American Journal of Audiology

Early Intervention in Localized Wegener's Granulomatosis With Sensorineural Hearing Loss Preserves Hearing

Sriskandarajah, V., Bansal, R. A., Yeoh, R., Bansal, A. S. — 2012-12-11T11:59:18-08:00

Purpose

Wegener's granulomatosis has been renamed granulomatosis with polyangiitis (GPA). In this article, the authors refer to WG as "WG/GPA" to indicate the old and new names of this condition. WG/GPA is a systemic necrotizing granulomatous vasculitis that can affect, in particular, the lungs, sinuses, and kidneys. The authors report 2 cases with antineutrophil cytoplasmic antibodies (c-ANCA) positive WG/GPA whose initial presentations were in the form of both conductive and sensorineural hearing loss without systemic features. The authors contrast the reversal of hearing loss and prevention of disease progression with early recognition and treatment.

Method

The authors present 2 contrasting cases of WG/GPA. Changes in hearing were measured through use of a GSI 61 audiometer as well as guidelines from the British Society of Audiology. Serum ANCA were detected by indirect immunofluorescence and formalin fixed neutrophils. Proteinase 3 (PR3) and myeloperoxidase antibodies were measured through use of a fluoroenzyme immunoassay.

Results

Persistent deafness and systemic disease are more likely, and more aggressive therapy was required when the diagnosis of WG/GPA was delayed.

Conclusion

WG/GPA should be considered in acute or subacute deafness presenting over days to weeks and even in the absence of systemic symptoms. A negative or weak ANCA with absent antibodies to serine PR3 and myeloperoxidase should not exclude the possible diagnosis of WG/GPA, and a high index of suspicion should be maintained.

Linguistic and Attitudinal Factors in Normal-Hearing Bilingual Listeners' Perception of Degraded English Passages

Shi, L.-F., Farooq, N. — 2012-12-11T11:59:18-08:00

Purpose

Linguistic variables alone cannot fully account for bilingual listeners' perception of English-running speech. In the present study, the authors investigated how linguistic and attitudinal factors, in combination, affect bilingual processing of temporally degraded English passages in quiet and in noise.

Method

Thirty-six bilinguals with various linguistic and attitudinal characteristics participated in the study. Bilingual individuals completed questionnaires that assessed their language background, willingness to communicate (WTC), and self-perceived communication competency (SPCC) in English. Participants listened to English passage pairs from the Connected Speech Test, presented at 45 dB HL at 3 rates (unprocessed, expanded, compressed), in quiet and in noise.

Results

Language proficiency measures were the most significant linguistic variables, accounting for the largest amount of variance in performance across most conditions. Both WTC and SPCC were associated with performance and contributed to regression models. Subscales assessing listeners' WTC and SPCC in a group were more predictive of performance than communication in an interpersonal or public setting. Performance in noise was more difficult to predict than in quiet. Performance with compression was more difficult to predict than with expansion.

Conclusion

To fully understand bilingual clients' perception of English speech, hearing professionals should consider their attitudinal characteristics in addition to language background.

Audiologists' Professional Satisfaction

Saccone, P., Steiger, J. — 2012-12-11T11:59:18-08:00

Purpose

The authors surveyed currently practicing audiologists to evaluate their professional satisfaction and compared the results to a similar survey conducted in 1997.

Method

The authors repeated an audiologist professional satisfaction survey conducted in 1997; 382 randomly chosen, currently practicing audiologists participated. Responses to 38 statements were on a 5-point Likert scale (5 = strong agreement with a statement, 1 = strong disagreement with a statement). The respondent sample was broken down into demographic subgroups, and statements were divided into subgroups reflecting 6 core reward areas that contribute to overall professional satisfaction.

Results

Mean group satisfaction was 3.9 ( n = 382; SD = 1.01), which has remained unchanged since 1997 ( p < .05). Private practice audiologists' mean group satisfaction of 4.31 ( n = 80, SD = 0.78) was higher than for other practice settings ( p < .05). AuD private practice owners' mean group satisfaction of 4.52 ( n = 46, SD = 0.66) was higher than for other degrees and practice settings ( p < .05). Core reward area ratings differed for AuD, MA/MS, and PhD degree holders ( p < .05). Correlations between the average core reward area ratings and mean group satisfaction met statistical significance ( p < .05).

