American Journal of Audiology recent issues

The More Things Change [Editorial]

Pratt, S. R. — 2009-06-03

Laryngologist Leon Zamenhof--Brother of Dr. Esperanto [Perspective]

Wincewicz, A., Sulkowska, M., Musiatowicz, M., Sulkowski, S. — 2009-06-03

Purpose

To reconstruct the biography of the Polish otorhinolaryngologist Leon Zamenhof (1875–1934), a brother of Ludwik Zamenhof, who is famous for invention of the international language Esperanto.

Method

Biographical information was collected from pre-World War II resources.

Results

Zamenhof developed several important new forms of treatment to help the hearing impaired. Zamenhof was especially interested in the education of deaf children and the therapy necessary to facilitate their integration into society. His significant achievements were a phonetic method of therapy for the hearing impaired and an automatic device for ear insufflation that was considered indispensable in the management of pyorrhea. In addition, Zamenhof initiated various forms of social support among physicians within the medical community of Warsaw, Poland; made health care available to children with hearing impairments; and organized a Jewish school for deaf children. Zamenhof tried to change public attitudes toward deafness, working to promote the integration of the deaf into wider society. He also translated Polish literature into Esperanto.

Conclusions

With similar aims to his brother Ludwik, Leon Zamenhof strived to enhance and broaden communication among people who could not hear and to persuade people to change their attitudes about deafness.

Patient-Centered Tinnitus Management Tool: A Clinical Audit [Clinical Focus • Innovation]

Aazh, H., Moore, B. C. J., Roberts, P. — 2009-06-03

Purpose

To evaluate the impact of an educational poster describing treatment options available to patients experiencing tinnitus.

Method

A patient-centered tinnitus management tool (PCTMT) was developed in the form of an educational poster that encouraged patients to decide how they wanted to deal with their tinnitus from the following options: (a) ignore the tinnitus and forget about it, (b) use a sound generator, (c) undertake tinnitus counseling with an expert, or (d) deal with the tinnitus using hearing aids (in the case of tinnitus and hearing loss). Fifty-five patients who were referred to the audiology department of a London hospital from the ENT department for tinnitus counseling were asked to read the PCTMT and to choose the option(s) that suited them the best.

Results

Forty-two percent of the patients wished to undertake counseling, 9% decided to try to ignore their tinnitus without help, 26% wanted to deal with their tinnitus with the help of a sound generator, and 24% decided to use hearing aids.

Conclusions

The PCTMT reduced the number of patients who would otherwise have been referred for tinnitus counseling by 58%. This reduced the length of the waiting list and increased the time available for counseling of those patients who wanted it.

Consistency of Hearing Aid Use in Infants With Early-Identified Hearing Loss [Research and Technology • Paper]

Moeller, M. P., Hoover, B., Peterson, B., Stelmachowicz, P. — 2009-06-03

Purpose

To examine the consistency of hearing aid use by infants. A goal was to identify maternal, child, and situational factors that affected consistency of device use.

Method

Maternal interviews were conducted using a nonvalidated structured interview (Amplification in Daily Life Questionnaire) that included 5-point Likert scale items and open-ended questions. Participants were mothers of 7 infants with mild to moderately severe hearing loss who were enrolled in a longitudinal study. Data were collected at 4 intervals (10.5–12, 16.5, 22.5, and 28.5 months old).

Results

Consistency of amplification use was variable at early ages but improved with age. By age 28.5 months, toddlers used amplification regularly in most settings. Selected daily situations (e.g., in car or outdoors) were more challenging for maintaining device use than contexts where the child was closely monitored. Only 2 families established early, consistent full-time use across all contexts examined. Qualitative results were used to identify familial, developmental, and situational variables that influenced the consistency of infant/toddler device use.

Conclusion

Families may benefit from audiologic counseling that acknowledges the multifaceted challenges that arise. Audiologists can work in partnership with families to promote consistent device use across a variety of daily situations.

Newborn Hearing Screening Follow-Up: Factors Affecting Hearing Aid Fitting by 6 Months of Age [Research and Technology • Article]

Spivak, L., Sokol, H., Auerbach, C., Gershkovich, S. — 2009-06-03

Purpose

To determine the extent to which the goal of hearing aid fitting by 6 months of age is being achieved and to identify barriers to achieving that goal.

Method

Screening and follow-up records from 114,121 infants born at 6 hospitals were collected over a 6-year period. Infants diagnosed with permanent hearing loss requiring amplification were categorized as fit on time, fit late, or lost to follow-up. Seven factors were empirically identified as potential barriers to timely intervention.

