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Sommerhalder N, Neff P, Bureš Z, Profant O, Kleinjung T, Meyer M. Deficient central mechanisms in tinnitus: Exploring the impact on speech comprehension and executive functions. Hear Res 2023; 440:108914. [PMID: 37979435 DOI: 10.1016/j.heares.2023.108914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/18/2023] [Accepted: 11/06/2023] [Indexed: 11/20/2023]
Abstract
Many individuals with chronic subjective tinnitus report significant problems in comprehending speech in adverse listening situations. A large body of studies has provided evidence to support the notion that deficits in speech-in-noise (SIN) are prevalent in the tinnitus population, while some studies have challenged these findings. Elemental auditory perception is usually only minimally or not impaired. In addition, deficits in cognitive functions, particularly executive functions, have also been observed in individuals with tinnitus. Given these previous findings, we theorize that deficient central mechanisms may be responsible for the reported speech comprehension problems in tinnitus. 25 participants suffering from chronic subjective tinnitus and 25 control participants, between 23 and 58 years of age, were examined in a cross-sectional design. The groups were case-matched for age, sex, education, and hearing loss. A large audiometric battery was used ranging from threshold and supra-threshold tasks to spoken sentence level speech tasks. Additionally, four cognitive tests were performed, primarily covering the area of executive functions. Tinnitometry and tinnitus-related questionnaires were applied to complement sample description and allow for secondary analyses. We hypothesized that tinnitus participants score lower in complex speech comprehension tasks and executive function tasks compared to healthy controls, while no group differences in elementary audiometric tasks were expected. As expected, individuals with chronic subjective tinnitus scored lower in the SIN and gated speech task, while there were no differences in the basic speech recognition threshold task and the other elementary auditory perception tasks. The cognitive tests revealed clear deficits in interference control in the Stroop task, but not in the Flanker task, in the tinnitus group. There were no differences in inhibition or working memory tasks. Our results clearly delineate differences between tinnitus individuals and control participants in two tests on speech intelligibility under adverse listening conditions. Further, the poorer performance in a task of interference control in individuals with tinnitus points towards an impaired central executive control in individuals with tinnitus. Taken together, our (partly) exploratory study provides novel evidence to the view that deficient central executive system in individuals with tinnitus probably account for impaired speech comprehension.
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Affiliation(s)
- Nick Sommerhalder
- Evolutionary Neuroscience of Language, Department of Comparative Language Science, University of Zurich, Zurich, Switzerland.
| | - Patrick Neff
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland; Department of Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Zbyněk Bureš
- Department of Cognitive Systems and Neurosciences, Czech Institute of Informatics, Robotics and Cybernetics, Czech Technical University in Prague, Prague, Czech Republic; Department of Otorhinolaryngology, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Oliver Profant
- Department of Otorhinolaryngology, Third Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Auditory Neuroscience, Institute of Experimental Medicine, Czech Academy of Sciences, Prague, Czech Republic
| | - Tobias Kleinjung
- Department of Otorhinolaryngology - Head and Neck Surgery, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Martin Meyer
- Evolutionary Neuroscience of Language, Department of Comparative Language Science, University of Zurich, Zurich, Switzerland; Center for the Interdisciplinary Study of Language Evolution, University of Zurich, Zurich, Switzerland; Cognitive Psychology Unit, Alpen-Adria University of Klagenfurt, Klagenfurt, Austria
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A Systematic Review and Meta-Analysis of Extended High-Frequency Hearing Thresholds in Tinnitus With a Normal Audiogram. Ear Hear 2022; 43:1643-1652. [PMID: 35612517 DOI: 10.1097/aud.0000000000001229] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Current evidence supports the growing application of extended high-frequency (EHF: 9 to 20 kHz) audiometry in hearing research, which likely results from the high vulnerability of this frequency region to damage induced by known auditory risk factors. The present systematic review and meta-analysis were performed to investigate whether adults with a normal audiogram and tinnitus show increased EHF hearing thresholds relative to control peers. DESIGN A comprehensive search was undertaken on electronic databases consisting of PubMed, ScienceDirect, Wiley, and Google Scholar using combined keywords: "tinnitus," "extended high frequency," "normal audiogram," and "hidden hearing loss." RESULTS From 261 articles found by searching databases, nine studies met the inclusion criteria for the meta-analysis. A significant difference was observed between tinnitus and control groups in the effect size analysis of hearing thresholds at 10, 12.5, 14, 16, and 18 kHz ( p ≤ 0.001), and the I-square heterogeneity analysis was below 50% in all studies ( p ≥ 0.131). Visual inspection by the Funnel plot and Egger's regression test ( p ≥ 0.211) also exhibited no publication bias in the meta-analyses. CONCLUSIONS Our findings are in support of the idea that in most cases, tinnitus is associated with some degree of cochlear mechanical dysfunction, which may not be detected by conventional audiometry alone. This finding underscores the significance of EHF audiometry in clinical practice, which may help both early identification of individuals susceptible to developing tinnitus and reduce the number of new cases through preventive counseling programs.
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Objective Detection of Tinnitus Based on Electrophysiology. Brain Sci 2022; 12:brainsci12081086. [PMID: 36009149 PMCID: PMC9406100 DOI: 10.3390/brainsci12081086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/29/2022] [Accepted: 08/12/2022] [Indexed: 11/24/2022] Open
Abstract
Tinnitus, a common disease in the clinic, is associated with persistent pain and high costs to society. Several aspects of tinnitus, such as the pathophysiology mechanism, effective treatment, objective detection, etc., have not been elucidated. Any change in the auditory pathway can lead to tinnitus. At present, there is no clear and unified mechanism to explain tinnitus, and the hypotheses regarding its mechanism include auditory plasticity theory, cortical reorganization theory, dorsal cochlear nucleus hypothesis, etc. Current theories on the mechanism of tinnitus mainly focus on the abnormal activity of the central nervous system. Unfortunately, there is currently a lack of objective diagnostic methods for tinnitus. Developing a method that can detect tinnitus objectively is crucial, only in this way can we identify whether the patient really suffers from tinnitus in the case of cognitive impairment or medical disputes and the therapeutic effect of tinnitus. Electrophysiological investigations have prompted the development of an objective detection of tinnitus by potentials recorded in the auditory pathway. However, there is no objective indicator with sufficient sensitivity and specificity to diagnose tinnitus at present. Based on recent findings of studies with various methods, possible electrophysiological approaches to detect the presence of tinnitus have been summarized. We analyze the change of neural activity throughout the auditory pathway in tinnitus subjects and in patients with tinnitus of varying severity to find available parameters in these methods, which is helpful to further explore the feasibility of using electrophysiological methods for the objective detection of tinnitus.
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Tai Y, Mertes IB, Chappell J, Jeon CB, Husain FT. Comparison of otoacoustic emissions in tinnitus and hyperacusis in adults with normal hearing sensitivity. Int J Audiol 2022; 62:442-452. [PMID: 35439083 DOI: 10.1080/14992027.2022.2052980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effect of tinnitus and/or hyperacusis on distortion product otoacoustic emission (DPOAE) measures in adults with normal hearing thresholds from 0.25 to 8 kHz, while accounting for extended high-frequency (EHF) thresholds.Design: A behavioural study consisted of comprehensive audiological assessment, validated tinnitus and hyperacusis questionnaires, DPOAE amplitudes and input/output (I/O) functions.Study sample: Data of 56 participants with normal hearing were included for the analysis. Participants were categorised into four groups: (1) without tinnitus or hyperacusis, (2) with tinnitus only, (3) with hyperacusis only, and (4) with both tinnitus and hyperacusis.Results: The groups with tinnitus showed elevated EHF thresholds compared with those without tinnitus. DPOAE amplitudes were not significantly affected by tinnitus and/or hyperacusis status; however, they were significantly affected by EHF thresholds. Further, no appreciable differences in DPOAE I/O functions were found across groups.Conclusions: The reported non-significant differences in DPOAEs in individuals with tinnitus and/or hyperacusis do not support a peripheral mechanism or an interaction between peripheral and central mechanisms underlying tinnitus or hyperacusis. Our findings, however, suggest the need to assess basal cochlear function (e.g. EHF thresholds) for a better understanding of differences in DPOAE measures in tinnitus and/or hyperacusis.
