Totally implantable active middle-ear implants: a large, single-surgeon cohort

2021 ◽  
pp. 1-6
Author(s):  
E McCarty Walsh ◽  
D R Morrison ◽  
W J McFeely
Keyword(s):  
Hearing Loss ◽  
Word Recognition ◽  
Middle Ear ◽  
Pure Tone ◽  
Case Series ◽  
Recognition Score ◽  
Hearing Level ◽  
Pure Tone Average ◽  
Surgeon Experience ◽  
Middle Ear Implants

Abstract Objectives This study aimed to evaluate hearing outcomes and device safety in a large, single-surgeon experience with the totally implantable active middle-ear implants. Methods This was a retrospective case series review of 116 patients with moderate-to-severe sensorineural hearing loss undergoing implantation of active middle-ear implants. Results Mean baseline unaided pure tone average improved from 57.6 dB before surgery to 34.1 dB post-operatively, signifying a mean gain in pure tone average of 23.5 dB (p = 0.0002). Phonetically balanced maximum word recognition score improved slightly from 70.5 per cent to 75.8 per cent (p = 0.416), and word recognition score at a hearing level of 50 dB values increased substantially from 14.4 per cent to 70.4 per cent (p < 0.0001). Both revision and explant rates were low and dropped with increasing surgeon experience over time. Conclusion This study showed excellent post-operative hearing results with active middle-ear implants with regard to pure tone average and word recognition score at a hearing level of 50 db. Complication rates in this case series were significantly lower with increasing experience of the surgeon. Active middle-ear implants should be considered in appropriate patients with moderate-to-severe sensorineural hearing loss who have struggled with conventional amplification and are good surgical candidates.

Modification of auditory pathway functions in patients with hearing improvement after middle ear surgery

1998 ◽  
Vol 119 (1) ◽  
pp. 125-130 ◽  
Author(s):  
Juha-Pekka Vasama ◽  
Jyrki P. Mäkelä ◽  
Hans A. Ramsay
Keyword(s):  
Hearing Loss ◽  
Middle Ear ◽  
Pure Tone ◽  
Conductive Hearing Loss ◽  
Adult Patients ◽  
Middle Ear Surgery ◽  
Ear Surgery ◽  
Pure Tone Average ◽  
The Mean ◽  
Conductive Hearing

We recorded auditory-evoked magnetic responses with a whole-scalp 122-channel neuromagnetometer from seven adult patients with unilateral conductive hearing loss before and after middle ear surgery. The stimuli were 50-msec 1-kHz tone bursts, delivered to the healthy, nonoperated ear at interstimulus intervals of 1, 2, and 4 seconds. The mean preoperative pure-tone average in the affected ear was 57 dB hearing level; the mean postoperative pure-tone average was 17 dB. The 100-msec auditory-evoked response originating in the auditory cortex peaked, on average, 7 msecs earlier after than before surgery over the hemisphere contralateral to the stimulated ear and 2 msecs earlier over the ipsilateral hemisphere. The contralateral response strengths increased by 5% after surgery; ipsilateral strengths increased by 11%. The variation of the response latency and amplitude in the patients who underwent surgery was similar to that of seven control subjects. The postoperative source locations did not differ noticeably from preoperative ones. These findings suggest that temporary unilateral conductive hearing loss in adult patients modifies the function of the auditory neural pathway. (Otolaryngol Head Neck Surg 1998;119:125-30.)

