Hearing Aid Use Reduces Hospital and ER Visits in Older Adults

Hearing aid use among older adults is associated with fewer hospitalizations and emergency visits and fewer nights at the hospital, study finds.

Examining the data of 1,336 adults aged 65 to 85 years with severe hearing loss, researchers from University of Michigan found out that the 602 adults (42% of the study participants) who used hearing aids had fewer adverse health events than those who do not use hearing aids.  The study reported that while the difference of the incidence of hospitalization or emergency room visit was only approximately two percentage points, it was large enough to be significant. Also, the research found out that those with hearing aids had shorter stays in the hospital.

The data used came from a self-reported survey by the U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. The researchers had no objective measurement of how severe the participant's hearing loss, the number of hearing aids they use and the how consistently the hearing aids were used. "This was a cross-sectional study and had many limitations, yet I am still very confident about the findings," lead author Dr. Elham Mahmoudi, PhD, MBA. said. "We are involved in a longitudinal analysis of the effect of hearing aids among individuals with severe hearing loss and conducting a cost-effectiveness analysis of hearing aids."

Results of the study included cost implications. The use of hearing aid correlated with reduced Medicare expense, and higher annual health care spending and out-of-pocket spending.

"Hearing aids are not covered by Medicare. If they are covered by insurance, the out-of-pocket costs are relatively high. These financial barriers prevent many individuals from having access to proper hearing aids. Severe hearing loss affects a growing number of individuals, but it is an addressable disability issue. We are hoping that our findings encourage insurers—particularly Medicare—to cover hearing aids and the related care," Mahmoudi explained.

When asked about what inspired the study, Mahnmoudi told The Hearing Journal that it was personal. "My dad is 82 years old and has been suffering from severe hearing loss for many years. Hearing aids are expensive and are not covered by health insurance. If not fitted well by a specialist, they can be noisy and annoying. Consequently, my dad resisted using hearing aids despite his apparent need. As a result, I personally witnessed his hearing difficulty result in social isolation and fewer meaningful conversation with friends and family members. In February 2017, I started working in the Department of Family Medicine. I was amazed that the Chair of our Department, Dr. Phillip Zazove, and another faculty member, Dr. Michael McKee (both co-authors in this manuscript), are deaf yet, with the use of hearing devices, are excellent physicians and researchers. My motivation to complete this study was inspired by them."

Mahmoudi and colleagues are already examining five-year insurance data and patient data from the University of Michigan's academic medical center to further study the issue to see if hearing aids might be, in the longer run, more cost-effective.

Published: 4/27/2018 3:21:00 PM

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Effects of Cerebral Blood Flow and Vessel Conditions on Speech Recognition in Patients With Postlingual Adult Cochlear Implant: Predictable Factors for the Efficacy of Cochlear Implant

Objectives: Cochlear implantation (CI) has been the most successful procedure for restoring hearing in a patient with severe and profound hearing loss. However, possibly owing to the variable brain functions of each patient, its performance and the associated patient satisfaction are widely variable. The authors hypothesize that peripheral and cerebral circulation can be assessed by noninvasive and globally available methods, yielding superior presurgical predictive factors of the performance of CI in adult patients with postlingual hearing loss who are scheduled to undergo CI. Design: Twenty-two adult patients with cochlear implants for postlingual hearing loss were evaluated using Doppler sonography measurement of the cervical arteries (reflecting cerebral blood flow), flow-mediated dilation (FMD; reflecting the condition of cerebral arteries), and their pre-/post-CI best score on a monosyllabic discrimination test (pre-/post-CI best monosyllabic discrimination [BMD] score). Correlations between post-CI BMD score and the other factors were examined using univariate analysis and stepwise multiple linear regression analysis. The prediction factors were calculated by examining the receiver-operating characteristic curve between post-CI BMD score and the significantly positively correlated factors. Results: Age and duration of deafness had a moderately negative correlation. The mean velocity of the internal carotid arteries and FMD had a moderate-to-strong positive correlation with the post-CI BMD score in univariate analysis. Stepwise multiple linear regression analysis revealed that only FMD was significantly positively correlated with post-CI BMD score. Analysis of the receiver-operating characteristic curve showed that a FMD cutoff score of 1.8 significantly predicted post-CI BMD score. Conclusions: These data suggest that FMD is a convenient, noninvasive, and widely available tool for predicting the efficacy of cochlear implants. An FMD cutoff score of 1.8 could be a good index for determining whether patients will hear well with cochlear implants. It could also be used to predict whether cochlear implants will provide good speech recognition benefits to candidates, even if their speech discrimination is poor. This FMD index could become a useful predictive tool for candidates with poor speech discrimination to determine the efficacy of CI before surgery.

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Use of Electrically Evoked Compound Action Potentials for Cochlear Implant Fitting: A Systematic Review

Objectives: The electrically evoked compound action potential (eCAP) is widely used in the clinic as an objective measure to assess cochlear implant functionality. During the past decade, there has been increasing interest in applying eCAPs for fitting of cochlear implants. Several studies have shown that eCAP-based fitting can potentially replace time-consuming behavioral fitting procedures, especially in young children. However, a closer look to all available literature revealed that there is no clear consensus on the validity of this fitting procedure. This study evaluated the validity of eCAP-based fitting of cochlear implant recipients based on a systematic review of the recent literature. Design: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to search the PubMed, Web of Science, and Cochrane Library databases. The term “eCAP” was combined with “cochlear implants,” “thresholds,” and “levels,” in addition to a range of related terms. Finally, 32 studies met the inclusion criteria. These studies were evaluated on the risk of bias and, when possible, compared by meta-analysis. Results: Almost all assessed studies suffered from some form of risk of bias. Twenty-nine of the studies based their conclusion on a group correlation instead of individual subject correlations (analytical bias); 14 studies were unclear about randomization or blinding (outcome assessment bias); 9 studies provided no clear description of the populations used, for example, prelingually or postlingually implanted subjects (selection bias); and 4 studies had a high rate of loss (>10%) for patients or electrodes (attrition bias). Meta-analysis of these studies revealed a weak pooled correlation between eCAP thresholds and both behavioral T- and C-levels (r = 0.58 and r = 0.61, respectively). Conclusions: This review shows that the majority of the assessed studies suffered from substantial shortcomings in study design and statistical analysis. Meta-analysis showed that there is only weak evidence to support the use of eCAP data for cochlear implant fitting purposes; eCAP thresholds are an equally weak predictor for both T- and C-levels. Based on this review, it can be concluded that research on eCAP-based fitting needs a profound reflection on study design and analysis to draw well-grounded conclusions about the validity of eCAP-based fitting of cochlear implant recipients.

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Combined Amplification and Sound Generation for Tinnitus: A Scoping Review

Objectives: In most cases, tinnitus is accompanied by some degree of hearing loss. Current tinnitus management guidelines recognize the importance of addressing hearing difficulties, with hearing aids being a common option. Sound therapy is the preferred mode of audiological tinnitus management in many countries, including in the United Kingdom. Combination instruments provide a further option for those with an aidable hearing loss, as they combine amplification with a sound generation option. The aims of this scoping review were to catalog the existing body of evidence on combined amplification and sound generation for tinnitus and consider opportunities for further research or evidence synthesis. Design: A scoping review is a rigorous way to identify and review an established body of knowledge in the field for suggestive but not definitive findings and gaps in current knowledge. A wide variety of databases were used to ensure that all relevant records within the scope of this review were captured, including gray literature, conference proceedings, dissertations and theses, and peer-reviewed articles. Data were gathered using scoping review methodology and consisted of the following steps: (1) identifying potentially relevant records; (2) selecting relevant records; (3) extracting data; and (4) collating, summarizing, and reporting results. Results: Searches using 20 different databases covered peer-reviewed and gray literature and returned 5959 records. After exclusion of duplicates and works that were out of scope, 89 records remained for further analysis. A large number of records identified varied considerably in methodology, applied management programs, and type of devices. There were significant differences in practice between different countries and clinics regarding candidature and fitting of combination aids, partly driven by the application of different management programs. Conclusions: Further studies on the use and effects of combined amplification and sound generation for tinnitus are indicated, including further efficacy studies, evidence synthesis, development of guidelines, and recommended procedures that are based on existing knowledge, expert knowledge, and clinical service evaluations.

