Hearing Aid Use is Associated with Better Mini-Mental State Exam Performance.

OBJECTIVE: Hearing loss is associated with cognitive decline in the elderly. However, it is unknown if the use of hearing aids (HAs) is associated with enhanced cognitive function. METHODS: In a cross-sectional study at an academic medical center, participants underwent audiometric evaluation, the Mini-Mental State Exam (MMSE), and the Trail Making Test, Part B (TMT-B). The impact of use versus disuse of HAs was assessed. Performance on cognitive tests was then compared with unaided hearing levels. RESULTS: HA users performed better on the MMSE (1.9 points; rank-sum, p = 0.008) despite having worse hearing at both high frequencies (15.3-dB hearing level; t test, p < 0.001) and low frequencies (15.7-dB hearing level; t test p < 0.001). HA use had no effect TMT-B performance. Better performance on the MMSE was correlated with both low frequency (ρ = -0.28, p = 0.021) and high frequency (ρ = -0.21, p = 0.038) hearing level, but there was no correlation between performance on the TMT-B and hearing at any frequency. CONCLUSION: Despite having poorer hearing, HA users performed better on the MMSE. Better performance on cognitive tests with auditory stimuli (MMSE) but not visual stimuli (TMT-B) suggests that hearing loss is associated with sensory-specific cognitive decline rather than global cognitive impairment. Because hearing loss is nearly universal in those older than 80 years, HAs should be strongly recommended to minimize cognitive impairment in the elderly.

Maximizing Cochlear Implant Outcomes with Short-Term Aural Rehabilitation.

BACKGROUND: Increasing numbers of adults are receiving cochlear implants (CIs) and many achieve high levels of speech perception and improved quality of life. However, a proportion of implant recipients still struggle due to limited speech recognition and/or greater communication demands in their daily lives. For these individuals a program of aural rehabilitation (AR) has the potential to improve outcomes. PURPOSE: The study investigated the effects of a short-term AR intervention on speech recognition, functional communication, and psychosocial outcomes in post lingually deafened adult CI users. RESEARCH DESIGN: The experimental design was a multisite clinical study with participants randomized to either an AR treatment or active control group. Each group completed 6 weekly 90-minute individual treatment sessions. Assessments were completed pretreatment, 1 week and 2 months post-treatment. STUDY SAMPLE: Twenty-five post lingually deafened adult CI recipients participated. AR group: mean age 66.2 (48-80); nine females, four males; months postactivation 7.7 (3-16); mean years severe to profound deafness 18.4 (2-40). Active control group: mean age 62.8 (47-85); eight females, four males; months postactivation 7.0 (3-13); mean years severe to profound deafness 18.8 (1-55). INTERVENTION: The AR protocol consisted of auditory training (words, sentences, speech tracking), and psychosocial counseling (informational and communication strategies). Active control group participants engaged in cognitive stimulation activities (e.g., crosswords, sudoku, etc.). DATA COLLECTION AND ANALYSIS: Repeated measures ANOVA or analysis of variance, MANOVA or multivariate analysis of variance, and planned contrasts were used to compare group performance on the following measures: CasperSent; Hearing Handicap Inventory; Nijmegen Cochlear Implant Questionnaire; Client Oriented Scale of Improvement; Glasgow Benefit Inventory. RESULTS: The AR group showed statistically significant improvements on speech recognition performance, psychosocial function, and communication goals with no significant improvement seen in the control group. The two groups were statistically equivalent on all outcome measures at preassessment. The robust improvements for the AR group were maintained at 2 months post-treatment. CONCLUSION: Results of this clinical study provide evidence that a short-term AR intervention protocol can maximize outcomes for adult post lingually deafened CI users. The impact of this brief multidimensional AR intervention to extend CI benefit is compelling, and may serve as a template for best practices with adult CI users.

Development of a clinical test of musical perception: appreciation of music in cochlear implantees (AMICI).

The purpose of this study was to develop a test to assess the ability of persons with cochlear implants (CIs) to interpret musical signals. Up to this time, the main direction in outcomes studies of cochlear implantation has been in relation to speech recognition abilities. With improvement in CI hardware and processing strategies, there has been a growing interest in musical perception as a dimension that could improve greatly users' quality of life. The Appreciation of Music in Cochlear Implantees (AMICI) test was designed to measure the following abilities: discrimination of music versus noise; identification of musical instruments (from a closed set); identification of musical styles (from a closed set); and recognition of individual musical pieces (open set). The first phase of the study was test development and recording. The second phase entailed presentation of a large set of stimuli to normal listeners. Based on phase 2 findings, an item analysis was performed to eliminate stimuli that were confusing or resulted in high error rates in normals. In phase 3, hearing-impaired participants, using cochlear Implants, were assessed using the beta version of the AMICI test.

