Reijo Johansson

Relationship between self-reported hearing and measured hearing impairment in an elderly population in Finland

Abstract Objective: The objective of this study was to evaluate the usefulness of the Finnish version of the Hearing Handicap Inventory for Elderly Screening (HHIE-S) questionnaire and a simple single-question method in detecting hearing loss. Design: We compared the HHIE-S score and the single question with audiometry results. By analysing the receiver operating characteristic (ROC) curves of the HHIE-S scores we estimated the appropriate cut-off points for the different degrees of hearing loss. Study Sample: 164 home-dwelling subjects in the age cohorts of 70, 75, 80 and 85 years in an industrialized town in Finland filled in the questionnaire, and attended the audiometry. Results: For the detection of moderate or worse hearing loss (i.e., pure tone average at 0.5-4 kHz frequencies >40 dB), the HHIE-S cut-off score of >8 had a sensitivity of 100% and a specificity of 59.7%. The single question had a sensitivity of 100% and a specificity of 70.7%. Thus, the single question was equally sensitive and more specific in detecting moderate or worse hearing loss than the HHIE-S score. However, for the detection of mild hearing loss (i.e., pure tone average >25 dB), the HHIE-S was more sensitive but less specific than the single question. Sumario Objetivo: El objetivo de este estudio fue evaluar la utilidad de la versión finlandesa del Cuestionario para la Identificación de Discapacidad Auditiva de Adultos Mayores (HHIE-S) y la de un método simple de una sola pregunta para detectar pérdidas auditivas. Diseño: Comparamos la puntuación del HHIE-S y de la pregunta aislada con los resultados audiométricos. Al analizar las curvas caracter sticas de operación del receptor (ROC) y las puntuaciones del HHIE-S, estimamos los puntos de corte apropiados para los diferentes grados de pérdida auditiva. Muestra de Estudio: Llenaron el cuestionario 164 sujetos que vivían en sus propias casas, pertenecientes a las cohortes de edad de 70, 75, 80 y 85 ańos, en una localidad industrializada de Finlandia y que se sometieron a la audiometría. Resultados: Para la identificación de pérdidas moderadas o peores (p. ej. promedio de tonos puros en las frecuencias de 0.5–4 kHz, >40 dB), la puntuación para el corte del HHIE-S en >8, tuvo una sensibilidad de 100% y una especificidad de 59.7%. La pregunta aislada tuvo una sensibilidad de 100% y una especificidad de 70.7%. Por esto, la pregunta aislada fue igualmente sensible pero más específica para la identificación de pérdidas auditivas moderadas o peores que la puntuación del HHIE-S. No obstante, para la identificación de pérdidas leves (p. ej. promedio de tonos puros >25 dB), el HHIE-S tuvo mayor sensibilidad aunque su especificidad fue menor que para la pregunta aislada.

Contralateral White Noise Masking Affects Auditory N1 and P2 Waves Differently

Abstract In this study, we examined the effect of contralateral masking on cortical auditory evoked potentials N1 (modal-specific slowly adapting component) and P2 at different masking intensities. N1 and P2 potentials were recorded from 15 subjects with normal hearing using 500Hz tone pips (intensity 65dB HL, duration 100ms, ISI 1s) presented to the right ear. Continuous white noise was delivered to the left ear at the intensities of 35, 50, 65, or 75dB effective masking level (EML), as well as a no-mask condition. The electrodes F3, Fz, F4, C3, Cz, C4, and Pz were used. The results show that N1 amplitude was significantly attenuated and, in contrast, P2 amplitude was significantly increased, with contralateral 75dB EML white noise. N1P2 peak to peak amplitude was not affected by masking, nor were the peak latencies. Thus, contralateral masking affects the exogenous cortical evoked N1 and P2 curves differently. We suggest that the effect is mediated by the efferent hearing system. The effect of ≤ 50dB EM...

Diffusion tensor imaging of the inferior colliculus and brainstem auditory-evoked potentials in preterm infants

BackgroundPreterm and low-birth-weight infants have an increased risk of sensorineural hearing loss. Brainstem auditory-evoked potentials (BAEP) are an effective method to detect subtle deficits in impulse conduction in the auditory pathway. Abnormalities on diffusion tensor imaging (DTI) have been shown to be associated with perinatal white-matter injury and reduced fractional anisotropy (FA) has been reported in patients with sensorineural hearing loss.ObjectivesTo evaluate the possibility of a correlation between BAEP and DTI of the inferior colliculus in preterm infants.Materials and methodsDTI at term age and BAEP measurements were performed on all very-low-birth-weight or very preterm study infants (n=56). FA and apparent diffusion coefficient (ADC) of the inferior colliculus were measured from the DTI.ResultsShorter BAEP wave I, III, and V latencies and I–III and I–V intervals and higher wave V amplitude correlated with higher FA of the inferior colliculus.Conclusion:The association between the DTI findings of the inferior colliculus and BAEP responses suggests that DTI can be used to assess the integrity of the auditory pathway in preterm infants.

