Bilateral mixed hearing loss definition que,sudden hearing loss fluid in ear bluetooth,dokter tinus hoeveel afleveringen zijn er - 2016 Feature

Author: admin, 27.12.2014. Category: Medicine For Tinnitus Over The Counter

BILATERAL SENSORINEURAL HEARING LOSS SYMPTOMSSuggested causes of hearing loss mimic the conductive, sensorineural, or bilaterally both. Recently, I've been trying to organize some of the columns and articles I've written over the past ten years. For audiologists, the audiogram is such a basic dimension and so self-evident that its explanation, after the thousandth time, is often unconsciously truncated and simplified.
Yet in spite of the recent advances made in diagnostic audiological evaluations, and they are truly impressive, the information and insights provided by the simple audiogram can still provide the most pertinent information to explain the behavioral implications of a hearing loss.
This is a figure of an audiogram (with frequency in Hz along the top and Hearing Loss in decibels down the left side). In addition to their energy locations on the frequency axis, speech sounds also vary in intensity.
Looking at the audiogram again, and relating it to the speech banana, it is apparent that a person with this hearing loss will hear more of the lower frequency speech sounds than the higher ones. I don't want to give the impression that the perception of vowels is unimportant on the contrary, it is and can be very important -- only that by not actually hearing some of the consonants, hearing-impaired people have to struggle to fill in the acoustical gaps they produce in the stream of speech. This is a figure of an audiogram (with Frequency in Hz along the top and Hearing Loss in decibels down the left side).
What I have often found useful in explaining the need to understand the audiogram is commenting that it is possible for someone to be completely deaf and have completely normal hearing in the same ear at the same time. There is another dimension of hearing loss that is sometimes also included on an audiogram and that is the discomfort threshold. The dilemma of the threshold of discomfort for hearing-impaired people is that it is often the same as that observed with normally hearing individuals (perhaps 90 dB or so across frequency). Finally, it is important for people to be familiar with the details of their audiogram so that they can track any changes with time. We will be provided with an authorization token (please note: passwords are not shared with us) and will sync your accounts for you. Older listeners are more likely than younger listeners to have difficulties in making temporal discriminations among auditory stimuli presented to one or both ears. The second issue that could make it difficult to draw strong inferences about the effects of aging on temporal processing is the fact that studies of aging and temporal sensitivity routinely have found that as a group older listeners are much more variable than are younger listeners, regardless of the task examined and the stimuli used. To test these various hypotheses, and to generally learn more about the temporal processing abilities of older listeners, three temporal discrimination tasks were investigated in a large group of listeners varying in age and with normal hearing ranging to moderate hearing loss, using a variety of stimuli varying in TFS. The second main goal of the study was to use a statistical model to distinguish the effects of age on performance from the effects of hearing loss. The first task was the discrimination of the duration of temporal gaps in pairs of monaurally-presented stimuli. The final task was a binaural discrimination task, in which the same stimuli were used, but presentation was synchronized across ears such that only a single stimulus was perceived, with the task now being the discirimination of diotic standard vs. By testing a large group of listeners on a range of tests that probe the auditory system's temporal resolution abilities at a range of time scales, it was anticipated that stronger conclusions could be drawn regarding the effects of aging separate from hearing loss, as well as the importance of factors underpinning monaural temporal sensitivity for processing involving binaural brainstem mechanisms, such as ITD sensitivity. Two very similar experiments were conducted over two to three test sessions, using largely identical methods but a range of different stimuli.
Tasks (described below in Procedures) were each conducted using one of four different types of stimuli (shown in Figure 2).
To address some of the issues associated with comparing such different stimuli, two further stimuli were developed, on which a subset of the listeners were tested in the second experiment. Following the detection task, three discrimination tasks were conducted in fixed order: monaural gap discrimination, bilateral gap discrimination, and ITD discrimination. Objective: To determine the frequency and causes of hearing impairment in patients attending the out patient department of Civil Hospital Karachi. Methods: This study was carried out at the ENT department of Civil Hospital Karachi from January 1998 to October 2000. Results: Frequency of conductive hearing loss was 50%, sensorineural hearing loss 20% and mixed hearing loss in 30%. Hearing is the function of the ear which receives the sound by external ear and transmits it to the cochlea in the inner ear via middle ear acoustic impedence matching system. The task of Cochlea is to analyze the environmental sounds and transmit the result of that analysis to the brain.1 Any pathology in this system will cause deafness or hearing impairment, which may be conductive, sensorineural or mixed.
