Relations among Auditory Brainstem and Middle Latency Response Measures, Categorical Loudness Judgments, and Their Associated Physical Intensities

Semin Hear 2017; 38: 094-114
DOI: 10.1055/s-0037-1598067

This study characterizes changes in response properties of toneburst-evoked auditory brainstem responses (ABRs) and/or middle latency responses (MLRs) as a function of perceived loudness and physical intensity of these stimuli and delineates the range of levels corresponding to categorical loudness judgments for these stimuli. ABRs/MLRs were recorded simultaneously to 500- and 2,000-Hz tonebursts in 10 normal-hearing adults at levels corresponding to each listener's loudness judgments for four categories on Contour Test of Loudness. Group mean ABR wave V and MLR wave Pa latency values increased significantly as loudness judgments decreased. Group mean amplitude values for ABR wave V-V′ and MLR wave Na-Pa increased as the listeners' categorical judgments increased. Listeners assigned a broad range (30 to 40 dB) of stimulus intensities when judging loudness of these stimuli within a specific loudness category. This was true for all four loudness categories and both frequencies. Thus, it appears that tone-evoked ABR/MLR response measures reflect, in part, the listener's perception of loudness. Response latencies are a more sensitive indicator of listener's loudness percept than corresponding response amplitudes. An appreciable range of signal levels was judged to be categorically equivalent across listeners. Thus, limiting how loudness judgments can be applied to prescriptive hearing aid fittings in individuals who cannot provide accurate loudness judgments.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Self-Assessment Questions

Semin Hear 2017; 38: C1-C10
DOI: 10.1055/s-0037-1598117

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

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Considerations in the Development of a Sound Tolerance Interview and Questionnaire Instrument

Semin Hear 2017; 38: 053-070
DOI: 10.1055/s-0037-1598065

Most clinicians approach the objective fitting of hearing aids with three goals in mind: audibility, comfort, and tolerance. When these three amplification goals have been met, the hearing aid user is more likely to adapt to and perceive benefit from hearing aid use. However, problems related to the loudness of sounds and reduced sound tolerance, which may or may not be reported by the aided user, can adversely impact adaptation to amplification and the individual's quality of life. Although there are several standardized questionnaires available to evaluate hearing aid benefit and satisfaction, there is no standardized questionnaire or interview tool for evaluating reduced sound tolerance and the related impact on hearing aid use. We describe a 36-item tool, the Sound Tolerance Questionnaire (STQ), consisting of six sections, including experience with hearing aids, sound sensitivity/intolerance, medical and noise exposure histories, coexisting tinnitus problems, and a final question to differentiate the primary and secondary problems related to sound intolerance, tinnitus, and hearing loss. In its current format as a research tool, the STQ was sensitive in pinpointing vague sound tolerance complaints not reported by the study participants in eligibility screening by Formby et al. A refined version of the STQ, the Sound Tolerance Interview and Questionnaire Instrument (STIQI), structured as a two-part tool, is presented in the appendix for prospective clinical use. The STIQI has potential utility to delineate factors contributing to loudness complaints and/or reduced sound tolerance in individuals considering hearing aid use, as well as those who have been unsuccessful hearing aid users secondary to loudness complaints or sound intolerance. The STIQI, when validated and refined, also may hold promise for predicting hearing aid benefit and/or assessing treatment-related change over time of hearing aid use or interventions designed to remediate problems of loudness and/or sound intolerance among hearing aid candidates or users.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Consideration of Methodology and Measures of Loudness

Semin Hear 2017; 38: 001-002
DOI: 10.1055/s-0037-1599079

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

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The Importance of Facts and the Role of Academic Publishers in Today's World—A Publisher's View

Semin Hear 2017; 38: vii-vii
DOI: 10.1055/s-0037-1600102

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

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Intra- and Intersubject Variability in Audiometric Measures and Loudness Judgments in Older Listeners with Normal Hearing

Semin Hear 2017; 38: 003-025
DOI: 10.1055/s-0037-1598063

This research was to document intra- and intersubject variability in measures of pure tone thresholds, loudness discomfort levels, and the Contour test of loudness for tonal and speech stimuli across 8 to 10 repeated test sessions over a period of almost 1 year in a group of 11 normal-hearing, older middle-aged adults (39 to 73 years, mean of 56 years). The measured pure tone thresholds and loudness discomfort levels were determined to be stable across sessions, with variability on the order of 5 dB. The categorical judgments for the Contour test for both warbled tones and spondaic speech stimuli decreased over time in level required for categories greater than comfortable. This result contrasts with reports of a slight increase over time when young, normal-hearing adults were tested in comparable measures. The intrasubject variability in the Contour test results was greatest for the 4,000-Hz tonal stimulus for which the largest time effects were observed. The intersubject variability was typically greater than the intrasubject variability and typically increased as the loudness category increased, with some exceptions. The results from this study can be used to aid in power and sample size analyses using these measures in future studies designed to compare effects of treatments based on changes in loudness judgments over time.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Auditory Brainstem and Middle Latency Responses Measured Pre- and Posttreatment for Hyperacusic Hearing-Impaired Persons Successfully Treated to Improve Sound Tolerance and to Expand the Dynamic Range for Loudness: Case Evidence

Semin Hear 2017; 38: 071-093
DOI: 10.1055/s-0037-1598066

In this report of three cases, we consider electrophysiologic measures from three hyperacusic hearing-impaired individuals who, prior to treatment to expand their dynamic ranges for loudness, were problematic hearing aid candidates because of their diminished sound tolerance and reduced dynamic ranges. Two of these individuals were treated with structured counseling combined with low-level broadband sound therapy from bilateral sound generators and the third case received structured counseling in combination with a short-acting placebo sound therapy. Each individual was highly responsive to his or her assigned treatment as revealed by expansion of the dynamic range by at least 20 dB at one or more frequencies posttreatment. Of specific interest in this report are their latency and amplitude measures taken from tone burst-evoked auditory brainstem response (ABR) and cortically derived middle latency response (MLR) recordings, measured as a function of increasing loudness at 500 and 2,000 Hz pre- and posttreatment. The resulting ABR and MLR latency and amplitude measures for each case are considered here in terms of pre- and posttreatment predictions. The respective pre- and posttreatment predictions anticipated larger pretreatment response amplitudes and shorter pretreatment response latencies relative to typical normal control values and smaller normative-like posttreatment response amplitudes and longer posttreatment response latencies relative to the corresponding pretreatment values for each individual. From these results and predictions, we conjecture about the neural origins of the hyperacusis conditions (i.e., brainstem versus cortical) and the neuronal sites responsive to treatment. The only consistent finding in support of the pre- and posttreatment predictions and, thus, the strongest index of hyperacusis and positive treatment-related effects was measured for MLR latency responses for wave Pa at 2,000 Hz. Other response indices, including ABR wave V latency and wave V-V′ amplitude and MLR wave Na-Pa amplitude for 500 and 2,000 Hz, appear either ambiguous across and/or within these individuals. Notwithstanding significant challenges for interpreting these findings, including associated confounding effects of their sensorineural hearing losses and differences in the presentation levels of the toneburst stimuli used to collect these measures for each individual, our limited analyses of three cases suggest measures of MLR wave Pa latency at 2,000 Hz (reflecting cortical contributions) may be a promising objective indicator of hyperacusis and dynamic range expansion treatment effects.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Repeated Measurement of Absolute and Relative Judgments of Loudness: Clinical Relevance for Prescriptive Fitting of Aided Target Gains for soft, Comfortable, and Loud, But Ok Sound Levels

