Thesis (B.Sc)--University of Hong Kong, 1999. / "A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, May 14, 1999." Also available in print.

abstract: Otoacoustic emissions (OAEs) are soft sounds generated by the inner ear and can be recorded within the ear canal. Since OAEs can reflect the functional status of the inner ear, OAE measurements have been widely used for hearing loss screening in the clinic. However, there are limitations in current clinical OAE measurements, such as the restricted frequency range, low efficiency and inaccurate calibration. In this dissertation project, a new method of OAE measurement which used a swept tone to evoke the stimulus frequency OAEs (SFOAEs) was developed to overcome the limitations of current methods. In addition, an in-situ calibration was applied to equalize the spectral level of the swept-tone stimulus at the tympanic membrane (TM). With this method, SFOAEs could be recorded with high resolution over a wide frequency range within one or two minutes. Two experiments were conducted to verify the accuracy of the in-situ calibration and to test the performance of the swept-tone SFOAEs. In experiment I, the calibration of the TM sound pressure was verified in both acoustic cavities and real ears by using a second probe microphone. In addition, the benefits of the in-situ calibration were investigated by measuring OAEs under different calibration conditions. Results showed that the TM pressure could be predicted correctly, and the in-situ calibration provided the most reliable results in OAE measurements. In experiment II, a three-interval paradigm with a tracking-filter technique was used to record the swept-tone SFOAEs in 20 normal-hearing subjects. The test-retest reliability of the swept-tone SFOAEs was examined using a repeated-measure design under various stimulus levels and durations. The accuracy of the swept-tone method was evaluated by comparisons with a standard method using discrete pure tones. Results showed that SFOAEs could be reliably and accurately measured with the swept-tone method. Comparing with the pure-tone approach, the swept-tone method showed significantly improved efficiency. The swept-tone SFOAEs with in-situ calibration may be an alternative of current clinical OAE measurements for more detailed evaluation of inner ear function and accurate diagnosis. / Dissertation/Thesis / Ph.D. Speech and Hearing Science 2012

No description available.

published_or_final_version / Speech and Hearing Sciences / Master / Master of Science in Audiology

published_or_final_version / Speech and Hearing Sciences / Doctoral / Doctor of Philosophy

The primary aim of the research was to describe hearing function in a group of children with chronic renal dysfunction receiving treatment in an academic hospital in Johannesburg, South Africa. Specific objectives in the study were to determine the prevalence of hearing loss in paediatric patients with chronic renal dysfunction; to describe the type, degree and configuration of the hearing loss; and to establish if there was a relationship between the presenting hearing loss and the severity of renal dysfunction, the different treatment regimens, duration of renal dysfunction, and the duration of treatment. One hundred children between the ages five -18 years participated in the study and comprised 65 males and 35 females. The mean age of the participants was 11.68 years. A cross-sectional, descriptive, quantitative research design was employed. All participants underwent a case history interview and a full audiological examination which included an otoscopic examination, immittance testing (tympanometry and ipsilateral acoustic reflex testing), pure tone audiometry including extended high frequency testing up to 16 kilohertz as well as diagnostic distortion product otoacoustic emission testing. A record review was also done. Both descriptive and inferential statistics were used to analyse the collected data. Inferential statistics included parametric measures using multiple regression measures as well as non parametric measures using the Kruskal-Wallis statistical analysis. Results revealed that there was a high prevalence of hearing loss in children with chronic renal dysfunction. Results from the extended high frequency pure tone testing as well as the diagnostic distortion product testing revealed that the most common hearing loss was a low and high to ultrahigh frequency mild sensorineural hearing loss. The study showed that there was no relationship between the severity of hearing loss and the severity of renal dysfunction, or the duration of renal dysfunction and the duration of treatment. However, the study showed that there was a relationship between the severity of hearing loss and certain treatments, that is, v haemodialysis and the use of ototoxic medication such as loop diuretics, tuberculosis medication, and antimalarial medication. As the potential to miss hearing loss in this population is high, the research highlighted the importance of extended high frequency audiometry as well as diagnostic distortion product otoacoustic emission testing for the use of ototoxic monitoring in patients with chronic renal dysfunction. The research also highlighted the need for further research in this area as well as the need for educating medical personnel and caregivers working with children with chronic renal disease.