The effect of brief subway station noise exposure on commuter hearing.

OBJECTIVE: To demonstrate that brief exposure to subway noise causes temporary threshold shift and is preventable with noise protection. METHODS: The study was conducted as a randomized crossover trial. Twenty subjects were randomly assigned to two groups, one with hearing protection and one without. Subjects were exposed to subway platform noise for 15 minutes. Pre- and post-exposure pure tone audiometry (PTA) and otoacoustic emissions were compared. After a washout period, subjects switched hearing protection groups and repeated the process. RESULTS: A statistically significant reduction in PTA thresholds after subway noise exposure was identified, for subjects with and without hearing protection (P < .001). For exposure without hearing protection, the mean threshold was 5.19 dB pre-exposure and 3.91 dB post-exposure (decrease of 1.28 dB; 95% confidence interval, 0.82-1.74). For exposure with hearing protection, the mean threshold was 4.81 dB pre-exposure and 3.47 dB post-exposure (decrease of 1.34 dB; 95% confidence interval, 0.89-1.79). CONCLUSION: Brief exposure to subway noise did not cause hearing loss with or without noise protection. Though clinically insignificant, the unexpected finding of reduction in PTA suggests that there are complex heterogeneous short- and long-term cochlear responses to noise exposure that should be further explored. LEVEL OF EVIDENCE: 1b.

Association of Cardiovascular Comorbidities With Hearing Loss in the Older Old.

Importance: In the United States, the population of individuals older than 80 years is expected to double in the next 40 years. Cardiovascular comorbidities are prevalent in this older old population, and their relationship with hearing loss has not been well characterized. Objective: To investigate the association of cardiovascular disease (CVD)-related risk factors with auditory function among the older old (>80 years). Design, Setting, and Participants: Audiological data and medical records from 2001 through 2014 of 433 patients aged 80 to 106 years at an academic medical center were analyzed in 2017. Main Outcomes and Measures: The degree of low- and high-frequency hearing loss of participants with coronary artery disease, diabetes, hypertension, history of cerebrovascular accident, and smoking status was compared with that of disease-free individuals. Rate of hearing loss was also determined. Results: Among the 433 patients (67% female; mean [SD] age, 89 [5.8] years), the presence of at least 1 cardiovascular morbidity was associated with elevated mean (SD) low-frequency pure-tone average (LFPTA) of 42.4 (1.6) vs 36.9 (3.5) decibels hearing loss (dB HL), a difference of 5.47 (95% CI, 4.15-9.49) dB HL. Among the 96 patients with 2 audiograms performed at age 80 years or older from which the rate of hearing loss could be calculated, 32 patients had CVD or related risk factors and 64 were healthy controls. Those with at least 1 disease had accelerated hearing loss. Patients with cardiovascular morbidity experienced a faster mean (SD) decline in LFPTA of 1.90 (0.27) vs 1.18 (0.42) dB HL/y, a difference of 0.72 (95% CI, 0.08-1.36) dB HL/y. Of the conditions studied, coronary artery disease had the highest association with audiometric thresholds and was associated with hearing loss at all frequencies tested and with poor word recognition score. Hearing loss was more strongly associated with CVD risk factors in men than in women. Conclusions and Relevance: In this study of the older old, cardiovascular risk factors and disease were associated with worse hearing and a greater rate of hearing deterioration. Hearing loss in women was less associated with the presence of CVD, possibly owing to the cardioprotective effects of estrogen. The association of hearing with CVD severity and management remains to be determined.

The development and validation of the speech quality instrument.