Semin Hear 2017; 38: 026-052
DOI: 10.1055/s-0037-1598064

This study was undertaken with the purpose of streamlining clinical measures of loudness growth to facilitate and enhance prescriptive fitting of nonlinear hearing aids. Repeated measures of loudness at 500 and 3,000 Hz were obtained bilaterally at monthly intervals over a 6-month period from three groups of young adult listeners. All volunteers had normal audiometric hearing sensitivity and middle ear function, and all denied problems related to sound tolerance. Group 1 performed judgments of soft and loud, but OK for presentation of ascending sound levels. We defined these judgments operationally as absolute judgments of loudness. Group 2 initially performed loudness judgments across a continuum of seven loudness categories ranging from judgments of very soft to uncomfortably loud for presentation of ascending sound levels per the Contour Test of Loudness; we defined these judgments as relative judgments of loudness. In the same session, they then performed the absolute judgments for soft and loud, but OK sound levels. Group 3 performed the same set of loudness judgments as did group 2, but the task order was reversed such that they performed the absolute judgments initially within each test session followed by the relative judgments. The key findings from this study were as follows: (1) Within group, the absolute and relative tasks yielded clinically similar judgments for soft and for loud, but OK sound levels. These judgments were largely independent of task order, ear, frequency, or trial order within a given session. (2) Loudness judgments increased, on average, by ∼3 dB between the first and last test session, which is consistent with the commonly reported acclimatization effect reported for incremental changes in loudness discomfort levels as a consequence of chronic bilateral hearing aid use. (3) Measured and predicted comfortable judgments of loudness were in good agreement for the individual listener and for groups of listeners. These comfortable judgments bisect the measured levels judged for soft and for loud, but OK sounds. (4) Loudness judgments within the same loudness category varied across listeners within group by as much as 50 to 60 dB. Such large variation in judgments of loudness is problematic, especially because hearing-impaired listeners are known to exhibit similarly large ranges of intersubject response variation and, yet, poplar prescriptive fitting strategies continue to use average rather than individual loudness data to fit nonlinear hearing aids. The primary conclusions drawn from these findings are that reliable absolute judgments of soft and loud, but OK are clinically practical and economical to measure and, from these judgments, good estimates of comfortable loudness can also be predicted for individuals or for groups of listeners. Such loudness data, as measured as described in this report, offer promise for streamlining and enhancing prescriptive fitting of nonlinear hearing aids to target gain settings for soft (audible), comfortable, and loud, but OK (tolerable) sound inputs for the individual listener.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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Structured Counseling for Auditory Dynamic Range Expansion

Semin Hear 2017; 38: 115-129
DOI: 10.1055/s-0037-1598068

A structured counseling protocol is described that, when combined with low-level broadband sound therapy from bilateral sound generators, offers audiologists a new tool for facilitating the expansion of the auditory dynamic range (DR) for loudness. The protocol and its content are specifically designed to address and treat problems that impact hearing-impaired persons who, due to their reduced DRs, may be limited in the use and benefit of amplified sound from hearing aids. The reduced DRs may result from elevated audiometric thresholds and/or reduced sound tolerance as documented by lower-than-normal loudness discomfort levels (LDLs). Accordingly, the counseling protocol is appropriate for challenging and difficult-to-fit persons with sensorineural hearing losses who experience loudness recruitment or hyperacusis. Positive treatment outcomes for individuals with the former and latter conditions are highlighted in this issue by incremental shifts (improvements) in LDL and/or categorical loudness judgments, associated reduced complaints of sound intolerance, and functional improvements in daily communication, speech understanding, and quality of life leading to improved hearing aid benefit, satisfaction, and aided sound quality, posttreatment.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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A Sound Therapy-Based Intervention to Expand the Auditory Dynamic Range for Loudness among Persons with Sensorineural Hearing Losses: Case Evidence Showcasing Treatment Efficacy

Semin Hear 2017; 38: 130-150
DOI: 10.1055/s-0037-1598069

Case evidence is presented that highlights the clinical relevance and significance of a novel sound therapy-based treatment. This intervention has been shown to be efficacious in a randomized controlled trial for promoting expansion of the dynamic range for loudness and increased sound tolerance among persons with sensorineural hearing losses. Prior to treatment, these individuals were unable to use aided sound effectively because of their limited dynamic ranges. These promising treatment effects are shown in this article to be functionally significant, giving rise to improved speech understanding and enhanced hearing aid benefit and satisfaction, and, in turn, to enhanced quality of life posttreatment. These posttreatment sound therapy effects also are shown to be sustained, in whole or part, with aided environmental sound and to be dependent on specialized counseling to maximize treatment benefit. Importantly, the treatment appears to be efficacious for hearing-impaired persons with primary hyperacusis (i.e., abnormally reduced loudness discomfort levels [LDLs]) and for persons with loudness recruitment (i.e., LDLs within the typical range), which suggests the intervention should generalize across most individuals with reduced dynamic ranges owing to sensorineural hearing loss. An exception presented in this article is for a person describing the perceptual experience of pronounced loudness adaptation, which apparently rendered the sound therapy inaudible and ineffectual for this individual. Ultimately, these case examples showcase the enormous potential of a surprisingly simple sound therapy intervention, which has utility for virtually all audiologists to master and empower the adaptive plasticity of the auditory system to achieve remarkable treatment benefits for large numbers of individuals with sensorineural hearing losses.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Audiology via ola Kala on Inoreader http://ift.tt/2mGEZgX
via IFTTT

Relations among Auditory Brainstem and Middle Latency Response Measures, Categorical Loudness Judgments, and Their Associated Physical Intensities

Semin Hear 2017; 38: 094-114
DOI: 10.1055/s-0037-1598067

This study characterizes changes in response properties of toneburst-evoked auditory brainstem responses (ABRs) and/or middle latency responses (MLRs) as a function of perceived loudness and physical intensity of these stimuli and delineates the range of levels corresponding to categorical loudness judgments for these stimuli. ABRs/MLRs were recorded simultaneously to 500- and 2,000-Hz tonebursts in 10 normal-hearing adults at levels corresponding to each listener's loudness judgments for four categories on Contour Test of Loudness. Group mean ABR wave V and MLR wave Pa latency values increased significantly as loudness judgments decreased. Group mean amplitude values for ABR wave V-V′ and MLR wave Na-Pa increased as the listeners' categorical judgments increased. Listeners assigned a broad range (30 to 40 dB) of stimulus intensities when judging loudness of these stimuli within a specific loudness category. This was true for all four loudness categories and both frequencies. Thus, it appears that tone-evoked ABR/MLR response measures reflect, in part, the listener's perception of loudness. Response latencies are a more sensitive indicator of listener's loudness percept than corresponding response amplitudes. An appreciable range of signal levels was judged to be categorically equivalent across listeners. Thus, limiting how loudness judgments can be applied to prescriptive hearing aid fittings in individuals who cannot provide accurate loudness judgments.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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via IFTTT

Self-Assessment Questions

Semin Hear 2017; 38: C1-C10
DOI: 10.1055/s-0037-1598117

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

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via IFTTT

Considerations in the Development of a Sound Tolerance Interview and Questionnaire Instrument

Semin Hear 2017; 38: 053-070
DOI: 10.1055/s-0037-1598065

Most clinicians approach the objective fitting of hearing aids with three goals in mind: audibility, comfort, and tolerance. When these three amplification goals have been met, the hearing aid user is more likely to adapt to and perceive benefit from hearing aid use. However, problems related to the loudness of sounds and reduced sound tolerance, which may or may not be reported by the aided user, can adversely impact adaptation to amplification and the individual's quality of life. Although there are several standardized questionnaires available to evaluate hearing aid benefit and satisfaction, there is no standardized questionnaire or interview tool for evaluating reduced sound tolerance and the related impact on hearing aid use. We describe a 36-item tool, the Sound Tolerance Questionnaire (STQ), consisting of six sections, including experience with hearing aids, sound sensitivity/intolerance, medical and noise exposure histories, coexisting tinnitus problems, and a final question to differentiate the primary and secondary problems related to sound intolerance, tinnitus, and hearing loss. In its current format as a research tool, the STQ was sensitive in pinpointing vague sound tolerance complaints not reported by the study participants in eligibility screening by Formby et al. A refined version of the STQ, the Sound Tolerance Interview and Questionnaire Instrument (STIQI), structured as a two-part tool, is presented in the appendix for prospective clinical use. The STIQI has potential utility to delineate factors contributing to loudness complaints and/or reduced sound tolerance in individuals considering hearing aid use, as well as those who have been unsuccessful hearing aid users secondary to loudness complaints or sound intolerance. The STIQI, when validated and refined, also may hold promise for predicting hearing aid benefit and/or assessing treatment-related change over time of hearing aid use or interventions designed to remediate problems of loudness and/or sound intolerance among hearing aid candidates or users.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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via IFTTT

Consideration of Methodology and Measures of Loudness

Semin Hear 2017; 38: 001-002
DOI: 10.1055/s-0037-1599079

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

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The Importance of Facts and the Role of Academic Publishers in Today's World—A Publisher's View

Semin Hear 2017; 38: vii-vii
DOI: 10.1055/s-0037-1600102

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Full text

from #Audiology via xlomafota13 on Inoreader http://ift.tt/2m8qKOw
via IFTTT

Intra- and Intersubject Variability in Audiometric Measures and Loudness Judgments in Older Listeners with Normal Hearing

Semin Hear 2017; 38: 003-025
DOI: 10.1055/s-0037-1598063

This research was to document intra- and intersubject variability in measures of pure tone thresholds, loudness discomfort levels, and the Contour test of loudness for tonal and speech stimuli across 8 to 10 repeated test sessions over a period of almost 1 year in a group of 11 normal-hearing, older middle-aged adults (39 to 73 years, mean of 56 years). The measured pure tone thresholds and loudness discomfort levels were determined to be stable across sessions, with variability on the order of 5 dB. The categorical judgments for the Contour test for both warbled tones and spondaic speech stimuli decreased over time in level required for categories greater than comfortable. This result contrasts with reports of a slight increase over time when young, normal-hearing adults were tested in comparable measures. The intrasubject variability in the Contour test results was greatest for the 4,000-Hz tonal stimulus for which the largest time effects were observed. The intersubject variability was typically greater than the intrasubject variability and typically increased as the loudness category increased, with some exceptions. The results from this study can be used to aid in power and sample size analyses using these measures in future studies designed to compare effects of treatments based on changes in loudness judgments over time.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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via IFTTT

