The results from the Danish model of acoustic neuroma surgery are presented. In the period from 1976 to 1985, 300 patients with acoustic neuromas were operated upon using the translabyrinthine procedure. Only one small intrameatal tumour was encountered; 96 tumours were medium sized and 203 were larger than 25 mm. Of these 118 measured more than 40 mm. Mortality rate was 2%, CSF leaks occurred in 11%, and had to be closed surgically in 5%. Facial nerve function was postoperatively normal in 66%, slightly reduced in 17%, moderately reduced in 8% and abolished in 9%. Reconstruction, most often as a XII-VII anastomosis, was performed in only 6% of the patients. Cerebellar symptoms, which occurred in 45% preoperatively were present in only 7% after surgery. The preoperative hearing in both the tumour and non-tumour ear was analysed in 72 patients with tumours smaller than 2 cm. In the tumour ear, only four patients had a PTA of 0-20 dB and SDS of 81-100%; eight patients had a PTA of 0-40 dB and SDS of 61-100%; 14 had a PTA of 0-50 dB and SDS of 51-100%. This means that only a maximum of 5% of the patients, using the broadest criteria, could be candidates for hearing-conserving surgery. In all these patients the contralateral ear had hearing within normal limits (PTA 0-20 dB and SDS 95-100%). Since preservation of hearing would be achieved in only half of those subjected to suboccipital removal and since the hearing retained in patients with successful operations generally is poorer than the preoperative level, the number of patients obtaining serviceable hearing is so modest that preservation of hearing cannot be considered a valid argument in favour of suboccipital tumour removal. From a statistical point of view the risk of losing hearing in the opposite ear after tumour removal is negligible. The general morbidity after suboccipital surgery is higher than after translabyrinthine surgery, and hearing loss must be listed low among the other sequelae after tumour removal.
The HINT provides an efficient and reliable method of assessing speech intelligibility in quiet and in noise by using an adaptive strategy to measure speech reception thresholds for sentences, thus avoiding ceiling and floor effects that plague traditional measures performed at fixed presentation levels A strong need for such a test within the Canadian Francophone population, led us to develop a French version of the HINT. Here we describe the development of this test. The Canadian French version is composed of 240-recorded sentences, equated for intelligibility, and cast into 12 phonemically balanced 20-sentence lists. Average headphone SRTs, measured with 36 adult Canadian Francophone native speakers with normal hearing, were 16.4 dBA in quiet, -3.0 dBA SNR in a 65 dBA noise front condition and -11.4 dBA SNR in a 65 dBA noise side condition. Reliability was established by means of within-subjects standard deviation of repeated SRT measurements over different lists and yielded values of 2.2 and 1.1 dB for the quiet and noise conditions, respectively.
Spotted seals (Phoca largha) inhabit Arctic regions that are facing both rapid climate change and increasing industrialization. While little is known about their sensory capabilities, available knowledge suggests that spotted seals and other ice seals use sound to obtain information from the surrounding environment. To quantitatively assess their auditory capabilities, the hearing of two young spotted seals was tested using a psychophysical paradigm. Absolute detection thresholds for tonal sounds were measured in air and under water over the frequency range of hearing, and critical ratios were determined using octave-band masking noise in both media. The behavioral audiograms show a range of best sensitivity spanning four octaves in air, from approximately 0.6 to 11 kHz. The range of sensitive hearing extends across seven octaves in water, with lowest thresholds between 0.3 and 56 kHz. Critical ratio measurements were similar in air and water and increased monotonically from 12 dB at 0.1 kHz to 30 dB at 25.6 kHz, indicating that the auditory systems of these seals are quite efficient at extracting signals from background noise. This study demonstrates that spotted seals possess sound reception capabilities different from those previously described for ice seals, and more similar to those reported for harbor seals (Phoca vitulina). The results are consistent with the amphibious lifestyle of these seals and their apparent reliance on sound. The hearing data reported herein are the first available for spotted seals and can inform best management practices for this vulnerable species in a changing Arctic.
We carried out an audiological survey of 204 officers at an infantry regiment in southern Sweden. The officers were exposed to impulse noise from firearms with peak levels up to 185 dB (SPL). The audiological measurement results were summarized in four age-groups, all of which showed significant hearing loss compared to ISO 1999 (1990) database A of a non-noise-exposed male population. Even officers who claimed regular use of hearing protectors during their entire military career showed these significant hearing losses. In the survey we also studied the association of the hearing thresholds with subjective exposure to heavy detonations and the annoyance of tinnitus. We found a significant relation between exposure to heavy detonations and tinnitus.
Despite various infant screening programmes, congenital hearing deficit is normally detected too late. However, the measurement of otoacoustic emissions (OAE) has now proved to be an effective means of assessing neonatal hearing. The article consists in an outline of both international and Swedish experience of universal neonatal screening programmes using OAE testing. Since universal OAE screening was introduced at University Hospital, LinkÃ¶ping, in September 1995, some 6,000 infants have been tested. During the first two years 98.5 per cent of the children participated. Satisfactory bilateral OAE test results were obtained in 97.1 per cent of cases. Where further investigation was necessary, it took the form of auditory brainstem response (ABR) testing during natural rest, or full diagnostic ABR testing under general anaesthesia.
Comment In: Lakartidningen. 1999 Jun 9;96(23):2835-610405529
To account for use of hearing protection devices (HPDs) in retrospective noise exposure assessment, adjust noise exposure estimates accordingly, and validate the adjusted estimates.
A previous study in the same working population showed a stronger relation for noise and acute myocardial infarction among those who did not wear HPD. Because accurate noise exposure assessment is complicated by the use of HPD, we previously developed a multilevel model of the likelihood of HPD use for British Columbia (Canada) lumber mill workers. Historical estimates of noise exposure can be adjusted according to models predictions and a reduction in misclassifying workers, exposure is expected.
Work history and exposure information were obtained for 13,147 lumber mill workers followed from 1909 until 1998. Audiometric data for the cohort, including hearing threshold levels at several pure tone frequencies, were obtained from the local regulatory agency for the period from 1978 to 2003. Following the modeling of HPD use, noise estimates were adjusted according to models predictions and attenuation factors based on existing research and standards. Adjusted and unadjusted noise metrics were compared by investigating their ability to predict noise-induced hearing loss.
We showed a 4-fold increase in the noise exposure and hearing loss slope, after adjusting for HPD use, while controlling for gender, age, race, as well as medical and non-occupational confounding variables.
While the relative difference before and after adjustment for use of HPD is considerable, we observed a subtle absolute magnitude of the effect. Using noise-induced hearing loss as a 'gold standard' for testing the assessment of retrospective noise exposure estimates should continue to be investigated.