Hearing Measurement Lecture - PDF

Hearing Measurement Lect.05 Dr. Steve J Aiken, Dalhousie University, 2025  Hodgepodge Day Hodgepodge Topics – Case History – Pseudohypoacusis – Tinnitus – Hyperacusis – Hearing Loss Prevention Hearing Measurement Case History Reason for Visit and Reported Hearing Centering...

Hearing Measurement Lect.05 Dr. Steve J Aiken, Dalhousie University, 2025  Hodgepodge Day Hodgepodge Topics – Case History – Pseudohypoacusis – Tinnitus – Hyperacusis – Hearing Loss Prevention Hearing Measurement Case History Reason for Visit and Reported Hearing Centering the Client checklists can be helpful, but the real skill is in listening – follow-up thoughtfully on things that the person says be sensitive to cultural differences and individual differences focus on creating a safe and comfortable space Previous Evaluations previous evaluations often contain critical information – they will save time and stress – but remember that things change (especially when patient is experiencing a new problem)  Tinnitus may be related to hearing loss – temporary or permanent threshold shift ototoxicity vestibular schwannomas – likely unilateral in these cases (95%) Ménière’s disease – tinnitus may be described as ‘roaring’ or have a sound like wind or rushing water – often accompanied by aural fullness and low frequency hearing loss – balance problems – progressive  Ear Surgery may influence thresholds may be residual differences (e.g., stapedotomy) may affect what procedures you perform – ear impressions – immittance measures  Middle Ear History chronic otitis media trauma and disarticulation barotrauma perilymphatic fistula otosclerosis cholesteatoma  Otitis Media eustachian tube dysfunction by infection - Children at a greater risk because ET is shorter, more horizontal and more compliant – 95% of children will have 1 episode of OM before 6 years of age – 50% of children will have OM prior to 1 year & will have 6 or more bouts in the following 2 years eustachian tube is normally closed – can be blocked by edema, so cannot open (fluid build-up under skin) – oxygen is trapped in ME and creates a vacuum and results in negative pressure within the ME space – lining becomes reddened if it persists, often leads to transudation (serous fluid)  Types of Otitis Media Acute Otitis Media (< 3 weeks) – with or without effusion (fluid in middle ear space) with effusion called “Serous “ or “Secretory” – purulent (i.e., with pus) or non-purulent Chronic Otitis Media (≥ 3 months) – with or without effusion (fluid in middle ear space) – over time, may become thick: ‘glue ear’ Chronic Suppurative (discharge) Otitis Media – perforation in TM – otorrhea (discharge of pus)  Cholesteatoma after a perforation, tympanic membrane skin grows through hole, and continues to grow into a benign tumour in the middle ear may eat away at middle ear structures Hawke & McCombe, 95  Otosclerosis disorder of bony growth – stapes becomes spongy and often fixed genetic component more common in females (twice as likely) – onset may be related to pregnancy (although this has recently been challenged — Qian & Alyono, 2020) usually bilateral  Otosclerosis Carhart’s notch – reduction of bone conduction values at 2 kHz (but not SNHL!) treatment: surgical or hearing aids (if surgery rejected) – placement of prosthesis  Dizziness may relate to – Meniere’s disease – recent (or fluctuating) vestibular problem – but there are many reasons that people are dizzy low blood sugar other medications – e.g. Bance Dizziness Diary Head Injuries Why might this matter?  Illnesses, Conditions Hearing loss associated with many conditions e.g., – diabetes – Alport’s syndrome – cancer – Charcot-Marie-Tooth – multiple sclerosis – COVID 19  Family History: Genetics http://www.genome.gov/Pages/Education/Modules/YourFamilyHealthHistory.pdf  Drawing Your Tree http://www.genome.gov/Pages/Education/Modules/YourFamilyHealthHistory.pdf  Potential Otoxicity loop diuretics (for kidney problems or hypertension – congestive heart failure) – furosemide salicylates (e.g., aspirin) cancer medications – carboplatin – cisplatin quinine aminoglycosides (for bacterial infection) – gentamycin – kanamycin  Noise Exposure musicians industrial workers hunters consider temporary threshold shift (TTS) and permanent (PTS) in evaluation Hearing Aids how are the drawers hearing? what are the issues? – read the file – call the company Hearing Measurement Pseudohypoacusis  Pseudohypoacusis also called malingering, functional hearing loss, non-organic hearing loss may be psychogenic (psychological cause) prevalence estimates 2% …. 50% ??  