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Affiliation(s)
- Yihsin Tai
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA.,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, USA.,Department of Speech Pathology and Audiology, Ball State University, Muncie, IN, USA
| | - Ian B Mertes
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Jenise Chappell
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Carolyn B Jeon
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Fatima T Husain
- Department of Speech and Hearing Science, University of Illinois at Urbana-Champaign, Champaign, IL, USA.,Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Champaign, IL, USA.,Neuroscience Program, University of Illinois at Urbana-Champaign, Champaign, IL, USA
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Abstract
OBJECTIVES Tinnitus and hearing loss commonly coexist, however, the temporal relation between tinnitus and hearing loss is complex and not fully understood. Our objective was to examine the longitudinal association between persistent tinnitus, bothersome tinnitus, and 3-year elevation of audiometric hearing thresholds. DESIGN We conducted a longitudinal cohort study among 3106 women (mean age 59 years) who were participants in the Nurses' Health Study II (2012-2018). Information on tinnitus was obtained from biennial questionnaires. Longitudinal changes in air conduction thresholds (0.5 to 8 kHz) were assessed by pure-tone audiometry conducted by licensed audiologists at 19 audiology testing sites across the United States. Logistic regression was used to estimate multivariable-adjusted odds ratios (MVORs, 95% confidence interval [CI]) and evaluate the relations of persistent tinnitus (several days per week or more), bothersome tinnitus (interferes with work, sleep, or daily activities), and risk of 3-year elevation of hearing thresholds. RESULTS Persistent tinnitus was associated with higher risk of 3-year elevation of hearing thresholds across a broad range of frequencies. Compared with women without tinnitus, the MVORs (95% CI) for ≥5-dB threshold elevation among women with persistent tinnitus were 1.01 (0.81, 1.25) at 0.5 kHz, 1.45 (1.17, 1.81) at 1 kHz, 1.25 (1.00, 1.56) at 2 kHz, 1.34 (1.07, 1.69) at 3 kHz, 1.34 (1.06, 1.70) at 4 kHz, 1.49 (1.16, 1.91) at 6 kHz, and 1.63 (1.25, 2.12) at 8 kHz. The magnitudes of the associations for ≥10-dB threshold elevation were similar. The magnitudes of the associations were substantially greater among women with bothersome tinnitus. For example, compared with women without tinnitus, the MVORs (95% CI) for a ≥5- and ≥10-dB elevation of hearing thresholds at 4 kHz were 2.97 (1.50, 5.89) and 2.79 (1.38, 5.65), respectively. The risk was elevated even among women with tinnitus who had clinically normal hearing thresholds at baseline. In analyses that examined the association of tinnitus and elevation of low-, mid- and high-frequency pure-tone average (PTA) hearing thresholds, the results were similar. Compared with women without tinnitus, the MVORs (95% CI) for ≥5-dB PTA elevation among women with persistent tinnitus were 1.29 (0.99,1.67) for LPTA(0.5,1,2 kHz); 1.44 (1.16, 1.78) for MPTA(3,4 kHz); and 1.38 (1.11, 1.71) for HPTA(6,8 kHz). For ≥10-dB elevation, the MVORs were 2.85 (1.55, 5.23), 1.52 (1.10, 2.09), and 1.41 (1.10, 1.82), respectively. CONCLUSION Persistent tinnitus was associated with substantially higher risk of 3-year hearing threshold elevation, even among women with clinically normal baseline hearing. The magnitudes of the associations were greater among those with bothersome tinnitus. Monitoring hearing sensitivities may be indicated in patients with tinnitus, including those without audiometric evidence of hearing impairment.
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Auditory processing in normally hearing individuals with and without tinnitus: assessment with four psychoacoustic tests. Eur Arch Otorhinolaryngol 2021; 279:275-283. [PMID: 34363504 PMCID: PMC8739298 DOI: 10.1007/s00405-021-07023-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 07/27/2021] [Indexed: 11/06/2022]
Abstract
Purpose In most cases, tinnitus co-exists with hearing loss, suggesting that poorer speech understanding is simply due to a lack of acoustic information reaching the central nervous system (CNS). However, it also happens that patients with tinnitus who have normal hearing also report problems with speech understanding, and it is possible to suppose that tinnitus is to blame for difficulties in perceptual processing of auditory information. The purpose of the study was to evaluate the auditory processing abilities of normally hearing subjects with and without tinnitus. Methods The study group comprised 97 adults, 54 of whom had normal hearing and chronic tinnitus (the study group) and 43 who had normal hearing and no tinnitus (the control group). The audiological assessment comprised pure-tone audiometry and high-frequency pure-tone audiometry, impedance audiometry, and distortion product oto-acoustic emission assessment. To evaluate possible auditory processing deficits, the Frequency Pattern Test (FPT), Duration Pattern Test (DPT), Dichotic Listening Test (DLT), and Gap Detection Threshold (GDT) tests were performed. Results The tinnitus subjects had significantly lower scores than the controls in the gap detection test (p < 0.01) and in the dichotic listening test (p < 0.001), but only for the right ear. The results for both groups were similar in the temporal ordering tests (FPT and DPT). Right-ear advantage (REA) was found for the controls, but not for the tinnitus subjects. Conclusion In normally hearing patients, the presence of tinnitus may be accompanied with auditory processing difficulties.
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Song Z, Wu Y, Tang D, Lu X, Qiao L, Wang J, Li H. Tinnitus Is Associated With Extended High-frequency Hearing Loss and Hidden High-frequency Damage in Young Patients. Otol Neurotol 2021; 42:377-383. [PMID: 33196532 PMCID: PMC7879827 DOI: 10.1097/mao.0000000000002983] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To analyze the results of extended high-frequency (EHF) and high-frequency hearing tests in young patients with tinnitus who show normal response in conventional pure-tone audiometry (PTA), and to explore the correlation between tinnitus and hearing loss (HL). STUDY DESIGN A case-control study. SETTING A Tertiary Eye Ear Nose & Throat Hospital of China. PARTICIPANTS Patients with tinnitus, aged 18 to 35 years old, and with normal conventional PTA (125 Hz-8 kHz) were enrolled in the tinnitus group. Volunteers without tinnitus of the same age were enrolled in the control group. MAIN OUTCOME MEASURES The incidence of EHF-HL and the hearing thresholds at each frequency, as well as the distribution of maximum HL frequency and edge frequency in all participants were compared. RESULTS In total, 28 cases (43 ears) were enrolled in the tinnitus group and 34 cases (68 ears) in the control group. The incidence of EHF-HL, average hearing threshold of each frequency ranging from 4 to 16 kHz, and the maximum hearing threshold were significantly higher in the tinnitus group. The edge frequency in the tinnitus group was lower than that in the control group (10.4 ± 3.1 kHz versus 12.3 ± 2.5 kHz, p = 0.010). The dominant tinnitus pitch in cases whose EHF was impaired was positively correlated with the hearing-level loudness of tinnitus (r = 0.627, p < 0.001). CONCLUSION Patients with tinnitus and normal hearing in conventional PTA showed signs of EHF-HL and hidden damage in the high-frequencies more easily. EHF hearing tests and the follow-up of HF hearing tests are recommended to facilitate early detection of hearing impairment for timely intervention.