Childhood deafness is the hidden disability and leads to poor education and employments prospects.3 So, Scientific Epidemiological data is the key for preventive strategic planning.
The aim of this study was to identify the frequency and causative factors of hearing impairment and deafness in a tertiary care hospital, a major problem affecting the population resulting in communication and psychiatric problems in society. Six hundred patients of all age groups were randomly selected in the tertiary care teaching hospital i.e. As at the time of the study there was no Ethical Review Board in Dow University, an approval could not be obtained. Incidence of conductive hearing loss in this study was 50% [300] out of which 65%[195] were unilateral and 35%[105] were bilateral. In conductive type of hearing loss discharging ear remains the most common cause in this study. Hearing impairment is a multi factorial disease and it is very difficult to find out the exact cause.
In conductive type of hearing loss Chronic Suppurative Otitis Media (CSOM) is the commonest cause in this study. In this study, the second common cause of conductive hearing loss was secretary otitis media in 57 cases (19%).
This journal is a member of and subscribes to the principles of the Committee on Publication Ethics. Otologic Dx: 1) Tympanomastoiditis, chronic, healed, inactive, manifested by retraction pocket, tympanic fibrosis, and mastoid sclerosis, right ear2. As I was looking through them, it became apparent that I've neglected to discuss what is perhaps most important hearing dimension of all, the simple audiogram. Perhaps the most important insight of all is an appreciation of how specific audiograms impact upon the perception of certain speech sounds.
Frequency (or pitch) is depicted on the horizontal axis, from low frequencies on the left (250 Hz) to high frequencies on the right (8000 Hz). This is a general, but static, representation of the acoustical speech energy across frequency. In reality, however, conversational speech is a dynamic and time-varying event, with one speech sound (phoneme) following another in a rapid succession. Those individuals with superior linguistic skills would perform this task better than those with lesser skills. Somebody with this type of hearing loss actually hears better at 250 Hz than the one whose audiogram is shown in figure 1, but much worse at 1000 Hz and higher. Without a hearing aid (and even with one) this person needs to depend upon visual cues (speechreading) to supplement the information received through hearing.
Looking at this audiogram, we can state that this person has perfectly normal hearing in the left ear, but this is only true at 250 Hz and 500 Hz. In a room full of people with hearing loss, it is doubtful that any two would exhibit exactly the same audiogram for both their ears. While an audiogram can help explain much of the auditory behavior of a person, it does not explain it all.
But because their threshold of hearing is elevated, but not their threshold of discomfort, this means that people with hearing loss generally have a reduced listening area (or narrow dynamic range). 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. In addition, the performance of older listeners is often observed to be more variable than that of younger listeners.
The first is that there are few examples of studies that have examined how aging affects performance in the same listeners across multiple tasks and multiple stimuli, which raises the possibility that the deficits observed may not generalize to other stimuli and to the sorts of real world situations with which we are most concerned. This was facilitated by recruiting a large number of listeners with a range of ages, all with relatively good hearing thresholds. Previous research on monaural gap detection and duration discrimination (reviewed in Fitzgibbons and Gordon-Salant, 2010) has been fairly inconclusive, owing in large part to the variability among older listeners and the influence of various stimulus factors such as bandwidth and duration.
The pairs of stimuli were almost identical to those used in the monaural gap discrimination task, with the crucial difference that the first stimulus in the pair was presented to the left ear and the second stimulus was presented to the right ear. Seventy-eight listeners participated in the first experiment and 65 of those returned for the second experiment.
