Age standardization and time-of-day performance for the Oldenburg Sentence Test (OLSA): results from the population-based Gutenberg Health Study.

PURPOSE: The Oldenburg Sentence Test (OLSA) is a German matrix test designed to determine speech recognition thresholds (SRT). It is widely used for hearing-aids and cochlear implant fitting, but an age-adjusted standard is still lacking. In addition, knowing that the ability to concentrate is an important factor in OLSA performance, we hypothesized that OLSA performance would depend on the time of day it was administered. The aim of this study was to propose an age standardization for the OLSA and to determine its diurnal performance. METHODS: The Gutenberg Health Study is an ongoing population-based study and designed as a single-centre observational, prospective cohort study. Participants were interviewed about common otologic symptoms and tested with pure-tone audiometry and OLSA. Two groups-subjects with and without hearing loss-were established. The OLSA was performed in two runs. The SRT was evaluated for each participant. Results were characterized by age in 5-year cohorts, gender and speech recognition threshold (SRT). A time stamp with an hourly interval was also implemented. RESULTS: The mean OLSA SRT was - 6.9 ± 1.0 dB (group 1 male) and - 7.1 ± 0.8 dB (group 1 female) showing an inverse relationship with age in the whole cohort, whereas a linear increase was observed in those without hearing loss. OLSA-SRT values increased more in males than in females with increasing age. No statistical significance was found for the diurnal performance. CONCLUSIONS: A study with 2900 evaluable Oldenburg Sentence Tests is a novelty and representative for the population of Mainz and its surroundings. We postulate an age- and gender-standardized scale for the evaluation of the OLSA. In fact, with an intergroup standard deviation (of about 1.5 dB) compared to the age dependence of 0.7 dB/10 years, this age normalization should be considered as clinically relevant.

Tinnitus and Its Relation to Depression, Anxiety, and Stress-A Population-Based Cohort Study.

Tinnitus is a common symptom reported in otolaryngologic practice. Although the pathophysiology of tinnitus has not been fully understood, clinical studies suggest that psychological symptoms of depression, anxiety, and somatization are increased in tinnitus patients. However, patients seeking medical treatment for tinnitus may be especially vulnerable. Population-based studies reporting on the association between tinnitus and psychological distress are still lacking. The aim of this study was to investigate the correlation of tinnitus with depression, anxiety, or somatization in a large population-based cohort. The Gutenberg Health Study is a population-based cohort study. Participants were asked about the occurrence of tinnitus (yes/no) and how much they were bothered by it. In addition, they completed the PHQ-9, GAD-7, and SSS-8 questionnaires to assess depressive symptoms, anxiety, and somatic symptom disorders. A total of 8539 participants were included in the study cohort. Tinnitus prevalence was 28.0% (2387). The prevalence of depression/anxiety/somatic symptom disorders was significantly higher among participants with tinnitus than among participants without tinnitus (7.9%/5.4%/40.4% participants with tinnitus vs. 4.6%/3.3%/26.9% participants without tinnitus, p-value < 0.0001). Logistic regression results showed that participants with tinnitus were more likely to suffer from depression (OR = 2.033, 95% CI [1.584; 2.601], p-value < 0.0001), anxiety (OR = 1.841, 95% CI [1.228; 2.728], p-value = 0.0027), or somatic symptom disorders (OR = 2.057, 95% CI [1.799; 2.352], p-value < 0.0001). Symptoms of depression, anxiety, and somatic symptom disorders were increased in participants with tinnitus. This must be taken into account when treating these patients.

The German hearing in noise test with a female talker: development and comparison with German male speech test.

PURPOSE: The aim of the study was to develop the German Hearing in Noise Test (HINT) with female speaker by fulfilling the recommendations by International Collegium of Rehabilitative Audiology (ICRA) for using a female speaker to create new multilingual speech tests and to determine norms and to compare these norms with German male speech tests-the male speakers HINT and the Oldenburg Sentence Test (OLSA). METHODS: The HINT with a female speaker consists of the same speech material as the male speaking HINT. After recording the speech material, 10 normal hearing subjects were included to determine the performance-intensity function (PI function). 24 subjects were part of the measurements to determine the norms and compare them with the norms of male HINT and OLSA. Comparably, adaptive, open-set methods under headphones (HINT) and sound field (OLSA) were used. RESULTS: Acoustic phonetic analysis demonstrated significant difference in mean fundamental frequency, its range and mean speaking rate between both HINT speakers. The calculated norms by three of the tested four conditions of the HINT with a female speaker are not significantly different from the norms with a male speaker. No significant effect of the speaker's gender of the first HINT measurement and no significant correlation between the threshold results of the HINT and the OLSA were determined. CONCLUSIONS: The Norms for German HINT with a female speaker are comparable to the norms of the HINT with a male speaker. The speech intelligibility score of the HINT does not depend on the speakers' gender despite significant difference of acoustic-phonetic parameters between the female and male HINT speaker's voice. Instead, the speech intelligibility rating must be seen as a function of the used speech material.

