Development of Velopharyngeal Closure for Vocalization During the First 2 Years of Life

Purpose

The vocalizations of young infants often sound nasalized, suggesting that the velopharynx is open during the 1st few months of life. Whereas acoustic and perceptual studies seemed to support the idea that the velopharynx closes for vocalization by about 4 months of age, an aeromechanical study contradicted this (Thom, Hoit, Hixon, & Smith, 2006). Thus, the current large-scale investigation was undertaken to determine when the velopharynx closes for speech production by following infants during their first 2 years of life.

Method

This longitudinal study used nasal ram pressure to determine the status of the velopharynx (open or closed) during spontaneous speech production in 92 participants (46 male, 46 female) studied monthly from age 4 to 24 months.

Results

The velopharynx was closed during at least 90% of the utterances by 19 months, though there was substantial variability across participants. When considered by sound category, the velopharynx was closed from most to least often during production of oral obstruents, approximants, vowels (only), and glottal obstruents. No sex effects were observed.

Conclusion

Velopharyngeal closure for spontaneous speech production can be considered complete by 19 months, but closure occurs earlier for speech sounds with higher oral pressure demands.

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Targeting Complex Sentences in Older School Children With Specific Language Impairment: Results From an Early-Phase Treatment Study

Purpose

This study investigated the effects of a complex sentence treatment at 2 dosage levels on language performance of 30 school-age children ages 10–14 years with specific language impairment.

Method

Three types of complex sentences (adverbial, object complement, relative) were taught in sequence in once or twice weekly dosage conditions. Outcome measures included sentence probes administered at baseline, treatment, and posttreatment phases and comparisons of pre–post performance on oral and written language tests and tasks. Relationships between pretest variables and treatment outcomes were also explored.

Results

Treatment was effective at improving performance on the sentence probes for the majority of participants; however, results differed by sentence type, with the largest effect sizes for adverbial and relative clauses. Significant and clinically meaningful pre–post treatment gains were found on a comprehensive oral language test, but not on reading and writing measures. There was no treatment advantage for the higher dosage group. Several significant correlations indicated a relationship between lower pretest scores and higher outcome measures.

Conclusions

Results suggest that a focused intervention can produce improvements in complex sentence productions of older school children with language impairment. Future research should explore ways to maximize gains and extend impact to natural language contexts.

Supplemental Material

https://doi.org/10.23641/asha.5923318

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Vocalization Subsystem Responses to a Temporarily Induced Unilateral Vocal Fold Paralysis

Purpose

The purpose of this study is to quantify the interactions of the 3 vocalization subsystems of respiration, phonation, and resonance before, during, and after a perturbation to the larynx (temporarily induced unilateral vocal fold paralysis) in 10 vocally healthy participants. Using dynamic systems theory as a guide, we hypothesized that data groupings would emerge revealing context-dependent patterns in the relationships of variables representing the 3 vocalization subsystems. We also hypothesized that group data would mask important individual variability important to understanding the relationships among the vocalization subsystems.

Method

A perturbation paradigm was used to obtain respiratory kinematic, aerodynamic, and acoustic formant measures from 10 healthy participants (8 women, 2 men) with normal voices. Group and individual data were analyzed to provide a multilevel analysis of the data. A 3-dimensional state space model was constructed to demonstrate the interactive relationships among the 3 subsystems before, during, and after perturbation.

Results

During perturbation, group data revealed that lung volume initiations and terminations were lower, with longer respiratory excursions; airflow rates increased while subglottic pressures were maintained. Acoustic formant measures indicated that the spacing between the upper formants decreased (F3–F5), whereas the spacing between F1 and F2 increased. State space modeling revealed the changing directionality and interactions among the 3 subsystems.

Conclusions

Group data alone masked important variability necessary to understand the unique relationships among the 3 subsystems. Multilevel analysis permitted a richer understanding of the individual differences in phonatory regulation and permitted subgroup analysis. Dynamic systems theory may be a useful heuristic to model the interactive relationships among vocalization subsystems.

Supplemental Material

https://doi.org/10.23641/asha.5913532

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Development of Velopharyngeal Closure for Vocalization During the First 2 Years of Life

Purpose

The vocalizations of young infants often sound nasalized, suggesting that the velopharynx is open during the 1st few months of life. Whereas acoustic and perceptual studies seemed to support the idea that the velopharynx closes for vocalization by about 4 months of age, an aeromechanical study contradicted this (Thom, Hoit, Hixon, & Smith, 2006). Thus, the current large-scale investigation was undertaken to determine when the velopharynx closes for speech production by following infants during their first 2 years of life.

Method

This longitudinal study used nasal ram pressure to determine the status of the velopharynx (open or closed) during spontaneous speech production in 92 participants (46 male, 46 female) studied monthly from age 4 to 24 months.

Results

The velopharynx was closed during at least 90% of the utterances by 19 months, though there was substantial variability across participants. When considered by sound category, the velopharynx was closed from most to least often during production of oral obstruents, approximants, vowels (only), and glottal obstruents. No sex effects were observed.

Conclusion

Velopharyngeal closure for spontaneous speech production can be considered complete by 19 months, but closure occurs earlier for speech sounds with higher oral pressure demands.

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Targeting Complex Sentences in Older School Children With Specific Language Impairment: Results From an Early-Phase Treatment Study

Purpose

This study investigated the effects of a complex sentence treatment at 2 dosage levels on language performance of 30 school-age children ages 10–14 years with specific language impairment.

Method

Three types of complex sentences (adverbial, object complement, relative) were taught in sequence in once or twice weekly dosage conditions. Outcome measures included sentence probes administered at baseline, treatment, and posttreatment phases and comparisons of pre–post performance on oral and written language tests and tasks. Relationships between pretest variables and treatment outcomes were also explored.

Results

Treatment was effective at improving performance on the sentence probes for the majority of participants; however, results differed by sentence type, with the largest effect sizes for adverbial and relative clauses. Significant and clinically meaningful pre–post treatment gains were found on a comprehensive oral language test, but not on reading and writing measures. There was no treatment advantage for the higher dosage group. Several significant correlations indicated a relationship between lower pretest scores and higher outcome measures.

Conclusions

Results suggest that a focused intervention can produce improvements in complex sentence productions of older school children with language impairment. Future research should explore ways to maximize gains and extend impact to natural language contexts.

Supplemental Material

https://doi.org/10.23641/asha.5923318

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Vocalization Subsystem Responses to a Temporarily Induced Unilateral Vocal Fold Paralysis

Purpose

The purpose of this study is to quantify the interactions of the 3 vocalization subsystems of respiration, phonation, and resonance before, during, and after a perturbation to the larynx (temporarily induced unilateral vocal fold paralysis) in 10 vocally healthy participants. Using dynamic systems theory as a guide, we hypothesized that data groupings would emerge revealing context-dependent patterns in the relationships of variables representing the 3 vocalization subsystems. We also hypothesized that group data would mask important individual variability important to understanding the relationships among the vocalization subsystems.

Method

A perturbation paradigm was used to obtain respiratory kinematic, aerodynamic, and acoustic formant measures from 10 healthy participants (8 women, 2 men) with normal voices. Group and individual data were analyzed to provide a multilevel analysis of the data. A 3-dimensional state space model was constructed to demonstrate the interactive relationships among the 3 subsystems before, during, and after perturbation.

Results

During perturbation, group data revealed that lung volume initiations and terminations were lower, with longer respiratory excursions; airflow rates increased while subglottic pressures were maintained. Acoustic formant measures indicated that the spacing between the upper formants decreased (F3–F5), whereas the spacing between F1 and F2 increased. State space modeling revealed the changing directionality and interactions among the 3 subsystems.

Conclusions

Group data alone masked important variability necessary to understand the unique relationships among the 3 subsystems. Multilevel analysis permitted a richer understanding of the individual differences in phonatory regulation and permitted subgroup analysis. Dynamic systems theory may be a useful heuristic to model the interactive relationships among vocalization subsystems.

Supplemental Material

https://doi.org/10.23641/asha.5913532

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Development of Velopharyngeal Closure for Vocalization During the First 2 Years of Life

Purpose

The vocalizations of young infants often sound nasalized, suggesting that the velopharynx is open during the 1st few months of life. Whereas acoustic and perceptual studies seemed to support the idea that the velopharynx closes for vocalization by about 4 months of age, an aeromechanical study contradicted this (Thom, Hoit, Hixon, & Smith, 2006). Thus, the current large-scale investigation was undertaken to determine when the velopharynx closes for speech production by following infants during their first 2 years of life.

Method

This longitudinal study used nasal ram pressure to determine the status of the velopharynx (open or closed) during spontaneous speech production in 92 participants (46 male, 46 female) studied monthly from age 4 to 24 months.

Results

The velopharynx was closed during at least 90% of the utterances by 19 months, though there was substantial variability across participants. When considered by sound category, the velopharynx was closed from most to least often during production of oral obstruents, approximants, vowels (only), and glottal obstruents. No sex effects were observed.

Conclusion

Velopharyngeal closure for spontaneous speech production can be considered complete by 19 months, but closure occurs earlier for speech sounds with higher oral pressure demands.

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Targeting Complex Sentences in Older School Children With Specific Language Impairment: Results From an Early-Phase Treatment Study

Purpose

This study investigated the effects of a complex sentence treatment at 2 dosage levels on language performance of 30 school-age children ages 10–14 years with specific language impairment.

