Informational Masking Effects on Neural Encoding of Stimulus Onset and Acoustic Change

Objective: Recent investigations using cortical auditory evoked potentials have shown masker-dependent effects on sensory cortical processing of speech information. Background noise maskers consisting of other people talking are particularly difficult for speech recognition. Behavioral studies have related this to perceptual masking, or informational masking, beyond just the overlap of the masker and target at the auditory periphery. The aim of the present study was to use cortical auditory evoked potentials, to examine how maskers (i.e., continuous speech-shaped noise [SSN] and multi-talker babble) affect the cortical sensory encoding of speech information at an obligatory level of processing. Specifically, cortical responses to vowel onset and formant change were recorded under different background noise conditions presumed to represent varying amounts of energetic or informational masking. The hypothesis was, that even at this obligatory cortical level of sensory processing, we would observe larger effects on the amplitude and latency of the onset and change components as the amount of informational masking increased across background noise conditions. Design: Onset and change responses were recorded to a vowel change from /u-i/ in young adults under four conditions: quiet, continuous SSN, eight-talker (8T) babble, and two-talker (2T) babble. Repeated measures analyses by noise condition were conducted on amplitude, latency, and response area measurements to determine the differential effects of these noise conditions, designed to represent increasing and varying levels of informational and energetic masking, on cortical neural representation of a vowel onset and acoustic change response waveforms. Results: All noise conditions significantly reduced onset N1 and P2 amplitudes, onset N1-P2 peak to peak amplitudes, as well as both onset and change response area compared with quiet conditions. Further, all amplitude and area measures were significantly reduced for the two babble conditions compared with continuous SSN. However, there were no significant differences in peak amplitude or area for either onset or change responses between the two different babble conditions (eight versus two talkers). Mean latencies for all onset peaks were delayed for noise conditions compared with quiet. However, in contrast to the amplitude and area results, differences in peak latency between SSN and the babble conditions did not reach statistical significance. Conclusions: These results support the idea that while background noise maskers generally reduce amplitude and increase latency of speech-sound evoked cortical responses, the type of masking has a significant influence. Speech babble maskers (eight talkers and two talkers) have a larger effect on the obligatory cortical response to speech sound onset and change compared with purely energetic continuous SSN maskers, which may be attributed to informational masking effects. Neither the neural responses to the onset nor the vowel change, however, were sensitive to the hypothesized increase in the amount of informational masking between speech babble maskers with two talkers compared with eight talkers. ACKNOWLEDGMENTS: This research was supported by Gerber Family Funds for Auditory Research, Syracuse University. The authors have no conflicts of interest to disclose. Received May 1, 2017; accepted March 27, 2018. Address for correspondence: Christopher E. Niemczak, Department of Communication Sciences and Disorders, Syracuse University, Communication Sciences and Disorders, 621 Skytop Road, Suite 1200, Syracuse, NY 13214, USA. E-mail: ceniemcz@syr.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Association Between Vestibular Vertigo and Motor Vehicle Accidents: Data From the 2016 National Health Interview Survey

Recent evidence has shown that individuals with vestibular impairment have higher rates of self-reported driving difficulty compared with individuals without vestibular impairment. However, it is unknown whether individuals with vestibular impairment are more likely to be involved in motor vehicle accidents. We used data from the 2016 National Health Interview Survey of U.S. adults to evaluate whether individuals with vestibular vertigo are more likely to experience motor vehicle accidents relative to individuals without vestibular vertigo. In multivariate analysis, vestibular vertigo was associated with an over threefold increased odds of motor vehicle accidents (odds ratio, 3.5; 95% confidence interval, 1.7–7.3). This study supports an assciation between vestibular dysfunction and driving impairment, and provides a relative risk of motor vehicle accidents associated with vestibular vertigo that clinicians may utilize in counseling patients on the potential safety hazards of driving. ACKNOWLEDGMENTS: Y.A. was funded by a National Institutes of Health K23 Award (5K23DC013056-02). The authors have no conflict of interest to report. The authors have no conflicts of interest to disclose. Address for correspondence: Eric X. Wei, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, 601 N. Caroline Street, Baltimore, MD 21287, USA. E-mail: eric.wei@jhmi.edu Received December 5, 2017; accepted March 22, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Prevalence of Hearing Impairment in Mahabubnagar District, Telangana State, India