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Affiliation(s)
- Zijun Song
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital
| | - Yongzhen Wu
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital
- National Health Commission Key Laboratory of Hearing Medicine
| | - Dongmei Tang
- Ear Nose & Throat Institute and Otorhinolaryngology Department of Affiliated Eye Ear Nose & Throat Hospital, State Key Laboratory of Medical Neurobiology
| | - Xiaoling Lu
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital
| | - Liang Qiao
- Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Jing Wang
- Department of Otology and Skull Base Surgery, Eye Ear Nose & Throat Hospital
- National Health Commission Key Laboratory of Hearing Medicine
| | - Huawei Li
- Ear Nose & Throat Institute and Otorhinolaryngology Department of Affiliated Eye Ear Nose & Throat Hospital, State Key Laboratory of Medical Neurobiology
- Institutes of Biomedical Sciences
- National Health Commission Key Laboratory of Hearing Medicine
- Shanghai Engineering Research Centre of Cochlear Implant
- The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
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Liu YW, Wang B, Chen B, Galvin JJ, Fu QJ. Tinnitus impairs segregation of competing speech in normal-hearing listeners. Sci Rep 2020; 10:19851. [PMID: 33199782 PMCID: PMC7670434 DOI: 10.1038/s41598-020-76942-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/02/2020] [Indexed: 12/03/2022] Open
Abstract
Many tinnitus patients report difficulties understanding speech in noise or competing talkers, despite having "normal" hearing in terms of audiometric thresholds. The interference caused by tinnitus is more likely central in origin. Release from informational masking (more central in origin) produced by competing speech may further illuminate central interference due to tinnitus. In the present study, masked speech understanding was measured in normal hearing listeners with or without tinnitus. Speech recognition thresholds were measured for target speech in the presence of multi-talker babble or competing speech. For competing speech, speech recognition thresholds were measured for different cue conditions (i.e., with and without target-masker sex differences and/or with and without spatial cues). The present data suggest that tinnitus negatively affected masked speech recognition even in individuals with no measurable hearing loss. Tinnitus severity appeared to especially limit listeners' ability to segregate competing speech using talker sex differences. The data suggest that increased informational masking via lexical interference may tax tinnitus patients' central auditory processing resources.
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Affiliation(s)
- Yang Wenyi Liu
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, NHC Key Laboratory of Hearing Medicine, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Bing Wang
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, NHC Key Laboratory of Hearing Medicine, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Bing Chen
- Department of Otology and Skull Base Surgery, Eye Ear Nose and Throat Hospital, NHC Key Laboratory of Hearing Medicine, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
| | - John J Galvin
- House Ear Institute, 2100 West Third Street, Los Angeles, CA, 90057, USA
| | - Qian-Jie Fu
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
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Tinnitus Does Not Interfere with Auditory and Speech Perception. J Neurosci 2020; 40:6007-6017. [PMID: 32554549 DOI: 10.1523/jneurosci.0396-20.2020] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/31/2020] [Accepted: 06/12/2020] [Indexed: 12/13/2022] Open
Abstract
Tinnitus is a sound heard by 15% of the general population in the absence of any external sound. Because external sounds can sometimes mask tinnitus, tinnitus is assumed to affect the perception of external sounds, leading to hypotheses such as "tinnitus filling in the temporal gap" in animal models and "tinnitus inducing hearing difficulty" in human subjects. Here we compared performance in temporal, spectral, intensive, masking and speech-in-noise perception tasks between 45 human listeners with chronic tinnitus (18 females and 27 males with a range of ages and degrees of hearing loss) and 27 young, normal-hearing listeners without tinnitus (11 females and 16 males). After controlling for age, hearing loss, and stimulus variables, we discovered that, contradictory to the widely held assumption, tinnitus does not interfere with the perception of external sounds in 32 of the 36 measures. We interpret the present result to reflect a bottom-up pathway for the external sound and a separate top-down pathway for tinnitus. We propose that these two perceptual pathways can be independently modulated by attention, which leads to the asymmetrical interaction between external and internal sounds, and several other puzzling tinnitus phenomena such as discrepancy in loudness between tinnitus rating and matching. The present results suggest not only a need for new theories involving attention and central noise in animal tinnitus models but also a shift in focus from treating tinnitus to managing its comorbid conditions when addressing complaints about hearing difficulty in individuals with tinnitus.SIGNIFICANCE STATEMENT Tinnitus, or ringing in the ears, is a neurologic disorder that affects 15% of the general population. Here we discovered an asymmetrical relationship between tinnitus and external sounds: although external sounds have been widely used to cover up tinnitus, tinnitus does not impair, and sometimes even improves, the perception of external sounds. This counterintuitive discovery contradicts the general belief held by scientists, clinicians, and even individuals with tinnitus themselves, who often report hearing difficulty, especially in noise. We attribute the counterintuitive discovery to two independent pathways: the bottom-up perception of external sounds and the top-down perception of tinnitus. Clinically, the present work suggests a shift in focus from treating tinnitus itself to treating its comorbid conditions and secondary effects.
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Ravirose U, Thanikaiarasu P, Prabhu P. Evaluation of Differential Sensitivity for Frequency, Intensity, and Duration around the Tinnitus Frequency in Adults with Tonal Tinnitus. J Int Adv Otol 2020; 15:253-256. [PMID: 31418714 DOI: 10.5152/iao.2019.6698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The perceptual characteristics of tinnitus are usually assessed by a matching procedure, where loudness and pitch of an external sound are matched to those of the tinnitus percept. The duration discrimination test (DDT), differential limen for intensity (DLI) and differential limen for frequency (DLF) are relatively simple psychoacoustic methods of measuring differential sensitivity. MATERIALS AND METHODS 15 participants with normal or minimal hearing loss with tinnitus in the age range of 18 to 40 years were enrolled in the present study. Pure tone audiometry (PTA), immittance audiometry and otoacoustic emissions were done to diagnose the degree of hearing loss. Duration discrimination test (DDT), differential limen for intensity (DLI) and differential limen for frequency (DLF) was administered on all the participants using MATLAB software (MLP toolbox) at the matched tinnitus frequency, half an octave below - above the frequency. RESULTS The results show that there was a significant increase in DDT, DLI and DLF thresholds at the tinnitus frequency compared to half an octave above and below the matched frequency. The result suggests that differential sensitivity abilities regarding frequency, intensity, and duration are affected at the tinnitus frequency in individuals with tinnitus. CONCLUSION The results of the study suggest that the differential sensitivity ability is affected in individuals with tinnitus especially at the frequency of tinnitus.