Method

Three types of complex sentences (adverbial, object complement, relative) were taught in sequence in once or twice weekly dosage conditions. Outcome measures included sentence probes administered at baseline, treatment, and posttreatment phases and comparisons of pre–post performance on oral and written language tests and tasks. Relationships between pretest variables and treatment outcomes were also explored.

Results

Treatment was effective at improving performance on the sentence probes for the majority of participants; however, results differed by sentence type, with the largest effect sizes for adverbial and relative clauses. Significant and clinically meaningful pre–post treatment gains were found on a comprehensive oral language test, but not on reading and writing measures. There was no treatment advantage for the higher dosage group. Several significant correlations indicated a relationship between lower pretest scores and higher outcome measures.

Conclusions

Results suggest that a focused intervention can produce improvements in complex sentence productions of older school children with language impairment. Future research should explore ways to maximize gains and extend impact to natural language contexts.

Supplemental Material

https://doi.org/10.23641/asha.5923318

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Vocalization Subsystem Responses to a Temporarily Induced Unilateral Vocal Fold Paralysis

Purpose

The purpose of this study is to quantify the interactions of the 3 vocalization subsystems of respiration, phonation, and resonance before, during, and after a perturbation to the larynx (temporarily induced unilateral vocal fold paralysis) in 10 vocally healthy participants. Using dynamic systems theory as a guide, we hypothesized that data groupings would emerge revealing context-dependent patterns in the relationships of variables representing the 3 vocalization subsystems. We also hypothesized that group data would mask important individual variability important to understanding the relationships among the vocalization subsystems.

Method

A perturbation paradigm was used to obtain respiratory kinematic, aerodynamic, and acoustic formant measures from 10 healthy participants (8 women, 2 men) with normal voices. Group and individual data were analyzed to provide a multilevel analysis of the data. A 3-dimensional state space model was constructed to demonstrate the interactive relationships among the 3 subsystems before, during, and after perturbation.

Results

During perturbation, group data revealed that lung volume initiations and terminations were lower, with longer respiratory excursions; airflow rates increased while subglottic pressures were maintained. Acoustic formant measures indicated that the spacing between the upper formants decreased (F3–F5), whereas the spacing between F1 and F2 increased. State space modeling revealed the changing directionality and interactions among the 3 subsystems.

Conclusions

Group data alone masked important variability necessary to understand the unique relationships among the 3 subsystems. Multilevel analysis permitted a richer understanding of the individual differences in phonatory regulation and permitted subgroup analysis. Dynamic systems theory may be a useful heuristic to model the interactive relationships among vocalization subsystems.

Supplemental Material

https://doi.org/10.23641/asha.5913532

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A Pilot Study to Investigate the Relationship Between Interaural Differences in Temporal Bone Anatomy and Normal Variations in Caloric Asymmetry

Purpose

This study assesses interaural differences in temporal bone anatomy in subjects with normal caloric findings.

Method

Eligible patients included those referred to the Duke University Medical Center otology clinic complaining of dizziness, with a head computed tomography scan and caloric stimulation results within normal ranges (inter-ear difference ≤ 10% or < 25% unilateral weakness). Three-dimensional reconstructions of computed tomography scans in 11 patients were used to calculate the surface area and volume of lateral semicircular canals (LSCCs), mastoid airspaces, mastoid bones, and internal auditory canal diameter and circumference. Percent differences in interaural temporal bone anatomy (i.e., left-to-right asymmetry) were analyzed and correlated with warm caloric inter-ear difference (WCD) and clinically indicated caloric predictor asymmetry.

Results

A multivariate model predicting WCD from 9 interaural anatomic variables demonstrated a Pearson's coefficient of 0.999. A similarly constructed model of the clinically indicated caloric predictor demonstrated a Pearson's coefficient of 0.999. The univariate correlation was strongest for WCD versus Proctor internal auditory canal diameter (r = 0.476; p = .139) and WCD versus lateral semicircular canal surface-area-to-volume ratio (r = −0.474; p = .141).

Conclusions

This pilot study provides multivariate models that predict caloric asymmetry in subjects without vestibular pathologic findings per caloric testing, based on interaural differences across variables of the temporal bone anatomy.

Supplemental Material

https://doi.org/10.23641/asha.5895988

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A Cross-Sectional Study on the Hearing Threshold Levels Among People in Qinling, Qinghai, and Nanjing, China

Purpose

This study aimed to investigate the hearing threshold among different age groups, genders, and geographic areas in China to provide some insight into the appropriate clinical interventions for hearing loss.

Method

Using a systematic random sampling technique, 562 participants from Qinling, Qinghai, and Nanjing were included. Participants in the same area were divided into 3 groups according to their age. Pure-tone audiometric thresholds were measured at octave and interoctave frequencies of 0.125–16 kHz for each subject.

Results

There were significant differences in auditory thresholds at nearly all frequencies among young, middle-aged, and elderly people, and hearing thresholds increased with increasing age. People generally had the best hearing ability in Nanjing, better hearing ability in Qinghai, and the worst hearing ability in Qinling. Significant differences in hearing thresholds were found between males and females at several frequencies in Qinling.

Conclusion

People living in the rural area of Qinling in China had higher hearing threshold levels, particularly males, and hearing thresholds increased with age.

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A Pilot Study to Investigate the Relationship Between Interaural Differences in Temporal Bone Anatomy and Normal Variations in Caloric Asymmetry

Purpose

This study assesses interaural differences in temporal bone anatomy in subjects with normal caloric findings.

Method

Eligible patients included those referred to the Duke University Medical Center otology clinic complaining of dizziness, with a head computed tomography scan and caloric stimulation results within normal ranges (inter-ear difference ≤ 10% or < 25% unilateral weakness). Three-dimensional reconstructions of computed tomography scans in 11 patients were used to calculate the surface area and volume of lateral semicircular canals (LSCCs), mastoid airspaces, mastoid bones, and internal auditory canal diameter and circumference. Percent differences in interaural temporal bone anatomy (i.e., left-to-right asymmetry) were analyzed and correlated with warm caloric inter-ear difference (WCD) and clinically indicated caloric predictor asymmetry.

Results

A multivariate model predicting WCD from 9 interaural anatomic variables demonstrated a Pearson's coefficient of 0.999. A similarly constructed model of the clinically indicated caloric predictor demonstrated a Pearson's coefficient of 0.999. The univariate correlation was strongest for WCD versus Proctor internal auditory canal diameter (r = 0.476; p = .139) and WCD versus lateral semicircular canal surface-area-to-volume ratio (r = −0.474; p = .141).

Conclusions

This pilot study provides multivariate models that predict caloric asymmetry in subjects without vestibular pathologic findings per caloric testing, based on interaural differences across variables of the temporal bone anatomy.

Supplemental Material

https://doi.org/10.23641/asha.5895988

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A Cross-Sectional Study on the Hearing Threshold Levels Among People in Qinling, Qinghai, and Nanjing, China

Purpose

This study aimed to investigate the hearing threshold among different age groups, genders, and geographic areas in China to provide some insight into the appropriate clinical interventions for hearing loss.

Method

Using a systematic random sampling technique, 562 participants from Qinling, Qinghai, and Nanjing were included. Participants in the same area were divided into 3 groups according to their age. Pure-tone audiometric thresholds were measured at octave and interoctave frequencies of 0.125–16 kHz for each subject.

Results

There were significant differences in auditory thresholds at nearly all frequencies among young, middle-aged, and elderly people, and hearing thresholds increased with increasing age. People generally had the best hearing ability in Nanjing, better hearing ability in Qinghai, and the worst hearing ability in Qinling. Significant differences in hearing thresholds were found between males and females at several frequencies in Qinling.

Conclusion

People living in the rural area of Qinling in China had higher hearing threshold levels, particularly males, and hearing thresholds increased with age.

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A Pilot Study to Investigate the Relationship Between Interaural Differences in Temporal Bone Anatomy and Normal Variations in Caloric Asymmetry

Purpose

This study assesses interaural differences in temporal bone anatomy in subjects with normal caloric findings.

Method

Eligible patients included those referred to the Duke University Medical Center otology clinic complaining of dizziness, with a head computed tomography scan and caloric stimulation results within normal ranges (inter-ear difference ≤ 10% or < 25% unilateral weakness). Three-dimensional reconstructions of computed tomography scans in 11 patients were used to calculate the surface area and volume of lateral semicircular canals (LSCCs), mastoid airspaces, mastoid bones, and internal auditory canal diameter and circumference. Percent differences in interaural temporal bone anatomy (i.e., left-to-right asymmetry) were analyzed and correlated with warm caloric inter-ear difference (WCD) and clinically indicated caloric predictor asymmetry.

Results

A multivariate model predicting WCD from 9 interaural anatomic variables demonstrated a Pearson's coefficient of 0.999. A similarly constructed model of the clinically indicated caloric predictor demonstrated a Pearson's coefficient of 0.999. The univariate correlation was strongest for WCD versus Proctor internal auditory canal diameter (r = 0.476; p = .139) and WCD versus lateral semicircular canal surface-area-to-volume ratio (r = −0.474; p = .141).

Conclusions

This pilot study provides multivariate models that predict caloric asymmetry in subjects without vestibular pathologic findings per caloric testing, based on interaural differences across variables of the temporal bone anatomy.

