Tinnitus and other auditory problems - occupational noise exposure below risk limits may cause inner ear dysfunction.

The aim of the investigation was to study if dysfunctions associated to the cochlea or its regulatory system can be found, and possibly explain hearing problems in subjects with normal or near-normal audiograms. The design was a prospective study of subjects recruited from the general population. The included subjects were persons with auditory problems who had normal, or near-normal, pure tone hearing thresholds, who could be included in one of three subgroups: teachers, Education; people working with music, Music; and people with moderate or negligible noise exposure, Other. A fourth group included people with poorer pure tone hearing thresholds and a history of severe occupational noise, Industry. Ntotal = 193. The following hearing tests were used: - pure tone audiometry with Békésy technique, - transient evoked otoacoustic emissions and distortion product otoacoustic emissions, without and with contralateral noise; - psychoacoustical modulation transfer function, - forward masking, - speech recognition in noise, - tinnitus matching. A questionnaire about occupations, noise exposure, stress/anxiety, muscular problems, medication, and heredity, was addressed to the participants. Forward masking results were significantly worse for Education and Industry than for the other groups, possibly associated to the inner hair cell area. Forward masking results were significantly correlated to louder matched tinnitus. For many subjects speech recognition in noise, left ear, did not increase in a normal way when the listening level was increased. Subjects hypersensitive to loud sound had significantly better speech recognition in noise at the lower test level than subjects not hypersensitive. Self-reported stress/anxiety was similar for all groups. In conclusion, hearing dysfunctions were found in subjects with tinnitus and other auditory problems, combined with normal or near-normal pure tone thresholds. The teachers, mostly regarded as a group exposed to noise below risk levels, had dysfunctions almost identical to those of the more exposed Industry group.

Musicians' ability to judge the risk of acquiring noise induced hearing loss.

The objective of this research was to study musicians' abilities to estimate the risk to obtain a hearing loss. Twenty-two professional musicians mainly playing classical music wore dosimeters during 2 working weeks. They also wrote a diary describing all their musical activities and tried to judge the percentage of time that every activity was harmful to their hearing. Half of the musicians seemed to be capable to reasonably judge the harmfulness of the music that they were exposed to. They started to judge the levels to be risky at 80 dB(A) and regarded themselves as slightly more susceptible to noise induced hearing loss than normal.

The efficacy of N-acetylcysteine to protect the human cochlea from subclinical hearing loss caused by impulse noise: a controlled trial.

In military outdoor shooting training, with safety measures enforced, the risk of a permanent, noise-induced hearing loss is very small. But urban warfare training performed indoors, with reflections from walls, might increase the risk. A question is whether antioxidants can reduce the negative effects of noise on human hearing as it does on research animals. Hearing tests were performed on a control group of 23 military officers before and after a shooting session in a bunker-like room. The experiments were repeated on another group of 11 officers with peroral adminstration of N-acetyl-cysteine (NAC), directly after the shooting. The measurements performed were tone thresholds; transient-evoked otoacoustic emissions, with and without contralateral noise; and psycho-acoustical modulation transfer function (PMTF), thresholds for brief tones in modulated noise. Effects from shooting on hearing thresholds were small, but threshold behavior supports use of NAC treatment. On the PMTF, shooting without NAC gave strong effects. Those effects were like those from continuous noise, which means that strict safety measures should be enforced. The most striking finding was that the non-linearity of the cochlea, that was strongly reduced in the group without NAC, as manifested by the PMTF-results, was practically unchanged in the NAC-group throughout the study. NAC treatment directly after shooting in a bunkerlike room seems to give some protection of the cochlea.

Noise-induced tinnitus: a comparison between four clinical groups without apparent hearing loss.

The number of people with normal hearing thresholds seeking medical help for tinnitus and other hearing problems is increasing. For diagnostic purposes, existence/nonexistence of lesions or combinations of lesions in the inner ear not reflected in the audiogram was evaluated with advanced hearing tests applied to tinnitus patients with certain backgrounds, including noise exposure. For forty-six patients with pronounced tinnitus, and other symptoms, tentative diagnoses were established, including judgments of the influence of four causative factors: (1) acoustic trauma, (2) music, (3) suspected hereditary, and (4) nonauditory, for example, stress or muscular tension. They were analyzed with a test battery sensitive to lesions involving the outer hair cells, damage from impulse noise, and dysfunction of the efferent system. There were significant differences in test results between groups with individuals with the same most likely causative factor. Most patients claiming acoustic trauma had a specific type of result, 'hyper-PMTF' (psychoacoustical modulation transfer function), and abnormal test results of the efferent system. Everyone in the hereditary group had dysfunction of the efferent system. All patients working with music, except one, had some abnormality, but without specific pattern. The nonauditory group mostly had normal test results. The investigation shows that it is possible to diagnose minor cochlear lesions as well as dysfunction of the efferent system, which might be causing the tinnitus. Those abnormalities could not be detected with routine audiological tests. Malfunctioning caused by impulse noise is an obvious example of this. These findings facilitate choice of treatment, rehabilitation programs, and medicolegal decisions.

Successful and unsuccessful users of bilateral amplification: differences and similarities in binaural performance.

