OBJECTIVES: Asymmetric or unilateral hearing loss (AHL) may cause irreversible changes in the processing of acoustic signals in the auditory system. We aim to provide a comprehensive view of the auditory processing abilities for subjects with acquired AHL, and to examine the influence of AHL on speech perception under difficult conditions, and on auditory temporal and intensity processing. DESIGN: We examined peripheral and central auditory functions for 25 subjects with AHL resulting from vestibular schwannoma, and compared them to those from 24 normal-hearing controls that were matched with the AHL subjects in mean age and hearing thresholds in the healthy ear. Besides the basic hearing threshold assessment, the tests comprised the detection of tones and gaps in a continuous noise, comprehension of speech in babble noise, binaural interactions, difference limen of intensity, and detection of frequency modulation. For the AHL subjects, the selected tests were performed separately for the healthy and diseased ear. RESULTS: We observed that binaural speech comprehension, gap detection, and frequency modulation detection abilities were dominated by the healthy ear and were comparable for both groups. The AHL subjects were less sensitive to interaural delays, however, they exhibited a higher sensitivity to sound level, as indicated by lower difference limen of intensity and a higher sensitivity to interaural intensity difference. Correlations between the individual test scores indicated that speech comprehension by the AHL subjects was associated with different auditory processing mechanisms than for the control subjects. CONCLUSIONS: The data suggest that AHL influences both peripheral and central auditory processing abilities and that speech comprehension under difficult conditions relies on different mechanisms for the AHL subjects than for normal-hearing controls.

• MeSH
• dospělí MeSH
• jednostranná nedoslýchavost * patofyziologie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• percepce řeči * fyziologie   MeSH
• senioři MeSH
• sluchová percepce fyziologie   MeSH
• sluchový práh * MeSH
• studie případů a kontrol MeSH
• vestibulární schwannom * patofyziologie   komplikace   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Aging negatively influences the structure of the human brain including the white matter. The objective of our study was to identify, using fixel-based morphometry, the age induced changes in the pathways connecting several regions of the central auditory system (inferior colliculus, Heschl's gyrus, planum temporale) and the pathways connecting these structures with parts of the limbic system (anterior insula, hippocampus and amygdala). In addition, we were interested in the extent to which the integrity of these pathways is influenced by hearing loss and tinnitus. METHODS: Tractographic data were acquired using a 3 T MRI in 79 volunteers. The participants were categorized into multiple groups in accordance with their age, auditory thresholds and tinnitus status. Fixel-based analysis was utilized to identify alterations in the subsequent three parameters: logarithm of fiber cross-section, fiber density, fiber density and cross-section. Two modes of analysis were used: whole brain analysis and targeted analysis using fixel mask, corresponding to the pathways connecting the aforementioned structures. RESULTS: A significantly negative effect of aging was present for all fixel-based metrics, namely the logarithm of the fiber cross-section, (7 % fixels in whole-brain, 14% fixels in fixel mask), fiber density (5 % fixels in whole-brain, 15% fixels in fixel mask), fiber density and cross section (7 % fixels in whole-brain, 19% fixels in fixel mask). Expressed age-related losses, exceeding 30% fixels, were particularly present in pathways connecting the auditory structures with limbic structures. The effect of hearing loss and/or tinnitus did not reach significance. CONCLUSIONS: Our results show that although an age-related reduction of fibers is present in pathways connecting several auditory regions, the connections of these structures with limbic structures are even more reduced. To what extent this fact influences the symptoms of presbycusis, such as decreased speech comprehension, especially in noise conditions, remains to be elucidated.

• Publikační typ
• časopisecké články MeSH

PURPOSE: Previous studies have shown that levels for 50% speech intelligibility in quiet and in noise differ for different languages. Here, we aimed to find out whether these differences may relate to different auditory processing of temporal sound features in different languages, and to determine the influence of tinnitus on speech comprehension in different languages. METHODS: We measured speech intelligibility under various conditions (words in quiet, sentences in babble noise, interrupted sentences) along with tone detection thresholds in quiet [PTA] and in noise [PTAnoise], gap detection thresholds [GDT], and detection thresholds for frequency modulation [FMT], and compared them between Czech and Swiss subjects matched in mean age and PTA. RESULTS: The Swiss subjects exhibited higher speech reception thresholds in quiet, higher threshold speech-to-noise ratio, and shallower slope of performance-intensity function for the words in quiet. Importantly, the intelligibility of temporally gated speech was similar in the Czech and Swiss subjects. The PTAnoise, GDT, and FMT were similar in the two groups. The Czech subjects exhibited correlations of the speech tests with GDT and FMT, which was not the case in the Swiss group. Qualitatively, the results of comparisons between the Swiss and Czech populations were not influenced by presence of subjective tinnitus. CONCLUSION: The results support the notion of language-specific differences in speech comprehension which persists also in tinnitus subjects, and indicates different associations with the elementary measures of auditory temporal processing.

