Loudness discomfort levels in patients with conductive and mixed hearing loss

Objective: The purpose of this study is to investigate the effects of conductive component on the loudness discomfort level (LDL) judgments. The relation between LDL value and the magnitude of air-bone gap in such subjects was also assessed. Methods: LDLs were obtained from 100 ears of 50 hearing-impaired subjects. Twenty five subjects (50 ears) had either conductive or mixed hearing loss for both ears. Another 25 subjects (50 ears) with bilateral sensorineural hearing loss served as control. LDL measurements were performed using the method reported by Hawkins et al. in 1987. LDL data were plotted and analyzed as a function of hearing loss for three stimulus frequencies (0.5, 1.0 and 2 kHz). Also, LDL values were plotted as a function of air-bone gap in the conductive group. Results: LDLs were significantly higher in subjects with conductive or mixed hearing loss for all three tested frequencies. There is a significant positive correlation between LDL value and the magnitude of air-bone gap for all three test frequencies. Considerable intersubject variability was found in LDLs obtained from subjects with conductive component which prevented the accurate prediction of LDLs from threshold data for such patients. Conclusion: The large intersubject variation in LDL data strongly suggests the need for individualized LDL measurements in patients with conductive or mixed hearing loss. Higher LDLs indicates that higher maximal power output can be prescribed for such patients without worrying about loudness intolerance.