One-year vestibular and balance outcomes of Oklahoma City bombing survivors.

This multisite investigation assessed subjective, behavioral, and objective balance function in 30 blast survivors. Subjects with vertigo, dizziness, or imbalance were screened (n = 6) or evaluated (n = 27) during 1 year. Tests included a questionnaire, electronystagmography (ENG), and computerized dynamic posturography (CDP). Ninety-seven percent of subjects were located inside a building during the blast, and 63 percent of subjects experienced dysequilibrium within 48 hours. Forty-three percent of symptoms could not be attributed to head injury. Sixty percent of subjects had abnormal ENG and/or CDP; ENG abnormalities mostly were peripheral or nonlocalizing, whereas CDP patterns were "vestibular," "surface dependent," and "physiologically inconsistent." At 1-year postblast, 55 percent of initially abnormal CDP results were normal, and 72 percent of subjects said symptoms were unchanged or occurred intermittently. A serial, test battery approach is recommended to assess symptoms. Blast-related dysequilibrium had clinically significant manifestations and should be considered a valid component of aural blast injury.

One-year audiologic monitoring of individuals exposed to the 1995 Oklahoma City bombing.

This longitudinal study evaluated subjective, behavioral, and objective auditory function in 83 explosion survivors. Subjects were evaluated quarterly for 1 year with conventional pure-tone and extended high-frequencies audiometry, otoscopic inspections, immittance and speech audiometry, and questionnaires. There was no obvious relationship between subject location and symptoms or test results. Tinnitus, distorted hearing, loudness sensitivity, and otalgia were common symptoms. On average, 76 percent of subjects had predominantly sensorineural hearing loss at one or more frequencies. Twenty-four percent of subjects required amplification. Extended high frequencies showed evidence of acoustic trauma even when conventional frequencies fell within the normal range. Males had significantly poorer responses than females across frequencies. Auditory status of the group was significantly compromised and unchanged at the end of 1-year postblast.

Pediatric eighth cranial nerve schwannoma without evidence of neurofibromatosis.

Schwannomas of the eighth cranial nerve are rare in children. We report a 4 10/12 - year-old girl with no evidence of neurofibromatosis who presented with facial droop. Radiographic studies revealed a large cerebellopontine angle tumor. At surgery, the tumor was attached to the eighth cranial nerve and histologically was a schwannoma. This is the youngest reported case of unilateral eighth cranial nerve schwannoma in a patient without the stigmata of neurofibromatosis.

Human offset auditory brainstem response: effects of stimulus acoustic ringing and rise-fall time.

Offset auditory brainstem response (ABR) traditionally has been thought to be an artifactual response elicited by stimulus acoustic ringing. Additionally, offset ABR's sensitivity to stimulus rise-fall time has been associated with concurrent changes in acoustic ringing. The present study tested the validity of offset ABR by recording the response in 40 young, normal-hearing adults using tone burst stimuli with varying degrees of acoustic ringing and various rise-fall times. Stimuli were computer-generated 10-ms tone bursts of 500 and 2000 Hz. In Experiment 1, offset ABR was recorded using stimuli with no acoustic ringing, normal ringing, and excessive ringing. Rise-fall time was held constant at 0.5 ms. In Experiment 2, rise-fall time was manipulated in a stimulus with no ringing. In Experiment 3, only rise time was manipulated in a no-ringing stimulus, while fall time was held constant at 0.5 ms. Reliable offset ABRs were recorded for all degrees of acoustic ringing, including the "no-ringing' condition. Offset ABR was sensitive to rise and fall times, and was elicited best with a 500-Hz stimulus. The results indicate that offset ABR is a real response and not an artifact produced by acoustic ringing.

Motivation and methods for manipulating acoustic ringing of earphones.

Transient acoustic stimuli are used for generating auditory evoked responses (AERs). Common transducers do not accurately reproduce transient stimuli, since the transducer diaphragm oscillates at its resonant frequency at the abrupt initiation or termination of a stimulus. These oscillations are called "acoustic ringing." This paper discusses methods for reducing and canceling acoustic ringing, and describes one method, a systems approach, in detail. It also delineates one method for enhancing acoustic ringing. The methods described provide effective techniques for empirical study of the effects of acoustic ringing on AERs or for any application requiring accurate transduction of a transient stimulus.

Comparison of Etymotic insert and TDH supra-aural earphones in auditory brainstem response measurement.

There are few systematic comparisons of Etymotic ER-3A insert earphones versus supra-aural earphones in auditory brainstem response (ABR) measurement. We compared ER-3A insert earphones and two types of supra-aural earphones (TDH-39P and TDH-49P) in a group of normal hearing adults. Acoustic analyses revealed spectral and temporal differences among earphones. Behavioral and ABR thresholds to click stimuli were slightly elevated with the ER-3A compared to the TDH earphones. The ER-3A earphones produced a latency delay, relative to the TDH earphones, that varied from about 0.8 to 1.0 msec, and increased at lower stimulus intensity levels. In addition, ABR wave I amplitude was significantly reduced with the ER-3A earphone. Based on these data, we recommend collection of normative data with the ER-3A earphones prior to their use in ABR measurement.

Interaural attenuation using etymotic ER-3A insert earphones in auditory brain stem response testing.

Click interaural attenuation (IA) was measured behaviorally and with the auditory brain stem response (ABR) in two unilaterally deaf adults with Etymotic ER-3A insert earphones, and TDH-39P and TDH-49P supraaural earphones. Stimulus crossover for each set of earphones was also determined with pure-tone audiometry. Pure-tone results agreed with previous research, showing that the ER-3A provided substantially greater IA than the supraaural earphones, particularly for low frequencies. For click stimuli, behavioral and ABR results revealed only modest, if any, improvement in IA with the ER-3A relative to the supraaural earphones. The results of this study suggest that while the ER-3A earphones provide a clear IA advantage for behavioral pure-tone audiometry, they do not eliminate the need for contralateral masking of click stimuli in ABR testing.