Objectives: To estimate the prevalence of hearing impairment in Mahabubnagar district, Telangana state, India. Methods: A population-based prevalence survey of hearing impairment was undertaken in 2014. Fifty-one clusters of 80 people aged 6 months and older were selected using probability-proportionate-to-size sampling. A two-stage hearing screening was conducted using otoacoustic emissions on all participants followed by pure-tone audiometry on those aged 4 years and older who failed otoacoustic emissions. Cases of hearing impairment were defined using the World Health Organization definition of disabling hearing impairment: a pure-tone average of thresholds at 500, 1000, 2000, and 4000 Hz of ≥41 dB HL for adults and ≥31 dB HL for children based on the better ear. Possible causes of hearing impairment were ascertained by a certified audiologist. Reported hearing difficulties were also measured in this survey and compared with audiometry results. Results: Three thousand five hundred seventy-three people were examined (response rate 87%), of whom 52% were female. The prevalence of disabling hearing impairment was 4.5% [95% confidence interval (CI) = 3.8 to 5.3). Disabling hearing impairment prevalence increased with age from 0.4% in those aged 4 to 17 years (95% CI = 0.2 to 1.1) to 34.7% (95% CI = 28.7 to 41.1) in those aged older than 65 years. No difference in prevalence was seen by sex. Ear examination suggested that the possible cause of disabling hearing impairment was chronic suppurative otitis media for 6.9% of cases and dry perforation for 5.6% cases. For the vast majority of people with disabling hearing impairment, a possible cause could not be established. The overall prevalence of reported or proxy reported hearing impairment was 2.6% (95% CI = 2.0 to 3.4), and this ranged from 0.6% (95% CI = 0.08 to 4.4) in those aged 0 to 3 years to 14.4% (95% CI = 9.8 to 20.7) in those aged older than 65 years. Conclusions: Disabling hearing impairment in Telangana State is common, affecting approximately 1 in 23 people overall and a third of people aged older than 65 years. These findings suggest that there are a substantial number of individuals with hearing impairment who could potentially benefit from improved access to low-cost interventions. 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). ACKNOWLEDGMENTS: This study was funded by CBM. The funders had no role in the design of the study, data extraction, analysis, interpretation, or writing of the report. The authors have no conflicts of interest to disclose. Address for correspondence: Tess Bright, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom. E-mail: tess.bright@lshtm.ac.uk Received May 19, 2017; accepted March 20, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Comparing Two Hearing Aid Fitting Algorithms for Bimodal Cochlear Implant Users

Objectives: To investigate the possible advantage of the use of a dedicated bimodal hearing aid fitting formula, the Adaptive Phonak Digital Bimodal (APDB), compared with a frequently used standard hearing aid fitting formula, the NAL-NL2. We evaluated the effects of bimodal hearing aid fitting on provided hearing aid gain and on bimodal auditory functioning in a group of experienced bimodal cochlear implant (CI) users. A second aim of our study was to determine the effect of broadband loudness balancing on the prescribed gain of those two fitting formulas. Design: This prospective study used a crossover design in which two fitting methods were compared varying in basic prescription formula (NAL-NL2 or APDB fitting formula). The study consisted of a three-visit crossover design with 3 weeks between sessions. Nineteen postlingually deafened experienced bimodal CI users participated in this study. Auditory functioning was evaluated by a speech in quiet test, a speech in noise test, and a questionnaire on auditory performance. Results: Significant differences between the two fitting formulas were found for frequencies of 2000 Hz and above. For these frequencies, less gain was provided by the APDB fitting formula compared with NAL-NL2. For the APDB fitting formula, a higher compression ratio for frequencies of 1000 Hz and above was found compared with the NAL-NL2 fitting formula. Loudness balancing did not result in large deviations from the prescribed gain by the initial fitting formula. Bimodal benefit was found for speech perception in quiet and for speech perception in noise. No differences in auditory performance were found between the two fitting formulas for any of the auditory performance tests. Conclusions: The results of this study show that CI users with residual hearing at the contralateral ear can benefit from bimodal stimulation, regardless of the fitting method that was applied. Although significant differences between the output and compression ratio of the NAL-NL2 and the APDB fitting formula existed, no differences in bimodal auditory performance were observed. Therefore, NAL-NL2 or the APDB fitting prescription both seem suited for bimodal fitting purposes. Additional loudness balancing has a marginal effect on the provided hearing aid output. ACKNOWLEDGMENTS: The authors gratefully acknowledge all participants of the research project. They also thank Gertjan Dingemanse, Teun van Immerzeel, and Marian Rodenburg-Vlot for their contribution to the experimental work and the data collection. J.L.V. designed and performed experiments, analyzed data, and wrote the paper. N.C.H. designed and performed experiments and provided critical revision of the paper. M.P.v.d.S. and A.G. designed the experiments and provided analysis and critical revision of the paper. All authors discussed the results and implications and commented on the manuscript at all stages. Advanced Bionics funded the hearing aids for the use in the study. The authors have no conflicts of interest to disclose. Address for correspondence: Jantien L. Vroegop, ENT Department, Erasmus Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands. E-mail: j.l.vroegop@erasmusmc.nl Received December 15, 2017; accepted March 16, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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How Do Hearing Aid Owners Respond to Hearing Aid Problems?

