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05.06.2015
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Durch Klicken auf 1-Klick-Gebot verpflichten Sie sich, diesen Artikel zu kaufen, wenn Sie HA¶chstbietender sind. Medical history, your current and past these abnormalities include hypothyroidism, hyperthyroidism, hyperlipidemia because of the multifactorial nature. Osborne discovered that it was helpful to practice with the devices, and shared this with his friend and collaborator Alban Gerhardt, who doesna€™t have tinnitus. Treatment for tinnitus depends on the underlying cause and may include medications in addition to home remedies. Medications may be prescribed in some cases, often to treat the psychological effects of anxiety or depression that may accompany the tinnitus. Anything that blocks the background noise of everyday life such as earwax, earplugs, or a foreign body in the ear can make people more aware of the natural sounds our body makes. Always struggled with the phase delayed otolaryngologist.ear plugs prevent tinnitus 2,5 A full clinical evaluation should precede radiologic studies loss. Dysfunction.4Patients with vascular abnormalities complain of pulsatile spinal fluid may continue to drip proven to be effective in reducing. Thirty-three years ago, craniocorpography (CCG) was designed as a nonelectronic, simple office recording procedure for head and body movements in equilibriometry.
Initially, the regular CCG test procedure combined a stepping test [7, 8] with a standing test (Romberg) [9]. For US-COMP-CCG testing, we use the evaluation of run-time differences of ultrasound impulses between a sender and several receivers at fixed positions within the laboratory.
For recording and measuring head and shoulder positions in the typical vestibular spinal tests, such as the standing test [6, 9, 15] and the stepping test [6-8, 15], as well as for NEFERT [15], four ultrasound markers are applied.
During the recording procedure, as depicted in Figure 2, each of the markers is producing 20 very short sound impulses per second, which impulses are triggered by the same computer that transfers them to the markers on the subject (see arrows Lc to Lm). The technical precision of this system allows one to measure the locations and the flow of the locations of the markers at a 0.1-mm discrimination level.
Storing in a data bank the serial marker positions during, for instance, a i-minute test duration allows the drawing of 2-,3-, or n-dimensional images, such as real or virtual trajectories, of each of the recorded marker movements on the head or the shoulders, either separately or together, or images that depict the changing interrelations of these parameters.
The performance of NEFERT requires little additional preparation as compared with the application of USCOMP-CCG (see Fig. Before the test is begun, the voluntary movement procedure is explained by the instructor or the investigator. In phase 1, the test subject is asked to stand upright with eyes open and head in the normal position (see Fig. In phase 2, on the instructor's command, the subject should bend forward maximally (see Fig.
In phase 3, again on the instructor's command, the subject should extend backward maximally (see Fig. The investigator controls the time intervals for the three sets of instructions (phases 1-3) by a time bar presented on the computer screen (see Fig. Quantitative evaluations allow judgments about the dimensions of movements at the marker sites on the head and on the shoulders during NEFERT. The disparities between the linear measures-for instance, between forehead and occiput-result from the angular components within the real movements, which are reflected against cartesian planes by our evaluation programs.
To summarize the planar dimensions provided in Table 2 in a metric spatial extension of the frame boxes encapsulating the three-dimensional locus curves of the four markers, we use volume calculations in liters, as shown in Table 3.
For making determinations about complete motor activity at the four marker positions in comparison to the graphs of Figure 3, we measure the entire movement cycle for each marker in the three cartesian planes (see Fig. The dynamic aspect of the data presented in Table 4 can also be exhibited in velocity tables depicting I minute of NEFERT performance (Table 5).
Recently, new applications for CCG have been devised, among them the assessment of neck-related tinnitus [16] and whiplash injuries.
Neuroradiological examination revealed a lesion within the alar ligaments of the head plinth joint COIC II C2.
By means of audiometric testing, we were able to confirm a severe right-sided hearing deficit and a minor left-sided deficit. In this neurootological case, we also investigated by means of US-COMP-CCG and NEFERT to confirm the complaints about a posttraumatic head and neck movement disorder.
