Otoacoustic emissions (OAEs) are generated in the cochlea in response to sound and are used clinically to separate ears with normal hearing from sensorineural hearing loss (SNHL). OAEs were elicited at ambient pressure by clicks (CEOAE) and wideband chirps (TEOAE) sweeping from low-to-high frequency with a sweep rate of either 187.6 Hz/ms (short chirps) or 58.2 Hz/ms (long chirps) and a bandwidth extending to 8 kHz. Chirps were presented at the same sound exposure level (SEL) as clicks, or + 6 dB relative to clicks. A total of 288 OAE waveforms were averaged for short chirps in ~1 minute compared to 120 waveforms for long chirps. Compared to clicks, the chirp has a lower crest factor, which allows it to be presented at an overall higher SEL without distortion. OAEs were elicited in 79 adults with normal hearing and 51 adults with mild-to-moderate SNHL. One-sixth octave OAE signal-to-noise ratios from 0.7 to 8.0 kHz were compared across stimulus types and conditions. The area under the receiver operating curve (AUC) was used to assess the accuracy of detecting SNHL. Average AUCs across 1/6th octave frequencies ranged from 0.90 to 0.89 for TEOAEs and were 0.87 for the CEOAE suggesting excellent test performance.

Older listeners, both with and without hearing loss, often complain of difficulty understanding conversational speech. One reason for such difficulty may be a decreased ability to process the rapid changes in intensity, frequency, or temporal information that serve to differentiate speech sounds. Two important cues for the identification of stop consonants are the duration of the interruption of airflow (i.e., closure duration) and rapid spectral changes following the release of closure. Many researchers have shown that age and hearing loss affect a listener's cue weighting strategies and trading relationship between spectral and temporal cues. The study of trading relationships between speech cues enables researchers to investigate how much various listeners rely on different speech cues. Different cue weighting strategies and trading relationships have been demonstrated for individuals with hearing loss, compared to listeners with normal hearing. These differences have been attributed to the decreased ability of the individuals with hearing loss to process spectral information. While it is established that processing of temporal information deteriorates with age, it is not known whether the speech processing difficulties of older listeners are due solely to the effects of hearing loss or to separate age-related effects as well. The present study addresses this question by comparing the performance on a series of psychoacoustic and speech identification tasks of three groups of listeners (young with normal-hearing, older with normal-hearing, and older with impaired hearing) using synthetic word pairs ("slit" and "split"), in which spectral and temporal cues are altered systematically. Results of the present study suggest different cue weighting strategies and trading relationships for all three groups of listeners, with older listeners with hearing loss showing the least effect of spectral cue changes and young listeners with normal hearing showing the greatest effect of spectral cue changes. Results are consistent with previous studies showing that older listeners with and without hearing loss seem to weight spectral information less heavily than young listeners with normal hearing. Each listener group showed a different pattern of cue weighting strategies when spectral and temporal cues varied.