Purpose: The main objective of the current study was to investigate and monitor the auditory status in a group of adult patients with AIDS receiving antiretroviral therapy (ART) and other therapies in a hospital outpatient clinic in Gauteng, South Africa. Specific objectives included estimating the prevalence of hearing loss and the presence of other otologic effects over and above hearing impairment (tinnitus, aural fullness, disequilibrium, and so forth); assessing the type, degree and configuration of the hearing loss; exploring the type of hearing symptom onset; documenting case history data such as signs and symptoms of each participant and identifying any associations between obtained signs and symptoms and hearing loss; documenting the names of all medications used and their possible impact on hearing function (specifically ototoxicity monitoring of ART); and comparing the results of the experimental group to those of a control group.

Objective: To determine the feasibility of audiological screening in low-risk neonates, using Otoacoustic Emissions (OAEs), at various test times following birth. The achievability of a screening programme within the Midwife Obstetric Unit (MOU) 3-day assessment clinic at the Phola Park Community Health Centre (PPCHC) was deliberated. Participants: Two hundred and seventy two neonates were included in this study. Design: A prospective and longitudinal design was employed. Methods and Materials: Case history interviews, otoscopic examinations and Distortion Product Otoacoustic Emissions (DPOAEs) were carried out at two sessions. The initial session took place within 6 hours after birth and the second session at approximately 3 days after birth at the MOU 3-day assessment clinic. Data Analysis: Data was collected as “pass” and “refer” screening results, the number of births was compared to the number of participants at the two sessions. The number of “pass” and “refer” results per session were analysed and results per participant at the two sessions were compared to detect false-positives. The return for follow-up rate was considered. Results: Screening is possible within hours of birth but is more practical and efficient at the MOU 3-day assessment clinic. During the study, 260 neonates were born at PPCHC, 38.07% of these were screened at session 1 and a total of 268 newborns were screened at session 2. The pass rate was 16.16% at session 1 and 99.25% at session 2; rendering a false-positive rate of 82.10% at session 1. Time of birth relative to discharge, resources, environmental factors, noise levels, return for follow-up rate and referral rate have been identified as factors that may impact the practicability and efficiency of screening. Conclusion: Outcomes of the study highlight the importance of studying methodologies to ensure effective reach for hearing screening within the South African context. Based hereon, screening neonates immediately after birth is possible. However, it is recommended that screening forms part of the MOU 3-day assessment protocol to ensure that a higher number of neonates are reached when confounding factors such as vernix have plummeted; hence decreasing false- positives.

