TESTS TO DIAGNOSE DEAD

REGIONS IN COCHLEA

-Amritha G
Assistant professor and Clinical
Supervisor in Audiology, MERFISH
• Place coding of basilar membrane
• The frequency that leads to maximal vibration at a
given place on BM is called characteristic frequency
for that place
• OHC – active mechanism – increases the response to
weak sounds and sharpens the tuning on BM –
increases the frequency selectivity of AS which helps
to separate frequencies that are present in complex
sounds – speech/ music
• IHC – neurotransmitter – leads to neural
activity
• Threshold elevation secondary to cochlear
damage – OHC damage/ IHC damage
• Loss up to 55 dBHL – damage to OHC
• >55 dBHL loss of OHC and IHC
• Audiogram alone is insufficient to determine
the proportion of OHC and IHC damage
• At certain places where IHC are non
functioning along with the neurons which are
in contact with IHC
• Places with non functioning IHC/ neurons –
‘Lacunae/holes in hearing/ dead regions/ dead
zones’
? Possible high frequency dead region
• Suppose – HF dead region – neurons connected
to the basal end (High CF) – will not respond
• If high frequency pure tone presented – if it
sufficiently produces vibration at a region
closer to the low frequency apical end adjacent
to it- then this sound may be detected by
neurons closer to it which are tuned to a lower
frequency – OFF PLACE LISTENING/ OFF
FREQUENCY LISTENING
• Could be low frequency/ mid frequency/ high
frequency dead regions
• Hearing loss >70 dBHL in PTA – S/O dead
regions but PTA is not a sufficient tool
• Dead region – expressed in range
• Eg: IHC are non functioning over a region on
BM whose CF ranges from 2.5 KHz to 20
KHz- we describe as dead region extending
from 2.5 KHz upwards
• Edge frequency- 2.5KHz
• Diagnosing – TEN(HL), PTC- using masking
noise
• Threshold for detecting tone in the presence
of TEN – Threshold Equalizing Noise
• Synthesized noise- threshold for detecting a
tone in noise in dBSPL was approximately
same for all frequencies in the range of 250
KHz – 10 KHz for people with normal hearing
• The masked threshold= to the nominal level of
level of noise in dBSPL
• When the puretone signal frequency falls in a
dead region, the signal will only be detected
when it produces sufficient basilar membrane
vibration at a remote region in the cochlea
where there are surviving IHCs and neurons.

