Hannah Keppler

The vestibular evoked myogenic potential: A test–retest reliability study

OBJECTIVE The purpose of this study was to evaluate the reliability of the vestibular evoked myogenic potential (VEMP) response in a clinical setting when only a feedback mechanism is available for monitoring background EMG. METHODS Sixty-one healthy subjects participated in the investigation of the within-session reliability, whereas fourteen of them were retested after one week for examination of the between-session reliability. VEMPs were recorded using 500 Hz tone bursts with the subjects in a sitting position and their heads turned away from the test ear to the contralateral shoulder, thereby pushing their chin against the inflatable cuff of a blood pressure manometer, serving as feedback method. RESULTS The feedback method revealed latency and amplitude values comparable to other data in the literature where different test conditions were applied. Excellent reliability with ICC values ranging from 0.78 to 0.96 and CV(ME) values ranging from 4% to 36%, was achieved for P1 and N1 latency, threshold and interpeak amplitude. Good reliability with ICC values of 0.65 and 0.68 and CV(ME) values of 170% and 189%, was obtained for the asymmetry ratio. CONCLUSIONS A unilateral muscle contraction controlled by a feedback mechanism resulted in reliable response parameters, comparable right to left and corresponding to literature data obtained in different test conditions. SIGNIFICANCE The use of a blood pressure manometer as feedback mechanism combined with a meticulously controlled positioning of the head and contraction of the SCM muscle provides a reliable alternative in clinical settings, when the background muscle contraction cannot be measured or software related correction algorithms are not accessible.

Short-term Auditory Effects of Listening to an MP3 Player

OBJECTIVES To determine the output levels of a commercially available MPEG layer-3 (MP3) player and to evaluate changes in hearing after 1 hour of listening to the MP3 player. DESIGN First, A-weighted sound pressure levels (measured in decibels [dBA]) for 1 hour of pop-rock music on an MP3 player were measured on a head and torso simulator. Second, after participants listened to 1 hour of pop-rock music using an MP3 player, changes in hearing were evaluated with pure-tone audiometry, transient-evoked otoacoustic emissions, and distortion product otoacoustic emissions. PARTICIPANTS Twenty-one participants were exposed to pop-rock music in 6 different sessions using 2 types of headphones at multiple preset gain settings of the MP3 player. MAIN OUTCOME MEASURES Output levels of an MP3 player and temporary threshold and emission shifts after 1 hour of listening. RESULTS The output levels at the full gain setting were 97.36 dBA and 102.56 dBA for the supra-aural headphones and stock earbuds, respectively. In the noise exposure group, significant changes in hearing thresholds and transient-evoked otoacoustic emission amplitudes were found between preexposure and postexposure measurements. However, this pattern was not seen for distortion product otoacoustic emission amplitudes. Significant differences in the incidence of significant threshold or emission shifts were observed between almost every session of the noise exposure group compared with the control group. CONCLUSIONS Temporary changes in hearing sensitivity measured by audiometry and otoacoustic emissions indicate the potential harmful effects of listening to an MP3 player. Further research is needed to evaluate the long-term risk of cumulative noise exposure on the auditory system of adolescents and adults.

Impact of newborn hearing screening: comparing outcomes in pediatric cochlear implant users.

To evaluate the impact of a newborn hearing screening program on the management and outcome of deaf children and to identify underlying factors that may be responsible for the differences between high and low performing implanted children.

Characteristics and determinants of music appreciation in adult CI users.

The main objective of this study was to assess the associations between self-reported listening habits and perception of music and speech perception outcomes in quiet and noise for both unilateral cochlear implant (CI) users and bimodal (CI in one ear, hearing aid in contra-lateral ear) users. Information concerning music appreciation was gathered by means of a newly developed questionnaire. Moreover, audiological data (pure-tone audiometry, speech tests in noise and quiet) were gathered and the relationship between speech perception and music appreciation is studied. Bimodal users enjoy listening to music more in comparison with unilateral CI users. Also, music training within rehabilitation is still uncommon, while CI recipients believe that music training might be helpful to maximize their potential with current CI technology. Music training should not be exclusively reserved for the good speech performers. Therefore, a music training program (MTP) that consists of different difficulty levels should be developed. Hopefully, early implementation of MTP in rehabilitation programs can enable adult CI users to enjoy and appreciate music and to maximize their potential with commercially available technology. Furthermore, because bimodal users consider the bimodal stimulation to be the most enjoyable way to listen to music, CI users with residual hearing in the contra-lateral ear should be encouraged to continue wearing their hearing aid in that ear.

