Investigating Peripheral Sources of Speech-in-Noise Variability in Listeners with Normal Audiograms

Publication date: Available online 22 November 2018

Source: Hearing Research

Author(s): S.B. Smith, J. Krizman, C. Liu, T. White-Schwoch, T. Nicol, N. Kraus

Abstract:

A current initiative in auditory neuroscience research is to better understand why some listeners struggle to perceive speech-in-noise (SIN) despite having normal hearing sensitivity. Various hypotheses regarding the physiologic bases of this disorder have been proposed. Notably, recent work has suggested that the site of lesion underlying SIN deficits in normal hearing listeners may be either in “sub-clinical” outer hair cell damage or synaptopathic degeneration at the inner hair cell-auditory nerve fiber synapse. In this study, we present a retrospective investigation of these peripheral sources and their relationship with SIN performance variability in one of the largest datasets of young normal-hearing listeners presented to date. 194 participants completed detailed case history questionnaires assessing noise exposure, SIN complaints, tinnitus, and hyperacusis. Standard and extended high frequency audiograms, distortion product otoacoustic emissions, click-evoked auditory brainstem responses, and SIN performance measures were also collected. We found that: 1) the prevalence of SIN deficits in normal hearing listeners was 42% when based on subjective report and 8% when based on SIN performance, 2) hearing complaints and hyperacusis were more common in listeners with self-reported noise exposure histories than controls, 3) neither extended high frequency thresholds nor compound action potential amplitudes differed between noise-exposed and control groups, 4) extended high frequency hearing thresholds and compound action potential amplitudes were not predictive of SIN performance. These results suggest an association between noise exposure and hearing complaints in young, normal hearing listeners; however, SIN performance variability is not explained by peripheral auditory function to the extent that these measures capture subtle physiologic differences between participants.

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Development of Intra-operative Assessment System for Ossicular Mobility and Middle Ear Transfer Function

Publication date: Available online 22 November 2018

Source: Hearing Research

Author(s): Takuji Koike, Yuuka Irie, Ryo Ebine, Takaaki Fujishiro, Sho Kanzaki, Chee Sze Keat, Takenobu Higo, Kenji Ohoyama, Masaaki Hayashi, Hajime Ikegami

Abstract

Objective measurements of the ossicular mobility have not been commonly performed during the surgery, and the assessment of ossicular mobility is made by palpation in most cases. Palpation is inherently subjective and may not always be reliable, especially in milder degrees of ossicular fixation and in the case of multiple fixation. Although several devices have been developed to quantitatively measure the ossicular mobility during surgery, they have not been widely used. In this study, a new system with a hand-held probe which enables intraoperative quantitative measurements of ossicular mobility has been developed. This system not only measures the ossicular mobility, but also investigates “local” transmission characteristics of the middle ear by directly applying vibration to the ossicles and measuring cochlear microphonic. The basic performance of this system was confirmed by measuring the mobility of artificial ossicles and cochlear microphonics in an animal experiment. Our system may contribute to selection of a better surgical method and reducing the risks of revision surgery.

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Differential responses to spectrally degraded speech within human auditory cortex: An intracranial electrophysiology study

Publication date: Available online 22 November 2018

Source: Hearing Research

Author(s): Kirill V. Nourski, Mitchell Steinschneider, Ariane E. Rhone, Christopher K. Kovach, Hiroto Kawasaki, Matthew A. Howard

Abstract

Understanding cortical processing of spectrally degraded speech in normal-hearing subjects may provide insights into how sound information is processed by cochlear implant (CI) users. This study investigated electrocorticographic (ECoG) responses to noise-vocoded speech and related these responses to behavioral performance in a phonemic identification task. Subjects were neurosurgical patients undergoing chronic invasive monitoring for medically refractory epilepsy. Stimuli were utterances /aba/ and /ada/, spectrally degraded using a noise vocoder (1-4 bands). ECoG responses were obtained from Heschl’s gyrus (HG) and superior temporal gyrus (STG), and were examined within the high gamma frequency range (70-150 Hz). All subjects performed at chance accuracy with speech degraded to 1 and 2 spectral bands, and at or near ceiling for clear speech. Inter-subject variability was observed in the 3 and 4-band conditions. High gamma responses in posteromedial HG (auditory core cortex) were similar for all vocoded conditions and clear speech. A progressive preference for clear speech emerged in anterolateral segments of HG, regardless of behavioral performance. On the lateral STG, responses to all vocoded stimuli were larger in subjects with better task performance. In contrast, both behavioral and neural responses to clear speech were comparable across subjects regardless of their ability to identify degraded stimuli. Findings highlight differences in representation of spectrally degraded speech across cortical areas and their relationship to perception. The results are in agreement with prior non-invasive results. The data provide insight into the neural mechanisms associated with variability in perception of degraded speech and potentially into sources of such variability in CI users.

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Investigating Peripheral Sources of Speech-in-Noise Variability in Listeners with Normal Audiograms

Publication date: Available online 22 November 2018

Source: Hearing Research

Author(s): S.B. Smith, J. Krizman, C. Liu, T. White-Schwoch, T. Nicol, N. Kraus

Abstract:

A current initiative in auditory neuroscience research is to better understand why some listeners struggle to perceive speech-in-noise (SIN) despite having normal hearing sensitivity. Various hypotheses regarding the physiologic bases of this disorder have been proposed. Notably, recent work has suggested that the site of lesion underlying SIN deficits in normal hearing listeners may be either in “sub-clinical” outer hair cell damage or synaptopathic degeneration at the inner hair cell-auditory nerve fiber synapse. In this study, we present a retrospective investigation of these peripheral sources and their relationship with SIN performance variability in one of the largest datasets of young normal-hearing listeners presented to date. 194 participants completed detailed case history questionnaires assessing noise exposure, SIN complaints, tinnitus, and hyperacusis. Standard and extended high frequency audiograms, distortion product otoacoustic emissions, click-evoked auditory brainstem responses, and SIN performance measures were also collected. We found that: 1) the prevalence of SIN deficits in normal hearing listeners was 42% when based on subjective report and 8% when based on SIN performance, 2) hearing complaints and hyperacusis were more common in listeners with self-reported noise exposure histories than controls, 3) neither extended high frequency thresholds nor compound action potential amplitudes differed between noise-exposed and control groups, 4) extended high frequency hearing thresholds and compound action potential amplitudes were not predictive of SIN performance. These results suggest an association between noise exposure and hearing complaints in young, normal hearing listeners; however, SIN performance variability is not explained by peripheral auditory function to the extent that these measures capture subtle physiologic differences between participants.

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Development of Intra-operative Assessment System for Ossicular Mobility and Middle Ear Transfer Function

Publication date: Available online 22 November 2018

Source: Hearing Research

Author(s): Takuji Koike, Yuuka Irie, Ryo Ebine, Takaaki Fujishiro, Sho Kanzaki, Chee Sze Keat, Takenobu Higo, Kenji Ohoyama, Masaaki Hayashi, Hajime Ikegami

Abstract

Objective measurements of the ossicular mobility have not been commonly performed during the surgery, and the assessment of ossicular mobility is made by palpation in most cases. Palpation is inherently subjective and may not always be reliable, especially in milder degrees of ossicular fixation and in the case of multiple fixation. Although several devices have been developed to quantitatively measure the ossicular mobility during surgery, they have not been widely used. In this study, a new system with a hand-held probe which enables intraoperative quantitative measurements of ossicular mobility has been developed. This system not only measures the ossicular mobility, but also investigates “local” transmission characteristics of the middle ear by directly applying vibration to the ossicles and measuring cochlear microphonic. The basic performance of this system was confirmed by measuring the mobility of artificial ossicles and cochlear microphonics in an animal experiment. Our system may contribute to selection of a better surgical method and reducing the risks of revision surgery.

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Differential responses to spectrally degraded speech within human auditory cortex: An intracranial electrophysiology study

Publication date: Available online 22 November 2018

Source: Hearing Research

Author(s): Kirill V. Nourski, Mitchell Steinschneider, Ariane E. Rhone, Christopher K. Kovach, Hiroto Kawasaki, Matthew A. Howard

Abstract

Understanding cortical processing of spectrally degraded speech in normal-hearing subjects may provide insights into how sound information is processed by cochlear implant (CI) users. This study investigated electrocorticographic (ECoG) responses to noise-vocoded speech and related these responses to behavioral performance in a phonemic identification task. Subjects were neurosurgical patients undergoing chronic invasive monitoring for medically refractory epilepsy. Stimuli were utterances /aba/ and /ada/, spectrally degraded using a noise vocoder (1-4 bands). ECoG responses were obtained from Heschl’s gyrus (HG) and superior temporal gyrus (STG), and were examined within the high gamma frequency range (70-150 Hz). All subjects performed at chance accuracy with speech degraded to 1 and 2 spectral bands, and at or near ceiling for clear speech. Inter-subject variability was observed in the 3 and 4-band conditions. High gamma responses in posteromedial HG (auditory core cortex) were similar for all vocoded conditions and clear speech. A progressive preference for clear speech emerged in anterolateral segments of HG, regardless of behavioral performance. On the lateral STG, responses to all vocoded stimuli were larger in subjects with better task performance. In contrast, both behavioral and neural responses to clear speech were comparable across subjects regardless of their ability to identify degraded stimuli. Findings highlight differences in representation of spectrally degraded speech across cortical areas and their relationship to perception. The results are in agreement with prior non-invasive results. The data provide insight into the neural mechanisms associated with variability in perception of degraded speech and potentially into sources of such variability in CI users.