Supplemental Material

https://doi.org/10.23641/asha.5895988

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A Cross-Sectional Study on the Hearing Threshold Levels Among People in Qinling, Qinghai, and Nanjing, China

Purpose

This study aimed to investigate the hearing threshold among different age groups, genders, and geographic areas in China to provide some insight into the appropriate clinical interventions for hearing loss.

Method

Using a systematic random sampling technique, 562 participants from Qinling, Qinghai, and Nanjing were included. Participants in the same area were divided into 3 groups according to their age. Pure-tone audiometric thresholds were measured at octave and interoctave frequencies of 0.125–16 kHz for each subject.

Results

There were significant differences in auditory thresholds at nearly all frequencies among young, middle-aged, and elderly people, and hearing thresholds increased with increasing age. People generally had the best hearing ability in Nanjing, better hearing ability in Qinghai, and the worst hearing ability in Qinling. Significant differences in hearing thresholds were found between males and females at several frequencies in Qinling.

Conclusion

People living in the rural area of Qinling in China had higher hearing threshold levels, particularly males, and hearing thresholds increased with age.

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Study Finds Gaps in Hearing Specialist Referrals and Hearing Aid Use

​​

More than 40 million adults in the United States have reported having hearing problems from minor hearing issues to deafness. Despite this prevalence, there are considerable low specialist referrals. A new study found a disproportion between self-reported cases of hearing loss and those who received medical evaluation and treatment recommendations, such as auditory rehabilitative options and amplification, including hearing aids and cochlear implants (CI).

Researchers performed a cross-sectional analysis of data collected from 239.6 million adult respondents, who provided answers to the hearing module questions in the 2014 National Health Interview Survey. The study participants were 51.8 percent women and 48.2 percent men, with an average age of 47 years.

About 95.5 percent of the participants reported functional hearing or the ability to hear either normal voice or whispering, 3.4 percent can only hear shouting, and 1.1 percent could not hear shouting. Also, 16.8 percent of the respondents noted that their hearing was less than "excellent/good," ranging from "a little trouble hearing" to "being deaf." Of these, 12.9 million had never seen a clinician for hearing problems and 11.1 million had never had their hearing tested.

The study also reports that out of the 48.8 million who visited a physician for hearing-related problems in the five years prior to the study, about 60 percent were referred to specialists: 15.9 million were referred to otolaryngologists and 13.3 million to audiologists. About 2.8 million adult respondents reported they could not hear shouting (not appreciating shouting). Of these, about 148,000 were recommended getting a CI but only 22.1 percent received it.

"It is difficult to determine the exact contributing factors with the data presented in this study," Hossein Mahboubi, MD, MPH, study lead author, told The Hearing Journal about the possible contributing factors for this gap. "However, it is likely a multi-factorial process with lack of access, lack of awareness, and financial aspects playing the major roles."

"The low CI utilization rate is also likely multi-factorial. Need for surgical implantation and possible comorbid conditions or patient preference/compliance may influence candidacy and financial constraints may also play a role. Future studies are required to further characterize these associations and investigate the contributing factors," said Mahboubi on the main issues deterring patients from getting a cochlear implant.

The study noted that improved awareness of the importance of referrals to otolaryngologists and audiologists as well as auditory rehabilitative options among clinicians may improve hearing loss care.

"I believe there needs to be an effort, most appropriately led by otolaryngologists and audiologists, to increase awareness of physicians and the community about hearing loss, its common prevalence, and consequences if left untreated," Mahboubi added.

Published: 2/28/2018 8:48:00 AM

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Study Finds Gaps in Hearing Specialist Referrals and Hearing Aid Use

​​

More than 40 million adults in the United States have reported having hearing problems from minor hearing issues to deafness. Despite this prevalence, there are considerable low specialist referrals. A new study found a disproportion between self-reported cases of hearing loss and those who received medical evaluation and treatment recommendations, such as auditory rehabilitative options and amplification, including hearing aids and cochlear implants (CI).

Researchers performed a cross-sectional analysis of data collected from 239.6 million adult respondents, who provided answers to the hearing module questions in the 2014 National Health Interview Survey. The study participants were 51.8 percent women and 48.2 percent men, with an average age of 47 years.

About 95.5 percent of the participants reported functional hearing or the ability to hear either normal voice or whispering, 3.4 percent can only hear shouting, and 1.1 percent could not hear shouting. Also, 16.8 percent of the respondents noted that their hearing was less than "excellent/good," ranging from "a little trouble hearing" to "being deaf." Of these, 12.9 million had never seen a clinician for hearing problems and 11.1 million had never had their hearing tested.

The study also reports that out of the 48.8 million who visited a physician for hearing-related problems in the five years prior to the study, about 60 percent were referred to specialists: 15.9 million were referred to otolaryngologists and 13.3 million to audiologists. About 2.8 million adult respondents reported they could not hear shouting (not appreciating shouting). Of these, about 148,000 were recommended getting a CI but only 22.1 percent received it.

"It is difficult to determine the exact contributing factors with the data presented in this study," Hossein Mahboubi, MD, MPH, study lead author, told The Hearing Journal about the possible contributing factors for this gap. "However, it is likely a multi-factorial process with lack of access, lack of awareness, and financial aspects playing the major roles."

"The low CI utilization rate is also likely multi-factorial. Need for surgical implantation and possible comorbid conditions or patient preference/compliance may influence candidacy and financial constraints may also play a role. Future studies are required to further characterize these associations and investigate the contributing factors," said Mahboubi on the main issues deterring patients from getting a cochlear implant.

The study noted that improved awareness of the importance of referrals to otolaryngologists and audiologists as well as auditory rehabilitative options among clinicians may improve hearing loss care.

"I believe there needs to be an effort, most appropriately led by otolaryngologists and audiologists, to increase awareness of physicians and the community about hearing loss, its common prevalence, and consequences if left untreated," Mahboubi added.

Published: 2/28/2018 8:48:00 AM

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Study Finds Gaps in Hearing Specialist Referrals and Hearing Aid Use

​​

More than 40 million adults in the United States have reported having hearing problems from minor hearing issues to deafness. Despite this prevalence, there are considerable low specialist referrals. A new study found a disproportion between self-reported cases of hearing loss and those who received medical evaluation and treatment recommendations, such as auditory rehabilitative options and amplification, including hearing aids and cochlear implants (CI).

Researchers performed a cross-sectional analysis of data collected from 239.6 million adult respondents, who provided answers to the hearing module questions in the 2014 National Health Interview Survey. The study participants were 51.8 percent women and 48.2 percent men, with an average age of 47 years.

About 95.5 percent of the participants reported functional hearing or the ability to hear either normal voice or whispering, 3.4 percent can only hear shouting, and 1.1 percent could not hear shouting. Also, 16.8 percent of the respondents noted that their hearing was less than "excellent/good," ranging from "a little trouble hearing" to "being deaf." Of these, 12.9 million had never seen a clinician for hearing problems and 11.1 million had never had their hearing tested.

The study also reports that out of the 48.8 million who visited a physician for hearing-related problems in the five years prior to the study, about 60 percent were referred to specialists: 15.9 million were referred to otolaryngologists and 13.3 million to audiologists. About 2.8 million adult respondents reported they could not hear shouting (not appreciating shouting). Of these, about 148,000 were recommended getting a CI but only 22.1 percent received it.

"It is difficult to determine the exact contributing factors with the data presented in this study," Hossein Mahboubi, MD, MPH, study lead author, told The Hearing Journal about the possible contributing factors for this gap. "However, it is likely a multi-factorial process with lack of access, lack of awareness, and financial aspects playing the major roles."

"The low CI utilization rate is also likely multi-factorial. Need for surgical implantation and possible comorbid conditions or patient preference/compliance may influence candidacy and financial constraints may also play a role. Future studies are required to further characterize these associations and investigate the contributing factors," said Mahboubi on the main issues deterring patients from getting a cochlear implant.

The study noted that improved awareness of the importance of referrals to otolaryngologists and audiologists as well as auditory rehabilitative options among clinicians may improve hearing loss care.

"I believe there needs to be an effort, most appropriately led by otolaryngologists and audiologists, to increase awareness of physicians and the community about hearing loss, its common prevalence, and consequences if left untreated," Mahboubi added.

