Iron Deficiency Anemia Linked to Hearing Loss

​A new study found that sensorineural hearing loss and conductive hearing loss are associated with iron deficiency anemia (JAMA Otolaryngol Head Neck Surg. 2016). Of the 305,339 patients aged 21 to 90 in the study, 4,807 (1.6%) had hearing loss and 2,274 (0.7%) had iron deficiency anemia. Researchers from the Penn State Milton S. Hershey Medical Center used logistic regression analysis to confirm that there are increased odds of sensorineural hearing loss (82%) and combined hearing loss among people with iron deficiency. This retrospective cohort study included data from Jan. 1, 2011 to Oct. 1, 2015.

Lead author Kathleen M. Schieffer, a doctoral candidate at Pennsylvania State University, emphasized in an interview with the New York Times that this study did not prove a causal relationship between iron deficiency anemia and hearing loss, only an association. "I would not recommend that anyone take iron supplements prophylactically without consulting a physician."​

Published: 1/6/2017 9:08:00 AM

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Iron Deficiency Anemia Linked to Hearing Loss

​A new study found that sensorineural hearing loss and conductive hearing loss are associated with iron deficiency anemia (JAMA Otolaryngol Head Neck Surg. 2016). Of the 305,339 patients aged 21 to 90 in the study, 4,807 (1.6%) had hearing loss and 2,274 (0.7%) had iron deficiency anemia. Researchers from the Penn State Milton S. Hershey Medical Center used logistic regression analysis to confirm that there are increased odds of sensorineural hearing loss (82%) and combined hearing loss among people with iron deficiency. This retrospective cohort study included data from Jan. 1, 2011 to Oct. 1, 2015.

Lead author Kathleen M. Schieffer, a doctoral candidate at Pennsylvania State University, emphasized in an interview with the New York Times that this study did not prove a causal relationship between iron deficiency anemia and hearing loss, only an association. "I would not recommend that anyone take iron supplements prophylactically without consulting a physician."​

Published: 1/6/2017 9:08:00 AM

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Iron Deficiency Anemia Linked to Hearing Loss

​A new study found that sensorineural hearing loss and conductive hearing loss are associated with iron deficiency anemia (JAMA Otolaryngol Head Neck Surg. 2016). Of the 305,339 patients aged 21 to 90 in the study, 4,807 (1.6%) had hearing loss and 2,274 (0.7%) had iron deficiency anemia. Researchers from the Penn State Milton S. Hershey Medical Center used logistic regression analysis to confirm that there are increased odds of sensorineural hearing loss (82%) and combined hearing loss among people with iron deficiency. This retrospective cohort study included data from Jan. 1, 2011 to Oct. 1, 2015.

Lead author Kathleen M. Schieffer, a doctoral candidate at Pennsylvania State University, emphasized in an interview with the New York Times that this study did not prove a causal relationship between iron deficiency anemia and hearing loss, only an association. "I would not recommend that anyone take iron supplements prophylactically without consulting a physician."​

Published: 1/6/2017 9:08:00 AM

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Intratympanic Triamcinolone and Dexamethasone in the Treatment of Meniere's Syndrome.

Objective: To describe the safety and potential efficacy of intratympanic administration of triamcinolone (40 mg/mL) in the treatment of unilateral Meniere's syndrome. Study Design: Single-institution retrospective analysis. Setting: Tertiary referral neurotology clinic. Patients: Eighteen patients diagnosed with unilateral Meniere's syndrome with vertigo refractory to medical management. Intervention(s): Intratympanic injection of triamcinolone or dexamethasone. Outcome Measure(s): Kaplan-Meier analysis was implemented to determine the rate of successful vertigo control. Responders were defined as patients who achieved sufficient vertigo control to decline ablative therapy. Nonresponders were defined as those who did not achieve satisfactory vertigo control and required ablative or surgical therapy. Pre- and posttreatment audiogram data was used to evaluate changes in hearing. Patient follow-up data was assessed for complications potentially resulting from intratympanic therapy. Results: No patient experienced profound hearing loss or other serious adverse events as a result of intratympanic triamcinolone therapy. Tympanic membrane perforation occurred in three (18%) patients, all of whom had received three or more previous intratympanic injections. Satisfactory vertigo control with intratympanic triamcinolone therapy was achieved in 14 (78%) of 18 subjects. Conclusion: Our results suggest that intratympanic triamcinolone therapy on an as-needed basis is a safe and potentially effective procedure for vertigo control in patients with Meniere's syndrome. These findings warrant the implementation of prospective, controlled trials to investigate its safety and efficacy further. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Endoscopic Management of Middle Ear Paragangliomas: A Case Series.

Objective: To investigate the efficacy and safety of endoscopic middle ear paraganglioma (glomus tympanicum) resection. Study Design: Case series with chart review. Setting: Multi-institutional tertiary university medical centers. Patients: Adult patients with middle ear paragangliomas treated via a transcanal endoscopic approach from 1/2012 to 11/2015. Intervention: All tumors were initially approached via a transcanal endoscopic technique. An operating microscope was used only if the tumor could not be adequately visualized or resected with endoscopic techniques alone. Main Outcome Measures: The main outcome was completeness of tumor resection via the endoscopic technique. Secondary measures were resolution of pulsatile tinnitus, audiometric outcomes, surgical duration, and surgical complications. Results: Endoscopic resection was attempted on 14 middle ear paragangliomas. Thirteen patients (93%) were women with a mean age of 61.6 years. The mean tumor size was 6.2 mm (SD, 3.3). Eleven cases (79%) had complete resection via an exclusive endoscopic approach. The mean surgical duration was 108.1 minutes (SD, 55.6). One case required use of an operating microscope via a transcanal route and two cases required postauricular incisions with mastoidectomy. There were no significant postoperative complications. Two patients (14%) had tympanic membrane perforations repaired intraoperatively without residual perforation on follow-up. All patients had normal postoperative facial nerve function. Pulsatile tinnitus resolved after surgery in all 13 patients who presented with this symptom preoperatively. The mean pure-tone average improved by 5.9 dB (SD, 4.6) after surgery. Conclusions: Endoscopic management of middle ear paraganglioma is safe, feasible, and effective. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Lucae's Springy Pressure Probe to Mobilize the Ossicular Chain: Rise and Fall of an Ingenious Instrument.

Objectives/Hypotheses: In 1884, Johann Constantin August Lucae (1835-1911), a German otologist from Berlin, introduced a new "method to mechanically treat chronic troubles of the mobility of the hearing organ transmission apparatus." It consisted in the use of a springy pressure probe to directly mobilize the handle of the malleus. The aim of this study is to trace the invention, clinical use, technological modifications, and ultimate extinction of this instrument. Method: Review of Lucae's publications, comments by his colleagues, and trade catalogues published between 1880 and 1940. Results: Lucae presented at least six different models of his springy pressure probe during his career. Some of his colleagues modified it. The success rate was much disputed, and the instrument died with Lucae. Conclusion: Lucae's spring pressure probe is another example of the ingenuity of man to try to find a solution when confronted with an unclear and unresolved otological problem. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Comparison of Treatment Outcomes Following Either Prefrontal Cortical-only or Dual-site Repetitive Transcranial Magnetic Stimulation in Chronic Tinnitus Patients: A Double-blind Randomized Study.

Objectives: We evaluated treatment outcomes following single-site repetitive transcranial magnetic stimulation (rTMS) in the dorsolateral prefrontal cortex (DLPFC) and dual-site rTMS in the auditory cortex (AC) and DLPFC (AC + FC). Study Design and Patients: This prospective randomized double-blind trial initially included 19 patients with chronic tinnitus and 17 of these patients received rTMS on the left AC and left DLPFC or only the left DLPFC. The subjects were randomly allocated to either the dual-site rTMS (AC + FC) protocol (Group 1, n = 9) or the singlesite rTMS (DLPFC) protocol (Group 2, n = 8). Group 1 received daily treatments with 2,000 pulses applied to the AC and 1,000 pulses applied to the DLPFC for 4 days (total of 12,000 pulses) and Group 2 received daily treatments with 3,000 pulses applied the DLPFC for 4 days (total of 12,000 pulses). Main Outcome Measures: The severity of tinnitus was assessed before rTMS treatment using the Tinnitus Handicap Inventory (THI) and the self-rated Visual Analog Scale. These measures were used to determine the awareness, loudness, annoyance, and effects of tinnitus on daily life at 1, 2, 4, and 12 weeks after treatment. Results: The improvement in THI score was significantly better in Group 1 than in Group 2, even after controlling for the between-group differences in pretreatment THI score. In terms of psychological factors, Group 1 exhibited significant improvements in scores on the State-Trait Anxiety Inventory (STAI) for both state anxiety (STAI-X1) and trait anxiety (STAI-X2) at 12 weeks posttreatment and scores on the Pittsburgh Sleep Quality Index at 4 weeks posttreatment. Group 2 showed an improvement in only the STAI-X2 score at 12 weeks posttreatment. Conclusions: The rTMS protocol effectively suppressed tinnitus in the dual-site rTMS (AC+FC) group but not in the single-site rTMS (DLPFC) group. Although recent evidence has shown that non-auditory cortices in the tinnitus network play an important role in the generation of tinnitus, our findings indicate that rTMS on non-auditory cortical sites alone may not be sufficient for treatment. Thus, dual-site rTMS in the AC and DLPFC may be preferable for controlling this condition. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Delayed Vestibular Schwannoma Regrowth Following Shrinkage After Stereotactic Radiosurgery: Implication for Life-Long Surveillance.

