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Author: admin, 10.02.2014. Category: Tinnitus Causes And Cures

As an overview, low frequency (or tone) sensorineural hearing loss (LF SNHL or LT SNHL) is unusual, and mainly reported in Meniere's disease as well as related conditions such as low CSF pressure.
Le Prell et al (2011) suggested that low frequency hearing loss was detected in 2.7% of normal college student's ears. Oishi et al (2010) suggested that about half of patients with LTSNHL developed high or flat hearing loss within 10 years of onset. The new international criteria for Meniere's disease require observation of a low-tone SNHL. Gatland et al (1991) reported fluctuation in hearing at low frequencies with dialysis was common, and suggested there might be treatment induced changes in fluid or electrolyte composition of endolymph (e.g. Although OAE's are generally obliterated in patients with hearing loss > 30 dB, for any mechanism other than neural, this is not always the case in the low-tone SNHL associated with Meniere's disease.
The lack of universal correspondence between audios and OAE's in low-tone SNHL in at least some patients with Meniere's, suggests that the mechanism of hearing loss may not always be due to cochlear damage.
Of course, in a different clinical context, one might wonder if the patient with the discrepency between OAE and audiogram might be pretending to have hearing loss.
Papers are easy to publish about genetic hearing loss conditions, so the literature is somewhat oversupplied with these. Bespalova et al (2001) reported that low frequency SNHL may be associated with Wolfram syndrome, an autosomal recessive genetic disorder (diabetes insipidus, diabetes mellitus, optic atrophy, and deafness).
Bramhall et al (2008) a reported that "the majority of hereditary LFSNHL is associated with heterozygous mutations in the WFS1 gene (wolframin protein). Eckert et al(2013) suggested that cerebral white matter hyperintensities predict low frequency hearing in older adults.
Fukaya et al (1991) suggested that LFSN can be due to microinfarcts in the brainstem during surgery. Ito et al (1998) suggested that bilateral low-frequency SNHL suggested vertebrobasilar insufficiency. Yurtsever et al (2015) reported low and mid-frequency hearing loss in a single patient with Susac syndrome. There are an immense number of reports of LTSNHL after spinal anesthesia and related conditions with low CSF pressure. Fog et al (1990) reported low frequency hearing loss in patients undergoing spinal anesthesia where a larger needle was used. Waisted et al (1991) suggested that LFSNHL after spinal anesthesia was due to low perilymph pressure. Wang et al reported hearing reduction after prostate surgery with spinal anesthesia (1987).
We have encountered a patient, about 50 years old, with a low-tone sensorineural hearing loss that occured in the context of a herpes zoster infection (Ramsay-Hunt). LTSNHL is generally viewed as either a variant of Meniere's disease or a variant of sudden hearing loss, and the same medications are used. Recent studies and continuing dialog in the field have shed light on the challenges in the fitting of advanced hearing instruments on people who have a severe or profound hearing loss.
As universal newborn hearing screening (UNHS) becomes more widespread, the issue of providing a solution for these young infants becomes a more pressing concern. We are restricted in methods to measure the outcomes of technologies provided to young children. Recent studies have highlighted the benefit of providing a hearing aid in the contralateral ear to the cochlear implant.
High Frequencies and Adults with Severe or Profound Losses Fitting hearing aids to people with a severe or profound hearing impairment poses challenges to the dispensing professional. Byrne et al.5 found that an extra 10 dB of gain is required for people with a severe or profound hearing loss. Conversely, it should also be remembered that people with severe or profound hearing impairments often have a restricted dynamic range and an extreme loudness growth function. A longstanding maxim of hearing aid fitting is to ensure audibility across the entire speech frequency range.6 While this is excellent advice for individuals with a mild-to-moderate loss, it may not hold true for people with a severe or profound hearing impairment.
However, the data of Byrne et al.5 suggest a different strategy for those who have more severe losses. It has been known for decades that there is more to speech recognition than audibility and the ability to listen at high sensation levels.9 More recent research confirms that hearing care professionals need to consider the impact of distortion and lack of surviving hair cells. Despite this, dispensing professionals should not totally remove the high frequency sounds when hearing loss is greater than 80 dBHL, but should be aware and cautious of the effect of providing audibility in high frequency regions. When providing amplification to people with a severe or profound hearing impairment, remember that these people can require more amplification than may be predicted by some fitting strategies—especially in the low frequencies. Obviously, the difficulty is finding a procedure that provides more audibility in some frequencies, and less audibility in others, while keeping loudness at a comfortable level. The implications of over-amplification and potential damage to the cochlear hair cells is even more of a concern for infants with profound hearing impairment. This presents a challenge for the hearing care professional, as it is not easy to obtain hearing thresholds using insert earphones and children’s earmolds in neonates.
