Πέμπτη 29 Σεπτεμβρίου 2016

Temporal Regularity Detection and Rate Discrimination in Cochlear-Implant Listeners

Abstract

Cochlear implants (CIs) convey fundamental-frequency information using primarily temporal cues. However, temporal pitch perception in CI users is weak and, when measured using rate discrimination tasks, deteriorates markedly as the rate increases beyond 300 pulses-per-second. Rate pitch may be weak because the electrical stimulation of the surviving neural population of the implant recipient may not allow accurate coding of inter-pulse time intervals. If so, this phenomenon should prevent listeners from detecting when a pulse train is physically temporally jittered. Performance in a jitter detection task was compared to that in a rate-pitch discrimination task. Stimuli were delivered using direct stimulation in cochlear implants, on a mid-array and an apical electrode, and at two different rates (100 and 300 pps). Average performance on both tasks was worse at the higher pulse rate and did not depend on electrode. However, there was a large variability across and within listeners that did not correlate between the two tasks, suggesting that rate-pitch judgement and regularity detection are to some extent limited by task-specific processes. Simulations with filtered pulse trains presented to NH listeners yielded broadly similar results, except that, for the rate discrimination task, the difference between performance with 100- and 300-pps base rates was smaller than observed for CI users.



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Minimal Hearing Loss: From a Failure-Based Approach to Evidence-Based Practice

Purpose
A representative sample of the literature on minimal hearing loss (MHL) was reviewed to provide evidence of challenges faced by children with MHL and to establish the need for evidence-based options for early intervention.
Method
Research articles published from 1950 to 2013 were searched in the Medline database using the keywords minimal hearing loss, unilateral hearing loss, and mild hearing loss. References cited in retrieved articles were also reviewed.
Results
In total, 69 articles contained relevant information about pediatric outcomes and/or intervention for unilateral hearing loss, 50 for mild hearing loss, and 6 for high-frequency hearing loss. Six challenges associated with MHL emerged, and 6 interventions were indicated. Evidence indicates that although some individuals may appear to have no observable speech-language or academic difficulties, others experience considerable difficulties. It also indicates that even though children with MHL may appear to catch up in some areas, difficulties in select domains continue into adulthood.
Conclusions
Evidence indicates significant risks associated with untreated MHL. Evidence also demonstrates the need for early intervention and identifies several appropriate intervention strategies; however, no single protocol is appropriate for all children. Therefore, families should be educated about the impact of MHL and about available interventions so that informed decisions can be made.

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Acoustic–Phonetic Versus Lexical Processing in Nonnative Listeners Differing in Their Dominant Language

Purpose
Nonnative listeners have difficulty recognizing English words due to underdeveloped acoustic–phonetic and/or lexical skills. The present study used Boothroyd and Nittrouer's (1988) j factor to tease apart these two components of word recognition.
Method
Participants included 15 native English and 29 native Russian listeners. Fourteen and 15 of the Russian listeners reported English (ED) and Russian (RD) to be their dominant language, respectively. Listeners were presented 119 consonant–vowel–consonant real and nonsense words in speech-spectrum noise at +6 dB SNR. Responses were scored for word and phoneme recognition, the logarithmic quotient of which yielded j.
Results
Word and phoneme recognition was comparable between native and ED listeners but poorer in RD listeners. Analysis of j indicated less effective use of lexical information in RD than in native and ED listeners. Lexical processing was strongly correlated with the length of residence in the United States.
Conclusions
Language background is important for nonnative word recognition. Lexical skills can be regarded as nativelike in ED nonnative listeners. Compromised word recognition in ED listeners is unlikely a result of poor lexical processing. Performance should be interpreted with caution for listeners dominant in their first language, whose word recognition is affected by both lexical and acoustic–phonetic factors.

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Use of Baby Isao Simulator and Standardized Parents in Hearing Screening and Parent Counseling Education

Purpose
The primary purpose of this study was to test the effect of the combined use of trained standardized parents and a baby simulator on students' hearing screening and parental counseling knowledge and skills.
Method
A one-group pretest-posttest quasi-experimental study design was used to assess self-ratings of confidence in knowledge and skills and satisfaction of the educational experience with standardized parents and a baby simulator. The mean age of the 14 audiology students participating in this study was 24.79 years (SD = 1.58). Participants completed a pre- and postevent questionnaire in which they rated their level of confidence for specific knowledge and skills. Six students (2 students in each scenario) volunteered to participate in the infant hearing screening and counseling scenarios, whereas others participated as observers. All participants participated in the briefing and debriefing sessions immediately before and after each of 3 scenarios. After the last scenario, participants were asked to complete a satisfaction survey of their learning experience using simulation and standardized parents.
Results
Overall, the pre- and post–simulation event questionnaire revealed a significant improvement in the participants' self-rated confidence levels regarding knowledge and skills. The mean difference between pre- and postevent scores was 0.52 (p SD = 0.30) based on a Likert scale, where 1 = not satisfied and 5 = very satisfied.
Conclusions
The results of this novel educational activity demonstrate the value of using infant hearing screening and parental counseling simulation sessions to enhance student learning. In addition, this study demonstrates the use of simulation and standardized parents as an important pedagogical tool for audiology students. Students experienced a high level of satisfaction with the learning experience.

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Mental Tasking and Caloric-Induced Vestibular Nystagmus Utilizing Videonystagmography

Purpose
The purpose of this study was to quantify the effects of mental tasking on measures of the caloric vestibulo-ocular reflex utilizing videonystagmography as the measurement technique.
Method
A within-subjects repeated-measures design was utilized. Sixteen healthy adults were evaluated (13 women, 3 men; ages 19–31 years). Each participant underwent bithermal caloric irrigation at 2 separate counterbalanced visits. At 1 visit mental tasking was utilized, whereas the other visit did not utilize mental tasking. The following outcomes were measured for each visit: peak slow-phase velocity (SPV), response duration, peak SPV latency, and eye blink artifact.
Results
No significant difference was seen for tasking versus no tasking with peak SPV, peak latency, or response duration. A significant difference was seen for the amount of eye blink artifact, with significantly more eye blinks present for the tasking condition.
Conclusions
Results could indicate mental tasking does not affect the important measure of SPV. Moreover, increased eye blink artifact with tasking could obscure the clinician's ability to read the nystagmograph. However, this investigation is limited to the healthy young adult population, and more studies should be performed to corroborate the presented evidence.

