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Audiometry results from the 2012 and 2013 Canadian Health Measures Survey (CHMS) indicate that 20% of adults aged 19 to 79 years had at least mild hearing loss in at least one ear (Chart 1). The survey assessed hearing loss as either unilateral (occurring in only one ear) or bilateral (occurring in both ears). Audiometry results indicate that 5% of children and youth aged 6 to 18 years had hearing loss that was considered mild or worse (Chart 2). The majority of Canadians with measured hearing loss were not aware they had any hearing problems (Chart 3).
42% of Canadians aged 16 to 79 years have worked or currently work in an environment where it is required to speak in a raised voice to communicate with someone standing an arm’s length away.
51% of Canadians aged 3 to 79 years have used earbuds or headphones to listen to music, movies or other types of audio in the last 12 months.
41% of Canadians aged 3 to 79 have experienced tinnitus (hissing, buzzing, ringing, rushing or roaring sounds in the ears). Sensorineural hearing loss is the most common type of permanent hearing loss and occurs when there is damage to the inner ear or the nerve pathways from the ear to the brain. Audiometric tests were administered as part of the Canadian Health Measures Survey to assess sensorineural hearing loss in children and adults aged 6 to 79. Otoscopy, tympanometry and distortion product otoacoustic emissions (DPOAE) tests were also conducted on respondents aged 3 to 79. Additional Canadian Health Measures Survey data on this topic are available in CANSIM table 117-0022. Basic information for the concerned parent: Ear Infections and Early Learning has information that sheds light on the effects of hearing loss that comes and goes on children’s development. Research Summary: Otitis media with effusion (OME) often results in hearing loss for children with the condition. We will be provided with an authorization token (please note: passwords are not shared with us) and will sync your accounts for you. 1Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Effects of early abnormal auditory experience and later recovery have been reported in several animal studies.
Congenital conductive hearing loss may occur for reasons of atresia or middle ear anomalies such as a fused malleus and incus, or fixation of the stapes. In the current case study, we investigated the effects of long-term congenital, unilateral mixed (conductive and sensorineural) hearing loss on sound localization, speech understanding, and cortical organization, both before and after the conductive component of the hearing loss was corrected in adulthood.
Written informed consent was obtained from the participant in accordance with the Declaration of Helsinki and guidelines approved by the Human Research Protection Office at Washington University School of Medicine (WUSM).
The participant (P1) was a 41 year old female who had a history of unilateral hearing loss in the right ear that had been present since early childhood (probably since birth).
Pre-operative, high resolution CT scanning revealed a slightly thickened stapes footplate with no other abnormalities suggestive of otosclerosis.
All testing occurred in double-walled sound booths with the participant comfortably seated. An adaptive speech reception threshold (SRT) psychoacoustic task resulted in speech thresholds for quiet and nine competing noise conditions (modified from the task described in Litovsky (2005) and Johnstone and Litovsky (2006)). A psychoacoustic measure determined the random spectrogram sound (RSS) that was most different from two others during each trial. Previously described protocols (Burton et al., 2012, 2013) were used to perform functional magnetic resonance imaging (fMRI), preprocess the images, and analyze blood oxygen level-dependent (BOLD) responses to auditory stimulation of the unaffected left ear.
The distribution of volume-based F-Zstats from each imaging session was superimposed on coronal slices through the patient’s brain. Figure 3 displays results for R-Space sentence understanding in the presence of restaurant noise. Hearing loss was unilateral in 48% and bilateral in 52% of adults with at least mild hearing loss (data not shown). However, results from the otoacoustic emissions testing indicate that about 7% of children aged 3 to 5 had results consistent with conductive hearing loss (data not shown, see About hearing). About 70% of adults with measured hearing loss did not report any diagnosis by a health care professional, while the same occurred in 83% of children and youth. One-third of those individuals regularly listened at a volume that was at or above three quarters of the maximum volume. Tympanometry measures the mobility of the ear drum and the pressure of the middle ear system. In order to provide appropriate and effective audiologic management, it is important to understand the impact of OME on speech recognition ability when hearing loss is present. This means that you will not need to remember your user name and password in the future and you will be able to login with the account you choose to sync, with the click of a button. This page doesn't support Internet Explorer 6, 7 and 8.Please upgrade your browser or activate Google Chrome Frame to improve your experience. Imbalanced input also degrades time-intensity cues for sound localization and signal segregation for listening in noise.
