Managing low frequency hearing loss zedd,ear nose and throat associates of erie gratis,cure for sensorineural hearing loss quotes,imagenes de zapatos de messi 2014 - Downloads 2016

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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. The aim of our study was to outline the prevalence of hyperlipidemia in patients who had high-frequency hearing loss and tinnitus due to noise exposure.
Cochlear hair cells and neural and central auditory pathways are involved in the generation of subjective tinnitus [1]. Decrease in internal diameter of the vascular bed resulting from hyperlipidemia compromises the oxygen transportation capability of the blood to the cochlea, and chronic hypoxia is likely to occur by the reduction in oxygen supply of the inner ear, which in turn would lead to insufficient adjustment of the cochlear metabolism. This may result in the overproduction and accumulation of free radicals, which disturb the microcirculation of the cochlea and play an important role in ischemiainduced cochlear injury [7].
The reasons for the susceptibility to noise-induced hearing loss of patients who have been exposed to a noisy environment have been the subject of various studies. Previous data indicate that the cochlea and the central auditory system age faster and earlier in patients with hyperlipidemia and that the risk of noise-induced hearing loss is much higher [5,11]. The aim of this study was to outline the prevalence of hyperlipidemia in patients who had high-frequency hearing loss and tinnitus due to chronic noise exposure and to evaluate the risk of developing sensory hearing loss in those patients as compared to risk in control subjects. We conducted this prospective study in 120 consecutive patients with complaints of chronic subjective tinnitus of varying degrees of severity and hearing loss due to noise exposure.
The patients were examined otoscopically and were reviewed by an audiometric test battery including puretone audiometer (AC-30, IAC, Copenhagen, Denmark), stapes reflex, and tympanometry (Amplaid 775, Milan, Italy). Antilipid treatment with statin derivatives was planned once-daily oral dosing for up to 1-2 years (minimum, 12.4 months). We then compared tinnitus scores and hearing levels in patients with no response to antihyperlipidemic therapy and in patients who had a normal blood cholesterol level after the treatment. The duration of tinnitus in patients with noise exposure varied from 2 months to 12 years (mean, 5.5 years). Of 22 patients in the unresponsive group, 6 had high cholesterol and triglyceride, 9 had high triglyceride, and 7 had high cholesterol only before the antilipidemic therapy.
Of 20 patients in the responsive group, 7 had high cholesterol or triglyceride, 10 had high triglyceride, and 3 had high cholesterol only before the antilipidemic therapy.
The difference between the pitch-match frequencies before and after therapy was not significant.
Epidemiological investigations emphasizing the relationship between hearing loss and the risk factors for coronary artery disease date back to the 1960s [18].
Spencer [19] found that 42.3% of 300 patients with different symptoms of inner-ear pathology had clearly defined hyperlipoproteinemia. The effect of hyperlipidemia on auditory perception has been studied clinically and experimentally. The exact pathological mechanism for the hyperlipidemia-induced hearing loss remains obscure. In his study of 64 rats, Pillsbury [37] exposed half to loud noise and fed half of each subgroup a fat diet and found elevated auditory brainstem response thresholds in the hyperlipidemic animals. Studies investigating the restorative possibility of a low-cholesterol diet and antihyperlipidemic therapy on hearing loss and tinnitus are very few.
LDL apheresis has been reported to be much more effective as compared with standard prednisolone, dextran, and pentoxifylline therapy in patients with sudden hearing loss [9]. In our study, changes in tinnitus scores before and after therapy in the responsive group were significant as compared with those in the unresponsive group. Tinnitus and hearing loss are frequently encountered after an acute acoustic and blast trauma or chronic noise exposure.
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.
Low-Cholesterol Diet and Antilipid Therapy in Managing Tinnitus and Hearing Loss in Patients with Noise-Induced Hearing Loss and Hyperlipidemia. We investigated the role of a low-cholesterol diet and antihyperlipidemic therapy to alleviate the severity of tinnitus and possibly promote hearing gain after therapy in patients with acoustic trauma.
Analysis of the epidemiological data indicates that exposure to noise is widespread and is one of the most common causes of tinnitus, which leads to various somatic and psychological disorders and interferes with the quality of life [2].