Auditory Brainstem and Middle Latency Responses Measured Pre- and Posttreatment for Hyperacusic Hearing-Impaired Persons Successfully Treated to Improve Sound Tolerance and to Expand the Dynamic Range for Loudness: Case Evidence

Semin Hear 2017; 38: 071-093
DOI: 10.1055/s-0037-1598066

In this report of three cases, we consider electrophysiologic measures from three hyperacusic hearing-impaired individuals who, prior to treatment to expand their dynamic ranges for loudness, were problematic hearing aid candidates because of their diminished sound tolerance and reduced dynamic ranges. Two of these individuals were treated with structured counseling combined with low-level broadband sound therapy from bilateral sound generators and the third case received structured counseling in combination with a short-acting placebo sound therapy. Each individual was highly responsive to his or her assigned treatment as revealed by expansion of the dynamic range by at least 20 dB at one or more frequencies posttreatment. Of specific interest in this report are their latency and amplitude measures taken from tone burst-evoked auditory brainstem response (ABR) and cortically derived middle latency response (MLR) recordings, measured as a function of increasing loudness at 500 and 2,000 Hz pre- and posttreatment. The resulting ABR and MLR latency and amplitude measures for each case are considered here in terms of pre- and posttreatment predictions. The respective pre- and posttreatment predictions anticipated larger pretreatment response amplitudes and shorter pretreatment response latencies relative to typical normal control values and smaller normative-like posttreatment response amplitudes and longer posttreatment response latencies relative to the corresponding pretreatment values for each individual. From these results and predictions, we conjecture about the neural origins of the hyperacusis conditions (i.e., brainstem versus cortical) and the neuronal sites responsive to treatment. The only consistent finding in support of the pre- and posttreatment predictions and, thus, the strongest index of hyperacusis and positive treatment-related effects was measured for MLR latency responses for wave Pa at 2,000 Hz. Other response indices, including ABR wave V latency and wave V-V′ amplitude and MLR wave Na-Pa amplitude for 500 and 2,000 Hz, appear either ambiguous across and/or within these individuals. Notwithstanding significant challenges for interpreting these findings, including associated confounding effects of their sensorineural hearing losses and differences in the presentation levels of the toneburst stimuli used to collect these measures for each individual, our limited analyses of three cases suggest measures of MLR wave Pa latency at 2,000 Hz (reflecting cortical contributions) may be a promising objective indicator of hyperacusis and dynamic range expansion treatment effects.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Audiology via xlomafota13 on Inoreader http://ift.tt/2m8jx0Y
via IFTTT

Repeated Measurement of Absolute and Relative Judgments of Loudness: Clinical Relevance for Prescriptive Fitting of Aided Target Gains for soft, Comfortable, and Loud, But Ok Sound Levels

Semin Hear 2017; 38: 026-052
DOI: 10.1055/s-0037-1598064

This study was undertaken with the purpose of streamlining clinical measures of loudness growth to facilitate and enhance prescriptive fitting of nonlinear hearing aids. Repeated measures of loudness at 500 and 3,000 Hz were obtained bilaterally at monthly intervals over a 6-month period from three groups of young adult listeners. All volunteers had normal audiometric hearing sensitivity and middle ear function, and all denied problems related to sound tolerance. Group 1 performed judgments of soft and loud, but OK for presentation of ascending sound levels. We defined these judgments operationally as absolute judgments of loudness. Group 2 initially performed loudness judgments across a continuum of seven loudness categories ranging from judgments of very soft to uncomfortably loud for presentation of ascending sound levels per the Contour Test of Loudness; we defined these judgments as relative judgments of loudness. In the same session, they then performed the absolute judgments for soft and loud, but OK sound levels. Group 3 performed the same set of loudness judgments as did group 2, but the task order was reversed such that they performed the absolute judgments initially within each test session followed by the relative judgments. The key findings from this study were as follows: (1) Within group, the absolute and relative tasks yielded clinically similar judgments for soft and for loud, but OK sound levels. These judgments were largely independent of task order, ear, frequency, or trial order within a given session. (2) Loudness judgments increased, on average, by ∼3 dB between the first and last test session, which is consistent with the commonly reported acclimatization effect reported for incremental changes in loudness discomfort levels as a consequence of chronic bilateral hearing aid use. (3) Measured and predicted comfortable judgments of loudness were in good agreement for the individual listener and for groups of listeners. These comfortable judgments bisect the measured levels judged for soft and for loud, but OK sounds. (4) Loudness judgments within the same loudness category varied across listeners within group by as much as 50 to 60 dB. Such large variation in judgments of loudness is problematic, especially because hearing-impaired listeners are known to exhibit similarly large ranges of intersubject response variation and, yet, poplar prescriptive fitting strategies continue to use average rather than individual loudness data to fit nonlinear hearing aids. The primary conclusions drawn from these findings are that reliable absolute judgments of soft and loud, but OK are clinically practical and economical to measure and, from these judgments, good estimates of comfortable loudness can also be predicted for individuals or for groups of listeners. Such loudness data, as measured as described in this report, offer promise for streamlining and enhancing prescriptive fitting of nonlinear hearing aids to target gain settings for soft (audible), comfortable, and loud, but OK (tolerable) sound inputs for the individual listener.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Audiology via xlomafota13 on Inoreader http://ift.tt/2mGKCvF
via IFTTT

Structured Counseling for Auditory Dynamic Range Expansion

Semin Hear 2017; 38: 115-129
DOI: 10.1055/s-0037-1598068

A structured counseling protocol is described that, when combined with low-level broadband sound therapy from bilateral sound generators, offers audiologists a new tool for facilitating the expansion of the auditory dynamic range (DR) for loudness. The protocol and its content are specifically designed to address and treat problems that impact hearing-impaired persons who, due to their reduced DRs, may be limited in the use and benefit of amplified sound from hearing aids. The reduced DRs may result from elevated audiometric thresholds and/or reduced sound tolerance as documented by lower-than-normal loudness discomfort levels (LDLs). Accordingly, the counseling protocol is appropriate for challenging and difficult-to-fit persons with sensorineural hearing losses who experience loudness recruitment or hyperacusis. Positive treatment outcomes for individuals with the former and latter conditions are highlighted in this issue by incremental shifts (improvements) in LDL and/or categorical loudness judgments, associated reduced complaints of sound intolerance, and functional improvements in daily communication, speech understanding, and quality of life leading to improved hearing aid benefit, satisfaction, and aided sound quality, posttreatment.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Audiology via xlomafota13 on Inoreader http://ift.tt/2m8jdzy
via IFTTT

A Sound Therapy-Based Intervention to Expand the Auditory Dynamic Range for Loudness among Persons with Sensorineural Hearing Losses: Case Evidence Showcasing Treatment Efficacy

Semin Hear 2017; 38: 130-150
DOI: 10.1055/s-0037-1598069

Case evidence is presented that highlights the clinical relevance and significance of a novel sound therapy-based treatment. This intervention has been shown to be efficacious in a randomized controlled trial for promoting expansion of the dynamic range for loudness and increased sound tolerance among persons with sensorineural hearing losses. Prior to treatment, these individuals were unable to use aided sound effectively because of their limited dynamic ranges. These promising treatment effects are shown in this article to be functionally significant, giving rise to improved speech understanding and enhanced hearing aid benefit and satisfaction, and, in turn, to enhanced quality of life posttreatment. These posttreatment sound therapy effects also are shown to be sustained, in whole or part, with aided environmental sound and to be dependent on specialized counseling to maximize treatment benefit. Importantly, the treatment appears to be efficacious for hearing-impaired persons with primary hyperacusis (i.e., abnormally reduced loudness discomfort levels [LDLs]) and for persons with loudness recruitment (i.e., LDLs within the typical range), which suggests the intervention should generalize across most individuals with reduced dynamic ranges owing to sensorineural hearing loss. An exception presented in this article is for a person describing the perceptual experience of pronounced loudness adaptation, which apparently rendered the sound therapy inaudible and ineffectual for this individual. Ultimately, these case examples showcase the enormous potential of a surprisingly simple sound therapy intervention, which has utility for virtually all audiologists to master and empower the adaptive plasticity of the auditory system to achieve remarkable treatment benefits for large numbers of individuals with sensorineural hearing losses.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

from #Audiology via xlomafota13 on Inoreader http://ift.tt/2mGEZgX
via IFTTT

Relations among Auditory Brainstem and Middle Latency Response Measures, Categorical Loudness Judgments, and Their Associated Physical Intensities

