Tone-in-noise detection deficits in elderly patients with clinically normal hearing

Abstract

Purpose: One of the most common complaints among the elderly is the inability to understand speech in noisey environments. In many cases, these deficits are due to age-related hearing loss; however, some of the elderly that have difficulty hearing in noise have clinically normal pure-tone thresholds. While speech in noise testing is informative, it fails to identify specific frequencies responsible for the speech processing deficit. Auditory neuropathy patients and animal models of hidden hearing loss suggest that tone-in-noise thresholds may provide frequency specific information for those patients who express difficulty, but have normal thresholds in quiet. Therefore, we aimed to determine if tone-in-noise thresholds could be a useful measure in detecting age-related hearing deficits, despite having normal audiometric thresholds. Materials & Methods: We tested this hypothesis by measuring tone-in-noise thresholds in 11 Old (62.4 +/− 5 years) and 21 Young (23.1 +/− 2.2 years) patients with clinically normal thresholds. Tone thresholds were measured in a quite sound field, then in 20, 30 and 40 dB HL broadband noise. Results: Despite having normal hearing (thresholds ≤ 25 dB HL), the Old patients had significantly worse tone-in-noise thresholds than the Young patients at 0.125, 4, and 8 kHz. Linear regression analysis showed that the growth of masking in Old and Young patients was nearly identical at all frequencies. However, the amount of masking at low and high frequencies was typically 10–18 dB greater in the Old patients compared to the Young, except near 1 kHz. The frequency-dependent changes in masking are discussed in the context of a “line busy” model and temporal bone studies of auditory nerve fiber loss.

Otolaryngologic Symptoms in Multiple Sclerosis: A Review

“…Sudden SNHL is more common in the early stages (within two years from diagnosis), while progressive SNHL in late stages (after five years) [16][17][18][19][20] or derive from central nervous system demyelination, especially in cases in which no auditory alterations are evident 18,40 .…”

“…Audiological investigations as tonal and speech audiometry, Auditory Brainstem Responses (ABR), and transient (TEOAE) or Distortion Product Otoacoustic Emissions (DPOAE) are crucial to correctly describe and characterize hearing deficits in patients with MS. Often, clinical audiometry is not able to detect deficits in MS patients possibly due to forms of hidden hearing loss 30,31,40 , and ABR is necessary 16 . A recent review of the literature that included 47 studies and 1533 patients evaluated, among other tests, the role of ABR in MS patients, showing that it was abnormal in the majority of MS patients during the active phase and remained altered in nearly ¼ of the patients even after complete hearing recovery occurred 16 .…”

Presbycusis: An Update on Cochlear Mechanisms and Therapies

“…Although these low-spontaneous rate (SR) fibers do not contribute to threshold detection in quiet situations, they contribute to coding of transient stimuli in the presence of continuous background noise [11], leading to the new concept called hidden hearing loss. Therefore, tone in noise detection may be a useful measure in detecting age-related hearing deficits for those patients who express difficulty, but have relatively normal thresholds in quiet [12].…”

Oto-acoustic emissions and brainstem evoked response audiometry in patients of tinnitus with normal hearing

“…Tone in-noise thresholds may provide frequency specific information in auditory neuropathy patients with normal pure tone threshold. Ralli et al 29 found that, despite having normal hearing (thresholds ≤ 25 dB HL), the Old patients had significantly worse tone in-noise thresholds than the Young patients thus concluding the significance of tone in-noise detection as a effective way for diagnosis of hidden hearing loss. 28 We observed TEOAE and DPOAE result as REFER in 37.5% and 43.8% of patients of tinnitus with normal hearing respectively.…”