The feeling of ear fullness (FEF) arising from otitis media with effusion is thought to evoke swallowing or the Valsalva maneuver and thereby accelerate spontaneous ventilation in the middle ear. However, it is suspected that children have difficulty in sensing FEF since they do not concretely complain of FEF. Stimulation of the trigeminal nerve by the tension of the eardrum due to inward depression is thought to be accountable for FEF Therefore, it is possible that the superficial sensation of the eardrum changes when a subject is conscious of FEF. In 21 children (33 ears) with otitis media with effusion (FEF present in 17 ears and absent in 16 ears), air-loading pressure was applied to the auditory canal, and changes in the subjects' ability to sense that stimulation were observed. As a result, the ability of children to be conscious of FEF was found to equal that of adults. The superficial sensation of the eardrum could thus possibly be used for the qualitative evaluation of FEF as our results showed that it changed with the presence or absence of FEF.
The aim of this study was to compare auditory brain stem response (ABR) and distortion product otoacoustic emission (DPOAE) in the audiologic evaluation of neonates and infants. We investigated 53 cases (106 ears) of neonates and infants under 1 year old who underwent the DPOAE and ABR tests concurrently. The different rate of the results of the two tests was 28/106 (26.4%). The main causes of the DPOAE failures when compared with ABR were middle-ear effusion and a narrow external ear canal. In one case, the difference of the results of DPOAE and ABR was thought to be due to a high-frequency hearing loss. We found 4 cases (7 ears) with auditory neuropathy, which is a disorder characterized by an absent ABR together with preserved otoacoustic emissions. The combined use of objective testing (such as DPOAE, ABR) and behavioral testing is recommended for pediatric audiologic assessment.
The reliability of the clinical application of the Multiple Auditory Steady-State Response (MASTER) test as a measure of the hearing threshold was evaluated in 35 children with hearing impairment. The thresholds of MASTER were given within two hours. The mean of the time for completing MASTER testing was 57 minutes with a range of 25-115min. In 14 affected ears, the findings of both MASTER and the 80Hz amplitude modulation following response (80Hz AMFR) at a carrier frequency of 1000Hz were examined during sleep. The thresholds of MASTER were compared with behavioral thresholds, which were determined by standard pure-tone audiometry or play audiometry in 13 ears. A significant relationship between MASTER and 80Hz AMFR thresholds was observed, with a Pearson r value of 0.81. MASTER and behavioral hearing thresholds highly correlated at the audiometric test frequencies of 1000Hz, 2000Hz and 4000Hz with the exception of 500Hz. Overall, MASTER can be used as a predictor of the behavioral threshold in children with hearing loss at the frequencies 1000-4000Hz.
Behavioral Observation Audiometry (BOA) and Conditioned Orientation Response Audiometry (COR) were used in 15 children whose hearing loss had been identified with a newborn hearing screening program. The cases with moderate hearing impairment especially demonstrated greater improvements than those with severe and profound deafness, although improvements in the COR threshold, compared to the BOA threshold, could in some degree be observed in most cases regardless of their severity of deafness. Thus, interventional procedures including hearing assessments, amplification using hearing aids and counseling families with hearing impaired children must be conducted carefully and appropriate revision should repeatedly be required. It has already been reported that normal hearing infants demonstrated improvements in hearing thresholds during their first year of life, and similar improvement can be observed among children with hearing impairment as regards their auditory development.
A 55-year-old male visited our hospital complaining of right ear fullness from a few days previously. Pure tone audiometry showed right sensorineural hearing loss. On MRI evaluation, a tumor was found in the right internal auditory canal, with intermediate intensity on T1-weighted image, high intensity on T2-weighted image and enhanced by Gadolinium contrast. Moreover, the patient had a history of two recurrent episodes of right facial paralysis. The tumor was diagnosed as a facial nerve neurinoma. Although in our everyday clinical practice we may encounter many patients complaining of ear fullness owing to sensorineural hearing loss or middle ear disease, there has been no report of a facial nerve neurinoma causing ear fullness. Some hypotheses of the pathogenesis of ear fullness in this case could be put forward as follows: 1) Caused by acute hearing loss on its own. 2) Influence of the affected facial nerve twig on the tympanic plexus of the glossopharyngeal nerve. 3) Influence of the meningeal branch of the vagus nerve occupied by the tumor, that is the general sensory component of the internal auditory canal.