Semin Hear 2017; 38: 094-114
DOI: 10.1055/s-0037-1598067

This study characterizes changes in response properties of toneburst-evoked auditory brainstem responses (ABRs) and/or middle latency responses (MLRs) as a function of perceived loudness and physical intensity of these stimuli and delineates the range of levels corresponding to categorical loudness judgments for these stimuli. ABRs/MLRs were recorded simultaneously to 500- and 2,000-Hz tonebursts in 10 normal-hearing adults at levels corresponding to each listener's loudness judgments for four categories on Contour Test of Loudness. Group mean ABR wave V and MLR wave Pa latency values increased significantly as loudness judgments decreased. Group mean amplitude values for ABR wave V-V′ and MLR wave Na-Pa increased as the listeners' categorical judgments increased. Listeners assigned a broad range (30 to 40 dB) of stimulus intensities when judging loudness of these stimuli within a specific loudness category. This was true for all four loudness categories and both frequencies. Thus, it appears that tone-evoked ABR/MLR response measures reflect, in part, the listener's perception of loudness. Response latencies are a more sensitive indicator of listener's loudness percept than corresponding response amplitudes. An appreciable range of signal levels was judged to be categorically equivalent across listeners. Thus, limiting how loudness judgments can be applied to prescriptive hearing aid fittings in individuals who cannot provide accurate loudness judgments.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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Self-Assessment Questions

Semin Hear 2017; 38: C1-C10
DOI: 10.1055/s-0037-1598117

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Considerations in the Development of a Sound Tolerance Interview and Questionnaire Instrument

Semin Hear 2017; 38: 053-070
DOI: 10.1055/s-0037-1598065

Most clinicians approach the objective fitting of hearing aids with three goals in mind: audibility, comfort, and tolerance. When these three amplification goals have been met, the hearing aid user is more likely to adapt to and perceive benefit from hearing aid use. However, problems related to the loudness of sounds and reduced sound tolerance, which may or may not be reported by the aided user, can adversely impact adaptation to amplification and the individual's quality of life. Although there are several standardized questionnaires available to evaluate hearing aid benefit and satisfaction, there is no standardized questionnaire or interview tool for evaluating reduced sound tolerance and the related impact on hearing aid use. We describe a 36-item tool, the Sound Tolerance Questionnaire (STQ), consisting of six sections, including experience with hearing aids, sound sensitivity/intolerance, medical and noise exposure histories, coexisting tinnitus problems, and a final question to differentiate the primary and secondary problems related to sound intolerance, tinnitus, and hearing loss. In its current format as a research tool, the STQ was sensitive in pinpointing vague sound tolerance complaints not reported by the study participants in eligibility screening by Formby et al. A refined version of the STQ, the Sound Tolerance Interview and Questionnaire Instrument (STIQI), structured as a two-part tool, is presented in the appendix for prospective clinical use. The STIQI has potential utility to delineate factors contributing to loudness complaints and/or reduced sound tolerance in individuals considering hearing aid use, as well as those who have been unsuccessful hearing aid users secondary to loudness complaints or sound intolerance. The STIQI, when validated and refined, also may hold promise for predicting hearing aid benefit and/or assessing treatment-related change over time of hearing aid use or interventions designed to remediate problems of loudness and/or sound intolerance among hearing aid candidates or users.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Consideration of Methodology and Measures of Loudness

Semin Hear 2017; 38: 001-002
DOI: 10.1055/s-0037-1599079

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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The Importance of Facts and the Role of Academic Publishers in Today's World—A Publisher's View

Semin Hear 2017; 38: vii-vii
DOI: 10.1055/s-0037-1600102

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Intra- and Intersubject Variability in Audiometric Measures and Loudness Judgments in Older Listeners with Normal Hearing

Semin Hear 2017; 38: 003-025
DOI: 10.1055/s-0037-1598063

This research was to document intra- and intersubject variability in measures of pure tone thresholds, loudness discomfort levels, and the Contour test of loudness for tonal and speech stimuli across 8 to 10 repeated test sessions over a period of almost 1 year in a group of 11 normal-hearing, older middle-aged adults (39 to 73 years, mean of 56 years). The measured pure tone thresholds and loudness discomfort levels were determined to be stable across sessions, with variability on the order of 5 dB. The categorical judgments for the Contour test for both warbled tones and spondaic speech stimuli decreased over time in level required for categories greater than comfortable. This result contrasts with reports of a slight increase over time when young, normal-hearing adults were tested in comparable measures. The intrasubject variability in the Contour test results was greatest for the 4,000-Hz tonal stimulus for which the largest time effects were observed. The intersubject variability was typically greater than the intrasubject variability and typically increased as the loudness category increased, with some exceptions. The results from this study can be used to aid in power and sample size analyses using these measures in future studies designed to compare effects of treatments based on changes in loudness judgments over time.
[...]

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Auditory Brainstem and Middle Latency Responses Measured Pre- and Posttreatment for Hyperacusic Hearing-Impaired Persons Successfully Treated to Improve Sound Tolerance and to Expand the Dynamic Range for Loudness: Case Evidence

Semin Hear 2017; 38: 071-093
DOI: 10.1055/s-0037-1598066

In this report of three cases, we consider electrophysiologic measures from three hyperacusic hearing-impaired individuals who, prior to treatment to expand their dynamic ranges for loudness, were problematic hearing aid candidates because of their diminished sound tolerance and reduced dynamic ranges. Two of these individuals were treated with structured counseling combined with low-level broadband sound therapy from bilateral sound generators and the third case received structured counseling in combination with a short-acting placebo sound therapy. Each individual was highly responsive to his or her assigned treatment as revealed by expansion of the dynamic range by at least 20 dB at one or more frequencies posttreatment. Of specific interest in this report are their latency and amplitude measures taken from tone burst-evoked auditory brainstem response (ABR) and cortically derived middle latency response (MLR) recordings, measured as a function of increasing loudness at 500 and 2,000 Hz pre- and posttreatment. The resulting ABR and MLR latency and amplitude measures for each case are considered here in terms of pre- and posttreatment predictions. The respective pre- and posttreatment predictions anticipated larger pretreatment response amplitudes and shorter pretreatment response latencies relative to typical normal control values and smaller normative-like posttreatment response amplitudes and longer posttreatment response latencies relative to the corresponding pretreatment values for each individual. From these results and predictions, we conjecture about the neural origins of the hyperacusis conditions (i.e., brainstem versus cortical) and the neuronal sites responsive to treatment. The only consistent finding in support of the pre- and posttreatment predictions and, thus, the strongest index of hyperacusis and positive treatment-related effects was measured for MLR latency responses for wave Pa at 2,000 Hz. Other response indices, including ABR wave V latency and wave V-V′ amplitude and MLR wave Na-Pa amplitude for 500 and 2,000 Hz, appear either ambiguous across and/or within these individuals. Notwithstanding significant challenges for interpreting these findings, including associated confounding effects of their sensorineural hearing losses and differences in the presentation levels of the toneburst stimuli used to collect these measures for each individual, our limited analyses of three cases suggest measures of MLR wave Pa latency at 2,000 Hz (reflecting cortical contributions) may be a promising objective indicator of hyperacusis and dynamic range expansion treatment effects.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Repeated Measurement of Absolute and Relative Judgments of Loudness: Clinical Relevance for Prescriptive Fitting of Aided Target Gains for soft, Comfortable, and Loud, But Ok Sound Levels

Semin Hear 2017; 38: 026-052
DOI: 10.1055/s-0037-1598064

This study was undertaken with the purpose of streamlining clinical measures of loudness growth to facilitate and enhance prescriptive fitting of nonlinear hearing aids. Repeated measures of loudness at 500 and 3,000 Hz were obtained bilaterally at monthly intervals over a 6-month period from three groups of young adult listeners. All volunteers had normal audiometric hearing sensitivity and middle ear function, and all denied problems related to sound tolerance. Group 1 performed judgments of soft and loud, but OK for presentation of ascending sound levels. We defined these judgments operationally as absolute judgments of loudness. Group 2 initially performed loudness judgments across a continuum of seven loudness categories ranging from judgments of very soft to uncomfortably loud for presentation of ascending sound levels per the Contour Test of Loudness; we defined these judgments as relative judgments of loudness. In the same session, they then performed the absolute judgments for soft and loud, but OK sound levels. Group 3 performed the same set of loudness judgments as did group 2, but the task order was reversed such that they performed the absolute judgments initially within each test session followed by the relative judgments. The key findings from this study were as follows: (1) Within group, the absolute and relative tasks yielded clinically similar judgments for soft and for loud, but OK sound levels. These judgments were largely independent of task order, ear, frequency, or trial order within a given session. (2) Loudness judgments increased, on average, by ∼3 dB between the first and last test session, which is consistent with the commonly reported acclimatization effect reported for incremental changes in loudness discomfort levels as a consequence of chronic bilateral hearing aid use. (3) Measured and predicted comfortable judgments of loudness were in good agreement for the individual listener and for groups of listeners. These comfortable judgments bisect the measured levels judged for soft and for loud, but OK sounds. (4) Loudness judgments within the same loudness category varied across listeners within group by as much as 50 to 60 dB. Such large variation in judgments of loudness is problematic, especially because hearing-impaired listeners are known to exhibit similarly large ranges of intersubject response variation and, yet, poplar prescriptive fitting strategies continue to use average rather than individual loudness data to fit nonlinear hearing aids. The primary conclusions drawn from these findings are that reliable absolute judgments of soft and loud, but OK are clinically practical and economical to measure and, from these judgments, good estimates of comfortable loudness can also be predicted for individuals or for groups of listeners. Such loudness data, as measured as described in this report, offer promise for streamlining and enhancing prescriptive fitting of nonlinear hearing aids to target gain settings for soft (audible), comfortable, and loud, but OK (tolerable) sound inputs for the individual listener.
[...]

