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In this report, performance intensity functions for monosyllabic materials (PI-PB) were obtained on two groups of subject: 20 patients with eighth nerve pathology and 15 individuals with Meniere's disease. The subjects with retrocochlear involvement exhibited marked deterioration in word recognition as the speech intensity was increased beyond the level required for a maximum discrimination score. Such a dramatic breakdown, referred to as the "rollover effect," was not seen to occur among the subjects with cochlear disorders. Hence, the PI-PB function appears to be a valuable tool for use in the special test battery.

There appears to be an increase in the number of premature infants who survive treatment in neonatal intensive care units. Such an increase is expected to result in a greater number of children with developmental delays in a variety of dimensions, including auditory and psycholinguistic abilities. This report presents hearing and speech/language data on a sample of 266 high-risk infants. The data revealed that approximately one-third of the population exhibited hearing impairment and/or speech/language problems. The need for early identification and periodic assessment with this population is emphasized.

The present study consisted of two experiments. Experiment I was directed toward the detection of subtle mid-frequency cochlear dysfunction and the determination of word discrimination in noise for persons with noise-induced hearing loss. The presence of significantly elevated aural-overload thresholds, consistent with the presence of cochlear pathology in regions of normal pure-tone sensitivity, confirmed previous findings obtained with this subject population by other investigators. In addition, a marked reduction in word discrimination was observed in the presence of a background of competing noise. For experiment II, normal hearers listened to consonant-nucleus-consonant monosyllables filtered to match the mean audiometric configuration of the noise-exposed subjects in experiment I. Results showed significantly better performance with these filtered words by the normally hearing subjects than that by the noise-exposed group for unfiltered materials. The results of the second experiment were interpreted as providing further support for the presence of subtle auditory dysfunction in the mid-frequencies despite normal threshold sensitivity in this same frequency region.

This paper presents the data from medical and educational case histories on a group of 60 unilaterally hearing-impaired children. The case history data revealed that approximately one-half of the 60 children with unilateral sensorineural hearing loss exhibited some difficulty in educational progress. More specifically, 35% had failed at least one grade and an additional 13% were in need of some special resource assistance. Similar findings were obtained on a subset of 25 unilaterally hearing-impaired children who satisfied rather stringent criteria for age, hearing level, intelligence, length of time the impairment was present, history of middle ear disease, and general growth and development.

Word recognition scores were compared between a younger age group (15 to 35 years) and an older age group (55 to 85 years) exhibiting similar mild sensorineural hearing losses. No differences were found between the two sets of subjects for recognition ability in quiet and only 5% in noise. Contrary to widespread belief, these results revealed no tendency for the older age group to display poorer recognition performance than the younger listeners. The importance of hearing sensitivity as well as age as a factor affecting work recognition is discussed, and comparative data from the literature are presented.

Two instruments for the detection of hearing impairment, the Welch-Allyn audioscope (Welch-Allyn Inc, Skaneateles Falls, NY) and the Hearing Handicap Inventory for the Elderly--Screening Version (HHIE-S), were validated against pure tone audiometry in 178 patients over 65 years old screened in primary care practice. The prevalence of hearing impairment in this sample was 30%. The audioscope yielded reproducible results in the physicians' offices and a hearing center. The sensitivity of the audioscope was 94% in both locations, while its specificity was 90% in the hearing center and 72% in the physicians' offices. The HHIE-S yielded reproducible results between the two test locations. An HHIE-S score from 0 to 8 resulted in a likelihood ratio of 0.36 (95% confidence interval, 0.19 to 0.68), and a score of 26 or more yielded a likelihood ratio of 12.00 (95% confidence interval, 2.62 to 55.00) for predicting the presence of hearing impairment. Used together, the two instruments had a test accuracy of 83%. The audioscope and HHIE-S are valid, reliable, inexpensive tools for detecting hearing impairment in the elderly.