• The amount of vibration produced by the tone at

this remote region will be less than in the dead
region, and so the noise will be very effective in
masking it. Thus, the signal threshold is
expected to be markedly higher than normal.
 Criteria
• A dead region at a particular frequency is
indicated by a masked threshold that is at
least 10 dB above the absolute threshold and
10 dB above the nominal noise level
• TEN is performed ipsilaterally – tone and
noise in one ear- TDH 39/ inserts
• CD/ audiometric
• second version of the TEN test was developed
in which the noise was designed to give equal
masked thresholds in dBHL for all frequencies
from 500 to 4000 Hz for normally hearing
people.13 This version is called the “TEN(HL)”
test.
• absolute thresholds could be measured either
using the tones generated by the audiometer,
or using the test tones from the CD; the results
were expected to be very similar. This version
of the TEN(HL) test can only be used with
specific (TDH39, TDH49, and TDH50)
headphones.
• Designed such that there are minimal
amplitude fluctuations- this type of noise-
low noise- noise
• All peaks and dips in the waveform have
similar amplitude
• 500-4000 Hz
• For frequencies where the hearing loss is less than or
equal to 60 dBHL, set the TEN level to 70 dBHL. This is
not unpleasantly loud for most people, and it leads to a
definitive result.
• When the hearing loss is 70 dBHL or more at a given
frequency, set the TEN level 10 dB above the audiometric
threshold at that frequency. For example, if the
audiometric threshold is 75 dBHL, set the TEN level to 85
dBHL.
• If the TEN is found to be unpleasantly loud, or if the
maximum TEN level of 90 dBHL is reached, then the TEN
level can be set equal to the audiometric threshold. This
should still give a definitive result.
• Step size for detecting threshold- 2 DB
• For a person with normal hearing, the
threshold of the test tone in the TEN is
typically equal to the TEN level. For example,
if the TEN level is set to 70 dBHL, the
threshold for detecting the test tone is about
70 dBHL for any frequency from 500 to 4000
Hz
• If a patient has a cochlear hearing loss but
does not have a dead region at the test
frequency, then the threshold of the test tone
in the TEN is typically a few dB above the TEN
level. For example, if the TEN level is set to 70
dBHL, the threshold for detecting the test tone
might be 73 dBHL
• when the test tone frequency falls in a
dead region, the threshold for detecting
the test tone in the TEN is typically well
above the TEN level. The criteria for
diagnosing a dead region at a specific
frequency are:
• The threshold of the test tone in the TEN is
10 dB or more above the TEN level.
• The threshold of the test tone in the TEN is
10 dB or more above the audiometric
(absolute) threshold.
• not necessary to conduct the TEN(HL) test for
frequencies where the hearing loss is 50 dB or
less.
• For example, if a patient has a typical sloping
hearing loss, with relatively good hearing at
low frequencies and poor hearing at high
frequencies, it is only necessary to conduct the
test for the medium and high frequencies.
• However, if the patient has an unusually
shaped audiogram, such as a localized mid-
frequency loss, it may be worth conducting
the TEN(HL) test even when the loss is mild.
 Clinical applications of TEN(HL)
• implications for fitting hearing aids
• for predicting the likely benefit of hearing
aids
• When a patient has a dead region, there may
be little or no benefit in applying
amplification (via a hearing aid) for
frequencies well inside the dead region.
• 1) high frequency dead region-
• fe= 1000 Hz – some benefit can be expected
upto 1.7Khz to maximum beyond which no
benefit –if we try to increase gain – feed back
issues + distortions would be the result –
incorporate frequency transposition/
frequency lowering/ frequency compression
is suggested
• 2)Low frequency dead regions
• MD – low frequency hearing loss – if fe= 0.57
Hz – above this is benefit below – reduced
intelligibility
• 3) restricted areas of cochlear function
• Rare cases- inverted V – good hearing in small
range – poor at high and low frequencies-
restricted functioning in the cochlea – extensive
dead regions above and below it
• 4) assessing potential use of implants/ hybrids
• patient with extensive dead regions- do
better with a CI than with a Hearing aid
• Hybrid implants – functional hearing in low
frequency- but dead at mid and high
frequencies – so usefulness if we determine
the edge frequency – decide on insertion
depth, frequency distribution for acoustic n
electric stimulation
 Note this!!!!!

 Patients with ANSD will have high thresholds – masked

threshold in TEN – does not mean that they are having
extensive dead region – patchy survival of IHC
Also in those individuals with central problems – trauma/
brain injury- high thresholds are due to poor detection
efficiency rather than from dead regions
TEN – in all cases to be associated with poor ability to
understand speech in noise
PSYCHOACOUSTICAL TUNING CURVES
(PTC)
 Signal is fixed in intensity and frequency
 Usually at 10 dBSL
 Masker is either sinusoid/ NBN
 Usually noise masker because tonal maskers can create
beats
 For each frequency the level of noise needed to just mask
the signal is determined
 tip of the PTC –the frequency at which the masker level is
lowest – close to the signal frequency ; other words –
masker is most effective when its frequency is close to that
of the signal
 tips will be shifted away from the signal
frequency in hearing impaired – broader PTC
–when the signal frequency falls within the
dead region
when the signal frequency falls in a dead
region- low frequency dead region– low
frequency tones are detected by high
frequency fibers-then masker centered above
the signal frequency will be more effective
than a masker that is more close to the signal
frequency
PTC tip shifted downwards in low frequency
dead regions
• Tip of the PTC
Shifted towards
The lower frequencies –
HF dead region
• Overall, PTC s is useful in detecting the dead
regions of cochlea and also to determine the
boundaries. When the Tip of PTC is markedly
shifted, the frequency at the tip indicates the
boundary of dead region, however, it is not a
precise measure if the shift is smaller (<few
hundred Hz)
• good laboratory method- used for research
purposes mostly
• Time consuming
• Choice of appropriate signal frequency and
level can be difficult