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Structured Counseling for Auditory Dynamic Range Expansion

Semin Hear 2017; 38: 115-129
DOI: 10.1055/s-0037-1598068

A structured counseling protocol is described that, when combined with low-level broadband sound therapy from bilateral sound generators, offers audiologists a new tool for facilitating the expansion of the auditory dynamic range (DR) for loudness. The protocol and its content are specifically designed to address and treat problems that impact hearing-impaired persons who, due to their reduced DRs, may be limited in the use and benefit of amplified sound from hearing aids. The reduced DRs may result from elevated audiometric thresholds and/or reduced sound tolerance as documented by lower-than-normal loudness discomfort levels (LDLs). Accordingly, the counseling protocol is appropriate for challenging and difficult-to-fit persons with sensorineural hearing losses who experience loudness recruitment or hyperacusis. Positive treatment outcomes for individuals with the former and latter conditions are highlighted in this issue by incremental shifts (improvements) in LDL and/or categorical loudness judgments, associated reduced complaints of sound intolerance, and functional improvements in daily communication, speech understanding, and quality of life leading to improved hearing aid benefit, satisfaction, and aided sound quality, posttreatment.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Article in Thieme eJournals:
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A Sound Therapy-Based Intervention to Expand the Auditory Dynamic Range for Loudness among Persons with Sensorineural Hearing Losses: Case Evidence Showcasing Treatment Efficacy

Semin Hear 2017; 38: 130-150
DOI: 10.1055/s-0037-1598069

Case evidence is presented that highlights the clinical relevance and significance of a novel sound therapy-based treatment. This intervention has been shown to be efficacious in a randomized controlled trial for promoting expansion of the dynamic range for loudness and increased sound tolerance among persons with sensorineural hearing losses. Prior to treatment, these individuals were unable to use aided sound effectively because of their limited dynamic ranges. These promising treatment effects are shown in this article to be functionally significant, giving rise to improved speech understanding and enhanced hearing aid benefit and satisfaction, and, in turn, to enhanced quality of life posttreatment. These posttreatment sound therapy effects also are shown to be sustained, in whole or part, with aided environmental sound and to be dependent on specialized counseling to maximize treatment benefit. Importantly, the treatment appears to be efficacious for hearing-impaired persons with primary hyperacusis (i.e., abnormally reduced loudness discomfort levels [LDLs]) and for persons with loudness recruitment (i.e., LDLs within the typical range), which suggests the intervention should generalize across most individuals with reduced dynamic ranges owing to sensorineural hearing loss. An exception presented in this article is for a person describing the perceptual experience of pronounced loudness adaptation, which apparently rendered the sound therapy inaudible and ineffectual for this individual. Ultimately, these case examples showcase the enormous potential of a surprisingly simple sound therapy intervention, which has utility for virtually all audiologists to master and empower the adaptive plasticity of the auditory system to achieve remarkable treatment benefits for large numbers of individuals with sensorineural hearing losses.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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Dynamical analysis of balance in vestibular schwannoma patients

Publication date: Available online 9 March 2017
Source:Gait & Posture
Author(s): Charles P. Hoffmann, Benoît Seigle, Julien Frère, Cécile Parietti-Winkler
The analysis of the complexity of postural fluctuations is a recent method for assessing postural control. Complexity relates to the irregularity of the center of pressure time series and characterizes the ability of postural control to meet a changing environment. In our study, we used the sample entropy (SampEn) parameter to evaluate the complexity of postural sway velocity time series in patients with vestibular schwannoma (n=19) compared to healthy controls (n=20), using the sensory organization test. Patients performed postural assessments three days before surgical ablation of the tumor, then three times after surgery, at eight, thirty, and ninety days. The control group underwent posturographic tests only once. Our results demonstrated that SampEn values distinguished both groups before surgery only in postural tasks where vestibular afferences significantly contribute to maintaining balance. We also found an immediate decrease of complexity after the surgical resection of the tumor. Our results are in line with the theory of complexity loss of physiological systems stating that reducing the number of their structural components or altering their coupling leads to a decrease in complexity. Finally, our findings showed that progressive restoration of complexity over time was such that no difference was found between the two groups ninety days after surgery, due to the implementation of central adaptive mechanisms and the substitution by other sensory afferences. Thus, the SampEn parameter can highlight the postural effects of vestibular pathology, and complexity analysis appears to be a valuable tool for investigating the temporal structure of CoP time series.



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Abnormality of standing posture improves in patients with bilateral spastic cerebral palsy following lower limb surgery

Publication date: Available online 9 March 2017
Source:Gait & Posture
Author(s): P. Buddhdev, N.R. Fry, R. LePage, M. Wiley, M. Gough, A.P. Shortland
ObjectivesThe degree of abnormality of the gait pattern of children with bilateral spastic cerebral palsy (BSCP) can be reduced by lower limb orthopedic surgery. However, little attention is paid to the effects of surgery on standing posture. Here, we investigated the abnormality of standing posture in young people with BSCP as well as the effects of surgery on standing posture.MethodsWe have developed an index of standing posture, the Standing Posture Score (SPS), which is similar in composition to the gait profile score (GPS). We applied SPS retrospectively to 32 typically developing children and 85 children with BSCP before and after surgery to the lower limbs aimed at improving gait. We investigated the relationship between SPS and GPS before surgery and also the relationship between changes in these variables before and after surgery.ResultsSPS is significantly higher in young people with BSCP. SPS reduces after surgery and this reduction is correlated with the reduction in GPS.InterpretationSuccessful surgery improves the alignment of the lower limbs in BSCP in standing and may have a positive impact on the activities of daily living which depend on a stable and efficient standing posture.



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Effect of whole-body vibration on center-of-mass movement during standing in children and young adults

Publication date: Available online 8 March 2017
Source:Gait & Posture
Author(s): Huaqing Liang, Matthew Beerse, Xiang Ke, Jianhua Wu
Whole body vibration (WBV) can affect postural control and muscular activation. The purpose of this study was to investigate the center-of-mass (COM) movement of children and young adults before, during, immediately after, and 5minutes after 40-second WBV in quiet standing. Fourteen young adults (mean age 24.5 years) and fourteen children (mean age 8.1 years) participated in the study. A full-body 35-marker set was placed on the participants and used to calculate COM. Forty-second standing trials were collected before, during, immediately after, and 5minutes after WBV with an frequency of 28Hz and an amplitude of <1mm. Two visual conditions were provided: eyes-open (EO) and eyes-closed (EC). COM variables included time-domain measures (average velocity, range, sway area and fractal dimension), frequency-domain measures (total power and median frequency), and detrended fluctuation analysis (DFA) scaling exponent in both anterior-posterior (AP) and medial-lateral (ML) directions. Results show that during WBV both children and adults increased average velocity and median frequency, but decreased range and the DFA scaling exponent. Immediately after WBV both groups increased the range, but showed pre-vibration values for most of the COM variables. Comparing to adults, children displayed a higher COM velocity, range, fractal dimension, and total power, but a lower DFA scaling exponent at all phases. The results suggest that both children and adults can quickly adapt their postural control system to WBV and maintain balance during and after vibration. Children display some adult-like postural control during and after WBV; however, their postural development continues into adolescence.



