The Nasal Musculature as a Control Panel for Singing—Why Classical Singers Use a Special Facial Expression?

Publication date: Available online 7 April 2018
Source:Journal of Voice
Author(s): Maarit Aura, Ahmed Geneid, Kåre Bjørkøy, Marita Rantanen, Anne-Maria Laukkanen
ObjectivesThis study aimed to explain the possible reason why classical singers seem to spread their nostrils and raise their cheeks before starting to sing.Study DesignThis is an experimental study.MethodsFive subjects (three classical singers, two nonsingers) were investigated with nasofiberoscopy holding their breath after inhalation. The subjects were instructed to have a neutral expression first and then to take the singers' expression characterized by nostril flaring. In case of nonsingers, the special expression was rehearsed beforehand, guided by a classical singer. The following measurements were made: (1) height of soft palate, (2) area of the hypopharynx, (3) area of the epilaryngeal tube inlet (Aditus laryngis), and (4) dimensions of the (visible) glottis (length, width, and length-to-width ratio).ResultsAll subjects raised the palate and widened the pharyngeal inlet, epilaryngeal inlet, and the glottis during “singer's expression.”ConclusionsThe results suggest that classical singers may take advantage of breathing- and smelling-related connections between nasal and facial muscles and the larynx to avoid a hard glottal attack and pressed phonation and possibly also to assist the production of mixed register (head voice), characterized by a relatively low adduction between the vocal folds.



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Supra-threshold auditory brainstem response amplitudes in humans: Test-retest reliability, electrode montage and noise exposure

Publication date: Available online 6 April 2018
Source:Hearing Research
Author(s): Garreth Prendergast, Wenhe Tu, Hannah Guest, Rebecca E. Millman, Karolina Kluk, Samuel Couth, Kevin J. Munro, Christopher J. Plack
The auditory brainstem response (ABR) is a sub-cortical evoked potential in which a series of well-defined waves occur in the first 10 ms after the onset of an auditory stimulus. Wave V of the ABR, particularly wave V latency, has been shown to be remarkably stable over time in individual listeners. However, little attention has been paid to the reliability of wave I which reflects auditory nerve activity. This ABR component has attracted interest recently, as wave I amplitude has been identified as a possible non-invasive measure of noise-induced cochlear synaptopathy. The current study aimed to determine whether ABR wave I amplitude has sufficient test-retest reliability to detect impaired auditory nerve function in an otherwise normal-hearing listener. Thirty normal-hearing females were tested, divided into equal groups of low- and high-noise exposure. The stimulus was an 80 dB nHL click. ABR recordings were made from the ipsilateral mastoid and from the ear canal (using a tiptrode). Although there was some variability between listeners, wave I amplitude had high test-retest reliability, with an intraclass correlation coefficient (ICC) comparable to that for wave V amplitude. There were slight gains in reliability for wave I amplitude when recording from the ear canal (ICC of 0.88) compared to the mastoid (ICC of 0.85). The summating potential (SP) and ratio of SP to wave I were also quantified and found to be much less reliable than measures of wave I and V amplitude. Finally, we found no significant differences in the amplitude of any wave components between low- and high-noise exposure groups. We conclude that, if the other sources of between-subject variability can be controlled, wave I amplitude is sufficiently reliable to accurately characterize individual differences in auditory nerve function.



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The effects of the activation of the inner-hair-cell basolateral K+ channels on auditory nerve responses

Publication date: Available online 6 April 2018
Source:Hearing Research
Author(s): Alessandro Altoè, Ville Pulkki, Sarah Verhulst
The basolateral membrane of the mammalian inner hair cell (IHC) expresses large voltage and Ca²⁺ gated outward K⁺ currents. To quantify how the voltage-dependent activation of the K⁺ channels affects the functionality of the auditory nerve innervating the IHC, this study adopts a model of mechanical-to-neural transduction in which the basolateral K⁺ conductances of the IHC can be made voltage-dependent or not. The model shows that the voltage-dependent activation of the K⁺ channels (i) enhances the phase-locking properties of the auditory fiber (AF) responses; (ii) enables the auditory nerve to encode a large dynamic range of sound levels; (iii) enables the AF responses to synchronize precisely with the envelope of amplitude modulated stimuli; and (iv), is responsible for the steep offset responses of the AFs. These results suggest that the basolateral K⁺ channels play a major role in determining the well-known response properties of the AFs and challenge the classical view that describes the IHC membrane as an electrical low-pass filter. In contrast to previous models of the IHC-AF complex, this study ascribes many of the AF response properties to fairly basic mechanisms in the IHC membrane rather than to complex mechanisms in the synapse.