• MeSH
• jazyk (prostředek komunikace) MeSH
• lidé MeSH
• percepce řeči * MeSH
• percepční maskování MeSH
• sluchová percepce MeSH
• sluchový práh MeSH
• srozumitelnost řeči MeSH
• tinnitus * MeSH
• vnímání času * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika MeSH
• Švýcarsko MeSH

Noise-induced tinnitus is generally associated with hearing impairment caused by traumatic acoustic overexposure. Previous studies in laboratory animals and human subjects, however, have observed differences in tinnitus susceptibility, even among individuals with similar hearing loss. The mechanisms underlying increased sensitivity or, conversely, resistance to tinnitus are still incompletely understood. Here, we used behavioral tests and ABR audiometry to compare the sound-evoked responses of mice that differed in the presence of noise-induced tinnitus. The aim was to find a specific pre-exposure neurophysiological marker that would predict the development of tinnitus after acoustic trauma. Noise-exposed mice were screened for tinnitus-like behavior with the GPIAS paradigm and subsequently divided into tinnitus (+T) and non-tinnitus (-T) groups. Both groups showed hearing loss after exposure, manifested by elevated audiometric thresholds along with reduced amplitudes and prolonged latencies of ABR waves. Prior to exposure, except for a slightly increased slope of growth function for ABR amplitudes in +T mice, the two groups did not show significant audiometric differences. Behavioral measures, such as the magnitude of the acoustic startle response and its inhibition by gap pre-pulse, were also similar before exposure in both groups. However, +T mice showed significantly increased suppression of the acoustic startle response in the presence of background noise of moderate intensity. Thus, increased modulation of startle by background sounds may represent a behavioral correlate of susceptibility to noise-induced tinnitus, and its measurement may form the basis of a simple non-invasive method for predicting tinnitus development in laboratory rodents.

• Publikační typ
• časopisecké články MeSH

INTRODUCTION: The video head impulse test (vHIT) evaluates the vestibulo-ocular reflex (VOR). It's usually recorded from only one eye. Newer vHIT devices allow a binocular quantification of the VOR. PURPOSE AIM: To investigate the advantages of simultaneously recorded binocular vHIT (bvHIT) to detect the differences between the VOR gains of the adducting and the abducting eye, to define the most precise VOR measure, and to assess gaze dys/conjugacy. We aimed to establish normative values for bvHIT adducting/abducting eye VOR gains and to introduce the VOR dysconjugacy ratio (vorDR) between adducting and abducting eyes for bvHIT. METHODS: We enrolled 44 healthy adult participants in a cross-sectional, prospective study using a repeated-measures design to assess test-retest reliability. A binocular EyeSeeCam Sci 2 device was used to simultaneously record bvHIT from both eyes during impulsive head stimulation in the horizontal plane. RESULTS: Pooled bvHIT retest gains of the adducting eye significantly exceeded those of the abducting eye (mean (SD): 1.08 (SD = 0.06), 0.95 (SD = 0.06), respectively). Both adduction and abduction gains showed similar variability, suggesting comparable precision and therefore equal suitability for VOR asymmetry assessment. The pooled vorDR here introduced to bvHIT was 1.13 (SD = 0.05). The test-retest repeatability coefficient was 0.06. CONCLUSION: Our study provides normative values reflecting the conjugacy of eye movement responses to horizontal bvHIT in healthy participants. The results were similar to a previous study using the gold-standard scleral search coil, which also reported greater VOR gains in the adducting than in the abducting eye. In analogy to the analysis of saccade conjugacy, we propose the use of a novel bvHIT dysconjugacy ratio to assess dys/conjugacy of VOR-induced eye movements. In addition, to accurately assess VOR asymmetry, and to avoid directional gain preponderance between adduction and abduction VOR-induced eye movements leading to monocular vHIT bias, we recommend using a binocular ductional VOR asymmetry index that compares the VOR gains of only the abduction or only the adduction movements of both eyes.

