Παρασκευή 9 Ιουνίου 2017

Typicality Effect and Category Structure in Spanish–English Bilingual Children and Adults

Purpose
The study examines the typicality effect in Spanish–English bilingual children and adults in their 2 languages.
Method
Two studies were conducted using a category-generation task to compare the typical items generated by children with those generated by adults. Children in the 1st study differed orthogonally with respect to age (older, younger) and language use (higher Spanish use, higher English use). In the 2nd study, the older and younger children were matched with adults on their current Spanish use to delineate the influence of test language and age.
Results
Children with higher English use generated more typical items, and these occurred earlier in their word lists in English than in Spanish. Participants at all levels of Spanish experience generated fewer typical items in Spanish than in English. Thus, there was less convergence of items considered typical among participants in Spanish. Older and younger children did not differ in the number of typical items generated. However, when participants were matched for language use, older children produced typical items earlier in their word lists than did younger children.
Conclusion
This study demonstrates the influence of language use and test language in generation of typical items in bilingual children. Supplemental Materials: http://ift.tt/2r3Xaw7

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Velopharyngeal Status of Stop Consonants and Vowels Produced by Young Children With and Without Repaired Cleft Palate at 12, 14, and 18 Months of Age: A Preliminary Analysis

Purpose
The objective was to determine velopharyngeal (VP) status of stop consonants and vowels produced by young children with repaired cleft palate (CP) and typically developing (TD) children from 12 to 18 months of age.
Method
Nasal ram pressure (NRP) was monitored in 9 children (5 boys, 4 girls) with repaired CP with or without cleft lip and 9 TD children (5 boys, 4 girls) at 12, 14, and 18 months of age. VP status was categorized as open or closed for oral stops and vowels in three contexts—consonant–vowel syllables, vowel–consonant–vowel syllables, and isolated vowels—on the basis of the presence or absence of positive nasal ram pressure.
Results
At 12 months of age, TD children produced 98% of stops and vowels in syllables with VP closure throughout the entire segment compared with 81% of stops and vowels for children with CP (p Conclusions

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Erratum



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Relative Fundamental Frequency Distinguishes Between Phonotraumatic and Non-Phonotraumatic Vocal Hyperfunction

Purpose
The purpose of this article is to examine the ability of an acoustic measure, relative fundamental frequency (RFF), to distinguish between two subtypes of vocal hyperfunction (VH): phonotraumatic (PVH) and non-phonotraumatic (NPVH).
Method
RFF values were compared among control individuals with typical voices (N = 49), individuals with PVH (N = 54), and individuals with NPVH (N = 35).
Results
Offset Cycle 10 RFF differed significantly among all 3 groups with values progressively decreasing for controls, individuals with NPVH, and individuals with PVH. Individuals with PVH also had lower Offset Cycles 8 and 9 relative to the other 2 groups and lower RFF values for Offset Cycle 7 relative to controls. There was also a trend for lower Onset Cycle 1 RFF values for the PVH group compared with the NPVH group.
Conclusions
RFF values were significantly different between controls and individuals with VH and also between the two subtypes of VH. This study adds further support to the notion that the differences between these two subsets of VH may be functional as well as structural.

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Masked Visual Analysis: Minimizing Type I Error in Visually Guided Single-Case Design for Communication Disorders

Purpose
Single-case experimental designs are widely used to study interventions for communication disorders. Traditionally, single-case experiments follow a response-guided approach, where design decisions during the study are based on participants' observed patterns of behavior. However, this approach has been criticized for its high rate of Type I error. In masked visual analysis (MVA), response-guided decisions are made by a researcher who is blinded to participants' identities and treatment assignments. MVA also makes it possible to conduct a hypothesis test assessing the significance of treatment effects.
Method
This tutorial describes the principles of MVA, including both how experiments can be set up and how results can be used for hypothesis testing. We then report a case study showing how MVA was deployed in a multiple-baseline across-subjects study investigating treatment for residual errors affecting rhotics. Strengths and weaknesses of MVA are discussed.
Conclusions
Given their important role in the evidence base that informs clinical decision making, it is critical for single-case experimental studies to be conducted in a way that allows researchers to draw valid inferences. As a method that can increase the rigor of single-case studies while preserving the benefits of a response-guided approach, MVA warrants expanded attention from researchers in communication disorders.

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Gauging the Auditory Dimensions of Dysarthric Impairment: Reliability and Construct Validity of the Bogenhausen Dysarthria Scales (BoDyS)

Purpose
Standardized clinical assessment of dysarthria is essential for management and research. We present a new, fully standardized dysarthria assessment, the Bogenhausen Dysarthria Scales (BoDyS). The measurement model of the BoDyS is based on auditory evaluations of connected speech using 9 scales (traits) assessed by 4 elicitation methods. Analyses of the BoDyS' reliability and construct validity were performed to test this model, with the aim of gauging the auditory dimensions of speech impairment in dysarthria.
Method
Interrater agreement was examined in 70 persons with dysarthria. Construct validity was examined in 190 persons with dysarthria using a multitrait-multimethod design with confirmatory factor analysis.
Results
Interrater agreement of Conclusions

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Language Development and Impairment in Children With Mild to Moderate Sensorineural Hearing Loss

Purpose
The goal of this study was to examine language development and factors related to language impairments in children with mild to moderate sensorineural hearing loss (MMHL).
Method
Ninety children, aged 8–16 years (46 children with MMHL; 44 aged-matched controls), were administered a battery of standardized language assessments, including measures of phonological processing, receptive and expressive vocabulary and grammar, word and nonword reading, and parental report of communication skills. Group differences were examined after controlling for nonverbal ability.
Results
Children with MMHL performed as well as controls on receptive vocabulary and word and nonword reading. They also performed within normal limits, albeit significantly worse than controls, on expressive vocabulary, and on receptive and expressive grammar, and worse than both controls and standardized norms on phonological processing and parental report of communication skills. However, there was considerable variation in performance, with 26% showing evidence of clinically significant oral or written language impairments. Poor performance was not linked to severity of hearing loss nor age of diagnosis. Rather, outcomes were related to nonverbal ability, maternal education, and presence/absence of family history of language problems.
Conclusions
Clinically significant language impairments are not an inevitable consequence of MMHL. Risk factors appear to include lower maternal education and family history of language problems, whereas nonverbal ability may constitute a protective factor.

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The Effect of Visual Variability on the Learning of Academic Concepts

Purpose
The purpose of this study was to identify effects of variability of visual input on development of conceptual representations of academic concepts for college-age students with normal language (NL) and those with language-learning disabilities (LLD).
Method
Students with NL (n = 11) and LLD (n = 11) participated in a computer-based training for introductory biology course concepts. Participants were trained on half the concepts under a low-variability condition and half under a high-variability condition. Participants completed a posttest in which they were asked to identify and rate the accuracy of novel and trained visual representations of the concepts. We performed separate repeated measures analyses of variance to examine the accuracy of identification and ratings.
Results
Participants were equally accurate on trained and novel items in the high-variability condition, but were less accurate on novel items only in the low-variability condition. The LLD group showed the same pattern as the NL group; they were just less accurate.
Conclusions
Results indicated that high-variability visual input may facilitate the acquisition of academic concepts in college students with NL and LLD. High-variability visual input may be especially beneficial for generalization to novel representations of concepts. Implicit learning methods may be harnessed by college courses to provide students with basic conceptual knowledge when they are entering courses or beginning new units.