The glomus tumor is considered to be the most common of all tumors that involve the middle ear. This report defines the glomus tumor and discusses the symptomatology of the tumor with respect to the various developmental courses it may follow. Forty clinical cases of glomus tumor are reviewed, with emphasis upon the incidence of the tumor and its symptoms, including the audiological manifestations noted in this series of cases. Current medical management of the glomus tumor recommends surgical removal of the lesion when possible; however, irradiation and embolization of the tumor may also be considered when its invasion into surrounding structures has been extensive. The pathology and its treatment may have marked temporary or permanent effects upon the hearing of the patient, and the importance of ongoing audiological management is therefore emphasized.

This report provides a review and discussion of bilateral acoustic tumors (von Recklinghausen's Disease) with emphasis on the audiological manifestations. To aid in our clinical description of this disease a series of 22 patients are summarized and three case reports are presented. The audiometric findings are shown to be quite different from what is generally seen in unilateral tumors. Because of the significant complications that can be associated with this disorder, especially in the later stages, the importance of early detection is emphasized. Strategies for audiologic management are also presented.

Clinical acoustic impedance findings in a group of 40 children with cleft lip or palate and a group of 20 noncleft children are presented. The cleft subjects exhibited a high incidence of hearing loss and aural pathology. The data suggest that impedance measurements lend pertinent supportive information to routine puretone audiometric testing in the detection and management of middle-ear disease in the cleft-palate population.

This paper offers a general review of literature on issues pertinent to unilateral hearing loss in children. The paper focuses on such areas as demographic considerations, the importance of binaural hearing, the effects of noise on speech recognition, learning and educational factors, and auditory deprivation. It is concluded that there is sufficient evidence to suspect that children with unilateral sensorineural hearing loss can experience complications in communication and education. Finally, this paper presents the description of a research plan used in our study on unilateral sensorineural hearing loss in children.

This study examined stapedial reflex recordings of pulsed pure tones (500, 1,000, 2,000, and 4,000 Hz) in 26 subjects with normal hearing and 18 with sensorineural impairment. The stapedial reflex tracings clearly differentiated the two groups of subjects. Like many of our special audiometric procedures, this test was least effective in those with mild hearing loss. The test also appeared to be useful in identifying high-frequency hearing losses. Although this reflex measurement appears to have potential as a clinical tool, additional field study appears necessary.

Two sets of recommendations for impedance screening have been generated recently for use with preschool and school age children. One set of these recommendations, developed in Nashville, purports that it is premature to mass-screen on a routine basis for the detection of middle ear disease. These recommendations do encourage, however, the screening of special populations of children considered at risk for otitis media. This paper offers support for Nashville recommendations and suggests that there is a critical need for additional research before we begin to screen in mass. Areas in need of further research and clarification included the use of impedance as a screening tool, natural history and medical management of middle ear disease, and the educational and linguistic complications of middle ear disease. Hence, while the potential value for screening is recognized by the Nashville recommendations, they also recognize the need for more study of the procedure and the disease.

This clinical, practice-based study explores the research question: Is there a relationship between hearing loss and functional disturbance in elderly patients? We analyzed the impact of hearing impairment on 153 patients over 65 years of age screened in primary care practice. Functional and psychosocial impairment were measured using the Sickness Impact Profile (SIP), a standardized measure for assessing sickness related dysfunction. Hearing level was determined with pure tone audiometry. Multiple linear regression was used to adjust for patient case-mix differences and other clinical variables. After adjustment, a 10 dB increase in hearing loss was found to result in a 2.8 point increase in Physical SIP scores (95% confidence interval = 1.8-3.8), a 2.0 point increase in psychosocial SIP scores (95% confidence interval = 0.8-3.2) and a 1.3 point increase in overall SIP scores (95% confidence interval = 0.1-2.5). Poor hearing was associated with higher SIP scores and increased dysfunction. Thus, hearing impairment is an important determinant of function in the elderly.

This paper offers a summary of the general findings from a study on unilateral sensorineural hearing loss as well as some comments with regard to possible reasons for outcome. Additional comments are provided on the management of unilaterally hearing-impaired children, future directions for research, and an emphasis on the limitations and interpretations of this investigation.