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Supra-threshold auditory brainstem response amplitudes in humans: Test-retest reliability, electrode montage and noise exposure

Publication date: Available online 6 April 2018
Source:Hearing Research
Author(s): Garreth Prendergast, Wenhe Tu, Hannah Guest, Rebecca E. Millman, Karolina Kluk, Samuel Couth, Kevin J. Munro, Christopher J. Plack
The auditory brainstem response (ABR) is a sub-cortical evoked potential in which a series of well-defined waves occur in the first 10 ms after the onset of an auditory stimulus. Wave V of the ABR, particularly wave V latency, has been shown to be remarkably stable over time in individual listeners. However, little attention has been paid to the reliability of wave I which reflects auditory nerve activity. This ABR component has attracted interest recently, as wave I amplitude has been identified as a possible non-invasive measure of noise-induced cochlear synaptopathy. The current study aimed to determine whether ABR wave I amplitude has sufficient test-retest reliability to detect impaired auditory nerve function in an otherwise normal-hearing listener. Thirty normal-hearing females were tested, divided into equal groups of low- and high-noise exposure. The stimulus was an 80 dB nHL click. ABR recordings were made from the ipsilateral mastoid and from the ear canal (using a tiptrode). Although there was some variability between listeners, wave I amplitude had high test-retest reliability, with an intraclass correlation coefficient (ICC) comparable to that for wave V amplitude. There were slight gains in reliability for wave I amplitude when recording from the ear canal (ICC of 0.88) compared to the mastoid (ICC of 0.85). The summating potential (SP) and ratio of SP to wave I were also quantified and found to be much less reliable than measures of wave I and V amplitude. Finally, we found no significant differences in the amplitude of any wave components between low- and high-noise exposure groups. We conclude that, if the other sources of between-subject variability can be controlled, wave I amplitude is sufficiently reliable to accurately characterize individual differences in auditory nerve function.



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The effects of the activation of the inner-hair-cell basolateral K+ channels on auditory nerve responses

Publication date: Available online 6 April 2018
Source:Hearing Research
Author(s): Alessandro Altoè, Ville Pulkki, Sarah Verhulst
The basolateral membrane of the mammalian inner hair cell (IHC) expresses large voltage and Ca²⁺ gated outward K⁺ currents. To quantify how the voltage-dependent activation of the K⁺ channels affects the functionality of the auditory nerve innervating the IHC, this study adopts a model of mechanical-to-neural transduction in which the basolateral K⁺ conductances of the IHC can be made voltage-dependent or not. The model shows that the voltage-dependent activation of the K⁺ channels (i) enhances the phase-locking properties of the auditory fiber (AF) responses; (ii) enables the auditory nerve to encode a large dynamic range of sound levels; (iii) enables the AF responses to synchronize precisely with the envelope of amplitude modulated stimuli; and (iv), is responsible for the steep offset responses of the AFs. These results suggest that the basolateral K⁺ channels play a major role in determining the well-known response properties of the AFs and challenge the classical view that describes the IHC membrane as an electrical low-pass filter. In contrast to previous models of the IHC-AF complex, this study ascribes many of the AF response properties to fairly basic mechanisms in the IHC membrane rather than to complex mechanisms in the synapse.



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Supra-threshold auditory brainstem response amplitudes in humans: Test-retest reliability, electrode montage and noise exposure

Publication date: Available online 6 April 2018
Source:Hearing Research
Author(s): Garreth Prendergast, Wenhe Tu, Hannah Guest, Rebecca E. Millman, Karolina Kluk, Samuel Couth, Kevin J. Munro, Christopher J. Plack
The auditory brainstem response (ABR) is a sub-cortical evoked potential in which a series of well-defined waves occur in the first 10 ms after the onset of an auditory stimulus. Wave V of the ABR, particularly wave V latency, has been shown to be remarkably stable over time in individual listeners. However, little attention has been paid to the reliability of wave I which reflects auditory nerve activity. This ABR component has attracted interest recently, as wave I amplitude has been identified as a possible non-invasive measure of noise-induced cochlear synaptopathy. The current study aimed to determine whether ABR wave I amplitude has sufficient test-retest reliability to detect impaired auditory nerve function in an otherwise normal-hearing listener. Thirty normal-hearing females were tested, divided into equal groups of low- and high-noise exposure. The stimulus was an 80 dB nHL click. ABR recordings were made from the ipsilateral mastoid and from the ear canal (using a tiptrode). Although there was some variability between listeners, wave I amplitude had high test-retest reliability, with an intraclass correlation coefficient (ICC) comparable to that for wave V amplitude. There were slight gains in reliability for wave I amplitude when recording from the ear canal (ICC of 0.88) compared to the mastoid (ICC of 0.85). The summating potential (SP) and ratio of SP to wave I were also quantified and found to be much less reliable than measures of wave I and V amplitude. Finally, we found no significant differences in the amplitude of any wave components between low- and high-noise exposure groups. We conclude that, if the other sources of between-subject variability can be controlled, wave I amplitude is sufficiently reliable to accurately characterize individual differences in auditory nerve function.



