Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL) and the French Society of Audiology (SFA) for Speech-in-Noise Testing in Adults

ObjectivesThis document presents the fundamentals of speech audiometry in noise, general requirements for implementation and criteria for choice among the tests available in French according to the health-professional's needs.Material and methodsThe recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors, audiologists and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence.ResultsEight tests of speech audiometry in noise can be used in France.ConclusionTo be complete, evaluation of hearing status requires testing understanding of speech in noise. The examination must begin with a minimum of two measurements familiarizing the subject with the test procedure. For initial diagnosis, adaptive procedures establishing the 50% speech reception threshold (SRT50) in noise are to be preferred in order to obtain a rapid and standardized measurement of perception of speech in noise. When the aim is to measure real-life speech comprehension, tests based on sentences, cocktail-party noise and free-field stimulation are to be preferred. Prosthetic gain is evaluated exclusively in free field. This is the only way to evaluate the contribution of binaurality and to measure perception in noise in an environment as close as possible to real life. In order to avoid acoustic interference in free field, at least five loudspeakers should be used, in particular for evaluating the effectiveness of directional microphones, CROS devices enabling sounds picked up in the damaged ear to be rerouted to the functional ear, or bimodal fitting (i.e., when hearing is enabled by two modalities: for example, hearing aid for one ear, cochlear implant for the other).     

Investigation of hearing loss in patients with acute brucellosis by standard and high-frequency audiometry

This study aimed to determine the effect of acute brucellosis on the auditory system. Forty-two patients with acute brucellosis were evaluated clinically, and with serological and audiological tests, before and after treatment. Hearing threshold averages were calculated at 11 different frequencies (250-8000 Hz) of the auditory airway, and statistical analysis was performed. The average hearing thresholds were > 20 dB, with standard audiometry at 6000-8000 Hz, and < 20 dB at all other frequencies. After treatment, the average auditory threshold decreased to < 20 dB at 6000-8000 Hz (p < 0.0001). Pure-tone hearing thresholds were improved at all frequencies after treatment, with statistically significant differences at all frequencies except 12,000, 14,000 and 16 000 Hz (p < 0.05). There was no permanent hearing loss caused by acute brucellosis, and hearing thresholds were restored after treatment. It was concluded that acute brucellosis affects the auditory system, especially at high frequencies, and that patients with all forms of brucellosis should be evaluated for hearing loss.     

双音节普通话言语测听词表的等价性评估

目的：本项研究针对已编制完成的具有语音平衡特性的双音节普通话测听词汇表（MSTM）进行难度等价性分析，以期挑选出具有难度一致性的一组词表应用于临床。方法：对10张（每张50词）的双音节词表进行数字化录音。选取65名年龄18～25岁具有大专以上文化程度，日常生活中以普通话为交流方式的听力正常人作为受试者。对5名受试者进行预试验，获得正式测试时所需的给声强度。对60名受试者进行正式的言语识别测试，使用SPSS11．0软件对结果进行等价性分析。结果：10张双音节测试词表中，除测试表5外，其余各表间均具有难度等价性。结论：9张双音节普通话测听词汇表具有较好的难度等价性，可应用于临床测试和实验研究中。     

慢性肾功能衰竭患者畸变产物耳声发射分析

测定２１例（４２耳）慢性肾功能衰竭（ＣＲＦ）患者的畸变产物耳声发射（ＤＰＯＡＥ）。结果表明：ＣＲＦ患者的耳聋 为耳蜗性聋,表现为高频听力损失,ＤＰＯＡＥ检测可客观、快速地反映耳蜗的病变。且ＤＰＯＡＥ具有频率特异性,有助于对该病患者听力障碍的早期诊断。     

Bilateral stapedotomy in patients with otosclerosis: a disability-orientated evaluation of the benefit of second ear surgery

This study reports the evaluation of the results of 80 stapedotomies in patients with bilateral otosclerosis. All pre- and postoperative audiological data, together with all relevant information of the operations, were stored in a database and analysed retrospectively. A new approach has been developed in order to evaluate the benefit of second ear stapes surgery in a more disability-orientated way using the AMA-criteria in the Guides to the Evaluation of Permanent Impairment. In all patients the percentage of Binaural Hearing Impairment (BHI) and the percentage of Impairment of the Whole Person (IWP) were determined according to the AMA-criteria. In patients who had both operations at the Academic Medical Centre it was found after the first operation that there was an important decrease in the BHI-percentage (from 26% to 10%) as well as for the IWP-percentage (from 9% to 4%). In addition, the percentages dropped significantly after the second operation (from 11% to 7% and from 4% to 2%, respectively). During follow-up there were no serious complications. It is concluded that bilateral stapedotomy is a safe procedure with good results.     

