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06.01.2015
Presbycusis is defined as an alteration of audition related to age, but it should not be forgotten that an aged subject may present with all the types of hearing loss observed in younger patients. Antecedents of otitis, otospongiosis, trauma of any nature, toxic agents, and certain infections can provoke hearing loss to which is added the effect of aging.
Presbycusis affects the sensory cells of the organ of Corti, which undergo a larger degeneration at the base of the cochlea (high-pitched sounds) than at the summit (low-pitched sounds). It is a perception deafness that is bilateral and symmetric, which predominantly involves the high-pitched frequencies. The auditive disturbance is frank, and the patient needs to request repetition and an elevation of the voice. The results of a patient's hearing screening are illustrated on a graph called an audiogram.
An audiogram indicates how much hearing varies from normal and, if there is a hearing loss, where the problem might be located in the hearing pathway. Frequency or pitch of sound is measured along the horizontal axis of the graph in Hertz (Hz), from 125Hz to 8,000Hz.
Normal, young, healthy human ears can hear frequencies as low as 20Hz and as high as 20,000Hz. Loudness or level of sounds is measured along the vertical axis of the audiogram in decibels (dB). The audiogram shows how loud a sound has to be for the patient to hear it at a particular frequency. Air conduction thresholds for the right ear (that is, the softest sounds the right ear can hear at each frequency) are marked as an 'O' and the left as an 'X' on the audiogram. Bone conduction thresholds are marked on the audiogram as (better ear), [(right ear) or] (left ear).
In the example above, the patient can't hear high pitched sounds as well as the low pitched sounds. If the hearing thresholds obtained by bone conduction are the same as the air thresholds, this indicates no blockage in the outer or middle ear. A sensorineural hearing loss can be caused by exposure to excessive noise, or by the ageing process.
There is rarely any medical treatment for sensorineural hearing losses and so the impairment is permanent. If the bone conduction hearing thresholds are normal, but there is a loss of hearing for air conduction sounds, this is called a conductive hearing loss. This means that the cochlea is normal, but there is some blockage to sound in the middle or outer ears.
It is possible to have both a sensorineural and a conductive hearing loss - for example, if a person has a noise caused impairment and a perforated ear drum. The degree of hearing loss essentially describes the degree of impact on a person's everyday life. This web site is intended for Australian residents and is not a substitute for independent professional advice. Upon confirming your order, we will send you a link to make a payment via Alipay’s secure payment page. When you take a hearing test, your audiologist will have you listen to a series of different pitches through earphones. Thresholds will be measured for different pitches in each ear and then charted on an audiogram. Hearing loss is complicated, thus the audio simulations on this web page do not reflect the true nature of hearing loss but instead are intended for educational use. Central Auditory Processing Disorder (CAPD) may also be present in those with normal thresholds.
Some prescription drugs are toxic to the ear and hearing must be monitored during drug treatment. Even when a hearing loss is considered mild, its impact on everday listening should not be underestimated, especially for children. Another way to get a rough idea of what a mild hearing loss sounds like, is to plug your ears with your fingers. The audiogram to the left is typical of an age-related hearing loss, also called presbycusis.
A severe hearing loss significantly reduces ones ability to understand conversational speech. A severe age-related hearing loss may significantly impair onea€™s ability to hear most consonants but they may hear some vowels. The Centers for Disease Control and Prevention estimate that 17% of adults aged 20-69 years have permanent hearing loss from exposure to loud noise. A rising audiogram is a less common configuration but may be associated with Menierea€™s disease.
Menierea€™s disease usually affects one ear first before eventually affecting the other ear. The views and opinions expressed in this page are strictly those of the page author.The contents of this page have not been reviewed or approved by the University of Minnesota. The Siemens Pure 700 hearing aids pack the most advanced hearing technology into an almost invisible, ultra-small size.
The RIC (Receiver-in-Canal) model can be equipped with one of three receivers that regulate the power of the Siemens Pure 700 hearing aids. Science, Technology and Medicine open access publisher.Publish, read and share novel research.