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Affiliation(s)
- Udhayakumar Ravirose
- Department of Audiology, All India Institute of Speech and Hearing, Mysuru, India
| | | | - Prashanth Prabhu
- Department of Audiology, All India Institute of Speech and Hearing, Mysuru, India
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Bureš Z, Profant O, Svobodová V, Tóthová D, Vencovský V, Syka J. Speech Comprehension and Its Relation to Other Auditory Parameters in Elderly Patients With Tinnitus. Front Aging Neurosci 2019; 11:219. [PMID: 31496946 PMCID: PMC6713070 DOI: 10.3389/fnagi.2019.00219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/02/2019] [Indexed: 11/13/2022] Open
Abstract
Deteriorated speech comprehension is a common manifestation of the age-related decline of auditory functions (presbycusis). It could be assumed that when presbycusis is accompanied by tinnitus, general hearing functions, and particularly comprehension of speech in quiet and speech in noise (SIN), will be significantly affected. In this study, speech comprehension ability and other parameters of auditory function were assessed in elderly subjects with (T, n = 25) and without (NT, n = 26) tinnitus, aiming for examination of both peripheral and central auditory processing. Apart from high-frequency audiograms in quiet and in background noise, speech recognition thresholds in silence or in competitive babble noise, and the ability to understand temporally gated speech (GS), we measured also sensitivity to frequency modulation (FM) and interaural delay, gap detection thresholds (GDT), or the difference limens of intensity. The results show that in elderly participants matched by age (mean ages around 68 years), cognitive status (median MoCA scores around 27), and hearing thresholds [median pure-tone averages (PTA) around 16 dB hearing loss (HL)], tinnitus per se has little influence on speech comprehension. The tinnitus patients also show similar GDT, sensitivity to interaural intensity difference, and sensitivity to FM as the NT subjects. Despite these similarities, nevertheless, significant differences in auditory processing have been found in the tinnitus participants: a worse ability to detect tones in noise, a higher sensitivity to intensity changes, and a higher sensitivity to interaural time differences. Additional correlation analyses further revealed that speech comprehension in the T subjects is dependent on the sensitivity to temporal modulation and interaural time delay (ITD), while these correlations are weak and non-significant in the NT subjects. Therefore, despite similarities in average speech comprehension and several other parameters of auditory function, elderly people with tinnitus exhibit different auditory processing, particularly at a suprathreshold level. The results also suggest that speech comprehension ability of elderly tinnitus patients relies more on temporal features of the sound stimuli, especially under difficult conditions, compared to elderly people without tinnitus.
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Affiliation(s)
- Zbyněk Bureš
- Department of Auditory Neuroscience, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czechia.,Department of Technical Studies, College of Polytechnics, Jihlava, Czechia
| | - Oliver Profant
- Department of Auditory Neuroscience, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czechia.,Department of Otorhinolaryngology of Faculty Hospital Královské Vinohrady and 3rd Faculty of Medicine, Charles University, Prague, Czechia
| | - Veronika Svobodová
- Department of Auditory Neuroscience, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czechia.,Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czechia
| | - Diana Tóthová
- Department of Auditory Neuroscience, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czechia.,Department of Otorhinolaryngology and Head and Neck Surgery, 1st Faculty of Medicine, Charles University in Prague, University Hospital Motol, Prague, Czechia
| | - Václav Vencovský
- Department of Auditory Neuroscience, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czechia.,Department of Radioelectronics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czechia
| | - Josef Syka
- Department of Auditory Neuroscience, Institute of Experimental Medicine of the Czech Academy of Sciences, Prague, Czechia
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Morse K, Vander Werff KR. Comparison of Silent Gap in Noise Cortical Auditory Evoked Potentials in Matched Tinnitus and No-Tinnitus Control Subjects. Am J Audiol 2019; 28:260-273. [PMID: 31184965 DOI: 10.1044/2018_aja-18-0074] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Purpose Previous research suggests the existence of gap detection impairments because of tinnitus. The current study aimed to determine whether there was objective evidence of gap impairment in individuals with tinnitus by recording silent gap in white noise cortical auditory evoked potentials (CAEPs) in a chronic tinnitus group and a no-tinnitus group. The results were compared to previous gap-evoked potential and behavioral gap detection studies. Method Chronic tinnitus and no-tinnitus groups were formed by matching pairs of subjects ( n = 26) based on age, gender, and hearing thresholds. Behaviorally determined gap detection thresholds were used to define the electrophysiological gap duration conditions of subthreshold, threshold, and suprathreshold gaps in white noise. Amplitude, latency, and area of the CAEP were analyzed by group and condition using mixed-model analyses of variance. Results Across all participants, as the duration of the gap increased, amplitude and area of the CAEP increased. There were no significant differences by tinnitus status between groups for any outcome measures, except for a significant interaction between group and gap duration for P1 latency. Conclusions Silent gap-evoked CAEPs can be recorded in adults with and without tinnitus. Amplitude and area were sensitive to gap duration across groups; latency was not. Contrary to hypotheses, there was little evidence supporting differences in gap-evoked CAEPs between the tinnitus and control groups. Stimulus and other factors that may have contributed to the lack of a group difference in the current study are discussed, as well as implications for future studies of objective measures of tinnitus perception. Supplemental Material https://doi.org/10.23641/asha.7822601.
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Affiliation(s)
- Kenneth Morse
- Department of Communication Sciences and Disorders, Syracuse University, New York
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Campbell J, LaBrec A, Bean C, Nielsen M, So W. Auditory Gating and Extended High-Frequency Thresholds in Normal-Hearing Adults With Minimal Tinnitus. Am J Audiol 2019; 28:209-224. [PMID: 31022362 DOI: 10.1044/2019_aja-ttr17-18-0036] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Purpose The goal of this study was to assess whether peripheral auditory sensitivity in frequency regions above 8 kHz is related to central inhibitory function, as measured through a sensory gating paradigm, in normal-hearing adults with tinnitus (TINN) and without tinnitus (NTINN). The contribution of gating processes and peripheral sensitivity in extended high frequencies to tinnitus severity was evaluated via a hierarchical multiple regression method. Method Cortical auditory evoked potentials (CAEPs) were recorded in response to pairs of tones in normal-hearing adults without tinnitus, NTINN ( n = 45), and adults with tinnitus, TINN ( n = 21). CAEP peak component amplitude, latency, and gating indices were compared and correlated with extended high-frequency (EHF) pure-tone averages (PTAs) across groups and with tinnitus severity. An exploratory analysis was performed to investigate gating variability within the TINN group. Based on Tinnitus Handicap Inventory (Newman, Jacobson, & Spitzer, 1996) median scores, the TINN group was categorized into low- and high-median subgroups, and gating indices were compared between these subgroups. A hierarchical multiple regression analysis was performed to determine the amount of variance accounted for in the TINN group. Results Decreased gating via the CAEP Pa component and increased gating via the N1 component correlated with increased tinnitus severity, even in individuals who would traditionally be classified as having no tinnitus handicap. In the TINN group, lower EHF PTA thresholds correlated with tinnitus severity and decreased Pa gating. Individuals with a greater severity of tinnitus demonstrated atypical gating function reflected in both Pa and N1 components. Gating function and EHF PTA accounted for significant variance regarding tinnitus severity. Conclusions A trade-off between lower and higher level gating function was observed in adults with normal hearing and tinnitus, indicative of higher order compensatory mechanisms. Better cochlear sensitivity in extended high frequencies was related to decreased lower level gating processes and increased tinnitus THI scores, suggestive of an interaction between decreased gating and heightened auditory awareness. We are currently exploring whether gating processes in this population are compensatory, and the role of gating in auditory awareness.
