Scientific Publications
The following scientific publications present the academic and research work, professional experience and findings of Dr Celene McNeill and her research colleagues. Dr McNeill is an independent audiologist and the founding director of Healthy Hearing and Balance Care.
Management of patient’s with Meniere’s disease.
Meniere’s is not a single entity but several different diseases that may cause the combination of symptoms known as Meniere’s disease (MD).
Cochlear Implantation in Ménière’s Disease With and Without Labyrinthectomy.
Outcomes of cochlear implantation (CI) were investigated in patients with Ménière’s disease (MD) with and without surgical labyrinthectomy. CI in MD can yield good hearing outcomes in all three groups investigated and this is possible even after a long delay after labyrinthectomy. Bilateral MD patients are complex and prospective quality of life (QoL) measures would be beneficial in being better able to manage the vestibular outcomes as well as the audiological ones.
Cochlear Implant Impedance Fluctuation in Meniere’s Disease.
Electrode impedances in the ear with MD showed a variation pattern similar to that found in the hearing fluctuation characteristic of the disease. These findings raise the possibility that the same physiological mechanisms of hearing fluctuation may be responsible for intracochlear electrode impedance changes. Impedance fluctuation may be because of changes in the permeability of the blood-labyrinth barrier because of cyclic immune activity in the inner ear which alters the electrical resistance between scala tympani and blood.
Improving Sound Localization After Cochlear Management of Single-Sided Deafness.
Cochlear implantation followed by 3 months of auditory training may have improved sound localization in a patient with single-sided deafness. Further case-controlled studies need to be undertaken to ascertain whether Cochlear implantation alone without formal auditory training will promote the same results.
Tonic tensor tympani syndrome in tinnitus and hyperacusis patients: A multi‑clinic prevalence study.
Tonic tensor tympani syndrome (TTTS) is an involuntary, anxiety‐based condition where the reflex threshold for tensor tympani muscle activity is reduced, causing a frequent spasm. This can trigger aural symptoms from tympanic membrane tension, middle ear ventilation alterations and trigeminal nerve irritability. TTTS is considered to cause the distinctive symptoms of acoustic shock (AS), which can develop after exposure to an unexpected loud sound perceived as highly threatening. Hyperacusis is a dominant AS symptom. Aural pain/blockage without underlying pathology has been noted in tinnitus and hyperacusis patients, without wide acknowledgment. The high prevalence of TTTS symptoms suggests they readily develop in tinnitus patients, more particularly with hyperacusis.
Behcet’s Disease presenting as a peripheral vestibulopathy.
Prolonged acute spontaneous vertigo can be secondary to acute vestibular neuritis or posterior circulation ischaemia. We present a 66-year-old man who first developed an acute vestibular syndrome with profound unilateral hearing loss 34 years ago. First treated as vestibular neuritis, he subsequently developed manifestations of Behcet’s disease, including mouth ulcers, genital ulcers and erythema nodosum over a period of 10 years. Subsequently, sudden sensorineural hearing loss affecting his only hearing ear responded to immunomodulation, confirming an autoimmune cause for the audio-vestibular symptoms. This report serves as a reminder that vestibular neuritis seldom causes hearing loss; ischaemic, infective and autoimmune causes should be sought when an acute vestibular syndrome is accompanied by hearing impairment.
Tinnitus pitch, masking, and the effectiveness of hearing aids in tinnitus therapy.
Objective: To assess the benefits of hearing aids on tinnitus according to the tinnitus reaction questionnaire (TRQ; Wilson et al, 1991), to verify whether the degree of masking provided by the hearing aid influenced the TRQ score, to examine whether the matched tinnitus pitch predicted the effectiveness of hearing aids in masking tinnitus, and to determine whether prescription of high-frequency amplification might be desirable in tinnitus management when tinnitus pitch is high. Design and study sample: A retrospective evaluation of the clinical outcomes of 70 tinnitus patients fitted with hearing aids was undertaken. The primary outcome measure was the TRQ, with a secondary subjective measure of tinnitus masking. Results: Participants who achieved masking with their hearing aids had a greater reduction in TRQ scores. Masking was more likely to be achieved when participants had good low-frequency hearing and tinnitus pitch fell into the frequency range of the hearing aids. Conclusions: The results support the use of hearing aids for tinnitus management, and suggest that masking may be a significant contributor to hearing aid success, implying that high-frequency amplification may be effective in high-pitch tinnitus.