Results

Ninety-one percent of referred infants returned for follow-up evaluation. Hearing aids were fit on 107 of the 192 infants requiring amplification. Thirty-nine percent were fit on time, and 61% were fit late or lost to follow-up. Unilateral hearing loss and late diagnosis were statistically significant (p < .0001) predictors for late fitting and loss to follow-up. Conductive hearing loss and coverage by Medicaid were also statistically significant (p < .0001) predictors for loss to follow-up.

Conclusion

High return rate for follow-up does not ensure hearing aid fitting by 6 months of age. Infants with unilateral hearing loss are at particular risk of being lost to follow-up.

Test Order Effects of Computerized Dynamic Posturography and Calorics [Research and Technology • Article]

Bernstein, J., Burkard, R. — 2009-06-03

Purpose

To determine whether there is a test order effect of the caloric subtest of videonystagmography on the Sensory Organization Test (SOT) of computerized dynamic posturography, and to assess the learning effect of multiple posturography test sessions on the SOT score.

Method

Scores on the 6 SOT conditions before and after caloric testing were compared for 10 participants age 18–36 years. Four SOT sessions were completed prior to caloric testing to assess the presence of a learning effect and establish precaloric baseline SOT scores. All participants had normal vestibular systems with no history of dizziness or imbalance.

Results

Caloric testing had a significant effect on the equilibrium score for only 1 of 6 test conditions. While meeting statistical significance, the actual change in score for this condition was very small. Equilibrium scores improved for the more difficult test conditions between the 1st and 2nd SOT sessions.

Conclusion

Results indicate that there are minimal test order effects of calorics on the SOT. Results confirm that a significant improvement in score for more challenging test conditions occurs between SOT Sessions 1 and 2 as a result of learning. Therefore, clinicians must be cautious when using posturography to monitor patient improvement.

Hearing Aid Outcomes for Listeners With High-Frequency Hearing Loss [Research and Technology • Article]

Roup, C. M., Noe, C. M. — 2009-06-03

Purpose

To determine whether listeners with primarily high-frequency sensorineural hearing loss (HF SNHL) perceived benefit from amplification provided by completely-in-the-canal (CIC) hearing aids.

Method

The Hearing Handicap for the Elderly—Screening version, the Abbreviated Profile of Hearing Aid Benefit, and the Satisfaction With Amplification in Daily Life questionnaires were mailed to 2 groups of listeners (n = 79) who matched preset criteria, including threshold at 2000 Hz and use of CIC amplification. Sixty-seven percent (n = 53) of the questionnaires were returned and were divided into 2 groups. Group I (n = 26) consisted of listeners with normal hearing through 2000 Hz, and Group II (n = 27) consisted of listeners with normal hearing only through 1000 Hz.

Results

Results revealed that both groups perceived significant hearing handicap, hearing aid benefit, and hearing aid satisfaction. Differences between the 2 groups on the 3 measures, however, were not statistically significant.

Conclusions

Listeners with HF SNHL perceived benefit and satisfaction from amplification with CIC hearing aids. Individuals with SNHL limited to the high frequencies should be considered candidates for amplification.

Head Shake Computerized Dynamic Posturography in Peripheral Vestibular Lesions [Research and Technology • Article]

Mishra, A., Davis, S., Speers, R., Shepard, N. T. — 2009-06-03

Purpose

To determine the sensitivity of a head shake modification to the Sensory Organization Test (SOT) of dynamic posturography in identifying (a) those patients with unilateral, peripheral vestibular hypofunction as indicated by caloric irrigation findings and (b) those patients who report that head movements provoke disruption in postural control.

Method

A prospective, single-blinded, random selection methodology was used with 91 patients stratified by the presence or absence of a significant caloric asymmetry and by the presence or absence of head movement provoked symptoms (independent variables). Postural control performance, as measured by EquiTest during the standard test and a head shake modification, served as the dependent variables.

Results

Receiver operating characteristic curves demonstrated only minor improvement in sensitivity (a) with the head shake modification for unilateral peripheral asymmetry and (b) for identification of those with complaints of head movement provoked imbalance.

Conclusions

The head shake modification to standard SOT increased the test sensitivity to identification of patients with unilateral, peripheral vestibular hypofunction and those with head movement provoked symptoms. However, this occurred with low specificity, resulting in no significant improvement in overall performance with this head shake protocol. Suggestions for further research to improve the performance of the head shake modification of SOT for clinical application are discussed.

