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Low frequency hearing loss is attributed to sensorineural hearing impairment which is caused by the hair cells found in the inner ear. A low frequency hearing impairment is hard to identify because it has a tendency of not having any symptoms.
Fluid buildup in the middle part of the ear is one of the reasons for developing low frequency hearing loss. Treatment options can be limited for this type of hearing loss, since it is directly hurting the nerves in the ear.
Copyright © 2016 Shear Hearing Loss And Hearing Aids - Hearing Impairment Tips and Fixes. 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.
These findings suggest that amplifying the low-frequency dead region alone may not result in improved speech understanding.
A low frequency hearing loss may also be related to disease processes that affect the integrity of the hair cells in the apex of the cochlea. In summary, it is difficult to identify and to convince patients who have a low frequency hearing loss that they need to wear hearing aids. By using the paired comparison technique, we can systematically change the bandwidth and gain in discrete steps in order to estimate the optimal bandwidth and preferred gain at different input levels. A Case with Tonal Perception Figure 3a shows the audiogram of Subject A, a 45-year old female community hospital administrator. During the paired comparison task, the hearing aids were first set to the default settings. Subject A reported no occlusion problem with either the default settings or the self-selected settings.
Halpin et al.2 examined the effect of ipsilateral pure-tone masking of the basal fibers (higher frequencies) at a high stimulus level (80-90 dB HL) while re-determining the audiogram of the low frequencies. One can also compare word-recognition scores with the predicted Articulation Index (AI) scores with and without the low frequency contribution in order to estimate functional status.2 If the low frequency fibers are functional, the measured word recognition scores should change according to the predicted AI scores when the low frequency contribution is included. In summary, the current thinking on managing a low-frequency hearing loss would support broadband amplification instead of low-pass filtering. Digital Technology and New Options for LF Losses One difficulty in the management of low frequency hearing loss is predicting the appropriate level-dependent frequency-gain characteristics based on the audiogram. The use of nonlinear or compression hearing aids can ensure audibility while maximizing comfort for the wearer. One advantage of using digital nonlinear hearing aids over linear ones is seen in the hypothetical input-output (I-O) curve of the Senso Diva hearing aid in Figure 2.
One advantage of digital technology is the capability to save alternate settings of the hearing aids into a temporary memory for comparison of preference. A broad bandwidth, including amplification in the normal or near-normal frequency region, is desirable. Send Home Our method Usage examples Index Contact StatisticsWe do not evaluate or guarantee the accuracy of any content in this site. DOCTOR-RECOMMENDED SMOKE DETECTORS FOR SENIORS, HEARING AID WEARERS AND PEOPLE WITH MODERATE HEARING LOSS. Audiologists emphasize it's not enough to be able to hear a smoke alarm, you must be awakened by it.
The Loudenlow™ Alarm is superior at waking people during a fire because of its power and low frequency.
Attention researchers and students: If you are interested in a Loudenlow to use in a sleep study, hearing study, or other research project please don't hesitate to let us know. People suffering from this problem cannot hear words with frequency 2000 Hz and less but can hear voices consisting of high frequency sounds and that is why, it is called as the ‘reverse slope audiogram’. The lower frequency sounds do not posses much information compared to higher frequency words. Meniere’s disease is another cause for developing this and it originates from the inner side of the ear and usually related to fluids accumulated in the inner part of the ear.
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. Although many researchers1,2 have proposed solutions to manage this hearing loss configuration, some of these solutions were not fully achievable because of the limitations of the hearing aid technology at the time. One reason why people with a low frequency hearing loss are able to identify the low-frequency speech information is because low frequency information may also be carried by high frequency fibers through temporal coding.
