Ulf Rosenhall

Autism and Hearing Loss

A group of 199 children and adolescents (153 boys, 46 girls) with autistic disorder was audiologically evaluated. Mild to moderate hearing loss was diagnosed in 7.9% and unilateral hearing loss in 1.6% of those who could be tested appropriately. Pronounced to profound bilateral hearing loss or deafness was diagnosed in 3.5% of all cases, representing a prevalence considerably above that in the general population and comparable to the prevalence found in populations with mental retardation. Hearing deficits in autism occurred at similar rates at all levels of intellectual functioning, so it does not appear that the covariation with intellectual impairment per se can account for all of the variance of hearing deficit in autism. Hyperacusis was common, affecting 18.0% of the autism group and 0% in an age-matched nonautism comparison group. In addition, the rate of serous otitis media (23.5%) and related conductive hearing loss (18.3%) appeared to be increased in autistic disorder. The study emphasizes the need for auditory evaluation of individuals with autism in order to refer those with pronouced to profound hearing loss for aural habilitation and to follow those with mild to moderate hearing loss because of the risk of deterioration.

Hearing Thresholds with Direct Bone Conduction Versus Conventional Bone Conduction

Some patients who need hearing aids are unable to use an aid which transmits the sound via the external ear canal but have to use a bone-conduction hearing aid. The pressure needed to apply the transducer often gives the patient discomfort, and the attenuating effect of the skin gives poor electroacoustical function of the aid. A permanent skin penetration has made it possible to develop a bone-anchored hearing aid with all components in one housing. Ten patients have been equipped with such an aid. This paper deals with a comparative hearing threshold measurement on 10 patients. Békésy audiometry was performed and a conventional Oticon (A-type) transducer was used. In the frequency range 600 to 6 000 Hz, there was a lowering of 10-20 dB in thresholds when skin penetration was performed. This lowering in thresholds means lower transducer distortion, lower electrical gain, and lower power consumption to produce a given sensation level.

Autism and auditory brain stem responses

Objective To study a controversy that has been discussed for more than two decades: whether or not children with autism have abnormalities affecting the cochlear nerve or the auditory pathway in the brain stem and, if so, to describe these abnormalities. Design A group of 153 children and adolescents with autistic disorder were included in an investigation of auditory brain stem responses (ABR). Two thirds of this group, 101 individuals (75 boys, 26 girls), had normal hearing and they were selected for an in-depth ABR study. The results from the study group were compared with those of an age-matched comparison group. Results The III-V interpeak latency (IPL) was significantly prolonged in both boys and girls with autism, compared with the controls. The latencies of ABR waves I and V were also significantly lengthened in the study groups. The individual test results showed that more than half of this normal-hearing autistic disorder group (58%) had abnormalities of one or more of eight ABR parameters studied. The most common abnormalities were prolongation of wave V (38%), and of I-V IPL (28%). A lengthening of the I-V IPL was also recorded in 27% of 49 children who were difficult to test or who had hearing loss. Abnormal left–right differences of ABR latencies were found in 18% of autism cases with normal hearing. Conclusions Possible causes of the reported ABR abnormalities, observed here as well as in other studies, are discussed. Brain stem lesion, occult cochlear dysfunction, and involvement of the cochlear efferent system are probable factors that can explain the ABR findings

Auditory brainstem responses in childhood psychosis.

Auditory brainstem responses were compared in 24 autistic children, 7 children with other childhood psychoses, and 31 normal children. One-third of the autistic children showed abnormal ABR indicative of brainstem dysfunction and correlating with muscular hypotonia and severe language impairment. The children with other psychoses and the normal children showed normal results.

Brain-stem auditory evoked potentials in different age groups

Brain-stem auditory potential (BAEP) latencies were measured from individuals with normal or nearly normal hearing. Different age groups were studied separately. Males have 0.1-0.2 msec longer latencies of waves III and V and longer I-V IPLs than females in all age groups. The latencies of waves I, III and V increase 0.1-0.2 msec with increasing age, but the I-V IPL was the same in all age groups. The recognizability was very good for waves I, III and V and fairly good for waves II and IV. There was no interaural time difference.

Oculomotor findings in autistic children

Eleven children with infantile autism or autistic-like conditions were examined with oculomotor tests and with auditory brainstem response audiometry. Measurements of voluntary, horizontal non-predictable saccades showed that the eye motor function was abnormal in six (55 per cent) of the eleven patients. The saccades were hypometric in all six instances and the saccadic velocity was reduced in four instances. The abnormalities observed are consistent with brain dysfunction, in most cases probably indicating pontocerebellar involvement. In five instances ABR was found to be abnormal which indicates brainstem dysfunction. Oculomotor dysfunction and/or ABR abnormality was observed in eight (73 per cent) of the patients studied.