Background: Although hearing aids can improve hearing and communication, problems that arise following the acquisition of hearing aids can result in their disuse. This study aimed to gather perspectives of hearing aid owners and hearing health care clinicians about how hearing aid owners respond to problems that arise following hearing aid fitting, and then use these perspectives to generate a conceptual framework to better understand these responses. Methods: Seventeen hearing aid owners and 21 hearing health care clinicians generated, sorted, and rated statements regarding how hearing aid owners respond to problems associated with hearing aid use. Concept mapping was used to identify key themes and to develop a conceptual framework. Results: Participants identified four concepts regarding how hearing aid owners respond to problems associated with hearing aids: (1) Seeking External Help; (2) Problem Solving; (3) Putting Up with Problems; and (4) Negative Emotional Response. Participants described behaviors of the clinician and significant others that influenced their decision to seek help for hearing aid problems. Participants recognized that these behaviors could either have a helpful or unhelpful impact. Conclusions: Despite the ongoing support offered to clients after they acquire hearing aids, they are hesitant to seek help from their clinician and instead engage in a myriad of helpful and unhelpful behaviors in response to problems that arise with their hearing aid. Previous positive or negative experiences with the clinic, clinician, or significant other influenced these actions, highlighting the influential role of these individuals’ in the success of the rehabilitation program. The data generated from this study suggests that clinicians could improve hearing aid problem resolution by providing technical and emotional support, including to significant others, and promoting client empowerment and self-management. 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). ACKNOWLEDGMENTS: The authors acknowledge the assistance of the Lions Hearing Clinic with participant recruitment and the participants for devoting their time to this study. The authors report no declarations of interest. The authors thank the Ear Science Institute Australia for financial support of this project. The authors have no conflicts of interest to disclose. R. Bennett is funded by an Australian Postgraduate Award scholarship through The University of Western Australia. Received October 30, 2017; accepted March 16, 2018. Address for correspondence: Rebecca Bennett, Ear Science Institute Australia, Suite 1, Level 2, 1 Salvado Road, Subiaco, WA 6008, Australia. E-mail: bec.bennett@earscience.org.au. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Informational Masking Effects on Neural Encoding of Stimulus Onset and Acoustic Change

Objective: Recent investigations using cortical auditory evoked potentials have shown masker-dependent effects on sensory cortical processing of speech information. Background noise maskers consisting of other people talking are particularly difficult for speech recognition. Behavioral studies have related this to perceptual masking, or informational masking, beyond just the overlap of the masker and target at the auditory periphery. The aim of the present study was to use cortical auditory evoked potentials, to examine how maskers (i.e., continuous speech-shaped noise [SSN] and multi-talker babble) affect the cortical sensory encoding of speech information at an obligatory level of processing. Specifically, cortical responses to vowel onset and formant change were recorded under different background noise conditions presumed to represent varying amounts of energetic or informational masking. The hypothesis was, that even at this obligatory cortical level of sensory processing, we would observe larger effects on the amplitude and latency of the onset and change components as the amount of informational masking increased across background noise conditions. Design: Onset and change responses were recorded to a vowel change from /u-i/ in young adults under four conditions: quiet, continuous SSN, eight-talker (8T) babble, and two-talker (2T) babble. Repeated measures analyses by noise condition were conducted on amplitude, latency, and response area measurements to determine the differential effects of these noise conditions, designed to represent increasing and varying levels of informational and energetic masking, on cortical neural representation of a vowel onset and acoustic change response waveforms. Results: All noise conditions significantly reduced onset N1 and P2 amplitudes, onset N1-P2 peak to peak amplitudes, as well as both onset and change response area compared with quiet conditions. Further, all amplitude and area measures were significantly reduced for the two babble conditions compared with continuous SSN. However, there were no significant differences in peak amplitude or area for either onset or change responses between the two different babble conditions (eight versus two talkers). Mean latencies for all onset peaks were delayed for noise conditions compared with quiet. However, in contrast to the amplitude and area results, differences in peak latency between SSN and the babble conditions did not reach statistical significance. Conclusions: These results support the idea that while background noise maskers generally reduce amplitude and increase latency of speech-sound evoked cortical responses, the type of masking has a significant influence. Speech babble maskers (eight talkers and two talkers) have a larger effect on the obligatory cortical response to speech sound onset and change compared with purely energetic continuous SSN maskers, which may be attributed to informational masking effects. Neither the neural responses to the onset nor the vowel change, however, were sensitive to the hypothesized increase in the amount of informational masking between speech babble maskers with two talkers compared with eight talkers. ACKNOWLEDGMENTS: This research was supported by Gerber Family Funds for Auditory Research, Syracuse University. The authors have no conflicts of interest to disclose. Received May 1, 2017; accepted March 27, 2018. Address for correspondence: Christopher E. Niemczak, Department of Communication Sciences and Disorders, Syracuse University, Communication Sciences and Disorders, 621 Skytop Road, Suite 1200, Syracuse, NY 13214, USA. E-mail: ceniemcz@syr.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Association Between Vestibular Vertigo and Motor Vehicle Accidents: Data From the 2016 National Health Interview Survey