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Relations Between Self-Reported Daily-Life Fatigue, Hearing Status, and Pupil Dilation During a Speech Perception in Noise Task

Objective: People with hearing impairment are likely to experience higher levels of fatigue because of effortful listening in daily communication. This hearing-related fatigue might not only constrain their work performance but also result in withdrawal from major social roles. Therefore, it is important to understand the relationships between fatigue, listening effort, and hearing impairment by examining the evidence from both subjective and objective measurements. The aim of the present study was to investigate these relationships by assessing subjectively measured daily-life fatigue (self-report questionnaires) and objectively measured listening effort (pupillometry) in both normally hearing and hearing-impaired participants. Design: Twenty-seven normally hearing and 19 age-matched participants with hearing impairment were included in this study. Two self-report fatigue questionnaires Need For Recovery and Checklist Individual Strength were given to the participants before the test session to evaluate the subjectively measured daily fatigue. Participants were asked to perform a speech reception threshold test with single-talker masker targeting a 50% correct response criterion. The pupil diameter was recorded during the speech processing, and we used peak pupil dilation (PPD) as the main outcome measure of the pupillometry. Results: No correlation was found between subjectively measured fatigue and hearing acuity, nor was a group difference found between the normally hearing and the hearing-impaired participants on the fatigue scores. A significant negative correlation was found between self-reported fatigue and PPD. A similar correlation was also found between Speech Intelligibility Index required for 50% correct and PPD. Multiple regression analysis showed that factors representing “hearing acuity” and “self-reported fatigue” had equal and independent associations with the PPD during the speech in noise test. Less fatigue and better hearing acuity were associated with a larger pupil dilation. Conclusions: To the best of our knowledge, this is the first study to investigate the relationship between a subjective measure of daily-life fatigue and an objective measure of pupil dilation, as an indicator of listening effort. These findings help to provide an empirical link between pupil responses, as observed in the laboratory, and daily-life fatigue.

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Audiologist-Guided Internet-Based Cognitive Behavior Therapy for Adults With Tinnitus in the United Kingdom: A Randomized Controlled Trial

Objectives: Specialist tinnitus services are in high demand as a result of the negative effect tinnitus may have on quality of life. Additional clinically and cost-effective tinnitus management routes are needed. One potential route is providing Cognitive Behavioural Therapy for tinnitus via the Internet (iCBT). This study aimed to determine the efficacy of guided iCBT, using audiological support, on tinnitus distress and tinnitus-related comorbidities, in the United Kingdom. A further aim was to establish the stability of intervention effects 2-months postintervention. The hypothesis was that iCBT for tinnitus would be more effective at reducing tinnitus distress than weekly monitoring. Design: A randomized, delayed intervention efficacy trial, with a 2-month follow-up was implemented to evaluate the efficacy of iCBT in the United Kingdom. Participants were randomly assigned to the experimental (n = 73) or weekly monitoring control group (n = 73) after being stratified for tinnitus severity and age. After the experimental group completed the 8-week long iCBT intervention, the control group undertook the same intervention. Intervention effects were, therefore, evaluated in two independent groups at two time points. The primary outcome was a change in tinnitus distress between the groups as assessed by the Tinnitus Functional Index. Secondary assessment measures were included for insomnia, anxiety, depression, hearing disability, hyperacusis, cognitive failures, and satisfaction with life. These were completed at baseline, postintervention, and at a 2-month postintervention follow-up. Results: After undertaking the iCBT intervention, the experimental group had a greater reduction in tinnitus distress when compared with the control group. This reduction was statistically significant (Cohen’s d = 0.7) and was clinically significant for 51% of the experimental group and 5% of the control group. This reduction was evident 4 weeks after commencing the iCBT intervention. Furthermore, the experimental group had a greater reduction in insomnia, depression, hyperacusis, cognitive failures, and a greater improvement in quality of life, as evidenced by the significant differences in these assessment measures postintervention. Results were maintained 2 months postintervention. Conclusions: Guided (using audiological support) iCBT for tinnitus resulted in statistically significant reductions in tinnitus distress and comorbidities (insomnia, depression, hyperacusis, cognitive failures) and a significant increase in quality of life. These effects remained stable at 2-months postintervention. Further trials to determine the longer term efficacy of iCBT to investigate predictors of outcome and to compare iCBT with standard clinical care in the United Kingdom are required. Registered at clinicaltrials.gov: NCT02370810 on 5/03/2015.

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Prevalence of and Risk Factors for Tinnitus and Tinnitus-Related Handicap in a College-Aged Population

Objective: Tinnitus is a common otological condition that affects almost 10% of US adults. Research suggests that college students are vulnerable to tinnitus and hearing loss as they are exposed to traumatic levels of noise on a regular basis. Tinnitus and its influence in daily living continue to be underappreciated in the college-aged population. Therefore, the objective for the present study was to analyze prevalence and associated risk factors of tinnitus and tinnitus-related handicap in a sample of college-aged students. Design: A survey was administered to 678 students aged 18–30 years in a cross-section of randomly selected university classes. The survey was adopted from the National Health and Nutrition Examination Survey (2010). It inquired about demographic details, medical and audiological history, routine noise exposure, smoking, sound level tolerance, tinnitus, and tinnitus-related handicap in daily living. Tinnitus-related handicap was assessed by the Tinnitus Handicap Inventory (THI). Participants were divided into four groups: chronic tinnitus (bothersome tinnitus for >1 year), acute tinnitus (bothersome tinnitus for ≤1 year), subacute tinnitus (at least one experience of tinnitus in a lifetime), and no tinnitus (no experience of tinnitus in a lifetime). Results: The prevalence of chronic, acute, subacute, and no tinnitus was 8.4%, 13.0%, 37.9%, and 40.7% respectively. Almost 9% of subjects with any form of tinnitus reported more than a slight tinnitus-related handicap (i.e., THI score ≥18). A multinomial regression analysis revealed that individuals with high noise exposure, high sound level tolerance score, recurring ear infections, and self-reported hearing loss had high odds of chronic tinnitus. Females showed higher prevalence of acute tinnitus than males. Individuals with European American ethnicity and smoking history showed high odds of reporting subacute tinnitus. Almost 10% of the subjects reported that they were music students. The prevalence of chronic, acute, and subacute tinnitus was 11.3%, 22.5%, and 32.4%, respectively, for musicians, which was significantly higher than that for nonmusicians. Music exposure, firearm noise exposure, and occupational noise exposure were significantly correlated with tinnitus. Temporal characteristics of tinnitus, self-reported tinnitus loudness, and sound level tolerance were identified as major predictors for the overall THI score. Conclusions: Despite the reluctance to complain about tinnitus, a substantial portion of college-aged individuals reported tinnitus experience and its adverse influence in daily living. It was concluded that environmental and health-related factors can trigger tinnitus perception, while self-reported psychoacoustic descriptors of tinnitus may explain perceived tinnitus-related handicap in daily living by college-aged individuals. Future research is required to explore effects of tinnitus on educational achievements, social interaction, and vocational aspects of college students.