White KR, Vohr BR, Meyer S, Widen JE, Johnson JL, Gravel JS, James M, Kennalley T, Maxon AB, Spivak L, Sullivan-Mahoney M, Weirather Y. TRAVELING WAVE PHENOMENON a€“ The cochlea is tonotopically organized due to the gradation mentioned above. Describe the functional morphology of hair cells and name the motor protein involved in their action? The molecular mechanism for this action involves the motor protein 'prestin', and is able to contract the cell by up to 10% of its length [5,6]. Like the endolymph, the intracellular fluid is also high in K+ and low in Na, but therea€™s a more potassium in the endolymph than in the cell, so potassium will diffuse inside the cell (from high conc.
If only 5% of ANF innervate Outer Hair Cells and Ototoxic drugs damage Outer Hair Cells, why would there be a significant Hearing Loss due to ototoxic drug?
It must be something Outer Hair Cells are contributing to the process that once gone results in Hearing Loss. They function as active mechanical amplifiers.- Fine tuning of BM attributed to motile response of OHC1. Spike rate of one Afferent Nerve Fiber (ANF) as a function of stimulus levelNOTES:INTENSITY ENCODING a€“ hear from 0 to the 140 db in the pain threashold.
The concept of intensity encoding, illustrating the Spike rate of one ANF at different intensities and frequencies. Response of many ANFs as function of intensitya€“ the characteristic freq (CF) is where it discharges the most. For example, 250 Hz sounds like middle C on the piano, while the high pitched ringing of the telephone is about 3,000Hz. However we only test hearing in the range of 250Hz to 8,000Hz, as most sounds of speech occur in this frequency range. Conversational voice level is around 65dB, and 120dB is very loud - about as loud as a jet taking off if you are standing 100 metres away. You can see this by looking at the sloping line on the graph: as the frequency increases the required sound level also increases before the patient can hear it. Middle ear conditions caused by these blockages can often be corrected by medical or surgical treatment. Information and interactions contained in this Web site are for information purposes only and are not intended to be used to diagnose, treat, cure or prevent any disease.
CAPD affects ones ability to process auditory information which leads to increased difficulty understanding speech and may account for language delays in children. Pass, ambiguous, and retest regions for wideband reflectance using chirp (solid regions) and sine (symbols) stimuli.
To respond to these clinical demands, several new methodologies have been introduced to the UNHS clinical practice.
Neonatal newborn hearing screening: four years of experience at the Ferrara University Hospital (cheap project).
Comparison of ABR response amplitude, test time and estimation of hearing threshold using specific chirp and tone pip stimuli in newborns. Comparing auditory brainstem responses to toneburst and narrow band CE-chirp in young infants.


Establishing auditory steady-state response thresholds to narrow band CE-chirps in full term neonates.
Conductive hearing loss and middle ear pathology in young infants referred through a newborn universal hearing screening program in Australia.
Sound-conduction effects on distortion-product otoacoustic emission screening outcomes in newborn infants: test performance of wideband acoustic transfer functions and 1 kHz tympanometry. Human auditory steady-state responses to amplitude-modulated tones: phase and latency measurements.
Determining the upper limits of stimulation for auditory steady-state response measurements. Estimation of hearing loss in children: comparison of auditory steady-state response, auditory brainstem response, and behavioral test methods. Comparing statistics for objective detection of transient and steady-state evoked responses in newborns.
Dependence of distortion-product otoacoustic emissions in primary tone level in normal and impaired ears.
Effects of ear-canal standing waves on measurements of distortion-product otoacoustic emissions.
Evoked otoacoustic emissions arise by two fundamentally different mechanisms: a taxonomy for mammalian OAEs. Distortion product otoacoustic emission suppression tuning curves in normal-hearing and hearing-impaired human ears. The level and growth behavior of the 2f1-f2 distortion product otoacoustic emission and its relationship to auditory sensitivity in normal hearing and cochlear hearing loss. Automatische Horschwellenbestimung bei Neugeborenen mit extrapolierten DPOAE-Wachstumsfunktionen. The basis of the lever effect is that a little pressure generates a greater force on the opposite ear.
