Fitting range of the BAHA Cordelle

The performance of the most powerful Bone-Anchored Hearing Aid (BAHA) currently available, the BAHA Cordelle, was evaluated in 25 patients with severe to profound mixed hearing loss. Patients showed bone conduction thresholds at 500, 1000 and 2000 Hz, ranged between 30 and 70 dB HL, and an additional air-bone gap of about at least 30 dB. With the BAHA Cordelle, free-field thresholds improve relative to bone-conduction thresholds with 1.5, 5.0, 17.8, and 4.3 dB at 500, 1000, 2000, and 4000 Hz, respectively, with substantial inter-individual variability. The differences in unaided air conduction thresholds and aided free-field thresholds amount to 45.3, 45.8, 47.5, and 43.5 dB at 500, 1000, 2000, and 4000 Hz, respectively. Speech perception, measured both with monosyllables of the consonant-vowel-consonant type and with bisyllables, showed highly similar results. The fitting range of a (linear) hearing aid is determined by its gain characteristics. Requiring aided speech reception thresholds at or better than 65 dB SPL results in an upper limit of the fitting range of the BAHA Cordelle for bone-conduction thresholds of 51, 56, 67, and 58 dB HL at 500, 1000, 2000, and 4000 Hz, respectively. The dynamic range provided by the BAHA Cordelle was estimated from loudness growth functions at 500, 1500, and 3000 Hz employing 7-point categorical scaling. On average, aided loudness growth functions exhibit normal slopes but they level off at input levels of about 80, 70, 65 dB SPL for 500, 1500, and 3000 Hz stimuli, respectively. Measurements with a skull simulator demonstrated that the levelling-off reflects saturation of the output of the Cordelle. The relatively low saturation levels of the device suggest that increasing maximum output levels may be a worthwhile consideration for candidates with more profound sensorineural loss.     

Multiple auditory steady-state responses to bone-conduction stimuli in adults with normal hearing

ASSR thresholds to bone-conduction stimuli were determined in 10 adults with normal hearing using mastoid placement of the bone oscillator. ASSRs to 0-50 dB HL bone-conduction stimuli and to 30-60 dB HL air-conduction stimuli were compared. The effect of alternating stimulus polarity on air- and bone-conduction ASSRs was also investigated. Stimuli were bone- and air-conduction amplitude-modulated tones (500-4000 Hz carrier frequencies, modulated at 77-101 Hz). ASSRs were recorded using the Rotman MASTER research system. Mean (1SD) bone-conduction ASSR thresholds were 22(11), 26(13), 18(8), and 18(11) dB HL for 500, 1000, 2000, and 4000 Hz, respectively. Except for a steeper slope at 500 Hz, ASSR intensity-amplitude functions for binaural bone- and air-conduction stimuli showed the same slopes; intensity-phase-delay functions were steeper at 1000 Hz for ASSRs to bone-conduction stimuli. ASSR amplitudes and phases did not differ for single- versus alternated-stimulus polarities for both bone- and air-conduction stimuli. The steeper amplitude slope for ASSRs to 500 Hz stimuli may reflect a nonauditory contribution to the ASSR.     

Multiple auditory steady-state response thresholds to bone-conduction stimuli in young infants with normal hearing

