The Japanese standard test methods used to assess tinnitus are described in this paper. The standard test methods use three different procedures. The first method consists of evaluation of subjective manifestations of tinnitus. Patients were asked to describe the character of their tinnitus, for example, its loudness. The second method is a test of the physical characteristics of the tinnitus. The pitch mach test and the loudness balance test are included in the second method. The pitch match test estimates pitch sensation as its frequency, and the loudness balance test measures the loudness of the tinnitus as the sound pressure level. The third method consist of a test that uses the masking phenomenon. As the test sound grows louder, the tinnitus becomes masked by the test sound. This phenomenon had been used for tinnitus masker therapy.
Biological tissues are permeable to near-infrared light (NIR), and the changes in its absorbance are mostly due to hemoglobin (Hb). Spectroscopy (NIRS) of the head exposed to weak NIR can noninvasively detect Hb changes that accompany cerebral activation, and it can be performed in a sound-attenuated room without any interference by cochlear implants or hearing aids. Although most NIRS signals come from the gray matter at the surface of the brain, stable responses have been obtained to band-passed noise at the levels equal or close to the individuals' hearing thresholds, and to phonemic and intonational contrasts. The responses to the two kinds of linguistic contrasts diverged significantly to the left and to the right, respectively, in the 11-12 months and older age groups and can serve as an indicator of receptive linguistic development. Good correspondence between the brain responses and subjective audio-linguistic percepts was observed in postlingually deaf adults with cochlear implants, while behavioral discrimination appeared several months later than positive brain responses in a congenitally deaf child with a cochlear implant, and there was a concomitant increase in the amplitude of the evoked response. This suggests that NIRS can be used to objectively assess the auditory linguistic development of hearing impaired children.
The ultimate goal of objective audiometry is to predict an audiogram in a frequency-specific manner. The frequency specificity of ABR is inadequate to predict hearing accurately in the low frequency range. The auditory steady-state response (ASSR) is elicited by high-frequency tonal stimuli, and its waveform resembles a sinewave. ASSRs elicited by sinusoidally amplitudemodulated (SAM) tones are expected to be an ideal tool for objective audiometry, because of the high frequency specificity of the stimulus tones and because its waveform is suitable for Fourier transform analyses. When applied to awake adults and detected by phase coherence, the threshold patterns of 40-Hz ASSR closely resemble the corresponding audiogram patterns in all types of hearing impairment. However, the 40-Hz ASSR is not reliable enough to determine the hearing threshold of young children during sleep. The 80-Hz ASSR, however, is clearly detected in young children during sleep by phase coherence, and the threshold patterns of the 80-Hz ASSR resemble the corresponding audiogram patterns. The 80-Hz ASSR therefore appears to be potentially useful for objective audiometry in children. This paper reviews present knowledge about objective audiometry and ASSR, and techniques for detecting ASSR and its clinical application are discussed.
Patients with acute low-tone sensorineural hearing loss (ALSH) who came to my clinic during the past 13 years were classified into the following 3 groups: 1) a definite ALSH group, who completely satisfied the new diagnostic criteria for ALSH proposed by the Research Committee on Acute Profound Deafness, the Ministry of Health, Labour and Welfare of Japan, 2) a practical ALSH group who did not satisfy the criteria 100%, but were considered to have ALSH because of their present history and contralateral hearing, and 3) an uncertain ALSH group that could not be diagnosed as either of the other two groups. The clinical pictures of the definite ALSH group and practical ALSH group were mainly investigated, and the following diagnostic care points were obtained.1) The practical or uncertain ALSH occurs more frequently in the outpatient clinic. 2) Taking a history of mental stress in an outpatient clinic is very difficult. 3) ALSH may occur in any age group and in patients with fixed hearing loss at any frequency, and thus various types of audiogram, except for the ascending type, may be obtained in ALSH patients. 4) ALSH-like patients with dizziness should be followed as the practical ALSH. 5) Atypical Meniere's disease should be treated as the uncertain ALSH. 6) Long-term observation for more than 2 years after onset is desirable to ascertain whether there is recurrence of ALSH.
A clinical survey of patients with acute low-tone sensorineural hearing loss (ALSH) who consulted the author's clinic between 1987 and 2004 was carried out. The increase in number of patients that we described before continued and was caused by an increase in female patients, the same as before. The etiology and pathological changes in the inner ear in ALSH were speculated. ALSH may be due to autonomic nervous system dysfunction or a hormone imbalance, probably caused by some form of social anxiety. Endolymphatic hydorops is thought to be most acceptable pathological change of the inner ear in ALSH. Impaired blood supply to the stria vascularis via the external radiating artery in the middle turn of the cochlea may also cause ALSH. Based on these speculations some drugs that are expected to be effective against ALSH are described. The recent trends in the number of ASLH patients and results of therapy are also presented.
Seventy-one patients (33 male, 38 female) treated who complained of severe tinnitus had been treated in the department of Otolaryngology of Nippon Koukan Hospital and Koukan Clinic during the 1-year period, from April 2004. Thirty-seven patients(19 male, 18 female) had been treated by TRT (Tinnitus Retraining Therapy) with a TCI (Tinnitus Control Instrument) and followed up for 6 months after treatment. We evaluated recovery from the tinnitus by questionnire. The THI (Tinnitus Handicap Inventory) and VAS (Visual Analoque Scale) improved after treatment by TRT. We devided all cases into 2 groups, Hearing Gap (+) group and Hearing Gap (-) group, in whether there was a more than 10dB hearing gap between the right ear and the left ear or not. Both THI and VAS test improved in the Hearing Gap (-) group (25 cases) after 1 month of tratment, whereas the Hearing Gap (+) group (12 cases) improved after 6 months of treatment. These results suggest that it takes a long time forthe Hearing Gap (+) group to improve.
