iotaMotion Receives NIH Grant to Develop Robotics for Cochlear Implant Surgery

​The medical device startup iotaMotion (http://iotamotion.com/) has been awarded a $1.4 million grant from the National Institutes of Health (NIH) to develop its next-generation implantable robotic technology IOTA-Progress. The company will use this funding from the NIH's Small Business Innovation Research program to hone a robotic-assisted cochlear implant insertion system that will provide precise and controlled electrode advancement during hybrid cochlear implant surgeries. Marlan Hansen, MD, one of the founders of iotaMotion, said providing a more controlled, fine electrode insertion of the electrode should significantly enhance professionals' ability to preserve hearing. "Then we have what this grant is helping to fund for our company, which is the development of an implantable system allowing for electrode adjustments within the cochlea after the original surgery, without surgical intervention," Hansen said. "The goal here is optimal positioning within the cochlea to best match that patient's hearing, which often changes over time."

Published: 9/29/2017 9:16:00 AM

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Owls May Shed Light on Age-Related Hearing Loss Prevention

Researchers in Europe found that barn owls have what they call "ageless ears," which could potentially help with identifying new treatment options for hearing-impaired humans (Proc Biol Sci 2017;284[1863] pii: 20171584). They measured the auditory sensitivity of seven barn owls ranging from less than 2 years old to 23 years old by training them to fly to a perch to receive a food reward in response to an auditory cue. Young and old owls both responded to the varying levels of auditory cues, and the oldest owl at 23 years old heard just as well as the younger owls. ​Georg Klump, a professor at the University of Oldenburg, Germany and one of the study authors, told BBC that owls keep their hearing into very old age. "Birds can repair their ears like (humans) can repair a wound," he said. "Humans cannot re-grow the sensory cells of the ears but birds can do this." Work is underway to investigate the differences between birds and mammals, which commonly lose their hearing at old age. ​

​Photo credit: ​Lubos Houska

Published: 9/22/2017 9:55:00 AM

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UNGA Highlights Global Ear and Hearing Health

Hearing health took center stage at the high-level United Nations General Assembly panel on "Ear Care and Hearing Health"​ last September 14, with keynote speaker former U.S. President Bill Clinton. 

Organized by the International Federation for Peace and Sustainable Development (IFPSD) and the Permanent Mission of Guatemala to the U.N., the meeting highlighted the global impact of hearing impairment, as well as the importance of hearing health in promoting peace and sustainability, especially in developing nations.

"It is important to know that children in developing countries are seven times more likely to experience hearing loss because of avoidable conditions that routine checkup and treatment can take care of in countries with comprehensive health care system," said Clinton.

William F. Austin, the founder of the Starkey Hearing Foundation, which has worked with the Clinton Global Initiative on hearing health projects, was the other keynote speaker and named the first Goodwill Global Ambassador for Ear and Hearing.

In the first panel, the keynote speakers and fellow panelist tackled the need for increased support and funding ear and hearing health.

Hearing "helps us understand each other and creates more avenues for peace and development," said Sandra Granger, first lady of the Cooperative Republic of Guyana, who was also part of the panel. "It is not only hearing as a sense but also the connection with the rest of the world that we all need and desire."

 

"If you think about it, this is a problem of manageable cause with a proven delivery system that has a community-based solution to promote hearing health and to maintain the supply chain," Clinton said.

"If we get enough people trained then we can feed that system with instruments needed to satisfy the broader problem," Austin noted on developing solutions.

The second panel, which focused on the global status of ear and hearing health, was moderated by Barbara Bush, CEO and co-founder of the Global Health Corps.

"We can work as hard as we want to every single day on solving health issues, but if someone can't access the health care system because they can't hear, that's not a 'nice' to have--that's a 'must' to have," shared Bush.

In this panel, Charlotte Chiong, MD of the University of the Philippines recapped the recently approved World Health Assembly resolution that underscored the need to integrate ear and hearing health within primary health care. The resolution also called for improved training of medical professionals, informed government policies, implementation of hearing screenings, and enhanced access to cost-effective hearing services and devices.

"Everybody should think of hearing as a right to life," said Chiong. "Nobody gets left behind."

Published: 9/19/2017 12:04:00 PM

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Comparison of the Spectral-Temporally Modulated Ripple Test With the Arizona Biomedical Institute Sentence Test in Cochlear Implant Users.

Objectives: Although speech perception is the gold standard for measuring cochlear implant (CI) users' performance, speech perception tests often require extensive adaptation to obtain accurate results, particularly after large changes in maps. Spectral ripple tests, which measure spectral resolution, are an alternate measure that has been shown to correlate with speech perception. A modified spectral ripple test, the spectral-temporally modulated ripple test (SMRT) has recently been developed, and the objective of this study was to compare speech perception and performance on the SMRT for a heterogeneous population of unilateral CI users, bilateral CI users, and bimodal users. Design: Twenty-five CI users (eight using unilateral CIs, nine using bilateral CIs, and eight using a CI and a hearing aid) were tested on the Arizona Biomedical Institute Sentence Test (AzBio) with a +8 dB signal to noise ratio, and on the SMRT. All participants were tested with their clinical programs. Results: There was a significant correlation between SMRT and AzBio performance. After a practice block, an improvement of one ripple per octave for SMRT corresponded to an improvement of 12.1% for AzBio. Additionally, there was no significant difference in slope or intercept between any of the CI populations. Conclusion: The results indicate that performance on the SMRT correlates with speech recognition in noise when measured across unilateral, bilateral, and bimodal CI populations. These results suggest that SMRT scores are strongly associated with speech recognition in noise ability in experienced CI users. Further studies should focus on increasing both the size and diversity of the tested participants, and on determining whether the SMRT technique can be used for early predictions of long-term speech scores, or for evaluating differences among different stimulation strategies or parameter settings. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Learning Effects in Psychophysical Tests of Spectral and Temporal Resolution.

Objectives: Psychophysical tests of spectral and temporal resolution, such as the spectral-ripple discrimination task and the temporal modulation detection test, are valuable tools for the evaluation of cochlear implant performance. Both tests correlate with speech intelligibility and are reported to show no instantaneous learning effect. However, some of our previous trials have suggested that there is a learning effect over time. The aim of this study was to investigate the test-retest reliability of the two tests when measured over time. Design: Ten adult cochlear implant recipients, experienced with the HiResolution speech coding strategy, participated in this study. Spectral ripple discrimination and temporal modulation detection ability with the HiResolution strategy were assessed both before and after participation in a previous trial that evaluated two research speech coding strategies after 2 weeks of home-usage. Each test was repeated six times on each test day. Results: No improvement was observed for same-day testing. However, comparison of the mean spectral ripple discrimination scores before and after participation in the take-home trial showed improvement from 3.4 to 4.8 ripples per octave (p

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Use of Electrically Evoked Compound Action Potentials for Cochlear Implant Fitting: A Systematic Review.

Objectives: The electrically evoked compound action potential (eCAP) is widely used in the clinic as an objective measure to assess cochlear implant functionality. During the past decade, there has been increasing interest in applying eCAPs for fitting of cochlear implants. Several studies have shown that eCAP-based fitting can potentially replace time-consuming behavioral fitting procedures, especially in young children. However, a closer look to all available literature revealed that there is no clear consensus on the validity of this fitting procedure. This study evaluated the validity of eCAP-based fitting of cochlear implant recipients based on a systematic review of the recent literature. Design: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to search the PubMed, Web of Science, and Cochrane Library databases. The term "eCAP" was combined with "cochlear implants," "thresholds," and "levels," in addition to a range of related terms. Finally, 32 studies met the inclusion criteria. These studies were evaluated on the risk of bias and, when possible, compared by meta-analysis. Results: Almost all assessed studies suffered from some form of risk of bias. Twenty-nine of the studies based their conclusion on a group correlation instead of individual subject correlations (analytical bias); 14 studies were unclear about randomization or blinding (outcome assessment bias); 9 studies provided no clear description of the populations used, for example, prelingually or postlingually implanted subjects (selection bias); and 4 studies had a high rate of loss (>10%) for patients or electrodes (attrition bias). Meta-analysis of these studies revealed a weak pooled correlation between eCAP thresholds and both behavioral T- and C-levels (r = 0.58 and r = 0.61, respectively). Conclusions: This review shows that the majority of the assessed studies suffered from substantial shortcomings in study design and statistical analysis. Meta-analysis showed that there is only weak evidence to support the use of eCAP data for cochlear implant fitting purposes; eCAP thresholds are an equally weak predictor for both T- and C-levels. Based on this review, it can be concluded that research on eCAP-based fitting needs a profound reflection on study design and analysis to draw well-grounded conclusions about the validity of eCAP-based fitting of cochlear implant recipients. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Binaural Pitch Fusion in Bilateral Cochlear Implant Users.