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Voluntary control of forward leaning posture relates to low-frequency neural inputs to the medial gastrocnemius muscle

Publication date: Available online 22 November 2018

Source: Gait & Posture

Author(s): Tatsunori Watanabe, Ippei Nojima, Hideshi Sugiura, Basma Yacoubi, Evangelos A. Christou

Abstract

Background

Variability is an inherent feature of the motor output. Although low-frequency oscillations (<0.5 Hz) are the most important contributor to the variability of force during single-joint isolated force tasks, it remains unclear whether they contribute to the variability of a more complex task, such as a voluntary postural task.

Research question

Do low-frequency oscillations contribute to postural sway (center of pressure (COP) variability) when participants attempt to voluntarily maintain posture in a forward leaning position?

Methods

Fourteen healthy young adults performed two tasks: 1) stand quietly (control condition); 2) leaned their body forward to 60% of their maximum lean distance by dorsiflexing the ankle joint. We recorded the COP and electromyographic (EMG) activity from the medial gastrocnemius (MG) and soleus (SL) muscles. We quantified the following: 1) COP variability as the standard deviation (SD) of anteroposterior COP displacements; 2) modulation of COP as the power in COP displacements from 0-2 Hz; 3) modulation of EMG bursting as the power in the rectified and smoothed EMG from 0-2 Hz; 4) modulation of the interference EMG as the power in the EMG from 10-35 and 35-60 Hz.

Results

The SD of COP displacements related to the COP oscillations <0.5 Hz in both quiet standing and lean tasks. However, only for the lean task, the <0.5 Hz COP oscillations related to the EMG burst oscillations <0.5 Hz of the MG muscle. The EMG burst oscillations <0.5 Hz of the MG muscle further related to the interference EMG oscillations from 35-60 Hz for the lean task.

Significance

Voluntary control of forward leaning posture relates to low-frequency neural inputs to the MG muscle.

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Voluntary control of forward leaning posture relates to low-frequency neural inputs to the medial gastrocnemius muscle

Publication date: Available online 22 November 2018

Source: Gait & Posture

Author(s): Tatsunori Watanabe, Ippei Nojima, Hideshi Sugiura, Basma Yacoubi, Evangelos A. Christou

Abstract

Background

Variability is an inherent feature of the motor output. Although low-frequency oscillations (<0.5 Hz) are the most important contributor to the variability of force during single-joint isolated force tasks, it remains unclear whether they contribute to the variability of a more complex task, such as a voluntary postural task.

Research question

Do low-frequency oscillations contribute to postural sway (center of pressure (COP) variability) when participants attempt to voluntarily maintain posture in a forward leaning position?

Methods

Fourteen healthy young adults performed two tasks: 1) stand quietly (control condition); 2) leaned their body forward to 60% of their maximum lean distance by dorsiflexing the ankle joint. We recorded the COP and electromyographic (EMG) activity from the medial gastrocnemius (MG) and soleus (SL) muscles. We quantified the following: 1) COP variability as the standard deviation (SD) of anteroposterior COP displacements; 2) modulation of COP as the power in COP displacements from 0-2 Hz; 3) modulation of EMG bursting as the power in the rectified and smoothed EMG from 0-2 Hz; 4) modulation of the interference EMG as the power in the EMG from 10-35 and 35-60 Hz.

Results

The SD of COP displacements related to the COP oscillations <0.5 Hz in both quiet standing and lean tasks. However, only for the lean task, the <0.5 Hz COP oscillations related to the EMG burst oscillations <0.5 Hz of the MG muscle. The EMG burst oscillations <0.5 Hz of the MG muscle further related to the interference EMG oscillations from 35-60 Hz for the lean task.

Significance

Voluntary control of forward leaning posture relates to low-frequency neural inputs to the MG muscle.

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Psychometric Comparison of the Hearing in Noise Test and the American English Matrix Test.

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Psychometric Comparison of the Hearing in Noise Test and the American English Matrix Test.

J Am Acad Audiol. 2018 Sep 25;:

Authors: Harianawala J, Galster J, Hornsby B

Abstract
BACKGROUND: The hearing in noise test (HINT) is the most popular adaptive test used to evaluate speech in noise performance, especially in context of hearing aid features. However, the number of conditions that can be tested on the HINT is limited by a small speech corpus. The American English Matrix test (AEMT) is a new alternative adaptive speech in noise test with a larger speech corpus. The study examined the relationships between the performance of hearing aid wearers on the HINT and the AEMT.
PURPOSE: To examine whether there was a difference in performance of hearing aid wearers on the HINT and the AEMT. A secondary purpose, given the AEMT's steep performance-intensity function, was to determine whether the AEMT is more sensitive to changes in speech recognition resulting from directional (DIR) microphone processing in hearing aids.
RESEARCH DESIGN: A repeated measures design was used in this study. Multiple measurements were made on each subject. Each measurement involved a different experimental condition.
STUDY SAMPLE: Ten adults with hearing loss participated in this study.
DATA COLLECTION AND ANALYSIS: All participants completed the AEMT and HINT, using adaptive and fixed test formats while wearing hearing aids. Speech recognition was assessed in two hearing aid microphone settings-omnidirectional and fixed DIR. All testing was conducted via sound field presentation. Performance on HINT and AEMT were systematically compared across all test conditions using a linear model with repeated measures.
RESULTS: The results of this study revealed that adult hearing aid users perform differently on the HINT and AEMT, with adaptive AEMT testing yielding significantly better (more negative) thresholds than the HINT. Slopes of performance intensity functions obtained by testing at multiple fixed signal-to-noise ratios, revealed a somewhat steeper slope for the HINT compared with the AEMT. Despite this steeper slope, the benefit provided by DIR microphones was not significantly different between the two speech tests.
CONCLUSIONS: The observation of similar DIR benefits of the HINT and AEMT suggests that the HINT and AEMT are equally sensitive to changes in speech recognition thresholds following intervention. Therefore, the decision to use the AEMT or the HINT will depend on the purpose of the study and/or the technology being investigated. Other test related factors such as available sentence corpus, learning effects and test time will also influence test selection.

PMID: 30461418 [PubMed - as supplied by publisher]

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A Client Oriented Scale of Improvement in Tinnitus for Therapy Goal Planning and Assessing Outcomes.

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A Client Oriented Scale of Improvement in Tinnitus for Therapy Goal Planning and Assessing Outcomes.

J Am Acad Audiol. 2018 Feb 15;:

Authors: Searchfield GD

Abstract
BACKGROUND: There is a need to develop methods to help clinicians work with clients to select and personalize tinnitus therapies. The use of validated measures to determine treatment success is also essential for research and clinical practice. A goal planning method widely used in audiologic rehabilitation is the client oriented scale of improvement (COSI). A modified version of the COSI has been used to identify tinnitus treatment goals and outcomes (client oriented scale of improvement in tinnitus [COSIT]).
PURPOSE: The aims of this study were to identify treatment goals in a clinic sample and ascertain the convergent validity of the COSIT to three widely used standardized questionnaires.
RESEARCH DESIGN: A retrospective evaluation of client treatment goals using thematic analysis and correlational analysis of secondary research data comparing the COSIT to tinnitus handicap questionnaire (THQ), tinnitus handicap inventory (THI), and tinnitus functional index (TFI).
STUDY SAMPLE: One hundred and twenty-two adult patients and research participants attending the University of Auckland Hearing and Tinnitus Clinic.
RESULTS: Specific treatment goals were categorized into 11 themes. The most common treatment goals (>10% of responses) were: (1) Reducing tinnitus' effects on Hearing. (2) Improved wellbeing and being less depressed. (3) Coping with or controlling the tinnitus. (4) Managing the effect of the environment (context) on tinnitus. (5) Improving sleep. (6) Understanding tinnitus. Individuals differed in their complaints and priorities for treatment. The COSIT showed moderate convergent validity with the THQ, THI, and TFI indicating that the total scores measured similar constructs.
CONCLUSIONS: The COSIT is a pragmatic method for determining tinnitus treatment goals and priorities in a format that should be familiar to audiologists.

PMID: 30461417 [PubMed - as supplied by publisher]

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Extended High-Frequency Smartphone Audiometry: Validity and Reliability.

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Extended High-Frequency Smartphone Audiometry: Validity and Reliability.

J Am Acad Audiol. 2018 Jan 18;:

Authors: Bornman M, Swanepoel W, De Jager LB, Eikelboom RH

Abstract
BACKGROUND: Extended high-frequency (EHF) audiometry (8-16 kHz) has an important role in audiological assessments such as ototoxicity monitoring, and for speech recognition and localization. Accurate and reliable EHF testing with smartphone technologies has the potential to provide more affordable and accessible hearing-care services, especially in underserved contexts.
PURPOSE: To determine the accuracy and test-retest reliability of EHF audiometry with a smartphone application, using calibrated headphones.
RESEARCH DESIGN: Air-conduction thresholds (8-16 kHz) and test-retest reproducibility, recorded with conventional audiometry (CA) and smartphone audiometry (SA), using audiometric (Sennheiser HDA 300 circumaural) and nonstandard audiometric (Sennheiser HD202 II supra-aural) headphones, were compared in a repeated-measures design.
STUDY SAMPLE: A total of 61 participants (122 ears) were included in the study. Of these, 24 were adults attending a tuberculosis clinic (mean age = 36.8, standard deviation [SD] = 14.2 yr; 48% female) and 37 were adolescents and young adults recruited from a prospective students program (mean age = 17.6, SD = 3.2 yr; 76% female). Of these, 22.3% (n = 326) of EHF thresholds were ≥25 dB HL.
DATA ANALYSIS: Threshold comparisons were made between CA and SA, with audiometric headphones and nonstandard audiometric headphones. A paired samples t-test was used for comparison of threshold correspondence between conventional and smartphone thresholds, and test-retest reproducibility of smartphone thresholds.
RESULTS: Conventional thresholds corresponded with smartphone thresholds at the lowest intensity (10 dB HL), using audiometric and nonstandard audiometric headphones in 59.4% and 57.6% of cases, respectively. Conventional thresholds (exceeding 10 dB HL) corresponded within 10 dB or less, with smartphone thresholds in 82.9% of cases using audiometric headphones and 84.1% of cases using nonstandard audiometric headphones. There was no significant difference between CA and SA, using audiometric headphones across all frequencies (p > 0.05). Test-retest comparison also showed no significant differences between conditions (p > 0.05). Smartphone test-retest thresholds corresponded within 10 dB or less in 86.7% and 93.4% of cases using audiometric and nonstandard audiometric headphones, respectively.
CONCLUSIONS: EHF smartphone testing with calibrated headphones can provide an accurate and reliable option for affordable mobile audiometry. The validity of EHF smartphone testing outside a sound booth as a cost-effective and readily available option to detect high-frequency hearing loss in community-based settings should be established.