Tinnitus Retraining Therapy (TRT) consists of directive counseling and sound therapy. As sound therapy, patients are told to use the following competing auditory stimuli to achieve habituation a sound generator, hearing aid, or environmental sound enrichment, and in most cases a sound generator is recommended and adapted for individual use. In this study we retrospectively investigated the efficacy of sound generators and environmental sound enrichment in the early phase of TRT by evaluating differences in Tinnitus Handicap Inventory (THI) scores. The THI is a validated self-report tinnitus handicap measure with internal consistency reliability and construct validity, and a 20-point or greater score change is considered statistically significant. The early-phase out-comes of TRT for the severely handicapped cases showed significant improvement in THI scores in both sound therapy alternative groups (sound generator or environmental sound enrichment). However, the difference in improvement level between the two groups was not significant. These results indicate that the selection of sound therapy modalities could be instructed accordingly to the case treated.
Tinnitus Retraining Therapy (TRT) is a well-defined method of treating tinnitus. TRT involves Directive Counseling and Sound Therapy to habituate tinnitus. TRT is effective in only about 80% of tinnitus sufferers. We propose that the effectiveness of TRT is improved by early consultation with a clinical psychologist. We performed reinforced TRT, i. e., TRT plus early consultation with a clinical psychologist and evaluated the effectiveness of early consultation with a clinical psychologist. Since 2002, the Reinforced TRT has been performed at Kasugai Municipal Hospital on a total of 69 patients. The Tinnitus Handicap Inventory (THI), Visual Analogue Scale (VAS), and Hospital Anxiety and Depression Scale (HADS) of the 69 patients improved significantly, suggesting that early consultation with a clinical psychologist is needed to improve the effectiveness of TRT.
Prior to selecting young deaf children as candidates for cochlear implantation in our clinic, we recommend to that parents of a deaf child use home signs, signed Japanese and manual codes of Japanese in everyday communication with their deaf child in addition to hearing aids in order to facilitate their child's language development. According to our top-down approach to auro-oral language education, increases in vocabulary by means of signed Japanese or manual codes of Japanese are easily transformed to speaking, even though cochlear implantation is performed in deaf children at higher ages, if residual hearing has been actively used with hearing aids. During the period from April 2002 to May 2005 24 children two to five years old with hearing loss over 100dB received cochlear implants. The tentative conclusions drawn from the findings obtained in the 24 children are as follows: 1. To obtain the desired results of language education it is important to establish close relations among the parents, the speech therapist, the surgeon, and the teacher for the deaf, with a coordinator at the center. 2. Careful use of manual communication including gestures, signed Japanese, manual codes of Japanese prior to cochlear implantation does not interfere with the postoperative development of spoken Japanese. Instead facilitating language development by means of signed language can be said to be advantageous for the development of postoperative spoken language.
The current status of 16 schoolchildren who had received a cochlear implant between two and five years of age was assessed in terms of language development and school achievement. They were classified into two groups according to differences in language education received before entering school. The first group consisted of children who had received language education by a combination of the auditory-oral mode and manual communication mode, including signed Japanese and manual codes of Japanese, prior to cochlear implantation. The second group consisted of five children who had never received language education before cochlear implantation. They were admitted to a day nursery after surgery on the surgeon's advice to facilitate their language development among hearing peers. The results of the WISC-III demonstrated that the language skills of the children in the first group were significantly superior to those of the children in the second group, with a few exceptions. Based on this finding it was concluded that consistent, long-term language education is indispensable from the beginning of habilitation in candidates for cochlear implantation.
We investigated the speech-language and cognitive-neuropsychological ability of 17 congenitally deaf children wearing cochlear implants and who underwent habilitation for an average of 7 years 8 months by clinical-audiologists using the auditory-oral method at 3 years, 6 years, and 9 years of age. 1. Their achievement levels varied and there were individual differences. One caught up to normal children by 3 years of age, the an other had severe retardation at 9 years of age. 2. We investigated the factors related to the individual differences, especially the developmental retardation, by using the checklists of Mori, and obtained the following results: older age at the time of cochlear implantation, shorter habilitation period before entrance into primary school, parental problems (e. g., difficult with home training), and in relation for these, poor systematic, continuous and gradual speech-language habilitation, and lack of attention, the retardation of Performance Intelligence Quotient. 3. It was suggested that we should intensively educate Japanese speech-therapists to become specialists in the habilitation of hearing-impaired children.
We encountered a 3-year-old child with a cochlear implant for profound loss of hearing and Mondini dysplasia 9 months after the operation. The child had not shown any improvement in auditory perception or language acquisition and had difficulty communicating and relating to his mother. We undertook responsibility for his auditory and language training and continuously assessed the mother's child-rearing attitude both toward her child and toward his loss of hearing, and then analyzed the factors most related to the changes in the mother's attitudes in terms of the child's development of auditory, language, and communication abilities. The following results were obtained. 1) In a case that fails to show improvement in auditory perception and language acquisition after a CI operation, the mother's feelings of more difficulty increase, and there is more stress in child rearing and less self-efficacy. It also adversely affected the mother's overall childrearing attitudes. It is suggested that giving higher priority to establishment of interaction between mother and child than on auditory and language training triggered the change in the mother's child-rearing attitude and toward the loss of hearing. 2) Proactivel use of gestures in addition to the auditory-oral method improved communication between mother and child.