Recent evidence has shown that individuals with vestibular impairment have higher rates of self-reported driving difficulty compared with individuals without vestibular impairment. However, it is unknown whether individuals with vestibular impairment are more likely to be involved in motor vehicle accidents. We used data from the 2016 National Health Interview Survey of U.S. adults to evaluate whether individuals with vestibular vertigo are more likely to experience motor vehicle accidents relative to individuals without vestibular vertigo. In multivariate analysis, vestibular vertigo was associated with an over threefold increased odds of motor vehicle accidents (odds ratio, 3.5; 95% confidence interval, 1.7–7.3). This study supports an assciation between vestibular dysfunction and driving impairment, and provides a relative risk of motor vehicle accidents associated with vestibular vertigo that clinicians may utilize in counseling patients on the potential safety hazards of driving. ACKNOWLEDGMENTS: Y.A. was funded by a National Institutes of Health K23 Award (5K23DC013056-02). The authors have no conflict of interest to report. The authors have no conflicts of interest to disclose. Address for correspondence: Eric X. Wei, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, 601 N. Caroline Street, Baltimore, MD 21287, USA. E-mail: eric.wei@jhmi.edu Received December 5, 2017; accepted March 22, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Prevalence of Hearing Impairment in Mahabubnagar District, Telangana State, India

Objectives: To estimate the prevalence of hearing impairment in Mahabubnagar district, Telangana state, India. Methods: A population-based prevalence survey of hearing impairment was undertaken in 2014. Fifty-one clusters of 80 people aged 6 months and older were selected using probability-proportionate-to-size sampling. A two-stage hearing screening was conducted using otoacoustic emissions on all participants followed by pure-tone audiometry on those aged 4 years and older who failed otoacoustic emissions. Cases of hearing impairment were defined using the World Health Organization definition of disabling hearing impairment: a pure-tone average of thresholds at 500, 1000, 2000, and 4000 Hz of ≥41 dB HL for adults and ≥31 dB HL for children based on the better ear. Possible causes of hearing impairment were ascertained by a certified audiologist. Reported hearing difficulties were also measured in this survey and compared with audiometry results. Results: Three thousand five hundred seventy-three people were examined (response rate 87%), of whom 52% were female. The prevalence of disabling hearing impairment was 4.5% [95% confidence interval (CI) = 3.8 to 5.3). Disabling hearing impairment prevalence increased with age from 0.4% in those aged 4 to 17 years (95% CI = 0.2 to 1.1) to 34.7% (95% CI = 28.7 to 41.1) in those aged older than 65 years. No difference in prevalence was seen by sex. Ear examination suggested that the possible cause of disabling hearing impairment was chronic suppurative otitis media for 6.9% of cases and dry perforation for 5.6% cases. For the vast majority of people with disabling hearing impairment, a possible cause could not be established. The overall prevalence of reported or proxy reported hearing impairment was 2.6% (95% CI = 2.0 to 3.4), and this ranged from 0.6% (95% CI = 0.08 to 4.4) in those aged 0 to 3 years to 14.4% (95% CI = 9.8 to 20.7) in those aged older than 65 years. Conclusions: Disabling hearing impairment in Telangana State is common, affecting approximately 1 in 23 people overall and a third of people aged older than 65 years. These findings suggest that there are a substantial number of individuals with hearing impairment who could potentially benefit from improved access to low-cost interventions. 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). ACKNOWLEDGMENTS: This study was funded by CBM. The funders had no role in the design of the study, data extraction, analysis, interpretation, or writing of the report. The authors have no conflicts of interest to disclose. Address for correspondence: Tess Bright, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom. E-mail: tess.bright@lshtm.ac.uk Received May 19, 2017; accepted March 20, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Comparing Two Hearing Aid Fitting Algorithms for Bimodal Cochlear Implant Users

