Utility of electronystagmography in the prediction of post-operative outcome following cochlear implantation.

OBJECTIVE: To examine the relationship between pre-operative electronystagmography and videonystagmography test results and post-operative outcomes in dizziness, auditory sensitivity and speech recognition. METHODS: A retrospective chart review was performed. Auditory sensitivity and speech perception ability were tested pre- and post-operatively in 37 adult cochlear implant recipients. Auditory sensitivity was evaluated using either pure tones (for testing with earphones) or frequency-modulated warble tones (for sound-field testing). Speech perception ability was evaluated using Northwestern University Auditory Test Number 6. RESULTS: No correlation was found between pre-operative electronystagmography test results and post-operative subjective dizziness. However, pre-operative electronystagmography testing and post-operative hearing sensitivity as measured by warble tone average (dB HL) correlated significantly at six months or later after cochlear implant activation (r  ≥  -0.34, n = 34, p < 0.05). CONCLUSION: This study, which has a level of evidence 4, demonstrates that pre-operative electronystagmography testing has a potential use in predicting post-operative outcomes in hearing sensitivity following cochlear implantation. However, larger studies are needed to confirm this novel finding.

The expanding domain of implantable hearing devices: an update on current status in the United States.

Several implantable devices are now approved in the United States for rehabilitation of conductive, mixed, and sensorineural hearing loss. This paper will review current rehabilitative options including middle ear implants, used for mild to severe sloping sensorineural loss, and bone-anchored hearing aids, for conductive or mixed hearing loss. The indications for these devices differ, as do the bases for exclusion. Audiologic evaluation parameters will be reviewed as a guideline to selection, and as a baseline to determine potential rehabilitative impact. We will also describe emerging applications, based on our ongoing research projects, for these devices that are anticipated to broaden the indications.

Ototoxic impact of cisplatin in pediatric oncology patients.

OBJECTIVE: To describe hearing changes in a group of 28 children (age range, 8-180 mo) undergoing protocol-based cisplatin therapy. METHODS: Conventional, play audiometry, visual reinforcement audiometry (VRA), immittance audiometry, transient click evoked otoacoustic emissions (OAEs), and auditory brainstem response (ABR) evoked potentials were used to assess peripheral sensitivity and for threshold determination. RESULTS: Bilateral symmetrical high-frequency sensorineural hearing loss was noted in 9 of the 28 children (26%). Hearing loss was evident as early as 1 month after chemotherapy and as late as 50 months and was not dependent on individual or cumulative dosage of cisplatin. CONCLUSIONS: 1) Presence of sensorineural hearing loss was independent of individual and/or cumulative dosage of cisplatin; 2) audiologic assessment should be incorporated into a child's periodic medical evaluations after chemotherapy treatment, as onset of sensorineural hearing loss cannot be predicted; 3) personal hearing aids may be indicated for those children with hearing loss affecting the low- to mid-frequencies; a personal assistive listening device (frequency modulated system) may be more appropriate for losses above 3000 Hz; and 4) evaluation and intervention by a speech-language pathologist may be indicated to address possible articulation or language development problems consequent to hearing loss.

Use of glycopyrrolate in the treatment of Meniere's disease.

OBJECTIVES/HYPOTHESIS: The objective of this study was to determine whether glycopyrrolate is useful as a vestibular suppressant in patients with Meniere's disease. The tested hypotheses were that glycopyrrolate would decrease the perception of dizziness measured by the Dizziness Handicap Inventory in patients with Meniere's disease and that placebo would cause no such decrease. STUDY DESIGN: Randomized, prospective. METHODS: Thirty-seven subjects with a diagnosis of Meniere's disease were administered either 2 mg of glycopyrrolate or placebo twice daily as needed for vertigo. All were also administered the regimen of 1500 mg sodium/day diet and diuretic. The following indices were examined: Dizziness Handicap Inventory, Tinnitus Handicap Inventory, Modified Somatic Perception Questionnaire, Beck Depression Inventory, hearing examination, and electronystagmography. After 4 to 6 weeks of the drug regimen, Dizziness Handicap Inventory, Tinnitus Handicap Inventory, Modified Somatic Perception Questionnaire, and Beck Depression Scale were reexamined. Paired t tests were performed to verify the significance of improvement before and after treatment. RESULTS: Subjects who received glycopyrrolate had statistically significant reduction in Dizziness Handicap Inventory, Beck Depression Score, and Modified Somatic Perception Score. In the placebo group, no improvement in any index was found. CONCLUSIONS: The hypothesis that glycopyrrolate is a useful vestibular suppressant in patients with Meniere's disease was statistically verified.