Time waveforms (upper panels) and frequency spectra (lower panels) for the four stimulus types used. Thresholds were obtained for both ears by employing a four-interval (two-cue, two-alternative) forced-choice procedure in which the target was silence and the level of the standard was adaptively varied using a two-down, one-up procedure (Levitt, 1971). Because of the very short duration of the signals, the root-mean-square (RMS) level is a poor descriptor of signal level, so peak level (peSPL) was used instead. Speech is intimately related to hearing as patients with impaired hearing or deafness develop speech problems and the result is poor communication between patient and environment.


General information is given on Paedoaudiology for both parents and professionals.4 It evaluates the size and extent of the problem, which helps in planning for prevention. This study will highlight this problem so the measure may be taken for prevention and rehabilitation. Sensorineural type of hearing loss was found to be 20% [120] of which 87% [104] were bilateral and 13% [16] were unilateral.
Before the dawn of civilization, the primitive man used such tools of communication as drawing pictures, patterns, a shriek, a yell, a shout etc to draw attention or convey a message.
Hearing impairment and deafness are a common problem in our country because 52% of our population lives below the poverty line and only 38% have access to clean water and proper sanitation. However, etiology of hearing loss was estimated as genetic, congenital non-genetic, delayed onset non-genetic and unknown.8 Identification of causative factors, timely eradication of disease and rehabilitation of the effected persons are the milestones of prevention. According to Tantany AC, Hypoxia is the most common cause of sensorineural hearing loss in the perinatal stage.18 Noise is the commonest cause of preventable hearing loss.
Causes of childhood deafness in Pukhtoonkhwa Province of Pakistan and the role of consanguinity.
Prevalence and etiology of bilateral sensorineural hearing impairment in a Finnish childhood population. The ciliary beat frequency of middle ear mucosa in children with chronic secretory otitis media. Causes of deafness in British Bangladeshi children: a prevalence twice that of the UK population cannot be accounted for by consanguinity alone.
For people who may not even have heard of a pure-tone audiometer before they stepped into the audiologist's office, this is a quite understandable. Without including speech in the equation, it is simply not possible to intelligibly discuss the audiogram. For some specific purposes, it may be useful to test 125 Hz as well as some frequencies higher than 8000 Hz (for example, a progressive hearing loss above 8000 Hz can occur with certain type of ototoxic medications). Some speech sounds, such as vowels are predominately composed of low frequency energy, with less of their power in the higher frequencies.
The specific acoustical composition of speech sounds is partially shaped by the preceding and following sounds in an utterance.
Looking at the speech banana, it is apparent that while a great deal of low frequency vowel energy will be perceived, practically no high frequency consonants would be. Some people, because of their superior ability to utilize some of the secondary cues in a speech signal referred to above, or their superior linguistic ability may do better than these comments would suggest.
Or one could assert that he is completely deaf in the left ear, as again indeed he is (but only at 4000 Hz and higher).
There would be differences in degree of hearing loss at the different frequencies as well as divergences between the ears. We know that there are other dimensions to auditory experiences that cannot be explained by the audiogram.
The aim of this work was to relate age and hearing loss to temporal processing ability in a group of younger and older listeners with a range of hearing thresholds. Hopkins and Moore (2011) reported on one of the few studies that has examined TFS sensitivity and aging using multiple tests. The first was to determine whether or not performance was limited for the older listeners across all tasks and stimuli, or whether there were some tasks or stimuli for which performance was preserved. If the effects of age were due primarily to small changes in hearing thresholds, then the model would be expected to account for performance primarily based on hearing thresholds with little independent contributions of aging. While this does not ensure that the same internal processes are used, it does eliminate potential confounds such as grouping or pitch cues that might be present in one task but not another if very different stimuli were used. For young normal-hearing listeners, diotic presentation produces a single fused percept located in the center of the head. For ease of comparison, the methods, results, and discussion of the two experiments are presented together in the sections below. Average hearing thresholds were between 8 and 20 dB HL for octave and half-octave audiometric frequencies between 250 and 8000 Hz, with SD at each frequency of 6–20 dB HL. On each trial, four temporal intervals were presented (each marked visually), three of which contained the standard stimulus and one of which contained silence. The initial level was changed by 5 dB on each of the first three reversals and then changed by 1 dB for the remaining six reversals, after which the levels at which those six reversals had occurred were averaged and that average was the estimated threshold.