In addition, it suggests that people with a low frequency hearing loss may be able to utilize the surviving mid- and high-frequency hearing as effectively, if not more effectively, than normal-hearing subjects. Because of their ability to utilize mid- and high-frequency signals, many adults who are born with a low frequency hearing loss develop normal speech and language skills. Unlike a high frequency hearing loss where a majority of cases are related to prolonged exposure to loud sounds and aging, a low frequency hearing loss is typically not related to the same factors. Sudden hearing loss,8 viral infection,9 renal failure,10 and Meniere’s disease11 have been associated with a low frequency hearing loss. This is mitigated by the fact that some of these patients may have a dead region in the low frequencies where amplification may not result in any improvement.
This allows one to examine if these patients would prefer a broader bandwidth (versus low-pass and high-pass) than their audiogram would indicate, and if their gain preference at different input levels is similar to patients with more typical audiometric configurations.
She reportedly was identified with a low frequency hearing loss when she was in elementary school. The Connected Sentence Test (CST) was presented at 45 dB HL (approximately 65 dB SPL), and Subject A was asked to adjust the insertion gain setting for conversational sounds (IG normal) at each of the four basic frequency channels, starting at 500 Hz and proceeding to 1000, 2000, 4000, and then 500 Hz. Speech recognition scores for the default settings were similar to the self-selected settings in both quiet and noisy situations.
Previous research on the management of a low frequency hearing loss focused on two main issues: 1) the identification of a dead region, and 2) the assignment of optimum frequency-gain characteristics on the hearing aids. In the previous section we reviewed the audiometric characteristics of a low frequency hearing loss with a dead region.17,18 There are also tools that directly measure the functional status of the low frequency fibers. An increase in thresholds in the low frequencies will occur if the responses are mediated by the higher frequency fibers. Otherwise, the measured word scores would not be affected by the low frequency contribution.
In this way, both the low frequency fibers and the mid-to-high frequency fibers can be stimulated. These settings can be compared in pairs adaptively in the clinic in order to zero-in on the optimal settings for the wearer.
This however affects the suffering person to a great extent to understand the spoken words.
But people with this problem can make out the entire speech with what they hear in the high and middle ranges thus camouflaging the loss. Otosclerosis disease in which the free movement of the last ear bone is hampered because it is fixed in one place. Their product is designed to help improve the health of the nerves in the inner ear, thus helping improve hearing.
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.
With the advent of digital multichannel nonlinear hearing aids that offer greater flexibility of adjustment and increased specificity, a clinician may experience enhanced success in managing this loss configuration. Thornton & Abbas3 compared the speech recognition ability of 3 subjects who were identified with a low frequency dead region and 5 normal-hearing individuals in various filtered conditions.
Although they may have some difficulties in groups or in noisy environments, many of these individuals have learned to manage their communication.
Changes in the endolymphatic pressure, as in cases with fistula,12 intracranial hypertension,13 and even spinal and general anesthesia14 have also been reported with varying degrees of transient and permanent low frequency hearing loss. An increase in leakage (or vent diameter) will decrease the amount of low-frequency output measured in the ear canal.
Increasing the vent diameter (or leakage) could reduce the physical occlusion effect when the wearer speaks.25 A compromise on venting is necessary between achieving the desired low frequency output and minimizing any potential occlusion effect.
This technique may account for individual differences in etiology of loss as well as preferences for specific sound quality. Amplification was not attempted because she did not exhibit any communication difficulties.
She compared the default settings with alternate settings (more or less gain) until she had the best speech understanding with the best sound quality. Moore & Alcantara16 recommended the use of psychophysical tuning curve to determine the status of the low frequencies.
Schum & Collins1 examined speech-recognition skills of 6 subjects with a low frequency hearing loss by spectrally shaping speech materials (NST and CCT) to approximate different amplification schemes.
Furthermore, many would support the use of a large vent or open mold to reduce the low frequency output and minimize the incidence of loudness intolerance, upward spread of masking, and potential occlusion. Until the last 10 years, the majority of hearing loss was managed with linear amplification. Furthermore, some nonlinear hearing aids allow clinicians to adjust gain for different input levels (soft, medium and loud) independently. For an individual with a 50 dB hearing loss in the low frequency, one can ensure comfort while maintaining audibility for soft sounds by reducing gain for loud inputs only. In general, as the number of channels in a hearing aid increases, the specificity at which one can limit the type of processing to a restricted frequency region increases. One of the main concerns of people with a low frequency hearing loss is their difficulty understanding speech in noise.