Development of the Tinnitus Handicap Inventory.

OBJECTIVE: To develop a self-report tinnitus handicap measure that is brief, easy to administer and interpret, broad in scope, and psychometrically robust. DESIGN: A standardization study of a self-report tinnitus handicap measure was conducted to determine its internal consistency reliability and convergent and construct validity. SETTING: Audiology clinics in tertiary care centers in two sites. PARTICIPANTS: In the first investigation, 84 patients reporting tinnitus as their primary complaint or secondary to hearing loss completed the 45-item alpha version of the Tinnitus Handicap Inventory (THI). In the second investigation, 66 subjects also reporting tinnitus completed the 25-item beta version. OUTCOME MEASURES: Convergent validity was assessed using another measure of perceived tinnitus handicap (Tinnitus Handicap Questionnaire). Construct validity was assessed using the Beck Depression Inventory, Modified Somatic Perception Questionnaire, symptom rating scales (annoyance, sleep disruption, depression, and concentration), and perceived tinnitus pitch and loudness judgments. RESULTS: From the alpha version of the THI, we derived a 25-item beta version with the items grouped into functional, emotional, and catastrophic subscales. The total scale yielded excellent internal consistency reliability (Cronbach's alpha = .93). No significant age or gender effects were seen. Weak correlations were observed between the THI and the Beck Depression Inventory, Modified Somatic Perception Questionnaire, and pitch and loudness judgments. Significant correlations were found between the THI and the symptom rating scales. CONCLUSION: The THI is a self-report measure that can be used in a busy clinical practice to quantify the impact of tinnitus on daily living.

Speaking fundamental frequency, intensity, and rate of adventitiously profoundly hearing-impaired adult women.

No objective group data on speaking fundamental frequency (F0), intensity, or rate have been reported on the speech of adventitiously profoundly hearing-impaired adult women. Results of the present study showed that F0 was significantly higher, intensity significantly greater, and speaking rate significantly slower for 12 adventitiously profoundly hearing-impaired adult women than for 20 normal-hearing control subjects of the same sex and approximate age. Based on these objective data, aural rehabilitation is recommended for the improvement and monitoring of speaking F0, intensity, and rate abnormalities in the adventitiously profoundly hearing impaired.

A perceptual evaluation of the speech of adventitiously deaf adult males.

The present study investigated the effects of adventitious deafness on perceptual judgments of segmental and suprasegmental speech production skills. Subjects were 25 adventitiously deaf and 10 normal-hearing adult male speakers. Twelve subjects were classified as aidable profound (AP) and 13 subjects were classified as unaidable profound (UP). Each subject was judged by 15 listeners, first on seven speech and voice variables and, second, on whether they were adventitiously deaf or normal-hearing and, if adventitiously deaf, if speech rehabilitation was warranted. Both the AP and UP adventitiously deaf subjects were judged significantly different from each other and from normal-hearing subjects on all seven variables. They were, in hierarchical order: intonation, pitch, rate, nasality, vowel duration, articulation, and intensity. Aural rehabilitation was judged to be warranted in 49% of the speakers identified as being adventitiously deaf, specifically 26% of the AP speakers and 74% of the UP speakers. This finding indicates that auditory information is a necessary component for maintaining accurate speech and voice production abilities following onset of profound hearing loss after the acquisition of an adult phonological system.

Longitudinal effects of single-channel cochlear implantation on voice quality.

No studies have reported longitudinal group data on the voice characteristics of adult participants with adventitious profound sensorineural hearing loss before and after single-channel cochlear implantation. This study investigated voice fundamental frequency, intensity, and speaking duration preimplantation and longitudinally 1-day, 6-months, and 1-year poststimulation. Results revealed only fundamental frequency 1-day poststimulation to be significantly different from preimplantation. Trends for all three variables, i.e., lowered Fo, reduced intensity, and shortened speaking duration (a faster rate), however, moved toward the measures that typify normal-hearing speakers.

An evaluation of the relationship among electronystagmographic, audiologic, and self-report descriptors of dizziness.

Although descriptions of dizziness constitute a major category of complaints among patients seen in many clinical practices, the actual significance of the patient's report of symptoms has been disputed. Furthermore, the relationship of report to outcomes of clinical tests of the audio-vestibular system has not been well described. The present study examined the relationship of a self-report measure to results of electronystagmographic and audiometric evaluations in a consecutive sampling of patients at a Veterans Administration Medical Center. The findings reflected poor predictability of peripheral vestibular involvement when using the self-reporting questionnaire by patients, even when combined with audiometric observations. The utility of the self-report approach is discussed.