Cochlear Microphonic (CM)-AC potential-generated primarily by OHCs and selective destruction of OHCs attenuate the CM2. OHC damage-loss of volume-Loss of frequency selectivity: ability to separate sounds of different frequencies is compromised2. Increase the intensity and you increase the spike rate to a point to a range of about 30 db. Further, the accuracy, currency and completeness of the information available on this Web site cannot be guaranteed. The left side of the audiogram corresponds to low pitches, whereas the right side corresponds to high pitches. Results above this region, especially at 2 kHz, are associated with false-positive DPOAE refer results. The equation relating the two variables (c = Cochlea-Scan; p = behavioral threshold) is shown at the top of each graph.
Considering this clinical setup, there are other protocols that could be candidates for a hearing assessment of neonates, children, and adults. The shape of the curve is due to transformer action of middle earNOTES:i??You lose about 97 %, and you gain about 60 % of the incoming sound in your ear. The outer hair cells receive little afferent innervation, and are therefore believed to play little role in directly transducing sound stimuli to the brain.
The outer hair cells have a resting potential of - 70 mV, and inner hair cells have a resting potential of -45 mV, relative to the scala tympani. Vesicles in the cell will then bind to the membrane, releasing neurotransmitters into the synaptic cleft.When the bending (fluid here is the perilymph, which is high in sodium, low in potassium)is away from the longest stereocilium, the tip links are compressed, and the potassium will diffuse from inside the cell towards the outside the cell, causing hyperpolarization. In the inner hair cells, a low frequency tone (300) will induce an oscillating alternating (AC) current, constituted of alternating depolarizations and hyperpolarizations.
And although the 8th cranial nerve is intact, the damage causes broad tuning of the 8th cranial nerve. Generate a motile response -electrical stimulation causes them to change in length-depolarization of OHC associated with contraction-hyperpolarization of OHC associated with cell body elongation3.
IHC damage -loss of volume-Loss of clarityNOTES:i??Damage to the inner ear results in sensorineural hearing loss. As the intensity increases, the spike rate increases, and then it plateaus, so one auditory nerve fiber cannot be responsible for the wide range of intensity range that we have.
Cirrus Media Pty Ltd, its affiliates and their respective servants and agents do not accept any liability for any injury, loss or damage incurred by use of or reliance on the information made available via or through myDr whether arising from negligence or otherwise. The last sound you were able to hear is marked as your "threshold" for that particular pitch.
Similarly, a dot towards the top of the audiogram means an individual can detect quiet sounds whereas a marking towards the bottom of the audiogram means the sound needed to be much louder before the person could detect it. The x axis shows behavioral threshold in dB HL and the y axis the probability of a Cochlea-Scan response.
IntroductionOtoacoustic emissions (OAEs) or cochlear echoes is a term coined by David Kemp in 1978 [1], describing the transient responses from the inner ear, upon its stimulation by an acoustic click stimulus. Among those is the electrocochleography (EcoG), the middle latency (ML) responses, and the most recently reported steady-state responses (SSR).
A 100 % gain is not good, since it will disrupt important sounds(speech), since you will hear too much(mouth moving, heartbeat). The scala vestibuli should have no resting potential difference, since the liquid that flows through the scala vestibule and the scala tympani are the same. If you increase the current (500,700, 900), the oscillations increase and the amplitude decreases. The intensity that it just begins to fire above its spontaneous rate is the threshold response of the auditory nerve fibers.- At 1000 Hz, it begins to fire above its spontaneous rate at 20 dB, for example.