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The effects of the activation of the inner-hair-cell basolateral K+ channels on auditory nerve responses

Publication date: Available online 6 April 2018
Source:Hearing Research
Author(s): Alessandro Altoè, Ville Pulkki, Sarah Verhulst
The basolateral membrane of the mammalian inner hair cell (IHC) expresses large voltage and Ca²⁺ gated outward K⁺ currents. To quantify how the voltage-dependent activation of the K⁺ channels affects the functionality of the auditory nerve innervating the IHC, this study adopts a model of mechanical-to-neural transduction in which the basolateral K⁺ conductances of the IHC can be made voltage-dependent or not. The model shows that the voltage-dependent activation of the K⁺ channels (i) enhances the phase-locking properties of the auditory fiber (AF) responses; (ii) enables the auditory nerve to encode a large dynamic range of sound levels; (iii) enables the AF responses to synchronize precisely with the envelope of amplitude modulated stimuli; and (iv), is responsible for the steep offset responses of the AFs. These results suggest that the basolateral K⁺ channels play a major role in determining the well-known response properties of the AFs and challenge the classical view that describes the IHC membrane as an electrical low-pass filter. In contrast to previous models of the IHC-AF complex, this study ascribes many of the AF response properties to fairly basic mechanisms in the IHC membrane rather than to complex mechanisms in the synapse.



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The Impact of Individual Differences on a Bilingual Vocabulary Approach for Latino Preschoolers

Purpose

The purpose of this study was twofold: First, we replicated in a new sample our previous findings that a culturally and linguistically responsive (CLR) bilingual approach for English vocabulary instruction for preschool Latino dual language learners was effective. Subsequently, we investigated whether the positive effect of CLR instruction varies as a function of individual child characteristics, including baseline vocabulary levels and gender.

Method

Using a randomized pretest–posttest follow-up group design, we first replicated our previous study (N = 42) with a new sample by randomly assigning 35 Spanish-speaking Latino preschoolers to a CLR bilingual group or an English-only group. The preschoolers received small-group evidence-informed shared readings targeting 30 English words 3 times a week for 5 weeks in their preschools. Vocabulary outcomes were measured using both standardized and researcher-developed measures. We subsequently conducted further studies with the combined sample size of 77 children to examine the variability in intervention effects related to child gender and baseline vocabulary levels.

Results

The direct replication study confirmed findings of our earlier work suggesting that the CLR bilingual approach promoted greater gains in L1 and L2 vocabulary than in an English-only approach. The extension studies revealed that the effect of the CLR bilingual vocabulary approach on English and Spanish vocabulary outcomes was not impacted by gender or vocabulary status at baseline.

Conclusion

This study provides additional evidence of the benefits of strategically combining L1 and L2 for vocabulary instruction over an English-only approach. Our findings also suggest that preschool Latino dual language learners can benefit from a bilingual vocabulary instructional approach regardless of gender or baseline vocabulary levels in L1.

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Comprehension of Degraded Speech Matures During Adolescence

Purpose

The aim of the study was to compare comprehension of spectrally degraded (noise-vocoded [NV]) speech and perceptual learning of NV speech between adolescents and young adults and examine the role of phonological processing and executive functions in this perception.

Method

Sixteen younger adolescents (11–13 years), 16 older adolescents (14–16 years), and 16 young adults (18–22 years) listened to 40 NV sentences and repeated back what they heard. They also completed tests assessing phonological processing and a variety of executive functions.

Results

Word-report scores were generally poorer for younger adolescents than for the older age groups. Phonological processing also predicted initial word-report scores. Learning (i.e., improvement across training times) did not differ with age. Starting performance and processing speed predicted learning, with greater learning for those who started with the lowest scores and those with faster processing speed.

Conclusions

Degraded (NV) speech comprehension is not mature even by early adolescence; however, like adults, adolescents are able to improve their comprehension of degraded speech with training. Thus, although adolescents may have initial difficulty in understanding degraded speech or speech as presented through hearing aids or cochlear implants, they are able to improve their perception with experience. Processing speed and phonological processing may play a role in degraded speech comprehension in these age groups.