Conclusions

These results have implications for goal setting and planning within the profession and for audiologists' career choices.

Children's Speech Recognition and Loudness Perception With the Desired Sensation Level v5 Quiet and Noise Prescriptions

Crukley, J., Scollie, S. D. — 2012-12-11T11:59:18-08:00

Purpose

To determine whether Desired Sensation Level (DSL) v5 Noise is a viable hearing instrument prescriptive algorithm for children, in comparison with DSL v5 Quiet. In particular, the authors compared children's performance on measures of consonant recognition in quiet, sentence recognition in noise, and loudness perception when fitted with DSL v5 Quiet and Noise.

Method

Eleven children (ages 8 to 17 years) with stable, congenital sensorineural hearing losses participated in the study. Participants were fitted bilaterally to DSL v5 prescriptions with behind-the-ear hearing instruments. The order of prescription was counterbalanced across participants. Repeated measures analysis of variance was used to compare performance between prescriptions.

Results

Use of the Noise prescription resulted in a significant decrease in consonant perception in Quiet with low-level input, but no difference with average-level input. There was no significant difference in sentence-in-noise recognition between the two prescriptions. Loudness ratings for input levels above 72 dB SPL were significantly lower with the noise prescription.

Conclusions

Average-level consonant recognition in quiet was preserved and aversive loudness was alleviated by the Noise prescription relative to the quiet prescription, which suggests that the DSL v5 Noise prescription may be an effective approach to managing the nonquiet listening needs of children with hearing loss.

Factors Influencing Follow-Up to Newborn Hearing Screening for Infants Who Are Hard of Hearing

2012-12-11T11:59:18-08:00

Purpose

To document the epidemiological characteristics of a group of children who are hard of hearing, identify individual predictor variables for timely follow-up after a failed newborn hearing screening, and identify barriers to follow-up encountered by families.

Method

The authors used an accelerated longitudinal design to investigate outcomes for children who are hard of hearing in a large, multicenter study. The present study involved a subgroup of 193 children with hearing loss who did not pass the newborn hearing screening. The authors used available records to capture ages of confirmation of hearing loss, hearing aid fitting, and entry into early intervention. Linear regression models were used to investigate relationships among individual predictor variables and age at each follow-up benchmark.

Results

Of several predictor variables, only higher levels of maternal education were significantly associated with earlier confirmation of hearing loss and fitting of hearing aids; severity of hearing loss was not. No variables were significantly associated with age of entry into early intervention. Each recommended benchmark was met by a majority of children, but only one third met all of the benchmarks within the recommended time frame.

Conclusion

Results suggest that underserved communities need extra support in navigating steps that follow failed newborn hearing screening.

The Accuracy of Matching Target Insertion Gains With Open-Fit Hearing Aids

Aazh, H., Moore, B. C. J., Prasher, D. — 2012-12-11T11:59:18-08:00

Purpose

To assess the accuracy with which target insertion gains were matched for a single type of open-fit hearing aid, both on initial fitting and after adjustment.

Method

The hearing aids were fitted using the first-fit setting in the programming software and the target formula was selected as NAL–NL1. The difference between the real ear insertion gain (REIG) and the NAL–NL1 target REIG was recorded. The initial fitting was considered acceptable if the difference was less than 10 dB at all frequencies. If an initial fitting was not acceptable, the frequency-gain response was modified. The difference between the final REIG and the NAL–NL1 target REIG was recorded as final target mismatch.

Results

Of the 51 initial fittings, 36 (71%) failed to achieve a match within ±10 dB of the NAL–NL1 insertion gain target at 1 or more frequencies between 0.25 and 4 kHz. After the authors adjusted the frequency-gain response of the hearing aids, only 9 fittings (18%) failed to achieve a match.

Conclusion

These outcomes suggest that target insertion gains for the open-fit hearing aids used here are rarely achieved with a first fitting but can usually be achieved through adjustments based on REIG measurements.

Sequential Bilateral Cochlear Implantation: Speech Perception and Localization Pre- and Post-Second Cochlear Implantation

Dunn, C. C., Tyler, R. S., Witt, S., Ji, H., Gantz, B. J. — 2012-12-11T11:59:18-08:00

Purpose

In this study, the authors sought to compare speech perception and localization in subjects who wear 1 cochlear implant (unilateral CI) or 1 cochlear implant and hearing aid (CI+HA) and then receive a second cochlear implant (bilateral CI), and to evaluate the importance of the duration between implant surgeries and duration of deafness.