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Masthead



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Typicality Effect and Category Structure in Spanish–English Bilingual Children and Adults

Purpose
The study examines the typicality effect in Spanish–English bilingual children and adults in their 2 languages.
Method
Two studies were conducted using a category-generation task to compare the typical items generated by children with those generated by adults. Children in the 1st study differed orthogonally with respect to age (older, younger) and language use (higher Spanish use, higher English use). In the 2nd study, the older and younger children were matched with adults on their current Spanish use to delineate the influence of test language and age.
Results
Children with higher English use generated more typical items, and these occurred earlier in their word lists in English than in Spanish. Participants at all levels of Spanish experience generated fewer typical items in Spanish than in English. Thus, there was less convergence of items considered typical among participants in Spanish. Older and younger children did not differ in the number of typical items generated. However, when participants were matched for language use, older children produced typical items earlier in their word lists than did younger children.
Conclusion
This study demonstrates the influence of language use and test language in generation of typical items in bilingual children. Supplemental Materials: http://ift.tt/2r3Xaw7

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Velopharyngeal Status of Stop Consonants and Vowels Produced by Young Children With and Without Repaired Cleft Palate at 12, 14, and 18 Months of Age: A Preliminary Analysis

Purpose
The objective was to determine velopharyngeal (VP) status of stop consonants and vowels produced by young children with repaired cleft palate (CP) and typically developing (TD) children from 12 to 18 months of age.
Method
Nasal ram pressure (NRP) was monitored in 9 children (5 boys, 4 girls) with repaired CP with or without cleft lip and 9 TD children (5 boys, 4 girls) at 12, 14, and 18 months of age. VP status was categorized as open or closed for oral stops and vowels in three contexts—consonant–vowel syllables, vowel–consonant–vowel syllables, and isolated vowels—on the basis of the presence or absence of positive nasal ram pressure.
Results
At 12 months of age, TD children produced 98% of stops and vowels in syllables with VP closure throughout the entire segment compared with 81% of stops and vowels for children with CP (p Conclusions

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Sensitivity of the Speech Intelligibility Index to the Assumed Dynamic Range

Purpose
This study aims to evaluate the sensitivity of the speech intelligibility index (SII) to the assumed speech dynamic range (DR) in different languages and with different types of stimuli.
Method
Intelligibility prediction uses the absolute transfer function (ATF) to map the SII value to the predicted intelligibility for a given stimuli. To evaluate the sensitivity of the predicted intelligibility to the assumed DR, ATF-transformed SII scores for English (words), Korean (sentences), and Mandarin (sentences) were derived for DRs ranging from 10 dB to 60 dB.
Results
Increasing the assumed DR caused steeper ATFs for all languages. However, high correlation coefficients between predicted and measured intelligibility scores were observed for DRs from 20 dB to 60 dB for ATFs in English, Korean, and Mandarin.
Conclusions
Results of the present study indicate that the intelligibility computed from the SII is not sensitive to the assumed DR. The 30-dB DR commonly used in computing the SII is thus a reasonable assumption that produces accurate predictions for different languages and different types of stimuli.

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Speech Motor Sequence Learning: Acquisition and Retention in Parkinson Disease and Normal Aging

Purpose
The aim of the current investigation was to examine speech motor sequence learning in neurologically healthy younger adults, neurologically healthy older adults, and individuals with Parkinson disease (PD) over a 2-day period.
Method
A sequential nonword repetition task was used to examine learning over 2 days. Participants practiced a sequence of 6 monosyllabic nonwords that was retested following nighttime sleep. The speed and accuracy of the nonword sequence were measured, and learning was inferred by examining performance within and between sessions.
Results
Though all groups exhibited comparable improvements of the nonword sequence performance during the initial session, between-session retention of the nonword sequence differed between groups. Younger adult controls exhibited offline gains, characterized by an increase in the speed and accuracy of nonword sequence performance across sessions, whereas older adults exhibited stable between-session performance. Individuals with PD exhibited offline losses, marked by an increase in sequence duration between sessions.
Conclusions
The current results demonstrate that both PD and normal aging affect retention of speech motor learning. Furthermore, these data suggest that basal ganglia dysfunction associated with PD may affect the later stages of speech motor learning. Findings from the current investigation are discussed in relation to studies examining consolidation of nonspeech motor learning.

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Noncomprehension Signaling in Males and Females With Fragile X Syndrome

Purpose
This study used a prospective longitudinal design to evaluate the trajectory and predictors of noncomprehension signaling in male and female youth with fragile X syndrome (FXS).
Method
A direction-following task in which some of the directions were inadequate was administered. Participants were 52 youth (36 boys, 16 girls) with FXS. Upon study entry, participants ranged from 10 to 16 years. The average number of annual assessments per participant was 3.65 (range = 1–4), providing 198 data points for analysis.
Results
Participants with FXS were less likely to signal noncomprehension than younger, typically developing, cognitively matched children. The average rate of change in noncomprehension signaling was not significantly different from 0 for either boys or girls, suggesting a plateau. Both FMRP and nonverbal IQ were significant independent predictors of noncomprehension signaling for boys. Variability in noncomprehension signaling among girls was not explained by any of the predictors, but trends similar to those observed for boys were observed.
Conclusions
Noncomprehension signaling appears to be an area of weakness for individuals with FXS. Because the failure to signal noncomprehension can have negative, cumulative effects on comprehension, the results suggest a need for interventions targeting the requisite cognitive skills.

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Cross-Linguistic Differences in Bilinguals' Fundamental Frequency Ranges

Purpose
We investigated cross-linguistic differences in fundamental frequency range (FFR) in Welsh-English bilingual speech. This is the first study that reports gender-specific behavior in switching FFRs across languages in bilingual speech.
Method
FFR was conceptualized as a behavioral pattern using measures of span (range of fundamental frequency—in semitones—covered by the speaker's voice) and level (overall height of fundamental frequency maxima, minima, and means of speaker's voice) in each language.
Results
FFR measures were taken from recordings of 30 Welsh-English bilinguals (14 women and 16 men), who read 70 semantically matched sentences, 35 in each language. Comparisons were made within speakers across languages, separately in male and female speech. Language background and language use information was elicited for qualitative analysis of extralinguistic factors that might affect the FFR.
Conclusions
Cross-linguistic differences in FFR were found to be consistent across female bilinguals but random across male bilinguals. Most female bilinguals showed distinct FFRs for each language. Most male bilinguals, however, were found not to change their FFR when switching languages. Those who did change used different strategies than women when differentiating FFRs between languages. Detected cross-linguistic differences in FFR can be explained by sociocultural factors. Therefore, sociolinguistic factors are to be taken into account in any further study of language-specific pitch setting and cross-linguistic differences in FFR.

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Erratum



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Relative Fundamental Frequency Distinguishes Between Phonotraumatic and Non-Phonotraumatic Vocal Hyperfunction

Purpose
The purpose of this article is to examine the ability of an acoustic measure, relative fundamental frequency (RFF), to distinguish between two subtypes of vocal hyperfunction (VH): phonotraumatic (PVH) and non-phonotraumatic (NPVH).
Method
RFF values were compared among control individuals with typical voices (N = 49), individuals with PVH (N = 54), and individuals with NPVH (N = 35).
Results
Offset Cycle 10 RFF differed significantly among all 3 groups with values progressively decreasing for controls, individuals with NPVH, and individuals with PVH. Individuals with PVH also had lower Offset Cycles 8 and 9 relative to the other 2 groups and lower RFF values for Offset Cycle 7 relative to controls. There was also a trend for lower Onset Cycle 1 RFF values for the PVH group compared with the NPVH group.
Conclusions
RFF values were significantly different between controls and individuals with VH and also between the two subtypes of VH. This study adds further support to the notion that the differences between these two subsets of VH may be functional as well as structural.