PMID: 30461416 [PubMed - as supplied by publisher]

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Early Indices of Reduced Cochlear Function in Young Adults with Type-1 Diabetes Revealed by DPOAE Fine Structure.

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Early Indices of Reduced Cochlear Function in Young Adults with Type-1 Diabetes Revealed by DPOAE Fine Structure.

J Am Acad Audiol. 2018 Sep 25;:

Authors: Spankovich C, Long GR, Hood LJ

Abstract
BACKGROUND: The relationship between type-1 diabetes mellitus (DM) and cochlear dysfunction remains inconclusive.
PURPOSE: The purpose of this study was to examine otoacoustic emissions (OAEs) in normal-hearing young adults with type-1 DM as compared with matched controls and identify potential covariates influencing OAE findings.
RESEARCH DESIGN: Cross-sectional study.
STUDY SAMPLE: N = 40 young adults aged 18-28 years including individuals with type-1 DM (n = 20) and age-gender matched controls (n = 20) with normal hearing sensitivity.
DATA COLLECTION AND ANALYSIS: Measures of pure-tone threshold sensitivity and OAEs, including distortion product otoacoustic emissions (DPOAEs), transient evoked OAEs, and DPOAE fine structure, were compared between groups. Covariates such as noise exposure and DM-related factors (e.g., duration of disease, glycated hemoglobin levels) were considered. Statistical analysis included analysis of variance and linear regression.
RESULTS: Measures of hearing sensitivity and auditory function in both groups were comparable for all assays, except DPOAE fine structure. A reduced number of fine structure peaks and component amplitudes were found in the type-1 diabetes DM group with the primary difference in the reflection component.
CONCLUSIONS: The results indicate that reduced cochlear function in young adults with type-1 DM can be revealed using DPOAE fine structure, suggesting potential clinical applications of DPOAE fine structure in early identification of cochlear pathology. Potential factors underlying these findings are discussed.

PMID: 30461415 [PubMed - as supplied by publisher]

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Negative Side Effects Associated with Hearing Aid Use in Adults with Hearing Loss.

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Negative Side Effects Associated with Hearing Aid Use in Adults with Hearing Loss.

J Am Acad Audiol. 2018 Sep 25;:

Authors: Manchaiah V, Abrams H, Bailey A, Andersson G

Abstract
BACKGROUND: The low uptake of hearing aids in the United States has been attributed to a number of reasons, including low perceived hearing disability, limited perceived benefit and cost. Another possible reason may be related to negative side effects associated with hearing aid use.
PURPOSE: The present study was aimed at determining and classifying the negative side effects associated with hearing aid use in adults with hearing loss.
RESEARCH DESIGN: The study used a cross-sectional survey design.
STUDY SAMPLE: Five hundred and twelve participants completed an electronic survey.
DATA COLLECTION AND ANALYSIS: The data was collected using the negative side effects of hearing aids (NSE-HAs) questionnaire. Data were analyzed using Chi square analysis, principal components analysis, and calculation of Cronbach's alpha.
RESULTS: Some individuals reported negative side effects for all 32 items. However, careful examination of results suggests that, as a whole, reported negative side effects tend to be mild with mean scores falling close to the lower quartile of the total scores. Chi square test results suggest that the variables of age, gender, duration of hearing loss, self-reported hearing disability, and duration of hearing aid use seem to be significantly associated with the reported negative side effects. The NSE-HAs questionnaire was found to have a complex structure as indicated by the principal components analysis. However, good internal consistency was found in both the full scale and subscales.
CONCLUSIONS: The present study suggests that, although a large number of adults with hearing loss who use hearing aids experience some degree of negative side effects, those effects tend to be mild.

PMID: 30461414 [PubMed - as supplied by publisher]

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Contralateral Routing of Signal Yields Significant Speech in Noise Benefit for Unilateral Cochlear Implant Recipients.

Related Articles

Contralateral Routing of Signal Yields Significant Speech in Noise Benefit for Unilateral Cochlear Implant Recipients.

J Am Acad Audiol. 2018 Jan 30;:

Authors: Dwyer RT, Kessler D, Butera IM, Gifford RH

Abstract
BACKGROUND: Bilateral cochlear implantation is the standard of care for individuals with moderate sloping-to-profound sensorineural hearing loss who do not receive benefit from appropriately fit hearing aids. Because of financial, insurance, or medical reasons, some unilateral cochlear implant (CI) recipients are unable to obtain a second CI. Here, we evaluated the first clinically available solution for individuals who have been unilaterally implanted and who do not or cannot use technology (e.g., hearing aid or CI) on the non-implanted ear.
PURPOSE: We aimed to investigate how the addition of a contralateral routing of signal (CROS) device could provide objective and/or subjective benefit to adult CI recipients with moderate-to-profound hearing loss in the non-implanted ear.
RESEARCH DESIGN: Single-center prospective study using a within-subjects repeated-measures design.
STUDY SAMPLE: Participants included ten experienced unilateral CI recipients with severe-to-profound (n = 9) or moderate-to-profound (n = 1) sensorineural hearing loss in the non-implanted ear. At the time of study enrollment, participants did not use any technology on the non-implanted ear. No other exclusion criteria were used.
INTERVENTION: Individuals were tested with and without a CROS device worn on the non-implanted ear.
DATA COLLECTION AND ANALYSIS: We obtained measures of speech understanding in quiet (50 and 65 dBA) and in noise (+5-dB signal-to-noise ratio with a 65-dBA speech signal) both with and without the CROS device in an acute listening condition. Subjective benefit was assessed via the Speech, Spatial and Qualities 12-item questionnaire before CROS fitting and after two weeks of continuous use. A mixed-model, repeated-measures analysis of variance was completed with three talker locations and three presentation levels included as within-subjects factors and the presence or absence of a CROS device as a between-subjects factor.
RESULTS: There was an 11% improvement in speech understanding in noise with the addition of the CROS device when speech was located at 0° azimuth. Subjective benefit in the speech domain of the SSQ was also observed.
CONCLUSIONS: Use of CROS provided both subjective and objective speech recognition benefit for unilateral CI recipients who do not have access to bilateral cochlear implantation.

PMID: 30461413 [PubMed - as supplied by publisher]

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Face and Content Validity of a Probe Tube Placement Training Simulator.

Related Articles

Face and Content Validity of a Probe Tube Placement Training Simulator.

J Am Acad Audiol. 2018 Jan 24;:

Authors: Koch RW, Moodie S, Folkeard P, Scollie S, Janeteas C, Agrawal SK, Ladak HM

Abstract
BACKGROUND: Probe tube placement is an important skill audiologists must learn to make real-ear measurements in an audiology clinic. With current evidence-based guidelines recommending insertion of the probe tube within 5 mm of the tympanic membrane (TM) for proper acoustical measurements, students must be well trained to ensure they are capable to perform this placement in clinical practice. This is not always the case as it has been found that real-ear measurements are not performed in a clinic as often as required. To address this, a simulator consisting of a 3D-printed ear model and an optical tracking system was developed to provide a training system for students to practice probe tube placement and to provide a method to evaluate competency before starting clinical practicum placements. Two simulators were developed, an adult model and a pediatric model.
PURPOSE: To assess the face and content validity of the two probe tube placement simulators (adult and pediatric) and define barriers and facilitators to implementing this system into an educational setting.
RESEARCH DESIGN: Participants followed the setup and operating instructions designed to guide them through each functionality of the simulator. A questionnaire was used to assess face and content validity, applicability to an educational setting, and to determine perceived barriers and facilitators to using the probe tube simulators for training purposes. Five additional probe tube placements with each simulator were performed in which distance-to-TM was recorded.
STUDY SAMPLE: Twelve participants with significant probe tube placement experience.
DATA COLLECTION AND ANALYSIS: Participants rated each question in the questionnaire from 0% to 100% depending on their level of agreement. Averages and standard deviations (SDs) were compiled and presented for each section (face validity, content validity, and applicability to an educational setting). Final facilitators and barriers for the simulator were compiled and the top answers of each are presented. The five quantitative probe tube placement measurements for each participant were averaged, SDs were calculated, and contacts with the TM while placing the probe tube were recorded.
RESULTS: The average face validity score over all questions for the adult model was 65% (SD = 18.2) whereas the pediatric model received a score of 64% (16.4). The overall content validity average score was 78.7% (17) and applicability to an educational setting had an average score of 80% (5.33). The average distance-to-TM across all trials and participants was 3.74 mm (1.82) for the adult model and 2.77 mm (0.94) for the pediatric model with only one participant exceeding the recommended maximum of 5 mm. Listed shortcomings of the current simulator included realism of the 3D-printed ear, ease of insertion of an otoscope tip into the ear, ability to visualize the ear canal "landmarks" and the TM, and foam tip insertion experience.
CONCLUSIONS: Results were generally very positive for the simulator, and future iterations will look to improve the flexibility and texture of the ear, as well as the otoscopic view of the ear canal and TM.

PMID: 30461412 [PubMed - as supplied by publisher]

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Can Self-Reported Personal Audio System Volume Predict Actual Listening Levels in Young Adults?