Objectives: Binaural pitch fusion is the fusion of stimuli that evoke different pitches between the ears into a single auditory image. Individuals who use hearing aids or bimodal cochlear implants (CIs) experience abnormally broad binaural pitch fusion, such that sounds differing in pitch by as much as 3-4 octaves are fused across ears, leading to spectral averaging and speech perception interference. The goal of this study was to determine if adult bilateral CI users also experience broad binaural pitch fusion. Design: Stimuli were pulse trains delivered to individual electrodes. Fusion ranges were measured using simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus to find the range that fused with the reference stimulus. Results: Bilateral CI listeners had binaural pitch fusion ranges varying from 0 to 12 mm (average 6.1 +/- 3.9 mm), where 12 mm indicates fusion over all electrodes in the array. No significant correlations of fusion range were observed with any subject factors related to age, hearing loss history, or hearing device history, or with any electrode factors including interaural electrode pitch mismatch, pitch match bandwidth, or within-ear electrode discrimination abilities. Conclusions: Bilateral CI listeners have abnormally broad fusion, similar to hearing aid and bimodal CI listeners. This broad fusion may explain the variability of binaural benefits for speech perception in quiet and in noise in bilateral CI users. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Extrinsic Cognitive Load Impairs Spoken Word Recognition in High- and Low-Predictability Sentences.

Objectives: Listening effort (LE) induced by speech degradation reduces performance on concurrent cognitive tasks. However, a converse effect of extrinsic cognitive load on recognition of spoken words in sentences has not been shown. The aims of the present study were to (a) examine the impact of extrinsic cognitive load on spoken word recognition in a sentence recognition task and (b) determine whether cognitive load and/or LE needed to understand spectrally degraded speech would differentially affect word recognition in high- and low-predictability sentences. Downstream effects of speech degradation and sentence predictability on the cognitive load task were also examined. Design: One hundred twenty young adults identified sentence-final spoken words in high- and low-predictability Speech Perception in Noise sentences. Cognitive load consisted of a preload of short (low-load) or long (high-load) sequences of digits, presented visually before each spoken sentence and reported either before or after identification of the sentence-final word. LE was varied by spectrally degrading sentences with four-, six-, or eight-channel noise vocoding. Level of spectral degradation and order of report (digits first or words first) were between-participants variables. Effects of cognitive load, sentence predictability, and speech degradation on accuracy of sentence-final word identification as well as recall of preload digit sequences were examined. Results: In addition to anticipated main effects of sentence predictability and spectral degradation on word recognition, we found an effect of cognitive load, such that words were identified more accurately under low load than high load. However, load differentially affected word identification in high- and low-predictability sentences depending on the level of sentence degradation. Under severe spectral degradation (four-channel vocoding), the effect of cognitive load on word identification was present for high-predictability sentences but not for low-predictability sentences. Under mild spectral degradation (eight-channel vocoding), the effect of load was present for low-predictability sentences but not for high-predictability sentences. There were also reliable downstream effects of speech degradation and sentence predictability on recall of the preload digit sequences. Long digit sequences were more easily recalled following spoken sentences that were less spectrally degraded. When digits were reported after identification of sentence-final words, short digit sequences were recalled more accurately when the spoken sentences were predictable. Conclusions: Extrinsic cognitive load can impair recognition of spectrally degraded spoken words in a sentence recognition task. Cognitive load affected word identification in both high- and low-predictability sentences, suggesting that load may impact both context use and lower-level perceptual processes. Consistent with prior work, LE also had downstream effects on memory for visual digit sequences. Results support the proposal that extrinsic cognitive load and LE induced by signal degradation both draw on a central, limited pool of cognitive resources that is used to recognize spoken words in sentences under adverse listening conditions. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Mindfulness-Based Cognitive Therapy for Chronic Tinnitus: Evaluation of Benefits in a Large Sample of Patients Attending a Tinnitus Clinic.

Objectives: Mindfulness-based approaches may benefit patients with chronic tinnitus, but most evidence is from small studies of nonstandardized interventions, and there is little exploration of the processes of change. This study describes the impact of mindfulness-based cognitive therapy (MBCT) in a "real world" tinnitus clinic, using standardized MBCT on the largest sample of patients with chronic tinnitus to date while exploring predictors of change. Design: Participants were 182 adults with chronic and distressing tinnitus who completed an 8-week MBCT group. Measures of tinnitus-related distress, psychological distress, tinnitus acceptance, and mindfulness were taken preintervention, postintervention, and at 6-week follow-up. Results: MBCT was associated with significant improvements on all outcome measures. Postintervention, reliable improvements were detected in tinnitus-related distress in 50% and in psychological distress in 41.2% of patients. Changes in mindfulness and tinnitus acceptance explained unique variance in tinnitus-related and psychological distress postintervention. Conclusions: MBCT was associated with significant and reliable improvements in patients with chronic, distressing tinnitus. Changes were associated with increases in tinnitus acceptance and dispositional mindfulness. This study doubles the combined sample size of all previously published studies. Randomized controlled trials of standardized MBCT protocols are now required to test whether MBCT might offer a new and effective treatment for chronic tinnitus. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Listening Effort: How the Cognitive Consequences of Acoustic Challenge Are Reflected in Brain and Behavior.

Everyday conversation frequently includes challenges to the clarity of the acoustic speech signal, including hearing impairment, background noise, and foreign accents. Although an obvious problem is the increased risk of making word identification errors, extracting meaning from a degraded acoustic signal is also cognitively demanding, which contributes to increased listening effort. The concepts of cognitive demand and listening effort are critical in understanding the challenges listeners face in comprehension, which are not fully predicted by audiometric measures. In this article, the authors review converging behavioral, pupillometric, and neuroimaging evidence that understanding acoustically degraded speech requires additional cognitive support and that this cognitive load can interfere with other operations such as language processing and memory for what has been heard. Behaviorally, acoustic challenge is associated with increased errors in speech understanding, poorer performance on concurrent secondary tasks, more difficulty processing linguistically complex sentences, and reduced memory for verbal material. Measures of pupil dilation support the challenge associated with processing a degraded acoustic signal, indirectly reflecting an increase in neural activity. Finally, functional brain imaging reveals that the neural resources required to understand degraded speech extend beyond traditional perisylvian language networks, most commonly including regions of prefrontal cortex, premotor cortex, and the cingulo-opercular network. Far from being exclusively an auditory problem, acoustic degradation presents listeners with a systems-level challenge that requires the allocation of executive cognitive resources. An important point is that a number of dissociable processes can be engaged to understand degraded speech, including verbal working memory and attention-based performance monitoring. The specific resources required likely differ as a function of the acoustic, linguistic, and cognitive demands of the task, as well as individual differences in listeners' abilities. A greater appreciation of cognitive contributions to processing degraded speech is critical in understanding individual differences in comprehension ability, variability in the efficacy of assistive devices, and guiding rehabilitation approaches to reducing listening effort and facilitating communication. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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The Electrically Evoked Auditory Change Complex Evoked by Temporal Gaps Using Cochlear Implants or Auditory Brainstem Implants in Children With Cochlear Nerve Deficiency.