Analysis of Distortion Product Otoacoustic Emission Spectra in Normal-Hearing Adults [Research and Technology • Article]

Bhagat, S. — 2009-06-03

Purpose

To evaluate the ability of distortion product otoacoustic emission (DPOAE) spectral characteristics to distinguish between ears with variable hearing sensitivity within the normal range.

Method

Distortion product grams (DP-grams) were acquired with primary tones decremented in 1/8-octave steps and primary-tone levels presented at 65 dB SPL (L1) and 45 dB SPL (L2) across an f2 frequency range of 842–7996 Hz from 22 normal-hearing adults (44 ears). Hearing thresholds of ears classified in Group A (n = 22) were better than ears classified in Group B (n = 22). Examined parameters of the DP-grams included spectral peak occurrence, peak height, peak width, and DPOAE levels. Analyses of variance were conducted to determine whether DP-gram parameters differed between Group A and Group B.

Results

For the low-resolution DP-grams examined in this study, no significant between-group differences in peak occurrence, peak height, and peak width were observed. DPOAE levels were significantly higher in ears classified in Group A compared with ears classified in Group B in individuals with symmetrical hearing.

Conclusions

Although spectral peaks are evident in DP-grams acquired with low resolution of the primary tones, DPOAE levels are more effective in distinguishing ears with greater hearing sensitivity from less sensitive ears.

Do Experienced Hearing Aid Users Know How to Use Their Hearing Aids Correctly? [Research and Technology • Article]

Desjardins, J. L., Doherty, K. A. — 2009-06-03

Purpose

To assess experienced hearing aid users' ability to use their hearing aids correctly.

Method

In this study, we developed the Practical Hearing Aid Skills Test (PHAST) to objectively test a hearing aid user's ability to manipulate his or her hearing aids. The PHAST requires hearing aid users to perform 8 hearing aid care and use tasks that are basic skills typically taught to new hearing aid users at the time of their hearing aid fitting. The PHAST was administered to a group of 50 experienced hearing aid users. In addition, participants were administered questionnaires about hearing aid satisfaction (i.e., Satisfaction With Amplification in Daily Life; R. M. Cox & G. C. Alexander, 1999), benefit (i.e., Abbreviated Profile of Hearing Aid Benefit; R. M. Cox & G. C. Alexander, 1995), and use.

Results

Participants' performance on the PHAST ranged from 48% to 100%, and the scores were normally distributed around the mean (78.56%). No significant relationship was observed between the PHAST and any of the other tests administered in this study. The only variable significantly associated with participants' performance on the PHAST was age.

Conclusions

Results from this study suggest that experienced hearing aid users range from having an excellent understanding of how to use their hearing aids to a poor understanding. The variability in performance among experienced hearing aid users highlights the importance of directly assessing a client's ability to use his or her hearing aids.

A Selective Annotated Bibliography for Clinical Audiology (1988-2008): Reference Works [Supplement]

Ferrer-Vinent, S. T., Ferrer-Vinent, I. J. — 2009-06-03

Purpose

This is the 1st in a series of 3 planned companion articles that present a selected, annotated, and indexed bibliography of clinical audiology publications from 1988 to 2008.

Method

Research and preparation of the bibliography were based on published guidelines, professional audiology experience, and professional librarian experience.

Results

This article presents reference works (dictionaries, encyclopedias, handbooks, and manuals). The future planned articles will cover other monographs, periodicals, and online resources.

Conclusions

Audiologists and librarians can use these lists as a guide when seeking clinical audiology literature.

Advancing Tinnitus Research: Tales From a Grand Meeting at Grand Island, NY [Editorial]

Cacace, A. T. — 2008-12-04

Summary Publication Statistics for 2005-2007 [Editor's Report]

2008-12-04

Automated Pure-Tone Audiometry: An Analysis of Capacity, Need, and Benefit [Perspective]

Margolis, R. H., Morgan, D. E. — 2008-12-04

Purpose

The rationale for automating pure-tone audiometry based on the need for hearing tests and the capacity of audiologists to provide testing is presented. The personnel time savings from automated testing are analyzed. Some possible effects of automated testing on the profession are explored.

Method

Need for testing was based on prevalence of hearing impairment, number of normal hearing patients seen for testing, and an assumption of the frequency of testing. Capacity is based on the number of audiologists and the number of audiograms performed in a typical workday. Time savings were estimated from the average duration of an audiogram and an assumption that 80% can be automated.

Results

A large gap exists between the need and the capacity of audiologists to provide testing. Automating 80% of audiograms would only partially close the gap. A significant time savings could accrue, permitting reallocation of time for doctoral level services.