Treatment of severe tinnitus.

In 1995-96 we selected a group of 26 patients who were suffering from severe invalidating idiopathic tinnitus (IT) in order to evaluate the efficacy of rehabilitation and some alternative therapies. All patients were assessed thoroughly by means of audiology and radiology regarding any objective cause for the symptom. In order to help patients control their symptom by increasing knowledge and adding supportive elements, they were given basic education (presentations of the anatomy and physiology of the ear and hearing system, psychological and social aspects of IT, guided and non-guided group discussions, relaxation therapy, physiotherapy, music therapy) for 4 months, comprising one 2-h session bi-weekly. This type of group therapy was found to be extremely helpful, although no objective evaluation revealed effects on IT sensation (VAS) or psychometric measures (SLC-90). In a second limb of the study, the same patients attended a 6-day intensive course in a spa. The purpose was to evaluate the possible usefulness of the widely recommended alternative therapies for IT. All patients had an opportunity to sample the treatments. Six months later only a few had tried any of these treatments, but all reported that the lessons were the most helpful in association with supportive group discussions. The results indicated that none of these therapies can be recommended, based on rational medical practise.

Transtympanic Versus Tympanic Membrane Electrocochleography in Examining Cochleovestibular Disorders

The use of electrocochleography (EcoG) is considered to be of clinical value in otological diagnosis. Non-invasive ear canal (EC) and tympanic membrane (TM) EcoG recording techniques, and invasive transtympanic (TT) technique are the methods used for objective assessment of cochlear function. In this study, eight adults (16 ears) with suspected Menieres disease were examined using a newly designed, disposable tympanic electrode and a traditional, thin transtympanic needle. The amplitudes of the TT electrode responses were 4-6-fold larger than those produced by the TM electrode. The morphology of the waveforms for the two recording techniques was nearly identical. The mean amplitudes of the action potential (AP) obtained with the TM electrode were 2.39-3.73 microV, and with the TT electrode 14.08-19.60 microV, depending on the stimulus intensity. For the summating potential (SP), the TM and TT electrodes had mean amplitudes of 0.82-1.60 microV and 3.53-5.81 microV respectively. The SP/AP ratios were larger with the TM electrode than with the TT electrode. They were inconsistent in four ears (25%) when measured with the TM and TT electrodes. All patients were more satisfied with the TT examination, since it was quite painless, unlike the TM examination. The authors recommend the use of the TT recording technique as a painless examination in which the electrode is close to the inner ear, allowing a good signal-to-noise ratio and large amplitudes. Diagnostic interpretations are easier and more reliable with the TT electrode than with the TM electrode.The use of electrocochleography (EcoG) is considered to be of clinical value in otological diagnosis. Non-invasive ear canal (EC) and tympanic membrane (TM) EcoG recording techniques, and invasive transtympanic (TT) technique are the methods used for objective assessment of cochlear function. In this study, eight adults (16 ears) with suspected Menieres disease were examined using a newly designed, disposable tympanic electrode and a traditional, thin transtympanic needle. The amplitudes of the TT electrode responses were 4-6-fold larger than those produced by the TM electrode. The morphology of the waveforms for the two recording techniques was nearly identical. The mean amplitudes of the action potential (AP) obtained with the TM electrode were 2.39-3.73 w V, and with the TT electrode 14.08-19.60 w V, depending on the stimulus intensity. For the summating potential (SP), the TM and TT electrodes had mean amplitudes of 0.82-1.60 w V and 3.53-5.81 w V, respectively. The SP/AP ratios were larger with the TM electrode than with the TT electrode. They were inconsistent in four ears (25%) when measured with the TM and TT electrodes. All patients were more satisfied with the TT examination, since it was quite painless, unlike the TM examination. The authors recommend the use of the TT recording technique as a painless examination in which the electrode is close to the inner ear, allowing a good signal-to-noise ratio and large amplitudes. Diagnostic interpretations are easier and more reliable with the TT electrode than with the TM electrode.

Cochleovestibular symptoms related to the site of vestibular schwannoma

The purpose of the investigation was to study the symptoms that may provide clues to the early diagnosis of vestibular schwannoma (VS). The symptoms associated with VS in 41 patients were compared with the tumour locations detected by magnetic resonance imaging (MRI). There were 9 (22%) mainly intracanalicular and 32 (78%) mainly extracanalicular tumours. MRI visualized the enhancement of the intracanalicular nerve in 27 of 32 extracanalicular schwannomas. Hearing impairment was found as an initial symptom equally frequently in patients with intra- or extracanalicular VS. Tinnitus was reported as the first symptom more often in patients with extracanalicular VS and dizziness more often in patients with intracanalicular tumours. At the time of diagnosis, unilateral hearing loss was present in 98% of patients, independent of tumour location. Likewise, dizziness was found equally frequently in both patient groups. Instead, tinnitus was found almost significantly more frequently in patients with intracanalicular VS ( p =0.07). Although statistically insignificantly so, neurological symptoms were more common in patients with extracanalicular VS ( p =0.45).