The locus curves shown in Figure 4A-C and in Figure 5A-C have a lateral (x), a longitudinal (y), and a vertical (z) dimension in 0.01 centimeters, which are measured within the array of data points. To summarize the planar dimensions of Table 7 in a metric spatial extension of the frame boxes encapsulating the three-dimensional locus curves of the four markers in Table 8, we used the volume calculations (expressed in liters as a comprehensive measure for space) depicted earlier in Table 3.
For making determinations about complete motor activity at the four marker positions in Table 8 as compared with the graphs of Figure 5 (a severe reduction being evident in a comparison with Table 3 and Figure 4), we measured the entire movement cycle for each marker in the three cartesian planes (see Fig.
The dynamic aspect of the data presented in Table 9 can also be exhibited in velocity tables during 1 minute of NEFERT performance (Table 10).
This 50-year-old female patient with late whiplash injury syndrome exhibits a significant reduction of head, neck, and shoulder mobility in the I-minute NEFERT, as compared with a normal adult. This article serves to introduce the newly designed US-COMP-CCO and NEFERT together with our multidimensional evaluation software HUSP A TRAC.
N = 23), high-frequency gently sloping (N = 10) and high-frequency steeply sloping (N = 22). Appalachian Audiology is a professional speech and hearing diagnostic and treatment center, accessible to all ages from infants to seniors. Unique to East Tennessee are effective treatments for hearing in noise, tinnitus, misophonia, hyperacusis, and Bluetooth auditory pathway tests. Our bi-monthly newsletter features useful information on new advances in hearing aid technology, tinnitus, and the proper care of hearing aids. Hearing aids are recommended based on the type and severity of hearing loss, the degree of difficulty hearing in background noise, lifestyle, manual dexterity, and budget. New hearing aid technology significantly reduces difficulty hearing in groups, television, telephone, and lectures. Adult hearing testing includes measurement of hearing ranges- frequency specific measures of the softest sounds audible to the loudest sounds you wish to hear, and your ability to hear in background noise. Tinnitus and hyperacusis evaluations evaluate the severity of the symptoms, match and quantify head noises and tolerance to sounds, look for medical causes, and suggest reasonable treatment beyond fans and maskers.
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Wenn Sie auf Gebot bestA¤tigen klicken und HA¶chstbietender sind, gehen Sie einen rechtsverbindlichen Vertrag mit dem VerkA¤ufer ein. More Info About This Blog…My Cure Tinnitus is dedicated to bringing the Internet all of the latest information regarding tinnitus treatment and tinnitus relief. Many recreational events such as concerts, sports, or hunting may come with loud noise that can bother the ears. Pushing a swab into the ear can cause the wax in the ear canal to become impacted against the eardrum, causing tinnitus.
Do not use tissue or cotton in the ears as these not only do not offer adequate protection against certain loud or high-pitched noises, they may become lodged in the ear canal. The light tracings of the head and shoulder movements were transformed through an instant camera into photographs that look like a radar image of the trails of head and shoulders floating through a spatial plane [1-3].
1), we sought to develop a special voluntary head and neck movement test mainly containing rotatory components. Position of two markers on the head (Marker A and P) and two markers on the shoulders (Marker Rand L) within a three-dimensional-space model. Thus, very precise localization of ultrasound senders is possible through computer calculation and conversion into positioning charts.
By means of a set of microphones installed in a spatial arrangement, the source of a sound signal can be concisely calculated. Two of these markers are fixed to the test subject frontally and above the occiput through a workman's hard hat, allowing the measurement of head movements. Within the receiver (UsRec), the sound impulses (Ta, Tp, Tr, Tl) are received by a fixed set of at least three microphones installed in the measurement system, from which they are received and processed by and transmitted to (arrows Lr to Lc) the computer.
In addition, the computer program has been modified in such a manner that it can also detect and exclude noisedisturbed signals (which may arrive through echo reflections) or other sources of failure.
This operation is performed by our specially designed software, HUSPATRAC (human space trail system Claussen), which currently provides us with nearly 50 different analytical designs, although ongoing development is continually increasing this number.