Objective: To enhance understanding of the behavior of vestibular schwannomas (VS) after stereotactic radiosurgery (SRS), including the potential for late tumor regrowth, and the need for lifelong radiological and clinical surveillance. Patients: From a total of 540 patients with VS and out of 95 patients receiving SRS for their growing VS, the cases of two women patients aged 58 and 59 years with medium sized, growing VS are presented. Intervention: Both patients were treated with SRS. Following treatment, both patients had close clinical follow-up and serial magnetic resonance imaging (MRI). Main Outcome Measures: Post-SRS clinical assessment and serial MRI to determine VS size and respond to treatment. Results: Close clinical follow-up after SRS identified no change in symptoms in one patient; the other developed ipsilateral facial nerve twitching without weakness. Serial MRI identified that in both patients, VS that had initially decreased in size following SRS, exhibited significant late regrowth after a 3-year period, reaching the pretreatment size. Conclusions: This is the first report of late vestibular schwannoma regrowth following a period of significant shrinkage after SRS. Potential reason may be the presence of living cells within the tumor; the possibility of malignant transformation should also be taken into account. Following SRS, patients with VS warrant lifelong radiological and clinical surveillance, even following good response, as there seems to be a small chance of initial regression followed by further growth. Microsurgery for tumor removal and histological diagnosis is indicated in such cases. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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First Report: Linear Incision for Placement of a Magnetically Coupled Bone-Anchored Hearing Implant.

Objectives: Discuss use of a linear incision for placement of a magnetically coupled bone anchored hearing implant. Methods: Case series. Results: Two patients underwent placement of magnetically coupled bone-anchored hearing implants (BAHI) through linear incisions. The first, a 40-year-old female with congenital single-sided deafness, previously had successful implantation of a percutaneous bone anchored hearing implant through a linear incision; unfortunately, she developed pain and intermittent drainage at her abutment site with time, resulting in a request for removal of her device. As an alternative to complete removal, we offered to replace the percutaneous implant with a magnetically coupled BAHI, employing the same linear incision previously. The second patient, a 53-year-old obese female with limited neck mobility and mixed hearing loss, underwent primary placement of a magnetically coupled BAHI through a linear incision. Limitations in neck mobility and patient body habitus precluded use of a traditional C-shaped incision. Both patients underwent surgery successfully, healed without incident, had their devices activated 6 weeks after their procedures, and are able to wear their implants more than 8 hours per day without discomfort. Conclusion: Surgical techniques for bone-anchored implants continue to evolve. Though manufacturers of magnetically coupled devices recommend using C-shaped incisions with large skin flaps, our first reported cases suggest that a small linear incision immediately overlying the implant magnet may be an acceptable alternative. Potential benefits include a smaller incision, less hair removal, smaller flap, decreased surgical time, and less postoperative pain. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Benefits of High-dose Steroid + Hespander + Mannitol Administration in the Treatment of Bell's Palsy.

Objective: Large-scale investigations have not been recently conducted on the efficacy of high-dose steroid administration of prednisolone (PSL) for Bell's palsy. We compared treatment results between normal-dose steroid (PSL 60 mg/d) and high-dose steroid (PSL 200 mg/d) + Hespander + Mannitol administration. We also investigated the recovery rate for antiviral agents. Study Design: Retrospective case review. Setting: Tertiary referral center. Patients: A total of 675 patients with Bell's palsy who had grade V and grade VI on the House-Brackmann (HB) scale were treated in our department between 1995 and 2014. These patients could be divided into a normal-dose group and high-dose group. Methods: We separately assessed treatment outcomes for HB grade V patients and HB grade VI patients. Logistic regression analysis was also performed to investigate factors that can impact treatment outcomes, i.e., sex, age, days to start of treatment, PSL dosage, and antiviral drug administration. Results: Recovery rates were significantly better in the high-dose steroid + Hespander + Mannitol group in comparison with the normal-dose steroid group for HB grade V (100% versus 77.7%) and HB grade VI (92.5% versus 68.2%). Additional effects of antiviral agents were only shown in the normal-dose group. Significant factors for treatment outcomes were PSL 200 mg/d administration and early initiation of treatment. Insignificant factors were sex, age, and the antiviral agent. Conclusion: We showed the high-dose steroid + Hespander + Mannitol administration produced significantly better outcomes than normal-dose steroid administration in the treatment of patients with Bell's palsy. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Successful Loading of a Bone-Anchored Hearing Implant at 1 Week After Surgery.

Objective: To assess implant stability and safety of loading a bone-anchored implant 1 week after surgery. The patients were loaded at 1 week for fast rehabilitation and ease of logistics. Design: Single center, prospective cohort study of 25 adults with expected normal skin and bone quality. Intervention: Implantation of the Baha BA400 implant system using a linear incision technique without skin thinning. Abutment lengths of 8, 10, and 12 mm were used. Main Outcome Measures: Implant stability quotient (ISQ) 0, 7, 14, 30 days and 3, 6, and 12 months postoperatively. Results: Twenty-five patients were included, 23 could be followed up for 1 year. Mean ISQ was increasing throughout the observation period with no sign of adverse influence from the early loading. No implants were lost or clinically unstable. Individual ISQ curves fall in two categories-continually increasing ISQ or increasing ISQ with initial dip. ISQ for patients in the initial dip group eventually increased despite the early and continued loading. Conclusion: Loading of the implant system under study 1 week after surgery have been successful for 25 patients with expected normal bone quality followed up for 1 year. No implants were lost. All individual ISQ were increasing throughout the study period. The early loading of the implant under study does not seem to influence the osseointegration. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Early Postoperative Imaging of the Labyrinth by Cone Beam CT After Stapes Surgery for Otosclerosis With Correlation to Audiovestibular Outcome.

Background: Sensorineural complications of stapes surgery are rare but potentially serious. Imaging is usually performed to identify an underlying cause, such as excessive intravestibular penetration of the prosthesis or pneumolabyrinth suggesting perilymphatic fistula. Unfortunately, there is very little data in an unselected series of uneventful patients. The aim of this study was to analyze the depth of prosthesis penetration within the vestibule and the rate of pneumolabyrinth the day or the day after the procedure by performing a cone beam computed tomography of the temporal bone in a cohort of unselected patients, and to correlate imaging findings to clinical outcome. Methods: A prospective monocentric study was conducted in a tertiary referral medical center. A cone beam computed tomography was performed in 80 consecutive patients having undergone stapes surgery for otosclerosis, the day or the day after the procedure. Penetration length and location of the prosthesis within the vestibule, as well as presence or absence of a pneumolabyrinth, were recorded, and compared with clinical data (vertigo, nystagmus, hearing measurement). Results: Pneumolabyrinth was found in 15% of the patients. The mean penetration length of the prosthesis within the vestibule was 1 mm (0-1.9 mm). No serious complication occurred during the study period. No correlations were found when comparing imaging findings to clinical outcome. Conclusion: Our results do not support empirically insights into detrimental effects of postoperative pneumolabyrinth or too long prosthesis after stapes surgery. Further studies are needed to better understand the causes of postoperative complications of stapes surgery. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Plasmacytoma of the Temporal Bone, a Great Imitator: Report of Seven Cases and Comprehensive Review of the Literature.