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Affiliation(s)
- Julia Campbell
- Department of Communication Sciences and Disorders, The University of Texas at Austin
- Central Sensory Processes Laboratory, The University of Texas at Austin
| | - Alison LaBrec
- Department of Communication Sciences and Disorders, The University of Texas at Austin
- Central Sensory Processes Laboratory, The University of Texas at Austin
| | - Connor Bean
- Department of Communication Sciences and Disorders, The University of Texas at Austin
- Central Sensory Processes Laboratory, The University of Texas at Austin
| | - Mashhood Nielsen
- Department of Communication Sciences and Disorders, The University of Texas at Austin
- Central Sensory Processes Laboratory, The University of Texas at Austin
| | - Won So
- Department of Communication Sciences and Disorders, The University of Texas at Austin
- Central Sensory Processes Laboratory, The University of Texas at Austin
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Silva PBD, Fiorini AC, Azevedo MFD. Otoacoustic emissions in young adults exposed to drums noise of a college band. REVISTA CEFAC 2017. [DOI: 10.1590/1982-0216201719512216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to identify cochlear dysfunction and occurrence of tinnitus in young adults exposed to drums noise of a college band. Methods: the sample included 50 subjects: 25 musicians (study group) and 25 non-musicians (control group). The procedures included anamnesis, pure tone audiometry, acoustic impedance and Transient Evoked Otoacoustic Emissions, Distortion Product Otoacoustic Emissions and Distortion Product Otoacoustic Emissions Input-Output function. Results: positive correlation between the occurrence of tinnitus and the variables exposure time and use of personal stereos was found. Overall, the study group showed significantly lower Transient Evoked Otoacoustic Emissions, when compared to the control group. In the study group, there was a tendency toward worse response in 6 kHz(f2) in Distortion Product Otoacoustic Emissions in both ears. The Distortion Product Otoacoustic Emissions Input-Output function did not differ between groups nor did its slope. Conclusion: in general, otoacoustic emissions were worse in noise-exposed young people (study group) when compared to the unexposed (control group), indicating that the test may be important in early identification of cochlear changes.
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Tugumia D, Samelli AG, Matas CG, Magliaro FCL, Rabelo CM. Auditory training program in subjects with tinnitus. Codas 2016; 28:27-33. [PMID: 27074186 DOI: 10.1590/2317-1782/20162015113] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 05/27/2015] [Indexed: 11/21/2022] Open
Abstract
UNLABELLED Tinnitus may be defined as the conscious perception of sound or noise, without the presence of external acoustic stimulation. Given the damage caused by tinnitus and the lack of effective treatment, alternatives are necessary to rehabilitate subjects with tinnitus. There is an assumption that auditory training (AT) could lead to a plastic reorganization of this system, thus promoting an improvement of the symptom. OBJECTIVE To verify the effect of an AT program in subjects with tinnitus in the perception of this symptom. METHODS Twelve subjects with tinnitus were included in the study and divided into two groups: Study Group (SG) and Control Group (CG). All of them underwent audiometric and electrophysiological assessments; acuphenometry; Tinnitus Handicap Inventory and auditory processing assessment (GIN - Gaps in Noise, Frequency Pattern Test and Speech-in-Noise). Afterward, trainings began and the SG was submitted to the formal AT, and the CG to the visual training. RESULTS In the characterization of the groups, no statistically significant difference was found for the variables such as age, pitch, and loudness of tinnitus, or for hearing thresholds in conventional audiometry and high frequencies. Comparisons were performed between the groups, before and after the trainings, regarding electrophysiological, behavioral, and Tinnitus Handicap Inventory tests, and no statistically significant differences were found between them for any of the evaluations. CONCLUSION Findings showed no statistically significant differences between groups in the comparison between the moments pre- and post-trainings (auditory or visual), nor for the electrophysiological findings or behavioral assessment of the auditory processing and for the Tinnitus Handicap Inventory, although some specific differences in the individual analysis have occurred.
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Affiliation(s)
- Daniele Tugumia
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brazil
| | | | - Carla Gentile Matas
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brazil
| | | | - Camila Maia Rabelo
- Departamento de Fonoaudiologia, Faculdade de Medicina, Universidade São Paulo, São Paulo, SP, Brazil
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De Paula Campos U, Hatzopoulos S, Śliwa LK, Skarżyński PH, Jędrzejczak WW, Skarżyński H, Carvallo RMM. Relationship Between Distortion Product - Otoacoustic Emissions (DPOAEs) and High-Frequency Acoustic Immittance Measures. Med Sci Monit 2016; 22:2028-34. [PMID: 27299792 PMCID: PMC4913870 DOI: 10.12659/msm.897157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/25/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Pathologies that alter the impedance of the middle ear may consequently modify the DPOAE amplitude. The aim of this study was to correlate information from 2 different clinical procedures assessing middle ear status. Data from DPOAE responses (both DP-Gram and DP I/O functions) were correlated with data from multi-component tympanometry at 1000 Hz. MATERIAL AND METHODS The subjects were divided into a double-peak group (DPG) and a single-peak group (SPG) depending on 1000 Hz tympanogram pattern. Exclusion criteria (described in the Methods section) were applied to both groups and finally only 31 ears were assigned to each group. The subjects were also assessed with traditional tympanometry and behavioral audiometry. RESULTS Compared to the single-peak group, in terms of the 226 Hz tympanometry data, subjects in the DPG group presented: (i) higher values of ear canal volume; (ii) higher peak pressure, and (iii) significantly higher values of acoustic admittance. DPOAE amplitudes were lower in the DPG group only at 6006 Hz, but the difference in amplitude between the DPG and SPG groups decreased as the frequency increased. Statistical differences were observed only at 1001 Hz and a borderline difference at 1501 Hz. In terms of DPOAE I/O functions, significant differences were observed only in 4 of the 50 tested points. CONCLUSIONS The 1000-Hz tympanometric pattern significantly affects the structure of DPOAE responses only at 1001 Hz. In this context, changes in the properties of the middle ear (as detected by the 1000 Hz tympanometry) can be considered as prime candidates for the observed variability in the DP-grams and the DP I/O functions.
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Affiliation(s)
- Ualace De Paula Campos
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, University of São Paulo of Medicine, São Paulo, SP, Brazil
| | | | - Lech K. Śliwa
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
| | - Piotr H. Skarżyński
- World Hearing Center, Warsaw/Kajetany, Poland
- Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | | | - Henryk Skarżyński
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Warsaw/Kajetany, Poland
| | - Renata Mota Mamede Carvallo
- Department of Physical Therapy, Speech Therapy and Occupational Therapy, University of São Paulo of Medicine, São Paulo, SP, Brazil
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Ibraheem OA, Hassaan MR. Psychoacoustic Characteristics of Tinnitus versus Temporal Resolution in Subjects with Normal Hearing Sensitivity. Int Arch Otorhinolaryngol 2016; 21:144-150. [PMID: 28382121 PMCID: PMC5375708 DOI: 10.1055/s-0036-1583526] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 03/25/2016] [Indexed: 11/07/2022] Open
Abstract
Introduction Cochlear or neural mechanisms of tinnitus generation may affect auditory temporal resolution in tinnitus patients even with normal audiometry. Thus, studying the correlation between tinnitus characteristics and auditory temporal resolution in subjects with tinnitus may help in proper modification of tinnitus management strategy. Objective This study aims to examine the relationship between the psychoacoustic measures of tinnitus and the auditory temporal resolution in subjects with normal audiometry. Methods Two normal hearing groups with ages ranging from 20 to 45 years were involved: control group of 15 adults (30 ears) without tinnitus and study group of 15 adults (24 ears) with tinnitus. Subjective scaling of annoyance and sleep disturbance caused by tinnitus, basic audiological evaluation, tinnitus psychoacoustic measures and Gaps in Noise test were performed. Data from both groups were compared using independent sample t-test. Psychoacoustic measures of tinnitus and Gaps in Noise test parameters of the tinnitus group were correlated with Pearson's correlation coefficient. Results Significantly higher hearing threshold, higher approximate threshold and lower correct Gaps in Noise scores were observed in tinnitus ears. There was no significant correlation between psychoacoustic measures of tinnitus and Gaps in Noise test parameters of the tinnitus group. Conclusion Auditory temporal resolution impairment was found in tinnitus patients, which could be attributed to cochlear impairment or altered neural firing within the auditory pathway. It is recommended to include temporal resolution testing in the tinnitus evaluation battery to provide a proper management planning.