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Masked Visual Analysis: Minimizing Type I Error in Visually Guided Single-Case Design for Communication Disorders

Purpose
Single-case experimental designs are widely used to study interventions for communication disorders. Traditionally, single-case experiments follow a response-guided approach, where design decisions during the study are based on participants' observed patterns of behavior. However, this approach has been criticized for its high rate of Type I error. In masked visual analysis (MVA), response-guided decisions are made by a researcher who is blinded to participants' identities and treatment assignments. MVA also makes it possible to conduct a hypothesis test assessing the significance of treatment effects.
Method
This tutorial describes the principles of MVA, including both how experiments can be set up and how results can be used for hypothesis testing. We then report a case study showing how MVA was deployed in a multiple-baseline across-subjects study investigating treatment for residual errors affecting rhotics. Strengths and weaknesses of MVA are discussed.
Conclusions
Given their important role in the evidence base that informs clinical decision making, it is critical for single-case experimental studies to be conducted in a way that allows researchers to draw valid inferences. As a method that can increase the rigor of single-case studies while preserving the benefits of a response-guided approach, MVA warrants expanded attention from researchers in communication disorders.

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Gauging the Auditory Dimensions of Dysarthric Impairment: Reliability and Construct Validity of the Bogenhausen Dysarthria Scales (BoDyS)

Purpose
Standardized clinical assessment of dysarthria is essential for management and research. We present a new, fully standardized dysarthria assessment, the Bogenhausen Dysarthria Scales (BoDyS). The measurement model of the BoDyS is based on auditory evaluations of connected speech using 9 scales (traits) assessed by 4 elicitation methods. Analyses of the BoDyS' reliability and construct validity were performed to test this model, with the aim of gauging the auditory dimensions of speech impairment in dysarthria.
Method
Interrater agreement was examined in 70 persons with dysarthria. Construct validity was examined in 190 persons with dysarthria using a multitrait-multimethod design with confirmatory factor analysis.
Results
Interrater agreement of Conclusions

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Predictors of Language Gains Among School-Age Children With Language Impairment in the Public Schools

Purpose
This study aimed to identify child-level characteristics that predict gains in language skills for children with language impairment who were receiving therapy within the public schools. The therapy provided represented business-as-usual speech/language treatment provided by speech-language pathologists in the public schools.
Method
The sample included 272 kindergartners and first-graders with language impairment who participated in a larger study titled “Speech-Therapy Experiences in the Public Schools.” Multilevel regression analyses were applied to examine the extent to which select child-level characteristics, including age, nonverbal cognition, memory, phonological awareness, vocabulary, behavior problems, and self-regulation, predicted children's language gains over an academic year. Pratt indices were computed to establish the relative importance of the predictors of interest.
Results
Phonological awareness and vocabulary skill related to greater gains in language skills, and together they accounted for nearly 70% of the explained variance, or 10% of total variance at child level. Externalizing behavior, nonverbal cognition, and age were also potentially important predictors of language gains.
Conclusions
This study significantly advances our understanding of the characteristics of children that may contribute to their language gains while receiving therapy in the public schools. Researchers can explore how these characteristics may serve to moderate treatment outcomes, whereas clinicians can assess how these characteristics may factor into understanding treatment responses.

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Goal-Directed Drinking Behaviors Can Be Modified Through Behavioral Mimicry

Purpose
This study tested whether behavioral mimicry can alter drinking behavior. It was hypothesized that participants would increase drinking behaviors given increased confederate drinking but not cup touching.
Methods
Nineteen healthy adults (M age = 20.32 years) completed 2 picture description tasks; during 1 task, a confederate frequently sipped water (complete drinking gesture), and during the other, the confederate touched her cup but did not drink (partial gesture). Outcome measures included number of drinks per minute, number of cup touches per minute, percentage of time spent drinking, and percentage of time spent touching the cup.
Results
Participants spent more time drinking and had an increased drinking rate during the drinking condition versus the cup-touching condition. For a majority of participants, drinking rate increased during the drinking condition versus baseline. Drinking, but not cup touching, rate also increased given increased confederate cup touching for many.
Conclusions
Mimicry likely contributes to social modeling of drinking behaviors. This effect appears more robust given a complete target gesture (full drink); however, a partial goal-directed drinking gesture may also yield a mimicked response. Beyond the theoretical implications, these results provide directions for research investigating more naturalistic mechanisms for increasing dietary intake in various patient populations (e.g., individuals with dysphagia).

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Using Pupillometry to Investigate Sentence Comprehension in Children With and Without Specific Language Impairment

Purpose
In this study pupillometry was used to investigate the allocation of attentional resources associated with sentence comprehension in children with and without specific language impairment (SLI).
Method
Eighteen children with SLI (age: M = 6.4 years) and 18 typically developing (TD) children (age: M = 6.3 years) participated in the study. A sentence comprehension task was presented that comprised items designated as easy or hard. Easy sentences contained 4 or 5 words, and hard sentences contained 6 or 7 words.
Results
For the TD group, pupil size was significantly larger when comprehending hard sentences compared with easy sentences. There was no effect of sentence difficulty on pupil size in the SLI group. Comparisons between groups revealed pupil sizes for the SLI group were significantly larger than those for the TD group for easy sentences. There were no group differences for the hard sentences.
Conclusion
In TD children, pupillometry was sensitive to the attentional demands associated with sentence comprehension. Between-subjects comparisons indicated that the TD group allocated less attention than did the children with SLI for the easy sentences but not for the hard sentences. This study provides evidence of attentional differences between children with SLI and TD children under conditions of low processing demands.

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Language Development and Impairment in Children With Mild to Moderate Sensorineural Hearing Loss

Purpose
The goal of this study was to examine language development and factors related to language impairments in children with mild to moderate sensorineural hearing loss (MMHL).
Method
Ninety children, aged 8–16 years (46 children with MMHL; 44 aged-matched controls), were administered a battery of standardized language assessments, including measures of phonological processing, receptive and expressive vocabulary and grammar, word and nonword reading, and parental report of communication skills. Group differences were examined after controlling for nonverbal ability.
Results
Children with MMHL performed as well as controls on receptive vocabulary and word and nonword reading. They also performed within normal limits, albeit significantly worse than controls, on expressive vocabulary, and on receptive and expressive grammar, and worse than both controls and standardized norms on phonological processing and parental report of communication skills. However, there was considerable variation in performance, with 26% showing evidence of clinically significant oral or written language impairments. Poor performance was not linked to severity of hearing loss nor age of diagnosis. Rather, outcomes were related to nonverbal ability, maternal education, and presence/absence of family history of language problems.
Conclusions
Clinically significant language impairments are not an inevitable consequence of MMHL. Risk factors appear to include lower maternal education and family history of language problems, whereas nonverbal ability may constitute a protective factor.

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The Effect of Visual Variability on the Learning of Academic Concepts

Purpose
The purpose of this study was to identify effects of variability of visual input on development of conceptual representations of academic concepts for college-age students with normal language (NL) and those with language-learning disabilities (LLD).
Method
Students with NL (n = 11) and LLD (n = 11) participated in a computer-based training for introductory biology course concepts. Participants were trained on half the concepts under a low-variability condition and half under a high-variability condition. Participants completed a posttest in which they were asked to identify and rate the accuracy of novel and trained visual representations of the concepts. We performed separate repeated measures analyses of variance to examine the accuracy of identification and ratings.
Results
Participants were equally accurate on trained and novel items in the high-variability condition, but were less accurate on novel items only in the low-variability condition. The LLD group showed the same pattern as the NL group; they were just less accurate.
Conclusions
Results indicated that high-variability visual input may facilitate the acquisition of academic concepts in college students with NL and LLD. High-variability visual input may be especially beneficial for generalization to novel representations of concepts. Implicit learning methods may be harnessed by college courses to provide students with basic conceptual knowledge when they are entering courses or beginning new units.