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Dynamical analysis of balance in vestibular schwannoma patients

Publication date: Available online 9 March 2017
Source:Gait & Posture
Author(s): Charles P. Hoffmann, Benoît Seigle, Julien Frère, Cécile Parietti-Winkler
The analysis of the complexity of postural fluctuations is a recent method for assessing postural control. Complexity relates to the irregularity of the center of pressure time series and characterizes the ability of postural control to meet a changing environment. In our study, we used the sample entropy (SampEn) parameter to evaluate the complexity of postural sway velocity time series in patients with vestibular schwannoma (n=19) compared to healthy controls (n=20), using the sensory organization test. Patients performed postural assessments three days before surgical ablation of the tumor, then three times after surgery, at eight, thirty, and ninety days. The control group underwent posturographic tests only once. Our results demonstrated that SampEn values distinguished both groups before surgery only in postural tasks where vestibular afferences significantly contribute to maintaining balance. We also found an immediate decrease of complexity after the surgical resection of the tumor. Our results are in line with the theory of complexity loss of physiological systems stating that reducing the number of their structural components or altering their coupling leads to a decrease in complexity. Finally, our findings showed that progressive restoration of complexity over time was such that no difference was found between the two groups ninety days after surgery, due to the implementation of central adaptive mechanisms and the substitution by other sensory afferences. Thus, the SampEn parameter can highlight the postural effects of vestibular pathology, and complexity analysis appears to be a valuable tool for investigating the temporal structure of CoP time series.



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Abnormality of standing posture improves in patients with bilateral spastic cerebral palsy following lower limb surgery

Publication date: Available online 9 March 2017
Source:Gait & Posture
Author(s): P. Buddhdev, N.R. Fry, R. LePage, M. Wiley, M. Gough, A.P. Shortland
ObjectivesThe degree of abnormality of the gait pattern of children with bilateral spastic cerebral palsy (BSCP) can be reduced by lower limb orthopedic surgery. However, little attention is paid to the effects of surgery on standing posture. Here, we investigated the abnormality of standing posture in young people with BSCP as well as the effects of surgery on standing posture.MethodsWe have developed an index of standing posture, the Standing Posture Score (SPS), which is similar in composition to the gait profile score (GPS). We applied SPS retrospectively to 32 typically developing children and 85 children with BSCP before and after surgery to the lower limbs aimed at improving gait. We investigated the relationship between SPS and GPS before surgery and also the relationship between changes in these variables before and after surgery.ResultsSPS is significantly higher in young people with BSCP. SPS reduces after surgery and this reduction is correlated with the reduction in GPS.InterpretationSuccessful surgery improves the alignment of the lower limbs in BSCP in standing and may have a positive impact on the activities of daily living which depend on a stable and efficient standing posture.



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Effect of whole-body vibration on center-of-mass movement during standing in children and young adults

Publication date: Available online 8 March 2017
Source:Gait & Posture
Author(s): Huaqing Liang, Matthew Beerse, Xiang Ke, Jianhua Wu
Whole body vibration (WBV) can affect postural control and muscular activation. The purpose of this study was to investigate the center-of-mass (COM) movement of children and young adults before, during, immediately after, and 5minutes after 40-second WBV in quiet standing. Fourteen young adults (mean age 24.5 years) and fourteen children (mean age 8.1 years) participated in the study. A full-body 35-marker set was placed on the participants and used to calculate COM. Forty-second standing trials were collected before, during, immediately after, and 5minutes after WBV with an frequency of 28Hz and an amplitude of <1mm. Two visual conditions were provided: eyes-open (EO) and eyes-closed (EC). COM variables included time-domain measures (average velocity, range, sway area and fractal dimension), frequency-domain measures (total power and median frequency), and detrended fluctuation analysis (DFA) scaling exponent in both anterior-posterior (AP) and medial-lateral (ML) directions. Results show that during WBV both children and adults increased average velocity and median frequency, but decreased range and the DFA scaling exponent. Immediately after WBV both groups increased the range, but showed pre-vibration values for most of the COM variables. Comparing to adults, children displayed a higher COM velocity, range, fractal dimension, and total power, but a lower DFA scaling exponent at all phases. The results suggest that both children and adults can quickly adapt their postural control system to WBV and maintain balance during and after vibration. Children display some adult-like postural control during and after WBV; however, their postural development continues into adolescence.



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Dynamical analysis of balance in vestibular schwannoma patients

Publication date: Available online 9 March 2017
Source:Gait & Posture
Author(s): Charles P. Hoffmann, Benoît Seigle, Julien Frère, Cécile Parietti-Winkler
The analysis of the complexity of postural fluctuations is a recent method for assessing postural control. Complexity relates to the irregularity of the center of pressure time series and characterizes the ability of postural control to meet a changing environment. In our study, we used the sample entropy (SampEn) parameter to evaluate the complexity of postural sway velocity time series in patients with vestibular schwannoma (n=19) compared to healthy controls (n=20), using the sensory organization test. Patients performed postural assessments three days before surgical ablation of the tumor, then three times after surgery, at eight, thirty, and ninety days. The control group underwent posturographic tests only once. Our results demonstrated that SampEn values distinguished both groups before surgery only in postural tasks where vestibular afferences significantly contribute to maintaining balance. We also found an immediate decrease of complexity after the surgical resection of the tumor. Our results are in line with the theory of complexity loss of physiological systems stating that reducing the number of their structural components or altering their coupling leads to a decrease in complexity. Finally, our findings showed that progressive restoration of complexity over time was such that no difference was found between the two groups ninety days after surgery, due to the implementation of central adaptive mechanisms and the substitution by other sensory afferences. Thus, the SampEn parameter can highlight the postural effects of vestibular pathology, and complexity analysis appears to be a valuable tool for investigating the temporal structure of CoP time series.



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Abnormality of standing posture improves in patients with bilateral spastic cerebral palsy following lower limb surgery

Publication date: Available online 9 March 2017
Source:Gait & Posture
Author(s): P. Buddhdev, N.R. Fry, R. LePage, M. Wiley, M. Gough, A.P. Shortland
ObjectivesThe degree of abnormality of the gait pattern of children with bilateral spastic cerebral palsy (BSCP) can be reduced by lower limb orthopedic surgery. However, little attention is paid to the effects of surgery on standing posture. Here, we investigated the abnormality of standing posture in young people with BSCP as well as the effects of surgery on standing posture.MethodsWe have developed an index of standing posture, the Standing Posture Score (SPS), which is similar in composition to the gait profile score (GPS). We applied SPS retrospectively to 32 typically developing children and 85 children with BSCP before and after surgery to the lower limbs aimed at improving gait. We investigated the relationship between SPS and GPS before surgery and also the relationship between changes in these variables before and after surgery.ResultsSPS is significantly higher in young people with BSCP. SPS reduces after surgery and this reduction is correlated with the reduction in GPS.InterpretationSuccessful surgery improves the alignment of the lower limbs in BSCP in standing and may have a positive impact on the activities of daily living which depend on a stable and efficient standing posture.



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Effect of whole-body vibration on center-of-mass movement during standing in children and young adults

Publication date: Available online 8 March 2017
Source:Gait & Posture
Author(s): Huaqing Liang, Matthew Beerse, Xiang Ke, Jianhua Wu
Whole body vibration (WBV) can affect postural control and muscular activation. The purpose of this study was to investigate the center-of-mass (COM) movement of children and young adults before, during, immediately after, and 5minutes after 40-second WBV in quiet standing. Fourteen young adults (mean age 24.5 years) and fourteen children (mean age 8.1 years) participated in the study. A full-body 35-marker set was placed on the participants and used to calculate COM. Forty-second standing trials were collected before, during, immediately after, and 5minutes after WBV with an frequency of 28Hz and an amplitude of <1mm. Two visual conditions were provided: eyes-open (EO) and eyes-closed (EC). COM variables included time-domain measures (average velocity, range, sway area and fractal dimension), frequency-domain measures (total power and median frequency), and detrended fluctuation analysis (DFA) scaling exponent in both anterior-posterior (AP) and medial-lateral (ML) directions. Results show that during WBV both children and adults increased average velocity and median frequency, but decreased range and the DFA scaling exponent. Immediately after WBV both groups increased the range, but showed pre-vibration values for most of the COM variables. Comparing to adults, children displayed a higher COM velocity, range, fractal dimension, and total power, but a lower DFA scaling exponent at all phases. The results suggest that both children and adults can quickly adapt their postural control system to WBV and maintain balance during and after vibration. Children display some adult-like postural control during and after WBV; however, their postural development continues into adolescence.



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Usefulness of self-report questionnaires for psychological assessment of patients with tinnitus and hyperacusis and patients’ views of the questionnaires

.


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Usefulness of self-report questionnaires for psychological assessment of patients with tinnitus and hyperacusis and patients’ views of the questionnaires

.


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Usefulness of self-report questionnaires for psychological assessment of patients with tinnitus and hyperacusis and patients’ views of the questionnaires

.