In patients who have difficulty in understanding, a training run of the test is recommended prior to recording. 3, index 3) and, while maintaining that position, should repeatedly rotate the head from right to left and back again (see Fig. 3, from index 4 to 5), and there should repeatedly rotate the head from right to left and back (see Fig.
Six representative HUSPATRAC graphs of a 50-year-old woman suffering from a late whiplash injury syndrome due to a traffic accident more than 2 years ago.
The numerical values provided in Tables 1-5 complement the visual inspection and interpretation of the six graphs depicted in Figure 4. Furthermore, it must be noted that the "hinge" between the head and the neck is positioned on the border between the most backward and the middle third of the skull base, as the head is asymmetrically suspended in its longitudinal axis. The velocity calculations (expressed in kilometers per hour) are related as mean velocities of the locus curves from Figure 4A-C. However, for intracorporeal testing of head and neck mobility, NEFERT is now our test method of choice. Therefore, we undertook to demonstrate the results of NEFERT in a 50-year-old woman who suffered severe whiplash contact trauma in May 1995.


Testing the reduced acoustic dynamics led to the diagnosis of an external tinnitus due to hypersensitive ear syndrome. The specific results for the patient whose test findings are depicted in Figure 5 are exhibited in Table 7.
The velocity calculations are related as mean velocities of the locus curves from Figure SA-C. In this patient, most of the dynamic mobility reduction is found in the vertical direction and least in the lateral direction. These tools are very easily applied in patients with head and neck movement disorders as well as in patients in whom a neck-derived tinnitus is suspected. Explains both sudden conductive hearing loss and various kinds of Sudden Sensorineural Hearing Loss (SSHL) Sudden deafness (sudden sensorineural hearing loss): diagnosis, causes and treatment Sudden Sensorineural Hearing Loss is a Medical Emergency. No cochlear dead regions detected in non-pulsatile tinnitus patients: An assessment with the threshold equalizing noise (sound pressure level) test. Adding insult to injury: Cochlear nerve degeneration after temporary noise-induced hearing loss. Identifying dead regions in the cochlea: Psychophysical tuning curves and tone detection in threshold-equalizing noise. Many reputable manufacturers' products are offered, based on the listener's specific needs.
Tinnitus and other auditory sound sensitivity challenges are treated with over a 90% success rate, as evidenced by patient report and improvements on the Tinnitus Functional Index.
Tests include non-sedated ABR hearing tests, multi-frequency tympanometry, conditioned play audiometry, and visual reinforcement audiometry.
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Zeigt sich der Sachmangel erst nach Ablauf von sechs Monaten, muss der KA¤ufer beweisen, dass der Sachmangel bereits bei A?bergabe des Kaufgegenstands vorlag. Bei Unternehmern geht die Gefahr mit Absendung der Ware oder A?bergabe an den Transporteur A?ber. Bei Verbrauchern gilt diese Rechtswahl nur insoweit, als nicht der gewA¤hrte Schutz durch zwingende Bestimmungen des Rechts des Staates, in dem der Verbraucher seinen gewA¶hnlichen Aufenthalt hat, entzogen wird. Bestellseite in den entsprechenden Eingabefeldern erfolgen Nach Anklicken des a€zSofort-Kaufena€?- bzw. A ringing, swishing, or other noise in the ears or head when no external sound is present is called tinnitus.
Osborne was custom-fitted with a special a€?musiciana€? pair of earplugs, which filter out a calibrated amount of noise while allowing other sounds to enter.
Occupational Safety & Health Administration (OSHA) regulations have recommendations to protect hearing that include wearing earplugs or earmuffs. Nicotine in tobacco products may reduce blood flow to the structures of the ear, leading to tinnitus. This objective and quantitative equilibrium test was developed especially for the West German Berufsgenossenschaften (labor security surveillance boards) as a field test for occupational medical purposes. The conventional photooptical CCG has proved to be an important tool for equilibriometric field and office investigations [11-14]. This test, which has been dubbed the neck flexion, extension, and rotation test (NEFERT), differs substantially from the longitudinal lateral vertical head sliding test, which contains mainly linear components. Patient is wearing a helmet bearing two ultrasound markers (UsMr-A and P) and a shoulder fixation bearing two other ultrasound markers (UsMr-R and L). There a fourdimensional digital array of position data is processed and deposited by means of a specific computer program.
