Cochlear Deafness

Causes
congenital aplasia labyrinthitis (viral, bacterial) ototoxic drug: streptomycin, kanamycin, garamycin, neomycin, quinine, alcohol sudden deafness head trauma/trauma kapitis noise-induced

Clinical Manifestation
recruitment: unable to hear soft sound, but loud sound is uncomfortable able to hear sound, but difficult to understand conversation

Investigation: special audiometry

SISI (Short Increment Sensitivity Index) test ABLB (Alternate Binaural Loudness Balance) test Speech audiometry Bekessy Audiometry Objective audiometry:
Impedance audiometry Otoacoustic emission BAER

SISI test
detect recruitment phenomenon
determine the pts hearing treshold give stimuli 20 dB above hearing treshold give additional 5 dB stimuli reduce stimuli to 4, 3, 2, 1 dB pts able to discriminate + SISI or: increase stimuli 1 dB every 5s up to 20 times count how many times pts able to discriminate the differences + if 70 100% score 0 70% : not specific, maybe normal or other perceptive deafness

ABLB test
requires: - normal hrg in one ear at freq to be used - difference in between ears > 25 dB
tones pulse alternating between ears 2 or 3 times per judgement. pt is asked which ear is louder or same begin at 20 SL in poorer ear, 0 SL in better ear. adjust level in better ear 5 dB steps

 find level where loudness judged equal. increase poorer ear by 10 or 20 dB and repeat adjustments in better ear.

plotting result:
Use the LADDERGRAM Connect decibel values judged equally loud

Speech audiometry
obj: to assess pts ability in daily conversation, or to assess the need of hearing aid
pts asked to repeat heard word from recorder cochlear deafness: pts unable to discriminate S R C N H CH interpretation of speech discrimination score:
90 100%: normal 75 90%: mild hearing loss 60 75%: moderate hearing loss 50 60%: difficult to follow daily conversation <50%: severe hearing loss

speech reception test: ability to correctly repeat 50% of recorded words, 20-30 dB above hearing threshold Speech discrimination score: highest score reached by pts in particular intensity

Bekessy audiometry
given interrupted and continuous sound pts responds by pressing button when a sound heard N: amplitude 10 dB recruitment: amplitude <10 dB
type 1 (normal): interrupted and continuous sound coincide (berhimpit) type 2 (cochlear deafness): coincide only until 1000 Hz type 3 (retrocochlear deafness): separated on all freq type 4: same w/ type 3, but smaller amplitude

I: C and I overlap: norm or cond. II: C below I at freqs of HL: Cochlear III: I follows loss, C drops to bottom: Retro IV: C below I by 20-25 dB: Coch or Ret V: I below C: False hearing loss

Loudness Growth Patterns

120 100 80 60 40 20 0 10 30 50 70
Normal Cochlear Retro-cochlear

Impedance Audiometry
decrease treshold of acoustic reflex

Otoacoustic Emission
=cochlear response produced by outer hair cell with probe, microphone, loudspeaker

Brainstem Auditory Evoked-Response

wave:
I: cochlea II: cochlear nucleus III: superior olivary nucleus IV: lateral lemniscus V: inferior colliculi