Patients of all age groups and both genders were included, who complained of hearing impairment in one or both ears. In majority of cases of sensorineural hearing loss, prenatal and perinatal factors predominate.
Profound hearing impairment is more prevalent in countries where consanguineous marriages are common such as Pakistan.3No definite epidemiological figures are available in Pakistan. The prevalence of hearing impairment is estimated to about 440 million people world wide, While Griffith K. Even though just about everybody who receives a hearing aid has his or her hearing tested with a pure-tone audiometer, not everybody receives a comprehensive explanation of exactly what the results mean and what the implications are for them. To expect them to fully understand how the pattern of their hearing loss impacts upon their listening behavior is not very realistic. This, after all, is the signal we are most interested in hearing (not to minimize the specific needs of certain groups of people for other types of sounds, such as musicians).
The amount of hearing loss is shown on the vertical axis with the higher numbers indicating a greater degree of hearing loss. The intensity of all other speech sounds in the English language fall within these bounds (note, however, that this does not take into consideration inflected speech, which will move the entire speech banana up and down). These specific effects, such as the unique modifications in vowels made by different preceding and following consonants, are actually secondary cues that can be helpful for understanding speech. Yes, but only with some difficulty and then only if the talker is close by and raises his or her voice slightly.
Looking at the audiogram, we can understand somewhat why this should occur: they are not hearing the full range of high frequencies where many of the consonants have their predominant energy. An individual with this audiogram would have even more difficulty in understanding speech than the one whose audiogram is shown in figure 1.
But there are limits to even the keenest brain and the most developed auditory integration ability; at some point, people do need to detect speech energy in order to understand a spoken message. While there is merit and often necessity to this practice, there is also the danger of oversimplification. In the right ear, the hearing loss at each of the three frequencies is the same, also resulting in an average of 40 dB.
People with bilaterally symmetrical hearing losses (that is, with similar hearing losses in both ears) may have quite different auditory experiences than people with bilaterally asymmetrical hearing losses. Still, the audiogram is a good place to begin when trying to understand someone's speech perception problems. Sounds delivered by the hearing aid below the threshold of hearing would not be audible; those exceeding the threshold of discomfort would not be tolerated (the hearing aid user would either turn the volume control down or simply remove the hearing aid). It is a good idea for people to keep copies of all the audiometric tests administered to them so that comparisons can be made (and to be sure that they are dated correctly). Seventy-eight listeners were tested on a set of three temporal discrimination tasks (monaural gap discrimination, bilateral gap discrimination, and binaural discrimination of interaural differences in time). In that study, they found significant impacts of age on TFS processing (but not frequency selectivity) as well as a modest but significant relationship between two different TFS tests. This was assessed by examining both the group differences in performance and the correlations in performance across the tasks and stimuli. A within-subjects design using similar stimuli also has the advantage that cognitive factors related to general task performance and memory for signal information (such as those identified by Neher et al., 2011) would be more likely to have equal influence on all measures than if the tests involved very different tasks or different groups of listeners.
The percept is entirely lateralized to the left ear for very short delays and then eventually becomes more centrally lateralized before finally breaking apart into two different stimuli (for a full description, see Stecker and Gallun, 2012). For the comparison stimulus, the onset of the stimulus presented to the right ear was delayed in time. This signal was created by transforming the chirp into a frequency domain representation by Fast-Fourier Transform (FFT, Matlab; Mathworks, Natick, MA), randomizing the phase values, and then performing an inverse transform (IFFT, Matlab). On each trial, listeners were presented with an array of four vertically-aligned boxes, each of which was illuminated during one of the four listening intervals. Consanguinity was the most frequent factor in this study in sensorineural type of hearing loss.
Prevention of prenatal and postnatal factors can decrease the frequency of sensorineural hearing loss. However, it is estimated that prevalence of the disease is near about 10% of the population in our country.