Clues financial incentive childhood/adolescence – difficulty at school mismatch between thresholds and $$$ performance speech results different than expected  Clues excessive straining to hear excessive detail about impact of loss attributing success to lipreading Clues inconsistent thresholds during test a large number of false negatives Clues: No Shadow Curve  Clues: Speech Tests SRT measurements strange SRT errors – Repeat only half of spondee even though they’ve been familiarised WRS scores odd – Could be retrocochlear problem but pretalk can indicate what should be expected Pseudohypoacusis Strategies ascending measurement random level presentation inform patient of discrepancy  Pseudohypoacusis Strategies: Children the gift of fear – If you know they’re faking open communicatio n false task Physiological Approaches electrodermal audiometry acoustic reflexes OAEs electrophysiology – ABR/MLR/LLR the Lombard effect …. the STENGER!  The “Stenger” requires falsifying at least 40 dB asymmetry a tone is presented 10 dB above (louder than) threshold in the better ear, and 10 dB below (softer than) threshold in the “worse” ear (interlock) , e.g., – “better” ear 0 dB HL threshold (present at 10 dB HL)—will def. hear it – “worse” ear 60 dB HL threshold (present at 50 dB HL)—will only hear it if they’re faking the loss – patient will think this is only in the “worse” ear if they’re faking the hearing loss, because the tone is at a much higher level in the worse ear (and they will NOT respond)  positive Stenger (pseudohypoacusis) – patient will hear this as coming from the better ear if the hearing loss is real (since it’s inaudible in poorer ear), and the patient WILL respond  negative Stenger (true hearing loss) – the patient always hears it, so if they say they don’t, they’re lying The Stenger Hearing Measurement Tinnitus  Tinnitus Permanent Tinnitus – 5-15% – 12% after 60 yrs – 5% from 20-30 yrs – Interferes with QOL for 1-3%  Causes of Tinnitus produced in cochlea? – auditory nerve activity is decreased in noise-induced hearing loss and for toxic substances like quinine and aminoglycosides, but these cause tinnitus, so the answer is no could be related to increased gain in brainstem (Schaette and McAlpine, 2011)up-regulation of excitatory receptors and a  Cortical Reorganization and Synchrony could also be cortical  diminished cochlear output causes reduced cortical inhibition, hyperexcitability, increased synchrony, and cortical remapping (image from Jos Eggermont) Helping with Tinnitus background noise – fans – noisy appliances music hearing aids noise generators tinnitus apps Acoustic Enrichment (Eggermont) after hearing loss is induced, an acoustically enriching environment prevents or mitigates cortical reorganization likely better to wear hearing aids early  Tinnitus Retraining Therapy (Jastreboff) tinnitus masker (but incomplete masking) intensive counseling Hearing Measurement Hyperacusis Hyperacusis Ménière’s disease neuropathies head trauma emotional and psychological problems  Misophonia and Phonophobia Misophonia – hatred of sound, usually particular sounds Phonophobia – fear of sound loud sounds voices  Jastreboff’s Model emotion is involved in perception misophonia (term coined by Jastreboff) develops because of association with limbic system  Naïve Strategies and Appropriate Strategies naïve wearing earplugs makes sounds strategies sound louder (Formby et al., 2003, – quiet lifestyle 2007; Schaette et al., 2014) – earplugs this occurs after about 5 days of plugging recovery can take a day to a week better strategies – hearing aids – noise generators – sensitization  *Upregulation in Brainstem or Cortex? Gu et al., 2010 – recruited individuals with tinnitus and hyperacusis, tinnitus only, hyperacusis only and controls (4 groups) “SLT” in figure is abnormal Sound Level Tolerance (i.e., hyperacusis) – used fMRI to estimate activity levels in midbrain (IC), thalamus, and primary cortex – tinnitus only (without hyperacusis) showed increased activity in cortex only (relative to controls) – tinnitus + hyperacusis (and just hyperacusis) also showed increased activity in midbrain, thalamus and cortex Hearing Measurement Hearing Loss Prevention Basic Sound Levels Sound Levels – What is dBA? NIOSH (CDC) Analysis of Carpentry Permissible Sound Levels: 3 dB Rule Hearing Protection: NIOSH Testing 1998 Personal Sound Devices Portnuff, & Fligor, 2006 Personal Sound Devices Portnuff, & Fligor, 2006  Study Guide for Exam Format: 40 multiple choice questions (1 hour) – in-person on Brightspace See study guide on Brightspace – focus on lectures primarily, with book as supplement (everything has been covered in class) – know how to describe loss from audiogram e.g., degree, config, type, PTA, percent loss – understand different types of speech tests, why we do them e.g., why do we do the SRT, why spondees – understand why we do masking and when it is required – understand topics (e.g., tinnitus and hyperacusis, stenger, sound dosage)