OBJECTIVE: Although speech perception tests are available to evaluate hearing, there is no standardized validated tool to quantify speech quality. The objective of this study is to develop a validated tool to measure quality of speech heard. STUDY DESIGN: Prospective instrument validation study of 35 normal hearing adults recruited at a tertiary referral center. METHODS: Participants listened to 44 speech clips of male/female voices reciting the Rainbow Passage. Speech clips included original and manipulated excerpts capturing goal qualities such as mechanical and garbled. Listeners rated clips on a 10-point visual analog scale (VAS) of 18 characteristics (e.g. cartoonish, garbled). RESULTS: Skewed distribution analysis identified mean ratings in the upper and lower 2-point limits of the VAS (ratings of 8-10, 0-2, respectively); items with inconsistent responses were eliminated. The test was pruned to a final instrument of nine speech clips that clearly define qualities of interest: speech-like, male/female, cartoonish, echo-y, garbled, tinny, mechanical, rough, breathy, soothing, hoarse, like, pleasant, natural. Mean ratings were highest for original female clips (8.8) and lowest for not-speech manipulation (2.1). Factor analysis identified two subsets of characteristics: internal consistency demonstrated Cronbach's alpha of 0.95 and 0.82 per subset. Test-retest reliability of total scores was high, with an intraclass correlation coefficient of 0.76. CONCLUSION: The Speech Quality Instrument (SQI) is a concise, valid tool for assessing speech quality as an indicator for hearing performance. SQI may be a valuable outcome measure for cochlear implant recipients who, despite achieving excellent speech perception, often experience poor speech quality. LEVEL OF EVIDENCE: 2b. Laryngoscope, 128:1622-1627, 2018.

The influence of subway station design on noise levels.

OBJECTIVES/HYPOTHESIS: To investigate the impact of subway station design on platform noise levels. STUDY DESIGN: Observational. METHODS: Continuous A-weighted decibel (dBA) sound levels were recorded in 20 New York City subway stations, where trains entered on either a straight track or curved track in 10 stations each. Equivalent continuous noise levels (Leq ) at various locations on the boarding platform (inbound end, midplatform, and outbound end) during train entry and exit were compared between the straight and curved stations in broadband as well as narrow one-third octave bands. RESULTS: Overall, curved stations trended louder than straight stations, although the difference in broadband Leq did not reach statistical significance (curve, 83.4 dBA; straight, 82.6 dBA; P = .054). Noise levels were significantly louder at the inbound end of the platform during train entry (inbound, 89.7 dBA; mid, 85.5 dBA; outbound, 78.7 dBA; P < .001) and at the outbound end during train exit (inbound, 79.7 dBA; mid, 85.3 dBA; outbound, 89.1 dBA; P < .001). Narrow band analysis showed that curved stations were significantly louder than straight stations at 100 Hz and high frequencies from 8 to 20 kHz. Peak impact levels ranged from 104 to 121 dBA. CONCLUSIONS: Curved stations have a different noise profile compared to straight stations and are significantly louder than straight stations at high frequencies. Designing stations with straight tracks within the platform can help reduce commuter noise exposure. LEVEL OF EVIDENCE: NA Laryngoscope, 127:1169-1174, 2017.

Increases in the Rate of Age-Related Hearing Loss in the Older Old.

Importance: There is a critical disparity in knowledge regarding the rate and nature of hearing loss in the older old (80 years and older). Objective: To determine if the rate of age-related hearing loss is constant in the older old. Design, Setting, and Participants: We performed a retrospective review that began on August 1, 2014, with audiometric evaluations at an academic medical center of 647 patients aged between 80 and 106 years, of whom 141 had multiple audiograms. Main Outcomes and Measures: From a population perspective, the degree of hearing loss was compared across the following age brackets: 80 to 84 years, 85 to 89 years, 90 to 94 years, and 95 years and older. From an individual perspective, the rate of hearing decrease between 2 audiograms was compared with age. Results: Changes in hearing among age brackets were higher during the 10th decade of life than the 9th decade at all frequencies (5.4-11.9 dB hearing level [dB HL]) for the 647 patients (mean [SD] age, 90 [5.5] years). Correspondingly, the annual rate of low-frequency hearing loss was faster during the 10th decade by the 3.8 dB HL per year at 0.25 kHz, 3.8 dB HL per year at 0.5 kHz, and 3.2 dB HL per year at 1 kHz. Despite the universal presence of hearing loss in our sample, 382 patients (59%) used hearing aids. Conclusions and Relevance: There is a significant increase in the rate of hearing loss in patients during the 10th decade of life compared with the 9th decade that represents a fundamental change in the mechanistic process of presbycusis. Despite the potential benefit of hearing aids, they remain underused in the older old. Use may be improved by changing the method of hearing rehabilitation counseling from a patient-initiated model to a chronic disease example.