INTRODUÇÃO: O sistema auditivo eferente tem a função de regular e controlar a atividade do sistema auditivo aferente proporcionando ao indivíduo melhores condições para decifrar a mensagem acústica, fazendo parte, portanto, do processamento auditivo central. A detecção, acompanhamento e intervenção precoce em alterações do sistema eferente são de suma importância para minimizar os efeitos nocivos do distúrbio de processamento auditivo ao longo da vida. MATERIAL E METODO: Foram avaliados 125 RN(s) de ambos os gêneros, sendo 79 pertencentes ao grupo de baixo risco para deficiência auditiva e 46 do grupo de alto risco. A amostra foi submetida à EOET, EOEPD e PEATE com e sem a presença de um ruído branco contralateral a orelha testada emitido a 60 dBNPS. Foi calculado o efeito de inibição (EI) resultante da subtração do valor do nível de resposta total, no caso das EOE e da amplitude e latência da onda V no PEATE na condição sem ruído contralateral do valor obtido com ruído contralateral. O efeito de inibição foi analisado dentro de cada grupo segundo as variáveis orelha, gênero e condição de estimulação. Foi analisado, também, o efeito de inibição entre os grupos avaliados. Foi verificado, ainda, a correlação entre efeito de inibição e idade gestacional, pós-concepcional e fatores de risco, bem como foi verificada a correlação do efeito de inibição entre os testes aplicados. RESULTADOS: A média do EI observado pelas EOET foi de 0,3 dB na orelha direita (OD) e na orelha esquerda (OE) no grupo de baixo risco e de 1,2 dB (OD) e de 0,8 dB (OE) no grupo de alto risco. Nas EOEPD o EI foi maior nas frequências baixas em ambos os grupos. No PEATE a média do EI da amplitude da onda V foi de 0,07 µV (OD) e de 0,06 µV (OE) no grupo de baixo risco e de 0,03 µV (OD) e de 0,06 µV (OE) no grupo de alto risco. A média do EI da latência da onda V nos grupos de baixo e alto risco foi respectivamente de -0,02 ms na OD e OE e de -0,03 ms(OD) e 0,1 ms(OE). Não houve diferença estatisticamente significante do EI entre as orelhas e gêneros em ambos os grupos. A comparação entre as condições de estimulação mostrou diferença estatisticamente significante na OD e OE nas EOET no grupo de alto risco e na amplitude e latência no PEATE em ambos os grupos. Houve diferença estatisticamente significante do EI da OD entre o grupo de baixo e alto risco nas EOET e PEATE. Com o aumento da idade gestacional não houve um aumento do número de RN(s) com presença de EI nos testes aplicados. Com o aumento da idade pós-concepcional houve um aumento do valor médio do EI. Não houve variação linear do valor do EI conforme aumentava o número de fatores de risco. Houve maior concordância dos resultados da avaliação do sistema eferente entre as EOET e PEATE. CONCLUSÕES: O PEATE detectou maior número de RN(s) com presença de EI no grupo de baixo risco quando comparado ao grupo de alto risco. / The efferent auditory system has the function of regulating and controlling the activity of the afferent auditory system providing better conditions for individuals to decipher acoustic messages, therefore, it is part of the central auditory processing. The detection, monitoring and early intervention of changes in the efferent system is of paramount importance to minimize the harmful effects of auditory processing disorders throughout life. MATERIAL AND METHODS: 125 newborn infants of both genders have been screened, of which 79 belonged to the low-risk group for hearing loss and 46 to the high-risk group. The sample underwent OAET, OAEDP and ABR with and without the presence of white noise contralateral to the ear tested emitted at 60 dB SPL. Effect of inhibition (EI) was evaluated, resulting from subtracting the value of the total level of response, in the case of OAE and the amplitude and latency of wave V in the ABR provided without contralateral noise from the value obtained with contralateral noise. The effect of inhibition was analyzed within each group according to the variables ear, gender and condition of stimulation and also among the groups. The correlation between effect of inhibition and gestational age, postconceptional and risk factors was observed, as well as the correlation of the effect of inhibition between the tests carried out. RESULTS: Mean EI observed for OAET was 0.3 dB in the right ear (RE) and left ear (LE) in the low-risk group and 1.2 dB (RE) and 0.8 dB (LE) in the high risk group. In OAEDP EI was greater at low frequencies in both groups. In the mean EI ABR wave amplitude V was 0.07 microvolts (RE) and 0.06 microvolts (LE) in the low-risk group and 0.03 microvolts (RE) and 0.06 microvolts (LE) in the high risk group. The average EI of wave V latency in the groups of low and high risk was respectively -0.02 ms in the right and left ears and -0.03 ms (RE) and 0.1 ms (LE). There was no statistically significant difference in EI between the ears and genders in both groups. The comparison between the conditions of stimulation showed a statistically significant difference in RE and LE in OAET in the high risk group and the amplitude and latency of ABR in both groups. There was a statistically significant difference in EI between the RE group of low and high risk in OAET and ABR. The number of newborn (s) with presence of EI did not increase with increasing gestational age. Increasing post-conceptional age showed an increase in the Mean EI in the tests carried out. There was no linear variation of the value of EI as the number of risk factors increased. There was greater agreement amongst the results of the evaluation of the efferent system between OAET and ABR. CONCLUSIONS: ABR detected a higher number of newborn (s) with the presence of EI in the low-risk group when compared to the high-risk group.