Method

Nine subjects were tested on speech perception in quiet, and 13 subjects were tested on speech perception and localization in noise using an array of 8 loudspeakers. All subjects were tested with unilateral CI prior to bilateral implantation and then again with bilateral CI after at least 3 months of bilateral experience.

Results

No significant difference was found between bilateral CI and unilateral CI on averaged speech perception in quiet performance. A significant benefit was found for bilateral CI on averaged speech perception in noise and on localization. Nonsignificant correlations were found for duration between surgeries, duration of deafness, and duration of bilateral use.

Conclusions

Improvements for speech perception and localization played in background noise were indicated for most subjects after they received their 2nd implant. The correlations should be reassessed with a larger number of subjects to appropriately evaluate the effects of duration between surgeries, duration of deafness, and duration of bilateral use.

Frequency Dependence of Binaural Interaction in the Auditory Brainstem and Middle Latency Responses

Fowler, C. G., Horn, J. H. — 2012-12-11T11:59:18-08:00

Purpose

The primary purpose of this investigation was to determine the relative frequency representation of binaural function in the brainstem and cortex of adults. The secondary purpose was to compare adult responses to previously reported infant responses.

Methods

Simultaneous auditory brainstem responses and auditory middle responses were recorded monaurally and binaurally in 20 young women. The binaural (BIN) response was subtracted from the summed monaural waves (L+R) to obtain the binaural interaction components (BIC) from waves V (peak A) and Pa (BIC-Pa). Amplitude ratios were calculated as BIC/L+R. Repeated-measures analyses of variance evaluated responses to frequency (500 Hz vs. 4000 Hz), wave condition (L+R vs. BIN), and wave class (auditory brainstem response vs. auditory middle response).

Results

Waveforms were present for all conditions. The L+R responses were larger than the BIN responses, 500 Hz produced larger amplitudes than 4000 Hz, and Pa was larger than wave V. The largest response, overall, was the Pa(L+R) response to 500 Hz. For amplitude ratios, BIC-Pa/Pa(L+R) was larger than Peak A/[V(L+R)].

Conclusion

More neural resources are devoted to binaural function in the cortex than in the brainstem, and more resources are devoted to lower frequencies than to higher frequencies. The adult data confirm that previously recorded infant data reveal binaural immaturity. Longitudinal data should characterize developmental characteristics of binaural function.

Acceptable Noise Level and Psychophysical Masking

Rishiq, D. A., Harkrider, A. W., Hedrick, M. S. — 2012-12-11T11:59:18-08:00

Purpose

Individuals with low acceptable noise levels (ANLs) accept more noise than individuals with high ANLs. To determine whether ANL is influenced more by afferent or efferent cortical responsiveness, the authors measured differences in temporal masking responses between individuals with low versus high ANLs. If listeners with low ANLs have masked thresholds similar to those of listeners with high ANLs, low ANLs may be due to reduced afferent responsiveness affecting both the masker and signal. If, however, listeners with low ANLs have masked thresholds better than that of listeners with high ANLs, there may be a physiological basis for improved selective attention via stronger efferent inhibition of the "unwanted" sound.

Method

Participants were 19 listeners with normal hearing between the ages of 19 and 35. Ten listeners had low ANLs and 9 had high ANLs. All participants were compared using tone-in-noise simultaneous, forward, and backward masking tasks.

Results

Results revealed no observed differences in masked thresholds between the low versus high ANL group. The low ANL group, however, required significantly more threshold runs to achieve criterion necessary for threshold determinations.

Conclusions

Findings suggest that low ANLs are associated with reduced afferent cortical responsiveness and, possibly, decreased sustained attention.

Hearing Aid Instruction Booklets: Employing Usability Testing to Determine Effectiveness

Brooke, R. E., Isherwood, S., Herbert, N. C., Raynor, D. K., Knapp, P. — 2012-12-11T11:59:18-08:00

Purpose

This study implemented performance-based usability and literature testing to determine whether people could use 2 instruction booklets for hearing aids (HAs) to carry out basic maintenance tasks and find and understand key facts.