While evidence12-14 suggests that providing a cochlear implant as early as possible will lead to the best possible outcomes, it is also quite possible that advances in hearing aid technology could reduce the urgency of fitting a cochlear implant. For potential cochlear implant candidates, this will be in the low frequency region of the cochlea. With the wide-scale introduction of UNHS, more infants with severe and profound hearing loss are being detected at an earlier age. Inattention to dynamic range issues can lead to rejection of the device, and over-amplification can lead to damage of the auditory structures. Similar to hearing aid fitting, the focus in the literature on aural habilitation of children has been on improving access to crucial speech sounds. The reality of the situation is that we need to re-address and bolster our knowledge of speech acoustics to ensure that children receive meaningful auditory speech and language information so they have an opportunity to develop these skills during the critical period.
People with severe or profound hearing loss receive suprasegmental (duration, frequency, and intensity) and segmental (vowels and consonants) information.
The goal should be to maximize the perception of speech rather than to maximize audibility.
Providing a Hearing Aid to the Contralateral Ear in CI wearers Cochlear implants are recommended when there is no useable hearing bilaterally. Recent studies have shown the utility of providing a hearing aid in the contralateral ear for adults19,20 and children7 who use cochlear implants.
Importantly, the hearing care professional should remember that the performance with the hearing aid alone will be poor—or even non-existent. An important question is, How should the audiologist fit the contralateral hearing aid, especially when performance in the aided alone condition is difficult to observe?


Additionally, extra information may be provided by acoustical hearing in the low frequencies due to the position of the electrode array within the cochlea.
Some people have argued for the use of bilateral cochlear implants, citing the potential benefits of improved localization, speech understanding in noise, and speech production. Bilateral cochlear implants should be considered in cases where binaural stimulation is seen as a benefit and where the patient, after extensive clinical trial, has been shown to experience no benefit from the contralateral fitting of a hearing aid. Conclusion Providing sound amplification solutions to adults and children with a severe or profound hearing impairment presents many challenges. Universal newborn hearing screening will result in a greater proportion of babies with severe and profound hearing loss being identified earlier, which creates a series of challenges in terms of the required amplification and how to measure benefit. The overlap between cochlear implants and hearing aids continues to grow, and should now be seen as a continuum.
To us, this seems a little overly stringent, compared to the earlier 1995 AAO criteria that just required any kind of hearing loss, but criteria are better than no criteria.
That being said, genetic conditions should not be your first thought when you encounter a patient with LTSNHL. One would think that diabetes insipidus is so rare that hearing loss is probably not the main reason these individuals are seeking attention. These patients are extremely rare because there isn't much microsurgery done close to the brainstem. We are dubious about the conclusion of this paper because it is different than nearly every other paper in the literature.
We are dubious that this has any applicability to humans and we have never seen a patient with lithium toxicity with any LFSNHL. We have observed this occasionally ourselves, but of course, the usual pattern is a conductive hyperacusis. We find this somewhat plausible as pregnancy and delivery might be associated with spinal anesthesia, with changes in collagen, and with gigantic changes in hormonal status. This is particularly problematic when assisting the lower frequency region of the cochlea. In fact, the half-gain rule for sensorineural hearing loss does not appear to apply once the hearing loss becomes greater than 70 dBHL. Unfortunately, many fitting rationales are based on the assumption that useful hearing can be provided across the entire frequency range. Audiogram highlighting that, for a person with confirmed cochlear dead zones, the best amplification solution may be to increase the low frequency gain while decreasing the high frequency gain. For hearing losses that are greater than 95 dBHTL at 2000 Hz, decreasing the slope of the frequency response should provide more amplification in the low frequencies (Figure 1).
Caution also should be observed regarding amplification across the entire frequency range, as applying gain in areas of little residual hearing (ie, the cochlear dead regions) may not improve intelligibility of speech, and may actually lead to worse performance and concomitant discomfort. Traditionally, limitations in hearing aid designs and capabilities have, at times, prevented us from reaching desired target gain levels—particularly in the area of 4000 Hz. Infants identified with a severe or profound hearing loss need a small, robust, and durable hearing aid that can provide the necessary gain to ensure that the child has the best hearing possible during the critical period for speech and language acquisition.