Hearing rehabilitation for unilateral deafness using a cochlear implant: the influence of the subjective duration of deafness on speech intelligibility.

BACKGROUND: For patients with single sided deafness (SSD) or severe asymmetric sensorineural hearing loss (ASHL), cochlear implantation remains the only solution to restore bilateral hearing capacity. Prognostically, the duration of hearing loss in terms of audiological outcome is not yet clear. Therefore, the aim of this study was to retrospectively investigate the influence of subjective deafness duration on postoperative speech perception after cochlear implantation for SSD as well as its impact on quality of life. MATERIALS AND METHODS: The present study included a total of 36 adults aged 50.2 ± 15.5 years who underwent CI for SSD/ASHL at our clinic between 2010 and 2015. Patients were audiometrically assessed at 3 and 12-36 months postoperatively. Test results were correlated with self-reported duration of deafness. Quality of life was assessed by questionnaire. RESULTS: Mean duration of deafness was 193.9 ± 185.7 months. The side-separated hearing threshold showed an averaged target range between 30 and 40 dB HL. Freiburg monosyllable test increased from 0% pre-operatively to 20% after 3 months (p = 0.001) and to 50% after 12-36 months (p = 0.002). There was a significant correlation between audiometric outcome and subjective deafness duration at 12-36 months postoperatively (r = - 0.564; p = 0.02) with a cutoff for open-set monosyllable recognition at a duration of deafness of greater than 408 months. Quality of life was significantly improved by CI. CONCLUSIONS: CI implantation in unilaterally deafened patients provides objective and subjective benefits. Duration of deafness is unlikely to be an independent negative predictive factor and thus should not generally be considered as contraindication.

The Prevalence of Hearing Loss and Provision With Hearing Aids in the Gutenberg Health Study.

BACKGROUND: Hearing is a basic ability that is needed for participation in daily life. Hearing loss often greatly reduces a person's quality of life. Nevertheless, epidemiological data on the prevalence of hearing disorders in Germany are sparse. This study investigated the prevalence of hearing disorders and the actual provision with hearing aids. METHODS: The Gutenberg Health Study (GHS) is a representative cohort study carried out at the Department of Medicine of Mainz University to investigate the health of the population of the city of Mainz and the neighboring Mainz‒Bingen district. The GHS participants underwent pure-tone audiometry of each ear independently. RESULTS: Tone audiometry data from a total of 5024 participants were evaluated. The prevalence of hearing loss-regardless of severity-in at least one ear was 40.6% in this study population. The hearing loss was mild in 22.5% of the participants, moderate in 8.3%. Some 2.8% had severe hearing loss. In this group, the women had better hearing than the men (by a mean 4.3 dB). The prevalence of hearing disorders rose with increasing age. The minimum tone audiometry conditions for bilateral hearing aid provision-as defined in the relevant German guideline-were met in 47.7% of the participants. Only 7.7% of the participants already had hearing aids for both ears. The discrepancy between the prevalence of hearing loss and the indication for provision with hearing aids arises from differences in how hearing loss was ascertained and the indications set. CONCLUSION: The prevalence of hearing loss was high, at 40.6%. Regular hearing tests should be recommended for the general German population, starting at no later than 60 years of age.

The German hearing in noise test.

OBJECTIVES: The aims of this study were to develop a German Hearing In Noise Test (HINT) using the same methodology as with previous HINT tests; to develop sentence lists for measuring speech reception thresholds (SRTs); and to determine test-retest reliability and norms for measures obtained under headphones. DESIGN: The following steps were followed: develop and record sentences, synthesise masking noise, determine the performance-intensity (PI) function, equalise sentence difficulty in the masking noise. Form sentence lists of equal difficulty. Measure SRTs for normal hearing individuals to determine practice/learning effects, test-retest reliability, and norms. STUDY SAMPLE: Three groups of adults (median age = 25 years) with average better ear pure-tone averages (PTAs) ≤ 5 dB HL participated. RESULTS: The 12 20-sentence lists were well-matched phonemically and did not differ significantly in difficulty. Test-retest reliability 95% confidence intervals ranged from 1.3 to 2.5 dB. Norms in quiet and in noise exhibited the same pattern as those for other HINT languages. German norms were approximately 2 dB lower than other languages in the noise conditions. CONCLUSIONS: The German HINT materials are comparable to those for other languages and are partially consistent with recommendations for construction of multilingual speech tests. They can be used for comparing and pooling research results from the international research community.