Electric field navigated transcranial magnetic stimulation for chronic tinnitus: A pilot study

Objective: Repetitive transcranial magnetic stimulation (rTMS) has shown potential in reducing tinnitus symptoms. We evaluated effects of electric field (E-field) navigated rTMS targeted neuroanatomically according to tinnitus pitch. Design: In this open methodological pilot study, the patients received E-field navigated 1-Hz rTMS in daily treatment sessions to the left superior temporal gyrus, targeted according to tonotopic representation of their individual tinnitus pitch. Patients rated their tinnitus intensity and annoyance with a numeric rating scale (NRS) from 0 to 10 at the baseline and after each rTMS session. They also rated their global impression of change (scale − 3 to + 3) after the treatment. Study sample: Thirteen patients (mean age 53 years; 10 men, 3 women) with chronic, intractable tinnitus. Results: The mean intensity was 7.1 (SD 1.8) at the baseline, decreasing to 4.5 (SD 2.2) after the rTMS (p < 0.0001). The mean annoyance 7.0 (SD 1.8) at the baseline decreased to 4.0 (SD 2.4) after the treatment (p < 0.0001). Intensity diminished at least 30% in 8/13 patients and annoyance in 9/13 patients. A total of 10/13 patients felt subjective benefit from the treatment. Conclusions: These preliminary observations suggest that E-field-rTMS may improve the current treatment options for intractable tinnitus.

Electronystagmographic findings in patients with acute cerebral vascular disease and vertigo.

A neurootologist examined 233 successive cases of acute disabling vertigo from the Clinic of Neurology of Turku University Central Hospital. On magnetic resonance imaging (MRI), 24 patients had evidence of acute cerebral or cerebellar brain infarction. The examination scheme included a case history analysis, clinical neurootological examination and electronystagmography (ENG). The audiological examination included pure-tone thresholds and speech audiometry. The ENG analyses were done by two neurootologists who had no information about the aetiology of the diseases. A central disturbance in ENG was observed in 59% (10/17) of the patients with cerebral brain infarction and 71% (5/7) of the patients with cerebellar brain infarction. ENG is not valid as a screening method for the central aetiology of vertigo; imaging of the central nervous system is needed.

Transtympanic Electrocochleography in Evaluation of Cochleovestibular Disorders

We examined the electrocochleography (ECochG) parameters in patients suffering from Menieres disease (n = 5) or other type of vertiginous disorder (n = 4). Fourteen ears were examined by introducing a needle electrode through the tympanic membrane to the promontorium. The summating potential (SP), action potential (AP) and the SP/AP ratio were measured from the alternating polarity click response, and the latency difference from the condensation and rarefaction click responses. These 2 patient groups differed from each other most clearly as to the audiometry results and the duration of symptoms. We also found differences in electrocochleographic results, especially in latency differences between the condensation and rarefaction click responses. Although the present material is small we conclude that transtympanic electrocochleography is a sensitive method to measure cochlear potentials, and might be a valuable addition in diagnosing patients suffering from various cochleovestibular disorders.

Blood Flow-independent Accumulation of Cisplatin in the Guinea Pig Cochlea

Considerable interindividual variability in the ototoxic effect of cisplatin has become the unpredictable dose-limiting factor in its use as curative as well as palliative therapy. The drug accumulates in highly vascular areas in the cochlea, causing dose-related hair cell loss. The purpose of this study was to assess blood flow-dependent aspects of cisplatin absorption in the cochlea in order to better understand factors that may influence cisplatin-induced ototoxicity. The effect of reduced cochlear blood flow on the ototoxic action of cisplatin was studied in guinea pigs. Before cisplatin administration the cochlear vasculature in each animal was unilaterally pre-constricted, by the application of 2% epinephrine to the round window. A 20-30% reduction in cochlear blood flow, assessed by laser Doppler flowmetry, was maintained before and after intravenous infusion of 0.1% cisplatin. Cisplatin infusion affected cochlear blood flow but not vessel conductivity. The cochlear blood flow decrease, maintained by local epinephrine application to the round window during cisplatin infusion, did not alter the cisplatin-induced hearing loss. In addition, the concentration of free cisplatin in scala tympani perilymph did not differ between epinephrine-treated and non-treated ears. Our results indicate that cisplatin transport into the cochlea is not an energy-dependent process in the lateral wall vasculature.