A systematic set of simple instructions must be given orally to the technically prepared test subject and can be stressed by a poster (Fig. In phase 1, the upright test subject with head up (index 1) is requested to rotate the head repeatedly from right to left and backward (index 2) for 20 seconds. The subject then should repeatedly rotate the head maximally from the right to the left side and back again (see Fig. 3, index 6) over a 20-second interval, until the instructor indicates that the subject should stop and assume the initial head position (see Fig.
During the investigation, a preliminary graphical test result is presented by means of a polar coordinate type chart, showing the head rotations with respect to the shoulder rotations in a horizontal plane on the computer screen. Moreover, many types of frequency analyses and other derived dynamic parameter analyses are applied. Neurootologically, the patient exhibits a cervicoencephalic syndrome resulting in multisensory neurootological deficits. As these six graphs are drawn for a specific person who is undergoing the NEFERT, we obtain a simple series of characteristic data about that subject, including age, gender, size, and weight (Table 1). This then leads to rotational circles of different diameters created by the forehead and the occiput in the horizontal and the veltical planes. Using this test, we can graphically and numerically display the dynamic test parameters (as shown earlier) and permanently record the mobility of the neck through relative head-neck rotation [15]. Our NEFERT investigation dates from July 1997, at which time the patient was exhibiting a late whiplash injury syndrome of the cervicoencephalic type. However, the neurootological network analysis, based on an equilibriometric, audiometric, olfactometric, and gustometric workup, unveiled a combined peripheral and central disequilibrium, including disturbances of the spontaneous and the caloric tests as well as several optokinetic nystagmus tests.
This case shows clearly that the extensions of the patient's movements in all planes are much reduced in comparison with those of a normal adult: The differences between Tables 2 and 7 are obvious. The results in Table 9 show remarkable reductions of the wavelengths of execution of NEFERT in the tested patient as compared with a normal adult (see Table 4). She appears to try to carry her body and her head as smoothly erect as possible so as not to provoke irritations through vertical head shaking. This combination of techniques is an important achievement in equilibriometry, providing a new and important tool for regular and general neurootological investigations. Uber eine Gleichgewichtsfunktionsprufung mit Hilfe der Cranio-Corpo-Graphie (CCG) und Polarkoordinaten im Raume. Die Cranio-Corpo-Graphie (CCG), eine einfache photooptische Registriermethode für vestibulospinale Reaktionen.
Epidemiologische und arbeitsmedizinische Erkenntnisse wr Entwicklung eines berufsgenossenschaftlichen Grundsatzes "Absturzgefahr." Arbeitsmed Kolloquium. Cranio-Corpo-Graphy (CCG), a simple objective and quantitative whole-body as well as intracorporal posturography. Forschungsbericht CranioCorpo-Graphie (CCG)-Ein einfacher, objektiver und quantitativer Gleichgewichtstest für die Praxis.
Neue objektive registrierbare Vestibulariskorperdrehreaktionen, erhalten durch Treten auf der Stelle. Vestibulospinal testing using cranio-corpo-graphy in patients suffering from acoustic neuroma.
Cranio-corpo-graphy, an Objective and Quantitative Representation of Movement Patterns During the Stepping and Standing Test. Cranio-corpo-graphy (CCG)-30 years of equilibriometric measurements of spatial head, neck and trunk movements.
Sudden Sensorineural Hearing Loss (SSHL, Sudden Deafness) Sudden Sensorineural Hearing Loss (SSHL), or sudden deafness, is a rapid loss of hearing. A tone producing peak vibration at a particular place on the basilar membrane can be detected by off-place or off-frequency listening provided that the stimulus is sufficiently loud. Alle Seiten sind vollstA¤ndig vorhanden, es gibt keine zerknitterten oder eingerissenen Seiten und im Text oder im Randbereich wurden keine Unterstreichungen, Markierungen oder Notizen vorgenommen. Beim Kauf mehrerer Artikel, auch von verschiedenen VerkA¤ufern, kann der KA¤ufer diese in den Warenkorb ablegen und dann die Bestellung auslA¶sen. In rare cases, tinnitus can be a symptom of a serious medical problem such as a brain aneurysm or acoustic nerve tumor. Wearing earplugs in the practice room prevents him from getting seduced by the vibrant acoustics, he said. In the past the supplement niacin was recommended or the drug gabapentin (Neurontin, Gabarone) was prescribed but both have been shown to have no effect on reliving tinnitus.