Objectives: To describe the clinical presentation, radiological features, and outcome of patients with plasmacytoma of the temporal bone. Methods: Multicenter retrospective case series of all patients diagnosed with plasmacytoma of the temporal bone between 1990 and 2015. Comprehensive literature review of all previously published cases. Results: A total of seven patients (average age, 57.3 yr; 57% women) met inclusion criteria. Three (43%) had a known history of multiple myeloma (MM). The most common symptoms at presentation included otalgia, headache, and dizziness (43%, each). Five (71%) presented with a vascular appearing middle ear mass visible on otoscopy. Four of these patients did not have an established history of MM and were referred with presumptive diagnoses of paraganglioma or endolymphatic sac tumor (ELST). The average maximum tumor diameter was 3.7 cm (median, 3.5 cm; range, 0.9-6.6 cm) and the most commonly involved temporal bone subsites were the middle ear and mastoid (71% each). MM was ultimately diagnosed in six cases (86%). In addition to the new cases presented herein, 18 previously published reports were analyzed. In the 25 aggregate cases, 44% of cases were associated with MM, and the mastoid (72%) and middle ear (53%) were the most commonly involved temporal bone subsites. Conclusion: Plasmacytoma of the temporal bone is rare, and the clinical presentation can closely mimic that of other primary temporal bone tumors. In patients with an established history of MM, it is imperative to have a high index of suspicion for temporal bone plasmacytoma, even when radiological features suggest an alternate diagnosis. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Pilot Study Evaluating the Impact of Otology Surgery Videos on Otolaryngology Resident Education.

Objectives: Use of videos as educational tools is not a novel concept; however, there is a paucity of high-quality video resources available to otolaryngology trainees. We hypothesized that residents would deem surgical-videos using a multimedia-style format more valuable as preparatory tools. Aims of this study: 1) develop portfolio of otology/neurotology videos overviewing key steps, anatomy, and pearls by a senior surgeon; 2) have residents rate the effectiveness of the videos as a preoperative tool. Study Design: Prospective study. Methods: A video-library of procedures at ( https://www.youtube.com/user/cisurgeon) was formatted via time-stamping to coincide expert level narration with closed captioning, critical procedural steps, relevant instrumentation, radiographic pictures, orientation cues, and anatomical highlights. Otolaryngology trainees of postgraduate years 2 through 5 (n = 13) watched a minimum of three videos and completed an assessment addressing: current resource identification/usefulness comparison, self-efficacy, impact on preparation time, and prioritization of resources. Results: The videos rated as highly useful compared with current resources (p = 0.002) and capable of promoting self-efficacy. Residents reported moderate-high prioritization of our multi-media formatted resource (scores >6) among their current preoperative regimen. Conclusion: The varied videos were rated highly in terms of usefulness, promoting self-efficacy and as a high-priority for a resident's surgical preparation. Multimedia-formatted training videos should be further explored for this generation of electronic-learners. Future studies with a larger cohort, objective approaches, and multidisciplinary involvement are needed to determine the full impact of this education medium on surgical-training. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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Speech language therapy practice in a bilingual dialogical clinic: case report.

Related Articles

Speech language therapy practice in a bilingual dialogical clinic: case report.

Codas. 2016 9-10;28(5):653-660

Authors: Mariani BZ, Guarinello AC, Massi G, Tonocchi R, Berberian AP

Abstract
Purpose: this study aims to discuss the use of Brazilian sign language as the first language for a deaf individual going to a bilingual dialogic clinic from dialogic activities.
Methods: This is a longitudinal study, including one deaf individual, called N, interacting with his family and speech therapists.
Results: During the therapeutic process developed inside the bilingual dialogical clinic, N participated in interactive contexts and could constitute himself as author of his sign language texts. In addition, he started to act dialogically and use verbal and nonverbal signs.
Conclusion: Through interactive and dialogical situations developed inside the speech language therapy clinic, this deaf participant got control of his sign language, and started to get interest in and control of the Portuguese language, especially in the written form.

PMID: 27849242 [PubMed - indexed for MEDLINE]

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JAAA CEU Program.

JAAA CEU Program.

J Am Acad Audiol. 2017 Jan;28(1):103-104

Authors:

PMID: 28054917 [PubMed - in process]

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A Response to Dr. Jerger regarding "On Diagnostic Accuracy in Audiology: Central Site of Lesion and Central Auditory Processing Disorder Studies".

A Response to Dr. Jerger regarding "On Diagnostic Accuracy in Audiology: Central Site of Lesion and Central Auditory Processing Disorder Studies".

J Am Acad Audiol. 2017 Jan;28(1):102

Authors: Vermiglio AJ

PMID: 28054916 [PubMed - in process]

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Auditory Processing Disorder as the Sole Manifestation of a Cerebellopontine and Internal Auditory Canal Lesion.

Auditory Processing Disorder as the Sole Manifestation of a Cerebellopontine and Internal Auditory Canal Lesion.

J Am Acad Audiol. 2017 Jan;28(1):91-101

Authors: Iliadou VV, Eleftheriadis N

Abstract
BACKGROUND: Clinical importance of auditory processing disorder (APD) testing is often overlooked and regarded with skepticism given the challenging interpretation of results and the current growing debate of its nature and clinical entity.
PURPOSE: Presentation of this case is highly educational as APD is the single clinical manifestation of a large cerebellopontine and internal auditory canal lesion.
RESEARCH DESIGN: A case report.
DATA COLLECTION AND ANALYSIS: The patient underwent a standard audiological evaluation with normal results. She was referred for APD evaluation. The APD test battery consisted of speech in babble (SinB), dichotic digits (DD), frequency and duration of pattern sequence testing, Random Gap Detection Test, and gaps in noise. These were followed by otoacoustic emissions testing, auditory brainstem responses (ABR) and magnetic resonance imaging (MRI).
RESULTS: Her auditory processing results showed deficits in SinB and DD limited to the right ear as well as deficits in temporal processing. Both verbal and nonverbal tests exhibited deficits strictly limited to the right ear, which was in accordance with what she was experiencing as reduced loudness for the incoming sounds on the right ear. This less costly evaluation revealed that there was good reason to assess electrophysiologically the auditory system. ABR showed an abnormal waveform with either missing or severely prolongated wave V (depending on stimulus polarity). Otoacoustic emissions were normal. MRI was then implemented revealing a large cerebellopontine and internal auditory canal lesion.
CONCLUSIONS: This clinical case stresses the importance of testing for APD with a psychoacoustical test battery despite current debate of lack of a gold standard diagnostic approach to APD. In this case, APD diagnosis led to a cerebellopontine lesion identification with extension to the right internal auditory canal. This rare cause of APD demonstrates the efficiency of the current diagnostic test battery in revealing lesional causes of central APD.

PMID: 28054915 [PubMed - in process]

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Detailed Audiological Evaluation of a Patient with Xeroderma Pigmentosum with Neural Degeneration.

Detailed Audiological Evaluation of a Patient with Xeroderma Pigmentosum with Neural Degeneration.

J Am Acad Audiol. 2017 Jan;28(1):80-90

Authors: Mercer D, Hurley A, Tsien F

Abstract
BACKGROUND: Xeroderma pigmentosum (XP) is a rare autosomal recessive condition characterized by extreme sensitivity to ultraviolet light. Individuals with XP lack the ability to repair DNA (deoxyribonucleic acid) damage caused by ultraviolet radiation, leading to sunburn and increased susceptibility to skin cancers. Approximately 25% of patients also exhibit neural degeneration, which includes progressive mental deterioration, cortical thinning, and sensorineural hearing loss.
PURPOSE: Herein, we describe the audiological and genetic findings in a patient with XP subtype D with neural degeneration and hearing loss.
RESEARCH DESIGN: This is a case report of a patient with XP subtype D, type 1 diabetes, and some clinical features typical of Charcot-Marie-Tooth disease.
DATA COLLECTION AND ANALYSIS: We obtained audiological evaluations over a course of 11 yr, including serial audiograms, auditory processing disorders evaluations, and electrophysiological testing.
RESULTS: Hearing sensitivity has progressed from a unilateral mild high-frequency sensorineural hearing loss to a bilateral sloping moderate to severe/profound sensorineural hearing loss. In addition to the dramatic decline in hearing sensitivity, the patient demonstrates global auditory processing deficits, indicating a central component to his hearing loss.
CONCLUSION: These findings emphasize the importance of the contribution of audiological evaluations to the diagnosis of a genetic disorder. Periodic evaluations of hearing sensitivity and auditory processing can provide information on disease progression in patients with XP with neural degeneration.

PMID: 28054914 [PubMed - in process]

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Interrupted Monosyllabic Words: The Effects of Ten Interruption Locations on Recognition Performance by Older Listeners with Sensorineural Hearing Loss.

Interrupted Monosyllabic Words: The Effects of Ten Interruption Locations on Recognition Performance by Older Listeners with Sensorineural Hearing Loss.