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Beyond the Audiogram: Application of Models of Auditory Fitness for Duty to Assess Communication in the Real World

This manuscript provides a Commentary on a paper published in the current issue of Ear and Hearing and the companion paper published in the International Journal of Audiology (Soli et al. 2018a, 2018b). These papers report background, rationale, and results of a novel modeling approach to assess “auditory fitness for duty” or an individual’s ability to perform hearing-critical tasks related to their job, based on their likelihood of effective speech communication in the listening environment in which the task is performed.

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ABO Blood Group and Cochlear Status: Otoacoustic Emission Markers

Objectives: There are an increasing number of research studies examining the effects of ABO blood group on susceptibility to disease. However, little is known regarding the potential relationship between blood group and hearing. Higher risk of noise-induced hearing loss was linked to blood group O in several occupational health studies. Based on this finding, a recent study of cochlear status was conducted with normal-hearing female participants representing equal numbers of the four blood groups in the ABO blood group system. ABO blood group was associated with cochlear characteristics, including the prevalence of spontaneous otoacoustic emissions (SOAEs) and the amplitudes of transient-evoked otoacoustic emissions (TEOAEs) and distortion-product otoacoustic emissions (DPOAEs). Females with blood group O showed significantly lower amplitudes of DPOAEs at some frequencies and lower prevalence of SOAEs compared with participants with blood group B. There was a general trend of reduced TEOAE and DPOAE amplitudes in blood group O individuals compared with participants with non-O blood groups. Following from this finding, and based on known sex differences in otoacoustic emission characteristics, the present study examined the possible effects of blood group on otoacoustic emission status in males. Design: Sixty clinically normal-hearing males aged between 18 and 26 years, with equal numbers of participants in each of the ABO blood groups, were recruited by purposive sampling. SOAE, DPOAE, and linear and nonlinear TEOAE recordings were collected from all participants, as well as tympanometric data related to external and middle ear characteristics. Results: The male blood group O participants exhibited significantly lower SOAE prevalence and reduced amplitudes of DPOAEs on average, and in the midfrequency range, than participants with blood group B, and lower nonlinear and linear TEOAE amplitudes at a number of frequencies when compared with participants with blood groups A and B. A consistent trend of lower TEOAE and DPOAE response amplitudes was observed in participants with blood group O. No significant difference was noted among blood groups for outer or middle ear characteristics. Conclusions: These results were consistent with previous findings of reduced otoacoustic emission responses in female blood group O individuals. Results support the hypothesis that blood group O individuals may be at increased risk of cochlear damage from noise exposure. Further investigation on the potential link between ABO blood group and auditory status, including potentially differential effects of noise exposure on cochlear function, is needed. The possible effects of ABO blood group on other aspects of audition, such as hearing sensitivity, speech understanding, and auditory processing, should be evaluated.

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Evidence-Based Occupational Hearing Screening I: Modeling the Effects of Real-World Noise Environments on the Likelihood of Effective Speech Communication

Objectives: The objectives of this study were to (1) identify essential hearing-critical job tasks for public safety and law enforcement personnel; (2) determine the locations and real-world noise environments where these tasks are performed; (3) characterize each noise environment in terms of its impact on the likelihood of effective speech communication, considering the effects of different levels of vocal effort, communication distances, and repetition; and (4) use this characterization to define an objective normative reference for evaluating the ability of individuals to perform essential hearing-critical job tasks in noisy real-world environments. Design: Data from five occupational hearing studies performed over a 17-year period for various public safety agencies were analyzed. In each study, job task analyses by job content experts identified essential hearing-critical tasks and the real-world noise environments where these tasks are performed. These environments were visited, and calibrated recordings of each noise environment were made. The extended speech intelligibility index (ESII) was calculated for each 4-sec interval in each recording. These data, together with the estimated ESII value required for effective speech communication by individuals with normal hearing, allowed the likelihood of effective speech communication in each noise environment for different levels of vocal effort and communication distances to be determined. These likelihoods provide an objective norm-referenced and standardized means of characterizing the predicted impact of real-world noise on the ability to perform essential hearing-critical tasks. Results: A total of 16 noise environments for law enforcement personnel and eight noise environments for corrections personnel were analyzed. Effective speech communication was essential to hearing-critical tasks performed in these environments. Average noise levels, ranged from approximately 70 to 87 dBA in law enforcement environments and 64 to 80 dBA in corrections environments. The likelihood of effective speech communication at communication distances of 0.5 and 1 m was often less than 0.50 for normal vocal effort. Likelihood values often increased to 0.80 or more when raised or loud vocal effort was used. Effective speech communication at and beyond 5 m was often unlikely, regardless of vocal effort. Conclusions: ESII modeling of nonstationary real-world noise environments may prove an objective means of characterizing their impact on the likelihood of effective speech communication. The normative reference provided by these measures predicts the extent to which hearing impairments that increase the ESII value required for effective speech communication also decrease the likelihood of effective speech communication. These predictions may provide an objective evidence-based link between the essential hearing-critical job task requirements of public safety and law enforcement personnel and ESII-based hearing assessment of individuals who seek to perform these jobs.

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Cortical Correlates of Binaural Temporal Processing Deficits in Older Adults

Objectives: This study was designed to evaluate binaural temporal processing in young and older adults using a binaural masking level difference (BMLD) paradigm. Using behavioral and electrophysiological measures within the same listeners, a series of stimulus manipulations was used to evaluate the relative contribution of binaural temporal fine-structure and temporal envelope cues. We evaluated the hypotheses that age-related declines in the BMLD task would be more strongly associated with temporal fine-structure than envelope cues and that age-related declines in behavioral measures would be correlated with cortical auditory evoked potential (CAEP) measures. Design: Thirty adults participated in the study, including 10 young normal-hearing, 10 older normal-hearing, and 10 older hearing-impaired adults with bilaterally symmetric, mild-to-moderate sensorineural hearing loss. Behavioral and CAEP thresholds were measured for diotic (So) and dichotic (Sπ) tonal signals presented in continuous diotic (No) narrowband noise (50-Hz wide) maskers. Temporal envelope cues were manipulated by using two different narrowband maskers; Gaussian noise (GN) with robust envelope fluctuations and low-noise noise (LNN) with minimal envelope fluctuations. The potential to use temporal fine-structure cues was controlled by varying the signal frequency (500 or 4000 Hz), thereby relying on the natural decline in phase-locking with increasing frequency. Results: Behavioral and CAEP thresholds were similar across groups for diotic conditions, while the masking release in dichotic conditions was larger for younger than for older participants. Across all participants, BMLDs were larger for GN than LNN and for 500-Hz than for 4000-Hz conditions, where envelope and fine-structure cues were most salient, respectively. Specific age-related differences were demonstrated for 500-Hz dichotic conditions in GN and LNN, reflecting reduced binaural temporal fine-structure coding. No significant age effects were observed for 4000-Hz dichotic conditions, consistent with similar use of binaural temporal envelope cues across age in these conditions. For all groups, thresholds and derived BMLD values obtained using the behavioral and CAEP methods were strongly correlated, supporting the notion that CAEP measures may be useful as an objective index of age-related changes in binaural temporal processing. Conclusions: These results demonstrate an age-related decline in the processing of binaural temporal fine-structure cues with preserved temporal envelope coding that was similar with and without mild-to-moderate peripheral hearing loss. Such age-related changes can be reliably indexed by both behavioral and CAEP measures in young and older adults.