Conclusion

Although certain jobs could be affected, the gap between capacity and need is so great that automated audiometry will not significantly affect employment. Automation could increase the number of hearing impaired patients that could be served. The reallocation of personnel time would be a positive change for our patients and our profession.

Remote Hearing Screenings via Telehealth in a Rural Elementary School [Paper]

Lancaster, P., Krumm, M., Ribera, J., Klich, R. — 2008-12-04

Purpose

Telehealth (telepractice) is the provision of health care services using telecommunications. Telehealth technology typically has been employed to increase the level of health care access for consumers living in rural communities. In this way, audiologists can use telehealth to provide services in the rural school systems. This is important because school hearing screening programs are the foundation of educational audiology programs. Therefore, the goal of this study was to determine the feasibility of providing hearing screening services by telehealth technology to school-age children.

Method

Hearing screening services—including otoscopy, pure-tone, and immittance audiometry—were conducted on 32 children in 3rd grade attending an elementary school in rural Utah. Each child received 1 screening on-site and another through telehealth procedures.

Results

Immittance and otoscopy results were identical for on-site and telehealth screening protocols. Five children responded differently to pure-tone stimuli presented by the telehealth protocol than by the on-site protocol. However, no statistically significant difference was found for pure-tone screening results obtained by telehealth or on-site screening procedures (binomial test, p = .37). Likewise, overall screening results obtained by traditional and telehealth procedures were not statistically significant (binomial test, p = .37).

Conclusion

The results of this study suggest that school hearing screenings may be provided using telehealth technology. This study did find that 5 students performed differently to pure-tone screenings administered by the telehealth protocol in contrast to on-site hearing screening services. Further research is necessary to identify factors leading to false responses to pure-tone hearing screening when telehealth technology is used. In addition, telehealth hearing screening protocols should be conducted with participants of different age groups and experiencing a wide range of hearing loss to further clarify the value of telehealth technology.

Exposure to Disability and Hearing Loss Narratives in Undergraduate Audiology Curriculum [Paper]

Berg, A. L., Canellas, M., Salbod, S., Velayo, R. — 2008-12-04

Purpose

To determine whether exposure to disability and hearing loss narratives increased undergraduate communication sciences and disorders (CSD) students' affective responses to scenarios of individuals with hearing impairment.

Method

Thirty-five CSD undergraduates responded to 8 scenarios (K. English, L. L. Mendel, T. Rojeski, & J. Hornak, 1999). Sixteen students completed a course in audiologic rehabilitation with no exposure to disability and hearing loss narratives; 19 students completed the same course with exposure. Two audiologists, independent and blind to group status, rated the 35 student responses for affective and technical content.

Results

Students exposed to the narratives incorporated more affective elements into their technical responses than students not exposed.

Conclusions

Narratives appear to be effective in increasing affective elements in students' technical/informational responses and may have a place and be of value in undergraduate CSD curriculum.

Acceptance of Noise With Intelligible, Reversed, and Unfamiliar Primary Discourse [Paper]

Gordon-Hickey, S., Moore, R. E. — 2008-12-04

Purpose

The purpose of this study was to investigate the effects of intelligible and unintelligible primary discourse on acceptance of noise. Of particular interest was the effect of intelligibility on the most comfortable loudness (MCL) component of acceptable noise level (ANL).

Method

ANLs were measured for 30 participants using an intelligible discourse, a reversed discourse, and an unfamiliar primary discourse. For each discourse, MCL and background noise level (BNL) were found. The ANL was then computed by subtracting the mean BNL from the MCL.

Results

The intelligibility of the primary discourse did not affect MCL. The ANL was significantly different for the intelligible versus reversed condition and the intelligible versus unfamiliar (Chinese) condition.

Conclusion

Results indicate that ANL may change as speech intelligibility changes and/or speech recognition ability decreases in adults with normal hearing.

Long-Term Usage of Modern Signal Processing by Listeners With Severe or Profound Hearing Loss: A Retrospective Survey [Paper]

Keidser, G., Hartley, D., Carter, L. — 2008-12-04

Purpose

To investigate the long-term benefit of multichannel wide dynamic range compression (WDRC) alone and in combination with directional microphones and noise reduction/speech enhancement for listeners with severe or profound hearing loss.

Method

At the conclusion of a research project, 39 participants with severe or profound hearing loss were fitted with WDRC in one program and WDRC with directional microphones and speech enhancement enabled in a 2nd program. More than 2 years after the 1st participants exited the project, a retrospective survey was conducted to determine the participants' use of, and satisfaction with, the 2 programs.