Objectives: This study aimed to (1) establish the feasibility of measuring the electrically evoked auditory change complex (eACC) in response to temporal gaps in children with cochlear nerve deficiency (CND) who are using cochlear implants (CIs) and/or auditory brainstem implants (ABIs); and (2) explore the association between neural encoding of, and perceptual sensitivity to, temporal gaps in these patients. Design: Study participants included 5 children (S1 to S5) ranging in age from 3.8 to 8.2 years (mean: 6.3 years) at the time of testing. All subjects were unilaterally implanted with a Nucleus 24M ABI due to CND. For each subject, two or more stimulating electrodes of the ABI were tested. S2, S3, and S5 previously received a CI in the contralateral ear. For these 3 subjects, at least two stimulating electrodes of their CIs were also tested. For electrophysiological measures, the stimulus was an 800-msec biphasic pulse train delivered to individual electrodes at the maximum comfortable level (C level). The electrically evoked responses, including the onset response and the eACC, were measured for two stimulation conditions. In the standard condition, the 800-msec pulse train was delivered uninterrupted to individual stimulating electrodes. In the gapped condition, a temporal gap was inserted into the pulse train after 400 msec of stimulation. Gap durations tested in this study ranged from 2 up to 128 msec. The shortest gap that could reliably evoke the eACC was defined as the objective gap detection threshold (GDT). For behavioral GDT measures, the stimulus was a 500-msec biphasic pulse train presented at the C level. The behavioral GDT was measured for individual stimulating electrodes using a one-interval, two-alternative forced-choice procedure. Results: The eACCs to temporal gaps were recorded successfully in all subjects for at least one stimulating electrode using either the ABI or the CI. Objective GDTs showed intersubject variations, as well as variations across stimulating electrodes of the ABI or the CI within each subject. Behavioral GDTs were measured for one ABI electrode in S2 and for multiple ABI and CI electrodes in S5. All other subjects could not complete the task. S5 showed smaller behavioral GDTs for CI electrodes than those measured for ABI electrodes. One CI and two ABI electrodes in S5 showed comparable objective and behavioral GDTs. In contrast, one CI and two ABI electrodes in S5 and one ABI electrode in S2 showed measurable behavioral GDTs but no identifiable eACCs. Conclusions: The eACCs to temporal gaps were recorded in children with CND using either ABIs or CIs. Both objective and behavioral GDTs showed inter- and intrasubject variations. Consistency between results of eACC recordings and psychophysical measures of GDT was observed for some but not all ABI or CI electrodes in these subjects. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Patients' and Clinicians' Views of the Psychological Components of Tinnitus Treatment That Could Inform Audiologists' Usual Care: A Delphi Survey.

Objectives: The aim of this study was to determine which components of psychological therapies are most important and appropriate to inform audiologists' usual care for people with tinnitus. Design: A 39-member panel of patients, audiologists, hearing therapists, and psychologists completed a three-round Delphi survey to reach consensus on essential components of audiologist-delivered psychologically informed care for tinnitus. Results: Consensus (>=80% agreement) was reached on including 76 of 160 components. No components reached consensus for exclusion. The components reaching consensus were predominantly common therapeutic skills such as Socratic questioning and active listening, rather than specific techniques, for example, graded exposure therapy or cognitive restructuring. Consensus on educational components to include largely concerned psychological models of tinnitus rather than neurophysiological information. Conclusions: The results of this Delphi survey provide a tool to develop audiologists' usual tinnitus care using components that both patients and clinicians agree are important and appropriate to be delivered by an audiologist for adults with tinnitus-related distress. Research is now necessary to test the added effects of these components when delivered by audiologists. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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An Innovative and Cost Effective Approach to Wireless Remote Microphones in Schools

This article reviews the use of Hearing Assistive Technology in educational settings and presents a cost-effective solution for usage of the most commonly recommended technology.

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Madsen Zodiac - What's New in Immittance!

Instruction for efficient use of the Madsen Zodiac Immittance device.

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Rethinking Your Diagnostic Audiology Battery: Using Value Added Tests

Guidance for creating an individualized diagnostic test battery for each patient to enhance efficient and accurate assessment of auditory function. This practical course stresses the importance of selecting test procedures that add value to the diagnosis and management of hearing loss and related disorders.

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Introduction to the New Tempus Platform and the World's Smallest Rechargeable Solution

Review of the features and benefits of Unitron’s new Tempus™ hearing instrument platform.

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20Q: Hearing Loss and Its Comorbidities

A discussion of common hearing loss comorbidities, with implications for audiology clinical practice, written in an engaging Q & A format.

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Meet Enchant

An overview of the Enchant hearing instrument family from Sonic.

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Comparison of Music Sound Quality Between Hearing Aids and Music Programs

While hearing aid users often wear their hearing aids for music listening, they are frequently dissatisfied with the sound quality of music. This articles describes a study of music sound quality ratings between the universal and music programs of five premiere market hearing aids.

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The Simple Way to Hear More with the Naida Link CROS Solution

An overview of Advanced Bionic’s newest innovation, the Naída Link CROS Solution, including candidacy, features, and benefits.

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iotaMotion Receives NIH Grant to Develop Robotics for Cochlear Implant Surgery

​The medical device startup iotaMotion (http://iotamotion.com/) has been awarded a $1.4 million grant from the National Institutes of Health (NIH) to develop its next-generation implantable robotic technology IOTA-Progress. The company will use this funding from the NIH's Small Business Innovation Research program to hone a robotic-assisted cochlear implant insertion system that will provide precise and controlled electrode advancement during hybrid cochlear implant surgeries. Marlan Hansen, MD, one of the founders of iotaMotion, said providing a more controlled, fine electrode insertion of the electrode should significantly enhance professionals' ability to preserve hearing. "Then we have what this grant is helping to fund for our company, which is the development of an implantable system allowing for electrode adjustments within the cochlea after the original surgery, without surgical intervention," Hansen said. "The goal here is optimal positioning within the cochlea to best match that patient's hearing, which often changes over time."

Published: 9/29/2017 9:16:00 AM

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Owls May Shed Light on Age-Related Hearing Loss Prevention

Researchers in Europe found that barn owls have what they call "ageless ears," which could potentially help with identifying new treatment options for hearing-impaired humans (Proc Biol Sci 2017;284[1863] pii: 20171584). They measured the auditory sensitivity of seven barn owls ranging from less than 2 years old to 23 years old by training them to fly to a perch to receive a food reward in response to an auditory cue. Young and old owls both responded to the varying levels of auditory cues, and the oldest owl at 23 years old heard just as well as the younger owls. ​Georg Klump, a professor at the University of Oldenburg, Germany and one of the study authors, told BBC that owls keep their hearing into very old age. "Birds can repair their ears like (humans) can repair a wound," he said. "Humans cannot re-grow the sensory cells of the ears but birds can do this." Work is underway to investigate the differences between birds and mammals, which commonly lose their hearing at old age. ​

​Photo credit: ​Lubos Houska

Published: 9/22/2017 9:55:00 AM

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UNGA Highlights Global Ear and Hearing Health

Hearing health took center stage at the high-level United Nations General Assembly panel on "Ear Care and Hearing Health"​ last September 14, with keynote speaker former U.S. President Bill Clinton. 

Organized by the International Federation for Peace and Sustainable Development (IFPSD) and the Permanent Mission of Guatemala to the U.N., the meeting highlighted the global impact of hearing impairment, as well as the importance of hearing health in promoting peace and sustainability, especially in developing nations.

"It is important to know that children in developing countries are seven times more likely to experience hearing loss because of avoidable conditions that routine checkup and treatment can take care of in countries with comprehensive health care system," said Clinton.

William F. Austin, the founder of the Starkey Hearing Foundation, which has worked with the Clinton Global Initiative on hearing health projects, was the other keynote speaker and named the first Goodwill Global Ambassador for Ear and Hearing.

In the first panel, the keynote speakers and fellow panelist tackled the need for increased support and funding ear and hearing health.

Hearing "helps us understand each other and creates more avenues for peace and development," said Sandra Granger, first lady of the Cooperative Republic of Guyana, who was also part of the panel. "It is not only hearing as a sense but also the connection with the rest of the world that we all need and desire."

 

"If you think about it, this is a problem of manageable cause with a proven delivery system that has a community-based solution to promote hearing health and to maintain the supply chain," Clinton said.

"If we get enough people trained then we can feed that system with instruments needed to satisfy the broader problem," Austin noted on developing solutions.

The second panel, which focused on the global status of ear and hearing health, was moderated by Barbara Bush, CEO and co-founder of the Global Health Corps.

"We can work as hard as we want to every single day on solving health issues, but if someone can't access the health care system because they can't hear, that's not a 'nice' to have--that's a 'must' to have," shared Bush.

In this panel, Charlotte Chiong, MD of the University of the Philippines recapped the recently approved World Health Assembly resolution that underscored the need to integrate ear and hearing health within primary health care. The resolution also called for improved training of medical professionals, informed government policies, implementation of hearing screenings, and enhanced access to cost-effective hearing services and devices.

"Everybody should think of hearing as a right to life," said Chiong. "Nobody gets left behind."

Published: 9/19/2017 12:04:00 PM

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Comparison of the Spectral-Temporally Modulated Ripple Test With the Arizona Biomedical Institute Sentence Test in Cochlear Implant Users.

