Turkiye Klinikleri Journal of Health Sciences

.: ORIGINAL RESEARCH
Binaural Etkileşimin Değerlendirilmesi: Normal İşiten Bireylerde Yaşa Bağlı Değişen Maskeleme Düzeyi Farkı
Evaluation of Binaural Interaction: Age-Related Altering Masking Level Difference in Normal Hearing Individuals
Ahsen KARTALa, Barış YAMANb, Müjde KAYAb, Burcu YERLİKAYAb, Özlem KONUKSEVENb
aSağlık Bilimleri Üniversitesi Hamidiye Sağlık Bilimleri Fakültesi, Odyoloji ABD, İstanbul, TÜRKİYE
bİstanbul Aydın Üniversitesi Sağlık Bilimleri Fakültesi, Odyoloji ABD, İstanbul, TÜRKİYE
Turkiye Klinikleri J Health Sci. 2021;6(3):585-91
doi: 10.5336/healthsci.2020-75954
Article Language: TR
Full Text
ÖZET
 Amaç: Çalışmamızın amacı, normal işitmeye sahip erişkin bireylerde maskeleme düzeyi farkı değerlerini karşılaştırmak ve yaş değişkeni ile saf ses ortalaması, konuşma testleri ve maskeleme düzeyi farkı test sonuçları aralarındaki ilişkiyi incelemektir. Gereç ve Yöntemler: Çalışmaya normal işitmeye sahip 18-30 yaş arası 45 birey, 45- 75 yaş arası 42 birey olmak üzere 87 birey dâhil edilmiş olup toplam 174 kulak değerlendirilmiştir. Bireylere sırasıyla otoskopik muayene, akustik immitansmetri, saf ses odyometrisi, konuşma odyometrisi ve binaural etkileşimi değerlendirmek için maskeleme düzeyi farkı testleri yapılmıştır. Maskeleme düzeyi farkı testi 500 Hz saf ton ve dar bant gürültü kullanılarak S0N0 homofazik ve SπN0 antifazik olmak üzere 2 koşulda ayrı ayrı değerlendirilmiştir. Bulgular: İki grup arasında konuşmayı alma eşiği (sağ kulak ve sol kulak p<0,001), konuşmayı ayırt etme skoru (sağ kulak ve sol kulak p<0,001) ve maskeleme düzeyi farkı (p=0,003) test sonuçları arasında istatistiksel olarak anlamlı bir farklılık vardır. Yaş ile yapılan tüm testler arasında istatistiksel olarak anlamlı ilişkiye rastlanmıştır. Yaş ile saf ses ortalaması (r=0,724, p<0,001; r=0,688, p<0,001) ve konuşmayı alma eşiği (r=0,599, p<0,001; r=0,651, p<0,001) arasında istatistiksel açıdan pozitif yönde, konuşmayı ayırt etme skoru (r=-0,567, p<0,001; r=-0,553, p<0,001) ve maskeleme düzeyi farkı (r=-0,260, p=0,015) arasında istatistiksel açıdan negatif yönde anlamlı ilişkiye rastlanmıştır. Sonuç: Normal işitme eşiklerine rağmen yaşın artması ile işitsel ve binaural etkileşim fonksiyonlarında azalma olduğu gözlenmiştir.

Anahtar Kelimeler: Algısal maskeleme; işitsel algılama; ses lokalizasyonu; yaşlanma; genç erişkin
ABSTRACT
 Objective: The aim of our study is to compare the masking level difference values in adult individuals with normal hearing and to examine the relationship between age and pure tone average, speech tests, and masking level difference results. Material and Methods: The study included 87 individuals with normal hearing and a total of 174 ears were evaluated. 45 individuals aged between 18-30 and 42 individuals aged between 45-75 were included. The individuals were evaluated by otoscopic examination, acoustic immitancemetry, pure tone audiometry, speech audiometry, and masking level difference test, respectively. The masking level difference test was evaluated separately under two conditions, S0N0 homophasic and SπN0 antifasic, using 500 Hz pure tone stimulus and narrow-band noise. Results: A statistically significant difference between the speech reception threshold (right and left ear p<0.001), speech discrimination score (right and left ear p<0.001), and masking level difference (p=0.003) test results between the two groups were found. A statistically significant correlations was found between all tests and age. Statistically positive correlation between age and pure tone average (r=0.724, p<0.001; r=0.688, p<0.001) and speech reception threshold (r=0.599, p<0.001; r=0.651, p<0.001); statistically negative correlation between the age and speech discrimination score (r=-0.567, p<0.001; r=-0.553, p<0.001) and masking level difference (r=-0.260, p=0.015) were found. Conclusion: Despite having normal hearing thresholds, a decrease in auditory and binaural interaction functions were observed along with an increase in age.

