiaplasty on QoL, the meatal diameter of the operated ear canal, and the cumulative number of post-operative hospital visits in 14 CAA patients, on average, 12 years (range: 4–17 years) post-operatively.

Results: The mean preoperative pure tone average (PTA) was 61?dB HL. The postoperative short-term PTA was 36?dB HL and the long-term PTA was 51?dB HL. The mean total Glasgow Benefit Inventory (GBI) score was 16 (range: ?11–39), showing the positive benefit of atresiaplasty on QoL. The mean postoperative diameter of the auditory meatus was 6?mm. The average number of hospital outpatient visits during the first postoperative year was 10.

Conclusion: Surgery for CAA is a demanding operation with variable anatomical and hearing outcomes. Atresiaplasty operations should be centralized to hospitals with large numbers of such patients to ensure sufficient levels of surgical experience. Bone-anchored hearing devices or middle-ear implants should be considered as a first-line option because they offer good hearing predictability.     

Reference thresholds for the TEN(HL) test for people with normal hearing

Objective: To estimate normative values and repeatability of thresholds for the TEN(HL) test for diagnosing dead regions in the cochlea, as a function of signal frequency, TEN(HL) level, age and gender. Design: The TEN(HL) test was administered twice for each ear of each participant using signal frequencies from 0.5 to 4?kHz and TEN(HL) levels of 30, 50 and 70?dB HL/ERB_N. Study sample: In all, 29 young participants and 8 older participants were tested. All had normal audiograms with no history of hearing problems. Results: There was good repeatability across sessions. There was no significant effect of ear, gender or age group. The average signal-to-TEN ratio (STR) at threshold was close to 0?dB. For low signal frequencies, the STR at threshold varied only slightly with TEN(HL) level, but for the signal frequencies of 3 and 4?kHz the STR at threshold increased to about +2.7?dB for the TEN(HL) level of 70?dB/ERB_N. Conclusions: For a high TEN(HL) level, the “normal” STR at threshold at 3 and 4?kHz is closer to +2?dB than to 0?dB. Further research is needed to assess whether the TEN(HL)-test criteria need to be modified when testing at high frequencies and high levels.     

Review of a single surgeon’s stapedotomy cases performed with a nickel titanium prosthesis over a 14-year period

Abstract

Conclusion: Stapes surgery with a nickel titanium prosthesis is a safe and well-tolerated procedure that leads to a significant improvement in hearing outcomes.

Objective: To identify the efficacy and safety of stapedotomy procedures performed with a nickel titanium prosthesis for patients with otosclerosis.

Methods: A review of 431 unique stapedotomies performed over 14 years by a single surgeon at an academic tertiary care center yielded 312 cases with nickel titanium prosthesis that met inclusion criteria of otosclerosis diagnosis, initial surgery in operative ear, and presence of pre-operative and post-operative audiograms. Pure-tone averages (PTA) at baseline and 8 weeks after surgery were calculated over four frequencies; 0.5, 1, 2, and 4?kHz. Average air–bone gaps (ABG) were calculated from pre-operative and post-operative audiograms.

Results: Average pre-operative baseline PTA was 56.7?dB in the affected ear. Post-operative PTA was 30.1?dB, a 26.6?dB improvement. Initial average ABG was 29.7?dB, while post-operative ABG averaged 5.4?dB, a 24.2?dB improvement. Surgical success (closure of ABG within 10?dB) was achieved in 263 (84%) patients. Rate of surgical success was not correlated with age, gender, race, or affected ear. Complications included recurrent conductive hearing loss (14), progressive SNHL (4), and post-operative BPPV (3).     