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Can Self-Reported Personal Audio System Volume Predict Actual Listening Levels in Young Adults?

J Am Acad Audiol. 2018 Jan 10;:

Authors: Torre P, Reed MB

Abstract
BACKGROUND: Most young adults report using personal audio systems (PAS) with earphones as part of their daily activities. PAS exposure is intermittent and research examining the levels these young adults are listening to is increasing. On average, preferred listening levels are below what would be considered at risk in an occupational setting.
PURPOSE: The purpose of this study was to evaluate how two questions predicted preferred listening level in young adults with normal hearing; specifically, whether these young adults could identify if they listen at a high level or not.
STUDY SAMPLE: One hundred and sixty young adults (111 women, 49 men) with normal hearing completed a questionnaire that had questions about PAS listening habits and then had preferred listening level assessed using a probe microphone system while listening to 1 hour of music through earphones.
DATA COLLECTION AND ANALYSIS: Otoscopy, tympanometry, and pure-tone thresholds were completed in a randomly determined test ear. As part of the Risk Factors Survey, two closed-set questions were completed. First, "For a typical day, what is the most common volume used during this day?" with the following response options "Low," "Medium/Comfortable," "Loud," or "Very Loud." And second, "Do you listen to your personal music system at a volume where you…" with the following response options "Easily hear people," "Have a little trouble hearing people," "Have a lot of trouble hearing people," or "Cannot hear people." Using a probe microphone, chosen listening level (A-weighted, diffuse-field correction and a conversion to free-field equivalent [LDFeq]) was calculated over 1 hour while the participant listened to music with earphones. Sensitivity and specificity were determined to see how well young adults could identify themselves as listening at a high level (>85 dBA) or not. Linear regression analyses were performed to determine the amount of variance explained by the two survey questions as predictors of measured LDFeq.
RESULTS: Almost half of the participants reported a longest single use of a PAS as <1 hour daily and more than half reported listening at a medium/comfortable volume and had a little trouble hearing people. Mean LDFeq was 72.5 dBA, with young adult men having a significantly higher mean LDFeq (76.5 dBA) compared with young adult women (70.8 dBA). Sensitivity was 88.9% and specificity was 70.6% for the question asking about volume on a typical day. For the question asking about being able to hear other people while listening to music sensitivity was 83.3% and specificity was 82.5%. Two variables, listening volume on a typical day and sex, accounted for 28.4% of the variability associated with LDFeq; the answer to the question asking about being able to hear others and sex accounted for 22.8% of the variability associated with LDFeq.
CONCLUSIONS: About 11% of young adults in the present study listen to a PAS with earphones at a high level (>85 dBA) while in a quiet background. The participants who do report listening at a high level, however, do well at self-reporting this risk behavior in survey questions.

PMID: 30461411 [PubMed - as supplied by publisher]

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Knowledge of Hearing Loss among University Students Pursuing Careers in Health Care.

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Knowledge of Hearing Loss among University Students Pursuing Careers in Health Care.

J Am Acad Audiol. 2018 Sep 24;:

Authors: Squires ES, Pakulski LA, Glassman J, Diehm E

Abstract
BACKGROUND: Albeit limited, research suggests that students pursuing careers in health care receive limited training on the provision of services for people with hearing loss. As the incidence of hearing loss continues to increase among Americans, it is critical that medical professionals understand how hearing loss among patients may affect the manner in which they can provide services most effectively.
PURPOSE: The aim of this project is to assess the amount of experience and confidence that preprofessional health-care students at one university obtain during the course of their training and whether these students would be interested in additional information related to hearing health.
RESEARCH DESIGN: Preprofessional health-care students in terminal degree programs at one university completed a survey regarding the provision of services for individuals with hearing loss. Students were asked to quantify their prior training on topics related to hearing loss, report their perceptions of the benefits and barriers to screening hearing, and report their self-efficacy in providing services for individuals with hearing loss. Additional survey items investigated students' interest in receiving further training on these topics.
STUDY SAMPLE: Participants (n = 95; 16.2% response rate) were students at a mid-sized, Midwestern university who were pursuing the following terminal degrees: medicine, physician assistant, nursing, pharmacy, physical therapy, occupational therapy, speech-language pathology, and respiratory therapy (bachelor's degree in respiratory care). Participants were selected based on membership in an interdisciplinary education training program. All students in this program received an invitation to participate in the study. Of the participants, 68 (71.6%) were Caucasian and 86 (90.5%) were female.
DATA COLLECTION AND ANALYSIS: A 28-item online survey on various topics related to hearing loss was used to document student responses. All students enrolled in a university's interdisciplinary professional education course (n = 586) received an online link to the survey via an initial email, which contained a brief introduction to the study, the assurance of response anonymity, and a statement regarding implied consent. A second email was sent to students, which reminded participants of the request to complete the survey.
RESULTS: Overall, 60% of participants reported an interest in receiving additional information on hearing health and 66.3% of respondents indicated that they wished to receive training via an in-service or internet workshop facilitated by their university program. Most of the participants reported that they had not received training and did not feel confident identifying the signs and symptoms of hearing loss and making an appropriate referral, which led to the request for additional information.
CONCLUSIONS: The results of this study suggest that preprofessional health-care students have an interest in receiving additional education on various topics related to hearing loss including a better understanding of how hearing loss impacts the quality of life in affected individuals. These findings provide an incentive to provide additional training related to hearing loss identification and management for preprofessional health-care students to foster increased competency and improved patient care.

PMID: 30461410 [PubMed - as supplied by publisher]

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Tracking of Noise Tolerance to Predict Hearing Aid Satisfaction in Loud Noisy Environments.

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Tracking of Noise Tolerance to Predict Hearing Aid Satisfaction in Loud Noisy Environments.

J Am Acad Audiol. 2018 Sep 24;:

Authors: Seper E, Kuk F, Korhonen P, Slugocki C

Abstract
BACKGROUND: A method that tracked tolerable noise level (TNL) over time while maintaining subjective speech intelligibility was reported previously. Although this method was reliable and efficacious as a research tool, its clinical efficacy and predictive ability of real-life hearing aid satisfaction were not measured.
PURPOSE: The study evaluated an adaptive method to estimate TNL using slope and variance of tracked noise level as criteria in a clinical setting. The relationship between TNL and subjective hearing aid satisfaction in noisy environments was also investigated.
RESEARCH DESIGN: A single-blinded, repeated-measures design.
STUDY SAMPLE: Seventeen experienced hearing aid wearers with bilateral mild-to-moderately-severe sensorineural hearing loss.
DATA COLLECTION AND ANALYSIS: Participants listened to 82-dB SPL continuous speech and tracked the background noise level that they could "put up with" while subjectively understanding >90% of the speech material. Two trials with each babble noise and continuous speech-shaped noise were measured in a single session. All four trials were completed aided using the participants' own hearing aids. The stimuli were presented in the sound field with speech from 0° and noise from the 180° azimuth. The instantaneous tolerable noise level was measured using a custom program and scored in two ways; the averaged TNL (aTNL) over the 2-min trial and the estimated TNL (eTNL) as soon as the listeners reached a stable noise estimate. Correlation between TNL and proportion of satisfied noisy environments was examined using the MarkeTrak questionnaire.
RESULTS: All listeners completed the tracking of noise tolerance procedure within 2 min with good reliability. Sixty-five percent of the listeners yielded a stable noise estimate after 59.9 sec of actual test time. The eTNL for all trials was 78.6 dB SPL (standard deviation [SD] = 4.4 dB). The aTNL for all trials was 78.0 dB SPL (SD = 3.3 dB) after 120 sec. The aTNL was 79.2 dB SPL (SD = 5.4 dB) for babble noise and 77.0 dB SPL (SD = 5.9 dB) for speech-shaped noise. High within-session test-retest reliability was evident. The 95% confidence interval was 1.5 dB for babble noise and 2.8 dB for continuous speech-shaped noise. No significant correlation was measured between overall hearing aid satisfaction and the aTNL (ρ = 0.20 for both noises); however, a significant relationship between aTNL and proportion of satisfied noisy situations was evident (ρ = 0.48 for babble noise and ρ = 0.55 for speech-shaped noise).
CONCLUSION: The eTNL scoring method yielded similar results as the aTNL method although requiring only half the time for 65% of the listeners. This time efficiency, along with its reliability and the potential relationship between TNL and hearing aid satisfaction in noisy listening situations suggests that this procedure may be a good clinical tool to evaluate whether specific features on a hearing aid would improve noise tolerance and predict wearer satisfaction with the selected hearing aid in real-life loud noisy situations. A larger sample of hearing aid wearers is needed to further validate these potential uses.

PMID: 30461409 [PubMed - as supplied by publisher]

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The Impact of Tinnitus on N-Back Performance in Normal Hearing Individuals.

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The Impact of Tinnitus on N-Back Performance in Normal Hearing Individuals.

J Am Acad Audiol. 2018 Feb 01;:

Authors: Waechter S, Hallendorf L, Malmstein E, Olsson A, Brännström KJ

Abstract
BACKGROUND: Tinnitus sufferers commonly report concentration difficulties. Despite several previous studies investigating this, the underlying cause and the role of hearing status remains unclear.
PURPOSE: To investigate whether there are any differences between normal hearing individuals with and without tinnitus in terms of working memory capacity, and whether working memory capacity correlates with high-frequency hearing thresholds.
RESEARCH DESIGN: Participants had their hearing thresholds measured (0.125-16 kHz) and performed a visual n-back test. All participants completed the Hospital Anxiety and Depression Scale, in addition tinnitus participants filled out the Tinnitus Questionnaire.
STUDY SAMPLE: Sixty-two individuals participated, 31 had tinnitus (tinnitus group) and 31 did not have tinnitus (control group). Groups were age- and sex matched, and all participants had normal hearing thresholds (20 dB HL or better at 0.125-8 kHz).
DATA ANALYSIS: Friedman test of differences among repeated measures was conducted on the collected data of n-back performance, and Mann-Whitney U-test was used to compare groups. Age-corrected correlations were calculated for high-frequency hearing and each n-back condition.
RESULTS: We found no significant differences between the groups in terms of n-back task performances, except for the 2-back condition where the tinnitus group performed significantly better than the controls (p = 0.007). Furthermore, we found high-frequency hearing thresholds of the best ear (10-16 kHz) to correlate with performances at more demanding n-back conditions (p = 0.029 for 1-back and p = 0.015 for 2-back).
CONCLUSION: This suggests that presence of tinnitus might not imply poorer working memory capacity and that deteriorated high-frequency hearing thresholds.