Auditory perception in such cochleas is very sensitive to reduction of the oxygenation in the inner ear [6]. Platelet aggregation and blood viscosity due to high lipid levels will intensify inner-ear damage owing to slowing of microcirculation and will contribute to the development of both progressive and sudden hearing loss [8,9]. Gratton and Wright [10] demonstrated the accumulation of lipid in the stria vascularis and outer hair cells in chinchillas after experimentally induced hypercholesterolemia, which might intensify the detrimental effect of ototoxic drugs or noise.
We instituted a low-cholesterol diet and antihyperlipidemic therapy to investigate whether any benefit accrued in terms of hearing gain and tinnitus relief. The project was approved by the local medical research ethical committee, and we obtained informed consent from each patient. Audiometric tests included air- and boneconduction thresholds for pure tones of 125-8,000 Hz, tests of speech reception and speech discrimination, contralateral and ipsilateral reflex measurements, and tympanometry.
Measurement of loudness of the tinnitus was based on subjective assessment by the patients. Daily dosage ranged from 10 to 40 mg for simvastatin (Zocor) and from 10 to 80 mg for atorvastatin calcium (Lipitor). Average ages of patients in the unresponsive and the responsive groups were 39 and 42 years, respectively.


Wilcoxon and Mann-Whitney U tests were used to compare the pretreatment data with the posttreatment results and to compare the results of responders and nonresponders. None of these patients demonstrated any drop to normal ranges in cholesterol or triglyceride values after the treatment. When those patients were asked to qualify the severity of their tinnitus, seven rated their tinnitus as the same (35%), two rated it as increased (10%), seven rated it as decreased (35%), and four had no tinnitus (20%).
The correlation between serum lipids and auditory dysfunction has been investigated before, and it has been reported that sensorineural hearing loss is more prominent in those with high levels of cholesterol, triglyceride, and lowLDL and in patients with low HDL concentration [18-23].
Increased blood viscosity and atherosclerosis of the cochlear vessels reduce the blood perfusion of the cochlea and promote hearing impairment [6,8,19,20,23,24]. When patients were required to qualify the severity of their tinnitus, 35% of the patients in the responsive group rated their tinnitus as decreased, and 20% of patients reported no tinnitus. Even though other factors making the patients susceptible to noise-induced hearing loss should be considered, on the basis of present results it can be concluded that the incidence of hyperlipidemia is high among patients with noise-induced hearing loss and that significant improvement in lowered intensity of tinnitus and in average hearing thresholds at higher frequencies can be achieved after lowering patients' serum lipid level [43].
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.
Fortytwo hyperlipidemic patients with subjective tinnitus and hearing loss due to noise exposure were enrolled for the study.
It has been reported that high-plasma cholesterol and triglyceride levels are one of the major risk factors for the development of occupational hearing loss [3-5].
It seems that noise and other metabolic disturbances have a synergistic effect on the development of tinnitus and hearing loss [5].
A diagnosis of acoustic trauma was verified by an ear, nose, and throat physician according to a clinical history of chronic noise exposure in patients who sought medical help for complaints of tinnitus and high-frequency hearing loss. Patients who had chronic otitis media or middle-ear effusion, those with an abnormal ear drum (perforation, retraction, etc.) or auditory canal, and those who had abnormal tympanometry (other than type A) were excluded. In the study, from 120 patients we chose 42 male patients (35%) with elevated cholesterol or triglyceride or both (age range, 19-60 years; mean age, 45 years). The patients were separated into two groups: the "unresponsive" group, made up of 22 patients who had no response to either of the therapies and still had hyperlipidemia, and the "responsive" group, consisting of 20 patients who had lower cholesterol or triglyceride levels. The results of the blood lipid profiles were withheld from the individual to prevent a placebo effect with the tinnitus therapy. The significance of the difference in patient's comments on their tinnitus after the treatment ("same," "decreased," "increased," and "disappeared") was analyzed using McNemar and chi-square tests. However, the incidence of hyperlipidemia among a selected group of patients with neurosensory hearing loss varies. They selected a group of subjects aged between 20 and 50 years and compared auditory thresholds at high frequencies and serum lipid levels.
Noise and metabolic disturbances have a synergistic effect on the development of tinnitus and hearing loss.
Effects of experimental cochlear thrombosis on oxygenation: Auditory function of the inner ear. Direct effects of intraperilymphatic reactive oxygen species generation on cochlear function. Clinical utility of LDL-apheresis in the treatment of sudden hearing loss: A prospective, randomized study. The relation of hearing in the elderly to the presence of cardiovascular disease and cardiovascular risk factors.