OBJECTIVE: Multiple auditory steady-state responses (ASSRs) probably will be incorporated into the diagnostic test battery for estimating hearing thresholds in young infants in the near future. Limiting this, however, is the fact that there are no published bone-conduction ASSR threshold data for infants with normal or impaired hearing. The objective of this study was to investigate bone-conduction ASSR thresholds in infants from a Neonatal Intensive Care Unit (NICU) and in young infants with normal hearing and to compare these with adult ASSR thresholds. DESIGN: ASSR thresholds to multiple bone-conduction stimuli (carrier frequencies: 500 to 4000 Hz; 77 to 101-Hz modulation rates; amplitude/frequency modulated; single-polarity stimulus) were obtained in two infant groups [N = 29 preterm (32 to 43 wk PCA), tested in NICU; N = 14 postterm (0 to 8 mo), tested in sound booth]. All infants had passed a hearing screening test. ASSR thresholds, amplitudes, and phase delays for preterm and postterm infants were compared with previously collected adult data. RESULTS: Mean (+/-1 SD) ASSR thresholds were 16 (11), 16 (10), 37 (10), and 33 (13) dB HL for the preterm infants and 14 (13), 2 (7), 26 (6), and 22 (8) dB HL for the postterm infants at 500, 1000, 2000, and 4000 Hz, respectively. Both infant groups had significantly better thresholds for 500 and 1000 Hz compared with 2000 and 4000 Hz, in contrast to adults who have similar thresholds across frequency (22, 26, 18, and 18 dB HL). When 500- and 1000-Hz thresholds were pooled, pre- and postterm infants had better low-frequency thresholds than adults. When 2000- and 4000-Hz thresholds were pooled, pre- and postterm infants had poorer thresholds than adults. ASSR amplitudes were significantly larger for low frequencies compared with high frequencies for both infant groups, in contrast to adults, who show little difference across frequency. ASSR phase delays were later for lower frequencies compared with higher frequencies for infants and adults, except for 500 Hz in the preterm group. ASSR phase delays were later for infants compared with adults across frequency. CONCLUSIONS: Infant bone-conduction ASSR thresholds are very different from those of adults. Overall, these results indicate that low-frequency bone-conduction thresholds worsen and high-frequency bone-conduction thresholds improve with maturation. Bone-conduction ASSR threshold differences between the postterm infants and adults probably are due to skull maturation. Differences between preterm and older infants may be explained both by skull changes and a masking effect of high ambient noise levels in the NICU (and possibly to other issues due to prematurity).     

Evaluation of relationship between hearing threshold and loudness discomfort level in sensorineural hearing loss.

The relationship between hearing level and loudness discomfort level (LDL) for narrow-band noise was evaluated in two groups of patients with sensorineural hearing loss. Group I had thresholds ranging from 25-60 dB SPL and Group II's thresholds ranged from 65-100 dB SPL. LDLs were determined for narrow bands of noise centered at 500, 1000, 2000, and 4000 Hz. The LDLs for Group II were greater than those for Group I and the differences were statistically significant. It is speculated that one reason for others not finding differences as a function of hearing level may be the absence of severe to profound hearing loss in the test populations.     

Artifactual responses when recording auditory steady-state responses

OBJECTIVE: The goal of this study was to investigate, in hearing-impaired participants who could not hear the stimuli, the possibility of artifactual auditory steady-state responses (ASSRs) when stimuli are presented at high intensities. DESIGN: ASSRs to single (60 dB HL) and multiple (20 to 50 dB HL; 500 to 4000 Hz) bone-conduction stimuli as well as single 114 to 120 dB HL air-conduction stimuli, were obtained using the Rotman MASTER system, using analog-to-digital (A/D) conversion rates of 500, 1000, and 1250 Hz. Responses (p < 0.05) were considered artifactual when their numbers exceeded that expected by chance. In some conditions, we also obtained ASSRs to "alternated" stimuli (stimuli inverted and ASSRs to the two polarities averaged). A total of 17 subjects were tested. RESULTS: Bone conduction results: 500 Hz A/D rate: Large-amplitude (43 to 1558 nV) artifactual ASSRs were seen at 40 and 50 dB HL for the 500 Hz carrier frequency. Smaller responses (28 to 53 nV) were also recorded at 20 dB HL for the 500 Hz carrier frequency. Artifactual ASSRs (17 to 62 nV) were seen at 40 dB HL and above for the 1000 Hz carrier frequency and at 50 dB HL for the 2000 Hz carrier frequency. Alternating the stimulus polarity decreased the amplitude and occurrence of these artifactual responses but did not eliminate responses for the 500 Hz carrier frequency at 40 dB HL and above. No artifactual responses were recorded for 4000 Hz stimuli for any condition. 1000 Hz A/D rate: Artifactual ASSRs (15 to 523 nV) were seen at 50 dB HL and above for the 500 Hz carrier frequency and 40 dB HL and above for the 1000 Hz carrier frequency. Artifactual responses were also obtained at 50 dB HL for a 2000 Hz carrier frequency but not at lower levels. Artifactual responses were not seen for the 4000 Hz carrier frequency. Alternating the stimulus polarity removed the responses for the 1000 and 2000 Hz carrier frequencies but did not change the results for the 500 Hz carrier frequency. 1250 Hz A/D rate: Artifactual ASSRs (16 to 220 nV) were seen at 50 dB HL and above for the 500 Hz carrier frequency and 60 dB HL and above for the 1000 Hz carrier frequency. Alternating the stimulus polarity removed the responses for the 1000 Hz carrier frequency but did not change the results for the 500 Hz carrier frequency. There were no artifactual responses at 2000 and 4000 Hz. Air conduction results: 500 Hz A/D rate: Artifactual ASSRs (49 to 153 nV) were seen for 114 to 120 dB HL stimuli for 500 and 1000 Hz carrier frequencies. Alternating the stimulus polarity removed these responses. There were no artifactual responses at 2000 and 4000 Hz. 1000 and 1250 Hz A/D rates: Artifactual ASSRs (19 to 55 nV) were seen for a 120 dB HL stimulus for a 1000 Hz carrier. Alternating the stimulus polarity removed these responses. CONCLUSIONS: High-intensity air- or bone-conduction stimuli can produce spurious ASSRs, especially for 500 and 1000 Hz carrier frequencies. High-amplitude stimulus artifact can result in energy that is aliased to exactly the modulation frequency. Choice of signal conditioning (electroencephalogram filter slope and low-pass cutoff) and processing (A/D rate) can avoid spurious responses due to aliasing. However, artifactual responses due to other causes may still occur for bone-conduction stimuli 50 dB HL and higher (and possibly for high-level air conduction). Because the phases of these spurious responses do not invert with inversion of stimulus, the possibility of nonauditory physiologic responses cannot be ruled out. The clinical implications of these results are that artifactual responses may occur for any patient for bone-conduction stimuli at levels greater than 40 dB HL and for high-intensity air-conduction stimuli used to assess patients with profound hearing loss.     