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Readability of Patient-Reported Outcome Measures in Adult Audiologic Rehabilitation

Purpose

The purpose of this study was to examine the readability of published patient-reported outcome measures (PROMs) designed for use in adult audiologic rehabilitation. The readability results were compared with the readability levels recommended for health information by health literacy experts.

Method

Reading grade levels were calculated using the Flesch–Kincaid Grade Level Formula (Flesch, 1948), Gunning Fog Index (Gunning, 1952), Simple Measure of Gobbledygook (McLaughlin, 1969), and FORCAST (Caylor, Sticht, Fox, & Ford, 1973) readability formulas for 10 published PROMs. Descriptive statistics were computed across the different PROM sections: instructions, items, response scale, and overall contents of the measure directed toward respondents.

Results

The majority of the PROM sections exceeded the 6th grade reading level recommended by health literacy experts, regardless of the formula applied. All PROM sections exceeded the 6th grade reading level when calculated according to the FORCAST formula, the most appropriate readability formula for use with a nonnarrative text format, such as PROMs.

Conclusions

When developing or reevaluating PROMs designed for use in adult audiologic rehabilitation, researchers should consider ways to improve the readability of their measure, as poor readability may affect the validity of the empirical data collected using the PROM. Additionally, the adequate readability of audiologic PROMs is required if patient/family-centered care values are to be adhered to within the field of adult audiologic rehabilitation.

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Tinnitus, Depression, Anxiety, and Suicide in Recent Veterans: A Retrospective Analysis

Objectives: The purpose of this project was to investigate whether there is an association between tinnitus diagnosis and suicide and whether depression and anxiety strengthen that association. Given that tinnitus is the top service–connected disability among U.S. Veterans (Veterans Benefits Administration, 2016) and that suicide among Veterans has been occurring at a higher frequency as compared with community suicide rates (Hoffmire et al., 2015), the possible associations between tinnitus and suicide will be explored. Co-occurring physical conditions also will be examined to determine if they increase the risk of suicide in the context of tinnitus. Design: Administrative health care data related to Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) were used to identify Veterans who accessed the Veterans Administration (VA) health care system from January 1, 2002, to December 31, 2011. Veterans who were deceased as of December 2011 were identified using the National Death Index (NDI) files. Tinnitus cases were followed until either they were deceased or to the end of the study period. The International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) codes were used to identify all conditions and diseases. As per mortality research standards, International Classification of Diseases 10th Revision (ICD-10) codes were used to identify cause of death. Results: Of 769,934 OEF/OIF/OND Veterans receiving VA care January 2002 to December 2011, 15% (n =116,358) were diagnosed with tinnitus. Of these Veterans diagnosed with tinnitus, 21% were also diagnosed with depression, another 8% with anxiety, and another 17% with both depression and anxiety. Fifty-four percentage were identified as having tinnitus without depression or anxiety. Among individuals with tinnitus, 41.9% had co-occurring hearing loss. Suicide rates were lower among Veterans with tinnitus than Veterans without tinnitus. Co-occurring diagnoses of mental-health conditions did not significantly increase the risk of suicide. Conclusions: The study results do not confirm clinical and anecdotal reports that tinnitus could be related to suicide among Veterans. However, tenets from rehabilitation psychology suggest that the onset of chronic impairment or disability does not predict an individual’s subsequent psychological states; other personal attributes may be more influential. Health care professionals, such as audiologists and psychologists, should be cognizant of the associations between tinnitus and mental health issues and be prepared to address the psychological needs of individuals who have tinnitus. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (www.ear-hearing.com). ACKNOWLEDGEMENTS: This material is the result of work supported with resources and the use of facilities at the VA Portland Healthcare System and the support of the VHA Office of Patient Care Services, Post Deployment Health Services. The authors acknowledge the help that Dr. Robert Bossarte provided to the first two authors as they were starting this research study. Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. All authors contributed equally to this work. E.M. and C.J. conducted the literature review, and E.M. wrote most of the introduction and discussion sections. D.D. and C.W. ran the data analyses and wrote most of the Methods section, including the results, and created the tables. A.S. reviewed and discussed the data analyses with D.D. and C.W. All authors not only discussed the results and their implications but also edited the article throughout its evolution. There are no conflicts of interest to report. Received June 27, 2017; accepted January 23, 2018. Address for correspondence: Erin Martz, VA Portland Healthcare System, Bldg. 6, Room 114A, 3710 SW U.S. Veterans Hospital Rd, Portland, OR 97239. E-mail: rehabilityoregon@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Evaluation of Speed and Accuracy of Next-Generation Auditory Steady State Response and Auditory Brainstem Response Audiometry in Children With Normal Hearing and Hearing Loss