J Am Acad Audiol. 2017 Jan;28(1):68-79

Authors: Wilson RH, Sharrett KC

Abstract
BACKGROUND: Two previous experiments from our laboratory with 70 interrupted monosyllabic words demonstrated that recognition performance was influenced by the temporal location of the interruption pattern. The interruption pattern (10 interruptions/sec, 50% duty cycle) was always the same and referenced word onset; the only difference between the patterns was the temporal location of the on- and off-segments of the interruption cycle. In the first study, both young and older listeners obtained better recognition performances when the initial on-segment coincided with word onset than when the initial on-segment was delayed by 50 msec. The second experiment with 24 young listeners detailed recognition performance as the interruption pattern was incremented in 10-msec steps through the 0- to 90-msec onset range. Across the onset conditions, 95% of the functions were either flat or U-shaped.
PURPOSE: To define the effects that interruption pattern locations had on word recognition by older listeners with sensorineural hearing loss as the interruption pattern incremented, re: word onset, from 0 to 90 msec in 10-msec steps.
RESEARCH DESIGN: A repeated-measures design with ten interruption patterns (onset conditions) and one uninterruption condition.
STUDY SAMPLE: Twenty-four older males (mean = 69.6 yr) with sensorineural hearing loss participated in two 1-hour sessions. The three-frequency pure-tone average was 24.0 dB HL and word recognition was ≥80% correct.
DATA COLLECTION AND ANALYSES: Seventy consonant-vowel nucleus-consonant words formed the corpus of materials with 25 additional words used for practice. For each participant, the 700 interrupted stimuli (70 words by 10 onset conditions), the 70 words uninterrupted, and two practice lists each were randomized and recorded on compact disc in 33 tracks of 25 words each.
RESULTS: The data were analyzed at the participant and word levels and compared to the results obtained earlier on 24 young listeners with normal hearing. The mean recognition performance on the 70 words uninterrupted was 91.0% with an overall mean performance on the ten interruption conditions of 63.2% (range: 57.9-69.3%), compared to 80.4% (range: 73.0-87.7%) obtained earlier on the young adults. The best performances were at the extremes of the onset conditions. Standard deviations ranged from 22.1% to 28.1% (24 participants) and from 9.2% to 12.8% (70 words). An arithmetic algorithm categorized the shapes of the psychometric functions across the ten onset conditions. With the older participants in the current study, 40% of the functions were flat, 41.4% were U-shaped, and 18.6% were inverted U-shaped, which compared favorably to the function shapes by the young listeners in the earlier study of 50.0%, 41.4%, and 8.6%, respectively. There were two words on which the older listeners had 40% better performances.
CONCLUSION: Collectively, the data are orderly, but at the individual word or participant level, the data are somewhat volatile, which may reflect auditory processing differences between the participant groups. The diversity of recognition performances by the older listeners on the ten interruption conditions with each of the 70 words supports the notion that the term hearing loss is inclusive of processes well beyond the filtering produced by end-organ sensitivity deficits.

PMID: 28054913 [PubMed - in process]

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The Effect of Conventional and Transparent Surgical Masks on Speech Understanding in Individuals with and without Hearing Loss.

The Effect of Conventional and Transparent Surgical Masks on Speech Understanding in Individuals with and without Hearing Loss.

J Am Acad Audiol. 2017 Jan;28(1):58-67

Authors: Atcherson SR, Mendel LL, Baltimore WJ, Patro C, Lee S, Pousson M, Spann MJ

Abstract
BACKGROUND: It is generally well known that speech perception is often improved with integrated audiovisual input whether in quiet or in noise. In many health-care environments, however, conventional surgical masks block visual access to the mouth and obscure other potential facial cues. In addition, these environments can be noisy. Although these masks may not alter the acoustic properties, the presence of noise in addition to the lack of visual input can have a deleterious effect on speech understanding. A transparent ("see-through") surgical mask may help to overcome this issue.
PURPOSE: To compare the effect of noise and various visual input conditions on speech understanding for listeners with normal hearing (NH) and hearing impairment using different surgical masks.
RESEARCH DESIGN: Participants were assigned to one of three groups based on hearing sensitivity in this quasi-experimental, cross-sectional study.
STUDY SAMPLE: A total of 31 adults participated in this study: one talker, ten listeners with NH, ten listeners with moderate sensorineural hearing loss, and ten listeners with severe-to-profound hearing loss.
DATA COLLECTION AND ANALYSIS: Selected lists from the Connected Speech Test were digitally recorded with and without surgical masks and then presented to the listeners at 65 dB HL in five conditions against a background of four-talker babble (+10 dB SNR): without a mask (auditory only), without a mask (auditory and visual), with a transparent mask (auditory only), with a transparent mask (auditory and visual), and with a paper mask (auditory only).
RESULTS: A significant difference was found in the spectral analyses of the speech stimuli with and without the masks; however, no more than ∼2 dB root mean square. Listeners with NH performed consistently well across all conditions. Both groups of listeners with hearing impairment benefitted from visual input from the transparent mask. The magnitude of improvement in speech perception in noise was greatest for the severe-to-profound group.
CONCLUSIONS: Findings confirm improved speech perception performance in noise for listeners with hearing impairment when visual input is provided using a transparent surgical mask. Most importantly, the use of the transparent mask did not negatively affect speech perception performance in noise.

PMID: 28054912 [PubMed - in process]

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Evaluation of a Wind Noise Attenuation Algorithm on Subjective Annoyance and Speech-in-Wind Performance.

Evaluation of a Wind Noise Attenuation Algorithm on Subjective Annoyance and Speech-in-Wind Performance.

J Am Acad Audiol. 2017 Jan;28(1):46-57

Authors: Korhonen P, Kuk F, Seper E, Mørkebjerg M, Roikjer M

Abstract
BACKGROUND: Wind noise is a common problem reported by hearing aid wearers. The MarkeTrak VIII reported that 42% of hearing aid wearers are not satisfied with the performance of their hearing aids in situations where wind is present.
PURPOSE: The current study investigated the effect of a new wind noise attenuation (WNA) algorithm on subjective annoyance and speech recognition in the presence of wind.
RESEARCH DESIGN: A single-blinded, repeated measures design was used.
STUDY SAMPLE: Fifteen experienced hearing aid wearers with bilaterally symmetrical (≤10 dB) mild-to-moderate sensorineural hearing loss participated in the study.
DATA COLLECTION AND ANALYSIS: Subjective rating for wind noise annoyance was measured for wind presented alone from 0° and 290° at wind speeds of 4, 5, 6, 7, and 10 m/sec. Phoneme identification performance was measured using Widex Office of Clinical Amplification Nonsense Syllable Test presented at 60, 65, 70, and 75 dB SPL from 270° in the presence of wind originating from 0° at a speed of 5 m/sec.
RESULTS: The subjective annoyance from wind noise was reduced for wind originating from 0° at wind speeds from 4 to 7 m/sec. The largest improvement in phoneme identification with the WNA algorithm was 48.2% when speech was presented from 270° at 65 dB SPL and the wind originated from 0° azimuth at 5 m/sec.
CONCLUSION: The WNA algorithm used in this study reduced subjective annoyance for wind speeds ranging from 4 to 7 m/sec. The algorithm was effective in improving speech identification in the presence of wind originating from 0° at 5 m/sec. These results suggest that the WNA algorithm used in the current study could expand the range of real-life situations where a hearing-impaired person can use the hearing aid optimally.

PMID: 28054911 [PubMed - in process]

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Examining Effects of Physical Exertion on the Dynamic Visual Acuity Test in Collegiate Athletes.

Examining Effects of Physical Exertion on the Dynamic Visual Acuity Test in Collegiate Athletes.