Objectives: To investigate the possible advantage of the use of a dedicated bimodal hearing aid fitting formula, the Adaptive Phonak Digital Bimodal (APDB), compared with a frequently used standard hearing aid fitting formula, the NAL-NL2. We evaluated the effects of bimodal hearing aid fitting on provided hearing aid gain and on bimodal auditory functioning in a group of experienced bimodal cochlear implant (CI) users. A second aim of our study was to determine the effect of broadband loudness balancing on the prescribed gain of those two fitting formulas. Design: This prospective study used a crossover design in which two fitting methods were compared varying in basic prescription formula (NAL-NL2 or APDB fitting formula). The study consisted of a three-visit crossover design with 3 weeks between sessions. Nineteen postlingually deafened experienced bimodal CI users participated in this study. Auditory functioning was evaluated by a speech in quiet test, a speech in noise test, and a questionnaire on auditory performance. Results: Significant differences between the two fitting formulas were found for frequencies of 2000 Hz and above. For these frequencies, less gain was provided by the APDB fitting formula compared with NAL-NL2. For the APDB fitting formula, a higher compression ratio for frequencies of 1000 Hz and above was found compared with the NAL-NL2 fitting formula. Loudness balancing did not result in large deviations from the prescribed gain by the initial fitting formula. Bimodal benefit was found for speech perception in quiet and for speech perception in noise. No differences in auditory performance were found between the two fitting formulas for any of the auditory performance tests. Conclusions: The results of this study show that CI users with residual hearing at the contralateral ear can benefit from bimodal stimulation, regardless of the fitting method that was applied. Although significant differences between the output and compression ratio of the NAL-NL2 and the APDB fitting formula existed, no differences in bimodal auditory performance were observed. Therefore, NAL-NL2 or the APDB fitting prescription both seem suited for bimodal fitting purposes. Additional loudness balancing has a marginal effect on the provided hearing aid output. ACKNOWLEDGMENTS: The authors gratefully acknowledge all participants of the research project. They also thank Gertjan Dingemanse, Teun van Immerzeel, and Marian Rodenburg-Vlot for their contribution to the experimental work and the data collection. J.L.V. designed and performed experiments, analyzed data, and wrote the paper. N.C.H. designed and performed experiments and provided critical revision of the paper. M.P.v.d.S. and A.G. designed the experiments and provided analysis and critical revision of the paper. All authors discussed the results and implications and commented on the manuscript at all stages. Advanced Bionics funded the hearing aids for the use in the study. The authors have no conflicts of interest to disclose. Address for correspondence: Jantien L. Vroegop, ENT Department, Erasmus Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands. E-mail: j.l.vroegop@erasmusmc.nl Received December 15, 2017; accepted March 16, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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How Do Hearing Aid Owners Respond to Hearing Aid Problems?

Background: Although hearing aids can improve hearing and communication, problems that arise following the acquisition of hearing aids can result in their disuse. This study aimed to gather perspectives of hearing aid owners and hearing health care clinicians about how hearing aid owners respond to problems that arise following hearing aid fitting, and then use these perspectives to generate a conceptual framework to better understand these responses. Methods: Seventeen hearing aid owners and 21 hearing health care clinicians generated, sorted, and rated statements regarding how hearing aid owners respond to problems associated with hearing aid use. Concept mapping was used to identify key themes and to develop a conceptual framework. Results: Participants identified four concepts regarding how hearing aid owners respond to problems associated with hearing aids: (1) Seeking External Help; (2) Problem Solving; (3) Putting Up with Problems; and (4) Negative Emotional Response. Participants described behaviors of the clinician and significant others that influenced their decision to seek help for hearing aid problems. Participants recognized that these behaviors could either have a helpful or unhelpful impact. Conclusions: Despite the ongoing support offered to clients after they acquire hearing aids, they are hesitant to seek help from their clinician and instead engage in a myriad of helpful and unhelpful behaviors in response to problems that arise with their hearing aid. Previous positive or negative experiences with the clinic, clinician, or significant other influenced these actions, highlighting the influential role of these individuals’ in the success of the rehabilitation program. The data generated from this study suggests that clinicians could improve hearing aid problem resolution by providing technical and emotional support, including to significant others, and promoting client empowerment and self-management. 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). ACKNOWLEDGMENTS: The authors acknowledge the assistance of the Lions Hearing Clinic with participant recruitment and the participants for devoting their time to this study. The authors report no declarations of interest. The authors thank the Ear Science Institute Australia for financial support of this project. The authors have no conflicts of interest to disclose. R. Bennett is funded by an Australian Postgraduate Award scholarship through The University of Western Australia. Received October 30, 2017; accepted March 16, 2018. Address for correspondence: Rebecca Bennett, Ear Science Institute Australia, Suite 1, Level 2, 1 Salvado Road, Subiaco, WA 6008, Australia. E-mail: bec.bennett@earscience.org.au. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Informational Masking Effects on Neural Encoding of Stimulus Onset and Acoustic Change