Bilateral Cochlear Implants in Long-Term and Short-Term Deafness
This is a case study of a 70-year-old man with single-sided deafness (SSD) in the right ear since childhood, who developed a sudden severe hearing loss in the left ear at age 63. Eventually, after he received cochlear implants in both ears, he started to present behavioural auditory processing skills associated with binaural hearing, such as improved ability to understand speech in the presence of background noise and sound localisation. Outcomes were measured using cortical auditory evoked potentials, speech perception in noise, sound-localisation tests, and a self-rating questionnaire. The results suggest that even after more than 50 years of unilateral deafness it was possible to develop binaural interaction and sound localisation as a result of electric auditory stimulation.
Signs of Binaural Processing with Bilateral Cochlear Implants in the case of someone with more than 50 years of unilateral deafness.
A case is presented of a 70-year-old man with a profound sensorineural hearing loss in the right ear since childhood and who developed sudden severe hearing loss in the left ear at age 63. Eventually, after he received cochlear implants in both ears, he started to present behavioural auditory processing skills associated with binaural hearing, such as improved ability understanding speech in the presence of background noise, and sound localisation. Responsiveness and outcomes were measured using cortical auditory evoked potentials, speech perception in noise, sound localisation performance, and a self-rating questionnaire. The results suggest that even after more than 50 years of unilateral deafness it is possible to develop binaural interaction and sound localisation.
Short-term hearing fluctuation in Meniere’s disease.
This study aimed to assess the extent and implications of short-term hearing fluctuation in Meniere’s disease. Thirty-six subjects diagnosed with Meniere’s were recruited to measure their own hearing using in-situ audiometry via a hearing aid (Widex Diva) and a portable programmer (SP3). Self-hearing tests measuring up to 14 frequency bands were conducted three times a day over eight weeks using the expanded SensogramIM. Twenty-three ears showed low-frequency fluctuation while ten fluctuated in mid frequencies with some ‘double peak’ audiogram configurations. Eight ears in the later stages of Meniere’s, contrary to expected, also recorded fluctuation across all frequencies. Self-hearing testing Meniere’s ears over eight weeks revealed great hearing fluctuation with significant changes in audiogram configuration. It suggests that as endolymphatic hydrops progresses through the cochlea, low-frequency fluctuation is followed by fluctuation in the mid frequencies, leading to fluctuation across all frequencies. Use of a self-hearing test may facilitate diagnosis and hearing aid fitting for this population, as clinical audiograms may not provide accurate information of hearing fluctuation.
Hearing fluctuation is not a predictor of vertigo attacks in Meniere’s syndrome.
This study aimed to determine if regular self-hearing tests would be useful as a predictor of vertigo in patients with Meniere’s syndrome. The study group consisted of patients who had a clinical diagnosis of definite Meniere’s syndrome according to the AAO-HNS criteria, a score on the Gibson scale of 7 or over and an enhanced negative summating potential on transtympanic electrocochleography. These patients were supplied with a programmable hearing aid and a portable programmer that allowed them to measure their own hearing in-situ. They were asked to measure their audiometric thresholds daily and if possible during the attacks of vertigo. Hearing fluctuation occurred more often than expected but did not usually correlate with vertigo episodes. Statistical analysis showed that it would not be possible to predict an attack based on changes in hearing thresholds in this group of patients with Meniere’s disease.
Tinnitus perception and the effects of a self-programmable hearing aid on hearing fluctuation due to Meniere’s disease.
Fifty patients with Meniere’s disease rated their subjective perception of tinnitus loudness just before measuring their own hearing thresholds 3 times a day for a period of 8 weeks. Tinnitus loudness was recorded using a subjective scale 1-5. Hearing thresholds were recorded in dBHL as tested in-situ at 14 frequency bands using a portable programmer connected to custom fitted hearing aids. This equipment allowed the hearing aids to be automatically programmed to the given hearing loss at the end of each self-hearing testing. Patients were given the option to continue wearing the hearing aids and portable programmer to adjust for hearing fluctuation. Data analysis showed no correlation between changes in tinnitus loudness perception and hearing fluctuation. Usage of self-programmable hearing aids caused a positive impact on tinnitus perception in this group: 20% reported not hearing their tinnitus while wearing their aids. 69% perceived their tinnitus softer and 11% did not notice any changes. Importantly, none of the patients in this group noticed an increase in tinnitus loudness while wearing optimally fitted hearing aids.