Objectives: The first objective of this study was to compare the predicted audiometric thresholds obtained by auditory steady state response (ASSR) and auditory brainstem response (ABR) in infants and toddlers when both techniques use optimal stimuli and detection algorithms. This information will aid in determining the basis for large discrepancies in ABR and ASSR measures found in past studies. The hypothesis was that advancements in ASSR response detection would improve (lower) thresholds and decrease discrepancies between the thresholds produced by the two techniques. The second objective was to determine and compare test times required by the two techniques to predict thresholds for both ears at the 4 basic audiometric frequencies of 500, 1000, 2000, and 4000 Hz. Design: A multicenter clinical study was implemented at three university-based children’s hospital audiology departments. Participants were 102 infants and toddlers referred to the centers for electrophysiologic testing for audiometric purposes. The test battery included wideband tympanometry, distortion-product otoacoustic emissions, and threshold measurements at four frequencies in both ears using ABR and ASSR (randomized) as implemented on the Interacoustics Eclipse systems with “Next-Generation” ASSR detection and FMP analysis for ABR. Both methods utilized narrow band CE-Chirp stimuli. Testers were trained on a specialized test battery designed to minimize test time for both techniques. Testing with both techniques was performed in one session. Thresholds were evaluated and confirmed by the first author and correction factors were applied. Test times were documented in system software. Results: Corrected thresholds for ABR and ASSR were compared by regression, by the Bland–Altman technique and by matched pairs t tests. Thresholds were significantly lower for ASSR than ABR. The ABR–ASSR discrepancy at 500 Hz was 14.39 dB, at 1000 Hz was 10.12 dB, at 2000 Hz was 3.73 dB, and at 4000 Hz was 3.67 dB. The average test time for ASSR of 19.93 min (for 8 thresholds) was found to be significantly lower (p

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Toward Optimizing VEMP: Calculating VEMP Inhibition Depth With a Generic Template

Objectives: Cervical vestibular evoked myogenic potentials (cVEMP) indirectly reveal the response of the saccule to acoustic stimuli through the inhibition of sternocleidomastoid muscle electromyographic response. VEMP inhibition depth (VEMPid) is a recently developed metric that estimates the percentage of saccular inhibition. VEMPid provides both normalization and better accuracy at low response levels than amplitude-normalized cVEMPs. Hopefully, VEMPid will aid in the clinical assessment of patients with vestibulopatholgy. To calculate VEMPid a template is needed. In the original method, a subject’s own cVEMP was used as the template, but this method can be problematic in patients who do not have robust cVEMP responses. We hypothesize that a “generic” template, created by assembling cVEMPs from healthy subjects, can be used to compute VEMPid, which would facilitate the use of VEMPid in subjects with pathological conditions. Design: A generic template was created by averaging cVEMP responses from 6 normal subjects. To compare VEMPid calculations using a generic versus a subject-specific template, cVEMPs were obtained in 40 healthy subjects using 500, 750, and 1000 Hz tonebursts at sound levels ranging from 98 to 123 dB peSPL. VEMPids were calculated both with the generic template and with the subject’s own template. The ability of both templates to determine whether a cVEMP was present or not was compared with receiver operating characteristic curves. Results: No significant differences were found between VEMPid calculations using a generic template versus using a subject-specific template for all frequencies and sound levels. Based on the receiver operating characteristic curves, the subject-specific and generic template did an equally good job at determining threshold. Within limits, the shape of the generic template did not affect these results. Conclusions: A generic template can be used instead of a subject-specific template to calculate VEMPid. Compared with cVEMP normalized by electromyographic amplitudes, VEMPid is advantageous because it averages zero when there is no sound stimulus and it allows the accumulating VEMPid value to be shown during data acquisition as a guide to deciding when enough data has been collected. ACKNOWLEDGMENTS: The authors thank audiologists Heidi Leonard and Mark Sanders for their help with threshold determination. This study was conducted with support from Harvard Catalyst, The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award UL1 TR001102), and financial contributions from Harvard University and its affiliated academic healthcare centers. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University and its affiliated academic healthcare centers, or the National Institutes of Health. This work was presented as a poster at the Association of Research in Otolaryngology Midwinter meeting in Baltimore, MD (February 11-15, 2017). This study was approved by the Human Studies Committee of the Massachusetts Eye and Ear Infirmary. Protocol number: 13-097H. Principal Investigator: Steven D. Rauch. The authors have no conflicts of interest to disclose. Address for correspondence: John J. Guinan Jr., 243 Charles Street, Boston, MA 02114, USA. E-mail: John_Guinan@meei.harvard.edu Received November 1, 2017; accepted February 10, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Comparisons of IQ in Children With and Without Cochlear Implants: Longitudinal Findings and Associations With Language