This paper reviews evidence which suggests that middle ear disease with effusion and associated hearing loss, unilateral sensorineural hearing impairment, and mild bilateral sensorinural hearing loss in children can result in far more educational and/or communicative difficulty than was previously supposed. The author rejects the notion that a decibel level on an audiogram truly reflects the degree of hardship the child experiences and argues for a more active identification and management program in the early years.

This paper reviews the status of children with unilateral sensorineural hearing loss. There is mounting evidence to show that some unilaterally hearing-impaired children experience difficulty in school. Furthermore, these children may have trouble understanding speech in noise, exhibit poor localization skills, and display behavior problems in school and at home. Suggested management strategies for this population are discussed.

The purpose of this study was to conduct an acoustic analysis of incubator noise under two conditions: when the incubator was associated with different types of life-support equipment; and when impulse noise was created by striking the side of the incubator or by opening and closing the doors of the storage unit. It was found that the life-support equipment increased the overall noise levels of incubators by as much as 15 to 20 dB. Much of this increased energy was in the high frequency region. Impulse signals created by striking the side of the incubator ranged from 130 to 140 dB. A representative impulse for opening the incubator was 92.8 dB, whereas closing the door produced a peak amplitude of 114 dB.

We examined the prevalence of hearing loss and/or middle ear disease among 34 children with cleft palates, using pure-tone audiometry, acoustic impedance, and pneumatic otoscopy. The overall incidence of hearing loss and otitic complications varied from 57% to 68%, depending on the procedure used. Of the three clinical procedures used in this study, pure-tone audiometry exhibited the poorest diagnostic efficiency. Close predictive agreement was found between impedance and otoscopy.

Two clinical word discrimination tests, the Northwestern University Auditory Test No. 6 (NU-6) and the Modified Rhyme Test (MRT), were examined for internal consistency and for split-half reliability under varying primary-to-secondary ratios (P:S) in normal hearers. Although the statistical analysis indicated that half-lists could be used reliably for both discrimination tests at most P:S conditions, the wide variability found among individual listeners does not support the clinical practice of half-list testing in noise--at least not for normal-hearing listeners.

In the present field study, ambient noise levels and the status of group FM-wireless amplification systems were examined in 19 classrooms for the hearing impaired. Classroom noise was judged to be unacceptably high thus justifying the need for group amplification devices. Physical inspection of the group systems revealed defects in approximately one-half of the 28 teacher and 89 student amplification units. The electroacoustic measurements showed wide variability in performance among systems. There also appeared to be no systematic relationship between the degree of hearing loss of the children and the amount of unit gain being employed by each specific amplification system.

The diagnostic performance of the Hearing Handicap Inventory for the Elderly--Screening Version (HHIE-S) was evaluated against five definitions of hearing loss in 178 elderly subjects screened in primary care. Hearing loss was assessed by pure-tone audiometry. Using a score of greater than 8 as a cut point, the HHIE-S had sensitivities ranging from 53 to 72% and specificities ranging from 70 to 84% with the different definitions. The HHIE-S receiver-operating characteristics and likelihood ratios were similar regardless of hearing loss definition used. The HHIE-S is a valid, robust test for identifying hearing-impaired elderly, irrespective of the audiometric definition used to finally diagnose hearing difficulties.

This report reviews some of the developments and changes that are occurring in the field of amplification. The discussion focuses on such areas as hearing aid rules and regulations, hearing aid sales and dispensing practices, hearing aid technology, and selection and evaluation procedures.

We determined and compared the associations of four commonly used audiometric criteria of hearing impairment with two functional outcome measures in 152 aged persons screened in primary care medicine practices. The outcome measures were the Sickness Impact Profile (SIP, a measure of global function), and the Hearing Handicap Inventory for the Elderly-Screening Version (HHIE-S, a communication-specific measure of functional impairment). There were five main findings. (1) The four criteria of hearing loss were not independent. (2) The criterion of loss chosen depends on the functional measure of impairment. (3) Functional hearing impairment may also be classified by the number of criteria met. (4) A large subset (21%) of aged persons met one criterion but had little in the way of communicative or global dysfunction. (5) Hearing handicap as measured by the HHIE-S was directly associated with global dysfunction as measured by the SIP.

