The Audiometric Assessment of the Effectiveness of Surgical Treatment of Otosclerosis Depending on the Preoperative Incidence of Carhart’s Notch

Objective: The presence of Carhart’s notch at 2000 Hz in otosclerosis links the changed bone conduction for this frequency with the otosclerotic process occurring in the oval window. The aim of this study is to perform an audiometric assessment of the effectiveness of surgical treatment of otosclerosis depending on the incidence of Carhart’s notch. Methods: The analysis included 116 patients treated surgically for the first time due to otosclerosis. Patients were divided into 4 groups depending on the occurrence of Carhart’s notch, determined by pure-tone audiometry (PTA) before the surgery and 36 months afterward. The mean value of bone conduction thresholds was calculated for 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz in the groups in which the Cahart’s notch was observed. This value of bone conduction (BC) was a reference point for further analysis in patients who had no preoperative or postoperative Carhart’s notch. Results: The analysis indicated that Cahart’s notch in preoperative PTA is a statistically significant improvement factor for average BC. It was found that over a longer observation period, the presence of Carhart’s notch has adverse effects on the size of the postoperative air-bone gap, and consequently on hearing improvement after surgical treatment. A comparison between patients from the two groups without preoperative Carhart’s notch found that no beneficial effects of the surgery on speech comprehension were observed regarding high-level sensorineural hearing loss (SNHL). Conclusions: (1) In a long-term observation post-stapedotomy, average BC values were found to improve. Nevertheless, the improvement is less evident in patients with preoperative Carhart’s notch. (2) Disappearance of Cahart’s notch after surgical treatment of otosclerosis is a good prognosis of improvement in speech audiometry. (3) Deep SNHL in the absence of Carhart’s notch in PTA constitutes a bad prognostic factor for improvement in speech audiometry in patients qualified for surgical treatment of otosclerosis.

Method of selection and assessment of hearing aids efficiency based on comparative speech audiometry

Objectives to improve the quality of hearing aids (HA) selection for patients with sensorineural hearing loss using a comparative free sound field speech audiometry according to our modified method "Delta Test". Material and methods. The study involved 56 patients aged from 18 to 62 years with bilateral chronic sensorineural hearing loss of 2-4 degrees. The study group included 32 patients, a test for speech recognition in a free sound field (speech audiometry) was conducted using the method proposed by us. The control group consisted of 24 patients who were aided without the use of comparative speech audiometry. The "Delta Test" included the use of audio files sets containing a speech material in pure form and mixed with speech noise with different signal-to-noise ratios, supplied through a speaker system connected to a personal computer. The percentage of correctly repeated words was measured without HA and with several HA having different settings. The effectiveness of using HA was defined as the difference in the percentage of speech recognition when using HA in relation to the "ear without HA". Results. According to "The International Outcome Inventory for Hearing Aids" the average score was 4.13 0.10 in the group where the HA were selected using the "Delta Test", which is statistically significantly higher than in the control group, where the average score was 3.720.15(p 0.05). "Delta Test" allows optimally select the HA parameters. This method is easy to perform and does not require expensive equipment.