Objectives: To make longitudinal comparisons of intelligence quotient (IQ) in children with cochlear implants (CIs) and typical hearing peers from early in development to the school-age period. Children with additional comorbidities and CIs were also evaluated. To estimate the impact of socioeconomic status and oral language on school-age cognitive performance. Design: This longitudinal study evaluated nonverbal IQ in a multicenter, national sample of 147 children with CIs and 75 typically hearing peers. IQ was evaluated at baseline, prior to cochlear implantation, using the Bayley Scales of Infant and Toddler Development and the Leiter International Performance Scale. School-age IQ was assessed using the Wechsler Intelligence Scales for Children. For the current study, only the Perceptual Reasoning and Processing Speed indices were administered. Oral language was evaluated using the Comprehensive Assessment of Spoken Language. Results: Children in the CI group scored within the normal range of intelligence at both time points. However, children with additional comorbidities scored significantly worse on the Processing Speed, but not the Perceptual Reasoning Index. Maternal education and language were significantly related to school-age IQ in both groups. Importantly, language was the strongest predictor of intellectual functioning in both children with CIs and normal hearing. Conclusion: These results suggest that children using cochlear implants perform similarly to hearing peers on measures of intelligence, but those with severe comorbidities are at-risk for cognitive deficits. Despite the strong link between socioeconomic status and intelligence, this association was no longer significant once spoken language performance was accounted for. These results reveal the important contributions that early intervention programs, which emphasize language and parent training, contribute to cognitive functioning in school-age children with CIs. For families from economically disadvantaged backgrounds, who are at-risk for suboptimal outcomes, these early intervention programs are critical to improve overall functioning. ACKNOWLEDGMENTS: This work was supported by grant R01DC004797 from NIH. Dr. Cejas is on the AG Bell Board of Directors, MED-EL pediatric advisory board, and consults with ASHA, and has a research agreement and consultancy with Advanced Bionics. Ms. Mitchell has received support from Advanced Bionics through a research contract to her institution. The other authors do not have any conflicts of interest with regard to this study. Address for correspondence: Ivette Cejas, PhD, The Barton G Kids Hear Now Cochlear Implant Family Resource Center, University of Miami Ear Institute, 1120 NW 14th Street, CRB 5th Floor, Miami, FL 33136. E-mail: icejas@med.miami.edu Received June 23, 2017; accepted February 5, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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The Impact of Individual Differences on a Bilingual Vocabulary Approach for Latino Preschoolers

Purpose

The purpose of this study was twofold: First, we replicated in a new sample our previous findings that a culturally and linguistically responsive (CLR) bilingual approach for English vocabulary instruction for preschool Latino dual language learners was effective. Subsequently, we investigated whether the positive effect of CLR instruction varies as a function of individual child characteristics, including baseline vocabulary levels and gender.

Method

Using a randomized pretest–posttest follow-up group design, we first replicated our previous study (N = 42) with a new sample by randomly assigning 35 Spanish-speaking Latino preschoolers to a CLR bilingual group or an English-only group. The preschoolers received small-group evidence-informed shared readings targeting 30 English words 3 times a week for 5 weeks in their preschools. Vocabulary outcomes were measured using both standardized and researcher-developed measures. We subsequently conducted further studies with the combined sample size of 77 children to examine the variability in intervention effects related to child gender and baseline vocabulary levels.

Results

The direct replication study confirmed findings of our earlier work suggesting that the CLR bilingual approach promoted greater gains in L1 and L2 vocabulary than in an English-only approach. The extension studies revealed that the effect of the CLR bilingual vocabulary approach on English and Spanish vocabulary outcomes was not impacted by gender or vocabulary status at baseline.

Conclusion

This study provides additional evidence of the benefits of strategically combining L1 and L2 for vocabulary instruction over an English-only approach. Our findings also suggest that preschool Latino dual language learners can benefit from a bilingual vocabulary instructional approach regardless of gender or baseline vocabulary levels in L1.

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Comprehension of Degraded Speech Matures During Adolescence

Purpose

The aim of the study was to compare comprehension of spectrally degraded (noise-vocoded [NV]) speech and perceptual learning of NV speech between adolescents and young adults and examine the role of phonological processing and executive functions in this perception.

Method

Sixteen younger adolescents (11–13 years), 16 older adolescents (14–16 years), and 16 young adults (18–22 years) listened to 40 NV sentences and repeated back what they heard. They also completed tests assessing phonological processing and a variety of executive functions.

Results

Word-report scores were generally poorer for younger adolescents than for the older age groups. Phonological processing also predicted initial word-report scores. Learning (i.e., improvement across training times) did not differ with age. Starting performance and processing speed predicted learning, with greater learning for those who started with the lowest scores and those with faster processing speed.