Published: 2/28/2018 8:48:00 AM

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The Influence of Hearing Aid Gain on Gap-Detection Thresholds for Children and Adults With Hearing Loss

Objectives: The objective of this experiment was to examine the contributions of audibility to the ability to perceive a gap in noise for children and adults. Sensorineural hearing loss (SNHL) in adulthood is associated with a deficit in gap detection. It is well known that reduced audibility in adult listeners with SNHL contributes to this deficit; however, it is unclear the extent to which hearing aid amplification can restore gap-detection thresholds, and the effect of childhood SNHL on gap-detection thresholds have not been described. For adults, it was hypothesized that restoring the dynamic range of hearing for listeners with SNHL would lead to approximately normal gap-detection thresholds. Children with normal hearing (NH) exhibit poorer gap-detection thresholds than adults. Because of their hearing loss, children with SNHL have less auditory experience than their peers with NH. Yet, it is unknown the extent to which auditory experience impacts their ability to perceive gaps in noise. Even with the provision of amplification, it was hypothesized that children with SNHL would show a deficit in gap detection, relative to their peers with normal hearing, because of reduced auditory experience. Design: The ability to detect a silent interval in noise was tested by adapting the stimulus level required for detection of gap durations between 3 and 20 ms for adults and children with and without SNHL. Stimulus-level thresholds were measured for participants with SNHL without amplification and with two prescriptive procedures—the adult and child versions of the desired sensation level i/o program—using a hearing aid simulator. The child version better restored the normal dynamic range than the adult version. Adults and children with NH were tested without amplification. Results: When fitted using the procedure that best restored the dynamic range, adults with SNHL had stimulus-level thresholds similar to those of adults with normal hearing. Compared to the children with NH, the children with SNHL required a higher stimulus level to detect a 5-ms gap, despite having used the procedure that better restored the normal dynamic range of hearing. Otherwise, the two groups of children had similar stimulus-level thresholds. Conclusion: These findings suggest that apparent deficits in temporal resolution, as measured using stimulus-level thresholds for the detection of gaps, are dependent on age and audibility. These novel results indicate that childhood SNHL may impair temporal resolution as measured by stimulus-level thresholds for the detection of a gap in noise. This work has implications for understanding the effects of amplification on the ability to perceive temporal cues in speech. ACKNOWLEDGMENTS: We thank Alex Baker, Brianna Byllesby, Evan Cordrey, and Clairissa Mollak for help in data collection and analysis. M. B. designed and performed experiments, analyzed data, and wrote the paper. All authors discussed analysis and implications and commented on the manuscript at all stages. This research was funded by grants R01 DC013591 (to R. M.), F32 DC12709 (to M. B.), P20 GM109023 (to M. B. and W. J.), and P30 DC4662 from the National Institutes of Health (NIH). Presented at the International Hearing Aid Research Conference, Lake Tahoe, Nevada, August 13, 2016. The authors have no conflicts of interest to disclose. Address for correspondence: Marc Brennan, University of Nebraska-Lincoln, 274 Barkley Center, Lincoln, NE 68583, USA. E-mail: marc.brennan@unl.edu Received February 21, 2017; accepted December 28, 2017. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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The Influence of Hearing Aid Gain on Gap-Detection Thresholds for Children and Adults With Hearing Loss

Objectives: The objective of this experiment was to examine the contributions of audibility to the ability to perceive a gap in noise for children and adults. Sensorineural hearing loss (SNHL) in adulthood is associated with a deficit in gap detection. It is well known that reduced audibility in adult listeners with SNHL contributes to this deficit; however, it is unclear the extent to which hearing aid amplification can restore gap-detection thresholds, and the effect of childhood SNHL on gap-detection thresholds have not been described. For adults, it was hypothesized that restoring the dynamic range of hearing for listeners with SNHL would lead to approximately normal gap-detection thresholds. Children with normal hearing (NH) exhibit poorer gap-detection thresholds than adults. Because of their hearing loss, children with SNHL have less auditory experience than their peers with NH. Yet, it is unknown the extent to which auditory experience impacts their ability to perceive gaps in noise. Even with the provision of amplification, it was hypothesized that children with SNHL would show a deficit in gap detection, relative to their peers with normal hearing, because of reduced auditory experience. Design: The ability to detect a silent interval in noise was tested by adapting the stimulus level required for detection of gap durations between 3 and 20 ms for adults and children with and without SNHL. Stimulus-level thresholds were measured for participants with SNHL without amplification and with two prescriptive procedures—the adult and child versions of the desired sensation level i/o program—using a hearing aid simulator. The child version better restored the normal dynamic range than the adult version. Adults and children with NH were tested without amplification. Results: When fitted using the procedure that best restored the dynamic range, adults with SNHL had stimulus-level thresholds similar to those of adults with normal hearing. Compared to the children with NH, the children with SNHL required a higher stimulus level to detect a 5-ms gap, despite having used the procedure that better restored the normal dynamic range of hearing. Otherwise, the two groups of children had similar stimulus-level thresholds. Conclusion: These findings suggest that apparent deficits in temporal resolution, as measured using stimulus-level thresholds for the detection of gaps, are dependent on age and audibility. These novel results indicate that childhood SNHL may impair temporal resolution as measured by stimulus-level thresholds for the detection of a gap in noise. This work has implications for understanding the effects of amplification on the ability to perceive temporal cues in speech. ACKNOWLEDGMENTS: We thank Alex Baker, Brianna Byllesby, Evan Cordrey, and Clairissa Mollak for help in data collection and analysis. M. B. designed and performed experiments, analyzed data, and wrote the paper. All authors discussed analysis and implications and commented on the manuscript at all stages. This research was funded by grants R01 DC013591 (to R. M.), F32 DC12709 (to M. B.), P20 GM109023 (to M. B. and W. J.), and P30 DC4662 from the National Institutes of Health (NIH). Presented at the International Hearing Aid Research Conference, Lake Tahoe, Nevada, August 13, 2016. The authors have no conflicts of interest to disclose. Address for correspondence: Marc Brennan, University of Nebraska-Lincoln, 274 Barkley Center, Lincoln, NE 68583, USA. E-mail: marc.brennan@unl.edu Received February 21, 2017; accepted December 28, 2017. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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The Influence of Hearing Aid Gain on Gap-Detection Thresholds for Children and Adults With Hearing Loss

Objectives: The objective of this experiment was to examine the contributions of audibility to the ability to perceive a gap in noise for children and adults. Sensorineural hearing loss (SNHL) in adulthood is associated with a deficit in gap detection. It is well known that reduced audibility in adult listeners with SNHL contributes to this deficit; however, it is unclear the extent to which hearing aid amplification can restore gap-detection thresholds, and the effect of childhood SNHL on gap-detection thresholds have not been described. For adults, it was hypothesized that restoring the dynamic range of hearing for listeners with SNHL would lead to approximately normal gap-detection thresholds. Children with normal hearing (NH) exhibit poorer gap-detection thresholds than adults. Because of their hearing loss, children with SNHL have less auditory experience than their peers with NH. Yet, it is unknown the extent to which auditory experience impacts their ability to perceive gaps in noise. Even with the provision of amplification, it was hypothesized that children with SNHL would show a deficit in gap detection, relative to their peers with normal hearing, because of reduced auditory experience. Design: The ability to detect a silent interval in noise was tested by adapting the stimulus level required for detection of gap durations between 3 and 20 ms for adults and children with and without SNHL. Stimulus-level thresholds were measured for participants with SNHL without amplification and with two prescriptive procedures—the adult and child versions of the desired sensation level i/o program—using a hearing aid simulator. The child version better restored the normal dynamic range than the adult version. Adults and children with NH were tested without amplification. Results: When fitted using the procedure that best restored the dynamic range, adults with SNHL had stimulus-level thresholds similar to those of adults with normal hearing. Compared to the children with NH, the children with SNHL required a higher stimulus level to detect a 5-ms gap, despite having used the procedure that better restored the normal dynamic range of hearing. Otherwise, the two groups of children had similar stimulus-level thresholds. Conclusion: These findings suggest that apparent deficits in temporal resolution, as measured using stimulus-level thresholds for the detection of gaps, are dependent on age and audibility. These novel results indicate that childhood SNHL may impair temporal resolution as measured by stimulus-level thresholds for the detection of a gap in noise. This work has implications for understanding the effects of amplification on the ability to perceive temporal cues in speech. ACKNOWLEDGMENTS: We thank Alex Baker, Brianna Byllesby, Evan Cordrey, and Clairissa Mollak for help in data collection and analysis. M. B. designed and performed experiments, analyzed data, and wrote the paper. All authors discussed analysis and implications and commented on the manuscript at all stages. This research was funded by grants R01 DC013591 (to R. M.), F32 DC12709 (to M. B.), P20 GM109023 (to M. B. and W. J.), and P30 DC4662 from the National Institutes of Health (NIH). Presented at the International Hearing Aid Research Conference, Lake Tahoe, Nevada, August 13, 2016. The authors have no conflicts of interest to disclose. Address for correspondence: Marc Brennan, University of Nebraska-Lincoln, 274 Barkley Center, Lincoln, NE 68583, USA. E-mail: marc.brennan@unl.edu Received February 21, 2017; accepted December 28, 2017. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Pre- and postsynaptic ionotropic glutamate receptors in the auditory system of mammals

Publication date: Available online 28 February 2018
Source:Hearing Research
Author(s): Hideki Takago, Tomoko Oshima-Takago
The ionotropic glutamate receptors (iGluRs) concertedly mediate neurotransmission to convey, process, and integrate acoustic information along the auditory pathway. In order to ensure these challenging tasks, the iGluRs are variously expressed in auditory neurons in an age- and site-dependent manner. The subunit compositions of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs) and N-methyl-D-aspartate receptors (NMDARs) are altered with development, underlying the acceleration in kinetics of excitatory postsynaptic responses. AMPAR desensitization partly affects short-term synaptic plasticity upon repetitive stimuli in subsets of auditory neurons at a given period of maturation. NMDAR activation is required for long-term synaptic plasticity in a cerebellum-like microcircuit within the first auditory brainstem nucleus. Along with their postsynaptic functions, AMPARs and NMDARs fulfill essential roles in presynaptic modulation of auditory neurotransmission. Despite the expression of the kainate and delta receptors, their functions remain unknown. Here this review aims to discuss the diverse distribution and functions of pre- and postsynaptic iGluRs in the peripheral and central auditory systems.