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Chosen Listening Levels for Music With and Without the Use of Hearing Aids

Purpose
The objective of this study was to describe chosen listening levels (CLLs) for recorded music for listeners with hearing loss in aided and unaided conditions.
Method
The study used a within-subject, repeated-measures design with 13 adult hearing-aid users. The music included rock and classical samples with different amounts of audio-industry compression limiting. CLL measurements were taken at ear level (i.e., at input to the hearing aid) and at the tympanic membrane.
Results
For aided listening, average CLLs were 69.3 dBA at the input to the hearing aid and 80.3 dBA at the tympanic membrane. For unaided listening, average CLLs were 76.9 dBA at the entrance to the ear canal and 77.1 dBA at the tympanic membrane. Although wide intersubject variability was observed, CLLs were not associated with audiometric thresholds. CLLs for rock music were higher than for classical music at the tympanic membrane, but no differences were observed between genres for ear-level CLLs. The amount of audio-industry compression had no significant effect on CLLs.
Conclusion
By describing the levels of recorded music chosen by hearing-aid users, this study provides a basis for ecologically valid testing conditions in clinical and laboratory settings.

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Survey on the Effectiveness of Dietary Supplements to Treat Tinnitus

Purpose
We surveyed the benefit of dietary supplements to treat tinnitus and reported adverse effects.
Method
A website was created for people with tinnitus to complete a variety of questions.
Results
The 1,788 subjects who responded to questionnaires came from 53 different countries; 413 (23.1%) reported taking supplements. No effect on tinnitus was reported in 70.7%, improvement in 19.0%, and worsening in 10.3%. Adverse effects were reported in 6% (n = 36), including bleeding, diarrhea, headache, and others. Supplements were reported to be helpful for sleep: melatonin (effect size, d = 1.228) and lipoflavonoid (d = 0.5244); emotional reactions: melatonin (d = 0.6138) and lipoflavonoid (d = 0.457); hearing: Ginkgo biloba (d = 0.3758); and concentration Ginkgo biloba (d = 0.3611). The positive, subjective reports should be interpreted cautiously; many might have reported a positive effect because they were committed to treatment and expected a benefit. Users of supplements were more likely to have loudness hyperacusis and to have a louder tinnitus.
Conclusions
The use of dietary supplements to treat tinnitus is common, particularly with Ginkgo biloba, lipoflavonoids, magnesium, melatonin, vitamin B12, and zinc. It is likely that some supplements will help with sleep for some patients. However, they are generally not effective, and many produced adverse effects. We concluded that dietary supplements should not be recommended to treat tinnitus but could have a positive outcome on tinnitus reactions in some people.

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Identifying and Prioritizing Diseases Important for Detection in Adult Hearing Health Care

Purpose
The purpose of this research note is to identify and prioritize diseases important for detection in adult hearing health care delivery systems.
Method
Through literature review and expert consultation, the authors identified 195 diseases likely to occur in adults complaining of hearing loss. Five neurotologists rated the importance of disease on 3 dimensions related to the necessity of detection prior to adult hearing aid fitting.
Results
Ratings of adverse health consequences, diagnostic difficulty, and presence of nonotologic symptoms associated with these diseases resulted in the identification of 104 diseases potentially important for detection prior to adult hearing aid fitting.
Conclusions
Current and evolving health care delivery systems, including direct-to-consumer sales, involve inconsistent means of disease detection vigilance prior to device fitting. The first steps in determining the safety of these different delivery methods are to identify and prioritize which diseases present the greatest risk for poor health outcomes and, thus, should be detected in hearing health care delivery systems. Here the authors have developed a novel multidimensional rating system to rank disease importance. The rankings can be used to evaluate the effectiveness of alternative detection methods and to inform public health policy. The authors are currently using this information to validate a consumer questionnaire designed to accurately identify when pre- fitting medical evaluations should be required for hearing aid patients.

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Efficiency of Melatonin as Compared to Pentobarbital for Audiometry Brainstem Response in Children With Associated Disorders

Purpose
Outpatient pediatric audiometry brainstem response (ABR) uses various techniques (no drug, hydroxyzine, pentobarbital, melatonin). The aim of this study was to evaluate the efficiency of melatonin as compared to pentobarbital in children with associated disorders.
Method
This was a retrospective study that took place in a tertiary care center. Eighty-three children (34 girls and 49 boys) had performed ABR under pentobarbital (GPent) or melatonin (GMel) between 2013 and 2014 and were included. All children had associated neurological or behavioral disorders or had failed a previous ABR using another technique. Success rate, defined as completed binaural investigation, delay, and duration of sleep (minutes), as well as side effects, were compared between GPent and GMel.
Results
There were 56 patients in GMel and 27 in GPent, with a mean age at test of 3 years and 10 months (1–13 years) and 4 years and 1 month (1–14.5 years), respectively. Success rate was 76.8% and 88.8%, respectively (p > .05), sleep duration was 23 and 153 min (p Conclusions

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Mandarin Lexical Tone Acquisition in Cochlear Implant Users With Prelingual Deafness: A Review

Purpose
The purpose of this review article is to synthesize evidence from the fields of developmental linguistics and cochlear implant technology relevant to the production and perception of Mandarin lexical tone in cochlear implant users with prelingual deafness. The aim of this review was to identify potential factors that determine outcomes for tonal-language speaking cochlear implant users and possible directions for further research.
Method
A computerized database search of MEDLINE, CINAHL, Academic Search Premier, Web of Science, and Google Scholar was undertaken in June and July 2014. Search terms used were lexical tone AND tonal language, speech development AND/OR speech production AND/OR speech perception AND cochlear implants, and pitch perception AND cochlear implants, anywhere in the title or abstract.
Conclusion
Despite the demonstrated limitations of pitch perception in cochlear implant users, there is some evidence that typical production and perception of lexical tone is possible by cochlear implant users with prelingual deafness. Further studies are required to determine the factors that contribute to better outcomes to inform rehabilitation processes for cochlear implant users in tonal-language environments.

