Relations between Electric Response Audiometry,Conventional Audiometry and Psychodiagnostic Examinations in Hearing-Impaired Children

To obtain a more objective determination of the hearing loss and thereby a more effective therapy, we compared the results of conventional audiometry (reflex and behavioural audiometry) with electric response audiometry (ERA) results in 522 children whose median age was 3 years. ERA threshold was more sensitive at 10.8±17.5 dB. The mean difference and its standard deviation are both much greater for the younger children and particularly for non-cooperative children, but neither relates clearly to intelligence. In the case of 'difficult-to-test' children (due to behavioural disturbance, mental retardation or brain damage), we carried out a psychological examination consisting of several special non-verbal tests. 62.7% of children with IQs under 70 needed sedation; for the children whose IQs lay above 70, this proportion was only 37.3%. Our artefact rejection system greatly reduced the percentage of sedations required, particularly for children under 3 years of age     

Simultaneous Four-Channel Electric-Response Audiometry Results in 8 Years of Hearing Evaluation among Small Children

The results of 8 years’ experience with slow cortical-evoked responses obtained by a four-channel method are reported. The conclusion is that, even in this form, ERA is not a reliable tool for diagnosing hearing defects in children. The time course of the mean ERA threshold of 138 children examined in Turku University for periods ranging from 6 months to over 3 years is presented. The results are discussed. Electrocochleography or brain stem audiometry is recommended for clinical use.     

Suction Pressure Electrodes for Electric-Response Audiometry

The advantages, as well as the disadvantages, of some electrode types for use in bioelectric measurements are discussed, with the intention of finding the types which are most suitable for measuring cortical responses, when undertaking electric-response audiometry (ERA). Two factors must be considered; the comfort of the patient and the relation to the measuring technique. The construction and the clinical test are discussed.     

Evoked Response Audiometry: Influence of Somatosensation

Averaged vertex response thresholds evoked with the oscillator on the mastoid process and tibia in patients deaf since birth or early childhood, patients with sensorineural hearing loss acquired during adulthood, and subjects with normal hearing were compared and the following conclusions were reached:

(1) This study provided the first objective documentation of the pseudoauditory nature of the low-freqency air-bone gap. This vibratory phenomenon is acute in individuals who have been deaf since early childhood.

(2) Evoked response audiometry (ERA) demonstrated a potential hazard in testing deaf children. If ERA shows a low-frequency air-bone gap, one should suspect that the response is of vibratory origin. Confirmation of the origin can be obtained by recording responses evoked by tibial stimulation.

(3) ERA bone-conduction thresholds accurately correlate with conventional bone-conduction thresholds.     

The Use of Masking in Evoked Response Audiometry

The authors studied the influence of white noise on acoustically evoked potetials. In evoked reponse audiometry (ERA), the rules of masking in common use in subjective audiometry must be applied. Bone conduction caused an evoked potential from the opposite ear even for 0-5 dB. To avoid cross-hearing, masking of the opposite ear is required. A noise level below 50 dB had only little effect on the evoked potentials of the contralateral ear

For contralateral noise levels exceeding 60 dB or monaural stimulation with white noise and tones, the threshold was displaced by the amount of the masking noise level, and the steepness of the input-output curve was increased. In 16 patients with inner ear deafness, this masking effect showed a different behaviour. Thus an additional diagnosis on inner ear deafness is possible in ERA     

自动纯音听阈检测技术

应用电声设备行纯音听阈检测发展已有百余年,纯音听阈检测技术应用需求日益增加。自动纯音听阈检测技术发展迅猛有望达到临床诊断应用水平。听力师、耳科医师应注意到该现象可能影响各自日常工作。     

The Role Of Electro-Physiological Tests in the Diagnosis of Non-Organic Hearing Loss

Today it is possible, by the use of newly developed tests, to diagnose cases of non-organic hearing loss with reasonable certainty. Having once decided that there may be non-organic elements, it is useful to supplement routine pure-tone and speech audiometry with a neurophysiological test like an ERA by means of which the auditory threshold can be established without the patients subjective judgement. A hearing loss which is apparent by routine pure-tone audiometry, but which is not evident after ERA is almost certainly non-organic, although confirmation of this state of affairs by other reliable tests is advisable. Measurement of the acoustic reflex thresholds and delayed speech feedback tests are both useful in this respect and rarely cause any confusion, except in some cases of true hearing loss in strongly recruiting ears.     