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Pre- and postsynaptic ionotropic glutamate receptors in the auditory system of mammals

Publication date: Available online 28 February 2018
Source:Hearing Research
Author(s): Hideki Takago, Tomoko Oshima-Takago
The ionotropic glutamate receptors (iGluRs) concertedly mediate neurotransmission to convey, process, and integrate acoustic information along the auditory pathway. In order to ensure these challenging tasks, the iGluRs are variously expressed in auditory neurons in an age- and site-dependent manner. The subunit compositions of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs) and N-methyl-D-aspartate receptors (NMDARs) are altered with development, underlying the acceleration in kinetics of excitatory postsynaptic responses. AMPAR desensitization partly affects short-term synaptic plasticity upon repetitive stimuli in subsets of auditory neurons at a given period of maturation. NMDAR activation is required for long-term synaptic plasticity in a cerebellum-like microcircuit within the first auditory brainstem nucleus. Along with their postsynaptic functions, AMPARs and NMDARs fulfill essential roles in presynaptic modulation of auditory neurotransmission. Despite the expression of the kainate and delta receptors, their functions remain unknown. Here this review aims to discuss the diverse distribution and functions of pre- and postsynaptic iGluRs in the peripheral and central auditory systems.



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Pre- and postsynaptic ionotropic glutamate receptors in the auditory system of mammals

Publication date: Available online 28 February 2018
Source:Hearing Research
Author(s): Hideki Takago, Tomoko Oshima-Takago
The ionotropic glutamate receptors (iGluRs) concertedly mediate neurotransmission to convey, process, and integrate acoustic information along the auditory pathway. In order to ensure these challenging tasks, the iGluRs are variously expressed in auditory neurons in an age- and site-dependent manner. The subunit compositions of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs) and N-methyl-D-aspartate receptors (NMDARs) are altered with development, underlying the acceleration in kinetics of excitatory postsynaptic responses. AMPAR desensitization partly affects short-term synaptic plasticity upon repetitive stimuli in subsets of auditory neurons at a given period of maturation. NMDAR activation is required for long-term synaptic plasticity in a cerebellum-like microcircuit within the first auditory brainstem nucleus. Along with their postsynaptic functions, AMPARs and NMDARs fulfill essential roles in presynaptic modulation of auditory neurotransmission. Despite the expression of the kainate and delta receptors, their functions remain unknown. Here this review aims to discuss the diverse distribution and functions of pre- and postsynaptic iGluRs in the peripheral and central auditory systems.



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Interpreting Mini-Mental State Examination Performance in Highly Proficient Bilingual Spanish–English and Asian Indian–English Speakers: Demographic Adjustments, Item Analyses, and Supplemental Measures

Purpose

Performance on the Mini-Mental State Examination (MMSE), among the most widely used global screens of adult cognitive status, is affected by demographic variables including age, education, and ethnicity. This study extends prior research by examining the specific effects of bilingualism on MMSE performance.

Method

Sixty independent community-dwelling monolingual and bilingual adults were recruited from eastern and western regions of the United States in this cross-sectional group study. Independent sample t tests were used to compare 2 bilingual groups (Spanish–English and Asian Indian–English) with matched monolingual speakers on the MMSE, demographically adjusted MMSE scores, MMSE item scores, and a nonverbal cognitive measure. Regression analyses were also performed to determine whether language proficiency predicted MMSE performance in both groups of bilingual speakers.

Results

Group differences were evident on the MMSE, on demographically adjusted MMSE scores, and on a small subset of individual MMSE items. Scores on a standardized screen of language proficiency predicted a significant proportion of the variance in the MMSE scores of both bilingual groups.

Conclusions

Bilingual speakers demonstrated distinct performance profiles on the MMSE. Results suggest that supplementing the MMSE with a language screen, administering a nonverbal measure, and/or evaluating item-based patterns of performance may assist with test interpretation for this population.

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Masked Repetition Priming Treatment for Anomia

Purpose

Masked priming has been suggested as a way to directly target implicit lexical retrieval processes in aphasia. This study was designed to investigate repeated use of masked repetition priming to improve picture naming in individuals with anomia due to aphasia.

Method

A single-subject, multiple-baseline design was used across 6 people with aphasia. Training involved repeated exposure to pictures that were paired with masked identity primes or sham primes. Two semantic categories were trained in series for each participant. Analyses assessed treatment effects, generalization within and across semantic categories, and effects on broader language skills, immediately and 3 months after treatment.

Results

Four of the 6 participants improved in naming trained items immediately after treatment. Improvements were generally greater for items that were presented in training with masked identity primes than items that were presented repeatedly during training with masked sham primes. Generalization within and across semantic categories was limited. Generalization to broader language skills was inconsistent.

Conclusion

Masked repetition priming may improve naming for some individuals with anomia due to aphasia. A number of methodological and theoretical insights into further development of this treatment approach are discussed.

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What Does a Cue Do? Comparing Phonological and Semantic Cues for Picture Naming in Aphasia

Purpose

Impaired naming is one of the most common symptoms in aphasia, often treated with cued picture naming paradigms. It has been argued that semantic cues facilitate the reliable categorization of the picture, and phonological cues facilitate the retrieval of target phonology. To test these hypotheses, we compared the effectiveness of phonological and semantic cues in picture naming for a group of individuals with aphasia. To establish the locus of effective cueing, we also tested whether cue type interacted with lexical and image properties of the targets.

Method

Individuals with aphasia (n = 10) were tested with a within-subject design. They named a large set of items (n = 175) 4 times. Each presentation of the items was accompanied by a different cueing condition (phonological, semantic, nonassociated word and tone). Item level variables for the targets (i.e., phoneme length, frequency, imageability, name agreement, and visual complexity) were used to test the interaction of cue type and item variables. Naming accuracy data were analyzed using generalized linear mixed effects models.

Results

Phonological cues were more effective than semantic cues, improving accuracy across individuals. However, phonological cues did not interact with phonological or lexical aspects of the picture names (e.g., phoneme length, frequency). Instead, they interacted with properties of the picture itself (i.e., visual complexity), such that phonological cues improved naming accuracy for items with low visual complexity.

Conclusions

The findings challenge the theoretical assumptions that phonological cues map to phonological processes. Instead, phonological information benefits the earliest stages of picture recognition, aiding the initial categorization of the target. The data help to explain why patterns of cueing are not consistent in aphasia; that is, it is not the case that phonological impairments always benefit from phonological cues and semantic impairments form semantic cues. A substantial amount of the literature in naming therapy focuses on picture naming paradigms. Therefore, the results are also critically important for rehabilitation, allowing for therapy development to be more rooted in the true mechanisms through which cues are processed.

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Interpreting Mini-Mental State Examination Performance in Highly Proficient Bilingual Spanish–English and Asian Indian–English Speakers: Demographic Adjustments, Item Analyses, and Supplemental Measures

Purpose

Performance on the Mini-Mental State Examination (MMSE), among the most widely used global screens of adult cognitive status, is affected by demographic variables including age, education, and ethnicity. This study extends prior research by examining the specific effects of bilingualism on MMSE performance.

Method

Sixty independent community-dwelling monolingual and bilingual adults were recruited from eastern and western regions of the United States in this cross-sectional group study. Independent sample t tests were used to compare 2 bilingual groups (Spanish–English and Asian Indian–English) with matched monolingual speakers on the MMSE, demographically adjusted MMSE scores, MMSE item scores, and a nonverbal cognitive measure. Regression analyses were also performed to determine whether language proficiency predicted MMSE performance in both groups of bilingual speakers.

Results

Group differences were evident on the MMSE, on demographically adjusted MMSE scores, and on a small subset of individual MMSE items. Scores on a standardized screen of language proficiency predicted a significant proportion of the variance in the MMSE scores of both bilingual groups.

Conclusions

Bilingual speakers demonstrated distinct performance profiles on the MMSE. Results suggest that supplementing the MMSE with a language screen, administering a nonverbal measure, and/or evaluating item-based patterns of performance may assist with test interpretation for this population.

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Masked Repetition Priming Treatment for Anomia

Purpose

Masked priming has been suggested as a way to directly target implicit lexical retrieval processes in aphasia. This study was designed to investigate repeated use of masked repetition priming to improve picture naming in individuals with anomia due to aphasia.

Method

A single-subject, multiple-baseline design was used across 6 people with aphasia. Training involved repeated exposure to pictures that were paired with masked identity primes or sham primes. Two semantic categories were trained in series for each participant. Analyses assessed treatment effects, generalization within and across semantic categories, and effects on broader language skills, immediately and 3 months after treatment.

Results

Four of the 6 participants improved in naming trained items immediately after treatment. Improvements were generally greater for items that were presented in training with masked identity primes than items that were presented repeatedly during training with masked sham primes. Generalization within and across semantic categories was limited. Generalization to broader language skills was inconsistent.

Conclusion

Masked repetition priming may improve naming for some individuals with anomia due to aphasia. A number of methodological and theoretical insights into further development of this treatment approach are discussed.

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What Does a Cue Do? Comparing Phonological and Semantic Cues for Picture Naming in Aphasia

Purpose

Impaired naming is one of the most common symptoms in aphasia, often treated with cued picture naming paradigms. It has been argued that semantic cues facilitate the reliable categorization of the picture, and phonological cues facilitate the retrieval of target phonology. To test these hypotheses, we compared the effectiveness of phonological and semantic cues in picture naming for a group of individuals with aphasia. To establish the locus of effective cueing, we also tested whether cue type interacted with lexical and image properties of the targets.