Introdução: O fenômeno das Emissões Otoacústicas (EOA) é considerado como uma das grandes descobertas científicas na área da Audiologia. Seu exame possi-bilita avaliar a atividade motora da cóclea e traz novos conhecimentos sobre a fisiologia coclear. No entanto, tais registros trazem informações somente sobre o sistema auditivo aferente. Os estudos sobre a supressão das EOA contribuíram para a avaliação do sistema auditivo eferente. Atualmente, não são conhecidos outros testes audiológicos que possam avaliar a atividade eferente deste sistema olivococlear. Quando as EOA são registradas com apresentação de ruído, seja ele ipsilateral, contralateral ou bilateral, as vias eferentes do sistema olivococlear medial são ativadas, de forma a afetar o processo coclear. Tal fato pode ser observado com a redução no nível de respostas das EOA e é denominado de Efeito de Supressão das Emissões Otoacústicas. Tal teste avalia o efeito inibitório da função auditiva eferente (EIVE) sobre as células ciliadas externas (CCE). Objetivo: Este trabalho tem o objetivo de verificar a ocorrência do efeito inibitório da via eferente auditiva nas respostas de emissões otoacústicas por transientes, com diferentes estímulos supressores apresentados de forma contralateral: Ruído Branco, Ruído de fala (Talk Noise) e História Gravada. Método: A bateria de testes foi realizada em 30 indivíduos com idades entre 18 e 35 anos, com limiares auditivos em nível de intensidade inferior a 20 decibéis nível de audição (dBNA) nas frequências de 250 a 8.000 Hz. Foram realizadas seis provas, duas medidas iniciais de EOA Transiente sem ruído contralateral, seguida de três medidas de EOAT com diferentes estímulos contralaterais, ruído branco, ruído de fala e com história gravada. A sexta prova foi uma medida final de EOAT sem ruído contralateral. O efeito inibitório da via eferente foi investigado com o registro de EOAT obtidas com cliques lineares, e nível de intensidade do estimulo de aproximadamente 60dB NPS, em janela de análise de 4-20ms. O efeito inibitório foi quantificado pela variação do nível de resposta entre a apresentação do clique linear sem estímulo contralateral e, a apresentação do mesmo clique linear com cada um dos três estímulos contralaterais. Resultados: Não existe diferença média estatisticamente significante para as medidas de EOAT entre as orelhas em todas as variáveis. Houve uma média maior para os valores do EIVE na prova com o ruído contralateral do tipo Ruído Branco nas duas comparações, tanto com a primeira medida de EOAT sem ruído contralateral e na segunda medida de EOAT sem ruído contralateral. Existe diferença média estatisticamente significante entre Ruído Branco, Ruído de Fala e História Gravada somente para a orelha direita. Conclusão: O efeito inibitório da via eferente foi obtido com os três estímulos contralaterais estudados. Pode-se concluir que houve uma média maior nos valores de EIVE para a prova com o estímulo contralateral do tipo Ruído Branco. Todas as orelhas testadas, após a apresentação dos três estímulos contralaterais, apresentaram um valor de EOAT final sem ruído por volta dos valores encontrados inicialmente, o que nos mostra que assim que o ruído contralateral deixa de ser apresentado, a ativação do efeito inibitório da via eferente cessa instantaneamente e todo o sistema olivo coclear volta ao seu estado inicial / Introduction: The phenomenon of otoacoustic emissions (OAE) is considered as one of the greatest scientific discoveries in the field of Audiology. The exam provides the access to the motor activity of the cochlea and brings new knowledge about cochlear physiology. However, such records provide information only from the afferent auditory system. Studies on the suppression of the OAE contribute to the assessment of the efferent auditory system. Currently, there are known other audiologic tests that could evaluate the activity of the efferent olivocochlear system. When OAE are registered with noise presentation (whether ipsilateral, contralateral or bilateral), the efferent pathways of olivocochlear system are activated in order to affect the cochlear process. This fact can be observed with the reduction in the level of OAE responses and is called Effect Suppression of otoacoustic emissions. This test evaluates the inhibitory effect of efferent auditory function on the CCE. Objective: This study aims to establish the occurrence of the inhibitory effect of auditory efferent pathway in the responses of transient evoked otoacoustic emission, with different stimuli presented in contralateral suppressors: White Noise, Talk Noise and Recorded History. Method: The battery of tests was performed in 30 subjects aged between 18 and 35 years and auditory thresholds in intensity level less than 20 decibel hearing level (dB HL) at frequencies 250-8000 Hz. Were performed six tests, two initial measures OAE Transient without contralateral noise a measure of TOAE with white noise, a measure of TOAE with speech noise, a measure of TOAE with recorded history and finally a final measure of TOAE without contralateral noise. Results: There is no average difference statistically significant for measures of TOAE between the ears in all variables. The contralateral white noise showed the highest average in inhibitory effect of efferent auditory for the two situations without contralateral noise. There is a statistically significant difference between White Noise, Talk Noise and Recorded History only for the right ear. Conclusion: The inhibitory effect of the efferent pathway was observed in the three studied contralateral stimuli. It can be concluded that there was a greater mean values for inhibitory effect of efferent auditory in the condition with the contralateral white noise stimulus. All tested ears, after the presentation of the three contralateral stimuli, showed a value of TOAE end without noise around the values found initially, which shows us that once the contralateral noise is no longer displayed, the activation of the inhibitory effect of the efferent ceases instantly and all olivocochlear system back to its initial state