Method

Using a cross-sectional study design, researchers recruited 40 participants (25 women, 15 men, ages 46–72 years) with no experience of HAs or audiology services to test instruction booklets for a Danalogic and Unitron HA (20 participants each). Participants were asked to follow instructions provided within the booklets to complete common HA tasks (e.g., cleaning the HA and mold and changing the battery) and demonstrate understanding of information. Participants' views of the booklets were then obtained within a short individual interview.

Results

Participants experienced problems in completing all tasks while following instructions provided by the Danalogic and Unitron booklets. Individual interviews highlighted further issues regarding layout, diagrams, and content, including missing information.

Conclusions

Some HA instruction booklets contain information that some users may find difficult to find, understand, and follow. These limitations may negatively impact on HA satisfaction and use. It is recommended that written information for clients be evaluated prior to use. This study supports the premise that performance-based usability and literature testing are appropriate methods to use.

Psychometric Evaluation of Visual Analog Scale for the Assessment of Chronic Tinnitus

Adamchic, I., Langguth, B., Hauptmann, C., Alexander Tass, P. — 2012-12-11T11:59:18-08:00

Purpose

The development of therapeutic interventions for chronic tinnitus requires sensitive and clinically responsive tools to measure treatment-induced changes in tinnitus loudness and annoyance. In this study, the authors evaluated the psychometric properties of patient-reported visual analog scales (VAS) for measuring subjectively perceived tinnitus loudness and annoyance.

Method

The authors analyzed data from a single-blind, randomized, placebo-controlled study of acoustic coordinated reset (CR) neuromodulation in patients with chronic tinnitus (trial registration: "Randomized Evaluation of Sound Evoked Treatment of Tinnitus [RESET] study"; ClinicalTrials.gov identifier: NCT00927121) to assess the reliability, validity, and minimally clinically identifiable difference (MCID) of the VAS loudness and VAS annoyance. The VAS loudness and VAS annoyance were completed at screening, at baseline, and at 5 visits during the 16 weeks of the clinical study. Data were analyzed with respect to test–retest reliability, validity, and MCID.

Results

VAS loudness and VAS annoyance showed good test-retest reliability of .8 and .79, respectively. In terms of convergent validity, VAS loudness and VAS annoyance correlated well with the tinnitus questionnaire at all clinical visits (max r = .67, p < .05). MCID estimates clustered between 10 and 15 points.

Conclusion

VAS loudness and VAS annoyance are valid and effective measurements for capturing reductions in tinnitus severity in patients with chronic tinnitus.

Suppression of the Vestibulo-Ocular Reflex Using Visual and Nonvisual Stimuli

Jacobson, G. P., Piker, E. G., Do, C., McCaslin, D. L., Hood, L. — 2012-12-11T11:59:18-08:00

Purpose

To determine to what extent attention directed toward visual, auditory, somesthetic, and imaginary sources would attenuate the vestibulo-ocular reflex (VOR).

Method

Two prospective studies included 16 (Investigation 1) and 5 (Investigation 2) healthy participants (mean age of 24 years in Investigation 1 and 37 years in Investigation 2). VOR gain was assessed with a commercially available rotary chair and was measured in dark both while the subject was tasked with mental alerting exercises and while not being tasked. VOR suppression was measured for the following conditions: (a) visual suppression, (b) auditory suppression, (c) somatosensory suppression, (d) imaginary visual target suppression, and (e) combined auditory and somatosensory suppression.

Results

Attention directed to visual source attenuated the VOR by approximately 85%. Attention directed toward auditory and somatosensory targets (both separately and combined) and attention directed toward an imaginary target suppressed the VOR between 28% and 44%. The extent of VOR suppression that occurred with attention directed toward various nonvisual stimuli was significantly less than the visual suppression of the VOR. The various nonvisual conditions were not statistically different from one another.

Conclusion

The data suggest that it is possible for typical adults to suppress the VOR in the absence of a visual target. That is, the VOR can be attenuated with attention directed toward chair-fixed visual, auditory, somatosensory, and imaginary targets.

Stimuli and Normative Data for Detection of Ling-6 Sounds in Hearing Level

2012-12-11T11:59:18-08:00

Purpose

The purpose of this work was to develop and evaluate a calibrated version of the Ling-6 sounds for evaluation of aided detection thresholds. Stimuli were recorded, and data from calibration values in dB HL were developed. Aided performance was characterized in adults and children.