Are cortical auditory evoked potentials useful in the clinical assessment of adults with cochlear implants?
Cochlear implant (Cl) trends are changing as more recipients are receiving bilateral implantation. Also more pre-lingually deafened adults are choosing to be implanted. Clinical assessment after cochlear implantation is usually based on speech perception tests. Such tests, however, may not be a realistic outcome measure for some of these cases, creating a need for more objective measures of Cl performance. Cortical auditory evoked potentials (CAEPs) recorded in the sound field may be a fast and reliable procedure for the clinical audiologist to determine Cl outcomes. This paper presents two case studies illustrating CAEP findings in an adult Cl user who was pre-lingually deafened and a bilateral Cl user.
Changes in Audiometric thresholds before, during and after attacks of vertigo associated with Meniere’s Syndrome.
No significant changes in hearing thresholds were observed during vertigo attacks associated with Meniere’s disease. Objectives: To determine if tile hearing alters during the period of the attacks of vertigo in Meniere’s disease. Patients and methods: The study group consisted of patients who had a clinical diagnosis of definite Meniere’s syndrome according to the AAOOHNS criteria, a score on the Gibson scale of 7 or over and an enhanced negative summating potential on transtympanic electrocochleography. These patients were supplied with a programmable hearing aid and a portable programmer that allowed them to measure their own hearing in situ. They were asked to measure their audiometric thresholds daily and if possible during the attacks of vertigo. Results: Six of the patients were able to measure their hearing during attacks of vertigo and their hearing thresholds obtained before, during and after the vertigo attacks were compared. Five of six subjects showed < 10 dBHL change in the hearing levels at all tested audiometric frequencies before, during and after the attacks of vertigo. One subject had a probable change in threshold before the attack but not during the attack of vertigo.
Hearing Aids for Meniere’s Syndrome: Implications of Hearing Fluctuation.
Hearing fluctuation imposes the biggest challenge in the fitting of hearing aids for patients with Meniere’s syndrome. This study shows that the problem maybe be overcome by allowing the patients to test their own hearing and to program their own hearing aids to adjust for hearing fluctuation. Among participants, 70 percent continued to program their hearing aids on a regular basis and reported great satisfaction with amplification because they are now able to adjust their own devices when their hearing fluctuates.
Cortical auditory evoked responses from an implanted ear after 50 years of profound unilateral deafness.
A male with unilateral deafness in the right ear since 8 years of age developed a sudden hearing loss in the left ear at age 63. A hearing aid was fitted in the left ear with limited benefit. The right ear received a cochlear implant (CI) 20 months later. Cortical auditory evoked potentials (CAEPs) and speech recognition scores (SRS) were measured in free-field three, six and nine months after implantation with the hearing aid alone, CI alone and bimodal condition (hearing aid and CI together). Three months after implantation the cortical responses for the two ears were similar, despite more than 50 years of unilateral auditory deprivation. CAEPs measured over time show evidence of binaural interaction and improvements in SRS.
A Hearing Aid System for Fluctuating Hearing Loss Due to Meniere’s Disease: A Case Study.
A case study of a client with Meniere’s disease who was successfully fitted with hearing aids in spite of his fluctuating hearing loss. The selected hearing instruments had a portable programmer that allowed the client to measure his own hearing and to program his own hearing aids at home. It shows the hearing fluctuation, as measured by the client three times a day, over a period of time, as well as different audiograms performed in the clinic by the audiologist. This study demonstrates the feasibility of training a client with fluctuating hearing loss to reliably measure his own hearing levels and program his hearing aids to enhance the level of satisfaction with amplification.
Conventional behind-the-ear hearing aids after subtotal petrosectomy with blind sac surgery.
For patients troubled by the limitations imposed on hearing with a unilateral conductive loss following a subtotal petrosectomy and blind sac closure, a behind-the-ear aid is a simple and easy option to try, if the residual canal allows fitting of the aid. Three patients reported good hearing result despite the absence of the middle ear structures.