Normal brief-tone bone-conduction behavioral thresholds using the B-71 transducer: three occlusion conditions

Behavioral thresholds were measured from 31 adults with normal hearing for 500, 1000, 2000, and 4000 Hz brief tones presented using a B-71 bone oscillator. Three occlusion conditions were assessed: ears unoccluded, one ear occluded, and both ears occluded. Mean threshold force levels were 67, 54, 49, and 41 dB re:1 microN peak-to-peak equivalent in the unoccluded condition for 500, 1000, 2000, and 4000 Hz, respectively (corrected for air-conduction pure-tone thresholds). A significant occlusion effect was observed for 500 and 1000 Hz stimuli. These thresholds may be used as the 0 dB nHL (normal-hearing level) for brief-tone bone-conduction stimuli for auditory brainstem response testing.     

An investigation into the clinical utility of ipsilateral/ contralateral asymmetries in bone-conduction auditory steady-state responses

Abstract

Objective: To determine whether ipsilateral/contralateral asymmetries in the bone-conduction (BC) ASSR are robust enough in infants to be used clinically to isolate the test ear. Design: Retrospective investigation of three two-channel BC ASSR datasets. Subjects: Forty-eight adults (mean age 26.7 years), 49 infants (mean age 29.6 weeks). Methods: BC ASSR stimuli were presented as amplitude/frequency modulated sinusoidal tones with carrier frequencies of 500, 1000, 2000, and 4000 Hz (?10 to 45 dB HL). Results: Infants showed greater differences in ipsilateral/contralateral mean amplitudes and phase delays for all experimental conditions compared to adults. Ninety percent of infants had ipsilateral/contralateral asymmetries at 500 and 4000 Hz (20–35 dB HL) using an “amplitude or phase delay” criterion, and at 4000 Hz (20–25 dB HL) using an “amplitude and phase delay” criterion. Conclusions: As ipsilateral/contralateral asymmetries are not consistently present for 1000- and 2000-Hz BC ASSRs in infants, clinical masking would be needed at these frequencies to isolate the test ear. For 500- and 4000-Hz BC ASSRs, the accuracy of using these asymmetries requires clinical confirmation in a group of infants with hearing loss.     