The glycerol test (GT) was performed in 35 ears in 35 patients with acute low-tone sensorineural hearing loss and Meniere's disease, and changes in the feeling of fullness and sensitivity for pressure loading associated with the trigeminal nerve in the tympanic membrane were investigated. Of 20 ears with a feeling of fullness before GT, the feeling of fullness improved in 40.0% after GT, but remained unchanged in 60.0%. The GT positivity rate was 74.3%, but was 75.0% in both groups of improved and unchanged feeling of fullness, suggesting that the system which conduct the feeling of fullness is also present in a region different from the system determining the pure-tone auditory threshold, i. e., a region other than the auditory pathway. The sensitivity for pressure loading was measured in 13 patients who gave consent, and significant improvement was noted in GT-positive ears, suggesting a relationship between the auditory pathway and the afferent pathway of the trigeminal nerve. Based on these findings, somatic sensation through the trigeminal nerve may be related to the development of feeling of fullness in the 2 disorders.
We propose 4 objective hearing tests requiring only short hospitalization for difficult-to-test infants and young children: ABR, auditory steadystate response (ASSR), electrocochleography (ECoG), and electrically induced ABR (EABR) via the ear canal. Both ASSR and ECoG have an advantage in that the use of frequency-specific test tones produces frequency specific thresholds. We used this system to examine 9 infants and young children with profound deafness. The results were as followas; 1) Fourteen ears of 17 ears with no response to ABR responded to ASSR and/or ECoG in the lower frequency areas. 2) Thresholds determined by ECoG test were 5 to 15dB lower than the thresholds predicted by ASSR. The difference was bigger at the low frequency. 3) Detection rate of the response was also twice higher in ECoG (52%) than ASSR (26%). 4) EABR was useful to determine suitable candidates for a cochlear implant. In conclusion, the use of these objective hearing tests during a short hospital stay was useful to predict the remaining hearing ability, the efficacy of hearing aids and also the eventual possibility for a cochlear implant in difficult-to-test infants and young children.
Estimating the hearing threshold in multiply-handicapped children is so difficlt that diagnosis of hearing loss and rehabilitation are usually delayed. Recently, the auditory steady-state resopnse (ASSR) test has been used as a measure of hearing sensitivity. In the present study, we investigated the effectiveness of ASSR for estimating the hearing threshold in multiply-handicapped children. Fifteen multiply-handicapped children were studied, ranging in age from 1 to 12 years with suspected severe hearing loss detected with ABR or infant audiometry. Both ears of all the subjects were tested with MASTER (Bio Logic Corporation). Airconducted ASSRs were recorded with carrier frequencies of 0.5, 1, 2, and 4kHz under sedation. Furthermore, in some cases, bone-conducted ASSR and free field ASSR with hearing aids were recorded. In all cases, ASSR thresholds were recorded. Under the condition of bone-conducted recordings, ASSR would possibly distinguish between conductive and sensorineural hearing loss. Under the in condition of free field recordings, ASSR could possibly evaluate functional gains. This suggested that ASSR might be helpful for planning therapy, and in selecting candidate suitable for hearing aids and cochlear implantation among multiply-handicapped children.
The subjects were 20 infants who had a medical examination, and in whom the speech therapist had been asked to check their hearing and development following high ABR readings in their neonatal hearing screening. We analyzed the process of our strict hearing tests and discuss herein the essential support until required a diagnosis could be made. Infants who were in the NICU required a longer time to reach diagnosis than normal healthy infants. In 5 cases, there was no correlation between the ABR and the neonates' and infants hearing test because of their ABR, or the test findings improved during the strict hearing test. It is important to combine the neonatal and infant hearing test with ABR, after the normal neonatal hearing screening. Additionally, support should be offered to both the child and their parents during their developmental period, and the child's hearing tests, so that the anxiety felt by the family can be decreased, and the child is encouraged to give clean and prompt responses during hearing tests.