Objective: Recent investigations using cortical auditory evoked potentials have shown masker-dependent effects on sensory cortical processing of speech information. Background noise maskers consisting of other people talking are particularly difficult for speech recognition. Behavioral studies have related this to perceptual masking, or informational masking, beyond just the overlap of the masker and target at the auditory periphery. The aim of the present study was to use cortical auditory evoked potentials, to examine how maskers (i.e., continuous speech-shaped noise [SSN] and multi-talker babble) affect the cortical sensory encoding of speech information at an obligatory level of processing. Specifically, cortical responses to vowel onset and formant change were recorded under different background noise conditions presumed to represent varying amounts of energetic or informational masking. The hypothesis was, that even at this obligatory cortical level of sensory processing, we would observe larger effects on the amplitude and latency of the onset and change components as the amount of informational masking increased across background noise conditions. Design: Onset and change responses were recorded to a vowel change from /u-i/ in young adults under four conditions: quiet, continuous SSN, eight-talker (8T) babble, and two-talker (2T) babble. Repeated measures analyses by noise condition were conducted on amplitude, latency, and response area measurements to determine the differential effects of these noise conditions, designed to represent increasing and varying levels of informational and energetic masking, on cortical neural representation of a vowel onset and acoustic change response waveforms. Results: All noise conditions significantly reduced onset N1 and P2 amplitudes, onset N1-P2 peak to peak amplitudes, as well as both onset and change response area compared with quiet conditions. Further, all amplitude and area measures were significantly reduced for the two babble conditions compared with continuous SSN. However, there were no significant differences in peak amplitude or area for either onset or change responses between the two different babble conditions (eight versus two talkers). Mean latencies for all onset peaks were delayed for noise conditions compared with quiet. However, in contrast to the amplitude and area results, differences in peak latency between SSN and the babble conditions did not reach statistical significance. Conclusions: These results support the idea that while background noise maskers generally reduce amplitude and increase latency of speech-sound evoked cortical responses, the type of masking has a significant influence. Speech babble maskers (eight talkers and two talkers) have a larger effect on the obligatory cortical response to speech sound onset and change compared with purely energetic continuous SSN maskers, which may be attributed to informational masking effects. Neither the neural responses to the onset nor the vowel change, however, were sensitive to the hypothesized increase in the amount of informational masking between speech babble maskers with two talkers compared with eight talkers. ACKNOWLEDGMENTS: This research was supported by Gerber Family Funds for Auditory Research, Syracuse University. The authors have no conflicts of interest to disclose. Received May 1, 2017; accepted March 27, 2018. Address for correspondence: Christopher E. Niemczak, Department of Communication Sciences and Disorders, Syracuse University, Communication Sciences and Disorders, 621 Skytop Road, Suite 1200, Syracuse, NY 13214, USA. E-mail: ceniemcz@syr.edu Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Association Between Vestibular Vertigo and Motor Vehicle Accidents: Data From the 2016 National Health Interview Survey

Recent evidence has shown that individuals with vestibular impairment have higher rates of self-reported driving difficulty compared with individuals without vestibular impairment. However, it is unknown whether individuals with vestibular impairment are more likely to be involved in motor vehicle accidents. We used data from the 2016 National Health Interview Survey of U.S. adults to evaluate whether individuals with vestibular vertigo are more likely to experience motor vehicle accidents relative to individuals without vestibular vertigo. In multivariate analysis, vestibular vertigo was associated with an over threefold increased odds of motor vehicle accidents (odds ratio, 3.5; 95% confidence interval, 1.7–7.3). This study supports an assciation between vestibular dysfunction and driving impairment, and provides a relative risk of motor vehicle accidents associated with vestibular vertigo that clinicians may utilize in counseling patients on the potential safety hazards of driving. ACKNOWLEDGMENTS: Y.A. was funded by a National Institutes of Health K23 Award (5K23DC013056-02). The authors have no conflict of interest to report. The authors have no conflicts of interest to disclose. Address for correspondence: Eric X. Wei, Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins, 601 N. Caroline Street, Baltimore, MD 21287, USA. E-mail: eric.wei@jhmi.edu Received December 5, 2017; accepted March 22, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Prevalence of Hearing Impairment in Mahabubnagar District, Telangana State, India