Evaluation of residual hearing in cochlear implants candidates using auditory steady-state response

Conclusion: The correlations between behavioral and auditory steady-state response (ASSR) thresholds were significant at 500, 1000, 2000, and 4000 Hz. ASSR presented high sensitivity and specificity in the detection of residual hearing in cochlear implant candidates when compared with warble-tone audiometry. Objectives: To assess residual hearing in cochlear implant candidates by comparing the electrophysiological thresholds obtained in dichotic single-frequency ASSR with behavioral thresholds at 500, 1000, 2000, and 4000 Hz. Methods: This was a comparative study between ASSR and warble-tone audiometry thresholds in 40 cochlear implant candidates (80 ears) before cochlear implantation with bilateral severe-to-profound sensorineural hearing loss. Results: Thresholds were obtained in 62.5% of all frequencies evaluated in warble-tone audiometry and in 63.1% in the ASSR. ASSR sensitivity was 96% and specificity was 91.6%. Mean differences between behavioral and ASSR thresholds did not reach significance at any frequencies. Strong correlations between behavioral and ASSR thresholds were observed in 500, 1000, and 2000 Hz and moderate in 4000 Hz, with correlation coefficients varying from 0.65 to 0.81. On 90% of occasions, ASSR thresholds were acquired within 10 dB of behavioral thresholds.     

New version of the TEN test with calibrations in dB HL

OBJECTIVE: To develop a new version of the threshold-equalizing-noise (TEN) test for the diagnosis of dead regions, with levels calibrated in dB HL rather than dB SPL, and with levels corresponding to the dial readings on the audiometer. DESIGN: The spectral shape of the noise required to give equal masked thresholds at all frequencies, when expressed in dB HL, was derived by two calculation methods and by empirical measurements of the electrical output of audiometers using TDH50 earphones and TDH39 earphones. To reduce the loudness of the noise and to minimize distortion generated in the audiometer and/or earphone, the noise was bandlimited between 354 and 6500 Hz. In addition, the noise was synthesized using a method that leads to a low crest factor (ratio of peak to root-mean-square value). This further reduced audiometer/earphone distortion and allowed higher levels per ERBN; ERBN is the equivalent rectangular bandwidth of the auditory filter at 1 kHz, as determined in young, normally hearing subjects. The test tone frequencies were limited to the range 500 to 4000 Hz. Subjects with normal or near-normal hearing were tested by using a noise level of 60 dB HL/ERBN to assess whether the noise did lead to equal masked thresholds in dB HL for all audiometric frequencies from 500 to 4000 Hz. Thresholds in the TEN were measured by means of manual audiometry with a 2 dB final step size. RESULTS: The mean masked thresholds were almost constant across frequency when expressed in dB HL and were within 0.5 dB of the noise level per ERBN. For a single noise level, the test takes approximately 5 minutes per ear to administer. CONCLUSIONS: The new TEN test has the following advantages over the original version (which used levels calibrated in dB SPL): (1) All levels are expressed in dB HL. Thus, absolute thresholds only need to be measured once. (2) Calibration is such that both the noise level/ERBN and the test tone levels correspond to the values indicated on the audiometer. This makes the test simpler to apply and reduces the likelihood of errors. (3) The noise bandwidth is restricted, and the noise has a low crest factor. This allows the noise level/ERBN to be increased while avoiding distortion, excessive loudness, and possible further damage to hearing.     

Estimation of the loudness of tinnitus from matching tests.

To correct for the influence of recruitment when the loudness of tinnitus is measured by a balance test in an ear with sensorineural hearing loss, an averaged loudness function was devised, which converts the sensation level (SL) of tinnitus into an estimate of the effective loudness level. This is essentially the same as a phon scale except for the difference in reference level, and is defined as the equivalent SL of the tinnitus as if measured in an ear with a bone-conduction threshold of 0 dB HL at a frequency between 500 Hz and 4000 Hz. Using this function, the median estimated loudness of tinnitus from 301 randomly selected patients was 15 dB 'effective loudness level' with a maximum of more than 60 dB. A nomogram was made for clinical use to determine the effective loudness level easily from the SL of tinnitus and the bone-conduction HTL of the test ear. Although somewhat approximate, the effective loudness level is considered to be an unbiased loudness estimate of tinnitus under the condition that only the SL of tinnitus and the bone-conduction HTL are available, and makes it easier to appreciate the actual loudness compared with a complex loudness unit such as on the sone scale.     