Conclusions

Degraded (NV) speech comprehension is not mature even by early adolescence; however, like adults, adolescents are able to improve their comprehension of degraded speech with training. Thus, although adolescents may have initial difficulty in understanding degraded speech or speech as presented through hearing aids or cochlear implants, they are able to improve their perception with experience. Processing speed and phonological processing may play a role in degraded speech comprehension in these age groups.

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Readability of Patient-Reported Outcome Measures in Adult Audiologic Rehabilitation

Purpose

The purpose of this study was to examine the readability of published patient-reported outcome measures (PROMs) designed for use in adult audiologic rehabilitation. The readability results were compared with the readability levels recommended for health information by health literacy experts.

Method

Reading grade levels were calculated using the Flesch–Kincaid Grade Level Formula (Flesch, 1948), Gunning Fog Index (Gunning, 1952), Simple Measure of Gobbledygook (McLaughlin, 1969), and FORCAST (Caylor, Sticht, Fox, & Ford, 1973) readability formulas for 10 published PROMs. Descriptive statistics were computed across the different PROM sections: instructions, items, response scale, and overall contents of the measure directed toward respondents.

Results

The majority of the PROM sections exceeded the 6th grade reading level recommended by health literacy experts, regardless of the formula applied. All PROM sections exceeded the 6th grade reading level when calculated according to the FORCAST formula, the most appropriate readability formula for use with a nonnarrative text format, such as PROMs.

Conclusions

When developing or reevaluating PROMs designed for use in adult audiologic rehabilitation, researchers should consider ways to improve the readability of their measure, as poor readability may affect the validity of the empirical data collected using the PROM. Additionally, the adequate readability of audiologic PROMs is required if patient/family-centered care values are to be adhered to within the field of adult audiologic rehabilitation.

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Tinnitus, Depression, Anxiety, and Suicide in Recent Veterans: A Retrospective Analysis

Objectives: The purpose of this project was to investigate whether there is an association between tinnitus diagnosis and suicide and whether depression and anxiety strengthen that association. Given that tinnitus is the top service–connected disability among U.S. Veterans (Veterans Benefits Administration, 2016) and that suicide among Veterans has been occurring at a higher frequency as compared with community suicide rates (Hoffmire et al., 2015), the possible associations between tinnitus and suicide will be explored. Co-occurring physical conditions also will be examined to determine if they increase the risk of suicide in the context of tinnitus. Design: Administrative health care data related to Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) were used to identify Veterans who accessed the Veterans Administration (VA) health care system from January 1, 2002, to December 31, 2011. Veterans who were deceased as of December 2011 were identified using the National Death Index (NDI) files. Tinnitus cases were followed until either they were deceased or to the end of the study period. The International Classification of Diseases 9th Revision Clinical Modification (ICD-9-CM) codes were used to identify all conditions and diseases. As per mortality research standards, International Classification of Diseases 10th Revision (ICD-10) codes were used to identify cause of death. Results: Of 769,934 OEF/OIF/OND Veterans receiving VA care January 2002 to December 2011, 15% (n =116,358) were diagnosed with tinnitus. Of these Veterans diagnosed with tinnitus, 21% were also diagnosed with depression, another 8% with anxiety, and another 17% with both depression and anxiety. Fifty-four percentage were identified as having tinnitus without depression or anxiety. Among individuals with tinnitus, 41.9% had co-occurring hearing loss. Suicide rates were lower among Veterans with tinnitus than Veterans without tinnitus. Co-occurring diagnoses of mental-health conditions did not significantly increase the risk of suicide. Conclusions: The study results do not confirm clinical and anecdotal reports that tinnitus could be related to suicide among Veterans. However, tenets from rehabilitation psychology suggest that the onset of chronic impairment or disability does not predict an individual’s subsequent psychological states; other personal attributes may be more influential. Health care professionals, such as audiologists and psychologists, should be cognizant of the associations between tinnitus and mental health issues and be prepared to address the psychological needs of individuals who have tinnitus. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and text of this article on the journal’s Web site (www.ear-hearing.com). ACKNOWLEDGEMENTS: This material is the result of work supported with resources and the use of facilities at the VA Portland Healthcare System and the support of the VHA Office of Patient Care Services, Post Deployment Health Services. The authors acknowledge the help that Dr. Robert Bossarte provided to the first two authors as they were starting this research study. Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government. All authors contributed equally to this work. E.M. and C.J. conducted the literature review, and E.M. wrote most of the introduction and discussion sections. D.D. and C.W. ran the data analyses and wrote most of the Methods section, including the results, and created the tables. A.S. reviewed and discussed the data analyses with D.D. and C.W. All authors not only discussed the results and their implications but also edited the article throughout its evolution. There are no conflicts of interest to report. Received June 27, 2017; accepted January 23, 2018. Address for correspondence: Erin Martz, VA Portland Healthcare System, Bldg. 6, Room 114A, 3710 SW U.S. Veterans Hospital Rd, Portland, OR 97239. E-mail: rehabilityoregon@gmail.com Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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The Impact of Individual Differences on a Bilingual Vocabulary Approach for Latino Preschoolers