Objectives: Although speech perception is the gold standard for measuring cochlear implant (CI) users' performance, speech perception tests often require extensive adaptation to obtain accurate results, particularly after large changes in maps. Spectral ripple tests, which measure spectral resolution, are an alternate measure that has been shown to correlate with speech perception. A modified spectral ripple test, the spectral-temporally modulated ripple test (SMRT) has recently been developed, and the objective of this study was to compare speech perception and performance on the SMRT for a heterogeneous population of unilateral CI users, bilateral CI users, and bimodal users. Design: Twenty-five CI users (eight using unilateral CIs, nine using bilateral CIs, and eight using a CI and a hearing aid) were tested on the Arizona Biomedical Institute Sentence Test (AzBio) with a +8 dB signal to noise ratio, and on the SMRT. All participants were tested with their clinical programs. Results: There was a significant correlation between SMRT and AzBio performance. After a practice block, an improvement of one ripple per octave for SMRT corresponded to an improvement of 12.1% for AzBio. Additionally, there was no significant difference in slope or intercept between any of the CI populations. Conclusion: The results indicate that performance on the SMRT correlates with speech recognition in noise when measured across unilateral, bilateral, and bimodal CI populations. These results suggest that SMRT scores are strongly associated with speech recognition in noise ability in experienced CI users. Further studies should focus on increasing both the size and diversity of the tested participants, and on determining whether the SMRT technique can be used for early predictions of long-term speech scores, or for evaluating differences among different stimulation strategies or parameter settings. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Learning Effects in Psychophysical Tests of Spectral and Temporal Resolution.

Objectives: Psychophysical tests of spectral and temporal resolution, such as the spectral-ripple discrimination task and the temporal modulation detection test, are valuable tools for the evaluation of cochlear implant performance. Both tests correlate with speech intelligibility and are reported to show no instantaneous learning effect. However, some of our previous trials have suggested that there is a learning effect over time. The aim of this study was to investigate the test-retest reliability of the two tests when measured over time. Design: Ten adult cochlear implant recipients, experienced with the HiResolution speech coding strategy, participated in this study. Spectral ripple discrimination and temporal modulation detection ability with the HiResolution strategy were assessed both before and after participation in a previous trial that evaluated two research speech coding strategies after 2 weeks of home-usage. Each test was repeated six times on each test day. Results: No improvement was observed for same-day testing. However, comparison of the mean spectral ripple discrimination scores before and after participation in the take-home trial showed improvement from 3.4 to 4.8 ripples per octave (p

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Use of Electrically Evoked Compound Action Potentials for Cochlear Implant Fitting: A Systematic Review.

Objectives: The electrically evoked compound action potential (eCAP) is widely used in the clinic as an objective measure to assess cochlear implant functionality. During the past decade, there has been increasing interest in applying eCAPs for fitting of cochlear implants. Several studies have shown that eCAP-based fitting can potentially replace time-consuming behavioral fitting procedures, especially in young children. However, a closer look to all available literature revealed that there is no clear consensus on the validity of this fitting procedure. This study evaluated the validity of eCAP-based fitting of cochlear implant recipients based on a systematic review of the recent literature. Design: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to search the PubMed, Web of Science, and Cochrane Library databases. The term "eCAP" was combined with "cochlear implants," "thresholds," and "levels," in addition to a range of related terms. Finally, 32 studies met the inclusion criteria. These studies were evaluated on the risk of bias and, when possible, compared by meta-analysis. Results: Almost all assessed studies suffered from some form of risk of bias. Twenty-nine of the studies based their conclusion on a group correlation instead of individual subject correlations (analytical bias); 14 studies were unclear about randomization or blinding (outcome assessment bias); 9 studies provided no clear description of the populations used, for example, prelingually or postlingually implanted subjects (selection bias); and 4 studies had a high rate of loss (>10%) for patients or electrodes (attrition bias). Meta-analysis of these studies revealed a weak pooled correlation between eCAP thresholds and both behavioral T- and C-levels (r = 0.58 and r = 0.61, respectively). Conclusions: This review shows that the majority of the assessed studies suffered from substantial shortcomings in study design and statistical analysis. Meta-analysis showed that there is only weak evidence to support the use of eCAP data for cochlear implant fitting purposes; eCAP thresholds are an equally weak predictor for both T- and C-levels. Based on this review, it can be concluded that research on eCAP-based fitting needs a profound reflection on study design and analysis to draw well-grounded conclusions about the validity of eCAP-based fitting of cochlear implant recipients. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Binaural Pitch Fusion in Bilateral Cochlear Implant Users.

Objectives: Binaural pitch fusion is the fusion of stimuli that evoke different pitches between the ears into a single auditory image. Individuals who use hearing aids or bimodal cochlear implants (CIs) experience abnormally broad binaural pitch fusion, such that sounds differing in pitch by as much as 3-4 octaves are fused across ears, leading to spectral averaging and speech perception interference. The goal of this study was to determine if adult bilateral CI users also experience broad binaural pitch fusion. Design: Stimuli were pulse trains delivered to individual electrodes. Fusion ranges were measured using simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus to find the range that fused with the reference stimulus. Results: Bilateral CI listeners had binaural pitch fusion ranges varying from 0 to 12 mm (average 6.1 +/- 3.9 mm), where 12 mm indicates fusion over all electrodes in the array. No significant correlations of fusion range were observed with any subject factors related to age, hearing loss history, or hearing device history, or with any electrode factors including interaural electrode pitch mismatch, pitch match bandwidth, or within-ear electrode discrimination abilities. Conclusions: Bilateral CI listeners have abnormally broad fusion, similar to hearing aid and bimodal CI listeners. This broad fusion may explain the variability of binaural benefits for speech perception in quiet and in noise in bilateral CI users. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Extrinsic Cognitive Load Impairs Spoken Word Recognition in High- and Low-Predictability Sentences.

Objectives: Listening effort (LE) induced by speech degradation reduces performance on concurrent cognitive tasks. However, a converse effect of extrinsic cognitive load on recognition of spoken words in sentences has not been shown. The aims of the present study were to (a) examine the impact of extrinsic cognitive load on spoken word recognition in a sentence recognition task and (b) determine whether cognitive load and/or LE needed to understand spectrally degraded speech would differentially affect word recognition in high- and low-predictability sentences. Downstream effects of speech degradation and sentence predictability on the cognitive load task were also examined. Design: One hundred twenty young adults identified sentence-final spoken words in high- and low-predictability Speech Perception in Noise sentences. Cognitive load consisted of a preload of short (low-load) or long (high-load) sequences of digits, presented visually before each spoken sentence and reported either before or after identification of the sentence-final word. LE was varied by spectrally degrading sentences with four-, six-, or eight-channel noise vocoding. Level of spectral degradation and order of report (digits first or words first) were between-participants variables. Effects of cognitive load, sentence predictability, and speech degradation on accuracy of sentence-final word identification as well as recall of preload digit sequences were examined. Results: In addition to anticipated main effects of sentence predictability and spectral degradation on word recognition, we found an effect of cognitive load, such that words were identified more accurately under low load than high load. However, load differentially affected word identification in high- and low-predictability sentences depending on the level of sentence degradation. Under severe spectral degradation (four-channel vocoding), the effect of cognitive load on word identification was present for high-predictability sentences but not for low-predictability sentences. Under mild spectral degradation (eight-channel vocoding), the effect of load was present for low-predictability sentences but not for high-predictability sentences. There were also reliable downstream effects of speech degradation and sentence predictability on recall of the preload digit sequences. Long digit sequences were more easily recalled following spoken sentences that were less spectrally degraded. When digits were reported after identification of sentence-final words, short digit sequences were recalled more accurately when the spoken sentences were predictable. Conclusions: Extrinsic cognitive load can impair recognition of spectrally degraded spoken words in a sentence recognition task. Cognitive load affected word identification in both high- and low-predictability sentences, suggesting that load may impact both context use and lower-level perceptual processes. Consistent with prior work, LE also had downstream effects on memory for visual digit sequences. Results support the proposal that extrinsic cognitive load and LE induced by signal degradation both draw on a central, limited pool of cognitive resources that is used to recognize spoken words in sentences under adverse listening conditions. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Mindfulness-Based Cognitive Therapy for Chronic Tinnitus: Evaluation of Benefits in a Large Sample of Patients Attending a Tinnitus Clinic.