Towards new criteria for hearing aids recommendation.
Hearing aids have significantly improved in recent times but fitting criteria have not followed technological development. Traditional contra-indications are high-frequency hearing losses with normal hearing up to 2kHz, poor speech recognition scores and unilateral hearing losses. A survey sent to 50 otolaryngologists in New South Wales (NSW), Australia, showed that these criteria are still current. This study reviewed 3 groups of patients who have been successfully fitted with hearing aids despite having the above-mentioned audiological characteristics, indicating that criteria for hearing aid recommendation need to be updated.
Deafness in adults: the role of the cochlear implant.
In the past major damage to both inner ears resulted in total or near-total sensorineural hearing loss and complete isolation of the patient. The development of the cochlear implant – the so-called bionic ear – has brought such patients back to the hearing world. It has become common in recent times for these patients to manage to hear well without any visual clues.
Drill-induced hearing loss in the non-operated ear.
The reversible hearing loss in the non-operated ear noted by patients after ear surgery remains unexplained. This study proposes that this hearing loss is caused by drill noise conducted to the non-operated ear by vibrations of the intact skull. This noise exposure results in dysfunction of the outer hair cells, which may produce a temporary hearing loss. Estimations of outer hair cell function in the non-operated ear were made by recording the change in amplitude of the distortion-product otoacoustic emissions before and during ear surgery. Reversible drill-related outer hair cell dysfunction was seen in 2 of 12 cases. The changes in outer hair cell function and their Clinical implications are discussed.
Testing for Perilymphatic Fistula based on Hennebert’s Sign and Tullio Phenomenon.
A test procedure for perilymphatic fistula (PI.F) using both subsonic and sonic stimuli relying on the patients’ reported reactions are described. Its reliability to predict the presence of perilymph fistula is assessed by comparing the pre-operative test results, the surgical findings, and the post-Operative reported symptoms. Based on a sample of 40 operated ears and a control group of 129 ears, the test’s sensitivity to predict PLF was 76% using a sonic stimulus and 83% using a subsonic stimulus. The procedure gave false positive results in ears with Meniere’s disease.
Distortion product otoacoustic emissions: twelve months experience in a diagnostic clinic.
Over twelve months the distortion product otoacoustic emissions (DPOAF.) of 626 patients with various aetiologies of sensorineural hearing loss were measured. The results were compared to the contour of the audiogram to assess the test’s ability to predict configuration of hearing loss. The DPOAE amplitudes from 317 patients were compared to the behavioural hearing threshold at 500, 1000. 2000 and 4000 Hz. The data demonstrated a relationship between emission size and degree of cochlear hearing loss. The findings indicate that the test can be a useful tool to predict the degree of cochlear hearing loss as well as the contour of the audiogram in up to 70% of cases.
The Validity of the Acoustic Reflex Decay Test in the Diagnosis of Acoustic Neuroma.
Acoustic Reflex Decay is the main test used in the screening of retro-cochlear lesions at those clinics where Auditory Evoked Response facilities are not available. This study looked at the reflex decay findings of 46 patients with surgically confirmed acoustic neuromas to assess the validity of this procedure, comparing the size of a tumour to the presence of reflex decay at 1kHz. No correlation was found between tumour size and decay. The smallest tumour presented reflex decay while the largest had normal acoustic reflex results. Based on this study acoustic reflex decay is not a good predictor of retro-cochlear pathology.
Naunton’s Masking Dilemma Revisited
Pure-tone audiometry is essential in diagnosing clinical hearing loss. Masking of the nontest ear is mandatory for determining accurate hearing thresholds in the presence of asymmetrical levels between the two ears and for ascertaining the presence of a conductive hearing loss. Paradoxically, over masking occurs when the intensity of the required masking noise to the contralateral ear is such that it exceeds interaural cranial attenuation by an amount sufficient to mask the test ear. Ralph F Naunton was the first to describe this phenomenon, which has since been known as “Naunton’s masking dilemma.” A formula was derived mathematically to predict when Naunton’s masking dilemma might occur in air and bone conduction. Review of Ralph F Naunton’s primary works and related publications was performed.
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