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Development of a Test Battery for Evaluating Speech Perception in Complex Listening Environments: Effects of Sensorineural Hearing Loss

Objective: To evaluate the speech-in-noise performance of listeners with different levels of hearing loss in a variety of complex listening environments. Design: The quick speech-in-noise (QuickSIN)-based test battery was used to measure the speech recognition performance of listeners with different levels of hearing loss. Subjective estimates of speech reception thresholds (SRTs) corresponding to 100% and 0% speech intelligibility, respectively, were obtained using a method of adjustment before objective measurement of the actual SRT corresponding to 50% speech intelligibility in every listening condition. Results: Of the seven alternative listening conditions, two conditions, one involving time-compressed, reverberant speech (TC+Rev), and the other (N0Sπ) having in-phase noise masker (N0) and out-of-phase target (Sπ), were found to be substantially more sensitive to the effect of hearing loss than the standard QuickSIN test. The performance in these two conditions also correlated with self-reported difficulties in attention/concentration during speech communication and in localizing the sound source, respectively. Hearing thresholds could account for about 50% or less variance in SRTs in any listening condition. Subjectively estimated SRTs (SRTs corresponding to 0% and 100% speech intelligibility) were highly correlated with the objective SRT measurements (SRT corresponding to 50% speech intelligibility). Conclusions: A test battery that includes the TC+Rev and the N0Sπ conditions would be useful in identifying individuals with hearing loss with speech-in-noise deficits in everyday communication.

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Validating a Method to Assess Lipreading, Audiovisual Gain, and Integration During Speech Reception With Cochlear-Implanted and Normal-Hearing Subjects Using a Talking Head

Objectives: Watching a talker’s mouth is beneficial for speech reception (SR) in many communication settings, especially in noise and when hearing is impaired. Measures for audiovisual (AV) SR can be valuable in the framework of diagnosing or treating hearing disorders. This study addresses the lack of standardized methods in many languages for assessing lipreading, AV gain, and integration. A new method is validated that supplements a German speech audiometric test with visualizations of the synthetic articulation of an avatar that was used, for it is feasible to lip-sync auditory speech in a highly standardized way. Three hypotheses were formed according to the literature on AV SR that used live or filmed talkers. It was tested whether respective effects could be reproduced with synthetic articulation: (1) cochlear implant (CI) users have a higher visual-only SR than normal-hearing (NH) individuals, and younger individuals obtain higher lipreading scores than older persons. (2) Both CI and NH gain from presenting AV over unimodal (auditory or visual) sentences in noise. (3) Both CI and NH listeners efficiently integrate complementary auditory and visual speech features. Design: In a controlled, cross-sectional study with 14 experienced CI users (mean age 47.4) and 14 NH individuals (mean age 46.3, similar broad age distribution), lipreading, AV gain, and integration of a German matrix sentence test were assessed. Visual speech stimuli were synthesized by the articulation of the Talking Head system “MASSY” (Modular Audiovisual Speech Synthesizer), which displayed standardized articulation with respect to the visibility of German phones. Results: In line with the hypotheses and previous literature, CI users had a higher mean visual-only SR than NH individuals (CI, 38%; NH, 12%; p

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Effect of Blast Injury on Auditory Localization in Military Service Members

Objectives: Among the many advantages of binaural hearing are the abilities to localize sounds in space and to attend to one sound in the presence of many sounds. Binaural hearing provides benefits for all listeners, but it may be especially critical for military personnel who must maintain situational awareness in complex tactical environments with multiple speech and noise sources. There is concern that Military Service Members who have been exposed to one or more high-intensity blasts during their tour of duty may have difficulty with binaural and spatial ability due to degradation in auditory and cognitive processes. The primary objective of this study was to assess the ability of blast-exposed Military Service Members to localize speech sounds in quiet and in multisource environments with one or two competing talkers. Design: Participants were presented with one, two, or three topic-related (e.g., sports, food, travel) sentences under headphones and required to attend to, and then locate the source of, the sentence pertaining to a prespecified target topic within a virtual space. The listener’s head position was monitored by a head-mounted tracking device that continuously updated the apparent spatial location of the target and competing speech sounds as the subject turned within the virtual space. Measurements of auditory localization ability included mean absolute error in locating the source of the target sentence, the time it took to locate the target sentence within 30 degrees, target/competitor confusion errors, response time, and cumulative head motion. Twenty-one blast-exposed Active-Duty or Veteran Military Service Members (blast-exposed group) and 33 non-blast-exposed Service Members and beneficiaries (control group) were evaluated. Results: In general, the blast-exposed group performed as well as the control group if the task involved localizing the source of a single speech target. However, if the task involved two or three simultaneous talkers, localization ability was compromised for some participants in the blast-exposed group. Blast-exposed participants were less accurate in their localization responses and required more exploratory head movements to find the location of the target talker. Conclusions: Results suggest that blast-exposed participants have more difficulty than non-blast-exposed participants in localizing sounds in complex acoustic environments. This apparent deficit in spatial hearing ability highlights the need to develop new diagnostic tests using complex listening tasks that involve multiple sound sources that require speech segregation and comprehension.

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Psychosocial Outcomes in Long-Term Cochlear Implant Users

Objectives: The objectives of this study were to investigate psychosocial outcomes in a sample of prelingually deaf, early-implanted children, adolescents, and young adults who are long-term cochlear implant (CI) users and to examine the extent to which language and executive functioning predict psychosocial outcomes. Design: Psychosocial outcomes were measured using two well-validated, parent-completed checklists: the Behavior Assessment System for Children and the Conduct Hyperactive Attention Problem Oppositional Symptom. Neurocognitive skills were measured using gold standard, performance-based assessments of language and executive functioning. Results: CI users were at greater risk for clinically significant deficits in areas related to attention, oppositional behavior, hyperactivity–impulsivity, and social-adaptive skills compared with their normal-hearing peers, although the majority of CI users scored within average ranges relative to Behavior Assessment System for Children norms. Regression analyses revealed that language, visual–spatial working memory, and inhibition–concentration skills predicted psychosocial outcomes. Conclusions: Findings suggest that underlying delays and deficits in language and executive functioning may place some CI users at a risk for difficulties in psychosocial adjustment.