Perceived Hearing Handicap of Patients with Unilateral or Mild Hearing Loss

1997 ◽  
Vol 106 (3) ◽  
pp. 210-214 ◽  
Author(s):  
Craig W. Newman ◽  
Gerald A. Hug ◽  
Gary P. Jacobson ◽  
Sharon A. Sandridge
Keyword(s):  
Hearing Loss ◽  
Individual Differences ◽  
Hearing Impairment ◽  
Pure Tone ◽  
Hearing Level ◽  
Intersubject Variability ◽  
Pure Tone Average ◽  
Hearing Handicap ◽  
Mild Hearing Loss ◽  
The Individual

Using the Hearing Handicap Inventory for Adults (HHIA), we assessed self-perceived hearing handicap in a sample of 63 patients having either unilaterally normal hearing or a mild hearing loss (pure tone average ≤40 dB hearing level). Large intersubject variability in responses to the HHIA confirmed observations that reactions to minimal hearing impairment vary greatly among patients. The individual differences in responses highlight the importance of quantifying the perceived communication and psychosocial handicap, which cannot be determined from the audiogram alone. An item examination of responses to the HHIA revealed a number of emotional and social-situational problems encountered by patients with minimal hearing loss.

Clinical Experience with the Words-in-Noise Test on 3430 Veterans: Comparisons with Pure-Tone Thresholds and Word Recognition in Quiet

2011 ◽  
Vol 22 (07) ◽  
pp. 405-423 ◽  
Author(s):  
Richard H. Wilson
Keyword(s):  
Hearing Loss ◽  
Speech Recognition ◽  
Word Recognition ◽  
Pure Tone ◽  
Recognition Performance ◽  
Laboratory Studies ◽  
Auditory Function ◽  
Pure Tone Average ◽  
Correct Point ◽  
Audiologic Evaluation

Background: Since the 1940s, measures of pure-tone sensitivity and speech recognition in quiet have been vital components of the audiologic evaluation. Although early investigators urged that speech recognition in noise also should be a component of the audiologic evaluation, only recently has this suggestion started to become a reality. This report focuses on the Words-in-Noise (WIN) Test, which evaluates word recognition in multitalker babble at seven signal-to-noise ratios and uses the 50% correct point (in dB SNR) calculated with the Spearman-Kärber equation as the primary metric. The WIN was developed and validated in a series of 12 laboratory studies. The current study examined the effectiveness of the WIN materials for measuring the word-recognition performance of patients in a typical clinical setting. Purpose: To examine the relations among three audiometric measures including pure-tone thresholds, word-recognition performances in quiet, and word-recognition performances in multitalker babble for veterans seeking remediation for their hearing loss. Research Design: Retrospective, descriptive. Study Sample: The participants were 3430 veterans who for the most part were evaluated consecutively in the Audiology Clinic at the VA Medical Center, Mountain Home, Tennessee. The mean age was 62.3 yr (SD = 12.8 yr). Data Collection and Analysis: The data were collected in the course of a 60 min routine audiologic evaluation. A history, otoscopy, and aural-acoustic immittance measures also were included in the clinic protocol but were not evaluated in this report. Results: Overall, the 1000–8000 Hz thresholds were significantly lower (better) in the right ear (RE) than in the left ear (LE). There was a direct relation between age and the pure-tone thresholds, with greater change across age in the high frequencies than in the low frequencies. Notched audiograms at 4000 Hz were observed in at least one ear in 41% of the participants with more unilateral than bilateral notches. Normal pure-tone thresholds (≤20 dB HL) were obtained from 6% of the participants. Maximum performance on the Northwestern University Auditory Test No. 6 (NU-6) in quiet was ≥90% correct by 50% of the participants, with an additional 20% performing at ≥80% correct; the RE performed 1–3% better than the LE. Of the 3291 who completed the WIN on both ears, only 7% exhibited normal performance (50% correct point of ≤6 dB SNR). Overall, WIN performance was significantly better in the RE (mean = 13.3 dB SNR) than in the LE (mean = 13.8 dB SNR). Recognition performance on both the NU-6 and the WIN decreased as a function of both pure-tone hearing loss and age. There was a stronger relation between the high-frequency pure-tone average (1000, 2000, and 4000 Hz) and the WIN than between the pure-tone average (500, 1000, and 2000 Hz) and the WIN. Conclusions: The results on the WIN from both the previous laboratory studies and the current clinical study indicate that the WIN is an appropriate clinic instrument to assess word-recognition performance in background noise. Recognition performance on a speech-in-quiet task does not predict performance on a speech-in-noise task, as the two tasks reflect different domains of auditory function. Experience with the WIN indicates that word-in-noise tasks should be considered the “stress test” for auditory function.