PMID: 30461408 [PubMed - as supplied by publisher]

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Hormones and Hearing: Central Auditory Processing in Women.

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Hormones and Hearing: Central Auditory Processing in Women.

J Am Acad Audiol. 2018 Sep 23;:

Authors: Trott S, Cline T, Weihing J, Beshear D, Bush M, Shinn J

Abstract
BACKGROUND: Estrogen has been identified as playing a key role in many organ systems. Recently, estrogen has been found to be produced in the human brain and is believed contribute to central auditory processing. After menopause, a low estrogen state, many women report hearing loss but demonstrate no deficits in peripheral hearing sensitivity, which support the notion that estrogen plays an effect on central auditory processing. Although animal research on estrogen and hearing loss is extensive, there is little in the literature on the human model.
PURPOSE: The aim of this study was to evaluate relationships between hormonal changes and hearing as it relates to higher auditory function in pre- and postmenopausal (Post-M) females.
RESEARCH DESIGN: A prospective, group comparison study.
STUDY SAMPLE: Twenty eight women between the ages of 18 and 70 at the University of Kentucky were recruited.
DATA COLLECTION AND ANALYSIS: Participants were separated into premenopausal and peri-/Post-M groups. Participants had normal peripheral hearing sensitivity and underwent a behavioral auditory processing battery and electrophysiological evaluation. An analysis of variance was performed to address the aims of the study.
RESULTS: Results from the study demonstrated statistically significant difference between groups, where Post-M females had difficulties in spatial hearing abilities as reflected on the Listening in Spatialized Noise Test-Sentences test. In addition, measures on the auditory brainstem response and the middle latency response reflected statistically significant differences between groups with Post-M females having longer latencies.
CONCLUSIONS: Results from the present study demonstrated significant differences between groups, particularly listening in noise. Females who present with auditory complaints in spite of normal hearing thresholds should have a more extensive audiological evaluation to further evaluate possible central deficits.

PMID: 30461407 [PubMed - as supplied by publisher]

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An Evaluation of Hearing Aid Beamforming Microphone Arrays in a Noisy Laboratory Setting.

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An Evaluation of Hearing Aid Beamforming Microphone Arrays in a Noisy Laboratory Setting.

J Am Acad Audiol. 2018 Jan 02;:

Authors: Picou EM, Ricketts TA

Abstract
BACKGROUND: People with hearing loss experience difficulty understanding speech in noisy environments. Beamforming microphone arrays in hearing aids can improve the signal-to-noise ratio (SNR) and thus also speech recognition and subjective ratings. Unilateral beamformer arrays, also known as directional microphones, accomplish this improvement using two microphones in one hearing aid. Bilateral beamformer arrays, which combine information across four microphones in a bilateral fitting, further improve the SNR. Early bilateral beamformers were static with fixed attenuation patterns. Recently adaptive, bilateral beamformers have been introduced in commercial hearing aids.
PURPOSE: The purpose of this article was to evaluate the potential benefits of adaptive unilateral and bilateral beamformers for improving sentence recognition and subjective ratings in a laboratory setting. A secondary purpose was to identify potential participant factors that explain some of the variability in beamformer benefit.
RESEARCH DESIGN: Participants were fitted with study hearing aids equipped with commercially available adaptive unilateral and bilateral beamformers. Participants completed sentence recognition testing in background noise using three hearing aid settings (omnidirectional, unilateral beamformer, bilateral beamformer) and two noise source configurations (surround, side). After each condition, participants made subjective ratings of their perceived work, desire to control the situation, willingness to give up, and tiredness.
STUDY SAMPLE: Eighteen adults (50-80 yr, M = 66.2, σ = 8.6) with symmetrical mild sloping to severe hearing loss participated.
DATA COLLECTION AND ANALYSIS: Sentence recognition scores and subjective ratings were analyzed separately using generalized linear models with two within-subject factors (hearing aid microphone and noise configuration). Two benefit scores were calculated: (1) unilateral beamformer benefit (relative to performance with omnidirectional) and (2) additional bilateral beamformer benefit (relative to performance with unilateral beamformer). Hierarchical multiple linear regression was used to determine if beamformer benefit was associated with participant factors (age, degree of hearing loss, unaided speech in noise ability, spatial release from masking, and performance in omnidirectional).
RESULTS: Sentence recognition and subjective ratings of work, control, and tiredness were better with both types of beamformers relative to the omnidirectional conditions. In addition, the bilateral beamformer offered small additional improvements relative to the unilateral beamformer in terms of sentence recognition and subjective ratings of tiredness. Speech recognition performance and subjective ratings were generally independent of noise configuration. Performance in the omnidirectional setting and pure-tone average were independently related to unilateral beamformer benefits. Those with the lowest performance or the largest degree of hearing loss benefited the most. No factors were significantly related to additional bilateral beamformer benefit.
CONCLUSIONS: Adaptive bilateral beamformers offer additional advantages over adaptive unilateral beamformers in hearing aids. The small additional advantages with the adaptive beamformer are comparable to those reported in the literature with static beamformers. Although the additional benefits are small, they positively affected subjective ratings of tiredness. These data suggest that adaptive bilateral beamformers have the potential to improve listening in difficult situations for hearing aid users. In addition, patients who struggle the most without beamforming microphones may also benefit the most from the technology.

PMID: 30461406 [PubMed - as supplied by publisher]

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Difference in Speech Recognition between a Default and Programmed Telecoil Program.

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Difference in Speech Recognition between a Default and Programmed Telecoil Program.

J Am Acad Audiol. 2018 Sep 25;:

Authors: Ledda KT, Valente M, Oeding K, Kallogjeri D

Abstract
BACKGROUND: Hearing loss can lead to isolation and social withdrawal. The telephone oftentimes connects persons with hearing loss to society; however, telephone use is impeded by narrow bandwidth, loss of visual cues, electromagnetic interference, and inherent phone-line noise. In the past, research assessing telephone communication has consistently reported that switching from the microphone to a telecoil will typically result in the acoustic signal being discernibly softer. Properly used telecoils improve the signal-to-noise ratio (SNR), decrease the chance for acoustic feedback, and overcome the impact of distance and reverberation creating an opportunity for clearer telephone communication. Little research, however, has examined matching the telecoil frequency response to the prescribed target of the microphone frequency response (National Acoustics Laboratories, Non-Linear, version 1 [NAL-NL1]).
PURPOSE: The primary goal of this study was to determine if differences exist in speech recognition for sentences (AZ-BIO) and consonant-vowel nucleus-consonant monosyllabic words (CNC) between two telecoil conditions (default and programmed). A secondary goal was to determine if differences exist in speech recognition for sentences between male and female talkers.
RESEARCH DESIGN: A single-blinded randomized controlled trial.
STUDY SAMPLE: Twenty experienced adult hearing aid users with bilateral symmetric slight to severe sensorineural hearing loss were recruited from Washington University in St. Louis School of Medicine. In addition, ten normal-hearing participants were recruited to determine the presentation level of the speech stimuli for the hearing aid participants.
DATA COLLECTION AND ANALYSIS: Participants underwent real-ear measures to program the microphone frequency response of a receiver-in-the-canal hearing aid to NAL-NL1. Using the manufacturer software, one telecoil program remained as the manufacturer default and a second telecoil program was programmed so the sound pressure level for an inductive telephone simulator frequency response matching the microphone's frequency response to obtain as close to a 0 dB relative simulated equivalent telephone sensitivity value as possible. Participants then completed speech recognition measures including AZ-BIO sentences (male and female talkers) and CNC monosyllabic words and phonemes, using both telecoil programs. A mixed model analysis was performed to examine if significant differences in speech recognition exist between the two conditions and speech stimuli.
RESULTS: Results revealed significant improvement in overall speech recognition for the programmed telecoil performance compared with default telecoil performance (p < 0.001). Also, improved performance in the programmed telecoil was reported with a male talker (p < 0.001) and performance for sentences compared with monosyllabic words (p < 0.001) or phonemes (p < 0.001).
CONCLUSIONS: The programmed telecoil condition revealed significant improvement in speech recognition for all speech stimuli conditions compared with the default telecoil (sentences, monosyllables, and phonemes). Additional improvement was observed in both telecoil conditions when the talker was male.

PMID: 30461405 [PubMed - as supplied by publisher]

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Hearing Screening in the Community.

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Hearing Screening in the Community.

