改良Contour试验测试正常听力与感音神经性听力损失儿童响度增长

目的 应用改良Contour试验测试听力正常与感音神经性听力损失儿童的响度增长,探讨改良Contour试验的临床应用价值.方法 对26例(26耳)听力正常儿童、25例(25耳)感音神经性听力损失儿童采用临床对照试验用改良Contour试验进行响度测试.在初测2～3周后进行复测.采用多因素方差分析进行统计学分析.结果 在听力正常组、不同程度听力损失组间(F=1386.32,P值＜0.001)及不同响度分级间(F=682.21,P＜0.001)响度的差异均有统计学意义.听力正常组与听力损失组动态范围间差异有统计学意义(F=214.26,P＜0.001).感音神经性听力损失儿童响度增长特征:听力损失越重,响度增长越快,动态范围越小.听力正常组与听力损失组初复测结果高度相关(r值分别为0.97和0.91),可信度较高.结论 儿童助听器验配应尽可能获取个体的响度测试结果以帮助助听器调试到最适合该患儿使用.改良Contour试验易为儿童接受、可靠性好,值得进一步研究用于临床,以帮助提高助听器验配质量.     

Adaptation of the HINT (hearing in noise test) for adult Canadian Francophone populations

The HINT provides an efficient and reliable method of assessing speech intelligibility in quiet and in noise by using an adaptive strategy to measure speech reception thresholds for sentences, thus avoiding ceiling and floor effects that plague traditional measures performed at fixed presentation levels. A strong need for such a test within the Canadian Francophone population, led us to develop a French version of the HINT. Here we describe the development of this test. The Canadian French version is composed of 240-recorded sentences, equated for intelligibility, and cast into 12 phonemically balanced 20-sentence lists. Average headphone SRTs, measured with 36 adult Canadian Francophone native speakers with normal hearing, were 16.4?dBA in quiet, ?3.0?dBA SNR in a 65?dBA noise front condition and ?11.4?dBA SNR in a 65?dBA noise side condition. Reliability was established by means of within-subjects standard deviation of repeated SRT measurements over different lists and yielded values of 2.2 and 1.1?dB for the quiet and noise conditions, respectively.     

水杨酸钠对噪声性听力损失影响的实验观察

目的　观察水杨酸钠能否减轻噪声引起的听力损失。方法　将 3 6只健康且耳廓反射正常的花色豚鼠随机分为水杨酸钠实验组、生理盐水对照组、水杨酸钠对照组和噪声暴露组。噪声暴露采用 10 5dBSPL的 4kHz窄带噪声下暴露 2h ,连续 5d。水杨酸钠给药为每天 0 5g/kg体重连续10d。由短声诱发听性脑干反应 (auditorybrainstemresponse ,ABR) ,连续测试其阈值 ;而后取动物双侧耳蜗荧光染色后光镜下行毛细胞计数和形态学观察。结果　ABR阈值测试显示 ,实验组动物在噪声暴露结束后 2 4h的听力略好于对照组 ;形态学观察表明 ,实验组细胞核异常数据低于对照组。结论　水杨酸钠可能在一定程度上具有拮抗噪声引起的听力损失及保护耳蜗毛细胞的作用     

中文广东话版与普通话版噪声下言语测试材料的开发

开发两种中文版本的噪声下言语测试材料(hearinginnoisetest,HINT)–广东话版(Cantonesehearinginnoisetest,CHINT)和普通话版(Mandarinhearinginnoisetest,MHINT),用于评估讲广东话和普通话者的言语理解能力。共168名听力正常的受试者参与本研究,短句材料均选用日常用语。通过调整短句在噪声下的给声强度达到每个短句难度均等,得到每表20句音素平衡的句表。使用这些句表测试受试者的短句接受阈(ReceptionThresholdsforSentences,RTSs),RTSs定义为:短句重复的正确率为50%时的信噪比。受试者佩戴耳机分别在安静和三种噪声条件下—噪声在两侧、左侧和右侧进行测试。噪声固定在65dB(A),通过调整言语声强度来改变信噪比。句表间测试的可比性和同一句表重复测试的可靠性均非常高,表明使用任意句表均能得到一致的结果。同时得到了测试结果的置信区间,并将CHINT和MHINT的正常值与英文版进行了比较。     