Results of Federichi Tuning fork test in different bone-air gap sizes

Background: Tuning fork tests, in particular the Federici test, allow to some extent verifying the correctness of subjective audiometry. During the Federici test patients should compare the volume of the tuning fork placed on the tragus or mastoid process. Federici test is considered positive if the sound seems louder from the tragus than from the mastoid process. Federici test is considered negative if the sound of the tuning fork seems louder from the mastoid process than from the tragus. Literature data indicate that the results of certain tuning fork tests may be different if tuning forks are made of different alloys. Publications describing the characteristics of Federici test at presence different sizes of air-bone gap (ABG) are extremely limited. Aim: improving the effectiveness of the hearing loss diagnosis by clarifying the Federici test value in case of conduction hearing loss. Materials and methods: We analyzed 50 audiograms with a sizes of ABG of 10 dB or more at 125 Hz to clarify when the Federici test can be positive or negative. All tuning fork tests were performed with C128 aluminum tuning forks. The Federici test method: after activation the tuning fork it is placed on the mastoid process, then on the tragus. The forms were marked with the results of the following tuning fork tests: Weber, Federici, Bing; and the distance of the patient's perception of whispered and spoken language, the results of audiometric Weber test, pure tone (in the conventional frequency range) and speech audiometry. Results and discussion: Among the audiograms with ABG, a positive Federici test (group I) was observed in 39 cases (57 %), and a negative test (group II) was observed in 30 cases (43 %). Assessment of hearing loss was performed according to the criteria by Bazarov VH and Rozkladka AI (1989). The results of first group: the first degree of hearing loss was registered in 30 cases (76.9 %), the second degree in 6 cases (15.4 %) and the third degree in 3 cases (7.7 %). The results of the second group were following: the first degree of hearing loss was registered in 24 cases (80 %), the second degree was registered in 2 cases (6.7 %) and the third degree was registered in 3 cases (13.3 %). The article contains tables with data of sizes of ABG at different frequencies in cases of positive and negative Federici tests, as well as the difference between air and bone conduction in speech audiometry (performing the test of 50 % numerals discrimination threshold by Kharshak). There are samples of audiograms for both positive and negative Federici tests with the same ABG size given. Conclusions: We studied the characteristics of the Federici test performed with C128 aluminum tuning forks in patients with different sizes of bone-air gap at a frequency of 125 Hz. When ABG is from 10 to 35 at a frequency of 125 Hz, the Federici test can be both positive and negative, because the result is also affected by size of ABG at frequencies of 250, 500 and 1000 Hz. If Federici test is positive, there is a decrease in a difference between air and bone conduction when performing speech audiometry (performing of the test of 50 % numerals discrimination threshold by Kharshak), and if test is negative there is an increase in the difference. The Federici test is always negative when size of ABG is 40 dB and more at a frequency of 125 Hz. Our results partially different from the literature. In particular, we have shown that a positive Federici test can be with a maximum size of ABG 35 dB at a frequency of 125 Hz and clarified in which cases that can be possible. One of the promising directions of research is the diagnostic value of the Federici test in different middle ear pathology.

The variability in potential biomarkers for cochlear synaptopathy after recreational noise exposure

ABSTRACTObjectivesSpeech-in-noise tests and suprathreshold auditory evoked potentials are promising biomarkers to diagnose cochlear synaptopathy (CS) in humans. This study investigated whether these biomarkers changed after recreational noise exposure.DesignThe baseline auditory status of 19 normal hearing young adults was analyzed using questionnaires, pure-tone audiometry, speech audiometry and auditory evoked potentials. Nineteen subjects attended a music festival and completed the same tests again at day 1, day 3 and day 5 after the music festival.ResultsNo significant relations were found between lifetime noise-exposure history and the hearing tests. Changes in biomarkers from the first session to the follow-up sessions were non-significant, except for speech audiometry, that showed a significant training effect (performance improvement).ConclusionsDespite the individual variability in pre-festival biomarkers, we did not observe changes related to the noise-exposure dose caused by the attended event. This can indicate the absence of noise-exposure-driven cochlear synaptopathy in the study cohort, or reflect that biomarkers were not sensitive enough to detect mild CS. Future research should include a more diverse study cohort, dosimetry and results from test-retest reliability studies to provide more insight into the relationship between recreational noise exposure and cochlear synaptopathy.

Speech intelligibility in patients of different ages with chronic sensorineural hearing loss

Deterioration in speech intelligibility, the most common complaint of people with hearing loss, leads to social isolation and dramatically reduces the quality of life. The correction of peripheral hearing loss by hearing aid fitting does not always solve this problem in patients with chronic sensorineural hearing loss (SNHL). That is why in the process of audiological examination of patients with complaints of hearing loss, it is necessary to include methods of speech audiometry, which make it possible to comprehensively assess the functioning of the auditory system. The aim of the study: assessment of speech intelligibility in patients of different ages with SNHL. 94 people from 20 to 74 years of age were examined: 54 patients with SNHL (14 young and 40 elderly) and 40 people with normal hearing thresholds (20 young and 20 elderly). Besides the standard audiological examination, speech audiometry testing was conducted: evaluation of monosyllabic words intelligibility in quiet, binaural rapidly alternating speech test, dichotic digits test, Russian matrix sentence test (RuMatrix). Results: Speech intelligibility in elderly patients with SNHL was shown to be significantly worse than in young patients with a similar degree of hearing loss. The RuMatrix test in noise was proved to be the most sensitive test for comprehensive evaluation of the hearing system functioning.