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Isolating spectral cues in amplitude and quasi-frequency modulation discrimination by reducing stimulus duration

Publication date: Available online 8 March 2017
Source:Hearing Research
Author(s): Ewa Borucki, Bruce G. Berg
This study investigated the psychophysical effects of distortion products in a listening task traditionally used to estimate the bandwidth of phase sensitivity. For a 2000 Hz carrier, estimates of modulation depth necessary to discriminate amplitude modulated (AM) tones and quasi-frequency modulated (QFM) were measured in a two interval forced choice task as a function modulation frequency. Temporal modulation transfer functions were often non-monotonic at modulation frequencies above 300 Hz. This was likely to be due to a spectral cue arising from the interaction of auditory distortion products and the lower sideband of the stimulus complex. When the stimulus duration was decreased from 200 ms to 20 ms, thresholds for low-frequency modulators rose to near-chance levels, whereas thresholds in the region of non-monotonicities were less affected. The decrease in stimulus duration appears to hinder the listener's ability to use temporal cues in order to discriminate between AM and QFM, whereas spectral information derived from distortion product cues appears more resilient.



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Contributions of sensory tuning to auditory-vocal interactions in marmoset auditory cortex

Publication date: Available online 9 March 2017
Source:Hearing Research
Author(s): Steven J. Eliades, Xiaoqin Wang
During speech, humans continuously listen to their own vocal output to ensure accurate communication. Such self-monitoring is thought to require the integration of information about the feedback of vocal acoustics with internal motor control signals. The neural mechanism of this auditory-vocal interaction remains largely unknown at the cellular level. Previous studies in naturally vocalizing marmosets have demonstrated diverse neural activities in auditory cortex during vocalization, dominated by a vocalization-induced suppression of neural firing. How underlying auditory tuning properties of these neurons might contribute to this sensory-motor processing is unknown. In the present study, we quantitatively compared marmoset auditory cortex neural activities during vocal production with those during passive listening. We found that neurons excited during vocalization were readily driven by passive playback of vocalizations and other acoustic stimuli. In contrast, neurons suppressed during vocalization exhibited more diverse playback responses, including responses that were not predictable by auditory tuning properties. These results suggest that vocalization-related excitation in auditory cortex is largely a sensory-driven response. In contrast, vocalization-induced suppression is not well predicted by a neuron's auditory responses, supporting the prevailing theory that internal motor-related signals contribute to the auditory-vocal interaction observed in auditory cortex.



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Isolating spectral cues in amplitude and quasi-frequency modulation discrimination by reducing stimulus duration

Publication date: Available online 8 March 2017
Source:Hearing Research
Author(s): Ewa Borucki, Bruce G. Berg
This study investigated the psychophysical effects of distortion products in a listening task traditionally used to estimate the bandwidth of phase sensitivity. For a 2000 Hz carrier, estimates of modulation depth necessary to discriminate amplitude modulated (AM) tones and quasi-frequency modulated (QFM) were measured in a two interval forced choice task as a function modulation frequency. Temporal modulation transfer functions were often non-monotonic at modulation frequencies above 300 Hz. This was likely to be due to a spectral cue arising from the interaction of auditory distortion products and the lower sideband of the stimulus complex. When the stimulus duration was decreased from 200 ms to 20 ms, thresholds for low-frequency modulators rose to near-chance levels, whereas thresholds in the region of non-monotonicities were less affected. The decrease in stimulus duration appears to hinder the listener's ability to use temporal cues in order to discriminate between AM and QFM, whereas spectral information derived from distortion product cues appears more resilient.



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Contributions of sensory tuning to auditory-vocal interactions in marmoset auditory cortex

Publication date: Available online 9 March 2017
Source:Hearing Research
Author(s): Steven J. Eliades, Xiaoqin Wang
During speech, humans continuously listen to their own vocal output to ensure accurate communication. Such self-monitoring is thought to require the integration of information about the feedback of vocal acoustics with internal motor control signals. The neural mechanism of this auditory-vocal interaction remains largely unknown at the cellular level. Previous studies in naturally vocalizing marmosets have demonstrated diverse neural activities in auditory cortex during vocalization, dominated by a vocalization-induced suppression of neural firing. How underlying auditory tuning properties of these neurons might contribute to this sensory-motor processing is unknown. In the present study, we quantitatively compared marmoset auditory cortex neural activities during vocal production with those during passive listening. We found that neurons excited during vocalization were readily driven by passive playback of vocalizations and other acoustic stimuli. In contrast, neurons suppressed during vocalization exhibited more diverse playback responses, including responses that were not predictable by auditory tuning properties. These results suggest that vocalization-related excitation in auditory cortex is largely a sensory-driven response. In contrast, vocalization-induced suppression is not well predicted by a neuron's auditory responses, supporting the prevailing theory that internal motor-related signals contribute to the auditory-vocal interaction observed in auditory cortex.



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Isolating spectral cues in amplitude and quasi-frequency modulation discrimination by reducing stimulus duration

Publication date: Available online 8 March 2017
Source:Hearing Research
Author(s): Ewa Borucki, Bruce G. Berg
This study investigated the psychophysical effects of distortion products in a listening task traditionally used to estimate the bandwidth of phase sensitivity. For a 2000 Hz carrier, estimates of modulation depth necessary to discriminate amplitude modulated (AM) tones and quasi-frequency modulated (QFM) were measured in a two interval forced choice task as a function modulation frequency. Temporal modulation transfer functions were often non-monotonic at modulation frequencies above 300 Hz. This was likely to be due to a spectral cue arising from the interaction of auditory distortion products and the lower sideband of the stimulus complex. When the stimulus duration was decreased from 200 ms to 20 ms, thresholds for low-frequency modulators rose to near-chance levels, whereas thresholds in the region of non-monotonicities were less affected. The decrease in stimulus duration appears to hinder the listener's ability to use temporal cues in order to discriminate between AM and QFM, whereas spectral information derived from distortion product cues appears more resilient.



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Contributions of sensory tuning to auditory-vocal interactions in marmoset auditory cortex

Publication date: Available online 9 March 2017
Source:Hearing Research
Author(s): Steven J. Eliades, Xiaoqin Wang
During speech, humans continuously listen to their own vocal output to ensure accurate communication. Such self-monitoring is thought to require the integration of information about the feedback of vocal acoustics with internal motor control signals. The neural mechanism of this auditory-vocal interaction remains largely unknown at the cellular level. Previous studies in naturally vocalizing marmosets have demonstrated diverse neural activities in auditory cortex during vocalization, dominated by a vocalization-induced suppression of neural firing. How underlying auditory tuning properties of these neurons might contribute to this sensory-motor processing is unknown. In the present study, we quantitatively compared marmoset auditory cortex neural activities during vocal production with those during passive listening. We found that neurons excited during vocalization were readily driven by passive playback of vocalizations and other acoustic stimuli. In contrast, neurons suppressed during vocalization exhibited more diverse playback responses, including responses that were not predictable by auditory tuning properties. These results suggest that vocalization-related excitation in auditory cortex is largely a sensory-driven response. In contrast, vocalization-induced suppression is not well predicted by a neuron's auditory responses, supporting the prevailing theory that internal motor-related signals contribute to the auditory-vocal interaction observed in auditory cortex.



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[Perception of hearing problems in the older population].

Related Articles

[Perception of hearing problems in the older population].

HNO. 2017 Mar 07;:

Authors: Moser S, Luxenberger W, Freidl W

Abstract
BACKGROUND: Age-related hearing loss is one of the most common chronic sensory impairments in the older population. This chronic condition is associated with bio-psychosocial consequences such as cognitive decline, depression, withdrawal, isolation, and reduced wellbeing.
OBJECTIVE: This study aimed to investigate the perception of hearing problems among older women and men (≥55 years) with age-related hearing loss. Furthermore, the association between functional hearing loss and perceived hearing problems was examined. Lastly, this study undertook a detailed investigation of subjective experiences in order to better understand the consequences of age-related hearing loss for daily life.
MATERIALS AND METHODS: With the aid of mixed methods, quantitative data were gathered from 65 participants with age-related hearing impairment in Austria using the Hearing Handicap Inventory for the Elderly (HHIE). Moreover, qualitative data regarding experiences with hearing problems were collected by performing semi-structured problem-centered interviews and analyzing the results of a further 14 older adults with hearing loss.
RESULTS: On average, participants assessed their hearing handicap as mild and perceived consequences on emotional, social, and communication levels. Moreover, feelings of insecurity were evident. In addition, the findings indicate a relationship but also a discrepancy between hearing loss and hearing handicap, i. e., not all participants perceived a hearing handicap.
CONCLUSION: Patient-centered care encompassing (1) objective and self-report measures for assessing hearing problems, (2) involvement of family members and significant others, (3) counseling and exchange of information, and (4) a shared decision-making approach could enhance quality of life and quality of care.