Evaluation of hearing handicap in textile mill employees with noise induced hearing loss

Objective  To calculate héaring handicap in textile mill employees with noise induced hearing loss. Design  Cross-sectional study. Setting  Model Mills, Nagpur and Govt. Medical College, Nagpur. Participants  77 employees with noise induced hearing loss. Study Variables  Noise levels (by sound level meter), Noise Induced Hearing Loss (by audiometry), Hearing handicap (AAOO guidelines). Statistical Analysis  Chi square test, Odds ratios, ANOVA. Results  NIHL was significantly higher (76.6%) in employees exposed to >85 dB(A) than to 70-85 dB(A) (35.2%) and to <70 dB(A) (10.7%) (x²=60.6, df=2, p<0.001). Hearing handicap in employees with NIHL increased in severity as the noise level increased. Average hearing handicap was significantly higher (12.5%) in >85 dB(A) exposure group than 70-85 dB(A) (7.9%) and <70 dB(A) (4.9%) exposure groups (F=5.17, p <0.05). The risk of having hearing handicap >10% was 5.2 times higher in > 85 dB(A) exposure group than in <85 dB(A) exposure group (OR = 5.22, 95% C.I. 1.76-15.44). Conclusion  One third of textile mill employees had hearing handicap. Noise levels >85 dB(A) are associated with high proportion as well as greater severity of hearing handicap.     

Hear here: Children with hearing loss learn words by listening

Objectives

Early use of hearing devices and family participation in auditory-verbal therapy has been associated with age-appropriate verbal communication outcomes for children with hearing loss. However, there continues to be great variability in outcomes across different oral intervention programmes and little consensus on how therapists should prioritise goals at each therapy session for positive clinical outcomes. This pilot intervention study aimed to determine whether therapy goals that concentrate on teaching preschool children with hearing loss how to distinguish between words in a structured listening programme is effective, and whether gains in speech perception skills impact on vocabulary and speech development without them having to be worked on directly in therapy.

Method

A multiple baseline across subjects design was used in this within-subject controlled study. 3 children aged between 2:6 and 3:1 with moderate–severe to severe-profound hearing loss were recruited for a 6-week intervention programme. Each participant commenced at different stages of the 10-staged listening programme depending on their individual listening skills at recruitment. Speech development and vocabulary assessments were conducted before and after the training programme in addition to speech perception assessments and probes conducted throughout the intervention programme.

Results

All participants made gains in speech perception skills as well as vocabulary and speech development. Speech perception skills acquired were noted to be maintained a week after intervention. In addition, all participants were able to generalise speech perception skills learnt to words that had not been used in the intervention programme.

Conclusions

This pilot study found that therapy directed at listening alone is promising and that it may have positive impact on speech and vocabulary development without these goals having to be incorporated into a therapy programme. Although a larger study is necessary for more conclusive findings, the results from this preliminary study are promising in support of emphasise on listening skills within auditory-verbal therapy programmes.     

Relationships between speech perception abilities and spoken language skills in young children with hearing loss

The goal of this study was to examine the relationships between scores obtained from measures of speech perception and language in a group of young children with hearing loss (HL). Eighteen children (mean age = 4.3 years) and their mothers participated in this study. Speech perception was measured using the online imitative test of speech pattern contrast perception (OLIMSPAC). Standardized language age equivalent scores were obtained using the Reynell developmental language scales-III. Number of word tokens, word types, and mean length of utterance (MLU) were extracted from the children's spontaneous language samples. Significant positive relationships were observed between children's OLIMSPAC scores and both standardized language scores (r ranging from 0.60 to 0.69; p <0.01) and all measures derived from children's spontaneous language samples (r ranging from 0.80 to 0.86; p<0.01). After controlling for child age, OLIMSPAC scores explained 34.1% of the variance in children's MLU. Using a new speech perception measure with reduced language demands, strong positive correlations were evident between speech perception and language skills for a young group of children with HL.     