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Masthead



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Typicality Effect and Category Structure in Spanish–English Bilingual Children and Adults

Purpose
The study examines the typicality effect in Spanish–English bilingual children and adults in their 2 languages.
Method
Two studies were conducted using a category-generation task to compare the typical items generated by children with those generated by adults. Children in the 1st study differed orthogonally with respect to age (older, younger) and language use (higher Spanish use, higher English use). In the 2nd study, the older and younger children were matched with adults on their current Spanish use to delineate the influence of test language and age.
Results
Children with higher English use generated more typical items, and these occurred earlier in their word lists in English than in Spanish. Participants at all levels of Spanish experience generated fewer typical items in Spanish than in English. Thus, there was less convergence of items considered typical among participants in Spanish. Older and younger children did not differ in the number of typical items generated. However, when participants were matched for language use, older children produced typical items earlier in their word lists than did younger children.
Conclusion
This study demonstrates the influence of language use and test language in generation of typical items in bilingual children. Supplemental Materials: http://ift.tt/2r3Xaw7

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Velopharyngeal Status of Stop Consonants and Vowels Produced by Young Children With and Without Repaired Cleft Palate at 12, 14, and 18 Months of Age: A Preliminary Analysis

Purpose
The objective was to determine velopharyngeal (VP) status of stop consonants and vowels produced by young children with repaired cleft palate (CP) and typically developing (TD) children from 12 to 18 months of age.
Method
Nasal ram pressure (NRP) was monitored in 9 children (5 boys, 4 girls) with repaired CP with or without cleft lip and 9 TD children (5 boys, 4 girls) at 12, 14, and 18 months of age. VP status was categorized as open or closed for oral stops and vowels in three contexts—consonant–vowel syllables, vowel–consonant–vowel syllables, and isolated vowels—on the basis of the presence or absence of positive nasal ram pressure.
Results
At 12 months of age, TD children produced 98% of stops and vowels in syllables with VP closure throughout the entire segment compared with 81% of stops and vowels for children with CP (p Conclusions

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Erratum



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Relative Fundamental Frequency Distinguishes Between Phonotraumatic and Non-Phonotraumatic Vocal Hyperfunction

Purpose
The purpose of this article is to examine the ability of an acoustic measure, relative fundamental frequency (RFF), to distinguish between two subtypes of vocal hyperfunction (VH): phonotraumatic (PVH) and non-phonotraumatic (NPVH).
Method
RFF values were compared among control individuals with typical voices (N = 49), individuals with PVH (N = 54), and individuals with NPVH (N = 35).
Results
Offset Cycle 10 RFF differed significantly among all 3 groups with values progressively decreasing for controls, individuals with NPVH, and individuals with PVH. Individuals with PVH also had lower Offset Cycles 8 and 9 relative to the other 2 groups and lower RFF values for Offset Cycle 7 relative to controls. There was also a trend for lower Onset Cycle 1 RFF values for the PVH group compared with the NPVH group.
Conclusions
RFF values were significantly different between controls and individuals with VH and also between the two subtypes of VH. This study adds further support to the notion that the differences between these two subsets of VH may be functional as well as structural.

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Masked Visual Analysis: Minimizing Type I Error in Visually Guided Single-Case Design for Communication Disorders

Purpose
Single-case experimental designs are widely used to study interventions for communication disorders. Traditionally, single-case experiments follow a response-guided approach, where design decisions during the study are based on participants' observed patterns of behavior. However, this approach has been criticized for its high rate of Type I error. In masked visual analysis (MVA), response-guided decisions are made by a researcher who is blinded to participants' identities and treatment assignments. MVA also makes it possible to conduct a hypothesis test assessing the significance of treatment effects.
Method
This tutorial describes the principles of MVA, including both how experiments can be set up and how results can be used for hypothesis testing. We then report a case study showing how MVA was deployed in a multiple-baseline across-subjects study investigating treatment for residual errors affecting rhotics. Strengths and weaknesses of MVA are discussed.
Conclusions
Given their important role in the evidence base that informs clinical decision making, it is critical for single-case experimental studies to be conducted in a way that allows researchers to draw valid inferences. As a method that can increase the rigor of single-case studies while preserving the benefits of a response-guided approach, MVA warrants expanded attention from researchers in communication disorders.

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Gauging the Auditory Dimensions of Dysarthric Impairment: Reliability and Construct Validity of the Bogenhausen Dysarthria Scales (BoDyS)

Purpose
Standardized clinical assessment of dysarthria is essential for management and research. We present a new, fully standardized dysarthria assessment, the Bogenhausen Dysarthria Scales (BoDyS). The measurement model of the BoDyS is based on auditory evaluations of connected speech using 9 scales (traits) assessed by 4 elicitation methods. Analyses of the BoDyS' reliability and construct validity were performed to test this model, with the aim of gauging the auditory dimensions of speech impairment in dysarthria.
Method
Interrater agreement was examined in 70 persons with dysarthria. Construct validity was examined in 190 persons with dysarthria using a multitrait-multimethod design with confirmatory factor analysis.
Results
Interrater agreement of Conclusions

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Language Development and Impairment in Children With Mild to Moderate Sensorineural Hearing Loss

Purpose
The goal of this study was to examine language development and factors related to language impairments in children with mild to moderate sensorineural hearing loss (MMHL).
Method
Ninety children, aged 8–16 years (46 children with MMHL; 44 aged-matched controls), were administered a battery of standardized language assessments, including measures of phonological processing, receptive and expressive vocabulary and grammar, word and nonword reading, and parental report of communication skills. Group differences were examined after controlling for nonverbal ability.
Results
Children with MMHL performed as well as controls on receptive vocabulary and word and nonword reading. They also performed within normal limits, albeit significantly worse than controls, on expressive vocabulary, and on receptive and expressive grammar, and worse than both controls and standardized norms on phonological processing and parental report of communication skills. However, there was considerable variation in performance, with 26% showing evidence of clinically significant oral or written language impairments. Poor performance was not linked to severity of hearing loss nor age of diagnosis. Rather, outcomes were related to nonverbal ability, maternal education, and presence/absence of family history of language problems.
Conclusions
Clinically significant language impairments are not an inevitable consequence of MMHL. Risk factors appear to include lower maternal education and family history of language problems, whereas nonverbal ability may constitute a protective factor.

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The Effect of Visual Variability on the Learning of Academic Concepts

Purpose
The purpose of this study was to identify effects of variability of visual input on development of conceptual representations of academic concepts for college-age students with normal language (NL) and those with language-learning disabilities (LLD).
Method
Students with NL (n = 11) and LLD (n = 11) participated in a computer-based training for introductory biology course concepts. Participants were trained on half the concepts under a low-variability condition and half under a high-variability condition. Participants completed a posttest in which they were asked to identify and rate the accuracy of novel and trained visual representations of the concepts. We performed separate repeated measures analyses of variance to examine the accuracy of identification and ratings.
Results
Participants were equally accurate on trained and novel items in the high-variability condition, but were less accurate on novel items only in the low-variability condition. The LLD group showed the same pattern as the NL group; they were just less accurate.
Conclusions
Results indicated that high-variability visual input may facilitate the acquisition of academic concepts in college students with NL and LLD. High-variability visual input may be especially beneficial for generalization to novel representations of concepts. Implicit learning methods may be harnessed by college courses to provide students with basic conceptual knowledge when they are entering courses or beginning new units.

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Masthead



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Evidence for Notched Sound Therapy: Does it Actually Lower Tinnitus Volume?

Here’s a summary of experimental research that has demonstrated a reduction in tinnitus volume with Notched Sound Therapy:

Year: 2009
Region: Italy
Windowed Sound Therapy and Personalized Tinnitus Treatment

43 people were recruited for an experiment to test the efficacy of Tailor-Made Notched White Noise, listening daily for 12 months duration. 4 of 20 patients receiving the treatment had their tinnitus tones eliminated entirely. The average reduction in tinnitus volume in the treatment group was approximately 12 dB, or a 75% volume reduction.