Reduction of the Harmonic Series Influences Musical Enjoyment With Cochlear Implants.

OBJECTIVE: Cochlear implantation is associated with poor music perception and enjoyment. Reducing music complexity has been shown to enhance music enjoyment in cochlear implant (CI) recipients. In this study, we assess the impact of harmonic series reduction on music enjoyment. STUDY DESIGN: Prospective analysis of music enjoyment in normal-hearing (NH) individuals and CI recipients. SETTING: Single tertiary academic medical center. PATIENTS: NH adults (N = 20) and CI users (N = 8) rated the Happy Birthday song on three validated enjoyment modalities-musicality, pleasantness, and naturalness. INTERVENTION: Subjective rating of music excerpts. MAIN OUTCOME MEASURES: Participants listened to seven different instruments play the melody, each with five levels of harmonic reduction (Full, F3+F2+F1+F0, F2+F1+F0, F1+F0, F0). NH participants listened to the segments both with and without CI simulation. Linear mixed effect models (LME) and likelihood ratio tests were used to assess the impact of harmonic reduction on enjoyment. RESULTS: NH listeners without simulation rated segments with the first four harmonics (F3+F2+F1+F0) most pleasant and natural (p <0.001, p = 0.004). NH listeners with simulation rated the first harmonic alone (F0) most pleasant and natural (p <0.001, p = 0.003). Their ratings demonstrated a positive linear relationship between harmonic reduction and both pleasantness (slope estimate = 0.030, SE = 0.004, p <0.001, LME) and naturalness (slope estimate = 0.012, SE = 0.003, p = 0.003, LME). CI recipients also found the first harmonic alone (F0) to be most pleasant (p = 0.003), with a positive linear relationship between harmonic reduction and pleasantness (slope estimate = 0.029, SE = 0.008, p <0.001, LME). CONCLUSION: Harmonic series reduction increases music enjoyment in CI and NH individuals with or without CI simulation. Therefore, minimization of the harmonics may be a useful strategy for enhancing musical enjoyment among both NH and CI listeners.

The Use of Sound Level Meter Apps in the Clinical Setting.

PURPOSE: The purpose of this study was to compare sound level meter (SLM) readings obtained using a Larson-Davis (Depew, NY) Model 831 Type 1 SLM, a RadioShack (Fort Worth, TX) SLM, and iPhone 5 (Apple, Cupertino, CA) SLM apps. METHOD: In Procedure 1, pure tones were measured in an anechoic chamber (125, 250, 500, 1000, 2000, 4000, and 8000 Hz); sound pressure levels (SPLs) ranged from 60 to 100 dB SPL in 10-dB increments. In Procedure 2, human voices were measured. Participants were 20 vocally healthy adults (7 women, 13 men; mean age = 25.1 years). The task was to sustain a vowel "ah" at 3 intensity levels: soft, habitual, and loud. Microphones were lined up equal distances from the participant's mouth, and recordings were captured simultaneously. RESULTS: Overall, the 3 SLM apps and the RadioShack SLM yielded inconsistent readings compared with the Type 1 SLM. CONCLUSION: The use of apps for SPL readings in the clinical setting is premature because all 3 apps adopted were incomparable with the Type 1 SLM.

Impact of Noise Reduction Algorithm in Cochlear Implant Processing on Music Enjoyment.

OBJECTIVE: Noise reduction algorithm (NRA) in speech processing strategy has positive impact on speech perception among cochlear implant (CI) listeners. We sought to evaluate the effect of NRA on music enjoyment. STUDY DESIGN: Prospective analysis of music enjoyment. SETTING: Academic medical center. PATIENTS: Normal-hearing (NH) adults (N = 16) and CI listeners (N = 9). INTERVENTION: Subjective rating of music excerpts. MAIN OUTCOME MEASURES: NH and CI listeners evaluated country music piece on three enjoyment modalities: pleasantness, musicality, and naturalness. Participants listened to the original version and 20 modified, less complex versions created by including subsets of musical instruments from the original song. NH participants listened to the segments through CI simulation and CI listeners listened to the segments with their usual speech processing strategy, with and without NRA. RESULTS: Decreasing the number of instruments was significantly associated with increase in the pleasantness and naturalness in both NH and CI subjects (p < 0.05). However, there was no difference in music enjoyment with or without NRA for either NH listeners with CI simulation or CI listeners across all three modalities of pleasantness, musicality, and naturalness (p > 0.05): this was true for the original and the modified music segments with one to three instruments (p > 0.05). CONCLUSION: NRA does not affect music enjoyment in CI listener or NH individual with CI simulation. This suggests that strategies to enhance speech processing will not necessarily have a positive impact on music enjoyment. However, reducing the complexity of music shows promise in enhancing music enjoyment and should be further explored.