Due to etiologies, one challenge in managing a low frequency hearing loss is the difficulty in predicting the desired frequency-gain. For example, the bandwidth and gain of the hearing aids at each input level may be adaptively changed based on the wearer’s preference. But in a noisy or crowded place, an individual with this syndrome cannot come-up with the speeches easily. Roughly speaking, the frequency patterns of hearing loss are divided up into: Low-frequency, mid-frequency, high-frequency, notches, and flat. This article reviews some of the challenges involved in fitting reverse-slope hearing loss.
One reason is that low frequency sounds are more intense and carry less information than high-frequency sounds.
In the unfiltered condition, the speech scores were 56% to 88% for the impaired group and 94% to 100% for the normal-hearing group.
From a practical standpoint, this means that the application of a prescriptive target where the amount of gain is directly proportional to the degree of hearing loss may lead to less than satisfactory results in many wearers. As a result, even when these individuals agree to try hearing aids, they may have unrealistic expectations for the chosen devices and reject any attempts that may be less than perfect.

For example, Konigsmark et al.5 reported that a progressive low frequency hearing loss may be dominantly inherited. The diverse etiologies, permanence (transient vs permanent vs progressive), and severity (moderate to profound) would suggest that one should understand the etiology of a particular patient’s hearing loss in order to customize management. Moore18 indicated that a hearing loss which exceeds 50 dB HL in the low-frequency region, with normal-to-mild hearing loss in the mid-to-high frequencies, may indicate a dead region. However, Moore18 reported erratic results on pitch perception in low frequency dead regions.
Unfortunately, with linear hearing aids, it may be difficult to provide just the right amount of low frequency amplification to ensure audibility without over-amplifying higher inputs. Alternatively, methods to manage occlusion should be available to achieve the low frequency amplification without compromising the benefits of the other features of the hearing aids and affecting the wearer’s voice quality.
However, she reported increasing difficulty at work, especially on the phone and in group situations. She was then asked to listen to a different passage at a presentation level of 25 dB HL and adjust the gain parameter for soft sounds (IG soft) in the four frequency channels. In an effort to make the test more clinically feasible, Moore18 proposed the use of the Threshold Equalizing Noise (TEN) as a quick means to assess the functional status of the low frequency region.
A defining characteristic of linear processing is that the same gain is applied to all input levels. An advantage of using digital nonlinear hearing aids is that gain adjustment at more discrete input levels can be made.
This is often helpful in a reverse-slope audiogram where the change in threshold between octaves is rather abrupt. The problem may be exacerbated when the wearer is given significant amount of gain in the low frequencies.
Moore18 acknowledged that, even when one makes a diagnosis of a dead region, the amount of amplification one provides to the dead region and to the mid- and high-frequency region is still unclear. Alternatively, the clinicians can save different combinations of settings into the different memories of the hearing aids and have the wearer evaluate their relative performance in real-life situations. A person with a moderate degree of low frequency hearing loss may not exhibit any outward signs of a hearing loss, such as missing speech sounds or aberrant speech production patterns. For the high-pass condition, the scores were 34% to 46% for the hearing-impaired group but 16% to 38% for the normal-hearing group.
Lesperance & Burmeister6 reported that Wolfram Syndrome 1 (an autosomal recessive disorder) is a result of mutation in the WSF1 gene.
This over-amplification can lead to higher frequencies being compromised by the upward spread of masking, and a decrease in intelligibility and sound quality. Her instructions were to select the best gain settings so that the sounds are audible and soft, but not necessarily intelligible. That is, Subject A selected similar gain as recommended by the proprietary fitting algorithm. First, the self-selected frequency output curve at the 40 dB SPL input level was similar between the default and self-selected settings. This means that one may control gain just for loud sounds without sacrificing gain for soft and medium level sounds.