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Minimal Hearing Loss: From a Failure-Based Approach to Evidence-Based Practice

Purpose
A representative sample of the literature on minimal hearing loss (MHL) was reviewed to provide evidence of challenges faced by children with MHL and to establish the need for evidence-based options for early intervention.
Method
Research articles published from 1950 to 2013 were searched in the Medline database using the keywords minimal hearing loss, unilateral hearing loss, and mild hearing loss. References cited in retrieved articles were also reviewed.
Results
In total, 69 articles contained relevant information about pediatric outcomes and/or intervention for unilateral hearing loss, 50 for mild hearing loss, and 6 for high-frequency hearing loss. Six challenges associated with MHL emerged, and 6 interventions were indicated. Evidence indicates that although some individuals may appear to have no observable speech-language or academic difficulties, others experience considerable difficulties. It also indicates that even though children with MHL may appear to catch up in some areas, difficulties in select domains continue into adulthood.
Conclusions
Evidence indicates significant risks associated with untreated MHL. Evidence also demonstrates the need for early intervention and identifies several appropriate intervention strategies; however, no single protocol is appropriate for all children. Therefore, families should be educated about the impact of MHL and about available interventions so that informed decisions can be made.

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Acoustic–Phonetic Versus Lexical Processing in Nonnative Listeners Differing in Their Dominant Language

Purpose
Nonnative listeners have difficulty recognizing English words due to underdeveloped acoustic–phonetic and/or lexical skills. The present study used Boothroyd and Nittrouer's (1988) j factor to tease apart these two components of word recognition.
Method
Participants included 15 native English and 29 native Russian listeners. Fourteen and 15 of the Russian listeners reported English (ED) and Russian (RD) to be their dominant language, respectively. Listeners were presented 119 consonant–vowel–consonant real and nonsense words in speech-spectrum noise at +6 dB SNR. Responses were scored for word and phoneme recognition, the logarithmic quotient of which yielded j.
Results
Word and phoneme recognition was comparable between native and ED listeners but poorer in RD listeners. Analysis of j indicated less effective use of lexical information in RD than in native and ED listeners. Lexical processing was strongly correlated with the length of residence in the United States.
Conclusions
Language background is important for nonnative word recognition. Lexical skills can be regarded as nativelike in ED nonnative listeners. Compromised word recognition in ED listeners is unlikely a result of poor lexical processing. Performance should be interpreted with caution for listeners dominant in their first language, whose word recognition is affected by both lexical and acoustic–phonetic factors.

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Use of Baby Isao Simulator and Standardized Parents in Hearing Screening and Parent Counseling Education

Purpose
The primary purpose of this study was to test the effect of the combined use of trained standardized parents and a baby simulator on students' hearing screening and parental counseling knowledge and skills.
Method
A one-group pretest-posttest quasi-experimental study design was used to assess self-ratings of confidence in knowledge and skills and satisfaction of the educational experience with standardized parents and a baby simulator. The mean age of the 14 audiology students participating in this study was 24.79 years (SD = 1.58). Participants completed a pre- and postevent questionnaire in which they rated their level of confidence for specific knowledge and skills. Six students (2 students in each scenario) volunteered to participate in the infant hearing screening and counseling scenarios, whereas others participated as observers. All participants participated in the briefing and debriefing sessions immediately before and after each of 3 scenarios. After the last scenario, participants were asked to complete a satisfaction survey of their learning experience using simulation and standardized parents.
Results
Overall, the pre- and post–simulation event questionnaire revealed a significant improvement in the participants' self-rated confidence levels regarding knowledge and skills. The mean difference between pre- and postevent scores was 0.52 (p SD = 0.30) based on a Likert scale, where 1 = not satisfied and 5 = very satisfied.
Conclusions
The results of this novel educational activity demonstrate the value of using infant hearing screening and parental counseling simulation sessions to enhance student learning. In addition, this study demonstrates the use of simulation and standardized parents as an important pedagogical tool for audiology students. Students experienced a high level of satisfaction with the learning experience.

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Mental Tasking and Caloric-Induced Vestibular Nystagmus Utilizing Videonystagmography

Purpose
The purpose of this study was to quantify the effects of mental tasking on measures of the caloric vestibulo-ocular reflex utilizing videonystagmography as the measurement technique.
Method
A within-subjects repeated-measures design was utilized. Sixteen healthy adults were evaluated (13 women, 3 men; ages 19–31 years). Each participant underwent bithermal caloric irrigation at 2 separate counterbalanced visits. At 1 visit mental tasking was utilized, whereas the other visit did not utilize mental tasking. The following outcomes were measured for each visit: peak slow-phase velocity (SPV), response duration, peak SPV latency, and eye blink artifact.
Results
No significant difference was seen for tasking versus no tasking with peak SPV, peak latency, or response duration. A significant difference was seen for the amount of eye blink artifact, with significantly more eye blinks present for the tasking condition.
Conclusions
Results could indicate mental tasking does not affect the important measure of SPV. Moreover, increased eye blink artifact with tasking could obscure the clinician's ability to read the nystagmograph. However, this investigation is limited to the healthy young adult population, and more studies should be performed to corroborate the presented evidence.

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Chosen Listening Levels for Music With and Without the Use of Hearing Aids

Purpose
The objective of this study was to describe chosen listening levels (CLLs) for recorded music for listeners with hearing loss in aided and unaided conditions.
Method
The study used a within-subject, repeated-measures design with 13 adult hearing-aid users. The music included rock and classical samples with different amounts of audio-industry compression limiting. CLL measurements were taken at ear level (i.e., at input to the hearing aid) and at the tympanic membrane.
Results
For aided listening, average CLLs were 69.3 dBA at the input to the hearing aid and 80.3 dBA at the tympanic membrane. For unaided listening, average CLLs were 76.9 dBA at the entrance to the ear canal and 77.1 dBA at the tympanic membrane. Although wide intersubject variability was observed, CLLs were not associated with audiometric thresholds. CLLs for rock music were higher than for classical music at the tympanic membrane, but no differences were observed between genres for ear-level CLLs. The amount of audio-industry compression had no significant effect on CLLs.
Conclusion
By describing the levels of recorded music chosen by hearing-aid users, this study provides a basis for ecologically valid testing conditions in clinical and laboratory settings.

