Smoking Associated with Hearing Impairment in Infants

​​Exposure to tobacco smoke prenatally and postnatally is associated with hearing impairment in children, according to researchers in Japan (Paediatr Perinat Epidemiol. 2018 Jun 5. doi: 10.1111/ppe.12477. [Epub ahead of print]). They conducted a retrospective study of 50,734 children born between 2004 and 2010 in Kobe City, and measured smoking during pregnancy and exposure to tobacco smoke at 4 months with parent-reported questionnaires. 

The prevalence of hearing impairment at 3 years old was 4.6 percent. Compared with children not exposed to tobacco smoke prenatally and at 4 months, children exposed to only maternal smoking during pregnancy had a 26 percent increased relative risk, those exposed to only second-hand smoke at 4 months had a 30 percent increased relative risk, those exposed to smoking only during pregnancy had a 68 percent increased relative risk, and those exposed to both smoking during pregnancy and second-hand smoke at 4 months had a 2.4-time increased relative risk.
 
Senior author of the study, Koji Kawakami, MD, PhD, a professor at Kyoto University, said this study clearly shows that preventing exposure to tobacco smoke during pregnancy and postnatally may reduce the risk of hearing problems in children. “The findings remind us of the need to continue strengthening interventions to prevent smoking before and during pregnancy and exposure to second-hand smoke in children,” he said in a press release. 

Published: 6/8/2018 11:05:00 AM

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Smoking Associated with Hearing Impairment in Infants

​​Exposure to tobacco smoke prenatally and postnatally is associated with hearing impairment in children, according to researchers in Japan (Paediatr Perinat Epidemiol. 2018 Jun 5. doi: 10.1111/ppe.12477. [Epub ahead of print]). They conducted a retrospective study of 50,734 children born between 2004 and 2010 in Kobe City, and measured smoking during pregnancy and exposure to tobacco smoke at 4 months with parent-reported questionnaires. 

The prevalence of hearing impairment at 3 years old was 4.6 percent. Compared with children not exposed to tobacco smoke prenatally and at 4 months, children exposed to only maternal smoking during pregnancy had a 26 percent increased relative risk, those exposed to only second-hand smoke at 4 months had a 30 percent increased relative risk, those exposed to smoking only during pregnancy had a 68 percent increased relative risk, and those exposed to both smoking during pregnancy and second-hand smoke at 4 months had a 2.4-time increased relative risk.
 
Senior author of the study, Koji Kawakami, MD, PhD, a professor at Kyoto University, said this study clearly shows that preventing exposure to tobacco smoke during pregnancy and postnatally may reduce the risk of hearing problems in children. “The findings remind us of the need to continue strengthening interventions to prevent smoking before and during pregnancy and exposure to second-hand smoke in children,” he said in a press release. 

Published: 6/8/2018 11:05:00 AM

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The Effect of Presentation Level on the SCAN-3 in Children and Adults

Purpose

The pediatric and adult versions of the SCAN-3 test (Keith, 2009a, 2009b) are widely used to screen and diagnose auditory processing disorders. According to the instruction manual, the test administration is flexible in that it may be administered through an audiometer at 50 dB HL or a portable CD player at the patient or administrator's most comfortable listening level (MCL). Because MCL may vary across individuals, even in those with normal hearing sensitivity, this study explored whether the presentation level affected scores on the SCAN-3 for both pediatric and adult populations.

Method

Twenty-two young adults and 23 children with normal hearing sensitivity and middle ear function were administered the SCAN-3 three different times at 1-month intervals, at 40, 50, and 60 dB HL. The stimulus level of the SCAN-3 was counterbalanced across participants to eliminate test order effects. In addition, MCL was measured in the pediatric participants during each session.

Results

MCL varied significantly across children as well as between test sessions, ranging from 40 to 75 dB HL. Performance on 3 of the 4 subtests administered, as well as composite scores, was significantly different across presentation levels (based on scaled scores). Effect sizes were also calculated and found to be strong. The number of composite scores interpreted as within normal limits versus borderline or disordered was also statistically different across presentation levels.

Conclusions

Presentation level appears to affect performance on auditory figure ground, monaural low-redundancy, and binaural integration types of auditory processing tasks that are measured by the SCAN-3. In children, MCL was found to vary significantly both between and within individuals. Although several professions outside audiology are qualified to administer the SCAN-3, it is likely that many of these individuals administer the test without an audiometer and would use an MCL to determine presentation level. It is recommended that SCAN-3 users administer the test through an audiometer at 50 dB HL, rather than with a portable CD player, using MCL values to avoid any presentation level effects.