Results

From the 30 returned questionnaires, it seems that WDRC is used with a high degree of satisfaction in general everyday listening situations. The reported benefit from the addition of a directional microphone and speech enhancement for listening in noisy environments was lower and varied among the users. This variable was significantly correlated with how much the program was used.

Conclusions

The less frequent and more varied use of the program with directional microphones and speech enhancement activated in combination suggests that these features may be best offered in a 2nd listening program for listeners with severe or profound hearing loss.

Dorsal Cochlear Nucleus Hyperactivity and Tinnitus: Are They Related? [Supplement]

Kaltenbach, J. A., Godfrey, D. A. — 2008-12-04

Purpose

Eight lines of evidence implicating the dorsal cochlear nucleus (DCN) as a tinnitus contributing site are reviewed. We now expand the presentation of this model, elaborate on its essential details, and provide answers to commonly asked questions regarding its validity.

Conclusions

Over the past decade, numerous studies have converged to support the hypothesis that the DCN may be an important brain center in the generation and modulation of tinnitus. Although other auditory centers have been similarly implicated, the DCN deserves special emphasis because, as a primary acoustic nucleus, it occupies a potentially pivotal position in the hierarchy of functional processes leading to the emergence of tinnitus percepts. Moreover, because a great deal is known about the underlying cellular categories and the details of synaptic circuitry within the DCN, this brain center offers a potentially powerful model for probing mechanisms underlying tinnitus.

Role of Auditory Cortex in Noise- and Drug-Induced Tinnitus [Supplement]

Eggermont, J. J. — 2008-12-04

Purpose

To elucidate the role of auditory cortex in tinnitus.

Method

Neurophysiological findings in cat auditory cortex following noise trauma or the application of salicylate and quinine, all expected to induce tinnitus, were reviewed. Those findings were interpreted in the context of what is expected from studies in humans, specifically in the brains of people with tinnitus.

Results

Tinnitus is an auditory percept to which several central structures in the auditory system may contribute. Because the central auditory system has both feed-forward connections and feedback connections, it can be described as a set of nested loops. Once these loops become activated in a pathological fashion, as they may be in tinnitus, it becomes hard to assign importance to each contributing structure. Strongly interconnected networks, that is, neural assemblies, may be determining the quality of the tinnitus percept.

Conclusion

It is unlikely that tinnitus is the expression of a set of independently firing neurons, and more likely that it is the result of a pathologically increased synchrony between sets of neurons. There is clear evidence for this from both evoked potentials and from neuron-pair synchrony measures.

Mechanisms of Synaptic Plasticity in the Dorsal Cochlear Nucleus: Plasticity-Induced Changes That Could Underlie Tinnitus [Supplement]

Tzounopoulos, T. — 2008-12-04

Purpose

Tinnitus is the persistent perception of a subjective sound. Tinnitus is almost universally experienced in some forms. In most cases, recovery may occur in seconds, hours, or days. How does tinnitus shift from a transient condition to a lifelong disorder? Several lines of evidence, including clinical studies and animal models, indicate that the brain, rather than the inner ear, may in some cases be the site of maintenance of tinnitus. One hypothesis is that normal electrical activity in the auditory system becomes pathologically persistent due to plasticity-like mechanisms that can lead to long-term changes in the communication between neurons. A candidate site for the expression of this so-called synaptic plasticity is a region of the brainstem called the dorsal cochlear nucleus (DCN), a site of integration of acoustic and multimodal, sensory inputs.

Conclusions

Here we review recent findings on cellular mechanisms observed in the DCN that can lead to long-term changes in the synaptic strength between different neurons in the DCN. These cellular mechanisms could provide candidate signaling pathways underlying the induction (ignition) and/or the expression (maintenance) of tinnitus.

Identifying Tinnitus Subgroups With Cluster Analysis [Supplement]

Tyler, R., Coelho, C., Tao, P., Ji, H., Noble, W., Gehringer, A., Gogel, S. — 2008-12-04

Purpose

We believe it is important to uncover tinnitus subgroups to identify subsets of patients most likely to benefit from different treatments. We review strategies for subgrouping based on etiology, subjective reports, the audiogram, psychoacoustics, imaging, and cluster analysis.

Method

Preliminary results of a 2-step cluster analysis based on 246 participants from whom we had 26 categorical and 25 continuous variables were determined.