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Survey on the Effectiveness of Dietary Supplements to Treat Tinnitus

Purpose
We surveyed the benefit of dietary supplements to treat tinnitus and reported adverse effects.
Method
A website was created for people with tinnitus to complete a variety of questions.
Results
The 1,788 subjects who responded to questionnaires came from 53 different countries; 413 (23.1%) reported taking supplements. No effect on tinnitus was reported in 70.7%, improvement in 19.0%, and worsening in 10.3%. Adverse effects were reported in 6% (n = 36), including bleeding, diarrhea, headache, and others. Supplements were reported to be helpful for sleep: melatonin (effect size, d = 1.228) and lipoflavonoid (d = 0.5244); emotional reactions: melatonin (d = 0.6138) and lipoflavonoid (d = 0.457); hearing: Ginkgo biloba (d = 0.3758); and concentration Ginkgo biloba (d = 0.3611). The positive, subjective reports should be interpreted cautiously; many might have reported a positive effect because they were committed to treatment and expected a benefit. Users of supplements were more likely to have loudness hyperacusis and to have a louder tinnitus.
Conclusions
The use of dietary supplements to treat tinnitus is common, particularly with Ginkgo biloba, lipoflavonoids, magnesium, melatonin, vitamin B12, and zinc. It is likely that some supplements will help with sleep for some patients. However, they are generally not effective, and many produced adverse effects. We concluded that dietary supplements should not be recommended to treat tinnitus but could have a positive outcome on tinnitus reactions in some people.

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Identifying and Prioritizing Diseases Important for Detection in Adult Hearing Health Care

Purpose
The purpose of this research note is to identify and prioritize diseases important for detection in adult hearing health care delivery systems.
Method
Through literature review and expert consultation, the authors identified 195 diseases likely to occur in adults complaining of hearing loss. Five neurotologists rated the importance of disease on 3 dimensions related to the necessity of detection prior to adult hearing aid fitting.
Results
Ratings of adverse health consequences, diagnostic difficulty, and presence of nonotologic symptoms associated with these diseases resulted in the identification of 104 diseases potentially important for detection prior to adult hearing aid fitting.
Conclusions
Current and evolving health care delivery systems, including direct-to-consumer sales, involve inconsistent means of disease detection vigilance prior to device fitting. The first steps in determining the safety of these different delivery methods are to identify and prioritize which diseases present the greatest risk for poor health outcomes and, thus, should be detected in hearing health care delivery systems. Here the authors have developed a novel multidimensional rating system to rank disease importance. The rankings can be used to evaluate the effectiveness of alternative detection methods and to inform public health policy. The authors are currently using this information to validate a consumer questionnaire designed to accurately identify when pre- fitting medical evaluations should be required for hearing aid patients.

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Efficiency of Melatonin as Compared to Pentobarbital for Audiometry Brainstem Response in Children With Associated Disorders

Purpose
Outpatient pediatric audiometry brainstem response (ABR) uses various techniques (no drug, hydroxyzine, pentobarbital, melatonin). The aim of this study was to evaluate the efficiency of melatonin as compared to pentobarbital in children with associated disorders.
Method
This was a retrospective study that took place in a tertiary care center. Eighty-three children (34 girls and 49 boys) had performed ABR under pentobarbital (GPent) or melatonin (GMel) between 2013 and 2014 and were included. All children had associated neurological or behavioral disorders or had failed a previous ABR using another technique. Success rate, defined as completed binaural investigation, delay, and duration of sleep (minutes), as well as side effects, were compared between GPent and GMel.
Results
There were 56 patients in GMel and 27 in GPent, with a mean age at test of 3 years and 10 months (1–13 years) and 4 years and 1 month (1–14.5 years), respectively. Success rate was 76.8% and 88.8%, respectively (p > .05), sleep duration was 23 and 153 min (p Conclusions

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Mandarin Lexical Tone Acquisition in Cochlear Implant Users With Prelingual Deafness: A Review

Purpose
The purpose of this review article is to synthesize evidence from the fields of developmental linguistics and cochlear implant technology relevant to the production and perception of Mandarin lexical tone in cochlear implant users with prelingual deafness. The aim of this review was to identify potential factors that determine outcomes for tonal-language speaking cochlear implant users and possible directions for further research.
Method
A computerized database search of MEDLINE, CINAHL, Academic Search Premier, Web of Science, and Google Scholar was undertaken in June and July 2014. Search terms used were lexical tone AND tonal language, speech development AND/OR speech production AND/OR speech perception AND cochlear implants, and pitch perception AND cochlear implants, anywhere in the title or abstract.
Conclusion
Despite the demonstrated limitations of pitch perception in cochlear implant users, there is some evidence that typical production and perception of lexical tone is possible by cochlear implant users with prelingual deafness. Further studies are required to determine the factors that contribute to better outcomes to inform rehabilitation processes for cochlear implant users in tonal-language environments.

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Minimal Hearing Loss: From a Failure-Based Approach to Evidence-Based Practice

Purpose
A representative sample of the literature on minimal hearing loss (MHL) was reviewed to provide evidence of challenges faced by children with MHL and to establish the need for evidence-based options for early intervention.
Method
Research articles published from 1950 to 2013 were searched in the Medline database using the keywords minimal hearing loss, unilateral hearing loss, and mild hearing loss. References cited in retrieved articles were also reviewed.
Results
In total, 69 articles contained relevant information about pediatric outcomes and/or intervention for unilateral hearing loss, 50 for mild hearing loss, and 6 for high-frequency hearing loss. Six challenges associated with MHL emerged, and 6 interventions were indicated. Evidence indicates that although some individuals may appear to have no observable speech-language or academic difficulties, others experience considerable difficulties. It also indicates that even though children with MHL may appear to catch up in some areas, difficulties in select domains continue into adulthood.
Conclusions
Evidence indicates significant risks associated with untreated MHL. Evidence also demonstrates the need for early intervention and identifies several appropriate intervention strategies; however, no single protocol is appropriate for all children. Therefore, families should be educated about the impact of MHL and about available interventions so that informed decisions can be made.