Transient-evoked and distortion product otoacoustic emissions: A short-term test-retest reliability study

Abstract Knowledge regarding the variability of transient-evoked otoacoustic emissions (TEOAEs) and distortion product otoacoustic emissions (DPOAEs) is essential in clinical settings and improves their utility in monitoring hearing status over time. In the current study, TEOAEs and DPOAEs were measured with commercially available OAE-equipment in 56 normally-hearing ears during three sessions. Reliability was analysed for the retest measurement without probe-refitting, the immediate retest measurement with probe-refitting, and retest measurements after one hour and one week. The highest reliability was obtained in the retest measurement without probe-refitting, and decreased with increasing time-interval between measurements. For TEOAEs, the lowest reliability was seen at half-octave frequency bands 1.0 and 1.4 kHz; whereas for DPOAEs half-octave frequency band 8.0 kHz had also poor reliability. Higher primary tone level combination for DPOAEs yielded to a better reliability of DPOAE amplitudes. External environmental noise seemed to be the dominating noise source in normal-hearing subjects, decreasing the reliability of emission amplitudes especially in the low-frequency region. Sumario Es esencial conocer la variabilidad de las emisiones otoacústicas evocadas por transitorios (TEOAEs) y por productos de distorsión (DPOAEs) en ambientes clínicos para mejorar su utilidad en el monitoreo de la condición auditiva en el tiempo. En este estudio se midieron TEOAEs y DPOAEs con equipo de OAE comercialmente disponible en 56 oídos normales durante tres sesiones. La confiabilidad se analizó en el retest sin re-colocar la sonda, en el retest inmediato con recolocación de la sonda y con mediciones después de una hora y una semana. La mayor confiabilidad se obtuvo en el retest sin recolocación de la sonda y disminuyó a aumentar el intervalo entre mediciones. Con TEOAEs la confiabilidad más baja se observó en bandas de frecuencia en 1.0 y 1.4 kHz mien-tras que para las DPOAEs también la banda de frecuencia de media octava de 8 kHz tuvo también confiabilidad pobre. La combinación de niveles tonales primarios superiores con DPOAEs, llevó a una mejor confiabilidad de las amplitudes de las DPOAEs. El ruido ambiental externo parece ser la fuente de ruido dominante en sujetos normales, disminuyendo la confiabilidad de las amplitudes de la emisión, especialmente en la región de las frecuencias graves.

The Effect of Age on the Sinusoidal Harmonic Acceleration Test, Pseudorandom Rotation Test, Velocity Step Test, Caloric Test, and Vestibular-evoked Myogenic Potential Test

Objectives: Age-related anatomical and morphologic vestibular deterioration has already been elaborated. Demonstrating a corresponding degradation in physiologic function, however, entails a much higher challenge. The objective of this study was to investigate age-related changes using rotational tests, caloric tests, and the vestibular-evoked myogenic potentials (VEMP) test. Design: Eighty healthy human subjects (38 men and 42 women) ranging in age from 18 to 80 yrs participated in this study and were subjected to an extensive vestibular test battery. Function tests included sinusoidal harmonic acceleration tests, a pseudorandom rotation test, velocity step tests, a caloric test, and a VEMP test. Results: No significant age trends were noted for the sinusoidal harmonic acceleration test and velocity step tests response parameters, in contrast to subtle decreasing gain values with advancing age for the pseudorandom rotation test. Increasing slow-component velocity values were measured with the caloric test, whereas the frequency parameter showed no relevant age changes. The largest age trends were detected with the VEMP, with decreasing amplitudes, increasing thresholds, and decreasing N1 latencies. All asymmetry parameters remained stable across the different age categories. Conclusions: Only subtle age changes could be demonstrated with the rotational and caloric tests, in contrast to more pronounced age trends with the VEMP.

Auditory steady-state responses in normal hearing adults: a test-retest reliability study.

The test-retest reliability of the auditory steady-state response (ASSR) has received limited attention. Therefore, the aim was to assess the test-retest reliability of an 80-Hz multiple-ASSR system in normal-hearing subjects by a comprehensive set of statistical methods. Twenty-nine participants (15 females) aged between 18 and 30 years contributed to two sessions (test-retest), and the ASSR thresholds were determined with a descending search protocol using a 10-dB precision. The test-retest reliability was assessed by a three-layered approach which consisted of Pearson product-moment correlation, analysis of variance (ANOVA), and standard error of measurement (SEM). The correlations for ASSR thresholds ranged from poor (0.34) for 500 Hz CF to moderate (0.55) for 1000, 2000, and 4000 Hz CF. A two-way ANOVA of the difference scores (ASSR threshold minus behavioral threshold) demonstrated no significant difference between test and retest. The SEM determined the normal tolerance for clinical error of repeated thresholds and the ASSR SEM values fell well within ±10 dB HL. This investigation shows that the multiple ASSR-technique produces a clinically acceptable test-retest reliability for normal-hearing adults.