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Moon IJ, Won JH, Kang HW, Kim DH, An YH, Shim HJ. Influence of Tinnitus on Auditory Spectral and Temporal Resolution and Speech Perception in Tinnitus Patients. J Neurosci 2015; 35:14260-9. [PMID: 26490865 PMCID: PMC6605422 DOI: 10.1523/jneurosci.5091-14.2015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 08/25/2015] [Accepted: 09/11/2015] [Indexed: 11/21/2022] Open
Abstract
Although cochlear damage is believed to trigger the perception of tinnitus in the central auditory system, its pathophysiological mechanism is still unclear. We aimed to investigate the pathophysiology of tinnitus using psychoacoustic assessments of auditory spectral and temporal resolution and speech perception in noise. Human subjects with tinnitus and symmetric hearing thresholds were divided into three groups: nine unilateral tinnitus subjects with normal hearing thresholds (Group 1), 12 unilateral tinnitus subjects with hearing loss (HL; Group 2), and nine bilateral tinnitus subjects with HL. Fifteen normal-hearing subjects without tinnitus were also tested as a control group. Four different tests were administered: (1) the spectral-ripple discrimination (SRD) test, (2) the temporal modulation detection (TMD) test, (3) the Schroeder-phase discrimination (SPD) test, and (4) the speech recognition threshold (SRT) in noise test. There were no significant differences in SRD, TMD, and SPD between the tinnitus-affected ears (TEs) and non-tinnitus ears (NTEs) in Groups 1 and 2 (p > 0.05). In contrast, the TEs showed poorer SRTs than the NTEs in these two subject groups (p = 0.022 and 0.049). No inferiority of spectral/temporal resolution in TEs compared with NTEs suggests that there may be no more outer hair cell (OHC) damage on the tinnitus side given that damaged OHCs are associated with broadening the auditory filters. The decoupling of the SRT results from the spectral/temporal resolution data could imply that the occurrence of tinnitus does not depend upon the degree of damage to the OHCs, but rather upon different plastic changes in the central auditory system after cochlear damage. SIGNIFICANCE STATEMENT We can easily find unilateral tinnitus patients who have symmetric hearing thresholds. Our research question was what kind of difference would be responsible for the tinnitus in the tinnitus-affected ears but not in the non-tinnitus ears of subjects with symmetric hearing thresholds. The answer to this fundamental question could help us to understand the pathophysiology of tinnitus. We evaluated the potential influence of tinnitus upon the subjects' auditory spectral and temporal resolution and speech perception in noise by comparing these psychoacoustic performances between tinnitus-affected ears and non-tinnitus ears in the same subjects.
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Affiliation(s)
- Il Joon Moon
- Department of Otorhinolaryngology and Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul 135-710, Korea
| | - Jong Ho Won
- Department of Audiology and Speech Pathology, University of Tennessee Health Science Center, Knoxville, Tennessee 37996, and
| | - Hyun Woo Kang
- Department of Otorhinolaryngology and Head and Neck Surgery, Eulji University School of Medicine, Eulji Medical Center, Seoul 139-711, Korea
| | - Dong Hyun Kim
- Department of Otorhinolaryngology and Head and Neck Surgery, Eulji University School of Medicine, Eulji Medical Center, Seoul 139-711, Korea
| | - Yong-Hwi An
- Department of Otorhinolaryngology and Head and Neck Surgery, Eulji University School of Medicine, Eulji Medical Center, Seoul 139-711, Korea
| | - Hyun Joon Shim
- Department of Otorhinolaryngology and Head and Neck Surgery, Eulji University School of Medicine, Eulji Medical Center, Seoul 139-711, Korea
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Abstract
OBJECTIVE Temporal processing refers to the ability of the central auditory nervous system to encode and detect subtle changes in acoustic signals. This study aims to investigate the temporal resolution ability of individuals with mesial temporal sclerosis and to determine the sensitivity and specificity of the gaps-in-noise test in identifying this type of lesion. METHOD This prospective study investigated differences in temporal resolution between 30 individuals with normal hearing and without neurological lesions (G1) and 16 individuals with both normal hearing and mesial temporal sclerosis (G2). Test performances were compared, and the sensitivity and specificity were calculated. RESULTS There was no difference in gap detection thresholds between the two groups, although G1 revealed better average thresholds than G2 did. The sensitivity and specificity of the gaps-in-noise test for neurological lesions were 68% and 98%, respectively. CONCLUSIONS Temporal resolution ability is compromised in individuals with neurological lesions caused by mesial temporal sclerosis. The gaps-in-noise test was shown to be a sensitive and specific measure of central auditory dysfunction in these patients.
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Affiliation(s)
- Camila Maia Rabelo
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia, São Paulo/SP, Brasil
- Corresponding author: E-mail:
| | - Jeffrey A Weihing
- University of Louisville, Division of Communicative Disorders, Louisville/Kentucky, USA
| | - Eliane Schochat
- Faculdade de Medicina da Universidade de São Paulo, Departamento de Fisioterapia, Fonoaudiologia e Terapia, São Paulo/SP, Brasil
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Sanchez TG, Oliveira JC, Kii MA, Freire K, Cota J, Moraes FVD. Tinnitus in adolescents: the start of the vulnerability of the auditory pathways. Codas 2015; 27:5-12. [PMID: 25885191 DOI: 10.1590/2317-1782/20152013045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 09/25/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Although tinnitus is an increasingly common symptom, few studies have assessed its prevalence or incidence among adolescents. PURPOSE To assess whether the presence of tinnitus in adolescents is associated with minimal hearing damage, evaluated through high-frequency audiometry (HFA), otoacoustic emission (OAE), and loudness discomfort level (LDL). METHODS The sample comprised 168 adolescents of a private school (61.3% boys; mean age 14.1 years old; standard deviation=2). All of them completed a questionnaire about tinnitus and hypersensitivity to sounds (sound intolerance), and then underwent otoscopy, pure-tone audiometry, HFA, LDL, transient and distortion product otoacoustic emissions (TOAE and DPOAE), and tinnitus pitch/loudness matching (the latter only in those with tinnitus). Participants were later divided into three groups: with no tinnitus (n=73, 43.4%), with sporadic tinnitus (n=47, 28%), and with constant tinnitus (n=48, 28.6%). RESULTS No significant difference was observed between the groups regarding audiometry thresholds in frequencies from 0.25 to 16 kHz, or TOAE and DPOAE. However, the LDL in adolescents with constant tinnitus was significantly lower than that in other groups, suggesting hypersensitivity to sounds. CONCLUSION There was no evidence of minimal hearing damage in the audiometry and OAE. Nonetheless, the decreased LDL in adolescents with constant tinnitus suggests that their auditory system is more sensitive. Therefore, this may be the first sign of vulnerability to sounds. Future medium- to long-term monitoring of these students may show whether they will begin a process of functional impairment, altering hearing thresholds, and OAE.