Comparison between Brainstem-Evoked Response Audiometry and Behavioral Audiometry in 270 Infants and Children

The authors refer their results obtained with brainstem-evoked response audiometry (BSERA) and behavioral audiometry in a group of 270 children (aged from 6 months to 12 years) divided into subjects with (group A) and without (group B) reliable audiograms. In group A an agreement between the two methods was found in 77% of cases and a serious discrepancy in 5%. In group B an agreement was found only in 34% of cases, while a serious discrepancy was found in 20% of the children. BSERA was useful because many diagnostic mistakes were avoided. The authors think that BSERA is a reliable technique, as their data show, but in at least 4 cases they found that BSERA gave a hearing level much higher than that obtained with behavioral audiometry or that observed in the children's responses to everyday sounds. Since click gives only partial information of the tonal field and because it is possible to make technical mistakes, the authors believe that BSERA must not be used as the only diagnostic test but that it should be part of a test battery which includes, at least, behavioral audiometry and impedance audiometry.     

自动数字听力计健听儿童测定初探

目的探讨8~18岁健听儿童使用自动听力计的可行性及有效性。方法采用标准听力计和自动数字听力计,在隔音室中采集30名8~18岁健听儿童0.5、1、2、4 kHz的听阈,记录两种测试所用时间。结果8~18岁健听儿童自动测听气导听阈14.21±2.97 dB HL,骨导听阈13.38±2.98 dB HL;标准听力计气导听阈12.58±2.53 dB HL,骨导听阈11.65±2.26 dB HL,两者听阈比较无统计学差异(P>0.05)。不同频率下阈值比较显示,0.5 kHz气导听阈比较无统计学差异(P>0.05),1、2、4 kHz气导听阈比较有统计学差异(P<0.05);0.5、1、2、4 kHz骨导听阈比较有统计学差异(P<0.05)。自动测听平均测听时间为13.76±3.66分,标准听力计平均测听时间为14.15±3.21分,两者比较无统计学差异(P>0.05)。结论8~18岁儿童使用自动听力计可检测出可靠有效的听力阈值。     

梅尼埃病的高频测听观察

本文报告34例30～40岁梅尼埃病患者常规测听(0.25～8kHz)和高频测听(9～20kHz)与相同年龄组正常人比较的结果.发现梅尼埃病早期常规测听低频听力下降的同时,也存在高频听力下降,并非到病变后期才出现高频下降,若能及时行高频测听检查,有利于梅尼埃病的早期诊断.本文还对高频听力下降的机理进行初步探讨.     

小儿行为测听技术的教学思考

听力学是发展迅速的交叉学科，小儿行为测听是其中最基本的听力检测技术，是系统化听觉功能评估中不可替代的评估方法，也是听力学专业学生应熟练掌握的重要技能。本文从听力学的教学实践和临床需求出发，阐述小儿行为测听技术的理论和实践，旨在为听力学教学工作提供指导，培养优质的听力学理论一临床复合型人才。     

Four-Year Experience with Electric Respose Audiometry

The paper is based on a 4-year clinical experience with electric response audiometry in cases with diagnostic difficulties. Two of these cases are presented. The peripheral hearing organ was investigated by means of electrocochleography. Spectral analysis of the electrocochleograms was realised in a general purpose computer     

Diagnostic Significance of the Electrocochleogram in Clinical Audiometry

In order to understand fully the diagnostic significance of electorcochleography (E. Co. G.) in clinical audiology, the present study was designed to cover 3 problems concerning (1) objective threshold audiometry by E. Co. G., (2) objective bone-conduction audiometry by E. Co. G., and (3) objective differential audiometry of sensory-neural hearing loss by E. Co. G.