Auditory brainstem response results as predictors of behavioral auditory thresholds in severe and profound hearing impairment

Pediatric cochlear implantation is restricted to patients with stable, bilateral profound sensorineural hearing losses who derive no benefit from conventional amplification. Obtaining reliable audiologic thresholds in a young child with sudden or early-onset hearing loss can be challenging. This study examines the accuracy with which auditory brainstem response evaluation can predict unaided and aided behavioral thresholds in a child with severe-to-profound hearing loss. Reliable behavioral thresholds were obtained on 119 children who had no measurable click-evoked auditory brainstem responses at instrumentation limits of 100 dB HLn. These data show that an absent auditory brainstem response at 100 dB HLn does not necessarily indicate the absence of measurable unaided hearing for test frequencies ranging from 250 Hz to 4000 Hz. Average aided thresholds of better than 60 dB were present in 43% of the children for 500, 1000, and 2000 Hz and in 53% for 500 and 1000 Hz. Therefore, the absence of a click-evoked auditory brainstem response at 100 dB HLn in a young child is not prima facie evidence of the child's cochlear implant candidacy.     

Comparison of threshold estimation in infants with hearing loss or normal hearing using auditory steady-state response evoked by narrow band CE-chirps and auditory brainstem response evoked by tone pips

Objective: The objective of this study is to compare air-conduction thresholds obtained with ASSR evoked by narrow band (NB) CE-chirps and ABR evoked by tone pips (tpABR) in infants with various degrees of hearing loss. Design: Thresholds were measured at 500, 1000, 2000 and 4000?Hz. Data on each participant were collected at the same day. Study sample: Sixty-seven infants aged 4 d to 22 months (median age?=?96 days), resulting in 57, 52, 87 and 56 ears for 500, 1000, 2000 and 4000?Hz, respectively. Results: Statistical analysis was performed for ears with hearing loss (HL) and showed a very strong correlation between tpABR and ASSR evoked by NB CE-chirps: 0.90 (n?=?28), 0.90 (n?=?28), 0.96 (n?=?42) and 0.95 (n?=?30) for 500, 1000, 2000 and 4000?Hz, respectively. At these frequencies, the mean difference between tpABR and ASSR was ?3.6?dB (±?7.0), ?5.2?dB (±?7.3), ?3.9?dB (±?5.2) and ?5.2?dB (±?4.7). Linear regression analysis indicated that the relationship was not influenced by the degree of hearing loss. Conclusion: We propose that dB nHL to dB eHL correction values for ASSR evoked by NB CE-chirps should be 5?dB lower than values used for tpABR.     

Comparison of air-conduction and bone-conduction hearing thresholds for pure tones and octave-band filtered sound effects

The purpose of this study was to measure air-conduction (AC) and bone-conduction (BC) hearing thresholds with pure-tone and filtered sound effect stimuli using standard audiometric equipment. A group of 20 young, normal-hearing listeners participated in the study. Pure-tone stimuli were 250, 500, 1000, 2000, and 4000 Hz. Sound effect stimuli were 12 natural sounds that were spectrally limited to an octave bandwidth centered at either 250, 500, 1000, 2000, or 4000 Hz. The AC and BC detection thresholds were measured using a clinical audiometer (Madsen Orbiter 922) with a B-71 bone oscillator and TDH-50 earphones. Results indicated that detection thresholds for the pure-tone and corresponding octave-band sound effect stimuli were within 3 to 4 dB of each other for both AC and BC testing. The findings support the notion that octave-filtered sound effects are a viable alternative to pure-tone stimuli for use in audiology clinics.     

索菲康骨导助听器助听效果的多中心研究

目的 评估软带或头带佩戴新型经皮传导索菲康骨导助听器对传导性聋或混合性聋、单侧聋患者的助听效果.方法 以来自国内4家三级甲等医院的109例传导性或混合性聋患者及11例单侧聋(single-sided deafness,SSD)患者为研究对象,均以纯音测听(≥6岁患者)或听性脑干反应(ABR)(<6岁患者)评估裸耳听阈后予以头带或软带佩戴索菲康Alpha 2 MPO骨导助听器;并在声场下进行未助听、佩戴当日及佩戴2周后的助听听阈(0.5~4 kHz)测试;≥6岁患者进行未助听、佩戴当日及佩戴2周助听下的言语识别阈(speech recognition threshold, SRT)测试,并记录患者佩戴后的不良反应.结果 传导性或混合性聋患者中≥6岁患者助听耳裸耳骨导及气导平均听阈均值分别为18.55±8.99、71.45±10.25 dB HL,<6岁组助听耳裸耳骨导及气导ABR阈值均值分别为18.33±8.36、70.80±8.24 dB HL;SSD患者助听耳裸耳听阈不能测出;佩戴2周后,三组助听后纯音听阈均值分别为32.21±10.00、37.33±14.15、34.38±10.76 dB HL,较未助听时明显改善,差异有统计学意义(P<0.05);≥6岁传导性或混合性聋组和SSD组患者佩戴2周后助听下各方向SRT较未助听时均显著降低,差异有统计学意义(P<0.05);各组患者均无与佩戴助听器相关的不良皮肤反应等.结论 使用软带、头带佩戴索菲康骨导助听器,可有效改善传导性或混合性聋、SSD患者听阈和安静环境下言语识别阈.     