Bilateral amplification seems to be the best solution for bilaterally hearing-impaired persons. Nevertheless, some individuals are unsuccessful with this strategy. The goals of the present study were to develop tests to improve the diagnostic test battery before rehabilitation of hearing-impaired persons with bilateral or unilateral amplification, and to evaluate the tests with normally-hearing subjects and with two groups of hearing-impaired persons. The latter two groups contained 11 successful and 11 unsuccessful users of bilateral amplification respectively. Hearing thresholds, speech recognition in noise, signal analysis ability, binaural abilities, and dichotic tests were used in the investigation. The subjects answered a questionnaire and hearing aid gain curves were measured. The results for the two groups were similar for peripheral hearing functions and binaural performance. The unilateral amplification group showed significantly worse results in speech-in-noise and dichotic tests. Spatial aspects within the questionnaire were correlated to amplification preference. We therefore suggest the inclusion of speech-in-noise, dichotic tests, and questions on spatial orientation into the diagnostic scheme before rehabilitation with hearing aids.

Auditory intensity discrimination as a function of level-rove and tone duration in normal-hearing and impaired subjects: the "mid-level hump" revisited.

The just-noticeable difference (DeltaI) in the intensity (I) of sound is typically reported to be a constant or a slightly decreasing ratio of the baseline intensity (known as Weber's law, and the "near-miss to Weber's law", respectively). However, in the relatively few studies on the intensity discrimination of very brief sounds, DeltaI/I is usually found to be non-monotonic, with poorest discrimination in the middle of the auditory dynamic range. Here, it is demonstrated that this "severe departure from Weber's law" or "mid-level hump" is not merely a phenomenon of short-duration sounds. In normal-hearing subjects (n=8), the near-miss to Weber's law that is observed with the discrimination of 300 ms-long, 4 kHz tones, gives way to a significant mid-level hump if tone intensities are not fixed over a great many trials (as is standard practice) but are instead randomly roved, trial-to-trial, over a wide intensity range. This was not the case in subjects with mild to moderate hearing impairment (n=4). Furthermore, in the discrimination of widely-roved, 4 ms-long, 4 kHz tone bursts, the performance of normal-hearing subjects did not significantly worsen at mid-levels compared to the unroved condition, unlike what was found with the 300 ms-long tones. It is suggested that mid-level humps could simply be the product of the well-known mid-level compressive nonlinearity in cochlear mechanics. We further suggest that the hump is eliminated, and the near-miss to Weber's law is produced, by a more central mechanism such as the recently reported "adaptation to sound-level statistics", which is bypassed during wide-range roving and possibly when sound durations are brief.

The effect of audibility, signal-to-noise ratio, and temporal speech cues on the benefit from fast-acting compression in modulated noise.

The objective of the experiment was to investigate three aspects that might contribute to the benefit of fast-acting compression seen in normal-hearing listeners. Six normal-hearing listeners were tested with speech recognition in a fully modulated noise (FUM) either through a fast-acting compressor or through linear amplification. In the first experiment, three different presentation levels of the FUM noise (15, 30, and 45 dB SL) were tested. The second experiment manipulated the control signal of the compressor independently of the audio input signal at four signal-to-noise ratios (-15, 10, -5, and 0 dB). A signal correlated noise version of the speech signal was tested in the third experiment at three speech-to-noise ratios (-20, -15 and -10 dB). Results showed that performance was better with compression than with linear amplification through all of the tested conditions at least when the signal-to-noise ratio was negative. The results suggest that other aspects of the hearing impairment than those simulated here are involved in the degraded performance seen for some hearing-impaired listeners with fast-acting compression.

The effect of presentation level and compression characteristics on sentence recognition in modulated noise.

The effect of fast-acting compression on speech recognition in fully modulated (FUM) noise in listeners with normal and impaired hearing was investigated in two experiments We wanted to determine the relationships between the benefit from compression and some audiological factors. Furthermore, the sensitivity to changes in compression parameters was also evaluated. The results showed that two-thirds of the listeners performed worse with fast-acting compression than with linear processing. Normal-hearing listeners showed the most benefit from compression. A significant relationship was found between benefit from compression and speech-to-noise ratio at threshold (SNRT) in slightly modulated (SM) noise. Pure-tone threshold was found to be a weak predictor of benefit from compression. No relationship was found between benefit from compression and the release of masking for the FUM noise. The variability in the results across different compression parameters was related to SNRT in SM noise. The results suggest an inverse relationship between benefit from compression and the severity of the suprathreshold hearing loss

Directivity of different hearing aid microphone locations.

In this study, we present a new method to derive a single-number measure of the directivity of hearing aids. The method is an extension of the conventional directivity index (DI), and is called overall directivity index (ODI). The directivities of five different hearing aid styles were compared with that of the open ear. The behind-the-ear (BTE) style showed the lowest directionality compared to the other hearing aid styles and the open ear. There were only minor differences in directivity between any of the four different hearing aid styles placed in the ear and of the open ear canal. The conventional measure of DI is less suitable for hearing aids, because it ignores sound coming from other than the frontal direction. To quantify directionality of a hearing aid in a real-life situation, we suggest the single-number ODI, weighted with the articulation index and related to a listening segment of 0-30 degrees. An application of the data is shown for a BTE with a directional microphone.

Speech recognition threshold in slightly and fully modulated noise for hearing-impaired subjects.

A previously developed speech test with sentences in noise was modified in an attempt to increase its efficiency. Thus the original, slightly modulated (SM) noise was changed to be fully modulated (FUM), and the speech-to-noise ratio of each word was controlled to make all the words equally difficult. The new and the old version were compared in 41 hearing-impaired subjects. The learning effect was similar for both noises, but the variability was higher for the FUM noise. However, the efficiency of the speech test was slightly better for the FUM noise. Speech recognition in both types of noise was correlated with pure-tone thresholds at high frequencies, i.e. 2000 Hz and above, but not to tone thresholds at lower frequencies. Results in FUM noise and in SM noise were highly correlated, with a correlation coefficient of 0.86.