scholarly journals Hearing Aid Treatment in Patients with Mixed Hearing Loss. Part I: Expected Benefit and Limitations after Stapes Surgery

2020 ◽  
Vol 25 (3) ◽  
pp. 125-132
Author(s):  
Nina Wardenga ◽  
Victoria Diedrich ◽  
Bernd Waldmann ◽  
Thomas Lenarz ◽  
Hannes Maier
Keyword(s):  
Hearing Loss ◽  
Middle Ear ◽  
Hearing Aids ◽  
State Of The Art ◽  
Treatment Success ◽  
Stapes Surgery ◽  
Pure Tone Average ◽  
Mixed Hearing Loss ◽  
Hearing Devices ◽  
Middle Ear Implants

Objective: The purpose of the present study was to determine the fraction of patients with mixed hearing loss who can or cannot expect benefit from power hearing aids (HAs) after stapes surgery. Design: The audiological outcome of 374 stapes surgeries was used to calculate the patients’ individual postoperative requirements in terms of gain and output of HAs. These requirements were compared to the available gain and output provided by state-of-the-art power HAs at 0.5, 1.0, 2.0, and 4.0 kHz. According to these comparisons, ears were divided into three groups. For G0, required gain and output lay within the corresponding technical limits of the HAs at all frequencies. In G1, one or both requirements could not be fulfilled at 1 frequency. G2 combined all ears where the requirements lay beyond the HA’s technical limitations at 2 or more frequencies. Results: Stapes surgery resulted in an improvement of air-bone gap (ABG) in 84.5% of the cases by 15.7 dB on average. Based on pure-tone average (0.5, 1.0, 2.0, 4.0 kHz), 40.6% of all cases showed an ABG ≤10 dB. 44.9% of all cases did no longer need a HA after stapes surgery. A power HA would fulfill both audiological criteria at all 4 frequencies in 81.6% of cases that needed a HA postoperatively. However, 18.4% would not be sufficiently treatable at 1 or more frequencies (15.0% in G1, 3.4% in G2). Conclusions: The present study identified a subset of patients with mixed hearing loss after stapes surgery that cannot be treated sufficiently with available power HAs. As the residual ABG is an important reason for this lack of treatment success, the advancement of alternative hearing devices that circumvent the middle ear, such as powerful active middle ear implants, is indicated.

scholarly journals Longitudinal Tracking of Sound Exposure and Hearing Aid Usage through Objective Data Logs

2018 ◽  
Vol 159 (1) ◽  
pp. 110-116
Author(s):  
John B. Doyle ◽  
Rohit R. Raghunathan ◽  
Ilana Cellum ◽  
Gen Li ◽  
Justin S. Golub
Keyword(s):  
Hearing Loss ◽  
Pure Tone ◽  
Hearing Aid ◽  
Medical Center ◽  
Academic Medical Center ◽  
Case Series ◽  
Data Logging ◽  
Sound Exposure ◽  
Pure Tone Average