Clinical benefit of wideband-tympanometry: a pediatric audiology clinical study.

PURPOSE: Wideband-tympanometry (WBT) could give more informative data about the tympanic condition than the conventional tympanometry. In the actual literature, the clinical profit of wideband-tympanometry in pediatric audiological settings is not well evaluated. The aim of this study was to analyze the additional clinical benefit. METHODS: 150 children (281 ears) with normal hearing, at the age from 11 days up to 14;10 years, checked with pure tone audiometry or auditory brainstem responses (ABR) participated in this retrospective study. We divided in four age ranges (≤ 6 month; > 6 month ≤ 3 years; > 3 years ≤ 11 years; > 11 years). All children were evaluated with ENT examination including ear microscopy, conventional 226-Hz or 1000-Hz tympanometry and WBT. Ear canal volumes were determined. RESULTS: Compared with literature data, our patients aged ≤ 3 years showed smaller mean ear canal volumes (≤ 4 ml). We found a good statistical correlation between the WBT-results and 1000-Hz tympanometry but a rare correlation between WBT-results and ear microscopic findings. In the patients with pathologic ear microscopic results in all groups of age, a significant reduction of WBT-absorbance in 1000 Hz and 2000 Hz was found. CONCLUSIONS: This study confirms that WBT collects additive data to detect the correct middle ear status. In pediatric audiology, WBT is an additional useful method to value middle ear problems and to analyze the character of infantile hearing loss. Standard guidelines for the interpretation of the pediatric population are needed. Hence, it will be necessary to determine these findings in a larger number of infantile ears.

The Effect of Adaptive Nonlinear Frequency Compression on Phoneme Perception.

PURPOSE: This study implemented a fitting method, developed for use with frequency lowering hearing aids, across multiple testing sites, participants, and hearing aid conditions to evaluate speech perception with a novel type of frequency lowering. METHOD: A total of 8 participants, including children and young adults, participated in real-world hearing aid trials. A blinded crossover design, including posttrial withdrawal testing, was used to assess aided phoneme perception. The hearing aid conditions included adaptive nonlinear frequency compression (NFC), static NFC, and conventional processing. RESULTS: Enabling either adaptive NFC or static NFC improved group-level detection and recognition results for some high-frequency phonemes, when compared with conventional processing. Mean results for the distinction component of the Phoneme Perception Test (Schmitt, Winkler, Boretzki, & Holube, 2016) were similar to those obtained with conventional processing. CONCLUSIONS: Findings suggest that both types of NFC tested in this study provided a similar amount of speech perception benefit, when compared with group-level performance with conventional hearing aid technology. Individual-level results are presented with discussion around patterns of results that differ from the group average.

Unilateral hearing loss in children: a retrospective study and a review of the current literature.

Despite the introduction of universal newborn hearing screening (UNHS), unilateral hearing loss (UHL) is sometimes recognized late. This diagnostic delay has adverse repercussions, given the importance of binaural hearing for the development of normal auditory processing. It is incorrect to maintain that unilateral hearing is the minimum requirement for adequate speech development and that hearing aid provision is consequently unnecessary. In our retrospective study, hearing aid provision resulted in improved directional and selective hearing (quiet and noisy environments) and, compared with their chronically ill counterparts, the children in our study displayed superior health-related quality of life (HRQoL) scores in all areas. On the basis of the results, the authors conclude that even mild hearing losses (from an auditory threshold of 30 to 40 dB) should have the opportunity for hearing aid provision. A selective literature review was conducted in PubMed and textbooks and with reference to national and international guidelines. Early diagnosis and treatment of UHL have a positive effect on verbal-cognitive, linguistic, communicative, and socio-emotional development, as demonstrated by neurophysiological studies. Among the treatment modalities with differing effects on the quality of binaural hearing, cochlear implants are now used increasingly in children with hearing loss bordering on deafness. CONCLUSION: Published evidence and clinical experience support early diagnosis and treatment. Wherever feasible, hearing aid provision before or at the end of the first year of life is recommended for children with UHL. What is Known: • Almost 30 years ago, poor academic performance was reported in children with unilateral hearing loss (UHL). • Despite improvements in treatment options, it is traditionally held that unilateral hearing is the minimum requirement for adequate speech development and hearing aid provision is unnecessary. What is New: • Academic and behavioral deficits in children with UHL may be mediated by deficiencies in the default mode network. • Published evidence supports the recommendation for hearing aid provision before or at the end of the first year of life in children with UHL.