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Hearing Handicap and Speech Recognition Correlate With Self-Reported Listening Effort and Fatigue

Objectives: To investigate the correlations between hearing handicap, speech recognition, listening effort, and fatigue. Design: Eighty-four adults with hearing loss (65 to 85 years) completed three self-report questionnaires: the Fatigue Assessment Scale, the Effort Assessment Scale, and the Hearing Handicap Inventory for Elderly. Audiometric assessment included pure-tone audiometry and speech recognition in noise. Results: There was a significant positive correlation between handicap and fatigue (r = 0.39, p

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Speech in Noise Perception as a Marker of Cognitive Impairment in HIV Infection

Objectives: Human immunodeficiency virus positive (HIV+) individuals report hearing difficulties, but standard audiological tests show no, or small, changes in peripheral hearing ability. The hearing complaints may reflect central nervous system (CNS) auditory processing deficits, rather than middle or inner ear problems, and may result from CNS damage due to HIV infection or treatment. If central auditory task performance and cognitive deficits in HIV+ individuals are shown to be related, then central auditory tests might serve as a “window” into CNS function in these patients. Design: We measured cognitive performance (Mandarin Montreal Cognitive Assessment [MoCA]) and speech in noise perception (Mandarin hearing-in-noise test [HINT]) in 166 normal-hearing HIV+ individuals (158 men, 8 women, average age 36 years) at the Shanghai Public Health Clinical Center in Shanghai, China. Data collection included audiometry, tympanometry, and the Amsterdam Inventory of Auditory Handicap (AIAH), which assesses the subjective ability to understand speech and localize sound. Results: Subjects had no middle ear disease and met criteria for normal-hearing sensitivity (all thresholds 20 dB HL or less). A significant negative relationship between speech reception thresholds (SRT) and MoCA scores (r2 = 0.15, F = 28.2, p

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Learning Effects in Psychophysical Tests of Spectral and Temporal Resolution

Objectives: Psychophysical tests of spectral and temporal resolution, such as the spectral-ripple discrimination task and the temporal modulation detection test, are valuable tools for the evaluation of cochlear implant performance. Both tests correlate with speech intelligibility and are reported to show no instantaneous learning effect. However, some of our previous trials have suggested that there is a learning effect over time. The aim of this study was to investigate the test-retest reliability of the two tests when measured over time. Design: Ten adult cochlear implant recipients, experienced with the HiResolution speech coding strategy, participated in this study. Spectral ripple discrimination and temporal modulation detection ability with the HiResolution strategy were assessed both before and after participation in a previous trial that evaluated two research speech coding strategies after 2 weeks of home-usage. Each test was repeated six times on each test day. Results: No improvement was observed for same-day testing. However, comparison of the mean spectral ripple discrimination scores before and after participation in the take-home trial showed improvement from 3.4 to 4.8 ripples per octave (p

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Three-Dimensional Analysis of the Fundus of the Human Internal Acoustic Canal

Objectives: Documentation of the nerve components in the internal acoustic canal is essential before cochlea implantation surgery. Interpretations may be challenged by wide anatomical variations of the VIIIth nerve and their ramifications. Malformations may further defy proper nerve identification. Design: Using microcomputed tomography, we analyzed the fundus bone channels in an archival collection of 113 macerated human temporal bones and 325 plastic inner molds. Data were subsequently processed by volume-rendering software using a bony tissue algorithm. Three-dimensional reconstructions were made, and through orthogonal sections, the topographic anatomy was established. Results: The technique provided additional information regarding the anatomy of the nerve foramina/channels of the human fundus region, including variations and destinations. Channel anastomosis were found beyond the level of the fundus. A foramen of the transverse crest was identified. Conclusions: Three-dimensional reconstructions and cropping outlined the bone canals and demonstrated the highly variable VIIIth nerve anatomy at the fundus of the human inner acoustic canal. Myriad channel interconnections suggested an intricate system of neural interactive pathways in humans. Particularly striking was the variable anatomy of the saccule nerve channels. The results may assist in the preoperative interpretation of the VIIIth nerve anatomy.

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The Electrically Evoked Auditory Change Complex Evoked by Temporal Gaps Using Cochlear Implants or Auditory Brainstem Implants in Children With Cochlear Nerve Deficiency

Objectives: This study aimed to (1) establish the feasibility of measuring the electrically evoked auditory change complex (eACC) in response to temporal gaps in children with cochlear nerve deficiency (CND) who are using cochlear implants (CIs) and/or auditory brainstem implants (ABIs); and (2) explore the association between neural encoding of, and perceptual sensitivity to, temporal gaps in these patients. Design: Study participants included 5 children (S1 to S5) ranging in age from 3.8 to 8.2 years (mean: 6.3 years) at the time of testing. All subjects were unilaterally implanted with a Nucleus 24M ABI due to CND. For each subject, two or more stimulating electrodes of the ABI were tested. S2, S3, and S5 previously received a CI in the contralateral ear. For these 3 subjects, at least two stimulating electrodes of their CIs were also tested. For electrophysiological measures, the stimulus was an 800-msec biphasic pulse train delivered to individual electrodes at the maximum comfortable level (C level). The electrically evoked responses, including the onset response and the eACC, were measured for two stimulation conditions. In the standard condition, the 800-msec pulse train was delivered uninterrupted to individual stimulating electrodes. In the gapped condition, a temporal gap was inserted into the pulse train after 400 msec of stimulation. Gap durations tested in this study ranged from 2 up to 128 msec. The shortest gap that could reliably evoke the eACC was defined as the objective gap detection threshold (GDT). For behavioral GDT measures, the stimulus was a 500-msec biphasic pulse train presented at the C level. The behavioral GDT was measured for individual stimulating electrodes using a one-interval, two-alternative forced-choice procedure. Results: The eACCs to temporal gaps were recorded successfully in all subjects for at least one stimulating electrode using either the ABI or the CI. Objective GDTs showed intersubject variations, as well as variations across stimulating electrodes of the ABI or the CI within each subject. Behavioral GDTs were measured for one ABI electrode in S2 and for multiple ABI and CI electrodes in S5. All other subjects could not complete the task. S5 showed smaller behavioral GDTs for CI electrodes than those measured for ABI electrodes. One CI and two ABI electrodes in S5 showed comparable objective and behavioral GDTs. In contrast, one CI and two ABI electrodes in S5 and one ABI electrode in S2 showed measurable behavioral GDTs but no identifiable eACCs. Conclusions: The eACCs to temporal gaps were recorded in children with CND using either ABIs or CIs. Both objective and behavioral GDTs showed inter- and intrasubject variations. Consistency between results of eACC recordings and psychophysical measures of GDT was observed for some but not all ABI or CI electrodes in these subjects.

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Olivocochlear Efferent Activity Is Associated With the Slope of the Psychometric Function of Speech Recognition in Noise

Objectives: The medial olivocochlear (MOC) efferent system can modify cochlear function to improve sound detection in noise, but its role in speech perception in noise is unclear. The purpose of this study was to determine the association between MOC efferent activity and performance on two speech-in-noise tasks at two signal-to-noise ratios (SNRs). It was hypothesized that efferent activity would be more strongly correlated with performance at the more challenging SNR, relative to performance at the less challenging SNR. Design: Sixteen adults aged 35 to 73 years participated. Subjects had pure-tone averages ≤25 dB HL and normal middle ear function. High-frequency pure-tone averages were computed across 3000 to 8000 Hz and ranged from 6.3 to 48.8 dB HL. Efferent activity was assessed using contralateral suppression of transient-evoked otoacoustic emissions (TEOAEs) measured in right ears, and MOC activation was achieved by presenting broadband noise to left ears. Contralateral suppression was expressed as the decibel change in TEOAE magnitude obtained with versus without the presence of the broadband noise. TEOAE responses were also examined for middle ear muscle reflex activation and synchronous spontaneous otoacoustic emissions (SSOAEs). Speech-in-noise perception was assessed using the closed-set coordinate response measure word recognition task and the open-set Institute of Electrical and Electronics Engineers sentence task. Speech and noise were presented to right ears at two SNRs. Performance on each task was scored as percent correct. Associations between contralateral suppression and speech-in-noise performance were quantified using partial rank correlational analyses, controlling for the variables age and high-frequency pure-tone average. Results: One subject was excluded due to probable middle ear muscle reflex activation. Subjects showed a wide range of contralateral suppression values, consistent with previous reports. Three subjects with SSOAEs had similar contralateral suppression results as subjects without SSOAEs. The magnitude of contralateral suppression was not significantly correlated with speech-in-noise performance on either task at a single SNR (p > 0.05), contrary to hypothesis. However, contralateral suppression was significantly correlated with the slope of the psychometric function, computed as the difference between performance levels at the two SNRs divided by 3 (decibel difference between the 2 SNRs) for the coordinate response measure task (partial rs = 0.59; p = 0.04) and for the Institute of Electrical and Electronics Engineers task (partial rs = 0.60; p = 0.03). Conclusions: In a group of primarily older adults with normal hearing or mild hearing loss, olivocochlear efferent activity assessed using contralateral suppression of TEOAEs was not associated with speech-in-noise performance at a single SNR. However, auditory efferent activity appears to be associated with the slope of the psychometric function for both a word and sentence recognition task in noise. Results suggest that individuals with stronger MOC efferent activity tend to be more responsive to changes in SNR, where small increases in SNR result in better speech-in-noise performance relative to individuals with weaker MOC efferent activity. Additionally, the results suggest that the slope of the psychometric function may be a more useful metric than performance at a single SNR when examining the relationship between speech recognition in noise and MOC efferent activity.