This occurs in cases of unilateral sensorineural hearing loss, where there is sensory (inner ear) or neural dysfunction, as well as losses in the conductive pathway between the outer and inner ear.
For example, UCHL created by plugging one ear in young owls initially altered localization abilities but abilities then recovered, that is, the owls made use of abnormal cues to accurately localize (Knudsen et al., 1984a,b). Degree of hearing loss and the presence or absence of other inner ear deficits varies with the abnormality, but can result in 60 dB of hearing loss from the conductive aspect alone. Measures included interaural temporal difference limens, MLDs, sound localization and speech recognition in noise. Family history included a father and paternal grandmother with mixed unilateral hearing loss.
The participant underwent a laser stapedotomy procedure with prosthetic reconstruction completed under general anesthesia through an aural speculum. All test stimuli were from recordings and individually calibrated for the presentation equipment. SRT determinations were for test spondees (two-syllable words with equal stress on both syllables) spoken by a male talker and always presented from a loudspeaker facing the front of the seated participant. BOLD responses to RSS stimuli of 2 s duration were recorded at three times: pre-surgery and at 3 and 9 months post-surgery.

Additionally, BOLD response time courses were extracted from regions of interest for peak F-Zstats identified with an automated search (Kerr et al., 2004). For each plot, the location of the loudspeaker source (in degrees azimuth) is indicated along the x-axis and of the reported loudspeaker along the y-axis.
Adults aged 60 to 79 years were significantly more likely to have hearing loss (47%) compared with younger adults aged 40 to 59 years (16%) and 19 to 39 years (7%).
Among children and youth with hearing loss, the majority (90%) had hearing loss in only one ear (unilateral, data not shown). Males and females were similar in that 70% of males and 72% of females with measured hearing loss did not report having been diagnosed with a hearing loss.
Refer to the webpage on cholesteatomas for more information about this disease and how it can effect learning. This study examined the speech recognition abilities of normal-hearing six- and seven-year-old children (n = 12) and adults (n = 12) using monosyllabic words and nonsense syllables presented at two levels of simulated conductive hearing loss characteristic of OME. Average speech recognition scores decreased as the degree of simulated conductive hearing loss increased.
In animals, unilateral conductive hearing loss (UCHL) results in structural and functional changes within the auditory system. Self-assessment questionnaires that probe hearing in different listening environments indicated numerous hearing difficulties in those with congenital UCHL (Priwin et al., 2007).
After the earplug was removed, these owls again made localization errors but after some weeks they regained accuracy. However, in a later longitudinal study of adults with otosclerosis, MLDs returned to normal in many participants when tested a year after hearing restoration (Hall and Grose, 1993).
Post-surgery binaural improvements were significant for some individuals and some tasks but not all; sound localization and speech recognition continued to be difficult especially when noise was towards the NH ear and the restored ear was relied upon for speech understanding. P1’s father had successful stapes surgery in adulthood as a treatment for otosclerosis induced hearing loss. This procedure is designed to restore mobility to the middle ear bones for improved sound conduction. All loudspeakers presented a recording of diffuse restaurant noise (60 dB SPL), replicating a challenging real-life listening situation. Spectral RSS differed by dividing the bandwidth into 3–16 spectral bands and changing between bands at a fixed temporal rate of 3 Hz. The Speech domain probes speech recognition in a variety of listening environments and a range of talker visibility.
Presentation times for RSS stimuli varied during 9-s silent intervals in 11-s volume acquisitions, which enabled capture of BOLD at different stimulus delays with respect to the echo-planar images (EPI) in this interrupted single event design (Belin et al., 1999). Note that the 9-month results were equivalent.) As expected, thresholds for the NH or left ear (blue symbols) were unchanged compared to pre-surgical results.
Means and standard deviations of reported loudspeakers are plotted for each source loudspeaker location for pre-surgery and post-surgery test intervals of 3 and 9 months, respectively in Panels A to C. Males (25%) were significantly more likely to have hearing loss compared with females (14%) (Chart 1).