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Affiliation(s)
| | | | | | - Katya Freire
- Associação de Pesquisa Interdisciplinar e Divulgação do Zumbido, São Paulo, SP, Brazil
| | - Jaci Cota
- Instituto Ganz Sanchez, São Paulo, SP, Brazil
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Barbosa TA, Durante AS, Granato L. Distortion-product otoacoustic emission growth curves in neonates. Rev Assoc Med Bras (1992) 2015; 60:591-8. [PMID: 25650862 DOI: 10.1590/1806-9282.60.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 02/20/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The recording of otoacoustic emissions (OAE) enabled us to prove that the cochlea is able not only to receive sounds but also to produce acoustic energy. Through the use of distortion-product otoacoustic emission measurements, the growth of the response was seen according to the intensity of the sound stimulus presented (growth curve). OBJECTIVE to determine the thresholds for the emergence of distortion-product otoacoustic emissions (DPOAE) on frequencies of 2000 and 4000 Hz with a stimulus varying from 20 to 65 dB SPL, and to establish the slope values obtained in the growth curves. METHODS 39 neonates aged 5 to 28 days without risk indicators of hearing loss were studied. The DPOAE growth curves were obtained on the frequencies from 2000 Hz and 4000 Hz with a level of intensity ranging from 20 to 65 dB SPL divided into two paradigms (20 to 40 dB SPL and 40-65 dB SPL). RESULTS there was a statistically significant difference in the thresholds for the emergence of DPOAE depending on the criteria used. The thresholds were on average higher at 4000 Hz than 2000 Hz and the slope was higher on average at 2000 Hz than 4000 Hz, although not statistically significant in either case. CONCLUSION the thresholds were on average 30 dB SPL at 2000 Hz and 35 dB SPL at 4000 Hz. The slope values varied between 3 and 4 on average, reaching 15 in some cases.
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Affiliation(s)
| | | | - Lidio Granato
- Department of Otorhinolaryngology, Faculty of Medical Sciences, Santa Casa de São Paulo, São Paulo, SP, Brazil
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An YH, Jin SY, Yoon SW, Shim HJ. The effects of unilateral tinnitus on auditory temporal resolution: gaps-in-noise performance. KOREAN JOURNAL OF AUDIOLOGY 2014; 18:119-25. [PMID: 25558405 PMCID: PMC4280753 DOI: 10.7874/kja.2014.18.3.119] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 11/25/2014] [Accepted: 11/26/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES The Gaps-In-Noise (GIN) test is a measure to assess auditory temporal resolution, which is the ability to follow rapid changes in the envelope of a sound stimulus over time. We investigated whether unilateral tinnitus affects temporal resolution by the GIN performance. SUBJECTS AND METHODS Hearing tests including the GIN test were performed in 120 ears of 60 patients with unilateral tinnitus who showed symmetric hearing within 20 dB HL difference up to 8 kHz (tinnitus-affected ears, 14.6±11.2 dB HL; non-tinnitus ears 15.1±11.5 dB HL) and 60 ears of 30 subjects with normal hearing. Comparisons were made between tinnitus and non-tinnitus side of patients and normal ears of controls. RESULTS There was no significant difference of the mean GIN thresholds among tinnitus-affected ears (5.18±0.6 ms), non-tinnitus ears (4.98±0.6 ms) and normal ears (4.97±0.8 ms). The mean percentage of correct answers in tinnitus side (67.3±5.5%) was slightly less than that in non-tinnitus side (70.0±5.5%) but it was not significantly different from that in normal ears (69.4±7.5%). Neither the GIN threshold nor the GIN perception level in tinnitus ears has relation to sex, frequency and loudness of tinnitus, and audiometric data. Age only showed a significant correlation with the GIN performance. CONCLUSIONS We found no evidence which supported the influence of unilateral tinnitus on auditory temporal resolution. These results imply that tinnitus may not simply fill in the silent gaps in the background noise.
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Affiliation(s)
- Yong-Hwi An
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - So Young Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Won Yoon
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Hyun Joon Shim
- Department of Otorhinolaryngology-Head and Neck Surgery, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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Buzo BC, Carvallo RMM. Psychoacoustic analyses of cochlear mechanisms in tinnitus patients with normal auditory thresholds. Int J Audiol 2013; 53:40-7. [PMID: 24168288 DOI: 10.3109/14992027.2013.840931] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Tinnitus is often related to auditory dysfunction. We hypothesised that, among individuals with normal auditory thresholds, the mechanism of frequency selectivity might differ between subjects with and without tinnitus. Our objective was to identify any differences between normal-hearing individuals with tinnitus and those without in terms of psychophysical tuning curves (PTCs) and threshold-equalising noise (TEN) test results. DESIGN We determined PTCs and performed the TEN test. STUDY SAMPLE We evaluated 57 individuals, 16 with bilateral tinnitus (tinnitus-group) and 41 without tinnitus (control-group). RESULTS We found significant differences between tinnitus and control groups regarding the following: 2 kHz PTCs obtained in noise at 6 and 8 kHz; 4 kHz PTCs obtained in noise at 2 and 8 kHz; and 6 and 8 kHz PTCs obtained in noise at 2 and 3 kHz. The TEN test revealed differences between groups in terms of auditory thresholds, which were significantly higher in the tinnitus group. In addition, none of the individuals in the tinnitus group were found to have dead regions in the cochlea. CONCLUSIONS Despite having normal auditory thresholds, individuals with tinnitus have auditory patterns that differ significantly from those seen in individuals without tinnitus, such differences being suggestive of cochlear impairment.
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Fabijańska A, Smurzyński J, Hatzopoulos S, Kochanek K, Bartnik G, Raj-Koziak D, Mazzoli M, Skarżynski PH, Jędrzejczak WW, Szkiełkowska A, Skarżyński H. The relationship between distortion product otoacoustic emissions and extended high-frequency audiometry in tinnitus patients. Part 1: normally hearing patients with unilateral tinnitus. Med Sci Monit 2012; 18:CR765-70. [PMID: 23197241 PMCID: PMC3560797 DOI: 10.12659/msm.883606] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Accepted: 05/30/2012] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The aim of this study was to evaluate distortion product otoacoustic emissions (DPOAEs) and extended high-frequency (EHF) thresholds in a control group and in patients with normal hearing sensitivity in the conventional frequency range and reporting unilateral tinnitus. MATERIAL/METHODS Seventy patients were enrolled in the study: 47 patients with tinnitus in the left ear (Group 1) and 23 patients with tinnitus in the right ear (Group 2). The control group included 60 otologically normal subjects with no history of pathological tinnitus. Pure-tone thresholds were measured at all standard frequencies from 0.25 to 8 kHz, and at 10, 12.5, 14, and 16 kHz. The DPOAEs were measured in the frequency range from approximately 0.5 to 9 kHz using the primary tones presented at 65/55 dB SPL. RESULTS The left ears of patients in Group 1 had higher median hearing thresholds than those in the control subjects at all 4 EHFs, and lower mean DPOAE levels than those in the controls for almost all primary frequencies, but significantly lower only in the 2-kHz region. Median hearing thresholds in the right ears of patients in Group 2 were higher than those in the right ears of the control subjects in the EHF range at 12.5, 14, and 16 kHz. The mean DPOAE levels in the right ears were lower in patients from Group 2 than those in the controls for the majority of primary frequencies, but only reached statistical significance in the 8-kHz region. CONCLUSIONS Hearing thresholds in tinnitus ears with normal hearing sensitivity in the conventional range were higher in the EHF region than those in non-tinnitus control subjects, implying that cochlear damage in the basal region may result in the perception of tinnitus. In general, DPOAE levels in tinnitus ears were lower than those in ears of non-tinnitus subjects, suggesting that subclinical cochlear impairment in limited areas, which can be revealed by DPOAEs but not by conventional audiometry, may exist in tinnitus ears. For patients with tinnitus, DPOAE measures combined with behavioral EHF hearing thresholds may provide additional clinical information about the status of the peripheral hearing.
