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      Current audiological diagnostics

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          Abstract

          Today’s audiological functional diagnostics is based on a variety of hearing tests, whose large number takes account of the variety of malfunctions of a complex sensory organ system and the necessity to examine it in a differentiated manner and at any age of life. The objective is to identify nature and origin of the hearing loss and to quantify its extent as far as necessary to dispose of the information needed to initiate the adequate medical (conservative or operational) treatment or the provision with technical hearing aids or prostheses. Moreover, audiometry provides the basis for the assessment of impairment and handicap as well as for the calculation of the degree of disability. In the present overview, the current state of the method inventory available for practical use is described, starting from basic diagnostics over to complex special techniques. The presentation is systematically grouped in subjective procedures, based on psychoacoustic exploration, and objective methods, based on physical measurements: preliminary hearing tests, pure tone threshold, suprathreshold processing of sound intensity, directional hearing, speech understanding in quiet and in noise, dichotic hearing, tympanogram, acoustic reflex, otoacoustic emissions and auditory evoked potentials. Apart from a few still existing gaps, this method inventory covers the whole spectrum of all clinically relevant functional deficits of the auditory system.

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          Most cited references334

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          Human auditory steady-state responses.

          Steady-state evoked potentials can be recorded from the human scalp in response to auditory stimuli presented at rates between 1 and 200 Hz or by periodic modulations of the amplitude and/or frequency of a continuous tone. Responses can be objectively detected using frequency-based analyses. In waking subjects, the responses are particularly prominent at rates near 40 Hz. Responses evoked by more rapidly presented stimuli are less affected by changes in arousal and can be evoked by multiple simultaneous stimuli without significant loss of amplitude. Response amplitude increases as the depth of modulation or the intensity increases. The phase delay of the response increases as the intensity or the carrier frequency decreases. Auditory steady-state responses are generated throughout the auditory nervous system, with cortical regions contributing more than brainstem generators to responses at lower modulation frequencies. These responses are useful for objectively evaluating auditory thresholds, assessing suprathreshold hearing, and monitoring the state of arousal during anesthesia.
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            Efficient adaptive procedures for threshold and concurrent slope estimates for psychophysics and speech intelligibility tests.

            The minimum standard deviations achievable for concurrent estimates of thresholds and psychometric function slopes as well as the optimal target values for adaptive procedures are calculated as functions of stimulus level and track length on the basis of the binomial theory. The optimum pair of targets for a concurrent estimate is found at the correct response probabilities p1 = 0.19 and p2 = 0.81 for the logistic psychometric function. An adaptive procedure that converges at these optimal targets is introduced and tested with Monte Carlo simulations. The efficiency increases rapidly when each subject's response consists of more than one statistically independent Bernoulli trial. Sentence intelligibility tests provide more than one Bernoulli trial per sentence when each word is scored separately. The number of within-sentence trials can be quantified by the j factor [Boothroyd and Nittrouer, J. Acoust. Soc. Am. 84, 101-114 (1988)]. The adaptive procedure was evaluated with 10 normal-hearing and 11 hearing-impaired listeners using two German sentence tests that differ in j factors. The expected advantage of the sentence test with the higher j factor was not observed, possibly due to training effects. Hence, the number of sentences required for a reliable speech reception threshold (approximately 1 dB standard deviation) concurrently with a slope estimate (approximately 20%-30% relative standard deviation) is at least N = 30 if word scoring for short, meaningful sentences (j approximately 2) is performed.
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              A 40-Hz auditory potential recorded from the human scalp.

              Computer techniques readily extract from the brainwaves an orderly sequence of brain potentials locked in time to sound stimuli. The potentials that appear 8 to 80 msec after the stimulus resemble 3 or 4 cycles of a 40-Hz sine wave; we show here that these waves combined to form a single, stable, composite wave when the sounds are repeated at rates around 40 per sec. This phenomenon, the 40-Hz event-related potential (ERP), displays several properties of theoretical and practical interest. First, it reportedly disappears with surgical anesthesia, and it resembles similar phenomena in the visual and olfactory system, facts which suggest that adequate processing of sensory information may require cyclical brain events in the 30- to 50-Hz range. Second, latency and amplitude measurements on the 40-Hz ERP indicate it may contain useful information on the number and basilar membrane location of the auditory nerve fibers a given tone excites. Third, the response is present at sound intensities very close to normal adult thresholds for the audiometric frequencies, a fact that could have application in clinical hearing testing.
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                Author and article information

                Journal
                GMS Curr Top Otorhinolaryngol Head Neck Surg
                GMS Curr Top Otorhinolaryngol Head Neck Surg
                GMS Curr Top Otorhinolaryngol Head Neck Surg
                GMS Current Topics in Otorhinolaryngology, Head and Neck Surgery
                German Medical Science GMS Publishing House
                1865-1011
                18 December 2017
                2017
                : 16
                : Doc09
                Affiliations
                [1 ]Functional Area of Audiology, Department of Otolaryngology, University of Heidelberg, Germany
                [2 ]Department of Otolaryngology, HELIOS Hospital of Erfurt, Germany
                Author notes
                *To whom correspondence should be addressed: Sebastian Hoth, Functional Area of Audiology, Department of Otolaryngology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany, E-mail: sebastian.hoth@ 123456med.uni-heidelberg.de
                Article
                cto000148 Doc09 urn:nbn:de:0183-cto0001484
                10.3205/cto000148
                5738938
                29279727
                bf478c45-67a2-49ae-ac2d-fd4efd43380e
                Copyright © 2017 Hoth et al.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

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                Categories
                Article

                Surgery
                hearing disorders,hearing tests,pure tone threshold,recruitment tests,speech audiometry,impedance audiometry,otoacoustic emissions,auditory evoked potentials

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