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Audiology Students' Perspectives of Enacting and Learning Clinical Communication: A Qualitative Interview and Video Reflexivity Study

Purpose

Effective clinical communication is pivotal to the provision of quality hearing health care. To date, audiology students reportedly felt ill-prepared when counseling patients about their hearing impairment, yet there is a paucity of studies exploring how clinical communication is taught and learned in audiology programs. Thus, the aims of the study were (a) to explore final year audiology students' perspectives of their own clinical communication skills during an in-house university clinical placement and (b) to explore students' perceptions of their clinical communication education.

Method

Using a qualitative description approach, students were asked to coview their filmed clinical encounter using video reflexivity during a semistructured interview on clinical communication education. Fifteen final year graduate audiology students from The University of Melbourne, Australia, participated in the study. The interviews were audio-recorded and analyzed thematically.

Results

The overarching themes of striving to be patient-centered, assessment shapes behavior, and power relations emerged from students' reflection of their own clinical encounter. In addition, the theme what students want described the perceived teaching methods that assisted students' clinical communication practices.

Conclusions

The findings of this study highlight the challenges that students perceived during their clinical placement as they strive to enact a patient-centered interaction. An assessment rubric that incorporates communication skills can provide greater opportunities for feedback and self-reflection. Additionally, clinical communication education that adopts experiential learning and is longitudinally integrated into the curriculum can further reinforce students' communication learning needs.

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Patient Acceptance of Invasive Treatments for Tinnitus

Purpose

The field of neuromodulation is currently seeking to treat a wide range of disorders with various types of invasive devices. In recent years, several preclinical trials and case reports in humans have been published on their potential for chronic tinnitus. However, studies to obtain insight into patients' willingness to undergo these treatments are scarce. The aim of this survey study was to find out whether tinnitus patients are willing to undergo invasive neuromodulation when taking its risks, costs, and potential benefits into account.

Method

A Visual Analog Scale (VAS, 0–10) was used to measure the outcome. Spearman's rank-order correlation coefficients were computed to determine the correlation between patient characteristics and acceptance rates.

Results

Around one fifth of the patients were reasonably willing to undergo invasive treatment (VAS 5–7), and around one fifth were fully willing to do so (VAS 8–10). Hearing aids, used as a control, were accepted most, followed by cochlear implantation, deep brain stimulation, and cortical stimulation. Acceptance rates were slightly higher when the chance of cure was higher. Patients with a history of attempted treatments were more eager than others to find a new treatment for tinnitus.

Conclusions

A considerable proportion of patients with tinnitus would accept a variety of invasive treatments despite the associated risks or costs. When clinical neuromodulatory studies for tinnitus are to be performed, particular attention should be given to obtaining informed consent, including explaining the potential risks and providing a realistic outcome expectation.

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Criteria to Classify Children as Having Auditory Processing Disorders

Purpose

The study aimed to determine a criterion to diagnose the presence of auditory processing disorder (APD) in children.

Method

Using a standard comparison design, 280 children “not at risk” for APD and 100 children “at risk” for APD were evaluated on 4 different tests: Speech-in-Noise Test in Indian English (Yathiraj, Vanaja, & Muthuselvi, 2010), Dichotic Consonant–Vowel (Yathiraj, 1999), Duration Pattern Test (Musiek, Baran, & Pinheiro, 1990), and the Revised Auditory Memory and Sequencing Test in Indian English (Yathiraj, Vanaja, & Muthuselvi, 2010). The age of the children ranged from 6 to 10 years.

Results

With a cutoff criterion of 1 SD below the mean of the test scores, 8% of the children “at risk” for APD passed all the tests, whereas 28% passed with a criterion of 2 SDs below the mean scores. The tests most frequently failed by these children were Speech-in-Noise Test in Indian English and Dichotic Consonant–Vowel.

Conclusions

A cutoff criterion of 2 SDs below the mean scores of typically developing children is recommended to diagnose children as having APD if they performed poorly on only one test. For children who performed poorly on more than one test, a cutoff criterion of 1 SD below the mean scores of typically developing children is recommended.

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Examination of Prosody and Timbre Perception in Adults With Cochlear Implants Comparing Different Fine Structure Coding Strategies

Purpose

This study aimed to investigate whether adults with cochlear implants benefit from a change of fine structure (FS) coding strategies regarding the discrimination of prosodic speech cues, timbre cues, and the identification of natural instruments. The FS processing (FSP) coding strategy was compared to 2 settings of the FS4 strategy.

Method

A longitudinal crossover, double-blinded study was conducted. This study consisted of 2 parts, with 14 participants in the first part and 12 participants in the second part. Each part lasted 3 months, in which participants were alternately fitted with either the established FSP strategy or 1 of the 2 newly developed FS4 settings. Participants had to complete an intonation identification test; a timbre discrimination test in which 1 of 2 isolated cues changed, either the spectral centroid or the spectral irregularity; and an instrument identification test.

Results

A significant effect was seen in the discrimination of spectral irregularity with 1 of the 2 FS4 settings. The improvement was seen in the FS4 setting in which the upper envelope channels had a low stimulation rate. This improvement was not seen with the FS4 setting that had a higher stimulation rate on the envelope channels.

Conclusions

In general, the FSP strategy and the 2 settings of the FS4 strategy provided similar levels in the perception of prosody and timbre cues, as well as in the identification of instruments.

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Immediate Passage Comprehension and Encoding of Information Into Long-Term Memory in Children With Normal Hearing: The Effect of Voice Quality and Multitalker Babble Noise

Purpose

This study examines how voice quality and multitalker babble noise affect immediate passage comprehension and the efficiency of information encoding into long-term memory in children with normal hearing.

Method

Eighteen children (mean age = 9 years) with normal hearing participated. Immediate passage comprehension performance and delayed performance (after 5 to 8 days) were assessed for 4 listening conditions: a typical voice in quiet, a typical voice in noise, a dysphonic voice in quiet, and a dysphonic voice in noise.

Results

Multitalker babble noise had a significant effect on immediate and delayed performance. This effect was more pronounced for delayed performance. No significant main effect of voice quality was seen on immediate or delayed performance.

Conclusions

Multitalker babble noise impairs immediate passage comprehension and encoding of information into long-term memory for later recall in children with normal hearing. In learning situations where competing speech signals are present, background noise may reduce the prerequisites for optimal learning.

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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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Masthead

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The Effect of Presentation Level on the SCAN-3 in Children and Adults

Purpose

The pediatric and adult versions of the SCAN-3 test (Keith, 2009a, 2009b) are widely used to screen and diagnose auditory processing disorders. According to the instruction manual, the test administration is flexible in that it may be administered through an audiometer at 50 dB HL or a portable CD player at the patient or administrator's most comfortable listening level (MCL). Because MCL may vary across individuals, even in those with normal hearing sensitivity, this study explored whether the presentation level affected scores on the SCAN-3 for both pediatric and adult populations.

Method

Twenty-two young adults and 23 children with normal hearing sensitivity and middle ear function were administered the SCAN-3 three different times at 1-month intervals, at 40, 50, and 60 dB HL. The stimulus level of the SCAN-3 was counterbalanced across participants to eliminate test order effects. In addition, MCL was measured in the pediatric participants during each session.

Results

MCL varied significantly across children as well as between test sessions, ranging from 40 to 75 dB HL. Performance on 3 of the 4 subtests administered, as well as composite scores, was significantly different across presentation levels (based on scaled scores). Effect sizes were also calculated and found to be strong. The number of composite scores interpreted as within normal limits versus borderline or disordered was also statistically different across presentation levels.

Conclusions

Presentation level appears to affect performance on auditory figure ground, monaural low-redundancy, and binaural integration types of auditory processing tasks that are measured by the SCAN-3. In children, MCL was found to vary significantly both between and within individuals. Although several professions outside audiology are qualified to administer the SCAN-3, it is likely that many of these individuals administer the test without an audiometer and would use an MCL to determine presentation level. It is recommended that SCAN-3 users administer the test through an audiometer at 50 dB HL, rather than with a portable CD player, using MCL values to avoid any presentation level effects.

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Audiology Students' Perspectives of Enacting and Learning Clinical Communication: A Qualitative Interview and Video Reflexivity Study

Purpose

Effective clinical communication is pivotal to the provision of quality hearing health care. To date, audiology students reportedly felt ill-prepared when counseling patients about their hearing impairment, yet there is a paucity of studies exploring how clinical communication is taught and learned in audiology programs. Thus, the aims of the study were (a) to explore final year audiology students' perspectives of their own clinical communication skills during an in-house university clinical placement and (b) to explore students' perceptions of their clinical communication education.

Method

Using a qualitative description approach, students were asked to coview their filmed clinical encounter using video reflexivity during a semistructured interview on clinical communication education. Fifteen final year graduate audiology students from The University of Melbourne, Australia, participated in the study. The interviews were audio-recorded and analyzed thematically.

Results

The overarching themes of striving to be patient-centered, assessment shapes behavior, and power relations emerged from students' reflection of their own clinical encounter. In addition, the theme what students want described the perceived teaching methods that assisted students' clinical communication practices.

Conclusions

The findings of this study highlight the challenges that students perceived during their clinical placement as they strive to enact a patient-centered interaction. An assessment rubric that incorporates communication skills can provide greater opportunities for feedback and self-reflection. Additionally, clinical communication education that adopts experiential learning and is longitudinally integrated into the curriculum can further reinforce students' communication learning needs.

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Patient Acceptance of Invasive Treatments for Tinnitus

Purpose

The field of neuromodulation is currently seeking to treat a wide range of disorders with various types of invasive devices. In recent years, several preclinical trials and case reports in humans have been published on their potential for chronic tinnitus. However, studies to obtain insight into patients' willingness to undergo these treatments are scarce. The aim of this survey study was to find out whether tinnitus patients are willing to undergo invasive neuromodulation when taking its risks, costs, and potential benefits into account.

Method

A Visual Analog Scale (VAS, 0–10) was used to measure the outcome. Spearman's rank-order correlation coefficients were computed to determine the correlation between patient characteristics and acceptance rates.

Results

Around one fifth of the patients were reasonably willing to undergo invasive treatment (VAS 5–7), and around one fifth were fully willing to do so (VAS 8–10). Hearing aids, used as a control, were accepted most, followed by cochlear implantation, deep brain stimulation, and cortical stimulation. Acceptance rates were slightly higher when the chance of cure was higher. Patients with a history of attempted treatments were more eager than others to find a new treatment for tinnitus.

Conclusions

A considerable proportion of patients with tinnitus would accept a variety of invasive treatments despite the associated risks or costs. When clinical neuromodulatory studies for tinnitus are to be performed, particular attention should be given to obtaining informed consent, including explaining the potential risks and providing a realistic outcome expectation.

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Criteria to Classify Children as Having Auditory Processing Disorders

Purpose

The study aimed to determine a criterion to diagnose the presence of auditory processing disorder (APD) in children.

Method

Using a standard comparison design, 280 children “not at risk” for APD and 100 children “at risk” for APD were evaluated on 4 different tests: Speech-in-Noise Test in Indian English (Yathiraj, Vanaja, & Muthuselvi, 2010), Dichotic Consonant–Vowel (Yathiraj, 1999), Duration Pattern Test (Musiek, Baran, & Pinheiro, 1990), and the Revised Auditory Memory and Sequencing Test in Indian English (Yathiraj, Vanaja, & Muthuselvi, 2010). The age of the children ranged from 6 to 10 years.

Results

With a cutoff criterion of 1 SD below the mean of the test scores, 8% of the children “at risk” for APD passed all the tests, whereas 28% passed with a criterion of 2 SDs below the mean scores. The tests most frequently failed by these children were Speech-in-Noise Test in Indian English and Dichotic Consonant–Vowel.

Conclusions

A cutoff criterion of 2 SDs below the mean scores of typically developing children is recommended to diagnose children as having APD if they performed poorly on only one test. For children who performed poorly on more than one test, a cutoff criterion of 1 SD below the mean scores of typically developing children is recommended.

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Examination of Prosody and Timbre Perception in Adults With Cochlear Implants Comparing Different Fine Structure Coding Strategies

Purpose

This study aimed to investigate whether adults with cochlear implants benefit from a change of fine structure (FS) coding strategies regarding the discrimination of prosodic speech cues, timbre cues, and the identification of natural instruments. The FS processing (FSP) coding strategy was compared to 2 settings of the FS4 strategy.

Method

A longitudinal crossover, double-blinded study was conducted. This study consisted of 2 parts, with 14 participants in the first part and 12 participants in the second part. Each part lasted 3 months, in which participants were alternately fitted with either the established FSP strategy or 1 of the 2 newly developed FS4 settings. Participants had to complete an intonation identification test; a timbre discrimination test in which 1 of 2 isolated cues changed, either the spectral centroid or the spectral irregularity; and an instrument identification test.

Results

A significant effect was seen in the discrimination of spectral irregularity with 1 of the 2 FS4 settings. The improvement was seen in the FS4 setting in which the upper envelope channels had a low stimulation rate. This improvement was not seen with the FS4 setting that had a higher stimulation rate on the envelope channels.

Conclusions

In general, the FSP strategy and the 2 settings of the FS4 strategy provided similar levels in the perception of prosody and timbre cues, as well as in the identification of instruments.

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Immediate Passage Comprehension and Encoding of Information Into Long-Term Memory in Children With Normal Hearing: The Effect of Voice Quality and Multitalker Babble Noise

Purpose

This study examines how voice quality and multitalker babble noise affect immediate passage comprehension and the efficiency of information encoding into long-term memory in children with normal hearing.

Method

Eighteen children (mean age = 9 years) with normal hearing participated. Immediate passage comprehension performance and delayed performance (after 5 to 8 days) were assessed for 4 listening conditions: a typical voice in quiet, a typical voice in noise, a dysphonic voice in quiet, and a dysphonic voice in noise.

Results

Multitalker babble noise had a significant effect on immediate and delayed performance. This effect was more pronounced for delayed performance. No significant main effect of voice quality was seen on immediate or delayed performance.

Conclusions

Multitalker babble noise impairs immediate passage comprehension and encoding of information into long-term memory for later recall in children with normal hearing. In learning situations where competing speech signals are present, background noise may reduce the prerequisites for optimal learning.

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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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Masthead

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