Asymmetric hearing loss is common and benign in patients aged 95 years and older.

OBJECTIVES/HYPOTHESIS: The objective of our study was to investigate age-specific auditory function in the patient population aged 95 years and older. STUDY DESIGN: Retrospective chart review at a tertiary medical center. METHODS: Medical records of 51 patients older than 95 years (82% female, 18% male) who underwent audiologic testing were reviewed. The following information was collected: age at time of most recent audiogram and prior audiograms; results of pure tone, immittance, and speech audiometry; and findings on radiologic imaging. RESULTS: None of the subjects had hearing in the normal range. For the poorer hearing ear, average low-frequency, high-frequency, and overall pure tone averages (PTA) for the population were 67.9, 82.1, and 74.9 dB hearing level, respectively. Mean word recognition score (WRS) was 57.6% and deteriorated with increasing PTA (P = .0002). Asymmetry, defined by a 10-dB difference at two frequencies, was present in 39.2% of the sample, and WRS asymmetry, defined as a difference of 12% in WRS between ears, was present in 33.0% of the sample. Retrocochlear evaluation did not identify pathology in any of the cases tested. In the poorer hearing ear, average decline in PTA per year was 2.9 dB. CONCLUSIONS: In individuals >95 years of age, hearing loss was universal, moderately severe to profound in magnitude, and associated with substantial loss of speech recognition. Hearing loss progresses at a rate greater than for younger cohorts. In this "oldest old" population, asymmetry of loss and WRS was common and is not indicative of retrocochlear pathology. LEVEL OF EVIDENCE: 4 Laryngoscope, 126:1630-1632, 2016.

Localization by unilateral BAHA users.

OBJECTIVES: Patients with unilateral hearing loss report difficulty hearing conversation on their impaired side, localizing sound, and understanding of speech in background noise. The bone-anchored cochlear stimulator (BAHA) (Entific, Gothenburg, Sweden) has been shown to improve performance in persons with unilateral severe-profound sensorineural loss (USNHL). The purpose of this study is to evaluate the effectiveness of BAHA in sound localization for USNHL listeners. STUDY DESIGN: Prospective study of 12 USNHL subjects, 9 of whom received implants on the poorer hearing side. A control group of 10 normal hearing subjects were assessed for comparison. Localization with and without BAHA was assessed using an array of 8 speakers at head level separated by 45 degrees. Error analysis matrix was generated to evaluate the confusions, accuracy in response, and laterality judgment. RESULTS: The average accuracy of speaker localization was 16% in the unaided condition, with no improvement with BAHA use. Laterality judgment was poorer than 43% in both aided and nonaided conditions. CONCLUSIONS: Patients with UNSNHL had poor sound localization and laterality judgment abilities that did not improve with BAHA use.

A Speech Perception Test in Simulated Reverberation Conditions.

PURPOSE: This study developed new test materials by applying various reverberation treatments to sentences having high and low contextual redundancy. METHOD: The Speech Perception in Noise-Revised (SPIN-R; Bilger, Nuetzel, Rabinowitz, & Rzeczkowski, 1984; Kalikow, Stevens, & Elliott, 1977) sentences were modified (SPIN-Reverb) with reverberation times (RT60) from simulated environments: unprocessed, RevCond 1 (RT60 = 600 ms), RevCond 2 (RT60 = 1200 ms), and RevCond 3 (RT60 = 3600 ms). Phase 1 investigated list equivalency among 75 listeners with normal hearing; Phase 2 examined the utility of SPIN-Reverb for 15 cochlear implant (CI) recipients. RESULTS: Equivalent lists within each reverberation condition (unprocessed, RevCond 1, 2, and 3) were identified using nonparametric bootstrapping. Analysis of variance (Phase 1) demonstrated significant differences across conditions for high predictability and total scores. Listening performance decreased for both high and low predictability as RT60 increased for listeners with normal hearing and CI recipients. Unprocessed, RevCond 1, RevCond 2, and RevCond 3 conditions were significantly different from each other. Within RevCond conditions, high- and low-predictability sentences were significantly different from each other. CONCLUSIONS: RevCond 1 and RevCond 2 may be useful supplements to the current CI battery. The SPIN-Reverb has potential as a set of clinically feasible materials that are graded in difficulty and representative of real-life acoustic challenges for the evaluation of sensory devices.