Occurrence and suppression effect of Otoacoustic Emissions in normal hearing adults with tinnitus and hyperacusis

The association between tinnitus and hyperacusis is common according to the literature.AimTo verify the occurrence and the suppression effect of transient otoacoustic emissions (TEOAE), the existence of association between tinnitus degrees and hyperacusis degrees, and between the suppressive effect of TEOAE and laterality, tinnitus and hyperacusis degrees in normal hearing adults with complaints of tinnitus and hyperacusis.Materials and Methods25 normal hearing subjects with complaints of hyperacusis and tinnitus were studied in this cross-sectional study. The Tinnitus Handicap Inventory (THI) was used for the classification of tinnitus degrees, and the Loudness Discomfort Level (LDL) for the hyperacusis classification.ResultsThe occurrence of TEOAE ranged from 33 to 88%. We observed the presence of TEOAE suppression effect on 63.7% in the right ear and 81.7% in the left ear. There was no significant correlation between the degrees of tinnitus and hyperacusis in both ears. No statistically significant associations between the TEOAE suppression effect and laterality, tinnitus degrees and hyperacusis degrees were found.ConclusionThe occurrence of TEOAE was lower than that found in normal hearing adults. A higher percentage of the presence of TEOAE suppression effect has been found in both ears. No association between the variables was observed.     

Hearing disorder from music; a neglected dysfunction

Conclusion: Music-induced acute acoustic trauma is not inevitably linked to hearing dysfunction as validated by conventional pure tone audiometry. Tinnitus is often in combination with hyperacusis. Our results point at ‘silent hearing loss’ as the underlying pathology, having afferent nerve terminal damage rather than hair cell loss as the structural correlate.

Objectives: Exposure to loud music is one of the most common causes of acute acoustic trauma, which adolescents and teenagers experience by voluntary exposure to loud music of sound levels up to 110?dB(A).

Methods: The clinical and psychophysical data of 104 consecutive patients with music-induced hearing disorder (MIHD) were analyzed to construct individual hearing and tinnitus profiles. In all cases, tinnitus was the presenting symptom.

Results: Hearing abilities were normal in about two-thirds of the tinnitus patients. Tinnitus was experienced most often as a high-frequency tone (83%). The Tinnitus Handicap Inventory (THI) scores ranged from 0 to 94 with an average score of 43.1. Visual analog scales (VAS) were used to assess tinnitus loudness (average 42.4) and annoyance (average 54.2), and tinnitus awareness was estimated (average 60.3). All VAS values correlated strongly with the THI. Hyperacusis was present in 65% and 71% of the patients reported sleeping disorders.     

Assessment of hyperacusis with a newly produced Japanese version of the Khalfa hyperacusis questionnaire

Objectives: The purpose of this study was to determine the validity and reliability of a Japanese version of the Khalfa hyperacusis questionnaire (KHQ) and proposed a threshold KHQ score for classifying hyperacusis.

Methods: In total, 112 patients with hyperacusis (group A) and 103 patients without hyperacusis (group B). The patients in group A were further classified into the following subgroups: subjects with hyperacusis as their chief complaint (n?=?26, group A1) and subjects with hyperacusis accompanied by chief complaints of tinnitus and/or hearing loss (n?=?86, group A2).

Results: The average total questionnaire score for patients in group A was 11.8?±?9.7, which was statistically significantly higher than that of patients in group B, 5.7?±?4.8. Cronbach’s coefficients for internal consistency were high for the total score (0.92). The average total scores for groups A1 and A2 were 18.1?±?11.1 and 9.9?±?8.4, respectively, and the difference between the groups was statistically significant.

Conclusions: We developed a Japanese version of the KHQ. It showed high reliability and validity; suggesting its usefulness in clinical practice. We propose that a total KHQ score of 16 is an appropriate cutoff for classifying hyperacusis     

DPOAE otoemission in patients with tinnitus and normal hearing

The goal of our study was analysis of characteristic interrogation, audiometry and distortion products otoacoustic emission in patients with normal hearing and complaining of tinnitus. We examined the group of 24 ill patients with hearing threshold up till 25 dB HL and with tinnitus and the control group of 18 with no audiological complains. All the patients were made tonal audiometry and the discomfort level as well as tinnitus frequency and intensity were evaluated. For each ear separately, we examined DPAOE of DP-gram function with resolving power of half the octave and the fine structure on the level of stimulation L1 = L2 = 70 dB. In the group of patients average time of tinnitus was 1.5 year. Average hearing threshold in patients with tinnitus was 18 dB HL for air conduction and 11 dB HL for bone conduction, average discomfort threshold--93 dB HL. In the control group hearing threshold was comparatively 16 dB and 10 dB HL and average discomfort threshold--95 dB HL. In the tinnitus group 8 patients (21%) complained of hyperacusis. The differences between the two groups in DP-gram were observed mainly in high frequencies (higher than 3000 Hz). In DP-gram fine structure in the group of patients with tinnitus we noted wider span of otoemission decreases (over the octave) compared to control group. In the tinnitus group among 20 examined ears with decreases of otoacoustic emission DP--fine structure only in 6 patients (30%) the frequency of tinnitus given by the patient was overlapping with the frequency for which decreases of otoemission were observed. In both groups we observed decreases of DPOAE for some frequencies but in the patients with tinnitus we noticed the lack of otoacoustic emission in wider span of frequencies, mainly in higher frequencies compared to controls.     

