A review of current approaches to aural rehabilitation

Summary

Degree of hearing impairment is not directly related to hearing handicap or disability. Since the 1940s measures of peripheral auditory function have been the basis of hearing aid selection even though they provide no direct information on psychosocial, vocational, or educational handicap or disability or on rehabilitation needs. Rehabilitation beyond provision of the hearing aid has been limited and demands new approaches. The evolution of aural rehabilitation is based on the notion of its being an ongoing process, of communication as a behaviour which relies on the integration of many types of information, and of the individual as a total person with multi-faceted hearing needs.

Résumé

Le degré de la déficience auditive n'est pas directement lié à un handicap auditif ou à une infirmité. Depuis 1940, le choix d'une aide auditive a été basé sur les mesures de la fonction périphérique auditive alors que celles-ci ne fournissent aucune information directe sur le handicap causé, du point de vue psychosocial, éducatif, ou en ce qui concerne la vocation—ni sur l'infirmité elle-měme ou les besoins que nécessite une rééducation. Une rééducation au-delà de l'apport d'un aide auditive est restée limitée et a besoin d'approches nouvelles. L'évolution de la rééducation aurale se base sur la notion qu'il s'agit d'un processus continuel, de la communication en tant que comportement qui dépend d'une intégration de types d'information multiples, ainsi que d'un individu en tant que personne dans sa totalité aux besoins auditifs multiples.

Zusammenfassung

Der Grad der Schwerhörigkeit steht nicht in einer direkten Beziehung zur Gehörsbehinderung oder -beeinträchtigung. Seit den 1940er Jahren wurden Messungen der peripheren Gehörsfunktion als Basisinformation für die Wahl von Hörgeräten verwendet, jedoch geben diese keine direkte Auskunft über Behinderungen psychosozialer oder beruflicher Art oder im Unterricht. Rehabilitationsmassnahmen, ausser der eigentlichen Beschaffung des Hörgerätes, waren bisher spärlich. In dieser Beziehung bedarf es einer neuen Einstellung. Die Arbeit der Rehabilitation der Gehörgeschädigten sollte darauf basieren, dass es sich um einen fortschreitenden Vorgang handelt. Als Verhalten empfiehlt sich die Integration vieler Typen der Information, welche das Individuum mit sehr unterschiedlichem, vielfältigem Anspruch an sein Gehör versteht.

Resumen

El grado de menoscabo de la audición no está directamente relacionado con la incapacitación o disminución auditoria. Desde los años 1940, las determinaciones de la función auditoria periférica han constituído la base de la selección de un audifono, si bien no aportan datos directos sobre el tipo de disminución psicosológica, vocacional o formativa, ni tampoco sobre la rehabilitación necesaria. Esta última, aparte de la provisión del audifono, ha sido muy limitada y exije nuevos enfoques. La evolución de la rehabilitación aural se ha basado en el concepto de que se trata de un proceso continuado, de que la comunicación depende de la combinación de diversos tipos de información, y de que el individuo es una persona completa con necesidades auditorias de muchas facetas.     

A prospective study of hyperlipidemia as a pathogenic factor in sudden hearing loss

Summary The pathogenic role of hyperlipidemia in sudden hearing loss (SHL) was examined in a prospective study. Twenty-five patients (14 males, 11 females; age range, 23–59 years) with a first event of SHL (group I) were compared with 9 patients (4 males, 5 females; age range, 28–86 years) with a repeated event of SHL (group II). Audiological examination revealed different types of SHL in group I vs group II: high-frequency loss, 76% vs 22%; low-frequency loss, 12% vs 22%; pancochlear hearing loss, 12% vs 56%. Serum lipid patterns and atherogenic risk factors in both groups were not different and corresponded to lipid patterns in the average population. These findings indicate that both hyperlipidemia and atherogenic risk factors are not of major pathological importance in SHL.     

言语测听中校准与强度控制

在言语测听中,信号校准非常重要。言语测听中用言语听力级（dB HLspeech）表示信号强度。国家标准中规定了两种对各语音测试项进行均一化的方法。本文介绍了实际言语测试中的强度控制和校准的实现方法。     

外周性双侧前庭病的听-前庭功能与诊断

目的探讨外周性双侧前庭病的听-前庭功能特点及其在诊断中的价值。方法对自2006年12月～2010年10月我科眩晕专科诊治的具步态不稳和振动幻视特征性症状的外周性双侧前庭病53例,行听-前庭功能检查和病因分析。结果明确或可能病因42例(79.2%),原因不明者11例(20.8%)。听力正常10例(18.9%)、异常43(81.1%)。冷热试验:双侧前庭功能低下共49例(92.5%),双侧前庭功能丧失4例(7.5%)。头脉冲试验病理阳性38例(71.7%)。接受动态姿势描记图检查39例,显示不同程度的前庭输入下降或前庭输入为主下降。结论双侧前庭病的诊断根据病史、特征性的临床表现及听-前庭功能检查,冷热试验及头脉冲试验结合有诊断价值,听力学检查有助原发疾病的诊断。     