“Figure 3. Mean values of dBtfinal (1 SE), and PdBtfinal, of the three sound therapy groups. Note that the number of cases in which dBtfinal was less than 0 (i.e., tinnitus severity decreased) differed statistically from chance only in the WWN group (binomial test) [17]. For further details, see the Results section. (**p .01; WN broadband noise; WWN notched broadband noise; Wa water noise.)”

“Figure 4. Variation of tinnitus loudness over time in four patients (indicated with a different symbol) taken as an example. Three patients received a different type of sound therapy (i.e., WWN, Wa, or WN), whereas one patient initially receiving the Wa therapy shifted to the WWN therapy about 3 months (arrow) after the first visit. Decibel units on the y-axis are values of dBt computed using dBt measurements in subsequent control visits of the same subject (date on the x-axis). dBt values are expressed relative to the decibel measurement at the first visit. See Methods for further details. (WN broadband noise; WWN notched broadband noise; Wa water noise.)”

Year: 2010
Region: Germany
Customized notched music training reduces tinnitus loudness

People listened to 2 hours of Tailor-Made Notched Music daily for 12 months resulted in a 26.1% reduction in tinnitus loudness.

“Figure 1. Tinnitus perception change over the course of the training. The bars denote average changes in percent relative to baseline; the error bars
denote the standard errors of the means. Negative values reflect improvement, positive values reflect impairment. Subjective tinnitus loudness, subjective
tinnitus annoyance, and experienced handicapping by the tinnitus were measured with visual analogue scales. Groups (Target, Placebo and
Monitoring) are coded by grayscale (black, white and gray). Significant changes from baseline are marked with asterisks.”

Year: 2011
Region: Germany
Short and Intense Tailor-Made Notched Music Training against Tinnitus: The Tinnitus Frequency Matters

24 users were recruited with chronic tinnitus and less than 50 dB of hearing loss to listen to Tailor-Made Notched Music Therapy for 6 hours a day for 5 days. 3 hours after completing only five days of therapy, tinnitus loudness was decreased by approximately 20%, and 31 days later, remained reduced by about 10%. This effect was noted only for Notched Music applied to users with a tinnitus frequency under 8,000 hZ.

“Figure 1. Tinnitus loudness ratios.
Normalized tinnitus loudness changes relative to baseline at four time points after training completion for both patient groups. White bars represent the low tinnitus frequency (≤8 kHz) group, black bars represent the high tinnitus frequency (>8 kHz) group. Asterisks denote significant changes, the error bars denote standard errors of the mean. Positive values indicate aggravation, and negative values indicate alleviation.”

Year: 2016
Region: Germany
Clinical Trial on Tonal Tinnitus with Tailor-Made Notched Music Training

The original German team that pioneered Tailor-Made Notched Music Therapy enrolled 100 patients in a clinical trial to evaluate the efficacy of this same treatment. After a three month duration, tinnitus loudness was found to be decreased in the treatment group. The reduction in loudness was observed to be small, but persisted one month after the cessation of therapy.



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AUNA2: A Novel Type of Non-Syndromic Slowly Progressive Auditory Synaptopathy/Auditory Neuropathy with Autosomal-Dominant Inheritance

Background: Auditory synaptopathy/neuropathy (AS/AN) is a heterogeneous disorder, which may be caused by environmental factors like postnatal hyperbilirubinemia or by genetic factors. The genetic forms are subdivided into syndromic and non-syndromic types, and show different inheritance patterns with a strong preponderance of autosomal-recessive forms. To date, only a single locus for non-syndromic autosomal-dominant AS/AN (AUNA1) has been reported in a single family, in which a non-coding DIAPH3 mutation was subsequently described as causative. Materials and Methods: Here, we report detailed clinical data on a large German AS/AN family with slowly progressive postlingual hearing loss. Affected family members developed their first symptoms in their second decade. Moderate hearing loss in the fourth decade then progressed to profound hearing impairment in older family members. Comprehensive audiological and neurological tests were performed in the affected family members. Genetic testing comprised linkage analyses with polymorphic markers and a genome-wide linkage analysis using the Affymetrix GeneChip® Human Mapping 250K. Results and Conclusion: We identified a large family with autosomal-dominant AS/AN. By means of linkage analyses, the AUNA1 locus was excluded, and putatively linked regions on chromosomal bands 12q24 and 13q34 were identified as likely carrying the second locus for autosomal-dominant AS/AN (AUNA2). AUNA2 is associated with a slowly progressive postlingual hearing loss without any evidence for additional symptoms in other organ systems.
Audiol Neurotol 2017;22:30-40

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Ipsilesional Nystagmus Induced by Vibration in Subjects With Ménière's Disease or Vestibular Schwannoma

imageObjective: To analyze the frequency in which vibration-induced nystagmus (VIN) with ipsilesional direction appears in subjects with Ménière's disease (MD) or vestibular schwannoma (VS). Study Design: Cross-sectional study. Setting: Tertiary referral center. Patients: Fifty-two subjects with MD and 21 subjects with vestibular schwannoma. Intervention: Videonystagmographic recordings of VIN at 30, 60, and 100 Hz. Main Outcome Measures: Direction and slow phase velocity of VIN at 30, 60, and 100 Hz. Results: Ipsilesional Nystagmus was observed in 8 of 52 subjects with MD (15.4%) and in 11 of 21 subjects affected of unilateral VS (52.4%). Ipsilesional nystagmus was significantly higher in patients with VS (p = 0.003). The frequency of appearance of ipsilesional nystagmus in the subjects with VS who has not been treated was significantly higher than those who underwent radiosurgery (84.6% vs 0%, p = 0.046). Conclusion: Ipsilesional vibration-induced Nystagmus can be present in subjects with vestibular deficits caused by MD and VS.

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Use of Positive Airway Pressure Following Middle Ear Surgery: A Practice Survey of Otologists

imageBackground: Positive airway pressure (PAP) devices are used as treatment for obstructive sleep apnea (OSA). PAP may increase middle ear pressure which is of interest to otologic surgeons. There is a lack of data to guide management of PAP therapy after middle ear surgery. Objective: To elucidate how otologic surgeons manage PAP in their patients after ear surgery. Study Design: A survey e-mailed to practicing members of the American Neurotology Society. Results: Among 60 respondents, the most common recommendations to patients were to avoid PAP use for 1 week (40%), return to normal use immediately (23.3%), avoid PAP for 1 month (13.3%), or avoid PAP for 1 day (13.3%) after surgery. Twenty percent of providers reported that they change their advice on the basis of the PAP pressure settings (i.e., shorter hiatus for higher settings). Among respondents, 47% think that they have patients with middle ear issues because of PAP and 13% attributed surgical failures to PAP use. One-third of providers routinely pack the Eustachian tube during surgery. Providers who attributed a negative surgical outcome to PAP use were more likely to routinely pack/plug the Eustachian tube during otologic surgery (p = 0.001). Conclusion: Treatment recommendations regarding postoperative PAP treatment for obstructive sleep apnea vary greatly among practicing otologists. Providers who think that an adverse outcome was attributed to PAP use were more likely to prophylactically plug the Eustachian tube during surgery. Future research will provide additional information which will allow a better understanding of the effect of PAP on the middle ear, especially after otologic surgery.

