Rehabilitation of the hearing impaired adult in Denmark

An outline is given of the rehabilitation of the hearing impaired adult in Denmark. Emphasis is put on the comprehensiveness and the professionalism of the services provided.     

Assessment of the American Medical Association guide to the evaluation of binaural hearing impairment

Abstract

Objective: To assess the American Medical Association (AMA) guide to the evaluation of binaural hearing impairment (BHI) as a procedure for estimating severity of hearing loss from audiograms. Design: The BHIs of Australian war veterans were calculated from their hearing threshold levels (HTLs) and compared with their scores on a hearing questionnaire, the hearing measurement scale (HMS). Study sample: The HTLs of 282 Australian war veterans were measured at frequencies from 0.25 to 8 kHz and scores on the HMS were obtained from 154 of those veterans. Results: No grounds could be found for altering the frequencies included in the average HTL or the high fence of 92 dB HL used in calculating the monaural hearing impairments (MHIs) of the veterans, and no grounds could be found for altering the ratio of 5:1 used in determining the BHI from the MHIs of the better and worse ears. However, agreement between HMS score and BHI was improved by reducing the low fence used in calculating MHI from 25 to 15 dB HL. Conclusion: A modified version of BHI provided an improved procedure for estimating severity of hearing loss from audiograms but would not be suitable for compensation purposes.     

Audiological and genetics studies in high-risk infants

Hearing is one of the main ways with which one person can contact the external world; it plays a key role in their integration with society.AimThe objective of this study was to analyze the results of the hearing, medical and genetic evaluation of high-risk infants who failed the newborn hearing screening.Materials and MethodsClinical and experimental study. We assessed thirty-eight neonates, with ages between one and six months. The infants underwent the following procedures: medical interview; immittance testing; Brainstem Auditory Evoked Potential; Transient Evoked Otoacoustic Emission and otorhinolaryngological evaluation. DNA extraction from the oral mucosa was performed for genetic studies using the protocol method adapted from the Human Genetics Lab of the CBMEG/UNICAMP.ResultsRegarding gender and presence of risk factors, significant statistically differences were not found in normal hearing infants and in those with hearing loss. Concerning gestational age, term infants were more affected by hearing loss. Hearing loss was identified in 58% of the sample, conduction hearing loss represented 31.5% (12/38) and neurossensory 28.9% of cases. There were none of the genetic mutations most commonly seen in cases with a genetic etiology.ConclusionHearing loss was identified in the majority of High-risk infants.     

Results of the bone-anchored hearing aid in unilateral hearing loss

OBJECTIVES: The advantages of binaural hearing are well established and universally accepted. However, a tendency remains to withhold the benefits of binaural hearing to adults and children with one normal ear. The purpose of this study is to demonstrate the benefit of the bone-anchored hearing aid (BAHA) in a group of patients with unilateral conductive or mixed hearing loss. STUDY DESIGN: This is a prospective study of nine patients (five males and four female patients) with conductive or mixed hearing loss who met the criteria for BAHA except for having normal hearing in the other ear. They had congenital aural atresia or mastoidectomies secondary to chronic ear infections with or without cholesteatoma or had a temporal bone tumor excised METHODS: Patients had evaluations before and after implantation, including audiological testing and responses to a standardized hearing handicap questionnaire. Statistical analyses of the data were made using the Wilcoxon signed rank test and the paired Student t test for repeated measures. RESULTS: All patients had tonal and spondee threshold improvement with BAHA when compared with thresholds before treatment. Speech recognition performance in BAHA-aided conditions was comparable to the patient's best score in unaided condition. Patients reported a significant improvement in their hearing handicap scores with the BAHA. CONCLUSIONS: The use of BAHA has significantly improved the hearing handicap scores in patients with unilateral conductive or mixed hearing loss. The proven safety and efficacy of the device promote its use in unilateral cases that traditionally had been left unaided.     