Orientador: Antonio José Maria Cataneo / Resumo: Introdução: a surdez súbita, também denominada perda auditiva neurossensorial súbita idiopática (PANSI), é definida como perda neurossensorial de no mínimo 30 dB, em pelo menos três frequências audiométricas contíguas, instalada em até 72 horas. A etiologia da doença não está claramente definida e não há consenso na literatura sobre o melhor tratamento. Objetivo: avaliar a efetividade da pentoxifilina no tratamento da surdez súbita. Métodos: foram realizadas revisão sistemática e metanálise proporcional de estudos que avaliaram o tratamento de surdez súbita, os quais foram encontrados nas seguintes bases de dados eletrônicos: Pubmed, Embase, Lilacs, Cochrane, Scopus, Web of Science. Os critérios de elegibilidade foram: estudos experimentais ou observacionais (com no mínimo 5 pacientes cada estudo) que tenham avaliado tratamentos para surdez súbita. Os desfechos foram recuperação total e parcial da audição e presença de efeitos adversos. Para análise dos dados, utilizou-se o progama Stats Direct, versão 3.0.121. Resultados: dos 160 artigos encontrados, 128 foram selecionados para leitura de título e resumo, dos quais 104 foram excluídos. Foram eleitos para leitura na íntegra 24 artigos, sendo que 9 foram incluídos na revisão, totalizando 787 pacientes. Os tratamentos usados foram pentoxifilina, corticoide sistêmico e intratimpânico, betaistina, metilcolabamina, Ginkgo biloba. Os pacientes foram divididos em grupos: grupo 1 usou pentoxifilina isolada ou associada a outras droga... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Sudden deafness, also called idiopathic sudden sensorineural hearing loss, is defined as sensorineural loss of at least 30 dB in at least three contiguous audiometric frequencies, installed within 72 hours. The etiology of the disease is not clearly defined and there is no consensus in the literature on the best treatment. Objective: to evaluate the effectiveness of pentoxifylline in the treatment of sudden deafness. Methods: a systematic review and proportional meta-analysis of studies evaluating the treatment of sudden deafness were performed, which were found in the following electronic databases: Pubmed, Embase, Lilacs, Cochrane, Scopus, Web of Science. Eligibility criteria were: experimental or observational studies (with at least 5 patients per study) who evaluated treatments for sudden deafness. The outcomes were total and partial recovery of hearing and presence of adverse effects. Stats Direct, version 3.0.121 was used to analyze the data. Results: of the 160 articles found, 128 were selected for title and abstract reading, of which 104 were excluded. Twenty-four articles were selected for reading, of which 9 were included in the review, totaling 787 patients. The treatments used were pentoxifylline, systemic and intratympanic corticoid, betaystine, methylcolabamine, Ginkgo biloba. Patients were divided into groups: group 1 used pentoxifylline alone or associated to other drugs and group 2 did not use pentoxifylline. For the outcome of total hearing rec... (Complete abstract click electronic access below) / Mestre

Central auditory processing is complex and can not be evaluated by a single method. This thesis focuses on assessment of some aspects of central auditory functions by the use of dichotic speech tests and cognitive tests that tax functions important for speech processing. Paper A deals with the cognitive effects in dichotic speech testing in elderly hearing-impaired subjects. It was found that different listening tasks in the dichotic tests put different demands on cognitive ability, shown by a varying degree of correlation between cognitive functions and dichotic test parameters. Age-related cognitive decline was strongly connected with problems to perceive stimuli presented to the left ear. Paper B presents a new cognitive test battery sensitive for functions important for speech processing and understanding, performed in text, auditory and audiovisual modalities. The test battery was evaluated in four groups, differing in age and hearing status, and has proven to be useful in assessing the relative contribution of different input-modalities and the effect of age, hearingimpairment and visual contribution on functions important for speech processing. In Paper C the test battery developed in Paper B was used to study listening situations with different kinds of background noise. Interfering noise at +10 dB signal-to-noise ratio has significant negative effects on performance in speech processing tasks and on the effort perceived. Hearing-impaired subjects showed poorer results in noise with temporal variations, and elderly subjects were more distracted by noise with temporal variations, especially by noise with meaningful content. In noise, all subjects, particularly those with impaired hearing, were more dependent upon visual cues than in the quiet condition. Hearing aid benefit in speech processing with and without background noise was studied in Paper D. The test battery developed in Paper B was used together with a standard measure of speech recognition. With hearing aids, speech recognition was improved in the background condition without noise and in the background condition of ordinary speech. Significantly less effort was perceived in the cognitive tests when hearing aids were used, although only minor benefits of hearing aid amplification were seen. This underlines the importance of considering perceived effort as a dimension when evaluating hearing aid benefit, in further research as well as in clinical practice. The results from the studies contribute to the knowledge about speech processing but also to the search for more specific evaluation of speech understanding, incorporating both sensory and cognitive factors. / The ISBN 91-85297-49-6 in the printed verison is incorrect. The correct ISBN is 91-85297-93-3.