J Am Acad Audiol. 2017 Jan;28(1):36-45

Authors: Patterson JN, Murphy AM, Honaker JA

Abstract
BACKGROUND: Acute symptoms of dizziness and/or imbalance commonly experienced in athletes postconcussion are speculated to arise from dysfunction at multiple levels (i.e., inner ear or central vestibular system) to appropriately integrate afferent sensory information. Disruption along any pathway of the balance system can result in symptoms of dizziness, decreased postural control function (vestibulospinal reflex), and reduced vestibulo-ocular reflex function. This may also lead to decreased gaze stability with movements of the head and may account for symptoms of blurred vision or diplopia reported in almost half of athletes sustaining a concussion. Current concussion position statements include measures of postural control to examine changes to the balance system postconcussion. The Balance Error Scoring System (BESS) is a commonly used low-cost postural control measure for concussion assessment. Although this is a widely used measure for documenting balance function on both immediate (sideline) and recovery monitoring, the BESS has been shown to be affected by physical exertion. Therefore, the BESS may not be the most efficient means of examining functional changes to the balance system immediately after head injury. Dynamic Visual Acuity Test (DVAT) has been found to effectively evaluate and monitor changes to the gaze stability system postinjury. Thus, DVAT may be an additional measure in the concussion assessment battery, as well as an alternative for more immediate sideline assessment to help make objective return-to-play decisions.
PURPOSE: The aim of the study was to determine the effects of physical exertion on a clinical vestibular assessment, the DVAT, in collegiate athletes, as a first step in defining the role of this measure in the concussion assessment battery.
RESEARCH DESIGN: Cross-sectional, repeated-measures design.
STUDY SAMPLE: Twenty-eight healthy collegiate athletes (20 males, 8 females; age = 20.25 ± 1.46 yr, range = 18-25 yr) volunteered to participate in the study.
DATA COLLECTION AND ANALYSIS: Participants were randomly assigned to complete a 20-min protocol of physical exertion or rest. DVAT was completed pre-exertion or rest (pre-DVAT), immediately following the 20-min protocol (post-DVAT I), and again 10 min after the completion of the 20-min protocol (post-DVAT II). Ratings of perceived exertion (RPE) and heart rate (HR) were monitored throughout testing. Repeated-measures analysis of the variance were used to examine the effects of exertion on DVAT. Additionally, intraclass correlation coefficients were used to examine test reliability.
RESULTS: No significant main effect was observed for right and left DVAT logarithm of the minimal angle of resolution loss between groups or across time points (p > 0.05). A significant main effect was observed for RPE and HR for groups and time points (p < 0.001), indicating adequate physical exertion and rest. Fair to good reliability (intraclass correlation coefficient values between 0.4 and 0.74) was observed for both rightward and leftward movements of the head across the three time points.
CONCLUSIONS: Findings from this study suggest that DVAT is not affected by physical exertion and may provide a more immediate assessment of the balance system that may be of use for the sideline concussion assessment. Future studies will be performed to examine additional factors (e.g., background noise, complex visual backgrounds) that may affect DVAT performance in the sideline environment.

PMID: 28054910 [PubMed - in process]

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Noise Exposure Questionnaire: A Tool for Quantifying Annual Noise Exposure.

Noise Exposure Questionnaire: A Tool for Quantifying Annual Noise Exposure.

J Am Acad Audiol. 2017 Jan;28(1):14-35

Authors: Johnson TA, Cooper S, Stamper GC, Chertoff M

Abstract
BACKGROUND: Exposure to both occupational and nonoccupational noise is recognized as a risk factor for noise-induced hearing loss (NIHL). Although audiologists routinely inquire regarding history of noise exposure, there are limited tools available for quantifying this history or for identifying those individuals who are at highest risk for NIHL. Identifying those at highest risk would allow hearing conservation activities to be focused on those individuals.
PURPOSE: To develop a detailed, task-based questionnaire for quantifying an individual's annual noise exposure (ANE) arising from both occupational and nonoccupational sources (aim 1) and to develop a short screening tool that could be used to identify individuals at high risk of NIHL (aim 2).
RESEARCH DESIGN: Review of relevant literature for questionnaire development followed by a cross-sectional descriptive and correlational investigation of the newly developed questionnaire and screening tool.
STUDY SAMPLE: One hundred fourteen college freshmen completed the detailed questionnaire for estimating ANE (aim 1) and answered the potential screening questions (aim 2). An additional 59 adults participated in data collection where the accuracy of the screening tool was evaluated (aim 2).
DATA COLLECTION AND ANALYSIS: In study aim 1, all participants completed the detailed questionnaire and the potential screening questions. Descriptive statistics were used to quantify participant participation in various noisy activities and their associated ANE estimates. In study aim 2, linear regression techniques were used to identify screening questions that could be used to predict a participant's estimated ANE. Clinical decision theory was then used to assess the accuracy with which the screening tool predicted high and low risk of NIHL in a new group of participants.
RESULTS: Responses on the detailed questionnaire indicated that our sample of college freshmen reported high rates of participation in a variety of occupational and nonoccupational activities associated with high sound levels. Although participation rates were high, ANE estimates were below highest-risk levels for many participants because the frequency of participation in these activities was low in many cases. These data illustrate how the Noise Exposure Questionnaire (NEQ) could be used to provide detailed and specific information regarding an individual's exposure to noise. The results of aim 2 suggest that the screening tool, the 1-Minute Noise Screen, can be used to identify those participants with high- and low-risk noise exposure, allowing more in-depth assessment of noise exposure history to be targeted at those most at risk.
CONCLUSIONS: The NEQ can be used to estimate an individual's ANE and the 1-Minute Noise Screen can be used to identify those participants at highest risk of NIHL. These tools allow audiologists to focus hearing conservation efforts on those individuals who are most in need of those services.

PMID: 28054909 [PubMed - in process]

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Binaural Interference and the Effects of Age and Hearing Loss.

Binaural Interference and the Effects of Age and Hearing Loss.

J Am Acad Audiol. 2017 Jan;28(1):5-13

Authors: Mussoi BS, Bentler RA

Abstract
BACKGROUND: The existence of binaural interference, defined here as poorer speech recognition with both ears than with the better ear alone, is well documented. Studies have suggested that its prevalence may be higher in the elderly population. However, no study to date has explored binaural interference in groups of younger and older adults in conditions that favor binaural processing (i.e., in spatially separated noise). Also, the effects of hearing loss have not been studied.
PURPOSE: To examine binaural interference through speech perception tests, in groups of younger adults with normal hearing, older adults with normal hearing for their age, and older adults with hearing loss.
RESEARCH DESIGN: A cross-sectional study.
STUDY SAMPLE: Thirty-three participants with symmetric thresholds were recruited from the University of Iowa community. Participants were grouped as follows: younger with normal hearing (18-28 yr, n = 12), older with normal hearing for their age (73-87 yr, n = 9), and older with hearing loss (78-94 yr, n = 12). Prior noise exposure was ruled out.
DATA COLLECTION AND ANALYSIS: The Connected Speech Test (CST) and Hearing in Noise Test (HINT) were administered to all participants bilaterally, and to each ear separately. Test materials were presented in the sound field with speech at 0° azimuth and the noise at 180°. The Dichotic Digits Test (DDT) was administered to all participants through earphones. Hearing aids were not used during testing. Group results were compared with repeated measures and one-way analysis of variances, as appropriate. Within-subject analyses using pre-established critical differences for each test were also performed.
RESULTS: The HINT revealed no effect of condition (individual ear versus bilateral presentation) using group analysis, although within-subject analysis showed that 27% of the participants had binaural interference (18% had binaural advantage). On the CST, there was significant binaural advantage across all groups with group data analysis, as well as for 12% of the participants at each of the two signal-to-babble ratios (SBRs) tested. One participant had binaural interference at each SBR. Finally, on the DDT, a significant right-ear advantage was found with group data, and for at least some participants. Regarding age effects, more participants in the pooled elderly groups had binaural interference (33.3%) than in the younger group (16.7%), on the HINT. The presence of hearing loss yielded overall lower scores, but none of the comparisons between bilateral and unilateral performance were affected by hearing loss.
CONCLUSIONS: Results of within-subject analyses on the HINT agree with previous findings of binaural interference in ≥17% of listeners. Across all groups, a significant right-ear advantage was also seen on the DDT. HINT results support the notion that the prevalence of binaural interference is likely higher in the elderly population. Hearing loss, however, did not affect the differences between bilateral and better unilateral scores. The possibility of binaural interference should be considered when fitting hearing aids to listeners with symmetric hearing loss. Comparing bilateral to unilateral (unaided) performance on tests such as the HINT may provide the clinician with objective data to support subjective preference for one hearing aid as opposed to two.

PMID: 28054908 [PubMed - in process]

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"The effect of conventional and transparent surgical masks on speech understanding in individuals with and without hearing loss" by Atcherson et al.

"The effect of conventional and transparent surgical masks on speech understanding in individuals with and without hearing loss" by Atcherson et al.

J Am Acad Audiol. 2017 Jan;28(1):4

Authors: Jacobson GP

PMID: 28054907 [PubMed - in process]

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JAAA CEU Program.

JAAA CEU Program.

J Am Acad Audiol. 2017 Jan;28(1):103-104

Authors:

PMID: 28054917 [PubMed - in process]

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A Response to Dr. Jerger regarding "On Diagnostic Accuracy in Audiology: Central Site of Lesion and Central Auditory Processing Disorder Studies".

A Response to Dr. Jerger regarding "On Diagnostic Accuracy in Audiology: Central Site of Lesion and Central Auditory Processing Disorder Studies".

J Am Acad Audiol. 2017 Jan;28(1):102

Authors: Vermiglio AJ

PMID: 28054916 [PubMed - in process]

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Auditory Processing Disorder as the Sole Manifestation of a Cerebellopontine and Internal Auditory Canal Lesion.

Auditory Processing Disorder as the Sole Manifestation of a Cerebellopontine and Internal Auditory Canal Lesion.