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Cochlear Implantation: Vast Unmet Need to Address Deafness Globally

imageNo abstract available

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Defining the Hook Region Anatomy of the Guinea Pig Cochlea for Modeling of Inner Ear Surgery

imageHypothesis: The aim of this study was to describe the hook region anatomy of the guinea pig cochlea to identify the optimal surgical approach for cochlear implantation and to determine what anatomical structures are at risk. Background: Animal studies investigating hearing loss after cochlear implantation surgery are currently constrained by the lack of a reproducible implantation model. Methods: Guinea pig cochleae were imaged using thin-sheet laser imaging microscopy. Images were stitched, reconstructed, and segmented for analysis. Insertion vectors were determined by tracing their paths to the outer wall and converting to Cartesian coordinates. Spherical surface and multiplane views were generated to analyze outer wall and radial forces of the insertion vector. Results: Thin-sheet laser imaging microscopy enabled quantitative, whole specimen analysis of the soft and bony tissue relationships of the complex cochlear hook region in any desired plane without loss of image quality. Round window or cochleostomy approaches in the anteroinferior plane avoided direct damage to cochlear structures. Cochleostomy approach had large interindividual variability of angular depth and outer wall forces but predictable radial force. Conclusion: The guinea pig hook region and lower basal turn have similar structural relationships to humans. Careful cochleostomy placement is essentially for minimizing cochlear trauma and for ensuring a straight insertion vector that successfully advances around the outer wall. Experiments with guinea pigs that control for the surgical approach are likely to provide useful insights into the aetiology and the development of therapies directed at postimplantation hearing loss.

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Surgical Management of a Persistent Stapedial Artery: A Review

imageObjective: To evaluate the outcome and per- and postoperative complications of the surgical management of patients with a persistent stapedial artery (PSA). Methods: A systemic literature search for reports on patients treated for pulsatile tinnitus and/or conductive hearing loss caused by a PSA was conducted of the PubMed and Embase databases using the terms “stapedial” and “artery.” Inclusion criteria were adequate description of the intervention and pre- and postoperative signs and symptoms. In addition, one case of a PSA, treated at VU University Medical Center Amsterdam, The Netherlands, was included in this series. Intervention: Middle ear surgery consisting of stapedotomy or stapedectomy, and/or transection of the PSA. Main Outcome Measures: Pre- and postoperative hearing levels, pre- and postoperative pulsatile tinnitus, and per- and postoperative complications. Results: Seventeen patients and 18 operated ears were evaluated (16 patients described in 14 articles and our case). Twelve out of 14 ears in which a stapedotomy or stapedectomy was initiated experienced improvement in hearing. In four cases pulsatile tinnitus was described pre- and postoperatively. In all four, pulsatile tinnitus subsided after transection of the PSA. Peroperative bleeding from the PSA was described in four patients, which could be controlled during the procedure. No significant postoperative sequelae were reported. Conclusions: In case of a PSA, improvement of conductive hearing loss is best achieved by stapes surgery, while pulsatile tinnitus is effectively treated with transection of the PSA. To date no long-term postoperative complications have been reported.

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Are Cervical Collars a Necessary Postprocedure Restriction in Patients With Benign Paroxysmal Positional Vertigo Treated With Particle Repositioning Maneuvers?

imageIntroduction: Benign paroxysmal positional vertigo (BPPV) is managed with particle repositioning maneuvers (PRM), following which patients are advised of activity restrictions to prevent recurrence. This can include wearing a cervical collar. Objective: Does the use of BPPV postprocedure restriction with a cervical collar impact on the number of PRMs required to resolve a patient's symptoms? Method: Combination of retrospective and prospective review of 624 patients treated in a tertiary UK hospital. All were diagnosed with posterior canal BPPV and received a modified Epley maneuver (PRM). The “with cervical collar” (WC) retrospective group 2002 to 2009 (n = 263) were advised to wear a cervical collar for 48 hours postprocedure, and the “no cervical collar” (NC) prospective group 2010 to 2014 (n = 361) were not. The main outcome measure was the resolution of patient symptoms following a PRM for BPPV. Quantitative and statistical analysis using χ2 test was undertaken. Results: In the WC group, 84% (n = 221) had resolution of symptoms after the first PRM, versus 82.8% (n = 299) in the NC group. After the second PRM 11% (n = 29) resolved, versus 13.6% (n = 49) in the NC group. After the third PRM 4.9% (n = 13) resolved, versus 3.6% (n = 13) in the NC group. Both clinically and statistically there was no significant difference in outcome between groups. Conclusions: Our review of 624 patients is the largest study in this subject and the results demonstrate that wearing a cervical collar following PRM for BPPV concedes no significant benefit. Excluding this from postprocedure guidance allows patients to manage without the inconvenience of wearing a cervical collar, and allows departments to update clinical guidance.

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Emerging Therapies for Sensorineural Hearing Loss

imageObjective: To critically review and evaluate the proposed mechanisms and documented results of the therapeutics currently in active clinical drug trials for the treatment of sensorineural hearing loss. Data Sources: US National Institutes of Health (NIH) Clinical Trials registry, MEDLINE/PubMed. Study Selection & Data Extraction: A review of the NIH Clinical Trials registry identified candidate hearing loss therapies, and supporting publications were acquired from MEDLINE/PubMed. Proof-of-concept, therapeutic mechanisms, and clinical outcomes were critically appraised. Data Synthesis: Twenty-two active clinical drug trials registered in the United States were identified, and six potentially therapeutic molecules were reviewed. Of the six molecules reviewed, four comprised mechanisms pertaining to mitigating oxidative stress pathways that presumably lead to inner ear cell death. One remaining therapy sought to manipulate the cell death cascade, and the last remaining therapy was a novel cell replacement therapy approach to introduce a transcription factor that promotes hair cell regeneration. Conclusion: A common theme in recent clinical trials registered in the United States appears to be the targeting of cell death pathways and influence of oxidant stressors on cochlear sensory neuroepithelium. In addition, a virus-delivered cell replacement therapy would be the first of its kind should it prove safe and efficacious. Significant challenges for bringing these bench-to-bedside therapies to market remain. It is never assured that results in non-human animal models translate to effective therapies in the setting of human biology. Moreover, as additional processes are described in association with hearing loss, such as an immune response and loss of synaptic contacts, additional pathways for targeting become available.

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Calculating the Tumor Volumes in Vestibular Schwannomas: Are the ABC/2 and Volumetric Methods Comparable?

imagePurpose: To assess the efficacy of the ABC/2 method for calculating the volume of vestibular schwannomas as compared with 3-D planimetric method. Study Design: Retrospective. Methods: Fifty eight cases of pathologically confirmed sporadic vestibular schwannomas (VS) were analyzed. Tumors volumes were calculated for each tumor twice, once through semiautomated 3-D volumetric method and subsequently through ABC/2 (AP × ML × CC/2) methodology after calculating the maximal tumor dimensions in anteroposterior (AP), coronal (ML), and craniocaudal (CC) dimensions. Tumor volumes were initially correlated as a group and subsequently by dividing them into three groups using the Hannover classification. Results: The two methodologies were highly correlated when tumors were analyzed as a group (rho = 0.913, p 

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Pilot Electroacoustic Analyses of a Sample of Direct-to-Consumer Amplification Products

imageObjective: Recent national initiatives from the White House and Institute of Medicine have focused on strategies to increase the accessibility and affordability of hearing loss treatment given the average cost of $4700 for bilateral hearing aids. More affordable direct-to-consumer hearing technologies are increasingly gaining recognition, but the performance of these devices has been poorly studied. We investigated the technical and electroacoustic capabilities of several direct-to-consumer hearing devices to inform otolaryngologists who may be asked by patients to comment on these devices. Patients/Intervention: Nine direct-to-consumer hearing devices ranging in retail cost from $144.99 to $395.00 and one direct-to-consumer hearing device with a retail cost of $30.00. Main Outcome Measure: Electroacoustic results and simulated real-ear measurements. Main electroacoustic measures are frequency response, equivalent input noise, total harmonic distortion, and maximum output sound pressure level at 90 dB. Results: Five devices met all four electroacoustic tolerances presented in this study, two devices met three tolerances, one device met two tolerances, one device met one tolerance, and one device did not meet any tolerances. Nine devices were able to approximate five of nine National Acoustics Laboratories (NAL) targets within 10 dB while only three devices were able to approximate five of nine NAL targets within a more stringent 5 dB. Conclusion: While there is substantial heterogeneity among the selection of devices, certain direct-to-consumer hearing devices may be able to provide appropriate amplification to persons with mild-to-moderate hearing loss and serve as alternatives for hearing aids in specific cases.