The effect of background babble on working memory in young and middle-aged adults.

BACKGROUND: Background noise has been found to negatively affect working memory. Numerous studies have also found that older adults perform more poorly on working memory tasks than young adults (YA). Hearing status has often been a confounding factor in older individuals. Therefore, it would be beneficial to investigate working memory functions in adverse listening conditions early in the aging process (i.e., middle-age), when hearing function is relatively unaffected. PURPOSE: The focus of this study was to determine the influence of background babble on working memory in YA and middle-aged adults (MA) with normal hearing. RESEARCH DESIGN: Before testing was begun, we established that all participants could correctly identify words in a degraded experimental testing environment with 100% accuracy. Then, the participants listened to lists composed of five pairs of words in quiet and in 20-talker babble. After the final word pair, the participants were cued with the first word of one of the previous five word pairs. The participants were required to write down the second word of the pair. The percent correct scores for each of the five serial positions were analyzed comparing the two listening conditions for YA and MA. Ten YA and ten MA with normal hearing between 250-8000 Hz and a score of at least 26/30 on the Mini-Mental State Examination participated in the study. As different cognitive processes are used for initial, middle, and final serial positions, averaged scores were obtained for Positions 2 and 3 and for Positions 4 and 5. Subsequently, repeated-measures analyses of variance (ANOVAs) were conducted on mean scores of correctly recalled word pairs with serial positions (initial, middle, and final) and listening condition (quiet, babble) as the within-participant variables and age group (YA, MA) as the between-participant independent variable. This OMNIBUS repeated-measures ANOVA was then followed up with separate repeated-measures ANOVAS for the initial, middle, and final positions. RESULTS: Correct recall scores were lower for early positions compared with the latter positions, irrespective of listening condition. For Position 1, YA-but not MA-performed significantly better in babble than in quiet. For the middle positions (Positions 2 and 3), MA performed significantly more poorly than the YA irrespective of listening condition. For the final positions (Positions 4 and 5), no age differences or effects of listening condition were found. CONCLUSIONS: The results indicate that both YA and MA have trouble recalling earlier pieces of information in quiet and in babble. However, MA exhibited significantly poorer recall scores than YA in babble for Position 1, which suggest that cognitive processes related to memory encoding and retrieval are different in background babble for MA and YA.

High-frequency pulsed electromagnetic energy in tinnitus treatment.

OBJECTIVES/HYPOTHESIS: Electromagnetic therapy has been used with reported success in multiple clinical settings, including the treatment of seizure disorders, brain edema, migraine headaches, revascularization of burn wounds, and diabetic ulcers. The purpose of the study was to investigate the effect of pulsed high-frequency electromagnetic therapy on chronic tinnitus. STUDY DESIGN: A randomized, prospective, double-blind, placebo-controlled pilot study was conducted to evaluate the effectiveness of high-frequency pulsed electromagnetic energy using the Diapulse device in the treatment of chronic tinnitus. Thirty-seven adult patients with chronic tinnitus of at least 6 months' duration were recruited and randomly assigned to either a treatment or a placebo group. METHODS: Patients received 30-minute treatments with the Diapulse device three times a week for 1 month. The unit was set to deliver electromagnetic energy at a frequency of 27.12 MHz at a repetition rate of 600 pulses per second. All subjects had pretreatment and post-treatment audiological testing, including tinnitus frequency and intensity matching. They responded to a tinnitus rating questionnaire and the Tinnitus Handicap Inventory before and after treatment. RESULTS: There was no significant change in the pretreatment and post-treatment audiometric thresholds in either group. There were no significant differences between the pretreatment and post-treatment Tinnitus Handicap Inventory scores or the tinnitus rating scores in either subject group (Student t test). No diagnosis-specific differences were identified. CONCLUSION: High-frequency pulsed electromagnetic energy (Diapulse) at the settings used in the study showed no role in the therapy of patients with chronic tinnitus.