Becomes more broadly tunedNOTES:The traveling wave is going from base (high frequency) to apex (low frequency). If you have a strong sound coming in, then ita€™s going to cause the inner hair cells cilia, which are not embedded in the tectorial membrane, to bend. TENSOR TYMPANI MUSCLE:-i??The tendon of the tensor tympani attaches to the manubrium of the malleus, and when it contracts, it pulls manubrium medially. The large size of the error bars, at 2.0 and 4 kHz, show threshold means at 60 and 55 dB HL, but the variability of the measurements makes the threshold prediction difficult to be considered. The acronym “NA” means that at the specific frequency no threshold estimation was possible.
For a fixed response probability of 90%, the detectable threshold level is approximately 35 dB HL. During the last 20 years, OAE protocols have been used in many areas of audiology and hearing science [2].
The first two approaches can be excluded because they require long times either for the position of an intratympanic electrode or for sampling purposes.
The sound gain is specific for each species(speech oriented for humans, survival oriented for other animals).i??The chart shows threshold of listening. When you continue to raise the frequency of the input (5000 Hz), you see a baseline shift( constant depolarizing DC current), with minimal AC potential.
This results in the depolarization of the inner hair cells, which will release neurotransmitter unto the nerve fiber, subsequently generating an action potential.
The most significant contribution of OAEs is in the area of universal neonatal hearing screening (UNHS).While the main objective of neonatal hearing screening (NHS) is the identification of infants with a hearing deficit (?30 dB HL), the objectives of a UNHS program have a broader vision.
The last protocol has shown a good potential for hearing screening since with an adequate manipulation of the stimulus modulation frequency, one can record responses or from the auditory cortex (low modulation frequencies around 40 Hz) or from the brainstem (frequencies around 50–120 Hz) [16–18]. They kept increasing the frequency(control) on the X-axis until the threshold was at its lowest.i??On the chart, the y-axis the sound level, and the x-axis is the frequency.
For this particular chart, it is evaluated at the characteristic frequency(lowest threshold response) at 1000 Hz. The basic SSR protocol has evolved into an automated procedure (ASSR) where multiple stimulus frequencies are used and regression models predict hearing levels at the tested stimuli. Then the crest occurs at apex, in the vicinity where the reference frequency matches the incoming signal. Outer hair cells with a low frequency stimulus will produce a large AC and a depolarizing DC, but with a high frequency stimulus will produce attenuated AC and DC.
The characteristic frequency is the frequency that auditory nerve fiber responds best, and it is located at the basal end on this chart (remember, the basal end is the region that encodes high frequencies.-The auditory nerve fiber also responds to other frequencies above and below its characteristic frequency, but at a higher intensity. Therefore, they will innervate the basal end of the cochlea.-An animal with the normal auditory nerve fiber was given kanamycin, which damages the outer hair cells in the cochlea.
The ASSR protocols have been greatly optimized for lower frequency stimuli such as 500 Hz [19].In 2002, Conne-Wesson et al. The threshold is way elevated with the damaged auditory nerve fiber, with the tip now located at a much lower frequency.


ACTIVE AND PASSIVE MECHANISM- low intensity sound may not allow enough movement for them to respond. When the cochlea gets damaged, the Outer hair cells get damaged first, then, with continued exposure, the inner hair cells get damaged. This will stiffen the chain and more sound reflects of the eardrum thus protects from the loud sound. The second order neuron then passes through the ipsilateral motor nucleus of VII, which houses the cell bodies of the CN VII, which innervates the stapedius muscle, and then the muscle contracts.-Any lesion in the facial nerve or CN VIII, will make the stapedius muscle unable to contract, since the neural information wona€™t reach it = hyperacusia. The error bars around the threshold average (indicated by an “x”) are small and the prediction can be considered practical.
In this context, the aim of this chapter is to provide information on these new technological trends.2. Frequency below 20 Hz is infrasonic, and frequency above 20,000 Hz is ultrasonic.i??Soft consonants are high frequency sounds and the vowels are low frequency sounds. Automated auditory brainstem responsesIn the early 2002, the first fourth-generation OAE devices appeared in the market and offered the possibility to integrate information from different testing protocols such as automated OAE (AOAE) and automated ABR (AABR) responses.