Evaluation of decisions regarding candidates for cochlear implants.

Stepwise regression analysis was used to evaluate measures predictive of the selection of candidates for cochlear implants. Results of a comprehensive selection protocol were compiled for a group of 31 profoundly hearing-impaired adults undergoing intensive pre-selection evaluation. Data included: unaided audiologic; aided audiologic; vestibular; otologic; medical; radiologic; voice/speech; speechreading; psychoacoustic; and electrophysiologic parameters. The results of the Cochlear Implant Team's decisions concerning selections of patients for implants were compared with the predictive outcome of regression analysis. Ramifications for the construction of cochlear implant evaluation protocols are discussed.

Speaking rate of adventitiously deaf male cochlear implant candidates.

No objective group data on speaking rate or speaking duration have been reported on the speech of adventitiously profoundly hearing-impaired adults. Results of the present study showed that speaking rate, i.e., number of syllables per second, was significantly slower and speaking duration was significantly longer for 25 adventitiously profoundly hearing-impaired adult male cochlear implant candidates than for 10 normal-hearing control subjects. The factors of length of time since onset of profound hearing loss and hearing aid use did not significantly affect speaking rate. Based on these objective data, a rationale and method are presented for aural rehabilitation of the profoundly hearing-impaired who exhibit speaking rate abnormalities.

Standardization of four videotaped tests of speechreading ranging in task difficulty.

Repeated measures are needed to assess speechreading ability of prospective cochlear implant candidates and to follow their progress over the course of treatment. To perform such measures, high quality color videotaped versions of four speechreading tests were constructed using a male and a female speaker. Materials were selected to provide gradations in task difficulty ranging from responses to questions with the topic known, to verbatim repetition, to abstraction of information from a spoken paragraph in order to answer questions. The tests were: (1) NAL/West Haven modification; (2) Iowa-Keaster, Forms A and B; (3) CID Everyday Sentences; and (4) Gold Rush Paragraph. The tapes were standardized by presentation to young adult normal subjects. Results indicated that a range of performance could be measured by using the present tests as a battery, although the anticipated ranking of tests was not obtained.

Speaking fundamental frequency of postlingually profoundly deaf adult men.

We investigated the speaking fundamental frequency (F0) of 21 postlingually profoundly sensorineurally deaf men. Results indicated that speaking F0 was significantly higher for the deaf group than for normal-hearing, age-matched men. Neither duration of profound deafness nor hearing aid usage affected speaking F0 values significantly. The findings of the present study provide a baseline for determining the effects of rehabilitation.

Voice intensity of prospective cochlear implant candidates and normal hearing adult males.

Voice intensity in 19 prospective cochlear implant candidates, all adventitiously profoundly sensorineurally deaf adult males, was investigated. For the first time with objective data, it was shown that such deaf subjects spoke with significantly increased voice intensity and with greater intensity fluctuations than normal hearing male speakers. Neither length of time of profound deafness nor history of hearing aid use significantly affected voice intensity. Based on quantitative data, rehabilitation of voice intensity problems in the adventitiously deaf is indicated.

Immediate effects of cochlear implantation on voice quality.

Seminal quantitative group acoustic data are presented on voice quality changes following electrical stimulation (ES) of the auditory nerve via a single-channel cochlear implant (CI). It was found that the fundamental frequency (Fo) of our patients was significantly lower after the first day of ES, while intensity and speaking duration were not significantly different from pre-CI values. These results suggest that the CI provides enough frequency information less than 300 Hz to permit immediate and independent alterations in voice Fo towards normal-hearing speakers values. Our findings also indicate that intensity and speaking duration require additional time before differences found become significant. Longitudinal data are still needed to determine if Fo continues to lower and if intensity and/or speaking duration change significantly to approximate values observed in normal-hearing individuals.

Brainstem auditory evoked potentials in newly detoxified alcoholics.

The effects of detoxication on auditory transmission were examined using Brainstem Auditory Evoked Potentials (BAEP) in a group of alcoholics undergoing treatment and compared to nonalcoholic controls. BAEP responses, obtained at 2 click stimulation rates (11.3/sec and 31.3/sec), were examined for morphology, absolute latencies, interpeak latencies and I/V amplitude differences. All mean latency values were found comparable for the two groups. For a number of waves in each ear, data for alcoholics were significantly more variable than that of controls. A significant number of alcoholics, however, had atypical waveforms (i.e., missing components) and some, unexpected I/V amplitude differences, with the amplitude of wave I larger than that of V in comparison to controls. The clinical interpretation of evoked potential findings for individual alcoholic patients is likely to be precarious due to the observed high variability of latency and amplitude values.