Auditory processing performance in blind people

Hearing has an important role in human development and social adaptation in blind people.ObjectiveTo evaluate the performance of temporal auditory processing in blind people; to characterize the temporal resolution ability; to characterize the temporal ordinance ability and to compare the performance of the study population in the applied tests.MethodsFifteen blind adults participated in this study. A cross-sectional study was undertaken; approval was obtained from the Pernambuco Catholic University Ethics Committee, no. 003/2008.ResultsTemporal auditory processing was excellent - the average composed threshold in the original RGDT version was 4.98 ms; it was 50 ms for all frequencies in the expanded version. PPS and DPS results ranged from 95% to 100%. There were no quantitative differences in the comparison of tests; but oral reports suggested that the original RGDT original version was more difficult.ConclusionThe study sample performed well in temporal auditory processing; it also performed well in temporal resolution and ordinance abilities.     

Auditory steady state response in pediatric audiology

The main issue regarding pediatric audiology diagnosis is determining procedures to configure reliable results which can be used to predict frequency-specific hearing thresholds.AimTo investigate the correlation between auditory steady-state response (ASSR) with other tests in children with sensorineural hearing loss.MethodsProspective cross-sectional contemporary cohort study. Twenty-three children (ages 1 to 7; mean, 3 years old) were submitted to ASSR, behavioral audiometry, click audiometry brain stem response (ABR), tone burst ABR, and predicting hearing level from the acoustic reflex.Resultsthe correlation between behavioral thresholds and ASSR was (0.70- 0.93), for the ABR tone burst it was (0.73 -0.93), for the ABR click it was (0.83-0.89) only at 2k and 4 kHz. The match between the ASSR and the hearing threshold prediction rule was considered moderate.Conclusionthere was a significant correlation between the ASSR and audiometry, as well as between ABR click (2k and 4 kHz) and for the ABR tone burst. The acoustic reflex can be used to add information to diagnosis in children.     

Amplification of transcutaneous and percutaneous bone-conduction devices with a test-band in an induced model of conductive hearing loss

Objective: Transcutaneous devices have a disadvantage, the dampening effect by soft tissue between the bone and devices. We investigated hearing outcomes with percutaneous and transcutaneous devices using test-bands in an induced unilateral conductive hearing loss. Design: Comparison of hearing outcomes of two devices in the same individuals. Study sample: The right ear was plugged in 30 subjects and a test-band with devices (Cochlear? Baha® BP110 Power and Sophono® Alpha-2 MPO?) was applied on the right mastoid tip with the left ear masked. Sound-field thresholds, speech recognition thresholds (SRTs), and word recognition scores (WRSs) were compared. Results: Aided thresholds of Sophono were significantly better than those of Baha at most frequencies. Sophono WRSs (86?±?12%) at 40?dB SPL and SRTs (14?±?5?dB HL) were significantly better than those (73?±?24% and 23?±?8?dB HL) of Baha. However, Sophono WRSs (98?±?3%) at 60?dB SPL did not differ from Baha WRSs (95?±?12%). Conclusion: Amplifications of the current transcutaneous device were not inferior to those of percutaneous devices with a test-band in subjects with normal bone-conduction thresholds. Since the percutaneous devices can increase the gain when fixed to the skull by eliminating the dampening effect, both devices are expected to provide sufficient hearing amplification.     

Comparison: real and simulated ear insertion gain

The development of hearing aid (HA) software programming does not replace the analysis of real ears with probe microphones.AimTo compare simulated insertion gain in HA software programming and real ear insertion gain.MethodA prospective study of 62 patients (aged from 29 to 93 years; 30 male and 32 female). All patients presented unilateral (n=14) or bilateral (n=48) and mild to profound sensorineural hearing impairment. 110 ears assessed. Data was gathered from medical records and the insertion gain was obtained in real ears for comparison with the simulated insertion gain in HA software programming. Statistical tests were applied to analyze the correlation of data - difference of real ear and simulated insertion gain.ResultsHA software programming simulated insertion gain was higher than real ear insertion gain obtained with probe microphone measures. There were statistically significant frequency differences. Age did not correlate with the difference of real ear and simulated measures.ConclusionThe use of real ear measures is important during verification of HA.     