This study examined the relationship between two previously proposed measures of the fragile ear, the aural overload test and word discrimination score in noise. Ten normal-hearing young adults served as subjects. Aural overload thresholds were determined for fundamental frequencies of 500, 1000, and 2000 Hz. Word intelligibility in noise was assessed with tests using an open response-set (Northwestern University Auditory Test No. 6) and closed response-set (Modified Rhyme Test) at a variety of primary-to-secondary ratios. Results revealed a lack of correlation between threshold of overload and word discrimination in noise at unfavorable primary:secondary ratios for both tests(-6 and 0 dB for the NU-6' s and -12 and -6 dB for the Modified Rhythm Test). Significant correlations (p less than 0.05) were achieved, however, with both word discrimination tests when administered at the more advantageous primary:secondary ratios.

In a survey of the hearing sensitivity of a rural mid-Michigan population, 1,325 adults over 15 years of age received pure tone air conduction tests in a "mini" IAC room housed in a small trailer. In addition, a detailed questionnaire was administered to each person to obtain information about his exposure to noise vocationally and avocationally, family history of hearing loss, etc. Results indicated that, on the average, individuals displayed hearing losses considerably greater than was predicted on the basis of presbycusis alone. Also, people who had never had any industrial noise exposure had thresholds almost as poor as those who had worked in factories. These findings are discussed in view of the subject's exposure to various types of nonoccupational noise such as snowmobiles and motorcycles.

This study examined discrimination scores among listeners (742 ears) with flat sensorineural hearing losses. The discrimination data were analyzed in terms of degree of hearing impairment and subject age. Contrary to previous findings, the results showed that the average subject exhibited a discriminative ability of 70% or better for hearing levels less than 60 dB. A 10 to 20% decline in intelligibility, however, was found for losses 60 dB and greater. Listeners' performance decreased somewhat as a function of age especially for subjects with the greatest hearing losses. Finally, a subject's word discrimination was similar whether hearing loss was based on a three- or a five-frequency average.

Whether recurrent otitis media in infants and young children is followed by delayed language development was addressed by following 210 normal subjects longitudinally through the first 2 years of life with pneumatic otoscopy and tympanometry performed at every physician encounter. Otitis accounted for 26% of the medical visits. One hundred fifty-six of these children had speech and hearing evaluation at 2 years of age. Thirty percent of the children with recurrent otitis media had a mild or moderate hearing loss. However, after multiple speech and language tests, we could not identify a delay in language acquisition in the otitis-prone children. At 3 to 4 years old, 36 children, including nine with a hearing loss at 2 years of age, were retested; all nine had normal hearing. Recurrent otitis media induced a temporary decrease in hearing sensitivity demonstrable at 2 years of age, which appeared to resolve as the children matured and which was not associated with delay in language acquisition.

Horizontal sound localization and syllable recognition skills were examined in a group of children with unilateral sensorineural hearing loss and a matched group of normal hearers. The results showed that the unilaterally hearing-impaired children performed more poorly than the normal counterparts in both localization and speech recognition of nonsense syllables. The unilaterally hearing-impaired children had considerable difficulty understanding in a background of noise. The clinical implications of these findings are discussed.

This study examined individual differences among various psychophysical measures that have been suggested previously as predictors of susceptibility to noise-induced temporary threshold shift (TTS). The test battery was administered to a group of five normal-hearing young adults and consisted of the following procedures: (1) critical intensity (CI) at 2 kHz; (2) loudness discomfort level (LDL) at 0.5, 1, 2 and 4 kHz; (3) aural overload thresholds at 0.5, 1 and 2 kHz. Three measures of TTS, one employing a broad-band noise as the exposure stimulus and two others using tonal fatiguers, were utilized to assess susceptibility to TTS. Results revealed that the test battery delineated tough from tender ears. Furthermore, the aural overload test was found to be a highly accurate predictor of TTS.