J Am Acad Audiol. 2018 Jan 25;:

Authors: Saunders GH, Frederick MT, Silverman SC, Penman T, Gardner A, Chisolm TH, Escabi CD, Oree PH, Westermann LC, Sanchez VA, Arnold ML

Abstract
BACKGROUND: Adults typically wait 7-10 yr after noticing hearing problems before seeking help, possibly because they are unaware of the extent of their impairment. Hearing screenings, frequently conducted at health fairs, community events, and retirement centers can increase this awareness. To our knowledge, there are no published studies in which testing conditions and outcomes have been examined for multiple "typical screening events."
PURPOSE: The purpose of this article is to report hearing screening outcomes for pure tones and self-report screening tests and to examine their relationship with ambient noise levels in various screening environments.
STUDY SAMPLE: One thousand nine hundred fifty-four individuals who completed a hearing screening at one of 191 community-based screening events that took place in the Portland, OR, and Tampa, FL, metro areas.
DATA COLLECTION AND ANALYSIS: The data were collected during the recruitment phase of a large multisite study. All participants received a hearing screening that consisted of otoscopy, pure-tone screening, and completion of the Hearing Handicap Inventory-Screening Version (HHI-S). In addition, ambient sound pressure levels were measured just before pure-tone testing.
RESULTS: Many more individuals failed the pure-tone screening (n = 1,238) and then failed the HHI-S (n = 796). The percentage of individuals who failed the pure-tone screening increased linearly with age from <20% for ages <45 yr to almost 100% for individuals aged ≥85 yr. On the other hand, the percentage of individuals who failed the HHI-S remained unchanged at approximately 40% for individuals aged ≥55 yr. Ambient noise levels varied considerably across the hearing screening locations. They impacted the pure-tone screen failure rate but not the HHI-S failure rate.
CONCLUSIONS: It is important to select screening locations with a quiet space for pure-tone screening, use headphones with good passive attenuation, measure sound levels regularly during hearing screening events, halt testing if ambient noise levels are high, and/or alert individuals to the possibility of a false-positive screening failure. The data substantiate prior findings that the relationship between pure-tone sensitivity and reported hearing loss changes with age. Although it might be possible to develop age-specific HHI-S failure criteria to adjust for this, such an endeavor is not recommended because perceived difficulties are the best predictor of hearing health behaviors. Instead, it is proposed that a public health focus on education about hearing and hearing loss would be more effective.

PMID: 30461404 [PubMed - as supplied by publisher]

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Monitoring Hearing in an Infectious Disease Clinic with mHealth Technologies.

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Monitoring Hearing in an Infectious Disease Clinic with mHealth Technologies.

J Am Acad Audiol. 2018 Sep 25;:

Authors: Brittz M, Heinze B, Mahomed-Asmail F, Swanepoel W, Stoltz A

Abstract
BACKGROUND: Decentralized detection and monitoring of hearing loss can be supported by new mobile health technologies using automated testing that can be facilitated by minimally trained persons. These may prove particularly useful in an infectious disease (ID) clinic setting where the risk of hearing loss is high.
PURPOSE: To evaluate the clinical utility of mobile and automated audiometry hearing health technology in an ID clinic setting.
RESEARCH DESIGN: Smartphone-automated pure-tone audiometry (PTA) (hearTest™) and speech-in-noise testing (SA English digits-in-noise [DIN] test) were compared with manual audiometry (2, 4, and 8 kHz). Smartphone-automated PTA and the DIN test were repeated to determine the test-retest reliability.
STUDY SAMPLE: Two hundred subjects (73% female and 27% male) were enrolled. Fifty participants were retested with the smartphone applications. Participants ranged from an age of 18 to 55 years with a mean age of 44.4 (8.7 standard deviation).
DATA ANALYSIS: Threshold comparisons were made between smartphone audiometry testing and manual audiometry. Smartphone-automated PTA, manual audiometry, and test-retest measures were compared (Wilcoxon signed ranked test). Spearman rank correlation test was used to determine the relationship between the smartphone applications and manual audiometry, as well as for test-retest reliability.
RESULTS: Within all participants, 88.2% of thresholds corresponded within 10 dB or less between smartphone audiometry and manual audiometry. There was a significant difference (p < 0.05) between the right ear at 4 and 8 kHz and in the left ear at 2 and 4 kHz between smartphone and manual audiometry, respectively. No significant difference was noted (p < 0.05) between test and retest measures of smartphone technology.
CONCLUSIONS: Smartphone audiometry with calibrated headphones provides reliable results in an ID clinic setting and can be used as a baseline and monitoring tool at ID clinics.

PMID: 30461403 [PubMed - as supplied by publisher]

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Levels of Music Played by Caucasian and Filipino Musicians with and without Conventional and Musicians' Earplugs.

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Levels of Music Played by Caucasian and Filipino Musicians with and without Conventional and Musicians' Earplugs.

J Am Acad Audiol. 2017 Dec 14;:

Authors: Rawool V, Buñag R

Abstract
BACKGROUND: Some musicians may play the music louder while using earplugs thus reducing the effectiveness of the hearing protection offered by earplugs. In addition, the dynamic range (DR) of the music may be altered because of the use of earplugs with negative impact on perceived quality of music. There are some cultural differences in attitudes toward loudness, which may lead to differences in the loudness of music played by musicians from different cultures.
PURPOSE: To investigate the effect of the use of two different types of earplugs on the loudness and DR of music played by musicians of Caucasian and Filipino origins.
RESEARCH DESIGN: Quasi-experimental repeated measures design.
STUDY SAMPLE: Thirty six musicians with normal hearing within the age range of 18-49 yr. Fifteen were of Caucasian (eight men and 7 women) origin and 21 were of the Filipino (nine men and 12 women) origin.
INTERVENTION: All participants received a brief educational session, which included information on music-induced hearing loss, the benefit of using earplugs, and the correct procedures for inserting and removing earplugs. They played music in five different conditions (three min each): Trial 1 of conventional and musicians' earplugs in random order, no earplug, and trial 2 of conventional and musicians' earplugs in random order.
DATA COLLECTION AND ANALYSIS: Maximum, minimum, average (average sound level measured over the measurement period; LAVG), and peak levels were recorded using a dosimeter while playing music in each of the five conditions. The DR was derived by subtracting the minimum values from the maximum values. A different measure of the dynamic range 2 (DR2) was derived by subtracting the LAVG value from the peak value. Mixed analyses of variance (ANOVA) (Cultural origin and Gender as nonrepeated variables) was performed on LAVG, DR, and DR2.
RESULTS: Based on the LAVG levels yielded by them, 42-61% of the musicians may be at risk for hearing loss. The mixed ANOVA revealed some main effects of culture and some significant interactions involving cultural origin, the plug conditions, type of earplugs, and trial number.
CONCLUSIONS: Use of earplugs may vary the overall loudness of music, the DR, or the DR2 in some musicians depending on the type of earplugs and cultural origin, and the effect may change with practice.

PMID: 30461402 [PubMed - as supplied by publisher]

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Verification Protocol for Signal Transparency Using the Cochlear Mini-Microphone 2+ and Digital Modulation Transmitter and Receiver with Cochlear Implants.

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Verification Protocol for Signal Transparency Using the Cochlear Mini-Microphone 2+ and Digital Modulation Transmitter and Receiver with Cochlear Implants.

J Am Acad Audiol. 2018 Jan 30;:

Authors: Sousa R, Nair E, Wannagot S

Abstract
BACKGROUND: Guidelines established by the American Academy of Audiology (AAA) currently recommend behavioral testing when fitting frequency-modulated (FM) systems to individuals with cochlear implants (CIs). A protocol for completing electroacoustic measures on CI sound processors has not yet been established or validated when fitting either FM or digital-modulated (DM) systems, mini microphones, or mini microphones coupled to DM systems. In response, professionals have used or altered the AAA (2008) electroacoustic verification steps for fitting FM systems to hearing aids when fitting FM/DM systems, mini microphones, or mini microphones coupled to FM/DM systems to CI sound processors.
PURPOSE: The purpose of this research is to determine if the electroacoustic verification guidelines established by AAA (2008) for fitting FM systems to hearing aids are feasible and verifiable when fitting mini microphones and mini microphones coupled to DM systems to CI sound processors.
RESEARCH DESIGN: Electroacoustic measures were conducted on 51 Cochlear Nucleus 6/CP910 sound processors, one Cochlear Wireless Mini Microphone 2+ (MM2+), and one Phonak DM System (one Roger Inspiro transmitter and one Roger X receiver) using an adapted AAA (2008) protocol (Nair et al, 2017). Phonak's recommended default receiver gain setting was used with the Roger X receiver and adjusted if necessary to achieve transparency. Transparency refers to when the signal output of the device is the same when coupled and when not coupled to remote microphone technology.
STUDY SAMPLE: Electroacoustic measures were conducted on 51 Cochlear Nucleus 6/CP910 sound processors. In this study, the 51 Cochlear Nucleus 6/CP910 sound processors were either streaming to the Cochlear MM2+ or streaming to the MM2+ coupled to a Phonak DM system.
DATA COLLECTION AND ANALYSIS: In a clinical setting, using the AAA (2008) protocol for electroacoustic measurements when fitting FM systems to hearing aids, electroacoustic measurements using various equipment (MM2+ and Phonak DM system) were performed on 51 Cochlear Nucleus 6/CP910 sound processors using the Audioscan Verifit to determine transparency and verify DM advantage, comparing speech inputs (65 dB SPL) in an effort to achieve equal outputs. If transparency was not achieved when the CI sound processor was streaming to the MM2+ coupled to the Phonak DM system at the default receiver gain, adjustments were made to the Roger X receiver's gain. The integrity of the signal was monitored with the manufacturer's monitor earphones.
RESULTS: Using the AAA (2008) hearing aid protocol, when the Cochlear Nucleus 6/CP910 sound processor was streaming to the Cochlear MM2+, transparency was achieved for 50 of 51 CI sound processors. Again, using the AAA (2008) protocol when the Cochlear Nucleus 6/CP910 sound processor was streaming to the Cochlear MM2+ coupled to the Phonak DM system at Phonak's recommended default receiver gain, 28 sound processors achieved transparency. After the receiver gain was adjusted, the remaining 23 sound processors met transparency.
CONCLUSION: Electroacoustic measurements and transparency can be achieved for CI sound processors coupled to either a MM2+ only or to a MM2+ and a DM system by adapting the AAA (2008) guidelines.