Diagnosis and treatment of sudden-onset sensorineural hearing loss: a study of 51 patients.

OBJECTIVE: The study purpose was to determine the efficacy of steroid and antiviral therapy in the management of idiopathic sudden sensorineural hearing loss (SSNHL). STUDY DESIGN AND SETTING: We conducted a retrospective study of patients presenting to an academic tertiary care center. Fifty-one patients were evaluated. All patients were placed on the same treatment protocol. RESULTS: Thirty-seven patients (73%) had recovery of hearing. Ninety-one percent of patients with vertigo and all patients with mid-frequency hearing loss and up-sloping hearing loss recovered with treatment (P < 0.05). Recovery was significantly related to age, onset of hearing loss, and audiogram type; however outcome was not significantly related to gender, vertigo, tinnitus, or laterality (P < 0.05). CONCLUSION: Our treatment protocol produced a recovery rate, which exceeds the spontaneous recovery rate. Unlike prior studies, all patients with up-sloping and mid-frequency SSNHL had recovery. In addition, vertigo did not indicate a poor prognosis. SIGNIFICANCE: Antiviral therapy and increased length of steroid treatment may play a role in the improved recovery rates.

Transcranial contralateral cochlear stimulation in unilateral deafness.

OBJECTIVES: The purpose of this study is to evaluate the effectiveness of Bone Anchored Cochlear Stimulator (BAHA) in transcranial routing of signal by implanting the deaf ear. Study design and settings Eighteen patients with unilateral deafness were included in a multisite study. They had a 1-month pre-implantation trial with a contralateral routing of signal (CROS) hearing aid. Their performance with BAHA was compared with the CROS device using speech reception thresholds, speech recognition performance in noise, and the Abbreviated Profile Hearing Benefit and Single Sided Deafness questionnaires. RESULTS: Patients reported a significant improvement in speech intelligibility in noise and greater benefit from BAHA compared with CROS hearing aids. Patients were satisfied with the device and its impact on their quality of life. No major complications were reported. Conclusion and significance BAHA is effective in unilateral deafness. Auditory stimuli from the deaf side can be transmitted to the good ear, avoiding the limitations inherent in CROS amplification.

Evolving applications in the use of bone-anchored hearing aids.

The bone-anchored hearing aid (BAHA) is an effective means of intervention, its use being well documented in persons with chronic conductive pathology and congenital aural anomalies. This article describes the standard guidelines (both auditory and extraauditory aspects) for patient selection and expands the criteria to include bilateral BAHA implantation, unilateral conductive hearing loss, and unilateral profound sensorineural hearing loss. The BAHA's development, design features, and patient outcomes are also reviewed. Suggestions are presented for fitting, counseling, and following BAHA users.

Stability of audiometric measures and challenges in long-term management of the elderly cochlear implant patient.

OBJECTIVE: To determine the long-term audiometric stability and the types and frequency of management challenges encountered when working with elderly cochlear implant users. STUDY DESIGN: Retrospective chart review. SETTING: University hospital. PATIENTS: The final sample is 23 cochlear implantees over the age of 60, followed an average of 8.4 years. INTERVENTION: Rehabilitative (cochlear implantation for clinical purposes, audiologic management). MAIN CLINICAL OUTCOME MEASURES: Warble tone thresholds, spondee thresholds, speech recognition scores, and frequency counts of management problems. RESULTS: Warble tone thresholds were stable over the study period. Speech recognition performance was not significantly changed statistically over the study period, but examination of individual results showed that 26% improved in performance, 17% participants decreased, and 17% remained the same. Thirteen percent of the sample had noteworthy thinning of the flap, including one individual whose flap deteriorated and required explantation.Management challenges relating to failing health, broken and lost equipment, thinning of the skin flap, critical judgment and emotional difficulties during programming sessions, and the need for repeated instructions on device use were noted with varying frequencies. CONCLUSION: Cochlear implantation is beneficial for elderly patients with severe-profound sensorineural hearing loss as demonstrated by long-term stability of function, with the caveat that some individuals may experience significant decreases in speech recognition over time. However, unique management challenges resulting from age-related cognitive decline, health problems, and/or reduced dexterity may present themselves. Audiologists must keep these issues in mind during preoperative counseling and when structuring postoperative follow-up sessions.