Keywords: Perceptual masking; auditory perception; sound localization; aging; young adult
REFERENCES:
  1. Eddins AC, Eddins DA. Cortical Correlates of Binaural Temporal Processing Deficits in Older Adults. Ear Hear. 2018;39(3):594-604. [Crossref]  [PubMed]  [PMC] 
  2. Hirsh IJ. The Influence of Interaural Phase on Interaural Summation and Inhibition. J Acoust Soc Am. 1948;20(4). [Crossref] 
  3. Licklider JCR. The Influence of Interaural Phase Relations upon the Masking of Speech by White Noise. J Acoust Soc Am. 1948;20(2). [Crossref] 
  4. Goldstein DP, Stephens SD. Masking level difference: a measure of auditory processing capability. Audiology. 1975;14(4):354-67. [Crossref]  [PubMed] 
  5. Flanagan JL, Watson BJ. Binaural Unmasking of Complex Signals. J Acoust Soc Am. 1966; 40(2). [Crossref] 
  6. Hirsh IJ, Burgeat M. Binaural Effects in Remote Masking. J Acoust Soc Am. 1958;30(9). [Crossref] 
  7. Musiek FE, Chermak GD. Psychophysical and behavioral peripheral and central auditory tests. Handb Clin Neurol. 2015;129:313-32. [Crossref]  [PubMed] 
  8. Harris RW, Brey RH, Miller RW, Channell RW. Influence of masker bandwidth on binaural masking level differences. Audiology. 1992; 31(4):196-204. [Crossref]  [PubMed] 
  9. Olsen WO, Noffsinger D, Carhart R. Masking level differences encountered in clinical populations. Audiology. 1976;15(4):287-301. [Crossref]  [PubMed] 
  10. Quaranta A, Cervellera G. Masking level difference in normal and pathological ears. Audiology. 1974;13(5):428-31. [Crossref]  [PubMed] 
  11. Wilson RH, Arcos JT, Brown CJ, Bennett LA. Masking-level difference in filtered-random and amplitude-modulated noise. J Speech Hear Res. 1984;27(2):267-74. [Crossref]  [PubMed] 
  12. Güven AG, Mutlu M. Merkezi işitsel işlemleme fonksiyonlarinin değerlendirilmesinde maske-leme düzeyi farki testi: Normal işiten gruptan elde edilen norm değerler [The use of masking level differences in evaluating central auditory processing: the norms for the normal hearing subjects]. Kulak Burun Bogaz Ihtis Derg. 2003;10(3):93-7. Turkish. [PubMed] 
  13. Humes LE, Busey TA, Craig J, Kewley-Port D. Are age-related changes in cognitive function driven by age-related changes in sensory processing? Atten Percept Psychophys. 2013; 75(3):508-24. [Crossref]  [PubMed]  [PMC] 
  14. Fostick L, Babkoff H. Temporal and non-temporal processes in the elderly. J Basic Clin Physiol Pharmacol. 2013;24(3):191-9. [Crossref]  [PubMed] 
  15. Frtusova JB, Winneke AH, Phillips NA. ERP evidence that auditory-visual speech facilitates working memory in younger and older adults. Psychol Aging. 2013;28(2):481-94. [Crossref]  [PubMed] 
  16. Hall JW, Tyler RS, Fernandes MA. Factors influencing the masking level difference in cochlear hearing-impaired and normal-hearing listeners. J Speech Hear Res. 1984;27(1): 145-54. [Crossref]  [PubMed] 
  17. Staffel JG, Hall JW 3rd, Grose JH, Pillsbury HC. NoSo and NoS pi detection as a function of masker bandwidth in normal-hearing and cochlear-impaired listeners. J Acoust Soc Am. 1990;87(4):1720-7. [Crossref]  [PubMed] 