J Am Acad Audiol. 2017 Jan;28(1):91-101

Authors: Iliadou VV, Eleftheriadis N

Abstract
BACKGROUND: Clinical importance of auditory processing disorder (APD) testing is often overlooked and regarded with skepticism given the challenging interpretation of results and the current growing debate of its nature and clinical entity.
PURPOSE: Presentation of this case is highly educational as APD is the single clinical manifestation of a large cerebellopontine and internal auditory canal lesion.
RESEARCH DESIGN: A case report.
DATA COLLECTION AND ANALYSIS: The patient underwent a standard audiological evaluation with normal results. She was referred for APD evaluation. The APD test battery consisted of speech in babble (SinB), dichotic digits (DD), frequency and duration of pattern sequence testing, Random Gap Detection Test, and gaps in noise. These were followed by otoacoustic emissions testing, auditory brainstem responses (ABR) and magnetic resonance imaging (MRI).
RESULTS: Her auditory processing results showed deficits in SinB and DD limited to the right ear as well as deficits in temporal processing. Both verbal and nonverbal tests exhibited deficits strictly limited to the right ear, which was in accordance with what she was experiencing as reduced loudness for the incoming sounds on the right ear. This less costly evaluation revealed that there was good reason to assess electrophysiologically the auditory system. ABR showed an abnormal waveform with either missing or severely prolongated wave V (depending on stimulus polarity). Otoacoustic emissions were normal. MRI was then implemented revealing a large cerebellopontine and internal auditory canal lesion.
CONCLUSIONS: This clinical case stresses the importance of testing for APD with a psychoacoustical test battery despite current debate of lack of a gold standard diagnostic approach to APD. In this case, APD diagnosis led to a cerebellopontine lesion identification with extension to the right internal auditory canal. This rare cause of APD demonstrates the efficiency of the current diagnostic test battery in revealing lesional causes of central APD.

PMID: 28054915 [PubMed - in process]

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Detailed Audiological Evaluation of a Patient with Xeroderma Pigmentosum with Neural Degeneration.

Detailed Audiological Evaluation of a Patient with Xeroderma Pigmentosum with Neural Degeneration.

J Am Acad Audiol. 2017 Jan;28(1):80-90

Authors: Mercer D, Hurley A, Tsien F

Abstract
BACKGROUND: Xeroderma pigmentosum (XP) is a rare autosomal recessive condition characterized by extreme sensitivity to ultraviolet light. Individuals with XP lack the ability to repair DNA (deoxyribonucleic acid) damage caused by ultraviolet radiation, leading to sunburn and increased susceptibility to skin cancers. Approximately 25% of patients also exhibit neural degeneration, which includes progressive mental deterioration, cortical thinning, and sensorineural hearing loss.
PURPOSE: Herein, we describe the audiological and genetic findings in a patient with XP subtype D with neural degeneration and hearing loss.
RESEARCH DESIGN: This is a case report of a patient with XP subtype D, type 1 diabetes, and some clinical features typical of Charcot-Marie-Tooth disease.
DATA COLLECTION AND ANALYSIS: We obtained audiological evaluations over a course of 11 yr, including serial audiograms, auditory processing disorders evaluations, and electrophysiological testing.
RESULTS: Hearing sensitivity has progressed from a unilateral mild high-frequency sensorineural hearing loss to a bilateral sloping moderate to severe/profound sensorineural hearing loss. In addition to the dramatic decline in hearing sensitivity, the patient demonstrates global auditory processing deficits, indicating a central component to his hearing loss.
CONCLUSION: These findings emphasize the importance of the contribution of audiological evaluations to the diagnosis of a genetic disorder. Periodic evaluations of hearing sensitivity and auditory processing can provide information on disease progression in patients with XP with neural degeneration.

PMID: 28054914 [PubMed - in process]

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Interrupted Monosyllabic Words: The Effects of Ten Interruption Locations on Recognition Performance by Older Listeners with Sensorineural Hearing Loss.

Interrupted Monosyllabic Words: The Effects of Ten Interruption Locations on Recognition Performance by Older Listeners with Sensorineural Hearing Loss.

J Am Acad Audiol. 2017 Jan;28(1):68-79

Authors: Wilson RH, Sharrett KC

Abstract
BACKGROUND: Two previous experiments from our laboratory with 70 interrupted monosyllabic words demonstrated that recognition performance was influenced by the temporal location of the interruption pattern. The interruption pattern (10 interruptions/sec, 50% duty cycle) was always the same and referenced word onset; the only difference between the patterns was the temporal location of the on- and off-segments of the interruption cycle. In the first study, both young and older listeners obtained better recognition performances when the initial on-segment coincided with word onset than when the initial on-segment was delayed by 50 msec. The second experiment with 24 young listeners detailed recognition performance as the interruption pattern was incremented in 10-msec steps through the 0- to 90-msec onset range. Across the onset conditions, 95% of the functions were either flat or U-shaped.
PURPOSE: To define the effects that interruption pattern locations had on word recognition by older listeners with sensorineural hearing loss as the interruption pattern incremented, re: word onset, from 0 to 90 msec in 10-msec steps.
RESEARCH DESIGN: A repeated-measures design with ten interruption patterns (onset conditions) and one uninterruption condition.
STUDY SAMPLE: Twenty-four older males (mean = 69.6 yr) with sensorineural hearing loss participated in two 1-hour sessions. The three-frequency pure-tone average was 24.0 dB HL and word recognition was ≥80% correct.
DATA COLLECTION AND ANALYSES: Seventy consonant-vowel nucleus-consonant words formed the corpus of materials with 25 additional words used for practice. For each participant, the 700 interrupted stimuli (70 words by 10 onset conditions), the 70 words uninterrupted, and two practice lists each were randomized and recorded on compact disc in 33 tracks of 25 words each.
RESULTS: The data were analyzed at the participant and word levels and compared to the results obtained earlier on 24 young listeners with normal hearing. The mean recognition performance on the 70 words uninterrupted was 91.0% with an overall mean performance on the ten interruption conditions of 63.2% (range: 57.9-69.3%), compared to 80.4% (range: 73.0-87.7%) obtained earlier on the young adults. The best performances were at the extremes of the onset conditions. Standard deviations ranged from 22.1% to 28.1% (24 participants) and from 9.2% to 12.8% (70 words). An arithmetic algorithm categorized the shapes of the psychometric functions across the ten onset conditions. With the older participants in the current study, 40% of the functions were flat, 41.4% were U-shaped, and 18.6% were inverted U-shaped, which compared favorably to the function shapes by the young listeners in the earlier study of 50.0%, 41.4%, and 8.6%, respectively. There were two words on which the older listeners had 40% better performances.
CONCLUSION: Collectively, the data are orderly, but at the individual word or participant level, the data are somewhat volatile, which may reflect auditory processing differences between the participant groups. The diversity of recognition performances by the older listeners on the ten interruption conditions with each of the 70 words supports the notion that the term hearing loss is inclusive of processes well beyond the filtering produced by end-organ sensitivity deficits.

PMID: 28054913 [PubMed - in process]

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The Effect of Conventional and Transparent Surgical Masks on Speech Understanding in Individuals with and without Hearing Loss.

The Effect of Conventional and Transparent Surgical Masks on Speech Understanding in Individuals with and without Hearing Loss.

J Am Acad Audiol. 2017 Jan;28(1):58-67

Authors: Atcherson SR, Mendel LL, Baltimore WJ, Patro C, Lee S, Pousson M, Spann MJ

Abstract
BACKGROUND: It is generally well known that speech perception is often improved with integrated audiovisual input whether in quiet or in noise. In many health-care environments, however, conventional surgical masks block visual access to the mouth and obscure other potential facial cues. In addition, these environments can be noisy. Although these masks may not alter the acoustic properties, the presence of noise in addition to the lack of visual input can have a deleterious effect on speech understanding. A transparent ("see-through") surgical mask may help to overcome this issue.
PURPOSE: To compare the effect of noise and various visual input conditions on speech understanding for listeners with normal hearing (NH) and hearing impairment using different surgical masks.
RESEARCH DESIGN: Participants were assigned to one of three groups based on hearing sensitivity in this quasi-experimental, cross-sectional study.
STUDY SAMPLE: A total of 31 adults participated in this study: one talker, ten listeners with NH, ten listeners with moderate sensorineural hearing loss, and ten listeners with severe-to-profound hearing loss.
DATA COLLECTION AND ANALYSIS: Selected lists from the Connected Speech Test were digitally recorded with and without surgical masks and then presented to the listeners at 65 dB HL in five conditions against a background of four-talker babble (+10 dB SNR): without a mask (auditory only), without a mask (auditory and visual), with a transparent mask (auditory only), with a transparent mask (auditory and visual), and with a paper mask (auditory only).
RESULTS: A significant difference was found in the spectral analyses of the speech stimuli with and without the masks; however, no more than ∼2 dB root mean square. Listeners with NH performed consistently well across all conditions. Both groups of listeners with hearing impairment benefitted from visual input from the transparent mask. The magnitude of improvement in speech perception in noise was greatest for the severe-to-profound group.
CONCLUSIONS: Findings confirm improved speech perception performance in noise for listeners with hearing impairment when visual input is provided using a transparent surgical mask. Most importantly, the use of the transparent mask did not negatively affect speech perception performance in noise.