Objective To use data-logging technology to objectively track and identify predictors of hearing aid (HA) usage and aided sound exposure. Study Design Case series with planned data collection. Setting Tertiary academic medical center. Subjects and Methods Individuals with HAs between 2007 and 2016 were included (N = 431; mean, 74.6 years; 95% CI, 73.1-76.0). Data-logging technology intrinsic to new-generation HAs was enabled to track usage and sound exposure. With multivariable linear regression, age, sex, number of audiology visits, duration of audiologic follow-up, pure tone average, and HA side were assessed as predictors of usage (hours/day) and aided sound exposure (dB-hours/day; ie, “dose” of sound per day). Results Mean follow-up was 319 days (95% CI, 277-360). Mean HA usage was 8.4 hours/day (95% CI, 8.0-8.8; N = 431). Mean aided sound exposure was 440 dB-hours/day (95% CI, 385-493; n = 110). HA use (β < 0.001, P = .45) and aided sound exposure (β = −0.006, P = .87) were both stable over time. HA usage was associated only with hearing loss level (pure tone average; β = 0.030, P = .04). Aided sound exposure was associated only with duration of audiologic follow-up (β = 0.100, P = .02). Conclusion While measurement of HA use has traditionally relied on subjective reporting, data logging offers an objective tool to longitudinally track HA use and sound exposure. We demonstrate the feasibility of using this potentially powerful research tool. Usage and sound exposure were stable among patients throughout the study period. Use was greater among subjects with greater hearing loss. Maximizing aided sound exposure might be possible through continued audiology follow-up visits.

Normative Data for the Maryland CNC Test

2014 ◽  
Vol 25 (08) ◽  
pp. 775-781 ◽  
Author(s):  
Lisa Lucks Mendel ◽  
William D. Mustain ◽  
Jessica Magro
Keyword(s):  
Hearing Loss ◽  
Word Recognition ◽  
Pure Tone ◽  
Normative Data ◽  
Medical Center ◽  
Recognition Score ◽  
Veterans Administration ◽  
Administration Medical ◽  
Wide Range ◽  
Intensity Functions

Background: The Maryland consonant-vowel nucleus-consonant (CNC) Test is routinely used in Veterans Administration medical centers, yet there is a paucity of published normative data for this test. Purpose: The purpose of this study was to provide information on the means and distribution of word-recognition scores on the Maryland CNC Test as a function of degree of hearing loss for a veteran population. Research Design: A retrospective, descriptive design was conducted. Study Sample: The sample consisted of records from veterans who had Compensation and Pension (C&P) examinations at a Veterans Administration medical center (N = 1,760 ears). Data Collection and Analysis: Audiometric records of veterans who had C&P examinations during a 10 yr period were reviewed, and the pure-tone averages (PTA4) at four frequencies (1000, 2000, 3000, and 4000 Hz) were documented. The maximum word-recognition score (PBmax) was determined from the performance-intensity functions obtained using the Maryland CNC Test. Correlations were made between PBmax and PTA4. Results: A wide range of word-recognition scores were obtained at all levels of PTA4 for this population. In addition, a strong negative correlation between the PBmax and the PTA4 was observed, indicating that as PTA4 increased, PBmax decreased. Word-recognition scores decreased significantly as hearing loss increased beyond a mild hearing loss. Although threshold was influenced by age, no statistically significant relationship was found between word-recognition score and the age of the participants. Conclusions: Results from this study provide normative data in table and figure format to assist audiologists in interpreting patient results on the Maryland CNC test for a veteran population. These results provide a quantitative method for audiologists to use to interpret word-recognition scores based on pure-tone hearing loss.

A Comparison of Two Word-Recognition Tasks in Multitalker Babble: Speech Recognition in Noise Test (SPRINT) and Words-in-Noise Test (WIN)

2008 ◽  
Vol 19 (07) ◽  
pp. 548-556 ◽  
Author(s):  
Richard H. Wilson ◽  
Wendy B. Cates
Keyword(s):  
Hearing Loss ◽  
Speech Recognition ◽  
Data Collection ◽  
Word Recognition ◽  
Concurrent Validity ◽  
Pure Tone ◽  
Normal Hearing ◽  
Pure Tone Average ◽  
Noise Test ◽  
Speech Recognition In Noise