In 1983, it was officially introduced into occupational medicine in West Germany through the digital G41 of the West German Berufsgenossenschaften [4-6].
Very shortly after the test is performed, the results of the investigations are available, making this nearly an on-line charting procedure [6, 10].
The performance of the NEFERT, its recording and evaluation in relation to our US-COMP-CCG, are presented along with a clinical example.
A computer unit depicted in the lower right-hand corner (PosAnalysator [position analyzer]) is triggering the ultrasound impulses. Several computer programs then establish a numerical analysis and spatial as well as temporal images of each of the markers.
In phase 2, at the command of the instructor, the upright test subject must maximally bend forward (index 3) and in this position repeatedly rotate the head from right to left and backward (index 4) for 20 seconds. The locus curves, especially as shown in Figure 4A-C, have a lateral (x), a longitudinal (y), and a vertical (z) dimension in centimeters, which are measured within the array of data points. Even 2 years after the trauma, the patient continued to report headache, neck pain and neck sprain, loss of personal dri ve and efficacy, forgetfulness, concentration disturbances, weakness, sleeping problems, anxiety, irritation, and loneliness.
Now CCO can even more efficiently solve the problem of dynamically measuring the mobility of the neck-for instance, in late whiplash injury syndromeby means of our newly designed test procedure for measuring yaw, pitch, and roll movements in the voluntary head movement portion of NEFERT, as recorded and evaluated by means of the US-COMP-CCO in conjunction with our special software, HUSPATRAC. We have applied this method regularly and successfully for more than S years in our Bad Kissingen neurootological laboratory. Presented at the Sixth International Symposium of Posturography, Kyoto, Japan, September 17-19. The tone will not be detected at its usual place on the basilar membrane but at an adjacent place where the IHCs are functioning more effectively.
This care, attention, customization and preparation result in less than a 1% return rate of products. To diagnose tinnitus, a doctor will do a physical examination and ask you about your history, including whether the tinnitus is constant, intermittent, or pulsating (like the heartbeat, called pulsatile tinnitus), or if it is associated with hearing loss or loss of balance (vertigo or vestibular balance disorders). A doctor determined that Osborne had developed tinnitus from practicing too loudly in a small room. For the recording of complex simultaneous movements at different body points-such as, for instance, the head and the shoulder-calculating a single spot or position and its traces in space is insufficient. Behind and above patient is the ultrasound receiving unit (UsRec), containing several ultrasound microphones and data processors, which receive sound traces from the head (Ta, Tp) and shoulders (Tr, Tl). In phase 3, again at the instructor's command, the upright test subject must maximally extend backward (from index 4 to 5) and there repeatedly rotate the head from right to left and backward (index 6) for a 20-second interval. The head rotations, especially for the forehead and occiput in maximal flexion, are broad and well synchronized.
As expected, the highest velocities during 1 minute of NEFERT occur at the level of the head, especially at the forehead marker.
Furthermore, the patient was suffering from vertigo, including dizziness, falling toward the right, blackouts, and instability, accompanied by sweating, palpitations, dyspnea, nausea and vomiting, blurred vision, and oscillopsia.
As expected, the highest velocities during I minute of NEFERT occur at the level of the head, especially at the forehead marker.
In a future study, we plan to present the statistical standards of major samples together with a broader spectrum of applications. Therefore, the CMS is arranged for the recording of several acoustic markers simultaneously. The olfactory investigation, carried out by means of the target olfactogram, displayed an allotriosmia on the patient's right side in the form of a cacosmia. In comparison to the values of the normal person, this patient exhibits a remarkable dynamic movement reduction in kilometers per hour during 1 minute of voluntary neck flexion, extension, rotation movements. Explains both sudden conductive hearing loss and various kinds of Sudden Sensorineural Hearing Loss (SSHL).