• Publikační typ
• časopisecké články MeSH

Presbycusis and tinnitus are the two most common hearing related pathologies. Although both of these conditions presumably originate in the inner ear, there are several reports concerning their central components. Interestingly, the onset of presbycusis coincides with the highest occurrence of tinnitus. The aim of this study was to identify age, hearing loss, and tinnitus related functional changes, within the auditory system and its associated structures. Seventy-eight participants were selected for the study based on their age, hearing, and tinnitus, and they were divided into six groups: young controls (Y-NH-NT), subjects with mild presbycusis (O-NH-NT) or expressed presbycusis (O-HL-NT), young subjects with tinnitus (Y-NH-T), subjects with mild presbycusis and tinnitus (O-NH-T), and subjects with expressed presbycusis and tinnitus (O-HL-T). An MRI functional study was performed with a 3T MRI system, using an event related design (different types of acoustic and visual stimulations and their combinations). The amount of activation of the auditory cortices (ACs) was dependent on the complexity of the stimuli; higher complexity resulted in a larger area of the activated cortex. Auditory stimulation produced a slightly greater activation in the elderly, with a negative effect of hearing loss (lower activation). The congruent audiovisual stimulation led to an increased activity within the default mode network, whereas incongruent stimulation led to increased activation of the visual cortex. The presence of tinnitus increased activation of the AC, specifically in the aged population, with a slight prevalence in the left AC. The occurrence of tinnitus was accompanied by increased activity within the insula and hippocampus bilaterally. Overall, we can conclude that expressed presbycusis leads to a lower activation of the AC, compared to the elderly with normal hearing; aging itself leads to increased activity in the right AC. The complexity of acoustic stimuli plays a major role in the activation of the AC, its support by visual stimulation leads to minimal changes within the AC. Tinnitus causes changes in the activity of the limbic system, as well as in the auditory AC, where it is bound to the left hemisphere.

• Publikační typ
• časopisecké články MeSH

Úvod: Vysokofrekvenční tónová audiometrie (VFA) nepatří k rutinnímu audiologickému vyšetření. Na ORL klinice FN v Motole je tato metoda využívána často, zejména v případě pacientů sledovaných pro tumor mostomozečkového koutu (MMK), avšak jednoznačná indikační kritéria nejsou stanovena. Zpětně jsme procházeli audiometrické záznamy s cílem charakterizovat skupinu osob, u které měla metoda diagnostický přínos. Materiál a metodika: Retrospektivně jsme analyzovali 1 515 audiogramů provedených audiometrem MADSEN Astera firmy GN Otometrics během let 2011–2018 u 773 dospělých osob ve věku 16–80 let (47,79 ± 13,54) a anamnézu těchto pacientů. U všech byla provedena VFA zahrnující běžně vyšetřované frekvence do 8 kHz a frekvence nad 8 kHz: 9 kHz, 10 kHz, 11,2 kHz, 12,5 kHz, 14 kHz a 16 kHz. Pacienti podstoupili VFA v rámci vyšetření z různých indikací – pro subjektivní hypakuzi/hyperakuzi, tinitus, vestibulopatii, po akutraumatu či byli odesláni na naše pracoviště již s diagnostikovaným tumorem MMK. Výsledky: U 52 osob (6,73 %) se objevily patologické hodnoty nebo klinicky významná asymetrie pouze v oblasti nad 8 kHz. Tuto skupinu tvořili z 48,08 % pacienti s vestibulárním schwannomem. Dalších 11,53 % byli pacienti s konečnou diagnózou jiných tumorů a vaskulárních malformací otologické oblasti, 3,85 % pacienti postižení vestibulopatií a 23,08 % vyšetřených dále nevyvinulo významně patologický stav, jednalo se většinou o pacienty s prostou hypakuzí a tinitem. Závěr: V klinické praxi se objevují případy pacientů se sluchovou vadou zjistitelnou pouze při provedení VFA. VFA zpřesňuje diagnostiku sluchových poruch a může vést k odhalení i potenciálně život ohrožujících stavů, jako jsou nádory a cévní malformace otologické oblasti.

Introduction: High-frequency audiometry is not usually carried out during routine hearing examinations. It is a frequently used method at the ENT Clinic of the University Hospital Motol (especially in patients being treated for tumours of the pontocerebellar angle), although the exact indicative criteria for this have not been determined. We aimed to characterize a group of patients, using a method which improved the accuracy of the diagnostics. Material and methodology: We analysed 1,515 audiograms retrospectively. These audiograms were performed by using audiometer MADSEN Astera of GN Otometrics during 2011–2018 in 773 adults, aged 16–80 (47.79 ±13.54). They all underwent high-frequency audiometry comprising of all commonly examined frequencies up to 8 kHz, and also at higher frequencies of – 9 kHz, 10 kHz, 11.2 kHz, 12.5 kHz, 14 kHz a 16 kHz. The indication was very diverse – subjective hypacusis/hyperacusis, tinnitus, vestibulopathy, acutrauma, or an already known diagnosis of a pontocerebellar tumour. Results: We identified a clinically significant asymmetry or pathological elevation of the hearing threshold, which was only detectable at frequencies above 8 kHz in 52 patients (6.73%). This group consisted of patients with vestibular schwannoma (48.08%), other tumours and vascular malformations of the temporal region (11.53%), vestibulopathy (3.85%), and patients that had never developed a serious pathology (23.08%). They were mostly patients with straightforward hypacusis or tinnitus. Conclusion: In clinical practice, there are cases of patients with a hearing defect that can only be detected when HFA is performed. HFA clarifies the diagnosis of hearing disorders and can lead to the detection of potentially life-threatening conditions such as tumours and vascular malformations of the otological area.