PMID: 28271168 [PubMed - as supplied by publisher]

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Design and Methods of the Pan-Canadian Applying Biomarkers to Minimize Long-Term Effects of Childhood/Adolescent Cancer Treatment (ABLE) Nephrotoxicity Study: A Prospective Observational Cohort Study.

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Design and Methods of the Pan-Canadian Applying Biomarkers to Minimize Long-Term Effects of Childhood/Adolescent Cancer Treatment (ABLE) Nephrotoxicity Study: A Prospective Observational Cohort Study.

Can J Kidney Health Dis. 2017;4:2054358117690338

Authors: McMahon KR, Rod Rassekh S, Schultz KR, Pinsk M, Blydt-Hansen T, Mammen C, Tsuyuki RT, Devarajan P, Cuvelier GD, Mitchell LG, Baruchel S, Palijan A, Carleton BC, Ross CJ, Zappitelli M, Applying Biomarkers to Minimize Long-Term Effects of Childhood/Adolescent Cancer Treatment (ABLE) Research Group

Abstract
BACKGROUND: Childhood cancer survivors experience adverse drug events leading to lifelong health issues. The Applying Biomarkers to Minimize Long-Term Effects of Childhood/Adolescent Cancer Treatment (ABLE) team was established to validate and apply biomarkers of cancer treatment effects, with a goal of identifying children at high risk of developing cancer treatment complications associated with thrombosis, graft-versus-host disease, hearing loss, and kidney damage. Cisplatin is a chemotherapy well known to cause acute and chronic nephrotoxicity. Data on biomarkers of acute kidney injury (AKI) and late renal outcomes in children treated with cisplatin are limited.
OBJECTIVE: To describe the design and methods of the pan-Canadian ABLE Nephrotoxicity study, which aims to evaluate urine biomarkers (neutrophil gelatinase-associated lipocalin [NGAL] and kidney injury molecule-1 [KIM-1]) for AKI diagnosis, and determine whether they predict risk of long-term renal outcomes (chronic kidney disease [CKD], hypertension).
DESIGN: This is a 3-year observational prospective cohort study.
SETTING: The study includes 12 Canadian pediatric oncology centers.
PATIENTS: The target recruitment goal is 150 patients aged less than 18 years receiving cisplatin. Exclusion criteria: Patients with an estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m(2) or a pre-existing renal transplantation at baseline.
MEASUREMENTS: Serum creatinine (SCr), urine NGAL, and KIM-1 are measured during cisplatin infusion episodes (pre-infusion, immediate post-infusion, discharge sampling). At follow-up visits, eGFR, microalbuminuria, and blood pressure are measured and outcomes are collected.
METHODS: Outcomes: AKI is defined as per SCr criteria of the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. CKD is defined as eGFR <90 mL/min/1.73m2 or albumin-to-creatinine ratio≥3mg/mmol. Hypertension is defined as per guidelines. Procedure: Patients are recruited before their first or second cisplatin cycle. Participants are evaluated during 2 cisplatin infusion episodes (AKI biomarker validation) and at 3, 12, and 36 months post-cisplatin treatment (late outcomes).
LIMITATIONS: The study has a relatively moderate sample size and short follow-up duration. There is potential for variability in data collection since multiple sites are involved.
CONCLUSIONS: ABLE will provide a national platform to study biomarkers of late cancer treatment complications. The Nephrotoxicity study is a novel study of AKI biomarkers in children treated with cisplatin that will greatly inform on late cisplatin renal outcomes and follow-up needs.

PMID: 28270931 [PubMed]

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WFS1 and GJB2 mutations in patients with bilateral low-frequency sensorineural hearing loss.

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WFS1 and GJB2 mutations in patients with bilateral low-frequency sensorineural hearing loss.

Laryngoscope. 2017 Mar 08;:

Authors: Kasakura-Kimura N, Masuda M, Mutai H, Masuda S, Morimoto N, Ogahara N, Misawa H, Sakamoto H, Saito K, Matsunaga T

Abstract
OBJECTIVE: Evaluating the prevalence of specific gene mutations associated with a certain audiometric configuration facilitates clinical assessment of patients with sensorineural hearing loss (SNHL). WFS1 is responsible for autosomal dominant nonsyndromic deafness 6/14/38 and is the most frequent genetic cause of low-frequency SNHL (LFSNHL); however, the exact prevalence of WFS1 mutations in LFSNHL is unknown. Therefore, we evaluated genetic mutations and clinical features in patients with nonsyndromic bilateral LFSNHL, focusing on the WFS1.
STUDY DESIGN: Retrospective case series from 2002 to 2013 at the National Hospital Organization Tokyo Medical Center and collaborating hospitals.
METHODS: WFS1, GJB2, and mitochondrial DNA mutation screening was carried out for 74 of 1,007 Japanese probands with bilateral LFSNHL.
RESULTS: WFS1 and GJB2 mutations were identified in eight of 74 cases (10.8%). Four cases had heterozygous WFS1 mutations; one case had a heterozygous WFS1 mutation and a heterozygous GJB2 mutation; and three cases had biallelic GJB2 mutations. Three cases with WFS1 mutations were sporadic; two of them were confirmed to be caused by a de novo mutation based on the genetic analysis of their parents. In the case with mutations in both WFS1 and GJB2, a de novo mutation of WFS1 was confirmed in the proband's mother by genetic screening of the mother's parents.
CONCLUSION: Genetic screening focusing on LFSNHL has not been conducted. The present study first revealed the prevalence of specific gene mutations. WFS1 autosomal dominant mutations were identified even in sporadic cases. Our results also suggested a mutational hotspot in WFS1.
LEVEL OF EVIDENCE: 4. Laryngoscope, 2017.

PMID: 28271504 [PubMed - as supplied by publisher]

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Two microphones spectral-coherence based speech enhancement for hearing aids using smartphone as an assistive device.

Related Articles

Two microphones spectral-coherence based speech enhancement for hearing aids using smartphone as an assistive device.

Conf Proc IEEE Eng Med Biol Soc. 2016 Aug;2016:3670-3673

Authors: Reddy CK, Yiya Hao, Panahi I

Abstract
In this paper, we present a new Speech Enhancement (SE) technique capable of running on a smartphone, as an assistive device for hearing aids (HAs). The developed method incorporates the coherence between the speech and noise signals to obtain a SE gain function which is used in conjunction with the gain function obtained by Spectral Subtraction using adaptive gain averaging. SE using coherence based gain function is found to suppress the background noise well, while inducing speech distortion. On the other hand, SE using Spectral Subtraction improves speech quality with tolerable speech distortion, but introduces background musical noise for certain noise types. The weighted fusion of the two gain functions strikes a balance between noise suppression and speech distortion. Also it allows the user to control the weighting factor based on the noisy environment and their comfort level of hearing. The developed method is computationally fast and operates in real-time. The proposed method was evaluated for machinery, babble, and car noise types, using both objective and subjective measures for both quality and intelligibility of the enhanced speech. The results show significant improvements in comparison with stand-alone Spectral Subtraction with weighted gain averaging SE methods.

PMID: 28269090 [PubMed - in process]

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[Evaluation of the perceptual equivalence of test lists in the Freiburg monosyllabic speech test].

Related Articles

[Evaluation of the perceptual equivalence of test lists in the Freiburg monosyllabic speech test].

HNO. 2016 Aug;64(8):572-83

Authors: Baljić I, Winkler A, Schmidt T, Holube I

Abstract
BACKGROUND: In the past, the perceptual balance of test lists for the Freiburg monosyllabic speech test (FBE) was frequently evaluated without producing consistent results. Until now, the studies used very diverse methods and did not accurately follow the standardized specifications. In this study, therefore, the perceptual equivalence of test lists was verified with a large group of participants according to the standard ISO EN 8253-3.
METHODS: A total of 160  suitable otologically normal subjects were recruited at two institutions, each of whom listened to all test lists of the FBE using predefined measurement conditions. The subjects were divided in three groups depending on the transducer used for test list presentation (headphones "HDA 200" and "TDH 39", as well as free-field loudspeaker, "FF"). Lists that deviated were identified using the approaches specified in the standard.
RESULTS: The reference curve for FBE was not met by any group. While the "HDA 200" group indicated 4.6 dB lower thresholds, results for the "TDH 39" and "FF" groups showed 1.2 and 2.5 dB higher thresholds, respectively. For an average speech recognition score of 44.3 %, test lists 5, 11, 12, and 15 lay outside the calculated tolerance range of 4.5 to -4.4 percent points. The same lists also deviated when calculating discrimination functions and therefore do not fulfill the criteria for perceptual equivalence.
DISCUSSION: In the future, lists identified as deviating from the norm should not be used. The results of this study only partly agree with results from former studies.

PMID: 27418349 [PubMed - indexed for MEDLINE]

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