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Hearing Screening for Public Safety Professionals – New Method for 'Fitness for Duty' Assessments

Hearing is an important part of fitness-for-duty assessments of police officers and other public safety professionals – but standard hearing tests don't give a true picture of whether these professionals can hear and communicate in the specific "noise environments" where they must work. A new approach to hearing assessment in public safety officers − which has been adopted by five government agencies in the United States and Canada − is presented in an article in Ear and Hearing. The official journal of the American Auditory Society, Ear and Hearing is published by Wolters Kluwer.

An international group led by Sigfrid D. Soli, PhD, of the House Clinic, Los Angeles, has developed and validated a new method for assessing auditory fitness for duty for public safety occupations – focusing on whether these professionals can perform "hearing-critical" job tasks in the settings where they must work. "This method is the first to provide an objective, evidence-based means assessing functional hearing in individuals who must perform hearing-critical job tasks that can directly affect public safety," Dr. Soli commented.

New Model for Occupational Hearing Screening Accounts for 'Real-World Noise Environments' 

Dr. Soli and colleagues have taken a new approach to assessing fitness for duty in public safety professionals with hearing loss. Current guidelines for hearing screening use standard diagnostic tests of hearing disorders, such as pure-tone audiometry. However, these tests do not necessarily provide objective information as to whether the individual can effectively perform essential hearing-critical job tasks in everyday occupational settings.

With standard diagnostic hearing tests, some individuals with hearing loss can be denied access to public safety positions or removed from their jobs – even with hearing technologies that may allow them to function adequately. Current approaches also may not be valid under the Americans with Disabilities Act, which requires that screening criteria reflect the actual requirements of the job.

To develop their model, Dr. Soli and colleagues conducted research to evaluate hearing-critical tasks and real-world noise environments in public safety and law enforcement jobs: specifically, law enforcement and corrections officers. Their studies included expert analyses of the essential hearing-critical tasks for each type of job, along with on-site recordings of the noise environments where those tasks are performed.

The studies included many noise environments for law enforcement and corrections officers. For example, for police officers, effective in-person and radio communications often take place in a background of indoor and outdoor voices, vehicle sounds, sirens, and other noises. The researchers used the Extended Speech Intelligibility Index, which is based on an American National Standard, to obtain measures of functional hearing ability necessary for effective speech communication in each noise environment.

The researchers found that even for individuals with normal hearing, real-world noise environments pose a challenge to effective communication. In noisy environments, the likelihood of effective speech communication at distances of one meter or less was often predicted to be less than 50 percent. With raised or loud vocal effort, predicted likelihood values increased to 80 percent or higher. At distances of five meters or beyond, effective speech communication was often unlikely, regardless of vocal effort.

Based on their findings, Dr. Soli and colleagues developed a method for predicting the likelihood of effective speech communication in each real-world noise environment. In a companion article, published in the International Journal of Audiology, they validated these predictions in samples of adults with normal hearing and those with mild to moderate hearing impairment. They stated that "these predictions provide an objective means of occupational hearing screening" that more accurately reflects the way functional hearing ability influences job performance.

The two articles, published simultaneously, are accompanied by a commentary by Judy R. Dubno, PhD, of Medical University of South Carolina, Charleston. She stated that the new studies "are an important example of a more ecologically valid approach that assesses an individual's ability to perform hearing-critical tasks in their occupational listening environments." She also observed that there may be broader applications, noting that "such an approach would likely be more relevant and understandable to patients/consumers and could lead to more accurate assessments and more effective interventions for people with hearing loss."

Published: 4/27/2018 1:53:00 PM

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Hearing Screening for Public Safety Professionals – New Method for 'Fitness for Duty' Assessments

Hearing is an important part of fitness-for-duty assessments of police officers and other public safety professionals – but standard hearing tests don't give a true picture of whether these professionals can hear and communicate in the specific "noise environments" where they must work. A new approach to hearing assessment in public safety officers − which has been adopted by five government agencies in the United States and Canada − is presented in an article in Ear and Hearing. The official journal of the American Auditory Society, Ear and Hearing is published by Wolters Kluwer.

An international group led by Sigfrid D. Soli, PhD, of the House Clinic, Los Angeles, has developed and validated a new method for assessing auditory fitness for duty for public safety occupations – focusing on whether these professionals can perform "hearing-critical" job tasks in the settings where they must work. "This method is the first to provide an objective, evidence-based means assessing functional hearing in individuals who must perform hearing-critical job tasks that can directly affect public safety," Dr. Soli commented.

New Model for Occupational Hearing Screening Accounts for 'Real-World Noise Environments' 

Dr. Soli and colleagues have taken a new approach to assessing fitness for duty in public safety professionals with hearing loss. Current guidelines for hearing screening use standard diagnostic tests of hearing disorders, such as pure-tone audiometry. However, these tests do not necessarily provide objective information as to whether the individual can effectively perform essential hearing-critical job tasks in everyday occupational settings.

With standard diagnostic hearing tests, some individuals with hearing loss can be denied access to public safety positions or removed from their jobs – even with hearing technologies that may allow them to function adequately. Current approaches also may not be valid under the Americans with Disabilities Act, which requires that screening criteria reflect the actual requirements of the job.

To develop their model, Dr. Soli and colleagues conducted research to evaluate hearing-critical tasks and real-world noise environments in public safety and law enforcement jobs: specifically, law enforcement and corrections officers. Their studies included expert analyses of the essential hearing-critical tasks for each type of job, along with on-site recordings of the noise environments where those tasks are performed.

The studies included many noise environments for law enforcement and corrections officers. For example, for police officers, effective in-person and radio communications often take place in a background of indoor and outdoor voices, vehicle sounds, sirens, and other noises. The researchers used the Extended Speech Intelligibility Index, which is based on an American National Standard, to obtain measures of functional hearing ability necessary for effective speech communication in each noise environment.

The researchers found that even for individuals with normal hearing, real-world noise environments pose a challenge to effective communication. In noisy environments, the likelihood of effective speech communication at distances of one meter or less was often predicted to be less than 50 percent. With raised or loud vocal effort, predicted likelihood values increased to 80 percent or higher. At distances of five meters or beyond, effective speech communication was often unlikely, regardless of vocal effort.

Based on their findings, Dr. Soli and colleagues developed a method for predicting the likelihood of effective speech communication in each real-world noise environment. In a companion article, published in the International Journal of Audiology, they validated these predictions in samples of adults with normal hearing and those with mild to moderate hearing impairment. They stated that "these predictions provide an objective means of occupational hearing screening" that more accurately reflects the way functional hearing ability influences job performance.