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Acoustic–Phonetic Versus Lexical Processing in Nonnative Listeners Differing in Their Dominant Language

Purpose
Nonnative listeners have difficulty recognizing English words due to underdeveloped acoustic–phonetic and/or lexical skills. The present study used Boothroyd and Nittrouer's (1988) j factor to tease apart these two components of word recognition.
Method
Participants included 15 native English and 29 native Russian listeners. Fourteen and 15 of the Russian listeners reported English (ED) and Russian (RD) to be their dominant language, respectively. Listeners were presented 119 consonant–vowel–consonant real and nonsense words in speech-spectrum noise at +6 dB SNR. Responses were scored for word and phoneme recognition, the logarithmic quotient of which yielded j.
Results
Word and phoneme recognition was comparable between native and ED listeners but poorer in RD listeners. Analysis of j indicated less effective use of lexical information in RD than in native and ED listeners. Lexical processing was strongly correlated with the length of residence in the United States.
Conclusions
Language background is important for nonnative word recognition. Lexical skills can be regarded as nativelike in ED nonnative listeners. Compromised word recognition in ED listeners is unlikely a result of poor lexical processing. Performance should be interpreted with caution for listeners dominant in their first language, whose word recognition is affected by both lexical and acoustic–phonetic factors.

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Use of Baby Isao Simulator and Standardized Parents in Hearing Screening and Parent Counseling Education

Purpose
The primary purpose of this study was to test the effect of the combined use of trained standardized parents and a baby simulator on students' hearing screening and parental counseling knowledge and skills.
Method
A one-group pretest-posttest quasi-experimental study design was used to assess self-ratings of confidence in knowledge and skills and satisfaction of the educational experience with standardized parents and a baby simulator. The mean age of the 14 audiology students participating in this study was 24.79 years (SD = 1.58). Participants completed a pre- and postevent questionnaire in which they rated their level of confidence for specific knowledge and skills. Six students (2 students in each scenario) volunteered to participate in the infant hearing screening and counseling scenarios, whereas others participated as observers. All participants participated in the briefing and debriefing sessions immediately before and after each of 3 scenarios. After the last scenario, participants were asked to complete a satisfaction survey of their learning experience using simulation and standardized parents.
Results
Overall, the pre- and post–simulation event questionnaire revealed a significant improvement in the participants' self-rated confidence levels regarding knowledge and skills. The mean difference between pre- and postevent scores was 0.52 (p SD = 0.30) based on a Likert scale, where 1 = not satisfied and 5 = very satisfied.
Conclusions
The results of this novel educational activity demonstrate the value of using infant hearing screening and parental counseling simulation sessions to enhance student learning. In addition, this study demonstrates the use of simulation and standardized parents as an important pedagogical tool for audiology students. Students experienced a high level of satisfaction with the learning experience.

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Mental Tasking and Caloric-Induced Vestibular Nystagmus Utilizing Videonystagmography

Purpose
The purpose of this study was to quantify the effects of mental tasking on measures of the caloric vestibulo-ocular reflex utilizing videonystagmography as the measurement technique.
Method
A within-subjects repeated-measures design was utilized. Sixteen healthy adults were evaluated (13 women, 3 men; ages 19–31 years). Each participant underwent bithermal caloric irrigation at 2 separate counterbalanced visits. At 1 visit mental tasking was utilized, whereas the other visit did not utilize mental tasking. The following outcomes were measured for each visit: peak slow-phase velocity (SPV), response duration, peak SPV latency, and eye blink artifact.
Results
No significant difference was seen for tasking versus no tasking with peak SPV, peak latency, or response duration. A significant difference was seen for the amount of eye blink artifact, with significantly more eye blinks present for the tasking condition.
Conclusions
Results could indicate mental tasking does not affect the important measure of SPV. Moreover, increased eye blink artifact with tasking could obscure the clinician's ability to read the nystagmograph. However, this investigation is limited to the healthy young adult population, and more studies should be performed to corroborate the presented evidence.

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Chosen Listening Levels for Music With and Without the Use of Hearing Aids

Purpose
The objective of this study was to describe chosen listening levels (CLLs) for recorded music for listeners with hearing loss in aided and unaided conditions.
Method
The study used a within-subject, repeated-measures design with 13 adult hearing-aid users. The music included rock and classical samples with different amounts of audio-industry compression limiting. CLL measurements were taken at ear level (i.e., at input to the hearing aid) and at the tympanic membrane.
Results
For aided listening, average CLLs were 69.3 dBA at the input to the hearing aid and 80.3 dBA at the tympanic membrane. For unaided listening, average CLLs were 76.9 dBA at the entrance to the ear canal and 77.1 dBA at the tympanic membrane. Although wide intersubject variability was observed, CLLs were not associated with audiometric thresholds. CLLs for rock music were higher than for classical music at the tympanic membrane, but no differences were observed between genres for ear-level CLLs. The amount of audio-industry compression had no significant effect on CLLs.
Conclusion
By describing the levels of recorded music chosen by hearing-aid users, this study provides a basis for ecologically valid testing conditions in clinical and laboratory settings.

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Survey on the Effectiveness of Dietary Supplements to Treat Tinnitus

Purpose
We surveyed the benefit of dietary supplements to treat tinnitus and reported adverse effects.
Method
A website was created for people with tinnitus to complete a variety of questions.
Results
The 1,788 subjects who responded to questionnaires came from 53 different countries; 413 (23.1%) reported taking supplements. No effect on tinnitus was reported in 70.7%, improvement in 19.0%, and worsening in 10.3%. Adverse effects were reported in 6% (n = 36), including bleeding, diarrhea, headache, and others. Supplements were reported to be helpful for sleep: melatonin (effect size, d = 1.228) and lipoflavonoid (d = 0.5244); emotional reactions: melatonin (d = 0.6138) and lipoflavonoid (d = 0.457); hearing: Ginkgo biloba (d = 0.3758); and concentration Ginkgo biloba (d = 0.3611). The positive, subjective reports should be interpreted cautiously; many might have reported a positive effect because they were committed to treatment and expected a benefit. Users of supplements were more likely to have loudness hyperacusis and to have a louder tinnitus.
Conclusions
The use of dietary supplements to treat tinnitus is common, particularly with Ginkgo biloba, lipoflavonoids, magnesium, melatonin, vitamin B12, and zinc. It is likely that some supplements will help with sleep for some patients. However, they are generally not effective, and many produced adverse effects. We concluded that dietary supplements should not be recommended to treat tinnitus but could have a positive outcome on tinnitus reactions in some people.