PMID: 28054912 [PubMed - in process]

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Evaluation of a Wind Noise Attenuation Algorithm on Subjective Annoyance and Speech-in-Wind Performance.

Evaluation of a Wind Noise Attenuation Algorithm on Subjective Annoyance and Speech-in-Wind Performance.

J Am Acad Audiol. 2017 Jan;28(1):46-57

Authors: Korhonen P, Kuk F, Seper E, Mørkebjerg M, Roikjer M

Abstract
BACKGROUND: Wind noise is a common problem reported by hearing aid wearers. The MarkeTrak VIII reported that 42% of hearing aid wearers are not satisfied with the performance of their hearing aids in situations where wind is present.
PURPOSE: The current study investigated the effect of a new wind noise attenuation (WNA) algorithm on subjective annoyance and speech recognition in the presence of wind.
RESEARCH DESIGN: A single-blinded, repeated measures design was used.
STUDY SAMPLE: Fifteen experienced hearing aid wearers with bilaterally symmetrical (≤10 dB) mild-to-moderate sensorineural hearing loss participated in the study.
DATA COLLECTION AND ANALYSIS: Subjective rating for wind noise annoyance was measured for wind presented alone from 0° and 290° at wind speeds of 4, 5, 6, 7, and 10 m/sec. Phoneme identification performance was measured using Widex Office of Clinical Amplification Nonsense Syllable Test presented at 60, 65, 70, and 75 dB SPL from 270° in the presence of wind originating from 0° at a speed of 5 m/sec.
RESULTS: The subjective annoyance from wind noise was reduced for wind originating from 0° at wind speeds from 4 to 7 m/sec. The largest improvement in phoneme identification with the WNA algorithm was 48.2% when speech was presented from 270° at 65 dB SPL and the wind originated from 0° azimuth at 5 m/sec.
CONCLUSION: The WNA algorithm used in this study reduced subjective annoyance for wind speeds ranging from 4 to 7 m/sec. The algorithm was effective in improving speech identification in the presence of wind originating from 0° at 5 m/sec. These results suggest that the WNA algorithm used in the current study could expand the range of real-life situations where a hearing-impaired person can use the hearing aid optimally.

PMID: 28054911 [PubMed - in process]

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Examining Effects of Physical Exertion on the Dynamic Visual Acuity Test in Collegiate Athletes.

Examining Effects of Physical Exertion on the Dynamic Visual Acuity Test in Collegiate Athletes.

J Am Acad Audiol. 2017 Jan;28(1):36-45

Authors: Patterson JN, Murphy AM, Honaker JA

Abstract
BACKGROUND: Acute symptoms of dizziness and/or imbalance commonly experienced in athletes postconcussion are speculated to arise from dysfunction at multiple levels (i.e., inner ear or central vestibular system) to appropriately integrate afferent sensory information. Disruption along any pathway of the balance system can result in symptoms of dizziness, decreased postural control function (vestibulospinal reflex), and reduced vestibulo-ocular reflex function. This may also lead to decreased gaze stability with movements of the head and may account for symptoms of blurred vision or diplopia reported in almost half of athletes sustaining a concussion. Current concussion position statements include measures of postural control to examine changes to the balance system postconcussion. The Balance Error Scoring System (BESS) is a commonly used low-cost postural control measure for concussion assessment. Although this is a widely used measure for documenting balance function on both immediate (sideline) and recovery monitoring, the BESS has been shown to be affected by physical exertion. Therefore, the BESS may not be the most efficient means of examining functional changes to the balance system immediately after head injury. Dynamic Visual Acuity Test (DVAT) has been found to effectively evaluate and monitor changes to the gaze stability system postinjury. Thus, DVAT may be an additional measure in the concussion assessment battery, as well as an alternative for more immediate sideline assessment to help make objective return-to-play decisions.
PURPOSE: The aim of the study was to determine the effects of physical exertion on a clinical vestibular assessment, the DVAT, in collegiate athletes, as a first step in defining the role of this measure in the concussion assessment battery.
RESEARCH DESIGN: Cross-sectional, repeated-measures design.
STUDY SAMPLE: Twenty-eight healthy collegiate athletes (20 males, 8 females; age = 20.25 ± 1.46 yr, range = 18-25 yr) volunteered to participate in the study.
DATA COLLECTION AND ANALYSIS: Participants were randomly assigned to complete a 20-min protocol of physical exertion or rest. DVAT was completed pre-exertion or rest (pre-DVAT), immediately following the 20-min protocol (post-DVAT I), and again 10 min after the completion of the 20-min protocol (post-DVAT II). Ratings of perceived exertion (RPE) and heart rate (HR) were monitored throughout testing. Repeated-measures analysis of the variance were used to examine the effects of exertion on DVAT. Additionally, intraclass correlation coefficients were used to examine test reliability.
RESULTS: No significant main effect was observed for right and left DVAT logarithm of the minimal angle of resolution loss between groups or across time points (p > 0.05). A significant main effect was observed for RPE and HR for groups and time points (p < 0.001), indicating adequate physical exertion and rest. Fair to good reliability (intraclass correlation coefficient values between 0.4 and 0.74) was observed for both rightward and leftward movements of the head across the three time points.
CONCLUSIONS: Findings from this study suggest that DVAT is not affected by physical exertion and may provide a more immediate assessment of the balance system that may be of use for the sideline concussion assessment. Future studies will be performed to examine additional factors (e.g., background noise, complex visual backgrounds) that may affect DVAT performance in the sideline environment.

PMID: 28054910 [PubMed - in process]

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Noise Exposure Questionnaire: A Tool for Quantifying Annual Noise Exposure.

Noise Exposure Questionnaire: A Tool for Quantifying Annual Noise Exposure.

J Am Acad Audiol. 2017 Jan;28(1):14-35

Authors: Johnson TA, Cooper S, Stamper GC, Chertoff M

Abstract
BACKGROUND: Exposure to both occupational and nonoccupational noise is recognized as a risk factor for noise-induced hearing loss (NIHL). Although audiologists routinely inquire regarding history of noise exposure, there are limited tools available for quantifying this history or for identifying those individuals who are at highest risk for NIHL. Identifying those at highest risk would allow hearing conservation activities to be focused on those individuals.
PURPOSE: To develop a detailed, task-based questionnaire for quantifying an individual's annual noise exposure (ANE) arising from both occupational and nonoccupational sources (aim 1) and to develop a short screening tool that could be used to identify individuals at high risk of NIHL (aim 2).
RESEARCH DESIGN: Review of relevant literature for questionnaire development followed by a cross-sectional descriptive and correlational investigation of the newly developed questionnaire and screening tool.
STUDY SAMPLE: One hundred fourteen college freshmen completed the detailed questionnaire for estimating ANE (aim 1) and answered the potential screening questions (aim 2). An additional 59 adults participated in data collection where the accuracy of the screening tool was evaluated (aim 2).
DATA COLLECTION AND ANALYSIS: In study aim 1, all participants completed the detailed questionnaire and the potential screening questions. Descriptive statistics were used to quantify participant participation in various noisy activities and their associated ANE estimates. In study aim 2, linear regression techniques were used to identify screening questions that could be used to predict a participant's estimated ANE. Clinical decision theory was then used to assess the accuracy with which the screening tool predicted high and low risk of NIHL in a new group of participants.
RESULTS: Responses on the detailed questionnaire indicated that our sample of college freshmen reported high rates of participation in a variety of occupational and nonoccupational activities associated with high sound levels. Although participation rates were high, ANE estimates were below highest-risk levels for many participants because the frequency of participation in these activities was low in many cases. These data illustrate how the Noise Exposure Questionnaire (NEQ) could be used to provide detailed and specific information regarding an individual's exposure to noise. The results of aim 2 suggest that the screening tool, the 1-Minute Noise Screen, can be used to identify those participants with high- and low-risk noise exposure, allowing more in-depth assessment of noise exposure history to be targeted at those most at risk.
CONCLUSIONS: The NEQ can be used to estimate an individual's ANE and the 1-Minute Noise Screen can be used to identify those participants at highest risk of NIHL. These tools allow audiologists to focus hearing conservation efforts on those individuals who are most in need of those services.

