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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