Effects of stimulus level on the speech perception abilities of children using cochlear implants or digital hearing aids

OBJECTIVE: The present investigation was designed to provide information to facilitate the decision of whether a child should continue using digital signal processing (DSP) hearing aids with wide dynamic range compression (WDRC) or be recommended for a cochlear implant, based on the unaided pure-tone average (PTA at 500, 1000, and 2000 Hz). DESIGN: Fifty-two children (ages 5 to 15 yr) with unaided PTAs in the moderately severe to profound range, wearing (DSP) hearing aids with (WDRC) or a Nucleus 24, Clarion 1.2, or CII cochlear implant system, participated: 26 with unaided PTAs from 60 to 98 dB HL using DSP hearing aids and 26 with pre-implant unaided PTAs from 93 to 120 dB HL, using cochlear implants. An open-set speech perception test, the Lexical Neighborhood Test (LNT; ), was administered at intensity levels representative of raised (70 dB SPL) and soft (50 dB SPL) speech at two different times approximately 1 mo apart. Minimum audibility of soft sounds was determined for the children with implants and with DSP hearing aids using warble-tone thresholds at octave intervals between 250 and 4000 Hz. RESULT: Regression analyses and significance testing were used to determine the unaided PTA values at which the performance of the DSP Hearing Aid group (DSP HA group) and Cochlear Implant group on the LNT test were statistically different at the 0.05 significance level. For the 70 dB SPL presentation level, the statistically different PTAs were 113 and 97 dB HL at Time 1 and Time 2, respectively, and 96 and 88 dB HL at 50 dB SPL for Time 1 and Time 2, respectively. CONCLUSIONS: The Unaided PTA at which children in the cochlear implant group would be expected to score significantly better than the children in the DSP HA group was lowest (96 and 88 dB HL) for the lower signal level (50 dB SPL). Assuming that LNT scores at 50 dB SPL are representative of long-term hearing of soft incidental speech that is essential for language learning and fluent communication, the children with PTA values greater than the range from 88 to 96 dB HL would be expected to have significantly better LNT scores with a cochlear implant. These results should be further examined with research efforts focusing on early intervention with optimally fitted DSP hearing aids and cochlear implants.     

Bone-anchored hearing aid system application for unilateral congenital conductive hearing impairment: audiometric results.

OBJECTIVE: To study the audiologic outcome of bone-anchored hearing aid (BAHA) application in patients with congenital unilateral conductive hearing impairment. STUDY DESIGN: Prospective audiometric evaluation on 20 patients. SETTING: Tertiary referral center. PATIENTS: The experimental group comprised 20 consecutive patients with congenital unilateral conductive hearing impairment, with a mean air-bone gap of 50 dB. METHODS: Aided and unaided hearing was assessed using sound localization and speech recognition-in-noise tests. RESULTS: Aided hearing thresholds and aided speech perception thresholds were measured to verify the effect of the BAHA system on the hearing acuity. All patients fulfilled the criteria that the aided speech reception thresholds or the mean aided sound field thresholds were 25 dB or better in the aided situation. Most patients were still using the BAHA almost every day. Sound localization scores varied widely in the unaided and aided situations. Many patients showed unexpectedly good unaided performance. However, nonsignificant improvements of 3.0 (500 Hz) and 6.9 degrees (3,000 Hz) were observed in favor of the BAHA. Speech recognition in noise with spatially separated speech and noise sources also improved after BAHA implantation, but not significantly. CONCLUSION: Some patients with congenital unilateral conductive hearing impairment had such good directional hearing and speech-in-noise scores in the unaided situation that no overall significant improvement occurred after BAHA fitting in our setup. Of the 18 patients with a complete data set, 6 did not show any significant improvement at all. However, compliance with BAHA use in this patient group was remarkably high. Observations of consistent use of the device are highly suggestive of patient benefit. Further research is recommended to get more insight into these findings.     