Method

Individuals with aphasia (n = 10) were tested with a within-subject design. They named a large set of items (n = 175) 4 times. Each presentation of the items was accompanied by a different cueing condition (phonological, semantic, nonassociated word and tone). Item level variables for the targets (i.e., phoneme length, frequency, imageability, name agreement, and visual complexity) were used to test the interaction of cue type and item variables. Naming accuracy data were analyzed using generalized linear mixed effects models.

Results

Phonological cues were more effective than semantic cues, improving accuracy across individuals. However, phonological cues did not interact with phonological or lexical aspects of the picture names (e.g., phoneme length, frequency). Instead, they interacted with properties of the picture itself (i.e., visual complexity), such that phonological cues improved naming accuracy for items with low visual complexity.

Conclusions

The findings challenge the theoretical assumptions that phonological cues map to phonological processes. Instead, phonological information benefits the earliest stages of picture recognition, aiding the initial categorization of the target. The data help to explain why patterns of cueing are not consistent in aphasia; that is, it is not the case that phonological impairments always benefit from phonological cues and semantic impairments form semantic cues. A substantial amount of the literature in naming therapy focuses on picture naming paradigms. Therefore, the results are also critically important for rehabilitation, allowing for therapy development to be more rooted in the true mechanisms through which cues are processed.

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Interpreting Mini-Mental State Examination Performance in Highly Proficient Bilingual Spanish–English and Asian Indian–English Speakers: Demographic Adjustments, Item Analyses, and Supplemental Measures

Purpose

Performance on the Mini-Mental State Examination (MMSE), among the most widely used global screens of adult cognitive status, is affected by demographic variables including age, education, and ethnicity. This study extends prior research by examining the specific effects of bilingualism on MMSE performance.

Method

Sixty independent community-dwelling monolingual and bilingual adults were recruited from eastern and western regions of the United States in this cross-sectional group study. Independent sample t tests were used to compare 2 bilingual groups (Spanish–English and Asian Indian–English) with matched monolingual speakers on the MMSE, demographically adjusted MMSE scores, MMSE item scores, and a nonverbal cognitive measure. Regression analyses were also performed to determine whether language proficiency predicted MMSE performance in both groups of bilingual speakers.

Results

Group differences were evident on the MMSE, on demographically adjusted MMSE scores, and on a small subset of individual MMSE items. Scores on a standardized screen of language proficiency predicted a significant proportion of the variance in the MMSE scores of both bilingual groups.

Conclusions

Bilingual speakers demonstrated distinct performance profiles on the MMSE. Results suggest that supplementing the MMSE with a language screen, administering a nonverbal measure, and/or evaluating item-based patterns of performance may assist with test interpretation for this population.

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Masked Repetition Priming Treatment for Anomia

Purpose

Masked priming has been suggested as a way to directly target implicit lexical retrieval processes in aphasia. This study was designed to investigate repeated use of masked repetition priming to improve picture naming in individuals with anomia due to aphasia.

Method

A single-subject, multiple-baseline design was used across 6 people with aphasia. Training involved repeated exposure to pictures that were paired with masked identity primes or sham primes. Two semantic categories were trained in series for each participant. Analyses assessed treatment effects, generalization within and across semantic categories, and effects on broader language skills, immediately and 3 months after treatment.

Results

Four of the 6 participants improved in naming trained items immediately after treatment. Improvements were generally greater for items that were presented in training with masked identity primes than items that were presented repeatedly during training with masked sham primes. Generalization within and across semantic categories was limited. Generalization to broader language skills was inconsistent.

Conclusion

Masked repetition priming may improve naming for some individuals with anomia due to aphasia. A number of methodological and theoretical insights into further development of this treatment approach are discussed.

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What Does a Cue Do? Comparing Phonological and Semantic Cues for Picture Naming in Aphasia

Purpose

Impaired naming is one of the most common symptoms in aphasia, often treated with cued picture naming paradigms. It has been argued that semantic cues facilitate the reliable categorization of the picture, and phonological cues facilitate the retrieval of target phonology. To test these hypotheses, we compared the effectiveness of phonological and semantic cues in picture naming for a group of individuals with aphasia. To establish the locus of effective cueing, we also tested whether cue type interacted with lexical and image properties of the targets.

Method

Individuals with aphasia (n = 10) were tested with a within-subject design. They named a large set of items (n = 175) 4 times. Each presentation of the items was accompanied by a different cueing condition (phonological, semantic, nonassociated word and tone). Item level variables for the targets (i.e., phoneme length, frequency, imageability, name agreement, and visual complexity) were used to test the interaction of cue type and item variables. Naming accuracy data were analyzed using generalized linear mixed effects models.

Results

Phonological cues were more effective than semantic cues, improving accuracy across individuals. However, phonological cues did not interact with phonological or lexical aspects of the picture names (e.g., phoneme length, frequency). Instead, they interacted with properties of the picture itself (i.e., visual complexity), such that phonological cues improved naming accuracy for items with low visual complexity.

Conclusions

The findings challenge the theoretical assumptions that phonological cues map to phonological processes. Instead, phonological information benefits the earliest stages of picture recognition, aiding the initial categorization of the target. The data help to explain why patterns of cueing are not consistent in aphasia; that is, it is not the case that phonological impairments always benefit from phonological cues and semantic impairments form semantic cues. A substantial amount of the literature in naming therapy focuses on picture naming paradigms. Therefore, the results are also critically important for rehabilitation, allowing for therapy development to be more rooted in the true mechanisms through which cues are processed.

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Poor hearing could lead to poor memory

New research — by scientists in Italy — suggests that a form of age-related hearing loss significantly raises the risk of mild cognitive impairment among seniors.

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Poor hearing could lead to poor memory

New research — by scientists in Italy — suggests that a form of age-related hearing loss significantly raises the risk of mild cognitive impairment among seniors.

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Poor hearing could lead to poor memory

New research — by scientists in Italy — suggests that a form of age-related hearing loss significantly raises the risk of mild cognitive impairment among seniors.

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Effects of Intracordal Estradiol and Dexamethasone Injection on Wound Healing in Vocal Fold Injuries

Publication date: Available online 26 February 2018
Source:Journal of Voice
Author(s): Muhammet Yildiz, Ozgür Yigit, Ahmet Volkan Sünter, Deniz Tuna Edizer, Nevra Dursun, Oguzhan Okcu
ObjectiveThe aim of this study was to investigate the effects of intracordal estradiol and dexamethasone injection on wound healing in vocal fold injuries.Study DesignA prospective controlled animal study was carried out.SettingThis study was conducted at a tertiary center.Subjects-MethodsTen rabbits were randomly divided into two groups. As surgical procedure, cordotomy technique was performed in the middle third of the vocal folds bilaterally. In the first group, 0.1 mL of dexamethasone was injected into the right side, and 0.1 mL of saline was injected into the left side. In the second group, 0.1 mL of estradiol was injected into the right side, and 0.1 mL of saline was injected into the left side. Animals were sacrificed after 1 month and laryngeal specimens were evaluated histopathologically.ResultsNo statistically significant difference was observed in terms of inflammatory response, epithelial thickness, type I and III collagen, and hyaluronic acid parameters in dexamethasone and estradiol injections compared to the saline injection. In terms of elastin level, estradiol injection demonstrated statistically higher values compared to the saline injection. Elastin level of dexamethasone injected vocal folds was not statistically different compared to the saline injection. No significant differences were observed in terms of inflammatory response, epithelial thickness, type I and III collagen, and hyaluronic acid parameters between the estradiol and dexamethasone injected vocal folds.ConclusionIt is thought that the effects of estradiol or dexamethasone injections may have similar effects on wound healing in vocal fold injuries. Intracordal estradiol injection has positive effects on tissue elastin levels.



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Hearing Preservation with the Slim Modiolar Electrode Nucleus CI532® Cochlear Implant: A Preliminary Experience

As the indications for cochlear implant have expanded to include younger patients and individuals with greater degrees of residual hearing, increasing emphasis has been placed on atraumatic surgery and the preservation of the cochlear structure. Here, a descriptive prospective randomized study was performed. It was shown that residual hearing preservation is possible 12 months postoperatively with an atraumatic perimodiolar flexible electrode array CI532® (Cochlear Ltd, Sydney, Australia). Residual hearing preservation, considered as #x3c; 15 dB, was obtained in 70% of the cases. Better clinical outcomes and performance could be obtained compared with the previous perimodiolar CI512®, but further research and a longer follow-up are necessary to verify the impact of outcomes.
Audiol Neurotol 2017;22:317–325

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Predictive Factors for Vestibular Loss in Children With Hearing Loss

Purpose

The aim of this study was to determine if there are factors that can predict whether a child with hearing loss will also have vestibular loss.

Method

A retrospective chart review was completed on 186 children with hearing loss seen at Boys Town National Research Hospital for vestibular testing from 1999 to 2015 through neurosensory genetics clinic or cochlear implant candidacy. Each child's medical chart was reviewed to obtain the following data: vestibular loss severity (classified as normal, bilateral, or mild to moderate), degree of hearing loss (bilateral pure-tone average [PTA]), imaging abnormalities (classified as “normal” or “abnormal”), parental concerns for gross motor delay (classified as “yes, there is concern” or “no, there is not a concern”), parent report of age when their child sat (months) and walked independently (months), comorbidities (classified as “yes” if there were 1 or more comorbidities or “no” if there were no comorbidities), and score on the Developmental Profile-3.