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Identifying and Prioritizing Diseases Important for Detection in Adult Hearing Health Care

Purpose
The purpose of this research note is to identify and prioritize diseases important for detection in adult hearing health care delivery systems.
Method
Through literature review and expert consultation, the authors identified 195 diseases likely to occur in adults complaining of hearing loss. Five neurotologists rated the importance of disease on 3 dimensions related to the necessity of detection prior to adult hearing aid fitting.
Results
Ratings of adverse health consequences, diagnostic difficulty, and presence of nonotologic symptoms associated with these diseases resulted in the identification of 104 diseases potentially important for detection prior to adult hearing aid fitting.
Conclusions
Current and evolving health care delivery systems, including direct-to-consumer sales, involve inconsistent means of disease detection vigilance prior to device fitting. The first steps in determining the safety of these different delivery methods are to identify and prioritize which diseases present the greatest risk for poor health outcomes and, thus, should be detected in hearing health care delivery systems. Here the authors have developed a novel multidimensional rating system to rank disease importance. The rankings can be used to evaluate the effectiveness of alternative detection methods and to inform public health policy. The authors are currently using this information to validate a consumer questionnaire designed to accurately identify when pre- fitting medical evaluations should be required for hearing aid patients.

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Efficiency of Melatonin as Compared to Pentobarbital for Audiometry Brainstem Response in Children With Associated Disorders

Purpose
Outpatient pediatric audiometry brainstem response (ABR) uses various techniques (no drug, hydroxyzine, pentobarbital, melatonin). The aim of this study was to evaluate the efficiency of melatonin as compared to pentobarbital in children with associated disorders.
Method
This was a retrospective study that took place in a tertiary care center. Eighty-three children (34 girls and 49 boys) had performed ABR under pentobarbital (GPent) or melatonin (GMel) between 2013 and 2014 and were included. All children had associated neurological or behavioral disorders or had failed a previous ABR using another technique. Success rate, defined as completed binaural investigation, delay, and duration of sleep (minutes), as well as side effects, were compared between GPent and GMel.
Results
There were 56 patients in GMel and 27 in GPent, with a mean age at test of 3 years and 10 months (1–13 years) and 4 years and 1 month (1–14.5 years), respectively. Success rate was 76.8% and 88.8%, respectively (p > .05), sleep duration was 23 and 153 min (p Conclusions

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Mandarin Lexical Tone Acquisition in Cochlear Implant Users With Prelingual Deafness: A Review

Purpose
The purpose of this review article is to synthesize evidence from the fields of developmental linguistics and cochlear implant technology relevant to the production and perception of Mandarin lexical tone in cochlear implant users with prelingual deafness. The aim of this review was to identify potential factors that determine outcomes for tonal-language speaking cochlear implant users and possible directions for further research.
Method
A computerized database search of MEDLINE, CINAHL, Academic Search Premier, Web of Science, and Google Scholar was undertaken in June and July 2014. Search terms used were lexical tone AND tonal language, speech development AND/OR speech production AND/OR speech perception AND cochlear implants, and pitch perception AND cochlear implants, anywhere in the title or abstract.
Conclusion
Despite the demonstrated limitations of pitch perception in cochlear implant users, there is some evidence that typical production and perception of lexical tone is possible by cochlear implant users with prelingual deafness. Further studies are required to determine the factors that contribute to better outcomes to inform rehabilitation processes for cochlear implant users in tonal-language environments.

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Biologically-variable rhythmic auditory cues are superior to isochronous cues in fostering natural gait variability in Parkinson’s disease

Publication date: Available online 28 September 2016
Source:Gait & Posture
Author(s): D.G. Dotov, S. Bayard, V. Cochen de Cock, C. Geny, V. Driss, G. Garrigue, B. Bardy, S. Dalla Bella
IntroductionRhythmic auditory cueing improves certain gait symptoms of Parkinson's disease (PD). Cues are typically stimuli or beats with a fixed inter-beat interval. We show that isochronous cueing has an unwanted side-effect in that it exacerbates one of the motor symptoms characteristic of advanced PD. Whereas the parameters of the stride cycle of healthy walkers and early patients possess a persistent correlation in time, or long-range correlation (LRC), isochronous cueing renders stride-to-stride variability random. Random stride cycle variability is also associated with reduced gait stability and lack of flexibility.MethodTo investigate how to prevent patients from acquiring a random stride cycle pattern, we tested rhythmic cueing which mimics the properties of variability found in healthy gait (biological variability). PD patients (n=19) and age-matched healthy participants (n=19) walked with three rhythmic cueing stimuli: isochronous, random variability, and with biological variability (LRC). Synchronization was not instructed.ResultsThe persistent correlation in gait was preserved only with stimuli with biological variability, equally for patients and controls (p's<.05). In contrast, cueing with isochronous or randomly varying inter-stimulus/beat intervals removed the LRC in the stride cycle. Notably, the individual's tendency to synchronize steps with beats determined the amount of negative effects of isochronous and random cues (p's<.05) but not the positive effect of biological variability.ConclusionStimulus variability and patients’ propensity to synchronize play a critical role in fostering healthier gait dynamics during cueing. The beneficial effects of biological variability provide useful guidelines for improving existing cueing treatments.



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A test of fixed and moving reference point control in posture

Publication date: Available online 28 September 2016
Source:Gait & Posture
Author(s): I-Chieh Lee, Matheus M. Pacheco, Karl M. Newell
This study investigated two contrasting assumptions of the regulation of posture: namely, fixed and moving reference point control. These assumptions were tested in terms of time-dependent structure and data distribution properties when stability is manipulated. Fifteen male participants performed a tightrope simulated balance task that is, maintaining a tandem stance while holding a pole. Pole length (and mass) and the standing support surface (fixed surface/balance board) were manipulated so as to mechanically change the balance stability. The mean and standard deviation (SD) of COP length were reduced with pole length increment but only in the balance board surface condition. Also, the SampEn was lower with greater pole length for the balance board but not the fixed surface. More than one peak was present in the distribution of COP in the majority of trials. Collectively, the findings provide evidence for a moving reference point in the maintenance of postural stability for quiet standing.