The criteria of patient selection was hearing loss for 01 month duration or more, in one or both ears, to exclude the psychogenic and malingerer. Hypoxia, low birth weight and kernicterus can be prevented by good obstetric services while infection like mumps, measles, and meningitis can be prevented by immunization. Infection including intrauterine infection, neonatal and childhood infection is the commonest cause of SNHL.


And even for those that do, at a time when prospective hearing aid purchasers are being inundated with new information, anxious about the test results, and worried about the cost involved, much of this explanation will be forgotten or misconstrued the time several weeks have passed.
Indeed, the ability to take advantage of these cues may help explain why some people seem to understand speech much better than one would predict on the basis of their audiogram.
There are, unfortunately, many people with audiograms similar to this who do not, for one reason or another, wear hearing aids. And we know from many years of research, that consonants contribute more to the understanding of speech than vowels.
In truth, they may be hanging on to speech comprehension with their finger tips; any further distortion in the speech signal, such as someone talking rapidly or in a foreign accent, or in the presence of noise and reverberation, and they lose it. These people depend upon whatever low frequency energy they do receive for comprehending speech. And this person is missing just too much of the speech signal to expect easy communication in any oral exchange. Or perhaps someone's hearing loss is described by employing a single figure (derived usually from averaging the hearing losses at 500 Hz, 1000 Hz, and 2000 Hz). But it should be apparent, just from a visual inspection, that these two ears would perceive speech quite differently. All it would take would to resolve this verbal conundrum would be an understanding of what the audiogram actually signifies (degree of hearing loss across frequency). While most people exhibit a gradually sloping hearing loss across frequency (such as in figure 1), some people have audiograms that are very atypical.
Hearing losses greater than about 70 dB may produce qualitatively different effects than losses less than this. In brief, the audiogram is perhaps the most important indictor of one's hearing function, the particulars of which everybody who has a hearing loss should be aware of. To examine the role of temporal fine structure in these tasks, four types of brief stimuli were used: tone bursts, broad-frequency chirps with rising or falling frequency contours, and random-phase noise bursts. In order to examine the importance of sensitivity to TFS, both in the various tasks and across listener groups, four stimuli were developed (described in detail below).
Similarly, Roberts and Lister (2004; Lister and Roberts, (2005), found that while gap detection thresholds were significantly higher for their older listeners, the difference between the younger and older listeners was fairly modest when the gap occurred between two stimuli of the same frequency rather than when the gap occurred between two stimuli differing in frequency.
Roberts and Lister (2004; Lister and Roberts, 2005) found that the ability to detect a gap was much greater than in the monaural condition for all listeners and that the bilateral presentation revealed a greater difference between older and younger listeners than did the monaural.
This ITD produces the percept of a single stimulus located to the left of the center of the head.
As the waveforms created in this way were influenced substantially by the randomization process, a new waveform was generated on each trial, although the same waveform was used throughout the entire trial.
The first and last intervals always contained the standard stimulus, as did either the second or third interval. Tracks hitting these upper or lower limits simply resulted in repeated presentations of the limiting values. I know that I'm often bemused when I hear what some people recount to me what they think their audiologist told them about their audiogram and its implications. Only the shaded area of the speech banana above the threshold curve is audible; portions below will not be perceived.
Still, there are certain anchor locations for all speech sounds, as displayed on the speech banana, and these can offer valuable insights in understanding the effects of differing hearing losses.
And this audiogram depicts only a gradual high frequency hearing loss; were this person's audiogram something like the one shown in figure 2, problems with speech perception would be even more severe. The presence of noise and reverberation (not exactly an uncommon occurrence in our society!) would have a disproportionate effect on them, since it would mask the only speech energy they are able to receive. Quite clearly this example demonstrates that the shorthand description of a hearing loss with a number or a verbal label can be quite deceptive.