Professional research project (Au.D.)--University of South Florida, 2002. / Title from PDF of title page. / Document formatted into pages; contains 45 pages. / Includes bibliographical references. / Text (Electronic thesis) in PDF format. / ABSTRACT: The aim of this study was to measure the effects of audiologic intervention on self-perceived quality of life in the elderly hearing-impaired population. The tested hypothesis was that hearing aid use would result in improved quality of life as measured by utilities. In this study, utilities were obtained using the U-Titer II, an interactive software program designed to measure an individual's health state preference or utility. This study also examined the issue of numeracy, which is described as an understanding of basic probability, and its effect with an individual's ability to accurately complete utilities. / Data from 54 individuals fit with hearing aids in this randomized, controlled, pre-test/post-test experimental design study were analyzed. The participants completed the U-Titer II, a test of numeracy and the International Outcome Inventory for hearing Aids (IOI-HA). Three utility approaches were used in this study: Time Trade-Off (TTO), Standard Gamble (SG) and Rating Scale (RS). With each of the utility approaches, disease-specific (e.g., deafness vs. perfect hearing) and generic (death vs. perfect health) anchors were incorporated. / Several research questions were posed to examine the sensitivity of utilities to hearing aid intervention. Question 1: Can the effects of hearing aid intervention be determined with a utility approach? Statistically significant differences between pre- and post-intervention utility scores were measured with disease-specific and generic anchors for only the TTO and RS approaches. These findings suggest that hearing aid intervention outcomes can be measured using either the TTO or RS utility approaches. / Question 2: Is numeracy ability a factor in the usefulness of a utility approach for assessing the effects of hearing aid intervention? Statistical analysis showed that mean utility scores changed very little as a function of numeracy ability. These findings suggest that numeracy ability does not appear to affect utility scores. Question 3: What, if any, are the relationships between hearing aid benefit as measured by a utility approach and hearing aid benefit as measured by the IOI-HA? / Spearman Rho correlations were conducted on the benefit data obtained from the two self-report measures (IOI-HA and utilities). The major findings from these analyses determined that the IOI-HA total scores were significantly correlated with utility outcomes as measured by TTO generic, TTO disease-specific, and RS disease-specific anchors. In general, correlations between the measures were higher with the disease-specific anchors than the generic anchors. Also, none of the correlations between any IOI-HA outcome domains and utility change scores with generic anchors obtained with the RS scale were significant. / For utilities measured with disease-specific anchors, significant correlations were found with two IOI-HA outcome domains (benefit and satisfaction) and utility change scores as measured by the TTO technique. When the RS technique was utilized, significant correlations were found for four of the seven outcome domains (benefit, satisfaction, participation and impact of others). Thus, if the IOI-HA is used as a measure against which to validate the utility approach as a measure of hearing aid outcomes, the measure with the most face validity is a RS method with disease-specific anchors. However, if one wished to compare hearing aid intervention to intervention in other areas of health care, these data support the use of a TTO approach. / System requirements: World Wide Web browser and PDF reader. / Mode of access: World Wide Web.

A hearing impairment is primarily diagnosed by measuring the hearing thresholds at a range of auditory frequencies (air-conduction audiometry). Although this clinical procedure is simple, affordable, reliable and fast, it does not offer differential information about origins of the hearing impairment. The main goal of this thesis is to quantitatively link specific cochlear pathologies to certain changes in the spectral and temporal characteristics of the auditory system. This can help better understand the underlying mechanisms associated with sensorineural hearing impairments, beyond what is shown in the audiogram. Here, an electromechanical signal-transmission model is devised in MATLAB where the parameters of the model convey biological interpretations of mammalian cochlear structures. The model is exploited to simulate the cell-level cochlear pathologies associated with two common types of sensorineural hearing impairments, 1: presbyacusis (age-related hearing impairment) and, 2: noise-induced hearing impairment. Furthermore, a clinical study, consisting of different psychoacoustic and physiological tests, was performed to trace and validate the model predictions in human. The results of the clinical tests were collated and compared with the model predictions, showing a reasonable agreement. In summary, the present model provides a biophysical foundation for simulating the effect of specific cellular lesions, due to different inner-ear diseases and external insults, on the entire cochlear mechanism and thereby on the whole auditory system. This is a multidisciplinary work in the sense that it connects the ‘biological processes’ with ‘acoustic modelling’ and ‘clinical audiology’ in a translational context.

Thesis (Doctoral)--Uppsala University, 1983. / Includes bibliographical references (p. 33-34).