Factors influencing degree of hearing loss at presentation,hearing aid choice,and usage in first time hearing aid users in Singapore

Abstract

Objective: To examine the factors associated with late presentation at first hearing aid (HA) fitting, HA choice and usage among users in Singapore.

Design: Retrospective cross-sectional study.

Study sample: 1068 subjects issued with HAs at a tertiary hospital from 2001 to 2013.

Results: Half of the subjects presented with more severe (>55?dB) hearing loss (HL) in their better ear. In multivariable analysis, older age, Malay ethnicity, conductive and mixed HL, and combination type of HL were associated with more severe HL at first presentation. Over 70% of subjects were older than 65 years. Worse pure tone audiometry (PTA) thresholds of the better ear, gradual onset and sensorineural HL were associated with older age presentation. For unilaterally fitted subjects, PTA thresholds were the only determinant of having the better ear aided. Better PTA thresholds, younger age and sensorineural HL were associated with choosing in ear compared to behind the ear HAs. Younger age and worse PTA of the better ear were associated with ≥4?h of daily HA usage.

Conclusions: Age, ethnicity and type of HL were important determinants for more severe HL at first HA fitting. Older patients and those with better hearing were less likely to use their HAs regularly.     

Extended high-frequency pure tone hearing thresholds and core executive functions

Abstract

Objective: To examine the relationship between extended high-frequency pure tone hearing thresholds (frequencies 10 to 14?kHz) and working memory capacity (WMC), inhibitory control, and cognitive flexibility.

Design: Experimental study measuring correlations between different high-frequency hearing threshold measures and cognitive measures.

Study: Pure tone audiometry was assessed in the extended high-frequency (frequencies 10, 12.5 and 14?kHz). Subjects were also tested regarding WMC, inhibitory control (response inhibition), and cognitive flexibility (information updating and shifting ability).

Sample: Forty-three subjects between 20 and 29 years old with normal hearing (≤?20?dB HL) in the frequency range between 0.125 to 8?kHz.

Results: No significant correlations were seen between high-frequency hearing thresholds defined as average best and worst ear high-frequency hearing thresholds and the cognitive measures. Differences between the best and the worst ear showed significant negative correlations with inhibitory control and global executive function (combination score for WMC, inhibitory control and cognitive flexibility).

Conclusions: The present study suggests that global executive functions, more specifically response inhibition, and hearing threshold asymmetry in the extended high-frequency range are interrelated.     

Evaluating recommended audiometric changes to candidacy using the speech intelligibility index

Introduction: The National Institute of Health and Care Excellence (NICE) has derived candidacy guidelines for cochlear implants in the UK based on audiometric thresholds (90 dB HL or above at 2 and 4 kHz; hereafter referred to as the 90 dB HL criteria). Recent research has proposed that these criteria should be changed to 80 dB HL at 2 and 4 kHz (hereafter referred to as the 80 dB HL criteria) in the ear to be implanted.

Methods: In this study, we analysed aided SII scores derived for different hearing loss profiles falling within the current 90 dB HL criteria and equivalent profiles falling within the new 80 dB HL criteria.

Results: The aided SII scores demonstrated that the majority of potential hearing configurations falling within the new proposed 80 dB HL criteria have aided SII values of less than 0.65 (a recommended cut-off point below which there is not sufficient audibility to receive adequate benefit through hearing aids).

Conclusions: This supports the proposed change to the 80 dB HL criterion level and also highlights the additional value of the SII score in supporting candidacy decisions for CI, especially for borderline candidates.