Objectives: Mindfulness-based approaches may benefit patients with chronic tinnitus, but most evidence is from small studies of nonstandardized interventions, and there is little exploration of the processes of change. This study describes the impact of mindfulness-based cognitive therapy (MBCT) in a "real world" tinnitus clinic, using standardized MBCT on the largest sample of patients with chronic tinnitus to date while exploring predictors of change. Design: Participants were 182 adults with chronic and distressing tinnitus who completed an 8-week MBCT group. Measures of tinnitus-related distress, psychological distress, tinnitus acceptance, and mindfulness were taken preintervention, postintervention, and at 6-week follow-up. Results: MBCT was associated with significant improvements on all outcome measures. Postintervention, reliable improvements were detected in tinnitus-related distress in 50% and in psychological distress in 41.2% of patients. Changes in mindfulness and tinnitus acceptance explained unique variance in tinnitus-related and psychological distress postintervention. Conclusions: MBCT was associated with significant and reliable improvements in patients with chronic, distressing tinnitus. Changes were associated with increases in tinnitus acceptance and dispositional mindfulness. This study doubles the combined sample size of all previously published studies. Randomized controlled trials of standardized MBCT protocols are now required to test whether MBCT might offer a new and effective treatment for chronic tinnitus. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Listening Effort: How the Cognitive Consequences of Acoustic Challenge Are Reflected in Brain and Behavior.

Everyday conversation frequently includes challenges to the clarity of the acoustic speech signal, including hearing impairment, background noise, and foreign accents. Although an obvious problem is the increased risk of making word identification errors, extracting meaning from a degraded acoustic signal is also cognitively demanding, which contributes to increased listening effort. The concepts of cognitive demand and listening effort are critical in understanding the challenges listeners face in comprehension, which are not fully predicted by audiometric measures. In this article, the authors review converging behavioral, pupillometric, and neuroimaging evidence that understanding acoustically degraded speech requires additional cognitive support and that this cognitive load can interfere with other operations such as language processing and memory for what has been heard. Behaviorally, acoustic challenge is associated with increased errors in speech understanding, poorer performance on concurrent secondary tasks, more difficulty processing linguistically complex sentences, and reduced memory for verbal material. Measures of pupil dilation support the challenge associated with processing a degraded acoustic signal, indirectly reflecting an increase in neural activity. Finally, functional brain imaging reveals that the neural resources required to understand degraded speech extend beyond traditional perisylvian language networks, most commonly including regions of prefrontal cortex, premotor cortex, and the cingulo-opercular network. Far from being exclusively an auditory problem, acoustic degradation presents listeners with a systems-level challenge that requires the allocation of executive cognitive resources. An important point is that a number of dissociable processes can be engaged to understand degraded speech, including verbal working memory and attention-based performance monitoring. The specific resources required likely differ as a function of the acoustic, linguistic, and cognitive demands of the task, as well as individual differences in listeners' abilities. A greater appreciation of cognitive contributions to processing degraded speech is critical in understanding individual differences in comprehension ability, variability in the efficacy of assistive devices, and guiding rehabilitation approaches to reducing listening effort and facilitating communication. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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The Electrically Evoked Auditory Change Complex Evoked by Temporal Gaps Using Cochlear Implants or Auditory Brainstem Implants in Children With Cochlear Nerve Deficiency.

Objectives: This study aimed to (1) establish the feasibility of measuring the electrically evoked auditory change complex (eACC) in response to temporal gaps in children with cochlear nerve deficiency (CND) who are using cochlear implants (CIs) and/or auditory brainstem implants (ABIs); and (2) explore the association between neural encoding of, and perceptual sensitivity to, temporal gaps in these patients. Design: Study participants included 5 children (S1 to S5) ranging in age from 3.8 to 8.2 years (mean: 6.3 years) at the time of testing. All subjects were unilaterally implanted with a Nucleus 24M ABI due to CND. For each subject, two or more stimulating electrodes of the ABI were tested. S2, S3, and S5 previously received a CI in the contralateral ear. For these 3 subjects, at least two stimulating electrodes of their CIs were also tested. For electrophysiological measures, the stimulus was an 800-msec biphasic pulse train delivered to individual electrodes at the maximum comfortable level (C level). The electrically evoked responses, including the onset response and the eACC, were measured for two stimulation conditions. In the standard condition, the 800-msec pulse train was delivered uninterrupted to individual stimulating electrodes. In the gapped condition, a temporal gap was inserted into the pulse train after 400 msec of stimulation. Gap durations tested in this study ranged from 2 up to 128 msec. The shortest gap that could reliably evoke the eACC was defined as the objective gap detection threshold (GDT). For behavioral GDT measures, the stimulus was a 500-msec biphasic pulse train presented at the C level. The behavioral GDT was measured for individual stimulating electrodes using a one-interval, two-alternative forced-choice procedure. Results: The eACCs to temporal gaps were recorded successfully in all subjects for at least one stimulating electrode using either the ABI or the CI. Objective GDTs showed intersubject variations, as well as variations across stimulating electrodes of the ABI or the CI within each subject. Behavioral GDTs were measured for one ABI electrode in S2 and for multiple ABI and CI electrodes in S5. All other subjects could not complete the task. S5 showed smaller behavioral GDTs for CI electrodes than those measured for ABI electrodes. One CI and two ABI electrodes in S5 showed comparable objective and behavioral GDTs. In contrast, one CI and two ABI electrodes in S5 and one ABI electrode in S2 showed measurable behavioral GDTs but no identifiable eACCs. Conclusions: The eACCs to temporal gaps were recorded in children with CND using either ABIs or CIs. Both objective and behavioral GDTs showed inter- and intrasubject variations. Consistency between results of eACC recordings and psychophysical measures of GDT was observed for some but not all ABI or CI electrodes in these subjects. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Patients' and Clinicians' Views of the Psychological Components of Tinnitus Treatment That Could Inform Audiologists' Usual Care: A Delphi Survey.

Objectives: The aim of this study was to determine which components of psychological therapies are most important and appropriate to inform audiologists' usual care for people with tinnitus. Design: A 39-member panel of patients, audiologists, hearing therapists, and psychologists completed a three-round Delphi survey to reach consensus on essential components of audiologist-delivered psychologically informed care for tinnitus. Results: Consensus (>=80% agreement) was reached on including 76 of 160 components. No components reached consensus for exclusion. The components reaching consensus were predominantly common therapeutic skills such as Socratic questioning and active listening, rather than specific techniques, for example, graded exposure therapy or cognitive restructuring. Consensus on educational components to include largely concerned psychological models of tinnitus rather than neurophysiological information. Conclusions: The results of this Delphi survey provide a tool to develop audiologists' usual tinnitus care using components that both patients and clinicians agree are important and appropriate to be delivered by an audiologist for adults with tinnitus-related distress. Research is now necessary to test the added effects of these components when delivered by audiologists. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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An Innovative and Cost Effective Approach to Wireless Remote Microphones in Schools

This article reviews the use of Hearing Assistive Technology in educational settings and presents a cost-effective solution for usage of the most commonly recommended technology.

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Madsen Zodiac - What's New in Immittance!

Instruction for efficient use of the Madsen Zodiac Immittance device.

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Rethinking Your Diagnostic Audiology Battery: Using Value Added Tests

Guidance for creating an individualized diagnostic test battery for each patient to enhance efficient and accurate assessment of auditory function. This practical course stresses the importance of selecting test procedures that add value to the diagnosis and management of hearing loss and related disorders.

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Introduction to the New Tempus Platform and the World's Smallest Rechargeable Solution

Review of the features and benefits of Unitron’s new Tempus™ hearing instrument platform.

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20Q: Hearing Loss and Its Comorbidities

A discussion of common hearing loss comorbidities, with implications for audiology clinical practice, written in an engaging Q & A format.

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Meet Enchant

An overview of the Enchant hearing instrument family from Sonic.

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Comparison of Music Sound Quality Between Hearing Aids and Music Programs

While hearing aid users often wear their hearing aids for music listening, they are frequently dissatisfied with the sound quality of music. This articles describes a study of music sound quality ratings between the universal and music programs of five premiere market hearing aids.

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The Simple Way to Hear More with the Naida Link CROS Solution

An overview of Advanced Bionic’s newest innovation, the Naída Link CROS Solution, including candidacy, features, and benefits.

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iotaMotion Receives NIH Grant to Develop Robotics for Cochlear Implant Surgery

​The medical device startup iotaMotion (http://iotamotion.com/) has been awarded a $1.4 million grant from the National Institutes of Health (NIH) to develop its next-generation implantable robotic technology IOTA-Progress. The company will use this funding from the NIH's Small Business Innovation Research program to hone a robotic-assisted cochlear implant insertion system that will provide precise and controlled electrode advancement during hybrid cochlear implant surgeries. Marlan Hansen, MD, one of the founders of iotaMotion, said providing a more controlled, fine electrode insertion of the electrode should significantly enhance professionals' ability to preserve hearing. "Then we have what this grant is helping to fund for our company, which is the development of an implantable system allowing for electrode adjustments within the cochlea after the original surgery, without surgical intervention," Hansen said. "The goal here is optimal positioning within the cochlea to best match that patient's hearing, which often changes over time."