PMID: 30461401 [PubMed - as supplied by publisher]

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The Effect of Test, Electrode, and Rate on Electrocochleography Measures.

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The Effect of Test, Electrode, and Rate on Electrocochleography Measures.

J Am Acad Audiol. 2017 Dec 21;:

Authors: Lake AB, Stuart A

Abstract
BACKGROUND: Electrocochleography (ECochG) is the measurement of stimulus-related cochlear potentials and the compound action potential (AP). Its primary clinical application is with the assessment of inner ear disorders. There are few studies examining the variability of ECochG measures.
PURPOSE: The objective of the study was to examine the effect of test (i.e., initial versus retest), electrode (i.e., extratympanic versus tympanic), and stimulus rate (i.e., 7.7 versus 77.7/sec) on ECochG indices (i.e., summating potential [SP] amplitude, AP latency, AP amplitude, SP/AP amplitude ratio, and SP/AP area ratio).
RESEARCH DESIGN: Correlational and three-factor repeated measures designs were employed.
STUDY SAMPLE: Eighteen normal-hearing young adults participated.
DATA COLLECTION AND ANALYSIS: ECochG responses were obtained with 90 dB nHL click stimuli for an initial test and retest at two stimulus rates with a commercially available extratympanic (TIPtrode™) and tympanic (Lilly TM-Wick) electrode. Separate repeated measures linear mixed-model analysis of variance examined the effect of test, electrode, and rate for all ECochG indices. Test-retest variability was also examined with correlation analyses; an examination of mean test-retest differences and their 95% confidence intervals (CI); and construction of Bland-Altman plots.
RESULTS: The presence of SP and AP responses varied across experimental conditions. Electrode and rate were statistically significant predictors (p < 0.05) of SP and AP responses: SP and AP responses were more likely to be present with the tympanic electrode and at the slow rate. Statistically significant correlations (p < 0.05) were found between initial tests and retests with all ECochG indices with both electrodes with the exception of SP amplitude with the TIPtrode™ electrode. There were no significant main effects of test (initial versus retest) or interactions of test and electrode or rate for any of the ECochG indices (p > 0.05). The 95% CI of the mean test-retest differences contained 0 confirming that the effect of test was not statistically significant. There was a statistically significant main effect of electrode (p < 0.05) on three ECochG measures. The Lilly TM-Wick electrode produced larger SP amplitudes, AP amplitudes, and SP/AP area ratios than TIPtrode™ electrodes. A statistically significant main effect of rate (p < 0.05) was identified for all ECochG measures. The effect of rate on AP latency and amplitude was expected. Increasing the stimulus rate prolonged the AP latency and decreased AP amplitude. SP amplitude was larger for the faster rate.
CONCLUSIONS: There was no difference between electrodes with regard to test-retest measures. However, considering the higher likelihood of ECochG SP and AP responses and larger SP amplitude, SP/AP amplitude ratio, and SP/AP area ratio indices, the tympanic electrode placement is recommended for clinical practice. The addition of a fast stimulus rate may be considered for enhanced SP amplitude, SP/AP amplitude ratio, and SP/AP area ratio albeit with the consideration of the loss of SP and AP responses in some individuals.

PMID: 30461400 [PubMed - as supplied by publisher]

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An Epidemiologic Study of the Association between Free Recall Dichotic Digits Test Performance and Vascular Health.

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An Epidemiologic Study of the Association between Free Recall Dichotic Digits Test Performance and Vascular Health.

J Am Acad Audiol. 2018 Feb 13;:

Authors: Fischer ME, Cruickshanks KJ, Dillard LK, Nondahl DM, Klein BEK, Klein R, Pankow JS, Tweed TS, Schubert CR, Dalton DS, Paulsen AJ

Abstract
BACKGROUND: Associations between vascular health-related factors and hearing loss defined using audiometric pure-tone thresholds have been found. Studies have not focused on a potential relationship between vascular health-related factors and central auditory processing.
PURPOSE: The aim of this study was to evaluate, on a population level, the relationship of vascular health-related factors with central auditory function.
RESEARCH DESIGN: A cross-sectional, population study.
STUDY SAMPLE: Subjects were participants in the Epidemiology of Hearing Loss Study (EHLS) or the Beaver Dam Offspring Study (BOSS)-prospective studies of aging and sensory loss. BOSS participants were the adult offspring of participants in the EHLS. Participants who completed the Dichotic Digits Test (DDT) during the fourth examination period of the EHLS (2008-2010) or the second examination period of the BOSS (2010-2013) were included (n = 3,655, mean age = 61.1 years).
DATA COLLECTION AND ANALYSIS: The DDT-free recall test was conducted using 25 sets of triple-digit pairs at a 70 dB HL presentation level. The total number of correctly repeated digits from the right and left ears was converted to a percentage correct and used as an outcome. The percentage correct in the left ear was subtracted from the percentage correct in the right ear and used as an outcome. Vascular health-related measures obtained during the examination included blood pressure, mean carotid intima-media thickness, femoral pulse wave velocity (PWV), hemoglobin A1C, and non-high-density lipoprotein (HDL) cholesterol, and, in the EHLS participants, C-reactive protein and interleukin-6. Information on vascular health-related history and behaviors was self-reported. General linear modeling produced estimates of the age- and sex-adjusted least squares means for each vascular factor, and multiple linear regression was used for multivariable modeling of each outcome.
RESULTS: After multivariable adjustment, participants with diabetes had a significantly lower (worse) mean DDT-free recall total score (-2.08 percentage points, p < 0.001) than those without diabetes. Participants who exercised at least once per week had a significantly higher (better) mean DDT-free recall total score (+1.07 percentage points, p < 0.01) than those who did not exercise at least once per week. Alcohol consumption was associated with a higher DDT-free recall total score (+0.15 percentage points per +25 g ethanol, p < 0.01). In multivariable modeling of the right-left ear difference in DDT-free recall scores, participants with a history of cardiovascular disease (CVD) or higher PWV demonstrated significantly larger differences (CVD: +3.11 percentage points, p = 0.02; PWV: +0.36 percentage points per 1 m/sec, p < 0.01). Higher levels of non-HDL cholesterol were associated with smaller right-left ear differences (-0.22 percentage points per 10 mg/dL, p = 0.01). Adjustment for handedness did not affect the results.
CONCLUSIONS: Vascular health-related factors may play a role in central auditory function.

PMID: 30461399 [PubMed - as supplied by publisher]

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Psychometric Comparison of the Hearing in Noise Test and the American English Matrix Test.

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Psychometric Comparison of the Hearing in Noise Test and the American English Matrix Test.

J Am Acad Audiol. 2018 Sep 25;:

Authors: Harianawala J, Galster J, Hornsby B

Abstract
BACKGROUND: The hearing in noise test (HINT) is the most popular adaptive test used to evaluate speech in noise performance, especially in context of hearing aid features. However, the number of conditions that can be tested on the HINT is limited by a small speech corpus. The American English Matrix test (AEMT) is a new alternative adaptive speech in noise test with a larger speech corpus. The study examined the relationships between the performance of hearing aid wearers on the HINT and the AEMT.
PURPOSE: To examine whether there was a difference in performance of hearing aid wearers on the HINT and the AEMT. A secondary purpose, given the AEMT's steep performance-intensity function, was to determine whether the AEMT is more sensitive to changes in speech recognition resulting from directional (DIR) microphone processing in hearing aids.
RESEARCH DESIGN: A repeated measures design was used in this study. Multiple measurements were made on each subject. Each measurement involved a different experimental condition.
STUDY SAMPLE: Ten adults with hearing loss participated in this study.
DATA COLLECTION AND ANALYSIS: All participants completed the AEMT and HINT, using adaptive and fixed test formats while wearing hearing aids. Speech recognition was assessed in two hearing aid microphone settings-omnidirectional and fixed DIR. All testing was conducted via sound field presentation. Performance on HINT and AEMT were systematically compared across all test conditions using a linear model with repeated measures.
RESULTS: The results of this study revealed that adult hearing aid users perform differently on the HINT and AEMT, with adaptive AEMT testing yielding significantly better (more negative) thresholds than the HINT. Slopes of performance intensity functions obtained by testing at multiple fixed signal-to-noise ratios, revealed a somewhat steeper slope for the HINT compared with the AEMT. Despite this steeper slope, the benefit provided by DIR microphones was not significantly different between the two speech tests.
CONCLUSIONS: The observation of similar DIR benefits of the HINT and AEMT suggests that the HINT and AEMT are equally sensitive to changes in speech recognition thresholds following intervention. Therefore, the decision to use the AEMT or the HINT will depend on the purpose of the study and/or the technology being investigated. Other test related factors such as available sentence corpus, learning effects and test time will also influence test selection.

PMID: 30461418 [PubMed - as supplied by publisher]

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A Client Oriented Scale of Improvement in Tinnitus for Therapy Goal Planning and Assessing Outcomes.

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A Client Oriented Scale of Improvement in Tinnitus for Therapy Goal Planning and Assessing Outcomes.