Nearly 2 in 10 adults aged 19 to 39 with hearing loss had bilateral loss compared with 5 in 10 of those aged 40 to 59 and 7 in 10 of those aged 60 to 79 (data not shown). Other permanent damage can also be caused from longstanding hearing loss due to middle ear infection.
Both age groups scored significantly poorer for nonsense syllables than for monosyllabic words. We investigated effects of long-term congenital unilateral hearing loss on localization, speech understanding, and cortical organization following hearing recovery. For example, on the UCHL side in rats, the size of neurons in the anteroventral cochlear nucleus was smaller (Coleman and O’Connor, 1979) and binaural interactions were absent in the inferior colliculus (Silverman and Clopton, 1977). However, localization performance did not recover when ear plugging occurred in older owls or even in younger owls when the plug remained in place beyond a few weeks. Otosclerosis is typically diagnosed in young to middle adulthood and the hearing loss is often progressive in nature (and primarily conductive), thus these individuals had several years of normal hearing (NH) prior to hearing loss onset.
When left untreated into adulthood, individuals will have extended periods of auditory deprivation. Abnormal auditory experience in early life may affect later binaural abilities; however, the nature and impact of these interactions are not entirely clear. P1 and her family had believed P1’s hearing loss to be sensorineural and non-correctable. Air-conduction thresholds via TDH headphones (Panel A) or insert earphones (Panel B) are indicated with blue Xs for the left ear and red triangles or circles for the right ear.
The participant sat approximately three feet in front of the center loudspeaker, was unaware that five loudspeakers were inactive (#2, 4, 8, 12, 14), and was instructed to face the center loudspeaker between each presentation but was allowed head turns during each carrier-word presentation. Two 20 sentence lists were administered and an average signal-to-noise ratio (SNR) for 50% accuracy (SNR-50) obtained.
There were three noise types: multi-talker babble (MTB) and two types of single-talker noise (a female talker and a male talker each presenting Harvard IEEE sentences). Temporal RSS differed by changing between three spectral bands at temporal rates between 8 and 30 Hz. Subsequent assembly of BOLD amplitudes relative to baseline (% change in response) at stimulus delays from 2 to 9 s prior to the EPI reconstructed an average BOLD response time course. Thus, the analyses evaluated activity in core primary auditory (Te1), planum temporale (Te2), and planum polare (Te3). The red line connects post-surgical air-conduction thresholds (obtained with insert earphones having approximately 75–90 dB interaural attenuation). Correct identification of all presentations results in a straight diagonal line from the lower left- to the upper right corner.
The y-axis shows the possible reported response loudspeaker locations in degrees azimuth that range from −70 degrees toward the NH ear side at the bottom of the axis to +70 degrees toward the hearing-impaired ear side at the top of the axis. Pre-surgery, P1 had 50% accuracy for sentences presented 3.5 dB softer than the surrounding restaurant noise (60 dB SPL). This form of hearing loss can occur independently or in conjunction with sensorineural hearing loss.
In general, the children performed more poorly than the adults with the exception of the easiest listening condition for word stimuli. Hearing in the congenitally affected ear of a 41 year old female improved significantly after stapedotomy and reconstruction.

Likewise in cats, UCHL reduced the inhibition from the ipsilateral ear on neurons in the inferior colliculus when the contralateral ear was deprived of sound (Moore and Irvine, 1981).
Thus, the ability to recover was affected by the age at which UCHL occurred as well as the age at which hearing was restored. A hearing aid was fitted around age 5 but discontinued after a brief trial due to lack of benefit. Circles indicate unmasked right ear thresholds and triangles indicate thresholds obtained with masking noise presented to the better hearing left ear.
The malleus and incus were mobile and the stapes firmly fixed in the oval window consistent with a congenitally fixed stapes.
Head turns were allowed since it more accurately simulates talker localization in conversational settings. Sentences were presented from the front loudspeaker beginning at a +6 dB SNR and adapted to be easier or more difficult based on the participant’s responses. Spectral RSS had greater complexity with more spectral bands and temporal RSS were more complex with higher temporal rates. In the Qualities domain, respondents indicate sound naturalness, listening effort and the ability to segregate multiple sounds. Open circles indicate unmasked thresholds and open triangles indicate thresholds obtained with the unaffected ear masked.