Published: 9/29/2017 9:16:00 AM

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Owls May Shed Light on Age-Related Hearing Loss Prevention

Researchers in Europe found that barn owls have what they call "ageless ears," which could potentially help with identifying new treatment options for hearing-impaired humans (Proc Biol Sci 2017;284[1863] pii: 20171584). They measured the auditory sensitivity of seven barn owls ranging from less than 2 years old to 23 years old by training them to fly to a perch to receive a food reward in response to an auditory cue. Young and old owls both responded to the varying levels of auditory cues, and the oldest owl at 23 years old heard just as well as the younger owls. ​Georg Klump, a professor at the University of Oldenburg, Germany and one of the study authors, told BBC that owls keep their hearing into very old age. "Birds can repair their ears like (humans) can repair a wound," he said. "Humans cannot re-grow the sensory cells of the ears but birds can do this." Work is underway to investigate the differences between birds and mammals, which commonly lose their hearing at old age. ​

​Photo credit: ​Lubos Houska

Published: 9/22/2017 9:55:00 AM

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UNGA Highlights Global Ear and Hearing Health

Hearing health took center stage at the high-level United Nations General Assembly panel on "Ear Care and Hearing Health"​ last September 14, with keynote speaker former U.S. President Bill Clinton. 

Organized by the International Federation for Peace and Sustainable Development (IFPSD) and the Permanent Mission of Guatemala to the U.N., the meeting highlighted the global impact of hearing impairment, as well as the importance of hearing health in promoting peace and sustainability, especially in developing nations.

"It is important to know that children in developing countries are seven times more likely to experience hearing loss because of avoidable conditions that routine checkup and treatment can take care of in countries with comprehensive health care system," said Clinton.

William F. Austin, the founder of the Starkey Hearing Foundation, which has worked with the Clinton Global Initiative on hearing health projects, was the other keynote speaker and named the first Goodwill Global Ambassador for Ear and Hearing.

In the first panel, the keynote speakers and fellow panelist tackled the need for increased support and funding ear and hearing health.

Hearing "helps us understand each other and creates more avenues for peace and development," said Sandra Granger, first lady of the Cooperative Republic of Guyana, who was also part of the panel. "It is not only hearing as a sense but also the connection with the rest of the world that we all need and desire."

 

"If you think about it, this is a problem of manageable cause with a proven delivery system that has a community-based solution to promote hearing health and to maintain the supply chain," Clinton said.

"If we get enough people trained then we can feed that system with instruments needed to satisfy the broader problem," Austin noted on developing solutions.

The second panel, which focused on the global status of ear and hearing health, was moderated by Barbara Bush, CEO and co-founder of the Global Health Corps.

"We can work as hard as we want to every single day on solving health issues, but if someone can't access the health care system because they can't hear, that's not a 'nice' to have--that's a 'must' to have," shared Bush.

In this panel, Charlotte Chiong, MD of the University of the Philippines recapped the recently approved World Health Assembly resolution that underscored the need to integrate ear and hearing health within primary health care. The resolution also called for improved training of medical professionals, informed government policies, implementation of hearing screenings, and enhanced access to cost-effective hearing services and devices.

"Everybody should think of hearing as a right to life," said Chiong. "Nobody gets left behind."

Published: 9/19/2017 12:04:00 PM

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Comparison of the Spectral-Temporally Modulated Ripple Test With the Arizona Biomedical Institute Sentence Test in Cochlear Implant Users.

Objectives: Although speech perception is the gold standard for measuring cochlear implant (CI) users' performance, speech perception tests often require extensive adaptation to obtain accurate results, particularly after large changes in maps. Spectral ripple tests, which measure spectral resolution, are an alternate measure that has been shown to correlate with speech perception. A modified spectral ripple test, the spectral-temporally modulated ripple test (SMRT) has recently been developed, and the objective of this study was to compare speech perception and performance on the SMRT for a heterogeneous population of unilateral CI users, bilateral CI users, and bimodal users. Design: Twenty-five CI users (eight using unilateral CIs, nine using bilateral CIs, and eight using a CI and a hearing aid) were tested on the Arizona Biomedical Institute Sentence Test (AzBio) with a +8 dB signal to noise ratio, and on the SMRT. All participants were tested with their clinical programs. Results: There was a significant correlation between SMRT and AzBio performance. After a practice block, an improvement of one ripple per octave for SMRT corresponded to an improvement of 12.1% for AzBio. Additionally, there was no significant difference in slope or intercept between any of the CI populations. Conclusion: The results indicate that performance on the SMRT correlates with speech recognition in noise when measured across unilateral, bilateral, and bimodal CI populations. These results suggest that SMRT scores are strongly associated with speech recognition in noise ability in experienced CI users. Further studies should focus on increasing both the size and diversity of the tested participants, and on determining whether the SMRT technique can be used for early predictions of long-term speech scores, or for evaluating differences among different stimulation strategies or parameter settings. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Learning Effects in Psychophysical Tests of Spectral and Temporal Resolution.

Objectives: Psychophysical tests of spectral and temporal resolution, such as the spectral-ripple discrimination task and the temporal modulation detection test, are valuable tools for the evaluation of cochlear implant performance. Both tests correlate with speech intelligibility and are reported to show no instantaneous learning effect. However, some of our previous trials have suggested that there is a learning effect over time. The aim of this study was to investigate the test-retest reliability of the two tests when measured over time. Design: Ten adult cochlear implant recipients, experienced with the HiResolution speech coding strategy, participated in this study. Spectral ripple discrimination and temporal modulation detection ability with the HiResolution strategy were assessed both before and after participation in a previous trial that evaluated two research speech coding strategies after 2 weeks of home-usage. Each test was repeated six times on each test day. Results: No improvement was observed for same-day testing. However, comparison of the mean spectral ripple discrimination scores before and after participation in the take-home trial showed improvement from 3.4 to 4.8 ripples per octave (p

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Use of Electrically Evoked Compound Action Potentials for Cochlear Implant Fitting: A Systematic Review.

Objectives: The electrically evoked compound action potential (eCAP) is widely used in the clinic as an objective measure to assess cochlear implant functionality. During the past decade, there has been increasing interest in applying eCAPs for fitting of cochlear implants. Several studies have shown that eCAP-based fitting can potentially replace time-consuming behavioral fitting procedures, especially in young children. However, a closer look to all available literature revealed that there is no clear consensus on the validity of this fitting procedure. This study evaluated the validity of eCAP-based fitting of cochlear implant recipients based on a systematic review of the recent literature. Design: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to search the PubMed, Web of Science, and Cochrane Library databases. The term "eCAP" was combined with "cochlear implants," "thresholds," and "levels," in addition to a range of related terms. Finally, 32 studies met the inclusion criteria. These studies were evaluated on the risk of bias and, when possible, compared by meta-analysis. Results: Almost all assessed studies suffered from some form of risk of bias. Twenty-nine of the studies based their conclusion on a group correlation instead of individual subject correlations (analytical bias); 14 studies were unclear about randomization or blinding (outcome assessment bias); 9 studies provided no clear description of the populations used, for example, prelingually or postlingually implanted subjects (selection bias); and 4 studies had a high rate of loss (>10%) for patients or electrodes (attrition bias). Meta-analysis of these studies revealed a weak pooled correlation between eCAP thresholds and both behavioral T- and C-levels (r = 0.58 and r = 0.61, respectively). Conclusions: This review shows that the majority of the assessed studies suffered from substantial shortcomings in study design and statistical analysis. Meta-analysis showed that there is only weak evidence to support the use of eCAP data for cochlear implant fitting purposes; eCAP thresholds are an equally weak predictor for both T- and C-levels. Based on this review, it can be concluded that research on eCAP-based fitting needs a profound reflection on study design and analysis to draw well-grounded conclusions about the validity of eCAP-based fitting of cochlear implant recipients. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Binaural Pitch Fusion in Bilateral Cochlear Implant Users.