A neurobiological model for the effects of early brainstem functioning on the development of behavior and emotion regulation in infants: implications for prenatal and perinatal risk

Neurobiological models propose an evolutionary, vertical-integrative perspective on emotion and behavior regulation, which postulates that regulatory functions are processed along three core brain systems: the brainstem, limbic, and cortical systems. To date, few developmental studies applied these models to research on prenatal and perinatal risk. We propose a conceptual model that incorporates three integrated levels of observations for the study of early risk: (a) brainstem-related physiological regulation of cyclic processes and sensory integration, e.g., vagal regulation, circadian rhythms; (b) emotion and attention regulation capacities that draw on the integration of brainstem and limbic systems; and (c) higher-level outcomes that draw on the intactness of brainstem and limbic networks, including socio-emotional self-regulation, inhibitory control, and cognitive processing. We discuss implications of the model for the development of regulatory capacities during the prenatal and early postnatal stages in infants born with specific perinatal risk. We underscore the importance of assessing sub-cortical and brainstem systems and the longitudinal effects of transitory brainstem dysfunction on physiological homeostasis, motivation, arousal-modulated attention, stress reactivity, and mother-infant co-regulation. The assessment of brainstem dysfunction can be conducted during hospitalization and may help detect infants at risk for the development of self-regulatory deficits at the first weeks of life.     

Meniere’s disease: rare or underdiagnosed among Africans

Meniere's disease can easily be misdiagnosed because several otological disorders mimic the disease. Conflicting reports on the incidence of this disease among the Africans had been documented. The goal of our study was to verify the prevalence and clinical features of Meniere's disease in WA sub-region. A 10 year (1996-2005) retrospective study carried out in our hospital. The diagnostic criteria for the disease were outlined and Oyedeji's social classification instrument was adapted for socio-economic stratification of patients. The method of treatment and prognostic out-come were discussed. Out of 11,463 patients seen within the period, 25 (16 females and 9 males) met the diagnostic criteria for Meniere's disease. The age ranged from 27 to 75 years (mean=47.2 SD13.2) and the most predominant age group was 41-50 years. Sixty-eight percent were of low socio-economic class and the rest high. About 84% had unilateral and 16% bilateral Meniere's disease. All the patients presented with tinnitus, vertigo and audiologically confirmed sensorineural hearing loss. CT-scan and MRI were used to rule out some differentials, while caloric and recruitment tests were used to strengthen the diagnosis. Treatment regimen (conservative) outcome: 72% had good improvement, 8% fair, while 20% absconded from follow-up. The prevalence of Meniere's disease in West African sub-region is 0.22%. This prevalence among Africans may not differ from the Caucasians. Under- or over-diagnosis of the disease previously must have been responsible for the contrasting results. Appropriate diagnostic tools are necessary for accurate diagnosis of the disease.     

A descriptive study of children with chronic hoarseness

Chronically hoarse children with nodules were found to be similar to those without nodules on various perceptual measures. Twenty of thirty of these children showed improvement after a year of rehabilitation in the public schools; improvement varied according to the abilities of individual clinicians.     

Identifying Hearing Loss by Means of Iridology

Isolated reports of hearing loss presenting as markings on the iris exist, but to date the effectiveness of iridology to identify hearing loss has not been investigated. This study therefore aimed to determine the efficacy of iridological analysis in the identification of moderate to profound sensorineural hearing loss in adolescents. A controlled trial was conducted with an iridologist, blind to the actual hearing status of participants, analyzing the irises of participants with and without hearing loss. Fifty hearing impaired and fifty normal hearing subjects, between the ages of 15 and 19 years, controlled for gender, participated in the study. An experienced iridologist analyzed the randomised set of participants'' irises. A 70% correct identification of hearing status was obtained by iridological analyses with a false negative rate of 41% compared to a 19% false positive rate. The respective sensitivity and specificity rates therefore came to 59% and 81%. Iridological analysis of hearing status indicated a statistically significant relationship to actual hearing status (P < 0.05). Although statistically significant sensitivity and specificity rates for identifying hearing loss by iridology were not comparable to those of traditional audiological screening procedures.     

Audiology in South Africa

Audiology in South Africa is an established profession facing the challenge of serving a diverse population in predominantly developing contexts. The profession has developed over the last half century from an adjunct to speech-language pathology into a profession in its own right. Several tertiary institutions offer undergraduate training in audiology with optional postgraduate qualifications. Institutions are continually adapting to a profession characterised by rapid change – evidenced even in the very composition of the profession itself. This article aims to provide an overview of the development and current status of audiology as a profession in South Africa.