Objectives: To estimate the prevalence of hearing impairment in Mahabubnagar district, Telangana state, India. Methods: A population-based prevalence survey of hearing impairment was undertaken in 2014. Fifty-one clusters of 80 people aged 6 months and older were selected using probability-proportionate-to-size sampling. A two-stage hearing screening was conducted using otoacoustic emissions on all participants followed by pure-tone audiometry on those aged 4 years and older who failed otoacoustic emissions. Cases of hearing impairment were defined using the World Health Organization definition of disabling hearing impairment: a pure-tone average of thresholds at 500, 1000, 2000, and 4000 Hz of ≥41 dB HL for adults and ≥31 dB HL for children based on the better ear. Possible causes of hearing impairment were ascertained by a certified audiologist. Reported hearing difficulties were also measured in this survey and compared with audiometry results. Results: Three thousand five hundred seventy-three people were examined (response rate 87%), of whom 52% were female. The prevalence of disabling hearing impairment was 4.5% [95% confidence interval (CI) = 3.8 to 5.3). Disabling hearing impairment prevalence increased with age from 0.4% in those aged 4 to 17 years (95% CI = 0.2 to 1.1) to 34.7% (95% CI = 28.7 to 41.1) in those aged older than 65 years. No difference in prevalence was seen by sex. Ear examination suggested that the possible cause of disabling hearing impairment was chronic suppurative otitis media for 6.9% of cases and dry perforation for 5.6% cases. For the vast majority of people with disabling hearing impairment, a possible cause could not be established. The overall prevalence of reported or proxy reported hearing impairment was 2.6% (95% CI = 2.0 to 3.4), and this ranged from 0.6% (95% CI = 0.08 to 4.4) in those aged 0 to 3 years to 14.4% (95% CI = 9.8 to 20.7) in those aged older than 65 years. Conclusions: Disabling hearing impairment in Telangana State is common, affecting approximately 1 in 23 people overall and a third of people aged older than 65 years. These findings suggest that there are a substantial number of individuals with hearing impairment who could potentially benefit from improved access to low-cost interventions. 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). ACKNOWLEDGMENTS: This study was funded by CBM. The funders had no role in the design of the study, data extraction, analysis, interpretation, or writing of the report. The authors have no conflicts of interest to disclose. Address for correspondence: Tess Bright, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom. E-mail: tess.bright@lshtm.ac.uk Received May 19, 2017; accepted March 20, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Comparing Two Hearing Aid Fitting Algorithms for Bimodal Cochlear Implant Users

Objectives: To investigate the possible advantage of the use of a dedicated bimodal hearing aid fitting formula, the Adaptive Phonak Digital Bimodal (APDB), compared with a frequently used standard hearing aid fitting formula, the NAL-NL2. We evaluated the effects of bimodal hearing aid fitting on provided hearing aid gain and on bimodal auditory functioning in a group of experienced bimodal cochlear implant (CI) users. A second aim of our study was to determine the effect of broadband loudness balancing on the prescribed gain of those two fitting formulas. Design: This prospective study used a crossover design in which two fitting methods were compared varying in basic prescription formula (NAL-NL2 or APDB fitting formula). The study consisted of a three-visit crossover design with 3 weeks between sessions. Nineteen postlingually deafened experienced bimodal CI users participated in this study. Auditory functioning was evaluated by a speech in quiet test, a speech in noise test, and a questionnaire on auditory performance. Results: Significant differences between the two fitting formulas were found for frequencies of 2000 Hz and above. For these frequencies, less gain was provided by the APDB fitting formula compared with NAL-NL2. For the APDB fitting formula, a higher compression ratio for frequencies of 1000 Hz and above was found compared with the NAL-NL2 fitting formula. Loudness balancing did not result in large deviations from the prescribed gain by the initial fitting formula. Bimodal benefit was found for speech perception in quiet and for speech perception in noise. No differences in auditory performance were found between the two fitting formulas for any of the auditory performance tests. Conclusions: The results of this study show that CI users with residual hearing at the contralateral ear can benefit from bimodal stimulation, regardless of the fitting method that was applied. Although significant differences between the output and compression ratio of the NAL-NL2 and the APDB fitting formula existed, no differences in bimodal auditory performance were observed. Therefore, NAL-NL2 or the APDB fitting prescription both seem suited for bimodal fitting purposes. Additional loudness balancing has a marginal effect on the provided hearing aid output. ACKNOWLEDGMENTS: The authors gratefully acknowledge all participants of the research project. They also thank Gertjan Dingemanse, Teun van Immerzeel, and Marian Rodenburg-Vlot for their contribution to the experimental work and the data collection. J.L.V. designed and performed experiments, analyzed data, and wrote the paper. N.C.H. designed and performed experiments and provided critical revision of the paper. M.P.v.d.S. and A.G. designed the experiments and provided analysis and critical revision of the paper. All authors discussed the results and implications and commented on the manuscript at all stages. Advanced Bionics funded the hearing aids for the use in the study. The authors have no conflicts of interest to disclose. Address for correspondence: Jantien L. Vroegop, ENT Department, Erasmus Medical Center, Postbus 2040, 3000 CA Rotterdam, The Netherlands. E-mail: j.l.vroegop@erasmusmc.nl Received December 15, 2017; accepted March 16, 2018. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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How Do Hearing Aid Owners Respond to Hearing Aid Problems?

