Guidelines of the French Society of Otorhinolaryngology-Head and Neck Surgery (SFORL) and the French Society of Audiology (SFA) for Speech-in-Noise Testing in Adults

OBJECTIVES

This document presents the fundamentals of speech audiometry in noise, general requirements for implementation and criteria for choice among the tests available in French according to the health-professional's needs.

MATERIAL AND METHODS

The recommendations are based on a systematic analysis of the literature carried out by a multidisciplinary group of doctors, audiologists and audioprosthetists from all over France. They are graded A, B, C or expert opinion according to decreasing level of scientific evidence.

RESULTS

Eight tests of speech audiometry in noise can be used in France.

CONCLUSION

To be complete, evaluation of hearing status requires testing understanding of speech in noise. The examination must begin with a minimum of two measurements familiarizing the subject with the test procedure. For initial diagnosis, adaptive procedures establishing the 50% speech reception threshold (SRT50) in noise are to be preferred in order to obtain a rapid and standardized measurement of perception of speech in noise. When the aim is to measure real-life speech comprehension, tests based on sentences, cocktail-party noise and free-field stimulation are to be preferred. Prosthetic gain is evaluated exclusively in free field. This is the only way to evaluate the contribution of binaurality and to measure perception in noise in an environment as close as possible to real life. In order to avoid acoustic interference in free field, at least five loudspeakers should be used, in particular for evaluating the effectiveness of directional microphones, CROS devices enabling sounds picked up in the damaged ear to be rerouted to the functional ear, or bimodal fitting (i.e., when hearing is enabled by two modalities: for example, hearing aid for one ear, cochlear implant for the other).

Determination of hydrocarbon types in petroleum and coal-derived products by thin-layer chromatography/densitometry

Different methodologies based on thin-layer chromatography (TLC)/densitometry were used to separate and quantitate hydrocarbon types in middle distillates (gas oil), heavy distillates (lubricant) from petroleum, and coal-derived products. Thus, petroleum products were separated into saturates and aromatics by development, using n-hexane (9 min) followed by dichloromethane (4.5 min), of silica gel plates impregnated with berberine sulfate. Detection of saturates and aromatics was performed by fluorescence scanning using 365 nm as the excitation wavelength. Alternative detection of aromatics can be performed on either silica gel or berberine-impregnated plates by using ultraviolet (UV) densitometry at 250 nm. On the other hand, polar coal-derived products were separated into aromatics, polar compounds, and uneluted components by using silica gel plates and development with toluene (12 min), followed by dichloromethane-methanol (95 + 5, v/v), with detection by UV densitometry at 250 nm. In all cases, external standard calibration was used for quantitation. Results were validated by using standard methods or well-established techniques of the petrochemical industry. The potential usefulness of TLC/densitometry is discussed.

[Inappropriate secretion of antidiuretic hormone (ISADH) after head injury (author's transl)]

Two new observations of ISADH following head injury are described. A review of the medical literature is presented. Reports of ISADH after head injury are rare in comparison to the frequent occurrence of hydroelectrolytic disorders in the same situation. Attention is drawn to misleading clinical pictures, suggestive of neurosurgical conditions. Intracranial hematoma is frequently associated with ISADH and should be looked for in patients who fail to respond to therapy.