Eureka-project: ‘totally implantable artificial larynx’: progress report

Objective. The European Eureka project ‘Artificial larynx’ aims at realizing an implantable artificial larynx, consisting of artificial vocal folds, artificial epiglottis, tissue connector for tracheal fixation and valve mechanism to switch between breathing and speaking. The last part has been realized. Because its functioning is identical to a tracheostomal valve, it was tested as such. Materials and methods. The device consists of two valves: a speech valve, that will be open during normal breathing and closed by strong expiration and a cough valve that opens during coughing and closes automatically during inhalation. Magnets keep the valves in the breathing position. The magnetic force can be varied. Several prototypes have been tested in vitro and in situ. Results. The prototypes showed good in vitro behaviour. The range of adjustability of speech and cough was wide enough, flow resistance acceptable. This was confirmed by preliminary in vivo experiments. Patients were enthusiastic; hands-free speaking and coughing is possible. Conclusion. Numerous problems have to be solved to produce an artificial larynx. Each solution generated up till now, however, can already be applied to improve the existing rehabilitation process of laryngectomized patients.     

Ocular torsion induced by static visual stimulation and static whole body roll

Objective. This study was aimed to improve the reliability of clinical statolith testing by quantifying the influence of visual orientation and stimulation on the statolith-ocular reflex. Materials and methods. Ocular torsion was induced in 12 healthy adults by visual stimulation and by static whole body roll with and without simultaneous visual orientation. Visual stimulation was achieved by a horizontal grating oscillating sinusoidally in a frontal plane. Visual orientation during whole body roll was established by mounting an illuminated horizontal grating either on a tilting device (head-fixed) or on the wall in the frontal plane (earth-fixed). Results. No eye torsion was observed in static visual tilts of the grating. Dynamic visual stimulation elicited substantial eye torsion. Static whole body roll in the dark induced static ocular counter-rolling. Visual orientation either head- or earth-fixed did not affect the amplitude or gain of the body roll induced ocular counter-rolling. Conclusion. Dynamic visually induced torsional eye movements can be used to test the ability of the oculomotor system to generate torsional eye movements prior to quantifying the statolith-ocular reflex. Simultaneously visual information does not affect the gain of the static statolith-ocular reflex.     

A comparison of cochlear implant processing strategies in children using Speech Pattern Audiometry

Abstract

The aim of this study was to use Speech Pattern Audiometry (SPA) to compare phoneme perception performance between SPEAK and ACE processing strategies with children using the Nucleus 24 cochlear implant. Listeners were evaluated in terms of ability to identify two synthetic word pairs, one signalling a voicing contrast and the other signalling a place of articulation contrast. For both word pairs, ACE was associated with more ‘normal’ phoneme boundaries than SPEAK. There was also a nonsignificant trend for better identification ability with ACE compared to SPEAK. The study suggests that there may be a place for SPA as part of the clinical battery of tests used for evaluation of cochlear implant speech processing strategies in children. Copyright © 2005 John Wiley & Sons, Ltd.     

Behaviour of High-Frequency Hearing in Noise

Because of an improved coupling and of special loudspeakers high-frequency (HF) audiometry may now be used for routine audiometry. Examinations of 200 weaving-mill workers showed hearing threshold levels with a broad dip at about 4 or 6 kHz but with relatively good hearing at about 11 and 12 kHz. The greatest hearing threshold shifts were observed at 15 kHz and above. The course of the curves clearly showed a dependence on the noise level. With most cases of acute acoustic traumata there was a total loss in the HF range reaching far into the frequency range of normal hearing. This pattern is correlated with the area of destruction of the hair cells in the cytocochleogram. Another characteristic course of the curves was marked by an extreme hearing loss in the HF range showing, however, a horizontal course. A similar cytohistogram could not be found in the literature.