Evaluation of auditory development in infants and toddlers who received cochlear implants under the age of 24 months with the LittlEARS) Auditory Questionnaire.

BACKGROUND AND AIMS: Newborn hearing screening and early intervention for congenital hearing loss have created a need for tools assessing the hearing development of very young children. A multidisciplinary evaluation of children's development is now becoming standard in clinical practice, though not many reliable diagnostic instruments exist. For this reason, the LittlEARS Auditory Questionnaire (LEAQ) was created to assess the auditory skills of a growing population of infants and toddlers who receive hearing instruments. The LEAQ relies on parent report, which has been shown to be a reliable way of assessing child development. Results with this tool in a group of children who received very early cochlear implantation are presented. METHODS: The LEAQ is the first module of the LittlEARS comprehensive test battery for children under the age of two who have normal hearing (NH), cochlear implants (CIs) or hearing aids (HAs). The LEAQ is a parent questionnaire comprised of 35 "yes/no" questions which can be completed by parents in less than 10 min. Sixty-three children who received unilateral CIs at a young age were assessed longitudinally and their performance was compared to that of a NH group. RESULTS: All CI children reached the maximum possible score on the LEAQ on average by 22 months of hearing age, i.e. 38 months of chronological age. In comparison, the NH group reached the maximum score by 24 months of age demonstrating that auditory skills of CI children often develop quicker than those of NH children. In the two comparison groups of children aged (a) younger and older than 12 months, and (b) between 6-9 and 21-24 months at first fitting, the early implanted children reached the highest scores faster than the later implanted children. Furthermore, three children with additional needs were tested. They showed slower growth over time but also received benefits from early implantation. CONCLUSIONS: The LEAQ is a quick and effective tool for assessing auditory skills of very young children with or without hearing loss. In our study, the auditory skills of children with CI progressed very quickly after implantation and were comparable with those of NH peers.

Auditory, speech and language development in young children with cochlear implants compared with children with normal hearing.

OBJECTIVE: This study had two aims: (1) to document the auditory and lexical development of children who are deaf and received the first cochlear implant (CI) by the age of 16 months and the second CI by the age of 31 months and (2) to compare these children's results with those of children with normal hearing (NH). METHODS: This longitudinal study included five children with NH and five with sensorineural deafness. All children of the second group were observed for 36 months after the first fitting of the device (cochlear implant). The auditory development of the CI group was documented every 3 months up to the age of two years in hearing age and chronological age and for the NH group in chronological age. The language development of each NH child was assessed at 12, 18, 24 and 36 months of chronological age. Children with CIs were examined at the same age intervals at chronological and hearing age. RESULTS: In both groups, children showed individual patterns of auditory and language development. The children with CIs developed differently in the amount of receptive and expressive vocabulary compared with the NH control group. Three children in the CI group needed almost 6 months to make gains in speech development that were consistent with what would be expected for their chronological age. Overall, the receptive and expressive development in all children of the implanted group increased with their hearing age. CONCLUSION: These results indicate that early identification and early implantation is advisable to give children with sensorineural hearing loss a realistic chance to develop satisfactory expressive and receptive vocabulary and also to develop stable phonological, morphological and syntactical skills for school life. On the basis of these longitudinal data, we will be able to develop new diagnostic tools that enable clinicians to assess child's progress in hearing and speech development.

Advantages of a non-linear frequency compression algorithm in noise.

A multichannel non-linear frequency compression algorithm was evaluated in comparison to conventional amplification hearing aids using a test of speech understanding in noise (Oldenburger Satztest-OLSA) and subjective questionnaires. The new algorithm compresses frequencies above a pre-calculated cut off frequency and shifts them to a lower frequency range, thereby providing high-frequency audibility. Low-frequencies, below the compression cut off frequency, are amplified normally. This algorithm is called SoundRecover (SR). In this study, 11 experienced hearing aid users with a severe to profound sensorineural hearing loss were tested. Seven subjects showed enhanced levels of understanding in noise (OLSA) using frequency compression. However, 4 out of the 11 subjects could not benefit from the high-frequency gain. Evaluation using questionnaires demonstrated an increased level of satisfaction after 2 months of experimental devices wearing (p = 0.08) and after 4 months of wearing (p = 0.09), respectively, compared to conventional hearing instruments.