Results

A 4-cluster solution suggested the following subgroups: (a) constant distressing tinnitus, (b) varying tinnitus that is worse in noise, (c) tinnitus patients who are copers and whose tinnitus is not influenced by touch (somatic modulation), and (d) tinnitus patients who are copers but whose tinnitus is worse in quiet environments.

Conclusions

Subgroups of tinnitus patients can be identified by using statistical approaches. The subgroups we identify here represent a preliminary attempt at identifying such patients. One next step would be to explore clinical trials of tinnitus treatments based on subgroup analyses or on using subgroups in the selection criteria.

Gap Detection Methods for Assessing Salicylate-Induced Tinnitus and Hyperacusis in Rats [Supplement]

Turner, J. G., Parrish, J. — 2008-12-04

Purpose

A variety of options for behavioral assessment of tinnitus in laboratory animals are available to researchers today. These options are briefly reviewed, followed by data suggesting that gap detection procedures might be used to efficiently measure acute, salicylate-induced tinnitus and possibly hyperacusis in rats.

Method

Fischer Brown Norway rats (n = 10) were given intraperitoneal injections of 350 mg/kg sodium salicylate on 2 consecutive days, and the effects on gap detection were observed across 9 different frequency bands. Pretest, posttest, and washout data were collected. An additional 4 rats were each given 4 different doses of sodium salicylate (0, 150, 250, and 300 mg/kg), and gap detection and prepulse inhibition were measured.

Results

Significant gap detection deficits were observed from pre- to posttest that were consistent with tinnitus. Consistent gap detection deficits were found using broadband noise backgrounds, while significant improvements in responding to frequency-specific test bands were found. Similar effects were repeated in the dose response portion of the study.

Conclusions

Gap detection procedures efficiently measured salicylate-induced changes in behavior that were consistent with the presence of tinnitus. In addition, the reliable, stronger responses at many frequencies after salicylate injections suggest the possibility of measuring a hyperacusis-like phenomenon using these methods.

Cross-Modal Interactions of Auditory and Somatic Inputs in the Brainstem and Midbrain and Their Imbalance in Tinnitus and Deafness [Supplement]

Dehmel, S., Cui, Y. L., Shore, S. E. — 2008-12-04

Purpose

This review outlines the anatomical and functional bases of somatosensory influences on auditory processing in the normal brainstem and midbrain. It then explores how interactions between the auditory and somatosensory system are modified through deafness, and their impact on tinnitus is discussed.

Method

Literature review, tract tracing, immunohistochemistry, and in vivo electrophysiological recordings were used.

Results

Somatosensory input originates in the dorsal root ganglia and trigeminal ganglia, and is transmitted directly and indirectly through 2nd-order nuclei to the ventral cochlear nucleus, dorsal cochlear nucleus (DCN), and inferior colliculus. The glutamatergic somatosensory afferents can be segregated from auditory nerve inputs by the type of vesicular glutamate transporters present in their terminals. Electrical stimulation of the somatosensory input results in a complex combination of excitation and inhibition, and alters the rate and timing of responses to acoustic stimulation. Deafness increases the spontaneous rates of those neurons that receive excitatory somatosensory input and results in a greater sensitivity of DCN neurons to trigeminal stimulation.

Conclusions

Auditory-somatosensory bimodal integration is already present in 1st-order auditory nuclei. The balance of excitation and inhibition elicited by somatosensory input is altered following deafness. The increase in somatosensory influence on auditory neurons when their auditory input is diminished could be due to cross-modal reinnervation or increased synaptic strength, and may contribute to mechanisms underlying somatic tinnitus.

Toward Developing Constructive Collaborations [Editorial]

Cacace, A. T. — 2008-06-02

Use of a Hearing and Balance Screening Survey With Local Primary Care Physicians [Innovation]

Danhauer, J. L., Celani, K. E., Johnson, C. E. — 2008-06-02

Purpose

This investigation is a follow-up to a national survey of hearing/balance screening and referrals in elderly patients by primary care physicians (PCPs). This local study focused on PCPs who actually treated elderly patients and could be contacted and followed in a single community.

Method

PCPs in Santa Barbara, CA, were surveyed with a 35-item questionnaire via mailings, phone calls, and hand delivery to determine their participation in, knowledge of, and attitudes toward hearing/balance screening and referrals for the elderly. Potential respondents were 154 PCPs obtained from WebMD, Google, and telephone and provider directories for Santa Barbara. Of the 154 surveys mailed/delivered, 33 were returned undeliverable or unusable, and 32 were returned usable, producing an overall response rate of 26.5%.