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Affiliation(s)
- Anna Fabijańska
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
| | - Jacek Smurzyński
- Department of Audiology and Speech-Language Pathology, East Tennessee State University, Johnson City, TN, U.S.A
| | | | - Krzysztof Kochanek
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
| | - Grażyna Bartnik
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
| | - Danuta Raj-Koziak
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
| | - Manuela Mazzoli
- Department of Audiology and ENT, University of Ferrara, Ferrara, Italy
| | - Piotr H. Skarżynski
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
| | - Wiesław W. Jędrzejczak
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
| | - Agata Szkiełkowska
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
| | - Henryk Skarżyński
- Institute of Physiology and Pathology of Hearing, Warsaw, Poland
- World Hearing Center, Kajetany, Poland
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De P Campos U, Sanches SG, Hatzopoulos S, Carvallo RMM, Kochanek K, Skarżyński H. Alteration of distortion product otoacoustic emission input/output functions in subjects with a previous history of middle ear dysfunction. Med Sci Monit 2012; 18:MT27-31. [PMID: 22460101 PMCID: PMC3560824 DOI: 10.12659/msm.882605] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background The aim of this study was to investigate the effects of sub-clinical alterations on the amplitudes and slopes of the DPOAE input-output responses from subjects with previous history of middle ear dysfunction. Material/Methods The study included 15 subjects with and 15 subjects without a history of otitis media in the last 10 years. All participants were assessed with acoustic immittance, pure-tone audiometry, and DPOAEs. For the later, I/O functions and I/O slopes were estimated at 1501, 2002, 3174, 4004 and 6384Hz. Results No statistically significant differences were found between the 2 groups in terms of behavioral thresholds. The group with a previous history of middle ear dysfunction presented significantly lower mean DPOAE amplitudes at 2002, 3174 and 4004 Hz. In terms of DPOAE slopes, no statistically significant differences were observed at the tested frequencies, except at 3174 Hz. Conclusions Middle ear pathologies can produce subclinical alterations that are undetectable with traditional pure-tone audiometry. The data from the present study show that reduced amplitude DPOAEs are associated with a previous history of middle ear complications. The corresponding DPOAE slopes were affected at only 1 tested frequency, suggesting that the cochlear non-linearity is preserved. Considering these results, it remains to be elucidated to what degree the DPOAE amplitude attenuation interferes with higher-order auditory tasks.
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Silva LSD, Netto RCM, Sanches SGG, Carvallo RMM. Auditory measurements in parents of individuals with autosomal recessive hearing loss. PRO-FONO : REVISTA DE ATUALIZACAO CIENTIFICA 2011; 22:403-8. [PMID: 21271090 DOI: 10.1590/s0104-56872010000400007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 11/30/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Audiological evaluation of parents of individuals with autosomal recessive hearing loss. AIM To study the audiological profile of parents of individuals with autosomal recessive hearing loss, inferred by family history or by molecular tests that detected heterozygous mutations in the GJB2 gene. This gene codes Connexin 26. METHOD Participants were 36 subjects, ranging between 30 and 60 years, who were divided into two groups: a control group composed by individuals without auditory complaints and without family history of hearing loss, and a research group composed by heterozygous parents of individuals with autosomal recessive hearing loss or heterozygous for connexin 26 mutations. All subjects underwent pure tone audiometry (0.25 to 8 kHz), high frequencies audiometry (9 to 20 kHz) and distortion product otoacoustic emissions (DPOAE). RESULTS There were significant differences between the groups when considering the amplitude of DPOAE in the frequencies of 1001 and 1501 Hz. Amplitude was higher in the control group. There was no significant difference between the groups for pure tone thresholds from 0.25 to 20 KHz. CONCLUSION The DPOAE were more effective, in comparison to the pure tone audiometry, to detect auditory differences between the groups. More studies of this type are necessary to confirm the observed results.
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Almeida PPD, Sanches SGG, Carvallo RMM. Otoacoustic emissions growth rate threshold: distortion product in neonates. PRO-FONO : REVISTA DE ATUALIZACAO CIENTIFICA 2011; 22:409-14. [PMID: 21271091 DOI: 10.1590/s0104-56872010000400008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 11/30/2010] [Indexed: 11/22/2022]
Abstract
BACKGROUND Distortion product otoacoustic emission measures (DPOAE) verifies, among other characteristics, the emergence and growth rate of the DPOAE response according to sound stimulus intensity (growth curve). AIM To estimate the DPOAE threshold in neonates according to the DPOAE growth curve at 2 kHz and 4 kHz, with stimulus presentation ranging between 35 and 70 dB SPL. METHOD Participants were 51 neonates, with 24 to 84 hours of life and with no indication of risk for hearing impairment. The DPOAE were registered in the growth curve function at 2 kHz and at 4 kHz. Neonates were evaluated during the period of hospital stay, after birth. Three possible thresholds were considered (LIM 1, LIM 2 and LIM 3) based on the presence of response at 3 dB SPL in the signal to noise ratio. RESULTS The average thresholds intensities ranged from 47.55 to 49.85 dB at 2 kHz and from 55.52 to 59.94 dB at 4 kHz. The mean amplitude response ranged from 6.67 to 8.27 dB at 2 kHz and from 6.99 to 11.35 dB at 4 kHz. There was significant difference between the three thresholds for the two studied frequencies. CONCLUSION The procedure was feasible for the neonatal population revealing mean thresholds of up to 60 dB for both frequencies. Even though participants presented elevated thresholds, robust amplitude responses were observed.
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Sanches SGG, Samelli AG, Nishiyama AK, Sanchez TG, Carvallo RMM. Teste GIN (Gaps-in-Noise) em ouvintes normais com e sem zumbido. ACTA ACUST UNITED AC 2010; 22:257-62. [DOI: 10.1590/s0104-56872010000300017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 08/18/2010] [Indexed: 11/22/2022]
Abstract
TEMA: o teste Gaps-in-Noise (GIN) avalia a habilidade auditiva de resolução temporal. Estudos têm mostrado o teste GIN como um instrumento de fácil aplicação, com boa sensibilidade e especificidade. OBJETIVO: comparar os resultados do teste GIN em ouvintes normais com e sem zumbido e fazer a correlação entre os resultados deste, os limiares tonais e idade. MÉTODO: foram avaliados 44 adultos (limiares tonais 25 dBNA nas freqüências de 0,25 a 8 kHz), formando 2 grupos: Grupo Controle composto por 23 sujeitos, 8 homens e 15 mulheres, sem queixa de zumbido, idade entre 22 e 40 anos (média 29,7); Grupo Pesquisa formado por 18 indivíduos, 3 homens e 15 mulheres, com queixa de zumbido, idade entre 21 e 45 anos (média 31,3). Os sujeitos foram submetidos à audiometria tonal e vocal, imitanciometria e ao teste GIN. Para a análise estatística foi adotado nível de significância de 0.05. RESULTADOS: na audiometria tonal, a média global dos limiares tonais foi mais elevada para o Grupo Pesquisa, comparado ao Grupo Controle (p = 0,001). A comparação do desempenho no teste GIN mostrou que o Grupo Controle detectou intervalos de silêncio em média com intervalo de tempo menor que o Grupo Pesquisa (p < 0,001). Não houve correlação entre a idade dos sujeitos e o limiar do GIN. CONCLUSÃO: o teste GIN identificou prejuízo na habilidade auditiva de resolução temporal nos indivíduos com zumbido. Na faixa etária pesquisada (entre 21 e 45 anos) não houve correlação entre a idade e os resultados do teste GIN.
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