The prelexical development in children implanted by 16 months compared with normal hearing children.

OBJECTIVE: Few studies exist which document the early speech development of German-speaking children or German-speaking children who are deaf and using cochlear implants. The current study aims to: (1) document the pre-canonical and canonical speech development of German-speaking children who are deaf and receive cochlear implants by the age of 16 months and (2) compare these children's results with those of children with normal hearing. DESIGN: This longitudinal study included 5 German-speaking children with normal hearing and 5 with sensorineural deafness. All children from the deaf group received hearing amplification before cochlear implantation, received their first implant by 16 months of age, and became bilateral implant users by 31 months of age. The pre-canonical and canonical vocalisations of each child were recorded on video- and audiotapes in a semi-standardised playing situation every 4 weeks over a span of 1 year. In the cochlear implant group, the recording started 4-5 days postoperatively (first implant); in the normal hearing group it began between the ages of 4 and 5 months. The video and audio recordings were analysed using EUDICO Linguistic Annotator version 2.4 (Nijmegen, The Netherlands) and International Phonetic Alphabet transcription. RESULTS: Both groups showed individual patterns of babbling acquisition, though the groups' patterns of acquisition were similar when analysed for consonant manner and place. Some children started with plosives and others, with nasals, but all acquired fricatives and laterals next. Onset of canonical babbling for children in the cochlear implant group began 0-4 months after first fitting of the first device, while children from the normal hearing group demonstrated an onset of canonical babbling between 4 and 9 months of age. CONCLUSION: Our results show that deaf children who receive cochlear implants at an early age are capable of reaching the canonical babbling milestone in a shorter time than children with normal hearing typically do and that their consonant phoneme acquisition follows a similar sequence to normal hearing peers'. These results are consistent with the literature indicating that early identification and intervention are important for allowing children with cochlear implants the opportunity to catch up to hearing peers.

Cochlear implant and hearing aid: a new approach to optimizing the fitting in this bimodal situation.

More and more patients with residual hearing on the contralateral side are becoming candidates for cochlear implants (CI) surgery due to increasing CI. The major benefits of regular binaural hearing are spatial hearing, localization, and signal source discrimination in both quiet and noisy surroundings. In most of the reports, hearing aid fitting was carried out without balancing both the devices. Twelve children and eight adults with residual hearing on the non-operated side were binaurally fitted. Our fitting procedure for the hearing aid was based on the desired sensation level [i/o] method. A loudness scaling was used to adjust the loudness perception monaurally and to balance the volume of both devices. Speech audiometry in quiet and noisy surroundings was conducted both monaurally and in the bimodal mode. The fitting was modified according to the respective test results. In all children and six adults, a measurable gain and/or a subjective improvement of speech perception was achieved. Two adult patients did not accept the new fitting. In seven younger children, loudness scaling was impossible to perform because of age. This was also the case with speech audiometry for two children. A structured bimodal fitting using loudness scaling for both the cochlear implant and the hearing aid results in a subjective and objective amelioration of the patient's hearing and speech perception.

Intrafamilial variability of the deafness and goiter phenotype in Pendred syndrome caused by a T416P mutation in the SLC26A4 gene.

Pendred syndrome (PS) is the most common cause of syndromic deafness, accounting for more than 5% of all autosomal-recessive hearing loss cases. It is characterized by bilateral sensorineural hearing loss and by goiter with or without hypothyroidism. Mutations in the SLC26A4 gene cause both classical PS and deafness associated with an enlarged vestibular aqueduct without goiter. To investigate a possible genotype-phenotype correlation in PS, we performed a detailed clinical and genetic study in three adult German sibs with typical PS caused by a common homozygous SLC26A4 mutation, T416P. An audiological long-term follow-up of 23 yr showed that the mutation T416P is associated with a distinct type of hearing loss in each of the three sibs: moderate-to-profound progressive deafness, profound nonprogressive deafness, and a milder but more rapidly progressing form. We show that these phenotypic differences are not caused by either different degrees of inner ear malformations or sequence variations in the GJB2/connexin 26 gene. Because the thyroid phenotype was also highly variable within the family, with thyroid sizes ranging from normal to large goiters requiring thyroidectomy, this study leads to the conclusion that other environmental and/or genetic factors have an impact on the PS phenotype.