Sentence recognition in noise: Variables in compilation and interpretation of tests

Abstract

Tests of sentence recognition in noise constitute an essential tool for the assessment of auditory abilities that are representative of everyday listening experiences. A number of recent articles have reported on the development of such tests, documenting different approaches and methods. However, both the development and interpretation of these tests require careful consideration of many variables. This article reviews and categorizes the stimulus, presentation, subject, response, and performance variables influencing the development and interpretation of tests of sentence recognition in noise. A systematic framework is utilized to document published findings on these variables. Recommendations and guidelines, based on test performance requirements and test objectives, are provided concerning the interpretation of results and the development of new test materials.

Sumario

La ECoG ha mostrado desde hace mucho que complementa el diagnóstico de la MD, primariamente por la medición de la tasa de amplitud SP/AP. Aunque se reporta en la literatura como una prueba de alta especificidad para este trastorno, la sensibilidad de la ECoG, en la población general de MD, se mantiene relativamente baja (rango de 20-65%), El presente estudio evaluó la sensibilidad y la especificidad del protocolo de ECoG que empleamos para pacientes con sospecha de MD, que incluyó la medición de la amplitud y las áreas de los SP y AP ante clicks (para derivar las tasas de amplitud y de área de SP/AP) y la amplitud del SP ante bursts tonales de 1000 y 2000 Hz. Se condujo un cuadro de revisión retrospectivo para comparar los resultados de de la ECoG de 178 pacientes sospechosos de MD, con su diagnóstico eventual. Las medidas de la mayor sensibilidad y especificidad (determinadas utilizando un análisis logístico de regresión) incluyeron: amplitud del PS, área del PS, tasa de área SP/AP y área total de SP-AP. Los valores de sensibilidad y especificidad asociados con esas medidas fueron de 92% y 84%, respectivamente. El valor de sensibilidad fue considerablemente mayor que el previamente reportado y esto es atribuible a la inclusión de mediciones de área en nuestro protocolo.     

Speech perception in noise for bilingual listeners with normal hearing

Objective: The purpose of this study was to determine if speech-in-noise ability, as measured by SNR-50 and SNR loss in bilingual Spanish listeners with normal hearing, was affected by test difficulty. Design: Quasi-experimental, non-randomized intervention study. Study sample: Two groups of adult listeners participated: monolingual English listeners with normal hearing (N?=?12) and bilingual Spanish listeners with normal hearing who were proficient in English (N?=?10). The quick speech-in-noise (QuickSIN), the Bamford-Kowal-Bench speech-in-noise (BKB-SIN), and the words-in-noise (WIN) tests were used to assess signal-to-noise ratio (SNR) loss and SNR-50 for both groups. Results: Despite the fact that the bilinguals had normal hearing and were proficient in English, each of the speech-in-noise tests evaluated indicated the Spanish listeners had measurable SNR loss and higher than normal SNR-50s. Performance on the BKB-SIN was best for both groups, indicating test difficulty had a significant impact on speech perception in noise. Conclusions: Bilingual Spanish listeners with normal hearing exhibited a mild SNR loss comparable to that observed for a person with hearing loss. This decreased performance in noise requires an improved SNR for this population to reach a comparable level of comprehension to their monolingual English counterparts.     

Classification of steady state gain reduction produced by amplitude modulation based noise reduction in digital hearing aids

Digital noise reduction systems in modern digital hearing aids aim to improve either speech intelligibility or listening comfort. Little is known, however, about the actual gain reduction produced by different noise reduction systems. The aim of this study is to compare the gain reduction of different noise reduction systems.