O diagnóstico precoce da perda auditiva tem sido cada vez mais freqüente em virtude dos programas de saúde auditiva que estão sendo implantados em todo o país. Existe, contudo, a necessidade de técnicas e procedimentos que ajudem a identificar, com maior precisão, a presença e o grau da mesma. A Resposta Auditiva de Estado Estável (RAEE) é um procedimento eletrofisiológico que, ao contrário do Potencial Evocado Auditivo de Tronco Encefálico (PEATE) realizado com estímulo tone burst, possibilita avaliar, ao mesmo tempo limiares auditivos com especificidade por freqüência e por orelha, reduzindo assim o tempo do exame. Além disso, ele permite a estimulação até níveis próximos a 130 dBHL, podendo assim medir a audição residual. O objetivo deste estudo foi verificar a aplicabilidade da RAEE para determinar os limiares auditivos nos diferentes graus de perda auditiva neurossensorial. Foram avaliados 65 indivíduos com perda auditiva neurossensorial, sendo que 48 apresentaram alteração neurossensorial (coclear) de grau leve até profundo, e idades entre sete e 30 anos; e 17 apresentaram alteração neurossensorial (Neuropatia Auditiva/Dessincronia Auditiva) e idades entre 0,6 e cinco anos. A avaliação foi composta por Audiometria Tonal Liminar (ATL) e pesquisa da RAEE para o grupo com alteração neurossensorial (coclear) e somente a pesquisa da RAEE para o grupo com alteração neurossensorial (NA/DA). Os resultados demonstraram que, nos indivíduos com perda auditiva neurossensorial (coclear), houve associação significante (p<0,01) entre os limiares obtidos na ATL e RAEE para as freqüências de 0,5 a 4 kHz, ocorrendo uma maior concordância para graus de deficiências auditivas mais acentuadas. Já na perda auditiva neurossensorial (NA/DA), a RAEE mostrou ausência de resposta na maioria dos indivíduos avaliados. Concluímos que a RAEE pode predizer os limiares da ATL com maior precisão para os graus de perda auditiva mais acentuados, e que a utilização deste procedimento não mostrou informações adicionais que podem contribuir para o diagnóstico da perda auditiva neurossensorial (NA/DA). / The diagnosis of hearing loss in the first months of life has been increasingly frequent due to hearing health programs established throughout the country. Thus, techniques and procedures should be developed for accurate identification of the presence and severity of hearing loss, in a population whose motor and cognitive development does not allow response to behavioral methods. The auditory steady state response (ASSR) is an electrophysiological procedure which, different from the brainstem evoked response audiometry (BERA) conducted with tone burst stimuli, allows the establishment of hearing thresholds at multiple frequencies and for both ears, thus reducing the examination time. Moreover, it allows measurement of residual hearing due to the possibility of stimulation at levels close to 130 dBHL. Therefore, the present study aimed to investigate the applicability of ASSR for establishment of hearing thresholds in different severities of sensorineural hearing loss. A total of 65 individuals with sensorineural hearing loss were evaluated, among whom 48 presented mild to deep sensorineural disorder (cochlear), at the age range 7 to 30 years; and 17 presented sensorineural disorder (neuropathy/hearing dyssynchrony) aged 0.6 to 5 years. The evaluation comprised pure-tone threshold audiometry (PTTA) and ASSR analysis for the group with deep sensorineural disorder (cochlear) and only ASSR analysis for the group with sensorineural disorder (neuropathy/hearing dyssynchrony). The results demonstrated that, for individuals with deep sensorineural hearing loss (cochlear), there was significant association (p<0.01) between the thresholds obtained by PTTA and ASSR at frequencies from 0.5 to 4 kHz, with higher agreement in cases with more severe hearing loss. On the other hand, for the sensorineural hearing loss (neuropathy/hearing dyssynchrony), the ASSR was absent in most individuals analyzed. It was concluded that there is significant association between the thresholds obtained by PTTA and ASSR, and that the utilization of this procedure did not provide additional information that might contribute to the diagnosis of sensorineural hearing loss (neuropathy/hearing dyssynchrony), when compared to BERA