Results

Children were grouped according to vestibular loss severity; 115 children had normal vestibular function, 31 had bilateral vestibular loss, and 40 had mild-to-moderate vestibular loss. As severity of vestibular loss increased, children (a) sat and walked later, (b) scored more poorly on the Developmental Profile-3 physical subscale, (c) had more severe hearing loss, (d) had parents who more frequently reported concern for gross motor delay, and (e) were more likely to have other comorbidities. Of these factors, age-to-sit, age-to-walk, PTA, and parental concerns for gross motor developmental delay had the greatest ability to differentiate children with vestibular loss from children with normal vestibular function. For age-to-sit, using a cutoff value of 7.25 months yielded a sensitivity of 62% and a specificity of 81%. For age-to-walk, a cutoff value of 14.5 months yielded a sensitivity of 78% and a specificity of 77%. For PTA for the neurosensory genetics group, a cutoff value of 40 dB yielded a sensitivity of 80% and a specificity of 55%; however, a cutoff value of 66 dB yielded a sensitivity of 33% and an improved specificity of 91%.

Conclusions

A referral for vestibular evaluation should be considered for children whose hearing loss is greater than 66 dB and particularly those who sit later than 7.25 months or walk later than 14.5 months or whose parents report concerns for gross motor development. Collectively, these factors appear to be more sensitive for identifying children with bilateral vestibular loss compared with children with mild-to-moderate vestibular loss. Because of the benefit of physical therapy, children identified with vestibular loss should then be referred to physical therapy for further evaluation and treatment.

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Structured Review of Dichotic Tests of Binaural Integration: Clinical Performance in Children

Purpose

The aim of the study was to evaluate the evidence of clinical utility for dichotic speech tests of binaural integration used to assess auditory processing in English-speaking children 6–14 years old.

Method

Dichotic speech test recordings and pertinent research studies were identified from iterative searches of the Internet and bibliographic databases, as well as communication with colleagues and test publishers. Test documentation and peer-reviewed literature were evaluated for evidence of reliability, accuracy, usefulness, and value.

Results

Eleven dichotic tests of binaural integration were identified for children. Evidence of test–retest reliability was found for 5 tests and demonstrated moderate to good correlation between results on repeated administration (r = .59–.92). Evidence of accuracy was identified for 5 tests but was either inconsistent with accurate performance or was not generalizable due to significant limitations in study design. No evidence was found to either support or dispute claims of usefulness or value.

Conclusions

A medical diagnostic framework is useful for evaluating dichotic tests. Although dichotic procedures show moderate reliability, the absence of a widely accepted gold standard reference test limits our ability to assess their value. Overall, the data available at the time of this review do not support the routine use of dichotic tests of binaural integration for clinical evaluation of children.

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Validation of the Chinese Sound Test: Auditory Performance of Hearing Aid Users

Purpose

The Chinese Sound Test (Hung, Lin, Tsai, & Lee, 2016) has been recently developed as a modified version of the Ling Six-Sound Test (Ling, 2012). By incorporating Chinese speech sounds, this test should be able to estimate whether the listener can hear across the Chinese speech spectrum. To establish the clinical validity of the test, this study examined the relationship between the aided audiometric thresholds and the distance thresholds.

Method

Sixty children with bilateral hearing aids were recruited. The aided sound-field thresholds at 250, 500, 1000, 2000, 4000, and 6000 Hz were compared with the distance thresholds of six sounds, /u, ə, a, i, tɕʰ, and s/, which encompass the entire Chinese speech frequency range from low to high.

Results

Partial correlation and stepwise regression analyses revealed that the Chinese testing sounds are frequency specific and that the audibility of each sound could be predicted by a specific frequency threshold.

Conclusions

The results confirm the validity of the Chinese Sound Test, indicating that the testing sounds can be reliably used to assess the perception of frequency-specific information. Crucially, these data also demonstrate that the Chinese Sound Test is a useful tool to identify red flags of poor auditory access in daily environment to monitor device malfunctions and possible hearing fluctuations.

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Predictive Factors for Vestibular Loss in Children With Hearing Loss

Purpose

The aim of this study was to determine if there are factors that can predict whether a child with hearing loss will also have vestibular loss.

Method

A retrospective chart review was completed on 186 children with hearing loss seen at Boys Town National Research Hospital for vestibular testing from 1999 to 2015 through neurosensory genetics clinic or cochlear implant candidacy. Each child's medical chart was reviewed to obtain the following data: vestibular loss severity (classified as normal, bilateral, or mild to moderate), degree of hearing loss (bilateral pure-tone average [PTA]), imaging abnormalities (classified as “normal” or “abnormal”), parental concerns for gross motor delay (classified as “yes, there is concern” or “no, there is not a concern”), parent report of age when their child sat (months) and walked independently (months), comorbidities (classified as “yes” if there were 1 or more comorbidities or “no” if there were no comorbidities), and score on the Developmental Profile-3.

Results

Children were grouped according to vestibular loss severity; 115 children had normal vestibular function, 31 had bilateral vestibular loss, and 40 had mild-to-moderate vestibular loss. As severity of vestibular loss increased, children (a) sat and walked later, (b) scored more poorly on the Developmental Profile-3 physical subscale, (c) had more severe hearing loss, (d) had parents who more frequently reported concern for gross motor delay, and (e) were more likely to have other comorbidities. Of these factors, age-to-sit, age-to-walk, PTA, and parental concerns for gross motor developmental delay had the greatest ability to differentiate children with vestibular loss from children with normal vestibular function. For age-to-sit, using a cutoff value of 7.25 months yielded a sensitivity of 62% and a specificity of 81%. For age-to-walk, a cutoff value of 14.5 months yielded a sensitivity of 78% and a specificity of 77%. For PTA for the neurosensory genetics group, a cutoff value of 40 dB yielded a sensitivity of 80% and a specificity of 55%; however, a cutoff value of 66 dB yielded a sensitivity of 33% and an improved specificity of 91%.

Conclusions

A referral for vestibular evaluation should be considered for children whose hearing loss is greater than 66 dB and particularly those who sit later than 7.25 months or walk later than 14.5 months or whose parents report concerns for gross motor development. Collectively, these factors appear to be more sensitive for identifying children with bilateral vestibular loss compared with children with mild-to-moderate vestibular loss. Because of the benefit of physical therapy, children identified with vestibular loss should then be referred to physical therapy for further evaluation and treatment.

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Structured Review of Dichotic Tests of Binaural Integration: Clinical Performance in Children

Purpose

The aim of the study was to evaluate the evidence of clinical utility for dichotic speech tests of binaural integration used to assess auditory processing in English-speaking children 6–14 years old.

Method

Dichotic speech test recordings and pertinent research studies were identified from iterative searches of the Internet and bibliographic databases, as well as communication with colleagues and test publishers. Test documentation and peer-reviewed literature were evaluated for evidence of reliability, accuracy, usefulness, and value.

Results

Eleven dichotic tests of binaural integration were identified for children. Evidence of test–retest reliability was found for 5 tests and demonstrated moderate to good correlation between results on repeated administration (r = .59–.92). Evidence of accuracy was identified for 5 tests but was either inconsistent with accurate performance or was not generalizable due to significant limitations in study design. No evidence was found to either support or dispute claims of usefulness or value.

Conclusions

A medical diagnostic framework is useful for evaluating dichotic tests. Although dichotic procedures show moderate reliability, the absence of a widely accepted gold standard reference test limits our ability to assess their value. Overall, the data available at the time of this review do not support the routine use of dichotic tests of binaural integration for clinical evaluation of children.

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Validation of the Chinese Sound Test: Auditory Performance of Hearing Aid Users

Purpose

The Chinese Sound Test (Hung, Lin, Tsai, & Lee, 2016) has been recently developed as a modified version of the Ling Six-Sound Test (Ling, 2012). By incorporating Chinese speech sounds, this test should be able to estimate whether the listener can hear across the Chinese speech spectrum. To establish the clinical validity of the test, this study examined the relationship between the aided audiometric thresholds and the distance thresholds.

Method

Sixty children with bilateral hearing aids were recruited. The aided sound-field thresholds at 250, 500, 1000, 2000, 4000, and 6000 Hz were compared with the distance thresholds of six sounds, /u, ə, a, i, tɕʰ, and s/, which encompass the entire Chinese speech frequency range from low to high.

Results

Partial correlation and stepwise regression analyses revealed that the Chinese testing sounds are frequency specific and that the audibility of each sound could be predicted by a specific frequency threshold.

Conclusions

The results confirm the validity of the Chinese Sound Test, indicating that the testing sounds can be reliably used to assess the perception of frequency-specific information. Crucially, these data also demonstrate that the Chinese Sound Test is a useful tool to identify red flags of poor auditory access in daily environment to monitor device malfunctions and possible hearing fluctuations.

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Predictive Factors for Vestibular Loss in Children With Hearing Loss

Purpose

The aim of this study was to determine if there are factors that can predict whether a child with hearing loss will also have vestibular loss.