Objectives: Binaural pitch fusion is the fusion of stimuli that evoke different pitches between the ears into a single auditory image. Individuals who use hearing aids or bimodal cochlear implants (CIs) experience abnormally broad binaural pitch fusion, such that sounds differing in pitch by as much as 3-4 octaves are fused across ears, leading to spectral averaging and speech perception interference. The goal of this study was to determine if adult bilateral CI users also experience broad binaural pitch fusion. Design: Stimuli were pulse trains delivered to individual electrodes. Fusion ranges were measured using simultaneous, dichotic presentation of reference and comparison stimuli in opposite ears, and varying the comparison stimulus to find the range that fused with the reference stimulus. Results: Bilateral CI listeners had binaural pitch fusion ranges varying from 0 to 12 mm (average 6.1 +/- 3.9 mm), where 12 mm indicates fusion over all electrodes in the array. No significant correlations of fusion range were observed with any subject factors related to age, hearing loss history, or hearing device history, or with any electrode factors including interaural electrode pitch mismatch, pitch match bandwidth, or within-ear electrode discrimination abilities. Conclusions: Bilateral CI listeners have abnormally broad fusion, similar to hearing aid and bimodal CI listeners. This broad fusion may explain the variability of binaural benefits for speech perception in quiet and in noise in bilateral CI users. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Extrinsic Cognitive Load Impairs Spoken Word Recognition in High- and Low-Predictability Sentences.

Objectives: Listening effort (LE) induced by speech degradation reduces performance on concurrent cognitive tasks. However, a converse effect of extrinsic cognitive load on recognition of spoken words in sentences has not been shown. The aims of the present study were to (a) examine the impact of extrinsic cognitive load on spoken word recognition in a sentence recognition task and (b) determine whether cognitive load and/or LE needed to understand spectrally degraded speech would differentially affect word recognition in high- and low-predictability sentences. Downstream effects of speech degradation and sentence predictability on the cognitive load task were also examined. Design: One hundred twenty young adults identified sentence-final spoken words in high- and low-predictability Speech Perception in Noise sentences. Cognitive load consisted of a preload of short (low-load) or long (high-load) sequences of digits, presented visually before each spoken sentence and reported either before or after identification of the sentence-final word. LE was varied by spectrally degrading sentences with four-, six-, or eight-channel noise vocoding. Level of spectral degradation and order of report (digits first or words first) were between-participants variables. Effects of cognitive load, sentence predictability, and speech degradation on accuracy of sentence-final word identification as well as recall of preload digit sequences were examined. Results: In addition to anticipated main effects of sentence predictability and spectral degradation on word recognition, we found an effect of cognitive load, such that words were identified more accurately under low load than high load. However, load differentially affected word identification in high- and low-predictability sentences depending on the level of sentence degradation. Under severe spectral degradation (four-channel vocoding), the effect of cognitive load on word identification was present for high-predictability sentences but not for low-predictability sentences. Under mild spectral degradation (eight-channel vocoding), the effect of load was present for low-predictability sentences but not for high-predictability sentences. There were also reliable downstream effects of speech degradation and sentence predictability on recall of the preload digit sequences. Long digit sequences were more easily recalled following spoken sentences that were less spectrally degraded. When digits were reported after identification of sentence-final words, short digit sequences were recalled more accurately when the spoken sentences were predictable. Conclusions: Extrinsic cognitive load can impair recognition of spectrally degraded spoken words in a sentence recognition task. Cognitive load affected word identification in both high- and low-predictability sentences, suggesting that load may impact both context use and lower-level perceptual processes. Consistent with prior work, LE also had downstream effects on memory for visual digit sequences. Results support the proposal that extrinsic cognitive load and LE induced by signal degradation both draw on a central, limited pool of cognitive resources that is used to recognize spoken words in sentences under adverse listening conditions. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Mindfulness-Based Cognitive Therapy for Chronic Tinnitus: Evaluation of Benefits in a Large Sample of Patients Attending a Tinnitus Clinic.

Objectives: Mindfulness-based approaches may benefit patients with chronic tinnitus, but most evidence is from small studies of nonstandardized interventions, and there is little exploration of the processes of change. This study describes the impact of mindfulness-based cognitive therapy (MBCT) in a "real world" tinnitus clinic, using standardized MBCT on the largest sample of patients with chronic tinnitus to date while exploring predictors of change. Design: Participants were 182 adults with chronic and distressing tinnitus who completed an 8-week MBCT group. Measures of tinnitus-related distress, psychological distress, tinnitus acceptance, and mindfulness were taken preintervention, postintervention, and at 6-week follow-up. Results: MBCT was associated with significant improvements on all outcome measures. Postintervention, reliable improvements were detected in tinnitus-related distress in 50% and in psychological distress in 41.2% of patients. Changes in mindfulness and tinnitus acceptance explained unique variance in tinnitus-related and psychological distress postintervention. Conclusions: MBCT was associated with significant and reliable improvements in patients with chronic, distressing tinnitus. Changes were associated with increases in tinnitus acceptance and dispositional mindfulness. This study doubles the combined sample size of all previously published studies. Randomized controlled trials of standardized MBCT protocols are now required to test whether MBCT might offer a new and effective treatment for chronic tinnitus. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Listening Effort: How the Cognitive Consequences of Acoustic Challenge Are Reflected in Brain and Behavior.

Everyday conversation frequently includes challenges to the clarity of the acoustic speech signal, including hearing impairment, background noise, and foreign accents. Although an obvious problem is the increased risk of making word identification errors, extracting meaning from a degraded acoustic signal is also cognitively demanding, which contributes to increased listening effort. The concepts of cognitive demand and listening effort are critical in understanding the challenges listeners face in comprehension, which are not fully predicted by audiometric measures. In this article, the authors review converging behavioral, pupillometric, and neuroimaging evidence that understanding acoustically degraded speech requires additional cognitive support and that this cognitive load can interfere with other operations such as language processing and memory for what has been heard. Behaviorally, acoustic challenge is associated with increased errors in speech understanding, poorer performance on concurrent secondary tasks, more difficulty processing linguistically complex sentences, and reduced memory for verbal material. Measures of pupil dilation support the challenge associated with processing a degraded acoustic signal, indirectly reflecting an increase in neural activity. Finally, functional brain imaging reveals that the neural resources required to understand degraded speech extend beyond traditional perisylvian language networks, most commonly including regions of prefrontal cortex, premotor cortex, and the cingulo-opercular network. Far from being exclusively an auditory problem, acoustic degradation presents listeners with a systems-level challenge that requires the allocation of executive cognitive resources. An important point is that a number of dissociable processes can be engaged to understand degraded speech, including verbal working memory and attention-based performance monitoring. The specific resources required likely differ as a function of the acoustic, linguistic, and cognitive demands of the task, as well as individual differences in listeners' abilities. A greater appreciation of cognitive contributions to processing degraded speech is critical in understanding individual differences in comprehension ability, variability in the efficacy of assistive devices, and guiding rehabilitation approaches to reducing listening effort and facilitating communication. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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The Electrically Evoked Auditory Change Complex Evoked by Temporal Gaps Using Cochlear Implants or Auditory Brainstem Implants in Children With Cochlear Nerve Deficiency.

Objectives: This study aimed to (1) establish the feasibility of measuring the electrically evoked auditory change complex (eACC) in response to temporal gaps in children with cochlear nerve deficiency (CND) who are using cochlear implants (CIs) and/or auditory brainstem implants (ABIs); and (2) explore the association between neural encoding of, and perceptual sensitivity to, temporal gaps in these patients. Design: Study participants included 5 children (S1 to S5) ranging in age from 3.8 to 8.2 years (mean: 6.3 years) at the time of testing. All subjects were unilaterally implanted with a Nucleus 24M ABI due to CND. For each subject, two or more stimulating electrodes of the ABI were tested. S2, S3, and S5 previously received a CI in the contralateral ear. For these 3 subjects, at least two stimulating electrodes of their CIs were also tested. For electrophysiological measures, the stimulus was an 800-msec biphasic pulse train delivered to individual electrodes at the maximum comfortable level (C level). The electrically evoked responses, including the onset response and the eACC, were measured for two stimulation conditions. In the standard condition, the 800-msec pulse train was delivered uninterrupted to individual stimulating electrodes. In the gapped condition, a temporal gap was inserted into the pulse train after 400 msec of stimulation. Gap durations tested in this study ranged from 2 up to 128 msec. The shortest gap that could reliably evoke the eACC was defined as the objective gap detection threshold (GDT). For behavioral GDT measures, the stimulus was a 500-msec biphasic pulse train presented at the C level. The behavioral GDT was measured for individual stimulating electrodes using a one-interval, two-alternative forced-choice procedure. Results: The eACCs to temporal gaps were recorded successfully in all subjects for at least one stimulating electrode using either the ABI or the CI. Objective GDTs showed intersubject variations, as well as variations across stimulating electrodes of the ABI or the CI within each subject. Behavioral GDTs were measured for one ABI electrode in S2 and for multiple ABI and CI electrodes in S5. All other subjects could not complete the task. S5 showed smaller behavioral GDTs for CI electrodes than those measured for ABI electrodes. One CI and two ABI electrodes in S5 showed comparable objective and behavioral GDTs. In contrast, one CI and two ABI electrodes in S5 and one ABI electrode in S2 showed measurable behavioral GDTs but no identifiable eACCs. Conclusions: The eACCs to temporal gaps were recorded in children with CND using either ABIs or CIs. Both objective and behavioral GDTs showed inter- and intrasubject variations. Consistency between results of eACC recordings and psychophysical measures of GDT was observed for some but not all ABI or CI electrodes in these subjects. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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Patients' and Clinicians' Views of the Psychological Components of Tinnitus Treatment That Could Inform Audiologists' Usual Care: A Delphi Survey.