Test-retest reliability of the Hearing Handicap Inventory for the Elderly.

The Hearing Handicap Inventory for the Elderly (HHIE) is a self-assessment tool, composed of emotional and social/situational subscales and designed to measure the perceived effects of hearing impairment in the noninstitutionalized elderly. Previous study has indicated that the HHIE has a high internal consistency, as well as high split-half reliability. The present study was undertaken to examine test-retest reliability associated with the HHIE, as the latter information is prerequisite to the application of the HHIE as a measure of change in perception of handicap which may result from audiologic intervention. Forty-seven noninstitutionalized elderly individuals with sensorineural hearing loss were sampled, using two measurement techniques: face-to-face (N = 20) and paper-and-pencil (N = 27) administration. Test-retest reliability was high for both the face-to-face and paper-and-pencil administration, suggesting that the HHIE has potential as a measure of change resulting from rehabilitation.

Vibrotactile stimulation for the adventitiously deaf: an alternative to cochlear implantation.

Acoustic correlates of the prosodic features identifying English contrastive stress, ie, fundamental frequency (Fo), duration and intensity, and listener perceptions were investigated in a profoundly adventitiously deaf subject (D) pre/postvibrotactile stimulation, and in an age-peer normally-hearing person as a control (N). Stimuli were a group of general American English words in which a change of function from noun to verb was associated with a shift of stress from initial to final syllable, eg, CON'test vs conTEST'. Prior to vibrotactile stimulation, D was unable to produce contrastive stress correctly. Only final syllable intensity differences were noted, but proved to be inadequate cues for contrastive stress. Vibrotactile stimulation resulted in changes, specifically significantly higher Fo for initial stressed vs unstressed syllables, significantly louder intensity for final stressed vs unstressed syllables, and significantly longer duration for final stressed vs unstressed syllables. Perceptually, listeners judged D's contrastive stress placement as always occurring on the final syllable previbrotactile stimulation and as 78% correct postvibrotactile stimulation. N's contrastive stress placement was always correct. It was concluded that use of vibrotactile stimulation enhanced D's production and resulted in listeners' perceptions of correct prosody.

Reacquisition of contrastive stress in an adventitiously deaf speaker using a single-channel cochlear implant.

Acoustic correlates of contrastive stress, i.e., fundamental frequency (F0), duration, and intensity, and listener perceptions of stress, were investigated in a profoundly deaf subject (RS) pre/post single-channel cochlear implant and longitudinally, and compared to the overall patterns of age-peer profoundly deaf (JM) and normally hearing subjects (DL). The stimuli were a group of general American English words in which a change of function from noun to verb is associated with a shift of stress from initial to final syllable, e.g., CON'trast versus conTRAST'. Precochlear implant, RS was unable to produce contrastive stress correctly. Hearing one day post-stimulation resulted in significantly higher F0 for initial and final stressed versus unstressed syllables. Four months post-stimulation, RS maintained significantly higher F0 on stressed syllables, as well as generalization of significantly increased intensity and longer syllable duration differences for all stressed versus unstressed syllables. Perceptually, listeners judged RS's contrastive stress placement as incorrect precochlear implant and as always correct post-cochlear implant. JM's contrastive stress was judged as 96% correct, and DL's contrastive stress placement was 100% correct. It was concluded that RS reacquired all acoustic correlates needed for appropriate differentiation of contrastive stress with longitudinal use of the cochlear implant.

Reliability of a measure of eustachian tube function in normal subjects.

Short-term reliability of a tympanometric pressure-swallow technique for assessing eustachian tube (ET) ventilating efficiency was measured in 20 normals with intact tympanic membranes on otoadmittance and impedance instruments. Tympanograms were examined for middle ear pressure and amplitude after a swallow maneuver and manipulation of ear canal pressure in a repeated measures design. Test-retest correlations were examined for both pressure shift and amplitude. Poor reliability was obtained for pressure measures with otoadmittance, while high reliability was observed for pressure values on impedance trials and amplitude for both instruments. Findings suggested significant probability of misclassification of normals for repeated measures of ET efficiency, using the currently accepted criterion for minimum pressure shift.