For these children, there is a time period between diagnosis and surgery when the child is participating in a hearing aid trial, undergoing candidacy evaluations, and the team is being cautious due to the increased risk of general anesthetic in babies less than 12 months old. The fitting of advanced hearing instruments to babies who are cochlear implant candidates will remove much of the sense of urgency from the procedure, as the child will have greater access to the speech information than with pervious devices that were more limited in output and frequency response. These children often require a powerful hearing instrument to maximize their speech and language development while they are being assessed for cochlear implant candidacy. They frequently exhibit a greater reliance on amplitude and low frequency speech cues, and less reliance on frequency specific cues (especially in the high frequency regions).
Our attention needs to be focused on what benefits (and possible detriments) this population receives from restricting amplification in high frequencies. With appropriate amplification up to and including 2000 Hz, this population receives the benefit of discriminating most vowel formants, voicing of consonants, transitions between consonants and vowels, and some manner of consonants.
Following a model based strictly on audibility from the speech transmission perspective may actually lead to a less accurate perception of speech for people with severe hearing loss. Simple paradigms can be established that allow comparison of different hearing aid fittings (eg, hearing aid versus no hearing aid) over a short period of time (eg, months rather than years) to shed light on whether a child is experiencing benefit from high frequency amplification or if high frequency amplification should be reduced.
Typically, this entails a lack of speech information received at and above 2000 Hz following the hearing aid trial. Collectively, these studies provide increasing support for contralateral fitting of hearing aids (bimodal amplification) to be the standard of care for adults and children with cochlear implants. For example, in the Ching et al21 study, the children had open-set sentence scores below 15% in the hearing aid alone condition. As children with a cochlear implant have minimal (if any) hearing in the contralateral ear relative to high frequencies, hearing aid selection should focus on the performance of the aid for low frequency sounds in particular, because this is where the most useable hearing resides. However, recent research by Summerfield25 indicates that the second implant must cost less than 10% of the cost of the first to achieve the same cost-benefit ratio. The contralateral fitting of a hearing instrument for people with cochlear implants should be the standard of care with all patients with useable aided residual hearing. The extent of damage to the cochlea in these cases requires the hearing care professional to be more circumspect in selecting fitting rationales. In these infants, the hearing care professional more than ever is going to be working in a team using new and improved measures of outcomes to determine adequacy of the hearing aid fitting (including auditory, speech, and language development). No longer is it the case that dispensing professionals should view people with cochlear implants as not being potential candidates for amplification. However, we should continue to be mindful of the additional challenges, as well as what new research tells us about the provision of amplification for successful client outcomes. There is a large literature about genetic causes, mainly in Wolfram's syndrome ( diabetes insipidus, diabetes mellitus, optic atrophy, and deafness), probably because it is relatively easier to publish articles about genetic problems.
He defined LTSNH as that the sum of the three low frequencies (125, 250, 500) was more than 100 dB, and the sum of the 3 high frequencies (2, 4, 8) was less than 60 dB.
In other words, Wolfram's is probably not diagnosed mainly by ENT's or audiologists, but rather by renal medicine doctors, as DI is exceedingly rare, while LTSNHL is not so rare in hearing tests. That being said, it is very rare to encounter any substantial change in hearing after pregnancy. For severe hearing losses, the required gain to achieve the most comfortable level (MCL) for the listener rises at greater than the half-gain rule.5 Therefore, when fitting people with power and super power instruments, the fitting rationales used should consider the amount of gain required for this population.
Ching et al.7 built on this research and found that people with extreme hearing losses at high frequencies preferred amplification that results in zero or low audibility for the high frequency components of speech.
As the signal processing capability and flexibility of hearing aids have advanced, these issues are increasingly being addressed more successfully in clinical practice. In this period, it is critical that the infant is fit with the best possible hearing instrument and a fitting method that maximizes amplification where the infant has the most useable hearing.