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In Reply to the Letter to the Editor: “Two Common Second Causes of Dizziness in Patients With MÉniÈre's Disease

No abstract available

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Influence of Floating-Mass Transducer Coupling Efficiency for Active Middle-Ear Implants on Speech Recognition

imageObjective: The efficiency of vibroplasty (coupler-floating mass transducer [FMT] assembly) can be monitored by direct stimulation of the inner ear through the active middle-ear implant system and comparison of the vibroplasty in vivo threshold and the postoperative bone-conduction pure-tone threshold. The aim of this study was to compare the vibroplasty in vivo threshold with the postoperative speech recognition in patients with a high preoperative maximum word recognition score. Study Design: Retrospective cohort study of German-speaking patients implanted with a vibrating ossicular prosthesis (VORP) 502 or VORP 503 and high preoperative maximum word recognition score between the years of 2011 and 2015. Setting: Multicenter study of four German centers. Patients: Twenty-three active middle-ear implant users. Intervention: Rehabilitative. Main Outcome Measures: Bone-conduction pure-tone and vibroplasty thresholds, postoperative aided word recognition score (WRS) at 65 dB SPL (sound pressure level) and preoperative maximum WRS with Freiburg monosyllabic words. Results: The mean postoperative aided WRS at 65 dB SPL was 82%. An increasing difference between vibroplasty thresholds and bone-conduction thresholds was associated with a higher discrepancy between the unaided maximum WRS and the postoperative aided WRS. Only if this difference was less than 20 dB, an articulation index of 0.5 (WRS = 75%) or more was achieved. Conclusions: Audiological outcome after vibroplasty depends on the coupling efficiency reflected by the vibroplasty threshold.

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Round Window Application of an Active Middle Ear Implant: A Comparison With Hearing Aid Usage in Japan

imageObjective: To report on the safety and efficacy of an investigational active middle ear implant (AMEI) in Japan, and to compare results to preoperative results with a hearing aid. Design: Prospective study conducted in Japan in which 23 Japanese-speaking adults suffering from conductive or mixed hearing loss received a VIBRANT SOUNDBRIDGE with implantation at the round window. Postoperative thresholds, speech perception results (word recognition scores, speech reception thresholds, signal-to-noise ratio [SNR]), and quality of life questionnaires at 20 weeks were compared with preoperative results with all patients receiving the same, best available hearing aid (HA). Results: Statistically significant improvements in postoperative AMEI-aided thresholds (1, 2, 4, and 8 kHz) and on the speech reception thresholds and word recognition scores tests, compared with preoperative HA-aided results, were observed. On the SNR, the subjects’ mean values showed statistically significant improvement, with −5.7 dB SNR for the AMEI-aided mean and −2.1 dB SNR for the preoperative HA-assisted mean. The APHAB quality of life questionnaire also showed statistically significant improvement with the AMEI. Conclusion: Results with the AMEI applied to the round window exceeded those of the best available hearing aid in speech perception as well as quality of life questionnaires. There were minimal adverse events or changes to patients’ residual hearing.

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Dichotic Listening Deficit Associated With Solvent Exposure

imageHypothesis: A significant left ear deficit can be observed in solvent-exposed individuals using the dichotic digit test. Background: Solvents are ubiquitous in global industrial processes. Due to their lipophilic nature, solvents can adversely affect large white matter tracks such as the corpus callosum. Previous investigations reveal that long-term workplace exposure to solvents is also deleterious to various auditory processes. Investigations in exposed populations suggest a decreased performance for dichotic listening. Methods: In this present study, we examined the lateralization of a dichotic digit test score for 49 solvent-exposed individuals along with 49 age- and sex-matched controls. We evaluated group differences between test scores and the right ear advantage using a laterality index (LI). Results: Individual ear results suggest that long-term workplace solvent exposure is associated with a significantly lower dichotic listening score for the left ear. A binaural compound score analysis using a laterality index supports this left-ear deficit. Conclusion: These results provide an insight on the effects of solvent exposure on dichotic listening abilities. Further research should investigate the importance of using dichotic listening tasks to screen for solvent-induced auditory dysfunction in exposed individuals.

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Epidemiology of Dizzy Patient Population in a Neurotology Clinic and Predictors of Peripheral Etiology

imageObjective: To compare the proportion of peripheral versus nonperipheral dizziness etiologies among all patients, inclusive of those presenting primarily or as referrals, to rank diagnoses in order of frequency, to determine whether or not age and sex predict diagnosis, and to determine which subgroups tended to undergo formal vestibular testing. Study Design: Retrospective cohort. Setting: Academic neurotology clinic. Patients: Age greater than 18 neurotology clinic patients with the chief complaint of dizziness. Intervention(s): None. Main Outcome Measure(s): Age, sex, diagnosis, record of vestibular testing. Results: Two thousand seventy-nine patients were assigned 2,468 diagnoses, of which 57.7 and 42.3% were of peripheral and nonperipheral etiologies, respectively. The most common diagnoses were Ménière's (23.0%), vestibular migraine (19.3%), benign paroxysmal positional vertigo (BPPV) (19.1%), and central origin, nonmigraine (16.4%). Peripheral diagnoses are more likely to be found in men than in women (odds ratio [OR] 1.59). Peripheral diagnoses were most likely to be found in the 60 to 69 age group (OR 3.82). There was not a significant difference in rate of vestibular testing between women and men. Among patients with two diagnoses, the most common combinations were vestibular migraine and BPPV then vestibular migraine and Ménière's. Conclusions: A large proportion of patients seen for the chief complaint of dizziness in the neurotology clinic were found not to have a peripheral etiology of their symptoms. These data challenge a prevalent dogma that the most common causes of dizziness are peripheral: BPPV, vestibular neuritis, and Ménière's disease. Age and sex are statistically significant predictors of peripheral etiology of dizziness.

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Imaging Criteria to Predict Surgical Difficulties During Stapes Surgery

imageBackground and Purpose: Stapes surgery for otosclerosis can be challenging if access to the oval window niche is restricted. The aim of this study was to determine the accuracy of the computed tomographic (CT) scan in the evaluation of anatomical distances, and to analyze its reliability in predicting surgical technical difficulties. Material and Methods: A total of 96 patients (101 ears) were enrolled in a prospective study between 2012 and May 2015. During surgery, we evaluated the distance D1 between the stapes and the facial nerve, distance D2 between the promontory and the facial nerve after ablation of the superstructure, and the intraoperative discomfort of the surgeon. On preoperative CT scans, we measured the width and depth of the oval window niche, and the angle formed by two axes starting from the center-point of the footplate, the first tangential to the superior wall of the promontory, and the second tangential to the inferior wall of the fallopian canal. Results: Intraoperative distances D1 and D2 were correlated with the width of the oval window and with the facial-promontory angle measured on imaging. CT scan measurements of the facial-promontory angle and width of the oval window were associated with the degree of discomfort of the surgeon. The cut-off threshold for intraoperative subjective discomfort was computed as 1.1 mm for the width of the oval window niche, with a sensibility of 71% and a specificity of 84%. Conclusion: Preoperative imaging analysis of the oval window width and the facialpromontory angle can predict operative difficulty in otosclerosis surgery.