  18. Strouse A, Ashmead DH, Ohde RN, Grantham DW. Temporal processing in the aging auditory system. J Acoust Soc Am. 1998;104(4): 2385-99. [Crossref]  [PubMed] 
  19. Pichora-Fuller MK, Schneider BA. The effect of interaural delay of the masker on masking-level differences in young and old adults. J Acoust Soc Am. 1992;91(4 Pt 1):2129-35. [Crossref]  [PubMed] 
  20. Pichora-Fuller MK, Schneider BA. Masking-level differences in older adults: the effect of the level of the masking noise. Percept Psychophys. 1998;60(7):1197-205. [Crossref]  [PubMed] 
  21. Moore BCJ. Effects of Age and Hearing Loss on the Processing of Auditory Temporal Fine Structure. Adv Exp Med Biol. 2016;894:1-8. [PubMed] 
  22. Adel Ghahraman M, Ashrafi M, Mohammadkhani G, Jalaie S. Effects of aging on spatial hearing. Aging Clin Exp Res. 2020;32(4):733-9. [Crossref]  [PubMed] 
  23. Anderson S, Ellis R, Mehta J, Goupell MJ. Age-related differences in binaural masking level differences: behavioral and electrophysiological evidence. J Neurophysiol. 2018; 120(6):2939-52. [Crossref]  [PubMed]  [PMC] 
  24. Dubno JR, Ahlstrom JB, Horwitz AR. Binaural advantage for younger and older adults with normal hearing. J Speech Lang Hear Res. 2008;51(2):539-56. [Crossref]  [PubMed] 
  25. Kelly-Ballweber D, Dobie RA. Binaural interaction measured behaviorally and electrophysiologically in young and old adults. Audiology. 1984;23(2):181-94. [Crossref]  [PubMed] 
  26. Schneider BA, Hamstra SJ. Gap detection thresholds as a function of tonal duration for younger and older listeners. J Acoust Soc Am. 1999;106(1):371-80. [Crossref]  [PubMed] 
  27. Anderson S, Parbery-Clark A, White-Schwoch T, Kraus N. Aging affects neural precision of speech encoding. J Neurosci. 2012;32(41): 14156-64. [Crossref]  [PubMed]  [PMC] 
  28. Tun PA, Williams VA, Small BJ, Hafter ER. The effects of aging on auditory processing and cognition. Am J Audiol. 2012;21(2):344-50. [Crossref]  [PubMed] 
  29. Abdala C, Dhar S. Maturation and aging of the human cochlea: a view through the DPOAE looking glass. J Assoc Res Otolaryngol. 2012;13(3):403-21. [Crossref]  [PubMed]  [PMC] 
  30. Abdala C, Ortmann AJ, Shera CA. Reflection- and Distortion-Source Otoacoustic Emissions: Evidence for Increased Irregularity in the Human Cochlea During Aging. J Assoc Res Otolaryngol. 2018;19(5):493-510. [Crossref]  [PubMed]  [PMC] 
  31. Chisolm TH, Willott JF, Lister JJ. The aging auditory system: anatomic and physiologic changes and implications for rehabilitation. Int J Audiol. 2003;42 Suppl 2:2S3-10. [Crossref]  [PubMed] 
  32. Kim BJ, Oh SH. Age-related changes in cognition and speech perception. Korean J Audiol. 2013;17(2):54-8. [Crossref]  [PubMed]  [PMC] 
  33. Ward KM, Shen J, Souza PE, Grieco-Calub TM. Age-Related Differences in Listening Effort During Degraded Speech Recognition. Ear Hear. 2017;38(1):74-84. [Crossref]  [PubMed]  [PMC] 
  34. Gordon-Salant S, Fitzgibbons PJ. Effects of stimulus and noise rate variability on speech perception by younger and older adults. J Acoust Soc Am. 2004;115(4):1808-17. [Crossref]  [PubMed] 
  35. Jerger J. The remarkable history of right-ear advantage. Hear Rev. 2018. [Link] 

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