Results

Results were similar to those of the national study; PCPs were unlikely to screen for hearing/balance problems unless patients complained. The PCPs were unaware of patient self-report screening methods and probably would not use them in the future.

Conclusions

These PCPs acknowledged the importance of hearing/balance problems in the elderly, but their responses demonstrated insufficiencies in knowledge and potential attitudinal, time, and reimbursement obstacles that could interfere with their screening for hearing/balance problems. Audiologists should partner with PCPs to improve ways of meeting patients' needs but must consider resource/payoff implications for such endeavours.

An Electroacoustic Analysis of Over-the-Counter Hearing Aids [Innovation]

Callaway, S. L., Punch, J. L. — 2008-06-02

Purpose

To determine whether 11 over-the-counter (OTC) hearing devices have the flexibility to provide adequate gain and output for 3 common hearing loss configurations.

Method

The 11 OTC hearing devices were separated into 2 price groups: a low-range group (<$100) consisting of 8 hearing devices and a midrange group ($100–$500) consisting of 3 hearing devices. Gain and output were prescribed for 3 hearing loss configurations using National Acoustic Laboratories prescriptive procedures. Low-range hearing devices were measured electroacoustically, and technical specifications were used as the source of electroacoustic information for the midrange hearing devices.

Results

Overall, midrange hearing devices met gain and output targets to a greater extent than did low-range devices. All low-range devices could be classified as special-purpose hearing aids with low-frequency emphasis. The low-range group had high equivalent input noise levels and potentially posed a residual hearing safety hazard.

Conclusions

The low-range OTC devices were found to be electroacoustically inadequate to meet the needs of the hearing impaired. Midrange OTC hearing devices are arguably a good solution for the cost-conscious consumer who cannot afford professional audiologic rehabilitation, especially if considered an interim step in the rehabilitation process.

Establishing a Tinnitus Clinic in Your Practice [Grand Rounds]

Tyler, R. S., Haskell, G. B., Gogel, S. A., Gehringer, A. K. — 2008-06-02

Purpose

While tinnitus is very common among the hearing impaired population, specific treatment for tinnitus is not provided in most clinics. This article provides a plan for establishing a tinnitus treatment program that can be implemented in stages at most audiology clinics.

Method

Preparation for establishing a tinnitus clinic includes having an overall plan regarding the type and degree of tinnitus management. Assessment involves a measurement of tinnitus and of the reaction a patient has to the tinnitus, including the use of handicap questionnaires. Management typically involves some form of counseling and sound therapy. Four problematic areas in tinnitus management are thoughts and emotions, hearing and communication, sleep, and concentration.

Conclusions

Licensed audiologists generally have the essential training necessary to provide counseling and sound therapy to treat tinnitus patients. We introduce 3 levels of treatment implementation, depending on whether the patient is curious, concerned, or distressed. Follow-up and referrals might be necessary in more severe cases. Finally, the development of a tinnitus clinic centers around establishing a need for individual treatment, creating a treatment plan, estimating the need for additional staff and resources, reimbursement options, and assessing the effectiveness of the program.

Parents' Needs Following Identification of Childhood Hearing Loss [Article]

Fitzpatrick, E., Angus, D., Durieux-Smith, A., Graham, I. D., Coyle, D. — 2008-06-02

Purpose

Appropriate support for families of children diagnosed with hearing impairment may have a direct impact on the success of early hearing detection and intervention programs in reducing the negative effects of permanent hearing loss. We conducted a qualitative study to explore parents' needs after learning of their child's hearing loss to better understand the important components of service delivery from families' perspectives.

Method

Semistructured interviews were conducted with 17 families (21 parents) of preschool children in 4 centers in Ontario, Canada. Parents of children identified by neonatal screening as well as those identified through traditional referral routes participated. We asked parents to share their perceptions of the strengths and gaps in the care system.

Results

Although the majority of parents were satisfied with the range and quality of audiology and therapy services available, they identified gaps in the areas of service coordination, availability of information, and the integration of social service and parent support into the system. Access to audiology services appears to have been facilitated for children who were systematically screened.

Conclusions

The findings provide insights into the services most valued by families. These findings highlight the importance of eliciting parents' perspectives in designing optimal care models for children and families.