J Am Acad Audiol. 2018 Feb 15;:

Authors: Searchfield GD

Abstract
BACKGROUND: There is a need to develop methods to help clinicians work with clients to select and personalize tinnitus therapies. The use of validated measures to determine treatment success is also essential for research and clinical practice. A goal planning method widely used in audiologic rehabilitation is the client oriented scale of improvement (COSI). A modified version of the COSI has been used to identify tinnitus treatment goals and outcomes (client oriented scale of improvement in tinnitus [COSIT]).
PURPOSE: The aims of this study were to identify treatment goals in a clinic sample and ascertain the convergent validity of the COSIT to three widely used standardized questionnaires.
RESEARCH DESIGN: A retrospective evaluation of client treatment goals using thematic analysis and correlational analysis of secondary research data comparing the COSIT to tinnitus handicap questionnaire (THQ), tinnitus handicap inventory (THI), and tinnitus functional index (TFI).
STUDY SAMPLE: One hundred and twenty-two adult patients and research participants attending the University of Auckland Hearing and Tinnitus Clinic.
RESULTS: Specific treatment goals were categorized into 11 themes. The most common treatment goals (>10% of responses) were: (1) Reducing tinnitus' effects on Hearing. (2) Improved wellbeing and being less depressed. (3) Coping with or controlling the tinnitus. (4) Managing the effect of the environment (context) on tinnitus. (5) Improving sleep. (6) Understanding tinnitus. Individuals differed in their complaints and priorities for treatment. The COSIT showed moderate convergent validity with the THQ, THI, and TFI indicating that the total scores measured similar constructs.
CONCLUSIONS: The COSIT is a pragmatic method for determining tinnitus treatment goals and priorities in a format that should be familiar to audiologists.

PMID: 30461417 [PubMed - as supplied by publisher]

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Extended High-Frequency Smartphone Audiometry: Validity and Reliability.

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Extended High-Frequency Smartphone Audiometry: Validity and Reliability.

J Am Acad Audiol. 2018 Jan 18;:

Authors: Bornman M, Swanepoel W, De Jager LB, Eikelboom RH

Abstract
BACKGROUND: Extended high-frequency (EHF) audiometry (8-16 kHz) has an important role in audiological assessments such as ototoxicity monitoring, and for speech recognition and localization. Accurate and reliable EHF testing with smartphone technologies has the potential to provide more affordable and accessible hearing-care services, especially in underserved contexts.
PURPOSE: To determine the accuracy and test-retest reliability of EHF audiometry with a smartphone application, using calibrated headphones.
RESEARCH DESIGN: Air-conduction thresholds (8-16 kHz) and test-retest reproducibility, recorded with conventional audiometry (CA) and smartphone audiometry (SA), using audiometric (Sennheiser HDA 300 circumaural) and nonstandard audiometric (Sennheiser HD202 II supra-aural) headphones, were compared in a repeated-measures design.
STUDY SAMPLE: A total of 61 participants (122 ears) were included in the study. Of these, 24 were adults attending a tuberculosis clinic (mean age = 36.8, standard deviation [SD] = 14.2 yr; 48% female) and 37 were adolescents and young adults recruited from a prospective students program (mean age = 17.6, SD = 3.2 yr; 76% female). Of these, 22.3% (n = 326) of EHF thresholds were ≥25 dB HL.
DATA ANALYSIS: Threshold comparisons were made between CA and SA, with audiometric headphones and nonstandard audiometric headphones. A paired samples t-test was used for comparison of threshold correspondence between conventional and smartphone thresholds, and test-retest reproducibility of smartphone thresholds.
RESULTS: Conventional thresholds corresponded with smartphone thresholds at the lowest intensity (10 dB HL), using audiometric and nonstandard audiometric headphones in 59.4% and 57.6% of cases, respectively. Conventional thresholds (exceeding 10 dB HL) corresponded within 10 dB or less, with smartphone thresholds in 82.9% of cases using audiometric headphones and 84.1% of cases using nonstandard audiometric headphones. There was no significant difference between CA and SA, using audiometric headphones across all frequencies (p > 0.05). Test-retest comparison also showed no significant differences between conditions (p > 0.05). Smartphone test-retest thresholds corresponded within 10 dB or less in 86.7% and 93.4% of cases using audiometric and nonstandard audiometric headphones, respectively.
CONCLUSIONS: EHF smartphone testing with calibrated headphones can provide an accurate and reliable option for affordable mobile audiometry. The validity of EHF smartphone testing outside a sound booth as a cost-effective and readily available option to detect high-frequency hearing loss in community-based settings should be established.

PMID: 30461416 [PubMed - as supplied by publisher]

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Early Indices of Reduced Cochlear Function in Young Adults with Type-1 Diabetes Revealed by DPOAE Fine Structure.

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Early Indices of Reduced Cochlear Function in Young Adults with Type-1 Diabetes Revealed by DPOAE Fine Structure.

J Am Acad Audiol. 2018 Sep 25;:

Authors: Spankovich C, Long GR, Hood LJ

Abstract
BACKGROUND: The relationship between type-1 diabetes mellitus (DM) and cochlear dysfunction remains inconclusive.
PURPOSE: The purpose of this study was to examine otoacoustic emissions (OAEs) in normal-hearing young adults with type-1 DM as compared with matched controls and identify potential covariates influencing OAE findings.
RESEARCH DESIGN: Cross-sectional study.
STUDY SAMPLE: N = 40 young adults aged 18-28 years including individuals with type-1 DM (n = 20) and age-gender matched controls (n = 20) with normal hearing sensitivity.
DATA COLLECTION AND ANALYSIS: Measures of pure-tone threshold sensitivity and OAEs, including distortion product otoacoustic emissions (DPOAEs), transient evoked OAEs, and DPOAE fine structure, were compared between groups. Covariates such as noise exposure and DM-related factors (e.g., duration of disease, glycated hemoglobin levels) were considered. Statistical analysis included analysis of variance and linear regression.
RESULTS: Measures of hearing sensitivity and auditory function in both groups were comparable for all assays, except DPOAE fine structure. A reduced number of fine structure peaks and component amplitudes were found in the type-1 diabetes DM group with the primary difference in the reflection component.
CONCLUSIONS: The results indicate that reduced cochlear function in young adults with type-1 DM can be revealed using DPOAE fine structure, suggesting potential clinical applications of DPOAE fine structure in early identification of cochlear pathology. Potential factors underlying these findings are discussed.

PMID: 30461415 [PubMed - as supplied by publisher]

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Negative Side Effects Associated with Hearing Aid Use in Adults with Hearing Loss.

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Negative Side Effects Associated with Hearing Aid Use in Adults with Hearing Loss.

J Am Acad Audiol. 2018 Sep 25;:

Authors: Manchaiah V, Abrams H, Bailey A, Andersson G

Abstract
BACKGROUND: The low uptake of hearing aids in the United States has been attributed to a number of reasons, including low perceived hearing disability, limited perceived benefit and cost. Another possible reason may be related to negative side effects associated with hearing aid use.
PURPOSE: The present study was aimed at determining and classifying the negative side effects associated with hearing aid use in adults with hearing loss.
RESEARCH DESIGN: The study used a cross-sectional survey design.
STUDY SAMPLE: Five hundred and twelve participants completed an electronic survey.
DATA COLLECTION AND ANALYSIS: The data was collected using the negative side effects of hearing aids (NSE-HAs) questionnaire. Data were analyzed using Chi square analysis, principal components analysis, and calculation of Cronbach's alpha.
RESULTS: Some individuals reported negative side effects for all 32 items. However, careful examination of results suggests that, as a whole, reported negative side effects tend to be mild with mean scores falling close to the lower quartile of the total scores. Chi square test results suggest that the variables of age, gender, duration of hearing loss, self-reported hearing disability, and duration of hearing aid use seem to be significantly associated with the reported negative side effects. The NSE-HAs questionnaire was found to have a complex structure as indicated by the principal components analysis. However, good internal consistency was found in both the full scale and subscales.
CONCLUSIONS: The present study suggests that, although a large number of adults with hearing loss who use hearing aids experience some degree of negative side effects, those effects tend to be mild.

PMID: 30461414 [PubMed - as supplied by publisher]

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Contralateral Routing of Signal Yields Significant Speech in Noise Benefit for Unilateral Cochlear Implant Recipients.

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Contralateral Routing of Signal Yields Significant Speech in Noise Benefit for Unilateral Cochlear Implant Recipients.

J Am Acad Audiol. 2018 Jan 30;:

Authors: Dwyer RT, Kessler D, Butera IM, Gifford RH

Abstract
BACKGROUND: Bilateral cochlear implantation is the standard of care for individuals with moderate sloping-to-profound sensorineural hearing loss who do not receive benefit from appropriately fit hearing aids. Because of financial, insurance, or medical reasons, some unilateral cochlear implant (CI) recipients are unable to obtain a second CI. Here, we evaluated the first clinically available solution for individuals who have been unilaterally implanted and who do not or cannot use technology (e.g., hearing aid or CI) on the non-implanted ear.
PURPOSE: We aimed to investigate how the addition of a contralateral routing of signal (CROS) device could provide objective and/or subjective benefit to adult CI recipients with moderate-to-profound hearing loss in the non-implanted ear.
RESEARCH DESIGN: Single-center prospective study using a within-subjects repeated-measures design.
STUDY SAMPLE: Participants included ten experienced unilateral CI recipients with severe-to-profound (n = 9) or moderate-to-profound (n = 1) sensorineural hearing loss in the non-implanted ear. At the time of study enrollment, participants did not use any technology on the non-implanted ear. No other exclusion criteria were used.
INTERVENTION: Individuals were tested with and without a CROS device worn on the non-implanted ear.
DATA COLLECTION AND ANALYSIS: We obtained measures of speech understanding in quiet (50 and 65 dBA) and in noise (+5-dB signal-to-noise ratio with a 65-dBA speech signal) both with and without the CROS device in an acute listening condition. Subjective benefit was assessed via the Speech, Spatial and Qualities 12-item questionnaire before CROS fitting and after two weeks of continuous use. A mixed-model, repeated-measures analysis of variance was completed with three talker locations and three presentation levels included as within-subjects factors and the presence or absence of a CROS device as a between-subjects factor.
RESULTS: There was an 11% improvement in speech understanding in noise with the addition of the CROS device when speech was located at 0° azimuth. Subjective benefit in the speech domain of the SSQ was also observed.
CONCLUSIONS: Use of CROS provided both subjective and objective speech recognition benefit for unilateral CI recipients who do not have access to bilateral cochlear implantation.

PMID: 30461413 [PubMed - as supplied by publisher]

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