The compound action potential (AP) of the cochlear nerve was used as an indicator for this purpose. It was recorded simultaneously from both ears of the same subject with a promontory electrode or a meatal skin electrode by means of an average response computer.

Acoustic signals such as clicks or 3 different tone-pips with center frequencies of 2 000, 4 000, and 8 000 Hz, were given to the subject by both air-conduction and bone-conduction.

Five different electric indices were determined from the AP measurements as measures of neurophysiological activity of the cochlea, i. e., (1) the threshold of the AP, (2) the input-output function of N₁, (3) the increments of the N₁ amplitude, (4) the intensity-latency relation of N₁, and (5) the wave form of the AP. These results lead to the following conclusions

(1) The promontory-recorded AP thresholds were in an excellent agreement statistically not only with the subjective thresholds for the same stimuli but also with the clinical hearing thresholds shown on the audiogram.

(2) The promontory-recorded AP provided significantly more precise and reliable data on E. Co. G. as compared with the meatal skin surface-recorded AP. The difference between the AP thresholds and the subjective thresholds, on the average, was + 0.2 dB, subjective more sensitive, for the promontory recording, and + 17.8 dB, subjective more sensitive, for the meatal skin surface recording. But the choice of electrodes must be according to what is required of the E. Co. G.

(3) The bone-conduction AP measurements could be carried out with the promontory electrode. There was a relatively good agreement between the bone-conduction AP thresholds and the bone-conduction subjective thresholds, but the agreement was worse than that for the air-conduction AP measurements.

(4) An air-bone gap was determined objectively from the input-output and intensity-latency relations of the bone-conduction AP compared to those of the air-conduction AP. The promontory-recorded AP measurements by bone-conduction should be very helpful in estimating objectively the degree of an air-bone gap.

(5) There were some interesting correlations between the changes in the electric indices of the AP measurements and the patterns of subtractive loss. Some patterns of subtractive loss seemed to be specified by various combinations of the threshold elevation of the AP, the 'H curve' type of input-output relation, the reduction in the maximum amplitude of N₁, and the distortion of the AP wave form.

(6) A distinctive pattern of the distorted AP wave form appeared in Ménière's disease. The depression and recovery of the AP was closely correlated with the course of audiological and vestibular symptoms of this disease.

(7) On the basis of observations on the AP measurements for sensorineural hearing loss, 3 conceptual populations of sensory units are hypothesized, i.e., (a) the more sensitive population of sensory units capable of discharging well-synchronized impulses with lower thresholds, (b) the less sensitive population of sensory units capable of discharging well-synchronized impulses with higher thresholds, and (c) the more sensitive population of sensory units capable of discharging less well-synchronized or dispersed impulses with lower thresholds.

Finally, some serious problems confronting the routing clinical use of E. Co. G. are discussed, and the current status of E. Co. G. is described. It seems reasonable to speculate that E. Co. G., combined with electric response audiometry, will serve as the most practical method of objective differential audiometry as well as of objective threshold audiometry.     

Validity and accuracy of electric response audiometry using the auditory steady-state response: evaluation in an empirical design

The validity and accuracy of the application of the auditory steady-state response (ASSR) to electric response audiometry (ERA) was tested further in a study permitting subjects to be their own controls for hearing loss. Simulated sensorineural hearing loss (SSHL) of complex configuration and varying degrees was effected using filtered masking noise. Thresholds estimated via ASSR-ERA were compared to those measured via conventional pure-tone audiometry. Further, the slow vertex potential N1-P2 was recorded to permit a comparison with an evoked-response test of common content validity and known accuracy. Results in a homogeneous subject sample demonstrated strong interest correlation and agreement within 10 dB at 1000 to 4000 Hz (on average), but not at 500 Hz. The configurations determined by ASSR-ERA followed behavioral audiometric patterns well, except for the mildest degree of SSHL tested. Consequently, limitations of ERA remain, although ASSR-ERA appears to be quite valid overall and promises (justifiably) broad clinical applicability.     