Genauere Einzelheiten sowie eine Beschreibung eventueller MA¤ngel entnehmen Sie bitte dem Angebot des VerkA¤ufers. During the recording procedure, each marker is producing 20 very short sound impulses per second, which impulses are triggered by the same computer that transfers them to the markers on the subject (arrows Lc to Lm). The shoulder tracings appear below and to the left of the tracings of the head in the form of dots.
In addition to these symptoms, the patient reported a severe disabling tinnitus in both the ears, which she described as high-pitched and hissing, as if a train were running through her head. Therefore, we also calculated the differences between the values of Tables Sand 10, assuming the values of Table S (for a normal person) represented 100% of the values of Table 10 (in a 50-year-old female patient).


The head rotation positions for the forehead and occiput in lateral view are represented by dots, which are connected by flat circular lines. The head rotations, especially for the forehead and occiput in maximal flexion, are very small and reduced in the coverage of the surface. Definitions of sudden hearing loss have been based on severity, time course, audiometric criteria, and frequency spectrum of the loss. The computer unit calculates the spatial positions of all four ultrasound markers and instantly displays on the screen a (radar image-like) graph including all four head and shoulder movement traces (lower right-hand corner).
This means that, for subjects with normal hearing thresholds, the masked threshold for a pure tone is the same for all frequencies over the range of 250-10 000 Hz. The software within the computer is handling the protocol, the procedure, and the movement analysis online. Viewing frontally on the tracings, the shoulders are lateral to and below the head tracings in the form of dots. More specifically, the TEN level is specified as the level in a one-Equivalent Rectangular Bandwidth N (ERB N ) (132 Hz) wide band centered at 1000 Hz, where ERB N stands for the average of the auditory filter as determined for young normal-hearing subjects at moderate sound levels. The head rotation positions for the forehead and occiput in lateral view are represented by small lines with very little vertical elevation. Lateral analysis of the small bands of minor shoulder movements below and above the widely oscillating and overlaid two bands of head movements extending from the start (left border) to the end (right border). Looking at the top panel, the solid curve represents the basilar membrane vibration pattern for a pure tone with a CF of.
Especially during maximal flexion, the frontal head rotations extend over the entire space defined between the shoulders.
Viewing frontally on the tracings, the shoulders are on both sides laterally and much below the tracings of the head in the form more of compressed lines than of vertically elevated dots. Head rotations of the forehead and occiput are remarkably small and are extensively overlaid in their arches except for the downward-directed distance during the last phase (phase 3, Oc Ph3) of the occipital marker. Sudden hearing loss or sudden sensorineural hearing loss, SSNHL, is defined as a loss greater than 30 dB in three contiguous frequencies, occurring over a period of less than three. The shaded area reflects the presence of a high-frequency DR starting at approximately 1.07 kHz. Longitudinal analysis of the small bands of minor shoulder movements located in the lower part of the plot.
To measure absolute thresholds for frequencies below 1.07 kHz, 40 dB of basilar membrane vibration is needed (long-dashed line).
Chart is separated into three sections by the steep flexion movement at the end of phase 1 and the steep extension movement by the end of phase 2 of the neck flexion, extension, and rotation test (NEFERT). Lateral analysis of the small bands of minor shoulder movements below and above the small and slowly oscillating two bands of head movements, extending from start (left border) to finish (right border). Intratympanic dexamethasone with hyaluronic acid in the treatment of idiopathic sudden sensorineural hearing loss after failure of. As indicated by the short-dashed line, the absolute threshold value of a 1.5 kHz tone (which falls within the DR) is 67 dB. Especially during maximal flexion, the frontal head rotations do not range sufficiently to cover the entire space defined between the shoulders. Sudden hearing loss (SHL) is a medical emergency for which definitive diagnosis and treatment is still.
A threshold is measurable because of the intact IHC's adjacent to the DR (= off-frequency listening).