Background: Although hearing aids can improve hearing and communication, problems that arise following the acquisition of hearing aids can result in their disuse. This study aimed to gather perspectives of hearing aid owners and hearing health care clinicians about how hearing aid owners respond to problems that arise following hearing aid fitting, and then use these perspectives to generate a conceptual framework to better understand these responses. Methods: Seventeen hearing aid owners and 21 hearing health care clinicians generated, sorted, and rated statements regarding how hearing aid owners respond to problems associated with hearing aid use. Concept mapping was used to identify key themes and to develop a conceptual framework. Results: Participants identified four concepts regarding how hearing aid owners respond to problems associated with hearing aids: (1) Seeking External Help; (2) Problem Solving; (3) Putting Up with Problems; and (4) Negative Emotional Response. Participants described behaviors of the clinician and significant others that influenced their decision to seek help for hearing aid problems. Participants recognized that these behaviors could either have a helpful or unhelpful impact. Conclusions: Despite the ongoing support offered to clients after they acquire hearing aids, they are hesitant to seek help from their clinician and instead engage in a myriad of helpful and unhelpful behaviors in response to problems that arise with their hearing aid. Previous positive or negative experiences with the clinic, clinician, or significant other influenced these actions, highlighting the influential role of these individuals’ in the success of the rehabilitation program. The data generated from this study suggests that clinicians could improve hearing aid problem resolution by providing technical and emotional support, including to significant others, and promoting client empowerment and self-management. 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). ACKNOWLEDGMENTS: The authors acknowledge the assistance of the Lions Hearing Clinic with participant recruitment and the participants for devoting their time to this study. The authors report no declarations of interest. The authors thank the Ear Science Institute Australia for financial support of this project. The authors have no conflicts of interest to disclose. R. Bennett is funded by an Australian Postgraduate Award scholarship through The University of Western Australia. Received October 30, 2017; accepted March 16, 2018. Address for correspondence: Rebecca Bennett, Ear Science Institute Australia, Suite 1, Level 2, 1 Salvado Road, Subiaco, WA 6008, Australia. E-mail: bec.bennett@earscience.org.au. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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A Systematic Review of Semantic Feature Analysis Therapy Studies for Aphasia

Purpose

The purpose of this study was to review treatment studies of semantic feature analysis (SFA) for persons with aphasia. The review documents how SFA is used, appraises the quality of the included studies, and evaluates the efficacy of SFA.

Method

The following electronic databases were systematically searched (last search February 2017): Academic Search Complete, CINAHL Plus, E-journals, Health Policy Reference Centre, MEDLINE, PsycARTICLES, PsycINFO, and SocINDEX. The quality of the included studies was rated. Clinical efficacy was determined by calculating effect sizes (Cohen's d) or percent of nonoverlapping data when d could not be calculated.

Results

Twenty-one studies were reviewed reporting on 55 persons with aphasia. SFA was used in 6 different types of studies: confrontation naming of nouns, confrontation naming of verbs, connected speech/discourse, group, multilingual, and studies where SFA was compared with other approaches. The quality of included studies was high (Single Case Experimental Design Scale average [range] = 9.55 [8.0–11]). Naming of trained items improved for 45 participants (81.82%). Effect sizes indicated that there was a small treatment effect.

Conclusions

SFA leads to positive outcomes despite the variability of treatment procedures, dosage, duration, and variations to the traditional SFA protocol. Further research is warranted to examine the efficacy of SFA and generalization effects in larger controlled studies.

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Suprasegmental Features Are Not Acquired Early: Perception and Production of Monosyllabic Cantonese Lexical Tones in 4- to 6-Year-Old Preschool Children

Purpose

Previous studies reported that children acquire Cantonese tones before 3 years of age, supporting the assumption in models of phonological development that suprasegmental features are acquired rapidly and early in children. Yet, recent research found a large disparity in the age of Cantonese tone acquisition. This study investigated Cantonese tone development in 4- to 6-year-old children.

Method

Forty-eight 4- to 6-year-old Cantonese-speaking children and 28 mothers of the children labeled 30 pictures representing familiar words in the 6 tones in a picture-naming task and identified pictures representing words in different Cantonese tones in a picture-pointing task. To control for lexical biases in tone assessment, tone productions were low-pass filtered to eliminate lexical information. Five judges categorized the tones in filtered stimuli. Tone production accuracy, tone perception accuracy, and correlation between tone production and perception accuracy were examined.

Results

Children did not start to produce adultlike tones until 5 and 6 years of age. Four-year-olds produced none of the tones with adultlike accuracy. Five- and 6-year-olds attained adultlike productions in 2 (T5 and T6) to 3 (T4, T5, and T6) tones, respectively. Children made better progress in tone perception and achieved higher accuracy in perception than in production. However, children in all age groups perceived none of the tones as accurately as adults, except that T1 was perceived with adultlike accuracy by 6-year-olds. Only weak association was found between children's tone perception and production accuracy.

Conclusions

Contradicting to the long-held assumption that children acquire lexical tone rapidly and early before the mastery of segmentals, this study found that 4- to 6-year-old children have not mastered the perception or production of the full set of Cantonese tones in familiar monosyllabic words. Larger development was found in children's tone perception than tone production. The higher tone perception accuracy but weak correlation between tone perception and production abilities in children suggested that tone perception accuracy is not sufficient for children's tone production accuracy. The findings have clinical and theoretical implications.

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