INTRODUÇÃO: A introdução dos princípios da soft surgery desencadeou busca constante pela preservação auditiva, principalmente após a expansão dos critérios de inclusão para a cirurgia do implante coclear. Esses princípios cirúrgicos, associados a novos modelos de eletrodos e ao uso de fármacos no intraoperatório, têm sido utilizados a partir do melhor conhecimento da anatomia da orelha interna e da repercussão dos mecanismos inflamatórios desencadeados pelo trauma de inserção dos eletrodos. O objetivo deste estudo é avaliar o efeito de dexametasona tópica isolada e associada ao ácido hialurônico no intraoperatório de pacientes com audição residual submetidos ao implante coclear na preservação dos limiares tonais dos mesmos. MÉTODO: Foram avaliados 18 pacientes adultos com surdez severaprofunda submetidos à cirurgia de implante coclear divididos em 3 grupos: Implante coclear como grupo-controle, grupo 1; implante coclear com uso de dexametasona tópica no intraoperatório, grupo 2; e implante coclear com uso de dexametasona tópica associada ao ácido hialurônico no intraoperatório, grupo 3. Foram comparadas as médias dos limiares tonais nas frequências de 125, 250 e 500 Hz e nas frequências de 1000, 2000 e 4000 Hz no pré-operatório e no pós-operatório. RESULTADOS: A diferença entre as médias dos limiares tonais nas frequências baixas obtidas no 6º mês de pós-operatório e no pré-operatório foi de 28,03 dB + 6,77 dB no grupo 1, 30 dB + 14,53 dB no grupo 2 e 7,23 dB + 6,12 dB no grupo 3. Houve diferença estatisticamente significante dos valores do grupo 3 em relação ao grupo 1 e 2 (p = 0,002). A diferença entre as médias dos limiares tonais nas frequências altas obtidas no 6º mês de pós-operatório e no pré-operatório foi de 11,12 dB (DP + 9,71 dB) no grupo 1, 22,77 dB (DP + 12,79 dB) e 3,89 dB (DP + 3,1 dB). Houve diferença estatística entre os grupos 2 e 3 (p = 0,01). CONCLUSÕES: A associação do uso tópico de dexametasona e ácido hialurônico no intraoperatório de pacientes submetidos à cirurgia do implante coclear foi significantemente superior ao grupo controle e ao grupo no qual foi utilizado apenas a dexametasona tópica na preservação dos limiares auditivos. Por outro lado, o uso isolado de dexametasona tópica não demonstrou resultados superiores na preservação dos limiares acústicos quando comparado ao grupo controle / INTRODUCTION: The expansion of candidacy criteria for cochlear implantation led to a constant care for hearing preservation. The in-depth knowledge of the anatomy and function of the inner ear as well as the inflammatory repercussion caused by the insertion trauma led to the development of soft surgery principles, new electrode designs and pharmacotherapy. The purpose of this study was to compare the effects of topical dexamethasone isolated and associated with hyaluronic acid in hearing preservation in cochlear implantation. METHOD: Eighteen severely to profoundly hearing impaired adult patients were evaluated and divided into 3 groups: Cochlear implantation as a control group in group 1, cochlear implantation using topical dexamethasone intraoperatively in group 2 and cochlear implantation using topical dexamethasone associated with hyaluronic acid intraoperatively in group 3. Preimplant and postimplant low frequency and high frequency pure-tone average (PTA) from 125, 250, 500 Hz and 1000, 2000, 4000 Hz were calculated and compared from unaided audiograms. RESULTS: The mean changes in the low frequency PTA of preoperative and postoperative thresholds were 28.03 dB + 6.77 dB in group 1, 30 dB + 14.53 dB in group 2 and 7.23 dB + 6.12 dB in group 3. There was statistical difference comparing group 3 with group 1 and 2 (p = 0.002). The mean changes in the high frequency PTA of preoperative and postoperative thresholds were 11.12 dB + 9.71 dB in group 1, 22.77 dB + 12.79 dB e 3.89 dB + 3.1 dB. There was statistical difference between group 2 and 3 (p = 0.01). CONCLUSIONS: The use of topical dexamethasone associated with hyaluronic acid intraoperatively in cochlear implant surgery demonstrated a statistically significant difference in the preservation of low frequency thresholds when compared with the use of isolated topical dexamethasone and a control group. The use of isolated topical dexamethasone was not superior in hearing preservation when compared to a control group

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