Especially during maximal extension (phase 3), the frontal head movements dip behind the curves of both shoulders. Longitudinal analysis of the small bands of minor shoulder movements, located in the lower portion of the plot. To make the tone audible again the level has to be increased so that basilar vibration just below the 1.07 kHz DR slightly exceeds 70 dB. The chart is visibly separated into only two sections by the steep extension movement at the end of phase 2 of the neck flexion, extension, and rotation test (NEFERT).
Being in a complete phase shift, these are located in the lower part of the plot, and above them are depicted the head movements.
This figure shows that for the person with a DR, the masked threshold was 30 dB higher than the unmasked threshold (97 dB vs. The chart is separated into three sections by the small occipital upward flexion movement at the end of phase I and the steeper occipital downward extension movement at the end of phase 2 of NEFERT. Especially during maximal extension (phase 3), the frontal and especially the occipital head movements dip behind the curves of both shoulders, although with small oscillations. Especially during maximal flexion (phase 2) and maximal extension (phase 3), the excursions of the two head movements are well synchronized. Vertical analysis of the very small bands of vertically oscillating shoulder movements, located in the extreme lower portion of the plot, above which are depicted the head movements, with very small vertical elevations.
This last remark demonstrates the two criteria that need to be fulfilled to determine a DR: (1) at least 10 dB of masking is required and (2) the masked threshold should be at least 10 dB higher than normal. The chart is separated into two sections by the occipital downward extension movement at the end of phase 2 of NEFERT. The time chart extends from start (left border) to finish (right border), with very few oscillations. The TEN (HL) test is the modified version of the TEN (SPL), calibrated in dB HL which is easier to interpret as the audiometer is also calibrated in dB HL.
The frequency range of the TEN (HL) is narrowed to 250-4000 Hz and the TEN noise contains a lower crest factor.
The present study aims to investigate whether cochlear DRs are more prevalent in patients suffering from tinnitus. Tinnitus, the perception of sound in the absence of an external acoustic sound source, poses a clinical problem for millions of people around the world. One of the hypotheses on the etiology of non-pulsatile tinnitus is the existence of sharp edged cochlear DRs flanking normal functioning hair cells. 40 dB of basilar membrane vibration is needed (long-dashed line) in order to measure absolute thresholds below 1.07 kHz.
The short-dashed line represents the absolute threshold value of a 1.5 kHz tone, which is 67 dB.
In case of a dead region, the intensity of the tone needs to be raised substantially in order to achieve audibility again. Twenty-two patients suffered from bilateral tinnitus while eleven patients perceived a unilateral tinnitus in either the right or left ear. Pure-tone audiometry All patients received visual inspection of the eardrum by an ORL-specialist.
In addition, tympanometry was normal in all subjects so middle ear pathologies were excluded. According to current clinical standards (ISO 8253-1, 1989), air conduction threshold were measured at 125, 250, 500, 1000, 2000, 3000, 4000, 6000 and 8000 Hz using a 2-channel Interacoustics AC-40 audiometer in a soundproof booth. All the patients included in this study had a normal hearing or a sensorineural hearing loss (SNHL) as the air-bone gap never exceeded 10 dB HL. For all the analyses only those ears in which tinnitus was perceived were included in this study. Tinnitus analysis A Dutch validated version of the Tinnitus Questionnaire (TQ), [12] was completed by the majority of patients (four patients did not complete the questionnaire). Finally, tinnitus pitch and intensity were determined through tinnitus analysis using pitch matching and loudness matching procedures.
Threshold equalizing noise (SPL) procedure The TEN (SPL) test was performed in all fifty-five tinnitus ears using an original TEN (SPL) CD played by a CD player (Sony CDP-XE270) and presented through a TDH-39 supra-aural earphone. Input channel 1 on the audiometer was selected on the left side, and channel 2 was selected on the right side. The first track on the CD, a calibrating tone, was played continuously and both volume unit (VU) meters were adjusted to read 0 dB. Subsequently, the TEN was presented with a level of 70 dB and the masked thresholds were measured in a similar way.
In case the absolute thresholds of a patient were 60 dB SPL or worse, the level of the TEN was raised.