We applied a systematic variation of different presentation levels of the input signal, different signal-to-noise ratios, and different target hearing loss configurations. The gain reduction of 12 different hearing aids was compared both qualitatively and quantitatively by means of principal value decomposition.

The results show that these hearing aids differ considerably in their responses. These differences are presented qualitatively by plotting contour maps that give the gain reduction as function of signal-to-noise-ratio and frequency. The quantitative analysis shows that the gain reduction produced by most hearing aids can be characterized by two transfer functions. The most important being an overall gain reduction. In addition to this, the frequency response is tilted to achieve either more low-frequency reduction and less high-frequency reduction, or the opposite.     

普通话噪声下言语测试在方言人群中的应用

目的:使用普通话版噪声下言语测试材料(mandarinhearinginnoisetest,MHINT),得到听力正常不同方言人群的MHINT测试结果。方法:选择听力正常、母语非普通话受试者82名完成MHINT测试。结果进行统计学分析,并与母语普通话结果进行比较。结果:得到母语非普通话82名受试者的328个结果。母语非普通话受试者和母语普通话受试者之间在安静环境,噪声方位0°、90°、270°的测试结果均差异有统计学意义(均P<0.01);母语非普通话高学历受试者与母语非普通话低学历受试者之间结果差异有统计学意义(P<0.01)。母语非普通话受试者按年龄、讲普通话时间等因素之间测试结果差异无统计学意义(P>0.05)。结论:母语非普通话人群进行MHINT测试,与母语普通话人群相比需要更高的言语信号声和信噪比。影响MHINT测试结果的因素有受试者母语是否为普通话以及受试者的文化水平。     

扩展高频测听在噪声性听力损失早期诊断中的应用

目的　探讨扩展高频测听 (1 0～ 2 0kHz)在噪声性听力损失早期诊断中的作用及不同年龄、工龄、暴露噪声的强度与 1 0～ 2 0kHz听阈损失的关系。方法　应用频率范围为 0 5～ 2 0kHz的纯音听力计对 1 0 0 0名噪声下作业工人的听力进行检测 ,以 1 2 0名不同年龄的健康人作为对照组。结果在 95～ 1 1 5dB(A)的噪声强度下 ,当 0 5～ 6kHz的阈值未出现异常时 ,1 0～ 1 8kHz的阈值明显高于对照组 (1 0～ 1 6kHzP <0 0 0 1 ,1 8kHzP <0 0 1 ) ,对最大输出没有反应耳数的比率明显高于对照组 (1 4～2 0kHzP <0 0 1 )。接触噪声的各年龄组 1 0～ 1 8kHz阈值随年龄的增长而升高 ;不同工龄组比较 ,6～1 0年工龄组的 1 0～ 1 8kHz阈值明显升高 ;不同噪声强度组的 1 0～ 2 0kHz阈值比较差异无显著性 (P >0 0 5 )。结论　高强度噪声引起的听力损失 ,1 0～ 2 0kHz听阈的变化早于 0 5～ 6kHz,年龄和工龄影响1 0～ 2 0kHz听阈 ,其对最大输出引不出反应和听阈阈值的变化可作为早期检测噪声性听力损失及噪声易感者的指标。     

An office procedure to detect vestibular loss in children with hearing impairment

As coexisting vestibular and cochlear lesions are of etiological importance, evaluation of children with congenital or early acquired hearing impairment (HI) should include vestibular assessment. A rotation test requires specific equipment and allows only detection of bilateral vestibular impairment. An impulse or head thrust test allows assessment of one ear at a time, detects more pronounced caloric side differences and can be performed without any equipment. We report a consecutive series of children with profound sensorineural HI investigated at a tertiary hospital unit. Age at taking first steps without help, the results of temporal bone images (CT/MRT) and vestibular tests were collected retrospectively from patient files. The children were 12 to 90 months old at the time they attended both a rotation and an impulse test. All 14 children cooperated in the impulse test, and 12 completed the vestibular rotation test successfully. Three out of 14 children tested so far have been confirmed to have a bilaterally pathological vestibulo-ocular reflex confirmed both in the rotation test and the impulse test. Our results show that both the rotation test and the vestibular impulse test can be successfully performed on small children at a regular outpatient appointment.     