Symbols indicate mean responses for each active sound-source location and error bars represent ±1 standard deviation.
By 9 months post-surgery, P1 was able to understand sentences at even softer levels (4.9 dB softer than the restaurant noise). Furthermore, children appeared less able than adults to use their knowledge of familiar words to improve performance. These findings suggest that rehabilitative strategies may best be focused on combining familiarization techniques and amplification options. Pre-operative hearing threshold levels showed unilateral, mixed, moderately-severe to profound hearing loss.
Additionally, UCHL leads to decreased 2-deoxyglucose uptake bilaterally in the higher auditory medial and lateral superior olive nuclei even in silence, indicating decreased neuronal activity (Tucci et al., 2001). While it is well known that unilateral deprivation of the visual system early in life results in permanent impairment of binocular vision (Hubel and Wiesel, 1970), less is known about the developing auditory system’s ability to recover binaural abilities.
In adulthood, the participant had a comprehensive audiological evaluation that diagnosed the loss as mixed. Masked bone-conduction thresholds for the right ear are indicated with red left-facing brackets.
A CO2 laser was used to make a stapedotomy in the center of the stapes footplate and a Teflon piston was placed and connected to the incus. After each presentation, the participant repeated the word and indicated the source speaker number. A four-alternative forced-choice task, without feedback, determined subsequent presentation levels that continued through four reversals using an adaptive paradigm based on participant responses. Separately for each imaging session, F-tests per voxel evaluated whether the variance of evoked BOLD responses was greater than variance due to baseline noise. Interestingly, in a number of these studies, bilateral conductive hearing loss had little to no effect on neuronal size or binaural interactions, with normal maintenance of contralateral and ipsilateral projections. Undefined in humans is a sensitive period for binaural hearing, where behavior can adapt to abnormal experience and develop accurate abilities, and a critical period, after which the ability to adapt to altered (including restored) hearing is greatly diminished or nonexistent.
For localization, a root mean square (RMS) error score was calculated as the mean target-response difference, irrespective of error direction. Together, these studies suggest that modifications in the balance of afferent activity alter binaural interactions and auditory system structures.
The manipulated variable was minimum detectable changes (JND) in spectral or temporal complexity.
Measurements were of sound localization with intensity-roved stimuli and speech recognition in various noise conditions. The difference between the air- and bone-conduction thresholds identifies the conductive component of the participant’s hearing loss, that is, the portion of the loss that could potentially be corrected through surgery. Activation magnitudes were determined in core, belt, and parabelt auditory cortex regions via an interrupted single event design. Hearing levels were normal in the unaffected left ear (blue symbols) resulting in a large hearing asymmetry between ears.
Feedback was provided for correct responses and each of four test runs concluded with eight reversals. Hearing improvement following 40 years of congenital unilateral hearing loss resulted in substantially improved sound localization and speech recognition in noise. With this level of asymmetry and the mixed nature of the hearing loss in the affected ear, audiological masking approaches become more complicated due to potential cross masking effects. Each of the JNDs for spectral and temporal RSS complexity was an average of the last four reversals. One-third octave narrow bands of masking noise (centered at the test frequency) were presented to the unaffected ear to isolate the affected ear during testing.
Contralateral auditory cortex responses were increased after hearing recovery and the extent of activated cortex was bilateral, including a greater portion of the posterior superior temporal plane.
Testing was completed with TDH-49 headphones with 40–60 dB of interaural attenuation. Thus, prolonged predominant monaural stimulation did not prevent auditory system changes consequent to restored binaural hearing. Although a 15 dB plateau was achieved at each frequency (increases in masking level at the unaffected ear did not increase the patient’s response level in the affected ear), high levels of masking noise to the unaffected ear could possibly have been detected by the cochlea of the affected ear via bone conduction while attempting to identify accurate air-conduction thresholds of the affected ear. Results support future research of unilateral auditory deprivation effects and plasticity, with consideration for length of deprivation, age at hearing correction and degree and type of hearing loss.

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