Background: The Speech Recognition in Noise Test (SPRINT) is a word-recognition instrument that presents the 200 Northwestern University Auditory Test No. 6 (NU-6) words binaurally at 50 dB HL in a multitalker babble at a 9 dB signal-to-noise ratio (S/N) (Cord et al, 1992). The SPRINT was developed by and used by the Army as a more valid predictor of communication abilities (than pure-tone thresholds or word-recognition in quiet) for issues involving fitness for duty from a hearing perspective of Army personnel. The Words-in-Noise test (WIN) is a slightly different word-recognition task in a fixed level multitalker babble with 10 NU-6 words presented at each of 7 S/N from 24 to 0 dB S/N in 4 dB decrements (Wilson, 2003; Wilson and McArdle, 2007). For the two instruments, both the babble and the speakers of the words are different. The SPRINT uses all 200 NU-6 words, whereas the WIN uses a maximum of 70 words. Purpose: The purpose was to compare recognition performances by 24 young listeners with normal hearing and 48 older listeners with sensorineural hearing on the SPRINT and WIN protocols. Research Design: A quasi-experimental, mixed model design was used. Study Sample: The 24 young listeners with normal hearing (19 to 29 years, mean = 23.3 years) were from the local university and had normal hearing (≤20 dB HL; American National Standards Institute, 2004) at the 250–8000 Hz octave intervals. The 48 older listeners with sensorineural hearing loss (60 to 82 years, mean = 69.9 years) had the following inclusion criteria: (1) a threshold at 500 Hz between 15 and 30 dB HL, (2) a threshold at 1000 Hz between 20 and 40 dB HL, (3) a three-frequency pure-tone average (500, 1000, and 2000 Hz) of ≤40 dB HL, (4) word-recognition scores in quiet ≥40%, and (5) no history of middle ear or retrocochlear pathology as determined by an audiologic evaluation. Data Collection and Analysis: The speech materials were presented bilaterally in the following order: (1) the SPRINT at 50 dB HL, (2) two half lists of NU-6 words in quiet at 60 dB HL and 80 dB HL, and (3) the two 35-word lists of the WIN materials with the multitalker babble fixed at 60 dB HL. Data collection occurred during a 40–60 minute session. Recognition performances on each stimulus word were analyzed. Results: The listeners with normal hearing obtained 92.5% correct on the SPRINT with a 50% point on the WIN of 2.7 dB S/N. The listeners with hearing loss obtained 65.3% correct on the SPRINT and a WIN 50% point at 12.0 dB S/N. The SPRINT and WIN were significantly correlated (r = −0.81, p < .01), indicating that the SPRINT had good concurrent validity. The high-frequency, pure-tone average (1000, 2000, 4000 Hz) had higher correlations with the SPRINT, WIN, and NU-6 in quiet than did the traditional three-frequency pure-tone average (500, 1000, 2000 Hz). Conclusions: Graphically and numerically the SPRINT and WIN were highly related, which is indicative of good concurrent validity of the SPRINT.

Ossicular chain reconstruction: endoscopic or microscopic?

2021 ◽  
pp. 1-7
Author(s):  
E A Guneri ◽  
A Cakir Cetin
Keyword(s):  
Word Recognition ◽  
Middle Ear ◽  
Risk Index ◽  
Ossicular Chain ◽  
Recognition Score ◽  
Reconstruction Surgery ◽  
Ossicular Chain Reconstruction ◽  
Operation Duration ◽  
Air Conduction

Abstract Objective To compare the results of endoscopic and microscopic ossicular chain reconstruction surgery. Methods Patients undergoing ossicular chain reconstruction surgery via an endoscopic (n = 31) or microscopic (n = 34) technique were analysed for age, gender, Middle Ear Risk Index, ossicular chain defect, incision type, ossicular chain reconstruction surgery material, mean air conduction threshold, air–bone gap, air–bone gap gain, word recognition score, mean operation duration and mean post-operative follow up. Results Post-operative air conduction, air–bone gap and word recognition score improved significantly in both groups (within-subject p < 0.001 for air conduction and air–bone gap, and 0.026 for word recognition score); differences between groups were not significant (between-subject p = 0.192 for air conduction, 0.102 for air–bone gap, and 0.709 for word recognition score). Other parameters were similar between groups, except for incision type. However, endoscopic ossicular chain reconstruction surgery was associated with a significantly shorter operation duration (p < 0.001). Conclusion Endoscopic ossicular chain reconstruction surgery can achieve comparable surgical and audiological outcomes to those of microscopic ossicular chain reconstruction surgery in a shorter time.