PMID: 28054909 [PubMed - in process]

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Binaural Interference and the Effects of Age and Hearing Loss.

Binaural Interference and the Effects of Age and Hearing Loss.

J Am Acad Audiol. 2017 Jan;28(1):5-13

Authors: Mussoi BS, Bentler RA

Abstract
BACKGROUND: The existence of binaural interference, defined here as poorer speech recognition with both ears than with the better ear alone, is well documented. Studies have suggested that its prevalence may be higher in the elderly population. However, no study to date has explored binaural interference in groups of younger and older adults in conditions that favor binaural processing (i.e., in spatially separated noise). Also, the effects of hearing loss have not been studied.
PURPOSE: To examine binaural interference through speech perception tests, in groups of younger adults with normal hearing, older adults with normal hearing for their age, and older adults with hearing loss.
RESEARCH DESIGN: A cross-sectional study.
STUDY SAMPLE: Thirty-three participants with symmetric thresholds were recruited from the University of Iowa community. Participants were grouped as follows: younger with normal hearing (18-28 yr, n = 12), older with normal hearing for their age (73-87 yr, n = 9), and older with hearing loss (78-94 yr, n = 12). Prior noise exposure was ruled out.
DATA COLLECTION AND ANALYSIS: The Connected Speech Test (CST) and Hearing in Noise Test (HINT) were administered to all participants bilaterally, and to each ear separately. Test materials were presented in the sound field with speech at 0° azimuth and the noise at 180°. The Dichotic Digits Test (DDT) was administered to all participants through earphones. Hearing aids were not used during testing. Group results were compared with repeated measures and one-way analysis of variances, as appropriate. Within-subject analyses using pre-established critical differences for each test were also performed.
RESULTS: The HINT revealed no effect of condition (individual ear versus bilateral presentation) using group analysis, although within-subject analysis showed that 27% of the participants had binaural interference (18% had binaural advantage). On the CST, there was significant binaural advantage across all groups with group data analysis, as well as for 12% of the participants at each of the two signal-to-babble ratios (SBRs) tested. One participant had binaural interference at each SBR. Finally, on the DDT, a significant right-ear advantage was found with group data, and for at least some participants. Regarding age effects, more participants in the pooled elderly groups had binaural interference (33.3%) than in the younger group (16.7%), on the HINT. The presence of hearing loss yielded overall lower scores, but none of the comparisons between bilateral and unilateral performance were affected by hearing loss.
CONCLUSIONS: Results of within-subject analyses on the HINT agree with previous findings of binaural interference in ≥17% of listeners. Across all groups, a significant right-ear advantage was also seen on the DDT. HINT results support the notion that the prevalence of binaural interference is likely higher in the elderly population. Hearing loss, however, did not affect the differences between bilateral and better unilateral scores. The possibility of binaural interference should be considered when fitting hearing aids to listeners with symmetric hearing loss. Comparing bilateral to unilateral (unaided) performance on tests such as the HINT may provide the clinician with objective data to support subjective preference for one hearing aid as opposed to two.

PMID: 28054908 [PubMed - in process]

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"The effect of conventional and transparent surgical masks on speech understanding in individuals with and without hearing loss" by Atcherson et al.

"The effect of conventional and transparent surgical masks on speech understanding in individuals with and without hearing loss" by Atcherson et al.

J Am Acad Audiol. 2017 Jan;28(1):4

Authors: Jacobson GP

PMID: 28054907 [PubMed - in process]

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Comparison of tri-axial accelerometers step-count accuracy in slow walking conditions

Publication date: March 2017
Source:Gait & Posture, Volume 53
Author(s): Yuanyuan Feng, Christopher K. Wong, Vandana Janeja, Ravi Kuber, Helena M. Mentis
Accelerometers have shown great promise and popularity for monitoring gait. However, the accuracy of accelerometers for gait analysis in slow walking conditions is largely unknown. In this study, we compared the accuracy of three accelerometers recommended for gait analysis – Axivity AX3, APDM Opal, and the Actigraph wGT3X-BT, by holding the step-count algorithm constant. We evaluated device accuracy in four minutes of treadmill walking at the speeds of 0.9m/s, 1.1m/s, and 1.3m/s. We constructed a symbolization of the gait data to count the steps using Piecewise Aggregate Approximation and compared the estimated step counts with observer counted steps from video recordings. Our results highlight the variation between the performance of devices – the Axivity AX3 provides more accurate step counts than the other two devices. In this, we provide evidence for future scientific teams to make decisions on selecting accelerometers which can more accurately measure steps taken at slower walking speeds, and suggest ways to improve the design of algorithms and accelerometers.



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Comparison of tri-axial accelerometers step-count accuracy in slow walking conditions

Publication date: March 2017
Source:Gait & Posture, Volume 53
Author(s): Yuanyuan Feng, Christopher K. Wong, Vandana Janeja, Ravi Kuber, Helena M. Mentis
Accelerometers have shown great promise and popularity for monitoring gait. However, the accuracy of accelerometers for gait analysis in slow walking conditions is largely unknown. In this study, we compared the accuracy of three accelerometers recommended for gait analysis – Axivity AX3, APDM Opal, and the Actigraph wGT3X-BT, by holding the step-count algorithm constant. We evaluated device accuracy in four minutes of treadmill walking at the speeds of 0.9m/s, 1.1m/s, and 1.3m/s. We constructed a symbolization of the gait data to count the steps using Piecewise Aggregate Approximation and compared the estimated step counts with observer counted steps from video recordings. Our results highlight the variation between the performance of devices – the Axivity AX3 provides more accurate step counts than the other two devices. In this, we provide evidence for future scientific teams to make decisions on selecting accelerometers which can more accurately measure steps taken at slower walking speeds, and suggest ways to improve the design of algorithms and accelerometers.



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Comparison of tri-axial accelerometers step-count accuracy in slow walking conditions

Publication date: March 2017
Source:Gait & Posture, Volume 53
Author(s): Yuanyuan Feng, Christopher K. Wong, Vandana Janeja, Ravi Kuber, Helena M. Mentis
Accelerometers have shown great promise and popularity for monitoring gait. However, the accuracy of accelerometers for gait analysis in slow walking conditions is largely unknown. In this study, we compared the accuracy of three accelerometers recommended for gait analysis – Axivity AX3, APDM Opal, and the Actigraph wGT3X-BT, by holding the step-count algorithm constant. We evaluated device accuracy in four minutes of treadmill walking at the speeds of 0.9m/s, 1.1m/s, and 1.3m/s. We constructed a symbolization of the gait data to count the steps using Piecewise Aggregate Approximation and compared the estimated step counts with observer counted steps from video recordings. Our results highlight the variation between the performance of devices – the Axivity AX3 provides more accurate step counts than the other two devices. In this, we provide evidence for future scientific teams to make decisions on selecting accelerometers which can more accurately measure steps taken at slower walking speeds, and suggest ways to improve the design of algorithms and accelerometers.



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Cochlear Nerve Deficiency and Brain Abnormalities in Pediatric Patients.

Hypothesis: To investigate the intracranial abnormalities present in children with cochlear nerve deficiency (CND), including abnormalities of other cranial nerves, and to describe their auditory abilities. Background: The prevalence of CND has increased with the development of high resolution magnetic resonance imaging (MRI). There are varying degrees of CND from true aplasia to hypoplasia. The etiology of CND remains unclear and it may be associated with intracranial abnormalities in some instances. CND needs to be identified as early as possible to ensure prompt and adequate management of hearing loss since hearing aids and cochlear implants may not be an option. Methods: A retrospective chart review of 56 ears of pediatric patients with CND was conducted between August 2006 and November 2014 at a tertiary care pediatric hospital. Results: 27.6% of children had cochlear abnormalities and 48.9.8% had concomitant vestibular anomalies. Five patients had absent or abnormal facial nerves and two patients had aplastic bilateral olfactory nerves. In the 27 ears with an absent nerve that were functionally tested, eight (29.6%) had partial hearing which indicates the presence of an extremely small nerve whose size is below the limits of spatial resolution of the MRI. Conclusion: MRI is becoming the initial imaging choice for children with sensorineural hearing loss to identify CND and other brain anomalies. Concomitant vestibular and cochlear abnormalities were observed in respectively half and one-third of the pediatric patients with CND. The incidence of vestibular malformation suggests that balance testing should be recommended for most if not all CND patients. Copyright (C) 2017 by Otology & Neurotology, Inc. Image copyright (C) 2010 Wolters Kluwer Health/Anatomical Chart Company

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