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Evaluation of the performance of accelerometer-based gait event detection algorithms in different real-world scenarios using the MAREA gait database

Publication date: Available online 28 September 2016
Source:Gait & Posture
Author(s): Siddhartha Khandelwal, Nicholas Wickström
Numerous gait event detection (GED) algorithms have been developed using accelerometers as they allow the possibility of long-term gait analysis in everyday life. However, almost all such existing algorithms have been developed and assessed using data collected in controlled indoor experiments with pre-defined paths and walking speeds. On the contrary, human gait is quite dynamic in the real-world, often involving varying gait speeds, changing surfaces and varying surface inclinations. Though portable wearable systems can be used to conduct experiments directly in the real-world, there is a lack of publicly available gait datasets or studies evaluating the performance of existing GED algorithms in various real-world settings.This paper presents a new gait database called MAREA (n=20 healthy subjects) that consists of walking and running in indoor and outdoor environments with accelerometers positioned on waist, wrist and both ankles. The study also evaluates the performance of six state-of-the-art accelerometer-based GED algorithms in different real-world scenarios, using the MAREA gait database. The results reveal that the performance of these algorithms is inconsistent and varies with changing environments and gait speeds. All algorithms demonstrated good performance for the scenario of steady walking in a controlled indoor environment with a combined median F1score of 0.98 for Heel-Strikes and 0.94 for Toe-Offs. However, they exhibited significantly decreased performance when evaluated in other lesser controlled scenarios such as walking and running in an outdoor street, with a combined median F1score of 0.82 for Heel-Strikes and 0.53 for Toe-Offs. Moreover, all GED algorithms displayed better performance for detecting Heel-Strikes as compared to Toe-Offs, when evaluated in different scenarios.



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Biologically-variable rhythmic auditory cues are superior to isochronous cues in fostering natural gait variability in Parkinson’s disease

Publication date: Available online 28 September 2016
Source:Gait & Posture
Author(s): D.G. Dotov, S. Bayard, V. Cochen de Cock, C. Geny, V. Driss, G. Garrigue, B. Bardy, S. Dalla Bella
IntroductionRhythmic auditory cueing improves certain gait symptoms of Parkinson's disease (PD). Cues are typically stimuli or beats with a fixed inter-beat interval. We show that isochronous cueing has an unwanted side-effect in that it exacerbates one of the motor symptoms characteristic of advanced PD. Whereas the parameters of the stride cycle of healthy walkers and early patients possess a persistent correlation in time, or long-range correlation (LRC), isochronous cueing renders stride-to-stride variability random. Random stride cycle variability is also associated with reduced gait stability and lack of flexibility.MethodTo investigate how to prevent patients from acquiring a random stride cycle pattern, we tested rhythmic cueing which mimics the properties of variability found in healthy gait (biological variability). PD patients (n=19) and age-matched healthy participants (n=19) walked with three rhythmic cueing stimuli: isochronous, random variability, and with biological variability (LRC). Synchronization was not instructed.ResultsThe persistent correlation in gait was preserved only with stimuli with biological variability, equally for patients and controls (p's<.05). In contrast, cueing with isochronous or randomly varying inter-stimulus/beat intervals removed the LRC in the stride cycle. Notably, the individual's tendency to synchronize steps with beats determined the amount of negative effects of isochronous and random cues (p's<.05) but not the positive effect of biological variability.ConclusionStimulus variability and patients’ propensity to synchronize play a critical role in fostering healthier gait dynamics during cueing. The beneficial effects of biological variability provide useful guidelines for improving existing cueing treatments.



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A test of fixed and moving reference point control in posture

Publication date: Available online 28 September 2016
Source:Gait & Posture
Author(s): I-Chieh Lee, Matheus M. Pacheco, Karl M. Newell
This study investigated two contrasting assumptions of the regulation of posture: namely, fixed and moving reference point control. These assumptions were tested in terms of time-dependent structure and data distribution properties when stability is manipulated. Fifteen male participants performed a tightrope simulated balance task that is, maintaining a tandem stance while holding a pole. Pole length (and mass) and the standing support surface (fixed surface/balance board) were manipulated so as to mechanically change the balance stability. The mean and standard deviation (SD) of COP length were reduced with pole length increment but only in the balance board surface condition. Also, the SampEn was lower with greater pole length for the balance board but not the fixed surface. More than one peak was present in the distribution of COP in the majority of trials. Collectively, the findings provide evidence for a moving reference point in the maintenance of postural stability for quiet standing.



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Evaluation of the performance of accelerometer-based gait event detection algorithms in different real-world scenarios using the MAREA gait database

Publication date: Available online 28 September 2016
Source:Gait & Posture
Author(s): Siddhartha Khandelwal, Nicholas Wickström
Numerous gait event detection (GED) algorithms have been developed using accelerometers as they allow the possibility of long-term gait analysis in everyday life. However, almost all such existing algorithms have been developed and assessed using data collected in controlled indoor experiments with pre-defined paths and walking speeds. On the contrary, human gait is quite dynamic in the real-world, often involving varying gait speeds, changing surfaces and varying surface inclinations. Though portable wearable systems can be used to conduct experiments directly in the real-world, there is a lack of publicly available gait datasets or studies evaluating the performance of existing GED algorithms in various real-world settings.This paper presents a new gait database called MAREA (n=20 healthy subjects) that consists of walking and running in indoor and outdoor environments with accelerometers positioned on waist, wrist and both ankles. The study also evaluates the performance of six state-of-the-art accelerometer-based GED algorithms in different real-world scenarios, using the MAREA gait database. The results reveal that the performance of these algorithms is inconsistent and varies with changing environments and gait speeds. All algorithms demonstrated good performance for the scenario of steady walking in a controlled indoor environment with a combined median F1score of 0.98 for Heel-Strikes and 0.94 for Toe-Offs. However, they exhibited significantly decreased performance when evaluated in other lesser controlled scenarios such as walking and running in an outdoor street, with a combined median F1score of 0.82 for Heel-Strikes and 0.53 for Toe-Offs. Moreover, all GED algorithms displayed better performance for detecting Heel-Strikes as compared to Toe-Offs, when evaluated in different scenarios.



