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It has been suggested that the presence of a limited area of damaged outer hair cells (OHCs) with intact inner hair cells, which may not be detected on the conventional audiogram, results in unbalanced neural activity between Type I and Type II fibers leading to tinnitus. In normal-hearing tinnitus patients, DPOAEs provided ambiguous data of OHC function when compared to non-tinnitus controls. Hearing loss in the extended high-frequency (EHF) region may decrease DPOAEs evoked at lower frequencies. Results of EHF audiometry in tinnitus patients are limited. The aim of the study was to evaluate DPOAEs and EHF thresholds in normal-hearing patients reporting unilateral tinnitus in left ear. Thus, each subject acted as their own control. Data were obtained for 26 subjects with bilateral hearing thresholds10, 12.5, 14, and 16 kHz. The DP-grams were measured in the 0.5-8 kHz range using 65/55-dB SPL primaries and f2/f1=1.2. The data analyses included DPOAEs with S/N>3 dB. Median audiometric data showed that thresholds in the left ears were significantly higher than those in the right ears at all four EHFs. Mean DPOAE levels of the left ears were lower than those of the right ears in the frequency range above 1 kHz. Additionally, a paired-comparison test of DPOAE levels of each patient’s right and left ear revealed significant differences at 6 and 8 kHz. The results indicate that: 1. OHC impairment in the most basal region reduces contribution to more apically generated DPOAEs; 2. OHC impairment in a limited area, which may be revealed by DPOAEs but not by conventional audiometry, can contribute to tinnitus generation; and 3. patients with unilateral tinnitus and normal hearing on the conventional audiogram are likely to demonstrate hearing loss in the EHF region.

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Book Summary: This one-of-a-kind resource presents a wide range of expert opinions about phonological disorders in children, allowing readers to understand and compare diverse approaches to assessment and intervention, choose the ones that will work best, and use their new knowledge to make decisions during clinical interventions. For each of the book's three sections—Assessment and Classification, Goal and Target Selection, and Intervention —the editors pose important "frequently asked questions" for each contributor to answer, such as Which diagnostic classification system do you find useful? How does your assessment differ for children of different ages, developmental levels, or linguistic backgrounds? How do you integrate language goals with phonological goals? What factors influence your selection of treatment goals and targets? When should a child receive individual therapy as opposed to group therapy? What do you do when your intervention plan is not working? Through the theoretical insights and practical experience each contributor shares— and a helpful conclusion that comments on all the approaches discussed — readers will have the broad and balanced knowledge they need for informed clinical decision making. Speech-language pathologists, graduate students, audiologists, and educators will use this comprehensive, accessible resource to shape their practices and improve the lives of children with phonological disorders. Phonological Disorders in Children is a part of the Communication and Language Intervention Series

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