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In a group of 30 adults with impaired hearing, objective thresholds defined with 40 Hz middle latency responses (MLR) were compared with subjective audiometric measures. Frequencies of 0.25, 0.5, and 1 kHz were studied. In order to guarantee a good frequency specificity, subjects presenting large high-frequency hearing loss were particularly chosen. The 40-Hz MLR thresholds were generally worse than the audiometric measures. The average difference was around 12 dB, but in about one-third of the cases it was between 20 and 30 dB. Although not perfect, 40-Hz MLR estimates on low frequencies can be very helpful and deserve further consideration, especially in children.

We have reviewed the most recent 120 cases of acoustic neuromas operated upon in Bordeaux, France. In so doing, we have defined the strategy required to reach an accurate diagnosis as essentially comprising three stages. The first of these is to understand that the presenting symptom complex may be typical with progressive unilateral hearing loss, tinnitus, etc., or atypical with sudden hearing loss (10%), recovering facial paralysis (3.3%) or a Menière's syndrome (3.3%). Included in the first stage of diagnosis are audiovestibular investigations. An absent stapedial reflex was noted in 41% of our cases and an abnormality in vestibular testing in 95% of cases tested. These findings would be clear indicators to proceed to the second stage of the diagnostic strategy. This second stage comprises electric response audiometry consisting of auditory brainstem response (ABR) testing and electrocochleography (ECochG) employed as a filter for determining which patients should proceed to the third stage of testing. A combination of ABR and ECochG provides the clinician with results of high sensitivity and specificity. The false-negative rate for combined results in our experience has been less than 1%. The final diagnostic stage is radiological imaging, in particular using magnetic resonance imaging (MRI) with gadolinium contrast as the modality of choice. MRI is superior to CAT scanning, especially in the diagnosis of stage I intracanalicular tumors.

The technique of hemodilution was assessed in 12 cases of sudden hearing loss as it is known to improve peripheral circulation. Good results were obtained in nine patients. The immediacy of the effects suggests the real efficacy of hemodilution as opposed to spontaneous recovery. Hemodilution is supposed to improve oxygenation in the cochlea. This technique is very simple and quick to perform.

In the majority of cases tinnitus has a high pitch and can be matched rather precisely to an objective high frequency sound. However, it is well known that tinnitus can be masked by different tones without any frequency selectivity. We wondered whether objective tones matched to tinnitus would show a more significant deterioration of frequency selectivity than could be expected from any associated hearing loss. Psychoacoustic tuning curves were obtained using simultaneous pure-tone masking and revealed a broadening of frequency selectivity. In cases of comparable bilateral hearing losses with unilateral tinnitus, the broadening associated with the tinnitus was particularly conspicuous. This broadening strongly suggests that tinnitus originates in the cochlea, although some involvement of central pathways may also occur. Tinnitus-induced broadening of frequency selectivity as a possible sign of cochlear origin deserves further consideration in future studies.