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Endoscopic Infracochlear Approach for Drainage of Petrous Apex Cholesterol Granulomas: A Case Series

imageObjective: To describe the feasibility and technical nuances of a transcanal endoscopic infracochlear approach for drainage of petrous apex cholesterol granulomas. Study Design: Retrospective case review. Setting: Tertiary care university hospital. Patients: A 32-year-old man with bilateral petrous apex cholesterol granulomas and a 54-year-old man with a left-sided petrous apex granuloma each with symptoms necessitating surgical intervention. Interventions: Transcanal endoscopic infracochlear approach for drainage of the cholesterol granulomas. Main Outcome Measures: Operation efficacy, corridor size, and perioperative morbidity. Results: All three cholesterol granulomas were successful drained without violating the cochlea, jugular bulb, or carotid artery. The dimensions of the infracochlear surgical corridor measured 5 mm × 6 mm, 3.5 mm × 3.5 mm, and 6 mm × 4 mm, respectively. All corridors facilitated visualization within the cyst and allowed lyses of adhesions for additional cyst content eradication. All patients had resolution of their acute symptoms. Two of the three subjects had serviceable hearing before and after their procedures. One patient required revision surgery 2-months after their initial procedure secondary to recurrent symptoms from acute hemorrhage within the cyst cavity. The infracochlear tract in this patient was noted to be patent. Conclusions: A transcanal endoscopic infracochlear approach is feasible for the management of cholesterol granuloma. The surgical access was wide enough to introduce the endoscope into the petrous apex cavity in each case. Further studies are needed to compare the efficacy and perioperative morbidity versus the traditional postauricular transtemporal approaches.

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Cochlear Implant in Severe Impaired Psychiatric Patients: A Case Series

imageObjective: Psychotic disorders and intelligence deficiencies are no longer contraindications for cochlear implantation regarding the revised German guidelines from May 2012. This article aims to evaluate the outcome of patients with severe psychiatric comorbidities. Therefore the database of the Cochlear Implant Center of the University Hospital of Heidelberg was investigated. Study Design: Retrospective case review. Methods: We present three patients who received a cochlear implant (CI) despite a serious psychiatric disorder. Two were sent from psychiatrists asking if a CI was possible for their profound hearing loss. One patient had acoustic hallucinations and a recurrent depressive disorder, the other had a schizophrenic psychosis and a minor impairment of intelligence. The third patient had a recurrent depressive disorder, a posttraumatic stress disorder, a chronic pain disorder, and paranoid personality traits. We discuss the preoperative diagnosis, course of diseases, and psychosocial situation. Results: All three patients received a CI and rehabilitation in the Cochlear Implant Center of the University Hospital of Heidelberg. All three of them opted for a second implant and developed a good hearing outcome. Free field understanding of words in quite is for all three of them over 60% in the Freiburger monosyllable test with two implants, similar to nonpsychiatric patients’ results. No patient has acceptance problems. In the long run, no aggravation of the psychiatric diseases occurred. Conclusion: With interdisciplinary evaluation, a cochlear implantation is possible in severely impaired psychiatric patients. For a good result the indication is to be discussed interdisciplinary.

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The Application of Next-Generation Sequencing for Mutation Detection in Autosomal-Dominant Hereditary Hearing Impairment

imageObjective: Identification of the causative mutation using next-generation sequencing in autosomal-dominant hereditary hearing impairment, as mutation analysis in hereditary hearing impairment by classic genetic methods, is hindered by the high heterogeneity of the disease. Patients: Two Swiss families with autosomal-dominant hereditary hearing impairment. Intervention: Amplified DNA libraries for next-generation sequencing were constructed from extracted genomic DNA, derived from peripheral blood, and enriched by a custom-made sequence capture library. Validated, pooled libraries were sequenced on an Illumina MiSeq instrument, 300 cycles and paired-end sequencing. Technical data analysis was performed with SeqMonk, variant analysis with GeneTalk or VariantStudio. The detection of mutations in genes related to hearing loss by next-generation sequencing was subsequently confirmed using specific polymerase-chain-reaction and Sanger sequencing. Main Outcome Measure: Mutation detection in hearing-loss-related genes. Results: The first family harbored the mutation c.5383+5delGTGA in the TECTA-gene. In the second family, a novel mutation c.2614-2625delCATGGCGCCGTG in the WFS1-gene and a second mutation TCOF1-c.1028G>A were identified. Conclusion: Next-generation sequencing successfully identified the causative mutation in families with autosomal-dominant hereditary hearing impairment. The results helped to clarify the pathogenic role of a known mutation and led to the detection of a novel one. NGS represents a feasible approach with great potential future in the diagnostics of hereditary hearing impairment, even in smaller labs.

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Intra- and Interobserver Variability of Cochlear Length Measurements in Clinical CT

imageHypothesis: The cochlear A-value measurement exhibits significant inter- and intraobserver variability, and its accuracy is dependent on the visualization method in clinical computed tomography (CT) images of the cochlea. Background: An accurate estimate of the cochlear duct length (CDL) can be used to determine electrode choice, and frequency map the cochlea based on the Greenwood equation. Studies have described estimating the CDL using a single A-value measurement, however the observer variability has not been assessed. Methods: Clinical and micro-CT images of 20 cadaveric cochleae were acquired. Four specialists measured A-values on clinical CT images using both standard views and multiplanar reconstructed (MPR) views. Measurements were repeated to assess for intraobserver variability. Observer variabilities were evaluated using intra-class correlation and absolute differences. Accuracy was evaluated by comparison to the gold standard micro-CT images of the same specimens. Results: Interobserver variability was good (average absolute difference: 0.77 ± 0.42 mm) using standard views and fair (average absolute difference: 0.90 ± 0.31 mm) using MPR views. Intraobserver variability had an average absolute difference of 0.31 ± 0.09 mm for the standard views and 0.38 ± 0.17 mm for the MPR views. MPR view measurements were more accurate than standard views, with average relative errors of 9.5 and 14.5%, respectively. Conclusion: There was significant observer variability in A-value measurements using both the standard and MPR views. Creating the MPR views increased variability between experts, however MPR views yielded more accurate results. Automated A-value measurement algorithms may help to reduce variability and increase accuracy in the future.

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The Effect of Elevated Intracranial Pressure on Frequency Tuning of Air-Conducted Ocular Vestibular Myogenic Potentials in Ménière's Disease Patients

imageObjective: To investigate the effect of increased intracranial pressure on ocular vestibular-evoked myogenic potential (oVEMP) amplitudes and frequency tuning in patients with Ménière's disease (MD) to elucidate whether oVEMPS recorded under such conditions could provide a simple and accurate diagnostic test for MD. Setting: Tertiary referral center for otology and neurotology. Patients: Ten patients with certain unilateral MD (mean age = 48.2 yr, range 25–75 yr, 6 males and 4 females) as confirmed by a locally enhanced inner ear MRI (LEIM) were enrolled in this study. Design: Air-conducted tone-burst oVEMP amplitudes were measured in response to 500 Hz and 1000 Hz in the horizontal plane (0 degree), a 20-degree head-down position. Results: Tilting the patients from the horizontal position to the 20-degree head-down position led to a large reduction in oVEMP amplitudes to the 500 Hz tone burst (3.02 μV vs 1.17 μV, p = 0.005) and to a smaller one in the 1000 Hz tone burst (2.28 μV vs 1.78 μV, p = 0.013) in the Ménière's ear. Accordingly, the 500/1000 Hz frequency–tuning ratio was significantly decreased in the Ménière's ear as a result of this manoeuver (1.36 vs 0.75, p = 0.005). Conclusion: oVEMP amplitudes and frequency tuning in MD patients show a similar behavior to that found in healthy control subjects. oVEMP testing of putative MD patients in the tilted position is therefore unlikely to be diagnostically useful.

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