Hearing in Noise Test Brazil: standardization for young adults with normal hearing

IntroductionIndividuals with the same ability of speech recognition in quiet can have extremely different results in noisy environments.ObjectiveTo standardize speech perception in adults with normal hearing in the free field using the Brazilian Hearing in Noise Test.MethodsContemporary, cross-sectional cohort study. 79 adults with normal hearing and without cognitive impairment participated in the study. Lists of Hearing in Noise Test sentences were randomly in quiet, noise front, noise right, and noise left.ResultsThere were no significant differences between right and left ears at all frequencies tested (paired t − 1 test). Nor were significant differences observed when comparing gender and interaction between these conditions. A difference was observed among the free field positions tested, except in the situations of noise right and noise left.ConclusionResults of speech perception in adults with normal hearing in the free field during different listening situations in noise indicated poorer performance during the condition with noise and speech in front, i.e., 0°/0°. The values found in the standardization of the Hearing in Noise Test free field can be used as a reference in the development of protocols for tests of speech perception in noise, and for monitoring individuals with hearing impairment.     

不同指向传声器技术对助听后噪声下言语理解力的影响

目的 比较不同的助听器指向传声器技术对助听后噪声下的言语理解力的影响。方法 20名感音神经性聋患者双耳配戴编程为自适应指向传声器、固定指向传声器和全指向传声器模式的全数码助听器,分别在3种言语噪声给声条件下进行改良的噪声下的听力测试（hearing in nose test,HINT)法,记录信噪比。结果 在3种噪声环境下,信噪比由低到高的传声器模式依次为自适应指向传声器,固定指向传声器,全指向传声器。结论 自适应指向传声器适宜于环境噪声不仅来自身后或／和主要噪声源在变换方向的听环境;固定指向传声器适宜于噪声仅来自身后的听环境;全指向传声器适宜于安静环境下使用。     

The effectiveness of N-acetyl-L-cysteine (L-NAC) in the prevention of severe noise-induced hearing loss

Three groups of chinchillas were exposed to a nonGaussian continuous broadband noise at an Leq=10 5dB SPL, 8h/d for 5d. One group (N=6) received only the noise. A second group (N=6) received the noise and was additionally treated with L-NAC (325 mg/kg, i.p.). Treatment was administered twice daily for 2d prior to exposure and for 2d following the exposure. During exposure the animals received the L-NAC just prior to and immediately after each daily exposure. The third group (N=4) was exposed to the noise and received saline injections on the same schedule as the L-NAC treated animals. Auditory evoked potential recordings from the inferior colliculus were used to estimate pure tone thresholds and surface preparations of the organ of Corti quantified the sensory cell population. In all three groups PTS exceeded 50 dB at 2.0k Hz and above with severe sensory cell loss in the basal half of the cochlea. There was no statistically significant difference among the three groups in all measures of noise-induced trauma. Treatment with L-NAC did not reduce the trauma produced by a high-level, long duration, broadband noise exposure.     

噪声频谱特性对正常听力成人词汇识别影响

目的　探讨噪声频谱特性对词汇识别的影响作用。方法　31名听力正常成人参与研究,研究采用汉语普通话词汇相邻性测试,分别获得言语谱噪声（speech spectrum-shaped noise,SSN）和多人谈话噪声（babble noise,BN）下不同信噪比（signal noise ratio,SNR）的言语识别率,并计算词汇识别率为20%、50%和80%时所需要SNR和斜率,进而分析噪声频谱特性对词汇识别的影响作用。结果　SSN条件下单音节词和双音节词的言语识别阈,即正确识别率为50%所对应的SNR（SNR50）分别为-4.83 dB和-7.63 dB（t 50=11.918,P＜0.05）,对应斜率分别为5.61和11.14（t 50=-7.006,P＜0.05)。BN条件下单音节词和双音节词的SNR50分别为-3.34 dB和-5.52 dB（t 50=8.860,P＜0.05),对应斜率分别为6.04和9.28（t 50=-4.316,P＜0.05）。统计显示SSN和BN下单、双音节词识别阈均有统计学差异（t 50M=-5.037,t 50D=-10.275,P＜0.05）,两类噪声下双音节词的斜率有统计学差异（t 50D=2.920,P＜0.05）。结论　BN噪声频谱掩蔽效应比SSN更强。在两种噪声下,单音节词均需要更高的SNR,才能达到和双音节词相同的词汇识别。     