Congenital aural atresia: bone-anchored hearing aid vs. external auditory canal reconstruction

Objective

To compare the audiologic outcome and feasibility of bone-anchored hearing aid (BAHA) and external auditory canal reconstruction (EACR) surgeries in pediatric patients presenting a congenital aural atresia (CAA).

Methods

A retrospective chart review of 40 patients operated in our tertiary pediatric care center between 2002 and 2010 was performed. 20 patients underwent EACR, whereas another 20 patients were implanted with a BAHA device. Air conduction (AC), bone conduction (BC), pure tone average (PTA) and speech discrimination score (SDS) were compared preoperatively, and hearing gain (HG) postoperatively at 6 and at 12 months at frequencies of 500, 1000, 2000 and 4000 Hz. Operative time, complications and associated microtia were documented as well. EACR patients were graded retrospectively upon Jahrsdoerfer's classification.

Results

Preoperative AC were significantly different between groups, at 500, 1000 and 2000 Hz but not at 4000 Hz. BAHA group compared postoperatively to EACR group showed significantly a superior HG of 46.9 ± 7.0 dB (p < 0.001) and of 39.8(7) ± 7.2(6.9) dB (p < 0.001) at 6 months and at 1 year, respectively.Moreover, aided air thresholds from the EACR group revealed an audiologic status similar to those of the BAHA group patients, at 6 months and one year postoperatively. Both groups had a similar evolution of their BC, as well as of the incidence of complications. We report one case of transient facial paralysis in the EACR group. Total operative time is significantly lower (p < 0.001) for a BAHA implantation (56 ± 21 min) than for EACR surgery (216 ± 174 min). No preoperative or postoperative correlation (Pearson correlation test; p > 0.05) was found between patient's Jahrsdoerfer's score and their audiologic outcome. HG does not seem to be influenced by the presence of microtia.

Conclusion

EACR, although constituting an attractive option, does not give acceptable results alone. It can however, when combined to conventional air conduction hearing aids, provide excellent audiologic outcomes comparable to BAHA. BAHA implantation is a reliable, safe and efficient therapeutic option that allows a significantly better audiologic outcome when compared to unaided EACR for patients with CAA.     

Occupational hearing loss: screening with distortion-product otoacoustic emissions

Hearing assessment of applicants for occupational hearing loss compensation can be a time-consuming process. An accurate screening procedure that is sensitive to occupational hearing loss may have application in many situations. The present study developed distortion-product otoacoustic emission (DPOAE) screening criteria to identify subjects likely to meet the Hong Kong requirements for occupational hearing loss compensation, namely a bilateral sensorineural loss ≥ 40 dB HL (average of 1000, 2000 and 3000 Hz). The screening criteria of 1500 and/ or 2000 Hz, with a signal-to-noise ratio of >0 or 3 dB, yielded high sensitivity and specificity. DPOAE measures therefore have the potential to accurately indicate possible occupational hearing loss. However, DPOAEs should be used as a screening tool only, as conventional pure-tone audiometry remains the more comprehensive measure of hearing sensitivity.     

Objective assessment of auditory thresholds in noise‐induced hearing loss using steady‐state evoked potentials

Objective assessment of auditory thresholds in noise‐induced hearing loss using steady‐state evoked potentials The purpose of this study is to evaluate whether steady‐state evoked potential (SSEP) can be used for objective estimation of auditory thresholds in patients with noise‐induced hearing loss (NIHL). Eleven subjects (22 ears) with a characteristic audiometric notch between 3000 and 6000 Hz participated in this study. Both pure‐tone thresholds and SSEP thresholds were obtained for each ear of all subjects. The correlation of SSEP thresholds and pure‐tone thresholds was assessed. The results show that SSEP thresholds predicted pure‐tone thresholds with correlation coefficients (r) of 0.86, 0.92, 0.94 and 0.95 at 500, 1000, 2000 and 4000 Hz respectively. Typically, the SSEP thresholds overestimate the pure‐tone thresholds by 10–20 dB, but they closely reflect the configuration of the audiogram. The strength of the relationship between SSEP and pure‐tone thresholds increased with increasing frequency and increasing degree of hearing loss. In conclusion, SSEP can be used as a reliable and objective tool to assess auditory thresholds in patients with noise‐induced hearing loss with high‐frequency dips.