Purpose

The purpose of this study was twofold: First, we replicated in a new sample our previous findings that a culturally and linguistically responsive (CLR) bilingual approach for English vocabulary instruction for preschool Latino dual language learners was effective. Subsequently, we investigated whether the positive effect of CLR instruction varies as a function of individual child characteristics, including baseline vocabulary levels and gender.

Method

Using a randomized pretest–posttest follow-up group design, we first replicated our previous study (N = 42) with a new sample by randomly assigning 35 Spanish-speaking Latino preschoolers to a CLR bilingual group or an English-only group. The preschoolers received small-group evidence-informed shared readings targeting 30 English words 3 times a week for 5 weeks in their preschools. Vocabulary outcomes were measured using both standardized and researcher-developed measures. We subsequently conducted further studies with the combined sample size of 77 children to examine the variability in intervention effects related to child gender and baseline vocabulary levels.

Results

The direct replication study confirmed findings of our earlier work suggesting that the CLR bilingual approach promoted greater gains in L1 and L2 vocabulary than in an English-only approach. The extension studies revealed that the effect of the CLR bilingual vocabulary approach on English and Spanish vocabulary outcomes was not impacted by gender or vocabulary status at baseline.

Conclusion

This study provides additional evidence of the benefits of strategically combining L1 and L2 for vocabulary instruction over an English-only approach. Our findings also suggest that preschool Latino dual language learners can benefit from a bilingual vocabulary instructional approach regardless of gender or baseline vocabulary levels in L1.

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Comprehension of Degraded Speech Matures During Adolescence

Purpose

The aim of the study was to compare comprehension of spectrally degraded (noise-vocoded [NV]) speech and perceptual learning of NV speech between adolescents and young adults and examine the role of phonological processing and executive functions in this perception.

Method

Sixteen younger adolescents (11–13 years), 16 older adolescents (14–16 years), and 16 young adults (18–22 years) listened to 40 NV sentences and repeated back what they heard. They also completed tests assessing phonological processing and a variety of executive functions.

Results

Word-report scores were generally poorer for younger adolescents than for the older age groups. Phonological processing also predicted initial word-report scores. Learning (i.e., improvement across training times) did not differ with age. Starting performance and processing speed predicted learning, with greater learning for those who started with the lowest scores and those with faster processing speed.

Conclusions

Degraded (NV) speech comprehension is not mature even by early adolescence; however, like adults, adolescents are able to improve their comprehension of degraded speech with training. Thus, although adolescents may have initial difficulty in understanding degraded speech or speech as presented through hearing aids or cochlear implants, they are able to improve their perception with experience. Processing speed and phonological processing may play a role in degraded speech comprehension in these age groups.

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Readability of Patient-Reported Outcome Measures in Adult Audiologic Rehabilitation

Purpose

The purpose of this study was to examine the readability of published patient-reported outcome measures (PROMs) designed for use in adult audiologic rehabilitation. The readability results were compared with the readability levels recommended for health information by health literacy experts.

Method

Reading grade levels were calculated using the Flesch–Kincaid Grade Level Formula (Flesch, 1948), Gunning Fog Index (Gunning, 1952), Simple Measure of Gobbledygook (McLaughlin, 1969), and FORCAST (Caylor, Sticht, Fox, & Ford, 1973) readability formulas for 10 published PROMs. Descriptive statistics were computed across the different PROM sections: instructions, items, response scale, and overall contents of the measure directed toward respondents.

Results

The majority of the PROM sections exceeded the 6th grade reading level recommended by health literacy experts, regardless of the formula applied. All PROM sections exceeded the 6th grade reading level when calculated according to the FORCAST formula, the most appropriate readability formula for use with a nonnarrative text format, such as PROMs.

Conclusions

When developing or reevaluating PROMs designed for use in adult audiologic rehabilitation, researchers should consider ways to improve the readability of their measure, as poor readability may affect the validity of the empirical data collected using the PROM. Additionally, the adequate readability of audiologic PROMs is required if patient/family-centered care values are to be adhered to within the field of adult audiologic rehabilitation.

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