The effects of a hearing education program on recreational noise exposure, attitudes and beliefs toward noise, hearing loss, and hearing protector devices in young adults

Excessive recreational noise exposure in young adults might result in noise-induced hearing loss (NIHL) and tinnitus. Inducing behavioral change in young adults is one of the aims of a hearing conservation program (HCP). The goal of the current study was to evaluate the effect of a hearing education program after 6 months in young adults in relation to knowledge regarding their individual hearing status. The results of a questionnaire regarding the weekly equivalent recreational noise exposure, attitudes and beliefs toward noise, and hearing loss and hearing protector devices (HPDs) were compared between both sessions. Seventy-eight young adults completed the questionnaire concerning recreational noise exposure, youth attitude to noise scale (YANS), and beliefs about hearing protection and hearing loss (BAHPHL). Their hearing status was evaluated based on admittance measures, audiometry, transient-evoked otoacoustic emissions (TEOAEs), and distortion-product otoacoustic emissions (DPOAEs). The main analysis consisted of a mixed model analysis of variance with dependent variables of either the noise exposure or the scores on (subscales of) YANS and BAHPHL. The independent variables were hearing status and session one versus session two. There was a significant decrease in recreational noise exposure and several (sub) scales of YANS and BAHPHL between both the sessions. This behavioral change resulted in a more frequent use of HPDs in 12% of the participants. However, the behavioral change was not completely related to the knowledge of young adults′ individual hearing status. To prevent hearing damage in young people, investing in HCPs is necessary, apart from regulating sound levels and its compliance at various leisure-time activities. Also, the long-term effect of HCPs and their most cost-efficient repetition rates should be further investigated.

Effectiveness of hearing protector devices in impulse noise verified with transiently evoked and distortion product otoacoustic emissions

This study aimed to evaluate the effect of impulse noise on otoacoustic emissions (OAEs) while a passive non-linear earplug or an active level-dependent earmuff was worn. Since none of the standardized attenuation measurement techniques, REAT (real ear at threshold), ATF (acoustic test fixture), or MIRE (microphone in real ear), is designed to test both types in real-wearing condition, OAEs, suitable for detecting subtle changes in the functional integrity of the cochlear outer hair cells, are used. First, DPOAEs (distortion product) and TEOAEs (transiently evoked) of 24 subjects were compared before, immediately after gunfire practice, and after one hour of non-exposure. Secondly, both types of OAEs were evaluated in 31 subjects before and after exposure during a five-day military practice. Significant differences existed between the ears in most cases; the emissions from the right ear had a tendency to be more robust. There were no significant changes in OAEs either before and after exposure, or in the second experiment over multiple days. These findings suggest that the HPDs are able to prevent cochlear damage.

Hearing in young adults. Part II : The effects of recreational noise exposure

Great concern arises from recreational noise exposure, which might lead to noise-induced hearing loss in young adults. The objective of the current study was to evaluate the effects of recreational noise exposure on hearing function in young adults. A questionnaire concerning recreational noise exposures and an audiological test battery were completed by 163 subjects (aged 18-30 years). Based on the duration of exposure and self-estimated loudness of various leisure-time activities, the weekly and lifetime equivalent noise exposure were calculated. Subjects were categorized in groups with low, intermediate, and high recreational noise exposure based on these values. Hearing was evaluated using audiometry, transient-evoked otoacoustic emissions (TEOAEs), and distortion-product otoacoustic emissions (DPOAEs). Mean differences in hearing between groups with low, intermediate, and high recreational noise exposure were evaluated using one-way analysis of variance (ANOVA). There were no significant differences in hearing thresholds, TEOAE amplitudes, and DPOAE amplitudes between groups with low, intermediate, or high recreational noise exposure. Nevertheless, one-third of our subjects exceeded the weekly equivalent noise exposure for all activities of 75 dBA. Further, the highest equivalent sound pressure levels (SPLs) were calculated for the activities visiting nightclubs or pubs, attending concerts or festivals, and playing in a band or orchestra. Moreover, temporary tinnitus after recreational noise exposure was found in 86% of our subjects. There were no significant differences in hearing between groups with low, intermediate, and high recreational noise exposure. Nevertheless, a long-term assessment of young adults′ hearing in relation to recreational noise exposure is needed.