Transient Otoacustic Emissions with tone pip in Individuals with Sensorineural Hearing Loss

Otoacoustic Emissions are generated by the cochlea in response to sound stimuli. They can be generated by clicks or specific frequency stimuli, such as tone pips. This is a quick and objective test with several applications.ObjectiveTo investigate the influence of the type of stimulus achieving otoacoustic emissions in individuals with mild and moderate sensorineural hearing loss of sloping configuration.Material and MethodThirty-two male and female patients aged from 17 to 63 years, with symmetric sensorineural hearing loss with a sloping configuration were evaluated. All subjects underwent transient otoacoustic emissions testing elicited by clicks and 2.000Hz and 4.000Hz tone pips.ResultsThe degree of hearing loss and gender influenced otoacoustic emissions; it was significant for click stimulus and tone pips at 2.000Hz. Emissions were absent more often in females with both procedures.ConclusionsOtoacoustic emissions evoked with clicks coincided with the emissions of tone pips at 2.000Hz. Tone pips at 4.000Hz were more sensitive than clicks for detecting impairment in individuals with high frequencies hearing loss. Gender and the degree of hearing loss ere factors that affected OAE registration.     

Exploring the influence of culture on hearing help-seeking and hearing-aid uptake

Objective: The purpose of this paper was to highlight the importance of cultural influence in understanding hearing-help seeking and hearing-aid uptake. Design: Information on audiological services in different countries and ‘theories related to cross-culture’ is presented, followed by a general discussion. Study sample: Twenty-seven relevant literature reviews on hearing impairment, cross-cultural studies, and the health psychology model and others as secondary resources. Results: Despite the adverse consequences of hearing impairment and the significant potential benefits of audiological rehabilitation, only a small number of those with hearing impairment seek professional help and take up appropriate rehabilitation. Therefore, hearing help-seeking and hearing-aid uptake has recently become the hot topic for clinicians and researchers. Previous research has identified many contributing factors for hearing help-seeking with self-reported hearing disability being one of the main factors. Although significant differences in help-seeking and hearing-aid adoption rates have been reported across countries in population studies, limited literature on the influence of cross-cultural factors in this area calls for an immediate need for research. Conclusions: This paper highlights the importance of psychological models and cross-cultural research in the area of hearing help-seeking and hearing-aid uptake, and consequently some directions for future research are proposed.     

Plasticity of the auditory system: theoretical considerations

Auditory plasticity refers to the possibility of anatomical and/or functional changes in the system where transmission of auditory information takes place. The auditory system is often required in communication; it is important to learn how the auditory system reacts to stimuli in order to improve performance in individual communication of subjects with impaired hearing.AimTo review the literature on auditory plasticity and the possibility and ability of plastic responses in the auditory system; also to review the evidence of auditory plasticity.MethodologyA review of the Brazilian and international literature (journals, books, and graduate studies) was carried out. The MEDLINE, SCIELO, BIREME, PUBMED, and LILACS data bases were consulted, as well as 24 papers from the 1990s to the present date; each paper was assessed for relevance to the topic.ConclusionThe findings showed that the auditory system is able to reorganize itself if there is variation, whether by by reducing, increasing, or conditioning of sound stimuli. This is evidence of plasticity in the auditory system.     

Intratympanic Methylprednisolone as Rescue Therapy in Sudden Sensorineural Hearing Loss

Treatment in sudden sensorineural hearing loss is a contentious issue, today, oral steroids are the most common choice and considered the best treatment option, but the use of intratympanic steroids has become an attractive alternative, especially in cases when systemic therapy fails, or to avoid the side effects of the systemic use of steroids.AimTo describe the results of intratympanic methylprednisolone in idiopathic sudden sensorineural hearing loss after failure of oral prednisolone.MethodsIn a prospective study fourteen patients with idiopathic sudden sensorineural hearing loss were treated with intratympanic methylprednisolone after failing in the treatment with systemic steroids. Pretreatment and post-treatment audiometric evaluations including pure tone average (PTA) and speech reception thresholds (SRT) were analyzed.ResultsTen from 14 patients treated with intra-tympanic methylprednisolone presented with hearing recovery > 20 dB in PTA or 20% in SRT.ConclusionThree intratympanic injections of methylprednisolone improved pure-tone average or speech discrimination scores for a subset of sudden hearing loss subjects that failed to benefit from oral steroids.