助听器无线调频系统临床应用研究

目的 观察助听器无线调频系统（hearing aid-frequency modulated，HA-FM）对于助听器听力补偿效果的影响。方法 在不同的声音环境下，分别采用麦克风（microphone，M），无线调频（frequency modulated，FM）．无线调频＋麦克风（frequency modulated＋microphone，FM＋M）三种输入方式．观察HA-FM使用者的言语听辨率和言语交流变化。结果 在安静环境下．近距离交流时。HA-FM的不同输入方式对言语听辨没有影响．在嘈杂环境下或远距离交流时．FM输入方式的听辨率几乎不受影响．M，FM＋M的昕辨率则明显下降。结论 在复杂的声音环境中。HA-FM是一种非常有用的助听辅助设备。     

The interaction of hearing loss and level-dependent hearing protection on speech recognition in noise

Abstract

Objectives: To determine the effects of different control settings of level-dependent hearing protectors on speech recognition performance in interaction with hearing loss. Design: Controlled laboratory experiment with two level-dependent devices (Peltor^® PowerCom Plus? and Nacre QuietPro^®) in two military noises. Study sample: Word recognition scores were collected in protected and unprotected conditions for 45 participants grouped into four hearing profile categories ranging from within normal limits to moderate-to-severe hearing loss. Results: When the level-dependent mode was switched off to simulate conventional hearing protection, there were large differences across hearing profile categories regarding the effects of wearing the devices on speech recognition in noise; participants with normal hearing showed little effect while participants in the most hearing-impaired category showed large decrements in scores compared to unprotected listening. Activating the level-dependent mode of the devices produced large speech recognition benefits over the passive mode at both low and high gain pass-through settings. The category of participants with the most impaired hearing benefitted the most from the level-dependent mode. Conclusions: The findings indicate that level-dependent hearing protection circuitry can provide substantial benefits in speech recognition performance in noise, compared to conventional passive protection, for individuals covering a wide range of hearing losses.     

Investigation of hearing aid users' speech understanding in noise and their spectral-temporal resolution skills

PurposeOur study aims to compare speech understanding in noise and spectral- temporal resolution skills with regard to the degree of hearing loss, age, hearing aid use experience and gender of hearing aid users.MethodsOur study included sixty-eight hearing aid users aged between 40-70 years, with bilateral mild and moderate symmetrical sensorineural hearing loss. Random gap detection test, Turkish matrix test and spectral-temporally modulated ripple test were implemented on the participants with bilateral hearing aids. The test results acquired were compared statistically according to different variables and the correlations were examined.ResultsNo statistically significant differences were observed for speech-in-noise recognition, spectral-temporal resolution among older and younger adults in hearing aid users (p>0.05). There wasn’t found a statistically significant difference among test outcomes as regards different hearing loss degrees (p>0.05). Higher performances were obtained in terms of temporal resolution in male participants and participants with more hearing aid use experience (p<0.05). Significant correlations were obtained between the results of speech-in-noise recognition, temporal resolution and spectral resolution tests performed with hearing aids (p<0.05).ConclusionOur study findings emphasized the importance of regular hearing aid use and it showed that some auditory skills can be improved with hearing aids. Observation of correlations among the speech-in-noise recognition, temporal resolution and spectral resolution tests have revealed that these skills should be evaluated as a whole to maximize the patient's communication abilities.