Objectives: The aim of this study was to determine which components of psychological therapies are most important and appropriate to inform audiologists' usual care for people with tinnitus. Design: A 39-member panel of patients, audiologists, hearing therapists, and psychologists completed a three-round Delphi survey to reach consensus on essential components of audiologist-delivered psychologically informed care for tinnitus. Results: Consensus (>=80% agreement) was reached on including 76 of 160 components. No components reached consensus for exclusion. The components reaching consensus were predominantly common therapeutic skills such as Socratic questioning and active listening, rather than specific techniques, for example, graded exposure therapy or cognitive restructuring. Consensus on educational components to include largely concerned psychological models of tinnitus rather than neurophysiological information. Conclusions: The results of this Delphi survey provide a tool to develop audiologists' usual tinnitus care using components that both patients and clinicians agree are important and appropriate to be delivered by an audiologist for adults with tinnitus-related distress. Research is now necessary to test the added effects of these components when delivered by audiologists. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.

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An Innovative and Cost Effective Approach to Wireless Remote Microphones in Schools

This article reviews the use of Hearing Assistive Technology in educational settings and presents a cost-effective solution for usage of the most commonly recommended technology.

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Madsen Zodiac - What's New in Immittance!

Instruction for efficient use of the Madsen Zodiac Immittance device.

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Rethinking Your Diagnostic Audiology Battery: Using Value Added Tests

Guidance for creating an individualized diagnostic test battery for each patient to enhance efficient and accurate assessment of auditory function. This practical course stresses the importance of selecting test procedures that add value to the diagnosis and management of hearing loss and related disorders.

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Introduction to the New Tempus Platform and the World's Smallest Rechargeable Solution

Review of the features and benefits of Unitron’s new Tempus™ hearing instrument platform.

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20Q: Hearing Loss and Its Comorbidities

A discussion of common hearing loss comorbidities, with implications for audiology clinical practice, written in an engaging Q & A format.

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Meet Enchant

An overview of the Enchant hearing instrument family from Sonic.

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Comparison of Music Sound Quality Between Hearing Aids and Music Programs

While hearing aid users often wear their hearing aids for music listening, they are frequently dissatisfied with the sound quality of music. This articles describes a study of music sound quality ratings between the universal and music programs of five premiere market hearing aids.

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The Simple Way to Hear More with the Naida Link CROS Solution

An overview of Advanced Bionic’s newest innovation, the Naída Link CROS Solution, including candidacy, features, and benefits.

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How to Choose Between Measures of Tinnitus Loudness for Clinical Research? A Report on the Reliability and Validity of an Investigator-Administered Test and a Patient-Reported Measure Using Baseline Data Collected in a Phase IIa Drug Trial

Purpose

Loudness is a major auditory dimension of tinnitus and is used to diagnose severity, counsel patients, or as a measure of clinical efficacy in audiological research. There is no standard test for tinnitus loudness, but matching and rating methods are popular. This article provides important new knowledge about the reliability and validity of an audiologist-administered tinnitus loudness matching test and a patient-reported tinnitus loudness rating.

Method

Retrospective analysis of loudness data for 91 participants with stable subjective tinnitus enrolled in a randomized controlled trial of a novel drug for tinnitus. There were two baseline assessments (screening, Day 1) and a posttreatment assessment (Day 28).

Results

About 66%–70% of the variability from screening to Day 1 was attributable to the true score. But measurement error, indicated by the smallest detectable change, was high for both tinnitus loudness matching (20 dB) and tinnitus loudness rating (3.5 units). Only loudness rating captured a sensation that was meaningful to people who lived with the experience of tinnitus.

Conclusions

The tinnitus loudness rating performed better against acceptability criteria for reliability and validity than did the tinnitus loudness matching test administered by an audiologist. But the rating question is still limited because it is a single-item instrument and is probably able to detect only large changes (at least 3.5 points).

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Understanding Hearing and Hearing Loss in Children With Down Syndrome

Purpose

This study evaluated the prevalence of permanent and transient hearing loss, the use of hearing aids as a recommendation, and middle ear dysfunction in children with Down syndrome (DS) through a large multiage and ethnically diverse sample, using current audiologic testing practices.

Method

Retrospective analysis of data collected on 308 children with DS (168 boys, 140 girls; average age = 5.99 ± 4.88 years) who received an audiological evaluation during 2013 as part of their medical care at a large pediatric hospital.

Results

Permanent hearing loss was identified in 24.9% of the children, among whom bilateral (75.4%) and conductive (33.3%) hearing losses occurred most often. Of children with DS, 22%–30% experienced a transient hearing loss, with a high incidence of middle ear pathologies from infancy until early adulthood. There were no statistical differences between ethnicity and permanent/transient hearing loss diagnosis. Twenty-three percent were current hearing aid users or had them recommended in a treatment plan.

Conclusions

The prevalence of hearing loss and abnormal middle ear status is high in the pediatric population with DS. Audiologic evaluations should follow the American Academy of Pediatrics practice guidelines to monitor this high-risk population, and amplification should be considered as an appropriate intervention option if repeated audiologic examinations reveal hearing loss.

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(Central) Auditory Processing Disorder Grand Rounds: Multiple Cases, Multiple Causes, Multiple Outcomes

Purpose

The purpose of this article was to provide multiple examples of how (central) auditory processing disorder ([C]APD) is being evaluated and treated at various audiology clinics throughout the United States.

Method

The authors present 5 cases highlighting the diagnosis and treatment of (C)APD in children and adults. Similarities and differences between these cases have been showcased through detailed histories, evaluation protocol, and treatment options. When possible, the rationale for evaluation procedures and intervention processes were described and compared with guidelines and findings within the literature.

Results and Conclusions

These cases illustrate the varied processes and clinical protocols by which children and adults are evaluated, diagnosed, counseled, and treated for (C)APD. In addition, similarities and differences between the referral source, evaluation team, developmental history, comorbidities, test battery, recommendations, and remediations were described. The multiple clinic sites, diversity of clinical philosophies, variety of test measures, and diversity of patient populations make these cases ideal for showcasing the assortment of methodologies used with patients who present with histories and characteristics consistent with (C)APD.

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The Effectiveness of the Progression of Widex Zen Tinnitus Therapy: A Pilot Study

Purpose

The aim of this study was to measure the progression of benefits to individuals with tinnitus from providing informational counseling, hearing aids, a brief tinnitus activities treatment and Zen therapy.

Method

Several magnitude estimation scales and tinnitus handicap scales were administered for the duration of the study to 20 participants.

Results

Results indicated that all participants benefited from this sequential approach of providing different components of this tinnitus treatment. Large benefits were observed following the tinnitus activities treatment and the Zen treatments.

Conclusion

We conclude that the progressive approach of treatment demonstrated here should be of benefit to most individuals with tinnitus and that the Widex Zen sound therapy is a worthwhile treatment for many tinnitus sufferers.

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Written Instructions vs. Audiology Service for PSAP Use

No abstract available

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Where Do You Place Value?

No abstract available

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‘Least Stressful’ Job in America?Demystifying workplace stress in audiology

No abstract available

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Musical and Brain Training. How previous and current trainings enhance cognition

No abstract available

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Autoimmune Inner Ear Disorders: A Case Study

No abstract available

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Targeted Screening for Cytomegalovirus and Hearing Loss

No abstract available

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Symptom: Conductive Hearing Loss After Stapedectomy

No abstract available

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Monitoring Children With Hearing Fluctuation

No abstract available

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