scholarly journals Modeling Hearing Loss Progression and Asymmetry in the Older Old: A National Population-Based Survey

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 214-215
Author(s):  
Rahul Sharma ◽  
Anil Lalwani ◽  
Justin Golub
Keyword(s):  
Hearing Loss ◽  
Pure Tone ◽  
Population Level ◽  
Population Based ◽  
National Database ◽  
Cross Sectional ◽  
Adult Lifespan ◽  
Pure Tone Average ◽  
Age Related ◽  
Public Datasets

Abstract The progression and asymmetry of age-related hearing loss has not been well characterized in those 80 years of age and older because public datasets mask upper extremes of age to protect anonymity. We aimed to model the progression and asymmetry of hearing loss in the older old using a representative, national database. This was a cross-sectional, multicentered US epidemiologic analysis using the National Health and Nutrition Examination Study (NHANES) 2005-2006, 2009-2010, and 2011-2012 cycles. Subjects included non-institutionalized, civilian adults 80 years and older (n=621). Federal security clearance was granted to access publicly-restricted age data. Outcome measures included pure-tone average air conduction thresholds and the 4-frequency pure tone average (PTA). 621 subjects were 80 years old or older (mean=84.2 years, range=80-104 years), representing 10,600,197 Americans. Hearing loss exhibited constant acceleration across the adult lifespan at a rate of 0.0052 dB/year2 (95% CI = 0.0049, 0.0055). Compounded over a lifetime, the velocity of hearing loss would increase five-fold, from 0.2 dB loss/year at age 20 to 1 dB loss/year at age 100. This model predicted mean PTA within 2 dB of accuracy for most ages between 20 and 100 years. There was no change in the asymmetry of hearing loss with increasing age over 80 years (linear regression coefficient of asymmetry over age=0.07 (95% CI=-0.01, 0.24). In conclusion, hearing loss steadily and predictably accelerates across the adult lifespan to at least age 100, becoming near-universal. These population-level statistics will guide treatment and policy recommendations for hearing health in the older old.

scholarly journals Design Study of a Round Window Piezoelectric Transducer for Active Middle Ear Implants

Sensors ◽  
2021 ◽  
Vol 21 (3) ◽  
pp. 946
Author(s):  
Dong Ho Shin
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Middle Ear ◽  
Piezoelectric Transducer ◽  
Round Window ◽  
Piezoelectric Element ◽  
Sensorineural Hearing ◽  
Flat Band ◽  
Middle Ear Implants ◽  
Output Characteristics

This report describes the design of a new piezoelectric transducer for round window (RW)-driven middle ear implants. The transducer consists of a piezoelectric element, gold-coated copper bellows, silicone elastomer (polydimethylsiloxane, PDMS), metal cylinder (tungsten), and titanium housing. The piezoelectric element is fixed to the titanium housing and mechanical resonance is generated by the interaction of the bellows, PDMS, and tungsten cylinder. The dimensions of PDMS and the tungsten cylinder with output characteristics suitable for compensation of sensorineural hearing loss were derived by mechanical vibrational analysis (equivalent mechanical model and finite element analysis (FEA)). Based on the results of FEA, the RW piezoelectric transducer was implemented, and bench tests were performed under no-load conditions to confirm the output characteristics. The transducer generates an average displacement of 219.6 nm in the flat band (0.1–1 kHz); the resonance frequency is 2.3 kHz. To evaluate the output characteristics, the response was compared to that of an earlier transducer. When driven by the same voltage (6 Vp), the flat band displacement averaged 30 nm larger than that of the other transducer, and no anti-resonance was noted. Therefore, we expect that the new transducer can serve as an output device for hearing aids, and that it will improve speech recognition and treat high-frequency sensorineural hearing loss more effectively.

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