Method

Stimuli were recorded, prepared, and transferred to a CD for testing. Initial testing was completed on 29 normally hearing young adults to determine typical responses in dB SPL and reliability. Corrections to dB HL were determined for each stimulus. Twenty-seven adults and 5 children with hearing losses were tested.

Results

Average normal sound field thresholds were 1 dB HL. Aided thresholds for adults varied with unaided hearing level and were better for low-frequency sounds. Adults and children performed differently, possibly because of greater hearing aid gain for children.

Conclusions

Stimulus preparation and shaping resulted in a recorded, calibrated set of Ling-6 stimuli that provide flat normal thresholds in hearing level for normally hearing listeners. Typical performance ranges may vary with hearing level and prescription. More data are required to fully characterize this trend in the pediatric population.

Effects of Advancing Age and Hearing Loss on Gaps-in-Noise Test Performance

John, A. B., Hall, J. W., Kreisman, B. M. — 2012-12-11T11:59:18-08:00

Purpose

The present study evaluated the effects of advancing age and sensorineural hearing loss (SNHL) on approximate temporal gap detection thresholds obtained from the Gaps-in-Noise (GIN; Musiek et al., 2005) test.

Method

Approximate thresholds from the GIN test were compared among 3 groups of participants (older adults with SNHL, older adults with essentially normal hearing, and young adults with normal hearing). Analyses of variance and regression modeling were used to determine the effect of age and audibility on GIN performance. Comparisons of thresholds obtained from the 4 test lists of the GIN were also conducted.

Results

Approximate gap thresholds differed significantly across all groups, with the poorest thresholds found in older adults with SNHL and with the best thresholds found in young adults with normal hearing. The strongest predictor of decreases in GIN performance was increased Audibility Index score, but a significant independent effect of age was also documented. Test list influenced GIN performance only in the group of young adults with normal hearing.

Conclusions

The GIN test is a promising clinical measure of temporal resolution. Findings from the present study suggest that age and audibility influence GIN performance and may affect test analysis and interpretation with published normative data.

Determining the Presence or Absence of Middle Ear Disorders: An Evidence-Based Systematic Review on the Diagnostic Accuracy of Selected Assessment Instruments

Sanford, C. A., Schooling, T., Frymark, T. — 2012-12-11T11:59:19-08:00

Purpose

To conduct an evidence-based systematic review on the state of the evidence and the diagnostic accuracy of multifrequency tympanometry (MFT), 1000 Hz tympanometry, and wideband acoustic transfer functions in determining the presence or absence of middle ear disorders.

Method

A systematic search of the literature published between 1975 and 2011 was conducted. Articles meeting the selection criteria were appraised by 2 reviewers and vetted by a 3rd for methodological quality.

Results

Ten studies were included and focused on participants with otosclerosis or otitis media. Two studies investigated 1000 Hz tympanometry, 7 examined MFT, and 2 addressed wideband reflectance (WBR). Methodological quality varied. Positive likelihood ratios (LR+) were predominantly uninformative for MFT and were mixed for 1000 Hz tympanometry. LR+ values for WBR ranged from diagnostically suggestive to informative. Negative likelihood ratios (LR–) for 1000 Hz tympanometry and WBR were at least diagnostically suggestive. LR– values for MFT were mixed, with half considered clinically uninformative and half considered diagnostically suggestive.

Conclusions

Although some of the results are promising, limited evidence and methodological considerations restrict the conclusions that can be drawn regarding the diagnostic accuracy of these technologies. Additional investigations are needed to determine which tools can most accurately predict middle ear status.

An Evidence-Based Systematic Review of Amplitude Compression in Hearing Aids for School-Age Children With Hearing Loss

McCreery, R. W., Venediktov, R. A., Coleman, J. J., Leech, H. M. — 2012-12-11T11:59:19-08:00

Purpose

Two clinical questions were developed: one addressing the comparison of linear amplification with compression limiting to linear amplification with peak clipping, and the second comparing wide dynamic range compression with linear amplification for outcomes of audibility, speech recognition, speech and language, and self- or parent report in children with hearing loss.

Method

Twenty-six databases were systematically searched for studies addressing a clinical question and meeting all inclusion criteria. Studies were evaluated for methodological quality, and effect sizes were reported or calculated when possible.