AUDITORY FUNCTION IN 70- AND 75-YEAR-OLDS OF FOUR AGE COHORTS. A CROSS-SECTIONAL AND TIME-LAG STUDY OF PRESBYACUSIS

Within the framework of the gerontological and geriatric population studies in Göteborg, Sweden, 473 elderly persons were examined using pure-tone audiometry in two recent cohorts. The aim of this study was to present cross-sectionally acquired hearing data in these contemporary groups aged 70 and 75. Another objective was to compare hearing function at the same age over the last two decades (time-lag study) in three 70-year-old cohorts and three 75-year-old cohorts. The largest time-lags were 14 years (75-year-olds) and 21 years (70-year-olds). The most recently tested cohort of 70-year-olds, studied in 1992, demonstrated median pure-tone averages (PTA: 0.5, 1 and 2 kHz) of 20.2 dB HL in the left ear of men and 18.2 dB HL in women. The left median pure-tone thresholds at 4 kHz were 56.0 dB HL in men and 34.7 dB HL in women. Hearing acuity in 70-year-olds was not demonstrated to have changed in any consistent fashion over a 21-year time-lag. For the most recently evaluated 75-year-olds, the median PTA in the left ear was 27.3 dB HL in men and 21.6 dB in women. The left median 4 kHz threshold was 67.3 in the male group and 45.5 dB HL in the female group. Hearing in 75-year-olds over a time-lag of 14 years demonstrated somewhat better pure-tone thresholds predominantly in the mens better ear in the earliest cohort when compared to the cohort tested in 1990-91. However, there were no consistent differences of pure-tone thresholds between these age cohorts, except for the intermediate cohort 2, in which the men had generally worse hearing. Thus, there was no apparent evidence of changes of the auditory function in elderly of the same age over the last two decades. Gender-specific dissimilarities in annual pure-tone threshold deterioration between the ages of 70 and 75 were found and are discussed.

Correlations between Presbyacusis and Extrinsic Noxious Factors

As part of the longitudinal gerontological and geriatric population study of 70-year-olds in Göteborg, Sweden, the possible correlation between presbyacusis and extrinsic factors affecting health in elderly persons was investigated. Participants from one cohort (F 01) were studied longitudinally at ages 70, 75, 79 and 85 years, and from another cohort (F 06) at age 70 years. A weak correlation between hearing loss and smoking, alcohol abuse and head trauma was found for men and between hearing loss and intake of pharmaceutical agents (especially salicylates) for women.

Changes in Pure-Tone Thresholds in Individuals Aged 70-81: Results from a Longitudinal Study

The results of audiometric evaluation of 376 randomly selected men and women, 70 years old and born in 1901, are reported. The investigation is part of a large study on a gerontological population in which the original participants were tested again with pure-tone and speech audiometry at ages 75, 79 and 81. We also report audiometric results obtained at ages 70 and 75 from a second group, consisting of 297 men and women born in 1906. Hearing loss was most pronounced at higher frequencies for both sexes, and men had an average of 10 dB greater hearing loss at 8 kHz than women. The decrease in hearing threshold in men between the ages of 70 and 81 was more pronounced at 2 kHz (27 dB) than at 4 and 8 kHz (15 and 20 dB, respectively). The average hearing loss in women increased at a constant rate between the ages of 70 and 79 (15 dB), while between the ages of 79 and 81 the changes in pure-tone threshold was minimal. There were no significant differences in pure-tone thresholds for women born in 1901 when compared to those born in 1906 at the ages of 70 and 75. However, men born in 1906 had a more pronounced hearing loss at the age of 75 than those born in 1901.

Hearing in women at menopause. Prevalence of hearing loss, audiometric configuration and relation to hormone replacement therapy

Conclusion. Hormone replacement therapy (HRT) may have a protective effect on hearing impairment in postmenopausal women. New guidelines for classification of audiometric configuration in age-related hearing loss are suggested. Objectives. To describe prevalence of hearing loss and audiometric configuration in a group of middle-aged women with respect to menopausal stage and HRT. Subjects and methods. A total of 143 women around menopause were sampled through the Swedish population register. The mean hearing threshold levels were compared according to menopausal status. The audiograms in the 57 women with hearing loss were classified according to audiometric configuration. Results. In all, 57 women (40%) had any kind of hearing loss; 42 had very minute hearing loss; 15 had a 4FA (average of thresholds at 0.5, 1, 2, and 4 kHz) of at least 20–39 dB HL in at least one ear. Two of these had a 4FA of 40–69 dB HL in at least one ear. The most common configurations were: gently sloping (47%), steeply sloping (14%), and high-frequency U-shaped (14%). The postmenopausal women who were not on HRT had poorer hearing mainly at 2 and 3 kHz, compared with pre- and perimenopausal women, and postmenopausal women on HRT.