Our hearing is most sensitive at 1000 Hz to 4000 Hz.i??The minimum audibility curve shape is due to the shape of the transformer action of middle ear . Right after returning from a loud concert, one may get temporary threshold shift (difficulty in hearing result right after the event). The combined screening protocols (AOAE + AABR) targeted the identification of auditory neuropathy, most prevalent in the neonatal intensive care (NICU) environment.With the introduction of the AABR protocols in the NHS programs, several issues became evident, and among those questions related to screening times and screening costs. Ototoxic drugs such as kanamycin will damage the outer hair cells, resulting in hearing loss. Once the stimulus is strong enough, the cilia moves, depolarizedi?  NT onto the nervei?  to the brain then to the cortex, but you need a 60 db stimulus: 95% of the auditory nerve fibers innervate the ear.
In 2010, Vivosonic presented a new family of devices (called amplitrodes) using a novel approach. Cochlea is tonotopically organizedNOTES:i??A high frequency sound will move in the basilar membrane in the form of a traveling wave. This will translate into a 25 dB boost in amplification or a 1000 Hz gain(frequency that our ears are most sensitive to). Low intensity i?  shearingi?  cilia movei?  longest areai?  depolarizedi?  contract (away, hyper and elongation)i?  movement goes higheri?  then the inner hair cells make contact and trigger the process. Data from the above study suggested that (i) the average time for AOAE responses is less than 10 s in a cooperative subject and less that 120 s (2 min) in non-cooperative subjects and (ii) the average AABR test times were less than 120 s, while longer times (600 s per ear) were required for uncooperative subjects. The crest of the traveling wave will be in the same location where the basilar fibers have the same resonance frequency as the incoming sound. THE OUTTER HAIR CELLS SERFVE AS HEARING AIDS FOR THEINER HAIR CELLS AND FACILITATE THE ABILITY FOT THE INNER HAIR CELLS TO HEAR.
The placement of the AABR electrodes might be a complicated process, especially when highly skin impedances (caused by excessive lipid layers) are encountered. Therefore, a high frequency sound will travel through the outer ear, through the middle ear, through the basilar membrane and the energy of that sound will be used whenever its frequency matches the resonance frequency of the basilar membrane, and its energy will be dissipated at the basal end of the cochlea.i??On the other hand, a low frequency sound will travel and dissipate its energy at the apical end of the cochlea.
One of the problems of the early ASSR devices (Audera by Viasys; Master by Natus) was that the mean hearing threshold estimates were characterized by large variance.
Traditionally, ABR and AABR protocols use click stimuli to synchronize as many neural fibers as possible and to obtain an ABR response of large amplitude with less sweeps. According to Kristensen and Elberling [5], “Upward chirps are often designed to compensate for the cochlear traveling wave delay which is regarded as independent of stimulation level. A chirp based on a traveling wave model is therefore referred to as a level-independent chirp. Another compensation strategy, for instance based on frequency-specific auditory brainstem response (ABR) latencies, results in a chirp that changes with stimulation level and is therefore referred to as a level-dependent chirp.
One such strategy, the direct approach, results in a chirp family that is called the level-specific chirp.” Data from studies using level-dependent chirps [6–11] are very encouraging, reporting ABRs recorded in less time and with higher amplitude values. The latter is very important for the statistical algorithms of the AABR devices, meaning that higher statistical accuracy can be obtained in the chirp-evoked AABRs.3.
Middle ear reflectance and Middle Ear Power Analysis (MEPA)Data from studies that have evaluated the performance of NHS programs in the well-baby clinic or in the NICU [4, 12, 13] have reported that the majority of “screening refers” are due to transmission impeding factors such as the amniotic fluid or any substance blocking the propagation of the acoustic stimulus.