Results

The literature search resulted in the inclusion of 8 studies. All 8 studies included comparisons of wide dynamic range compression to linear amplification, and 2 of the 8 studies provided comparisons of compression limiting versus peak clipping.

Conclusions

Moderate evidence from the included studies demonstrated that audibility was improved and speech recognition was either maintained or improved with wide dynamic range compression as compared with linear amplification. No significant differences were observed between compression limiting and peak clipping on outcomes (i.e., speech recognition and self-/parent report) reported across the 2 studies. Preference ratings appear to be influenced by participant characteristics and environmental factors. Further research is needed before conclusions can confidently be drawn.

An Evidence-Based Systematic Review of Directional Microphones and Digital Noise Reduction Hearing Aids in School-Age Children With Hearing Loss

McCreery, R. W., Venediktov, R. A., Coleman, J. J., Leech, H. M. — 2012-12-11T11:59:19-08:00

Purpose

The purpose of this evidence-based systematic review was to evaluate the efficacy of digital noise reduction and directional microphones for outcome measures of audibility, speech recognition, speech and language, and self- or parent-report in pediatric hearing aid users.

Method

The authors searched 26 databases for experimental studies published after 1980 addressing one or more clinical questions and meeting all inclusion criteria. The authors evaluated studies for methodological quality and reported or calculated p values and effect sizes when possible.

Results

A systematic search of the literature resulted in the inclusion of 4 digital noise reduction and 7 directional microphone studies (in 9 journal articles) that addressed speech recognition, speech and language, and/or self- or parent-report outcomes. No digital noise reduction or directional microphone studies addressed audibility outcomes.

Conclusions

On the basis of a moderate level of evidence, digital noise reduction was not found to improve or degrade speech understanding. Additional research is needed before conclusions can be drawn regarding the impact of digital noise reduction on important speech, language, hearing, and satisfaction outcomes. Moderate evidence also indicates that directional microphones resulted in improved speech recognition in controlled optimal settings; however, additional research is needed to determine the effectiveness of directional microphones in actual everyday listening environments.

An Evidence-Based Systematic Review of Frequency Lowering in Hearing Aids for School-Age Children With Hearing Loss

McCreery, R. W., Venediktov, R. A., Coleman, J. J., Leech, H. M. — 2012-12-11T11:59:19-08:00

Purpose

We developed 1 clinical question for this review, which addressed the comparison of hearing aids using frequency lowering compared to conventional processing amplification for outcomes of audibility, speech recognition, speech and language, and self- or parent-report for children with hearing loss.

Method

We systematically searched 26 databases for studies addressing a clinical question and meeting all inclusion criteria. We evaluated studies for methodological quality and reported or calculated effect sizes when possible.

Results

The literature search resulted in the inclusion of 5 studies. We implemented several different frequency-lowering strategies across studies; 2 studies used nonlinear frequency compression, 2 used frequency transposition, and 1 used frequency compression with dynamic consonant boost.

Conclusions

Whereas methodological limitations of the included studies preclude the formulation of strong conclusions, findings were generally positive across frequency-lowering strategies and outcomes. Additional high-quality research is needed in this area.

An Introduction to the Second Starkey Research Summit

Abrams, H. B. — 2012-12-11T11:59:19-08:00

Purpose

In the coming decades, Americans with hearing and cognitive deficits will represent a growing proportion of the population. This article describes the rationale and goals of the second Starkey Research Summit, which was convened to better understand the challenges that an aging demographic represents to the future of hearing health care.

Method

A multidisciplinary group of scientists representing audiology, cognitive science, psychology, aging, and hearing science met in the fall of 2011 to explore key issues associated with the convergence of aging, hearing loss, and cognitive deficit.

Results

Four major topic areas were identified for discussion and further exploration: (a) the effects of aging on auditory processing and cognition; (b) the effects of hearing technology on auditory processing and cognition in the elderly; (c) the effects of training on auditory processing and cognition in the elderly; and (d) the effects of aging on hearing help-seeking behavior.

Conclusion

A brief overview of each of the four major topic areas, to include the identification of unmet research needs, was prepared and is included in this issue of the American Journal of Audiology.