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Biologically-variable rhythmic auditory cues are superior to isochronous cues in fostering natural gait variability in Parkinson’s disease

Publication date: Available online 28 September 2016
Source:Gait & Posture
Author(s): D.G. Dotov, S. Bayard, V. Cochen de Cock, C. Geny, V. Driss, G. Garrigue, B. Bardy, S. Dalla Bella
IntroductionRhythmic auditory cueing improves certain gait symptoms of Parkinson's disease (PD). Cues are typically stimuli or beats with a fixed inter-beat interval. We show that isochronous cueing has an unwanted side-effect in that it exacerbates one of the motor symptoms characteristic of advanced PD. Whereas the parameters of the stride cycle of healthy walkers and early patients possess a persistent correlation in time, or long-range correlation (LRC), isochronous cueing renders stride-to-stride variability random. Random stride cycle variability is also associated with reduced gait stability and lack of flexibility.MethodTo investigate how to prevent patients from acquiring a random stride cycle pattern, we tested rhythmic cueing which mimics the properties of variability found in healthy gait (biological variability). PD patients (n=19) and age-matched healthy participants (n=19) walked with three rhythmic cueing stimuli: isochronous, random variability, and with biological variability (LRC). Synchronization was not instructed.ResultsThe persistent correlation in gait was preserved only with stimuli with biological variability, equally for patients and controls (p's<.05). In contrast, cueing with isochronous or randomly varying inter-stimulus/beat intervals removed the LRC in the stride cycle. Notably, the individual's tendency to synchronize steps with beats determined the amount of negative effects of isochronous and random cues (p's<.05) but not the positive effect of biological variability.ConclusionStimulus variability and patients’ propensity to synchronize play a critical role in fostering healthier gait dynamics during cueing. The beneficial effects of biological variability provide useful guidelines for improving existing cueing treatments.



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A test of fixed and moving reference point control in posture

Publication date: Available online 28 September 2016
Source:Gait & Posture
Author(s): I-Chieh Lee, Matheus M. Pacheco, Karl M. Newell
This study investigated two contrasting assumptions of the regulation of posture: namely, fixed and moving reference point control. These assumptions were tested in terms of time-dependent structure and data distribution properties when stability is manipulated. Fifteen male participants performed a tightrope simulated balance task that is, maintaining a tandem stance while holding a pole. Pole length (and mass) and the standing support surface (fixed surface/balance board) were manipulated so as to mechanically change the balance stability. The mean and standard deviation (SD) of COP length were reduced with pole length increment but only in the balance board surface condition. Also, the SampEn was lower with greater pole length for the balance board but not the fixed surface. More than one peak was present in the distribution of COP in the majority of trials. Collectively, the findings provide evidence for a moving reference point in the maintenance of postural stability for quiet standing.



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Evaluation of the performance of accelerometer-based gait event detection algorithms in different real-world scenarios using the MAREA gait database

Publication date: Available online 28 September 2016
Source:Gait & Posture
Author(s): Siddhartha Khandelwal, Nicholas Wickström
Numerous gait event detection (GED) algorithms have been developed using accelerometers as they allow the possibility of long-term gait analysis in everyday life. However, almost all such existing algorithms have been developed and assessed using data collected in controlled indoor experiments with pre-defined paths and walking speeds. On the contrary, human gait is quite dynamic in the real-world, often involving varying gait speeds, changing surfaces and varying surface inclinations. Though portable wearable systems can be used to conduct experiments directly in the real-world, there is a lack of publicly available gait datasets or studies evaluating the performance of existing GED algorithms in various real-world settings.This paper presents a new gait database called MAREA (n=20 healthy subjects) that consists of walking and running in indoor and outdoor environments with accelerometers positioned on waist, wrist and both ankles. The study also evaluates the performance of six state-of-the-art accelerometer-based GED algorithms in different real-world scenarios, using the MAREA gait database. The results reveal that the performance of these algorithms is inconsistent and varies with changing environments and gait speeds. All algorithms demonstrated good performance for the scenario of steady walking in a controlled indoor environment with a combined median F1score of 0.98 for Heel-Strikes and 0.94 for Toe-Offs. However, they exhibited significantly decreased performance when evaluated in other lesser controlled scenarios such as walking and running in an outdoor street, with a combined median F1score of 0.82 for Heel-Strikes and 0.53 for Toe-Offs. Moreover, all GED algorithms displayed better performance for detecting Heel-Strikes as compared to Toe-Offs, when evaluated in different scenarios.



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Impact of Cricothyroid Muscle Contraction on Vocal Fold Vibration: Experimental Study with High-Speed Videoendoscopy

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Publication date: Available online 28 September 2016
Source:Journal of Voice
Author(s): Camila Cristina Ishikawa, Thais Gonçalves Pinheiro, Adriana Hachiya, Arlindo Neto Montagnoli, Domingos Hiroshi Tsuji
ObjectivesThe aim of this study was to evaluate the effects of cricothyroid muscle contraction on vocal fold vibration, as evaluated with high-speed videoendoscopy, and to identify one or more aspects of vocal fold vibration that could be used as an irrefutable indicator of unilateral cricothyroid muscle paralysis.Study DesignThis was an experimental study employing excised human larynges.MethodsTwenty freshly excised human larynges were evaluated during artificially produced vibration. Each larynx was assessed in three situations: bilateral cricothyroid muscle contraction, unilateral cricothyroid muscle contraction, and no contraction of either cricothyroid muscle. The following parameters were evaluated by high-speed videoendoscopy: fundamental frequency, periodicity, amplitude of vocal fold vibration, and phase symmetry between the vocal folds.ResultsAlthough neither unilateral nor bilateral cricothyroid muscle contraction altered the periodicity of vibration or the occurrence of phase asymmetry, there was a significant decrease in fundamental frequency in parallel with decreasing longitudinal tension. We also found an increase in vibration amplitude of right and left vocal folds, which were similar in terms of their behavior for this parameter in the various situations studied.ConclusionOur results suggest that differences in vibration amplitude and phase symmetry between vocal folds are not reliable indicators of unilateral cricothyroid muscle paralysis.



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The Impact of Language on Voice: An LTAS Study

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Publication date: Available online 28 September 2016
Source:Journal of Voice
Author(s): Samad Afshari Bahmanbiglu, Fariba Mojiri, Fateme Abnavi
ObjectivesThe present study investigates possible differences in sound characteristics associated with Farsi and Qashqai produced by Farsi-Qashqai bilinguals.Study DesignThis is a descriptive-analytical and cross-sectional study.MethodsThirty-two Farsi-Qashqai bilinguals (16 men and 16 women) participated in the study. Mean spectral energy (MSE) and spectral tilt (ST) obtained from long-term average speech spectra were extracted from continuous speech samples of Farsi-Qashqai bilingual speakers. MSE and ST were calculated using Praat and then compared between Farsi and Turkish.ResultsResults showed that bilingual speakers had higher MSE and lower ST in Farsi than in Turkish.ConclusionsFindings show that even with the same phonatory apparatus, spoken language affects the speaker's voice quality.



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