This would include people with rising thresholds with frequency as well as those with perfectly normal hearing at the very low and high frequencies, but with moderately or severe hearing losses in the mid frequencies. In this instance, it would be more of a challenge to package sound within this more restricted dynamic range (this is where advanced technology can be very helpful, as in hearing aids with fast acting automatic gain control circuits). Between-subject group analyses conducted separately for each task revealed substantial increases in temporal thresholds for the older listeners across all three tasks, regardless of stimulus type, as well as significant correlations among the performance of individual listeners across most combinations of tasks and stimuli.
While these central-auditory changes might be correlated to some extent with hearing loss, they may represent sources of additional variability in temporal processing performance. Fitzgibbons and Gordon-Salant (2010) suggest that variability in performance across a group of older listeners is more common when gaps are inserted into long-duration stimuli. The number of listeners tested in those studies (24) was small enough, however, that some of the trends apparent in the data failed to reach statistical significance. The greatest difference in the younger group was 6.25 dB and the greatest difference in the older group was 15 dB.
The remaining interval (either the second or the third) contained the target (silence) and the task of the listener was to use the computer mouse to click on the box that had been illuminated while the target was presented. After that point, people will usually begin to display some communication difficulties because of the elevated hearing thresholds.
In spite of portrayals to the contrary on some charts, no speech sound can be pinpointed to a speech point on the audiogram; all of them spread their energy somewhat along some segment of the frequency spectrum. For example people with an average 40 dB hearing loss are considered to have just a moderate hearing loss. The varieties are almost (but not quite) endless and many of these differences have behavioral implications. A hearing loss may also involve central auditory pathways and these, too, may affect speech perception quite severely. Differences in performance were associated with the stimuli in the monaural and binaural tasks, but not the bilateral task.
It was hypothesized that if listeners were sensitive only to the envelope cues, then all four stimuli would produce similar thresholds and performance for the four stimuli would be highly correlated for a given task. By recruiting a larger group of listeners and limiting the amount of hearing loss, it was hoped that stronger relationships among tasks could be examined.
No listeners had sensorineural hearing losses greater than 40 dB HL at frequencies below 1000 Hz or greater than 60 dB HL at frequencies between 1000 and 4000 Hz. The data from Experiment Two were also entered into the statistical model in order to better distinguish the effects of age and hearing loss. Substantial energy was still present at the lower frequencies, however (approximately 10 dB down at 20 Hz and 4 kHz). The higher the number, the greater the impact of the hearing loss (referring only to the unaided condition). But such a shorthand label does not reflect the pattern of a hearing loss, a pattern, as we have seen, that may lead to more insights into the behavioral implications of a hearing loss.
Nevertheless, in spite of all these caveats, the audiogram is still the most fundamental auditory dimension of all. Temporal fine structure differences among the stimuli had the greatest impact on monaural thresholds.
Futhermore, it was hypothesized that older listeners might obtain less benefit from the rising-frequency chirps due to increased temporal jitter at the level of the auditory nerve, which would reduce the ability to take advantage of a stimulus designed to create synchronous activity across many auditory nerve fibers.
Crucially, it was anticipated that the potential similarity (or dissimilarity) of the mechanisms underlying the monaural and bilateral gap discrimination tasks might be revealed by correlating performance within individual listeners—an analysis that failed to produce conclusive results for Lister and Roberts (2005). Comparisons of air and bone conduction audiometric thresholds, along with immittance results confirmed the sensorineural nature of the hearing losses. In addition, the detection task served to familiarize the listeners both with the four-interval procedure and with the stimuli.
The 100 dB point should not be confused with a 100% hearing loss, which is a total lack of hearing. Threshold estimate values across all tasks and stimuli did not show any greater variability for the older listeners as compared to the younger listeners. Patients who complained of hearing impairment and did not have any positive clnical or audiological sign were excluded from the study. Hearing sensations do continue past this point, with some audiometers extending this vertical range to 120 dB. The greatest difference in the younger group was 8.75 dB and the greatest difference in the older group was 15 dB. Consequently, a statistical model was applied to the data to allow these two factors to be further distinguished. All subjects provided written informed consent prior to participation and were paid per session. The procedures were approved and overseen by the Portland VA Medical Center's Institutional Review Board.



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