French Society of ENT (SFORL) guidelines (short version): Audiometry in adults and children

IntroductionFrench Society of ENT (SFORL) good practice guidelines for audiometric examination in adults and children.MethodsA multidisciplinary working group performed a review of the scientific literature. Guidelines were drawn up, reviewed by an independent reading group, and finalized in a consensus meeting.ResultsAudiometry should be performed in an acoustically controlled environment (< 30 dBA); audiometer calibration should be regularly checked; and patient-specific masking rules should be systematically applied. It should be ensured that masking is not overmasking. Adult pure-tone audiometry data should be interpreted taking account of clinical data, speech audiometry and impedancemetry. In case of discrepancies between clinical and pure-tone and speech audiometry data, objective auditory tests should be perform. In children aged 2 years or younger, subjective audiometry should be associated to behavioral audiometry adapted to the child's age. In suspected hearing impairment, behavioral audiometry should be systematically supplemented by objective hearing tests to determine and confirm the level and type of hearing impairment.     

The Use of CNV in Audiometry

The contingent negative variation (CNV) has been used to design an objective test of the threshold of perception of a simple acoustic stimulus. A tone of adjustable intensity was delivered by an audiometer to predict a second stimulus (weak flash of light to follow after a short interval. A CNV was generated during this interval if the subject expected the second stimulus. When the subject did not perceive the tone, the CNV did not appear. Acoustic stimuli near the threshold frequently produced a CNV of higher amplitude than those following stronger stimuli. Comparatively short intervals between the conditioning and the test stimulus can be used. The advantages of the use of the CNV as an objective audiometric test as compared to evoked cerebral potential (ECP) audiometry and the possibility of using the method in clinical practice are discussed     

Audiometry in critical frequency bands of hearing

The analysis of the choice and distribution of the fixed frequencies in the course of audiometry and mechanisms of automatic regulation in the hearing system (HS) gave grounds to suppose that: 1) HS is rather a multichannel system than a single channel, the number of channels being equal to the number of frequency critical acoustic bands (that is 24); 2) not one but 24 mechanisms of threshold hearing adaptation operate in HS, one for each critical hearing band; 3) the number of fixed frequencies at which audiometry is made (125 Hz-8 kHz) should be 21 while now it is 9 and these frequencies should not change by ostave, but must correspond to central frequencies of critical hearing bands this number of frequencies being optimal.     

Audiometry by parents. Informal hearing testing by parents

The parent audiometry deals with an informal hearing test administered by the parents, which is suitable for infants and small children (up to two years of age) with high degrees or unclear hearing damages. In such cases, the parents should record their multiple to be repeated behavioral observations in a delivered scheme. The binaural hearing ability is tested in distances up to ten meters for low, middle, and high sounds and ringings. The results of the parent audiometry are integrated in the subjective and objective investigation findings and alleviate the pedaudiological longitudinal judgment of children with hearing damages. The work is conceived in reference to the practicing otologist; however, the assistance of the parents is not to be disregarded concerning early recognition and early diagnosis of children with hearing damages.     

Brief-Tone Audiometry in Persons Treated with Salicylate

The ability to integrate acoustic energy over a period of time has been measured by brief-tone audiometry on 14 young persons treated with salicylate and after the salicylate has been excreted. The investigation showed that the temporal integration can be reversible reduced by salicylate treatment, and a relation was demonstrated between the change in temporal integration and the salicylate concentration in the blood. As the test persons had had general anaesthesia, a control test was performed on seven persons. It was shown that anaesthesia does not influence temporal integration. Experimental investigations have shown that the hearing loss produced by salicylate is due to an inhibition of enzymatic systems in the cochlea

Taking into consideration the results of brief-tone audiometry and the cochlear effect of the salicylates, one must conclude that reduced cochlear function caused reduced temporal integration     

不同程度感音神经性听力损失儿童ASSR、click-ABR反应阈与行为听阈的相关性

目的 探讨不同程度感音神经性听力损失儿童听性稳态反应(ASSR)、短声听性脑干反应(click-ABR)与行为阈值的相关性及在听障儿童听力评估中的价值.方法 回顾性分析2019年1月至2019年12月确诊的46例(92耳)感音神经性听力损失儿童的ASSR、click-ABR及行为听阈结果,其中,轻度听力损失4耳,中度听...