• Klíčová slova
• vysokofrekvenční tónová audiometrie,
• MeSH
• audiometrie čistými tóny * metody   MeSH
• lidé MeSH
• nedoslýchavost diagnóza   MeSH
• retrospektivní studie MeSH
• tinnitus diagnóza   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

PURPOSE: We aimed to assess the ability of a head-shaking test (HST) to reflect vestibular compensation in patients after unilateral peripheral vestibular loss and to provide missing evidence and new insights into the features of head-shaking-induced nystagmus (HSN) over a 2-year follow-up. BACKGROUND: HSN may occur after a prolonged sinusoidal oscillation of the head. HSN is frequently observed in subjects with vestibular function asymmetry; it usually beats toward the functionally intact or "stronger" ear and can be followed by a reversal of its direction. STUDY DESIGN: A prospective observational case-control study. SETTINGS: A tertiary academic referral center. METHODS: A total of 38 patients after acute unilateral vestibular loss (22 patients with vestibular neuronitis and 16 patients after vestibular neurectomy) and 28 healthy controls were followed for four consecutive visits over a 2-year period. A complex vestibular assessment was performed on all participants, which included spontaneous nystagmus (SPN), the caloric test, the head-shaking test (HST), the video head impulse test (vHIT), the Timed Up and Go (TUG) test, and the Dizziness Handicap Inventory (DHI) questionnaire. We established the criteria for the poorly compensated group to assess different compensatory behaviors and results. RESULTS: We found a time-related decrease in HSN (ρ < -0.84, p < 0.001) after unilateral vestibular loss. After 2 years of follow-up, HSN intensity in compensated patients reached the level of the control group; TUG and DHI also improved to normal; however, the caloric and vHIT tests remained abnormal throughout all follow-ups, indicating a chronic vestibular deficit. Besides, poorly compensated patients had a well-detectable HSN throughout all follow-ups; TUG remained abnormal, and DHI showed at least a moderate deficit. CONCLUSIONS: Our study showed that, after a unilateral peripheral vestibular loss, the intensity of HSN decreased exponentially over time, reflecting an improvement in dynamic ability and self-perceived deficit. HSN tended to decline to the value of the control group once vestibular compensation was satisfactory and sufficient for a patient's everyday life. In contrast, well-detectable HSN in poorly compensated patients with insufficient clinical recovery confirmed the potential of HSN to reflect and distinguish between adequate and insufficient dynamic compensation. HSN could serve as an objective indicator of stable unilateral vestibular loss.

• Publikační typ
• časopisecké články MeSH

Příručka, která se zaměřuje na diagnostiku akutní závrati. Určeno odborníkům v praxi.

• MeSH
• akutní nemoc MeSH
• fyzikální vyšetření MeSH
• závrať diagnóza   MeSH
• Publikační typ
• příručky MeSH

• Konspekt
• Patologie. Klinická medicína
• NLK Obory
• neurologie
• otorinolaryngologie
• NLK Publikační typ
• brožury

Decision making on the treatment of vestibular schwannoma (VS) is mainly based on the symptoms, tumor size, patient's preference, and experience of the medical team. Here we provide objective tools to support the decision process by answering two questions: can a single checkup predict the need of active treatment?, and which attributes of VS development are important in decision making on active treatment? Using a machine-learning analysis of medical records of 93 patients, the objectives were addressed using two classification tasks: a time-independent case-based reasoning (CBR), where each medical record was treated as independent, and a personalized dynamic analysis (PDA), during which we analyzed the individual development of each patient's state in time. Using the CBR method we found that Koos classification of tumor size, speech reception threshold, and pure tone audiometry, collectively predict the need for active treatment with approximately 90% accuracy; in the PDA task, only the increase of Koos classification and VS size were sufficient. Our results indicate that VS treatment may be reliably predicted using only a small set of basic parameters, even without the knowledge of individual development, which may help to simplify VS treatment strategies, reduce the number of examinations, and increase cause effectiveness.

• MeSH
• dospělí MeSH
• klinické rozhodování * MeSH
• lidé středního věku MeSH
• lidé MeSH
• management nemoci * MeSH
• reprodukovatelnost výsledků MeSH
• řízené strojové učení MeSH
• ROC křivka MeSH
• rozhodovací stromy MeSH
• senioři MeSH
• sluch MeSH
• sluchové testy MeSH
• strojové učení * MeSH
• určení symptomu MeSH
• vestibulární schwannom diagnóza   terapie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH