Slight Hearing Loss in Young People May Lead to Cognitive Problems

​Hearing loss while young may negatively impact brain function, according to a new study (eNeuro 21 May 2018, 5 (3) ENEURO.0263-17.2018). Researchers at Ohio State University tested how differences in hearing acuity neurologically influence speech processing in their subjects. The researchers took fMRIs of 35 subjects, aged 18-41, as they listened to sentences with varying in difficulty. The study originally aimed to observe the neural activity as the subject attempted to comprehend sentences of differing complexity, and the researchers found that subjects with subtle hearing loss had very different fMRIs. The fMRIs of those subjects showed activity in the right frontal cortex of the brain, rather than exclusively in the left hemisphere.

Previous research has established that as hearing gets progressively worse with time, more of the right frontal cortex is used to process language. “But in our study, young people with mild hearing decline were already experiencing this phenomenon,” said lead researcher Yune Lee, PhD, an assistant professor of speech and hearing science at Ohio State University. “Their brains already know that the perception of sound is not what it used to be and the right side starts compensating for the left.”

The researchers noted that the slight hearing loss they observed in their subjects went unnoticed because of the brain’s compensation, but the extra effort invested in understanding spoken sentences might have other adverse effects. The study raised the concern that such extra wear on the brain might cause harm beyond only aural.

Previous research has noted that increased hearing loss is correlated with greater risk of dementia, and if people lose their hearing before they reach seniority, they may also suffer from dementia earlier. “Hearing loss, even minor deficits, can take a toll in young people – they’re using cognitive resources that could be preserved until much later in life,” said Lee. “Most concerning, this early hearing loss could pave the way for dementia.”

Published: 6/14/2018 10:20:00 AM

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Slight Hearing Loss in Young People May Lead to Cognitive Problems

​Hearing loss while young may negatively impact brain function, according to a new study (eNeuro 21 May 2018, 5 (3) ENEURO.0263-17.2018). Researchers at Ohio State University tested how differences in hearing acuity neurologically influence speech processing in their subjects. The researchers took fMRIs of 35 subjects, aged 18-41, as they listened to sentences with varying in difficulty. The study originally aimed to observe the neural activity as the subject attempted to comprehend sentences of differing complexity, and the researchers found that subjects with subtle hearing loss had very different fMRIs. The fMRIs of those subjects showed activity in the right frontal cortex of the brain, rather than exclusively in the left hemisphere.

Previous research has established that as hearing gets progressively worse with time, more of the right frontal cortex is used to process language. “But in our study, young people with mild hearing decline were already experiencing this phenomenon,” said lead researcher Yune Lee, PhD, an assistant professor of speech and hearing science at Ohio State University. “Their brains already know that the perception of sound is not what it used to be and the right side starts compensating for the left.”

The researchers noted that the slight hearing loss they observed in their subjects went unnoticed because of the brain’s compensation, but the extra effort invested in understanding spoken sentences might have other adverse effects. The study raised the concern that such extra wear on the brain might cause harm beyond only aural.

Previous research has noted that increased hearing loss is correlated with greater risk of dementia, and if people lose their hearing before they reach seniority, they may also suffer from dementia earlier. “Hearing loss, even minor deficits, can take a toll in young people – they’re using cognitive resources that could be preserved until much later in life,” said Lee. “Most concerning, this early hearing loss could pave the way for dementia.”

Published: 6/14/2018 10:20:00 AM

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Why do I feel pain in my ear when swallowing?

The ears are linked to the nose and throat, and infections in any of these areas can cause ear pain when swallowing. A range of other issues, such as dental abscesses and joint damage, can also cause this pain. Here, learn about the many causes and their symptoms and treatments. We also describe when to see a doctor.

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Why do I feel pain in my ear when swallowing?

The ears are linked to the nose and throat, and infections in any of these areas can cause ear pain when swallowing. A range of other issues, such as dental abscesses and joint damage, can also cause this pain. Here, learn about the many causes and their symptoms and treatments. We also describe when to see a doctor.

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Behavioral Measures of Listening Effort in School-Age Children: Examining the Effects of Signal-to-Noise Ratio, Hearing Loss, and Amplification

Objectives: Increased listening effort in school-age children with hearing loss (CHL) could compromise learning and academic achievement. Identifying a sensitive behavioral measure of listening effort for this group could have both clinical and research value. This study examined the effects of signal-to-noise ratio (SNR), hearing loss, and personal amplification on 2 commonly used behavioral measures of listening effort: dual-task visual response times (visual RTs) and verbal response times (verbal RTs). Design: A total of 82 children (aged 6–13 years) took part in this study; 37 children with normal hearing (CNH) and 45 CHL. All children performed a dual-task paradigm from which both measures of listening effort (dual-task visual RT and verbal RT) were derived. The primary task was word recognition in multi-talker babble in three individually selected SNR conditions: Easy, Moderate, and Hard. The secondary task was a visual monitoring task. Listening effort during the dual-task was quantified as the change in secondary task RT from baseline (single-task visual RT) to the dual-task condition. Listening effort based on verbal RT was quantified as the time elapsed from the onset of the auditory stimulus to the onset of the verbal response when performing the primary (word recognition) task in isolation. CHL completed the task aided and/or unaided to examine the effect of amplification on listening effort. Results: Verbal RTs were generally slower in the more challenging SNR conditions. However, there was no effect of SNR on dual-task visual RT. Overall, verbal RTs were significantly slower in CHL versus CNH. No group difference in dual-task visual RTs was found between CNH and CHL. No effect of amplification was found on either dual-task visual RTs or verbal RTs. Conclusions: This study compared dual-task visual RT and verbal RT measures of listening effort in the child population. Overall, verbal RTs appear more sensitive than dual-task visual RTs to the negative effects of SNR and hearing loss. The current findings extend the literature on listening effort in the pediatric population by demonstrating that, even for speech that is accurately recognized, school-age CHL show a greater processing speed decrement than their normal-hearing counterparts, a decrement that could have a negative impact on learning and academic achievement in the classroom. ACKNOWLEDGMENTS: The authors would like to acknowledge the contributions of Hilary Davis and the many graduate students who assisted in participant recruitment and data collection. The authors also thank Wes Grantham for the development of the coding software, as well as Nick Bennett, Elizabeth Geller, Stone Dawson, Quela Royster, and Beth Suba for their help with coding and reliability checks. This work was supported by the Dan and Margaret Maddox Charitable Trust, and the Institute of Education Sciences (IES), U.S. Department of Education, through Grant R324A110266 to Vanderbilt University (Nashville, TN; awarded to Fred H. Bess, PI). The content expressed are those of the authors and do not necessarily represent the views of the Institute of Education Sciences, or the U.S. Department of Education. The authors declare no other conflict of interest. Received June 9, 2017; accepted April 27, 2018. Address for correspondence: Ronan McGarrigle, Department of Psychology, University of Chester, Parkgate Road, Chester, United Kingdom. E-mail: r.mcgarrigle@chester.ac.uk. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Refinement and Validation of the Social Participation Restrictions Questionnaire: An Application of Rasch Analysis and Traditional Psychometric Analysis Techniques

Objectives: The primary aim of this research was to refine and validate the Social Participation Restrictions Questionnaire (SPaRQ). The SPaRQ is a hearing-specific, patient-reported outcome measure that was originally developed through consultation with adults with hearing loss, clinicians, and researchers. This research comprised two studies. Study 1 aimed to assess the psychometric properties of the SPaRQ and to improve these properties by amending the questionnaire (e.g., removing items) as required. Study 2 aimed to validate the refined SPaRQ. Design: In study 1, 279 adults with hearing loss completed a long-form, 53-item SPaRQ. Rasch analysis, a modern psychometric analysis technique, was used to assess a range of psychometric properties for the questionnaire (e.g., unidimensionality, fit to the Rasch model). The properties of the individual items were also assessed (e.g., response dependency, differential item functioning). In study 2, 102 adults with hearing loss completed the refined SPaRQ. In addition, they completed three questionnaires that had been designed to measure related constructs. These were a hearing-specific questionnaire (Hearing Handicap Inventory for the Elderly), a generic health and disability questionnaire (shortened World Health Organization Disability Assessment Schedule 2.0), and a brief depression and anxiety screening questionnaire (Patient Health Questionnaire-4). Traditional psychometric analysis techniques (e.g., Cronbach’s alpha) were used to assess the construct validity and internal consistency of the refined SPaRQ. Results: Rasch analysis was used to refine the SPaRQ. The result was a 19-item measure divided into two subscales. The 9-item Social Behaviors subscale measured difficulties with performing actions in a social context due to hearing loss. The 10-item Social Perceptions subscale measured negative thoughts and feelings experienced in a social context due to hearing loss. Both Rasch analysis and the traditional psychometric analysis techniques demonstrated that each subscale had strong psychometric properties. In particular, each subscale passed the test of unidimensionality, displayed good fit to the Rasch model, and had high internal consistency. In addition, it was found that, as predicted, each subscale had strong, positive correlations with the hearing-specific questionnaire and moderate, positive correlations with the generic health and disability questionnaire and the depression and anxiety screening questionnaire. Taken together, these findings support the construct validity of the 19-item SPaRQ. Conclusions: This was one of the first studies to devise a new hearing-specific outcome measure using Rasch analysis. Rasch analysis proved to be a powerful technique for supporting decisions regarding which items to retain in order to achieve a psychometrically robust questionnaire. Additional support for the robustness of this questionnaire came from the utilization of traditional psychometric analysis techniques. Therefore, this questionnaire has the potential to be used in research and clinical practice to evaluate whether auditory rehabilitation interventions improve social participation in adults with hearing loss. The next stage of this research will be to further validate this questionnaire by assessing its responsiveness in a clinical population. The combined use of modern and traditional psychometric analysis techniques should be considered in future questionnaire development and validation research. ACKNOWLEDGMENTS: The authors thank Sandra Smith (NIHR Nottingham Biomedical Research Centre, University of Nottingham) for her assistance with data management. The authors also thank Mike Horton (Psychometric Laboratory for Health Sciences, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds) for providing Rasch analysis training and guidance. The authors are grateful to Richard Nicholson, Julie Brady, Asma Hussain, Julie Carr, Karenbir Basi, Huw Cooper, the staff of the Nottingham Audiology Service, and the staff of the Queen Elizabeth Hospital Audiology Centre in Birmingham for their assistance with participant identification. Finally, the authors thank the participants for taking the time to be part of this research. This paper presents independent research supported by the NIHR Biomedical Research Unit Programme. The views expressed in this paper are those of the authors and not necessarily those of the NHS, the NIHR, or the UK Department of Health and Social Care. The authors have no conflicts of interest to disclose. Please contact hearingnihr@nottingham.ac.uk to obtain a copy of the Social Participation Restrictions Questionnaire (SPaRQ). Received August 31, 2017; accepted April 10, 2018. Address for correspondence: Eithne Heffernan, National Institute for Health Research Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, United Kingdom. E-mail: eithne.heffernan1@nottingham.ac.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Behavioral Measures of Listening Effort in School-Age Children: Examining the Effects of Signal-to-Noise Ratio, Hearing Loss, and Amplification

Objectives: Increased listening effort in school-age children with hearing loss (CHL) could compromise learning and academic achievement. Identifying a sensitive behavioral measure of listening effort for this group could have both clinical and research value. This study examined the effects of signal-to-noise ratio (SNR), hearing loss, and personal amplification on 2 commonly used behavioral measures of listening effort: dual-task visual response times (visual RTs) and verbal response times (verbal RTs). Design: A total of 82 children (aged 6–13 years) took part in this study; 37 children with normal hearing (CNH) and 45 CHL. All children performed a dual-task paradigm from which both measures of listening effort (dual-task visual RT and verbal RT) were derived. The primary task was word recognition in multi-talker babble in three individually selected SNR conditions: Easy, Moderate, and Hard. The secondary task was a visual monitoring task. Listening effort during the dual-task was quantified as the change in secondary task RT from baseline (single-task visual RT) to the dual-task condition. Listening effort based on verbal RT was quantified as the time elapsed from the onset of the auditory stimulus to the onset of the verbal response when performing the primary (word recognition) task in isolation. CHL completed the task aided and/or unaided to examine the effect of amplification on listening effort. Results: Verbal RTs were generally slower in the more challenging SNR conditions. However, there was no effect of SNR on dual-task visual RT. Overall, verbal RTs were significantly slower in CHL versus CNH. No group difference in dual-task visual RTs was found between CNH and CHL. No effect of amplification was found on either dual-task visual RTs or verbal RTs. Conclusions: This study compared dual-task visual RT and verbal RT measures of listening effort in the child population. Overall, verbal RTs appear more sensitive than dual-task visual RTs to the negative effects of SNR and hearing loss. The current findings extend the literature on listening effort in the pediatric population by demonstrating that, even for speech that is accurately recognized, school-age CHL show a greater processing speed decrement than their normal-hearing counterparts, a decrement that could have a negative impact on learning and academic achievement in the classroom. ACKNOWLEDGMENTS: The authors would like to acknowledge the contributions of Hilary Davis and the many graduate students who assisted in participant recruitment and data collection. The authors also thank Wes Grantham for the development of the coding software, as well as Nick Bennett, Elizabeth Geller, Stone Dawson, Quela Royster, and Beth Suba for their help with coding and reliability checks. This work was supported by the Dan and Margaret Maddox Charitable Trust, and the Institute of Education Sciences (IES), U.S. Department of Education, through Grant R324A110266 to Vanderbilt University (Nashville, TN; awarded to Fred H. Bess, PI). The content expressed are those of the authors and do not necessarily represent the views of the Institute of Education Sciences, or the U.S. Department of Education. The authors declare no other conflict of interest. Received June 9, 2017; accepted April 27, 2018. Address for correspondence: Ronan McGarrigle, Department of Psychology, University of Chester, Parkgate Road, Chester, United Kingdom. E-mail: r.mcgarrigle@chester.ac.uk. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Refinement and Validation of the Social Participation Restrictions Questionnaire: An Application of Rasch Analysis and Traditional Psychometric Analysis Techniques

Objectives: The primary aim of this research was to refine and validate the Social Participation Restrictions Questionnaire (SPaRQ). The SPaRQ is a hearing-specific, patient-reported outcome measure that was originally developed through consultation with adults with hearing loss, clinicians, and researchers. This research comprised two studies. Study 1 aimed to assess the psychometric properties of the SPaRQ and to improve these properties by amending the questionnaire (e.g., removing items) as required. Study 2 aimed to validate the refined SPaRQ. Design: In study 1, 279 adults with hearing loss completed a long-form, 53-item SPaRQ. Rasch analysis, a modern psychometric analysis technique, was used to assess a range of psychometric properties for the questionnaire (e.g., unidimensionality, fit to the Rasch model). The properties of the individual items were also assessed (e.g., response dependency, differential item functioning). In study 2, 102 adults with hearing loss completed the refined SPaRQ. In addition, they completed three questionnaires that had been designed to measure related constructs. These were a hearing-specific questionnaire (Hearing Handicap Inventory for the Elderly), a generic health and disability questionnaire (shortened World Health Organization Disability Assessment Schedule 2.0), and a brief depression and anxiety screening questionnaire (Patient Health Questionnaire-4). Traditional psychometric analysis techniques (e.g., Cronbach’s alpha) were used to assess the construct validity and internal consistency of the refined SPaRQ. Results: Rasch analysis was used to refine the SPaRQ. The result was a 19-item measure divided into two subscales. The 9-item Social Behaviors subscale measured difficulties with performing actions in a social context due to hearing loss. The 10-item Social Perceptions subscale measured negative thoughts and feelings experienced in a social context due to hearing loss. Both Rasch analysis and the traditional psychometric analysis techniques demonstrated that each subscale had strong psychometric properties. In particular, each subscale passed the test of unidimensionality, displayed good fit to the Rasch model, and had high internal consistency. In addition, it was found that, as predicted, each subscale had strong, positive correlations with the hearing-specific questionnaire and moderate, positive correlations with the generic health and disability questionnaire and the depression and anxiety screening questionnaire. Taken together, these findings support the construct validity of the 19-item SPaRQ. Conclusions: This was one of the first studies to devise a new hearing-specific outcome measure using Rasch analysis. Rasch analysis proved to be a powerful technique for supporting decisions regarding which items to retain in order to achieve a psychometrically robust questionnaire. Additional support for the robustness of this questionnaire came from the utilization of traditional psychometric analysis techniques. Therefore, this questionnaire has the potential to be used in research and clinical practice to evaluate whether auditory rehabilitation interventions improve social participation in adults with hearing loss. The next stage of this research will be to further validate this questionnaire by assessing its responsiveness in a clinical population. The combined use of modern and traditional psychometric analysis techniques should be considered in future questionnaire development and validation research. ACKNOWLEDGMENTS: The authors thank Sandra Smith (NIHR Nottingham Biomedical Research Centre, University of Nottingham) for her assistance with data management. The authors also thank Mike Horton (Psychometric Laboratory for Health Sciences, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds) for providing Rasch analysis training and guidance. The authors are grateful to Richard Nicholson, Julie Brady, Asma Hussain, Julie Carr, Karenbir Basi, Huw Cooper, the staff of the Nottingham Audiology Service, and the staff of the Queen Elizabeth Hospital Audiology Centre in Birmingham for their assistance with participant identification. Finally, the authors thank the participants for taking the time to be part of this research. This paper presents independent research supported by the NIHR Biomedical Research Unit Programme. The views expressed in this paper are those of the authors and not necessarily those of the NHS, the NIHR, or the UK Department of Health and Social Care. The authors have no conflicts of interest to disclose. Please contact hearingnihr@nottingham.ac.uk to obtain a copy of the Social Participation Restrictions Questionnaire (SPaRQ). Received August 31, 2017; accepted April 10, 2018. Address for correspondence: Eithne Heffernan, National Institute for Health Research Nottingham Biomedical Research Centre, Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, United Kingdom. E-mail: eithne.heffernan1@nottingham.ac.uk Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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