The two articles, published simultaneously, are accompanied by a commentary by Judy R. Dubno, PhD, of Medical University of South Carolina, Charleston. She stated that the new studies "are an important example of a more ecologically valid approach that assesses an individual's ability to perform hearing-critical tasks in their occupational listening environments." She also observed that there may be broader applications, noting that "such an approach would likely be more relevant and understandable to patients/consumers and could lead to more accurate assessments and more effective interventions for people with hearing loss."

Published: 4/27/2018 1:53:00 PM

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Hearing Screening for Public Safety Professionals – New Method for 'Fitness for Duty' Assessments

Hearing is an important part of fitness-for-duty assessments of police officers and other public safety professionals – but standard hearing tests don't give a true picture of whether these professionals can hear and communicate in the specific "noise environments" where they must work. A new approach to hearing assessment in public safety officers − which has been adopted by five government agencies in the United States and Canada − is presented in an article in Ear and Hearing. The official journal of the American Auditory Society, Ear and Hearing is published by Wolters Kluwer.

An international group led by Sigfrid D. Soli, PhD, of the House Clinic, Los Angeles, has developed and validated a new method for assessing auditory fitness for duty for public safety occupations – focusing on whether these professionals can perform "hearing-critical" job tasks in the settings where they must work. "This method is the first to provide an objective, evidence-based means assessing functional hearing in individuals who must perform hearing-critical job tasks that can directly affect public safety," Dr. Soli commented.

New Model for Occupational Hearing Screening Accounts for 'Real-World Noise Environments' 

Dr. Soli and colleagues have taken a new approach to assessing fitness for duty in public safety professionals with hearing loss. Current guidelines for hearing screening use standard diagnostic tests of hearing disorders, such as pure-tone audiometry. However, these tests do not necessarily provide objective information as to whether the individual can effectively perform essential hearing-critical job tasks in everyday occupational settings.

With standard diagnostic hearing tests, some individuals with hearing loss can be denied access to public safety positions or removed from their jobs – even with hearing technologies that may allow them to function adequately. Current approaches also may not be valid under the Americans with Disabilities Act, which requires that screening criteria reflect the actual requirements of the job.

To develop their model, Dr. Soli and colleagues conducted research to evaluate hearing-critical tasks and real-world noise environments in public safety and law enforcement jobs: specifically, law enforcement and corrections officers. Their studies included expert analyses of the essential hearing-critical tasks for each type of job, along with on-site recordings of the noise environments where those tasks are performed.

The studies included many noise environments for law enforcement and corrections officers. For example, for police officers, effective in-person and radio communications often take place in a background of indoor and outdoor voices, vehicle sounds, sirens, and other noises. The researchers used the Extended Speech Intelligibility Index, which is based on an American National Standard, to obtain measures of functional hearing ability necessary for effective speech communication in each noise environment.

The researchers found that even for individuals with normal hearing, real-world noise environments pose a challenge to effective communication. In noisy environments, the likelihood of effective speech communication at distances of one meter or less was often predicted to be less than 50 percent. With raised or loud vocal effort, predicted likelihood values increased to 80 percent or higher. At distances of five meters or beyond, effective speech communication was often unlikely, regardless of vocal effort.

Based on their findings, Dr. Soli and colleagues developed a method for predicting the likelihood of effective speech communication in each real-world noise environment. In a companion article, published in the International Journal of Audiology, they validated these predictions in samples of adults with normal hearing and those with mild to moderate hearing impairment. They stated that "these predictions provide an objective means of occupational hearing screening" that more accurately reflects the way functional hearing ability influences job performance.

The two articles, published simultaneously, are accompanied by a commentary by Judy R. Dubno, PhD, of Medical University of South Carolina, Charleston. She stated that the new studies "are an important example of a more ecologically valid approach that assesses an individual's ability to perform hearing-critical tasks in their occupational listening environments." She also observed that there may be broader applications, noting that "such an approach would likely be more relevant and understandable to patients/consumers and could lead to more accurate assessments and more effective interventions for people with hearing loss."

Published: 4/27/2018 1:53:00 PM

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Population Health in Pediatric Speech and Language Disorders: Available Data Sources and a Research Agenda for the Field

Purpose

The aim of the study was to provide an overview of population science as applied to speech and language disorders, illustrate data sources, and advance a research agenda on the epidemiology of these conditions.

Method

Computer-aided database searches were performed to identify key national surveys and other sources of data necessary to establish the incidence, prevalence, and course and outcome of speech and language disorders. This article also summarizes a research agenda that could enhance our understanding of the epidemiology of these disorders.

Results

Although the data yielded estimates of prevalence and incidence for speech and language disorders, existing sources of data are inadequate to establish reliable rates of incidence, prevalence, and outcomes for speech and language disorders at the population level.

Conclusions

Greater support for inclusion of speech and language disorder–relevant questions is necessary in national health surveys to build the population science in the field.

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

Purpose

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

Method

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

Results

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

Conclusions

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

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Population Health in Pediatric Speech and Language Disorders: Available Data Sources and a Research Agenda for the Field

Purpose

The aim of the study was to provide an overview of population science as applied to speech and language disorders, illustrate data sources, and advance a research agenda on the epidemiology of these conditions.

Method

Computer-aided database searches were performed to identify key national surveys and other sources of data necessary to establish the incidence, prevalence, and course and outcome of speech and language disorders. This article also summarizes a research agenda that could enhance our understanding of the epidemiology of these disorders.

Results

Although the data yielded estimates of prevalence and incidence for speech and language disorders, existing sources of data are inadequate to establish reliable rates of incidence, prevalence, and outcomes for speech and language disorders at the population level.

Conclusions

Greater support for inclusion of speech and language disorder–relevant questions is necessary in national health surveys to build the population science in the field.

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

Purpose

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

Method

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

Results

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

Conclusions

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

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Population Health in Pediatric Speech and Language Disorders: Available Data Sources and a Research Agenda for the Field

Purpose

The aim of the study was to provide an overview of population science as applied to speech and language disorders, illustrate data sources, and advance a research agenda on the epidemiology of these conditions.

Method

Computer-aided database searches were performed to identify key national surveys and other sources of data necessary to establish the incidence, prevalence, and course and outcome of speech and language disorders. This article also summarizes a research agenda that could enhance our understanding of the epidemiology of these disorders.

Results

Although the data yielded estimates of prevalence and incidence for speech and language disorders, existing sources of data are inadequate to establish reliable rates of incidence, prevalence, and outcomes for speech and language disorders at the population level.

Conclusions

Greater support for inclusion of speech and language disorder–relevant questions is necessary in national health surveys to build the population science in the field.

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

Purpose

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

Method

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

Results

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

Conclusions

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

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Light-Driven Hearing Aid Wins Edison Award

​

​Earlens (https://earlens.com/) has received the Best New Product Award at the 2018 Edison Awards for its light-driven hearing aid. The Earlens Hearing Aid uses focused light and a small lens resting on the eardrum. Together, they create a rich, natural sound by expanding the frequency range delivered to the user.  This technology also eliminates the major source of whistling afflicting conventional hearing aids. Clinical studies have shown that Earlens Hearing Aid can make it easier for people with mild to severe sensorineural hearing loss to understand speech in noisy environments. The Edison Awards is an annual competition honoring excellence in new product and service development, marketing, human-centered design, and innovation. They are given to game-changing products and services, as well as excellence and leadership in innovation.