Firstly, it may be impossible to produce 10 dB of masking in patients with severe or profound SNHL because the maximum output of the audiometer is reached. Secondly, when the TEN level was considered as too loud by the patient, the level was lowered and did not provide sufficient masking, leading to inconclusive results.
A full tinnitus analysis was performed on 31 ears of 21 patients (10 with bilaterally tinnitus, 11 with unilateral tinnitus). The majority of patients experienced a high-pitched tinnitus and mostly a noise-like character.
The tinnitus loudness was scored on a VAS by nineteen of the thirty-three patients (of which in 11 patients with bilateral tinnitus, the VAS was also scored bilaterally).
Tinnitus intensity was measured in 26 patients and 29 patients completed the TQ of which eight patients were categorized with a degree 1, 10 with a 2 nd degree, 9 with a 3 rd and 2 with a 4 th degree. Because of time shortcomings in the daily clinical practice, all (TQ, VAS and tinnitus analysis) were not always done completely. Therefore, [Table 1] and [Table 2] do not contain data of all ears of all patients on which the TEN (SPL) was applied.
In patients suffering from bilateral tinnitus, the TEN (SPL) test was performed in both ears.
As one of the criteria for a DR states that the masked threshold should be at least 10 dB worse than the unmasked threshold, no DRs were found in these patients. In one patient with a symmetric HFSS audiogram configuration and bilateral non-pulsatile tinnitus, the unmasked threshold could not be measured bilaterally upwards from 2 kHz because of audiometer output limitation as the unmasked threshold exceeded 120 dB HL. In three other patients with a HFSS configuration (two patients with bilateral tinnitus and one with unilateral tinnitus), the unmasked threshold were measured but the TEN noise could not be set loud enough to provide sufficient masking. Therefore the results in these patients remained inconclusive for a DR located in the high frequencies. In the present study tinnitus patients with different audiometric configurations and hearing thresholds (going from normal hearing to profound hearing loss) were tested for DRs by use of the TEN (SPL) test. In the study of Weisz et al., (2006) a normal hearing student population suffering from tinnitus was tested of which eight out of eleven subjects were identified with a DR. However, as mentioned earlier and elucidated in [Table 3], in four patients with a HFSS configuration, unmasked or masked thresholds could not be obtained in seven tinnitus ears because of audiometer output limitations. The problem of the amount of inconclusive results of the TEN (SPL) test has been previously reported by Hornsby and Dundas (2009) where in 80% of the ears inconclusive results were found for at least one frequency and 30% at three frequencies or more. Furthermore, as tinnitus analysis showed that most patients included in this study, perceived a high pitched tinnitus, we were especially interested in the cochlear preservation at those frequencies. Thirty-two ears of the patients included in the present study, were characterized as a HFGS (N = 10) or a HFSS (N = 22) configuration. As mentioned before, patients with high-frequency steeply sloping audiometric configurations are more likely to have a DR in that area. As the present study aimed to assess the TEN (SPL) as a clinical tool for the explanation of tinnitus, the question arises whether cochlear DRs are necessary for a tinnitus percept.
It has been shown that immediately after acute (impulse) noise trauma in military personnel, 88% of the soldiers perceived a noise-induced tinnitus. However, the fact that some patients with tinnitus had no DRs and some patients with DRs had no tinnitus supports the hypothesis that the presence of a DR is neither necessary nor sufficient to induce tinnitus. While the etiology of tinnitus remains elusive in many cases, research is needed in order to identify a possible causative factor.
One of the hypotheses on non-pulsatile tinnitus is the presence of cochlear DR leading to central hyperactivity.
If DR can be identified by use of the TEN test, the present study does not support the concept that DR are necessary for tinnitus. Therefore, the use of the TEN test as a diagnostic tool in a tinnitus population might be of limited value.
The authors would like to point out that the present study does not designate the TEN test to be unreliable as a whole but as a result of the present findings the TEN test does not provide a useful tool in the diagnostics of tinnitus patients. Further research with the TEN test in tinnitus patients is necessary in order to confirm these findings.



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