Appearance of free radicals in the guinea pig inner ear after noise-induced acoustic trauma. Progressive sensorineural hearing loss, subjective tinnitus and vertigo caused by elevated blood lipids. A comparison of auditory brainstem evoked potentials in hyperlipidemic and normolipidemic subjects. Exploration of the early auditory effects of hyperlipoproteinemia and diabetes mellitus using otoacoustic emissions.
Hypertension, hyperlipoproteinemia, chronic noise exposure: Is there a synergism in cochlear pathology? Effects of noise exposure and hypercholesterolemia on auditory function in the New Zealand white rabbit. Hearing improvement after therapy for hyperlipidemia in patients with chronic-phase sudden deafness. A prospective case-controlled study of 197 men, 50-60 years old, selected at random from a population at risk from hyperlipidemia to examine the relationship between hyperlipidemia and sensorineural hearing loss. 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.
All patients who were required to complete the questionnaire and who were subjected to clinical examination were military personnel.
A pure-tone signal was presented continuously at 50-Hz intervals at between 10- and 20-dB levels. We placed all these patients on a low-cholesterol diet or antihyperlipidemic therapy (Table 2).
When patients were asked to qualify the severity of their tinnitus, 10 rated their tinnitus as the same (47%), 9 rated it as increased (42%), 2 rated it as decreased (9%), and 1 patient had no tinnitus (2%).
Lowry and Isaacson [12] reported 20% hyperlipoproteinemia among 100 patients with bilateral hearing loss.
Lipidosis of the inner ear has been postulated by Nguyen and Brownell [33] as an alternate mechanism. Insufficient perfusion of the cochlea due to increased blood viscosity and microthrombosis related to hyperlipidemia has been claimed to cause susceptibility to noiseinduced hearing loss [35]. We found in our study that the incidence of hyperlipidemia among patients with noiseinduced tinnitus and hearing loss was 35%. Characteristics of tinnitus and etiology of associated hearing loss: A study of 123 patients. 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).
We excluded on the basis of their response to the questionnaire or clinical examination subjects who had a history of familial hearing loss, head trauma, collagen disease, neurological or hormonal disturbance, addiction to alcohol, or ototoxic drug therapy. The main criteria for response to the antihyperlipidemic therapy was defined as a return to normal cholesterol or triglyceride levels after therapy or at least a 40% drop from either of the initial blood cholesterol or triglyceride levels if the values were slightly above the normal limits. The latter authors showed that the lateral wall of outer hair cells from guinea pig cochlea incorporates water-soluble cholesterol. Axelsson and Lindgren [34] matched 78 men at age 50 years with high serum cholesterol levels to 75 randomly selected 50-year-old men and found significant correlation between noise exposure and high cholesterol level. 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. The difference between tinnitus scores in the unresponsive and responsive groups and the change in tinnitus scores before and after therapy in the responsive group were significant.
None of the patients had cerebrovascular disease, hypertension, electrolyte imbalance, cranial nerve deficit, or clinical signs of peripheral neuropathy.
Then, the pitch-match frequency threshold of the tinnitus was measured as the tinnitus loudness match of the pure-tone stimulus presented with a 1-dB increase of tinnitus frequency.
Morizono and Paparella [30], using cholesterolfed rabbits, showed increased auditory dysfunction with time at all frequencies. This uptake of cholesterol is accompanied by an increased stiffness of the cells, which may impair the cells' electromotile response. Enhancement of cochlear action potentials and auditory brainstem responses has been demonstrated after limited intake of cholesterol.
However, patients were at the chronic phase, more than 1 month from the onset of the hearing loss. 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.
It seems that the order of destruction and the high-frequency nature of the auditory dysfunction are correlated not only with the frequency and severity of the noise exposure but with the presence of the secondary pathology, as the formation of vasoactive lipid peroxidation products after intense noise is similar to the condition seen in metabolic damage to the organ of Corti [7,14-17]. In a survey of 44 patients with cochlear-type hearing loss, Booth [26] found hyperlipidemia in 28% of the men and 10% of the women. These authors observed hearing improvement of more than 10 dB in 9 of the 12 patients after antihyperlipidemic therapy. 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.
In this manner, preventive measures may provide restorative support to the injured cochlea.
We required all patients to rate their tinnitus from 1 to 10, with 10 being loudest (Table 1).
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. Each level was defined by short explanations to simplify the patients' grading of their tinnitus.
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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