Older Adults and Hearing Help-Seeking Behaviors

Saunders, G. H., Chisolm, T. H., Wallhagen, M. I. — 2012-12-11T11:59:19-08:00

Purpose

To review the current literature on help seeking for hearing health care among older adults.

Method

The authors conducted a literature review regarding help seeking for hearing-related communication difficulties as well as for other chronic medical conditions.

Results

Untreated hearing loss can lead to numerous negative secondary consequences; uptake and use of hearing aids remain low, despite the fact that hearing aids provide an effective treatment option for older adults with hearing loss. The authors describe models relevant to understanding the help-seeking and decision-making behaviors of older adults with hearing loss and discuss recommendations for future research.

Conclusion

Because of the considerable overlap in factors associated with help-seeking behaviors across chronic medical conditions and because help-seeking behaviors are complex, help seeking should be examined within the framework of a multifactorial model, such as the health belief model or the transtheoretical stages of change model.

Hearing Technology and Cognition

Kalluri, S., Humes, L. E. — 2012-12-11T11:59:19-08:00

Purpose

To summarize existing data on the interactions of cognitive function and hearing technology in older adults.

Method

A narrative review was used to summarize previous data for the short-term interactions of cognition and hearing technology on measured outcomes. For long-term outcomes, typically for 3–24 months of hearing aid use, a computerized database search was conducted.

Results

There is accumulating evidence that cognitive function can impact outcomes following immediate or short-term use of hearing aids and that hearing aids can impact immediate cognitive function. There is limited evidence regarding the long-term impact of hearing aids on cognition, and the most rigorous studies in this area have not observed a positive effect.

Conclusions

Although interactions have been observed between cognition and use of hearing aids for measures obtained following immediate or short-term usage of hearing technology, limited evidence is available following long-term usage, and that evidence that is available does not support an effect of hearing aids on cognitive function. More research is needed, however, including rigorous studies of older adults following longer periods of hearing aid usage.

The Effects of Aging on Auditory Processing and Cognition

Tun, P. A., Williams, V. A., Small, B. J., Hafter, E. R. — 2012-12-11T11:59:19-08:00

Purpose

To briefly summarize existing data on effects of aging on auditory processing and cognition.

Method

A narrative review summarized previously reported data on age-related changes in auditory processing and in cognitive processes with a focus on spoken language comprehension and memory. In addition, recent data on effects of lifestyle engagement on cognitive processes are reviewed.

Results

There is substantial evidence for age-related declines in both auditory processes and cognitive abilities. Accumulating evidence supports the idea that the perceptual burden associated with hearing loss impacts the processing resources available for good comprehension and memory for spoken language, particularly in older adults with limited resources. However, many language abilities are well preserved in old age, and there is considerable variability among individuals in cognitive performance across the life span. The authors discuss how lifestyle factors and socioemotional engagement can help to offset declining abilities.

Conclusions

It is clear that spoken language processing in adulthood and old age is affected by changes in perceptual, cognitive, and socioemotional processes as well as by interactions among these changes. Recommendations for further research include studying speech comprehension in complex conditions, including meaningful-connection spoken language, and tailoring clinical interventions based on patients' auditory processing and cognitive abilities along with their individual socioemotional demands.

Speech Comprehension Training and Auditory and Cognitive Processing in Older Adults

Pichora-Fuller, M. K., Levitt, H. — 2012-12-11T11:59:19-08:00

Purpose

To provide a brief history of speech comprehension training systems and an overview of research on auditory and cognitive aging as background to recommendations for future directions for rehabilitation.

Method

Two distinct domains were reviewed: one concerning technological and the other concerning psychological aspects of training. Historical trends and advances in these 2 domains were interrelated to highlight converging trends and directions for future practice.

Results

Over the last century, technological advances have influenced both the design of hearing aids and training systems. Initially, training focused on children and those with severe loss for whom amplification was insufficient. Now the focus has shifted to older adults with relatively little loss but difficulties listening in noise. Evidence of brain plasticity from auditory and cognitive neuroscience provides new insights into how to facilitate perceptual (re-)learning by older adults.

Conclusions

There is a new imperative to complement training to increase bottom-up processing of the signal with more ecologically valid training to boost top-down information processing based on knowledge of language and the world. Advances in digital technologies enable the development of increasingly sophisticated training systems incorporating complex meaningful materials such as music, audiovisual interactive displays, and conversation.