The latter estimates are derived from the values of the error bars.Recently, a study by Ciorba et al. Data from the literature [14, 15] have shown that one of the MEPA metrics, the middle ear reflectance, is more sensitive to the distortion product OAE (DPOAE) status than the 1-kHz tympanometry values. The data suggested a very good relationship between the outcomes of the ASSR and the COR techniques, with the ASSR data being closer to the ABR estimates. It is the ratio or percentage of power reflected from the eardrum to the incident power as a function of frequency. Threshold estimation via DPOAE measurementsFrom the early nineties, where OAEs were accepted in the clinical practice, the relationship between hearing threshold and OAE responses received a lot of attention [26–28].
Acoustic power measurements objectively quantify middle ear function or malfunction.Currently, there is only one manufacturer (Mimosa Acoustics) offering reflectance measurements.
The company offers two devices capable of MEPA, DPOAE, and general OAE measurements: the Otostat (handheld) and the HearID (research oriented) model. In this context, distortion product OAE (DPOAE) protocols can provide additional information [26, 29–31].
Data supporting this hypothesis are derived from animal experiments (furosemide intoxication) [32] and clinical human studies from cases presenting sensorineural deficits [29, 33–34].
In terms of interpretation, If the MEPA reflectance values fall above the “pass” area, especially around 2 kHz, outer or middle ear problems may be the cause, and a rescreening session after a few hours or a day is recommended prior to diagnostic referral. If the MEPA reflectance values fall within the “pass” area, especially around 2 kHz, the middle ear is more likely to be normal and associated with a DPOAE pass result. According to their data, “The hearing threshold was found to be increasing within the early postnatal period (average age: 3 days), predominantly at the higher frequencies, and to be normalized in a follow-up measurement (after four weeks). If the DPOAE result is ambiguous or a “refer”, then middle ear issues are not suspected as a hearing deficit cause and further clinical assessment is necessary. Therefore, this procedure has the theoretical potential to discriminate middle from inner ear deficits. Data from the literature have not validated yet this hypothesis.The research findings from Janssen et al. Hearing threshold can be extrapolated up to values relative to 50 dB HL in the frequency range from 1.5 to 6 kHz. Figure 4 shows a typical hearing threshold profile and the corresponding Cochlea-Scan-mediated estimation of hearing threshold. The acronym “NA” means that at the specific frequency no threshold estimation was possible.Further analyses [38, 39] on the efficacy of the Cochlea-Scan DPOAE algorithm, relating hearing threshold data and Cochlea-Scan estimated thresholds from a group of adult sensorineural cases, suggested a different scenario than the one proposed initially by Janssen et al.
The data suggested that the maximum behavioral levels where valid DPOAEs could be detected were equal to of 32.8, 21, and 34 dB, respectively. For example, in Figure 5 and for 2.0 kHz, a probability of 90% Cochlea-Scan response detection corresponds to a threshold approximately of 15 dB HL.
Cochlea-Scan threshold estimation could be greatly improved by introducing changes in the device’s algorithms related to (i) the sample size, which was used to calibrate the prototype device. Sampling a larger population can minimize the variance of the average DPOAE amplitude per tested frequency (ii) by inserting correction factors in the algorithm, which extrapolates DPOAE amplitudes to hearing levels. Integration of multiple hearing assessment protocols into an automated deviceThe success of the NHS screening practices challenged another area of pediatric audiology, the area of schoolchildren screening. Data from large-scale screening programs, as in Poland, suggested that in this area different protocols could be applied than in UNHS programs, with emphasis on pure tone behavioral responses, tympanometry, and ABR [40]. The OAEs were found the less effective tool in the battery of screening tests, suffering mainly from the ambient noise present in schools.Recently, the fifth-generation OAE equipment appeared in the market. A tympanometry assessment has not appeared so far due to complications in the probe of the device (canal pressurization issues).
ConclusionsDuring the last 10–15 years, significant advances have been made toward the integration of various protocols and technologies in UNHS strategies. The most important contribution is in the area of auditory steady-state responses, which has been shown to be well correlated with other metrics in audiology such as the AABR, ABR, OAEs, and COR. The current technological trends call for an integration of even more protocols and algorithms in a handheld device.
The clinical robustness and response quality of these new entries is yet to be evaluated.8.



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