This ability to allow paired comparisons27 in digital and programmable aids will be especially helpful to select the optimal level-dependent frequency-gain settings on a hearing aid for people with a low-frequency hearing loss (and other hearing loss configurations as well). For the low-pass condition, the scores were 12% to 44% for the hearing-impaired group but 76% to 84% for the normal-hearing group. During audiometric testing, she indicated that all the test sounds (including the lows) had a tonal quality to them. Finally, she was asked to listen to a discourse passage presented at 65 dB HL and instructed to adjust the gain parameter for loud sounds (IG loud) so that the passage was loud, but not uncomfortable. The default setting attempts to bring the aided sound-field threshold at all frequencies to about 20 dB HL in the ideal situation. She also exhibited a severe loudness tolerance problem, reporting that loud speech was uncomfortable to her for any period of time. This suggests that, even though 250 Hz may sound atonal, the subject still preferred the default gain for soft sounds in the nearby frequency region. This suggests that amplifying the low frequency alone (or region of hearing loss alone) is not sufficient.
If someone with a low-frequency hearing loss desires less than the prescribed gain (eg, because of loudness intolerance), such gain reduction will occur for all input levels. Having multiple channels in a nonlinear hearing aid allows one to provide appropriate amplification at one frequency region without over-amplifying (or under-amplifying) nearby frequency regions.
Binaural Diva ITCs with no vents were recommended because of the severity of the loss and the desire to preserve the directivity index of the hearing aids.
Secondly, significantly higher output than the default setting was selected for the 65 dB SPL input level condition in the 250-500 Hz region, while a lower output was selected in the 1000 Hz region. On the other hand, the preferred gain for the low-frequency at 65 dB SPL and 90 dB SPL input levels was lower than that recommended by the default setting, whereas the output in the 2000 Hz-4000 Hz region was higher for the self-selected settings than the default settings. Figure 1 is an input-output (I-O) curve of a linear hearing aid where the gain curve has been lowered from 40 dB to 20 dB in order to avoid discomfort at high input levels, a common complaint of people with a reverse-slope audiogram. Moore18 also recommended the use of nonlinear WDRC hearing aids for people with a low frequency hearing loss. Subject A wore the default settings (and two other alternate settings) for more than 2 months before she selected her preferred frequency-gain settings using the paired comparison technique. Her speech-in-noise score (as evaluated by the HINT) was significantly better with the self-selected settings than with the default settings. It is obvious that not only the output at a high input level is reduced, but the output at other input levels is reduced as well. Low-frequency sensorineural loss: Clinical evaluation and implications for hearing aid fitting. Despite these recommendations, a practical approach to customize the individual fittings with linear hearing aids has been difficult. This sacrifices the audibility of soft sounds and potentially compromises sound quality at conversational levels. If one recognizes that the problems associated with masking, occlusion, loudness intolerance, and difficulty in noise are all related to a high output (from amplifying high input levels) in the wearer’s ears, one should only reduce gain for high input level sounds and not gain for sounds at all input levels. For the 90 dB SPL input level, the self-selected setting is slightly lower than the default setting predicted from Pascoe’s findings28 on the relationship between UCL and the degree of hearing loss. The cause (multifactorial inheritance) and pathogenesis (endolymphatic malabsorption) of Meniere’s disease and its symptoms (mechanical and chemical).
Otologic manifestations of benign intercranial hypertension syndrome: Diagnosis and management.
Validity of hearing thresholds obtained from the rising portion of the audiogram in sensorineural hearing loss. Dead regions in the cochlea: Diagnosis, perceptual consequences, and implications for the fitting of hearing aids.
Tuning curves and pitch matches in a listener with a unilateral, low-frequency hearing loss.

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