Method

A retrospective chart review was completed on 186 children with hearing loss seen at Boys Town National Research Hospital for vestibular testing from 1999 to 2015 through neurosensory genetics clinic or cochlear implant candidacy. Each child's medical chart was reviewed to obtain the following data: vestibular loss severity (classified as normal, bilateral, or mild to moderate), degree of hearing loss (bilateral pure-tone average [PTA]), imaging abnormalities (classified as “normal” or “abnormal”), parental concerns for gross motor delay (classified as “yes, there is concern” or “no, there is not a concern”), parent report of age when their child sat (months) and walked independently (months), comorbidities (classified as “yes” if there were 1 or more comorbidities or “no” if there were no comorbidities), and score on the Developmental Profile-3.

Results

Children were grouped according to vestibular loss severity; 115 children had normal vestibular function, 31 had bilateral vestibular loss, and 40 had mild-to-moderate vestibular loss. As severity of vestibular loss increased, children (a) sat and walked later, (b) scored more poorly on the Developmental Profile-3 physical subscale, (c) had more severe hearing loss, (d) had parents who more frequently reported concern for gross motor delay, and (e) were more likely to have other comorbidities. Of these factors, age-to-sit, age-to-walk, PTA, and parental concerns for gross motor developmental delay had the greatest ability to differentiate children with vestibular loss from children with normal vestibular function. For age-to-sit, using a cutoff value of 7.25 months yielded a sensitivity of 62% and a specificity of 81%. For age-to-walk, a cutoff value of 14.5 months yielded a sensitivity of 78% and a specificity of 77%. For PTA for the neurosensory genetics group, a cutoff value of 40 dB yielded a sensitivity of 80% and a specificity of 55%; however, a cutoff value of 66 dB yielded a sensitivity of 33% and an improved specificity of 91%.

Conclusions

A referral for vestibular evaluation should be considered for children whose hearing loss is greater than 66 dB and particularly those who sit later than 7.25 months or walk later than 14.5 months or whose parents report concerns for gross motor development. Collectively, these factors appear to be more sensitive for identifying children with bilateral vestibular loss compared with children with mild-to-moderate vestibular loss. Because of the benefit of physical therapy, children identified with vestibular loss should then be referred to physical therapy for further evaluation and treatment.

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Structured Review of Dichotic Tests of Binaural Integration: Clinical Performance in Children

Purpose

The aim of the study was to evaluate the evidence of clinical utility for dichotic speech tests of binaural integration used to assess auditory processing in English-speaking children 6–14 years old.

Method

Dichotic speech test recordings and pertinent research studies were identified from iterative searches of the Internet and bibliographic databases, as well as communication with colleagues and test publishers. Test documentation and peer-reviewed literature were evaluated for evidence of reliability, accuracy, usefulness, and value.

Results

Eleven dichotic tests of binaural integration were identified for children. Evidence of test–retest reliability was found for 5 tests and demonstrated moderate to good correlation between results on repeated administration (r = .59–.92). Evidence of accuracy was identified for 5 tests but was either inconsistent with accurate performance or was not generalizable due to significant limitations in study design. No evidence was found to either support or dispute claims of usefulness or value.

Conclusions

A medical diagnostic framework is useful for evaluating dichotic tests. Although dichotic procedures show moderate reliability, the absence of a widely accepted gold standard reference test limits our ability to assess their value. Overall, the data available at the time of this review do not support the routine use of dichotic tests of binaural integration for clinical evaluation of children.

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Validation of the Chinese Sound Test: Auditory Performance of Hearing Aid Users

Purpose

The Chinese Sound Test (Hung, Lin, Tsai, & Lee, 2016) has been recently developed as a modified version of the Ling Six-Sound Test (Ling, 2012). By incorporating Chinese speech sounds, this test should be able to estimate whether the listener can hear across the Chinese speech spectrum. To establish the clinical validity of the test, this study examined the relationship between the aided audiometric thresholds and the distance thresholds.

Method

Sixty children with bilateral hearing aids were recruited. The aided sound-field thresholds at 250, 500, 1000, 2000, 4000, and 6000 Hz were compared with the distance thresholds of six sounds, /u, ə, a, i, tɕʰ, and s/, which encompass the entire Chinese speech frequency range from low to high.

Results

Partial correlation and stepwise regression analyses revealed that the Chinese testing sounds are frequency specific and that the audibility of each sound could be predicted by a specific frequency threshold.

Conclusions

The results confirm the validity of the Chinese Sound Test, indicating that the testing sounds can be reliably used to assess the perception of frequency-specific information. Crucially, these data also demonstrate that the Chinese Sound Test is a useful tool to identify red flags of poor auditory access in daily environment to monitor device malfunctions and possible hearing fluctuations.

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An Initial Investigation of the Neural Correlates of Word Processing in Preschoolers With Specific Language Impairment

Purpose

Previous behavioral studies have found deficits in lexical–semantic abilities in children with specific language impairment (SLI), including reduced depth and breadth of word knowledge. This study explored the neural correlates of early emerging familiar word processing in preschoolers with SLI and typical development.

Method

Fifteen preschoolers with typical development and 15 preschoolers with SLI were presented with pictures followed after a brief delay by an auditory label that did or did not match. Event-related brain potentials were time locked to the onset of the auditory labels. Children provided verbal judgments of whether the label matched the picture.

Results

There were no group differences in the accuracy of identifying when pictures and labels matched or mismatched. Event-related brain potential data revealed that mismatch trials elicited a robust N400 in both groups, with no group differences in mean amplitude or peak latency. However, the typically developing group demonstrated a more robust late positive component, elicited by mismatch trials.

Conclusions

These initial findings indicate that lexical–semantic access of early acquired words, indexed by the N400, does not differ between preschoolers with SLI and typical development when highly familiar words are presented in isolation. However, the typically developing group demonstrated a more mature profile of postlexical reanalysis and integration, indexed by an emerging late positive component. The findings lay the necessary groundwork for better understanding processing of newly learned words in children with SLI.

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Influence of Language Load on Speech Motor Skill in Children With Specific Language Impairment

Purpose

Children with specific language impairment (SLI) show particular deficits in the generation of sequenced action: the quintessential procedural task. Practiced imitation of a sequence may become rote and require reduced procedural memory. This study explored whether speech motor deficits in children with SLI occur generally or only in conditions of high linguistic load, whether speech motor deficits diminish with practice, and whether it is beneficial to incorporate conditions of high load to understand speech production.

Method

Children with SLI and typical development participated in a syntactic priming task during which they generated sentences (high linguistic load) and, then, practiced repeating a sentence (low load) across 3 sessions. We assessed phonetic accuracy, speech movement variability, and duration.

Results

Children with SLI produced more variable articulatory movements than peers with typical development in the high load condition. The groups converged in the low load condition. Children with SLI continued to show increased articulatory stability over 3 practice sessions. Both groups produced generated sentences with increased duration and variability compared with repeated sentences.

Conclusions

Linguistic demands influence speech motor production. Children with SLI show reduced speech motor performance in tasks that require language generation but not when task demands are reduced in rote practice.

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An Initial Investigation of the Neural Correlates of Word Processing in Preschoolers With Specific Language Impairment

Purpose

Previous behavioral studies have found deficits in lexical–semantic abilities in children with specific language impairment (SLI), including reduced depth and breadth of word knowledge. This study explored the neural correlates of early emerging familiar word processing in preschoolers with SLI and typical development.

Method

Fifteen preschoolers with typical development and 15 preschoolers with SLI were presented with pictures followed after a brief delay by an auditory label that did or did not match. Event-related brain potentials were time locked to the onset of the auditory labels. Children provided verbal judgments of whether the label matched the picture.

Results

There were no group differences in the accuracy of identifying when pictures and labels matched or mismatched. Event-related brain potential data revealed that mismatch trials elicited a robust N400 in both groups, with no group differences in mean amplitude or peak latency. However, the typically developing group demonstrated a more robust late positive component, elicited by mismatch trials.

Conclusions

These initial findings indicate that lexical–semantic access of early acquired words, indexed by the N400, does not differ between preschoolers with SLI and typical development when highly familiar words are presented in isolation. However, the typically developing group demonstrated a more mature profile of postlexical reanalysis and integration, indexed by an emerging late positive component. The findings lay the necessary groundwork for better understanding processing of newly learned words in children with SLI.

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Influence of Language Load on Speech Motor Skill in Children With Specific Language Impairment

Purpose

Children with specific language impairment (SLI) show particular deficits in the generation of sequenced action: the quintessential procedural task. Practiced imitation of a sequence may become rote and require reduced procedural memory. This study explored whether speech motor deficits in children with SLI occur generally or only in conditions of high linguistic load, whether speech motor deficits diminish with practice, and whether it is beneficial to incorporate conditions of high load to understand speech production.

Method

Children with SLI and typical development participated in a syntactic priming task during which they generated sentences (high linguistic load) and, then, practiced repeating a sentence (low load) across 3 sessions. We assessed phonetic accuracy, speech movement variability, and duration.

Results

Children with SLI produced more variable articulatory movements than peers with typical development in the high load condition. The groups converged in the low load condition. Children with SLI continued to show increased articulatory stability over 3 practice sessions. Both groups produced generated sentences with increased duration and variability compared with repeated sentences.

Conclusions

Linguistic demands influence speech motor production. Children with SLI show reduced speech motor performance in tasks that require language generation but not when task demands are reduced in rote practice.

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