The Effect of Room Acoustics and Sound-Field Amplification on Word Recognition Performance in Young Adult Listeners in Suboptimal Listening Conditions [Article]

Larsen, J. B., Vega, A., Ribera, J. E. — 2008-06-02

Purpose

To compare the speech recognition performance of young adult listeners with normal hearing in 2 college classrooms, only 1 of which met American National Standards Institute (ANSI) S12.60-2002 acoustic standards. Also, differences in speech recognition performance were compared in both classrooms with and without the use of a classroom amplification system. The speech was presented at low intensity to simulate listening in the rear seats of a large college classroom.

Method

Listeners were randomly assigned seats in the 2 classrooms, and Northwestern University Auditory Test No. 6 (NU-6) words were presented via a loudspeaker from the front of the classroom for all listening conditions as well as through a sound-field infrared system with ceiling-mounted speakers during the amplified condition.

Results

Results showed statistically significant differences in speech recognition performance between classrooms, with and without classroom amplification, and across the rows of each classroom when the classroom amplification system was not used.

Conclusions

These results demonstrate how meeting the ANSI S12.60-2002 standard, which was written for elementary school classrooms, can benefit young adult listeners in postsecondary classrooms. Also, classroom amplification was shown to improve speech recognition for students across the classroom in both acoustically poor and acoustically sound classroom environments.

Measures of Follow-Up in Early Hearing Detection and Intervention Programs: A Need for Standardization [Article]

Mason, C. A., Gaffney, M., Green, D. R., Grosse, S. D. — 2008-06-02

Purpose

To demonstrate the need for standardized data definitions and reporting for early hearing detection and intervention (EHDI) programs collecting information on newborn hearing screening and follow-up, and types of information best collected in a standardized manner.

Method

A hypothetical birth cohort was used to show the potential effects of nonstandardized definitions and data classifications on rates of hearing screening, audiologic follow-up, and hearing loss.

Results

The true screening rate in this cohort was 92.4%. The calculated rate was between 90.0% and 96.5%, depending on the measure used. Among children documented as screened and referred for follow-up, 61.0% received this testing. Only 49.0% were documented to have been tested. Despite a true prevalence of 3.7 per 1,000 births, only 1.5 per 1,000 children were documented with a hearing loss.

Conclusion

Ensuring that children receive recommended follow-up is challenging. Without complete reporting by audiologists to EHDI programs, accurate calculation of performance measures is impossible. Lack of documentation can lead to the overstatement of "loss to follow-up." Also, standardization of measures is essential for programs to evaluate how many children receive recommended services and assess progress toward national goals. A new survey has been implemented to collect more detailed and standardized information about recommended services.

Word Recognition Materials for Native Speakers of Taiwan Mandarin [Article]

Nissen, S. L., Harris, R. W., Dukes, A. — 2008-06-02

Purpose

To select, digitally record, evaluate, and psychometrically equate word recognition materials that can be used to measure the speech perception abilities of native speakers of Taiwan Mandarin in quiet.

Method

Frequently used bisyllabic words produced by male and female talkers of Taiwan Mandarin were digitally recorded and subsequently evaluated using 20 native listeners with normal hearing at 10 intensity levels (–5 to 40 dB HL) in increments of 5 dB.

Results

Using logistic regression, 200 words with the steepest psychometric slopes were divided into 4 lists and 8 half-lists that were relatively equivalent in psychometric function slope. To increase auditory homogeneity of the lists, the intensity of words in each list was digitally adjusted so that the threshold of each list was equal to the midpoint between the mean thresholds of the male and female half-lists.

Conclusions

Digital recordings of the word recognition lists and the associated clinical instructions are available on CD upon request.

Can Auditory and Visual Speech Perception Be Trained Within a Group Setting? [Article]

Preminger, J. E., Ziegler, C. H. — 2008-06-02

Purpose

This study attempted to determine whether auditory-only and auditory-visual speech perception could be trained in a group format.

Method

A randomized controlled trial with at least 16 participants per group was completed. A training-only group completed at least 5 hr of group speech perception training; a training plus psychosocial group completed at least 5 hr of group speech perception training and psychosocial exercises; and a control group did not receive training. Evaluations were conducted before and after training and included analytic and synthetic measures of speech perception, hearing loss–related and generic quality of life scales, and a class evaluation form.

Results

No significant group changes were measured on any of the analytic auditory-only or auditory-visual measures of speech perception, yet the majority of training participants (regardless of training group) reported improvement in auditory and auditory-visual speech perception. The training participants demonstrated a significant reduction on the emotional subscale of the hearing loss–related quality of life scale, while the control participants did not demonstrate a change on this subscale.

Conclusions

Benefits of group audiologic rehabilitation classes may not result from an actual improvement in auditory or visual speech perception abilities, but participants still perceive training in these areas as useful.