For these children with restricted audibility, increased low frequency gain and MPO provides the most access to crucial speech information. In children, not gaining access to important speech features can result in speech and language acquisition problems. Without question, high frequencies provide important information to the listener (eg, consonant production and important information regarding fricatives). As implant candidacy criteria have widened to encompass patients with less severe hearing loss, there have become more cochlear implant users who have sufficient useable hearing in their contralateral ear. It is when the cochlear implant and the hearing aid are combined that the maximum benefit is obtained. It is for these reasons the selected hearing aid should have sufficient headroom and gain in the low frequencies to provide the best aided response for the child or adult. With a surgically implanted medical device, such as a cochlear implant, this is not possible due to the high cost. No longer does the sensible maxim of providing audibility across the speech frequencies hold true in all cases. Following the same arguments that led to binaural hearing aid fittings becoming a standard of care, the hearing care field now has the opportunity to fit a hearing aid on the contralateral ear of a person with a cochlear implant so that person can benefit from bimodal stimulation. Roughly speaking, the frequency patterns of hearing loss are divided up into: Low-frequency, mid-frequency, high-frequency, notches, and flat. For people with milder losses and typical, gradually sloping hearing loss configurations, we would intuitively expect the best results to occur when the patients are provided with more amplification in the high frequency region—where they need it most. Unfortunately, as discussed above, some people with severe or profound hearing loss may receive little or no benefit from amplification in the high frequency region. At a practical level, we do not currently have the technology or tools to evaluate whether a reduction of high frequency gain for these children will be a benefit or a mistake. It was unclear from the study how the increase in gain was related to the overall hearing loss. The fitting of a hearing aid on the contralateral ear to provide bimodal input allows similar benefits of bilateral implants but at 2%-3% the cost of an implant. Instead, one should balance audibility with the realization that providing too much amplification in the areas of maximum hearing loss may actually result in poorer speech outcomes and comfort. For example, did the children with less useable high frequency thresholds require more gain than the theoretical rationale or vice versa? An answer to this question and more specific guidelines to the fitting of contralateral hearing aids will emerge as the weight of research evidence increases.
People with this form of hearing loss may struggle to hear lower male voices and other sounds that fall into the low frequency category. Hearing loss of this type may be mild, moderate, severe or profound, and it tends to take its toll on communication.
Since hearing other people and interacting with them is such an important part of life, learning how to manage this type of hearing loss is very important. Aided speech recognition abilities of adults with a severe or severe-to-profound hearing loss. If you suffer from low frequency hearing loss, you should know that there is nothing to be afraid of. While a formal diagnosis of low frequency hearing loss may be very upsetting, it is certainly not the end of the world.
By using the right treatments for your hearing problem, you may begin to experience improvements in hearing that allow you to connect more easily with others (the way that you used to).
People who choose the proper treatment for their low frequency hearing loss symptoms enjoy better relationships, more career success, and more self-confidence in social situations, such as parties or business meetings. Treatment for Low Frequency Hearing Loss Coping with this type of hearing loss begins with the right natural treatment. The best holistic treatment, the Hearing Fix, works by strengthening healthy nerves in the inner ear to boost all remaining hearing.
This commonsense treatment is successfully achieved through an ideal blend of vitamins, minerals, and active botanicals. Instead of spending a fortune on hearing aids that may not be covered by your medical insurance, why not choose the affordable Hearing Loss Pill formula today? By taking these dietary supplements, according to the package directions, you’ll give you access to the best organic hearing loss treatment available in the world today, and you’ll be able to enjoy better hearing, even at very low frequencies.
The Hearing Fix assists in optimizing nerve function between the ear and the brain (make the hearing nerves in the ear work better), as well as stopping harmful molecules from causing more damage to the inner ear.
This supplement is even powerful enough to limit or prevent hearing loss from exposure to noise. As a treatment and as a preventative measure, the Hearing Fix is truly second to none… By giving the body access to the ultimate essential compounds for optimum hearing, this formula corrects deficiencies that may be contributing to low frequency hearing loss. The makers of this product are inner ear experts, and they’ve worked hard to create an all-natural formula that reduces tinnitus, boosts hearing in all registers, and prevents further hearing loss.
Effects of frequency response characteristics on speech discrimination and perceived intelligibility and pleasantness of speech for hearing-impaired listeners. This multipurpose product is the perfect treatment plan, and it will never cause any adverse symptoms or side effects. No matter what the causes of your low frequency hearing loss are, you’ll find that the Hearing Fix is the answer to your prayers.
Speech recognition of hearing-impaired listeners: predictions from audibility and the limited role of high-frequency amplification. Speech intelligibility in noise-induced hearing loss: Effects of high frequency compensation.
Dead regions in the cochlea: Diagnosis, perceptual consequences, and implications for the fitting of hearing aids. Early identification and cochlear implantation: critical factors for spoken language development. Articulatory changes with short-term deactivation of the cochlear implants of two prelingually deafened children. Monaural and binaural loudness measures in cochlear implant users with contralateral residual hearing.
The costs, effectiveness, and cost-effectiveness of cochlear implants: What have we learned in the last decade?



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