Published: 4/27/2018 1:52:00 PM

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Light-Driven Hearing Aid Wins Edison Award

​

​Earlens (https://earlens.com/) has received the Best New Product Award at the 2018 Edison Awards for its light-driven hearing aid. The Earlens Hearing Aid uses focused light and a small lens resting on the eardrum. Together, they create a rich, natural sound by expanding the frequency range delivered to the user.  This technology also eliminates the major source of whistling afflicting conventional hearing aids. Clinical studies have shown that Earlens Hearing Aid can make it easier for people with mild to severe sensorineural hearing loss to understand speech in noisy environments. The Edison Awards is an annual competition honoring excellence in new product and service development, marketing, human-centered design, and innovation. They are given to game-changing products and services, as well as excellence and leadership in innovation.

Published: 4/27/2018 1:52:00 PM

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Light-Driven Hearing Aid Wins Edison Award

​

​Earlens (https://earlens.com/) has received the Best New Product Award at the 2018 Edison Awards for its light-driven hearing aid. The Earlens Hearing Aid uses focused light and a small lens resting on the eardrum. Together, they create a rich, natural sound by expanding the frequency range delivered to the user.  This technology also eliminates the major source of whistling afflicting conventional hearing aids. Clinical studies have shown that Earlens Hearing Aid can make it easier for people with mild to severe sensorineural hearing loss to understand speech in noisy environments. The Edison Awards is an annual competition honoring excellence in new product and service development, marketing, human-centered design, and innovation. They are given to game-changing products and services, as well as excellence and leadership in innovation.

Published: 4/27/2018 1:52:00 PM

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Signia Talks Silk™ Nx and Innovation at AAA 2018

In the midst of the energetic crowd at the American Academy of Audiology (AAA) 2018 Conference last week in Nashville, TN, Signia introduced Silk Nx hearing aids, the company's latest innovation that features advanced hearing aid technology with new design and improved natural hearing capability.

Silk Nx builds on the core sound of the Nx technology, explained Eric Branda, AuD, the director of product management at Sivantos, Inc. "It addresses three of the key things for hearing aid wearers: small size for discretion, comfort so they can enjoy wearing the device, and the highest level of technology, " he added.

Noting the concern of many hearing aid users, particularly those getting hearing aids for the first time, about the visibility of their device, Silk Nx is a move towards invisibility of hearing aids. It is 20 percent smaller than previous models and comes with a darker faceplate that blends well in the ear canal for utmost discretion.

"But there's no compromise on sound quality," stressed Branda. "It still offers features like one-mic directionality. No other product is doing directionality on one mic instrument. By using our wireless exchange, we can provide directionality even though we don't have two mics on a tiny faceplate."

Signia's drive for continuous innovation comes with an acute awareness of the changing landscape in audiology—including the anticipated over-the-counter (OTC) hearing aids.

"We know that there's a lot of change coming, so we want to make sure we're helping our customers provide the best hearing care they can," Branda told The Hearing Journal.

"When you think of OTC hearing aids, we know that they're going to be for the lower end of the spectrum in terms of hearing loss," noted Debra Ludgate, director of marketing and public relations at Sivantos. "But we know that hearing loss progresses. So when a hearing professional is fitting someone, perhaps with an OTC, you know that they're going to come back because that hearing aid will fail them eventually as their hearing loss progresses. So it's almost like getting a new person into the market where you can convert them over to a better hearing aid for a longer term."

"It's an opportunity for the hearing aid professional to service that patient population with the right business model." 

Published: 4/25/2018 10:18:00 AM

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Signia Talks Silk™ Nx and Innovation at AAA 2018

In the midst of the energetic crowd at the American Academy of Audiology (AAA) 2018 Conference last week in Nashville, TN, Signia introduced Silk Nx hearing aids, the company's latest innovation that features advanced hearing aid technology with new design and improved natural hearing capability.

Silk Nx builds on the core sound of the Nx technology, explained Eric Branda, AuD, the director of product management at Sivantos, Inc. "It addresses three of the key things for hearing aid wearers: small size for discretion, comfort so they can enjoy wearing the device, and the highest level of technology, " he added.

Noting the concern of many hearing aid users, particularly those getting hearing aids for the first time, about the visibility of their device, Silk Nx is a move towards invisibility of hearing aids. It is 20 percent smaller than previous models and comes with a darker faceplate that blends well in the ear canal for utmost discretion.

"But there's no compromise on sound quality," stressed Branda. "It still offers features like one-mic directionality. No other product is doing directionality on one mic instrument. By using our wireless exchange, we can provide directionality even though we don't have two mics on a tiny faceplate."

Signia's drive for continuous innovation comes with an acute awareness of the changing landscape in audiology—including the anticipated over-the-counter (OTC) hearing aids.

"We know that there's a lot of change coming, so we want to make sure we're helping our customers provide the best hearing care they can," Branda told The Hearing Journal.

"When you think of OTC hearing aids, we know that they're going to be for the lower end of the spectrum in terms of hearing loss," noted Debra Ludgate, director of marketing and public relations at Sivantos. "But we know that hearing loss progresses. So when a hearing professional is fitting someone, perhaps with an OTC, you know that they're going to come back because that hearing aid will fail them eventually as their hearing loss progresses. So it's almost like getting a new person into the market where you can convert them over to a better hearing aid for a longer term."

"It's an opportunity for the hearing aid professional to service that patient population with the right business model." 

Published: 4/25/2018 10:18:00 AM

from #Audiology via xlomafota13 on Inoreader https://ift.tt/2FkqXHf
via IFTTT

Signia Talks Silk™ Nx and Innovation at AAA 2018

In the midst of the energetic crowd at the American Academy of Audiology (AAA) 2018 Conference last week in Nashville, TN, Signia introduced Silk Nx hearing aids, the company's latest innovation that features advanced hearing aid technology with new design and improved natural hearing capability.

Silk Nx builds on the core sound of the Nx technology, explained Eric Branda, AuD, the director of product management at Sivantos, Inc. "It addresses three of the key things for hearing aid wearers: small size for discretion, comfort so they can enjoy wearing the device, and the highest level of technology, " he added.

Noting the concern of many hearing aid users, particularly those getting hearing aids for the first time, about the visibility of their device, Silk Nx is a move towards invisibility of hearing aids. It is 20 percent smaller than previous models and comes with a darker faceplate that blends well in the ear canal for utmost discretion.

"But there's no compromise on sound quality," stressed Branda. "It still offers features like one-mic directionality. No other product is doing directionality on one mic instrument. By using our wireless exchange, we can provide directionality even though we don't have two mics on a tiny faceplate."

Signia's drive for continuous innovation comes with an acute awareness of the changing landscape in audiology—including the anticipated over-the-counter (OTC) hearing aids.

"We know that there's a lot of change coming, so we want to make sure we're helping our customers provide the best hearing care they can," Branda told The Hearing Journal.

"When you think of OTC hearing aids, we know that they're going to be for the lower end of the spectrum in terms of hearing loss," noted Debra Ludgate, director of marketing and public relations at Sivantos. "But we know that hearing loss progresses. So when a hearing professional is fitting someone, perhaps with an OTC, you know that they're going to come back because that hearing aid will fail them eventually as their hearing loss progresses. So it's almost like getting a new person into the market where you can convert them over to a better hearing aid for a longer term."

"It's an opportunity for the hearing aid professional to service that patient population with the right business model." 

Published: 4/25/2018 10:18:00 AM

from #Audiology via ola Kala on Inoreader https://ift.tt/2FkqXHf
via IFTTT